Cpt distal biceps repair

Aug 29, 2014 · I use 24340 for longitudinal tears that would just be sutured, or partial tears that are repaired with anchors to the bone/or maybe repaired right back to the stump of tendon. I look at this code as a repair. I use 24342 for complete ruptures off the bone, where holes are drilled and tendon is reinserted through those drill holes.

Distal Biceps Tendon Repair Indications Complete rupture of the distal bicep tendon at its insertion with contracture. Considerations 1. Repair should occur within the first three to six weeks post-rupture in order to restore the normal ... You must know the surgical procedure before starting the rehabilitation protocol. General Precautions for ...The ACS NSQIP database was used to identify patients undergoing distal biceps repair between January 1, 2011, and December 31, 2017, using Current Procedural Terminology (CPT) code 24342. Cases with concurrent procedures, as determined by concurrent reported CPT codes, were excluded from the final analysis.The distal biceps is usually repaired through a single incision (front of the elbow) or a double incision (front and back of the elbow) technique. During the procedure: You will be administered general anesthesia. A small incision is made at the elbow, and the torn or ruptured end of the biceps located. Any damaged tissues are removed using ...Bain et al recently reported the use of the Endobutton for repair of the tendon. This procedure allows for a relatively minimal single anterior incision to reattach the tendon without struggling in a small space. This is a report of our use of the Endobutton in 11 patients who suffered rupture of the distal biceps tendon.Achieve a simple, reproducible repair of the distal biceps with the BicepsButton implant systems and associated tension-slide technique. Using a titanium BicepsButton implant, this technique reliably seats the tendon against the far cortex of the bone socket to maximize the surface area for tendon-to-bone healing. A tenodesis screw adds to the construct strength and helps place the tendon at ...CPT ® 25405, Under Repair, Revision, and/or Reconstruction Procedures on the Forearm and Wrist The Current Procedural Terminology (CPT ® ) code 25405 as maintained by American Medical Association, is a medical procedural code under the range - Repair, Revision, and/or Reconstruction Procedures on the Forearm and Wrist.

With Morrey’s modification, the 2-incision approach is a safe and effective method for repair of a distal biceps tendon rupture. We describe the modified procedure in full and report on recovery, complications, and comparative outcomes. Previous. distal biceps tendon rupture. double-incision repair. two-incision repair.Instability - Bony Procedure Latarjet Procedure for Glenoid Deficit - Open Degenerative Conditions ... Distal Biceps Repair Through Single Incision Tendonopathies Neurovascular Disorders Arthroplasty Total Elbow Arthroplasty with Triceps-Reflecting Approach, Supine ...The lacertus fibrosus originates at the level of the musculotendinous junction and consists of three distinct layers, enveloping the forearm flexors and serving as a stabilizer to the distal biceps tendon. 6 A tense lacertus fibrosus secondary to contraction of the forearm flexors may contribute to tendon rupture due to a medial pull at the time of injury. 7 The preservation of the lacertus at ...CPT® coding is 25609 Open treatment of distal radial intra-articular fracture or epiphyseal separation; with internal fixation of 3 or more fragments. ... whether one or more portals is required to repair the cuff (February 2008 CPT® Assistant). Often the surgeon will perform a biceps tenotomy (i.e., tendon release) via arthroscopy, and then ...This implant and technique allow tensioning and repair of the biceps tendon through a single anterior incision. The combination of the cortical button fixation coupled with an interference screw creates a strong, anatomic repair.Distal Biceps Repair . Clinic Practice Guideline . Background . Distal biceps tendon ruptures occur primarily in males and risk factors include smoking, corticosteroid use, and anabolic steroid use. Tears occur secondary to unexpected extension forces and are typically associated with a "pop".Dear Lifehacker,

It’s easy to exercise the muscles you can see—your biceps, your quads—but there are more muscles in your body than just the big ones. We’ve talked before about the muscles in your ...CPT code 24342 should be used when a healthcare provider performs the reinsertion of a ruptured biceps or triceps tendon, specifically the distal end, with or without a tendon graft. It is important to accurately document the details of the procedure to support the use of this code. 6. Documentation requirements.The lower biceps tendon is called the distal biceps tendon. The word distal means that the tendon is further down the arm. The upper two tendons of the biceps are called the proximal biceps tendons, because they are closer to the top of the arm. The distal biceps tendon attaches to a small bump on the radius bone of the forearm. ThisThe distal biceps tendon connects the biceps muscle to the elbow bone. Your arm may be in a splint or an elbow brace for 4 to 6 weeks. You may also be in a sling for a week or so. You may feel tired and have some pain for several days. Your arm may be swollen, but the swelling should go down a little each day. You will need rehabilitation ...In the largest study to date for distal biceps femoris avulsion repairs (n = 4), Ahearn and Wood 1 reported a mean return to sport of 5 months. In our study, we observed earlier return to sport in elite athletes at 16.7 ± 8.7 weeks (3.8 ± 2.0 months) after surgical repair of the distal biceps femoris. This may be multifactorial.It’s easy to exercise the muscles you can see—your biceps, your quads—but there are more muscles in your body than just the big ones. We’ve talked before about the muscles in your ...

