Supraspinatus Tendon Research Articles

Anterolateral Acromioplasty Reduces Gliding Resistance Between the Supraspinatus Tendon and the Coracoacromial Arch in a Cadaveric Model

PurposeTo investigate the gliding resistance dynamics between the supraspinatus (SSP) tendon and the coracoacromial arch, both before and after subacromial decompression (anterolateral acromioplasty) and acromion resection (acromionectomy). MethodsUsing four fresh-frozen cadaveric shoulders, acromion shapes were classified (2 type I and 2 type III). Subacromial bursa and coracoacromial ligament maintenance replicated physiological sliding conditions. Gliding resistance was measured during glenohumeral abduction (0° to 60°) in internal rotation (IR) and external rotation (ER). Peak gliding resistance between the SSP tendon and the coracoacromial arch was determined and compared between intact, anterolateral acromioplasty, and acromionectomy. ResultsPeak SSP gliding resistance during abduction in an intact shoulder was significantly higher in IR than in ER (4.1N vs. 2.1N; p<0.001). The mean peak SSP gliding resistance during 0° to 60° glenouhumeral abduction in IR in the intact condition was significantly higher compared with the subacromial decompression condition (4.1N vs. 2.8N; p=0.021) and with the acromionectomy condition (4.1N vs. 0.9N; p<0.001). During 0° to 60° glenohumeral abduction in ER, mean peak SSP gliding resistance in the intact condition was not significantly different compared with the subacromial decompression condition (2.1N vs. 2.0N; p=0.999). The two specimens with a hooked acromion showed significantly higher mean peak SSP gliding resistance during glenohumeral abduction in IR and ER when compared with the two specimens with a flat acromion (IR: 5.8N vs. 3.0N; p=0.006; ER: 2.8N vs. 1.4N; p=0.001). ConclusionsIn this cadaveric study, peak gliding resistance between the SSP tendon and the coracoacromial arch during combined abduction and IR was significantly reduced after anterolateral acromioplasty and was significantly higher in specimens with a hooked acromion. Clinical relevanceThe clinical benefit of subacromial decompression remains unclear. This study suggests that anterolateral acromioplasty might reduce supraspinatus gliding resistance in those with a hooked acromion and in the typical “impingement” position.

Arthroscopic Double-Pulley Suture-Bridge Repair of Supraspinatus Tendon Tear

At present, the suture bridge is a widely used surgical pattern in the treatment of supraspinatus tendon tear, but the shortcomings of a suture bridge, including expensive lateral-row anchor and increased type 2 retear rate, is obvious. The double-pulley suture-bridge described in this Technical Note uses a double-loaded suture anchor (medial-row anchor) as lateral-row anchor instead of traditional lateral-row anchor, combined with double-pulley technology forming suture-bridge in treatment of supraspinatus tendon tears. The surgical technique is described in pearls, pitfalls, advantages, and disadvantages.

Middle trapezius tendon transfer using Achilles allograft for irreparable isolated supraspinatus tendon tears effectively restores the superior stability of the humeral head without restricting range of motion: a biomechanical study

BackgroundMiddle trapezius tendon (MTT) transfer has been suggested for promising treatment of irreparable isolated supraspinatus tendon tears (IISTTs). However, there have been no attempts to assess the biomechanical efficacy of MTT transfer. This study aims to evaluate the biomechanical efficacy of MTT transfer in the setting of IISTTs. MethodsEight fresh-frozen cadaveric shoulders were tested in three conditions (1) intact rotator cuff, (2) IISTTs, and (3) Middle trapezius tendon transfer (MTT) using Achilles allograft for IISTTs. Total humeral rotational range of motion, superior translation of the humeral head, and subacromial contact characteristics were measured at 0°, 20°, and 40° glenohumeral abduction (representing 0°, 30°, and 60° shoulder abduction). Superior translation and subacromial contact pressures were measured at 0°, 30°, 60° and 90° external rotation (ER). Two different MTT muscle loading conditions were investigated. A linear mixed-effects model and Tukey post hoc test were used for statistical analysis. ResultsTotal range of motion was significantly increased after IISTT at 20° abduction (P =.037). There were no changes in total ROM following MTT transfer compared to the IISTT condition (P>.625 for all comparisons). The IISTT condition significantly increased superior translation compared to the intact rotator cuff condition in 0° and 20° abduction with all ER angles (P<.001), 40° abduction/30° ER (P=.016), and 40° abduction/60° ER (P=.002). MTT transfer significantly decreased superior translation of the humeral head at all abduction angles compared to the IISTTs condition (P<.026). MTT transfer significantly decreased peak contact pressure by 638.7 kPa (normal loading) and 726.8 kPa (double loading) at 0° abduction/30° ER compared to the IISTTs condition (P<.001). Mean contact pressure was decreased by 102.8 kPa (normal loading) and 118.0 kPa (double loading) at 0° abduction/30° ER (P<.001) and 101.0 kPa (normal loading) and 99.2 kPa (double loading) at 0° abduction/60° ER (P<.001). MTT transfer at 20° abduction/30° ER with 24N loading significantly decreased contact pressure by 91.2 kPa (P=.035). ConclusionsThe MTT transfer biomechanically restored the superior humeral head translation and reduced the subacromial contact pressure in a cadaveric model of IISTT, while not restricting total ROM. These findings suggest that MTT transfer may have potential as a surgical treatment for IISTTs.

