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Kanne TR, Lusk J, Clark C, Jones C, Kanne L, Cawley D. A Cadaveric Study of the Rotator Cable: Interrogating the Suspension Bridge Model. Cureus 2024; 16:e70795. [PMID: 39372380 PMCID: PMC11449884 DOI: 10.7759/cureus.70795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Accepted: 10/03/2024] [Indexed: 10/08/2024] Open
Abstract
Purpose The objective of this cadaveric study was to describe the anatomical relationships between the rotator cuff muscles and the rotator cable. Methods In 30 formaldehyde-fixed shoulders from 20 cadavers, the rotator cuff and rotator cable were dissected and the glenohumeral joint opened. The orientation and attachments of the rotator cable to the rotator cuff muscles were described, and the severity of any osteoarthritis, labral pathology, and rotator cuff pathology present was documented. The width and thickness of the infraspinatus attachments to the rotator cable were measured. Results The infraspinatus muscle was noted to be more loosely adherent to the rotator cable, while the supraspinatus and teres minor were tightly adherent to the cable. Specifically, the superior-most portion of the infraspinatus was found to be less tightly adherent than the inferior-most portion in 26 of the 30 shoulders studied. The thickness/width ratio of the inferior-most portion of infraspinatus was significantly different in shoulders with more-than-minimal osteoarthritis and labral pathology (p=0.048 and p=0.041, respectively). Conclusion While the supraspinatus and teres minor muscles were tightly adherent to the cable in all shoulders, the degree of attachment of the superior-most portion of the infraspinatus muscle was notably less in 26 of the 30 shoulders studied. This could mean that only the inferior portion of the infraspinatus participates in stress shielding through the cable or be a compensatory response to increased load on the tendon. This work is expected to provide insight into the function of the rotator cable and the different functions of the infraspinatus.
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Affiliation(s)
- Timothy R Kanne
- Medicine, Edward Via College of Osteopathic Medicine-Auburn, Auburn, USA
| | - John Lusk
- Medicine, Edward Via College of Osteopathic Medicine-Auburn, Auburn, USA
| | - Cassidy Clark
- Medicine, Edward Via College of Osteopathic Medicine-Auburn, Auburn, USA
| | - Cody Jones
- Medicine, Edward Via College of Osteopathic Medicine-Auburn, Auburn, USA
| | - Leanna Kanne
- Education, Truett McConnell University, Cleveland, USA
| | - Daniel Cawley
- Anatomy, Edward Via College of Osteopathic Medicine-Auburn, Auburn, USA
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2
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Hasan SS. MRI Reveals Rotator Cuff Tear Size, Retraction, Length, and Geometry; Muscle Volume and Degeneration, and Tendon Quality. Arthroscopy 2024:S0749-8063(24)00758-8. [PMID: 39341260 DOI: 10.1016/j.arthro.2024.09.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2024] [Accepted: 09/20/2024] [Indexed: 09/30/2024]
Abstract
Magnetic resonance imaging (MRI) of the shoulder is commonly used for evaluating muscle bulk and fatty degeneration as well as tendon tear size, geometry, retraction, and length. However, MRI can also be used to evaluate tendon quality. Increased rotator cuff tendon signal on T2-weighted fat-suppressed MRI appears to be a marker of tendon degeneration, and potentially of impaired healing potential. Tendon signal intensity merits closer attention and may be especially relevant when selecting chronic degenerative tears for repair in patients with other risk factors for nonhealing.
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Affiliation(s)
- Samer S Hasan
- Mercy Health-Cincinnati SportsMedicine and Orthopaedic Center, 4700 E. Galbraith Road, 3(rd) Floor, Cincinnati, Ohio 45236.
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Tashjian RZ, Zitnay J, Kazmers NH, Veerabhadraiah SR, Zelada AC, Honeggar M, Smith MC, Chalmers PN, Henninger HB, Jurynec MJ. Tenascin C Deletion Impairs Tendon Healing and Functional Recovery After Rotator Cuff Repair. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.09.11.612543. [PMID: 39314362 PMCID: PMC11419033 DOI: 10.1101/2024.09.11.612543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 09/25/2024]
Abstract
The biological factors that affect healing after rotator cuff repair (RCR) are not well understood. Genetic variants in the extracellular matrix protein Tenascin C (TNC) are associated with impaired tendon healing and it is expressed in rotator cuff tendon tissue after injury, suggesting it may have a role in the repair process. The purpose of the current study was to determine the role of TNC on tendon healing after RCR in a murine model. The supraspinatus tendon was transected and repaired on the left shoulder of Wild-Type (WT-RCR), Tenascin C null (Tnc --RCR) and Tnc heterozygous (Tnc +/--RCR) mice. Controls included the unoperated, contralateral shoulder of WT-RCR, Tnc - RCR, Tnc +/--RCR mice and unoperated shoulders from age and genotype matched controls. We performed histologic, activity testing, RNA-seq, and biomechanical analyses. At 8-weeks post-RCR, Tnc - and Tnc +/- mice had severe bone and tendon defects following rotator cuff repair. Tnc --RCR mice had reduced activity after rotator cuff repair including reduced wheel rotations, wheel duration, and wheel episode average velocity compared with WT-RCR. Loss of Tnc following RCR altered gene expression in the shoulder, including upregulation of sex hormone and WNT pathways and a downregulation of inflammation and cell cycle pathways. Tnc - mice had similar biomechanical properties after repair as WT. Further research is required to evaluate tissue specific alterations of Tnc, the interactions of Tnc and sex hormone and inflammation pathways as well as possible adjuvants to improve enthesis healing in the setting of reduced TNC function.
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Affiliation(s)
- Robert Z. Tashjian
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, Utah 84108 USA
| | - Jared Zitnay
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, Utah 84108 USA
| | - Nikolas H. Kazmers
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, Utah 84108 USA
| | | | - Antonio C. Zelada
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, Utah 84108 USA
| | - Matthew Honeggar
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, Utah 84108 USA
| | - Matthew C. Smith
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, Utah 84108 USA
| | - Peter N. Chalmers
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, Utah 84108 USA
| | - Heath B. Henninger
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, Utah 84108 USA
| | - Michael J. Jurynec
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, Utah 84108 USA
- Department of Human Genetics, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Department of Biomedical Engineering, University of Utah School of Medicine, Salt Lake City, Utah, USA
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4
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Savoie Iii FH, Delvadia BP, Tate JP, Winter JE, Williams GH, Sherman WF, O'Brien MJ. Biologics in rotator cuff repair. Bone Joint J 2024; 106-B:978-985. [PMID: 39216849 DOI: 10.1302/0301-620x.106b9.bjj-2024-0513.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Rotator cuff tears are common in middle-aged and elderly patients. Despite advances in the surgical repair of rotator cuff tears, the rates of recurrent tear remain high. This may be due to the complexity of the tendons of the rotator cuff, which contributes to an inherently hostile healing environment. During the past 20 years, there has been an increased interest in the use of biologics to complement the healing environment in the shoulder, in order to improve rotator cuff healing and reduce the rate of recurrent tears. The aim of this review is to provide a summary of the current evidence for the use of forms of biological augmentation when repairing rotator cuff tears.
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Affiliation(s)
- Felix H Savoie Iii
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Tulane Doctors-Sports Medicine Plus, University Medical Center New Orleans, Lakeside Hospital, Omega Hospital Surgery Center, East Jefferson Hospital, and Slidell Memorial Hospital, Slidell, Louisiana, USA
| | - Bela P Delvadia
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Tulane Doctors-Sports Medicine Plus, University Medical Center New Orleans, Lakeside Hospital, Omega Hospital Surgery Center, East Jefferson Hospital, and Slidell Memorial Hospital, Slidell, Louisiana, USA
| | - Jackson P Tate
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Tulane Doctors-Sports Medicine Plus, University Medical Center New Orleans, Lakeside Hospital, Omega Hospital Surgery Center, East Jefferson Hospital, and Slidell Memorial Hospital, Slidell, Louisiana, USA
| | - Julianna E Winter
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Tulane Doctors-Sports Medicine Plus, University Medical Center New Orleans, Lakeside Hospital, Omega Hospital Surgery Center, East Jefferson Hospital, and Slidell Memorial Hospital, Slidell, Louisiana, USA
| | - Garrett H Williams
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Tulane Doctors-Sports Medicine Plus, University Medical Center New Orleans, Lakeside Hospital, Omega Hospital Surgery Center, East Jefferson Hospital, and Slidell Memorial Hospital, Slidell, Louisiana, USA
| | - William F Sherman
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Tulane Doctors-Sports Medicine Plus, University Medical Center New Orleans, Lakeside Hospital, Omega Hospital Surgery Center, East Jefferson Hospital, and Slidell Memorial Hospital, Slidell, Louisiana, USA
| | - Michael J O'Brien
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Tulane Doctors-Sports Medicine Plus, University Medical Center New Orleans, Lakeside Hospital, Omega Hospital Surgery Center, East Jefferson Hospital, and Slidell Memorial Hospital, Slidell, Louisiana, USA
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Kusunose M, Mifune Y, Inui A, Yamaura K, Furukawa T, Kato T, Kuroda R. Preoperative Increases in T2-Weighted Fat-Suppressed Magnetic Resonance Imaging Signal Intensities Associated With Advanced Tissue Degeneration and Mitochondrial Dysfunction in Rotator Cuff Tears. Arthroscopy 2024:S0749-8063(24)00615-7. [PMID: 39214430 DOI: 10.1016/j.arthro.2024.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 08/08/2024] [Accepted: 08/08/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE To investigate the relationship between magnetic resonance imaging (MRI) signal intensities and mitochondrial function in patients undergoing arthroscopic rotator cuff repair, assessed through histological and genetic profiling of tendon tissue. METHODS This study, conducted between April 2022 and January 2023, included 20 patients undergoing rotator cuff repair for atraumatic/degenerative tears. Rotator cuff tendon edge samples were obtained during arthroscopic rotator cuff repair. Patients were classified based on signal intensity from preoperative T2-weighted fat suppressed MRI. Specifically, they were categorized as having either high or low signal intensity at the rotator cuff tendon edge, with the deltoid muscle serving as a reference. Comparative analyses specifically compared the histological features and genetic profiles of the tendon tissue at the rotator cuff tendon edge. Histological evaluation of harvested tendon specimens during arthroscopic rotator cuff repair employed the modified Bonar score. Real-time polymerase chain reaction was used to assess expression of various mitochondrial and apoptosis-related genes. The mitochondrial morphology of the rotator cuff torn site was examined using electron microscopy. RESULTS The higher signal intensity group showed significantly higher modified Bonar scores (P = .0068), decreased mitochondrial gene expression, increased TdT-mediated dUTP-biotin nick end labeling-positive cells (P = .032), lower superoxide dismutase activity (P = .011), reduced ATP5A (P = .031), and increased cleaved caspase-9 activity (P = .026) compared with the lower signal intensity group. Electron microscopy revealed fewer mitochondrial cristae in the higher signal intensity group. CONCLUSIONS Our results suggest correlations between high MRI signal intensities and the presence of degeneration, mitochondrial dysfunction, and increased apoptosis in rotator cuff tissues. This underscores the utility of MRI signal intensity as an indicator of tissue condition. CLINICAL RELEVANCE: This work builds on the premise that elevated preoperative MRI signal intensities may indicate higher rates of postoperative rotator cuff re-tears, substantiating these findings from a mitochondrial function perspective.
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Affiliation(s)
- Masaya Kusunose
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yutaka Mifune
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Atsuyuki Inui
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kohei Yamaura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takahiro Furukawa
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tatsuo Kato
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Zhang H, Wague A, Diaz A, Liu M, Sang L, Youn A, Sharma S, Milan N, Kim H, Feeley B, Liu X. Overexpression of PRDM16 improves muscle function after rotator cuff tears. J Shoulder Elbow Surg 2024:S1058-2746(24)00490-7. [PMID: 39032686 DOI: 10.1016/j.jse.2024.05.037] [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: 01/04/2024] [Revised: 05/01/2024] [Accepted: 05/19/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Muscle atrophy, fibrosis, and fatty infiltration are commonly seen in rotator cuff tears (RCTs), which are critical factors that directly determine the clinical outcomes for patients with this injury. Therefore, improving muscle quality after RCT is crucial in improving the clinical outcome of tendon repair. In recent years, it has been discovered that adults have functional beige/brown adipose tissue (BAT) that can secrete batokines to promote muscle growth. PRDM16, a PR-domain-containing protein, was discovered with the ability to determine the brown fat cell fate and stimulate its development. Thus, the goal of this study was to discover the role of PRDM16 in improving muscle function after massive tendon tears using a transgenic mouse model with an elevated level of PRDM16 expression. METHODS Transgenic aP2-driven PRDM16-overexpressing mice and C57BL/6J mice underwent unilateral supraspinatus (SS) tendon transection and suprascapular nerve transection (TTDN) as described previously (n = 8 in each group). DigiGait was performed to evaluate forelimb function at 6 weeks post the TTDN injury. Bilateral SS muscles, interscapular brown fat, epididymal white fat, and inguinal beige fat were harvested for analysis. The expression of PRDM16 in adipose tissue was detected by Western blot. Masson Trichrome staining was conducted to evaluate the muscle fibrosis, and Oil Red O staining was used to determine the fat infiltration. Muscle fiber type was determined by major histocompatibility complex (MHC) expression via immunostaining. All data were presented in the form of mean ± standard deviation. t test and 2-way analysis of variance was performed to determine a statistically significant difference between groups. Significance was considered when P < .05. RESULTS Western blot data showed an increased expression of PRDM16 protein in both white and brown fat in PRDM16-overexpressing mice compared with wild-type (WT) mice. Even though PRDM16 overexpression had no effect on increasing muscle weight, it significantly improved the forelimbs function with longer brake, stance, and stride time and larger stride length and paw area in mice after RCT. Additionally, PRDM16-overexpressing mice showed no difference in the amount of fibrosis when compared to WT mice; however, they had a significantly reduced area of fatty infiltration. These mice also exhibited abundant MHC-IIx fiber percentage in the supraspinatus muscle after TTDN. CONCLUSION Overexpression of PRDM16 significantly improved muscle function and reduced fatty infiltration after rotator cuff tears. Promoting BAT activity is beneficial in improving rotator cuff muscle quality and shoulder function after RCT.
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Affiliation(s)
- He Zhang
- Department of Physical Education, Central South University, Changsha, Hunan, China; Department of Veterans Affairs, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Aboubacar Wague
- Department of Veterans Affairs, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Agustin Diaz
- Department of Veterans Affairs, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Mengyao Liu
- Department of Veterans Affairs, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Luke Sang
- Department of Veterans Affairs, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Alex Youn
- Department of Veterans Affairs, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Sankalp Sharma
- Department of Veterans Affairs, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Nesa Milan
- Department of Veterans Affairs, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Hubert Kim
- Department of Veterans Affairs, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Brian Feeley
- Department of Veterans Affairs, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Xuhui Liu
- Department of Veterans Affairs, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA; Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, CA, USA.
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7
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Herzberg SD, Zhao Z, Freeman TH, Prakash R, Baumgarten KM, Bishop JY, Carey JL, Jones GL, McCarty EC, Spencer EE, Vidal AF, Jain NB, Giri A, Kuhn JE, Khazzam MS, Matzkin EG, Brophy RH, Dunn WR, Ma CB, Marx RG, Poddar SK, Smith MV, Wolf BR, Wright RW. Obesity is associated with muscle atrophy in rotator cuff tear. BMJ Open Sport Exerc Med 2024; 10:e001993. [PMID: 38974096 PMCID: PMC11227827 DOI: 10.1136/bmjsem-2024-001993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2024] [Indexed: 07/09/2024] Open
Abstract
Objective The primary goal of this study is to evaluate the relationship between Body Mass Index (BMI) and muscle atrophy in individuals with rotator cuff tears. Methods This study consists of patients with rotator cuff tears identified by MRI from two independent cohorts, the Rotator Cuff Outcomes Workgroup (ROW) and the Multicenter Orthopaedic Outcomes Network (MOON). Presence of atrophy (yes/no) and severity of atrophy (as an ordinal variable) were assessed on MRI by expert physicians. We used multivariable regression models to evaluate the relationship between BMI and muscle atrophy while adjusting for age and sex in each study, conducted sensitivity analyses for full-thickness tear and combined results using inverse variance-weighted meta-analysis. Results A total of 539 patients (MOON=395, ROW=144) from the combined cohorts had MRI data available on muscle atrophy. Among these patients, 246 (46%) had atrophy of at least one of the muscles of the rotator cuff and 282 (52%) had full-thickness tears. In meta-analysis across both cohorts, each 5 kg/m2 increase in BMI was associated with a 21% (aOR=1.21, 95% CI=1.02, 1.43) increased odds of having muscle atrophy among individuals with any tear size, and 36% (aOR=1.36, 95% CI=1.01-1.81) increased odds among individuals with full-thickness tear. Conclusions Higher BMI was associated with significantly higher odds of muscle atrophy in patiens with rotator cuff tears. More study is needed to unders1tand why and how this relationship exists, as well as whether interventions to reduce BMI may help improve outcomes for these patients. Level of Evidence III.
