Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 12/2019

01-12-2019 | Arthroscopic Rotator Cuff Repair | SHOULDER

Magnetic resonance arthrography is insufficiently accurate to diagnose biceps lesions prior to rotator cuff repair

Authors: Elise Loock, Aude Michelet, Amaury D’Utruy, Pierre Molinazzi, Gerjon Hannink, Simon Bertiaux, Olivier Courage

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 12/2019

Login to get access

Abstract

Purpose

To evaluate the diagnostic accuracy between magnetic resonance arthrography (MRA) and arthroscopic examination for the assessment of pathologies of the long head of the biceps (LHB) prior to rotator cuff (RC) repair. The hypothesis was that MRA is suitable to identify biceps instabilities, due to improved visibility of the biceps pulley.

Methods

Sixty-six patients aged 58.5 ± 17.6 (range, 46–71) scheduled to have RC repair between 2016 and 2017 were prospectively enrolled. MRA images of the LHB were interpreted by one radiologist and two surgeons, then compared to arthroscopic findings. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated by comparing MRA axial readings to arthroscopic assessment in the neutral position (static instability), MRA sagittal readings to arthroscopic assessment in external rotation (dynamic s instability), MRA coronal and axial readings to arthroscopic assessment in the neutral position (tendinopathy).

Results

Among the three observers, the radiologist obtained the highest sensitivity and specificity for MRA, which were respectively: (1) for static instability, 62% (C.I. 35–85) and 77% (C.I. 63–88); (2) for dynamic instability, 50% (C.I. 29–71) and 62% (C.I. 46–77), and (3) for tendinopathy, 49% (C.I. 36–62) and 100% (C.I. 3–100).

Conclusions

MRA is not suitable for the diagnosis of LHB lesions prior to arthroscopic rotator cuff repair.

