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Gibbons MC, Silldorff M, Okuno H, Esparza MC, Migdal C, Johnson S, Schenk S, Ward SR. The effect of tenotomy, neurotomy, and dual injury on mouse rotator cuff muscles: Consequences for the mouse as a preclinical model. J Orthop Res 2024; 42:1170-1179. [PMID: 38245849 DOI: 10.1002/jor.25786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 12/13/2023] [Accepted: 01/03/2024] [Indexed: 01/22/2024]
Abstract
A common animal model of muscle pathology following rotator cuff tear (RCT) is a tenotomy of the supraspinatus and infraspinatus, often combined with neurotomy of the suprascapular nerve, which induces a more robust atrophy response than tenotomy alone. However, the utility of this model depends on its similarity to human muscle pathology post-RCT, both in terms of the disease phenotype and mechanisms of muscle atrophy and fatty infiltration. Given the clinical prevalence of nerve injury is low and the muscular response to denervation is distinct from mechanical unloading in other models, an understanding of the biological influence of the nerve injury is critical for interpreting data from this RCT model. We evaluated the individual and combined effect of tenotomy and neurotomy across multiple biological scales, in a robust time-series in the mouse supraspinatus. Muscle composition, histological, and gene expression data related to muscle atrophy, degeneration-regeneration, fatty infiltration, and fibrosis were evaluated. Broadly, we found tenotomy alone caused small, transient changes in these pathological features, which resolved over the course of the study, while neurotomy alone caused a significant fatty atrophy phenotype. The dual injury group had a similar fatty atrophy phenotype to the neurotomy group, though the addition of tenotomy did marginally enhance the fat and connective tissue. Overall, these results suggest the most clinically relevant injury model, tenotomy alone, does not produce a clinically relevant phenotype. The dual injury model partially recapitulates the human condition, but it does so through a nerve injury, which is not well justified clinically.
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Affiliation(s)
- Michael C Gibbons
- Department of Bioengineering, University of California San Diego, San Diego, California, USA
| | - Morgan Silldorff
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, California, USA
| | - Hiroshi Okuno
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, California, USA
| | - Mary C Esparza
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, California, USA
| | - Christopher Migdal
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, California, USA
| | - Seth Johnson
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, California, USA
| | - Simon Schenk
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, California, USA
| | - Samuel R Ward
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, California, USA
- Department of Radiology, University of California San Diego, San Diego, California, USA
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Yoon JP, Park SJ, Kim DH, Chung SW. Metformin increases the expression of proinflammatory cytokines and inhibits supraspinatus fatty infiltration. J Orthop Surg Res 2023; 18:674. [PMID: 37700364 PMCID: PMC10496168 DOI: 10.1186/s13018-023-04163-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/04/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND After a rotator cuff (RC) tendon tear, the supraspinatus (SS) inflammatory response induces fatty infiltration (FI). Metformin has the effect of regulating the initial inflammatory response of atrophic muscles. Therefore, this study aimed to investigate the effect of metformin use on modulating the expression of proinflammatory cytokines and SS FI in an acute RC tear rat model. METHODS This study used 26 male Sprague-Dawley rats. Animals were randomly divided into two groups: The metformin group received metformin for 5 days after cutting the RC tendon, and the control group was administered only with saline after cutting the tendon. Metformin 50 mg/kg was intraperitoneally injected for 5 days. Three rats in each group were sacrificed 5 days after SS tendon rupture surgery, and 10 rats in each group were sacrificed 14 days after surgery. The SS was sampled 5 days after SS tendon tear surgery, and the expression of proinflammatory cytokines was measured by quantitative reverse-transcription polymerase chain reaction (qRT-PCR). On day 14 after sampling, histological analysis of the SS was performed using hematoxylin and eosin, Masson's trichrome, and picrosirius red staining. RESULTS On day 5 of surgery, the expression values of interferon gamma (increased 7.2-fold, P < .01), tumor necrosis factor alpha (increased 13-fold, P < .05), interleukin-1β (increased 4.7-fold, P < .001), and interleukin-6 (increased 4.6-fold, P < .01) increased significantly in the metformin group compared with those in the control group. As a result of Oil Red O staining, SS FI was significantly suppressed in the metformin group compared with that in the control group (metformin group, 305 ± 50.3 µm2, P < .001; control group, 3136 ± 662.8 µm2, P < .001). In addition, the SS volume of the metformin group was not reduced compared with those of the control group, and the morphology and structure of the SS were better preserved. CONCLUSIONS The results of this study revealed that metformin can increase the expression of proinflammatory cytokines and suppress SS fat infiltration in delayed sutures.
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Affiliation(s)
- Jong Pil Yoon
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sung-Jin Park
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea.
| | - Dong-Hyun Kim
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Seok Won Chung
- Department of Orthopaedic Surgery, School of Medicine, Konkuk University Medical Center, Seoul, Korea
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3
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Moon YJ, Cui B, Cho SY, Hwang JW, Chung HC, Kwon J, Kim D, Jang KY, Kim JR, Wang SI. Sirtuin 6 Overexpression Improves Rotator Cuff Tendon-to-Bone Healing in the Aged. Cells 2023; 12:2035. [PMID: 37626845 PMCID: PMC10453227 DOI: 10.3390/cells12162035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/08/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
Aging is an independent risk factor for recurrent tearing after surgical repair of rotator cuff ruptures around the tendon-to-bone area. However, aging signature factors and related mechanisms involved in the healing of the rotator cuff are still unknown. We hypothesized that differences in proteins involved in the rotator cuff according to age may affect tendon-to-bone healing. The proteome analysis performed to identify the signature aging proteins of the rotator cuff confirmed the sirtuin signal as an age-specific protein. In particular, the expression of SIRT6 was markedly down-regulated with age. Ingenuity pathway analysis of omics data from age-dependent rat rotator cuffs and linear regression from human rotator cuffs showed SIRT6 to be closely related to the Wnt/β-catenin signal. We confirmed that overexpression of SIRT6 in the rotator cuff and primary tenocyte regulated canonical Wnt signaling by inhibiting the transcriptional expression of sclerostin, a Wnt antagonist. Finally, SIRT6 overexpression promoted tendon-to-bone healing after tenotomy with reconstruction in elderly rats. This approach is considered an effective treatment method for recovery from recurrent rotator cuff tears, which frequently occur in the elderly.
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Affiliation(s)
- Young Jae Moon
- Department of Biochemistry and Orthopaedic Surgery, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju 54896, Republic of Korea
| | - Baoning Cui
- Department of Orthopaedic Surgery, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju 54896, Republic of Korea; (B.C.)
| | - Se-Young Cho
- Department of Food Science and Technology, Foodborne Virus Research Center, Chonnam National University, Gwangju 61186, Republic of Korea
| | - Jae Won Hwang
- Department of Orthopaedic Surgery, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju 54896, Republic of Korea; (B.C.)
| | - Hee-Chung Chung
- Department of BioChemical Analysis, Korea Basic Science Institute, Daejeon 30147, Republic of Korea
| | - Joseph Kwon
- Department of BioChemical Analysis, Korea Basic Science Institute, Daejeon 30147, Republic of Korea
| | - Duwoon Kim
- Department of Food Science and Technology, Foodborne Virus Research Center, Chonnam National University, Gwangju 61186, Republic of Korea
| | - Kyu Yun Jang
- Department of Pathology, Jeonbuk National University Medical School, Jeonju 54896, Republic of Korea
| | - Jung Ryul Kim
- Department of Orthopaedic Surgery, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju 54896, Republic of Korea; (B.C.)
| | - Sung Il Wang
- Department of Orthopaedic Surgery, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju 54896, Republic of Korea; (B.C.)
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Vasquez-Bolanos LS, Gibbons MC, Ruoss S, Wu IT, Esparza MC, Fithian DC, Lane JG, Singh A, Nasamran CA, Fisch KM, Ward SR. Transcriptional time course after rotator cuff repair in 6 month old female rabbits. Front Physiol 2023; 14:1164055. [PMID: 37228812 PMCID: PMC10203179 DOI: 10.3389/fphys.2023.1164055] [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: 02/11/2023] [Accepted: 04/25/2023] [Indexed: 05/27/2023] Open
Abstract
Introduction: Rotator cuff tears are prevalent in the population above the age of 60. The disease progression leads to muscle atrophy, fibrosis, and fatty infiltration, which is not improved upon with surgical repair, highlighting the need to better understand the underlying biology impairing more favorable outcomes. Methods: In this study, we collected supraspinatus muscle tissue from 6 month old female rabbits who had undergone unilateral tenotomy for 8 weeks at 1, 2, 4, or 8 weeks post-repair (n = 4/group). RNA sequencing and enrichment analyses were performed to identify a transcriptional timeline of rotator cuff muscle adaptations and related morphological sequelae. Results: There were differentially expressed (DE) genes at 1 (819 up/210 down), 2 (776/120), and 4 (63/27) weeks post-repair, with none at 8 week post-repair. Of the time points with DE genes, there were 1092 unique DE genes and 442 shared genes, highlighting that there are changing processes in the muscle at each time point. Broadly, 1-week post-repair differentially expressed genes were significantly enriched in pathways of metabolism and energetic activity, binding, and regulation. Many were also significantly enriched at 2 weeks, with the addition of NIF/NF-kappaB signaling, transcription in response to hypoxia, and mRNA stability alongside many additional pathways. There was also a shift in transcriptional activity at 4 weeks post-repair with significantly enriched pathways for lipids, hormones, apoptosis, and cytokine activity, despite an overall decrease in the number of differentially expressed genes. At 8 weeks post-repair there were no DE genes when compared to control. These transcriptional profiles were correlated with the histological findings of increased fat, degeneration, and fibrosis. Specifically, correlated gene sets were enriched for fatty acid metabolism, TGF-B-related, and other pathways. Discussion: This study identifies the timeline of transcriptional changes in muscle after RC repair, which by itself, does not induce a growth/regenerative response as desired. Instead, it is predominately related to metabolism/energetics changes at 1 week post-repair, unclear or asynchronous transcriptional diversity at 2 weeks post-repair, increased adipogenesis at 4 weeks post-repair, and a low transcriptional steady state or a dysregulated stress response at 8 weeks post-repair.
