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Mousavizadeh R, Waugh CM, McCormack RG, Cairns BE, Scott A. MRGPRX2-mediated mast cell activation by substance P from overloaded human tenocytes induces inflammatory and degenerative responses in tendons. Sci Rep 2024; 14:13540. [PMID: 38866832 PMCID: PMC11169467 DOI: 10.1038/s41598-024-64222-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 06/06/2024] [Indexed: 06/14/2024] Open
Abstract
Mast cells are immune cells minimally present in normal tendon tissue. The increased abundance of mast cells in tendinopathy biopsies and at the sites of tendon injury suggests an unexplored role of this cell population in overuse tendon injuries. Mast cells are particularly present in tendon biopsies from patients with more chronic symptom duration and a history of intensive mechanical loading. This study, therefore, examined the cross talk between mast cells and human tendon cells in either static or mechanically active conditions in order to explore the potential mechanistic roles of mast cells in overuse tendon injuries. A coculture of isolated human tenocytes and mast cells (HMC-1) combined with Flexcell Tension System for cyclic stretching of tenocytes was used. Additionally, human tenocytes were exposed to agonists and antagonists of substance P (SP) receptors. Mast cell degranulation was assessed by measuring β-hexosaminidase activity. Transwell and cell adhesion assays were used to evaluate mast cell migration and binding to tendon extracellular matrix components (collagen and fibronectin), respectively. Gene expressions were analyzed using real time qRT-PCR. Our results indicate that mechanical stimulation of human tenocytes leads to release of SP which, in turn, activates mast cells through the Mas-related G-protein-coupled receptor X2 (MRGPRX2). The degranulation and migration of mast cells in response to MRGPRX2 activation subsequently cause human tenocytes to increase their expression of inflammatory factors, matrix proteins and matrix metalloproteinase enzymes. These observations may be important in understanding the mechanisms by which tendons become tendinopathic in response to repetitive mechanical stimulation.
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Affiliation(s)
- Rouhollah Mousavizadeh
- Department of Physical Therapy, Centre for Aging SMART, Centre for Aging SMART, University of British Columbia, 2635 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Charlie M Waugh
- Department of Physical Therapy, Centre for Aging SMART, Centre for Aging SMART, University of British Columbia, 2635 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Robert G McCormack
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - Brian E Cairns
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Alex Scott
- Department of Physical Therapy, Centre for Aging SMART, Centre for Aging SMART, University of British Columbia, 2635 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
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2
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Yuan T, Lai CT, Yang SQ, Meng J, Qian H, Yu X, Jiang H, Cao QG, Xu JD, Bao NR. The rat as a novel model for chronic rotator cuff injuries. Sci Rep 2024; 14:5344. [PMID: 38438458 PMCID: PMC10912722 DOI: 10.1038/s41598-024-55281-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/22/2024] [Indexed: 03/06/2024] Open
Abstract
Chronic rotator cuff injuries (CRCIs) still present a great challenge for orthopaedics surgeons. Many new therapeutic strategies are developed to facilitate repair and improve the healing process. However, there is no reliable animal model for chronic rotator cuff injury research. To present a new valuable rat model for future chronic rotator cuff injuries (CRCIs) repair studies, and describe the changes of CRCIs on the perspectives of histology, behavior and MRI. Sixty male Wistar rats were enrolled and underwent surgery of the left shoulder joint for persistent subacromial impingement. They were randomly divided into experimental group (n = 30, a 3D printed PEEK implant shuttled into the lower surface of the acromion) and sham operation group (n = 30, insert the same implant, but remove it immediately). Analyses of histology, behavior, MRI and inflammatory pain-related genes expression profiles were performed to evaluate the changes of CRCIs. After 2-weeks running, the rats in the experimental group exhibited compensatory gait patterns to protect the injured forelimb from loading after 2-weeks running. After 8-weeks running, the rats in the experimental group showed obvious CRCIs pathological changes: (1) acromion bone hyperplasia and thickening of the cortical bone; (2) supraspinatus muscle tendon of the humeral head: the bursal-side tendon was torn and layered with disordered structure, forming obvious gaps; the humeral-side tendon is partially broken, and has a neatly arranged collagen. Partial fat infiltration is found. The coronal T2-weighted images showed that abnormal tendon-to-bone junctions of the supraspinatus tendon. The signal intensity and continuity were destroyed with contracted tendon. At the nighttime, compared with the sham operation group, the expression level of IL-1β and COX-2 increased significantly (P = 0063, 0.0005) in the experimental group. The expression of COX-2 in experimental group is up-regulated about 1.5 times than that of daytime (P = 0.0011), but the expression of IL-1β, TNF-a, and NGF are all down-regulated (P = 0.0146, 0.0232, 0.0161). This novel rat model of chronic rotator cuff injuries has the similar characteristics with that of human shoulders. And it supplies a cost-effective, reliable animal model for advanced tissue engineered strategies and future therapeutic strategies.
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Affiliation(s)
- Tao Yuan
- Department of Orthopaedics, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 Zhongshan East Road, Nanjing, 210002, China
| | - Cheng-Teng Lai
- Department of Orthopaedics, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 Zhongshan East Road, Nanjing, 210002, China
| | - Shao-Qiang Yang
- Department of Orthopaedics, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 Zhongshan East Road, Nanjing, 210002, China
| | - Jia Meng
- Department of Orthopaedics, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 Zhongshan East Road, Nanjing, 210002, China
| | - Hong Qian
- Department of Orthopaedics, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 Zhongshan East Road, Nanjing, 210002, China
| | - Xin Yu
- Department of Orthopaedics, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 Zhongshan East Road, Nanjing, 210002, China
| | - Hui Jiang
- Department of Orthopaedics, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 Zhongshan East Road, Nanjing, 210002, China
| | - Qing-Gang Cao
- Department of Orthopaedics, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 Zhongshan East Road, Nanjing, 210002, China
| | - Jian-Da Xu
- Department of Orthopaedics, Changzhou Traditional Chinese Medical Hospital, Changzhou hospital Affiliated to Nanjing University of Chinese Medicine, 25 North Heping Road, Changzhou, 213000, Jiangsu, China.
| | - Ni-Rong Bao
- Department of Orthopaedics, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, 305 Zhongshan East Road, Nanjing, 210002, China.
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3
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Lawrence RL, Soliman SB, Dalbøge A, Lohse K, Bey MJ. Investigating the multifactorial etiology of supraspinatus tendon tears. J Orthop Res 2024; 42:578-587. [PMID: 37814893 PMCID: PMC10932906 DOI: 10.1002/jor.25699] [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: 03/09/2023] [Revised: 05/23/2023] [Accepted: 10/05/2023] [Indexed: 10/11/2023]
Abstract
The purpose of this study was to develop a multivariable model to determine the extent to which a combination of etiological factors is associated with supraspinatus tendon tears. Fifty-four asymptomatic individuals (55 ± 4 years) underwent testing of their dominant shoulder. Diagnostic ultrasound was used to assess for a supraspinatus tendon tear. The etiological factors investigated included demographics (age and sex), tendon impingement during shoulder motion (via biplane videoradiography), glenohumeral morphology (via computed tomography imaging), family history of a tear (via self-report), occupational shoulder exposure (via shoulder job exposure matrix), and athletic exposure (via self-report). Univariate relationships between etiological predictors and supraspinatus tears were assessed using logistic regression and odds ratios (ORs), while multivariable relationships were assessed using classification and regression tree analysis. Thirteen participants (24.1%) had evidence of a supraspinatus tear. Individuals with a tear had a higher critical shoulder angle (OR 1.2, p = 0.028) and acromial index (OR 1.2, p = 0.016) than individuals without a tear. The multivariable model suggested that a tear in this cohort can be explained with acceptable accuracy (AUROC = 0.731) by the interaction between acromial index and shoulder occupational exposure: a tear is more likely in individuals with a high acromial index (p < 0.001), and in individuals with a low acromial index and high occupational exposure (p < 0.001). The combination of an individual's glenohumeral morphology (acromial index) and occupational shoulder exposure may be important in the development of supraspinatus tears.
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Affiliation(s)
- Rebekah L. Lawrence
- Program in Physical Therapy, Washington University School of Medicine; St. Louis, MO, USA
- Henry Ford Health; Detroit, MI, USA
| | - Steven B. Soliman
- Henry Ford Health; Detroit, MI, USA
- Department of Radiology, University of Michigan; Ann Arbor, MI, USA
| | - Annett Dalbøge
- Department of Clinical Medicine, Aarhus University; Aarhus, Denmark
- Department of Occupational Medicine, Aarhus University Hospital; Aarhus, Denmark
| | - Keith Lohse
- Program in Physical Therapy, Washington University School of Medicine; St. Louis, MO, USA
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4
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Bedi A, Bishop J, Keener J, Lansdown DA, Levy O, MacDonald P, Maffulli N, Oh JH, Sabesan VJ, Sanchez-Sotelo J, Williams RJ, Feeley BT. Rotator cuff tears. Nat Rev Dis Primers 2024; 10:8. [PMID: 38332156 DOI: 10.1038/s41572-024-00492-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 02/10/2024]
Abstract
Rotator cuff tears are the most common upper extremity condition seen by primary care and orthopaedic surgeons, with a spectrum ranging from tendinopathy to full-thickness tears with arthritic change. Some tears are traumatic, but most rotator cuff problems are degenerative. Not all tears are symptomatic and not all progress, and many patients in whom tears become more extensive do not experience symptom worsening. Hence, a standard algorithm for managing patients is challenging. The pathophysiology of rotator cuff tears is complex and encompasses an interplay between the tendon, bone and muscle. Rotator cuff tears begin as degenerative changes within the tendon, with matrix disorganization and inflammatory changes. Subsequently, tears progress to partial-thickness and then full-thickness tears. Muscle quality, as evidenced by the overall size of the muscle and intramuscular fatty infiltration, also influences symptoms, tear progression and the outcomes of surgery. Treatment depends primarily on symptoms, with non-operative management sufficient for most patients with rotator cuff problems. Modern arthroscopic repair techniques have improved recovery, but outcomes are still limited by a lack of understanding of how to improve tendon to bone healing in many patients.
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Affiliation(s)
- Asheesh Bedi
- Department of Orthopedic Surgery, University of Chicago, Chicago, IL, USA
- NorthShore Health System, Chicago, IL, USA
| | - Julie Bishop
- Department of Orthopedic Surgery, The Ohio State Wexner Medical Center, Columbus, OH, USA
| | - Jay Keener
- Department of Orthopedic Surgery, Washington University, St. Louis, MO, USA
| | - Drew A Lansdown
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Ofer Levy
- Reading Shoulder Unit, Berkshire Independent Hospital, Reading, UK
| | - Peter MacDonald
- Department of Surgery, Max Rady College of Medicine, Winnipeg, Manitoba, Canada
| | - Nicola Maffulli
- Department of Trauma and Orthopaedic Surgery, Faculty of Medicine and Psychology, University of Rome Sapienza, Rome, Italy
| | - Joo Han Oh
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Korea
| | - Vani J Sabesan
- HCA Florida JFK Orthopaedic Surgery Residency Program, Atlantis Orthopedics, Atlantis, FL, USA
| | | | - Riley J Williams
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Brian T Feeley
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA, USA.
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5
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Umehara J, Ueda Y, Yagi M, Nojiri S, Tachibana T, Nobuhara K, Ichihashi N. Mechanical characteristic of supraspinatus muscle changes independent of its size and intramuscular fat in patient with rotator cuff repair. J Electromyogr Kinesiol 2023; 73:102831. [PMID: 37871509 DOI: 10.1016/j.jelekin.2023.102831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 09/23/2023] [Accepted: 10/13/2023] [Indexed: 10/25/2023] Open
Abstract
PURPOSE This study aimed i) to investigate the mechanical, morphological, and compositional characteristics of the supraspinatus muscle after rotator cuff repair by using ultrasound shear wave elastography (SWE) and B-mode imaging, and ii) to determine whether the morphological or compositional characteristics are associated with the mechanical characteristic of the supraspinatus during contraction. METHODS Using SWE and B-mode imaging, active and passive shear moduli, muscle thickness, and echo intensity of the supraspinatus were measured from the repaired and contralateral control shoulders of 22 patients with rotator cuff repair. The shear modulus, muscle thickness, and echo intensity were compared between the repaired and control shoulders. The association between the active shear modulus and the other variables was determined. RESULTS While the active and passive shear moduli were lower in the repaired shoulder compared to the control, the muscle thickness and echo intensity did not vary between them. Interestingly, the passive shear modulus was positively correlated with the active shear modulus only in the control shoulder. CONCLUSION The mechanical characteristic of supraspinatus remains impaired, even without degenerative changes in the morphological and compositional characteristics after rotator cuff repair. Furthermore, the association between contractile and elastic characteristics in the supraspinatus was deteriorated in control shoulder.
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Affiliation(s)
- Jun Umehara
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Faculty of Rehabilitation, Kansai Medical University, Osaka, Japan.
| | - Yasuyuki Ueda
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Faculty of Health Science, Takarazuka University of Medical and Healthcare, Takarazuka, Japan
| | - Masahide Yagi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shusuke Nojiri
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | | | - Noriaki Ichihashi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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6
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Chatterjee M, Evans MK, Bell R, Nguyen PK, Kamalitdinov TB, Korntner S, Kuo CK, Dyment NA, Andarawis-Puri N. Histological and immunohistochemical guide to tendon tissue. J Orthop Res 2023; 41:2114-2132. [PMID: 37321983 DOI: 10.1002/jor.25645] [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: 12/01/2022] [Revised: 06/02/2023] [Accepted: 06/11/2023] [Indexed: 06/17/2023]
Abstract
Tendons are unique dense connective tissues with discrete zones having specific structure and function. They are juxtaposed with other tissues (e.g., bone, muscle, and fat) with different compositional, structural, and mechanical properties. Additionally, tendon properties change drastically with growth and development, disease, aging, and injury. Consequently, there are unique challenges to performing high quality histological assessment of this tissue. To address this need, histological assessment was one of the breakout session topics at the 2022 Orthopaedic Research Society (ORS) Tendon Conference hosted at the University of Pennsylvania. The purpose of the breakout session was to discuss needs from members of the ORS Tendon Section related to histological procedures, data presentation, knowledge dissemination, and guidelines for future work. Therefore, this review provides a brief overview of the outcomes of this discussion and provides a set of guidelines, based on the perspectives from our laboratories, for histological assessment to assist researchers in their quest to utilize these techniques to enhance the outcomes and interpretations of their studies.
