Rotator cuff re-tear or non-healing: histopathological aspects and predictive factors

Chillemi, Claudio; Petrozza, Vincenzo; Garro, Luca; Sardella, Barbara; Diotallevi, R.; Ferrara, Antonella; Gigante, Antonio; Cristofano, Claudio Di; Castagna, Alessandro; Rocca, Carlo Della

doi:10.1007/s00167-011-1521-1

Cited by 87 publications

(71 citation statements)

References 37 publications

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“…It is postulated that increased fibrosis results in higher tension in the muscle in RC tears, thus making repair more challenging in chronic, retracted tears. In a clinical setting, fibrosis has been found in human RC tissue at time of repair and has been correlated with decreased force production and increased disruption of myofibril architecture 6,[22][23][24] . Fibrosis has also been identified as a direct cause of muscle dysfunction in muscular dystrophy.…”

Section: @ C I C E D I Z I O N I I N T E R N a Z I O N A L Imentioning

confidence: 99%

Investigating the cellular origin of rotator cuff muscle fatty infiltration and fibrosis after injury

Liu

Ning

Chang

et al. 2016

MLTJ

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SummaryBackground: rotator cuff muscle atrophy, fibrosis and fatty infiltration are common complications after large and massive rotator cuff tears. Currently, there are no effective treatments for these muscle pathologies after injury. Furthermore, the cellular source for fibrotic and adipose tissues in rotator cuff muscle after injury remains unknown. In this study, we proposed that two groups of muscle resident progenitors, Tie2+ muscle mesenchymal progenitors and PDGFRα + fibro/adipogenic progenitor cells (FAPs), contribute significantly to rotator cuff muscle fibrosis and fatty infiltration. Methods: we tested our hypothesis using reporter mice. Rotator cuff muscles from Tie2-GFP and PDGFRα-GFP reporter mice were harvested at 2 and 6 weeks after unilateral massive rotator cuff tear surgeries. Immunofluorescent staining for fibroblast and adipocyte markers was conducted. Results: our results showed significant co-localization of Tie2+ cells with fibrotic markers vimentin and αSMA. In the PDGFRα-GFP reporter mice, GFP signal was seen in only a small fraction of cells staining positive for vimentin and αSMA. However, PDGFRα showed significant co-localization with adipocyte markers, including PPAR-γ, adiponectin, and perilipin A. Oil red O staining confirmed that the mature adipocytes appearing in rotator cuff muscles after injury are also PDGFRα + . Conclusion: these data demonstrated that the Tie2 + muscle mesenchymal progenitors are the major source of fibroblasts while PDGFRα + FAPs are the major source of adipocytes in rotator cuff muscle fatty infiltration. Basic Science Study.

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Section: @ C I C E D I Z I O N I I N T E R N a Z I O N A L Imentioning

confidence: 99%

Investigating the cellular origin of rotator cuff muscle fatty infiltration and fibrosis after injury

Liu

Ning

Chang

et al. 2016

MLTJ

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“…The histopathological changes associated with rotator cuff tears include thinning and disorganization of collagen fibers, the presence of granulation tissue, infiltration of glycosaminoglycans, fibrocartilaginous metaplasia, calcification, fatty degeneration, and necrosis of the tendon margin with cell apoptosis (3)(4)(5). These changes are also present in macroscopically intact tendons in the early stage of the degenerative process (3,6). The degenerative changes at the tendon margin can also explain the high rate of recurrence after surgery, even in cases with less than grade 2 fatty infiltration (4).…”

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confidence: 99%

Degenerative disease in rotator cuff tears: what are the biochemical and histological changes?

