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Seo SJ, Lee SS, Hwang JT, Han SH, Lee JR, Kim S. Effect of polydeoxyribonucleotide and polynucleotide on rotator cuff healing and fatty infiltration in a diabetic rat model. Sci Rep 2024; 14:20623. [PMID: 39232106 PMCID: PMC11375112 DOI: 10.1038/s41598-024-71206-8] [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: 02/20/2024] [Accepted: 08/26/2024] [Indexed: 09/06/2024] Open
Abstract
Failure rate after chronic rotator cuff repair is considerably high. Moreover, diabetes mellitus is known as a compromising factor of rotator cuff tear. The effect of Polydeoxyribonucleotide (PDRN) and polynucleotide (PN) on tendon healing and fatty infiltration is unclear as tissue regeneration activator in diabetic state. Therefore, a diabetic rat model with chronic rotator cuff tear was made for mechanical, histologic and blood tests. In the animal study using a diabetic rat cuff repair model, the administration of PDRN and PN increased the load to failure of repaired cuffs and improved tendon healing and decreased fatty infiltration. Also, the plasma levels of vascular endothelial growth factor and fibroblast growth factor were elevated in PDRN and PN administrated groups. We concluded that PDRN and PN appear to boost tendon recovery and reduce the presence of fatty infiltration following cuff repair in diabetic state. Also, PN showed a later onset and a longer duration than PDRN associated with the mean plasma growth factors.
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Affiliation(s)
- Su-Jung Seo
- Department of Orthopedic Surgery, Hallym University Medical College, Chuncheon-Si, Gangwon-Do, Republic of Korea
| | - Sang-Soo Lee
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University Medical College, 77, Sakju-Ro, Chuncheon-Si, Gangwon-Do, 24253, Republic of Korea
| | - Jung-Taek Hwang
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University Medical College, 77, Sakju-Ro, Chuncheon-Si, Gangwon-Do, 24253, Republic of Korea.
| | - Sang Hak Han
- Department of Pathology, Chuncheon Sacred Heart Hospital, Hallym University Medical College, 77, Sakju-Ro, Chuncheon-Si, Gangwon-Do, 24253, Republic of Korea.
| | - Jae-Ryeong Lee
- Department of Pharmacology, Institute of Natural Medicine, Hallym University Medical College, Chuncheon-Si, Gangwon-Do, Republic of Korea
| | - Sungsu Kim
- Department of Pharmacology, Institute of Natural Medicine, Hallym University Medical College, Chuncheon-Si, Gangwon-Do, Republic of Korea
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2
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Morimoto T, Izumi M, Aso K, Ikeuchi M. Role of tear size and tendon degeneration for development of pain in rat models of rotator cuff tear. J Shoulder Elbow Surg 2024; 33:1473-1482. [PMID: 38311102 DOI: 10.1016/j.jse.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 12/12/2023] [Accepted: 12/17/2023] [Indexed: 02/06/2024]
Abstract
BACKGROUND Rotator cuff tear (RCT) is a frequent etiology of shoulder pain and disability; however, the triggers for the onset and aggravation of pain remain obscure. In this study, we established novel rat RCT models to examine the impact of tear size and tendon degeneration on pain. METHODS Fifty-five adult male Sprague-Dawley rats were allocated into 4 study groups: large tear (L group, n = 10), small tear (S group, n = 15), small tear with scratching (S+ group n = 15), and sham surgery (Sham group, n = 15). Pain-related behaviors were evaluated by weight distribution of forelimbs during a 5-minute free gait using a dynamic weight-bearing apparatus at 2, 4, 6, and 8 weeks. Calcitonin gene-related peptide (CGRP) expressions in ipsilateral dorsal root ganglion (DRG) neurons of C4, C5, and C6 were evaluated at 4 and 8 weeks. The area of scar tissues around the torn tendon, infiltration of inflammatory cells, and severity of tendon degeneration (modified Bonar score) were histologically assessed at 4 and 8 weeks. Additionally, enzyme-linked immunosorbent assay (ELISA) was conducted to evaluate the levels of cyclooxygenase-2 (COX-2) and nerve growth factor (NGF) expression in torn tendons and surrounding tissues at 4 weeks. RESULTS The weight distribution ratio (ipsilateral and contralateral side) was significantly decreased in the L and S+ group compared with its baseline and Sham group (P < .05), but the S group showed no significant difference compared with the Sham. The ratio of CGRP-immunoreactive neurons in the DRGs was significantly higher in the L and S+ groups than in the S and Sham groups. The histologic assessment indicated that scar tissue formation was more extensive in the L group than in the S and S+ groups. Still, there was no significant difference between the S and S+ groups. The modified Bonar score was considerably higher in the S+ group than in the S group. Furthermore, ELISA analysis demonstrated no significant disparity in COX-2 levels between the groups; however, NGF levels were substantially higher in the S+ group than in the S and Sham groups. CONCLUSION The present study provides compelling evidence that large RCT is strongly associated with heightened pain severity in a rat model. Nevertheless, even a small tear can significantly aggravate pain when the torn tendon is degenerated. CGRP upregulation driven by peripheral NGF possibly played a pivotal role in the genesis and exacerbation of pain in small RCT.
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Affiliation(s)
- Toru Morimoto
- Department of Orthopaedic Surgery, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Masashi Izumi
- Department of Orthopaedic Surgery, Kochi Medical School, Kochi University, Nankoku, Japan; Department of Rehabilitation, Kochi Medical School Hospital, Kochi University, Nankoku, Japan.
| | - Koji Aso
- Department of Orthopaedic Surgery, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Masahiko Ikeuchi
- Department of Orthopaedic Surgery, Kochi Medical School, Kochi University, Nankoku, Japan; Department of Rehabilitation, Kochi Medical School Hospital, Kochi University, Nankoku, Japan
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3
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Gibbons MC, Silldorff M, Okuno H, Esparza MC, Migdal C, Johnson S, Schenk S, Ward SR. The effect of tenotomy, neurotomy, and dual injury on mouse rotator cuff muscles: Consequences for the mouse as a preclinical model. J Orthop Res 2024; 42:1170-1179. [PMID: 38245849 DOI: 10.1002/jor.25786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 12/13/2023] [Accepted: 01/03/2024] [Indexed: 01/22/2024]
Abstract
A common animal model of muscle pathology following rotator cuff tear (RCT) is a tenotomy of the supraspinatus and infraspinatus, often combined with neurotomy of the suprascapular nerve, which induces a more robust atrophy response than tenotomy alone. However, the utility of this model depends on its similarity to human muscle pathology post-RCT, both in terms of the disease phenotype and mechanisms of muscle atrophy and fatty infiltration. Given the clinical prevalence of nerve injury is low and the muscular response to denervation is distinct from mechanical unloading in other models, an understanding of the biological influence of the nerve injury is critical for interpreting data from this RCT model. We evaluated the individual and combined effect of tenotomy and neurotomy across multiple biological scales, in a robust time-series in the mouse supraspinatus. Muscle composition, histological, and gene expression data related to muscle atrophy, degeneration-regeneration, fatty infiltration, and fibrosis were evaluated. Broadly, we found tenotomy alone caused small, transient changes in these pathological features, which resolved over the course of the study, while neurotomy alone caused a significant fatty atrophy phenotype. The dual injury group had a similar fatty atrophy phenotype to the neurotomy group, though the addition of tenotomy did marginally enhance the fat and connective tissue. Overall, these results suggest the most clinically relevant injury model, tenotomy alone, does not produce a clinically relevant phenotype. The dual injury model partially recapitulates the human condition, but it does so through a nerve injury, which is not well justified clinically.
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Affiliation(s)
- Michael C Gibbons
- Department of Bioengineering, University of California San Diego, San Diego, California, USA
| | - Morgan Silldorff
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, California, USA
| | - Hiroshi Okuno
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, California, USA
| | - Mary C Esparza
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, California, USA
| | - Christopher Migdal
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, California, USA
| | - Seth Johnson
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, California, USA
| | - Simon Schenk
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, California, USA
| | - Samuel R Ward
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, California, USA
- Department of Radiology, University of California San Diego, San Diego, California, USA
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4
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Walluks K, Praetorius JP, Arnold D, Figge MT. Impact of functional electrical stimulation on nerve-damaged muscles by quantifying fat infiltration using deep learning. Sci Rep 2024; 14:12158. [PMID: 38802457 PMCID: PMC11130129 DOI: 10.1038/s41598-024-62805-6] [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: 12/04/2023] [Accepted: 05/21/2024] [Indexed: 05/29/2024] Open
Abstract
Quantitative imaging in life sciences has evolved into a powerful approach combining advanced microscopy acquisition and automated analysis of image data. The focus of the present study is on the imaging-based evaluation of the posterior cricoarytenoid muscle (PCA) influenced by long-term functional electrical stimulation (FES), which may assist the inspiration of patients with bilateral vocal fold paresis. To this end, muscle cross-sections of the PCA of sheep were examined by quantitative image analysis. Previous investigations of the muscle fibers and the collagen amount have not revealed signs of atrophy and fibrosis due to FES by a laryngeal pacemaker. It was therefore hypothesized that regardless of the stimulation parameters the fat in the muscle cross-sections would not be significantly altered. We here extending our previous investigations using quantitative imaging of intramuscular fat in cross-sections. In order to perform this analysis both reliably and faster than a qualitative evaluation and time-consuming manual annotation, the selection of the automated method was of crucial importance. To this end, our recently established deep neural network IMFSegNet, which provides more accurate results compared to standard machine learning approaches, was applied to more than 300 H&E stained muscle cross-sections from 22 sheep. It was found that there were no significant differences in the amount of intramuscular fat between the PCA with and without long-term FES, nor were any significant differences found between the low and high duty cycle stimulated groups. This study on a human-like animal model not only confirms the hypothesis that FES with the selected parameters has no negative impact on the PCA, but also demonstrates that objective and automated deep learning-based quantitative imaging is a powerful tool for such a challenging analysis.
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Affiliation(s)
- Kassandra Walluks
- Applied Systems Biology, Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute, Jena, Germany
- Faculty of Biological Sciences, Friedrich Schiller University Jena, Jena, Germany
- Institute of Zoology and Evolutionary Research, Faculty of Biological Sciences, Friedrich Schiller University Jena, Jena, Germany
| | - Jan-Philipp Praetorius
- Applied Systems Biology, Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute, Jena, Germany
- Faculty of Biological Sciences, Friedrich Schiller University Jena, Jena, Germany
| | - Dirk Arnold
- Clinic and Polyclinic for Otorhinolaryngology, University Hospital Jena, Jena, Germany.
| | - Marc Thilo Figge
- Applied Systems Biology, Leibniz Institute for Natural Product Research and Infection Biology, Hans Knöll Institute, Jena, Germany.
- Institute of Microbiology, Faculty of Biological Sciences, Friedrich Schiller University Jena, Jena, Germany.
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5
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Yuan T, Lai CT, Yang SQ, Meng J, Qian H, Yu X, Jiang H, Cao QG, Xu JD, Bao NR. The rat as a novel model for chronic rotator cuff injuries. Sci Rep 2024; 14:5344. [PMID: 38438458 PMCID: PMC10912722 DOI: 10.1038/s41598-024-55281-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/22/2024] [Indexed: 03/06/2024] Open
Abstract
Chronic rotator cuff injuries (CRCIs) still present a great challenge for orthopaedics surgeons. Many new therapeutic strategies are developed to facilitate repair and improve the healing process. However, there is no reliable animal model for chronic rotator cuff injury research. To present a new valuable rat model for future chronic rotator cuff injuries (CRCIs) repair studies, and describe the changes of CRCIs on the perspectives of histology, behavior and MRI. Sixty male Wistar rats were enrolled and underwent surgery of the left shoulder joint for persistent subacromial impingement. They were randomly divided into experimental group (n = 30, a 3D printed PEEK implant shuttled into the lower surface of the acromion) and sham operation group (n = 30, insert the same implant, but remove it immediately). Analyses of histology, behavior, MRI and inflammatory pain-related genes expression profiles were performed to evaluate the changes of CRCIs. After 2-weeks running, the rats in the experimental group exhibited compensatory gait patterns to protect the injured forelimb from loading after 2-weeks running. After 8-weeks running, the rats in the experimental group showed obvious CRCIs pathological changes: (1) acromion bone hyperplasia and thickening of the cortical bone; (2) supraspinatus muscle tendon of the humeral head: the bursal-side tendon was torn and layered with disordered structure, forming obvious gaps; the humeral-side tendon is partially broken, and has a neatly arranged collagen. Partial fat infiltration is found. The coronal T2-weighted images showed that abnormal tendon-to-bone junctions of the supraspinatus tendon. The signal intensity and continuity were destroyed with contracted tendon. At the nighttime, compared with the sham operation group, the expression level of IL-1β and COX-2 increased significantly (P = 0063, 0.0005) in the experimental group. The expression of COX-2 in experimental group is up-regulated about 1.5 times than that of daytime (P = 0.0011), but the expression of IL-1β, TNF-a, and NGF are all down-regulated (P = 0.0146, 0.0232, 0.0161). This novel rat model of chronic rotator cuff injuries has the similar characteristics with that of human shoulders. And it supplies a cost-effective, reliable animal model for advanced tissue engineered strategies and future therapeutic strategies.
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Affiliation(s)
- Tao Yuan
- Department of Orthopaedics, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 Zhongshan East Road, Nanjing, 210002, China
| | - Cheng-Teng Lai
- Department of Orthopaedics, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 Zhongshan East Road, Nanjing, 210002, China
| | - Shao-Qiang Yang
- Department of Orthopaedics, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 Zhongshan East Road, Nanjing, 210002, China
| | - Jia Meng
- Department of Orthopaedics, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 Zhongshan East Road, Nanjing, 210002, China
| | - Hong Qian
- Department of Orthopaedics, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 Zhongshan East Road, Nanjing, 210002, China
| | - Xin Yu
- Department of Orthopaedics, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 Zhongshan East Road, Nanjing, 210002, China
| | - Hui Jiang
- Department of Orthopaedics, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 Zhongshan East Road, Nanjing, 210002, China
| | - Qing-Gang Cao
- Department of Orthopaedics, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 Zhongshan East Road, Nanjing, 210002, China
| | - Jian-Da Xu
- Department of Orthopaedics, Changzhou Traditional Chinese Medical Hospital, Changzhou hospital Affiliated to Nanjing University of Chinese Medicine, 25 North Heping Road, Changzhou, 213000, Jiangsu, China.
| | - Ni-Rong Bao
- Department of Orthopaedics, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 Zhongshan East Road, Nanjing, 210002, China.
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6
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Chang EY, Suprana A, Tang Q, Cheng X, Fu E, Orozco E, Jerban S, Shah SB, Du J, Ma Y. Rotator cuff muscle fibrosis can be assessed using ultrashort echo time magnetization transfer MRI with fat suppression. NMR IN BIOMEDICINE 2024; 37:e5058. [PMID: 37828713 PMCID: PMC10841248 DOI: 10.1002/nbm.5058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/30/2023] [Accepted: 09/19/2023] [Indexed: 10/14/2023]
Abstract
Muscle degeneration following rotator cuff tendon tearing is characterized by fatty infiltration and fibrosis. While tools exist for the characterization of fat, the ability to noninvasively assess muscle fibrosis is limited. The purpose of this study was to evaluate the capability of quantitative ultrashort echo time T1 (UTE-T1) and UTE magnetization transfer (UTE-MT) mapping with and without fat suppression (FS) for the differentiation of injured and control rotator cuff muscles and for the detection of fibrosis. A rat model of chronic massive rotator cuff tearing (n = 12) was used with tenotomy of the right supraspinatus and infraspinatus tendons and silicone implants to prevent healing. Imaging was performed on a 3-T scanner, and UTE-T1 mapping with and without FS and UTE-MT with and without FS for macromolecular fraction (MMF) mapping was performed. At 20 weeks postinjury, T1 and MMF were measured in the supraspinatus and infraspinatus muscles of the injured and contralateral, internal control sides. Histology was performed and connective tissue fraction (CTF) was measured, defined as the area of collagen-rich extracellular matrix divided by the total muscle area. Paired t-tests and correlation analyses were performed. Significant differences between injured and control sides were found for CTF in the supraspinatus (mean ± SD, 14.5% ± 3.9% vs. 11.3% ± 3.7%, p = 0.01) and infraspinatus (17.0% ± 5.4% vs. 12.5% ± 4.6%, p < 0.01) muscles, as well as for MMF using UTE-MT FS in the supraspinatus (9.7% ± 0.3% vs. 9.5% ± 0.2%, p = 0.04) and infraspinatus (10.9% ± 0.8% vs. 10.1% ± 0.5%, p < 0.01) muscles. No significant differences between sides were evident for T1 without or with FS or for MMF using UTE-MT. Only MMF using UTE-MT FS was significantly correlated with CTF for both supraspinatus (r = 0.46, p = 0.03) and infraspinatus (r = 0.51, p = 0.01) muscles. Fibrosis occurs in rotator cuff muscle degeneration, and the UTE-MT FS technique may be helpful to evaluate the fibrosis component, independent from the fatty infiltration process.
