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What is the difference between tenodesis and tenotomy?

Published in Tendon Surgery 4 mins read

The primary difference between tenodesis and tenotomy lies in the fate of the tendon after it is cut: tenodesis involves reattaching the tendon to a different location, while tenotomy involves cutting the tendon without reattachment, allowing it to heal naturally in a new position.

These surgical procedures are commonly performed to address issues with damaged or inflamed tendons, particularly around joints like the shoulder.

Understanding Tenodesis

Tenodesis is a surgical procedure where a tendon, after being detached from its original insertion point, is then reattached to another bone. The goal is often to alleviate pain, restore stability, or improve function by relocating the tendon to a healthier or more biomechanically advantageous position.

For example, in a biceps tenodesis, the biceps tendon is cut from its original attachment point, which is typically off the labrum – a crucial pad of cartilage inside the glenoid (the shoulder socket part of the shoulder blade). This detached tendon is then carefully reattached to the humerus, which is the upper arm bone. This relocation aims to remove the problematic portion of the tendon from its painful location within the shoulder joint while preserving the function of the biceps muscle.

Understanding Tenotomy

In contrast, tenotomy involves surgically cutting a tendon without reattaching it to a new location. The severed tendon is simply allowed to retract and heal naturally. While this might seem counterintuitive, it's often done to release tension, alleviate pain caused by an irritated or degenerated tendon, or reduce muscle spasm.

Taking the example of a biceps tenotomy, the biceps tendon is cut from its attachment point, typically off the labrum. Instead of being reattached, the cut tendon is left to heal to the humerus (upper arm bone) over a period of a few weeks. This effectively "releases" the tendon, often leading to pain relief, though it may result in some cosmetic changes (like a "Popeye" deformity) or slight functional limitations in some individuals.

Key Differences: Tenodesis vs. Tenotomy

To highlight their distinctions, consider the following comparison:

Feature Tenodesis Tenotomy
Action Cutting a tendon from its original attachment and reattaching it to a new bone. Cutting a tendon from its original attachment and allowing it to retract and heal naturally.
Tendon Fate The tendon is secured to a new bone, maintaining tension and length as much as possible, albeit in a different location. The tendon is not reattached; it typically retracts and forms scar tissue that adheres to surrounding structures, often shortening its functional length.
Purpose To preserve the function of the muscle by relocating the tendon to a healthier site, often for stability or to eliminate intra-articular pain. To alleviate pain and symptoms by releasing a problematic, irritated, or degenerated tendon, sacrificing some potential function or cosmetic appearance.
Complexity Generally considered a more complex procedure due to the need for precise reattachment. Typically a simpler and quicker procedure as it does not involve reattachment.
Recovery May involve a longer or more structured rehabilitation period to ensure proper healing and integration of the reattached tendon. Often has a quicker initial recovery period, but long-term outcomes may vary depending on the degree of functional loss.
Examples Biceps tenodesis, often chosen for active individuals to maintain biceps muscle strength and aesthetics. Biceps tenotomy, sometimes preferred for older, less active individuals, or when a quicker, less invasive solution for pain relief is desired.

When are These Procedures Performed?

Both procedures are primarily used in orthopedic surgery to manage tendon pathologies, especially those affecting the shoulder. Conditions that might warrant tenodesis or tenotomy include:

  • Biceps tendonitis or degeneration: Inflammation or tearing of the biceps tendon, particularly where it attaches within the shoulder joint.
  • Rotator cuff tears: Sometimes performed concurrently with rotator cuff repair to address associated biceps issues.
  • Persistent shoulder pain: When conservative treatments fail to relieve pain caused by tendon irritation.

Factors Influencing Surgical Choice

The decision between tenodesis and tenotomy is individualized and depends on several factors, including:

  • Patient age and activity level: Younger, more active individuals may benefit more from tenodesis to preserve strength and cosmetic appearance.
  • Severity of tendon damage: The extent of the tear or degeneration.
  • Patient goals and expectations: Whether the priority is pain relief, strength preservation, or cosmetic outcome.
  • Associated pathologies: Other injuries in the shoulder that need to be addressed.
  • Surgeon's preference and experience: The surgeon's expertise and assessment of the most suitable option for the specific case.

For more information on orthopedic procedures and conditions, you can consult resources from reputable organizations like the American Academy of Orthopaedic Surgeons (AAOS).

In essence, tenodesis is about relocating and reattaching for function and stability, while tenotomy is about releasing a problematic tendon for pain relief.