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Affiliation(s)
- Monideepa Chatterjee
- Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York, USA
| | - Mary K Evans
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rebecca Bell
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, New York, USA
| | - Phong K Nguyen
- Department of Biomedical Engineering, University of Rochester, Rochester, New York, USA
| | - Timur B Kamalitdinov
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stefanie Korntner
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland, USA
| | - Catherine K Kuo
- Department of Biomedical Engineering, University of Rochester, Rochester, New York, USA
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland, USA
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, New York, USA
- Department of Orthopaedics, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Nathaniel A Dyment
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nelly Andarawis-Puri
- Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York, USA
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, New York, USA
- Hospital for Special Surgery, New York, New York, USA
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7
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Little D, Amadio PC, Awad HA, Cone SG, Dyment NA, Fisher MB, Huang AH, Koch DW, Kuntz AF, Madi R, McGilvray K, Schnabel LV, Shetye SS, Thomopoulos S, Zhao C, Soslowsky LJ. Preclinical tendon and ligament models: Beyond the 3Rs (replacement, reduction, and refinement) to 5W1H (why, who, what, where, when, how). J Orthop Res 2023; 41:2133-2162. [PMID: 37573480 PMCID: PMC10561191 DOI: 10.1002/jor.25678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/21/2023] [Accepted: 08/02/2023] [Indexed: 08/14/2023]
Abstract
Several tendon and ligament animal models were presented at the 2022 Orthopaedic Research Society Tendon Section Conference held at the University of Pennsylvania, May 5 to 7, 2022. A key objective of the breakout sessions at this meeting was to develop guidelines for the field, including for preclinical tendon and ligament animal models. This review summarizes the perspectives of experts for eight surgical small and large animal models of rotator cuff tear, flexor tendon transection, anterior cruciate ligament tear, and Achilles tendon injury using the framework: "Why, Who, What, Where, When, and How" (5W1H). A notable conclusion is that the perfect tendon model does not exist; there is no single gold standard animal model that represents the totality of tendon and ligament disease. Each model has advantages and disadvantages and should be carefully considered in light of the specific research question. There are also circumstances when an animal model is not the best approach. The wide variety of tendon and ligament pathologies necessitates choices between small and large animal models, different anatomic sites, and a range of factors associated with each model during the planning phase. Attendees agreed on some guiding principles including: providing clear justification for the model selected, providing animal model details at publication, encouraging sharing of protocols and expertise, improving training of research personnel, and considering greater collaboration with veterinarians. A clear path for translating from animal models to clinical practice was also considered as a critical next step for accelerating progress in the tendon and ligament field.
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Affiliation(s)
- Dianne Little
- Department of Basic Medical Sciences, The Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, USA
| | - Peter C Amadio
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Hani A Awad
- Department of Orthopaedics, Department of Biomedical Engineering, The Center for Musculoskeletal Research, University of Rochester, Rochester, New York, USA
| | - Stephanie G Cone
- Department of Biomedical Engineering, University of Delaware, Newark, Delaware, USA
| | - Nathaniel A Dyment
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Matthew B Fisher
- Joint Department of Biomedical Engineering, College of Engineering, North Carolina State University-University of North Carolina at Chapel Hill, Raleigh, North Carolina, USA
| | - Alice H Huang
- Department of Orthopedic Surgery, Department of Biomedical Engineering, Columbia University, New York, New York, USA
| | - Drew W Koch
- Department of Clinical Sciences, College of Veterinary Medicine, and Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina, USA
| | - Andrew F Kuntz
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rashad Madi
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kirk McGilvray
- Department of Mechanical Engineering, School of Biomedical Engineering, Colorado State University, Fort Collins, Colorado, USA
| | - Lauren V Schnabel
- Department of Clinical Sciences, College of Veterinary Medicine, and Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina, USA
| | - Snehal S Shetye
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stavros Thomopoulos
- Department of Orthopedic Surgery, Department of Biomedical Engineering, Columbia University, New York, New York, USA
| | - Chunfeng Zhao
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Louis J Soslowsky
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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De Starkey KR, Groth AM, Thyssen RR, Kernozek TW. Added mass increases Achilles tendon stress in female runners. Foot (Edinb) 2023; 56:102028. [PMID: 37011454 DOI: 10.1016/j.foot.2023.102028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/06/2023] [Accepted: 03/24/2023] [Indexed: 04/05/2023]
Abstract
CONTEXT Achilles tendon (AT) injuries are common in female runners and military personnel where increased AT loading may be a contributing factor. Few studies have examined AT stress during running with added mass. The purpose was to examine the stress, strain, and force placed on the AT, kinematics and temporospatial variable in running with different amounts of added mass. DESIGN Repeated measure design METHODS: Twenty-three female runners with a rear-foot strike pattern were participants. AT stress, strain, and force were measured during running using a musculoskeletal model that used kinematic (180 Hz) and kinetic data (1800 Hz) as input. Ultrasound data were used to measure AT cross sectional area. A repeated measures multivariate analysis of variance (α = 0.05) was used on AT loading variables, kinematics and temporospatial variables. RESULTS Peak AT stress, strain, and force were greatest during the 9.0 kg added load running condition (p < .0001). There was a 4.3% and 8.8% increase in AT stress and strain during the 4.5 kg and 9.0 kg added load conditions, respectively, compared to baseline. Kinematics at the hip and knee changed with added load but not at the ankle. Small changes in temporospatial variables were seen. CONCLUSION Added load increased stress on the AT during running. There may be an increased risk for AT injury with added load. Individuals may consider slowly progressing training with added load to allow for increased AT loading.
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Affiliation(s)
- Katelyn R De Starkey
- La Crosse Institute for Movement Science, Physical Therapy Program, Department of Health Professions, University of Wisconsin-La Crosse, La Crosse, USA
| | - Ashley M Groth
- La Crosse Institute for Movement Science, Physical Therapy Program, Department of Health Professions, University of Wisconsin-La Crosse, La Crosse, USA
| | - Ryan R Thyssen
- La Crosse Institute for Movement Science, Physical Therapy Program, Department of Health Professions, University of Wisconsin-La Crosse, La Crosse, USA
| | - Thomas W Kernozek
- La Crosse Institute for Movement Science, Physical Therapy Program, Department of Health Professions, University of Wisconsin-La Crosse, La Crosse, USA.
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9
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Bloom ET, Lin LM, Locke RC, Giordani A, Krassan E, Peloquin JM, Silbernagel KG, Parreno J, Santare MH, Killian ML, Elliott DM. Overload in a Rat In Vivo Model of Synergist Ablation Induces Tendon Multiscale Structural and Functional Degeneration. J Biomech Eng 2023; 145:081003. [PMID: 37184932 PMCID: PMC10782872 DOI: 10.1115/1.4062523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 05/02/2023] [Accepted: 05/04/2023] [Indexed: 05/16/2023]
Abstract
Tendon degeneration is typically described as an overuse injury with little distinction made between magnitude of load (overload) and number of cycles (overuse). Further, in vivo, animal models of tendon degeneration are mostly overuse models, where tendon damage is caused by a high number of load cycles. As a result, there is a lack of knowledge of how isolated overload leads to degeneration in tendons. A surgical model of synergist ablation (SynAb) overloads the target tendon, plantaris, by ablating its synergist tendon, Achilles. The objective of this study was to evaluate the structural and functional changes that occur following overload of plantaris tendon in a rat SynAb model. Tendon cross-sectional area (CSA) and shape changes were evaluated by longitudinal MR imaging up to 8 weeks postsurgery. Tissue-scale structural changes were evaluated by semiquantified histology and second harmonic generation microscopy. Fibril level changes were evaluated with serial block face scanning electron microscopy (SBF-SEM). Functional changes were evaluated using tension tests at the tissue and microscale using a custom testing system allowing both video and microscopy imaging. At 8 weeks, overloaded plantaris tendons exhibited degenerative changes including increases in CSA, cell density, collagen damage area fraction (DAF), and fibril diameter, and decreases in collagen alignment, modulus, and yield stress. To interpret the differences between overload and overuse in tendon, we introduce a new framework for tendon remodeling and degeneration that differentiates between the inputs of overload and overuse. In summary, isolated overload induces multiscale degenerative structural and functional changes in plantaris tendon.
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Affiliation(s)
- Ellen T Bloom
- Department of Biomedical Engineering, University of Delaware, Newark, DE 19716
| | - Lily M Lin
- Department of Biomedical Engineering, University of Delaware, Newark, DE 19716
| | - Ryan C Locke
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA 19104; Translational Musculoskeletal Research Center, CMCVAMC, Philadelphia, PA 19104
| | - Alyssa Giordani
- Department of Biomedical Engineering, University of Delaware, Newark, DE 19716
| | - Erin Krassan
- Department of Biomedical Engineering, University of Delaware, Newark, DE 19716
| | - John M Peloquin
- Department of Biomedical Engineering, University of Delaware, Newark, DE 19716
| | | | - Justin Parreno
- Department of Biological Sciences, University of Delaware, Newark, DE 19716
| | - Michael H Santare
- Department of Mechanical Engineering, University of Delaware, Newark, DE 19716
| | - Megan L Killian
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI 48104
| | - Dawn M Elliott
- Department of Biomedical Engineering, University of Delaware, Newark, DE 19716
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10
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Ganji E, Lamia SN, Stepanovich M, Whyte N, Goulet RW, Abraham AC, Killian ML. Optogenetic-induced muscle loading leads to mechanical adaptation of the Achilles tendon enthesis in mice. SCIENCE ADVANCES 2023; 9:eadf4683. [PMID: 37352350 PMCID: PMC10289645 DOI: 10.1126/sciadv.adf4683] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 05/17/2023] [Indexed: 06/25/2023]
Abstract
Skeletal shape depends on the transmission of contractile muscle forces from tendon to bone across the enthesis. Loss of muscle loading impairs enthesis development, yet little is known if and how the postnatal enthesis adapts to increased loading. Here, we studied adaptations in enthesis structure and function in response to increased loading, using optogenetically induced muscle contraction in young (i.e., growth) and adult (i.e., mature) mice. Daily bouts of unilateral optogenetic loading in young mice led to radial calcaneal expansion and warping. This also led to a weaker enthesis with increased collagen damage in young tendon and enthisis, with little change in adult mice. We then used RNA sequencing to identify the pathways associated with increased mechanical loading during growth. In tendon, we found enrichment of glycolysis, focal adhesion, and cell-matrix interactions. In bone, we found enrichment of inflammation and cell cycle. Together, we demonstrate the utility of optogenetic-induced muscle contraction to elicit in vivo adaptation of the enthesis.
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Affiliation(s)
- Elahe Ganji
- Department of Orthopaedic Surgery, Michigan Medicine, University of Michigan, 109 Zina Pitcher Pl., Ann Arbor, MI 48109, USA
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, 405 North Mathews Ave., Urbana, IL 61801, USA
- Department of Biomedical Engineering, University of Delaware, 540 S. College Ave., Newark, DE 19713, USA
| | - Syeda N. Lamia
- Department of Orthopaedic Surgery, Michigan Medicine, University of Michigan, 109 Zina Pitcher Pl., Ann Arbor, MI 48109, USA
- Department of Mechanical Engineering, University of Michigan, 2350 Hayward St., Ann Arbor, MI 48109, USA
| | - Matthew Stepanovich
- Department of Orthopaedic Surgery, Michigan Medicine, University of Michigan, 109 Zina Pitcher Pl., Ann Arbor, MI 48109, USA
| | - Noelle Whyte
- Department of Orthopaedic Surgery, Michigan Medicine, University of Michigan, 109 Zina Pitcher Pl., Ann Arbor, MI 48109, USA
| | - Robert W. Goulet
- Department of Orthopaedic Surgery, Michigan Medicine, University of Michigan, 109 Zina Pitcher Pl., Ann Arbor, MI 48109, USA
| | - Adam C. Abraham
- Department of Orthopaedic Surgery, Michigan Medicine, University of Michigan, 109 Zina Pitcher Pl., Ann Arbor, MI 48109, USA
| | - Megan L. Killian
- Department of Orthopaedic Surgery, Michigan Medicine, University of Michigan, 109 Zina Pitcher Pl., Ann Arbor, MI 48109, USA
- Department of Biomedical Engineering, University of Delaware, 540 S. College Ave., Newark, DE 19713, USA
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11
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Suito H, Fujikawa K, Ohsako M. Eccentric contractions during downhill running induce Osgood‒Schlatter disease in the tibial tuberosity in rats: a focus on histological structures. Sci Rep 2023; 13:9863. [PMID: 37332037 PMCID: PMC10277288 DOI: 10.1038/s41598-023-36914-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 06/12/2023] [Indexed: 06/20/2023] Open
Abstract
Osgood-Schlatter disease (OSD), a condition that affects adolescents, causes inflammation, pain, and prominence at the tibial tuberosity. The causes of OSD are not well understood, but eccentric contractions in the quadriceps have been suggested as a possible factor. To investigate this, a study was conducted in which 24 rats were divided into two groups: the downhill treadmill running (DR) group and the control (CO) group. The DR group underwent a preliminary running program for 1 week, followed by a main running program for 3 weeks. The results showed that the deep region of the tibial tuberosity in the DR group was larger than that in the CO group, and inflammatory cytokines involved in gene expression were upregulated in the DR group. The anterior articular cartilage and deep region in the DR group were also immunoreactive to substance P. Additionally, high-activity chondrocytes of small size were observed in the non-calcified matrix. Thus, the DR group exhibited symptoms similar to OSD, including inflammation, pain, and prominence. These findings suggest that eccentric contractions in the quadriceps may play a role in the development of OSD. Further research is needed to better understand the pathophysiology of this condition and develop effective treatment options.
