Biceps Tenodesis Versus Tenotomy in the Treatment of Lesions of the Long Head of the Biceps Tendon in Patients Undergoing Arthroscopic Shoulder Surgery: A Prospective Double-Blinded Randomized Controlled Trial
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OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2021;9(4):15 Am J Sports Med . 2020 May;48(6):1439-1449Qu'est-ce que cela signifie pour ma pratique ?
Study findings may suggest that for patients with a lesion of the long head of the biceps tendon, a tenodesis approach can provide more favourable results with respect to decreasing the incidence of Popeye deformity of the tendon. However, both approaches provide similar clinical outcomes up to 1 year post-treatment. Limitations of this study included the small sample size of 57 patients in each treatment arm as well as the variability in surgeon preference during surgery. Therefore, future larger randomized controlled trials with standardized surgeon expertise are needed to confirm the findings of this randomized controlled trial.
Résumé de l'étude
One hundred and fourteen patients scheduled to undergo arthroscopic shoulder surgery to treat peri-operatively confirmed lesion of the long head of the biceps tendon were randomized to undergo a bicep tenodesis (n=57) or tenotomy (n=57). The primary outcome of interest was disease specific progression measured by the American Shoulder and Elbow Surgeons (ASES) at 3, 6, 12, and 24months follow-up. Secondary outcomes of interest included time of surgery, shoulder function evaluated by the Western Ontario Rotator Cuff Index (WORC) score, shoulder and elbow strength, incidence of complications, incidence of revision surgery, pain evaluated using the Visual Analogue Scale (VAS), severity of cramping on a VAS, and incidence of a Popeye deformity. All secondary outcomes were measured at 3, 6, 12, and 24 months follow-up except for incidence of Popeye deformity, which was evaluated only and 3 and 24 months. The incidence of complications and revision surgery was evaluated at 24 months. Moreover, a sub-group analysis was conducted by tenodesis type for outcomes including ASES, WORC, VAS pain, VAS cramping, and strength of the elbow and shoulder at 24 months follow-up. The results of this randomized controlled trial revealed that no statistically significant differences were observed for any of the outcomes at any of the timepoints (p>0.05 for all), except for the incidence of Popeye deformity. Popeye deformity was statistically significantly less frequent in the tenodesis group vs the tenotomy group (11.4% vs. 39%, p=0.003) at 3 months follow-up. Furthermore, the same pattern was demonstrated at 24 months follow-up, with 10% in the tenodesis group and 33% in the tenotomy group reporting popeye deformity (p=0.016). 4 patients in the tenodesis group and 5 patients in the tenotomy group required revision surgery. Two patients in the tenotomy group developed adhesive capsulitis and 1 patient developed postoperative capsulitis. The subgroup analysis did not reveal any statistical significant different between the 2 groups for any of the outcomes (p>0.05 for all).
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