Biceps tenotomy versus tenodesis: patient-reported outcomes and satisfaction

Abstract

Background: Biceps tenotomy and tenodesis are surgical treatments for pathology of the proximal tendon of the long head of the biceps. There is debate over which procedure provides better patient outcomes.

Purpose: Compare patient-reported outcomes and satisfaction between biceps tenotomy and tenodesis.

Methods: This retrospective cohort study including all patients undergoing arthroscopic biceps tenodesis or tenotomy as part of more extensive shoulder surgery with a single surgeon. Concomitant procedures included rotator cuff repair, subacromial decompression, acromioclavicular joint resection, and debridement. Patients 36-81 years old were contacted by phone at > 2-year post-operatively to complete a biceps-specific outcome questionnaire. Subject decision not to participate was the sole exclusion criterion. Satisfaction scores and frequencies of potential biceps-related downsides (biceps cramping/spasms, biceps pain, shoulder pain, weakness, cosmetic deformity) were analyzed for the effects of procedure, sex, and age.

Results: Satisfaction score distributions were similar between patients with tenodesis and patients with tenotomy (χ² = 8.34, P = 0.08), although slightly more patients with tenodesis than patients with tenotomy reported being satisfied or very satisfied (96% versus 91%). Perceived downsides occurred more frequently among patients with tenotomy than in patients with tenodesis: 59% of patients with tenotomy reported ≥ 1 downside, versus 37% of patients with tenodesis (P < 0.01). In patients reporting ≥ 1 downside, distributions of total downsides differed between procedures (χ² = 10.04, P = 0.04): patients with tenotomy were more likely to report multiple concurrent downsides than were patients with tenodesis (31% versus 16%). Each individual downside tended to be reported as present by a greater proportion of patients with tenotomy than patients with tenodesis. Sex had no effect on satisfaction or downsides, but there was a trend for older patients to report higher satisfaction and fewer downsides.

Conclusions: Biceps tenotomy and tenodesis are both viable treatments for proximal biceps tendon pathology, yielding high patient satisfaction. There were trends toward greater satisfaction and fewer problems in patients with tenodesis. Still, younger patients with tenodesis did report perceived downsides. Alternatively, older patients tended to be more satisfied with both procedures overall. Regardless of procedure, most patients receiving either tenotomy or tenodesis would undergo their respective surgery again.

Level of evidence: Level III evidence, retrospective comparative cohort study.

Keywords: Biceps tendon; Downsides; Shoulder arthroscopy; Shoulder pain; Spasms/cramping.

Fig. 1

Patient-reported satisfaction after biceps tenotomy or tenodesis and concomitant procedure. The first pie chart is for tenotomy, followed by the tenodesis chart. a Percentage of patients reporting satisfaction. Among patients with tenodesis, ninety-eight, nine, three, and one gave a score of 5 (“very satisfied”), 4 (“satisfied”), 3 (“neutral”), and 1 (“very unsatisfied”), respectively, with no patients giving a score of 2 (“unsatisfied”). Among patient with tenotomy, seventy-eight, seventeen, six, two, and one gave a satisfaction score of 5, 4, 3, 2, and 1, respectively. b Percentage of patients reporting they would have the same surgery again. Among patients with tenodesis, 104 reported they would have the procedure again. Among patients with tenotomy, 91 reported that they would have the procedure again

Fig. 2

Pie charts comparing patient-reported downsides following either biceps tenotomy or tenodesis, and an associated bar graph providing further details about that downside. The top pie chart, for each downside, is for tenotomy followed by the lower chart for tenodesis. a Patients reporting biceps spasms and cramping with a graph detailing the frequency of this downside. b Patients reporting biceps muscle pain with a graph rating their pain 1–5. c Patients reporting shoulder pain with a graph rating their pain 1–5. d Patients reporting activity-specific weakness with an accompanying graph detailing which activity patients noticed weakness. e Patients reporting daily activity limitation with a graph rating the level of limitation. f Patients noticing a popeye sign with a graph detailing how many were cosmetically bothered by this

Fig. 3

Forest plot of odds ratios of the likelihood of patients with tenotomy to experience a negative outcome relative to patients with tenodesis. Spasms/cramping (tenotomy 20%; tenodesis 8%; P = 0.02; OR = 2.87, 95% CI 1.25–6.60); biceps pain (tenotomy 20%; tenodesis 11%; P = 0.09; OR = 1.96, 95% CI 0.91–4.25); shoulder pain (tenotomy 36%; tenodesis 19%; P = 0.01; OR = 2.37, 95% CI 1.27–4.41); weakness (tenotomy 17%; tenodesis 11%; P = 0.24; OR = 1.73, 95% CI 0.79–3.79); limitations (tenotomy 11%; tenodesis 8%; P = 0.64; OR = 1.34, 95% CI 0.53–3.38); and the popeye sign (tenotomy 14%; tenodesis 11%; P = 0.54; OR = 1.39, 95% CI 0.62–3.13)