Complications of Distal Biceps Tendon Repair: A Meta-analysis of Single-Incision Versus Double-Incision Surgical Technique

Abstract

Background: Anatomic reinsertion of the distal biceps is critical for restoring flexion and supination strength. Single- and double-incision surgical techniques have been reported, analyzing complications and outcomes measures. Which technique results in superior clinical outcomes and the lowest associated complications remains unclear.

Hypothesis: We hypothesized that rerupture rates would be similar between the 2 techniques, while nerve complications would be higher for the single-incision technique and heterotopic ossification would be more frequent with the double-incision technique.

Study design: Systematic review and meta-analysis; Level of evidence, 4.

Methods: A systematic review was conducted using the PubMed, MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), SPORTSDiscus, and the Cochrane Central Register of Controlled Trials databases to identify articles reporting distal biceps ruptures up to August 2013. We included English-language articles on adult patients with a minimum of 3 cases reporting single- and double-incision techniques. Frequencies of each complication as a percentage of total cases were calculated. Fisher exact tests were used to test the association between frequencies for each repair method, with P < .05 considered statistically significant. Odds ratios with 95% CIs were also computed.

Results: A total of 87 articles met the inclusion criteria. Lateral antebrachial cutaneous nerve neurapraxia was the most common complication in the single-incision group, occurring in 77 of 785 cases (9.8%). Heterotopic ossification was the most common complication in the double-incision group, occurring in 36 of 498 cases (7.2%).

Conclusion: The overall frequency of reported complications is higher for single-incision distal biceps repair than for double-incision repair. The frequencies of rerupture and nerve complications are both higher for single-incision repairs while the frequency of heterotopic ossification is higher for double-incision repairs. These findings can help surgeons make better-informed decisions about surgical technique and provide their patients with detailed information about expected outcomes and possible complications.

Keywords: complications; distal biceps nerve injuries; distal biceps repair.

Figure 1.

Flowchart of study inclusion.

Figure 2.

Forest plot of distal biceps repair complications. The plot shows the odds ratio (OR) with a 95% CI for single-incision versus double-incision distal biceps repair. An OR <1 indicates that double-incision was associated with a greater complication rate; an OR >1 indicates that single-incision was associated with a greater complication rate. LABC, lateral antebrachial cutaneous nerve; PIN, posterior interosseous nerve.