Long Head Of Biceps Tendon Research Articles

Magnetic resonance imaging of the shoulder in symptomatic professional rugby players: a retrospective analysis.

Shoulder injuries in rugby players are common due to frequent high-impact collisions and tackles. This study aimed to describe the spectrum and pattern of shoulder MRI findings in professional rugby players. Single-center retrospective study of shoulder MRI was carried out between 2012 and 2016 in symptomatic professional male rugby league and rugby union players. One hundred ten shoulder MRIs were scored for rotator cuff and long head of biceps tendons, labral, bursal, joint, and osseous abnormalities. MRI features were compared using the chi-square or Fisher's exact tests for categorical variables. There were a total of one hundred ten professional male rugby players (80 rugby league and 30 rugby union), with a mean age of 24.6 (range 17-38) and 23.7 (range 17-33) years old, respectively. Rotator cuff or long head biceps abnormality was found in 36 (33%) players, of which 22 (20%) were either partial or full-thickness tears. Glenoid labral tears were present in 63 (57%) players. There was no significant difference (p > 0.05) in the frequency of tears of the superior (24%), anterior inferior (25%), posterior superior (25%), and posterior inferior (32%) labrum. Forty-seven percent of players presented with two or more abnormalities of the rotator cuff tendons and glenoid labrum. There were significantly more osseous abnormalities in backs compared to forwards (48% vs. 21%; p = 0.01). There is a wide spectrum of shoulder abnormalities on MRI in professional rugby players, and many have two or more abnormalities. In common with other contact sports, posterior labral injury was a common finding and may relate to sub-clinical trauma, without an association with instability.

Long head of biceps tendon autograft is effective in the management of large to massive rotator cuff tear: a systematic review.

The aim of this systematic review is to review the functional, clinical and radiological outcomes of patients undergoing large to massive rotator cuff repair with long head of biceps tendon (LHBT) autograft, as well as compare these to standard arthroscopic cuff repair. A review of the online Medline database was conducted on 20 October 2022 according to PRISMA guidelines and registered prospectively on the PROSPERO database. Clinical studies assessing patients with large to massive rotator cuff tears undergoing LHBT autograft repair were included. All studies reported on functional outcomes, range of movement (ROM) and radiological re-tear rates. The Methodological Index for Non-Randomised Studies (MINORS) tool was used to appraise all studies. The search strategy identified ten studies for inclusion including a total of 594 patients. Five studies were comparable (346 patients), assessing LHBT autograft repair against arthroscopic rotator cuff repair without autograft. A variety of techniques of LHBT autograft were used across all studies, including bridging and augmentation styles. Radiographic comparison showed lower re-tear rates in the LHBT autograft group with two studies demonstrating statistically significant results. Pain scores, functional outcomes and ROM were significantly improved post-operatively in all studies for LHBT autograft patients, with no significant difference when compared to standard arthroscopic repair. LHBT autograft looks to significantly improve functional scoring and range of motion in patients with large to massive rotator cuff tears. When compared to standard arthroscopic cuff repair, LHBT autograft appears to significantly reduce the re-tear rate. Further randomised studies are needed to assess the efficacy of this technique.

Shoulder balloon spacer for massive irreparable rotator cuff tears results in significant improvements.

The aim of the present study was to assess the effectiveness of balloon implantation in patients with irreparable supraspinatus tears alone or in combination withother rotator cuff (RC) tendon tearsand the effect of several covariables, such as age, gender, status of the long head biceps, with or without tendon repair and regardless the number of tendon involved. Patients enrolled from 'San Carlo' Hospital of Potenza (Italy, IT), from January 2012 to September 2014, underwent arthroscopic implantation of shoulder balloon by a single surgeon, and followed for 3 years. The American Shoulder and Elbow Surgeons (ASES) and Constant score (CS) were administered pre-, post-operatively at 12 months, and then annually. Patients were classified on the basis of the number of tendons involved in the tears and treatment performed, considering the reparability of the tendons themselves. Gleno-humeral joint osteoarthrosis (OA) was evaluated through shoulder radiographs and classified according to the Samilson-Prieto classification, at the first examination and at the final follow-up. Statistical improvements were evaluated using a variance model (least-squares means)and a T distribution test for the evaluation between different treatment groups. A total of 61 procedures were performed, and eight patients were lost during follow-up. The mean baseline CS was 30.2 ± 15.4 with statistically significant improvement, respectively, at 1-, 2- and 3-year follow-up to 69.3 ± 4.2, 74.6 ± 3.6 and 69.7 ± 5.1 respectively. ASES score at baseline was 22.5 ± 10.9, with a statistically significant improvement to 69.7 ± 9.2, 68 ± 17.8 and 71.2 ± 16.6 at 1-, 2- and 3-year follow-up, respectively. Tenotomy or absence of long head biceps at presentation did not influence results (n.s.), with no difference according to gender and age. At final follow-up, 24 patients (43.9%) showed progression of glenohumeral OA. One patient required secondary surgery for shoulder replacement after 18 months for persistent pain and one patient required implant removal following post-operative laser treatment. Arthroscopic rotator cuff tears repair with subacromial spacer balloon implantation showed statistically significant clinical and functional improvement at 3-year follow-up. Patients treated with combined partial repair and subacromial spacer balloon implantation experienced good results independent of gender, age, type of tear and long-head biceps tendon status. The risks related to this procedure appear to be minimal. Level IV.

