Kim Yang-Soo, Lee Yun-Gyoung, Park Hyung-Seok, Cho Ryu-Kyoung, Lee Hyo-Jin
Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Orthop J Sports Med. 2021 Oct 11;9(10):23259671211032543. doi: 10.1177/23259671211032543. eCollection 2021 Oct.
Arthroscopic capsular release is an effective treatment for refractory shoulder stiffness, yet there are no basic studies that can explain the extent of the release.
This study aimed to compare the genetic expression of inflammation- and fibrosis-related factors between the anterior and posterior capsules in patients with shoulder stiffness and rotator cuff tear.
Descriptive laboratory study.
Enrolled in this study were 35 patients who underwent arthroscopic capsular release for shoulder stiffness along with the rotator cuff repair. Anterior and posterior glenohumeral joint capsular tissues were obtained during the capsular release. For the control tissue, anterior capsule was obtained from 40 patients without stiffness who underwent arthroscopic rotator cuff repair. The gene expression of collagen types I and III, fibronectin, extracellular matrix, basic fibroblast growth factor, transforming growth factor-β, connective tissue growth factor, matrix metalloproteinase (MMP)-1, MMP-2, MMP-9, tissue inhibitor of metalloproteinase (TIMP)-1, TIMP-2, intercellular adhesion molecule 1, interleukin 1, and tumor necrotizing factor-α were analyzed using real-time reverse transcription polymerase chain reaction. Differences in gene expression between the anterior capsule, the posterior capsule, and the control tissue were compared with the Kruskal-Wallis test.
The expression levels of collagen types I and III were significantly higher in the anterior capsule with stiffness com (pared with both the posterior capsule with stiffness ( = .010 for both) and the control ( = .038 and .010, respectively). The levels of fibronectin, MMP-2, and MMP-9 in the anterior capsule were significantly higher than in both the posterior capsule ( = .013, .003, and .006, respectively) and the control ( = .014, .003, and .005, respectively).
Genetic analysis of the shoulder capsule revealed that more fibrogenic processes occur in the anterior capsule compared with the posterior capsule in patients with shoulder stiffness.
Capsular release for shoulder stiffness should be more focused on the anterior capsule than on the posterior capsule.
关节镜下关节囊松解术是治疗难治性肩关节僵硬的有效方法，但尚无基础研究能解释松解的范围。
本研究旨在比较肩关节僵硬合并肩袖撕裂患者前后关节囊炎症和纤维化相关因子的基因表达。
描述性实验室研究。
本研究纳入了35例行关节镜下关节囊松解术治疗肩关节僵硬并同时行肩袖修复术的患者。在关节囊松解过程中获取肱骨头前、后关节囊组织。作为对照组织，从40例无僵硬症状且接受关节镜下肩袖修复术的患者中获取前关节囊。使用实时逆转录聚合酶链反应分析Ⅰ型和Ⅲ型胶原蛋白、纤连蛋白、细胞外基质、碱性成纤维细胞生长因子、转化生长因子-β、结缔组织生长因子、基质金属蛋白酶（MMP）-1、MMP-2、MMP-9、金属蛋白酶组织抑制剂（TIMP）-1、TIMP-2、细胞间黏附分子1、白细胞介素1和肿瘤坏死因子-α的基因表达。采用Kruskal-Wallis检验比较前关节囊、后关节囊和对照组织之间基因表达的差异。
合并僵硬的前关节囊中Ⅰ型和Ⅲ型胶原蛋白的表达水平显著高于合并僵硬的后关节囊（两者均为P = .010）以及对照组织（分别为P = .038和.010）。前关节囊中纤连蛋白、MMP-2和MMP-9的水平显著高于后关节囊（分别为P = .013、.003和.006）和对照组织（分别为P = .014、.003和.005）。
肩关节囊的基因分析显示，肩关节僵硬患者的前关节囊比后关节囊发生更多的纤维化过程。
治疗肩关节僵硬的关节囊松解术应更关注前关节囊而非后关节囊。