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Affiliation(s)
- Eric Y Chang
- Radiology Service, VA San Diego Healthcare System, San Diego, California, USA
- Department of Radiology, University of California San Diego, San Diego, California, USA
| | - Arya Suprana
- Department of Radiology, University of California San Diego, San Diego, California, USA
- Department of Bioengineering, University of California San Diego, San Diego, California, USA
| | - Qingbo Tang
- Department of Radiology, University of California San Diego, San Diego, California, USA
- Research Service, VA San Diego Healthcare System, San Diego, California, USA
| | - Xin Cheng
- Department of Radiology, University of California San Diego, San Diego, California, USA
- Research Service, VA San Diego Healthcare System, San Diego, California, USA
| | - Eddie Fu
- Department of Radiology, University of California San Diego, San Diego, California, USA
- Research Service, VA San Diego Healthcare System, San Diego, California, USA
| | - Elisabeth Orozco
- Research Service, VA San Diego Healthcare System, San Diego, California, USA
- Department of Orthopedic Surgery, University of California San Diego, San Diego, California, USA
| | - Saeed Jerban
- Department of Radiology, University of California San Diego, San Diego, California, USA
- Research Service, VA San Diego Healthcare System, San Diego, California, USA
- Department of Orthopedic Surgery, University of California San Diego, San Diego, California, USA
| | - Sameer B Shah
- Department of Bioengineering, University of California San Diego, San Diego, California, USA
- Research Service, VA San Diego Healthcare System, San Diego, California, USA
- Department of Orthopedic Surgery, University of California San Diego, San Diego, California, USA
| | - Jiang Du
- Department of Radiology, University of California San Diego, San Diego, California, USA
- Department of Bioengineering, University of California San Diego, San Diego, California, USA
- Research Service, VA San Diego Healthcare System, San Diego, California, USA
| | - Yajun Ma
- Department of Radiology, University of California San Diego, San Diego, California, USA
- Research Service, VA San Diego Healthcare System, San Diego, California, USA
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7
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Saveh-Shemshaki N, Barajaa MA, Otsuka T, Mirdamadi ES, Nair LS, Laurencin CT. Electroconductivity, a regenerative engineering approach to reverse rotator cuff muscle degeneration. Regen Biomater 2023; 10:rbad099. [PMID: 38020235 PMCID: PMC10676522 DOI: 10.1093/rb/rbad099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/25/2023] [Accepted: 10/28/2023] [Indexed: 12/01/2023] Open
Abstract
Muscle degeneration is one the main factors that lead to the high rate of retear after a successful repair of rotator cuff (RC) tears. The current surgical practices have failed to treat patients with chronic massive rotator cuff tears (RCTs). Therefore, regenerative engineering approaches are being studied to address the challenges. Recent studies showed the promising outcomes of electroactive materials (EAMs) on the regeneration of electrically excitable tissues such as skeletal muscle. Here, we review the most important biological mechanism of RC muscle degeneration. Further, the review covers the recent studies on EAMs for muscle regeneration including RC muscle. Finally, we will discuss the future direction toward the application of EAMs for the augmentation of RCTs.
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Affiliation(s)
- Nikoo Saveh-Shemshaki
- The Cato T. Laurencin Institute for Regenerative Engineering, University of Connecticut, Farmington, CT 06030, USA
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA
| | - Mohammed A Barajaa
- Department of Biomedical Engineering, Imam Abdulrahman Bin Faisal University, Dammam 31451, Saudi Arabia
| | - Takayoshi Otsuka
- The Cato T. Laurencin Institute for Regenerative Engineering, University of Connecticut, Farmington, CT 06030, USA
| | - Elnaz S Mirdamadi
- The Cato T. Laurencin Institute for Regenerative Engineering, University of Connecticut, Farmington, CT 06030, USA
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA
| | - Lakshmi S Nair
- The Cato T. Laurencin Institute for Regenerative Engineering, University of Connecticut, Farmington, CT 06030, USA
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA
- Department of Orthopedic Surgery, University of Connecticut Health Center, Farmington, CT 06030, USA
- Department of Materials Science and Engineering, University of Connecticut, Storrs, CT 06269, USA
| | - Cato T Laurencin
- The Cato T. Laurencin Institute for Regenerative Engineering, University of Connecticut, Farmington, CT 06030, USA
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269, USA
- Department of Orthopedic Surgery, University of Connecticut Health Center, Farmington, CT 06030, USA
- Department of Materials Science and Engineering, University of Connecticut, Storrs, CT 06269, USA
- Department of Chemical & Biomolecular Engineering, University of Connecticut, Storrs, CT 06269, USA
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8
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Shemshaki NS, Kan HM, Barajaa MA, Lebaschi A, Otsuka T, Mishra N, Nair LS, Laurencin CT. Efficacy of a Novel Electroconductive Matrix To Treat Muscle Atrophy and Fat Accumulation in Chronic Massive Rotator Cuff Tears of the Shoulder. ACS Biomater Sci Eng 2023; 9:5782-5792. [PMID: 37769114 DOI: 10.1021/acsbiomaterials.3c00585] [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] [Indexed: 09/30/2023]
Abstract
The high retear rate after a successful repair of the rotator cuff (RC) is a major clinical challenge. Muscle atrophy and fat accumulation of RC muscles over time adversely affect the rate of retear. Since current surgical techniques do not improve muscle degenerative conditions, new treatments are being developed to reduce muscle atrophy and fat accumulation. In the previous study, we have shown the efficacy of aligned electroconductive nanofibrous fabricated by coating poly(3,4-ethylene dioxythiophene): poly(styrenesulfonate) (PEDOT:PSS) nanoparticles onto aligned poly(ε-caprolactone) (PCL) electrospun nanofibers (PEDOT:PSS matrix) to reduce muscle atrophy in acute and subacute models of RC tears (RCTs). In this study, we further evaluated the efficacy of the PEDOT:PSS matrix to reduce muscle atrophy and fat accumulation in a rat model of chronic massive full-thickness RCTs (MRCTs). The matrices were transplanted on the myotendinous junction to the belly of the supraspinatus and infraspinatus muscles at 16 weeks after MRCTs. The biomechanics and histological assessments showed the potential of the PEDOT:PSS matrix to suppress the progression of muscle atrophy, fat accumulation, and fibrosis in both supraspinatus and infraspinatus muscles at 24 and 32 weeks after MRCTs. We also demonstrated that the PEDOT:PSS matrix implantation significantly improved the tendon morphology and tensile properties compared with current surgical techniques.
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Affiliation(s)
- Nikoo Saveh Shemshaki
- The Cato T. Laurencin Institute for Regenerative Engineering, University of Connecticut, Farmington, Connecticut 06030, United States
- Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, University of Connecticut Health Center, Farmington, Connecticut 06030, United States
- Department of Biomedical Engineering, University of Connecticut, Storrs, Connecticut 06269, United States
| | - Ho-Man Kan
- The Cato T. Laurencin Institute for Regenerative Engineering, University of Connecticut, Farmington, Connecticut 06030, United States
- Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, University of Connecticut Health Center, Farmington, Connecticut 06030, United States
| | - Mohammed A Barajaa
- Department of Biomedical Engineering, Imam Abdulrahman Bin Faisal University, Dammam 31451, Saudi Arabia
| | - Amir Lebaschi
- Department of Orthopedic Surgery, University of Connecticut Health Center, Farmington, Connecticut 06030, United States
| | - Takayoshi Otsuka
- The Cato T. Laurencin Institute for Regenerative Engineering, University of Connecticut, Farmington, Connecticut 06030, United States
- Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, University of Connecticut Health Center, Farmington, Connecticut 06030, United States
| | - Neha Mishra
- Department of Pathobiology and Veterinary Science, University of Connecticut, Storrs, Connecticut 06269, United States
- Connecticut Veterinary Medical Diagnostic Laboratory, Storrs, Connecticut 06269, United States
| | - Lakshmi S Nair
- The Cato T. Laurencin Institute for Regenerative Engineering, University of Connecticut, Farmington, Connecticut 06030, United States
- Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, University of Connecticut Health Center, Farmington, Connecticut 06030, United States
- Department of Biomedical Engineering, University of Connecticut, Storrs, Connecticut 06269, United States
- Department of Orthopedic Surgery, University of Connecticut Health Center, Farmington, Connecticut 06030, United States
- Department of Materials Science and Engineering, University of Connecticut, Storrs, Connecticut 06269, United States
- Department of Chemical & Biomolecular Engineering, University of Connecticut, Storrs, Connecticut 06269, United States
| | - Cato T Laurencin
- The Cato T. Laurencin Institute for Regenerative Engineering, University of Connecticut, Farmington, Connecticut 06030, United States
- Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, University of Connecticut Health Center, Farmington, Connecticut 06030, United States
- Department of Biomedical Engineering, University of Connecticut, Storrs, Connecticut 06269, United States
- Department of Orthopedic Surgery, University of Connecticut Health Center, Farmington, Connecticut 06030, United States
- Department of Materials Science and Engineering, University of Connecticut, Storrs, Connecticut 06269, United States
- Department of Chemical & Biomolecular Engineering, University of Connecticut, Storrs, Connecticut 06269, United States
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Little D, Amadio PC, Awad HA, Cone SG, Dyment NA, Fisher MB, Huang AH, Koch DW, Kuntz AF, Madi R, McGilvray K, Schnabel LV, Shetye SS, Thomopoulos S, Zhao C, Soslowsky LJ. Preclinical tendon and ligament models: Beyond the 3Rs (replacement, reduction, and refinement) to 5W1H (why, who, what, where, when, how). J Orthop Res 2023; 41:2133-2162. [PMID: 37573480 PMCID: PMC10561191 DOI: 10.1002/jor.25678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/21/2023] [Accepted: 08/02/2023] [Indexed: 08/14/2023]
Abstract
Several tendon and ligament animal models were presented at the 2022 Orthopaedic Research Society Tendon Section Conference held at the University of Pennsylvania, May 5 to 7, 2022. A key objective of the breakout sessions at this meeting was to develop guidelines for the field, including for preclinical tendon and ligament animal models. This review summarizes the perspectives of experts for eight surgical small and large animal models of rotator cuff tear, flexor tendon transection, anterior cruciate ligament tear, and Achilles tendon injury using the framework: "Why, Who, What, Where, When, and How" (5W1H). A notable conclusion is that the perfect tendon model does not exist; there is no single gold standard animal model that represents the totality of tendon and ligament disease. Each model has advantages and disadvantages and should be carefully considered in light of the specific research question. There are also circumstances when an animal model is not the best approach. The wide variety of tendon and ligament pathologies necessitates choices between small and large animal models, different anatomic sites, and a range of factors associated with each model during the planning phase. Attendees agreed on some guiding principles including: providing clear justification for the model selected, providing animal model details at publication, encouraging sharing of protocols and expertise, improving training of research personnel, and considering greater collaboration with veterinarians. A clear path for translating from animal models to clinical practice was also considered as a critical next step for accelerating progress in the tendon and ligament field.
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Affiliation(s)
- Dianne Little
- Department of Basic Medical Sciences, The Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, USA
| | - Peter C Amadio
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Hani A Awad
- Department of Orthopaedics, Department of Biomedical Engineering, The Center for Musculoskeletal Research, University of Rochester, Rochester, New York, USA
| | - Stephanie G Cone
- Department of Biomedical Engineering, University of Delaware, Newark, Delaware, USA
| | - Nathaniel A Dyment
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Matthew B Fisher
- Joint Department of Biomedical Engineering, College of Engineering, North Carolina State University-University of North Carolina at Chapel Hill, Raleigh, North Carolina, USA
| | - Alice H Huang
- Department of Orthopedic Surgery, Department of Biomedical Engineering, Columbia University, New York, New York, USA
| | - Drew W Koch
- Department of Clinical Sciences, College of Veterinary Medicine, and Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina, USA
| | - Andrew F Kuntz
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rashad Madi
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kirk McGilvray
- Department of Mechanical Engineering, School of Biomedical Engineering, Colorado State University, Fort Collins, Colorado, USA
| | - Lauren V Schnabel
- Department of Clinical Sciences, College of Veterinary Medicine, and Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina, USA
| | - Snehal S Shetye
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stavros Thomopoulos
- Department of Orthopedic Surgery, Department of Biomedical Engineering, Columbia University, New York, New York, USA
| | - Chunfeng Zhao
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Louis J Soslowsky
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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10
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Muellner M, Haffer H, Moser M, Amoroso K, Wang Z, Arzani A, Tan ET, Chiapparelli E, Dodo Y, Shue J, Pumberger M, Sama AA, Cammisa FP, Girardi FP, Hughes AP. Changes of the posterior paraspinal and psoas muscle in patients with low back pain: a 3-year longitudinal study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:3290-3299. [PMID: 37378708 DOI: 10.1007/s00586-023-07814-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/23/2023] [Accepted: 06/03/2023] [Indexed: 06/29/2023]
Abstract
PURPOSE This study aimed to investigate the changes of the posterior paraspinal muscles (PPM) and psoas muscle in patients with low back pain (LBP) over time. METHODS Patients with LBP who had a repeat lumbar MRI with a minimum of 3-years apart at a tertiary referral center were analyzed. MRI-based quantitative assessments of the PPM and the psoas muscle were conducted for the baseline and follow-up MRI. The cross sectional area (CSA), the functional cross sectional area (fCSA) and the fat area (FAT) were calculated using a dedicated software program. The fatty infiltration (FI,%) of the regions of interest was calculated. Differences between the 1st and 2nd MRI were calculated for all assessed muscular parameters. RESULTS A total of 353 patients (54.4%female) with a median age of 60.1 years and BMI of 25.8 kg/m2 at baseline were analyzed. The mean time between the 1st and 2nd MRI was 3.6 years. The fCSAPPM declined in both sexes significantly from the 1st to the 2nd MRI, whereas the FATPPM increased. In line with this result, the FIPPM increased in both males (29.9%) and females (19.4%). Females had a higher FIPPM and FIPsoas than males in both MRIs. In females, no significant changes were found for the psoas muscle. The CSAPsoas and fCSAPsoas in males were significantly smaller in the 2nd MRI. With increasing age, a significant trend in a decrease in ∆FIPPM was observed for both sexes. CONCLUSION The study revealed significant quantitatively muscular changes in males and females, especially in the posterior paraspinal muscles in only three years' time.
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Affiliation(s)
- Maximilian Muellner
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Henryk Haffer
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Manuel Moser
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
- Department of Spine Surgery, Lucerne Cantonal Hospital, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Krizia Amoroso
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Zhaorui Wang
- Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10065, USA
| | - Artine Arzani
- Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10065, USA
| | - Ek T Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Erika Chiapparelli
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Yusuke Dodo
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Jennifer Shue
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Matthias Pumberger
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Andrew A Sama
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Frank P Cammisa
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Federico P Girardi
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA
| | - Alexander P Hughes
- Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA.
