Barth Johannes, Berhouet Julien, Gallinet David, Antoni Maxime, Dordain Franck, Bonnevialle Nicolas, Guery Jacques, Gadea François, Jacquot Adrien, Charousset Christophe
Department of Orthopedic Surgery, Clinique des Cedres, Echirolles, France.
Service de Chirurgie Orthopédique et Traumatologique, Centre Hospitalier Universitaire Grenoble Alpe Hôpital Sud, Grenoble, France.
Video J Sports Med. 2024 May 29;4(3):26350254231222030. doi: 10.1177/26350254231222030. eCollection 2024 May-Jun.
Considering the long head of biceps (LHB) management, important cultural differences exist among the surgeons around the world, especially when repairing small isolated distal supraspinatus tears under arthroscopy. In the perspective of an international survey to analyze our practice regarding biceps management in small rotator cuff tears, the aim is to collect all the possible LHB abnormalities according to literature review, before considering that the LHB could be normal or pathologic.
The SFA (Société Francophone d'Arthroscopie) behind its research biceps group summarized these abnormalities in a description analysis called the "biceps box" concept, which was validated with a strong inter-rater reliability. The aim is to present the description analysis using a common language with short video records for each abnormality described to reproduce "intraoperatively" the different possible scenarios the surgeon has to encounter during arthroscopic evaluation.
The description of the "biceps box" concept classifies lesions of the LHB, with so-called intrinsic lesions, for which the LHB should be considered pathological: partial rupture or delamination, fissuring, lateral or medial instability or subluxation, hypertrophy with an hourglass figure; and so-called extrinsic lesions, for which the LHB should be considered healthy: damage to the pulley without bicipital instability, exposure of the articular portion of the biceps by rupture of the supraspinatus tendon, inflammation of the superficial surface of the tendon, presence of type 1 or 2 superior labral anterior to posterior (SLAP) lesions, or a chondral print.
We present the 10 possible scenarios with video records according to our description analysis.
DISCUSSION/CONCLUSION: The LHB could be considered as a pain generator in certain situations which are still not completely clear. The indication of biceps tenotomy or tenodesis depends on the interpretation of the surgeon of these abnormalities as a pathologic or a normal condition. The next step is to use these videos in an international survey to assess cultural differences regarding the management and eventually find a consensus regarding treatment options for each abnormality.
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
在肱二头肌长头（LHB）的处理方面，世界各地的外科医生存在重要的文化差异，尤其是在关节镜下修复孤立的小肩袖远端撕裂时。从一项国际调查的角度来分析我们在小肩袖撕裂中对肱二头肌的处理实践，目的是在考虑LHB可能正常或病变之前，根据文献综述收集所有可能的LHB异常情况。
法国关节镜协会（SFA）的研究肱二头肌小组在一项名为“肱二头肌箱”概念的描述性分析中总结了这些异常情况，该分析具有很高的评分者间信度。目的是使用通用语言并结合短视频记录来呈现描述性分析，针对所描述的每种异常情况进行记录，以便在关节镜评估过程中“术中”重现外科医生可能遇到的不同场景。
“肱二头肌箱”概念的描述对LHB的病变进行了分类，有所谓的内在病变，对于这些病变，LHB应被视为病理性的：部分断裂或分层、裂隙、外侧或内侧不稳定或半脱位、沙漏形肥大；以及所谓的外在病变，对于这些病变，LHB应被视为健康的：滑轮损伤但肱二头肌无不稳定、肩袖肌腱断裂导致肱二头肌关节部分暴露、肌腱表面炎症、1型或2型上盂唇前向后方（SLAP）损伤的存在或软骨印记。
根据我们的描述性分析，我们用视频记录展示了10种可能的情况。
讨论/结论：在某些仍不完全清楚的情况下，LHB可被视为疼痛产生源。肱二头肌切断术或固定术的适应症取决于外科医生对这些异常情况是病理性还是正常情况的判断。下一步是在国际调查中使用这些视频，以评估处理方面的文化差异，并最终就每种异常情况的治疗方案达成共识。
作者证明已获得本出版物中出现的任何患者的同意。如果个体可能被识别，作者在本次提交发表的材料中包含了患者的豁免声明或其他书面批准形式。
