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Guo T, Song Y, Tong J, Jiao S, Shen C, Wang H, Cui J, Dai D, Ma J, Chen M. Collagen degradation assessment with an in vitro rotator cuff tendinopathy model using multiparametric ultrashort-TE magnetization transfer (UTE-MT) imaging. Magn Reson Med 2024; 92:1658-1669. [PMID: 38725197 DOI: 10.1002/mrm.30144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 07/23/2024]
Abstract
PURPOSE This study aims to assess ultrashort-TE magnetization transfer (UTE-MT) imaging of collagen degradation using an in vitro model of rotator cuff tendinopathy. METHODS Thirty-six supraspinatus tendon specimens were divided into three groups and treated with 600 U collagenase (Group 1), 150 U collagenase (Group 2), and phosphate buffer saline (Group 3). UTE-MT imaging was performed to assess changes in macromolecular fraction (MMF), macromolecule transverse relaxation time (T2m), water longitudinal relaxation rate constant (R1m), the magnetization exchange rate from the macromolecular to water pool (Rm0 w) and from water to the macromolecular pool (Rm0 m), and magnetization transfer ratio (MTR) at baseline and following digestion and their differences between groups. Biochemical and histological studies were conducted to determine the extent of collagen degradation. Correlation analyses were performed with MMF, T2m, R1m, Rm0 w, Rm0 m, and MTR, respectively. Univariate and multivariate linear regression analyses were performed to evaluate combinations of UTE-MT parameters to predict collagen degradation. RESULTS MMF, T2m, R1m, Rm0 m, and MTR decreased after digestion. MMF (r = -0.842, p < 0.001), MTR (r = -0.78, p < 0.001), and Rm0 m (r = -0.662, p < 0.001) were strongly negatively correlated with collagen degradation. The linear regression model of differences in MMF and Rm0 m before and after digestion explained 68.9% of collagen degradation variation in the tendon. The model of postdigestion in MMF and T2m and the model of MTR explained 54.2% and 52.3% of collagen degradation variation, respectively. CONCLUSION This study highlighted the potential of UTE-MT parameters for evaluation of supraspinatus tendinopathy.
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Affiliation(s)
- Tan Guo
- Peking University Fifth School of Clinical Medicine, Beijing, China
- Department of Radiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yan Song
- Department of Radiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jinlian Tong
- Biotherapy Center, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Sheng Jiao
- Department of Radiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Cheng Shen
- Department of Radiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Hong Wang
- Department of Radiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Ju Cui
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing Hospital/National Center of Gerontology of National Health Commission, Beijing, China
| | - Dapeng Dai
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing Hospital/National Center of Gerontology of National Health Commission, Beijing, China
| | - Jie Ma
- Biotherapy Center, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Min Chen
- Peking University Fifth School of Clinical Medicine, Beijing, China
- Department of Radiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
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Spielman AF, Griffin MF, Titan AL, Guardino N, Cotterell AC, Akras D, Wan DC, Longaker MT. Reduction of Tendon Fibrosis Using Galectin-3 Inhibitors. Plast Reconstr Surg 2024; 154:113-121. [PMID: 37344932 DOI: 10.1097/prs.0000000000010880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
BACKGROUND Fibrosis is a complication of both tendon injuries and repairs. The authors aimed to develop a mouse model to assess tendon fibrosis and to identify an antifibrotic agent capable of overcoming it. METHODS The Achilles tendon of adult C57Bl/6 mice was exposed via skin incision, followed by 50% tendon injury and abrasion with sandpaper. Sham operations were conducted on contralateral hindlimbs. Histologic analyses and immunofluorescent staining for fibrotic markers (collagen type 1 [ Col1 ], α-smooth muscle actin [ α-SMA ]) were used to confirm that the model induced tendon fibrosis. A second experiment further examined the role of α-SMA in adhesion formation using α-SMA.mTmG mice (6 to 8 weeks old; n = 3) with the same injury model. Lastly, α-SMA.mTmG mice were randomized to either condition 1 (tendon injury [control group]) or condition 2 (tendon injury with galectin-3 inhibitor [Gal3i] treatment at time of injury [treatment group]). RESULTS Histologic analyses confirmed tendon thickening and collagen deposition after tendon injury and abrasion compared with control. Immunofluorescence showed higher levels of Col1 and α-SMA protein expression after injury compared with sham ( P < 0.05). Real-time quantitative polymerase chain reaction also demonstrated increased gene expression of Col1 and α-SMA after injury compared with sham ( P < 0.05). Gal3 protein expression also increased after injury and colocalized with α-SMA+ fibroblasts surrounding the fibrotic tendon. Gal3i treatment decreased collagen deposition and scarring observed in the treatment group ( P < 0.05). CONCLUSIONS The authors' study provides a reproducible and reliable model to investigate tendon fibrosis. Findings suggest the potential of Gal3i to overcome fibrosis resulting from tendon injuries. CLINICAL RELEVANCE STATEMENT Tendon injuries are common presentations to hand surgeons. Complications include adhesion formation, which results in reduced strength and frequent reinjury. Advancements in management require a better understanding of the mechanisms behind tendon fibrosis in order to identify ways to overcome it.
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Affiliation(s)
- Amanda F Spielman
- From the Hagey Laboratory for Pediatric Regenerative Medicine and Department of Surgery, Division of Plastic and Reconstructive Surgery
| | - Michelle F Griffin
- From the Hagey Laboratory for Pediatric Regenerative Medicine and Department of Surgery, Division of Plastic and Reconstructive Surgery
| | - Ashley L Titan
- From the Hagey Laboratory for Pediatric Regenerative Medicine and Department of Surgery, Division of Plastic and Reconstructive Surgery
| | - Nicholas Guardino
- From the Hagey Laboratory for Pediatric Regenerative Medicine and Department of Surgery, Division of Plastic and Reconstructive Surgery
| | - Asha C Cotterell
- From the Hagey Laboratory for Pediatric Regenerative Medicine and Department of Surgery, Division of Plastic and Reconstructive Surgery
| | - Deena Akras
- From the Hagey Laboratory for Pediatric Regenerative Medicine and Department of Surgery, Division of Plastic and Reconstructive Surgery
| | - Derrick C Wan
- From the Hagey Laboratory for Pediatric Regenerative Medicine and Department of Surgery, Division of Plastic and Reconstructive Surgery
| | - Michael T Longaker
- From the Hagey Laboratory for Pediatric Regenerative Medicine and Department of Surgery, Division of Plastic and Reconstructive Surgery
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine
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Mlawer SJ, Frank EH, Connizzo BK. Aged tendons lack adaptive response to acute compressive injury. J Orthop Res 2024; 42:973-984. [PMID: 38041209 PMCID: PMC11009076 DOI: 10.1002/jor.25752] [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: 08/10/2023] [Revised: 10/24/2023] [Accepted: 11/29/2023] [Indexed: 12/03/2023]
Abstract
Rotator cuff tendinopathy has a multifactorial etiology, with both aging and external compression found to influence disease progression. However, tendon's response to these factors is still poorly understood and in vivo animal models make it difficult to decouple these effects. Therefore, we developed an explant culture model that allows us to directly apply compression to tendons and then observe their biological responses. Using this model, we applied a single acute compressive injury to C57BL/6J flexor digitorum longus tendon explants and observed changes in viability, metabolic activity, matrix composition, matrix biosynthesis, matrix structure, gene expression, and mechanical properties. We hypothesized that a single acute compressive load would result in an injury response in tendon and that this effect would be amplified in aged tendons. We found that young tendons had increased matrix turnover with a decrease in small leucine-rich proteoglycans, increase in compression-resistant proteoglycan aggrecan, increase in collagen synthesis, and an upregulation of collagen-degrading MMP-9. Aged tendons lacked any of these adaptive responses and instead had decreased metabolic activity and collagen synthesis. This implies that aged tendons lack the adaptation mechanisms required to return to homeostasis, and therefore are at greater risk for compression-induced injury. Overall, we present a novel compressive injury model that demonstrates lasting age-dependent changes and has the potential to examine the long-term response of tendon to a variety of compressive loading conditions.
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Affiliation(s)
- Samuel J. Mlawer
- Department of Biomedical Engineering, Boston University, Boston, MA, 02215, United States
| | - Eliot H. Frank
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, United States
| | - Brianne K. Connizzo
- Department of Biomedical Engineering, Boston University, Boston, MA, 02215, United States
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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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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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Zhang Y, Lu S, Yu G, Wang C, Zhao Q. NAMPT-Improved Mitochondrial Function Alleviates Degenerative Rotator Cuff Tendinopathy in Aged Mice. J Bone Joint Surg Am 2023; 105:1502-1511. [PMID: 37616388 DOI: 10.2106/jbjs.22.00894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
BACKGROUND Age-related rotator cuff tendinopathy (RCT) is associated with increased rotator cuff tear and postoperative retear rates. This study aimed to determine whether nicotinamide phosphoribosyltransferase (NAMPT) can alleviate degenerative RCT and prevent postoperative retears by reversing mitochondrial dysfunction in aged mice. METHODS We assigned 32 young (4 months) and 64 aged (19 to 20 months) male wild-type C57BL/6 mice to young, aged, and aged NAMPT-treated (ANAMPT) groups (n = 32 each). Mice in the ANAMPT group underwent subacromial injection with NAMPT-loaded fibrin gel, whereas the other 2 groups were injected with fibrin gel alone. Histological staining and each of the biomechanical and mitochondrial function tests were performed using 8 samples each. RESULTS Histological staining in the aged group revealed decreased cellularity, disrupted fiber architecture, and reduced type-I collagen content inside tendon tissues proximal to the enthesis, demonstrating the spontaneous development of age-related degenerative RCT. Compared with the young group, the maximum tendon-to-bone failure load (4.22 ± 0.81 versus 5.52 ± 0.81 N, p = 0.0106) and maximum suture cut-through force (0.83 ± 0.08 versus 1.07 ± 0.10 N, p = 0.0006) of degenerated tendon tissues in the aged group were significantly lower. Significantly reduced nicotinamide adenine dinucleotide (NAD + ) levels, adenosine triphosphate (ATP) production, and citrate synthase activity indicated that mitochondrial dysfunction was closely related to the development of the degenerative RCT. Furthermore, NAMPT-improved mitochondrial function alleviated age-induced degenerative histological changes and increased the maximum failure load (5.32 ± 0.68 N, p = 0.0375) and maximum suture cut-through force (0.99 ± 0.13 N, p = 0.0285). CONCLUSIONS Spontaneously developed degenerative RCT in aged mice mimicked the clinical situation in elderly patients. NAMPT-improved mitochondrial function could alleviate age-induced degenerative RCT and prevent postoperative suture cut-through of tendons with degenerative RCT. CLINICAL RELEVANCE This study confirmed the spontaneous development of degenerative RCT in aged mice, which will facilitate future studies of this condition. The results also suggest that NAMPT offers a novel therapeutic approach for treating age-related degenerative RCT.