Greater tuberosity morphology is altered in individuals with symptomatic isolated supraspinatus tendon tears.

In the presence of an isolated supraspinatus tear, the force applied to the greater tuberosity is reduced, which may lead to bony morphologic changes. Thus, diagnostic or surgical identification of landmarks to properly repair the torn tendon might be difficult if the anatomy of the greater tuberosity is altered. The objectives of the study were to assess the presence of the superior, middle, and inferior facets of the greater tuberosity in individuals with symptomatic isolated supraspinatus tendon tears and the associations between tear size, tear location and presence of each facet. Thirty-seven individuals with symptomatic isolated supraspinatus tendon tears were recruited to participate in the study. Individuals underwent a high-resolution computed tomography scan of the involved shoulder and images were segmented to generate subject specific models of each humerus. The vertices comprising each facet were identified; however, if even a single vertex comprising the facet was missing, the facet was considered altered. Percentage agreement for correctly identifying the presence of each facet was determined using 2 additional observers and 5 randomly selected humeri. Ultrasonography was performed to assess anterior-posterior (AP) tear size and tear location. Outcome parameters included presence of the superior, middle, and inferior facets; AP tear size; and tear location. Point-biserial correlations were used to determine the associations between AP tear size, tear location, and presence of the superior, middle, and inferior facets. Supraspinatus tear size and tear location was 13.1±6.1 mm (range, 1.9-28.3 mm) and 2.0±4.4 mm from the posterior edge of the long head of the biceps tendon (range, 0.0-19.0 mm), respectively. Overall, the superior, middle, and inferior facets were not altered in 24.3%, 29.7%, and 45.9% of individuals, respectively. Percentage agreement between observers was 83.4% on average. No associations were found between tear size or tear location and presence of the superior, middle, or inferior facet (P values ranged from .19 to .74). Individuals with symptomatic isolated supraspinatus tears experience significant alterations in the bony morphology of the greater tuberosity that were irrespective of supraspinatus tear size and location. This information is useful for radiologists and orthopedic surgeons as the altered anatomy may influence the ability to identify important anatomic landmarks during diagnostic imaging or surgical procedures.

Untargeted metabolomics reveals dynamic changes in metabolic profiles of rat supraspinatus tendon at three different time points after diabetes induction.

To investigate the dynamic changes of metabolite composition in rat supraspinatus tendons at different stages of diabetes by untargeted metabolomics analysis. A total of 80 Sprague-Dawley rats were randomly divided into normal (NG, n = 20) and type 2 diabetes mellitus groups (T2DM, n = 60) and subdivided into three groups according to the duration of diabetes: T2DM-4w, T2DM-12w, and T2DM-24w groups; the duration was calculated from the time point of T2DM rat model establishment. The three comparison groups were set up in this study, T2DM-4w group vs. NG, T2DM-12w group vs. T2DM-4w group, and T2DM-24w group vs. T2DM-12w group. The metabolite profiles of supraspinatus tendon were obtained using tandem mass spectrometry. Metabolomics multivariate statistics were used for metabolic data analysis and differential metabolite (DEM) determination. The intersection of the three comparison groups' DEMs was defined as key metabolites that changed consistently in the supraspinatus tendon after diabetes induction; then, Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis was performed. T2DM-4w group vs. NG, T2DM-12w group vs. T2DM-4w group, and T2DM-24w group vs. T2DM-12w group detected 94 (86 up-regulated and 8 down-regulated), 36 (13 up-regulated and 23 down-regulated) and 86 (24 up-regulated and 62 down-regulated) DEMs, respectively. Seven key metabolites of sustained changes in the supraspinatus tendon following induction of diabetes include D-Lactic acid, xanthine, O-acetyl-L-carnitine, isoleucylproline, propoxycarbazone, uric acid, and cytidine, which are the first identified biomarkers of the supraspinatus tendon as it progresses through the course of diabetes. The results of KEGG pathway enrichment analysis showed that the main pathway of supraspinatus metabolism affected by diabetes (p < 0.05) was purine metabolism. The results of the KEGG metabolic pathway vs. DEMs correlation network graph revealed that uric acid and xanthine play a role in more metabolic pathways. Untargeted metabolomics revealed the dynamic changes of metabolite composition in rat supraspinatus tendons at different stages of diabetes, and the newly discovered seven metabolites, especially uric acid and xanthine, may provide novel research to elucidate the mechanism of diabetes-induced tendinopathy.