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Affiliation(s)
- Laura S. Vasquez-Bolanos
- Department of Bioengineering, University of California, San Diego, San Diego, CA, United States
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Michael C. Gibbons
- Department of Bioengineering, University of California, San Diego, San Diego, CA, United States
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Severin Ruoss
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Isabella T. Wu
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Mary C. Esparza
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Donald C. Fithian
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - John G. Lane
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Anshuman Singh
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
- Department of Orthopaedic Surgery, Kaiser Permanente, San Diego, CA, United States
| | - Chanond A. Nasamran
- Center for Computational Biology and Bioinformatics, Department of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Kathleen M. Fisch
- Center for Computational Biology and Bioinformatics, Department of Medicine, University of California, San Diego, San Diego, CA, United States
- Department of Obstetrics, Gynecology and Reproductive Science, University of California, San Diego, San Diego, CA, United States
| | - Samuel R. Ward
- Department of Bioengineering, University of California, San Diego, San Diego, CA, United States
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
- Department of Radiology, University of California, San Diego, San Diego, CA, United States
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5
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Longo UG, Mazzola A, Magrì F, Catapano S, De Salvatore S, Carotti S, Denaro V. Histological, radiological and clinical analysis of the supraspinatus tendon and muscle in rotator cuff tears. BMC Musculoskelet Disord 2023; 24:127. [PMID: 36797741 PMCID: PMC9933395 DOI: 10.1186/s12891-023-06237-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 02/09/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Macroscopic alterations of the affected rotator cuff (RC) are undoubtedly linked to microscopic changes, but they may underestimate the actual degree of the disease. Moreover, it remains unclear whether preoperative structural RC changes may alter clinical outcomes. METHODS Supraspinatus tendon and muscle samples were collected from 47 patients undergoing RC surgery. Tendons were evaluated histologically according to the Bonar score; fatty infiltration and muscle atrophy were quantified using a software for biomedical image analysis (ImageJ) in percentage of area affected in the observed muscle section. Preoperative shoulder ROM and pain were evaluated. Radiological muscle atrophy was evaluated with the Tangent Sign and Occupation Ratio; fatty infiltration was assessed according to the Goutallier classification. Correlations between histological, radiological and clinical outcomes were assessed. Statistics were performed using the Spearman correlation coefficient. Intraobserver and interobserver agreement was calculated. RESULTS Histopathologic fatty infiltration (r = 0.007, p = 0.962), muscle atrophy (r = 0.003, p = 0.984) and the total Bonar score (r = 0.157, p = 0.292) were not correlated to preoperative shoulder pain. Muscle atrophy showed a significant but weak negative correlation with the preoperative movement of abduction (r = -0.344, p = 0.018). A significant but weak positive correlation was found between muscle atrophy and the total Bonar score (r = 0.352, p = 0.015). No correlation between histological and radiological evaluation was found for both fatty infiltration (r = 0.099, p = 0.510) and muscle atrophy (Tangent Sign: r = -0.223, p = 0.131; Occupation Ratio: r = -0.148, p = 0.319). Our histological evaluation showed a modal value of 3 (out of 3) for fatty infiltration and an equal modal value of 2 and 3 (out of 3) for muscle atrophy. In contrast, the modal value of the Goutallier score was 1 (out of 4) and 28 patients out of 47 showed a negative Tangent sign. At histology, intraobserver agreement ranged from 0.59 to 0.81 and interobserver agreement from 0.57 to 0.64. On the MRI intraobserver agreement ranged from 0.57 to 0.71 and interobserver agreement ranged from 0.53 to 0.65. CONCLUSIONS Microscopic muscle atrophy appeared to negatively correlate with the movement of abduction leading to functional impairment. Shoulder pain did not show any relationship with microscopic changes. Radiological evaluation of the supraspinatus muscle alterations seemed to underestimate the degree of the same abnormalities evaluated at histology.
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Affiliation(s)
- Umile Giuseppe Longo
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Roma, Italy. .,Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 21 - 00128, Roma, Italy.
| | - Alessandro Mazzola
- grid.488514.40000000417684285Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy ,grid.9657.d0000 0004 1757 5329Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy
| | - Francesco Magrì
- grid.488514.40000000417684285Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy ,grid.9657.d0000 0004 1757 5329Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy
| | - Simone Catapano
- grid.488514.40000000417684285Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy ,grid.9657.d0000 0004 1757 5329Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy
| | - Sergio De Salvatore
- grid.488514.40000000417684285Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy ,grid.9657.d0000 0004 1757 5329Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy
| | - Simone Carotti
- grid.9657.d0000 0004 1757 5329Unit of Microscopic and Ultrastructural Anatomy, University Campus Bio-Medico, Rome, Italy
| | - Vincenzo Denaro
- grid.488514.40000000417684285Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy ,grid.9657.d0000 0004 1757 5329Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy
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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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7
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Vargas-Vila MA, Gibbons MC, Wu IT, Esparza MC, Kato K, Johnson SD, Masuda K, Ward SR. Progression of muscle loss and fat accumulation in a rabbit model of rotator cuff tear. J Orthop Res 2022; 40:1016-1025. [PMID: 34392563 PMCID: PMC8844305 DOI: 10.1002/jor.25160] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 06/09/2021] [Accepted: 07/30/2021] [Indexed: 02/04/2023]
Abstract
Rotator cuff (RC) tears present a treatment challenge due to muscle atrophy and degeneration, fatty infiltration, and fibrosis. The purpose of this study was to generate a high time-resolution model of RC tear in rabbits and to characterize the progression of architectural and histological changes. Thirty-five female New Zealand White rabbits (age: 6 months) underwent left supraspinatus tenotomy. Five rabbits were used to evaluate immediate muscle architectural changes. The remaining 30 rabbits underwent right shoulder sham surgery and sacrifice at 1, 2, 4, 8, or 16 weeks. Histology was used to quantify muscle fiber cross-sectional area (CSA), muscle degeneration and regeneration, and fat localized to inter- versus intrafascicular regions. Muscle fiber CSA decreased by 26.5% compared to sham at 16 weeks (effect of treatment, p < 0.0001). Muscle degeneration increased after tenotomy (effect of treatment, p = 0.0006) without any change in regeneration. Collagen and fat content increased by 4 weeks and persisted through 16 weeks. Interfascicular fat was increased at all time points, but intrafascicular fat was increased only at 1, 4, and 16 weeks posttenotomy. Intrafascicular fat adjacent to degenerating muscle fibers increased as well (effect of treatment, p < 0.0001; effect of time, p = 0.0102). Statement of clinical relevance: Rabbit supraspinatus tenotomy recapitulates key features of the pathophysiology of human RC tears, including muscle atrophy and degeneration, lack of regeneration, fat accumulation, and fibrosis.
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Affiliation(s)
| | | | - Isabella T. Wu
- Department of Orthopaedic Surgery, UC San Diego, La Jolla CA, USA
| | - Mary C. Esparza
- Department of Orthopaedic Surgery, UC San Diego, La Jolla CA, USA
| | - Kenji Kato
- Department of Orthopaedic Surgery, Nagoya City University, Nagoya, Japan
| | - Seth D. Johnson
- Department of Orthopaedic Surgery, UC San Diego, La Jolla CA, USA
| | - Koichi Masuda
- Department of Orthopaedic Surgery, UC San Diego, La Jolla CA, USA
| | - Samuel R. Ward
- Department of Orthopaedic Surgery, UC San Diego, La Jolla CA, USA,Department of Bioengineering, UC San Diego, La Jolla CA, USA,Department of Radiology, UC San Diego, La Jolla CA, USA
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8
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Vasquez-Bolanos LS, Gibbons MC, Ruoss S, Wu IT, Vargas-Vila M, Hyman SA, Esparza MC, Fithian DC, Lane JG, Singh A, Nasamran CA, Fisch KM, Ward SR. Transcriptional Time Course After Rotator Cuff Tear. Front Physiol 2021; 12:707116. [PMID: 34421646 PMCID: PMC8378535 DOI: 10.3389/fphys.2021.707116] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 07/06/2021] [Indexed: 12/13/2022] Open
Abstract
Rotator cuff (RC) tears are prevalent in the population above the age of 60. The disease progression leads to muscle atrophy, fibrosis, and fatty infiltration in the chronic state, which is not improved with intervention or surgical repair. This highlights the need to better understand the underlying dysfunction in muscle after RC tendon tear. Contemporary studies aimed at understanding muscle pathobiology after RC tear have considered transcriptional data in mice, rats and sheep models at 2–3 time points (1 to 16 weeks post injury). However, none of these studies observed a transition or resurgence of gene expression after the initial acute time points. In this study, we collected rabbit supraspinatus muscle tissue with high temporal resolution (1, 2, 4, 8, and 16 weeks) post-tenotomy (n = 6/group), to determine if unique, time-dependent transcriptional changes occur. RNA sequencing and analyses were performed to identify a transcriptional timeline of RC muscle changes and related morphological sequelae. At 1-week post-tenotomy, the greatest number of differentially expressed genes was observed (1,069 up/873 down) which decreases through 2 (170/133), 4 (86/41), and 8 weeks (16/18), followed by a resurgence and transition of expression at 16 weeks (1,421/293), a behavior which previously has not been captured or reported. Broadly, 1-week post-tenotomy is an acute time point with expected immune system responses, catabolism, and changes in energy metabolism, which continues into 2 weeks with less intensity and greater contribution from mitochondrial effects. Expression shifts at 4 weeks post-tenotomy to fatty acid oxidation, lipolysis, and general upregulation of adipogenesis related genes. The effects of previous weeks’ transcriptional dysfunction present themselves at 8 weeks post-tenotomy with enriched DNA damage binding, aggresome activity, extracellular matrix-receptor changes, and significant expression of genes known to induce apoptosis. At 16 weeks post-tenotomy, there is a range of enriched pathways including extracellular matrix constituent binding, mitophagy, neuronal activity, immune response, and more, highlighting the chaotic nature of this time point and possibility of a chronic classification. Transcriptional activity correlated significantly with histological changes and were enriched for biologically relevant pathways such as lipid metabolism. These data provide platform for understanding the biological mechanisms of chronic muscle degeneration after RC tears.
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Affiliation(s)
- Laura S Vasquez-Bolanos
- Department of Bioengineering, University of California, San Diego, San Diego, CA, United States.,Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Michael C Gibbons
- Department of Bioengineering, University of California, San Diego, San Diego, CA, United States.,Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Severin Ruoss
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Isabella T Wu
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Mario Vargas-Vila
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Sydnee A Hyman
- Department of Bioengineering, University of California, San Diego, San Diego, CA, United States.,Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Mary C Esparza
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Donald C Fithian
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - John G Lane
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States
| | - Anshuman Singh
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States.,Department of Orthopedic Surgery, Kaiser Permanente, San Diego, CA, United States
| | - Chanond A Nasamran
- Center for Computational Biology and Bioinformatics, Department of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Kathleen M Fisch
- Center for Computational Biology and Bioinformatics, Department of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Samuel R Ward
- Department of Bioengineering, University of California, San Diego, San Diego, CA, United States.,Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, United States.,Department of Radiology, University of California, San Diego, San Diego, CA, United States
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9
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Kunz P, Mick P, Gross S, Schmidmaier G, Zeifang F, Weber MA, Fischer C. Contrast-Enhanced Ultrasound (CEUS) as Predictor for Early Retear and Functional Outcome After Supraspinatus Tendon Repair. J Orthop Res 2020; 38:1150-1158. [PMID: 31769543 DOI: 10.1002/jor.24535] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 11/19/2019] [Indexed: 02/04/2023]
Abstract
Supraspinatus (SSP) tendon tears represent a common indication for shoulder surgery. Yet, prediction of postoperative function and tendon retear remains challenging and primarily relies on morphologic magnetic resonance imaging (MRI)-based parameters, supported by patients' demographic data like age, gender, and comorbidities. Considering continuously high retear rates, especially in patients with larger tears and negative prognostic factors, improved outcome prediction could be of high clinical value. Contrast-enhanced ultrasound (CEUS) enables an assessment of dynamic perfusion of the SSP muscle. As a potential surrogate for muscle vitality, CEUS might reflect functional properties of the SSP and support improved outcome prediction after tendon repair. Fifty patients with isolated SSP tendon tears were prospectively enrolled. Preoperatively, SSP muscle perfusion was quantified by CEUS and conventional morphologic parameters like tear size, fatty infiltration, and tendon retraction were assessed by MRI. At six months follow-up, shoulder function, tendon integrity, and muscle perfusion were reassessed. The predictive value of preoperative CEUS for postoperative shoulder function and tendon integrity was evaluated. 35 patients entered the statistical analysis. Preoperative CEUS-based assessment of SSP perfusion significantly correlated with early postoperative shoulder function (Constant, r = 0.48, p < 0.018) and tendon retear (r = 0.67, p < 0.001). CEUS-based subgroup analysis identified patients with exceptionally high, respectively low risk for tendon retear. CEUS-based assessment of the SSP seemed to predict early shoulder function and tendon retear after SSP repair and allowed to identify patient subgroups with exceptionally high or low risk for tendon retear. © 2019 The Authors. Journal of Orthopaedic Research® published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 38:1150-1158, 2020.
