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Reconstruction of Chronic Distal Biceps Tendon Rupture With Autogenous Semitendinosis Graft Using the “Anatomic Length Method” and Concomitant Bicipital Aponeurosis Repair

Albishi, Waleed MD, MSc, FRCSC*,†; Lam, Jason J. MD*; Elmaraghy, Amr MD, FRCSC*,†

Techniques in Shoulder & Elbow Surgery: December 2019 - Volume 20 - Issue 4 - p 125–129
doi: 10.1097/BTE.0000000000000177

We present a novel variation of a surgical technique for reconstruction of chronic distal biceps tendon ruptures using the “Anatomic Length Method.” Graft length for chronic distal biceps tendon rupture reconstruction is extremely variable and typically empirically determined by elbow position during final fixation. These techniques do not account for chronicity and varying degrees of retraction and muscle shortening. For this unique variation in the surgical technique, the graft length used is based on previous anatomic cadaveric measurements done in our center with an external distal biceps tendon length mean of 6.3 cm. In addition, our technique routinely reconstructs the bicipital aponeurosis. This allows for a highly reproducible surgical technique and restores a more normal biceps anatomy and muscle length-tension relationship.

*Department of Orthopaedic Surgery, University of Toronto

St. Joseph’s Health Centre, Toronto, ON, Canada

The authors declare no conflict of interest.

Reprints: Jason J. Lam, MD, Department of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada M6R 1B5 (e-mail:

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