Table 2.
Characteristics of studies that fulfilled the inclusion criteria for systematic review and meta-analysis
| Author | Type of study | Number of patients/sex/ mean age | Country | Diagnosis | Outcomes and evaluation methods | Tenotomy | Tenodesis | Results | Complications | Quality of evidence Grade |
| Belay et al. [4] | Randomized, prospective, single-blinded study | n = 34 Male (n = 31) Female (n = 3) 56 years |
UK | Disorders of the long head of the biceps | (1) Pain - VAS Reduced pain Nighttime pain (2) Cosmetic deformities (evaluated as Popeye sign) |
n = 20 (1) Reduced pain 8 (42.1) Nighttime pain 8 (44.4) (2) Popeye deformity (n = 5) (none were associated with cramping) |
n = 14 (1) Reduced pain 4 (28.6) Nighttime pain 6 (42.9) |
The mean pain score in 3 months was lower in the tenotomy group There were no statistical differences in pain improvement and night pain |
Adhesive capsulitis in both groups after 3 months | ⊕⊕⊕⊕ High |
| Castricini et al. [6] | Randomized, prospective, single-blinded study | n = 55 Male: (n = 21) Female: (n = 34) Tenotomy: 59 years Tenodesis: 57 years |
Italy | Long head of the biceps tendon lesions | (1) Pain - VAS (6, 24 months) (2) Constant-Murley Scale (3) Complications (4) Cosmetic deformities (evaluated as Popeye sign) - number of events |
n = 31 (1) 1.1 ± 1.9 (6 months), 1 ± 1.9 (24 months) (2) Improvement: 42.9% ± 8.8% (3) Cramps (n = 0), rotator cuff retear (n = 1) (4) 18 |
n = 24 (1) 1.5 ± 2 (6 months); 1± 2 (24 months) (2) Improvement: 44.1% ± 7.8% (3) Cramps (n = 3), rotator cuff retear (n = 1) (4) 5 |
There was no statistical difference in pain, Constant-Murley Scale, and complications There was a higher incidence of Popeye sign deformity in the tenotomy group |
Cramps occurred in tenodesis group at 6-month follow-up One case of rotator cuff retear for each group |
⊕⊕⊕⊕ High |
| De Carli et al. [7] | Quasirandomized, prospective | n = 65 Male: 48 Female: 17 58 years |
Italy | Reparable rotator cuff tears with concomitant long head of the biceps lesions | (1) Constant score (preoperative and postoperative) (2) Cosmetic deformities (Popeye sign) - number of events |
n = 30 (1) 47.4 ± 12.1/94.6 ± 4.9 (2) 5 |
n = 35 (1) 44.1 ± 12.1/ 94.6 ± 4.9 (2) 0 |
There was no statistical difference in Constant Score and Popeye deformities There was a higher incidence of Popeye sign deformity in the tenotomy group |
Not assessed in the study | ⊕⊕⊕◯ Moderate |
| Hufeland et al. [15] | Quasirandomized, prospective, single-blinded study | n = 20 Male: 11 Female: 9 52 years |
Germany | SLAP biceps pulley lesions | (1) Constant score preoperatively, 6 months, and 12 months (2) Popeye |
n = 11 (1) 50.9 ± 8.5; 6 months 68.5 ± 14; 12 months 77.4 ± 11.8 (2) 3 |
n = 9 (1) 60.1 ± 8.5; 6 months 77.7 ± 10.2; 12 months 88.1 ± 7.5 (2) 1 |
There was no significant difference on the Popeye between the groups | Cramping was observed in 2 patients in the tenotomy group at 6-month follow-up. At 12-month follow-up, no patient complained about cramps | ⊕⊕⊕⊕ High |
| Lee et al. [17] | Randomized, prospective, double-blinded study | n = 128 Male: 29 Female: 99 62..9 years (mean age in tenodesis group) |
Korea | Long head of the biceps lesions | (1) Popeye (2) VAS preoperatively and 12 months (3) Constant preoperatively and 12 months |
n = 56 (1) 11 (2) 7.1 ± 1.41; 12 months 2.0 (3) 69.9 ± 7.47; 12 months 88.3 |
n = 72 (1) 4 (2) 6.8 ± 1.27; 12 months 1.8 (3) 69.9 ± 7.19; 12 months 86.5 |
The incidence of Popeye deformity was about 3 times higher in the tenotomy group and was higher in men (5 of 11) than in women (7 of 45) in the tenotomy group | ⊕⊕⊕◯ Moderate |
|
| MacDonald et al. [19] | Randomized, prospective, double-blinded study | n = 114 Male: 92 Female: 22 57.7 years |
Canada | Lesions of the long head of the biceps | (1) Popeye (3 months and 24 months) (2) Cramping (3, 6, and 12 months) (3) Reoperations |
n = 52 (1) 17 and 15 (2) 2.0 ± 2.6; 2.2 ± 2.9; 2.1 ± 2.8; 2.3 ± 2.9 (3) 5 |
n = 48 (1) 5 and 4 (2) 2.5 ± 3; 2.3 ± 2.7; 1.7 ± 2.4; 2.1 ± 2.9 (3) 4 |
There were no differences in cramping between the two groups There was a 3.5-times higher risk of Popeye deformity after tenotomy |
One patient had adhesive capsulitis and underwent reoperation | ⊕⊕⊕⊕ High |
| Mardani-Kivi et al. [20] | Randomized, prospective | n = 62 Male: 42 Female: 20 54.5 years (mean age of tenotomy group) and 55.5 years (mean age of tenodesis group) |
Iran | Disorders of the long head of the biceps with rotator cuff tear | (1) Popeye (2) VAS preoperatively, 6 months, 12 months, 24 months (3) Constant score preoperatively, 6 months, 12 months, 24 months |
n = 29 (1) 7 (2) 1.96 ± 1.22; 6 months 6.38 ± 0.6; 12 months 8.07 ± 0.66; 24 months 9.07 ± 0.58 (3) 61.01 ± 6.12; 6 months 73.07 ± 5.85; 12 months 82.14 ± 7.93; 24 months 88.1 ± 5.4 |
n = 33 (1) 1 (2) 2.01 ± 1.23; 6 months 6.10 ± 0.74; 12 months 8.61 ± 0.66; 24 months 9.53 ± 0.48 (3) 61.76 ± 8.07; 6 months 73.12 ± 6.83; 12 months 83.51 ± 5.13; 24 months 89.94 ± 3.24 |
The Constant score and the VAS increased The only significant difference between the two methods was the Popeye sign, with higher incidence in tenotomy group |
Cramping was measured as a complication and occurred in 9 patients in the tenotomy group | ⊕⊕⊕◯ Moderate |
| Zhang et al. [27] | Randomized, prospective, double-blinded study | n = 151 Male: 71 Female: 80 61 years |
China | Long head of the biceps lesions and reparable rotator cuff tears | (1) Constant score (2) Popeye sign (3) VAS 2 and 4 weeks postoperatively |
n = 77 (1) Improved (2) 7 (3) 2 weeks 3.1 ± 1.8; 4 weeks 2 ± 1.1 |
n = 74 (1) Improved (2) 2 (3) 2 weeks 4.8 ± 1.9; 4 weeks 2.1 ± 1.6 |
The VAS was lower in the tenodesis group in the 2-week postoperative examination There were no differences between other outcomes in the two groups |
Cramping was observed in 9 patients in the tenotomy group and 5 in the tenodesis group and was considered a complication | ⊕⊕⊕⊕ High |
SLAP = superior labrum anterior posterior.