Reconstruction of distal biceps tendon ruptures with a cortical button

Izaäk F. Kodde*, Michel P.J. van den Bekerom, Denise Eygendaal

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review


Purpose: Reconstruction of the ruptured distal biceps tendon is best done with a cortical button technique according to recent biomechanical studies. However, clinical outcome studies that evaluate the cortical button reconstruction technique are scarce. The purpose of this study was to evaluate the results of a cortical button reconstruction technique in patients with a traumatic distal biceps tendon rupture. Methods: Twenty-two patients with 24 traumatic distal biceps tendon ruptures underwent surgical treatment. Reconstructions were done using the Endobutton or Toggle Loc. Postoperative evaluation consisted of ROM, strength, stability, neurological status and standard radiographs in AP view and lateral direction. The Mayo Elbow Performance Index (MEPI) and quick Disabilities of Arm, Shoulder and Hand (qDASH) questionnaires were also obtained. Results: At a median follow-up of 22 months, the mean strength for flexion was 100 % (SD 21.3) and for supination 97 % (SD 7.8), compared to the contralateral side. There were complications in 8 patients (36 %), and heterotopic ossifications were seen on radiographs in 23 % of patients. Heterotopic ossifications were symptomatic in one patient. Conclusions: The results after distal biceps tendon refixation with a cortical button were good according to ROM, MEPI and qDASH scores and strength. However, this procedure was accompanied with complications; in particular, the formation of heterotopic ossifications was frequently seen, though clinically relevant in only one patient. Level of evidence: Case series, Level IV.

Original languageEnglish
Pages (from-to)919-925
Number of pages7
JournalKnee Surgery, Sports Traumatology, Arthroscopy
Issue number3
Publication statusPublished - 1 Jan 2015
Externally publishedYes


  • Complications
  • Cortical button
  • Distal biceps tendon
  • Elbow
  • Heterotopic ossifications
  • Rupture


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