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Affiliation(s)
- Yao Zhang
- Department of Orthopedics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People's Republic of China
| | - Shuai Lu
- Department of Orthopedics, Affiliated Provincial Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Gang Yu
- Department of Orthopedics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People's Republic of China
| | - Chongyang Wang
- Department of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Qichun Zhao
- Department of Orthopedics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People's Republic of China
- Department of Orthopedics, Affiliated Provincial Hospital of Anhui Medical University, Hefei, People's Republic of China
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Pringels L, Cook JL, Witvrouw E, Burssens A, Vanden Bossche L, Wezenbeek E. Exploring the role of intratendinous pressure in the pathogenesis of tendon pathology: a narrative review and conceptual framework. Br J Sports Med 2023; 57:1042-1048. [PMID: 36323498 PMCID: PMC10423488 DOI: 10.1136/bjsports-2022-106066] [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] [Accepted: 10/13/2022] [Indexed: 02/07/2023]
Abstract
Despite the high prevalence of tendon pathology in athletes, the underlying pathogenesis is still poorly understood. Various aetiological theories have been presented and rejected in the past, but the tendon cell response model still holds true. This model describes how the tendon cell is the key regulator of the extracellular matrix and how pathology is induced by a failed adaptation to a disturbance of tissue homeostasis. Such failure has been attributed to various kinds of stressors (eg, mechanical, thermal and ischaemic), but crucial elements seem to be missing to fully understand the pathogenesis. Importantly, a disturbance of tissue pressure homeostasis has not yet been considered a possible factor, despite it being associated with numerous pathologies. Therefore, we conducted an extensive narrative literature review on the possible role of intratendinous pressure in the pathogenesis of tendon pathology. This review explores the current understanding of pressure dynamics and the role of tissue pressure in the pathogenesis of other disorders with structural similarities to tendons. By bridging these insights with known structural changes that occur in tendon pathology, a conceptual model was constituted. This model provides an overview of the possible mechanism of how an increase in intratendinous pressure might be involved in the development and progression of tendon pathology and contribute to tendon pain. In addition, some therapies that could reduce intratendinous pressure and accelerate tendon healing are proposed. Further experimental research is encouraged to investigate our hypotheses and to initiate debate on the relevance of intratendinous pressure in tendon pathology.
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Affiliation(s)
- Lauren Pringels
- Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Jill L Cook
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Erik Witvrouw
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Arne Burssens
- Department of Orthopaedic Surgery, Ghent University Hospital, Ghent, Belgium
| | - Luc Vanden Bossche
- Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Evi Wezenbeek
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
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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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Hogaboom N, Shaw J, Barrance P, Capella T, Malanga G. A pilot study testing an Achilles tendinopathy human cadaver model using intratendinous injection of collagenase. Clin Biomech (Bristol, Avon) 2023; 107:106034. [PMID: 37413812 DOI: 10.1016/j.clinbiomech.2023.106034] [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: 07/12/2022] [Revised: 01/26/2023] [Accepted: 06/26/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Achilles tendinopathy is one of the most frequently occurring soft-tissue injuries. Despite decades of research, there is still much that is unknown about the progression of tendinopathy. Animal models, such as collagenase injection, allow researchers to gain insight into disease progression and investigate clinical interventions, yet are limited in their direct application to humans. Establishment of a cadaver model of tendinopathy would provide another method of investigating clinical interventions in human tissues. The purpose of this study is to develop such a model and evaluate biomechanical changes in cadaveric Achilles tendons using ultrasound elastography. METHODS Achilles tendons of five female foot/ankle cadavers were injected with two different concentrations (three with 10 mg/mL, two 20 mg/mL) of collagenase and incubated for 24 h. Ultrasound elastography images were collected at baseline, 16 and 24 h post-injection. Elasticity of tendons was calculated using a custom image analysis program. FINDINGS Elasticity decreased over time in both dosage groups. In the 10 mg/mL group, mean elasticity decreased from 642 ± 246 kPa at baseline to 392 ± 38.3 kPa at 16 h and 263 ± 87.3 kPa at 24 h. In the 20 mg/mL group, mean elasticity decreased from 628 ± 206 kPa at baseline to 176 ± 152 kPa at 16 h and 188 ± 120 kPa at 24 h. INTERPRETATION Injection of collagenase into cadaveric Achilles tendons resulted in decreases in elasticity. Decreases were observed in tendons that received injections with both 10 and 20 mg/mL collagenase dosages. Further biomechanical and histological testing is needed to evaluate this cadaveric tendinopathy.
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Affiliation(s)
- Nathan Hogaboom
- Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA; Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, 183 South Orange Avenue, Suite F-1560, Newark, NJ 07101, USA.
| | - Jonathan Shaw
- Tendonova, 3050 Business Park Drive, Suite A-2, Norcross, GA 30071, USA
| | - Peter Barrance
- Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA; Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, 183 South Orange Avenue, Suite F-1560, Newark, NJ 07101, USA
| | - Teresa Capella
- New Jersey Regenerative Institute, 197 Ridgedale Avenue, Suite 210, Cedar Knolls, NJ 07927, USA
| | - Gerard Malanga
- Tendonova, 3050 Business Park Drive, Suite A-2, Norcross, GA 30071, USA; New Jersey Regenerative Institute, 197 Ridgedale Avenue, Suite 210, Cedar Knolls, NJ 07927, USA
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10
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Jones DL, Hallström GF, Jiang X, Locke RC, Evans MK, Bonnevie ED, Srikumar A, Leahy TP, Nijsure MP, Boerckel JD, Mauck RL, Dyment NA. Mechanoepigenetic regulation of extracellular matrix homeostasis via Yap and Taz. Proc Natl Acad Sci U S A 2023; 120:e2211947120. [PMID: 37216538 PMCID: PMC10235980 DOI: 10.1073/pnas.2211947120] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 04/20/2023] [Indexed: 05/24/2023] Open
Abstract
Cells integrate mechanical cues to direct fate specification to maintain tissue function and homeostasis. While disruption of these cues is known to lead to aberrant cell behavior and chronic diseases, such as tendinopathies, the underlying mechanisms by which mechanical signals maintain cell function are not well understood. Here, we show using a model of tendon de-tensioning that loss of tensile cues in vivo acutely changes nuclear morphology, positioning, and expression of catabolic gene programs, resulting in subsequent weakening of the tendon. In vitro studies using paired ATAC/RNAseq demonstrate that the loss of cellular tension rapidly reduces chromatin accessibility in the vicinity of Yap/Taz genomic targets while also increasing expression of genes involved in matrix catabolism. Concordantly, the depletion of Yap/Taz elevates matrix catabolic expression. Conversely, overexpression of Yap results in a reduction of chromatin accessibility at matrix catabolic gene loci, while also reducing transcriptional levels. The overexpression of Yap not only prevents the induction of this broad catabolic program following a loss of cellular tension, but also preserves the underlying chromatin state from force-induced alterations. Taken together, these results provide novel mechanistic details by which mechanoepigenetic signals regulate tendon cell function through a Yap/Taz axis.
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Affiliation(s)
- Dakota L. Jones
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA19104
| | - Grey F. Hallström
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA19104
| | - Xi Jiang
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA19104
| | - Ryan C. Locke
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA19104
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA19104
- Translational Musculoskeletal Research Center, Corporal Michael Crescenz Veterans Affairs Medical Center, Philadelphia, PA19104
| | - Mary Kate Evans
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA19104
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA19104
| | - Edward D. Bonnevie
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA19104
- Translational Musculoskeletal Research Center, Corporal Michael Crescenz Veterans Affairs Medical Center, Philadelphia, PA19104
| | - Anjana Srikumar
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA19104
| | - Thomas P. Leahy
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA19104
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA19104
| | - Madhura P. Nijsure
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA19104
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA19104
- Center for Engineering Mechanobiology, University of Pennsylvania, Philadelphia, PA19104
| | - Joel D. Boerckel
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA19104
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA19104
- Center for Engineering Mechanobiology, University of Pennsylvania, Philadelphia, PA19104
| | - Robert L. Mauck
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA19104
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA19104
- Translational Musculoskeletal Research Center, Corporal Michael Crescenz Veterans Affairs Medical Center, Philadelphia, PA19104
- Center for Engineering Mechanobiology, University of Pennsylvania, Philadelphia, PA19104
| | - Nathaniel A. Dyment
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA19104
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA19104
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Peniche Silva CJ, De La Vega RE, Panos J, Joris V, Evans CH, Balmayor ER, van Griensven M. MiRNAs as Potential Regulators of Enthesis Healing: Findings in a Rodent Injury Model. Int J Mol Sci 2023; 24:ijms24108556. [PMID: 37239902 DOI: 10.3390/ijms24108556] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/01/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
MicroRNAs (miRNAs) are short non-coding RNA sequences with the ability to inhibit the expression of a target mRNA at the post-transcriptional level, acting as modulators of both the degenerative and regenerative processes. Therefore, these molecules constitute a potential source of novel therapeutic tools. In this study, we investigated the miRNA expression profile that presented in enthesis tissue upon injury. For this, a rodent enthesis injury model was developed by creating a defect at a rat's patellar enthesis. Following injury, explants were collected on days 1 (n = 10) and 10 (n = 10). Contra lateral samples (n = 10) were harvested to be used for normalization. The expression of miRNAs was investigated using a "Fibrosis" pathway-focused miScript qPCR array. Later, target prediction for the aberrantly expressed miRNAs was performed by means of the Ingenuity Pathway Analysis, and the expression of mRNA targets relevant for enthesis healing was confirmed using qPCRs. Additionally, the protein expression levels of collagens I, II, III, and X were investigated using Western blotting. The mRNA expression pattern of EGR1, COL2A1, RUNX2, SMAD1, and SMAD3 in the injured samples indicated their possible regulation by their respective targeting miRNA, which included miR-16, -17, -100, -124, -133a, -155 and -182. Furthermore, the protein levels of collagens I and II were reduced directly after the injury (i.e., day 1) and increased 10 days post-injury, while collagens III and X showed the opposite pattern of expression.
