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Author Reply to “Regarding ‘Editorial Commentary: Thank You, Thank You, Thank You…for Demonstrating Histologic Evidence of Shoulder Bicipital Tunnel Disease in the Absence of Magnetic Resonance Imaging Findings’”

      We appreciate the interest and comments from Saithna and Jordan regarding our recent study
      • Nuelle C.W.
      • Stokes D.C.
      • Kuroki K.
      • Crim J.R.
      • Sherman S.L.
      Radiologic and histologic evaluation of the proximal bicep pathology in patients with chronic biceps tendinopathy undergoing open subpectoral biceps tenodesis.
      and the corresponding editorial comments by Taylor.
      • Taylor S.A.
      Editorial Commentary: Thank you, thank you, thank you…for demonstrating histologic evidence of shoulder bicipital tunnel disease in the absence of magnetic resonance imaging findings.
      We would like to thank them for documenting further studies that also add to our understanding and management approach in patients with chronic long head of the biceps tendon pathology.
      Regarding the ability to fully visualize the extra-articular tendon arthroscopically, multiple studies have been published recently.
      • Bhatia D.N.
      • van Rooyen K.S.
      • de Beer J.F.
      Direct arthroscopy of the bicipital groove: A new approach to the evaluation and treatment of bicipital groove and biceps tendon pathology.
      • Saithna A.
      • Longo A.
      • Leiter J.
      • MacDonald P.
      • Old J.
      Biceps tenoscopy: Arthroscopic evaluation of the extra-articular portion of the long head of the biceps tendon.
      • Taylor S.A.
      • Khair M.M.
      • Gulotta L.V.
      • et al.
      Diagnostic glenohumeral arthroscopy fails to fully evaluate the biceps-labral complex.
      • Moon S.C.
      • Cho N.S.
      • Rhee Y.G.
      Analysis of “hidden lesions” of the extra-articular biceps after subpectoral biceps tenodesis: The subpectoral portion as the optimal tenodesis site.
      • Gilmer B.B.
      • DeMers A.M.
      • Guerrero D.
      • Reid J.B.
      • Lubowitz J.H.
      • Guttmann D.
      Arthroscopic versus open comparison of long head of biceps tendon visualization and pathology in patients requiring tenodesis.
      • Festa A.
      • Allert J.
      • Issa K.
      • Tasto J.P.
      • Myer J.J.
      Visualization of the extra-articular portion of the long head of the biceps tendon during intra-articular shoulder arthroscopy.
      • Sheean A.J.
      • Hartzler R.U.
      • Denard P.J.
      • Ladermann A.
      • Hanypsiak B.T.
      • Burkhart S.S.
      A 70° arthroscope significantly improves visualization of the bicipital groove in the lateral decubitus position.
      • Taylor S.A.
      • Newman A.
      • Dawson C.
      • et al.
      The “3-pack” examination is critical for comprehensive evaluation of the biceps-labrum complex and the bicipital tunnel: A prospective study.
      Whereas Bhatia et al.
      • Bhatia D.N.
      • van Rooyen K.S.
      • de Beer J.F.
      Direct arthroscopy of the bicipital groove: A new approach to the evaluation and treatment of bicipital groove and biceps tendon pathology.
      and Saithna et al.
      • Saithna A.
      • Longo A.
      • Leiter J.
      • MacDonald P.
      • Old J.
      Biceps tenoscopy: Arthroscopic evaluation of the extra-articular portion of the long head of the biceps tendon.
      have reported techniques to evaluate the tendon arthroscopically, there have been other studies documenting the limitations of diagnostic arthroscopy.
      • Taylor S.A.
      • Khair M.M.
      • Gulotta L.V.
      • et al.
      Diagnostic glenohumeral arthroscopy fails to fully evaluate the biceps-labral complex.
      • Moon S.C.
      • Cho N.S.
      • Rhee Y.G.
      Analysis of “hidden lesions” of the extra-articular biceps after subpectoral biceps tenodesis: The subpectoral portion as the optimal tenodesis site.
      • Gilmer B.B.
      • DeMers A.M.
      • Guerrero D.
      • Reid J.B.
      • Lubowitz J.H.
      • Guttmann D.
      Arthroscopic versus open comparison of long head of biceps tendon visualization and pathology in patients requiring tenodesis.
      • Festa A.
      • Allert J.
      • Issa K.
      • Tasto J.P.
      • Myer J.J.
      Visualization of the extra-articular portion of the long head of the biceps tendon during intra-articular shoulder arthroscopy.
      Sheean et al.
      • Sheean A.J.
      • Hartzler R.U.
      • Denard P.J.
      • Ladermann A.
      • Hanypsiak B.T.
      • Burkhart S.S.
      A 70° arthroscope significantly improves visualization of the bicipital groove in the lateral decubitus position.
      showed improved visualization of the bicipital groove (zone 1) with the aid of a 70° arthroscope, but zone 2 and zone 3 (subpectoral region) remained poorly visualized. Therefore, there may remain more distal “hidden” lesions
      • Taylor S.A.
      • Khair M.M.
      • Gulotta L.V.
      • et al.
      Diagnostic glenohumeral arthroscopy fails to fully evaluate the biceps-labral complex.
      that go unrecognized with routine arthroscopy with either a 30° or 70° arthroscope.
      We believe our recent study provides data that support our clinical thought, which is that there may often be pathology present further distal than the groove itself (past zone 1 and into zone 2). In addition, as Saithna and Jordan stated in their letter and as supported by our study results, even if you can perform a thorough intraoperative evaluation of the tendon, macroscopic changes in the long head of the biceps tendon do not always correlate with preoperative symptoms or imaging. In conclusion, I think we all agree that a thorough preoperative evaluation, inclusive of the history, appropriate physical examination maneuvers,
      • Taylor S.A.
      • Newman A.
      • Dawson C.
      • et al.
      The “3-pack” examination is critical for comprehensive evaluation of the biceps-labrum complex and the bicipital tunnel: A prospective study.
      and diagnostic imaging to evaluate concomitant pathologies, should all be considered, but the decision to perform a tenotomy or tenodesis should be made preoperatively to avoid potentially false-negative diagnostic arthroscopic findings.

      Supplementary Data

      References

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