{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T10:07:31Z","timestamp":1779271651468,"version":"3.51.4"},"reference-count":37,"publisher":"SAGE Publications","issue":"12","license":[{"start":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T00:00:00Z","timestamp":1757548800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Sports Med"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Recent biomechanical investigations of distal biceps tendon repair (DBTR) constructs have typically evaluated time-zero fixation security, while tendon-bone repair footprint characterization has been limited. Consequently, interactions between repair construct design, fixation security, and repair footprint parameters remain minimally assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose\/Hypothesis:<\/jats:title>\n                    <jats:p>The purpose was to compare time-zero fixation security and repair footprint parameters between a new DBTR construct with 2 interlinked knotless all-suture anchors and an established DBTR construct with an intramedullary cortical button. It was hypothesized that the new interlinked twin-anchor repair technique would demonstrate greater time-zero fixation security and footprint optimization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Controlled laboratory study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A total of 20 cadaveric elbows in 2 matched groups underwent DBTR with either (1) twin interlinked knotless all-suture anchors or (2) a single intramedullary cortical button. Anatomic and repair footprints were digitally captured with a 3-dimensional coordinate-measuring machine. The repair constructs underwent cyclic loading and then were loaded to failure. Anatomic and repair footprint areas and their overlap, tendon-bone interface and total construct displacement, ultimate failure load, and failure mode were recorded. Anatomic footprint restoration and repair footprint accuracy were calculated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The interlinked knotless twin-anchor repair construct demonstrated a larger repair footprint area (55.1 \u00b1 14.9 vs 35.2 \u00b1 19.8 mm\n                      <jats:sup>2<\/jats:sup>\n                      , respectively;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .032), greater anatomic footprint restoration (42.7% \u00b1 12.9% vs 20.2% \u00b1 9.4%, respectively;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .003), lower tendon-bone interface displacement (3.2 \u00b1 1.2 vs 12.4 \u00b1 6.6 mm, respectively;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .003), lower total construct displacement (5.5 \u00b1 1.7 vs 13.9 \u00b1 8.1 mm, respectively;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .015), and higher ultimate failure load (468.3 \u00b1 124.2 vs 313.2 \u00b1 103.4 N, respectively;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .001) compared with the single-button repair construct. The most common failure mode was knot slippage\/suture breakage (60%) in the single-button group and suture-tendon interface failure (50%) in the twin-anchor group.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>While this cadaveric study did not account for the effects of tendon-bone healing, the novel interlinked twin-anchor DBTR construct demonstrated greater time-zero fixation security, a larger repair footprint, and greater anatomic footprint restoration over the established single-button repair construct.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance:<\/jats:title>\n                    <jats:p>A DBTR construct with twin interlinked knotless all-suture anchors offers multiple features, including time-zero fixation security and footprint optimization, that may potentially improve clinical outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/03635465251365498","type":"journal-article","created":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T21:35:29Z","timestamp":1757626529000},"page":"2944-2954","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Distal Biceps Tendon Repair With Interlinked Knotless All-Suture Anchors Provides Greater Footprint Optimization and Higher Fixation Security Over Intramedullary Cortical Button Repair: A Biomechanical Study"],"prefix":"10.1177","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2393-2268","authenticated-orcid":false,"given":"Jim C.","family":"Hsu","sequence":"first","affiliation":[{"name":"Department of Orthopaedics &amp; 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