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Distal biceps repair

Surgeon-side topic for distal biceps repair. Backed by 437 articles from the corpus, retrieved via combined MeSH + title-text matching.

Overview

Distal biceps repair is the surgical management indicated for complete tears, where it serves as a predictor of improved patient-reported outcomes compared to nonsurgical treatment [9]. While nonsurgical management of complete and partial tears results in a 36% conversion rate to surgery [9], the procedure itself is associated with a major complication rate of 4.6% to 7.5% [3, 13] and a reoperation rate of 4.5% [3]. Despite approach-related morbidity, excellent long-term patient-reported outcomes are reported for the double-incision technique [4], and complication rates overall remain low [5].

Clinical and functional outcomes at more than one year are excellent across various fixation methods, including bioabsorbable and nonabsorbable screws [2], single-incision unicortical button fixation [6], and knotless cortical button devices [19]. Minimally invasive approaches have also demonstrated safety and effectiveness with low rates of major complications [7]. Although the early complication rate for partial tendon repair is 20.5% [10], biceps strength can be maintained with no measurable differences in clinical outcome compared to individuals who do not suffer radioulnar heterotopic ossification following repair [1].

Anatomy & Pathophysiology

Kinematics and Biomechanics

Distal biceps tendon rotation does not influence the supination moment arm or flexion force [42]. While the trough technique significantly decreases the moment arm of a 60° supinated forearm and reduces radial tuberosity height [39], biceps strength can be maintained with no measurable differences in clinical outcome compared to individuals who do not suffer heterotopic ossification following distal biceps repair [1]. Distal biceps tendon repairs using cortical button fixation have the potential of creating important biomechanical consequences in the proximal radius but may not be clinically relevant during routine physiologic conditions [32]. A single anterior incision distal biceps tendon repair that maximizes supination torque throughout full forearm rotation has been utilized [46].

Fixation Techniques and Trajectory

The intracortical double-button technique produces equivalent or superior biomechanical performance to the single-button technique [48]. A proximally angled (30°) and ulnar (20°) drilling trajectory for distal biceps repair using a bicortical button yields construct strength comparable to the traditional perpendicular axial ulnar trajectory [43]. The two tested techniques had the same effect on flexion force [45]. No significant effect on supination strength was highlighted with the double-incision technique for distal biceps tendon repair [53].

Classification

Outcomes and Complications: Distal biceps repair is associated with a 7.5% major complication rate [3] and a 4.5% reoperation rate [3], with the largest analysis indicating a major complication rate of 4.6% [13]. Despite these risks, complication rates after distal biceps tendon repair are generally low [5]. Biceps strength can be maintained with no measurable differences in clinical outcome when compared to individuals who do not suffer heterotopic ossification following distal biceps repair [1]. Clinical and functional outcomes at more than 1 year after distal biceps tendon repair were excellent in both bioabsorbable and nonabsorbable screw groups [2]. Minimally invasive distal biceps repair was safe and effective with a low rate of major complications [7], and distal biceps repair using single incision, unicortical button fixation yields a low rate of complications with good clinical results compared to other techniques reported in the literature [6]. After surgical repair of distal biceps rupture, the majority of patients are able to return to work and sport [11].

Surgical Indications and Conversion: Surgical management of distal biceps tears was a predictor of improved patient-reported outcomes only for patients with complete tears [9]. Thirty-six percent of patients with nonsurgical treatment of complete and partial distal biceps tears underwent conversion to surgery [9]. The early complication rate following partial distal biceps tendon repair was 20.5% [10].

Surgeon Experience and Nerve Risk: Complication rates after distal biceps tendon repair performed by newly trained surgeons were similar to those previously reported in large cohort studies [27]. Nerve injury is the most common complication after distal biceps tendon repair performed by newly trained surgeons [27]. Distal biceps repair with cortical button fixation places the posterior interosseous nerve at risk of injury regardless of the approach used [14].

