The effect of biseps tenotomy on clinical results in patients with rotator cuff tears

Rotator cuff rupture is one of the most common cause of shoulder pain. Several tecniques are defined to repair this ruptures. In early time, all of the surgical techniques were based on open repair, but today, thanks to development of technology and surgical techniques, all this repairs can be done with arthroscopic tecnique. The aim of this study is research for functional and radiological results of biceps tenotomy in the patients have rotator cuff rupture that repaired with arthroscopic tecnique. Between March 2013 and July 2017, in the Department of Orthopedics and Traumatology of Fırat University Medical Faculty, the patients with rotator cuff rupture were divided in two groups retrospectively as biceps tenotomy was performed or not performed in addition to arthroscopic cuff repair. The patients who have inclusion criteria was invited to our hospital for clinical and radiological evaluation. Then they were evaluated clinically (Modified Constant-Murley was applied), functionally (bilaterally elbow flexion strength and forearm supination strength measured with the help of isokinetic dynamometer device the we developed as a scientific research project), radiologically (on tenotomy applied side, ultrasonic examination was performed for the long head of biceps was in groove or not), cosmeticly (Popeye's sign was occured or not). The study was completed with a total of 66 patients whose final controls were performed. Tenotomy had been performed in 40 patients and tenotomy had not been performed in 26 patients. 25 of the patients were male and 41 were female. The mean age was 58,17 ± 7,95 years in patients who underwent tenotomy and 28,7 months for the follow-up period, the mean age was 60,61 ± 4,66 years and the duration of follow-up was 35,28 months. No significant difference was observed between the two groups according to age and follow-up period (p>0,05). There was no significant difference between the two groups according to the Modified Constant-Murley scoring (p>0,05). Functionally, there was no significant difference between the two groups in the flexion and supination strengths of the forearm (p>0,05). However, in each patient, a significant difference was observed in muscle strength between operative side and the non-operative side (p <0,05). One of the findings that was expected to be seen in the tenotomy group was Popeye's Sign and found in 3 patients (7,5%). These patients were thinner than the other patients and the subcutaneous fat tissues were slimmer. Because of these patient did not have any pain and the Popeye's sign was mild, they did not notice this so the patient satisfaction was high. Any cramp pain and sensitivity in the biceps groove were not observed in these patients. Radiographically, the localization of the biceps long head in the biceps groove was evaluated with ultrasound. Even in patients whom the long head of biceps were not seen in the groove, this study suggested that the Popeye's sign was rare. According to the results of this study, successful results were obtained in both groups. In the Modified Constant Murley clinical scoring we evaluated the many parameters with patient satisfaction, the satisfaction in both groups was high. The satisfaction score in the tenotomy group (89,83%) was higher than the non-tenotomy group (86,19%), although not a significant difference. It was observed that the application of biceps tenotomy did not have a negative effect for daily functional activity. Keywords: Rotator cuff, arthroscopic repair, biceps, tenotomy