JSES - 2026-05-20 - Journal Article
ASSOCIATION BETWEEN LONG HEAD OF THE BICEPS TENDON ORIGIN AND ROTATOR CUFF TEARS: A MRI-BASED RETROSPECTIVE OBSERVATIONAL COHORT STUDY.
Dünki A, Birinci M, Kaya HB, Polat Ö, Çamur S, Çepni SK
Topics
Key Takeaway
Posterior LHBT glenoid origin is independently associated with increased odds of full-thickness rotator cuff tears (OR ~3.6 vs. supraglenoid tubercle origin, OR 0.27) in patients aged 45–70 undergoing shoulder MRI.
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Summary
This retrospective single-center case-control study examined whether MRI-classified LHBT origin pattern (posterior supraglenoid tubercle, supraglenoid tubercle, or dual attachment) is associated with full-thickness supraspinatus/infraspinatus tears in 1,067 patients aged 45–70. Full-thickness RC tear prevalence was 40.2%, and multivariable logistic regression controlling for age, sex, CSA, glenoid version, diabetes, LHBT subluxation, and subscapularis tear showed posterior LHBT origin carried significantly higher odds of RC tears compared to supraglenoid tubercle (OR 0.27) and dual attachment (OR 0.28) origins. The authors conclude that LHBT origin pattern is an independent morphologic marker of RC integrity.
Key Limitation
Cross-sectional design cannot determine whether posterior LHBT origin predisposes to RC tears or is a secondary adaptation to chronic cuff pathology, making causal directionality entirely unresolved.
Original Abstract
BACKGROUND
The long head of the biceps tendon (LHBT) plays an important role in glenohumeral stability and frequently coexists with rotator cuff (RC) pathology. Although anatomical variations in the glenoid origin of the LHBT have been described, their relationship with RC tears has not been fully elucidated. This study aimed to investigate the association between LHBT origin variations and the presence of full-thickness RC tears.
METHODS
This retrospective single-center cross-sectional case-control design, epidemiology study included patients aged 45-70 years who underwent shoulder magnetic resonance imaging (MRI) for the evaluation of chronic non-traumatic shoulder pain or suspected RC impingement syndrome between January and December 2024. LHBT origin was classified on routine MRI sequences into three patterns: posterior supraglenoid tubercle, supraglenoid tubercle, and dual attachment. Full-thickness RC tears involving the supraspinatus and/or infraspinatus tendons were evaluated. Scapular morphologic parameters, including critical shoulder angle (CSA) and glenoid version, as well as demographic variables and metabolic comorbidities, were recorded. Associations were analyzed using nonparametric tests and binary logistic regression.
RESULTS
A total of 1,067 patients were included (mean age, 56.5 ± 7.4 years). The overall prevalence of full-thickness RC tears was 40.2%. RC tears were significantly less associated in patients with a posterior LHBT origin compared with supraglenoid tubercle and dual attachment patterns (p < .001). Multivariable logistic regression analysis demonstrated that age, gender, CSA, glenoid version, DM, LHBT subluxation, Subscapularis tear and LHBT origin pattern were independently associated with RC tears. Using posterior LHBT origin as the reference category, supraglenoid tubercle origin (odds ratio [OR], 0.27) and dual attachment (OR, 0.28) were associated with lower odds of RC tears, indicating that posterior LHBT attachment was independently associated with an increased likelihood of RC tears (both p < .001).
CONCLUSION
LHBT origin variations are independently associated with the presence of full-thickness RC tears. A posterior LHBT origin appears to be associated with a lower frequency of RC tears, suggesting that LHBT origin pattern may represent a potential morphologic marker of RC integrity.
LEVEL OF EVIDENCE
Level III; Cross Sectional Case Control Design; Epidemiology Study.