The Effect of Intramuscular Botulinum Toxin-A: An Experimental study on rat rotator cuff repair model

Şahin, Ercan; Kalem, Mahmut; Zehir, Sinan; Songür, Murat; Demirtaş, Mehmet

doi:10.3944/aott.2015.14.0296

Cited by 4 publications

(9 citation statements)

References 20 publications

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“…However, little is known about how protracted unloading affects the site of load transfer between bone and tendon and the most common site of rotator cuff tears, the enthesis. Previous work has demonstrated that muscle loading is necessary for the fetal and postnatal development of the enthesis [16–18] and can affect the healing of injuries to the enthesis [19–21]. However, the effects of unloading on the homeostasis of the mature enthesis is not understood.…”

Section: Introductionmentioning

confidence: 99%

The multiscale structural and mechanical effects of mouse supraspinatus muscle unloading on the mature enthesis

et al. 2019

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The musculoskeletal system is sensitive to its loading environment; this is of particular concern under conditions such as disuse, paralysis, and extended-duration space flight. Although structural and mechanical changes to tendon and bone following paralysis and disuse are well understood, there is a pressing need to understand how this unloading affects the bone-tendon interface (enthesis); the location most prone to tears and injury. We therefore elucidated these effects of unloading in the entheses of adult mice shoulders that were paralyzed for 21 days by treatment with botulinum toxin A. Unloading significantly increased the extent of mechanical failure and was associated with structural changes across hierarchical scales. At the millimeter scale, unloading caused bone loss. At the micrometer scale, unloading decreased bioapatite crystal size and crystallographic alignment in the enthesis. At the nanometer scale, unloading induced compositional changes that stiffened the bioapatite/collagen composite tissue. Mathematical modeling and mechanical testing indicated that these factors combined to increase local elevations of stress while decreasing the ability of the tissue to absorb energy prior to failure, thereby increasing injury risk. These first observations of the multiscale effects of unloading on the adult enthesis provide new insight into the hierarchical features of structure and composition that endow the enthesis with increased resistance to failure.

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Section: Introductionmentioning

confidence: 99%

The multiscale structural and mechanical effects of mouse supraspinatus muscle unloading on the mature enthesis

et al. 2019

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“… 2008 [ 19 ] Rats SS repair Passive ROM 56 Passive ROM decreased from baseline Sahin et al. 2015 [ 25 ] Rats SS repair Running performance 84 Penalty score was higher than the uninjured control Yamazaki et al., 2014 [ 23 ] Rats SS, IS repair Gait analysis 56 Stride length, print area, contact intensity were less than the sham group Delayed RC tendon repair Wang et al. 2018 [ 29 ] Mice SS, IS immediate repair/delayed repair Gait analysis 42 Stride length, stance width, and paw print area were higher in the immediate repair group than the delayed repair groups Hsu et al.…”

Section: Resultsmentioning

confidence: 99%

“…Only one study [ 25 ] used a running endurance test to assess shoulder function with a motorised treadmill. A low-dose electrical foot shock occurred at the end of the trial when the rat stopped running.…”

Section: Resultsmentioning

confidence: 99%

Evaluation of animal models and methods for assessing shoulder function after rotator cuff tear: A systematic review

Liu

Leong

et al. 2021

Journal of Orthopaedic Translation

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“…The proposed mechanism of Botox-assisted rotator cuff healing is unknown. Şahin et al [ 31 ] found improvements in gait analysis after intramuscular Botox injection after cuff repair. It is unknown, however, whether this is a function of anti-nociceptive effects of Botox or improved cuff healing.…”

Section: Discussionmentioning

confidence: 99%

“…The literature on the topic of botulinum toxin-assisted rotator cuff repair is confusing. Multiple factors need to be considered, including timing of injection, acute versus chronic repair, combining chemical paralysis with immobilization, and the species of the animal model [ 12 , 31 – 33 ]. Botox might have its best effect when injected before an acute repair with minimal immobilization.…”

Section: Discussionmentioning

confidence: 99%

Healing of rotator cuff tendons using botulinum toxin A and immobilization in a rat model

Gilotra

Shorofsky

Stein

et al. 2016

BMC Musculoskelet Disord

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BackgroundWe evaluated effects of botulinum toxin A (Botox) and cast immobilization on tendon healing in a rat model. Injection of Botox into rat supraspinatus was hypothesized to reduce muscle active force and improved healing.MethodsEighty-four supraspinatus tendons were surgically transected and repaired in 42 Sprague-Dawley rats (transosseous technique). After repair, supraspinatus muscle was injected with saline or Botox (3 or 6 U/kg). Half the shoulders were cast-immobilized for the entire postoperative period; half were allowed free cage activity. Histology was examined at 2, 4, 8, and 12 weeks. A healing zone cross-sectional area was measured, and biomechanical testing of repair strength and tendon viscoelastic properties was conducted at 4 and 12 weeks.ResultsBotox alone and cast immobilization alone exhibited increased ultimate load compared with controls (saline injection, no immobilization) at 4 weeks. No difference in ultimate load occurred between Botox-only and cast-only groups. At 12 weeks, the Botox (6 U/kg) plus cast immobilization group was significantly weakest (p < 0.05). A trend was shown toward decreased healing zone cross-sectional areas in casted groups.ConclusionsSupraspinatus Botox injection after rotator cuff repair might help protect the repair. However, cast immobilization plus Botox administration is harmful to rotator cuff healing in a rat tendon model.

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The Effect of Intramuscular Botulinum Toxin-A: An Experimental study on rat rotator cuff repair model

Abstract: BTX-A injections resulted in a better function based on running performance, probably due to decreased tissue tension at the repair site and less pain. Further studies on humans are needed to demonstrate this effect clinically.

Cited by 4 publications

References 20 publications

The multiscale structural and mechanical effects of mouse supraspinatus muscle unloading on the mature enthesis

The multiscale structural and mechanical effects of mouse supraspinatus muscle unloading on the mature enthesis

Evaluation of animal models and methods for assessing shoulder function after rotator cuff tear: A systematic review

Healing of rotator cuff tendons using botulinum toxin A and immobilization in a rat model

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