Effect of Surgical Approach on Complication Rates in Distal Biceps Tendon Repair: A Systematic Review
Claire Marie McDaniel, BS1; Haley Elizabeth Smith, MD1,2; Kevin O'Malley, MD3; Michael W Kessler, MD3
1Georgetown University School of Medicine, Washington, DC, 2Northwestern University, Chicago, IL, 3Medstar Georgetown University Hospital, Washington, DC
Distal biceps tendon rupture (DBTR) is a relatively uncommon injury, representing only 10% of all biceps brachii injuries. DBTR most commonly results from an eccentric load being placed on a flexed arm, forcing the arm into extension and avulsing the distal biceps tendon from the radial tuberosity. Anatomic repair is the standard of care as it restores excellent functionality with high rates of patient satisfaction. There are two preferred surgical approaches: the single anterior incision and the modified Boyd-Anderson. However, each approach has been associated with various complications. While there have been previous reviews addressing surgical approach in DBTR repair, they have covered time periods prior to the modification of the Boyd-Anderson, included case series that did not include direct intra-study comparisons, or simultaneously compared fixation method. The purpose of this systematic review is to determine whether complication rates differ between the two preferred surgical approaches.
Systematic database searches of Ovid Medline, PubMed, CINAHL, and Cochrane Central Register of Clinical Trials were conducted for studies on DBTR that included a comparison of single anterior incision and two incision approaches. Data was extracted in parallel by two independent researchers. Using Review Manager software version 5.3.5, single anterior incision and modified Boyd-Anderson approaches were compared.
9 studies were included in the analysis comprising 1368 patients total with 1008 in the single anterior incision group and 360 in the modified Boyd-Anderson group. There were significantly fewer overall complications (OR 1.68, 95% CI 1.26-2.25) and sensory paresthesias (OR 3.03, 95% CI 2.05-4.47) with the modified Boyd-Anderson approach. There was a significantly lower rate of HO development in the single anterior incision group (OR 0.39, 95% CI 0.21-0.74). There was no significant difference in re-ruptures (OR 1.13, 95% CI 0.47-2.75) between groups.
Surgical repair of DBTR is indicated in most patients. The results of this systematic review indicate that the modified Boyd-Anderson is the preferable approach as it leads to a significantly lower overall complication rate, specifically fewer sensory paresthesias. Nonetheless, there was a significantly lower rate of HO development with the single anterior incision approach. This is the first study to apply the PRISMA systematic review protocols to the complication rates between single anterior and modified Boyd-Anderson approaches. Further systematic analysis is warranted concerning patient satisfaction with DBTR repair, as well as the role of fixation method in complication development. Surgeons should consider complication rate when determining approach for surgical repair of DBTR.
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