The Effect of Postoperative Passive Motion on Rotator Cuff Healing in a Rat Model

Peltz, Cathryn D.; Dourte, LeAnn M.; Kuntz, Andrew F.; Sarver, Joseph J.; Kim, Soung-Yon; Williams, Gerald R.; Soslowsky, Louis J.

doi:10.2106/jbjs.h.01121

Cited by 101 publications

(86 citation statements)

References 33 publications

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“…The humeral diaphysis was potted in polymethylmethacrylate and placed in a base fixture. Specimens were submerged in a 37°C phosphatebuffered saline bath and tensile tested using an Instron 5543 mechanical test frame (Instron Corp, Norwood MA, USA) using a protocol described previously [3,21]. Briefly, tendons were subjected to 10 cycles of preconditioning between 0.1 and 0.5 N to provide consistent strain history between specimens and then allowed to return to equilibrium over 300 seconds.…”

Section: Methodsmentioning

confidence: 99%

The Detrimental Effects of Systemic Ibuprofen Delivery on Tendon Healing Are Time-Dependent

Connizzo

Yannascoli

Tucker

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Current clinical treatment after tendon repairs often includes prescribing NSAIDs to limit pain and inflammation. The negative influence of NSAIDs on bone repair is well documented, but their effects on tendon healing are less clear. While NSAIDs may be detrimental to early tendon healing, some evidence suggests that they may improve healing if administered later in the repair process.Questions/purposes We asked whether the biomechanical and histologic effects of systemic ibuprofen administration on tendon healing are influenced by either immediate or delayed drug administration. Methods After bilateral supraspinatus detachment and repair surgeries, rats were divided into groups and given ibuprofen orally for either Days 0 to 7 (early) or Days 8 to 14 (delayed) after surgery; a control group did not receive ibuprofen. Healing was evaluated at 1, 2, and 4 weeks postsurgery through biomechanical testing and histologic assessment. Results Biomechanical evaluation resulted in decreased stiffness and modulus at 4 weeks postsurgery for early ibuprofen delivery (mean ± SD [95% CI]: 10.8 ± 6.4 N/mm [6.7-14.8] and 8.9 ± 5.9 MPa [5.4-12.3]) when compared to control repair .2]) (p = 0.003 and 0.013); however, there were no differences between the delayed ibuprofen group (18.1 ± 7.4 N/mm [14.2-22.1] and 11.5 ± 5.6 MPa [8.2-14.9]) and the control group. Histology confirmed mechanical results with reduced fiber reorganization over time in the early ibuprofen group.

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Section: Methodsmentioning

confidence: 99%

The Detrimental Effects of Systemic Ibuprofen Delivery on Tendon Healing Are Time-Dependent

Connizzo

Yannascoli

Tucker

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…Researchers have therefore turned to animal models to study rotator cuff pathology. When making decisions about repair options, clinicians often refer to animal studies of rotator cuff injury that include mice (Thomopoulos et al, 2007), rats (Soslowsky et al, 1996), sheep (Gerber et al, 1999), rabbits (Björkenheim, 1989), dogs (Kujat, 1990), goats and others (Adams et al, 2006;Das et al, 2011;Grumet et al, 2009;MacGillivray et al, 2006;Peltz et al, 2009;Uggen et al, 2010). Although a variety of animal models have been used to study rotator cuff disease, questions remain about their relevance to humans, because of differences in their basic muscle architecture, bony anatomy and healing capacity (Brand, 2008;Dourte et al, 2010;Soslowsky et al, 1996).…”

Section: Introductionmentioning

confidence: 99%

Comparison of rotator cuff muscle architecture among humans and selected vertebrate species

Mathewson

Kwan

Eng

et al. 2013

Journal of Experimental Biology

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In this study, we compare rotator cuff muscle architecture of typically used animal models with that of humans and quantify the scaling relationships of these muscles across mammals. The four muscles that correspond to the human rotator cuff -supraspinatus, infraspinatus, subscapularis and teres minor -of 10 commonly studied animals were excised and subjected to a series of comparative measurements. When body mass among animals was regressed against physiological cross-sectional area, muscle mass and normalized fiber length, the confidence intervals suggested geometric scaling but did not exclude other scaling relationships. Based on the architectural difference index (ADI), a combined measure of fiber length-to-moment arm ratio, fiber length-to-muscle length ratio and the fraction of the total rotator cuff physiological cross-sectional area contributed by each muscle, chimpanzees were found to be the most similar to humans (ADI=2.15), followed closely by capuchins (ADI=2.16). Interestingly, of the eight non-primates studied, smaller mammals such as mice, rats and dogs were more similar to humans in architectural parameters compared with larger mammals such as sheep, pigs or cows. The force production versus velocity trade-off (indicated by fiber length-to-moment arm ratio) and the excursion ability (indicated by fiber length-to-muscle length ratio) of humans were also most similar to those of primates, followed by the small mammals. Overall, primates provide the best architectural representation of human muscle architecture. However, based on the muscle architectural parameters of non-primates, smaller rather than larger mammals may be better models for studying muscles related to the human rotator cuff.

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“…Another animal model has shown that immediate early passive motion should be avoided and that delayed passive motion had no negative effect on the strength and maturity of the remodeled tendon [16]. Early passive motion may stimulate excessive matrix formation and increased scar formation in the subacromial space which leads to worsening passive shoulder mechanics, increased stiffness, and loss of motion [17]. A 2-week period of immobilization helps extracellular matrix represent similar characteristics of uninjured tissue.…”

Section: Range Of Motionmentioning

confidence: 99%

Rotator cuff repair: post-operative rehabilitation concepts

Sgroi

Cilenti

2018

Curr Rev Musculoskelet Med

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Purpose of review With improvements in surgical techniques and increased knowledge of rotator cuff healing, there was a need to identify a safe progression after rotator cuff repair. The rehabilitation specialist plays an integral role in the care of these patients, and by implementing an evidence and criteria-based model, patients may be able to return to their prior levels of function sooner with fewer complications. Recent findings Timing of progression for rotator cuff patients should align not only with healing but also potential strain on the involved tissue. Recent electromyography studies have identified exercises which elicit highest level of muscle activation for individual dynamic stabilizers. The physical therapist should also be aware of potential complications and be prepared to manage appropriately if they should arise. Summary During rehabilitation after rotator cuff repair, there should be constant communication with the surgical team. Awareness of complication management, healing potential of the repaired tendon, and anatomy of the shoulder complex are critical. During the early stages, reducing pain and inflammation should be prioritized followed by progressive restoration of range of motion. When advancing range of motion, progression from passive, active assisted, and active movements allow for gradual introduction of stress to the healing construct. Even though time frames are not used for progression, it is important not to place excessive stress on the shoulder for up to 12 weeks to allow for proper tendonto-bone healing. As exercises are progressed, scapular muscle activation is initiated, followed by isometric and lastly isotonic rotator cuff exercises. When treating overhead athletes, advanced strengthening in the overhead position is performed, followed by plyometric training. Advanced strengthening is initiated when all preceding criteria have been met. It is important that patients are educated early in the rehabilitation process so that they can manage their expectations to realistic time frames.

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The Effect of Postoperative Passive Motion on Rotator Cuff Healing in a Rat Model

Cited by 101 publications

References 33 publications

The Detrimental Effects of Systemic Ibuprofen Delivery on Tendon Healing Are Time-Dependent

The Detrimental Effects of Systemic Ibuprofen Delivery on Tendon Healing Are Time-Dependent

Comparison of rotator cuff muscle architecture among humans and selected vertebrate species

Rotator cuff repair: post-operative rehabilitation concepts

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