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Modelling gluteus medius tendon degeneration and repair in a large animal model

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Gluteus medius tendon tears often occur in the context of chronic tendinopathy and remain a difficult clinical problem. Surgical repair is challenging as it is often delayed and performed in degenerative tendons. No animal model currently exists to mimic the delayed repair of tendinopathic gluteus medius tears. The aims of this study were to develop a chronic model of gluteus medius tendinopathy and tear and then compare this model to an acute gluteus medius tear and repair.

Materials and methods

Six gluteus medius muscles were dissected and examined in mature sheep to confirm anatomical similarity to the human counterpart. Ten separate adult sheep underwent tendon detachment, followed by relook and histological sampling at 6 and 16 weeks to assess the extent of tendon degeneration. Six adult sheep underwent tendon repair at 6 weeks and were later assessed for healing of the tendon and compared to a further four adult sheep who underwent an acute tendon detachment and repair procedure.

Results

The sheep gluteus medius muscle consisted of three compartments, the anterior, middle and posterior. All compartments inserted via the common tendon on the superolateral aspect of the greater trochanter. At both 6 and 16 weeks, there was significant tendinopathic changes on histology compared to controls as assessed by modified Movin’s score (p = 0.018, p = 0.047) but no difference between the 6- and 16-week groups (p = 0.25). There were significant differences between delayed and acute repair in both histological appearance (p = 0.025) and biomechanical properties (p = 0.019), with acute repair superior in both.

Conclusions

Tendon detachment for 6 weeks is sufficient to produce histological changes similar to chronic tendinopathy and repair of this degenerative tendon results in significantly poorer healing when compared to an acute repair model. Animal models for gluteus medius tears should use a delayed repair model to improve clinical validity.

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Acknowledgements

The authors would like to acknowledge the New Zealand Orthopaedic Association (Grant number 371455) and the Health Research Council of New Zealand (Grant number 3714609) for funding this study.

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Authors and Affiliations

  1. Bone and Joint Laboratory, University of Auckland, 85 Park Road, Grafton, 1023, New Zealand

    Mark Zhu, David Musson, Jillian Cornish & Jacob Munro

  2. Department of Orthopaedic Surgery, Auckland City Hospital, 2 Park Road, Grafton, New Zealand

    Mark Zhu & Jacob Munro

  3. Liggins Institute, University of Auckland, 85 Park Road, Grafton, New Zealand

    Mark Oliver & Elwyn Firth

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Contributions

MZ participated in study design, performed all surgeries, acquisition of data, interpretation of data, drafting of the article, revision of the manuscript and approval of submitted manuscript. DM participated in study conception and design, analysis, drafting of the article and critical revision of the manuscript and approval of submitted manuscript. MO participated in study design, assistance with surgeries, post-surgical care of study subjects, drafting of the article, revision of the manuscript and approval of submitted manuscript. EF participated in study conception and design, planning of surgical technique and analysis of animals post-operatively, critical revision of the manuscript and approval of submitted manuscript. JC participated in study conception and design, analysis and interpretation of data, critical revision of the manuscript and approval of submitted manuscript. JM participated in study conception and design, planning of surgical technique, analysis and interpretation of data, critical revision of the manuscript and approval of submitted manuscript. All authors have read and approved the final submitted manuscript.

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Correspondence to Mark Zhu.

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Zhu, M., Musson, D., Oliver, M. et al. Modelling gluteus medius tendon degeneration and repair in a large animal model. Arch Orthop Trauma Surg 142, 1–12 (2022). https://doi.org/10.1007/s00402-020-03573-6

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  • DOI: https://doi.org/10.1007/s00402-020-03573-6

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