All Suture Bone Tunnel Docking Technique for Distal Biceps Tendon Repair

Distal biceps tendon ruptures result in significant functional deficits, including 40% to 50% loss of supination strength if left untreated. Current hardware-based fixation methods achieve excellent outcomes but are associated with higher costs, 20% to 25% complication rates, and technical complexity. The bone tunnel technique represents a cost-effective alternative that eliminates hardware-related complications while maintaining anatomic restoration. This technique utilizes a single 5 cm anterior incision with protection of the lateral antebrachial cutaneous nerve. A bone tunnel is created at the anatomic footprint using a spade-tip drill, followed by 7 mm reaming, sized 1 mm smaller than the tendon diameter. The tendon is secured with #2 FiberLoop (Arthrex, Naples, FL) whip-stitch sutures, seated into the tunnel, and fixed by passing sutures around the radial aspect of the radius shaft and through the tendon with square knots. Key advantages include elimination of expensive implants, no intraoperative imaging requirements, preservation of natural tendon-bone healing, and universal accessibility. This technique provides reliable fixation through biological integration with reduced complexity and cost compared with hardware-based methods.