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11
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Praetorius JP, Walluks K, Svensson CM, Arnold D, Figge MT. IMFSegNet: Cost-effective and objective quantification of intramuscular fat in histological sections by deep learning. Comput Struct Biotechnol J 2023; 21:3696-3704. [PMID: 37560127 PMCID: PMC10407270 DOI: 10.1016/j.csbj.2023.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/21/2023] [Accepted: 07/22/2023] [Indexed: 08/11/2023] Open
Abstract
The assessment of muscle condition is of great importance in various research areas. In particular, evaluating the degree of intramuscular fat (IMF) in tissue sections is a challenging task, which today is still mostly performed qualitatively or quantitatively by a highly subjective and error-prone manual analysis. We here realize the mission to make automated IMF analysis possible that (i) minimizes subjectivity, (ii) provides accurate and quantitative results quickly, and (iii) is cost-effective using standard hematoxylin and eosin (H&E) stained tissue sections. To address all these needs in a deep learning approach, we utilized the convolutional encoder-decoder network SegNet to train the specialized network IMFSegNet allowing to accurately quantify the spatial distribution of IMF in histological sections. Our fully automated analysis was validated on 17 H&E-stained muscle sections from individual sheep and compared to various state-of-the-art approaches. Not only does IMFSegNet outperform all other approaches, but this neural network also provides fully automated and highly accurate results utilizing the most cost-effective procedures of sample preparation and imaging. Furthermore, we shed light on the opacity of black-box approaches such as neural networks by applying an explainable artificial intelligence technique to clarify that the success of IMFSegNet actually lies in identifying the hard-to-detect IMF structures. Embedded in our open-source visual programming language JIPipe that does not require programming skills, it can be expected that IMFSegNet advances muscle condition assessment in basic research across multiple areas as well as in research fields focusing on translational clinical applications.
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Affiliation(s)
- Jan-Philipp Praetorius
- Applied Systems Biology, Leibniz institute for natural Product Research and infection Biology – Hans Knöll institute (HKI), Jena, Germany
- Faculty of Biological Sciences, Friedrich Schiller University Jena, Jena, Germany
| | - Kassandra Walluks
- Applied Systems Biology, Leibniz institute for natural Product Research and infection Biology – Hans Knöll institute (HKI), Jena, Germany
- Faculty of Biological Sciences, Friedrich Schiller University Jena, Jena, Germany
- Institute of Zoology and Evolutionary Research, Faculty of Biological Sciences, Friedrich Schiller University Jena, Jena, Germany
| | - Carl-Magnus Svensson
- Applied Systems Biology, Leibniz institute for natural Product Research and infection Biology – Hans Knöll institute (HKI), Jena, Germany
| | - Dirk Arnold
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany
- Facial-Nerve-Center Jena, Jena University Hospital, Jena, Germany
| | - Marc Thilo Figge
- Applied Systems Biology, Leibniz institute for natural Product Research and infection Biology – Hans Knöll institute (HKI), Jena, Germany
- Institute of Microbiology, Faculty of Biological Sciences, Friedrich Schiller University Jena, Jena, Germany
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12
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Lacheta L, Siebenlist S, Scheiderer B, Beitzel K, Woertler K, Imhoff AB, Buchmann S, Willinger L. Intact revision rotator cuff repair stabilizes muscle atrophy and fatty infiltration after minimum follow up of two years. BMC Musculoskelet Disord 2023; 24:515. [PMID: 37353825 DOI: 10.1186/s12891-023-06616-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 06/09/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND The extent of fatty infiltration and rotator cuff (RC) atrophy is crucial for the clinical results after rotator cuff repair (RCR). The purpose of this study was to evaluate changes in fatty infiltration and RC atrophy after revision RCR and to correlate them with functional outcome parameters. METHODS Patients who underwent arthroscopic revision RCR for symptomatic recurrent full-thickness tear of the supraspinatus tendon between 2008 and 2014 and were retrospectively reviewed with a minimum follow up of 2 years. Magnetic resonance imaging (MRI) was performed pre- and postoperatively to assess 1) tendon integrity after revision RCR according to Sugaya classification, (2) RC atrophy according to Thomazeau classification, and (3) fatty infiltration according to Fuchs MRI classification. Constant score (CS) and the American Shoulder and Elbow Surgeon (ASES) score were used to correlate functional outcome, tendon integrity, and muscle degeneration. RESULTS 19 patients (17 males and 2 females) with a mean age of 57.5 years (range, 34 to 72) were included into the study at a mean follow-up of 50.3 months (range, 24 - 101). At final evaluation, 9 patients (47%) presented with intact RCR and 10 patients (53%) suffered a re-tear after revision repair. No progress of fatty infiltration was observed postoperatively in the group with intact RC, atrophy progressed in only 1 out of 9 patient (11%). Fatty infiltration progressed in 5/10 patients (50%) and RC atrophy increased in 2/10 patients (20%) within the re-tear group. CS (42.7 ± 17.7 preop, 65.2 ± 20.1 postop) and ASES (47.7 ± 17.2 preop, 75.4 ± 23.7 postop) improved significantly from pre- to postoperatively (p < 0.001). A positive correlation between fatty infiltration and RC integrity was detected (r = 0.77, p < 0.01). No correlation between clinical outcome and tendon integrity or RC atrophy was observed. CONCLUSION Arthroscopic revision RCR leads to reliable functional outcomes even in case of a recurrent RC retear. An intact RCR maintains the preoperative state of fatty infiltration and muscle atrophy but does not lead to muscle regeneration. LEVEL OF EVIDENCE Level IV; Therapeutic study.
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Affiliation(s)
- Lucca Lacheta
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Sebastian Siebenlist
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Bastian Scheiderer
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Knut Beitzel
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- ATOS Orthoparc Klinik, Cologne, Germany
| | - Klaus Woertler
- Musculoskeletal Radiology Section, TUM School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Stefan Buchmann
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
- Orthopaedisches Fachzentrum (OFZ) Weilheim/Garmisch/Starnberg/Penzberg, Weilheim, Germany
| | - Lukas Willinger
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
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13
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Parson JC, Biltz NK, Meyer GA. Decellularization-Based Quantification of Skeletal Muscle Fatty Infiltration. J Vis Exp 2023. [PMID: 37358301 PMCID: PMC10837739 DOI: 10.3791/65461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023] Open
Abstract
Fatty infiltration is the accumulation of adipocytes between myofibers in skeletal muscle and is a prominent feature of many myopathies, metabolic disorders, and dystrophies. Clinically in human populations, fatty infiltration is assessed using noninvasive methods, including computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound (US). Although some studies have used CT or MRI to quantify fatty infiltration in mouse muscle, costs and insufficient spatial resolution remain challenging. Other small animal methods utilize histology to visualize individual adipocytes; however, this methodology suffers from sampling bias in heterogeneous pathology. This protocol describes the methodology to qualitatively view and quantitatively measure fatty infiltration comprehensively throughout intact mouse muscle and at the level of individual adipocytes using decellularization. The protocol is not limited to specific muscles or specific species and can be extended to human biopsy. Additionally, gross qualitative and quantitative assessments can be made with standard laboratory equipment for little cost, making this procedure more accessible across research laboratories.
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Affiliation(s)
- Jacob C Parson
- Program in Physical Therapy, Washington University in St. Louis
| | - Nicole K Biltz
- Program in Physical Therapy, Washington University in St. Louis
| | - Gretchen A Meyer
- Program in Physical Therapy, Washington University in St. Louis; Departments of Neurology, Orthopaedic Surgery and Biomedical Engineering, Washington University in St. Louis;
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14
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Eshima K, Ohzono H, Gotoh M, Shimokobe H, Tanaka K, Nakamura H, Kanazawa T, Okawa T, Shiba N. Effect of suprascapular nerve injury on muscle and regenerated enthesis in a rat rotator cuff tear model. Clin Shoulder Elb 2023; 26:131-139. [PMID: 37316174 DOI: 10.5397/cise.2022.01207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 12/08/2022] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Massive rotator cuff tears (RCTs) are complicated by muscle atrophy, fibrosis, and intramuscular fatty degeneration, which are associated with postoperative tendon-to-bone healing failure and poor clinical outcomes. We evaluated muscle and enthesis changes in large tears with or without suprascapular nerve (SN) injury in a rat model. METHODS Sixty-two adult Sprague-Dawley rats were divided into SN injury (+) and SN injury (-) groups (n=31 each), comprising tendon (supraspinatus [SSP]/infraspinatus [ISP]) and nerve resection and tendon resection only cases, respectively. Muscle weight measurement, histological evaluation, and biomechanical testing were performed 4, 8, and 12 weeks postoperatively. Ultrastructural analysis with block face imaging was performed 8 weeks postoperatively. RESULTS SSP/ISP muscles in the SN injury (+) group appeared atrophic, with increased fatty tissue and decreased muscle weight, compared to those in the control and SN injury (-) groups. Immunoreactivity was only positive in the SN injury (+) group. Myofibril arrangement irregularity and mitochondrial swelling severity, along with number of fatty cells, were higher in the SN injury (+) group than in the SN injury (-) group. The bone-tendon junction enthesis was firm in the SN injury (-) group; this was atrophic and thinner in the SN injury (+) group, with decreased cell density and immature fibrocartilage. Mechanically, the tendon-bone insertion was significantly weaker in the SN injury (+) group than in the control and SN injury (+) groups. CONCLUSIONS In clinical settings, SN injury may cause severe fatty changes and inhibition of postoperative tendon healing in large RCTs. Level of evidence: Basic research, controlled laboratory study.
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Affiliation(s)
- Kenichiro Eshima
- Department of Orthopedic Surgery, Kurume University Hospital, Fukuoka, Japan
| | - Hiroki Ohzono
- Department of Orthopedic Surgery, Kurume University Medical Center, Fukuoka, Japan
| | - Masafumi Gotoh
- Department of Orthopedic Surgery, Kurume University Medical Center, Fukuoka, Japan
| | - Hisao Shimokobe
- Department of Orthopedic Surgery, Kurume University Hospital, Fukuoka, Japan
| | - Koji Tanaka
- Department of Orthopedic Surgery, Kurume University Hospital, Fukuoka, Japan
| | - Hidehiro Nakamura
- Department of Orthopedic Surgery, Kurume University Medical Center, Fukuoka, Japan
| | - Tomonoshin Kanazawa
- Department of Orthopedic Surgery, Kurume University Hospital, Fukuoka, Japan
| | - Takahiro Okawa
- Department of Orthopedic Surgery, Kurume University Medical Center, Fukuoka, Japan
| | - Naoto Shiba
- Department of Orthopedic Surgery, Kurume University Hospital, Fukuoka, Japan
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15
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Waugh CM, Mousavizadeh R, Lee J, Screen HRC, Scott A. Mild hypercholesterolemia impacts achilles sub-tendon mechanical properties in young rats. BMC Musculoskelet Disord 2023; 24:282. [PMID: 37046262 PMCID: PMC10091839 DOI: 10.1186/s12891-023-06375-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/27/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Hypercholesterolemia is associated with tendon pathology, but the reasons underpinning this relationship are not well understood. Cholesterol can accumulate in the tendon non-collagenous matrix which may affect both global and local tissue mechanics. Changes to the local strain environment within tendon may have significant implications for mechanosensitive tenocytes. Here, we investigated the association between elevated blood cholesterol and presence of tendon lipids in the Achilles tendon. We expected lipids to be localised in the proteoglycan-rich inter-sub-tendon matrix (ISTM), therefore we also sought to examine the impact of this on the biomechanical and viscoelastic properties of the ISTM. METHODS The Achilles tendons of 32 young wild-type (SD) and 32 apolipoprotein E knock-out rats (ApoE-/-) were harvested at 15.6 ± 2.3 weeks of age. 32 specimens underwent histological examination to assess the distribution of lipids throughout sub-tendons and ISTM. The remaining specimens were prepared for biomechanical testing, where the ISTM between the gastrocnemius and soleus sub-tendons was subjected to shear load mechanical testing. A sub-set of tests were video recorded to enable a strain analysis. RESULTS ApoE-/- serum cholesterol was double that of SD rats (mean 2.25 vs. 1.10 mg/ml, p < 0.001) indicating a relatively mild hypercholesterolemia phenotype. Nonetheless, we found histological evidence of esterified lipids in the ISTM and unesterified lipids in the sub-tendons, although the location or intensity of staining was not appreciably different between rat strains. Despite a lack of observable histological differences in lipid content between groups, there were significant differences in the mechanical and viscoelastic behaviour of the Achilles sub-tendon matrix. CONCLUSION Even slightly elevated cholesterol may result in subtle changes to tendon biomechanical properties and hence injury risk. The young age of our cohort and the mild phenotype of our ApoE-/- rats are likely to have limited our findings and so we also conclude that the ApoE-/- rat model is not well suited for investigating the biomechanical impact of tendon xanthomas on Achilles sub-tendon function.
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Affiliation(s)
- Charlie M Waugh
- Dept. Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver BC, Canada.
- School of Engineering and Materials Science, Queen Mary, University of London, London, U.K..
| | - Rouhollah Mousavizadeh
- Dept. Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver BC, Canada
| | - Jenny Lee
- Dept. Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver BC, Canada
| | - Hazel R C Screen
- School of Engineering and Materials Science, Queen Mary, University of London, London, U.K
| | - Alexander Scott
- Dept. Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver BC, Canada
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16
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Sahai A, Jones DL, Hughes M, Pu A, Williams K, Iyer SR, Rathinam C, Davis DL, Lovering RM, Gilotra MN. Fibroadipogenic progenitor cell response peaks prior to progressive fatty infiltration after rotator cuff tendon tear. J Orthop Res 2022; 40:2743-2753. [PMID: 35239216 PMCID: PMC9440165 DOI: 10.1002/jor.25321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 02/22/2022] [Accepted: 03/01/2022] [Indexed: 02/04/2023]
Abstract
Fibroadipogenic progenitor (FAP) cells are implicated as a major source of fatty infiltration (FI) in murine rotator cuff (RC) injury, but FAP cell response after RC tear in a rabbit model is unknown. This study determined whether changes in FAP cell count after an RC tear predate muscle degeneration in a clinically relevant rabbit model. We hypothesized increases in FAP cell count correlate temporally with RC degeneration. New Zealand white rabbits (n = 26) were evaluated at 1, 2, 4, and 6 weeks after unilateral full-thickness tenotomy of supraspinatus and infraspinatus tendons. FI area and adipocyte size were histologically analyzed, muscle density was measured by computerized tomography, and quantification of FAP cells was measured by flow cytometry and immunohistochemistry. The percentage of intrafascicular adipocyte area increased over time in supraspinatus muscle samples (p = 0.03), significantly between 1- and 6-week samples (p = 0.04). There were no differences in perifascicular adipocyte area percentages between time points. Peak increase in FAP cell count occurred at 1-week (p = 0.03), with a decrease in the following weeks. There was a negative correlation between supraspinatus adipocyte area and FAP cell count (p < 0.05). On computed tomography (CT) scan, maximal decrease in muscle density was observed in the 4th to 6th weeks. In summary, FAP cell response occurred early after tenotomy and did not correlate temporally with increases in FI. This suggests that FAP cell response may predate degenerative changes, and early targeting of FAPs before adipocyte maturation could blunt FI after RC tear.
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Affiliation(s)
- Amil Sahai
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Baltimore, USA
| | - Derek L. Jones
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Baltimore, USA
| | - Marcus Hughes
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Baltimore, USA
| | - Alex Pu
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Baltimore, USA
| | - Katrina Williams
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Baltimore, USA
| | - Shama R. Iyer
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Baltimore, USA
| | - Chozha Rathinam
- Department of Immunology, University of Maryland School of Medicine, Baltimore, Baltimore, USA
| | - Derik L. Davis
- Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Baltimore, USA
| | - Richard M. Lovering
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Baltimore, USA
| | - Mohit N. Gilotra
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Baltimore, USA
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17
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Saveh Shemshaki N, Kan HM, Barajaa M, Otsuka T, Lebaschi A, Mishra N, Nair LS, Laurencin CT. Muscle degeneration in chronic massive rotator cuff tears of the shoulder: Addressing the real problem using a graphene matrix. Proc Natl Acad Sci U S A 2022; 119:e2208106119. [PMID: 35939692 PMCID: PMC9388153 DOI: 10.1073/pnas.2208106119] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 06/21/2022] [Indexed: 11/18/2022] Open
Abstract
Massive rotator cuff tears (MRCTs) of the shoulder cause disability and pain among the adult population. In chronic injuries, the tendon retraction and subsequently the loss of mechanical load lead to muscle atrophy, fat accumulation, and fibrosis formation over time. The intrinsic repair mechanism of muscle and the successful repair of the torn tendon cannot reverse the muscle degeneration following MRCTs. To address these limitations, we developed an electroconductive matrix by incorporating graphene nanoplatelets (GnPs) into aligned poly(l-lactic acid) (PLLA) nanofibers. This study aimed to understand 1) the effects of GnP matrices on muscle regeneration and inhibition of fat formation in vitro and 2) the ability of GnP matrices to reverse muscle degenerative changes in vivo following an MRCT. The GnP matrix significantly increased myotube formation, which can be attributed to enhanced intracellular calcium ions in myoblasts. Moreover, the GnP matrix suppressed adipogenesis in adipose-derived stem cells. These results supported the clinical effects of the GnP matrix on reducing fat accumulation and muscle atrophy. The histological evaluation showed the potential of the GnP matrix to reverse muscle atrophy, fat accumulation, and fibrosis in both supraspinatus and infraspinatus muscles at 24 and 32 wk after the chronic MRCTs of the rat shoulder. The pathological evaluation of internal organs confirmed the long-term biocompatibility of the GnP matrix. We found that reversing muscle degenerative changes improved the morphology and tensile properties of the tendon compared with current surgical techniques. The long-term biocompatibility and the ability of the GnP matrix to treat muscle degeneration are promising for the realization of MRCT healing and regeneration.
