Table 2 Characteristics of included studies

Franceschi et al. [15]

To demonstrate that in patients over 50 years of age with arthroscopically confirmed lesions of the RC and a type II SLAP (labrum and LHBT), there is no difference between (1) repair of both lesions and (2) repair of the RC tear without repair of the type II SLAP lesion but with tenotomy of the LHBT.

Level of evidence: I (determined by the authors).

n = 63.

33 men (52.38%);

30 women (47.62%).

Mean age = 63.25.

Dominant arm = 76.19%.Inclusion criteria:

- RC tear diagnosed,

- > 50 years,

- No episodes of shoulder instability,

- No radiographic signs fx of the glenoid or the greater or lesser tuberosity,

- MRI evidence of RC tear and type II SLAP lesion,

- Symptoms at least 3 months

- Inadequate response to conservative management,

- RC tear and a type SLAP II lesion found at the time of surgery.Exclusion criteria:

- Inflammatory joint disease,

- Prior surgery on the affected shoulder, an arthroscopic diagnosis of SbT tear,

- Inability to complete questionnaires.

Diagnostic: arthroscopy, MRI and RX.

RC tears:

Tear size:

• Small (< 1 cm): 30.15%.

• Medium (1–3 cm): 36.51%.

• Large (3–5 cm): 33.33%.

Tear shape:

• Crescent shaped: 49.20%.

• L-shaped: 28.58%.

• U-shaped: 22.22%.

Involved tendons:

• ST: 58.73%.

• ST and IT: 41.27%.

Type II SLAP lesion: 100%;

• Anterosuperior type II: 34.92%.

• Posterosuperior type II: 25.40%.

• Combined anterosuperior and posterosuperior type II: 39.68%.

Surgical technique:

• EG1: arthroscopy; RC repair and type II SLAP lesion repair (labrum+LHBT).

• EG2: arthroscopy; RC repair and biceps tenotomy.

Postoperative management:

• Sling with an abduction pillow (6 weeks).

• Active elbow flexion and extension were allowed, but terminal extension was restricted. Passive ER (1 day after surgery).

• Overhead stretching was restricted (6 weeks postoperatively).

• At 6 weeks, the sling was removed, and overhead stretching were started (rope and pulley).

• Isoinertial strengthening and rehabilitation of RC, deltoid, and scapular stabilizers were initiated (10 or 12 weeks post-operation).

• Rehabilitation continued 6 months.

• Heavy manual work and overhead activities were allowed after 6 to 10 months after surgery.

The mean follow-up was 5.2 years.

Comparison between pre-intervention and post-intervention

UCLA rating system(0–35 points):

EG1: 10.4 (range, 6–14) vs 27.9 (range, 24–35); p<  0.001.

EG2: 10.1 (range, 5–14) vs 32.1 (range, 30–35); p < 0.001.

ROM goniometer:

Flexion:

EG1: 107° (range 30°–140°) vs 139° (120°–170°); p < 0.001.

EG2: 99° (range, 30°–140°) vs 166° (range, 140°–170°); p < 0.001.

ER:

EG1: 81.7° (range, 6°–95°) vs 121.4° (range, 90°–140°); p < 0.001.

EG2: 76.6° (range, 60°–90°) vs 134.3° (range, 90°–140°); p < 0.001.

IR:

EG1: 26.0° (range, 20°–33°) vs 34.3° (range, 26°–40°); p < 0.001.

EG2: 29.1° (range, 21°–35°) vs 40.0° (range, 30°–45°); p < 0.001.

Comparison between the 2 groups postoperatively

There was a statistically significant difference in total postoperative UCLA scores and ROM (p < 0.05).

Franceschi et al. [16]

To determine whether or not

to detach the biceps tendon from the glenoid after tenodesis performed with the inclusion of the biceps in the RC suture results in an improved outcome.

Level of evidence: not specified.

n = 22.

11 men (50%);

11 women (50%)

Mean age = 59.2.

Dominant arm = yes.

EG1: Dominant/Not dominant: 8/11: 72.7%.

EG2: Dominant/Not dominant: 8/11: 72.7%.Inclusion criteria:

- No improvements after preoperative conservative

treatments,

- Had at least one positive biceps test.Exclusion criteria:

- Prior surgical procedure on the affected shoulder.

Diagnostic: arthroscopy, MRI and RX.

RC tears:

Involved tendons:

• 3 tendons: 27.27%.

• ST and IT: 13.64%.

• ST and SbT: 18.18%.

• ST: 40.91%.

LHBT:

• Tear > 50%: 36.36%.

• Dislocated: 31.82%.

• Unstable: 31.82%.

Surgical technique:

• EG1: arthroscopy; RC repair and tenodesis without tenotomy of LHBT.

• EG2: arthroscopy; RC repair and tenodesis with tenotomy of LHBT.

