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Updated: Sep 27, 2025

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Power-Optimizing Repair for Distal Biceps Tendon Rupture: Stronger and Safer.

Joshua T Tadevich1, Neel D Bhagat1, Boon H Lim2

  • 1Indiana University School of Medicine, Indianapolis, IN.

Journal of Hand Surgery Global Online
|April 13, 2022
PubMed
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A new power-optimizing distal biceps tendon repair offers superior supination strength and a safer drill exit point, reducing the risk of posterior interosseous nerve (PIN) injury compared to traditional methods.

Area of Science:

  • Orthopedic Surgery
  • Biomechanics
  • Anatomy

Background:

  • Distal biceps tendon ruptures require surgical reattachment to the radial tuberosity.
  • Current repair methods have varying success rates and potential complications, including posterior interosseous nerve (PIN) injury.
  • A consensus on the optimal surgical approach is lacking.

Purpose of the Study:

  • To evaluate the supination strength of a novel power-optimizing distal biceps repair.
  • To assess the proximity of drill exit points to the PIN in this new method.
  • To compare these outcomes against a traditional anterior endobutton repair.

Main Methods:

  • Cadaveric arms underwent distal biceps tendon excision and repair using two methods: power-optimizing and traditional anterior endobutton.
Keywords:
Distal biceps tendon repairPosterior interosseous nerveSupination

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Using Q Suture to Enhance Resistance to Gap Formation and Tensile Strength of Repaired Flexor Tendons
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  • Supination torque was measured using a custom apparatus across three arm orientations.
  • The distance from repair drill exit holes to the PIN was measured post-repair.

    • Main Results:

    • The power-optimizing repair yielded significantly greater supination torque (82% to 13% higher) across all tested orientations.
    • Drill exit points for the power-optimizing repair averaged 23 mm from the PIN.
    • Traditional endobutton repairs had drill exit points averaging 14 mm from the PIN.

    Conclusions:

    • The power-optimizing distal biceps repair demonstrates superior biomechanical performance.
    • This method significantly increases supination torque compared to the traditional endobutton repair.
    • The power-optimizing repair offers an improved safety profile by increasing the distance from the critical PIN.