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Tenodesis has higher functional outcome; tenotomy has shorter OR times in LHBT treatment

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Tenodesis has higher functional outcome; tenotomy has shorter OR times in LHBT treatment

Vol: 4| Issue: 12| Number:55| ISSN#: 2564-2537
Study Type:Meta-analysis/Systematic Review
OE Level Evidence:2
Journal Level of Evidence:N/A

Tenotomy or tenodesis for the long head of biceps lesions in shoulders: a systematic review and meta-analysis

PLoS One. 2015 Mar 18;10(3):e0121286

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Seven 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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None disclosed

Risk of Bias


Reporting Criteria


Fragility Index


Were the search methods used to find evidence (original research) on the primary question or questions stated?

Was the search for evidence reasonably comprehensive?

Were the criteria used for deciding which studies to include in the overview reported?

Was the bias in the selection of studies avoided?

Were the criteria used for assessing the validity of the included studies reported?

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)?

Were the methods used to combine the findings of the relevant studies (to reach a conclusion) reported?

Were the findings of the relevant studies combined appropriately relative to the primary question that the overview addresses?

Were the conclusions made by the author or authors supported by the data and or analysis reported in the overview?

How would you rate the scientific quality of this evidence?

Yes = 1

Uncertain = 0.5

Not Relevant = 0

No = 0

The Reporting Criteria Assessment evaluates the transparency with which authors report the methodological and trial characteristics of the trial within the publication. The assessment is divided into five categories which are presented below.




Accessing Data


Analysing Data





Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65

The Fragility Index is a tool that aids in the interpretation of significant findings, providing a measure of strength for a result. The Fragility Index represents the number of consecutive events that need to be added to a dichotomous outcome to make the finding no longer significant. A small number represents a weaker finding and a large number represents a stronger finding.

Why was this study needed now?

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.

What was the principal research question?

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?

Study Characteristics -
Data Source:
PubMed, MEDLINE, and EMBASE were searched for relevant articles published up to August 2014. Reference lists of identified articles were also search for studies possibly missed by the electronic search.
Index Terms:
Search terms included: "long head of biceps", "biceps tenotomy", and "biceps tenodesis".
Study Selection:
Inclusion criteria were: randomized controlled trials and cohort studies comparing tenotomy and tenodesis in patients with LHBT lesion, and reported minimum 1 year follow-up of patient outcomes. Search and selection were performed independently by two reviewers. A total of seven studies (3 RCTs, 4 cohort) with 622 patients were selection for final inclusion.
Data Extraction:
Data extraction was performed independently by two reviewers, with disagreement resolved through discussion and, if necessary, consultation with a third reviewer.
Data Synthesis:
Meta-analysis was performed using Review Manager software (RevMan 5.2). Effect sizes were expressed as risk ratios (RRs) for dichotomous outcomes and mean differences (MDs) for continuous outcomes, both with 95% confidence intervals. Heterogeneity was assessed using the Chi-square test and I-squared statistic, with I>50% considered significant heterogeneity. If heterogeneity was significant, a random-effects model was used. If heterogeneity was non-significant, a fixed-effects model was used.

What were the important findings?

  • 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).

What should I remember most?

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.

How will this affect the care of my patients?

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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