The severity of the long head biceps tendinopathy in patients with chronic rotator cuff tears: macroscopic versus microscopic results.
BACKGROUND
This study investigated the histopathology of the long head of biceps (LHB) tendon and correlated the findings with the macroscopic appearances of the LHB and the size of rotator cuff tears (RCTs) in patients with chronic RCTs.


METHODS
We compared biopsy specimens from LHBs in 34 patients with chronic RCTs and grossly normal LHBs in 8 patients undergoing shoulder hemiarthroplasty (controls). Duration of preoperative symptoms, the severity of RCTs, and macroscopic appearance of LHBs were recorded, classified, and compared with the histologic grading and apoptosis index of terminal deoxynucleotide transferase-mediated biotin-deoxy uridine triphosphate nick-end labeling (TUNEL) assays of LHBs.


RESULTS
In the RCT group, there were 8 partial-thickness tears with 5 macroscopic LHB lesions, 12 full-thickness tears with 8 macroscopic LHB lesions, and 14 massive tears with 13 macroscopic LHB lesions. There were 6 LHB subluxations. However, the macroscopic grading and the symptom duration were not correlated with the severity of the histology. In patients with massive tears, no matter what the macroscopic appearance of the LHB, the proportion of end-stage (grade 4) histologic LHB tendinopathy significantly increased (85.7%, P < .05) compared with patients with other types of RCTs. There was a consistently high incidence of advanced LHB histology (grade 3 or higher) in each classification of RCTs (75.0%-100.0%). The 8 patients in the control group showed milder histopathology (grade 1 or 2). The apoptosis index significantly increased as the tendinopathy progressed (P < .05).


CONCLUSIONS
The macroscopic pathology of LHB may not fully reflect the severity of tendinopathy, and the coexisting size of RCTs plays a role in the severity of LHB tendinopathy.
Institute of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Department of Orthopedics, National Cheng Kung University Hospital, Tainan, Taiwan.
Po-Ting
PT
Wu
Department of Orthopedics, National Cheng Kung University Hospital, Tainan, Taiwan.
I-Ming
IM
Jou
Institute of Basic Medical Sciences, National Cheng Kung University, Tainan, Taiwan.
Cheng-Chang
CC
Yang
Department of Orthopedics, National Cheng Kung University Hospital, Tainan, Taiwan.
Chii-Jeng
CJ
Lin
Department of Orthopedics, National Cheng Kung University Hospital, Tainan, Taiwan.
Chyun-Yu
CY
Yang
Department of Orthopedics, National Cheng Kung University Hospital, Tainan, Taiwan.
Fong-Chin
FC
Su
Department of Orthopedics, National Cheng Kung University Hospital, Tainan, Taiwan. Electronic address: suwr@ms28.hinet.net.
Wei-Ren
WR
Su
D000368:Aged; D001134:Arm Injuries / Q000473:pathology*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017006:Rotator Cuff / Q000473:pathology* / Q000601:surgery; D000070636:Rotator Cuff Injuries; D052256:Tendinopathy / Q000473:pathology*
Long head of biceps; apoptosis; rotator cuff tear; shoulder pain; tendinopathy; tenotomy/tenodesis