Department of Orthopaedics, University of Colorado School of Medicine, Aurora, CO, USA.
Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, NJ, USA.
J Shoulder Elbow Surg. 2021 May;30(5):951-960. doi: 10.1016/j.jse.2020.11.012. Epub 2020 Dec 26.
Biceps tenodesis and tenotomy are 2 surgical treatment options for relief of long head of the biceps tendon (LHBT) pathology and superior labrum anterior-to-posterior (SLAP) tears. The purpose of this systematic review was to compare the clinical outcomes and complications of biceps tenodesis and tenotomy for the treatment of LHBT or SLAP pathology during shoulder arthroscopy.
We performed a systematic review by searching PubMed, the Cochrane Library, and Embase to identify level I randomized controlled trials that compared the clinical outcomes of biceps tenodesis vs. tenotomy. The search phrase used was as follows: biceps tenodesis tenotomy randomized. Patients were assessed based on the American Shoulder and Elbow Surgeons score, visual analog scale score for pain, and Constant-Murley score, as well as postoperative range of motion, strength, and cosmetic deformity.
Five studies (all level I) met the inclusion criteria, including 236 patients undergoing biceps tenodesis (mean age, 60.3 years) and 232 patients undergoing biceps tenotomy (mean age, 59.7 years). The mean follow-up period was 23.0 months. Overall, 6.8% of tenodesis patients experienced cosmetic deformity at latest follow-up compared with 23.3% of tenotomy patients (P < .001). No differences in Constant-Murley, visual analog scale, or American Shoulder and Elbow Surgeons scores were found between groups in any study, and of all the studies evaluating strength and range of motion at latest follow-up, only 1 found a significant difference between groups, in which tenodesis patients demonstrated significantly increased forearm supination strength (P = .02). One study found tenodesis patients to experience significantly more biceps cramping at 6-month follow-up compared with tenotomy patients (P = .043), although no differences in complication rates at latest follow-up were found in any study.
Patients undergoing treatment for LHBT or SLAP pathology with either biceps tenodesis or tenotomy can be expected to experience similar improvements in patient-reported and functional outcomes. There is an increased rate of cosmetic deformity in patients undergoing biceps tenotomy compared with tenodesis.
肱二头肌肌腱切断术和肌腱固定术是治疗肱二头肌长头肌腱（LHBT）病变和上盂唇前-后（SLAP）撕裂的两种手术治疗选择。本系统评价的目的是比较 LHBT 或 SLAP 病变行肩关节镜下肱二头肌肌腱固定术和肌腱切断术的临床疗效和并发症。
我们通过检索 PubMed、Cochrane 图书馆和 Embase 来进行系统评价，以确定比较肱二头肌肌腱固定术与肌腱切断术的临床疗效的 I 级随机对照试验。使用的搜索词如下：肱二头肌肌腱固定术肌腱切断术随机。根据美国肩肘外科医生评分、疼痛视觉模拟评分和 Constant-Murley 评分以及术后活动范围、力量和美容畸形评估患者。
符合纳入标准的研究有 5 项（均为 I 级），共纳入 236 例行肱二头肌肌腱固定术（平均年龄 60.3 岁）和 232 例行肱二头肌肌腱切断术（平均年龄 59.7 岁）的患者。平均随访时间为 23.0 个月。总体而言，最新随访时，肌腱固定术患者中有 6.8%出现美容畸形，肌腱切断术患者中有 23.3%（P<.001）。在任何研究中，两组间的 Constant-Murley、视觉模拟评分或美国肩肘外科医生评分均无差异，在所有评估最新随访时力量和活动范围的研究中，只有 1 项研究发现两组间存在显著差异，其中肌腱固定术患者的前臂旋后力量显著增加（P=.02）。有 1 项研究发现，肌腱固定术患者在 6 个月随访时出现肱二头肌痉挛的发生率明显高于肌腱切断术患者（P=.043），但在任何研究中，最新随访时的并发症发生率均无差异。
对于 LHBT 或 SLAP 病变，行肱二头肌肌腱固定术或肌腱切断术的患者，预计其患者报告的和功能结局均会得到相似的改善。与肌腱固定术相比，肌腱切断术患者的美容畸形发生率更高。