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Affiliation(s)
- Hirai Suito
- Graduate School of Human Life Design, Toyo University, 1-7-11 Akabanedai, Kita-Ku 115-8650, Tokyo, Japan.
- Japan Society for the Promotion of Science Research Fellowships DC, Tokyo, Japan.
| | - Kaoru Fujikawa
- Department of Oral Anatomy and Developmental Biology, Showa University School of Density, Tokyo, Japan
| | - Masafumi Ohsako
- Graduate School of Health and Sports Science, Toyo University, Tokyo, Japan
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12
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Kim H, Kim AY, Kang BJ. Insertional biceps tendinopathy palliated successfully with intra-articular triamcinolone acetonide injection in a dog: A case report. Vet Med Sci 2023. [PMID: 37327466 DOI: 10.1002/vms3.1182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 04/05/2023] [Accepted: 05/29/2023] [Indexed: 06/18/2023] Open
Abstract
This report describes a dog diagnosed with insertional biceps tendinopathy that was palliated with intra-articular triamcinolone acetonide injections. The patient was a 6-year-old spayed female Chihuahua dog that had left thoracic limb lameness for 3 months before presentation. On physical examination, moderate pain was elicited by performing the biceps test and isolated full elbow extension on the left thoracic limb. Gait analysis showed asymmetrical peak vertical force and vertical impulse between thoracic limbs. Computed tomography (CT) revealed enthesophyte formation on the ulnar tuberosity of the left elbow joint. Ultrasonography showed a heterogeneous fibre pattern at the biceps tendon insertion site on the left elbow joint. These findings confirmed insertional biceps tendinopathy based on physical examination, CT and ultrasonography results. The dog received an intra-articular triamcinolone acetonide injection with hyaluronic acid in the left elbow joint. Clinical signs improved after the first injection, including a range of motion, pain and gait. A second injection was given in the same manner because of recurring mild lameness 3 months later. No clinical signs were observed during the follow-up period.
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Affiliation(s)
- Hyunsoo Kim
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, Republic of Korea
- BK21 FOUR Future Veterinary Medicine Leading Education and Research Center, Seoul National University, Seoul, Republic of Korea
| | - Ah-Young Kim
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, Republic of Korea
| | - Byung-Jae Kang
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, Republic of Korea
- BK21 FOUR Future Veterinary Medicine Leading Education and Research Center, Seoul National University, Seoul, Republic of Korea
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13
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Ozone K, Minegishi Y, Oka Y, Sato M, Kanemura N. The Effects of Downhill Running and Maturation on Histological and Morphological Properties of Tendon and Enthesis in Mice. BIOLOGY 2023; 12:biology12030456. [PMID: 36979148 PMCID: PMC10045940 DOI: 10.3390/biology12030456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 03/17/2023]
Abstract
To date, it remains unclear how overuse affects the tendons and entheses at different stages of maturation. Therefore, we evaluated histological and morphological changes in the tendons and entheses in adolescent (4-week-old) and adult mice (8-week-old) by performing flat-land and downhill running exercises. The mice were divided into the Sedentary, High Flat (flat-land high-speed running; concentric-contraction exercise), Low Down (downhill low-speed running; eccentric-contraction exercise), and High Down (downhill high-speed running; eccentric-contraction exercise) groups. Histological changes and inflammatory factor expressions were compared in the entheses and tendons after 4 weeks of exercise. Downhill, but not flat-land high-speed running, induced muscle–tendon complex hypertrophy in both adolescent and adult mice. Histological enthesis changes were induced in both groups during downhill running but were less pronounced in adult mice. Conversely, no significant cell aggregation or fiber orientation changes were observed in the tendon, but increased inflammatory factors were observed in both groups, with significantly higher expression in the tendons of adult mice. Downhill running induced histological and morphological enthesis changes and inflammatory factor increase in the tendons, regardless of running speed variations. These results may help elucidate the pathogenesis of enthesopathy and tendinopathy, which have different pathophysiologies despite having the same pathogenetic factors.
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Affiliation(s)
- Kaichi Ozone
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Koshigaya 343-8540, Japan; (K.O.)
- Department of Rehabilitation, University of Tsukuba Hospital, Tsukuba 305-8576, Japan
| | - Yuki Minegishi
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Koshigaya 343-8540, Japan; (K.O.)
- Japan Society for the Promotion of Science, Tokyo 102-0083, Japan
| | - Yuichiro Oka
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Koshigaya 343-8540, Japan; (K.O.)
| | - Michiaki Sato
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Koshigaya 343-8540, Japan; (K.O.)
| | - Naohiko Kanemura
- Department of Physical Therapy, Health and Social Services, Saitama Prefectural University, Koshigaya 343-8540, Japan
- Correspondence: ; Tel.: +81-48-971-0500
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14
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Gains CC, Giannapoulos A, Zamboulis DE, Lopez-Tremoleda J, Screen HRC. Development and application of a novel in vivo overload model of the Achilles tendon in rat. J Biomech 2023; 151:111546. [PMID: 36958089 DOI: 10.1016/j.jbiomech.2023.111546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 03/03/2023] [Accepted: 03/09/2023] [Indexed: 03/17/2023]
Abstract
Repetitive overload is a primary factor in tendon injury, causing progressive accumulation of matrix damage concurrent with a cellular response. However, it remains unclear how these events occur at the initial stages of the disease, making it difficult to identify appropriate treatment approaches. Here, we describe the development of a new model to cyclically load the Achilles tendon (AT) of rats in vivo and investigate the initial structural and cellular responses. The model utilizes controlled dorsiflexion of the ankle joint applied near maximal dorsiflexion, for 10,000 cycles at 3 Hz. Animals were subjected to a single bout of in vivo loading under anaesthesia, and either culled immediately (without recovery from anaesthesia), or 48 h or 4-weeks post-loading. Macro strains were assessed in cadavers, whilst tendon specific microdamage was assessed through collagen-hybridizing peptide (CHP) immunohistochemistry which highlighted a significant rise in CHP staining in loaded ATs compared to contralateral controls, indicating an accumulation of overload-induced damage. Staining for pro-inflammatory mediators (IL-6 and COX-2) and matrix degradation markers (MMP-3 and -13) also suggests an initial cellular response to overload. Model validation confirmed our approach was able to explore early overload-induced damage within the AT, with microdamage present and no evidence of broader musculoskeletal damage. The new model may be implemented to map the progression of tendinopathy in the AT, and thus study potential therapeutic interventions.
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Affiliation(s)
- Connor Charles Gains
- School of Engineering and Materials Science (SEMS), Queen Mary University of London, Mile End Road, London E1 4NS, United Kingdom.
| | - Antonios Giannapoulos
- School of Engineering and Materials Science (SEMS), Queen Mary University of London, Mile End Road, London E1 4NS, United Kingdom
| | - Danae Emilie Zamboulis
- School of Engineering and Materials Science (SEMS), Queen Mary University of London, Mile End Road, London E1 4NS, United Kingdom
| | - Jordi Lopez-Tremoleda
- Blizard Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, Mile End Road, London E1 4NS, United Kingdom
| | - Hazel R C Screen
- School of Engineering and Materials Science (SEMS), Queen Mary University of London, Mile End Road, London E1 4NS, United Kingdom
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15
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Ozone K, Minegishi Y, Takahata K, Takahashi H, Yoneno M, Hattori S, Xianglan L, Oka Y, Murata K, Kanemura N. Eccentric contraction-dominant exercise leads to molecular biological changes in enthesis and enthesopathy-like morphological changes. J Orthop Res 2023; 41:511-523. [PMID: 35716158 DOI: 10.1002/jor.25399] [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: 01/09/2022] [Revised: 06/02/2022] [Accepted: 06/15/2022] [Indexed: 02/04/2023]
Abstract
Entheses, which are tendon-to-bone attachment sites in the musculoskeletal system, play important roles in optimizing the mechanical stress and force transmitted from the muscle to the bone. Sports-related enthesopathy shows pathological features, including hyperplasia of the fibrocartilage (FC) region in the enthesis. The amount of exercise and type of muscle contraction during movement is involved in the pathogenesis of sports-related enthesopathy; however, the details of this condition are unclear. Here we examined the molecular pathways involved in the morphological changes of the muscle-tendon-enthesis complex and enthesis FC region in the supraspinatus muscle enthesis of mice under different exercise conditions. Following intervention, morphological changes in the muscle-tendon-enthesis complex were initiated in the eccentric contraction-dominant exercise group at 2 weeks, with activation of the transforming growth factor-β (TGFβ) superfamily pathway predicted by proteome and ingenuity pathway analyses. Histological and molecular biological analyses confirmed the activation of the TGFβ/bone morphogenetic protein (BMP)-Smad pathway. The concentric contraction-dominant exercise group showed no change in the morphology of the muscle-tendon-enthesis complex or activation of the TGFβ/BMP-Smad pathway, despite overuse exercise. Statement of Clinical Significance: These results suggest that eccentric contraction-dominant exercise induces sports-related enthesopathy-like morphological changes in the early stages as well as molecular biological changes, mainly in the transforming growth factor-β superfamily pathway in enthesis. Statement of Clinical Significance: These results suggest that eccentric contraction-dominant exercise induces sports-related enthesopathy-like morphological changes in the early stages as well as molecular biological changes, mainly in the transforming growth factor-β superfamily pathway in enthesis.
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Affiliation(s)
- Kaichi Ozone
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Koshigaya, Saitama, Japan.,Japan Society for the Promotion of Science, Tokyo, Japan
| | - Yuki Minegishi
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Koshigaya, Saitama, Japan.,Japan Society for the Promotion of Science, Tokyo, Japan
| | - Kei Takahata
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Koshigaya, Saitama, Japan
| | - Haruna Takahashi
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Koshigaya, Saitama, Japan
| | - Moe Yoneno
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Koshigaya, Saitama, Japan
| | - Shinya Hattori
- Nanotechnology Innovation Station, National Institute for Materials Science, Tsukuba, Japan
| | - Li Xianglan
- Nanotechnology Innovation Station, National Institute for Materials Science, Tsukuba, Japan
| | - Yuichiro Oka
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Koshigaya, Saitama, Japan
| | - Kenji Murata
- Department of Physical Therapy, Health and Social Services, Saitama Prefectural University, Koshigaya, Saitama, Japan
| | - Naohiko Kanemura
- Department of Physical Therapy, Health and Social Services, Saitama Prefectural University, Koshigaya, Saitama, Japan
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16
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So BCL, Lau SCT, Kwok WY, Tse DHT, Man SS. Investigating The Association Between Supraspinatus Tendon Abnormality, Shoulder Pain and Isokinetic Strength in Elite Swimmers: A Cross-Sectional Study. J Sports Sci Med 2023; 22:17-27. [PMID: 36876175 PMCID: PMC9982540 DOI: 10.52082/jssm.2023.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 12/05/2022] [Indexed: 03/07/2023]
Abstract
Shoulder pain is common among elite swimmers due to the tremendous stress over shoulders during swimming. Supraspinatus muscle is one of the major prime movers and stabilizers of shoulder and is highly susceptible to overloading and tendinopathy. An understanding of the relationship between supraspinatus tendon and pain; and between supraspinatus tendon and strength would assist health care practitioners for developing training regime. The objectives of this study are to evaluate 1) the association between structural abnormality of supraspinatus tendon and shoulder pain and 2) the association between structural abnormality of supraspinatus tendon and shoulder strength. We hypothesized that structural abnormality of supraspinatus tendons positively associated with shoulder pain and negatively associated with shoulder muscle strength among elite swimmers. 44 elite swimmers were recruited from the Hong Kong China Swimming Association. Supraspinatus tendon condition was evaluated using diagnostic ultrasound imaging and shoulder internal and external rotation strength was evaluated by the isokinetic dynamometer. Pearson's R was used to study the correlation between shoulder pain and supraspinatus tendon condition and to evaluate the association between isokinetic strength of shoulders and supraspinatus tendon condition. 82 shoulders had supraspinatus tendinopathy or tendon tear (93.18%). However, there was no statistically significant association between structural abnormality of supraspinatus tendon and shoulder pain. The results showed that there was no association between supraspinatus tendon abnormality and shoulder pain and there was a significant correlation between left maximal supraspinatus tendon thickness (LMSTT) and left external rotation/ concentric (LER/Con) and left external rotation/ eccentric (LER/Ecc) shoulder strength (p < 0.05) while internal rotation/ external rotation (IR/ER) ratio can also be a significant predicator on LMSTT >6mm (R2 = 0.462, F = 7.016, df = 1, p = 0.038). Structural change of supraspinatus tendon was not associated with shoulder pain, but could be a predictor on MSTT >6mm in elite swimmers.
