Return to sport and weightlifting analysis following distal biceps tendon repair

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.

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.

Acute Distal Biceps Tendon Injury: Diagnosis and Treatment

Acute distal biceps injuries clinically present with sudden pain and acute loss of flexion and supination strength. The main injury mechanism occurs during the eccentric load of the biceps. The hook test is the most significant examination test, presenting the highest sensibility and specificity for this lesion. Magnetic resonance imaging, the gold standard imaging test, can provide information regarding integrity and identify partial and/or complete tears. The surgical treatment uses an anterior or double approach and several reattachment techniques. Although there is no clinical evidence to recommend one fixation method over the other, biomechanical studies show that the cortical button resists better to failure. Although surgical treatment led to an 89% rate of return to work in 14 weeks, the recovery of high sports performance occurred in 1 year, with unsustainable outcomes.

Return to sports following distal biceps tendon repair: A current concepts review

Distal biceps tendon ruptures are relatively rare injuries but tend to occur in active and athletic populations, especially in weightlifting and contact sports. The distal biceps tendon is an important supinator of the forearm and flexor of the elbow, thus an injury to this ligament can be invalidating for athletes. The aim of this review was to determine the ability and the time to return to sports following distal biceps tendon repair in athletes and the level of performance. The literature is scarce about the return to sports among athletes. Most studies include athletes are National Football League (NFL) players, others are weightlifters and a few recreational athletes. The return to play rate after distal biceps tendon repair is high. The performances of the returned players were similar to matched players and most players returned to the same level. Most players-depending on the sport-were not able to return to competition within the same season. In order to manage expectations, it should be discussed preoperatively with the athlete (and their coach) that the return to sports rate is high, but the return will probably be the following season.

Common Orthopaedic Injuries in CrossFit Athletes

CrossFit is a high-intensity exercise program that has gained popularity over the past few decades. CrossFit combines movements from Olympic weight lifting, gymnastics, powerlifting, and high-intensity interval training. As CrossFit continues to expand, knowledge of the associated orthopaedic injuries to aid providers in diagnosis, treatment, and prevention will be increasingly important. The most common CrossFit injuries occur in the shoulder (25% of all injuries), spine (14%), and knee (13%). Male athletes are markedly more likely to experience injuries than female athletes, and injuries occur markedly less when there is supervised coaching of the athletes. The most common causes of injury in CrossFit include improper form and exacerbation of a prior injury. The purpose of this article was to review the literature to aid clinicians in identifying and treating common orthopaedic injuries in CrossFit athletes. Understanding the injury patterns, treatment, and prevention options is important for a successful recovery and return to sport.

Systematic review of distal biceps tendon rupture in athletes: treatment and rehabilitation

BACKGROUND

Distal biceps tendon rupture is a rare injury associated with decreased elbow flexion and forearm supination strength. This impairment is not tolerated by high-demand patients like athletes.

PURPOSE

To review treatment and rehabilitation applied to injured athletes and study their impact in return to sports.

METHODS

MEDLINE, Cochrane, Web of Science, and Scopus online databases were searched. A systematic review was conducted using the PRISMA guidelines; studies published on distal biceps tendon rupture treatment and rehabilitation of athletes until June 30, 2021, were identified. A quantitative synthesis of factor related to return to preinjury sport activity was made.

RESULTS

Ten articles were identified, including 157 athletes. Mean age was 40.5 years, and the dominant arm was injured in 103 cases (66%). Rupture was acute in 121 athletes (77%), and the mean follow-up was 25.7 months. A hundred and fifty-three athletes (97.5%) successfully returned to sport within a mean time of 6.2 months. Surgical treatment was followed in all cases. One-incision technique was chosen in 115 (73%) and suture anchor fixation in 52 (33%) cases. No postsurgical immobilization was reported in 38 (24%) and immobilization for 2 weeks in 124 (79%) athletes. Decreased supination-pronation and flexion-extension arc was found in 63 (40%) and 27 (17%) cases, respectively. Earlier return to sport was associated with nondominant-side (P = .007) and acute (P < .001) injuries, participation in weightlifting (P = .001), double-incision approach (P = .005), cortical button fixation (P < .001), and absence of supination-pronation restriction (P = .032). Time of return to sport activity was independent of rehabilitation, including immobilization (P = .539) and strengthening (P = .155), and decreased flexion-extension arc (P = .059).

CONCLUSION

Athletes sustaining distal biceps tendon rupture have a high postoperative return to sport rate, independently of selected surgical technique or rehabilitation program. However, a relation between the surgical technique and time of return to sport was found. Rehabilitation did not influence time of return to sport.

Golf and Health, More than 18 Holes—A Bibliometric Analysis

Despite golf’s contribution to health, scientific production related to golf and health has been relatively scarce. This work aims to investigate the state of the art on golf and health and to identify existing gaps and the principal and most notable potential future research trends, contributing to connecting the reality of the facilities dedicated to the practice of this sport and its contribution to raising awareness of the importance of sport in maintaining health. A total of 179 articles were analyzed following the steps for systematic reviews and meta-analysis protocols based on the PRISMA 2020 methodology and QUORUM, and a bibliometric analysis was carried out. Research to date has mainly focused on the benefits of golf in improving health, preventing illness, slowing down aging, or as rehabilitation and on exploring the risks and injuries involved in playing golf. The different ways of promoting participation or changing the image of golf by showing its healthy side are outlined as research trends in the coming years. There is a lack of exploration of the use of technology, the effects of the sport on certain disorders related to psychosocial factors, and further knowledge of the relationships between playing intentions and health. This research provides essential information for researchers who plan to work with golf in the future.

Return to Play After Distal Biceps Tendon Repair

PURPOSE OF REVIEW

Distal biceps tendon ruptures (DBTR) are uncommon injuries in 40- to 50-year-old men but occur at a younger age in the athlete population. The distal biceps tendon is an important supinator of the forearm and flexor of the elbow. A complete injury results in limiting function in the upper extremity. The current review evaluates the different options in management and the current literature on return to play in athletes.

RECENT FINDINGS

The distal biceps tendon inserts on the posterior aspect of the radial tuberosity as two independent heads. The long head footprint is more proximal and posterior giving it a better lever arm for supination. The short head footprint is more distal and anterior giving it a better lever arm for flexion. Surgical anatomic repair is highly recommended among the athlete population, to restore proper function of the upper extremity. There is scarce literature on return to play among athletes. The most recent studies on high-performance athletes are on National Football League (NFL) players. These studies showed that 84-94% of NFL players returned to play at least one game after distal biceps repair. Compared to matched control groups, there was no difference in the player's performance after surgery. Anatomic repair of DBTR results in excellent outcomes, high return to work, and high rate of return to play among athletes. When compared to matched control groups, NFL players have the performance score and play the same number of games after surgery.