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Study: Similarities in strength, outcomes for younger patients treated with tenotomy or tenodesis
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BALTIMORE — Despite increased demands on biceps function, there are no significant differences in functional and outcome measurements in younger patients who had biceps tenotomy or tenodesis for the treatment of shoulder pain, according to a study presented at the American Orthopaedic Society for Sport Medicine Annual Meeting, here.
“This study confirms general similarities between tenotomy and tenodesis in both strength and fatigue measurements and clinical outcomes in a population younger than 55 years old,” Jamie Friedman, MS, of the University of Colorado Sports Medicine, said during the presentation.
 Jamie Friedman |
In the retrospective cohort study, researchers contacted 20 patients who underwent biceps tenotomy and 22 patients who underwent subpectoral biceps tenodesis at least 1 year prior. All patients underwent isokinetic strength and endurance testing of both the operative and nonoperative shoulders for forearm supination, as well as elbow flexion testing with an isokinetic dynamometer.
Outcomes measures included the modified American Shoulder and Elbow Surgeons (ASES), the Disability of the Arm, Shoulder and Hand (DASH), and Visual Analogue Score (VAS). Each patient was also evaluated for perceived biceps deformity.
Average follow-up was 3.1 years, and the average age at follow-up was 49.5 years. In the study, 20% of tenotomy patients had popeye deformity, compared with 8% of tenodesis patients. Strength prior to fatigue was similar between groups for forearm supination (6.9 vs. 7.3 lbs), elbow flexion in neutral (35.4 vs. 35.4) and elbow flexion in supination (33.8 vs. 34.2).
Strength before and after fatigue was similar, Friedman reported, with no significant differences between the groups for isokinetic strength and endurance measures. DASH, ASES and VAS scores were all similar between groups. Patient complaints of deformity, pain, weakness and cramping were similar between both groups.
“Other considerations of cost and rehabilitation are factors that were not addressed in the study, but may also guide the decision-making process of the physician and the patient,” Friedman said.
Reference:
Friedman J, FitzPatrick JL, Rylander LS, Bennett C, et al. Biceps tenotomy vs tenodesis in the younger active patient under age 55: Is there a difference in strength and outcomes? Paper #7. Presented at the American Orthopaedic Society for Sports Medicine Annual Meeting 2012. July 12-15. Baltimore.
Disclosure: Friedman has no relevant financial disclosures.
Perspective
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Brett D. Owens, MD
Friedman and colleagues are congratulated on this award winning paper. This choice of biceps tenotomy vs. tenodesis is often a clinical dilemma. They compared two nonrandomized groups of 18 middle-aged patients in a retrospective fashion, but performed strength analysis in addition to subjective outcome scores. They found no differences in subjective scores or in strength of supination or elbow flexion. Twenty percent of the tenotomy patients and 8% of the tenodesis patients developed a popeye deformity. The rate of popeye deformity in the tenotomy patients is lower than other reports.
There are some limitations, including small numbers of patients and the possibility of selection bias. While clearly, well-designed randomized controlled trials are needed to answer this complex question definitively, it appears that either tenotomy or tenodesis is an effective treatment option in the middle-aged patient with biceps pathology. This study can be used to help guide surgeons and patients in making this decision, with optimal treatment individualized to the patient’s needs and ability to adhere to the rehabilitation program of each.
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