A functional analysis of distal biceps tendon repair: Single-incision Endobutton technique vs. two-incision modified Boyd–Anderson technique

Steven B. Cohen, Patrick S. Buckley, Brian J Neuman, J. Martin Leland, Michael G. Ciccotti, Mark Lazarus

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


Introduction: The optimal surgical technique for a distal biceps tendon rupture repair still remains controversial. Current biomechanical evidence shows Endobutton fixation to have the highest load-to-failure testing, but clinical results of this are limited. The purpose of this study was to compare patient-oriented functional outcome between a modified Boyd– Anderson two-incision technique and repair with a single-incision Endobutton technique. Methods: All patients who underwent distal biceps tendon repair with a two-incision or Endobutton technique between 2000 and 2010 with two-year follow-up at our institution were identified. Their clinical, operative, and follow-up data was collected and analyzed. The primary outcome was a patient-oriented functional outcome measure (Disabilities of the Arm, Shoulder, and Hand: DASH). Secondary outcomes were evaluated using a subjective questionnaire. Results: Thirty-three patients were repaired with the two-incision technique and twenty-five patients had a repair with a single incision Endobutton technique. All patients receiving the two-incision repair were male, while there were 2 females who had an Endobutton procedure. There was no significant difference between the two-incision and the Endobutton groups in regards to mean DASH score (6.31 versus 5.91, p = 0.697), mean Work DASH score (10.49 versus 0.93, p = 0.166), and mean Sports DASH score (10.54 versus 9.56, p = 0.987). Regardless of technique, most patients were “extremely satisfied” (n = 42, or 72.41%) or “satisfied” (n = 10, or 17.24%) postoperatively, and returned to pre-operative activity in approximately 6 months (6.87 months versus 6.82 months, respectively) (p = 0.457). There was no significant difference in the prevalence of complications (39.39% versus 32.0%, respectively for two incision versus single incision) (p = 0.594). Conclusion: Patients from both surgical groups were satisfied with their post-operative function and had similar functional outcomes and complication rates. Both surgical techniques for distal biceps tendon repair are effective and are similarly safe methods of treatment.

Original languageEnglish (US)
Pages (from-to)59-62
Number of pages4
JournalPhysician and Sportsmedicine
Issue number1
StatePublished - Jan 1 2016
Externally publishedYes


  • Biceps
  • Distal
  • Endobutton
  • Repair
  • Rupture
  • Technique

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation


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