Level of evidence

Diagnostic study, Level I.
Literature
1.
Amouyel T, Le Moulec YP, Tarissi N, Saffarini M, Courage O (2017) Arthroscopic biceps tenodesis using interference screw fixation in the bicipital groove. Arthrosc Tech 6(5):e1953–e1957PubMedPubMedCentral
2.
Banerjee M, Muller-Hubenthal J, Grimme S, Balke M, Bouillon B, Lefering R, Gossmann A, Shafizadeh S (2016) Moderate value of non-contrast magnetic resonance imaging after non-dislocating shoulder trauma. Knee Surg Sports Traumatol Arthrosc 24(6):1888–1895PubMed
3.
Beall DP, Williamson EE, Ly JQ, Adkins MC, Emery RL, Jones TP, Rowland CM (2003) Association of biceps tendon tears with rotator cuff abnormalities: degree of correlation with tears of the anterior and superior portions of the rotator cuff. AJR Am J Roentgenol 180(3):633–639PubMed
4.
Belanger V, Dupuis F, Leblond J, Roy JS (2019) Accuracy of examination of the long head of the biceps tendon in the clinical setting: a systematic review. J Rehabil Med 51(7):479–491PubMed
5.
Ben Kibler W, Sciascia AD, Hester P, Dome D, Jacobs C (2009) Clinical utility of traditional and new tests in the diagnosis of biceps tendon injuries and superior labrum anterior and posterior lesions in the shoulder. Am J Sports Med 37(9):1840–1847PubMed
6.
Bennett WF (1998) Specificity of the Speed’s test: arthroscopic technique for evaluating the biceps tendon at the level of the bicipital groove. Arthroscopy 14(8):789–796PubMed
7.
Boileau P, Ahrens PM, Hatzidakis AM (2004) Entrapment of the long head of the biceps tendon: the hourglass biceps—a cause of pain and locking of the shoulder. J Shoulder Elbow Surg 13(3):249–257PubMed
8.
Boileau P, Baque F, Valerio L, Ahrens P, Chuinard C, Trojani C (2007) Isolated arthroscopic biceps tenotomy or tenodesis improves symptoms in patients with massive irreparable rotator cuff tears. J Bone Joint Surg Am 89(4):747–757PubMed
9.
Corazza A, Orlandi D, Fabbro E, Ferrero G, Messina C, Sartoris R, Perugin Bernardi S, Arcidiacono A, Silvestri E, Sconfienza LM (2015) Dynamic high-resolution ultrasound of the shoulder: how we do it. Eur J Radiol 84(2):266–277PubMed
10.
De Carli A, Vadala A, Zanzotto E, Zampar G, Vetrano M, Iorio R, Ferretti A (2012) Reparable rotator cuff tears with concomitant long-head biceps lesions: tenotomy or tenotomy/tenodesis? Knee Surg Sports Traumatol Arthrosc 20(12):2553–2558PubMed
11.
de la Fuente J, Blasi M, Martinez S, Barcelo P, Cachan C, Miguel M, Pedret C (2018) Ultrasound classification of traumatic distal biceps brachii tendon injuries. Skeletal Radiol 47(4):519–532PubMed
12.
de Vet HC, Mokkink LB, Terwee CB, Hoekstra OS, Knol DL (2013) Clinicians are right not to like Cohen’s kappa. BMJ 346:f2125PubMed
13.
Dubrow SA, Streit JJ, Shishani Y, Robbin MR, Gobezie R (2014) Diagnostic accuracy in detecting tears in the proximal biceps tendon using standard nonenhancing shoulder MRI. Open Access J Sports Med 5:81–87PubMedPubMedCentral
14.
Festa A, Allert J, Issa K, Tasto JP, Myer JJ (2014) Visualization of the extra-articular portion of the long head of the biceps tendon during intra-articular shoulder arthroscopy. Arthroscopy 30(11):1413–1417PubMed
15.
Gaskin CM, Anderson MW, Choudhri A, Diduch DR (2009) Focal partial tears of the long head of the biceps brachii tendon at the entrance to the bicipital groove: mR imaging findings, surgical correlation, and clinical significance. Skeletal Radiol 38(10):959–965PubMed
16.
Gazzillo GP, Finnoff JT, Hall MM, Sayeed YA, Smith J (2011) Accuracy of palpating the long head of the biceps tendon: an ultrasonographic study. PM R 3(11):1035–1040PubMed
17.
Ge H, Zhang Q, Sun Y, Li J, Sun L, Cheng B (2015) Tenotomy or tenodesis for the long head of biceps lesions in shoulders: a systematic review and meta-analysis. PLoS One 10(3):e0121286PubMedPubMedCentral
18.
Genovese E, Spano E, Castagna A, Leonardi A, Angeretti MG, Callegari L, Fugazzola C (2013) MR-arthrography in superior instability of the shoulder: correlation with arthroscopy. Radiol Med (Torino) 118:1022–1033
19.
Gill HS, El Rassi G, Bahk MS, Castillo RC, McFarland EG (2007) Physical examination for partial tears of the biceps tendon. Am J Sports Med 35(8):1334–1340PubMed
20.
Gilmer BB, DeMers AM, Guerrero D, Reid JB 3rd, Lubowitz JH, Guttmann D (2015) Arthroscopic versus open comparison of long head of biceps tendon visualization and pathology in patients requiring tenodesis. Arthroscopy 31(1):29–34PubMed
21.
