Treatment of Long Head of Biceps Tendon Lesions Together With Rotator Cuff Tears: Which Method is Preferred? Tenotomy or Tenodesis

Abstract

Long head of biceps tendon lesions are associated with rotator cuff tears, and, in large tears, surgery is the treatment of choice. Here, we aimed to evaluate outcomes of tenotomy and tenodesis in such cases. In this randomized clinical trial, patients aged 45 to 60 years, who were candidates for arthroscopic treatment of rotator cuff tears, with at least 1 positive biceps test before surgery, were enrolled. Patients were allocated in tenotomy or tenodesis groups using random block. Therapeutic outcomes were investigated by evaluation of occurrence of Popeye deformity, patient’s satisfaction based on visual analog scale (VAS), shoulder function according to the Constant score and simple shoulder test, and pain intensity based on numerical rating scale (NRS) and were measured before treatment and at 6 months, and 1 and 2 years after operation. All data analyzed using SPSS software version 20. Both Popeye deformity and biceps brachii cramping were significantly higher in the tenotomy group. Values of NRS, simple shoulder test, VAS of patient’s satisfaction, and Constant score significantly changed after operation as a decrease in NRS and increase in all 3 others. However, only VAS of patient’s satisfaction significantly differed between the 2 groups just at 12 and 24 months after operation. Only age, sex, and dominance of the involved limb had a significant association with patient’s satisfaction. Indeed, younger female patients with involvement of the recessive limb had significant higher satisfaction (P<0.05). Both methods produced good clinical outcomes. Although patient satisfaction was higher in the tenodesis group, no significant differences existed in functional outcomes. Level of Evidence: Level II.