Tenodesis yields better functional results than tenotomy in long head of the biceps tendon operations-a systematic review and meta-analysis

Abstract

Background: Pathology of the long head of the biceps tendon (LHBT) is a common disorder affecting muscle function and causing considerable pain for the patient. The literature on the two surgical treatment methods (tenotomy and tenodesis) is controversial; therefore, our aim was to compare the results of these interventions.

Methods: We performed a meta-analysis using the following strategy: (P) patients with LHBT pathology, (I) tenodesis, (C) tenotomy, (O) elbow flexion and forearm supination strength, pain assessed on the ten-point Visual Analog Scale (VAS), bicipital cramping pain, Constant, ASES, and SST score, Popeye deformity, and operative time. We included only randomized clinical trials. We searched five databases. During statistical analysis, odds ratios (OR) and weighted mean differences (WMD) were calculated for dichotomous and continuous outcomes, respectively, using the Bayesian method with random effect model.

Results: We included 11 studies in the systematic review, nine of these were eligible for the meta-analysis, containing data about 572 patients (279 in the tenodesis, 293 in the tenotomy group). Our analysis concluded that tenodesis is more beneficial considering 12-month elbow flexion strength (WMD: 3.67 kg; p = 0.006), 12-month forearm supination strength (WMD: 0.36 kg; p = 0.012), and 24-month Popeye deformity (OR: 0.19; p < 0.001), whereas tenotomy was associated with decreased 3-month pain scores on VAS (WMD: 0.99; p < 0.001). We did not find significant difference among the other outcomes.

Conclusion: Tenodesis yields better results in terms of biceps function and is non-inferior regarding long-term pain, while tenotomy is associated with earlier pain relief.

Keywords: LHBT; Long head of the biceps tendon; Meta-analysis; Rotator cuff; Shoulder arthroscopy; Systematic review; Tenodesis; Tenotomy.

Fig. 1

A Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) flow chart representing the search and selection process

Fig. 2

A forest plot that compares the results of elbow flexion strength measurements in kg in tenotomy and tenodesis at the 12-month follow-up and the results of the 12-month forearm supination strength levels of tenotomy and tenodesis. The black diamonds represent the effect of individual studies, and the vertical lines show the corresponding 95% confidence intervals (CI). The size of the grey squares reflects the weight of a particular study. The blue diamond reflects the overall or summary effect. The outer edges of the diamonds represent the CIs

Fig. 3

A forest plot that compares the level of postoperative pain on the Visual Analog Scale (VAS) in tenotomy and tenodesis, measured three months post-operatively. The black diamonds represent the effect of individual studies, and the vertical lines show the corresponding 95% confidence intervals (CI). The size of the grey squares reflects the weight of a particular study. The blue diamond reflects the overall or summary effect. The outer edges of the diamonds represent the CIs

Fig. 4

A forest plot that compares the occurrence of Popeye deformity in tenotomy and tenodesis, measured 24 months post-operatively. The black diamonds represent the effect of individual studies, and the vertical lines show the corresponding 95% confidence intervals (CI). The size of the grey squares reflects the weight of a particular study. The blue diamond reflects the overall or summary effect. The outer edges of the diamonds represent the CIs