Postoperative management:

• Sling with an abduction pillow (6 weeks).

• Active elbow flexion and extension were allowed, but terminal extension was restricted.

• Passive ER (1 day after surgery).

• Overhead stretching was restricted (6 weeks postoperatively).

• At 6 weeks, the sling was removed, and overhead stretching were started (rope and pulley).

• Isoinertial strengthening and rehabilitation of RC, deltoid, and scapular stabilizers were initiated (10 or 12 weeks post-operation).

• Rehabilitation continued 6 months.

• Heavy manual work and overhead activities were allowed after 6 to 10 months after surgery.

The mean follow-up was 47.2 months.

Comparison between pre-intervention and post-intervention

UCLA Score0–35 points):(0–35 points):

EG1: 10.5 vs 33; p < 0.05.

EG2: 11.1 vs 32.9; p < 0.05.

ROM goniometer:

Flexion:

EG1: 102° (range 30°–140°) vs 161° (range 150°–170°); p < 0.05.

EG2: 110° (range 30°–150°) vs 159° (range 140°–170°); p < 0.05.

ER:

EG1: 37° (range 30°–60°) vs 59° (range 45°–70°); p < 0.05.

EG2: 41° (range 30°–60°) vs 60° (range 45°–90°); p < 0.05.

IR:

EG1: (L5 a T10) vs (T11 a T5).

EG2: (L5 a T12) vs (T12 a T5).

Comparison between groups did not show statistically significant differences.

Grasso et al. [17]

To compare the clinical outcome of arthroscopic RC repair with single-row and double-row techniques.

Level of evidence: I (determined by the authors).

n = 72.

34 men (47.22%)

38 women (52.77%).

Mean age = 56.8.

Dominant arm = yes.

Dominant = 77.77%.Inclusion criteria: 

-Repairable full-thickness tear of the supraspinatus or the posterior superior RC, with rotator interval involvement or biceps pathology.Exclusion criteria:

- Partial-thickness or irreparable full-thickness tear, subscapularis tendon tear, an isolated subscapularis tear, labral pathology amenable to surgical repair,

-Degenerative arthritis glenohumeral joint,

- Symptomatic arthritis of the acromioclavicular joint,

- RC arthropathy,

- Previous surgery on the same shoulder,

- Workers’ Compensation claims.

Diagnostic: arthroscopy and MRI.

RC tears:

Involved tendons:

• ST: 54.17%.

• ST and part of IT: 26.38%.

• ST and IT: 19.44%.

Tear shape:

• Crescent shaped: 48.61%.

• L-shaped: 15.28%.

• Inverse L shaped: 13.89%.

• V-shaped: 19.44%.

• U-shaped: 2.78%.

LHB: biceps pathology.

Surgical Technique:

• EG1: arthroscopy; RC repair with single-row and biceps tenodesis or tenotomy (depending on the patient’s age: > 50, tenotomy).

• EG2: arthroscopy; RC repair with double-row and biceps tenodesis or tenotomy.

Postoperative rehabilitation:

A sling during 3 weeks; after this, the following rehabilitation program:

• 1 phase (4–8 weeks after surgery): ROM exercise program (passive, active assisted, and active).

• 2 phase (9–12 weeks after surgery): Muscle-strengthening program using closed kinetic chain exercises for RC, subscapularis, biceps, deltoid, pectoralis major, and scapular stabilizers.

• 3 phase (13–16 weeks after surgery): Open kinetic chain exercises, proprioceptive and plyometric exercises, and postural rehabilitation of kinetic chain (lumbopelvic, thoracolumbar, and scapulothoracic regions).

The mean follow-up was 24.8 ± 1.4 months.

Comparison between groups did not show significant differences.

DASH score (0–100 points):

EG1 (15.4 ± 15.6) vs EG2 (12.7 ± 10.1);

p = 0.482.

Work-DASH score (0–100 points):

EG1 (16.0 ± 22.0) vs EG2 (9.6 ± 13.3);

p = 0.212.

Constant Score (0–100 points):

EG1 (100.5 ± 17.8) vs EG2 (104.9 ± 21.8);

p = 0.378.

Muscle strength evaluation with a digital dynamometer:

EG1 (12.7 ± 5.7) vs EG2 (12.9 ± 7.0);

p = 0.382.

Lee et al. [18]

To compare the clinical outcomes of

tenotomy with those of tenodesis for treatment of LHBT lesions in patients with RC tears.

Level of evidence: I (determined by the authors).

n = 128.

29 men (22.65%);

99 women (77.34%).

Mean age = 62.85.

Dominant arm = no. Inclusion criteria:

- Symptomatic LHBT partial tears and small- to medium-sized RC tears,

- No improvements after conservative treatments (1 month). Exclusion criteria:

- Large or massive RC tears

- History of shoulder surgery or trauma or concomitant shoulder lesions.

