Analysis of "Hidden Lesions" of the Extra-articular Biceps After Subpectoral Biceps Tenodesis The Subpectoral Portion as the Optimal Tenodesis Site

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. Purpose: 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. Study Design: 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%). Conclusion: 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.