The surgical repair of distal biceps tendon ruptures has an overall low rate of serious complications, regardless of approach or technique. However, the double-incision technique has a higher rate of posterior interosseous nerve palsy, heterotopic bone formation, and reoperation rate. Surgeon's years of practice, fellowship training, and case volume do not affect the rate of major complications.

Objectives:Our objective was to evaluate whether indomethacin would reduce the incidence of heterotopic ossification (HO) after two-incision distal biceps repairs.Methods:After obtaining IRB approval, all two-incision distal biceps tendon repairs performed between 2008 and 2015 by 17 surgeons in a multi-center (14) integrated, health care system were retrospectively reviewed. Indomethacin use was confirmed by the use of our pharmacy database search of a prescription being filled 10 days prior and up to 6 weeks after to surgery. A minimum of 1 year of follow-up was required for all patients. Variables recorded were patient demographics, time from injury to surgery, re-operation rate, infection, re-rupture, nerve complications, and time to release from medical care. Inclusion criteria included age 18 and over, primary repairs using the two-incision technique with bone tunnel - suture fixation. A Fischer Exact test was performed to test for significance.Results:146 patients met our inclusion criteria. The average age was 48 years (range: 23-69). All (100%) were male. The non-dominant side was involved in 76 patients (52.1%). There was no difference in age, gender, time from injury to surgery in groups receiving indomethacin to those not receiving it (P>0.05). 109 (74.7%) patients underwent distal biceps repair without indomethacin and 6 (5.5%) patients developed HO. In 37 patients who received indomethacin prophylaxis, 5 (13.5%) patients developed HO. There was no statistically significant difference in HO formation between patients who received indomethacin prophylaxis and those who did not (P=0.14).Conclusion:Based on our findings and the risk of gastrointestinal complications, we do not recommend indomethacin prophylaxis for two-incision distal biceps repairs.

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