title: Failure of distal biceps repair by gapping.
abstract: BACKGROUND
  We describe the clinical, radiological and surgical findings of failed distal biceps repair by gapping and report the functional outcomes following revision repair.
  
  
  METHODS
  A retrospective review of five consecutive patients was conducted. Patients presented with radial-sided forearm pain after their distal biceps fixation. All patients had less than 5 cm of retraction of the biceps muscle belly, a palpable tendon although the manoeuvre was painful with weakness on resisted supination. Flexed abducted supinated magnetic resonance imaging (FABS MRI) showed a gap between the distal end of the tendon and the footprint on the radial tuberosity.
  
  
  RESULTS
  Mean FEA score at presentation was 44/100 (35 to 49). Mean time to re-operation was 18 months (range 4 months to 36 months). At revision, the distal end of the tendon was retracted and not making contact with the bone. All cases were revised to an in-bone endobutton repair. Mean postoperative Functional Elbow Assessment (FEA) scores undertaken at a mean of 14 months (range 5 months to 22 months) after revision improved to 95/100 (90 to 100).
  
  
  CONCLUSIONS
  Patients presenting with persistent radial sided forearm pain and weakness on provocative testing after distal biceps repair with a seemingly intact repair should be investigated with FABS MRI to look for evidence of failure of repair by gapping. Revision repair with an anatomic in-bone technique can lead to good results.
authors: Upper Limb Unit, Wrightington Hospital, Wigan, UK.
authors: Abbas
authors: A
authors: Rashid
authors: Upper Limb Unit, Wrightington Hospital, Wigan, UK.
authors: David
authors: D
authors: Copas
authors: Upper Limb Unit, Wrightington Hospital, Wigan, UK.
authors: Adam C
authors: AC
authors: Watts
keywords: biceps; distal; failure; gapping; repair