Department of Orthopaedics, Helsingborg Hospital, Region Skåne, Sweden.
Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden.
Knee Surg Sports Traumatol Arthrosc. 2022 Jul;30(7):2521-2527. doi: 10.1007/s00167-022-06884-w. Epub 2022 Feb 8.
Acute trauma-related rotator cuff tears are believed to have better healing potential than chronic tears due to less degenerative changes of the tendons. However, the histopathological condition of tendons from trauma-related tears is not well investigated. The purpose of this study was to explore specific histopathological features in tendons from acute trauma-related full-thickness rotator cuff tears and to compare them to findings in tendons from nontraumatic, chronic tears.
In a prospective cohort study, 62 previously asymptomatic patients [14 women, median age 61 years (range 42-75)] with trauma-related full-thickness rotator cuff tears were consecutively included. Arthroscopic repair was performed within 30 (median, IQR 25-37) days after the injury. During surgery, tissue biopsies were harvested from the supraspinatus tendons in 53 (86%) of the patients. In addition, similar biopsies were harvested from 10 patients undergoing surgery for chronic tears without history of trauma. All tissue samples were examined by a well-experienced pathologist under light microscope. Tendon degeneration was determined using the Bonar score whereas immunostaining was used for proliferation (Ki67), inflammation (CD45), apoptosis (p53) and haemosiderin staining to study traces of bleeding.
The median (IQR) Bonar score for the acute trauma-related biopsies was 10.5 (7.5-14.5) compared to 11 (5-12.8) for the control group with no statistically significant difference between the groups. No statistically significant between-group difference was found for the inflammatory index whereas tendons from patients with trauma-related full-thickness rotator cuff tears had statistically significantly higher apoptosis [3.1 (0.5-8.9) vs. 0.1 (0-1.5), p = 0.003] and proliferation [4.0 (1.8-6.9) vs. 0.4 (0-2.0), p = 0.001) indices than those undergoing surgery for chronic tears. Positive haemosiderin staining was found in 34% of tissue samples from patients with trauma-related tears compared to 10% in the control group (n.s).
This study suggests that there is no difference with regard to degenerative changes between supraspinatus tendons harvested from patients with acute, trauma-related rotator cuff tears and patients with nontraumatic, chronic tears.
II.
由于肌腱退变程度较轻，人们普遍认为急性创伤性肩袖全层撕裂的愈合潜能优于慢性撕裂。然而，对于创伤性肩袖全层撕裂的肌腱的组织病理学状况，目前研究甚少。本研究旨在探讨急性创伤性肩袖全层撕裂的肌腱的特定组织病理学特征，并与非创伤性、慢性撕裂的肌腱进行比较。
本研究为前瞻性队列研究，连续纳入 62 例既往无症状、因创伤导致肩袖全层撕裂的患者（14 名女性，中位年龄 61 岁（范围 42-75 岁））。所有患者均于损伤后 30 天（中位数，IQR 25-37 天）内行关节镜下修复术。术中，53 例（86%）患者的冈上肌腱均行关节镜下活检，另外 10 例因慢性肩袖撕裂而无创伤史的患者也接受了类似的活检。所有组织标本均由经验丰富的病理学家在光镜下进行检查。采用 Bonar 评分评估肌腱退变情况，采用 Ki67 增殖指数、CD45 炎症指数、p53 凋亡指数和含铁血黄素染色评估出血痕迹。
与无创伤性、慢性肩袖撕裂的对照组（11 分（5-12.8 分）相比，急性创伤性肩袖全层撕裂患者的肌腱 Bonar 评分中位数（IQR）为 10.5（7.5-14.5），两组间无统计学差异。两组的炎症指数无统计学差异，而创伤性肩袖全层撕裂患者的肌腱组织中，凋亡（3.1（0.5-8.9）vs. 0.1（0-1.5），p=0.003）和增殖（4.0（1.8-6.9）vs. 0.4（0-2.0），p=0.001）指数显著高于慢性肩袖撕裂患者。创伤性肩袖全层撕裂患者的组织样本中，有 34%出现含铁血黄素染色阳性，而对照组为 10%（无统计学差异）。
本研究表明，与非创伤性、慢性肩袖撕裂患者相比，急性创伤性肩袖全层撕裂患者冈上肌腱的退变程度无差异。
II 级。
