Rotator cuff tear (RCT) is the leading cause of shoulder pain, primarily associated with age-related tendon degeneration. This study aimed to elucidate the potential differential gene expressions in tendons across different age groups, and to investigate their roles in tendon degeneration. Linear regression and differential expression (DE) analyses were performed on two transcriptome profiling datasets of torn supraspinatus tendons to identify age-related genes. Subsequent functional analyses were conducted on these candidate genes to explore their potential roles in tendon ageing. Additionally, a secondary DE analysis was performed on candidate genes by comparing their expressions between lesioned and normal tendons to explore their correlations with RCTs.Aims
Methods
We have studied cellular and vascular changes in different stages of full thickness tears of the rotator cuff. We examined biopsies from the supraspinatus tendon in 40 patients with chronic rotator cuff tears who were undergoing surgery and compared them with biopsies from four uninjured subscapularis tendons. Morphological and immunocytochemical methods using monoclonal antibodies directed against leucocytes, macrophages, mast cells, proliferative and vascular markers were used. Histological changes indicative of repair and inflammation were most evident in small sized rotator cuff tears with increased fibroblast cellularity and intimal hyperplasia, together with increased expression of leucocyte and vascular markers. These reparative and inflammatory changes diminished as the size of the rotator cuff tear increased. Marked oedema and degeneration was seen in large and massive tears, which more often showed chondroid metaplasia and amyloid deposition. There was no association between the age of the patient and the duration of symptoms. In contrast, large and massive tears showed no increase in the number of inflammatory cells and blood vessels. Small sized rotator cuff tears retained the greatest potential to heal, showing increased fibroblast cellularity, blood vessel proliferation and the presence of a significant inflammatory component. Tissue from large and massive tears is of such a degenerative nature that it may be a significant cause of re-rupture after surgical repair and could make healing improbable in this group.
This study reports the application of a novel method for quantitatively determining differences in the mechanical properties of healthy and torn rotator cuff tissues. In order to overcome problems of stress risers at the grip-tendon interface that can obscure mechanical measurements of small tendons, we conducted our investigation using dynamic shear analysis. Rotator cuff tendon specimens were obtained from 100 patients during shoulder surgery. They included 82 differently sized tears and 18 matched controls. We subjected biopsy samples of 3 mm in diameter to oscillatory deformation under compression using dynamic shear analysis. The storage modulus (G’) was calculated as an indicator of mechanical integrity. Normal tendons had a significantly higher storage modulus than torn tendons, indicating that torn tendons are mechanically weaker than normal tendons (p = 0.003). Normal tendons had a significantly higher mean shear modulus than tendons with massive tears (p <
0.01). Dynamic shear analysis allows the determination of shear mechanical properties of small tissue specimens obtained intra-operatively that could not be studied by conventional methods of tensile testing. These methods could be employed to investigate other musculoskeletal tissues. This pilot study provides some insight into mechanisms that might contribute to the failure of repair surgery, and with future application could help direct the most appropriate treatment for specific rotator cuff tears.
Previous perfusion studies of the rotator cuff have demonstrated an area of hypovascularity in the distal part of the supraspinatus tendon. This has been implicated in the pathogenesis of its rupture. We performed a quantitative histological analysis of the vascularity of the tendons of supraspinatus and infraspinatus. Vessel number, size and the percentage of the tendon occupied by vessels were measured at 5 mm intervals from the humeral insertions to the muscle bellies. Both tendons were hypovascular in their distal 15 mm. No significant difference was demonstrated between the vascularity of supraspinatus and infraspinatus. We conclude that factors other than vascularity are important in the pathogenesis of supraspinatus rupture.
