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

Abstract

Background The aim of this study is to describe and quantitatively analyze the histopathology of proximal long head biceps (LHB) tendinopathy in patients who have undergone LHB tenodesis. The hypothesis is that severe histopathologic changes of the LHB tendon (LHBT) will most likely be reflected with improved postoperative clinical outcomes. Methods The study included patients with isolated LHB tendinopathy or LHB tendinopathy associated with concomitant shoulder pathologies. All had failed conservative treatment (12 months) and had a positive pain response (> 50% reduction) pre-operatively after LHB tendon injection with local anesthetic. All underwent biceps tenodesis procedure between 2008 and 2014. Tendon specimens were collected and histologically analyzed with the semi-quantitative Bonar scoring system. Minimum follow-up time was 1 year. A subset of patients was retrospectively reviewed postoperatively and evaluated employing visual analogue score (VAS), short form survey (SF-12), American Shoulder and Elbow Surgeon (ASES) score, Disability of Arm, Shoulder and Hand (DASH) score, and Oxford Shoulder Score (OSS) and postoperative return to work status. Results Forty-five biceps tendon specimens were obtained from 44 patients (mean age 50 ± 9.6 years). Histopathological analyses demonstrated advanced degenerative changes with myxoid degeneration and marked collagen disorganization. Minimal inflammation was identified. There were no regional differences in histopathological changes. Clinical outcomes did not correlate significantly with severity of histopathologic changes. Conclusions This study confirms that LHBT specimens in patients undergoing tenodesis demonstrate with the use of the Bonar score histopathologic changes of chronic degeneration and not inflammation. The correct histopathologic terminology for this process is LHB tendinosis. The histopathological changes appear uniform throughout the entire length of the LHBT which may inform the nature of the procedure performed.

Detection and Quantitative Assessment of Arthroscopically Proven Long Biceps Tendon Pathologies Using T2 Mapping

“…In addition to significant changes in the tendon diameter, the study group found mucoid degeneration with subsequent alterations in the water content as the main histopathological correlate for T2-signal hyperintensities in MRI. Another study showed that collagen network disorganization and myxoid/mucoid degeneration were the major histological correlates of tendon degeneration in 45 LBT specimens obtained from tenodesis [30]. These biochemical and histological processes are in line not only with the increased T2 relaxation times of the LBT shown in our study but also with several other studies describing an increase in the T2 values in damaged tendons other than the LBT or in the focal lesions of articular cartilage [31,32].…”

Clinical Analysis For Arthroscopic Intra-articular Bicipital Tendonesis; A Prospective Cohort Study.

“…Several methods have been used to treat the LHB tendon, including non-surgical and surgical management [14]. Regarding nonsurgical management, non-steroidal antiinflammatory drugs combined with rest are the first line of treatment [15].…”