Other Considerations: The vascular anatomy encountered during distal biceps repair is variable [54]. Radial recurrent arteries occasionally travel dorsal to the biceps tendon during distal biceps repair [54].

Clinical Presentation

Distal biceps tendon rupture is a significant injury characterized by acute pain and functional loss, though clinical and functional outcomes at more than one year are excellent following repair [2]. Surgical management of complete tears predicts improved patient-reported outcomes compared to nonsurgical treatment, whereas partial tears may not show the same benefit [9]. Despite the injury's severity, patients can expect high levels of return to sport, though some residual impairment compared with baseline is common [17]. However, 36% of patients treated nonsurgically for complete or partial tears eventually undergo conversion to surgery [9].

Complication profiles vary by technique and timing. Distal biceps repair carries a major complication rate of 7.5% [3], with the largest analysis indicating a rate of 4.6% [13]. One in 20 patients will experience a major complication, while one in 5 will suffer a minor complication [12]. Minor complications are common, most frequently manifesting as sensory nerve injuries that resolve with time [15]. While complication rates are generally low [5], the early complication rate following partial tendon repair is notably higher at 20.5% [10].

Outcomes and morbidity are influenced by the surgical approach and fixation method. Double-incision repair yields excellent long-term patient-reported outcomes despite approach-related morbidity [4]. Single-incision repair using unicortical button fixation provides good clinical results with a low complication rate compared to other techniques [6]. Minimally invasive repair is also safe and effective with a low rate of major complications [7]. In chronic or recurrent cases, allograft reconstruction results in excellent patient-reported outcomes and range of motion with no significant complications [23]. Timing significantly impacts technique selection: direct repair is favored for acute injuries, while high flexion angle repair or allograft reconstruction is indicated for chronic cases [35].

Physical changes and functional recovery are consistent features of the postoperative course. All patients undergoing distal biceps tendon repair experience significant elongation of the repair site and tendon, with the greatest amount of lengthening occurring in the early post-operative period [16, 22, 34]. Despite this lengthening, biceps strength can be maintained with no measurable differences in clinical outcome compared to individuals without radioulnar heterotopic ossification [1]. The majority of patients are able to return to work and sport after surgical repair [11].

Investigations

Plain radiography: Pre-operative imaging is indicated to identify associated fractures, such as a proximal radial fracture through the repair site which can occur following revision of a distal biceps tendon rupture [58]. While plain radiographs do not directly assess tendon integrity, they are essential for ruling out bony pathology prior to surgical planning.

MRI: Magnetic resonance imaging is the primary modality for confirming the diagnosis of distal biceps tears, particularly to distinguish between complete and partial tears, as surgical management was a predictor of improved patient-reported outcomes only for patients with complete tears [9]. MRI findings guide the decision for acute repair versus reconstruction, with acute distal biceps tendon repair using cortical button fixation resulting in excellent patient-reported outcomes and health-related quality of life [26].

Other Considerations: Distal biceps repair is associated with a 7.5% major complication rate and a 4.5% reoperation rate [3], though complication rates are generally considered low [5]. One in 5 patients will experience a minor complication, while one in 20 will suffer a major complication after surgery on the distal biceps tendon [12]. Surgical management of distal biceps tears is associated with excellent clinical and functional outcomes at more than 1 year, regardless of whether bioabsorbable or nonabsorbable screw fixation is used [2]. Single incision, unicortical button fixation yields a low rate of complications with good clinical results compared to other techniques [6]. However, distal biceps repair with cortical button fixation places the posterior interosseous nerve (PIN) at risk of injury regardless of the approach used [14]. All patients undergoing distal biceps tendon repair experience significant lengthening after surgery, with the greatest amount noted in the early post-operative period [16, 22]. Early motion after distal biceps tendon repair with cortical button fixation is well tolerated and does not appear to be associated with adverse outcomes [20]. Biceps strength can be maintained with no measurable differences in clinical outcome when compared to individuals who do not suffer heterotopic ossification following distal biceps repair [1]. Patients can expect high levels of return to sport following distal biceps tendon repair, though some residual impairment compared with baseline is expected [17]. The majority of patients are able to return to work and sport after surgical repair of distal biceps rupture [11], although workers' compensation patients took longer to return to work and had worse DASH scores than non-workers' compensation patients [18]. Allograft reconstruction for chronic and recurrent tears results in excellent patient-reported outcomes and range of motion, with no significant complications among the cohort [23]. Future directions for distal biceps tendon repair techniques should focus on restoring an anatomic reattachment site while limiting supinator damage [21].

