Age is not a contraindication: outcomes of distal biceps tendon repair in elderly patients

Distal biceps tendon ruptures are increasingly common in the elderly, yet no studies have specifically examined surgical outcomes in patients aged more than 65 years. This represents a significant knowledge gap given the growing elderly population and increasing activity levels among older adults. The purpose of this study is to determine major and minor complication rates in patients aged 65 years andmore undergoing surgical repair of distal biceps tendon ruptures and to compare outcomes with a matched younger cohort.

This retrospective cohort study identified 163 patients aged ≥65 years who underwent distal biceps tendon repair at a multifacility orthopedic practice between 2005 and 2025. Patients were matched 1:1 with controls <65 years based on sex, smoking status, and time to surgery. Major complications included rerupture, deep infection, posterior interosseous nerve palsy, symptomatic heterotopic ossification, functional loss of range of motion requiring surgery, proximal radioulnar synostosis, and complex regional pain syndrome. Secondary outcomes included minor complications such as lateral antebrachial cutaneous and radial sensory nerve neuritis, adhesive capsulitis, and reoperation rates.

The mean age was 69.6 ± 4.2 years in the elderly cohort vs. 47.2 ± 8.7 years in controls. The major complication rate was 6.1% in elderly patients vs. 6.7% in controls (P = .822). Rerupture rates were similar between groups (3.1% vs. 3.7%, P = .759). Lateral antebrachial cutaneous nerve neuritis occurred in 9.2% of elderly patients vs. 14.7% of controls (P = .128). Reoperation rates were comparable (6.1% vs. 6.7%, P = .822). No significant differences were observed in individual complication rates between age groups.

Appropriately selected elderly patients aged 65 years and more can undergo surgical repair of distal biceps tendon ruptures with complication and reoperation rates comparable to younger patients. Age alone should not be considered a contraindication to surgical repair in healthy, active elderly patients with adequate functional demands.