Macroscopic Rotator Cuff Tendinopathy and Histopathology Do Not Predict Repair Outcomes of Rotator Cuff Tears

Sethi, Paul M.; Sheth, Chirag D.; Pauzenberger, Leo; McCarthy, Mary Beth; Cote, Mark P.; Soneson, Emma; Miller, Steven; Mazzocca, Augustus D.

doi:10.1177/0363546517746986

Cited by 28 publications

(24 citation statements)

References 13 publications

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“…Multiple groups have performed destructive testing on ovine infraspinatus tendons and reported decreases in ultimate load between 2,754. (13,(49)(50)(51). Translatable changes include those defined in the semi-quantitative Bonar scoring (Figure 4).…”

Section: Discussionmentioning

confidence: 99%

Enthesis trauma as a means for the development of translatable chronic rotator cuff degeneration in an ovine model

Johnson¹,

Stade²,

Regan³

et al. 2021

Ann Transl Med

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Background: Untreated rotator cuff tears lead to irreversible tendon degeneration, resulting in unacceptable repair prognosis. The inability of current animal models of degenerated rotator cuff tendons to more fully emulate the manifestation and degree of pathology seen in humans with a previously torn rotator cuff tendon (s) significantly impairs the development of novel therapeutics. Therefore, the objective of this study was to develop a large-animal translational model of enthesis damage to the rotator cuff tendons to mimic the chronic degenerative changes that occur in patients that demonstrate clinical manifestations of tendinopathy.Methods: A partial enthesis tear model (i.e., sharp transection) in adult sheep was created by cutting the tendon fibers perpendicularly through the enthesis midpoint, while leaving the other portion of the tendon in-tact. To assess tendon integrity, non-destructive biomechanical tests were performed, followed by histopathological, histomorphological, and gene expression analysis. Samples of degenerated human rotator cuff tendons obtained from patients undergoing reverse total shoulder arthroplasty to use for comparative pathological analysis.Results: In the sheep model, transected tendons at all timepoints had significantly decreased mechanical properties. Histopathologic evaluation and Bonar scoring revealed that the tendons in sheep underwent degenerative changes similar in magnitude and manifestation as the degenerated human tendon samples. Furthermore, similar levels of collagen disorganization were noted between the 6 and 12-week ovine samples and the degenerated human samples. Conclusions: These findings indicate that the new sheep model of rotator cuff injury reliably recapitulates the structural and cellular changes that occur clinically in humans with chronic rotator cuff tendon injuries and suggest that this new model is well suited to evaluation of new therapeutic interventions.

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Section: Discussionmentioning

confidence: 99%

Enthesis trauma as a means for the development of translatable chronic rotator cuff degeneration in an ovine model

Johnson¹,

Stade²,

Regan³

et al. 2021

Ann Transl Med

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“…Regarding the analysis of the histological and macroscopic quality of the tendon, it has been suggested that a worse quality tendon would lead to worse healing rates. However, Mazzoca et al 17 showed that there is no correlation between the macroscopic appearance of the tendon in the arthroscopy, or in the histological analysis, and healing. Furthermore, they showed that the macroscopic appearance is not correlated with the histological quality of the tendon, and there is no association between the degree of histological tendinopathy, the macroscopic appearance and the healing index or clinical results of the repair.…”

Section: Local Factorsmentioning

confidence: 99%

“…Em relação à análise da qualidade histológica e macroscópica do tendão, foi sugerido que um tendão de qualidade pior acarretaria piores índices de cicatrização. Contudo, Mazzoca et al 17 mostraram que não há correlação entre a aparência macroscópica do tendão na artroscopia, ou na análise histológica, e a cicatrização. Mais ainda, mostraram que a aparência macroscópica não é correlacionada com a qualidade histológica do tendão, não havendo associação entre o grau de tendinopatia histológica, a aparência macroscópica e o índice de cicatrização ou resultados clínicos do reparo.…”

