Does Concomitant Biceps Tenotomy Affect Shoulder Proprioception and Strength? A Prospective Intra-Individual Comparison After Arthroscopic Rotator Cuff Repair

Abstract

Background: Pathology of the long head of the biceps tendon (LHBT) frequently accompanies rotator cuff tears. Whether concurrent LHBT tenotomy during arthroscopic rotator cuff repair (RCR) adversely affects postoperative shoulder proprioception or upper-limb strength remains uncertain; intra-individual evidence is limited. Material/Methods: A prospective intra-individual comparison was conducted at a single center between May 2018 and December 2021. Consecutive adults who underwent arthroscopic RCR with LHBT tenotomy were evaluated at a postoperative visit. Standardized assessments were performed by a single team. Primary outcomes included shoulder joint-position sense, measured by active position reproduction at predefined targets, and maximum isometric strength, measured with a handheld dynamometer. Statistical analysis included normality testing, paired tests, effect sizes, and 95% confidence intervals (CIs) with Holm adjustment. Results: Seventy-seven patients were analyzed (mean age 58.1 years; 73% women; 69% right side). Side-to-side differences were small. Representative metrics included elbow flexion 4=-0.56 (95% CI,-1.05 to-0.06; P=0.028) and shoulder flexion 4=-0.87 (95% CI,-1.41 to-0.33; P=0.002). Absolute proprioception error at 30 degrees rotation was modestly lower on the operated side (4=-2.00 degrees; 95% CI,-3.68 degrees to-0.32 degrees; P=0.020). Other targets showed no clinically meaningful differences. Effect sizes were small. Conclusions: In patients with clinical indications for tenotomy, concurrent LHBT tenotomy during arthroscopic RCR was unrelated to measurable deficits in shoulder proprioception or upper-limb strength. These findings support clinical acceptability of tenotomy when indicated. Comparative studies are warranted to refine patient selection.