Long head biceps and rotator cuff surgery in the shoulder

Pooling data of studies that compared LHB tenotomy with tenodesis revealed no difference in clinical outcome parameters such as Constant score, elbow flexion strength and forearm supination strength. Popeye deformity and cramping pain were more prevalent following LHB tenotomy.
Our randomized trial demonstrated that patients older than 50 year who were surgically treated for small to medium sized degenerative rotator cuff tears substantially improved in CMS after both LHB tenotomy and LHB tenodesis. At one year follow up none of the clinical outcome parameters, revealed a clinically relevant difference between groups. Surgical time for LHB tenotomy was significantly shorter compared to LHB tenodesis. As tenotomy is a more simple and quick procedure, these findings question the need for performing LHB tenodesis in this group of patients.
In a reliability study we observed that the Popeye sign is more frequently identified by doctors than by patients older than 50 years after undergoing LHB surgery. Furthermore, doctors do not agree on the presence of Popeye sign. Maybe even more important, patients who reported a Popeye deformity were not dissatisfied.
Several anatomical studies indicate that persisting pain following LHB surgery may originate from the bicipital groove. Tenodesis below the bicipital groove could therefore be preferred over a proximal tenodesis site. Release of the transverse ligament should be considered for all patients undergoing LHB surgery as it is involved in anterior shoulder pain.
Pooling data of studies comparing subpectoral LHB tenodesis with suprapectoral LHB tenodesis revealed no clinical significant difference with regard to functional outcome scores, pain in the bicipital groove and avoiding a Popeye deformity.
Literature reporting outcome of rotator cuff repair after one year shows significant improvements in the shoulder-specific indices after non-traumatic arthroscopic or mini-open rotator cuff repair.
Functional and radiological assessment of patients 11 years after repair of small- to medium-size rotator cuff lesions revealed that functional outcome is good and structural integrity is high for the majority of patients.