160 patients over the age of 55 with rotator cuff tear and associated pathology of the long head of the biceps tendon (LHBT) were randomized to either LHBT tenotomy or tenodesis. The purpose of this study was to evaluate the comparative efficacy between treatment methods in older patients with respect to function, strength, pain, and possible complications. Follow-up was performed for 24 months postoperatively. Results indicated similar Constant scores and recovery of flexion strength and forearm supination strength between groups. Tenotomy was associated with significantly shorter operative time and lower pain at 2 weeks, though difference in pain between groups at 4 weeks was lost. A total of 7 tenotomy patients and 2 tenodesis patients displayed a popeye deformity postoperatively.