Biceps tenodesis in the setting of rotator cuff repair - does it make a difference?

Clinical and radiologic results of arthroscopic biceps tenodesis with suture anchor in the setting of rotator cuff tear

These authors wanted to find the  clinical and radiologic results of arthroscopic biceps tenodesis in 84 patients having rotator cuff repair. The description of the management of the rotator cuff tear is sparse: "The residual biceps tendon was cut from a site just proximal to the sutures, and the remaining stump was excised at an attachment site to the superior labrum. Afterward, the rotator cuff and combined lesion were addressed." The anatomic outcome of the cuff surgery was not described even though 60 patients had post op MRI's.

Clinical measures were improved after surgery. Eleven patients had popeye deformity, indicating failure of the tenodesis, yet the presence of this deformity did not correlate with poorer clinical scores. postoperative magnetic resonance imagine analysis, 15 patients (25%) showed distal migration of tenodesed biceps tendon, although only 6 (7.1%) had clinical popeye. 

While the authors concluded that "arthroscopic biceps tenodesis with 1 suture anchor resulted in good clinical outcomes at 2 years postoperatively", the data presented do not show a relationship between the clinical outcome and the success of the tenodesis. The data presented do not suggest any advantage of tenodesis over tenotomy and do not distinguish the relative roles of the biceps surgery and the cuff surgery in determining the clinical result.

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Subscapularis tenotomy versus lesser tuberosity osteotomy during total shoulder replacement: a comparison of patient outcomes. JSES

The October JSES published Subscapularis tenotomy versus lesser tuberosity osteotomy during total shoulder replacement: a comparison of patient outcomes. The authors retrospectively reviewed shoulders having total shoulder replacement, 10 with subscapularis tenotomy and 26 with lesser tuberosity osteotomy.  While patients having osteotomy tended to have better 'belly-press' scores, the clinical results were not significantly better for this group. The patients were not randomized and the tenotomy cases were apparently done earlier in the surgeon's experience than the osteotomy cases, so the two groups cannot be directly compared. The most important finding in this study was that patients with a functionally intact subscapularis (by the belly-press test), whether having tenotomy or osteotomy, had better clinical outcomes. The authors performed routine biceps tenotomy and recommend avoiding external rotation beyond neutral for the first six weeks to protect the repair.

A recent cadaveric study did not find differences in strength of repair.

We continue to use subscapularis tenotomy with secure transosseous repair for all our shoulder arthroplasties, preserving the long head of the biceps when it is healthy. As the authors of the recent paper point out, it is important to protect all subscapularis repairs during the period of healing.

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