Abstract
Background
Despite arthroscopy being the gold standard for long head of biceps pathology, the literature is seemingly lacking in any critical appraisal or validation to support its use. The aim of this study was to evaluate its appropriateness as a benchmark for diagnosis. The objectives were to evaluate whether the length of the tendon examined at arthroscopy allows visualisation of areas of predilection of pathology and also to determine the rates of missed diagnoses when compared to an open approach.
Methods
A systematic review of cadaveric and clinical studies was performed. The search strategy was applied to Medline, PubMed and Google Scholar databases. All relevant articles were included. Critical appraisal of clinical studies was performed using a validated quality assessment scale.
Results
Six articles were identified for inclusion in the review. This included both clinical and cadaveric studies. The overall population comprised 25 cadaveric specimens and 575 patients. Cadaveric studies showed that the use of a hook probe allowed arthroscopic visualisation of between 28% and 48% of the overall length of the LHB. In the clinical series the rate of missed diagnoses at arthroscopy when compared to open exploration ranged between 33% and 49%.
Conclusions
The standard technique of pulling the LHB tendon into the joint at glenohumeral arthroscopy provides only limited excursion and does not allow visualisation of areas of predilection of pathology. This is confirmed by an extremely high rate of missed diagnoses when comparing arthroscopy to open exploration. It is important that clinicians recognise that a “normal” arthroscopic examination of the LHB tendon does not exclude pathology and that published literature reporting sensitivities and specificities for physical examination and imaging tests based on arthroscopy as a gold standard are invalid.
Level of evidence
IIa – systematic review of cohort studies
Conflict of Interests
The authors confirm that they have no relevant financial disclosures or conflicts of interest.
Ethical approval was not sought as this was a systematic review.
