Changes in sarcomere length following tenotomy in the rat

Muscle stem cells and rotator cuff injury

The incidence of reinjury after treatment of rotator cuff tears (RCTs) remains very high despite the variety of nonoperative treatments and the high volume of surgical interventions performed. Muscle stem cells (MuSCs), also known as satellite cells, have risen to the forefront of rotator cuff tear research as a potential adjuvant therapy to aid unsatisfactory surgical outcomes. MuSCs are adult stem cells exhibiting the capacity to proliferate and self-renew, both symmetrically and asymmetrically. As part of this niche, they have been shown to adopt an activated phenotype in response to musculoskeletal injury and decrease their cellular populations during aging, implicating them as key players in both pathologic and normal physiological processes. While commonly connected to the regenerative phase of muscle healing, MuSCs also have the potential to differentiate into adverse morphologies. For instance, if MuSCs differentiate into adipocytes, the ensuing fatty infiltration serves as an obstacle to proper muscle healing and has been associated with the failure of surgical management of RCTs. With the potential to both harm and heal, we have identified MuSCs as a key player in RCT repair. To better understand this dichotomy, the following review will identify key studies regarding the morphology, function, and behavior of MuSCs with respect to RCTs and healing.

The neurophysiology of deforming spastic paresis: A revised taxonomy

This paper revisits the taxonomy of the neurophysiological consequences of a persistent impairment of motor command execution in the classic environment of sensorimotor restriction and muscle hypo-mobilization in short position. Around each joint, the syndrome involves 2 disorders, muscular and neurologic. The muscular disorder is promoted by muscle hypo-mobilization in short position in the context of paresis, in the hours and days after paresis onset: this genetically mediated, evolving myopathy, is called spastic myopathy. The clinician may suspect it by feeling extensibility loss in a resting muscle, although long after the actual onset of the disease. The neurologic disorder, promoted by sensorimotor restriction in the context of paresis and by the muscle disorder itself, comprises 4 main components, mostly affecting antagonists to desired movements: the first is spastic dystonia, an unwanted, involuntary muscle activation at rest, in the absence of stretch or voluntary effort; spastic dystonia superimposes on spastic myopathy to cause visible, gradually increasing body deformities; the second is spastic cocontraction, an unwanted, involuntary antagonist muscle activation during voluntary effort directed to the agonist, aggravated by antagonist stretch; it is primarily due to misdirection of the supraspinal descending drive and contributes to reducing movement amplitude; and the third is spasticity, one form of hyperreflexia, defined by an enhancement of the velocity-dependent responses to phasic stretch, detected and measured at rest (another form of hyperreflexia is "nociceptive spasms", following flexor reflex afferent stimulation, particularly after spinal cord lesions). The 3 main forms of overactivity, spastic dystonia, spastic cocontraction and spasticity, share the same motor neuron hyperexcitability as a contributing factor, all being predominant in the muscles that are more affected by spastic myopathy. The fourth component of the neurologic disorder affects the agonist: it is stretch-sensitive paresis, which is a decreased access of the central command to the agonist, aggravated by antagonist stretch. Improved understanding of the pathophysiology of deforming spastic paresis should help clinicians select meaningful assessments and refined treatments, including the utmost need to preserve muscle tissue integrity as soon as paresis sets in.

Local inhibition of nitrergic activity in tenotomized rats accelerates muscle regeneration by increasing fiber area and decreasing central core lesions

Muscular atrophy is a progressive degeneration characterized by muscular proteolysis, loss of mass and decrease in fiber area. Tendon rupture induces muscular atrophy due to an intrinsic functional connection. Local inhibition of nitric oxide synthase (NOS) by Nω-nitro-L-arginine methyl ester (L-NAME) accelerates tendon histological recovery and induces functional improvement. Here we evaluate the effects of such local nitrergic inhibition on the pattern of soleus muscle regeneration after tenotomy. Adult male Wistar rats (240 to 280 g) were divided into four experimental groups: control (n=4), tenotomized (n=6), vehicle (n=6), and L-NAME (n=6). Muscular atrophy was induced by calcaneal tendon rupture in rats. Changes in muscle wet weight and total protein levels were determined by the Bradford method, and muscle fiber area and central core lesion (CCL) occurrence were evaluated by histochemical assays. Compared to tenotomized (69.3±22%) and vehicle groups (68.1%±17%), L-NAME treatment induced an increase in total protein level (108.3±21%) after 21 days post-injury. A reduction in fiber areas was observed in tenotomized (56.3±1.3%) and vehicle groups (53.9±3.9%). However, L-NAME treatment caused an increase in this parameter (69.3±1.6%). Such events were preceded by a remarkable reduction in the number of fibers with CCL in L-NAME-treated animals (12±2%), but not in tenotomized (21±2.5%) and vehicle groups (19.6±2.8%). Altogether, our data reveal that inhibition of tendon NOS contributed to the attenuation of atrophy and acceleration of muscle regeneration.

Effects of a Resting Foot Splint in Early Brain Injury Patients

Objective

To assess the effectiveness of the resting foot splint to prevent ankle contracture.

Methods

We performed a randomized controlled trial in 33 patients with brain injury with ankle dorsiflexor weakness (muscle power ≤grade 2). Both groups continued conventional customized physical therapy, but the patients in the foot splint group were advised to wear a resting foot splint for more than 12 hours per day for 3 weeks. The data were assessed before and 3 weeks after the study. The primary outcome was the change in ankle dorsiflexion angle after 3 weeks.

