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Lau YK, Iyer K, Shetye S, Friday CS, Dodge GR, Hast MW, Casal ML, Gawri R, Smith LJ. Evaluation of tendon and ligament microstructure and mechanical properties in a canine model of mucopolysaccharidosis I. J Orthop Res 2024; 42:1409-1419. [PMID: 38368531 PMCID: PMC11161329 DOI: 10.1002/jor.25813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/16/2024] [Accepted: 02/02/2024] [Indexed: 02/19/2024]
Abstract
Mucopolysaccharidosis (MPS) I is a lysosomal storage disorder characterized by deficient alpha-l-iduronidase activity, leading to abnormal accumulation of glycosaminoglycans (GAGs) in cells and tissues. Synovial joint disease is prevalent and significantly reduces patient quality of life. There is a strong clinical need for improved treatment approaches that specifically target joint tissues; however, their development is hampered by poor understanding of underlying disease pathophysiology, including how pathological changes to component tissues contribute to overall joint dysfunction. Ligaments and tendons, in particular, have received very little attention, despite the critical roles of these tissues in joint stability and biomechanical function. The goal of this study was to leverage the naturally canine model to undertake functional and structural assessments of the anterior (cranial) cruciate ligament (CCL) and Achilles tendon in MPS I. Tissues were obtained postmortem from 12-month-old MPS I and control dogs and tested to failure in uniaxial tension. Both CCLs and Achilles tendons from MPS I animals exhibited significantly lower stiffness and failure properties compared to those from healthy controls. Histological examination revealed multiple pathological abnormalities, including collagen fiber disorganization, increased cellularity and vascularity, and elevated GAG content in both tissues. Clinically, animals exhibited mobility deficits, including abnormal gait, which was associated with hyperextensibility of the stifle and hock joints. These findings demonstrate that pathological changes to both ligaments and tendons contribute to abnormal joint function in MPS I, and suggest that effective clinical management of joint disease in patients should incorporate treatments targeting these tissues.
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Affiliation(s)
- Yian Khai Lau
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, 3450 Hamilton Walk, Philadelphia, PA, 19104 USA
| | - Keerthana Iyer
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, 3450 Hamilton Walk, Philadelphia, PA, 19104 USA
| | - Snehal Shetye
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, 3450 Hamilton Walk, Philadelphia, PA, 19104 USA
| | - Chet S. Friday
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, 3450 Hamilton Walk, Philadelphia, PA, 19104 USA
| | - George R. Dodge
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, 3450 Hamilton Walk, Philadelphia, PA, 19104 USA
- Mechano Therapeutics LLC, 3401 Grays Ferry Ave, Philadelphia, PA 19146
| | - Michael W. Hast
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, 3450 Hamilton Walk, Philadelphia, PA, 19104 USA
| | - Margret L. Casal
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, 3900 Spruce St, Philadelphia, PA 19104 USA
| | - Rahul Gawri
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, 3450 Hamilton Walk, Philadelphia, PA, 19104 USA
| | - Lachlan J. Smith
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, 3450 Hamilton Walk, Philadelphia, PA, 19104 USA
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104 USA
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Celikten M, Sahin H, Senturk GE, Bilsel K, Pulatkan A, Kapicioglu M, Sakul BU. The effect of platelet-rich fibrin, platelet-rich plasma, and concentrated growth factor in the repair of full thickness rotator cuff tears. J Shoulder Elbow Surg 2024; 33:e261-e277. [PMID: 37898418 DOI: 10.1016/j.jse.2023.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 09/11/2023] [Accepted: 09/24/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Rotator cuff lesions rank among the prevalent causes of shoulder pain. Combining surgical interventions with growth factors, scaffolds, and stem cell therapies can effectively decrease the likelihood of rotator cuff repair recurrence. Platelet-rich plasma (PRP), platelet-rich fibrin (PRF), and concentrated growth factor (CGF), isolated from blood and rich in growth factors, have a critical role in cell migration, cell proliferation, and angiogenesis during the tissue regeneration process. Investigations have further substantiated the beneficial impact of PRP and PRF on the biomechanical and histologic attributes of the tendon-bone interface. We aimed to investigate the effectiveness of CGF compared with PRF and PRP in the repair of rotator cuff lesions as a new treatment strategy. METHODS Incision was performed on both shoulder regions of 21 adult rabbits. After 8 weeks, both shoulders of the rabbits were repaired by suturing. PRF and CGF were administered to 2 separate groups along with the repair. Tissues were collected for biomechanical measurements and histologic evaluations. RESULTS Histologically, CGF, PRF, and PRP showed similar results to the healthy control group. The level of improvement was significant in the PRF and PRP groups. In the PRF group, the distribution of Ki67 (+), CD31 (+), and CD34 (+) cells was determined intensely in the tendon-bone junction regions. Apoptotic cells increased significantly in the repair group compared with the healthy group, whereas fewer apoptotic cells were found in the PRF-, PRP-, and CGF-applied groups. In the biomechanical results, no statistical difference was recorded among the groups. CONCLUSION The use of PRF, PRP, and CGF in rotator cuff repair shows promise in shortening the treatment period and preventing the recurrence of rotator cuff lesions.
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Affiliation(s)
- Mert Celikten
- Department of Anatomy, Health Sciences Institute, Istanbul Medipol University, Istanbul, Turkey.
| | - Hakan Sahin
- Department of Histology and Embryology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Gozde Erkanli Senturk
- Department of Histology and Embryology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Kerem Bilsel
- Department of Orthopaedics and Traumatology, Acibadem Mehmet Ali Aydinlar University, Faculty of Medicine, Istanbul, Turkey
| | - Anil Pulatkan
- Department of Orthopedics and Traumatology, School of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Mehmet Kapicioglu
- Department of Orthopedics and Traumatology, School of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Bayram Ufuk Sakul
- Department of Anatomy, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
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Bloom ET, Lin LM, Locke RC, Giordani A, Krassan E, Peloquin JM, Silbernagel KG, Parreno J, Santare MH, Killian ML, Elliott DM. Overload in a Rat In Vivo Model of Synergist Ablation Induces Tendon Multiscale Structural and Functional Degeneration. J Biomech Eng 2023; 145:081003. [PMID: 37184932 PMCID: PMC10782872 DOI: 10.1115/1.4062523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 05/02/2023] [Accepted: 05/04/2023] [Indexed: 05/16/2023]
Abstract
Tendon degeneration is typically described as an overuse injury with little distinction made between magnitude of load (overload) and number of cycles (overuse). Further, in vivo, animal models of tendon degeneration are mostly overuse models, where tendon damage is caused by a high number of load cycles. As a result, there is a lack of knowledge of how isolated overload leads to degeneration in tendons. A surgical model of synergist ablation (SynAb) overloads the target tendon, plantaris, by ablating its synergist tendon, Achilles. The objective of this study was to evaluate the structural and functional changes that occur following overload of plantaris tendon in a rat SynAb model. Tendon cross-sectional area (CSA) and shape changes were evaluated by longitudinal MR imaging up to 8 weeks postsurgery. Tissue-scale structural changes were evaluated by semiquantified histology and second harmonic generation microscopy. Fibril level changes were evaluated with serial block face scanning electron microscopy (SBF-SEM). Functional changes were evaluated using tension tests at the tissue and microscale using a custom testing system allowing both video and microscopy imaging. At 8 weeks, overloaded plantaris tendons exhibited degenerative changes including increases in CSA, cell density, collagen damage area fraction (DAF), and fibril diameter, and decreases in collagen alignment, modulus, and yield stress. To interpret the differences between overload and overuse in tendon, we introduce a new framework for tendon remodeling and degeneration that differentiates between the inputs of overload and overuse. In summary, isolated overload induces multiscale degenerative structural and functional changes in plantaris tendon.
