Is it safe to perform aggressive rehabilitation after distal biceps tendon repair using the modified 2-incision approach? A biomechanical study

Background: Despite improved methods of fixation, there is still a delay in early active motion after distal biceps repair. Hypothesis: Distal biceps repairs using the modified 2-incision technique can be treated with early motion, and there is no difference in the cyclic performance of Ethibond and Fiberwire when used for the repair. Study Design: Controlled laboratory study. Methods: Nine matched pairs of cadaveric elbows had release of the distal biceps followed by repair with either No. 5 Ethibond or Fiberwire through a bone tunnel. The repairs were cyclically loaded for 3000 cycles (1000 cycles from 10-50 N, 1000 cycles from 10-75 N, 1000 cycles from 10-100 N) followed by single-load displacement to failure in surviving specimens. Results: There was no difference in the displacement or stiffness between surviving repairs at any point measured. Ethibond repairs survived significantly more cycles than did Fiberwire repairs, particularly at higher loads. Conclusion: Distal biceps repair using the 2-incision technique with Ethibond should allow early active motion, but early active motion may not be possible with Fiberwire.