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Fox AJS, Fox OJK, Schär MO, Chaudhury S, Warren RF, Rodeo SA. The glenohumeral ligaments: Superior, middle, and inferior: Anatomy, biomechanics, injury, and diagnosis. Clin Anat 2021; 34:283-296. [PMID: 33386636 DOI: 10.1002/ca.23717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 12/13/2020] [Accepted: 12/20/2020] [Indexed: 01/03/2023]
Abstract
The three glenohumeral ligaments (superior, middle, and inferior) are discrete thickenings of the glenohumeral joint capsule and are critical to shoulder stability and function. Injuries to this area are a cause of significant musculoskeletal morbidity. A literature search was performed by a review of PubMed, Google Scholar, and OVID for all relevant articles published up until 2020. This study highlights the anatomy, biomechanical function, and injury patterns of the glenohumeral ligaments, which may be relevant to clinical presentation and diagnosis. A detailed understanding of the normal anatomy and biomechanics is a necessary prerequisite to understanding the injury patterns and clinical presentations of disorders involving the glenohumeral ligaments of the shoulder.
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Affiliation(s)
- Alice J S Fox
- Hawkesbury District Health Service, Windsor, New South Wales, Australia
| | - Olivia J K Fox
- University of Notre Dame Australia, Darlinghurst, New South Wales, Australia
| | - Michael O Schär
- Department of Orthopaedic Surgery and Traumatology, University of Bern, Switzerland
| | - Salma Chaudhury
- Department of Orthopaedic Surgery, University of Oxford, Oxford, UK
| | - Russell F Warren
- Department of Orthopaedic Surgery and Sports Medicine, Hospital for Special Surgery, New York, New York, USA
| | - Scott A Rodeo
- Department of Orthopaedic Surgery and Sports Medicine, Hospital for Special Surgery, New York, New York, USA
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Fox AJS, Schär MO, Wanivenhaus F, Chen T, Attia E, Binder NB, Otero M, Gilbert SL, Nguyen JT, Chaudhury S, Warren RF, Rodeo SA. Fluoroquinolones impair tendon healing in a rat rotator cuff repair model: a preliminary study. Am J Sports Med 2014; 42:2851-9. [PMID: 25143490 DOI: 10.1177/0363546514545858] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Recent studies suggest that fluoroquinolone antibiotics predispose tendons to tendinopathy and/or rupture. However, no investigations on the reparative capacity of tendons exposed to fluoroquinolones have been conducted. HYPOTHESIS Fluoroquinolone-treated animals will have inferior biochemical, histological, and biomechanical properties at the healing tendon-bone enthesis compared with controls. STUDY DESIGN Controlled laboratory study. METHODS Ninety-two rats underwent rotator cuff repair and were randomly assigned to 1 of 4 groups: (1) preoperative (Preop), whereby animals received fleroxacin for 1 week preoperatively; (2) pre- and postoperative (Pre/Postop), whereby animals received fleroxacin for 1 week preoperatively and for 2 weeks postoperatively; (3) postoperative (Postop), whereby animals received fleroxacin for 2 weeks postoperatively; and (4) control, whereby animals received vehicle for 1 week preoperatively and for 2 weeks postoperatively. Rats were euthanized at 2 weeks postoperatively for biochemical, histological, and biomechanical analysis. All data were expressed as mean ± standard error of the mean (SEM). Statistical comparisons were performed using either 1-way or 2-way ANOVA, with P < .05 considered significant. RESULTS Reverse transcriptase quantitative polymerase chain reaction (RTqPCR) analysis revealed a 30-fold increase in expression of matrix metalloproteinase (MMP)-3, a 7-fold increase in MMP-13, and a 4-fold increase in tissue inhibitor of metalloproteinases (TIMP)-1 in the Pre/Postop group compared with the other groups. The appearance of the healing enthesis in all treated animals was qualitatively different than that in controls. The tendons were friable and atrophic. All 3 treated groups showed significantly less fibrocartilage and poorly organized collagen at the healing enthesis compared with control animals. There was a significant difference in the mode of failure, with treated animals demonstrating an intrasubstance failure of the supraspinatus tendon during testing. In contrast, only 1 of 10 control samples failed within the tendon substance. The healing enthesis of the Pre/Postop group displayed significantly reduced ultimate load to failure compared with the Preop, Postop, and control groups. There was no significant difference in load to failure in the Preop group compared with the Postop group. Pre/Postop animals demonstrated significantly reduced cross-sectional area compared with the Postop and control groups. There was also a significant reduction in area between the Preop and control groups. CONCLUSION In this preliminary study, fluoroquinolone treatment negatively influenced tendon healing. CLINICAL RELEVANCE These findings indicate that there was an active but inadequate repair response that has potential clinical implications for patients who are exposed to fluoroquinolones before tendon repair surgery.
