Distal biceps tendon repair with the endobutton technique

Acute distal biceps tendon reinsertion is the treatment of choice in distal biceps tendon tears. We prefer to use a single 2-cm incision approach and fix the biceps tendon in a bone tunnel with a bicortical Endobutton. The original Bain technique was adapted and will be described in this chapter. The patient is placed in supine position with the arm on an arm table. A 2-cm incision is made, 3 cm distal to the elbow crease. The bicipital tuberosity is approached by blunt dissection. The tendon is usually retracted proximal to the elbow crease. The elbow is flexed, and the stump of the tendon is palpated. The tendon can be milked distally by squeezing the biceps muscle belly. The tendon is then pulled outside the skin and sutured to a cortical bone button. A leading and a trailing suture are inserted in the outer holes of the button. The elbow is extended and the forearm hypersupinated. A guide wire is then drilled centrally in the bicipital tuberosity. Care is taken not to aim this too radial or distal as this increases the risk of a posterior interosseous nerve injury. The first cortex is drilled with an 8–9-mm cannulated drill over the guide pin. The second cortex is drilled with a 4.5-mm drill. The guide pin is then used to shuttle the leading and trailing sutures through the bone tunnel. The button is flipped once it clears the second cortex and its position is verified with fluoroscopy.