Results

Before the study, there were no differences between groups in gender, age, time post-injury, brain injury type, initial edema, spasticity, passive range of ankle dorsiflexion, Fugl-Meyer score (FMS), or Functional Ambulation Classification. A significant improvement in ankle dorsiflexion angle, and FMS was found after 3 weeks in both groups. The splint group showed more spasticity than the control group after 3 weeks (p=0.04). The change of ankle dorsiflexion angle, foot circumference, spasticity, and FMS after adjusting initial value and spasticity were not significantly different between the 2 groups.

Conclusion

Wearing a resting foot splint for 3 weeks did not affect joint mobility in patients with subacute brain injury regularly attending personalized rehabilitation programs. Further studies of larger sample sizes with well controlled in spasticity are required to evaluate the effects of the resting foot splint.

Quantifying changes in material properties of stroke-impaired muscle

BACKGROUND

Material properties of muscles are clinically important parameters for evaluating altered muscle function. Stroke survivors display motor impairments almost immediately after the vascular event, and then gradually develop altered muscle properties. Little is known about the magnitude of these changes in muscle material properties, specifically stiffness. Previous measures of stiffness are limited to estimates of joint stiffness or groups of muscles. Thus, our aim was to determine changes in passive muscle stiffness and composition by measuring: (1) shear wave speed using shear wave ultrasound elastography and (2) echo intensity of the B-mode ultrasound images of the biceps brachii muscle in individuals who have had a stroke.

METHODS

Shear wave ultrasound elastography and B-mode ultrasound images of the biceps brachii muscle of the paretic and non-paretic limbs of sixteen stroke survivors were captured at rest.

FINDINGS

Our main results show that shear wave speed and echo intensity of the paretic side were on average 69.5% and 15.5% significantly greater than those of the non-paretic side, respectively. Differences in shear wave speed between the non-paretic and the paretic muscles were strongly correlated with differences in echo intensity, time since stroke, and with Fugl-Meyer scores.

INTERPRETATION

Muscle stiffness and muscle composition, as indicated by SW speed and echo intensity, may be altered in stroke-impaired muscle at rest. These findings highlight the potential for SW elastography as a tool for both investigating the fundamental mechanisms behind changes in stroke-impaired muscle, and for evaluation of muscle mechanical properties as part of clinical examination.

Passive skeletal muscle excursion after tendon rupture correlates with increased collagen content in muscle

PURPOSE

This study was designed to measure time-dependent changes in muscle excursion and collagen content after tenotomy, and to analyze the correlation between muscle excursion and collagen content in a rabbit model.

MATERIALS AND METHODS

Twenty-four rabbits underwent tenotomy of the second extensor digitorum longus (EDL) muscles on the right legs and were randomly assigned to three groups based on the period of time after tenotomy (2, 4, and 6 weeks). The second EDL muscles on left legs were used as controls. At each time after tenotomy, passive muscle excursion and collagen content, determined by hydroxyproline content, were measured bilaterally, and the ratio of each value to the normal one was used.

RESULTS

The mean ratio of muscle excursion after tenotomy to the value of the control decreased in a time-dependent fashion: 92.5% at 2 weeks, 78.6% at 4 weeks, and 55.1% at 6 weeks. The mean ratio of hydroxyproline content in muscle to the value of the control increased in a time-dependent fashion: 119.5% at 2 weeks, 157.3% at 4 weeks, and 166.6% at 6 weeks. There was a significant negative correlation between the ratio of hydroxyproline content in muscle after tenotomy to the control values and the ratio of muscle excursion after tenotomy to the control values (r=-0.602, p=0.002).

CONCLUSION

The decrease in muscle excursion seems to correlate with the increase in collagen content in the muscle in a time-dependent fashion following tenotomy.

2013 Neer Award: Effect of the adipose-derived stem cell for the improvement of fatty degeneration and rotator cuff healing in rabbit model

BACKGROUND

This study was conducted to verify the effects of adipose-derived stem cells (ADSCs) on tendon healing and reversal of fatty infiltration in a chronic rotator cuff tear model by using the rabbit subscapularis (SSC).

METHODS

The SSC insertions in 32 rabbits were cut bilaterally. After 6 weeks, secondary procedures were performed bilaterally, dividing the rabbits into 4 groups of 8 rabbits each as follows: the ADSC+repair group, saline+repair group, ADSC-only group, and saline-only group. A fifth group of 8 rabbits served as normal controls (control group). Electromyographic, biomechanical, and histologic analyses were performed 6 weeks after the secondary procedures.

RESULTS

All SSC tendons in the ADSC-only and saline-only groups failed to heal and were excluded from the electromyographic and biomechanical tests. On electromyographic evaluation, the ADSC+repair group exhibited a larger compound muscle action potential area than the saline+repair group (11.86 ± 2.97 ms · mV vs 9.42 ± 3.57 ms · mV, P = .029), and this response was almost at the level of the control group (13.17 ± 6.6 3 ms · mV, P = .456). Biomechanically, the load-to-failure of the ADSC+repair group (87.02 ± 29.81 N) was higher than that of the saline+repair group (59.85 ± 37.77 N), although this difference did not reach statistical significance (P = .085). Histologically, the mean proportions of fatty infiltration in the SSC muscles were 29% ± 15%, 43% ± 9%, 51% ± 14%, 63% ± 10%, and 18% ± 9% for the ADSC+repair, saline+repair, ADSC-only, saline-only, and control groups, respectively (P < .001). The degree of fat staining increased from the ADSC+repair group (unclear or weak) to the saline-only group (strongly present).