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Affiliation(s)
- Alice J S Fox
- Laboratory for Soft Tissue Research, Hospital for Special Surgery, New York, New York, USA
| | - Michael O Schär
- Laboratory for Soft Tissue Research, Hospital for Special Surgery, New York, New York, USA
| | - Florian Wanivenhaus
- Laboratory for Soft Tissue Research, Hospital for Special Surgery, New York, New York, USA
| | - Tony Chen
- Laboratory for Soft Tissue Research, Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | - Erik Attia
- Laboratory for Soft Tissue Research, Hospital for Special Surgery, New York, New York, USA
| | - Nikolaus B Binder
- Laboratory for Soft Tissue Research, Hospital for Special Surgery, New York, New York, USA
| | - Miguel Otero
- Laboratory for Soft Tissue Research, Hospital for Special Surgery, New York, New York, USA
| | - Susannah L Gilbert
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | - Joseph T Nguyen
- Healthcare Research Institute, Hospital for Special Surgery, New York, New York, USA
| | - Salma Chaudhury
- Laboratory for Soft Tissue Research, Hospital for Special Surgery, New York, New York, USA
| | - Russell F Warren
- Laboratory for Soft Tissue Research, Hospital for Special Surgery, New York, New York, USA
| | - Scott A Rodeo
- Laboratory for Soft Tissue Research, Hospital for Special Surgery, New York, New York, USA
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Fox AJS, Wanivenhaus F, Burge AJ, Warren RF, Rodeo SA. The human meniscus: a review of anatomy, function, injury, and advances in treatment. Clin Anat 2014; 28:269-87. [PMID: 25125315 DOI: 10.1002/ca.22456] [Citation(s) in RCA: 224] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 07/23/2014] [Indexed: 12/22/2022]
Abstract
Meniscal injuries are recognized as a cause of significant musculoskeletal morbidity. The menisci are vital for the normal function and long-term health of the knee joint. The purpose of this review is to provide current knowledge regarding the anatomy and biomechanical functions of the menisci, incidence, injury patterns and the advancements in treatment options of meniscal injury. A literature search was performed by a review of PubMed, Google Scholar, MEDLINE, and OVID for all relevant articles published between 1897 and 2014. This study highlights the anatomical and biomechanical characteristics of the menisci, which may be relevant to injury patterns and treatment options. An understanding of the normal anatomy and biomechanical functions of the knee menisci is a necessary prerequisite to understanding pathologies associated with the knee.
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Affiliation(s)
- Alice J S Fox
- Laboratory for Soft Tissue Research, Hospital for Special Surgery, 535 East 70th Street, New York, New York
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Abstract
Context: Competitive swimmers are predisposed to musculoskeletal injuries of the upper limb, knee, and spine. This review discusses the epidemiology of these injuries, in addition to prevention strategies that may assist the physician in formulating rehabilitation programs for the swimmer following an injury. Evidence Acquisition: A literature search was performed by a review of Google Scholar, OVID, and PubMed articles published from 1972 to 2011. Results: This study highlights the epidemiology of injuries common to competitive swimmers and provides prevention strategies for the sports health professional. Conclusions: An understanding of swimming biomechanics and typical injuries in swimming aids in early recognition of injury, initiation of treatment, and design of optimal prevention and rehabilitation strategies.