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Affiliation(s)
- Nikoo Saveh Shemshaki
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health, Farmington, CT 06030
- Raymond and Beverly Sackler Center for Biomedical, Biological, Physical, and Engineering Sciences, University of Connecticut Health Center, Farmington, CT 06030
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269
| | - Ho-Man Kan
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health, Farmington, CT 06030
- Raymond and Beverly Sackler Center for Biomedical, Biological, Physical, and Engineering Sciences, University of Connecticut Health Center, Farmington, CT 06030
| | - Mohammed Barajaa
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health, Farmington, CT 06030
- Raymond and Beverly Sackler Center for Biomedical, Biological, Physical, and Engineering Sciences, University of Connecticut Health Center, Farmington, CT 06030
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269
| | - Takayoshi Otsuka
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health, Farmington, CT 06030
- Raymond and Beverly Sackler Center for Biomedical, Biological, Physical, and Engineering Sciences, University of Connecticut Health Center, Farmington, CT 06030
| | - Amir Lebaschi
- Department of Orthopedic Surgery, University of Connecticut Health Center, Farmington, CT 06030
| | - Neha Mishra
- Department of Pathobiology and Veterinary Science, University of Connecticut, Storrs, CT 06269
- Connecticut Veterinary Medical Diagnostic Laboratory, Storrs, CT
| | - Lakshmi S. Nair
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health, Farmington, CT 06030
- Raymond and Beverly Sackler Center for Biomedical, Biological, Physical, and Engineering Sciences, University of Connecticut Health Center, Farmington, CT 06030
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269
- Department of Orthopedic Surgery, University of Connecticut Health Center, Farmington, CT 06030
- Department of Materials Science and Engineering, University of Connecticut, Storrs, CT 06269
| | - Cato T. Laurencin
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health, Farmington, CT 06030
- Raymond and Beverly Sackler Center for Biomedical, Biological, Physical, and Engineering Sciences, University of Connecticut Health Center, Farmington, CT 06030
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT 06269
- Department of Orthopedic Surgery, University of Connecticut Health Center, Farmington, CT 06030
- Department of Materials Science and Engineering, University of Connecticut, Storrs, CT 06269
- Department of Chemical and Biomolecular Engineering, University of Connecticut, Storrs, CT 06269
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Vargas-Vila MA, Gibbons MC, Wu IT, Esparza MC, Kato K, Johnson SD, Masuda K, Ward SR. Progression of muscle loss and fat accumulation in a rabbit model of rotator cuff tear. J Orthop Res 2022; 40:1016-1025. [PMID: 34392563 PMCID: PMC8844305 DOI: 10.1002/jor.25160] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 06/09/2021] [Accepted: 07/30/2021] [Indexed: 02/04/2023]
Abstract
Rotator cuff (RC) tears present a treatment challenge due to muscle atrophy and degeneration, fatty infiltration, and fibrosis. The purpose of this study was to generate a high time-resolution model of RC tear in rabbits and to characterize the progression of architectural and histological changes. Thirty-five female New Zealand White rabbits (age: 6 months) underwent left supraspinatus tenotomy. Five rabbits were used to evaluate immediate muscle architectural changes. The remaining 30 rabbits underwent right shoulder sham surgery and sacrifice at 1, 2, 4, 8, or 16 weeks. Histology was used to quantify muscle fiber cross-sectional area (CSA), muscle degeneration and regeneration, and fat localized to inter- versus intrafascicular regions. Muscle fiber CSA decreased by 26.5% compared to sham at 16 weeks (effect of treatment, p < 0.0001). Muscle degeneration increased after tenotomy (effect of treatment, p = 0.0006) without any change in regeneration. Collagen and fat content increased by 4 weeks and persisted through 16 weeks. Interfascicular fat was increased at all time points, but intrafascicular fat was increased only at 1, 4, and 16 weeks posttenotomy. Intrafascicular fat adjacent to degenerating muscle fibers increased as well (effect of treatment, p < 0.0001; effect of time, p = 0.0102). Statement of clinical relevance: Rabbit supraspinatus tenotomy recapitulates key features of the pathophysiology of human RC tears, including muscle atrophy and degeneration, lack of regeneration, fat accumulation, and fibrosis.
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Affiliation(s)
| | | | - Isabella T. Wu
- Department of Orthopaedic Surgery, UC San Diego, La Jolla CA, USA
| | - Mary C. Esparza
- Department of Orthopaedic Surgery, UC San Diego, La Jolla CA, USA
| | - Kenji Kato
- Department of Orthopaedic Surgery, Nagoya City University, Nagoya, Japan
| | - Seth D. Johnson
- Department of Orthopaedic Surgery, UC San Diego, La Jolla CA, USA
| | - Koichi Masuda
- Department of Orthopaedic Surgery, UC San Diego, La Jolla CA, USA
| | - Samuel R. Ward
- Department of Orthopaedic Surgery, UC San Diego, La Jolla CA, USA,Department of Bioengineering, UC San Diego, La Jolla CA, USA,Department of Radiology, UC San Diego, La Jolla CA, USA
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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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Yang Y, Qiu L, Gu X, Chen J, Chen S, Hu D, Hao Y, Shang X. Monitoring Rotator Cuff Muscle Fatty Infiltration Progression by Magnetic Resonance Imaging T1 Mapping: Correlation With Direct Evaluation Findings in Rats. Am J Sports Med 2022; 50:1078-1087. [PMID: 35099310 DOI: 10.1177/03635465211069976] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Monitoring the fatty infiltration (FI) process in rotator cuff muscles is of value in establishing a treatment plan and predicting the postoperative prognosis. Quantitative T1 mapping shows promise for evaluating muscle degeneration, while its validity in monitoring rotator cuff muscle FI progression needs further investigation. PURPOSE To determine the validity of T1 mapping in monitoring FI progression of rotator cuff muscles. STUDY DESIGN Controlled laboratory study. METHODS Sprague-Dawley rats (N = 108) underwent left supraspinatus (SS) and infraspinatus (IS) tenotomy only (TT), suprascapular nerve transection only (NT), or SS and IS tenotomy plus suprascapular nerve transection (TT+NT). Sham surgery on the right shoulder served as the control. The magnetic resonance imaging examination included T1 mapping performed at 12, 16, and 20 weeks postoperation. SS and IS muscles were harvested to quantitatively evaluate FI via direct evaluation (triglyceride quantification assay and histological analysis) at the same predetermined intervals. The correlation of the imaging data with direct evaluation of rotator cuff muscles was analyzed. RESULTS T1 values were significantly lower in left SS and IS muscles at 12, 16, and 20 weeks postoperation as compared with those on the right side. T1 values of the left SS and IS muscles were continuously decreased in all groups. The TT+NT group had a greater decrease in T1 value than did the TT and NT groups. Triglyceride quantification assay and histological analysis demonstrated significant and progressive FI of the left SS and IS muscles in the 3 groups. The most serious FI changes were observed in the TT+NT group. T1 values were also well correlated with triglyceride contents and area fractions of fat. CONCLUSION T1 mapping can be an effective imaging modality for sensitive and quantitative monitoring of FI progression in rotator cuff muscles. CLINICAL RELEVANCE The findings of this study provide a tool for researchers to noninvasively and quantitatively monitor the process of muscle degeneration, contributing to the evaluation of surgical indication and postoperative prognosis.
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Affiliation(s)
- Yimeng Yang
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Longhua Qiu
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xueping Gu
- Department of Orthopedics, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Jun Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Shiyi Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Dan Hu
- Department of Orthopedics, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Yuefeng Hao
- Department of Orthopedics, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Xiliang Shang
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
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Takada Y, Matsumura N, Shirasawa H, Yoda M, Matsumoto M, Nakamura M, Horiuchi K. Aging Aggravates the Progression of Muscle Degeneration After Rotator Cuff Tears in Mice. Arthroscopy 2022; 38:752-760. [PMID: 34571183 DOI: 10.1016/j.arthro.2021.09.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 09/02/2021] [Accepted: 09/07/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the impact of aging on muscle degeneration after rotator cuff tear (RCT) in mice. METHODS Young (12-week-old) and aged (50-to-60-week-old) female C57BL/6 mice were used (n = 29 for each group). The rotator cuff was transected, and the proximal humerus was removed to induce degeneration of the rotator cuff muscles. The mice were euthanized 4 and 12 weeks after the procedure (referred to as RCT-4wk mice and RCT-12wk mice, respectively) and compared with the sham-treated mice. The supraspinatus muscles were collected for histology, Western blot analysis, and gene expression analyses. RESULTS There was a significant increase in fat tissue in aged RCT-4wk mice (P = .001) and aged RCT-12wk mice (P < .001) compared with sham-treated aged mice, and aged RCT-12wk mice had a significantly increased fat area ratio compared with aged RCT-4wk mice (P < .001). The fat area was significantly larger in both the aged RCT-4wk (P = .002) and RCT-12wk mice (P < .001) than in the corresponding young mice. Muscular fibrosis was significantly increased in aged RCT-12wk mice compared with aged sham-treated mice (P = .005) and young RCT-12wk mice (P = .016). There were also significant increases in the expression of perilipin and transcripts of adipogenic and fibrogenic differentiation markers in aged RCT mice compared with young RCT mice. CONCLUSION The present results show that aging is critically involved in the pathology of muscular fatty infiltration and fibrosis after RCT, and muscular degeneration progresses over time in aged mice. CLINICAL RELEVANCE Aging promotes the progression of muscle degeneration in a mouse RCT model. Furthermore, this study shows that muscle degeneration occurs in aged mice even without denervation and that the model described in the present study is a useful tool for studying the pathology of muscle degeneration.
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Affiliation(s)
- Yuhei Takada
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Noboru Matsumura
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan.
| | - Hideyuki Shirasawa
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masaki Yoda
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Keisuke Horiuchi
- Department of Orthopedic Surgery, National Defense Medical College, Saitama, Japan
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22
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Seo SJ, Park JY, Park HJ, Hwang JT. Protocatechuic acid impacts rotator cuff healing and reduces fatty degeneration in a chronic rotator cuff tear model in rats. Clin Shoulder Elb 2022; 25:5-14. [PMID: 35045600 PMCID: PMC8907501 DOI: 10.5397/cise.2021.00395] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/10/2021] [Indexed: 11/25/2022] Open
Abstract
Background The purpose of this study was to verify the effect of protocatechuic acid (PCA) on tendon healing and fatty degeneration in a chronic rotator cuff model. Methods Twenty-eight Sprague-Dawley male rats were randomly allocated into two groups: Saline+repair (SR) and PCA+repair (PR). The right shoulder was used for experimental interventions, and the left served as a control. PCA (30 mg/kg/day) was administered intraperitoneally at the site of infraspinatus tendon detachment in rats in the PR group, and the same volume of saline was administered to the same site in the SR group. The torn tendon was repaired 4 weeks after infraspinatus detachment. Four weeks after repair, hematoxylin and eosin (H&E), S100, and CD68 stains were performed to evaluate the degree of fatty degeneration and H&E and Masson trichrome stains were performed to assess tendon healing. Superoxide dismutase (SOD) was measured to test the efficacy of PCA as an antioxidant. Results Results from histological evaluation indicated that SOD and CD68 levels at the musculotendinous region and collagen fiber parallel to the orientation at the tendon-to-bone junction were not significantly different between the SR and PR groups. The mean load-to-failure of the PR group (20.32±9.37 N) was higher than that of the SR group (16.44±6.90 N), although this difference was not statistically significant (p=0.395). The SOD activity in the operative side infraspinatus muscle of the PR group was higher than that of the SR group, but the difference was not statistically significant (p=0.053). Conclusions The use of PCA could improve tendon healing and decrease fatty degeneration after rotator cuff repair.
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Affiliation(s)
- Su-Jung Seo
- Department of Orthopedic Surgery, Hallym University College of Medicine, Chuncheon, Korea
| | - Jae-Young Park
- Department of Pathology, Bucheon Sejong Hospital, Bucheon, Korea
| | - Hyoung-Jin Park
- Department of Physiology, Hallym University College of Medicine, Chuncheon, Korea
| | - Jung-Taek Hwang
- Department of Orthopedic Surgery, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
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Wang JY, Lin YR, Liaw CK, Chen CH, Lin HW, Huang SW. Cervical Spine Pathology Increases the Risk of Rotator Cuff Tear: A Population-Based Cohort Study. Orthop J Sports Med 2021; 9:23259671211058726. [PMID: 34917691 PMCID: PMC8669129 DOI: 10.1177/23259671211058726] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 08/24/2021] [Indexed: 11/26/2022] Open
Abstract
Background: Patients with cervical radiculopathy typically present with shoulder pain and weakness; these symptoms are similar to those of rotator cuff disease. Studies investigating cervical spine pathology (CSP) as an independent risk factor for rotator cuff tear (RCT) are lacking in the literature. Purpose: To investigate the risk of RCT among patients with CSP who have undergone cervical diskectomy (CD) and to determine whether CD reduces this risk. Study Design: Cohort study; Level of evidence, 3. Methods: The authors queried the Taiwan National Health Insurance Research Database for patients diagnosed with CSP between 2004 and 2008 and followed up until the end of 2010. A control cohort comprised patients without CSP who were age- and sex-matched in a 4-to-1 ratio with patients with CSP through propensity score matching. A Cox multivariate proportional hazards model was applied to analyze the risk factors for RCT. After adjustment for confounders, the authors calculated the hazard ratio (HR) and adjusted HR (aHR) between the study and control cohorts. The effects of CD on the risk of RCT were also analyzed. Results: The study included 3245 patients and 12,980 matched controls. A higher RCT incidence rate was found in the CSP cohort, with an aHR of 1.52 (95% CI, 1.22-1.89; P < .001). Patients with CSP who underwent CD had a risk of RCT similar to that of the controls, with an aHR of 1.65 (95% CI, 0.90-3.03; P > .05). Conclusion: Patients with CSP had a 1.52-fold higher risk of RCT than healthy controls. Patients with CSP with CD did not have a high risk of RCT, possibly indicating a protective effect of diskectomy against RCT.