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Affiliation(s)
- Pierre Kunz
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Ultrasound Center, HTRG-Heidelberg Trauma Research Group, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany.,Clinic for Shoulder and Elbow Surgery, Catholic Hospital Mainz, An der Goldgrube 11, 55131, Mainz, Germany
| | - Paul Mick
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Ultrasound Center, HTRG-Heidelberg Trauma Research Group, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany
| | - Sascha Gross
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Ultrasound Center, HTRG-Heidelberg Trauma Research Group, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany
| | - Gerhard Schmidmaier
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Ultrasound Center, HTRG-Heidelberg Trauma Research Group, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany
| | - Felix Zeifang
- Ethianum Klinik Heidelberg, Voßstraße 6, 69115, Heidelberg, Germany
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, University Medical Center Rostock, Ernst-Heydemann-Straße 6, 18057, Rostock, Germany
| | - Christian Fischer
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Ultrasound Center, HTRG-Heidelberg Trauma Research Group, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany
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10
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Thankam FG, Boosani CS, Dilisio MF, Gross RM, Agrawal DK. Genes interconnecting AMPK and TREM-1 and associated microRNAs in rotator cuff tendon injury. Mol Cell Biochem 2019; 454:97-109. [PMID: 30306456 PMCID: PMC6438203 DOI: 10.1007/s11010-018-3456-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 10/05/2018] [Indexed: 12/14/2022]
Abstract
Fatty infiltration and inflammation delay the healing responses and raise major concerns in the therapeutic management of rotator cuff tendon injuries (RCTI). Our evaluations showed the upregulation of 'metabolic check point' AMPK and inflammatory molecule, TREM-1 from shoulder biceps tendons collected from RCTI subjects. However, the epigenetic regulation of these biomolecules by miRNAs is largely unknown and it is likely that a deeper understanding of the mechanism of action can have therapeutic potential for RCTI. Based on this background, we have evaluated the miRNAs from RCTI patients with fatty infiltration and inflammation (FI group) and compared with RCTI patients without fatty infiltration and inflammation (No-FI group). NetworkAnalyst was employed to evaluate the genes interconnecting AMPK and TREM-1 pathway, using PRKAA1 (AMPK), TREM-1, HIF1α, HMGB1, and AGER as input genes. The most relevant miRNAs were screened by considering the fold change below - 7.5 and the number of target genes 10 and more which showed 13 miRNAs and 216 target genes. The exact role of these miRNAs in the fatty infiltration and inflammation associated with RCTI is still unknown and the understanding of biological activity of these miRNAs can pave ways to develop miRNA-based therapeutics in the management of RCTI.
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Affiliation(s)
- Finosh G Thankam
- Departments of Clinical & Translational Science and Orthopedic Surgery, Creighton University School of Medicine, Omaha, NE, 68178, USA
| | - Chandra S Boosani
- Departments of Clinical & Translational Science and Orthopedic Surgery, Creighton University School of Medicine, Omaha, NE, 68178, USA
| | - Matthew F Dilisio
- Departments of Clinical & Translational Science and Orthopedic Surgery, Creighton University School of Medicine, Omaha, NE, 68178, USA
| | - R Michael Gross
- Departments of Clinical & Translational Science and Orthopedic Surgery, Creighton University School of Medicine, Omaha, NE, 68178, USA
| | - Devendra K Agrawal
- Departments of Clinical & Translational Science and Orthopedic Surgery, Creighton University School of Medicine, Omaha, NE, 68178, USA.
- Department of Clinical & Translational Science, The Peekie Nash Carpenter Endowed Chair in Medicine, CRISS II Room 510, 2500 California Plaza, Omaha, NE, 68178, USA.
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11
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Ueda Y, Inui A, Mifune Y, Takase F, Kataoka T, Kurosawa T, Yamaura K, Kokubu T, Kuroda R. Molecular changes to tendons after collagenase-induced acute tendon injury in a senescence-accelerated mouse model. BMC Musculoskelet Disord 2019; 20:120. [PMID: 30902076 PMCID: PMC6429773 DOI: 10.1186/s12891-019-2488-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 03/04/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Aging impairs tendon healing and is a potential risk factor for chronic tendinitis. During normal aging, tendons undergo structural and biomechanical degenerative changes, accompanied by a reduction in the number of tenocytes and changes to their properties. However, molecular changes in aged tendons under inflammatory conditions are not well understood. The present study analyzed the molecular changes in collagenase induced acute tendon injury using a senescence-accelerated mouse (SAM) model. METHODS SAMP6 mice were used as an aging animal model and SAMR1 mice were used as a control to represent a senescence-resistant inbred strain. All the mice used in the study were 40 weeks old. Collagenase I from Clostridium histolyticum (20 μL) was injected percutaneously to the tendon-bone junction of the Achilles tendon. Two weeks after treatment, the Achilles tendons were harvested and stained using Picrosirius Red to determine collagen expression. Real-time PCR was performed to analyze gene expression of IL-6, tenomodulin, type I and type II collagen, MMP-9, TIMP-1, and TIMP-2. RESULTS Collagenase injection resulted in significantly higher gene expression of IL-6 but significantly lower tenomodulin expression compared with the control in SAMP6 and SAMR1 mice. In SAMP6 mice, gene expression of type III collagen and MMP-9 was significantly higher in the collagenase-injected group compared with the control group. SAMP6 mice also showed lower expression of type I collagen, TIMP-1, and TIMP-2 in the collagenase-injected group compared with the control group. Picrosirius Red staining showed the highest expression of type III collagen in the collagenase-injected SAMP6 group compared with the other groups. CONCLUSIONS The collagenase-injected SAMP6 group showed higher expression of IL-6, MMP-9, and type III collagen and lower expression of type I collagen, TIMP-1, and TIMP-2, which are known to suppress metalloproteinases. The results indicate that aging may lead to dysfunction of the tendon healing process after acute tendon injury.
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Affiliation(s)
- Yasuhiro Ueda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, chuo-ku, Kobe, 650-0017, Japan
| | - Atsuyuki Inui
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, chuo-ku, Kobe, 650-0017, Japan
| | - Yutaka Mifune
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, chuo-ku, Kobe, 650-0017, Japan.
| | - Fumiaki Takase
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, chuo-ku, Kobe, 650-0017, Japan
| | - Takeshi Kataoka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, chuo-ku, Kobe, 650-0017, Japan
| | - Takashi Kurosawa
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, chuo-ku, Kobe, 650-0017, Japan
| | - Kohei Yamaura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, chuo-ku, Kobe, 650-0017, Japan
| | - Takeshi Kokubu
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, chuo-ku, Kobe, 650-0017, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, chuo-ku, Kobe, 650-0017, Japan
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12
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Güleçyüz MF, Macha K, Pietschmann MF, Ficklscherer A, Sievers B, Roßbach BP, Jansson V, Müller PE. Allogenic Myocytes and Mesenchymal Stem Cells Partially Improve Fatty Rotator Cuff Degeneration in a Rat Model. Stem Cell Rev Rep 2019; 14:847-859. [PMID: 29855989 DOI: 10.1007/s12015-018-9829-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE Rotator cuff (RC) tears result not only in functional impairment but also in RC muscle atrophy, muscle fattening and eventually to muscle fibrosis. We hypothesized that allogenic bone marrow derived mesenchymal stem cells (MSC) and myocytes can be utilized to improve the rotator cuff muscle fattening and increase the atrophied muscle mass in a rat model. METHODS The right supraspinatus (SSP) tendons of 105 inbred rats were detached and muscle fattening was provoked over 4 weeks; the left side remained untouched (control group). The animals (n = 25) of the output group were euthanized after 4 weeks for reference purposes. The SSP-tendon of one group (n = 16) was left unoperated to heal spontaneously. The SSP-tendons of the remaining 64 rats (4 groups with n = 16) were repaired with transosseous sutures. One group received a saline solution injection in the SSP muscle belly, two other groups received 5 × 106 allogenic myocytes and 5 × 106 allogenic MSC injections from donor rats, respectively, and one group received no additional treatment. After 4 weeks of healing, the supraspinatus muscle mass was compared quantitatively and histologically to all the treated groups and to the untreated contralateral side. RESULTS In the end of the experiments at week 8, the myocyte and MCS treated groups showed a significantly higher muscle mass with 0.2322 g and 0.2257 g, respectively, in comparison to the output group (0.1911 g) at week 4 with p < 0.05. There was no statistical difference between the repaired, treated, or spontaneous healing groups at week 8. Supraspinatus muscle mass of all experimental groups of the right side was significantly lower compared to the untreated contralateral muscle mass. CONCLUSION This defect model shows that the injection of allogenic mycocytes and MSC in fatty infiltrated SSP muscles is better than no treatment and can partially improve the SSP muscle belly fattening. Nevertheless, a full restoration of the degenerated and fattened rotator cuff muscle to its original condition is not possible using myocytes and MSC in this model.
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Affiliation(s)
- Mehmet F Güleçyüz
- Department of Orthopaedics, Physical Medicine and Rehabilitation, Medical Center of the University of Munich (Ludwig-Maximilians-University), Marchioninistrasse 15, 81377, Munich, Germany.
| | - Konstanze Macha
- Department of Orthopaedics and Traumatology, Klinikum Landsberg am Lech, Bgm.-Dr.-Hartmann-Straße 50, 86899, Landsberg am Lech, Germany
| | - Matthias F Pietschmann
- Department of Orthopaedics, Physical Medicine and Rehabilitation, Medical Center of the University of Munich (Ludwig-Maximilians-University), Marchioninistrasse 15, 81377, Munich, Germany
| | | | - Birte Sievers
- Numares AG, Am Biopark 9, 93053, Regensburg, Germany
| | - Björn P Roßbach
- Department of Orthopaedics and Traumatology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Germany
| | - Volkmar Jansson
- Department of Orthopaedics, Physical Medicine and Rehabilitation, Medical Center of the University of Munich (Ludwig-Maximilians-University), Marchioninistrasse 15, 81377, Munich, Germany
| | - Peter E Müller
- Department of Orthopaedics, Physical Medicine and Rehabilitation, Medical Center of the University of Munich (Ludwig-Maximilians-University), Marchioninistrasse 15, 81377, Munich, Germany
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13
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More tendon degeneration in patients with shoulder osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2019; 27:267-275. [PMID: 30284007 DOI: 10.1007/s00167-018-5186-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 09/27/2018] [Indexed: 12/27/2022]
Abstract
PURPOSE Tendon disorders are a major problem in the general population. It is known that rotator cuff tendinopathy contributes to osteoarthritis (OA) of the shoulder. The aim of the study was to analyse the presence of tendinopathy in patients with shoulder OA and an intact rotator cuff, using a multimodal approach. METHODS Thirteen consecutive patients median age 67 (52-84) years, with OA of the shoulder, and 13 consecutive control patients, with a fracture of the proximal humerus, median age 70 (51-84) years, underwent an open biopsy procedure from the biceps and subscapularis tendon in conjunction with shoulder arthroplasty. In addition to a macroscopic evaluation, the samples underwent histologic, morphologic and ultrastructural analyses in light and transmission electron microscopy. RESULTS Macroscopic degeneration was found in 15 of 26 specimen in the OA group but in seven of 25 in the control group (p = 0.048). The histologic analysis revealed a non-significant difference for the total degeneration score (TDS) between the study groups. The morphologic evaluation of the samples revealed that the OA group had significantly more samples with non-homogeneous extracellular matrix (ECM), (p = 0.048). Ultrastructurally, the OA group revealed a significantly larger fibril diameter in the biceps tendon (p < 0.0001) but not in the subscapularis tendon compared with the control group. CONCLUSION A significantly worse macroscopic appearance and significantly more morphologically inhomogeneous ECM, indicating more tendon degeneration, were found in the OA group compared with the control group. This indicates that it could be beneficial to treat the tendinosis in an early stage to decrease symptoms from the OA. STUDY DESIGN Level of evidence, III.
