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Bono OJ, Jenkin B, Forlizzi J, Mousad A, Le Breton S, MacAskill M, Mandalia K, Mithoefer K, Ramappa A, Ross G, Shah SS. Evidence for Utilization of Injectable Biologic Augmentation in Primary Rotator Cuff Repair: A Systematic Review of Data From 2010 to 2022. Orthop J Sports Med 2023; 11:23259671221150037. [PMID: 36756167 PMCID: PMC9900676 DOI: 10.1177/23259671221150037] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/21/2022] [Indexed: 02/05/2023] Open
Abstract
Background Biologic healing after rotator cuff repair remains a significant challenge. Injectable biologic augmentation may improve tissue quality at the suture-tendon interface. Purpose To investigate the effect of injectable biologic supplementation in rotator cuff repair and to assess the quality and adherence to evolving reporting standards. Study Design Systematic review; Level of evidence, 3. Methods A systematic review was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Included were 40 studies: 29 preclinical (in vivo animal models) and 11 clinical. Each clinical study was assessed for quality, risk of bias, and adherence to relevant MIBO (Minimum Information for Studies Evaluating Biologics in Orthopaedics) guidelines. The outcomes of interest were reported load to failure, load to gap, gap size, and stiffness in the preclinical studies, and healing rate and any patient-reported outcome measures in the clinical studies. Results Injectables reported included growth factors (eg, transforming growth factor-beta 3, erythropoietin), bone marrow-derived mesenchymal stem cells and adipose-derived mesenchymal stem cells (ADSCs), and other agents such as platelet-rich plasma (PRP) and hyaluronic acid. The most common findings for preclinical injectables were increased load to failure (16/29 studies; 55.2%) and improved collagen histological quality (11/29 studies; 37.9%). All 11 clinical studies (10 PRP, 1 ADSC) indicated no adverse events, with similar or improved patient-reported outcomes compared with repairs in the control groups. In 1 study utilizing an innovative delivery technique, a concentrated PRP globule with fibrin matrix was shuttled over a suture to maintain concentrated PRP at the repair site and demonstrated a significant decrease in retears (P = .03) at a 31-month follow-up. A matched-cohort study investigating augmentation with ADSCs demonstrated a significantly lower retear rate in the ADSC-augmented group than the control group at a 28-month follow-up (P < .001). On average, the clinical studies adhered to 66% of relevant MIBO reporting guidelines and had a low risk of bias. Conclusion Approximately 83% of preclinical studies found a positive biomechanical or histological effect, with no studies showing an overall negative effect. Clinically, utilization of innovative delivery techniques may reduce the risk of arthroscopic washout of PRP and improve retear rates. ADSCs were shown to reduce retear rates at a 28-month follow-up.
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Affiliation(s)
- Olivia J. Bono
- Albany Medical College, Albany, New York, USA.,Olivia J. Bono, BA, Albany Medical College, 49 New Scotland
Avenue, Albany, NY 12208, USA (
)
| | - Bryan Jenkin
- Tufts University School of Medicine, Boston, Massachusetts,
USA
| | | | - Albert Mousad
- Tufts University School of Medicine, Boston, Massachusetts,
USA
| | | | | | | | - Kai Mithoefer
- New England Baptist Hospital, Boston, Massachusetts, USA
| | - Arun Ramappa
- Beth Israel Deaconess Medical Center, Boston, Massachusetts,
USA
| | - Glen Ross
- New England Baptist Hospital, Boston, Massachusetts, USA
| | - Sarav S. Shah
- New England Baptist Hospital, Boston, Massachusetts, USA
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Chen Y, Zhang T, Wan L, Wang Z, Li S, Hu J, Xu D, Lu H. Early treadmill running delays rotator cuff healing via Neuropeptide Y mediated inactivation of the Wnt/β-catenin signaling. J Orthop Translat 2021; 30:103-111. [PMID: 34722153 PMCID: PMC8517718 DOI: 10.1016/j.jot.2021.08.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 08/19/2021] [Accepted: 08/22/2021] [Indexed: 11/29/2022] Open
Abstract
Background Defining the optimal rehabilitation programs for rotator cuff healing remains a challenge. Early treadmill running may have negative effects on tendon-bone interface (TBI) healing with increased expression of Neuropeptide Y (NPY). However, the underlying mechanism is still unknown. Methods The mice were randomly assigned to four groups: control group, treadmill group, treadmill + BIBO3304 group and BIBO3304 group alone. Specifically, the control group was allowed free cage activity without any treatment after surgery. The treadmill group received early treadmill running initiated from postoperative day 2. The treadmill + BIBO3304 group received treadmill running combined with intra-articular injection of BIBO3304 postoperatively. The BIBO3304 group only received type 1 NPY receptor (Y1 receptor, Y1R) antagonist BIBO3304 postoperatively. Healing outcomes of the rotator cuff were evaluated by histological analysis, synchrotron radiation micro-computed tomography (SR-μCT) scanning, and biomechanical testing at 4 and 8 weeks after surgery. The expression of NPY and its Y1 receptor during the treadmill running were tested by immunofluorescence. In addition, the related signaling pathway of Neuropeptide Y among all groups was detected by immunohistochemistry and western-blot. Results Immunofluorescence results show that early treadmill training could lead to a significant increase in the expression of NPY at the healing site, and Y1R was widely expressed in both normal or injured rotator cuff without statistical difference. At the same time, early treadmill running delayed the healing of rotator cuff, as indicated with unsatisfactory outcomes, including a significantly lower histological score, decreased bone formation