Our study aims to demonstrate the efficacy of using endobutton and interference screw technique in the repair of acute distal biceps ruptures. From April 2009 to May 2013, 25 consecutive patients had acute distal biceps tendon repairs using an endobutton and interference screw technique. 3 patients were lost to follow up leaving 22 patients available for review. Mean follow up was 24 months(1–51). All were evaluated using a questionnaire, examination, radiographs, power measurements, and Oxford Elbow and MAYO scores. Overall 95% patients (21/22) felt that their surgery was successful and rated their overall experience as excellent or good. Mean return to work was at 100 days(0–280) and mean postoperative pain relief was 23 days(1–56). 55% returned to sport at their pre-injury level. There was one case (4.5%) of heterotopic calcification with 3 superficial infections(14%). There were no intra or postoperative radial fractures, metalwork failures or metalwork soft tissue irritations. Mean pre-operative Oxford Elbow Scores were 18(6–37) and post operative 43(24–48) (p<0.00001). Mean pre-operative Mayo scores were 48(5–95) and post-operative were 95(80–100)(p<0.00001). Our study supports that distal biceps repairs using the endobutton and interference screw technique appears to lead to high patient satisfaction rates with a relatively early return to function

Introduction. ACL reconstruction using hamstring tendons has gained general acceptance. However, it has been recommended to seek a tight fit of the tendon in the bone canal in order to provide circumferential contact and healing of the graft, and to prevent secondary tunnel widening. Recent findings show, that the graft dynamically adapts to pressure in the canal resulting in a potentially loose graft-bone contact. It was the goal of this study to understand the viscoelastic behaviour of hamstring grafts under pressure and to develop a new method for tendon pre-conditioning to reduce the graft volume before implantation, in order to reduce the necessary bone canal diameter to accommodate the same graft. Material and Methods. Flexor digitorum tendons of calf and extensor digitorum tendons of adult sheep were identified to be suitable as ACL grafts substitutes for human hamstring tendons in vitro. The effect of different compression forces on dimensions and weight of the grafts were determined. Further, different strain rates (1mm/min vs 10mm/min), compression methods (steady compression vs. creep) and different compression durations(1, 5, 10min) were tested to identify the most effective combination to reduce graft size by preserving its macroscopic structure. Results. The effect of compression on volume reduction (25% of initial volume) reached a plateau at 6000N. Both, steady compression and creeping were able to reduce dimensions of the graft, however, creeping was more effective. There was no difference in effect with different durations for compression (p>0.05) in both methods. With a strain rate of 1mm/min no macroscopic destruction was documented, however with 10mm/min some parts were ruptured. During all pressure tests, considerable amounts of liquid were pressed out from the tendons, and if the graft was submersed in saline solution overnight, the volume reduction was mostly reversible. Conclusion. Compression reduces the dimensions of the ACL graft reversibly, to the greatest part by squeezing out of interstitial water. It is reasonable to assume that this effect also occurs if tendons are under constant pressure in the body, such as at the bend where entering a bone tunnel or under the pressure of interference screws. This in vitro experiment suggests that preconditioning of a 8mm hamstring graft is achieved best by creeping compression with 6kN at a strain rate of 1mm/min. By using this technique, indeed a canal of approximately 10–15% less diameter (i.e. 7 instead of 8mm) may be drilled for the same tendon, resulting in a tight fit of the graft in the bone