Repair of distal biceps tendon ruptures has become widely accepted. Unfortunately, care of chronic injuries remains a challenge to the orthopedic surgeon. Patients with chronic ruptures often present complaining of weakness in elbow flexion and supination. Nonoperative management of these injuries does not restore function to the elbow. Tenodesis of the biceps tendon to the brachialis may improve flexion strength but does not reliably improve supination weakness. Addressing these injuries through restoration of anatomy, either with direct repair of the tendon to the radial tuberosity or with the use of a tendon graft to regain length, results in improved functional outcomes. Complications rates appear to be increased when surgery is performed in chronic injuries compared to those operated upon acutely.
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