title: A comparison of nonoperative vs. Endobutton repair of distal biceps ruptures.
abstract: BACKGROUND
  The aim of this study was to compare the outcome of patients who have undergone distal biceps tendon repair by a single-incision Endobutton fixation technique with the results of another cohort of patients who elected not to undergo surgery for distal biceps tendon rupture.
  
  
  METHODS
  A retrospective cohort study was performed of patients diagnosed with distal biceps ruptures, repaired with an Endobutton (Smith & Nephew, Andover, MA, USA) technique or treated nonoperatively by the senior surgeon (S.A.S.). With a minimum follow-up of 6 months, a routine elbow examination, radiographs, and functional questionnaires were performed. Isometric supination, flexion, and grip strength was measured using a BTE machine (Baltimore Therapeutic Equipment, Hanover, MD, USA). There were 47 patients available for follow-up with 50 distal biceps ruptures; 40 ruptures have undergone repair, and 10 have been managed nonoperatively. Three patients had sustained bilateral ruptures.
  
  
  RESULTS
  There was a significant difference in flexion and supination isometric strength between the operative and nonoperative cohorts compared with the uninjured contralateral side (92.94% vs. 70.65%, P = .01512; 87.91% vs 59.11%, P = .00414, respectively). The difference in grip strengths between the 2 cohorts compared with the uninjured side was not significant (100.00% vs. 79.16%; P = .16002). The operated cohort had significantly better QuickDASH score, Oxford Elbow Score, and Mayo Elbow Performance Score (6.29 vs. 14.10, P = .02123; 44.71 vs. 38.70, P = .00429; 93.13 vs. 84.50, P = .01423).
  
  
  CONCLUSIONS
  Repair of distal biceps ruptures using an Endobutton fixation results in nearly normal return of strength and function, which is significantly better than in those managed nonoperatively.
  
  
  METHODS
  Level III, Retrospective Cohort Design; Treatment Study.
authors.affiliation: Chesterfield Royal Hospital, Chesterfield, Derbyshire, UK. Electronic address: drandrewlegg@hotmail.com.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Legg
authors.affiliation: Chesterfield Royal Hospital, Chesterfield, Derbyshire, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Stevens
authors.affiliation: Chesterfield Royal Hospital, Chesterfield, Derbyshire, UK.
authors.forename: Nanette O
authors.initials: NO
authors.lastname: Oakes
authors.affiliation: Chesterfield Royal Hospital, Chesterfield, Derbyshire, UK.
authors.forename: Shantanu A
authors.initials: SA
authors.lastname: Shahane
mesh_terms: D000328:Adult; D001134:Arm Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging / Q000293:injuries* / Q000503:physiopathology; D019637:Orthopedic Procedures / Q000379:methods*; D016059:Range of Motion, Articular / Q000502:physiology*; D012189:Retrospective Studies; D012421:Rupture / Q000000981:diagnostic imaging / Q000628:therapy; D013997:Time Factors
keywords: Biceps; Endobutton; distal; repair; rupture; tendon