Distal biceps tendon ruptures – the relation of radiological retraction and chronicity to the ability of tendon reattachment and long-term functional outcomes

Abstract

Aims
To assess whether the degree of radiological retraction and chronicity of distal biceps tendon ruptures are related to the ability to reattach the tendon and long-term functional outcomes.

Methods
Analysis of consecutive patients undergoing surgery for distal biceps tendon ruptures by a single surgeon. Measurements regarding the site and degree of tendon retraction in relation to anatomical landmarks following rupture were correlated with intraoperative findings. Postoperative functional outcomes were assessed in cases with >12 months follow-up.

Results
24 cases of distal biceps tendon ruptures treated surgically were identified. Mean tendon retraction was 6.0cm (range 1.2-9.5) from the radial tuberosity. 22 cases were reattached successfully. 2 required ligament augmentation/bridging using a synthetic ligament. In 2 cases the tendon could not be reattached due to poor quality of the tendon stump. Ability to reattach the tendon was unrelated to degree of radiological retraction or chronicity of rupture. Degree of retraction was not related to rupture chronicity. All re-attachments healed with no re-rupture at follow-up with no substantial motion loss. In 17 cases >12months follow-up the DASH and OES were not related to retraction or chronicity of rupture.

Conclusions
Radiological retraction and chronicity are not related to the ability to reattach distal biceps tendon ruptures or their clinical outcomes, hence should not discourage surgical exploration and attempted reattachment. Substantial tendon retractions can occur acutely and reattachment in considerable flexion did not produce any significant motion loss. Some cases will need augmentation or gap bridging and augmentation devices need to be available at surgery.

Level of Evidence
Level IV Retrospective Study Defined