Comparison of Treatments for Superior Labrum–Biceps Complex Lesions With Concomitant Rotator Cuff Repair: A Prospective, Randomized, Comparative Analysis of Debridement, Biceps Tenotomy, and Biceps Tenodesis

Oh, Joo Han; Lee, Ye Hyun; Kim, Sae Hoon; Park, Ji Soon; Seo, Hyuk Jun; Kim, Woo; Park, Hae Bong

doi:10.1016/j.arthro.2015.11.036

Cited by 59 publications

(101 citation statements)

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“…Alternatively, men favored tenotomy citing the shorter recovery time, lack of hardware, and decreased incidence of bicipital groove pain as motivating factors [26]. Other studies have found that a popeye deformity was more likely to both develop and become severe in men versus women who received tenotomy [6]. Despite these results, we found only a 3% difference in reported popeye deformity between our study groups.…”

Section: Discussioncontrasting

confidence: 72%

“…Our results show that very high patient satisfaction can be achieved with either tenotomy or tenodesis to address proximal biceps pathology. Recent literature is consistent with this finding, as many studies have found no significant differences in pain, function, or limitations between tenotomy and patients with tenodesis [6,16,[20][21][22][23][24]. However, others have shown increased shoulder pain and loss of supination power with biceps tenotomy, with many authors favoring biceps tenodesis in younger patients with a higher work and activity level [8,20,23].…”

Section: Discussionsupporting

confidence: 62%

“…The biceps tendon is therefore often addressed intraoperatively during concomitant surgery [1,2]. Tenotomy and tenodesis are two accepted alternative procedures used to treat proximal biceps pathology and superior labrum anteriorposterior (SLAP) tears in the proper setting [2][3][4][5][6][7][8]. However, debate exists over which procedure provides better surgical outcomes, and studies have failed to demonstrate clear superiority of one procedure over the other [9].…”

Section: Introductionmentioning

confidence: 99%

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Biceps tenotomy versus tenodesis: patient-reported outcomes and satisfaction

et al. 2020

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Background: Biceps tenotomy and tenodesis are surgical treatments for pathology of the proximal tendon of the long head of the biceps. There is debate over which procedure provides better patient outcomes.Purpose: Compare patient-reported outcomes and satisfaction between biceps tenotomy and tenodesis. Methods: This retrospective cohort study including all patients undergoing arthroscopic biceps tenodesis or tenotomy as part of more extensive shoulder surgery with a single surgeon. Concomitant procedures included rotator cuff repair, subacromial decompression, acromioclavicular joint resection, and debridement. Patients 36-81 years old were contacted by phone at > 2-year post-operatively to complete a biceps-specific outcome questionnaire. Subject decision not to participate was the sole exclusion criterion. Satisfaction scores and frequencies of potential biceps-related downsides (biceps cramping/spasms, biceps pain, shoulder pain, weakness, cosmetic deformity) were analyzed for the effects of procedure, sex, and age.Results: Satisfaction score distributions were similar between patients with tenodesis and patients with tenotomy (χ 2 = 8.34, P = 0.08), although slightly more patients with tenodesis than patients with tenotomy reported being satisfied or very satisfied (96% versus 91%). Perceived downsides occurred more frequently among patients with tenotomy than in patients with tenodesis: 59% of patients with tenotomy reported ≥ 1 downside, versus 37% of patients with tenodesis (P < 0.01). In patients reporting ≥ 1 downside, distributions of total downsides differed between procedures (χ 2 = 10.04, P = 0.04): patients with tenotomy were more likely to report multiple concurrent downsides than were patients with tenodesis (31% versus 16%). Each individual downside tended to be reported as present by a greater proportion of patients with tenotomy than patients with tenodesis. Sex had no effect on satisfaction or downsides, but there was a trend for older patients to report higher satisfaction and fewer downsides.Conclusions: Biceps tenotomy and tenodesis are both viable treatments for proximal biceps tendon pathology, yielding high patient satisfaction. There were trends toward greater satisfaction and fewer problems in patients with tenodesis. Still, younger patients with tenodesis did report perceived downsides. Alternatively, older patients tended to be more satisfied with both procedures overall. Regardless of procedure, most patients receiving either tenotomy or tenodesis would undergo their respective surgery again. Level of Evidence: Level III evidence, retrospective comparative cohort study

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Section: Discussioncontrasting

confidence: 72%

Section: Discussionsupporting

confidence: 62%

Section: Introductionmentioning

confidence: 99%

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Biceps tenotomy versus tenodesis: patient-reported outcomes and satisfaction

et al. 2020

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“…In recent years, a large number of comparative studies on the clinical efficacy of LHBT tenotomy and LHBT tenodesis have been performed (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31), but the results remain controversial. It has been reported that LHBT tenotomy and LHBT tenodesis achieve satisfactory efficacy.…”

Section: Introductionmentioning

confidence: 99%

Small‑incision open distal subpectoral vs. arthroscopic proximal biceps tenodesis for biceps long head tendon lesions with repair of rotator cuff tears

