JSES - 2026-05-12 - Journal Article
Age Is Not a Contraindication: Outcomes of Distal Biceps Tendon Repair in Elderly Patients.
Dib A, Kammire M, Rieker M, Padley J, Graham D, Arendale R, Gachigi K, Hamid N
Topics
Key Takeaway
Elderly patients (≥65 years) undergoing distal biceps repair had a major complication rate of 6.1% versus 6.7% in matched younger controls (p=0.822), with no significant difference in any individual complication.
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Summary
This study asked whether patients ≥65 years face higher complication rates after distal biceps repair compared to younger patients. A 1:1 sex-, smoking-, and time-to-surgery-matched retrospective cohort from a multi-facility practice (2005–2025) compared major and minor complication rates. Major complications (6.1% vs 6.7%), re-rupture (3.1% vs 3.7%), LABCN neuritis (9.2% vs 14.7%), and reoperation rates (6.1% vs 6.7%) were all statistically equivalent between groups.
Key Limitation
Absence of functional outcome data (strength, supination endurance, patient-reported outcomes) means the study cannot confirm that equivalent complication rates translate to equivalent functional benefit in elderly patients.
Original Abstract
BACKGROUND
Distal biceps tendon ruptures are increasingly common in the elderly, yet no studies have specifically examined surgical outcomes in patients over 65 years of age. This represents a significant knowledge gap given the growing elderly population and increasing activity levels among older adults.
PURPOSE
To determine major and minor complication rates in patients aged 65 years and older undergoing surgical repair of distal biceps tendon ruptures and to compare outcomes with a matched younger cohort.
METHODS
This retrospective cohort study identified 163 patients aged ≥65 years who underwent distal biceps tendon repair at a multi-facility orthopedic practice between 2005 and 2025. Patients were matched 1:1 with controls <65 years based on sex, smoking status, and time to surgery. Major complications included re-rupture, deep infection, posterior interosseous nerve palsy, symptomatic heterotopic ossification, functional loss of range of motion requiring surgery, proximal radioulnar synostosis, complex regional pain syndrome. Secondary outcomes included minor complications such as lateral antebrachial cutaneous and radial sensory nerve neuritis, adhesive capsulitis and reoperation rates.
RESULTS
The mean age was 69.6±4.2 years in the elderly cohort versus 47.2±8.7 years in controls. The major complication rate was 6.1% in elderly patients versus 6.7% in controls (p=0.822). Re-rupture rates were similar between groups (3.1% vs 3.7%, p=0.759). Lateral antebrachial cutaneous nerve neuritis occurred in 9.2% of elderly patients versus 14.7% of controls (p=0.128). Reoperation rates were comparable (6.1% vs 6.7%, p=0.822). No significant differences were observed in individual complication rates between age groups.
CONCLUSIONS
Appropriately selected elderly patients aged 65 years and older can undergo surgical repair of distal biceps tendon ruptures with complication and reoperation rates comparable to younger patients. Age alone should not be considered a contraindication to surgical repair in healthy, active elderly patients with adequate functional demands.