Inflammatory infiltrate of the edges of a torn rotator cuff

Abstract

There is still considerable controversy as to whether or not the inflamed margins of a cuff tear should be excised during surgical suture. We have tried to discover whether anti-inflammatory drugs used before surgical treatment could resolve this issue. Thirty-eight patients were randomly either treated with an anti-inflammatory drug for 2 weeks or not. During the subsequent arthroscopic repair, a few fragments of supraspinatus edge were excised and examined microscopically. No significant differences emerged among samples belonging to the two groups. In all cases, we observed inflammatory infiltratelined tear edges. Fibrocytes and newly formed vessels were detected near the margin. Dystrophic calcifications were observed in both groups. Away from the edge, the tendon appeared hypocellular; containing areas with myxoid or fatty degeneration. Our study demonstrates that an antiinflammatory drug is unable to resolve the inflammatory infiltrate. This failure is probably related to the poor blood supply to the cuff, which, in cases of rupture, is deprived of vessels coming from the humeral periosteum. Further studies are needed to understand how to eliminate the inflammatory process and clarify whether it might inhibit cuff healing and give rise to re-tearing of the sutured cuff.Résumé Quelle est la réponse à la controverse: faut-il exciser les tissus inflammatoires dans les lésions de la coiffe des rotateurs? Nous avons vérifié ce problème en invitant les patients à prendre un traitement inflammatoire avant le traitement chirurgical. Trente-huit patients ont été randomisés avec ou sans traitement anti-inflammatoire dans les quinze jours précédant l'intervention. Au cours de la réparation arthroscopique, de petits fragments sous épineux ont été excisés et étudiés microscopiquement sans différence significative entre les deux groupes. Dans tous les cas nous observons une infiltration inflammatoire des berges des lésions. Des fibrocytes et des néo-vaisseaux ont été détectés au niveau des marges, des calcifications ont été également observées dans les deux groupes. A distance des bords le tendon apparaît avec des lésions hypo-cellulaires, une dégénérescence mixoide ou graisseuse. Notre étude démontre que le traitement anti-inflammatoire n'est pas capable de résoudre le problème de l'infiltration inflammatoire, ceci est dû au fait que les lésions cicatricielles sont privées de vaisseaux venant du périoste huméral. Des études ultérieures seront nécessaires pour comprendre comment nous pouvons éliminer ce processus inflammatoire et permettre une meilleure cicatrisation de la coiffe après suture.

The impact of preoperative smoking habit on rotator cuff tear: cigarette smoking influences rotator cuff tear sizes

“…8 It is understandable that tobacco smoking has an important part in tendon degeneration processes because it causes hypoxia in an already hypovascular zone.…”

The 2-Scope Technique for Rotator Cuff Surgery: Are 2 Scopes Better Than 1?

“…Tear margins are usually defined as regular, frayed, or double layered. 1 , 2 , 3 , 4 , 5 Classification parameters emerge intraoperatively from a separate view of the lesion from the articular side, at the beginning of the procedure, and then from the subacromial space. In our hands, the 2-scope technique has provided further information on tear delamination and appearance, in particular in the case of a flute-beak margin that is often constituted only by the bursal layer.…”

Culture of human rotator cuff cells on orthobiologic support (porcine small intestinal submucosa

“…This tissue is principally represented by lymphocytes, macrophages, plasma cells, giant cells that phagocytise dystrophic calcifications and synoviallike cells [29]. Distribution of these cells and degree of inflammation depend substantially on the tear dimension and age.…”