Relationship between long head of the biceps tendon histopathology and long-term functional results in smokers. A time to reevaluate the Bonar score?

Abstract

Aim: The purpose of this study was to investigate whether there is an association between smoking, the extent of the degeneration process in the biceps tendinopathy, including cells and extracellular matrix (ECM) alterations, and long-term surgical results. Methods: This study comprised 40 consecutive patients admitted for shoulder arthroscopy due to symptomatic biceps tendinopathy and classified into three groups based on smoking status: active smokers, former smokers, and non-smokers. According to the classical Bonar score criteria, the histopathologic evaluation of the harvested intra-articular portion of the tendon was done. The follow-up examination was based on the American Shoulder and Elbow Surgeons Score (ASES). Results: A cohort of 32 patients was enrolled in the final follow-up examination; mean 37.56 months. Histopathological evaluation according to the classical Bonar score revealed degeneration of the tendinous tissue in each group but there was no correlation between the extent of degeneration, smoking indexes and the ASES. After revision of Bonar scale within the vascularity criterion, we found a correlation between the extent of degeneration of tendinous tissue, smoking data, ASES score, and the severity of rotator cuff injury. Conclusion: In this paper, we indicate the ambiguous role of the neovascularization in the biceps tendinopathy, and it was used for modification of the classical Bonar score. Consequently, recalculated, modified Bonar score was correlated positively with smoking indexes and functional outcomes. Furthermore, the morphological alterations of rotator cuff tendons also correlated positively with the extent of biceps tendon degeneration, measured according to the modified scoring system.

Collagenase-Induced Patellar Tendinopathy with Neovascularization: First Results towards a Piglet Model of Musculoskeletal Embolization

“…These results should be taken with caution. Indeed, a recent study has discussed the vascularity subclass index of the Bonar score which may not be well adapted to tendinopathy and could be revised [ 32 ]. Furthermore, neovascularization in tendinopathy is a complex process implicated in wound healing.…”

Histopathology of long head of biceps tendon removed during tenodesis demonstrates degenerative histopathology and not inflammatory changes

“…The current study identified on average only moderate histopathological changes, uniformly distributed according to the Bonar score (9.1 ± 2.3) despite the analysis of the entire LHBT. Fearon et al suggest to use the area of the tendon with the worst histopathological Bonar score in order to identify the worst degree of tendinopathy and use this section’s score for representative purposes despite that, we and similarly, Zabrzynski et al did not identify any correlation of the histopathological changes of the LHBT by the Bonar score and clinical outcomes [ 30 ]. The LHBT is a unique tendon as its main portion is located intraarticularly and therefore the tendon histology can be different to other, particularly extraarticular, tendons of the body.…”

mRNA and long non-coding RNA expression profiles of rotator cuff tear patients reveal inflammatory features in long head of biceps tendon

“…The neovascularization process is crucial in biceps tendinopathy and was significantly reduced in patients with smoking history. Furthermore, the morphological alterations of rotator cuff tendons also correlated positively with the extent of biceps tendon degeneration [ 30 , 31 ]. These studies indicated the influence of RCT on the structural and biochemical changes in LHBT.…”