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Affiliation(s)
- Jr-Yi Wang
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Yu-Ru Lin
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chen-Kun Liaw
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Chih-Hwa Chen
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Graduate Institute of Biomedical Optomechatronics, College of Biomedical Engineering, and Research Center of Biomedical Device, Taipei Medical University, Taipei, Taiwan
| | - Hui-Wen Lin
- Department of Mathematics, Soochow University, Taipei, Taiwan
- ICF Research Center, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Shih-Wei Huang
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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24
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Hodges PW, Bailey JF, Fortin M, Battié MC. Paraspinal muscle imaging measurements for common spinal disorders: review and consensus-based recommendations from the ISSLS degenerative spinal phenotypes group. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:3428-3441. [PMID: 34542672 DOI: 10.1007/s00586-021-06990-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/12/2021] [Accepted: 09/05/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE Paraspinal muscle imaging is of growing interest related to improved phenotyping, prognosis, and treatment of common spinal disorders. We reviewed issues related to paraspinal muscle imaging measurement that contribute to inconsistent findings between studies and impede understanding. METHODS Three key contributors to inconsistencies among studies of paraspinal muscle imaging measurements were reviewed: failure to consider possible mechanisms underlying changes in paraspinal muscles, lack of control of confounding factors, and variations in spinal muscle imaging modalities and measurement protocols. Recommendations are provided to address these issues to improve the quality and coherence of future research. RESULTS Possible pathophysiological responses of paraspinal muscle to various common spinal disorders in acute or chronic phases are often overlooked, yet have important implications for the timing, distribution, and nature of changes in paraspinal muscle. These considerations, as well as adjustment for possible confounding factors, such as sex, age, and physical activity must be considered when planning and interpreting paraspinal muscle measurements in studies of spinal conditions. Adoption of standardised imaging measurement protocols for paraspinal muscle morphology and composition, considering the strengths and limitations of various imaging modalities, is critically important to interpretation and synthesis of research. CONCLUSION Study designs that consider physiological and pathophysiological responses of muscle, adjust for possible confounding factors, and use common, standardised measures are needed to advance knowledge of the determinants of variations or changes in paraspinal muscle and their influence on spinal health.
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Affiliation(s)
- Paul W Hodges
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, 4072, Australia.
| | - Jeannie F Bailey
- Department of Orthopedic Surgery, University of California, San Francisco, CA, USA
| | - Maryse Fortin
- Department of Health, Kinesiology & Applied Physiology, Concordia University, Montreal, QC, Canada
| | - Michele C Battié
- Faculty of Health Sciences and Western's Bone and Joint Institute, Western University, London, ON, Canada
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25
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Bogdanov J, Lan R, Chu TN, Bolia IK, Weber AE, Petrigliano FA. Fatty degeneration of the rotator cuff: pathogenesis, clinical implications, and future treatment. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:301-308. [PMID: 37588720 PMCID: PMC10426606 DOI: 10.1016/j.xrrt.2021.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Chronic rotator cuff pathology is often complicated by fatty degeneration of the rotator cuff (FDRC) muscles, an insidious process associated with poor prognosis with or without surgical intervention. Currently there is no treatment for FDRC, and many studies have described a natural course for this disease almost always resulting in further degeneration and morbidity. Recapitulating FDRC using animal injury models, and using imaging-based studies of human FDRC, the pathophysiology of this disease continues to be further characterized. Researchers studying mesenchymal stem cell-derived progenitor cells and known fibrogenic and adipogenic signaling pathways implicated in FDRC seek to clarify the underlying processes driving these changes. While new cell- and molecular-based therapies are being developed, currently the strongest available avenue for improved management of FDRC is the use of novel imaging techniques which allow for more accurate and personalized staging of fatty degeneration. This narrative review summarizes the evidence on the molecular and pathophysiologic mechanisms of FDRC and provides a clinical update on the diagnosis and management of this condition based on the existing knowledge. We also sought to examine the role of newer biologic therapies in the management of RC fatty degeneration and to identify areas of future research.
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Affiliation(s)
- Jacob Bogdanov
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Rae Lan
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Timothy N. Chu
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Ioanna K. Bolia
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Alexander E. Weber
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Frank A. Petrigliano
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
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26
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Davis DL, Gilotra MN, Calderon R, Roberts A, Hasan SA. Reliability of supraspinatus intramuscular fatty infiltration estimates on T1-weighted MRI in potential candidates for rotator cuff repair surgery: full-thickness tear versus high-grade partial-thickness tear. Skeletal Radiol 2021; 50:2233-2243. [PMID: 33959799 PMCID: PMC8565455 DOI: 10.1007/s00256-021-03805-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/28/2021] [Accepted: 04/28/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Patients with supraspinatus high-grade partial-thickness tear or full-thickness tear are potential candidates for rotator cuff repair surgery. We sought (1) to compare supraspinatus intramuscular fatty infiltration between these groups by Goutallier grade, fuzzy C-means and an orthopaedic surgeon visible percentage estimate, (2) and to determine the reliability of each method. MATERIALS AND METHODS We performed a retrospective cross-sectional study of supraspinatus intramuscular fatty infiltration on T1-weighted MR images for 93 shoulders with either supraspinatus partial-thickness tear > 50% tendon thickness or full-thickness tear by Goutallier grade, fuzzy C-means and an orthopaedic surgeon visible percentage estimate, by two observers for each method. Descriptive statistics were performed to compare groups. Inter- and intra-observer reliability was determined. Correlative analysis among the three methods was performed. RESULTS Significant differences of mean supraspinatus intramuscular fatty infiltration were present when comparing supraspinatus high-grade partial-thickness tear versus full-thickness tears by Goutallier grade (p = 0.004), fuzzy C-means (p = 0.002) and orthopaedic surgeon visible percentage estimate (p = 0.001). There was no significant difference for age (55.0 ± 11.1 years versus 56.1 ± 9.6 years) or sex (35.4% male versus 47.8% male) for supraspinatus high-grade partial-thickness tear and full-thickness tear, respectively. A significant difference existed among the subgroup of full-thickness tears stratified by tear size by all three methods (p < 0.020). Inter- and intra-observer reliability was Goutallier grade 0.590 and 0.624, fuzzy C-means 0.768 and 0.925 and orthopaedic surgeon visible percentage estimate 0.858 and 0.686, respectively. For shoulders with mean Goutallier grade ≥ 2.0, inter-observer reliability was 0.878 and 0.802 for fuzzy C-means and orthopaedic surgeon visible percentage estimate, respectively. A strong correlation was present among the three methods of supraspinatus FI analysis (rho ≥ 0.72). CONCLUSION Supraspinatus full-thickness tears have higher amounts of intramuscular fatty infiltration compared to high-grade partial-thickness tear. Quantitative fuzzy C-means shows excellent inter-observer reliability for estimating supraspinatus intramuscular fat. Experienced orthopaedic surgeons' semi-quantitative estimation of supraspinatus visible intramuscular fat may offer improved reliability as compared to semi-quantitative Goutallier grade.
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Affiliation(s)
- Derik L. Davis
- Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, 22 S. Greene Street, Baltimore, MD 21201, USA
| | - Mohit N. Gilotra
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Andrew Roberts
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - S. Ashfaq Hasan
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
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27
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Fu C, Huang AH, Galatz LM, Han WM. Cellular and molecular modulation of rotator cuff muscle pathophysiology. J Orthop Res 2021; 39:2310-2322. [PMID: 34553789 DOI: 10.1002/jor.25179] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/04/2021] [Accepted: 09/07/2021] [Indexed: 02/04/2023]
Abstract
Rotator cuff (RC) tendon tears are common shoulder injuries that result in irreversible and persistent degeneration of the associated muscles, which is characterized by severe inflammation, atrophy, fibrosis, and fatty infiltration. Although RC muscle degeneration strongly dictates the overall clinical outcomes, strategies to stimulate RC muscle regeneration have largely been overlooked to date. In this review, we highlight the current understanding of the cellular processes that coordinate muscle regeneration, and the roles of muscle resident cells, including immune cells, fibroadipogenic progenitors, and muscle satellite cells in the pathophysiologic regulation of RC muscles following injury. This review also provides perspectives for potential therapies to alleviate the hallmarks of RC muscle degeneration to address current limitations in postsurgical recovery.
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Affiliation(s)
- Chengcheng Fu
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Alice H Huang
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York City, New York, USA.,Department of Orthopedic Surgery, Columbia University, New York City, New York, USA
| | - Leesa M Galatz
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Woojin M Han
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York City, New York, USA.,Black Family Stem Cell Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
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Polydeoxyribonucleotide and Polynucleotide Improve Tendon Healing and Decrease Fatty Degeneration in a Rat Cuff Repair Model. Tissue Eng Regen Med 2021; 18:1009-1020. [PMID: 34387852 DOI: 10.1007/s13770-021-00378-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/12/2021] [Accepted: 07/12/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND After surgical repair of chronic rotator cuff tears, healing of the repaired tendons often fails and is accompanied by high-level fatty degeneration. Our purpose was to explore the effects of polydeoxyribonucleotide (PDRN) and polynucleotide (PN) on tendon healing and the reversal of fatty degeneration in a chronic rotator cuff tear model using a rat infraspinatus. METHODS Sixty rats were randomly assigned to the following three groups (20 rats per group: 12 for histological evaluation and 8 for mechanical testing): saline + repair (SR), PDRN + repair (PR), and PN + repair (PNR). The right shoulder was used for experimental intervention, and the left served as a control. Four weeks after detaching the infraspinatus, the torn tendon was repaired. Saline, PDRN, and PN were applied to the repair sites. Histological evaluation was performed 3 and 6 weeks after repair and biomechanical analysis was performed at 6 weeks. RESULTS Three weeks after repair, the PR and PNR groups had more CD168-stained cells than the SR group. The PR group showed a larger cross-sectional area (CSA) of muscle fibers than the SR and PNR groups. Six weeks after repair, the PR and PNR groups showed more adipose cells, less CD68-stained cells, and more parallel tendon collagen fibers than the SR group. The PR group had more CD 68-stained cells than the PNR group. The PR group showed a larger CSA than the SR group. The mean load-to-failure values of the PR and PNR groups were higher than that of the SR group, although these differences were not significant. CONCLUSION PDRN and PN may improve tendon healing and decrease fatty degeneration after cuff repair.
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29
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Wu G, Hu VJ, McClintick DJ, Gatto JD, Aderibigbe T, Lu L, Jensen AR, Dar A, Petrigliano FA. Lateral to medial fibro-adipogenic degeneration are greater in infraspinatus than supraspinatus following nerve and tendon injury of murine rotator cuff. J Orthop Res 2021; 39:184-195. [PMID: 32886404 DOI: 10.1002/jor.24847] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 08/19/2020] [Accepted: 08/24/2020] [Indexed: 02/04/2023]
Abstract
Small animal models of massive tears of the rotator cuff (RC) were introduced a decade ago and have been extensively used to study the pathophysiology of chronically injured RC. Transection of rodent suprascapular nerve and RC tendon results in progressive muscle atrophy, fibrosis and fat accumulation and affect the infraspinatus and supraspinatus muscles similarly to that seen in the setting of massive RC tears in humans. The purpose of this study was to perform a comprehensive and detailed analysis of the kinetics of fibrotic scar and adipose tissue development comparing phenotypic differences between chronically injured infraspinatus and supraspinatus. Automatic mosaic imaging was used to create large image of whole infraspinatus or supraspinatus sectioned area for quantification of spatial heterogeneity of muscle damage. Pathologic changes advanced from the lateral site of transection to the medial region far from the transection site. A prominent, accelerated muscle fibrosis and fat accumulation was measured in injured infraspinatus compared to supraspinatus. Furthermore, adipose tissue occupied significantly larger area than that of fibrotic tissue in both muscles but was greater in infraspinatus within 6 weeks post induction of injury. Our findings confirm that infraspinatus is more susceptible to accelerated chronic degeneration and can be used to identify the physiological functions that distinguish between the response of infraspinatus and supraspinatus in the setting of massive tears. Whether these pathologic differences observed in mice are reflected in humans is one key aspect that awaits clarification.
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Affiliation(s)
- Genbin Wu
- Department of Joint Surgery, Shanghai East Hospital, Tongji University, School of Medicine, Shanghai, China.,Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Vivian J Hu
- Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Daniel J McClintick
- Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Jonathan D Gatto
- Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Temidayo Aderibigbe
- Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Liangyu Lu
- Department of Joint Surgery, Shanghai East Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Andrew R Jensen
- Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Ayelet Dar
- Epstein Family Center for Sports Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Frank A Petrigliano
- Epstein Family Center for Sports Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
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30
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Hyman SA, Norman MB, Dorn SN, Bremner SN, Esparza MC, Lieber RL, Ward SR. In vivo supraspinatus muscle contractility and architecture in rabbit. J Appl Physiol (1985) 2020; 129:1405-1412. [PMID: 33031015 DOI: 10.1152/japplphysiol.00609.2020] [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: 11/22/2022] Open
Abstract
The rotator cuff (RC) muscles are crucial in moving and stabilizing the glenohumeral joint, and tears can be functionally devastating. Chronic fatty and fibrotic muscle changes, which are nonresponsive to surgical tendon repair, are a focus of contemporary research. The rabbit model recapitulates key biological features of human RC tears, but function and physiology are poorly characterized; limited force and stress data are inconsistent with literature norms in other mammalian species. Here, we present an improved method to assess the physiology of the rabbit supraspinatus muscle (SSP), and we report values for healthy SSP architecture and physiology. Using female New Zealand White Rabbits (n = 6) under 2% isoflurane anesthesia, we surgically isolated the SSP and maximum isometric force measured at 4-6 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. Maximum isometric force (80.87 ± 5.58 N) was dramatically greater than previous reports (11.06 and 16.1 N; P < 0.05). Architectural measurement of fiber length (34.25 ± 7.18 mm), muscle mass (9.9 ± 0.93 g), pennation angle (23.67 ± 8.32°), and PCSA (2.57 ± 0.20 cm2) were consistent with prior literature. Isometric stress (30.5 ± 3.07 N/cm2) was greater than previous reports of rabbit SSP (3.10 and 4.51 N/cm2), but similar to mammalian skeletal muscles (15.7-30.13 N/cm2). Previous studies underestimated peak force by ∼90%, which has profound implications for interpreting physiological changes as a function of disease state. The data that are presented here enable understanding the physiological implications of disease and repair in the RC of the rabbit.NEW & NOTEWORTHY We introduce an improved method to assess rabbit supraspinatus muscle physiology. Maximum isometric force measured for the rabbit supraspinatus was dramatically greater than previous reports in the literature. Consequently, the isometric contractile stress reported is almost 10 times greater than previous reports of rabbit supraspinatus, but similar to available literature of other mammalian skeletal muscle. We show that previous reports of peak supraspinatus isometric force were subphysiological by ∼90.
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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
| | - Mackenzie B Norman
- Department of Orthopaedic Surgery, University of California, San Diego, California.,Dartmouth Geisel School of Medicine, Hanover, New Hampshire
| | - Shanelle N Dorn
- Department of Orthopaedic Surgery, University of California, San Diego, California
| | - Shannon N Bremner
- Department of Orthopaedic Surgery, University of California, San Diego, California
| | - Mary C Esparza
- Department of Orthopaedic Surgery, University of California, San Diego, California
| | - Richard L Lieber
- Shirley Ryan Ability Lab, Northwestern University, Chicago, Illinois
| | - 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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31
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Correa-de-Araujo R, Addison O, Miljkovic I, Goodpaster BH, Bergman BC, Clark RV, Elena JW, Esser KA, Ferrucci L, Harris-Love MO, Kritchevsky SB, Lorbergs A, Shepherd JA, Shulman GI, Rosen CJ. Myosteatosis in the Context of Skeletal Muscle Function Deficit: An Interdisciplinary Workshop at the National Institute on Aging. Front Physiol 2020; 11:963. [PMID: 32903666 DOI: 10.3389/fphys.2020.00963/bibtex] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 07/15/2020] [Indexed: 05/26/2023] Open
Abstract
Skeletal muscle fat infiltration (known as myosteatosis) is an ectopic fat depot that increases with aging and is recognized to negatively correlate with muscle mass, strength, and mobility and disrupt metabolism (insulin resistance, diabetes). An interdisciplinary workshop convened by the National Institute on Aging Division of Geriatrics and Clinical Gerontology on September 2018, discussed myosteatosis in the context of skeletal muscle function deficit (SMFD). Its purpose was to gain a better understanding of the roles of myosteatosis in aging muscles and metabolic disease, particularly its potential determinants and clinical consequences, and ways of properly assessing it. Special attention was given to functional status and standardization of measures of body composition (including the value of D3-creatine dilution method) and imaging approaches [including ways to better use dual-energy X-ray absorptiometry (DXA) through the shape and appearance modeling] to assess lean mass, sarcopenia, and myosteatosis. The workshop convened innovative new areas of scientific relevance to light such as the effect of circadian rhythms and clock disruption in skeletal muscle structure, function, metabolism, and potential contribution to increased myosteatosis. A muscle-bone interaction perspective compared mechanisms associated with myosteatosis and bone marrow adiposity. Potential preventive and therapeutic approaches highlighted ongoing work on physical activity, myostatin treatment, and calorie restriction. Myosteatosis' impact on cancer survivors raised new possibilities to identify its role and to engage in cross-disciplinary collaboration. A wide range of research opportunities and challenges in planning for the most appropriate study design, interpretation, and translation of findings into clinical practice were discussed and are presented here.