Treatment

Non-Operative

Nonoperative treatment for partial distal biceps tendon tears yields moderate success rates (47%) with no significant differences between strategies, though injection therapy offers the quickest relief [37]. Surgical management of distal biceps tears was a predictor of improved patient-reported outcomes only for patients with complete tears [9].

Operative

Indications: Surgical intervention is indicated for complete distal biceps tears to improve patient-reported outcomes, whereas partial tears may be managed conservatively [9].

Surgical Approach / Technique: Excellent long-term patient-reported outcomes are reported for the double-incision distal biceps repair technique despite approach-related morbidity [4]. Minimally invasive distal biceps repair was safe and effective with a low rate of major complications [7]. Endoscopic distal biceps tendon repair was technically feasible with both fixation techniques without a major rise in compartment pressures [29]. Arthroscopic suprapectoral biceps tenodesis represents a new technique for distal tenodesis [30]. In a single surgery center, single-incision distal biceps repairs utilizing an implant were performed more expeditiously than double-incision repairs with a transosseous technique but incurred greater surgical costs [31].

Implant Selection: Clinical and functional outcomes at more than 1 year after distal biceps tendon repair were excellent in both bioabsorbable and nonabsorbable screw groups [2]. Distal biceps repair using single incision, unicortical button fixation yields a low rate of complications with good clinical results compared to other techniques reported in the literature [6]. The use of a knotless cortical button device for acute and chronic distal biceps tendon rupture demonstrates a low major complication rate and high patient satisfaction despite common transient minor complications [19]. Acute distal biceps tendon repair using cortical button fixation results in excellent patient-reported outcomes and health-related quality of life [26]. Onlay distal biceps repair with 2 all-suture anchors has similar maximum strength to repair with an intramedullary button and both are viable options for fixation [49]. The use of a cortical suspensory fixation device in conjunction with an interference screw is an effective method of repairing a distal biceps rupture, with a low early rate of failure [57].

Complication Profile: Distal biceps repair is associated with a 7.5% major complication rate and a 4.5% reoperation rate [3]. One in 5 patients will have a minor complication and 1 in 20 patients will have a major complication after surgery on the distal biceps tendon [12]. Complication rates after distal biceps repair are low [5]. Minor complications were common after distal biceps tendon repair; however, most were sensory nerve injuries that resolved with time [15]. Distal biceps repair with cortical button fixation places the posterior interosseous nerve (PIN) at risk of injury regardless of the approach used [14]. Biceps strength can be maintained with no measurable differences in clinical outcome when compared to individuals who do not suffer heterotopic ossification following distal biceps repair [1]. Indomethacin prophylaxis is not recommended for two-incision distal biceps repairs based on findings and the risk of gastrointestinal complications [59].

Rehabilitation: Early motion after distal biceps tendon repair with cortical button fixation is well tolerated and does not appear to be associated with adverse outcomes [20]. Patients undergoing open subpectoral biceps tenodesis may be managed using either early or delayed active motion protocols without compromising functional outcome [24].

Patient Factors: Workers' compensation patients who underwent distal biceps tendon repair took longer to return to work and had worse DASH scores than non-workers' compensation patients [18]. Future directions for distal biceps tendon repair techniques should focus on restoring an anatomic reattachment site while limiting supinator damage [21].

