Distal biceps tendon repair using cortical button with or without interference screw: A comparative study

Distal biceps tendon repair may be performed using cortical button (CB) alone or combined with an interference screw (CBIS), however direct clinical comparison remains limited. We aimed to compare clinical and functional outcomes between these techniques.

Patients with acute distal biceps tendon rupture managed with CB or CBIS were identified from 2019 to 2024 at a single institution. Treatment allocation was based exclusively on surgeon preference, with each of the two operating surgeons consistently using a single technique throughout the study period. Outcomes were recorded at minimum 12 months using Mayo Elbow Performance Score (MEPS), Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) and Visual Analogue Scale scores, and patients were assessed for complications and return to activity.

Fifty-five patients were included (CB n = 27, CBIS n = 28) with similar baseline demographics. Mean follow-up was 21.6 months (CB) and 19.8 months (CBIS). Mean MEPS and Q-DASH scores were 96.3 and 2.8 versus 97.1 and 2.2 respectively. No statistically significant differences were found between groups in any outcome measure.

Both techniques provided excellent short- to mid-term clinical and functional outcomes. No statistically significant or clinically meaningful difference was detected between groups, though the study may be underpowered to detect small between-group differences. Within the context of surgeon-specific practice patterns, CB fixation alone appears sufficient for routine acute distal biceps tendon repair.

Level III, retrospective comparative study.