Abstract
Purpose
To compare the effectiveness of tenodesis and tenotomy in the treatment of long head of the biceps tendon (LHBT) lesions. The null hypothesis was that there is no difference in functional scores between the tenotomy and tenodesis groups.
Methods
A total of 69 patients with a combined supraspinatus tear and LHBT lesion aged over 40 years entered this prospective comparative study and were randomly assigned to the arthroscopic LHB tenotomy or tenodesis group. Fifty-five patients (31 in the tenotomy group and 24 in the tenodesis group) were available for the 6- and 24-month post-operative evaluations.
Results
There were no statistically significant differences in post-operative Constant and Murley score, quality of life, pain, and strengths between groups. Higher rates of Popeye’s sign were noted 6 and 24 months post-operatively in the tenotomy group compared to tenodesis.
Conclusions
Although tenotomy is affected by a higher incidence of cosmetic deformity, there is no superiority of arthroscopic tenodesis over tenotomy in the treatment of LHBT lesion as a concomitant procedure to an arthroscopic repair of the supraspinatus tendon in terms of functional outcomes, quality of life, pain, and strength measured 6 and 24 months post-operatively.
Level of evidence
I.
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References
Ahmad CS, ElAttrache NS (2003) Arthroscopic biceps tenodesis. Orthop Clin North Am 34(4):499–506
Ahrens PM, Boileau P (2007) The long head of biceps and associated tendinopathy. J Bone Joint Surg Br 89(8):1001–1009
Apolone G, Mosconi P (1998) The Italian SF-36 Health Survey: translation, validation and norming. J Clin Epidemiol 51(11):1025–1036
Barber FA, Field LD, Ryu RK (2008) Biceps tendon and superior labrum injuries: decision making. Instr Course Lect 57:527–538
Beall DP, Williamson EE, Ly JQ, Adkins MC, Emery RL, Jones TP, Rowland CM (2003) Association of biceps tendon tears with rotator cuff abnormalities: degree of correlation with tears of the anterior and superior portions of the rotator cuff. AJR Am J Roentgenol 180(3):633–639
Boileau P, Baqué F, Valerio L, Ahrens P, Chuinard C, Trojani C (2007) Isolated arthroscopic biceps tenotomy or tenodesis improves symptoms in patients with massive irreparable rotator cuff tears. J Bone Joint Surg Am 89(4):747–757
Carroll R, Hamilton L (1967) Rupture of biceps brachii. A conservative method of treatment. J Bone Joint Surg Am 49:1016
Castricini R, De Benedetto M, Familiari F, De Gori M, De Nardo P, Orlando N, Gasparini G, Galasso O (2016) Functional status and failed rotator cuff repair predict outcomes after arthroscopic-assisted latissimus dorsi transfer for irreparable massive rotator cuff tears. J Shoulder Elbow Surg 25(4):658–665
Castricini R, Gasparini G, Di Luggo F, De Benedetto M, De Gori M, Galasso O (2013) Health-related quality of life and functionality after reverse shoulder arthroplasty. J Shoulder Elbow Surg 22(12):1639–1649
Constant CR, Gerber C, Emery RJ, Søjbjerg JO, Gohlke F, Boileau P (2008) A review of the constant score: modifications and guidelines for its use. J Shoulder Elbow Surg 17(2):355–361
Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164
De Carli A, Vadalà A, Zanzotto E, Zampar G, Vetrano M, Iorio R, Ferretti A (2012) Reparable rotator cuff tears with concomitant long-head biceps lesions: tenotomy or tenotomy/tenodesis? Knee Surg Sports Traumatol Arthrosc 20(12):2553–2558
Delle Rose G, Borroni M, Silvestro A, Garofalo R, Conti M, De Nittis P, Castagna A (2012) The long head of biceps as a source of pain in active population: tenotomy or tenodesis? A comparison of 2 case series with isolated lesions. Musculoskelet Surg 96(Suppl 1):S47–S52
Franceschi F, Longo UG, Ruzzini L, Papalia R, Rizzello G, Denaro V (2007) To detach the long head of the biceps tendon after tenodesis or not: outcome analysis at the 4-year follow-up of two different techniques. Int Orthop 31(4):537–545
Frost A, Zafar MS, Maffulli N (2009) Tenotomy versus tenodesis in the management of pathologic lesions of the tendon of the long head of the biceps brachii. Am J Sports Med 37(4):828–833
Gasparini G, De Benedetto M, Cundari A, De Gori M, Orlando N, McFarland EG, Galasso O, Castricini R (2016) Predictors of functional outcomes and recurrent shoulder instability after arthroscopic anterior stabilization. Knee Surg Sports Traumatol Arthrosc 24(2):406–413
Ge H, Zhang Q, Sun Y, Li J, Sun L, Cheng B (2015) Tenotomy or tenodesis for the long head of biceps lesions in shoulders: a systematic review and meta-analysis. PLoS ONE 10(3):e0121286
Gill TJ, McIrvin E, Mair SD, Hawkins RJ (2001) Results of biceps tenotomy for treatment of pathology of the long head of the biceps brachii. J Shoulder Elbow Surg 10(3):247–249
Gurnani N, van Deurzen DF, Janmaat VT, van den Bekerom MP (2015) Tenotomy or tenodesis for pathology of the long head of the biceps brachii: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 24(12):3765–3771
