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Galdamez ME, Huber FA, Buckless CG, Medina G, Galetta MD, Oh LS, Torriani M. Cross-sectional areas of rotator cuff muscles in males without tears on shoulder MRI. Skeletal Radiol 2024; 53:285-291. [PMID: 37421446 DOI: 10.1007/s00256-023-04400-w] [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: 06/20/2023] [Revised: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVE To establish reference values of rotator cuff (RC) cross sectional area (CSA) in males. MATERIALS AND METHODS We retrospectively analyzed shoulder MRIs from 500 patients aged 13-78 years, grouped as follows (N=100 in each): <20, 20-30, 30-40, 40-50, >50 years. All examinations were reviewed to exclude prior surgery, tears, or significant RC pathology. We segmented a standardized T1 sagittal MR image in each case to obtain CSA of supraspinatus (SUP), infraspinatus/teres minor (INF), and subscapularis (SUB) muscles. Across age groups, we recorded individual and total muscle CSA. We also performed ratios between individual muscle CSA and total CSA to examine total muscle mass contribution over age groups. We tested for differences between age groups controlled for BMI. RESULTS CSAs for SUP, INF, SUB, and total RC CSA were lower in subjects >50 years compared to all other groups (P<0.003 for all comparisons), persisting after controlling for BMI (P<0.03). Relative contribution of SUP CSA to total RC CSA was stable across age groups (P>0.32). INF CSA relative to total RC CSA increased with age, whereas SUB decreased (P<0.005). Subjects >50 years showed lower SUP (-15%), INF (-6%), and SUB (-21%) CSA, when compared to mean CSAs of all subjects <50 years. Total RC CSA significantly correlated with age (r=-0.34, P<0.001), persisting after controlling for BMI (r=-0.42, P<0.001). CONCLUSION RC muscles in male subjects with no tears on MRI show decreasing CSA with age, independent of BMI.
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Affiliation(s)
- Marilyn E Galdamez
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Florian A Huber
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Colleen G Buckless
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Giovanna Medina
- Department of Orthopedic Surgery-Sports Medicine Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael D Galetta
- Department of Orthopedic Surgery-Sports Medicine Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Luke S Oh
- Department of Orthopedic Surgery-Sports Medicine Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Rothman Orthopaedics & AdventHealth Orthopaedic Institute, Orlando, FL, USA
| | - Martin Torriani
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Scarberry SR, Prutchi H, Frye BM, Herr J, Scott C, Long CM, Jorgensen MJ, Shively CA, Kavanagh K. Development and assessment of a stair ascension challenge as a measure of aging and physical function in nonhuman primates. Am J Primatol 2024; 86:e23582. [PMID: 38050788 PMCID: PMC10843660 DOI: 10.1002/ajp.23582] [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: 08/08/2023] [Revised: 11/03/2023] [Accepted: 11/23/2023] [Indexed: 12/06/2023]
Abstract
Nonhuman primates (NHPs) are valuable models for studying healthspan, including frailty development. Frailty metrics in people centers on functional measures, including usual gait speed which can be predictive of all-cause mortality. This concept that physical competencies are able to prognosticate an individual's health trajectory over chronologic aging is well-accepted and has led to refinements in how physical function is evaluated, and include measures of strength and power along with walking speed. NHP studies of aging require evaluation of physical function, which can be difficult in field and research settings. We compared stair climb velocity to usual walking speed in 28 peri-geriatric to geriatric NHPs, as incorporating a climbing obstacle integrates multiple components of physical function: isolated leg and back strength, proprioception, balance, and range of motion. We find that stair climbing speed was reliable between observers, and whether timing was in-person take from video capture. The stair climb rates were 50% more associated with chronological age than walking speed (R = -0.68 vs. -0.45) and only stair climbing speeds were retained as predictive of age when walking speed and bodyweight were included in multivariate models (overall R2 = 0.44; p < 0.0001). When comparing young (10-16 years) versus geriatric (16-29 years) stair climbing speed was significantly different (p < 0.001), while walking speeds only tended to be slower (p = 0.12) suggesting that the additional challenge of a stair climb better unmasks subclinical frailty development that usual walking speed.
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Affiliation(s)
- Shannon R. Scarberry
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Hannah Prutchi
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- College of Veterinary Medicine, Tufts University, Boston, Massachusetts, USA
| | - Brett M. Frye
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Department of Biology, Emory and Henry College, Emory, Virginia, USA
| | - Justin Herr
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Christie Scott
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Chrissy M. Long
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Matthew J. Jorgensen
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Carol A. Shively
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Kylie Kavanagh
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- College of Health and Medicine, University of Tasmania, Tasmania, Australia
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3
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Vermeulen V, Kozma E, Delsupehe A, Cornillie P, Stock E, Van Tongel A, De Wilde L, Vereecke EE. Scapular morphology of great apes and humans: A three-dimensional computed tomography-based comparative study. J Anat 2023; 242:164-173. [PMID: 36302086 PMCID: PMC9877474 DOI: 10.1111/joa.13784] [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: 03/18/2022] [Revised: 10/06/2022] [Accepted: 10/11/2022] [Indexed: 02/01/2023] Open
Abstract
The primate scapula has been studied widely since its shape has been shown to correlate with how the forelimb is used in daily activities. In this study, we expand on the existing literature and use an image-based methodology that was originally developed for orthopaedic practice to quantify and compare the three-dimensional (3D) morphology of the scapula across humans and great apes. We expect that this image-based approach will allow us to identify differences between great apes and humans that can be related to differences in mobility and loading regime of the shoulder. We hypothesize that gorillas and chimpanzees will have a similar scapular morphology, geared towards stability and weight-bearing in knuckle-walking, whilst the scapular morphology of orangutans is expected to be more similar to that of humans given their high glenohumeral mobility associated with their suspensory lifestyle. We made 3D reconstructions of computed tomography scans of 69 scapulae from four hominid genera (Pongo, Gorilla, Pan and Homo). On these 3D bone meshes, the inferior glenoid plane was determined, and subsequently, a set of bony landmarks on the scapular body, coracoid, and acromion were defined. These landmarks allowed us to measure a set of functionally relevant angles which represent acromial overhang, subacromial space and coracoacromial space. The angles that were measured are: the delto-fulcral triangle (DFT), comprising the alpha, beta, and delta angle, the acromion-glenoid angle (AGA), the coracoid-glenoid centre-posterior acromial angle (CGA), the anterior tilt (TA CGA) and the posterior tilt of the CGA (PT CGA). Three observers placed the landmarks on the 3D bone meshes, allowing us to calculate the inter-observer error. The main differences in the DFT were found between humans and the great apes, with small differences between the great apes. The DFT of humans was significantly lower compared to that of the great apes, with the smallest alpha (32.7°), smallest delta (45.7°) and highest beta angle (101.6°) of all genera. The DFT of chimpanzees was significantly higher compared to that of humans (p < 0.01), with a larger alpha (37.6°) and delta angle (54.5°) and smaller beta angle (87.9°). The mean AGA of humans (59.1°) was significantly smaller (p < 0.001) than that of gorillas (68.8°). The mean CGA of humans (110.1°) was significantly higher (p < 0.001) than in orangutans (92.9°). Humans and gorillas showed mainly a posterior tilt of their coracoacromial complex whilst chimpanzees showed mainly an anterior tilt. The coracoacromial complex of the orangutans was not tilted anteriorly or posteriorly. With our image-based method, we were able to identify morphological features of the scapula that differed significantly between hominid genera. However, we did not find an overall dichotomy in scapular morphology geared towards high stability (Pan/Gorilla) or high mobility (Homo/Pongo). Further research is needed to investigate the functional implications of these differences in scapular morphology.
