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Indomethacin Does Not Reduce Heterotopic Ossification In Two-incision Distal Biceps Repairs

Objectives: Our objective was to evaluate whether indomethacin would reduce the incidence of heterotopic ossification (HO) after two-incision distal biceps repairs. Methods: After obtaining IRB approval, all two-incision distal biceps tendon repairs performed between 2008 and 2015 by 17 surgeons in a multi-center (14) integrated, health care system were retrospectively reviewed. Indomethacin use was confirmed by the use of our pharmacy database search of a prescription being filled 10 days prior and up to 6 weeks after to surgery. A minimum of 1 year of follow-up was required for all patients. Variables recorded were patient demographics, time from injury to surgery, re-operation rate, infection, re-rupture, nerve complications, and time to release from medical care. Inclusion criteria included age 18 and over, primary repairs using the two-incision technique with bone tunnel - suture fixation. A Fischer Exact test was performed to test for significance. Results: 146 patients met our inclusion criteria. The average age was 48 years (range: 23-69). All (100%) were male. The non-dominant side was involved in 76 patients (52.1%). There was no difference in age, gender, time from injury to surgery in groups receiving indomethacin to those not receiving it (P>0.05). 109 (74.7%) patients underwent distal biceps repair without indomethacin and 6 (5.5%) patients developed HO. In 37 patients who received indomethacin prophylaxis, 5 (13.5%) patients developed HO. There was no statistically significant difference in HO formation between patients who received indomethacin prophylaxis and those who did not (P=0.14). Conclusion: Based on our findings and the risk of gastrointestinal complications, we do not recommend indomethacin prophylaxis for two-incision distal biceps repairs.