From the Research
Repairing a biceps tendon rupture after it has healed is possible but challenging, and the decision to undergo surgery should be based on the presence of significant pain, weakness, or cosmetic deformity that affects daily activities, as supported by the most recent study 1. The procedure, called chronic biceps tendon reconstruction, may involve tendon grafting using autografts (from your own body) or allografts (donor tissue). The success of this surgery depends on several factors including:
- the time since injury
- the quality of remaining tissue
- the degree of muscle atrophy
- your functional requirements Surgery is generally considered when there is significant pain, weakness, or cosmetic deformity that affects daily activities. Recovery involves immobilization for 1-2 weeks followed by progressive physical therapy for 3-6 months, including range of motion exercises, strengthening, and gradual return to activities. The biological challenge in delayed repair stems from muscle retraction, tissue scarring, and potential degeneration of the muscle-tendon unit over time, which can compromise functional outcomes compared to acute repairs performed within the first few weeks after injury, as noted in 2 and 3. However, a recent systematic review and meta-analysis 1 found that operative treatment resulted in superior elbow and forearm strength and endurance, as well as superior patient-reported outcomes, compared to nonoperative management. Another study 4 found that patients with complete or partial distal biceps tendon ruptures achieved satisfactory outcomes regardless of whether they were treated nonoperatively or with an anatomic single-incision approach. A survey of the British Elbow and Shoulder Society surgical membership 5 found that most surgeons advise surgical repair of acute distal biceps tendon ruptures for the majority of their patients, despite a paucity of evidence to support improved outcomes following surgical, rather than non-operative, management. Overall, the decision to undergo surgery for a biceps tendon rupture after it has healed should be based on individual factors and the presence of significant symptoms, and should be made in consultation with a qualified healthcare professional.