Godeneche A, Kempf JF, Nove-Josserand L, Michelet A, Saffarini M, Hannink G, Collin P (2018) Tenodesis renders better results than tenotomy in repairs of isolated supraspinatus tears with pathologic biceps. J Shoulder Elbow Surg 27(11):1939–1945PubMed
22.
Godeneche A, Nove-Josserand L, Audebert S, Toussaint B, Denard PJ, Ladermann A (2017) Relationship between subscapularis tears and injuries to the biceps pulley. Knee Surg Sports Traumatol Arthrosc 25(7):2114–2120PubMed
23.
Habermeyer P, Magosch P, Pritsch M, Scheibel MT, Lichtenberg S (2004) Anterosuperior impingement of the shoulder as a result of pulley lesions: a prospective arthroscopic study. J Shoulder Elbow Surg 13(1):5–12PubMed
24.
Halma JJ, Eshuis R, Krebbers YMJ, Weits T, de Gast A (2012) Interdisciplinary inter-observer agreement and accuracy of MR imaging of the shoulder with arthroscopic correlation. Arch Orthop Trauma Surg 132:311–320PubMed
25.
Hawi N, Liodakis E, Garving C, Habermeyer P, Tauber M (2017) Pulley lesions in rotator cuff tears: prevalence, etiology, and concomitant pathologies. Arch Orthop Trauma Surg 137(8):1097–1105PubMed
26.
Hufeland M, Wicke S, Verde PE, Krauspe R, Patzer T (2019) Biceps tenodesis versus tenotomy in isolated LHB lesions: a prospective randomized clinical trial. Arch Orthop Trauma Surg 139(7):961–970PubMed
27.
Jacobson JA (2011) Shoulder US: anatomy, technique, and scanning pitfalls. Radiology 260(1):6–16PubMed
28.
29.
Kang Y, Lee JW, Ahn JM, Lee E, Kang HS (2017) Instability of the long head of the biceps tendon in patients with rotator cuff tear: evaluation on magnetic resonance arthrography of the shoulder with arthroscopic correlation. Skeletal Radiol 46(10):1335–1342PubMed
30.
Klauser AS, Tagliafico A, Allen GM, Boutry N, Campbell R, Court-Payen M, Grainger A, Guerini H, McNally E, O’Connor PJ, Ostlere S, Petroons P, Reijnierse M, Sconfienza LM, Silvestri E, Wilson DJ, Martinoli C (2012) Clinical indications for musculoskeletal ultrasound: a Delphi-based consensus paper of the European Society of Musculoskeletal Radiology. Eur Radiol 22(5):1140–1148PubMed
31.
Koh KH, Ahn JH, Kim SM, Yoo JC (2010) Treatment of biceps tendon lesions in the setting of rotator cuff tears: prospective cohort study of tenotomy versus tenodesis. Am J Sports Med 38(8):1584–1590PubMed
32.
Kukkonen J, Rantakokko J, Virolainen P, Aarimaa V (2013) The effect of biceps procedure on the outcome of rotator cuff reconstruction. ISRN Orthop 2013:840965PubMedPubMedCentral
33.
Lafosse L, Reiland Y, Baier GP, Toussaint B, Jost B (2007) Anterior and posterior instability of the long head of the biceps tendon in rotator cuff tears: a new classification based on arthroscopic observations. Arthroscopy 23(1):73–80PubMed
34.
Landis JR, Koch GG (1977) An application of hierarchical kappa-type statistics in the assessment of majority agreement among multiple observers. Biometrics 33(2):363–374PubMed
35.
Leroux T, Chahal J, Wasserstein D, Verma NN, Romeo AA (2015) A systematic review and meta-analysis comparing clinical outcomes after concurrent rotator cuff repair and long head biceps tenodesis or tenotomy. Sports Health 7(4):303–307PubMedPubMedCentral
36.
McFarland EG, Borade A (2016) Examination of the Biceps Tendon. Clin Sports Med 35(1):29–45PubMed
37.
Meraner D, Sternberg C, Vega J, Hahne J, Kleine M, Leuzinger J (2016) Arthroscopic tenodesis versus tenotomy of the long head of biceps tendon in simultaneous rotator cuff repair. Arch Orthop Trauma Surg 136(1):101–106PubMed
38.
Moon SC, Cho NS, Rhee YG (2015) Analysis of “hidden lesions” of the extra-articular biceps after subpectoral biceps tenodesis: the subpectoral portion as the optimal tenodesis site. Am J Sports Med 43(1):63–68PubMed
39.
Nazarian LN, Jacobson JA, Benson CB, Bancroft LW, Bedi A, McShane JM, Miller TT, Parker L, Smith J, Steinbach LS, Teefey SA, Thiele RG, Tuite MJ, Wise JN, Yamaguchi K (2013) Imaging algorithms for evaluating suspected rotator cuff disease: society of Radiologists in Ultrasound consensus conference statement. Radiology 267(2):589–595PubMedPubMedCentral
40.
Nourissat G, Tribot-Laspiere Q, Aim F, Radier C (2014) Contribution of MRI and CT arthrography to the diagnosis of intra-articular tendinopathy of the long head of the biceps. Orthop Traumatol Surg Res 100(8 Suppl):S391–394PubMed
41.
O’Brien SJ, Pagnani MJ, Fealy S, McGlynn SR, Wilson JB (1998) The active compression test: a new and effective test for diagnosing labral tears and acromioclavicular joint abnormality. Am J Sports Med 26(5):610–613PubMed
