Treatment of acute distal biceps tendon ruptures – A survey of the British Elbow and Shoulder Society surgical membership

Abstract

Background Acute distal biceps tendon ruptures result in weakness and deformity. While in other jurisdictions the rate of surgical repair has outpaced rises in incidence, UK practice for distal biceps tendon ruptures is unknown. The aim of this survey was to characterise current UK clinical practice. Methods An online survey was sent to the surgeon members of the British Elbow and Shoulder Society. Questions covered respondent demographics, clinical decision making, surgical experience and willingness to be involved in future research. Results A total of 242 surgeons responded; 99% undertook acute distal biceps tendon repairs with 83% repairing at least half of all distal biceps tendon ruptures, and 84% of surgeons would have their own, hypothetical, acute distal biceps tendon rupture repaired in their dominant arm and 67% for their non-dominant arm. Patient age, occupation and restoration of strength were the commonest factors underpinning a recommendation of surgical fixation. Most surgeons (87%) supported a national trial to study operative and non-operative treatments. Conclusions UK upper limb surgeons currently advise surgical repair of acute distal biceps tendon ruptures for the majority of their patients. This is despite a paucity of evidence to support improved outcomes following surgical, rather than non-operative, management. There is a clear need for robust clinical evaluation in this area.

Shoulder & Elbow

“…Researchers from Oxford (UK) performed a nationwide survey of surgical practice in the UK to characterize behaviour and opinion with regard to the surgical management of distal biceps tendon ruptures. 6 In other countries, the rate of surgical repair has risen; indeed, this has been over and above any increase in detected incidence, whereas in the UK patterns of practice are unknown. The area of surgical repair is controversial; while mechanical studies demonstrate deficiencies in supination and flexion, surgery is not a panacea with a not insignificant rate of postoperative complications, which include heterotopic ossification, fracture, re-rupture, and serious nerve injury, which can result in a greater impairment than non-operative management would be expected to produce.…”

Patient-Reported Outcome Measures of a Novel Cortical Button System for Distal Biceps Tendon Repair: A Retrospective Study

“…This is partly due to reports of a supination strength reduction of 37-40% and flexion strength reduction of 7-30% with conservative management [ 6 , 7 ]. Indeed, in a recent survey of shoulder surgeons in the United Kingdom, 83% of respondents reported repairing more than half of these injuries [ 8 ]. Systematic reviews and meta-analyses comparing non-operative versus operative management have suggested operative management to result in improved strength and better patient-reported outcomes [ 9 , 10 ].…”