This controlled cadaveric study compared 4 distal biceps tendon repair techniques. It tested transosseous bone tunnel, suture anchor, EndoButton, and interference screw fixation under cyclic loading and load to failure. The goal was to determine which construct is strongest and whether repairs can tolerate early postoperative motion.
When choosing a distal biceps repair construct, this study establishes that the EndoButton delivers the highest initial fixation strength at roughly 440 N. That strength is well above the 100 to 200 N of maximum eccentric elbow flexor force, meaning every technique tested is strong enough to survive physiologic loading.
The practical distinction is failure behavior under motion. Suture anchor repairs showed suture breakage at the eyelet and surface-cortex gap formation, so a more conservative early rehab protocol is reasonable after anchor fixation.
The socket-based techniques (bone tunnel, EndoButton, interference screw) seat the tendon inside the tuberosity, so their small 2-3 mm displacements do not threaten bone-tendon apposition.
Remember the anatomy pearl: the footprint sits on the ulnar side of the tuberosity, so aim fixation there to restore the supination lever arm. This is a cadaveric study in elderly osteoporotic bone, which likely lowered absolute strength and drove the interference screw insertion fractures.
This controlled cadaveric study compared 4 distal biceps tendon repair techniques. It tested transosseous bone tunnel, suture anchor, EndoButton, and interference screw fixation under cyclic loading and load to failure. The goal was to determine which construct is strongest and whether repairs can tolerate early postoperative motion.
When choosing a distal biceps repair construct, this study establishes that the EndoButton delivers the highest initial fixation strength at roughly 440 N. That strength is well above the 100 to 200 N of maximum eccentric elbow flexor force, meaning every technique tested is strong enough to survive physiologic loading.
The practical distinction is failure behavior under motion. Suture anchor repairs showed suture breakage at the eyelet and surface-cortex gap formation, so a more conservative early rehab protocol is reasonable after anchor fixation.
The socket-based techniques (bone tunnel, EndoButton, interference screw) seat the tendon inside the tuberosity, so their small 2-3 mm displacements do not threaten bone-tendon apposition.
Remember the anatomy pearl: the footprint sits on the ulnar side of the tuberosity, so aim fixation there to restore the supination lever arm. This is a cadaveric study in elderly osteoporotic bone, which likely lowered absolute strength and drove the interference screw insertion fractures.