Tenotomy Versus Tenodesis in the Management of Pathologic Lesions of the Tendon of the Long Head of the Biceps Brachii

Background: Primary and secondary lesions of the tendon of the long head of the biceps brachii are common, with no clear consensus about their optimal management. Hypothesis: There is no difference in outcomes of tenotomy and tenodesis for lesions of the tendon of the long head of the biceps brachii. Study Design: We performed a comprehensive quantitative review of the published English-language literature comparing the outcomes of tenotony and tenodesis for lesions of the tendon of the long head of the biceps brachii. Methods: All relevant articles in peer-reviewed journals were retrieved, and each article was scored using the Coleman Methodology Score, a highly repeatable methodology score, by 2 independent reviewers. Results: Scores were predominantly low for quality of the studies, with patient number and validated outcome measures being the weakest areas. Conclusion: There is a lack of quality evidence to advocate one technique over the other. We emphasize the need for appropriately powered, well-conducted, randomized, controlled trials comparing the outcomes of these 2 procedures. There is little difference in the outcome of tenotomy compared with tenodesis. Tenotomy is easy and quick, with less need for postoperative rehabilitation. We therefore suggest that biceps tenotomy be the preferred method. Clinical Relevance: Biceps pathologic lesions are common. There is no evidence base for their most appropriate management.