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Vajda M, Szakó L, Hegyi P, Erőss B, Görbe A, Molnár Z, Kozma K, Józsa G, Bucsi L, Schandl K. Tenodesis yields better functional results than tenotomy in long head of the biceps tendon operations-a systematic review and meta-analysis. INTERNATIONAL ORTHOPAEDICS 2022; 46:1037-1051. [PMID: 35254476 PMCID: PMC9001564 DOI: 10.1007/s00264-022-05338-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 02/01/2022] [Indexed: 12/29/2022]
Abstract
Background Pathology of the long head of the biceps tendon (LHBT) is a common disorder affecting muscle function and causing considerable pain for the patient. The literature on the two surgical treatment methods (tenotomy and tenodesis) is controversial; therefore, our aim was to compare the results of these interventions. Methods We performed a meta-analysis using the following strategy: (P) patients with LHBT pathology, (I) tenodesis, (C) tenotomy, (O) elbow flexion and forearm supination strength, pain assessed on the ten-point Visual Analog Scale (VAS), bicipital cramping pain, Constant, ASES, and SST score, Popeye deformity, and operative time. We included only randomized clinical trials. We searched five databases. During statistical analysis, odds ratios (OR) and weighted mean differences (WMD) were calculated for dichotomous and continuous outcomes, respectively, using the Bayesian method with random effect model. Results We included 11 studies in the systematic review, nine of these were eligible for the meta-analysis, containing data about 572 patients (279 in the tenodesis, 293 in the tenotomy group). Our analysis concluded that tenodesis is more beneficial considering 12-month elbow flexion strength (WMD: 3.67 kg; p = 0.006), 12-month forearm supination strength (WMD: 0.36 kg; p = 0.012), and 24-month Popeye deformity (OR: 0.19; p < 0.001), whereas tenotomy was associated with decreased 3-month pain scores on VAS (WMD: 0.99; p < 0.001). We did not find significant difference among the other outcomes. Conclusion Tenodesis yields better results in terms of biceps function and is non-inferior regarding long-term pain, while tenotomy is associated with earlier pain relief. Supplementary Information The online version contains supplementary material available at 10.1007/s00264-022-05338-9.
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Affiliation(s)
- Mátyás Vajda
- Institute for Translational Medicine, Medical School, University of Pécs, Szigeti út 12, 2nd floor, 7624 Pécs, Hungary
- Saint George University Teaching Hospital of County-Fejér, Seregélyesi u. 3., 8000 Székesfehérvár, Hungary
- Department of Orthodaedics, Medical School, University of Pécs, Akác u. 1, 7632 Pécs, Hungary
| | - Lajos Szakó
- Institute for Translational Medicine, Medical School, University of Pécs, Szigeti út 12, 2nd floor, 7624 Pécs, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine, Medical School, University of Pécs, Szigeti út 12, 2nd floor, 7624 Pécs, Hungary
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085 Hungary
| | - Bálint Erőss
- Institute for Translational Medicine, Medical School, University of Pécs, Szigeti út 12, 2nd floor, 7624 Pécs, Hungary
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085 Hungary
| | - Anikó Görbe
- Institute for Translational Medicine, Medical School, University of Pécs, Szigeti út 12, 2nd floor, 7624 Pécs, Hungary
| | - Zsolt Molnár
- Institute for Translational Medicine, Medical School, University of Pécs, Szigeti út 12, 2nd floor, 7624 Pécs, Hungary
- Department of Anaesthesiology and Intensive Therapy and Pain Management, Poznan University of Medical Sciences, 49 Przybyszewskiego St, 60-355 Poznan, Poland
| | - Kincső Kozma
- Department of Ophtalmology, Medical School, University of Pécs, Rákóczi út 2, 7623 Pécs, Hungary
| | - Gergő Józsa
- Department of Paediatrics, Surgical Division, University of Pécs, József Attila u. 7, 7623 Pécs, Hungary