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Affiliation(s)
- Simone D Herzberg
- Epidemiology, Vanderbilt University, Nashville, Tennessee, USA
- School of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Zhiguo Zhao
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Ravi Prakash
- Departments of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Julie Y Bishop
- Departments of Orthopaedic Surgery and Sports Medicine, Ohio State University, Columbus, Ohio, USA
| | - James L Carey
- Department of Orthopaedic Surgery, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Grant L Jones
- Departments of Orthopaedic Surgery and Sports Medicine, Ohio State University, Columbus, Ohio, USA
| | - Eric C McCarty
- Department of Orthopedic Sports Medicine, University of Colorado Denver, Denver, Colorado, USA
| | - Edwin E Spencer
- Shoulder & Elbow Division, Knoxville Orthopaedic Clinic, Knoxville, Tennessee, USA
| | | | - Nitin B Jain
- PM&R and Orthopaedics, University of Michigan-Ann Arbor, Ann Arbor, Michigan, USA
| | - Ayush Giri
- Division of Epidemiology, Department of Medicine Division of Quantitative Sciences, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - John E Kuhn
- Orthopaedics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michael S Khazzam
- Department of Orthopedic Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Robert H Brophy
- Orthopaedic Surgery, Washington University in Saint Louis School of Medicine, Chesterfield, Missouri, USA
| | - Warren R Dunn
- Department of Clinical Research, Fondren Orthopedic Group LLP, Houston, Texas, USA
| | - C. Benjamin Ma
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, California, USA
| | - Robert G Marx
- Hospital for Special Surgery, New York, New York, USA
| | - Sourav K Poddar
- Department of Orthopedic Sports Medicine, University of Colorado Denver, Denver, Colorado, USA
| | - Matthew V Smith
- Orthopaedic Surgery, Washington University in Saint Louis School of Medicine, Chesterfield, Missouri, USA
| | - Brian R Wolf
- Orthopedics and Rehabilitation, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Rick W Wright
- Orthopaedics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Collin P, Martinho T, Denard PJ, Gain S, Pernoud A, Bothorel H, Lädermann A. Are Lower Passive Anterior Elevation and External Rotation at 6 Weeks Postoperatively Associated With Healing of Isolated Arthroscopic Supraspinatus Repairs? Am J Sports Med 2024; 52:1411-1418. [PMID: 38616551 DOI: 10.1177/03635465241241549] [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] [Indexed: 04/16/2024]
Abstract
BACKGROUND Despite advancements in surgical technique, failure of tendon healing remains a common problem after arthroscopic rotator cuff repair (ARCR). PURPOSE/HYPOTHESIS The purpose of this study was to examine the relationship between range of motion (ROM) recovery and healing after ARCR. It was hypothesized that an early loss of ROM would be associated with tendon healing. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS This was a retrospective comparative study of primary ARCR of isolated full-thickness supraspinatus (SSN) tendon tears. Cases were retrieved from a prospective rotator cuff repair database and divided into 2 groups based on healing (healed/nonhealed). A standardized clinical evaluation was performed before and at 6 weeks, 3 months, and 6 months after surgery. Collected data included passive and active ROM, visual analog scale for pain, and Constant score. Healing was assessed by ultrasound at 6 months. RESULTS Of 1397 eligible ARCRs, 1207 were included. The healing rate was 86.7%. Age was higher in the nonhealed group (57.8 ± 7.9 years vs 61.6 ± 8.8 years; P < .001). Patients with healed repairs had a larger decrease in passive anterior elevation (AE) from the preoperative to the 6-week postoperative visit (-31°± 28° vs -18°± 26°; P < .001), followed by a more substantial increase throughout the remaining follow-up period (32°± 23° vs 18°± 21°; P < .001). At 6 months postoperatively, there was no difference in AE between groups (159°± 17° vs 161°± 14°; P > .999). External rotation elbow at side (ER1) and internal rotation hand in the back (IR1) followed similar courses of recovery. Passive and active ROM had a strong positive correlation at each follow-up. Age (odds ratio [OR], 1.79; 95% CI, 1.45-2.23; P < .001) and 6-week passive AE (OR, 1.33; 95% CI, 1.20-1.48; P < .001) and ER1 (OR, 1.15; 95% CI, 1.03-1.29; P = .017) were predictors for nonhealing. CONCLUSION Lower passive AE and ER1 at 6 weeks postoperatively and younger age are associated with healing after ARCR of isolated SSN tendon tears. At 6 months postoperatively, there were no differences in ROM, regardless of tendon healing.
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Affiliation(s)
- Philippe Collin
- CHP Saint-Gregoire, Saint-Grégoire, France
- Clinique Victor Hugo, Paris, France
- American Hospital of Paris, Neuilly-sur-Seine, France
| | - Tiago Martinho
- Division of Orthopaedics and Trauma Surgery, Hôpital de La Tour, Meyrin, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | | | | | | | - Hugo Bothorel
- Research Department, La Tour Hospital, Meyrin, Switzerland
| | - Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, Hôpital de La Tour, Meyrin, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
- FORE (Foundation for Research and Teaching in Orthopedics, Sports Medicine, Trauma, and Imaging in the Musculoskeletal System), Meyrin, Switzerland
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Solari HE, Hackett LM, Lam P, Murrell GAC. The Fate of the Shoulder Post Rotator Cuff Repair: Biomechanical Properties of the Supraspinatus Tendon and Surrounding Structures. Sports Med Arthrosc Rev 2024; 32:51-57. [PMID: 38695504 DOI: 10.1097/jsa.0000000000000386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2024]
Abstract
The study aimed to describe the changes in biomechanical properties of the supraspinatus tendon, deltoid muscle, and humeral head post arthroscopic rotator cuff repair using shear wave elastography. Shear wave velocity of the tendon, deltoid, and humeral head of 48 patients was measured at predetermined sites at 1 week, 6 weeks, 12 weeks, 6 months, and 12 months post repair. One-way ANOVA with Tukey's correction and Spearman's correlation were performed. Mean±SEM healing tendon stiffness, adjacent to tendon footprint, increased from 1 week (6.2±0.2 m/s) to 6 months (7.5±0.3 m/s) and 12 months (7.8±0.3 m/s) (P<0.001). Mean±SEM deltoid muscle stiffness was higher at 12 months (4.1±0.2 m/s) compared to 1 week (3.4±0.1 m/s) and 12 weeks (3.5±0.1 m/s) (P<0.05). Humeral head stiffness did not change. Following arthroscopic rotator cuff repair, supraspinatus tendon stiffness increased in a curvilinear fashion over 6 months. From 6 months, deltoid muscle stiffness increased, corresponding to when patients were instructed to return to normal activities.
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Affiliation(s)
- Hannah E Solari
- Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, New South Wales, Australia
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10
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Zhang J, Cai Z, Feng F, Peng Y, Cui Y, Xu Y. Age-different BMSCs-derived exosomes accelerate tendon-bone interface healing in rotator cuff tears model. Gene 2024; 895:148002. [PMID: 37979948 DOI: 10.1016/j.gene.2023.148002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 11/07/2023] [Accepted: 11/14/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Rotator cuff tears (RCTs) are culprit of shoulder pain and dysfunction. Tendon-bone interface (TBI) mal-healing is an essential contributor to retear after RCTs. Consequently, present project was conducted to investigate the role of bone marrow mesenchymal stem cells (BMSCs)-derived exosomes on TBI healing. METHOD Young BMSCs (Y-BMSCs) and Aged BMSCs (A-BMSCs) were isolated from Young (3-month-old) and old (24-month-old) SD rats, and their-derived exosomes (A-BMSCs-exo and Y-BMSCs-exo) were identified. RCTs model was established, and A-BMSCs-exo and Y-BMSCs-exo were injected at the rotator cuff using hydrogel as a vehicle. Pathological changes of TBI were observed by HE, Sirius Red and Oil Red O staining. Western blotting and RT-qPCR were applied to assess the expression of extracellular matrix (ECM)-, tendon cell (TCs)-, osteogenic-, tendon-derived stem cell (TDSCs)- and angiogenic-associated proteins and mRNAs in TBI. RESULT Y-BMSCs exhibited increased activity, osteogenic and lipogenic abilities than A-BMSCs. After A-BMSCs-exo and Y-BMSCs-exo treatment, TBI displayed massive sharpey's fibers growing along the tendon longitudinally, and a collagen fiber-chondrocyte migration zone forming a typical tendon-noncalcified fibrocartilage-calcified fibrocartilage-bone structure. A-BMSCs-exo and Y-BMSCs-exo significantly upregulated the expression of collagen Col I/II/III, Aggrecan, TNMD, SCX, Runx2, OPN, CD45, Sox2, CD31 and VEGFR2 in TBI. In vitro, A-BMSCs-exo and Y-BMSCs-exo significantly enhanced the activity of TCs and TDSCs, TDSCs stemness, and reduced the osteogenic and lipogenic capacity of TDSCs. The effect of Y-BMSCs-exo was significantly stronger than that of A-BMSCs-exo. CONCLUSION BMSCs-derived exosomes facilitate ECM remodeling, osteogenic differentiation, angiogenesis, and stemness of TDSCs, thereby accelerating TBI healing in RCTs, with better outcomes using young individual-derived BMSCs.
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Affiliation(s)
- Jianping Zhang
- Department of Orthopaedics, 920th Hospital of Joint Logistic Support Force, PLA, No. 212 Daguan Road, Kunming, Yunnan 650032, China.
| | - Zhijun Cai
- Department of Orthopaedics, 920th Hospital of Joint Logistic Support Force, PLA, No. 212 Daguan Road, Kunming, Yunnan 650032, China.
| | - Fanzhe Feng
- Department of Orthopaedics, 920th Hospital of Joint Logistic Support Force, PLA, No. 212 Daguan Road, Kunming, Yunnan 650032, China
| | - Yufeng Peng
- Department of Orthopaedics, 920th Hospital of Joint Logistic Support Force, PLA, No. 212 Daguan Road, Kunming, Yunnan 650032, China
| | - Yi Cui
- Department of Orthopaedics, 920th Hospital of Joint Logistic Support Force, PLA, No. 212 Daguan Road, Kunming, Yunnan 650032, China.
| | - Yongiqing Xu
- Department of Orthopaedics, 920th Hospital of Joint Logistic Support Force, PLA, No. 212 Daguan Road, Kunming, Yunnan 650032, China.
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11
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Peng Y, Diao L, Wang J, Wang G, Jia S, Zheng C. Effect of Platelet-Rich Plasma at Different Initiation Times on Healing of the Bone-Tendon Interface of the Rotator Cuff in a Mouse Model. Orthop J Sports Med 2024; 12:23259671231219812. [PMID: 38405010 PMCID: PMC10893834 DOI: 10.1177/23259671231219812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/31/2023] [Indexed: 02/27/2024] Open
Abstract
Background Platelet-rich plasma (PRP) has demonstrated beneficial effects on healing of the bone-tendon interface (BTI). Purpose To determine the optimal initiation time for PRP application after rotator cuff repair in an animal model. Study Design Controlled laboratory study. Methods A total of 136 C57BL/6 mice were included; 40 mice were used to prepare PRP, while 96 mice underwent acute supraspinatus tendon (SST) repair. The animals were randomly divided into 4 groups: a control group and 3 groups in which PRP was injected into the injury interface immediately after surgery, on the 7th postoperative day (PRP-7d), and on the 14th postoperative day. At 4 and 8 weeks postoperatively, the animals were sacrificed, blood was collected by eyeball removal, and samples of the SST-humerus complex were collected. Histological, imaging, immunological, and biomechanical data were compared among the groups using 1-way analysis of variance with the Bonferroni post hoc test. Results Histological analysis revealed that the fibrocartilage layer at the BTI was larger in the PRP-7d group compared to the other groups at both 4 and 8 weeks postoperatively. Moreover, the PRP-7d group exhibited improved proteoglycan content and distribution compared to the other groups. Enzyme-linked immunosorbent assay results demonstrated that at 4 weeks postoperatively, higher concentrations of transforming growth factor-β1 and platelet-derived growth factor-BB (PDGF-BB) were seen in the PRP-7d group versus the PRP-14d and control gruops (P < .05), and at 8 weeks postoperatively, the concentration of PDGF-BB was higher in the PRP-7d group versus the control group (P < .05). Biomechanical testing at 4 weeks postoperatively revealed that the failure load and ultimate strength of the SST-humerus complex were superior in the PRP-7d group compared to the other groups (P < .05), at 8 weeks, PRP-7d group was superior to the control group (P < .05). Additionally, at 8 weeks postoperatively, the PRP-7d group exhibited a greater trabecular number and trabecular thickness at the BTI compared to the PRP-14d and control gruops (P < .05). Conclusion PRP promoted healing of the BTI after a rotator cuff injury at an early stage. Clinical Relevance A PRP injection on the 7th postoperative day demonstrated superior therapeutic effects compared with injections at other time points.
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Affiliation(s)
- Yundong Peng
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
- College of Sports Medicine, Wuhan Sports University, Wuhan, China
| | - Luyu Diao
- College of Sports Medicine, Wuhan Sports University, Wuhan, China
| | - Juan Wang
- College of Sports Medicine, Wuhan Sports University, Wuhan, China
| | - Guanglan Wang
- College of Sports Medicine, Wuhan Sports University, Wuhan, China
| | - Shaohui Jia
- Hubei Key Laboratory of Sport Training and Monitoring, College of Sports Medicine, Wuhan Sports University, Wuhan, China
| | - Cheng Zheng
- Department of Sports Medicine, Affiliated Hospital, Wuhan Sports University, Wuhan, China
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12
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Codispoti G, Carniato M, Brogini S, Romanelli A, Martini L, Giavaresi G, Tschon M. Decellularized biological matrices for the repair of rotator cuff lesions: a systematic review of preclinical in vivo studies. Front Bioeng Biotechnol 2024; 12:1345343. [PMID: 38361793 PMCID: PMC10867272 DOI: 10.3389/fbioe.2024.1345343] [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: 11/28/2023] [Accepted: 01/11/2024] [Indexed: 02/17/2024] Open
Abstract
Background: Rotator cuff tears (RCTs), resulting from degeneration or trauma of the shoulder tendons, are one of the main causes of shoulder pain. In particular, massive RCTs represent 40% of all injuries, require surgical treatment, and are characterized by poor clinical outcomes and a high rate of failure. In recent years, the use of biological decellularized patches for augmentation procedures has received great interest owing to their excellent self-integration properties, improving healing and, thus, presenting an innovative therapeutic option. However, the findings from clinical studies have emerged with conflicting viewpoints regarding the benefits of this procedure, as an excessive tension load might compromise the integrity of the tendon-to-bone connection when the patch exhibits low elasticity or insufficient strength. This could prevent the healing process, leading to unpredictable results in clinical practice. Methods: This systematic review was conducted following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines across three databases (PubMed, Scopus, and Web of Knowledge) to underline the results obtained in preclinical studies involving animal models of RCT surgeries that utilized the biological decellularized matrix augmentation technique in the last 5 years. Results: Thirteen articles were included after the screening, and the SYRCLE tools were applied to assess the risk of bias in in vivo studies. Open-surgery techniques were conducted to create tendon defects or detachment in different animal models: rat (31%), rabbit (46%), dog (15%), and sheep (8%). Patches decellularized with non-standardized protocols were used in 77% of studies, while commercially available matrices were used in 15%. Of the studies, 31% used allogenic patches, 61% used xenogenic patches, and 8% utilized both xenogenic and autologous patches. Conclusion: Overall, this review provides a comprehensive overview of the use of acellular patches and their effective therapeutic potential in rotator cuff (RC) repair at the preclinical level with the aim of expanding the strategies and matrices available for surgeons. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42023468716.
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Affiliation(s)
| | | | - Silvia Brogini
- Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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13
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Huang B, Yang M, Kou Y, Jiang B. Absorbable implants in sport medicine and arthroscopic surgery: A narrative review of recent development. Bioact Mater 2024; 31:272-283. [PMID: 37637087 PMCID: PMC10457691 DOI: 10.1016/j.bioactmat.2023.08.015] [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: 06/01/2023] [Revised: 07/29/2023] [Accepted: 08/14/2023] [Indexed: 08/29/2023] Open
Abstract
Over the past two decades, advances in arthroscopic and minimally invasive surgical techniques have led to significant growth in sports medicine surgery. Implants such as suture anchors, interference screws, and endo-buttons are commonly used in these procedures. However, traditional implants made of metal or inert materials are not absorbable, leading to complications that affect treatment outcomes. To address this issue, absorbable materials with excellent mechanical properties, good biocompatibility, and controlled degradation rates have been developed and applied in clinical practice. These materials include absorbable polymers, absorbable bioceramics, and absorbable metals. In this paper, we will provide a comprehensive summary of these absorbable materials from the perspective of clinicians, and discuss their clinical applications and related research in sport medicine.
