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. 2025;45(1):203-212.

Long Head of Biceps Tendinopathy: A Scoping Review of Classifications and Proposed Novel Classification System

William Curtis  1 , Ryan Price  1 , Eric Kruger  1 , Christopher Paiz  2 , Gehron Treme  1 , Dustin Richter  1 , Christopher Shultz  1
Affiliations

Long Head of Biceps Tendinopathy: A Scoping Review of Classifications and Proposed Novel Classification System

William Curtis et al. Iowa Orthop J. 2025.

Abstract

Background: While authors have subclassified long head of biceps tendon (LHBT) lesions in numerous ways, there is no classification system based solely on the arthroscopic appearance of the LHBT. We present a scoping review of the existing classification systems for LHBT tendinopathy and propose a novel classification based on its intraoperative, arthroscopic appearance.

Methods: We conducted a comprehensive search of classification systems for LHBT pathology using EMBASE and Ovid-Medline platforms. Our proposed classification system consists of four types based on intraoperative arthroscopic appearance of the LHBT: normal (A), erythema without fraying (B), fraying (C), and labral anchor instability (D). Fourteen arthroscopic videos and thirteen photos were reviewed by three orthopaedic sports medicine surgeons and two orthopaedic sports medicine fellows. Intra-and inter-observer reliability were assessed using Krippendorff's Alpha (α).

Results: Seventeen full length articles were included in our review, including classification systems based on visual characteristics, advanced imaging, and histology. For our proposed classification, there was excellent inter- and intra-observer reliability between all reviewers (α=0.92). Interobserver reliability when reviewing arthroscopic photos was also excellent (α=0.81). There was excellent agreement for all reviewers between video and photo cases (α=0.81).

Conclusion: The current literature lacks a concise classification system for LHBT tendinopathy based on its intraoperative, arthroscopic appearance. Our proposed classification system is intended to offer a simple and reproducible way to describe LHBT tendinopathy based on intraoperative arthroscopic appearance of the tendon. This classification has excellent inter- and intra-observer reliability when reviewing arthroscopic video cases as well as excellent inter-observer reliability when reviewing arthroscopic photos. This serves as a validation of classification for a future planned randomized control trial comparing LHBT tenodesis to benign neglect in the setting of rotator cuff repair. Level of Evidence: III.

Keywords: biceps tendinopathy; classification; long head of biceps tendon; shoulder arthroscopy.

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Conflict of interest statement

Disclosures: The authors report no potential conflicts of interest related to this study.

Figures

Figure 1:
Figure 1:
Literature search PRISMA diagram.
Figure 2:
Figure 2:
Illustration depicting novel classification system for long head of biceps tendinopathy.
Figure 3A to 3D.
Figure 3A to 3D.
Arthroscopic photograms depicting novel classification system. Type (3A) top left, (3B) top right, (3C) bottom left, and (3D) bottom right.
Figure 4:
Figure 4:
Inter- and intra-observer reliability of novel classification system based on arthroscopic video.
Figure 5:
Figure 5:
Inter- and intra-observer reliability of novel classification system based on arthroscopic photographs.
Figure 6:
Figure 6:
Agreement in classification between arthroscopic video and photographs.
See this image and copyright information in PMC

References

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