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Kositsky A, Stenroth L, Barrett RS, Korhonen RK, Vertullo CJ, Diamond LE, Saxby DJ. Muscle Morphology Does Not Solely Determine Knee Flexion Weakness After Anterior Cruciate Ligament Reconstruction with a Semitendinosus Tendon Graft: A Combined Experimental and Computational Modeling Study. Ann Biomed Eng 2024; 52:1313-1325. [PMID: 38421479 PMCID: PMC10995045 DOI: 10.1007/s10439-024-03455-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 01/16/2024] [Indexed: 03/02/2024]
Abstract
The distal semitendinosus tendon is commonly harvested for anterior cruciate ligament reconstruction, inducing substantial morbidity at the knee. The aim of this study was to probe how morphological changes of the semitendinosus muscle after harvest of its distal tendon for anterior cruciate ligament reconstruction affects knee flexion strength and whether the knee flexor synergists can compensate for the knee flexion weakness. Ten participants 8-18 months after anterior cruciate ligament reconstruction with an ipsilateral distal semitendinosus tendon autograft performed isometric knee flexion strength testing (15°, 45°, 60°, and 90°; 0° = knee extension) positioned prone on an isokinetic dynamometer. Morphological parameters extracted from magnetic resonance images were used to inform a musculoskeletal model. Knee flexion moments estimated by the model were then compared with those measured experimentally at each knee angle position. A statistically significant between-leg difference in experimentally-measured maximal isometric strength was found at 60° and 90°, but not 15° or 45°, of knee flexion. The musculoskeletal model matched the between-leg differences observed in experimental knee flexion moments at 15° and 45° but did not well estimate between-leg differences with a more flexed knee, particularly at 90°. Further, the knee flexor synergists could not physiologically compensate for weakness in deep knee flexion. These results suggest additional factors other than knee flexor muscle morphology play a role in knee flexion weakness following anterior cruciate ligament reconstruction with a distal semitendinosus tendon graft and thus more work at neural and microscopic levels is required for informing treatment and rehabilitation in this demographic.
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Affiliation(s)
- Adam Kositsky
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland.
| | - Lauri Stenroth
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
| | - Rod S Barrett
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Rami K Korhonen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
| | - Christopher J Vertullo
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- Knee Research Australia, Gold Coast, Queensland, Australia
| | - Laura E Diamond
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - David J Saxby
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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Yaşaroğlu ÖF, Serel Arslan S, Cengiz E, Alıcı R, Demir N, Oğuz B, Düger T. Swallowing kinematics and submental muscles activation during a newly designed maneuver called Mouth Open Swallowing Maneuver: A comparative study. PLoS One 2024; 19:e0299845. [PMID: 38527058 PMCID: PMC10962842 DOI: 10.1371/journal.pone.0299845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/18/2024] [Indexed: 03/27/2024] Open
Abstract
The aim of this study was to design a new maneuver called the Mouth Open Swallowing Maneuver (MOSM), and to compare swallowing kinematics and submental muscles activation (SMA) between MOSM and two current approaches used in dysphagia rehabilitation. Fifty healthy volunteers were asked to perform three repetitions of dry swallowing (DS) (control task), the MOSM, the Mendelsohn Maneuver (MM), and the Tongue-Hold Maneuver (THM) during videofluoroscopic swallowing study accompanied with simultaneous SMA recording. Swallowing kinematics were measured by frame-by-frame analysis on hyolaryngeal movement using ImageJ. Swallowing with maximum hyolaryngeal movement and SMA during these tasks was used for comparative analysis. Vertical movement of the hyoid during the MOSM was significantly greater than those observed during the DS and the THM (p<0.001, p<0.001). Horizontal movement of the hyoid during DS and the THM was significantly greater than that observed during the MM (p = 0.001, p = 0.001). Vertical movement of the larynx during the MOSM was significantly greater than those observed during DS, MM, and THM (p<0.001). There was no significant difference between tasks in horizontal movement of the larynx (p = 0.785). SMA during the THM was significantly greater than that observed during MOSM (p = 0.002). No significant difference was found between other tasks in terms of SMA (p>0.05). The MOSM as a newly designed maneuver was significantly superior to other maneuvers in increasing vertical hyolaryngeal movement. The THM has as much effect on hyolaryngeal movement as the MM. In this study, the MOSM was shown to be effective in increasing hyolaryngeal movement. ClinicalTrials.gov Protocol Registration and Results System (PRS); the clinical trial registration number (NCT05579041).
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Affiliation(s)
- Ömer Faruk Yaşaroğlu
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Türkiye
| | - Selen Serel Arslan
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Türkiye
| | - Emre Cengiz
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Türkiye
| | - Rabia Alıcı
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Türkiye
| | - Numan Demir
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Türkiye
| | - Berna Oğuz
- Department of Radiology, Hacettepe University Hospitals, Ankara, Türkiye
| | - Tülin Düger
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Türkiye
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Cengiz E, Serel Arslan S, Demir N, Mutlu A. Possible Impact of Mylohyoid Muscle Architecture on Reduced Hyolaryngeal Elevation. Med Hypotheses 2022. [DOI: 10.1016/j.mehy.2022.110906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Liu Q, Tang Q, Liao L, Li D, Zhu W, Zhao C. Translational therapy from preclinical animal models for muscle degeneration after rotator cuff injury. J Orthop Translat 2022; 35:13-22. [PMID: 35846726 PMCID: PMC9260436 DOI: 10.1016/j.jot.2022.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 11/29/2022] Open
Abstract
Chronic rotator cuff tears are debilitating diseases which significantly affect patients’ quality of life and pose substantial financial burden to the society. The intraoperative reparability of injured tendon and postoperative probability of tendon retear are highly associated with the quality of torn muscles, specifically, the severity of muscle atrophy and fatty infiltration. Animal models that reproduce the characteristic muscle pathology after rotator cuff injury have been developed and used to provide insight into the underlying biology and pathophysiology. In this review, we briefly summarize the current information obtained from preclinical animal studies regarding the degenerative change of cuff muscle subsequent to tendon release and/or suprascapular nerve denervation. Importantly, we focus on the potential translational therapeutic targets or agents for the prevention or reversal of muscle atrophy and fatty infiltration. While further studies are warranted to assess the safety and efficacy of novel therapies derived from these preclinical animal research, we believe that their clinical translation for the treatment of rotator cuff disorders is on the horizon. The Translational potential of this article Novel therapeutic strategies described in this review from preclinical animal studies hold a great translational potential for preventing or reversing rotator cuff muscle pathology, while further assessments on their safety and efficacy are warranted.
