Tendon degeneration and chronic shoulder pain: changes in the collagen composition of the human rotator cuff tendons in rotator cuff tendinitis.

Riley, Graham P.; Harrall, R L; Constant, C. R.; Chard, M D; Cawston, Tim E.; Hazleman, B. L.

doi:10.1136/ard.53.6.359

Cited by 337 publications

(247 citation statements)

References 30 publications

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“…Feng et al [12] reported aging was the main factor in progressive degeneration of the rotator cuff and aging should be considered the most important factor contributing to the pathogenesis of rotator cuff tears. Age-dependent decline of healing potential in degenerated rotator cuffs and age-dependent progression of shoulder dysfunction caused by rotator cuff tears have been observed [4,26]. Oh et al [22] reported postoperative clinical outcomes were lower in older patients.…”

Section: Discussionmentioning

confidence: 99%

Functional Recovery Period after Arthroscopic Rotator Cuff Repair: Is it Predictable Before Surgery?

Manaka

Ito

Matsumoto

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Several studies have reported functional recovery of the shoulder after arthroscopic rotator cuff repair (ARCR). Preoperative estimation of the time required for functional recovery is important for determining surgical indications and for planning timing of the surgery and an appropriate postoperative physical therapy. Questions/purposes We therefore asked: (1) how long it takes to obtain functional recovery after ARCR, and (2) what preoperative factors influence functional recovery time. Patients and Methods We retrospectively evaluated 201 patients who had undergone ARCR. Using the Japanese Orthopaedic Association (JOA) shoulder scoring system, we defined the functional recovery period as the time required to achieve a score greater than 80% in each component. We evaluated the functional recovery periods and assessed preoperative influencing factors such as age, gender, shoulder stiffness, morphologic features of rotator cuff tears, and rotator cuff tear size. Results Sixty-three patients (31%) took less than 3 months, 81 patients (40%) took between 3 and 6 months, and 57 patients (28%) took greater than 6 months to achieve a score greater than 80% in each JOA shoulder assessment component. Younger patients without shoulder stiffness and with smaller rotator cuff tears had shorter functional recovery periods. Conclusions One hundred forty-four patients (72%) obtained functional recovery within 6 months after ARCR. Age, shoulder stiffness, and rotator cuff tear size influenced functional recovery time.

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Section: Discussionmentioning

confidence: 99%

Functional Recovery Period after Arthroscopic Rotator Cuff Repair: Is it Predictable Before Surgery?

Manaka

Ito

Matsumoto

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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“…We have recently shown that the amount of denatured collagen molecules correlates with the loss in tensile stiffness of tissues Wang et al, 2000). The decreased collagen content (Riley et al, 1994a;Bank et al, 1999), the change in collagen types (Riley et al, 1994a), the changed post-translational profile of the deposited collagen (Bank et al, 1999), the increased amount of denatured collagen and the enhanced expression of MMP-1 all may contribute to a mechanically less stable tendon that is susceptible to rupture. This may explain why tendon pathology is mostly of a chronic nature, particularly since the supraspinatus is constantly subjected to considerable forces, due to its role in the rotator cuff as a dynamic stabiliser of the shoulder joint.…”

Section: Discussionmentioning

confidence: 99%

“…We have previously shown that the collagen network are an integral part of tendon pathology (Birch et al, 1998). The changes seen in pathological tendons have been attributed to a deposition of newly synthesised collagen molecules showing a different profile of posttranslational modifications (Riley et al, 1994a;Bank et al, 1999). The altered collagen content in degenerate and ruptured tendons implies that the mature collagen network is at least partially removed by proteinases and this may predispose to tendon rupture.…”

Section: Introductionmentioning

confidence: 99%

Matrix metalloproteinase activities and their relationship with collagen remodelling in tendon pathology