and inferior biomechanical properties at postoperative week 4 and 8. Moreover, the use of BIBO3304 could partly alleviate the negative effects of early treadmill running on the healing of rotator cuff and promote the natural healing process of rotator cuff, as evidenced by significant differences observed between the treadmill and treadmill + BIBO3304 groups, as well as observed between the control and BIBO3304 groups. On the other hand, the expressions of Wnt3a and β-catenin in the treadmill group were significantly lower compared with the other groups, while the expression in the BIBO3304 group was the highest, as evaluated by immunohistochemistry and western-blot. Conclusions Early treadmill running increased the expression of NPY at the RC healing site, which might burden the expression of Wnt3a/β-catenin and delay the healing process, inhibition of Y1 receptor with BIBO3304 could promote bone-tendon healing through the Wnt/β-catenin signaling. The translational potential of this article: This is the first study to evaluate the specific role of the NPY-Y1R axis and its underlying mechanism by which early treadmill running delays bone-tendon healing. Further, our study may provide references of precise and individualized exercise-based rehabilitation strategies for TBI healing in clinic. The translational potential of this article This is the first study to evaluate the specific role of the NPY-Y1R axis and its underlying mechanism by which early treadmill running delays bone-tendon healing. Further, our study may provide references of precise and individualized exercise-based rehabilitation strategies for TBI healing in clinic.
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Affiliation(s)
- Yang Chen
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, 410008, China.,Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, 410008, China
| | - Tao Zhang
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, 410008, China.,Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, 410008, China
| | - Liyang Wan
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, 410008, China.,Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, 410008, China
| | - Zhanwen Wang
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, 410008, China
| | - Shengcan Li
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, 410008, China.,Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, 410008, China
| | - Jianzhong Hu
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, 410008, China.,Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Daqi Xu
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, 410008, China.,Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, 410008, China
| | - Hongbin Lu
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, 410008, China.,Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, 410008, China
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3
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Chen P, Chen Z, Mitchell C, Gao J, Chen L, Wang A, Leys T, Landao-Bassonga E, Zheng Q, Wang T, Zheng M. Intramuscular injection of Botox causes tendon atrophy by induction of senescence of tendon-derived stem cells. Stem Cell Res Ther 2021; 12:38. [PMID: 33413592 PMCID: PMC7791643 DOI: 10.1186/s13287-020-02084-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/07/2020] [Indexed: 01/04/2023] Open
Abstract
Background Botulinum toxin (Botox) injection is in widespread clinical use for the treatment of muscle spasms and tendinopathy but the mechanism of action is poorly understood. Hypothesis We hypothesised that the reduction of patellar-tendon mechanical-loading following intra-muscular injection of Botox results in tendon atrophy that is at least in part mediated by the induction of senescence of tendon-derived stem cells (TDSCs). Study design Controlled laboratory study Methods A total of 36 mice were randomly divided into 2 groups (18 Botox-injected and 18 vehicle-only control). Mice were injected into the right vastus lateralis of quadriceps muscles either with Botox (to induce mechanical stress deprivation of the patellar tendon) or with normal saline as a control. At 2 weeks post-injection, animals were euthanized prior to tissues being harvested for either evaluation of tendon morphology or in vitro studies. TDSCs were isolated by cell-sorting prior to determination of viability, differentiation capacity or the presence of senescence markers, as well as assessing their response to mechanical loading in a bioreactor. Finally, to examine the mechanism of tendon atrophy in vitro, the PTEN/AKT-mediated cell senescence pathway was evaluated in TDSCs from both groups. Results Two weeks after Botox injection, patellar tendons displayed several atrophic features including tissue volume reduction, collagen fibre misalignment and increased degradation. A colony formation assay revealed a significantly reduced number of colony forming units of TDSCs in the Botox-injected group compared to controls. Multipotent differentiation capacities of TDSCs were also diminished after Botox injection. To examine if mechanically deprived TDSC are capable of forming tendon tissue, we used an isolated bioreactor system to culture tendon constructs using TDSC. These results showed that TDSCs from the Botox-treated group failed to restore tenogenic differentiation after appropriate mechanical loading. Examination of the signalling pathway revealed that injection of Botox into quadriceps muscles causes PTEN/AKT-mediated cell senescence of TDSCs. Conclusion Intramuscular injection of Botox interferes with tendon homeostasis by inducing tendon atrophy and senescence of TDSCs. Botox injection may have long-term adverse consequences for the treatment of tendinopathy. Clinical relevance Intramuscular Botox injection for tendinopathy or tendon injury could result in adverse effects in human tendons and evaluation of its long-term efficacy is warranted.
