Distal biceps tendon injuries typically occur from forced eccentric contraction against a heavy load and are more common in males than females. Most patients who rupture their distal biceps tendon undergo operative repair to minimize strength loss and fatigue. Single-incision and two-incision techniques have been developed in recent decades and achieve satisfactory outcomes. Cortical button and bone tunnel fixation demonstrate superior strength relative to suture anchors and interference screws for acute repairs. Patients who present late or who undergo surgery greater than 4 to 6 weeks from their injury are deemed chronic ruptures and may require autograft or allograft reconstruction.