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Tenodesis is not superior to tenotomy in the treatment of the long head of biceps tendon lesions

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  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

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

  1. Ahmad CS, ElAttrache NS (2003) Arthroscopic biceps tenodesis. Orthop Clin North Am 34(4):499–506

    Article  PubMed  Google Scholar 

  2. Ahrens PM, Boileau P (2007) The long head of biceps and associated tendinopathy. J Bone Joint Surg Br 89(8):1001–1009

    Article  CAS  PubMed  Google Scholar 

  3. Apolone G, Mosconi P (1998) The Italian SF-36 Health Survey: translation, validation and norming. J Clin Epidemiol 51(11):1025–1036

    Article  CAS  PubMed  Google Scholar 

  4. Barber FA, Field LD, Ryu RK (2008) Biceps tendon and superior labrum injuries: decision making. Instr Course Lect 57:527–538

    PubMed  Google Scholar 

  5. 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

    Article  PubMed  Google Scholar 

  6. 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

    PubMed  Google Scholar 

  7. Carroll R, Hamilton L (1967) Rupture of biceps brachii. A conservative method of treatment. J Bone Joint Surg Am 49:1016

    Google Scholar 

  8. 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

    Article  PubMed  Google Scholar 

  9. 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

    Article  PubMed  Google Scholar 

  10. 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

    Article  PubMed  Google Scholar 

  11. Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164

    Google Scholar 

  12. 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

    Article  PubMed  Google Scholar 

  13. 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

    Article  PubMed  Google Scholar 

  14. 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

    Article  PubMed  Google Scholar 

  15. 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

    Article  PubMed  Google Scholar 

  16. 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

    Article  PubMed  Google Scholar 

  17. 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

    Article  PubMed  PubMed Central  Google Scholar 

  18. 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

    Article  CAS  PubMed  Google Scholar 

  19. 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

    Article  PubMed  Google Scholar 

  20. 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

    Article  PubMed  Google Scholar 

  21. 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

    Article  PubMed  Google Scholar 

  22. Kim SH, Yoo JC (2005) Arthroscopic biceps tenodesis using interference screw: end-tunnel technique. Arthroscopy 21(11):1405

    PubMed  Google Scholar 

  23. 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

    Article  PubMed  Google Scholar 

  24. 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

    Article  PubMed  Google Scholar 

  25. 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

    Google Scholar 

  26. 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

    PubMed  PubMed Central  Google Scholar 

  27. 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

    Article  PubMed  Google Scholar 

  28. Patel KV, Bravman J, Vidal A, Chrisman A, McCarty E (2016) Biceps tenotomy versus tenodesis. Clin Sports Med 35(1):93–111

    Article  PubMed  Google Scholar 

  29. Patte D (1990) Classification of rotator cuff lesions. Clin Orthop Relat Res 254:81–86

    Google Scholar 

  30. 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

    Article  CAS  PubMed  Google Scholar 

  31. Post M, Benca P (1989) Primary tendinitis of the long head of the biceps. Clin Orthop Relat Res 246:117–125

    Google Scholar 

  32. 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

    Article  CAS  PubMed  Google Scholar 

  33. 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

    Article  PubMed  Google Scholar 

  34. Soifer TB, Levy HJ, Soifer FM, Kleinbart F, Vigorita V, Bryk E (1996) Neurohistology of the subacromial space. Arthroscopy 12(2):182–186

    Article  CAS  PubMed  Google Scholar 

  35. 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

    PubMed  Google Scholar 

  36. 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

    Article  PubMed  Google Scholar 

  37. 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

    Article  PubMed  Google Scholar 

  38. 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

  39. 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

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

Authors

Contributions

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.

Corresponding author

Correspondence to Olimpio Galasso.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Funding

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

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