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Affiliation(s)
- Valérie Vermeulen
- Department of Human Structure and Repair, Faculty of Medicine and Health SciencesGhent University HospitalGentBelgium
- Department of Development and RegenerationKU Leuven Campus KulakKortrijkBelgium
| | - Elaine Kozma
- Department of Development and RegenerationKU Leuven Campus KulakKortrijkBelgium
| | - Arne Delsupehe
- Department of Development and RegenerationKU Leuven Campus KulakKortrijkBelgium
| | - Pieter Cornillie
- Department of Morphology, Faculty of Veterinary MedicineGhent UniversityMerelbekeBelgium
| | - Emmelie Stock
- Department of Morphology, Imaging, Orthopaedics, Rehabilitation and Nutrition, Faculty of Veterinary MedicineGhent UniversityMerelbekeBelgium
| | - Alexander Van Tongel
- Department of Human Structure and Repair, Faculty of Medicine and Health SciencesGhent University HospitalGentBelgium
| | - Lieven De Wilde
- Department of Human Structure and Repair, Faculty of Medicine and Health SciencesGhent University HospitalGentBelgium
| | - Evie E. Vereecke
- Department of Development and RegenerationKU Leuven Campus KulakKortrijkBelgium
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Zhang G, Zhou X, Hu S, Jin Y, Qiu Z. Large animal models for the study of tendinopathy. Front Cell Dev Biol 2022; 10:1031638. [PMID: 36393858 PMCID: PMC9640604 DOI: 10.3389/fcell.2022.1031638] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/12/2022] [Indexed: 11/23/2022] Open
Abstract
Tendinopathy has a high incidence in athletes and the aging population. It can cause pain and movement disorders, and is one of the most difficult problems in orthopedics. Animal models of tendinopathy provide potentially efficient and effective means to develop understanding of human tendinopathy and its underlying pathological mechanisms and treatments. The selection of preclinical models is essential to ensure the successful translation of effective and innovative treatments into clinical practice. Large animals can be used in both micro- and macro-level research owing to their similarity to humans in size, structure, and function. This article reviews the application of large animal models in tendinopathy regarding injuries to four tendons: rotator cuff, patellar ligament, Achilles tendon, and flexor tendon. The advantages and disadvantages of studying tendinopathy with large animal models are summarized. It is hoped that, with further development of animal models of tendinopathy, new strategies for the prevention and treatment of tendinopathy in humans will be developed.
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Affiliation(s)
- Guorong Zhang
- School of Clinical Medicine, Changchun University of Chinese Medicine, Changchun, China
- School of Pharmacy, Changchun University of Chinese Medicine, Changchun, China
| | - Xuyan Zhou
- School of Pharmacy, Changchun University of Chinese Medicine, Changchun, China
| | - Shuang Hu
- School of Pharmacy, Changchun University of Chinese Medicine, Changchun, China
| | - Ye Jin
- School of Pharmacy, Changchun University of Chinese Medicine, Changchun, China
- *Correspondence: Ye Jin, ; Zhidong Qiu,
| | - Zhidong Qiu
- School of Pharmacy, Changchun University of Chinese Medicine, Changchun, China
- *Correspondence: Ye Jin, ; Zhidong Qiu,
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5
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Frye BM, Craft S, Latimer CS, Keene CD, Montine TJ, Register TC, Orr ME, Kavanagh K, Macauley SL, Shively CA. Aging-related Alzheimer's disease-like neuropathology and functional decline in captive vervet monkeys (Chlorocebus aethiops sabaeus). Am J Primatol 2021; 83:e23260. [PMID: 33818801 PMCID: PMC8626867 DOI: 10.1002/ajp.23260] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/05/2021] [Accepted: 03/21/2021] [Indexed: 12/17/2022]
Abstract
Age-related neurodegeneration characteristic of late-onset Alzheimer's disease (LOAD) begins in middle age, well before symptoms. Translational models to identify modifiable risk factors are needed to understand etiology and identify therapeutic targets. Here, we outline the evidence supporting the vervet monkey (Chlorocebus aethiops sabaeus) as a model of aging-related AD-like neuropathology and associated phenotypes including cognitive function, physical function, glucose handling, intestinal physiology, and CSF, blood, and neuroimaging biomarkers. This review provides the most comprehensive multisystem description of aging in vervets to date. This review synthesizes a large body of evidence that suggests that aging vervets exhibit a coordinated suite of traits consistent with early AD and provide a powerful, naturally occurring model for LOAD. Notably, relationships are identified between AD-like neuropathology and modifiable risk factors. Gaps in knowledge and key limitations are provided to shape future studies to illuminate mechanisms underlying divergent neurocognitive aging trajectories and to develop interventions that increase resilience to aging-associated chronic disease, particularly, LOAD.
