Major complications after distal biceps tendon repairs: retrospective cohort analysis of 970 cases

Ford, Samuel E.; Andersen, Jason; Macknet, David M.; Connor, Patrick M.; Loeffler, Bryan J.; Gaston, R. Glenn

doi:10.1016/j.jse.2018.06.028

Cited by 66 publications

(56 citation statements)

References 15 publications

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“…Other papers have also noted that the single incision repair technique, used in all cases in this cohort, is associated with greater rates of lateral antebrachial cutaneous neuropraxia. 14 This may explain the rate at the higher end of that described by other papers. 9,14,17 There were no reported posterior interosseous nerve injuries.…”

Section: Discussionmentioning

confidence: 66%

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Mid-term clinical and functional outcomes of distal biceps tendon repair: A comparative study of two surgical fixation techniques

Poyser

Abdul

Mehta

2020

Journal of Orthopaedics, Trauma and Rehabilitation

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Objective: Acute rupture of the distal biceps tendon is relatively uncommon, and surgical repair is advocated for acute injuries to restore strength and function. Numerous techniques are described in the literature, with no true consensus regarding the optimal method of fixation. The aim of this study was to evaluate patient-reported outcome measures, clinical outcomes and complications for patients undergoing distal biceps tendon repair using two fixation techniques: cortical button and suture anchor. Methods: A retrospective single-unit case series of 51 cases (50 patients) underwent distal biceps tendon repair, comprising 19 cortical button and 32 suture anchor fixations. Patients were assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and overall satisfaction. Clinical outcomes and complications were reviewed from patient records. Results: Thirty-eight (76.5%) patients responded to DASH questionnaires with a mean follow-up of 189 weeks (11.5–425 weeks). Mean DASH scores for cortical button and suture anchor groups were 6.2 (0–30.8) and 3.3 (0–16.7), respectively ( p = 0.21). Eight patients (16%) reported lateral cutaneous neuropraxia in the early post-operative period. All but two of these patients experienced complete resolution at the final follow-up. One patient had heterotrophic ossification, which did not require any further intervention. There was one re-rupture (suture anchor), but the patient declined further surgical intervention. Conclusion: There were no statistically significant differences in the patient-reported outcome measures, overall satisfaction and complication rate between patients undergoing either method of fixation. Level of evidence: III

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Section: Discussionmentioning

confidence: 66%

“…14 This may explain the rate at the higher end of that described by other papers. 9,14,17 There were no reported posterior interosseous nerve injuries.…”

Section: Discussionmentioning

confidence: 66%

Mid-term clinical and functional outcomes of distal biceps tendon repair: A comparative study of two surgical fixation techniques

Poyser

Abdul

Mehta

2020

Journal of Orthopaedics, Trauma and Rehabilitation

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“…Historically, the single-incision approach is associated with increased nerve injury, most commonly the lateral antebrachial cutaneous (LABC) nerve and radial sensory nerve, while the double-incision is associated with an increased rate of proximal radioulnar synostosis, heterotopic ossification, and stiffness with supination/pronation. 6,8,10,19 Notably, while the overall complication rate is relatively high, the incidence of complications leading to revision surgery is comparatively low. 3,5 Thus, there are few data available with regard to the clinical outcomes after revision surgery.…”

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confidence: 99%

Clinical Outcomes After Revision Distal Biceps Tendon Surgery

Grewal

Bernardoni

Cohen

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Little is known about the clinical indications of performing a revision distal biceps tendon repair/reconstruction, and there is even less data available on the clinical outcomes of patients after revision surgery. Purpose: To determine the clinical outcomes of patients undergoing revision distal biceps tendon repair/reconstruction and evaluate the causes of primary repair failure. Study Design: Case series; Level of evidence, 4. Methods: We performed a retrospective review of patients undergoing ipsilateral primary and revision distal biceps tendon repair/reconstruction at a single institution. Between 2011 and 2016, a total of 277 patients underwent distal biceps tendon repair, with 8 patients requiring revision surgery. Patient characteristics, surgical technique, and patient-reported outcome scores (shortened version of Disabilities of Arm, Shoulder and Hand [QuickDASH], 12-Item Short Form Health Survey [SF-12], visual analog scale [VAS] for pain, and Mayo Elbow Performance Score [MEPS]), were assessed. Complications as well as indications for reoperation after primary and revision surgery were examined. Results: The overall revision rate was 2.9%. The number of single- and double-incision techniques utilized were similar among the primary repairs (50% single-incision, 50% double-incision) and revision repairs/reconstructions (62.5% single-incision, 37.5% double-incision). Reasons for reoperation included continued pain and weakness (n = 7), limited range of motion (n = 2), and acute traumatic re-rupture (n = 1). The median duration between primary and revision surgery was 9.5 months (interquartile range [IQR], 5.8-12.8 months). Intraoperatively, the most common finding during revision was a partially ruptured, fibrotic distal tendon with extensive adhesions. At a median of 33.7 months after revision surgery (IQR, 21.7-40.7 months), the median QuickDASH was 12.5 (IQR, 1.7-23.3), MEPS was 92.5 (IQR, 80.0-100), SF-12 mental component measure was 53.4 (IQR, 47.6-58.2), SF-12 physical component measure was 52.1 (IQR, 36.9-55.4), and VAS for elbow pain was 1.0 (IQR, 0-2.0). Revision surgery had a complication rate of 37.5% (3 of 8 patients), consisting of persistent pain and weakness (2 patients; 25%) and numbness over the dorsal radial sensory nerve (1 patient; 12.5%). Two patients required reoperation (25% reoperation rate). Conclusion: The overall revision distal biceps repair/reconstruction rate was approximately 3%. While patients undergoing revision distal biceps repair demonstrated improved outcomes after revision surgery, these outcomes remained inferior to previously reported outcomes of patients undergoing only primary distal biceps repair.