Translated article] Efficacy of transplantation of lipoaspired mesenchymal stem cells in the treatment of chronic rotator cuff tears. Experimental model in rats

Background and aimRotator cuff tears emerge in approximately 30% of the population over 60 years of age. Arthroscopic surgical treatment of these lesions is the treatment of choice, however, despite the improved repair techniques, the rate of re-tears ranges between 11 and 94%. Therefore, researchers seek to improve the biological healing process through the use of different alternatives such as mesenchymal stem cells (MSCs). Our objective is to evaluate the efficacy of a cellular therapy drug made from allogeneic stem cells derived from adipose tissue in a rat model of chronic rotator cuff injury. Material and methodsThe supraspinatus lesion was created in 48 rats for subsequent suturing at 4 weeks. MSCs in suspension were added to 24 animals after suturing, and HypoThermosol-FRS® (HTS) to 24 animals as a control group. Histology (Åström and Rausing scale) and the maximum load, displacement and elastic constant of the supraspinatus tendon were analysed in both groups 4 months after the repair. ResultsNo statistically significant differences were found in the histological score comparing the tendons treated with MSCs with respect to the tendons treated with HTS (P=0.811) nor in the results of maximum load (P=0.770), displacement (P=0.852) or elastic constant (P=0.669) of the tendon in both groups. ConclusionsThe addition of adipose-derived cells in suspension to the repair of a chronic cuff injury does not improve the histology or biomechanics of the sutured tendon.

Ultrasound Findings in Adult Patients with Chronic Shoulder Pain Having No History of Trauma

OBJECTIVE: To evaluate the frequency of non-traumatic chronic shoulder pain sonographically in the local population. METHODOLOGY: This cross-sectional study was conducted at the Department of Radiology, Combined Military Hospital Malir, from March to October 2020. A history of shoulder pain of more than one month duration was included. Patients with a History of shoulder dislocation, neurological, renal, hepatic and cardiac diseases were excluded. The sample size was 196. A non-probability consecutive sampling technique was employed. SPSS version 23 was used for statistical analysis. RESULTS: 196 patients (69.9% males and 30.1% females) with non-traumatic shoulder pain (56.4 % right side and 43.4% left) were scanned. The mean age was 42.80±11.20 years. Out of 196, 118(60.2%) were having complaints in dominant limbs (right 51.0% and left 9.2%); 78(39.8%) were having pain in non-dominant limbs (right 6.6% and left 33.2%). Significant findings were supraspinatus partial tear (46.9%), sub-acromial sub-deltoid bursitis(8.2%), and biceps tenosynovitis(6.1%), adhesive capsulitis, a complete tear of supraspinatus tendon, impingement syndrome, joint effusion, subscapularis tendon tear and tenosynovitis. 44(22.4%) patients had two pathologies, and 31 (15.8%) patients had three pathologies, respectively. Significant co-existent findings were biceps tenosynovitis (13.8%), Impingement syndrome (9.2%), bursitis (8.2%) and joint effusion (7.1%). Age and number of pathological were moderately positively correlated, r (194) = 0.46, p &lt; 0.01 and keeping CI = 95%. CONCLUSION: Partial tears of the supraspinatus tendon were the most common pathology in non-traumatic shoulder myalgia, diagnosed on ultrasound, followed by sub-acromial sub-deltoid bursitis and biceps tenosynovitis, having moderate linear relation with age. KEYWORDS: Shoulder pain, Impingement syndrome, Rotator Cuff Tears, Tenosynovitis, Ultrasound Shoulder

MRI-based automated multitask deep learning system to evaluate supraspinatus tendon injuries.

