Analysis of 784 Surgically Treated Distal Biceps Tendon Ruptures

Abstract

The surgical repair of distal biceps tendon ruptures has an overall low rate of serious complications, regardless of approach or technique. However, two-incision technique has a higher rate of posterior interosseous nerve palsy, heterotopic bone formation, and re-operation rate. To examine clinical and surgical outcomes for distal biceps tendon repairs in a large, multi-specialty, integrated healthcare system. Retrospective cohort study of distal biceps tendon repairs performed from January 1, 2008 through December 31, 2015. The repair methods were classified as: two-incision approach using bone tunnel-suture fixation, or anterior single incision approach. Anterior single incisions were further classified according to the fixation method: cortical button alone, cortical button and interference screw, or suture anchors alone. Patient demographics, surgeon characteristics, surgical outcomes, and complications were analyzed for all repair types. Of the 784 repairs that met our inclusion criteria, 639 (81.5%) were single incision approaches. When comparing two-incision and single incision repairs, there was a significantly higher rate of posterior interosseous nerve palsy (3.4% vs. 0.8% respectively, P: 0.010), heterotopic bone formation (7.6% vs 2.7%, respectively. P: 0.004), and re-operations (8.3% vs 2.3%, respectively. P<0.001). When excluding lateral antebrachial cutaneous nerve palsies, there was no significant difference in the overall nerve palsies between single incision and two-incision (5.8% vs. 6.9%, respectively, P: 0.612). The overall rate of tendon re-rupture was 1.9% (single incision: 1.6%, two-incision: 2.8%, P: 0.327). The overall rate of post-operative wound infection was 1.5% (single incision: 1.3%, two-incision: 2.8%, P: 0.182). The average time from surgery to release from medical care was 14.4 weeks (single incision: 14.0 weeks, two-incisions: 16.0 weeks, P: 0.286). Patients treated with cortical button + interference screw were released significantly sooner than other single incision repair types (13.1±8.01 weeks, P: 0.011). There were no significant differences in rates of motor neuropraxia, infection, re-rupture, re-operation in regards to surgeon’s years of practice, fellowship training, or case volume. The surgical repair of distal biceps tendon ruptures has an overall low rate of serious complications, regardless of approach or technique. However, two-incision technique has a higher rate of posterior interosseous nerve palsy, heterotopic bone formation, and re-operation rate. Surgeon’s years of practice, fellowship training, and case volume do not affect the rate of major complications.