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Regional histologic differences in the long head of the biceps tendon following subpectoral biceps tenodesis in patients with rotator cuff tears and SLAP lesions

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to quantify the regional histology of the long head of the biceps tendon (LHBT) and compare the histopathology present to clinical findings in patients with rotator cuff tears and SLAP lesions.

Methods

Prospectively enrolled patients undergoing an open subpectoral LHBT tenodesis in the setting of a rotator cuff (RTC) tear or SLAP lesion. Perioperative data were collected and the excised LHBT was analyzed by a fellowship trained pathologist. Tendons were sectioned into proximal (biceps anchor), middle (bicipital groove), and distal (myotendinous junction) portions. Sections were stained with Movat’s pentachrome stain and digitized for analysis. Comparisons were made between the histologic findings present in the setting of a rotator cuff tear with those seen in the setting of a SLAP tear.

Results

39 tendons were analyzed: 20 from patients with SLAP lesions (mean age of 44.7 years, range 23–60 years) and 19 from patients with rotator cuff tears (mean age of 58.7 years, range 43–71). Patients with the most pathologic tendons in the bicipital groove were significantly older (59.4 vs. 50.4 years; p < 0.05), reported higher pre-operative VAS scores (6.6 vs. 5.0; p < 0.02), and demonstrated lower pre-operative ASES scores (41.6 vs. 50.7; p < 0.05). The RTC group showed significantly more mucinous degeneration at both the proximal (p < 0.03) and the middle (p < 0.01) tendon portions compared to the SLAP group. In both groups, the portions of proximal tendon showed significantly (p < 0.05) more mucinous degeneration than distal portions.

Conclusion

Regional histologic differences exist in the LHBT. Rotator cuff patients showed the most degenerated tendon in the bicipital groove and these patients tended to be older and have higher VAS and lower ASES scores. Surgeons should consider performing a subpectoral biceps tenodesis as the bicipital groove portion of the tendon may be very degenerated, especially in patients with rotator cuff disease. Additional research is warranted to distinguish whether treating the biceps differently in distinct geographic regions affects patient outcomes.

Level of evidence

II.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, NYU Langone Medical Center Hospital for Joint Diseases, 301 E 17th St., New York, NY, 10003, USA

    Sergio A. Glait, Siddharth Mahure, Hien Pham, Andrew Feldman, Laith M. Jazrawi & Eric J. Strauss

  2. Department of Pathology, NYU Langone Medical Center, New York, NY, USA

    Cynthia A. Loomis

  3. Microscopy Core, Office of Collaborative Science, NYU Langone Medical Center, New York, NY, USA

    Michael Cammer

Authors
  1. Sergio A. Glait
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  2. Siddharth Mahure
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  3. Cynthia A. Loomis
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  4. Michael Cammer
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Correspondence to Sergio A. Glait.

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IRB Approved by Helen Panageas, Director of NYU School of Medicine IRB IRB#: i14-01529.

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Glait, S.A., Mahure, S., Loomis, C.A. et al. Regional histologic differences in the long head of the biceps tendon following subpectoral biceps tenodesis in patients with rotator cuff tears and SLAP lesions. Knee Surg Sports Traumatol Arthrosc 26, 2481–2489 (2018). https://doi.org/10.1007/s00167-018-4839-0

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  • DOI: https://doi.org/10.1007/s00167-018-4839-0

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