Treatment of acute distal biceps tendon ruptures – a survey of BESS surgical membership

Background: Acute distal biceps tendon (DBT) ruptures result in weakness and deformity. While in other jurisdictions the rate of surgical repair has outpaced rises in incidence, UK practice for DBT ruptures is unknown. The aim of this survey was to characterise current UK clinical practice. Methods: An online survey was sent to the surgeon members of the British Elbow and Shoulder Society (BESS). Questions covered respondent demographics, clinical decision making, surgical experience and willingness to be involved in future research. Results: 242 surgeons responded. 99% undertook acute DBT repairs with 83% repairing at least half of all DBT ruptures. 84% of surgeons would have their own, hypothetical, acute DBT rupture repaired in their dominant arm and 67% for their nondominant arm. Patient age, occupation and restoration of strength were the commonest factors underpinning a recommendation of surgical fixation. Most surgeons (87%) supported a national trial to study operative and non-operative treatments. Discussion: UK upper limb surgeons currently advise surgical repair of acute DBT ruptures for the majority of their patients. This is despite a paucity of evidence to support improved outcomes following surgical, rather than non-operative, management. There is a clear need for robust clinical evaluation in this area.