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The trick to growing a thick, healthy lawn is no secret. In this guide to lawn maintenance, learn what you need to keep it looking good. Expert Advice On Improving Your Home Videos...CPT® 23430, Under Repair, Revision, and/or Reconstruction Procedures on the Shoulder. The Current Procedural Terminology (CPT®) code 23430 as maintained by American Medical Association, is a medical procedural code under the range – Repair, Revision, and/or Reconstruction Procedures on the Shoulder. What is a biceps tendon …Introduction. Primary surgical repair generally is accepted as the preferred treatment of complete distal biceps tendon avulsions [3, 19, 24].Because of the rarity of this entity, the diagnosis often is delayed and the distal tendon may retract sufficiently to make primary repair difficult or impossible.Medical Coding. Outpatient Facilities . Wiki distal bicep tendon repair. Thread starter ... . Wiki distal bicep tendon repair. Thread starter trose45116; Start date Sep 17, 2008; Create Wiki T. trose45116 Expert. Messages 313 Location Zephyrhills, FL Best answers 0. Sep 17, 2008 #1 need some help....would 23430 work . M. mbort True …The lower biceps tendon is called the distal biceps tendon. The word distal means that the tendon is further down the arm. The upper two tendons of the biceps are called the proximal biceps tendons, because they are closer to the top of the arm. The distal biceps tendon attaches to a small bump on the radius bone of the forearm. ThisDistal biceps tendon injuries of the elbow have been reported in 2.55 cases per 100,000 patient-years in the United States. 10, 13, 14 Affected patients are commonly male, aged 40-50 yr, and who sustained an acute eccentric loading force in the dominant arm. A subset of older patients can present with chronic degenerative and cystic …

The demographics of and how to diagnose distal biceps tendon rupture Surgical indications and optimal techniques for distal biceps tendon repair and reconstruction Postoperative rehabilitation and outcomes of surgical intervention for distal biceps tendon rupture Deadline: Each examination purchased in 2020 must be completed by January …Distal Biceps Tendon Repair. There are many different techniques for repairing the ruptured biceps tendon. This is our prefered method, but other methods are equally successful. Please discuss with your surgeon. ... The operation is usually a day-case procedure, so you should be able to go home about 4 hours after the operation. A ...The distal biceps tendon connects the biceps muscle to the elbow bone. During the surgery, the doctor makes a cut (incision) on the inside of the arm just above the elbow. This allows the doctor to see and repair the tendon. Sometimes the doctor will make another incision on the back of the arm. The doctor will reattach the tendon to the bone.Purchase a Biceps or Triceps Tendon Repair today on MDsave. Costs range from $4,290 to $21,084. Those on high deductible health plans or without insurance can save when they buy their procedure upfront through MDsave. Read more about how MDsave works.Learn about the diagnosis, treatment and anatomy of distal biceps avulsion, a rare injury to the biceps tendon at the elbow. Find out the CPT codes for operative and nonoperative management and the surgical techniques for repair.a The single-incision technique for biceps tendon repair can be more cosmetically appealing than the two-incision technique. b Exposure of the tuberosity through a single anterior incision with placement of a suture anchor. If a two-incision approach was used, exposure of the radial tuberosity was performed through a second incision located …Bain et al recently reported the use of the Endobutton for repair of the tendon. This procedure allows for a relatively minimal single anterior incision to reattach the tendon without struggling in a small space. This is a report of our use of the Endobutton in 11 patients who suffered rupture of the distal biceps tendon.This Ovation Credit Repair review will tell you everything you need to know about this company, the services it offers, and how to sign up. We may receive compensation from the pro...Variations of the surgical approach and techniques for distal biceps tendon repair have been reported in the literature. 1, 2, 15, 17 Single-incision procedures tend to have a higher risk of cutaneous nerve injury, while double-incision approaches have higher rates of radioulnar synostosis. 1, 2, 15, 20 The number of fixation techniques ... Distal Biceps Repair Surgery (with Endobutton) Page 3 of 8 Aims and Benefits Without surgery you will be able to compensate for most of the reduced power of biceps with appropriate rehabilitation, and will manage most activities with no problems. Repetitive motions turning the hand over and back (such as using a screwdriver) can tire When the rupture occurs at the distal biceps tendon at the elbow, where there is only one attachment, surgical repair is much more commonly needed. If pain …

Distal Biceps Repair . Clinic Practice Guideline . Background . Distal biceps tendon ruptures occur primarily in males and risk factors include smoking, corticosteroid use, and anabolic steroid use. Tears occur secondary to unexpected extension forces and are typically associated with a "pop".