Diagnostic: arthroscopy and MRI.

RC tears: 100%.

Size: small (< 1 cm) or medium (1–3 cm).

LHBT:

• LHBT tears: 65.62%.

• Subluxated: 23.44%.

• Dislocated: 10.94%.

Surgical technique:

• EG1: arthroscopy; RC repair (single row for small RC tears and transosseous equivalent repair for medium RC tears) and LHBT tenotomy.

• EG2: arthroscopy; RC repair and LHBT tenotomy with tenodesis.

Postoperative rehabilitation:

• Abduction brace immediately after the operation for 4 weeks postoperatively.

• Afterwards, pulley exercises were prescribed to increase their range of flexion.

• Home-based active assisted shoulder exercises; 3 times daily, each session 20 min.

• Elastic band exercises, strengthening exercises for the muscles stabilizing the scapula, were initiated 2 months after the operation.

• All sports activities were permitted after 6 months.

The mean follow-up was 25.1 months in EG1 and 19.7 months in EG2.

Comparison between pre-intervention and post-intervention

Pain (VAS0–10):

EG1: (7.1 vs 2.0); p = 0.02.

EG2: (5.9 vs 1.8); p = 0.03.

ASES score (0–100 points):

EG1: (44.2 vs 82.8); p = 0.01.

EG2: (51.5 vs 77.6); p = 0.02.

Constant Score (0-100 points): (0–100 points)

 EG1: (69.9 vs 88.3); p = 0.03.

EG2: (69.9 vs 86.5); p = 0.02.

Comparison between groups

12 months post-operatively: no significant differences were found in ROM, pain and functional scores between the groups

(p > 0.05).

Popeye´s deformity was 3 times higher in group I than in group II (19.6% vs 5.6%) p = 0.04. Besides, group II showed greater forearm supination  power (0.818 ± 0.108) than group I (0.998 ± 0.015, p = 0.02).

Zhang et al. [19]

To compare the clinical outcomes between tenotomy and tenodesis for the treatment of LHB lesions in patients > 55 years of age affected

by reparable RC tears with concomitant LHB pathologies.

Level of evidence: I (determined by the authors).

n = 151.

71 men (47.02%)

80 women (52.98%).

Mean age = 61.

Dominant arm = no. Inclusion criteria:

Inclusion criteria:

- Had not improved after non-operative treatments,

-Affected by both RC tears and LHBT pathologies.Exclusion criteria:

Exclusion criteria:

- < 55 years,

- Previous surgical treatment on the affected shoulder,

- Radiological signs of glenohumeral arthritis,

and disability at the contralateral arm.

-Small to large full-thickness RC tears and massive irreparable tears.

Diagnostic: Physical examination, arthroscopy, MRI, US and RX.

RC tears:

Size:

• Small: 47.01%.

• Medium: 33.77%.

• Large: 19.22%.

Biceps tendon pathologies (some cases overlapped):

• Severe inflammation: 26.49%.

• Tears more than 25 %: 68.21%.

• Subluxations or dislocations: 20.53%.

• Type II or type IV SLAP lesions: 23.84%.

Surgical technique:

• EG1: arthroscopy; RC repair and LHBT tenotomy.

• EG2: arthroscopy; RC repair and LHBT tenotomy with tenodesis.

Postoperative rehabilitation:

• All the patients followed the routine rehabilitation procedures after RC repair.

• For tenotomy group: immobilization of their elbow motion for 1 week.

• Active ROM and gentle strength training 6 weeks post operation.

• Unrestricted use of the biceps muscle was not allowed until 16–20 weeks post operation.

Follow-up average of 25 months.

Comparison between groups

Constant Score (0–100 points):

EG1 (95.6 ± 3.0) vs EG2 (96.5 ± 2.6); NS. Muscle strength measured with a digital dynamometer:

Flexion:

EG1 (0.9 ± 0.2) vs EG2 (0.9 ± 0.2); NS.

Supination:

EG1 (0.9 ± 0.2) vs EG2 (0.9 ± 0.1; NS.Popeye´s sign:

EG1 (7) vs EG2 (2); NS.

Pain (VAS, 4 weeks post-operatively):

EG1 (2.0 ± 1.1) vs EG2 (2.1 ± 1.6); NS.Degree of satisfaction:

Excellent or good: EG1 (65) vs EG2 (60); NS.

Fair: EG1 (12) vs EG2 (13); NS.

Poor: EG1 (0) vs EG2 (1); NS.

Tenotomy (EG1) required a shorter surgical time (40.4 ± 4.0 vs. 50.4 ± 5.9 min; p < 0.001) and resulted in faster pain relief, 2 weeks post-operatively (3.1 ± 1.8 vs. 4.8 ± 1.9; p < 0.001).

Park et al. [20]

To compare the clinical and anatomic outcomes of the interference screw and suture anchor fixation techniques for biceps tenodesis performed along with arthroscopic RC repair.

