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Kajiwara D, Ochiai N, Hashimoto E, Hirosawa N, Akimoto K, Nojima D, Shimada Y, Ise S, Ohtori S. Imaging and histological evaluation of the long head of the biceps tendon in the presence of different types of rotator cuff tears. BMC Musculoskelet Disord 2023; 24:230. [PMID: 36973696 PMCID: PMC10045614 DOI: 10.1186/s12891-023-06338-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/20/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND A comparison of changes in the long head of the biceps tendon for different types of rotator cuff tears has not been previously performed. Furthermore, the correlation between the thickening and degeneration of the long head of the biceps tendon and the cause of these changes have not been fully clarified. We evaluated the relationship between degenerative changes in the long head of the biceps tendon and rotator cuff tears in a rat model using imaging and histology. METHODS Ninety-six 12-week-old Sprague-Dawley rats were divided into anterior (subscapularis tear), anterosuperior (subscapularis, supraspinatus, and infraspinatus tears), superior (supraspinatus and infraspinatus tears), and control groups. The long head of the biceps tendon was harvested at 4 or 12 weeks postoperatively. The cross-sectional areas of the intra- and extra-capsular components of the tendon were measured using micro-computed tomography, and the affected/normal ratio of the cross-sectional area was calculated. Masson's trichrome staining and Alcian blue staining were performed for histologic analysis, with degenerative changes described using the modified Bonar scale. The correlation between the affected/normal ratio and Bonar scores was evaluated. RESULTS The affected/normal ratio was higher for the anterior and anterosuperior groups than for the control group at 4 and 12 weeks. The ratio increased for the intra-articular portion in the superior group and for both the intra- and extra-articular portions in the anterior and anterosuperior groups. Degeneration considerably progressed in the anterior and anterosuperior groups compared with the control group from weeks 4 to 12 and was greater in the intra- than in the extra-articular portion. The ratio correlated with extracellular matrix score. CONCLUSIONS Subscapularis tears were associated with progressive thickening and degeneration of the long head of the biceps tendon at 4 and 12 weeks postoperatively, which was more significant in the intra- than in the extra-articular portion. Histologic evaluation indicated that the extracellular matrix likely caused these degenerative changes.
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Affiliation(s)
- Daisuke Kajiwara
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-Ku, Chiba, 260-0856, Japan.
| | - Nobuyasu Ochiai
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-Ku, Chiba, 260-0856, Japan
| | - Eiko Hashimoto
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-Ku, Chiba, 260-0856, Japan
| | - Naoya Hirosawa
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-Ku, Chiba, 260-0856, Japan
| | - Koji Akimoto
- Department of Orthopedic Surgery, Chiba Rosai Hospital, Chiba, Japan
| | - Daisuke Nojima
- Nojima Orthopedics and Internal Medicine Clinic, Tokyo, Japan
| | - Yohei Shimada
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-Ku, Chiba, 260-0856, Japan
| | - Shohei Ise
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-Ku, Chiba, 260-0856, Japan
| | - Seiji Ohtori
- Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-Ku, Chiba, 260-0856, Japan
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Posterior subacromial injections are superior in differentiating a rotator cuff from a biceps pathology: A cadaveric study. J Orthop 2019; 19:89-92. [PMID: 32021043 DOI: 10.1016/j.jor.2019.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 11/03/2019] [Indexed: 11/20/2022] Open
Abstract
Backgroud the ideal route and accuracy of subacromial injections in shoulder pathologies are often questioned. This study aimed at comparing anterior and posterior injections in terms of subacromial space dye localization and diagnostic accuracy. We hypothesized that posterior injections would prove more accurate. Methods lidocaine-dye mix was injected posteriorly and anteriorly in five cadaveric shoulders each. Presence of dye was ascertained at dissection. Results All five posterior injections remained confined to the subacromial space. In all five anteriorly injected shoulders, the dye was seen leaking from the subacromial space into bicipital groove. Conclusions Varying accuracies of anterior [69-90%] and posterior [56-80%] subacromial injections have been reported. We observed both routes to be equally accurate [100%]. The dye exclusively remained within the subacromial space with posterior injections. This has higher diagnostic value in differentiating subacromial and long head of biceps pathologies. The anterior approach may have a better therapeutic role in combined subacromial and biceps pathologies.
