The relevance of long head biceps degeneration in the presence of rotator cuff tears.
BACKGROUND
Long head biceps (LHB) degeneration in combination with rotator cuff tears can be a source of chronic shoulder pain. LHB tenotomy is an approved surgical procedure for pain reduction and improvement of joint function, however, the pathophysiology of LHB degeneration is not fully understood. In the literature, neoangiogenesis in tendon tissue has previously been shown to be associated with tendon degeneration. Vascular Endothelial Growth Factor (VEGF) is an important inducer of neoangiogenesis. The hypotheses are first that an elevated VEGF expression and vessel density can be found in degenerated LHB tissue and second that there is a relation between VEGF expression, vessel density and the different types of rotator cuff tears.


METHODS
LHB samples of 116 patients with degenerative rotator cuff tears were harvested during arthroscopic tenotomy. The samples were dehydrated and paraffin embedded. VEGF expression was determined using immunohistochemistry. Vessel density and vessel size were determined on Masson-Goldner stained tissue sections. On the basis of intraoperative findings, patients were assigned to 4 different groups (control group, partial thickness rotator cuff tear, full thickness rotator cuff tear and cuff arthropathy). Partial thickness rotator cuff tears were classified according to Ellman grade I-III, full thickness rotator cuff tears according to Bateman's classification (grade I-IV). The control group consisted of eight healthy tendon samples.


RESULTS
VEGF expression in the LHB was significantly higher in the presence of rotator cuff tears than in healthy tendons (p < 0.05) whereas vessel density and vessel size were significantly higher in the LHB of patients with cuff arthropathy (p < 0.05). Furthermore, there was significantly higher VEGF expression in LHB samples from patients with articular-sided compared to bursal-sided partial thickness rotator cuff tears (p < 0.05). No significant dependence was found between VEGF expression, vessel size and vessel density in LHB of patients with full thickness rotator cuff tears and the extent of the cuff tear following Bateman's classification.


CONCLUSIONS
Elevated VEGF expression can be detected in degenerated LHB tissue. The quantity of VEGF expression and vessels are related to the extent of LHB degeneration.
Lakemeier
Stefan
S
Department of Orthopedics and Rheumatology, University Hospital Marburg, Germany. lakemeie@med.uni-marburg.de
Reichelt
Johannes J A
JJ
Timmesfeld
Nina
N
Fuchs-Winkelmann
Susanne
S
Paletta
Juergen R J
JR
Schofer
Markus D
MD
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000098:blood supply* / Q000473:pathology*; D010003:Osteoarthritis / Q000209:etiology / Q000378:metabolism / Q000473:pathology; D011237:Predictive Value of Tests; D017006:Rotator Cuff / Q000473:pathology*; D012785:Shoulder Joint / Q000098:blood supply / Q000473:pathology; D020069:Shoulder Pain / Q000209:etiology / Q000473:pathology*; D013710:Tendons / Q000098:blood supply / Q000473:pathology; D042461:Vascular Endothelial Growth Factor A / Q000378:metabolism
D015415:Biomarkers; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A
Clin Orthop Relat Res. 2008 Jul;466(7):1598-604
18459027
J Biomech. 2009 Aug 7;42(11):1740-5
19450803
J Am Acad Orthop Surg. 2007 Jun;15(6):340-9
17548883
Knee Surg Sports Traumatol Arthrosc. 2001;9(2):123-6
11354854
Rheumatology (Oxford). 2001 Feb;40(2):229-30
11257166
J Shoulder Elbow Surg. 2006 May-Jun;15(3):271-8
16679225
AJR Am J Roentgenol. 2003 Mar;180(3):633-9
12591665
Sports Med Arthrosc Rev. 2008 Sep;16(3):180-6
18703979
Arch Orthop Trauma Surg. 2003 May;123(4):168-74
12734715
J Orthop Res. 2009 Mar;27(3):416-20
18924143
Orthopade. 1993 Sep;22(5):288-93
8414487
Virchows Arch. 2001 Oct;439(4):579-85
11710646
J Shoulder Elbow Surg. 1995 Nov-Dec;4(6):436-40
8665288
J Shoulder Elbow Surg. 1998 Jul-Aug;7(4):381-8
9752648
AJR Am J Roentgenol. 1994 Nov;163(5):1183-8
7976897
Clin J Sport Med. 2003 Jan;13(1):11-5
12544158
Int Orthop. 2003;27(3):180-3
12799763
AJR Am J Roentgenol. 2006 Aug;187(2):376-82
16861541
Surg Clin North Am. 1963 Dec;43:1523-30
14090198
Recent Prog Horm Res. 2000;55:15-35; discussion 35-6
11036931
J Bone Joint Surg Am. 2007 Apr;89(4):747-57
17403796
J Trauma. 2005 Jun;58(6):1189-93
15995469
J Shoulder Elbow Surg. 2005 May-Jun;14(3):238-46
15889020
J Orthop Res. 2009 Oct;27(10):1379-85
19340876
Clin Orthop Relat Res. 1990 May;(254):35-8
2323147
Dev Biol. 2005 Mar 1;279(1):169-78
15708566
J Bone Joint Surg Am. 1983 Dec;65(9):1232-44
6654936
Arthroscopy. 1993;9(2):195-200
8461081
Z Orthop Unfall. 2009 May-Jun;147(3):321-6
19551583
J Bone Joint Surg Br. 1970 Aug;52(3):540-53
5455089
Anat Embryol (Berl). 2002 Jul;205(4):263-70
12136256
Br J Sports Med. 2009 Aug;43(8):603-7
18070808
AJR Am J Roentgenol. 1992 May;158(5):1091-6
1566673
Clin Biomech (Bristol, Avon). 2005 Feb;20(2):162-5
15621320