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Affiliation(s)
- Brett M. Frye
- Department of Pathology/Comparative Medicine, Wake Forest School of Medicine
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine
| | - Suzanne Craft
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine
- Wake Forest Alzheimer’s Disease Research Center
- J. Paul Sticht Center for Healthy Aging and Alzheimer’s Prevention, Wake Forest School of Medicine
| | - Caitlin S. Latimer
- Department of Laboratory Medicine and Pathology, University of Washington-Seattle
| | - C. Dirk Keene
- Department of Laboratory Medicine and Pathology, University of Washington-Seattle
| | | | - Thomas C. Register
- Department of Pathology/Comparative Medicine, Wake Forest School of Medicine
- Wake Forest Alzheimer’s Disease Research Center
- J. Paul Sticht Center for Healthy Aging and Alzheimer’s Prevention, Wake Forest School of Medicine
| | - Miranda E. Orr
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine
| | - Kylie Kavanagh
- Department of Pathology/Comparative Medicine, Wake Forest School of Medicine
| | - Shannon L. Macauley
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine
- Wake Forest Alzheimer’s Disease Research Center
| | - Carol A. Shively
- Department of Pathology/Comparative Medicine, Wake Forest School of Medicine
- Wake Forest Alzheimer’s Disease Research Center
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6
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Como CJ, Rothrauff BB, Alexander PG, Lin A, Musahl V. Common animal models lack a distinct glenoid labrum: a comparative anatomy study. J Exp Orthop 2021; 8:63. [PMID: 34401967 PMCID: PMC8368311 DOI: 10.1186/s40634-021-00383-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/29/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose Development and validation of an animal model of labral healing would facilitate translation of novel surgical and biological strategies to improve glenolabral healing. The purpose of this study was to characterize the anatomic and histological properties of the shoulder labrum in rat, rabbit, dog, pig, goat, and humans. Given the demonstrated similarities in size and structural morphology in other joints, it was hypothesized that the goat glenoid with surrounding capsulolabral complex would most closely resemble that of humans in terms of dimensions and structure, as observed grossly and histologically. Methods Cadaveric glenohumeral joints from rats (n = 8), New Zealand white rabbits (n = 13), Mongrel dogs (n = 9), Spanish goats (n = 10), Yorkshire pigs (n = 10), and humans (n = 9) were freshly harvested. Photographs were taken of the glenoid with its surrounding capsulolabral complex. Linear dimensions of the glenoid articular surface were measured. It was determined where the capsulolabral complex was continuous with, or recessed from, the articular glenoid surface. The glenoid was divided into 6 equal segments radiating out toward 12, 2, 4, 6, 8, and 10 o’clock positions. Samples were sectioned and stained with Safranin O/Fast green and Mallory Trichrome. Insertion of the capsulolabral tissue onto the glenoid was qualitatively assessed and compared with gross morphology. Results Dimensions of the goat glenoid most closely paralleled dimensions of the human glenoid. A capsulolabral complex was continuous with the glenoid surface from ~ 9 to 12 o’clock in the rats, 7 to 12 o’clock in rabbits, 5 to 12 o’clock in the dogs, and 9 to 12 o’clock in goats, 6 to 12 o’clock in pigs, and 2 to 8 o’clock in humans. In contrast to humans, no other species demonstrated an organized fibrocartilaginous labrum either macroscopically or histologically. Conclusion The animals in the present study did not possess a discrete fibrocartilaginous labrum by gross or histological evaluation, as directly compared to humans. While models using these animals may be acceptable for examining other shoulder pathologies, they are not adequate to evaluate labral pathology. Level of evidence Basic Science Study; Anatomy and Histology; Cadaveric Animal Model. Supplementary Information The online version contains supplementary material available at 10.1186/s40634-021-00383-6.
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Affiliation(s)
- Christopher J Como
- Department of Orthopaedic Surgery, University of Pittsburgh, 3350 Terrace Street, Pittsburgh, PA, 15213, USA.
| | - Benjamin B Rothrauff
- Department of Orthopaedic Surgery, University of Pittsburgh, 3350 Terrace Street, Pittsburgh, PA, 15213, USA
| | - Peter G Alexander
- Department of Orthopaedic Surgery, University of Pittsburgh, 3350 Terrace Street, Pittsburgh, PA, 15213, USA
| | - Albert Lin
- Department of Orthopaedic Surgery, University of Pittsburgh, 3350 Terrace Street, Pittsburgh, PA, 15213, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh, 3350 Terrace Street, Pittsburgh, PA, 15213, USA
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Ferrer GA, Miller RM, Yoshida M, Wang JHC, Musahl V, Debski RE. Localized Rotator Cuff Tendon Degeneration for Cadaveric Shoulders with and Without Tears Isolated to the Supraspinatus Tendon. Clin Anat 2019; 33:1007-1013. [PMID: 31750575 DOI: 10.1002/ca.23526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/12/2019] [Accepted: 11/15/2019] [Indexed: 01/13/2023]
Abstract
Localized differences in tissue degeneration throughout intact and torn rotator cuff tendons have not been well quantified. The objective of this study was to investigate histological differences in localized degeneration in tendons with and without rotator cuff tears isolated to the supraspinatus tendon. Four intact shoulders and four shoulders with rotator cuff tears isolated to the supraspinatus tendon were dissected down to the infraspinatus and supraspinatus tendons. Biopsies were taken throughout the tendon insertion, mid-substance, myotendinous junction, and around the tear if present. Samples were stained with hematoxylin and eosin and tendon degeneration was graded based on collagen fiber organization, nuclei shape, cellularity, and lipoid degeneration. Comparisons in degeneration parameters were made based on the tendon type (supraspinatus vs. infraspinatus), location within the tendon, and presence of a tear. Supraspinatus tendons exhibited more degeneration than the infraspinatus tendon (P < 0.05). Significant increases in lipoid degeneration were found near the myotendinous junction compared to the rest of the tendon (P < 0.001). Tendons with rotator cuff tears showed greater amounts of lipoid degeneration compared to intact tendons (P = 0.03). A strong negative correlation was found between lipoid degeneration and collagen fiber organization (r = -0.922, P = 0.001). No differences in degeneration were found between medial, anterior, and posterior edges of the tear. The study highlights specific factors of tendon degeneration contributing to the local differences in tendon degeneration. By understanding local differences in tendon degeneration, surgical protocols for repair can be improved. Clin. Anat., 33:1007-1013, 2020. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Gerald A Ferrer
- Orthopaedic Robotics Laboratory, Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - R Matthew Miller
- Orthopaedic Robotics Laboratory, Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Masahito Yoshida
- Orthopaedic Robotics Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - James H-C Wang
- Orthopaedic Robotics Laboratory, Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania.,Orthopaedic Robotics Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Volker Musahl
- Orthopaedic Robotics Laboratory, Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania.,Orthopaedic Robotics Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Richard E Debski
- Orthopaedic Robotics Laboratory, Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania.,Orthopaedic Robotics Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
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Cope P, Ourradi K, Li Y, Sharif M. Models of osteoarthritis: the good, the bad and the promising. Osteoarthritis Cartilage 2019; 27:230-239. [PMID: 30391394 PMCID: PMC6350005 DOI: 10.1016/j.joca.2018.09.016] [Citation(s) in RCA: 148] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 08/30/2018] [Accepted: 09/13/2018] [Indexed: 02/02/2023]
Abstract
Osteoarthritis (OA) is a chronic degenerative disease of diarthrodial joints most commonly affecting people over the age of forty. The causes of OA are still unknown and there is much debate in the literature as to the exact sequence of events that trigger the onset of the heterogeneous disease we recognise as OA. There is currently no consensus model for OA that naturally reflects human disease. Existing ex-vivo models do not incorporate the important inter-tissue communication between joint components required for disease progression and differences in size, anatomy, histology and biomechanics between different animal models makes translation to the human model very difficult. This narrative review highlights the advantages and disadvantages of the current models used to study OA. It discusses the challenges of producing a more reliable OA-model and proposes a direction for the development of a consensus model that reflects the natural environment of human OA. We suggest that a human osteochondral plug-based model may overcome many of the fundamental limitations associated with animal and in-vitro models based on isolated cells. Such a model will also provide a platform for the development and testing of targeted treatment and validation of novel OA markers directly on human tissues.
