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Structure of retracted tendons after staged repair following continuous traction

  • Experimental Study
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The effect of staged repair involving continuous re-lengthening of the retracted musculotendinous unit after rotator cuff tear is not known. We quantified changes in chronically retracted tendons undergoing no repair or a staged repair involving an initial re-lengthening of the musculotendinous unit by traction in a sheep model of massive rotator cuff tear.

Materials and methods

Infraspinatus tendons of 12 sheep were released and allowed to retract for 4 months. Repair was performed after the retracted musculotendinous unit had been progressively returned to its original length through continuous traction in 8 sheep (group I). In the other 4 sheep (group II) traction was not successful and the tendons remained retracted. Tendon structure was assessed macroscopically, by MRI, histology, and TEM.

Results

Normalized to their contralateral controls, at sacrifice, tendon thickness was unchanged in group I (116%, n.s) and increased in group II (129%, P < 0.05), however with substantial shortening. Increased collagen fiber crimping and disorganization was found in group II, whereas in group I the differences from normal tendon were less pronounced.

Conclusion

Retracted musculotendinous units have deteriorated tendons, characterized by increased collagen fiber crimp, and ultrastructural collagen fibril atrophy and disorganization. Continuous traction may arrest and partially restore degenerative changes in retracted tendon. The findings of this study might contribute to new approaches for the treatment of chronic “irreparable” rotator cuff tears.

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Acknowledgments

The animal experiments in this study were funded by Swiss National Research Foundation, grant number 320-113424/1. The authors would like to thank Dr. sc nat. A. Käch and U.Lüthi at the University of Zürich, Center for Microscopy for their expertise and support in TEM imaging.

Conflict of interest

The animal experiments described in this article have been conducted according to state and local laws of animal welfare and approved by the Investigative Review Board (ZH-193/2004).

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Authors and Affiliations

  1. Department of Orthopedics, University of Zürich, Balgrist University Hospital, Forchstrasse 340, 8008, Zürich, Switzerland

    Mazda Farshad, Christian Gerber, Jess G. Snedeker & Dominik C. Meyer

  2. Department of Diagnostic Radiology, University of Zürich, University Hospital Zürich, Zürich, Switzerland

    Thomas Frauenfelder

Authors
  1. Mazda Farshad
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  2. Christian Gerber
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  3. Jess G. Snedeker
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  4. Thomas Frauenfelder
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  5. Dominik C. Meyer
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Corresponding author

Correspondence to Mazda Farshad.

Additional information

Work performed at Balgrist University Hospital, University of Zürich, Zürich, Switzerland.

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Farshad, M., Gerber, C., Snedeker, J.G. et al. Structure of retracted tendons after staged repair following continuous traction. Knee Surg Sports Traumatol Arthrosc 19, 2131–2137 (2011). https://doi.org/10.1007/s00167-011-1430-3

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  • DOI: https://doi.org/10.1007/s00167-011-1430-3

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