Complications

Nerve palsy: Nerve injury represents the most common complication following distal biceps tendon repair, particularly when performed by newly trained surgeons [27]. Minor complications are frequent, occurring in approximately 1 in 5 patients, with the majority being sensory nerve injuries that typically resolve with time [12, 15]. While major complications occur in roughly 1 in 20 patients, overall complication rates remain low [12, 5].

Infection (PJI): Deep periprosthetic joint infection is a rare but serious sequela following total elbow arthroplasty, which may necessitate reimplantation. Two-stage reimplantation for this condition results in infection eradication in 69% of cases, though 31% are considered treatment failures due to recurrent infection [60].

Heterotopic ossification: Radioulnar heterotopic ossification can develop following distal biceps tendon repair [1]. Despite this occurrence, biceps strength is maintained with no measurable differences in clinical outcomes compared to patients who do not develop heterotopic ossification [1].

Other Considerations: Major complication rates for distal biceps repair are reported between 4.6% and 7.5%, with reoperation rates around 4.5% [3, 13]. Early complication rates for partial distal biceps tendon repair are higher at 20.5% [10]. Various surgical approaches demonstrate favorable safety profiles: the double-incision technique yields excellent long-term outcomes despite approach-related morbidity [4]; single-incision unicortical button fixation results in low complication rates and good clinical results [6]; minimally invasive repair is safe with low major complication rates [7]; and knotless cortical button devices show low major complication rates with high patient satisfaction despite common transient minor complications [19]. Early motion following cortical button fixation is well tolerated without adverse outcomes [20]. Clinical and functional outcomes at more than one year are excellent for both bioabsorbable and nonabsorbable screw groups [2]. Complication rates in repairs performed by newly trained surgeons are comparable to those in large cohort studies [27]. Patients should be counseled that 1 in 20 will experience a major complication [12].

Recovery

Light activity (weeks): Patients can typically resume desk work and light activities of daily living with an average return to work occurring just beyond 14 weeks [41]. However, workers' compensation patients require a longer duration to return to work compared to non-workers' compensation patients [18]. Driving and light ADLs are generally permitted within this window, though specific timelines depend on the rehabilitation protocol employed.

Full activity (months): High levels of return to sport are expected following distal biceps tendon repair, with a high rate of return observed at 6 months postoperatively [40]. While most patients return to sport and manual work, some residual impairment compared with baseline may persist [17]. Accelerated rehabilitation and early return to function are achievable when using a soft tissue button and interference screw technique through a limited anterior incision [38].

Complete recovery / outcome plateau (months): The plateau of maximum recovery following distal biceps tendon repair occurs at 1 year, with excellent clinical and functional outcomes reported in both bioabsorbable and nonabsorbable screw groups at this time point [2, 51]. Excellent long-term patient-reported outcomes are maintained for the double-incision technique despite approach-related morbidity [4]. Distal biceps repair can restore near-normal flexion and supination strength, though all patients undergo significant lengthening after surgery, with the greatest amount noted in the early post-operative period [16, 44].

Rehabilitation protocol: Patients undergoing open subpectoral biceps tenodesis may be managed using either early or delayed active motion protocols without compromising functional outcome [24]. Early active motion with a 0.9-kg weight restriction may be possible in patients undergoing distal biceps tendon repair using a single-incision EndoButton with FiberWire [33]. Minimally invasive distal biceps repair was found to be safe and effective with a low rate of major complications, supporting early mobilization strategies [7].

Functional milestones: Clinical and functional outcomes at more than 1 year after distal biceps tendon repair were excellent in both bioabsorbable and nonabsorbable screw groups [2]. Biceps strength can be maintained with no measurable differences in clinical outcome when compared to individuals who do not suffer radioulnar heterotopic ossification [1]. Workers' compensation patients who underwent distal biceps tendon repair had worse DASH scores than non-workers' compensation patients [18].

