A retrospective review of 307 arthroscopic biceps tenotomies performed for full-thickness rotator cuff tears deemed irreparable or in older patients unwilling to undergo repair rehabilitation. It asks whether cutting the long head of the biceps provides durable pain relief and function without repairing the cuff. Patients were followed clinically and radiographically for a mean of 57 months.
When you face a full-thickness cuff tear that is irreparable, or an older low-demand patient unwilling to commit to months of rehab, biceps tenotomy is a legitimate palliative option. The mental model: you are treating a pain generator, not restoring the cuff. Expect strong pain and activity gains but little strength recovery.
Use secondary imaging to grade Goutallier fatty infiltration and check the acromiohumeral interval. Marked infiltration of the infraspinatus or subscapularis predicts a worse result, and an AHI under 7 mm signals an irreparable tear with proximal migration.
Add an acromioplasty only when the AHI exceeds 6 mm and the head is centered. In a migrated head, acromioplasty can violate the coracoacromial arch and worsen elevation. Counsel patients that arthritis will still progress radiographically, so this is symptom control, not disease prevention. Favor tenodesis over tenotomy in patients under 55 to avoid Popeye deformity and supination weakness.
A retrospective review of 307 arthroscopic biceps tenotomies performed for full-thickness rotator cuff tears deemed irreparable or in older patients unwilling to undergo repair rehabilitation. It asks whether cutting the long head of the biceps provides durable pain relief and function without repairing the cuff. Patients were followed clinically and radiographically for a mean of 57 months.
When you face a full-thickness cuff tear that is irreparable, or an older low-demand patient unwilling to commit to months of rehab, biceps tenotomy is a legitimate palliative option. The mental model: you are treating a pain generator, not restoring the cuff. Expect strong pain and activity gains but little strength recovery.
Use secondary imaging to grade Goutallier fatty infiltration and check the acromiohumeral interval. Marked infiltration of the infraspinatus or subscapularis predicts a worse result, and an AHI under 7 mm signals an irreparable tear with proximal migration.
Add an acromioplasty only when the AHI exceeds 6 mm and the head is centered. In a migrated head, acromioplasty can violate the coracoacromial arch and worsen elevation. Counsel patients that arthritis will still progress radiographically, so this is symptom control, not disease prevention. Favor tenodesis over tenotomy in patients under 55 to avoid Popeye deformity and supination weakness.