Surgical repair of distal biceps tendon ruptures: a biomechanical comparison of two techniques.

BACKGROUND: Rupture of the distal biceps brachii tendon has most commonly been repaired by anatomic reattachment of the tendon to the radial tuberosity by a single- or two-incision approach. Researchers have studied suture anchor attachment through a single incision, but the tendon-suture interface and bone quality have not previously been analyzed.

HYPOTHESIS: Suture anchor repair results in stiffness and tensile strength equal to that of bone-tunnel repair for biceps tendon rupture.

STUDY DESIGN: Controlled laboratory study.

METHODS: Twelve matched pairs of fresh-frozen cadaveric elbow specimens were used. Suture anchor and bone-tunnel tendon repairs were performed in a randomized fashion. Each specimen was loaded to tensile failure. Load-displacement graphs were generated to calculate repair stiffness, yield strength, and ultimate strength. Computed tomography bone density measurements and additional statistical analyses were then performed after grouping the specimens by mode of failure.

RESULTS: The bone-tunnel repair was found to be significantly stiffer in all cases and to have significantly greater tensile strength than the suture anchor repair in the younger, nonosteoporotic elbows.

CONCLUSIONS: Suture anchor repairs were not as stiff or strong as bone-tunnel repairs.

CLINICAL RELEVANCE: Biceps tendon surgery using the traditional two-incision technique yields a stronger and stiffer repair in the typical patient with this injury.