JSES - 2026-08-13 - Journal Article; Review
Cortical Button and Suture Anchor Fixation for Distal Biceps Tendon Repair Provide Similar Clinical Outcomes and Complication Profiles: A Systematic Review.
Nadeem SM, Yousafzai H, Haque O, Bouchard MD, Vivekanantha P, Parlange A, Hantouly A, Yan J, Moro J, Khan M
Topics
Key Takeaway
Cortical button and suture anchor fixation for distal biceps repair yield equivalent re-rupture rates (2.9% vs 4.1%, RR 0.78, 95% CI 0.39–1.55) and LABCN neuropraxia rates (24.4% vs 22.7%, RR 1.12) across 1,757 patients.
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Summary
This PRISMA-compliant systematic review compared cortical button versus suture anchor fixation for distal biceps repair across 10 comparative studies (n=1,757). Pooled meta-analyses showed no significant differences in re-rupture, LABCN neuropraxia, or PIN palsy between constructs. Strength recovery reached 85–95% of the contralateral limb and ROM deficits in supination/pronation were under 10° in both groups.
Key Limitation
All included studies are observational with no RCTs, introducing selection bias in implant assignment that cannot be corrected by pooled analysis.
Original Abstract
BACKGROUND
Distal biceps tendon ruptures in active adults are repaired surgically, with cortical button and suture anchor fixation among the most frequently used implants. This study aimed to systematically review and compare functional outcomes and complication profiles of cortical button versus suture anchor fixation in distal biceps tendon repair.
METHODS
This review followed PRISMA guidelines. Ovid MEDLINE, Embase, and Ovid Emcare were searched from inception to November 2025. Studies were eligible if they reported on the outcomes of distal biceps tendon repair using cortical button or suture anchor fixation in adults. Methodological quality was assessed using MINORS. Continuous outcomes were summarized descriptively, and random-effects meta-analyses were conducted for complications consistently reported as binary event counts, calculating pooled risk ratios with 95% confidence intervals.
RESULTS
Ten comparative studies, comprising 1,757 patients (693 treated with a cortical button, 490 with a cortical button plus interference screw, and 574 with suture anchors), were included, with a mean age of 44.6 years and mean follow-up of 24.9 months for cortical button constructs and 26.6 months for suture anchors. PROMs, including DASH, QuickDASH, MEPS, and EQ-5D-5L showed improvements from baseline in both cortical button and suture anchor cohorts, with between-group differences in reported scores generally within only a few points. ROM outcomes demonstrated near-full elbow flexion and extension and forearm rotation in both cohorts, with differences between the operated and contralateral limbs in supination and pronation typically less than 10° in both groups. Strength recovery was approximately 85-95% of the contralateral limb for elbow flexion, supination, and pronation in both fixation cohorts. Complications were dominated by nerve-related events, with lateral antebrachial cutaneous nerve neuropraxia accounting for approximately 67% of all complications, followed by other sensory nerve symptoms (15%) and re-rupture (6%). Pooled analyses showed no significant differences between fixation methods in re-rupture risk (2.9% vs 4.1%; RR 0.78; 95% CI, 0.39-1.55; I 2 = 3%; p>0.05), LABCN neuropraxia (24.4.9% vs 22.7%; RR 1.12; 95% CI, 0.85-1.46; I 2 = 0%; p>0.05), or posterior interosseous nerve palsy (5.6% vs 1.3%; RR 1.64; 95% CI, 0.64-4.22; I 2 = 0%; p>0.05).
CONCLUSION
Cortical button and suture anchor fixation provide comparable clinical outcomes after distal biceps tendon repair, with high postoperative function, near-full range of motion, and similar strength recovery and complication rates. Current clinical evidence does not demonstrate clear superiority of either fixation method, underscoring the need for high-quality prospective comparative trials.
LEVEL OF EVIDENCE
Level IV, Systematic Review.