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Affiliation(s)
| | | | | | - M. Sharif
- Address correspondence and reprint requests to: M. Sharif, Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research Building level 2, Southmead Hospital, Bristol, BS10 5NB, UK. Tel: 44-117-414-7926.
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9
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Kälin PS, Crawford RJ, Marcon M, Manoliu A, Bouaicha S, Fischer MA, Ulbrich EJ. Shoulder muscle volume and fat content in healthy adult volunteers: quantification with DIXON MRI to determine the influence of demographics and handedness. Skeletal Radiol 2018; 47:1393-1402. [PMID: 29687149 DOI: 10.1007/s00256-018-2945-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 03/05/2018] [Accepted: 04/02/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We aimed to provide mean values for fat-fraction and volume for full-length bilateral rotator cuff and deltoid muscles in asymptomatic adults selected on the basis of their good musculoskeletal and systemic health, and to understand the influence of gender, age, and arm dominance. MATERIALS AND METHODS Seventy-six volunteers aged 20 to 60 years who were screened for normal BMI and high general health were included in the study. MRI was performed at 3 Tesla using three-point DIXON sequences. Volume and fat-signal fraction of the rotator cuff muscles and the deltoid muscle were determined with semi-automated segmentation of entire muscle lengths. Differences according to age, gender, and handedness per muscle were evaluated. RESULTS Fat-signal fractions were comparable between genders (mean ± 2 SD, 95% CI, women 7.0 ± 3.0; 6.8-7.2%, men 6.8 ± 2.7; 6.7-7.0%) but did not show convincing changes with age. Higher shoulder muscle volume and lower fat-signal fraction in the dominant arm were shown for teres minor and deltoid (p < 0.01) with similar trends shown for the other rotator cuff muscles. CONCLUSIONS Bilateral fat-signal fractions and volumes based on entire length shoulder muscles in asymptomatic 20-60 year old adults may provide reference for clinicians. Differences shown according to arm dominance should be considered and may rationalize the need for bilateral imaging in determining appropriate management.
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Affiliation(s)
- Pascal S Kälin
- Department of Radiology, University Hospital and University of Zurich, Ramistrasse 100, 8091, Zurich, Switzerland.
| | - Rebecca J Crawford
- Centre for Health Sciences, Zurich University of Applied Sciences, Winterthur, Switzerland.,Faculty of Health Professions, Curtin University, Perth, Australia
| | - Magda Marcon
- Department of Radiology, University Hospital and University of Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
| | - Andrei Manoliu
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Samy Bouaicha
- Department of Orthopedics, University Hospital Balgrist and University of Zurich, Zurich, Switzerland
| | | | - Erika J Ulbrich
- Department of Radiology, University Hospital and University of Zurich, Ramistrasse 100, 8091, Zurich, Switzerland
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Rothermel SD, Smuin D, Dhawan A. Are Outcomes After Meniscal Repair Age Dependent? A Systematic Review. Arthroscopy 2018; 34:979-987. [PMID: 29273257 DOI: 10.1016/j.arthro.2017.08.287] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 08/19/2017] [Accepted: 08/19/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine if the failure rate and functional outcome after arthroscopic meniscus suture repair are age dependent. METHODS A systematic review was conducted using a computerized search of the electronic databases MEDLINE and ScienceDirect in adherence with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Extracted data from each included study were recorded on a standardized form. Studies were included if they (1) were English-language studies in peer-reviewed journals, (2) used a distinct age cut-off to evaluate outcome of meniscal surgery for those above and below the specified cut-off, and (3) used meniscal repairs using suture based technique with inside-out, outside-in, or all-inside techniques. Review papers, case reports, technique papers, non-English language publications, abstracts, and data on meniscal repairs using meniscal screws, arrows, or darts were excluded. RESULTS 15 of 305 identified articles met the inclusion/exclusion criteria. There were 1,141 menisci treated in 1,063 patients. Seven and 8 studies met the inclusion/exclusion criteria for analysis for the age thresholds of 25 years and 30 years, respectively, demonstrating no difference in failure rates relative to age threshold. Four of 6 studies that met analysis criteria found no difference in failure rates above or below an age threshold of 35 years. No significant difference in failure in patients younger than 40 than patients older than 40 was found for 4 of the 5 studies in that arm of the review. CONCLUSIONS Analysis of the composite data in this systematic review reveals that no significant difference exists when evaluating meniscal repair failure rate as a function of age above or below the given age thresholds. LEVEL OF EVIDENCE Level IV, systematic review of level III and IV studies.
