The Comparison Of Arthroscopic Tenotomy And Tenodesis In The Treatment Of Biceps Long Head Tendinitis

Objectives The purpose of this study is to compare the clinical efficacy of arthroscopic tenotomy and tenodesis in the treatment of biceps long head tendinitis.By this study,we except to supply more reliable theoretical basis for the choice to surgical treatments of long head tendonitis of biceps brachii.Methods This study is a prospective clinical randomized controlled trial,which is designed to compare the clinical efficacy of arthroscopic tenotomy and tenodesis in the treatment of biceps long head tendinitis.And it has been permitted by the Medical Ethics Committee.Fifty patients(age range 60~75years,average age 66.78±4.44 years)included in this study are all from the first arthroscopy specialist clinic of the Hospital Affiliated to North China University of science and technology(The Second Hospital of Tangshan)between January 2015 and June 2015.The fifty patients who satisfy the including criteria and voluntarily participate in this study will be further evaluated before surgical operations.We will inform all the patients of the superiority and the relevant complications of the two surgical methods,respectively.And the patients will sign the informed consent forms before operations.The fifty patients will be randomly allocated into two groups according to the computer program,that is,the group of arthroscopic tenotomy and the group of arthroscopic tenodesis.All the surgical operations will be accomplished by the same senior surgeon who are skilled in shoulder arthroscopy.The duration of surgery will be recorded and compared between groups.The ache situation to the patient shoulder joint will be appraised by visual analogue score(VAS)in pre-operation,6 weeks postoperatively and in 3,6,9,12 months after operation.Outcomes of shoulder strength,function,range of motion and degree of satisfaction will be assessed by The University of California at Los Angeles(UCLA)shoulder score and Constant-Murley shoulder score before and after surgery.The rate of Popeye deformity and cramping of the biceps muscle will be also compared between groups.Analyses all the data by making using of SPSS21.0 software.To analyses the outcome of intra-group before and after surgery and that of between groups,adopt independent t-test and paired t-test to carry out statistical analysis comparison respectively,marking measuring data as sx ±.Numeration data will be statistically analyzed with x2 test.The inspection level?is set to equal 0.05.If P?0.05,we will think the difference has statistical sense,and if P?0.01,significant statistical significance is considered.Results We successfully completed all surgical operations and postoperative follow-up for the fifty patients included in the study,average follow-up period is 15.26±1.93 months(range,13 to 18 months).1 The mean operation time of the group of arthroscopic tenotomy or tenodesis is 24.24±3.81 minutes and 55.88±5.29 minutes respectively,the difference has significant statistical significance(P?0.01).2 All patients?shoulder pain is relieved obviously comparing with preoperative situation in both groups.The pre-and postoperative VAS in the group of arthroscopic tenotomy is 8.48±1.09 and 0.40±0.56 respectively,and it is separately 7.92±0.95 and 0.48±0.77 in the group of arthroscopic tenodesis.There are 64%(16/25)and 68%(17/25)patients whose aches are cured.Although the differences of VAS at the 6nd week,3nd month,6 month of postoperative follow-up are statistically significant(P?0.05),while there is no statistic difference in the mean VAS at the 12 nd and the last follow-up between two groups(P?0.05).3 To either group,the postoperative UCLA score and Constant score have significantly improved in comparison with preoperative situations,the difference has statistical sense(P?0.05).The UCLA score and Constant score in the tenotomy group are respectively 14.04±4.28 and 35.04±6.21 before operations,and they are separately improved into 30.84±2.46 and 72.60±5.55 after operations.The UCLA score and Constant score in the tenodesis group are respectively 13.88±3.07 and 35.72±6.76 before operations,and they are separately improved into 31.24±3.23 and 73.24±5.37 after operations.The comparison of postoperative UCLA and Constant score between two groups has no statistical difference(P?0.05).4 To the rate of Popeye deformity after surgery,the tenotomy group is much higher than tenodesis(P?0.05).However,there is no statistical difference demonstrated in the rate of cramping of the biceps muscle between groups(P?0.05),just two patients in tenotomy group occur mild pain or discomfort,when doing exercise after operations.Conclusions 1 Both of the surgical methods,arthroscopic tenotomy and arthroscopic tenodesis have excellent clinical efficacy in the treatment of biceps long head tendinitis.2 When comparing the postoperative outcomes of arthroscopic tenotomy and tenodesis,there are no significant differences founded.Although in terms of relieving shoulder pain,the arthroscopic tenotomy may be much superior to the arthroscopic tenodesis.However,each patient?ache has been relieved obviously in both of groups,even some is cured,the postoperative VAS has no statistical significance between two groups.3 When comes to the rate of Popeye deformity between arthroscopic tenotomy and tenodesis,the former is much higher than the latter.But a Popeye deformity is not inevitable after arthroscopic tenotomy,moreover,in spite of occurring a Popeye deformity after surgery,it is not appreciable in some patients with a large amount of subcutaneous adipose tissue.However,in the other hand,because of the relative complicated surgical procedure,an arthroscopic tenodesis requires a longer duration of surgery than an arthroscopic tenotomy.So when choosing the operative approach to treating biceps long head tendinitis,we should make a comprehensive consideration.