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Affiliation(s)
- Billy Chun Lung So
- Gait and Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.,Research Institute for Sports Science and Technology, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Stan Cheuk Ting Lau
- Gait and Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Wan Yu Kwok
- Gait and Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Daniel Hon Ting Tse
- Gait and Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Siu Shing Man
- Gait and Motion Analysis Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
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17
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Piras LA, Olimpo M, Lafuente P, Tomba A, Del Magno S, Lardone E, Peirone B, Mancusi D. Surgical Treatment of Nonmineralized Supraspinatus Tendinopathy in Dogs: A Retrospective Long-Term Follow-Up. Animals (Basel) 2023; 13:ani13040592. [PMID: 36830379 PMCID: PMC9951642 DOI: 10.3390/ani13040592] [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: 12/30/2022] [Revised: 02/03/2023] [Accepted: 02/05/2023] [Indexed: 02/10/2023] Open
Abstract
(1) Background: two forms of supraspinatus tendinopathy (ST) have been reported in dogs: mineralized and non-mineralized. Surgical treatment consists of longitudinal incisions (splitting) in the tendon of insertion of the supraspinatus muscle. The purpose of this retrospective study is to describe the diagnostic workout, the surgical procedure and the short and long term follow up of dogs treated for non-mineralized ST. (2) Methods: medical records (2010-2017) of dogs diagnosed with non-mineralized ST that underwent surgical treatment were reviewed. Data retrieved were: signalment, history, clinical signs, orthopaedic examination findings, diagnostic imaging findings, surgical treatment, histopathologic diagnosis and clinical outcome. (3) Results: A total of 27 dogs met the inclusion criteria. The most consistent clinical findings were intermittent lameness accompanied by pain on palpation of the insertion of the supraspinatus. Magnetic resonance imaging (MRI) of 27 shoulders distended sheaths of the biceps tendon (10/27), compression of the biceps brachii tendon sheaths (5/27) and enlargement of the supraspinatus tendon (3/27) were observed. The most prominent histologic finding was severe myxomatous degeneration in all 27 samples. Resolution of lameness was achieved in 80% of the cases surgically treated without any further lameness episodes in the long-term follow-up. (4) Conclusions: the surgical splitting of the non-mineralized supraspinatus tendon is an effective procedure with no intra-operative complications and a low incidence of minor (18%) and major (4%) complications.
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Affiliation(s)
- Lisa Adele Piras
- Department of Veterinary Science, University of Turin, 10095 Grugliasco, Italy
- Correspondence:
| | - Matteo Olimpo
- Department of Veterinary Science, University of Turin, 10095 Grugliasco, Italy
| | - Pilar Lafuente
- Facultad de Salud, Universidad International de La Rioja (UNIR), 26006 Logroño, Spain
| | - Anna Tomba
- Norad Diagnostica, 21017 Samarate, Italy
| | - Sara Del Magno
- Department of Veterinary Medical Sciences, University of Bologna, 40126 Bologna, Italy
| | - Elena Lardone
- Department of Veterinary Science, University of Turin, 10095 Grugliasco, Italy
| | - Bruno Peirone
- Department of Veterinary Science, University of Turin, 10095 Grugliasco, Italy
| | - Davide Mancusi
- Department of Veterinary Science, University of Turin, 10095 Grugliasco, Italy
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18
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Pre-procedural Imaging. Regen Med 2023. [DOI: 10.1007/978-3-030-75517-1_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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19
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Tendinopathy. Regen Med 2023. [DOI: 10.1007/978-3-030-75517-1_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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20
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Zhao W, Yang J, Kang Y, Hu K, Jiao M, Zhao B, Jiang Y, Liu C, Ding F, Yuan B, Ma B, Zhang K, Mikos AG, Zhang X. Animal Models of Rotator Cuff Injury and Repair: A Systematic Review. TISSUE ENGINEERING. PART B, REVIEWS 2022; 28:1258-1273. [PMID: 35972750 DOI: 10.1089/ten.teb.2022.0034] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
There are a large number of animal studies on rotator cuff injury and repair, but a lack of detailed research and evaluation on the animal models. This systematic review aims to provide a framework for animal studies and repair patches for rotator cuff injury. Four hundred nine animal studies were included, of which the most common animal model of rotator cuff injury is rat (53.56%), the most common site of rotator cuff injury is the supraspinatus tendon (62.10%), and the most common injury type (degree) is acute tear (full thickness) (48.41%). The most common research purpose is to evaluate the repair effect of the patch (24.94%), followed by the observation of pathophysiological changes after rotator cuff injury (20.87%). Among the five types of repair patch materials including nondegradable and degradable synthetic materials, autologous and allogeneic tissues, and naturally derived biomaterial, the last one is the mostly used (52.74%). For different animal models, the rodent models (rat and mouse) are the most commonly used and probably the most suitable species for preliminary studies of rotator cuff injury; the rabbit, canine, sheep, and goat models are more suitable for biomechanical performance testing, rehabilitation training, and validation of surgical methods; and the nonhuman primate models (monkey and baboon) are the closest to human, but it is more difficult to carry out the animal studies on them because of ethical issues, high feeding cost, and management difficulties.
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Affiliation(s)
- Wanlu Zhao
- College of Biomedical Engineering and Sichuan University, Chengdu, People's Republic of China.,National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, People's Republic of China
| | - Jinwei Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, People's Republic of China.,Reproductive Medicine Center, Gansu Provincial Maternity and Child-Care Hospital, Lanzhou, People's Republic of China
| | - Yuhao Kang
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Kaiyan Hu
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, People's Republic of China
| | - Mingyue Jiao
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, People's Republic of China
| | - Bing Zhao
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, People's Republic of China
| | - Yanbiao Jiang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, People's Republic of China.,The First Hospital of Lanzhou University, Lanzhou, People's Republic of China
| | - Chen Liu
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, People's Republic of China
| | - Fengxing Ding
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, People's Republic of China
| | - Bo Yuan
- College of Biomedical Engineering and Sichuan University, Chengdu, People's Republic of China.,National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, People's Republic of China
| | - Bin Ma
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, People's Republic of China.,Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, People's Republic of China
| | - Kai Zhang
- College of Biomedical Engineering and Sichuan University, Chengdu, People's Republic of China.,National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, People's Republic of China.,Institute of Regulatory Science for Medical Devices, Sichuan University, Chengdu, People's Republic of China
| | - Antonios G Mikos
- Department of Bioengineering, Chemical and Biomolecular Engineering, Rice University, Houston, Texas, USA
| | - Xingdong Zhang
- College of Biomedical Engineering and Sichuan University, Chengdu, People's Republic of China.,National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, People's Republic of China.,Institute of Regulatory Science for Medical Devices, Sichuan University, Chengdu, People's Republic of China
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21
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Review of human supraspinatus tendon mechanics. Part I: fatigue damage accumulation and failure. J Shoulder Elbow Surg 2022; 31:2671-2677. [PMID: 35931330 DOI: 10.1016/j.jse.2022.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 06/10/2022] [Accepted: 06/27/2022] [Indexed: 02/01/2023]
Abstract
Repetitive stress injuries to the rotator cuff, and particularly the supraspinatus tendon (SST), are highly prevalent and debilitating. These injuries typically occur through the application of cyclic load below the threshold necessary to cause acute tears, leading to accumulation of incremental damage that exceeds the body's ability to heal, resulting in decreased mechanical strength and increased risk of frank rupture at lower loads. Consistent progression of fatigue damage across multiple model systems suggests a generalized tendon response to overuse. This finding may allow for interventions before gross injury of the SST occurs. Further research into the human SST response to fatigue loading is necessary to characterize the fatigue life of the tendon, which will help determine the frequency, duration, and magnitude of load spectra the SST may experience before injury. Future studies may allow in vivo SST strain analysis during specific activities, generation of a human SST stress-cycle curve, and characterization of damage and repair related to repetitive tasks.
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22
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Butler DL. Evolution of functional tissue engineering for tendon and ligament repair. J Tissue Eng Regen Med 2022; 16:1091-1108. [PMID: 36397198 DOI: 10.1002/term.3360] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/21/2022] [Accepted: 10/22/2022] [Indexed: 11/19/2022]
Abstract
This review paper is motivated by a Back-to-Basics presentation given by the author at the 2022 Orthopaedic Research Society meeting in Tampa, Florida. I was tasked with providing a brief history of research leading up to the introduction of functional tissue engineering (FTE) for tendon and ligament repair. Beginning in the 1970s, this timeline focused on two common orthopedic soft tissue problems, anterior cruciate ligament ruptures in the knee and supraspinatus tendon injuries in the shoulder. Historic changes in the field over the next 5 decades revealed a transformation from a focus more on mechanics (called "bioMECHANICS") on a larger (tissue) scale to a more recent focus on biology (called "mechanoBIOLOGY") on a smaller (cellular and molecular) scale. Early studies by surgeons and engineers revealed the importance of testing conditions for ligaments and tendons (e.g., high strain rates while avoiding subject disuse and immobility) and the need to measure in vivo forces in these tissues. But any true tissue engineering and regeneration in these early decades was limited more to the use of auto-, allo- and xenografts than actual generation of stimulated cell-scaffold constructs in culture. It was only after the discovery of tissue engineering in 1988 and the recognition of frequent rotator cuff injuries in the early 1990s, that biologists joined surgeons and engineers to discover mechanical and biological testing criteria for FTE. This review emphasizes the need for broader and more inclusive collaborations by surgeons, biologists and engineers in the short term with involvement of those in biomaterials, manufacturing, and regulation of new products in the longer term.
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Affiliation(s)
- David L Butler
- College of Engineering and Applied Sciences, University of Cincinnati, Cincinnati, Ohio, USA
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23
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Ozone K, Kokubun T, Takahata K, Takahashi H, Yoneno M, Oka Y, Minegishi Y, Arakawa K, Kano T, Murata K, Kanemura N. Structural and pathological changes in the enthesis are influenced by the muscle contraction type during exercise. J Orthop Res 2022; 40:2076-2088. [PMID: 34862672 DOI: 10.1002/jor.25233] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 08/10/2021] [Accepted: 11/20/2021] [Indexed: 02/04/2023]
Abstract
Mechanical stress is involved in the onset of sports-related enthesopathy. Although the amount of exercise undertaken is a recognized problem during disease onset, changes in muscle contraction type are also involved in the increase in mechanical stress during exercise. This study aimed to clarify the effects of increased mechanical stress associated with muscle contraction type and amount of exercise on enthesis. Twenty mice underwent treadmill exercise, and the muscle contraction type and overall load during exercise were adjusted by varying the angle and speed conditions. Histological analysis was used to the cross-sectional area of the muscle; area of the enthesis fibrocartilage (FC), and expression of inflammation-, degeneration-, and calcification-related factors in the FC area. In addition, the volume and structure of the bone and FC area were examined using microcomputer imaging. Molecular biological analysis was conducted to compare relative expression levels of inflammation and cytokine-related factors in tendons. The Overuse group, which increased the amount of exercise, showed no significant differences in parameters compared to the sedentary mice (Control group). The mice subjected to slow-speed downhill running (Misuse group) showed pathological changes compared to the Control and Overuse groups, despite the small amount of exercise. Thus, the enthesis FC area may be altered by local mechanical stress that would be increased by eccentric muscle contraction rather than by mechanical stress that increases with the overall amount of exercise. Clinical Significance: The muscle contraction type might be more involved in the onset of sports-related enthesopathy rather than the amount of exercise.
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Affiliation(s)
- Kaichi Ozone
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Koshigaya, Saitama, Japan.,Japan Society for the Promotion of Science, Tokyo, Japan
| | - Takanori Kokubun
- Department of Physical Therapy, Health and Social Services, Saitama Prefectural University, Koshigaya, Saitama, Japan
| | - Kei Takahata
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Koshigaya, Saitama, Japan
| | - Haruna Takahashi
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Koshigaya, Saitama, Japan
| | - Moe Yoneno
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Koshigaya, Saitama, Japan
| | - Yuichiro Oka
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Koshigaya, Saitama, Japan
| | - Yuki Minegishi
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Koshigaya, Saitama, Japan.,Japan Society for the Promotion of Science, Tokyo, Japan
| | - Kohei Arakawa
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Koshigaya, Saitama, Japan
| | - Takuma Kano
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Koshigaya, Saitama, Japan
| | - Kenji Murata
- Department of Physical Therapy, Health and Social Services, Saitama Prefectural University, Koshigaya, Saitama, Japan
| | - Naohiko Kanemura
- Department of Physical Therapy, Health and Social Services, Saitama Prefectural University, Koshigaya, Saitama, Japan
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24
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Huang Y, Hoppe ED, Kurtaliaj I, Birman V, Thomopoulos S, Genin GM. Effects of tendon viscoelasticity on the distribution of forces across sutures in a model tendon-to-bone repair. INTERNATIONAL JOURNAL OF SOLIDS AND STRUCTURES 2022; 250:111725. [PMID: 38161357 PMCID: PMC10756498 DOI: 10.1016/j.ijsolstr.2022.111725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Tears to the rotator cuff often require surgical repair. These repairs often culminate in re-tearing when sutures break through the tendon in the weeks following repair. Although numerous studies have been performed to identify suturing strategies that reduce this risk by balancing forces across sutures, none have accounted for how the viscoelastic nature of tendon influences load sharing. With the aim of providing insight into this problem, we studied how tendon viscoelasticity, tendon stiffness, and suture anchor spacing affect this balancing of forces across sutures. Results from a model of a three-row sutured re-attachment demonstrated that optimized distributions of suture stiffnesses and of the spacing of suture anchors can balance the forces across sutures to within a few percent, even when accounting for tendon viscoelasticity. Non-optimized distributions resulted in concentrated force, typically in the outermost sutures. Results underscore the importance of accounting for viscoelastic effects in the design of tendon to bone repairs.
