Amarasooriya and colleagues pooled the reported complications of primary distal biceps repair and compared them by surgical approach and fixation method.
PROSPERO‑registered systematic review of 72 studies from 1998 to 2019, covering 3091 primary repairs of complete ruptures.
Key Findings
Complications were reported after 25% of 3091 repairs, and major complications after 4.6%.
Lateral antebrachial cutaneous nerve injury was the most common complication (9.2%). Of these, 64% resolved, 10% persisted and the rest were unreported.
Posterior interosseous nerve injury occurred in 1.6%, and 47 of 51 recovered without surgery. Its rate did not differ significantly by approach or fixation.
Cortical buttons had the highest LABCN injury rate, 18.6%, vs 7.7% with suture anchors and 5.9% with bone tunnels (p ≤ .001).
Rerupture occurred in 1.4% and did not differ by fixation method (0.8% with buttons vs 1.7% with anchors, not significant). All 4 synostoses followed two‑incision repair.
Most included studies were Level 4, with a weighted mean follow‑up of 22 weeks. The authors regard the rates as minimums because complications tend to be underreported.
Board pearl
Limited anterior incisions had more LABCN injuries than extensile ones. The rate was 9.7% vs 5.2% (p = .03), which the authors suggest may reflect traction, while extensile incisions injured the superficial radial nerve more often (6% vs 2.1%).
Authors' conclusion
This is the largest analysis of complications after distal biceps repair, indicating a major complication rate of 4.6%. This study provides valuable data with regard to the choice of technique, surgical approach, and rate of complications, which is essential for surgical planning and patient consent.
Amarasooriya and colleagues pooled the reported complications of primary distal biceps repair and compared them by surgical approach and fixation method.
PROSPERO‑registered systematic review of 72 studies from 1998 to 2019, covering 3091 primary repairs of complete ruptures.
Key Findings
Complications were reported after 25% of 3091 repairs, and major complications after 4.6%.
Lateral antebrachial cutaneous nerve injury was the most common complication (9.2%). Of these, 64% resolved, 10% persisted and the rest were unreported.
Posterior interosseous nerve injury occurred in 1.6%, and 47 of 51 recovered without surgery. Its rate did not differ significantly by approach or fixation.
Cortical buttons had the highest LABCN injury rate, 18.6%, vs 7.7% with suture anchors and 5.9% with bone tunnels (p ≤ .001).
Rerupture occurred in 1.4% and did not differ by fixation method (0.8% with buttons vs 1.7% with anchors, not significant). All 4 synostoses followed two‑incision repair.
Most included studies were Level 4, with a weighted mean follow‑up of 22 weeks. The authors regard the rates as minimums because complications tend to be underreported.
Board pearl
Limited anterior incisions had more LABCN injuries than extensile ones. The rate was 9.7% vs 5.2% (p = .03), which the authors suggest may reflect traction, while extensile incisions injured the superficial radial nerve more often (6% vs 2.1%).
Authors' conclusion
This is the largest analysis of complications after distal biceps repair, indicating a major complication rate of 4.6%. This study provides valuable data with regard to the choice of technique, surgical approach, and rate of complications, which is essential for surgical planning and patient consent.