Treatment Delay and Type of Retraction Affect the Surgical Treatment of Distal Biceps Tendon Ruptures: A Quantitative Analysis of 123 Patients

<b>Introduction</b>: This study aimed to quantitatively evaluate the effect of the trauma to surgery time interval (Tt-Ts) and the type of tendon retraction (unretracted vs. coiled) in distal biceps tendon ruptures (DBTRs) on the choice between primary tendon repair (PR) and tendon reconstruction with graft (RG). <b>Materials and Methods</b>: In total, 123 patients with surgically treated DBTRs were analyzed. Patients were divided into three groups: Group I-acute (75 patients with Tt-Ts < 21 days), Group II-subacute (20 patients with Tt-Ts between 21 and 45 days), and Group III-chronic (28 patients with Tt-Ts > 45 days). The type of surgical treatment (PR vs. RG) was evaluated in each group. The type of tendon retraction (unretracted vs. coiled) was analyzed in subacute and chronic lesions. A statistical analysis was performed. <b>Results:</b> The mean Tt-Ts interval in the overall sample was 59.3 days; in Group I, it was 9 days (range, 2-20); in Group II, it was 29 days (range, 22-42); and in Group III, it was 196 days (range, 45-1095). PR was performed in 100%, 90%, and 29% of the patients in Groups I, II, and III, respectively. Coiled tendons were found in 60% and 71% of patients in Groups II and III, respectively. Among patients with coiled tendons, 2 and 20 received RG in Groups II and III, respectively. The Tt-Ts and the type of retraction were significantly associated with the choice of surgical treatment (PR vs. RG), with statistical differences between Group III and the other two groups (<i>p</i> < 0.05). A cut-off of 43.5 days following injury was found to predict the need to perform RG with an accuracy, sensitivity, and specificity of 94%, 100%, and 92%, respectively. The likelihood of receiving RG rather than PR increased each day by 6%. <b>Conclusions</b>: Treatment delay significantly affects the choice of surgical technique in DBTRs. PR is feasible in 98% of acute and subacute ruptures, whereas RG is necessary in 70% of chronic ruptures. The type of tendon retraction affects the choice of treatment only in chronic lesions, as coiled tendons always require RG.