Abstract
Introduction
Full thickness rotator cuff tears are a common cause of shoulder pain and disability. While the role of the rotator cuff seems to be well known, the clinical significance of the biceps tendon for shoulder function has still been a subject of controversy. The aim of this study was to evaluate differences between tenodesis or tenotomy in simultaneous rotator cuff repair.
Methods
For this retrospective study 53 consecutive patients (25f/28m, Ø age 58 years) undergoing arthroscopic double row rotator cuff reconstruction and suture bridge repair were included. The LHB was treated with tenodesis (n = 24) or tenotomy (n = 29). Clinical examination was carried out for all patients after an average of 34 months (range 27–38) following arthroscopic surgery. The Constant score, level of pain, range of motion in flexion and abduction, and isometric force for the operated and healthy shoulder in flexion and abduction were recorded.
Results
Patients in the tenodesis and tenotomy group reached similar good result regarding the Constant score (86.6 ± 11.9 vs. 81.3 ± 12.2; P = 0.120), pain (median 0, range 0–8 vs. Median 0, range 0–10; P = 0.421), and range of motion (flexion: median 180°, range 90°–180° vs. median 180°, range 90°–180°; P = 0.833; abduction: median 180°, range 90°–180° vs. median 180°, range 120°–180°; P = 0.472). Postoperative popeye sign was found only in one patient (1.9 %). At the time of postoperative follow-up, no patient reported cramping of the biceps. Isometric forces in abduction of the tenotomy group (mean 4.7 ± 2.9 kg; maximum 5.5 ± 2.8 kg) was significant lower compared to the tenodesis group (mean 6.6 ± 3.0 kg, P = 0.019; maximum 7.7 ± 2.9 kg, P = 0.007) and compared to healthy shoulders (mean 6.1 ± 3.0 kg P = 0.004; maximum 7.4 ± 3.1 kg, P = 0.001), all other measurements were similar.
Conclusion
According to our results arthroscopic biceps tenodesis and tenotomy are valuable procedures in simultaneous rotator cuff repair regarding function, pain, and range of motion. However, the tenotomy group showed reduced strength in abduction.
Level of evidence
Level IV, retrospective case series.
Similar content being viewed by others
References
Andrews JR, Carson WG Jr, McLeod WD (1985) Glenoid labrum tears related to long head of the biceps. Am J Sports Med 13:337–341
Bennet WF (2003) Arthroscopic repair of isolated subscapularis tears: a prospective cohort with 2- to 4-year follow-up. Arthroscopy 19(2):131–143. doi:10.1053/jars.2003.50053
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. doi:10.2106/JBJS.E.01097
Boileau P, Krishan SG, Coste JS, Walch G (2002) Arthroscopic biceps tenodesis: a new technique using bioabsorbable interference screw fixation. Arthroscopy 18(9):1002–1012. doi:10.1053/jars.2002.36488
Cofield RH (1985) Rotator cuff disease oft he shoulder. J Bone Joint Surg Am 67(6):974–979
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. doi:10.1007/s00167-012-1918-5 (Epub 2012 Feb 15)
Edwards TB, Walch G, Sirveaux F, Molé D, Nové-Josserand L, Boulahia A, Neyton L, Szabo I, Lindgren B (2005) Repair of tears of the subscapularis. J Bone Joint Surg Am 87(4):725–730. doi:10.2106/JBJS.D.02051
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. doi:10.1177/0363546508322179 (Epub 2008 Sep 1)
Habermeyer P, Magosch P, Pritsch M, Scheibel MT, Lichtenberg S (2004) Anterosuperior impingement of the shoulder as a result of pulley lesions: a prospective arthroscopic study. J Shoulder Elbow Surg 13(1):5–12. doi:10.1016/j.jse.2003.09.013
Itoi E, Kuechle DK, Newman SR, Morrey BF, An KN (1993) Stabilising function of the biceps in stable and unstable shoulders. J Bone Joint Surg Br 75:546–550
