Retracted Rotator Cuff Repairs Heal With Disorganized Fibrogenesis Without Affecting Biomechanical Properties: A Comparative Animal Model Study

Rhee, Sung Min; Youn, Seung-Min; Ko, Young Gwan; Kwon, Tae Yoon; Park, Yong Koo; Rhee, Yong Girl

doi:10.1016/j.arthro.2021.06.025

Cited by 9 publications

(5 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…13 During rotator cuff healing after rotator cuff repair, inflammatory cells accumulate and result in fibrotic tissue formation, which impairs tendon healing instead of regenerating the tendon itself. 13,28,34 HA possesses anti-inflammatory properties; thus, it promotes tendon-to-bone healing. 8 Moreover, HA binds and interacts with specific cell-associated receptors, such as CD44.…”

Section: Discussionmentioning

confidence: 99%

“…However, numerous studies of the animal models on the rotator cuff tendon were done by using rabbits. [9][10][11]28 Furthermore, there is a study suggesting that the rotator cuff muscles of smaller animals such as rabbits more closely match those of the humans than does the relatively physiological crosssectional area of the larger quadrupeds. 16 Second, unlike chronic rotator cuff tears in humans induced by repeated stress, we simulated the chronic rotator cuff tear rabbit model by detaching and leaving the rabbits' supraspinatus tendons for 6 weeks.…”

Section: Limitationsmentioning

confidence: 99%

See 1 more Smart Citation

The Effect of Combining Hyaluronic Acid and Human Dermal Fibroblasts on Tendon Healing

Rhee,

Jeon,

Han

et al. 2023

Am J Sports Med

Self Cite

View full text Add to dashboard Cite

Background: The incidence of rotator cuff tears is rapidly increasing, and operative techniques for rotator cuff repair have been developed. However, the rates of postoperative retear remain high. Purpose/Hypothesis: The purpose was to determine the effects of human dermal fibroblasts (HDFs) with hyaluronic acid (HA) on tendon-to-bone healing in a rabbit model of chronic rotator cuff tear injury. It was hypothesized that HA would enhance HDF proliferation and that a combination of HA and HDFs would produce a synergistic effect on the healing of repaired rotator cuff tendons of rabbits. Study Design: Controlled laboratory study. Methods: For in vitro study, HDFs were plated on a 24-well plate. After 1 day, 2 wells were designated as the test group and treated with 0.75% HA in phenol red–free Dulbecco's modified Eagle medium (DMEM). An other 2 wells served as control groups and were treated with the same volume of phenol red–free DMEM without HA. Each group was duplicated, resulting in a total of 4 wells, with 2 wells in each group for replication purposes. The cells were incubated for 24 hours, followed by 72-hour cultivation. Absorbance ratios at 96 and 24 hours were compared to evaluate cell proliferation. For the in vivo study, a total of 24 rabbits were randomly allocated to groups A, B, and C (n = 8 each). Supraspinatus tendons were detached bilaterally and left for 6 weeks to establish a chronic rotator tear model. Torn tendons were subsequently repaired using the following injections: group A, 0.5 × 106 HDFs with HA; group B, HA only; and group C, saline only. At 12 weeks after repair, biomechanical tests and histological evaluation were performed. Results: In vitro study showed that HDF proliferation significantly increased with HA (HDFs with HA vs HDFs without HA; 3.96 ± 0.09 vs 2.53 ± 0.15; P < .01). In vivo, group A showed significantly higher load-to-failure values than the other groups (53.8 ± 6.9 N/kg for group A, 30.6 ± 6.4 N/kg for group B, and 24.3 ± 7.6 N/kg for group C; P < .001). Histological evaluation confirmed that group A showed higher collagen fiber density and better collagen fiber continuity, tendon-to-bone interface maturation, and nuclear shape than the other groups (all P < .05). Conclusion: This controlled laboratory study verified the potential of the combination of HDFs and HA in enhancing healing in a chronic rotator cuff tear rabbit model. Clinical Relevance: A potential synergistic effect on rotator cuff tendon healing may be expected from a combination of HDFs and HA.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

The Effect of Combining Hyaluronic Acid and Human Dermal Fibroblasts on Tendon Healing

Rhee,

Jeon,

Han

et al. 2023

Am J Sports Med

Self Cite

View full text Add to dashboard Cite

show abstract

“…11,15,31 However, in the natural history of PTRCT, tear size may decrease in 4% to 25% of patients, although this rate is not high. 15,17,20 Such a decrease in tear size may be related to the formation of scar or fibrotic tissues in the tear defects 7,26 or healing of the torn rotator cuff. 17 However, the detailed mechanisms are unknown.…”

Section: Discussionmentioning

confidence: 99%

Progression of Symptomatic Partial-Thickness Rotator Cuff Tears: Association With Initial Tear Involvement and Work Level

