Distal biceps tendon rupture – Is surgical reconstruction really always necessary?

Abstract

Summary Background Rupture oft the distal biceps tendon is a rare injury which leads to a considerable loss of supination and flexion strength. A deficit of 40% of flexion and more than 50% of supination strength is reported in the literature. Therefore, surgical reconstruction of the distal tendon is the method of choice. However, some patients opt for non-operative management and a small number of patients are not fit for surgery. The purpose of this retrospective study was to assess the results of non-operative treatment using objective muscle strength testing and evaluation of the subjective satisfaction. Patients and method Between 1999 and 2010, 206 patients had suffered from a distal biceps tendon rupture after trauma. Clinical examination, sonography and MRI confirmed the diagnosis. Most of these patients (85,4%, N - 176) underwent surgical intervention by refixation. 30 patients were treated non-operatively. All these patients were treated with a short-term cast-fixation followed by physiotherapy. The screened patients underwent clinical assessment using a modified Mayo Clinic Performance Index. The supination and flexion strength was measured with an isometric strength test, taking muscle dominance into account. Visual Analogue Scale (VAS) was used for the evaluation of the subjective satisfaction. Results Of the 30 patients who were treated non-operatively 24 (80%) underwent follow-up examination. The mean time between trauma and follow-up was 80 months (18-138 months). A deficit of ROM was only found in one patient. The loss of supination strength was 26,6%, compared to the other arm. Loss of flexion strength was 16,1% -18,1% depending on whether the forearm was in pronation, neutral position or supination. The overall subjective satisfaction for non-operative management was 8,9 for the VAS (10 max). The modified Mayo elbow performing score was 81,05 (90 max). Conclusion In the literature, a significant loss of strength is reported in case of distal biceps tendon rupture. However the evidence for this is sparse. We evaluated more than 20 patients and we found that the loss of supination and flexion strength was not as severe as reported. A high patient satisfaction was found in this study as well. Taking further into consideration the loss of strength after surgical repair with the risk of nerve lesions, non-operative treatment seems to be an acceptable alternative option.