repair

Definition

Medial subluxation of long head of biceps tendon out of groove and into rotator interval

Issues

Operative v Nonoperative

Levy et al Arthroscopy 2009

- systematic Review

- improved outcomes with operative management

https://pubmed.ncbi.nlm.nih.gov/19341932/

Vicenti et al. Injury 2019

- systematic review

- two studies compare operative v nonoperative

Epidemiology

Middle age men

Steroids / Growth Hormone

Aetiology

Usually occurs in gym

Bench Press

Clinical

Significant bruising in the acute phase

In chronic setting, ask patient to adduct against hip / resistance

Timing of Surgery

Issue

- reported higher incidence with immediate reconstruction in acute phase

- reduced by settling inflammation / effusion and obtaining FROM

- always best to delay if not professional athlete

- problematic if patient has locked bucket handle mensical tear

Results

Bottoni et al Am J Sports Med 2008

- RCT of early (average 9 days) v late reconstruction (average 85 days)

Advantages

Improved cosmesis

Anatomy

1. Seebacher's 3 layers of the medial knee

Layer 1

- sartorius and sartorius fascia

Layer 2

- superficial MCL

- posterior oblique ligament

- semimembranosus

Layer 3

- deep MCL (meniscofemoral and meniscotibial ligament)

- posteromedial capsule 

2. MCL

Superficial MCL