LAUSR

The treatment of chronic distal biceps ruptures is challenging. Direct anatomical reinsertion is often difficult as a consequence of tendon retraction, muscle atrophy, and scar tissue. Nonanatomical repair is a controversial option. Repair and reinforcement with autografts or allografts is a reliable option. Achilles allograft has several advantages over other grafts. Indications to this procedure are discussed as well as surgical tips and tricks; in addition, outcomes and complications from the available literature are reported. The literature is lacking on this specific field. Only few case series describe surgical tips and report clinical outcomes. Good results are generally reported in terms of function and strength recovery bot in flexion and supination. Complications, mainly involving neurological problem, are similar to those observed in acute cases. Achilles tendon allograft is a reliable option to reinforce the anatomical repair of chronic distal biceps tendon ruptures. Proximal tendinous portion wraps biceps muscle to ensure solid interface. Distal calcaneus bone plug allows for bone-to-bone fixation. The choice of which is the best option for distal fixation and postoperative protocol are still debated issues.