Abstract
BACKGROUND: Single-incision and double-incision techniques are widely used for distal biceps tendon repair, yet debate continues over which yields better outcomes. METHODS: A literature search was conducted across PubMed, Scopus, Cochrane Library, and Google Scholar through May 2025. Nineteen studies involving 2833 adult patients met inclusion criteria. Assessed endpoints included visual analog scale for pain, disabilities of the arm, shoulder and hand (DASH) scores, elbow ROM assessments, isometric flexion strength, heterotopic ossification, radioulnar synostosis, nerve injuries including lateral antebrachial cutaneous nerve (LACN), posterior interosseous nerve (PIN), and superficial radial nerve (SRN). Additionally, rerupture rates and other complication rates were evaluated. RESULTS: Compared with the double-incision approach, the single-incision technique was associated with improved DASH scores (MD: -1.08, p = .01), greater elbow flexion (MD: 8.18°, p < .001), higher isometric flexion strength (MD: 6%, p = .02), and greater pronation (MD: 4.29°, p = .03). It was also associated with a lower incidence of heterotopic ossification (risk ratio (RR): 0.51, p = .02) and radioulnar synostosis (RR: 0.07, p < .001). Conversely, the double-incision technique was associated with lower rates of LACN and SRN injuries (RR: 4.45, p < .001; and RR: 2.74, p = .005, respectively) but remained susceptible to PIN injury (RR: 0.48, p = .02). Infection, rerupture, reoperation, stiffness, delayed wound healing, and persistent pain rates were comparable between techniques (p > .05). CONCLUSIONS: The single-incision technique appears to be associated with more favorable objective functional outcomes and fewer structural complications, whereas the double-incision approach may reduce the risk of certain sensory nerve injuries. Further high-quality randomized trials are required to confirm these associations.