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Affiliation(s)
- Shane D Rothermel
- Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, U.S.A..
| | - Dallas Smuin
- Penn State University College of Medicine, Hershey, Pennsylvania, U.S.A
| | - Aman Dhawan
- Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, U.S.A
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Patel BA, Romanu JT, Carlson KJ. Subchondral Bone Radiodensity Patterns in the Glenoid Fossa of Ape and Human Scapulae. Anat Rec (Hoboken) 2017; 301:776-785. [PMID: 29281860 DOI: 10.1002/ar.23767] [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: 06/16/2017] [Revised: 09/06/2017] [Accepted: 10/04/2017] [Indexed: 11/07/2022]
Abstract
Regions of denser subchondral bone deep to a joint's articular surface indicate locations where the joint experiences relatively higher or more frequent compressive trans-articular forces than less dense regions. Human clinically focused studies have hypothesized that regional variation of acquired with computed tomography osteoabsorptiomety (CT-OAM), in the scapular glenoid fossa (GF) is specifically related to forces arising from everyday rotator cuff muscle function. We test this hypothesis by investigating the relationship between rotator cuff function and GF HiRD subchondral bone patterns in a broader comparative context. CT-OAM was used on scapulae of chimpanzees, gibbons and humans to visualize HiRD subchondral bone patterns and assess regional (anterior-posterior; superior-inferior) differences in HiRD concentrations within each group. Like patterns observed in humans, ape GFs show HiRD concentrations in anterior, posterior and superior regions. Gibbons exhibit significantly larger concentrations anteriorly, probably serving as a skeletal correlate of increased subscapularis activity during humeral internal rotation during arm-swinging locomotion. Chimpanzees exhibit relatively larger areas posteriorly (though not statistically significant), conceivably serving as a correlate of increased infraspinatus activity during humeral external rotation and retraction during knuckle-walking. All groups show relatively larger HiRD areas superiorly, likely correlating with forceful humeral abduction (rather than adduction) during routine upper limb use across behaviors. Subchondral bone HiRD patterns in the GF appear to correspond with normal and unbalanced rotator cuff activity and force production not only in humans, but also in other primates, thereby corroborating their value in human clinical studies and functional morphology research. Anat Rec, 301:776-785, 2018. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Biren A Patel
- Department of Integrative Anatomical Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California 90033
- Human and Evolutionary Biology Section, Department of Biological Sciences, University of Southern California, Los Angeles, California 90089
| | - Joshua T Romanu
- Department of Integrative Anatomical Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California 90033
| | - Kristian J Carlson
- Department of Integrative Anatomical Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California 90033
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12
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Bateman DK, Black EM, Lazarus MD, Abboud JA. Outcomes Following Arthroscopic Repair of Posterior Labral Tears in Patients Older Than 35 Years. Orthopedics 2017; 40:e305-e311. [PMID: 27925639 DOI: 10.3928/01477447-20161128-06] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 10/12/2016] [Indexed: 02/03/2023]
Abstract
Although the results of arthroscopic management of posterior labral pathology in young athletes have been reported extensively in the literature, the clinical outcomes in older patients are unknown. This retrospective review included patients older than 35 years who underwent arthroscopic posterior labral repair. Functional outcome scores were collected, and subgroup analyses were performed to evaluate the impact of patient-specific factors. Forty-three patients met the inclusion criteria; average follow-up was 36.9 months (range, 24-54 months). Mean patient age at the time of surgery was 40.9 years (range, 35-57 years). Average outcome scores at final follow-up were Quick Disabilities of the Arm, Shoulder and Hand Scale (QuickDASH), 19±22; Simple Shoulder Test (SST), 9.9±3; Western Ontario Shoulder Instability Index (WOSI), 601±546; and Single Assessment Numeric Evaluation (SANE), 79.6%±23.4%. No significant differences in outcomes were observed in patients with preoperative symptomatic instability, active workers' compensation claims, or traumatic injury (P>.05). The presence of intraoperatively definable chondral damage (Outerbridge grade III or higher) was associated with significantly worse final functional outcomes (QuickDASH: 29 vs 11.9, P=.03; SST: 8.5 vs 10.9, P=.02; WOSI: 875 vs 407, P=.01; and SANE: 70.6% vs 86%, P=.05). One patient (2%) experienced a minor postoperative complication, and 3 patients (7%) required subsequent procedures: 2 total shoulder arthroplasties and 1 revision labral repair. The results of arthroscopic posterior labral repair in patients older than 35 years were variable and worse than those previously reported in younger patients. The presence of chondral damage at the time of the index procedure was a negative predictive factor. [Orthopedics. 2017; 40(2):e305-e311.].
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An age- and gender-related three-dimensional analysis of rotator cuff transverse force couple volume ratio in 304 shoulders. Surg Radiol Anat 2016; 39:127-134. [PMID: 27312431 DOI: 10.1007/s00276-016-1714-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 06/10/2016] [Indexed: 12/11/2022]
Abstract
PURPOSE The rotator cuff transverse force couple (RCTFC) is fundamental in the shoulder biomechanics, as the balance of its muscle components (the subscapularis relative to the infraspinatus and teres minor) provides stability to the joint. The chronic progression of rotator cuff tears usually present alterations in muscle volume, along with atrophy and compensatory hypertrophy, which can be determined using imaging techniques. The aim of this study was to quantify RCTFC muscle volume in a large sample taking into account the age and gender of the participants involved. METHODS An observational, retrospective, cross-sectional, descriptive and comparative study was conducted, evaluating thoracic computed tomography scans from 152 patients (304 shoulders) of indistinct gender, with ages ranging between 18 and 85 years. The RCTFC muscle volume was quantified with an oblique/multiplanar segmentation technique. Measuring time was also documented. RESULTS We observed that muscle volume decreases among the different age (p < 0.04) and gender (p < 0.001) groups. However, the RCTFC volume ratio remained constant at 1.02 ± 0.18 without significant differences throughout all age and gender groups evaluated (p > 0.298). CONCLUSION The decrease in the RCTFC muscle volume is proportional during the different stages of life, maintaining a constant ratio between its components (physiological RCTFC muscle atrophy). The time-saving segmentation method and volume ratio formula proposed in this study contribute to the management and understanding of rotator cuff tear/pathology.