The rotator cuff tendinopathy is one of the most common shoulder problems leading to full-thickness
Glutamate regulates the expression of apoptosis-related genes and triggers the apoptosis of fibroblasts in
Objectives. Indocyanine green (ICG) fluorescence angiography is an emerging technique that can provide detailed anatomical information during surgery. The purpose of this study is to determine whether ICG fluorescence angiography can be used to evaluate the blood flow of the
Background. High re-rupture rates following repairs of rotator cuff tears (RCTs) have resulted in the increased use of repair grafts to act as temporary scaffolds to support tendon healing. It has been estimated that thousands of extracellular matrix repair grafts are used annually to augment surgical repair of rotator cuff tears. The only mechanical assessment of the suitability of these grafts for rotator cuff repair has been made using tensile testing only, and compared grafts to canine infraspinatus. As the shoulder and
Objectives . The effects of disease progression and common tendinopathy treatments
on the tissue characteristics of human
INTRODUCTION. In order to address high failure rates following rotator cuff repairs, a greater understanding is required of the underlying structural changes so that treatments can be appropriately targeted and biomarkers of failure can be identified. As collagen is the primary constituent of tendon and determines force transmission, collagen structural changes may affect responses to loading. For example changes in collagen 1 and 5 are associated with the hyperelastic Ehlers-Danlos syndrome, which is diagnosed by looking for pathopneumonic altered collagen fibres or ‘collagen flowers’ in skin using transmission electron microscopy (TEM). To date no study has been performed on the microstructure of torn human
Aims. This study compared patients who underwent arthroscopic repair of large to massive rotator cuff tears (LMRCTs) with isolated incomplete repair of the tear and patients with incomplete repair with biceps tendon augmentation. We aimed to evaluate the additional benefit on clinical outcomes and the capacity to lower the re-tear rate. Methods. We retrospectively reviewed 1,115 patients who underwent arthroscopic rotator cuff repair for full-thickness tears between October 2011 and May 2019. From this series, we identified 77 patients (28 male, 49 female) with a mean age of 64.1 years (50 to 80). Patients were classified into groups A (n = 47 incomplete) and B (n = 30 with biceps augmentation) according to the nature of their reconstruction. Clinical scores were checked preoperatively and at six months, one year, and two years postoperatively. In preoperative MRI, we measured the tear size, the degree of fatty infiltration, and muscle volume ratio of the supraspinatus. In postoperative MRI, the integrity of the repaired
Large and retracted
Introduction Rotator cuff degeneration is considered to be a major factor in the pathogenesis of
Approximately 30% of general practice consultations for musculoskeletal pain are related to tendon disorders, causing substantial personal suffering and enormous related healthcare costs. Treatments are often prone to long rehabilitation times, incomplete functional recovery, and secondary complications following surgical repair. Overall, due to their hypocellular and hypovascular nature, the regenerative capacity of tendons is very poor and intrinsically a disorganized scar tissue with inferior biomechanical properties forms after injury. Therefore, advanced therapeutic modalities need to be developed to enable functional tissue regeneration within a degenerative environment, moving beyond pure mechanical repair and overcoming the natural biological limits of tendon healing. Our recent studies have focused on developing biologically augmented treatment strategies for tendon injuries, aiming at restoring a physiological microenvironment and boosting endogenous tissue repair. Along these lines, we have demonstrated that the local application of mesenchymal stromal cell-derived small extracellular vesicles (sEVs) has the potential to improve
This study aims to investigate the mechanical properties of a rotator cuff tear repaired with a polypropylene interposition graft in an ovine infraspinatus ex-vivo model. Twenty fresh shoulders from skeletally mature sheep were used in this study. A tear size of 20 mm from the tendon joint was created in the infraspinatus tendon to simulate a large tear in fifteen specimens. This was repaired with a polypropylene mesh used as an interposition graft between the ends of the tendon. Eight specimens were secured with mattress stitches while seven were secured to the remnant tendon on the greater tuberosity side by continuous stitching. Remaining five specimens with an intact tendon served as a control group. All specimens underwent cyclic loading with a universal testing machine to determine the ultimate failure load and gap distance. Gap distance increased with progressive cyclic loading through 3000 cycles for all repaired specimens. Mean gap distance after 3000 cycles for both continuous and mattress groups are 1.7 mm and 4.2 mm respectively (P = .001). Significantly higher mean ultimate failure load was also observed with 549.2 N in the continuous group, 426.6 N in the mattress group and 370 N in the intact group. The use of a polypropylene mesh as an interposition graft for large irreparable rotator cuff tears is biomechanically suitable and results in a robust repair that is comparable to an intact
