Is the inflammation process absolutely absent in tendinopathy of the long head of the biceps tendon? Histopathologic study of the long head of the biceps tendon after arthroscopic treatment

Zabrzyński, Jan; Paczesny, Łukasz; Łapaj, Łukasz; Grzanka, Dariusz; Szukalski, Jacenty

doi:10.5114/pjp.2017.73928

Cited by 18 publications

(17 citation statements)

References 19 publications

(39 reference statements)

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“…40 Zabrzynski et al histologically examined symptomatic LHBT after tenodesis and found both degeneration and inflammatory cells. 41 With these recent advances characterizing pathology in the extra-articular LHBT and confining bicipital tunnel, our work supports the hypothesis that the extra-articular LHBT and its confining tunnel are active areas of inflammation, degradation, and pain generation and are likely a source of chronic pain. Our results support the presence of inflammation and subsequent degeneration in the LHBT, with a significantly increased expression of TGF-β, similar to the tendinopathic process that has been described in the patellar, Achilles, and most similarly the supraspinatus tendons.…”

Section: Discussionsupporting

confidence: 78%

“…The authors describe 16 patients undergoing subpectoral biceps tenodesis and found histologic evidence of degradation particularly in Zones 1 and 2 as well as histologic inflammation in all extra‐articular zones, despite the absence of significant structural abnormalities noted on MRI and arthroscopic examination 40 . Zabrzynski et al histologically examined symptomatic LHBT after tenodesis and found both degeneration and inflammatory cells 41 …”

Section: Discussionmentioning

confidence: 99%

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A molecular characterization of inflammation in the bicipital tunnel

et al. 2021

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The pathophysiology of extra‐articular biceps disease is not fully understood. The purpose of the study was to assess molecular evidence of inflammation, degradation, and nociception within the 3 separate anatomic zones of the extra‐articular biceps tendon and its confining tunnel. Arthroscopic biopsies were taken from the bicipital tunnel from 11 patients with suspected biceps‐labrum complex disease undergoing subdeltoid biceps transfer to the conjoint tendon. Tissue was analyzed for mRNA expression of various inflammatory mediators including interleukin‐6, interleukin‐1β, transforming growth factor‐β (TGF‐β), matrix metalloproteinase‐13, and substance P precursor. Extra‐articular tissue was compared with intra‐articular tendon (internal control) to determine fold change in expression. Compared to intra‐articular tendon, extra‐articular biceps tendon and synovium have increased levels of these aforementioned mediators, significantly TGF‐β (P = .012). In patients with clinical history of long head of the biceps tendon tendinopathy as well as arthroscopic findings of synovitis, tear, and loose bodies, pro‐inflammatory and degenerative cytokines were upregulated in the extra‐articular tendon. Inflammatory cytokines, degenerative mediators, and pain molecules associated with nociception were found within both the extra‐articular long head of biceps tendon and its constraining fibro‐osseous bicipital tunnel in patients with clinically evident biceps‐labral complex disease.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

A molecular characterization of inflammation in the bicipital tunnel

et al. 2021

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“…The surgical technique was performed in all patients as a standard procedure, as explained above. The adjustment of the technique to pathologies of the long biceps tendon, such as LHB tendinitis, as well as to concomitant procedures, e.g., in massive rotator cuff lesions, will have to be studied and evaluated closely in the future [ 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

The Loop Tenodesis Procedure—From Biomechanics to First Clinical Results

Riedl

Mayr

Greiner

et al. 2021

JCM

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(1) Introduction: Several surgical therapy options for the treatment of pathologies of the long biceps tendon (LHB) have been established. However, tenotomy, as well as established tenodesis techniques, has disadvantages, such as cosmetic deformities, functional impairments and residual shoulder pain. This study presents the first clinical and structural results of the recently introduced loop tenodesis procedure for the LHB, developed to overcome these issues. (2) Methods: 37 patients (11 women, 26 men, mean age 52 years), who underwent loop tenodesis of the LHB were examined six months after surgery. For the clinical evaluation the Constant score, as well as the LHB score, were used, complemented by elbow flexion and supination strength measurements. The integrity of the tenodesis construct was evaluated indirectly by sonographic detection of the LHB in the bicipital groove. (3) Results: Both, the overall Constant score as well as the LHB score showed significant improvements six months postoperatively, as compared to the preoperative value. Fourteen patients (38%) presented an examiner-dependent upper arm deformity, although only five patients (13%) reported subjective cosmetic deformities. Both, flexion and supination strength were preserved compared to the preoperative level. In 35 patients (95%), the tenodesis in the bicipital groove was proofed sonographically. (4) Conclusion: The loop tenodesis of the LHB provides good-to-excellent overall clinical results after a short-term follow-up of six month. The incidence of cosmetic deformities was inferior compared to conventional therapy options (tenotomy and anchor tenodesis).

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“…Murthi et al [5] histologically demonstrated that chronic inflammatory change is present in macroscopically degenerated or fibrillated LHBT. Zabrzynski et al [53] also histologically demonstrated the presence of the marginal inflammation process in LHBT with tendinopathy. Carp et al [25] suggested that elevated CRP can be initiated by a local response and is proportionally amplified in the presence of greater tissue injury and inflammation.…”

Section: Discussionmentioning

confidence: 99%

Association of high sensitivity C-reactive protein with tearing of the long head of the biceps tendon

Gwark

Park

2019

BMC Musculoskelet Disord

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BackgroundThis study proposed to investigate whether high-sensitivity C-reactive protein (hs-CRP) is an independent risk factor for long head of biceps tendon (LHBT) tear and whether hs-CRP can increase accuracy in diagnosing LHBT tear.MethodsThis study involved 582 shoulders of 557 consecutive patients who received arthroscopic examinations at the authors’ institution between January 2010 and July 2018. The strengths of associations between LHBT tear and various factors were determined by calculating the odds ratios (ORs), with 95% confidence intervals (CIs), using logistic regression analyses. The studied variables were demographic, physical, social, metabolic, comorbidity, hs-CRP, and pain on a visual analog scale (VAS) factors, as well as those related to rotator cuff tear (RCT). Significant factors in the multivariable logistic analysis were evaluated to determine their diagnostic values, including their likelihood ratios and post-test probabilities for LHBT tear.ResultsIn the multivariable analysis, five variables were significant: age, retraction degree of Patte, subscapularis tendon tear, hs-CRP > 1 mg/L, and pain VAS (p ≤ 0.01). The best combination of determinations for diagnosing LHBT tear, which yielded a strong positive likelihood ratio of 19.07 and a high post-test probability of 96%, was age ≥ 67 years, subscapularis tendon tear, grade of Patte ≥2, hs-CRP > 1, and pain VAS ≥ 7.ConclusionsSerum hs-CRP > 1 mg/L is an independent risk factor for LHBT tear, along with the expected risk factors of age, subscapularis tendon tear, retraction degree of Patte, and pain VAS. Serum hs-CRP > 1 mg/L increases the diagnostic accuracy for LHBT tear.Level of evidenceLevel IV, Clinical case series.

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Is the inflammation process absolutely absent in tendinopathy of the long head of the biceps tendon? Histopathologic study of the long head of the biceps tendon after arthroscopic treatment

Cited by 18 publications

References 19 publications

A molecular characterization of inflammation in the bicipital tunnel

A molecular characterization of inflammation in the bicipital tunnel

The Loop Tenodesis Procedure—From Biomechanics to First Clinical Results

Association of high sensitivity C-reactive protein with tearing of the long head of the biceps tendon

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