Skip to main content
SpringerLink
Log in

Clinical relevance of distal biceps insertional and footprint anatomy

  • Elbow
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The aim of this review was to present an overview, based on a literature search, of surgical anatomy for distal biceps tendon repairs, based on the current literature.

Methods

A narrative review was performed using Pubmed/Medline using key words: Search terms were distal biceps, insertional, and anatomy.

Results

Last decade, the interest in both reconstruction techniques, as well as surgical anatomy of the distal biceps tendon, has increased. The insights into various aspects of distal biceps tendon anatomy (two tendons, bicipital tuberosity, lacertus fibrosis, bicipital-radial bursa, posterior interosseous nerve, and lateral antebrachial cutaneous nerve) have evolved significantly in the last years.

Conclusion

Thorough knowledge of the anatomy is essential for the surgeon in order to understand the biomechanics of rupture and reconstruction of the distal biceps tendon and to avoid injuries of the nerves. Some tips and tricks are provided, and some pitfalls were described to avoid complications and optimize surgical outcome.

Level of evidence

IV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10

Similar content being viewed by others

References

  1. Athwal GS, Steinmann SP, Rispoli DM (2007) The distal biceps tendon: footprint and relevant clinical anatomy. J Hand Surg Am 32:1225–1229

    Article  PubMed  Google Scholar 

  2. Boyd HB, Anderson MD (1961) A method for reinsertion of the distal biceps brachii tendon. J Bone Joint Surg Am 43:1041–1043

    Google Scholar 

  3. Cain RA, Nydick JA, Stein MI, Williams BD, Polikandriotis JA, Hess AV (2012) Complications following distal biceps repair. J Hand Surg Am 37(10):2112–2117

    Article  PubMed  Google Scholar 

  4. Calfee RP, Wilson JM, Wong AH (2011) Variations in the anatomic relations of the posterior interosseous nerve associated with proximal forearm trauma. J Bone Joint Surg Am 93(1):81–90

    Article  PubMed  PubMed Central  Google Scholar 

  5. Chavan PR, Duquin TR, Bisson LJ (2008) Repair of the ruptured distal biceps tendon: a systematic review. Am J Sports Med 36(8):1618–1624

    Article  PubMed  Google Scholar 

  6. Cho CH, Song KS, Lee SM (2011) Isolated short head component rupture of a bifurcated distal biceps tendon mimicking as a complete rupture. J Hand Surg Eur 36(4):333–334

    Article  Google Scholar 

  7. Cho CH, Song KS, Choi IJ, Kim DK, Lee JH, Kim HT, Moon YS (2011) Insertional anatomy and clinical relevance of the distal biceps tendon. Knee Surg Sports Traumatol Arthrosc 19(11):1930–1935

    Article  PubMed  Google Scholar 

  8. Cohen MS (2008) Complications of distal biceps tendon repairs. Sports Med Arthrosc 16(3):148–153

    Article  PubMed  Google Scholar 

  9. Cucca YY, McLay SV, Okamoto T, Ecker J, McMenamin PG (2010) The biceps brachii muscle and its distal insertion: observations of surgical and evolutionary relevance. Surg Radiol Anat 32(4):371–375

    Article  CAS  PubMed  Google Scholar 

  10. Davis WM, Yassine Z (1956) An etiologic factor in the tear of the distal tendon of the biceps brachii. J Bone Joint Surg Am 38:1365–1368

    PubMed  Google Scholar 

  11. Eames MH, Bain GI (2006) Distal biceps tendon endoscopy and anterior elbow arthroscopy portal. Tech Shoulder Elbow Surg 7:139–142

    Article  Google Scholar 

  12. Eames MH, Bain GI, Fogg QA, van Riet RP (2007) Distal biceps tendon anatomy: a cadaveric study. J Bone Joint Surg Am 89:1044–1049

    Article  CAS  PubMed  Google Scholar 

  13. Forthman CL, Zimmerman RM, Sullivan MJ, Gabel GT (2008) Cross-sectional anatomy of the bicipital tuberosity and biceps brachii tendon insertion: relevance to anatomic tendon repair. J Shoulder Elbow Surg 17(3):522–526

    Article  PubMed  Google Scholar 

  14. Grewal R, Athwal GS, MacDermid JC, Faber KJ, Drosdowech DS, El-Hawary R, King GJ (2012) Single versus double-incision technique for the repair of acute distal biceps tendon ruptures: a randomized clinical trial. J Bone Joint Surg Am 94(13):1166–1174

    Article  PubMed  Google Scholar 

  15. Hamer MJ, Caputo AE (2008) Operative treatment of chronic distal biceps tendon ruptures. Sports Med Arthrosc 16(3):143–147

    Article  PubMed  Google Scholar 

  16. Henry J, Feinblatt J, Kaeding CC, Latshaw J, Litsky A, Sibel R, Stephens JA, Jones GL (2007) Biomechanical analysis of distal biceps tendon repair methods. Am J Sports Med 35:1950–1954

    Article  PubMed  Google Scholar 

  17. Hutchinson HL, Gloystein D, Gillespie M (2008) Distal biceps tendon insertion: an anatomic study. J Shoulder Elbow Surg 17:342–346

    Article  PubMed  Google Scholar 

  18. Jarrett CD, Weir DM, Stuffmann ES, Jain S, Miller MC, Schmidt CC (2012) Anatomic and biomechanical analysis of the short and long head components of the distal biceps tendon. J Shoulder Elbow Surg 21(7):942–948

