Analysis of Operative Versus Non-Operative Management of Distal Biceps Ruptures Using PROMIS
Thomas John Carroll, MD1; Jonathan Minto, MD1; Akhil Dondapati, MD1; Samantha Hoffman, BA1; Warren C. Hammert, MD2; Bilal Mahmood, MD1
1University of Rochester, Rochester, NY; 2Duke University, Durham, NC
Introduction: The purpose of our study is to compare the outcomes of patients undergoing operative versus non-operative management of distal biceps ruptures using PROMIS. Our hypothesis is that the operative cohort will demonstrate earlier functional improvement and higher overall PROMIS Upper Extremity (UE) and Physical Function (PF) scores with lower overall PROMIS Pain Interference (PI) scores at final 12 month follow up.
Methods: This is a 7-year retrospective study of 1022 consecutive patients with traumatic distal biceps ruptures presenting to a large academic institution. Demographic information, treatment method, PROMIS UE, PF, PI, and patient acceptable symptom state (PASS) were recorded for each patient at the initial, 2 week, 6 week, 12 week, 6 month, and 12 month visits. Statistical analysis was completed using unpaired T-test and Chi-square analysis.
Results: In total, 561 patients underwent non-operative intervention with 328 patients completing the questionnaire at initial visit and 118 completing at 12 months. Among this cohort, compared to initial visit, the 12-month mean PROMIS scores improved to PF 44.60(+3.60, p<0.0001), UE 42.2(+5.10, p<0.0001), and PI 57.65 (-1.19, p=0.03). In total, 461 patients underwent operative intervention with 290 patients completing the questionnaire preoperatively and 173 completing at 12 months. Among this cohort, compared to pre-op, the 12-month mean PROMIS scores improved (when compared to pre op scores) PF 44.12 (+0.01, p=0.98), UE 41.58 (+4.18, p<0.0001), and PI 55.13 (-3.24, p<0.0001). For PROMIS PF, there was no significant difference between the two cohorts at any follow up time but higher overall change among the non-operative group (+3.6 vs +0.01, p<0.0001) with later score plateau (6 month vs 12 wk). For PROMIS UE there was no significant difference in final visit score or overall change in score. For PROMIS PI, there were lower scores among the operative group at 6 weeks (56.5 vs 58.5, p<0.01), 12 weeks (55.6 vs 58.1, p=<0.01), 6 months (55.8 vs 57.9, p<0.01), and 12 months (55.13 vs 57.7, p<0.01) with overall greater change (-3.2 vs -1.19, p<0.01).
Conclusion: Compared to non-operative management, patients undergoing surgical repair for distal biceps ruptures reached lower PROMIS PI scores at intermediate and long-term follow up. They ultimately reached equivocal PROMIS UE and PF scores, however, had overall greater improvement in PROMIS PF scores among the non-operative group. Both operative and nonoperative treatment of distal biceps demonstrate similar improvement over 12 months and PROMIS may not be sensitive enough to detect differences.
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