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Affiliation(s)
- Boxuan Huang
- Department of Orthopedics and Trauma, Peking University People's Hospital, Beijing, 100044, China
- Key Laboratory of Trauma and Neural Regeneration (Peking University), Ministry of Education, Beijing, 100044, China
- National Center for Trauma Medicine, Beijing, 100044, China
| | - Ming Yang
- Department of Orthopedics and Trauma, Peking University People's Hospital, Beijing, 100044, China
- Key Laboratory of Trauma and Neural Regeneration (Peking University), Ministry of Education, Beijing, 100044, China
- National Center for Trauma Medicine, Beijing, 100044, China
| | - Yuhui Kou
- Department of Orthopedics and Trauma, Peking University People's Hospital, Beijing, 100044, China
- Key Laboratory of Trauma and Neural Regeneration (Peking University), Ministry of Education, Beijing, 100044, China
- National Center for Trauma Medicine, Beijing, 100044, China
| | - Baoguo Jiang
- Department of Orthopedics and Trauma, Peking University People's Hospital, Beijing, 100044, China
- Key Laboratory of Trauma and Neural Regeneration (Peking University), Ministry of Education, Beijing, 100044, China
- National Center for Trauma Medicine, Beijing, 100044, China
- Medical School, Shenzhen University, Shenzhen, 518060, Guangdong, China
- Shenzhen University General Hospital, Shenzhen, 518055, Guangdong, China
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14
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Peng Y, Du L, Yang B, Fan D, Jia S, Zheng C. Efficacy of platelet-rich plasma and platelet-rich fibrin in arthroscopic rotator cuff repair: A systematic review and meta-analysis. PM R 2023; 15:1643-1653. [PMID: 37526570 DOI: 10.1002/pmrj.13049] [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] [Received: 01/18/2023] [Revised: 06/27/2023] [Accepted: 07/07/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVE Basic scientific studies have demonstrated positive effects of platelet-rich therapies, such as platelet-rich plasma (PRP) and platelet-rich fibrin (PRF), on tendon repair. However, clinical evidence indicating improved prognosis is controversial. In this study, we aimed to determine whether augmentation of arthroscopic rotator cuff repair with PRP and PRF improves outcomes compared to arthroscopic repair alone. LITERATURE SURVEY PubMed, Embase, and Cochrane library databases were comprehensively searched for randomized controlled trials (RCTs) published until June 2022 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. No language restriction was applied. METHODOLOGY The primary outcomes were the rate of repeat tears after arthroscopic rotator cuff repair (retear rate) and clinical function scores (Constant-Murley Score, University of California, Los Angeles Score), and the extracted data were assessed for quality. Statistical analyses were performed using Review manager 5.3, and p < .05 was considered statistically significant. SYNTHESIS Ten RCTs with 628 patients were included. The results showed that augmenting surgery with PRP reduces retear rates compared to surgery alone (risk ratio [RR] = 0.40, 95% confidence interval [CI] 0.23-0.69, p = .001), whereas PRF has no effect on retear rates (p = .92). Regarding clinical function, PRP improves Constant-Murley scores (mean difference [MD] = 2.03, 95% CI 0.13-3.93, p = .04) and University of California, Los Angeles scores (MD = 1.30, 95% CI 0.36-2.24, p = .007), whereas PRF improves only Constant-Murley scores (MD = 3.93, 95% CI 1.50-6.36, p = .002). However, these differences were small and below the minimum clinically important difference threshold. CONCLUSIONS This study showed that compared to arthroscopic rotator cuff repair alone, the application of PRP in arthroscopic rotator cuff repair reduces retear rate and improves clinical function scores, whereas the application of PRF has no clinically meaningful benefit. The small number and heterogeneity of studies as well as methodological limitations and risk of bias limit confidence in the true effect.
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Affiliation(s)
- Yundong Peng
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Liang Du
- Department of Rehabilitation Medicine, PLA Middle Military Command General Hospital, Wuhan, China
| | - Bowen Yang
- Division of Pediatric Healthcare, Department of Pediatrics, Children's Rehabilitation Center, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Donghao Fan
- Department of Rehabilitation Medicine, People's Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Shaohui Jia
- Hubei Key Laboratory of Sport Training and Monitoring, College of Sports Medicine, Wuhan Sports University, Wuhan, China
| | - Cheng Zheng
- Department of Sports Medicine, Affiliated Hospital, Wuhan Sports University, Wuhan, China
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Dujeux C, Antoni M, Thery C, Eichler D, Meyer N, Clavert P. History of mood and anxiety disorders does not affect the outcomes of arthroscopic rotator cuff repair. Orthop Traumatol Surg Res 2023; 109:103550. [PMID: 36642405 DOI: 10.1016/j.otsr.2023.103550] [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: 05/30/2022] [Revised: 10/21/2022] [Accepted: 11/15/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND A pre-existing mood and anxiety disorder (MAD) is often present in patients with rotator cuff pathology, but its presumed negative effect on the outcomes has not been demonstrated. AIM OF STUDY AND HYPOTHESIS The primary objective of this study was to evaluate how a history of MAD affects the clinical outcomes 1 year after arthroscopic rotator cuff repair (RCR). The secondary objectives were to evaluate how a history of MAD affects tendon healing, analgesic consumption and the occurrence of complications. MATERIALS AND METHODS The study population consisted of 219 patients (mean age 54.5±6.6 years) who underwent arthroscopic repair for a distal supraspinatus tendon tear, with 17% (38/219) presenting an history of MAD (depression, unspecified mood disorder, anxiety, and bipolar disorder). Using univariate and multivariate analyses, the joint range of motion, Constant score, analgesic consumption, occurrence of complications during the first postoperative year and tendon healing at 1 year (MRI or CT arthrography) were compared between the two groups (with or without MAD). RESULTS The Constant score was lower preoperatively in patients with history of MAD (-4 points, p=.04) but there were no significant differences between the two groups at the various postoperative follow-up time points (p>.05). No significant difference was found between the two groups of patients in their analgesic consumption at the various postoperative time points (p>.05), tendon healing at 1 year (p=.17) or the occurrence of postoperative complications (p=.59). DISCUSSION/CONCLUSION Pre-existing MAD had no effect on the clinical outcomes after arthroscopic RCR at 1 year and no effect on tendon healing, analgesic consumption or the occurrence of complications in our study population. LEVEL OF EVIDENCE III; retrospective case-control study.
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Affiliation(s)
- Clément Dujeux
- Service de chirurgie du membre supérieur, hôpital de Hautepierre 2 - CHU Strasbourg, avenue Molière, 67000 Strasbourg, France
| | - Maxime Antoni
- Service de chirurgie du membre supérieur, hôpital de Hautepierre 2 - CHU Strasbourg, avenue Molière, 67000 Strasbourg, France.
| | - Charles Thery
- Service de chirurgie du membre supérieur, hôpital de Hautepierre 2 - CHU Strasbourg, avenue Molière, 67000 Strasbourg, France
| | - David Eichler
- Service de chirurgie du membre supérieur, hôpital de Hautepierre 2 - CHU Strasbourg, avenue Molière, 67000 Strasbourg, France
| | - Nicolas Meyer
- Service de chirurgie du membre supérieur, hôpital de Hautepierre 2 - CHU Strasbourg, avenue Molière, 67000 Strasbourg, France; Pôle de santé publique, secteur méthodologie et biostatistiques, hôpitaux universitaires de Strasbourg, 1, place de l'hôpital, 67000 Strasbourg, France
| | - Philippe Clavert
- Service de chirurgie du membre supérieur, hôpital de Hautepierre 2 - CHU Strasbourg, avenue Molière, 67000 Strasbourg, France
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Gultekin O, Kilinc BE, Akpolat AO, Cumbul A, Yilmaz B. Investigation of the effects of subacromial bursal tissue preservation and microfracture procedure on healing after rotator cuff repair in a rat model. Orthop Traumatol Surg Res 2023; 109:103608. [PMID: 36958622 DOI: 10.1016/j.otsr.2023.103608] [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: 10/19/2022] [Revised: 02/27/2023] [Accepted: 03/16/2023] [Indexed: 03/25/2023]
Abstract
INTRODUCTION The aim of this study is to compare the preservation of bursal tissue and microfracture techniques and to examine the effectiveness of the combination of the two methods in rotator cuff tear healing in the rat shoulder. HYPOTHESIS Bursal tissue preservation combined with microfracture is more effective in the rotator cuff repair. MATERIALS AND METHODS Twenty-three male Sprague-Dawley rats were randomly divided into two groups. The bursal tissue was preserved in group 1 (n=11) and excised in group 2 (n=12). Groups were categorized into subgroups as L (left) and R (right) based on the shoulder side receiving microfracture (L received microfracture, R did not). Histopathological examination was performed using modified Bonar Score System. RESULTS Cell morphology grades of group 1 were lower than group 2 (p<0.05). In terms of collagen measurements, the grade of group 1L (bursa preservation+microfracture) was lower than groups 1R, 2L, and 2R, and the grade of group 1R was lower than groups 2L and 2R. Cellularity grades of group 2 were higher than group 1 (p<0.05). Extracellular matrix grades of group 1 were lower than group 2 (p<0.05). The overall grades were lower in group 1 than in group 2 (p<0.05). DISCUSSION Combined treatment of bursal tissue preservation and microfracture was the most efficient method as determined by healing findings in histopathological specimens. Preservation of bursal tissue was a more effective option in tendon healing than performing only microfracture. LEVEL OF PROOF II, animal research.
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Affiliation(s)
- Onur Gultekin
- Department of Orthopedics and Traumatology, Health Sciences University Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Bekir Eray Kilinc
- Department of Orthopedics and Traumatology, Health Sciences University Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey.
| | - Ahmet Onur Akpolat
- Department of Orthopedics and Traumatology, Health Sciences University Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Alev Cumbul
- Department of Histology, Yeditepe University, Istanbul, Turkey
| | - Baris Yilmaz
- Department of Orthopedics and Traumatology, Health Sciences University Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
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Muench LN, Tamburini L, Kriscenski D, Berthold DP, Rupp MC, Cote MP, McCarthy MB, Mazzocca AD. The effect of augmenting suture material with magnesium and platelet-rich plasma on the in vitro adhesion and proliferation potential of subacromial bursa-derived progenitor cells. JSES Int 2023; 7:2367-2372. [PMID: 37969491 PMCID: PMC10638578 DOI: 10.1016/j.jseint.2023.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
Background Connective tissue subacromial bursa-derived progenitor cells (SBDCs) have been suggested as a potent biologic augment to promote healing of the repaired rotator cuff tendon. Maximizing the amount of retained progenitor cells at the tendon repair site is essential for ensuring an optimal healing environment, warranting a search for proadhesive and proliferative adjuvants. The purpose was to evaluate the effect of magnesium (Mg), platelet-rich plasma (PRP), and a combination of both adjuvants on the in vitro cellular adhesion and proliferation potential of SBDCs on suture material commonly used in rotator cuff surgery. Methods SBDCs were isolated from subacromial bursa samples harvested during rotator cuff repair and cultured in growth media. Commercially available collagen-coated nonabsorbable flat-braided suture was cut into 1-inch pieces, placed into 48-well culture dishes, and sterilized under ultraviolet light. Either a one-time dose of 5 mM sterile Mg, 0.2 mL of PRP, or a combination of both adjuvants was added, while a group without treatment served as a negative control. Cellular proliferation and adhesion assays on suture material were performed for each treatment condition. Results Augmenting the suture with Mg resulted in a significantly increased cellular adhesion (total number of attached cells) of SBDCs compared to PRP alone (31,527 ± 19,884 vs. 13,619 ± 8808; P < .001), no treatment (31,527 ± 19,884 vs. 21,643 ± 8194; P = .016), and combination of both adjuvants (31,527 ± 19,884 vs. 17,121 ± 11,935; P < .001). Further, augmentation with Mg achieved a significant increase in cellular proliferation (absorbance) of SBDCs on suture material when compared to the PRP (0.516 ± 0.207 vs. 0.424 ± 0.131; P = .001) and no treatment (0.516 ± 0.207 vs. 0.383 ± 0.094; P < .001) group. The combination of Mg and PRP showed a significantly higher proliferation potential compared to PRP alone (0.512 ± 0.194 vs. 0.424 ± 0.131; P = .001) and no treatment (0.512 ± 0.194 vs. 0.383 ± 0.094; P < .001). There were no significant differences in the remaining intergroup comparisons (P > .05, respectively). Conclusion Augmenting suture material with Mg resulted in a significantly increased cellular adhesion of SBDCs compared to untreated suture material, as well as augmentation with PRP alone or a combination of both adjuvants. Further, Mg with or without PRP augmentation achieved a significant increase in the cellular proliferation of SBDCs on suture material compared to untreated sutures and augmentation with PRP alone. Application of Mg may be a clinically feasible approach to optimizing the use of SBDCs as a biological augment in rotator cuff repair, while combined augmentation with PRP may harness the full potential for optimized tissue recovery due to the high concentration of PRP-derived growth factors.
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Affiliation(s)
- Lukas N. Muench
- Department of Sports Orthopaedics, Technical University of Munich, Munich, Germany
| | - Lisa Tamburini
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Danielle Kriscenski
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Daniel P. Berthold
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU, Munich, Germany
| | | | - Mark P. Cote
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Mary Beth McCarthy
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Augustus D. Mazzocca
- Massachusetts General Hospital, Massachusetts General Brigham, Harvard Medical School, Boston, MA, USA
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Thery C, Antoni M, Dujeux C, Eichler D, Meyer N, Clavert P. Increased operative time has a negative impact on clinical outcome in arthroscopic rotator cuff repair. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:2865-2871. [PMID: 36879163 DOI: 10.1007/s00590-023-03487-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/05/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Few data are available about the impact of operative time on outcome of rotator cuff repair. AIM The aim of this study was to evaluate the impact of operative time on clinical outcome and tendon healing after arthroscopic rotator cuff repair. METHODS Patients operated on for distal supraspinatus tear in our institution between 2012 and 2018 were included retrospectively. Operative time, from skin incision until skin closure, was extracted from medical files. For statistical analysis, operative time was treated as a quantitative variable. Endpoints were clinical outcome (Constant score, range of motion), tendon healing (on CT or MRI) and complications at 1 year. The significance threshold was set at p = 0.05. RESULTS A total of 219 Patients, with a mean age of 54.6 years (range 40-70 years), were included. Mean operative time 44.9 min (range 14-140 min). Significant correlations (p < 0.05) were found for Constant score and external rotation at 1 year: increasing operative time by 1 min led to a decrease in Constant score of 0.115 points, or 6.9 points for a 60-min increase (p = 0.0167) and a decrease in external rotation of 0.134°, or 8.04° for a 60-min increase (p = 0.0214). No significant correlations were found for anterior elevation at 1 year (p = 0.2577), tendon healing at 1 year (p = 0.295) or onset of complications during follow-up (p = 0.193). DISCUSSION The minimal clinically important difference in Constant score in patients undergoing rotator cuff surgery is between 6 and 10 points. An increase of more than 60 min in operative time significantly impacted clinical outcome of arthroscopic distal supraspinatus repair, but not tendon healing. LEVEL OF EVIDENCE Level III: Retrospective Cohort Design. Therapeutic Study.
