The most common surgical options for the management of proximal biceps tendon rupture are tenotomy, which is associated with muscle fatigue and an increased likelihood of Popeye deformity, and tenodesis, which is associated with increased outcome scores. However, adequate biceps tendon tissue is essential for tenodesis. Chronic injuries, such as those initially managed nonsurgically, may lead to distal retraction, leaving insufficient tendon tissue for tenodesis. This video demonstrates a technique for proximal long head of the biceps tendon reconstruction via Achilles tendon allograft for management of a chronic proximal biceps tendon tear with retraction. The video provides an overview of the pathogenesis, diagnosis, and management of biceps tendon rupture followed by a discussion of the indications for reconstruction via Achilles tendon allograft.

The video discusses the case presentation of a 61-year-old, right hand–dominant man who has experienced right shoulder pain for 1.5 years. The patient previously deferred surgical management because of work demands. The patient had chronic pain, 4/5 rotator cuff strength, a positive impingement sign, decreased range of motion, and a Popeye deformity. Advanced imaging studies revealed a long head of the biceps tendon rupture with distal atrophy and retraction. Proximal biceps tendon reconstruction was performed with the use of Achilles tendon allograft. Postoperative management included sling immobilization for 4 weeks followed by passive elbow range of motion as tolerated. Sling immobilization was discontinued at 8 weeks postoperatively, at which time light resistive biceps strengthening exercises were initiated. The patient experienced gradual relief of pain and improved shoulder range of motion. The cosmetic deformity was eliminated, and Biodex testing confirmed restoration of normal strength. Proximal biceps tendon reconstruction via Achilles tendon allograft is a promising treatment option for the management of long head of the biceps tendon rupture with distal retraction in patients in whom primary tenodesis is not possible.