A systematic review of distal biceps tendon repair pooling biomechanical, complication, and clinical outcome data. It asks which fixation method is strongest and whether the 2-incision or single-incision approach produces fewer complications and better outcomes. All clinical evidence was Level IV.
When counseling a patient with an acute distal biceps rupture, this review gives you a framework for choosing the approach.
Overall complication rates are similar between approaches, so the decision hinges on the type of complication you most want to avoid. The 2-incision approach trades a lower nerve-injury risk for a higher risk of losing forearm rotation and supination strength, driven by dissection in the radioulnar interval and injury to the supinator.
That tradeoff matters clinically: the 2-incision group had a 7.6-fold higher odds of an unsatisfactory outcome, mostly from weak or limited rotation. Biomechanically, EndoButton is the strongest construct, but no repair has yet failed rehab from being too weak. Reruptures are rare with current protected protocols, so construct choice is less about survival and more about surgeon familiarity.
Remember two board points: repair (not brachialis tenodesis) preserves supination, and earlier repair lowers complications.
A systematic review of distal biceps tendon repair pooling biomechanical, complication, and clinical outcome data. It asks which fixation method is strongest and whether the 2-incision or single-incision approach produces fewer complications and better outcomes. All clinical evidence was Level IV.
When counseling a patient with an acute distal biceps rupture, this review gives you a framework for choosing the approach.
Overall complication rates are similar between approaches, so the decision hinges on the type of complication you most want to avoid. The 2-incision approach trades a lower nerve-injury risk for a higher risk of losing forearm rotation and supination strength, driven by dissection in the radioulnar interval and injury to the supinator.
That tradeoff matters clinically: the 2-incision group had a 7.6-fold higher odds of an unsatisfactory outcome, mostly from weak or limited rotation. Biomechanically, EndoButton is the strongest construct, but no repair has yet failed rehab from being too weak. Reruptures are rare with current protected protocols, so construct choice is less about survival and more about surgeon familiarity.
Remember two board points: repair (not brachialis tenodesis) preserves supination, and earlier repair lowers complications.