Distal biceps tendon injuries continue to plague, primarily, active middle-aged men.

Surgical repair has been advocated for several decades to prevent chronic loss of supination and flex- ion strength.

Initially, much research effort was placed on modifying surgical technique and improving mechanical fixation strength of the repaired tendon. Recently, clinical reports have questioned our classic understanding of the structure and function of the bi- ceps tendon.

As a result, more research attention has been placed on investigating the anatomy and physiology of the native distal tendon. Conservative care of a ruptured biceps leads to a maximum supination loss of 26% to 60% and maximum flexion loss of 30%.

With improved understanding, surgeons are better suited to re-create the native anatomy, restore function, and optimize patient outcomes.