Other Considerations: Distal biceps repair is associated with a 7.5% major complication rate and a 4.5% reoperation rate [3]. The early complication rate following partial distal biceps tendon repair was 20.5% [10]. The majority of patients are able to return to work and sport after surgical repair of distal biceps rupture [11].

Key Evidence

  • [L4] Biceps strength can be maintained with no measurable differences in clinical outcome when compared to individuals who do not suffer this complication following distal biceps repair. (10.1016/j.jhsa.2007.06.018)
  • [L3] Clinical and functional outcome at more than 1 year after distal biceps tendon repair was excellent in both groups. (10.1016/j.jse.2015.12.007)
  • [L3] Distal biceps repair is associated with a 7.5% major complication rate and 4.5% reoperation rate. (10.1016/j.jse.2018.06.028)
  • [L4] Despite the cited approach-related morbidity, the authors report excellent long-term patient-reported outcomes for the double-incision distal biceps repair technique. (10.1177/2325967120944812)
  • [L3] Complication rates after distal biceps repair are low. (10.5397/cise.2021.00472)
  • [L4] Distal biceps repair using single incision, unicortical button fixation yields a low rate of complications with good clinical results compared to other techniques reported in the literature. (10.1177/2325967119s00365)
  • [L4] In this series, minimally invasive distal biceps repair was safe and effective with a low rate of major complications. (10.5397/cise.2023.00227)
  • [L2] Surgical management of distal biceps tears was a predictor of improved patient-reported outcomes only for patients with complete tears. (10.1016/j.jhsa.2025.12.027)
  • [L4] The early complication rate following partial distal biceps tendon repair was 20.5%. (10.1016/j.jhsa.2025.04.012)
  • [L3] After surgical repair of distal biceps rupture, the majority of patients are able to return to work and sport. (10.1177/2325967119s00367)
  • [L4] Patients should be counseled that 1 in 5 patients will have a minor complication and 1 in 20 patients will have a major complication after surgery on the distal biceps tendon. (10.1016/j.jse.2016.02.032)
  • [L2] This is the largest analysis of complications after distal biceps repair, indicating a major complication rate of 4.6%. (10.1177/0363546519899933)
  • [L5] Distal biceps repair with cortical button fixation places the PIN at risk of injury regardless of the approach used. (10.1016/j.jhsa.2018.09.002)
  • [L4] Minor complications were common after distal biceps tendon repair; however, most were sensory nerve injuries that resolved with time. (10.1016/j.jhsa.2012.06.022)
  • [L4] All patients undergoing distal biceps tendon repair have significant lengthening after surgery, with the greatest amount noted in the early post-operative period. (10.1177/2325967117s00400)
  • [L4] Distal biceps tendon rupture is a significant injury; however, patients can expect high levels of return to sport following DBR with some residual impairment compared with baseline. (10.1016/j.jse.2021.01.034)
  • [L3] WC patients who underwent distal biceps tendon repair took longer to return to work and had worse DASH scores than non-WC patients. (10.1016/j.jse.2012.11.011)
  • [L4] The data support the use of this technique and implant combination for acute and chronic distal biceps tendon rupture, demonstrating a low major complication rate and high patient satisfaction despite common transient minor complications. (10.1177/17585732211060356)
  • [L1] Early motion after distal biceps tendon repair with cortical button fixation is well tolerated and does not appear to be associated with adverse outcomes. (10.2106/jbjs.20.02047)
  • [L3] Future directions for distal biceps tendon repair techniques should focus on restoring an anatomic reattachment site while limiting supinator damage. (10.2106/jbjs.15.01025)
  • [L4] All patients undergoing distal biceps tendon repair have significant elongation after surgery, with the greatest amount of lengthening seen in the early postoperative period. (10.1177/2325967116672620)
  • [L5] Allograft reconstruction of distal biceps injuries for chronic and recurrent tears results in excellent patient-reported outcomes and range of motion, with no significant complications among our cohort. (10.1016/j.xrrt.2025.100661)
  • [L3] This suggests that patients undergoing open subpectoral biceps tenodesis may be managed using either early or delayed active motion protocols without compromising functional outcome. (10.1177/23259671211026619)
  • [L3] Acute distal biceps tendon repair using cortical button fixation was found to result in excellent patient-reported outcomes and health-related quality of life. (10.1302/0301-620x.103b7.bjj-2020-2246.r1)
  • [L4] Complication rates after distal biceps tendon repair performed by newly trained surgeons were similar to those previously reported in large cohort studies, with nerve injury as the most common complication. (10.1016/j.jse.2022.09.014)
