Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA.
J Shoulder Elbow Surg. 2011 Sep;20(6):917-27. doi: 10.1016/j.jse.2011.02.015. Epub 2011 May 25.
The objective of this study was to determine whether the tear size of a supraspinatus tendon correlated with synovial inflammation and tendon degeneration in patients who underwent shoulder arthroscopy for rotator cuff repair. We hypothesized that increased synovial inflammation would correlate with greater tear size of the supraspinatus tendon at the time of surgery.
Tissue from the synovium, bursa, torn supraspinatus tendon, and subscapularis tendon was obtained from patients during shoulder arthroscopy to evaluate the messenger RNA expression of proinflammatory cytokines, tissue remodeling, and angiogenesis factors in the tendon, bursa, and synovium. Additional tissue was fixed to determine histologic changes including inflammation, vascular ingrowth, and collagen organization.
Increased expression of interleukin 1β, interleukin 6, cyclooxygenase 2, matrix metalloproteinase (MMP) 9, and vascular endothelial growth factor was found in the synovium of patients with full-thickness tears versus partial-thickness tears (P < .05). In the supraspinatus tendon, increased expression of MMP-1, MMP-9, MMP-13, and vascular endothelial growth factor was found in the full-thickness group. The upregulation of these genes in the full-thickness group was consistent with enhanced synovial inflammation, greater vascular ingrowth, and the loss of collagen organization in both supraspinatus and subscapularis tendons as determined by histology.
Increased synovial inflammation and tissue degeneration correlate with the tear size of the supraspinatus tendon. A better understanding of the relationship between synovial inflammation and the progression of tendon degeneration can help in the design of novel and effective treatments to limit the advancement of rotator cuff disease and to improve their clinical outcomes.
本研究旨在确定接受肩袖修复的肩关节镜检查患者的冈上肌腱撕裂大小与滑膜炎症和肌腱退变之间是否存在相关性。我们假设，滑膜炎症的增加与手术时冈上肌腱撕裂的增大相关。
在肩关节镜检查期间，从患者的滑膜、滑囊、撕裂的冈上肌腱和肩胛下肌腱获取组织，以评估肌腱、滑囊和滑膜中的促炎细胞因子、组织重塑和血管生成因子的信使 RNA 表达。还固定了额外的组织以确定包括炎症、血管生成和胶原组织在内的组织学变化。
与部分厚度撕裂相比，全厚度撕裂患者的滑膜中白细胞介素 1β、白细胞介素 6、环氧化酶 2、基质金属蛋白酶（MMP）9 和血管内皮生长因子的表达增加（P <.05）。在冈上肌腱中，全厚度组中 MMP-1、MMP-9、MMP-13 和血管内皮生长因子的表达增加。这些基因在全厚度组中的上调与滑膜炎症增强、更大的血管生成以及肩胛下肌腱和冈上肌腱的胶原组织丢失相一致，这是通过组织学确定的。
滑膜炎症和组织退变的增加与冈上肌腱撕裂的大小相关。更好地了解滑膜炎症与肌腱退变进展之间的关系有助于设计新型有效的治疗方法，以限制肩袖疾病的进展并改善其临床结果。
