Tenotomy or tenodesis for pathology of the long head of the biceps brachii: a systematic review and meta-analysis

PURPOSE: The objective of this meta-analysis is to compare clinical outcomes of tenotomy and tenodesis in the surgical treatment of long head of the biceps brachii (LHB). METHODS: A literature search was conducted in Embase and PubMed from 2000 to April 2014. All studies comparing the clinical outcomes between LHB tenotomy and tenodesis were included. The quality assessment was done by utilizing the Coleman score. We included nine studies comprising 650 patients undergoing LHB tenotomy or tenodesis, mostly with concomitant shoulder pathology. RESULTS: No significant difference in post-operative Constant score (mean difference 1.77), elbow flexion strength (mean difference 0), and forearm supination strength (mean difference 0.01) in favour of tenodesis was observed. A Popeye deformity (odds ratio 0.17) and cramping pain (odds ratio 0.38) in the bicipital groove muscle were less frequently seen in patients treated with tenodesis. The Coleman score ranged between 45 and 100 in the included studies. CONCLUSION: Based on this meta-analysis, no differences in post-operative functional outcome between tenotomy and tenodesis for the treatment of LHB lesions were observed. A Popeye deformity and cramping pain in the bicipital groove are more frequently observed in patients treated with tenotomy. LEVEL OF EVIDENCE: IV.