42.
Oh JH, Lee YH, Kim SH, Park JS, Seo HJ, Kim W, Park HB (2016) Comparison of treatments for superior labrum-biceps complex lesions with concomitant rotator cuff repair: a prospective, randomized, comparative analysis of debridement, biceps tenotomy, and biceps tenodesis. Arthroscopy 32(6):958–967PubMed
43.
Patel KV, Bravman J, Vidal A, Chrisman A, McCarty E (2016) Biceps tenotomy versus tenodesis. Clin Sports Med 35(1):93–111PubMed
44.
Saied AM, Redant C, El-Batouty M, El-Lakkany MR, El-Adl WA, Anthonissen J, Verdonk R, Audenaert EA (2017) Accuracy of magnetic resonance studies in the detection of chondral and labral lesions in femoroacetabular impingement: systematic review and meta-analysis. BMC Musculoskelet Disord 18(1):83PubMedPubMedCentral
45.
Saithna A, Longo A, Leiter J, Old J, MacDonald PM (2016) Shoulder arthroscopy does not adequately visualize pathology of the long head of biceps tendon. Orthop J Sports Med 4(1):2325967115623944PubMedPubMedCentral
46.
Schaeffeler C, Waldt S, Holzapfel K, Kirchhoff C, Jungmann PM, Wolf P, Stat D, Schroder M, Rummeny EJ, Imhoff AB, Woertler K (2012) Lesions of the biceps pulley: diagnostic accuracy of MR arthrography of the shoulder and evaluation of previously described and new diagnostic signs. Radiology 264:504–513PubMed
47.
Tadros AS, Huang BK, Wymore L, Hoenecke H, Fronek J, Chang EY (2015) Long head of the biceps brachii tendon: unenhanced MRI versus direct MR arthrography. Skeletal Radiol 44:1263–1272PubMed
48.
Taylor SA, Newman AM, Nguyen J, Fabricant PD, Baret NJ, Shorey M, Ramkumar P, O’Brien SJ (2016) Magnetic resonance imaging currently fails to fully evaluate the biceps-labrum complex and bicipital tunnel. Arthroscopy 32:238–244PubMed
49.
Walch G, Edwards TB, Boulahia A, Nove-Josserand L, Neyton L, Szabo I (2005) Arthroscopic tenotomy of the long head of the biceps in the treatment of rotator cuff tears: clinical and radiographic results of 307 cases. J Shoulder Elbow Surg 14(3):238–246PubMed
50.
Walch G, Nove-Josserand L, Levigne C, Renaud E (1994) Tears of the supraspinatus tendon associated with “hidden” lesions of the rotator interval. J Shoulder Elbow Surg 3(6):353–360PubMed
51.
Yablon CM, Bedi A, Morag Y, Jacobson JA (2013) Ultrasonography of the shoulder with arthroscopic correlation. Clin Sports Med 32(3):391–408PubMed
52.
Yoon JS, Kim SJ, Choi YR, Lee W, Kim SH, Chun YM (2018) Medial subluxation or dislocation of the biceps on magnetic resonance arthrography is reliably correlated with concurrent subscapularis full-thickness tears confirmed arthroscopically. Biomed Res Int 2018:2674061PubMedPubMedCentral
53.
Zhang Q, Zhou J, Ge H, Cheng B (2015) Tenotomy or tenodesis for long head biceps lesions in shoulders with reparable rotator cuff tears: a prospective randomised trial. Knee Surg Sports Traumatol Arthrosc 23(2):464–469PubMed
Metadata
Title
Magnetic resonance arthrography is insufficiently accurate to diagnose biceps lesions prior to rotator cuff repair
Authors
Elise Loock
Aude Michelet
Amaury D’Utruy
Pierre Molinazzi
Gerjon Hannink
Simon Bertiaux
Olivier Courage
Publication date
01-12-2019
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 12/2019
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-019-05633-w

Other articles of this Issue 12/2019

Knee Surgery, Sports Traumatology, Arthroscopy 12/2019 Go to the issue

SHOULDER

Intra-articular injection of steroids in the early postoperative period does not have an adverse effect on the clinical outcomes and the re-tear rate after arthroscopic rotator cuff repair

LETTER TO THE EDITOR

Reply to the letter to the editor: Comment on “Anterior cruciate ligament reconstruction performed within 12 months of the index injury is associated with a lower rate of medial meniscus tears”

SHOULDER

Operative treatment of torsional humeral shaft fractures in throwers leads to an earlier return to sport: a survey of expert shoulder and elbow surgeons

SHOULDER

Acromioclavicular joint augmentation at the time of coracoclavicular ligament reconstruction fails to improve functional outcomes despite significantly improved horizontal stability

SHOULDER

Superior clavicle drilling points and fluoroscopic inclination for anatomic coracoclavicular ligament reconstruction: a cadaveric study

SHOULDER

Acromioclavicular joint reconstruction: an additional acromioclavicular cerclage does not improve horizontal stability in double coraco-clavicular tunnel technique