Funnel tenotomy versus intracuff tenodesis for lesions of the long head of the biceps tendon associated with rotator cuff tears

Abstract

Background: There is no clear consensus regarding optimal management of lesions of the long head of the biceps tendon (LHBT) associated with rotator cuff tears.

Purpose: To compare clinical outcome and cosmetic deformity of a funnel tenotomy versus intracuff tenodesis for concomitant LHBT lesion in patients with rotator cuff tears.

Study design: Cohort study; Level of evidence, 3.

Methods: Patients who underwent surgical treatment for rotator cuff tears associated with LHBT lesions between March 2005 and February 2011 were enrolled in the study (N = 83). Forty-one underwent a funnel tenotomy (group A), and 42 underwent an intracuff tenodesis (group B). The mean age at the time of operation was 63.8 years in group A (range, 44-68 years) and 58.6 years in group B (range, 45-70 years).

Results: At the most recent follow-up, the mean University of California at Los Angeles (UCLA) score in group A improved from a preoperative mean of 16.9 ± 3.6 to 30.6 ± 4.1 (P < .001), and the Constant score improved from 58.7 ± 14.2 to 73.8 ± 11.2 (P < .001). In group B, these scores improved from 18.1 ± 4.0 to 31.3 ± 3.0 (P < .001) and 53.6 ± 13.4 to 74.8 ± 11.9 (P < .001), respectively. There were no statistically significant differences between the 2 groups (P = .43 for UCLA, P = .81 for Constant score). Popeye deformity was detected in 11 cases of group A (26.8%) and in 7 cases of group B (16.7%) (P = .06).

Conclusion: For the treatment of concomitant LHBT lesions in patients with rotator cuff tears, both a funnel tenotomy and an intracuff tenodesis showed good clinical outcomes. Even though the incidence of Popeye deformity in the funnel tenotomy group tended to be higher, there was no significant difference in the overall incidence of cosmetic deformity between the 2 groups.

Keywords: biceps lesion; funnel; intracuff; rotator cuff tear; shoulder; tenodesis; tenotomy.