Purpose
To assess molecular and histologic differences between the proximal (intra-articular)
and distal (extra-articular) portions of the long head of the biceps (LHB) tendon
in 3 different disease states (biceps instability, tendinosis, and degenerative joint
disease [DJD]) compared with a healthy tendon (fresh frozen).
Methods
We used 32 LHB tendons of patients undergoing tenodesis (mean age, 54.7 ± 10.1 years)
and 9 harvested tissue donors. Tendons were divided according to 4 diagnostic groups:
(1) biceps instability, (2) tendinosis, (3) DJD, and (4) normal control. After sectioning,
tendons were fixed in formalin and stained with H&E and alcian blue for histologic
analysis. Measurements of collagen organization by use of polarized light microscopy
was then performed, and protein expression for type I and type III collagen, tenascin
C, and decorin was determined.
Results
There were no statistical differences found for protein expression of type I or type
III collagen, tenascin C, or decorin. The proximal and distal regions of the tendons
had statistically significant differences in alcian blue staining, with the proximal
portion containing a higher amount of proteoglycan (instability, P = .001; tendinosis, P = .005; DJD, P = .008; control, P = .011). When compared with the nonpathologic control tendons, a significant increase
in alcian blue staining for the proximal region was seen in all 3 groups. Total polarized
light analysis showed that the distal tendon had a significantly higher intensity
(organization) compared with the proximal tendon (P < .001); this was also seen in all of the diagnostic groups (instability, P = .010; tendinosis, P = .013; DJD, P = .07; control, P = .028).
Conclusions
This study showed a greater degree of degeneration of the proximal (intra-articular)
regions of the LHB tendon when compared with the distal regions in all pathologic
groups. However, no major differences at the cellular level were found among groups.
Clinical Relevance
The pathomechanisms of the various forms of known LHB diagnoses are not yet fully
understood and basic science studies may help in understanding their etiology and
therefore optimizing treatment options.
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Article info
Publication history
Published online: April 08, 2013
Accepted:
February 7,
2013
Received:
October 6,
2011
Footnotes
The authors report the following potential conflict of interest or source of funding in relation to this article: The University of Connecticut Health Center/New England Muscoloskeletal Institute has received direct funding or material support from Arthrex, Inc. The company had no influence on study design, data collection, or interpretation of the results or the final manuscript. A.D.M. receives research support from Arthrex and is also a consultant for Arthrex. A.A.R. receives research support from Arthrex Inc, Ossur, and Smith & Nephew; receives royalties and is a consultant for Arthrex Inc; and is a paid speaker for Arthrex, Inc, and DJ Orthopaedics.
Identification
Copyright
© 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