Jones CK, Savoie FH 3rd (2003) Arthroscopic repair of large and massive rotator cuff tears. Arthroscopy 19(6):564–571. doi:10.1016/S0749-8063(03)00169-5
Kido T, Itoi E, Konno N, Sano A, Urayama M, Sato K (2000) The depressor function of biceps on the head of the humerus in shoulders with tears of the rotator cuff. J Bone Joint Surg Br 82:416–419
Kho KH, Ahn SH, 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. doi:10.1177/0363546510364053. (Epub 2010 Jun 15)
Kumar VP, Satku K, Balasubramaniam P (1989) The role of the long head of the biceps brachii in the stabilization of the head of the humerus. Clin Orthop Relat Res 244:172–175
Lee HI, Shon MS, Koh KH, Lim TK, Heo J, Yoo JC (2014) Clinical and radiologic results of arthroscopic biceps tenodesis with suture anchor in the setting of rotator cuff tear. J Shoulder Elbow Surg 23(3):e53–e60. doi:10.1016/j.jse.2013.06.004 (Epub 2013 Sep 8)
Lyons TR, Savoie FH 3rd, Field LD (2001) Arthroscopic repair of partial-thickness tears of the rotator cuff. Arthroscopy 17(2):219–223
Millet PJ, Mazzocca A, Guanche CA (2004) Mattress double anchor footprint repair: a novel, arthroscopic rotator cuff repair technique. Arthroscopy 20(8):875–879. doi:10.1016/j-arthro.2004.07.015
Pagnani MJ, Deng XH, Warren RF, Torzilli PA, O’Brien SJ (1996) Role of the long head of the biceps brachii in glenohumeral stability: a biomechanical study in cadavera. J Shoulder Elbow Surg 5(4):255–262
Patte D (1990) Classification of rotator cuff lesions. Clin Orthop Relat Res (254):81–86
Scheibel M, Schröder RJ, Chen J, Bartsch M (2011) Arthroscopic soft tissue tenodesis versus bony fixation anchor tenodesis of the long head of the biceps tendon. Am J Sports Med 39(5):1046–1052. doi:10.1177/0363546510390777 (Epub 2011 Jan 21)
Sentürk I, Ozalay M, Akpinar S, Leblebici B, Cinar BM, Tuncay C (2011) Clinical and isokinetik comparison between tenotomy and tenodesis in biceps pathologies. Acta Orthop Traumatol Turc 45(1):41–46. doi:10.3944/AOTT.2011.2308 (Epub 2010 Jun 15)
Severud EL, Ruotolo C, Abbott DD, Nottage WM (2003) All-arthroscopic versus mini-open rotator cuff repair: a long term retrospective outcome comparison. Arthroscopy 19(3):234–238. doi:10.1053/jars.2003.50036
Shank JR, Singleton SB, Hawkins J, Decker MJ, Torry MR (2006) A comparison of supination and elbow flexion strength in patients either proximal biceps release or tenodesis. Presented at the Meeting of the American Orthopedic Society for Sports Medicine, Hershey
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. doi:10.1016/j.jse.2004.07.008
Warner JJ, MCMahon PJ (1995) The role of the long head of the biceps brachii in superior stability of the glenohumeral joint. J Bone Joint Surg Am 77:366–372
Kany J, Guinand R, Amaravathi RS, Alassaf I (2015) The keyhole technique for arthroscopic tenodesis of the long head of the biceps tendon. In vivo prospective study with a radio-opaque marker. Orthop Traumatol Surg Res 101(1):31–34. doi:10.1016/j.otsr.2014.10.016 (Epub 2015 Jan 8)
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. doi:10.1007/s00167-013-2587-8 (Epub 2013 Jul 5)
Duff SJ, Campbell PT (2012) Patient acceptance of long head of biceps brachii tenotomy. J Shoulder Elbow Surg 21(1):61–65. doi:10.1016/j.jse.2011.01.014 (Epub 2011 Mar 30)
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. doi:10.1177/0363546510387512 (Epub 2010 Dec 28)
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
None.
Rights and permissions
About this article
Cite this article
Meraner, D., Sternberg, C., Vega, J. et al. Arthroscopic tenodesis versus tenotomy of the long head of biceps tendon in simultaneous rotator cuff repair. Arch Orthop Trauma Surg 136, 101–106 (2016). https://doi.org/10.1007/s00402-015-2343-2
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00402-015-2343-2