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Hyman SA, Wu IT, Vasquez-Bolanos LS, Norman MB, Esparza MC, Bremner SN, Dorn SN, Ramirez I, Fithian DC, Lane JG, Singh A, Ward SR. Supraspinatus muscle architecture and physiology in a rabbit model of tenotomy and repair. J Appl Physiol (1985) 2021; 131:1708-1717. [PMID: 34647843 PMCID: PMC8828274 DOI: 10.1152/japplphysiol.01119.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 09/20/2021] [Accepted: 10/11/2021] [Indexed: 11/22/2022] Open
Abstract
Chronic rotator cuff tears can cause severe functional deficits. Addressing the chronic fatty and fibrotic muscle changes is of high clinical interest; however, the architectural and physiological consequences of chronic tear and repair are poorly characterized. We present a detailed architectural and physiological analysis of chronic tear and repair (both over 8 and 16 wk) compared with age-matched control rabbit supraspinatus (SSP) muscles. Using female New Zealand White Rabbits (n = 30, n = 6/group) under 2% isoflurane anesthesia, the SSP was surgically isolated and maximum isometric force was measured at four to six muscle lengths. Architectural analysis was performed, and maximum isometric stress was computed. Whole muscle length-tension curves were generated using architectural measurements to compare experimental physiology to theoretical predictions. Architectural measures are consistent with persistent radial and longitudinal atrophy over time in tenotomy that fails to recover after repair. Maximum isometric force was significantly decreased after 16 wk tenotomy and not significantly improved after repair. Peak isometric force reported here are greater than prior reports of rabbit SSP force after tenotomy. Peak stress was not significantly different between groups and consistent with prior literature of SSP stress. Muscle strain during contraction was significantly decreased after 8 wk of tenotomy and repair, indicating effects of tear and repair on muscle function. The experimental length-tension data were overlaid with predicted curves for each experimental group (generated from structural data), exposing the altered structure-function relationship for tenotomy and repair over time. Data presented here contribute to understanding the physiological implications of disease and repair in the rotator cuff.NEW & NOTEWORTHY We utilize an established method to measure the length-tension relationship for the rabbit supraspinatus in normal, torn, and repaired muscles. We then perform architectural analysis to evaluate structural changes after tear and repair. Although peak isometric force is lower in the tear and repair groups, there are no differences in peak stresses across groups. These findings indicate persistent structural changes (both radial and longitudinal atrophy) and physiological deficiencies (decreased peak force and uncoupling structure-function relationship) after tenotomy that do not significantly recover after repair.
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Affiliation(s)
- Sydnee A Hyman
- Department of Bioengineering, University of California, San Diego, California
- Department of Orthopaedic Surgery, University of California, San Diego, California
| | - Isabella T Wu
- Department of Orthopaedic Surgery, University of California, San Diego, California
| | - Laura S Vasquez-Bolanos
- Department of Bioengineering, University of California, San Diego, California
- Department of Orthopaedic Surgery, University of California, San Diego, California
| | - Mackenzie B Norman
- Department of Orthopaedic Surgery, University of California, San Diego, California
- Dartmouth Geisel School of Medicine, Hanover, New Hampshire
| | - Mary C Esparza
- Department of Orthopaedic Surgery, University of California, San Diego, California
| | - Shannon N Bremner
- Department of Orthopaedic Surgery, University of California, San Diego, California
| | - Shanelle N Dorn
- Department of Orthopaedic Surgery, University of California, San Diego, California
| | - Ivan Ramirez
- Department of Orthopaedic Surgery, University of California, San Diego, California
| | - Donald C Fithian
- Department of Orthopaedic Surgery, University of California, San Diego, California
| | - John G Lane
- Department of Orthopaedic Surgery, University of California, San Diego, California
| | - Anshuman Singh
- Department of Orthopaedic Surgery, University of California, San Diego, California
- Department of Orthopaedic Surgery, Kaiser Permanente, San Diego, California
| | - Samuel R Ward
- Department of Bioengineering, University of California, San Diego, California
- Department of Orthopaedic Surgery, University of California, San Diego, California
- Department of Radiology, University of California, San Diego, California
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Hasan SS. Editorial Commentary: Monitoring Tendon and Muscle Recovery After Rotator Cuff Repair Using Diagnostic Ultrasound Demonstrates that Early Repair is Beneficial for Many Patients With Reparable Tears. Arthroscopy 2021; 37:3049-3052. [PMID: 34602147 DOI: 10.1016/j.arthro.2021.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 07/06/2021] [Indexed: 02/02/2023]
Abstract
Rotator cuff repair is performed to effect healing of the enthesis; to restore shoulder comfort, strength, and function; to prevent tear propagation; and to prevent progression of atrophic muscle changes (fatty degeneration, fatty infiltration, and fatty atrophy) that eventually occur. Non-retracted and moderately retracted rotator cuff tears usually heal after repair, and muscle atrophy may recover over time. It follows that early rotator cuff repair is beneficial for many patients with chronic but reparable rotator cuff tears. Diagnostic ultrasound can provide quantitative information about the recovery of both muscle and tendon and represents a viable alternative to magnetic resonance imaging for evaluating healing after rotator cuff repair.
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Chalmers PN, Lindsay SR, Smith W, Kawakami J, Hill R, Tashjian RZ, Keener JD. Infraspinatus and deltoid length and patient height: implications for lateralization and distalization in reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2021; 30:712-719. [PMID: 32711102 PMCID: PMC7854847 DOI: 10.1016/j.jse.2020.07.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/30/2020] [Accepted: 07/07/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Restoration of muscular strength is predicated on restoration of muscle length. The purpose of this study was to describe infraspinatus and deltoid length preoperative to reverse total shoulder arthroplasty (RTSA) to guide distalization and lateralization to restore preoperative muscle length. METHODS This was a retrospective radiographic study. We measured the infraspinatus length on preoperative computed tomographic images and the deltoid length on preoperative radiographs. For all measurements, reliability was first established by comparing measurements between 2 observers, and intraclass correlation coefficients (ICCs) were calculated. We then calculated descriptive statistics for these muscle lengths and developed a formula to predict these muscle lengths from patient demographics. RESULTS We measured infraspinatus length in 97 patients and deltoid length in 108 patients. Inter-rater reliability was excellent, with all ICCs >0.886. The mean infraspinatus length was 15.5 cm (standard deviation 1.3) and ranged from 12.6-18.9 cm, whereas the deltoid length was 16.2±1.7 cm and ranged from 12.5-20.2 cm. Both infraspinatus (r = 0.775, P < .001) and deltoid length (r = 0.717, P < .001) were highly correlated with patient height but did not differ between diagnoses. Formulae developed through linear regression allowed prediction of muscle length to within 1 cm in 78% and within 2 cm in 100% for the infraspinatus and 60% and 88% for the deltoid. CONCLUSION Deltoid and infraspinatus length are variable but highly correlated with patient height. To maintain tension, 2 mm of lateralization and distalization should be added for every 6 inches (∼15 cm) of height above average for a Grammont-style RTSA.
