Biceps Tenodesis versus Tenotomy in the Treatment of Lesions of the Long Head of Biceps Brachii : Randomized Clinical Trial - An Interim Analysis

Abstract

Background: Both biceps tenotomy and tenodesis have been shown to produce comparable, effective results in treatment of lesions of the long head of biceps tendon (LHBT). The aim of this study was to provide an interim analysis of a level I prospective, randomized, clinical trial comparing subjective patient-reported outcomes and objective clinical results between biceps tenotomy and tenodesis. Methods: Fifty-nine patients have consented to participate in the study, the current interim analysis was performed for twenty-six patients.The primary outcome measure was the American Shoulder and Elbow Surgeons (ASES) shoulder assessment form. Secondary outcome measures included the Western Ontario Rotator Cuff (WORC) index, strength, cosmetic appearance, pain and cramping pain and operative time. Outcome measures were completed pre-operatively and at 3 and 6 months after surgery. Results: ASES scores improved in the tenotomy group post-op over time, scores in the tenodesis group improved at 3 months but not at 6 months. There were no differences found between the groups in ASES scores, WORC scores, elbow flexion or supination strength, pain, cramping pain, operative time and the incidence of a Popeye deformity at any time point. However at 6 months post-op a difference in elbow flexion strength was approached (p=.061) with the tenodesis group appearing stronger. Conclusion: The results of this interim analysis suggest that there is no difference in clinical or functional outcomes between tenodesis or tenotomy for treatment of lesions to the LHBT. However, tenodesis may preserve some elbow flexion strength and appears to be technically more difficult. Further analysis of a larger sample size and longer follow-up time is required to yield any definitive, evidence based conclusions for treating lesions of the LHBT.