Level of evidence: II (determined by the authors).

n = 67.

28 men (41.79%);

39 women (58.21%).

Mean age = 61.8

Dominant arm = no.Inclusion criteria:

- Partial or full-thickness RC tears by preoperative MR arthrography.

- Concomitant biceps lesions (LHBT

partial tear > 50%, type II SLAP lesion, pulley lesion, or subluxation/dislocation of the LHBT).

-Arthroscopic RC repair.Exclusion criteria:

- Isolated glenohumeral pathological conditions (e.g., SLAP lesion or instability),

- Previous surgery on the same shoulder,

- Complete ruptures of the LHBT,

- Incomplete repair of the RC,

- Symptomatic acromioclavicular arthritis,

- Refusal to be enrolled.

Diagnostic: arthroscopy, MRI and RX.

RC tears: 100%.

Biceps tendon pathologies (some cases overlapped):

EG1:

Biceps tears: 48.48%.

SLAP lesion: 63.63%.

Pulley lesion: 39.39%.

Subluxation: 24.24%.

Dislocation: 15.15%.

EG2:

Biceps tears: 52.94%.

SLAP lesion: 55.88%.

Pulley lesion: 29.41%.

Subluxation: 8.82%.

Dislocation: 20.58%.

Surgical technique:

• EG1: arthroscopy; RC repair and screw fixation techniques for biceps tenodesis.

• EG2: arthroscopy; RC repair and suture anchor fixation techniques for biceps tenodesis.

Postoperative rehabilitation:

• Immobilization in abduction: 4 weeks for a partial-thickness and small (< 1 cm) tear, 5 weeks for a medium (1–3 cm) tear, and 6 weeks for a large to massive tear (> 3 cm).

• Shrugging of both shoulders, active elbow flexion/extension, active forearm supination/pronation, and active hand and wrist motion were encouraged immediately after surgery.

• Active-assisted shoulder ROM exercises were encouraged after weaning from the brace.

• Muscle strengthening exercises were started at 9 to 12 weeks postoperatively.

• All sports activities were permitted from 6 months after surgery.

The mean follow-up 27.7 ± 6.41 months

28.8 ± 7.3 months in the EG1 group

26.6 ± 5.3 months in the EG2.

Comparison between pre-intervention and post-intervention

Pain (VAS, 0–10):

(6.7 ± 2.0) vs (0.6 ± 1.0); p < 0.001.

ASES score ASES score (0–100 points):

(53.7 ± 16.5) vs (93.2 ± 9.5); p < 0.001.

KSS (0–100 points):

(50.5 ± 11.7) vs (94.4 ± 6.2); p < 0.001.

Constant Score (0–100 points):

(51.8 ± 9.3) vs (69.6 ± 7.7); p < 0.001.

SST score(0–12 points):

(4.7 ± 2.1) vs (10.4 ± 2.4); p < 0.001.Flexion;

(158.7 ± 13.6) vs (167.2 ± 22.7); p = 0.007.  ER:

(60.5 ± 12.1) vs (70.8 ± 17.1); p < 0.001.IR:

(9.4 ± 2.4) vs (8.3 ± 1.8); p = 0.007.

Comparison between groups

Pain: (VAS, 0–10):

EG1 (0.5 ± 0.9) vs EG2 (0.8 ± 1.2); p = 0.225.

ASES (0–100 points):

EG1 (93.9 ± 9.2) vs EG2 (92.4 ± 9.8);

p = 0.507.

KSS (0–100 points):

EG1 (94.9 ± 6.1) vs EG2 (93.8 ± 6.3);

p = 0.487.

Constant (0–100 points):

EG1 (69.3 ± 8.3) vs EG2 (69.9 ± 7.2);

p = 0.720.

SST score (0–12 points):

EG1 (8.9 ± 1.2) vs EG2 (8.8 ± 1.1); p = 0.595.Flexion:

EG1 (170.1 ± 12.5) vs EG2 (164.5 ± 29.4);

p = 0.327.ER:

EG1 (72.1 ± 20.5) vs EG2 (70.1 ± 13.2);

p = 0.643.IR:

EG1 (8.6 ± 1.8) vs EG2 (8.1 ± 1.8); p = 0.219.Popeye´s deformity by patient:

EG1 (35.44) vs EG2 (32.60); p = 0.314.Popeye´s deformity by examiner:

EG1 (34.59) vs EG2 (33.43); p = 0.756.

De Carli et al. [21]

To determine clinical, functional, and radiological results of two groups of patients affected by RC tears with concomitant degeneration of LHBT treated with tenotomy and tenodesis or tenotomy.

Level of evidence: II (determined by the authors).

n = 65.

48 men (74%);

17 women (26 %).

Mean age = 57.95.

