Biceps pulley lesions associated with subscapularis tears and subacromial impingement: The triad of the rotator interval lesion

AIM: The aim of this study was to describe the association of biceps pulley lesions with subscapularis tendon tears and subacromial impingement, and present the outcome of surgical management  METHODS: Twenty-six consecutive patients with a mean age of 55 years (range 16-77) were included in this study. All of the patients were arthroscopically diagnosed with pulley lesions and associated subscapularis tears. The data was collected prospectively. Subacromial impingement was evident in 22 patients (92%). A final postoperative evaluation was carried out after a mean of 43 months  RESULTS: Ninety-two per cent of patients with pulley lesions and subscapularis tears showed subacromial impingement. Twelve cases (46%) had a selective tenodesis to treat partial tears or subluxations of the long head of the biceps (LHB). Subscapularis tears were repaired in 22 patients (85%) and debrided in four cases (15%). Associated SSP tears were sutured in nine and debrided in four of 13 patients. The Constant score improved from a mean of 64.8 points pre-operatively to 84.7 points post-operatively (P=0.003  CONCLUSION: There is a high association of pulley lesions with subscapularis tears and subacromial impingement. Rotator cuff repair and subacromial decompression led to favourable results in the treatment of these patients. LHB tenodesis is recommended if partial tears or subluxations of the biceps tendon are encountered

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