title: Analysis of "hidden lesions" of the extra-articular biceps after subpectoral biceps tenodesis: the subpectoral portion as the optimal tenodesis site.
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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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%).
  
  
  CONCLUSIONS
  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.affiliation: Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea.
authors.forename: Seong Cheol
authors.initials: SC
authors.lastname: Moon
authors.affiliation: Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea.
authors.forename: Nam Su
authors.initials: NS
authors.lastname: Cho
authors.affiliation: Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea shoulderrhee@hanmail.net.
authors.forename: Yong Girl
authors.initials: YG
authors.lastname: Rhee
mesh_terms: D000328:Adult; D000368:Aged; D001132:Arm; D005260:Female; D006801:Humans; D006811:Humerus / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012785:Shoulder Joint / Q000000981:diagnostic imaging / Q000601:surgery; D020069:Shoulder Pain / Q000209:etiology; D013708:Tendon Injuries / Q000473:pathology / Q000601:surgery*; D013710:Tendons / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D053656:Tenodesis / Q000379:methods*; D013717:Tenosynovitis / Q000473:pathology
keywords: biceps tendon; biceps tenodesis; hidden lesion; optimal site; shoulder; subpectoral; tear