Treatment of Biceps Lesions in the Setting of the Rotator Cuff Repair: When is Tenodesis Superior to Tenotomy?

OBJECTIVES: However, the optimal treatment of biceps pathology is unclear as few studies have compared tenotomy versus tenodesis in the setting of RCTs. Therefore, the purpose of this study is to compare the outcomes of biceps tenodesis versus tenotomy in the setting of RCTs in order to determine if and when an advantage exists for one technique over the other. METHODS: We retrospectively reviewed 134 patients(age=59.3± 8.6, males=88) following rotator cuff repair with concomitant biceps procedure and minimum 2-year follow up. Validated outcomes scores, including the American Society of Shoulder and Elbow Surgeons(ASES) score was completed before and after surgery. Patients were stratified by age, RCT size and biceps procedure (tenotomy or tenodesis). Separate mixed model ANOVAs (time by group) were performed to compare ASES scores between biceps procedure groups within each RCT size and age group. RESULTS: There were 91 tenodeses and 43 tenotomies. There were no differences in baseline ASES scores or demographics between the groups(P>0.05). Overall patients displayed improvements in ASES scores(43±13) post-operatively but there were no differences between biceps treatment selection within each RCT size group(P>0.05). However, Patients < 55 years old with RCTs > 4cm and biceps tenodesis(n=18) demonstrated nearly twice the improvement(52±3) in post-operative ASES scores compared to those with a biceps tenotomy(28±14; P=0.03). This difference was not observed in patients > 55 years old or with rotator cuff tears less than 4cm(P=0.56). CONCLUSION: This is the first study to demonstrate the superiority of tenodesis over tenotomy in setting of RCTs. Specifically, in younger patients with larger tears, tenodesis had nearly double the improvement in ASES score compared to tenotomy. Our results suggest biceps tenodesis should be considered over tenotomy with concurrent greater than 4cm rotator cuff repairs in patients < 55 years old.