Postoperative rehabilitation and return to sport criteria following distal biceps tendon rupture surgery

Background: Within the clinical literature, there is no consensus on optimal rehabilitation for return to sport (RTS) after distal biceps tendon rupture (DBTR) repair. The authors hypothesize that surgeons will utilize time-based criteria for RTS rather than performance-based or functional criteria for RTS. Methods: Level 1-4 studies that evaluated DBTR with a minimum of 12 months follow-up were eligible. Exclusion criteria included studies that treated DBTR nonoperatively, lacked RTS criteria, or included revision surgery. Studies were evaluated for RTS criteria, timeline/rate of RTS, and methodologic quality. Results: Out of 671 studies identified, 5 met inclusion criteria. These included 268 patients playing 22 different sports. Timeline for return ranged from 3 to 130 weeks. Range of motion exercises followed by strengthening (100%) and multiphase rehabilitation program (100%) were the most common parameters emphasized in rehabilitation protocols, followed by immediate postoperative cast/splint immobilization (80%). All studies included a timeline for RTS; however, no article listed subjective or specific objective measurement criteria for RTS. Conclusion: There is no consensus on RTS criteria in the literature. Eighty percent of the included studies reported utilizing initial cast/splint immobilization; 100% reported a multiphase program consisting of some form of progressive range of motion followed by strengthening. Sixty percent reported a supervised physical therapy routine. One hundred percent reported timing after surgery as a criterion for RTS, but this timing varied greatly across the included studies.