Shoulder Long Head Biceps Tendon Pathology Is Associated With Increasing Rotator Cuff Tear Size.

Purpose: To evaluate the association between rotator cuff tear (RCT) size and long head biceps tendon (LHBT) pathology.

Methods: We retrospectively enrolled 202 consecutive patients (114 women and 88 men with mean age at surgery of 62.14 years [SD, 7.73]) who underwent arthroscopic rotator cuff repair for different sized full-thickness RCTs. LHBT pathology was evaluated considering the presence of inflammation, section alteration, loss of integrity, dislocation, dynamic instability, and absence. The site of LHBT pathology was evaluated considering 3 portions: (1) the insertional element; (2) the free intra-articular portion; (3) the part that enters the intertubercular groove. Statistics were evluated.

Results: The LHBT was absent in 22 cases (10.9%): 2, 4, 15, and 1 patients with small, large, massive, and subscapularis RCTs, respectively. A significant correlation was found between the prevalence of LHBT absence and massive RCTs ( < .001). In 53 patients (26%), there was a healthy LHBT; a healthy LHBT was present in 47%, 20% and 8% of small, large and massive RCTs, respectively. A significant correlation between LHBT inflammation, section alteration, loss of integrity, and RCT severity was found ( < .001, < .001, and ). The insertional portion was the most involved (57% of cases); RCT severity was significantly associated with the number of involved portions ( < .001).

Conclusions: Shoulder LHBT pathology is associated with increasing rotator cuff tear size.

Clinical Relevance: Surgeons should be aware that biceps pathology is particularly prevalent in patients with larger RTCs.