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Time from Injury to Surgery Influences Surgical Technique and Complication Rate in Distal Biceps Tendon Repair
Laura Morrison, MD, MSc1, Bayan A Ghalimah, MBSS2, Chloe L. Elliott, Bachelor of Science Student3, Eric C. Sayre, PhD4 and Neil J White, MD, FRCS(C)1, (1)University of Calgary, Calgary, AB, Canada, (2)University of Calgary, Caglary, AB, Canada, (3)Lindenwood University, St. Charles, MO, (4)British Columbia Centre on Substance Use, Vancouver, BC, Canada

Missed distal biceps injuries can be difficult to treat. Depending on time from injury to surgery and tendon retraction, a primary or direct repair (DR) technique may not be possible. If the tendon is retracted or the tissue quality is poor, an allograft reconstruction (AR) may be required. High flexion angle (HFA) repairs are a newer technique, and are an alternative to AR. This study asked: (1) Does time from injury to surgery influence the type of repair technique selected? (2) What is the complication rate for each technique?
Materials and Methods:
A retrospective chart review was conducted using electronic medical records from a single center. Patients were included if they were over 18 years of age, had a unilateral biceps rupture and underwent surgical treatment between 2012 and 2022. Patient demographics, time from injury to surgery, type of surgery, and complications were recorded. Descriptive statistics were used to summarize demographic data and complication rates. A multinomial logistic regression model was used to compare likelihoods of the three surgical techniques versus time from injury to surgery.
A total of 360 patients were included, all of which were male. Most patients underwent DR (89%, n=321), followed by AR (6%, n=20) and HFA (5%, n=19). There was a statistically significant difference between time from injury to surgery and surgical technique performed (p<0.001). The mean (SD) number of days between injury and surgery was 15 (23) days, 48 (81) days and 303 (444) days for DR versus HFA versus AR, respectively. The multinomial model probabilities demonstrating this relationship are shown in Figure 1. Re-rupture rates were higher in the AR (15%, n=3) and HFA (5%, n=1) groups compared to the DR group (2%, n=7). There were four (1%) posterior interosseous nerve injuries in the DR group, one (5%) in the HFA group and zero in the AR group.
Missed or late-presenting distal biceps injury have a higher likelihood of undergoing HFA or AR compared to DR. HFA and AR may have higher complication rates than acute DR, but overall complication rates are low between all groups. This study supports the need for early diagnosis of distal biceps rupture, and can inform expectations based on time from injury to surgery.

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