Distal biceps tendon repair: a cadaveric analysis of suture anchor and interference screw restoration of the anatomic footprint.

BACKGROUND: Distal biceps tendon repair with interference screw or double suture-anchor fixation are 2 successful techniques performed with either 1- or 2-incision approaches. No study has examined the accuracy and quality of the repaired tendon footprint with these devices and approaches.

HYPOTHESIS: A 2-incision approach will allow a more anatomic repair of the distal biceps footprint compared with a 1-incision anterior approach. Fixation technique will affect insertional footprint location and footprint contact area.

STUDY DESIGN: Controlled laboratory study.

METHODS: After randomization, 36 distal biceps repairs were performed on human cadaveric upper extremity specimens, with 1- or 2-incision approaches and with fixation devices of either two 5.5-mm suture anchors or an 8-mm interference screw. Native and repaired footprint areas and centroid location were calculated with a 3-dimensional digitizer.

RESULTS: Interference screw repair had the smallest footprint area (135 mm(2)) compared with suture anchor repair (197 mm(2)) and the native tendon (259 mm(2)) (P = .013). The 2-incision approach repaired the footprint to a more posterior and anatomic position (2.5 mm) than a 1-incision approach (P = .001). The fixation device did not affect footprint location significantly.

CONCLUSION: Suture anchor repair more closely re-creates the footprint area on the radial tuberosity of the native distal biceps tendon compared with the interference screw repair. A 2-incision approach more closely re-creates footprint position compared with the 1-incision approach.

CLINICAL RELEVANCE: A 2-incision approach with double suture-anchor fixation may yield a more anatomic distal biceps repair based on reproduction of the footprint compared with a 1-incision approach.