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Affiliation(s)
- Ellen T Bloom
- Department of Biomedical Engineering, University of Delaware, Newark, DE 19716
| | - Lily M Lin
- Department of Biomedical Engineering, University of Delaware, Newark, DE 19716
| | - Ryan C Locke
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA 19104; Translational Musculoskeletal Research Center, CMCVAMC, Philadelphia, PA 19104
| | - Alyssa Giordani
- Department of Biomedical Engineering, University of Delaware, Newark, DE 19716
| | - Erin Krassan
- Department of Biomedical Engineering, University of Delaware, Newark, DE 19716
| | - John M Peloquin
- Department of Biomedical Engineering, University of Delaware, Newark, DE 19716
| | | | - Justin Parreno
- Department of Biological Sciences, University of Delaware, Newark, DE 19716
| | - Michael H Santare
- Department of Mechanical Engineering, University of Delaware, Newark, DE 19716
| | - Megan L Killian
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI 48104
| | - Dawn M Elliott
- Department of Biomedical Engineering, University of Delaware, Newark, DE 19716
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Park JH, Chung SG, Jun JY, Lee JJ, Lee K. Quantitative analysis of tendon histopathology using digital pathology in rat models with Achilles tendon injury. Connect Tissue Res 2022; 63:463-474. [PMID: 34974783 DOI: 10.1080/03008207.2021.2011251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Although digital image analysis methods that quantify histopathologic features have emerged, no validated quantitative methods are available to evaluate tendon injury. This study aimed to propose and validate a quantitative analysis method to identify the histopathologic features of tendon injuries. The histopathologic features of two Achilles tendon injury models (a partial full-thickness defect model and a collagenase injection model) using Sprague-Dawley rats were evaluated by semiquantitative grading and a quantitative analysis method using a digital pathology software at weeks 1 and 4 after tendon injury (six tendons per group at each time point). The outcome variables between tendon injury models and between time points were compared, and the correlation between semiquantitative scores and the results of the quantitative analysis was investigated. The proposed analysis method quantified the severity of the histopathological features after tendon injury. Quantitative analysis differentiated the cell morphology between tendon injury models and time points better than semiquantitative scoring. The results from quantitative measurements correlated significantly with the semiquantitative scores. The proposed quantitative method can be effective in evaluating the histopathology of tendon injuries.
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Affiliation(s)
- Jae Hyeon Park
- Department of Rehabilitation Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Gyeonggi-do, Republic of Korea
| | - Sun G Chung
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Institute of Aging, Seoul National University, Seoul, Republic of Korea
| | - Ji-Young Jun
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jin-Ju Lee
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyoungbun Lee
- Department of Pathology, Seoul National University Hospital, Seoul, Republic of Korea
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Dang R, Chen L, Sefat F, Li X, Liu S, Yuan X, Ning X, Zhang YS, Ji P, Zhang X. A Natural Hydrogel with Prohealing Properties Enhances Tendon Regeneration. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2022; 18:e2105255. [PMID: 35304821 DOI: 10.1002/smll.202105255] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 03/05/2022] [Indexed: 06/14/2023]
Abstract
Tendon regeneration and reduction of peritendinous adhesion remain major clinical challenges. This study addresses these challenges by adopting a unique hydrogel derived from the skin secretion of Andrias davidianus (SSAD) and taking advantage of its biological effects, adhesiveness, and controllable microstructures. The SSAD-derived hydrogel contains many cytokines, which could promote tendon healing. In vitro, leach liquid of SSAD powder could promote tendon stem/progenitor cells migration. In vivo, the SSAD-derived hydrogel featuring double layers possesses strong adhesiveness and could reconnect ruptured Achilles tendons of Sprague-Dawley rats without suturing. The intimal SSAD-derived hydrogel, with a pore size of 241.7 ± 21.0 µm, forms the first layer of the hydrogel to promote tendon healing, and the outer layer SSAD-derived hydrogel, with a pore size of 3.3 ± 1.4 µm, reducing peritendinous adhesion by serving as a dense barrier. Additionally, the SSAD-derived hydrogel exhibits antioxidant and antibacterial characteristics, which further contribute to the reduction of peritendinous adhesion. In vivo studies suggest that the SSAD-derived hydrogel reduces peritendinous adhesion, increases collagen fiber deposition, promotes cell proliferation, and improves the biomechanical properties of the regenerated tendons, indicating better functional restoration. The SSAD-derived bilayer hydrogel may be a feasible biomaterial for tendon repair in the future.
