Long-term outcomes of complete tears of the distal biceps tendon: surgical management at a median follow-up of 14.7 years

Key points

1. 0166 patients with MRI-confirmed complete distal biceps tears, all treated surgically, followed for a median of 14.7 years.
2. 02At final follow-up 91% had full elbow flexion strength and 76% had full supination strength, with near-normal range of motion preserved.
3. 03The overall complication rate was 24% (16 of 66 patients), mostly minor nerve issues that often resolved on their own.
4. 0498% of patients returned to work and 85% of those returned without restrictions, though a median of 115.5 days was missed.
5. 05Typical patients were men around age 50, right-hand dominant, current or former smokers, and laborers injured by trauma.

How it was conducted

Design

Retrospective case series, Level of evidence 4, single center (Mayo Clinic)

Participants

66 patients (63 male, 3 female) with MRI-confirmed complete distal biceps tendon ruptures sustained 1996 to 2016, cross-referenced with the Rochester Epidemiology Project

Intervention

All treated operatively; most commonly a 2-incision approach (86%) with bone-tunnel suture fixation (83%)

Follow-up

Median clinical follow-up of 14.7 years (IQR 9.6-17.9 years)

Outcomes

Range of motion, flexion and supination strength, complications, and return-to-work status at final follow-up

What they found

• 66 patients included (63 male, 3 female), median age 50.8 years (IQR 41.5-60.4) and median follow-up 14.7 years (IQR 9.6-17.9).
• At final follow-up the median flexion-extension arc was 140 deg (IQR 135-140) and median supination was 80 deg (IQR 75-80).
• 91% of patients had full elbow flexion strength and 76% had full elbow supination strength; on manual testing 3 of 33 (9%) had persistent flexion weakness and 8 of 33 (24%) had supination weakness.
• Overall complication rate was 24% (16 of 66 patients); no infections occurred.
• Nerve complications affected 9 patients (14%), including 7 (11%) with lateral antebrachial cutaneous nerve palsy; complete resolution occurred in 4 of 9 (44%).
• Rerupture occurred in 2 patients (3%), heterotopic ossification in 5 (8%), and reoperation in 3 (5%).
• Return to work was 98% (39 of 40 with data), 85% (33 of 39) without modifications, with a median of 115.5 days missed (IQR 64.5-190).
• Median time from injury to surgery was 17 days (IQR 8.25-52.5); 21% of patients were current smokers and 32% former, and 56% were laborers.

Limitations

• Retrospective design with data pooled across multiple databases, so data points were inconsistently available and missing values were omitted.
• No comparison group; this is a single-arm case series that cannot show surgery is superior to nonoperative care.
• Multiple non-standardized surgical approaches and postoperative protocols may have confounded outcomes, and the limited data prevented regression analysis by surgical approach.
• Strength and some outcomes were documented in only a subset of patients (for example strength testing in 33 of 66), limiting completeness.

Why it matters

For patients

If you have a complete distal biceps tear repaired surgically, you can expect most of your elbow motion and strength to last for well over a decade and a high chance of returning to work, though recovery takes months.

For clinicians

Operative repair of acute complete distal biceps tears yields durable long-term function with an expected complication rate near 24%, dominated by usually transient lateral antebrachial cutaneous nerve issues.

For readers

This long-term case series supports the durability of distal biceps repair but, lacking a control group, does not establish surgery's superiority over nonoperative management.