The long head of biceps as a source of pain in active population: tenotomy or tenodesis? A comparison of 2 case series with isolated lesions (original) (raw)
Related papers
Tenodesis is not superior to tenotomy in the treatment of the long head of biceps tendon lesions
Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2017
To compare the effectiveness of tenodesis and tenotomy in the treatment of long head of the biceps tendon (LHBT) lesions. The null hypothesis was that there is no difference in functional scores between the tenotomy and tenodesis groups. A total of 69 patients with a combined supraspinatus tear and LHBT lesion aged over 40 years entered this prospective comparative study and were randomly assigned to the arthroscopic LHB tenotomy or tenodesis group. Fifty-five patients (31 in the tenotomy group and 24 in the tenodesis group) were available for the 6- and 24-month post-operative evaluations. There were no statistically significant differences in post-operative Constant and Murley score, quality of life, pain, and strengths between groups. Higher rates of Popeye's sign were noted 6 and 24 months post-operatively in the tenotomy group compared to tenodesis. Although tenotomy is affected by a higher incidence of cosmetic deformity, there is no superiority of arthroscopic tenodesis o...
Biceps tenotomy versus tenodesis: a review of clinical outcomes and biomechanical results
Journal of Shoulder and Elbow Surgery, 2011
Hypothesis: There are significant differences in incidence of cosmetic deformity and load to tendon failure between biceps tenotomy versus tenodesis for the treatment of long head of the biceps brachii (LHB) tendon lesions which are supported by the evidence-based strengths and weaknesses of each procedure in the literature. Materials and methods: PubMed, Embase, and Cochrane databases were searched for eligible clinical and biomechanical articles relating to biceps tenotomy or tenodesis from 1966 to 2010. Keywords were biceps tenotomy, biceps tenodesis, long head of the biceps brachii, and Popeye sign. All relevant studies were included based on study objectives, and excluded studies consisted of abstracts, case reports, letters to the editor, and articles without outcome measures. Results: All articles reviewed were of level IV evidence. Combined results from reviewed papers on the differences between LHB tenotomy vs tenodesis demonstrated a higher incidence of cosmetic deformity in patients treated with biceps tenotomy. Complications were similar for each treatment, with a higher likelihood of bicipital pain associated with tenodesis. Lack of high levels of evidence from prospective randomized trials limits our ability to recommend one technique over another. Discussion: This review demonstrated a higher incidence of cosmetic deformity in patients treated with biceps tenotomy compared with tenodesis, with an associated lower load to tendon failure. However, there was no consensus in the literature regarding the use of tenotomy vs. tenodesis for LHB tendon lesions due to variable results and methodology of published studies. Individual patient factors and needs should guide surgeons on whether to use tenotomy or tenodesis. Conclusions: There is a great need for future studies with high levels of evidence, control, randomization, and power, with well-defined study variables, to compare biceps tenotomy and tenodesis for the treatment of LHB tendon lesions. Level of evidence: Review Article, with Supplementary Biomechanical Study.
Biceps Tenotomy Vs Tenodesis in Patients Younger Than 50, Systematic Review
International Journal for Research in Applied Science & Engineering Technology (IJRASET), 2021
Purpose: The objective of this meta-analysis was to offer an up-to-date comparison of clinical outcomes of tenotomy and tenodesis in the surgical treatment of LHB tendinopathy in patients under the age of 50. Methods: A literature search was conducted in EMBASE, PubMed/Medline and the Cochrane database from January 2010 to Dec 2020. All studies that compared the clinical results of LHB tenotomy and tenodesis were included. Results: The Meta-analysis data were from nine studies that comprised 669 participants who had LHB tenotomy or tenodesis with or without other shoulder surgeries (mainly rotator cuff repairs). There were no clinically significant changes in the Constant score, the American Shoulder and Elbow Society Score, shoulder pain, elbow flexion strength loss, or forearm supination strength when tenodesis and tenotomy were compared in randomized studies. Patients who have tenodesis were less likely to develop a Popeye deformity. Conclusion: In a meta-analysis, patients who had a tenotomy were more likely to have a Popeye deformity. There is no evidencebased benefit of LHB tenodesis over tenotomy in terms of shoulder function, shoulder discomfort, or biceps-related strength, according to a large number of studies. It's unknown whether LHB tenodesis is beneficial to some patient populations, such as children.
