Abstract
PurposeThe purpose of this meta-analysis was to assess whether there were differences in the outcomes between tenotomy and tenodesis in treating LHBT lesions combined with rotator cuff repairs.MethodsUsing Medline, Embase, and Cochrane, we searched for articles comparing tenotomy and tenodesis combined with rotator cuff repair which were published before April 2016 with the terms “biceps”, “tenotomy”, “tenodesis”, and “rotator cuff”. The controlled clinical studies that met the inclusion and exclusion criteria were assessed for quality of methodology by utilizing the Coleman score.ResultsOn the basis of the inclusion and exclusion criteria, ten articles (903 patients) were included in this meta-analysis. The Coleman score ranged between 40 and 89 in the included studies. The results showed that the incidence of the popeye sign (OR, 2.777, P = 0.000) were higher in tenotomy group compared with tenodesis group when concomitant rotator cuff repair. Statistically significant difference in favor of tenodesis was observed for Constant score (SMD, -0.230, P = 0.025). As for the arm cramping pain, patient satisfaction, VAS score, ASES score and UCLA increased score, the strength and the range of motion, there were no significant differences between tenodesis and tenotomy of the LHBT, corresponding to the currently available results in the literature.ConclusionsBased on this meta-analysis, both tenotomy and tenodesis are effective in pain relief and function improvement in patients with repairable rotator cuff tears. No significant differences in post-operative functional outcome between tenotomy and tenodesis for the treatment of LHBT lesions were observed except for a lower Constant score and higher risk of Popeye deformity in tenotomy.
Highlights
The long head of the biceps tendon (LHBT) lesions, including disclocation, subluxation, partial tears and tendinitis, are frequently associated with partial or complete rotator cuff tears (RCTs), in elderly patients[1,2,3,4,5,6,7,8]
The results showed that the incidence of the popeye sign (OR, 2.777, P = 0.000) were higher in tenotomy group compared with tenodesis group when concomitant rotator cuff repair
Significant difference in favor of tenodesis was observed for Constant score (SMD, -0.230, P = 0.025)
Summary
The long head of the biceps tendon (LHBT) lesions, including disclocation, subluxation, partial tears and tendinitis, are frequently associated with partial or complete rotator cuff tears (RCTs), in elderly patients[1,2,3,4,5,6,7,8]. Arthroscopic biceps tenotomy is an easy and fast procedure with less overall operating time and simplier postoperative rehabilitation [3, 11, 12] compared with tenodesis. It has drawbacks including the possibly deformity of the anatomic profile of the arm (“Popeye” sign) [1, 4, 8, 13], the loss of the LHB capability of stabilizing the head of the humerus [2], and the possible onset of cramping or fatigue pain [8, 14]. Which technique could result in the best patient outcome, especially between tenotomy and tenodesis, for treating patients with repairable cuff tears concomitant severe degeneration of LHBT, is still controversial
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