Outcomes of distal biceps tendon reattachment using the ToggleLoc™ fixation device with ZipLoop™ technology with single mini-open technique

Abstract

Anatomical repair of distal biceps tendon ruptures has been shown to restore elbow supination and flexion strength. Here, we report the outcomes of distal biceps tendon reattachment using the ToggleLoc fixation device with ZipLoop technology through a single incision. This was a retrospective study of 38 patients with a mean age of 49.5 years. The mean follow-up time was 15 months (range 4/28). The average time to surgery was 21 days. The fixation button was introduced in a bone tunnel and the tendon passed through a bone window using the ToggleLoc™, which allows the tendon to be tensioned using sutures. The tendon was reattached in 30° elbow flexion. The mean strength deficit in supination was 23.9% in comparison with the contralateral side. We discovered four instances of heterotopic ossification on follow-up radiographs. There were seven cases of persistent lateral antebrachial cutaneous nerve paresthesia, but no damage to the posterior interosseous nerve. This new technique places the tendon in a bone tunnel using a single surgical approach. It provides the surgeon with good feedback on the tension of the repair, which is unique among endobutton-type devices. We recommend using the ToggleLoc™ with ZipLoop™ technology as it is a simple, reliable and reproducible technique for distal biceps tendon reattachment.

Keywords: Distal biceps; Endobutton; ToggleLoc; ZipLoop.