Yang

Zhang

et al. 2019

Exp Ther Med

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The curative effect of small-incision open distal subpectoral vs. arthroscopic proximal biceps tenodesis for lesions in the long head of the biceps tendon (LHBT) combined with rotator cuff repairs (RCR) has remained controversial. The aim of the present study was to compare the two surgical methods. A total of 71 patients who received surgical treatment for LHBT lesions accompanied by RC tears were analyzed. Following arthroscopic RCR and tendectomy of the affected LHBT, 35 patients underwent small-incision open distal subpectoral tenodesis through a small incision (the subpectoral group), while the remaining 36 patients received arthroscopic proximal tenodesis (the arthroscopic group). The surgery time and intra-operative blood loss were compared between the two groups. In addition, the clinical outcomes were evaluated using scoring systems for the functional assessment of the shoulder joint. The subpectoral group had a shorter surgery time and less intra-operative blood loss than the arthroscopic group (P<0.05). The functional scores of the two groups significantly improved as time passed (P<0.05). The subpectoral group was significantly superior to the arthroscopic group with regard to the American Shoulder and Elbow Surgeons score at 2 weeks post-operatively and visual analog scale score at 2 weeks and 3 months post-operatively (P<0.05). Small-incision open distal subpectoral and arthroscopic proximal tenodesis were demonstrated to effectively improve the function of the shoulder joint and relieve pain caused by LHBT lesions accompanied by RCR. However, small-incision open distal subpectoral tenodesis had the additional advantage of shorter surgery time, less intra-operative bleeding and encouraging early results compared to arthroscopic proximal tenodesis. The study was registered as a clinical trial in the Chinese Trial Registry (no. ChiCTR1800015643).

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“…For patients with bicipital groove tenderness and concomitant biceps abnormality, biceps tenodesis was performed in those who wanted to preserve supination strength; otherwise, biceps tenotomy was performed. 47 Postoperatively, shoulders were immobilized with a brace for 4 to 6 weeks according to tear size. Shrugging of both shoulders, active elbow flexion-extension, active forearm supination-pronation, and active hand and wrist motion were encouraged immediately after surgery.…”

Section: Surgical Procedures and Rehabilitationmentioning

confidence: 99%

Comparison of Functional and Radiological Outcomes of Tears Involving the Subscapularis: Isolated Subscapularis Versus Combined Anterosuperior Rotator Cuff Tears

Meshram

Rhee

Park

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Few studies have compared the clinical and radiological characteristics and outcomes in isolated subscapularis (SSC) and combined anterosuperior (AS) rotator cuff tears (RCTs). Furthermore, risk factors for retear after SSC repair and the effect of preoperative fatty degeneration require further evaluation.Purpose: To compare the functional and radiological outcomes of isolated SSC with combined AS RCTs after arthroscopic repair and to determine the risk factors for SSC retear in these 2 groups.Study Design: Cohort study; Level of evidence, 3.Methods: Data from 30 patients in the isolated SSC group were compared with data from 110 patients in the combined AS group. All patients underwent primary arthroscopic rotator cuff repair between 2010 and 2016. Clinical outcomes were assessed through use of the visual analog scale for pain, American Shoulder and Elbow Surgeons score, and Simple Shoulder Test at a mean followup of 26.7 months (range, 24-96 months). SSC tendon integrity was examined via magnetic resonance imaging, computed tomography arthrogram, or ultrasonography at least 1 year after surgery.Results: The isolated SSC group had a greater proportion of males and the patients were younger compared with the combined AS group (both P < .050). The incidence of trauma was high but not significantly different between groups (56.7% vs 40.9%; P ¼ .180). Clinical outcome measures and radiological outcomes in terms of retear were not statistically different between both groups (16.7% vs 8/5%; P ¼ .337). The optimal cutoff values for the risk of SSC tendon retear in both groups were 19-mm retraction and 16-mm superoinferior dimension (P ¼ .048). Unfavorable preoperative fatty degeneration of the SSC muscle (grades 3 and 4) was a significant risk factor for retear (odds ratio, 9.8; P < .001).Conclusion: Isolated SSC and combined AS RCTs were comparable except for patient age and sex; both had a high incidence of traumatic history. The current data suggest that the risk factors for retear after SSC repair in RCTs involving the SSC were tear size greater than 19 mm of retraction and unfavorable fatty degeneration (grade 3 or higher) of the SSC muscle.Recently, an increase has been noted in the number of studies focused on rotator cuff tears (RCTs) involving the subscapularis (SSC) muscle to enable a better understanding of the diagnosis, management, and outcomes. 35 The SSC is the largest rotator cuff tendon; it provides 50% of the rotator cuff force and plays an important role in shoulder stability and movements such as internal rotation, adduction, abduction, flexion, and extension. 13,20,25,43 Hence, restoring the function of the SSC muscle after a tear is crucial for normal shoulder function.The SSC muscle is reported to be involved in 78% of RCTs, most often in combination with other rotator cuff tendons. 40 The incidence of isolated SSC RCTs is reported to be 4%, 13 whereas combined RCTs involving the SSC and supraspinatus but without the infraspinatus (combined anterosuperior [AS]) are reported to accoun...

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Comparison of Treatments for Superior Labrum–Biceps Complex Lesions With Concomitant Rotator Cuff Repair: A Prospective, Randomized, Comparative Analysis of Debridement, Biceps Tenotomy, and Biceps Tenodesis

Cited by 59 publications

References 36 publications

Biceps tenotomy versus tenodesis: patient-reported outcomes and satisfaction

Biceps tenotomy versus tenodesis: patient-reported outcomes and satisfaction

Small‑incision open distal subpectoral vs. arthroscopic proximal biceps tenodesis for biceps long head tendon lesions with repair of rotator cuff tears

Comparison of Functional and Radiological Outcomes of Tears Involving the Subscapularis: Isolated Subscapularis Versus Combined Anterosuperior Rotator Cuff Tears

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