Hsu AR, Ghodadra NS, Provencher MT, Lewis PB, Bach BR (2011) Biceps tenotomy versus tenodesis: a review of clinical outcomes and biomechanical results. J Shoulder Elbow Surg 20(2):326–332
Kelly AM, Drakos MC, Fealy S, Taylor SA, O’Brien SJ (2005) Arthroscopic release of the long head of the biceps tendon: functional outcome and clinical results. Am J Sports Med 33(2):208–213
Kim SH, Yoo JC (2005) Arthroscopic biceps tenodesis using interference screw: end-tunnel technique. Arthroscopy 21(11):1405
Koh KH, Ahn JH, Kim SM, Yoo JC (2010) Treatment of biceps tendon lesions in the setting of rotator cuff tears: prospective cohort study of tenotomy versus tenodesis. Am J Sports Med 38(8):1584–1590
Lee HJ, Jeong JY, Kim CK, Kim YS (2016) Surgical treatment of lesions of the long head of the biceps brachii tendon with rotator cuff tear: a prospective randomized clinical trial comparing the clinical results of tenotomy and tenodesis. J Shoulder Elbow Surg 25(7):1107–1114
Mariani E, Cofield R, Askew L, Li G, Chao E (1988) Rupture of the tendon of the long head of the biceps brachii: surgical versus nonsurgical treatment. Clin Orthop Relat Res 228:233–239
McFarland EG, Maffulli N, Del Buono A, Murrell GA, Garzon-Muvdi J, Petersen SA (2013) Impingement is not impingement: the case for calling it “Rotator Cuff Disease”. Muscles Ligaments Tendons J 3(3):196–200
Osbahr DC, Diamond AB, Speer KP (2002) The cosmetic appearance of the biceps muscle after long-head tenotomy versus tenodesis. Arthroscopy 18(5):483–487
Patel KV, Bravman J, Vidal A, Chrisman A, McCarty E (2016) Biceps tenotomy versus tenodesis. Clin Sports Med 35(1):93–111
Patte D (1990) Classification of rotator cuff lesions. Clin Orthop Relat Res 254:81–86
Patzer T, Habermeyer P, Hurschler C, Bobrowitsch E, Paletta JR, Fuchs-Winkelmann S, Schofer MD (2011) Increased glenohumeral translation and biceps load after SLAP lesions with potential influence on glenohumeral chondral lesions: a biomechanical study on human cadavers. Knee Surg Sports Traumatol Arthrosc 19(10):1780–1787
Post M, Benca P (1989) Primary tendinitis of the long head of the biceps. Clin Orthop Relat Res 246:117–125
Sakurai G, Ozaki J, Tomita Y, Nakagawa Y, Kondo T, Tamai S (1998) Morphologic changes in long head of biceps brachii in rotator cuff dysfunction. J Orthop Sci 3(3):137–142
Shank JR, Singleton SB, Braun S, Kissenberth MJ, Ramappa A, Ellis H, Decker MJ, Hawkins RJ, Torry MR (2011) A comparison of forearm supination and elbow flexion strength in patients with long head of the biceps tenotomy or tenodesis. Arthroscopy 27(1):9–16
Soifer TB, Levy HJ, Soifer FM, Kleinbart F, Vigorita V, Bryk E (1996) Neurohistology of the subacromial space. Arthroscopy 12(2):182–186
Tashjian RZ, Henn RF, Kang L, Green A (2006) Effect of medical comorbidity on self-assessed pain, function, and general health status after rotator cuff repair. J Bone Joint Surg Am 88(3):536–540
Walch G, Edwards TB, Boulahia A, Nové-Josserand L, Neyton L, Szabo I (2005) Arthroscopic tenotomy of the long head of the biceps in the treatment of rotator cuff tears: clinical and radiographic results of 307 cases. J Shoulder Elbow Surg 14(3):238–246
Wittstein JR, Queen R, Abbey A, Toth A, Moorman CT 3rd (2011) Isokinetic strength, endurance, and subjective outcomes after biceps tenotomy versus tenodesis: a postoperative study. Am J Sports Med 39(4):857–865
Yamaguchi K, Keener J, Galatz L (2007) Disorders of the biceps tendon. In: Iannotti J, Williams G (eds) Disorders of the shoulder: diagnosis and management vol 1, 2nd edn. Lippincott, Williams & Wilkins, Philadelphia, pp 218–260
Zhang Q, Zhou J, Ge H, Cheng B (2015) Tenotomy or tenodesis for long head biceps lesions in shoulders with reparable rotator cuff tears: a prospective randomised trial. Knee Surg Sports Traumatol Arthrosc 23(2):464–469
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RC conceived of the study and performed all surgeries. MDB and NO collected the data. FF, MDG, and DAR drafted the manuscript. MDG performed the statistical analysis. OG and GG conceived of the study and participated in its design and coordination and helped to draft the manuscript. All authors read and approved the final manuscript.
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The authors declare that they have no competing interests.
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No fundings were received for this study.
Ethical approval
The study protocol was approved by the local ethical committee (Villa Maria Cecilia Hospital, no. 03/2012), and the research was performed in compliance with the Helsinki Declaration.
Informed consent
All the patients gave informed consent for participation in this study.
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Castricini, R., Familiari, F., De Gori, M. et al. Tenodesis is not superior to tenotomy in the treatment of the long head of biceps tendon lesions. Knee Surg Sports Traumatol Arthrosc 26, 169–175 (2018). https://doi.org/10.1007/s00167-017-4609-4
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DOI: https://doi.org/10.1007/s00167-017-4609-4