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14
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Hik F, Ackland DC. The moment arms of the muscles spanning the glenohumeral joint: a systematic review. J Anat 2018; 234:1-15. [PMID: 30411350 DOI: 10.1111/joa.12903] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2018] [Indexed: 11/29/2022] Open
Abstract
The moment arm of a muscle represents its leverage or torque-producing capacity, and is indicative of the role of the muscle in joint actuation. The objective of this study was to undertake a systematic review of the moment arms of the major muscles spanning the glenohumeral joint during abduction, flexion and axial rotation. Moment arm data for the deltoid, pectoralis major, latissimus dorsi, teres major, supraspinatus, infraspinatus, subscapularis and teres minor were reported when measured using the geometric and tendon excursion methods. The anterior and middle sub-regions of the deltoid had the largest humeral elevator moment arm values of all muscles during coronal- and scapular-plane abduction, as well as during flexion. The pectoralis major, latissimus dorsi and teres major had the largest depressor moment arms, with each of these muscles exhibiting prominent leverage in shoulder adduction, and the latissimus dorsi and teres major also in extension. The rotator cuff muscles had the largest axial rotation moment arms regardless of the axial position of the humerus. The supraspinatus had the most prominent elevator moment arms during early abduction in both the coronal and scapular planes as well as in flexion. This systematic review shows that the rotator cuff muscles function as humeral rotators and weak humeral depressors or elevators, while the three sub-regions of the deltoid behave as substantial humeral elevators throughout the range of humeral motion. The pectoralis major, latissimus dorsi and teres major are significant shoulder depressors, particularly during abduction. This study provides muscle moment arm data on functionally relevant shoulder movements that are involved in tasks of daily living, including lifting and pushing. The results may be useful in quantifying shoulder muscle function during specific planes of movement, in designing and validating computational models of the shoulder, and in planning surgical procedures such as tendon transfer surgery.
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Affiliation(s)
- Freya Hik
- Department of Biomedical Engineering, University of Melbourne, Parkville, VIC, Australia
| | - David C Ackland
- Department of Biomedical Engineering, University of Melbourne, Parkville, VIC, Australia
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15
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Fischer C, Gross S, Zeifang F, Schmidmaier G, Weber MA, Kunz P. Contrast-Enhanced Ultrasound Determines Supraspinatus Muscle Atrophy After Cuff Repair and Correlates to Functional Shoulder Outcome. Am J Sports Med 2018; 46:2735-2742. [PMID: 30080421 DOI: 10.1177/0363546518787266] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Muscle degeneration as a consequence of rotator cuff tears is mainly assessed by magnetic resonance imaging. Contrast-enhanced ultrasound (CEUS) is a new functional imaging method to assess microvascular perfusion as a fundamental parameter of muscle tissue vitality. In this cross-sectional study, the authors evaluated supraspinatus muscle perfusion after cuff repair and analyzed its association with functional shoulder outcome and the grade of echogenicity in B-mode ultrasound indicating fatty infiltration. HYPOTHESIS The authors expected reduced microperfusion of the operated versus the contralateral supraspinatus muscle and a correlation of the muscular microperfusion with functional shoulder outcome. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Patients who received unilateral repair of the supraspinatus tendon between 2009 and 2014 were invited for a single follow-up examination. Functional scores were assessed, including the Constant-Murley score and American Shoulder and Elbow Surgeons score. CEUS examination was performed bilaterally in an oblique sagittal plane of the supraspinatus fossa. Perfusion was quantified by the parameters wash-in perfusion index (WiPI) and peak enhancement via VueBox quantification software. The results of the Constant-Murley score, American Shoulder and Elbow Surgeons score, and perfusion parameters were referenced to the contralateral shoulder. Echogenicity of the supraspinatus muscle was classified with a 3-point scale as compared with the trapezius muscle. RESULTS Sixty-seven patients were available, with a mean follow-up of 38.0 ± 18.5 months. Functional assessment showed impaired shoulder function on the operated shoulder as compared with the contralateral side (relative Constant Score [CS], 80% ± 19%). CEUS revealed diminished perfusion on the operated shoulder (WiPI, 55.1% ± 40.2%, P < .001). A strong correlation could be demonstrated between the perfusion deficit and functional impairment (relative WiPI and CS: rs = .644, P < .001). Higher grade of echogenicity in B-mode ultrasound was associated with reduced perfusion. CONCLUSION CEUS could visualize impaired supraspinatus muscle perfusion after rotator cuff repair as compared with the contralateral, healthy shoulder. With its ability to quantify microvascular perfusion as a surrogate parameter for muscle vitality and function, CEUS may serve as a quantitative method to evaluate rotator cuff muscles.
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Affiliation(s)
- Christian Fischer
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, HTRG-Heidelberg Trauma Research Group, Heidelberg University Hospital, Heidelberg, Germany
| | - Sascha Gross
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, HTRG-Heidelberg Trauma Research Group, Heidelberg University Hospital, Heidelberg, Germany
| | - Felix Zeifang
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, HTRG-Heidelberg Trauma Research Group, Heidelberg University Hospital, Heidelberg, Germany
| | - Gerhard Schmidmaier
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, HTRG-Heidelberg Trauma Research Group, Heidelberg University Hospital, Heidelberg, Germany
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, University Medical Center Rostock, Rostock, Germany
| | - Pierre Kunz
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, HTRG-Heidelberg Trauma Research Group, Heidelberg University Hospital, Heidelberg, Germany.,Shoulder and Elbow Surgery, Catholic Hospital Mainz, Mainz, Germany
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16
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Valencia AP, Lai JK, Iyer SR, Mistretta KL, Spangenburg EE, Davis DL, Lovering RM, Gilotra MN. Fatty Infiltration Is a Prognostic Marker of Muscle Function After Rotator Cuff Tear. Am J Sports Med 2018; 46:2161-2169. [PMID: 29750541 PMCID: PMC6397750 DOI: 10.1177/0363546518769267] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Massive rotator cuff tears (RCTs) begin as primary tendon injuries and cause a myriad of changes in the muscle, including atrophy, fatty infiltration (FI), and fibrosis. However, it is unclear which changes are most closely associated with muscle function. PURPOSE To determine if FI of the supraspinatus muscle after acute RCT relates to short-term changes in muscle function. STUDY DESIGN Controlled laboratory study. METHODS Unilateral RCTs were induced in female rabbits via tenotomy of the supraspinatus and infraspinatus. Maximal isometric force and rate of fatigue were measured in the supraspinatus in vivo at 6 and 12 weeks after tenotomy. Computed tomography scanning was performed, followed by histologic analysis of myofiber size, FI, and fibrosis. RESULTS Tenotomy resulted in supraspinatus weakness, reduced myofiber size, FI, and fibrosis, but no differences were evident between 6 and 12 weeks after tenotomy except for increased collagen content at 12 weeks. FI was a predictor of supraspinatus weakness and was strongly correlated to force, even after accounting for muscle cross-sectional area. While muscle atrophy accounted for the loss in force in tenotomized muscles with minimal FI, it did not account for the greater loss in force in tenotomized muscles with the most FI. Collagen content was not strongly correlated with maximal isometric force, even when normalized to muscle size. CONCLUSION After RCT, muscle atrophy results in the loss of contractile force from the supraspinatus, but exacerbated weakness is observed with increased FI. Therefore, the level of FI can help predict contractile function of torn rotator cuff muscles. CLINICAL RELEVANCE Markers to predict contractile function of RCTs will help determine the appropriate treatment to improve functional recovery after RCTs.
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Affiliation(s)
- Ana P. Valencia
- Department of Orthopaedics, School of Medicine, University of Maryland, Baltimore, Maryland, USA
- Department of Kinesiology, School of Public Health, University of Maryland, Baltimore, Maryland, USA
| | - Jim K. Lai
- Department of Orthopaedics, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Shama R. Iyer
- Department of Orthopaedics, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Katherine L. Mistretta
- Department of Orthopaedics, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Espen E. Spangenburg
- Department of Physiology, East Carolina Diabetes and Obesity Institute, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
| | - Derik L. Davis
- Department of Diagnostic Radiology and Nuclear Medicine, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Richard M. Lovering
- Department of Orthopaedics, School of Medicine, University of Maryland, Baltimore, Maryland, USA
- Department of Physiology, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Mohit N. Gilotra
- Department of Orthopaedics, School of Medicine, University of Maryland, Baltimore, Maryland, USA
- Department of Orthopaedics, Baltimore Veteran Affairs Medical Center, Baltimore, Maryland, USA
- Address correspondence to Mohit N. Gilotra, MD, Department of Orthopaedics, School of Medicine and VA Maryland Health Care System, University of Maryland, AHB, Rm 540, 100 Penn St, Baltimore, MD 21201, USA ()
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17
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Gibbons MC, Singh A, Engler AJ, Ward SR. The role of mechanobiology in progression of rotator cuff muscle atrophy and degeneration. J Orthop Res 2018; 36:546-556. [PMID: 28755470 PMCID: PMC5788743 DOI: 10.1002/jor.23662] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 07/24/2017] [Indexed: 02/06/2023]
Abstract
Rotator cuff (RC) muscles undergo several detrimental changes following mechanical unloading resulting from RC tendon tear. In this review, we highlight the pathological causes and consequences of mechanical alterations at the whole muscle, muscle fiber, and muscle resident cell level as they relate to RC disease progression. In brief, the altered mechanical loads associated with RC tear lead to architectural, structural, and compositional changes at the whole-muscle and muscle fiber level. At the cellular level, these changes equate to direct disruption of mechanobiological signaling, which is exacerbated by mechanically regulated biophysical and biochemical changes to the cellular and extra-cellular environment (also known as the stem cell "niche"). Together, these data have important implications for both pre-clinical models and clinical practice. In pre-clinical models, it is important to recapitulate both the atrophic and degenerative muscle loss found in humans using clinically relevant modes of injury. Clinically, understanding the mechanics and underlying biology of the muscle will impact both surgical decision-making and rehabilitation protocols, as interventions that may be good for atrophic muscle will have a detrimental effect on degenerating muscle, and vice versa. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:546-556, 2018.
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Affiliation(s)
| | | | - Adam J Engler
- University of California San Diego Department of Bioengineering
| | - Samuel R Ward
- University of California Department of Orthopedic Surgery,University of California Department of Radiology
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18
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Gibbons MC, Fisch KM, Pichika R, Cheng T, Engler AJ, Schenk S, Lane JG, Singh A, Ward SR. Heterogeneous muscle gene expression patterns in patients with massive rotator cuff tears. PLoS One 2018; 13:e0190439. [PMID: 29293645 PMCID: PMC5749784 DOI: 10.1371/journal.pone.0190439] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 12/14/2017] [Indexed: 01/26/2023] Open
Abstract
Detrimental changes in the composition and function of rotator cuff (RC) muscles are hallmarks of RC disease progression. Previous studies have demonstrated both atrophic and degenerative muscle loss in advanced RC disease. However, the relationship between gene expression and RC muscle pathology remains poorly defined, in large part due to a lack of studies correlating gene expression to tissue composition. Therefore, the purpose of this study was to determine how tissue composition relates to gene expression in muscle biopsies from patients undergoing reverse shoulder arthroplasty (RSA). Gene expression related to myogenesis, atrophy and cell death, adipogenesis and metabolism, inflammation, and fibrosis was measured in 40 RC muscle biopsies, including 31 biopsies from reverse shoulder arthroplasty (RSA) cases that had available histology data and 9 control biopsies from patients with intact RC tendons. After normalization to reference genes, linear regression was used to identify relationships between gene expression and tissue composition. Hierarchical clustering and principal component analysis (PCA) identified unique clusters, and fold-change analysis was used to determine significant differences in expression between clusters. We found that gene expression profiles were largely dependent on muscle presence, with muscle fraction being the only histological parameter that was significantly correlated to gene expression by linear regression. Similarly, samples with histologically-confirmed muscle distinctly segregated from samples without muscle. However, two sub-groups within the muscle-containing RSA biopsies suggest distinct phases of disease, with one group expressing markers of both atrophy and regeneration, and another group not significantly different from either control biopsies or biopsies lacking muscle. In conclusion, this study provides context for the interpretation of gene expression in heterogeneous and degenerating muscle, and provides further evidence for distinct stages of RC disease in humans.