Video 1 This is a repair of a chronic distal biceps injury in a 53-year-old man with tendon retraction of 7 cm shown on magnetic resonance imaging. He is supine, with the arm over a hand table. Our technique for reconstruction of chronic distal biceps injuries uses an Achilles allograft through a modified Henry approach.This week we are helping a couple tackle some exterior maintenance chores that may be on your list too. Expert Advice On Improving Your Home Videos Latest View All Guides Latest Vi...Files related to Reinsertion of ruptured biceps tendon, distal, with or without tendon graft (includes obtaining graft) (24342) Find Window. X. Type in text to find: Hand Surgery CPT Codes, sorted by number. Tendon / Muscle Repair CPT Codes - Proximal to hand. American.Blocks of the lateral and medial antebrachial cutaneous nerve. Anesthesia for lateral antebrachial cutaneous nerve requires two injections. The first deposits 5 mL local anesthetic just lateral to the border of the biceps tendon. A second 5 mL is then injected subcutaneously and lateral from the first injection site.Which code would be more appropriate for a distal biceps rupture repair using Endobutton and FiberWire technique? I like 24342 for this, my co-worker likes …Achieve a simple, reproducible repair of the distal biceps with the BicepsButton implant systems and associated tension-slide technique. Using a titanium BicepsButton implant, this technique reliably seats the tendon against the far cortex of the bone socket to maximize the surface area for tendon-to-bone healing. A tenodesis screw adds to the construct strength and helps place the tendon at ...Distal Biceps Repair Surgery (with Endobutton) Page 3 of 8 Aims and Benefits Without surgery you will be able to compensate for most of the reduced power of biceps with appropriate rehabilitation, and will manage most activities with no problems. Repetitive motions turning the hand over and back (such as using a screwdriver) can tireOct 4, 2016 · use a 3 mm spade tip drill if using the Arthrex biceps button or 4.5 mm tunnel if using the endobutton copiously irrigate the site to prevent heterotopic ossification tap the bone tunnel

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A distal biceps tendon tear causes the muscle to ball up near the shoulder, sometimes called the “popeye deformity”. Oftentimes, there is bruising at the elbow. If you tear this tendon, you may hear a “pop” at the elbow region. Pain is usually severe at first, but subsides after a couple of weeks.The primary database was assembled by Common Procedural Terminology codes. The code utilized to identify all distal biceps repairs was 24342 (Reinsertion of ruptured biceps or triceps tendon, distal, with or without graft). Direct chart review was then conducted to ensure that a distal biceps repair or reconstruction was performed.Repair involves surgical reattachment of the distal biceps tendon to the radius bone at the radial tuberosity, where the tendon naturally inserts into the bone. Surgery is typically performed through a single incision in the front of the elbow or two-incision approach, in which a small second incision is made at the back of the elbow.The purpose of this Technical Note and video is to provide our preferred method of repair using an open, onlay-tissue xation with all-suture anchors (FiberTak; Arthrex) and anatomic. fi. positioning of the biceps tendon on the radial tuberosity. uptures of the distal biceps tendon are a relatively rare condition occurring largely inmiddle-aged men.Answer: You can use 24342 (Reinsertion of ruptured biceps or triceps tendon, distal, with or without tendon graft ). This code specifies the reinsertion of ruptured biceps or triceps, distal end. Orthopedic surgeons always repair triceps distally. Another code possibility is 24341 (Repair, tendon or muscle, upper arm or elbow, each tendon or ...This technique is a safe and effective method of repair of distal biceps tendon avulsion that allows active mobilization with minimal risk of complication. Discover the world's research 25 ...Jun 14, 2016 · The distal biceps tendon complex may be injured at the musculotendinous junction, by a disruption of the tendon itself “in continuity” or a complete or partial tear or avulsion of the tendon from the radial tuberosity . By far, the most common lesion is the avulsion from the tuberosity, and this is the only lesion that is dealt with in this ... Best answers. 