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Affiliation(s)
- Ruyi Dang
- Chongqing Key Laboratory of Oral Disease and Biomedical Sciences and Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education and Stomatological Hospital of Chongqing Medical University, Chongqing, 401174, P. R. China
| | - Liling Chen
- Chongqing Key Laboratory of Oral Disease and Biomedical Sciences and Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education and Stomatological Hospital of Chongqing Medical University, Chongqing, 401174, P. R. China
| | - Farshid Sefat
- Interdisciplinary Research Centre in Polymer Science and Technology (Polymer IRC), University of Bradford, Bradford, BD7 1DP, UK
- Biomedical and Electronics Engineering Department, School of Engineering, University of Bradford, Bradford, BD7 1DP, UK
| | - Xian Li
- Chongqing Key Laboratory of Oral Disease and Biomedical Sciences and Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education and Stomatological Hospital of Chongqing Medical University, Chongqing, 401174, P. R. China
| | - Shilin Liu
- Chongqing Key Laboratory of Oral Disease and Biomedical Sciences and Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education and Stomatological Hospital of Chongqing Medical University, Chongqing, 401174, P. R. China
| | - Xulei Yuan
- Chongqing Key Laboratory of Oral Disease and Biomedical Sciences and Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education and Stomatological Hospital of Chongqing Medical University, Chongqing, 401174, P. R. China
| | - Xiaoqiao Ning
- Chongqing Key Laboratory of Oral Disease and Biomedical Sciences and Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education and Stomatological Hospital of Chongqing Medical University, Chongqing, 401174, P. R. China
| | - Yu Shrike Zhang
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, 02139, USA
| | - Ping Ji
- Chongqing Key Laboratory of Oral Disease and Biomedical Sciences and Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education and Stomatological Hospital of Chongqing Medical University, Chongqing, 401174, P. R. China
| | - Ximu Zhang
- Chongqing Key Laboratory of Oral Disease and Biomedical Sciences and Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education and Stomatological Hospital of Chongqing Medical University, Chongqing, 401174, P. R. China
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Advances in Microscopic Studies of Tendinopathy: Literature Review and Current Trends, with Special Reference to Neovascularization Process. J Clin Med 2022; 11:jcm11061572. [PMID: 35329898 PMCID: PMC8949578 DOI: 10.3390/jcm11061572] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/10/2022] [Accepted: 03/11/2022] [Indexed: 01/05/2023] Open
Abstract
Tendinopathy is a process of chaotic extracellular matrix remodeling followed by increased secretion of enzymes and mediators of inflammation. The histopathological assessment of tendinous tissue is crucial to formulate the diagnosis and establish the severity of tendon degeneration. Nevertheless, the microscopic analysis of tendinous tissue features is often challenging. In this review, we aimed to compare the most popular scales used in tendon pathology assessment and reevaluate the role of the neovascularization process. The following scores were evaluated: the Bonar score, the Movin score, the Astrom and Rausing Score, and the Soslowsky score. Moreover, the role of neovascularization in tendon degeneration was reassessed. The Bonar system is the most commonly used in tendon pathology. According to the literature, hematoxylin and eosin with additional Alcian Blue staining seems to provide satisfactory results. Furthermore, two observers experienced in musculoskeletal pathology are sufficient for tendinopathy microscopic evaluation. The control, due to similar and typical alterations in tendinous tissue, is not necessary. Neovascularization plays an ambiguous role in tendon disorders. The neovascularization process is crucial in the tendon healing process. On the other hand, it is also an important component of the degeneration of tendinous tissue when the regeneration is incomplete and insufficient. The microscopic analysis of tendinous tissue features is often challenging. The assessment of tendinous tissue using the Bonar system is the most universal. The neovascularization variable in tendinopathy scoring systems should be reconsidered due to discrepancies in studies.
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Park GY, Tarafder S, Eyen SL, Park S, Kim R, Siddiqui Z, Kumar V, Lee CH. Oxo-M and 4-PPBP Delivery via Multi-Domain Peptide Hydrogel Toward Tendon Regeneration. Front Bioeng Biotechnol 2022; 10:773004. [PMID: 35155388 PMCID: PMC8829701 DOI: 10.3389/fbioe.2022.773004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 01/05/2022] [Indexed: 12/01/2022] Open
Abstract
We have recently identified novel small molecules, Oxo-M and 4-PPBP, which specifically stimulate endogenous tendon stem/progenitor cells (TSCs), leading to potential regenerative healing of fully transected tendons. Here, we investigated an injectable, multidomain peptide (MDP) hydrogel providing controlled delivery of the small molecules for regenerative tendon healing. We investigated the release kinetics of Oxo-M and 4-PPBP from MDP hydrogels and the effect of MDP-released small molecules on tenogenic differentiation of TSCs and in vivo tendon healing. In vitro, MDP showed a sustained release of Oxo-M and 4-PPBP and a slower degradation than fibrin. In addition, tenogenic gene expression was significantly increased in TSC with MDP-released Oxo-M and 4-PPBP as compared to the fibrin-released. Invivo, MDP releasing Oxo-M and 4-PPBP significantly improved tendon healing, likely associated with prolonged effects of Oxo-M and 4-PPBP on suppression of M1 macrophages and promotion of M2 macrophages. Comprehensive analyses including histomorphology, digital image processing, and modulus mapping with nanoindentation consistently suggested that Oxo-M and 4-PPBP delivered via MDP further improved tendon healing as compared to fibrin-based delivery. In conclusion, MDP delivered with Oxo-M and 4-PPBP may serve as an efficient regenerative therapeutic for in situ tendon regeneration and healing.
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Affiliation(s)
- Ga Young Park
- Regenerative Engineering Laboratory, Center for Dental and Craniofacial Research, Columbia University Irving Medical Center, New York, NY, United States
| | - Solaiman Tarafder
- Regenerative Engineering Laboratory, Center for Dental and Craniofacial Research, Columbia University Irving Medical Center, New York, NY, United States
| | - Samantha Lewis Eyen
- Regenerative Engineering Laboratory, Center for Dental and Craniofacial Research, Columbia University Irving Medical Center, New York, NY, United States
| | - Soomin Park
- Regenerative Engineering Laboratory, Center for Dental and Craniofacial Research, Columbia University Irving Medical Center, New York, NY, United States
| | - Ryunhyung Kim
- Regenerative Engineering Laboratory, Center for Dental and Craniofacial Research, Columbia University Irving Medical Center, New York, NY, United States
| | - Zain Siddiqui
- Department of Bio-Medical Engineering, New Jersey Institute of Technology, Hoboken, NJ, United States
| | - Vivek Kumar
- Department of Bio-Medical Engineering, New Jersey Institute of Technology, Hoboken, NJ, United States
| | - Chang H. Lee
- Regenerative Engineering Laboratory, Center for Dental and Craniofacial Research, Columbia University Irving Medical Center, New York, NY, United States
- *Correspondence: Chang H. Lee,
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Modelling gluteus medius tendon degeneration and repair in a large animal model. Arch Orthop Trauma Surg 2022; 142:1-12. [PMID: 32813126 DOI: 10.1007/s00402-020-03573-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 08/02/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Gluteus medius tendon tears often occur in the context of chronic tendinopathy and remain a difficult clinical problem. Surgical repair is challenging as it is often delayed and performed in degenerative tendons. No animal model currently exists to mimic the delayed repair of tendinopathic gluteus medius tears. The aims of this study were to develop a chronic model of gluteus medius tendinopathy and tear and then compare this model to an acute gluteus medius tear and repair. MATERIALS AND METHODS Six gluteus medius muscles were dissected and examined in mature sheep to confirm anatomical similarity to the human counterpart. Ten separate adult sheep underwent tendon detachment, followed by relook and histological sampling at 6 and 16 weeks to assess the extent of tendon degeneration. Six adult sheep underwent tendon repair at 6 weeks and were later assessed for healing of the tendon and compared to a further four adult sheep who underwent an acute tendon detachment and repair procedure. RESULTS The sheep gluteus medius muscle consisted of three compartments, the anterior, middle and posterior. All compartments inserted via the common tendon on the superolateral aspect of the greater trochanter. At both 6 and 16 weeks, there was significant tendinopathic changes on histology compared to controls as assessed by modified Movin's score (p = 0.018, p = 0.047) but no difference between the 6- and 16-week groups (p = 0.25). There were significant differences between delayed and acute repair in both histological appearance (p = 0.025) and biomechanical properties (p = 0.019), with acute repair superior in both. CONCLUSIONS Tendon detachment for 6 weeks is sufficient to produce histological changes similar to chronic tendinopathy and repair of this degenerative tendon results in significantly poorer healing when compared to an acute repair model. Animal models for gluteus medius tears should use a delayed repair model to improve clinical validity.