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Affiliation(s)
- Peilin Chen
- Center for Orthopaedic Translational Research, Medical School, University of Western Australia, Nedlands, Australia
| | - Ziming Chen
- Center for Orthopaedic Translational Research, Medical School, University of Western Australia, Nedlands, Australia
| | - Christopher Mitchell
- Center for Orthopaedic Translational Research, Medical School, University of Western Australia, Nedlands, Australia
| | - Junjie Gao
- Perron Institute for Neurological and Translational Science, Perth, Western Australia, Australia
| | - Lianzhi Chen
- Center for Orthopaedic Translational Research, Medical School, University of Western Australia, Nedlands, Australia
| | - Allan Wang
- Center for Orthopaedic Translational Research, Medical School, University of Western Australia, Nedlands, Australia.,Medical School, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Toby Leys
- Department of Orthopaedics, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Euphemie Landao-Bassonga
- Center for Orthopaedic Translational Research, Medical School, University of Western Australia, Nedlands, Australia.,Perron Institute for Neurological and Translational Science, Perth, Western Australia, Australia
| | - Qiujian Zheng
- Division of Orthopaedic Surgery, Department of Surgery, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, Guangdong, China.
| | - Tao Wang
- Center for Orthopaedic Translational Research, Medical School, University of Western Australia, Nedlands, Australia. .,Division of Orthopaedic Surgery, Department of Surgery, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, Guangdong, China.
| | - Minghao Zheng
- Center for Orthopaedic Translational Research, Medical School, University of Western Australia, Nedlands, Australia. .,Perron Institute for Neurological and Translational Science, Perth, Western Australia, Australia.
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Xu T, Bai J, Xu M, Yu B, Lin J, Guo X, Liu Y, Zhang D, Yan K, Hu D, Hao Y, Geng D. Relaxin inhibits patellar tendon healing in rats: a histological and biochemical evaluation. BMC Musculoskelet Disord 2019; 20:349. [PMID: 31351472 PMCID: PMC6661089 DOI: 10.1186/s12891-019-2729-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 07/18/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Female patients are more likely to have tendon injuries than males, especially those who has a higher concentration of relaxin. Previous studies have demonstrated that relaxin attenuates extracellular matrix (ECM) formation. However, the mechanism of relaxin on tendon repair remains unclear. We hypothesize that relaxin inhibits tendon healing by disrupting collagen synthesis. METHODS A patellar tendon window defect model was established using Sprague-Dawley rats. The center of the patellar tendon was removed from the patella distal apex and inserted to the tibia tuberosity in width of 1 mm. Then, the rats were injected with saline (0.2 μg/kg/day) or relaxin (0.2 μg/kg/day) for two and four weeks, which was followed by biomechanical analysis and histological and histochemical examination. RESULTS Mechanical results indicated that relaxin induces a significant decrease in tear resistance, stiffness, and Young's modulus compared to those rats without relaxin treatment. In addition, it was shown that relaxin activates relaxin family peptide receptor 1(RXFP1), disturbs the balance between matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteases (TIMPs), and reduces the deposition of collagen in injury areas. CONCLUSIONS Relaxin impairs tendon healing in rats. Also, relaxin might lead to tendon injury more commonly for females than males.
