American Association for Hand Surgery
Theme: Beyond Innovation

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Outcomes of Revision Distal Biceps Tendon Repair
Raminta V Theriault, MS, MD1; Kayvon Golshani, MD1; Nora Cao, MD1; Louisa Bauer, BS2; Tara Heydari, BA1; Aria Sajjad, BA1; Jennifer Hoffman, MD1; Charles Cassidy, MD3; Hervey Kimball, MD4
1Tufts Medical Center, Boston, MA, 2Tufts University School Of Medicine, Boston, MA, 3Orthopaedic Surgery, Tufts Medical Center, Boston, MA, 4New England Baptist Hospital, Boston, MA

Introduction:
Distal biceps tendon rupture is a common pathology encountered in orthopedic practices. The outcomes of various surgical repair techniques have been well studied given the frequency with which these procedures are performed. Far less research has been dedicated to the indications and clinical outcomes of revision distal biceps repair. The purpose of this study is to assess the clinical outcomes of patients who underwent revision distal biceps surgery at two institutions from 2005 to present.
Materials and Methods:
Retrospective chart review of patients undergoing revision distal biceps tendon repair at two institutions from 2005 to present. Inclusion criteria were any patient undergoing revision distal biceps surgery. Subjects were identified using CPT code 24342. Patients were excluded if they underwent primary biceps tendon repair only or triceps repair only. A chart review was conducted and patient characteristics including age, smoking status, worker's compensation status, and diabetes. In addition, the mechanism of injury, initial treatment modality, timing of initial repair (chronic was greater than 4 weeks), failure mechanism, date and modality of revision repair, complications, length of follow up, and range of motion were all recorded and documented. Patients were contacted over telephone and via mail to obtain DASH scores, final pain score, and to obtain any missing data from chart review. Overall 17 patients were included for analysis, 11 of which were successfully contacted for interview and 2 were deceased.
Results:
The median time to failure was 291 days after primary repair. The majority of primary repairs utilized endobutton fixation (11). Failure at the suture-implant interface was the most common method of failure (9). The most common complication site was lateral antebrachial cutaneous neuritis (47% of patients) and the overall complication rate was 29.4%. The most common revision surgery modality was revision endobutton primary repair. 11 patients were available for phone interview and mean pain score was 1.63, mean self assessed strength 77.5% and mean DASH score of 15.31. Worker's compensation patients trended toward higher pain scores and worse DASH scores although study was not powered to reach statistical significance.
Conclusions:
Revision distal biceps tendon repair can be done with good clinical results with respect to pain control, motion and acceptable DASH scores. Worker's compensation patients trended toward doing subjectively worse. Failure tends to occur in the relatively early post-operative period and the most common failure was at the suture-implant interface.


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