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.

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.