Looney and colleagues pooled published outcomes to compare repair with nonoperative treatment of distal biceps ruptures for strength, endurance and patient‑reported function.
PROSPERO‑registered systematic review and meta‑analysis of 62 studies published through 2019, covering 2402 repaired and 79 unrepaired ruptures.
Operative treatment would give significantly better outcomes.
Key Findings
Pooled supination strength was 91.3% of the uninjured side after repair vs 63.7% without it, and flexion strength 96.0% vs 70.3% (both p < .0001).
Supination endurance showed the largest gap, 96.6% after repair vs 62.7% without (p < .0001). Flexion endurance differed less, 97.6% vs 86.5% (p = .027).
Pooled DASH was 8.1 after repair vs 15.9 without (p < .0001). The authors note the gap narrowly misses the 10.8‑point minimal clinically important difference.
MEPS was 95.5 after repair vs 88.1 without (p = .022), a difference the authors judge clinically similar because it falls below 10 points.
Only 79 of 2481 cases were treated nonoperatively, and only 3 studies compared both treatments directly. Motion and pain could not be compared.
Heterogeneity was moderate to considerable (I² 52.54% to 98.49%), and Begg or Egger tests suggested publication bias for endurance, DASH and MEPS.
Authors' conclusion
Although the overall number of patients treated nonoperatively is limited compared with those treated operatively, results demonstrate that operative treatment resulted in superior elbow and forearm strength and endurance, as well as superior DASH and MEPS.
Looney and colleagues pooled published outcomes to compare repair with nonoperative treatment of distal biceps ruptures for strength, endurance and patient‑reported function.
PROSPERO‑registered systematic review and meta‑analysis of 62 studies published through 2019, covering 2402 repaired and 79 unrepaired ruptures.
Operative treatment would give significantly better outcomes.
Key Findings
Pooled supination strength was 91.3% of the uninjured side after repair vs 63.7% without it, and flexion strength 96.0% vs 70.3% (both p < .0001).
Supination endurance showed the largest gap, 96.6% after repair vs 62.7% without (p < .0001). Flexion endurance differed less, 97.6% vs 86.5% (p = .027).
Pooled DASH was 8.1 after repair vs 15.9 without (p < .0001). The authors note the gap narrowly misses the 10.8‑point minimal clinically important difference.
MEPS was 95.5 after repair vs 88.1 without (p = .022), a difference the authors judge clinically similar because it falls below 10 points.
Only 79 of 2481 cases were treated nonoperatively, and only 3 studies compared both treatments directly. Motion and pain could not be compared.
Heterogeneity was moderate to considerable (I² 52.54% to 98.49%), and Begg or Egger tests suggested publication bias for endurance, DASH and MEPS.
Authors' conclusion
Although the overall number of patients treated nonoperatively is limited compared with those treated operatively, results demonstrate that operative treatment resulted in superior elbow and forearm strength and endurance, as well as superior DASH and MEPS.