Institute for Translational Medicine, Medical School, University of Pécs, Szigeti út 12, 2nd floor, 7624, Pécs, Hungary.
Saint George University Teaching Hospital of County-Fejér, Seregélyesi u. 3., 8000, Székesfehérvár, Hungary.
Int Orthop. 2022 May;46(5):1037-1051. doi: 10.1007/s00264-022-05338-9. Epub 2022 Mar 7.
Pathology of the long head of the biceps tendon (LHBT) is a common disorder affecting muscle function and causing considerable pain for the patient. The literature on the two surgical treatment methods (tenotomy and tenodesis) is controversial; therefore, our aim was to compare the results of these interventions.
We performed a meta-analysis using the following strategy: (P) patients with LHBT pathology, (I) tenodesis, (C) tenotomy, (O) elbow flexion and forearm supination strength, pain assessed on the ten-point Visual Analog Scale (VAS), bicipital cramping pain, Constant, ASES, and SST score, Popeye deformity, and operative time. We included only randomized clinical trials. We searched five databases. During statistical analysis, odds ratios (OR) and weighted mean differences (WMD) were calculated for dichotomous and continuous outcomes, respectively, using the Bayesian method with random effect model.
We included 11 studies in the systematic review, nine of these were eligible for the meta-analysis, containing data about 572 patients (279 in the tenodesis, 293 in the tenotomy group). Our analysis concluded that tenodesis is more beneficial considering 12-month elbow flexion strength (WMD: 3.67 kg; p = 0.006), 12-month forearm supination strength (WMD: 0.36 kg; p = 0.012), and 24-month Popeye deformity (OR: 0.19; p < 0.001), whereas tenotomy was associated with decreased 3-month pain scores on VAS (WMD: 0.99; p < 0.001). We did not find significant difference among the other outcomes.
Tenodesis yields better results in terms of biceps function and is non-inferior regarding long-term pain, while tenotomy is associated with earlier pain relief.
肱二头肌长头肌腱（LHBT）病变是一种常见的影响肌肉功能并导致患者产生严重疼痛的疾病。关于两种手术治疗方法（肌腱切断术和肌腱固定术）的文献存在争议；因此，我们旨在比较这两种干预措施的结果。
我们采用以下策略进行荟萃分析：（P）患有 LHBT 病变的患者，（I）肌腱固定术，（C）肌腱切断术，（O）肘部弯曲和前臂旋前力量，采用 10 分视觉模拟量表（VAS）评估的疼痛，二头肌痉挛疼痛，Constant、ASES 和 SST 评分，Popeye 畸形和手术时间。我们仅纳入随机临床试验。我们搜索了五个数据库。在统计分析中，使用贝叶斯随机效应模型计算二分类和连续结局的比值比（OR）和加权均数差（WMD）。
我们对系统评价进行了 11 项研究的综述，其中 9 项研究符合荟萃分析的纳入标准，共纳入 572 例患者的数据（肌腱固定术组 279 例，肌腱切断术组 293 例）。我们的分析得出结论，考虑到 12 个月时的肘部弯曲力量（WMD：3.67kg；p=0.006）、12 个月时的前臂旋前力量（WMD：0.36kg；p=0.012）和 24 个月时的 Popeye 畸形（OR：0.19；p<0.001），肌腱固定术更有益，而肌腱切断术与 3 个月时 VAS 的疼痛评分降低相关（WMD：0.99；p<0.001）。我们没有发现其他结局之间存在显著差异。
肌腱固定术在二头肌功能方面的效果更好，且在长期疼痛方面非劣效，而肌腱切断术则与早期疼痛缓解相关。
