Summary
The current results show no statistical correlation between the degree of acute distal biceps tendon retraction and the short-term functional PROM results as well as the activities of daily life.
Abstract
Background
Distal biceps tendon (DBT) ruptures mostly occur in middle-aged men and usually require surgical reconstruction. Studies demonstrate postoperative good results in strength, range of motion (ROM) and return to previous levels of activity. However, in some cases limited ROM, persisting pain and re-ruptures are observed. The aim of this prospective study is to establish the severity of the injury with a combination of patient-reported outcome measures (PROMs) and radiological imaging of the retraction distance of the ruptured DBT.
Methods
The current on-going prospective bi-center study collects peri- and postoperative results of surgically reconstructed DBT ruptures including clinical examination with ROM and PROMs such as Disabilities of Arm, Shoulder and Hand (DASH), Patient-Rated Elbow Evaluation (PREE), Oxford-Elbow-Score (OES) and EQ-5D. Inclusion criteria are patients 18 and above years of age with a clinical and MRI documented primary DBT rupture. Planned follow-up (FU) time points are at 6 weeks, 3, 6, 12 and 24 months.
Results
Currently, nineteen male patients are enrolled with a FU time of 6+ months. Results at 6 weeks demonstrate no significant differences in flexion, supination and pronation, but the extension showed significant differences to the contralateral side of 9.2° (±3.6°) (p>0.05). After 3 months, there no significant differences anymore between both sides. At 6 months, the PROMs demonstrate continuous improvement with the mean PREE being 1.2 (14 pre-op) points, the DASH 3.7 (11 pre-op) points, the OES was 46.2 (22 pre-op) points and the EQ-5D was 0.9. The MRI scans demonstrate a mean retraction distance of the DBT of 4.8 (± 3.9) cm. A correlation analysis of the retraction distance and the ROM as well as the obtained PROMs only revealed a poor correlation (r < 0.3). Up to date there were no complications.
Conclusions
The main portion (approx. 90%) of the treated patients successfully reached the original ROM at 3 months. The PROMs PREE, DASH, Oxford and EQ-5D demonstrate a significant improvement of activities of daily living (ADL), but mid-term results are pending in order to better interpret the outcomes. The current results show no statistical correlation (p<0.05) between the degree of tendon retraction and the short-term functional PROM results as well as the ADL. As the recruitment and the mid- to long-term FU is still ongoing, the upcoming data will potentially strengthen current trends.