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Affiliation(s)
- Peter N Chalmers
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA.
| | - Spencer R Lindsay
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Weston Smith
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Jun Kawakami
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Ryan Hill
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA
| | - Robert Z Tashjian
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Jay D Keener
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA
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Sachdeva R, Beavis C, Obaid H, Farthing JP, Kim SY. Surgical repair of the supraspinatus: architectural changes in the muscle pre- and postoperatively. Singapore Med J 2020; 63:97-104. [PMID: 32798361 DOI: 10.11622/smedj.2020123] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Shortening of the tendon and muscle is recognised as a strong predictor for surgical failure of supraspinatus tendon tears. Changes in muscle architecture following repair have not been thoroughly investigated. We aimed to compare the architecture of the supraspinatus pre- and postoperatively. METHODS We recruited eight participants with full-thickness supraspinatus tears. Images of the supraspinatus were captured preoperatively (pre-op) and postoperatively at one (post-op1), three (post-op2) and six (post-op3) months in relaxed and contracted states (0° and 60° glenohumeral abduction). Fibre bundle length (FBL), pennation angle (PA) and muscle thickness (MT) were quantified. Self-reported function, and maximal isometric abduction and external rotation strengths were assessed. RESULTS Mean FBL increased from pre-op to post-op1 (p = 0.001) in the relaxed state and from pre-op to post-op2 (p = 0.002) in the contracted state. Decrease in FBL was observed from post-op2 to post-op3 in the relaxed state. Mean PA decreased from pre-op to post-op1 (p < 0.001) in the relaxed state, but increased from post-op2 to post-op3 in both relaxed (p = 0.006) and contracted (p = 0.004) states. At post-op3, external rotation (p = 0.009) and abduction (p = 0.005) strengths were greater than at post-op2. Overall function increased by 47.67% from pre-op to post-op3. CONCLUSION Lengthening of the supraspinatus occurs with surgery, altering the length-tension relationship of the muscle, which can compromise muscle function and lead to inferior surgical outcomes. These findings may guide clinicians to optimise loads, velocities and shoulder ranges for effective postoperative rehabilitation.
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Affiliation(s)
- Rohit Sachdeva
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Cole Beavis
- Division of Orthopaedics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Haron Obaid
- Department of Medical Imaging, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jonathan P Farthing
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Soo Y Kim
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Effectiveness of Intramuscular Electrical Stimulation on Postsurgical Nociceptive Pain for Patients Undergoing Open Pancreaticoduodenectomy: A Randomized Clinical Trial. J Am Coll Surg 2020; 231:339-350. [PMID: 32623088 DOI: 10.1016/j.jamcollsurg.2020.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/30/2020] [Accepted: 06/02/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND After pylorus-preserving pancreaticoduodenectomy (PPPD), incision and suture of the abdominal muscles cause inflammatory changes and elicit somatic pain that deteriorates the quality of life. There have been no previous reports on needle electrical twitch obtaining intramuscular stimulation (NETOIMS) in abdominal open operation; this study aimed to apply NETOIMS for postoperative somatic pain in patients undergoing PPPD as a new treatment modality for pain control. METHODS Between June 2018 and January 2019, 44 patients who underwent PPPD were randomly assigned to a control group and the NETOIMS group. The NETOIMS group received NETOIMS in the transverse abdominis muscle under ultrasound guidance right after operation under general anesthesia. The pain score (visual analog scale), peak cough flow (PCF), and gait speed were repetitively measured from 1 day before operation to 2 weeks after discharge as scheduled. Data were analyzed by the linear mixed model and repeated-measures analysis of variance. RESULTS Of the 44 patients recruited, data from 38 patients were finally analyzed. The pain scores were significantly lower in the NETOIMS group after PPPD (p = 0.01). Although the PCF at each measuring time point did not show inter-group difference (p = 0.20), improvement of PCF from the second day after operation to discharge was greater (p = 0.02) and gait speed improved significantly faster (p < 0.01) in the NETOIMS group than in the control group. CONCLUSIONS NETOIMS helps in rapid reduction of postoperative somatic pain developed after PPPD and in improvement of PCF and gait speed.
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A potential factor in the pathophysiology of lateral epicondylitis: The long sarcomere length of the extensor carpi radialis brevis muscle and implications for physiotherapy. Med Hypotheses 2019; 130:109278. [DOI: 10.1016/j.mehy.2019.109278] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 06/04/2019] [Accepted: 06/10/2019] [Indexed: 11/18/2022]
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Gibbons MC, Singh A, Engler AJ, Ward SR. The role of mechanobiology in progression of rotator cuff muscle atrophy and degeneration. J Orthop Res 2018; 36:546-556. [PMID: 28755470 PMCID: PMC5788743 DOI: 10.1002/jor.23662] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 07/24/2017] [Indexed: 02/06/2023]
Abstract
Rotator cuff (RC) muscles undergo several detrimental changes following mechanical unloading resulting from RC tendon tear. In this review, we highlight the pathological causes and consequences of mechanical alterations at the whole muscle, muscle fiber, and muscle resident cell level as they relate to RC disease progression. In brief, the altered mechanical loads associated with RC tear lead to architectural, structural, and compositional changes at the whole-muscle and muscle fiber level. At the cellular level, these changes equate to direct disruption of mechanobiological signaling, which is exacerbated by mechanically regulated biophysical and biochemical changes to the cellular and extra-cellular environment (also known as the stem cell "niche"). Together, these data have important implications for both pre-clinical models and clinical practice. In pre-clinical models, it is important to recapitulate both the atrophic and degenerative muscle loss found in humans using clinically relevant modes of injury. Clinically, understanding the mechanics and underlying biology of the muscle will impact both surgical decision-making and rehabilitation protocols, as interventions that may be good for atrophic muscle will have a detrimental effect on degenerating muscle, and vice versa. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:546-556, 2018.
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Affiliation(s)
| | | | - Adam J Engler
- University of California San Diego Department of Bioengineering
| | - Samuel R Ward
- University of California Department of Orthopedic Surgery,University of California Department of Radiology
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Razmjou H, Christakis M, Dwyer T, van Osnabrugge V, Holtby R. Accuracy of infraspinatus isometric testing in predicting tear size and tendon reparability: comparison with imaging and arthroscopy. J Shoulder Elbow Surg 2017; 26:1390-1398. [PMID: 28734538 DOI: 10.1016/j.jse.2017.04.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 04/22/2017] [Accepted: 04/26/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to examine the accuracy of external rotation in neutral (0° external position) and in shortened position (45° external position) in relation to rotator cuff tear size, tendon reparability, and other clinical, surgical, and imaging findings. METHODS This was a prospective blinded diagnostic study of consecutive surgical candidates for rotator cuff repair using magnetic resonance imaging and arthroscopic surgery as the "gold standards." The area under a receiver operating characteristic (AUROC) curve was calculated for each position. RESULTS Eighty-five patients (35 female [41%] and 50 male [59%]; age, 65 years [standard deviation = 10]) were included. Sixty patients (71%) had a minor tear (4 small, 56 moderate), and 25 patients (29%) had a major tear (17 large and 8 massive). Seventy patients (82%) had a full repair, and 15 (18%) patients underwent a partial repair. There were 26 (31%) associated full-thickness tears of the infraspinatus. The isometric strength testing in both positions had good to excellent accuracy (range, 0.80-0.90) for detecting reparability, tear retraction, infraspinatus atrophic changes observed by the clinician, and infraspinatus fatty infiltration on magnetic resonance images. The shortened position had an overall higher accuracy than the neutral position and was more clinically useful for detecting an infraspinatus full-thickness tear (AUROC = 0.84 vs 0.78) and rotator cuff tear size (AUROC = 0.80 vs. 0.75). CONCLUSIONS The isometric external rotation is an accurate test in diagnosing different aspects of rotator cuff disease and specifically of the infraspinatus muscle. The isometric strength at the shortened position was a better predictor of clinical, surgical, and imaging findings.
