Biceps Tenotomy Versus Tenodesis in Active Patients Younger Than 55 Years

Abstract

Background:Proximal biceps pathology is a significant factor in shoulder pain. Surgical treatment options include biceps tenotomy and subpectoral biceps tenodesis. Tenotomy is a simple procedure, but it may produce visible deformity, subjective cramping, or loss of supination strength. Tenodesis is a comparatively technical procedure involving a longer recovery, but it has been hypothesized to achieve better outcomes in younger active patients (<55 years).Hypothesis:This study investigated the outcomes of younger patients who underwent either a biceps tenotomy or tenodesis as part of treatment for shoulder pain. The hypothesis was that, apart from cosmetic deformity, there will be no difference in outcome between the 2 treatment options.Study Design:Cohort study; Level of evidence, 3.Methods:Isometric strength and endurance testing of operative and nonoperative shoulders for forearm supination (FS) and elbow flexion (EF) were tested utilizing an isometric dynamometer. Objective physical assessment was also performed. Subjective outcomes using the modified American Shoulder and Elbow Surgeons score (ASES); Disability of the Arm, Shoulder, and Hand (DASH); visual analog scale (VAS); and perceived biceps symptoms were collected.Results:A total of 42 patients (22 tenotomy, 20 tenodesis) with an average follow-up of 3.3 years were studied. The average age at follow-up was 49.9 years. Thirty-five percent (7/20) of tenotomy patients exhibited a “Popeye” deformity, compared with 18.2% (4/22) of tenodesis patients. Strength prior to fatiguing exercise was similar between tenodesis and tenotomy for FS (6.9 vs 7.3 lbs; P < .05), EF in neutral (35.4 vs 35.4 lbs), and EF in supination (33.8 vs 34.2 lbs). Strength was not significantly different between groups for isometric strength and endurance measures. Subjective functional outcome measured by the DASH, ASES, and VAS scores were similar between groups. Frequency of complaints of cramping was higher in the tenotomy group (4/20 vs 1/22), and complaints of pain were higher in the tenodesis group (11/22 vs 5/20).Conclusion:Despite increased demands and activity placed on biceps function in a younger population, this study showed no differences in functional and subjective outcome measurements. The choice between biceps tenotomy and tenodesis for pathology of the proximal biceps tendon can continue to be based on surgeon and patient preference.

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

“…It has been reported that LHBT tenotomy and LHBT tenodesis achieve satisfactory efficacy. As compared with LHBT tenodesis, pure LHBT tenotomy has the advantages of simplicity, short surgery time and rapid post-operative recovery (21,32,33), but it may cause complications including Popeye sign deformity (21,24,25,28), upper arm spastic pain, loss of stability of the humeral head (34)(35)(36) and reduced forearm supination strength (20,22,23). LHBT tenodesis is a more invasive surgical procedure, but it maintains the length and tension of the original tendon and the strength of the elbow muscle, effectively prevents muscle atrophy and minimizes spastic and Popeye sign deformity in the upper arm (37,38).…”

Atypical tear of the long head of the biceps tendon in a young male adult

“…Both techniques are viable options with their respective risks and benefits. In fact, the literature has indicated both procedures to produce favourable clinical results in adults 25. Therefore, selection criteria should be driven by the surgeon’s experience and the patient’s desires.…”

Open subpectoral biceps tenodesis in patients over 65 does not result in an increased rate of complications

“…The outcomes are comparable to those reported in recent studies on younger patients with persistent pain having been reported in up to 50% of patients. [25,26].…”