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14
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Osteoarthritic changes in vervet monkey knees correlate with meniscus degradation and increased matrix metalloproteinase and cytokine secretion. Osteoarthritis Cartilage 2015; 23:1780-9. [PMID: 26033163 PMCID: PMC4642681 DOI: 10.1016/j.joca.2015.05.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 05/19/2015] [Accepted: 05/21/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Meniscus injury increases osteoarthritis risk but its pathobiology in osteoarthritis is unclear. We hypothesized that older adult vervet monkeys would exhibit knee osteoarthritic changes and the degenerative menisci from these animals would secrete matrix metalloproteinases (MMPs) and pro-inflammatory cytokines that contribute to the development of osteoarthritis. DESIGN In a cross sectional analysis of healthy young adult (9-12 years) and old (19-26 years) adult female vervet monkeys, knees were evaluated in vivo with computed tomography (CT) imaging, and joint tissues were morphologically graded at necropsy. Meniscus explants were subsequently cultured to evaluate meniscal MMP and cytokine secretion. RESULTS CT images revealed significant bony osteoarthritic changes in 80% of older monkeys which included increases in osteophyte number and meniscal calcification. Meniscus and cartilage degradation scores were greater in the older monkeys and were positively correlated (r > 0.7). Menisci from older animals exhibiting osteoarthritic changes secreted significantly more MMP-1, MMP-3, and MMP-8 than healthy menisci from younger monkeys. Older menisci without significant osteoarthritic changes secreted more IL-7 than healthy young menisci while older osteoarthritic menisci secreted more IL-7 and granulocyte-macrophage colony-stimulating factor than healthy older menisci. CONCLUSIONS Aged vervets develop naturally occurring knee osteoarthritis that includes involvement of the meniscus. Degenerative menisci secreted markedly increased amounts of matrix-degrading enzymes and inflammatory cytokines. These factors would be expected to act on the meniscus tissue and local joint tissues and may ultimately promote osteoarthritis development. These finding also suggest vervet monkeys are a useful animal model for studying the progression of osteoarthritis.
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15
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Santago AC, Plate JF, Shively CA, Register TC, Smith TL, Saul KR. Age-related structural changes in upper extremity muscle tissue in a nonhuman primate model. J Shoulder Elbow Surg 2015; 24:1660-8. [PMID: 25963066 PMCID: PMC4575823 DOI: 10.1016/j.jse.2015.03.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 03/09/2015] [Accepted: 03/18/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Longitudinal studies of upper extremity aging in humans include logistical concerns that animal models can overcome. The vervet is a promising species with which to study aging-related processes. However, age-related changes in upper extremity muscle structure have not been quantified in this species. This study measured age-related changes to muscle structure, examined relationships between muscle structure and measures of physical performance, and evaluated the presence of rotator cuff tears. METHODS Muscle structure (volume, optimal fiber length, and physiologic cross-sectional area (PCSA)) of 10 upper extremity muscles was quantified from the right upper limb of 5 middle-aged and 6 older adult female vervets. RESULTS Total measured PCSA was smaller (P = .001) in the older adult vervets than in the middle-aged vervets. Muscle volume reduction predominate the age-related reductions in PCSA. Total measured PCSA was not correlated to any measures of physical performance. No rotator cuff tears were observed. Supraspinatus volume was relatively larger and deltoid volume relatively smaller in the vervet compared with a human. CONCLUSIONS The vervet is an appropriate translational model for age-related upper extremity muscle volume loss. Functional measures were not correlated to PCSA, suggesting the vervets may have enough strength for normal function despite loss of muscle tissue. Reduced relative demand on the supraspinatus may be responsible for the lack of naturally occurring rotator cuff tears.
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Affiliation(s)
- Anthony C Santago
- Virginia Tech-Wake Forest School of Biomedical Engineering and Sciences, Winston-Salem, NC, USA; Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC, USA
| | - Johannes F Plate
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Carol A Shively
- Department of Pathology (Comparative Medicine) and the Wake Forest Primate Center, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Thomas C Register
- Department of Pathology (Comparative Medicine) and the Wake Forest Primate Center, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Thomas L Smith
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Katherine R Saul
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC, USA.
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16
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Yoshida M, Goto H, Nozaki M, Nishimori Y, Takenaga T, Murase A, Nagaya Y, Iguchi H, Kobayashi M, Sugimoto K, Nishiyama T, Otsuka T. Quantitative analysis of attachment of the labrum to the glenoid fossa: a cadaveric study. J Orthop Sci 2015; 20:823-9. [PMID: 26169109 DOI: 10.1007/s00776-015-0742-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 06/04/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE This study investigated the direct and continuous attachment of the labrum to the glenoid fossa, including the fibrocartilaginous tissue, using image-analysis software and histology. METHODS Twenty-six cadaveric shoulders (11 male, 15 female; mean age 80.1 years; age range 36-103 years) were used. The glenoid of each specimen was divided into six pie-slice-shaped pieces from the center perpendicular to the articular surface by radial incisions at the 2, 4, 6, 8, 10, and 12 o'clock positions. The general distribution of the labrum, including the fibrocartilage, was assessed in hematoxylin and eosin-, Safranin O- and Azan-Mallory-stained sections. The continuous length of attachment of the labrum to the glenoid was measured using image-analysis software. The width of attachment to the articular surface of the glenoid was assessed in each position. RESULTS The labrum attached to both the articular surface and the neck of the glenoid in all shoulders (100 %) in the 4 and 6 o'clock positions. The mean length of the entire attachment to the glenoid was 4.6 mm (range 3.2-6.1 mm). The width of attachment from the bony edge of the glenoid to the edge of the labrum on the articular surface ranged from 0 to 4.3 mm. The length of the entire attachment of the labrum was shortest in the 2 o'clock position (p = 0.229). Additionally, the length of the entire attachment of the labrum was longest in the 4 o'clock position. The width of attachment to the articular surface of the glenoid was greatest in the 4 o'clock position (p < 0.01). CONCLUSION In the 4 and 6 o'clock positions, the labrum attached to both the articular surface and neck of the glenoid in all of the shoulders (100 %). The length of the entire attachment to the labrum, including the fibrocartilage, was shortest in the 2 o'clock position. The width of attachment to the articular surface of the glenoid was greatest in the 4 o'clock position (p < 0.01).
