Hôpital Privé Saint-Martin, 18, rue des Roquemonts, 14000 Caen, France.
Centre Ortho-Globe, place du Globe, 83000 Toulon, France.
Orthop Traumatol Surg Res. 2023 Dec;109(8S):103685. doi: 10.1016/j.otsr.2023.103685. Epub 2023 Sep 11.
Inter-observer arthroscopic assessments of the Long head of the Biceps tendon (LHB) injuries, in the absence of predefined instructions, are poorly reproducible. There are several types of LHB injuries, of varying severity, which can make its intraoperative analysis subjective.
The application of a precise arthroscopic exploration protocol, particularly dynamic, associated with an equally precise analysis of the possible tendon lesions, intrinsic or extrinsic, makes it possible to obtain a reproducible analysis of the lesions of the LHB and aid decision-making around its conservation or its resection, in distal supraspinatus tendon ruptures.
This was a prospective, multicenter study including 371 patients with a stage 1 rupture of the supraspinatus tendon, in accordance with the Patte classification. An exploration protocol with intraoperative video recording of the articular portion of the biceps was systematically performed by the operators. It included static intra-articular and extra-articular observation of the LHB, as well as a dynamic intra-articular hook test with mobilization in internal and external rotation, and in anterior elevation. An analysis of the lesion status of the LHB was then made by the principal operator (Op), after defining the various possible lesions: intrinsic or extrinsic. This initial diagnostic assessment was then compared with the analysis made by two independent observers (Obs1, Obs2) based on a replay of the recorded videos. The reliability of agreement was then measured using Cohen's Kappa coefficient (K) and Fleiss' kappa.
Two hundred and fifty-seven videos were analyzable. The level of agreement between the two independent observers was strong (K=0.63) for applying the diagnosis of a healthy or pathological biceps. The agreement between the independent observers and the operator was weaker (respectively K Op-Obs1=0.51 - moderate and K Op-Obs2=0.39 - poor).
The application of a precise protocol for the exploration of the LHB, associated with a previously defined lesion classification, makes it possible to obtain a high rate of agreement for the arthroscopic diagnostic analysis of the LHB. However, arthroscopy cannot be used as the only criterion for deciding which procedure to perform on the LHB. Other clinical and para-clinical factors must be taken into consideration.
III; prospective inter-observer series.
在缺乏预设指导的情况下，对肱二头肌长头腱（LHB）损伤进行的关节镜下观察者间评估，重现性较差。LHB 损伤有多种类型，严重程度不一，这使得术中分析具有主观性。
应用精确的关节镜探查方案，特别是动态方案，结合对内源性或外源性可能的肌腱损伤的同样精确的分析，可以对 LHB 的损伤进行可重现的分析，并有助于在肩袖远端肌腱撕裂时对 LHB 的保留或切除做出决策。
这是一项前瞻性、多中心研究，纳入了 371 例符合 Patte 分类的 I 期肩袖撕裂患者。操作人员系统地进行了带有关节内二头肌录像的探查方案。它包括对 LHB 的关节内和关节外静态观察，以及在内外旋和前向抬高时进行的动态关节内钩试验。然后，主要操作人员（Op）根据各种可能的损伤：内源性或外源性，对 LHB 的损伤状况进行分析。然后，将初始诊断评估与两位独立观察者（Obs1、Obs2）基于记录视频的回放进行的分析进行比较。然后使用 Cohen 的 Kappa 系数（K）和 Fleiss' kappa 来衡量一致性的可靠性。
可分析的视频有 257 个。两位独立观察者之间的诊断一致性很强（K=0.63），适用于健康或病理二头肌的诊断。独立观察者与操作人员之间的一致性较弱（分别为 K Op-Obs1=0.51-中度和 K Op-Obs2=0.39-差）。
应用精确的 LHB 探查方案，结合预先定义的损伤分类，可以提高 LHB 关节镜诊断分析的一致性。然而，关节镜不能作为决定对 LHB 进行何种手术的唯一标准。必须考虑其他临床和辅助临床因素。
III；前瞻性观察者间系列。
