No difference between tenotomy vs tenodesis for the long head of the biceps tendinopathy in rotator cuff repair: a systematic review

Importance There is no consensus concerning the management of long head of the biceps (LHB) tendon pathology when this is concomitant to repairable rotator cuff (RC) tears. Objective The present systematic review collected and analysed the available evidence concerning the management of LHB tendinopathy associated with repair of RC tears. Evidence review An electronic search was performed through PubMed – MEDLINE database, Google scholar and Cochrane central. All types of studies were considered for inclusion, except for case report, systematic review and meta-analyses. No time interval of publication was set. Articles had to focus on the surgical treatment of LHB tendinopathy associated with RC arthroscopic repair in adult subjects. Furthermore, cadaver studies, in vitro or animal model studies, were not considered for inclusion. Findings The literature provided heterogeneous evidence regarding study design and methodology, evaluation outcome tools and surgical techniques. All the studies included subjects with RC pathology associated with LHB tendinopathy, managed by tenotomy or tenodesis. Different types of tenodesis were reported, including open subpectoral technique and arthroscopic intracuff tenodesis. Conclusion and relevance The results of either tenotomy or tenodesis are equivalent, in terms of clinical features and biomechanical characteristics, when LHB tendinopathy is concomitant to RC tears. This should be interpreted as a relevant stimulus for further research on this topic, focusing to the clinical outcomes of tenotomy and tenodesis, and restoration of muscle force and function of the shoulder–elbow complex. Level of evidence III