Isokinetic Strength, Endurance, and Subjective Outcomes After Biceps Tenotomy Versus Tenodesis

Abstract

Background: Similar subjective outcomes have been reported for tenotomy or tenodesis of the long head of the biceps. Few studies have reported on postoperative strength and endurance.Hypothesis: Biceps tenodesis results in superior subjective outcomes, strength, and endurance compared with tenotomy.Study Design: Cohort study; Level of evidence, 3.Methods: Participants completed isokinetic strength and endurance testing for elbow flexion and supination on the operative and nonoperative sides a minimum of 2 years after biceps tenotomy or tenodesis. Modified American Shoulder and Elbow Surgeons (MASES) and Single Assessment Numeric Evaluation (SANE) scores were obtained. The operative/nonoperative strength and endurance scores were compared for the tenotomy and tenodesis groups, with the nonoperative shoulder serving as the control for each participant’s operative shoulder. Change scores for strength and endurance were reported as percentage increase or decrease as compared with the nonoperative side. Change scores and MASES and SANE scores were compared between the 2 groups. The presence of a “popeye” deformity or pain at the tenodesis site was noted.Results: Thirty-five patients (19 tenotomy, 16 tenodesis) were studied. No significant difference was noted in postoperative MASES and SANE scores. Operative-side peak supination torque was significantly decreased relative to the nonoperative side in the tenotomy group, which had a significantly larger decrease in supination peak torque than did the tenodesis group on comparison of change scores. No significant difference was noted for peak flexion torque or flexion/supination endurance between operative and nonoperative sides in either group or between change scores for peak flexion torque or flexion/supination endurance in the tenotomy and tenodesis groups. Four tenotomy patients had a popeye deformity, 2 of whom reported painful cramping. Two patients had pain at the tenodesis site.Conclusion: Subjective outcomes are similar for patients treated with tenotomy and tenodesis. Tenotomy decreases supination peak torque relative to the nonoperative side and tenodesis.