Biceps Tendon Tears at the Elbow: One-Incision Repair Using a Metal Button

Biceps Tendon Tears at the Elbow: One-Incision Repair Using a Metal Button

In this surgical demonstration video, a full biceps tendon tear at the elbow will be repaired back to bone using a metal button and sutures. The surgeon marks out the elbow crease and the line of incision at the front of the elbow. The incision is made and careful dissection clears small vessels and nerves out of harm's way as a surgeon finds the stump of the torn tendon.

The tendon is clamped and delivered to the outside of the wound. Any small frayed edges are cut off the thick rope-like tendon. This will ensure that the tendon stump will fit the socket that will be drilled into the bone. Later, a strong double suture is passed several times through the end of the tendon. This suture will serve as the docking suture into the socket.

The tendon is placed back into the wound for safekeeping, and the surgeon turns his attention to the spot on the radius bone where the tendon tore from. This is the radial tuberosity, or the bony hill, where the tendon used to attach. This is identified and the tendon's footprint is marked out. A metal pin is drilled through the middle of this footprint to create a small tunnel all the way through the bone. This pin is left in place as a larger drill reams over it to just about one-third of the way into the bone.

These drills together will create a socket and through tunnel configuration for the tendon to be pulled into by the sutures and sit in. All the small bony fragments are cleared out. After this, attention is turned back to the tendon and sutures. The two limbs of suture are passed through a small metal button. The button is then attached to a button inserter tool.

Under direct visualization, the surgeon passes the button inserter tool with the button into the thinner tunnel all the way through the bone. By pulling the limbs of the sutures, the button is seated onto the outside wall of the bone, pulling further on the sutures, the tendon is docked into the larger bony socket once there is full tension on the sutures, this indicates that the tendon is at the bottom of the socket.

The tendon is stitched and secured in place with one of the limbs of suture, and a knot is tied. Here, a knot pusher tool is being used to advance the knot deeper into the socket. A screw is placed next to the tendon for a firm fixation to the bone. A final knot is tied over the inserted screw. The surgeon checks that the biceps tendon is properly attached by rotating the forearm from palm up to palm down several times.

This operation is now successfully completed and the wound is stitched up, and the patient is placed into a soft dressing.