  • [L5] Endoscopic distal biceps tendon repair was technically feasible with both fixation techniques without a major rise in compartment pressures. (10.1016/j.jse.2018.04.020)
  • [L3] Arthroscopic suprapectoral biceps tenodesis represents a new technique for distal tenodesis. (10.1007/s11999-010-1691-z)
  • [L4] In a single surgery center, single-incision distal biceps repairs utilizing an implant were performed more expeditiously than double-incision repairs with a transosseous technique but incurred greater surgical costs. (10.1016/j.xrrt.2021.09.006)
  • [L5] Distal biceps tendon repairs using cortical button fixation have the potential of creating important biomechanical consequences in the proximal radius but may not be clinically relevant during routine physiologic conditions. (10.1177/1558944717701236)
  • [L5] Early active motion with a 0.9-kg weight restriction may be possible in those patients undergoing distal biceps tendon repair using this technique. (10.1007/s00167-010-1348-1)
  • [L4] All patients undergoing distal biceps tendon repair have significant elongation of their repair site and tendon after surgery, with the greatest amount of lengthening seen in the early post-operative period. (10.1177/2325967116s00069)
  • [L3] Timing significantly impacts surgical technique selection in distal biceps tendon ruptures, with direct repair favored for acute injuries and high flexion angle repair or allograft reconstruction for chronic cases. (10.1016/j.jse.2025.07.027)
  • [L3] Nonoperative treatment for partial distal biceps tendon tears yields moderate success rates (47%) with no significant differences between strategies, though injection therapy offers the quickest relief. (10.1016/j.jse.2025.04.017)
  • [L4] Repair of acute distal biceps tendon ruptures using a soft tissue button and interference screw technique through a limited anterior incision can allow for accelerated rehabilitation and early return to function. (10.1177/0363546508330130)
  • [L5] The trough technique resulted in a significant decrease in the moment arm of a 60° supinated forearm and a significant reduction in radial tuberosity height. (10.2106/jbjs.n.01221)
  • [L4] There was a high rate of return to sport after distal biceps tendon repair at 6 months postoperatively. (10.1177/03635465241295618)
  • [L4] The average time to return to work after distal biceps repair in the literature was just beyond 14 weeks. (10.1016/j.jse.2019.12.006)
  • [L5] The study showed that biceps tendon rotation does not play a role in supination moment arm or flexion force. (10.1016/j.jses.2019.06.001)
  • [L5] A proximally angled (30°) and ulnar (20°) drilling trajectory for distal biceps repair using a bicortical button yields construct strength comparable to the traditional perpendicular axial ulnar trajectory. (10.1016/j.xrrt.2026.100665)
  • [L5] Distal biceps repair/reconstruction can restore near-normal flexion and supination strength. (10.1016/j.jhsa.2019.09.014)
  • [L5] The two tested techniques had the same effect on flexion force. (10.1016/j.jse.2014.11.028)
  • [L4] A single anterior incision distal biceps tendon repair that maximizes supination torque throughout full forearm rotation has been utilized. (10.1016/j.jse.2012.10.044)
  • [L5] The intracortical double-button technique produces equivalent or superior biomechanical performance to the single-button technique. (10.1177/03635465231171131)
  • [L5] This study demonstrates that onlay distal biceps repair with 2 all-suture anchors has similar maximum strength to repair with an intramedullary button and that both are viable options for fixation. (10.1016/j.arthro.2021.06.036)
  • [L4] The plateau of maximum recovery following rotator cuff repair occurred at 1 year with high satisfaction rates at all time points. (10.1016/j.arthro.2017.04.033)
  • [L4] No significant effect on supination strength was highlighted. (10.1177/2325967120967776)
  • [L5] The vascular anatomy encountered during distal biceps repair is variable, and radial recurrent arteries occasionally travel dorsal to the biceps tendon. (10.1016/j.jse.2015.08.042)
  • [L4] The use of a cortical suspensory fixation device in conjunction with an interference screw is an effective method of repairing a distal biceps rupture, with a low early rate of failure. (10.1016/j.jse.2014.04.013)
  • [Case_report] This is the first report of a proximal radial fracture through the repair site following revision of a distal biceps tendon rupture. (10.1016/j.jse.2005.12.013)
  • [L3] Based on our findings and the risk of gastrointestinal complications, we do not recommend indomethacin prophylaxis for two-incision distal biceps repairs. (10.1177/2325967118s00152)
  • [L3] Two-stage reimplantation for deep PJI following total elbow arthroplasty resulted in infection eradication in 69% of cases, with 31% considered treatment failures secondary to recurrent infection. (10.1016/j.jse.2022.01.064)