Clinical and isokinetic comparison between tenotomy and tenodesis in biceps pathologies
Acta Orthopaedica et Traumatologica Turcica, 2011
The purpose of this study to compare clinical and isokinetic results of patients who underwent biceps tenotomy or tenodesis for chronic tenosynovitis. Methods: Arthroscopic biceps tenotomy, arthroscopy assisted or arthroscopic biceps tenodesis were done in 20 patients who had diagnosis of chronic tenosynovitis and in whom conservative treatment was not helpful. Rotator cuff repair and acromioplasty was performed in 18 patients and acromioplasty alone in two patients in addition to biceps surgery. Arthroscopic biceps tenotomy was done in 10 patients (5 female, 5 male; mean age 63, range 53-75), 10 patients underwent tenodesis out of which arthroscopy assisted biceps tenodesis was done in 8 patients and all arthroscopic biceps tenodesis was done in 2 patients (4 female, 6 male; mean age 57, range 49-66). All patients were evaluated with Constant and UCLA scores preoperatively and postoperatively. The average follow-up of the patients 3,1 years (between 1-8 years). Isokinetically elbow flexion and forearm supination were compared using the Cybex (Biodex 3, Cybex Biomedical System, NY, USA) machine. Pre-operative results of each group were compared with the postoperative results, using Mann-Whitney U test. Results: Preoperative average constant scores of tenotomy group were 64.40, whereas postoperative scores were 89.50 (p=0.002), and preoperative average constant scores of tenodesis group were 62.80, whereas postoperative scores were 86.70 (p=0.003). Preoperative average UCLA scores of tenotomy group were 23.20 whereas postoperative UCLA scores 22.60 (p=0.003), preoperative average UCLA scores of tenodesis group were 30.00 whereas postoperative UCLA scores was 29.20 (p=0.004). In both groups statistically significant improvement of UCLA and Constant scores was detected. Comparison between Constant, UCLA scores and isokinetic measurements of both groups showed no statistically significant difference (p>0.05). No complication was noted. Conclusion: In the treatment of chronic tenosynovitis, biceps tenodesis and tenotomy of long head of biceps showed similar clinical, functional, isokinetic and cosmetic results. No Popeye deformity was seen in the tenotomy group.
No-holes transpectoral tenodesis technique vs tenotomy of the long head of the biceps brachii
Muscles, Ligaments and Tendons Journal
Background: There is no univocal consensus regarding Long Head of the Biceps (LHB) best treatment between tenotomy and tenodesis. There is no consensus regarding the best location to perform the tenodesis. The LHB tenodesis performed by the proximal tendon excision as first step can miss the proper tension to the muscle belly. Fixations proximal to the pectoralis major can lead to groove pain. This study aims to test the efficacy of a new LHB tenodesis technique by comparing its results with the tenotomy. Methods: We retrospectively evaluated patients who underwent surgery between May 2014 and May 2015. The mean follow up was 14.7 months. Sixteen patients underwent mini-open tenodesis to the Pectoralis Major tendon by the use of a resorbable suture (TD group); sixteen underwent tenotomy (TT group). The mean age of the TD group was 54 years; the mean age of the TT group was 56 years. We evaluated pain, subjective perception of the patient of possible aesthetic and strength differences between the two biceps, "Popeye sign", and tests to stimulate the LHB. We administered three evaluation questionnaires: the ASES score, the SPADI score, and the SST. Results: 32 consecutive patients were evaluated. The clinical scores did not record statistically significant differences: the mean ASES score was 92.9 (TD) and 90.8 (TT); the mean SPADI score was 92.5 (TD), and 89.7 (TT); the mean SST was 8.9 (TD), and 8.4 (TT). Compared to the TD group, in the TT group we registered with greater frequency the "Popeye sign" with a P value < 0.05 (9 cases vs 1), and spasms in the biceps muscle belly (5 cases vs 1). All other signs or symptoms evaluated were more frequent in the TT group, except the strength difference perceived by the patient (3 patients in the TT group, and 2 in the TD group). No complications were recorded. Conclusions: This new Long Head of the Biceps (LHB) tenodesis technique is valuable and reliable, and provided better results than tenotomy. Level of evidence: IV.
Arthroscopy, Sports Medicine, and Rehabilitation, 2021
The purpose of this meta-analysis was to provide an up-to-date comparison of clinical outcomes of tenotomy and tenodesis in the surgical treatment of long head of the biceps brachii (LHB) tendinopathy. Methods: A literature search was conducted in EMBASE, Pubmed/Medline and the Cochrane database from January 2000 to May 2020. All studies comparing clinical outcomes between LHB tenotomy and tenodesis were included. Quality was assessed using the Coleman score. Results: We included 25 studies (8 randomized studies) comprising 2,191 patients undergoing LHB tenotomy or tenodesis, with or without concomitant shoulder procedures (mainly rotator cuff repairs). The Coleman score ranged from 29 to 97 for all studies. When comparing tenodesis and tenotomy in randomized studies, no clinically relevant differences were found in the Constant score (mean difference, 0.9 points), the American Shoulder and Elbow Society Score (mean difference, 1.1 points), shoulder pain (mean difference in visual analogue scale,-0.3 points), elbow flexion strength loss (mean difference, 0%), or forearm supination strength (mean difference, 3%). A Popeye deformity (odds ratio, 0.32) was less commonly seen in patients treated with tenodesis (9% vs 23%). Conclusion: In our metaanalysis, a Popeye deformity was more frequently observed in patients treated with tenotomy. Based on a substantial number of studies, there is no evidence-based benefit of LHB tenodesis over tenotomy in terms of shoulder function, shoulder pain or biceps-related strength. It is unclear whether LHB tenodesis is of benefit in specific patient groups such as younger individuals. Level of evidence: Level III, systematic review of level III or higher studies.
