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

Abstract

Purpose: To compare clinical and radiologic outcomes between biceps anchor tenodesis (AT), biceps soft-tissue tenodesis (ST), and biceps tenotomy (TT) for patients with concomitant rotator cuff repair (RCR).

Methods: This retrospective study reviewed patients who underwent arthroscopic RCR for full-thickness rotator cuff tears with AT, ST, or TT with minimum 2-year follow-up. All biceps procedures were performed arthroscopically, and ST consisted of fixation to the transverse humeral ligament. We excluded massive rotator cuff tears, additional biceps procedures, and revisions. Patient-reported outcome measures (PROMs) (visual analog scale [VAS] pain score, VAS functional score, American Shoulder and Elbow Surgeons score, and Constant score) and elbow flexion (EF) strength were evaluated preoperatively and at final follow-up.

Results: A total of 155 patients (50 AT, 52 ST, and 53 TT patients) were included in this study. The AT group was younger (mean age, 58.7 ± 6.3 years in AT group, 67.6 ± 5.0 years in ST group, and 66.1 ± 5.3 years in TT group) and had a lower proportion of female patients (13 [26.0%] in AT group, 31 [59.6%] in ST group, 39 [73.6%] in TT group) than the ST and TT groups (all P < .001). At final follow-up, PROM scores were significantly improved in all 3 groups (all P < .001). The VAS pain score (P = .134), VAS functional score (P = .616), and American Shoulder and Elbow Surgeons score (P = .093) at final follow-up showed no significant differences between the 3 groups. The Constant score and EF strength were significantly higher in the AT group than in the ST and TT groups preoperatively (P = .009 for Constant score, P = .033 for EF strength) and at final follow-up (P < .001 for Constant score, P < .001 for EF strength). There was no significant difference in mean improvement in PROM scores and EF strength or in the proportion of achievement of the minimal clinically important difference. The incidence of Popeye deformity was significantly higher in the TT group (n = 11, 20.8%) than in the AT group (n = 3, 5.8%) and ST group (n = 4, 8.0%) (P = .035). Regression analysis showed that TT (odds ratio, 15.6; P < .001) and male sex (odds ratio, 103.9; P < .001) were associated with Popeye deformity and that ST (coefficient, -0.51; P = .035) was associated with bicipital groove pain.

Conclusions: Biceps AT, ST, and TT during arthroscopic RCR showed good clinical outcomes. Although there was a possibility of selection bias, there was no significant difference in mean improvement in clinical outcomes between the 3 long head of the biceps tendon procedures. The incidence of Popeye deformity was higher in the TT group, and that of biceps groove pain was higher in the ST group.

Level of evidence: Level III, retrospective cohort study.