A meta-analysis comparing tenotomy and tenodesis for treating rotator cuff tears combined with long head of the biceps tendon lesions

Abstract

Purpose: The purpose of this meta-analysis was to assess whether there were differences in the outcomes between tenotomy and tenodesis in treating LHBT lesions combined with rotator cuff repairs.

Methods: Using Medline, Embase, and Cochrane, we searched for articles comparing tenotomy and tenodesis combined with rotator cuff repair which were published before April 2016 with the terms "biceps", "tenotomy", "tenodesis", and "rotator cuff". The controlled clinical studies that met the inclusion and exclusion criteria were assessed for quality of methodology by utilizing the Coleman score.

Results: On the basis of the inclusion and exclusion criteria, ten articles (903 patients) were included in this meta-analysis. The Coleman score ranged between 40 and 89 in the included studies. The results showed that the incidence of the popeye sign (OR, 2.777, P = 0.000) were higher in tenotomy group compared with tenodesis group when concomitant rotator cuff repair. Statistically significant difference in favor of tenodesis was observed for Constant score (SMD, -0.230, P = 0.025). As for the arm cramping pain, patient satisfaction, VAS score, ASES score and UCLA increased score, the strength and the range of motion, there were no significant differences between tenodesis and tenotomy of the LHBT, corresponding to the currently available results in the literature.

Conclusions: Based on this meta-analysis, both tenotomy and tenodesis are effective in pain relief and function improvement in patients with repairable rotator cuff tears. No significant differences in post-operative functional outcome between tenotomy and tenodesis for the treatment of LHBT lesions were observed except for a lower Constant score and higher risk of Popeye deformity in tenotomy.

Fig 1. Flow chart summarizing the selection of relevant articles.

Fig 2. Standard differences in means for functional scores (UCLA increased score, ASES score, Constant score and VAS score) between tenodesis and tenotomy groups.

Fig 3. Standard differences in means for elbow flexion and forearm supination strength index between tenodesis and tenotomy groups.

Fig 4. Standard differences in means for range of motion between tenodesis and tenotomy groups.

Fig 5. Odds ratios for popeye deformity between tenodesis and tenotomy groups.

Fig 6. Odds ratios for arm cramping pain between tenodesis and tenotomy groups.

Fig 7. Odds ratios for patient satisfaction between tenodesis and tenotomy groups.