Biceps tenotomy has earlier pain relief compared to biceps tenodesis: a randomized prospective study

• Published in: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Vol. 27; no. 12; pp. 4032 - 4037
• Main Authors: Belay, Elshaday S., Wittstein, Jocelyn R., Garrigues, Grant E., Lassiter, Tally E., Scribani, Melissa, Goldner, Richard D., Bean, Christopher A.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.12.2019; John Wiley & Sons, Inc
• Subjects: Adult; Aged; Arthroscopy; Esthetics; Female; Humans; Luteinizing hormone; Maintenance; Male; Medicine; Medicine & Public Health; Middle Aged; Orthopedics; Pain; Prospective Studies; Randomization; Rotator cuff; Rotator Cuff Injuries - surgery; Shoulder; Shoulder Joint - surgery; Shoulder Pain - etiology; Shoulder Pain - surgery; Single-Blind Method; Statistical analysis; Statistical tests; Tendinopathy - complications; Tendinopathy - surgery; Tenodesis; Tenotomy; Variance analysis; Visual Analog Scale; Prospective; Bicep tenodesis; Randomized; Arthroscopy; Tenotomy
• ISSN: 0942-2056; 1433-7347; 1433-7347
• DOI: 10.1007/s00167-019-05682-1

Purpose  Surgical management for long head of the biceps (LHB) tendinopathy with either biceps tenotomy or tenodesis is a reliable, but debated treatment option. The aim of this prospective, randomized, single-blinded study is to evaluate differences in pain relief and subjective outcomes between biceps tenotomy versus tenodesis for LHB tendinopathy. Methods  Subjects were randomized and blinded to biceps tenotomy versus arthroscopic tenodesis intra-operatively. Outcomes evaluated included subjective patient outcome scores, pain, and cosmetic deformity. Subjective outcomes scores and pain were analyzed using a two-way ANOVA, controlling for concomitant rotator cuff repair. Binary outcomes were compared using Chi-square tests. Results  Thirty-four subjects (31 male, 3 female) with a median age of 56 (range 30–77) were enrolled. Twenty subjects were randomized to tenotomy and 14 to tenodesis. Fifty-six percent had concomitant rotator cuff repairs. The mean VAS pain score at 3 months was lower with tenotomy versus tenodesis. 2-year follow-up demonstrated no statistically significant differences for VAS, ASES, or SANE. 15/20 (75%) subjects with biceps tenotomy reported no pain medication use at the 2-week postoperative visit versus 5/14 (33%) for biceps tenodesis. Popeye deformity was found in 5/20 (25%) of tenotomy subjects versus 1/14 (7%) in tenodesis subjects. Conclusion Outcomes appear similar between biceps tenotomy versus tenodesis; however, the tenotomy group demonstrated greater incidence of cosmetic deformity but an earlier improvement in postoperative pain. Level of evidence Treatment Studies, Level II.