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Postoperative malrotation of humerus shaft fracture causes degeneration of rotator cuff and cartilage. Sci Rep 2021; 11:18596. [PMID: 34545141 PMCID: PMC8452695 DOI: 10.1038/s41598-021-98040-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 09/01/2021] [Indexed: 12/28/2022] Open
Abstract
We hypothesized that postoperative malrotation of humeral shaft fractures can alter the bio-mechanical environment of the shoulder; thus, rotator cuff and cartilage degeneration could be induced. Therefore, we designed an animal experiment to evaluate the impact of malrotation deformities after minimally invasive surgery for humeral fractures on the rotator cuff and cartilage, which has rarely been described in previous studies. Twenty-four New Zealand white rabbits were randomly divided into the sham control group (A), negative control group (B) and malrotated group (C). A sham operation with surgical exposure alone was performed in group A. Humeral shaft osteotomy was performed in Group B and C. In Group B, the fractures were fixed in situ with plate -screw system. While in Group C, iatrogenic rotational deformity was created after the proximal end of the fracture being internally rotated by 20 degrees and then subsequently fixed. The animals with bone healing were sacrificed for pathological and biochemical examination. In group C, the modified Mankin scale for cartilage pathology evaluation and the modified Movin scale for tendon both showed highest score among groups with statistical significance (P < 0.05); Disordered alignment and proportion of collagen I/III of rotator cuff were confirmed with picrosirius red staining; Transmission electron microscopy also showed ultrastructural tendon damage. Immunohistochemistry showed that both MMP-1 and MMP-13 expression were significantly higher in group C than groups A and B(P < 0.05). Minimally invasive techniques for humerus shaft fracture might be cosmetically advantageous, but the consequent postoperative malrotation could increase the risk of rotator cuff and cartilage degeneration. This conclusion is supported here by primary evidence from animal experiments.
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Amini M, Momeni M, Jahandideh A, Ghoranneviss M, Soudmand S, Yousefi P, Khandan S, Amini M. Tendon repair by plasma jet treatment. J Diabetes Metab Disord 2021; 20:621-626. [PMID: 34178855 DOI: 10.1007/s40200-021-00789-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 03/22/2021] [Indexed: 02/01/2023]
Abstract
Objective In recent years many researchers applied cold plasma for wound healing. The cold plasma is irradiated on the surface of wound. In this paper the effect of irradiation of cold plasma on the skin for healing of injured tissue which is located inside body, such as tendon, is evaluated. Methods The male, white New Zealand, (20-week-old) were selected. Aloxan injection induced for diabetes induction and a week later the blood glucose level was measured. The standard tendon injury was created. The rabbits was divided in 3 groups. Control group, Plasma treated group at 5 kv, plasma treated group at 10 kv. Cold plasma was applied to the rabbits for 21 days. Results After 21 days the tendon tissue were considered histologically. The results show that inflammatory cells were significantly lower in the tendon treated with cold plasma at 10 kv than the others, which confirms that cold plasma treatment reduce the inflammation phase. Cold plasma treatment led to increase neovascularation and collagen production. Conclusion The results of this study confirm that the cold plasma treatment of skin has positive effect on healing of tissue inside body.
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Affiliation(s)
- Maryam Amini
- Faculty of Physics, Shahrood University of Technology, Shahrood, Iran
| | - Mahdi Momeni
- Faculty of Physics, Shahrood University of Technology, Shahrood, Iran
| | - Alireza Jahandideh
- Department of Veterinary Medicine, Tehran Azad University Science and Research Branch, Tehran, Iran
| | - Mahmood Ghoranneviss
- Diabetes Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Science, Tehran, Iran
| | - Sahar Soudmand
- Department of Veterinary Medicine, Tehran Azad University Science and Research Branch, Tehran, Iran
| | - Paniz Yousefi
- Department of Veterinary Medicine, Tehran Azad University Science and Research Branch, Tehran, Iran
| | - Saeed Khandan
- Diabetes Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Science, Tehran, Iran
| | - Mohammadreza Amini
- Diabetes Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Science, Tehran, Iran
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The expression of substance P and calcitonin gene-related peptide is associated with the severity of tendon degeneration in lateral epicondylitis. BMC Musculoskelet Disord 2021; 22:210. [PMID: 33612098 PMCID: PMC7898744 DOI: 10.1186/s12891-021-04067-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 02/10/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND In this study, we investigated whether substance P (SP) or calcitonin gene-related peptide (CGRP) expression is associated with tendon degeneration in patients with lateral epicondylitis. METHODS Twenty-nine patients who underwent surgical treatment for lateral epicondylitis were enrolled in the final analyses. Extensor carpi radialis brevis tendon origins were harvested for histological analysis. RESULTS SP and CGRP immunostaining were negative in healthy tendons but positive in degenerative tendons; moreover, their immunoreactivity increased with degeneration severity. Univariate analysis indicated that variables such as the preoperative visual analog scale (VAS) score or SP or CGRP expression levels were significantly associated with the Movin score. However, multivariate analysis revealed that only higher SP and/or CGRP signals were associated with higher Movin scores. Elevations in SP or CGRP expression were also linked with significantly severe preoperative VAS scores. CONCLUSION We demonstrated that tendon degeneration severity is associated with increased SP and CGRP expression in the biopsy samples of lateral epicondylitis.
