of a previous randomized clinical trial that we did comparing tenotomy versus tinnedesis, we didn't show much difference between the two groups. We wanted to delve into this further to see if no difference really means no difference. These are my disclosures. As you know, longheaded biceps tenotomy is a common source, or longheaded biceps is a common source of pain and dysfunction, and there's continued controversy as to the surgical treatment. Tenotomy is simple. It's fast. Rehab is fast. There's a low cost, low amount of OR time, but you do get a Popeye deformity in a high percentage of cases. The loss of strength and cramping is implicated with tenotomy. Tinnedesis has a decreased instance of Popeye, perhaps better function, which is a bit of a question mark, perhaps less cramping. Technically it's more difficult. There's a longer OR time, although some surgeons who are proficient can do it in 10 minutes, and residual pain from the incision is possible. The purpose of the study was to determine the rates of perceived Popeye deformity following tenotomy versus tinnedesis, identify predictors for the development of a deformity, and report subjective and objective outcomes in patients with a perceived Popeye deformity. Popeye deformity can be perceived by the patient or perceived by the examiner, so sometimes patients don't even realize they have a Popeye deformity. Sometimes patients complain of a Popeye deformity and the examiner can't even see it. So there's a little bit of a discrepancy there, so we divided that up into two groups. Or you can find a Popeye in advanced imaging. So as I mentioned, this is a follow-up of our previous study. It's a sub-study of a larger RCT. 114 patients were originally randomized into two groups. Five fellowship-trained surgeons were involved, and the outcomes were 24 months post-operative. And what we looked at was the instance of Popeye deformity on clinical assessment or self-reporting, and the satisfaction and appearances weren't something we added, which wasn't in the original study. This was a 10-point VAS. And work and ASES were evaluated, as well as elbow flexion and supination strength. Pain and cramping were also evaluated on a 10-point VAS. So in data analysis, we looked at risk factors with logistic regression and independent variables such as procedure, age, gender, and BMI. And 87 participants were assessed at 24 months for clinical assessment of Popeye deformity. And the incidence in the study sample, both groups overall, was 21%. But as you would expect, there's 33% in the tenotomy group, which is probably a little bit lower than we expected, and 9.5% in the tenodesis group, which is a little bit higher than we expected. But there are multiple different surgeons and different techniques used, and this is higher than what Michael reported. Tenotomy had an overall 4.3 times greater odds of a Popeye deformity. And what were the characteristics? Male gender was 7.3 times greater odds than female to have a Popeye deformity. Age and BMI were not predictive. The work and the ASES were the same between the two groups. Based on self-reporting, there are 99 participants, a few more in this group just because we caught some on the phone. The incidence from the study sample overall was 18%. Based on the tenotomy group, there's 25%. And based on the tenodesis group, there was 10%. So similar numbers, but there are a few people who self-reported a Popeye who didn't have one on clinical assessment. So tenotomy patients had a 3.5 times greater odds of a Popeye deformity, and gender, age, and BMI were not predictive. So based on self-report, the mean satisfaction of those self-reporting Popeye was 7.3, but patient age trended towards significance as a predictor of satisfaction, and gender and BMI were not predictor of satisfaction. Clinical versus self-report. As I mentioned, there's a few patients that clinically assessed had a Popeye that did not perceive one, and 3% of patients reported a Popeye that was not detected on an initial assessment. The inter-rater reliability or assessment was similar between both groups. So discussion. Regardless of the assessment method used, the incidence of Popeye deformity was comparable in both groups. Overall, tenotomy obviously had a significantly greater incidence of Popeye, and male gender was the only thing we picked up on as a significant factor towards significance in terms of satisfaction and appearance of Popeye deformity. So there tended to be a greater satisfaction with increasing age, and gender and BMI were not associated with satisfaction. So biceps tenodesis probably should be considered in younger patients due to the lack of satisfaction in the appearance of a Popeye deformity in a younger patient. Thank you.

randomized clinical trial

Popeye deformity

tenotomy

tenodesis

surgical treatment