Superior capsular reconstruction using the long head of biceps tendon: a biomechanical assessment of tenodesis location and angle of fixation

BackgroundMassive irreparable rotator cuff tears (MIRCT) treated with superior capsular reconstruction (SCR) using the long head of the biceps tendon have shown satisfactory early results. Different techniques and positions for biceps tenodesis have been described. This study aimed to evaluate the effect of tenodesis location and glenohumeral fixation angle for graft tensioning on the biomechanics of a SCR using a single strand biceps technique. MethodsEight cadaveric shoulders were mounted to a custom biomechanical simulator which employed static tone loads to the deltoid and rotator cuff muscles. All cadavers were first tested in the intact condition, and then in the simulated MIRCT condition by sectioning the tendinous insertions of the supraspinatus and upper border of the infraspinatus. SCR using the long head of the biceps tendon was then evaluated. Three biceps tenodesis locations relative to the greater tuberosity (anterior, middle, and posterior) and two glenohumeral fixation angles (0° and 30°) for graft tensioning were tested. An optical tracking system was used to quantify superior-inferior (SI) and anterior-posterior (AP) humeral head translation relative to the glenoid, while the functional abduction force was quantified using a load sensor. All tests were conducted at 0°, 30° and 60° of glenohumeral abduction in a randomized fashion. ResultsWhen assessing isolated superior humeral head migration, all biceps tenodesis locations were effective at decreasing superior migration, with no tenodesis location significantly better than the other (P=0.213). However, biceps grafts tensioned at 30° of glenohumeral abduction were significantly better at reducing proximal humeral migration as compared to graft tensioning at 0° abduction (P=0.008).Posterior humeral head translation observed in the MIRCT condition was significantly reduced when tensioning the biceps tendon at 30° of glenohumeral abduction compared to 0° for all tenodesis locations (P≤0.043). Tenodesis location also significantly influenced posterior humeral head translation (P=0.001), with middle and posterior positions restoring near normal humeral head position when fixed at 30° glenohumeral abduction. All SCR techniques using the biceps tendon improved the functional abduction force relative to the MIRCT condition, although no statistically significant differences were observed relative to the intact condition (P≥0.448). DiscussionSCR using the long head biceps tendon is biomechanically effective in reducing posterosuperior translation of the humeral head in the setting of a MIRCT. Graft tensioning and fixation at 30° of glenohumeral abduction combined with either a middle or posterior tenodesis location on the greater tuberosity most effectively restores near normal time-zero humeral head kinematics.

Improved restoration of biomechanical factors using a narrow-box shaped reconstruction compared to a wide one in superior capsular reconstruction for irreparable supraspinatus tendon tears: a biomechanical study using a static shoulder simulator

PurposeTo biomechanically compare superior glenohumeral translation, subacromial contact pressures and area in a box-shape reconstruction using the long head of biceps tendon (LHBT) in an irreparable supraspinatus tendon tear model. MethodsSeven cadaveric shoulders (mean age 61 years; range 32-84 years; SD 22.3) were tested with a custom testing rig used to evaluate superior translation, subacromial contact pressures and areas at 0°, 30° and 60° of glenohumeral abduction. Conditions tested included the native state, a complete tear of the supraspinatus tendon, a wide box-shaped, double-bundle LHBT superior capsular reconstruction (wide BS-SCR), and a narrow box-shaped, double-bundle LHBT superior capsular reconstruction (narrow BS-SCR). ResultsCompared to the wide box-shape SCR, the narrow box-shape SCR had statistically significant lower median contact pressure at 30° and 60°. The subacromial contact area showed a statistically significant difference at 0° (p=0.001) and 30° (p=0.004) for the narrow compared to wide box-shape SCR. At an abduction angle of 0°, the narrow SCR could restore superior translation statistically significant better compared to the wide construct. For all angles, the wide and narrow box-shaped SCR increased the median subacromial distance statistically significantly. The contact areas in 30° and 60° of abduction were higher for all scenarios, both peaking in the intact state in 30° with approximately 600 mm2. ConclusionsIn comparison to a wide box-shape, a narrow box-shape SCR using the LHBT has biomechanical advantages in regard of subacromial contact pressures, the subacromial contact areas as well as the acromiohumeral distance. The width of the reconstruction therefore has direct influence in the success of the technique.