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Zhu MF, Smith B, Krishna S, Musson DS, Riordan PR, McGlashan SR, Cornish J, Munro JT. The pathological features of hip abductor tendon tears - a cadaveric study. BMC Musculoskelet Disord 2020; 21:778. [PMID: 33243210 PMCID: PMC7690166 DOI: 10.1186/s12891-020-03784-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 11/10/2020] [Indexed: 01/06/2023] Open
Abstract
Background The hip abductors are crucial in maintaining pelvic stability. Tears in these tendons are common and often debilitating. There is uncertainty regarding both the histological and macroscopic features of hip abductor tears. This study aims to clarify both the macroscopic and microscopic features of the tendon and enthesis in hip abductor tendon tears. Methods Thirty-six cadavers with an average age of 81 were dissected, and the hip abductor mechanisms removed en-bloc. The presence, location and size of the tears were recorded and analysed. The samples were processed into histological blocks and viewed using both transmitted and polarised light. Tendon histology was graded using the modified Movin’s score in three sections (deep, middle and superficial layers) and the enthesis graded separately using 5-point criteria. Analysis of variance was used to confirm histological features associated with tears. Results Tears were found in 24 of 36 samples (67%). The most common finding was an isolated tear in the gluteus minimus (46%), followed by concurrent gluteus medius and gluteus minimus tears (33%). Histology revealed significantly more degeneration in both the tendon (p = 0.0005) and enthesis (p = 0.0011) when tears were present. Furthermore, these changes were concentrated in the deeper layers of the tendon (p = 0.0002) and enthesis (p = 0.003). Conclusion This study demonstrated degeneration as the primary pathology underlying hip abductor tendon tears. Degenerative changes occur in both the tendon and enthesis, with the deeper layers predominantly affected. These findings are important for guiding surgical repair techniques and to aid the development of novel materials and biologics. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-020-03784-3.
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Affiliation(s)
- Mark F Zhu
- Bone and Joint Laboratory, University of Auckland, 85 Park Road, Grafton, 1023, New Zealand. .,Department of Orthopaedic Surgery, Auckland City Hospital, 2 Park Road, Grafton, New Zealand.
| | - Brittany Smith
- Bone and Joint Laboratory, University of Auckland, 85 Park Road, Grafton, 1023, New Zealand
| | - Sanjeev Krishna
- Bone and Joint Laboratory, University of Auckland, 85 Park Road, Grafton, 1023, New Zealand
| | - David S Musson
- Bone and Joint Laboratory, University of Auckland, 85 Park Road, Grafton, 1023, New Zealand
| | - Peter R Riordan
- Department of Anatomy and Medical Imaging, University of Auckland, 85 Park Road, Grafton, New Zealand
| | - Sue R McGlashan
- Department of Anatomy and Medical Imaging, University of Auckland, 85 Park Road, Grafton, New Zealand
| | - Jillian Cornish
- Bone and Joint Laboratory, University of Auckland, 85 Park Road, Grafton, 1023, New Zealand
| | - Jacob T Munro
- Bone and Joint Laboratory, University of Auckland, 85 Park Road, Grafton, 1023, New Zealand.,Department of Orthopaedic Surgery, Auckland City Hospital, 2 Park Road, Grafton, New Zealand
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Sustained Exposure of Substance P Causes Tendinopathy. Int J Mol Sci 2020; 21:ijms21228633. [PMID: 33207770 PMCID: PMC7709031 DOI: 10.3390/ijms21228633] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/08/2020] [Accepted: 11/12/2020] [Indexed: 01/09/2023] Open
Abstract
Recently, neuromediators such as substance P (SP) have been found to be important factors in tendon homeostasis. Some studies have found SP to be the cause of inflammation and tendinopathy, whereas others have determined it to be a critical component of tendon healing. As demonstrated by these conflicting findings, the effects of SP on tendinopathy remain unclear. In this study, we hypothesized that the duration of SP exposure determines its effect on the tendons, with repetitive long-term exposure leading to the development of tendinopathy. First, we verified the changes in gene and protein expression using in vitro tenocytes with 10-day exposure to SP. SP and SP + Run groups were injected with SP in their Achilles tendon every other day for 14 days. Achilles tendons were then harvested for biomechanical testing and histological processing. Notably, tendinopathic changes with decreased tensile strength, as observed in the Positive Control, were observed in the Achilles in the SP group compared to the Negative Control. Subsequent histological analysis, including Alcian blue staining, also revealed alterations in the Achilles tendon, which were generally consistent with the findings of tendinopathy in SP and SP + Run groups. Immunohistochemical analysis revealed increased expression of SP in the SP group, similar to the Positive Control. In general, the SP + Run group showed worse tendinopathic changes. These results suggest that sustained exposure to SP may be involved in the development of tendinopathy. Future research on inhibiting SP is warranted to target SP in the treatment of tendinopathy and may be beneficial to patients with tendinopathy.
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14
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Brochhausen C, Grevenstein D, Mamilos A, Babel M, Eysel P. [Histological diagnostics in joint pathology due to increasing regenerative therapeutic strategies - special consideration for cartilage damage]. DER PATHOLOGE 2020; 41:271-280. [PMID: 32215684 DOI: 10.1007/s00292-020-00768-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Orthopedic and trauma surgery are currently confronted with significant changes in their interventional and therapeutic strategies, especially in knee surgery. Minimally invasive and reconstructive techniques lead not only to modifications of the repertoire of interventional methods but also of the indications and questions for histopathological diagnostics. The classical problems in knee surgery remain important issues, which are traumatic, degenerative, and infectious lesions. In addition, questions regarding regeneration and integration of cell-material constructs will become more and more important in the future. Furthermore, questions regarding the regenerative potential of an implantation site for such constructs and the morphological quality of harvested tissue for the in vitro cell expansion of autologous cells are becoming increasingly important. The autologous chondrocyte transplantation is a good example of the relevance of the histopathological re-evaluation of the regenerated tissue for a better understanding of the pathophysiology of reconstructive therapies. It becomes clear that for specific aims based on reconstructive therapies, new scoring systems should be established for the histopathological routine diagnostic service. Furthermore, there is need for the definition of further histopathological criteria, which will help to optimize the differential application of reconstructive strategies via tissue engineering. The present report gives a short overview of the modifying requirements on the histopathological diagnostics in specimens from knee-surgery but does not claim to be exhaustive.
