Arthroscopy: The Journal of Arthroscopic & Related Surgery
Arthroscopic bicipital sheath repair: Two-year follow-up with pulley lesions
Section snippets
Methods
Since 1995, the author has performed 18 rotator cuff repairs that involved the supraspinatus tendon and the subscapularis tendon and both affected heads of the coracohumeral ligament, the pulley lesion. The inclusion criteria were any patients who had a tear of the intra-articular subscapularis tendon (IASS) and supraspinatus lesions. The supraspinatus lesions were all complete tears and the subscapularis tears ranged from tears of the IASS to lesions that extended inferiorly along the
Results
The dominant extremity was involved in 12 of the 18 cases. All patients except 2 had full passive range of motion, near complete alleviation of their pain, and, clinically, 5/5 strength of the affected extremity by 4 months postoperatively. Preoperative, ASES Index (Table 1), Total Constant scores (Table 2), Subjective Constant scores (Table 3), Objective Constant scores (Table 4), VAS (Table 5), and percent function (Table 6) were 31 ± 19, 53 ± 13, 12 ± 8, 41 ± 8, 7 ± 3, and 42 ± 17,
Discussion
This study included 18 patients with a type 5 biceps subluxation/instability lesion5 that consisted of tears of the supraspinatus, the subscapularis, and both the medial and lateral walls of the bicipital sheath, the pulley lesion.
Type 5 represents a complete loss of any integrity to the medial and lateral walls of the bicipital sheath. These tears are found more often in larger rotator cuff tears and ones that are chronic. However, they can be found in acute traumatic avulsion cases.
A
Acknowledgment
The author thanks John C. Pezullo, Ph.D., for the statistical analysis.
References (18)
- et al.
Diagnosis and treatment of anterosuperior rotator cuff tears
J Shoulder Elbow Surg
(2001) - et al.
Complete ruptures of the supraspinatus tendon associated with “hidden lesions” of the rotator interval
J Shoulder Elbow Surg
(1994) Arthroscopic repair of anterosuperior (supraspinatus/subscapularis) rotator cuff tears: A prospective cohort with 2- to 4-year follow-up. Classification of biceps subluxation/instability
Arthroscopy
(2003)Subscapularis, medial, and lateral head coracohumeral ligament insertion anatomyArthroscopic appearance and incidence of “hidden” rotator interval lesions
Arthroscopy
(2001)Arthroscopic “interval slide” in the repair of large rotator cuff tears
Arthroscopy
(1999)- et al.
Arthroscopic biceps tenodesisA new technique using bioabsorbable interference screw fixation
Arthroscopy
(2002) - et al.
Arthroscopic biceps tenodesisOperative technique
Arthroscopy
(2000) - et al.
Results of biceps tenotomy for treatment of pathology of the long head of the biceps brachii
J Shoulder Elbow Surg
(2001) - et al.
Disorders of the long head of the biceps tendon
J Shoulder Elbow Surg
(1999)
Cited by (29)
Lesions of the biceps pulley: a prospective study and classification update
2020, JSES InternationalCitation Excerpt :Although no relative statistical analysis was performed for type 1 (medial sling) lesions because of the small number of cases, none of the 5 patients with medial sling lesions exhibited complete SSC tears. Several authors have noted the association of medial sheath lesions with various injuries to the rotator cuff tendons and, in particular, with lesions of the intra-articular SSC tendon.2,3,12,14 Habermeyer et al12 concluded that a lesion of the pulley system that causes LHB instability may be related to a partial articular-side SSC tendon tear.
The backward traction test: a new and effective test for diagnosis of biceps and pulley lesions
2020, Journal of Shoulder and Elbow SurgeryIsolated Biceps Reflection Pulley Tears Treated With Subpectoral Biceps Tenodesis: Minimum 2-Year Outcomes
2017, Arthroscopy - Journal of Arthroscopic and Related SurgeryArthroscopic Subscapularis Repair: A Look at Primacy from a Historical Perspective
2014, Arthroscopy - Journal of Arthroscopic and Related SurgeryManagement of disorders of the rotator cuff: Proceedings of the ISAKOS upper extremity committee consensus meeting
2013, Arthroscopy - Journal of Arthroscopic and Related SurgeryCitation Excerpt :The biceps-pulley anatomy plays a major role in biceps stability and may be partly responsible for the development of a painful shoulder. Pulley reconstruction after an isolated tear is not advised because of its intricate nature.51 Wearing of the long head of the biceps can trigger pain and should be addressed with either tenotomy or tenodesis depending on the patient's demands and cosmesis.52,53
The Rotator Interval and Long Head Biceps Tendon: Anatomy, Function, Pathology, and Magnetic Resonance Imaging
2012, Magnetic Resonance Imaging Clinics of North America