title: A 3-Dimensional Anatomic Study of the Distal Biceps Tendon: Implications for Surgical Repair and Reconstruction.
abstract: BACKGROUND
  Complete rupture of the distal biceps tendon from its osseous attachment is most often treated with operative intervention. Knowledge of the overall tendon morphology as well as the orientation of the collagenous fibers throughout the musculotendinous junction are key to intraoperative decision making and surgical technique in both the acute and chronic setting. Unfortunately, there is little information available in the literature.
  
  
  OBJECTIVE
  To comprehensively describe the morphology of the distal biceps tendon.
  
  
  METHODS
  Descriptive laboratory study.
  
  
  METHODS
  The distal biceps terminal musculature, musculotendinous junction, and tendon were digitized in 10 cadaveric specimens and data reconstructed using 3-dimensional modeling.
  
  
  RESULTS
  The average length, width, and thickness of the external distal biceps tendon were found to be 63.0, 6.0, and 3.0 mm, respectively. A unique expansion of the tendon fibers within the distal muscle was characterized, creating a thick collagenous network along the central component between the long and short heads.
  
  
  CONCLUSIONS
  This study documents the morphologic parameters of the native distal biceps tendon. Reconstruction may be necessary, especially in chronic distal biceps tendon ruptures, if the remaining tendon morphology is significantly compromised compared with the native distal biceps tendon. Knowledge of normal anatomical distal biceps tendon parameters may also guide the selection of a substitute graft with similar morphological characteristics.
  
  
  CONCLUSIONS
  A thorough description of distal biceps tendon morphology is important to guide intraoperative decision making between primary repair and reconstruction and to better select the most appropriate graft. The detailed description of the tendinous expansion into the muscle may provide insight into better graft-weaving and suture-grasping techniques to maximize proximal graft incorporation.
authors.affiliation: Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Christine
authors.initials: C
authors.lastname: Walton
authors.affiliation: Department of Anatomy, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Zhi
authors.initials: Z
authors.lastname: Li
authors.affiliation: Division of Orthopaedic Surgery, St Joseph's Health Centre, Toronto, Ontario, Canada.
authors.forename: Amanda
authors.initials: A
authors.lastname: Pennings
authors.affiliation: Department of Anatomy, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Anne
authors.initials: A
authors.lastname: Agur
authors.affiliation: Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada. ; Division of Orthopaedic Surgery, St Joseph's Health Centre, Toronto, Ontario, Canada.
authors.forename: Amr
authors.initials: A
authors.lastname: Elmaraghy
keywords: 3D computer modeling; distal biceps tendon; graft; morphology