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Affiliation(s)
- Christoph Brochhausen
- Institut für Pathologie, Universität Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland. .,Zentrum für Rheumapathologie GmbH, Mainz, Deutschland.
| | - David Grevenstein
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Uniklinik Köln, Köln, Deutschland
| | - Andreas Mamilos
- Institut für Pathologie, Universität Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | | | - Peer Eysel
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Uniklinik Köln, Köln, Deutschland
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15
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Pulatkan A, Anwar W, Ayık O, Bozdag E, Yildirim AN, Kapicioglu M, Tuncay I, Bilsel K. Tear Completion Versus In Situ Repair for 50% Partial-Thickness Bursal-Side Rotator Cuff Tears: A Biomechanical and Histological Study in an Animal Model. Am J Sports Med 2020; 48:1818-1825. [PMID: 32298135 DOI: 10.1177/0363546520909854] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Tear completion followed by repair (TCR) and in situ repair (ISR) have been widely used for bursal-side partial-thickness rotator cuff tears (PTRCTs). Both techniques have shown favorable results; however, controversy continues in terms of the best management. PURPOSE To compare the histological and biomechanical outcomes of these 2 techniques for 50% partial-thickness bursal-side rotator cuff tear repair in a rabbit model. STUDY DESIGN Controlled laboratory study. METHODS A total of 27 rabbits were used in this experimental study. Seven rabbits were sacrificed at the beginning of the study to form an intact tendon control group. A chronic 50% partial-thickness bursal-side tear model was created in 20 rabbits, and 5 rabbits were sacrificed for biomechanical testing of chronic partial-thickness tears (control group) without repair. In 15 rabbits, partial-thickness tears were repaired after 8 weeks. Partial-thickness tears in the right shoulders were completed to full thickness and repaired; in contrast, left shoulders were repaired in situ. All rabbits were euthanized 8 weeks after the repair. The tendons were tested biomechanically for ultimate failure, linear stiffness, and displacement. Histological evaluations of tendon-to-bone healing were performed via the modified Watkins score. RESULTS Macroscopically, all repaired tendons were attached to the greater tuberosity. The TCR group had a higher failure load than the ISR group, with mean values of 140.4 ± 13.8 N and 108.1 ± 16.6 N, respectively (P = .001). The modified Watkins score was significantly higher in the TCR group (23.5; range, 22-27) than in the ISR group (19.5; range, 16-22) (P = .009). CONCLUSION Both repair techniques are effective for 50% partial-thickness bursal-side rotator cuff tears; however, TCR yields significantly superior biomechanical and histological characteristics compared with ISR. CLINICAL RELEVANCE Tear completion and repair technique may increase tendon-to-bone healing and thereby reduce re-rupture rate in the partial thickness bursal side rotator cuff tears.
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Affiliation(s)
- Anil Pulatkan
- Department of Orthopedics and Traumatology, School of Medicine, Bezmialem Vakif University, Fatih, Istanbul, Turkey
| | - Wasim Anwar
- FCPS Department of Orthopaedics, Medical Teaching Institute, Hayatabad Medical Complex, Peshawar, Pakistan
| | - Omer Ayık
- Department of Orthopaedics and Traumatology, Fatih, Istanbul University Medical Faculty, School of Medicine, Istanbul, Turkey
| | - Ergun Bozdag
- Biomechanics Laboratory, Department of Mechanical Engineering, Istanbul Technical University, Taksim, Istanbul, Turkey
| | - Ayse Nur Yildirim
- Department of Pathology, Medeniyet University Goztepe Research and Training Hospital, Istanbul, Turkey
| | - Mehmet Kapicioglu
- Department of Orthopedics and Traumatology, School of Medicine, Bezmialem Vakif University, Fatih, Istanbul, Turkey
| | - Ibrahim Tuncay
- Department of Orthopedics and Traumatology, School of Medicine, Bezmialem Vakif University, Fatih, Istanbul, Turkey
| | - Kerem Bilsel
- Department of Orthopedics and Traumatology, School of Medicine, Bezmialem Vakif University, Fatih, Istanbul, Turkey
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Sugiyama Y, Naito K, Goto K, Kojima Y, Furuhata A, Igarashi M, Nagaoka I, Kaneko K. Effect of aging on the tendon structure and tendon-associated gene expression in mouse foot flexor tendon. Biomed Rep 2019; 10:238-244. [PMID: 30972219 DOI: 10.3892/br.2019.1200] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 03/07/2019] [Indexed: 01/23/2023] Open
Abstract
To evaluate the biological changes in tendons during the aging process, the present study examined the effect of aging on the tendon structure, distribution of collagen types I and III, and expression of tendon-associated genes, using flexor tendons in a mouse model. Histological assessment of the tendon structure and distribution of collagen types I and III were performed, and the expression of tendon-associated genes was evaluated in flexor digitorium longus tendons of young (8 weeks) and aged (78 weeks) female C57BL/6 mice. The results indicated that the Soslowsky score, based on the analysis of cellularity, fibroblastic changes, and collagen fiber orientation and disruption, was significantly increased, or worsened, in the tendons of the aged group compared with those in the young group. Furthermore, in the aged group, the distribution of type I collagen was decreased and the distribution of type III collagen was relatively increased compared with the young group. Finally, the mRNA expression levels of collagen (type I and type III) and tenogenic markers (Mohawk homeobox, tenomodulin and scleraxis BHLH transcription factor) were significantly decreased in the aged group compared with the young group. The present observations demonstrated that the structure of the tendons, distribution of types I and III collagen and the expression of tendon-associated genes were modulated by aging in the flexor tendon, and that these changes may contribute to the degeneration of tendons in tendinopathy.
