Long Head of Biceps Tenotomy Is Not Inferior to Suprapectoral Tenodesis in Arthroscopic Repair of Nontraumatic Rotator Cuff Tears: A Multicenter, Non-inferiority, Randomized, Controlled Clinical Trial

Deurzen, Derek F.P. van; Yang, K.G. Auw; Onstenk, Ron; Raven, E. E. J.; Borne, Maaike P J van den; Hoelen, Max A; Wessel, Ronald N.; Willigenburg, Nienke W.; Klaassen, Amanda D; Bekerom, Michel P.J. van den; Zijl, Jacco A. C.; Wolterbeek, Nienke; Koenraadt, Koen L. M.; Beers, Loes W A H van; Willems, W. Jaap; Mathijssen, Nina M C; Hesseling, Brechtje; Lemmens, Eelke; Janssens, Roel C.; Garssen, Frans L.; Gurnani, Navin; Rhijn, Roos I. van; Spek, Reinier W.A.; Teuwen, M.; Verweij, Lukas P.E.; Volkers, Mariella; Scholtes, Vanessa A.

doi:10.1016/j.arthro.2021.01.036

Cited by 22 publications

(53 citation statements)

References 41 publications

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“…Following the removal of duplicates, 206 articles were screened by title, abstract, and full-text, due to as follows: not including subjects with lesions diagnosed for both RC tendons and LHBT, not having surgical treatment, not having ≥ 6 score in PEDro scale, not publishing in English or Spanish. Finally, 11 studies [ 15 – 25 ] were included in this review. Figure 1 shows study selection process based on PRISMA [ 12 ].…”

Section: Resultsmentioning

confidence: 99%

“…Not significantly difference between the two groups. Van Deurzen et al [ 25 ] To determine if LHB tenotomy is not inferior to suprapectoral LHB tenodesis when performed in conjunction with arthroscopic repair of small-to medium-sized nontraumatic RC tears. Level of evidence: I (determined by the authors).…”

Section: Resultsmentioning

confidence: 99%

“…Table 3 includes the results of the PEDro scale. Ten studies [ 15 – 21 , 23 – 25 ] (90.9%) were considered to be of good methodological quality (6-8 points) and one [ 22 ] (9.1%) as excellent quality (9 points).…”

Section: Resultsmentioning

confidence: 99%

“…The items: “subjects were randomly allocated to groups (in a crossover study, subjects were randomly allocated an order in which treatments were received)” [ 2 ]; “measures of at least one key outcome were obtained from more than 85% of the subjects initially allocated to groups” [ 8 ]; “all subjects for whom outcome measures were available received the treatment or control condition as allocated or, where this was not the case, data for at least one key outcome was analyzed by intention to treat” [ 9 ]; “the results of between-group statistical comparisons are reported for at least one key outcome” [ 10 ]; and “the study provides both point measures and measures of variability for at least one key outcome” [ 11 ], stood out as they were carried out in every study [ 15 – 25 ]. By contrast, item “there was blinding of all therapists who administered the therapy” [ 6 ], did not score.…”

Section: Resultsmentioning

confidence: 99%

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Efficacy of management of associated dysfunctions on rotator cuff and long head of the biceps: systematic review

2021

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Background The important functional role the rotator cuff (RC) and biceps play in the shoulder, the close anatomical relationship between them and the high incidence of injuries require an appropriate multidisciplinary therapeutic approach after a rigorous assessment. The objective is to identify and analyze surgical interventions, whether or not followed by a postsurgical one, of associated dysfunctions on the RC and long head of the biceps (LHB) and their effectiveness in improving shoulder functionality. Methods A systematic review based on PRISMA protocol was conducted using PubMed, Web of Science, PEDro, Scopus, CINAHL, and Dialnet until 22 April 2021. The main inclusion criteria were as follows: randomized clinical trials including subjects diagnosed with RC and LHB lesions who had surgical and/not post-surgical treatments. The methodological quality of trials was evaluated by the PEDro scale. Data were shown in 3 pre-established tables: (1)sample data, diagnostic methods, dysfunctions and injury frequency, interventions, outcome measures and results; (2)significance and effectiveness of interventions; and (3)comparison of the effectiveness of interventions. Results Eleven studies were selected. The methodological quality of ten of them was assessed as good and one excellent (PEDro scale). All articles had surgical treatments and ten had postoperative management. All trials used arthroscopy and two open surgery too. Single-row, double-row and transosseous repair were used for RC lesions, while SLAP repair, tenotomy, and tenodesis were applied to LHB injuries. Measured parameters were functionality, pain, Popeye’s sign, strength, range of motion, satisfaction degree, biceps cramping, and quality of life. All approaches in general, surgical plus postsurgical, were always effective to the parameters measured in each study. Seven trials compared tenotomy and tenodesis: four of them obtained statistically significant differences in favor of tenodesis in Popeye’s sign, cramping, satisfaction degree, and/or forearm supination strength; and one, in favor of tenotomy in cramping. All studies measured functionality using functional assessment scales. The most widely used was the Constant Score. Conclusions Surgical plus post-surgical interventions in associated dysfunctions on RC and LHB were effective. Tenodesis obtained better results than tenotomy in Popeye’s sign, satisfaction, and forearm supination strength. However, there was no difference regarding biceps cramping.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Efficacy of management of associated dysfunctions on rotator cuff and long head of the biceps: systematic review