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Affiliation(s)
- Florian Wanivenhaus
- Laboratory for Soft Tissue Research, Hospital for Special Surgery, New York, New York
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Abstract
CONTEXT Information regarding the structure, composition, and function of the knee menisci has been scattered across multiple sources and fields. This review contains a concise, detailed description of the knee menisci-including anatomy, etymology, phylogeny, ultrastructure and biochemistry, vascular anatomy and neuroanatomy, biomechanical function, maturation and aging, and imaging modalities. EVIDENCE ACQUISITION A literature search was performed by a review of PubMed and OVID articles published from 1858 to 2011. RESULTS This study highlights the structural, compositional, and functional characteristics of the menisci, which may be relevant to clinical presentations, diagnosis, and surgical repairs. CONCLUSIONS An understanding of the normal anatomy and biomechanics of the menisci is a necessary prerequisite to understanding the pathogenesis of disorders involving the knee.
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Affiliation(s)
| | - Asheesh Bedi
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
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Abstract
The patella is the largest sesamoid bone in the body. The patellofemoral joint provides an integral articulating component of the extensor mechanism of the knee joint. A detailed description of patella anatomy, embryology and development, neurovascular anatomy, biomechanical function, and imaging modalities is provided in this article. Common patellar pathologies such as patellar instability, trochlear dysplasia, patella alta and baja, and patellofemoral joint arthritis as well as patellofemoral arthroplasty as a treatment option are also discussed. An understanding of the normal anatomy and biomechanics of the patella is a necessary prerequisite for understanding the pathogenesis of disorders involving the knee.
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Affiliation(s)
- Alice J S Fox
- Laboratory for Soft Tissue Research, Hospital for Special Surgery, New York, New York 10021, USA.
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Fox AJS, Bedi A, Wanivenhaus F, Sculco TP, Fox JS. Femoral neuropathy following total hip arthroplasty: review and management guidelines. Acta Orthop Belg 2012; 78:145-151. [PMID: 22696981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Femoral neuropathy following primary or revision total hip arthroplasty (THA) is a rare but acknowledged complication. Treatment of femoral neuropathy has long been debated and there is a paucity of accepted principles on which to base management. Currently, no definitive management protocol exists in the literature. A literature search was performed by a review of PubMed, Google Scholar and OVID articles published from 1972-2011. The literature reports an incidence rate of femoral neuropathy following THA ranging from 0.1 to 2.4 percent. Determining the precise aetiology, establishing a diagnosis and subsequent treatment of femoral nerve injury remains a difficult task, with conservative management remaining the treatment benchmark. In this review, we aim to summarise the aetiologies and risk factors associated with femoral neuropathy following THA and provide management guidelines.
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Affiliation(s)
- Alice J S Fox
- Laboratory for Soft Tissue Research, Hospital for Special Surgery, New York City, NY 10021, USA.
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Bedi A, Kelly N, Baad M, Fox AJS, Ma Y, Warren RF, Maher SA. Dynamic contact mechanics of radial tears of the lateral meniscus: implications for treatment. Arthroscopy 2012; 28:372-81. [PMID: 22074620 DOI: 10.1016/j.arthro.2011.08.287] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 08/03/2011] [Accepted: 08/03/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE To characterize the effect of radial tears (RTs) of the lateral meniscus and their subsequent treatment (inside-out repair, partial meniscectomy) on joint contact mechanics during simulated gait. METHODS Six human cadaveric knees were mounted on a simulator programmed to mimic human gait. A sensor was inserted below the lateral meniscus to measure peak joint contact pressure location, magnitude, and contact area. The following conditions were compared: intact meniscus, 30% RT (at the popliteal hiatus), 60% RT, 90% RT, repair, and partial meniscectomy. Data were analyzed in the midstance phase of gait (14% and 45%) when axial force was at its highest (2,100 N). RESULTS Intact knees had peak contact pressures of 5.9 ± 0.9 MPa and 6.4 ± 1.1 MPa at 14% and 45% of gait, respectively. RTs of up to and including 60% had no effect on pressure magnitude or location. RTs of 90% resulted in significantly increased peak pressure (8.4 ± 1.1 MPa) in the postero-peripheral aspect of the tibial plateau and reduced contact area versus the intact knee, at 45% of gait. Repair resulted in a significant decrease in peak pressure (7.7 ± 1.0 MPa) relative to 90% RT but had no effect on contact area. Partial lateral meniscectomy resulted in areas and pressures that were not significantly different from 90% tears (8.7 ± 1.5 MPa). CONCLUSIONS Simulated large RTs of the lateral meniscus in the region of the popliteal hiatus show unfavorable dynamic contact mechanics that are not significantly different from those resulting from a partial lateral meniscectomy. Pressure was significantly reduced with inside-out repair but was not affected by partial meniscectomy; contact area was not restored to that of the intact condition for either procedure. CLINICAL RELEVANCE Large RTs in the region of the popliteal hiatus show unfavorable dynamic contact mechanics.
