Biceps Tenodesis versus Tenotomy in Treatment of Lesions of Long Head of Biceps Brachii in Patients Undergoing Arthroscopic Shoulder Surgery

Abstract

Introduction: To compare patient‐reported and objective outcomes between biceps tenotomy and tenodesis in patients with lesions of the long head of biceps tendon (LHBT). Methods: The study is a prospective, randomized, controlled trial targeting patients +18 years of age undergoing arthroscopic shoulder surgery to manage a lesion of LHBT. Previous surgery on the affected shoulder or any other significant medical comorbidity were exclusion criteria. The primary outcome measure was the American Shoulder and Elbow Society standardized assessment of shoulder function (ASES). Secondary outcomes included: Western Ontario Rotator Cuff score (WORC), operative time, presence of cosmetic deformity, and elbow flexion and supination strength (affected/unaffected ratio). Study time points were pre, and 3, 6, 12, and 24 months post‐operative. Magnetic resonance imaging (MRI) was conducted at 12‐months postoperative. Results: Fifty‐six participants were randomly assigned to each group. Table 1 summarizes the current results to 12‐months. There were no significant differences in ASES or WORC scores at pre‐or post‐surgery time points. MRI findings were available on 40 patients at the 12‐month post‐operative period. Of 23 in the tenodesis group, one was not intact and retracted 18 cm and two were partially torn. Of the 17 in the tenotomy group, none appeared retracted. The relative risk of patient‐reported cosmetic deformity in the tenotomy group relative to the tenodesis group was 11.0 (p=0.09) at 12‐months. There were no differences between groups in level of pain or cramping, or elbow flexion or supination strength at any time point. Conclusion: Arthroscopic treatment of lesions of LHBT, whether tenodesis or tenotomy, was shown to have favourable results. Tenodesis favoured tenotomy based on the presence/absence of cosmetic deformity. Otherwise, there were no measurable differences between techniques. As data continues to be gathered to 24‐month post‐operative, longer‐term benefits and drawbacks of each procedure may become evident.