Comparison of Gene Expression of Inflammation- and Fibrosis-Related Factors Between the Anterior and Posterior Capsule in Patients With Rotator Cuff Tear and Shoulder Stiffness

Abstract

Background: Arthroscopic capsular release is an effective treatment for refractory shoulder stiffness, yet there are no basic studies that can explain the extent of the release. Purpose: This study aimed to compare the genetic expression of inflammation- and fibrosis-related factors between the anterior and posterior capsules in patients with shoulder stiffness and rotator cuff tear. Study Design: Descriptive laboratory study. Methods: Enrolled in this study were 35 patients who underwent arthroscopic capsular release for shoulder stiffness along with the rotator cuff repair. Anterior and posterior glenohumeral joint capsular tissues were obtained during the capsular release. For the control tissue, anterior capsule was obtained from 40 patients without stiffness who underwent arthroscopic rotator cuff repair. The gene expression of collagen types I and III, fibronectin, extracellular matrix, basic fibroblast growth factor, transforming growth factor–β, connective tissue growth factor, matrix metalloproteinase (MMP)-1, MMP-2, MMP-9, tissue inhibitor of metalloproteinase (TIMP)-1, TIMP-2, intercellular adhesion molecule 1, interleukin 1, and tumor necrotizing factor–α were analyzed using real-time reverse transcription polymerase chain reaction. Differences in gene expression between the anterior capsule, the posterior capsule, and the control tissue were compared with the Kruskal-Wallis test. Results: The expression levels of collagen types I and III were significantly higher in the anterior capsule with stiffness com (pared with both the posterior capsule with stiffness ( P = .010 for both) and the control ( P = .038 and .010, respectively). The levels of fibronectin, MMP-2, and MMP-9 in the anterior capsule were significantly higher than in both the posterior capsule ( P = .013, .003, and .006, respectively) and the control ( P = .014, .003, and .005, respectively). Conclusion: Genetic analysis of the shoulder capsule revealed that more fibrogenic processes occur in the anterior capsule compared with the posterior capsule in patients with shoulder stiffness. Clinical Relevance: Capsular release for shoulder stiffness should be more focused on the anterior capsule than on the posterior capsule.

si-Tgfbr1-loading liposomes inhibit shoulder capsule fibrosis via mimicking the protective function of exosomes from patients with adhesive capsulitis

“…Rotator cuff tear (RCT) is another common glenohumeral complaint inducing joint pain and dysfunction especially in elderly [4]. In patients with RCT, the portion of concomitant adhesive capsulitis can be 10% to 40% [5,6], while in patients with adhesive capsulitis, ~ 30% have concomitant full-thickness RCT [7]. Surgically repairing of the torn rotator cuff has been accepted worldwide for decades, yielding overall satisfactory results [8], but how to treat RCT in patients with adhesive capsulitis is still controversial.…”

What is the most predictive magnetic resonance imaging finding of rotator cuff tear concomitant with shoulder stiffness?

“…They reported that more fibrous processes occur in the anterior capsule than in the posterior capsule in patients with stiffness. 12 The levels of fibronectin, matrix metalloproteinase-2, and matrix metalloproteinase-9 in the anterior capsule were significantly higher than those in the posterior capsule. 12 These pathophysiological and histological results also support our findings on the significance of anterior capsular thickness.…”

“… 24 Moreover, anterior capsular thickening was frequently evident on arthroscopy in patients with stiffness. 30 , 31 Similarly, Kim et al 12 conducted a prospective study to compare the genetic expressions of inflammation- and fibrosis-related factors in the anterior and posterior capsules between patients with and without stiffness and having RCT. They reported that more fibrous processes occur in the anterior capsule than in the posterior capsule in patients with stiffness.…”

Types and doses of anti‐adhesive agents injected into subacromial space do not have an effect on the clinical and anatomical outcomes after arthroscopic rotator cuff repair

“…Furthermore, it may impede post‐operative rehabilitation after rotator cuff repair and reduce the quality of life [6, 15, 33, 44]. The stiffness arises from post‐surgical adhesion in the subacromial space and capsular contracture [30, 45]. The procedures performed, such as acromioplasty, bursectomy, or footprint preparation, may cause bleeding, contributing to fibroblast proliferation and the progression of fibrous scar tissue adhesion [30, 50].…”

“…The stiffness arises from post‐surgical adhesion in the subacromial space and capsular contracture [30, 45]. The procedures performed, such as acromioplasty, bursectomy, or footprint preparation, may cause bleeding, contributing to fibroblast proliferation and the progression of fibrous scar tissue adhesion [30, 50]. To overcome post‐operative shoulder stiffness, meticulous hemostasis and capsular release should be performed, especially for patients with preoperative stiffness, intraarticular steroid injection, or early post‐operative rehabilitation [7, 8, 22, 27, 29].…”