A Combination Treatment of Raloxifene and Vitamin D Enhances Bone-to-Tendon Healing of the Rotator Cuff in a Rat Model

Kim, Dong-Min; Shim, In Kyong; Shin, Myung Jin; Choi, Jae-Hyeog; Lee, Yu Na; Kim, Hyojune; Park, Dongjun; Kholinne, Erica; Koh, Kyoung-Hwan

doi:10.1177/0363546520927015

Cited by 20 publications

(29 citation statements)

References 32 publications

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“…19,35 With respect to the recent studies of rotator cuffs, bone quality at the tendon insertion site of the humeral head has been determined to be an important factor that affects tendon-to-bone healing. 17,32,33,37,42 Tanaka et al 37 found that the estrogen-deficient state impaired bone quality at the repaired site as well as the biomechanical properties of the reattached rotator cuff of rats, causing worse tendon-to-bone healing. Shah et al 33 applied sclerostin antibody to increase bone quality and promote rotator cuff healing in a nonosteoporotic rat model.…”

Section: Discussionmentioning

confidence: 99%

“…More than 250,000 cases require rotator cuff repair (RCR) annually, and the structural failure rates range from 9% to 94%. 9,15,17,32,33 Notably, in older patients with massive tears, the retear rate is alarmingly higher than that in young population. This may be caused by adverse biological ''healing environ-ments.''…”

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confidence: 99%

“…26,28 The bone quality at the repaired interface is also an important factor that has been recently observed to influence rotator cuff healing. 17,32,33,37,42 Lower bone mineral density (BMD) found in osteoporotic status affects the insertion strength and tendon failure stress of the native rotator cuff. 5,27 Several approaches that increase bone density at the tendon attachment site of the humeral head have been shown to improve the mechanical properties of native or repaired rotator cuffs.…”

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confidence: 99%

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The Effect of Antiosteoporosis Therapy With Risedronate on Rotator Cuff Healing in an Osteoporotic Rat Model

Chen

et al. 2021

Am J Sports Med

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Background: Osteoporosis increases the revision rate of rotator cuff repair (RCR). Weak fixation might not be the only cause of high RCR failure rates. The biological mechanism associated with tendon-to-bone healing after RCR in osteoporosis should be investigated. Hypothesis: (1) Osteoporosis would impair rotator cuff healing through the high osteoclastic activity at the repaired interface. (2) Risedronate would promote rotator cuff healing by reducing osteoclastic activity at the repaired interface. Study Design: Controlled laboratory study. Methods: A total of 84 female Sprague Dawley rats were randomly treated using ovariectomy or sham surgeries to establish osteoporotic and nonosteoporotic rat models. After confirming osteoporosis, a chronic rotator cuff tear model was created and RCR was performed. Postoperatively, osteoporotic rats were randomly divided into osteoporosis (OP) and osteoporosis with risedronate administration (OP+RIS) groups. Nonosteoporotic rats were used as the control (CON) group. Osteoclastic activity was measured at 1 and 3 weeks after RCR, and histologic analysis of the tendon-to-bone interface, bone morphometric evaluation, and biomechanical tests were performed at 4 and 8 weeks. Results: At the early healing stages of 1 and 3 weeks after RCR, the OP group showed the highest osteoclast density at the repaired interface. Compared with the OP group, risedronate administration significantly decreased osteoclast density in the OP+RIS group. At 8 weeks, histologic scores were greater in the OP+RIS group than in the OP group but still lower than in the CON group. Histologic scores at 8 weeks were negatively correlated with osteoclast density at the early healing stage. Additionally, the OP+RIS group showed better bone morphometric parameters and biomechanical properties than did the OP group. Conclusion: Osteoporosis impaired rotator cuff healing, which might be related to the high osteoclast density at the repaired interface at the early healing stage. Postoperative risedronate administration decreased osteoclast density and enhanced rotator cuff healing in osteoporotic rats, although the effect was inferior to that in nonosteoporotic rats. Clinical Relevance: Postoperative risedronate administration can be considered a potential therapy to enhance rotator cuff healing in patients with postmenopausal osteoporosis. However, this needs to be verified in a clinical setting.

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Section: Discussionmentioning

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The Effect of Antiosteoporosis Therapy With Risedronate on Rotator Cuff Healing in an Osteoporotic Rat Model

Chen

et al. 2021

Am J Sports Med

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“…According to Tanaka et al, 37 ovariectomized rats showed decreased biomechanical properties and poor development of chondroid tissue that influenced the repair of the tendon insertion postoperatively. Kim et al 14 reported that the combination treatment of raloxifene and vitamin D prevented a decrease in local bone mineral density and enhanced tendon-to-bone healing of the rotator cuff in a rat model.…”

