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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 8/2023

Open Access 23-02-2023 | Arthroscopy | KNEE

A shallow morphology of the intertubercular groove is associated with medial and bilateral but not lateral pulley lesions

Authors: Benjamin Daniel Kleim, Jose Fernando Sanchez Carbonel, Maximilian Hinz, Marco-Christopher Rupp, Bastian Scheiderer, Andreas Balthasar Imhoff, Sebastian Siebenlist

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 8/2023

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Abstract

Purpose

To investigate the influence of intertubercular groove (IG) morphology on the development of different types of biceps reflection pulley (BRP) injuries.

Methods

A consecutive cohort of 221 patients with ventral shoulder pain and a preoperative diagnosis suspecting BRP injury, who underwent arthroscopy, was retrospectively reviewed. The presence or absence as well as type of pulley injury (medial, lateral or bilateral) was confirmed arthroscopically. The intertubercular groove was evaluated on MRIs after triplanar reconstruction of the axial plane. IG depth, width, medial wall angle (MWA), lateral wall angle (LWA) and total opening angle (TOA) were measured. IG depth and width were expressed in relation to the humeral head diameter. Measurements were performed by two clinicians independently and averaged.

Results

Of 166 included patients 43 had bilateral, 65 medial and 38 lateral BRP lesions. 20 patients had intact BRPs and represented the control group.
The intra-class correlation coefficient of measurements was 0.843–0.955. Patients with a medial or bilateral BRP injury had a flatter MWA (38.8° or 40.0° vs. 47.9°, p < 0.001), wider TOA (96.1° or 96.6° vs. 82.6°, p < 0.001), greater width (12.5 or 12.3 vs. 10.8 mm, p = 0.013) and shallower depth (5.5 or 5.4 vs. 6.2 mm, p < 0.001) than the control group. Conversely, the IG morphology of those with lateral BRP injuries did not differ significantly from the control group. The odds ratio for a medial or bilateral BRP injury when the TOA exceeded 95° was 6.8 (95% confidence interval 3.04–15.2).

Conclusion

A dysplastic type of IG morphology with a wide TOA, flat MWA, decreased depth and increased width is associated with the presence of medial and bilateral BRP injuries. A TOA of > 95° increases the likelihood of a medial or bilateral BRP injury 6.8-fold. Lateral BRP injuries are not associated with dysplastic IG morphology. Concomitant LHBT surgery may, therefore, not always be necessary during isolated supraspinatus tendon repair.

