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3D imaging has good specificity but poor sensitivity for the diagnosis of pathologies of the long head of the biceps: a systematic review and meta-analysis

Abstract

Purpose

To systematically review and meta-analyse the literature to determine which three-dimensional (3D) imaging modality provides the best diagnostic accuracy to detect pathologies of the long head of the biceps tendon (LHBT).

Materials and methods

A search was performed on PubMed, Embase®, and Cochrane. Studies that compared the diagnostic accuracy of 3D imaging modalities versus arthroscopy for the assessment of LHBT pathologies were included. Studies assessing superior labral anterior posterior (SLAP) lesions were excluded.

Results

Fifteen studies were included; nine were eligible for meta-analysis. Six studies on instability indicated a sensitivity of 0.68 (CI 0.46–0.84) and specificity of 0.76 (CI 0.68–0.82). Four studies on full-thickness tears indicated a sensitivity of 0.56 (CI 0.28–0.81) and specificity of 0.97 (CI 0.93–0.99). Four studies on partial-thickness tears indicated a sensitivity of 0.52 (CI 0.20–0.82) and specificity of 0.64 (CI 0.25–0.91). Two studies on any tear indicated a sensitivity of 0.58 (CI 0.28–0.83) and specificity of 0.99 (CI 0.93–1.00). Only one study on other pathologies indicated a sensitivity of 0.61 and specificity of 0.84.

Conclusion

To diagnose LHBT pathologies, 3D imaging modalities overall have low-to-moderate sensitivity, but high-to-excellent specificity. The consistency in reported sensitivity is generally poor, while the consistency and reported specificity is good for the detection of instability, full-thickness tears and any tear, but poor for the detection of partial-thickness tears. 3D imaging may be adequate to rule out LHBT pathologies, but are not sufficiently reliable to confirm the presence of such pathologies.

Level of evidence

III.

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Funding

This article was funded by GCS Ramsay Santé pour l’Enseignement et la Recherche

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Correspondence to Floris van Rooij.

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ML, FVR, AK, LN, and MS have nothing to declare. OC reports other from Arthrex, other from Zimmer, personal fees from Tornier-Corin, outside the submitted work.

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This study involved no human or animal subjects as it based on published literature; Its protocol including the search strategy was registered on PROSPERO (CRD42021254824).

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Lalevée, M., van Rooij, F., Nover, L. et al. 3D imaging has good specificity but poor sensitivity for the diagnosis of pathologies of the long head of the biceps: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 30, 2510–2520 (2022). https://doi.org/10.1007/s00167-022-06873-z

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Keywords

  • Biceps tendon
  • Pathology
  • Instability
  • Tear
  • MRI
  • MRA
  • CTA
  • Diagnostic accuracy