No differences in histopathological degenerative changes found in acute, trauma-related rotator cuff tears compared with chronic, nontraumatic tears

Abstract

Purpose Acute trauma-related rotator cuff tears are believed to have better healing potential than chronic tears due to less degenerative changes of the tendons. However, the histopathological condition of tendons from trauma-related tears is not well investigated. The purpose of this study was to explore specific histopathological features in tendons from acute trauma-related full-thickness rotator cuff tears and to compare them to findings in tendons from nontraumatic, chronic tears. Methods In a prospective cohort study, 62 previously asymptomatic patients [14 women, median age 61 years (range 42–75)] with trauma-related full-thickness rotator cuff tears were consecutively included. Arthroscopic repair was performed within 30 (median, IQR 25–37) days after the injury. During surgery, tissue biopsies were harvested from the supraspinatus tendons in 53 (86%) of the patients. In addition, similar biopsies were harvested from 10 patients undergoing surgery for chronic tears without history of trauma. All tissue samples were examined by a well-experienced pathologist under light microscope. Tendon degeneration was determined using the Bonar score whereas immunostaining was used for proliferation (Ki67), inflammation (CD45), apoptosis (p53) and haemosiderin staining to study traces of bleeding. Results The median (IQR) Bonar score for the acute trauma-related biopsies was 10.5 (7.5–14.5) compared to 11 (5–12.8) for the control group with no statistically significant difference between the groups. No statistically significant between-group difference was found for the inflammatory index whereas tendons from patients with trauma-related full-thickness rotator cuff tears had statistically significantly higher apoptosis [3.1 (0.5–8.9) vs. 0.1 (0–1.5), p = 0.003] and proliferation [4.0 (1.8–6.9) vs. 0.4 (0–2.0), p = 0.001) indices than those undergoing surgery for chronic tears. Positive haemosiderin staining was found in 34% of tissue samples from patients with trauma-related tears compared to 10% in the control group (n.s). Conclusion This study suggests that there is no difference with regard to degenerative changes between supraspinatus tendons harvested from patients with acute, trauma-related rotator cuff tears and patients with nontraumatic, chronic tears. Level of evidence II.

Absorbable suture knots on the supraspinatus tendon prevent adverse effects of nonabsorbable suture knots in a rat model

“…In addition, the ratio of the inflammatory area in the full vision of images was calculated by Image‐Pro Plus 6.0 (Media Cybernetics, Rockville, MD, USA) [25]. MT staining was used to evaluate the fiber continuity and orientation of collagen between the repaired tendon and bone using a semi‐quantitative Bonar score grading system [1, 18]. The detailed grading scale was as follows: Grade 0, collagen arranged in tightly cohesive well‐demarcated bundles with a smooth, dense, bright homogeneous polarization pattern with normal crimping; Grade 1, diminished fiber polarization: separation of individual fibers with maintenance of demarcated bundles; Grade 2, bundle changes: separation of fibers with loss of demarcation of bundles, giving rise to tissue expansion and the overall land clear loss of normal polarization pattern; Grade 3, marked separation of fibers with complete loss of architecture [21].…”

Protective and Regenerative Effects of Reconstituted HDL on Human Rotator Cuff Fibroblasts under Hypoxia: An In Vitro Study

“…Despite the high morbidity of rotator cuff tendinopathy, or tendon degeneration, its causes and involved factors remain incompletely elucidated [1,2]. Hypovascularity has been proposed as a cause of rotator cuff tendon tear, but this remains controversial [3][4][5][6].…”

Capsular remnant in the rotator cuff footprint is a novel arthroscopic finding may indicate the etiology of the tear

“…The non‐traumatic full‐thickness rotator cuff tears often begin as partial‐thickness tears either on the joint or bursal side. In recent studies, it is revealed that both tear types are completely different from each other in terms of etiology, accompanying pathologies, and conservative and surgical treatment options [1, 10–12]. Especially subacromial impingement syndrome is responsible for the formation of bursal‐side partial tears.…”