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Background: There is continued discussion regarding complications associated with distal biceps tendon repair and how they may be related to surgical approach or technique, patient factors or injury factors. The purpose of this study was to examine the types and rates of complications and associated factors in distal biceps repair.

Methods: Between 2000 and 2012, 268 consecutive patients who underwent primary distal biceps tendon repair with at least 6 weeks of follow up were reviewed. Multiple factors were reviewed including injury chronicity, surgical approach, fixation technique, obesity, age, diabetes, and nicotine use. 237 patients (88.4%) underwent two incision approach and 31 (11.6%) underwent single incision approach.

Results: Complications occurred in 32.8% of patients. 11.2% were considered major complications, of which 5.6% required reoperation. Major complications included symptomatic heterotopic ossification (HO) excisions, irrigation and debridement for hematoma or infection, revision for retear, and persistent nerve injury at final follow-up. Minor complications including transient nerve irritation, superficial cellulitis, and asymptomatic HO were found in 21.6% of patients. Single incision approach was significantly associated with nerve irritation or injury (54.8% vs 13.6%, p<0.01), overall higher risk when accounting for all complications, and approached significance with any accounted HO.

Conclusion: Despite modifications in surgical techniques in attempt to avoid complications, there are still a number of minor and major complications associated with biceps tendon surgery. Patients should be counseled on appropriate risks prior to surgery including up to an 11.2% risk of major and 21.6% risk of minor complication, and 5.6% risk of reoperation.

Level of Evidence: Level III; Retrospective Cohort Review

Keywords: Distal biceps; rupture; surgical repair; reconstruction; complications; adverse events; outcomes