2021

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“…In the current study, "Long Head of Biceps Tenotomy Is Not Inferior to Suprapectoral Tenodesis in Arthroscopic Repair of Nontraumatic Rotator Cuff Tears: A Multicenter, Non-inferiority, Randomized, Controlled Clinical Trial" by van Deurzen, Yang, Onstenk, Raven, van den Borne, Hoelen, Wessel, Willigenburg, Klaassen, van den Bekerom, and the BITE Study Group, 10 patients were prospectively randomized to receive either biceps tenotomy or tenodesis at the time of arthroscopic rotator cuff repair. This is a well-designed study that was powered to detect a 10-point noninferiority margin on the Constant Murley Score between groups.…”

mentioning

confidence: 96%

Editorial Commentary: Shoulder Biceps Tenotomy Versus Tenodesis Surgical Decision Making Must be Individualized for Each Patient

O’Brien

2021

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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The optimal treatment for proximal biceps tendon lesions identified at the time of arthroscopic rotator cuff repair remains a topic for debate. The decision between biceps tenotomy and tenodesis is one in which we will likely never have a clear-cut answer. Proponents of biceps tenotomy and biceps tenodesis will cite the pros and cons of each surgical option to support their treatment of choice. Several meta-analyses have shown no superior outcomes with either treatment. Cost analysis and surgical efficiency may favor biceps tenotomy, whereas the possible development of a Popeye deformity, biceps cramping, and supination strength favor tenodesis. The surgical treatment of choice requires an informed discussion and shared decision making between surgeon and patient to determine patients' expectations and maximize surgical outcomes for each individual patient.

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Interpositional scaffold anchor rotator cuff footprint tear repair: excellent survival, healing, and early outcomes

Krupp

Frankle

Nyland

et al. 2023

Knee Surg Sports Traumatol Arthrosc

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PurposeShoulder function limitation duration after a full‐thickness rotator cuff tendon (RCT) tear may influence post‐repair healing and outcomes. A suture anchor was developed to improve footprint repair fixation and healing through biological fluid delivery and scaffold augmentation. The primary multicenter study objective was to evaluate RCT repair failure rate based on 6‐month MRI examination, and device survival at 1‐year follow‐up. The secondary objective was to compare the clinical outcomes of subjects with shorter‐ and longer‐term shoulder function limitation duration. MethodsSeventy‐one subjects (46 men) with moderate‐to‐large RCT tears (1.5–4 cm), at a median 61 years of age (range = 40–76), participated in this study. Pre‐repair RCT tear location/size and 6‐month healing status were confirmed by an independent radiologist. Subjects with shorter‐ (Group 1: 17.8 ± 21 days, n = 37) and longer‐term (Group 2: 185.4 ± 89 days, n = 34) shoulder function limitation durations were also compared over 1 year for active mobility, strength, American Shoulder and Elbow Surgeon’s Shoulder Score (ASES score), Veterans RAND 12 Item Health Survey (VR‐12), and visual analog scale (VAS) pain and instability scores. ResultsThree of the 52 subjects [5.8%] who underwent 6‐month MRI experienced a re‐tear at the original RCT footprint repair site. By the 1‐year follow‐up, overall anchor survival was 97%. Although Group 2 displayed lower ASES and VR‐12 scores pre‐repair (ASES = 40.1 ± 17 vs. 47.9 ± 17; VR‐12 physical health (PH) = 37.2 ± 9 vs. 41.4 ± 8) (p ≤ 0.048), at 3‐month post‐RCT repair (ASES = 61.3 ± 19 vs. 71.3 ± 20; VR‐12 PH = 40.8 ± 8 vs. 46.8 ± 9) (p ≤ 0.038), and at 6‐month post‐RCT repair (ASES = 77.4 ± 18 vs. 87.8 ± 13; VR‐12 PH = 48.9 ± 11 vs. 54.0 ± 9) (p ≤ 0.045), by 1‐year post‐RCT repair, groups did not differ (n.s.). Between‐groups VR‐12 mental health score differences were not evident at any time period (n.s.). Shoulder pain and instability VAS scores also did not differ (n.s.), displaying comparable improvement between groups from pre‐RCT repair to 1‐year post‐RCT repair. Groups had comparable active shoulder mobility and strength recovery at each follow‐up (n.s.). ConclusionAt 6‐month post‐RCT repair, only 3/52 of patients [5.8%] had a footprint re‐tear, and at 1‐year follow‐up, overall anchor survival was 97%. Use of this scaffold anchor was associated with excellent early clinical outcomes regardless of shoulder function impairment duration. Level of evidenceII.

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Long Head of Biceps Tenotomy Is Not Inferior to Suprapectoral Tenodesis in Arthroscopic Repair of Nontraumatic Rotator Cuff Tears: A Multicenter, Non-inferiority, Randomized, Controlled Clinical Trial

Cited by 22 publications

References 41 publications

Efficacy of management of associated dysfunctions on rotator cuff and long head of the biceps: systematic review

Efficacy of management of associated dysfunctions on rotator cuff and long head of the biceps: systematic review

Editorial Commentary: Shoulder Biceps Tenotomy Versus Tenodesis Surgical Decision Making Must be Individualized for Each Patient

Interpositional scaffold anchor rotator cuff footprint tear repair: excellent survival, healing, and early outcomes

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