To establish an automated, multitask, MRI-based deep learning system for the detailed evaluation of supraspinatus tendon (SST) injuries. According to arthroscopy findings, 3087 patients were divided into normal, degenerative, and tear groups (groups 0-2). Group 2 was further divided into bursal-side, articular-side, intratendinous, and full-thickness tear groups (groups 2.1-2.4), and external validation was performed with 573 patients. Visual geometry group network 16 (VGG16) was used for preliminary image screening. Then, the rotator cuff multitask learning (RC-MTL) model performed multitask classification (classifiers 1-4). A multistage decision model produced the final output. Model performance was evaluated by receiver operating characteristic (ROC) curve analysis and calculation of related parameters. McNemar's test was used to compare the differences in the diagnostic effects between radiologists and the model. The intraclass correlation coefficient (ICC) was used to assess the radiologists' reliability. p < 0.05 indicated statistical significance. In the in-group dataset, the area under the ROC curve (AUC) of VGG16 was 0.92, and the average AUCs of RC-MTL classifiers 1-4 were 0.99, 0.98, 0.97, and 0.97, respectively. The average AUC of the automated multitask deep learning system for groups 0-2.4 was 0.98 and 0.97 in the in-group and out-group datasets, respectively. The ICCs of the radiologists were 0.97-0.99. The automated multitask deep learning system outperformed the radiologists in classifying groups 0-2.4 in both the in-group and out-group datasets (p < 0.001). The MRI-based automated multitask deep learning system performed well in diagnosing SST injuries and is comparable to experienced radiologists. Our study established an automated multitask deep learning system to evaluate supraspinatus tendon (SST) injuries and further determine the location of SST tears. The model can potentially improve radiologists' diagnostic efficiency, reduce diagnostic variability, and accurately assess SST injuries. • A detailed classification of supraspinatus tendon tears can help clinical decision-making. • Deep learning enables the detailed classification of supraspinatus tendon injuries. • The proposed automated multitask deep learning system is comparable to radiologists.

Early effectiveness of arthroscopic repair of supraspinatus tendon tears with douple-pulley suture-bridge

To investigate the early effectiveness of arthroscopic repair of supraspinatus tendon tears with douple-pulley suture-bridge. The clinical data of 38 patients with supraspinatus tendon tears who met the selection criteria between September 2020 and July 2022 were retrospectively analyzed, and all of them were treated with arthroscopic double-pulley suture-bridge technique. There were 15 males and 23 females, aged from 43 to 77 years, with an average of 61.5 years. There were 15 cases of left shoulder and 23 cases of right shoulder. Seven cases had a history of trauma, and the other 31 cases had no obvious inducement. The main clinical symptoms of the patient were pain in lifting the shoulder joint and hug resistance test (+). The time from onset of symptoms to admission ranged from 6 to 19 months, with an average of 10.3 months. Flexion, abduction, and external rotation of the shoulder were recorded before operation and at 3 and 12 months after operation. Pain and function of the shoulder were evaluated by visual analogue scale (VAS) score, University of California Los Angeles (UCLA) shoulder score, and American Society of Shoulder and Elbow Surgeons (ASES) score before operation and at 12 months after operation. Tendon healing, tendon continuity, and tension were evaluated by MRI at 3-6 months after operation, and patient's satisfaction was evaluated at last follow-up. All the incisions healed by first intention, and there was no complication such as incision infection or nerve injury. All patients were followed up 12-34 months, with an average of 23.3 months. VAS score, UCLA shoulder score, and ASES score at 12 months after operation were significantly better than those before operation ( P<0.05). The external rotation range of shoulder joint significantly improved at 3 and 12 months after operation ( P<0.05), and it further improved at 12 months after operation when compared with 3 months after operation ( P<0.05). There was no significant difference in the range of flexion and abduction at 3 months after operation when compared with those before operation ( P>0.05), but the range of flexion and abduction at 12 months after operation significantly improved when compared with those before operation and at 3 months after operation ( P<0.05). MRI reexamination was performed in 28 patients at 3-6 months after operation. Among them, 25 patients had intact supraspinatus tendon structure, good tension, and tendon healing, and 3 patients had type 1 retear. The remaining 10 patients refused to undergo MRI reexamination because of the satisfactory effectiveness. At last follow-up, 29 patients (76.3%) were very satisfied with the results, 6 (15.7%) were satisfied, and 3 (7.8%) were not satisfied. Arthroscopic double-pulley suture-bridge technique can achieve the effect of suture bridge operation, reduce the cost of operation and the risk of type 2 retear, and the early effectiveness is satisfactory, but the shoulder joint movement is limited within 3 months after operation.

