Clinical Outcomes After Revision Distal Biceps Tendon Surgery.

BACKGROUND

Little is known about the clinical indications of performing a revision distal biceps tendon repair/reconstruction, and there is even less data available on the clinical outcomes of patients after revision surgery.

PURPOSE

To determine the clinical outcomes of patients undergoing revision distal biceps tendon repair/reconstruction and evaluate the causes of primary repair failure.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

We performed a retrospective review of patients undergoing ipsilateral primary and revision distal biceps tendon repair/reconstruction at a single institution. Between 2011 and 2016, a total of 277 patients underwent distal biceps tendon repair, with 8 patients requiring revision surgery. Patient characteristics, surgical technique, and patient-reported outcome scores (shortened version of Disabilities of Arm, Shoulder and Hand [QuickDASH], 12-Item Short Form Health Survey [SF-12], visual analog scale [VAS] for pain, and Mayo Elbow Performance Score [MEPS]), were assessed. Complications as well as indications for reoperation after primary and revision surgery were examined.

RESULTS

The overall revision rate was 2.9%. The number of single- and double-incision techniques utilized were similar among the primary repairs (50% single-incision, 50% double-incision) and revision repairs/reconstructions (62.5% single-incision, 37.5% double-incision). Reasons for reoperation included continued pain and weakness (n = 7), limited range of motion (n = 2), and acute traumatic re-rupture (n = 1). The median duration between primary and revision surgery was 9.5 months (interquartile range [IQR], 5.8-12.8 months). Intraoperatively, the most common finding during revision was a partially ruptured, fibrotic distal tendon with extensive adhesions. At a median of 33.7 months after revision surgery (IQR, 21.7-40.7 months), the median QuickDASH was 12.5 (IQR, 1.7-23.3), MEPS was 92.5 (IQR, 80.0-100), SF-12 mental component measure was 53.4 (IQR, 47.6-58.2), SF-12 physical component measure was 52.1 (IQR, 36.9-55.4), and VAS for elbow pain was 1.0 (IQR, 0-2.0). Revision surgery had a complication rate of 37.5% (3 of 8 patients), consisting of persistent pain and weakness (2 patients; 25%) and numbness over the dorsal radial sensory nerve (1 patient; 12.5%). Two patients required reoperation (25% reoperation rate).

CONCLUSION

The overall revision distal biceps repair/reconstruction rate was approximately 3%. While patients undergoing revision distal biceps repair demonstrated improved outcomes after revision surgery, these outcomes remained inferior to previously reported outcomes of patients undergoing only primary distal biceps repair.

Informations de copyright

© The Author(s) 2021.

Déclaration de conflit d'intérêts

One or more of the authors has declared the following potential conflict of interest or source of funding: M.S.C. has received faculty/speaker fees from Synthes, consulting fees from Acumed, and royalties from Acumed and Integra LifeSciences. J.J.F. has received education payments from Arthrex. N.N.V. has received research support from Arthrex, Arthrosurface, Athletico, ConMed Linvatec, DJO, Miomed, Mitek, and Ossur; consulting fees from Minivasive, Smith & Nephew, Medacta, Orthospace, and Arthrex; nonconsulting fees from Arthrex; royalties from Smith & Nephew and Vindico Medical–Orthopedics Hyperguide; and stock/stock options from Cymedica, Minivasive, and Omeros. A.A.R. has received research support from Aesculap/B.Braun, Arthrex, Histogenics, Medipost, NuTech, OrthoSpace, Smith & Nephew, and Zimmer; consulting fees and speaking fees from Arthrex; and royalties from Arthrex, Saunders/Mosby-Elsevier, and SLACK. R.M.F. has received grant support from Arthrex, educational payments from Arthrex/Medwest and Smith & Nephew, and royalties from Elsevier. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.