title: Relationship between subscapularis tears and injuries to the biceps pulley.
abstract: OBJECTIVE
  The purpose of this study was to analyse the relationship between long head of the biceps brachii (LHBT) lesions and subscapularis tears. The hypothesis was that a bicipital pulley might remain intact, even in the case of a subscapularis tear.
  
  
  METHODS
  Between 2010 and 2011, all patients who had a primary arthroscopic repair of a subscapularis tear were potentially included in this prospective study. The outcome of interest was the prevalence and type of arthroscopic lesions of the LHBT and bicipital pulley. Furthermore, the supposed pathomechanics of injury and the treatment proposed (conservative, pulley repair, tenodesis, tenotomy, etc.) was recorded. The following baseline characteristics were assessed: age, sex, shoulder side, and limb dominance.
  
  
  RESULTS
  Of the 218 patients, the superior glenohumeral ligament/coracohumeral ligament (SGHL/CHL) complex was normal in 54 patients (25%), stretched in 84 patients (39%), and absent in 77 patients (35%). Below the SGHL/CHL complex in the bicipital groove, the medial wall of the LHBT sheath was normal in 25%, partially torn in 39%, and completely torn in 35%. In 25 of the 218 patients (11%), a pathologic LHBT with an intact SGHL/CHL complex was observed. In these cases, the medial wall of the bicipital sheath was torn in 92%.
  
  
  CONCLUSIONS
  The biceps pulley system, including the SGHL/CHL complex and subscapularis tendon, merits recognition as an important anatomical structure, and its lesions contribute to shoulder pathology. The subscapularis tendon is very important for the stability of the LHBT and should be included in the pulley system. In cases of a tear associated with a lesion of the SGHL/CHL complex, the LHBT is nearly always unstable and pathologic.
  
  
  METHODS
  II.
authors.affiliation: Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Ramsay Générale de Santé, 24 Avenue Paul Santy, 69008, Lyon, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Godenèche
authors.affiliation: Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Ramsay Générale de Santé, 24 Avenue Paul Santy, 69008, Lyon, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Nové-Josserand
authors.affiliation: Clinique du Cambresis, Cambrai, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Audebert
authors.affiliation: Clinique Générale, Annecy, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Toussaint
authors.affiliation: Southern Oregon Orthopedics, Medford, OR, USA.|Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Denard
authors.affiliation: Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Rue J.-D. Maillard 3, 1217, Meyrin, Switzerland. Alexandre.laedermann@gmail.com.|Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1211, Geneva 4, Switzerland. Alexandre.laedermann@gmail.com.|Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland. Alexandre.laedermann@gmail.com.
authors.forename: Alexandre
authors.identifier: http://orcid.org/0000-0002-2797-8936
authors.initials: A
authors.lastname: Lädermann
mesh_terms: D000328:Adult; D000368:Aged; D001134:Arm Injuries / Q000150:complications / Q000473:pathology* / Q000601:surgery; D001182:Arthroscopy; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D000070636:Rotator Cuff Injuries / Q000150:complications / Q000473:pathology* / Q000601:surgery; D052256:Tendinopathy / Q000150:complications / Q000473:pathology* / Q000601:surgery
keywords: Arthroscopy; Diagnosis; Long-head biceps dislocation; Pulley; Rotator cuff lesion; Shoulder surgery; Subscapularis tear