Title : Operative versus nonoperative outcomes: A cohort study on distal biceps tendon rupture
Abstract:
Background: Distal biceps tendon rupture is an uncommon injury affecting predominantly middle-aged men. Comparative outcome data between operative and nonoperative management remain limited. This study aimed to evaluate both approaches within a single UK centre.
Methods: A retrospective cohort study was conducted at Queen's Hospital Burton, including 72 male patients (52 operative, 20 nonoperative) with confirmed complete distal biceps tendon ruptures between 2016 and 2023. Operative repair employed single anterior incision or modified two-incision technique with cortical button fixation. Outcomes assessed included complications, range of motion, and return to activity over a minimum six-month follow-up.
Results: Complications occurred in 36.5% of operative patients, including transient neurapraxia (13.5%), reduced range of motion (19.2%), lateral cutaneous nerve injury (5.8%), cubital tunnel syndrome (3.8%), and isolated cases of posterior interosseous nerve palsy, arterial injury, wound infection, and granuloma. No re-ruptures were recorded. The nonoperative group reported zero complications, with all patients returning to pre-injury activity levels. Mild subjective supination weakness was noted in a few nonoperative cases without functional impact.
Conclusion: Nonoperative management offers excellent functional outcomes with a favourable safety profile, making it a viable option for selected patients. Operative repair provides superior supination strength recovery but carries significant morbidity. Treatment should be individualised based on patient activity demands, comorbidities, and risk tolerance. Prospective studies utilising validated outcome measures are needed to refine patient selection criteria.
