Biceps tenodesis versus biceps tenotomy for biceps tendinitis without rotator cuff tears

Abstract Background The best treatment for lesions of the long head of the biceps tendon (LHBT) with concomitant reparable rotator cuff tears is still controversial. The purpose of the meta-analysis was to compare clinical outcomes of biceps tenotomy and tenodesis for LHBT lesions. Methods A literature retrieval was conducted in MEDLINE, Embase, and Cochrane Library from 1979 to March 2018. Comparative studies (level of evidence I or II) comparing tenotomy and tenodesis for LHBT lesions with concomitant reparable rotator cuff tears were included. Risk of bias for all included studies was assessed using the Cochrane Collaboration’s risk of bias tool. Clinical outcomes compared were Popeye sign, Constant score, VAS pain score, cramping pain, elbow flexion and forearm supination strength, and re-tear of the rotator cuff. Results Two randomized controlled trials (RCTs) and five prospective cohort studies (PCS) with 288 biceps tenotomy patients and 303 biceps tenodesis patients were included in this review. Tenotomy resulted in significantly greater rates of Popeye sign (RR, 2.70 [95% CI, 1.80 to 4.04]; P < 0.01) and a less favorable Constant score (MD, − 1.09 [95% CI, − 1.90 to − 0.28]; P < 0.01) compared to tenodesis. No significant heterogeneity was found between the two groups across all parameters except forearm supination strength. Conclusions The current evidence indicates that biceps tenodesis for LHBT lesions with concomitant reparable rotator cuff tears results in decreased rate of Popeye sign and improved Constant score compared to biceps tenotomy. Trial registration PROSPERO, CRD42018105504. Registered on 13 August 2018.

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Arthroscopic Repair of Anterosuperior Rotator Cuff Tears Combined With Open Biceps Tenodesis

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2010.04.008 ◽

2010 ◽

Vol 26 (12) ◽

pp. 1667-1674 ◽

Cited By ~ 32

Author(s):

Shane J. Nho ◽

Rachel M. Frank ◽

Stefanie N. Reiff ◽

Nikhil N. Verma ◽

Anthony A. Romeo

Keyword(s):

Rotator Cuff ◽

Arthroscopic Repair ◽

Rotator Cuff Tears ◽

Biceps Tenodesis

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Biceps tenotomy versus soft-tissue tenodesis in females aged 60 years and older with rotator cuff tears

Journal of Orthopaedic Science ◽

10.1016/j.jos.2021.04.012 ◽

2021 ◽

Author(s):

Itaru Kawashima ◽

Shinya Ishizuka ◽

Hideki Hiraiwa ◽

Shiro Imagama ◽

Norimasa Takahashi ◽

...

Keyword(s):

Soft Tissue ◽

Rotator Cuff ◽

Rotator Cuff Tears ◽

Biceps Tenotomy

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Biceps Detachment Preserves Joint Function in a Chronic Massive Rotator Cuff Tear Rat Model

The American Journal of Sports Medicine ◽

10.1177/0363546518805091 ◽

2018 ◽

Vol 46 (14) ◽

pp. 3486-3494 ◽

Cited By ~ 5

Author(s):

Mengcun Chen ◽

Snehal S. Shetye ◽

Julianne Huegel ◽

Corinne N. Riggin ◽

Daniel J. Gittings ◽

...

Keyword(s):

