Distal Biceps Tendon Repair in Competitive Strength Athletes: A Retrospective Series of 183 Athletes.

Background: Elbow injuries are common among strength athletes, particularly distal biceps tendon ruptures. These injuries can significantly affect athletes' performance and require effective treatment strategies to ensure optimal recovery and return to sport.

Purpose/hypothesis: The purpose of this retrospective cohort study was to evaluate the patient-reported outcomes, return-to-sport rate, and postoperative strength of competitive strength athletes who underwent distal biceps tendon repair. It was hypothesized that patients would show excellent patient-reported outcomes on validated questionnaires and exhibit high rates of return to sport as well as high subjective strength levels.

Study design: Case series; Level of evidence, 4.

Methods: A retrospective chart review was performed for cases of distal biceps tendon repair in athletes competing in strength sports, such as weightlifting and powerlifting, between August 2003 and July 2020. The preoperative and postoperative sporting activity, mechanism of injury, and complications were assessed. Clinical outcomes were evaluated using the Mayo Elbow Performance Score (MEPS) and the Single Assessment Numeric Evaluation (SANE). Additionally, the athletes were asked to rate their elbow strength as a percentage compared with their uninjured side.

Results: A total of 183 patients were included (88% follow-up rate), with a mean follow-up of 69.6 ± 61.0 months. Among them, 168 underwent primary repair, while 15 underwent revision procedures, of which 7 involved allograft augmentation. All athletes were able to return to sport, and 73% of patients achieved full subjective strength of their affected arm. The median MEPS score was 100 (interquartile range, 100-100), and the median SANE score was 100 (interquartile range, 95-100). Multivariate linear regression analysis showed that an increased time between injury and surgery was associated with a decrease in the MEPS score (standard error [SE] = 0.002; t = -2.113; P = .036) and self-assessed strength (SE = 0.053; t = -3.183; P = .002). Graft usage was associated with a nonsignificant decrease in the SANE score (SE = 1.538; t = -1.791; P = .075). There were 28 complications (15%) that occurred, including 5 tendon retears (3%) and 1 intraoperative brachial artery injury (1%).

Conclusion: Distal biceps tendon repair in competitive strength athletes resulted in a high return-to-sport rate and excellent recovery. However, delayed surgery negatively affected outcomes, and 27% of patients experienced persistent subjective strength deficits. Future research is needed to further optimize treatment strategies for athletes.