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Affiliation(s)
- Tianpeng Xu
- Orthopedics and Sports Medicine Center, The Affiliated Suzhou Hospital of Nanjing Medical University, 242, Guangji Road, Suzhou, 215006 People’s Republic of China
| | - Jiaxiang Bai
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 188, shi zi Road, Suzhou, 215006 People’s Republic of China
| | - Menglei Xu
- Orthopedics and Sports Medicine Center, The Affiliated Suzhou Hospital of Nanjing Medical University, 242, Guangji Road, Suzhou, 215006 People’s Republic of China
| | - Binqing Yu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 188, shi zi Road, Suzhou, 215006 People’s Republic of China
| | - Jiayi Lin
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 188, shi zi Road, Suzhou, 215006 People’s Republic of China
| | - Xiaobin Guo
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 188, shi zi Road, Suzhou, 215006 People’s Republic of China
| | - Yu Liu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 188, shi zi Road, Suzhou, 215006 People’s Republic of China
| | - Di Zhang
- Orthopedics and Sports Medicine Center, The Affiliated Suzhou Hospital of Nanjing Medical University, 242, Guangji Road, Suzhou, 215006 People’s Republic of China
| | - Kai Yan
- Orthopedics and Sports Medicine Center, The Affiliated Suzhou Hospital of Nanjing Medical University, 242, Guangji Road, Suzhou, 215006 People’s Republic of China
| | - Dan Hu
- Orthopedics and Sports Medicine Center, The Affiliated Suzhou Hospital of Nanjing Medical University, 242, Guangji Road, Suzhou, 215006 People’s Republic of China
| | - Yuefeng Hao
- Orthopedics and Sports Medicine Center, The Affiliated Suzhou Hospital of Nanjing Medical University, 242, Guangji Road, Suzhou, 215006 People’s Republic of China
| | - Dechun Geng
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, 188, shi zi Road, Suzhou, 215006 People’s Republic of China
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5
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Güleçyüz MF, Macha K, Pietschmann MF, Ficklscherer A, Sievers B, Roßbach BP, Jansson V, Müller PE. Allogenic Myocytes and Mesenchymal Stem Cells Partially Improve Fatty Rotator Cuff Degeneration in a Rat Model. Stem Cell Rev Rep 2019; 14:847-859. [PMID: 29855989 DOI: 10.1007/s12015-018-9829-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE Rotator cuff (RC) tears result not only in functional impairment but also in RC muscle atrophy, muscle fattening and eventually to muscle fibrosis. We hypothesized that allogenic bone marrow derived mesenchymal stem cells (MSC) and myocytes can be utilized to improve the rotator cuff muscle fattening and increase the atrophied muscle mass in a rat model. METHODS The right supraspinatus (SSP) tendons of 105 inbred rats were detached and muscle fattening was provoked over 4 weeks; the left side remained untouched (control group). The animals (n = 25) of the output group were euthanized after 4 weeks for reference purposes. The SSP-tendon of one group (n = 16) was left unoperated to heal spontaneously. The SSP-tendons of the remaining 64 rats (4 groups with n = 16) were repaired with transosseous sutures. One group received a saline solution injection in the SSP muscle belly, two other groups received 5 × 106 allogenic myocytes and 5 × 106 allogenic MSC injections from donor rats, respectively, and one group received no additional treatment. After 4 weeks of healing, the supraspinatus muscle mass was compared quantitatively and histologically to all the treated groups and to the untreated contralateral side. RESULTS In the end of the experiments at week 8, the myocyte and MCS treated groups showed a significantly higher muscle mass with 0.2322 g and 0.2257 g, respectively, in comparison to the output group (0.1911 g) at week 4 with p < 0.05. There was no statistical difference between the repaired, treated, or spontaneous healing groups at week 8. Supraspinatus muscle mass of all experimental groups of the right side was significantly lower compared to the untreated contralateral muscle mass. CONCLUSION This defect model shows that the injection of allogenic mycocytes and MSC in fatty infiltrated SSP muscles is better than no treatment and can partially improve the SSP muscle belly fattening. Nevertheless, a full restoration of the degenerated and fattened rotator cuff muscle to its original condition is not possible using myocytes and MSC in this model.
