ARTHROSCOPIC TENOTOMY OF THE LONG HEAD OF THE BICEPS IN THE TREATMENT OF ROTATOR CUFF TEARS. CLINICAL AND RADIOGRAPHIC RESULTS OF 307 CASES

Abstract

The long head of the biceps tendon has been proposed as a source of pain in patients with rotator cuff tears. The purpose of this study is to evaluate the objective, subjective, and radiographic results of arthroscopic biceps tenotomy in selected patients with rotator cuff tears. Three hundred seven arthroscopic biceps tenotomies were performed in patients with full thickness rotator cuff tears. All patients had previously failed appropriate nonoperative management. Patients were selected for arthroscopic tenotomy if the tear was thought to be irreparable or the patient was older and not willing to participate in the rehabilitation required following rotator cuff repair. One hundred eleven shoulders underwent a concomitant acromioplasty. The mean age at surgery was 64.3 years. The mean preoperative radiographic acromiohumeral interval measured 6.6 mm. Patients were evaluated clinically and radiographically at a mean 57 months follow-up (range 24 to 168 months). The mean Constant score increased from 48.4 points preoperatively to 67.6 points postoperatively (p < 0.0001). Eighty-seven percent of patients were satisfied or very satisfied with the result. Nine patients underwent an additional surgical procedure (three for attempt at rotator cuff repair and six for reverse prostheses for cuff tear arthropathy). The acromiohumeral interval decreased by a mean

1.3 mm during the follow-up period and was associated with longer duration of follow-up (p < 0.0001). Preoperatively, 38% of patients had glenohumeral arthritis; postoperatively, 67% of patients had glenohumeral arthritis. Concomitant acromioplasty was statistically associated with better subjective and objective results only in patients with an acromiohumeral distance greater than 6 mm. Fatty infiltration of the rotator cuff musculature had a negative influence on both the functional and radiographic results (p < 0.0001). Arthroscopic biceps tenotomy in the treatment of rotator cuff tears in selected patients yields good objective improvement and a high degree of patient satisfaction. Despite these improvements, arthroscopic tenotomy does not appear to alter the progressive radiographic changes that occur with long standing rotator cuff tears.