Tenodesis has higher functional outcome; tenotomy has shorter OR times in LHBT treatment .
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2015;3(24):27 PLoS One. 2015 Mar 18;10(3):e0121286Seven studies (3 randomized controlled trials; 4 cohort studies) were included in this meta-analysis comparing tenodesis and tenotomy in the management of patients with lesions of the long head of the biceps tendon. Meta-analysis was performed on Constant score, complications, satisfaction, and operative time. Qualitative assessment was undertaken for postoperative range of motion. Tenodesis demonstrated higher postoperative Constant scores and lower rates of cramp pain and Popeye deformity, while no significant differences were observed in satisfaction or range of motion. Operative time was significantly shorter for tenotomy.
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Was the validity of all of the studies referred to in the text assessed with use of appropriate criteria (either in selecting the studies for inclusion or in analyzing the studies that were cited)?
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Were the findings of the relevant studies combined appropriately relative to the primary question that the overview addresses?
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Die Bewertung der Berichtskriterien bewertet die Transparenz, mit der die Autoren die methodischen und studienspezifischen Merkmale der Studie in der Veröffentlichung angeben. Die Bewertung ist in fünf Kategorien unterteilt, die im Folgenden vorgestellt werden.
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Introduction
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Discussion
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
Der Fragilitätsindex ist ein Instrument, das bei der Interpretation signifikanter Ergebnisse hilft und ein Maß für die Stärke eines Ergebnisses liefert. Der Fragilitätsindex gibt die Anzahl der aufeinanderfolgenden Ereignisse an, die zu einem dichotomen Ergebnis hinzugefügt werden müssen, damit das Ergebnis nicht mehr signifikant ist. Eine kleine Zahl steht für ein schwächeres Ergebnis und eine große Zahl für ein stärkeres Ergebnis.
Warum wurde diese Studie jetzt benötigt?
Long head of the biceps tendon lesions are common, particularly as individuals age. Surgery is indicated if conservative treatment can not manage symptoms. Tenotomy or tenodesis may be performed and are typically successful, though both are associated with their own advantages and disadvantages. As such, surgeons are split between which should be performed, and whether one option is superior to the other.
Was war die wichtigste Forschungsfrage?
Is there a significant difference in clinical or functional outcome between tenotomy and tenodesis in patients with long head of the biceps tendon (LHBT) lesions?
- Constant scores were significantly higher with tenodesis versus tenotomy (5 studies; MD 2.84 [95%CI 0.37, 5.31]; p=0.02).
- Qualitative assessment of range of motion from three studies was undertaken, with all reporting no significant difference between tenodesis and tenotomy groups.
- Tenodesis demonstrated significantly lower rates of cramp pain (4 studies; RR 0.51 [95%CI 0.26, 0.98]; p=0.04) and Popeye deformity (7 studies; RR 0.18 [ 95%CI 0.11, 0.30]; p<0.00001). Rate of satisfaction was similar between groups (4 studies; RR 1.00 [095%CI 0.92, 1.09]; p=0.94).
- Tenotomy demonstrated a significantly shorter operative time compared to tenodesis (3 studies; MD 10.54 [95%CI 8.96, 12.12]; p<0.00001).
Was sollte ich mir besonders merken?
Tenodesis demonstrated significantly higher postoperative Constant score and lower incidences of cramp pain and Popeye deformity compared to tenotomy in patients with long head of the biceps tendon lesions. Tenotomy took significantly less time to complete compared to tenodesis. Range of motion postoperative did not appear to significantly differ between tenodesis and tenotomy, and patients were generally satisfied with either surgical treatment.
Wie wird sich dies auf die Behandlung meiner Patienten auswirken?
The results of this meta-analysis suggest that despite having increased surgical time, tenodesis may have improved functional outcomes after surgery for lesions of the long head of the biceps tendon, and may also reduce the risk of associated painful cramping and Popeye deformity. Additional, randomized controlled trials should be considerd to further add to the body of evidence comparing these two methods of treatment.
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