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Updated: Jan 17, 2026
Arthroscopic Management of Massive Irreparable Rotator Cuff Tears: Whole Rotator Cable Reconstruction Using Proximal Biceps Tendon Autograft
Published on: June 6, 2025
Arthroscopic T-shaped biceps tenotomy decreased risk of Popeye deformity compared to traditional biceps tenotomy
Yen-Wei Huang1,2, Pu-Kuang Wang1,2, Shen-Wu Hung1,2
1Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taiwan.
Purpose:
This study compared the clinical efficacy of T-shaped biceps tenotomy (release of the long head of the biceps tendon with a portion of the superior labrum) with that of conventional cylinder-shaped biceps tenotomy (without the labrum) in patients with reparable rotator cuff tears and concomitant lesions of the long head of the biceps tendon.
Methods:
Among patients who underwent arthroscopic repair of rotator cuff tears and concomitant lesions of the long head of the biceps tendon, 89 patients aged ≥65 years who were treated with T-shaped biceps tenotomy (group T; n = 46) or conventional cylinder-shaped biceps tenotomy (group C; n = 43) were evaluated. The presence of a Popeye deformity, severity of cramping pain, elbow flexion strength, and forearm supination strength were recorded. The anatomic status of the biceps stump was assessed through ultrasonography. Anatomic failure was considered when the biceps tendon was not identified in the intertubercular groove.
Results:
Overall, 86 patients (45 in group T and 41 in group C) were monitored for more than 2 years. Their postoperative functional scores were significantly better than their preoperative scores (P < 0.03) and did not differ significantly between the two groups. Three patients (6.7 %) in group T and nine (22.0 %) in group C had a Popeye deformity (P = 0.036). Ultrasonography revealed anatomic failure in five patients (11.1 %) in group T and 13 (31.7 %) in group C (P = 0.021). Postoperative cramping pain and elbow flexion strength were evaluated, showing no significant differences between groups.
Conclusions:
For treating concomitant LHBT lesions in patients with rotator cuff tears, T-shaped tenotomy involving a portion of the superior labrum is an acceptable alternative to conventional cylinder-shaped tenotomy not involving the labrum. T-shaped tenotomy is associated with similar functional outcome and lower occurrence rates of a postoperative Popeye deformity than conventional cylinder-shaped tenotomy.
Level Of Evidence:
Level III, retrospective comparative study.
