Clinical outcomes following treatment of distal biceps tendon partial tears and tendinopathy: a systematic review

Background: While operative treatment of complete distal biceps tendon ruptures yields superior outcomes compared to nonoperative treatment, surgical indications and optimal treatment algorithms remain uncertain for distal biceps tendinopathy and partial tears. The purpose of this systematic review was to summarize the current literature on both operative and nonoperative treatment of distal biceps tendinopathy and partial tears. Methods: A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines by searching PubMed, MEDLINE, EMBASE, and the Cochrane Library. Clinical studies reporting outcomes following operative and/or nonoperative treatment of distal biceps tendinopathy and/or partial tears were included. Extracted data included study and patient characteristics, treatment details including postintervention rehabilitation, patient-reported outcomes, and complications. Where possible, comparisons between treatment strategy (operative vs. nonoperative) and tendon pathology (tendinopathy vs. partial tears) were made, albeit meta-analysis was not appropriate as no level I or II comparative studies exist. Results: Thirty studies were included, totaling 614 patients with 500 partial tears (81.4%) and 114 tendinopathies (18.6%). Operative treatment was performed in 20 studies, nonoperative treatment in 5 studies, and both operative and nonoperative treatment in 5 studies. Diagnosis was made by advanced imaging, most commonly magnetic resonance imaging, in 27 of 30 studies, and further aided by variable physical examination maneuvers. Generally, both operative and nonoperative management were reported to be effective in alleviating elbow pain and restoring function, although there was a propensity to treat tendinopathy nonoperatively and partial tears operatively. When reported, there were similar outcomes for full vs. partial tears and tendinopathy vs. partial tears as well as operative vs. nonoperative treatment strategies; however, low-level evidence and study heterogeneity prevented data pooling and statistical comparisons. Conclusion: A systematic review of the current literature on clinical outcomes following treatment of distal biceps tendinopathy and/or partial tears found that both operative and nonoperative strategies can improve elbow pain and restore function. At present, operative treatment is commonly recommended for partial tears, especially in high demand individuals. Nonoperative treatment is the initial strategy for tendinopathy and/or low-demand patients with partial tears. Future studies are needed to define surgical indications and elucidate optimal treatment algorithms.