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Tendinopathy is a vexing clinical problem as its onset and development is often asymptomatic and unrecognized until tendon rupture. While extensively studied in the rotator cuff, Achilles, and patellar tendons, no study to date has examined the histological and molecular characteristics of the tendinopathic biceps long-head (LHB). The anatomy of the LHB is unique in that it comprises intra- and extra-articular portions, each exposed to differing loading patterns. Eleven LHBs post-tenotomy were sectioned, fixed in formalin, and stained (H and E; Alcian Blue), and gross structural organization of collagen measured using polarized light microscopy. Protein expression of intra- and extra-articular portions of the tenotomized biceps for IGF-I, collagen III, and MMP-1, -2, -3, and -13 was determined with Western blot analyses. The intra-articular LHB exhibited significantly greater histological evidence of tendinopathy inclusive of increased proteoglycan (p < 0.05) and decreased organization as measured by polarized light microscopy (p < 0.01). The intra-articular LHB also had significantly increased expression of collagen type III (p < 0.01) and of MMP-1 and 3 (p < 0.01, p < 0.05 respectively). No significant differences were found for IGF-I or for MMP-2 and -13. The intra-articular LHB exhibited histological characteristics of tendinopathy. Protein expression of the intra-articular LHB did not universally display signs of tendinopathy in comparison to the extra-articular portion of the tendon.

Background: Subpectoral biceps tenodesis with an interference screw has been shown to be an effective procedure from both an anatomic and biomechanical perspective. There have been no clinical outcome data on this procedure to date., Hypothesis: Subpectoral biceps tenodesis is an effective procedure in eliminating biceps tendinosis symptoms., Study Design: Case series; Level of evidence, 4., Methods: Patients who underwent subpectoral biceps tenodesis with a minimum follow-up of 1 year were evaluated using a battery of clinical outcome measures, biceps apex difference, and pain scores. A diagnosis of biceps tendinosis was made using a specific diagnostic protocol coupled with observation of biceps tendon fraying and increased erythema on dry arthroscopy., Results: Between November 2002 and August 2005, 50 patients underwent subpectoral biceps tenodesis. Complete follow-up examinations were performed in 41 of 50 (82%). There were 16 women and 25 men (mean age, 50 years). Follow-up averaged 29 months (range, 12-49 months). The mean scores were 86, Rowe; 81, American Shoulder and Elbow Surgeons (ASES); 9, Simple Shoulder Test (SST); 87, Constant Murley; and 84, Single Assessment Numeric Evaluation (SANE). There was 1 failure as demonstrated by pull-out of the tendon from the bone tunnel resulting in a "Popeye" deformity on physical examination. The mean value for biceps apex distance was 0.15 cm, with 35 of 41 patients demonstrating no difference on physical examination. Twenty-three of 41 patients had complete preoperative and postoperative examinations. All clinical outcome measures demonstrated a statistically significant improvement at follow-up when compared with the preoperative scores. Thirty-one patients had identified lesions of the rotator cuff at time of arthroscopy. The mean ASES score in patients without rotator cuff lesion (89.2 +/- 10.3) was significantly greater than the mean ASES for those with rotator cuff lesion (78.0 +/- 21.0) (P = .0324). The mean SST score in patients without rotator cuff lesion (10.6 +/- 1.5) was significantly greater than the mean ASES score for those with rotator cuff lesion (8.8 +/- 2.7) (P = .0132)., Conclusion: Subpectoral biceps tenodesis with an interference screw is a viable treatment option for patients with symptomatic biceps tendinosis. Anterior shoulder pain and biceps symptoms were resolved with this technique. Patients with coexistent rotator cuff lesion had less favorable outcomes.