Radiologic and Histologic Evaluation of Proximal Bicep Pathology in Patients With Chronic Biceps Tendinopathy Undergoing Open Subpectoral Biceps Tenodesis

Nuelle, Clayton W.; Stokes, Derek; Kuroki, Keiichi; Crim, Julia R.; Sherman, Seth L.

doi:10.1016/j.arthro.2018.01.021

Cited by 30 publications

(22 citation statements)

References 36 publications

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“…The authors of included studies used mostly the four-variable classical Bonar score [ 19 , 20 , 23 , 24 , 25 , 26 , 29 , 31 , 32 ] ( Table 3 ).…”

Section: Resultsmentioning

confidence: 99%

“…Radiological evaluation was usually based on magnetic resonance imaging (MRI) (four studies) and ultrasound (US) (four studies). All MRI-involving studies revealed no correlation between histopathological and radiological alterations [ 23 , 24 , 26 , 34 ]. Only one US study by Zabrzynski et al revealed the association between the echogenicity of biceps tendon disturbance and the degenerated area of the tendon.…”

Section: Resultsmentioning

confidence: 99%

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The Bonar Score in the Histopathological Assessment of Tendinopathy and Its Clinical Relevance—A Systematic Review

et al. 2021

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This study aimed to perform a comprehensive systematic review, which reports the role of the Bonar score in the histopathological assessment of tendinopathy and its clinical relevance. To identify all of the studies that reported relevant information on the Bonar scoring system and tendinopathy, an extensive search of the major and the most significant electronic databases (PubMed, Cochrane Central, ScienceDirect, SciELO, Web of Science) was performed. A systematic review of the literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The extracted data included—year of study, geographical location, type of the study, radiological modifications, gender, number of patients, region of tendinopathy, mean age, control group, characteristics of the Bonar score and alterations in the scale, mean Bonar score, number of investigators, area of tendon investigation, clinical and radiological implications. An extensive search of the databases and other sources yielded a total of 807 articles. Eighteen papers were finally included in this systematic review, and of these, 13 original papers included the clinical and radiological implications of tendinopathy. Radiological evaluation was present in eight studies (both magnetic resonance imaging (MRI) and ultrasound (US)). The clinical implications were more frequent and present in 10 studies. Using the Bonar score, it is easy to quantify the pathological changes in tendinous tissue. However, its connection with clinical and radiological evaluation is much more complicated. Based on the current state of knowledge, we concluded that the neovascularization variable in the Bonar system should be reconsidered. Ideally, the microscopic assessment score should follow the established classification scale with the radiological and clinical agreement and should have a prognostic value.

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“…The authors of included studies used mostly the four-variable classical Bonar score [ 19 , 20 , 23 , 24 , 25 , 26 , 29 , 31 , 32 ] ( Table 3 ).…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

The Bonar Score in the Histopathological Assessment of Tendinopathy and Its Clinical Relevance—A Systematic Review

et al. 2021

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“…These findings may suggest the possible hidden lesion effect. 15,21,22,28 Taylor et al 28 found that 47% of 277 patients had biceps pathology that was extra-articular and would not have been visualized during diagnostic arthroscopy. The majority of these lesions were related to scarring, which may play a role in why patients had persistent pain after a suprapectoral biceps tenodesis.…”

Section: Discussionmentioning

confidence: 99%

Management of Failed Proximal Biceps Surgery: Clinical Outcomes After Revision to Subpectoral Biceps Tenodesis

et al. 2019

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Background: The preferred surgical technique to manage biceps–superior labral pathology is often debated, and rates of revision and persistence of pain vary widely according to surgical technique and patient characteristics. Purpose: To evaluate the clinical and functional outcomes of patients undergoing revision subpectoral tenodesis after failed primary tenodesis or tenotomy of the long head of the biceps. Study Design: Case series; Level of evidence, 4. Methods: All patients undergoing revision biceps management by the senior surgeon between 2006 and 2016 and with a minimum 24-month follow-up were retrospectively identified. Patients being treated with concomitant rotator cuff repair or capsular release were excluded. Patient characteristic variables were recorded. Patient-reported outcomes including the functional score, Single Assessment Numeric Evaluation (SANE), visual analog scale (VAS), Simple Shoulder Test (SST), and American Shoulder and Elbow Surgeons were obtained, and range of motion, strength, and complications were quantified. Results: In total, 25 patients with revision biceps tenodesis were identified at a mean follow-up of 76.5 ± 31.5 months. The average age was 44.4 ± 14.3 years, and the surgical indications included failure of index suprapectoral biceps tenodesis (56%), subpectoral biceps tenodesis (36%), and patient dissatisfaction after tenotomy (8%). There was a significant improvement in the VAS score ( P < .001), SANE ( P = .001), SST ( P = .035), functional score ( P < .001), and forward elevation ( P = .028), whereas postoperative strength ( P = .440), abduction ( P = .100), and external rotation ( P = .745) improvement failed to achieve statistical significance after revision surgery. There was no difference in postoperative outcome measures between modes of failures, concomitant procedures, and sex. Twenty-two (88%) patients reported high satisfaction and stated they would have this revision surgery again. The overall complication rate was 48%, with half of these reporting pain of >3 on a scale of 10 and 4% of patients requiring additional surgeries. Conclusion: The current study demonstrates high patient satisfaction (88%) and significant improvement in functional outcomes with revision biceps tenodesis, a mini-open subpectoral technique, after previous failed tenodesis or tenotomy. Although this may be an effective strategy to address failed prior biceps surgery, the potential complication of persistent pain must be emphasized. Patients should be counseled on the high complication rate (48%), with persistent pain being the most common complaint.

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“…21 The intra-articular part of the tendon due to its anatomical location in the bicipital groove 22 is susceptible to tear due to the presence of compressive and frictional forces. 23 Nuelle et al 24 published a radiological and histological evaluation of primary LHB tendinopathy in patients undergoing open subpectoral biceps tenodesis. Using the anatomical zones described by Taylor, the specimens of each of the three zones were evaluated.…”

Section: Pathogenesismentioning

confidence: 99%

Biceps tenodesis versus biceps tenotomy for biceps tendinitis without rotator cuff tears

Hassan

Patel

2019

Journal of Clinical Orthopaedics and Trauma

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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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Radiologic and Histologic Evaluation of Proximal Bicep Pathology in Patients With Chronic Biceps Tendinopathy Undergoing Open Subpectoral Biceps Tenodesis

Cited by 30 publications

References 36 publications

The Bonar Score in the Histopathological Assessment of Tendinopathy and Its Clinical Relevance—A Systematic Review

The Bonar Score in the Histopathological Assessment of Tendinopathy and Its Clinical Relevance—A Systematic Review

Management of Failed Proximal Biceps Surgery: Clinical Outcomes After Revision to Subpectoral Biceps Tenodesis

Biceps tenodesis versus biceps tenotomy for biceps tendinitis without rotator cuff tears

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