Double Attack Repair for Massive Rotator Cuff Tears: Superior Capsular Reconstruction Using the Long Head of Biceps Tendon Plus Margin Convergence Repair

Arthroscopic repair of massive retracted rotator cuff tears is very challenging with a high incidence of retears. Many techniques have been described to improve the outcomes of arthroscopic repair. In this technique, a superior capsular reconstruction using the long head of the biceps is combined with margin convergence repair aimed at improving the mechanical strength of the repair. The long head of the biceps is used as a superior capsular reconstruction to stabilize the humeral head and prevent proximal migration. Moreover, margin convergence provides an efficient gap filling between remnants of the supraspinatus and infraspinatus tendons to restore an efficient rotator repair in anatomical, biological, and tension-free fashion.

Does an Increase in Supraspinatus Tendon Thickness After Swimming Increase the Likelihood of Future Shoulder Pain?

Increase in supraspinatus tendon thickness (STT) resulting from swimming practice has been observed in those with a history of shoulder pain. The magnitude of change in STT after a swimming session and its rate of recovery may be an indicator of future shoulder pain incidence. The supraspinatus tendons that demonstrate a greater increase in thickness as a result of swimming practice will have an increased likelihood of future shoulder pain in a cohort of competitive swimmers over a period of 6 months. Descriptive epidemiology study. Level 2b, individual cohort studies. A cohort of 50 nationally qualified swimmers aged between 14 and 22 years, from 3 open National Swimming Programs in Victoria, Australia, were recruited for this study. Ultrasonographic measurements of swimmers' STT was obtained of both shoulders, before, immediately after, and 6 hours after a single swimming practice session. Data were recorded of any significant interfering shoulder pain at 3 and 6 months after the initial testing session. Stepwise logistic regression models indicated that significant predictors of the likelihood of experiencing significant interfering pain were sex [significant at 6 months; odds ratio (OR) 4.2] and the extent of change in STT immediately (OR 2.3 and 1.3 per mm at 3 and 6 months, respectively) and 6 hours postpractice (OR 1.9 and 1.5 per mm at 3 and 6 months, respectively). The current data suggest larger increases in tendon thickness after training are associated with an increased likelihood of future shoulder pain. These data may be valuable for monitoring training load and identifying athletes who may have an increased likelihood of shoulder pain.

Arthroscopic “Mini-Incision” Transtendon Repair of Shoulder Partial Articular-Sided Supraspinatus Tendon Avulsion

Currently, the treatment of PASTA (partial articular-sided supraspinatus tendon avulsion) lesions includes arthroscopic transtendon and completion repair, but the shortcomings of both surgical techniques are obvious. We present a modified transtendon technique combining the transtendon with the mini-completion repair that is able to minimize the trauma from anchor implantation and add more intra-articular working access using a “mini-incision” on the supraspinatus tendon.

Trans-tendon Suture Bridge Rotator Cuff Repair With Biceps Tendon Augmentation for Retorn High-Grade Partial Articular Supraspinatus Tendon Avulsion (PASTA) Lesions

Revision repair of retorn partial articular supraspinatus tendon avulsion (PASTA) lesion is difficult for poor tendon quality without tear completion and repair. Trans-tendon suture bridge repair with biceps tendon augmentation can preserve the intact bursal side cuff attachment and has shown satisfactory clinical outcomes. Moreover, trans-tendon suture bridge rotator cuff repair technique, along with biceps tendon augmentation, reinforces high-grade PASTA lesions by moving the tenotomized biceps tendon into the torn articular side cuff defect with added advantage of blood supply through the tenotomized biceps tendon graft. Retear after trans-tendon repair of high-grade PASTA lesions was rare, and its poor tendon quality cause the revision repair to be too difficult. Without tear completion and rotator cuff repair, this arthroscopic trans-tendon suture bridge rotator cuff repair with biceps tendon augmentation is a reliable procedure that could be expected to produce improved short-term functional and radiologic outcomes, along with improved tendon quality of repaired tendon.