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Affiliation(s)
- Yoichi Sugiyama
- Department of Medicine for Motor Organs, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Kiyohito Naito
- Department of Medicine for Motor Organs, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Kenji Goto
- Department of Medicine for Motor Organs, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Yuko Kojima
- Laboratory of Morphology and Image Analysis, Research Support Center, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Atsushi Furuhata
- Laboratory of Morphology and Image Analysis, Research Support Center, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Mamoru Igarashi
- Department of Host Defense and Biochemical Research, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Isao Nagaoka
- Department of Host Defense and Biochemical Research, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Kazuo Kaneko
- Department of Medicine for Motor Organs, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
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17
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Sun J, Mou C, Shi Q, Chen B, Hou X, Zhang W, Li X, Zhuang Y, Shi J, Chen Y, Dai J. Controlled release of collagen-binding SDF-1α from the collagen scaffold promoted tendon regeneration in a rat Achilles tendon defect model. Biomaterials 2018; 162:22-33. [DOI: 10.1016/j.biomaterials.2018.02.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/21/2018] [Accepted: 02/02/2018] [Indexed: 10/18/2022]
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18
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Albano D, Martinelli N, Bianchi A, Romeo G, Bulfamante G, Galia M, Sconfienza LM. Posterior tibial tendon dysfunction: Clinical and magnetic resonance imaging findings having histology as reference standard. Eur J Radiol 2017; 99:55-61. [PMID: 29362151 DOI: 10.1016/j.ejrad.2017.12.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 10/24/2017] [Accepted: 12/08/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To investigate the correlation between MRI, clinical tests, histopathologic features of posterior tibial tendon (PTT) dysfunction in patients with acquired adult flatfoot deformity surgically treated with medializing calcaneal osteotomy and flexor digitorum longus tendon transposition. MATERIALS AND METHODS Nineteen patients (11 females; age: 46 ± 15 year, range 18-75) were pre-operatively evaluated using the single heel rise (HR) and the first metatarsal rise (FMR) sign tests. Two reviewers graded the PTT tears on a I-III scale and measured the hindfoot valgus angle on the pre-operative MRI of the ankle. The specimens of the removed portion of PTT were histologically analysed by two pathologists using the Bonar and Movin score. Linear regression, Spearman's rank-order, and intraclass correlation coefficient (ICC) statistics were used. RESULTS ICC for MRI was excellent (0.952). Correlation between FMR and HR tests was at limit of significance (r = 0.454; P = 0.051). The HR and FMR tests were significantly correlated to the Movin score (r = 0.581; P = 0.009 and r = 0.538; P = 0.018, respectively) and were not significantly correlated to the Bonar score (both with a r = 0.424; P = 0.070). PTT tendinopathy grading at MRI was significantly correlated to the FMR test (p = 0.041) but not to the hindfoot valgus angle (p = 0.496), the HR test (p = 0.943), the Bonar score (p = 0.937), and the Movin score (p = 0.436). The hindfoot angle was not correlated to any of the other variables (p > 0.264). CONCLUSION For PTT dysfunction, there is high correlation between HR and FMR test and histology evaluated using the Movin score, while no correlation was seen for the Bonar score. Semiquantitative grading of PTT dysfunction at MRI only correlates to the FMR and not to histology. The hindfoot valgus angle is not correlated to any of the considered variables.
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Affiliation(s)
- Domenico Albano
- Department of Radiology, Di.Bi.Med., University of Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Nicolò Martinelli
- Foot and Ankle Surgery Unit, Istituto Clinico Città Studi, Milano, Italy
| | - Alberto Bianchi
- Foot and Ankle Surgery Unit, Istituto Clinico Città Studi, Milano, Italy
| | - Giovanni Romeo
- Foot and Ankle Surgery Unit, Istituto Clinico Città Studi, Milano, Italy
| | - Gaetano Bulfamante
- Department of Health Sciences, San Paolo Hospital Medical School University of Milan, Via di Rudinì 8, 20142, Milan, Italy
| | - Massimo Galia
- Department of Radiology, Di.Bi.Med., University of Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Luca Maria Sconfienza
- Department of Biomedical Sciences for Health, University of Milano, Via Pascal 36, 20135, Milano, Italy; Unit of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20166, Milano, Italy.
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19
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Johnston JM, Connizzo BK, Shetye SS, Robinson KA, Huegel J, Rodriguez AB, Sun M, Adams SM, Birk DE, Soslowsky LJ. Collagen V haploinsufficiency in a murine model of classic Ehlers-Danlos syndrome is associated with deficient structural and mechanical healing in tendons. J Orthop Res 2017; 35:2707-2715. [PMID: 28387435 PMCID: PMC5632109 DOI: 10.1002/jor.23571] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 03/28/2017] [Indexed: 02/04/2023]
Abstract
Classic Ehlers-Danlos syndrome (EDS) patients suffer from connective tissue hyperelasticity, joint instability, skin hyperextensibility, tissue fragility, and poor wound healing due to heterozygous mutations in COL5a1 or COL5a2 genes. This study investigated the roles of collagen V in establishing structure and function in uninjured patellar tendons as well as in the injury response using a Col5a1+/- mouse, a model for classic EDS. These analyses were done comparing tendons from a classic EDS model (Col5a1+/- ) with wild-type controls. Tendons were subjected to mechanical testing, histological, and fibril analysis before injury as well as 3 and 6 weeks after injury. We found that Col5a1+/- tendons demonstrated diminished recovery of mechanical competency after injury as compared to normal wild-type tendons, which recovered their pre-injury values by 6 weeks post injury. Additionally, the Col5a1+/- tendons demonstrated altered fibril morphology and diameter distributions compared to the wild-type tendons. This study indicates that collagen V plays an important role in regulating collagen fibrillogenesis and the associated recovery of mechanical integrity in tendons after injury. In addition, the dysregulation with decreased collagen V expression in EDS is associated with a diminished injury response. The results presented herein have the potential to direct future targeted therapeutics for classic EDS patients. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2707-2715, 2017.
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Affiliation(s)
- Jessica M. Johnston
- University Laboratory Animal Resources, Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania,McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brianne K. Connizzo
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Snehal S. Shetye
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kelsey A. Robinson
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Julianne Huegel
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ashley B. Rodriguez
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mei Sun
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Sheila M. Adams
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - David E. Birk
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Louis J. Soslowsky
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania
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20
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Tucker JJ, Soslowsky LJ. Effect of simvastatin on rat supraspinatus tendon mechanical and histological properties in a diet-induced hypercholesterolemia model. J Orthop Res 2016; 34:2009-2015. [PMID: 26970227 PMCID: PMC5349294 DOI: 10.1002/jor.23225] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 02/18/2016] [Indexed: 02/04/2023]
Abstract
Hypercholesterolemia is a common condition and is a risk factor for tendon rupture, specifically in the supraspinatus tendon. In the clinic, statins are commonly prescribed to lower cholesterol, but little information is available examining the effect of statin treatment on the musculoskeletal system. Therefore, the objective of this study was to determine the biomechanical and histological effects of statin treatment in a diet-induced hypercholesterolemia model. We hypothesized that hypercholesterolemic rats treated with statins would have improved tendon biomechanical and histological properties compared to hypercholesterolemic rats not receiving daily statin treatment. Thirty adult male Sprague-Dawley rats ate either high-cholesterol (HC) diet (n = 20) or normal chow (CTL, n = 10). After 6 months, a subset of HC rats began daily oral simvastatin dosing (HC+S) at 20 mg/kg. All rats were sacrificed after a total of 9 months (3 months of statin treatment) and evaluated for histology and mechanics. For mechanics, at the insertion region, HC+S group had increased tendon cross-sectional area decreased and modulus. No differences were noted in mechanical properties at the midsubstance. For histology, no differences were noted in the insertion region. In the midsubstance region, HC+S group had more spindle shaped cells. Our results suggest that 3 months of simvastatin treatment in a diet-induced hypercholesterolemia rat model alters some tendon mechanical and histological properties, although a strong conclusion in support of improved parameters cannot be drawn. Therefore, we conclude that simvastatin treatment does not negatively affect tendon properties. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:2009-2015, 2016.
