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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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Histopathology of long head of biceps tendon removed during tenodesis demonstrates degenerative histopathology and not inflammatory changes. BMC Musculoskelet Disord 2022; 23:185. [PMID: 35219297 PMCID: PMC8882305 DOI: 10.1186/s12891-022-05124-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 02/14/2022] [Indexed: 11/17/2022] Open
Abstract
Background The aim of this study is to describe and quantitatively analyze the histopathology of proximal long head biceps (LHB) tendinopathy in patients who have undergone LHB tenodesis. The hypothesis is that severe histopathologic changes of the LHB tendon (LHBT) will most likely be reflected with improved postoperative clinical outcomes. Methods The study included patients with isolated LHB tendinopathy or LHB tendinopathy associated with concomitant shoulder pathologies. All had failed conservative treatment (12 months) and had a positive pain response (> 50% reduction) pre-operatively after LHB tendon injection with local anesthetic. All underwent biceps tenodesis procedure between 2008 and 2014. Tendon specimens were collected and histologically analyzed with the semi-quantitative Bonar scoring system. Minimum follow-up time was 1 year. A subset of patients was retrospectively reviewed postoperatively and evaluated employing visual analogue score (VAS), short form survey (SF-12), American Shoulder and Elbow Surgeon (ASES) score, Disability of Arm, Shoulder and Hand (DASH) score, and Oxford Shoulder Score (OSS) and postoperative return to work status. Results Forty-five biceps tendon specimens were obtained from 44 patients (mean age 50 ± 9.6 years). Histopathological analyses demonstrated advanced degenerative changes with myxoid degeneration and marked collagen disorganization. Minimal inflammation was identified. There were no regional differences in histopathological changes. Clinical outcomes did not correlate significantly with severity of histopathologic changes. Conclusions This study confirms that LHBT specimens in patients undergoing tenodesis demonstrate with the use of the Bonar score histopathologic changes of chronic degeneration and not inflammation. The correct histopathologic terminology for this process is LHB tendinosis. The histopathological changes appear uniform throughout the entire length of the LHBT which may inform the nature of the procedure performed.
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Izumi M, Harada Y, Kajita Y, Muramatsu Y, Morimoto T, Morisawa Y, Iwahori Y, Ikeuchi M. Expression of Substance P and Nerve Growth Factor in Degenerative Long Head of Biceps Tendon in Patients with Painful Rotator Cuff Tear. J Pain Res 2021; 14:2481-2490. [PMID: 34429647 PMCID: PMC8379684 DOI: 10.2147/jpr.s320811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/27/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Degenerative long head of biceps tendon (LHBT) has been recognized as a notable pain source in patients with rotator cuff tear (RCT). Tenotomy or tenodesis of LHBT is frequently indicated together with arthroscopic rotator cuff repair (ARCR) aiming for complete pain relief; however, it has not been fully investigated whether resected LHBT is really a source of pain. The purpose of this study was to investigate expression levels of pain-associated mediators in LHBT and its association with preoperative pain profiles. Methods Twenty-seven RCT patients who underwent ARCR with LHBT resection were included. Each LHBT was resected due to its abnormal arthroscopic findings including tenosynovitis, hypertrophy, and partial tear. Worst macroscopic lesion of the LHBT was obtained, and expression levels of substance P (SP) and nerve growth factor (NGF) were evaluated using enzyme-linked immunosorbent assay (ELISA). Ten healthy knee flexor tendons were analyzed as non-degenerative samples. Preoperatively, subjective shoulder pain VAS and pain duration were investigated. Conventional LHBT pain provocation tests (Speed, Yergason, O’Brien) were performed. Pressure pain threshold (PPT) of bilateral LHBT on the groove was recorded. Results Levels of SP and NGF expression were significantly higher compared with non-degenerative tendons (P<0.01). Shoulder pain VAS and pain duration were not directly associated with SP and NGF expression level. Patients with positive O’Brien test expressed greater SP than negative patients (P=0.001). Significant negative correlation between the PPT ratio (ipsilateral/contralateral) and SP expression level was observed (r=−0.453, P=0.034). Conclusion Greater expression of SP and NGF in degenerative LHBT supported our hypothesis that it would be a pain source in RCT patients. SP was likely to be expressed highly in patients with localized pressure pain hypersensitivity and positive O’Brien test (ie, altered mechanistic pain profile of LHBT), which may help when considering simultaneous LHBT resection during ARCR. Clinical Registration UMIN000023943.