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Affiliation(s)
- Asheesh Bedi
- MedSport, University of Michigan, Ann Arbor, Michigan 48106, USA.
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Fox AJS, Bedi A, Deng XH, Ying L, Harris PE, Warren RF, Rodeo SA. Diabetes mellitus alters the mechanical properties of the native tendon in an experimental rat model. J Orthop Res 2011; 29:880-5. [PMID: 21246619 PMCID: PMC5243138 DOI: 10.1002/jor.21327] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Accepted: 11/09/2010] [Indexed: 02/04/2023]
Abstract
The purpose of this study was to determine the effect of the diabetic phenotype on the mechanical properties of the native patellar tendon and its enthesis. Diabetes was induced via intraperitoneal injection of streptozotocin in Lewis rats. Control (n = 18) and diabetic animals (n = 20) were killed at 12 and 19 days for analysis. Statistical comparisons were performed using Student's t-tests and a two-tailed Fisher test with significance set at p < 0.05. Pre- and post-injection intraperitoneal glucose tolerance tests demonstrated significant impairment of glycemic control in the diabetic compared to control animals (p = 0.001). Mean serum hemoglobin A1c levels at 19 days was 10.6 ± 2.7% and 6.0 ± 1.0% for the diabetic and control groups, respectively (p = 0.0001). Fifteen of sixteen diabetic animals demonstrated intrasubstance failure of the patellar tendon, while only 7 of 14 control specimens failed within the tendon substance. The Young's modulus of the diabetic tendon was significantly lower than control specimens by 19 days post-induction (161 ± 10 N m(-2) compared to 200 ± 46 N m(-2) , respectively) (p = 0.02). The metabolic condition of poorly controlled diabetes negatively affects the mechanical properties of the native patellar tendon. These altered structural properties may predispose diabetic patients to a greater risk of tendinopathy and/or traumatic rupture.
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Affiliation(s)
- Alice J. S. Fox
- Laboratory for Soft Tissue Research, Hospital for Special Surgery, 535 East 70th Street, New York, New York 10021
| | - Asheesh Bedi
- Laboratory for Soft Tissue Research, Hospital for Special Surgery, 535 East 70th Street, New York, New York 10021,Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, 10021
| | - Xiang-Hua Deng
- Laboratory for Soft Tissue Research, Hospital for Special Surgery, 535 East 70th Street, New York, New York 10021
| | - Liang Ying
- Laboratory for Soft Tissue Research, Hospital for Special Surgery, 535 East 70th Street, New York, New York 10021
| | - Paul E. Harris
- Columbia University, Black Building 20-06, 650 West 168th Street, New York, New York 10032
| | - Russell F. Warren
- Laboratory for Soft Tissue Research, Hospital for Special Surgery, 535 East 70th Street, New York, New York 10021,Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, 10021
| | - Scott A. Rodeo
- Laboratory for Soft Tissue Research, Hospital for Special Surgery, 535 East 70th Street, New York, New York 10021,Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, 10021
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Bedi A, Kelly NH, Baad M, Fox AJS, Brophy RH, Warren RF, Maher SA. Dynamic contact mechanics of the medial meniscus as a function of radial tear, repair, and partial meniscectomy. J Bone Joint Surg Am 2010; 92:1398-408. [PMID: 20516315 DOI: 10.2106/jbjs.i.00539] [Citation(s) in RCA: 208] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The menisci are integral to normal knee function. The purpose of this study was to measure the contact pressures transmitted to the medial tibial plateau under physiological loads as a function of the percentage of the meniscus involved by the radial tear or repair. Our hypotheses were that (1) there is a threshold size of radial tears above which contact mechanics are adversely affected, and (2) partial meniscectomy results in increased contact pressure compared with that found after meniscal repair. METHODS A knee simulator was used to apply physiological multidirectional dynamic gait loads across human cadaver knees. A sensor inserted below the medial meniscus recorded contact pressures in association with (1) an intact meniscus, (2) a radial tear involving 30% of the meniscal rim width, (3) a radial tear involving 60% of the width, (4) a radial tear involving 90% of the width, (5) an inside-out repair with horizontal mattress sutures, and (6) a partial meniscectomy. The effects of these different types of meniscal manipulation on the magnitude and location of the peak contact pressure were assessed at 14% and 45% of the gait cycle. RESULTS The peak tibial contact pressure in the intact knees was 6 +/- 0.5 MPa and 7.4 +/- 0.6 MPa at 14% and 45% of the gait cycle, respectively. The magnitude and location of the peak contact pressure were not affected by radial tears involving up to 60% of the meniscal rim width. Radial tears involving 90% resulted in a posterocentral shift in peak-pressure location manifested by an increase in pressure in that quadrant of 1.3 +/- 0.5 MPa at 14% of the gait cycle relative to the intact condition. Inside-out mattress suture repair of a 90% tear did not restore the location of the pressure peak to that of the intact knee. Partial meniscectomy led to a further increase in contact pressure in the posterocentral quadrant of 1.4 +/- 0.7 MPa at 14% of the gait cycle. CONCLUSIONS Large radial tears of the medial meniscus are not functionally equivalent to meniscectomies; the residual meniscus continues to provide some load transmission and distribution functions across the joint.
