Comparison of subacromial volume and clinical parameters of patients who underwent biceps tenotomy or tenodesis due to long head of biceps tendon pathologies during rotator cuff repair surgery

Objective: The aim of this study was to compare the results of patients who underwent biceps tenotomy or tenodesis alongside rotator cuff rupture repair (RCRR), as well as to assess its relationship with alterations in subacromial volume. The hypothesis was that patients undergoing biceps tenodesis would experience greater improvements in outcome scores 2 years after the surgery and larger subacromial volumes as the long head of the biceps tendon maintains its tension. Methods: This is a retrospective study including patients who underwent an RCRR concomitant with a biceps procedure (88 tenotomy and 63 tenodesis) with a minimum of 2 years of follow-up between January 2015 and December 2022. Results: Preoperative subacromial volumes of the tenotomy and tenodesis groups were 3.89 cm3 and 3.87 cm3, respectively, which were similar (P = .287). Postoperative subacromial volume was 4.29 cm3 in the tenotomy group and 4.51 cm3 in the tenodesis group (P = .000). Preoperative, postoperative first year and postoperative final follow-up Constant scores were 43.3, 83.1 and 84.8, respectively, in the tenotomy group and 43.7, 86.9 and 89.0, respectively, in the tenodesis group. A statistically significant difference was found between the 2 groups in terms of postoperative Constant scores (P = .000 for both parameters). Volume changes and Constant score changes were significantly correlated (P = .012 and r = 0.513). Although preoperative Visual Analog Scale scores were comparable between the tenodesis and tenotomy groups (P = .076), the tenodesis group demonstrated significantly lower pain scores at both the 1-year follow-up and final evaluation (P = .002 and P = .007, respectively). Conclusion: In this study, biceps tenodesis was superior to tenotomy in terms of outcome scores. The results also revealed that subacromial volume increases significantly following biceps tenodesis compared to biceps tenotomy and has a moderate relationship with postoperative Constant scores, unlike Visual Analog Scale score. Cite this article as: Gunes Z, Erdogan E, Aktekin CN. Comparison of subacromial volume and clinical parameters of patients who underwent biceps tenotomy or tenodesis due to long head of biceps tendon pathologies during rotator cuff repair surgery. Acta Orthop Traumatol Turc. 2026; 60(1), 0528, doi: 10.5152/j. aott.2026.25528