Treatment of Biceps Tendon Lesions in the Setting of Rotator Cuff Tears

Background: During rotator cuff repair, biceps tendon lesions are frequently encountered. However, there is still controversy about optimal treatment for these lesions. Purpose: To compare the results of tenotomy and suture anchor tenodesis prospectively. Study Design: Cohort study; Level of evidence, 2. Methods: From January 2006 to June 2007, 90 patients (age, >55 years) with a rotator cuff tear and biceps tendon lesion (tear more than 30%, subluxation or dislocation, or degenerative superior labrum anterior to posterior lesion type II) were evaluated prospectively. The first 45 patients treated consecutively underwent biceps tenodesis, and the next 45 underwent biceps tenotomy. Postoperatively, patient evaluations were conducted with a focus on (1) “Popeye” deformity, (2) arm cramping pain, and (3) elbow flexion powers (measured with a hand dynamometer). Overall shoulder function was assessed with the American Shoulder and Elbow Surgeons (ASES) score and the Constant score. Results: At final follow-up, 43 in the tenodesis and 41 in the tenotomy groups were available for evaluation. There was no difference between groups in demographic data such as age, sex, dominant arm, and the time from symptom to surgery and in preoperative ASES score, Constant score, and rotator cuff tear size. A Popeye deformity occurred in 4 (9%) in the tenodesis group and in 11 (27%) in the tenotomy group (P = .0360). Mild cramping pain was observed in 2 in the tenodesis group and 4 in the tenotomy group (P = .4274). Mean elbow flexor power ratio (vs the contralateral side) showed no difference between the 2 groups, with mean values of 0.92 ± 0.15 (tenodesis) and 0.94 ± 0.19 (tenotomy) (P = .7475). The ASES and Constant scores were improved from 38.9 ± 14.2 and 52.1 ± 21.3 to 84.7 ± 13.6 and 82.9 ± 13.5 in the tenodesis group (P < .0001) and from 35.2 ± 10.5 and 48.1 ± 21.3 to 79.6 ± 15.8 and 78.3 ± 14.1 in the tenotomy group (P < .0001), respectively. Conclusion: Suture anchor tenodesis of the long head of the biceps tendon appears to lead to less Popeye deformity than tenotomy. No other clinical variables showed a difference between the 2 modalities.

[1]  M. Torry,et al.  A comparison of forearm supination and elbow flexion strength in patients with long head of the biceps tenotomy or tenodesis. , 2011, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[2]  N. Maffulli,et al.  Tenotomy versus Tenodesis in the Management of Pathologic Lesions of the Tendon of the Long Head of the Biceps Brachii , 2009, The American journal of sports medicine.

[3]  Jinyoung Park,et al.  Comparison of the Clinical Outcomes of Single- and Double-Row Repairs in Rotator Cuff Tears , 2008, The American journal of sports medicine.

[4]  V. Denaro,et al.  Soft tissue tenodesis of the long head of the biceps tendon associated to the Roman Bridge repair , 2008, BMC musculoskeletal disorders.

[5]  Umile Giuseppe Longo,et al.  No Advantages in Repairing a Type II Superior Labrum Anterior and Posterior (SLAP) Lesion When Associated with Rotator Cuff Repair in Patients over Age 50 , 2008, The American journal of sports medicine.

[6]  R. Ryu,et al.  Biceps tendon and superior labrum injuries: decision making. , 2007, Instructional course lectures.

[7]  P Boileau,et al.  The long head of biceps and associated tendinopathy. , 2007, The Journal of bone and joint surgery. British volume.

[8]  P. Boileau,et al.  Isolated arthroscopic biceps tenotomy or tenodesis improves symptoms in patients with massive irreparable rotator cuff tears. , 2007, The Journal of bone and joint surgery. American volume.

[9]  V. Denaro,et al.  To detach the long head of the biceps tendon after tenodesis or not: Outcome analysis at the 4-year follow-up of two different techniques , 2007, International Orthopaedics.

[10]  D. P. O'connor,et al.  Repair of tears of the subscapularis. Surgical technique. , 2006, The Journal of bone and joint surgery. American volume.

