Abstract
PurposeAcute trauma-related rotator cuff tears are believed to have better healing potential than chronic tears due to less degenerative changes of the tendons. However, the histopathological condition of tendons from trauma-related tears is not well investigated. The purpose of this study was to explore specific histopathological features in tendons from acute trauma-related full-thickness rotator cuff tears and to compare them to findings in tendons from nontraumatic, chronic tears.MethodsIn a prospective cohort study, 62 previously asymptomatic patients [14 women, median age 61 years (range 42–75)] with trauma-related full-thickness rotator cuff tears were consecutively included. Arthroscopic repair was performed within 30 (median, IQR 25–37) days after the injury. During surgery, tissue biopsies were harvested from the supraspinatus tendons in 53 (86%) of the patients. In addition, similar biopsies were harvested from 10 patients undergoing surgery for chronic tears without history of trauma. All tissue samples were examined by a well-experienced pathologist under light microscope. Tendon degeneration was determined using the Bonar score whereas immunostaining was used for proliferation (Ki67), inflammation (CD45), apoptosis (p53) and haemosiderin staining to study traces of bleeding.ResultsThe median (IQR) Bonar score for the acute trauma-related biopsies was 10.5 (7.5–14.5) compared to 11 (5–12.8) for the control group with no statistically significant difference between the groups. No statistically significant between-group difference was found for the inflammatory index whereas tendons from patients with trauma-related full-thickness rotator cuff tears had statistically significantly higher apoptosis [3.1 (0.5–8.9) vs. 0.1 (0–1.5), p = 0.003] and proliferation [4.0 (1.8–6.9) vs. 0.4 (0–2.0), p = 0.001) indices than those undergoing surgery for chronic tears. Positive haemosiderin staining was found in 34% of tissue samples from patients with trauma-related tears compared to 10% in the control group (n.s).ConclusionThis study suggests that there is no difference with regard to degenerative changes between supraspinatus tendons harvested from patients with acute, trauma-related rotator cuff tears and patients with nontraumatic, chronic tears.Level of evidenceII.
Highlights
Pain and shoulder dysfunction are common in the general population where rotator cuff tendinopathy and rotator cuff tears (RCT) represent the most common cause of these conditions [36, 43]
The proliferation and the apoptotic (p53) indices were statistically significantly higher in patients with trauma-related tears compared to patients with chronic tears (p = 0.001 and p = 0.003, respectively, Table 3)
In the study group with trauma-related tears, the linear regression model showed a statistically significant relation between higher Bonar score and higher inflammatory index (B = 0.11, 95% CI [0.06, 0.16], p < 0.001) and higher apoptotic (p53) index (B = 0.13, 95% CI [0.01, 0.25], p = 0.04)
Summary
Pain and shoulder dysfunction are common in the general population where rotator cuff tendinopathy and rotator cuff tears (RCT) represent the most common cause of these conditions [36, 43]. Despite this suggested overall degenerative genesis of rotator cuff tears, trauma-related tears are often studied and discussed as acute injuries and separated from chronic, nontraumatic tears [13, 29, 34, 38, 42, 50]. Diagnostic methods and surgical techniques have developed significantly over the last decade, non-healing and retear rates of surgically repaired tendons are still unacceptably high [6, 15, 16, 35, 37]. We hypothesised that traumatic tears would show signs of bleeding that could be detected by haemosiderin staining
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