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Affiliation(s)
- Rosaly Correa-de-Araujo
- Division of Geriatrics and Clinical Gerontology, National Institute on Aging, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, United States
| | - Odessa Addison
- Department of Veterans Affairs and Veterans Affairs Medical Center Baltimore, Geriatric Research, Education and Clinical Center (GRECC), Baltimore, MD, United States
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Iva Miljkovic
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Bret H Goodpaster
- AdventHealth Translational Research Institute, Orlando, FL, United States
| | - Bryan C Bergman
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Richard V Clark
- United States Anti-Doping Agency, Colorado Springs, CO, United States
| | - Joanne W Elena
- National Cancer Institute, National Institutes of Health, U.S Department of Health and Human Services, Bethesda, MD, United States
| | - Karyn A Esser
- Department of Physiology and Functional Genomics, University of Florida, Gainesville, FL, United States
| | - Luigi Ferrucci
- Intramural Research Program, National Institute on Aging, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, United States
| | - Michael O Harris-Love
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Eastern Colorado VA Geriatric Research, Education, and Clinical Center, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, United States
| | - Steve B Kritchevsky
- Sticht Center for Healthy Aging and Alzheimer's Prevention Wake Forest School of Medicine, Winston-Salem, NC, United States
| | | | - John A Shepherd
- Department of Epidemiology, University of Hawaii Cancer Center, Honolulu, HI, United States
| | - Gerald I Shulman
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Clifford J Rosen
- The Maine Medical Center Research Institute, Scarborough, ME, United States
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32
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Correa-de-Araujo R, Addison O, Miljkovic I, Goodpaster BH, Bergman BC, Clark RV, Elena JW, Esser KA, Ferrucci L, Harris-Love MO, Kritchevsky SB, Lorbergs A, Shepherd JA, Shulman GI, Rosen CJ. Myosteatosis in the Context of Skeletal Muscle Function Deficit: An Interdisciplinary Workshop at the National Institute on Aging. Front Physiol 2020; 11:963. [PMID: 32903666 PMCID: PMC7438777 DOI: 10.3389/fphys.2020.00963] [Citation(s) in RCA: 202] [Impact Index Per Article: 50.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 07/15/2020] [Indexed: 12/15/2022] Open
Abstract
Skeletal muscle fat infiltration (known as myosteatosis) is an ectopic fat depot that increases with aging and is recognized to negatively correlate with muscle mass, strength, and mobility and disrupt metabolism (insulin resistance, diabetes). An interdisciplinary workshop convened by the National Institute on Aging Division of Geriatrics and Clinical Gerontology on September 2018, discussed myosteatosis in the context of skeletal muscle function deficit (SMFD). Its purpose was to gain a better understanding of the roles of myosteatosis in aging muscles and metabolic disease, particularly its potential determinants and clinical consequences, and ways of properly assessing it. Special attention was given to functional status and standardization of measures of body composition (including the value of D3-creatine dilution method) and imaging approaches [including ways to better use dual-energy X-ray absorptiometry (DXA) through the shape and appearance modeling] to assess lean mass, sarcopenia, and myosteatosis. The workshop convened innovative new areas of scientific relevance to light such as the effect of circadian rhythms and clock disruption in skeletal muscle structure, function, metabolism, and potential contribution to increased myosteatosis. A muscle-bone interaction perspective compared mechanisms associated with myosteatosis and bone marrow adiposity. Potential preventive and therapeutic approaches highlighted ongoing work on physical activity, myostatin treatment, and calorie restriction. Myosteatosis’ impact on cancer survivors raised new possibilities to identify its role and to engage in cross-disciplinary collaboration. A wide range of research opportunities and challenges in planning for the most appropriate study design, interpretation, and translation of findings into clinical practice were discussed and are presented here.
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Affiliation(s)
- Rosaly Correa-de-Araujo
- Division of Geriatrics and Clinical Gerontology, National Institute on Aging, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, United States
| | - Odessa Addison
- Department of Veterans Affairs and Veterans Affairs Medical Center Baltimore, Geriatric Research, Education and Clinical Center (GRECC), Baltimore, MD, United States.,Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Iva Miljkovic
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Bret H Goodpaster
- AdventHealth Translational Research Institute, Orlando, FL, United States
| | - Bryan C Bergman
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Richard V Clark
- United States Anti-Doping Agency, Colorado Springs, CO, United States
| | - Joanne W Elena
- National Cancer Institute, National Institutes of Health, U.S Department of Health and Human Services, Bethesda, MD, United States
| | - Karyn A Esser
- Department of Physiology and Functional Genomics, University of Florida, Gainesville, FL, United States
| | - Luigi Ferrucci
- Intramural Research Program, National Institute on Aging, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, United States
| | - Michael O Harris-Love
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Eastern Colorado VA Geriatric Research, Education, and Clinical Center, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, United States
| | - Steve B Kritchevsky
- Sticht Center for Healthy Aging and Alzheimer's Prevention Wake Forest School of Medicine, Winston-Salem, NC, United States
| | | | - John A Shepherd
- Department of Epidemiology, University of Hawaii Cancer Center, Honolulu, HI, United States
| | - Gerald I Shulman
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Clifford J Rosen
- The Maine Medical Center Research Institute, Scarborough, ME, United States
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33
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Gereli A, Uslu S, Okur B, Ulku TK, Kocaoğlu B, Yoo YS. Effect of suprascapular nerve injury on rotator cuff enthesis. J Shoulder Elbow Surg 2020; 29:1584-1589. [PMID: 32199756 DOI: 10.1016/j.jse.2019.12.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 12/17/2019] [Accepted: 12/21/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Numerous reports have shown that retracted rotator cuff tears may cause suprascapular nerve injury, and nerve injury causes atrophy and fat accumulation in the rotator cuff muscles. However, the effect of suprascapular nerve injury on rotator cuff enthesis has not been directly defined. This study aimed to investigate the effect of suprascapular nerve injury on rotator cuff enthesis. METHODS Twenty-four Wistar albino rats underwent bilateral transection of the suprascapular nerve. Additional 6 rats were used as the sham group. Bilateral supraspinatus and infraspinatus entheses were examined after 1, 4, 8, and 12 weeks of nerve transection. Histomorphometric analyses were performed for each zone of enthesis. RESULTS Compared with normal enthesis, significant and consistent decrease in cellularity were observed in the tendon and bone at all time points (P < .001). Collagen bundle diameter in the tendon also decreased in a similar manner (P < .001). Apart from the tendon and bone zones, fibrocartilage and calcified fibrocartilage zones showed similar response, and significant decrease in cellularity was observed 8 weeks after nerve transection (P < .001). CONCLUSION This study identifies suprascapular nerve injury as an underlying mechanism leading to compromise of the rotator cuff enthesis structure. Suprascapular nerve injury may be considered as an etiologic factor for the impaired healing after repair of a massive tear.
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Affiliation(s)
- Arel Gereli
- Department of Orthopedic Surgery, Acibadem University Faculty of Medicine, Istanbul, Turkey.
| | - Serap Uslu
- Department of Histology and Embryology, Istanbul Medeniyet University, Istanbul, Turkey
| | - Beril Okur
- Acibadem University Faculty of Medicine, Istanbul, Turkey
| | - Tekin Kerem Ulku
- Department of Orthopedic Surgery, Acibadem University Faculty of Medicine, Istanbul, Turkey
| | - Barış Kocaoğlu
- Department of Orthopedic Surgery, Acibadem University Faculty of Medicine, Istanbul, Turkey
| | - Yon-Sik Yoo
- Department of Orthopedic Surgery, Hallym University Medical College, Hwaseong, Republic of Korea
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34
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Altan E, Nayman A, Yildirim A, Ozbaydar MU, Ciftci S, Karahan M. Influence of Infraspinatus and Subscapularis Pathologies on Supraspinatus Muscle Atrophy - A Retrospective Cohort Study. Malays Orthop J 2020; 14:23-27. [PMID: 32983374 PMCID: PMC7513654 DOI: 10.5704/moj.2007.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Many factors could affect the supraspinatus (SSP) muscle after tendon rupture. We aimed to determine how infraspinatus and subscapularis tendon problems affect supraspinatus muscle atrophy associated with tears, in a retrospective cohort study conducted in a tertiary-level centre. Material and Methods Fifty-eight patients with a full-thickness SSP tendon tear who fulfilled the inclusion criteria were enrolled in the study. They were evaluated for tear retraction, fatty degeneration, and other rotator cuff tendon pathologies. Supraspinatus muscle was assessed using the Goutallier classification, and its average area was also measured. Accompanying lesions of the subscapularis and infraspinatus tendons and degree of supraspinatus muscle atrophy were evaluated using magnetic resonance imaging. Results Our results showed that supraspinatus tendon tears ranged between 3mm and 41mm, and the estimated average cross-sectional area of the SSP muscle was 247.6mm2. Any degree of infraspinatus tendon pathology, ranging from tendinosis to full-thickness tears, was significantly correlated with the SSP muscle area (P < 0.05). The subscapularis tendon pathologies did not show a similar correlation. The interobserver and intraobserver reliabilities of the measurements were graded as excellent. Conclusion Impairment of any of the rotator cuff muscles may affect the other muscles inversely. Our study showed that all infraspinatus tendon pathologies and partial subscapularis tears affect and alter the SSP muscle belly. We suggest early intervention for supraspinatus tears to avoid further fatty degeneration, as muscle atrophy and fatty degeneration progress in combination with the accompanying lesions.
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Affiliation(s)
- E Altan
- Department of Orthopaedics, Kadikoy Florence Nightingale Hospital - Beykent University Orthotics and Prosthetics Department, Istanbul, Turkey
| | - A Nayman
- Department of Radiology, Selcuk University Medical Faculty Hospital, Konya, Turkey
| | - A Yildirim
- Department of Orthopaedics and Traumatology, Selcuk University Medical Faculty Hospital, Konya, Turkey
| | - M U Ozbaydar
- Department of Orthopaedics and Traumatology, Acibadem University, Istanbul, Turkey
| | - S Ciftci
- Department of Orthopaedics and Traumatology, Selcuk University Medical Faculty Hospital, Konya, Turkey
| | - M Karahan
- Department of Orthopaedics and Traumatology, Acibadem Health Group, Istanbul, Turkey
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35
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Flück M, Fitze D, Ruoss S, Valdivieso P, von Rechenberg B, Bratus-Neuenschwander A, Opitz L, Hu J, Laczko E, Wieser K, Gerber C. Down-Regulation of Mitochondrial Metabolism after Tendon Release Primes Lipid Accumulation in Rotator Cuff Muscle. THE AMERICAN JOURNAL OF PATHOLOGY 2020; 190:1513-1529. [PMID: 32305353 DOI: 10.1016/j.ajpath.2020.03.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 02/14/2020] [Accepted: 03/26/2020] [Indexed: 12/12/2022]
Abstract
Atrophy and fat accumulation are debilitating aspects of muscle diseases and are rarely prevented. Using a vertical approach combining anatomic techniques with omics methodology in a tenotomy-induced sheep model of rotator cuff disease, we tested whether mitochondrial dysfunction is implicated in muscle wasting and perturbed lipid metabolism, speculating that both can be prevented by the stimulation of β-oxidation with l-carnitine. The infraspinatus muscle lost 22% of its volume over the first 6 weeks after tenotomy before the area-percentage of lipid increased from 8% to 18% at week 16. Atrophy was associated with the down-regulation of mitochondrial transcripts and protein and a slow-to-fast shift in muscle composition. Correspondingly, amino acid levels were increased 2 weeks after tendon release, when the levels of high-energy phosphates and glycerophospholipids were lowered. l-Carnitine administration (0.9 g/kg per day) prevented atrophy over the first 2 weeks, and mitigated alterations of glutamate, glycerophospholipids, and carnitine levels in released muscle, but did not prevent the level decrease in high-energy phosphates or protein constituents of mitochondrial respiration, promoting the accumulation of longer lipids with an increasing saturation. We conclude that the early phase of infraspinatus muscle degeneration after tendon release involves the elimination of oxidative characteristics associated with an aberrant accumulation of lipid species but is largely unrelated to the prevention of atrophy with oral l-carnitine administration.
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Affiliation(s)
- Martin Flück
- Laboratory for Muscle Plasticity, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
| | - Daniel Fitze
- Laboratory for Muscle Plasticity, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Severin Ruoss
- Laboratory for Muscle Plasticity, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Paola Valdivieso
- Laboratory for Muscle Plasticity, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Brigitte von Rechenberg
- Vetsuisse Faculty, Musculoskeletal Research Unit, Competence Center for Applied Biotechnology, University of Zurich, Zurich, Switzerland
| | | | - Lennart Opitz
- Functional Genomics Center Zurich, ETH Zurich, University of Zurich, Zurich, Switzerland
| | - Junmin Hu
- Functional Genomics Center Zurich, ETH Zurich, University of Zurich, Zurich, Switzerland
| | - Endre Laczko
- Functional Genomics Center Zurich, ETH Zurich, University of Zurich, Zurich, Switzerland
| | - Karl Wieser
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
| | - Christian Gerber
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
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36
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Lee C, Liu M, Agha O, Kim HT, Liu X, Feeley BT. Beige fibro-adipogenic progenitor transplantation reduces muscle degeneration and improves function in a mouse model of delayed repair of rotator cuff tears. J Shoulder Elbow Surg 2020; 29:719-727. [PMID: 31784382 PMCID: PMC7085983 DOI: 10.1016/j.jse.2019.09.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 09/03/2019] [Accepted: 09/12/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Muscle atrophy and fatty infiltration (FI) are common occurrences following rotator cuff (RC) tears. Tears of all sizes are subject to muscle degeneration. The degree of muscle degeneration following RC tears is highly correlated with repair success and functional outcomes. We have recently discovered that muscle fibro-adipogenic progenitors (FAPs) can differentiate into uncoupling protein 1 (UCP-1)-expressing beige adipocytes and induce muscle regeneration. This study evaluated the potential of local cell transplantation of beige adipose FAPs (BAT-FAPs) to treat RC muscle degeneration in a murine model of RC repair. METHODS BAT-FAPs were isolated from muscle in UCP-1 reporter mice by flow cytometry as UCP-1+/Sca1+/PDGFR+/CD31-/CD45-/integrin α7-. C57/BL6J mice underwent supraspinatus tendon tear with suprascapular nerve transection followed by repair 2 or 6 weeks after the initial injury. At the time of repair, mice received either no additional treatment, phosphate-buffered saline injection, or BAT-FAP injection. Functional outcomes were assessed by gait analysis. Mice were humanely killed at 6 weeks after cell transplantation. Supraspinatus muscle FI, fibrosis, muscle fiber size, and vascularity were analyzed and quantified via ImageJ. Analysis of variance with post hoc Tukey test and P <.05 was used to determine statistical significance. RESULTS Cell transplantation diminished fibrosis, FI, and atrophy and enhanced vascularization in both delayed repair models. Cell transplantation resulted in improved shoulder function as assessed with gait analysis in both the delayed repair models. CONCLUSIONS BAT-FAPs significantly reduced muscle degeneration and improved shoulder function after RC repair. BAT-FAPs hold significant promise as a therapeutic adjunct to repair for patients with advanced RC pathology.
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Affiliation(s)
- Carlin Lee
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA; Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Mengyao Liu
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA; Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Obiajulu Agha
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA; Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Hubert T Kim
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA; Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Xuhui Liu
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA; Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Brian T Feeley
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA; Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, CA, USA.
