Biomechanical In Vitro Validation of Intramedullary Cortical Button Fixation for Distal Biceps Tendon Repair

Distal biceps tendon rupture typically occurs in middle-aged male patients who suffered an acute trauma with massive eccentric loading of the biceps brachii. In the past few decades, the incidence of this injury has increased from 3% to 10%. For pathogenesis, focal degenerative processes caused by hypovascularity within the tendon and mechanical impingement on the biceps tendon during forearm rotation continue to be cited in the literature as the reason for rupture at the tendinous insertion at the radial tuberosity. Furthermore, the abuse of steroids and nicotine has been discussed to cause the tendon tear. Operative repair of these injuries has shown improved functional elbow outcome compared with nonoperative treatment.

Currently, anatomic reinsertion of the biceps tendon to the radial tuberosity has been recognized as the treatment of choice to restore normal flexion and supination strength. Because of the increased risk of heterotopic ossification or radioulnar synostosis using the ‘‘classic’’ or ‘‘modified’’ 2-incision technique, the 1-incision technique for distal biceps tendon repair has become more popular in recent times. Via a single anterior approach, a variety of surgical repair techniques using suture anchors, interference screws, and cortical fixation buttons have shown both good clinical results and near preinjury strength of forearm supination and elbow flexion. For fixation to the bone, the construct with the strongest biomechanical data is a titanium extra-medullary cortical fixation button (‘‘EndoButton technique’’), which is anchored to the tendon by sutures and deployed on the posterior cortex of the proximal radius. The strength of this construct may allow earlier, more aggressive protocols for postoperative rehabilitation. Possible gap formations using a double- or single- fixation method for distal biceps repair are controversially discussed in the current literature. The ‘‘EndoButton technique’’ may provide minor displacement of the repair and is able to maintain bone-tendon continuity because of its intramedullary placement of the restored tendon.40 How- ever, this cortical button–based technique cannot restore the anatomic footprint of the distal biceps tendon and furthermore runs the risk of posterior interosseous nerve (PIN) injury as well as loss of motion attributable to heterotopic ossification.

The purpose of the present study is to demonstrate the new technique of intramedullary cortical button fixation (Biceps- button, Arthrex, Naples, Florida) for distal biceps tendon repair and to evaluate this procedure with respect to fixation strength to the bone versus the standard extramedullary cortical button–based technique. Our hypothesis is that double intramedullary cortical button fixation will provide superior loads to failure when compared with the traditional single extramedullary cortical button–based technique.

Full Article: Biomechanical In Vitro Validation of Intramedullary Cortical Button Fixation for Distal Biceps Tendon Repair

Peter Millett, MD

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39 reviews

Alexandra Thompson

Mar 23, 2024

by Alexandra Thompson on Peter Millett, MD

110%

Dr. Millett and his team did a SLAP tear repair and bicep tenodesis on my left shoulder. I use my arms as an artist, and love to swim in the ocean, surf, paddle, and telemark ski. So regaining full use of my shoulder and keeping my bicep attached was very important to me. Now, over two years later, my shoulder has the equivalent range of motion as my other arm and as before the injury, and no pain. After the first three months it felt so good and was so strong that - to my horror - I completely forgot my six-month follow-up.

Not only did Dr. Millett and his team make my arm as good as new, but having had the experience of such kindness and expertise throughout the process of surgery and recovery is like an added shoulder superpower.

Thank you Rita, Brooke, Jason, Sarah, Camille, Olivia, Dr. Millett and everyone! And see you soon when my husband comes in for his knee...

Jeff Chandler

Jan 31, 2022

by Jeff Chandler on Peter Millett, MD

Flawless procedure, Easy recovery

Dr. Millet's repaired my knee and tibia, following a botched operation by a different surgeon. That procedure was virtually pain free and I was weight bearing within a few days. That was 18 years ago and the knee is still strong. A few years after the knee incident, Dr Millet repaired my shoulder. My insurance company approved me for 3 months of disability following that surgery. I was off pain medication in 2 days and had 90% range of motion within a week. I withdrew my disability claim and returned to work within two weeks of surgery. I’m not a famous athlete—just a regular guy. Nonetheless, I was treated like an NFL at the Steadman clinic. Most notable was the time for recovery. Other surgeons perform their hour-long task in the OR and don’t involve themselves in the other functions. Peter and his team manages the entire process from diagnosis, anesthesia, nursing care, and therapy. He takes a holistic approach to patient care and doesn’t skip any steps.

Jenn West

Jul 2, 2021

by Jenn West on Peter Millett, MD

Saved My Life

I went to Dr. Millett after 7 knee surgeries (6 on my right and 1 on my left) and had seen 11 different surgeons who all refused to remove femur metal from my right leg. I am highly allergic to metal and the chronic pain was leaving me bedridden for 3.5wks out of a month. He personally wrote me back on my inquiry, listened to my concerns, scheduled my surgery within a week (due to insurance issues) and personally followed up with my recovery. The level of patient care from Dr. Millett and his ENTIRE team is above any care I have ever received in my 20 years of dealing with orthopedic surgeons. There are not enough words to describe the level of care, dedication and professionalism you receive from Dr. Millett and his staff.
My only disappointment is that I did not find him sooner!!!

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Biomechanical In Vitro Validation of Intramedullary Cortical Button Fixation for Distal Biceps Tendon Repair

About the Author: Peter Millett, MD