- Design
- Retrospective comparative cohort, level 3 evidence
- Population
- 123 patients (50 isotension, 73 low-tension) with at least 1 year of follow-up
- Primary outcome
- Functional scores (ASES, Constant-Murley, LHB, VAS) with shear wave elastography
- Effect
- ASES 93.2 vs 87.7 (p=0.001); LHB 97.6 vs 91.4 (p=0.001); VAS no difference (p=0.129)
A retrospective cohort compared isotension tenodesis (fixing the tendon in situ in the groove) with low-tension tenodesis (resecting then fixing the residual stump) in 123 patients, 50 and 73 respectively, with mean follow-up around 26 months.
Shear wave elastography showed no change in tendon stiffness after isotension tenodesis and reduced stiffness after low-tension. Both groups improved. At final follow-up the isotension group scored higher on ASES (93.2 vs 87.7, p=0.001), Constant-Murley (94.2 vs 91.2, p=0.003) and the biceps-specific LHB score (97.6 vs 91.4, p=0.001), with better elbow flexion strength. Pain (VAS) did not differ, and Popeye sign was similar (2.0% vs 2.7%).
Only the LHB score showed a difference in the proportion reaching the minimal clinically important difference (86.0% vs 56.2%). Group allocation was by technique in a retrospective series, so surgeon choice and case mix may explain part of the gap.
- Both techniques gave satisfactory results; neither was worse on pain.
- Isotension fixation was linked to better elbow flexion strength in this series.
- Only the biceps-specific score showed a clinically important difference more often.
- Retrospective grouping means a randomised comparison is needed.
Why it matters
It puts tendon tension, rather than only fixation method, on the list of variables that may affect strength recovery.
Don't overread it
Retrospective, single-technique-per-group comparison without randomisation; pain did not differ.
The statistics, in plain English
A p-value of 0.001 shows the groups differed, not that the technique caused it. When only one of four scores shows a clinically important gap, the practical benefit is narrower than the headline suggests.
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