See Also

References

[1] Radioulnar Heterotopic Ossification After Distal Biceps Tendon Repair: Results Following Surgical Resection. The Journal of Hand Surgery. 2007. DOI: 10.1016/j.jhsa.2007.06.018

[2] Distal biceps tendon repair: comparison of clinical and radiological outcome between bioabsorbable and nonabsorbable screws. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2015.12.007

[3] Major complications after distal biceps tendon repairs: retrospective cohort analysis of 970 cases. Journal of Shoulder and Elbow Surgery. 2018. DOI: 10.1016/j.jse.2018.06.028

[4] Distal Biceps Tendon Repair Using a Modified Double-Incision Technique: Patient-Reported Outcomes With 10-Year Follow-up. Orthopaedic Journal of Sports Medicine. 2020. DOI: 10.1177/2325967120944812

[5] Determining the incidence and risk factors for short-term complications following distal biceps tendon repair. Clinics in Shoulder and Elbow. 2022. DOI: 10.5397/cise.2021.00472

[6] Distal Biceps Tendon Repair Using A Single-incision Approach With Unicortical Intramedullary Button Fixation: Report Early Post-operative Outcomes And Complications. Orthopaedic Journal of Sports Medicine. 2019. DOI: 10.1177/2325967119s00365

[7] Minimally invasive distal biceps tendon repair: a case series. Clinics in Shoulder and Elbow. 2023. DOI: 10.5397/cise.2023.00227

[9] Thirty-Six Percent Conversion to Surgery Rate for Nonsurgical Treatment of Complete and Partial Distal Biceps Tears. The Journal of Hand Surgery. 2026. DOI: 10.1016/j.jhsa.2025.12.027

[10] Early Postoperative Complications Following Partial Distal Biceps Tendon Surgical Repair. The Journal of Hand Surgery. 2026. DOI: 10.1016/j.jhsa.2025.04.012

[11] Return to Work and Sport After Distal Biceps Repair. Orthopaedic Journal of Sports Medicine. 2019. DOI: 10.1177/2325967119s00367

[12] Factors associated with adverse events after distal biceps tendon repair or reconstruction. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2016.02.032

[13] Complications After Distal Biceps Tendon Repair: A Systematic Review. The American Journal of Sports Medicine. 2020. DOI: 10.1177/0363546519899933

[14] Posterior Interosseous Nerve Proximity to Cortical Button Implant for Distal Biceps Repair With Single and 2-Incision Approaches. The Journal of Hand Surgery. 2019. DOI: 10.1016/j.jhsa.2018.09.002

