Dataset Information

A Systematic Review and Meta-analysis Comparing Clinical Outcomes After Concurrent Rotator Cuff Repair and Long Head Biceps Tenodesis or Tenotomy.

ABSTRACT:

Context

A comparison of clinical outcomes after long head of biceps (LHB) tenotomy or tenodesis performed concurrently with rotator cuff repair (RCR) is of interest to physicians and patients.

Objective

A systematic review of clinical outcome studies examining LHB tenotomy or tenodesis performed concurrently with RCR. Secondarily, perform a meta-analysis of data from comparative studies.

Data sources

MEDLINE (1946 to week 30 of 2013) and EMBASE (1980 to week 30 of 2013).

Study selection

Levels 1 through 4 studies reporting clinical outcomes of concurrent RCR and LHB tenotomy or tenodesis with minimum 1-year follow-up.

Study design

Systematic review and meta-analysis.

Level of evidence

Level 4.

Data extraction

Two independent reviewers identified eligible studies and applied the exclusion criteria. Clinical outcome data, including functional outcome score(s), biceps deformity and cramping, and patient satisfaction, were extracted. Clinical outcome data from included studies were pooled (weighted according to study size) and reported. A meta-analysis was performed only on outcomes extracted from comparative studies (? = 0.05).

Results

Twelve studies (N = 565 patients; mean age, 61.3 years; 46.3% men) were included. Of these, 6 (N = 263) included RCR and LHB tenotomy and 9 (N = 302) included RCR and LHB tenodesis. A meta-analysis was performed on 3 comparative studies (levels 1 and 2), demonstrating that the postoperative Constant score at a mean follow-up of 25.5 months was significantly greater after tenodesis (92.8 [tenodesis] vs 90.6 [tenotomy], P < 0.01); however, this difference was less than the reported minimal clinically important difference of 10.4 points. Similarly, the rate of biceps deformity was significantly less after tenodesis (15.5% [tenotomy] vs 3.9% [tenodesis], P < 0.01); however, most patients were not bothered by it. There were no significant differences in the rate of biceps cramping or patient satisfaction.

Conclusion

Although the postoperative Constant score and rate of biceps deformity favor LHB tenodesis statistically, the clinical significance appears negligible.

SUBMITTER: Leroux T

PROVIDER: S-EPMC4481674 | biostudies-literature | 2015 Jul

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

A Systematic Review and Meta-analysis Comparing Clinical Outcomes After Concurrent Rotator Cuff Repair and Long Head Biceps Tenodesis or Tenotomy.

Leroux Timothy T Chahal Jaskarndip J Wasserstein David D Verma Nikhil N NN Romeo Anthony A AA

Sports health 20150701 4

<h4>Context</h4>A comparison of clinical outcomes after long head of biceps (LHB) tenotomy or tenodesis performed concurrently with rotator cuff repair (RCR) is of interest to physicians and patients.<h4>Objective</h4>A systematic review of clinical outcome studies examining LHB tenotomy or tenodesis performed concurrently with RCR. Secondarily, perform a meta-analysis of data from comparative studies.<h4>Data sources</h4>MEDLINE (1946 to week 30 of 2013) and EMBASE (1980 to week 30 of 2013).<h4 ...[more]

PMID: 26137174

Similar Datasets

Project description:Optimal treatment of the diseased long head of the biceps (LHB) tendon during rotator cuff repair remains a topic of debate: tenotomy or tenodesis. A recent meta analysis revealed no difference in strength or functional outcome between treatments. The included studies varied in methodological quality, and only two were randomized controlled trials (RCTs). As strong evidence in favor of either tenotomy or tenodesis is still lacking, we designed this randomized controlled trial to compare functional outcomes after tenotomy and tenodesis when performed in adjunct to arthroscopic rotator cuff repair.Patients older than 50 years with a supraspinatus and/or infraspinatus tendon rupture sized smaller than 3 cm, who are encountered with LHB pathology, will be randomized to either LHB tenotomy or LHB tenodesis. Clinical and patient-reported data will be collected pre-operatively, 6 weeks, 3 months and 1 year after surgery. Primary outcome is overall shoulder function evaluated with the Constant score at 1 year after surgery. As additional measures of shoulder function, two patient reported outcomes (the Dutch Oxford Shoulder Test and the Disabilities of the Arm Shoulder and Hand questionnaire) will be assessed. Other evaluations include cosmetic appearance evaluated by the "Popeye" deformity, elbow flexion strength, arm cramping pain, MRI-based location of the biceps tendon, quality of life, and duration of surgery. To detect non-inferiority with a one-sided, two-sample t-test with 80 % power and a significance level (alpha) of 0.025, the required sample size is 98 patients.Treatment of LHB tendon lesions is performed differently around the world and meta analyses do not provide conclusive evidence in favor of one of these treatments. This study will strengthen evidence on the risks and benefits of LHB tenotomy and tenodesis in adjunct to a rotator cuff repair, which is important for managing patient expectations.Dutch Trial Register ( NTR3255 ) January 12, 2012, ClinicalTrials.gov (ID NCT02655848 ) January 14, 2016, retrospectively registered.