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Affiliation(s)
- Michael C. Gibbons
- Department of Bioengineering, University of California San Diego, La Jolla, California, United States of America
| | - Kathleen M. Fisch
- Department of Computational Biology, University of California San Diego, La Jolla, California, United States of America
| | - Rajeswari Pichika
- Department of Orthopedic Surgery, University of California San Diego, La Jolla, California, United States of America
| | - Timothy Cheng
- Department of Orthopedic Surgery, University of California San Diego, La Jolla, California, United States of America
| | - Adam J. Engler
- Department of Bioengineering, University of California San Diego, La Jolla, California, United States of America
| | - Simon Schenk
- Department of Orthopedic Surgery, University of California San Diego, La Jolla, California, United States of America
| | - John G. Lane
- Department of Orthopedic Surgery, University of California San Diego, La Jolla, California, United States of America
| | - Anshu Singh
- Department of Orthopedic Surgery, University of California San Diego, La Jolla, California, United States of America
- Department of Orthopedic Surgery, Kaiser Permanente, San Diego, La Jolla, California, United States of America
| | - Samuel R. Ward
- Department of Orthopedic Surgery, University of California San Diego, La Jolla, California, United States of America
- Department of Radiology, University of California San Diego, La Jolla, California, United States of America
- * E-mail:
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Valencia AP, Iyer SR, Spangenburg EE, Gilotra MN, Lovering RM. Impaired contractile function of the supraspinatus in the acute period following a rotator cuff tear. BMC Musculoskelet Disord 2017; 18:436. [PMID: 29121906 PMCID: PMC5679320 DOI: 10.1186/s12891-017-1789-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 10/26/2017] [Indexed: 01/16/2023] Open
Abstract
Background Rotator cuff (RTC) tears are a common clinical problem resulting in adverse changes to the muscle, but there is limited information comparing histopathology to contractile function. This study assessed supraspinatus force and susceptibility to injury in the rat model of RTC tear, and compared these functional changes to histopathology of the muscle. Methods Unilateral RTC tears were induced in male rats via tenotomy of the supraspinatus and infraspinatus. Maximal tetanic force and susceptibility to injury of the supraspinatus muscle were measured in vivo at day 2 and day 15 after tenotomy. Supraspinatus muscles were weighed and harvested for histologic analysis of the neuromuscular junction (NMJ), intramuscular lipid, and collagen. Results Tenotomy resulted in eventual atrophy and weakness. Despite no loss in muscle mass at day 2 there was a 30% reduction in contractile force, and a decrease in NMJ continuity and size. Reduced force persisted at day 15, a time point when muscle atrophy was evident but NMJ morphology was restored. At day 15, torn muscles had decreased collagen-packing density and were also more susceptible to contraction-induced injury. Conclusion Muscle size and histopathology are not direct indicators of overall RTC contractile health. Changes in NMJ morphology and collagen organization were associated with changes in contractile function and thus may play a role in response to injury. Although our findings are limited to the acute phase after a RTC tear, the most salient finding is that RTC tenotomy results in increased susceptibility to injury of the supraspinatus.
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Affiliation(s)
- Ana P Valencia
- Department of Orthopaedics, University of Maryland School of Medicine, AHB, Rm 540, 100 Penn St., Baltimore, MD, 21201, USA.,Department of Kinesiology, University of Maryland School of Public Health, College Park, USA
| | - Shama R Iyer
- Department of Orthopaedics, University of Maryland School of Medicine, AHB, Rm 540, 100 Penn St., Baltimore, MD, 21201, USA
| | - Espen E Spangenburg
- Department of Physiology, East Carolina Diabetes and Obesity Institute, Brody School of Medicine, East Carolina University, Greenville, USA
| | - Mohit N Gilotra
- Department of Orthopaedics, University of Maryland School of Medicine, AHB, Rm 540, 100 Penn St., Baltimore, MD, 21201, USA
| | - Richard M Lovering
- Department of Orthopaedics, University of Maryland School of Medicine, AHB, Rm 540, 100 Penn St., Baltimore, MD, 21201, USA.
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Gibbons MC, Singh A, Anakwenze O, Cheng T, Pomerantz M, Schenk S, Engler AJ, Ward SR. Histological Evidence of Muscle Degeneration in Advanced Human Rotator Cuff Disease. J Bone Joint Surg Am 2017; 99:190-199. [PMID: 28145949 PMCID: PMC5395080 DOI: 10.2106/jbjs.16.00335] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Cellular remodeling in rotator cuff muscles following a massive rotator cuff tear is poorly understood. The aim of the current study was to provide histological evidence to elucidate the mode of muscle loss in advanced human rotator cuff disease and to assess tissue-level changes in relation to findings on noninvasive imaging. METHODS Rotator cuff muscle biopsy samples were taken from the scapular fossae from 23 consecutive patients undergoing reverse total shoulder arthroplasty in order to evaluate muscle composition in severe rotator cuff disease. Markers of vascularity; inflammation; fat distribution; and muscle atrophy, degeneration, and regeneration were quantified. RESULTS The samples primarily consisted of dense, organized connective tissue (48.2% ± 19.1%) and disorganized, loose connective tissue (36.9% ± 15.9%), with substantially smaller fractions of muscle (10.4% ± 22.0%) and fat (6.5% ± 11.6%). Only 25.8% of the biopsy pool contained any muscle fibers at all. Increased inflammatory cell counts (111.3 ± 81.5 macrophages/mm) and increased vascularization (66.6 ± 38.0 vessels/mm) were observed across biopsies. Muscle fiber degeneration was observed in 90.0% ± 15.6% of observable muscle fascicles, and the percentage of centrally nucleated muscle fibers was pathologically elevated (11.3% ± 6.3%). Fat accumulation was noted in both perifascicular (60.7% ± 41.4%) and intrafascicular (42.2% ± 33.6%) spaces, with evidence that lipid may replace contractile elements without altering muscle organization. CONCLUSIONS Dramatic degeneration and inflammation of the rotator cuff muscles are characteristics of the most chronic and severe rotator cuff disease states, suggesting that muscle loss is more complicated than, and distinct from, the simple atrophy found in less severe cases. CLINICAL RELEVANCE In order to address degenerative muscle loss, alternative therapeutic approaches directed at muscle regeneration must be considered if muscle function is to be restored in late-stage rotator cuff disease.
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Affiliation(s)
- Michael C. Gibbons
- Departments of Bioengineering (M.C.G. and A.J.E.), Orthopaedic Surgery (T.C., M.P., S.S., and S.R.W.), and Radiology (S.R.W.), University of California San Diego, San Diego, California
| | | | | | - Timothy Cheng
- Departments of Bioengineering (M.C.G. and A.J.E.), Orthopaedic Surgery (T.C., M.P., S.S., and S.R.W.), and Radiology (S.R.W.), University of California San Diego, San Diego, California
| | - Maxwill Pomerantz
- Departments of Bioengineering (M.C.G. and A.J.E.), Orthopaedic Surgery (T.C., M.P., S.S., and S.R.W.), and Radiology (S.R.W.), University of California San Diego, San Diego, California
| | - Simon Schenk
- Departments of Bioengineering (M.C.G. and A.J.E.), Orthopaedic Surgery (T.C., M.P., S.S., and S.R.W.), and Radiology (S.R.W.), University of California San Diego, San Diego, California
| | - Adam J. Engler
- Departments of Bioengineering (M.C.G. and A.J.E.), Orthopaedic Surgery (T.C., M.P., S.S., and S.R.W.), and Radiology (S.R.W.), University of California San Diego, San Diego, California
| | - Samuel R. Ward
- Departments of Bioengineering (M.C.G. and A.J.E.), Orthopaedic Surgery (T.C., M.P., S.S., and S.R.W.), and Radiology (S.R.W.), University of California San Diego, San Diego, California,E-mail address for S.R. Ward:
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Gibbons MC, Sato EJ, Bachasson D, Cheng T, Azimi H, Schenk S, Engler AJ, Singh A, Ward SR. Muscle architectural changes after massive human rotator cuff tear. J Orthop Res 2016; 34:2089-2095. [PMID: 27061583 PMCID: PMC5423410 DOI: 10.1002/jor.23256] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 04/04/2016] [Indexed: 02/04/2023]
Abstract
Rotator cuff (RC) tendon tears lead to negative structural and functional changes in the associated musculature. The structural features of muscle that predict function are termed "muscle architecture." Although the architectural features of "normal" rotator cuff muscles are known, they are poorly understood in the context of cuff pathology. The purpose of this study was to investigate the effects of tear and repair on RC muscle architecture. To this end thirty cadaveric shoulders were grouped into one of four categories based on tear magnitude: Intact, Full-thickness tear (FTT), Massive tear (MT), or Intervention if sutures or hardware were present, and key parameters of muscle architecture were measured. We found that muscle mass and fiber length decreased proportionally with tear size, with significant differences between all groups. Conversely, sarcomere number was reduced in both FTT and MT with no significant difference between these two groups, in large part because sarcomere length was significantly reduced in MT but not FTT. The loss of muscle mass in FTT is due, in part, to subtraction of serial sarcomeres, which may help preserve sarcomere length. This indicates that function in FTT may be impaired, but there is some remaining mechanical loading to maintain "normal" sarcomere length-tension relationships. However, the changes resulting from MT suggest more severe limitations in force-generating capacity because sarcomere length-tension relationships are no longer normal. The architectural deficits observed in MT muscles may indicate deeper deficiencies in muscle adaptability to length change, which could negatively impact RC function despite successful anatomical repair. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:2089-2095, 2016.
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Affiliation(s)
| | - Eugene J Sato
- University of California San Diego Department of Bioengineering
| | | | - Timothy Cheng
- University of California Department of Orthopedic Surgery
| | - Hassan Azimi
- University of California Department of Orthopedic Surgery
| | - Simon Schenk
- University of California Department of Orthopedic Surgery
| | - Adam J Engler
- University of California San Diego Department of Bioengineering
| | | | - Samuel R Ward
- University of California Department of Orthopedic Surgery,University of California Department of Radiology
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Butt U, Rashid MS, Temperley D, Crank S, Birch A, Freemont AJ, Trail IA. Muscle regeneration following repair of the rotator cuff. Bone Joint J 2016; 98-B:1389-1394. [DOI: 10.1302/0301-620x.98b10.37231] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 06/29/2016] [Indexed: 11/05/2022]
Abstract
Aims The aim of this study was to analyse human muscle tissue before and after rotator cuff repair to look for evidence of regeneration, and to characterise the changes seen in the type of muscle fibre. Patients and Methods Patients were assessed pre-operatively and one year post-operatively using the Oxford Shoulder Score (OSS) and MRI. The cross-sectional area and distribution of the type of muscle fibre were assessed on biopsies, which were taken at surgery and one year post-operatively. Paired samples from eight patients were analysed. There were three men and five women with a mean age of 63 years (50 to 73). Results All but one patient showed improvement in OSS (p = 0.004). The mean increase in the cross-sectional area of the muscle was 1220 μm2 (-801 to 3712; p = 0.03). There was a reduction of type 2a fibres (p = 0.02). A clear relationship could not be seen between the MRI findings and the histological appearances. Conclusion This is the first study to provide evidence that atrophy of the supraspinatus muscle is reversible. Changes in the types of fibre are discussed. MRI assessment of muscle atrophy may not be fully representative of myofibre atrophy. Cite this article: Bone Joint J 2016;98-B:1389–94.
