Tenotomy, tenodesis offer similar objective results for lesions of long head of biceps tendon

TORONTO — A comparison of tenotomy and tenodesis as arthroscopic treatment for lesions of the long head of biceps tendon showed no differences in terms of patient-perceived quality of life scores at 12-month follow-up, according to results presented at the American Orthopaedic Society for Sports Medicine Annual Meeting.

“Cosmesis and strength advantage tenodesis in this study and as data continues to be gathered to 24-month postoperative, long-term benefits and drawbacks of each procedure may become evident,” Peter B. MacDonald, MD, FRCS, said in his presentation here.

MacDonald and colleagues randomly assigned 112 patients with a lesion of the long head of biceps tendon to undergo either tenodesis or tenotomy. The primary outcome measure was the American Shoulder and Elbow Society (ASES) standardized assessment of shoulder function. Secondary outcome measures included the Western Ontario Rotator Cuff Index (WORC), length of surgical time, patient-reported pain and cramping, presence of a cosmetic deformity, elbow flexion, and supination strength and power. Outcomes were collected preoperatively and postoperatively at 3 months, 6 months, 12 months and 24 months. Researchers conducted MRI at 12 months postoperatively.

MacDonald noted no significant differences between the two groups in terms of ASES scores, WORC scores, pain scores, cramping and supination strength.

“There was a significant risk of Popeye deformity in the tenotomy group relative to the tenodesis group, and isometric elbow flexion strength was actually different favoring the tenodesis group, especially at 6 months,” MacDonald said.

Results showed a complication related to rotator cuff repair in both the tenotomy and tenodesis groups. While elbow flexion strength decreased in both groups, according to MacDonald, elbow flexion strength recovered in the tenodesis group.

“There was 21% failure in tenodesis on critical analysis on MRI,” MacDonald said. “So, some of these tenodesis did not stand up over time.” – by Casey Tingle

Reference:

MacDonald PB, et al. Paper #101. Presented at: American Orthopaedic Society for Sports Medicine Annual Meeting; July 20-23, 2017; Toronto.

Disclosure: MacDonald reports research support from Arthrex Inc., Conmed Linvatec and Össur; is on the editorial or governing board for the Journal of Shoulder and Elbow Surgery Clinical Journal of Sports Medicine; and is on the board or committee for the American Shoulder and Elbow Surgeons and the Canadian Orthopaedic Association.