Shoulder replacement surgery for osteoarthritis and rotator cuff tear arthropathy.
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ABSTRACT:
SUBMITTER: Craig RS
PROVIDER: S-EPMC7173708 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Myosteatosis is the pathological accumulation of lipid that occurs in conjunction with atrophy and fibrosis following skeletal muscle injury or disease. Little is known about the mechanisms by which lipid accumulates in myosteatosis, but many studies have demonstrated the degree of lipid infiltration negatively correlates with muscle function and regeneration. Our goal was to identify biochemical pathways that lead to muscle dysfunction and lipid accumulation in injured rotator cuff muscles, a model that demonstrates severe myosteatosis. Adult rats were subjected to a massive tear to the rotator cuff musculature. After a period of either 0 (healthy control), 10, 30, or 60 days, muscles were prepared for RNA sequencing, shotgun lipidomics, metabolomics, biochemical measures, electron microscopy, and muscle fiber contractility. Following rotator cuff injury, there was a decrease in muscle fiber specific force production that was lowest at 30d. There was a dramatic time dependent increase in triacylglyceride content. Interestingly, genes related to not only triacylglyceride synthesis, but also lipid oxidation were largely downregulated over time. Using bioinformatics techniques, we identified that biochemical pathways related to mitochondrial dysfunction and reactive oxygen species were considerably increased in muscles with myosteatosis. Long chain acyl-carnitines and L-carnitine, precursors to beta-oxidation, were depleted following rotator cuff tear. Electron micrographs showed injured muscles displayed large lipid droplets within mitochondria at early time points, and an accumulation of peripheral segment mitochondria at all time points. Several markers of oxidative stress were elevated following rotator cuff tear. The results from this study suggest that the accumulation of lipid in myosteatosis is not a result of canonical lipid synthesis, but occurs due to decreased lipid oxidation in mitochondria. A failure in lipid utilization by mitochondria would ultimately cause an accumulation of lipid even in the absence of increased synthesis. Further study will identify whether this process is required for the onset of myosteatosis.
2018-08-29 | GSE103266 | GEO
Project description:Introduction: A massive rotator cuff tear (RCT) leads to glenohumeral joint destabilization and characteristic degenerative changes, termed cuff tear arthropathy (CTA). Understanding the response of articular cartilage to a massive RCT will elucidate opportunities to promote homeostasis following restoration of joint biomechanics with rotator cuff repair. Mechanically activated calcium-permeating channels, in part, modulate the response of distal femoral chondrocytes in the knee against injurious loading and inflammation. The objective of this study was to investigate PIEZO1-mediated mechanotransduction of glenohumeral articular chondrocytes in the altered biomechanical environment following RCT to ultimately identify potential therapeutic targets to attenuate cartilage degeneration after rotator cuff repair. Methods: First, we quantified mechanical susceptibility of chondrocytes in mouse humeral head cartilage ex vivo with treatments of specific chemical agonists targeting PIEZO1 and TRPV4 channels. Second, using a massive RCT mouse model, chondrocytes were assessed for mechano-vulnerability, PIEZO1 expression, and calcium signaling activity 14-week post-injury, an early stage of CTA. Results: In native humeral head chondrocytes, chemical activation of PIEZO1 (Yoda1) significantly increased chondrocyte mechanical susceptibility against impact loads, while TRPV4 activation (GSK101) significantly decreased impact-induced chondrocyte death. A massive RCT caused morphologic and histologic changes to the glenohumeral joint with decreased sphericity and characteristic bone bruising of the posterior superior quadrant of the humeral head. At early CTA, chondrocytes in RCT limbs exhibit a significantly decreased functional expression of PIEZO1 compared with uninjured or sham controls. Discussion: In contrast to the hypothesis, PIEZO1 expression and activity is not increased, but rather downregulated, after massive RCT at the early stage of cuff tear arthropathy. These results may be secondary to the decreased axial loading after glenohumeral joint decoupling in RCT limbs.