Riley

Curry

DeGroot³

et al. 2002

Matrix Biology

326

289

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“…shown that a number of molecular changes occur within the diseased tendon, including altered content and expression of collagen and proteoglycan (PG) and expression of matrix-degrading enzymes (6)(7)(8)(9)(10)(11)(12)(13)(14). However, which if any of these changes precede and lead to rupture, and which are a consequence of tearing is unknown.…”

mentioning

confidence: 99%

Modulation of aggrecan and ADAMTS expression in ovine tendinopathy induced by altered strain

Smith

Sakurai

Smith

et al. 2008

Arthritis & Rheumatism

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Objective. To evaluate histologic, immunohistochemical, and molecular changes in tendon induced by altered strain in a large-animal model.Methods. A full-thickness partial-width laceration of the infraspinatus tendon was created in 5 sheep, while 5 sham-operated sheep were used as controls. Sheep were killed after 4 weeks, and 4 differentially stressed tendon regions (tensile or near bone attachment from overstressed or stress-deprived halves) were evaluated for histopathology, proteoglycan (PG) accumulation, and characterization of glycosaminoglycans and aggrecan catabolites. Gene expression of matrix components, enzymes, and inhibitors was analyzed by reverse transcriptase-polymerase chain reaction.Results. Histopathologic changes were detected in both overstressed and stress-deprived tensile tendon, but only in stress-deprived tendon near bone. In overstressed and stress-deprived tensile tendon, levels of keratan sulfate, chondroitin 4-sulfate, and chondroitin 6-sulfate were increased. In overstressed tensile tendon, levels of ADAMTS-generated aggrecan catabolites were increased. There was increased matrix metalloproteinase 13 (MMP-13) and decreased fibromodulin and decorin expression in all regions. Increased MMP-1, MMP-9, MMP-14, and ADAMTS-1 expression, and decreased type II collagen expression were restricted to stress-deprived tendon. In stress-deprived boneattachment regions, messenger RNA (mRNA) for aggrecan was decreased, and ADAMTS was increased. In overstressed tensile tendon, aggrecan mRNA was increased, and ADAMTS was decreased.Conclusion. The distinct molecular changes in adjacent tissue implicate altered strain rather than humoral factors in controlling abnormal tenocyte metabolism, and highlight the importance of regional sampling. Tendon abnormalities induced by increased strain are accompanied by increased aggrecan, decreased ADAMTS, and low PG expression, which may negatively impact the structural integrity of the tissue and predispose to rupture.Injuries of the shoulder due to overuse are increasingly prevalent in both the sporting arena and the workplace. Occupational injury of the shoulder is second only to neck and low back pain in the frequency of consultation by general practitioners, with the most common injury involving the rotator cuff. (1,2) The prevalence of rotator cuff conditions increases with age, from 30-50% in the seventh decade of life to a staggering 70-80% by the ninth (3,4). Although most cases are treated conservatively, many patients undergo surgical repair with a prolonged convalescence. There are no drugs to specifically treat disorders of the rotator cuff or other tendons, and many surgical repairs fail within 12 months (5). Lack of knowledge of the fundamental mechanisms that underlie tendon breakdown results in limited and inadequate management options for tendon disorders.

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Tendon degeneration and chronic shoulder pain: changes in the collagen composition of the human rotator cuff tendons in rotator cuff tendinitis.

Abstract: Objectives-To analyse the collagen composition of normal adult human supraspinatus tendon and to compare with: (1) a flexor tendon (the common biceps tendon) which is rarely involved in any degenerative pathology; (2)

Cited by 337 publications

References 30 publications

Functional Recovery Period after Arthroscopic Rotator Cuff Repair: Is it Predictable Before Surgery?

Functional Recovery Period after Arthroscopic Rotator Cuff Repair: Is it Predictable Before Surgery?

Matrix metalloproteinase activities and their relationship with collagen remodelling in tendon pathology

Modulation of aggrecan and ADAMTS expression in ovine tendinopathy induced by altered strain

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