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Affiliation(s)
- Mehmet F Güleçyüz
- Department of Orthopaedics, Physical Medicine and Rehabilitation, Medical Center of the University of Munich (Ludwig-Maximilians-University), Marchioninistrasse 15, 81377, Munich, Germany.
| | - Konstanze Macha
- Department of Orthopaedics and Traumatology, Klinikum Landsberg am Lech, Bgm.-Dr.-Hartmann-Straße 50, 86899, Landsberg am Lech, Germany
| | - Matthias F Pietschmann
- Department of Orthopaedics, Physical Medicine and Rehabilitation, Medical Center of the University of Munich (Ludwig-Maximilians-University), Marchioninistrasse 15, 81377, Munich, Germany
| | | | - Birte Sievers
- Numares AG, Am Biopark 9, 93053, Regensburg, Germany
| | - Björn P Roßbach
- Department of Orthopaedics and Traumatology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Germany
| | - Volkmar Jansson
- Department of Orthopaedics, Physical Medicine and Rehabilitation, Medical Center of the University of Munich (Ludwig-Maximilians-University), Marchioninistrasse 15, 81377, Munich, Germany
| | - Peter E Müller
- Department of Orthopaedics, Physical Medicine and Rehabilitation, Medical Center of the University of Munich (Ludwig-Maximilians-University), Marchioninistrasse 15, 81377, Munich, Germany
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6
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Deymier AC, Schwartz AG, Cai Z, Daulton TL, Pasteris JD, Genin GM, Thomopoulos S. The multiscale structural and mechanical effects of mouse supraspinatus muscle unloading on the mature enthesis. Acta Biomater 2019; 83:302-313. [PMID: 30342287 DOI: 10.1016/j.actbio.2018.10.024] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 10/04/2018] [Accepted: 10/15/2018] [Indexed: 12/17/2022]
Abstract
The musculoskeletal system is sensitive to its loading environment; this is of particular concern under conditions such as disuse, paralysis, and extended-duration space flight. Although structural and mechanical changes to tendon and bone following paralysis and disuse are well understood, there is a pressing need to understand how this unloading affects the bone-tendon interface (enthesis); the location most prone to tears and injury. We therefore elucidated these effects of unloading in the entheses of adult mice shoulders that were paralyzed for 21 days by treatment with botulinum toxin A. Unloading significantly increased the extent of mechanical failure and was associated with structural changes across hierarchical scales. At the millimeter scale, unloading caused bone loss. At the micrometer scale, unloading decreased bioapatite crystal size and crystallographic alignment in the enthesis. At the nanometer scale, unloading induced compositional changes that stiffened the bioapatite/collagen composite tissue. Mathematical modeling and mechanical testing indicated that these factors combined to increase local elevations of stress while decreasing the ability of the tissue to absorb energy prior to failure, thereby increasing injury risk. These first observations of the multiscale effects of unloading on the adult enthesis provide new insight into the hierarchical features of structure and composition that endow the enthesis with increased resistance to failure. STATEMENT OF SIGNIFICANCE: The musculoskeletal system is sensitive to its loading environment; this is of particular concern under conditions such as disuse, paralysis, and extended-duration space flight. Although changes to tendon and bone following paralysis are understood, there is a pressing need to clarify how unloading affects the bone-tendon interface (enthesis), which is the location most prone to tears and injury. We elucidated the effects of enthesis unloading in adult mice shoulders showing, for the first time, that unloading significantly increased the risk and extent of mechanical failure and was associated with structural changes across hierarchical scales. These observations provide new insight into the hierarchical features of structure and composition that endow the enthesis with resilience. This knowledge can be used to develop more targeted treatments to improve mobility and function.
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Affiliation(s)
- Alix C Deymier
- Department of Biomedical Engineering, University of Connecticut, Farmington, CT, USA.
| | - Andrea G Schwartz
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA.
| | - Zhounghou Cai
- Advanced Photon Source, Argonne National Lab, Argonne, IL, USA.
| | - Tyrone L Daulton
- Department of Physics, Washington University, St. Louis, MO, USA; Institute of Materials Science and Engineering, Washington University, St. Louis, MO, USA.
| | - Jill D Pasteris
- Department of Earth and Planetary Science, Washington University, St. Louis, MO, USA.
| | - Guy M Genin
- Department of Mechanical Engineering and Materials Science, Washington University, St. Louis, MO, USA.
| | - Stavros Thomopoulos
- Department of Orthopedic Surgery, Columbia University, New York, NY, USA; Department of Biomedical Engineering, Columbia University, New York, NY, USA.
