Risk Factors for Tear Progression in Symptomatic Rotator Cuff Tears: A Prospective Study of 174 Shoulders

Yamamoto, Nobuyuki; Mineta, Mitsuyoshi; Kawakami, Jun; Sano, Hirotaka; Itoi, Eiji

doi:10.1177/0363546517709780

Cited by 79 publications

(73 citation statements)

References 30 publications

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“…Although our results are in agreement with the hypothesis that the increased ratio of type I/III collagen may be indicative of the repair response, our clinical findings show that the ratio of type I/III collagen cannot be used as a single marker of total repair, as previously postulated . Our clinical observations indicate that the attempted intrinsic tendon repair is insufficient to reestablish tissue integrity, and surgical treatment is necessary, even in patients who have experienced a longer disease period (personal note), which agrees with Yamamoto et al study demonstrating clinically the absence of healing and progression of about 47% of the shoulders tears …”

Section: Discussionsupporting

confidence: 92%

Changes in the expression of matrix extracellular genes and TGFB family members in rotator cuff tears

Belangero

Figueiredo

Cohen

et al. 2018

Journal Orthopaedic Research

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Lack of synthesis of extracellular matrix compounds may contribute to degeneration of the tendons. Thus, we aimed to evaluate the expression of extracellular matrix and TGFB family members in ruptured and non-ruptured tendons of the rotator cuff, as well as the effect of clinical factors on gene expression in tendon samples, and the relationship between histological findings and altered gene expression. Injured and non-injured supraspinatus tendon samples and subscapular non-injured tendon samples were collected from 38 patients with rotator cuff tears. Non-injured supraspinatus tendons were obtained from eight controls. Specimens were used for histological evaluation, quantification of collagen fibers, and mRNA and protein expression analyses. Increased COL1A1, COL1A2, COL3A1, COL5A1, FN1, TNC, and TGFBR1 mRNA expression was observed in the tear samples (p < 0.05). Duration of symptoms was correlated with the levels of collagen type I/III fibers (p = 0.032; ρ = 0.0447) and FN1 immunostaining (p = 0.031; ρ = 0.417). Smoking was associated with increased frequency of microcysts, myxoid degeneration, and COL5A1, FN1, TNC, and TGFB1 mRNA expression (p < 0.05). FN1 immunostaining was correlated with the number of years of smoking (p = 0.048; ρ = 0.384). Lower levels of collagen type I/III fibers were detected in samples with fissures (0 = 0.046). High frequency of microcysts was associated with increased COL5A1, FN1, and TNC expression (p < 0.05, for all comparisons). Neovascularization was associated with reduced FN1 (p = 0.035) and TGFBR1 expression (p = 0.034). Our findings show differential expression of matrix extracellular genes and TGFB family members in the degeneration process involved in rotator cuff tears. These molecular alterations are influenced by clinical factors. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2542-2553, 2018.

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Section: Discussionsupporting

confidence: 92%

Changes in the expression of matrix extracellular genes and TGFB family members in rotator cuff tears

Belangero

Figueiredo

Cohen

et al. 2018

Journal Orthopaedic Research

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“…Non‐surgical treatment of RCTs is effective in more than 70% of patients. However, it is important for surgeons to know the risk factors for tear progression because surgery should be performed at the appropriate time (especially in small‐ to medium‐sized tears) to obtain optimal clinical results . Therefore, knowledge of patient susceptibility may help in the determination of the best treatment options for each patient; for example, early surgery could be discussed with patients who are more likely to have a tear that progresses faster or have recurrent disease.…”

mentioning

confidence: 99%

Rotator Cuff Tear Susceptibility Is Associated With Variants in Genes Involved in Tendon Extracellular Matrix Homeostasis

Figueiredo

Loyola

Belangero

et al. 2019

Journal Orthopaedic Research

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Rotator cuff tears (RCT) is a multifactorial disease with genetic factors contributing for the disease etiology. We hypothesized that genetic variants in genes involved in extracellular matrix (ECM) homeostasis may alter susceptibility to RCT. We evaluated 20 polymorphisms of genes involved in ECM homeostasis in 211 cases of full‐thickness tears of the supraspinatus (Nfemales = 130; Nmales = 81) and 567 age‐matched controls (Nfemales = 317; Nmales = 250). Multivariate logistic regressions were carried out with age, gender, genetic ancestry (based on the analysis of 61 biallelic short insertion/deletion polymorphisms), and common co‐morbidities (diabetes, dyslipidemia, and smoking habits) as covariates. We observed that carriers of the rare allele of both studied variants of TGFB1, as well as their G/A (rs1800470/rs1800469) haplotype, were less susceptible to RCT (p < 0.05). In contrast, carriers of the G allele of MMP9 rs17576 (p = 0.014) or G/G haplotype (rs17576/rs17577; p < 0.001) had an increased risk for tendon tears. The presence of the T allele of MMP2 rs2285053 (p = 0.033), the T allele of MMP3 rs679620 (p = 0.024), and the TT‐genotype of TIMP2 rs2277698 (p = 0.01) was associated with susceptibility to tears, especially in females. In males, the A allele of COL5A1 rs3196378 (p = 0.032) and the G allele of TGFBR1 rs1590 (p = 0.039) were independent risk factors for RCT. The C/T COL5A1 (rs3196378/rs11103544) haplotype was associated with a reduced risk of tears in males (p = 0.03). In conclusion, we identified the genetic variants associated with RCT susceptibility, thereby reinforcing the role of genes involved in the structure and homeostasis of the ECM of tendons in disease development. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:192–201, 2020

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“…In paper I, we identified age and having a fullthickness tear as significant factors in multivariable logistic regression. Both age 177 and full-thickness tear 141,177,265 , have been identified in other studies as well and additional factors identified include pain 175,199,241 , smoking 265 and dominant side 141 . It is likely, but not convincingly shown as of yet in prospective studies, that identifying known risk factors for rotator cuff tear may aid in identifying patients at risk for tear progression with non-operative treatment, but factors that are currently unknown or unreachable to clinicians (like genetic factors) may be of greater importance.…”

Section: Discussionmentioning

confidence: 66%

“…The rate of progression seem however to be slow and require several years in many patients, and, estimated from 8 studies on asymptomatic and symptomatic patients, has been suggested to be 0.91 % per month 157 . Another estimate of progression rate is 2 mm/year for width and 3.8 mm/year for length 265 . Most studies have been performed on patients with small tears however, and the progression rate may differ depending on tear size 204 .…”

Section: Discussionmentioning

confidence: 99%

Rotator Cuff Tears : Short- and long-term aspects on treatment outcome

Ranebo

2020

Linköping University Medical Dissertations

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Risk Factors for Tear Progression in Symptomatic Rotator Cuff Tears: A Prospective Study of 174 Shoulders

Cited by 79 publications

References 30 publications

Changes in the expression of matrix extracellular genes and TGFB family members in rotator cuff tears

Changes in the expression of matrix extracellular genes and TGFB family members in rotator cuff tears

Rotator Cuff Tear Susceptibility Is Associated With Variants in Genes Involved in Tendon Extracellular Matrix Homeostasis

Rotator Cuff Tears : Short- and long-term aspects on treatment outcome

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