Effect of time from injury to surgery on surgical technique and complication rate in distal biceps tendon repair

Laura J Morrison; Chloe Elliott; Bayan Ghalimah; Eric C Sayre; Neil J White

doi:10.1016/j.jse.2025.07.027

Effect of time from injury to surgery on surgical technique and complication rate in distal biceps tendon repair

J Shoulder Elbow Surg. 2025 Sep 1:S1058-2746(25)00627-5. doi: 10.1016/j.jse.2025.07.027. Online ahead of print.

Authors

Laura J Morrison¹, Chloe Elliott², Bayan Ghalimah³, Eric C Sayre⁴, Neil J White⁵

Affiliations

¹ University of Calgary, Calgary, Alberta, Canada; South Health Campus Research Unit for Bone and Soft Tissue, Calgary, Alberta, Canada. Electronic address: drlauramorrison@gmail.com.
² South Health Campus Research Unit for Bone and Soft Tissue, Calgary, Alberta, Canada.
³ King Abdulaziz University, Jeddah, Saudi Arabia.
⁴ British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada.
⁵ University of Calgary, Calgary, Alberta, Canada; South Health Campus Research Unit for Bone and Soft Tissue, Calgary, Alberta, Canada.

PMID: 40902709
DOI: 10.1016/j.jse.2025.07.027

Abstract

Background: Surgical treatment options for distal biceps tendon ruptures vary based on time from injury to surgery. While direct repair (DR) is preferred for acute injuries, high flexion angle (HFA) repair and allograft reconstruction (AR) are alternatives for chronic cases. This study examines the relationship between time to surgery, surgical technique selection, and complication rates.

Methods: A retrospective chart review was conducted on patients treated surgically for distal biceps tendon ruptures at a single center from January 2012 to June 2023. Cases were identified through electronic medical records and included patients aged ≥ 18 years with unilateral ruptures. Demographics, time to surgery, surgical techniques (DR, HFA repair, and AR), and complications were recorded. Descriptive statistics and multinomial logistic regression were used to assess the association between time to surgery and surgical technique.

Results: A total of 373 patients were included, with 90% undergoing DR (n = 334), 6% HFA repair (n = 22), and 5% AR (n = 17). The mean (standard deviation) time from injury to surgery was 16 (± 30) days for DR, 82 (± 162) days for HFA repair, and 274 (± 455) days for AR. Surgical technique selection was significantly associated with time to surgery (Kruskal Wallis P < .001), with DR favored in acute cases and HFA repair/AR in chronic presentations. The inflection point for equal probabilities of DR, HFA repair, and AR occurred at 25-27 weeks postinjury. The overall complication rate was 12% (n = 45), with nerve injuries being the most common (7%, n = 25).

Conclusion: Timing significantly impacts surgical technique selection in distal biceps tendon ruptures. DR remains the standard for acute injuries, while HFA repair and AR are viable options for chronic cases. The multinomial probability graphic can be used to educate and counsel patients on surgical decision-making for chronic distal biceps ruptures.

Keywords: Distal biceps tendon rupture; allograft reconstruction; chronic injuries; complication rates; direct repair; high flexion angle repair; surgical timing; upper extremity surgery.