Decreased Strength, Complication Rate and Higher Satisfaction in Conservative Treatment of Partial Distal Biceps Tendon Rupture Compared to Surgical Treatment: A Systematic Review

Overview

Journal Orthop Rev (Pavia)

Specialty Orthopedics

Date 2024 Jul 15

PMID 39006104

Authors

Haleigh M Hopper

Chase T Nelson

Luke A Sandoval

John W Cyrus

James R Satalich

Conor N ONeill

Alexander R Vap

Affiliations

Soon will be listed here.

Abstract

Background: Treatment modalities for partial distal biceps tendon (DBT) ruptures include conservative management (immobilization, medication, and physical therapy) or surgery. Selecting treatment modality can present a challenge to both patient and provider.

Hypothesis: It was hypothesized that patients undergoing surgical treatment for partial DBT rupture would have higher complications but better overall strength, range of motion (ROM), and patient satisfaction.

Study Design: Systematic Review.

Methods: A systematic review was performed in adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Cochrane, Embase, and Medline databases were searched for studies published through May 2023. Studies were included if they examined patients with a partial DBT rupture who underwent treatment. Exclusion criteria were non-human studies, studies not in English, reviews, technical notes, letters to the editor, surgical technique papers, and studies reported in a prior review.

Results: 13 studies consisting of 290 patients with a partial DBT tear were included in this review. 75% of the patients were male and the ages ranged from 23 - 75 years. The follow up for the patients ranged from 1 - 94 months. 55 patients underwent conservative treatment versus 256 patients underwent surgical treatment. Outcomes examined by the studies included pain, strength, range of motion (ROM), complications, patient reported outcomes (PROs), return to activity, and patient satisfaction.

Conclusion: Treatment for partial DBT tear via surgery or conservative treatment both produce good clinical outcomes. There are similar outcomes between treatment options for pain and ROM. Conservative treatment had some poorer outcomes in terms of strength after treatment. Surgical treatment had more complications and a few patients with decreased satisfaction. Overall, both are viable treatment options, requiring a physician and patient discussion regarding the pros and cons of both options as a part of a shared decision-making process that incorporates patient priorities.

References

Giombini A, Innocenzi L, Di Cesare A, Di Salvo W, Fagnani F, Pigozzi F . Partial rupture of the distal biceps brachii tendon in elite waterpolo goalkeeper: a case report of conservative treatment. J Sports Med Phys Fitness. 2007; 47(1):79-83. View

Cain R, Nydick J, Stein M, Williams B, Polikandriotis J, Hess A . Complications following distal biceps repair. J Hand Surg Am. 2012; 37(10):2112-7. DOI: 10.1016/j.jhsa.2012.06.022. View

Dellaero D, Mallon W . Surgical treatment of partial biceps tendon ruptures at the elbow. J Shoulder Elbow Surg. 2006; 15(2):215-7. DOI: 10.1016/j.jse.2005.08.020. View

Schmidt G, Fischer J, Crosby N, Hoyer R . Clinical Outcomes of Surgical Repair for Partial Distal Biceps Tendon Tears. J Hand Surg Am. 2023; 49(9):930.e1-930.e8. DOI: 10.1016/j.jhsa.2022.11.015. View

Amarasooriya M, Bain G, Roper T, Bryant K, Iqbal K, Phadnis J . Complications After Distal Biceps Tendon Repair: A Systematic Review. Am J Sports Med. 2020; 48(12):3103-3111. DOI: 10.1177/0363546519899933. View

Amin N, Volpi A, Lynch T, Patel R, Cerynik D, Schickendantz M . Complications of Distal Biceps Tendon Repair: A Meta-analysis of Single-Incision Versus Double-Incision Surgical Technique. Orthop J Sports Med. 2016; 4(10):2325967116668137. PMC: 5056595. DOI: 10.1177/2325967116668137. View

