Major Complications after Distal Biceps Tendon Repairs: a Retrospective Cohort Analysis over 1000 Cases
Samuel E. Ford, MD1; Jason S Andersen, MD2; David M Macknet, MD1; Patrick M. Connor, MD2; Bryan Loeffler, MD3; Glenn Gaston, MD4; (1)Carolinas Healthcare, Charlotte, NC, (2)OrthoCarolina Sports Medicine Center, Charlotte, NC, (3)Hand Center, OrthoCarolina Hand Center, Charlotte, NC, (4)OrthoCarolina Hand Center, Charlotte, NC
Introduction: The major complication and reoperation rates following distal biceps rupture have been poorly defined in the literature to date. Inconsistent inclusion and categorization of isolated sensory neuroses in the few small published series have led to reported overall complication rates ranging from 15-36%. A larger cohort of data focused on major, clinically impactful complications needs to be examined in order to better define risk for patients undergoing distal biceps repair.
Methods: All distal biceps tendon repairs performed between January 2006 and December 2016 were identified using the CPT code 24342, which identified 1353 cases for review. This CPT code is also used to bill distal triceps tears, which were excluded. The primary outcome variable, total major complication rate, was defined as the sum of following complications: tendon re-rupture, deep infection or post-operative hematoma requiring operative intervention, PIN palsy, symptomatic heterotopic ossification or functional loss of range of motion requiring surgical intervention, proximal radioulnar synostosis, complex regional pain syndrome (CRPS), fascial dehiscence requiring reoperation, and vascular injury. Re-operations and their indication were also tracked. Peripheral sensory nerve numbness or neuritis were tabulated only if they persisted at three month or final follow-up.
Results: 925 distal biceps repairs performed by 72 orthopaedic surgeons were included for analysis. 590 were performed with a single incision technique, while 335 were performed using a two-incision technique. A 7.1% major complication rate and 4.7% reoperation rate was observed. Individual major complications occurred at the following rates: proximal radioulnar synostosis 1.1%, heterotopic ossification or loss of range of motion requiring reoperation 1.3%, tendon re-rupture 1.3%, deep infection 0.4%, PIN palsy 1.8%, and CRPS 0.5%.
Utilization of a two-incision modified Boyd-Anderson technique using bone tunnels and sutures for repair was identified as a significant risk factor for developing proximal radioulnar synostosis when compared with single incision repair techniques (p=0.008). Proximal radioulnar synostosis occurred in 2.7% (9 patients) of those repaired with a 2-incision technique.
Conclusions: Distal biceps repair, a procedure performed adjacent to many critical structures, is associated with 7.1% major complication and 4.7% reoperation rates. The use of a two-incision technique for repair increases the risk of radioulnar synostosis nearly 17 times, while the use of a single-incision approach correlates with a higher rate of minor complications. No difference in frequency of complications was found to correlate with the type of implant used to secure the biceps tendon repair.
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