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

doi:10.1016/j.jse.2018.06.028

Journal of Shoulder and Elbow Surgery

Volume 27, Issue 10, October 2018, Pages 1898-1906

https://doi.org/10.1016/j.jse.2018.06.028 Get rights and content

Background

The major complication and reoperation rates after distal biceps repair are poorly defined. The purpose of this large retrospective cohort study of distal biceps repairs performed by multiple surgeons within a large orthopedic group was to more clearly define the rates and risk factors of clinically impactful major complications and reoperations.

Methods

All distal biceps tendon repairs performed from January 2005 through April 2017 with a minimum 2-month follow-up were identified using Current Procedural Terminology code 24342. We included 970 patients. The primary outcome measure was the total major complication rate. Reoperations, minor complications, and risk factors were also tracked.

Results

Repairs were performed via a single anterior incision in 652 cases and a 2-incision exposure in 318 cases. A 7.5% major complication rate and 4.5% reoperation rate were observed overall. Major complications occurred at the following rates: proximal radioulnar synostosis, 1.0%; heterotopic ossification or loss of range of motion with reoperation, 0.9%; tendon rerupture, 1.6%; deep infection, 0.5%; posterior interosseous nerve palsy, 1.9%; and complex regional pain syndrome, 0.6%. The 2-incision exposure was identified as a significant risk factor for the development of proximal radioulnar synostosis when compared with single-incision repair techniques (P = .0003; odds ratio, 19), occurring in 2.8% of 2-incision exposure cases. Lateral antebrachial cutaneous nerve neuritis or numbness and radial sensory nerve neuritis or numbness were documented more frequently in the postoperative period among patients treated with a single-incision exposure (P < .0001 and P = .034, respectively).

Conclusions

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.

Section snippets

Materials and methods

A retrospective comparative treatment study was conducted. A query of patients surgically treated by multiple surgeons within a large independent orthopedic group (with >100 surgeons) for distal biceps tendon repair from January 2005 through April 2017 was generated using Current Procedural Terminology (CPT) code 24342 for repair of ruptured distal biceps or triceps tendons. Patients were excluded from the study if they had less than 2 months of follow-up unless a major complication or

Results

In total, 1515 cases were identified during the sample period using the single CPT code. After application of the aforementioned exclusion criteria, a consecutive sample of 970 cases was analyzed. We excluded 269 triceps tendon repairs, billed under the same CPT code, owing to the wrong procedure. An additional 12 patients were excluded after sustaining open biceps tendon ruptures. Finally, 264 patients were excluded because of incomplete records or inadequate follow-up. This series included

Discussion

Within this cohort study, major complications and reoperations occurred in 7.5% and 4.5% of cases, respectively. These findings are important to discuss with patients when making shared surgical decisions during the informed-consent process. Specifically, tendon rerupture and PIN palsy occur relatively commonly, create dysfunction for the patient when they occur, and may require reoperation. For patients undergoing repair with a 2-incision exposure, proximal radioulnar synostosis occurred at a

Conclusions

In this large cohort series of distal biceps tendon repair, the total major complication rate was 7.5%. The most common major complications were PIN palsy, 18 (1.9%); distal biceps tendon rerupture, 15 (1.5%); proximal radioulnar synostosis, 10 (1.0%); and symptomatic HO with reoperation, 8 (0.8%). Proximal radioulnar synostosis formation was found to correlate strongly with the use of a 2-incision exposure for repair. In addition, patients immobilized with a rigid splint or cast for longer

Disclaimer

Funding for the study was internal and without commercial or industry support

The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

Acknowledgments

The authors thank Bryce van Doren, MPA, MPH, for assistance with statistical analysis.

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: Institutional Review Board approval was received from Chesapeake IRB (Pro00020921).

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

Background

Methods

Results

Conclusions

Section snippets

Materials and methods

Results

Discussion

Conclusions

Disclaimer

Acknowledgments

J Hand Surg Am

J Shoulder Elbow Surg

J Shoulder Elbow Surg

J Shoulder Elbow Surg

J Shoulder Elbow Surg

J Shoulder Elbow Surg

J Shoulder Elbow Surg

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