Do Patient Age and Sex Influence Tendon Cell Biology and Clinical/Radiographic Outcomes After Rotator Cuff Repair?

Pauly, Stephan; Stahnke, Katharina; Klatte‐Schulz, Franka; Wildemann, Britt; Scheibel, Markus; Greiner, Stefan

doi:10.1177/0363546514562552

Cited by 34 publications

(21 citation statements)

References 64 publications

(107 reference statements)

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“…Moreover, it was demonstrated for the first time that tenocyte communication with macrophages results in a varied surface marker expression pattern and modifies cytokine release levels. Our data are robust because we have a relatively large donor number of 10 compared to other studies, and we have controlled for the tenocyte source, sex and age of the donors, using only supraspinatus tendons from 46–69 (median 59.5) year old male patients, since age and sex have been shown to impact tenocyte biology 26 , 27 .…”

Section: Discussionmentioning

confidence: 79%

New insights into tenocyte-immune cell interplay in an in vitro model of inflammation

Stolk

Klatte‐Schulz

Schmock

et al. 2017

Sci Rep

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Inflammation plays an important role in the development and resolution of tendon diseases, but underlying mechanisms are poorly understood. We therefore aimed to analyze the response of human tenocytes to inflammatory stimuli and to uncover their interplay with macrophages in vitro. Tenocytes from human ruptured supraspinatus tendons (n = 10) were treated for three days with a stimulation mixture derived from activated mononuclear cells isolated from healthy human peripheral blood. Significantly increased expression levels of selected adhesion- and human leukocyte antigen (HLA)-molecules, and enhanced interleukin (IL)-6 release were detected by flow cytometry. Tenocyte stimulation with the pro-inflammatory cytokines interferon gamma, tumor necrosis factor alpha and IL-1ß triggered similar changes in surface markers and enhanced the release of IL-6, IL-8 and monocyte chemoattractant protein 1 (MCP-1). In co-cultures of macrophages with pre-stimulated tenocytes, macrophages significantly increased CD80 expression, but simultaneously decreased HLA-DR-expression, which are both typical pro-inflammatory polarization markers. Co-cultures also released more IL-6, IL-8, MCP-1 than tenocyte-cultures alone. We demonstrate that tenocytes respond to inflammatory environments in vitro with altered surface marker and cytokine profiles and influence macrophage polarization. Importantly, all changes detected in direct co-cultures were also present in a transwell setting, implicating that communication between the cells involves soluble factors.

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Section: Discussionmentioning

confidence: 79%

New insights into tenocyte-immune cell interplay in an in vitro model of inflammation

Stolk

Klatte‐Schulz

Schmock

et al. 2017

Sci Rep

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“…We included 38 studies with 3072 patients for full-text review, as well as in the meta-analysis, as they met the final inclusion criteria. 1 , 4 , 40 , 41 , 42 , 43 , 44 , 46 , 5 , 50 , 52 , 53 , 54 , 56 , 57 , 6 , 8 , 10 , 11 , 12 , 13 , 14 , 15 , 20 , 21 , 22 , 23 , 25 , 28 , 29 , 31 , 32 , 33 , 34 , 36 , 37 , 38 , 39 , 4 , 40 , 41 , 42 , 43 , 44 , 46 , 50 , 52 , 53 , 54 , 56 , 57 The study characteristics of each included cohort are shown in Table I . A forest plot of retear rates is shown in Figure 2 .…”

Section: Resultsmentioning

confidence: 99%

The effect of age on risk of retear after rotator cuff repair: a systematic review and meta-analysis

