and thank you to my co-authors without whom this would not be possible. All of our disclosures are available on the Academy website. Distal biceps tears, although uncommon, representing only three percent of all biceps tendon tears, continue to result in significant pain and functional limitations for our patients. Incidence of distal biceps tears has been increasing over the last 20 years and partial thickness tears have been noted to typically involve the distal tendon of the short head. The incidence, long-term outcomes, and risk factors for progression to surgery remain unknown for partial thickness distal biceps tears. Therefore, the purpose of our study was to identify patient demographics and treatment strategies, to report on the long-term outcomes of partial thickness distal biceps tendon tears, and to report any identifiable risk factors for progression of surgery or tear completion. This is a retrospective study. Data was collected from 1996 to 2016 utilizing the Rochester Epidemiology Project, which is a geographic cohort representative sample of the United States population. We included all MRI-confirmed partial thickness distal biceps tears, and we excluded any absence of distal biceps tear on MR, any evidence of a full thickness distal biceps tear on MR, or patients who we did not have available clinical follow-up for. Ultimately, 381 patients were identified with MR-confirmed distal biceps tears, and after application of our exclusion criteria, we included 111 individuals in our study. Mean follow-up for the operative patients was about 10.3 years versus 9.7 years for the non-operative patients, and very similar numbers with 54 patients undergoing surgical repair and 57 undergoing non-operative management of their partial thickness distal biceps tear. The mean age for all tears in this cohort was 53.6 years. Most of our patients were male laborers and had exposure to tobacco. Interestingly, in this cohort, the injury did occur more frequently on the non-dominant limb. Looking at our outcomes, both cohorts achieved favorable outcomes at long-term follow-up, so you can see here similar numbers in both groups and similar mean follow-up, very similar mean arc range of motion at final follow-up, similar numbers of elbow flexion and supination weakness at final follow-up, equivalent return to work without modification percentages at 88 for both groups, and as you might expect, our operatively treated patients did miss more time from work than our non-operatively treated patients. Looking further at our outcomes, of those 54 patients who were treated operatively, the median time from injury to surgery was 101 days, and compared to the non-surgical patients, the operatively treated patients were more likely to be male or to experience a sensation of popping, ripping, or tearing at the time of the injury, and objectively demonstrated the following physical exam findings, abnormal hook test, tenors palpation at thin insertion, weakness of elbow flexion, and supination weakness. We then further investigated these physical exam findings with the use of a multivariate logistic progression to identify any independent predictors for progression to surgery. We identified that supination weakness with an odds ratio of 24.8 at initial presentation was the strongest predictor for progression to surgery in this cohort. In our cohort of operatively treated patients, only five patients at the time of surgery were noted to have full thickness tears, meaning only five patients of the partial thickness tendon tear group that went to the OR were noted to have progressed to a full thickness tendon tear in the OR. You can see that preoperatively on the MR there was a nice distribution in terms of the amount of the bicep tendon tear that was partially torn, and on the right you can see that our most common construct was a two incision technique with cortical button fixation in this cohort, but there was a significant amount of heterogeneity. Our study is not without limitations. This is a retrospective study and it was non-randomized in nature. We only included MRI-confirmed partial thickness distal bicep tear, so certainly we didn't catch everybody who came through in that 20-year period, and multiple operative approaches were utilized without any standardization of post-operative treatment. In conclusion, patients sustaining a partial thickness distal bicep tendon tear were commonly male laborers in their early 50s, current or former tobacco users with an injury on their non-dominant limb. The clinical outcomes were favorable for patients treated non-operatively or with surgery. Approximately 50 percent of patients went on to be treated surgically, and patients with supination weakness were 24 more times likely to undergo surgery. Only five percent of patients progressed to a full thickness tendon tear during our study period, and the majority of those did occur within the first three months from injury. Thank you very much for your time.

distal biceps tears

retrospective study

patient demographics

treatment strategies

long-term outcomes