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Affiliation(s)
- Helen Razmjou
- Holland Orthopaedic & Arthritic Centre, Rehabilitation Department, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
| | - Monique Christakis
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Medical Imaging, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Tim Dwyer
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Division of Orthopedic Surgery, Department of Surgery, Women's College and Mount Sinai Hospital, Toronto, ON, Canada
| | - Varda van Osnabrugge
- Holland Orthopaedic & Arthritic Centre, Rehabilitation Department, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Richard Holtby
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Division of Orthopedic Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Gibbons MC, Sato EJ, Bachasson D, Cheng T, Azimi H, Schenk S, Engler AJ, Singh A, Ward SR. Muscle architectural changes after massive human rotator cuff tear. J Orthop Res 2016; 34:2089-2095. [PMID: 27061583 PMCID: PMC5423410 DOI: 10.1002/jor.23256] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 04/04/2016] [Indexed: 02/04/2023]
Abstract
Rotator cuff (RC) tendon tears lead to negative structural and functional changes in the associated musculature. The structural features of muscle that predict function are termed "muscle architecture." Although the architectural features of "normal" rotator cuff muscles are known, they are poorly understood in the context of cuff pathology. The purpose of this study was to investigate the effects of tear and repair on RC muscle architecture. To this end thirty cadaveric shoulders were grouped into one of four categories based on tear magnitude: Intact, Full-thickness tear (FTT), Massive tear (MT), or Intervention if sutures or hardware were present, and key parameters of muscle architecture were measured. We found that muscle mass and fiber length decreased proportionally with tear size, with significant differences between all groups. Conversely, sarcomere number was reduced in both FTT and MT with no significant difference between these two groups, in large part because sarcomere length was significantly reduced in MT but not FTT. The loss of muscle mass in FTT is due, in part, to subtraction of serial sarcomeres, which may help preserve sarcomere length. This indicates that function in FTT may be impaired, but there is some remaining mechanical loading to maintain "normal" sarcomere length-tension relationships. However, the changes resulting from MT suggest more severe limitations in force-generating capacity because sarcomere length-tension relationships are no longer normal. The architectural deficits observed in MT muscles may indicate deeper deficiencies in muscle adaptability to length change, which could negatively impact RC function despite successful anatomical repair. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:2089-2095, 2016.
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Affiliation(s)
| | - Eugene J Sato
- University of California San Diego Department of Bioengineering
| | | | - Timothy Cheng
- University of California Department of Orthopedic Surgery
| | - Hassan Azimi
- University of California Department of Orthopedic Surgery
| | - Simon Schenk
- University of California Department of Orthopedic Surgery
| | - Adam J Engler
- University of California San Diego Department of Bioengineering
| | | | - Samuel R Ward
- University of California Department of Orthopedic Surgery,University of California Department of Radiology
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Developmental Biology and Regenerative Medicine: Addressing the Vexing Problem of Persistent Muscle Atrophy in the Chronically Torn Human Rotator Cuff. Phys Ther 2016; 96:722-33. [PMID: 26847008 PMCID: PMC4858662 DOI: 10.2522/ptj.20150029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 01/24/2016] [Indexed: 12/18/2022]
Abstract
Persistent muscle atrophy in the chronically torn rotator cuff is a significant obstacle for treatment and recovery. Large atrophic changes are predictive of poor surgical and nonsurgical outcomes and frequently fail to resolve even following functional restoration of loading and rehabilitation. New insights into the processes of muscle atrophy and recovery gained through studies in developmental biology combined with the novel tools and strategies emerging in regenerative medicine provide new avenues to combat the vexing problem of muscle atrophy in the rotator cuff. Moving these treatment strategies forward likely will involve the combination of surgery, biologic/cellular agents, and physical interventions, as increasing experimental evidence points to the beneficial interaction between biologic therapies and physiologic stresses. Thus, the physical therapy profession is poised to play a significant role in defining the success of these combinatorial therapies. This perspective article will provide an overview of the developmental biology and regenerative medicine strategies currently under investigation to combat muscle atrophy and how they may integrate into the current and future practice of physical therapy.
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Change in the Pathologic Supraspinatus: A Three-Dimensional Model of Fiber Bundle Architecture within Anterior and Posterior Regions. BIOMED RESEARCH INTERNATIONAL 2015; 2015:564825. [PMID: 26413533 PMCID: PMC4564630 DOI: 10.1155/2015/564825] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 04/02/2015] [Accepted: 04/03/2015] [Indexed: 11/21/2022]
Abstract
Supraspinatus tendon tears are common and lead to changes in the muscle architecture. To date, these changes have not been investigated for the distinct regions and parts of the pathologic supraspinatus. The purpose of this study was to create a novel three-dimensional (3D) model of the muscle architecture throughout the supraspinatus and to compare the architecture between muscle regions and parts in relation to tear severity. Twelve cadaveric specimens with varying degrees of tendon tears were used. Three-dimensional coordinates of fiber bundles were collected in situ using serial dissection and digitization. Data were reconstructed and modeled in 3D using Maya. Fiber bundle length (FBL) and pennation angle (PA) were computed and analyzed. FBL was significantly shorter in specimens with large retracted tears compared to smaller tears, with the deeper fibers being significantly shorter than other parts in the anterior region. PA was significantly greater in specimens with large retracted tears, with the superficial fibers often demonstrating the largest PA. The posterior region was absent in two specimens with extensive tears. Architectural changes associated with tendon tears affect the regions and varying depths of supraspinatus differently. The results provide important insights on residual function of the pathologic muscle, and the 3D model includes detailed data that can be used in future modeling studies.
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16
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Gigliotti D, Leiter JRS, Macek B, Davidson MJ, MacDonald PB, Anderson JE. Atrophy, inducible satellite cell activation, and possible denervation of supraspinatus muscle in injured human rotator-cuff muscle. Am J Physiol Cell Physiol 2015; 309:C383-91. [PMID: 26135801 DOI: 10.1152/ajpcell.00143.2015] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 06/29/2015] [Indexed: 12/17/2022]
Abstract
The high frequency of poor outcome and chronic pain after surgical repair of shoulder rotator-cuff injury (RCI) prompted this study to explore the potential to amplify muscle regeneration using nitric oxide (NO)-based treatment. After preoperative magnetic resonance imaging (MRI), biopsies of supraspinatus and ipsilateral deltoid (as a control) were collected during reparative surgery for RCI. Muscle fiber diameter, the pattern of neuromuscular junctions observed with alpha-bungarotoxin staining, and the γ:ε subunit ratio of acetylcholine receptors in Western blots were examined in tandem with experiments to determine the in vitro responsiveness of muscle satellite cells to activation (indicated by uptake of bromodeoxyuridine, BrdU) by the NO-donor drug, isosorbide dinitrate (ISDN). Consistent with MRI findings of supraspinatus atrophy (reduced occupation ratio and tangent sign), fiber diameter was lower in supraspinatus than in deltoid. ISDN induced a significant increase over baseline (up to 1.8-fold), in the proportion of BrdU+ (activated) Pax7+ satellite cells in supraspinatus, but not in deltoid, after 40 h in culture. The novel application of denervation indices revealed a trend for supraspinatus muscle to have a higher γ:ε subunit ratio than deltoid (P = 0.13); this ratio inversely with both occupancy ratio (P < 0.05) and the proportion of clusters at neuromuscular junctions (P = 0.05). Results implicate possible supraspinatus denervation in RCI and suggest NO-donor treatment has potential to promote growth in atrophic supraspinatus muscle after RCI and improve functional outcome.