Khazzam¹,

Sager²,

Box³

et al. 2020

JSES International

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Hypothesis The purpose of this study was to perform a systematic review and meta-analysis to determine the effect of age on rotator cuff repair failure. The hypothesis of this study was that increased patient age would lead to a higher rate of retears and/or repair failures after rotator cuff repair. Methods We conducted a systematic review and meta-analysis of level I and II studies evaluating patients undergoing rotator cuff repair that also included an imaging assessment of the structural integrity of the repair. Univariate and multivariate meta-regression was performed to assess the dependence of the retear rate on the mean age of the cohort, imaging modality, time to imaging, and publication year. Results The meta-regression included 38 studies with a total of 3072 patients. Significant heterogeneity in retear rates was found among the studies ( Q = 209.53, I 2 = 82.34, P < .001). By use of a random-effects model, the retear rate point estimate was 22.1% (95% confidence interval [CI], 18.6%-26.0%). On univariate analysis, type of imaging modality did not significantly influence the retear rate ( P = .188). On univariate analysis, mean age (odds ratio [OR], 1.05 [95% CI, 1.01-1.09]; P = .027) and mean time to imaging (OR, 1.04 [95% CI, 1.01-1.08]; P = .006) were associated with the retear rate. Publication year (OR, 0.94 [95% CI, 0.88-1.01]; P = .083) demonstrated a trend toward significance. On multivariate analysis, increased age was associated with a 5%/yr increased odds of retear (OR, 1.05 [95% CI, 1.01-1.08]; P = .025). The risk of retear doubled from 15% at age 50 years to >30% at age 70 years. Time to imaging demonstrated a trend toward increased odds of retear (OR, 1.03 [95% CI, 1.00-1.07]; P = .056). Publication year was not associated with the retear rate on multivariate analysis (OR, 0.96 [95% CI, 0.90-1.02]; P = .195). Conclusion The risk of retear after rotator cuff repair is associated with increased age and doubles between the ages of 50 and 70 years.

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“…Longo et al found that thinning and disorientation of the collagen fibers were more pronounced in biopsies from rotator cuff tears compared with cadaveric samples and that the pathologic score of ruptured tendons was poorer in comparison with that of the control cadaver samples [ 15 , 16 ]. Pauly et al [ 23 ] found decreased cell growth and a reduced amount of collagen type I in patients scheduled for rotator cuff repair. Both human and animal studies have demonstrated collagen cell alteration in Achilles tendinopathy.…”

Section: Discussionmentioning

confidence: 99%

More histologic and ultrastructural degenerative signs in the subscapularis tendon and the joint capsule in male patients with shoulder impingement

Farfaras

Ejerhed

Hallström

et al. 2017

Knee Surg Sports Traumatol Arthrosc

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PurposeThe purpose of the present study was to analyze biopsy samples from the subscapularis tendon and from the joint capsule from male patients with shoulder impingement syndrome (SAIS) and compare them with samples from male patients with post-traumatic recurrent shoulder instability. The hypothesis of the study was that patients with SAIS would have more histologic and ultrastructural degenerative changes in their subscapularis tendon and joint capsule than patients with post-traumatic recurrent shoulder instability.MethodsMale patients scheduled for surgery, with either subacromial decompression or Bankart reconstruction, were included. Four biopsies from each patient were obtained from the capsule and four from the subscapularis tendon during arthroscopic surgery. The histologic characteristics and the presence of glycosaminoglycans were assessed using the light microscope, and the ultrastructure was assessed using a transmission electron microscope.ResultsEight patients, median age 53 (45–74) years (p < 0.0001), were included in the impingement group, and 12 patients, median age 27 (22–48) years, were included in the instability group. The histologic assessment revealed significantly higher cellularity and total degeneration score in the capsule (p = 0.016 and p = 0.014 respectively) in patients with subacromial impingement compared with the instability patients. The corresponding finding was not made for the subscapularis tendon. The ultrastructural evaluation revealed that the instability patients had more fibrils with a large diameter (indicating less degeneration) in both the subscapularis tendon and the capsule compared with the impingement patients (p < 0.0001).ConclusionMale patients with subacromial impingement have more histologic and ultrastructural degenerative changes in their shoulder compared with patients with post-traumatic recurrent shoulder instability.Clinical relevanceIt appears that in patients with subacromial impingement, the whole shoulder joint is affected and not only the subacromial space. It is the opinion of the authors that intra-articular therapeutic injections could be tried more often in these patients.Level of evidenceIII.

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Do Patient Age and Sex Influence Tendon Cell Biology and Clinical/Radiographic Outcomes After Rotator Cuff Repair?

Abstract: Age, but not sex, was found to have a negative effect on RC tendon cell biology. However, neither sex nor, in particular, a higher age influenced repair outcomes after 24 months.

Cited by 34 publications

References 64 publications

New insights into tenocyte-immune cell interplay in an in vitro model of inflammation

New insights into tenocyte-immune cell interplay in an in vitro model of inflammation

The effect of age on risk of retear after rotator cuff repair: a systematic review and meta-analysis

More histologic and ultrastructural degenerative signs in the subscapularis tendon and the joint capsule in male patients with shoulder impingement

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