The incidence of Popeye Deformity after Soft Tissue Biceps Tenodesis is Comparable to Biceps Anchor Tenodesis and Lower than Biceps Tenotomy During Arthroscopic Rotator Cuff Repair

Hyun Gon Kim; Su Cheol Kim; Jong Hun Park; Jae Soo Kim; Dong Hun Suh; Sang Min Lee; Jae Chul Yoo

doi:10.1016/j.arthro.2024.11.069

The incidence of Popeye Deformity after Soft Tissue Biceps Tenodesis is Comparable to Biceps Anchor Tenodesis and Lower than Biceps Tenotomy During Arthroscopic Rotator Cuff Repair

Arthroscopy. 2024 Nov 22:S0749-8063(24)00973-3. doi: 10.1016/j.arthro.2024.11.069. Online ahead of print.

Authors

Hyun Gon Kim¹, Su Cheol Kim², Jong Hun Park³, Jae Soo Kim⁴, Dong Hun Suh¹, Sang Min Lee², Jae Chul Yoo⁵

Affiliations

¹ Department of Orthopedic Surgery, Korea University Ansan Hospital, Ansan, Republic of Korea.
² Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
³ Department of Orthopedic Surgery, Buchon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Republic of Korea.
⁴ Department of Orthopedic Surgery, Chung-ang Univeristy College of Medicine, Chung-ang University Gwangmyeong Hospital, Gwangmyeong, Republic of Korea.
⁵ Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Electronic address: shoulderyoo@gmail.com.

PMID: 39581279
DOI: 10.1016/j.arthro.2024.11.069

Abstract

Purpose: The purpose of this study was to compare outcomes between biceps anchor tenodesis (AT), soft tissue tenodesis (ST), and tenotomy (TT) for patients with concomitant rotator cuff repair (RCR).

Methods: This retrospective study reviewed patients who underwent arthroscopic RCR for full thickness RCT with AT, ST, TT with minimum 2-year follow-up. All biceps procedure was performed arthroscopically and ST was fixed to transverse humeral ligament. We excluded massive RCT, additional biceps procedure, revision. PROM (PVAS, FVAS, ASES, Constant) and elbow flexion (EF) strength were evaluated at preoperative and final follow-up.

Results: Total of 155 patients (AT : 50, ST : 52, TT : 53) were included in this study. AT group was younger (mean age, AT : 58.7 ± 6.3, ST : 67.6 ± 5.0, TT : 66.1 ± 5.3) and had a lower proportion of females(AT : 13 (26.0%), ST : 31 (59.6%), TT : 39 (73.6%)) than ST and TT groups (all P < .001). At final follow-up, PROM scores were significantly improved in all 3 groups (all P < .001). PVAS(P = .134), FVAS(P = .616) and ASES score(P = .093) at final follow-up showed no significant differences between three groups. Constant score and EF strength were significantly higher in AT group than in ST and TT groups at preoperative (Constant: P = .009, EF strength: P = .033) and final follow-up (Constant: P < .001, EF strength: P < .001). There was no significant difference in mean improvement of PROM scores and EF strength, and proportion of MCID achievement. Incidence of Popeye deformity was significantly higher in TT group (n = 11, 20.8%) compared to AT group (n = 3, 5.8%), and ST group (n = 4, 8.0%) (P = .035). Regression analysis showed that TT (OR = 15.6, P < .001) and male (OR = 103.9, P < .001) were associated with Popeye deformity and ST (Coeffieicnt = -0.51, P = .035) was associated with bicipital groove pain.

Conclusions: Biceps anchor tenodesis, soft tissue tenodesis, and tenotomy during arthroscopic rotator cuff repair showed good clinical outcomes. Although there is a possibility of selection bias, there was no significant difference in mean improvement of clinical outcomes between the three LHBT procedures. The incidence of Popeye deformity was higher in tenotomy group, and biceps groove pain was higher in the soft tissue tenodesis group.

Level of evidence: III, Retrospective cohort study.