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“…Although this technique may have reduced the risk of nerve injury, it requires dissection through the radioulnar syndesmosis and has been reported to increase the risk for heterotopic ossification (HO). 1,6,7 To date, no surgical technique has been proven superior, and results with sufficient long-term follow-up are lacking. The purpose of this study was to evaluate patient-reported long-term outcomes 10 years after distal biceps tendon repair using the modified double-incision technique described by Morrey et al 17…”

mentioning

confidence: 99%

mentioning

confidence: 99%

Distal Biceps Tendon Repair Using a Modified Double-Incision Technique: Patient-Reported Outcomes With 10-Year Follow-up

Razaeian

Zhang

Harb

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: In the setting of complete distal biceps tendon rupture, surgical repair has become the standard of care to restore optimal elbow function, but the optimal approach and method of tendon fixation are still subjects of debate and have remained controversial for more than half a century. Purpose: To evaluate patient-reported long-term outcomes after distal biceps tendon repair using a modified double-incision technique. Study Design: Case series; Level of evidence, 4. Methods: We reviewed primary distal biceps tendon repairs after isolated tendon rupture using the modified muscle-splitting double-incision approach and transosseous suture fixation technique described by Morrey et al (1985), which had been performed at our level 1 trauma center between January 2000 and December 2013. Outcome measures included the subjective elbow value (SEV), the Oxford Elbow Score (OES) with its 3 domains (function, pain, and social-psychological), a self-performed hook test, and the 3-level version of the EuroQoL 5-dimensional instrument (EQ-5D-3L) as a measure of health status. Levels of overall satisfaction were determined by asking whether the patient would consent to the operation again. In addition, patients were asked to report any complications. Results: A total of 30 patients met the inclusion criteria, and 25 patients were available for the survey. Mean age at the time of rupture was 47 years. All patients were male. Mean follow-up was 120 months (range, 57-207 months). The follow-up rate was 83.34%. The following outcome results were obtained: SEV, 88.16% ± 25.18%; OES, 43.80 ± 10.56 out of 48 points; OES Pain, 92.50% ± 23.03%; OES Function, 92.25% ± 22.19%; OES Social-Psychological, 89% ± 23.68%; EQ-5D-3L, 0.93 ± 0.21. All patients described a negative hook test. Patient-reported complications included painless limitation in forearm rotation in 8% of patients (n = 2); reduced flexion and forearm rotation strength with and without pain in 8% (n = 2) and 4% (n = 1), respectively; synostosis after 1 year requiring revision surgery in 4% (n = 1); and transient wrist drop in 4% (n = 1). The overall complication rate was 28% (7/25), and 96% (n = 24) would consent to the operation again. Conclusion: Despite the cited approach-related morbidity, we report an excellent patient-reported long-term outcome for the double-incision distal biceps repair technique.

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Major complications after distal biceps tendon repairs: retrospective cohort analysis of 970 cases

Abstract: Distal biceps repair is associated with a 7.5% major complication rate and 4.5% reoperation rate. The use of a 2-incision technique for repair increases the risk of radioulnar synostosis.

Cited by 66 publications

References 15 publications

Mid-term clinical and functional outcomes of distal biceps tendon repair: A comparative study of two surgical fixation techniques

Mid-term clinical and functional outcomes of distal biceps tendon repair: A comparative study of two surgical fixation techniques

Clinical Outcomes After Revision Distal Biceps Tendon Surgery

Distal Biceps Tendon Repair Using a Modified Double-Incision Technique: Patient-Reported Outcomes With 10-Year Follow-up

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