title: Refixation techniques and approaches for distal biceps tendon ruptures: a systematic review of clinical studies.
abstract: BACKGROUND
  Surgical fixation is the preferred method of treatment for the ruptured distal biceps tendon in active patients. To date, no fixation technique has been proven superior in a clinical setting. The purpose of the study was to systematically review the available literature on approach and fixation methods for distal biceps tendon repair in a clinical setting and to determine the optimal fixation methods of the distal biceps tendon on the radial tuberosity. Our hypothesis was that the outcomes would not be significantly different among the various fixation techniques and approaches.
  
  
  METHODS
  A systematic review of the available literature on anatomic reconstruction methods for distal biceps tendon ruptures was performed. The outcome measures evaluated were postoperative range of motion, elbow flexion and supination strength, and complication rates and types.
  
  
  RESULTS
  Forty articles were included, representing 1074 patients divided into 4 fixation groups: suture anchors, bone tunnels, interference screws, and cortical buttons. There was no significant difference in range of motion and strength between the different approaches and fixation techniques. Complications were significantly less common after the double-incision approach with bone tunnel fixation (P < .0005).
  
  
  CONCLUSIONS
  There were significantly fewer complications after the double-incision approach with bone tunnel fixation. The double-incision approach had significantly fewer complications than the single-incision anterior approach, and the bone tunnel fixation had significantly fewer complications than the other 3 fixation techniques. However, as the double-incision approach was used with bone tunnel fixation in 84% of cases, there was a strong interrelationship between these variables.
authors.affiliation: Department of Orthopedic Surgery, Academic Medical Center, Amsterdam, The Netherlands; Department of Orthopedic Surgery, Upper Limb Unit, Amphia Hospital, Breda, The Netherlands. Electronic address: if.kodde@hotmail.com.
authors.forename: Izaäk F
authors.initials: IF
authors.lastname: Kodde
authors.affiliation: Department of Radiology, Medical Center Alkmaar, Alkmaar, The Netherlands.
authors.forename: Remco C
authors.initials: RC
authors.lastname: Baerveldt
authors.affiliation: Amphia Academy, Amphia Hospital, Breda, The Netherlands.
authors.forename: Paul G H
authors.initials: PG
authors.lastname: Mulder
authors.affiliation: Department of Orthopedic Surgery, Upper Limb Unit, Amphia Hospital, Breda, The Netherlands.
authors.forename: Denise
authors.initials: D
authors.lastname: Eygendaal
authors.affiliation: Department of Orthopedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
authors.forename: Michel P J
authors.initials: MP
authors.lastname: van den Bekerom
mesh_terms: D001134:Arm Injuries / Q000601:surgery*; D006801:Humans; D009984:Orthopedic Fixation Devices; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods*; D063868:Patient Outcome Assessment; D012421:Rupture / Q000601:surgery; D013708:Tendon Injuries / Q000601:surgery*
keywords: Distal biceps tendon; elbow; fixation technique; repair; rupture; surgical approach