The Influence of Diabetes Mellitus on Clinical and Structural Outcomes After Arthroscopic Rotator Cuff Repair

Cho, Nam Su; Moon, Seong Cheol; Jeon, Jong Wook; Rhee, Yong Girl

doi:10.1177/0363546514565097

Cited by 124 publications

(128 citation statements)

References 31 publications

(49 reference statements)

Supporting

Mentioning

122

Contrasting

Unclassified

Order By: Relevance

“…Diabetic patients with tendinopathy were found to have a longer duration of chronic hyperglycemia than those without tendinopathy1. After surgical repair in the rotator cuff, diabetic patients with poorer glycemic control were found to have a higher retear rate24. These findings suggest that long-sustained high concentration of blood glucose is associated with diabetic tendinopathy.…”

Section: Discussionmentioning

confidence: 95%

High glucose alters tendon homeostasis through downregulation of the AMPK/Egr1 pathway

Wang

Chang

et al. 2017

Sci Rep

View full text Add to dashboard Cite

Diabetes mellitus (DM) is associated with higher risk of tendinopathy, which reduces tolerance to exercise and functional activities and affects lifestyle and glycemic control. Expression of tendon-related genes and matrix metabolism in tenocytes are essential for maintaining physiological functions of tendon. However, the molecular mechanisms involved in diabetic tendinopathy remain unclear. We hypothesized that high glucose (HG) alters the characteristics of tenocyte. Using in vitro 2-week culture of tenocytes, we found that expression of tendon-related genes, including Egr1, Mkx, TGF-β1, Col1a2, and Bgn, was significantly decreased in HG culture and that higher glucose consumption occurred. Down-regulation of Egr1 by siRNA decreased Scx, Mkx, TGF-β1, Col1a1, Col1a2, and Bgn expression. Blocking AMPK activation with Compound C reduced the expression of Egr1, Scx, TGF-β1, Col1a1, Col1a2, and Bgn in the low glucose condition. In addition, histological examination of tendons from diabetic mice displayed larger interfibrillar space and uneven glycoprotein deposition. Thus, we concluded that high glucose alters tendon homeostasis through downregulation of the AMPK/Egr1 pathway and the expression of downstream tendon-related genes in tenocytes. The findings render a molecular basis of the mechanism of diabetic tendinopathy and may help develop preventive and therapeutic strategies for the pathology.

show abstract

Section: Discussionmentioning

confidence: 95%

High glucose alters tendon homeostasis through downregulation of the AMPK/Egr1 pathway

Wang

Chang

et al. 2017

Sci Rep

View full text Add to dashboard Cite

show abstract

“…performed a comparative cohort study and demonstrated that patients with diabetes had an significantly increased retear rate (35.9%) following arthroscopic rotator cuff repair surgery as compared to controls (14.4%) as evaluated on MRI (P < .001). 39 These authors also found that effective glycemic control was associated with improved healing rates after rotator cuff repair, with 43.2% in an uncontrolled diabetic patient population (>7.0% hemoglobin A1c) as compared to 25.9% in patients with adequate glycemic control developing re-tears of the repaired tendon.…”

Section: Diabetes Mellitusmentioning

confidence: 91%

What is the Role of Systemic Conditions and Options for Manipulation of Bone Formation and Bone Resorption in Rotator Cuff Tendon Healing and Repair?

Lee

Gumucio

Mendias

et al. 2017

Techniques in Shoulder &Amp; Elbow Surgery

View full text Add to dashboard Cite

Rotator cuff pathology is a significant cause of shoulder pain. Operative repair of rotator cuff is an established standard of care for these patient, however, failure of the procedure is common. Systemic conditions such as diabetes mellitus, hypocholesteremia, thyroid disease, and smoking significantly affect the outcomes of rotator cuff repair and have significant implications for the management of these patients. Diabetes mellitus has been proposed to damage tendons through non-enzymatic glycosylation of collagen with advanced glycation end product formation and impaired microcirculation. Hypocholesteremia may lead to fatty infiltration and subsequent pro-inflammatory degenerative enzymatic degeneration. Thyroid disease may disrupt tendon homeostasis through the alteration of collagen production and the accumulation of glycosaminoglycans. Lastly, smoking inhibits tendon healing through the induction of hypovascularity and hypoperfusion. Understanding of the implications these systemic conditions have on the outcomes is important in the management of rotator cuff disease.

show abstract

“…This is particularly important given that T2DM increases the risk of tendon tear or rupture up to fivefold, relative to non‐diabetics . In terms of healing outcomes in specific tendons, the most abundant clinical data exists in the RC, with clear evidence of diminished healing and increased risk of repair failure (greater than twofold) . There is also some evidence that limitations in healing are particularly pronounced during the early phases of healing.…”

Section: Diabetic Tendon Healingmentioning

confidence: 99%

Effects of Type II Diabetes Mellitus on Tendon Homeostasis and Healing

Nichols

Loiselle

2019

Journal Orthopaedic Research

View full text Add to dashboard Cite

Over 300,000 tendon repairs are performed annually in the United States to repair damage to tendons as a result of either acute trauma or chronic tendinopathy. Individuals with type II diabetes mellitus (T2DM) are four times more likely to experience tendinopathy, and up to five times more likely to experience a tendon tear or rupture than non‐diabetics. As nearly 10% of the US population is diabetic, with an additional 33% pre‐diabetic, this is a particularly problematic health care challenge. Tendon healing in general is challenging and often unsatisfactory due to the formation of mechanically inferior scar‐tissue rather than regeneration of native tendon structure. In T2DM tendons, there is evidence of an amplified scar tissue response, which may be associated with the increased the risk of rupture or impaired restoration of range of motion. Despite the dramatic effect of T2DM on tendon function and outcomes following injury, there are few therapies available to promote improved healing in these patients. Several recent studies have enhanced our understanding of the pro‐inflammatory environment of T2DM healing and have assessed potential treatment approaches to mitigate pathological progression in pre‐clinical models of diabetic tendinopathy. This review discusses the current state of knowledge of diabetic tendon healing from molecular to mechanical disruptions and identifies promising approaches and critical knowledge gaps as the field moves toward identification of novel therapeutic strategies to maintain or restore tendon function in diabetic patients. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:13–22, 2020

show abstract

The Influence of Diabetes Mellitus on Clinical and Structural Outcomes After Arthroscopic Rotator Cuff Repair

Cited by 124 publications

References 31 publications

High glucose alters tendon homeostasis through downregulation of the AMPK/Egr1 pathway

High glucose alters tendon homeostasis through downregulation of the AMPK/Egr1 pathway

What is the Role of Systemic Conditions and Options for Manipulation of Bone Formation and Bone Resorption in Rotator Cuff Tendon Healing and Repair?

Effects of Type II Diabetes Mellitus on Tendon Homeostasis and Healing

Contact Info

Product

Resources

About