Seong Cheol Moon1, Nam Su Cho1, Yong Girl Rhee2. 1. Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea. 2. Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea shoulderrhee@hanmail.net.
Abstract
BACKGROUND: In biceps tenodesis for intra-articular tears, determining the distal extension of the lesions through the biceps groove is important in choosing the optimal tenodesis site. PURPOSE: To determine the optimal tenodesis site by analyzing the extension and delamination of an extra-articular lesion, or a "hidden lesion," in the retrieved biceps after subpectoral biceps tenodesis. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A total of 36 subpectoral tenodeses were performed, and the retrieved biceps were analyzed. The biceps lesions were divided into zones according to their location as follows: the proximal intra-articular (zone A), middle intragroove (zone B), and distal extra-articular portions (zone C); the lesions in zones B and C were called "hidden lesions." The length and delamination depth of the biceps tears were examined, and the severity of the accompanying tenosynovitis and degeneration was assessed. RESULTS: Tears invaded zone B in all the cases and extended to zone C in 28 cases (77.8%). Tenosynovitis was observed along the tear in 28 cases (77.8%) and extended to zone C in 26 cases (72.2%). The mean tear length in the hidden lesions, including the tear and tenosynovitis, was 34.2 mm. Degenerative changes in the proximal intra-articular and middle intragroove portions were observed in all the cases and up to the distal extra-articular portion in 29 cases (80.6%). CONCLUSION: In approximately 80% of the intra-articular biceps tears evaluated in this study, a "hidden lesion" was observed going beyond the bicipital groove and extending to the distal extra-articular portion. Therefore, the subpectoral portion may be considered the optimal tenodesis site for the complete removal of all hidden biceps lesions.
BACKGROUND: In biceps tenodesis for intra-articular tears, determining the distal extension of the lesions through the biceps groove is important in choosing the optimal tenodesis site. PURPOSE: To determine the optimal tenodesis site by analyzing the extension and delamination of an extra-articular lesion, or a "hidden lesion," in the retrieved biceps after subpectoral biceps tenodesis. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A total of 36 subpectoral tenodeses were performed, and the retrieved biceps were analyzed. The biceps lesions were divided into zones according to their location as follows: the proximal intra-articular (zone A), middle intragroove (zone B), and distal extra-articular portions (zone C); the lesions in zones B and C were called "hidden lesions." The length and delamination depth of the biceps tears were examined, and the severity of the accompanying tenosynovitis and degeneration was assessed. RESULTS: Tears invaded zone B in all the cases and extended to zone C in 28 cases (77.8%). Tenosynovitis was observed along the tear in 28 cases (77.8%) and extended to zone C in 26 cases (72.2%). The mean tear length in the hidden lesions, including the tear and tenosynovitis, was 34.2 mm. Degenerative changes in the proximal intra-articular and middle intragroove portions were observed in all the cases and up to the distal extra-articular portion in 29 cases (80.6%). CONCLUSION: In approximately 80% of the intra-articular biceps tears evaluated in this study, a "hidden lesion" was observed going beyond the bicipital groove and extending to the distal extra-articular portion. Therefore, the subpectoral portion may be considered the optimal tenodesis site for the complete removal of all hidden biceps lesions.
Authors: Adnan Saithna; Alison Longo; R W Jordan; Jeff Leiter; Peter MacDonald; Jason Old Journal: Knee Surg Sports Traumatol Arthrosc Date: 2016-01-06 Impact factor: 4.342
Authors: Sergio A Glait; Siddharth Mahure; Cynthia A Loomis; Michael Cammer; Hien Pham; Andrew Feldman; Laith M Jazrawi; Eric J Strauss Journal: Knee Surg Sports Traumatol Arthrosc Date: 2018-01-23 Impact factor: 4.342