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Affiliation(s)
- Masahito Yoshida
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Hideyuki Goto
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan.
| | - Masahiro Nozaki
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Yasuhiro Nishimori
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Tetsuya Takenaga
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Atsunori Murase
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Yuko Nagaya
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Hirotaka Iguchi
- Department of Arthroplastic Medicine, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Masaaki Kobayashi
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | | | - Takeshi Nishiyama
- Department of Public Health, Aichi Medical University, Nagakute, Japan
| | - Takanobu Otsuka
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
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Abstract
Osteoarthritis (OA) is unquestionably one of the most important chronic health issues in humans, affecting millions of individuals and costing billions of dollars annually. Despite widespread awareness of this disease and its devastating impact, the pathogenesis of early OA is not completely understood, hampering the development of effective tools for early diagnosis and disease-modifying therapeutics. Most human tissue available for study is obtained at the time of joint replacement, when OA lesions are end stage and little can be concluded about the factors that played a role in disease development. To overcome this limitation, over the past 50 years, numerous induced and spontaneous animal models have been utilized to study disease onset and progression, as well as to test novel therapeutic interventions. Reflecting the heterogeneity of OA itself, no single "gold standard" animal model for OA exists; thus, a challenge for researchers lies in selecting the most appropriate model to answer a particular scientific question of interest. This review provides general considerations for model selection, as well as important features of species such as mouse, rat, guinea pig, sheep, goat, and horse, which researchers should be mindful of when choosing the "best" animal model for their intended purpose. Special consideration is given to key variations in pathology among species as well as recommended guidelines for reporting the histologic features of each model.
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Affiliation(s)
- A M McCoy
- Department of Veterinary Clinical Medicine, University of Illinois, Urbana, IL, USA
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18
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Erickson J, Lavery K, Monica J, Gatt C, Dhawan A. Surgical treatment of symptomatic superior labrum anterior-posterior tears in patients older than 40 years: a systematic review. Am J Sports Med 2015; 43:1274-82. [PMID: 24961444 DOI: 10.1177/0363546514536874] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Successful arthroscopic repair of symptomatic superior labral tears in young athletes has been well documented. Superior labral repair in patients older than 40 years is controversial, with concerns for residual postoperative pain, stiffness, and higher rates of revision surgery. PURPOSE To analyze the published data on the surgical treatment of superior labral injuries in patients aged ≥40 years, including those with concomitant injuries to the rotator cuff. STUDY DESIGN Systematic review. METHODS A systematic review of the literature was performed using the Preferred Reporting Items of Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The MEDLINE database via PubMed and the Cochrane Database of Systematic Reviews were searched for articles related to superior labrum anterior-posterior (SLAP) tears. Studies were included if they met the following criteria: the study contained at least 1 group of patients who had undergone arthroscopic repair of a type II or IV SLAP lesion with a minimum 2-year follow-up, objective and/or functional scoring systems were used to evaluate postoperative outcomes, and the mean patient age was ≥40 years for at least 1 treatment arm or subgroup analysis. Studies were excluded if the article was a review or if the article included data for SLAP type I, III, or V to X tears or Bankart lesions. RESULTS While several authors reported equivalent outcomes of SLAP repair in patients both older than 40 years and younger than 40 years, others demonstrated significantly higher failure rates in the older cohort. Decreased patient satisfaction and increasing complications, including postoperative stiffness and reoperations, occur at higher rates as the patient age increases. The literature demonstrates that biceps tenotomy and tenodesis are reliable alternatives to SLAP repair and that biceps tenotomy is a viable revision procedure for failed SLAP repair. With concomitant rotator cuff tears, the evidence favors debridement or biceps tenotomy over SLAP repair. CONCLUSION While studies show that good outcomes can be obtained with SLAP repair in an older cohort of patients, age older than 40 years and workers' compensation status are independent risk factors for increased surgical complications. The cumulative evidence supports labral debridement or biceps tenotomy over labral repair when an associated rotator cuff injury is present.
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Affiliation(s)
- John Erickson
- Department of Orthopaedic Surgery, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, USA
| | - Kyle Lavery
- Department of Orthopaedic Surgery, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, USA
| | - James Monica
- Department of Orthopaedic Surgery, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, USA
| | - Charles Gatt
- Department of Orthopaedic Surgery, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, USA
| | - Aman Dhawan
- Department of Orthopaedic Surgery, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, USA
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Justice JN, Cesari M, Seals DR, Shively CA, Carter CS. Comparative Approaches to Understanding the Relation Between Aging and Physical Function. J Gerontol A Biol Sci Med Sci 2015; 71:1243-53. [PMID: 25910845 DOI: 10.1093/gerona/glv035] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 03/07/2015] [Indexed: 01/09/2023] Open
Abstract
Despite dedicated efforts to identify interventions to delay aging, most promising interventions yielding dramatic life-span extension in animal models of aging are often ineffective when translated to clinical trials. This may be due to differences in primary outcomes between species and difficulties in determining the optimal clinical trial paradigms for translation. Measures of physical function, including brief standardized testing batteries, are currently being proposed as biomarkers of aging in humans, are predictive of adverse health events, disability, and mortality, and are commonly used as functional outcomes for clinical trials. Motor outcomes are now being incorporated into preclinical testing, a positive step toward enhancing our ability to translate aging interventions to clinical trials. To further these efforts, we begin a discussion of physical function and disability assessment across species, with special emphasis on mice, rats, monkeys, and man. By understanding how physical function is assessed in humans, we can tailor measurements in animals to better model those outcomes to establish effective, standardized translational functional assessments with aging.
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Affiliation(s)
- Jamie N Justice
- Department of Integrative Physiology, University of Colorado Boulder.
