Classification Of Types Of Long Head Of Biceps Tendon Sheath Injury And Efficacy Of Shoulder Arthroscopic Surgery

Objective: Classification of long head of the biceps(LHB) tendon pulley lesions is imperfect. The purpose of this study was to better complement the types of LHB tendon by arthroscopy and evaluate the role of arthroscopy surgery on the pulley lesions.Methods: We analyzed 126 shoulder arthroscopies that were diagnosed with biceps pulley lesions in our hospital from January 1,2014 to August 31,2015. All the injury and the stability of the long head of biceps tendon under arthroscopy were documented. We selected debridement, tenotomy or tenodesis for the patients according to the damage. We researched the types of pulley lesions based on intra-operative findings and evaluate the role of arthroscopy surgery on the pulley lesions.Results: On the basis of the classification of pulley lesions according to Habermeyer et al., the LHB pulley lesions included typeⅠ(isolated lesion of the medial sheath of the LHB pulley), typeⅡ(combined lesions of the medial and lateral sheaths of the LHB pulley), type Ⅲ(tear of the medial sheath and the subscapularis), and type Ⅳ(combined lesions of the medial and lateral sheaths and the subscapularis). In addition, we identified two other types of LHB pulley lesions(types Ⅴ and VI). Type Ⅴ lesions are isolated lesions of the lateral sheath of the LHB pulley. TypeⅥ lesions are characterized by bucket handle tears of the sheath of the LHB pulley. This study included the following distribution of LHB lesions: typeⅠ(15,11.9%),typeⅡ(18,14.3%),typeⅢ(28,22.2%),typeⅣ(33,26.2%),typeⅤ( 26,20.6%) and typeⅥ(6,4.8%).Preoperative and postoperative patients were assessed using the American Shoulder and Elbow Surgery score(ASES)、the California University of Shoulder score(UCLA) and the VAS pain score. The scores of the patients after surgery 6 months improved significantly(P?0.05).Conclusion: Types Ⅴ and Ⅵ lesions are two new types of LHB pulley lesions.The new classification system of LHB pulley lesions should include typesⅠ-VI. The pulley lesions of the LHB is one of the symptoms of shoulder arthroscopy,and curative effect,worthy of promotion.And the specific operation method of the various types lesions(debridement、tenotomy or tenodesis) should be according to the stability of the LHB itself and the specific circumstances to determine patients,still needs further research.