CONCLUSION

Local administration of ADSCs might have the possibility to improve muscle function and tendon healing and decrease fatty infiltration after cuff repair.

Mechanisms of fatty degeneration in massive rotator cuff tears

Fatty degeneration of chronically injured muscle is a commonly recognized consequence of massive rotator cuff tears. Current surgical treatments are unable to alter or reverse the progression of fatty degeneration and are associated with poor functional outcomes in these patients. Therefore, a better understanding of the pathophysiology of fatty degeneration is required. As such, recent discoveries in stem cell biology and new animal models have significantly advanced our understanding of the cellular and molecular basis of fatty degeneration. Future studies will facilitate development of novel treatments to prevent the progression of fatty degeneration and improve muscle regeneration in patients with massive rotator cuff tears.

Evaluation of in vivo rotator cuff muscle function after acute and chronic detachment of the supraspinatus tendon: an experimental study in an animal model

BACKGROUND

Surgical repair of large chronic rotator cuff tears can be technically demanding because it requires manipulation of a muscle-tendon unit that is scarred, retracted, and stiffer than normal, all of which contribute to increased tension at the repair site. The purpose of the present study was to characterize the in vivo rotator cuff muscle-tendon unit function after acute and chronic injury at surgically relevant preload tensions.

METHODS

Sixty-two Sprague-Dawley rats were divided into a healthy, uninjured (control) group (n = 22), an acute injury group (n = 20), and a chronic injury group (n = 20) and underwent in vivo muscle force testing and electromyographic testing of the supraspinatus muscle-tendon unit at various preload tensions.

RESULTS

Preload tension affected the maximum supraspinatus muscle contractile force in all groups (p < 0.05). At the peak tension required to repair an acute tear, there was a 28% to 30% reduction in maximum tetanic contraction amplitude in all groups (p < 0.05). At the peak tension required to repair a chronic tear, there was a 40% to 53% reduction in maximal tetanic contraction amplitude in all groups (p < 0.05). The uninjured (control) group showed increased muscle endurance (p < 0.05) in comparison with the acute injury and chronic injury groups at all preload tensions. The chronic injury group showed reduced compound motor action potential amplitude (p < 0.05).

CONCLUSIONS

Both the acute and chronic injury groups demonstrated functional impairment related to increasing preload tensions. Higher repair tensions, associated with the chronic injury setting, resulted in greater functional impairment. The present study also demonstrates an association between increased time from rotator cuff tendon injury and impaired in vivo rotator cuff muscle electromyographic findings.

Development of fatty atrophy after neurologic and rotator cuff injuries in an animal model of rotator cuff pathology

BACKGROUND

Detachment of a tendon from its osseous insertion, as can be the case with severe rotator cuff injuries, leads to atrophy of and increased fat in the corresponding muscle. We sought to validate a rotator cuff injury model in the rabbit and to test the hypothesis that tenotomy of a rotator cuff tendon would consistently create muscle atrophy and fatty degeneration analogous to the changes that occur after injury to a nerve innervating the same muscle.

METHODS

New Zealand white rabbits were divided into three groups: (1) partial rotator cuff tear without retraction of the muscle, (2) complete rotator cuff tear with retraction of the muscle, and (3) nerve transection of the subscapular nerve. Animals were killed at two or six weeks after injury, and the muscles were analyzed for weight, cross-sectional area, myosin fiber-type composition, and fat content. In addition, the subscapular nerve was harvested at two weeks and evaluated for neuronal injury.

RESULTS

At six weeks after injury, the rabbit muscles in the complete tenotomy and nerve transection groups had significant decreases in wet mass and increases in fat content relative to the control groups. Fat accumulation had a similar spatial pattern at six weeks in both the nerve transection and complete tenotomy groups. Such changes were not seen in the partial tenotomy group. No change was found in muscle myosin fiber-type composition. At two weeks after injury, subscapular nerves in the complete tenotomy group showed gross evidence of neuronal injury.

CONCLUSIONS

This study establishes the rabbit subscapularis muscle as a valid model to study the muscular changes associated with rotator cuff tears. Our data suggest that the muscular changes associated with complete tenotomy are comparable with those seen with denervation of the muscle and suggest that chronic rotator cuff tears may induce a neurologic injury.

Muscle force and power following tendon repair at altered tendon length

BACKGROUND

While a great deal is known regarding the performance of muscle with intact tendon, little is known about muscle performance when tendon is surgically lengthened or shortened. This knowledge may allow surgeons to more accurately predict functional outcome following tendon repair when correcting a simple tendon laceration or performing a more complex vascularized neuromuscular transfer.

MATERIALS AND METHODS

We studied muscle performance 12 wk following extensor tendon repairs producing altered tendon lengths. Forty male Fischer 344 rats underwent division of the proximal and distal tendons of the extensor digitorum longus muscle. Tendons were immediately repaired producing tendons with increased length, decreased length, or presurgical length (control). Observation confirmed that altered tendon length produced inverse changes in initial resting muscle tension.