Project description:BackgroundStudies to date comparing biceps tenodesis methods in the setting of concomitant rotator cuff repair (RCR) have demonstrated relatively equivalent pain and functional outcomes.PurposeTo compare biceps tenodesis constructs, locations, and techniques in patients who underwent RCR using a large multicenter database.Study designCohort study; Level of evidence, 3.MethodsA global outcome database was queried for patients with medium- and large-sized tears who underwent biceps tenodesis with RCR between 2015 and 2021. Patients ≥18 years of age with a minimum follow-up of 1 year were included. The American Shoulder and Elbow Surgeons, Single Assessment Numeric Evaluation, visual analog scale for pain, and Veterans RAND 12-Item Health Survey (VR-12) scores were compared at 1 and 2 years of follow-up based on construct (anchor, screw, or suture), location (subpectoral, suprapectoral, or top of groove), and technique (inlay or onlay). Nonparametric hypothesis testing was used to compare continuous outcomes at each time point. The proportion of patients achieving the minimal clinically important difference (MCID) at the 1- and 2-year follow-ups were compared between groups using chi-square tests.ResultsA total of 1903 unique shoulder entries were analyzed. Improvement in VR-12 Mental score favored anchor and suture fixations at 1 year of follow-up (P = .042) and the onlay tenodesis technique at 2 years of follow-up (P = .029). No additional tenodesis comparisons demonstrated statistical significance. The proportion of patients with improvement exceeding the MCID did not differ based on tenodesis methods for any outcome score assessed at the 1- or 2-year follow-up.ConclusionBiceps tenodesis with concomitant RCR led to improved outcomes regardless of tenodesis fixation construct, location, or technique. A clear optimal tenodesis method with RCR remains to be determined. Surgeon preference and experience with various tenodesis methods as well as patient clinical presentation should continue to guide surgical decision-making.

Project description:Objectives: While short and mid-term clinical outcomes following implantation of an arthroscopic subacromial balloon spacer for massive, irreparable rotator cuff tears (MIRCTs) have been favorable [1], little is known about the effects of concomitant procedures on clinical outcomes and early post- operative recovery. The purpose of this study was to determine the effects of concomitant proximal biceps surgery on short and mid-term outcomes following partial rotator cuff repair or subacromial balloon spacer implantation using the InSpace? device (Stryker; Kalamazoo, MI; Figure 1). Methods: We conducted a retrospective review of prospectively collected data from a previously published randomized, clinical trial comparing the InSpace? device to partial rotator cuff repair in the management of symptomatic MIRCTs (ClinicalTrials.gov Identifier: NCT02493660) [1]. Study participants with posterosuperior MIRCTs (as defined by MRI diagnosis of ≥2 tendon involvement and ≥5 cm of retraction from the tendon insertion) treated operatively with subacromial balloon spacer implantation or partial rotator cuff repair and concomitant biceps tenotomy or tenodesis were considered for this study. The primary outcome in this study was the achievement of minimal clinically important difference (MCID) and substantial clinical benefit (SCB) for the American Shoulder and Elbow (ASES) score at 6 weeks and 24 months postoperatively. Established MCID and SCB thresholds from the literature were used, requiring a ≥11.1-point increase in ASES score for MCID achievement and a ≥17.5-point increase for SCB achievement [2]. Fisher’s exact test was used to compare MCID and SCB achievement rates between groups. Results: A total of 103 patients were included in this analysis, of which 48 patients were in the InSpace? cohort and 55 were in the partial rotator cuff repair cohort (Table 1). At 6 weeks post-operatively, a larger percentage of patients who received InSpace? with concomitant biceps tenotomy achieved MCID on ASES compared to those receiving a concomitant tenodesis, though this result was not statistically significant (64.3% vs 42.1%, p = 0.15) (Table 1). Similarly, a larger percentage of patients who underwent arthroscopic partial rotator cuff repair with biceps tenotomy achieved MCID on ASES compared to those undergoing partial repair with biceps tenodesis, though this was not statistically significant (56.3% vs 40.9%, p = 0.41). Similar trends were seen for SCB achievement rates at 6 weeks (Table 2). Notably, SCB achievement rates were significantly greater for patients undergoing InSpace? with biceps tenotomy versus partial repair with biceps tenodesis (p = 0.04). At 24 months, ASES MCID achievement rates for the InSpace? with biceps tenotomy group were similar to the InSpace? with biceps tenodesis group (96.2% vs 86.7%, p = 0.54) (Table 1). Similarly, there was no significant difference between the partial repair with concomitant tenodesis and tenotomy groups (100% vs 92.9%, p = 0.51). Similar trends were seen for SCB achievement rates at this time point (Table 2). Notably, there was no longer a significant difference in SCB achievement rates between the InSpace? with biceps tenotomy group and partial repair with biceps tenodesis group (p = 1.00). Conclusions: The primary goal of treatment during arthroscopic implantation of a subacromial balloon spacer is pain relief in the setting of relatively well-maintained function. Although all patients in this study received standardized post-operative rehabilitation, including 4-week sling use, our results suggest that providers seeking accelerated rehabilitation for their patients may consider concomitant biceps tenotomy for biceps pathology to avoid prolonged immobilization, decrease risk of stiffness, and provide earlier achievement of clinically significant outcomes on patient-reported outcome measures.

Dataset Information

A Systematic Review and Meta-analysis Comparing Clinical Outcomes After Concurrent Rotator Cuff Repair and Long Head Biceps Tenodesis or Tenotomy.

Context

Objective

Data sources

Study selection

Study design

Level of evidence

Data extraction

Results

Conclusion

Publications

A Systematic Review and Meta-analysis Comparing Clinical Outcomes After Concurrent Rotator Cuff Repair and Long Head Biceps Tenodesis or Tenotomy.

Similar Datasets

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