Introduction Treatment of a ruptured distal biceps tendon is mostly surgical, however there is still a debate and controversy about the surgical approach and the fixation method. Purpose Our purpose is to review the literature and our own cohort regarding single or double incision technique, different types of fixation methods and their clinical outcomes. Materials and methods In our review study we included only the complete distal biceps ruptures. A comprehensive search was made in the current literature regarding the surgical treatment of distal biceps tears. Numerous studies were found comparing single incision versus double incision approaches, as also for the type of fixation. Besides the literature found we also reviewed our own cohort between 2019-2024. The range of motion (ROM), Disabilities of the Arm, Shoulder and Hand (DASH) scores, Mayo Elbow Performance Score (MEPS) scores were assessed, as also the complications. Results In our cohort, we only used single incision (long „lazy S”, or small horizontal). We did not perform double incision in none of the cases. Also, surgeons’ preference was to use anchor or cortical button fixation. Small incision technique and cortical button fixation had better cosmesis, better MEPS score and lower complication rate (heterotopic ossification, pain, supination). Conclusions Regarding the literature, there was no significant difference between single or double incision technique. If using anchors, it is advisable to use two anchors, whcih have the same results as endobuttons.