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Affiliation(s)
- Charles Thery
- Service de Chirurgie du Membre Supérieur, Pôle de Chirurgie Orthopédique et de Traumatologie, Hôpital Hautepierre 2 - CHU Strasbourg, Avenue Molière, 67000, Strasbourg, France
| | - Maxime Antoni
- Service de Chirurgie du Membre Supérieur, Pôle de Chirurgie Orthopédique et de Traumatologie, Hôpital Hautepierre 2 - CHU Strasbourg, Avenue Molière, 67000, Strasbourg, France.
| | - Clément Dujeux
- Service de Chirurgie du Membre Supérieur, Pôle de Chirurgie Orthopédique et de Traumatologie, Hôpital Hautepierre 2 - CHU Strasbourg, Avenue Molière, 67000, Strasbourg, France
| | - David Eichler
- Service de Chirurgie du Membre Supérieur, Pôle de Chirurgie Orthopédique et de Traumatologie, Hôpital Hautepierre 2 - CHU Strasbourg, Avenue Molière, 67000, Strasbourg, France
| | - Nicolas Meyer
- Pole de Santé Publique, Secteur Méthodologie et Biostatistiques, Hôpitaux Universitaires de Strasbourg, 1 Place de l'Hôpital, 67000, Strasbourg, France
| | - Philippe Clavert
- Service de Chirurgie du Membre Supérieur, Pôle de Chirurgie Orthopédique et de Traumatologie, Hôpital Hautepierre 2 - CHU Strasbourg, Avenue Molière, 67000, Strasbourg, France
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19
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Bolam SM, Zhu MF, Lim KS, Konar S, Oliver MH, Buckels E, Matthews BG, Callon KE, Woodfield T, Workman J, Monk AP, Coleman B, Cornish J, Munro JT, Musson DS. Combined Growth Factor Hydrogel Enhances Rotator Cuff Enthesis Healing in Rat But Not Sheep Model. Tissue Eng Part A 2023; 29:449-459. [PMID: 37171123 DOI: 10.1089/ten.tea.2022.0215] [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] [Indexed: 05/13/2023] Open
Abstract
We hypothesized that a combined growth factor hydrogel would improve chronic rotator cuff tear healing in a rat and sheep model. Insulin-like growth factor 1, transforming growth factor β1, and parathyroid hormone were combined into a tyraminated poly-vinyl-alcohol (PVA-Tyr) hydrogel and applied directly at the enthesis. In total, 30 Sprague-Dawley rats and 16 Romney ewes underwent unilateral rotator cuff tenotomy and then delayed repairs were performed after 3-4 weeks. The animals were divided into a control group (repair alone) and treatment group. The rotator cuffs were harvested at 12 weeks after surgery for biomechanical and histological analyses of the repair site. In the rat model, the stress at failure and Young's modulus were higher in the treatment group in comparison with the control group (73% improvement, p = 0.010 and 56% improvement, p = 0.028, respectively). Histologically, the repaired entheses in the treatment group demonstrated improved healing with higher semi-quantitative scores (10.1 vs. 6.55 of 15, p = 0.032). In the large animal model, there was no observable treatment effect. This PVA-Tyr bound growth factor system holds promise for improving rotator cuff healing. However, our approach was not scalable from a small to a large animal model. Further tailoring of this growth factor delivery system is still required. Level of Evidence: Basic Science Study; Biomechanics and Histology; Animal Model Impact Statement Previous studies using single-growth factor treatment to improve enthesis healing after rotator cuff repair have reported promising, but inconsistent results. A novel approach is to combine multiple growth factors using controlled-release hydrogels that mimic the normal healing process. In this study, we report that a combined growth factor hydrogel can improve the histological quality and strength of rotator cuff repair in a rat chronic tear model. This novel hydrogel growth factor treatment has the potential to be used in human clinical applications to improve healing after rotator cuff repair.
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Affiliation(s)
- Scott M Bolam
- Department of Medicine, University of Auckland, Grafton, New Zealand
- Department of Orthopedic Surgery, Auckland City Hospital, Grafton, New Zealand
| | - Mark F Zhu
- Department of Medicine, University of Auckland, Grafton, New Zealand
- Department of Orthopedic Surgery, Auckland City Hospital, Grafton, New Zealand
| | - Khoon S Lim
- Department of Orthopedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - Subhajit Konar
- Department of Medicine, University of Auckland, Grafton, New Zealand
| | - Mark H Oliver
- Liggins Institute, University of Auckland, Grafton, New Zealand
| | - Emma Buckels
- Department of Molecular Medicine and Pathology, University of Auckland, Grafton, New Zealand
- Maurice Wilkins Centre for Molecular Biodiscovery, University of Auckland, Grafton, New Zealand
| | - Brya G Matthews
- Department of Molecular Medicine and Pathology, University of Auckland, Grafton, New Zealand
- Maurice Wilkins Centre for Molecular Biodiscovery, University of Auckland, Grafton, New Zealand
| | - Karen E Callon
- Department of Medicine, University of Auckland, Grafton, New Zealand
| | - Tim Woodfield
- Department of Orthopedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - Josh Workman
- Chemical and Materials Engineering, University of Auckland, Auckland, New Zealand
| | - A Paul Monk
- Department of Orthopedic Surgery, Auckland City Hospital, Grafton, New Zealand
- Auckland Bioengineering Institute, University of Auckland, Grafton, New Zealand
| | - Brendan Coleman
- Department of Orthopedic Surgery, Middlemore Hospital, Otahuhu, New Zealand
| | - Jillian Cornish
- Department of Medicine, University of Auckland, Grafton, New Zealand
| | - Jacob T Munro
- Department of Medicine, University of Auckland, Grafton, New Zealand
- Department of Orthopedic Surgery, Auckland City Hospital, Grafton, New Zealand
| | - David S Musson
- Department of Medicine, University of Auckland, Grafton, New Zealand
- Department of Nutrition and Dietetics, University of Auckland, Grafton, New Zealand
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20
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Ece B, Yigit H, Ergun E, Koseoglu EN, Karavas E, Aydin S, Kosar PN. Quantitative Analysis of Supraspinatus Tendon Pathologies via T2/T2* Mapping Techniques with 1.5 T MRI. Diagnostics (Basel) 2023; 13:2534. [PMID: 37568898 PMCID: PMC10417426 DOI: 10.3390/diagnostics13152534] [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: 06/02/2023] [Revised: 07/21/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
The aim of this study was to quantitatively assess supraspinatus tendon pathologies with T2/T2* mapping techniques, which are sensitive to biochemical changes. Conventional magnetic resonance imaging (MRI) and T2/T2* mapping techniques were applied to 41 patients with shoulder pathology, and there were also 20 asymptomatic cases included. The patients were divided into two groups: tendinosis and rupture. The supraspinatus tendon was divided into medial, middle, and lateral sub-regions, and the T2/T2* values were measured in both the coronal and sagittal planes for intergroup comparison. Intra-class and inter-class correlation coefficients (ICCs) were calculated to assess test reproducibility. Receiver operating characteristic (ROC) analysis was used to determine the cut-off value in each group. A total of 61 patients (27 males and 34 females)-including 20 asymptomatic individuals, 20 with tendinosis, and 21 with rupture-were evaluated using T2/T2* mapping techniques. In the rupture group, there were significant differences in the values of the lateral region (p < 0.001), as well as in the middle and medial regions (p < 0.05) of the supraspinatus tendon compared to the tendinosis and asymptomatic groups. These were determined using both T2* and T2 mapping in both the coronal and sagittal plane measurements. In the tendinosis group, there were significant differences in the values of the lateral region with T2* mapping (p < 0.001) in both the coronal and sagittal planes, and also with the T2 mapping in the coronal plane (p < 0.05) compared to the asymptomatic groups. The cut-off values for identifying supraspinatus pathology ranged from 85% to 90% for T2 measurements and above 90% for T2* measurements in both planes of the lateral section. The ICC values showed excellent reliability (ICC > 0.75) for all groups. In conclusion, T2 and T2* mapping techniques with 1.5 T MRI can be used to assess tendon rupture and tendinosis pathologies in the supraspinatus tendon. For an accurate evaluation, measurements from the lateral region in both the coronal and sagittal planes are more decisive.
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Affiliation(s)
- Bunyamin Ece
- Department of Radiology, Kastamonu University, 37150 Kastamonu, Turkey
| | - Hasan Yigit
- Department of Radiology, Health Sciences University, Ankara Education and Research Hospital, 06100 Ankara, Turkey; (H.Y.); (E.E.); (E.N.K.); (P.N.K.)
| | - Elif Ergun
- Department of Radiology, Health Sciences University, Ankara Education and Research Hospital, 06100 Ankara, Turkey; (H.Y.); (E.E.); (E.N.K.); (P.N.K.)
| | - Enver Necip Koseoglu
- Department of Radiology, Health Sciences University, Ankara Education and Research Hospital, 06100 Ankara, Turkey; (H.Y.); (E.E.); (E.N.K.); (P.N.K.)
| | - Erdal Karavas
- Department of Radiology, Bandırma Onyedi Eylül University, 10200 Bandırma, Turkey;
| | - Sonay Aydin
- Department of Radiology, Erzincan University, 24100 Erzincan, Turkey;
| | - Pinar Nercis Kosar
- Department of Radiology, Health Sciences University, Ankara Education and Research Hospital, 06100 Ankara, Turkey; (H.Y.); (E.E.); (E.N.K.); (P.N.K.)
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21
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Miyazaki AN, Silva LADA, Checchia CS, Mussatto JCDOA, Moraes VMDE, Sella GDOV. REASSESSMENT OF FATTY INFILTRATION BY MAGNETIC RESONANCE TEN YEARS AFTER ROTATOR CUFF INJURY REPAIR. ACTA ORTOPEDICA BRASILEIRA 2023; 31:e262497. [PMID: 37469501 PMCID: PMC10353870 DOI: 10.1590/1413-785220233103e262497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 06/28/2022] [Indexed: 07/21/2023]
Abstract
Quantitative assessments of rotator cuff muscle changes after successful tendon repair are scarce. On the other hand, semiquantitative and subjective assessments are more abundant, but their findings are controversial. One hypothesis about this divergence is that there is an immediate decrease in the proportion of fatty infiltration after surgical repair. Objective Reassess fatty infiltration and muscle trophism of the rotator cuff after ten years of repair. Methods Prospective comparison study. A total of 10 patients diagnosed with rotator cuff injury underwent repair of the lesion, and MRI of the affected shoulder was performed in the preoperative, immediate postoperative, and late postoperative periods (ten years). A comparative study was performed at every moment. Results At 5% significance level, the mean of the immediate postoperative period was higher for the variable trophism and true muscle percentage. Fatty infiltration showed no difference in the three periods observed. Conclusion Fatty infiltration does not change in the three periods evaluated and muscle trophism is greater in the immediate postoperative period. After ten years of rotator cuff repair, muscle trophism and fatty infiltration remain with statistically significantly equal results when compared to the preoperative period. Level of Evidence II, Prospective Comparison Study.
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Affiliation(s)
- Alberto Naoki Miyazaki
- Santa Casa de Misericordia de Sao Paulo, Faculdade de Ciencias Medicas, Departamento de Ortopedia e Traumatologia, Grupo de Cirurgia do Ombro e Cotovelo, São Paulo, SP, Brazil
| | - Luciana Andrade DA Silva
- Santa Casa de Misericordia de Sao Paulo, Faculdade de Ciencias Medicas, Departamento de Ortopedia e Traumatologia, Grupo de Cirurgia do Ombro e Cotovelo, São Paulo, SP, Brazil
| | - Caio Santos Checchia
- Santa Casa de Misericordia de Sao Paulo, Faculdade de Ciencias Medicas, Departamento de Ortopedia e Traumatologia, Grupo de Cirurgia do Ombro e Cotovelo, São Paulo, SP, Brazil
| | - Julio Cesar DO Amaral Mussatto
- Santa Casa de Misericordia de Sao Paulo, Faculdade de Ciencias Medicas, Departamento de Ortopedia e Traumatologia, Grupo de Cirurgia do Ombro e Cotovelo, São Paulo, SP, Brazil
| | - Vinicius Marques DE Moraes
- Santa Casa de Misericordia de Sao Paulo, Faculdade de Ciencias Medicas, Departamento de Ortopedia e Traumatologia, Grupo de Cirurgia do Ombro e Cotovelo, São Paulo, SP, Brazil
| | - Guilherme DO Val Sella
- Santa Casa de Misericordia de Sao Paulo, Faculdade de Ciencias Medicas, Departamento de Ortopedia e Traumatologia, Grupo de Cirurgia do Ombro e Cotovelo, São Paulo, SP, Brazil
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22
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Ji W, Han F, Feng X, Shi L, Ma H, Lu Y, Tao R. Cocktail-like gradient gelatin/hyaluronic acid bioimplant for enhancing tendon-bone healing in fatty-infiltrated rotator cuff injury models. Int J Biol Macromol 2023:125421. [PMID: 37330074 DOI: 10.1016/j.ijbiomac.2023.125421] [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: 01/18/2023] [Revised: 05/28/2023] [Accepted: 06/14/2023] [Indexed: 06/19/2023]
Abstract
The regeneration of enthesis tissue (native tendon-bone interface) at the post-surgically repaired rotator cuff remains a challenge for clinicians, especially with the emergence of degenerative affection such as fatty infiltration that exacerbate poor tendon-bone healing. In this study, we proposed a cocktail-like hydrogel with a four-layer structure (BMSCs+gNC@GH) for enhancing fatty infiltrated tendon-bone healing. As collagen and hyaluronic acid are the main biomacromolecules that constitute the extracellular matrix of enthesis tissue, this hydrogel was composed of UV-curable gelatin/hyaluronic acid (GelMA/HAMA) dual network gel (GH) with nanoclay (NC) and stem cells loaded. The results showed that NC exhibited a cocktail-like gradient distribution in GH, which effectively mimicked the structure of native enthesis and supported the long-term culture and encapsulation of BMSCs. What's more, the gradient variation of NC provided a biological signal for promoting gradient osteogenic differentiation of cells. Based on the in vivo results, BMSCs+gNC@GH effectively promoted fibrocartilage layer regeneration at the tendon-bone interface and inhibited fatty infiltration. Therefore, BMSCs+gNC@GH group exhibited better biomechanical properties. Thus, this cocktail-like implant may be a promising tissue-engineered scaffold for tendon-bone healing, and it provides a new idea for the development of scaffolds with the function of inhibiting degeneration.
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Affiliation(s)
- Wei Ji
- Department of Orthopaedics, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong 226001, China
| | - Fei Han
- Department of Orthopaedics, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong 226001, China
| | - Xian Feng
- Department of Orthopaedics, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong 226001, China
| | - Lei Shi
- Department of Orthopaedics, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong 226001, China
| | - Hongdong Ma
- Department of Orthopaedics, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong 226001, China
| | - Yue Lu
- Department of Orthopaedics, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong 226001, China.
| | - Ran Tao
- Department of Orthopaedics, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong 226001, China.
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23
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Berten-Schunk L, Roger Y, Bunjes H, Hoffmann A. Release of TGF-β 3 from Surface-Modified PCL Fiber Mats Triggers a Dose-Dependent Chondrogenic Differentiation of Human Mesenchymal Stromal Cells. Pharmaceutics 2023; 15:pharmaceutics15041303. [PMID: 37111788 PMCID: PMC10146193 DOI: 10.3390/pharmaceutics15041303] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/07/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
The design of implants for tissue transitions remains a major scientific challenge. This is due to gradients in characteristics that need to be restored. The rotator cuff in the shoulder, with its direct osteo-tendinous junction (enthesis), is a prime example of such a transition. Our approach towards an optimized implant for entheses is based on electrospun fiber mats of poly(ε-caprolactone) (PCL) as biodegradable scaffold material, loaded with biologically active factors. Chitosan/tripolyphosphate (CS/TPP) nanoparticles were used to load transforming growth factor-β3 (TGF-β3) with increasing loading concentrations for the regeneration of the cartilage zone within direct entheses. Release experiments were performed, and the concentration of TGF-β3 in the release medium was determined by ELISA. Chondrogenic differentiation of human mesenchymal stromal cells (MSCs) was analyzed in the presence of released TGF-β3. The amount of released TGF-β3 increased with the use of higher loading concentrations. This correlated with larger cell pellets and an increase in chondrogenic marker genes (SOX9, COL2A1, COMP). These data were further supported by an increase in the glycosaminoglycan (GAG)-to-DNA ratio of the cell pellets. The results demonstrate an increase in the total release of TGF-β3 by loading higher concentrations to the implant, which led to the desired biological effect.
