Background: Lesions of the long head of the biceps tendon are often
associated with massive rotator cuff tears and may be responsible for shoulder
pain and dysfunction. The purpose of this study was to evaluate the clinical
and radiographic outcomes of isolated arthroscopic biceps tenotomy or
tenodesis as treatment for persistent shoulder pain and dysfunction due to an
irreparable rotator cuff tear associated with a biceps lesion.
Methods: We conducted a retrospective study of sixty-eight
consecutive patients (mean age [and standard deviation], 68 ± 6 years)
in whom a total of seventy-two irreparable rotator cuff tears had been treated
arthroscopically with biceps tenotomy or tenodesis. A simple tenotomy was
performed in thirty-nine cases, and a tenodesis was performed in thirty-three.
No associated acromioplasty was performed. All patients were evaluated
clinically and radiographically by an independent observer at a mean of
thirty-five months postoperatively.
Results: Fifty-three patients (78%) were satisfied with the result.
The mean Constant score improved from 46.3 ± 11.9 points preoperatively
to 66.5 ± 16.3 points postoperatively (p < 0.001). A
healthy-appearing teres minor on preoperative imaging was associated with
significantly increased postoperative external rotation (40.4° ±
19.8° compared with 18.1° ± 18.4°) and a significantly
higher Constant score (p < 0.05 for both) compared with the values for the
patients with an absent or atrophic teres minor preoperatively. Three patients
with pseudoparalysis of the shoulder did not benefit from the procedure and
did not regain active elevation above the horizontal level. In contrast, the
fifteen patients with painful loss of active elevation recovered active
elevation. The acromiohumeral distance decreased 1.1 ± 1.9 mm on the
average, and glenohumeral osteoarthritis developed in only one patient. The
results did not differ between the tenotomy and tenodesis groups (mean
Constant score, 61.2 ± 18 points and 72.8 ± 12 points,
respectively). The "Popeye" sign was clinically apparent in
twenty-four (62%) of the shoulders that had been treated with a tenotomy; of
the sixteen patients who noticed it, none were bothered by it.
Conclusions: Both arthroscopic biceps tenotomy and arthroscopic
biceps tenodesis can effectively treat severe pain or dysfunction caused by an
irreparable rotator cuff tear associated with a biceps lesion. Shoulder
function is significantly inferior if the teres minor is atrophic or absent.
Pseudoparalysis of the shoulder and severe rotator cuff arthropathy are
contraindications to this procedure.
Level of Evidence: Therapeutic Level III. See
Instructions to Authors for a complete description of levels of evidence.