Heterotopic Ossification of the Elbow

  • Richard S. PageEmail author
  • Gregory Leverett
  • Gregory Bain


Distal biceps rupture is an uncommon injury, usually affects males in their fourth decade or older, and accounts for just 3% of all biceps ruptures. The functional results of non-operative treatment are generally poor, and acute injuries are best treated early with surgical repair. Missed or untreated chronic injuries present a challenge to reconstruct due to retraction and loss of musculotendinous length.

Traumatic ruptures and surgical repairs are both at risk of complication by heterotopic ossification (HO). Repairs that have failed are also at risk of HO, which is a challenge to treat, more so when the biceps is retracted and requires reconstruction. The need to re-establish tendon length and combined elbow flexion-rotation power often necessitates an interposition tendon graft. This is particularly the case to restore function at higher repetitive torque loads. This chapter explores the treatment options of distal biceps ruptures in the chronic setting, technical considerations including autografting, outcomes, and an approach to managing concurrent HO.


Elbow Late reconstruction Biceps rupture Heterotopic ossification Function 



Declaration of Conflict of Interest: Nil to declare in relation to this chapter.


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Copyright information

© ISAKOS 2020

Authors and Affiliations

  • Richard S. Page
    • 1
    • 2
    Email author
  • Gregory Leverett
    • 3
  • Gregory Bain
    • 4
  1. 1.Department Orthopaedic SurgeryBarwon HealthGeelongAustralia
  2. 2.Barwon Centre of Orthopaedic Research and Education (B-CORE), St John of God Hospital and School of Medicine, Deakin UniversityGeelongAustralia
  3. 3.Barwon HealthUniversity Hospital GeelongGeelongAustralia
  4. 4.Department of Orthopaedic and Trauma SurgeryFlinders UniversityAdelaideAustralia

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