Popeye sign: Tenodesis vs. self-locking "T" tenotomy of the long head of the biceps.

INTRODUCTION: Treatment of long head of the biceps lesions is controversial. A new technique of self-locking "T" tenotomy was developed in our department in 2013. HYPOTHESIS: The main objective of the present study was to assess onset of Popeye sign after "T" tenotomy, with comparison to long head of the biceps tenodesis. MATERIAL AND METHODS: A continuous retrospective study included 180 patients with long head of the biceps lesion, either isolated or associated with rotator cuff tear. RESULTS: 130 underwent "T" tenotomy (group A), and 50 tenodesis (group B). Mean age was 57.9 years (range, 23-88 years) in group A and 50.8 years (range, 20-66 years) in group B. At last follow-up, 27.7% of patients in group A and 24% in group B showed Popeye sign (P=0.616), after equivalence test and adjustment on age and occupational activity. Bicipital groove pain was more frequent in the tenodesis group (44% versus 25.4%; P=0.025). DISCUSSION: Self-locking "T" tenotomy did not significantly differ from tenodesis in onset of Popeye sign or clinical results, and showed better postoperative course. LEVEL OF EVIDENCE: IV, retrospective study.

Arthroscopic elbow joint release with radial head resection arthroplasty: 12 cases.

BACKGROUND: Elbow arthritis typically affects manual labourers aged 40 to 50 years and usually starts in the lateral compartment. The objective of this study was to evaluate the medium-term clinical, functional, and radiological outcomes in 12 patients after arthroscopic elbow joint release and radial head resection arthroplasty. HYPOTHESIS: Our main hypothesis was that pre-operative damage to the radio-capitellar joint was associated with poorer clinical outcomes after elbow joint release. MATERIAL AND METHOD: Consecutive patients treated by a single surgeon at a single centre between July 2006 and May 2014 were studied retrospectively. The 12 patients - 10 males and 2 females with a mean age of 54.5±9.3 years (33-69 years) - had osteoarthritis confined to the radio-capitellar compartment with elbow stiffness and pain and underwent arthroscopic elbow joint release with radial head resection arthroplasty. Among them, 9 had a history of trauma or micro-trauma and 3 had rheumatoid arthritis. The Broberg and Morrey osteoarthritis grade on the pre-operative radiographs was 1 in 4 patients, 2 in 6 patients, and 3 in 2 patients. RESULTS: Mean follow-up was 38.1±33.7 months (5-97). One patient required total elbow arthroplasty. Mean arc of motion was 79.6°±20.5° (30-110) pre-operatively, 123.6±18° (90-140) immediately after surgery, and 109°±11.7° (90-120) at last follow-up. At last follow-up, mean values were 81.4±12.5 (65-100) for the Mayo Elbow Score, 11.1±11.1 (2.3-31.8) for the Quick DASH score, and 1.1±1.6 (0-4) for the visual analogue scale pain score. The radiological assessment at last follow-up showed no evidence of osteoarthritis progression. CONCLUSION: In our case-series, arthroscopic elbow joint release with radial head resection arthroplasty produced good outcomes with a motion arc greater than 100° and little or no pain after a mean follow-up of 3.1 years. LEVEL OF EVIDENCE: IV, retrospective study.