Introduction. The pathophysiology of high failure rates following
Summary Statement. This study describes the design and preliminary in vitro testing of a novel patch for the repair of
A prospective study was carried out to determine if recognised histological features seen at surgery could help predict those
Background. Rotator cuff tears pose a huge socioeconomic burden. Our study uses Fourier transform infrared spectroscopy (FTIR) as it is a quick, non-manipulative and non-destructive test, which can identify a wide range of chemical targets from small intraoperatively obtained specimens. The aim of this study was (i) to characterise the chemical and structural composition of
Introduction and Aims: Treatment of
Aims: The aim of the study was to investigate the cap-suloligamentous structures of the shoulder joint and their association with
Introduction: New biotechnologies create opportunities for gene therapy to promote rotator cuff healing. We have previously demonstrated that genetically engineered mesenchymal stem cells (MSCs) over expressing BMP-2 and SMAD8 signaling molecule differentiate to tenocytes in vitro and in vivo. Therefore, we hypothesized that rotator cuff defect could be regenerated using genetically engineered MSCs. Method: Nonviral methods were utilized to establish genetically engineered MSCs that co-express BMP-2 and the Smad8 signaling molecule. A previously validated animal model was utilized to examine rotator cuff healing. A 2mm x2mm full thickness defect was created in the infraspinatus tendon of 8 nude rats. A collagen-I biomembrane (TissueMend) containing 3 x 10. 6. engineered cells was sewn into the defect. An identical control procedure was repeated on the contralateral side with biomembrane containing non-engineered MSCs. Results: 4 weeks post implantation the area of implantation was isolated and analyzed by light microscopy and histochemical staining. Analysis of the engineered implants revealed the formation of dense connective tissue with parallel-organized fibers and spindle shaped cells, unlike the control samples. Proton Double Quantum Filtered Magnetic Resonance Imaging technique of the
Aim To determine if tissue metabolism varies in supraspinatus tendons with distance from the edge of the
Rotator cuff tears are a common cause of shoulder pain and dysfunction. Therefore, the purpose of this in-vitro biomechanical study was conducted to determine the effects of simulated tears and subsequent repairs of the
Purpose: To determine if administration of recombinant bFGF in an alginate gel would increase early healing mechanical parameters in acutely injured rat
Background: Time dependent, quantitative studies of muscle atrophy or passive muscle mechanics following chronic muscle detachment have not been previously reported. We developed a chronic tear of the
Tears of the
Introduction: The Nottingham Hood is a polyester soft tissue reinforcement device for the treatment of weakened or torn
The Nottingham Hood is a polyester soft tissue reinforcement device for the treatment of weakened or torn
Background. Rotator cuff atrophy evaluated with computed tomography scans has been associated with asymmetric glenoid wear and humeral head subluxation in glenohumeral arthritis. Magnetic resonance imaging has increased sensitivity for identifying rotator cuff pathology and has not been used to investigate this relationship. The purpose of this study was to use MRI to assess the association of rotator cuff muscle atrophy and glenoid morphology in primary glenohumeral arthritis. Methods. 132 shoulders from 129 patients with primary GHOA were retrospectively reviewed and basic demographic information was collected. All patients had MRIs that included appropriate orthogonal imaging to assess glenoid morphology and rotator cuff pathology and were reviewed by two senior surgeons. All patients had intact
Introduction and Aims: Large or recurrent
Surgical reattachment of torn
Recent studies on animal models focused on the effect of preserving tendon remnant of
Purpose:. The objective of this study was to determine the tensile strength of the different components of the
Treatment of massive rotator cuff tears can be challenging. Previous studies with irreparable rotator cuff tears showed good clinical results of tendon healing with the arthroscopic insertion of a protective biodegradable spacer balloon filled with saline solution between the repaired tendon and the acromion [1,2], but so far no scientific evidence has showed how the device alters pressures over the repaired tendon. This biomechanical study investigated the effects of a spacer inserted in the subacromial space on pressures over the repaired
The health of a synovial joint is relied on normal function and coordination of a group of tissues such as articular cartilage (AC), ligaments, tendons and muscles. Osteoarthritis (OA), which is the most common joint disease, is clinically characterised by lesion of AC. Despite this, injury of a ligament or tendon or muscle generates a joint instability, which accelerates deterioration of AC and progression of OA. Traditional histology is often used to study the pathology of biological tissues. It requires tissue biopsy, which traumatises the donor tissues. Therefore, it is not an idea method for assessing AC, ligaments and tendons as the tissues have a poor healing capability. There is a worldwide demand of an imaging technique that diagnoses the microstructural changes of chondral and connective tissues without biopsy. Confocal arthroscopy (Optiscan Pty Ltd, Australia) possesses a Ø 6.3 mm probe and offers a 0.7 µm lateral imaging resolution and 7 µm axial resolution. It has been successfully used for examining the internal microstructural disorders in
