Patients Have Strong Preferences and Perceptions for Biceps Tenotomy Versus Tenodesis


      To evaluate what factors are important in the patients' preference and their perception of a successful surgical outcome.


      A biceps-specific questionnaire was developed using a series of questions assessing current symptoms, previous knowledge of biceps tendon surgery, surgical outcome priorities, and patient demographics and administered to 100 patients with proximal biceps pathology after approval by the Institutional Review Board. The patients were asked which surgery they would prefer. A set of χ2 tests were used to test the association between categorical variables. All tests were 2-sided and considered significant at P < .05.


      A total of 100 patients enrolled in the study, with 49 female and 51 male patients at an average age of 49 years (range, 19 to 79 years). Of the 100 patients, 64 (64%) chose to have biceps tenodesis. Factors predictive of choosing a biceps tenodesis included female sex, and concern of cosmetic deformity and residual postoperative pain with a tenotomy (P < .05). Factors predictive of choosing a tenotomy included male sex, high level of current biciptal groove pain, and concerns regarding the use of additional hardware and longer recovery with a tenodesis (P < .05). Age, body mass index, occupation, income level, and concerns regarding postoperative strength and muscle cramping were not found to have a significant predictive effect toward either procedure.


      Patient age should not be used as the sole criterion when deciding between biceps tenotomy and tenodesis. Our results can be consolidated to 5 predictive, reliable questions that will assist orthopaedic surgeons in making individualized patient-specific decisions regarding proximal biceps tendon surgery by emphasizing what factors are most important to patients for a successful surgical outcome.
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        • McDonald L.S.
        • Dewing C.B.
        • Shupe P.G.
        • Provencher M.T.
        Disorders of the proximal and distal aspects of the biceps muscle.
        J Bone Joint Surg Am. 2013; 95: 1235-1245
        • Jones G.
        • Miller T.
        • Moon Shoulder Group
        Arthroscopic evaluation and treatment of biceps brachii long head tendon injuries: A survey of the MOON shoulder group.
        Int J Shoulder Surg. 2011; 5: 68
        • Frost A.
        • Zafar M.S.
        • Maffulli N.
        Tenotomy versus tenodesis in the management of pathologic lesions of the tendon of the long head of the biceps brachii.
        Am J Sports Med. 2009; 37: 828-833
        • Slenker N.R.
        • Lawson K.
        • Ciccotti M.G.
        • Dodson C.C.
        • Cohen S.B.
        Biceps tenotomy versus tenodesis: Clinical outcomes.
        Arthroscopy. 2012; 28: 576-582
        • Boileau P.
        • Baqué F.
        • Valerio L.
        • Ahrens P.
        • Chuinard C.
        • Trojani C.
        Isolated arthroscopic biceps tenotomy or tenodesis improves symptoms in patients with massive irreparable rotator cuff tears.
        J Bone Joint Surg Am. 2007; 89: 747-757
        • Delle Rose G.
        • Borroni M.
        • Silvestro A.
        • et al.
        The long head of biceps as a source of pain in active population: Tenotomy or tenodesis? A comparison of 2 case series with isolated lesions.
        Musculoskelet Surg. 2012; 96: 47-52
        • Biz C.
        • Vinanti G.B.
        • Rossato A.
        • Arnaldi E.
        • Aldegheri R.
        Prospective study of three surgical procedures for long head biceps tendinopathy associated with rotator cuff tears.
        Muscles Ligaments Tendons J. 2012; 2: 133-136
        • De Carli A.
        • Vadalà A.
        • Zanzotto E.
        • et al.
        Reparable rotator cuff tears with concomitant long-head biceps lesions: Tenotomy or tenotomy/tenodesis?.
        Knee Surg Sports Traumatol Arthrosc. 2012; 20: 2553-2558
        • Reiff S.N.
        • Nho S.J.
        • Romeo A.A.
        Proximal humerus fracture after keyhole biceps tenodesis.
        Am J Orthop. 2010; 39: E61-E63
        • Ma H.
        • Van Heest A.
        • Glisson C.
        • Patel S.
        Musculocutaneous nerve entrapment: An unusual complication after biceps tenodesis.
        Am J Sports Med. 2009; 37: 2467-2469
        • Koh K.H.
        • Ahn J.H.
        • Kim S.M.
        • Yoo J.C.
        Treatment of biceps tendon lesions in the setting of rotator cuff tears: Prospective cohort study of tenotomy versus tenodesis.
        Am J Sports Med. 2010; 38: 1584-1590
        • Zhang Q.
        • Zhou J.
        • Ge H.
        • Cheng B.
        Tenotomy or tenodesis for long head biceps lesions in shoulders with reparable rotator cuff tears: A prospective randomised trial.
        Knee Surg Sports Traumatol Arthrosc. 2015; 23: 464-469
        • Randelli P.
        • Arrigoni P.
        • Cabitza F.
        • Ragone V.
        • Cabitza P.
        Current practice in shoulder pathology: Results of a web-based survey among a community of 1,084 orthopedic surgeons.
        Knee Surg Sports Traumatol Arthrosc. 2011; 20: 803-815
        • Duff S.J.
        • Campbell P.T.
        Patient acceptance of long head of biceps brachii tenotomy.
        J Shoulder Elbow Surg. 2012; 21: 61-65