Abstract
Purpose
While tendon degeneration has been known to be an important cause of rotator cuff disease, few studies have objectively proven the association of tendon degeneration and rotator cuff disease. The purpose of this study was to investigate changes of tendon degeneration with respect to the stage of rotator cuff disease.
Methods
A total of 48 patients were included in the study: 12 with tendinopathy, 12 with a partial-thickness tear (pRCT), 12 with a full-thickness tear (fRCT), and 12 as the control. A full-thickness supraspinatus tendon sample was harvested en bloc from the middle portion between the lateral edge and the musculotendinous junction of the tendon using a biopsy punch with a diameter of 3 mm. Harvested samples were evaluated using a semi-quantitative grading scale with 7 parameters after haematoxylin and eosin staining.
Results
There was no significant difference in age, gender, symptom duration, and Kellgren-Lawrence grade between the groups except for the global fatty degeneration index. All of the seven parameters were significantly different between the groups and could be categorized as follows: early responders (fibre structure and arrangement), gradual responder (rounding of the nuclei), after-tear responders (cellularity, vascularity, and stainability), and late responder (hyalinization). The total degeneration scores were not significantly different between the control (6.08 ± 1.16) and tendinopathy (6.67 ± 1.83) (n.s.). However, the score of pRCT group (10.42 ± 1.31) was greater than that of tendinopathy (P < 0.001), and so was the score of fRCT (12.33 ± 1.15) than that of pRCT (p = 0.009).
Conclusion
This study showed that the degeneration of supraspinatus tendon increases as the stage of rotator cuff disease progresses from tendinopathy to pRCT, and then to fRCT. The degree of degeneration of tendinopathy was not different from that of normal but aged tendons, and significant tendon degeneration began from the stage of pRCT. The clinical relevance of the study is that strategies and goals of the treatment for rotator cuff disease should be specific to its stage, in order to prevent disease progression for tendinopathy and pRCT, as well to restore the structural integrity for fRCT.
Level of evidence
Diagnostic, Level I.
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Acknowledgements
This research was supported by a Grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI) funded by the Ministry of Health & Welfare, Republic of Korea (HI14C2748) and by the Bio & Medical Technology Development Program of the NRF funded by the Korean government, MSIP (NRF-2011-0019773 & 2015M3A9E6028412).
Author’s contributions
CHJ designed the study, analysed the data, and drafted the manuscript. WHS, WKP, and JEK participated in the histological assessment. SJS participated in its design and coordination and helped to draft the manuscript. All authors read and approved the final manuscript.
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All of the authors have no conflict of interest to disclose.
Funding
This research was funded by grants of the KHIDI and the NRF (HI14C2748, NRF20110019773 & 2015M3A9E6028412).
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of SMG-SNU Boramae Medical Center and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Informed consent was obtained from all individual participants included in the study.
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Jo, C.H., Shin, W.H., Park, J.W. et al. Degree of tendon degeneration and stage of rotator cuff disease. Knee Surg Sports Traumatol Arthrosc 25, 2100–2108 (2017). https://doi.org/10.1007/s00167-016-4376-7
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DOI: https://doi.org/10.1007/s00167-016-4376-7