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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 7/2017

Open Access 01-07-2017 | Shoulder

Relationship between subscapularis tears and injuries to the biceps pulley

Authors: Arnaud Godenèche, Laurent Nové-Josserand, Stéphane Audebert, Bruno Toussaint, Patrick J. Denard, Alexandre Lädermann, French Society for Arthroscopy (SFA)

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 7/2017

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Abstract

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.

Methods

Between 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%.

Conclusions

The 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 evidence

II.
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Metadata
Title
Relationship between subscapularis tears and injuries to the biceps pulley
Authors
Arnaud Godenèche
Laurent Nové-Josserand
Stéphane Audebert
Bruno Toussaint
Patrick J. Denard
Alexandre Lädermann
French Society for Arthroscopy (SFA)
Publication date
01-07-2017
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 7/2017
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-016-4374-9

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