Clinical Outcomes of Surgical Repair for Partial Distal Biceps Tendon Tears
Gregory J Schmidt, MD1; James P. Fischer, MD1; Nicholas Crosby, MD2; Reed W Hoyer, MD3
1Indiana University, Indianapolis, IN; 2Hand Surgery, Indiana Hand to Shoulder Center, Indianapolis, IN; 3Indiana Hand to Shoulder Center, Indianapolis, IN
Introduction: The management of persistently symptomatic partial distal biceps tears is controversial, and there is limited data examining the results of surgical repair for treatment. Additionally, it is unclear how the presentation of symptoms and the timing of surgery may influence postoperative outcomes.
Methods: A retrospective review of all distal biceps tendon repairs at a single institution by multiple surgeons from January 1, 2015 to October 15, 2020 was performed. Inclusion criteria consisted of preoperative Magnetic Resonance Imaging (MRI) indicative of distal biceps pathology without complete tear, surgical treatment with intraoperative confirmation of a partial tear, and greater than one year of follow-up. Chart review was performed to document the presence of preceding trauma, preoperative duration of symptoms, procedure details and post-operative complications. Patients were contacted by telephone for outcome assessment using the Quick-Disability of the Arm, Shoulder, and Hand (QuickDASH) and Patient Reported Elbow Evaluation (PREE) outcome measures. Clinical outcomes were obtained from 56 of 74 eligible patients (76%) with 46 months (range: 15-85 months) average follow-up. Surgeries were performed using an anterior approach and cortical button repair. Statistical analysis included Wilcoxon Rank and Mann-Whitney testing between groups. Spearman’s correlation test assessed the relationship between outcome and symptom duration.
Results: Postoperatively, the median QuickDASH was 2.3 (IQR: 0 – 9.7), and the median PREE score was 1 (IQR: 0 – 12). Postoperative QuickDASH scores were significantly lower than preoperative scores (p < .001; 2.3 vs. 47.6). Known trauma preceding symptoms (p = 0.94, 2.3 vs. 2.5) and duration of symptoms prior to surgery (p = 0.63, r = 0.07) were not significantly associated with postoperative outcome. Of all eligible patients, 30 complications were reported in 25 patients (34%) and included two re-ruptures, two cases of heterotopic ossification (HO), one deep infection, one case of implant irritation, 21 neuropraxias, and three hematomas. Five patients (7%) underwent six reoperations including one revision for re-rupture, one irrigation and debridement, two for HO excision, one hematoma evacuation, and one for implant removal.
Conclusion: This study demonstrates predictably excellent outcomes following surgical repair of partial distal biceps tendon tears with significant improvement in outcome scores. Outcomes were not significantly different between patients with known traumatic or insidious onset of their symptoms, and they did not significantly correlate with the duration of symptoms prior to surgery.
Back to 2023 Abstracts