2023 ISAKOS Biennial Congress ePoster
Histopathology Of Long Head Of Biceps Tendon Removed During Tenodesis Demonstrates Degenerative Histopathology and Not Inflammatory Changes
Maciej Jk Simon, MD, PhD, Kiel GERMANY
Jane Yeoh, MD, FRCSC, Vancouver CANADA
Michael Nimmo, MD, FRCPC, Vancouver CANADA
William Regan, MD FRCSc, Vancouver, British Columbia CANADA
University of British Columbia, Vancouver, CANADA
FDA Status Not Applicable
Summary
LHBT histopathology following tenodesis with prior 12 months failed conservative treatment demonstrates chronic degenerative changes with minimal inflammation confirming that the histopathology resembles a tendinosis not a tendinitis.
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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 one 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
LHBT histopathology following tenodesis with prior 12 months failed conservative treatment demonstrates chronic degenerative changes with minimal inflammation confirming that the histopathology resembles a tendinosis not a tendinitis. There is no regional localization of histopathological change suggesting removal of subtotal tendon is recommended for complete pain elimination. Interpretation of postoperative clinical outcomes is limited due to a considerable loss of patient follow-up, however, outcomes appear to be independent of histopathologic changes.