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Affiliation(s)
- Masashi Izumi
- Department of Orthopaedic Surgery, Kochi Medical School, Kochi University, Nankoku-City, Japan
| | - Yohei Harada
- Department of Orthopaedic Surgery, Aichi Medical University, Nagakute, Japan.,Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yukihiro Kajita
- Department of Orthopaedic Surgery, Aichi Medical University, Nagakute, Japan
| | - Yoshitaka Muramatsu
- Department of Orthopaedic Surgery, Aichi Medical University, Nagakute, Japan.,Department of Orthopaedic Surgery, Saiseikai Futsukaichi Hospital, Futsukaichi, Japan
| | - Toru Morimoto
- Department of Orthopaedic Surgery, Kochi Medical School, Kochi University, Nankoku-City, Japan
| | - Yutaka Morisawa
- Department of Orthopaedic Surgery, Aki General Hospital, Aki, Japan
| | - Yusuke Iwahori
- Department of Orthopaedic Surgery, Aichi Medical University, Nagakute, Japan.,Department of Orthopaedic Surgery, Sports Medicine and Joint Center, Asahi Hospital, Kasugai, Japan
| | - Masahiko Ikeuchi
- Department of Orthopaedic Surgery, Kochi Medical School, Kochi University, Nankoku-City, Japan
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Li R, Jiang Y, Hu R, He X, Fang J. Effectiveness and safety of tenosynovitis of the long head of the biceps brachii with acupuncture: a protocol for a systematic review and meta-analysis. Trials 2020; 21:869. [PMID: 33081823 PMCID: PMC7576742 DOI: 10.1186/s13063-020-04800-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 10/10/2020] [Indexed: 11/17/2022] Open
Abstract
Background Tenosynovitis of the long head of the biceps (LHB) brachii is a common disease in patients over 40 years old. It can always result in chronic anterior shoulder pain and limited function. Acupuncture is one of most popular conservative treatment methods, and increasing studies indicate that it has remarkable therapeutic effects on the tenosynovitis of LHB brachii. However, the effectiveness and safety of acupuncture for treating tenosynovitis of LHB brachii remain largely uncertain. In our study, we will perform the first systematic review and meta-analysis to explore the effectiveness and safety of acupuncture on the tenosynovitis of LHB brachii. Methods We will search the randomized controlled trial (RCT) literatures involving acupuncture for treating tenosynovitis of LHB brachii in eight electric databases, including PubMed, Web of Science, EMBASE, the Cochrane Library, Chinese National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Wanfang Database, and Technology Periodical Database (VIP). We will define the visual analog scale (VAS), the Melle score of shoulder joint functional activity, and the ability assessment of daily living activities (ADL) as the primary outcomes. Besides quality of life, adverse events caused by acupuncture will be regarded as the secondary outcomes. Quality assessment of the included studies will be independently performed according to the Cochrane Risk of Bias tool. Meanwhile, the level of evidence for results will be assessed by using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. All analyses will be conducted by using the RevMan software V5.3. Results From the study, we will ascertain the effectiveness and safety of acupuncture treatment on tenosynovitis of LHB brachii. Conclusion The conclusion of this study will confirm the effectiveness and safety of acupuncture in the treatment of tenosynovitis of LHB brachii, which can provide new evidence to guide appropriate interventions on tenosynovitis of LHB brachii with acupuncture in the future. Ethics and dissemination Ethical approval is not required because no individual patient data are collected. This review will be published in a peer-reviewed journal and presented at an international academic conference for dissemination. Trial registration PROSPERO registration number CRD42020167434. Registered on April 28, 2020.
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Affiliation(s)
- Rongrong Li
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou City, 310053, Zhejiang Province, China
| | - Yongliang Jiang
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou City, 310053, Zhejiang Province, China
| | - Renjie Hu
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou City, 310053, Zhejiang Province, China
| | - Xiaofen He
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou City, 310053, Zhejiang Province, China
| | - Jianqiao Fang
- Key Laboratory of Acupuncture and Neurology of Zhejiang Province, The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou City, 310053, Zhejiang Province, China.