Systematic Review and Meta-Analysis Comparing Long Head Biceps Tendon Tenotomy versus Tenodesis with Concomitant Repiarable Rotator Cuff Tears

Abstract Background Both tenotomy and tenodesis have been widely used for the treatment of long head of biceps tendon (LHBT) lesions, but the optimal strategy remains considerably controversial. In this meta- analysis of published studies, we compared the results of the two procedures. Methods A literature search that compared tenotomy with tenodesis was performed using pubmed, MEDLINE, cochrane libaray and researchgate . A total of 6 studies reporting data on 659 subjects were included. Study quality was evaluated using Cochrane collaboration tool for assessing the risk of bias. Results Data synthesis showed higher ASES score, constant score, simple shoulder test mean, lower popeye sign and insignificant vas score in patients managed with tenodesis compared to tenotomy (ASES score, P <0.001; constant score, P < 0.001; simple shoulder test mean, P = 0.045, popeye sign, P = 0.010 ; vas score, P = 0.422 respectively). Conclusion The current evidence indicates that biceps tenodesis for LHBT lesions with concomitant reparable rotator cuff tears results in decreased rate of Popeye sign and improved Constant score also ASES score compared to biceps tenotomy.

Raised body mass index and reduced muscle bulk reduces the incidence of Popeye's deformity post tenotomy of long head of biceps brachii

ObjectivesThe development of the Popeye’s deformity is a known complication of long head of bicep tendon (LHBT) tenotomy. Incidence of developing Popeye’s deformity after LHBT tenotomy ranges between 13 - 70%. While this complication is well tolerated, it can be avoided with proper patient selection. We aim to study patient and clinical factors resulting in the development of the Popeye’s deformity after LHBT tenotomy so as to better identify suitable surgical candidates. Methods91 patients underwent unilateral rotator cuff repairs and concomitant LHBT tenotomy between March 2013 and March 2017. Assessment of patient factors contributing to Popeye’s deformity included patient demographics and physical attributes were analysed and correlated. Patients also completed a questionnaire regarding their overall post-operative satisfaction. Prospectively collated Visual Analogue Pain (VAS), Constant-Murley Shoulder Score (CSS), UCLA Shoulder Score (UCLA) and Oxford Shoulder Score (OSS) were compared at 6 and 24 months post-operation between patients who developed Popeye’s deformity and those who did not. ResultsThe incidence of post-tenotomy Popeye’s sign was 58.9%. Majority of patients were satisfied with their procedure, postoperative function and cosmesis. Patients who developed Popeye’s sign had a statistically significant lower body mass index (BMI) (24.9 ± 4.2 kg/m2 versus 27.3 ± 4.3 kg/m2, p = 0.048) (rpb = - 0.210, p > 0.05) and had a greater biceps circumference (in flexion) to wrist circumference ratio (1.91 ± 0.16 versus 1.83 ± 0.13, p = 0.012) (rpb = 0.319, p < 0.05) compared to those who did not. Nevertheless, the development of Popeye’s sign did not affect clinical outcomes (VAS, CSS, UCLA and OSS, p > 0.05) at 24 months. ConclusionsThe incidence of Popeye’s deformity is high post LHBT tenotomy. There was a greater incidence in patients with lower BMI and greater biceps brachii muscle bulk. However, this complication is well tolerated. By better selecting our patients, we can achieve better outcomes and minimise potential complications. Level of evidenceLevel III Evidence. Retrospective comparative study.

Long head of biceps tendon augmentation for massive rotator cuff tears improves clinical results regardless of the number of tendons involved.

