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Orthopaedics & Traumatology: Surgery & Research
Sous presse. Epreuves corrigées par l'auteur. Disponible en ligne depuis le mercredi 5 septembre 2018
Doi : 10.1016/j.otsr.2018.02.016
Received : 3 Mars 2017 ;  accepted : 27 February 2018
Popeye sign: Frequency and functional impact

Laure Pouliquen a, Julien Berhouet b, Marion Istvan c, Hervé Thomazeau a, Mickael Ropars a, Philippe Collin d,
a Service d’orthopédie, traumatologie, CHRU Pontchaillou, 35000 Rennes, France 
b Service d’orthopédie traumatologie, faculté de médecine de Tours, université François Rabelais de Tours, CHRU Trousseau, 37170 Chambray-les-Tours, France 
c Service de Santé publique, CHRU Pontchaillou, 35000 Rennes, France 
d Service d’orthopédie, Clinique Saint-Grégoire, 35000 Rennes, France 

Corresponding author.

There is currently no consensus on the choice between tenotomy and tenodesis of the long head of the biceps tendon in rotator cuff repair. The Popeye sign is often seen as a drawback of tenotomy. The main objective of the present study was to determine the frequency and clinical impact of the Popeye sign.


The Popeye sign is rarely found clinically, and shows little functional impact following tenotomy.

Materials and Methods

A single-center non-randomized prospective study was conducted between February and October 2015 in all patients undergoing rotator cuff surgery. Patients without surgery on the long head of the biceps tendon were excluded. The rate of Popeye sign was assessed 6 months postoperatively. Tenotomy patients with and without Popeye sign were compared in terms of pain on visual analog scale3, gain in range of motion, improvement in subjective shoulder value, discomfort or cramps and gain in Constant score.


Seven of the 55 patients included (15.2%) showed postoperative Popeye sign. There were no differences between the groups with and without Popeye sign on any of the assessment criteria except for a significantly greater improvement in mean Constant range of motion score in the Popeye group: gain of 13.8 versus 3.8 points; p =0.01.


The Popeye sign was relatively rarely observed. Functional impact in the present study was slight. Longhead of the biceps tenotomy is a justifiable treatment option in case of associated rotator cuff tear repair.

Level of evidence

IV, prospective non-randomized.

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Keywords : Popeye sign, Long head of the biceps, Tenotomy, Tenodesis, Rotator cuff

© 2018  Published by Elsevier Masson SAS.
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