From Sports Medicine Research: In the Lab & In the Field
Blog Written by: Mark Rice
Reviewed by: Stephen Thomas
Biceps Tenotomy Versus Tenodesis: Clinical Outcomes
Slenker NR, Lawson K, Ciccotti MG, Dodson CC, Cohen SB. Arthroscopy. 2012 Jan 25. [Epub ahead of print] (link to abstract)
Chronic inflammation of the long head of the biceps brachii (LHB) tendon can be a stubborn and complex condition. As with most chronic inflammatory conditions a course of rest, activity modification, nonsteroidal anti-inflammatory drugs (NSAIDs), rehabilitation, and even corticosteroid injection may be indicated. However, if conservative treatment fails there are two surgical interventions, biceps tenotomy (complete detachment of the LHB) or tenodesis (detachment with anchoring of the LHB in the bicipital groove). Slenker et al. conducted a systematic review to determine the clinical effectiveness of both surgical treatments. They conducted a systematic review of PubMed and were able to identify 16 studies with a total of 699 tenotomy procedures and 433 tenodesis procedures. Subjects ranged in age from 15 to 83 years of age and there was no mean age difference between the 2 treatment groups. Tenodesis resulted in a good to excellent outcome in 74% of the cases and yielded a cosmetic deformity (the Popeye sign) 8% of the time. After LHB tenotomy, 77% of the patients reported good to excellent outcomes, but cosmetic deformity was present in 43% of the cases. There was also less bicipital pain experienced post-op in the tenotomy group (19%) as compared to the tenodesis group (24%). The authors did analyze a subgroup of patients having either tenotomy or tenodesis performed along with concomitant rotator cuff pathology. The tenotomy subjects stated good to excellent outcomes 72 to 85% of the time. The subjects treated by tenodesis reported good to excellent outcomes 63 to 93% of the time. The Popeye sign was noted 27 to 62% and 0 to 9% respectively for tenotomy versus tenodesis.
The data collected shows that biceps tenotomy and tenodesis have very similar success rates, whether there is rotator cuff involvement or not. The authors state that procedure selection should be based on a multitude of factors, including age and activity level. Biceps tenotomy has a much shorter recovery period due to the procedure being much less invasive than the tenodesis. However, the tenotomy treatment experiences greater incidence of cosmetic deformity. The tenodesis procedure typically takes longer to perform and recover from, and there is greater associated post-operative pain but less chance of cosmetic deformity. Prevailing thought dictates that for older and/or more sedentary patients, biceps tenotomy might be more appropriately indicated. Younger and/or more active (athletic/labor intensive careers) individuals might benefit more from biceps tenodesis. One item that remains unclear is if there is any true strength loss after either procedure. Some studies have shown as much as a 20% decrease in elbow flexion and supination strength after tenotomy, while others haven’t demonstrated any decreases. The authors set out to determine which procedure is clinically more effective; however, both procedures had similar clinical outcomes. As with any treatment or surgical procedure, the main factor to consider is the patient’s quality of life and function. Future studies are going to need to be conducted in an effort to clarify this topic, especially involving individuals that participate in vigorous overhead activity. What are your experiences with LHB surgical options? Should we consider either option at all, based upon the LHB’s role as shoulder dynamic stabilizer? Aside from the cosmetic differences, can you say whether one procedure has worked better than the other for your patients?
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