RESULTS

Muscle in the decreased tendon length group demonstrated a 15.2% greater muscle mass, 4.9% greater muscle length, 9.6% greater physiological cross-sectional area, 12.6% greater maximum isometric force, and 31.9% greater maximum power relative to the control tendon length group (P < 0.05). The increased tendon length group did not differ significantly from the control tendon length group for any measurement. Histologically, muscles set with a decreased tendon length demonstrated normal appearing hypertrophied fibers, without evidence of detrimental histological effects such as fibrosis, denervation, necrosis, inflammation, fiber type changes, or fiber splitting.

CONCLUSION

These data support the clinical practice of setting muscles with increased passive tension when performing tendon transfer surgeries. Conversely, setting muscles with decreased tension does not necessarily result in a force or power deficit.

The effect of muscle length and excursion on muscle contracture after tendon injury: a study in rabbit soleus muscles

If tendon repair after injury is delayed, intramuscular fibrosis occurs and finally results in irreversible muscle contracture. The purpose of this study was to determine the effect of preserving muscle length and excursion on the progression of muscle contracture after tendon injury in a rabbit soleus tenotomy model. Forty rabbits underwent tenotomy of the soleus muscles bilaterally and the tendons were managed according to the five experimental groups (N=40). In group A, the tendon was lengthened maintaining half the excursion. In group B, maximal muscle length was preserved and in group C, resting muscle length was maintained. In group D, the tendon was allowed to retract and undergo fibrosis. In group E, the tendon was partially transected and repaired. Four and 8 weeks postoperatively, soleus muscles were harvested from each hind limb and histomorphometric evaluations were performed to measure the connective tissue areas. Electrophysiological studies were carried out to measure the compound muscle action potential to assess the number of functioning muscle fibres. The results showed that maximal muscle length preservation (group B) was the most protective in preventing muscle contracture within 4 weeks of tenotomy, but this effect was gradually offset by prolonged fixation of the muscle, and 8 weeks after tenotomy, maintenance of excursion (group A) was the most protective. These observations may be helpful in the intra-operative evaluation of muscle contracture in neglected tendon ruptures, and could be applied to the management of acute tendon injuries to prevent muscle contracture when immediate anatomical reconstruction is not possible.

The role of neural and mechanical influences in maintaining normal fast and slow muscle properties

The relative importance of neural and mechanical influences in maintaining normal slow and fast muscle properties remains unclear. To address this issue, we studied the effects of 10 days of hindlimb unloading (HU) with or without tenotomy and/or denervation on the cross-sectional area (CSA), myosin heavy chain (MHC) expression (immunohistochemistry) and composition (gel electrophoresis), and myonuclear number in soleus and plantaris fibers in adult male Wistar rats. In general, the adaptations in fiber type and size were similar using either single fiber gel or immunohistochemical analyses. HU resulted in atrophy of type I and I+IIa/x MHC fibers in the soleus and in type I, I+IIa/x, IIa/x, IIa/x+IIb, and IIb MHC fibers in the plantaris. Addition of tenotomy and/or denervation in HU rats had minimal effects on fiber CSA in the soleus, but fiber CSA in the plantaris further decreased, particularly in fibers expressing only fast MHCs. HU resulted in a de novo appearance of type I+IIa/x+IIb and IIa/x+IIb MHC fibers in the soleus and of type I+IIa/x+IIb MHC fibers in the plantaris. Tenotomy and/or denervation in HU rats had no further effect on the fiber type composition of either muscle. Mean myonuclear number/mm of type I fibers was decreased in the soleus of HU rats, and increased in type I and I+IIa/x fibers in HU plus tenotomy (HU+Ten) rats. In the plantaris, mean myonuclear number/mm of type IIa/x, IIa/x+IIb, and IIb fibers was lower after HU with or without tenotomy and/or denervation. Mean cytoplasmic volume/myonucleus ratio of type I and I+IIa/x fibers in the soleus of the HU group tended to be smaller than in controls. The largest decrease was noted in the HU+Ten group. In the plantaris, this ratio was unaffected by HU alone, but was decreased by addition of tenotomy and/or denervation when all fiber types were combined. These data indicate that the major cause of fiber atrophy and adaptations in myonuclear domain size in the slow soleus of HU rats is the chronic reduction in force generation, whereas the elimination of neuromuscular contact via denervation results in additional fiber atrophy and adaptations in myonuclear domain size in the fast plantaris.

Changes in rotator cuff muscle volume, fat content, and passive mechanics after chronic detachment in a canine model

BACKGROUND

Long-standing tears of the rotator cuff can lead to substantial and perhaps irreversible changes in the affected rotator cuff muscles. We developed a chronic rotator cuff tear in a canine model to investigate and quantify the time-related changes in passive mechanics, volume, and fat of the infraspinatus muscle. We hypothesized that infraspinatus muscle stiffness would increase, volume would decrease, and fat content would increase at twelve weeks following tendon detachment.

METHODS

The right infraspinatus tendon of eight adult mongrel dogs were surgically detached from the proximal part of the humerus. The uninvolved left shoulder served as a control. Muscle volume changes were quantified with use of magnetic resonance imaging. At twelve weeks, the passive mechanical properties of the chronically detached and control muscles were determined intraoperatively with use of a custom-designed device. Intramuscular fat was evaluated histologically at the time that the animals were killed.

