Operative repair of acute distal biceps tendon ruptures has been shown to result in improved elbow flexion and supination strength when compared with nonoperative management. However, with reconstruction of chronic distal biceps tendon ruptures, the proportion of patients that achieved 90% strength of the contralateral limb after reconstruction is reportedly 65% for peak supination torque and 62% for peak flexion torque.

Data from a large US private-payer insurance provider (PearlDiver Patient Record Database; PearlDiver Technologies) identified that chronic distal biceps tendon rupture repairs (using the International Classification of Diseases, Ninth Revision, Clinical Modification code 727.69) account for 19% of all distal biceps tendon repairs.

Several studies have reported on the outcomes of surgical management of acute distal biceps injuries. However, there is a paucity of literature reporting outcomes after surgical treatment of chronic distal biceps ruptures. A recent study comparing acutely treated distal biceps ruptures with chronic distal biceps ruptures has shown a higher complication rate in the latter. At least 90% of the complications in the chronic group were transient paresthesia’s. Another study demonstrated successful outcomes of long-delayed (4 years) reconstruction of a distal biceps tendon rupture; however, article was a single case report. We not only have limited patient numbers but also a large knowledge gap pertaining to surgical management of chronic distal biceps ruptures.

Distal biceps ruptures have been classified as chronic anywhere from 2 to 6 weeks after injury. Here, we define chronic distal biceps ruptures as rupture persisting beyond 21 days of injury, as described previously. The significant variability in defining chronicity is a direct result of the lack of literature on this topic. Our rationale in choosing 21 days to define “chronic” was not only based on previously seen definitions but also because the complication rate variability between chronic and acute ruptures were already apparent at that time point.

Currently, there is no systematic review of the literature evaluating outcomes after chronic distal biceps repair or reconstruction. Counseling patients on outcomes and complications of chronic distal biceps injuries is difficult. The primary purpose of this systematic review was to evaluate functional outcomes in patients undergoing surgical treatment of chronic distal biceps ruptures. It was hypothesized that overall outcomes are successful when managing chronic distal biceps ruptures surgically, which yields an acceptable complication profile.

Methods

Identification of Studies

A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist. This protocol was registered with PROSPERO (international prospective register of systematic reviews). A literature search was conducted using Medline (PubMed and Ovid), EMBASE, CINAHL physical therapy, Cochrane Database of Systematic Reviews and Central Register of Controlled Trials, and PubMed Central. The search terms used in the Ovid Medline search are provided in Appendix All databases were searched from their inception, except Medline, which was searched from 1946 onward owing to online availability, until September 29, 2020. All studies evaluating chronic distal biceps tendon tears were identified.