0. Jan 23, 2020. #1. Patient having repair of distal biceps tendon rupture, CPT 24342. Wondering if I need to code the Tenodesis Brachialis separately? After biceps was repair, doctor mentions he did Bio-Tenodesis with 1 Vicryl in medial and lateral aspect of biceps and the brachialis to make sure to keep it real medial and real ...This Ovation Credit Repair review will tell you everything you need to know about this company, the services it offers, and how to sign up. We may receive compensation from the pro...Video 1. This is a repair of a chronic distal biceps injury in a 53-year-old man with tendon retraction of 7 cm shown on magnetic resonance imaging. He is supine, with the arm over a hand table. Our technique for reconstruction of chronic distal biceps injuries uses an Achilles allograft through a modified Henry approach.Distal Biceps Repair Surgery (with Endobutton) Page 3 of 8 Aims and Benefits Without surgery you will be able to compensate for most of the reduced power of biceps with appropriate rehabilitation, and will manage most activities with no problems. Repetitive motions turning the hand over and back (such as using a screwdriver) can tire ….

Distal Biceps Tendon Repair. There are many different techniques for repairing the ruptured biceps tendon. This is our prefered method, but other methods are equally successful. Please discuss with your surgeon. The biceps tendon ruptures off the forearm bone (radius) and retracts up the upper arm, causing a deformity (known as the 'Popeye sign')Distal Biceps Repair. General Guidelines/Precautions: • Elbow bracing x 6 weeks or per physician • Early limitations in elbow extension passive range of motion (dependent on surgeon and operative procedure) • Avoid active elbow flexion and supination during the acute phase of rehabAll distal biceps tendon repairs from 2008 to 2020 were retrieved by CPT code 23432. Their charts were screened for repair method and duration of follow-up. All of the charts were reviewed, and the patients were called or examined in person. ... Complications following the repair of the distal biceps appear to occur early in the … A distal biceps rupture off the radial tuberosity often presents with painful swollen elbow and significant loss of strength in rotation and flexion. Distal biceps tendon repair using the BicepsButton™ and tension-slide technique allows the surgeon to tension and repair the biceps tendon through a single anterior incision. In most cases we use arthroscopy to evaluate and repair joint damage in order to reduce recovery time. ... What is a distal biceps tendon rupture? A distal biceps tendon rupture affects the tendon that attaches the biceps muscle to the elbow. ... This procedure is used to release the ulnar nerve when it’s compressed at the elbow.The majority of distal biceps ruptures can be treated with surgical repair of the distal biceps utilizing either a single or two‐incision technique; both of which achieve …The distal biceps tendon connects the biceps muscle to the elbow bone. Your arm may be in a splint or an elbow brace for 4 to 6 weeks. You may also be in a sling for a week or so. You may feel tired and have some pain for several days. Your arm may be swollen, but the swelling should go down a little each day. You will need rehabilitation ...Your first instinct may be to report CPT® 29827-RT Arthroscopy, shoulder, surgical; with rotator cuff repair-Right side, 29824-RT Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface (Mumford procedure), +29826-RT Arthroscopy, shoulder, surgical; decompression of subacromial space with partial …In our technique, subacromial decompression, distal clavicle resection, biceps tenodesis, and rotator cuff repair are performed using only a single working portal (anterior), leading to lower morbidities with minimal invasiveness (deltoid sparing), a faster recovery, and fewer anatomic structures at risk during and after the procedure. Cpt distal biceps repair, 3801 Wake Forest Rd, Ste 220, Raleigh, NC 27609. 5.00. 3 verified reviews. 