Case Report: Transosseous Two-Incision Repair for Distal Biceps Tendon Avulsion.

Ruptures of the distal biceps tendon (DBT) are uncommon musculoskeletal injuries, typically affecting middle-aged men and caused by excessive eccentric loading, such as during weightlifting [1,2]. Surgical repair is generally advised for active individuals to restore supination and flexion strength and prevent long-term functional loss [3,4]. This case report describes a 42-year-old male who sustained a complete DBT avulsion during weightlifting. The modified two-incision transosseous technique was employed for repair—a method originally described by Boyd and Anderson [5], later refined by Morrey to reduce complications like ectopic ossification [6,7]. The anterior incision allowed retrieval and whipstitch preparation of the tendon while protecting the lateral antebrachial cutaneous nerve (LABCN) [9]. A second dorsal incision was made after full forearm supination to avoid injury to the posterior interosseous nerve [10], allowing access to the radial tuberosity. A cavity and transosseous tunnels were created for suture passage and bone fixation [11,12]. Early postoperative rehabilitation focused on controlled motion, leveraging the robust fixation provided by the technique [14]. At six-week follow-up, the patient demonstrated a near-normal range of motion and functional recovery with minimal discomfort. This case highlights the reliability of the two-incision technique for DBT repair, combining anatomical safety with strong fixation and favorable early outcomes in appropriately selected patients [15].