Investigation of the impact of radiotherapy on the shoulder joint by ultrasonography in breast cancer patients

Objectives: This study aimed to investigate the impact of radiotherapy (RT) on the supraspinatus, long head of the biceps and subscapularis tendons, and shoulder subcutenous fat tissue. Methods: Patients diagnosed with breast cancer who received RT to the anterior chest wall and axillary-supraclavicular region after breast-conserving surgery or mastectomy in our hospital. Overall, 56 (36 RT, 20 control group) patients were enrolled in this study. Pre-RT, post-RT 6-week, 3-month, and 6-month ultrasonographic and clinical assessments were performed. Results: The mean interval between surgery and RT was 5.6 (range: 2-8) months. Ten (27.7%) patients developed ultrasonographic abnormalities during the post-RT period. However, only 2 of these patients had shoulder pain and restricted range of motion in the shoulder. The thickness of the supraspinatus, biceps and subscapularis tendons were similar between the dominant and non-dominant sides of the control and RT group patients (5.7 mm vs. 5.1 mm, 2.87 mm vs. 2.89 mm, and 4.13 mm vs. 3.97 mm; respectively, p &amp;gt; 0.05). Thirteen patients were given RT on the ipsilateral side, and 23 received RT on the contralateral side. The pre-RT supraspinatus tendon thickness was significantly higher in the ipsilateral group than in the contralateral group (p = 0.026). However, there was no significant difference in the post-RT period (p = 0.408). Conclusions: In breast cancer patients undergoing adjuvant RT, RT may cause temporary edema in shoulder tendons. In addition, shoulder pain and restricted range of motion of the shoulder joint can be present in these patients.

Contrast-Enhanced Ultrasound-Assessed Supraspinatus Muscle Perfusion Indicates Better Tissue Vitality and Outcome After Supraspinatus Tendon Repair and Subacromial Decompression.

Supraspinatus tendon (SSP) tears are a frequent indication for shoulder surgery. Therapy options include physiotherapy, tendon repair and less invasive surgical options like subacromial decompression (SAD). The selection of the most appropriate treatment depends on the specific characteristics and needs of each patient subgroup. Typically, physically active patients are candidates for tendon repair, while a conservative approach is preferred for individuals with severe muscle degeneration or low physical demands. The goal of this study was to assess the impact of contrast-enhanced ultrasound (CEUS)-assessed SSP muscle perfusion on post-operative shoulder function and tendon healing in patients undergoing SSP repair or SAD, thereby enhancing personalized therapy for SSP tendon tears. Two cohorts of patients with SSP tendon tears were treated either by SAD or tendon repair. Pre-operative and 6-month post-operative SSP muscle perfusion was quantified using CEUS and investigated as a surrogate for tissue vitality. The magnetic resonance imaging-derived parameters fatty infiltration and tendon retraction and established shoulder function scores were assessed pre- and post-operatively. Thirty-five SSP repair patients were compared with 20 SAD patients. Pre-operative perfusion was comparable in the SAD and SSP repair cohorts when a re-tear occurred (wash-in perfusion index=103.8 ± 124.0 vs. 114.6 ± 155.0, p=0.83), while being significantly higher among patients with an intact repair (103.8 ± 124 vs. 325.4 ± 388.6, p=0.006). Below-median pre-operative muscle perfusion was associated with lower post-operative shoulder function (Constant score: 59 ± 28 vs. 78 ± 19, p=0.012). CEUS can visualize SSP muscle perfusion as a surrogate for tissue vitality and tendon healing, which is associated with better post-operative shoulder function.

Morphological and histological evaluation of the tendon-bone junction in porcine shoulders to create a rotator cuff tear and repair model

