BACKGROUND: Distal biceps tendon rupture is a relatively rare injury, comprising only 3% of all biceps tendon ruptures. Though uncommon, the injury is typically seen in active middle-aged men and frequently occurs after an eccentric load on a flexed elbow. Early repair for acute rupture (less than four weeks since injury) has been recommended to avoid surgical complications such as tendon retraction, scarring, and extensive dissection. Although good results have been achieved with early direct repair, the optimal treatment for chronic ruptures of the distal biceps tendon remain uncertain. If tendon retraction is prevented by an intact biciptal aponeurosis, a late direct repair may be possible. Reconstruction with graft augmentation is an alternative for chronic injuries not amenable to primary repair in symptomatic patients with functional demands. The purpose of this video is to demonstrate an acute repair of a distal tendon rupture, and a chronic reconstruction of a similar injury.METHODS: A review of the current concepts in distal biceps tendon repair and reconstruction are conducted. This video demonstrates early repair with cortical button fixation and late reconstruction with Achilles allograft for distal biceps tendon rupture. Relevant patient history, imaging, injury presentation, surgical indications, surgical technique, postoperative rehabilitation, and clinical outcomes are discussed. The key steps of the procedure are highlighted, along with the rationale behind the approach.RESULTS: The video presents the successful repair and reconstruction of a distal biceps tendon rupture. Patients undergoing these procedures can expect to regain near normal strength, range of motion, and endurance after a course of rehabilitation. Our case series show favorable results and is supported by the orthopaedic literature.CONCLUSION: There are significant differences between biceps that can be repaired primarily and those necessitating reconstruction, including retraction distance, lacertus fibrosis integrity, and presence of extra-articular edema along the biceps tract. These findings can assist the clinician in preparing for the procedure and counseling the patient appropriately.