Guideline review compares tenodesis versus tenotomy for long head of biceps tendon pathology.

This document is a guideline review addressing the management of long head of biceps tendon pathology. The analysis compares tenodesis, performed as either subpectoral or non-subpectoral, with tenotomy as the alternative intervention. The review notes that no consensus currently exists regarding the optimal procedure for this condition.

Main results indicate that neither tenodesis nor tenotomy has demonstrated clear superiority over the other. Specific numerical data for primary or secondary outcomes were not reported in the provided evidence. Consequently, the decision between procedures relies heavily on patient-specific variables rather than robust comparative efficacy data.

Safety considerations highlight that tenotomy is associated with a risk of 'Popeye' deformity and potential aesthetic concerns. The review does not report specific rates of serious adverse events, discontinuations, or detailed tolerability metrics. These limitations underscore the need for shared decision-making that weighs functional outcomes against cosmetic risks.

Key limitations include the absence of a consensus on the optimal procedure and the lack of demonstrated superiority for either surgical option. Practice relevance centers on assisting surgeons in individualized decision-making based on factors such as tendon quality, bone density, economic considerations, injury type, cosmetic concerns, and surgeon experience. Clinicians must interpret these findings conservatively given the uncertainty in the evidence.