Failure Strengths in Distal Biceps Tendon Repair

Background: Surgical repair is the most favored treatment for a rupture of the distal biceps tendon. A variety of techniques have been described for distal biceps tendon reattachment, including transosseous sutures, suture anchors, interference screws, and an EndoButton-based technique.

Hypothesis: EndoButton and suture anchor have initially stronger fixation strengths than do transosseous sutures, allowing early postoperative rehabilitation.

Study Design: Controlled laboratory study.

Methods: Single loads to failure and mode of failure of 13 different fixation techniques were determined using 130 human cadaveric elbows. Quantitative computer tomography was performed to exclude differences in bone mineral density as an affecting factor. Repeated-measures analysis of variance was used to assess differences in failure load between repair techniques.

Results: The EndoButton-based technique showed a significantly higher failure load (259 ± 28 N) than did all other techniques (P < .05). No significant differences were seen between the transosseous suture technique (210 ± 29 N) and most other techniques (P > .05). Failure loads of the TwinFix-QuickT (57 ± 29 N) and Biocuff screw (105 ± 28 N) were significantly lower than those of all other repairs (P < .05).

Conclusion: Significant differences exist in failure loads and modes of failure for the different repair techniques after rupture of the distal biceps tendon.

Clinical Relevance: The transosseous technique is still a sufficient and cost-saving procedure for repair of the distal biceps tendon. TwinFix-QuickT 5.0 mm and Biocuff screw 5.7 mm had significantly lower failure loads, which might affect early rehabilitation, particularly in patients with poor bone quality.