title: A Systematic Review and Meta-analysis Comparing Clinical Outcomes After Concurrent Rotator Cuff Repair and Long Head Biceps Tenodesis or Tenotomy.
abstract: BACKGROUND
  A comparison of clinical outcomes after long head of biceps (LHB) tenotomy or tenodesis performed concurrently with rotator cuff repair (RCR) is of interest to physicians and patients.
  
  
  OBJECTIVE
  A systematic review of clinical outcome studies examining LHB tenotomy or tenodesis performed concurrently with RCR. Secondarily, perform a meta-analysis of data from comparative studies.
  
  
  METHODS
  MEDLINE (1946 to week 30 of 2013) and EMBASE (1980 to week 30 of 2013).
  
  
  METHODS
  Levels 1 through 4 studies reporting clinical outcomes of concurrent RCR and LHB tenotomy or tenodesis with minimum 1-year follow-up.
  
  
  METHODS
  Systematic review and meta-analysis.
  
  
  METHODS
  Level 4.
  
  
  METHODS
  Two independent reviewers identified eligible studies and applied the exclusion criteria. Clinical outcome data, including functional outcome score(s), biceps deformity and cramping, and patient satisfaction, were extracted. Clinical outcome data from included studies were pooled (weighted according to study size) and reported. A meta-analysis was performed only on outcomes extracted from comparative studies (α = 0.05).
  
  
  RESULTS
  Twelve studies (N = 565 patients; mean age, 61.3 years; 46.3% men) were included. Of these, 6 (N = 263) included RCR and LHB tenotomy and 9 (N = 302) included RCR and LHB tenodesis. A meta-analysis was performed on 3 comparative studies (levels 1 and 2), demonstrating that the postoperative Constant score at a mean follow-up of 25.5 months was significantly greater after tenodesis (92.8 [tenodesis] vs 90.6 [tenotomy], P < 0.01); however, this difference was less than the reported minimal clinically important difference of 10.4 points. Similarly, the rate of biceps deformity was significantly less after tenodesis (15.5% [tenotomy] vs 3.9% [tenodesis], P < 0.01); however, most patients were not bothered by it. There were no significant differences in the rate of biceps cramping or patient satisfaction.
  
  
  CONCLUSIONS
  Although the postoperative Constant score and rate of biceps deformity favor LHB tenodesis statistically, the clinical significance appears negligible.
authors.affiliation: University of Toronto Orthopaedic Sports Medicine, Toronto, Ontario, Canada.
authors.forename: Timothy
authors.initials: T
authors.lastname: Leroux
authors.affiliation: University of Toronto Orthopaedic Sports Medicine, Toronto, Ontario, Canada ; Osteoarthritis Research Unit, University Health Network, Toronto, Ontario, Canada.
authors.forename: Jaskarndip
authors.initials: J
authors.lastname: Chahal
authors.affiliation: University of Toronto Orthopaedic Sports Medicine, Toronto, Ontario, Canada ; Sunnybrook Health Sciences Center, Toronto, Ontario, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Wasserstein
authors.affiliation: Division of Sports Medicine, Rush University Medical Center, Chicago, Illinois.
authors.forename: Nikhil N
authors.initials: NN
authors.lastname: Verma
authors.affiliation: Division of Sports Medicine, Rush University Medical Center, Chicago, Illinois.
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Romeo
keywords: biceps tenodesis; biceps tenotomy; meta-analysis; rotator cuff repair; systematic review