Return to Sport After Distal Biceps Tendon Repair: A Systematic Review

Background: Ruptures of the distal biceps tendon (DBT) can affect the range of motion and strength of the elbow, raising concerns for patients seeking to restore normal function and engage in their regular activities, particularly returning to previous levels of sport participation. Purpose: To characterize and assess the rate and timing of return to sport (RTS) after DBT repair. Study Design: Systematic review; Level of evidence, 4. Methods: PubMed, Embase, and Google Scholar (pages 1-20) were searched from database inception to December 6, 2023 for clinical studies reporting RTS outcomes after DBT repair. The extracted data consisted of patient characteristics; information on the incision approach, fixation method, and rehabilitation protocol; and outcome data including RTS rates, patient-reported outcome measure scores, and complications. Results: A total of 42 studies, including 1093 patients (1100 elbows), met the inclusion criteria. The mean age of patients was 44.9 years, and 99.2% of patients were male. The mean follow-up time was 31.5 months. Ruptures were acute in 87.6% of cases, the dominant arm was injured in 64.9%, and the cause of the injury was sport related in 43.5%. The overall RTS rate was 91.5%, with 85.2% of patients returning to preinjury levels or higher, at a mean time of 6.3 months. Patients had excellent functional outcomes, irrespective of the incision approach or fixation method, although trends associated with a higher RTS rate were observed with bone tunnel fixation, ≤2 weeks of postoperative immobilization, early initiation of active range of motion postoperatively, and initiation of strengthening at ≤10 weeks. Single-incision repair had higher rates of nerve-related complications and reruptures compared with double-incision repair, and cortical button fixation had a higher rate of nerve-related complications among the fixation methods. Conclusion: There was a high rate of RTS after DBT repair at 6 months postoperatively. A positive trend for RTS was observed with respect to rehabilitation protocols favoring earlier active mobility.