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Affiliation(s)
- Leonie Berten-Schunk
- Technische Universität Braunschweig, Institut für Pharmazeutische Technologie und Biopharmazie, 38106 Braunschweig, Germany
| | - Yvonne Roger
- Hannover Medical School, Department of Orthopedic Surgery, Graded Implants and Regenerative Strategies, Laboratory of Biomechanics and Biomaterials, 30625 Hannover, Germany
- Niedersächsisches Zentrum für Biomedizintechnik, Implantatforschung und Entwicklung (NIFE), 30625 Hannover, Germany
| | - Heike Bunjes
- Technische Universität Braunschweig, Institut für Pharmazeutische Technologie und Biopharmazie, 38106 Braunschweig, Germany
- Technische Universität Braunschweig, Zentrum für Pharmaverfahrenstechnik (PVZ), 38106 Braunschweig, Germany
| | - Andrea Hoffmann
- Hannover Medical School, Department of Orthopedic Surgery, Graded Implants and Regenerative Strategies, Laboratory of Biomechanics and Biomaterials, 30625 Hannover, Germany
- Niedersächsisches Zentrum für Biomedizintechnik, Implantatforschung und Entwicklung (NIFE), 30625 Hannover, Germany
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24
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Krupp R, Frankle M, Nyland J, Baker CE, Werner BC, Pierre PS, Tashjian R. Interpositional scaffold anchor rotator cuff footprint tear repair: excellent survival, healing, and early outcomes. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07383-2. [PMID: 36976315 DOI: 10.1007/s00167-023-07383-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/01/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE Shoulder function limitation duration after a full-thickness rotator cuff tendon (RCT) tear may influence post-repair healing and outcomes. A suture anchor was developed to improve footprint repair fixation and healing through biological fluid delivery and scaffold augmentation. The primary multicenter study objective was to evaluate RCT repair failure rate based on 6-month MRI examination, and device survival at 1-year follow-up. The secondary objective was to compare the clinical outcomes of subjects with shorter- and longer-term shoulder function limitation duration. METHODS Seventy-one subjects (46 men) with moderate-to-large RCT tears (1.5-4 cm), at a median 61 years of age (range = 40-76), participated in this study. Pre-repair RCT tear location/size and 6-month healing status were confirmed by an independent radiologist. Subjects with shorter- (Group 1: 17.8 ± 21 days, n = 37) and longer-term (Group 2: 185.4 ± 89 days, n = 34) shoulder function limitation durations were also compared over 1 year for active mobility, strength, American Shoulder and Elbow Surgeon's Shoulder Score (ASES score), Veterans RAND 12 Item Health Survey (VR-12), and visual analog scale (VAS) pain and instability scores. RESULTS Three of the 52 subjects [5.8%] who underwent 6-month MRI experienced a re-tear at the original RCT footprint repair site. By the 1-year follow-up, overall anchor survival was 97%. Although Group 2 displayed lower ASES and VR-12 scores pre-repair (ASES = 40.1 ± 17 vs. 47.9 ± 17; VR-12 physical health (PH) = 37.2 ± 9 vs. 41.4 ± 8) (p ≤ 0.048), at 3-month post-RCT repair (ASES = 61.3 ± 19 vs. 71.3 ± 20; VR-12 PH = 40.8 ± 8 vs. 46.8 ± 9) (p ≤ 0.038), and at 6-month post-RCT repair (ASES = 77.4 ± 18 vs. 87.8 ± 13; VR-12 PH = 48.9 ± 11 vs. 54.0 ± 9) (p ≤ 0.045), by 1-year post-RCT repair, groups did not differ (n.s.). Between-groups VR-12 mental health score differences were not evident at any time period (n.s.). Shoulder pain and instability VAS scores also did not differ (n.s.), displaying comparable improvement between groups from pre-RCT repair to 1-year post-RCT repair. Groups had comparable active shoulder mobility and strength recovery at each follow-up (n.s.). CONCLUSION At 6-month post-RCT repair, only 3/52 of patients [5.8%] had a footprint re-tear, and at 1-year follow-up, overall anchor survival was 97%. Use of this scaffold anchor was associated with excellent early clinical outcomes regardless of shoulder function impairment duration. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Ryan Krupp
- Norton Orthopedic Institute, 9880 Angies Way Suite 250, Louisville, KY, 40241, USA
| | - Mark Frankle
- Florida Orthopaedic Institute, Temple Terrace, USA
| | - John Nyland
- Norton Orthopedic Institute, 9880 Angies Way Suite 250, Louisville, KY, 40241, USA.
- Department of Orthopaedic Surgery, University of Louisville, Louisville, USA.
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25
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Künzler MB, McGarry MH, Akeda M, Ihn H, Karol A, von Rechenberg B, Schär MO, Zumstein MA, Lee TQ. Effect of PARP-1 Inhibition on Rotator Cuff Healing: A Feasibility Study Using Veliparib in a Rat Model of Acute Rotator Cuff Repair. Am J Sports Med 2023; 51:758-767. [PMID: 36745049 DOI: 10.1177/03635465221148494] [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] [Indexed: 02/07/2023]
Abstract
BACKGROUND PARP-1 (poly[ADP-ribose]) was shown to influence the inflammatory response after rotator cuff tear, leading to fibrosis, muscular atrophy, and fatty infiltration in mouse rotator cuff degeneration. So far, it is not known how PARP-1 influences enthesis healing after rotator cuff tear repair. HYPOTHESIS/PURPOSE This study aimed to examine the feasibility of oral PARP-1 inhibition and investigate its influence on rat supraspinatus enthesis and muscle healing after rotator cuff repair. The hypothesis was that oral PARP-1 inhibition would improve enthesis healing after acute rotator cuff repair in a rat model. STUDY DESIGN Controlled laboratory study. METHODS In 24 Sprague-Dawley rats, the supraspinatus tendon was sharply detached and immediately repaired with a single transosseous suture. The rats were randomly allocated into 2 groups, with the rats in the inhibitor group receiving veliparib with a target dose of 12.5 mg/kg/d via drinking water during the postoperative recovery period. The animals were sacrificed 8 weeks after surgery. For the analysis, macroscopic, biomechanical, and histologic methods were used. RESULTS Oral veliparib was safe for the rats, with no adverse effects observed. In total, the inhibitor group had a significantly better histologic grading of the enthesis with less scar tissue formation. The macroscopic cross-sectional area of the supraspinatus muscles was 10.5% higher (P = .034) in the inhibitor group, which was in agreement with an 8.7% higher microscopic muscle fiber diameter on histologic sections (P < .0001). There were no statistically significant differences in the biomechanical properties between the groups. CONCLUSION This study is the first to investigate the influence of PARP-1 inhibition on healing enthesis. On the basis of these findings, we conclude that oral veliparib, which was previously shown to inhibit PARP-1 effectively, is safe to apply and has beneficial effects on morphologic enthesis healing and muscle fiber size. CLINICAL RELEVANCE Modulating the inflammatory response through PARP-1 inhibition during the postoperative healing period is a promising approach to improve enthesis healing and reduce rotator cuff retearing. With substances already approved by the Food and Drug Administration, PARP-1 inhibition bears high potential for future translation into clinical application.
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Affiliation(s)
- Michael B Künzler
- Shoulder, Elbow and Orthopaedic Sports Medicine, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland.,Orthopaedics Biomechanics Laboratory, VA Long Beach Healthcare System, Long Beach, California, USA.,Musculoskeletal Research Unit, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Michelle H McGarry
- Orthopaedics Biomechanics Laboratory, VA Long Beach Healthcare System, Long Beach, California, USA.,Orthopaedics Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, USA
| | - Masaki Akeda
- Orthopaedics Biomechanics Laboratory, VA Long Beach Healthcare System, Long Beach, California, USA
| | - Hansel Ihn
- Orthopaedics Biomechanics Laboratory, VA Long Beach Healthcare System, Long Beach, California, USA
| | - Agnieszka Karol
- Musculoskeletal Research Unit, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | | | - Michael O Schär
- Shoulder, Elbow and Orthopaedic Sports Medicine, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland
| | - Matthias A Zumstein
- Shoulder, Elbow and Orthopaedic Sports Medicine, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland.,Shoulder, Elbow and Orthopaedic Sports Medicine, Sonnenhof Orthopaedics, Bern, Switzerland
| | - Thay Q Lee
- Orthopaedics Biomechanics Laboratory, VA Long Beach Healthcare System, Long Beach, California, USA.,Orthopaedics Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, USA
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26
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Kim JN, Park HJ, Kim MS, Choi YJ, Kim E, Park JH, Hong SW. Sonographic and elastographic findings after arthroscopic rotator cuff repair: a comparison with clinical results. Br J Radiol 2023; 96:20210777. [PMID: 36383128 PMCID: PMC9975362 DOI: 10.1259/bjr.20210777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 06/20/2022] [Accepted: 10/11/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We assessed the relationship between early postoperative clinical outcomes of arthroscopic rotator cuff repair (ARCR) and observations obtained by postsurgical ultrasound (US) and strain elastography (SE) of repaired supraspinatus tendons (SSTs). METHODS This retrospective study included 42 cases in which the patient underwent ARCR followed by postoperative US and SE. The Korean Shoulder Scoring (KSS) system was used to assess preoperative and postoperative conditions. The thickness of the repaired SST and subdeltoid fluid was measured by US. SE scores were classified into four grades (1 to 4) according to elasticity of repaired SST. In addition, SE scores were divided into two groups: soft (SE scores of 1 and 2) and hard (SE scores of 3 and 4). The relationship between clinical outcomes and US parameters and SE scores was determined by KSS. RESULTS Postoperative SE scores observed by two readers correlated significantly with function (p = 0.021 and p = 0.021, respectively) and muscle strength (p = 0.008 and p = 0.015, respectively). SE scores were significantly correlated with a difference value of muscle strength of KSS scores (p = 0.002 and p = 0.014). In a comparison of hard and soft groups of repaired SSTs, function (p = 0.008 and p = 0.010, respectively) and muscle strength (p = 0.002 and p = 0.014, respectively) in postoperative KSS scores were statistically higher in the hard SE scores than the soft SE scores. The difference value of function (p = 0.021 and p = 0.021,) and muscle strength (p = 0.008 and p = 0.015) of KSS scores was significantly higher in the hard SE scores. CONCLUSIONS Postoperative SE scores of repaired tendons correlated significantly with muscle strength and function after ARCR. Postoperative US images including thickness of repaired tendon and subdeltoid fluid did not correlate with clinical outcome. ADVANCES IN KNOWLEDGE SE evaluations of repaired SST may provide important information about postoperative muscle strength and function.
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Affiliation(s)
- Ji Na Kim
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hee Jin Park
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Myung Sub Kim
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yoon Jung Choi
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eugene Kim
- Department of Orthopaedic surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jai Hyung Park
- Department of Orthopaedic surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seok Woo Hong
- Department of Orthopaedic surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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27
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Zhou Y, She H, Liu X, Wang R, Bai F. Outcomes After Combined Remnant Preservation and Bone Marrow Stimulation for Acute Rotator Cuff Tears. Orthop J Sports Med 2023; 11:23259671231152233. [PMID: 36814767 PMCID: PMC9940193 DOI: 10.1177/23259671231152233] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
Background Both remnant preservation (RP) and bone marrow stimulation (BMS) enhance the healing potential of the repaired rotator cuff by improving the biological milieu of the tendon-bone interface. Purpose To evaluate the clinical and imaging outcomes of arthroscopic rotator cuff repair using a combined RP-BMS technique in patients with acute rotator cuff tears. Study Design Cohort study; Level of evidence, 3. Methods Between January 2016 and June 2019, a total of 56 patients were diagnosed with acute rotator cuff tears; 29 patients underwent conventional repair (group 1), and 27 patients underwent RP-BMS (group 2). At a minimum follow-up period of 2 years, the authors compared clinical outcomes with the University of California-Los Angeles; Constant; American Shoulder and Elbow Surgeons; and pain visual analog scale scores as well as shoulder range of motion. Tendon integrity and retear were assessed on magnetic resonance imaging according to the Sugaya classification (intact, grades 1-3; retear, grades 4-5). Between-group comparisons were conducted using the Student t test or Mann-Whitney U test for continuous variables and the Pearson chi-square test or Fisher exact test for categorical variables. Results In both groups, patients had significant preoperative to postoperative improvement on all clinical outcome measures (P = .001 for all). Shoulder abduction in group 2 was significantly greater compared with group 1 at the postoperative 3-month (107.37° ± 8.32° vs 95.44° ± 8.78°; P = .001), 6-month (155.25° ± 10.02° vs 144.72° ± 9.28°; P = .001), and final (165.15° ± 9.17° vs 158.31° ± 8.01°; P = .021) follow-ups. At the final follow-up, significantly more patients in group 2 had intact tendons (Sugaya grades 1-3) compared with group 1 (P = .015), and the tendon retear rate was lower in group 2 (1/27; 3.70%) than in group 1 (7/29; 24.14%) (P = .033). Conclusion Both surgical techniques led to satisfactory clinical outcomes, but shoulder abduction was greater after the RP-BMS technique compared with conventional repair. RP-BMS may be an alternative surgical technique to improve tendon integrity and retear rates after the repair of acute rotator cuff tears.
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Affiliation(s)
- Yi Zhou
- Department of Orthopaedics, Jian Yang Hospital of Traditional Chinese Medicine, Jian Yang, China
| | - Hongjiang She
- Department of Orthopaedics, Third Affiliated Hospital of Zunyi Medical University (The First People’s Hospital of Zunyi City), Zunyi, China
| | - Xiaoyan Liu
- Department of Orthopaedics, Third Affiliated Hospital of Zunyi Medical University (The First People’s Hospital of Zunyi City), Zunyi, China
| | - Rui Wang
- Department of Orthopaedics, Third Affiliated Hospital of Zunyi Medical University (The First People’s Hospital of Zunyi City), Zunyi, China
| | - Fan Bai
- Department of Orthopaedics, Third Affiliated Hospital of Zunyi Medical University (The First People’s Hospital of Zunyi City), Zunyi, China.,Fan Bai, MD, Department of Orthopaedics, Third Affiliated Hospital of Zunyi Medical University (The First People’s Hospital of Zunyi City), Fenghuang Road No. 98, Huichuan District, Zunyi 563000, China ()
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Allaart LJH, Spanning SV, Lafosse L, Lafosse T, Ladermann A, Athwal GS, Hendrickx LAM, Doornberg JN, van den Bekerom MPJ, Buijze GA. Developing a machine learning algorithm to predict probability of retear and functional outcomes in patients undergoing rotator cuff repair surgery: protocol for a retrospective, multicentre study. BMJ Open 2023; 13:e063673. [PMID: 36764713 PMCID: PMC9923257 DOI: 10.1136/bmjopen-2022-063673] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
INTRODUCTION The effectiveness of rotator cuff tear repair surgery is influenced by multiple patient-related, pathology-centred and technical factors, which is thought to contribute to the reported retear rates between 17% and 94%. Adequate patient selection is thought to be essential in reaching satisfactory results. However, no clear consensus has been reached on which factors are most predictive of successful surgery. A clinical decision tool that encompassed all aspects is still to be made. Artificial intelligence (AI) and machine learning algorithms use complex self-learning models that can be used to make patient-specific decision-making tools. The aim of this study is to develop and train an algorithm that can be used as an online available clinical prediction tool, to predict the risk of retear in patients undergoing rotator cuff repair. METHODS AND ANALYSIS This is a retrospective, multicentre, cohort study using pooled individual patient data from multiple studies of patients who have undergone rotator cuff repair and were evaluated by advanced imaging for healing at a minimum of 6 months after surgery. This study consists of two parts. Part one: collecting all potential factors that might influence retear risks from retrospective multicentre data, aiming to include more than 1000 patients worldwide. Part two: combining all influencing factors into a model that can clinically be used as a prediction tool using machine learning. ETHICS AND DISSEMINATION For safe multicentre data exchange and analysis, our Machine Learning Consortium adheres to the WHO regulation 'Policy on Use and Sharing of Data Collected by WHO in Member States Outside the Context of Public Health Emergencies'. The study results will be disseminated through publication in a peer-reviewed journal. Institutional Review Board approval does not apply to the current study protocol.
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Affiliation(s)
- Laurens J H Allaart
- Orthopaedic Surgery, Clinique Générale Annecy, Annecy, Auvergne-Rhône-Alpes, France
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sanne van Spanning
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Shoulder and Elbow Unit, Joint Research, Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands
| | - Laurent Lafosse
- Orthopaedic Surgery, Clinique Générale Annecy, Annecy, Auvergne-Rhône-Alpes, France
| | - Thibault Lafosse
- Orthopaedic Surgery, Clinique Générale Annecy, Annecy, Auvergne-Rhône-Alpes, France
| | - Alexandre Ladermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hopital Prive SA, Meyrin, Switzerland
- Faculty of Medicine, University of Geneva, Geneve, Switzerland
| | - George S Athwal
- Roth McFarlane Hand and Upper Limb Center, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Laurent A M Hendrickx
- Department of Orthopedic Surgery, University of Amsterdam, Amsterdam, The Netherlands
- Orthopaedic and Trauma Surgery, Flinders University, Adelaide, South Australia, Australia
| | - Job N Doornberg
- Orthopaedic and Trauma Surgery, Flinders University, Adelaide, South Australia, Australia
- Orthopaedic Surgery, University Medical Centre Groningen, Groningen, The Netherlands
| | | | - Geert Alexander Buijze
- Orthopaedic Surgery, Clinique Générale Annecy, Annecy, Auvergne-Rhône-Alpes, France
- Department of Orthopedic Surgery, University of Amsterdam, Amsterdam, The Netherlands
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Chalmers PN, Joyce CD. Editorial Commentary: Rotator Cuff Repair in Patients With Diabetes: Stricter Glycemic Control for the First 6 Months Is Associated With Better Healing. Arthroscopy 2023; 39:183-184. [PMID: 36603989 DOI: 10.1016/j.arthro.2022.09.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 01/04/2023]
Abstract
Retear rates after arthroscopic rotator cuff repair continue to be unacceptably high. Of the known risk factors for failure of rotator cuff repair, many are nonmodifiable. Poor glycemic control in patients with diabetes in the first 3 to 6 months after arthroscopic rotator cuff repair is associated with a lower healing rate. This represents a modifiable risk factor that we should routinely address in patients postoperative rotator cuff repair.
