Long head of biceps tenotomy versus tenodesis: a systematic review and meta-analysis of randomized controlled trials

Abstract

Objective To compare tenotomy versus tenodesis for the treatment of long head of the biceps tendon pathologies. The primary outcome was the shoulder functional outcome. The secondary outcomes consisted of postoperative pain, elbow flexion and forearm supination strengths and postoperative complications. Methods PubMed, MEDLINE, Google Scholar and Web of Science were searched until April 2020. Included studies were randomized controlled trials with a minimum 12 months’ follow-up. Results Both treatments had similar improvement on the Constant–Murley score at 6 months and 12 months. However, tenotomy had a significantly lower Constant–Murley score at two years with a mean difference of −1.13 (95% confidence interval −1.9, −0.35). Furthermore, tenotomy had a risk ratio of 2.46 (95% confidence interval 1.66, 3.64) for developing Popeye’s deformity. No significant difference was detected in other functional outcomes, pain, or elbow flexion and forearm strength indices. Discussion Tenodesis and tenotomy are both well-established techniques that similarly yield satisfactory outcomes. Despite that tenodesis had a statistically significant better Constant–Murley score at two years, this was clinically irrelevant. With the current evidence, we recommend either technique for the management of the long head of the biceps tendon pathologies. Level of evidence Therapeutic, Level II

Tenodesis yields better functional results than tenotomy in long head of the biceps tendon operations—a systematic review and meta-analysis

“…Another major role of the biceps brachii is forearm supination. Our results showed a statistically significant difference between the 12-month supination strength results in favour of tenodesis, contradicting the literature so far [34,[37][38][39][40]. According to our trial sequential analysis, further clinical trials are needed to reach a more certain result.…”

“…Even though our analysis did not significantly differ at the 6-month follow-up, at 12 months, the elbow flexion strength was significantly better in the tenodesis group. To our knowledge, this result is a novelty compared to the results of previous meta-analyses that examined this particular outcome [34,[37][38][39][40]. Nevertheless, our TSA indicates that further RCTs are needed in the case of the six month results.…”

“…The earlier meta-analyses also included non-randomized trials [35][36][37][38][39][40][41] with the exception of Ahmed et al [34]; hence, their results must be regarded with caution.…”

“…The previous meta-analyses either did not reach a firm conclusion [34] or included cohort studies [35][36][37][38][39][40][41].…”

Wide-Awake Shoulder Nanoscopic Long Head of Biceps Tenotomy

“…Isolated arthroscopic tenotomy of the LHB has been shown to have a significant improvement in patient and clinician-reported outcomes measures. 7 However, many of these patients are elderly with medical comorbidities, and general anesthesia is not without risk. Therefore, this local anesthetic procedure described has significant advantages in excluding those anesthetic risks in a technique that is well tolerated by patients.…”