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Orthopaedics & Traumatology: Surgery & Research
Sous presse. Epreuves corrigées par l'auteur. Disponible en ligne depuis le jeudi 9 août 2018
Doi : 10.1016/j.otsr.2018.05.013
Received : 20 January 2018 ;  accepted : 29 May 2018
Treatment of primary total distal biceps tendon rupture using cortical button, transosseus fixation and suture anchor: A single center experience

Nikolaus W. Lang a, , Adam Bukaty b, Geraldine D. Sturz a, Patrick Platzer a, Julian Joestl a
a Department of Trauma Surgery, Medical University of Vienna, 18–20, Waehringerguertel, 1090 Vienna, Austria 
b Department of Anesthesiology, Medical University of Vienna, 18–20, Waehringerguertel, 1090 Vienna, Austria 

Corresponding author.

There remains as of yet no consensus on the optimal treatment for total or partial distal biceps tendon repairs. As such, the purpose of this study was to assess functional outcome, the impact of complications and cost effectiveness, in patients undergoing primary distal biceps tendon repair by either cortical button (CB), transosseous suture (TO) or suture anchor (SA).


There is no difference in functional outcome and cost effectiveness, in patients undergoing distal biceps tendon repair.

Material & methods

A retrospective analysis was performed on prospectively collected data from 47 consecutive patients treated for total or partial distal biceps tendon rupture. Functional outcome was assessed by the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Strength measurements (e.g., flexion, supination and pronation) in the operated and non-operated extremities were recorded with the use of a dynamometer. Furthermore, all complications, as well as their impact on functional outcome and costs for surgical intervention were evaluated.


Minimum follow-up time was 35 weeks, average 46.3±13.8 weeks. The overall DASH score was 7.9±4.7. There were no differences in functional outcome (i.e., DASH score) between CB, TO, SA (p =0.32), nor were there differences in regards to strength (supination, flexion and pronation) (p =0.60) and ability to return to work & sports activity. The total complication rate was 21.6%. Complications had a significant impact on functional outcome (p =0.003). Re-rupture occurred 2 times in the SA group. In 5 patients, revisional surgery had to be performed. The shortest operation times and the lowest material costs were observed in the TO group (p =0.004).


All reported fixation methods for total or partial distal biceps tendon rupture yielded good functional results. However, transosseous suture fixation for total distal biceps tendon rupture, performed through a double incision approach by an experienced surgeon, seems to be a simple, inexpensive and successful method, offering satisfying clinical results.

Level of evidence

IV, a retrospective, comparative study.

The full text of this article is available in PDF format.

Keywords : Cost effectiveness, Distal biceps tendon rupture, Functional outcome, Complications

 This study was approved by the governing institutional review board and was performed in accordance with the Declaration of Helsinki (EK Nr. 2011/160).

© 2018  Published by Elsevier Masson SAS.
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