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Affiliation(s)
- U. Butt
- Salford Royal NHS Foundation Trust, Salford, UK
| | - M. S. Rashid
- Royal London Hospital, Whitechapel
Road, London, E1 1BB, UK
| | - D. Temperley
- Wrightington Hospital, Hall
Lane, Appley Bridge, Wigan, Lancashire, WN6
9EP, UK
| | - S. Crank
- Wrightington Hospital, Hall
Lane, Appley Bridge, Wigan, Lancashire, WN6
9EP, UK
| | - A. Birch
- Wrightington Hospital, Hall
Lane, Appley Bridge, Wigan, Lancashire, WN6
9EP, UK
| | - A. J. Freemont
- University of Manchester and Manchester
Academic Health Sciences Centre, Stopford
Building, Oxford Road, Manchester, M13 9PT, UK
| | - I. A. Trail
- Wrightington Hospital, Hall
Lane, Appley Bridge, Wigan, Lancashire, WN6
9EP, UK
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23
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Developmental Biology and Regenerative Medicine: Addressing the Vexing Problem of Persistent Muscle Atrophy in the Chronically Torn Human Rotator Cuff. Phys Ther 2016; 96:722-33. [PMID: 26847008 PMCID: PMC4858662 DOI: 10.2522/ptj.20150029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 01/24/2016] [Indexed: 12/18/2022]
Abstract
Persistent muscle atrophy in the chronically torn rotator cuff is a significant obstacle for treatment and recovery. Large atrophic changes are predictive of poor surgical and nonsurgical outcomes and frequently fail to resolve even following functional restoration of loading and rehabilitation. New insights into the processes of muscle atrophy and recovery gained through studies in developmental biology combined with the novel tools and strategies emerging in regenerative medicine provide new avenues to combat the vexing problem of muscle atrophy in the rotator cuff. Moving these treatment strategies forward likely will involve the combination of surgery, biologic/cellular agents, and physical interventions, as increasing experimental evidence points to the beneficial interaction between biologic therapies and physiologic stresses. Thus, the physical therapy profession is poised to play a significant role in defining the success of these combinatorial therapies. This perspective article will provide an overview of the developmental biology and regenerative medicine strategies currently under investigation to combat muscle atrophy and how they may integrate into the current and future practice of physical therapy.
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Almeida LHO, Ikemoto R, Mader AM, Pinhal MAS, Munhoz B, Murachovsky J. EVALUATION OF THE EXTRACELLULAR MATRIX OF INJURED SUPRASPINATUS IN RATS. ACTA ORTOPEDICA BRASILEIRA 2016; 24:11-5. [PMID: 26997907 PMCID: PMC4775482 DOI: 10.1590/1413-785220162401146706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective: Methods: Results: Conclusion:
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Quantitative assessment of rotator cuff muscle elasticity: Reliability and feasibility of shear wave elastography. J Biomech 2015; 48:3853-8. [PMID: 26472309 DOI: 10.1016/j.jbiomech.2015.09.038] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 09/15/2015] [Accepted: 09/24/2015] [Indexed: 12/18/2022]
Abstract
Ultrasound imaging has been used to evaluate various shoulder pathologies, whereas, quantification of the rotator cuff muscle stiffness using shear wave elastography (SWE) has not been verified. The purpose of this study was to investigate the reliability and feasibility of SWE measurements for the quantification of supraspinatus (SSP) muscle elasticity. Thirty cadaveric shoulders (18 intact and 12 with torn rotator cuff) were used. Intra- and inter-observer reliability was evaluated on an established SWE technique for measuring the SSP muscle elasticity. To assess the effect of overlying soft tissues above the SSP muscle, SWE values were measured with the transducer placed on the skin, on the subcutaneous fat after removing the skin, on the trapezius muscle after removing the subcutaneous fat, and directly on the SSP muscle. In addition, SWE measurements on 4 shoulder positions (0°, 30°, 60°, and 90° abduction) were compared in those with/without rotator cuff tears. Intra- and inter-observer reliability of SWE measurements were excellent for all regions in SSP muscle. Also, removing the overlying soft tissue showed no significant difference on SWE values measured in the SSP muscle. The SSP muscle with 0° abduction showed large SWE values, whereas, shoulders with large-massive tear showed smaller variation throughout the adduction-abduction positions. SWE is a reliable and feasible tool for quantitatively assessing the SSP muscle elasticity. This study also presented SWE measurements on the SSP muscle under various shoulder abduction positions which might help characterize patterns in accordance to the size of rotator cuff tears.
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Schiefer M, Mendonça R, Magnanini MM, Fontenelle C, Pires Carvalho AC, Almeida M, Chu AC, Silva SM, Visconti F, Ferreira GAM, Franco JS. Intraobserver and interobserver agreement of Goutallier classification applied to magnetic resonance images. J Shoulder Elbow Surg 2015; 24:1314-21. [PMID: 25940380 DOI: 10.1016/j.jse.2015.02.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 02/08/2015] [Accepted: 02/16/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Fatty infiltration of the muscle bellies is an important prognostic factor in rotator cuff tears. It was described initially in computed tomography examinations, and there is an ongoing debate about whether magnetic resonance (MR) is a reliable method for staging fatty infiltration. This study sought to determine intraobserver and interobserver agreement for Goutallier's classification of fatty infiltration of the rotator cuff as evaluated through MR imaging. MATERIALS AND METHODS Twenty MR examinations of the shoulder showing full-thickness tear of the supraspinatus tendon, with or without associated lesions, were evaluated by 3 radiologists with experience in musculoskeletal system imaging and 3 fellowship-trained shoulder surgeons. The evaluators classified the fatty infiltration of the supraspinatus muscle according to the guidelines proposed by Goutallier et al. After 8 weeks, they re-evaluated the examinations, without access to their previous reports. Weighted κ index values were determined for intraobserver and interobserver agreement analyses, and intraobserver agreement κ values are reported with 95% confidence intervals (CIs). RESULTS The mean intraobserver agreement was 0.832 among the orthopedists (CI > 95%) and 0.741 among the radiologists (CI > 95%). Interobserver agreement was 0.8214 (evaluation 1) and 0.7231 (evaluation 2) among the orthopedists (P < .0001) and 0.6627 (evaluation 1) and 0.6067 (evaluation 2) among the radiologists (P < .0001). Intraobserver agreement was not associated with length of experience or frequency of routine evaluations. CONCLUSIONS When it is applied to MR images of rotator cuff musculature, Goutallier's fatty infiltration staging rubric yielded highly significant intraobserver and interobserver agreement.
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Affiliation(s)
- Marcio Schiefer
- Department of Orthopaedic Surgery, Center of Shoulder and Elbow Surgery, National Institute of Trauma and Orthopaedics, Rio de Janeiro, Brazil.
| | - Renato Mendonça
- Department of Radiology, Hospital Barra D'Or, Rio de Janeiro, Brazil
| | - Monica Maria Magnanini
- Collective Health Study Institute, Rio de Janeiro Federal University (UFRJ), Rio de Janeiro, Brazil
| | - César Fontenelle
- Department of Orthopaedics, Clementino Fraga Filho University Hospital (HUCFF), Rio de Janeiro Federal University (UFRJ), Rio de Janeiro, Brazil
| | | | - Mariana Almeida
- Department of Orthopaedics, Clementino Fraga Filho University Hospital (HUCFF), Rio de Janeiro Federal University (UFRJ), Rio de Janeiro, Brazil
| | - Ana Cláudia Chu
- Department of Orthopaedics, Clementino Fraga Filho University Hospital (HUCFF), Rio de Janeiro Federal University (UFRJ), Rio de Janeiro, Brazil
| | - Sérgio Maurício Silva
- Department of Orthopaedics, Clementino Fraga Filho University Hospital (HUCFF), Rio de Janeiro Federal University (UFRJ), Rio de Janeiro, Brazil
| | - Filipe Visconti
- Department of Orthopaedics, Faculty of Medicine, Rio de Janeiro Federal University (UFRJ), Rio de Janeiro, Brazil
| | - Gabriel A M Ferreira
- Department of Orthopaedics, Faculty of Medicine, Rio de Janeiro Federal University (UFRJ), Rio de Janeiro, Brazil
| | - José Sérgio Franco
- Department of Orthopaedics, Faculty of Medicine, Rio de Janeiro Federal University (UFRJ), Rio de Janeiro, Brazil
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Steinbacher P, Feichtinger RG, Kedenko L, Kedenko I, Reinhardt S, Schönauer AL, Leitner I, Sänger AM, Stoiber W, Kofler B, Förster H, Paulweber B, Ring-Dimitriou S. The single nucleotide polymorphism Gly482Ser in the PGC-1α gene impairs exercise-induced slow-twitch muscle fibre transformation in humans. PLoS One 2015; 10:e0123881. [PMID: 25886402 PMCID: PMC4401702 DOI: 10.1371/journal.pone.0123881] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 02/23/2015] [Indexed: 12/13/2022] Open
Abstract
PGC-1α (peroxisome proliferator-activated receptor γ co-activator 1α) is an important regulator of mitochondrial biogenesis and a master regulator of enzymes involved in oxidative phosphorylation. Recent evidence demonstrated that the Gly482Ser single nucleotide polymorphism (SNP) in the PGC-1α gene affects insulin sensitivity, blood lipid metabolism and binding to myocyte enhancer factor 2 (MEF2). Individuals carrying this SNP were shown to have a reduced cardiorespiratory fitness and a higher risk to develop type 2 diabetes. Here, we investigated the responses of untrained men with the Gly482Ser SNP to a 10 week programme of endurance training (cycling, 3 x 60 min/week, heart rate at 70-90% VO2peak). Quantitative data from analysis of biopsies from vastus lateralis muscle revealed that the SNP group, in contrast to the control group, lacked a training-induced increase in content of slow contracting oxidative fibres. Capillary supply, mitochondrial density, mitochondrial enzyme activities and intramyocellular lipid content increased similarly in both groups. These results indicate that the impaired binding of MEF2 to PGC-1α in humans with this SNP impedes exercise-induced fast-to-slow muscle fibre transformation.
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Affiliation(s)
- Peter Steinbacher
- Department of Cell Biology, Paris Lodron-University of Salzburg, Salzburg, Austria
- * E-mail:
| | - René G. Feichtinger
- Research Program for Receptor Biochemistry and Tumor Metabolism, Department of Pedicatrics, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Lyudmyla Kedenko
- First Department of Internal Medicine, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Igor Kedenko
- First Department of Internal Medicine, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Sandra Reinhardt
- Department of Cell Biology, Paris Lodron-University of Salzburg, Salzburg, Austria
| | - Anna-Lena Schönauer
- Department of Cell Biology, Paris Lodron-University of Salzburg, Salzburg, Austria
| | - Isabella Leitner
- Department of Cell Biology, Paris Lodron-University of Salzburg, Salzburg, Austria
| | - Alexandra M. Sänger
- Department of Cell Biology, Paris Lodron-University of Salzburg, Salzburg, Austria
| | - Walter Stoiber
- Department of Cell Biology, Paris Lodron-University of Salzburg, Salzburg, Austria
| | - Barbara Kofler
- Research Program for Receptor Biochemistry and Tumor Metabolism, Department of Pedicatrics, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Holger Förster
- Medical Office in Pediatrics and Sports Medicine, Salzburg, Austria
| | - Bernhard Paulweber
- First Department of Internal Medicine, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Susanne Ring-Dimitriou
- Department of Sport Science and Kinesiology, Paris Lodron-University of Salzburg, Hallein, Austria
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Stein T, Buckup J, Efe T, von Eisenhart-Rothe R, Hoffmann R, Zimmermann E, Welsch F. Structural and clinical integrity of the rotator cuff in athletes after arthroscopic Bankart repair using the three-portal technique. Arch Orthop Trauma Surg 2015; 135:369-82. [PMID: 25663019 DOI: 10.1007/s00402-015-2158-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Muscular recovery of structural integrity after arthroscopic Bankart repair using the para- and trans-musculotendinous three-portal technique has not been investigated. MATERIALS AND METHODS Twenty-seven athletes [mean age 26.9 years, (group 1; G1)] were prospectively and longitudinally monitored after arthroscopic Bankart repair using the three-portal technique by magnetic resonance imaging (MRI) and specific clinical muscular testing. The muscular integrity was assessed at the subscapularis (SSC) for the para-tendinous anteroinferior portal, the supraspinatus (SSP) for the trans-tendinous suprabicipital portal, and the infraspinatus (ISP) for the trans-tendinous posterior portal. Muscular atrophy was assessed by standardized ratios of transverse and vertical diameters for the SSC and ISP, as defined by cross-sectional area ratios for the SSP. Fatty infiltration was assessed by signal intensity analysis for the upper and lower SSC, SSP, and upper ISP as a ratio with the lower ISP. These parameters were analyzed for pre-operative (T0), 1-year (T1), and 2-year status (T2), and compared to 27 healthy volunteers [mean age 29.4 years, (group 2, G2)]. RESULTS The structural integrity assessments were performed after 14.8 (T1) and 32.0 months (T2). The SSC analysis revealed no muscular impairments in the upper and lower portions between T0 and T2 or compared to G2. MRI analysis for SSP and ISP showed full muscular recovery without any changes between T0 and T2 or deficits compared to G2. The number of pre-operative dislocations had no influence on the muscular integrity. MR analysis detected signs of overuse syndrome in 15 % at T0, 41 % at T1, and 63 % at T2; 77, 22, and 26 % of patients at T0, T1, and T2, respectively, were symptomatic. CONCLUSIONS Arthroscopic Bankart repair using the three-portal technique prevents full muscular integrity for para-tendinous anteroinferior portals at the SSC, the trans-tendinous suprabicipital portal through the SSP, and the trans-tendinous portal through the ISP.