    Article  PubMed  Google Scholar 

  19. Kodde IF, van den Bekerom MPJ, Eygendaal D (2013) Best approach for the repair of distal biceps tendon ruptures. World J Orthop 4(2):98–99

    Article  PubMed  PubMed Central  Google Scholar 

  20. Kodde IF, van den Bekerom MP, Eygendaal D (2013) Reconstruction of distal biceps tendon ruptures with a cortical button. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-013-2571-3

  21. Koulouris G, Malone W, Omar IM, Gopez AG, Wright W, Kavanagh EC (2009) Bifid insertion of the distal biceps tendon with isolated rupture: magnetic resonance findings. J Shoulder Elbow Surg 18(6):e22–e25

    Article  PubMed  Google Scholar 

  22. Kulshreshtha R, Singh R, Sinha J, Hall S (2007) Anatomy of the distal biceps brachii tendon and its clinical relevance. Clin Orthop Relat Res 456:117–120

    Article  PubMed  Google Scholar 

  23. Landa J, Bhandari S, Strauss EJ, Walker PS, Meislin RJ (2009) The effect of repair of the lacertus fibrosus on distal biceps tendon repairs: a biomechanical, functional, and anatomic study. Am J Sports Med 37(1):120–123

    Article  PubMed  Google Scholar 

  24. Mazzocca AD, Burton KJ, Romeo AA, Santangelo S, Adams DA, Arciero RA (2007) Biomechanical evaluation of 4 techniques of distal biceps brachii tendon repair. Am J Sports Med 35:252–258

    Article  PubMed  Google Scholar 

  25. Mazzocca AD, Cohen M, Berkson E, Nicholson G, Carofino BC, Arciero R, Romeo AA (2007) The anatomy of the bicipital tuberosity and distal biceps tendon. J Shoulder Elbow Surg 16(1):122–127

    Article  PubMed  Google Scholar 

  26. Miyamoto RG, Elser F, Millett PJ (2010) Distal biceps tendon injuries. J Bone Joint Surg Am 92(11):2128–2138

    Article  PubMed  Google Scholar 

  27. Nigro PT, Cain R, Mighell MA (2013) Prognosis for recovery of posterior interosseous nerve palsy after distal biceps repair. J Shoulder Elbow Surg 22(1):70–73

    Article  PubMed  Google Scholar 

  28. Pacha Vicente D, Forcada Calvet P, Carrera Burgaya A, Llusá Pérez M (2005) Innervation of biceps brachii and brachialis: anatomical and surgical approach. Clin Anat 18:186–194

    Article  CAS  PubMed  Google Scholar 

  29. Ray RD, Johnson RJ, Jameson RM (1951) Rotation of the forearm: an experimental study of pronation and supination. J Bone Joint Surg Am 33:993–996

    PubMed  Google Scholar 

  30. Ruch DS, Watters TS, Wartinbee DA, Richard MJ, Leversedge FJ, Mithani SK (2014) Anatomic findings and complications after surgical treatment of chronic, partial distal biceps tendon tears: a case cohort comparison study. J Hand Surg Am 39(8):1572–1577

  31. Safran MR, Graham SM (2002) Distal biceps tendon ruptures: incidence, demographics, and the effect of smoking. Clin Orthop Relat Res 404:275–283

    Article  PubMed  Google Scholar 

  32. Sassmannshausen G, Mair SD, Blazar PE (2004) Rupture of a bifurcated distal biceps tendon. A case report. J Bone Joint Surg Am 86:2737–2740

    PubMed  Google Scholar 

  33. Schmidt CC, Weir DM, Wong AS, Howard M, Miller MC (2010) The effect of biceps reattachment site. J Shoulder Elbow Surg 19(8):1157–1165

    Article  PubMed  Google Scholar 

  34. Seiler JG III, Parker LM, Chamberland PD, Sherbourne GM, Carpenter WA (1995) The distal biceps tendon. Two potential mechanisms involved in its rupture: arterial supply and mechanical impingement. J Shoulder Elbow Surg 4(3):149–156

    Article  PubMed  Google Scholar 

  35. Siebenlist S, Buchholz A, Zapf J, Sandmann GH, Braun KF, Martetschläger F, Hapfelmeier A, Kraus TM, Lenich A, Biberthaler P, Elser F (2013) Double intramedullary cortical button versus suture anchors for distal biceps tendon repair: a biomechanical comparison. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-013-2590-0

    Google Scholar 

Download references

Acknowledgments

Neither the authors nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Author information

Authors and Affiliations

  1. Shoulder and Elbow Unit, Department of Orthopedic Surgery, OLVG, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands

    Michel P. J. van den Bekerom

  2. Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands

    Izaäk F. Kodde & Denise Eygendaal

  3. Department of Orthopaedic Surgery, Salford Royal NHS Foundation Trust Hospital, Bolton, UK

    Asir Aster

  4. Department of Anatomy, UMC, Utrecht, The Netherlands

    Ronald L. A. W. Bleys

Authors
  1. Michel P. J. van den Bekerom
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Izaäk F. Kodde
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Asir Aster
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ronald L. A. W. Bleys
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Denise Eygendaal
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michel P. J. van den Bekerom.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

van den Bekerom, M.P.J., Kodde, I.F., Aster, A. et al. Clinical relevance of distal biceps insertional and footprint anatomy. Knee Surg Sports Traumatol Arthrosc 24, 2300–2307 (2016). https://doi.org/10.1007/s00167-014-3322-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-014-3322-9

Keywords

Search

Navigation