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Affiliation(s)
- Carlos Julio Peniche Silva
- Cell Biology-Inspired Tissue Engineering, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Rodolfo E De La Vega
- Cell Biology-Inspired Tissue Engineering, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, 6229 ER Maastricht, The Netherlands
- Musculoskeletal Gene Therapy Laboratory, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN 55905, USA
| | - Joseph Panos
- Musculoskeletal Gene Therapy Laboratory, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN 55905, USA
| | - Virginie Joris
- Cell Biology-Inspired Tissue Engineering, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Christopher H Evans
- Musculoskeletal Gene Therapy Laboratory, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN 55905, USA
| | - Elizabeth R Balmayor
- Musculoskeletal Gene Therapy Laboratory, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN 55905, USA
- Experimental Orthopaedics and Trauma Surgery, Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, 52074 Aachen, Germany
| | - Martijn van Griensven
- Cell Biology-Inspired Tissue Engineering, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, 6229 ER Maastricht, The Netherlands
- Musculoskeletal Gene Therapy Laboratory, Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, MN 55905, USA
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12
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Lawrence RL, Saini G, Staker JL, Ludewig PM. Comparison of rotator cuff to glenoid proximity based on scapulothoracic upward rotation classification. Braz J Phys Ther 2023; 27:100505. [PMID: 37167904 DOI: 10.1016/j.bjpt.2023.100505] [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: 09/11/2022] [Revised: 04/06/2023] [Accepted: 04/13/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Recent evidence suggests that internal impingement, or rotator cuff tendon deformation against the glenoid, occurs during overhead motions and may therefore be a mechanism of pathology even in non-athletes. Clinically, knowing how movement impacts potential injury mechanisms would be useful to guide movement-based treatment strategies. OBJECTIVE To compare the distance between the glenoid and rotator cuff footprint between two groups classified based on scapulothoracic upward rotation (UR) magnitude (i.e., low, high) at 90° humerothoracic elevation. METHODS Shoulder kinematics were quantified during scapular plane abduction in 60 participants using single-plane fluoroscopy. Of these, 40 were subsequently classified as having high or low scapulothoracic UR based on the sample's distribution. The minimum distance between the glenoid and rotator cuff footprint was calculated along with the locations of closest proximity (i.e., proximity centers). Minimum distances and proximity center locations were compared between groups using 2-factor mixed-model ANOVAs. The prevalence of glenoid-to-footprint contact was also compared. RESULTS Glenoid-to-footprint distances consistently decreased as humerothoracic elevation angle increased, and the anterior aspect of the footprint was closest to the posterosuperior glenoid. Minimum distances were not significantly different between UR groups (p≥0.16). However, group differences existed in proximity center locations (p<0.01). Glenoid-to-footprint contact was identified in 75.0% of participants at an average (SD) of 133.6° (3.2°) humerothoracic elevation. CONCLUSION The results of this study suggest that decreased UR as classified and assessed in this study does not significantly impact glenoid-to-footprint distances but does alter the location of the contact, which occurred in most participants.
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Affiliation(s)
- Rebekah L Lawrence
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, 4444 Forest Park Avenue, MSC 8502-66-1101, St. Louis, MO 63108, USA; Division of Rehabilitation Science, Dept. of Rehabilitation Medicine, University of Minnesota, 420 Delaware Street SE, MMC 388, Minneapolis, MN 55455, USA.
| | - Gaura Saini
- Division of Physical Therapy, Dept. of Rehabilitation Medicine, University of Minnesota, 420 Delaware Street SE, MMC 388, Minneapolis, MN 55455, USA
| | - Justin L Staker
- Division of Rehabilitation Science, Dept. of Rehabilitation Medicine, University of Minnesota, 420 Delaware Street SE, MMC 388, Minneapolis, MN 55455, USA; Division of Physical Therapy, Dept. of Rehabilitation Medicine, University of Minnesota, 420 Delaware Street SE, MMC 388, Minneapolis, MN 55455, USA
| | - Paula M Ludewig
- Division of Rehabilitation Science, Dept. of Rehabilitation Medicine, University of Minnesota, 420 Delaware Street SE, MMC 388, Minneapolis, MN 55455, USA; Division of Physical Therapy, Dept. of Rehabilitation Medicine, University of Minnesota, 420 Delaware Street SE, MMC 388, Minneapolis, MN 55455, USA
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13
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Jahanian O, Van Straaten MG, Goodwin BM, Lennon RJ, Barlow JD, Murthy NS, Morrow MM. Shoulder magnetic resonance imaging findings in manual wheelchair users with spinal cord injury. J Spinal Cord Med 2022; 45:564-574. [PMID: 33166207 PMCID: PMC9246118 DOI: 10.1080/10790268.2020.1834774] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: To investigate the prevalence of rotator cuff and long head of the biceps pathologies in manual wheelchair (MWC) users with spinal cord injury (SCI).Design: Cross-sectional study.Setting: Outpatient clinic at a tertiary medical center.Participants: Forty-four adult MWC users with SCI (36 men and 8 women) with an average age (SD) of 42 (13) years. SCI levels ranged from C6 to L1; complete and incomplete SCI.Outcome Measures: Participants' demographic and anthropometric information, presence of shoulder pain, Wheelchair User's Pain Index (WUSPI) scores, and magnetic resonance imaging findings of shoulder pathologies including tendinopathy, tendon tears, and muscle atrophy.Results: Fifty-nine percent of the participants reported some shoulder pain. The prevalence of any tendinopathy across the rotator cuff and the long head of biceps tendon was 98%. The prevalence of tendinopathy in the supraspinatus was 86%, infraspinatus was 91%, subscapularis was 75%, and biceps was 57%. The majority of tendinopathies had mild or moderate severity. The prevalence of any tears was 68%. The prevalence of tendon tears in the supraspinatus was 48%, infraspinatus was 36%, subscapularis was 43%, and biceps was 12%. The majority of the tears were partial-thickness tears. Participants without tendon tears were significantly younger (P < 0.001) and had been wheelchair user for a significantly shorter time (P = 0.005) than those with tendon tears.Conclusion: Mild and moderate shoulder tendinopathy and partial-thickness tendon tears were highly prevalent in MWC users with SCI. Additionally, the findings of this study suggest that strategies for monitoring shoulder pathologies in this population should not be overly reliant on patient-reported pain, but perhaps more concerned with years of wheelchair use and age.
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Affiliation(s)
- Omid Jahanian
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Meegan G. Van Straaten
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Brianna M. Goodwin
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan J. Lennon
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Jonathan D. Barlow
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Melissa M.B. Morrow
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA,Correspondence to: Melissa M. B. Morrow, 200 First Street SW, Rochester, MN55905, USA.
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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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16
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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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17
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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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18
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Kooistra B, Gurnani N, Weening A, van Deurzen D, van den Bekerom M. Tenotomy or Tenodesis for Tendinopathy of the Long Head of the Biceps Brachii: An Updated Systematic Review and Meta-analysis. Arthrosc Sports Med Rehabil 2021; 3:e1199-e1209. [PMID: 34430901 PMCID: PMC8365216 DOI: 10.1016/j.asmr.2021.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 02/25/2021] [Indexed: 01/29/2023] Open
Abstract
Purpose The purpose of this meta-analysis was to provide an up-to-date comparison of clinical outcomes of tenotomy and tenodesis in the surgical treatment of long head of the biceps brachii (LHB) tendinopathy. Methods A literature search was conducted in EMBASE, Pubmed/Medline and the Cochrane database from January 2000 to May 2020. All studies comparing clinical outcomes between LHB tenotomy and tenodesis were included. Quality was assessed using the Coleman score. Results We included 25 studies (8 randomized studies) comprising 2,191 patients undergoing LHB tenotomy or tenodesis, with or without concomitant shoulder procedures (mainly rotator cuff repairs). The Coleman score ranged from 29 to 97 for all studies. When comparing tenodesis and tenotomy in randomized studies, no clinically relevant differences were found in the Constant score (mean difference, 0.9 points), the American Shoulder and Elbow Society Score (mean difference, 1.1 points), shoulder pain (mean difference in visual analogue scale, -0.3 points), elbow flexion strength loss (mean difference, 0%), or forearm supination strength (mean difference, 3%). A Popeye deformity (odds ratio, 0.32) was less commonly seen in patients treated with tenodesis (9% vs 23%). Conclusion In our meta-analysis, a Popeye deformity was more frequently observed in patients treated with tenotomy. Based on a substantial number of studies, there is no evidence-based benefit of LHB tenodesis over tenotomy in terms of shoulder function, shoulder pain or biceps-related strength. It is unclear whether LHB tenodesis is of benefit in specific patient groups such as younger individuals. Level of evidence Level III, systematic review of level III or higher studies.
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Affiliation(s)
- Bauke Kooistra
- Department of Orthopaedic Surgery, Medische Kliniek Velsen, Velsen-Noord, the Netherlands.,Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - Navin Gurnani
- Department of Orthopaedic Surgery, Medische Kliniek Velsen, Velsen-Noord, the Netherlands
| | - Alexander Weening
- Department of Orthopaedic Surgery, Medische Kliniek Velsen, Velsen-Noord, the Netherlands
| | - Derek van Deurzen
- Department of Orthopaedic Surgery, Medische Kliniek Velsen, Velsen-Noord, the Netherlands
| | - Michel van den Bekerom
- Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands.,Department of Orthopaedic Surgery, Vrije Universiteit Medical Centre, Amsterdam, the Netherlands
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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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20
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Goodwin BM, Cain SM, Van Straaten MG, Fortune E, Jahanian O, Morrow MMB. Humeral elevation workspace during daily life of adults with spinal cord injury who use a manual wheelchair compared to age and sex matched able-bodied controls. PLoS One 2021; 16:e0248978. [PMID: 33891602 PMCID: PMC8064589 DOI: 10.1371/journal.pone.0248978] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 03/08/2021] [Indexed: 11/18/2022] Open
Abstract
Shoulder pain and pathology are extremely common for individuals with spinal cord injuries (SCI) who use manual wheelchairs (MWC). Although risky humeral kinematics have been measured during wheelchair-based activities performed in the lab, little is known about arm kinematics in the free-living environment. The purpose of this study was to measure the humeral elevation workspace throughout a typical day for individuals with SCI who use a MWC and matched able-bodied controls. Thirty-four individuals with SCI who use a MWC (42.7±12.7 years of age, 28 males/6 females, C6-L1) and 34 age-and sex-matched controls were enrolled. Participants wore three inertial measurement units (IMU) on their upper arms and torso for one to two days. Humeral elevation angles were estimated and the percentage of time individuals spent in five elevation bins (0–30°, 30–60°, 60–90°, 90–120°, and 120–180°) were calculated. For both arms, the SCI cohort spent a significantly lower percentage of the day in 0–30° of humeral elevation (Dominant: SCI = 15.7±12.6%, Control = 32.1±15.6%, p<0.0001; Non-Dominant: SCI = 21.9±17.8%, Control = 34.3±15.5%, p = 0.001) and a significantly higher percentage of time in elevations associated with tendon compression (30–60° of humeral elevation, Dominant: SCI = 62.8±14.4%, Control = 49.9.1±13.0%, p<0.0001; Non-Dominant: SCI = 58.8±14.9%, Control = 48.3±13.6%, p = 0.003) than controls. The increased percentage of time individuals with SCI spent in elevations associated with tendon compression may contribute to increased shoulder pathology. Characterizing the humeral elevation workspace utilized throughout a typical day may help in understanding the increased prevalence of shoulder pain and pathology in individuals with SCI who use MWCs.
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Affiliation(s)
- Brianna M. Goodwin
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, United States of America
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States of America
| | - Stephen M. Cain
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, United States of America
| | - Meegan G. Van Straaten
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, United States of America
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States of America
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, United States of America
| | - Emma Fortune
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, United States of America
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States of America
| | - Omid Jahanian
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, United States of America
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States of America
| | - Melissa M. B. Morrow
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, United States of America
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States of America
- * E-mail:
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Siadat SM, Zamboulis DE, Thorpe CT, Ruberti JW, Connizzo BK. Tendon Extracellular Matrix Assembly, Maintenance and Dysregulation Throughout Life. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1348:45-103. [PMID: 34807415 DOI: 10.1007/978-3-030-80614-9_3] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
In his Lissner Award medal lecture in 2000, Stephen Cowin asked the question: "How is a tissue built?" It is not a new question, but it remains as relevant today as it did when it was asked 20 years ago. In fact, research on the organization and development of tissue structure has been a primary focus of tendon and ligament research for over two centuries. The tendon extracellular matrix (ECM) is critical to overall tissue function; it gives the tissue its unique mechanical properties, exhibiting complex non-linear responses, viscoelasticity and flow mechanisms, excellent energy storage and fatigue resistance. This matrix also creates a unique microenvironment for resident cells, allowing cells to maintain their phenotype and translate mechanical and chemical signals into biological responses. Importantly, this architecture is constantly remodeled by local cell populations in response to changing biochemical (systemic and local disease or injury) and mechanical (exercise, disuse, and overuse) stimuli. Here, we review the current understanding of matrix remodeling throughout life, focusing on formation and assembly during the postnatal period, maintenance and homeostasis during adulthood, and changes to homeostasis in natural aging. We also discuss advances in model systems and novel tools for studying collagen and non-collagenous matrix remodeling throughout life, and finally conclude by identifying key questions that have yet to be answered.
