Tenotomy or Tenodesis for the Long Head of Biceps Lesions in Shoulders: A Systematic Review and Meta-Analysis

Ge, Heng’an; Zhang, Qiang; Sun, Yeqing; Li, Jie; Sun, Lin; Cheng, Biao

doi:10.1371/journal.pone.0121286

Cited by 64 publications

(61 citation statements)

References 40 publications

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“…In recent years, most researchers have focused on the comparison between the curative effects of LHBT tenotomy and tenodesis. A large number of clinical comparative studies and meta-analyses have assessed the treatment of LHBT lesions combined with RCR with tenotomy and tenodesis (20)(21)(22)(23)(49)(50)(51)(52)(53). These studies indicated that the pain and function of the shoulder joint may be significantly improved by the two methods.…”

Section: Discussionmentioning

confidence: 99%

“…Oh et al (22) also observed that residual pain in the pectoral muscles following LHBT tenotomy is likely to occur. A meta-analysis by Ge et al (49), including 7 studies, suggested that LHBT tenodesis had a higher Constant score and lower incidence of upper arm spastic pain and Popeye sign deformity than simple tenotomy. Shang et al (50) included 10 high-quality studies in their meta-analysis.…”

Section: Discussionmentioning

confidence: 99%

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Small‑incision open distal subpectoral vs. arthroscopic proximal biceps tenodesis for biceps long head tendon lesions with repair of rotator cuff tears

Yang

Zhang

et al. 2019

Exp Ther Med

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The curative effect of small-incision open distal subpectoral vs. arthroscopic proximal biceps tenodesis for lesions in the long head of the biceps tendon (LHBT) combined with rotator cuff repairs (RCR) has remained controversial. The aim of the present study was to compare the two surgical methods. A total of 71 patients who received surgical treatment for LHBT lesions accompanied by RC tears were analyzed. Following arthroscopic RCR and tendectomy of the affected LHBT, 35 patients underwent small-incision open distal subpectoral tenodesis through a small incision (the subpectoral group), while the remaining 36 patients received arthroscopic proximal tenodesis (the arthroscopic group). The surgery time and intra-operative blood loss were compared between the two groups. In addition, the clinical outcomes were evaluated using scoring systems for the functional assessment of the shoulder joint. The subpectoral group had a shorter surgery time and less intra-operative blood loss than the arthroscopic group (P<0.05). The functional scores of the two groups significantly improved as time passed (P<0.05). The subpectoral group was significantly superior to the arthroscopic group with regard to the American Shoulder and Elbow Surgeons score at 2 weeks post-operatively and visual analog scale score at 2 weeks and 3 months post-operatively (P<0.05). Small-incision open distal subpectoral and arthroscopic proximal tenodesis were demonstrated to effectively improve the function of the shoulder joint and relieve pain caused by LHBT lesions accompanied by RCR. However, small-incision open distal subpectoral tenodesis had the additional advantage of shorter surgery time, less intra-operative bleeding and encouraging early results compared to arthroscopic proximal tenodesis. The study was registered as a clinical trial in the Chinese Trial Registry (no. ChiCTR1800015643).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Small‑incision open distal subpectoral vs. arthroscopic proximal biceps tenodesis for biceps long head tendon lesions with repair of rotator cuff tears

Yang

Zhang

et al. 2019

Exp Ther Med

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“…Both techniques are commonly used in the clinical practice. A tenotomy is relatively simple and easy, but it is reported that cosmetic deformity and weakness of the biceps are likely to occur after surgery, while tenodesis requires longer operation time.…”

Section: Discussionmentioning

confidence: 99%

Lesions of the Long Head of the Biceps Tendon Concomitant with Rotator Cuff Tears: Tenotomy or Subpectoral Mini‐open Tenodesis? A Comparative Short to Mid‐term Follow‐up Study

Fang

Dai

et al. 2019

Orthopaedic Surgery

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ObjectiveTo compare the clinical and radiological outcomes of patients who underwent rotator cuff repair (RCR) concomitant with long head of the biceps tendon (LHBT) tenotomy or subpectoral mini‐open tenodesis.MethodsProspectively collected data was reviewed on 154 patients, who underwent a LHBT procedure (tenotomy or tenodesis) concomitant with RCR between January 2010 and January 2017. The exclusion criteria were irreparable massive rotator cuff tear, rotator cuff partial tear, subscapular tendon tear, glenohumeral arthritis, and prior shoulder surgery. The two patient groups are as follows: RCR + Tenotomy (Group A) and RCR + Subpectoral mini‐open tenodesis (Group B). The visual analog scale (VAS) for pain, Constant Score scale, American Shoulder and Elbow Surgeons (ASES) scores, and the Disabilities of the Arm, Shoulder and Hand (DASH) scores preoperatively and 1 month, 3 months, 6 months, 1 year postoperatively and the latest out‐patient clinic were compared between the two groups.ResultsNinety‐two patients in Group A and 62 patients in Group B completed the follow‐up, with a median follow‐up time of 27 and 42 months respectively. At the final follow‐up, the VAS, Constant, ASES, and DASH scores in Group A were 0.1 ± 0.2, 87.0 ± 12.8, 96.4 ± 4.3 and 6.6 ± 4.8 respectively, and the VAS, Constant, ASES, and DASH scores in Group B were 0.1 ± 0.3, 92.5 ± 3.9, 96.3 ± 3.6 and 2.9 ± 1.3 respectively. Clinical evaluation scales showed satisfactory results in both groups, and there were no statistically significant differences between the two groups at the same follow‐up time. Popeye sign was detected in one case of Group A (1.1%) and in one case of Group B (1.6%, P > 0.05).ConclusionBoth tenotomy and subpectoral mini‐open tenodesis are effective for concomitant lesions of the LHBT in patients with reparable rotator cuff tears, and subpectoral mini‐open tenodesis of the LHBT does not provide any significant clinical or functional improvement than isolated tenotomy.