| S-EPMC10508846 | biostudies-literature
Project description:Critical shoulder angle (CSA) is the angle between the superior and inferior bone margins of the glenoid and the most lateral border of the acromion and is potentially affected during a rotator cuff tear (RCT). Acromioplasty is generally performed to rectify the anatomy of the acromion during RCT repair surgery. However, limited information is available regarding the changes in the CSA after anterolateral acromioplasty. We hypothesized that CSA can be decreased after anterolateral acromioplasty. Data were retrospectively collected from 712 patients with RCTs and underwent arthroscopic rotator cuff repair between January 2012 and December 2018, of which 337 patients were included in the study. The presurgical and postsurgical CSA were then determined and compared using a paired samples t test. Because previous study mentioned CSA more than 38 degrees were at risk of rotator cuff re-tear, patients were segregated into two groups: CSA < 38° and CSA ≥ 38°; these groups were compared using an independent-samples t test. These 337 participants (160 male and 177 female) presented a CSA of 38.4° ± 6.0° before anterolateral acromioplasty, which significantly decreased to 35.8° ± 5.9° after surgery (P < .05). Before surgery, 172 patients were present in the CSA ≥ 38° group and 57 were preset in the CSA < 38° group after surgery. The CSA decreased significantly in the CSA ≥ 38° group rather than in the CSA < 38° group (P < .05). In conclusion, the CSA can be effectively decreased through anterolateral acromioplasty, and this reduction in the CSA is more significant among individuals with CSA ≥ 38° than among those with CSA < 38°, indicating that acromioplasty is recommended along with RCT repair especially among individuals with a wide presurgical CSA.
| S-EPMC8245121 | biostudies-literature
Project description:This study examines the association between strength measurements and supraspinatus tear in patients with shoulder pain. This study characterized determinants of abduction strength among patients with tears.A total of 208 patients with shoulder pain were recruited. Strength was tested using a handheld dynamometer. Supraspinatus tears were diagnosed by combination of clinical assessment and blinded magnetic resonance imaging review. Associations of supraspinatus tear with patient characteristics and strength measurements (abduction, internal rotation and external rotation) were assessed using multivariable logistic regression models.Patients with supraspinatus tear had decreased abduction strength (P = 0.02) and decreased external rotation strength (P < 0.01). When adjusted for age, sex, tear laterality, and body mass index, decreased abduction strength (odds ratio, 1.18/kg; 95% confidence interval, 1.06-1.32) and decreased external rotation strength (odds ratio, 1.29/kg; 95% confidence interval, 1.14-1.48) were associated with supraspinatus tear. In patients with tear, age 60 yrs or older, female sex, and visual analog scale pain score were significantly associated with decreased abduction strength but tear size, fatty infiltration, and atrophy were not.Decreased abduction and external rotation strength were associated with supraspinatus tear in patients with shoulder pain. In this cohort, the abduction strength of patients with tears was influenced by demographic factors but not tear characteristics.
| S-EPMC4713123 | biostudies-literature
Project description:Massive tears of the rotator cuff can result in severe functional deficits due to loss of the axial force couple and effective fulcrum that the intact cuff normally provides. For massive, irreparable rotator cuff tears, especially in the setting of early to moderate degenerative changes, reverse total shoulder arthroplasty functions to modify the center of joint rotation, allowing the deltoid and intact components of the cuff to carry out shoulder function more effectively. Our preferred technique uses a standard open deltopectoral shoulder approach with a 3-dimensional glenoid baseplate model and a 135° prosthesis in an onlay configuration to reduce the risk of scapular notching and increase lateralization of the humerus.
| S-EPMC9244853 | biostudies-literature
Project description:We harvested the blood samples from rotator cuff tear patients with and without shoulder stiffness.Then, circulating exosomes were harvested, and the miRNAs content was analyzed with an aim to idenfity differentially expressed miRNAs.
2021-08-31 | GSE182896 | GEO
Project description:BackgroundChronic inflammation is known to be associated with both rotator cuff tears (RCTs) and depression. However, no epidemiological studies with a longitudinal follow-up have been performed to prove this association. We aimed to investigate whether depressed patients had an elevated risk of RCT and subsequent repair surgery compared with those without depression.MethodsThis retrospective cohort study comprised of patients diagnosed with depression between 2000 and 2010 (depression cohort) and patients without depression (non-depression cohort, 1:2 age and sex matched). The risk of RCT and rotator cuff repair surgery were determined during a 13-year follow-up (2000-2013) between these two cohorts.ResultsThis study included 26,868 patients with depression and 53,736 patients without depression. The incidence of RCT was 648 and 438 per 100,000 person-years in the depression and non-depression cohorts, respectively. The adjusted hazard ratio (HR) was 1.46 (95% confidence interval [CI], 1.36-1.57) for depressed patients. The incidence of rotator cuff repair surgery was 28 and 18 per 100,000 person-years in the depression and non-depression cohorts, respectively. Depressed patients also had a significantly increased risk of subsequent rotator cuff repair surgery (adjusted HR = 1.46; 95% CI, 1.04-2.06).ConclusionThe present study showed that depression was associated with an increased risk of rotator cuff tear and rotator cuff repair surgery.