Dominant arm = no. Inclusion criteria:

- Diagnosis of a small to large RC tear and the presence of an associated degenerative lesion of the LHB (including degenerative tears, tenosynovitis, subluxation on the medial rim of the bicipital groove, and SLAP lesions). Exclusion criteria:

- Previous surgical treatment on shoulder,

- >  65 years,

- Radiological signs of glenohumeral arthritis,

- Grade 3 or 4 degeneration according to Goutallier.

Diagnostic: MRI, RX and arthroscopy.

RC tears: 100%.

Biceps pathology:

EG1:

Biceps tears: 65%.

Tenosynovitis: 20%.

Degenerative SLAP lesion: 15%.

EG2:

Biceps tears: 67%.

Tenosynovitis: 23%.

Degenerative SLAP lesion: 10%.

Surgical technique:

• EG1: arthroscopy; RC repair and LHBT tenotomy with tenodesis.

• EG2: arthroscopy; RC repair and LHBT tenotomy.

The mean follow-up was 24 months.

Comparison between groups

No significant differences between the groups:

Constant Score (0–100 points):

Pre-treatment:

EG1 (44.1 ± 6.3) vs EG2 (47.4 ± 12.1); NS.

Post-treatment:

EG1 (97.2 ± 4.9) vs EG2 (94.6 ± 4.9); NS.

SST (0–12 points):

Pre-treatment:

EG1 (4.4 ± 0.8) vs EG2 (4.4 ± 0.7); NS.

Post-treatment:

EG1 (11.7 ± 1.3) vs EG2 (10.6 ± 1.3); NS. Muscle strength measured with a digital dynamometer

(dynamometric test):

This test compared the operated side with health side.

Flexion shoulder (operated side vs health side):

EG1: (9.8 ± 4) vs (10.8 ± 3.5); p = 0.02.

EG2: (9.8 ± 2.4) vs (10.6 ± 2.4); p = 0.02.

Extension shoulder abducated:

EG1: (12.1 ± 4) vs (13.3 ± 2.9); p = 0.01.

EG2: (1.7 ± 2.4) vs (12.9 ± 17); p = 0.01.

Flexion forearm shoulder abducated:

EG1: (7.5 ± 2.5) vs (8.7 ± 2.7); p = 0.01.

EG2: (7.6 ± 3.1) vs (8.8 ± 1.6); p = 0.02.

Abduction shoulder abducated 45°:

EG1: (7.2 ± 1) vs (9 ± 4.2); p = 0.001.

EG2: (6.8 ± 1.1) vs (8 ± 0.8); p = 0.001.Popeye´s deformity:

A significant in 17% of patients treated with tenotomy (p < 0.05).

Castricini et al. [22]

To compare the effectiveness of tenodesis and tenotomy in the treatment of LHBT lesions.

Level of evidence: I (determined by the authors).

n = 55.

21 men (38.18%)

34 women (61.82 %).

Mean age = 58.5.

Dominant arm = yes.

Dominant = 81.82% .Inclusion criteria:

- Grade I or II full-thickness reparable supraspinatus tendon tear with a LHBT lesion,

- > 40 years. Exclusion criteria:

- Prior surgery on the affected shoulder, a lack of willingness to return for all scheduled follow-up visits,

- Previous upper extremity neurological disorder or diagnosis based upon physical examination,

- Complaint of pain in both shoulders,

- Life expectancy < 2 years

- Insurance trial, lawsuit, or pending legal action for shoulder disease.

Diagnostic: MRI and RX.

RC tears: ST tears 100%.

Biceps pathology:

EG1:

Biceps tendon instability:

Stable: 48.4%.

Unstable: 51.6%.

Biceps tendon lesion (partial ruptured of the tendon):

Normal: 71%.

Minor lesion: 3.2%.

Major lesion: 25.8%

EG2:

Biceps tendon instability:

Stable: 20.8%.

Unstable: 79.2%.

Biceps tendon lesion (partial ruptured of the tendon):

Normal: 87.5%.

Minor lesion: 8.3%.

Major lesion: 4.2%

Surgical technique:

• EG1: arthroscopy; RC repair and LHBT tenotomy.

• EG2: arthroscopy; RC repair and LHBT tenotomy and tenodesis.

Postoperative rehabilitation:

• Immobilization was maintained with a 20° abduction pillow for 3 weeks.

• Pendulum exercises were allowed, starting from the first post-operative day.

• After the immobilization period, passive and assisted exercises in forward flexion and external rotation were initiated.

• Strengthening exercises were restricted until 6 weeks after the surgical procedure.

• 3 months after the operation, patients were allowed to engage in light physical sports activity.

• Heavy manual work and overhead motion were allowed after 6 months.

The follow-up was 6 and 24 months.

Comparison between groups

No significant differences between the groups

Constant Score (0–100 points):

Pre-treatment:

EG1 (48.1 ± 4.7) vs EG2 (47 ± 6.3); NS.

