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Analysis consisted of arm\u2010based network meta\u2010analysis under Bayesian random\u2010effects model with Markov Chain Monte Carlo (MCMC) sampling. Biomechanical outcomes were summarized as treatment effects and their corresponding 95% confidence intervals (CI). Rank probabilities were calculated and used to generate each treatment\u2019s surface under the cumulative ranking (SUCRA) curve. Biomechanical properties were compared to native tendon. Displacement &gt;10 mm was defined as clinical failure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty\u2010one studies were included. For failure strength, no construct outperformed the native tendon but 2\u00d7 SA, IFS, SA, and TOS demonstrated poorer failure strength. For the maximum load to failure, EM CB+IFS outperformed the native tendon. Compared to native tendon, EM CB+IFS, EM CB, and 2\u00d7IM CB were stiffer, while 2x SA and IFS were less stiff. No construct demonstrated &gt;10 mm of displacement, but constructs with displacement above the mean (3.5 mm) included 2\u00d7 ASA, 2xIM CB, and TOS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The fixation constructs that consistently demonstrated comparable or better biomechanical properties (failure strength, maximum strength, and stiffness) to native tendon in distal biceps tendon repair were the extramedullary cortical button with or without interference screw and two intramedullary cortical buttons. No construct demonstrated displacement beyond standard definitions for clinical failure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance<\/jats:title>\n                    <jats:p>This network meta\u2010analysis of biomechanical studies suggests that extramedullary cortical button and two intramedullary cortical buttons may be the most stable construct for distal biceps repair fixation, with equivalent or better biomechanical properties compared to native tendon.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1016\/j.arthro.2022.08.037","type":"journal-article","created":{"date-parts":[[2022,10,13]],"date-time":"2022-10-13T05:37:38Z","timestamp":1665639458000},"page":"390-401","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":9,"title":["Two Intramedullary and 1 Extramedullary Cortical Button, With or Without Interference Screw, Show Biomechanical Properties Superior to Native Tendon in Repair of the Distal Biceps Tendon: A Systematic Review and Network Meta\u2010analysis of Biomechanical Performance"],"prefix":"10.1002","volume":"39","author":[{"given":"Enrico M.","family":"Forlenza","sequence":"first","affiliation":[{"name":"Rush University Medical Center Chicago Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ophelie","family":"Lavoie\u2010Gagne","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Massachusetts General Hospital Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin C.","family":"Parvaresh","sequence":"additional","affiliation":[{"name":"Orthopaedic Specialty Institute Orange California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elyse J.","family":"Berlinberg","sequence":"additional","affiliation":[{"name":"Rush University Medical Center Chicago Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Avinesh","family":"Agarwalla","sequence":"additional","affiliation":[{"name":"Westchester Medical Center Valhalla New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian","family":"Forsythe","sequence":"additional","affiliation":[{"name":"Rush University Medical Center Chicago Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,10,12]]},"reference":[{"key":"e_1_2_5_2_2","doi-asserted-by":"publisher","DOI":"10.1177\/036354659302100119"},{"key":"e_1_2_5_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546515587738"},{"key":"e_1_2_5_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-200211000-00042"},{"key":"e_1_2_5_5_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-198567030-00011"},{"key":"e_1_2_5_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2007.05.027"},{"key":"e_1_2_5_7_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546511404139"},{"key":"e_1_2_5_8_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-198567030-00010"},{"key":"e_1_2_5_9_2","doi-asserted-by":"publisher","DOI":"10.1007\/s001670050134"},{"key":"e_1_2_5_10_2","doi-asserted-by":"publisher","DOI":"10.1177\/03635465980260031501"},{"key":"e_1_2_5_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsb.2003.07.002"},{"key":"e_1_2_5_12_2","doi-asserted-by":"crossref","unstructured":"Idler CS Montgomery WH 3rd Lindsey DP Badua PA Wynne GF Yerby SA. 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