BackgroundThis study aimed to morphologically and histologically examine whether pig is useful as models for rotator cuff tear (RCT). MethodsThe morphology of the scapula and humerus bones was evaluated by taking X-ray and three-dimensional computed tomography (3D CT) scans of the right shoulders of five female pigs (age: 4 months). The rotator cuff (RC) footprint at the humeral insertion of these was observed and its shape was measured. Next, they underwent general anesthesia and an acute rotator cuff tear/rotator cuff repair (RCT/RCR) model was created using a deltoid split approach. Four weeks after surgery, the animals were euthanized, the shoulder joints were harvested, and the repaired RC was evaluated by hematoxylin and eosin staining and toluidine blue staining. ResultsThe scapula of the pig had a vestigial acromion, in contrast to that in humans. The supraspinatus and infraspinatus tendons were connected so as to overlap each other and attached to the postero-superior part of the greater tuberosity. These tendons were located extra-articularly, separate from the joint capsule. The average antero-posterior length of the foot print was 17.4 ± 0.7 mm on the medial margin and 19.1 ± 2.2 mm on the lateral margin. The maximum medial-to-lateral width of it was 5.1 ± 0.5 mm. In all RCT/RCR models at 4 weeks after surgery, the repaired RC compound tendon was visually confirmed to be continuous with the footprint. Histologically, it was confirmed that regeneration of the four-layer structure of the bone-tendon junction had occurred. ConclusionPorcine supraspinatus and infraspinatus attachment to the greater tuberosity have a structure similar to that of sheep and dogs, which is advantageous for creating the RCT/RCR model. It might be used for future in vivo studies of shoulder joint diseases. The Translational Potential of this ArticlePigs could potentially serve as a viable model for rotator cuff tears.

The Efficiency of Gray-Level Ultrasound Histogram Analysis in Patients with Supraspinatus Tendinopathy.

Musculoskeletal ultrasonography is a viable substitute for magnetic resonance imaging (MRI) that offers advantages in terms of time efficiency and cost-effectiveness. The gray-level histogram is a tool used to depict the distribution of pixel gray levels that provide quantitative data. The objective of our research was to establish a threshold value for ultrasonography-measured supraspinatus tendon gray-level values by comparing patients with tendinopathy to those without. This study comprised a cohort of 271 individuals, consisting of 124 patients diagnosed with supraspinatus tendinopathy and 147 cases without the aforementioned condition who underwent shoulder MRI and ultrasound examinations. Two radiologists independently conducted the gray-level histogram analyses. The histogram parameters were determined, including the mean, minimum, median, maximum, fifth, 10th, 25th, 50th, 75th, 90th, and 95th percentiles, as well as skewness, kurtosis, and variance. The interobserver agreement was evaluated using the interclass correlation coefficient. The supraspinatus tendinopathy group's all gray-level values were lower than those of the control group, and the difference was statistically significant (P < .05). The supraspinatus tendinopathy group exhibited greater values of skewness and kurtosis in comparison to the control group (P < .05). The area under the curve of the 95th percentile of the gray-level value was the highest (area under the curve = 0.960; cut-off value = 82.5; sensitivity = 96.7%; specificity = 88.2%). The analysis of the histogram of gray-level values has the potential to be a promising method for the monitoring of patients with supraspinatus tendinopathy. This approach could be considered a feasible alternative to MRI.

Effects of Arthroscopic Atelocollagen Insertion in High-Grade Partial Articular Supraspinatus Tendon Avulsion Lesions: A Retrospective Cohort Study With Propensity Score Matching.

This study sought to evaluate the effect of atelocollagen insertion into the bone-tendon interface of the repaired tendon after arthroscopic rotator cuff repair for high-grade partial articular supraspinatus tendon avulsion (PASTA) lesions. To compare clinical and radiological outcomes of atelocollagen-inserted rotator cuff repair and atelocollagen-noninserted rotator cuff repair in the high-grade PASTA lesions. Cohort study; Level of evidence, 3. The data from 301 consecutive patients who underwent arthroscopic rotator cuff repair of PASTA lesions between January 2017 and June 2020 were retrospectively reviewed. Patients with minimum 2-year follow-up data were included and divided into 2 groups: those treated with transtendon suture-bridge repair without additional augmentation (group 1) and those with atelocollagen-inserted transtendon suture-bridge repair (group 2). Patients in group 2 were matched 1:1 to patients in group 1 using propensity score matching (n = 68 per group); and pain visual analog scale, American Shoulder and Elbow Surgeons, University of California, Los Angeles, Korean Shoulder Scoring System, Simple Shoulder Test, and range of motion scores were compared between these groups. Also, repaired tendon integrity and thickness were compared immediately, 6 months, and 1 year after surgery on magnetic resonance imaging (MRI) using the vertical distance from the midpoint footprint of the greater tuberosity. In most comparisons, there were no significant differences in outcome measures and range of motion between groups. However, less residual discomfort at the final follow-up was also documented in group 2 (P = .043). Also, the difference in forward flexion was 3.7° at 1 year and 5.4° at final follow-up, and the difference in abduction was 2.2° at final follow-up, which were all significantly greater in the experimental group. Group 2 showed significant greater tendon thickness of the repaired tendon immediately, 6 months, and 1 year after surgery on MRI (P≤ .001). Addition of atelocollagen did not improve outcome scores. However, there was slightly greater flexion and abduction at final follow-up. Also, there was less residual discomfort at final follow-up.

