Article

Anterior and Posterior Instability of the Long Head of the Biceps Tendon in Rotator Cuff Tears: A New Classification Based on Arthroscopic Observations

Alps Surgery Institute, Clinique Générale d'Annecy, Annecy, France.
Arthroscopy The Journal of Arthroscopic and Related Surgery (Impact Factor: 3.19). 02/2007; 23(1):73-80. DOI: 10.1016/j.arthro.2006.08.025
Source: PubMed

ABSTRACT The purpose of this study was to evaluate arthroscopically the frequency and type of instability of the long head of the biceps (LHB) tendon in patients undergoing rotator cuff repair.
In 200 consecutive patients undergoing arthroscopic rotator cuff repair, LHB instability was assessed statically and dynamically in the anteroposterior direction. In addition, macroscopic lesions of the LHB, as well as lesions of the adjacent rotator cuff tendons, were documented.
LHB instability (subluxation or dislocation) was found in 45% of patients, with isolated anterior instability in 16%, isolated posterior instability in 19%, and combined anteroposterior instability in 10%. Whereas LHB subluxations were observed in both directions, dislocations were only seen in anterior LHB instability. Anterior instability was more associated with a subscapularis lesion, whereas posterior instability was more associated with a supraspinatus tear. Lesions of the LHB tendon were strongly associated with LHB instability and the size of the rotator cuff tear.
In 200 patients with rotator cuff tears LHB instability could be observed arthroscopically in 45%, with 16% being anterior, 19% being posterior, and 10% being anteroposterior. LHB instability was associated with LHB lesions, with 15% of the LHB tendons showing a normal appearance when unstable versus 70% when stable. Preoperative O'Brien and Speed tests did not correlate with intraoperative observed LHB pathology. The size of the rotator cuff tear could be correlated with the grade of LHB lesion, becoming more significant with augmenting tear size. On the basis of these observations, we created a new arthroscopic classification of LHB instability with respect to the direction and extent of LHB instability, lesions of the LHB, and status of the adjacent rotator cuff tendons.
Level IV, diagnostic study with poor reference standard.

1 Follower
 · 
137 Views
  • Source
    • " BPE and medial subluxation of the biceps tendon , which could be a concomitant finding in cases of biceps instability after subscapularis or supraspinatus tendon tears . Previous research indicated that the biceps tendon tends to dislocate medially rather than laterally because of its course and the relative weak - ness of the medial stabilizer ( Lafosse et al . 2007 ; Patton and McCluskey 2001 ) . Hence , an alternative expla - nation is that extensive peritendinous effusion expands the biceps tendon sheath and that the increased space facilitates medial dislocation of the biceps tendon . Fig . 2"
    [Show abstract] [Hide abstract]
    ABSTRACT: Bicipital peritendinous effusion (BPE), a common ultrasonographic finding of the long head of the biceps tendon, may be associated with shoulder joint derangement, but supporting evidence from large-scale studies is lacking. The aim of this cross-sectional study was to determine the strength of the association between BPE and sonographic abnormalities of the shoulder joint. We reviewed the sonographic reports of patients with suspected shoulder disorders investigated ultrasonographically between January 2011 and January 2012. BPE was graded according to its measured thickness as absent (<1 mm), mild (1-2 mm), moderate (2-3 mm) or severe (>3 mm). The associations between BPE and sonographic abnormalities were examined using multinomial logistic regression adjusted for age, gender, affected side and clinical diagnosis of frozen shoulder. The prevalence rates of absent, mild, moderate and severe BPE among the 907 shoulders examined were 64.1%, 17.8%, 10.4% and 7.7%, respectively. Frozen shoulder was associated with mild BPE (relative risk [RR] vs. participants without BPE = 1.83, 95% confidence interval [CI] = 1.28-2.50). Sonographic findings of biceps tendinopathy, subdeltoid bursitis and full-thickness tears of the supraspinatus tendon were significantly associated with the entire spectrum of BPE, whereas subscapularis tendon tears were significantly associated with moderate (RR = 2.47, 95% CI = 1.29-4.69) and severe (RR = 3.11, 95% CI = 1.51-6.33) BPE. Severe BPE was associated with articular-sided partial-thickness tears of the supraspinatus tendon (RR = 14.32, 95% CI = 4.30-34.35), posterior recess effusion (RR, 7.98, 95% CI = 1.44-34.93) and biceps medial subluxation (RR = 7.25, 95% CI = 1.90-22.33). Our study indicates that BPE is related to various shoulder abnormalities and that the strengths of these associations depend on the severity of BPE. Clinicians encountering BPE should grade its severity and be alert for hidden lesions of the shoulder joint.
    Ultrasound in medicine & biology 12/2013; 40(2). DOI:10.1016/j.ultrasmedbio.2013.10.002 · 2.10 Impact Factor
  • Source
    • "A rupture or instability of BLHT is rarely an isolated condition and is commonly associated with rotator cuff tendon pathology [4] [5] [6]. Lafosse et al. reported BLHT instability in 45% of the patients with an operatively treated rotator cuff tear [3]. Accordingly, Chen et al. found BLHT pathology in at least 76% of the patients with an operatively treated rotator cuff tear [7]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose. Biceps long head pathology is often associated with rotator cuff tears. The aim of this study was to determine the effect of possible associated biceps procedure on the treatment outcome in rotator cuff repair. Methods. 148 consecutive shoulders operated for isolated full-thickness supraspinatus tendon tear were included. A biceps tenotomy or tenodesis was performed in cases of irritated/frayed and/or unstable biceps tendon. The patients were grouped into three groups according to the biceps procedure (no procedure, tenotomy, and tenodesis). The age-adjusted Constant score was used as an outcome measure. Results. 145 shoulders (98%) were available for final followup. Preoperatively, there was no statistically significant difference in Constant scores. At three months, there was a statistically significant positive change in Constant scores compared with preoperative status in the tenotomy group in women. At one year there was a statistically significant positive change in Constant scores in all groups in both genders. However, there was no statistically significant difference between the groups at one year in either gender. Conclusion. Biceps procedure does not affect the final clinical treatment outcome after rotator cuff repair. Recovery from operative treatment may be faster in tenotomized female patients in cases of encountered biceps pathology.
    01/2013; 2013. DOI:10.1155/2013/840965
  • [Show abstract] [Hide abstract]
    ABSTRACT: A C¿ control system of type x = fo(x) + ¿i=1 m ui fi(x) |ui| ¿ 1 is considered. Under the assumption fo (xo)=0, a sufficient condition of local controllability at xo is given. The condition generalizes the one given by Sussmann [10].
    Decision and Control, 1986 25th IEEE Conference on; 01/1987
Show more