JSES - 2026-04-01 - Journal Article
Ultrasound shear wave elastography-derived tissue stiffness predicts intra-articular lesions of the long head of the biceps tendon.
Zhang H, Hu D, Wu J, Teng Q, Zhang C, Hou H, Fang G, Zheng X, Zhong X
Topics
Key Takeaway
Preoperative shear wave elastography Δ shear modulus of the LHBT proximal to the bicipital groove correlates strongly with arthroscopic lesion severity (ρ = 0.750), with a diagnostic threshold >14 distinguishing normal from frayed tendon.
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Summary
This study evaluated whether preoperative SWE-derived shear modulus values could predict intra-articular LHBT lesion severity (4-type arthroscopic classification) in 71 patients with unilateral rotator cuff tears. Unilateral shear modulus was negatively correlated with lesion severity (ρ = -0.614 at the proximal groove), while Δ shear modulus between sides showed stronger positive correlation (ρ = 0.750 proximal, 0.659 intertubercular). ROC analysis identified a Δ shear modulus threshold >14 for discriminating Type I (normal) from Type II (frayed) lesions.
Key Limitation
The 4-type arthroscopic classification used lacks universal standardization, limiting reproducibility and cross-study comparison of the diagnostic thresholds reported.
Original Abstract
BACKGROUND
Rotator cuff tears often coexist with intra-articular lesions in the long head of the biceps tendon (LHBT). Currently, biceps tendon injuries are often overlooked during treatment. Therefore, it is necessary to effectively identify LHBT lesions before surgery. This study aimed to predict intra-articular lesions using preoperative shear wave elastography (SWE) to assist with subsequent treatment.
METHODS
This retrospective study included 71 patients with unilateral rotator cuff tears admitted to the hospital between September 2023 and August 2024. All patients underwent preoperative ultrasound and SWE examinations. The shear modulus of the affected side and the difference in shear modulus between the 2 sides (Δ shear modulus) were used to assess outcomes. SWE records were compared with arthroscopic findings to detect abnormalities in the intra-articular portion of the LHBT. Receiver operating characteristic curves were used to determine the optimal cut-off values of SWE measurements for discriminating intra-articular LHBT lesions.
RESULTS
Among the 71 patients, 54 had full-thickness supraspinatus tears and 17 had partial-thickness tears. Additionally, 26 cases involved infraspinatus tears and 39 involved subscapularis tears. Arthroscopic examination categorized LHBT lesions into 4 types: type I, 20 cases (normal); type II, 29 cases (frayed); type III, 17 cases (partial tear); and type IV, 5 cases (complete tear). Unilateral SWE measurements were significantly correlated with the arthroscopic classification of LHBT lesions, especially those proximal to the bicipital groove portion (ρ = -0.614). The Δ shear modulus values of LHBT proximal to the bicipital groove portion (ρ = 0.750) and within the intertubercular groove portion (ρ = 0.659) were positively correlated with the classification of LHBT lesions. The receiver operating characteristic curve identified an optimal diagnostic threshold of > 14 for distinguishing between types I and II.
CONCLUSION
Preoperative SWE values were negatively correlated with intra-articular LHBT lesions. The Δ shear modulus of the LHBT effectively predicts arthroscopic classification and accurately differentiates diseased tendons. These findings highlight the potential of SWE in preoperative assessments.