RESULTS

After twelve weeks of detachment, the stiffness was significantly increased in the detached infraspinatus muscles relative to that in the controls (p < 0.0001). Magnetic resonance image analysis demonstrated that the detached muscle volumes decreased by an average of 32% in the first six weeks and remained constant thereafter. Intramuscular fat increased significantly in the detached muscles and to a greater extent in the lateral regions (p < 0.05).

CONCLUSIONS

The chronically detached muscle is not merely a smaller version of the original muscle but, rather, a different muscle. The detached muscle becomes stiffer, and the passive loads required to repair it can become excessive. A significant reduction in muscle volume occurs within days to weeks following tendon detachment (p < 0.0001). The nonuniformity of changes in muscle fat suggests that fat content should be used cautiously as an indicator of muscle quality.

Pathophysiology of spastic paresis. I: Paresis and soft tissue changes

Spastic paresis follows chronic disruption of the central execution of volitional command. Motor function in patients with spastic paresis is subjected over time to three fundamental insults, of which the last two are avoidable: (1) the neural insult itself, which causes paresis, i.e., reduced voluntary motor unit recruitment; (2) the relative immobilization of the paretic body part, commonly imposed by the current care environment, which causes adaptive shortening of the muscles left in a shortened position and joint contracture; and (3) the chronic disuse of the paretic body part, which is typically self-imposed in most patients. Chronic disuse causes plastic rearrangements in the higher centers that further reduce the ability to voluntarily recruit motor units, i.e., that aggravate baseline paresis. Part I of this review focuses on the pathophysiology of the first two factors causing motor impairment in spastic paresis: the vicious cycle of paresis-disuse-paresis and the contracture in soft tissues.

Passive stretch inhibits central corelike lesion formation in the soleus muscles of hindlimb-suspended unloaded rats

Hindlimb suspension unloading (HSU) is a ground-based model simulating the effects of microgravity unloading on the musculoskeletal system. In this model, gravity causes the hind foot of the rat to drop, opening the front of the ankle to 90–105° plantar flexion at rest. As HSU proceeds, the normal weight-bearing angle of 30° dorsiflexion is achieved progressively less, and the contraction range of soleus is abbreviated. Our laboratory reported that 12 days of HSU caused central corelike lesions (CCLs) of myofibril breakdown (Riley DA, Slocum GR, Bain JL, Sedlak FR, Sowa TE, and Mellender JW. J Appl Physiol. 69: 58–66, 1990). The present study investigated whether daily stretch of the calf muscles prevents CCL formation. The soleus muscles of HSU Sprague-Dawley male rats (∼287 g) were lengthened by unilateral ankle splinting at 30°. Compared with the nonsplinted side, splinting for 10 or 20 min per day in awake rats significantly decreased CCLs in soleus by 88 and 91%, respectively ( P < 0.01). Compared with control muscle wet weight, 20-min splinting reduced atrophy by 33%, whereas 10-min splinting ameliorated atrophy by 17% ( P < 0.01). Bilateral soleus electromyograph recording revealed higher levels of contractile activity on the splinted side during splinting. To isolate the effects of stretch from isometric contractile activity, contractions were eliminated by whole animal anesthesia with isoflurane during 10-min daily splinting. The percentage of fibers with CCLs was reduced by 57%, and the average lesion size was 29% smaller in the stretched muscle ( P < 0.05). Soleus muscle wet weight and fiber area were unaltered by stretch alone. Loaded contractions during splinting are necessary to prevent muscle fiber atrophy. Passive muscle stretch acts to maintain myofibril structural integrity.

Regulation of dihydropyridine receptor gene expression in mouse skeletal muscles by stretch and disuse

This study examined dihydropyridine receptor (DHPR) gene expression in mouse skeletal muscles during physiological adaptations to disuse. Disuse was produced by three in vivo models-denervation, tenotomy, and immobilization-and DHPR alpha1s mRNA was measured by quantitative Northern blot. After 14-day simultaneous denervation of the soleus (Sol), tibialis anterior (TA), extensor digitorum longus (EDL), and gastrocnemius (Gastr) muscles by sciatic nerve section, DHPR mRNA increased preferentially in the Sol and TA (+1.6-fold), whereas it increased in the EDL (+1.6-fold) and TA (+1.8-fold) after selective denervation of these muscles by peroneal nerve section. It declined in all muscles (-1.3- to -2.6-fold) after 14-day tenotomy, which preserves nerve input but removes mechanical tension. Atrophy was comparable in denervated and tenotomized muscles. These results suggest that factor(s) in addition to inactivity per se, muscle phenotype, or associated atrophy can regulate DHPR gene expression. To test the contribution of passive tension to this regulation, we subjected the same muscles to disuse by limb immobilization in a maximally dorsiflexed position. DHPR alpha1s mRNA increased in the stretched muscles (Sol, +2.3-fold; Gastr, +1.5-fold) and decreased in the shortened muscles (TA, -1.4-fold; EDL, -1.3-fold). The effect of stretch was confirmed in vitro. DHPR protein did not change significantly after 4-day immobilization, suggesting that additional levels of regulation may exist. These results demonstrate that DHPR alpha1s gene expression is regulated as an integral part of the adaptive response of skeletal muscles to disuse in both slow- and fast-twitch muscles and identify passive tension as an important signal for its regulation in vivo.