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Han F, Li T, Li M, Zhang B, Wang Y, Zhu Y, Wu C. Nano-calcium silicate mineralized fish scale scaffolds for enhancing tendon-bone healing. Bioact Mater 2023; 20:29-40. [PMID: 35633872 PMCID: PMC9123220 DOI: 10.1016/j.bioactmat.2022.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 04/14/2022] [Accepted: 04/26/2022] [Indexed: 11/12/2022] Open
Abstract
Tendon-bone healing is essential for an effective rotator cuff tendon repair surgery, however, this remains a significant challenge due to the lack of biomaterials with high strength and bioactivity. Inspired by the high-performance exoskeleton of natural organisms, we set out to apply natural fish scale (FS) modified by calcium silicate nanoparticles (CS NPs) as a new biomaterial (CS-FS) to overcome the challenge. Benefit from its “Bouligand” microstructure, such FS-based scaffold maintained excellent tensile strength (125.05 MPa) and toughness (14.16 MJ/m3), which are 1.93 and 2.72 times that of natural tendon respectively, allowing it to well meet the requirements for rotator cuff tendon repair. Additionally, CS-FS showed diverse bioactivities by stimulating the differentiation and phenotypic maintenance of multiple types of cells participated into the composition of tendon-bone junction, (e.g. bone marrow mesenchymal stem cells (BMSCs), chondrocyte, and tendon stem/progenitor cells (TSPCs)). In both rat and rabbit rotator cuff tear (RCT) models, CS-FS played a key role in the tendon-bone interface regeneration and biomechanical function, which may be achieved by activating BMP-2/Smad/Runx2 pathway in BMSCs. Therefore, natural fish scale -based biomaterials are the promising candidate for clinical tendon repair due to their outstanding strength and bioactivity. Nano-calcium silicate mineralized fish scale scaffold was first developed for tendon defect repair. •CS-FS exhibited excellent mechanical properties superior to those of natural tendon. •CS-FS showed diverse bioactivities by stimulating the differentiation of multiple types of cells. •CS NPs accelerated tendon-bone interface tendon-bone healing enhancement and biomechanical recovery.
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31
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Hart DA, Ahmed AS, Ackermann P. Optimizing repair of tendon ruptures and chronic tendinopathies: Integrating the use of biomarkers with biological interventions to improve patient outcomes and clinical trial design. Front Sports Act Living 2023; 4:1081129. [PMID: 36685063 PMCID: PMC9853460 DOI: 10.3389/fspor.2022.1081129] [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: 10/26/2022] [Accepted: 12/09/2022] [Indexed: 01/09/2023] Open
Abstract
Tendons are dense connective tissues of the musculoskeletal system that link bones with muscles to foster mobility. They have complex structures and exist in varying biomechanical, metabolic and biological environments. In addition, tendon composition and mechanical properties can change over the lifespan as an individual ages. Many tendons function in high stress conditions with a low vascular and neuronal supply, conditions often leading to development of chronic tendinopathies, and in some cases, overt rupture of the tissues. Given their essential nature for human mobility and navigation through the environment, the effective repair and regeneration of different tendons after injury or damage is critical for quality of life, and for elite athletes, the return to sport participation at a high level. However, for mainly unknown reasons, the outcomes following injury are not always successful and lead to functional compromise and risk for re-injury. Thus, there is a need to identify those patients who are at risk for developing tendon problems, as well those at risk for poor outcomes after injury and to design interventions to improve outcomes after injury or rupture to specific tendons. This review will discuss recent advances in the identification of biomarkers prognostic for successful and less successful outcomes after tendon injury, and the mechanistic implications of such biomarkers, as well as the potential for specific biologic interventions to enhance outcomes to improve both quality of life and a return to participation in sports. In addition, the implication of these biomarkers for clinical trial design is discussed, as is the issue of whether such biomarkers for successful healing of one tendon can be extended to all tendons or are valid only for tendons in specific biomechanical and biological environments. As maintaining an active lifestyle is critical for health, the successful implementation of these advances will benefit the large number of individuals at risk.
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Affiliation(s)
- David A. Hart
- Department of Surgery, Faculty of Kinesiology, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada,Correspondence: David A. Hart
| | - Aisha S. Ahmed
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Paul Ackermann
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Turcotte JJ, Kelly M, West M, Lashgari C, Petre BM, Redziniak DE. Rates of medial and lateral row failure and risk factors for Re-tear in arthroscopic double row rotator cuff repair. J Clin Orthop Trauma 2023; 36:102083. [PMID: 36506592 PMCID: PMC9731871 DOI: 10.1016/j.jcot.2022.102083] [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: 03/01/2022] [Revised: 10/25/2022] [Accepted: 11/24/2022] [Indexed: 11/30/2022] Open
Abstract
A common postoperative complication after rotator cuff repair is re-tear requiring a secondary procedure. Double row and trans-osseous equivalent repair techniques have become increasingly popular in recent years, however repair failure remains a relatively common complication after primary rotator cuff repair. A retrospective observational study of 389 consecutive patients undergoing arthroscopic double-row rotator cuff repair from February 1, 2014 to March 31, 2020 was conducted. Univariate and multivariate statistics were used to assess differences in demographics, comorbidities, and tear characteristics between patients who experienced re-tear and those who did not. Repair failures were confirmed by plain MRI or intraoperatively during repeat surgical treatment. A subgroup analysis of patients who experienced re-tear due to medial row failure was conducted. The overall re-tear rate was 8.2% (32 patients). Six patients (1.5%) experienced medial row failure, while 26 patients (6.7%) experienced lateral row failure. The average time to re-tear was 279.3 ± 291.2 days. On multivariate analysis, patients with Goutallier Classification ≥3 (OR: 4.274, p = 0.046) and 3 anchor repair (OR: 5.387, p = 0.027) were at significantly increased risk for any re-tear after controlling for other tear characteristics. No statistically significant independent risk factors for medial row failure were identified after controlling for confounding variables. Goutallier classification greater than 3 and a primary repair with 3 anchors are significant risk factors for re-tear after double row rotator cuff repair, however they are not associated with increased occurrence of medial row failure. Further evaluation of risk factors for medial row failure is required to avoid this rare but serious re-tear pattern.
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Bowen E, Allen A, Bedi A. Rotator Cuff Repair: How Many Rows? OPER TECHN SPORT MED 2023. [DOI: 10.1016/j.otsm.2023.150980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Luo W, Wang Y, Han Q, Wang Z, Jiao J, Gong X, Liu Y, Zhang A, Zhang H, Chen H, Wang J, Wu M. Advanced strategies for constructing interfacial tissues of bone and tendon/ligament. J Tissue Eng 2022; 13:20417314221144714. [PMID: 36582940 PMCID: PMC9793068 DOI: 10.1177/20417314221144714] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/26/2022] [Indexed: 12/25/2022] Open
Abstract
Enthesis, the interfacial tissue between a tendon/ligament and bone, exhibits a complex histological transition from soft to hard tissue, which significantly complicates its repair and regeneration after injury. Because traditional surgical treatments for enthesis injury are not satisfactory, tissue engineering has emerged as a strategy for improving treatment success. Rapid advances in enthesis tissue engineering have led to the development of several strategies for promoting enthesis tissue regeneration, including biological scaffolds, cells, growth factors, and biophysical modulation. In this review, we discuss recent advances in enthesis tissue engineering, particularly the use of biological scaffolds, as well as perspectives on the future directions in enthesis tissue engineering.
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Affiliation(s)
- Wangwang Luo
- Department of Orthopedics, The Second
Hospital of Jilin University, Changchun, China
| | - Yang Wang
- Department of Orthopedics, The Second
Hospital of Jilin University, Changchun, China
| | - Qing Han
- Department of Orthopedics, The Second
Hospital of Jilin University, Changchun, China
| | - Zhonghan Wang
- Department of Orthopedics, The Second
Hospital of Jilin University, Changchun, China,Orthopaedic Research Institute of Jilin
Province, Changchun, China
| | - Jianhang Jiao
- Department of Orthopedics, The Second
Hospital of Jilin University, Changchun, China
| | - Xuqiang Gong
- Department of Orthopedics, The Second
Hospital of Jilin University, Changchun, China
| | - Yang Liu
- Department of Orthopedics, The Second
Hospital of Jilin University, Changchun, China
| | - Aobo Zhang
- Department of Orthopedics, The Second
Hospital of Jilin University, Changchun, China
| | - Han Zhang
- Department of Orthopedics, The Second
Hospital of Jilin University, Changchun, China
| | - Hao Chen
- Department of Orthopedics, The Second
Hospital of Jilin University, Changchun, China
| | - Jincheng Wang
- Department of Orthopedics, The Second
Hospital of Jilin University, Changchun, China
| | - Minfei Wu
- Department of Orthopedics, The Second
Hospital of Jilin University, Changchun, China,Minfei Wu, Department of Orthopedics, The
Second Hospital of Jilin University, 218 Ziqiang Sreet, Changchun 130041, China.
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Płomiński J, Grzybowski R, Fiedorowicz E, Sienkiewicz-Szłapka E, Rozmus D, Król-Grzymała A, Jarmołowska B, Kordulewska N, Cieślińska A. Vitamin D Metabolic Pathway Components in Orthopedic Patientes-Systematic Review. Int J Mol Sci 2022; 23:ijms232415556. [PMID: 36555202 PMCID: PMC9779124 DOI: 10.3390/ijms232415556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/17/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022] Open
Abstract
Vitamin D takes part in the functioning of many processes that ensure the homeostasis of the body. In orthopedics, it is indicated as an inseparable element ensuring proper bone growth and functioning, and its deficiencies are indicated in various diseases, mainly in the proper structure and function of the skeleton. In this review, we focus on the most important components of the vitamin D metabolic pathway, in correlation with selected orthopedic conditions. Records were obtained from the PubMed database in a timeline of 2010-2022. The keywords were as follows: vitamin D/cholesterol/vitamin D binding protein/ VDBP/Cytochrome/CYP24A1/CYP 27B1/Vitamin D receptor/VDR/ + diseases (ACL reconstruction, rotator cuff, arthroplasty knee/hip/shoulder). The recent original studies were analyzed, discussed, and the most important data were shown. The vast majority of articles concern the metabolite of vitamin D (25(OH)D), which is measured as a standard in diagnostic laboratories. Even though there is a lot of valuable information in the literature, we believe that the other elements of the vitamin D pathway also deserve attention and suggest their research in correlation with orthopedic disorders to supplement the missing knowledge on this topic.
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Affiliation(s)
- Janusz Płomiński
- Clinical Department of Trauma—Orthopedic Surgery and Spine Surgery of the Provincial Specialist Hospital in Olsztyn, 10-561 Olsztyn, Poland
- Department and Clinic of Orthopedics and Traumatology, Collegium Medicum, University of Warmia and Mazury, 10-719 Olsztyn, Poland
| | - Roman Grzybowski
- Department and Clinic of Orthopedics and Traumatology, Collegium Medicum, University of Warmia and Mazury, 10-719 Olsztyn, Poland
| | - Ewa Fiedorowicz
- Faculty of Biology and Biotechnology, University of Warmia and Mazury, 10-719 Olsztyn, Poland
| | | | - Dominika Rozmus
- Faculty of Biology and Biotechnology, University of Warmia and Mazury, 10-719 Olsztyn, Poland
| | - Angelika Król-Grzymała
- Faculty of Biology and Biotechnology, University of Warmia and Mazury, 10-719 Olsztyn, Poland
| | - Beata Jarmołowska
- Faculty of Biology and Biotechnology, University of Warmia and Mazury, 10-719 Olsztyn, Poland
| | - Natalia Kordulewska
- Faculty of Biology and Biotechnology, University of Warmia and Mazury, 10-719 Olsztyn, Poland
| | - Anna Cieślińska
- Faculty of Biology and Biotechnology, University of Warmia and Mazury, 10-719 Olsztyn, Poland
- Correspondence:
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Li Y, Zhou M, Zheng W, Yang J, Jiang N. Scaffold-based tissue engineering strategies for soft-hard interface regeneration. Regen Biomater 2022; 10:rbac091. [PMID: 36683751 PMCID: PMC9847541 DOI: 10.1093/rb/rbac091] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 10/22/2022] [Accepted: 10/26/2022] [Indexed: 11/13/2022] Open
Abstract
Repairing injured tendon or ligament attachments to bones (enthesis) remains costly and challenging. Despite superb surgical management, the disorganized enthesis newly formed after surgery accounts for high recurrence rates after operations. Tissue engineering offers efficient alternatives to promote healing and regeneration of the specialized enthesis tissue. Load-transmitting functions thus can be restored with appropriate biomaterials and engineering strategies. Interestingly, recent studies have focused more on microstructure especially the arrangement of fibers since Rossetti successfully demonstrated the variability of fiber underspecific external force. In this review, we provide an important update on the current strategies for scaffold-based tissue engineering of enthesis when natural structure and properties are equally emphasized. We firstly described compositions, structures and features of natural enthesis with their special mechanical properties highlighted. Stimuli for growth, development and healing of enthesis widely used in popular strategies are systematically summarized. We discuss the fabrication of engineering scaffolds from the aspects of biomaterials, techniques and design strategies and comprehensively evaluate the advantages and disadvantages of each strategy. At last, this review pinpoints the remaining challenges and research directions to make breakthroughs in further studies.
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Affiliation(s)
| | | | - Wenzhuo Zheng
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | | | - Nan Jiang
- Correspondence address. E-mail: (N.J.); (J.Y.)
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Vervaecke AJ, Carbone AD, Abraham A, Bernstein Z, Laudier D, Verborgt O, Galatz LM, Huang AH. Tendon progenitor cells as biological augmentation improve functional gait and reduce scar formation after rotator cuff repair. J Shoulder Elbow Surg 2022; 31:2366-2380. [PMID: 35671924 PMCID: PMC9588545 DOI: 10.1016/j.jse.2022.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 05/04/2022] [Accepted: 05/07/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND High rates of structural failure are reported after rotator cuff repairs due to inability to recreate the native enthesis during healing. The development of biological augmentation methods that mitigate scar formation and regenerate the enthesis is still an unmet need. Since neonatal enthesis is capable of regeneration after injury, this study tested whether delivery of neonatal tendon progenitor cells (TPCs) into the adult injured environment can enhance functional and structural supraspinatus enthesis and tendon healing. METHODS TPCs were isolated from Ai14 Rosa26-TdTomato mouse Achilles tendons and labeled using adenovirus-Cre. Fifty-two CB57BL/6J mice underwent detachment and acute repair of the supraspinatus tendon and received either a fibrin-only or TPC-fibrin gel. Immunofluorescence analysis was carried out to determine cellularity (DAPI), fibrocartilage (SOX9), macrophages (F4/80), myofibroblasts (α-smooth muscle actin), and scar (laminin). Assays for function (gait and biomechanical testing) and structure (micro-computed tomography imaging, picrosirius red/Alcian Blue staining, type I and III collagen staining) were carried out. RESULTS Analysis of TdTomato cells after injury showed minimal retention of TPCs by day 7 and day 14, with detected cells localized near the bursa and deltoid rather than the enthesis/tendon. However, TPC delivery led to significantly increased %Sox9+ cells in the enthesis at day 7 after injury and decreased laminin intensity across almost all time points compared to fibrin-only treatment. Similarly, TPC-treated mice showed gait recovery by day 14 (paw area and stride length) and day 28 (stance time), while fibrin-treated mice failed to recover gait parameters. Despite improved gait, biomechanical testing showed no differences between groups. Structural analysis by micro-computed tomography suggests that TPC application improves cortical thickness after surgery compared to fibrin. Superior collagen alignment at the neo-enthesis was also observed in the TPC-augmented group at day 28, but no difference was detected in type I and III collagen intensity. CONCLUSION We found that neonatal TPCs improved and restored functional gait by reducing overall scar formation, improving enthesis collagen alignment, and altering bony composition response after supraspinatus tendon repair. TPCs did not appear to integrate into the healing tissue, suggesting improved healing may be due to paracrine effects at early stages. Future work will determine the factors secreted by TPCs to develop translational targets.
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Affiliation(s)
- Alexander J Vervaecke
- Department of Orthopaedics, The Mount Sinai Hospital, New York, NY, USA; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Orthopaedic Center Antwerp, AZ Monica, Antwerp, Belgium
| | - Andrew D Carbone
- Department of Orthopaedics, The Mount Sinai Hospital, New York, NY, USA
| | - Adam Abraham
- Department of Orthopaedics, University of Michigan, Ann Arbor, Mich, USA
| | - Zachary Bernstein
- Department of Orthopaedics, The Mount Sinai Hospital, New York, NY, USA
| | - Damien Laudier
- Department of Orthopaedics, The Mount Sinai Hospital, New York, NY, USA
| | - Olivier Verborgt
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Orthopaedic Center Antwerp, AZ Monica, Antwerp, Belgium
| | - Leesa M Galatz
- Department of Orthopaedics, The Mount Sinai Hospital, New York, NY, USA.
| | - Alice H Huang
- Department of Orthopedic Surgery, Columbia University, New York, NY, USA.