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Affiliation(s)
- Yuxuan Huang
- NSF Science and Technology Center for Engineering Mechanobiology, Department of Mechanical Engineering and Materials Science, Washington University, St. Louis, MO, USA
| | - Ethan D. Hoppe
- NSF Science and Technology Center for Engineering Mechanobiology, Department of Mechanical Engineering and Materials Science, Washington University, St. Louis, MO, USA
| | - Iden Kurtaliaj
- Department of Orthopedic Surgery, Columbia University, New York, NY, USA
| | - Victor Birman
- Department of Mechanical and Aerospace Engineering, Missouri University of Science & Technology, Rolla, Missouri, USA
| | | | - Guy M. Genin
- NSF Science and Technology Center for Engineering Mechanobiology, Department of Mechanical Engineering and Materials Science, Washington University, St. Louis, MO, USA
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25
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Abraham AC, Fang F, Golman M, Oikonomou P, Thomopoulos S. The role of loading in murine models of rotator cuff disease. J Orthop Res 2022; 40:977-986. [PMID: 34081350 PMCID: PMC8639823 DOI: 10.1002/jor.25113] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 04/07/2021] [Accepted: 05/31/2021] [Indexed: 02/04/2023]
Abstract
Rotator cuff disease pathogenesis is associated with intrinsic (e.g., age, joint laxity, muscle weakness) and extrinsic (e.g., mechanical load, fatigue) factors that lead to chronic degeneration of the cuff tissues. However, etiological studies are difficult to perform in patients due to the long duration of disease onset and progression. Therefore, the purpose of this study was to determine the effects of altered joint loading on the rotator cuff. Mice were subjected to one of three load-dependent rotator cuff tendinopathy models: underuse loading, achieved by injecting botulinum toxin-A into the supraspinatus muscle; overuse loading, achieved using downhill treadmill running; destabilization loading, achieved by surgical excision of the infraspinatus tendon. All models were compared to cage activity animals. Whole joint function was assessed longitudinally using gait analysis. Tissue-scale structure and function were determined using microCT, tensile testing, and histology. The molecular response of the supraspinatus tendon and enthesis was determined by measuring the expression of 84 wound healing-associated genes. Underuse and destabilization altered forepaw weight-bearing, decreased tendon-to-bone attachment strength, decreased mineral density of the humeral epiphysis, and reduced tendon strength. Transcriptional activity of the underuse group returned to baseline levels by 4 weeks, while destabilization had significant upregulation of inflammation, growth factors, and extracellular matrix remodeling genes. Surprisingly, overuse activity caused changes in walking patterns, increased tendon stiffness, and primarily suppressed expression of wound healing-related genes. In summary, the tendinopathy models demonstrated how divergent muscle loading can result in clinically relevant alterations in rotator cuff structure, function, and gene expression.
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Affiliation(s)
- Adam C. Abraham
- University of Michigan, Department of Orthopaedic Surgery, Biomedical Science Research Building, 109 Zina Pitcher Pl, Ann Arbor, MI 48109, USA,Corresponding author Adam C. Abraham, Ph.D., Research Investigator, University of Michigan, Department of Orthopaedic Surgery, Ann Arbor, MI 48109, USA,
| | - Fei Fang
- Columbia University Irving Medical Center, Department of Orthopaedic Surgery, New York, NY 10032, USA
| | - Mikhail Golman
- Columbia University, Department of Biomedical Engineering, New York, NY 10027
| | | | - Stavros Thomopoulos
- Columbia University Irving Medical Center, Department of Orthopaedic Surgery, New York, NY 10032, USA,Columbia University, Department of Biomedical Engineering, New York, NY 10027
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26
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Scleraxis and Collagen I Expression Increase Following Pilot Isometric Loading Experiments in a Rodent Model of Patellar Tendinopathy. Matrix Biol 2022; 109:34-48. [DOI: 10.1016/j.matbio.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/23/2022] [Accepted: 03/21/2022] [Indexed: 11/19/2022]
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27
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Peñin-Franch A, García-Vidal JA, Martínez CM, Escolar-Reina P, Martínez-Ojeda RM, Gómez AI, Bueno JM, Minaya-Muñoz F, Valera-Garrido F, Medina-Mirapeix F, Pelegrín P. Galvanic current activates the NLRP3 inflammasome to promote type I collagen production in tendon. eLife 2022; 11:73675. [PMID: 35199642 PMCID: PMC8896827 DOI: 10.7554/elife.73675] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 02/23/2022] [Indexed: 11/25/2022] Open
Abstract
The NLRP3 inflammasome coordinates inflammation in response to different pathogen- and damage-associated molecular patterns, being implicated in different infectious, chronic inflammatory, metabolic and degenerative diseases. In chronic tendinopathic lesions, different non-resolving mechanisms produce a degenerative condition that impairs tissue healing and which therefore complicates their clinical management. Percutaneous needle electrolysis consists of the application of a galvanic current and is an emerging treatment for tendinopathies. In the present study, we found that galvanic current activates the NLRP3 inflammasome and induces an inflammatory response that promotes a collagen-mediated regeneration of the tendon in mice. This study establishes the molecular mechanism of percutaneous electrolysis that can be used to treat chronic lesions and describes the beneficial effects of an induced inflammasome-related response.
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28
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Fortune E, Cloud-Biebl BA, Madansingh SI, Ngufor CG, Van Straaten MG, Goodwin BM, Murphree DH, Zhao KD, Morrow MM. Estimation of manual wheelchair-based activities in the free-living environment using a neural network model with inertial body-worn sensors. J Electromyogr Kinesiol 2022; 62:102337. [PMID: 31353200 PMCID: PMC6980511 DOI: 10.1016/j.jelekin.2019.07.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 06/24/2019] [Accepted: 07/15/2019] [Indexed: 02/03/2023] Open
Abstract
Shoulder pain is common in manual wheelchair (MWC) users. Overuse is thought to be a major cause, but little is known about exposure to activities of daily living (ADLs). The study goal was to develop a method to estimate three conditions in the field: (1) non-propulsion activity, (2) MWC propulsion, and (3) static time using an inertial measurement unit (IMU). Upper arm IMU data were collected as ten MWC users performed lab-based MWC-related ADLs. A neural network model was developed to classify data as non-propulsion activity, propulsion, or static, and validated for the lab-based data collection by video comparison. Six of the participants' free-living IMU data were collected and the lab-based model was applied to estimate daily non-propulsion activity, propulsion, and static time. The neural network model yielded lab-based validity measures ≥0.87 for differentiating non-propulsion activity, propulsion, and static time. A quasi-validation of one participant's field-based data yielded validity measures ≥0.66 for identifying propulsion. Participants' estimated mean daily non-propulsion activity, propulsion, and static time ranged from 158 to 409, 13 to 25, and 367 to 609 min, respectively. The preliminary results suggest the model may be able to accurately identify MWC users' field-based activities. The inclusion of field-based IMU data in the model could further improve field-based classification.
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Affiliation(s)
- Emma Fortune
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, 55905, USA,Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, 55905, USA
| | - Beth A. Cloud-Biebl
- Program in Physical Therapy, Mayo Clinic School of Health Sciences, Mayo Clinic, Rochester, MN, 55905, USA,Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, 55905, USA
| | - Stefan I. Madansingh
- Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, 55905, USA
| | - Che G. Ngufor
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, 55905, USA,Division of Biomedical Informatics and Statistics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, 55905, USA
| | - Meegan G. Van Straaten
- Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, 55905, USA
| | - Brianna M. Goodwin
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, 55905, USA,Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, 55905, USA
| | - Dennis H. Murphree
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, 55905, USA,Division of Biomedical Informatics and Statistics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, 55905, USA
| | - Kristin D. Zhao
- Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, 55905, USA
| | - Melissa M. Morrow
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, 55905, USA,Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, 55905, USA
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29
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Effects of focused ultrasound and dry needling on tendon mechanical properties. J Biomech 2022; 132:110934. [PMID: 34995989 PMCID: PMC8860888 DOI: 10.1016/j.jbiomech.2021.110934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/11/2021] [Accepted: 12/18/2021] [Indexed: 02/03/2023]
Abstract
Tendon injuries are extremely common, resulting in mechanically weaker tendons that could lead to tendon rupture. Dry needling (DN) is widely used to manage pain and function after injury. However, DN is invasive and high inter-practitioner variability has led to mixed success rates. Focused ultrasound (fUS) is a non-invasive medical technology that directs ultrasound energy into a well-defined focal volume. fUS can induce thermal ablation or mechanical fractionation, with bioeffect type controlled through ultrasound parameters. Tendons must withstand high physiological loads, thus treatments maintaining tendon mechanical properties while promoting healing are needed. Our objective was to evaluate mechanical effects of DN and 3 fUS parameter sets, chosen to prioritize mechanical fractionation, on Achilles and supraspinatus tendons. Ex vivo rat Achilles and supraspinatus tendons (50 each) were divided into sham, DN, fUS-1, fUS-2, and fUS-3 (n = 10/group). Following treatment, tendons were mechanically tested. Elastic modulus of supraspinatus tendons treated with DN (126.64 ± 28.1 MPa) was lower than sham (153.02 ± 29.3 MPa; p = 0.0280). Stiffness and percent relaxation of tendons treated with DN (Achilles: 114.40 ± 31.6 N/mm; 49.10 ± 6.1%; supraspinatus: 109.53 ± 30.8 N/mm; 50.17 ± 7.6%) were lower (all p < 0.0334) than sham (Achilles: 141.34 ± 20.9 N/mm; 60.30 ± 7.7%; supraspinatus: 135.14 ± 30.2 N/mm; 60.85 ± 15.4%). Modulus of Achilles and supraspinatus tendons treated with fUS-1 (159.88 ± 25.7 MPa; 150.12 ± 22.0 MPa, respectively) were similar to sham (156.35 ± 23.0 MPa; 153.02 ± 29.3 MPa, respectively). These results suggest that fUS preserves mechanical properties better than DN, with fUS-1 performing better than fUS-2 and fUS-3. fUS should be studied further to fully understand its mechanical and healing effects to help evaluate fUS as an alternative, non-invasive treatment for tendon injuries.
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30
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Pozzi F, Sousa CO, Plummer HA, Andrade B, Awokuse D, Kono N, Mack WJ, Roll SC, Michener LA. Development of shoulder pain with job-related repetitive load: mechanisms of tendon pathology and anxiety. J Shoulder Elbow Surg 2022; 31:225-234. [PMID: 34656782 PMCID: PMC9121627 DOI: 10.1016/j.jse.2021.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 09/13/2021] [Accepted: 09/17/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND The paucity of longitudinal clinical studies limits our understanding of the development of shoulder pain with repetitive shoulder tasks, and its association with underlying mind and body mechanisms. Tendon thickening characterizes painful shoulder supraspinatus tendinopathy, and the perception of pain can be affected by the presence of psychological factors such as anxiety and depression. This study determined the incidence of shoulder pain in novice individuals exposed to repetitive shoulder tasks, and the associated change in outcomes of supraspinatus tendon morphology and measures of anxiety and depression. METHODS We recruited dental hygiene (DH) students (n = 45, novice and exposed to shoulder repetitive tasks) and occupational therapy (OT) students (n = 52, novice, but not exposed to shoulder repetitive tasks), following them over their first year of training. We measured shoulder pain, supraspinatus morphology via ultrasonography, and psychosocial distress via the Hospital Anxiety and Depression Scale. We compared the incidence of shoulder pain (defined as a change of visual analog scale for pain score greater than the minimal clinically important difference) between DH and OT students using Fisher exact test. We used mixed effects models to longitudinally compare the change in outcomes between 3 groups: DH students who develop and did not develop shoulder pain, and OT students. RESULTS The incidence of shoulder pain is higher in DH students (relative risk = 4.0, 95% confidence interval [CI] 1.4, 11.4). After 1 year, DH students with pain had the greatest thickening of the supraspinatus (0.7 mm, 95% CI 0.4, 0.9). The change in supraspinatus thickness of DH students with pain was greater than both DH students with no pain (0.4 mm, 95% CI 0.1, 0.8) and OT students (0.9 mm, 95% CI 0.5, 1.2). Anxiety score increased 3.8 points (95% CI 1.6, 5.1) in DH students with pain, and 43% of DH students with pain had abnormal anxiety score at 1 year (relative risk = 2.9, 95% CI 1.0, 8.6). CONCLUSION Our results provide support for the theoretical model of repetitive load as a mechanism of tendinopathy. The supraspinatus tendon thickens in the presence of repetitive tasks, and it thickens the most in those who develop shoulder pain. Concurrently, anxiety develops with shoulder pain, indicating a potential maladaptive central mechanism that may impact the perception of pain.
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Affiliation(s)
- Federico Pozzi
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA.
| | - Catarina O Sousa
- Departemento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | - Hillary A Plummer
- Division of Biokinesiology, University of Southern California, Los Angeles, CA, USA
| | - Brittany Andrade
- Division of Biokinesiology, University of Southern California, Los Angeles, CA, USA
| | - Daniel Awokuse
- Division of Biokinesiology, University of Southern California, Los Angeles, CA, USA
| | - Naoko Kono
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Wendy J Mack
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Shawn C Roll
- USC Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Lori A Michener
- Division of Biokinesiology, University of Southern California, Los Angeles, CA, USA
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31
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Mora KE, Mlawer SJ, Bae AJ, Richards MS, Loiselle AE, Buckley MR. Ultrasound strain mapping of the mouse Achilles tendon during passive dorsiflexion. J Biomech 2022; 132:110920. [PMID: 34998182 PMCID: PMC10564406 DOI: 10.1016/j.jbiomech.2021.110920] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 12/14/2021] [Accepted: 12/15/2021] [Indexed: 11/21/2022]
Abstract
Immediately prior to inserting into bone, many healthy tendons experience impingement from nearby bony structures. However, super-physiological levels of impingement are implicated in insertional tendinopathies. Unfortunately, the mechanisms underlying the connection between impingement and tendon pathology remain poorly understood, in part due to the shortage of well-characterized animal models of impingement at clinically relevant sites. As a first step towards developing a model of excessive tendon impingement, the objective of this study was to characterize the mechanical strain environment in the mouse Achilles tendon insertion under passive dorsiflexion and confirm that - like humans - mice experience impingement of the tendon insertion from the calcaneus (heel bone) in dorsiflexed ankle positions. Based on previous work in humans, we hypothesized that during dorsiflexion, the mouse Achilles tendon insertion would experience high levels of transverse compressive strain due to calcaneal impingement. A custom-built loading platform was used to apply passive dorsiflexion, while an ultrasound transducer positioned over the Achilles tendon captured radiofrequency images. A non-rigid image registration algorithm was then used to map the transverse compressive strain based on the acquired ultrasound image sequences. Our results demonstrate that during passive dorsiflexion, transverse compressive strains were produced throughout the Achilles tendon, with significantly larger strain magnitudes at the tendon insertion than at the midsubstance. Furthermore, there was increasing transverse compressive strain observed within the Achilles tendon as a function of increasing dorsiflexion angle. This study enhances our understanding of the unique mechanical loading environment of the Achilles tendon under physiologically relevant conditions.
