First randomized trial comparing single-incision (two suture anchors) versus double-incision (transosseous tunnels) repair of acute distal biceps ruptures. 91 male patients randomized, followed to two years. Primary outcome was the ASES elbow score, with strength and complications as secondary endpoints.
When counseling a patient with an acute distal biceps rupture, this trial gives you a clear message: both repair techniques produce equivalent function, so the choice comes down to surgeon experience and the complication profile you want to avoid.
The key differentiator is the lateral antebrachial cutaneous nerve. Single-incision anterior exposure requires prolonged retraction of that nerve, producing transient neurapraxia in roughly 40% of patients versus 7% with the double-incision approach. Most of these resolve, but a minority persist, and this is the number to quote in the consent discussion.
The 10% flexion strength edge with the double-incision technique is real but of uncertain clinical meaning. Do not overweight it against the historical synostosis risk of the two-incision approach. Because all four reruptures traced to noncompliance or early reinjury, identifying and protecting the noncompliant patient matters more than the fixation construct you select.
First randomized trial comparing single-incision (two suture anchors) versus double-incision (transosseous tunnels) repair of acute distal biceps ruptures. 91 male patients randomized, followed to two years. Primary outcome was the ASES elbow score, with strength and complications as secondary endpoints.
When counseling a patient with an acute distal biceps rupture, this trial gives you a clear message: both repair techniques produce equivalent function, so the choice comes down to surgeon experience and the complication profile you want to avoid.
The key differentiator is the lateral antebrachial cutaneous nerve. Single-incision anterior exposure requires prolonged retraction of that nerve, producing transient neurapraxia in roughly 40% of patients versus 7% with the double-incision approach. Most of these resolve, but a minority persist, and this is the number to quote in the consent discussion.
The 10% flexion strength edge with the double-incision technique is real but of uncertain clinical meaning. Do not overweight it against the historical synostosis risk of the two-incision approach. Because all four reruptures traced to noncompliance or early reinjury, identifying and protecting the noncompliant patient matters more than the fixation construct you select.