Clinical effectiveness of supraspinatus tendon reconstruction using autogenous fascia latas for irreparable posterosuperior massive rotator cuff tears: study protocol for a randomized, controlled clinical trial

BackgroundSupraspinatus tendon reconstruction (STR) was recently introduced as a new treatment option for irreparable posterosuperior massive rotator cuff tears (IPMRCT). STR was thought to be more advantageous than superior capsule reconstruction (SCR) for restoring supraspinatus (SSP) dynamics. However, there has been no prospective randomized controlled study on the early clinical efficacy of STR.MethodsA single-site, prospective, observers and patients double-blinding randomized controlled trial was designed. Fifty-eight patients aged 50–85 years with IPMRCT will be randomized 1:1 to receive either STR or SCR. The clinical outcomes were evaluated using the American Society for Shoulder and Elbow Surgery (ASES) score, range of motion (ROM), visual analogue scale (VAS) for pain, acromiohumeral distance (AHD), Goutlliar grade for fatty infiltration in the SSP, Sugaya grade for the autogenous fascia latas, isokinetic muscle strength testing and surface electromyography (EMG) testing for shoulder abduction muscle strength and complications.DiscussionThe results of this study will contribute to the treatment algorithm of IPMRCT and assist surgeons in making treatment decisions. This is the first randomized controlled trial to compare the effects of STR and SCR for the treatment of IPMRCT.Trial registrationWe registered the trial in chictr.org.cn on July 17, 2023 (register number: ChiCTR2300073716). Items from the WHO trial registry were found within the protocol.

Hedgehog Activation for Enhanced Rotator Cuff Tendon-to-Bone Healing

Background: Rotator cuff repair is a common orthopaedic procedure, yet the rate of failure to heal after surgery is high. Repair site rupture is due to poor tendon-to-bone healing and lack of regeneration of the native fibrocartilaginous enthesis. During development, the enthesis is formed and mineralized by a pool of progenitors activated by hedgehog signaling. Furthermore, hedgehog signaling drives regenerative enthesis healing in young animals, in contrast to older animals, in which enthesis injuries heal via fibrovascular scar and without participation of hedgehog signaling. Hypothesis: Hedgehog activation improves tendon-to-bone healing in an animal model of rotator cuff repair. Study Design: Controlled laboratory study. Methods: A total of 78 adult Sprague-Dawley rats were used. Supraspinatus tendon injury and repair were completed bilaterally, with microsphere-encapsulated hedgehog agonist administered to right shoulders and control microspheres administered to left shoulders. Animals were sacrificed after 3, 14, 28, or 56 days. Gene expression and histological, biomechanical, and bone morphometric analyses were conducted. Results: At 3 days, hedgehog signaling pathway genes Gli1 (1.70; P = .029) and Smo (2.06; P = .0173), as well as Runx2 (1.69; P = .0386), a transcription factor of osteogenesis, were upregulated in treated relative to control repairs. At 14 days, transcription factors of tenogenesis, Scx (4.00; P = .041), and chondrogenesis, Sox9 (2.95; P = .010), and mineralized fibrocartilage genes Col2 (3.18; P = .031) and Colx (1.85; P = .006), were upregulated in treated relative to control repairs. Treatment promoted fibrocartilage formation at the healing interface by 28 days, with improvements in tendon-bone maturity, organization, and continuity. Treatment led to improved biomechanical properties. The material property strength (2.43 vs 1.89 N/m2; P = .046) and the structural property work to failure (29.01 vs 18.09 mJ; P = .030) were increased in treated relative to control repairs at 28 days and 56 days, respectively. Treatment had a marginal effect on bone morphometry underlying the repair. Trabecular thickness (0.08 vs 0.07 mm; P = .035) was increased at 28 days. Conclusion: Hedgehog agonist treatment activated hedgehog signaling at the tendon-to-bone repair site and prompted increased mineralized fibrocartilage production. This extracellular matrix production and mineralization resulted in improved biomechanical properties, demonstrating the therapeutic potential of hedgehog agonism for improving tendon-to-bone healing after rotator cuff repair. Clinical Relevance: This study demonstrates the therapeutic potential of hedgehog agonist treatment for improving tendon-to-bone healing after rotator cuff injury and repair.