Effects of type II SLAP lesion repair techniques on the vascular supply of the long head of the biceps tendon: a cadaveric injection study

Purpose and Hypothesis: The subscapularis tendon is the major medial support of the long head of biceps tendon (LHBT). Thus, tears of subscapularis may cause biceps tendon subluxation or dislocation. A subluxated biceps tendon may cause a superior labrum injury because of the changed direction of the biceps tendon pulling vector. The purpose of this study is to express the frequency of superior labrum anterior posterior (SLAP) lesions accompanying subscapularis tears. Methods: The digital files of 2010 patients who underwent shoulder arthroscopy were reviewed retrospectively. 141 videos of 141 patients with subscapularis tear were examined in terms of superior labrum and biceps tendon injuries by one of the authors in this study. The results were compared with those of all the 2010 patients who underwent shoulder arthroscopy for any reason. The statistical analysis was made with a statistics programme by the Independent Samples T-Test. Results: There were 113 videos on which the superior labrum and LHBT could be examined precisely. Mean age was 57.8 and 66% of the patients were female. 96.4% of the 113 patients were having a SLAP lesion. 10.6% of those were SLAP I and 89.4% were SLAP II lesion. Out of 2010 patients, the SLAP lesion ratio was 32.2% of which 4.9% were SLAP I. That difference between the patients with and without subscapularis tear was statistically significant. Conclusions: Following the loss of medial support, the LHBT and its pulling vector subluxate anteriorly resulting in a tear of the superior labrum from anterior to posterior. In this study, SLAP lesions were strongly correlated with subscapularis tears as well. Furthermore, the synovial hypertrophy initiated after a superior labrum pathology at superior aspect of the glenoid spreads over the LHBT. An inflamed LHBT firstly degenerates, and then ruptures. According to this study, tears of subscapularis should be repaired when encountered in order to prevent the upcoming secondary intra-articular disorders. [Figure: see text]

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SLAP Lesion and Injury of the Proximal Portion of Long Head of Biceps Tendon in Elite Amateur Wrestlers

Indian Journal of Orthopaedics ◽

10.1007/s43465-020-00041-6 ◽

2020 ◽

Vol 54 (3) ◽

pp. 310-316

Author(s):

Szabolcs Molnár ◽

Zsolt Hunya ◽

Attila Pavlik ◽

Attila Bozsik ◽

Babak Shadgan ◽

...

Keyword(s):

Biceps Tendon ◽

Slap Lesion ◽

Proximal Portion ◽

Long Head Of Biceps ◽

Long Head

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Treatment of SLAP Lesions

The Open Orthopaedics Journal ◽

10.2174/1874325001812010288 ◽

2018 ◽

Vol 12 (1) ◽

pp. 288-294

Author(s):

Apostolos Stathellis ◽

Emmanouil Brilakis ◽

Jim-Dimitris Georgoulis ◽

Emmanouil Antonogiannakis ◽

Anastasios Georgoulis

Keyword(s):

Biceps Tendon ◽

Surgical Techniques ◽

Slap Lesion ◽

Everyday Clinical Practice ◽

Postoperative Rehabilitation ◽

Excellent Outcome ◽

Slap Lesions ◽

Superior Labrum ◽

The Everyday ◽

Long Head

Background: The surgical treatment of a Superior Labrum Anterior and Posterior (SLAP) lesion becomes more and more frequent as the surgical techniques, the implants and the postoperative rehabilitation of the patient are improved and provide in most cases an excellent outcome. Objective: However, a standard therapy of SLAP lesions in the shoulder surgery has not been established yet. An algorithm on how to treat SLAP lesions according to their type and data on the factors that influence the surgical outcome is essential for the everyday clinical practice. Method: In this article, a retrospective evaluation of patients with SLAP lesion, treated surgically in our orthopaedic clinic was conducted. Results: According to the clinical outcome and our experience with the surgical therapy of SLAP lesions we demonstrate an algorithm on the proper therapeutic approach. Conclusion: SLAP I lesions are treated with debridement. Most controversies concern patients with SLAP II lesions, whose therapy is either fixation of the superior labrum or tenotomy/tenodesis of the long head of the biceps tendon. For patients with SLAP III or IV lesions the most commonly accepted approach is tenotomy or tenodesis of the long head of biceps tendon.

