Boileau, J Bone Joint Surg Am 2007 - Isolated Arthroscopic Biceps Tenotomy or Tenodesis Improves Symptoms in Patients with Massive Irreparable Rotator Cuff Tears - Article Summary

Isolated Arthroscopic Biceps Tenotomy or Tenodesis Improves Symptoms in Patients with Massive Irreparable Rotator Cuff Tears

Boileau, Trojani, et al.·J Bone Joint Surg Am·2007·489 citations·Retrospective cohort

Background

Lesions of the long head of the biceps tendon are often associated with massive rotator cuff tears and may be responsible for shoulder pain and dysfunction. The purpose of this study was to evaluate the clinical and radiographic outcomes of isolated arthroscopic biceps tenotomy or tenodesis as treatment for persistent shoulder pain and dysfunction due to an irreparable rotator cuff tear associated with a biceps lesion.

Methods

We conducted a retrospective study of 68 consecutive patients (mean age [and standard deviation], 68 ± 6 years) in whom a total of 72 irreparable rotator cuff tears had been treated arthroscopically with biceps tenotomy or tenodesis.
A simple tenotomy was performed in 39 cases, and a tenodesis was performed in 33.
No associated acromioplasty was performed.
All patients were evaluated clinically and radiographically by an independent observer at a mean of 35 months postoperatively.

Results

53 patients (78%) were satisfied with the result.
The mean Constant score improved from 46.3 ± 11.9 points preoperatively to 66.5 ± 16.3 points postoperatively (p < 0.001).
A healthy-appearing teres minor on preoperative imaging was associated with significantly increased postoperative external rotation (40.4° ± 19.8° compared with 18.1° ± 18.4°) and a significantly higher Constant score (p < 0.05 for both) compared with the values for the patients with an absent or atrophic teres minor preoperatively.
3 patients with pseudoparalysis of the shoulder did not benefit from the procedure and did not regain active elevation above the horizontal level.
In contrast, the 15 patients with painful loss of active elevation recovered active elevation.
The acromiohumeral distance decreased 1.1 ± 1.9 mm on the average, and glenohumeral osteoarthritis developed in only one patient.
The results did not differ between the tenotomy and tenodesis groups (mean Constant score, 61.2 ± 18 points and 72.8 ± 12 points, respectively).
The 'Popeye' sign was clinically apparent in 24 (62%) of the shoulders that had been treated with a tenotomy; of the 16 patients who noticed it, none were bothered by it.

Conclusions

Both arthroscopic biceps tenotomy and arthroscopic biceps tenodesis can effectively treat severe pain or dysfunction caused by an irreparable rotator cuff tear associated with a biceps lesion. Shoulder function is significantly inferior if the teres minor is atrophic or absent. Pseudoparalysis of the shoulder and severe rotator cuff arthropathy are contraindications to this procedure.

Level of evidence: Therapeutic Level III. Copyright remains with the authors and publisher.

Core

Isolated Arthroscopic Biceps Tenotomy or Tenodesis Improves Symptoms in Patients with Massive Irreparable Rotator Cuff Tears

Boileau, Trojani, et al.J Bone Joint Surg Am2007489 citationsRetrospective cohort