Blood supply of the subacromial bursa and rotator cuff tendons on the bursal side

Põldoja, Elle; Rahu, Madis; Kask, Kristo; Weyers, Imke; Kolts, Ivo

doi:10.1007/s00167-016-4379-4

Cited by 24 publications

(30 citation statements)

References 30 publications

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“…When compared to healthy bursae, tissue from the pathology groups 2–4 scored higher in the histological score classification system with respect to the number of fibroblasts, blood vessels and nerve fibers present. These results are in accordance with previous findings, showing that altered bursa tissue is well vascularized [ 12 ] and a rich source of cells such as fibroblasts, synoviocytes, endothelial cells and immune cells [ 13 , 29 ]. The present study supports the presence of leukocytes and monocytes/macrophages in bursae of pathological shoulders.…”

Section: Discussionsupporting

confidence: 93%

Histological and molecular features of the subacromial bursa of rotator cuff tears compared to non-tendon defects: a pilot study

Minkwitz

Thiele

Schmock

et al. 2021

BMC Musculoskelet Disord

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Background The role of the subacromial bursa in the development or healing of shoulder pathologies is unclear. Due to this limited knowledge, we aimed to understand specific reactions of the subacromial bursa according to rotator cuff (RC) pathologies compared to non-tendon defects of the shoulder. We hypothesized that the tissue composition and inflammatory status of the bursa are likely to vary between shoulder pathologies depending on the presence and the extent of RC lesion. Method Bursa samples from patients with either 1) shoulder instability with intact RC (healthy bursa, control), 2) osteochondral pathology with intact RC, 3) partial supraspinatus (SSP) tendon tear, or 4) full-thickness SSP tear were investigated histologically and on gene expression level. Result Bursae from SSP tears differed from non-tendon pathologies by exhibiting increased chondral metaplasia and TGFβ1 expression. MMP1 was not expressed in healthy bursa controls, but strongly increased with full-thickness SSP tears. Additionally, the expression of the inflammatory mediators IL1β, IL6, and COX2 increased with the extent of SSP tear as shown by correlation analysis. In contrast, increased angiogenesis and nerve fibers as well as significantly upregulated IL6 and COX2 expression were features of bursae from patients with osteochondral pathology. Using immunohistochemistry, CD45+ leukocytes were observed in all examined groups, which were identified in particular as CD68+ monocytes/macrophages. Conclusion In summary, besides the strong increase in MMP1 expression with SSP tear, molecular changes were minor between the investigated groups. However, expression of pro-inflammatory cytokines correlated with the severity of the SSP tear. Most pronounced tissue alterations occurred for the osteochondral pathology and full-thickness SSP tear group, which demonstrates that the bursal reaction is not exclusively dependent on the occurrence of an SSP tear rather than longstanding degenerative changes. The present bursa characterization contributes to the understanding of specific tissue alterations related to RC tears or non-tendon shoulder pathologies. This pilot study provides the basis for future studies elucidating the role of the subacromial bursa in the development or healing of shoulder pathologies.

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Section: Discussionsupporting

confidence: 93%

Histological and molecular features of the subacromial bursa of rotator cuff tears compared to non-tendon defects: a pilot study

Minkwitz

Thiele

Schmock

et al. 2021

BMC Musculoskelet Disord

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“…This is because the structural integrity and mechanical strength of injured rotator cuff tendon are far less than the original tendon. The underlying mechanism for this phenomenon is that the tendon lacks cells and blood supply and the regeneration ability is weak (Barile et al, 2017;Põldoja et al, 2017). Although physical methods can be used clinically, such as improving suture methods and knotting techniques to reduce the chance of suture prolapse (Kunze et al, 2020;Sundaram et al, 2020), only fundamental enhancement of regeneration ability of the rotator cuff tendon can make a big difference.…”

Section: Surgeries For Rotator Cuff Repairmentioning

confidence: 99%

Current Biological Strategies to Enhance Surgical Treatment for Rotator Cuff Repair

Zhang

et al. 2021

Front. Bioeng. Biotechnol.

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Rotator cuff tear is one of the most common shoulder problems encountered by orthopedic surgeons. Due to the slow healing process and high retear rate, rotator cuff tear has distressed millions of people all around the world every year, especially for the elderly and active athletes. This disease significantly impairs patients’ motor ability and reduces their quality of life. Besides conservative treatment, open and arthroscopic surgery contributes a lot to accelerate the healing process of rotator cuff tear. Currently, there are many emerging novel treatment methods to promote rotator cuff repair. A variety of biological stimulus has been utilized in clinical practice. Among them, platelet-rich plasma, growth factors, stem cells, and exosomes are the most popular biologics in laboratory research and clinical trials. This review will focus on the biologics of bioaugmentation methods for rotator cuff repair and tendon healing, including platelet-rich plasma, growth factors, exosomes and stem cells, etc. Relevant studies are summarized in this review and future research perspectives are introduced.

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“…4 This hypothesis has been contradicted in other studies, and a recent level 1 study has reported better outcomes with limited bursectomy. [5][6][7][8] The regenerative potential of subacromial bursal cells has been evaluated in basic science studies and the possible advantages of increased healing potential and better incorporation of the cuff at the tendonebone interface have been suggested. 2,3,9 The subacromial bursa extends from medial to lateral across the posterosuperior rotator cuff and is relatively thicker and structurally stronger medially and posteriorly.…”

Section: Pitfallsmentioning

confidence: 99%

Arthroscopic Bursa-Augmented Rotator Cuff Repair: A Vasculature-preserving Technique for Subacromial Bursal Harvest and Tendon Augmentation

Bhatia

2021

Arthroscopy Techniques

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Rotator cuff repairs are associated with suboptimal outcomes and possibly greater incidence of retears if the biological healing environment is compromised. Strategies to optimize tendon–bone healing include the use of bioinductive scaffolds and regenerative stem cell therapy. The subacromial bursa has been shown to have significant pluripotent stem cell potency for tendon healing and has the advantage of easy accessibility and no added cost. However, a reproducible surgical technique for bursal mobilization, harvest, and vascularity preservation has not been described. We describe our technique for vasculature-preserving bursal mobilization and harvest of the entire posterosuperior and lateral subacromial bursa, and its use in rotator cuff repair augmentation is presented. The technique involves mobilization of the bursa as a continuous layer by maintain its medial and lateral vascularity. The bursa is advanced laterally, and the “vascular bursal duvet” and cuff tendons are repaired together as a tendon–bursa unit.

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Blood supply of the subacromial bursa and rotator cuff tendons on the bursal side

Cited by 24 publications

References 30 publications

Histological and molecular features of the subacromial bursa of rotator cuff tears compared to non-tendon defects: a pilot study

Histological and molecular features of the subacromial bursa of rotator cuff tears compared to non-tendon defects: a pilot study

Current Biological Strategies to Enhance Surgical Treatment for Rotator Cuff Repair

Arthroscopic Bursa-Augmented Rotator Cuff Repair: A Vasculature-preserving Technique for Subacromial Bursal Harvest and Tendon Augmentation

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