Post-treatment: 6 months

EG1 (75.1 ± 8.1) vs EG2 (75 ± 8.1); NS.

Post- treatment: 24 months

EG1 (85.2 ± 8.1) vs EG2 (84.4 ± 6.5); NS.

Pain (VAS, 0–10):

Post-treatment: 6 months

EG1 (1.1 ± 1.9) vs EG2 (1.5 ± 2); NS.

Post-treatment: 24 months

EG1 (1 ± 1.9) vs EG2 (1 ± 2); NS. Muscle strength measured with a digital dynamometer

(dynamometric test):

Post-treatment: 6 months

Abduction:

EG1 (1.8 ± 1) vs EG2 (1.8 ± 1.4); NS.

Elbow flexion:

EG1 (12.1 ± 7) vs EG2 (10.5 ± 8.1); NS.

External rotation:

EG1 (5.9 ± 2.8) vs EG2 (5 ± 3.7); NS.

Post-treatment: 24 months

Abduction:

EG1 (6 ± 2.6) vs EG2 (5.2 ± 2.6); NS.

Elbow flexion:

EG1 (14.6 ± 8.8) vs EG2 (11.1 ± 6.4); NS.

External rotation:

EG1 (8.6 ± 4.8) vs EG2 (6.2 ± 3.7); NS.

SF-36 Health Survey (0–100 points):

Pre-treatment:

Physical Component Summary: EG1 (57.4 ± 20) vs EG2 (60.2 ± 24.4); NS.

Mental Component Summary: EG1 (61.3 ± 16.3) vs EG2 (62.2 ± 22.7); NS.

Post-treatment: 6 months

Physical Component Summary: EG1 (49 ± 10.1) vs EG2 (49.8 ± 10.2); NS.

Mental Component Summary: EG1 (51.7 ± 7.5) vs EG2 (50 ± 8.2); NS.

Post- treatment: 24 months

Physical Component Summary: EG1 (52.4 ± 6.8) vs EG2 (51.6 ± 6.5); NS.

Mental Component Summary: EG1 (49.9 ± 12.8) vs EG2 (51.2 ± 6.4); NS.

 Biceps cramping:

Post-treatment: 6 months

EG1 (0) vs EG2 (3); p = 0.043.

Post- treatment: 24 months

No cases were noted in both groups.Popeye´s sign

Post-treatment: 6 months

EG1 (17) vs EG2 (2); p < 0.001.

Post-treatment: 24 months

EG1 (18) vs EG2 (5); p = 0.006.

Mardani-Kivi et al. [23]

To evaluate outcomes of tenotomy and tenodesis in the treatment of LHBT lesions with RC tears and to compare their advantages and disadvantages.

Level of evidence: II (determined by the authors).

n = 62.

42 men (67.7%)

20 women (32.3%).

Mean age = 55.

Dominant arm = yes.

Dominant = 56.5%. Inclusion criteria:

- Patients aged 45 to 60 years.

- Candidates for arthroscopic healing of RC tears.

- At least 1 positive biceps test before surgery and who had inflammation, partial tears, or luxation or SLAP lesions during surgery .Exclusion criteria:

- Patients with extensive fatty infiltration between ruptured RC on MRI,

- Positive history of steroid injection or physical therapy,

- Popeye’s deformity, tumors or cysts in the area of the bicipital groove and the proximal humeral shaft,

- Pain in both shoulders,

- Impossibility of arthroscopic RC repair during surgery, and conversion to open surgery.

Diagnostic: MRI, arthroscopy and biceps test.

RC tears:

Size:

EG1:

• Small: 34.5%.

• Medium: 27.6%.

• Large: 24.1%.

• Massive: 13.8%.

•

EG2:

• Small: 36.4%.

• Medium: 24.2%.

• Large: 24.2 %.

Massive: 15.2%.

Biceps tendon pathologies:

EG1:

Tendinosis: 44.8%.

SLAP lesion: 10.3%.

Partial tear: 31%.

Instability: 13.8%.

EG2:

Tendinosis: 42.4%.

SLAP lesion: 12.1%.

Partial tear: 33.3%.

Instability: 12.1%.

Surgical technique:

• EG1: arthroscopy; RC repair and tenotomy of LHBT.

• EG2: arthroscopy; RC repair and tenotomy + open surgery; subpectoral tenodesis of LHBT.

Postoperative rehabilitation:

• The first 6 weeks after operation, sling and abduction pad were used. Elbow extension and flexion were allowed, but terminal extension was forbidden.

• 1st postoperative day: passive external rotation was started.

• Pull over was forbidden up to 6 weeks to prevent damage of the healing area.

• After 6 weeks, the sling was removed and pull over was started with the help of tackles.

• Isotonic strengthening of fixator muscles of RC, deltoid, and scapula were started at 10th to 12th postoperative weeks.

