A shallow morphology of the intertubercular groove is associated with medial and bilateral but not lateral pulley lesions

Abstract

Purpose To investigate the influence of intertubercular groove (IG) morphology on the development of different types of biceps reflection pulley (BRP) injuries. Methods A consecutive cohort of 221 patients with ventral shoulder pain and a preoperative diagnosis suspecting BRP injury, who underwent arthroscopy, was retrospectively reviewed. The presence or absence as well as type of pulley injury (medial, lateral or bilateral) was confirmed arthroscopically. The intertubercular groove was evaluated on MRIs after triplanar reconstruction of the axial plane. IG depth, width, medial wall angle (MWA), lateral wall angle (LWA) and total opening angle (TOA) were measured. IG depth and width were expressed in relation to the humeral head diameter. Measurements were performed by two clinicians independently and averaged. Results Of 166 included patients 43 had bilateral, 65 medial and 38 lateral BRP lesions. 20 patients had intact BRPs and represented the control group. The intra-class correlation coefficient of measurements was 0.843–0.955. Patients with a medial or bilateral BRP injury had a flatter MWA (38.8° or 40.0° vs. 47.9°, p < 0.001), wider TOA (96.1° or 96.6° vs. 82.6°, p < 0.001), greater width (12.5 or 12.3 vs. 10.8 mm, p = 0.013) and shallower depth (5.5 or 5.4 vs. 6.2 mm, p < 0.001) than the control group. Conversely, the IG morphology of those with lateral BRP injuries did not differ significantly from the control group. The odds ratio for a medial or bilateral BRP injury when the TOA exceeded 95° was 6.8 (95% confidence interval 3.04–15.2). Conclusion A dysplastic type of IG morphology with a wide TOA, flat MWA, decreased depth and increased width is associated with the presence of medial and bilateral BRP injuries. A TOA of > 95° increases the likelihood of a medial or bilateral BRP injury 6.8-fold. Lateral BRP injuries are not associated with dysplastic IG morphology. Concomitant LHBT surgery may, therefore, not always be necessary during isolated supraspinatus tendon repair. Level of evidence Level III.

Is the Tendon-to-Groove Ratio Associated with Elevated Risk for LHB Tendon Disorders?—A New Approach of Preoperative MR-Graphic Analysis for Targeted Diagnosis of Tendinopathy of the Long Head of Biceps

“…More than a decade earlier, Spritzer et al already postulated a strong correlation between ITG morphology and LHB tendon instabilities [27], limited by a small group size and lack of statistical analysis. Taking a closer look at LHB tendon instability and possible subsequent pathologies, Kleim et al analyzed different types of biceps reflection pulley (BRP) lesions on the basis of arthroscopy findings and showed that lateral BRP injuries are not influenced by the ITG morphology, whilst medial and bilateral ones are [28]. They presumed that a shallow BG morphology may lead to a dislocation of the LHBT, which may move out of the BG medially or laterally while external or internal rotation movement of the humerus subsequently damages the medial or lateral BRP [28].…”

“…Taking a closer look at LHB tendon instability and possible subsequent pathologies, Kleim et al analyzed different types of biceps reflection pulley (BRP) lesions on the basis of arthroscopy findings and showed that lateral BRP injuries are not influenced by the ITG morphology, whilst medial and bilateral ones are [28]. They presumed that a shallow BG morphology may lead to a dislocation of the LHBT, which may move out of the BG medially or laterally while external or internal rotation movement of the humerus subsequently damages the medial or lateral BRP [28]. Looking at this "Skipping" of the LHB tendon out of the ITG, while rubbing over its rims from a pathophysiological viewpoint, it seems at least possible that the LHB tendon itself has a high probability of getting altered or inflamed the more often this dislocation occurs.…”