Purpose
Early repair of distal biceps ruptures is recommended to avoid a more extensive surgical approach or need for reconstruction. The purpose of this meta-analysis was to compare function, patient reported outcomes (PROs) and complications of acute and chronic distal biceps tendon ruptures (DBTR). We hypothesized that treatment of acute ruptures would be associated with superior outcomes as compared to chronic ruptures.
Methods
Systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta Analysis (PRISMA) guidelines. Articles were reviewed by two reviewers to identify studies reporting outcomes following DBTR and included time from injury to surgery. Chronic DBTR was defined as repair being performed more than 4 weeks from injury.
Results
62 studies met inclusion criteria and were included in the analysis for at least one variable. Flexion-extension range of motion (ROM) (P = .510), supination (P = .456) and pronation (P = .260) ROM, flexion (P = .471) and supination (P = .419) strength and flexion endurance (P = .124) did not differ between acute vs chronic repairs. Supination endurance was significantly greater with acute repairs in multiple moderator analysis (17.55%; 95% CI, 1.83% to 33.27%; P = .029). The Disabilities of the Arm, Shoulder and Hand (DASH) score (P = .916) and the Mayo Elbow Performance Score (MEPS) (P = .742) did not differ between acute and chronic repairs. In multiple moderator analysis chronic repair was associated with a greater proportion of complications (P = .025), but no difference in rate. Again, in multiple moderator analysis controlling for fixation and approach chronic repairs were associated with a significantly greater proportion of infections (P = .011). Lastly, there was no significant difference between acute and chronic repairs in the proportion of sensory nerve complications (P = .134), proportion of failures (P = .612), or proportion of cases affected by heterotopic ossification (HO) (P = .308).
Conclusions
Acute repairs had better supination endurance, a lower proportion of complications, and a lower rate of subsequent surgery as compared to chronic repairs.