Physiological effects of botulinum toxin in spasticity

There is considerable evidence that injection of botulinum toxin (BTX) into muscles with spastic overactivity reduces resistance to passive movement in joints supplied by the injected muscles. The demonstration of improvement in active performance of the paretic limbs has been only anecdotal to date, and represents the most difficult challenge in research on BTX therapy in spastic paralysis. Data are reviewed that indicate several neurophysiological actions of BTX, other than the blocking of acetylcholine release at the neuromuscular ending: effects on the central nervous system, including retrograde axonal transport, reduced motoneuronal excitability, action on central synapses such as decreased Renshaw inhibition and increased presynaptic inhibition; action on gamma motoneuronal endings; action on most active terminals; spread of BTX to neighboring muscles; spread of BTX effects to remote muscles. Several of these neurophysiological actions are likely to contribute to improvement in active movements, as they may antagonize the primary mechanisms of functional impairment in patients with spastic paralysis: weakness, spastic cocontraction, spastic dystonia, and muscle shortening. We review the evidence for reduction of spastic cocontraction in both the injected muscle and its antagonist, and for improvement of antagonist weakness after BTX injection. The capacity of intramuscular BTX to reduce spastic dystonia and lengthen shortened muscles is also discussed based on prior literature. When injected into the more overactive of a pair of spastic antagonists around a joint, BTX should affect all the main mechanisms impairing active function around the joint.

Differential expression of neural cell adhesion molecule (NCAM) after tenotomy in rabbit skeletal muscle

Tenotomy is a commonly encountered event in orthopaedic surgery. In 23 rabbit extensor digitorum longus (EDL) muscles, within 24 h after tenotomy, a marked drop in maximum force production occurred. This was not explainable based on architectural changes and histological examination using standard markers for muscle injury, i.e., haematoxylin and eosin morphology, developmental myosin heavy chain (MHC) immunolabeling, and quantitation of muscle fiber type percentage, area and distribution. The expression of neural cell adhesion molecule (NCAM), a glycoprotein expressed during muscle development was measured as a function of time in these muscles. NCAM expression was increased as early as one day after tenotomy with 2.2+/-1.2% of the fibers showing positive expression. This expression level increased significantly to 15.4+/-15.2% after 7 days and then subsided to 13.2+/-10.6% 21 days after tenotomy. Two-way analysis of variance demonstrated a significant effect of time and a significant time x tenotomy method interaction. These results suggest that tenotomy leads to possible changes in muscle-nerve connections and/or excitation-contraction (EC) coupling.

Formation of unique vacuoles in tenotomized rat soleus muscle fibers

The formation of unique vacuoles in tenotomized rat soleus muscle fibers was examined by light and electron microscopy. After tenotomy at both proximal and distal tendons, virtually all muscle fibers underwent characteristic degenerative changes with a disorganization of myofibrils called the central core lesion, but eventually recovered. At 3 days after tenotomy, some muscle fibers showed small vacuoles in the sarcoplasm of the end segments, which were larger in diameter and paler in staining than those of the control fibers in light microscopy. At 5 days, more fibers formed larger vacuoles together with the extensive disorganization of myofibrils. Such vacuole formation was more conspicuous in the distal end than in the proximal end. At 1 week the myofibrillar disorganization was most extensive in the central areas, and vacuoles were considerably enlarged in some fibers to occupy most of the sarcoplasm near the fiber ends. Vacuoles decreased in number and size with time and could rarely be seen at 4 weeks postoperative. In thin-section electron microscopy, the early forms of vacuoles were often connected with the T-system tubules. The limiting membrane of such vacuoles possessed many caveolae, some of which appeared to be continuous with the T-system networks. The vacuole membrane was closely associated with the sarcoplasmic reticulum to form dyadic connections. In later stages, the vacuole membrane was lined in part with the basal lamina. From these findings, it can be concluded that the vacuoles are sarcolemmal in nature and derived from the T-system. The significances of the vacuole formation are discussed with special reference to the mechanism and fate of the vacuoles and their clinical implications.

Functional and clinical significance of skeletal muscle architecture

Skeletal muscle architecture is the structural property of whole muscles that dominates their function. This review describes the basic architectural properties of human upper and lower extremity muscles. The designs of various muscle groups in humans and other species are analyzed from the point of view of optimizing function. Muscle fiber arrangement and motor unit arrangement is discussed in terms of the control of movement. Finally, the ability of muscles to change their architecture in response to immobilization, eccentric exercise, and surgical tendon transfer is reviewed. Future integrative physiological studies will provide insights into the mechanisms by which such adaptations occur. It is likely that muscle fibers transduce both stress and strain and respond by modifying sarcomere number in a way more suited to the new biomechanical environment.

Skeletal muscle response to tenotomy

Tenotomy is a commonly encountered clinical entity, whether traumatic or iatrogenic. This article reviews the response of skeletal muscle to tenotomy. The changes are subdivided into molecular, architectural, and functional categories. Architectural disruption of the muscle includes myofiber disorganization, central core necrosis, Z-line streaming, fibrosis of fibers and Golgi tendon organs, changes in sarcomere number, and alterations in the number of membrane particles. Molecular changes include transient changes in myosin heavy chain composition and expression of neural cell adhesion molecule (NCAM). Functionally, tenotomized muscle produces decreased maximum tetanic and twitch tension. Alterations in normal skeletal muscle structure and function are clinically applicable to the understanding of pathological states that follow tendon rupture and iatrogenic tenotomy.