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Affiliation(s)
- Keshia E Mora
- Department of Biomedical Engineering, University of Rochester, Rochester, NY 14620, USA; Center for Musculoskeletal Research, Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY 14620, USA.
| | - Samuel J Mlawer
- Department of Biomedical Engineering, University of Rochester, Rochester, NY 14620, USA; Center for Musculoskeletal Research, Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY 14620, USA
| | - Albert J Bae
- Department of Biomedical Engineering, University of Rochester, Rochester, NY 14620, USA; Center for Musculoskeletal Research, Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY 14620, USA
| | - Michael S Richards
- Department of Biomedical Engineering, Rochester Institute of Technology, Rochester, NY 14623, USA
| | - Alayna E Loiselle
- Department of Biomedical Engineering, University of Rochester, Rochester, NY 14620, USA; Center for Musculoskeletal Research, Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY 14620, USA
| | - Mark R Buckley
- Department of Biomedical Engineering, University of Rochester, Rochester, NY 14620, USA; Center for Musculoskeletal Research, Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY 14620, USA
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32
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Chatterjee M, Muljadi PM, Andarawis-Puri N. The role of the tendon ECM in mechanotransduction: disruption and repair following overuse. Connect Tissue Res 2022; 63:28-42. [PMID: 34030531 DOI: 10.1080/03008207.2021.1925663] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Purpose: Tendon overuse injuries are prevalent conditions with limited therapeutic options to halt disease progression. The specialized extracellular matrix (ECM) both enables joint function and mediates mechanical signals to tendon cells, driving biological responses to exercise or injury. With overuse, tendon ECM composition and structure changes at multiple scales, disrupting mechanotransduction and resulting in inadequate repair and disease progression. This review highlights the multiscale ECM changes that occur with tendon overuse and corresponding effects on cell-matrix interactions and cellular response to load.Results: Different functional joint requirements and tendon types experience a wide range of loading profiles, creating varied downstream mechanical stimuli. Distinct ECM structure and mechanical properties within the fascicle matrix, interfascicle matrix, and enthesis and their varied disruption with overuse are considered. The pericellular matrix (PCM) comprising the microscale tendon cell environment has a unique composition that changes with overuse injury and exercise, suggesting an important role in mechanotransduction and promoting repair. Cell-matrix interactions are mediated by structures including cilia, integrins, connexins and cytoskeleton that signal downstream homeostasis, adaptation, or repair. ECM disruption with tendon overuse may cause altered mechanical loading and cell-matrix interactions, resulting in mechanobiological understimulation, apoptosis, and ineffective repair. Current interventions to promote repair of tendon overuse injuries including exercise, targeting cell signaling, and modulating inflammation are considered.Conclusion: Future therapeutics should be assessed with regard of their effects on multiscale mechanotransduction in addition to joint function, with consideration of the central role of ECM.
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Affiliation(s)
- Monideepa Chatterjee
- Nancy E. And Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York, USA
| | - Patrick M Muljadi
- Nancy E. And Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York, USA
| | - Nelly Andarawis-Puri
- Nancy E. And Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York, USA.,Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, New York, USA.,Hospital for Special Surgery, New York, New York, USA
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33
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Eraktas İ, Ayhan C, Hayran M, Soylu AR. Alterations in forearm muscle activation patterns after scapholunate interosseous ligament injury: A dynamic electromyography study. J Hand Ther 2021; 34:384-395. [PMID: 32620427 DOI: 10.1016/j.jht.2020.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/26/2020] [Accepted: 03/16/2020] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Case control. PURPOSE OF THE STUDY This study aimed to investigate the alterations seen in the activation patterns of the forearm muscles and to demonstrate the associated functional outcomes, in patients with scapholunate interosseous ligament (SLIL) injury. METHODS The study involved 15 patients with SLIL injury (instability group) and 11 healthy participants (control group). Both groups were evaluated with regard to their pain, grip strength, and upper extremity functional level (disabilities of the arm, shoulder and hand and patient-rated wrist evaluation questionnaires), and they also underwent a dynamic electromyography analysis of their forearm muscle activity. The activation patterns of the extensor carpi ulnaris (ECU), extensor carpi radialis (ECR), flexor carpi ulnaris, and flexor carpi radialis muscles during wrist extension and flexion were recorded by means of surface electromyography. RESULTS In the instability group, the pain severity was higher and the functional level was worse than in the control group (P < .05). Furthermore, during wrist extension, the ECR activity was lower and the ECU activity was higher in the instability group than in the control group (P < .05). CONCLUSION Dynamic stabilization of the wrist, flexor carpi ulnaris, and flexor carpi radialis muscles have been shown to play an active role with ECU and ECR. Increased ECU and decreased ECR activation may pose a potential risk in terms of enhancing the scapholunate gap. We, therefore, propose that appropriate preventive neuromuscular exercise strategies implemented as part of a physiotherapy program for patients with SLIL lesions might increase the contribution of the dynamic stability effect of the relevant muscles.
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Affiliation(s)
- İrem Eraktas
- Bolu Physical Therapy and Rehabilitation Hospital, Bolu, Turkey
| | - Cigdem Ayhan
- Faculty of Health Science, Department of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey.
| | - Mutlu Hayran
- School of Medicine, Department of Preventive Oncology, Hacettepe University, Ankara, Turkey
| | - Abdullah Ruhi Soylu
- School of Medicine, Department of Biophysics, Hacettepe University, Ankara, Turkey
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Williamson PM, Freedman BR, Kwok N, Beeram I, Pennings J, Johnson J, Hamparian D, Cohen E, Galloway JL, Ramappa AJ, DeAngelis JP, Nazarian A. Tendinopathy and tendon material response to load: What we can learn from small animal studies. Acta Biomater 2021; 134:43-56. [PMID: 34325074 DOI: 10.1016/j.actbio.2021.07.046] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 07/16/2021] [Accepted: 07/21/2021] [Indexed: 12/20/2022]
Abstract
Tendinopathy is a debilitating disease that causes as much as 30% of all musculoskeletal consultations. Existing treatments for tendinopathy have variable efficacy, possibly due to incomplete characterization of the underlying pathophysiology. Mechanical load can have both beneficial and detrimental effects on tendon, as the overall tendon response depends on the degree, frequency, timing, and magnitude of the load. The clinical continuum model of tendinopathy offers insight into the late stages of tendinopathy, but it does not capture the subclinical tendinopathic changes that begin before pain or loss of function. Small animal models that use high tendon loading to mimic human tendinopathy may be able to fill this knowledge gap. The goal of this review is to summarize the insights from in-vivo animal studies of mechanically-induced tendinopathy and higher loading regimens into the mechanical, microstructural, and biological features that help characterize the continuum between normal tendon and tendinopathy. STATEMENT OF SIGNIFICANCE: This review summarizes the insights gained from in-vivo animal studies of mechanically-induced tendinopathy by evaluating the effect high loading regimens have on the mechanical, structural, and biological features of tendinopathy. A better understanding of the interplay between these realms could lead to improved patient management, especially in the presence of painful tendon.
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Saini G, Lawrence RL, Staker JL, Braman JP, Ludewig PM. Supraspinatus-to-Glenoid Contact Occurs During Standardized Overhead Reaching Motion. Orthop J Sports Med 2021; 9:23259671211036908. [PMID: 34646898 PMCID: PMC8504240 DOI: 10.1177/23259671211036908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 05/13/2021] [Indexed: 01/03/2023] Open
Abstract
Background: Rotator cuff tears may result from repeated mechanical deformation of the cuff tendons, and internal impingement of the supraspinatus tendon against the glenoid is one such proposed mechanism of deformation. Purpose: To (1) describe the changing proximity of the supraspinatus tendon to the glenoid during a simulated overhead reaching task and (2) determine the relationship between scapular morphology and this proximity. Additionally, the patterns of supraspinatus-to-glenoid proximity were compared with previously described patterns of supraspinatus-to-coracoacromial arch proximity. Study Design: Descriptive laboratory study. Methods: Shoulder models were created from magnetic resonance images of 20 participants. Standardized kinematics were imposed on the models to simulate functional reaching, and the minimum distances between the supraspinatus tendon and the glenoid and the supraspinatus footprint and the glenoid were calculated every 5° between 0° and 150° of humerothoracic elevation. The angle at which contact between the supraspinatus and the glenoid occurred was documented. Additionally, the relationship between glenoid morphology (version and inclination) and the contact angle was evaluated. Descriptive statistics were calculated for the minimum distances, and glenoid morphology was assessed using Pearson correlation coefficients and simple linear regressions. Results: The minimum distances between the tendon and the glenoid and between the footprint and the glenoid decreased as elevation increased. Contact between the tendon and the glenoid occurred in all participant models at a mean elevation of 123° ± 10°. Contact between the footprint and the glenoid occurred in 13 of 20 models at a mean of 139° ± 10°. Less glenoid retroversion was associated with lower tendon-to-glenoid contact angles (r = –0.76; R2 = 0.58; P < .01). Conclusion: This study found that the supraspinatus tendon progressively approximated the glenoid during simulated overhead reaching. Additionally, all participant models eventually made contact with the glenoid by 150° of humerothoracic elevation, although anatomic factors influenced the precise angle at which contact occurred. Clinical Relevance: Contact between the supraspinatus and the glenoid may occur frequently within the range of elevation required for overhead activities. Therefore, internal impingement may be a prevalent mechanism for rotator cuff deformation that could contribute to cuff pathology.
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Affiliation(s)
- Gaura Saini
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Rebekah L Lawrence
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Justin L Staker
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, USA.,Division of Physical Therapy, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jonathan P Braman
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Paula M Ludewig
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, USA.,Division of Physical Therapy, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, USA
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Lawrence RL, Ludewig PM, Ward SR. An Integrated Approach to Musculoskeletal Performance, Disease, and Recovery. Phys Ther 2021; 101:6374810. [PMID: 34636897 PMCID: PMC8651066 DOI: 10.1093/ptj/pzab225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/11/2021] [Accepted: 08/17/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Rebekah L Lawrence
- Bone and Joint Center, Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan, USA,Address all correspondence to Dr Lawrence at:
| | - Paula M Ludewig
- Divisions of Physical Therapy and Rehabilitation Science, University of Minnesota, Minneapolis, Minnesota, USA
| | - Samuel R Ward
- Departments of Radiology, Orthopaedic Surgery, and Bioengineering, University of California San Diego, San Diego, California, USA
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Increasing transforming growth factor-beta concentrations with age decrease apelin in the rat rotator cuff. J Orthop Surg Res 2021; 16:539. [PMID: 34465345 PMCID: PMC8406891 DOI: 10.1186/s13018-021-02675-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/13/2021] [Indexed: 11/26/2022] Open
Abstract
Background The rotator cuff undergoes natural degeneration with age, leading to age-related rotator cuff tear; however, the precise mechanism remains unclear. Transforming growth factor-beta (TGF-β) concentrations rise with age and TGF-β contributes to the pathophysiology of skeletal muscle. TGF-β has also been shown to suppress expression of the myokine, apelin, in skin fibroblasts. We hypothesized that TGF-β expression in the rotator cuff changes with age and regulates apelin expression, thereby contributing to rotator cuff degeneration. Methods We used quantitative reverse-transcription polymerase chain reaction (Q-RT-PCR) to measure the expression of apelin and tendon-related genes (Tnmd, Col1a1, and Col3a1) in the rotator cuff of young (12 weeks), adult (24 weeks), and old (48 weeks) rats. Using Q-RT-PCR and enzyme-linked immunosorbent assay, we also measured Tgfb mRNA and TGF-β protein levels, respectively. Furthermore, we used Q-RT-PCR to measure apelin mRNA levels in rotator cuff-derived cells after treatment with 0 (control) and 10 ng/mL recombinant TGF-β. Results Apelin mRNA levels were significantly lower in old compared to young and adult rats. Similarly, tendon-related genes, Tnmd, Col1a1, and Col3a1, were significantly lower in adult and old rats than young rats. In contrast, Tgfb mRNA and TGF-β protein were significantly higher in old compared to young rats. Stimulation with exogenous TGF-β significantly decreased Apelin mRNA expression compared to control. Conclusions TGF-β regulates apelin expression in the rotator cuff and may play a key role in the degenerative pathology of the rotator cuff with age.
