Primary Repair of Traumatic Distal Biceps Ruptures in a Military Population: Clinical Outcomes of Single- Versus 2-Incision Technique

Purpose: To determine the success of distal biceps repair in a high-demand military population and to comparatively evaluate the perioperative risk profile, functional results, and adverse patient outcomes of a single- versus 2-incision technique within this high-risk group.

Methods: Between 2007-2013, all military service members undergoing primary surgical repair for distal biceps rupture through the Military Health System were isolated. Patients with allograft tendon reconstruction, revision procedures, nonmilitary status, and/or follow-up of less than 24 month were excluded. Demographic data (age, limb dominance) and surgical variables (time to surgery, surgical technique) were extracted, and rates of perioperative complications, rerupture, reoperation, revision, and inability to return to preinjury function were recorded. Logistic regression analysis was performed to evaluate for prognostic risk factors, whereas the Fisher exact test was used for comparative analysis.

Results: A total of 290 patients met the inclusion criteria, including 44 (15.2%) with a delayed presentation; all patients were men, with an average age of 38.9 years (range, 20-61 years). A single-incision technique was performed in 75.4% (n = 214) versus a 2-incision technique in 24.6% (n = 70), and a cortical button was the predominant fixation construct (73.4%). Reruptures occurred in 7 patients (2.4%), and 3 individuals (1.0%) had significant elbow dysfunction postoperatively. When we compared the overall complication rates, the 2-incision technique (7.1%, n = 5) was not significantly different from the single-incision repair (16.4%, n = 35; P = .0732). Tobacco use was significantly associated with risk of rerupture (odds ratio, 4.86; P = .0423) or combined surgical and clinical failures (odds ratio, 5.64; P = .0091), whereas age, limb dominance, time to surgery, fixation construct, and surgical technique were not statistically significant (P > .05).

Conclusions: Among active patients, a single-volar incision technique and a 2-incision technique showed similar complication profiles. Rerupture and persistent elbow dysfunction were uncommon, but adverse outcomes were significantly more likely among patients who used tobacco. Anatomic distal biceps repair is a safe surgical procedure with excellent clinical outcomes and a 96.6% rate of return to preoperative military function without restrictions.

Level of evidence: Level III, retrospective comparative study.