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• W2134536731 abstract "The purpose of this study is to compare arthroscopic versus open examination of the shoulder, proximal, long head of the biceps (LHB) tendon in patients undergoing shoulder arthroscopy followed by open, subpectoral tenodesis. Our hypothesis is that arthroscopic visualization may underestimate LHB pathology versus open observation. After statistical power analysis, IRB approval, and patient informed consent, 80 consecutive patients having shoulder arthroscopy with possible open subpectoral LHB tenodesis were prospectively enrolled, of whom 63 met intraoperative criteria for tenodesis (arthroscopically observed LHB fraying, redness, flattening, or medial subluxation, or degenerative labral tears, or unrepairable SLAP lesion), and were included in the study. In included patients, LHB fraying, redness, and flattening were graded as absent, mild, moderate, or severe using arthroscopic visualization and the most distal extent of LHB 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 as above. Finally, during open subpectoral tenodesis, the grossly visualized LHB was graded and the locations of both marks plus the total length of LHB 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. On average, during subpectoral tenodesis, 95mm (range 75-130mm) of LHB tendon was visualized. This is significantly greater (p≤0.0001) 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 30mm (range 15-45mm) or 32%. In addition, when compared to LHBT pathology observed open, arthroscopic visualization revealed only 67% of pathology, underestimated noted pathology in 56%, and overestimated noted pathology in 11%. Finally, histologic evaluation revealed fibrosis in 100% of cases, but inflammation in only 5%. Our primary result is that when compared to open observation during subpectoral tenodesis, arthroscopic examination of the LHB visualizes only 32% of the proximal LHB and reveals only 67% of pathology when pulling the tendon into the joint with an arthroscopic grasper. Limitations are that arthroscopic and open determination of pathology is subjective, and that underestimation or overestimation of noted pathology assumes open observation as a gold-standard, which has not been validated. Our results may justify future outcomes research to determine if inability to visualize the distal 68% of the proximal LHB results in clinical undertreatment of symptomatic pathology." @default.
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• W2134536731 date "2014-06-01" @default.
• W2134536731 modified "2023-10-17" @default.
• W2134536731 title "Arthroscopic Examination May Underestimate Shoulder Long Head of the Biceps Tendon Pathology" @default.
• W2134536731 doi "https://doi.org/10.1016/j.arthro.2014.04.029" @default.
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