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21
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Tucker JJ, Riggin CN, Connizzo BK, Mauck RL, Steinberg DR, Kuntz AF, Soslowsky LJ, Bernstein J. Effect of overuse-induced tendinopathy on tendon healing in a rat supraspinatus repair model. J Orthop Res 2016. [PMID: 26218457 PMCID: PMC4710550 DOI: 10.1002/jor.22993] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Supraspinatus tears often result in the setting of chronic tendinopathy. However, the typical repair model utilizes an acute injury. In recognition of that distinction, our laboratory developed an overuse animal model; however it is unclear whether induced overuse is necessary in the repair model. We studied the repair properties of overuse-induced tendons compared to normal tendons. We hypothesized that histological and mechanical properties would not be altered between the overuse-induced and normal tendons 1 and 4 weeks after repair. Thirty-one adult male Sprague-Dawley rats were subjected to either overuse or cage activity for 4 weeks prior to bilateral supraspinatus tendon repair surgery. Rats were sacrificed at 1 and 4 weeks post-surgery and evaluated for histology and mechanics. Results at 1 week showed no clear histologic changes, but increased inflammatory protein expression in overuse tendons. At 4 weeks, percent relaxation was slightly increased in the overuse group. No other alterations in mechanics or histology were observed. Our results suggest that the effects of the surgical injury overshadow the changes evoked by overuse. Because clinically relevant mechanical parameters were not altered in the overuse group, we conclude that when examining tendons 4 weeks after repair in the classic rat supraspinatus model, inducing overuse prior to surgery is likely to be unnecessary.
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Affiliation(s)
| | | | | | - Robert L. Mauck
- McKay Orthopaedic Research Laboratory, Philadelphia, PA,Philadelphia VA Medical Center (PVAMC), Philadelphia, PA
| | - David R. Steinberg
- McKay Orthopaedic Research Laboratory, Philadelphia, PA,Philadelphia VA Medical Center (PVAMC), Philadelphia, PA
| | - Andrew F. Kuntz
- McKay Orthopaedic Research Laboratory, Philadelphia, PA,Philadelphia VA Medical Center (PVAMC), Philadelphia, PA
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Kabuto Y, Morihara T, Sukenari T, Kida Y, Oda R, Arai Y, Sawada K, Matsuda KI, Kawata M, Tabata Y, Fujiwara H, Kubo T. Stimulation of Rotator Cuff Repair by Sustained Release of Bone Morphogenetic Protein-7 Using a Gelatin Hydrogel Sheet. Tissue Eng Part A 2015; 21:2025-33. [PMID: 25819324 DOI: 10.1089/ten.tea.2014.0541] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Bone morphogenetic protein-7 (BMP-7) promotes not only osteogenesis but also matrix production in chondrocytes and tenocytes. However, because of its short half-life, maintaining local concentrations of BMP-7 is difficult. We examined the use of a gelatin hydrogel sheet (GHS) for the sustained release of BMP-7 in stimulating rotator cuff repair at the tendon-to-bone insertion. Twelve-week-old male Sprague-Dawley rats were used. Radiolabeled BMP-7 ((125)I-BMP-7) was injected into the subacromial bursa in the (125)I-BMP-7 group, whereas a GHS impregnated with (125)I-BMP-7 was implanted on the tendon attached to the tendon-to-bone insertion in the (125)I-BMP-7+GHS group. Levels of (125)I-BMP-7 in the tendon-to-bone insertion were assessed at 1, 3, 7, 14, and 21 postoperative days. The BMP-7 concentrations were significantly higher in the (125)I-BMP-7+GHS group than in the (125)I-BMP-7 group. Next, the bilateral supraspinatus tendons were resected and sutured to the greater tuberosity of the humerus using the Mason-Allen technique. Treatment groups were created as follows: either phosphate-buffered saline (PBS) or BMP-7 was injected into the subacromial bursa in the PBS and BMP-7 groups, whereas a GHS impregnated with either PBS or BMP-7 was implanted on the repaired tendon attached to the tendon-to-bone insertion in the PBS+GHS and BMP-7+GHS groups. The resected specimens were stained at 2, 4, and 8 postoperative weeks with hematoxylin and eosin as well as Safranin O, and tissue repair was evaluated histologically by using the tendon-to-bone maturing score. Tissue repair was assessed biomechanically at 4 and 8 postoperative weeks. The BMP-7+GHS group at 8 postoperative weeks demonstrated a favorable cartilage matrix production and tendon orientation; moreover, the tendon-to-bone maturing score and the ultimate force-to-failure were the highest in this group. The ability of GHS to provide controlled release of various growth factors has been previously reported. We confirmed that the GHS releases BMP-7 in a sustained manner in the rat shoulder joint. At 8 postoperative weeks, the repaired tissue was mostly restored, both histologically and biomechanically, in the BMP-7+GHS group. We therefore conclude that the sustained release of BMP-7 from a GHS can stimulate rotator cuff repair.
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Affiliation(s)
- Yukichi Kabuto
- 1 Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine , Kyoto, Japan
| | - Toru Morihara
- 1 Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine , Kyoto, Japan
| | - Tsuyoshi Sukenari
- 1 Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine , Kyoto, Japan
| | - Yoshikazu Kida
- 1 Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine , Kyoto, Japan
| | - Ryo Oda
- 1 Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine , Kyoto, Japan
| | - Yuji Arai
- 1 Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine , Kyoto, Japan
| | - Koshiro Sawada
- 1 Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine , Kyoto, Japan
| | - Ken-Ichi Matsuda
- 2 Department of Anatomy and Neurobiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine , Kyoto, Japan
| | - Mitsuhiro Kawata
- 2 Department of Anatomy and Neurobiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine , Kyoto, Japan
| | - Yasuhiko Tabata
- 3 Department of Biomaterials, Institute for Frontier Medical Sciences, Kyoto University , Kyoto, Japan
| | - Hiroyoshi Fujiwara
- 1 Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine , Kyoto, Japan
| | - Toshikazu Kubo
- 1 Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine , Kyoto, Japan
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