Higher failure rate of suture anchors in partial distal biceps tendon ruptures in comparison to endobutton fixation

Abstract Purpose Little is known about the preferred repair technique of partial tears of the distal biceps tendon. In this study suture anchors were compared to the Endobutton technique for repair of partial distal biceps tendon ruptures, especially regarding failure rate. Methods In total 59 patients with 62 partial distal biceps ruptures underwent surgical treatment between 2008 and 2019. Repair of the partially ruptured distal biceps tendon was done using suture anchors (n = 21) or an Endobutton (n = 41). Postoperative evaluation consisted of integrity of physical examination of the distal biceps tendon, range of motion (ROM), stability, neurological status and radiographs in AP view and lateral direction of the elbow. Results At a median follow-up in all patients of 14 (1– 82) months, in total 5 patients had a rerupture of the reconstructed distal biceps tendon (8.1%). A significant higher rerupture rate was seen in the suture anchor group (n = 4), when compared to the Endobutton group (n =1) (p = 0.04). The other outcome measures were similar between groups. Other than rerupture rate, there were complications in 21 patients (34%). The major symptomatic complication was attributed to lateral antebrachial cutaneous nerve neuropraxia (LACN) (n = 8, 15%). Heterotopic ossifications were seen in 12 patients (34%), ossifications were symptomatic in 4 of these patients (33%). Conclusion A significantly higher failure rate was seen after repair of a partial distal biceps rupture using suture anchors, when compared to an Endobutton technique. Overall, both techniques were accompanied with complications; in particular, LACN neuropraxia and the formation of heterotopic ossifications, though clinically less relevant than a rerupture.