Carter T, Karunaratne B, Oliver W, Murray I, White T, Reid J . Acute distal biceps tendon repair using cortical button fixation results in excellent short- and long-term outcomes : a single-centre experience of 102 patients. Bone Joint J. 2021; 103-B(7):1284-1291. DOI: 10.1302/0301-620X.103B7.BJJ-2020-2246.R1. View

Bauer T, Wong J, Lazarus M . Is nonoperative management of partial distal biceps tears really successful?. J Shoulder Elbow Surg. 2018; 27(4):720-725. DOI: 10.1016/j.jse.2017.12.010. View

Worner E, van Oost I, Eygendaal D, The B . Higher failure rate of suture anchors in partial distal biceps tendon ruptures in comparison with Endobutton fixation. JSES Int. 2021; 5(4):821-826. PMC: 8245990. DOI: 10.1016/j.jseint.2021.02.012. View

10.

Ozasa Y, Wada T, Iba K, Yamashita T . Surgical treatment for partial rupture of the distal biceps tendon using palmaris longus tendon graft: A case report. Acta Orthop Traumatol Turc. 2018; 52(4):323-325. PMC: 6150445. DOI: 10.1016/j.aott.2018.02.006. View

11.

Caekebeke P, Duerinckx J, van Riet R . Acute complete and partial distal biceps tendon ruptures: what have we learned? A review. EFORT Open Rev. 2021; 6(10):956-965. PMC: 8559565. DOI: 10.1302/2058-5241.6.200145. View

12.

Voleti P, Berkowitz J, Konin G, Cordasco F . Rupture of the short head component of a bifurcated distal biceps tendon. J Shoulder Elbow Surg. 2016; 26(3):403-408. DOI: 10.1016/j.jse.2016.09.050. View

13.

Rao A, Scarola G, Rowe T, Yeatts N, Macknet D, Ford S . Distal Biceps Repairs in Females: A Large Single-Center Case Series. HSS J. 2022; 18(2):264-270. PMC: 9096998. DOI: 10.1177/15563316211009855. View

14.

Ruch D, Watters T, Wartinbee D, Richard M, Leversedge F, Mithani S . Anatomic findings and complications after surgical treatment of chronic, partial distal biceps tendon tears: a case cohort comparison study. J Hand Surg Am. 2014; 39(8):1572-7. DOI: 10.1016/j.jhsa.2014.04.023. View

15.

Behun M, Geeslin A, OHagan E, King J . Partial Tears of the Distal Biceps Brachii Tendon: A Systematic Review of Surgical Outcomes. J Hand Surg Am. 2016; 41(7):e175-89. DOI: 10.1016/j.jhsa.2016.04.019. View

16.

Robbrecht C, Defoort S, De Decker C, Petre D . Surgical treatment of partial and full distal biceps tendon ruptures. Acta Orthop Belg. 2020; 85(4):459-463. View

17.

Aggarwal V, Rose D . Case Report of a Bifid Distal Biceps Tendon with Traumatic Rupture and Subsequent Repair of Short Head Tendon Limb. Bull Hosp Jt Dis (2013). 2019; 77(2):153-156. View

18.

Hamoodi Z, Winton J, Bhalaik V . Partial tear of the distal biceps tendon: Current concepts. J Orthop. 2022; 32:18-24. PMC: 9111923. DOI: 10.1016/j.jor.2022.05.002. View

19.

Morrey B, Askew L, An K, Dobyns J . Rupture of the distal tendon of the biceps brachii. A biomechanical study. J Bone Joint Surg Am. 1985; 67(3):418-21. View

20.

Berthold D, Muench L, Cusano A, Uyeki C, Slater M, Tamburini L . Clinical and Functional Outcomes After Operative and Nonoperative Treatment of Distal Biceps Brachii Tendon Ruptures in a Consecutive Case Series. Orthop J Sports Med. 2021; 9(6):2325967120984841. PMC: 8193667. DOI: 10.1177/2325967120984841. View