Management of massive rotator cuff tears (MRCTs) remains debated, and various arthroscopic and open techniques have been described for their management. Nevertheless, the optimal strategy remains unclear. The present study evaluated the clinical results in patients managed arthroscopically for MRCTs augmented with the long head biceps tendon (LHBT) at a minimum 1-year follow-up, considering different type of tears, demographic data and number of torn tendons. Patients treated in a secondary referral centre from January 2021 to April 2022 were enroled prospectively. Inclusion criteria were pain, inability to fully elevate the affected shoulder, irreparable tears and active and motivated patients. All patients were managed within 2 months from diagnosis in a single centre by the same surgeons. Preoperative shoulder radiographs and magnetic resonance imaging (MRI) were collected, and clinical assessment was also performed using the Numerical analogue scale (NAS), Constant score (CS) American Shoulder and Elbow Surgeons Shoulder Score (ASES). Tissue retraction and tendon fatty infiltration were evaluated using Patte and Fuchs scale, respectively. Clinical assessment was performed using the same scales at 3-6 months and 1-year follow-up. A total of 55 patients (31 female and 24 male) with a mean age of 60 ± 7.1 years were enroled for a mean follow-up of 18.2 ± 4.3 months. The mean preoperative NAS was 7.8 ± 0.6, CS was 20.5 ± 7.6 and ASES was 22.6 ± 9.2, increasing, respectively, to 0.3 ± 0.6, 91.5 ± 6.9 and 94.2 ± 6.7. No adverse side effects (infection, rejection, allergy) were reported during the study period. All patients were evaluated after surgery at 3 and 6 months and 1 year with statistically significant improvement for each score at the first and last follow-up (p < 0.05). The use of LHBT augmentation in patients with MRCTs in appropriately selected patients is safe and effective and can lead to pain relief and acceptable clinical outcomes. Furthermore, its use carries low donor site morbidityand is cost effective. Comparative studies, including randomised controlled trials, with other proposed techniques are needed to confirm these findings. Level IV.

Can Secondary Adhesive Capsulitis Complicate Calcific Tendinitis of the Rotator Cuff? An Ultrasound Imaging Analysis.

Adhesive capsulitis (AC) of the glenohumeral joint is a recognized cause of pain associated with both active and passive restricted ranges of movement. AC can be subdivided into primary and secondary forms. Trauma, surgery, immobilization, and diabetes mellitus are the leading well-recognized causes of secondary AC. Calcific tendinitis/tendinitis (CT) of the rotator cuff is considered a possible trigger for AC, as reported in a few previous articles. However, there are no original investigations that assess the frequency and characteristics of this association. The aim of our research was to evaluate the presence of AC in a cohort of patients with a known CT condition of the rotator cuff by an ultrasound (US) examination. We prospectively enrolled all the patients admitted at our single institution (October 2022-June 2023) for the preoperative US evaluation of a known CT condition. In these patients, we searched for parameters related to secondary AC. An axillary pouch (AP) thickness equal to or greater than 4 mm (or greater than 60% of the contralateral AP) was considered diagnostic of AC. Moreover, rotator interval (RI) thickness and the presence of effusion within the long-head biceps tendon (LHBT) sheath was also assessed in all patients. A total of 78 patients (54F, 24M-mean age = 50.0 and range = 31-71 y.o.) were enrolled in the study. In 26 of those patients (26/78-33.3%), US signs of AC were detected. Notably, the mean AP thickness in patients with AC and CT was 3.96 ± 1.37 mm (Group 1) and 2.08 ± 0.40 mm in patients with CT only (Group 2). RI thickness was significantly greater in patients with superimposed AC: 2.54 ± 0.38 mm in Group 1 and 1.81 ± 0.41 mm in Group 2 (p < 0.00001). Moreover, effusion within the LHBT was significantly more frequently detected in patients with AC: 84.61% in Group 1 versus 15.79% in Group 2-p < 0.00001. US signs of AC are found in one-third of patients with CT of the rotator cuff, demonstrating that AC represents a frequent complication that should be routinely evaluated during US investigation to provide more personalized treatment strategies.

Is It Time to Rethink the Relationship Between Subscapularis Tears and the Long Head of Biceps Tendon?