Section: Qualidade Histológica E Macroscópica Do Tendãounclassified

A cicatrização do manguito rotador

Filho

Coelho

2020

Rev Bras Ortop (Sao Paulo)

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ResumoO presente artigo aborda de forma ampla os aspectos que interferem no processo de cicatrização do manguito rotador. São considerados hábitos de vida como tabagismo e alcoolismo, fatores sistêmicos como diabetes mellitus, hipertensão arterial e obesidade bem como fatores locais, dentre os quais aqueles relacionados ao pré, per e pós operatório. A partir de uma extensa revisão da literatura, com a citação de 60 artigos científicos tanto da literatura ocidental como oriental, os autores pretendem aprofundar no tema trazendo para a prática médica condutas embasadas em novos conceitos estabelecidos.

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“…Each variable is assessed on the scale of 0 to 3 points, where 0 indicates a normal appearance of tendinous tissue and 3 indicates the most severe detectable pathology [24]. The Bonar scoring system serves in the microscopic evaluation of the various regions of tendon pathology, but on the other side, it can be easily used reversely to investigate the decreasing degeneration after effective treatment and quantify the healing progress [24,[26][27][28][29][30]. The link between the histopathological scale and therapeutic advances of various treatment methods in chronic tendon disorders has been evaluated in only a few studies.…”

Section: Introductionmentioning

confidence: 99%

Therapeutic Advances in Tendinopathy Quantified Microscopically Using Bonar Score, with a Special Reference to PRP Therapy—A Systematic Review of Experimental Studies

et al. 2021

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(1) Background: The Bonar scoring system serves in the microscopic evaluation of tendon pathology. However, it can be easily adapted to investigate decreasing degeneration after treatment and quantify the healing progress. We believe that there is an actual need for a connection between clinical observations and tissue alterations arising during the treatment process, to gain superior functional outcomes. Herein, we perform a systematic review of the Bonar score’s application in the histopathological assessment of therapeutic advances in tendinopathy, with special reference to PRP therapy. (2) Methods: A systematic review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The searching strategy was conducted across major databases: PubMed, Cochrane Central, ScienceDirect, SciELO, and Web of Science. The risk-of-bias assessment was made using the Cochrane Collaboration’s Risk of Bias Tool and SYRCLE. (3) Results: The searching strategy produced 807 articles, and after selection, 22 studies were included. We collected 21 animal studies (n = 472) and 1 human study (n = 45). Three types of tendons were taken into account: 14 Achilles tendons, 7 supraspinatus tendons (SST), and in 1 case, Achilles and patellar tendons simultaneously. A variety of therapeutic methods were used—from intra-tendinous substance injections to surgical procedures or mechanical stimuli—but platelet-rich plasma (PRP) therapy dominated among them and was present in six studies. Most of the collected studies included an assessment of the tendons’ histopathology based on the classical Bonar score (with four variables and one observer). The staining protocol was based on the hematoxylin and eosin technique. An evaluation of therapeutic effects showed 15 positive results, 6 negative results, and 1 neutral result of treatments. (4) Conclusions: To understand the tendinopathy phenomenon, a link between histopathology and clinical observations in chronic tendon disorders is required due to the possibility of functional outcome improvements. The Bonar scoring system is well established in tendon pathology assessment and could also be adopted to assess therapeutic results in tendon disorders. Studies that included the PRP application showed Bonar-scoring-system-based evidence of superior tendinous tissue healing related to improved clinical results.

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Macroscopic Rotator Cuff Tendinopathy and Histopathology Do Not Predict Repair Outcomes of Rotator Cuff Tears

Cited by 28 publications

References 13 publications

Enthesis trauma as a means for the development of translatable chronic rotator cuff degeneration in an ovine model

Enthesis trauma as a means for the development of translatable chronic rotator cuff degeneration in an ovine model

A cicatrização do manguito rotador

Therapeutic Advances in Tendinopathy Quantified Microscopically Using Bonar Score, with a Special Reference to PRP Therapy—A Systematic Review of Experimental Studies

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