2017 ISAKOS Biennial Congress ePoster #2226

 

Rotator Cuff Tears Combined with Long Head of the Biceps Tendon Lesions: Tenotomy Versus Tenodesis

Xi-Liang Shang, PhD, MD, Shanghai CHINA
Jiwu Chen, MD, PhD, Shanghai CHINA
Shiyi Chen, MD, PhD, Prof., Shanghai CHINA

Department of Sports Medicine, Huashan Hospital, Fudan University, Shang Hai, CHINA

FDA Status Not Applicable

Summary

The Popeye sign and the Constant score were higher in tenotomy group compared with tenodesis group when concomitant rotator cuff repair. No other clinical variables showed a difference between the 2 modalities.

Abstract

Background

Long head of the biceps tendon (LHBT) lesions are often associated with partial or complete rotator cuff tears, especially in elderly patients. Arthroscopic biceps tenotomy and tenotomy with tenodesis are two well-established surgical procedures. However, which technique is preferred over the other in treating patients with LHBT lesions and repairable cuff tears is still a controversy.

Purpose

The 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.

Methods

Using 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. These results were evaluated and compared to provide an overview on benefits and drawbacks of the respective surgical procedures.

Results

On the basis of the inclusion and exclusion criteria, ten articles (903 patients) were used finally for this meta-analysis. The results showed that the incidence of the Popeye sign and the Constant score were higher in tenotomy group compared with tenodesis group when concomitant rotator cuff repair (P<0.05). 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 significient differences between tenodesis and tenotomy of the LHB, corresponding to the currently available results in the literature (P>0.05) . Because both the tenotomy and tenodesis with concomitant rotator cuff repair used the same rehabilitation protocol just for rotator cuff repair. Namely, this could somewhat offset the weakness that tenodesis needed a longer rehabilitation period than tenotomy.

Conclusions

Both tenotomy and tenodesis are effective in pain relief and function improvement in patients with repairable rotator cuff tears. Various factors should be taken into consideration, such as ages, cost, cosmesis concern, and surgeon preferences, in order to decide which surgical procedure to choose. Because tenotomy requires lower cost, more simple and avoid implant complication, we recommend tenotomy with concomitant rotator cuff repair in older patients, with a low level of physical activity, no cosmesis concern.