Inter- and intra-observer agreement in arthroscopic assessment of the long head of the biceps

Introduction: Long head of the biceps (LHB) pathology is frequent but can be difficult to diagnose. Arthroscopy is the current diagnostic gold-standard. The aim of the present study was to assess inter- and intra-observer agreement in arthroscopic analysis of the LHB.

Hypothesis: Agreement in arthroscopic analysis of the LHB is good in the particular case of small rotator cuff tears.

Material and methods: This prospective study included 49 patients operated on between November 1 and November 30, 2017. Seven surgeons were asked to record videos of arthroscopic LHB analysis for Patte-1 small supraspinatus tendon tears. One junior and 2 senior surgeons analyzed the videos independently, studying macroscopic intrinsic and extrinsic LHB aspect. Inter-observer agreement, and intra-observer agreement for the junior surgeon, were analyzed.

Results: Inter-observer agreement between the surgeons and intra-observer agreement for the junior surgeon were slight in describing the pathologic aspect of the LHB: respectively, κ=0.254, p<0.038; and κ=0.319, p<0.0019.

Discussion: Isolated arthroscopic LHB assessment without clinical or paraclinical input or precise surgical exploration protocol showed slight inter-observer agreement. Analysis and interpretation of LHB aspect should in practice be based on combined clinical, paraclinical and arthroscopic data.

Level of evidence: III.