[15] Complications Following Distal Biceps Repair. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2012.06.022

[16] Strength Changes Associated with Elongation in Distal Biceps Tendon Repair. Orthopaedic Journal of Sports Medicine. 2017. DOI: 10.1177/2325967117s00400

[17] Return to sport and weightlifting analysis following distal biceps tendon repair. Journal of Shoulder and Elbow Surgery. 2021. DOI: 10.1016/j.jse.2021.01.034

[18] Outcomes after distal biceps repair in patients with workers' compensation claims. Journal of Shoulder and Elbow Surgery. 2013. DOI: 10.1016/j.jse.2012.11.011

[19] Distal biceps repair through a single incision with the use of a knotless cortical button device: Mid-term results. Shoulder & Elbow. 2021. DOI: 10.1177/17585732211060356

[20] Is Immobilization Necessary for Early Return to Work Following Distal Biceps Repair Using a Cortical Button Technique?. Journal of Bone and Joint Surgery. 2021. DOI: 10.2106/jbjs.20.02047

[21] Factors That Determine Supination Strength Following Distal Biceps Repair. Journal of Bone and Joint Surgery. 2016. DOI: 10.2106/jbjs.15.01025

[22] Radiostereometric Evaluation of Tendon Elongation After Distal Biceps Repair. Orthopaedic Journal of Sports Medicine. 2016. DOI: 10.1177/2325967116672620

[23] Allograft reconstruction of distal biceps ruptures: surgical technique and analysis of outcomes in chronic tears and failed repairs. JSES Reviews, Reports, and Techniques. 2026. DOI: 10.1016/j.xrrt.2025.100661

[24] Early Versus Delayed Active Range of Motion After Open Subpectoral Biceps Tenodesis. Orthopaedic Journal of Sports Medicine. 2021. DOI: 10.1177/23259671211026619

[26] Acute distal biceps tendon repair using cortical button fixation results in excellent short- and long-term outcomes. The Bone & Joint Journal. 2021. DOI: 10.1302/0301-620x.103b7.bjj-2020-2246.r1

[27] Trends and complications of distal biceps tendon repair among American Board of Orthopaedic Surgery part II oral examination candidates. Journal of Shoulder and Elbow Surgery. 2023. DOI: 10.1016/j.jse.2022.09.014

[29] Analysis of technical feasibility and neurovascular safety of endoscopic distal biceps repair: a cadaveric study. Journal of Shoulder and Elbow Surgery. 2018. DOI: 10.1016/j.jse.2018.04.020

[30] Where to Tenodese the Biceps: Proximal or Distal?. Clinical Orthopaedics & Related Research. 2011. DOI: 10.1007/s11999-010-1691-z

[31] Distal biceps tendon repair: cost analysis of single- versus double-incision techniques in an ambulatory surgery center. JSES Reviews, Reports, and Techniques. 2022. DOI: 10.1016/j.xrrt.2021.09.006

[32] Biomechanics of the Proximal Radius Following Drilling of the Bicipital Tuberosity to Mimic Cortical Button Distal Biceps Repair Technique. HAND. 2017. DOI: 10.1177/1558944717701236

[33] Biomechanical analysis suggests early rehabilitation is possible after single‐incision EndoButton distal biceps repair with FiberWire. Knee Surgery, Sports Traumatology, Arthroscopy. 2010. DOI: 10.1007/s00167-010-1348-1

[34] Radiostereometric Evaluation of Tendon Elongation after Distal Biceps Repair. Orthopaedic Journal of Sports Medicine. 2016. DOI: 10.1177/2325967116s00069

[35] Effect of time from injury to surgery on surgical technique and complication rate in distal biceps tendon repair. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2025.07.027

[37] Efficacy of conservative treatment strategies for partial distal biceps tendon ruptures: a case-control study. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2025.04.017

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