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Arthroscopic Changes of the Biceps Pulley in Rotator Cuff Tear and Its Clinical Significance in Relation to Treatment.

Choi CH, Kim SS, Kim SJ, Lee JH - Clin Orthop Surg (2015)

Bottom Line: We classified normal stretched biceps pulleys as type I, stretched biceps pulleys with mild changes as type II, those with a partial tear as type III, and torn pulleys as type IV.Type I was seen in 91 cases (15.4%), type II in 216 cases (36.7%), type III in 157 cases (26.7%), and type IV in 101 cases (17.1%); unidentified cases numbered 24 (4.1%).Nearly three-quarters, 73.3%, of the cases (432/589) had associated anterosuperior lesions, and combined treatment for the associated lesions was administered in 29.2% (172/589) of cases.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Daegu Catholic University Medical Center, Daegu, Korea.

ABSTRACT

Background: In the case of rotator cuff tears, the biceps pulley can be stressed by the unstable biceps tendon, and this can subsequently affect the stability of the subscapularis tendon. Therefore, it is important to distinguish between normal variations and lesions of the biceps pulley that affect anterosuperior lesions in cases of rotator cuff tears.

Methods: From January 2002 through November 2010, we observed biceps pulley and associated anterosuperior lesions in 589 of 634 cases (93%) of arthroscopic rotator cuff repair, including 72 cases (12.2%) of small tears, 219 cases (37.2%) of medium tears, 134 cases (22.8%) of large tears, and 164 cases (27.8%) of massive tears. We classified normal stretched biceps pulleys as type I, stretched biceps pulleys with mild changes as type II, those with a partial tear as type III, and torn pulleys as type IV.

Results: We were able to classify 589 cases of biceps pulleys as type I, II, III, or IV associated lesions in rotator cuff tears. Type I was seen in 91 cases (15.4%), type II in 216 cases (36.7%), type III in 157 cases (26.7%), and type IV in 101 cases (17.1%); unidentified cases numbered 24 (4.1%). Nearly three-quarters, 73.3%, of the cases (432/589) had associated anterosuperior lesions, and combined treatment for the associated lesions was administered in 29.2% (172/589) of cases.

Conclusions: Biceps pulley lesions with more than partial tears were identified in 48% of rotator cuff tear cases. The incidence and severity of pulley lesions were related to the rotator cuff tear size, the status of the long head of the biceps tendon and subscapularis tendon lesion, and the treatment methods.

No MeSH data available.


Related in: MedlinePlus

The classification of the long head of the biceps pulley. Type I, II : normal or minor changes which preserve stability of the biceps pulley. Type III, IV : definite pathologic changes which influence stability of the biceps pulley.
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Figure 1: The classification of the long head of the biceps pulley. Type I, II : normal or minor changes which preserve stability of the biceps pulley. Type III, IV : definite pathologic changes which influence stability of the biceps pulley.

Mentions: On arthroscopic examination, the biceps pulley was classified by 4 types according to morphologic differences when it was inserted into the medial attachment site of the bicipital groove. The normal stretch type (type I) was confined as the elastic feature of the pulley with no irritation signs. Minor changes (type II) with basically intact structural integrity were subclassified according to their reactive changes, including fraying (II-a), synovitis (II-b) and hypertrophy (II-c) of the medial pulley. We defined pathologic changes rather than minor changes when the pulley structures were unstable with partial tears (type III). The patterns of partial tears were longitudinal type (III-a), transverse type (III-b), irregular type (III-c) and detached pulley (III-d). This classification was thought to have been developed according to the severity and duration of unstable biceps forces applied to the medial side of the bicipital groove because of the preexisting rotator cuff tear. Type IV was defined as when the whole attachment site of the pulley was disrupted, along with notable subscapularis tendon or biceps tendon lesions (Fig. 1).


Arthroscopic Changes of the Biceps Pulley in Rotator Cuff Tear and Its Clinical Significance in Relation to Treatment.

Choi CH, Kim SS, Kim SJ, Lee JH - Clin Orthop Surg (2015)

The classification of the long head of the biceps pulley. Type I, II : normal or minor changes which preserve stability of the biceps pulley. Type III, IV : definite pathologic changes which influence stability of the biceps pulley.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4553286&req=5

Figure 1: The classification of the long head of the biceps pulley. Type I, II : normal or minor changes which preserve stability of the biceps pulley. Type III, IV : definite pathologic changes which influence stability of the biceps pulley.
Mentions: On arthroscopic examination, the biceps pulley was classified by 4 types according to morphologic differences when it was inserted into the medial attachment site of the bicipital groove. The normal stretch type (type I) was confined as the elastic feature of the pulley with no irritation signs. Minor changes (type II) with basically intact structural integrity were subclassified according to their reactive changes, including fraying (II-a), synovitis (II-b) and hypertrophy (II-c) of the medial pulley. We defined pathologic changes rather than minor changes when the pulley structures were unstable with partial tears (type III). The patterns of partial tears were longitudinal type (III-a), transverse type (III-b), irregular type (III-c) and detached pulley (III-d). This classification was thought to have been developed according to the severity and duration of unstable biceps forces applied to the medial side of the bicipital groove because of the preexisting rotator cuff tear. Type IV was defined as when the whole attachment site of the pulley was disrupted, along with notable subscapularis tendon or biceps tendon lesions (Fig. 1).

Bottom Line: We classified normal stretched biceps pulleys as type I, stretched biceps pulleys with mild changes as type II, those with a partial tear as type III, and torn pulleys as type IV.Type I was seen in 91 cases (15.4%), type II in 216 cases (36.7%), type III in 157 cases (26.7%), and type IV in 101 cases (17.1%); unidentified cases numbered 24 (4.1%).Nearly three-quarters, 73.3%, of the cases (432/589) had associated anterosuperior lesions, and combined treatment for the associated lesions was administered in 29.2% (172/589) of cases.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Daegu Catholic University Medical Center, Daegu, Korea.

ABSTRACT

Background: In the case of rotator cuff tears, the biceps pulley can be stressed by the unstable biceps tendon, and this can subsequently affect the stability of the subscapularis tendon. Therefore, it is important to distinguish between normal variations and lesions of the biceps pulley that affect anterosuperior lesions in cases of rotator cuff tears.

Methods: From January 2002 through November 2010, we observed biceps pulley and associated anterosuperior lesions in 589 of 634 cases (93%) of arthroscopic rotator cuff repair, including 72 cases (12.2%) of small tears, 219 cases (37.2%) of medium tears, 134 cases (22.8%) of large tears, and 164 cases (27.8%) of massive tears. We classified normal stretched biceps pulleys as type I, stretched biceps pulleys with mild changes as type II, those with a partial tear as type III, and torn pulleys as type IV.

Results: We were able to classify 589 cases of biceps pulleys as type I, II, III, or IV associated lesions in rotator cuff tears. Type I was seen in 91 cases (15.4%), type II in 216 cases (36.7%), type III in 157 cases (26.7%), and type IV in 101 cases (17.1%); unidentified cases numbered 24 (4.1%). Nearly three-quarters, 73.3%, of the cases (432/589) had associated anterosuperior lesions, and combined treatment for the associated lesions was administered in 29.2% (172/589) of cases.

Conclusions: Biceps pulley lesions with more than partial tears were identified in 48% of rotator cuff tear cases. The incidence and severity of pulley lesions were related to the rotator cuff tear size, the status of the long head of the biceps tendon and subscapularis tendon lesion, and the treatment methods.

No MeSH data available.


Related in: MedlinePlus