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Affiliation(s)
- Deanna Gigliotti
- Department of Biological Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Bryce Macek
- College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Michael J Davidson
- Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Peter B MacDonald
- Section of Orthopedics, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada; and
| | - Judy E Anderson
- Department of Biological Sciences, University of Manitoba, Winnipeg, Manitoba, Canada;
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17
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Sachdeva R, Busch AJ, Harrison EL, Bidonde J, Kim SY. Architectural parameters of supraspinatus: a systematic review of cadaveric studies. PHYSICAL THERAPY REVIEWS 2015. [DOI: 10.1179/1743288x15y.0000000011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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18
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Sato EJ, Killian ML, Choi AJ, Lin E, Choo AD, Rodriguez-Soto AE, Lim CT, Thomopoulos S, Galatz LM, Ward SR. Architectural and biochemical adaptations in skeletal muscle and bone following rotator cuff injury in a rat model. J Bone Joint Surg Am 2015; 97:565-73. [PMID: 25834081 PMCID: PMC4372988 DOI: 10.2106/jbjs.m.01503] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Injury to the rotator cuff can cause irreversible changes to the structure and function of the associated muscles and bones. The temporal progression and pathomechanisms associated with these adaptations are unclear. The purpose of this study was to investigate the time course of structural muscle and osseous changes in a rat model of a massive rotator cuff tear. METHODS Supraspinatus and infraspinatus muscle architecture and biochemistry and humeral and scapular morphological parameters were measured three days, eight weeks, and sixteen weeks after dual tenotomy with and without chemical paralysis via botulinum toxin A (BTX). RESULTS Muscle mass and physiological cross-sectional area increased over time in the age-matched control animals, decreased over time in the tenotomy+BTX group, and remained nearly the same in the tenotomy-alone group. Tenotomy+BTX led to increased extracellular collagen in the muscle. Changes in scapular bone morphology were observed in both experimental groups, consistent with reductions in load transmission across the joint. CONCLUSIONS These data suggest that tenotomy alone interferes with normal age-related muscle growth. The addition of chemical paralysis yielded profound structural changes to the muscle and bone, potentially leading to impaired muscle function, increased muscle stiffness, and decreased bone strength. CLINICAL RELEVANCE Structural musculoskeletal changes occur after tendon injury, and these changes are severely exacerbated with the addition of neuromuscular compromise.
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Affiliation(s)
- Eugene J. Sato
- Departments of Bioengineering (E.J.S., A.E.R.-S., and S.R.W.), Radiology (S.R.W.), and Orthopaedic Surgery (A.J.C., E.L., A.D.C., and S.R.W.), University of California San Diego, 9500 Gilman Drive (0610), La Jolla, CA 92093. E-mail address for S.R. Ward:
| | - Megan L. Killian
- Department of Orthopaedic Surgery, Washington University, 660 South Euclid Avenue, St. Louis, MO 63110. E-mail address for L.M. Galatz:
| | - Anthony J. Choi
- Departments of Bioengineering (E.J.S., A.E.R.-S., and S.R.W.), Radiology (S.R.W.), and Orthopaedic Surgery (A.J.C., E.L., A.D.C., and S.R.W.), University of California San Diego, 9500 Gilman Drive (0610), La Jolla, CA 92093. E-mail address for S.R. Ward:
| | - Evie Lin
- Departments of Bioengineering (E.J.S., A.E.R.-S., and S.R.W.), Radiology (S.R.W.), and Orthopaedic Surgery (A.J.C., E.L., A.D.C., and S.R.W.), University of California San Diego, 9500 Gilman Drive (0610), La Jolla, CA 92093. E-mail address for S.R. Ward:
| | - Alexander D. Choo
- Departments of Bioengineering (E.J.S., A.E.R.-S., and S.R.W.), Radiology (S.R.W.), and Orthopaedic Surgery (A.J.C., E.L., A.D.C., and S.R.W.), University of California San Diego, 9500 Gilman Drive (0610), La Jolla, CA 92093. E-mail address for S.R. Ward:
| | - Ana E. Rodriguez-Soto
- Departments of Bioengineering (E.J.S., A.E.R.-S., and S.R.W.), Radiology (S.R.W.), and Orthopaedic Surgery (A.J.C., E.L., A.D.C., and S.R.W.), University of California San Diego, 9500 Gilman Drive (0610), La Jolla, CA 92093. E-mail address for S.R. Ward:
| | - Chanteak T. Lim
- Department of Orthopaedic Surgery, Washington University, 660 South Euclid Avenue, St. Louis, MO 63110. E-mail address for L.M. Galatz:
| | - Stavros Thomopoulos
- Department of Orthopaedic Surgery, Washington University, 660 South Euclid Avenue, St. Louis, MO 63110. E-mail address for L.M. Galatz:
| | - Leesa M. Galatz
- Department of Orthopaedic Surgery, Washington University, 660 South Euclid Avenue, St. Louis, MO 63110. E-mail address for L.M. Galatz:
| | - Samuel R. Ward
- Departments of Bioengineering (E.J.S., A.E.R.-S., and S.R.W.), Radiology (S.R.W.), and Orthopaedic Surgery (A.J.C., E.L., A.D.C., and S.R.W.), University of California San Diego, 9500 Gilman Drive (0610), La Jolla, CA 92093. E-mail address for S.R. Ward:
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Meyer GA, Farris AL, Sato E, Gibbons M, Lane JG, Ward SR, Engler AJ. Muscle progenitor cell regenerative capacity in the torn rotator cuff. J Orthop Res 2015; 33:421-9. [PMID: 25410765 PMCID: PMC4346515 DOI: 10.1002/jor.22786] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 11/06/2014] [Indexed: 02/04/2023]
Abstract
Chronic rotator cuff (RC) tears affect a large portion of the population and result in substantial upper extremity impairment, shoulder weakness, pain, and limited range of motion. Regardless of surgical or conservative treatment, persistent atrophic muscle changes limit functional restoration and may contribute to surgical failure. We hypothesized that deficits in the skeletal muscle progenitor (SMP) cell pool could contribute to poor muscle recovery following tendon repair. Biopsies were obtained from patients undergoing arthroscopic RC surgery. The SMP population was quantified, isolated, and assayed in culture for its ability to proliferate and fuse in vitro and in vivo. The SMP population was larger in muscles from cuffs with partial tears compared with no tears or full thickness tears. However, SMPs from muscles in the partial tear group also exhibited reduced proliferative ability. Cells from all cuff states were able to fuse robustly in culture and engraft when injected into injured mouse muscle, suggesting that when given the correct signals, SMPs are capable of contributing to muscle hypertrophy and regeneration regardless of tear severity. The fact that this does not appear to happen in vivo helps focus future therapeutic targets for promoting muscle recovery following rotator cuff repairs and may help improve clinical outcomes.