| | - Matteo Cesari
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France. INSERM UMR1207, Université de Toulouse III Paul Sabatier, Toulouse, France
| | - Douglas R Seals
- Department of Integrative Physiology, University of Colorado Boulder
| | - Carol A Shively
- Departments of Pathology Section on Comparative Medicine, Public Health Sciences and Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Christy S Carter
- Department of Aging and Geriatric Research, Institute on Aging, College of Medicine, University of Florida, Gainesville
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20
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High incidence of hemiarthroplasty for shoulder osteoarthritis among recently graduated orthopaedic surgeons. Clin Orthop Relat Res 2014; 472:3510-6. [PMID: 25146057 PMCID: PMC4182373 DOI: 10.1007/s11999-014-3823-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 07/14/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Primary glenohumeral osteoarthritis is a common indication for shoulder arthroplasty. Historically, both total shoulder arthroplasty (TSA) and hemi-shoulder arthroplasty (HSA) have been used to treat primary glenohumeral osteoarthritis. The choice between procedures is a topic of debate, with HSA proponents arguing that it is less invasive, faster, less expensive, and technically less demanding, with quality of life outcomes equivalent to those of TSA. More recent evidence suggests TSA is superior in terms of pain relief, function, ROM, strength, and patient satisfaction. We therefore investigated the practice of recently graduated orthopaedic surgeons pertaining to the surgical treatment of this disease. QUESTIONS/PURPOSES We hypothesized that (1) recently graduated, board eligible, orthopaedic surgeons with fellowship training in shoulder surgery are more likely to perform TSA than surgeons without this training; (2) younger patients are more likely to receive HSA than TSA; (3) patient sex affects the choice of surgery; (4) US geographic region affects practice patterns; and (5) complication rates for HSA and TSA are not different. METHODS We queried the American Board of Orthopaedic Surgery's database to identify practice patterns of orthopaedic surgeons taking their board examination. We identified 771 patients with primary glenohumeral osteoarthritis treated with TSA or HSA from 2006 to 2011. The rates of TSA and HSA were compared based on the treating surgeon's fellowship training, patient age and sex, US geographic region, and reported surgical complications. RESULTS Surgeons with fellowship training in shoulder surgery were more likely (86% versus 72%; OR 2.32; 95% CI, 1.56-3.45, p<0.001) than surgeons without this training to perform TSA rather than HSA. The mean age for patients receiving HSA was not different from that for patients receiving TSA (66 versus 68, years, p=0.057). Men were more likely to receive HSA than TSA when compared to women (RR 1.54; 95% CI, 1.19-2.00, p=0.0012). The proportions of TSA and HSA were similar regardless of US geographic region (Midwest HSA 21%, TSA 79%; Northeast HSA 25%, TSA 75%; Northwest HSA 16%, TSA 84%; South HSA 27%, TSA 73%; Southeast HSA 24%, TSA 76%; Southwest HSA 23%, TSA 77%; overall p=0.708). The overall complication rates were not different with the numbers available: 8.4% (15/179) for HSA and 8.1% (48/592) for TSA (p=0.7555). CONCLUSIONS The findings of this study are at odds with the recommendations in the current clinical practice guidelines for the treatment of glenohumeral osteoarthritis published by the American Academy of Orthopaedic Surgeons. These guidelines favor using TSA over HSA in the treatment of shoulder arthritis. Further investigation is needed to clarify if these practice patterns are isolated to recently graduated board eligible orthopaedic surgeons or if the use of HSA continues with orthopaedic surgeons applying for recertification. LEVEL OF EVIDENCE Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
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21
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High KP. Infrastructure and resources for an aging population: embracing complexity in translational research. Transl Res 2014; 163:446-55. [PMID: 24095640 PMCID: PMC3975733 DOI: 10.1016/j.trsl.2013.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 09/01/2013] [Accepted: 09/05/2013] [Indexed: 10/26/2022]
Abstract
The population of the United States and most industrialized nations is undergoing rapid expansion of persons aged 65 years and older. This group experiences more illness, disability, and dependency than young adults and consumes the majority of heath care resources. This demographic change presents a number of challenges to current research infrastructure aimed at translating discoveries to improved human health. Key issues include the need to expand the workforce trained in aging research, development of specific resources and harmonization of measures and outcomes, and a culture change within the scientific community. In particular, complexity must be represented within research design and embraced as an important aspect of review panel critiques.
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Affiliation(s)
- Kevin P High
- Wake Forest School of Medicine, Winston-Salem, NC.
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Plate JF, Brown PJ, Walters J, Clark JA, Smith TL, Freehill MT, Tuohy CJ, Stitzel JD, Mannava S. Advanced age diminishes tendon-to-bone healing in a rat model of rotator cuff repair. Am J Sports Med 2014; 42:859-68. [PMID: 24500915 DOI: 10.1177/0363546513518418] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Advanced patient age is associated with recurrent tearing and failure of rotator cuff repairs clinically; however, basic science studies have not evaluated the influence of aging on tendon-to-bone healing after rotator cuff repair in an animal model. Hypothesis/ PURPOSE This study examined the effect of aging on tendon-to-bone healing in an established rat model of rotator cuff repair using the aged animal colony from the National Institute on Aging of the National Institutes of Health. The authors hypothesized that normal aging decreases biomechanical strength and histologic organization at the tendon-to-bone junction after acute repair. STUDY DESIGN Controlled laboratory study. METHODS In 56 F344xBN rats, 28 old and 28 young (24 and 8 months of age, respectively), the supraspinatus tendon was transected and repaired. At 2 or 8 weeks after surgery, shoulder specimens underwent biomechanical testing to compare load-to-failure and load-relaxation response between age groups. Histologic sections of the tendon-to-bone interface were assessed with hematoxylin and eosin staining, and collagen fiber organization was assessed by semiquantitative analysis of picrosirius red birefringence under polarized light. RESULTS Peak failure load was similar between young and old animals at 2 weeks after repair (31% vs 26% of age-matched uninjured controls, respectively; P > .05) but significantly higher in young animals compared with old animals 8 weeks after repair (86% vs 65% of age-matched uninjured controls, respectively; P < .01). Eight weeks after repair, fibroblasts appeared more organized and uniformly aligned in young animals on hematoxylin and eosin slides compared with old animals. Collagen birefringence analysis of the tendon-to-bone junction demonstrated that young animals had increased collagen fiber organization and similar histologic structure compared with age-matched controls (53.7 ± 2.4 gray scales; P > .05). In contrast, old animals had decreased collagen fiber organization and altered structure compared with age-matched controls (49.8 ± 3.1 gray scales; P < .01). DISCUSSION In a rat model of aging, old animals demonstrated diminished tendon-to-bone healing after rotator cuff injury and repair. Old animals had significantly decreased failure strength and collagen fiber organization at the tendon-to-bone junction compared with young animals. This study implies that animal age may need to be considered in future studies of rotator cuff repair in animal models. CLINICAL RELEVANCE With increasing age and activity level of the population, the incidence of rotator cuff tears is predicted to rise. Despite advances in rotator cuff repair technique, the retear rate remains specifically high in elderly patients. The findings of this research suggest that aging negatively influences tendon-to-bone healing after rotator cuff repair in a validated animal model.
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Affiliation(s)
- Johannes F Plate
- Johannes F. Plate, Department of Orthopaedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA. )
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