Biceps Tenodesis Versus Tenotomy with Fast Rehabilitation Protocol—A Functional Perspective in Chronic Tendinopathy

Abstract

The study aimed to evaluate the results after arthroscopic tenodesis and tenotomy of the biceps tendon (LHBT), coupled in tenotomy modality with a personalized postoperative rehabilitation protocol. The study included patients who underwent arthroscopic biceps tenotomy or tenodesis due to chronic biceps tendinopathy. Postoperatively, a standard rehabilitation program was prescribed to the tenodesis group and personalized was introduced in the tenotomy group, respectively. The outcomes were assessed using the American Shoulder and Elbow Surgeons scale (ASES), clinical tests that are dedicated to biceps tendinopathy, the occurrence of a Popeye deformity, night pain, and return to previous sporting activities. A cohort of 67 patients was enrolled in the final follow-up examination (mean 27 months) of which 40 patients underwent tenotomy (60%), and 27 patients (40%) underwent tenodesis. The mean ASES score improved from 48.1 to 87.8 in the tenotomy group and from 44 to 72.7 in the tenodesis group during the follow-up (p < 0.0001). The tenotomy group had better mean postoperative ASES scores than the tenodesis group (p < 0.0001). Positive clinical tests for biceps pathology were noticed more often in patients after LHB tenodesis (p = 0.0541). The Popeye deformity occurred more often in the tenotomy group; however, no patient complained of the visual appearance of the arm contour (p = 0.0128). Moreover, the frequency of night pain decreased in the tenotomy group (p = 0.0059). Return to previous sporting activities was more frequent in the tenotomy group (p = 0.0090). Arthroscopic biceps tenotomy is a reproducible, simple procedure, and augmented by a rapid rehabilitation protocol that provides promising clinical outcomes, reduces shoulder pain, and allows the patient to return to previous sporting activities, even in population older than 50 years.

Superior Capsular Reconstruction of the Shoulder Using the Long Head of the Biceps Tendon: A Systematic Review of Surgical Techniques and Clinical Outcomes

“…Advocators of the tenotomy without tenodesis argue that it is a cost-effective and simple pain-relieving method, while those of the tenodesis that simple tenotomy may result in weakness on elbow flexion and supination, cramps, and popeye-sign deformity [ 39 ]. However, the literature so far reported no difference in pain relief and functional outcome between the two techniques [ 39 , 40 , 41 , 42 ]. In the third option, the LHBT is left intact and is supposed to create a tenodesis effect and a downward force to the humeral head, increasing the AHD and preventing the progression to cuff tear arthropathy [ 18 , 25 , 26 ].…”

Neovascularization in Meniscus and Tendon Pathology as a Potential Mechanism in Regenerative Therapies: Special Reference to Platelet-Rich Plasma Treatment

“…There is a group of tendons that contain specific hypovascular regions that lead to poor regeneration and predispose the tendons to pathology [4,6,7,[13][14][15][16][17][18][19]. Moreover, these specific tendons are usually exposed to increased forces with various vectors of action, e.g., the rotator cuff tendons, the long head of the biceps tendon, Achilles tendon, posterior tibialis tendon, patellar tendon, gluteal tendons, and the tibialis anterior tendon.…”

Effect of Microcurrent Stimulation on Pain, Shoulder Function, and Grip Strength in Early Post-Operative Phase after Rotator Cuff Repair

“…Therefore, a method is necessary in order to overcome postoperative pain and rehabilitation [ 7 ]. Previous studies on the treatment of patients with rotator cuff repairs have provided promising clinical outcomes with personalized postoperative rehabilitation protocol [ 8 , 9 ].…”