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Isolated Arthroscopic Biceps Tenotomy or Tenodesis Improves Symptoms in Patients with Massive Irreparable Rotator Cuff Tears
Pascal Boileau, MD1; François Baqué, MD1; Laure Valerio, MD1; Philip Ahrens, MD, FRCS2; Christopher Chuinard, MD1; Christophe Trojani, MD1
1 Department of Orthopaedic Surgery and Sports Traumatology (P.B., F.B., C.C., and C.T.) and Department of Statistics and Epidemiology (L.V.), Hôpital de l'Archet, University of Nice, 151, route de St. Antoine de Ginestière, 06202 Nice, France. E-mail address for P. Boileau: boileau.p@chu-nice.fr
2 The Royal Free Hospital, Pond Street, London NW3 2Q, United Kingdom
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. One or more of the authors, or a member of his or her immediate family, received, in any one year, payments or other benefits of less than $10,000 or a commitment or agreement to provide such benefits from a commercial entity (Phusis). No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Investigation performed at the Department of Orthopaedic Surgery and Sports Traumatology, Hôpital de l'Archet, University of Nice, Nice, France

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2007 Apr 01;89(4):747-757. doi: 10.2106/JBJS.E.01097
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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.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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