The "anchor shape" technique for long head of the biceps tenotomy to avoid the popeye deformity

Abstract

Surgical options for symptomatic pathologies of the long head of the biceps (LHB) include tenotomy and tenodesis. Tenotomy is surgically simple and quick, does not require immobilization, and avoids implant complications. However, it is associated with residual "Popeye" muscle deformity and biceps muscle cramps. Tenodesis avoids Popeye deformity, but it is technically a more difficult operation with a longer rehabilitation period and possible implant complications. The purpose of this report is to describe a novel technique for LHB tenotomy that avoids the Popeye muscle deformity. Before releasing the LHB from its anchor over the superior labrum, this technique consists of making an oblique incision, involving 50% of the tendon, distal to its attachment at the superior labrum. A second standard complete tenotomy incision is made about 1.5 cm medial to the oblique incision. The remaining stump of the LHB at the tendon-labrum junction is resected. The first incision, an oblique incomplete incision, allows the remnant of the LHB to open up and form an "anchor shape" that anchors the LHB at the articular entrance of the bicipital groove, thus decreasing the risk of Popeye deformity.

Fig 1

Oblique incomplete incision (first incision).

Fig 2

Standard tenotomy incision (second incision).

Fig 3

Photograph and diagram showing appearance after the 2 incisions. (Although the technique is arthroscopic, for clarity, this image was obtained during an open procedure.)

Fig 4

The remnant of the LHB forms an anchor shape that anchors the LHB at the articular entrance of the bicipital groove. Because this remnant is lodged at the bicipital groove, the risks of distal migration of the tendon and, thus, Popeye deformity are reduced. (Although the technique is arthroscopic, for clarity, the image was obtained during an open procedure.)