Anatomy of the
Forty-two shoulders in 37 patients with polyarthritis were treated with Neer total shoulder replacements and reviewed 12 to 66 months afterwards. There was good pain relief and improvement in function, but the range of movement was less than that seen after replacements for osteoarthritis; this may have been related to the fact that 34 shoulders had abnormal
This is a retrospective review of 108 patients who underwent decompressive anterior acromioplasty for chronic impingement in the absence of a full thickness rotator cuff tear. Before operation, all the patients had had shoulder pain for at least one year despite conservative treatment. At operation, the
Massive, irreparable rotator cuff tears occur in about 15% of patients with ruptures of the
The objective of this study was to determine the tensile strength of the different components of
To analyze the relationship between functional outcome and tissue quality after arthroscopic rotator cuff repair. One hundred and forty-five patients who had undergone arthroscopic repair of rotator cuff tear, during the period of 2003–2008, were evaluated. All operations were performed under the same surgeons. The mean follow-up period was 2.4±1.2 years (range, 0.5 to 5 ys). The patients were devided in two groups:. patients with good tissue quality and. patients with poor tissue quality. As good tissue quality is defined the tendon with enough mass for suturing (thickness>
3mm) and good elasticity (the footprint is covered properly under tendon traction with tissue grasper). The independent variable studied here was the tissue quality of
The aim of this study was to determine cell viability in different stages of
Given that there is limited time available to the surgeon in arthroscopic rotator cuff repair, how is the time best spent? Should they place one Modified Mason-Allen, two mattress or four simple sutures? This study reverses current thought. In an in-vitro biomechanical single pull to failure study we compared the ultimate tensile strength of simple, mattress and grasping sutures passed with an arthroscopic suture passer (Surgical Solutions Express-Sew). The aim was to determine which suture configurations would most simply, repeatably and reliably repair the rotator cuff. The ultimate tensile strength and mode of failure of six different suture configurations was repeatedly tested on a validated porcine
Introduction: Antegrade intramedullary locked nailing is a reliable method for the treatment of humeral shaft fractures. There is a still debate on the functional effect due to a possible damage during surgical approach of the rotator cuff, but in the Literature few paper deal with the analysis of tendons in these patients. Ultrasonography is still considered a reliable method in evaluating
Proximal humeral fractures are common and often occur in osteoporotic bone. Suture fixation utilises the
Aim: We hypothesize that anabolic steroid administration enhances matrix remodelling and improves the biomechanical properties of bio-artificially engineered human supraspinatus tendons (BATs). Method: BATs were treated either with nandrolone decanoate (NLS group, n=18), stretching (LNS group, n=18), or both (LS group, n=18). A control group received no treatment (NLNS group, n=18). BATs’ contractility was assessed by daily scanning and two dimensional analysis. Cytoskeletal organization was evaluated microscopically with DAPI and rhodamine phalloidin staining. Matrix metalloproteinase-3 (MMP-3) levels – an indicator of matrix remodelling – were discerned by ELISA assay, and biomechanical properties by load-to-failure testing. Results: The LS group showed greatest contractility and the best-organized actin cytoskeleton when compared to the other groups. On the second and third day of treatment, MMP-3 levels in the LS group were significantly greater than those of NLNS group and greater than NLS and LNS groups. The biomechanical properties (load to failure, ultimate stress, ultimate strain, elastic modulus, and energy to failure) in the LS group were significantly improved when compared to NLNS and NLS (p<
.05) groups and 26–48% greater than those in LNS group. Conclusions: Nandrolone decanoate and load act synergistically to increase matrix remodelling and biomechanical properties of bioengineered human supraspinatus tendons. Carefully prescribed and monitored, anabolic steroids may have an important adjunct role in postoperative healing and rehabilitation of repaired
Given that there is limited time available to the surgeon in arthroscopic rotator cuff repair, how is the time best spent? Should he place one Modified Mason-Allen, two mattress or four simple sutures? This study reverses current thought. In an in-vitro biomechanical single pull to failure study we compared the ultimate tensile strength of simple, mattress and grasping sutures passed with an arthroscopic suture passer (Surgical Solutions Express-Sew). The aim was to determine which suture configurations would most simply, repeatably and reliably repair the rotator cuff. The ultimate tensile strength and mode of failure of six different suture configurations was repeatedly tested on a validated porcine
Aim: The common cause for recurrent instability in older patients, is the massive tear of the
Surgical repair of