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“…Favorable outcomes have been reported for both procedures, and no clinical studies have definitively demonstrated the superiority of either arthroscopic technique. 2,[5][6][7][8]14 Advocates of biceps tenodesis cite its ability to better maintain length and tension of the proximal LHBT, thereby potentially preserving elbow flexion and supination strength and decreasing the risk of cosmetic deformity or cramping pain. 2,3,9,10,14 Compared with LHBT tenodesis, arthroscopic tenotomy is a less technically demanding surgery, decreases operative time, and requires little postoperative rehabilitation, allowing patients to return to full activity sooner.…”

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confidence: 99%

Risk Factors and Complications Following Arthroscopic Tenotomy of the Long Head of the Biceps Tendon

Mirzayan

McCrum

Butler

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Controversy exits regarding performing a tenotomy versus a tenodesis of the long head of the biceps tendon (LHBT). Purpose: To evaluate the complications after arthroscopic tenotomy of the LHBT and characterize the incidence of cosmetic deformity, cramping, subjective weakness, and continued anterior shoulder pain (ASP). Additionally, to identify patient-related factors that may predispose a patient to these complications. Study Design: Case-control study; Level of evidence, 3. Methods: Records of patients who underwent an arthroscopic LHBT tenotomy at an integrated health care system under the care of 55 surgeons were retrospectively reviewed. Exclusion criteria included LHBT tenodesis, arthroplasty, neoplastic, or fracture surgery; age younger than 18 years; incomplete documentation of physical examination; or incomplete operative reports. Characteristic data, concomitant procedures, LHBT morphology, and postoperative complications were recorded. Patients with and without postoperative complications—including cosmetic deformity, subjective weakness, continued ASP, and cramping—were analyzed by age, sex, dominant arm, body mass index (BMI), smoking status, workers’ compensation status, and intraoperative LHBT morphology to identify risk factors for developing these postoperative complications. Results: A total of 192 patients who underwent LHBT tenotomy were included in the final analysis. Tenotomy was performed with concomitant shoulder procedures in all but 1 individual. The mean ± SD patient age was 60.6 ± 9.5 years, and 55% were male. The overall complication rate was 37%. The most common postoperative complications include cosmetic (Popeye) deformity (14.1%), subjective weakness (10.4%), cramping (10.4%), and continued postoperative ASP over the bicipital groove (7.8%). Every 10-year increase in age was associated with 0.52 (95% CI, 0.28-0.94) times the odds of continued ASP and 0.59 (95% CI, 0.36-0.98) times the odds of cramping pain. Male patients had 3.9 (95% CI, 1.4-10.8) times the odds of cosmetic (Popeye) deformity. Patients who had active workers’ compensation claims had 12.5 (95% CI, 2.4-63.4) times the odds of having continued postoperative ASP. Tenotomy on the dominant arm, BMI, and active smoking status demonstrated no statistically significant association with postoperative complications. Conclusion: Patients experiencing complications after tenotomy were significantly younger and more likely to be male and to have a workers’ compensation injury. LHBT tenotomy may best be indicated for elderly patients, female patients, and those without active workers’ compensation claims.

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Tenotomy or Tenodesis for the Long Head of Biceps Lesions in Shoulders: A Systematic Review and Meta-Analysis

Cited by 64 publications

References 40 publications

Small‑incision open distal subpectoral vs. arthroscopic proximal biceps tenodesis for biceps long head tendon lesions with repair of rotator cuff tears

Small‑incision open distal subpectoral vs. arthroscopic proximal biceps tenodesis for biceps long head tendon lesions with repair of rotator cuff tears

Lesions of the Long Head of the Biceps Tendon Concomitant with Rotator Cuff Tears: Tenotomy or Subpectoral Mini‐open Tenodesis? A Comparative Short to Mid‐term Follow‐up Study

Risk Factors and Complications Following Arthroscopic Tenotomy of the Long Head of the Biceps Tendon

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