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Affiliation(s)
| | - Danae E Zamboulis
- Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Chavaunne T Thorpe
- Comparative Biomedical Sciences, The Royal Veterinary College, University of London, London, UK
| | - Jeffrey W Ruberti
- Department of Bioengineering, Northeastern University, Boston, MA, USA
| | - Brianne K Connizzo
- Department of Biomedical Engineering, Boston University, Boston, MA, USA.
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22
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Chen Y, Jiang F, Li H, Chen S, Qiao Y, Li Y, Hua Y, Chen J, Ge Y. Retears and Concomitant Functional Impairments After Rotator Cuff Repair: Shoulder Activity as a Risk Factor. Am J Sports Med 2020; 48:931-938. [PMID: 32040348 DOI: 10.1177/0363546519900897] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Most patients return successfully to shoulder involving sports or activity after rotator cuff repairs. It has not been decided yet whether postoperative participation in shoulder activity adds to the risk of retear. PURPOSE/HYPOTHESIS The purpose was to verify whether patients who participate in shoulder activities after rotator cuff repair have a higher risk of structural failure than nonactive patients and to investigate the relationship between postoperative shoulder function and tendon integrity in active and nonactive patients. The hypotheses were that (1) active patients have a higher retear rate than nonactive patients and (2) structural failure is associated with worse functional outcomes in active patients. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A cohort study was performed using 145 patients who underwent arthroscopic rotator cuff repair from 2015 to 2017. Functional assessments and magnetic resonance imaging were performed at least 24 months postoperatively. Shoulder activities since 6 months after surgery were rated in 4 categories (sports, job, activities of daily life, and weight of general lifting) as sedentary, light, moderate, or strenuous. The activity level of each patient was defined by the highest rated category. Patients who were involved in light, moderate, and strenuous activity were identified as active for the present study, and the rest were defined as sedentary. The proportion of retears between groups and the functional conditions between retorn and intact tendons were compared. RESULTS A total of 48 patients were enrolled in the active group, and 97 were enrolled in the sedentary group. The active group demonstrated a significantly higher retear rate than the sedentary group (27.1% vs 11.3%, respectively; P = .016; risk ratio, 2.39 [95% CI, 1.16-4.93]). In the active group, patients with retears showed higher visual analog scale scores for pain, decreased abduction strength, and lower shoulder functional scores (American Shoulder and Elbow Surgeons score, Fudan University Shoulder Score, and Constant-Murley score) than those with healed tendons, whereas in the sedentary group, functional outcomes were generally similar across patients with and without retears. CONCLUSION Shoulder activity after the early postoperative period was associated with a high risk of retears in patients who underwent rotator cuff repair. A correlation between inhibited function and structural failure was detected but only in active patients, while sedentary patients with retears retained functional improvements similar to those with intact tendons.
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Affiliation(s)
- Yuzhou Chen
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Fangyi Jiang
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Hong Li
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Shiyi Chen
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Yang Qiao
- Department of Radiology, Huashan Hospital, Shanghai, China
| | - Yunxia Li
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Yinghui Hua
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Jiwu Chen
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
| | - Yunshen Ge
- Department of Sports Medicine, Huashan Hospital, Shanghai, China
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23
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Wunderli SL, Blache U, Snedeker JG. Tendon explant models for physiologically relevant invitro study of tissue biology - a perspective. Connect Tissue Res 2020; 61:262-277. [PMID: 31931633 DOI: 10.1080/03008207.2019.1700962] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background: Tendon disorders increasingly afflict our aging society but we lack the scientific understanding to clinically address them. Clinically relevant models of tendon disease are urgently needed as established small animal models of tendinopathy fail to capture essential aspects of the disease. Two-dimensional and three-dimensional cell and tissue culture models are similarly limited, lacking many physiological extracellular matrix cues required to maintain tissue homeostasis or guide matrix remodeling. These cues reflect the biochemical and biomechanical status of the tissue, and encode information regarding the mechanical and metabolic competence of the tissue. Tendon explants overcome some of these limitations and have thus emerged as a valuable tool for the discovery and study of mechanisms associated with tendon homeostasis and pathophysiology. Tendon explants retain native cell-cell and cell-matrix connections, while allowing highly reproducible experimental control over extrinsic factors like mechanical loading and nutritional availability. In this sense tendon explant models can deliver insights that are otherwise impossible to obtain from in vivo animal or in vitro cell culture models. Purpose: In this review, we aimed to provide an overview of tissue explant models used in tendon research, with a specific focus on the value of explant culture systems for the controlled study of the tendon core tissue. We discuss their advantages, limitations and potential future utility. We include suggestions and technical recommendations for the successful use of tendon explant cultures and conclude with an outlook on how explant models may be leveraged with state-of-the-art biotechnologies to propel our understanding of tendon physiology and pathology.
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Affiliation(s)
- Stefania L Wunderli
- University Hospital Balgrist, University of Zurich, Zurich, Switzerland.,Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Ulrich Blache
- University Hospital Balgrist, University of Zurich, Zurich, Switzerland.,Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Jess G Snedeker
- University Hospital Balgrist, University of Zurich, Zurich, Switzerland.,Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
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24
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Yoshida K, Itoigawa Y, Wada T, Maruyama Y, Nojiri H, Kawasaki T, Kaneko K. Association of Superoxide-Induced Oxidative Stress With Rotator Cuff Tears in Human Patients. J Orthop Res 2020; 38:212-218. [PMID: 31520427 DOI: 10.1002/jor.24472] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 09/03/2019] [Indexed: 02/04/2023]
Abstract
Rotator cuff degeneration is one of the factors contributing to rotator cuff tears. Oxidative stress is involved in tendon degeneration, and superoxide-induced oxidative stress plays a pathological role in regulating the balance between oxidation and reduction. The role of oxidative stress in rotator cuff tears, however, is unclear. This study, therefore, aimed to investigate the contribution of superoxide-induced oxidative stress to rotator cuff tears. Seventy patients were recruited and divided into two groups: patients with (Ruptured group) and those without (Unruptured group) a rotator cuff tear. Specimens from both groups were collected during surgery. Degeneration morphology was classified according to the degeneration score. Superoxide-induced oxidative stress was assessed according to dihydroethidium (DHE) relative fluorescence intensity, capacity for antioxidation according to superoxide dismutase (SOD) activity, and the balance between oxidation and reduction based on the redox ratio. Data were compared between groups. Correlations between the degeneration score and the oxidative stress factors were calculated. Degeneration score and DHE relative fluorescence intensity were significantly higher in the Ruptured than the Unruptured group. The SOD activity was not significantly different between groups. Degeneration score was positively correlated with both DHE relative fluorescence intensity and SOD activity. Thus, superoxide-induced oxidative stress and tendon degeneration were greater in rotator cuff tear tissues than in those with no tear, suggesting that oxidative imbalance may be involved in degenerative rotator cuff tears. Clinical Relevance: Understanding the mechanisms of superoxide-induced oxidative stress may lead to targeted tissue therapy for degenerative rotator cuff tears. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:212-218, 2020.
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Affiliation(s)
- Keiichi Yoshida
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu-shi, Chiba, 279-0021, Japan
| | - Yoshiaki Itoigawa
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu-shi, Chiba, 279-0021, Japan
| | - Tomoki Wada
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu-shi, Chiba, 279-0021, Japan
| | - Yuichiro Maruyama
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu-shi, Chiba, 279-0021, Japan
| | - Hidetoshi Nojiri
- Department of Orthopaedic Surgery, Juntendo University, Tokyo, Japan
| | - Takayuki Kawasaki
- Department of Orthopaedic Surgery, Juntendo University, Tokyo, Japan
| | - Kazuo Kaneko
- Department of Orthopaedic Surgery, Juntendo University, Tokyo, Japan
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25
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Shoulder kinematics impact subacromial proximities: a review of the literature. Braz J Phys Ther 2019; 24:219-230. [PMID: 31377124 DOI: 10.1016/j.bjpt.2019.07.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/23/2019] [Accepted: 07/16/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Alterations in glenohumeral and scapulothoracic kinematics have been theorized to contribute to rotator cuff pathology by impacting the magnitude of the subacromial space. OBJECTIVE The purpose of this review is to summarize what is currently known about the relationship between shoulder kinematics and subacromial proximities. CONCLUSIONS A variety of methods have been used to quantify subacromial proximities including photographs, MR imaging, ultrasonography, and single- and bi-plane radiographs. Changes in glenohumeral and scapulothoracic kinematics are associated with changes in subacromial proximities. However, the magnitude and direction of a particular motion's impact on subacromial proximities often vary between studies, which likely reflects different methodologies and subject populations. Glenohumeral elevation angle has been consistently found to impact subacromial proximities. Plane of humeral elevation also impacts subacromial proximities but to a lesser degree than the elevation angle. The impact of decreased scapulothoracic upward rotation on subacromial proximities is not absolute, but instead depends on the angle of humerothoracic elevation. The effects of scapular dyskinesis and humeral and scapular axial rotations on subacromial proximities are less clear. Future research is needed to further investigate the relationship between kinematics and subacromial proximities using more homogenous groups, determine the extent to which compression and other factors contribute to rotator cuff pathology, and develop accurate and reliable clinical measures of shoulder motion.
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26
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Kocadal O, Pepe M, Akyurek N, Gunes Z, Surer H, Aksahin E, Ogut B, Aktekin CN. The Evaluation of Exogenous Melatonin Administration in Supraspinatus Overuse Tendinopathy in an Experimental Rat Model. Clin Shoulder Elb 2019; 22:79-86. [PMID: 33330199 PMCID: PMC7714296 DOI: 10.5397/cise.2019.22.2.79] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/07/2019] [Accepted: 03/12/2019] [Indexed: 11/25/2022] Open
Abstract
Background Increased oxidative stress and inflammation play a critical role in the etiopathogenesis of chronic tendinopathy. Melatonin is an endogenous molecule that exhibits antioxidant and anti-inflammatory activity. The aim of this study was to evaluate the biochemical and histopathological effects of exogenous melatonin administrations in supraspinatus overuse tendinopathy. Methods Fifty rats were divided into the following four groups: cage activity, melatonin treatment, corticosteriod therapy, and control. Melatonin (10 mg/kg, intraperitoneal; twice a day) and triamcinolone (0.3 mg/kg, subacromial; weekly) were administered to the treatment groups after the overuse period. Biochemical and histopathological evaluations were performed on serum samples and biopsies obtained from rats. Plasma inducible nitric oxide synthase (iNOS), vascular endothelial growth factor (VEGF), total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) levels were evaluated biochemically. Results The TAS, TOS, OSI, iNOS, and VEGF values were significantly lower than the pre-treatment levels in rats receiving exogenous melatonin treatment (3 or 6 weeks) (p<0.05). TOS, iNOS, VEGF, and OSI values after 3 weeks of triamcinolone administration, and TOS, VEGF, and OSI levels after 6 weeks of triamcinolone application, were significantly lower than the pre-treatment levels (p<0.05). Conclusions Exogenous melatonin application in overuse tendinopathy reduces oxidative stress and inflammation. Melatonin might be an alternative potential molecule to corticosteroids in the treatment of chronic tendinopathy.
