Post-operative Complications Following Distal Biceps Tendon Repairs: A Prospective Study

Abstract

Ownership Interest: Matador Medical, Dimension Orthotics LLC, Wright Medical (Beredjiklian) The reported incidence of post-operative complications following distal biceps tendon repairs (DBTR) has been largely determined by retrospective and small prospective studies.1-4 We hypothesized that a large prospective cohort study of DBTRs performed at our institution would demonstrate similar complication rates. All patients undergoing a primary DBTR by a surgeon from our institution were followed prospectively. The repair technique, post-operative protocol, and follow-up intervals were determined by the individual surgeons’ protocols. At each visit, the surgeon evaluated the patient for any complication, which included infection, wound dehiscence, sensory nerve injury, motor nerve injury, heterotopic ossification, re-rupture, and others. Demographic and surgical data was collected. Descriptive statistics were performed. Sixty patients (59 male, 1 female) underwent 60 distal biceps repairs by 25 orthopaedic surgeons over the course of 6 months. The mean age of the patients was 47 years (Range: 28 - 62), and the mean Body Mass Index (BMI) was 32 (Range: 23 to 54). Surgical techniques included one-incision tension-slide (33 cases), two-incision Modified Boyd Anderson (26 cases), and one-incision suture anchor (1 case). The average time to surgery was 2.9 weeks (Median: 2, Range: 0.5 - 10), the average post-operative length of immobilization was 1.5 weeks (Range: 0 - 4), and the average follow-up was 12 weeks (Range: 6 - 27). The overall complication rate was 23%. There were 14 sensory nerve injuries: 8 lateral antebrachial cutaneous nerves, 2 superficial radial nerves, 1 non-specific hand numbness, and 3 non-specific forearm numbness. Thirteen of 14 sensory nerve injuries occurred with single-incision techniques (38% of one-incision cases vs 4% of two-incision cases). While there was not a single infection, 1 patient had wound blisters, and 1 patient developed olecranon bursitis. Finally, 1 patient re-ruptured his biceps tendon, which required revision surgery. •Patients treated with a one-incision technique have a higher rate of complication than those treated with a two-incision technique.•Sensory nerve injury, specifically to the lateral antebrachial cutaneous nerve, is the most common complication.•The prospective incidence of complications is similar to that obtained retrospectively and reported in the literature.