Long Term Outcomes of Achilles Tendon Allograft Reconstruction for Chronic Ruptures of the Distal Biceps Tendon Using a Two-Incision Surgical Technique

Background Distal biceps tendon ruptures result in loss of function. Typically, surgery is recommended for acute tears to optimize outcomes and prevent muscle retraction and atrophy associated with delayed repair. However, delayed or missed diagnosis is not uncommon and may lead to irreparable disruption of the tendon. In such chronic cases, allograft augmentation is one possible option for reconstruction. The Achilles tendon is commonly used for this purpose due to its physical and mechanical properties. In this study, we report the outcomes of Achilles allograft reconstruction for elbows with chronic ruptures of the distal biceps tendon. Methods Between 2002 and 2022, 32 consecutive patients with chronic ruptures of the distal biceps tendon underwent Achilles tendon allograft reconstruction at a single institution. 9 patients were lost to follow-up; the remaining 23 patients form the basis of this study. There were 22 males and 1 female, with a mean age of 51±11.3 years (range 30-77). Their medical records were reviewed to collect demographics, pain, motion, strength, complications, reoperations, and subjective satisfaction. 18 patients could also contacted at most recent follow-up to assess Visual Analog Scale (VAS) for pain and satisfaction as well as Single Assessment Numeric Evaluation (SANE), American Shoulder and Elbow Surgeons (ASES) elbow score, and Mayo Elbow Performance Score (MEPS). The median length of follow-up for the whole cohort (n=23) was 8.9±6.5 years. The median length of follow-up for those patients who could be prospectively contacted for this study was 10.45±5.8 (range 2.5-19.7) years. Results Reconstruction of chronic ruptures of the distal biceps tendon was associated with substantial pain relief, functional restoration, and satisfactory subjective results. At the most recent follow-up, the median pain score was 0±1 points (range 0-4). Mean extension was 3.7 degrees and mean flexion 145 degrees; the median MEPS was 100 points, with outcomes graded as excellent in 78.26% of patients, good in 17.39%, and fair in 4%. For those patients contacted at most recent follow-up, the median SANE and ASES scores were 80 (IQR 70-95) and 79.7 (IQR 76.5-82) points respectively. Two patients complained of cramping, one of pain with supination, and six complained of subjective weakness. No elbows underwent reoperation. Conclusion Allograft reconstruction using Achilles tendon augmentation was associated with good outcomes for chronic ruptures of the distal biceps tendon, providing a high degree of patient satisfaction and restoration of function. Subjective weakness and cramping did occur, although only in a few patients.