Corticosteroids Reduce the Tensile Strength of Isolated Collagen Fascicles

Haraldsson, Bjarki Thor; Langberg, Henning; Aagaard, Per; Zuurmond, Anne‐Marie; El, B. van; DeGroot, Jeroen; Kjær, Michael; Magnusson, S. Peter

doi:10.1177/0363546506290402

Cited by 64 publications

(44 citation statements)

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“…The main finding of the present study was that individual rat‐tail tendon collagen fascicles had significantly lower yield stress and material stiffness (Young's modulus) 3 days after corticosteroid injection compared with collagen fascicles that were harvested from tails injected with 9% saline, while the strain properties of the fascicles remained unaffected. The present results confirm previous data obtained using an in vitro model (Haraldsson et al, 2006), while demonstrating a deleterious effect of corticosteroid injection on tendon collagen material properties using an in vivo model.…”

Section: Discussionsupporting

confidence: 92%

“…Moreover, it was also recently shown that incubation in corticosteroid solutions for 3 and 7 days markedly reduced the tensile strength of isolated collagen fascicles (Haraldsson et al, 2006). The purpose of the present study was to examine whether the biomechanical effects observed in the aforementioned in vitro study (Haraldsson et al, 2006) could be extended to an in vivo model of intratendinous corticosteroid injections on healthy rat‐tail tendon collagen fascicles. We hypothesized that the collagen fascicles receiving the corticosteroid injection would display reduced biomechanical properties compared with the controls.…”

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confidence: 92%

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Corticosteroid administration alters the mechanical properties of isolated collagen fascicles in rat‐tail tendon

Haraldsson

Aagaard

Crafoord-Larsen

et al. 2009

Scandinavian Med Sci Sports

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Overload tendon injuries are frequent in recreational and elite sports. The optimal treatment strategy remains unknown, but local administration of corticosteroids is one common treatment option. The direct effects of the corticosteroid administration on the tissue are not fully understood. The present study examined the biomechanical effects of intratendinous corticosteroid injections on healthy rat-tail tendon collagen fascicles. A total of 24 Wistar male rats were divided into (A) a corticosteroid group where the animals were injected in the tail tendon with methylprednisolone acetate, 1.0 mL of 40 mg/mL mixed with 1.0 mL 9% saline (n=12), and (B) a control group that was injected with 9% saline (n=12). Three days after the injections, the animals were sacrificed and single individual collagen fascicles were collected and underwent displacement to failure. Corticosteroid administration significantly reduced tensile fascicle yield strength by 16% and Young's modulus by 14% compared with sham treatment (10.5+/-0.8 vs 12.4+/-0.5 MPa, P< or =0.05, and 537+/-27 vs 641+/-30 MPa, P<0.05, respectively), while the strain properties were unaffected. Peak stress was similar between the two groups. There was no difference in fascicle diameter between the two groups.

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Section: Discussionsupporting

confidence: 92%

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confidence: 92%

Corticosteroid administration alters the mechanical properties of isolated collagen fascicles in rat‐tail tendon

Haraldsson

Aagaard

Crafoord-Larsen

et al. 2009

Scandinavian Med Sci Sports

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“…Some authors have hypothesized that any beneficial effects of corticosteroids in this condition are owed to other local steroid effects rather than suppression of inflammation, including lyses of tendon and peritendon adhesions or alteration of the function of pain generating nociceptor in the region [68]. Corticosteroid injections may have some benefit in the short term, but adverse effects were reported in up to 82% of corticosteroid trials [69]; these include tendon atrophy [69], tendon rupture [70], and decreased tendon strength [71, 72]. Corticosteroid injections could cause vasoconstriction through prostacyclin and adrenoceptors and inhibit nitric oxide synthase, which may be the source of adverse effects [20].…”

Section: Treatmentmentioning

confidence: 99%

Achilles Tendinopathy: Current Concepts about the Basic Science and Clinical Treatments

Liu

Hua

2016

BioMed Research International

142

120

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Achilles tendinopathy is one of the most frequently ankle and foot overuse injuries, which is a clinical syndrome characterized by the combination of pain, swelling, and impaired performance. The two main categories of Achilles tendinopathy are classified according to anatomical location and broadly include insertional and noninsertional tendinopathy. The etiology of Achilles tendinopathy is multifactorial including both intrinsic and extrinsic factors. Failed healing response and degenerative changes were found in the tendon. The failed healing response includes three different and continuous stages (reactive tendinopathy, tendon disrepair, and degenerative tendinopathy). The histological studies have demonstrated an increased number of tenocytes and concentration of glycosaminoglycans in the ground substance, disorganization and fragmentation of the collagen, and neovascularization. There are variable conservative and surgical treatment options for Achilles tendinopathy. However, there has not been a gold standard of these treatments because of the controversial clinical results between various studies. In the future, new level I researches will be needed to prove the effect of these treatment options.

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“…For example, a randomized, controlled clinical trial of patients with chronic cuff tendinosis or partial cuff tear reported subacromial injection of betamethasone no more effective in improving the quality of life, Neer impingement sign, and range of motion than xylocaine alone at 2, 6, 12, and 24 weeks after injection [1]. A recent in vitro study attempted to characterize the direct effects of corticosteroids on the mechanical properties and collagen crosslink amount of isolated collagen fascicles [33]. Incubating rat tail collagen fascicles in either high or low concentration of methylprednisolone acetate for 3 or 7 days reduced tensile strength by approximately 45% to 66% compared with saline-treated controls.…”

Section: The Role Of Corticosteroids On Tendon-bone Healingmentioning

confidence: 99%

Biological Augmentation of Rotator Cuff Tendon Repair

Kovacevic

Rodeo

2008

Clinical Orthopaedics &Amp; Related Research

225

181

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A histologically normal insertion site does not regenerate following rotator cuff tendon-to-bone repair, which is likely due to abnormal or insufficient gene expression and/or cell differentiation at the repair site. Techniques to manipulate the biologic events following tendon repair may improve healing. We used a sheep infraspinatus repair model to evaluate the effect of osteoinductive growth factors and BMP-12 on tendon-to-bone healing. Magnetic resonance imaging and histology showed increased formation of new bone and fibrocartilage at the healing tendon attachment site in the treated animals, and biomechanical testing showed improved load-to-failure. Other techniques with potential to augment repair site biology include use of platelets isolated from autologous blood to deliver growth factors to a tendon repair site. Modalities that improve local vascularity, such as pulsed ultrasound, have the potential to augment rotator cuff healing. Important information about the biology of tendon healing can also be gained from studies of substances that inhibit healing, such as nicotine and antiinflammatory medications. Future approaches may include the use of stem cells and transcription factors to induce formation of the native tendon-bone insertion site after rotator cuff repair surgery.

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Corticosteroids Reduce the Tensile Strength of Isolated Collagen Fascicles

Abstract: Corticosteroids may weaken specific regions of the injected tendon and leave it more prone to rupture. This weakening effect is manifested in the individual collagen fascicles that constitute the tendon.

Cited by 64 publications

References 43 publications

Corticosteroid administration alters the mechanical properties of isolated collagen fascicles in rat‐tail tendon

Corticosteroid administration alters the mechanical properties of isolated collagen fascicles in rat‐tail tendon

Achilles Tendinopathy: Current Concepts about the Basic Science and Clinical Treatments

Biological Augmentation of Rotator Cuff Tendon Repair

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