13 years of experience. Aetna, BlueCross BlueShield, Cigna. see more. Dr. Johnny T. Nelson is a Raleigh native and a second-generation orthopedic surgeon. He graduated magna cum laude and phi beta kappa from the University of Dallas, where he played …, • No. Distal biceps repair is performed as an outpatient surgery. You will arrive approximately 1.5 - 2 hours prior to your procedure. Typically, you will be able to return home about two hours after your surgery is over. Please ensure someone comes with you to surgery who will be available to drive you home., This technique is a safe and effective method of repair of distal biceps tendon avulsion that allows active mobilization with minimal risk of complication. Discover the world's research 25 ..., Tears of the distal biceps are common, and nonoperative treatment results in significant loss of supination strength. Surgery is indicated for most patients to restore this supination strength. Both 1- and 2-incision techniques are successful, but each has its own advantages and disadvantages. We believe the 2-incision technique better restores the anatomic attachment site of the tendon, which ... , Purpose: To determine the clinical outcomes of patients undergoing revision distal biceps tendon repair/reconstruction and evaluate the causes of primary repair failure. Study design: Case series; Level of evidence, 4. Methods: We performed a retrospective review of patients undergoing ipsilateral primary and revision distal biceps …, For the inexperienced mechanic or lay car enthusiast, repairing a turbocharger may seem complicated. However, most common problems are easy and relatively inexpensive to fix. Havin..., Each patient’s progress may vary based on specifics to their injury and procedure. Mayo Clinic Orthopedics and Sports Medicine | Rochester 507-266-9100 | Minneapolis 612-313-0520 sportsmedicine.mayoclinic.org ... Each patient’s progress may vary based on specifics of their injury and procedure. Distal Biceps Tendon Repair Rehabilitation ..., For questions on reimbursement or to find information for a specific product, please contact the Arthrex Coding and Reimbursement Hotline at 1-844-604-6359 or email us at [email protected]. Coding Guides (30) Achilles Soft-Tissue Implants - 2024 Coding and Reimbursement Guidelines. File Type:, Find the CPT codes for reinsertion of ruptured biceps tendon, distal, with or without tendon graft. Also see the codes for other tendon or muscle repair in the upper arm, elbow, forearm and wrist., The distal biceps tendon from the two heads may converge or remain anatomically separate before they attach to the radial tuberosity. 1 Despite this variance in tendon anatomy, the biceps short head attaches more distal than that of the bicep long head on the radial tuberosity. 2 The orientation of the biceps short head primarily contributes to ..., Purpose: To assess the effect of surgical repair for acute distal avulsion injuries of the biceps femoris tendon on (1) return to preinjury level of sporting function and (2) time to return to preinjury level of sporting function, patient satisfaction, and complications. Study design: Case series; Level of evidence, 4., Nov 22, 2012 · A distal biceps tendon tear causes the muscle to ball up near the shoulder, sometimes called the “popeye deformity”. Oftentimes, there is bruising at the elbow. If you tear this tendon, you may hear a “pop” at the elbow region. Pain is usually severe at first, but subsides after a couple of weeks. , How to Repair Hardwood Floors - You'll need a few special tools and tips to repair your hardwood floors, but otherwise it's a snap when following our simple, step-by-step guide. Ad..., • No. Distal biceps repair is performed as an outpatient surgery. You will arrive approximately 1.5 - 2 hours prior to your procedure. Typically, you will be able to return home about two hours after your surgery is over. Please ensure someone comes with you to surgery who will be available to drive you home., We would like to show you a description here but the site won’t allow us. , Best answers. 0. Jan 23, 2020. #1. Patient having repair of distal biceps tendon rupture, CPT 24342. Wondering if I need to code the Tenodesis Brachialis separately? After biceps was repair, doctor mentions he did Bio-Tenodesis with 1 Vicryl in medial and lateral aspect of biceps and the brachialis to make sure to keep it real medial and real ..., Tears of the distal biceps are common, and nonoperative treatment results in significant loss of supination strength. Surgery is indicated for most patients to restore this supination strength. Both 1- and 2-incision techniques are successful, but each has its own advantages and disadvantages. We believe the 2-incision technique better restores the anatomic attachment site of the tendon, which ... , Tears of the distal biceps are common, and nonoperative treatment results in significant loss of supination strength. Surgery is indicated for most patients to restore this supination strength. Both 1- and 2-incision techniques are successful, but each has its own advantages and disadvantages. We believe the 2-incision technique better restores the anatomic attachment site of the tendon, which ... , 4. Surgical Technique. 