Background: Lesions of the biceps pulley and instability of the long head of the biceps tendon are common diagnoses in patients with anterior shoulder pain.
Purpose: To analyze the pathoanatomy of the biceps reflection pulley (”pulley”) in consecutive patients undergoing shoulder arthroscopy.
Study Design: Cohort study (prevalence); Level of evidence, 2.
Methods: Prospective data were collected on 229 shoulders in consecutive patients (155 male,74 female) who underwent shoulder arthroscopy (121 rotator cuff pathology, 50 instability, 43 osteoarthritis, 15 miscellaneous). The average age was 48.5 years (range, 18-76 years). Sixty-eight shoulders had underwent a previous surgery.
Results: The long head of the biceps tendon was absent in 21 shoulders (9.2%); 1 was excluded for incomplete data. In 207 shoulders, the mean width of the long head of the biceps tendon was 6.0 mm (range, 3-10 mm), and the pulley complex, 7.2 mm (range, 4-15 mm). Sixty-seven patients (32.4%) had a pulley tear: 48 shoulders had anteromedial pulley tears, 32 posterolateral, with 13 combined anteromedial-posterolateral lesions. Patients with pulley tears were significantly older than those without (57 vs 44 years, P < .001). For anteromedial pulley tears, the mean width of the long head of the biceps tendon was significantly larger in the torn group (6.4 vs 5.8 mm, P = .012). The anteromedial or posterolateral pulley tears were significantly associated with subluxation or dislocation of the long head of the biceps tendon (P = .001), with a pulley torn in all 27 cases of biceps dislocation. In 173 shoulders with a centered long head of the biceps tendon, the pulley was torn in 36 (23 anteromedial, 18 posterolateral [with 5 being combined]). Pulley tears and rotator cuff injury showed a significant association (P < .001). Superior labral anterior posterior lesions were significantly associated with anteromedial (P < .008) and posterolateral pulley tears (P < .021).
Conclusion: Pulley lesions are fairly common in patients undergoing arthroscopic surgery and were found in 32.4% of this prospective cohort (67 of 207). Current consensus indicates that pulley lesions are often associated with rotator cuff tears. This series also showed correlations with superior labral anterior posterior tears, biceps instability, and long head of the biceps tendon tears.
Background: Causes of rotator cuff pathology are poorly understood.
Hypothesis: Macroscopically intact supraspinatus tendon may show profound light microscopy changes. These changes may be the pathogenic precursor to a subsequent rotator cuff tear.
Study Design: Comparative laboratory study.
Methods: Tendon samples were harvested from 88 individuals (49 men, 39 women; mean age, 58.2 years) who had sustained a rotator cuff tear and underwent arthroscopic repair of the lesion, and from 5 male patients who died of cardiovascular events (mean age, 69.6 years). A full-thickness supraspinatus tendon biopsy specimen was harvested en bloc within the arthroscopically intact middle portion of the tendon between the lateral edge of the tendon tear and the muscle-tendon junction. Slides stained with hematoxylin and eosin were interpreted twice by the same observer using a semiquantitative grading scale assessing fiber structure and arrangement, rounding of the nuclei, regional variations in cellularity, increased vascularity, decreased collagen stainability, and hyalinization. Intraobserver reliability of the subscore readings was calculated.
Results: The mean pathologic sum-score of ruptured tendons was significantly greater than the mean pathologic score of control tendons (15.66 ± 1.82 vs 3.7 ± 2.31, P = .001). Within each specific category of tendon abnormalities, the control and ruptured tendons were significantly different (2 test); all variables were significantly different (Mann-Whitney U test <0.05; P = .001). The agreement between the 2 readings ranged from 0.56 to 0.86 (kappa statistics).
Conclusion: Nonruptured supraspinatus tendons, even at an advanced age, and ruptured supraspinatus tendons are clearly part of 2 distinct populations.
Clinical Relevance: During cuff repair, it is not necessary to excessively freshen the torn tendon to bleeding tissue: the macroscopically intact supraspinatus tendon is degenerated as well, and the failed healing response is not limited to the ends of the torn tendon.
Purpose
This study aimed to elucidate the degree of biceps anchor displacement that occurs when specific zones of the superior labrum are detached from the glenoid.
Study Design
Descriptive laboratory study.
Methods
Twelve cadaveric scapulae with intact labrums were prepared by removing the surrounding musculature with the labrum, biceps anchor, and biceps tendon carefully preserved. Pulleys were used to apply traction in 3 different directions— superior, lateral, and combined posterior/superior/lateral, to simulate the “peel-back” mechanism—while a continuous 1.13 kg of traction was applied to the biceps tendon. Labral tears were created by sharp incisions in isolation and in combinations of 3 zones defined relative to the glenoid fossa: anterior, posterior, or superior. The displacement of the biceps anchor (position of the marker after the simulated lesion relative to the marker position with the labrum intact) was measured relative to a rigid reference frame.
Results
The greatest degree of displacement occurred with the sectioning of all 3 zones, followed by the sectioning of 2 adjacent zones. Superior traction created the least displacement in all combinations, while lateral traction created maximal displacement, with one exception: in the setting of anterosuperior/superior lesions, maximal displacement was observed using the peel-back mechanism.
Conclusion
Biceps anchor displacement, particularly the degree and direction of displacement, is affected by the labral detachment pattern. All 3 labral zones assessed in this study have important biomechanical contributions to biceps anchor displacement.
Clinical Significance
These findings have important implications relating to the clinician’s arthroscopic assessment of superior labrum anterior and posterior (SLAP) tears, as well as the determination of need for stabilization. This information is particularly useful when treating SLAP tears in certain laborers and athletes, whose activities may cause specific biceps anchor displacement patterns.
