Clinical Outcomes of Arthroscopic Tenodesis Versus Tenotomy for Long Head of the Biceps Tendon Lesions: A Systematic Review and Meta-analysis of Randomized Clinical Trials and Cohort Studies

Abstract

Background: Controversy exists concerning whether tenotomy or tenodesis is the optimal surgical treatment option for proximal biceps tendon lesions. Purpose: To evaluate the clinical outcomes after arthroscopic tenodesis and tenotomy in the treatment of long head of the biceps tendon (LHBT) lesions. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed by searching PubMed, the Cochrane Library, Web of Science, and Embase to identify randomized controlled trials (RCTs) and cohort studies that compared the clinical efficacy of tenotomy with that of tenodesis for LHBT lesions. A standardized data extraction form was predesigned to obtain bibliographic information of the study as well as patient, intervention, comparison, and outcome data. A random-effects model was used to pool quantitative data from the primary outcomes. Results: A total of 21 eligible studies were separated into 3 methodological groups: (1) 4 RCTs with level 1 evidence, (2) 3 RCTs and 4 prospective cohort studies with level 2 evidence, and (3) 10 retrospective cohort studies with level 3 to 4 evidence. Analysis of the 3 groups demonstrated a significantly higher risk of the Popeye sign after tenotomy versus tenodesis (group 1: risk ratio [RR], 3.29 [95% CI, 1.92-5.49]; group 2: RR, 2.35 [95% CI, 1.43-3.85]; and group 3: RR, 2.57 [95% CI, 1.33-4.98]). Arm cramping pain remained significantly higher after tenotomy only in the retrospective cohort group (RR, 2.17 [95% CI, 1.20-3.95]). The Constant score for tenotomy was significantly worse than that for tenodesis in the prospective cohort group (standardized mean difference [SMD], –0.47 [95% CI, –0.73 to –0.21]), as were the forearm supination strength index (SMD, –0.75 [95% CI, –1.28 to –0.21]) and the Simple Shoulder Test (SST) score (SMD, –0.60 [95% CI, –0.94 to –0.27]). Conclusion: The results demonstrated that compared with tenodesis, tenotomy had a higher risk of a Popeye deformity in all 3 study groups; worse functional outcomes in terms of the Constant score, forearm supination strength index, and SST score according to prospective cohort studies; and a higher incidence of arm cramping pain according to retrospective cohort studies.

Outcomes of Biceps Tenotomy Versus Tenodesis During Arthroscopic Rotator Cuff Repair: An Analysis of Patients From a Large Multicenter Database

“…Popeye deformity and cramping were more common after tenotomy than with tenodesis. The review by Liu et al 17 demonstrated decreased supination strength and worse Constant and Simple Shoulder Test scores after tenotomy. Ahmed et al 2 and Zhou et al 30 similarly demonstrated lower Constant scores after tenotomy.…”

“…Recently, 7 systematic reviews have been performed comparing biceps tenotomy versus tenodesis. 2,4,15,17,22,24,30 Most of these reviews did not demonstrate a significant functional difference between these 2 procedures. Popeye deformity and cramping were more common after tenotomy than with tenodesis.…”

Clinical effectiveness of tenotomy versus tenodesis for long head of biceps pathology: a systematic review and meta-analysis

“…Recently, several meta-analyses have been published on the topic of surgical treatments for the long head of biceps. [44][45][46][47][48][49][50] These studies are all limited to some extent, with some disagreement in their findings. Dekker et al reviewed cadaveric studies and demonstrated no difference in ultimate load to failure in various fixation types including screws and anchors.…”

“…Recently, several meta-analyses have been published on the topic of surgical treatments for the long head of biceps 44–50. These studies are all limited to some extent, with some disagreement in their findings.…”

Clinical Outcomes of Long Head Biceps Tendinitis Treatment by a Semitenodesis Technique

“…In the current study, we implemented a new surgical technique (semitenodesis) to minimize traditional surgical techniques' well-known complications. The failure of nonsurgical medical management of LHB tendonitis necessitates surgical intervention using tenotomy or tenodesis, which are well-known, established techniques whose superiority is debated [ 21 , 22 ]. The VAS pain score in patients who underwent the novel arthroscopic semitenodesis technique in this study showed a 58% improvement from 9.8 to 4.15 one month after the operation and a 96% improvement from 9.8 to 0.4 three months after the operation.…”