[Proximal and distal biceps tendon rupture--an indication for surgery?]

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Musculoskeletal Research

Background:

• Distal biceps tendon ruptures can occur in active individuals, leading to significant functional deficits.
• Review of literature comparing conservative and operative management strategies for these injuries is crucial.
• Understanding the outcomes and complication profiles of different surgical techniques is essential for patient care.

Purpose of the Study:

• To evaluate the efficacy of operative repair versus conservative management for distal biceps tendon ruptures.
• To compare different surgical techniques, including reinsertion to the brachialis muscle and anatomic reinsertion.
• To assess the impact of surgical repair on muscle strength, deformity, and complication rates.

Main Methods:

• Systematic literature review of conservatively and operatively treated cases of distal biceps tendon rupture.
• Analysis of 77 conservatively treated and 164 operatively treated cases for long head of biceps rupture.
• Review of 13 re-examined patients after operative repair for distal biceps tendon avulsion and 277 reported cases.

Main Results:

• Refixation of the long head of the biceps provides a modest but consistent improvement in flexion and supination strength.
• Conservative management of distal biceps tendon avulsion results in persistent weakness (30-40% flexion, >50% supination).
• Anatomic reinsertion reduces supination loss to 0-25% but carries a higher risk of complications; attachment to brachialis is safer but less effective for supination.

Conclusions:

• Operative treatment for distal biceps tendon rupture should be recommended for young, active patients and offered to less active individuals.
• Surgical repair can effectively correct deformity and significantly reduce residual weakness.
• The optimal surgical method for distal biceps tendon rupture repair should be individualized based on patient factors and desired outcomes.