All right, thank you for the opportunity to present today. How do I go forward here? Oh, here we go. All right. Our author's disclosures can be found on the Academy website. So bicep stenodesis is becoming an increasingly common procedure in recent years, and more and more are being done arthroscopically. In 2007, arthroscopic bicep stenodesis was exceedingly rare. In 2018, of all the proximal biceps procedures, arthroscopic approaches accounted for over a third. So there are a number of advantages of an arthroscopic approach. Importantly, you can avoid an axillary incision, so that typically leads to a better cosmetic result, and there's a lower risk of wound issues, including infection or dehiscence. There are, however, some potential disadvantages. Some cite risk of residual groove pain, and some believe that an arthroscopic onlay construct is less reliable in terms of fixation than an open subpeck technique. And to that point, the rates of Popeye deformity in the literature do vary with an arthroscopic stenodesis, from as low as 0% to as high as 33%. There is some biomechanical data, though, to support that two suture anchor constructs have a higher load to failure than single anchor constructs or even interference screw. So there may be some benefits of using two suture anchors. First, you may have better time-zero fixation with two suture anchors securing the tendon to the bone, and there may be a biological advantage as well, with a wider apposition area for tendon to heel to bone. So the purpose of this study was to compare a single suture anchor construct to a double suture anchor construct. Our primary outcome was Popeye deformity. We also assessed PROs and revision rates. We hypothesized that with a two suture anchor construct, we'd have lower rates of Popeye deformity and a lower rate of revision with no differences in PROs. So this was a retrospective review of prospectively collected data from 2017 to 2019. The senior author on this project transitioned from a single suture anchor construct to a double suture anchor construct in the middle of the study period. So here's a brief summary of the surgical technique. So you localize the biceps tendon in its groove. You open up the transverse humeral ligament in the biceps sheath with an 11 blade. You deliver the tendon. There's a thorough debridement of the biceps groove that's performed with an RF device. Place the first suture anchor or only suture anchor just proximal to the pec tendon. Then you perform your lasso loop type construct. And then if a second suture anchor is used, we place that 1 to 2 centimeters proximal. There we go. So you can see this would be an area, this would be a larger footprint for tendon to bone healing. Okay, so moving on to our results. So there were 50 patients in the one anchor cohort, and there were 54 in the two anchor cohort. The majority of our patients were males, and the mean age was 51 years old. Comparing the two cohorts, there were no differences in work comp, gender, or dominant-sided surgery. Of note, the single anchor cohort did have a longer follow-up time because they were performed earlier in the study period. So regarding concomitant procedures, cuff repair and distal clavicle excision were the two most common concomitant procedures. But importantly, the rate of cuff repair and distal clavicle excision and all these concomitant procedures was similar between the two groups. So moving on to our outcomes. There were six cases of Popeye deformity in the single anchor group, and there was one case of Popeye deformity in the two anchor group. So that's 12% versus 2%. There was no difference in residual groove pain. There was no difference in biceps flexion strength between the two cohorts. Taking a look at the PROs, there was no difference in PROs between the two cohorts. And both cohorts saw a statistically significant increase in PROs that exceeded the MCID. Regarding revisions, there was one patient in the two anchor group that was revised to an open biceps tenodesis because he had developed Popeye deformity. And interestingly, in the one anchor group, we had six patients who developed Popeye deformity and none of which elected to proceed with revision biceps tenodesis. So to summarize, a two suture anchor lasso loop construct did decrease our rate of Popeye deformity from 12% to 2%, but there were no differences in PROs or revision rates between the two cohorts. So I was planning on summarizing this study. I didn't realize you'd be summarizing it. This was a study you'd be summarizing just before me, so thank you for that. But the point to be made is that we have to consider the cost, the potential benefits of using two anchors versus the increased cost. And I think that in judging tenotomy versus tenodesis, the goal of tenodesis is really to prevent the cosmetic deformity. So I think that using two anchors and giving our patients the best chance at not developing that cosmetic deformity is preferable. Unless this is an older patient who may tolerate a cosmetic deformity or is low demand. The senior author likes to think of the single anchor construct as kind of a tenotomy plus, so to speak. Thank you for the opportunity. Looking forward to questions.

arthroscopic bicep stenodesis

cosmetic results

wound issues

Popeye deformity

patient-reported outcomes