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Yun SS, Kim K, Ahn J, Cho KJ. Body-powered variable impedance: An approach to augmenting humans with a passive device by reshaping lifting posture. Sci Robot 2021; 6:6/57/eabe1243. [PMID: 34433655 DOI: 10.1126/scirobotics.abe1243] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 07/22/2021] [Indexed: 11/02/2022]
Abstract
The movement patterns appropriate for exercise and manual labor do not always correspond to what people instinctively choose for better comfort. Without expert guidance, people can even increase the risk of injury by choosing a comfortable posture rather than the appropriate one, notably when lifting objects. Even in situations where squatting is accepted as a desirable lifting strategy, people tend to choose the more comfortable strategy of stooping or semisquatting. The common approach to correcting lifting posture, immobilizing vulnerable joints via fixation, is insufficient for preventing back injuries sustained from repetitive lifting. Instead, when lifting small but heavy objects, the entire kinetic chain should cooperate to achieve a series of squat-lifting patterns. Inspired by the observation that force fields affect the coordination of voluntary human motion, we devised a passive exosuit embedded with a body-powered variable-impedance mechanism. The exosuit adds impedance to the human joints according to how far the wearer's movement is from the squat-lifting trajectories so that it hinders stooping but facilitates squatting. In an experiment that entailed lifting a small 10-kg box, 10 first-time users changed their voluntary lifting motion closer to squatting on average. Simulation results based on recorded kinematic and kinetic data showed that this postural change reduced the compression force, shear force, and moment on the lumbosacral joint. Our work demonstrates the potential of using an exosuit to help people move in a desirable manner without requiring a complicated, bulky mechanical system.
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Affiliation(s)
- Sung-Sik Yun
- Soft Robotics Research Center, Seoul National University, Seoul, Republic of Korea.,Department of Mechanical Engineering, Institute of Advanced Machines and Design, Institute of Engineering, Seoul National University, Seoul, Republic of Korea
| | - Keewon Kim
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jooeun Ahn
- Soft Robotics Research Center, Seoul National University, Seoul, Republic of Korea. .,Department of Physical Education, Seoul National University, Seoul, Republic of Korea.,Institute of Sport Science, Seoul National University, Seoul, Republic of Korea
| | - Kyu-Jin Cho
- Soft Robotics Research Center, Seoul National University, Seoul, Republic of Korea. .,Department of Mechanical Engineering, Institute of Advanced Machines and Design, Institute of Engineering, Seoul National University, Seoul, Republic of Korea
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Moser HL, Abraham AC, Howell K, Laudier D, Zumstein MA, Galatz LM, Huang AH. Cell lineage tracing and functional assessment of supraspinatus tendon healing in an acute repair murine model. J Orthop Res 2021; 39:1789-1799. [PMID: 32497311 PMCID: PMC7714710 DOI: 10.1002/jor.24769] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/27/2020] [Accepted: 05/25/2020] [Indexed: 02/04/2023]
Abstract
Rotator cuff supraspinatus tendon injuries are common with high rates of anatomic failure after surgical repair. The purpose of the study was to define clinically relevant features of a mouse model of supraspinatus tendon injury to determine painful, functional, and structural outcomes; we further investigated two cell populations mediating healing using genetic lineage tracing after full detachment and repair of the supraspinatus tendon in mice. The pain was assessed using the mouse grimace scale and function by gait analysis and tensile testing. Histological and microCT analyses were used to determine enthesis/tendon and bone structure, respectively. Lineage tracing was carried out using inducible Cre lines for ScxCreERT2 (tendon cells) and αSMACreERT2 (myofibroblasts and mesenchymal progenitors). Mice only expressed pain transiently after surgery despite long-term impairment of functional and structural properties. Gait, tensile mechanical properties, and bone properties were significantly reduced after injury and repair. Lineage tracing showed relatively few Scx lin tendon cells while αSMA lin cells contributed strongly to scar formation. Despite surgical reattachment of healthy tendon, lineage tracing revealed poor preservation of supraspinatus tendon after acute injury and loss of tendon structure, suggesting that tendon degeneration is also a key impediment of successful rotator cuff repair. Scar formation after surgery is mediated largely by αSMA lin cells and results in permanently reduced functional and structural properties.
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Affiliation(s)
- Helen L. Moser
- Icahn School of Medicine at Mount Sinai, Department of Orthopaedics, 1 Gustave Levy Place, Box 1188, New York, NY 10029, USA,Inselspital, Bern University Hospital, University of Bern, Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, 3010 Bern, Switzerland
| | - Adam C. Abraham
- Columbia University Irving Medical Center, Department of Orthopedic Surgery, New York, NY 10032, USA
| | - Kristen Howell
- Icahn School of Medicine at Mount Sinai, Department of Orthopaedics, 1 Gustave Levy Place, Box 1188, New York, NY 10029, USA
| | - Damien Laudier
- Icahn School of Medicine at Mount Sinai, Department of Orthopaedics, 1 Gustave Levy Place, Box 1188, New York, NY 10029, USA
| | - Matthias A. Zumstein
- Inselspital, Bern University Hospital, University of Bern, Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, 3010 Bern, Switzerland,Shoulder, Elbow and Orthopaedic Sports Medicine, Orthopaedics Sonnenhof, 3006 Bern, Switzerland
| | - Leesa M. Galatz
- Icahn School of Medicine at Mount Sinai, Department of Orthopaedics, 1 Gustave Levy Place, Box 1188, New York, NY 10029, USA
| | - Alice H. Huang
- Icahn School of Medicine at Mount Sinai, Department of Orthopaedics, 1 Gustave Levy Place, Box 1188, New York, NY 10029, USA
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Nie D, Zhou Y, Wang W, Zhang J, Wang JHC. Mechanical Overloading Induced-Activation of mTOR Signaling in Tendon Stem/Progenitor Cells Contributes to Tendinopathy Development. Front Cell Dev Biol 2021; 9:687856. [PMID: 34322484 PMCID: PMC8311934 DOI: 10.3389/fcell.2021.687856] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/18/2021] [Indexed: 01/08/2023] Open
Abstract
Despite the importance of mechanical loading in tendon homeostasis and pathophysiology, the molecular responses involved in the mechanotransduction in tendon cells remain unclear. In this study, we found that in vitro mechanical loading activated the mammalian target of rapamycin (mTOR) in rat patellar tendon stem/progenitor cells (TSCs) in a stretching magnitude-dependent manner. Application of rapamycin, a specific inhibitor of mTOR, attenuated the phosphorylation of S6 and 4E-BP1 and as such, largely inhibited the mechanical activation of mTOR. Moreover, rapamycin significantly decreased the proliferation and non-tenocyte differentiation of PTSCs as indicated by the reduced expression levels of LPL, PPARγ, SOX-9, collagen II, Runx-2, and osteocalcin genes. In the animal studies, mice subjected to intensive treadmill running (ITR) developed tendon degeneration, as evidenced by the formation of round-shaped cells, accumulation of proteoglycans, and expression of SOX-9 and collagen II proteins. However, daily injections of rapamycin in ITR mice reduced all these tendon degenerative changes. Collectively, these findings suggest that mechanical loading activates the mTOR signaling in TSCs, and rapamycin may be used to prevent tendinopathy development by blocking non-tenocyte differentiation due to mechanical over-activation of mTOR in TSCs.
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Affiliation(s)
- Daibang Nie
- Department of Immunology, College of Basic Medicine, Chongqing Medical University, Chongqing, China
- MechanoBiology Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Yiqin Zhou
- MechanoBiology Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, United States
- Department of Orthopaedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Wang Wang
- Department of Immunology, College of Basic Medicine, Chongqing Medical University, Chongqing, China
| | - Jianying Zhang
- MechanoBiology Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - James H.-C. Wang
- MechanoBiology Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, United States
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, United States
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States
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Wang C, Zhang Y, Zhang G, Yu W, He Y. Adipose Stem Cell-Derived Exosomes Ameliorate Chronic Rotator Cuff Tendinopathy by Regulating Macrophage Polarization: From a Mouse Model to a Study in Human Tissue. Am J Sports Med 2021; 49:2321-2331. [PMID: 34259608 DOI: 10.1177/03635465211020010] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Chronic rotator cuff (RC) tendinopathy is one of the most prevalent causes of shoulder pain. Growing evidence suggests that macrophages play a significant role in the proinflammatory response, resolution of inflammation, and tissue healing of tendinopathy. In particular, enhancement of M2 macrophage (M2φ) activity contributes to the accelerated healing of tendinopathy. Therefore, a treatment that enhances M2φ polarization would be useful for patients with this common musculoskeletal disorder. PURPOSE To investigate whether adipose stem cell-derived exosomes (ASC-Exos) enhance M2φ polarization and ameliorate chronic RC tendinopathy. STUDY DESIGN Controlled laboratory study. METHODS First, we compared the effects of ASC-Exos on polarization of mouse bone marrow-derived macrophages between a classically activated phenotype (M1φ) and an alternatively activated phenotype (M2φ) in vitro. In total, 72 C57BL/6 mice were assigned to normal cage activity (n = 24) or 5 weeks of treadmill overuse (n = 48). The supraspinatus tendon of each treadmill overuse mouse was treated with ASC-Exos (n = 24) or saline (n = 24). Histological and biomechanical outcomes were assessed 4 weeks after treatment. Finally, tissue samples from human patients with RC tendinopathy were obtained to assay the effect of ASC-Exos on the M1φ/M2φ balance in tissue-resident macrophages. RESULTS ASC-Exos inhibited M1φ polarization and augmented M2φ polarization in vitro and in vivo. Mice in the ASC-Exos group showed less severe pathological changes than those in the saline group, including less cellular infiltration, disorganization of collagen, and ground substance deposition. The modified Bonar score of the ASC-Exos group (mean ± SD, 7.68 ± 1.03) was significantly lower than that of the saline group (9.81 ± 0.96; P < .05). Furthermore, the maximum failure load was significantly higher in the ASC-Exos group than in the saline group (4.23 ± 0.66 N vs 3.86 ± 0.65 N; P < .05), as was stiffness (3.38 ± 0.34 N/m vs 2.68 ± 0.49 N/m; P < .05). CONCLUSION ASC-Exos-mediated polarization balance of M1φ/M2φ contributes to the amelioration of chronic RC tendinopathy. Regulation of the M1φ/M2φ balance could be a new target for the treatment of chronic RC tendinopathy. CLINICAL RELEVANCE Administration of ASC-Exos is a cell-free approach that may become a novel treatment option for chronic RC tendinopathy and should be explored further.
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Affiliation(s)
- Chongyang Wang
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yao Zhang
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Guangcheng Zhang
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Weilin Yu
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yaohua He
- Jinshan Branch of Shanghai Sixth People's Hospital, Shanghai, China
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Porschke F, Loew M, Schnetzke M. Traumatische vs. degenerative Rotatorenmanschettenläsion. ARTHROSKOPIE 2021. [DOI: 10.1007/s00142-021-00438-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ning LJ, Zhang YJ, Zhang YJ, Zhu M, Ding W, Jiang YL, Zhang Y, Luo JC, Qin TW. Enhancement of Migration and Tenogenic Differentiation of Macaca Mulatta Tendon-Derived Stem Cells by Decellularized Tendon Hydrogel. Front Cell Dev Biol 2021; 9:651583. [PMID: 33987178 PMCID: PMC8111289 DOI: 10.3389/fcell.2021.651583] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 04/06/2021] [Indexed: 02/05/2023] Open
Abstract
Decellularized tendon hydrogel from human or porcine tendon has been manufactured and found to be capable of augmenting tendon repair in vivo. However, no studies have clarified the effect of decellularized tendon hydrogel upon stem cell behavior. In the present study, we developed a new decellularized tendon hydrogel (T-gel) from Macaca mulatta, and investigated the effect of T-gel on the proliferation, migration and tenogenic differentiation of Macaca mulatta tendon-derived stem cells (mTDSCs). The mTDSCs were first identified to have universal stem cell characteristics, including clonogenicity, expression of mesenchymal stem cell and embryonic stem cell markers, and multilineage differentiation potential. Decellularization of Macaca mulatta Achilles tendons was confirmed to be effective by histological staining and DNA quantification. The resultant T-gel exhibited highly porous structure or similar nanofibrous structure and approximately swelling ratio compared to the collagen gel (C-gel). Interestingly, stromal cell-derived factor-1 (SDF-1) and fibromodulin (Fmod) inherent in the native tendon extracellular matrix (ECM) microenvironment were retained and the values of SDF-1 and Fmod in the T-gel were significantly higher than those found in the C-gel. Compared with the C-gel, the T-gel was found to be cytocompatible with NIH-3T3 fibroblasts and displayed good histocompatibility when implanted into rat subcutaneous tissue. More importantly, it was demonstrated that the T-gel supported the proliferation of mTDSCs and significantly promoted the migration and tenogenic differentiation of mTDSCs compared to the C-gel. These findings indicated that the T-gel, with its retained nanofibrous structure and some bioactive factors of native tendon ECM microenvironment, represents a promising hydrogel for tendon regeneration.
