Primary Repair of Traumatic Distal Bicep Ruptures: Effect of 1 vs. 2-Incision Technique


      There is no consensus on the optimal method for surgical management, and rates of perioperative complications and re-rupture may vary widely. The purpose of this study was to determine success of distal biceps repair in active cohorts.


      All U.S. military servicemembers undergoing primary surgical repair for confirmed distal biceps rupture through the Military Health System were isolated between 2007-2013. Demographic variables (age, gender, and hand dominance) and surgical variables [time to surgery, surgical technique (e.g. single- vs. two-incision), method of fixation were extracted. Rates of perioperative complications, recurrent distal biceps rupture, reoperation, and revision repair were evaluated.


      A total of 303 surgical repairs were performed for traumatic distal biceps rupture, including 19% for subacute or chronic ruptures (e.g. >30 days after injury). The cohort was exclusively male with an average age of 39 years(range,20-61). The median time to the surgery was 13 days(range,1-365) and the majority of cases were performed using a single-incision volar technique(77%). Cortical button accounted for at least 87% of all repairs, as opposed to suture anchors(8.3%) and interference screw fixation (4.4%). At an average 51-month follow-up, a total of 46 complications(15%) occurred, including traction neuropraxia(n=24,7.9%; lateral antebrachial cutaneous nerve,n=13,4.3%), recurrent rupture (n=10; 3.3%), heterotopic ossification (n=8; 2.6%), superficial infection(n=2;0.7%), radial neck fracture(n=1;0.3%). When compared to two-incision technique (11.9%), complications were not significantly greater with single-incision repairs 19.7%;p=0.22). Similarly, the rate of re-rupture after primary repair with one- (n=8; 4.0%) and two-incision(n=2; 3.4%) was not significantly different(p=0.82). Only two patients underwent medical discharge due to persistent elbow pain after surgery(0.7%).


      There were no statistically significant differences in the rate of complications and/or re-rupture after single or two-incision distal biceps repair. In an active patient population, re-rupture (3.3%) or other complications (11.8%) can be anticipated with 99.6% return to military duty after primary biceps repair.