Distal Biceps with Allograft

Description

In this detailed surgical demonstration, Bijayendra Singh presents a reconstruction of a distal biceps rupture using an allograft in a 45-year-old male patient, who has lived with the injury for 18 months without treatment. Initial MRI scans reveal significant retraction at the junction of the upper and mid-third of the biceps tendon, indicating that very little tendon remains, likely just a stump of the muscle.



Under anesthesia, the surgical procedure begins with careful examination to locate the stump. The incision is made using a lazy S pattern to provide access while preserving the lacertus fibrosus, which may be utilized as a graft or to reinforce the allograft, despite its typical absence in chronic cases. Attention is given to avoid damage to superficial veins; these are either ligated or preserved for future reconnections if necessary.



Thick flaps are raised for optimal visibility and access, ensuring hemostasis throughout the procedure. The flaps also serve as retractors and help manage bleeding. The lateral cutaneous nerve of the forearm is identified to avoid injury. As surgery proceeds, the surgeon carefully navigates through the surrounding tissues and highlights the importance of locating the distal tendon—describing how the tendon merges with surrounding fascia, complicating its identification. In doing so, special caution is advised to protect the underlying neurovascular structures, particularly the brachialis muscle and musculocutaneous nerve. Ultimately, the remnant tendon or muscle belly is grasped with tissue forceps as the video concludes.

DOI: 10.1302/3114-240513

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