IV.

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Purpose This systematic review assesses evidence for improvements in outcome for all reported types of treatment modalities [physical therapy, tenotomy or tenodesis of the long head of the biceps, debridement, partial repair, subacromial spacer, deltoid lap, muscle transfer, rotator cuf advancement, graft interposition, superior capsular reconstruction (SCR), and reversed shoulder arthroplasty (RSA)] used for irreparable posterosuperior rotator cuf tears without glenohumeral osteoarthritis. The primary aim was to be able to inform patients about expectations of the amount of clinical improvement after these treatments. Methods A systematic search was conducted in MEDLINE, EMBASE, CINAHL, and Cochrane databases for studies on irreparable posterosuperior rotator cuf lesions without glenohumeral osteoarthritis, published from January 2007 until January 2019, with minimum 2-year follow-up. Studies with pre-operative and/or intra-operative determination of cuf tear irreparability were included. We deined the non-adjusted Constant Score as the primary outcome. Results Sixty studies (2000 patients) were included with a fair mean quality score, according to the Modiied Coleman Methodology Score. The employed deinitions of 'irreparable' were mainly based on MRI criteria and were highly variable among studies. The smallest weighted mean preoperative to post-operative improvements in Constant Score were reported for biceps tenotomy/tenodesis (10.7 points) and physical therapy (13.0). These were followed by debridement (21.8) and muscle transfer (27.8), whereas the largest increases were reported for partial repair (32.0), subacromial spacer (32.5), rotator cuf advancement (33.2), RSA (34.4), graft reconstruction (35.0), deltoid lap (39.8), and SCR (47.4). Treatment using deltoid lap showed highest mean weighted improvement in Constant Score among studies with available medium-term (4-5-year) follow-up. Treatments deltoid lap, muscle transfer, and debridement were the only treatments with available long-term (8-10-year) follow-up and showed similar improvements in Constant Score at this time point. ConclusionThe variability in patient characteristics, co-interventions, outcome reporting, and length of follow-up in studies on irreparable rotator cuf tears without osteoarthritis complicates sound comparison of treatments. Clinically important treatment efects were seen for all 11 diferent treatment modalities. Level of evidence IV.

The purpose of this meta-analysis was to provide an up-to-date comparison of clinical outcomes of tenotomy and tenodesis in the surgical treatment of long head of the biceps brachii (LHB) tendinopathy. Methods: A literature search was conducted in EMBASE, Pubmed/Medline and the Cochrane database from January 2000 to May 2020. All studies comparing clinical outcomes between LHB tenotomy and tenodesis were included. Quality was assessed using the Coleman score. Results: We included 25 studies (8 randomized studies) comprising 2,191 patients undergoing LHB tenotomy or tenodesis, with or without concomitant shoulder procedures (mainly rotator cuff repairs). The Coleman score ranged from 29 to 97 for all studies. When comparing tenodesis and tenotomy in randomized studies, no clinically relevant differences were found in the Constant score (mean difference, 0.9 points), the American Shoulder and Elbow Society Score (mean difference, 1.1 points), shoulder pain (mean difference in visual analogue scale, -0.3 points), elbow flexion strength loss (mean difference, 0%), or forearm supination strength (mean difference, 3%). A Popeye deformity (odds ratio, 0.32) was less commonly seen in patients treated with tenodesis (9% vs 23%). Conclusion: In our metaanalysis, a Popeye deformity was more frequently observed in patients treated with tenotomy. Based on a substantial number of studies, there is no evidence-based benefit of LHB tenodesis over tenotomy in terms of shoulder function, shoulder pain or biceps-related strength. It is unclear whether LHB tenodesis is of benefit in specific patient groups such as younger individuals. Level of evidence: Level III, systematic review of level III or higher studies.

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