Biceps Tendon Tears at the Elbow: Distal Biceps Repair With Metal Button Fixation Animation

Biceps Tendon Tears at the Elbow: Distal Biceps Repair With Metal Button Fixation Animation

When using a metal button and suture to repair a full tear of the biceps tendon at the elbow, the first step is to make a single incision through the skin at the front of the elbow. The biceps tendon is then identified, and any frayed or compromised tissue is removed.

The tendon is stitched with a strong suture along its length. This will provide a firm grasp of the tendon for later fixation into the bone. The two ends of the suture are passed through the metal button in a crossed fashion so that the button slides freely on the sutures.

A small tunnel is drilled with a metal pin through the radius bone at the bony bump where the tendon attaches. This tunnel will serve as a pass-through for the metal button on the far side of the bone. A second, larger drill passes over the metal pin. This larger socket will serve to seed the tendon into the bone.

The metal button is attached to its inserter, and the inserter passes the button through the bone. The button is flipped by pulling on the sutures, and the tendon slides and docks into the larger bone tunnel. One of the suture limbs is passed through the tendon, and a knot is tied over it.

The tool seen here is called a knot pusher, which tightens the knot into the tunnel. A screw is placed into the tunnel for a secure fit next to the tendon. Finally, the two suture limbs are tied to complete the repair.