No Clinically Significant Differences in Patient-Reported Outcomes and Range of Motion Between Early and Delayed Mobilization After Primary Distal Biceps Tendon Repair: A Systematic Review and Meta-analysis

Background: Currently, there is no uniform rehabilitation program concerning mobilization after a distal biceps tendon repair. A systematic review was conducted to investigate the effect of restrictions within the immediate postoperative period to evaluate clinical outcomes relative to mobilization after surgical repair of complete distal biceps tendon tears.Hypothesis: Early mobilization will not have a significant difference on outcomes compared with delayed mobilization.Study Design: Meta-analysis; Level of evidence, 3.Methods: The authors performed a systematic review in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines of studies reporting outcomes of the distal biceps tendon repair. The early mobilization cohort included studies with no restrictions beyond 2 weeks after surgery, and the delayed mobilization cohort included studies with continued restrictions beyond 2 weeks after surgery.Results: A total of 26 studies with 1114 patients (643 in the delayed mobilization cohort and 471 in the early mobilization cohort) met the inclusion criteria, with a weighted mean patient age of 45.14 years (range, 18-76 years) and a mean follow-up of 27.9 months (range, 3-120 months). Meta-analysis at the 24-month follow-up found that range of motion (ROM) was not significantly different across early and delayed mobilization cohorts for flexion (mean, 137.38 degrees vs 140.42 degrees; P = .34) and extension (mean, 3.23 degrees vs 1.5 degrees; P = .91). Early mobilization was found to be significantly associated with less pronation (mean, 75.68 degrees vs 83.18 degrees; P = .0019) and supination (mean, 76.38 degrees vs 83.93 degrees; P = .0049). Analysis of patient-reported outcomes (PROs) found that Disabilities of the Arm, Shoulder and Hand scores (mean, 3.93 vs 4.21; P = .77) and Mayo Elbow Performance Score values (mean, 96.33 vs 97.11;P = .65) were not significantly different across cohorts. Failure analysis found a significant difference when comparing proportion (mean, 0.0006 vs 0.0185; P = .0029) but no difference when comparing incidence rate (mean, 0.0001 vs 0.0001; P = .647). Complication analysis found no statistical difference in proportion (mean, 0.2181 vs 0.1918; P = .7388) or incidence rate (mean, 0.0012 vs 0.008; P = .344).Conclusion: These results suggest there may be no clinically significant difference in failure rates, complications, ROM, or PROs for early versus delayed mobilization after primary distal biceps tendon repair.