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Affiliation(s)
- T Stein
- Department of Sporttraumatology, Knee- and Shoulder-Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, 60389, Frankfurt am Main, Germany,
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Franceschi F, Papalia R, Vasta S, Leonardi F, Maffulli N, Denaro V. Surgical management of irreparable rotator cuff tears. Knee Surg Sports Traumatol Arthrosc 2015; 23:494-501. [PMID: 23212188 DOI: 10.1007/s00167-012-2317-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 11/19/2012] [Indexed: 12/31/2022]
Abstract
PURPOSE In this prospective case control study, the effectiveness of surgical management of irreparable rotator cuff tears in terms of patient's status and quality of life was evaluated in two groups of patients: one group receiving arthroscopic debridement associated with acromioplasty and bursectomy and the other receiving an arthroscopic partial repair of the rotator cuff tear. METHODS Sixty-eight patients (47 males and 21 females) undergoing arthroscopic shoulder surgery for massive irreparable rotator cuff tear were enrolled in our study. Patients were divided into two groups: Group AP (debridement associated with acromioplasty and bursectomy) and Group PR (partial repair). Pre- and post-operative range of motion (ROM), modified-UCLA shoulder score and strength measurement were performed. The RC-QOL was used at the time of the last follow-up to assess patients' perception of their quality of life. RESULTS The final follow-up was 7.8 (±2.3, range 5-9) years. ROM measures were significantly increased from pre- to post-operative evaluations, with significant intergroup differences (P < 0.001). The overall modified-UCLA shoulder score showed a mean pre-operative value of 7.6 ± 2.6 (95 % CI 6.7-8.5) for Group AP and 8.6 ± 4.1 (95 % CI 7.0-9.9) (n.s.) for Group PR. The post-operative values at the latest follow-up showed a statistically significant improvement in both groups [21.4 ± 3.7 (95 % CI 20.1-22.7) for Group AP and 28.8 ± 4.2 (95 % CI 27.3-30.2) for Group PR] (P < 0.0001), with a significant intergroup difference (P < 0.0001). The RC-QOL demonstrated a statistically significant difference between the groups [Group AP: 61.8 ± 6.1(95 % CI 59.6-63.9); Group PR: 71.2 ± 9.8 (95 % CI 67.7-74.6)] (P < 0.0002). CONCLUSION Both techniques are effective in reducing patients' symptoms, with higher functional outcomes for partial repair. However, the choice of which technique to undertake should take into account the patients' features concerning the acromio-humeral interval and levels of daily activities. LEVEL OF EVIDENCE Therapeutic case-control study, Level III.
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Affiliation(s)
- Francesco Franceschi
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Via Alvaro del Portillo 200, Rome, Italy,
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Simvastatin reduces fibrosis and protects against muscle weakness after massive rotator cuff tear. J Shoulder Elbow Surg 2015; 24:280-7. [PMID: 25213828 PMCID: PMC4291297 DOI: 10.1016/j.jse.2014.06.048] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Revised: 06/14/2014] [Accepted: 06/27/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Chronic rotator cuff tears are a common source of shoulder pain and disability, and patients with chronic cuff tears often have substantial weakness, fibrosis, inflammation, and fat accumulation. Identifying therapies to prevent the development of these pathologic processes will likely have a positive impact on clinical outcomes. Simvastatin is a drug with demonstrated anti-inflammatory and antifibrotic effects in many tissues but had not previously been studied in the context of rotator cuff tears. We hypothesized that after the induction of a massive supraspinatus tear, simvastatin would protect muscles from a loss of force production and fibrosis. METHODS We measured changes in muscle fiber contractility, histology, and biochemical markers of fibrosis and fatty infiltration in rats that received a full-thickness supraspinatus tear and were treated with either carrier alone or simvastatin. RESULTS Compared with vehicle-treated controls, simvastatin did not have an appreciable effect on muscle fiber size, but treatment did increase muscle fiber specific force by 20%. Simvastatin also reduced collagen accumulation by 50% but did not affect triglyceride content of muscles. Several favorable changes in the expression of genes and other markers of inflammation, fibrosis, and regeneration were also observed. CONCLUSIONS Simvastatin partially protected muscles from the weakness that occurs as a result of chronic rotator cuff tear. Fibrosis was also markedly reduced in simvastatin-treated animals. Whereas further studies are necessary, statin medication could potentially help improve outcomes for patients with rotator cuff tears.
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Itoigawa Y, Sperling JW, Steinmann SP, Chen Q, Song P, Chen S, Itoi E, Hatta T, An KN. Feasibility assessment of shear wave elastography to rotator cuff muscle. Clin Anat 2014; 28:213-8. [PMID: 25557287 DOI: 10.1002/ca.22498] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 11/21/2014] [Accepted: 11/24/2014] [Indexed: 11/11/2022]
Abstract
Pre-surgical measurement of supraspinatus muscle extensibility is important for rotator cuff repair. The purpose of the present study was to explore the potential feasibility of a shear wave ultrasound elastography (SWE)-based method, combined with B-mode ultrasound, to measure the in vivo stiffness of the supraspinatus muscle non-invasively and thus obtain key information about supraspinatus muscle extensibility. Our investigation comprised two steps. First, we determined the orientation of the supraspinatus muscle fibers in cadaveric shoulders without rotator cuff tear in order to optimize the ultrasound probe positions for SWE imaging. Second, we investigated the feasibility of quantifying the stiffness of the normal supraspinatus muscle by SWE in vivo. The supraspinatus muscle was divided into four anatomical regions: anterior superficial (AS), posterior superficial (PS), anterior deep (AD), and posterior deep (PD). Each region was examined by SWE. The SWE stiffnesses of AD, AS, PD, and PS were 40.0 ± 12.4, 34.0 ± 9.9, 32.7 ± 12.7, 39.1 ± 15.7 kPa, respectively. SWE combined with B-Mode ultrasound imaging could be a feasible method for quantifying the local stiffness of the rotator cuff muscles.
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Affiliation(s)
- Yoshiaki Itoigawa
- Biomechanics Laboratory and Tendon &Soft Tissue Biology Laboratories, Division of Orthopedic Research, Mayo Clinic, Rochester, Minnesota
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Pietschmann MF, Wagenhäuser MU, Gülecyüz MF, Ficklscherer A, Jansson V, Müller PE. The long head of the biceps tendon is a suitable cell source for tendon tissue regeneration. Arch Med Sci 2014; 10:587-96. [PMID: 25097592 PMCID: PMC4107264 DOI: 10.5114/aoms.2014.43752] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 04/19/2013] [Accepted: 07/09/2013] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Tendon tissue engineering (TTE) tries to produce tendinous tissue of high quality to replace dysfunctional tissue. One possible application of TTE might be the replacement of ruptured tissue of the rotator cuff. Autologous tenocytes seem to be most suitable as no differentiation in vitro is necessary. Today it is still uncertain if there is a difference between tendon-derived cells (TDC) of different native tissues. Moreover, the search for suitable scaffolds is another important issue in TTE. MATERIAL AND METHODS This study compared TDC of the long head of the biceps tendon (LHB), the anterior cruciate ligament (ACL) and the tendon of the musculus semitendinosus (TMS). The TDC were isolated using the cell migration method. Cell morphology was assessed using light microscopy and gene expression was performed using polymerase chain reaction (PCR). Afterwards, cell seeding efficiency and proliferation were tested on a collagen I scaffold using the WST-1 assay. Results were confirmed using H + E staining. RESULTS The TDC of the LHB showed higher expression levels of collagen type I and decorin (p < 0.01) compared to TDC of other origin. Results showed efficient cell seeding and proliferation within the scaffold. Proliferation within the scaffold was not as high as when cells were cultivated without a scaffold. CONCLUSIONS The TDC of the LHB seems to be the most suitable cell source. Further research is necessary to find out if the results can be transferred to an in vivo model. The new collagen I scaffold seems to offer an opportunity to combine good biocompatibility and mechanical strength.
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Affiliation(s)
- Matthias F Pietschmann
- Department of Orthopaedic Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Markus U Wagenhäuser
- Department of Vascular and Endovascular Surgery, University of Düsseldorf, Düsseldorf, Germany
| | - Mehmet F Gülecyüz
- Department of Orthopaedic Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Andreas Ficklscherer
- Department of Orthopaedic Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Volkmar Jansson
- Department of Orthopaedic Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Peter E Müller
- Department of Orthopaedic Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
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Lundgreen K, Lian ØB, Engebretsen L, Scott A. Lower muscle regenerative potential in full-thickness supraspinatus tears compared to partial-thickness tears. Acta Orthop 2013; 84:565-70. [PMID: 24171689 PMCID: PMC3851671 DOI: 10.3109/17453674.2013.858289] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Rotator cuff tears are associated with secondary rotator cuff muscle pathology, which is definitive for the prognosis of rotator cuff repair. There is little information regarding the early histological and immunohistochemical nature of these muscle changes in humans. We analyzed muscle biopsies from patients with supraspinatus tendon tears. METHODS Supraspinatus muscle biopsies were obtained from 24 patients undergoing arthroscopic repair of partial- or full-thickness supraspinatus tendon tears. Tissue was formalin-fixed and processed for histology (for assessment of fatty infiltration and other degenerative changes) or immunohistochemistry (to identify satellite cells (CD56+), proliferating cells (Ki67+), and myofibers containing predominantly type 1 or 2 myosin heavy chain (MHC)). Myofiber diameters and the relative content of MHC1 and MHC2 were determined morphometrically. RESULTS Degenerative changes were present in both patient groups (partial and full-thickness tears). Patients with full-thickness tears had a reduced density of satellite cells, fewer proliferating cells, atrophy of MHC1+ and MHC2+ myofibers, and reduced MHC1 content. INTERPRETATION Full-thickness tears show significantly reduced muscle proliferative capacity, myofiber atrophy, and loss of MHC1 content compared to partial-thickness supraspinatus tendon tears.
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Affiliation(s)
- Kirsten Lundgreen
- Department of Orthopaedic Surgery, Lovisenberg Diaconal Hospital, Oslo, Norway
| | | | - Lars Engebretsen
- Department of Orthopaedic Surgery, Oslo University Hospital, Ullevål, Norway
| | - Alex Scott
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
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Killian ML, Lim CT, Thomopoulos S, Charlton N, Kim HM, Galatz LM. The effect of unloading on gene expression of healthy and injured rotator cuffs. J Orthop Res 2013; 31:1240-8. [PMID: 23508698 PMCID: PMC3690165 DOI: 10.1002/jor.22345] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 02/12/2013] [Indexed: 02/04/2023]
Abstract
Tendon unloading following rupture of one of the rotator cuff tendons can induce alterations in muscle physiology and tendon structure, which can subsequently affect reparability and healing potential. Yet little is known about the effects of muscle and tendon unloading on the molecular response of the rotator cuff. We determined the effect of mechanical unloading on gene expression and morphology of healthy supraspinatus tendons and muscles, and the same muscles after acute injury and repair. Mechanical unloading was achieved by tenotomy and/or botulinum toxin A (BTX) chemical denervation in a rat rotator cuff model of injury and repair. Gene expression profiles varied across regions of the muscle, with the greatest changes seen in the distal aspect of the muscle for most genes. Myogenic and adipogenic genes were upregulated in muscle when unloaded (tenotomy and BTX). Tendon injury, with and without repair, resulted in upregulation of fibrosis- and tendon-specific gene expression. The expression of scleraxis, a transcription factor necessary for tendon development, was upregulated in response to injury and repair. In summary, tendon detachment and repair had the greatest effect on tendon gene expression, while unloading had the greatest effect on muscle gene expression.