Rotator Cuff ◽

Shoulder Joint ◽

Shoulder Function ◽

Rotator Cuff Tears ◽

Subscapularis Tendon ◽

Joint Function ◽

Massive Rotator Cuff Tears ◽

Sham Surgery ◽

Biceps Tenotomy

Background: Lesions of the long head of the biceps tendon are often associated with massive rotator cuff tears (MRCTs), and biceps tenotomy is frequently performed for pain relief and functional reservation. However, the efficacy and safety of biceps tenotomy regarding the effects on the surrounding tissues in chronic MRCT are unclear. Hypothesis: Biceps tenotomy would result in improved mechanical and histological properties of the intact subscapularis tendon and improved in vivo shoulder function while not compromising glenoid cartilage properties. Study Design: Controlled laboratory study. Methods: Right supraspinatus and infraspinatus tendons were detached in 25 male Sprague-Dawley rats, followed by 4 weeks of cage activity to create a chronic MRCT condition. Animals were randomly divided into 2 groups and received either biceps tenotomy (n = 11) or sham surgery (n = 14) and were sacrificed 4 weeks thereafter. Forelimb gait and ground-reaction forces were recorded 1 day before the tendon detachment (baseline), 1 day before the surgical intervention (biceps tenotomy or sham), and 3, 7, 10, 14, 21, and 28 days after the intervention to assess in vivo shoulder joint function. The subscapularis tendon and glenoid cartilage were randomly allocated for mechanical testing or histologic assessment after the sacrifice. Results: Compared with sham surgery, biceps tenotomy partially restored the in vivo shoulder joint function, with several gait and ground-reaction force parameters returning closer to preinjury baseline values at 4 weeks. With biceps tenotomy, mechanical properties of the subscapularis tendons were improved, while mechanical properties and histological Mankin scores of the glenoid cartilage were not diminished when compared with the sham group. Conclusion: Biceps tenotomy in the presence of chronic MRCT partially preserves overall shoulder function and potentially restores subscapularis tendon health without causing detrimental effects to joint cartilage. This laboratory study adds to the growing literature regarding the protective effects of biceps tenotomy on the shoulder joint in a chronic MRCT model. Clinical Relevance: This study provides important basic science evidence supporting the use of biceps tenotomy in patients with massive rotator cuff tears.

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Arthroscopic Debridement and Biceps Tenotomy/Tenodesis for the Management of Massive Rotator Cuff Tears

Operative Techniques in Orthopaedics ◽

10.1053/j.oto.2018.10.001 ◽

2018 ◽

Vol 28 (4) ◽

pp. 191-194

Author(s):

Justin W. Griffin ◽

Anthony A. Romeo

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Tears ◽

Arthroscopic Debridement ◽

Massive Rotator Cuff Tears ◽

Biceps Tenotomy

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Irreparable rotator cuff tears: Current treatment options

Orthopedic Reviews ◽

10.4081/or.2019.8146 ◽

2019 ◽

Vol 11 (3) ◽

Cited By ~ 1

Author(s):

Tristan Juhan ◽

Michael Stone ◽

Omid Jalali ◽

Will Curtis ◽

John Prodromo ◽

...

Keyword(s):

Rotator Cuff ◽

Reverse Shoulder Arthroplasty ◽

Treatment Options ◽

Current Treatment ◽

Rotator Cuff Tears ◽

Biceps Tenotomy ◽

Common Causes ◽

Cuff Repair ◽

Term Data

Rotator cuff disease is one of the most common causes of shoulder pain, yet controversy still exists regarding treatment of “irreparable” tears. Nonoperative management, including physical therapy and steroid injections, should be reserved for those without significant pain or functional impairment. Debridement may be used for low-demand patients, and should be performed with partial cuff repair, subacromial decompression, and/or acromioplasty to maximize outcomes. Biceps tenotomy and/or tenodesis have been shown to reduce postoperative pain and improve satisfaction when performed in conjunction with rotator cuff repairs, with no difference in functional outcome comparatively. Tendon transfers have been advocated with the potential benefit to improve function and decrease pain. More recently, extracellular matrix and human-derived dermal allografts have been used off-label as patch grafts in irreparable tears. Superior capsular reconstructive techniques and subacromial balloon spacers serve a similar function by acting to depress the humeral head in a cuff-deficient shoulder, however long-term data is needed before widespread adoption of these procedures. Finally, reverse shoulder arthroplasty serves as a salvage option for low demand elderly patients.

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Arthroscopic Superior Capsular Reconstruction in Males Provides Superior Outcomes to Reverse Total Shoulder or Debridement for Irreparable Rotator Cuff Tears

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118s00101 ◽

2018 ◽

Vol 6 (7_suppl4) ◽

pp. 2325967118S0010

Author(s):

John M. Tokish ◽

Michael J. Kissenberth ◽

Ellen Shanley ◽

Stefan John Tolan ◽

Kyle J. Adams ◽

...

