Anatomic reconstruction is now recognized as the optimal treatment for distal biceps ruptures to maximize functional upper extremity potential. Reconstruction minimizes the loss of flexion and supination strength and endurance that is associated with neglected or untreated ruptures. A single-incision, anterior approach for reconstruction of distal ruptures is facilitated by the use of a titanium button that is anchored to the end of the tendon and then engaged on the posterior proximal radius. This construct has been shown to have superior strength, facilitating early rehabilitation and return to activity.