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Affiliation(s)
- ML Killian
- Department of Orthopaedic Surgery, Washington University, St Louis, MO
| | - CT Lim
- Department of Orthopaedic Surgery, Sung-Ji Hospital, Gangwon-do, South Korea
| | - S Thomopoulos
- Department of Orthopaedic Surgery, Washington University, St Louis, MO
| | - N Charlton
- Department of Orthopaedic Surgery, Washington University, St Louis, MO
| | - HM Kim
- Department of Orthopaedic Surgery, Penn State University Hershey, Hershey, PA
| | - LM Galatz
- Department of Orthopaedic Surgery, Washington University, St Louis, MO
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Buckley MR, Dunkman AA, Reuther KE, Kumar A, Pathmanathan L, Beason DP, Birk DE, Soslowsky LJ. Validation of an empirical damage model for aging and in vivo injury of the murine patellar tendon. J Biomech Eng 2013; 135:041005. [PMID: 24231900 PMCID: PMC3705855 DOI: 10.1115/1.4023700] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2012] [Revised: 01/25/2013] [Accepted: 02/19/2013] [Indexed: 01/14/2023]
Abstract
While useful models have been proposed to predict the mechanical impact of damage in tendon and other soft tissues, the applicability of these models for describing in vivo injury and age-related degeneration has not been investigated. Therefore, the objective of this study was to develop and validate a simple damage model to predict mechanical alterations in mouse patellar tendons after aging, injury, or healing. To characterize baseline properties, uninjured controls at age 150 days were cyclically loaded across three strain levels and five frequencies. For comparison, damage was induced in mature (120 day-old) mice through either injury or aging. Injured mice were sacrificed at three or six weeks after surgery, while aged mice were sacrificed at either 300 or 570 days old. Changes in mechanical properties (relative to baseline) in the three week post-injury group were assessed and used to develop an empirical damage model based on a simple damage parameter related to the equilibrium stress at a prescribed strain (6%). From the derived model, the viscoelastic properties of the 300 day-old, 570 day-old, and six week post-injury groups were accurately predicted. Across testing conditions, nearly all correlations between predicted and measured parameters were statistically significant and coefficients of determination ranged from R² = 0.25 to 0.97. Results suggest that the proposed damage model could exploit simple in vivo mechanical measurements to predict how an injured or aged tendon will respond to complex physiological loading regimens.
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Affiliation(s)
| | | | | | | | | | - David P. Beason
- e-mail: McKay Orthopaedic Research Laboratory,424 Stemmler Hall,36th Street and Hamilton Walk,University of Pennsylvania,Philadelphia, PA 19104
| | - David E. Birk
- Department of Molecular Pharmacology and Physiology,Morsani College of Medicine,University of South Florida,12901 Bruce B. Downs Boulevard, MDC 8,Tampa, FL 33612e-mail:
| | - Louis J. Soslowsky
- McKay Orthopaedic Research Laboratory,424 Stemmler Hall, 36th Street and Hamilton Walk, University of Pennsylvania,Philadelphia,PA 19104e-mail:
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Schär A, Schär MO, Zumstein MA. [Influence of chronic, structural changes of the muscle-tendon unit on the indication and technique of rotator cuff reconstruction]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2012; 24:527-35. [PMID: 23111441 DOI: 10.1007/s00064-012-0159-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Rotator cuff lesions are common and the incidence increases with age. After tendon rupture of the rotator cuff, the muscle-tendon unit retracts, which is accompanied by muscle fatty infiltration, atrophy, and interstitial fibrosis of the musculature, thus, fundamentally changing the muscle architecture. These changes are important prognostic factors for the operative rotator cuff reconstruction outcome. Selection of the correct time point for reconstruction as well as the optimal mechanical fixation technique are decisive for successful attachment at the tendon-to-bone insertion site. Thus, knowledge of the pathophysiological processes plays an important role. The goal of this article is to establish a relationship between currently existing evidence with respect to the preoperatively existing changes of the muscle-tendon unit and the choice of the time for the operation and the operative technique.
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Affiliation(s)
- A Schär
- Sportorthopädie, Departement für Orthopädische Chirurgie und Traumatologie, Universität Bern, Inselspital, Bern, Schweiz
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Dean BJF, Franklin SL, Carr AJ. A systematic review of the histological and molecular changes in rotator cuff disease. Bone Joint Res 2012; 1:158-66. [PMID: 23610686 PMCID: PMC3626275 DOI: 10.1302/2046-3758.17.2000115] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 05/30/2012] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION The pathogenesis of rotator cuff disease (RCD) is complex and not fully understood. This systematic review set out to summarise the histological and molecular changes that occur throughout the spectrum of RCD. METHODS We conducted a systematic review of the scientific literature with specific inclusion and exclusion criteria. RESULTS A total of 101 studies met the inclusion criteria: 92 studies used human subjects exclusively, seven used animal overuse models, and the remaining two studies involved both humans and an animal overuse model. A total of 58 studies analysed supraspinatus tendon exclusively, 16 analysed subacromial bursal tissue exclusively, while the other studies analysed other tissue or varying combinations of tissue types including joint fluid and muscle. The molecular biomarkers that were altered in RCD included matrix substances, growth factors, enzymes and other proteins including certain neuropeptides. CONCLUSIONS The pathogenesis of RCD is being slowly unravelled as a result of the significant recent advances in molecular medicine. Future research aimed at further unlocking these key molecular processes will be pivotal in developing new surgical interventions both in terms of the diagnosis and treatment of RCD.
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Affiliation(s)
- B J F Dean
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Botnar Research Centre, Institute of Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK
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Chaudhury S, Carr AJ. Lessons we can learn from gene expression patterns in rotator cuff tears and tendinopathies. J Shoulder Elbow Surg 2012; 21:191-9. [PMID: 22244062 DOI: 10.1016/j.jse.2011.10.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2011] [Revised: 10/22/2011] [Accepted: 10/23/2011] [Indexed: 02/06/2023]
Abstract
Persistently high failure rates that are reported after rotator cuff repairs have encouraged greater understanding of the pathophysiology that underlies rotator cuff tears. Biologic changes that contribute to the pathogenesis of rotator cuff tears and tendinopathies, as well as adaptation after these changes, have been well described. A subset of patients with a genetic predisposition to early onset of rotator cuff tears and earlier symptom and disease progression have been identified. Many biologic changes occurring at the gene level have been identified. Pathways that are believed to contribute to rotator cuff tendinopathies include extracellular matrix remodeling, angiogenesis, changes in metabolism, apoptosis, and stress-related genes. Metaplasia of rotator cuff cells is contributed to by changes in gene expression. Modification of these gene changes may be possible through mechanical loading, drugs, or cellular manipulation. Gene changes may offer greater insight into why certain tears fail to heal and help to identify therapeutic targets.
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Affiliation(s)
- Salma Chaudhury
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Musculoskeletal Biomedical Research Unit, National Institute for Health Research, University of Oxford, Oxford, UK.
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Healing of the rotator cuff. CURRENT ORTHOPAEDIC PRACTICE 2012. [DOI: 10.1097/bco.0b013e3182410e91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chaudhury S, Dines JS, Delos D, Warren RF, Voigt C, Rodeo SA. Role of fatty infiltration in the pathophysiology and outcomes of rotator cuff tears. Arthritis Care Res (Hoboken) 2011; 64:76-82. [DOI: 10.1002/acr.20552] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Rotator cuff re-tear or non-healing: histopathological aspects and predictive factors. Knee Surg Sports Traumatol Arthrosc 2011; 19:1588-96. [PMID: 21533534 DOI: 10.1007/s00167-011-1521-1] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Accepted: 04/14/2011] [Indexed: 12/14/2022]
Abstract
PURPOSE The aim of the study was to evaluate the histopathological changes that occur in the tendon and subacromial bursal tissue in patients with rotator cuff tear trying to correlate these changes to their healing capability. METHODS Eighty-four patients were clinically evaluated with the Constant Scale. Radiographs and MRI were performed preoperatively and ultrasound were performed postoperatively. For each patient, a biopsy of the supraspinatus tendon and subacromial bursa was performed, and the specimens were histopathologically analyzed. RESULTS Tendons histopathological features consisted of loss of structural organization, poor or absent neoangiogenesis, chondral metaplasia, and fibrosis. Bursal features consisted of neoangiogenesis, absence of chondral metaplasia, hyperplasia/hypertrophy, and absence of necrosis. Direct correlation was seen between tendon and bursal hyperplasia and time of the onset of symptoms; between tendon chondral metaplasia, fibrosis, bursal neoangiogenesis, inflammation, and patient age; between tendon neoangiogenesis, hyperplasia, necrosis, fibrosis, bursal necrosis, inflammation, and lesion size; on the contrary, tendon fibrosis, necrosis, and bursal tissue inflammation decrease as time passes from the onset of symptoms. Tendon fibers disarray, neoangiogenesis, and inflammation decreases as the patient's age increases. Bursal tissue fibrosis decreases as lesion size increases. CONCLUSIONS Simple histopathological techniques should be employed routinely to assess the tissue quality, with the aim to predict future clinical evolution (repair or non-repair). Comparing the histopathological data with the demographical information and the descriptive statistics, it is possible to define the RCT repair at risk and identify which RCT will be able to heal.
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Lakemeier S, Reichelt JJA, Patzer T, Fuchs-Winkelmann S, Paletta JRJ, Schofer MD. The association between retraction of the torn rotator cuff and increasing expression of hypoxia inducible factor 1α and vascular endothelial growth factor expression: an immunohistological study. BMC Musculoskelet Disord 2010; 11:230. [PMID: 20932296 PMCID: PMC2958987 DOI: 10.1186/1471-2474-11-230] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2010] [Accepted: 10/08/2010] [Indexed: 01/13/2023] Open
Abstract
Background Differing levels of tendon retraction are found in full-thickness rotator cuff tears. The pathophysiology of tendon degeneration and retraction is unclear. Neoangiogenesis in tendon parenchyma indicates degeneration. Hypoxia inducible factor 1α (HIF) and vascular endothelial growth factor (VEGF) are important inducers of neoangiogenesis. Rotator cuff tendons rupture leads to fatty muscle infiltration (FI) and muscle atrophy (MA). The aim of this study is to clarify the relationship between HIF and VEGF expression, neoangiogenesis, FI, and MA in tendon retraction found in full-thickness rotator cuff tears. Methods Rotator cuff tendon samples of 33 patients with full-thickness medium-sized rotator cuff tears were harvested during reconstructive surgery. The samples were dehydrated and paraffin embedded. For immunohistological determination of VEGF and HIF expression, sample slices were strained with VEGF and HIF antibody dilution. Vessel density and vessel size were determined after Masson-Goldner staining of sample slices. The extent of tendon retraction was determined intraoperatively according to Patte's classification. Patients were assigned to 4 categories based upon Patte tendon retraction grade, including one control group. FI and MA were measured on standardized preoperative shoulder MRI. Results HIF and VEGF expression, FI, and MA were significantly higher in torn cuff samples compared with healthy tissue (p < 0.05). HIF and VEGF expression, and vessel density significantly increased with extent of tendon retraction (p < 0.05). A correlation between HIF/VEGF expression and FI and MA could be found (p < 0.05). There was no significant correlation between HIF/VEGF expression and neovascularity (p > 0.05) Conclusion Tendon retraction in full-thickness medium-sized rotator cuff tears is characterized by neovascularity, increased VEGF/HIF expression, FI, and MA. VEGF expression and neovascularity may be effective monitoring tools to assess tendon degeneration.
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Affiliation(s)
- Stefan Lakemeier
- Department of Orthopedics and Rheumatology, University Hospital Marburg, Marburg, Germany.
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