Keyword(s):

Rotator Cuff ◽

Patient Reported Outcomes ◽

Rotator Cuff Tears ◽

Preliminary Results ◽

Biceps Tenotomy ◽

Superior Capsular Reconstruction ◽

Patient Reported ◽

Male Patients ◽

Reverse Total Shoulder

Objectives: Early results following arthroscopic superior capsular reconstruction(SCR) in patients with massive, irreparable rotator cuff tears are promising. However, no studies have compared patient reported outcomes between SCR or reverse total shoulder(rTSA) and rotator cuff debridement for these patients. Therefore, the purpose of this study was to compare 1-year outcomes between patients with massive irreparable rotator cuff tears who underwent a SCR, rTSA, or rotator cuff debridement with a concurrent biceps tenotomy or tenodesis. Methods: Patients(n=63) who underwent either SCR(n=21), rTSA(21), or cuff debridement(n=21) and biceps tenotomy or tenodesis for a massive, irreparable rotator cuff tear treated with a minimum 1-year follow up were retrospectively reviewed. Age, sex, BMI, smoking status, Charlson Index, Hamada classification, and ASES scores were recorded and compared using a multivariate ANOVA were used to compare between surgical approaches. A Chi Square analyses were used to compare sex distribution and the Charlson Deyo Index between groups (α=0.05). Results: Overall, patients across the 3 groups were not statistically different in age or follow up ASES score at minimum 14 month follow up ( P> 0.05). There was a significant interaction effect between surgery group and sex (P=0.02) on ASES score but not age ( P=0.08). Univariate F tests revealed that male patients who received an SCR displayed a 10-14% better outcome at follow up compared to other groups (Table 1) which exceeds the reported ASES score MCID. Conclusion: Our results show comparable results across surgical options for massive irreparable cuff tears with good patient reported outcomes. Male patients displayed clinically important greater ASES scores at 1 year follow up. Future studies should evaluate these preliminary results to assess if these preliminary results hold up at longer follow up times.

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Epidemiological Analysis of Changes in Clinical Practice for Full-Thickness Rotator Cuff Tears From 2010 to 2015

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119845912 ◽

2019 ◽

Vol 7 (5) ◽

pp. 232596711984591 ◽

Cited By ~ 4

Author(s):

Avinesh Agarwalla ◽

Gregory L. Cvetanovich ◽

Anirudh K. Gowd ◽

Anthony A. Romeo ◽

Brian J. Cole ◽

...

Keyword(s):

Clinical Practice ◽

Rotator Cuff ◽

Rotator Cuff Repair ◽

Management Practices ◽

Rotator Cuff Tears ◽

Full Thickness ◽

Biceps Tenodesis ◽

Rotator Cuff Injuries ◽

Cuff Repair ◽

Corticosteroid Injections

Background: Rotator cuff injuries are a leading cause of shoulder disability among adults. Surgical intervention is a common treatment modality; however, conservative management has been described for the treatment of rotator cuff tears. As the cost of health care increases, the industry has shifted to optimizing patient outcomes, reducing readmissions, and reducing expenditure. In 2010, the American Academy of Orthopaedic Surgeons created clinical practice guidelines (CPGs) to guide the management of rotator cuff injuries. Since their publication, there have been several randomized controlled trials assessing the management of rotator cuff injuries. Purpose: To quantitatively describe changes in the management of full-thickness rotator cuff tears over time with regard to the publication of the CPGs and prospective clinical trials. Study Design: Cohort study; Level of evidence, 3. Methods: Included in the study were Humana-insured patients in the PearlDiver database with the diagnosis of a full-thickness rotator cuff tear from 2010 to 2015. Patients undergoing rotator cuff repair (CPT-29827, CPT-23410, CPT-23412, CPT-23420) and patients undergoing nonoperative management in the queried years were identified. The incidence of physical therapy (PT), nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroid injections was assessed. Results: In 2015, patients with full-thickness rotator cuff tears were less likely to receive a corticosteroid injection (16.5% vs 23.9%, respectively; odds ratio [OR], 0.6; P < .001) or undergo PT (7.8% vs 12.1%, respectively; OR, 0.6; P < .001) before rotator cuff repair in comparison with 2010. Additionally, patients were no more likely to be prescribed NSAIDs before rotator cuff repair in 2015 in comparison with 2010 (OR, 1.0; P = .6). Patients with full-thickness rotator cuff tears were less likely to undergo acromioplasty in 2015 in comparison with 2010 (48.2% vs 76.9%, respectively; OR, 0.4; P < .001); however, the rate of concomitant biceps tenodesis slightly increased (14.8% vs 14.6%, respectively; OR, 1.1; P = .01). Conclusion: From 2010 to 2015, there were changes in the management of full-thickness rotator cuff tears, including decreased preoperative utilization of corticosteroid injections and PT as well as a decrease in concomitant acromioplasty, and the rate of biceps tenodesis slightly increased. As CPGs and prospective investigations continue to proliferate, management practices of patients with full-thickness rotator cuff tears continue to evolve.

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