Introduction Pre-operative diagnosis of subscapularis tears remains a difficult challenge. Ultrasound has been shown to be ineffective at directly detecting subscapularis tears. It has been widely accepted that medial subluxation of the long head of biceps tendon (LHBT) is associated with full-thickness subscapularis tears. The aims of this study are to assess whether LHBT subluxation on ultrasound scanning has any predictive value for subscapularis tears and to determine the relationship between LHBT subluxation and subscapularis tears at arthroscopy. Methods Pre-operative ultrasound and arthroscopic findings for patients undergoing arthroscopic rotator cuff repair at our institution between March 2011 and January 2016 were analysed. The accuracy of LHBT subluxation on ultrasound and at arthroscopy as a predictor of subscapularis tears at arthroscopy was calculated. The correlation between LHBT subluxation and subscapularis tears was determined. A standardised technique was used for ultrasound scans, and the grade of the sonographer was recorded. Results Three hundred fifty-nine rotator cuff repairs were performed. Twenty-four patients had a subluxed LHBT. Ultrasound was poorly sensitive (50%), and a subluxed LHBT on ultrasound only correlated very weakly with subscapularis tears at arthroscopy (R = 0.268, p<0.001). At arthroscopy, 92 patients had full-thickness subscapularis tears. Of these, only 16 patients (17%) had a subluxed/dislocated LHBT. Of the 24 patients with a subluxed LHBT, eight had no subscapularis tears. Thus, LHBT subluxation/dislocation only correlated weakly with full-thickness subscapularis tears (R=0.252, p<0.001). Conclusion Due to their close anatomical relationship, traditional teaching suggests subscapularis tears are associated with medial LHBT subluxation. Our data indicate that, contrary to popular belief, the two are only weakly correlated. In our series, the majority of patients with subscapularis tears (83%) had their LHBT in-groove. The authors therefore recommend high vigilance during arthroscopy for the diagnosis and repair of subscapularis tears, regardless of pre-operative ultrasound findings and the intra-operative position of the LHBT.

Spectrum and patterns of shoulder pathology on MRI in symptomatic elite wheelchair basketball athletes.

Wheelchair basketball (WCB) is a popular para-sport adapted for athletes with physical disabilities. Shoulder injuries are commonly reported among WCB athletes. However, the understanding of the specific patterns and characteristics of shoulder injuries in WCB players is currently limited, and there is a lack of comprehensive literature available on this subject. To investigate the spectrum of pathologies observed in elite wheelchair basketball (WCB) athletes referred for MRI evaluation of symptomatic injuries of the shoulder. Retrospective review of consecutive elite WCB athletes referred for MRI evaluation of symptomatic shoulder injury. Demographic, clinical, and functional data including international wheelchair basketball federation (IWBF) classification of each athlete were collected. A total of 28 MRI studies were reviewed. Excluding MRI examinations of the same shoulder, 18 study cases were assessed for pathology of the rotator cuff (RC), labrum, long-head of biceps tendon, glenohumeral and acromioclavicular joints, and osseous lesions of the humerus or glenoid. Correlations between clinical-demographic features and MRI findings were statistically evaluated. Supraspinatus tears were observed in 72.2%, infraspinatus tears in 50%, and subscapularis tears in 38.9% shoulders. Articular-sided partial tears frequently involved posterior supraspinatus (88.9%) and anterior infraspinatus (100%). Labral tears were seen in 38.9%, with involvement of the posterosuperior labrum in all tears. Hill-Sachs and osseous Bankart lesions (5.6%), and anterior-inferior labral tears (11.1%), were uncommon findings. Statistically significant correlations were observed of low IWBF point class and non-ambulatory athletes with subscapularis tendinosis (p = 0.015, p = 0.001) and tearing (p = 0.050, p = 0.013), and athletes with limited trunk control with subscapularis tendinosis (p = 0.013). RC tears are common in elite WCB athletes with pattern of RC and labral tearing suggesting internal (superior-posterior) impingement as a contributory pathoetiologic mechanism. Non-ambulatory, low IWBF point class athletes, as well as those with limited trunk control have a statistically significant increase in subscapularis tendon pathology on MRI.

Treatment of Concomitant SLAP Lesion in Patients Aged 45 and Above Who Underwent Arthroscopic Rotator Cuff Repair: Tenotomy versus Labral Repair?

Background: The current study aimed to compare the clinical and functional outcomes of the long-head biceps tendon (LHBT) tenotomy or labrum repair for the biceps-labral complex in the presence of superior labrum anterior-posterior (SLAP) lesion accompanying Goutallier type 0-I-II rotator cuff injury in patients aged 45 and above who underwent arthroscopic repair. Method: A retrospective analysis was conducted on 1148 patients who underwent arthroscopic shoulder surgery. A total of 223 patients, who underwent arthroscopic repair for Goutallier type 0, I, and II rotator cuff tears (RCT) and received simultaneous treatment for SLAP lesions through either LHBT tenotomy or labral repair, were included in the study. Patients were divided into two groups according to the treatment of SLAP lesions such as tenotomy (n=78) and repair (n=145). Demographic data, pre-operative, post-operative 3-month, and 12-month range of motion, visual analog scale (VAS), and Constant Murley Scale (CMS) were compared. Results: Flexion and external rotation were significantly higher in the tenotomy group, and internal rotation in the repair group (p&lt;0.001, &lt;0.001, 0.005, respectively). Although the VAS score was significantly lower in the tenotomy group compared to the repair group in the 3rd-month postoperative control (p&lt;0.001), the difference between the two groups disappeared in the 12th-month control (p=0.081). The CMS score was low in the tenotomy group preoperatively (p=0.015), by the 12-month follow-up, although there was a severe increase in both groups, there was no statistically significant difference between them (p=0.071). Conclusion: The study determined that both LHBT tenotomy and labral repair treatments for SLAP lesions, performed in conjunction with arthroscopic rotator cuff repair, are successful methods in terms of function, pain, and range of motion changes. It was observed that flexion and external rotation outcomes were better in tenotomy patients, while internal rotation was more favorable in patients undergoing labral repair.