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Affiliation(s)
- Gretchen A. Meyer
- Investigation performed at the Department of Bioengineering, University of California, San Diego; La Jolla, CA 92093
| | - Ashley L. Farris
- Investigation performed at the Department of Bioengineering, University of California, San Diego; La Jolla, CA 92093
| | - Eugene Sato
- Investigation performed at the Department of Bioengineering, University of California, San Diego; La Jolla, CA 92093
| | - Michael Gibbons
- Investigation performed at the Department of Bioengineering, University of California, San Diego; La Jolla, CA 92093
| | - John G. Lane
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Diego; La Jolla, CA 92093
| | - Samuel R. Ward
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Diego; La Jolla, CA 92093,Investigation performed at the Department of Radiology, University of California, San Diego; La Jolla, CA 92093,Corresponding Authors: Dr. Adam J. Engler, 9500 Gilman Drive / MC 0695, La Jolla, CA 92093, Tel: 858-246-0678 Fax: 858-246-1469, , Dr. Samuel R. Ward, 9500 Gilman Drive / MC 0610, La Jolla, CA 92093, Tel: 858-534-4918 Fax: 858-822-3807,
| | - Adam J. Engler
- Investigation performed at the Department of Bioengineering, University of California, San Diego; La Jolla, CA 92093,Sanford Consortium for Regenerative Medicine; La Jolla, CA 92037,Corresponding Authors: Dr. Adam J. Engler, 9500 Gilman Drive / MC 0695, La Jolla, CA 92093, Tel: 858-246-0678 Fax: 858-246-1469, , Dr. Samuel R. Ward, 9500 Gilman Drive / MC 0610, La Jolla, CA 92093, Tel: 858-534-4918 Fax: 858-822-3807,
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20
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Davis ME, Stafford PL, Jergenson MJ, Bedi A, Mendias CL. Muscle fibers are injured at the time of acute and chronic rotator cuff repair. Clin Orthop Relat Res 2015; 473:226-32. [PMID: 25113269 PMCID: PMC4390944 DOI: 10.1007/s11999-014-3860-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 07/29/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Rotator cuff tears are a common source of shoulder pain and disability. Even after surgical repair, some patients continue to have reduced function and progression of fatty degeneration. Because patients with chronic cuff tears often experience muscle shortening, it is possible that repairing the tendon to its anatomic footprint induces a stretch-induced muscle injury that could contribute to failures of the repair and perhaps ongoing pain. QUESTIONS/PURPOSES We hypothesized that, compared with acutely torn and repaired muscles, the stretch that is required to repair a chronically torn cuff would result in more muscle fiber damage. Specifically, we asked: (1) Is there muscle fiber damage that occurs from repair of an acutely torn rotator cuff and does it vary by location in the muscle; and (2) is the damage greater in the case of repair of a chronic injury? METHODS We used an open surgical approach to create a full-thickness rotator cuff tear in rats, and measured changes in muscle mass, length, and the number of fibers containing the membrane impermeable Evans Blue Dye after acute (1 day) or chronic (28 days) cuff tear or repair in rats. Differences between groups were tested using a one-way ANOVA followed by Tukey's post hoc sorting. RESULTS Chronic tears resulted in 24% to 35% decreases in mass and a 20% decrease in length. The repair of acutely and chronically torn muscles resulted in damage to 90% of fibers in the distal portion of the muscle. In the proximal portion, no differences between the acutely torn and repaired groups and controls were observed, whereas repairing the chronically torn group resulted in injury to almost 70% of fibers. CONCLUSIONS In a rat model, marked injury to muscle fibers is induced when the tendons of torn rotator cuffs are repaired to their anatomic footprint. CLINICAL RELEVANCE In this animal model, we found that repair of chronically torn cuff muscles results in extensive injury throughout the muscle. Based on these findings, we posit that inducing a widespread injury at the time of surgical repair of chronically torn rotator cuff muscles may contribute to the problems of failed repairs or continued progression of fatty degeneration that is observed in some patients that undergo rotator cuff repair. Therapeutic interventions to protect muscle fiber membranes potentially could enhance outcomes for patients undergoing rotator cuff repair. To evaluate this, future studies that evaluate the use of membrane sealing compounds or drugs that upregulate endogenous membrane-sealing proteins are warranted.
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Affiliation(s)
- Max E. Davis
- />Department of Orthopaedic Surgery, University of Michigan Medical School, 109 Zina Pitcher Place, BSRB 2017, Ann Arbor, MI 48109-2200 USA
| | - Patrick L. Stafford
- />Department of Orthopaedic Surgery, University of Michigan Medical School, 109 Zina Pitcher Place, BSRB 2017, Ann Arbor, MI 48109-2200 USA
| | - Matthew J. Jergenson
- />Department of Orthopaedic Surgery, University of Michigan Medical School, 109 Zina Pitcher Place, BSRB 2017, Ann Arbor, MI 48109-2200 USA , />Department of Molecular and Integrative Physiology, University of Michigan Medical School, Ann Arbor, MI USA
| | - Asheesh Bedi
- />Department of Orthopaedic Surgery, University of Michigan Medical School, 109 Zina Pitcher Place, BSRB 2017, Ann Arbor, MI 48109-2200 USA
| | - Christopher L. Mendias
- />Department of Orthopaedic Surgery, University of Michigan Medical School, 109 Zina Pitcher Place, BSRB 2017, Ann Arbor, MI 48109-2200 USA , />Department of Molecular and Integrative Physiology, University of Michigan Medical School, Ann Arbor, MI USA
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21
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Kaar SG. CORR Insights®: Muscle fibers are injured at the time of acute and chronic rotator cuff repair. Clin Orthop Relat Res 2015; 473:233-4. [PMID: 25160943 PMCID: PMC4390946 DOI: 10.1007/s11999-014-3897-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Accepted: 08/13/2014] [Indexed: 01/31/2023]
Affiliation(s)
- Scott G. Kaar
- Department of Orthopedic Surgery, Saint Louis University, 221 N Grand Blvd., Saint Louis, MO 63103 USA
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22
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Itoigawa Y, Sperling JW, Steinmann SP, Chen Q, Song P, Chen S, Itoi E, Hatta T, An KN. Feasibility assessment of shear wave elastography to rotator cuff muscle. Clin Anat 2014; 28:213-8. [PMID: 25557287 DOI: 10.1002/ca.22498] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 11/21/2014] [Accepted: 11/24/2014] [Indexed: 11/11/2022]
Abstract
Pre-surgical measurement of supraspinatus muscle extensibility is important for rotator cuff repair. The purpose of the present study was to explore the potential feasibility of a shear wave ultrasound elastography (SWE)-based method, combined with B-mode ultrasound, to measure the in vivo stiffness of the supraspinatus muscle non-invasively and thus obtain key information about supraspinatus muscle extensibility. Our investigation comprised two steps. First, we determined the orientation of the supraspinatus muscle fibers in cadaveric shoulders without rotator cuff tear in order to optimize the ultrasound probe positions for SWE imaging. Second, we investigated the feasibility of quantifying the stiffness of the normal supraspinatus muscle by SWE in vivo. The supraspinatus muscle was divided into four anatomical regions: anterior superficial (AS), posterior superficial (PS), anterior deep (AD), and posterior deep (PD). Each region was examined by SWE. The SWE stiffnesses of AD, AS, PD, and PS were 40.0 ± 12.4, 34.0 ± 9.9, 32.7 ± 12.7, 39.1 ± 15.7 kPa, respectively. SWE combined with B-Mode ultrasound imaging could be a feasible method for quantifying the local stiffness of the rotator cuff muscles.