[11]  D. Mok,et al.  Treatment of the painful biceps tendon — Tenotomy or tenodesis ? , 2006 .

[12]  J. Yoo,et al.  Arthroscopic biceps tenodesis using interference screw: end-tunnel technique. , 2005, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[13]  S. Audebert,et al.  [Clinical results of arthroscopic tenotomy of the long head of the biceps brachii in full thickness tears of the rotator cuff without repair: 40 cases]. , 2005, Revue de chirurgie orthopedique et reparatrice de l'appareil moteur.

[14]  T. B. Edwards,et al.  Arthroscopic tenotomy of the long head of the biceps in the treatment of rotator cuff tears: clinical and radiographic results of 307 cases. , 2005, Journal of shoulder and elbow surgery.

[15]  Gilles Walch,et al.  Repair of tears of the subscapularis. , 2005, The Journal of bone and joint surgery. American volume.

[16]  S. Checchia,et al.  Biceps tenodesis associated with arthroscopic repair of rotator cuff tears. , 2005, Journal of shoulder and elbow surgery.

[17]  N. Zheng,et al.  Long head biceps tenotomy versus tenodesis: a cadaveric biomechanical analysis. , 2005, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[18]  H. Steckel,et al.  Arthroscopic Debridement of Irreparable Massive Rotator Cuff Tears — A Comparison of Debridement Alone and Combined Procedure with Biceps Tenotomy , 2005, Acta chirurgica Belgica.

[19]  C. Ahmad,et al.  Arthroscopic biceps tenodesis. , 2003, The Orthopedic clinics of North America.

[20]  Samuel A. Taylor,et al.  Paper #107 Arthroscopic release of the long head of the biceps tendon: functional outcome and clinical results , 2003 .

[21]  A. Cosgarea,et al.  Clinical Features of the Different Types of SLAP Lesions: An Analysis of One Hundred and Thirty-nine Cases , 2003, The Journal of bone and joint surgery. American volume.

[22]  K. Speer,et al.  The cosmetic appearance of the biceps muscle after long-head tenotomy versus tenodesis. , 2002, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[23]  G. Walch,et al.  Arthroscopic Biceps Tenodesis: A New Technique Using Bioabsorbable Interference Screw Fixation , 2001, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[24]  E. M. Wolf,et al.  How would you treat the partially torn biceps tendon? , 2001, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[25]  T. Gill,et al.  Results of biceps tenotomy for treatment of pathology of the long head of the biceps brachii. , 2001, Journal of shoulder and elbow surgery.

[26]  A. Murthi,et al.  The incidence of pathologic changes of the long head of the biceps tendon. , 2000, Journal of shoulder and elbow surgery.

[27]  K. Yamaguchi,et al.  Disorders of the long head of the biceps tendon. , 1999, Journal of shoulder and elbow surgery.

[28]  R. Hawkins,et al.  Biceps tendon disorders in athletes. , 1999, The Journal of the American Academy of Orthopaedic Surgeons.

[29]  G. Walch,et al.  Subluxations and dislocations of the tendon of the long head of the biceps. , 1998, Journal of shoulder and elbow surgery.

[30]  P. Benca,et al.  Primary tendinitis of the long head of the biceps. , 1989, Clinical orthopaedics and related research.

[31]  E. Chao,et al.  Rupture of the tendon of the long head of the biceps brachii. Surgical versus nonsurgical treatment. , 1988, Clinical orthopaedics and related research.

[32]  R. Warren,et al.  Surgical treatment of lesions of the long head of the biceps. , 1982, Clinical orthopaedics and related research.

[33]  R. Neviaser,et al.  The four-in-one arthroplasty for the painful arc syndrome. , 1982, Clinical orthopaedics and related research.

[34]  M J Glimcher,et al.  In vitro wear of articular cartilage. , 1975, The Journal of bone and joint surgery. American volume.

[35]  C O BECHTOL,et al.  Painful shoulder; observations on the role of the tendon of the long head of the biceps brachii in its causation. , 1948, The Journal of bone and joint surgery. American volume.