Complications from a Distal Bicep Repair: A Meta-Analysis of a Single Incision Versus Double Incision Surgical Technique

OBJECTIVES: Anatomical reinsertion of the distal biceps is critical for restoring elbow flexion and forearm supination strength. Surgical techniques utilizing one and two incisions have been reported in the literature, describing complications and outcomes. However, which technique is associated with a lower complication rate remains unclear. METHODS: A systematic review was conducted using the PubMed, Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), SPORTSDiscus, and the Cochrane Central Register of Controlled Trials database to identify articles reporting distal biceps ruptures through August 2013. We included English language publications based on adult patients with a minimum of three cases. Both single and dual incision technique studies were incorporated. The demographic and outcome data of all studies was retrieved and pooled. A Meta-analysis on the pooled data was then conducted to determine the role of surgical technique on different complications. This was adjusted for age, gender and other independent variables. RESULTS: Fifty-five articles met the inclusion criteria. The complication rate in the single incision group was 28.3% (222/785) versus 20.9% (104/498) in the double incision group. Neuropraxia was the most common complication in the single incision group at 9.8% (77/785), while heterotopic ossification was the most common in double incision cases at 7% (35/498). Re-rupture and failed reattachment occurred in 2.5% of single incision cases, versus 0.6% of double-incision cases (p < 0.034). Posterior interosseous nerve (PIN) palsy occurred in 2.7 % (13/785) of single incision procedures versus 0.2% (1/498) in the double incision group (p< 0.001). When combining heterotopic ossification and synostosis rates, the double incision group demonstrated complications in 9.8% of cases versus 3.2% for single incision cases. CONCLUSION: Surgical intervention for distal biceps ruptures may help restore function to an active individual; however, this procedure is not without risk of complications. The single incision technique has a higher rate of failed re-attachment and re-rupture compared to the double incision technique. The single incision technique also has a higher rate of overall nerve palsy (PIN, LABC, and Radial Nerve) compared to the double incision technique. The double incision technique does have higher rates of HO compared to the single incision. These complications are important for surgeons to consider and disclose to patients deciding on operative repair.