I'm looking for opinions on a distal biceps repair that was not repaired to the bone. I'm leaning towards 24342 but I would like some extra eyes on this one.
The arm was prepped and draped. After multidisciplinary time-out, we made an incision over the distal antecubital crease. We dissected down to through dermis and subcutaneous tissue identified the cephalic vein, mobilized it and identified the lateral cutaneous nerve, mobilized it and identified the brachialis fascia and then dissected proximally. We had difficulty finding the distal biceps tendon as it had started quite proximally and medially. I finally found the ruptured tendon and placed the traction suture in it. I was able to mobilize and then released multiple soft tissue adhesions with Mayo scissor and key soft tissue elevator. Despite releasing all these adhesions, the distal aspect of the tendon would only reached the antecubital crease and was still 5 cm short of arriving at the radial tuberosity. I got about placing an allograft at that point, but felt to be even an allograft would have difficulty reaching. I also found that the native tunnel for the biceps tendon had completely starred in and that tendon would not mobilize far enough even with a graft, even finding nor dissecting out the tunnel to anatomically repair the distal biceps to the radial tuberosity. At that point, I felt that I would be placing the patient at risk to place the graft and then dissect the course to radial tuberosity. I determined that it was in his best interest to repair the distal biceps to the fascia of the brachialis. At that point, I used a 0 Vicryl to suture the distal end of the biceps to the brachialis. I had the muscle maximal distraction to reduce the Popeye deformity. There was good tension on the tendon at the site of the repair. At that point, we irrigated copiously.