Treatment of biceps tendon lesions in the setting of rotator cuff tears: prospective cohort study of tenotomy versus tenodesis.
BACKGROUND
During rotator cuff repair, biceps tendon lesions are frequently encountered. However, there is still controversy about optimal treatment for these lesions.


OBJECTIVE
To compare the results of tenotomy and suture anchor tenodesis prospectively.


METHODS
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.


CONCLUSIONS
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.
Koh
Kyoung Hwan
KH
Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Gu, Seoul, Korea. osdoc.koh@gmail.com
Ahn
Jin Hwan
JH
Kim
Sang Min
SM
Yoo
Jae Chul
JC
D000368:Aged; D000369:Aged, 80 and over; D001132:Arm; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006811:Humerus / Q000601:surgery; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000601:surgery*; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D017006:Rotator Cuff / Q000601:surgery; D000070636:Rotator Cuff Injuries; D012785:Shoulder Joint / Q000601:surgery; D013708:Tendon Injuries / Q000601:surgery*; D053656:Tenodesis