Clinical and functional outcomes of distal biceps tendon repair using all-suture anchors

Abstract

Background: Various surgical approaches and fixation methods are available for distal biceps tendon repair. Although all-suture anchors offer theoretical advantages and are widely used in orthopedic surgery, clinical data on their use in distal biceps tendon repairs remain limited. This study aims to evaluate the clinical and functional outcomes of distal biceps tendon repair using two all-suture anchors via a single-incision approach. We hypothesized that this technique would result in effective restoration of supination strength, excellent patient-reported outcomes, and a low rerupture rate.

Methods: A retrospective analysis was conducted on patients who underwent distal biceps tendon repair using all-suture anchors between September 2016 and September 2022. A total of 40 patients were included. At clinical follow-up, range of motion, elbow flexion, and forearm supination strength were measured and compared to the contralateral side. Subjective outcomes were assessed using the Disabilities of the Arm, Shoulder and Hand questionnaire, Subjective Elbow Value, Mayo Elbow Performance Score, American Shoulder and Elbow Surgeons Standardized Elbow Assessment Questionnaire, and visual analog scale for pain. Complications were recorded.

Results: The mean age at the time of injury was 51.9 ± 9.2 years. The mean follow-up duration was 4.8 ± 2 years, and the mean time between injury and surgery was 14.2 ± 11.9 days. Median Disabilities of the Arm, Shoulder and Hand, Subjective Elbow Value, Mayo Elbow Performance Score, and American Shoulder and Elbow Surgeons Standardized Elbow Assessment Questionnaire scores were 2.3 (range, 0-31.8), 100 (range, 50-100), 100 (range, 70-100), and 98 (range, 53-100), respectively. The median pain level on the visual analog scale was 0 (range, 0-7), with only one patient reporting pain at rest. Mean relative elbow flexion strength compared to the uninjured side was 99.5 ± 23.3%, and forearm supination strength was 88.7 ± 28.2%. The rerupture rate was 2.5%, with 1 case occurring within the first postoperative week. All patients returned to work after an average of 8.7 ± 8.4 weeks, and 96.9% (31/32) returned to sports, with 81.3% (26/32) returning to >90% of their preinjury activity level.

Conclusions: Our findings demonstrate that distal biceps tendon repair using two all-suture anchors via a single-incision approach yields excellent patient-reported outcomes. With a low rerupture rate as well as high return-to-work and return-to-sport rates, this technique appears to be a reliable treatment option. However, the observed reduction of forearm supination strength underscores the need for further research to optimize anatomical footprint coverage.

Keywords: Sports medicine; all-suture anchors; distal biceps; elbow surgery; functional outcome; tendon repair.