Expression of matrix metalloproteinases 1, 3, and 9 in degenerated long head biceps tendon in the presence of rotator cuff tears: an immunohistological study

Abstract

BackgroundLong head biceps (LHB) degeneration, in combination with rotator cuff tears, can be a source of chronic shoulder pain. LHB tenotomy reduces pain and improves joint function although the pathophysiological context is not well understood. Tendon integrity depends on the extracellular matrix (ECM), which is regulated by matrix metalloproteinases (MMP). It is unclear which of these enzymes contribute to LHB but we chose to study MMP 1, 3, and 9 and hypothesized that one or more of them may be altered in LHB, whether diagnosed preoperatively or intraoperatively. We compared expression of these MMPs in both LHB and healthy tendon samples.MethodsLHB samples of 116 patients with degenerative rotator cuff tears were harvested during arthroscopic tenotomy. Patients were assigned to 4 groups (partial thickness tear, full thickness tear, cuff arthropathy, or control) based upon intraoperative findings. Partial and full thickness tears were graded according to Ellman and Bateman's classifications, respectively. MMP expression was determined by immunohistochemistry.ResultsMMP 1 and 9 expression was significantly higher in the presence of rotator cuff tears than in controls whereas MMP 3 expression was significantly decreased. MMP 1 and 9 expression was significantly higher in articular-sided than bursal-sided partial thickness tears. No significant association was found between MMP 1 and 9 expression and full thickness tears, and the extent of the cuff tear by Bateman's classification.ConclusionIncreased MMP 1 and 9 expression, and decreased MMP 3 expression are found in LHB degeneration. There is a significant association between the size and location of a rotator cuff tear and MMP expression.

Lessons we can learn from gene expression patterns in rotator cuff tears and tendinopathies

“…43 The location and size of rotator cuff tears may affect MMP biology, given that degenerated long head of the biceps samples taken from patients with articular-sided partial-thickness rotator cuff tears had higher levels of MMP-1 and MMP-9 compared with patients with partial tears on the bursal side. 33 In contrast, MMP-3 was found to be downregulated.…”

Returning to overuse activity following a supraspinatus and infraspinatus tear leads to joint damage in a rat model

“…This force balance disruption may lead to humeral head translations (Keener et al, 2009; Oh et al, 2011) and therefore increase the patient’s risk of developing secondary joint damage, such as tear propagation, long head of the biceps (LHB) degeneration (Lakemeier et al, 2010a), articular cartilage degeneration (Hsu et al, 2003), or cuff tear arthropathy (Neer et al, 1983). Clinical investigations have shown a correlation between two-tendon rotator cuff tears and secondary joint pathology (Keener et al, 2009), such as impaired joint function and LHB pain(Lakemeier et al, 2010a; Lakemeier et al, 2010b). Additionally, previous studies in a rat model have shown that in the presence of a two-tendon rotator cuff tear, joint function is altered (Perry et al, 2009b; Sarver et al, 2010) and the LHB tendon (Peltz et al, 2009), subscapularis tendon (Perry et al, 2009a), and glenoid articular cartilage (Reuther et al, 2012) display decreased mechanical properties.…”

Degenerative disease in rotator cuff tears: what are the biochemical and histological changes?

“…These changes could be the pathogenic precursor of a subsequent tear or a tendinopathic process occurring in the rupture area and extending to the portion of the tendon medial to the site of rupture. Lakemeier et al (13) showed that MMPs 1, 3, and 9 were also increased in degenerated long head of the biceps tendon in the presence of rotator cuff tears. TIMPs 1, 2, and 4 are present in the tissue matrix and in the blood, while TIMP3 is present only in the ECM.…”