Thirty-Six Percent Conversion to Surgery Rate for Nonsurgical Treatment of Complete and Partial Distal Biceps Tears

This purpose of this study was to evaluate the patient-reported outcomes of surgically and nonsurgically treated complete and partial distal biceps tears (DBTs) and report the conversion-to-surgery rate for patients initially treated nonsurgically.

A retrospective cohort study was conducted of patients with DBTs treated surgically or nonsurgically at a single, large institution. Patients were identified through an international classification of disease code query of our institution's database from January 1, 2018, to December 31, 2022. Records were reviewed for demographics and to confirm DBT diagnosis via magnetic resonance imaging. Patients completed shortened Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaires for treatment and outcome assessment. Regression analyses were performed to compare QuickDASH scores and the rate of achieving a patient-acceptable symptom state (PASS).

Of 1,549 patients surveyed, 488 responses were received (32% response rate), with a mean follow-up of 43.9 months. Among respondents, 423 were treated surgically, and 65 were treated nonsurgically. The conversion-to-surgery rate was 36%, with no significant differences between partial (34%) and complete tears (39%) (P = .7). For complete tears, regression analysis found that surgery was associated with better QuickDASH scores (adjusted mean difference -4.92, 95% confidence interval [CI] -9.75 to -0.09), but there was no difference in PASS achievement rate (odds ratio 3.01, 95% CI 0.90-8.69). For partial tears, there was no difference in QuickDASH score or PASS achievement rate between treatment groups; however, female sex was a predictor of worse QuickDASH scores (adjusted mean difference 25.50, 95% CI 13.65-37.35).

Surgical management of DBTs was a predictor of improved patient-reported outcomes only for patients with complete tears. For patients initially treated nonsurgically, the conversion-to-surgery rate was 36%. Nonsurgical treatment of DBTs remains a reasonable first-line option as most patients achieve an acceptable symptom state.

Therapeutic III.