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37
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Sun Y, Kwak JM, Zhou Y, Fu Y, Wang Z, Chen Q, Jeon IH. Suprascapular nerve injury affects rotator cuff healing: A paired controlled study in a rat model. J Orthop Translat 2020; 27:153-160. [PMID: 33981574 PMCID: PMC8071639 DOI: 10.1016/j.jot.2020.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 12/26/2019] [Accepted: 02/10/2020] [Indexed: 11/08/2022] Open
Abstract
Purpose We designed a paired controlled study to investigate the role of the suprascapular nerve (SSN) in rotator cuff healing using a rat tear model, and we hypothesised that rotator cuff healing is impaired in the absence of a healthy SSN. Methods Bilateral supraspinatus tenotomy from the great tuberosity was performed for 36 Wistar rats, which was then repaired immediately. A defect on the SSN was made on the right side, and a sham surgery was performed on the SSN at the left side. Twelve rats were sacrificed for biomechanical (six rats) and histological (six rats) testing, evaluated at 3, 6, and 9 weeks after surgery. Results The bone–tendon junction on the nerve-intact side showed significantly better biomechanical characteristics than the nerve-injured side in terms of maximum load, maximum stress over time, stiffness at 9 weeks, and Young's modulus at 3 and 9 weeks. On the nerve-injured side, significantly smaller fibrocartilage layers and muscle fibres could be obtained over time. In addition, on the nerve-injured side, inferior bone–tendon interface formation was obtained in terms of cell maturity, cell alignment, collagen orientation, and the occurrence of tidemark and Sharpey's fibres through 9 weeks. In addition, neuropeptide Y was secreted in the nerve-intact group at 6 and 9 weeks. Conclusion This study showed the inferior healing of the bone–tendon junction on the nerve-injured side compared with the nerve-intact side, which indicates that the SSN plays an important role in rotator cuff healing. Surgeons should pay more attention to SSN injury when treating patients with rotator cuff tear.
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Affiliation(s)
- Yucheng Sun
- Department of Hand Surgery, Affiliated Hospital of Nantong University, College of Medicine, University of Nantong, Nantong, China.,Department of Orthopedic Surgery, ASAN Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea
| | - Jae-Man Kwak
- Department of Orthopedic Surgery, ASAN Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea
| | - Youlang Zhou
- Department of Hand Surgery, Affiliated Hospital of Nantong University, College of Medicine, University of Nantong, Nantong, China
| | - Yan Fu
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhe Wang
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Qingzhong Chen
- Department of Hand Surgery, Affiliated Hospital of Nantong University, College of Medicine, University of Nantong, Nantong, China
| | - In-Ho Jeon
- Department of Orthopedic Surgery, ASAN Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea
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Sharma AK, Levian B, Shah P, Mosich GM, Husman R, Ariniello A, Gatto JD, Hu VJ, McClintick DJ, Jensen AR, McAllister DR, Péault B, Dar A, Petrigliano FA. Aged Mice Demonstrate Greater Muscle Degeneration of Chronically Injured Rotator Cuff. J Orthop Res 2020; 38:320-328. [PMID: 31517395 DOI: 10.1002/jor.24468] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 09/03/2019] [Indexed: 02/04/2023]
Abstract
Massive tears of the rotator cuff (RC) are often associated with progressive and irreversible muscle degeneration due to fibrosis, fatty infiltration, and muscle atrophy. RC tears are common in individuals older than 60 years and the repair of these tears is amongst the most prevalent of orthopedic procedures. However, most current models of this injury are established in young animals, which may not accurately recapitulate the clinical condition. In this study, we used a murine model of massive RC tears to evaluate age-related muscle degeneration following chronic injury. The expression of the fibro-adipogenic genes encoding collagen type III and leptin was higher in aged RC compared with matched injured young tissue at 2 weeks post-injury, and development of fibrosis was accelerated in aged mice within 5 days post-injury. Furthermore, the synthesis of collagens type I and III and fat tissue accumulation were significantly higher in injured RCs of aged mice. Similar frequency of fibro-adipogenic PDGFRβ+ PDGFRα+ progenitor cells was measured in non-injured RC of aged and young mice, but PDGFRβ+ PDGFRα+ cells contributed to significantly larger fibrotic lesions in aged RCs within 2 weeks post-injury, implying a more robust fibrotic environment in the aged injured muscle. Altogether, these findings demonstrate age-dependent differences in RC response to chronic injury with a more profound fibro-adipogenic change in aged muscles. Clinically, cell therapies for muscular pathologies should not only consider the cell type being transplanted but also the recipient milieu into which these cells are seeded. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:320-328, 2020.
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Affiliation(s)
- Abhinav K Sharma
- Department of Orthopaedic Surgery, David Geffen School of Medicine, Orthopaedic Hospital Research Center, University of California, Toyota Sports Performance Center 555 N. Nash St., Suite BEl Segundo, Los Angeles, California, 90245
| | - Brandon Levian
- Department of Orthopaedic Surgery, David Geffen School of Medicine, Orthopaedic Hospital Research Center, University of California, Toyota Sports Performance Center 555 N. Nash St., Suite BEl Segundo, Los Angeles, California, 90245
| | - Paras Shah
- Department of Orthopaedic Surgery, David Geffen School of Medicine, Orthopaedic Hospital Research Center, University of California, Toyota Sports Performance Center 555 N. Nash St., Suite BEl Segundo, Los Angeles, California, 90245
| | - Gina M Mosich
- Department of Orthopaedic Surgery, David Geffen School of Medicine, Orthopaedic Hospital Research Center, University of California, Toyota Sports Performance Center 555 N. Nash St., Suite BEl Segundo, Los Angeles, California, 90245
| | - Regina Husman
- Department of Orthopaedic Surgery, David Geffen School of Medicine, Orthopaedic Hospital Research Center, University of California, Toyota Sports Performance Center 555 N. Nash St., Suite BEl Segundo, Los Angeles, California, 90245
| | - Allison Ariniello
- Department of Orthopaedic Surgery, David Geffen School of Medicine, Orthopaedic Hospital Research Center, University of California, Toyota Sports Performance Center 555 N. Nash St., Suite BEl Segundo, Los Angeles, California, 90245
| | - Jonathan D Gatto
- Department of Orthopaedic Surgery, David Geffen School of Medicine, Orthopaedic Hospital Research Center, University of California, Toyota Sports Performance Center 555 N. Nash St., Suite BEl Segundo, Los Angeles, California, 90245
| | - Vivian J Hu
- Department of Orthopaedic Surgery, David Geffen School of Medicine, Orthopaedic Hospital Research Center, University of California, Toyota Sports Performance Center 555 N. Nash St., Suite BEl Segundo, Los Angeles, California, 90245
| | - Daniel J McClintick
- Department of Orthopaedic Surgery, David Geffen School of Medicine, Orthopaedic Hospital Research Center, University of California, Toyota Sports Performance Center 555 N. Nash St., Suite BEl Segundo, Los Angeles, California, 90245
| | - Andrew R Jensen
- Department of Orthopaedic Surgery, David Geffen School of Medicine, Orthopaedic Hospital Research Center, University of California, Toyota Sports Performance Center 555 N. Nash St., Suite BEl Segundo, Los Angeles, California, 90245
| | - David R McAllister
- Department of Orthopaedic Surgery, David Geffen School of Medicine, Orthopaedic Hospital Research Center, University of California, Toyota Sports Performance Center 555 N. Nash St., Suite BEl Segundo, Los Angeles, California, 90245
| | - Bruno Péault
- Department of Orthopaedic Surgery, David Geffen School of Medicine, Orthopaedic Hospital Research Center, University of California, Toyota Sports Performance Center 555 N. Nash St., Suite BEl Segundo, Los Angeles, California, 90245.,Center for Cardiovascular Science and MRC, Centre for Regenerative Medicine, University of Edinburgh, Edinburgh, UK
| | - Ayelet Dar
- Department of Orthopaedic Surgery, David Geffen School of Medicine, Orthopaedic Hospital Research Center, University of California, Toyota Sports Performance Center 555 N. Nash St., Suite BEl Segundo, Los Angeles, California, 90245
| | - Frank A Petrigliano
- Department of Orthopaedic Surgery, David Geffen School of Medicine, Orthopaedic Hospital Research Center, University of California, Toyota Sports Performance Center 555 N. Nash St., Suite BEl Segundo, Los Angeles, California, 90245
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Willbold E, Wellmann M, Welke B, Angrisani N, Gniesmer S, Kampmann A, Hoffmann A, Cassan D, Menzel H, Hoheisel AL, Glasmacher B, Reifenrath J. Possibilities and limitations of electrospun chitosan‐coated polycaprolactone grafts for rotator cuff tear repair. J Tissue Eng Regen Med 2019; 14:186-197. [DOI: 10.1002/term.2985] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 09/27/2019] [Accepted: 10/17/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Elmar Willbold
- Laboratory for Biomechanics and Biomaterials, Department of Orthopaedic SurgeryHannover Medical School Hannover Germany
- Lower Saxony Centre for Biomedical Engineering, Implant Research and Development (NIFE)Hannover Medical School Hannover Germany
| | - Mathias Wellmann
- Laboratory for Biomechanics and Biomaterials, Department of Orthopaedic SurgeryHannover Medical School Hannover Germany
| | - Bastian Welke
- Laboratory for Biomechanics and Biomaterials, Department of Orthopaedic SurgeryHannover Medical School Hannover Germany
| | - Nina Angrisani
- Laboratory for Biomechanics and Biomaterials, Department of Orthopaedic SurgeryHannover Medical School Hannover Germany
- Lower Saxony Centre for Biomedical Engineering, Implant Research and Development (NIFE)Hannover Medical School Hannover Germany
| | - Sarah Gniesmer
- Clinic for Cranio‐Maxillo‐Facial SurgeryHannover Medical School Hannover Germany
- Lower Saxony Centre for Biomedical Engineering, Implant Research and Development (NIFE)Hannover Medical School Hannover Germany
| | - Andreas Kampmann
- Clinic for Cranio‐Maxillo‐Facial SurgeryHannover Medical School Hannover Germany
- Lower Saxony Centre for Biomedical Engineering, Implant Research and Development (NIFE)Hannover Medical School Hannover Germany
| | - Andrea Hoffmann
- Laboratory for Biomechanics and Biomaterials, Department of Orthopaedic SurgeryHannover Medical School Hannover Germany
- Lower Saxony Centre for Biomedical Engineering, Implant Research and Development (NIFE)Hannover Medical School Hannover Germany
| | - Dominik Cassan
- Institute for Technical ChemistryBraunschweig University of Technology Braunschweig Germany
| | - Henning Menzel
- Institute for Technical ChemistryBraunschweig University of Technology Braunschweig Germany
| | - Anna Lena Hoheisel
- Lower Saxony Centre for Biomedical Engineering, Implant Research and Development (NIFE)Hannover Medical School Hannover Germany
- Institute for Multiphase ProcessesLeibniz University Hannover Hannover Germany
| | - Birgit Glasmacher
- Lower Saxony Centre for Biomedical Engineering, Implant Research and Development (NIFE)Hannover Medical School Hannover Germany
- Institute for Multiphase ProcessesLeibniz University Hannover Hannover Germany
| | - Janin Reifenrath
- Laboratory for Biomechanics and Biomaterials, Department of Orthopaedic SurgeryHannover Medical School Hannover Germany
- Lower Saxony Centre for Biomedical Engineering, Implant Research and Development (NIFE)Hannover Medical School Hannover Germany
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Muscle fat content in the intact infraspinatus muscle correlates with age and BMI, but not critical shoulder angle. Eur J Trauma Emerg Surg 2019; 47:607-616. [DOI: 10.1007/s00068-019-01246-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 10/11/2019] [Indexed: 12/28/2022]
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Trevino JH, Gorny KR, Gomez-Cintron A, Zhao C, Giambini H. A quantitative alternative to the Goutallier classification system using Lava Flex and Ideal MRI techniques: volumetric intramuscular fatty infiltration of the supraspinatus muscle, a cadaveric study. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2019; 32:607-615. [DOI: 10.1007/s10334-019-00774-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 08/05/2019] [Accepted: 08/24/2019] [Indexed: 01/18/2023]
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Zheng R, Huang S, Zhu J, Lin W, Xu H, Zheng X. Leucine attenuates muscle atrophy and autophagosome formation by activating PI3K/AKT/mTOR signaling pathway in rotator cuff tears. Cell Tissue Res 2019; 378:113-125. [PMID: 31020406 DOI: 10.1007/s00441-019-03021-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 03/25/2019] [Indexed: 12/22/2022]
Abstract
Rotator cuff tears (RCTs), the most common tendon injury, are always accompanied by muscle atrophy, which is characterized by excessive protein degradation. Autophagy-lysosome systems are the crucial proteolytic pathways and are activated in atrophying muscle. Thus, inhibition of the autophagy-lysosome pathway might be an alternative way to minimize skeletal muscle atrophy. In this present study, combined with a tendon transection-induced rat model of massive rotator cuff tears, HE staining and transmission electron microscopy methods, we found leucine supplementation effectively prevented muscle atrophy, muscle injury and autophagosome formation. Utilizing immunoblotting, we discovered that leucine supplementation is able to inhibit the rise in autophagy-related protein expression (including LC3, Atrogin-1, MuRF1, Bnip3 and FoxO3) driven by tendon transection. The PI3K/AKT/mTOR pathway that was essential in autophagosome formation and autophagy was blocked in atrophying muscle and reactivated in the presence of leucine. Once administrated with LY294002 (PI3K inhibitor) and Rapamycin (mTOR inhibitor), leucine mediated by the anti-atrophic effects was nearly blunted. These results suggest that leucine potentially attenuates tendon transection-induced muscle atrophy through autophagy inhibition via activating the PI3K/AKT/mTOR pathway.
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Affiliation(s)
- Rongzong Zheng
- Department of Orthopaedic Surgery, Zhejiang University Lishui Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, Zhejiang, People's Republic of China
| | - Shuming Huang
- Department of Orthopaedic Surgery, Zhejiang University Lishui Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, Zhejiang, People's Republic of China.
| | - Junkun Zhu
- Department of Orthopaedic Rehabilitation, Zhejiang University Lishui Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, Zhejiang, People's Republic of China
| | - Wei Lin
- Department of Orthopaedic Surgery, Zhejiang University Lishui Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, Zhejiang, People's Republic of China
| | - Huan Xu
- Department of Orthopaedic Surgery, Zhejiang University Lishui Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, Zhejiang, People's Republic of China
| | - Xiang Zheng
- Department of Orthopaedic Surgery, Zhejiang University Lishui Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, Zhejiang, People's Republic of China
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How Long Should We Wait to Create the Goutallier Stage 2 Fatty Infiltrations in the Rabbit Shoulder for Repairable Rotator Cuff Tear Model? BIOMED RESEARCH INTERNATIONAL 2019; 2019:7387131. [PMID: 31061826 PMCID: PMC6466932 DOI: 10.1155/2019/7387131] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 02/09/2019] [Accepted: 03/19/2019] [Indexed: 12/23/2022]
Abstract
Background Significant proportion of rotator cuff tears (RCTs) in clinical field are of a kind of repairable tear wherein the degree of fatty infiltration is of Goutallier stage 1 or stage 2. Therefore, the animal model, showing similar fatty infiltration, seems preferable for researches. The purpose of this study is to find out the proper time frame in which there is Goutallier stage 1 or stage 2 fatty infiltration in the rabbit RCT model for the research of repairable RCT in humans. Methods Supraspinatus tendon tears were created in forty male New Zealand white rabbits at their right shoulder (n= 8 for each group), and a sham operation on the left shoulder. Rabbits were divided into five groups (2nd, 4th, 6th, 8th, and 12th weeks). Specimens were harvested from the central portion of the supraspinatus muscle for haematoxylin and eosin (H &E) staining, followed by histological and Goutallier grading evaluation. Results are expressed as mean ± standard deviation by Sigma Plot software (version 7.0). Results At two weeks, mainly lipoblasts were observed around the muscle fibers, and at four weeks these lipoblasts were replaced by mature adipocytes with fatty infiltration amount (2.13 ± 0.35). The degree of muscle atrophy was (1.50 ± 0.53) at four weeks compared to sham group (0.88 ± 0.64) with significant difference (p < 0.05). The inflammatory process appeared as two phases. At two weeks, it was increased with grading value (1.88 ± 0.35). However, in the four-week group, it showed a sharp decrease (0.50 ± 0.53). At six weeks, inflammation reappeared to increase (1.13 ± 0.83). Then, a gradual decline appeared at eight weeks (0.88 ± 0.83) and at 12 weeks (0.50 ± 0.92). Conclusions At two and four weeks, both fat distribution in rabbit supraspinatus muscles and Goutallier grading scale mostly appeared as grade 2. Therefore, we can consider four weeks to be a suitable period for making a repairable RCT animal model for the human research, considering the early acute tissue reaction at 2 weeks after the tendon tears.
