2015 ISAKOS Biennial Congress ePoster #2202

Arthroscopic Examination May Underestimate Shoulder Long Head of the Biceps Tendon Pathology

Dan Guttmann, MD, Taos, NM UNITED STATES
Brian Gilmer, MD, Reno, Nevada UNITED STATES
Ariana Demers, DO, Sonora, CA UNITED STATES
John B. Reid, III, MD, Taos, NM UNITED STATES
James H. Lubowitz, MD, Santa Fe, NM UNITED STATES

Taos Orthopaedic Institute, Taos, New Mexico, USA

FDA Status Cleared

Summary: When compared to open observation during subpectoral tenodesis, arthroscopic examination of the LHB visualizes only 32% of the proximal LHB, and may underestimate pathology even when pulling the tendon into the joint with an arthroscopic grasper.

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Abstract:

Purpose

The purpose of this study is to compare arthroscopic versus open examination of the shoulder, proximal, long head of the biceps tendon (LHBT) in patients undergoing shoulder arthroscopy followed by open, subpectoral tenodesis. Our hypothesis is that arthroscopic visualization may underestimate LHB pathology versus open observation.

Methods

Eighty consecutive patients having shoulder arthroscopy with possible open subpectoral LHBT tenodesis were prospectively enrolled, of whom 63 met intraoperative criteria for tenodesis and were included in the study. In included patients, LHBT fraying, redness, and flattening were graded as absent, mild, moderate, or severe using arthroscopic visualization and the most distal extent of LHBT visualized during arthroscopy was marked with a bovie. Next, the tendon was pulled into the joint with an arthroscopic grasper revealing additional LHB and was again graded and marked as above. Finally, during open subpectoral tenodesis, the grossly visualized LHBT was graded and the locations of both marks plus the total length of LHBT observed during open visualization were measured and recorded. After subpectoral tenodesis the excised portion of LHB was histologically evaluated and graded as normal, fibrotic, or inflamed.

Results

On average, during subpectoral tenodesis, 96mm (range 75-130mm) of LHBT was visualized. This is significantly greater (p=0.001) than length visualized during diagnostic arthroscopy of 16mm (range 5-28mm) or 17%, and length visualized during arthroscopy and pulling with an arthroscopic grasper of 32mm (range 15-45mm) or 32%. In addition, when compared to LHBT pathology observed open, arthroscopic visualization did not reveal LHBT pathology in 50%, underestimated noted pathology in 56%, and overestimated noted pathology in 11%. Finally, histology revealed fibrosis in 100% of cases, plus inflammation in 5%.

Conclusions

When compared to open observation during subpectoral tenodesis, arthroscopic examination of the LHBT visualizes only 32% of the proximal LHBT, may underestimate pathology and reveals only 50% of pathology when pulling the tendon into the joint with an arthroscopic grasper.
Clinical Relevance
Inability to visualize the distal 68% of the proximal LHB may result in clinical undertreatment of symptomatic pathology.