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American Association for Hand Surgery

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Evaluating Primary Repairs of Chronic Distal Bicep Tendon Tears
Jakub M Dmochowski, MD1, Greg J Schmidt, MD2, Reed W Hoyer, MD1 and Jeffrey A Greenberg, MD1, (1)Indiana Hand to Shoulder Center, Indianapolis, IN, (2)Indiana University, Indianapolis, IN

Introduction: Currently there is no consensus on what defines a chronic distal bicep tendon rupture. Multiple papers have arbitrarily classified chronic as those undergoing surgery 3-4 weeks since the date of injury. Some of the issues that have been raised with repairs of chronic ruptures are that they may be more difficult due to adhesions, tendon shortening, and tunnel obliteration as well as needing a high flexion angle for primary repair. These factors could potentially contribute to higher surgical complications compared with those fixed in the acute setting. This study reports the results of primary repair of distal bicep tendon ruptures greater than six weeks after initial injury.

Materials and Methods: A retrospective review of all distal biceps tendon repairs performed by multiple surgeons from January 1, 2015 to October 15, 2020 at a single institution was performed. Patients treated for complete distal biceps tears ≥6 weeks after injury without tendon graft were eligible for inclusion. Thirty patients qualified for the study and underwent detailed chart review to document any complications and range of motion data. The patients were contacted for final Patient Reported Outcome Measures (PROM) using the quick-Disability of the Arm, Shoulder, and Hand (quick-DASH) and Patient Reported Elbow Evaluation (PREE) scores. Final PROM were obtained from 19 patients with an average follow up of 32 months (range: 4-71 months).

Results: Average time from injury to surgical repair was 71 days (range: 42-204). The average quick-DASH score was 4.3 (±4.5) and PREE score was 4.8 (±5.5). The amount of elbow flexion necessary to complete the repair was documented in 21 patients and averaged 64º (±10º). Postoperatively, patients achieved an average flexion/extension of 138º (±2º) to 0º (±1º) and pronation/supination of 75º (±4º) to 78º (±4º). Complications were reported in 14 patients (47%) and included two re-ruptures, one adhesive scar formation, one superficial infection, one intra-operative lateral antebrachial cutaneous nerve (LABCN) laceration, one case of radiographic heterotopic ossification (HO) and twelve transient neuropraxias (9 LABCN, 3 radial sensory nerve).

Conclusions: Primary repair of chronic distal bicep tendon tears greater than six weeks can still result in excellent functional outcomes following repair as evidenced by our post-operative PROMs. Additionally, high-flexion repair angles do not negatively impact final elbow extension. While the complication rate was higher than previously reported acute repairs, most were self-limiting.

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