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Review
. 2021 Oct 29;9(10):23259671211037311.
doi: 10.1177/23259671211037311. eCollection 2021 Oct.

Operative Versus Nonoperative Management for Distal Biceps Brachii Tendon Lesions: A Systematic Review and Meta-analysis

Marco Cuzzolin  1 , Davide Secco  1 , Enrico Guerra  2 , Sante Alessandro Altamura  2 , Giuseppe Filardo  1   3 , Christian Candrian  1   4
Affiliations
Review

Operative Versus Nonoperative Management for Distal Biceps Brachii Tendon Lesions: A Systematic Review and Meta-analysis

Marco Cuzzolin et al. Orthop J Sports Med. .

Abstract

Background: Both nonoperative and operative treatments have been proposed to manage distal biceps brachii tendon avulsions. However, the advantages and disadvantages of these approaches have not been properly quantified.

Purpose: To summarize the current literature on both nonoperative and operative approaches for distal biceps brachii tendon ruptures and to quantify results and limitations. The advantages and disadvantages of the different surgical strategies were investigated as well.

Study design: Systematic review; Level of evidence, 4.

Methods: A systematic literature search was performed in March 2020 using PubMed Central, Web of Science, Cochrane Library, MEDLINE, Iscrctn.com, clinicaltrials.gov, greylit.org, opengrey.eu, and Scopus literature databases. All human studies evaluating the clinical outcome of nonoperative treatment as well as different surgical techniques were included. The influence of the treatment approach was assessed in terms of the Disabilities of the Arm, Shoulder and Hand (DASH) score and the Mayo Elbow Performance Index; extension, flexion, supination, and pronation range of motion (ROM); and flexion and supination strength ratio between the injured and uninjured arms. Risk of bias and quality of evidence were assessed using the Cochrane guidelines.

Results: Of 1275 studies, 53 studies (N = 1380 patients) matched the inclusion criteria. The results of the meta-analysis comparing operative versus nonoperative approaches for distal biceps tendon avulsion showed significant differences in favor of surgery in terms of DASH score (P = .02), Mayo Elbow Performance Index (P < .001), flexion strength (94.7% vs 83.0%, respectively; P < .001), and supination strength (89.2% vs 62.6%, respectively; P < .001). The surgical approach presented 10% heterotopic ossifications, 10% transient sensory nerve injuries, 1.6% transient motor nerve injuries, and a 0.1% rate of persistent motorial disorders. Comparison of the different surgical techniques showed similar results for the fixation methods, whereas the single-incision technique led to a better pronation ROM versus the double-incision approach (81.5° vs 76.1°, respectively; P = .01).

Conclusion: The results of this meta-analysis showed the superiority of surgical management over the nonoperative approach for distal biceps tendon detachment, with superior flexion and supination strength and better patient-reported outcomes. The single-incision surgical approach demonstrated a slightly better pronation ROM compared with the double-incision approach, whereas all fixation methods led to similar outcomes.

Keywords: avulsion; biceps brachii distal tendon lesion; detachment; nonoperative treatment; rupture; surgical treatment.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: C.C. has received grants from Medacta International, Johnson & Johnson, Lima, Zimmer Biomet, and Oped. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart of the article selection process.
Figure 2.
Figure 2.
Included studies in the surgical group by level of evidence (LOE), technique, and fixation method.
Figure 3.
Figure 3.
Forest plot for the analysis on (A) flexion strength and (B) supination strength. MRAW, raw mean.
See this image and copyright information in PMC

References

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