Surgical outcomes and complications following distal biceps tendon reconstruction: a systematic review and meta-analysis

Abstract

Background Primary repair of chronic distal biceps tendon ruptures may not be possible because of tendon retraction, and there remains no clear consensus on the type of reconstruction technique used. The purpose of this study was to report the clinical outcomes and complication rates following reconstruction of chronic distal biceps tendon ruptures. Methods A systematic review was performed following PRISMA guidelines. The following databases were searched: Embase, MEDLINE, and Cochrane Central Register of Controlled Trials. The primary outcomes of interest included range of motion, strength, and functional outcome scores. Secondary outcomes included complication, reoperation, and revision rates. Outcomes and complication rates of each graft type and fixation technique were aggregated and compared with nonparametric Wilcoxon signed rank and rank sum tests. Spearman rank coefficients were calculated for time from injury to surgery on all outcomes. Results There were no significant differences found between the graft type or fixation technique for postoperative range of motion, strength, and patient-reported outcomes. Postoperative complications were substantially higher in the autograft group (34%) as compared to the allograft group (14%). The fixation technique used also demonstrated a significantly increased complication rate in the weave group compared with the onlay group (34% and 9%, respectively). Conclusion Our results do not reveal any statistically significant differences between groups in the primary outcomes. However, substantially higher complication rates were observed in the autograft and weave cohorts; more than half of the complications related to the use of autograft were associated with donor site morbidity. No specific graft type was identified as superior, although this may be due to the small patient numbers included within this study.

Chronic Distal Biceps Tendon Tear Reconstruction With Tibialis Anterior Allograft

“…Avoid excessive retraction of lateral antebrachial cutaneous nerve, as this is a common postoperative nerve palsy 13 …”

“…Several techniques and graft choices have been described, with no method found to be superior to others to date. A recent meta-analysis by Litowski et al 13 compared autografts and allografts as well as graft fixation technique and found no difference in postoperative range of motion, strength, patientreported outcomes, or re-rupture rates. The autograft cohort had increased complications due to graft-site morbidity.…”

“…Use gentle retraction when reaming the radial insertion site to avoid posterior interosseous nerve palsy 2. Avoid excessive retraction of lateral antebrachial cutaneous nerve, as this is a common postoperative nerve palsy 13 3. If a short graft is used, may not be able to make several passes through the muscle belly…”

“…A recent review and meta-analysis of these repairs showed no difference in complications between autograft and allograft tendon reconstruction. 13 However, the authors concluded that there is still no consensus on which graft and insertion technique is best. Here, we present a technique using a tibialis anterior allograft and Pulver-Taft implantation method.…”

Staged Achilles Allograft Reconstruction of Chronic Bilateral Simultaneous Tears of the Retracted Distal Biceps Tendon Using a Novel Fixation Technique

“…Chronic distal biceps tendon ruptures are often associated with considerable retraction of the muscle-tendon unit, scarring, and tissue atrophy. Surgical reconstruction, in such situations, is not only technically demanding but also associated with higher complication rates [ 1 , 2 ]. Direct end-to-end repair may still be possible but requires a higher elbow flexion angle, which may result in postoperative failure or flexion contracture [ 3 , 4 ].…”