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Rothrauff BB, Smith CA, Ferrer GA, Novaretti JV, Pauyo T, Chao T, Hirsch D, Beaudry MF, Herbst E, Tuan RS, Debski RE, Musahl V. The effect of adipose-derived stem cells on enthesis healing after repair of acute and chronic massive rotator cuff tears in rats. J Shoulder Elbow Surg 2019; 28:654-664. [PMID: 30527883 DOI: 10.1016/j.jse.2018.08.044] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/26/2018] [Accepted: 08/29/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Chronic massive rotator cuff tears heal poorly and often retear. This study investigated the effect of adipose-derived stem cells (ADSCs) and transforming growth factor-β3 (TGF-β3) delivered in 1 of 2 hydrogels (fibrin or gelatin methacrylate [GelMA]) on enthesis healing after repair of acute or chronic massive rotator cuff tears in rats. METHODS Adult male Lewis rats underwent bilateral transection of the supraspinatus and infraspinatus tendons with intramuscular injection of botulinum toxin A (n = 48 rats). After 8 weeks, animals received 1 of 8 interventions (n = 12 shoulders/group): (1) no repair, (2) repair only, or repair augmented with (3) fibrin, (4) GelMA, (5) fibrin + ADSCs, (6) GelMA + ADSCs, (7) fibrin + ADSCs + TGF-β3, or (8) GelMA + ADSCs + TGF-β3. An equal number of animals underwent acute tendon transection and immediate application of 1 of 8 interventions. Enthesis healing was evaluated 4 weeks after the repair by microcomputed tomography, histology, and mechanical testing. RESULTS Increased bone loss and reduced structural properties were seen in chronic compared with acute tears. Bone mineral density of the proximal humerus was higher in repairs of chronic tears augmented with fibrin + ADSCs and GelMA + ADSCs than in unrepaired chronic tears. Similar improvement was not seen in acute tears. No intervention enhanced histologic appearance or structural properties in acute or chronic tears. CONCLUSIONS Surgical repair augmented with ADSCs may provide more benefit in chronic tears compared with acute tears, although there was no added benefit to supplementing ADSCs with TGF-β3.
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Affiliation(s)
- Benjamin B Rothrauff
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Catherine A Smith
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Gerald A Ferrer
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - João V Novaretti
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Thierry Pauyo
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tom Chao
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - David Hirsch
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mason F Beaudry
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Elmar Herbst
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rocky S Tuan
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Richard E Debski
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.
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Tsikouris GD, Bolia IK, Vlaserou P, Odantzis N, Angelis K, Psychogios V. Shoulder Arthroscopy With Versus Without Suprascapular Nerve Release: Clinical Outcomes and Return to Sport Rate in Elite Overhead Athletes. Arthroscopy 2018; 34:2552-2557. [PMID: 29937345 DOI: 10.1016/j.arthro.2018.03.046] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 03/03/2018] [Accepted: 03/26/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the clinical outcomes and return to sport rate between elite overhead athletes who underwent shoulder arthroscopy and decompression of the suprascapular nerve (SSN) versus overhead athletes who underwent shoulder arthroscopy without SSN release. METHODS From 2007 to 2014, high-level overhead athletes diagnosed with a rotator cuff tear and/or a glenoid labral lesion and SSN entrapment were included in the study if their symptoms did not improve with nonoperative treatment and if they agreed to undergo surgery and participate. Their preoperative University of California at Los Angeles (UCLA) shoulder score, bilateral postoperative Constant scores, postoperative UCLA score, and return to sport rate were evaluated and compared with those of a group of elite athletes who had a similar diagnosis but refused to undergo SSN decompression during shoulder arthroscopy. RESULTS Thirty-five athletes (25 male, 10 female) were included in the SSN decompression group (group 1), and 21 athletes were included in the non-SSN decompression group (group 2). The mean age was 27 years (range: 19-34) and 24 years (range: 21-32) in group 1 and group 2, respectively (P = .56). The mean follow-up time was 38.4 months (24-50 months) in group 1 and 42.2 months (26-53 months) in group 2 (P = .09). Both groups had significantly improved UCLA scores after surgery (P < .05). The postoperative UCLA (P = .01) and Constant scores (P < .001) were significantly higher in the SSN decompression group. The mean difference in Constant score between the affected and the unaffected side was 4 points (range: 2-12) in the SSN decompression group and 8 points (range: 4-14) in the non-SSN decompression group postoperatively (P = .0002). In both groups, 100% of patients reached the patient acceptable symptom state value for Constant score at follow-up. For the UCLA score, patients who underwent SSN decompression had significantly higher pre- to postoperative improvement than the nondecompression group (P = .016). The return to sport rate was 97% in group 1 and 84% in group 2. The mean length of career was 2.1 years (range: 1.5-2.4 years) and 2.3 years (range: 1.2-3.2 years) in group 1 and group 2, respectively. CONCLUSIONS In elite overhead athletes with shoulder pathology and SSN entrapment, combined shoulder arthroscopy and SSN release yield superior clinical outcomes, greater improvement in UCLA score, and a higher return to sport rate than shoulder arthroscopy without SSN decompression. Regardless of SSN treatment, both groups achieved the patient acceptable symptom state after shoulder arthroscopy. LEVEL OF EVIDENCE Level III, comparative case series.
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Affiliation(s)
| | - Ioanna K Bolia
- Athens Kolonaki Orthopaedic and Sports Medicine Center, Athens, Greece
| | | | - Nikolaos Odantzis
- Athens Kolonaki Orthopaedic and Sports Medicine Center, Athens, Greece
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Sasaki Y, Ochiai N, Nakajima A, Sasho T, Kenmoku T, Yamaguchi T, Kijima T, Hashimoto E, Sasaki Y, Ohtori S. Histological analysis and biomechanical evaluation of fatty infiltration after rotator cuff tear and suprascapular nerve injury in a rat model. J Orthop Sci 2018; 23:834-841. [PMID: 29880227 DOI: 10.1016/j.jos.2018.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 03/26/2018] [Accepted: 04/09/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Rotator cuff tears are the most common shoulder injury, and little is known about the underlying etiology of fatty infiltration after rotator cuff tear. Previous studies speculated that rotator cuff tears lead to neural injury due to tethering of the suprascapular nerve at the notch. This study aimed to evaluate fatty infiltration after suprascapular nerve injury and rotator cuff tears. METHODS Ninety adult male Sprague-Dawley rats were used and were divided into four groups: sham, tendon transection only, suprascapular nerve ligation, and tendon transection plus suprascapular nerve ligation. The suprascapular nerve injury models were created by tying the suprascapular nerve. At 2, 4, and 8 weeks postoperatively, histological analysis and biomechanical testing were performed to evaluate fatty infiltration and elastic change in the supraspinatus muscles. RESULTS The amount of fatty infiltration in the supraspinatus muscle was significantly higher in both the suprascapular nerve ligation and tendon transection plus suprascapular nerve ligation groups than in the tendon transection only group at 2, 4, and 8 weeks. The ultimate failure load and tensile strength were significantly different among the tendon transection only, suprascapular nerve ligation, and tendon transection plus suprascapular nerve ligation groups at 8 weeks postoperatively. Furthermore, the mean Young's modulus of the muscle was significantly greater in the tendon transection plus suprascapular nerve ligation group than in both the tendon transection only and suprascapular nerve ligation groups at 8 weeks postoperatively. CONCLUSIONS In this study, based on the results of histological and biomechanical examinations in our rat models, the etiology of fatty infiltration after massive rotator cuff tear might be different from the suprascapular nerve injury.
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Affiliation(s)
- Yu Sasaki
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
| | - Nobuyasu Ochiai
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Arata Nakajima
- Department of Orthopedic Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura, Chiba, 285-8741, Japan
| | - Takahisa Sasho
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Tomonori Kenmoku
- Department of Orthopedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Takeshi Yamaguchi
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Takehiro Kijima
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Eiko Hashimoto
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Yasuhito Sasaki
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Seiji Ohtori
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
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Derwin KA, Galatz LM, Ratcliffe A, Thomopoulos S. Enthesis Repair: Challenges and Opportunities for Effective Tendon-to-Bone Healing. J Bone Joint Surg Am 2018; 100:e109. [PMID: 30106830 PMCID: PMC6133216 DOI: 10.2106/jbjs.18.00200] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
On May 22, 2017, the National Institutes of Health (NIH)/National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) hosted a roundtable on "Innovative Treatments for Enthesis Repair." A summary of the roundtable discussion, as well as a list of the extramural participants, can be found at https://www.niams.nih.gov/about/meetings-events/roundtables/roundtable-innovative-treatments-enthesis-repair. This paper reviews the challenges and opportunities for developing effective treatment strategies for enthesis repair that were identified at the roundtable discussion.
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Affiliation(s)
- Kathleen A. Derwin
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio,E-mail address for K.A. Derwin:
| | - Leesa M. Galatz
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Stavros Thomopoulos
- Department of Orthopedic Surgery, Department of Biomedical Engineering, Columbia University, New York, NY
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Flück M, Valdivieso P, Ruoss S, von Rechenberg B, Benn MC, Meyer DC, Wieser K, Gerber C. Neurectomy preserves fast fibers when combined with tenotomy of infraspinatus muscle via upregulation of myogenesis. Muscle Nerve 2018; 59:100-107. [PMID: 30073680 DOI: 10.1002/mus.26316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2018] [Indexed: 11/10/2022]
Abstract
INTRODUCTION We evaluated the contribution of denervation-related molecular processes to rotator cuff muscle degeneration after tendon release. METHODS We assessed the levels of myogenic (myogenin and myogenic differentiation factor [myoD]) and proadipogenic (peroxisome proliferator-activated receptor γ) transcription factors; the denervation-associated proteins tenascin-C, laminin-2, and calcium/calmodulin-dependent kinase II (CaMKII); and cellular alterations in sheep after infraspinatus tenotomy (TEN), suprascapular neurectomy (NEU), or both (TEN-NEU). RESULTS Extracellular ground substance increased at the expense of contractile tissue 16 weeks after surgery, correlating with CaMKII isoform levels. Sheep undergoing NEU and TEN-NEU had exaggerated infraspinatus atrophy and increased fast fibers compared with TEN sheep. The βMCaMKII isoform levels increased with TEN, and myoD levels tripled after denervation and were associated with slow fibers. DISCUSSION In sheep, denervation did not affect muscle-to-fat conversion after TEN of the infraspinatus. Furthermore, concurrent NEU mitigated the loss of fast fibers after TEN by inducing a fast-contractile phenotype. Muscle Nerve 59:100-107, 2019.
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Affiliation(s)
- Martin Flück
- Laboratory for Muscle Plasticity, Department of Orthopedics, University of Zurich, Lengghalde 5, Balgrist Campus, 8008, Zurich, Switzerland.,Competence Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zurich, Zurich, Switzerland
| | - Paola Valdivieso
- Laboratory for Muscle Plasticity, Department of Orthopedics, University of Zurich, Lengghalde 5, Balgrist Campus, 8008, Zurich, Switzerland
| | - Severin Ruoss
- Laboratory for Muscle Plasticity, Department of Orthopedics, University of Zurich, Lengghalde 5, Balgrist Campus, 8008, Zurich, Switzerland
| | - Brigitte von Rechenberg
- Musculoskeletal Research Unit, Department of Molecular Mechanisms, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.,Competence Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zurich, Zurich, Switzerland
| | - Mario C Benn
- Musculoskeletal Research Unit, Department of Molecular Mechanisms, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Dominik C Meyer
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,Competence Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zurich, Zurich, Switzerland
| | - Karl Wieser
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Christian Gerber
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,Competence Center for Applied Biotechnology and Molecular Medicine (CABMM), University of Zurich, Zurich, Switzerland
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Giambini H, Hatta T, Rezaei A, An KN. Extensibility of the supraspinatus muscle can be predicted by combining shear wave elastography and magnetic resonance imaging-measured quantitative metrics of stiffness and volumetric fat infiltration: A cadaveric study. Clin Biomech (Bristol, Avon) 2018; 57:144-149. [PMID: 29986277 PMCID: PMC6052767 DOI: 10.1016/j.clinbiomech.2018.07.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 03/05/2018] [Accepted: 07/02/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND A torn rotator cuff tendon will retract over time causing changes in muscle properties and decreasing its extensibility, or deformation. During surgery, large tensile loads are applied to bring the torn tendon to the footprint. Poor muscle extensibility and large tensile stresses at the repair might lead to gap formation or re-tear of the repair. A quantitative evaluation of muscle properties could be used to predict the extensibility of the supraspinatus (SSP) muscle. METHOD Magnetic resonance imaging (MRI)-measured volumetric fat fraction and shear wave elastography (SWE)-measured elastic modulus of the SSP muscle were obtained on seventeen cadaveric shoulders. Experimental extensibility and stiffness were then measured by axially pulling the tendon up-to 60 N. Univariate and multivariate analyses were used to determine the correlation and contribution of fat fraction and elastic modulus to experimental outcomes. FINDINGS SWE moduli negatively correlated with SSP muscle extensibility (r = 0.54-0.58, P ≤ 0.0259); fat fraction resulted in a positive correlation (r = 0.69, P = 0.0021). SWE measurements, solely, explained up to 34% and 33% of the variability in measured extensibility and stiffness, respectively. Fat Fraction, solely, explained 48% of the variability in extensibility and 36% of the variability in stiffness. These methods combined predicted up to 62% of the musculotendinous extensibility. INTERPRETATION This study showed a comprehensive quantitative assessment of SSP muscle properties using SWE to estimate stiffness and MRI to measure fatty infiltration. The extensibility of the detached muscle/tendon unit was highly correlated to material properties of the muscle when these methods were used in combination.
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Affiliation(s)
- Hugo Giambini
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
| | - Taku Hatta
- Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, MN, USA
| | - Asghar Rezaei
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Kai-Nan An
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA; Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, Rochester, MN, USA
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Song HJ, Heu JY, Song HS. Histological Changes in Biceps Muscle after Tenotomizing the Biceps Long Head in a Rat Model. Clin Shoulder Elb 2018; 21:87-94. [PMID: 33330158 PMCID: PMC7726384 DOI: 10.5397/cise.2018.21.2.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 05/01/2018] [Accepted: 05/01/2018] [Indexed: 11/25/2022] Open
Abstract
Background Popeye deformity is common after rupture of the biceps muscle’s long head tendon. Herein, we report on histological changes in biceps brachii muscles following tenotomy of the long head biceps tendon. Methods Twelve Sprague-Dawley rats (12-week-old) underwent tenotomy of the long head biceps tendon in the right shoulder. At postoperative weeks 4, 7, and 10, the operative shoulders were removed by detaching the biceps brachii muscle from the glenoid scapula and humerus; the opposite shoulders were removed as controls. H&E staining was performed to elucidate histological changes in myocytes. Oil-red O staining was performed to determine fatty infiltration. Myostatin antibody immunohistochemistry staining was performed as myostatin is expressed by skeletal muscle cells during myogenesis. Results H&E staining results revealed no changes in muscle cell nuclei. There were no adipocytes detected. Compared with that of the control biceps, the cross-sectional area of the long head biceps was significantly smaller (p=0.00). Statistical changes in the total extent of the 100 muscle cells were significant (p=0.00). Oil-red O staining revealed no fatty infiltration. Myostatin antibody immunohistochemical staining revealed no significant difference between the two sides. Conclusions Muscular changes after tenotomy of the long head biceps included a decrease in the size of the individual muscle cells and in relative muscle mass. There were no changes observed in muscle cell nuclei and no fatty infiltration. Moreover, there were no changes detected by myostatin antibody immunohistochemistry assay.
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Affiliation(s)
- Ha-Jung Song
- Department of Orthopedic Surgery, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jun-Young Heu
- Department of Orthopedic Surgery, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Seok Song
- Department of Orthopedic Surgery, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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