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Affiliation(s)
- Yoshiaki Itoigawa
- Biomechanics Laboratory and Tendon &Soft Tissue Biology Laboratories, Division of Orthopedic Research, Mayo Clinic, Rochester, Minnesota
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23
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Silldorff MD, Choo AD, Choi AJ, Lin E, Carr JA, Lieber RL, Lane JG, Ward SR. Effect of supraspinatus tendon injury on supraspinatus and infraspinatus muscle passive tension and associated biochemistry. J Bone Joint Surg Am 2014; 96:e175. [PMID: 25320205 PMCID: PMC4201769 DOI: 10.2106/jbjs.m.01315] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Injury to the supraspinatus and infraspinatus tendons and the associated atrophic changes to the muscle remain a common clinical problem. Specifically, increased muscle stiffness has been implicated in failure of the repair and poor functional outcomes. We present a comparison of the passive mechanical properties and associated biochemical studies from patients with and without torn supraspinatus tendons. METHODS Muscle biopsy samples (n = 40) were obtained from twenty patients undergoing arthroscopic shoulder surgery. Passive mechanical tests of both individual fibers and fiber bundles as well as analysis of titin molecular weight and collagen content were performed. RESULTS At the fiber-bundle level, a significant increase in passive modulus was observed between intact supraspinatus samples (mean [and standard error], 237.41 ± 59.78 kPa) and torn supraspinatus samples (515.74 ± 65.48 kPa) (p < 0.05), a finding that was not observed at the single fiber level. Within the torn samples, elastic moduli in the supraspinatus were greater than in the infraspinatus at both the single fiber and the fiber-bundle level. There was a significant positive correlation between bundle elastic modulus and collagen content (r(2) = 0.465) in the supraspinatus muscle as well as a significant positive correlation between tear size and bundle elastic modulus (r(2) = 0.702) in the torn supraspinatus samples. CONCLUSIONS Supraspinatus muscle passive tension increases in a tendon tear size-dependent manner after tendon injury. The increase in muscle stiffness appears to originate outside the muscle cell, in the extracellular matrix. CLINICAL RELEVANCE Muscle stiffness after rotator cuff tendon injury is more severe with large tears. This finding supports the concept of early intervention, when tendon tears are smaller, and interventions targeting the extracellular matrix.
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Affiliation(s)
- Morgan D. Silldorff
- Departments of Orthopaedic Surgery (M.D.S., A.D.C.,
A.J.C., E.L., J.A.C., R.L.L., and S.R.W.), Radiology (S.R.W.), and Bioengineering
(R.L.L. and S.R.W.), University of California, San Diego, 9500 Gilman Drive, La
Jolla, CA 92093-0610. E-mail address for S.R. Ward:
| | - Alexander D. Choo
- Departments of Orthopaedic Surgery (M.D.S., A.D.C.,
A.J.C., E.L., J.A.C., R.L.L., and S.R.W.), Radiology (S.R.W.), and Bioengineering
(R.L.L. and S.R.W.), University of California, San Diego, 9500 Gilman Drive, La
Jolla, CA 92093-0610. E-mail address for S.R. Ward:
| | - Anthony J. Choi
- Departments of Orthopaedic Surgery (M.D.S., A.D.C.,
A.J.C., E.L., J.A.C., R.L.L., and S.R.W.), Radiology (S.R.W.), and Bioengineering
(R.L.L. and S.R.W.), University of California, San Diego, 9500 Gilman Drive, La
Jolla, CA 92093-0610. E-mail address for S.R. Ward:
| | - Evie Lin
- Departments of Orthopaedic Surgery (M.D.S., A.D.C.,
A.J.C., E.L., J.A.C., R.L.L., and S.R.W.), Radiology (S.R.W.), and Bioengineering
(R.L.L. and S.R.W.), University of California, San Diego, 9500 Gilman Drive, La
Jolla, CA 92093-0610. E-mail address for S.R. Ward:
| | - J. Austin Carr
- Departments of Orthopaedic Surgery (M.D.S., A.D.C.,
A.J.C., E.L., J.A.C., R.L.L., and S.R.W.), Radiology (S.R.W.), and Bioengineering
(R.L.L. and S.R.W.), University of California, San Diego, 9500 Gilman Drive, La
Jolla, CA 92093-0610. E-mail address for S.R. Ward:
| | - Richard L. Lieber
- Departments of Orthopaedic Surgery (M.D.S., A.D.C.,
A.J.C., E.L., J.A.C., R.L.L., and S.R.W.), Radiology (S.R.W.), and Bioengineering
(R.L.L. and S.R.W.), University of California, San Diego, 9500 Gilman Drive, La
Jolla, CA 92093-0610. E-mail address for S.R. Ward:
| | - John G. Lane
- COAST Surgery Center, 3444 Kearny Villa Road, Suite 100,
San Diego, CA 92123
| | - Samuel R. Ward
- Departments of Orthopaedic Surgery (M.D.S., A.D.C.,
A.J.C., E.L., J.A.C., R.L.L., and S.R.W.), Radiology (S.R.W.), and Bioengineering
(R.L.L. and S.R.W.), University of California, San Diego, 9500 Gilman Drive, La
Jolla, CA 92093-0610. E-mail address for S.R. Ward:
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Hermenegildo J, Roberts S, Kim S. Innervation pattern of the suprascapular nerve within supraspinatus: A three-dimensional computer modeling study. Clin Anat 2013; 27:622-30. [DOI: 10.1002/ca.22250] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 03/04/2013] [Indexed: 11/07/2022]
Affiliation(s)
- J.A. Hermenegildo
- Division of Anatomy; Department of Surgery; University of Toronto; Canada
| | - S.L. Roberts
- Division of Anatomy; Department of Surgery; University of Toronto; Canada
| | - S.Y. Kim
- School of Physical Therapy, College of Medicine; University of Saskatchewan; Canada
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25
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Meyer DC, Wieser K, Farshad M, Gerber C. Retraction of supraspinatus muscle and tendon as predictors of success of rotator cuff repair. Am J Sports Med 2012; 40:2242-7. [PMID: 22926748 DOI: 10.1177/0363546512457587] [Citation(s) in RCA: 124] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The structural failure rate of rotator cuff repair can exceed 50%. Important predictors for repair failure are preoperative fatty muscle infiltration and myotendinous retraction. PURPOSE To quantitatively assess the prognostic value of preoperative retraction of both the supraspinatus muscle and tendon for the outcome of supraspinatus repair. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS In 33 shoulders with complete supraspinatus tendon ruptures subjected to arthroscopic repair, magnetic resonance imaging (MRI) scans taken preoperatively and after a mean follow-up of 24 months were studied. The exact position of the lateral extension of the supraspinatus muscle and of the tendon end was evaluated and correlated with the preoperative stage of fatty infiltration (Goutallier) and the failure rate of tendon repair. RESULTS The mean lengthening of the muscle and tendon end was -3 mm and 4 mm in the failed repairs (n = 19) and 14 mm and 8 mm in the successful repairs (n = 14). If the supraspinatus had preoperative Goutallier stages 2 to 3 and a tendon length of less than 15 mm, the failure rate was 92%, but if the tendon length was greater than 15 mm, the failure rate was only 33%. With Goutallier stages 0 to 1, the corresponding failure rates were 57% and 25%, respectively. CONCLUSION Rotator cuff repair lengthens the tendon, even if the repair fails. The possibility to lengthen the myotendinous unit is related to the preoperative length of the tendon. The combination of Goutallier grading and preoperative tendon length appears to be a more powerful predictor for the reparability of a tendon tear than Goutallier grading alone.
