69 patients with a long head of the biceps tendon lesion and full-thickness supraspinatus tear were randomized to management of the LHBT lesion through either tenodesis or tenotomy. Patients were assessed over 24-month follow-up for function as the primary outcome, as well as pain, quality of life, range of motion, strength, cosmesis, tendon integrity on ultrasound, and complication rate as secondary outcomes. Constant-Murley scores did not significantly differ between groups at 6 months or 24 months. Secondary outcomes also did not significantly differ between groups, with the exception of a significantly higher incidence of Popeye deformity following tenotomy versus tenodesis.