Pan Am Clinic, University of Manitoba, Winnipeg, MB, Canada.
Pan Am Clinic, University of Manitoba, Winnipeg, MB, Canada.
J Shoulder Elbow Surg. 2021 Aug;30(8):1733-1740. doi: 10.1016/j.jse.2021.05.003. Epub 2021 May 19.
The purpose of this study was to determine the incidence of Popeye deformity following biceps tenotomy vs. tenodesis and evaluate risk factors and subjective and objective outcomes.
Data for this study were collected as part of a randomized clinical trial in which patients aged ≥18 years undergoing arthroscopic shoulder surgery for a long head of the biceps tendon lesion were allocated to undergo tenotomy or tenodesis. The primary outcome measure for this secondary analysis was rate of Popeye deformity at 24 months postoperation as determined by an evaluator blinded to group allocation. Those with a deformity indicated their satisfaction with the appearance of their arm on a 10-cm visual analog scale, rated their pain and cramping, and completed the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form and the Western Ontario Rotator Cuff index. Isometric elbow flexion and supination strength were also measured. Cohen kappa was calculated to measure inter-rater reliability between patient and evaluator on the presence of a deformity. Logistic regression was performed to identify predictors of presence or absence of a Popeye deformity.
One hundred fourteen patients were randomly assigned to 2 groups, of which 42 to the tenodesis group and 45 to the tenotomy group completed a 24-month follow-up. Based on clinical observation, the odds of a Popeye in the tenotomy group were 4.3 times greater than in the tenodesis group (P = .018) with incidence of 33% (15/45) and 9.5% (4/42), respectively. Surgical technique was the only significant predictor of perceived deformity, with male gender trending toward significance (odds ratio 7.33, 95% confidence interval 0.867-61.906, P = .067). Mean (standard deviation) satisfaction score of those with a deformity regarding appearance of their arm was 7.3 (2.6). Increasing satisfaction was correlated with increasing age (r = 0.640, P = .025), but there was no association with gender (r = -0.155, P = .527) or body mass index (r = -0.221, P = .057). Differences in subjective outcomes were dependent on whether the Popeye was clinician- or self-assessed.
The odds of developing a perceived Popeye deformity was 4.3 higher after tenotomy compared to tenodesis based on clinician observation. Male gender was trending toward being predictive of having a deformity. Pain and cramping were increased in those with a self-reported Popeye. Younger patients were significantly less satisfied with a deformity despite no difference in functional outcomes at 24 months. Thus, biceps tenodesis may be favored in younger male patients to minimize the risk of Popeye and the risk of dissatisfaction in the appearance of their arm following surgery.
本研究旨在确定肱二头肌肌腱切断术与肌腱固定术治疗后出现 Popeye 畸形的发生率，并评估风险因素及主观和客观结果。
本研究数据来自一项随机临床试验，其中≥ 18 岁接受关节镜肩手术治疗肱二头肌长头肌腱病变的患者被分为接受肌腱切断术或肌腱固定术。次要分析的主要结局指标是术后 24 个月时评估者评估的 Popeye 畸形发生率。存在畸形的患者通过 10cm 视觉模拟评分（VAS）评估其对上肢外观的满意度，评估疼痛和痉挛程度，并完成美国肩肘外科医生协会（American Shoulder and Elbow Surgeons）标准肩部评估表和西部安大略省肩袖指数（Western Ontario Rotator Cuff index）。还测量等长肘屈伸和旋前力量。计算 Cohen κ值以评估患者和评估者在畸形存在方面的评分者间信度。采用逻辑回归分析确定 Popeye 畸形存在或不存在的预测因素。
114 名患者被随机分为 2 组，其中 42 名患者接受肌腱固定术，45 名患者接受肌腱切断术，两组均完成 24 个月随访。基于临床观察，肌腱切断术组发生 Popeye 的几率是肌腱固定术组的 4.3 倍（P =.018），分别为 33%（15/45）和 9.5%（4/42）。手术技术是唯一显著的畸形预测因素，男性呈显著趋势（优势比 7.33，95%置信区间 0.867-61.906，P =.067）。存在畸形的患者对上肢外观的满意度平均（标准差）为 7.3（2.6）。满意度随年龄增加而增加（r = 0.640，P =.025），但与性别（r = -0.155，P =.527）或体重指数（r = -0.221，P =.057）无关。主观结果的差异取决于 Popeye 是由临床医生评估还是患者自我评估。
与肌腱固定术相比，基于临床医生观察，肌腱切断术后发生可感知的 Popeye 畸形的几率高 4.3 倍。男性更有可能出现畸形。自我报告存在 Popeye 的患者疼痛和痉挛加重。尽管术后 24 个月的功能结果无差异，但年轻患者对畸形的满意度明显降低。因此，在年轻男性患者中，肌腱固定术可能更受欢迎，以降低 Popeye 风险和术后对上肢外观不满意的风险。
