{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T07:18:42Z","timestamp":1784099922223,"version":"3.55.0"},"reference-count":55,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2025,11,29]],"date-time":"2025-11-29T00:00:00Z","timestamp":1764374400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Distal biceps tendon rupture is a disabling injury that compromises elbow flexion and forearm supination strength, particularly in high-performance athletes. Although several fixation techniques have been proposed, no single method has proven optimal in combining mechanical stability, anatomical restoration, and early functional recovery. This study aimed to evaluate the efficacy, safety, and reproducibility of a hybrid dual-fixation technique combining a Tightrope\u00ae cortical button (Arthrex, Naples, FL, USA) with a PEEK interference screw for anatomic reinsertion of the distal biceps tendon in athletic individuals. Methods: A prospective observational study was conducted on 13 high-performance athletes who underwent distal biceps tendon repair using the hybrid Tightrope\u2013PEEK construct between March 2024 and September 2025. Functional recovery, muscle strength, esthetic contour, and patient satisfaction were evaluated using the Visual Analog Scale (VAS), Mayo Elbow Performance Score (MEPS), Quick Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH), and a 5-point Likert scale over a 12-month follow-up. Descriptive statistical analysis was performed using IBM SPSS Statistics, version 29.0. Results: All patients achieved secure fixation with no intraoperative or postoperative complications, loss of reduction, or hardware failure. Early controlled mobilization began within the first postoperative week. At 6 months, flexion and supination strength were fully restored, and at 12 months, all patients achieved full range of motion and optimal functional scores (mean MEPS 100; QuickDASH 0). No \u201cPopeye\u201d deformities or contour irregularities were observed, and mean patient satisfaction was 5\/5. Conclusions: The hybrid Tightrope\u2013PEEK dual-fixation technique provides excellent mechanical stability, allowing early mobilization and rapid functional recovery with minimal complications. Its reproducibility and cosmetic advantages suggest that it represents a safe and effective option for distal biceps tendon reinsertion in high-demand athletes.<\/jats:p>","DOI":"10.3390\/jcm14238488","type":"journal-article","created":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T16:20:29Z","timestamp":1765210829000},"page":"8488","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Hybrid Tightrope\u2013PEEK Dual Fixation for Distal Biceps Tendon Reinsertion in High-Performance Athletes: A Prospective Case Series"],"prefix":"10.3390","volume":"14","author":[{"given":"Roland","family":"Fazakas","sequence":"first","affiliation":[{"name":"Department of Biology and Life Sciences, Faculty of Medicine, \u201cVasile Goldi\u0219\u201d Western University of Arad, 310025 Arad, Romania"},{"name":"Multidisciplinary Doctoral School, \u201cVasile Goldi\u0219\u201d Western University of Arad, 310025 Arad, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gloria Alexandra","family":"Tolan","sequence":"additional","affiliation":[{"name":"Multidisciplinary Doctoral School, \u201cVasile Goldi\u0219\u201d Western University of Arad, 310025 Arad, Romania"},{"name":"Faculty of Physical Education and Sport, \u201cAurel Vlaicu\u201d University of Arad, 310130 Arad, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-2313-5053","authenticated-orcid":false,"given":"Brigitte","family":"Osser","sequence":"additional","affiliation":[{"name":"Faculty of Physical Education and Sport, \u201cAurel Vlaicu\u201d University of Arad, 310130 Arad, Romania"},{"name":"Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Csongor","family":"Toth","sequence":"additional","affiliation":[{"name":"Faculty of Physical Education and Sport, \u201cAurel Vlaicu\u201d University of Arad, 310130 Arad, Romania"},{"name":"Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0036-239X","authenticated-orcid":false,"given":"Iosif","family":"Ilia","sequence":"additional","affiliation":[{"name":"Faculty of Physical Education and Sport, \u201cAurel Vlaicu\u201d University of Arad, 310130 Arad, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florin Mihai","family":"Marcu","sequence":"additional","affiliation":[{"name":"Department of Psycho Neuroscience and Recovery, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicoleta Anamaria","family":"Pascalau","sequence":"additional","affiliation":[{"name":"Department of Psycho Neuroscience and Recovery, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramona Nicoleta","family":"Suciu","sequence":"additional","affiliation":[{"name":"Department of Psycho Neuroscience and Recovery, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8003-8866","authenticated-orcid":false,"given":"Liviu","family":"Gavrila-Ardelean","sequence":"additional","affiliation":[{"name":"Prosthetic Dentistry, Faculty of Dental Medicine, \u201cVasile Goldi\u0219\u201d Western University of Arad, 310025 Arad, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0121-9629","authenticated-orcid":false,"given":"Laura Ioana","family":"Bondar","sequence":"additional","affiliation":[{"name":"Department of Biology and Life Sciences, Faculty of Medicine, \u201cVasile Goldi\u0219\u201d Western University of Arad, 310025 Arad, Romania"},{"name":"Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"956","DOI":"10.1302\/2058-5241.6.200145","article-title":"Acute complete and partial distal biceps tendon ruptures: What have we learned?","volume":"6","author":"Caekebeke","year":"2021","journal-title":"EFORT Open Rev."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1530\/EOR-23-0035","article-title":"Distal biceps tendon rupture: A comprehensive overview","volume":"8","author":"Jaschke","year":"2023","journal-title":"EFORT Open Rev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"160","DOI":"10.52628\/88.1.20","article-title":"Distal biceps tendon ruptures: More efficient diagnostics for a better 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