Comparison of Treatments for Superior Labrum-Biceps Complex Lesions With Concomitant Rotator Cuff Repair: A Prospective, Randomized, Comparative Analysis of Debridement, Biceps Tenotomy, and Biceps Tenodesis

Purpose: To compare the clinical outcomes in patients with concomitant superior labrum-biceps complex (SLBC) lesions and rotator cuff tears who underwent arthroscopic rotator cuff repair, according to 3 different treatment methods (simple debridement, biceps tenotomy, or biceps tenodesis) for the SLBC lesions.

Methods: One hundred twenty patients who underwent arthroscopic rotator cuff repair with SLBC lesions (biceps partial tears <50%, partial pulley lesions, and type II SLAP lesions) were enrolled in this prospective comparative study and randomly assigned to 1 of 3 treatment groups (simple debridement [Deb], biceps tenotomy only [BTo], or biceps tenodesis with one suture anchor [BTd]). Patients with isolated subscapularis tears or osteoarthritis were excluded. Finally, 86 patients (Deb in 28, BTo in 27, and BTd in 31) were analyzed (mean follow-up, 22.1 ± 7.72 months; mean age, 58.98 ± 7.8 years). Pain; functional, clinical, and radiologic outcomes; and the strength index of elbow flexion and forearm supination were analyzed.

Results: Pain, range of motion, and functional scores significantly improved postoperatively in all 3 groups, with no significant differences across groups. At the 6-month follow-up, 8 patients reported cramping pain (5 Deb patients, 2 BTo patients, and 1 BTd patient), but the pain improved in most patients over time (with cramping pain reported by zero Deb patients, 1 BTo patient, and 1 BTd patient at final follow-up). Bicipital groove tenderness significantly improved in the BTo group postoperatively (P = .006). The Popeye deformity was noted in 10 patients (37.0%) in the BTo group, 8 (25.8%) in the BTd group, and only 2 (7.1%) in the Deb group (P = .029). On radiologic examination, the presence of tenodesis of the biceps tendons on the bicipital groove showed low agreement with the presence of the Popeye deformity (observed in 13 of 20 patients with the deformity, 65%). On strength index analysis, the BTo group showed lower forearm supination strength (0.877 ± 0.44) compared with that in the other groups (1.29 ± 0.525 in the Deb group and 1.12 ± 0.451 in the BTd group, P = .049).

Conclusions: All 3 treatments improved pain and function. Simple debridement showed the lowest risk of the Popeye deformity and preserved forearm supination strength. Biceps tenotomy and tenodesis may be preferable for selected patients: biceps tenotomy for patients with definite bicipital groove tenderness and biceps tenodesis for patients, especially male patients, with bicipital groove tenderness who want to preserve supination strength.

Level of evidence: Level II, prospective comparative study.