Tenotomy or Tenodesis for Tendinopathy of the Long Head of the Biceps Brachii: An Updated Systematic Review and Meta-analysis

Abstract

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.

Anatomia E Etiologia Do Ombro Doloroso

“…Portanto, para que a estabilização ocorra, é necessário equilíbrio entre forças estáticas e dinâmicas que atuam sobre o ombro, o qual se dá maioria das lesões ocorre devido à degeneração e após ruptura do tendão supra-espinal 1 . O tratamento consiste inicialmente em abordagem conservadora com fisioterapia; em alguns casos, em que ocorre degeneração ou luxação do tendão, está indicado procedimento cirúrgico com debridamento artroscópico combinado à tenotomia ou tenodese do músculo 1,8 .…”

“…A tenossinovite do músculo bíceps braquial é lesão altamente prevalente em pacientes com dor anterior e profunda do ombro 8 . Afeta o tendão da porção longa do músculo no seu trajeto intra-articular, com ocasional degeneração e ruptura.…”

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

“…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.…”