Section: Discussionmentioning

confidence: 99%

Poor Prognostic Factors in Patients With Rotator Cuff Retear

Kim

Yang

Shin

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: The treatment for retears after arthroscopic rotator cuff repair (ARCR) has long been a challenge. Purpose: This study aimed to (1) summarize the characteristics of patients with a retear after primary ARCR and (2) determine the risk factors for poor clinical outcomes after a retear. Study Design: Case-control study; Level of evidence, 3. Methods: We collected the data of patients with a retear after primary ARCR between January 2011 and December 2016. There were 45 patients with retears included (19 men [42.2%] and 26 women [57.8%]; mean ± SD age, 63.11 ± 8.87 years). Initially, the demographic and outcome data of patients with a retear were analyzed. Patients were classified into good and poor outcome groups according to their overall satisfaction at final follow-up. Univariable and multivariable logistic regression analyses were performed to determine the factors for poor clinical outcomes after a retear. Results: A total of 31 patients were classified into the good outcome group, and 14 patients were classified into the poor outcome group. Both the good and the poor outcome groups showed that clinical scores significantly improved at the time of the retear diagnosis, but the final scores were maintained or worse compared with scores at the time of the retear diagnosis. Final range of motion (ROM), except external rotation in the good outcome group, was worse or had no significant change compared with ROM at the time of the retear diagnosis. On multivariable logistic regression analysis, current smoking (odds ratio [OR], 45.580 [95% CI, 3.014-689.274]; P = .006), female sex (OR, 32.774 [95% CI, 2.433-441.575]; P = .009), and retears of the same or larger size than the initial tear (OR, 10.261 [95% CI, 1.544-68.202]; P = .016) showed a higher OR for poor clinical outcomes after a retear. Conclusion: Smoking, female sex, and retears of the same or larger size than the initial tear were independent risk factors for poor clinical outcomes after a rotator cuff retear. Final clinical scores and ROM were similar or worse compared with the scores and ROM at the time of the retear diagnosis. Therefore, revision surgery should be actively considered in female patients or those who smoke with poor clinical outcomes and a larger retear size than the preoperative tear size at the time of the retear diagnosis.

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“…However, adequate tendon‐bone healing is not always easily achieved and poses great challenges to patients and orthopaedic physicians. In the past few decades, a number of regenerative strategies have been developed to improve the process of tendon‐bone healing, including the delivery of growth factors 3 , 4 and stem cells 5 , 6 , as well as the use of various biomaterials 7 , 8 , 9 , 10 .…”

Section: Introductionmentioning

confidence: 99%

Effects of Platelet‐Rich Plasma on Tendon‐Bone Healing After Anterior Cruciate Ligament Reconstruction

Chen

Zhu

et al. 2021

Orthopaedic Surgery

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Objective: To investigate the effect of platelet-rich plasma on tendon-bone healing after anterior cruciate ligament reconstruction.Methods: This retrospective study included 85 patients (range, 18-50 years; mean age, 33.95 AE 10.53 years; male/female, 49/36) who underwent anterior cruciate ligament reconstruction using autologous hamstring tendons between August 2017 and June 2019 at our institute. The participants in the study group (n = 42) were injected with platelet-rich plasma at both ends of the tendon graft, while those in the control group (n = 43) received an injection of normal saline. Magnetic resonance imaging signal/noise quotient values of the femoral and tibial ends, knee Lysholm scores, and International Knee Documentation Committee scores were compared at 3, 6, and 12 months postoperatively. Results:The signal/noise quotient values of the femoral and tibial ends in both groups were higher at 6 months than at 3 and 12 months postoperatively. The signal/noise quotient values of the tibial end were significantly lower in the platelet-rich plasma group than in the normal saline group at all follow-up time points (P < 0.05). The signal/noise quotient values of the tibial and femoral ends in both groups were significantly different at 3, 6, and 12 months postoperatively (P < 0.05). Additionally, the signal/noise quotient values of the tibia were significantly lower than those of the femur in both groups (P < 0.05). The Lysholm and International Knee Documentation Committee scores were significantly better in the platelet-rich plasma group than in the normal saline group only at 3 months postoperatively. No complications, such as knee joint infection or vascular and nerve injuries, occurred in any of the 85 patients. The knee flexion of all patients were more than 90 , and the straight degree was 0 . No joint stiffness was observed in all patients. Conclusion:Platelet-rich plasma can promote tendon-bone healing in grafts and can improve early postoperative knee joint function.

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A Combination Treatment of Raloxifene and Vitamin D Enhances Bone-to-Tendon Healing of the Rotator Cuff in a Rat Model

Cited by 20 publications

References 32 publications

The Effect of Antiosteoporosis Therapy With Risedronate on Rotator Cuff Healing in an Osteoporotic Rat Model

The Effect of Antiosteoporosis Therapy With Risedronate on Rotator Cuff Healing in an Osteoporotic Rat Model

Poor Prognostic Factors in Patients With Rotator Cuff Retear

Effects of Platelet‐Rich Plasma on Tendon‐Bone Healing After Anterior Cruciate Ligament Reconstruction

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