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Distal Biceps Tendon Repair With Interlinked Knotless All-Suture Anchors Provides Greater Footprint Optimization and
Jim C Hsu1, Genevieve M Fraipont2, Michelle H McGarry2,3
1Department of Orthopaedics & Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA.
The American Journal of Sports Medicine
|September 11, 2025
Summary
A new twin interlinked knotless anchor technique for distal biceps tendon repair (DBTR) offers superior time-zero fixation security and optimizes the repair footprint compared to the established single-button method.
Area of Science:
- Orthopedic Surgery
- Biomedical Engineering
- Sports Medicine
Background:
- Limited biomechanical data exists on distal biceps tendon repair (DBTR) constructs, particularly regarding the repair footprint.
- Understanding the interplay between construct design, fixation security, and footprint parameters is crucial for improving DBTR outcomes.
Purpose of the Study:
- To compare time-zero fixation security and repair footprint characteristics of a novel twin interlinked knotless all-suture anchor DBTR construct against a standard intramedullary cortical button construct.
- To test the hypothesis that the twin anchor technique provides enhanced fixation and footprint optimization.
Main Methods:
- A controlled laboratory study involving 20 cadaveric elbows, divided into two groups for DBTR using either twin interlinked knotless anchors or a single cortical button.
- Digital capture of anatomic and repair footprints, followed by cyclic loading and load-to-failure testing to assess displacement, footprint area, overlap, and ultimate load.
Main Results:
- The twin anchor construct exhibited a significantly larger repair footprint area (55.1 vs 35.2 mm²), greater anatomic footprint restoration (42.7% vs 20.2%), reduced tendon-bone interface and total construct displacement, and a higher ultimate failure load (468.3 vs 313.2 N) compared to the single-button construct.
- Failure modes differed, with knot slippage/suture breakage in the single-button group and suture-tendon interface failure in the twin-anchor group.
Conclusions:
- The novel twin interlinked knotless anchor DBTR construct demonstrated superior time-zero fixation security, enhanced repair footprint, and improved anatomic footprint restoration compared to the single-button method in a cadaveric model.
- This technique shows potential for improved clinical outcomes in distal biceps tendon repair due to its fixation and footprint advantages.
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