Analysis of “Hidden Lesions” of the Extra-articular Biceps After Subpectoral Biceps Tenodesis

Moon, Seong Cheol; Cho, Nam Su; Rhee, Yong Girl

doi:10.1177/0363546514554193

Cited by 91 publications

(74 citation statements)

References 32 publications

(48 reference statements)

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“…The fixation sites include the osteochondral junction line, intertubercular sulcus, and inferior margin of the pectoralis major. It was later recognized that biceps tendon lesions, including wear and tendonitis, extend distally to the intertubercular sulcus, which incurs postoperative pain after proximal fixation. It has been reported that intertubercular sulcus tenodesis may result in a re‐tear rate of at least 25%, and may result in post‐operative pain, stiffness, and loss of external rotation.…”

Section: Discussionmentioning

confidence: 99%

Lesions of the Long Head of the Biceps Tendon Concomitant with Rotator Cuff Tears: Tenotomy or Subpectoral Mini‐open Tenodesis? A Comparative Short to Mid‐term Follow‐up Study

Fang

Dai

et al. 2019

Orthopaedic Surgery

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ObjectiveTo compare the clinical and radiological outcomes of patients who underwent rotator cuff repair (RCR) concomitant with long head of the biceps tendon (LHBT) tenotomy or subpectoral mini‐open tenodesis.MethodsProspectively collected data was reviewed on 154 patients, who underwent a LHBT procedure (tenotomy or tenodesis) concomitant with RCR between January 2010 and January 2017. The exclusion criteria were irreparable massive rotator cuff tear, rotator cuff partial tear, subscapular tendon tear, glenohumeral arthritis, and prior shoulder surgery. The two patient groups are as follows: RCR + Tenotomy (Group A) and RCR + Subpectoral mini‐open tenodesis (Group B). The visual analog scale (VAS) for pain, Constant Score scale, American Shoulder and Elbow Surgeons (ASES) scores, and the Disabilities of the Arm, Shoulder and Hand (DASH) scores preoperatively and 1 month, 3 months, 6 months, 1 year postoperatively and the latest out‐patient clinic were compared between the two groups.ResultsNinety‐two patients in Group A and 62 patients in Group B completed the follow‐up, with a median follow‐up time of 27 and 42 months respectively. At the final follow‐up, the VAS, Constant, ASES, and DASH scores in Group A were 0.1 ± 0.2, 87.0 ± 12.8, 96.4 ± 4.3 and 6.6 ± 4.8 respectively, and the VAS, Constant, ASES, and DASH scores in Group B were 0.1 ± 0.3, 92.5 ± 3.9, 96.3 ± 3.6 and 2.9 ± 1.3 respectively. Clinical evaluation scales showed satisfactory results in both groups, and there were no statistically significant differences between the two groups at the same follow‐up time. Popeye sign was detected in one case of Group A (1.1%) and in one case of Group B (1.6%, P > 0.05).ConclusionBoth tenotomy and subpectoral mini‐open tenodesis are effective for concomitant lesions of the LHBT in patients with reparable rotator cuff tears, and subpectoral mini‐open tenodesis of the LHBT does not provide any significant clinical or functional improvement than isolated tenotomy.

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Section: Discussionmentioning

confidence: 99%

Lesions of the Long Head of the Biceps Tendon Concomitant with Rotator Cuff Tears: Tenotomy or Subpectoral Mini‐open Tenodesis? A Comparative Short to Mid‐term Follow‐up Study

Fang

Dai

et al. 2019

Orthopaedic Surgery

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“…However, this manoeuvre appears insufficient based on the findings in the current study as medial sidewall lesions would be missed. Several recent researches have called into question whether arthroscopy provides an adequate view of the LHBT and bicipital groove [20, 26, 27]. Consequently, when a subscapularis tear is suspected and the SGHL/CHL complex appears normal during arthroscopic assessment, the LHBT in its intertubercular groove and the medial wall of the groove must be checked.…”

Section: Discussionmentioning

confidence: 99%

Relationship between subscapularis tears and injuries to the biceps pulley

Godenèche

Nové-Josserand

Audebert³

et al. 2016

Knee Surg Sports Traumatol Arthrosc

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Purpose The purpose of this study was to analyse the relationship between long head of the biceps brachii (LHBT) lesions and subscapularis tears. The hypothesis was that a bicipital pulley might remain intact, even in the case of a subscapularis tear.MethodsBetween 2010 and 2011, all patients who had a primary arthroscopic repair of a subscapularis tear were potentially included in this prospective study. The outcome of interest was the prevalence and type of arthroscopic lesions of the LHBT and bicipital pulley. Furthermore, the supposed pathomechanics of injury and the treatment proposed (conservative, pulley repair, tenodesis, tenotomy, etc.) was recorded. The following baseline characteristics were assessed: age, sex, shoulder side, and limb dominance.Results Of the 218 patients, the superior glenohumeral ligament/coracohumeral ligament (SGHL/CHL) complex was normal in 54 patients (25%), stretched in 84 patients (39%), and absent in 77 patients (35%). Below the SGHL/CHL complex in the bicipital groove, the medial wall of the LHBT sheath was normal in 25%, partially torn in 39%, and completely torn in 35%. In 25 of the 218 patients (11%), a pathologic LHBT with an intact SGHL/CHL complex was observed. In these cases, the medial wall of the bicipital sheath was torn in 92%.ConclusionsThe biceps pulley system, including the SGHL/CHL complex and subscapularis tendon, merits recognition as an important anatomical structure, and its lesions contribute to shoulder pathology. The subscapularis tendon is very important for the stability of the LHBT and should be included in the pulley system. In cases of a tear associated with a lesion of the SGHL/CHL complex, the LHBT is nearly always unstable and pathologic.Level of evidenceII.

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“…This is predominantly attributed to hidden lesions in the biceps that are not identified during the arthroscopic portion of the procedure. In one study by Moon et al 70% of all LHB tendons had a diseased tendon that extended into the distal 1/3 of the biceps [9].…”

Section: Discussionmentioning

confidence: 99%

All-Suture Anchor Fixation for Subpectoral Biceps Tenodesis

Marrache¹,

Baydoun²

2017

J Clin Exp Orthop

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Subpectoral biceps tenodesis has recently gained significant popularity for addressing lesions of the long head of the biceps. Several techniques have been reported, with fixation devices such as interference screws, bone tunnels, and suture anchors. Complications reported with this procedure include injuries to neurovascular structures and humeral fractures from an increase in stress. We report a new technique that uses an all-suture anchor for fixation. This may offer the advantages of subpectoral biceps tenodesis, and potentially avoid major post-operative complications.

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Analysis of “Hidden Lesions” of the Extra-articular Biceps After Subpectoral Biceps Tenodesis

Cited by 91 publications

References 32 publications

Lesions of the Long Head of the Biceps Tendon Concomitant with Rotator Cuff Tears: Tenotomy or Subpectoral Mini‐open Tenodesis? A Comparative Short to Mid‐term Follow‐up Study

Lesions of the Long Head of the Biceps Tendon Concomitant with Rotator Cuff Tears: Tenotomy or Subpectoral Mini‐open Tenodesis? A Comparative Short to Mid‐term Follow‐up Study

Relationship between subscapularis tears and injuries to the biceps pulley

All-Suture Anchor Fixation for Subpectoral Biceps Tenodesis

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