Abstract
BackgroundPathology of the long head of the biceps tendon (LHBT) is a common disorder affecting muscle function and causing considerable pain for the patient. The literature on the two surgical treatment methods (tenotomy and tenodesis) is controversial; therefore, our aim was to compare the results of these interventions.MethodsWe performed a meta-analysis using the following strategy: (P) patients with LHBT pathology, (I) tenodesis, (C) tenotomy, (O) elbow flexion and forearm supination strength, pain assessed on the ten-point Visual Analog Scale (VAS), bicipital cramping pain, Constant, ASES, and SST score, Popeye deformity, and operative time. We included only randomized clinical trials. We searched five databases. During statistical analysis, odds ratios (OR) and weighted mean differences (WMD) were calculated for dichotomous and continuous outcomes, respectively, using the Bayesian method with random effect model.ResultsWe included 11 studies in the systematic review, nine of these were eligible for the meta-analysis, containing data about 572 patients (279 in the tenodesis, 293 in the tenotomy group). Our analysis concluded that tenodesis is more beneficial considering 12-month elbow flexion strength (WMD: 3.67 kg; p = 0.006), 12-month forearm supination strength (WMD: 0.36 kg; p = 0.012), and 24-month Popeye deformity (OR: 0.19; p < 0.001), whereas tenotomy was associated with decreased 3-month pain scores on VAS (WMD: 0.99; p < 0.001). We did not find significant difference among the other outcomes.ConclusionTenodesis yields better results in terms of biceps function and is non-inferior regarding long-term pain, while tenotomy is associated with earlier pain relief.
Highlights
The biceps brachii muscle has a proven function in forearm supination and elbow flexion [1]
Two studies ([59, 60]) did not have outcomes with a comparable matching time point; we were only able to include these in the systematic review section
Four studies reported the 6-month [51, 54, 55, 58] (WMD, 0.05; 95% confidence intervals (CI), − 0.21–0.30; p = 0.724; I2 = 0.0%; moderate grade of evidence) (Supplementary Fig. 4), 12-month [52, 54, 55, 58] (WMD, 0.19; 95% CI, − 0.26–0.63; p = 0.411; I2 = 80.1%; very low grade of evidence) (Supplementary Fig. 5), and 24-month [50, 51, 54, 55] (WMD, 0.01; 95% CI, − 0.04–0.07; p = 0.637; I2 = 0.0%; moderate grade of evidence) (Supplementary Fig. 6) pain scores on Visual Analog Scale (VAS), and we found no significant difference at these time points
Summary
The biceps brachii muscle has a proven function in forearm supination and elbow flexion [1]. The pathology of the LHBT includes inflammation, partial or complete rupture (including SLAP lesions (superior labrum anterior and posterior)), and instability [1], which can lead to anterior shoulder pain or diminished function [10]. Methods We performed a meta-analysis using the following strategy: (P) patients with LHBT pathology, (I) tenodesis, (C) tenotomy, (O) elbow flexion and forearm supination strength, pain assessed on the ten-point Visual Analog Scale (VAS), bicipital cramping pain, Constant, ASES, and SST score, Popeye deformity, and operative time. Our analysis concluded that tenodesis is more beneficial considering 12-month elbow flexion strength (WMD: 3.67 kg; p = 0.006), 12-month forearm supination strength (WMD: 0.36 kg; p = 0.012), and 24-month Popeye deformity (OR: 0.19; p < 0.001), whereas tenotomy was associated with decreased 3-month pain scores on VAS (WMD: 0.99; p < 0.001). Conclusion Tenodesis yields better results in terms of biceps function and is non-inferior regarding long-term pain, while tenotomy is associated with earlier pain relief
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