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Distal Pullout Strengths of the Biceps Long Head Tendon for Different Adjacent Tissue and Tendon Pathologies during Rotator Cuff Repair

BioMed Research International ◽

10.1155/2018/4267163 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7

Author(s):

Young Jun Kim ◽

Ohhyo Kwon ◽

Hwa-Ryeong Lee ◽

Sae Hoon Kim

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Biceps Tendon ◽

Type Ii ◽

Pullout Strength ◽

Pulley Lesion ◽

Distal Migration ◽

Pathologic Findings ◽

Long Head ◽

Cuff Repair

Purpose.Pathologies of the long head of the biceps tendon (LHBT) are frequently recognized in cases of rotator cuff tear. Recommendations for managing such pathologies remain debatable, and distal migration of tenotomized biceps is always a concern when only tenotomy is performed.Methods.Seventy patients of mean age 60.4 ± 6.9 years (range: 44 to 82 years) were included in this retrospective study. During subpectoral tenodesis in rotator cuff repair, pullout tensions were measured using a digital tensiometer. Measured tensions obtained were analyzed with respect to sex, tear involvement of the subscapularis, and the presence of a partial tear of LHBT, type II SLAP lesion, subluxation/dislocation of the biceps, or a pulley lesion.Results. Mean LHBT pullout tension for the 70 study subjects was 86.5 ± 42.1 N (26.7-240.5 N). Distal LHBT pullout tension was significantly greater for men than women (93.2 ± 42.7 N versus 73.7 ± 38.7 N, P = 0.041). However, LHBT pullout tensions were not significantly associated with different pathologies of surrounding tissues or of LHBTs (all Ps > 0.05).Conclusion.The study failed to show pullout tension differences associated with pathologies affect distal migration of a tenotomized LHBT. Gender was the only factor found to affect LHBT pullout strength. Risk of distal migration of tenotomized LHBT could not be predicted with intraoperative arthroscopic pathologic findings.

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Symptomatic Superior Labral Anterior Posterior Lesion With Absence of the Long Head of the Biceps Tendon: A Case Report

Yearbook of Sports Medicine ◽

10.1016/s0162-0908(08)70296-4 ◽

2006 ◽

Vol 2006 ◽

pp. 60-61

Author(s):

D.E. Feldman

Keyword(s):

Case Report ◽

Biceps Tendon ◽

Posterior Lesion ◽

Long Head ◽

Anterior Posterior

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Measurements of Tendon Movement Within the Bicipital Groove After Suprapectoral Intra-articular Biceps Tenodesis in a Cadaveric Model

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120977538 ◽

2021 ◽

Vol 9 (1) ◽

pp. 232596712097753

Author(s):

Brian J. Kelly ◽

Alan W. Reynolds ◽

Patrick J. Schimoler ◽

Alexander Kharlamov ◽

Mark Carl Miller ◽

...

Keyword(s):

Biceps Tendon ◽

Full Range ◽

Elbow Flexion ◽

Biceps Tenodesis ◽

Bicipital Groove ◽

Biceps Tenotomy ◽

Flexion Extension ◽

Before And After ◽

Long Head ◽

Scapular Motion

Background: Lesions of the long head of the biceps can be successfully treated with biceps tenotomy or tenodesis when surgical management is elected. The advantage of a tenodesis is that it prevents the potential development of a cosmetic deformity or cramping muscle pain. Proponents of a subpectoral tenodesis believe that “groove pain” may remain a problem after suprapectoral tenodesis as a result of persistent motion of the tendon within the bicipital groove. Purpose/Hypothesis: To evaluate the motion of the biceps tendon within the bicipital groove before and after a suprapectoral intra-articular tenodesis. The hypothesis was that there would be minimal to no motion of the biceps tendon within the bicipital groove after tenodesis. Study Design: Controlled laboratory study. Methods: Six fresh-frozen cadaveric arms were dissected to expose the long head of the biceps tendon as well as the bicipital groove. Inclinometers and fiducials (optical markers) were used to measure the motions of the scapula, forearm, and biceps tendon through a full range of shoulder and elbow motions. A suprapectoral biceps tenodesis was then performed, and the motions were repeated. The motion of the biceps tendon was quantified as a function of scapular or forearm motion in each plane, both before and after the tenodesis. Results: There was minimal motion of the native biceps tendon during elbow flexion and extension but significant motion during all planes of scapular motion before tenodesis, with the most motion occurring during shoulder flexion-extension (20.73 ± 8.21 mm). The motion of the biceps tendon after tenodesis was significantly reduced during every plane of scapular motion compared with the native state ( P < .01 in all planes of motion), with a maximum motion of only 1.57 mm. Conclusion: There was a statistically significant reduction in motion of the biceps tendon in all planes of scapular motion after the intra-articular biceps tenodesis. The motion of the biceps tendon within the bicipital groove was essentially eliminated after the suprapectoral biceps tenodesis. Clinical Relevance: This arthroscopic suprapectoral tenodesis technique can significantly reduce motion of the biceps tendon within the groove in this cadaveric study, possibly reducing the likelihood of groove pain in the clinical setting.

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