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

Abstract

ObjectivesThe comparative clinical effectiveness of common surgical techniques to address long head of biceps (LHB) pathology is unclear. We synthesised the evidence to compare the clinical effectiveness of tenotomy versus tenodesis.DesignA systematic review and meta-analysis using the Grading of Recommendations Assessment, Development and Evaluation approach.Data sourcesEMBASE, Medline, PsycINFO and the Cochrane Library of randomised controlled trials were searched through 31 October 2021.Eligibility criteriaWe included randomised controlled trials, reporting patient reported outcome measures, comparing LHB tenotomy with tenodesis for LHB pathology, with or without concomitant rotator cuff pathology. Studies including patients treated for superior labral anterior–posterior tears were excluded. No language limits were employed. All publications from database inception to 31 October 2021 were included.Data extraction and synthesisScreening was performed by two authors independently. A third author reviewed the article, where consensus for inclusion was required. Data were extracted by two authors. Data were synthesised using RevMan. Inverse variance statistics and a random effects model were used.Results860 patients from 11 RCTs (426 tenotomy vs 434 tenodesis) were included. Pooled analysis of patient-reported functional outcome measures data demonstrated comparable outcomes (n=10 studies; 403 tenotomy vs 416 tenodesis; standardised mean difference (SMD): 0.14, 95% CI −0.04 to 0.32, p=0.13). There was no significant difference for pain (Visual Analogue Scale) (n=8 studies; 345 tenotomy vs 350 tenodesis; MD: −0.11, 95% CI −0.28 to 0.06, p=0.21). Tenodesis resulted in a lower rate of Popeye deformity (n=10 studies; 401 tenotomy vs 410 tenodesis; OR: 0.29, 95% CI 0.19 to 0.45, p<0.00001). Tenotomy demonstrated shorter operative time (n=4 studies; 204 tenotomy vs 201 tenodesis; MD 15.2, 95% CI 1.06 to 29.36, p<0.00001).ConclusionsAside from a lower rate of cosmetic deformity, tenodesis yielded no significant clinical benefit to tenotomy for addressing LHB pathology.PROSPERO registration numberCRD42020198658.

Arthroscopic Suprapectoral Biceps Tenodesis for Isolated Biceps Tendinopathy: Results From 23 Patients

“…Moreover, in our study, none of the patients reported any cosmetic complications in the tenodesis or biceps area, and none of the patients had any report indicating Popeye sign. This finding accords with previous reports [39,40] and especially in a meta-analysis of Level I randomized control trials by Belk et al [39]. The latter authors compared biceps tenotomy with tenodesis and found that it reportedly had a higher rate of cosmetic deformity [39].…”

Self-locking tenotomy of the long head of the biceps: What is the benefit?

“…We also noted muscle cramps and a slight loss of strength in flexion with supination of the elbow, as described in the literature. (16) Several studies have compared the functional results of tenotomy and tenodesis in the treatment of LB tendinopathy, with no clinical or functional difference between the two techniques. in fact, even with a low rate, but we can also have a Popeye sign with tenodesis.…”

Arthroscopic Superior Capsular Reconstruction With the Long Head of the Biceps Tendon to Reinforce the Repair of a Supraspinatus Tear and Increase Healing

“…This technique produces additional therapeutic effects for patients who have biceps pathology, such as tendonitis or biceps instabilities, in addition to the rupture of the cuff, since it has a tenotomy effect, a technique with widely demonstrated benefits. 27 , 28 …”

“… 12 , 13 , 14 , 15 , 16 , 17 , 18 , 30 There are risks associated with LHB tenotomy, such as the appearance of Popeye’s sign or cramps, although over time, they rarely represent a functional problem in patients. 27 , 28 …”