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Affiliation(s)
- Asheesh Bedi
- Sports Medicine and Shoulder Service, The Hospital for Special Surgery, New York, NY 10021, USA
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Bedi A, Fox AJS, Kovacevic D, Deng XH, Warren RF, Rodeo SA. Doxycycline-mediated inhibition of matrix metalloproteinases improves healing after rotator cuff repair. Am J Sports Med 2010; 38:308-17. [PMID: 19826139 DOI: 10.1177/0363546509347366] [Citation(s) in RCA: 118] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Recent studies demonstrate a potentially critical role of matrix metalloproteinases (MMPs) and their inhibitors in the pathophysiology of rotator cuff tears. HYPOTHESIS Doxycycline-mediated MMP inhibition after rotator cuff repair will improve tendon-to-bone healing. STUDY DESIGN Controlled laboratory study. METHODS Rats (n = 183) underwent acute detachment and repair of the supraspinatus tendon and the animals were divided into 4 groups: In controls (n = 66), the supraspinatus was repaired to its anatomical footprint. In experimental groups, an identical surgery was performed with doxycycline (130 mg/kg/d) administered orally at (1) preoperative day 1 (n = 66), (2) postoperative day (POD) 5 (n = 28), or (3) POD 14 (n = 23). Animals were sacrificed at 5 days, 8 days, 2 weeks, and 4 weeks. Tendon-bone interface was evaluated with histomorphometry. Enzyme-linked immunosorbent assay for local MMP-13 activity was performed at 8 days and 4 weeks. Biomechanical testing of the healing enthesis was performed at 8 days, 2 weeks, and 4 weeks. Serum doxycycline levels were measured at sacrifice. Statistical analysis was performed using unpaired t tests and 2-way analysis of variance (P < .05). RESULTS Serum doxycycline levels were significantly higher in all treated groups compared with controls (1830 +/- 835 vs 3 +/- 3 ng/mL, respectively; P < .001). Doxycycline-treated animals demonstrated greater metachromasia and improved collagen organization at the healing enthesis at POD 5 (P < .06), POD 8 (P < .03), and 2 weeks (P < .04). The MMP-13 activity was significantly reduced in doxycycline-treated compared with control animals at POD 8 (6740 +/- 2770 vs 10400 +/- 2930 relative fluorescent units [RFU], respectively; P < .02) but not at 4 weeks (3600 +/- 3280 vs 4530 +/- 2720 RFU, respectively). The healing enthesis of animals started on doxycycline preoperatively or at POD 5 had an increased load to failure compared to controls at 2 weeks (13.6 +/- 1.8 and 13.2 +/- 1.94 N vs 9.1 +/- 2.5 N, respectively; P < .01). CONCLUSION/CLINICAL RELEVANCE Modulation of MMP-13 activity after rotator cuff repair may offer a novel biological pathway to augment tendon-to-bone healing.
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Affiliation(s)
- Asheesh Bedi
- Laboratory for Soft Tissue Research, Hospital For Special Surgery, 535 East 70th Street, New York City, NY 10021, USA.
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