Distal biceps tendon repair: immobilization versus early mobilization. A systematic review and meta-analysis

Background: Distal biceps brachii tendon avulsions are a significant clinical issue, particularly in physically active, middle-aged men. The choice of postoperative rehabilitation strategy, specifically early mobilization versus immobilization, and the effectiveness of different immobilization tools, remains unclear. Purpose: This study aims to clarify these aspects by analysing the impact of rehabilitation protocols on clinical outcomes following tendon reinsertion. Methods: A detailed systematic literature search was conducted in January 2025 using multiple databases, including PubMed, Web of Science, and grey literature sources. The selection process followed PRISMA guidelines and included 50 studies encompassing 1,577 patients. The primary outcomes assessed were re-rupture rates, DASH scores, and functional outcomes, such as range of motion and strength ratios. The Downs and Black quality assessment checklist was used to evaluate the risk of bias, and the GRADE guidelines were applied to assess the quality of evidence. Results: The meta-analysis showed no significant differences in re-rupture rates, DASH scores, or strength ratios between early mobilization and immobilization groups. Similarly, the type of immobilization tool (splint, sling, or hinged brace) did not significantly affect these outcomes. The overall risk of bias was predominantly rated as poor to fair, and the quality of evidence was low to very low. Conclusion: This study suggests that both early mobilization and immobilization are viable postoperative rehabilitation strategies following distal biceps tendon reinsertion, with no significant difference in patient outcomes. The choice of immobilization tool also does not appear to significantly affect recovery. However, due to the low quality of evidence and risk of bias in the included studies, further high-quality research is needed to establish definitive postoperative care guidelines.