Skeletal muscle recovery after tenotomy and 7-day delayed muscle length restoration

Rabbit extensor digitorum longus (EDL) tendons were cut with the muscle active (active tenotomy, AT) or with the EDL at rest (passive tenotomy, PT). One, 7, and 21 days after tenotomy, contractile testing was performed. A second experiment was performed in which EDL tendons underwent PT and, after a 7-day delay, muscle-tendon units were restored to their original length. Maximum isometric tension dropped precipitously 1 day after either AT or PT to approximately 50% of normal and continued to decline by day 7. In contrast to PT, where peak tension (P(0)) decreased further by 21 days, after AT, P(0) partially recovered. Differences in muscle mass, cross-sectional area, fiber type, and sarcomere number did not explain the differential response. One day after length restoration of muscles, P(0) rapidly increased by approximately 40%. These observations have implications for understanding the outcome of muscle-tendon unit injury and surgical repair.

Masseter muscle atrophy after ostectomy of the mandibular angle in rabbits

In order to get information about changes in the masseter muscle when operations are performed on the mandibular angle area, we classified 70 New Zealand White rabbits into group O (ostectomy) and group D (dissection). In group O we performed unilateral ostectomy of the mandibular angle, while in group D we performed unilateral dissection of the masseter muscle limited to the mandibular angle area. Then we compared morphologic, histologic, and histochemical changes in experimental masseter muscles with those in normal control masseter muscles. We examined 5 rabbits in each group at the following intervals: 1, 2, 4, 6, 8, 12, and 24 weeks. In group D (dissection), there were no remarkable changes at all examinations. In group O (ostectomy), there was a 30 percent decrease in experimental muscle mass compared with control muscle. On examination of muscle fiber types, a decrease in type I fibers and an increase in type IIA and IIB fibers were noticed (p < 0.05). Each experimental muscle fiber became more irregularly and angularly shaped, and mean fiber area also was reduced. Sarcomere lengths of experimental muscle fibers were significantly reduced to 80 percent of control values (p < 0.05) during the first 4 weeks, but after 6 weeks they were lengthened to control values. Collagen and fibrin did not show much difference between experimental and control muscles. All these findings imply that masseter muscle atrophy after ostectomy of the mandibular angle is not due to connective-tissue changes but to individual muscle fiber atrophy accompanied by functional adaptation of sarcomeres and changes in muscle fiber types.

Tenotomy prevents the functional improvement of a muscle reinnervated with a chronically severed nerve

During the early stages of nerve implantation, we followed the dynamic properties of the lateral gastrocnemius muscle of the rat, reinnervated with an acutely or chronically severed peroneal nerve. The aim of this study was to ascertain whether 1) the better functional recovery of a muscle reinnervated by a chronically severed foreign nerve is present from the onset of reinnervation, and 2) whether such functional improvement is due to the conditioning lesion effect. Our results indicate that better functional recovery is already apparent one week after nerve implantation, and it is due to the conditioning lesion effect, since tenotomy prevents such improvement. The tenotomy effect underlines the fact that some environmental factors concerning the target tissue, and not only the predegenerated nerve, are involved in the conditioning effect.

Severe degeneration of rabbit vastus intermedius muscle immobilized in shortened position

The authors have previously shown that passive daily mobilization of the rabbit hind limb immobilized with the knee in extension leads to necrosis of the deep thigh muscles and myositis ossificans-like periosteal bone formation. In this study the effect of immobilization alone on the rabbit hind limb muscles was examined similarly to that of immobilized limbs. Serum creatine kinase activities increased significantly and intravenously administered Evans blue albumin showed increased vascular permeability in the deep vastus intermedius muscle even on day 1. Necrotic fibers were clearly present in the deep part of the vastus intermedius muscle on day 5 in light and electron microscopy and in enzyme histochemistry. Fibrosis and atrophy were found later. The superficial portion of the vastus intermedius and the deep contralateral nonimmobilized vastus intermedius showed degenerative changes. Bone formation was not noted. The conclusion was that the deep vastus intermedius muscle composed almost exclusively of type I fibers is exceptionally prone to damage when immobilized in a shortened position. Contact of the necrotic muscle with the underlying periosteum is not alone sufficient to induce heterotopic ossification. The additional trauma caused by daily mobilization is needed for the myositis ossificans-like bone formation.

Electrophysiological study of conditioning lesion effects on rat sciatic nerve regeneration following either prior section or freeze. II. Blocking by prior tenotomy

The conditioning lesion effects refer to the earlier formation and the accelerated regeneration of axonal sprouts following two successive axotomies. In a previous study, we observed that a prior freeze or a prior cut of rat sciatic nerve resulted in differences in the enhancement of the regeneration rate and the reduction of the initial delay. These differences were interpreted as a possible non-neuronal cells influence on the intrinsic regulation of the conditioning lesion phenomenon. In the present study, we attempted to modify the status of the muscles using tenotomy before the prior nerve injury to determine the respective influence of the muscular cells on conditioning lesion effects. Thus, the conditioning lesion, which was either a cut or a freeze of the tibial nerve at the ankle, was performed 14 days after foot sole muscles were tenotomized, close to their insertion into the calcaneus bone. The test lesion was always a freeze of the sciatic nerve at midthigh performed 7 days following the prior lesion. The elongation of the regenerating sprouts was electrophysiologically evaluated and the regeneration rate as well as the initial delay were calculated by means of regression analysis. Tenotomy did not influence the regeneration as was demonstrated in a group with a single sciatic nerve lesion. In contrast, when prior lesion was performed, the tenotomy prevented both the enhancement of the rate of regeneration and the reduction of the initial delay, whatever was the type of the conditioning lesion.(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation of skeletal muscle to immobilization in a shortened position