Arthroscopic Superior Capsular Reconstruction Using Hybrid Autologous Fascia Lata and the Long Head of Biceps Tendon Graft: the Central Beam Concept

Superior capsular reconstruction is a joint salvage treatment option for retracted irreparable rotator cuff tears in relatively young patients. Various graft options have been described in the literature, including autologous fascia lata graft, synthetic graft, and dermal patches. Superior capsular reconstruction using long head of biceps tendon autograft alone has also been described by few authors. In this technical note, we describe a modified technique of performing arthroscopic superior capsular reconstruction using both fascia lata graft and the intra articular portion of the long head of biceps tendon. Our technique resembles central beam concept over which the fascia lata graft is anchored, providing good structural support to the graft and enabling graft healing and improved clinical outcomes.

The long head of the biceps tendon undergoes multiaxial deformation during shoulder motion

The long head biceps tendon (LHBT) is presumed a common source of shoulder joint pain and injury. Despite common LHBT pathologies, diagnosis and preferred treatment remain frequently debated. This Short Communication reports the development of a subject-specific finite element model of the shoulder joint based on one subject’s 3D reconstructed anatomy and 3D in vivo kinematics recorded from bone-fixed electromagnetic sensors. The primary purpose of this study was to use the developed finite element model to investigate the LHBT mechanical environment during a typical shoulder motion of arm raising. Furthermore, this study aimed to assess the viability of material models derived from uniaxial tensile tests for accurate simulation of in vivo motion. The findings of our simulations indicate that the LHBT undergoes complex multidimensional deformations. As such, uniaxial material properties reported in the existing body of literature are not sufficient to simulate accurately the in vivo mechanical behavior of the LHBT. Further experimental tests on cadaveric specimens, such as biaxial tension and combinations of tension and torsion, are needed to describe fully the mechanical behavior of the LHBT and investigate its mechanisms of injury.

Higher Upper Subscapularis Goutallier Grade and Coracohumeral Distance Narrowing Are Predictive of Subscapularis Tears in Patients Undergoing Arthroscopic Rotator Cuff Repair

PurposeThe primary objective of this study was to evaluate the relationship between subscapularis (SSC) Goutallier grade and coracohumeral distance (CHD) and SSC tears. The second aim was to evaluate the relationship between these radiographic variables and long head biceps tendon (LHBT) lesions. MethodsA retrospective analysis was conducted on prospectively maintained data on patients who underwent arthroscopic rotator cuff repair (ARCR) of SSC tears between 2011 and 2021 with at least 6 months of follow-up. Patients with identified subscapularis tears during arthroscopy were included. A control group was established by randomly selecting patients without SSC tears from the same study period. Goutallier grading and CHD were obtained from preoperative magnetic resonance imaging (MRI) scans. Receiver operating characteristic (ROC) analysis was conducted to define optimal cutoff values for these diagnostic measures. ResultsThe study included 735 patients with SSC tears and 249 patients in the control group. Comparing subscapularis tear and intact groups' Goutallier grades revealed significant differences in infraspinatus, upper and lower SSC, and overall SSC (p<0.001). No significant difference was detected in supraspinatus Goutallier grade (p=0.364). A SSC tear was observed in 58.3% (n=265) of patients with Goutallier grade 0 of the upper SSC, 77.1% (n=195) of patients with grade 1 changes, 98.7% (n=155) with grade 2 changes, and 100% of grade 3 or 4 changes. Goutallier grade of the upper SSC showed a significant correlation with tear size (rs=0.533; p<0.01). CHD measurements were lower in individuals with SSC tears compared to those without tears (6.6 ± 1.7 vs 9.6 ± 1.8; p<0.001). Upper SSC Goutallier grade >1 had an acceptable area under the curve (AUC) of 0.742. In CHD of 7.96 mm or less had an excellent predictive AUC of 0.879. ConclusionHigher Goutallier grade and CHD narrowing are potential associations predictive of SSC tears. Routine MRI assessment of muscle of the upper SSC and the CHD can contribute to the diagnostic accuracy of SSC tears and offer valuable information regarding the severity of such tears. Level of EvidenceLevel III, diagnostic study