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Affiliation(s)
- Dominik C Meyer
- Balgrist University Hospital, Orthopaedic Department, University of Zurich, Zurich, Switzerland
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Is the long sarcomere length responsible for non-traumatic supraspinatus tendinopathy? Potential novel pathophysiology and implications for physiotherapy. ACTA ACUST UNITED AC 2012; 19:179-83. [PMID: 22633745 DOI: 10.1016/j.pathophys.2012.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2011] [Accepted: 04/18/2012] [Indexed: 11/23/2022]
Abstract
Several theories have been proposed to explain the mechanism of non-traumatic supraspinatus tendinopathy, which causes rotator cuff tendinitis and rotator cuff ruptures. However, these theories have not addressed all potential causes of rotator cuff tendinopathy. We propose that the microanatomy of the supraspinatus muscle and its response to gravity is the mechanism that responsible for non-traumatic supraspinatus tendinopathy and rotator cuff tears. Gravity causes chronic traction to the supraspinatus muscle, which results in elongation in the sarcomere length. Elongated sarcomere length causes compression on the micro vessels in the muscle which compromises internal microcirculation of the muscle and tendon. Poor microcirculation triggers ischemia and ischemia triggers inflammation process in the muscle and the tendon. This results in a higher incidence of tendinopathy. We also propose a new physiotherapeutic approach that may provide improved healing for rotator cuff tendinopathy.
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Kim SY, Bleakney RR, Rindlisbacher T, Ravichandiran K, Rosser BWC, Boynton E. Musculotendinous architecture of pathological supraspinatus: a pilot in vivo ultrasonography study. Clin Anat 2012; 26:228-35. [PMID: 22431385 DOI: 10.1002/ca.22065] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Revised: 02/07/2012] [Accepted: 02/14/2012] [Indexed: 11/10/2022]
Abstract
Architectural changes associated with tendon tears of the supraspinatus muscle (SP) have not been thoroughly investigated in vivo with the muscle in relaxed and contracted states. The purpose of this study was to quantify the geometric properties within the distinct regions of SP in subjects with full-thickness tendon tears using an ultrasound protocol previously developed in our laboratory, and to compare findings with age/gender matched normal controls. Twelve SP from eight participants (6 male/2 female), mean age 57 ± 6.0 years, were investigated. Muscle geometric properties of the anterior region (middle and deep parts) and posterior region (deep part) were measured using image analysis software. Along with whole muscle thickness, fiber bundle length (FBL) and pennation angle (PA) were computed for architecturally distinct regions and/or parts. Pathologic SP was categorized according to the extent of the tear in the tendon (with or without retraction). In the anterior region, mean FBL of the pathologic SP was similar with normal controls; however, mean PA was significantly smaller in pathologic SP with retraction compared with normal controls, in the contracted state (P < 0.05). Mean FBL in the posterior region in both relaxed and contracted states was significantly shorter in the pathologic SP with retraction compared with normal controls (P < 0.05). Findings suggest FBL changes associated with tendon pathology vary between the distinct regions, and PA changes are related to whether there is retraction of the tendon. The ultrasound protocol may provide important information on architectural changes that may assist in decision making and surgical planning.
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Affiliation(s)
- Soo Y Kim
- School of Physical Therapy, University of Saskatchewan, Saskatoon, Canada.
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Meyer DC, Farshad M, Amacker NA, Gerber C, Wieser K. Quantitative analysis of muscle and tendon retraction in chronic rotator cuff tears. Am J Sports Med 2012; 40:606-10. [PMID: 22174340 DOI: 10.1177/0363546511429778] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Musculotendinous retraction is a limiting factor for repair of long-standing rotator cuff tears. However, it is currently unknown to what extent the muscle and tendon contribute to the degree of total retraction. Further understanding of this may possibly influence the strategy of musculotendinous reconstruction. PURPOSE To analyze the contribution of muscle and tendon to the process of myotendinous retraction. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Magnetic resonance imaging of 130 shoulders with intact (n = 20) or completely torn supraspinatus tendons was analyzed. Fatty infiltration of the supraspinatus muscle was graded according to Goutallier stages. The degree of retraction of the tendon stump and of the musculotendinous junction was assessed. RESULTS There were 30 shoulders without evidence of supraspinatus fatty infiltration, 25 with stage 1, 23 with stage 2, 25 with stage 3, and 15 with stage 4 changes. The corresponding tear sizes (distance of tendon end from greater tuberosity) were 4, 21, 27, 37, and 41 mm; the distance of the myotendinous junction from the greater tuberosity was 22, 33, 39, 48, and 48 mm; and the length of the tendons (distance of tendon end to myotendinous junction) was 19, 13, 12, 11, and 8 mm, respectively. In Goutallier stage 3 and above, and in case of a positive tangent sign, the musculotendinous junction was, in 90% of the cases, retracted to or beyond the glenoid. CONCLUSION Musculotendinous retraction in chronic rotator cuff tears results mainly from shortening of the muscle fibers but in advanced stages results also from shortening of the tendon tissue itself. The present data demonstrate, for the first time, that the residual tendon stump in a tendon tear does not have the length of the original tendon and is further shortened over time. Therefore, direct anatomic tendon reinsertion will result in lengthening of the supraspinatus muscle greater than what it would have been before the tear.
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Affiliation(s)
- Dominik C Meyer
- Orthopedic Department, Balgrist University Hospital, University of Zurich, CH-8008 Zurich, Switzerland
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