Acute tendon ruptures are not always promptly recognized or referred appropriately, creating a delayed patients presentation to the surgeon. Previous reports have noted an increased complication rate of patients with a delay to surgery, however, there is a paucity of literature reporting functional outcomes of chronic/delayed distal biceps repair.

With our clinical experience, we noticed that a chronic distal biceps tendon rupture can safely be directly repaired to the radial tuberosity. We hypothesized that delayed primary distal biceps tendon repair (>21 days from injury) has similar functional outcomes and complication rate, compared to acute repair. A retrospective case-control study was used to compare the delayed (study) and acute (control) primary distal biceps tendon repair, performed between January 2017 and December 2021. Strength measurements were noted as a percentage of the unaffected contralateral side. Functional outcomes were recorded using the Visual Analog Scale, the Mayo Elbow Performance Score, the short version of the Disabilities of the Arm, Shoulder and Hand score and the Patient-Rated Elbow Evaluation. All questionaries, including Satisfaction, were completed at the final follow-up. All clinical records were evaluated for any adverse events.

We selected 210 out of 217 patients. The study and control cohort consisted of 75 and 135 patients respectively. Time to surgery was 73±66.05 days versus 11.27±5.14 days respectively. At short term (4.79±2.09 months), the functional outcome in terms of Mayo Elbow Performance Score, the short version of the Disabilities of the Arm, Shoulder and Hand score and the Patient-Rated Elbow Evaluation were statistically not significant different (P=0.354, P=0.412 and P=0.958, respectively). The mean flexion and supination strength were respectively 89.19±13.43% and 77.48±16.68%, similar for both cohorts (P=0.476 and P=0.395, respectively). Significantly higher incidence of asymptomatic heterotopic ossification in the control cohort (P=0.006), however not difference in overall complication rate (P=0.072). At long term (28.9±17.9 months), the functional outcomes remain similar.

This study demonstrates that delayed primary distal biceps repair is reliable and overall safe Functional outcomes and strength did not changed with a delayed repair. There was a higher incidence of heterotopic ossification in acute distal biceps repair. The overall complication rate was similar, no matter what time to surgery.