By Saul J. Kaplan, MD

During my orthopaedic surgery training in the mid 1980’s, I neither heard of nor read about distal biceps ruptures.  We read an article in journal club during my fellowship on loss of strength due to this injury. In truth, the elbow was sort of a black box at that time treated either with cast immobilization or benign neglect.  I first encountered a rupture  in my second year of practice.  I treated it with tenodesis to the bracchialis.  A few months later, one of my partners fixed one with an overly aggressive two incision technique.  I became involved when a synostosis occurred.  More appeared over the next few years. Clearly, this was something with which I would need to become better acquainted. In the early 1990’s, there was no Hand-E, no youtube, and no VuMedi.  We learned by reading journals and books, and by attending the annual ASSH meeting.  At the meeting there was a video library where one could watch the latest techniques.  Information dissemination was slow and required work.  The occurrence of this condition seemed to be increasing in frequency and the approach to this problem was evolving. Over many years, I learned to safely treat this condition first using the two incision technique, then single incision using suture anchors, single incision using endobutton, and finally single incision using an intramedullary anchor.  A condition initially unknown to me was  at first a challenge to treat and then became a straight forward procedure I enjoyed as long as I remembered that the bicipital tuberosity was three finger breadths from the antecubital crease of a flexed elbow and always paid attention to the location of the posterior interosseous nerve.