5. Hold tension on all four suture limbs and insert the tip of the Button Inserter into the end of the BicepsButton. Maintain tension on the sutures and insert the Biceps-Button through both cortices of the radial tuberosity. Flexing the forearm 20 ̊ to 30 ̊ can aid in button and Pull on the free suture limbs to seat ..., tendon repair. endobutton. B efore 1961, the recommended treatment for distal biceps ruptures was conservative care. Aside from suturing or attaching tendons through bony drill holes, there was no satisfactory, reliable technique to repair ruptures and, in general, patients regained motion and functional use of their arm., Achieve a simple, reproducible repair of the distal biceps with the BicepsButton implant systems and associated tension-slide technique. Using a titanium BicepsButton implant, this technique reliably seats the tendon against the far cortex of the bone socket to maximize the surface area for tendon-to-bone healing. A tenodesis screw adds to the construct strength and helps place the tendon at ..., Distal hereditary motor neuropathy, type II is a progressive disorder that affects nerve cells in the spinal cord. Explore symptoms, inheritance, genetics of this condition. Distal..., Distal biceps tendon injuries of the elbow have been reported in 2.55 cases per 100,000 patient-years in the United States. 10, 13, 14 Affected patients are commonly male, aged 40-50 yr, and who sustained an acute eccentric loading force in the dominant arm. A subset of older patients can present with chronic degenerative and cystic …, Distal biceps tendon ruptures are uncommon and generally occur in men aged 30 to 50 years in their dominant arm as a result of a strong eccentric load. Numerous surgical exposures and methods of fixation exist for repair of a ruptured distal biceps tendon. The goal of surgical management is to restore the anatomic footprint of the biceps tendon on the radial tuberosity to maximize flexion ..., Distal Biceps Repair. General Guidelines/Precautions: • Elbow bracing x 6 weeks or per physician • Early limitations in elbow extension passive range of motion (dependent on …, possible. It is designed for rehabilitation following surgical repair of distal biceps tendon. Modifications to the protocol may be necessary depending on the location and size of the repair, chronicity of tear, age, weight, comorbidities, and concomitant injuries or procedures performed. This evidence-based guideline, Introduction. The biceps brachii muscle is the primary supinator of the forearm and secondary flexor of the elbow [1, 2].Rupture to the distal biceps tendinous insertion make up 3–10% of all biceps injuries and has an incidence of up to 5.35 cases per 100,000 per year [3–5].These injuries are common among 40- to 50-year-old men and …, The ACS NSQIP database was used to identify patients undergoing distal biceps repair between January 1, 2011, and December 31, 2017, using Current Procedural Terminology (CPT) code 24342. Cases with concurrent procedures, as determined by concurrent reported CPT codes, were excluded from the final analysis., Our Research and Education in Distal Biceps Tendon Rupture. Learn more about our research and professional education opportunities. We can help you find a doctor. Call 646-929-7800 or. NYU Langone’s highly trained orthopedic surgeons are experts at performing repair procedures for a distal biceps tendon rupture. Learn more. , Distal biceps tendon (DBT) tears usually occur secondary to a sudden eccentric load applied to a flexed elbow. This relatively uncommon condition typically affects 40- to 60-year-old male patients and has a reported incidence of 1.2 ruptures per 100,000 people per year. 3,15 Nonoperative treatment is an option, but it can cause significant …, Other units of measurement include doughnuts, elephant trunks, and Arnold Schwarzenegger's biceps. Are you getting bored with our current units of measurement? Do you constantly we..., Distal biceps tendon ruptures are uncommon injuries that can cause impairment in range of motion and function. While distal bicep tendon repair to the radial tuberosity has been demonstrated to restore function and strength, there is a lack of consensus on the optimal technique. The purpose of this Technical Note and video is to provide our preferred method of repair using an open, onlay ..., Two-incision distal biceps repair with cortical button. This video demonstrates a technique of distal biceps repair to maximize supination strength, which is the most important …