This study determined the morphological changes and adaptations that occur following immobilization of rat soleus and gastrocnemius muscles when the ankle joint is placed in complete plantar flexion for 2, 5, 7, 14, 21, and 28 days by means of plaster casts. Previous studies of such shortened muscles have shown that the number of sarcomeres in series is reduced, but how the sarcomeres are reduced has not been determined. We observed that the fibers in the mid-belly region of the muscles demonstrated a progressive degenerative process over the first few weeks. Myofibrils across the entire width of the affected fibers underwent dissolution. However, by 4 weeks new myofibrils were being formed, and sarcomere lengths appeared normal. Portions of the fibers near the tendon underwent segmental necrosis. These findings are similar to the response of the soleus and gastrocnemius muscles to tenotomy and are clinically relevant to orthopedic procedures that maintain muscles in shortened conditions for prolonged periods.

Degeneration and alteration of axons and intrafusal muscle fibers in spindles following tenotomy

The effect of tenotomy (cutting of distal and proximal tendons) on the spindles in soleus muscle of adult rats was examined by light and electron microscopy in tissue obtained 1, 2, 3, 4, 5, 6, 7, and 14 days after surgery. Degenerative changes in the spindles progressed with time; also, the degree of alteration observed in a spindle varied with its position in the muscle, i.e., the earliest and most extensive changes occurred in spindles situated near the tendons. The disorganization and breakdown of myofibrils in the intrafusal muscle fibers were observed 3 days after tenotomy and continued with longer periods after surgery. The progression of morphological changes included alteration in fiber outline and the external lamina of the intrafusal muscle fibers and changes in the extracellular environment within the spindle capsule. The intrafusal muscle fibers of some spindles were shortened, apparently due to the loss of their polar ends, and degenerated axons which apparently supplied the intrafusal muscle fibers were also observed. Completely necrotic intrafusal fibers were absent. A possible relationship between the observed morphologic alterations and an adjustment of the spindle to muscle shortening is discussed.

The effects of tenotomy on the morphology of the rabbit digastric muscle

The digastric muscles of 17 New Zealand White rabbits were subjected to tenotomy. A sham operation was performed on six animals. Groups of three or four animals were killed at one hour, one day, 10 days, 30 days, and 60 days after the tenotomy. There was evidence of tendon regeneration by 10 days, and by 30 days the tendon appeared normal macroscopically. The tendon was normal in microscopic appearance in the animals examined at 60 days. Muscle belly length and fascicle length decreased after the tenotomy, and the angle of pinnation increased. Sarcomere lengths underwent a transient decrease within one hour of the tenotomy, but then were as long as or longer than those in the sham-operated group. A biomechanical analysis suggests that the net result of the morphological changes produced by the tenotomy leads to a reduction in force capability of only about 12%. The shorter belly and fascicle lengths, however, may diminish the effective range over which effective force can be exerted.

The development of central cores in both fiber types in tenotomized muscle

Using the histochemical reaction for myosin adenosine triphosphatase (ATPase), a study of the rat soleus muscle following tenotomy was undertaken. It was demonstrated that both type 2A and 2C fibers undergo degenerative changes following tenotomy. All previous studies have stated that only type 1 fibers were affected and developed central core lesions and that type 2 fibers were somehow protected from the degenerative process. The results of this experiment illustrate that central core lesions will develop in all three fiber types (types 1, 2A, and 2C) of the soleus following tenotomy.

Central core degeneration after tenotomy in soleus muscles of hyperthyroid rats

Tenotomy of the rat soleus muscle is followed by a central degeneration of slow, fatigue-resistant muscle fibers. Previous experiments showed that fast, fatigable fibers of the gastrocnemius when transformed to slow, fatigue-resistant fibers by cross-reinnervation also develop lesions after tenotomy. The experiments described in this communication were carried out to discover whether the susceptibility of fibers to lesions was determined by their fiber type or the nature of their innervation. Rats were rendered hyperthyroid by the administration of sodium 3,3',5-triiodo-L-thyronine (T3) for 7 to 10 weeks. Tenotomy of the soleus muscles was then carried out and the experimental and contralateral muscles were removed and stained for myosin ATPase activity after a further 2 weeks. The hyperthyroid state of each animal was confirmed by the assay of succinate dehydrogenase activity of liver and the contralateral muscle. After acid preincubation, whole muscle fiber type counts of contralateral muscles showed a statistically significant change from a predominantly acid-stable population of fibers to acid-labile fibers. In addition, many fibers of intermediate staining properties were seen. When the experimental muscles were examined, all three varieties of fiber showed central degeneration. The nature of the fiber type change induced by T3 and the role that innervation might play in this is discussed. It was concluded that the susceptibility of fibers to the lesions that follow tenotomy is dependent on the nature of their innervation rather than their fiber type.