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Shen W, Wang W, Xue Y, Shi J, Pu Z, Gao Q. Comparative effectiveness of different platelet-rich plasma for arthroscopic rotator cuff repair: A protocol for systematic review and network meta-analysis. Medicine (Baltimore) 2022; 101:e31260. [PMID: 36281097 PMCID: PMC9592368 DOI: 10.1097/md.0000000000031260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Rotator cuff tears are one of the most common injuries of the shoulder joint in adults. Arthroscopic rotator cuff repair (ARCR) has become the gold standard for the treatment of rotator cuff injuries, but it still has a high rate of retear. Platelet-rich plasma (PRP) has been widely used as an adjunct to ARCR. However, the comparative efficacy of different PRP for ARCR remain unclear. In order to evaluate the relative efficacy of PRP for individuals with ARCR, we will conduct a systematic review and network meta-analysis of randomized controlled trials. METHODS A systematic literature search will be conducted in Embase, PubMed, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang Database, and Chinese Biomedical Literature Database will be searched up to October 2022. The primary outcome will focus on the retear rate at the last follow-up. The secondary outcomes include the Visual Analogue Scale for postoperative pain and functional capacity scores. The risk of bias for individual studies will be assessed according to the revised Cochrane risk-of-bias tool for randomized trials (RoB 2.0). Data analysis will be performed using R 4.1.2. Publication bias will be examined using comparison-adjusted funnel plots and Egger's test using STATA 15.0. The quality of evidence will be assessed using the Grading of Recommendations, Assessment, Development and Evaluation approach. RESULTS The results of this study will be submitted to a peer-reviewed journal for publication. CONCLUSIONS The review will compare the efficacy of different PRP for patients with ARCR. The result of the study will provide evidence-based medical evidence for ARCR with PRP augmentation.
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Affiliation(s)
- Weiwei Shen
- Orthopedics Center of PLA, The 940th Hospital of Joint Logistics Support Force Army of PLA, Lanzhou, China
| | - Wei Wang
- Department of Orthopedics, The Third People’s Hospital, Baiyin, China
| | - Yun Xue
- Orthopedics Center of PLA, The 940th Hospital of Joint Logistics Support Force Army of PLA, Lanzhou, China
| | - Jie Shi
- Orthopedics Center of PLA, The 940th Hospital of Joint Logistics Support Force Army of PLA, Lanzhou, China
| | - Zhongshu Pu
- Department of Infection Control, The 940th Hospital of Joint Logistics Support Force Army of PLA, Lanzhou, China
| | - Qiuming Gao
- Orthopedics Center of PLA, The 940th Hospital of Joint Logistics Support Force Army of PLA, Lanzhou, China
- * Correspondence: Qiuming Gao, Orthopedics Center of PLA, The 940th Hospital of Joint Logistics Support Force Army of PLA, Lanzhou, Gansu Province 730050, China (e-mail: )
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Vaysman M, Alben M, Todd M, Ruotolo C. Pharmacologic Enhancement of Rotator Cuff Repair: A Narrative Review. Orthop Rev (Pavia) 2022; 14:37782. [PMID: 36072503 PMCID: PMC9441107 DOI: 10.52965/001c.37782] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2024] Open
Abstract
INTRODUCTION As rotator cuff repairs (RCRs) are among the most common procedures in upper extremity orthopedics, healing augmentation using pharmacologic enhancement of the repaired rotator cuff muscle is of particular interest. OBJECTIVE The purpose of this study is to review the current understanding of Matrix Metalloproteinases (MMPs), Doxycycline, Testosterone, Estrogen, Growth hormone/ IGF-1, Vitamin D, and Vitamin C as a means to mitigate deleterious effects and propagate factors that support healing following RCR. METHODS A review of English language articles in PubMed and Medline was conducted in December of 2020. All articles describing the current understanding of the aforementioned therapies were reviewed. Studies were excluded if they were non-English or reported incomplete results. RESULTS Matrix metalloproteinases (MMP's) are fundamental to the healing process after rotator cuff tears through a delicate balance of various proteases that can be modulated by doxycycline through inhibition. While testosterone has shown to induce replication and differentiation of the tendon stem-cells, estrogen agonists have been shown to decrease inflammation and muscle atrophy. Though growth hormone being associated with elevated collagen synthesis and decreased anoxic damage when present, clinical studies have shown inconclusive and adverse effects on rotator cuff healing. Patients with Vitamin D deficiency have shown to have increased fatty infiltration in rotator cuff muscle while Vitamin C functions as an antioxidant that increases collagen and fibroblast proliferation. CONCLUSION As manipulation of pharmacologic factors shows potential for enhancing healing following RCRs, future studies are needed to establish a viable augmentation strategy to improve patient outcomes.
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Affiliation(s)
| | - Matthew Alben
- Orthopedic Surgery, Nassau University Medical Center; Osteopathic Medicine, New York Institute of Technology
| | - Matthew Todd
- Orthopedic Surgery, Nassau University Medical Center; Osteopathic Medicine, Des Moines College of Osteopathic Medicine
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Otto A, LeVasseur MR, Baldino JB, Muench LN, Bellas N, Uyeki C, Trudeau MT, Mancini MR, McCarthy MBR, Mazzocca AD. Clinical Outcomes After Arthroscopic Rotator Cuff Repair With a Fibrin Scaffold Containing Growth Factors and Autologous Progenitor Cells Derived from cBMA. Arthrosc Sports Med Rehabil 2022; 4:e1629-e1637. [PMID: 36312725 PMCID: PMC9596864 DOI: 10.1016/j.asmr.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 06/07/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose To report the clinical outcomes after biologically augmented rotator cuff repair (RCR) with a fibrin scaffold derived from autologous whole blood and supplemented with concentrated bone marrow aspirate (cBMA) harvested at the proximal humerus. Methods Patients who underwent arthroscopic RCR with biologic augmentation using a fibrin clot scaffold (“Mega- Clot”) containing progenitor cells and growth factors from proximal humerus BMA and autologous whole blood between April 2015 and January 2018 were prospectively followed. Only high-risk patients in primary and revision cases that possessed relevant comorbidities or physically demanding occupation were included. Minimum follow-up for inclusion was 1 year. The visual analog score for pain (VAS), American Shoulder and Elbow Surgeons (ASES), Simple Shoulder Test (SST), Single Assessment Numerical Evaluation (SANE), and Constant-Murley scores were collected preoperatively and at final follow-up. In vitro analyses of the cBMA and fibrin clot using nucleated cell count, colony forming units, and live/dead assays were used to quantify the substrates. Results Thirteen patients (56.9 ± 7.7 years) were included. The mean follow-up was 26.9 ± 17.7 months (n = 13). There were significant improvements in all outcome scores from the preoperative to the postoperative state: VAS (5.6 ± 2.5 to 3.1 ± 3.2; P < .001), ASES (42.0 ± 17.1 to 65.5 ± 30.6; P < .001), SST (3.2 ± 2.8 to 6.5 ± 4.7; P = .002), SANE (11.5 ± 15.6 to 50.3 ± 36.5; P < .001), and Constant-Murley (38.9 ± 17.5 to 58.1 ± 26.3; P < .001). Six patients (46%) had retears on postoperative MRI, despite all having improvements in pain and function except one. All failures were chronic rotator cuff tears, and all were revision cases except one (1.6 ± 0.5 previous RCRs). The representative sample of harvested cBMA showed an average of 28.5 ± 9.1 × 106 nucleated cells per mL. Conclusions Arthroscopic rotator cuff repairs that are biologically augmented with a fibrin scaffold containing growth factors and autologous progenitor cells derived from autologous whole blood and humeral cBMA can improve clinical outcomes in primary, as well as revision cases in high-risk patients. However, the incidence of retears remains a concern in this population, demanding further improvements in biologic augmentation. Level of Evidence IV, therapeutic case series.
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Affiliation(s)
- Alexander Otto
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
- Department of Trauma, Orthopaedic, Plastic and Hand Surgery, University Hospital of Augsburg, Augsburg, Germany
| | - Matthew R. LeVasseur
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Joshua B. Baldino
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Lukas N. Muench
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Nicholas Bellas
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Colin Uyeki
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Maxwell T. Trudeau
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Michael R. Mancini
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Mary Beth R. McCarthy
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Augustus D. Mazzocca
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
- Address correspondence to Augustus D. Mazzocca, M.D., M.S., Division of Sports Medicine Mass General Hospital, Department of Orthopaedic Surgery Massachusetts General Hospital & Harvard Medical School, Boston, MA, U.S.A.
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Stengaard K, Hejbøl EK, Jensen PT, Degn M, Ta TML, Stensballe A, Andersen DC, Schrøder HD, Lambertsen KL, Frich LH. Early-stage inflammation changes in supraspinatus muscle after rotator cuff tear. J Shoulder Elbow Surg 2022; 31:1344-1356. [PMID: 35150831 DOI: 10.1016/j.jse.2021.12.046] [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: 06/30/2021] [Revised: 12/12/2021] [Accepted: 12/25/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Rotator cuff (RC) tendon tear leads to impaired shoulder function and pain. The supraspinatus (SS) tendon is most often affected, but the biological response of the SS muscle to SS tendon tear is largely unknown. This study aimed to investigate time-dependent muscle inflammation, degeneration, fatty infiltration, and regeneration in experimental SS tear conditions. METHODS Forty-five C57BL/6 mice were subjected to SS tendon tear and allowed to recover for 1, 3, 5, 7, 14, or 28 days. The extent of muscle damage was examined using histologic, flow cytometric, proteomic, and chemiluminescence analyses. RESULTS We found that muscle inflammation peaked around day 5 with increased monocyte infiltration and increased cytokine levels in the ipsilateral compared to the contralateral SS muscle. Bioinformatics analysis of proteomics on mice that survived 5 days after RC tendon tear revealed upregulated proteins involved in "neutrophil activation involved in immune response" and "extracellular matrix organization," whereas "skeletal muscle tissue development and contraction" and "respiratory electron transport chain" were among the most downregulated. Histologic analysis of collagen showed increased collagen accumulation and fatty infiltration of the ipsilateral SS over time. Finally, we observed time- and lesion-dependent changes in satellite cell and fibro-adipogenic progenitor populations. CONCLUSION Altogether, we demonstrate that the SS muscle shows severe signs of acute inflammation, early degeneration, and fatty infiltration, as well as reduced regenerative potential following SS tendon tear.
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Affiliation(s)
- Kira Stengaard
- Department of Neurobiology Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Eva Kildall Hejbøl
- Department of Orthopedics, Hospital Sønderjylland, Region of Southern Denmark, Denmark
| | - Peter Toft Jensen
- Department of Neurobiology Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Matilda Degn
- Pediatric Oncology Laboratory, Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Thi My Linh Ta
- Department of Neurobiology Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Allan Stensballe
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Ditte Caroline Andersen
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Institute of Clinical Research, University of Southern, Denmark
| | | | - Kate Lykke Lambertsen
- Department of Neurobiology Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark; Department of Neurology, Odense University Hospital, Odense, Denmark; BRIDGE-Brain Research-Inter-Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lars Henrik Frich
- Department of Neurobiology Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark; Department of Orthopedics, Hospital Sønderjylland, Region of Southern Denmark, Denmark; Orthopedic Research Unit, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
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Functional and radiologic results of the crimson duvet procedure in rotator cuff treatment: a randomized controlled clinical trial. J Shoulder Elbow Surg 2022; 31:1200-1207. [PMID: 35007748 DOI: 10.1016/j.jse.2021.12.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 11/25/2021] [Accepted: 12/04/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Rotator cuff tears are one of the more frequent pathologies of the shoulder. Arthroscopic techniques and biologic augmentation have been developed to improve the rate and quality of healing. The crimson duvet procedure (CDP) theoretically provides mesenchymal stem cells through microfracture treatment of the footprint. The aim of this research was to evaluate the effect of CDP in patients who had undergone arthroscopic surgery for complete rotator cuff repair. METHODS A prospective randomized clinical trial was performed in a total of 123 patients, consisting of 59 women and 64 men, with a mean age of 58 years. We included patients with a clinical and radiologic diagnosis of a complete rotator cuff tear. All patients were treated with arthroscopic rotator cuff repair. In group 1, the surface of the footprint was débrided; in group 2, the footprint underwent microfracture. The primary outcome was the nonhealing rate, which was detected by magnetic resonance imaging (MRI) or ultrasonography, and the secondary outcome was the functional result. A Sugaya classification of I to III was considered to indicate healing. For clinical evaluation, the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) and Constant scores were evaluated, along with the range of motion. The functional evaluation was performed preoperatively and at 6 months and 1 year postoperatively. The radiologic (MRI or ultrasonography) evaluation was performed at 6 months. Neither the patients nor the radiologists and physical therapists who performed the postoperative evaluations were informed of the random selection. RESULTS We observed a healing rate of 85.11% in the control group and 93.7% in the CDP group, which was not significant (P = .19). However, a significant improvement in function was observed in all patients. The ASES score improved from 68.9 (SD 13.8) preoperatively to 92.2 at 6 months and to 96.4 (SD 6.2) at 12 months (P < .05), but no difference was observed between the groups. A similar level of improvement was observed in the Constant score. CONCLUSION The arthroscopic repair of complete rotator cuff tears presents good and excellent clinical results in most patients. Nevertheless, nonhealing occurs at a rate that depends mainly on the age of the patient and the size of the tear. The addition of CDP did not improve the functional results or the healing rate.
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Peng Y, Li X, Wu W, Ma H, Wang G, Jia S, Zheng C. Effect of Mechanical Stimulation Combined With Platelet-Rich Plasma on Healing of the Rotator Cuff in a Murine Model. Am J Sports Med 2022; 50:1358-1368. [PMID: 35188809 DOI: 10.1177/03635465211073339] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND Mechanical stimulation and platelet-rich plasma (PRP) have been shown to be beneficial for healing of the bone-tendon interface (BTI), but few studies have explored the efficacy of a combination of these applications. We investigated the effect of mechanical stimulation combined with PRP on rotator cuff repair in mice. HYPOTHESIS Mechanical stimulation combined with PRP can enhance BTI healing in a murine model of rotator cuff repair. STUDY DESIGN Controlled laboratory study. METHODS A total of 160 C57BL/6 mice were used. Overall, 40 mice were used to prepare PRP, while 120 mice underwent acute supraspinatus tendon (SST) repair. The animals were randomly assigned to 4 groups: control group, mechanical stimulation group, PRP group, and mechanical stimulation combined with PRP group (combination group). At 4 and 8 weeks postoperatively, animals were sacrificed, the eyeballs were removed to collect blood, and the SST-humeral complexes were collected. Histological, biomechanical, immunological, and bone morphometric tests were performed. RESULTS Histologically, at 4 and 8 weeks after surgery, the area of the fibrocartilage layer at the BTI in the combination group was larger than in the other groups. The content and distribution of proteoglycans in this layer in the combination group were significantly greater than in the other groups. At 8 weeks postoperatively, trabecular number, and trabecular bone thickness of the subchondral bone area of interest at the BTI of the combination group were greater than those of the other groups, bone volume fraction of the combination group was greater than the control group. On biomechanical testing at 4 and 8 weeks after surgery, the failure load and ultimate strength of the SST-humeral complex in the combination group were higher than in the other groups. Enzyme-linked immunosorbent assay results showed that, at 4 weeks postoperatively, the serum concentrations of transforming growth factor beta 1 and platelet-derived growth factor (PDGF) in the combination group were significantly higher than in the other groups; at 8 weeks, the PDGF-AB concentration in the combination group was higher than in the control and mechanical stimulation groups. CONCLUSION Mechanical stimulation combined with PRP can effectively promote the early stage of healing after a rotator cuff injury. CLINICAL RELEVANCE These findings imply that mechanical stimulation combined with PRP can serve as a potential therapeutic strategy for rotator cuff healing.
