Biceps tenotomy versus tenodesis: clinical outcomes.

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Shoulder Surgery

Background:

• Lesions of the long head of the biceps brachii are common.
• Surgical management often involves either tenotomy or tenodesis.
• Current literature lacks consensus on the optimal surgical approach due to limited high-quality evidence.

Purpose of the Study:

• To systematically review and compare the clinical outcomes of biceps tenotomy versus tenodesis for long head lesions.
• To identify differences in efficacy and complication rates between the two surgical procedures.
• To highlight the need for further high-level evidence to guide clinical decision-making.

Main Methods:

• Systematic review of PubMed-indexed articles on biceps tenotomy and tenodesis.
• Inclusion of Level I-IV evidence and English-language studies reporting clinical outcomes.
• Normalization of outcome measurements to "excellent/good" versus "poor" results.

Main Results:

• Sixteen studies (predominantly Level IV evidence) were included.
• Tenotomy (699 procedures) yielded 77% excellent/good outcomes with 43% cosmetic deformity.
• Tenodesis (433 procedures) yielded 74% excellent/good outcomes with 8% cosmetic deformity.
• Postoperative pain rates were similar (19% tenotomy, 24% tenodesis).
• Direct comparative studies found no significant clinical differences, except for higher cosmetic deformity after tenotomy.

Conclusions:

• Biceps tenotomy and tenodesis demonstrate comparable clinical success rates for long head lesions.
• Biceps tenotomy is associated with a significantly higher incidence of cosmetic deformity.
• A lack of high-quality, randomized controlled trials hinders definitive recommendations.
• Individual patient factors should guide the choice between tenotomy and tenodesis.