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Rogier C, van der Ven M, van der Helm-van Mil AHM, de Jong PHP. Is shoulder involvement in clinically suspect arthralgia an early feature of rheumatoid arthritis? A longitudinal ultrasound study. Rheumatology (Oxford) 2020; 59:2640-2642. [PMID: 32118273 PMCID: PMC7571510 DOI: 10.1093/rheumatology/keaa052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 01/20/2020] [Accepted: 01/21/2020] [Indexed: 12/03/2022] Open
Affiliation(s)
- Cleo Rogier
- Department of Rheumatology, Erasmus University Medical Center (Erasmus MC), Rotterdam
| | - Myrthe van der Ven
- Department of Rheumatology, Erasmus University Medical Center (Erasmus MC), Rotterdam
| | - Annette H M van der Helm-van Mil
- Department of Rheumatology, Erasmus University Medical Center (Erasmus MC), Rotterdam.,Department of Rheumatology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Pascal H P de Jong
- Department of Rheumatology, Erasmus University Medical Center (Erasmus MC), Rotterdam
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Carvalho CD, Cohen C, Belangero PS, Pochini ADC, Andreoli CV, Ejnisman B. Supraspinatus Muscle Tendon Lesion and Its Relationship with Long Head of the Biceps Lesion. Rev Bras Ortop 2020; 55:329-338. [PMID: 32616979 PMCID: PMC7316548 DOI: 10.1055/s-0039-3402472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 02/05/2019] [Indexed: 10/27/2022] Open
Abstract
Objective To identify the clinical, radiological, and arthroscopic correlation of long head of the biceps tendon injuries and their influence on pain when associated with rotator cuff injuries. Methods Between April and December 2013, 50 patients were evaluated, including 38 (76%) women and 12 (24%) men, with a mean age of 65.1 years old. The patients were operated by the Shoulder and Elbow Group, Discipline of Sports Medicine, Orthopedics and Traumatology Department, Universidade Federal de São Paulo. The subjects underwent repair of the rotator cuff lesion with clinical, radiological and/or arthroscopic evidence of involvement of the long head of the biceps tendon. Results An association between pain at palpation of the intertubercular groove of the humerus and high-grade partial lesions (partial rupture of the tendon affecting more than 50% of its structure) was observed at the arthroscopy ( p = 0.003). There was also an association between the high-grade lesion of the long head of the biceps and injury to the supraspinatus muscle tendon ( p < 0.05). For each centimeter of the supraspinatus muscle tendon injury, the patient presented a 1.7 higher probability of having a high-grade lesion at the long head of the biceps. Conclusion Pain at the anterior shoulder region during palpation of the intertubercular groove of the humerus may be related to high-grade lesions to the long head of the biceps. Rotator cuff injury and its size are risk factors for high-grade injuries to the long head of the biceps tendon.
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Affiliation(s)
- Cassiano Diniz Carvalho
- Departamento de Ortopedia e Traumatologia, Centro de Traumatologia do Esporte (CETE), Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | - Carina Cohen
- Departamento de Ortopedia e Traumatologia, Centro de Traumatologia do Esporte (CETE), Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | - Paulo Santoro Belangero
- Departamento de Ortopedia e Traumatologia, Centro de Traumatologia do Esporte (CETE), Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | - Alberto de Castro Pochini
- Departamento de Ortopedia e Traumatologia, Centro de Traumatologia do Esporte (CETE), Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | - Carlos Vicente Andreoli
- Departamento de Ortopedia e Traumatologia, Centro de Traumatologia do Esporte (CETE), Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | - Benno Ejnisman
- Departamento de Ortopedia e Traumatologia, Centro de Traumatologia do Esporte (CETE), Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
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Mardani-Kivi M, Keyhani S, Ebrahim-Zadeh MH, Hashemi-Motlagh K, Saheb-Ekhtiari K. Rotator cuff tear with concomitant long head of biceps tendon (LHBT) degeneration: what is the preferred choice? Open subpectoral versus arthroscopic intraarticular tenodesis. J Orthop Traumatol 2019; 20:26. [PMID: 31278446 PMCID: PMC6611854 DOI: 10.1186/s10195-019-0531-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 08/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lesions associated with the biceps tendon are commonly detected during arthroscopic repair of rotator cuff tears. Acquiring a preferable technique to repair both cuff and long head of biceps tendon (LHBT) lesions was the aim of several recent studies. This study aimed to compare clinical and functional outcomes of open subpectoral versus arthroscopic intraarticular tenodesis in patients with repairable rotator cuff tear associated with LHBT degeneration. PATIENTS AND METHODS In this randomized clinical trial, 60 eligible candidates for arthroscopic rotator cuff repair (mean age 55.7 ± 6.9 years) were allocated to a control group (open subpectoral, SP) or intervention group (intraarticular, IA). In the IA group, an anchor suture was used for both rotator cuff repair and LHBT tenodesis. In the SP group, after arthroscopic repair of the rotator cuff, subpectoral tenodesis of LHBT was performed using an interference screw. Patients were evaluated for 2 years follow-up regarding pain intensity using the visual analogue scale (VAS) and shoulder function using the Constant Score and Simple Shoulder Test. RESULTS The two groups were similar with regard to demographic characteristics and preoperative evaluations (all P > 0.05). The functional status of both groups was improved, but not significantly differently so between the two groups (P = 0.1 and P = 0.4, respectively). Pain intensity decreased during the 2-year follow-up period, similarly so in the two groups. Patient satisfaction was also similar in the two groups. CONCLUSION Large and massive rotator cuff tears (tears > 3 cm) associated with LHBT pathologies benefited from intraarticular or subpectoral tenodesis similarly, with no differences in short- or mid-term results between these two techniques. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Mohsen Mardani-Kivi
- Orthopedic Department, Guilan University of Medical Sciences, Parastar Ave, Poursina Hospital, P.O. Box: 4193713191, Rasht, Iran
| | - Sohrab Keyhani
- Orthopedic Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Keyvan Hashemi-Motlagh
- Orthopedic Department, Guilan University of Medical Sciences, Parastar Ave, Poursina Hospital, P.O. Box: 4193713191, Rasht, Iran.
