Surgical Approach and Re-tear Rates in Distal Biceps Tendon Repairs: A Single-Centre Study

Introduction Distal biceps tendon rupture is a rare yet functionally significant injury, often requiring surgical repair to restore strength and movement. Various surgical approaches exist, with the single-incision and dual-incision techniques being the most common. This study aims to evaluate whether the choice of surgical approach affects re-rupture rates in a high-volume orthopaedic centre. Methods A retrospective review of 259 consecutive distal biceps tendon repairs performed between January 2015 and July 2023 was conducted. All procedures were performed by sub-specialist elbow surgeons using a standardised fixation technique. Patients were categorised into single-incision (n=183) and dual-incision (n=76) groups. Re-rupture rates, post-operative complications, and functional outcomes, including Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores, were analysed. Statistical comparisons were performed using Fisher's exact test and t-tests. Results The overall re-rupture rate was 0.38%, with only one patient experiencing a re-rupture in the single-incision group (0.55%). No significant difference in re-rupture rates was observed between the two approaches (p=1.00). At final follow-up, 90% of patients had no documented functional deficits, and 56% reported no disability based on QuickDASH scores. Conclusion This study demonstrates an exceptionally low re-rupture rate following distal biceps tendon repair, with no significant difference between single- and dual-incision approaches. The findings support the biomechanical integrity of both techniques. Whilst the study is limited by its retrospective design, its large sample size and standardised methodology strengthen its conclusions. Further multi-centre studies are recommended to explore additional risk factors for re-rupture.