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Affiliation(s)
- Yundong Peng
- College of Health Science, Wuhan Sports University, Wuhan, China
| | - Xiaomei Li
- College of Health Science, Wuhan Sports University, Wuhan, China.,Medical College, Huainan Union University, Huainan, China
| | - Wenxia Wu
- College of Health Science, Wuhan Sports University, Wuhan, China.,Department of Rehabilitation Therapy, Jinci College of Shanxi Medical University, Taiyuan, China
| | - Haozhe Ma
- College of International Education, Wuhan Sports University, Wuhan, China
| | - Guanglan Wang
- College of Health Science, Wuhan Sports University, Wuhan, China
| | - Shaohui Jia
- Hubei Provincial Collaborative Innovation Center for Exercise and Health Promotion, College of Health Science, Wuhan Sports University, Wuhan, China
| | - Cheng Zheng
- Department of Sports Medicine, Affiliated Hospital, Wuhan Sports University, Wuhan, China
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Yang J, Kang Y, Zhao W, Jiang J, Jiang Y, Zhao B, Jiao M, Yuan B, Zhao J, Ma B. Evaluation of patches for rotator cuff repair: A systematic review and meta-analysis based on animal studies. Bioact Mater 2022; 10:474-491. [PMID: 34901561 PMCID: PMC8633530 DOI: 10.1016/j.bioactmat.2021.08.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/12/2021] [Accepted: 08/12/2021] [Indexed: 02/06/2023] Open
Abstract
Based on the published animal studies, we systematically evaluated the outcomes of various materials for rotator cuff repair in animal models and the potentials of their clinical translation. 74 animal studies were finally included, of which naturally derived biomaterials were applied the most widely (50.0%), rats were the most commonly used animal model (47.0%), and autologous tissue demonstrated the best outcomes in all animal models. The biomechanical properties of naturally derived biomaterials (maximum failure load: WMD 18.68 [95%CI 7.71-29.66]; P = 0.001, and stiffness: WMD 1.30 [95%CI 0.01-2.60]; P = 0.048) was statistically significant in the rabbit model. The rabbit model showed better outcomes even though the injury was severer compared with the rat model.
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Affiliation(s)
- Jinwei Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China
- Reproductive Medicine Center, Gansu Provincial Maternity and Child-Care Hospital, Lanzhou, 730050, China
| | - Yuhao Kang
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Wanlu Zhao
- College of Biomedical Engineering, Sichuan University, Chengdu, 610064, China
- National Engineering Research Center for Biomaterials, Chengdu, 610064, China
| | - Jia Jiang
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Yanbiao Jiang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China
| | - Bing Zhao
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China
| | - Mingyue Jiao
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China
| | - Bo Yuan
- College of Biomedical Engineering, Sichuan University, Chengdu, 610064, China
- National Engineering Research Center for Biomaterials, Chengdu, 610064, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Bin Ma
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, China
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Efficacy of Arthroscopic Shavers for the Retrieval and Processing of Connective Tissue Progenitor Cells from Subacromial Bursal Tissue. J Clin Med 2022; 11:jcm11051272. [PMID: 35268363 PMCID: PMC8911141 DOI: 10.3390/jcm11051272] [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: 12/08/2021] [Revised: 02/15/2022] [Accepted: 02/23/2022] [Indexed: 12/04/2022] Open
Abstract
The purpose of this study is to determine if arthroscopic shavers can effectively collect and process connective tissue progenitor (CTP) cells from subacromial bursal tissue for utilization in rotator cuff repair augmentation. Subacromial bursal tissue was collected and processed using two arthroscopic shavers, Shaver A and Shaver B, in 10 patients undergoing arthroscopic rotator cuff repair. Each shaver was used in a random order for the same patient. Tissue samples underwent testing for cellular proliferation, cellular concentration, number of colony-forming units (CFU), live/dead assay, fluorescence-activated cells sorting (FACS) analysis, cytokine analysis, and growth factor analysis. Shaver A produced more CFUs compared to Shaver B (210.3 vs. 125.9; p < 0.001). At 3 weeks, cells collected via Shaver A had greater cellular proliferation (0.35 vs. 0.51; p < 0.001) as well as more viable cells (214,773 vs. 132,356 cells/gram; p < 0.001). Tissue collected with Shaver B had greater amounts of the cytokines MMP-1 (3741 vs. 5500 pg/mL; p < 0.001), MMP-3 (1131 vs. 1871 pg/mL; p < 0.001), and MMP-13 (179 vs. 401 pg/mL; p < 0.001), while those collected with Shaver A had greater vascular endothelial growth factor (VEGF) (47.8 vs. 9.0 pg/mL; p < 0.05). Arthroscopic shavers are capable of harvesting and processing CTP cells from subacromial bursal tissue. Different shavers may produce different yields of viable CTP cells.
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Significant Improvement in Shoulder Function and Pain in Patients Following Biologic Augmentation of Revision Arthroscopic Rotator Cuff Repair Using an Autologous Fibrin Scaffold and Bone Marrow Aspirate Derived From the Proximal Humerus. Arthrosc Sports Med Rehabil 2021; 3:e1819-e1825. [PMID: 34977636 PMCID: PMC8689277 DOI: 10.1016/j.asmr.2021.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 08/18/2021] [Indexed: 12/30/2022] Open
Abstract
Purpose To clinically evaluate patients who underwent a biologic augmentation technique in revision arthroscopic rotator cuff repair using an autologous fibrin scaffold and concentrated stem cells isolated from bone marrow aspirate (BMA) obtained from the proximal humerus. Methods This is a retrospective review of prospectively collected data from patients who underwent biologic augmentation of revision arthroscopic rotator cuff repair using an autologous fibrin scaffold and BMA obtained from the proximal humerus between 2014 and 2015. Minimum follow-up was 12 months. Outcome measures were collected preoperatively and postoperatively including range of motion as well as American Shoulder and Elbow Surgeons Shoulder Form, Simple Shoulder Test, single assessment numeric evaluation, and visual analog score. In addition, BMA samples of each patient were assessed for the number of nucleated cells and colony-forming units. Regression analysis was performed to investigate whether the number of nucleated cells and colony-forming units had an influence on outcome and failure. Results Ten patients who underwent biologic augmentation of revision arthroscopic rotator cuff repair using an autologous fibrin scaffold and concentrated BMA obtained from the proximal humerus between 2014 and 2015 were included. The mean follow-up time was 30.7 (range: 12-49) months. Four patients were revised at final follow-up. Postoperative clinical scores improved significantly: American Shoulder and Elbow Surgeons (28.1 ± 5.4 to 60.9 ± 9.0; P < .01), single assessment numeric evaluation (6.6 ± 2.3 to 65.1 ± 10.9; P < .01), visual analog scale (7.2 ± 0.9 to 3.1 ± 0.9; P < .01), and Simple Shoulder Test (1.6 ± 0.5 to 10.3 ± 5.7; P < .01). Postoperative range of motion increased significantly with regard to flexion (97.0 ± 13.6 to 151.0 ± 12.2; P < .01) and abduction (88.0 ± 14.0 to 134.0 ± 15.1; P = .038) but not with external rotation (38.0 ± 5.7 to 50.5 ± 6.5; P = .16). Less pain was correlated to an increased number of nucleated cells (P = .026); however, there was no correlation between failure rate and number of nucleated cells (P = .430). Conclusions Patients who underwent biologic augmentation of revision arthroscopic rotator cuff repair using an autologous fibrin scaffold and concentrated BMA demonstrated a significant improvement in shoulder function along with reduction of pain. However, the overall revision rate for this procedure was 40%. Level of Evidence Level IV, therapeutic case series.
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Muench LN, Kriscenski D, Tamburini L, Berthold DP, Rupp MC, Mancini MR, Cote MP, McCarthy MB, Mazzocca AD. Augmenting Suture Tape Used in Rotator Cuff Surgery With Magnesium Increases in Vitro Cellular Adhesion of Human Subacromial Bursal Tissue. Arthrosc Sports Med Rehabil 2021; 3:e1975-e1980. [PMID: 34977656 PMCID: PMC8689267 DOI: 10.1016/j.asmr.2021.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 09/23/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Lukas N. Muench
- Department of Orthopedic Surgery, UConn Health Center, Farmington, Connecticut, U.S.A
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Germany
- Address correspondence to Lukas N. Muench, M.D., Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany.
| | - Danielle Kriscenski
- Department of Orthopedic Surgery, UConn Health Center, Farmington, Connecticut, U.S.A
| | - Lisa Tamburini
- Department of Orthopedic Surgery, UConn Health Center, Farmington, Connecticut, U.S.A
| | - Daniel P. Berthold
- Department of Orthopedic Surgery, UConn Health Center, Farmington, Connecticut, U.S.A
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Germany
| | | | - Michael R. Mancini
- Department of Orthopedic Surgery, UConn Health Center, Farmington, Connecticut, U.S.A
| | - Mark P. Cote
- Department of Orthopedic Surgery, UConn Health Center, Farmington, Connecticut, U.S.A
| | - Mary Beth McCarthy
- Department of Orthopedic Surgery, UConn Health Center, Farmington, Connecticut, U.S.A
| | - Augustus D. Mazzocca
- Department of Orthopedic Surgery, UConn Health Center, Farmington, Connecticut, U.S.A
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Youn SM, Rhee YG, Rhee SM. Nontendinous healing after repairing of retracted rotator cuff tear: an imaging study. J Shoulder Elbow Surg 2021; 30:2560-2569. [PMID: 33964431 DOI: 10.1016/j.jse.2021.04.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 04/05/2021] [Accepted: 04/18/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Follow-up magnetic resonance imaging (MRI) after rotator cuff repair can sometimes demonstrate healing with nontendinous tissue that extends from the footprint to the retracted tendon end, which is inferred as fibrous tissue formation. The aim was to investigate this particular finding and its significance. METHODS There were 494 eligible cases of healed supero-posterior medium-sized to massive rotator cuff repairs, after the exclusion of retears. A retrospective review was performed for the 3 groups that were divided according to their MRI appearances of healing: type I described the direct healing of the tendon to the footprint, whereas type II demonstrated the distinctive continuity of nontendinous tissue from the footprint to the retracted tendinous portion, and type III also showed a similar appearance but with obvious thinning of the tissue, without any evidence of defect confirmed on the routine outpatient ultrasonograph. RESULTS Only 108 of 494 patients (21.9%) demonstrated type I healing, whereas the signs of nontendinous healing were evident for the rest, with the 116 patients (23.5%) being classified as type III with attenuation. Comparing the preoperative tendon retraction, 34.8% and 37.2% of the Patte stages 2 and 3, respectively, resulted in type III healing, which were significantly higher compared with that of stage 1 (15.3%, P < .001). Type III healing had the highest average preoperative Goutallier grades. The average postoperative visual analog scale and the American Shoulder and Elbow Surgeons (ASES) scores have improved significantly for all 3 groups (P < .05), with the ASES score being 86.1±15.9 for type I, 93.7±36.1 for type II, and 87.8±15.1 for type III without significant differences between the groups (P = .3). CONCLUSIONS Only a fifth of the rotator cuff repairs led to a direct healing to the footprint, and the rest healed with MRI appearance of nontendinous tissue formation bridging the retracted tendinous portion and the footprint. These MRI appearances did not represent the true tendinous tissue formation between the torn end of the tendon and the bone after healing. Such appearances did not seem to affect the clinical outcomes.
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Affiliation(s)
- Seung-Min Youn
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, Myongji Hospital, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Yong Girl Rhee
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, Myongji Hospital, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Sung-Min Rhee
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea.
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Lee JH, Kim YH, Rhee SM, Han J, Jeong HJ, Park JH, Oh JH, Jeon S. Rotator Cuff Tendon Healing Using Human Dermal Fibroblasts: Histological and Biomechanical Analyses in a Rabbit Model of Chronic Rotator Cuff Tears. Am J Sports Med 2021; 49:3669-3679. [PMID: 34554882 DOI: 10.1177/03635465211041102] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Tenocytes derived from tendons have been reported to be effective in the treatment of rotator cuff tears through the expression of extracellular matrix proteins. Human dermal fibroblasts, known to express collagen types I and III as tenocytes do, may likely be substitutes for tenocytes to enhance healing rotator cuff tears. PURPOSE To demonstrate the capability of human dermal fibroblasts to enhance healing of rotator cuff tears. STUDY DESIGN Controlled laboratory study. METHODS The cellular properties and expression profiles of growth factors were compared between human dermal fibroblasts and tenocytes. In both cell types, a series of extracellular matrix proteins were analyzed along with matrix metalloproteinases and tissue inhibitors of metalloproteinases involved in the collagenolytic system. A total of 35 rabbits were divided into 5 groups: normal (n = 2), saline control (n = 9), fibrin control (n = 9), low dose of human fibroblasts (HF-LD; n = 9), and high dose of human fibroblasts (HF-HD; n = 6). Cells were injected into the sutured lesions at 6 weeks after creation of bilateral rotator cuff tears, followed by histological and biomechanical analyses at 12 weeks. RESULTS Human dermal fibroblasts exhibited a protein expression pattern similar to that of tenocytes. More specifically, the expression levels of collagen types I and III were comparable between fibroblasts and tenocytes. The histological analysis of 30 surviving rabbits showed that collagen fibers were more continuous and better oriented with a more mature interface between the tendon and bone in the sutured lesions in the HF-LD and HF-HD groups. Most importantly, biomechanical strength, measured using the load to failure at the injection site, was 58.8 ± 8.9 N/kg in the HF-HD group, increasing by approximately 2-fold (P = .0003) over the saline control group. CONCLUSION Human dermal fibroblasts, showing cellular properties comparable with tenocytes, effectively enhanced healing of chronic rotator cuff tears in rabbits. CLINICAL RELEVANCE Human dermal fibroblasts can be used in place of tenocytes to enhance healing of rotator cuff tears.
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Affiliation(s)
- Ji-Hye Lee
- Cutigen Research Institute, Tego Science, Seoul, Republic of Korea
| | - Yun Hee Kim
- Cutigen Research Institute, Tego Science, Seoul, Republic of Korea
| | - Sung-Min Rhee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Jikhyon Han
- Cutigen Research Institute, Tego Science, Seoul, Republic of Korea
| | - Hyeon Jang Jeong
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Joo Hyun Park
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Joo Han Oh
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Saewha Jeon
- Cutigen Research Institute, Tego Science, Seoul, Republic of Korea
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50
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Waterman BR, Newgren J, Gowd AK, Cabarcas B, Lansdown D, Bach BR, Cole BJ, Romeo AA, Verma NN. Randomized Trial of Arthroscopic Rotator Cuff With or Without Acromioplasty: No Difference in Patient-Reported Outcomes at Long-Term Follow-Up. Arthroscopy 2021; 37:3072-3078. [PMID: 33940126 DOI: 10.1016/j.arthro.2021.04.041] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/12/2021] [Accepted: 04/18/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate long-term patient-reported outcomes and revision surgery after arthroscopic rotator cuff repair with or without acromioplasty. METHODS Between 2007 and 2011, prospectively enrolled patients undergoing arthroscopic repair for full-thickness rotator cuff tears, with any acromial morphology, were randomized into either acromioplasty or nonacromioplasty groups. Patients with revision surgery, subscapularis involvement, advanced neurologic conditions, or death were excluded. Baseline and long-term follow-up questionnaires, including the American Shoulder and Elbow Surgeons (ASES), Simple Shoulder Test (SST), University of California-Los Angeles (UCLA), Visual Analog Scale (VAS) for pain, and Constant scores were obtained. Rates of symptomatic retear, revision rotator cuff surgery, or secondary reoperation were recorded. Averages with standard deviation were calculated, and t-tests were used to compare outcomes of interest between cohorts. RESULTS In total, 69 of 90 patients (76.7%) were available at 92.4 months (± 10.5). There were 23 of 32 patients in the acromioplasty cohort and 24 of 37 patients in the nonacromioplasty cohort. Mean age for the nonacromioplasty cohort was 56.9 (± 7.6) years, whereas acromioplasty was 59.6 (± 6.8) years. Comparison of baseline demographics and intraoperative information revealed no significant differences, including age, sex, Workers' Compensation, acute mechanism of injury, tear size, degree of retraction, and surgical technique (e.g., single- vs. double-row). At final follow-up, there were no statistically significant differences according to ASES (P = .33), VAS pain (P = 0.79), Constant (P = .17), SST (P = .05), UCLA (P = .19), and Short Form-12 (SF-12) (P = .79) in patients with and without acromioplasty. Two patients with acromioplasty (5.6%) and 3 patients without acromioplasty (9.1%) sustained atraumatic recurrent rotator cuff tear with secondary repair (P = .99), and there was no significant difference in retear rates or patient-reported outcome measures by acromial morphology. CONCLUSIONS This randomized trial, with mean 7.5-year follow-up, found no difference in validated patient-reported outcomes, retear rate, or revision surgery rate between patients undergoing rotator cuff repair with or without acromioplasty. LEVEL OF EVIDENCE II, prospective randomized controlled trial.
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Affiliation(s)
- Brian R Waterman
- Department of Orthopaedic Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A..
| | - Jon Newgren
- Department of Orthopaedic Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - Anirudh K Gowd
- Department of Orthopaedic Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - Brandon Cabarcas
- Department of Orthopaedic Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - Drew Lansdown
- Department of Orthopaedic Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - Bernard R Bach
- Department of Orthopaedic Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - Brian J Cole
- Department of Orthopaedic Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - Anthony A Romeo
- Department of Orthopaedic Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - Nikhil N Verma
- Department of Orthopaedic Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
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