Modified Tension - Slide Technique for Anatomical Distal Biceps Tenodesis using a Bicortical EndoButton and a Tenodesis Screw.

INTRODUCTION: Many surgical techniques have been described in the literature. In this article, we describe surgical technical details along with tips and tricks of distal biceps tendon tenodesis using the EndoButton and tension - slide technique, a modification of the suspensory cortical button technique, which allows the surgeon to tension and repairs the biceps tendon through the single longitudinal anterior incision. This modification in surgical technique of using dual implants, i.e., EndoButton and interference screw as fixation tools and concept of tendon sliding principle made this procedure unique. In this article, we describe surgical technique along with tips and tricks of distal biceps tendon tenodesis using the EndoButton and tension - slide technique and also discussed about modification of EndoButton technique reported in many other articles to overcome the possible complications.

CASE REPORT: We report six consecutive patients, presented with distal biceps tendon rupture (4 acute; 2 chronic cases) between June 2013 and March 2015, who underwent single-incision, anatomical distal biceps tenodesis procedure with bicortical EndoButton and tenodesis screw using tension slide technique. Radiographs were taken immediate post-operative to document for displacement or loosening of EndoButton if any.

CONCLUSION: The use of an EndoButton and an interference screw for repairing distal biceps tendons have been previously described. We describe a modification of originally described technique which is worth considering, as it provides two levels of fixation, whilst avoiding possible complications of such procedures. It is ideal for repairing both acute and chronic ruptures, without the need for allograft or autograft augmentation and describes detailed technical steps to avoid possible iatrogenic complications.