Level of evidence

Level III.
Literature
1.
Abboud JA, Bartolozzi AR, Widmer BJ, DeMola PM (2010) Bicipital groove morphology on MRI has no correlation to intra-articular biceps tendon pathology. J Shoulder Elbow Surg 19:790–794CrossRefPubMed
2.
Ahrens PM, Boileau P (2007) The long head of biceps and associated tendinopathy. J Bone Joint Surg Br 89:1001–1009CrossRefPubMed
3.
Aldon-Villegas R, Perez-Cabezas V, Chamorro-Moriana G (2021) Efficacy of management of associated dysfunctions on rotator cuff and long head of the biceps: systematic review. J Orthop Surg Res 16:501CrossRefPubMedPubMedCentral
4.
Baumann B, Genning K, Bohm D, Rolf O, Gohlke F (2008) Arthroscopic prevalence of pulley lesions in 1007 consecutive patients. J Shoulder Elbow Surg 17:14–20CrossRefPubMed
5.
Bennett WF (1998) Specificity of the Speed’s test: arthroscopic technique for evaluating the biceps tendon at the level of the bicipital groove. Arthroscopy 14:789–796CrossRefPubMed
6.
Berlemann U, Bayley I (1995) Tenodesis of the long head of biceps brachii in the painful shoulder: improving results in the long term. J Shoulder Elbow Surg 4:429–435CrossRefPubMed
7.
Braun S, Millett PJ, Yongpravat C, Pault JD, Anstett T, Torry MR et al (2010) Biomechanical evaluation of shear force vectors leading to injury of the biceps reflection pulley: a biplane fluoroscopy study on cadaveric shoulders. Am J Sports Med 38:1015–1024CrossRefPubMed
8.
9.
10.
Fischetti M, Stoppino LP, Petrera MR, Francavilla A, Vinci R, Zappia M et al (2022) MRI morphological evaluation of humeral head bone profile inside region of the biceps pulley reflection. Skeletal Radiol 51:2017–2025CrossRefPubMedPubMedCentral
11.
Gialanella B, Grossetti F, Mazza M, Danna L, Comini L (2018) Functional recovery after rotator cuff repair: the role of biceps surgery. J Sport Rehabil 27:83–93CrossRefPubMed
12.
Habermeyer P, Magosch P, Pritsch M, Scheibel MT, Lichtenberg S (2004) Anterosuperior impingement of the shoulder as a result of pulley lesions: a prospective arthroscopic study. J Shoulder Elbow Surg 13:5–12CrossRefPubMed
13.
Hawi N, Liodakis E, Garving C, Habermeyer P, Tauber M (2017) Pulley lesions in rotator cuff tears: prevalence, etiology, and concomitant pathologies. Arch Orthop Trauma Surg 137:1097–1105CrossRefPubMed
14.
Hwang IM, Rayos Del Sol S, Jenkins SM, Bryant SA, Gardner BB, McGahan P et al (2022) Open peroneal tendon stabilization with fibular groove deepening. Arthrosc Tech 11:e347–e352CrossRefPubMedPubMedCentral
15.
Jost B, Koch PP, Gerber C (2000) Anatomy and functional aspects of the rotator interval. J Shoulder Elbow Surg 9:336–341CrossRefPubMed
16.
Kavak RP (2019) Effects of bicipital groove bony morphology on the stability of long head of the biceps tendon. Eurasian J Med Investigation 3:293–299
17.
Kawashima I, Sugaya H, Takahashi N, Matsuki K, Tokai M, Hiraiwa H et al (2021) Assessment of the preserved biceps tendon after arthroscopic rotator cuff repair in patients ≤ 55 years. Arthrosc Sports Med Rehabil 3:e1273–e1278CrossRefPubMedPubMedCentral
18.
Lafosse L, Reiland Y, Baier GP, Toussaint B, Jost B (2007) Anterior and posterior instability of the long head of the biceps tendon in rotator cuff tears: a new classification based on arthroscopic observations. Arthroscopy 23:73–80CrossRefPubMed
19.
Levinsohn EM, Santelli ED (1991) Bicipital groove dysplasia and medial dislocation of the biceps brachii tendon. Skeletal Radiol 20:419–423CrossRefPubMed
20.
Maier D, Jaeger M, Suedkamp NP, Koestler W (2007) Stabilization of the long head of the biceps tendon in the context of early repair of traumatic subscapularis tendon tears. J Bone Joint Surg Am 89:1763–1769CrossRefPubMed
21.
Mardani-Kivi M, Keyhani S, Ebrahim-Zadeh MH, Hashemi-Motlagh K, Saheb-Ekhtiari K (2019) Rotator cuff tear with concomitant long head of biceps tendon (LHBT) degeneration: what is the preferred choice? Open subpectoral versus arthroscopic intraarticular tenodesis. J Orthop Traumatol 20:26CrossRefPubMedPubMedCentral
22.
Martetschlager F, Tauber M, Habermeyer P (2016) Injuries to the Biceps Pulley. Clin Sports Med 35:19–27CrossRefPubMed
23.
Martetschlager F, Zampeli F, Tauber M, Habermeyer P (2020) Lesions of the biceps pulley: a prospective study and classification update. JSES Int 4:318–323CrossRefPubMedPubMedCentral
24.
Nemirov DA, Herman Z, Paul RW, Beucherie M, Hadley CJ, Ciccotti MG et al (2022) Evaluation of rotator cuff repair with and without concomitant biceps intervention: a retrospective review of patient outcomes. Am J Sports Med 50:1534–1540CrossRefPubMed
25.
Rattee J, Sims L, Leswick DA, Obaid H (2022) Correlation between superior humeral head migration and proximal long head of biceps tendon pathology in patients with and without rotator cuff tears using magnetic resonance imaging and radiography. JSES Int 6:809–814CrossRefPubMedPubMedCentral
26.
Schaeffeler C, Waldt S, Holzapfel K, Kirchhoff C, Jungmann PM, Wolf P et al (2012) Lesions of the biceps pulley: diagnostic accuracy of MR arthrography of the shoulder and evaluation of previously described and new diagnostic signs. Radiology 264:504–513CrossRefPubMed
27.
Shavana G, Cronjé JY, McDuling C, Verbeek RB, Nkwenika T, Hohmann E et al (2022) A biomechanical study on the effect of long head of biceps tenotomy on supraspinatus load and humeral head position during shoulder abduction. J Shoulder Elbow Surg 31:1294–1299CrossRefPubMed
28.
Ulucakoy C, Kaptan AY, Yapar A, Orhan O, Ozer M, Kanatli U (2021) The effect of bicipital groove morphology on the stability of the biceps long head tendon. Arch Orthop Trauma Surg 141:1325–1330CrossRefPubMed
29.
Varacallo M, Mair SD. Proximal Biceps Tendinitis and Tendinopathy. StatPearls. Treasure Island (FL): StatPearls Publishing
30.
Virk MS, Cole BJ (2016) Proximal biceps tendon and rotator cuff tears. Clin Sports Med 35:153–161CrossRefPubMed
31.
Walch G, Nove-Josserand L, Boileau P, Levigne C (1998) Subluxations and dislocations of the tendon of the long head of the biceps. J Shoulder Elbow Surg 7:100–108CrossRefPubMed
32.
Walch G, Nove-Josserand L, Levigne C, Renaud E (1994) Tears of the supraspinatus tendon associated with “hidden” lesions of the rotator interval. J Shoulder Elbow Surg 3:353–360CrossRefPubMed
33.
34.
Yoo JC, Iyyampillai G, Park D, Koh KH (2017) The influence of bicipital groove morphology on the stability of the long head of the biceps tendon. J Orthop Surg (Hong Kong) 25:2309499017717195CrossRefPubMed
35.
Zhao J, Luo M, Pan J, Liang G, Feng W, Zeng L et al (2021) Risk factors affecting rotator cuff retear after arthroscopic repair: a meta-analysis and systematic review. J Shoulder Elbow Surg 30:2660–2670CrossRefPubMed
Metadata
Title
A shallow morphology of the intertubercular groove is associated with medial and bilateral but not lateral pulley lesions
Authors
Benjamin Daniel Kleim
Jose Fernando Sanchez Carbonel
Maximilian Hinz
Marco-Christopher Rupp
Bastian Scheiderer
Andreas Balthasar Imhoff
Sebastian Siebenlist
Publication date
23-02-2023
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 8/2023
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-023-07350-x

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