Correlation of the depth, medial wall and opening angle of the bicipital groove and the dimensions of long head of the biceps tendon

Objectives: The aim of this study was to investigate the relationship between the morphological measurements of bicipital groove and long head of biceps tendon and determine the effect of age and gender on these measurements. Methods: The study included 110 patients (60 females, 50 males) aged 18–50 years, who underwent magnetic resonance imaging of the left shoulder between January and December 2020. The patients had stable biceps tendons, and did not have a rotator cuff tear. The bicipital groove morphology was evaluated based on depth, opening angle, medial wall angle and the biceps tendon morphology was assessed based on thickness (anteroposterior length) and width (transverse length). Results: There was no difference between the females and males in terms of age, opening angle and medial wall angle (p&gt;.05). The bicipital groove depth was lower in the females than in the males (p&lt;.001), while the biceps tendon was thicker in the males compared to the females (p&lt;.001). There was no correlation between age and the sizes of bicipital groove and the biceps tendon. A negative correlation was observed between the bicipital groove depth and opening angle (r=-0.55), and a positive correlation between medial wall angle (r=0.51), tendon thickness (r=0.50) and tendon width (r=0.34). Bicipital groove depth had a positive correlation with tendon thickness (r=0.54) in women and tendon width in men (r=0.28). Conclusion: The morphological measurements of bicipital groove and the biceps tendon showed correlations. There were also gender differences in these morphological measurements.

Biomechanical properties of suprapectoral biceps tenodesis with double-anchor knotless luggage tag sutures vs. subpectoral biceps tenodesis with single-anchor whipstitch suture using all-suture anchors

As the use of all-suture anchors continues to increase, limited biomechanical data on the use of these anchors in various configurations for tenodesis of the long head biceps tendon (LHBT) exists. The aim of this study was to compare the biomechanical properties of a 2-anchor luggage tag suprapectoral biceps tenodesis (Sup-BT) vs. a single-anchor whipstitch subpectoral biceps tenodesis (Sub-BT) using all-suture anchors. The hypothesis was that the Sub-BT will have a higher ultimate load to failure and less creep relative to the Sup-BT construct. Eighteen fresh frozen cadaveric humeri were used. The specimens were randomly divided into 2 groups of 9; i) The Sup-BT were performed with 2 1.8 mm knotless all-suture anchors using a luggage-tag fixation configuration, ii) The Sub-BT were performed using a single 1.9 mm all-suture anchor and a whipstitch suture configuration with a tied knot. The humeri were tested on a hydraulic MTS machine where the specimens were preloaded at 5 N for 2 minutes and then cyclically loaded from 5 to 50 N for 1000 cycles at 1 Hz while maximum displacement was recorded with a motion system and markers attached to the bone and bicep tendon. The tendon was then tensioned at a rate of 1 mm/s to obtain the ultimate load to failure. CT scans of the specimens were used to calculate the bone mineral density at the site of the anchor/bone interface and video recordings were captured during load to failure to document all modes of failure. There was no significant difference in the average load to failure of the Sup-BT and Sub-BT groups (197 N±45 N (SD), 164 N±68 N (SD) respectively; P=.122) or creep under fatigue between the Sup-BT vs. Sub-BT specimens (3.1 mm, SD=1.5 vs. 2.2 mm, SD=0.9; P=.162). The bone mineral density was statistically different between the 2 groups (P<.001); however, there were no observed failures at the anchor/bone interface and no correlation between failure load and bone mineral density. The ultimate load to failure and creep between a Sup-BT with 2 knotless all-suture anchors using a luggage tag suture configuration was equivalent to a Sub-BT with 1 all-suture anchor using a whipstitched suture configuration and a tied knot. Surgeons can perform either technique confidently knowing that they are biomechanically equivalent in a cadaver model at time zero, and they offer similar strength to other fixation methods cited in the literature.