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Affiliation(s)
- Onur Kocadal
- Department of Orthopedics and Traumatology, Yeditepe University Faculty of Medicine, Istanbul, Turkey
| | - Murad Pepe
- Department of Orthopedics and Traumatology, Alanya Research and Training Hospital, Alanya Alaaddin Keykubat Unversity, Alanya, Turkey
| | - Nalan Akyurek
- Department of Pathology, Gazi University Medical School, Ankara, Turkey
| | - Zafer Gunes
- Department of Orthopedics and Traumatology, Bursa Yüksek İhtisas Research and Training Hospital, Bursa, Turkey
| | - Hatice Surer
- Department of Biochemistry and Clinical Biochemistry, Ankara Education and Research Hospital, Ankara, Turkey
| | - Ertugrul Aksahin
- Department of Orthopedics and Traumatology, Medical Park Hospital, Ankara, Turkey
| | - Betul Ogut
- Department of Pathology, Gaziantep Cengiz Gokcek Obstetrics and Children's Hospital, Gaziantep, Turkey
| | - Cem Nuri Aktekin
- Department of Orthopedics and Traumatology, Ankara Education and Research Hospital, Ankara, Turkey
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27
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Abstract
BACKGROUND Decreased scapulothoracic upward rotation has been theorized to increase an individual's risk for rotator cuff compression by reducing the clearance for the tendons in the subacromial space (ie, subacromial proximities). However, the impact of decreased scapulothoracic upward rotation on subacromial proximities has not been tested during dynamic in vivo shoulder motion. OBJECTIVE To determine the impact of decreased scapulothoracic upward rotation on subacromial proximities. METHODS Shoulder kinematics were quantified in 40 participants, classified as having high or low scapulothoracic upward rotation, during scapular plane abduction using single-plane fluoroscopy and 2-D/3-D shape-matching. Subacromial proximities were calculated as (1) the normalized minimum distance between the coracoacromial arch and humeral rotator cuff insertion, and (2) the surface area of the humeral rotator cuff insertion in immediate proximity to the coracoacromial arch. The effect of decreased scapulothoracic upward rotation on subacromial proximities was assessed using 2-factor mixed-model analyses of variance. The prevalence of contact between the coracoacromial arch and rotator cuff was also quantified. RESULTS Subacromial distances were generally smallest below 70° of humerothoracic elevation. With the arm at the side, the normalized minimum distance for participants in the low scapulothoracic upward rotation group was 34.8% smaller compared to those in the high upward rotation group (P = .049). Contact between the coracoacromial arch and rotator cuff tendon occurred in 45% of participants. CONCLUSION Decreased scapulothoracic upward rotation shifts the range of risk for subacromial rotator cuff compression to lower angles. However, the low prevalence of contact suggests that subacromial rotator cuff compression may be less common than traditionally presumed. J Orthop Sports Phys Ther 2019;49(3):180-191. Epub 18 Jan 2019. doi:10.2519/jospt.2019.8590.
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28
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Abstract
Tendons connect muscle to bone and play an integral role in bone and joint alignment and loading. Tendons act as pulleys that provide anchorage of muscle forces for joint motion and stability, as well as for fracture reduction and realignment. Patients that experience complex fractures also have concomitant soft tissue injuries, such as tendon damage or rupture. Tendon injuries that occur at the time of bone fracture have long-term ramifications on musculoskeletal health, yet these injuries are often disregarded in clinical treatment and diagnosis for patients with bone fractures as well as in basic science approaches for understanding bone repair processes. Delayed assessment of soft tissue injuries during evaluation of trauma can lead to chronic pain, dysfunction, and delayed bone healing even following successful fracture repair, highlighting the importance of identifying and treating damaged tendons early. Treatment strategies for bone repair, such as mechanical stabilization and biological therapeutics, can impact tendon healing and function. Because poor tendon healing following complex fracture can significantly impact the function of tendon during bone fracture healing, a need exists to understand the healing process of complex fractures more broadly, beyond the healing of bone. In this review, we explored the mechanical and biological interaction of bone and tendon in the context of complex fracture, as well as the relevance and potential ramifications of tendon damage following bone fracture, which has particular impact on patients that experience complex fractures, such as from combat, automobile accidents, and other trauma.
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Affiliation(s)
- Elahe Ganji
- Department of Biomedical Engineering, University of Delaware, Newark, Delaware 19716
- Department of Mechanical Engineering, University of Delaware, Newark, Delaware 19716
| | - Megan L. Killian
- Department of Biomedical Engineering, University of Delaware, Newark, Delaware 19716
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29
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Dan M, Parr W, Broe D, Cross M, Walsh WR. Biomechanics of the knee extensor mechanism and its relationship to patella tendinopathy: A review. J Orthop Res 2018; 36:3105-3112. [PMID: 30074265 DOI: 10.1002/jor.24120] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 07/26/2018] [Indexed: 02/04/2023]
Abstract
The term jumpers knee for patella tendinitis, as coined by Dr. Martin Blazina, is now commonly referred to as tendinopathy. He believed it was associated with patella alta. Since then multiple studies have failed to reliably show an association between patella tendinopathy and associated intrinsic risk factors. There is, unfortunately, a well-established doctrine that the extensor mechanism is simply a pulley. The goal of the review is to examine the biomechanics of the extensor mechanism and apply this to studies investigating intrinsic risk factors for patella tendinopathy. A better understanding of the biomechanics of the extensor mechanism may stimulate the discovery of intrinsic risk factors for developing patella tendinopathy, and subsequent surgical options to address them. Clinical significance: The aim of this review is to direct future research into biomechanical risk factors for developing patella tendinopathy and subsequently, possible treatments. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:3105-3112, 2018.
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Affiliation(s)
- Michael Dan
- Surgical and Orthopaedic Research Laboratory, Prince of Wales Clinical School University of New South Wales, Sydney 2052, Australia.,Prince of Wales Hospital, Barker St, Randwick, New South Wales 2031, Australia
| | - William Parr
- Surgical and Orthopaedic Research Laboratory, Prince of Wales Clinical School University of New South Wales, Sydney 2052, Australia
| | - David Broe
- Surgical and Orthopaedic Research Laboratory, Prince of Wales Clinical School University of New South Wales, Sydney 2052, Australia.,Prince of Wales Hospital, Barker St, Randwick, New South Wales 2031, Australia
| | - Mervyn Cross
- The Stadium Sports Medicine Clinic, Sydney 2012, Australia
| | - William R Walsh
- Surgical and Orthopaedic Research Laboratory, Prince of Wales Clinical School University of New South Wales, Sydney 2052, Australia.,Prince of Wales Hospital, Barker St, Randwick, New South Wales 2031, Australia
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30
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Huntington L, Coles-Black J, Richardson M, Sobol T, Caldow J, Chuen J, Ackland DC. The use of suture-tape and suture-wire in arthroscopic rotator cuff repair: A comparative biomechanics study. Injury 2018; 49:2047-2052. [PMID: 30224178 DOI: 10.1016/j.injury.2018.09.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 07/22/2018] [Accepted: 09/03/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Rotator cuff repair surgery aims to create a secure, pressurized tendon-bone footprint to permit re-establishment of the fibrovascular interface and tendon healing. Flat-braided suture-tape is an alternative suture material to traditional suture-wire that has potential to reproduce a larger repair construct contact area. The objective of this study was to compare contact pressure, area as well as the mechanical fatigue strength between suture-wire and suture-tape Suture-bridge repair constructs in an ovine model. METHODS Sixty lamb infraspinatus tendons were harvested and randomly allocated to three- and four-anchor Suture-bridge repairs performed using either suture-wire or suture-tape. Thirty-two specimens were cyclically loaded for 200 cycles in an Instron testing machine, while tendon gap formation was recorded using a high speed digital motion analysis system. Loading to failure was then performed to evaluate construct ultimate tensile strength and stiffness. The remaining 28 specimens were assessed for repair contact pressure and area using pressure-sensitive film. RESULTS There was a significantly greater average tendon contact pressure (mean difference: 0.064 MPa, p = 0.04) and area (mean difference: 2.71 mm2, p = 0.03) in fiber-tape repair constructs compared to those in fiber-wire constructs for the three-anchor Suture-bridge configuration. The four-anchor suture-tape constructs had a significantly larger ultimate tensile strength than that of the four-anchor suture-wire constructs (mean difference: 56.4 N, p = 0.04). There were no significant differences in gap formation or stiffness between suture-tape and suture-wire constructs (p > 0.05). CONCLUSION Suture-tape offers greater pressurised tendon-bone contact than suture-wire in three-anchor Suture-bridge repairs, while greater mechanical strength is achieved with the use of suture-tape in four-anchor Suture-bridge constructs.
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Affiliation(s)
- Lachlan Huntington
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Jasamine Coles-Black
- Department of Surgery, Austin Health, Melbourne Medical School, The University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Martin Richardson
- Department of Orthopaedic Surgery, Epworth Healthcare, Richmond, Victoria, 3121, Australia
| | - Tony Sobol
- Department of Orthopaedic Surgery, Epworth Healthcare, Richmond, Victoria, 3121, Australia
| | - Jonathon Caldow
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Jason Chuen
- Department of Surgery, Austin Health, Melbourne Medical School, The University of Melbourne, Parkville, Victoria, 3010, Australia
| | - David C Ackland
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, 3010, Australia.
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31
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Cunningham G, Nicodème-Paulin E, Smith MM, Holzer N, Cass B, Young AA. The greater tuberosity angle: a new predictor for rotator cuff tear. J Shoulder Elbow Surg 2018; 27:1415-1421. [PMID: 29703680 DOI: 10.1016/j.jse.2018.02.051] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 02/10/2018] [Accepted: 02/13/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND The implication of scapular morphology in rotator cuff tears has been extensively studied. However, the role of the greater tuberosity (GT) should be of equal importance. The aim of this study was to propose a new radiographic marker, the GT angle (GTA), which measures the position of the GT in relation to the center of rotation of the humeral head. The hypothesis was that a higher angle value would be associated with a higher likelihood in detecting a rotator cuff tear. METHODS During 1 year, patients were prospectively recruited from a single institution specialized shoulder clinic in 2 different groups. The patient group consisted of individuals with a degenerative rotator cuff tear involving at least the supraspinatus. The control group consisted of individuals with no rotator cuff pathology. Individuals in both groups with congenital, post-traumatic, or degenerative alterations of the proximal humerus were excluded. The GTA was measured on an anteroposterior shoulder x-ray image with the arm in neutral rotation by 3 observers at 2 different times. RESULTS The study recruited 71 patients (33 patients, 38 controls). Mean GTA value was 72.5° (range, 67.6°-79.2°) in patients and 65.2° (range, 55.8°-70.5°) for controls (P <.001). A value above 70° resulted in 93-fold higher odds of detecting a rotator cuff tear (P <.001). Interobserver and intraobserver reliability were high. CONCLUSIONS GT morphology is implicated in rotator cuff tears. The GTA is a reliable radiographic marker, with more than 70° being highly predictive in detecting such lesions.