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Affiliation(s)
- Liang-Ju Ning
- Laboratory of Stem Cell and Tissue Engineering, Orthopedic Research Institute, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China
| | - Ya-Jing Zhang
- Laboratory of Stem Cell and Tissue Engineering, Orthopedic Research Institute, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China
| | - Yan-Jing Zhang
- Laboratory of Stem Cell and Tissue Engineering, Orthopedic Research Institute, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China.,Core Facility of West China Hospital, Sichuan University, Chengdu, China
| | - Min Zhu
- Laboratory of Stem Cell and Tissue Engineering, Orthopedic Research Institute, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China
| | - Wei Ding
- Laboratory of Stem Cell and Tissue Engineering, Orthopedic Research Institute, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China
| | - Yan-Lin Jiang
- Laboratory of Stem Cell and Tissue Engineering, Orthopedic Research Institute, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China
| | - Yi Zhang
- Core Facility of West China Hospital, Sichuan University, Chengdu, China
| | - Jing-Cong Luo
- Laboratory of Stem Cell and Tissue Engineering, Orthopedic Research Institute, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China
| | - Ting-Wu Qin
- Laboratory of Stem Cell and Tissue Engineering, Orthopedic Research Institute, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu, China
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Quantifying supraspinatus tendon responses to exposures emulative of human physiological levels in an animal model. J Biomech 2021; 122:110476. [PMID: 33933860 DOI: 10.1016/j.jbiomech.2021.110476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 02/21/2021] [Accepted: 04/19/2021] [Indexed: 11/21/2022]
Abstract
Rotator cuff pathology typically originates in the supraspinatus tendon, but uncertainty exists on how combinations of glenohumeral elevation angle and load intensity influence responses of the intact, functional supraspinatus unit. This study exposed the supraspinatus tendon to mechanical loading scenarios emulative of derived muscle force and postural conditions measured in vivo to document its responses. Right shoulders from 48 Sprague-Dawley rats were placed into one of eight testing groups combining glenohumeral elevation angles (0/30/60/75°) and a high or low load intensity for 1500 cycles at 0.25 Hz using a custom mounting apparatus attached to a tensile testing system. Load intensities were derived from in vivo human partitional muscular activation levels collected previously and scaled to the animal model. Mechanical response variables examined included tangent stiffness and hysteresis, in addition to localized surface stretch ratios calculated via virtual tracking points. A significant three-way interaction (p = 0.0009) between elevation angle, load magnitude and cycle number occurred for tangent stiffness, with increasing angles, loads and cycles increasing stiffness by up to 49%. Longitudinal stretch ratios had significant interactions (p = 0.0396) with increasing elevation angles, load intensities and cycle numbers, and differences existed between the articular and bursal sides of the tendon. Complex interactions between angle, load and cycle number suggest higher abduction angles, increased load magnitude and higher loading cycles increase tangent stiffness, stretch ratios and hysteresis within the tendon.
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45
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Leek CC, Soulas JM, Sullivan AL, Killian ML. Using tools in mechanobiology to repair tendons. ACTA ACUST UNITED AC 2021; 1:31-40. [PMID: 33585822 DOI: 10.1007/s43152-020-00005-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Purpose of review The purpose of this review is to describe the mechanobiological mechanisms of tendon repair as well as outline current and emerging tools in mechanobiology that might be useful for improving tendon healing and regeneration. Over 30 million musculoskeletal injuries are reported in the US per year and nearly 50% involve soft tissue injuries to tendons and ligaments. Yet current therapeutic strategies for treating tendon injuries are not always successful in regenerating and returning function of the healing tendon. Recent findings The use of rehabilitative strategies to control the motion and transmission of mechanical loads to repairing tendons following surgical reattachment is beneficial for some, but not all, tendon repairs. Scaffolds that are designed to recapitulate properties of developing tissues show potential to guide the mechanical and biological healing of tendon following rupture. The incorporation of biomaterials to control alignment and reintegration, as well as promote scar-less healing, are also promising. Improving our understanding of damage thresholds for resident cells and how these cells respond to bioelectrical cues may offer promising steps forward in the field of tendon regeneration. Summary The field of orthopaedics continues to advance and improve with the development of regenerative approaches for musculoskeletal injuries, especially for tendon, and deeper exploration in this area will lead to improved clinical outcomes.
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Affiliation(s)
- Connor C Leek
- College of Engineering, Department of Biomedical Engineering, 5 Innovation Way, Suite 200, University of Delaware, Newark, Delaware 19716
| | - Jaclyn M Soulas
- College of Engineering, Department of Biomedical Engineering, 5 Innovation Way, Suite 200, University of Delaware, Newark, Delaware 19716.,College of Agriculture and Natural Resources, Department of Animal Biosciences, 531 South College Avenue, University of Delaware, Newark, Delaware 19716
| | - Anna Lia Sullivan
- College of Engineering, Department of Biomedical Engineering, 5 Innovation Way, Suite 200, University of Delaware, Newark, Delaware 19716.,College of Agriculture and Natural Resources, Department of Animal Biosciences, 531 South College Avenue, University of Delaware, Newark, Delaware 19716
| | - Megan L Killian
- College of Engineering, Department of Biomedical Engineering, 5 Innovation Way, Suite 200, University of Delaware, Newark, Delaware 19716.,College of Medicine, Department of Orthopaedic Surgery, 109 Zina Pitcher Place, University of Michigan, Ann Arbor, Michigan 48109
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Ozone K, Oka Y, Minegishi Y, Kano T, Kokubun T, Murata K, Kanemura N. Effect of Various Types of Muscle Contraction with Different Running Conditions on Mouse Humerus Morphology. Life (Basel) 2021; 11:life11040284. [PMID: 33801768 PMCID: PMC8065967 DOI: 10.3390/life11040284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 03/14/2021] [Accepted: 03/24/2021] [Indexed: 12/01/2022] Open
Abstract
How various types of muscle contraction during exercises affect bone formation remains unclear. This study aimed to determine how exercises with different muscle contraction types affect bone morphology. In total, 20 mice were used and divided into four groups: Control, Level, Down Slow, and Down. Different types of muscle contraction were induced by changing the running angle of the treadmill. After the intervention, micro-computed tomography (Micro-CT), tartrate-resistant acid phosphatase/alkaline phosphatase (ALP) staining, and immunohistochemical staining were used to analyze the humerus head, tendon-to-bone attachment, and humerus diaphyseal region. Micro-CT found that the volume ratio of the humeral head, the volume of the tendon-to-bone attachment region, and the area of the humeral diaphyseal region increased in the Down group. However, no difference was detected in bone morphology between the Level and Down Slow groups. In addition, histology showed activation of ALP in the subarticular subchondral region in the Down Slow and Down groups and the fibrocartilage region in the tendon-to-bone attachment. Moreover, Osterix increased predominantly in the Down Slow and Down groups.Overall bone morphological changes in the humerus occur only when overuse is added to EC-dominant activity. Furthermore, different type of muscle contractile activities might promote bone formation in a site-specific manner.
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Affiliation(s)
- Kaichi Ozone
- Graduate Course of Health and Social Services, Graduate School of Saitama Prefectural University, Saitama 343-8540, Japan; (K.O.); (Y.O.); (Y.M.); (T.K.)
- Research Fellowship for Young Scientists, Japan Society for the Promotion of Science, Tokyo 102-0083, Japan
| | - Yuichiro Oka
- Graduate Course of Health and Social Services, Graduate School of Saitama Prefectural University, Saitama 343-8540, Japan; (K.O.); (Y.O.); (Y.M.); (T.K.)
| | - Yuki Minegishi
- Graduate Course of Health and Social Services, Graduate School of Saitama Prefectural University, Saitama 343-8540, Japan; (K.O.); (Y.O.); (Y.M.); (T.K.)
- Research Fellowship for Young Scientists, Japan Society for the Promotion of Science, Tokyo 102-0083, Japan
| | - Takuma Kano
- Graduate Course of Health and Social Services, Graduate School of Saitama Prefectural University, Saitama 343-8540, Japan; (K.O.); (Y.O.); (Y.M.); (T.K.)
| | - Takanori Kokubun
- Department of Health and Social Services, Saitama Prefectural University, Saitama 343-8540, Japan; (T.K.); (K.M.)
| | - Kenji Murata
- Department of Health and Social Services, Saitama Prefectural University, Saitama 343-8540, Japan; (T.K.); (K.M.)
| | - Naohiko Kanemura
- Department of Health and Social Services, Saitama Prefectural University, Saitama 343-8540, Japan; (T.K.); (K.M.)
- Correspondence: ; Tel.: +81-48-971-0500
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Zhang T, Chen Y, Chen C, Li S, Xiao H, Wang L, Hu J, Lu H. Treadmill exercise facilitated rotator cuff healing is coupled with regulating periphery neuropeptides expression in a murine model. J Orthop Res 2021; 39:680-692. [PMID: 32239544 DOI: 10.1002/jor.24678] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 02/18/2020] [Accepted: 03/12/2020] [Indexed: 02/04/2023]
Abstract
Postoperative exercise has been found able to accelerate bone-tendon (B-T) healing. In this study, we systematically compared tendon-to-bone healing in mice subjected to postoperative treadmill exercise and free cage recovery in a murine rotator cuff repair model. Specifically, C57BL/6 mice underwent unilateral supraspinatus tendon (SST) detachment and repair were randomly allocated into treadmill group and control group. Treadmill group received daily treadmill running initiated from postoperative day 7 while the control group was allowed free cage activity. Mice were euthanized at postoperative 4 and 8 weeks for synchrotron radiation micro-computed tomography (SR-μCT), histology and biomechanical tests to investigate the effect of treadmill running on B-T healing. The results indicated that treadmill running initiated at day 7 postoperatively was able to accelerate B-T healing, as evidenced by better tendon-to-bone maturation and increased mechanical property. Recent studies show that peripheral neuropeptides are closely associated with musculoskeletal tissue repair. We furtherly conducted quantitative reverse transcription-polymerase chain reaction and immunofluorescence staining to investigate the temporal-spatial expression of calcitonin gene-related peptide (CGRP), substance P (SP), and peripheral neuropeptide Y (NPY) to verify whether they are related to rotator cuff healing. Our results show increased expression of CGRP, SP, and NPY at the healing site under the effect of mechanical stimulation. In conclusion, delayed postoperative exercise with moderate strength appears to accelerate the early phase of B-T healing, a process that may prove to be linked to increased expression of periphery neuropeptides known to play a role in tissue healing.
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Affiliation(s)
- Tao Zhang
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, China
| | - Yang Chen
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, China
| | - Can Chen
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, China
| | - Shengcan Li
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, China
| | - Han Xiao
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, China
| | - Linfeng Wang
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, China
| | - Jianzhong Hu
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, China
- Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Hongbin Lu
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, China
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Notermans T, Tanska P, Korhonen RK, Khayyeri H, Isaksson H. A numerical framework for mechano-regulated tendon healing-Simulation of early regeneration of the Achilles tendon. PLoS Comput Biol 2021; 17:e1008636. [PMID: 33556080 PMCID: PMC7901741 DOI: 10.1371/journal.pcbi.1008636] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 02/23/2021] [Accepted: 12/15/2020] [Indexed: 12/19/2022] Open
Abstract
Mechano-regulation during tendon healing, i.e. the relationship between mechanical stimuli and cellular response, has received more attention recently. However, the basic mechanobiological mechanisms governing tendon healing after a rupture are still not well-understood. Literature has reported spatial and temporal variations in the healing of ruptured tendon tissue. In this study, we explored a computational modeling approach to describe tendon healing. In particular, a novel 3D mechano-regulatory framework was developed to investigate spatio-temporal evolution of collagen content and orientation, and temporal evolution of tendon stiffness during early tendon healing. Based on an extensive literature search, two possible relationships were proposed to connect levels of mechanical stimuli to collagen production. Since literature remains unclear on strain-dependent collagen production at high levels of strain, the two investigated production laws explored the presence or absence of collagen production upon non-physiologically high levels of strain (>15%). Implementation in a finite element framework, pointed to large spatial variations in strain magnitudes within the callus tissue, which resulted in predictions of distinct spatial distributions of collagen over time. The simulations showed that the magnitude of strain was highest in the tendon core along the central axis, and decreased towards the outer periphery. Consequently, decreased levels of collagen production for high levels of tensile strain were shown to accurately predict the experimentally observed delayed collagen production in the tendon core. In addition, our healing framework predicted evolution of collagen orientation towards alignment with the tendon axis and the overall predicted tendon stiffness agreed well with experimental data. In this study, we explored the capability of a numerical model to describe spatial and temporal variations in tendon healing and we identified that understanding mechano-regulated collagen production can play a key role in explaining heterogeneities observed during tendon healing.
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Affiliation(s)
- Thomas Notermans
- Department of Biomedical Engineering, Lund University, Lund, Sweden
- * E-mail:
| | - Petri Tanska
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Rami K. Korhonen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Hanifeh Khayyeri
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - Hanna Isaksson
- Department of Biomedical Engineering, Lund University, Lund, Sweden
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Keir PJ, Farias Zuniga A, Mulla DM, Somasundram KG. Relationships and Mechanisms Between Occupational Risk Factors and Distal Upper Extremity Disorders. HUMAN FACTORS 2021; 63:5-31. [PMID: 31314601 DOI: 10.1177/0018720819860683] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE The relationships between workplace risk factors and upper extremity injuries from epidemiological and laboratory studies were examined. BACKGROUND Epidemiological studies are associated with several limitations, affecting the strength of association between risk factors and the development of injuries. METHOD In this narrative review, we identified epidemiological and laboratory studies (published primarily since 1997) investigating exposure to workplace risk factors (force, repetition, posture, vibration) and risk of hand/wrist tendon-related disorders, epicondylitis, and carpal tunnel syndrome (CTS). RESULTS Forceful exertions are strongly associated with hand/wrist tendon-related disorders, epicondylitis, and CTS. Dose-response relationships were found for epicondylitis (repetition) and CTS (posture). Interactions demonstrate multiplicative effects of risk factors for injury risk. Laboratory studies display clear associations between task demands and biomechanical measures linked to mechanisms for upper extremity injuries with animal models providing further evidence of a dose-response between risk factors and injury. CONCLUSION Forceful, repetitive work requiring non-neutral postures are associated with increasing risk of hand/wrist tendon-related disorders, epicondylitis, and CTS as evidenced by epidemiology studies and laboratory-based investigations of humans and animals. APPLICATION Understanding the relationship between exposure levels of workplace risk factors and upper extremity disorders can improve injury prevention and rehabilitation strategies.
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Hasan SS. Do the Ends Justify the Means?: Commentary on an article by Xueying Zhang, BS, et al.: "Assessment of Mitochondrial Dysfunction in a Murine Model of Supraspinatus Tendinopathy". J Bone Joint Surg Am 2021; 103:e7. [PMID: 33476102 DOI: 10.2106/jbjs.20.01666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Samer S Hasan
- Mercy Health-Cincinnati SportsMedicine and Orthopaedic Center, Cincinnati, Ohio
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