Biceps-based 3-layer reconstruction of the irreparable rotator cuff: a technical note on biceps tendon as a common local graft for in-situ superior capsular reconstruction, partial cuff repair, and middle trapezius tendon transfer

BackgroundFor irreparable rotator cuff tears, 3-layer tendon reconstruction (in which in-situ superior capsular reconstruction-reinforced partial rotator cuff repair was augmented with hamstring-sheet-lengthened middle trapezius tendon transfer) was recently reported to achieve satisfactory postoperative outcomes. To avoid hamstring graft-related drawbacks, the current note describes a technical modification of that reconstruct; wherein long head of biceps tendon is used as a cornerstone structure for simultaneously reconstructing the superior capsule; lengthening the transferred middle trapezius tendon; and augmenting the partially-repaired rotator cuff.MethodsVia sub-pectoral approach, long head of biceps tendon is distally-tenotomized. Through McKenzie approach, proximal stump of the tenotomized long head of biceps is retrieved to the sub-acromial space where double-row biceps tenodesis (into a trough at the greater tuberosity) is performed for reconstructing the superior capsule. Next, postero-superior rotator cuff is partially repaired, and side-to-side sutured to the reconstructed capsule. Through a 7–8-cm skin incision over the medial scapular spine, middle trapezius tendon is released. Portion of long head of biceps tendon distal to the tenodesis site is retrieved via a sub-trapezius/sub-acromial corridor to the scapular wound where it is re-attached to the released middle trapezius tendon.ResultsUse of long head of biceps tendon as a common local graft (for simultaneously reconstructing the superior capsule, lengthening the transferred middle trapezius tendon, and augmenting the partially-repaired rotator cuff) is technically feasible provided that the harvested tendon stump is at least 10 cm in length.ConclusionWhile avoiding hamstring graft-related complications, the currently-reported biceps-based 3-layer rotator cuff tendon reconstruction might offer the advantages of reproducibility, safety, simplicity and quickness; however, it should be validated via further studies.Trial registration The present study was approved by the Institutional Committee of Scientific Research and Ethics (3-2023Orth10-1).

Sonography of Partial Tear of Distal Long Head of Biceps Tendon

A 64-year-old female presents herself to the ED. Her chief complaint is left arm pain x 4 days, with hx of past injury. Ultrasound imaging confirmed a partial tear in the long head biceps tendon at the myotendinous junction.

Can artificial intelligence help decision-making in arthroscopy? Part 1: Use of a standardized analysis protocol improves inter-observer agreement of arthroscopic diagnostic assessments of the long head of biceps tendon in small rotator cuff tears

IntroductionInjuries of the long head of biceps (LHB) tendon are common but difficult to diagnose clinically or using imaging. Arthroscopy is the preferred means of diagnostic assessment of the LHB, but it often proves challenging. Its reliability and reproducibility have not yet been assessed. Artificial intelligence (AI) could assist in the arthroscopic analysis of the LHB. The main objective of this study was to evaluate the inter-observer agreement for the specific LHB assessment, according to an analysis protocol based on images of interest. The secondary objective was to define a video database, called “ground truth”, intended to create and train AI for the LHB assessment. HypothesisThe hypothesis was that the inter-observer agreement analysis, on standardized images, was strong enough to allow the “ground truth” videos to be used as an input database for an AI solution to be used in making arthroscopic LHB diagnoses. Materials and methodOne hundred and ninety-nine sets of standardized arthroscopic images of LHB exploration were evaluated by 3 independent observers. Each had to characterize the healthy or pathological state of the tendon, specifying the type of lesion: partial tear, hourglass hypertrophy, instability, fissure, superior labral anterior posterior lesion (SLAP 2), chondral print and pathological pulley without instability. Inter-observer agreement levels were measured using Cohen's Kappa (K) coefficient and Kappa Accuracy. ResultsThe strength of agreement was moderate to strong according to the observers (Kappa 0.54 to 0.7 and KappaAcc from 86 to 92%), when determining the healthy or pathological state of the LHB. When the tendon was pathological, the strength of agreement was moderate to strong when it came to a partial tear (Kappa 0.49 to 0.71 and KappaAcc from 85 to 92%), fissure (Kappa −0.5 to 0.7 and KappaAcc from 36 to 93%) or a SLAP tear (0.54 to 0.88 and KappaAcc from 90 to 97%). It was low for unstable lesion (Kappa 0.04 to 0.25 and KappaAcc from 36 to 88%). ConclusionThe analysis of the LHB, from arthroscopic images, had a high level of agreement for the diagnosis of its healthy or pathological nature. However, the agreement rate decreased for the diagnosis of rare or dynamic tendon lesions. Thus, AI engineered from human analysis would have the same difficulties if it was limited only to an arthroscopic analysis. The integration of clinical and paraclinical data is necessary to improve the arthroscopic diagnosis of LHB injuries. It also seems to be an essential prerequisite for making a so-called “ground truth” database for building a high-performance AI solution. Level of evidenceIII; inter-observer prospective series.