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Affiliation(s)
- Gregory Cunningham
- Division of Orthopaedic and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland; Shoulder Center, Hirslanden Clinique la Colline, Geneva, Switzerland.
| | | | - Margaret M Smith
- Institute of Bone and Joint Research, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Nicolas Holzer
- Division of Orthopaedic and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Benjamin Cass
- Sydney Shoulder Research Institute, Sydney, NSW, Australia
| | - Allan A Young
- Sydney Shoulder Research Institute, Sydney, NSW, Australia
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Bianco ST, Moser HL, Galatz LM, Huang AH. Biologics and stem cell-based therapies for rotator cuff repair. Ann N Y Acad Sci 2018; 1442:35-47. [PMID: 30008172 DOI: 10.1111/nyas.13918] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 06/01/2018] [Accepted: 06/11/2018] [Indexed: 12/20/2022]
Abstract
The rotator cuff is composed of several distinct muscles and tendons that function in concert to coordinate shoulder motion. Injuries to these tendons frequently result in permanent dysfunction and persistent pain. Despite considerable advances in operation techniques, surgical repair alone still does not fully restore rotator cuff function. This review focuses on recent research in the use of biologics and stem cell-based therapies to augment repair, highlighting promising avenues for future work and remaining challenges. While a number of animal models are used for rotator cuff studies, the anatomy of the rotator cuff varies dramatically between species. Since the rodent rotator cuff shares the most anatomical features with the human, this review will focus primarily on rodent models to enable consistent interpretation of outcome measures.
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Affiliation(s)
- Spencer T Bianco
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Helen L Moser
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York.,Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Leesa M Galatz
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alice H Huang
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York
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33
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Beach ZM, Tucker JJ, Thomas SJ, Reuther KE, Gray CF, Lee CS, Glaser DL, Soslowsky LJ. Biceps tenotomy in the presence of a supraspinatus tear alters the adjacent intact tendons and glenoid cartilage. J Biomech 2017; 63:151-157. [PMID: 28893394 DOI: 10.1016/j.jbiomech.2017.08.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 07/14/2017] [Accepted: 08/20/2017] [Indexed: 11/17/2022]
Abstract
A rotator cuff tear is a common injury in athletes and workers who repeatedly perform overhead movements, and it is not uncommon for this demographic to return to activity shortly after treatment. A biceps tenotomy is often performed in the presence of a rotator cuff tear to help reduce pain and improve joint function. However, the effect of this procedure on the surrounding tissues in the glenohumeral joint is unknown. Therefore, the purpose of this study was to investigate the effect of a biceps tenotomy in the presence of a supraspinatus rotator cuff tear followed by overuse activity on ambulatory function and mechanical and histologic properties of the remaining rotator cuff tendons and glenoid cartilage. 46 rats underwent 4weeks of overuse activity to create a tendinopathic condition, then were randomized into two groups: unilateral detachment of the supraspinatus tendon or detachment of the supraspinatus and long head of the biceps tendons. Ambulatory measurements were performed throughout the 8weeks prior to euthanasia, followed by analysis of the properties of the remaining intact tendons and glenoid cartilage. Results demonstrate that shoulder function was not effected in the biceps tenotomy group. However, the intact tendons and glenoid cartilage showed altered mechanical and histologic properties. This study provides evidence from an animal model that does not support the use of tenotomy in the presence of a supraspinatus tendon rotator cuff tear, and provides a framework for physicians to better prescribe long-term treatment strategies for patients.
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Affiliation(s)
- Zakary M Beach
- McKay Orthopaedic Laboratory, University of Pennsylvania, Philadelphia, PA, USA
| | - Jennica J Tucker
- McKay Orthopaedic Laboratory, University of Pennsylvania, Philadelphia, PA, USA
| | - Stephen J Thomas
- McKay Orthopaedic Laboratory, University of Pennsylvania, Philadelphia, PA, USA
| | - Katherine E Reuther
- McKay Orthopaedic Laboratory, University of Pennsylvania, Philadelphia, PA, USA
| | - Chancellor F Gray
- McKay Orthopaedic Laboratory, University of Pennsylvania, Philadelphia, PA, USA
| | - Chang-Soo Lee
- McKay Orthopaedic Laboratory, University of Pennsylvania, Philadelphia, PA, USA
| | - David L Glaser
- McKay Orthopaedic Laboratory, University of Pennsylvania, Philadelphia, PA, USA
| | - Louis J Soslowsky
- McKay Orthopaedic Laboratory, University of Pennsylvania, Philadelphia, PA, USA.
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Dischler JD, Baumer TG, Finkelstein E, Siegal DS, Bey MJ. Association Between Years of Competition and Shoulder Function in Collegiate Swimmers. Sports Health 2017; 10:113-118. [PMID: 28829699 PMCID: PMC5857725 DOI: 10.1177/1941738117726771] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Shoulder injuries are common among competitive swimmers, and the progression of shoulder pathology is not well understood. The objective of this study was to assess the extent to which years of competitive swim training were associated with physical properties of the supraspinatus muscle and tendon, shoulder strength, and self-reported assessments of shoulder pain and function. HYPOTHESIS Increasing years of competition will be associated with declining physical properties of the supraspinatus muscle/tendon and declining self-reported assessments of pain and function. STUDY DESIGN Descriptive epidemiology study. LEVEL OF EVIDENCE Level 4. METHODS After institutional approval, 18 collegiate female swimmers enrolled in the study. For each swimmer, supraspinatus tendon thickness was measured; tendinosis was assessed using ultrasound imaging, supraspinatus muscle shear wave velocity was assessed using shear wave elastography, isometric shoulder strength was measured using a Biodex system, and self-reported assessments of pain/function were assessed using the Western Ontario Rotator Cuff (WORC) score. All subjects were tested before the start of the collegiate swim season. Linear regression was used to assess the association between years of competition and the outcome measures. RESULTS Years of participation was positively associated with tendon thickness ( P = 0.01) and negatively associated with shear wave velocity ( P = 0.04) and WORC score ( P < 0.01). Shoulder strength was not associated with years of participation ( P > 0.39). CONCLUSION Long-term competitive swim training is associated with declining measures of supraspinatus muscle/tendon properties and self-reported measures of pain and function. Although specific injury mechanisms are still not fully understood, these findings lend additional insight into the development of rotator cuff pathology in swimmers. CLINICAL RELEVANCE Lengthy swimming careers may lead to a chronic condition of reduced mechanical properties in the supraspinatus muscle and tendon, thereby increasing the likelihood of rotator cuff pathology.
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Affiliation(s)
- Jack D. Dischler
- Bone and Joint Center, Henry Ford Health System, Detroit, Michigan
| | | | - Evan Finkelstein
- Department of Radiology, Henry Ford Health System, Detroit, Michigan
| | - Daniel S. Siegal
- Department of Radiology, Henry Ford Health System, Detroit, Michigan
| | - Michael J. Bey
- Bone and Joint Center, Henry Ford Health System, Detroit, Michigan
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Howell K, Chien C, Bell R, Laudier D, Tufa SF, Keene DR, Andarawis-Puri N, Huang AH. Novel Model of Tendon Regeneration Reveals Distinct Cell Mechanisms Underlying Regenerative and Fibrotic Tendon Healing. Sci Rep 2017; 7:45238. [PMID: 28332620 PMCID: PMC5362908 DOI: 10.1038/srep45238] [Citation(s) in RCA: 159] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 02/20/2017] [Indexed: 12/19/2022] Open
Abstract
To date, the cell and molecular mechanisms regulating tendon healing are poorly understood. Here, we establish a novel model of tendon regeneration using neonatal mice and show that neonates heal via formation of a ‘neo-tendon’ that differentiates along the tendon specific lineage with functional restoration of gait and mechanical properties. In contrast, adults heal via fibrovascular scar, aberrant differentiation toward cartilage and bone, with persistently impaired function. Lineage tracing identified intrinsic recruitment of Scx-lineage cells as a key cellular mechanism of neonatal healing that is absent in adults. Instead, adult Scx-lineage tenocytes are not recruited into the defect but transdifferentiate into ectopic cartilage; in the absence of tenogenic cells, extrinsic αSMA-expressing cells persist to form a permanent scar. Collectively, these results establish an exciting model of tendon regeneration and uncover a novel cellular mechanism underlying regenerative vs non-regenerative tendon healing.
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Affiliation(s)
- Kristen Howell
- Dept. of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA
| | - Chun Chien
- Dept. of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA
| | - Rebecca Bell
- Dept. of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY 14853 USA
| | - Damien Laudier
- Dept. of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA
| | - Sara F Tufa
- Micro-Imaging Center, Shriners Hospital for Children, Portland, OR 97209, USA
| | - Douglas R Keene
- Micro-Imaging Center, Shriners Hospital for Children, Portland, OR 97209, USA
| | - Nelly Andarawis-Puri
- Dept. of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY 14853 USA
| | - Alice H Huang
- Dept. of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA
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Gurnani N, van Deurzen DFP, Janmaat VT, van den Bekerom MPJ. Tenotomy or tenodesis for pathology of the long head of the biceps brachii: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2016; 24:3765-3771. [PMID: 25975753 DOI: 10.1007/s00167-015-3640-6] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 05/05/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE The objective of this meta-analysis is to compare clinical outcomes of tenotomy and tenodesis in the surgical treatment of long head of the biceps brachii (LHB). METHODS A literature search was conducted in Embase and PubMed from 2000 to April 2014. All studies comparing the clinical outcomes between LHB tenotomy and tenodesis were included. The quality assessment was done by utilizing the Coleman score. We included nine studies comprising 650 patients undergoing LHB tenotomy or tenodesis, mostly with concomitant shoulder pathology. RESULTS No significant difference in post-operative Constant score (mean difference 1.77), elbow flexion strength (mean difference 0), and forearm supination strength (mean difference 0.01) in favour of tenodesis was observed. A Popeye deformity (odds ratio 0.17) and cramping pain (odds ratio 0.38) in the bicipital groove muscle were less frequently seen in patients treated with tenodesis. The Coleman score ranged between 45 and 100 in the included studies. CONCLUSION Based on this meta-analysis, no differences in post-operative functional outcome between tenotomy and tenodesis for the treatment of LHB lesions were observed. A Popeye deformity and cramping pain in the bicipital groove are more frequently observed in patients treated with tenotomy. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Navin Gurnani
- Department of Orthopedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
| | - Derek F P van Deurzen
- Department of Orthopedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Vincent T Janmaat
- Department of Orthopedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
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Pandey V, Bandi A, Madi S, Agarwal L, Acharya KKV, Maddukuri S, Sambhaji C, Willems WJ. Does application of moderately concentrated platelet-rich plasma improve clinical and structural outcome after arthroscopic repair of medium-sized to large rotator cuff tear? A randomized controlled trial. J Shoulder Elbow Surg 2016; 25:1312-22. [PMID: 27262412 DOI: 10.1016/j.jse.2016.01.036] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 01/13/2016] [Accepted: 01/22/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Platelet-rich plasma (PRP) has the potential to improve tendon-bone healing. The evidence is still controversial as to whether PRP application after repair of medium-sized to large cuff tears leads to superior structural and clinical outcome, especially after single-row repair. METHODS In a randomized study, 102 patients (PRP group, 52 patients; control group, 50 patients) with medium-sized and large degenerative posterosuperior tears were included for arthroscopic repair with a minimum follow-up of 2 years. Patients were evaluated with clinical scores (visual analog scale score, Constant-Murley score, University of California-Los Angeles score, and American Shoulder and Elbow Surgeons score) and ultrasound to assess retear and vascularity pattern of the cuff. RESULTS Visual analog scale scores were significantly lower in the PRP group than in controls at 1 month, 3 months, and 6 months but not later. Constant-Murley scores were significantly better in the PRP group compared with controls at 12 and 24 months, whereas University of California-Los Angeles scores were significantly higher in the PRP group at 6 and 12 months (P < .05). The American Shoulder and Elbow Surgeons score in both groups was comparable at all the times. At 24 months, retear in the PRP group (n = 2; 3.8%) was significantly lower than in the control group (n = 10; 20%; P = .01). The retear difference was significant only for large tears (PRP:control group, 1:6; P = .03). Doppler ultrasound examination showed significant vascularity in the PRP group repair site at 3 months postoperatively (P < .05) and in peribursal tissue until 12 months. CONCLUSION Application of moderately concentrated PRP improves clinical and structural outcome in large cuff tears. PRP also enhances vascularity around the repair site in the early phase.