| | - László Bucsi
- Saint George University Teaching Hospital of County-Fejér, Seregélyesi u. 3., 8000 Székesfehérvár, Hungary
- Department of Orthodaedics, Medical School, University of Pécs, Akác u. 1, 7632 Pécs, Hungary
| | - Károly Schandl
- Saint George University Teaching Hospital of County-Fejér, Seregélyesi u. 3., 8000 Székesfehérvár, Hungary
- Department of Orthodaedics, Medical School, University of Pécs, Akác u. 1, 7632 Pécs, Hungary
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Liu H, Song X, Liu P, Yu H, Zhang Q, Guo W. Clinical Outcomes of Arthroscopic Tenodesis Versus Tenotomy for Long Head of the Biceps Tendon Lesions: A Systematic Review and Meta-analysis of Randomized Clinical Trials and Cohort Studies. Orthop J Sports Med 2021; 9:2325967121993805. [PMID: 33997057 PMCID: PMC8071980 DOI: 10.1177/2325967121993805] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/11/2020] [Indexed: 12/15/2022] Open
Abstract
Background Controversy exists concerning whether tenotomy or tenodesis is the optimal surgical treatment option for proximal biceps tendon lesions. Purpose To evaluate the clinical outcomes after arthroscopic tenodesis and tenotomy in the treatment of long head of the biceps tendon (LHBT) lesions. Study Design Systematic review; Level of evidence, 4. Methods A systematic review was performed by searching PubMed, the Cochrane Library, Web of Science, and Embase to identify randomized controlled trials (RCTs) and cohort studies that compared the clinical efficacy of tenotomy with that of tenodesis for LHBT lesions. A standardized data extraction form was predesigned to obtain bibliographic information of the study as well as patient, intervention, comparison, and outcome data. A random-effects model was used to pool quantitative data from the primary outcomes. Results A total of 21 eligible studies were separated into 3 methodological groups: (1) 4 RCTs with level 1 evidence, (2) 3 RCTs and 4 prospective cohort studies with level 2 evidence, and (3) 10 retrospective cohort studies with level 3 to 4 evidence. Analysis of the 3 groups demonstrated a significantly higher risk of the Popeye sign after tenotomy versus tenodesis (group 1: risk ratio [RR], 3.29 [95% CI, 1.92-5.49]; group 2: RR, 2.35 [95% CI, 1.43-3.85]; and group 3: RR, 2.57 [95% CI, 1.33-4.98]). Arm cramping pain remained significantly higher after tenotomy only in the retrospective cohort group (RR, 2.17 [95% CI, 1.20-3.95]). The Constant score for tenotomy was significantly worse than that for tenodesis in the prospective cohort group (standardized mean difference [SMD], -0.47 [95% CI, -0.73 to -0.21]), as were the forearm supination strength index (SMD, -0.75 [95% CI, -1.28 to -0.21]) and the Simple Shoulder Test (SST) score (SMD, -0.60 [95% CI, -0.94 to -0.27]). Conclusion The results demonstrated that compared with tenodesis, tenotomy had a higher risk of a Popeye deformity in all 3 study groups; worse functional outcomes in terms of the Constant score, forearm supination strength index, and SST score according to prospective cohort studies; and a higher incidence of arm cramping pain according to retrospective cohort studies.
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Affiliation(s)
- Hongzhi Liu
- Beijing University of Chinese Medicine, Beijing, China
| | | | - Pei Liu
- Henan Luoyang Orthopedic-Traumatological Hospital, Zhengzhou, China
| | - Huachen Yu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qidong Zhang
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China.,Beijing Key Lab for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Wanshou Guo
- Department of Orthopaedic Surgery, China-Japan Friendship Hospital, Beijing, China.,Beijing Key Lab for Immune-Mediated Inflammatory Diseases, China-Japan Friendship Hospital, Beijing, China
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