• This rehabilitation process was continued for 6 months.

• Heavy hand work and pull over activities were allowed after 6 to 10 postoperative months.

The follow-up was 6, 12 and 24 months.

Comparison between preoperative and postoperative treatment

EG1: (before) vs (6 months post-treatment)

Constant (0–100 points):

(61.01 ± 6.12) vs (73.07 ± 5.85); p < 0.001.

Pain (NRS, 0–100 points):

(77.88 ± 12.27) vs (46.27 ± 7.25); p < 0.001.

SST (0–12 points):

(4.07 ± 1.66) vs (7.34 ± 1.34); p < 0.001.

Patient satisfaction (VAS, 0–10):

(1.96 ± 1.22) vs (6.38 ± 0.60); p < 0.001.

EG1: (before) vs (12 months post-treatment)

Constant (0–100 points):

(61.01 ± 6.12) vs (82.14 ± 7.93); p < 0.001.

Pain (NRS, 0–100 points):

(77.88 ± 12.27) vs (1.70 ± 3.07); p < 0.001.

SST (0–12 points):

(4.07 ± 1.66) vs (9.17 ± 1.44); p < 0.001.

Patient satisfaction (VAS, 0–10):

(1.96 ± 1.22) vs (8.07 ± 0.66); p < 0.001.

EG1: (before) vs (24 months post- treatment)

Constant (0–100 points):

(61.01 ± 6.12) vs (88.1 ± 5.4); p < 0.001. Pain 

NRS, 0–100 points):

(77.88 ± 12.27) vs (0.35 ± 0.85); p < 0.001.

SST (0–12 points):

(4.07 ± 1.66) vs (11.14 ± 0.74); p < 0.001. Patient satisfaction

(VAS, 0–10):

(1.96 ± 1.22) vs (9.07 ± 0.58); p < 0.001.

EG2: (before) vs (6 months post-treatment)

Constant (0–100 points):

(61.76 ± 8.07) vs (73.12 ± 6.83); p < 0.001.

Pain (NRS, 0–100 points):

(79.57 ± 11.80) vs (46.88 ± 5.61); p < 0.001.

SST (0–12 points):

(4 ± 1.27) vs (7.40 ± 1.65); p < 0.001. Patient satisfaction

(VAS, 0–10):

(2.01 ± 1.23) vs (6.10 ± 0.74); p < 0.001.

EG2: (before) vs (12 months post-treatment)

Cosntant (0–100 points):

(61.76 ± 8.07) vs (83.51 ± 5.13); p < 0.001.

Pain (NRS, 0–100 points):

(79.57 ± 11.80) vs (2.27 ± 4.04); p < 0.001.

SST (0–12 points):

(4 ± 1.27) vs (8.70 ± 1.51); p < 0.001. Patient satisfaction

(VAS, 0–10):

(2.01 ± 1.23) vs (8.61 ± 0.66); p < 0.001.

EG2: (before) vs (24 months post-treatment)

Constant (0–100 points):

(61.76 ± 8.07) vs (89.94 ± 3.24); p < 0.001.

Pain (NRS, 0–100 points):

(79.57 ± 11.80) vs (0.48 ± 1.27); p < 0.001.

SST (0–12 points):

(4 ± 1.27) vs (11.42 ± 0.87); p < 0.001. Patient satisfaction

(VAS, 0–10):

(2.01 ± 1.23) vs (9.53 ± 0.48); p < 0.001.

Comparison between EG1 vs EG2:

12 months post- treatment:

Patient satisfaction (VAS, 0–10):

EG1 (8.07 ± 0.66) vs EG2 (8.61 ± 0.66);

p = 0.003.

24 months post-treatment:24 months post-treatment:

Patient satisfaction (VAS, 0–10):

EG1 (9.07 ± 0.58) vs EG2 (9.53 ± 0.48);

p = 0.001. Popeye´s sign:

EG1 (7) vs EG2 (1); p = 0.017.Cramping:

EG1 (9) vs EG2 (0); p = 0.0001.

Mardani-Kivi et al. [24]

To compare clinical and functional outcomes of open subpectoral versus arthroscopic intraarticular tenodesis in patients with reparable RC tear associated with LHBT degeneration.

Level of evidence: II (determined by the authors).

n = 60.

26 men (43.3%)

34 women (56.6%).

Mean age = 55.7

Dominant arm = yes.

Dominant = 81.6%. Inclusion criteria:

- Age 18 to 65 years,

- Candidates for arthroscopic repair RC tear with anterior shoulder pain,

- At least 1 positive biceps test and who also had subluxation, dislocation, partial tear or SLAP lesion on arthroscopic evaluations.