Giorgi¹

2014

jts

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The histopathological changes associated with rotator cuff tears include thinning and disorganization of collagen fibers, the presence of granulation tissue, increased levels of glycosaminoglycans, fibrocartilaginous metaplasia, calcification, fatty infiltration, and necrosis of the tendon margin with cell apoptosis. The biochemical changes include an increase in the expression of matrix metalloproteinases (MMPs) and a decrease in tissue inhibitor of metalloproteinases (TIMP) messenger ribonucleic acid expression. Histological evidence of tendinopathy has been found in patients with rotator cuff tear. Biochemical changes include significant increases in MMP1, MMP2, MMP3, and in TIMP1 and TIMP2 levels, not only at the lateral supraspinatus edge, but also in the macroscopically intact portion of the supraspinatus tendon and in the intact subscapularis. The tissue in the ruptured area of the supraspinatus tendon undergoes marked rearrangement at molecular levels. This involves the activity of MMP1, 2, and 3 and supports a critical role of MMPs in tendon physiology. Intact parts of the torn supraspinatus tendon can present the histopathological changes associated with rotator cuff tears. These findings suggest that biochemical changes can already occur in a macroscopically intact tendon and seem to point to a global degenerative process in the shoulder.Key Words: biology, histology, degenerative changes, rotator cuff tear.Rotator cuff tears are a frequent cause of shoulder pain and disability. The pathogenesis and the biochemical changes associated with rotator cuff tears are unclear, but they may arise from a combination of extrinsic impingement and intrinsic alterations within the tendon tissue itself (1). The etiology of rotator cuff disease is likely multifactorial, including age-related degeneration and microtrauma. Smoking, hypercholesterolemia and genetics have all been shown to influence the development of rotator cuff tearing (2). Tendons have a water content of 70%, while type I collagen accounts for 85% of their dry weight. Cells are scarce and those present are mostly (90-95%) fibroblasts. The histopathological changes associated with rotator cuff tears include thinning and disorganization of collagen fibers, the presence of granulation tissue, infiltration of glycosaminoglycans, fibrocartilaginous metaplasia, calcification, fatty degeneration, and necrosis of the tendon margin with cell apoptosis (3-5). These changes are also present in macroscopically intact tendons in the early stage of the degenerative process (3, 6). The degenerative changes at the tendon margin can also explain the high rate of recurrence after surgery, even in cases with less than grade 2 fatty infiltration (4). Chronic rotator cuff tears in elderly patients have limited healing potential and a high risk of recurrence, even if surgically treated. In these cases, the weak healing process seems to be produced more from the bursal side than from the tendinous one. Conversely, the healing potential of small and acute rotator c...

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“…Our results focus on lateral instability in the presence of good quality tendon. A recent study analyzed the type and frequency of LHB instability in patients undergoing rotator cuff repair (9 (10). A complete lesion is definitely more prone than partial tears to torsional stresses on the remaining extremities of the tendon footprint (11).…”

Section: Discussionmentioning

confidence: 99%

Reliability of forced internal rotation and active internal rotation to assess lateral instability of the biceps pulley

Arrigoni

Rose

D’Ambrosi

et al. 2015

jts

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J AbstractPurpose: the aim of this study was to investigate the relationship between positive painful forced internal rotation (FIR) and lateral pulley instability in the presence of a pre-diagnosed posterosuperior cuff tear. The same investigation was conducted for painful active internal rotation (AIR). Methods: a multicenter prospective study was conducted in a series of patients scheduled to undergo arthroscopic posterosuperior cuff repair. Pain was assessed using a visual analog scale (VAS) and the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) was administered. The VAS score at rest, DASH score, and presence/absence of pain on FIR and AIR were recorded and their relationships with lesions of the lateral pulley, cuff tear patterns and shape of lesions were analyzed. Results: the study population consisted of 115 patients (mean age: 55.1 years) recruited from 12 centers. The dominant arm was affected in 72 cases (62.6%). The average anteroposterior extension of the lesion was 1.61 cm. The mean preoperative VAS and DASH scores were 6.1 and 41.8, respectively. FIR and AIR were positive in 94 (81.7%) and 85 (73.9%) cases, respectively. The lateral pulley was compromised

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Rotator cuff re-tear or non-healing: histopathological aspects and predictive factors

Cited by 87 publications

References 37 publications

Investigating the cellular origin of rotator cuff muscle fatty infiltration and fibrosis after injury

Investigating the cellular origin of rotator cuff muscle fatty infiltration and fibrosis after injury

Degenerative disease in rotator cuff tears: what are the biochemical and histological changes?

Reliability of forced internal rotation and active internal rotation to assess lateral instability of the biceps pulley

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