Abstract：
OBJECTIVE: Surgical options for long head of the biceps tendon (LHBT) lesions include tenotomy and tenodesis. This study aims to determine the optimal surgical strategy for LHBT lesions with updated evidence from randomised controlled trials (RCTs).
METHODS: Literature was retrieved from PubMed, Cochrane Library, Embase and Web of Science on 12 January 2022. Randomised controlled trials (RCTs) comparing the clinical outcomes of tenotomy and tenodesis were pooled in the meta-analyses.
RESULTS: Ten RCTs with 787 cases met the inclusion criteria, and were included in the meta-analysis. Constant scores (MD, -1.24; p = 0.001), improvement of Constant scores (MD, -1.54; p = 0.04), Simple Shoulder Test (SST) scores (MD, -0.73; p = 0.03) and improvement of SST (p < 0.05) were significantly better in patients with tenodesis. Tenotomy was associated with higher rates of Popeye deformity (OR, 3.34; p < 0.001) and cramping pain (OR, 3.36; p = 0.008]. No significant differences were noticed between tenotomy and tenodesis regarding pain (p = 0.59), American Shoulder and Elbow Surgeons (ASES) score (p = 0.42) and its improvement (p = 0.91), elbow flexion strength (p = 0.38), forearm supination strength (p = 0.68) and range of motion of shoulder external rotation (p = 0.62). Subgroup analyses showed higher Constant scores in all tenodesis types and significantly larger improvement of Constant scores regarding intracuff tenodesis (MD, -5.87; p = 0.001).
CONCLUSIONS: According to the analyses of RCTs, tenodesis better improves shoulder function in terms of Constant scores and SST scores, and reduces the risk of Popeye deformity and cramping bicipital pain. Intracuff tenodesis might offer the best shoulder function as measured with Constant scores. However, tenotomy and tenodesis provide similar satisfactory results for pain relief, ASES score, biceps strength and shoulder range of motion.
METHODS: Literature was retrieved from PubMed, Cochrane Library, Embase and Web of Science on 12 January 2022. Randomised controlled trials (RCTs) comparing the clinical outcomes of tenotomy and tenodesis were pooled in the meta-analyses.
RESULTS: Ten RCTs with 787 cases met the inclusion criteria, and were included in the meta-analysis. Constant scores (MD, -1.24; p = 0.001), improvement of Constant scores (MD, -1.54; p = 0.04), Simple Shoulder Test (SST) scores (MD, -0.73; p = 0.03) and improvement of SST (p < 0.05) were significantly better in patients with tenodesis. Tenotomy was associated with higher rates of Popeye deformity (OR, 3.34; p < 0.001) and cramping pain (OR, 3.36; p = 0.008]. No significant differences were noticed between tenotomy and tenodesis regarding pain (p = 0.59), American Shoulder and Elbow Surgeons (ASES) score (p = 0.42) and its improvement (p = 0.91), elbow flexion strength (p = 0.38), forearm supination strength (p = 0.68) and range of motion of shoulder external rotation (p = 0.62). Subgroup analyses showed higher Constant scores in all tenodesis types and significantly larger improvement of Constant scores regarding intracuff tenodesis (MD, -5.87; p = 0.001).
CONCLUSIONS: According to the analyses of RCTs, tenodesis better improves shoulder function in terms of Constant scores and SST scores, and reduces the risk of Popeye deformity and cramping bicipital pain. Intracuff tenodesis might offer the best shoulder function as measured with Constant scores. However, tenotomy and tenodesis provide similar satisfactory results for pain relief, ASES score, biceps strength and shoulder range of motion.
摘要：
目的：二头肌长头腱（LHBT）病变的手术选择包括肌腱切开术和肌腱固定术。本研究旨在利用随机对照试验（RCTs）的最新证据确定LHBT病变的最佳手术策略。
方法：文献检索自PubMed，科克伦图书馆,Embase和WebofScience于2022年1月12日发布。荟萃分析中汇总了比较肌腱切开术和肌腱固定术临床结局的随机对照试验（RCTs）。
结果：10个RCT，787例符合纳入标准，并纳入荟萃分析。常数分数(MD，-1.24；p=0.001），常数分数的提高(MD，-1.54；p=0.04），简单肩测试（SST）成绩（MD，-0.73；p=0.03）和SST的改善（p<0.05）在肌腱固定术患者中明显更好。张力切开术与Popeye畸形的发生率更高(OR，3.34;p<0.001)和痉挛疼痛(OR，3.36；p=0.008]。在疼痛方面，肌腱切开术和肌腱固定术之间没有显着差异（p=0.59），美国肩肘外科(ASES)评分(p=0.42)及其改善(p=0.91),肘部屈曲强度（p=0.38），前臂旋光强度(p=0.68)和肩外旋转活动范围(p=0.62)。亚组分析显示，所有肌腱固定术类型的Constant评分均较高，而Constant评分的改善幅度则显着较大（MD，-5.87；p=0.001）。
结论：根据随机对照试验的分析，在Constant评分和SST评分方面，肌腱固定术能更好地改善肩关节功能，并降低了Popeye畸形和颈椎痉挛疼痛的风险。以Constant评分测量，肌腱内固定术可能提供最佳的肩部功能。然而,肌腱切开术和肌腱固定术在缓解疼痛方面提供了类似的满意效果，ASES得分,二头肌的力量和肩膀的活动范围。
方法：文献检索自PubMed，科克伦图书馆,Embase和WebofScience于2022年1月12日发布。荟萃分析中汇总了比较肌腱切开术和肌腱固定术临床结局的随机对照试验（RCTs）。
结果：10个RCT，787例符合纳入标准，并纳入荟萃分析。常数分数(MD，-1.24；p=0.001），常数分数的提高(MD，-1.54；p=0.04），简单肩测试（SST）成绩（MD，-0.73；p=0.03）和SST的改善（p<0.05）在肌腱固定术患者中明显更好。张力切开术与Popeye畸形的发生率更高(OR，3.34;p<0.001)和痉挛疼痛(OR，3.36；p=0.008]。在疼痛方面，肌腱切开术和肌腱固定术之间没有显着差异（p=0.59），美国肩肘外科(ASES)评分(p=0.42)及其改善(p=0.91),肘部屈曲强度（p=0.38），前臂旋光强度(p=0.68)和肩外旋转活动范围(p=0.62)。亚组分析显示，所有肌腱固定术类型的Constant评分均较高，而Constant评分的改善幅度则显着较大（MD，-5.87；p=0.001）。
结论：根据随机对照试验的分析，在Constant评分和SST评分方面，肌腱固定术能更好地改善肩关节功能，并降低了Popeye畸形和颈椎痉挛疼痛的风险。以Constant评分测量，肌腱内固定术可能提供最佳的肩部功能。然而,肌腱切开术和肌腱固定术在缓解疼痛方面提供了类似的满意效果，ASES得分,二头肌的力量和肩膀的活动范围。