Jeon

Kim

2022

Orthopaedic Journal of Sports Medicine

View full text Add to dashboard Cite

Background: Partial-thickness rotator cuff tears (PTRCTs) often progress to full-thickness rotator cuff tears (FTRCTs). Thus, it is important to analyze the risk factors for tear progression to determine the proper timing of repair. Purpose: To identify the risk factors associated with progression of PTRCT. Study Design: Case-control study; Level of evidence, 3. Methods: Included were 89 patients diagnosed with PTRCT on magnetic resonance imaging (MRI) scans who underwent nonoperative treatment at the authors’ institution between August 2012 and August 2019. Patient characteristics, shoulder stiffness (compared with the contralateral shoulder); work level (classified as high [heavy manual labor], medium [manual labor with less activity], and low [sedentary activity]); and radiological factors including initial tear size, acromion type (flat, curved, hooked, or heel-shaped), and initial tear involvement (as a percentage of the rotator cuff tendon footprint length) were analyzed to assess their association with tear progression, defined as >20% increase in tear involvement. Results: The mean MRI follow-up period was 22.3 ± 17.2 months (median, 16.1 months; range, 6.4-89.5 months), and tear progression was observed in 12 patients (13.5%). In these 12 patients, tear involvement increased by 60% of the rotator cuff footprint, while mediolateral (ML) and anteroposterior (AP) tear sizes progressed by 1.1 and 1.8 mm, respectively. Univariate regression analysis showed that shoulder stiffness ( P = .031), work level ( P = .001), initial tear involvement ( P < .001), ML and AP tear sizes ( P < .001 and P = .005, respectively), and acromion type ( P = .003) were significantly associated with tear progression. Multivariate regression analysis showed that initial tear involvement (odds ratio [OR], 1.053; 95% CI, 1.006-1.102; P = .026) and high work level (OR, 15.831; 95% CI, 1.150-217.856; P = .039) were independent risk factors for tear progression. The cutoff value for initial tear involvement was 47.5% (sensitivity, 81.8%; specificity, 85.7%). Conclusion: Tear progression was observed in 14% of patients with PTRCT in this study. To predict tear progression, evaluating the tear involvement during initial MRI is essential. The risk of tear progression increased with initial tear involvement >47.5% and a heavy work level.

show abstract

“…Moreover, it is still difficult for full rotator cuff function to be recovered. Previous studies [ 2 , 3 ] showed that in the nonretracted and retracted cuff tear model of rabbit or sheep, disorganized immature fibrous tissue bound the tendon-to-bone junction with healing, although there is a difference in degree. For these reasons, treatments using biological adjuvants, which can create a favorable environment for rotator cuff tendons to be regenerated, have been in the limelight.…”

Section: Introductionmentioning

confidence: 99%

Regeneration of Chronic Rotator Cuff Tear in a Rabbit Model: Synergetic Benefits of Human Umbilical Cord Blood-Derived Mesenchymal Stem Cells, Polydeoxyribonucleotides, and Microcurrent Therapy

Kwon

Kim

Moon

2022

BioMed Research International

View full text Add to dashboard Cite

Objective. To investigate synergic therapeutic effects of combined injection of intralesional mesenchymal stem cells derived from human umbilical cord blood (UCB-MSCs) and polydeoxyribonucleotide (PDRN) combined with microcurrent therapy (MIC) on full thickness rotator cuff tendon tear (FTRCTT) in rabbit models. Methods. Thirty-two rabbit models were assigned to 4 different groups. FTRCTT in the supraspinatus tendon was created. After 6 weeks, 4 types of procedures (0.2 mL normal saline injection, group 1 (G1-NS); 0.2 mL SC injection, group 2 (G2-MSC); 0.2 mL SC and weekly four injections of 0.2 mL PDRN with sham MIC, group 3 (G3-MSC+PDRN+sham MIC); and 0.2 mL SC and weekly four injections of 0.2 mL PDRN with MIC for four weeks, group 4 (G4-MSC+PDRN+MIC)) were performed in FTRCTT. Gross morphologic and histological changes of proliferating cell nuclear antigen (PCNA), vascular endothelial growth factor (VEGF) and platelet endothelial cell adhesion molecule (PECAM-1) and motion analysis were performed. Results. There was a significant difference in gross morphologic changes between baseline and week 4 posttreatment in group 4 compared to the other three groups ( p = 0.01 ). In groups 3 and 4, all parameters of histochemical and motion analysis have been found to be significantly greater than the ones in groups 1 and 2 ( p < 0.05 ). In group 4, PCNA-, VEGF-, and PECAM-1-stained cells, as well as walking distance, were significantly greater than the ones in group 3 ( p < 0.05 ). Conclusion. The treatment with UCB-MSCs and PDRN combined with MIC might be the most effective in rabbit models’ traumatic FRTCTT.

show abstract

Retracted Rotator Cuff Repairs Heal With Disorganized Fibrogenesis Without Affecting Biomechanical Properties: A Comparative Animal Model Study

Cited by 9 publications

References 19 publications

The Effect of Combining Hyaluronic Acid and Human Dermal Fibroblasts on Tendon Healing

The Effect of Combining Hyaluronic Acid and Human Dermal Fibroblasts on Tendon Healing

Progression of Symptomatic Partial-Thickness Rotator Cuff Tears: Association With Initial Tear Involvement and Work Level

Regeneration of Chronic Rotator Cuff Tear in a Rabbit Model: Synergetic Benefits of Human Umbilical Cord Blood-Derived Mesenchymal Stem Cells, Polydeoxyribonucleotides, and Microcurrent Therapy

Contact Info

Product

Resources

About