| S-EPMC6876882 | biostudies-literature
Project description:Irreparable posterior-superior rotator cuff tear is encountered quite often in clinical practice. Bridging the tendon defect with various materials is reasonable. However, optimal bridging structures and techniques are still being pursued. We introduce a rotator cuff bridging technique, rooting rotator cuff reconstruction. In this technique, autogenous tendon is used to make grafts. On the medial side, the graft tendons are suspended on the rotator cuff tendon. On the lateral side, the graft tendons are placed into tunnels through the tuberosities. The most critical steps of this technique are properly fabricating the humeral tunnels and suspending the graft tendons onto the rotator cuff tendon. We believe this technique will shed light on rotator cuff reconstruction.
| S-EPMC7953171 | biostudies-literature
Project description:PurposeTo evaluate the association between rotator cuff tear (RCT) size and long head biceps tendon (LHBT) pathology.MethodsWe retrospectively enrolled 202 consecutive patients (114 women and 88 men with mean age at surgery of 62.14 years [SD, 7.73]) who underwent arthroscopic rotator cuff repair for different sized full-thickness RCTs. LHBT pathology was evaluated considering the presence of inflammation, section alteration, loss of integrity, dislocation, dynamic instability, and absence. The site of LHBT pathology was evaluated considering 3 portions: (1) the insertional element; (2) the free intra-articular portion; (3) the part that enters the intertubercular groove. Statistics were evluated.ResultsThe LHBT was absent in 22 cases (10.9%): 2, 4, 15, and 1 patients with small, large, massive, and subscapularis RCTs, respectively. A significant correlation was found between the prevalence of LHBT absence and massive RCTs (P < .001). In 53 patients (26%), there was a healthy LHBT; a healthy LHBT was present in 47%, 20% and 8% of small, large and massive RCTs, respectively. A significant correlation between LHBT inflammation, section alteration, loss of integrity, and RCT severity was found (P < .001, P < .001, and ). The insertional portion was the most involved (57% of cases); RCT severity was significantly associated with the number of involved portions (P < .001).ConclusionsShoulder LHBT pathology is associated with increasing rotator cuff tear size.Clinical relevanceSurgeons should be aware that biceps pathology is particularly prevalent in patients with larger RTCs.
| S-EPMC8527326 | biostudies-literature
Project description:We aimed to estimate the interrelation between preoperative deltoid muscle status by measuring the 3-dimensional deltoid muscle volume and postoperative functional outcomes after reverse total shoulder arthroplasty(RTSA). Thirty-five patients who underwent RTSA participated in this study. All patients underwent preoperative magnetic resonance imaging(MRI) as well as pre- and postoperative radiography and various functional outcome evaluations at least 1 year. The primary outcome parameter was set as age- and sex-matched Constant scores. The 3-dimensional deltoid muscle model was generated using a medical image processing software and in-house code, and the deltoid muscle volume was calculated automatically. Various clinical and radiographic factors comprising the deltoid muscle volume adjusted for body mass index(BMI) were analyzed, and their interrelation with the outcome parameters was appraised using a multivariate analysis. As a result, all practical consequences considerably improved following surgery(all p<0.01). Overall, 20 and 15 indicated a higher and a lower practical consequence than the average, respectively, which was assessed by the matched Constant scores. The deltoid muscle volume adjusted for BMI(p = 0.009), absence of a subscapularis complete tear (p = 0.040), and greater change in acromion-deltoid tuberosity distance(p = 0.013) were associated with higher matched Constant scores. Multivariate analysis indicated that the deltoid muscle volume was the single independent prognostic factor for practical consequences(p = 0.011). In conclusion, the preoperative deltoid muscle volume significantly affected the functional outcome following RTSA in patients with cuff tear arthropathy or irreparable cuff tears. Therefore, more attention should be paid to patients with severe atrophied deltoid muscle who are at a high risk for poor practical consequences subsequent to RTSA.
| S-EPMC5371314 | biostudies-literature