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Kurdziel MD, Moravek JE, Wiater BP, Davidson A, Seta J, Maerz T, Baker KC, Wiater JM. The impact of rotator cuff deficiency on structure, mechanical properties, and gene expression profiles of the long head of the biceps tendon (LHBT): Implications for management of the LHBT during primary shoulder arthroplasty. J Orthop Res 2015; 33:1158-64. [PMID: 25877256 DOI: 10.1002/jor.22895] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 03/02/2015] [Indexed: 02/04/2023]
Abstract
The long head of the biceps tendon (LHBT) occupies a unique proximal intra-articular and distal extra-articular position within the human shoulder. In the presence of a rotator cuff (RC) tear, the LHBT is recruited into an accelerated role undergoing potential mechanical and biochemical degeneration. Intra-articular sections of the LHBT were harvested during primary shoulder arthroplasty from patients with an intact or deficient RC. LHBTs were stained (H&E, Alcian Blue) and subjected to histologic analysis using the semiquantitative Bonar scale and measurement of collagen orientation. LHBTs (n = 12 per group) were also subjected to gene-expression analyses via an RT(2) -PCR Profiler Array quantifying 84 genes associated with cell-cell and cell-matrix interactions. LHBTs (n = 18 per group) were biomechanically tested with both stress-relaxation and load-to-failure protocols and subsequently modeled with the Quasilinear Viscoelastic (QLV) and Structural-Based Elastic (SBE) models. While no histologic differences were observed, significant differences in mechanical testing, and viscoelastic modeling parameters were found. PCR arrays identified five genes that were differentially expressed between RC-intact and RC-deficient LHBT groups. LHBTs display signs of pathology regardless of RC status in the arthroplasty population, which may be secondary to both glenohumeral joint arthritis and the additional mechanical role of the LHBT in this population.
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Affiliation(s)
- Michael D Kurdziel
- Beaumont Health System, Department of Orthopaedic Research, 3811 W. 13 Mile Rd., Suite 404, Royal Oak, Michigan, 48073-9952.,Oakland University-William Beaumont School of Medicine, Department of Orthopaedic Surgery, Rochester, Michigan, 48309-4401
| | - James E Moravek
- Beaumont Health System, Department of Orthopaedic Surgery, 3535 W. 13 Mile Rd., Suite 744, Royal Oak, Michigan, 48073-9952
| | - Brett P Wiater
- Beaumont Health System, Department of Orthopaedic Surgery, 3535 W. 13 Mile Rd., Suite 744, Royal Oak, Michigan, 48073-9952
| | - Abigail Davidson
- Beaumont Health System, Department of Orthopaedic Research, 3811 W. 13 Mile Rd., Suite 404, Royal Oak, Michigan, 48073-9952
| | - Joseph Seta
- Beaumont Health System, Department of Orthopaedic Research, 3811 W. 13 Mile Rd., Suite 404, Royal Oak, Michigan, 48073-9952
| | - Tristan Maerz
- Beaumont Health System, Department of Orthopaedic Research, 3811 W. 13 Mile Rd., Suite 404, Royal Oak, Michigan, 48073-9952.,Oakland University-William Beaumont School of Medicine, Department of Orthopaedic Surgery, Rochester, Michigan, 48309-4401
| | - Kevin C Baker
- Beaumont Health System, Department of Orthopaedic Research, 3811 W. 13 Mile Rd., Suite 404, Royal Oak, Michigan, 48073-9952.,Oakland University-William Beaumont School of Medicine, Department of Orthopaedic Surgery, Rochester, Michigan, 48309-4401
| | - J Michael Wiater
- Oakland University-William Beaumont School of Medicine, Department of Orthopaedic Surgery, Rochester, Michigan, 48309-4401.,Beaumont Health System, Department of Orthopaedic Surgery, 3535 W. 13 Mile Rd., Suite 744, Royal Oak, Michigan, 48073-9952
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Abstract
Tendinopathy is a debilitating musculoskeletal
condition which can cause significant pain and lead to complete rupture
of the tendon, which often requires surgical repair. Due in part
to the large spectrum of tendon pathologies, these disorders continue
to be a clinical challenge. Animal models are often used in this
field of research as they offer an attractive framework to examine
the cascade of processes that occur throughout both tendon pathology and
repair. This review discusses the structural, mechanical, and biological
changes that occur throughout tendon pathology in animal models,
as well as strategies for the improvement of tendon healing. Cite this article: Bone Joint Res 2014;3:193–202.
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Affiliation(s)
- M W Hast
- University of Pennsylvania, McKay Orthopaedic Research Laboratory, 424 Stemmler Hall 36th Street and Hamilton Walk, Philadelphia, 19104-6081, USA
| | - A Zuskov
- University of Pennsylvania, McKay Orthopaedic Research Laboratory, 424 Stemmler Hall 36th Street and Hamilton Walk, Philadelphia, 19104-6081, USA
| | - L J Soslowsky
- University of Pennsylvania, McKay Orthopaedic Research Laboratory, 424 Stemmler Hall 36th Street and Hamilton Walk, Philadelphia, 19104-6081, USA
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