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Affiliation(s)
- Vivek Pandey
- Department of Orthopaedics, Kasturba Medical College, Manipal, Karnataka, India.
| | - Atul Bandi
- Department of Orthopaedics, North DMC Medical College, New Delhi, India
| | - Sandesh Madi
- Department of Orthopaedics, Kasturba Medical College, Manipal, Karnataka, India
| | - Lipisha Agarwal
- Department of Orthopaedics, Kasturba Medical College, Manipal, Karnataka, India
| | - Kiran K V Acharya
- Department of Orthopaedics, Kasturba Medical College, Manipal, Karnataka, India
| | - Satish Maddukuri
- Department of Radio Diagnosis, Kasturba Medical College, Manipal, Karnataka, India
| | - Charudutt Sambhaji
- Department of Radio Diagnosis, Kasturba Medical College, Manipal, Karnataka, India
| | - W Jaap Willems
- Shoulder Unit, Lairesse Kliniek, Amsterdam, The Netherlands
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Hsu JE, Horneff JG, Gee AO. Immobilization After Rotator Cuff Repair: What Evidence Do We Have Now? Orthop Clin North Am 2016; 47:169-77. [PMID: 26614931 DOI: 10.1016/j.ocl.2015.08.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Recurrent tears after rotator cuff repair are common. Postoperative rehabilitation after rotator cuff repair is a modifiable factor controlled by the surgeon that can affect re-tear rates. Some surgeons prefer early mobilization after rotator cuff repair, whereas others prefer a period of immobilization to protect the repair site. The tendon-healing process incorporates biochemical and biomechanical responses to mechanical loading. Healing can be optimized with controlled loading. Complete load removal and chronic overload can be deleterious to the process. Several randomized clinical studies have also characterized the role of postoperative mobilization after rotator cuff repair.
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Affiliation(s)
- Jason E Hsu
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA 98195, USA
| | - John G Horneff
- Department of Orthopaedic Surgery, University of Pennsylvania, 2 Silverstein Pavilion, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Albert O Gee
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA 98195, USA.
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Dyment NA, Galloway JL. Regenerative biology of tendon: mechanisms for renewal and repair. ACTA ACUST UNITED AC 2015; 1:124-131. [PMID: 26389023 DOI: 10.1007/s40610-015-0021-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Understanding the molecular and cellular mechanisms underlying tissue turnover and repair are essential towards addressing pathologies in aging, injury and disease. Each tissue has distinct means of maintaining homeostasis and healing after injury. For some, resident stem cell populations mediate both of these processes. These stem cells, by definition, are self renewing and give rise to all the differentiated cells of that tissue. However, not all organs fit with this traditional stem cell model of regeneration, and some do not appear to harbor somatic stem or progenitor cells capable of multilineage in vivo reconstitution. Despite recent progress in tendon progenitor cell research, our current knowledge of the mechanisms regulating tendon cell homeostasis and injury response is limited. Understanding the role of resident tendon cell populations is of great importance for regenerative medicine based approaches to tendon injuries and disease. The goal of this review is to bring to light our current knowledge regarding tendon progenitor cells and their role in tissue maintenance and repair. We will focus on pressing questions in the field and the new tools, including model systems, available to address them.
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Affiliation(s)
- Nathaniel A Dyment
- Center for Regenerative Medicine and Skeletal Development, Department of Reconstructive Sciences, School of Dental Medicine, University of Connecticut Health Center
| | - Jenna L Galloway
- Center for Regenerative Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Harvard Stem Cell Institute
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New Developments in the Use of Biologics and Other Modalities in the Management of Lateral Epicondylitis. BIOMED RESEARCH INTERNATIONAL 2015; 2015:439309. [PMID: 26114106 PMCID: PMC4465648 DOI: 10.1155/2015/439309] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Revised: 05/11/2015] [Accepted: 05/12/2015] [Indexed: 12/26/2022]
Abstract
Lateral epicondylitis is a common source of elbow pain. Though it is often a self-limited condition, refractory lateral epicondylitis can lead to problems with activities of daily living and sometimes requires sick leave from work. Therefore prompt treatment is essential. Histopathologic studies have suggested that lateral epicondylitis is a tendinopathy, associated with apoptosis and autophagy, rather than a tendonitis associated with inflammation. Although corticosteroids have been used for short-term treatment, recent studies have suggested that they are not helpful and may even be harmful and delay healing in the treatment of lateral epicondylitis. Researchers have recently begun to investigate the use of biologics as potential treatment options for lateral epicondylitis. Autologous blood preparations including platelet rich plasma (PRP) and autologous whole blood injections (ABIs) have been proposed in order to deliver growth factors and other nutrients to the diseased tendon. Stem cell therapies have also been suggested as a method of improving tendon healing. This review discusses the current evidence for the use of PRP, ABI, and stem cell therapies for treatment of lateral epicondylitis. We also review the evidence for nonbiologic treatments including corticosteroids, prolotherapy, botulinum toxin A, and nitric oxide.
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Cao TV, Hicks MR, Standley PR. In vitro biomechanical strain regulation of fibroblast wound healing. J Osteopath Med 2014; 113:806-18. [PMID: 24174502 DOI: 10.7556/jaoa.2013.056] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
CONTEXT Strain-directed therapy such as vacuum compression and manual manipulative therapies are clinically effective, but their cellular and molecular mechanisms are not well understood. OBJECTIVE To determine the effects of modeled myofascial release (MFR) on fibroblast wound healing and to investigate the potential role of nitric oxide (NO) in mediating these responses. METHODS Using an in vitro scratch wound strain model, the authors investigated human fibroblast wound healing characteristics in response to injurious repetitive motion strain (RMS) and MFR. Secretion of NO was induced with interleukin-1β and sodium nitroprusside and inhibited with NO synthase inhibitor L-N(G)-monomethyl arginine citrate (L-NMMA) to determine the effects of NO on wound healing. Protein microarray was also performed to evaluate the expression of intracellular protein and activation of protein kinase G (PKG), extracellular signal-regulated kinase (ERK1/2), protein kinase C (PKC), and phosphoinositide 3-kinase (PI3K), the downstream effectors in the NO pathway. RESULTS Fibroblasts that received RMS resulted in reduced wound closure rates (vs nonstrain, P<.05), which are partially attenuated by a single dose of MFR. Interleukin-1β and exogenous NO did not appear to have an effect on nonstrained fibroblast wound healing. However, strained fibroblasts appeared to express increased sensitivity to NO. The authors also observed a 12.2% increase in NO secretion, an increase in PKG activation, and a downregulation of PKC and PI3K inhibitory domain in the combined strain group. CONCLUSION If clinically translatable, these data suggest that mechanical strain such as vacuum compression therapy and manual manipulative therapy may modify PKC and PI3K to sensitize fibroblasts to NO and improve wound healing by promoting cell proliferation and migration by means of PKC and PKG signaling.
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Affiliation(s)
- Thanh V Cao
- University of Arizona College of Medicine-Phoenix, HSEB, Room B558, 435 N 5th St, Phoenix, AZ 85004-2157.
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Lewis JS. Subacromial impingement syndrome: a musculoskeletal condition or a clinical illusion? PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/1743288x11y.0000000027] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Muslim K, Bazrgari B, Hendershot B, Toosizadeh N, Nussbaum MA, Madigan ML. Disturbance and recovery of trunk mechanical and neuromuscular behaviors following repeated static trunk flexion: influences of duration and duty cycle on creep-induced effects. APPLIED ERGONOMICS 2013; 44:643-651. [PMID: 23332771 DOI: 10.1016/j.apergo.2012.12.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 12/21/2012] [Accepted: 12/28/2012] [Indexed: 06/01/2023]
Abstract
Occupations involving frequent trunk flexion are associated with a higher incidence of low back pain. To investigate the effects of repeated static flexion on trunk behaviors, 12 participants completed six combinations of three static flexion durations (1, 2, and 4 min), and two flexion duty cycles (33% and 50%). Trunk mechanical and neuromuscular behaviors were obtained pre- and post-exposure and during recovery using sudden perturbations. A longer duration of static flexion and a higher duty cycle increased the magnitude of decrements in intrinsic stiffness. Increasing duty cycle caused larger decreases in reflexive muscle responses, and females had substantially larger decreases in reflexive responses following exposure. Patterns of recovery for intrinsic trunk stiffness and reflexive responses were consistent across conditions and genders, and none of these measures returned to pre-exposure values after 20 min of recovery. Reflexive responses may not provide a compensatory mechanism to offset decreases in intrinsic trunk stiffness following repetitive static trunk flexion. A prolonged recovery duration may lead to trunk instability and a higher risk of low back injury.
