Distal Biceps Repair Using a Unicortical Intramedullary Button Technique: A Case Series

Purpose: Although surgical repair of distal biceps tendon rupture improves functional outcomes compared with nonsurgical treatments, the choice of operative technique remains a matter of preference. This study retrospectively examined outcomes from a repair technique using a volar distal biceps reinsertion secured with a unicortical intramedullary button in the proximal radial tuberosity to determine its safety and functional outcomes. Methods: A single fellowship-trained shoulder and elbow surgeon treated 27 men, average age 48 years (range, 25–66 years), between 2012 and 2016. Patient-reported outcomes included the Disabilities of the Arm, Shoulder, and Hand and American Shoulder and Elbow Surgeons (ASES) satisfaction scores and the Mayo Elbow Performance Score. Average patient follow-up was 24 months. Results: This series had an overall complication rate of 39.3% (11 of 28): 9 lateral antebrachial cutaneous neuropraxias, one radial sensory nerve irritation, and one superficial infection. No complications of peripheral nerve injury, proximal radioulnar synostosis, or rerupture were observed. Results (mean ± SD) demonstrated low disability (Disabilities of the Arm, Shoulder, and Hand score = 2.9 ± 5.3), high satisfaction (American Shoulder and Elbow Surgeons score = 9.3 ± 1.4), and acceptable performance (Mayo Elbow Performance Score = 97.7 ± 6.3). Subcategory analysis identified a correlation between time to surgery and complications. Disability scores were higher in patients with workers’ compensation claims versus private insurance (mean, 11.0 vs 1.1). Conclusions: Further trials are required to compare the results and complication rates of this unicortical intramedullary button procedure with other established methods. Type of study/level of evidence: Therapeutic IV.