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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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No Functional Difference Between Three and Six Weeks of Immobilization After Arthroscopic Rotator Cuff Repair: A Prospective Randomized Controlled Non-Inferiority Trial. Arthroscopy 2018; 34:2765-2774. [PMID: 30195953 DOI: 10.1016/j.arthro.2018.05.036] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 05/15/2018] [Accepted: 05/15/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this study was to compare clinical and radiologic results among patients with 3 versus 6 weeks of immobilization after arthroscopic rotator cuff (RC) repair in a prospective randomized controlled non-inferiority trial. METHODS One hundred twenty patients were included after RC surgery for a small- to medium-sized tear of supraspinatus and upper infraspinatus tendons. Group A was immobilized in a simple sling for 3 weeks, and group B had a brace with a small abduction pillow with the arm in neutral position for 6 weeks. All patients started active range of motion when they removed the sling/brace. One hundred eighteen (98%) patients were assessed at 1-year follow-up. They underwent magnetic resonance imaging (MRI) of the shoulder, filled out the Western Ontario Rotator Cuff (WORC) index, and were evaluated with a Constant Murley (CM) score. RESULTS Statistical non-inferiority was demonstrated for the 2 groups on the basis of the WORC index, the primary endpoint at 1 year. The objective for the non-inferiority test was to determine whether the expected mean WORC index for group A was at most 13% worse than standard treatment (Group B). The WORC index at 1 year was similar in both groups, with mean percent scores of 83% in group A and 87% in group B (mean difference = -4; 95% one-sided CI -9, -4). Age-adjusted CM scores were also similar, with means of 86 in group A and 90 in group B (mean difference = -4; 95% CI -13, 5; P = .37). MRI after 1 year showed 50 (89%) patients in each group with healed RC repair. Four patients in group A had complications: 1 acute postoperative infection, 2 cases of postoperative capsulitis treated with corticosteroid injections, and 1 repeat operation because of a loose anchor and subacromial pain. No patients in group B had complications. CONCLUSION RC repair resulted in improved postoperative shoulder function, regardless of whether the shoulder was immobilized for 3 or 6 weeks. Three weeks of postoperative immobilization with sling use was non-inferior to the commonly used regimen involving 6 weeks of immobilization in a brace with regard to the WORC index at 12 months' follow-up. MRI indicated similar degrees of healing between the groups. Based on these findings, it is safe to immobilize patients in a simple sling for 3 to 6 weeks after repair of small to medium RC tears. LEVEL OF EVIDENCE Level I, high-quality randomized controlled trial with statistically significant differences.
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9
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Hashimoto E, Ochiai N, Kenmoku T, Sasaki Y, Yamaguchi T, Kijima T, Sasaki Y, Ohtori S, Takahashi K. Macroscopic and histologic evaluation of a rat model of chronic rotator cuff tear. J Shoulder Elbow Surg 2016; 25:2025-2033. [PMID: 27424252 DOI: 10.1016/j.jse.2016.04.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 04/24/2016] [Accepted: 04/25/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND The major cause of rotator cuff tears in humans is thought to be tendon degeneration. Although some studies have reported chronic rotator cuff tear models in animals, few studies of chronic rat models have demonstrated persistent defects for a relatively long time. The purpose of this study was to establish a chronic rotator cuff tear model in the rat and to evaluate the model macroscopically and histologically. METHODS Sixty Sprague Dawley rats were divided into 2 groups: tendon detachment only (tear group) and tendon detachment plus figure resin (chronic group). The contralateral shoulder served as a sham-operated control (sham group). In the tear group, the supraspinatus and infraspinatus tendons were completely detached. In addition to cuff detachment, figure resin was placed on the greater tuberosity to prevent cuff reattachment and scar formation in the chronic group. Macroscopic and histologic changes were assessed at 4 and 12 weeks after surgery. RESULTS A full-thickness cuff defect was observed in all chronic-group rats at both 4 and 12 weeks after surgery, and it could be repaired secondarily by traction in lower tension. However, no cuff defects were observed in the tear group because of obvious scar tissue formation. On histologic evaluation, progressive tendon degeneration, muscle atrophy, and fatty infiltration were observed in the chronic model at 12 weeks after surgery. CONCLUSION We established a rat model of chronic rotator cuff tears using figure resin. This chronic rotator cuff tear model might be useful for further clinical investigations of rotator cuff repair.
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Affiliation(s)
- Eiko Hashimoto
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
| | - Nobuyasu Ochiai
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tomonori Kenmoku
- Department of Orthopedic Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Yu Sasaki
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takeshi Yamaguchi
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takehiro Kijima
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yasuhito Sasaki
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Seiji Ohtori
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kazuhisa Takahashi
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
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