Check out our recent revision distal biceps repair.

This video features Dr. Grant H. Garcia demonstrating his surgical technique for a revision distal biceps tendon repair. The patient had previously undergone a distal biceps repair in 2016, but over time noticed an ongoing loosening of the repair, a "Popeye" deformity in the muscle belly, and progressively weakened forearm supination.

Here is a summary of the procedure shown in the video:

• Incision and Approach: The original surgery left a transverse scar. For this revision, the surgeon opts for an oblique incision over the previous site. This angle allows for a significantly more extensive approach if widespread scar tissue or severe retraction demands greater visibility.
• Nerve Protection: Throughout the early dissection, the surgeon explicitly identifies and isolates the lateral antebrachial cutaneous nerve, taking care to protect it from injury to avoid postoperative numbness on the outside of the forearm.
• Isolating the Tendon and Clearing Scar Tissue: The ruptured distal biceps tendon had retracted slightly, but it was heavily encased in dense scar tissue rather than being pulled all the way up into the upper arm. The surgeon frees the viable tendon from the surrounding scar web, locates and removes the old degraded sutures, and traces the tissue back down to its clean muscle base.
• Whip-stitching the Graft: Once a healthy segment of tendon is isolated, the surgeon places a secure whip-stitch down the length of the tissue to maximize pull-out strength.
• Preparing the New Bone Socket: Because the initial repair failed and the trajectory of the original bone tunnel was poor, the surgeon selects a fresh, optimized location on the radial tuberosity. A guide pin is placed to map out the directory, and a new socket is drilled. The surrounding bone is stable enough that there is no risk of a fracture propagating between the old and new holes.
• Cortical Button Fixation: The suture limbs are loaded onto an orthopedic button. A thin 0.042 Kirschner wire (K-wire) is passed completely through the radius, allowing the button to pass through the bone and flip flat against the far posterior cortex. An intraoperative X-ray is performed to confirm that the button has successfully flipped and is firmly anchored against the bone.
• Final Tensioning: The surgeon tensions the construct and dunks the tendon into its new socket while holding the patient's elbow at roughly 90 degrees of flexion. Dr. Garcia notes that while repairing a biceps at 90 degrees can feel snug, orthopedic literature confirms that the muscle-tendon unit safely stretches out over the first six to eight weeks post-op to restore full extension.