- No evidence of extensive fatty infiltration in ruptured RC muscles on MRI. Exclusion criteria:

- Previous shoulder surgery,

-Tumors or cysts in the area of the bicipital groove and the proximal humeral shaft,

- Pain in both shoulders,

- Impossibility of arthroscopic RC tear repair during surgery and conversion to open surgery.

Diagnostic: MRI, arthroscopy and biceps test.

RC tears: 100%.

Biceps tendon pathologies: subluxation, dislocation, partial tear or SLAP lesion.

Surgical technique:

• EG1: arthroscopy; RC repair and tenodesis of LHBT.

• EG2: arthroscopy; RC repair + open surgery; subpectoral tenodesis of LHBT.

Postoperative rehabilitation:

• The first 6 weeks after surgery, a sling with abduction pad was used.

• Active flexion and extension of the elbow were allowed, but terminal extension was forbidden.

• After 6 weeks, the sling was removed.

• Isotonic strengthening of the fixator muscles of RC, deltoid, and scapula was started at 10 to 12 postoperative weeks.

• This rehabilitation process was continued for 6 months.

• Heavy manual work and overhead activities were allowed only after sufficient muscle strengthening at approximately 6–10 months after surgery.

The follow-up was 6 and 24 months.

Comparison between EG1 vs EG2 (6 month follow-up):

Constant Score (0–100 points):

EG1 (82.1 ± 5.6) vs EG2 (81.2 ± 6.9); NS.

SST (0–12 points):

EG1 (10.2 ± 0.7) vs EG2 (10.2 ± 0.8); NS.

Pain (VAS, 0–10):

EG1 (2 ± 0.8) vs EG2 (2.2 ± 0.9); NS.

Comparison between EG1 vs EG2 (2 year follow-up):

Constant Score (0–100 points):

EG1 (93.1 ± 3.9) vs EG2 (92.7 ± 5.2); NS.

SST (0–12 points):

EG1 (11.5 ± 0.7) vs EG2 (11.3 ± 0.8); NS.

Pain (VAS, 0–10):

EG1 (0.4 ± 0.6) vs EG2 (0.4 ± 0.5); NS.

Patient satisfaction (VAS, 0–10) between EG1 and EG2

(9.7 ± 0.5 and 9.5 ± 0.7); p = 0.47.

Not significantly difference between the two groups.

Van Deurzen et al. [25]

To determine if LHB tenotomy is not inferior to suprapectoral LHB tenodesis when performed in conjunction with arthroscopic repair of small-to medium-sized nontraumatic RC tears.

Level of evidence: I

(determined by the authors).

n = 100.

61 men (61%)

39 women (39%).

Mean age = 61.

Dominant arm = yes.

Dominant = 60%. Inclusion Criteria:

- Patients older than 50 years,

- With a nontraumatic small-to medium-sized supraspinatus and/or infraspinatus lesions.

- Inflamed or unstable LHBT or an LHB tear greater than 30% encountered during arthroscopic RC repair. Exclusion criteria:

- Case of a traumatic or partial-thickness RC rupture, full-thickness tear larger than 3 cm, accompanying SbT tear, hourglass deformity or less than 30% tearing of the LHB, SLAP lesions, arthropathy of the glenohumeral joint, acromion-to-humeral head distance measuring 6 mm or smaller, Hamada classification of grade 2 or higher,

- Prior surgery on the involved shoulder

- Inability to complete the questionnaires and assessments.

Diagnostic: MRI and arthroscopy.

RC tears: small to medium sized supraspinatus and/or infraspinatus lesions.

Biceps tendon pathologies: inflamed or unstable LHBT, LHB tear greater than 30%.

Surgical technique:

• EG1: arthroscopy; RC repair (single or double-row technique) and tenotomy of LHBT.

• EG2: arthroscopy; RC repair (single or double-row technique) and LHBT tenotomy and tenodesis.

Postoperative rehabilitation:

• The first 6 weeks after surgery, an immobilizer was used and only passive ROM exercises of the shoulder and elbow were allowed.

• After 6 weeks, active movements of both the shoulder and elbow were started and gradually increased.

• Full-weight loading of the RC and biceps was not allowed until at least 3 months after surgery.

The mean follow-up period was 12.1 in EG1 and 12.5 months in EG2.

Comparison between preoperative and 1 year postoperative treatment

Constant Score (0–100 points)

EG1: 44 (95% CI, range 39–48) to 73 (95% CI, range 68–79).

EG2: 42 (95% CI, range 37–48) to 78 (95% CI, range 74–82).

Comparison between groups (1 year post-treatment):

Constant Score (0–100 points):

EG1 (73.4) vs EG2 (78.2); p > 0.06 Popeye´s sign:

EG1 (47%) vs EG2 (33%); p = 0.017.

Patient satisfaction (5-point Smiley Scale):

EG1 vs EG2; p = 0.8.

The total surgical time  was significantly shorter for the EG1 (mean, 73 min) vs EG2 (mean, 82 min): p = 0.03.