| | - Khashayar Saheb-Ekhtiari
- Orthopedic Department, Guilan University of Medical Sciences, Parastar Ave, Poursina Hospital, P.O. Box: 4193713191, Rasht, Iran
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Hassan S, Patel V. Biceps tenodesis versus biceps tenotomy for biceps tendinitis without rotator cuff tears. J Clin Orthop Trauma 2019; 10:248-256. [PMID: 30828187 PMCID: PMC6383069 DOI: 10.1016/j.jcot.2018.12.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 12/18/2018] [Accepted: 12/30/2018] [Indexed: 01/25/2023] Open
Abstract
Disorders of the long head of the biceps tendon (LHB) are a well-recognised cause of shoulder pain despite the function of the long head of the biceps remaining poorly understood. There has been a dramatic rise in the number of biceps tenodesis procedures being performed in the last decade. This may partly be attributed to concerns regarding residual cosmetic deformity and pain after biceps tenotomy though there is little evidence to suggest that functional outcomes of tenodesis are superior to biceps tenotomy. Current literature focuses on LHB disorders with concomitant rotator cuff tears. The aim of this review is to discuss the anatomy of the LHB, the pathogenesis of tendinopathy of the LHB, indications of biceps tenodesis and tenotomy and compare the current literature on the functional outcomes of these procedures for LHB disorders in the absence of rotator cuff tears.
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Affiliation(s)
| | - Vipul Patel
- Corresponding author. Department of Trauma and Orthopaedic Surgery, South West London Elective Orthopaedic Centre, Dorking Road, Epsom, KT18 7EG, United Kingdom
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Thankam FG, Evan DK, Agrawal DK, Dilisio MF. Collagen type III content of the long head of the biceps tendon as an indicator of glenohumeral arthritis. Mol Cell Biochem 2018; 454:25-31. [DOI: 10.1007/s11010-018-3449-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 09/19/2018] [Indexed: 11/28/2022]
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Effect of patient age on accuracy of primary MRI signs of long head of biceps tearing and instability in the shoulder: an MRI-arthroscopy correlation study. Skeletal Radiol 2018; 47:203-214. [PMID: 28983764 DOI: 10.1007/s00256-017-2783-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 09/15/2017] [Accepted: 09/24/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the effect of patient age on the accuracy of primary MRI signs of long head of biceps (LHB) tendon tearing and instability in the shoulder using arthroscopy as a reference standard. MATERIALS AND METHODS Subjects with MRI studies and subsequent arthroscopy documenting LHB tendon pathology were identified and organized into three age groups (18-40, 41-60, 61-87). Normal and tendinopathic tendons were labeled grade 0, partial tears grade 1 and full tears grade 2. Two radiologists blinded to arthroscopic data graded MRI studies independently. Prevalence of disease, MRI accuracy for outcomes of interest, and inter-reader agreement were calculated. RESULTS Eighty-nine subjects fulfilled inclusion criteria with 36 grade 0, 36 grade 1 and 17 grade 2 tendons found at arthroscopy. MRI sensitivity, regardless of age, ranged between 67-86% for grade 0, 72-94% for grade 1 and 82-94% for grade 2 tendons. Specificity ranged between 83-96% for grade 0, 75-85% for grade 1 and 99-100% for grade 2 tendons. MRI accuracy for detection of each LHB category was calculated for each age group. MRI was found to be least sensitive for grade 0 and 1 LHB tendons in the middle-aged group with sensitivity between 55-85% for grade 0 and 53-88% for grade 1 tendons. Agreement between MRI readers was moderate with an unweighted kappa statistic of 62%. CONCLUSION MRI accuracy was moderate to excellent and agreement between MRI readers was moderate. MRI appears to be less accurate in characterizing lower grades of LHB tendon disease in middle-aged subjects.
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