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Immobilization Modulates Macrophage Accumulation in Tendon-Bone Healing

  • Original Article
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Clinical Orthopaedics and Related Research

Abstract

Tendon-to-bone healing occurs by formation of a fibrous, scar tissue interface rather than regeneration of a normal insertion. Because inflammatory cells such as macrophages lead to formation of fibrous scar tissue, we hypothesized immobilization would allow resolution of acute inflammation and result in improved tendon-bone healing. We reconstructed the ACL of 60 Sprague-Dawley rats using a tendon autograft. An external fixation device was used to immobilize the surgically treated knee in 30 rats. We evaluated tendon-bone interface width, collagen fiber continuity, and new osteoid formation histologically. Immunohistochemistry was used to localize ED1+ and ED2+ macrophages at the tendon-bone interface at 2 and 4 weeks. Biomechanical testing was performed at 4 weeks. Interface width was smaller and collagen fiber continuity was greater in the immobilized group. Immobilized animals exhibited fewer ED1+ macrophages at the healing interface at 2 and 4 weeks. In contrast, there were more ED2+ macrophages at the interface in the immobilized group at 2 weeks. Failure load and stiffness were similar between groups at 4 weeks. The data suggest early immobilization diminishes macrophage accumulation and may allow improved tendon-bone integration

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Acknowledgments

We thank Liang Ying for preparation of the tissues for histologic analysis.

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Authors and Affiliations

  1. Laboratory for Soft Tissue Research, Sports Medicine and Shoulder Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Elias Dagher MD, MSc, Peyton L. Hays MD, Sumito Kawamura MD, Jon Godin BA, Xiang-hua Deng MD & Scott A. Rodeo MD

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  1. Elias Dagher MD, MSc
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  2. Peyton L. Hays MD
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  3. Sumito Kawamura MD
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  4. Jon Godin BA
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  5. Xiang-hua Deng MD
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  6. Scott A. Rodeo MD
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Corresponding author

Correspondence to Scott A. Rodeo MD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the animal protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

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Dagher, E., Hays, P.L., Kawamura, S. et al. Immobilization Modulates Macrophage Accumulation in Tendon-Bone Healing. Clin Orthop Relat Res 467, 281–287 (2009). https://doi.org/10.1007/s11999-008-0512-0

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  • DOI: https://doi.org/10.1007/s11999-008-0512-0

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