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2021
Purpose: To determine if long head of the biceps (LHB) tenotomy is not inferior to suprapectoral LHB tenodesis when performed in conjunction with arthroscopic repair of small-to medium-sized nontraumatic rotator cuff tears. Methods: This multicenter, randomized, non-inferiority trial recruited 100 participants older than 50 years who had a supraspinatus and/or infraspinatus tear sagittally smaller than 3 cm and arthroscopically confirmed LHB pathology. During arthroscopic rotator cuff repair, we randomized 48 patients to undergo suprapectoral LHB tenodesis and 52 patients to undergo LHB tenotomy. Data were collected preoperatively and at 6 weeks, 3 months, and 1 year postoperatively. The primary outcome was noninferiority of the Constant-Murley score (CMS) at 1-year follow-up. Secondary outcomes included the Dutch Oxford Shoulder Score; Disabilities of the Arm, Shoulder and Hand questionnaire; Popeye deformity; elbow flexion strength index; arm cramping pain; and quality of life (EQ-5D score). The integrity of the rotator cuff repair was assessed with magnetic resonance imaging. Differences between intervention groups were analyzed by mixed modeling. Results: The mean CMS in the LHB tenotomy group improved from 44 (95% confidence interval [CI], 39-48) to 73 (95% CI, 68-79). In patients with LHB tenodesis, the mean CMS improved from 42 (95% CI, 37-48) to 78 (95% CI, 74-82). The difference between groups at
Arthroscopy, 2015
The purpose of this study was to compare arthroscopic versus open examination of the proximal long head of the biceps tendon (LHB) in patients undergoing open, subpectoral tenodesis. Methods: Eighty consecutive patients were prospectively enrolled, of whom 62 were included in the study. During arthroscopy, the most distal extent of the LHB visualized was marked with a Bovie device. The tendon was pulled into the joint with an arthroscopic grasper, showing additional LHB and was again marked with the device. LHB fraying, flattening, redness, and degeneration were graded as absent, mild, moderate, or severe. During open subpectoral tenodesis, the grossly visualized LHB was graded in the same manner and the locations of both marks plus the total length of the LHB observed during open visualization were measured and recorded. After subpectoral tenodesis, the excised portion of the LHB was histologically graded as normal, fibrosis/ tendinosis, or inflamed. Results: On average, during open tenodesis, 95 mm (range, 75 to 130 mm) of LHB was visualized. This was greater than the length visualized during diagnostic arthroscopy of 16 mm (range, 5 to 28 mm), or 17%, and the length visualized while pulling the tendon into the joint with an arthroscopic grasper of 30 mm (range, 15 to 45 mm), or 32%. The difference in LHB length observed during open versus arthroscopic examination with a grasper was statistically significant (P < .0001). In addition, when compared with LHB pathology observed in an open manner, arthroscopic visualization showed only 67% of pathology, underestimated noted pathology in 56% of patients, and overestimated noted pathology in 11% of patients. Histologic evaluation showed fibrosis/tendinosis in 100% of cases but inflammation in only 5%. Conclusions: When compared with open inspection during subpectoral tenodesis, arthroscopic examination of the LHB visualizes only 32% of the tendon and may underestimate pathology. Level of Evidence: Level II, diagnostic studyddevelopment of diagnostic criteria based on consecutive patients with universally applied gold standard.
Biceps Tenodesis: An Evolution of Treatment
American journal of orthopedics (Belle Mead, N.J.)
The long head of the biceps (LHB) tendon is a potential generator of pain within the shoulder. Tenodesis of the LHB is a treatment option for several pathologic shoulder conditions. We conducted a study to determine trends in LHB tenodesis at a subspecialty-focused shoulder orthopedic practice. We hypothesized that the rate of LHB tenodesis would increase significantly over time and that there would be no significant change in the age of patients who underwent LHB tenodesis. Records of 4 fellowship-trained sports or shoulder/elbow orthopedic surgeons were used to identify total number of common arthroscopic shoulder surgeries performed between 2004 and 2014. Number of LHB tenodesis cases, combined or isolated, was recorded. Linear regression was used for analysis with significance set at P < .05. Of the 7640 patients who underwent arthroscopic shoulder procedures between 2004 and 2014, 2125 had LHB tenodesis. Mean (SD) age of the subgroup was 49.33 (13.2) years, and mean (SD) num...