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Affiliation(s)
- Khoirul Muslim
- Industrial and Systems Engineering, Virginia Tech, Blacksburg, VA 24061, USA
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Abstract
For the past few decades, the repair of rotator cuff tears has evolved significantly with advances in arthroscopy techniques, suture anchors and instrumentation. From the biomechanical perspective, the focus in arthroscopic repair has been on increasing fixation strength and restoration of the footprint contact characteristics to provide early rehabilitation and improve healing. To accomplish these objectives, various repair strategies and construct configurations have been developed for rotator cuff repair with the understanding that many factors contribute to the structural integrity of the repaired construct. These include repaired rotator cuff tendon-footprint motion, increased tendon-footprint contact area and pressure, and tissue quality of tendon and bone. In addition, the healing response may be compromised by intrinsic factors such as decreased vascularity, hypoxia, and fibrocartilaginous changes or aforementioned extrinsic compression factors. Furthermore, it is well documented that torn rotator cuff muscles have a tendency to atrophy and become subject to fatty infiltration which may affect the longevity of the repair. Despite all the aforementioned factors, initial fixation strength is an essential consideration in optimizing rotator cuff repair. Therefore, numerous biomechanical studies have focused on elucidating the strongest devices, knots, and repair configurations to improve contact characteristics for rotator cuff repair. In this review, the biomechanical concepts behind current rotator cuff repair techniques will be reviewed and discussed.
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Affiliation(s)
- Thay Q Lee
- Orthopaedic Biomechanics Laboratory, Long Beach VA Healthcare System, Long Beach & Department of Orthopaedic Surgery, University of California, Irvine, CA 90822, USA.
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Reuther KE, Thomas SJ, Sarver JJ, Tucker JJ, Lee CS, Gray CF, Glaser DL, Soslowsky LJ. Effect of return to overuse activity following an isolated supraspinatus tendon tear on adjacent intact tendons and glenoid cartilage in a rat model. J Orthop Res 2013; 31:710-5. [PMID: 23280495 PMCID: PMC3641891 DOI: 10.1002/jor.22295] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 11/23/2012] [Indexed: 02/04/2023]
Abstract
Rotator cuff tears are common conditions that can alter shoulder mechanics and may lead to damage of intact joint tissues. These injuries are of particular concern in populations who perform tasks requiring repetitive overhead activity (e.g., athletes and laborers) and who are likely to return to aggressive pre-injury activity levels despite limited understanding of the potentially damaging effects on the remaining tissues. Therefore, we investigated the effect of returning to overuse activity following a supraspinatus tear on shoulder function and the mechanical properties of the remaining intact tendons and glenoid cartilage. Forty rats underwent 4 weeks of overuse activity to create a tendinopathic condition followed by detachment of the supraspinatus tendon and were then randomized into two groups: continued overuse or cage activity. Ambulatory measurements were performed throughout the 8 weeks prior to euthaniasia, and properties of the adjacent tendons and cartilage were evaluated. Results demonstrated that shoulder function was not compromised in the return to overuse group. However, alterations of the glenoid cartilage and biceps tendon properties occurred. Our results help define the contributory roles of common mechanical injury mechanisms and provide a framework by which physicians could better prescribe long-term treatment strategies for patients.
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Affiliation(s)
- Katherine E Reuther
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, 424 Stemmler Hall 36th Street and Hamilton Walk, Philadelphia, PA, USA
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Shoulder impingement revisited: evolution of diagnostic understanding in orthopedic surgery and physical therapy. Med Biol Eng Comput 2013; 52:211-9. [PMID: 23572144 DOI: 10.1007/s11517-013-1074-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 04/03/2013] [Indexed: 01/03/2023]
Abstract
"Impingement syndrome" is a common diagnostic label for patients presenting with shoulder pain. Historically, it was believed to be due to compression of the rotator cuff tendons beneath the acromion. It has become evident that "impingement syndrome" is not likely an isolated condition that can be easily diagnosed with clinical tests or most successfully treated surgically. Rather, it is likely a complex of conditions involving a combination of intrinsic and extrinsic factors. A mechanical impingement phenomenon as an etiologic mechanism of rotator cuff disease may be distinct from the broad diagnostic label of "impingement syndrome". Acknowledging the concepts of mechanical impingement and movement-related impairments may better suit the diagnostic and interventional continuum as they support the existence of potentially modifiable impairments within the conservative treatment paradigm. Therefore, it is advocated that the clinical diagnosis of "impingement syndrome" be eliminated as it is no more informative than the diagnosis of "anterior shoulder pain". While both terms are ambiguous, the latter is less likely to presume an anatomical tissue pathology that may be difficult to isolate either with a clinical examination or with diagnostic imaging and may prevent potentially inappropriate surgical interventions. We further recommend investigation of mechanical impingement and movement patterns as potential mechanisms for the development of shoulder pain, but clearly distinguished from a clinical diagnostic label of "impingement syndrome". For shoulder researchers, we recommend investigations of homogenous patient groups with accurately defined specific pathologies, or with subgrouping or classification based on specific movement deviations. Diagnostic labels based on the movement system may allow more effective subgrouping of patients to guide treatment strategies.
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The upper band of the subscapularis tendon in the rat has altered mechanical and histologic properties. J Shoulder Elbow Surg 2012; 21:1687-93. [PMID: 22484390 PMCID: PMC3393832 DOI: 10.1016/j.jse.2011.11.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Revised: 11/14/2011] [Accepted: 11/28/2011] [Indexed: 02/01/2023]
Abstract
BACKGROUND The subscapularis is an important mover and stabilizer of the glenohumeral joint. Since the advent of shoulder arthroscopy, partial tears are found in 43% of rotator cuff patients. While partial tears to the upper band occur more commonly, little is known about the structure and mechanical behavior of the individual bands. Therefore, the objective of this study was to measure tensile mechanical properties, corresponding collagen fiber alignment, and histology in the upper and lower bands of the rat subscapularis tendon. MATERIALS AND METHODS Thirty adult Sprague-Dawley rats were euthanized and subscapularis tendons dissected out for mechanical organization (n = 24) and histologic assessment (n = 6). Collagen organization was measured with a custom device during mechanical testing. RESULTS Linear-region modulus at the insertion site was significantly lower in the upper band compared to the lower band, while no differences were found at the midsubstance location. The upper band was found to be significantly less aligned and demonstrated a more rounded cell shape than the lower band at the insertion site. DISCUSSION This study demonstrated that the 2 bands of the subscapularis tendon have differential mechanical, organizational, and histological properties, which suggests a functional deficit exists to the upper band of the subscapularis and may be contributing to the prevalence of partial subscapularis tears. CONCLUSIONS Clinicians should be aware that the upper band of the subscapularis tendon may be at higher risk of developing tears, based on decreased mechanical properties and a more disorganized collagen fiber distribution.
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Walker H, Gabbe B, Wajswelner H, Blanch P, Bennell K. Shoulder pain in swimmers: A 12-month prospective cohort study of incidence and risk factors. Phys Ther Sport 2012; 13:243-9. [DOI: 10.1016/j.ptsp.2012.01.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Revised: 11/15/2011] [Accepted: 01/12/2012] [Indexed: 01/06/2023]
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Kietrys DM, Barr-Gillespie AE, Amin M, Wade CK, Popoff SN, Barbe MF. Aging contributes to inflammation in upper extremity tendons and declines in forelimb agility in a rat model of upper extremity overuse. PLoS One 2012; 7:e46954. [PMID: 23056540 PMCID: PMC3463562 DOI: 10.1371/journal.pone.0046954] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 09/10/2012] [Indexed: 01/08/2023] Open
Abstract
We sought to determine if tendon inflammatory and histopathological responses increase in aged rats compared to young rats performing a voluntary upper extremity repetitive task, and if these changes are associated with motor declines. Ninety-six female Sprague-Dawley rats were used in the rat model of upper extremity overuse: 67 aged and 29 young adult rats. After a training period of 4 weeks, task rats performed a voluntary high repetition low force (HRLF) handle-pulling task for 2 hrs/day, 3 days/wk for up to 12 weeks. Upper extremity motor function was assessed, as were inflammatory and histomorphological changes in flexor digitorum and supraspinatus tendons. The percentage of successful reaches improved in young adult HRLF rats, but not in aged HRLF rats. Forelimb agility decreased transiently in young adult HRLF rats, but persistently in aged HRLF rats. HRLF task performance for 12 weeks lead to increased IL-1beta and IL-6 in flexor digitorum tendons of aged HRLF rats, compared to aged normal control (NC) as well as young adult HRLF rats. In contrast, TNF-alpha increased more in flexor digitorum tendons of young adult 12-week HRLF rats than in aged HRLF rats. Vascularity and collagen fibril organization were not affected by task performance in flexor digitorum tendons of either age group, although cellularity increased in both. By week 12 of HRLF task performance, vascularity and cellularity increased in the supraspinatus tendons of only aged rats. The increased cellularity was due to increased macrophages and connective tissue growth factor (CTGF)-immunoreactive fibroblasts in the peritendon. In conclusion, aged rat tendons were overall more affected by the HRLF task than young adult tendons, particularly supraspinatus tendons. Greater inflammatory changes in aged HRLF rat tendons were observed, increases associated temporally with decreased forelimb agility and lack of improvement in task success.
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Affiliation(s)
- David M. Kietrys
- Department of Rehabilitation and Movement Sciences, University of Medicine and Dentistry of New Jersey, School of Health Related Professions, Stratford, New Jersey, United States of America
| | - Ann E. Barr-Gillespie
- College of Health Professions, Pacific University, Hillsboro, Oregon, United States of America
| | - Mamta Amin
- Department of Anatomy and Cell Biology, Temple University School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Christine K. Wade
- Department of Physical Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Steve N. Popoff
- Department of Anatomy and Cell Biology, Temple University School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Mary F. Barbe
- Department of Anatomy and Cell Biology, Temple University School of Medicine, Philadelphia, Pennsylvania, United States of America
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Bokhari AR, Murrell GAC. The role of nitric oxide in tendon healing. J Shoulder Elbow Surg 2012; 21:238-44. [PMID: 22244067 DOI: 10.1016/j.jse.2011.11.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 11/08/2011] [Accepted: 11/08/2011] [Indexed: 02/01/2023]
Abstract
Nitric oxide (NO) is a small free radical that is generated by a family of enzymes called the nitric oxide synthases (NOS). There are 3 isoforms of NOS: endothelial NOS (eNOS), brain or neuronal NOS (bNOS), and inducible NOS (iNOS). In experiments performed during the last 20 years, we have shown that NO is induced by all 3 isoforms of NOS after tendon injury and that NOS activity is upregulated in tendinopathy. In normal uninjured tendons, there is very little NOS activity. In injured rat and human tendons, NOS activity was found in healing fibroblasts in a temporal fashion. In animal models, competitive inhibition of NOS resulted in reduced tendon healing, whereas the addition of NO resulted in enhanced tendon healing. In cultured human cells, the addition of NO via chemical means and adenovirus transfection resulted in enhanced collagen synthesis. We performed 3 randomized, double-blinded clinical trials that demonstrated a significant positive beneficial effect of NO treatment on clinical symptoms and function in patients with Achilles tendinopathy, tennis elbow, and supraspinatus tendonitis. NO was delivered via glyceryl trinitrate (GTN) patches. We also conducted a 3-year prospective follow-up that demonstrated significant long-term efficacy of GTN patches in treating noninsertional Achilles tendinopathy. In a 5-year prospective comparison treating lateral epicondylitis, we found no additional benefits of GTN vs placebo at 5 years. The use of a new GTN patch, OrthoDerm, demonstrated no evidence for efficacy in treating chronic lateral epicondylitis.
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Affiliation(s)
- Ali R Bokhari
- Orthopaedic Research Institute, University of New South Wales, The St George Hospital, Sydney, NSW, Australia.
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