Tenodesis Better Than Tenotomy for Biceps Tendon Repair During Rotator Cuff Surgery

Tenodesis Better Than Tenotomy for Biceps Tendon Repair During Rotator Cuff Surgery

NEW YORK (Reuters Health) Jul 09 - When patients having rotator cuff surgery also have a torn biceps tendon, repairing it with tenodesis takes only 10 minutes longer than tenotomy but yields better outcomes, Korean researchers say.

In tenodesis, the surgeon cuts the normal attachment of the biceps tendon on the shoulder socket and reattaches it to the humerus. This maneuver takes pressure off the cartilage rim of the shoulder socket (the labrum), and a portion of the tendon can be resected. The alternative -- a tenotomy -- simply involves cutting and suturing the tendon.

It's well known that with tenodesis, patients have a longer recovery, but they're also more likely to have better function and a normal appearing biceps muscle. With tenotomy, there can be arm cramping, weakness, and a biceps tendon abnormality called a "Popeye deformity" (after the cartoon character known for flexing his biceps).

Less well known is whether one procedure is better than another in the setting of simultaneous rotator cuff repair, when the biceps tendon tears are often discovered incidentally.

In a study published online June 15th in the American Journal of Sports Medicine, Dr. Jae Chul Yoo, of Sungkyunkwan University School of Medicine, Seoul, and colleagues report on 90 patients with rotator cuff tears and biceps tendon lesions. The first 45 patients had biceps tenodesis, and the next 45 had biceps tenotomy. All were more than 55 years old.

Forty-three patients in the tenodesis group and 41 in the tenotomy group were evaluated at a mean of roughly 27 months after surgery. The two groups were similar in age, sex, and time from symptom onset to surgery. They were also similar in preoperative American Shoulder and Elbow Surgeons (ASES) score and Constant score (used to assess overall shoulder function), and rotator cuff tear size.

As for the biceps lesions, inclusion criteria included a tear of more than 30% of the normal width of the tendon, subluxation or dislocation, or a degenerative SLAP II lesion (i.e., "superior labrum anterior to posterior").

Overall, there was no difference between the tenodesis and tenotomy groups in the mean elbow flexor power ratio at the final follow-up.

Shoulder function improved significantly in each group, with no significant differences between the two. The ASES score improved from 52.1 to 84.7 in the tenodesis group and from 48.1 to 79.6 in the tenotomy group. The Constant score improved from 38.9 to 82.9 with tenodesis and from 35.2 to 78.3 with tenotomy.

Two patients in the tenodesis group and four in the tenotomy group had mild cramping pain, but the difference was not significant.

The Popeye deformity developed in 11 tenotomy patients (26.8%) and in four tenodesis patients (9.3%; p=0.036).

The mean surgical time did not differ significantly between the tenodesis group and the tenotomy group (119.7 vs. 108.9 minutes, respectively).

The authors point out that in most comparisons of the two procedures, the differences between tenodesis and tenotomy are much more dramatic. It's possible, they say, that in patients with rotator cuff tears, associated inflammation may encourage an autotenodesis effect. The usual four weeks of immobilization after rotator cuff repair may also have contributed to an autotenodesis.

The authors note that tenodesis is "technically more complicated" than tenotomy, and that clinical results hardly differed in their study.

"Nonetheless," they conclude, "tenodesis is less likely to produce Popeye deformity so tenodesis is a better approach except for the aged, senile, and less active."

SOURCE: http://link.reuters.com/hen76m

Am J Sports Med 2010.

Reuters Health Information © 2010 

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