Mechanisms of Joint Damage Following Tendon Injury

Summary

Principal Investigator: LOUIS J contact SOSLOWSKY
Affiliation: University of Pennsylvania
Country: USA
Abstract: DESCRIPTION (provided by applicant): Tendon injuries through overuse, overload and/or tears are common conditions which can dramatically alter joint mechanics in a complex and multifactorial manner leading to significant joint damage. This joint damage can be manifested as articular cartilage degeneration, injury to adjacent (intact) tendons, and abnormal joint kinematics and kinetics. Unfortunately, the mechanism by which tendon injuries lead to permanent joint damage remains unclear and as a result, clinicians offer advice without scientific understanding of the deleterious effects on the uninjured tendons and adjacent joint tissues. The in vivo cause and effect relationships that these mechanical alterations and disruptions have on the associated structures cannot be evaluated in tissue culture or human cadaveric studies and therefore remains unknown. Although clinical studies have established a relationship between even a single joint injury event and the development of deleterious changes in the affected joints that can be transient or permanent, the mechanism by which these changes occur remains unclear. Recently, we extended our established in vivo rat model of supraspinatus tendon tears to include tears of other rotator cuff tendons which results in changes in joint kinematics and kinetics, adjacent (intact) rotator cuff tendons, as well as the long-head of the biceps tendon providing a direct parallel to the changes observed in the human condition. With the development of this novel model and in coordination with our previously established rotator cuff tendon overuse model, the overall objective of this study is to elucidate the mechanisms governing the relationship between tendon injury and joint damage in common clinical conditions. By providing a well-defined mechanical milieu, our global hypothesis is that increasing joint damage (measured by changes in adjacent (intact) tendons, articular cartilage, and joint kinematics and kinetics) will be explained through two mechanically-based mechanisms: 1) tendon overload/overuse and 2) tendon force couple disruption (joint balance). Our Specific Aims are: Specific Aim 1: Determine if the mechanism of overload (1a) or overuse (1b) leads to joint damage in the absence of force couple disruption and Specific Aim 2: Determine if the mechanism of force couple disruption leads to joint damage. This study is innovative in that it defines the contributory roles of common mechanical injury mechanisms (overload, overuse and force couple disruption) through a novel extension of an established in vivo animal model that mimics the human condition and further, evaluates joint damage in a multidisciplinary manner including a novel ambulation assessment method where joint kinematics and kinetics can be rigorously quantified in vivo. Results of this study will not only define the in vivo mechanical processes which cause joint damage due to tendon injury, but will also provide a framework and model system in which physicians could better advise patients on outcomes and in which targeted treatment modalities could be evaluated in a controlled manner in order to guide physicians on an optimal treatment strategy long-term for common injuries. PUBLIC HEALTH RELEVANCE: Tendon injuries through overuse, overload and/or tears are common conditions which can dramatically alter joint mechanics in a complex and multifactorial manner leading to significant joint damage. With the development of this novel model and in coordination with our previously established rotator cuff tendon overuse model, the overall objective of this study is to elucidate the mechanisms governing the relationship between tendon injury and joint damage. Results of this study will not only define the in vivo mechanical processes which cause joint damage due to tendon injury, but will also provide a framework and model system in which targeted treatment modalities could be evaluated in a controlled manner in order to guide physicians on an optimal treatment strategy long-term for common injuries.
Funding Period: -------------------- - --------------------
more information: NIH RePORT

Top Publications

  1. pmc Effect of return to overuse activity following an isolated supraspinatus tendon tear on adjacent intact tendons and glenoid cartilage in a rat model
    Katherine E Reuther
    McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, 424 Stemmler Hall 36th Street and Hamilton Walk, Philadelphia, PA, USA
    J Orthop Res 31:710-5. 2013
  2. pmc Returning to overuse activity following a supraspinatus and infraspinatus tear leads to joint damage in a rat model
    Katherine E Reuther
    McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, PA, USA
    J Biomech 46:1818-24. 2013
  3. pmc Biceps detachment decreases joint damage in a rotator cuff tear rat model
    Stephen J Thomas
    McKay Orthopaedic Research Laboratory, University of Pennsylvania, 424 Stemmler Hall, 36th Street and Hamilton Walk, Philadelphia, PA, 19104 6081, USA
    Clin Orthop Relat Res 472:2404-12. 2014
  4. pmc Disruption of the anterior-posterior rotator cuff force balance alters joint function and leads to joint damage in a rat model
    Katherine E Reuther
    McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
    J Orthop Res 32:638-44. 2014
  5. pmc The effect of altered loading following rotator cuff tears in a rat model on the regional mechanical properties of the long head of the biceps tendon
    Cathryn D Peltz
    McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, 424 Stemmler Hall, Philadelphia, PA 19104 6081, USA
    J Biomech 43:2904-7. 2010
  6. pmc Restoration of anterior-posterior rotator cuff force balance improves shoulder function in a rat model of chronic massive tears
    Jason E Hsu
    McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, 424 Stemmler Hall, 36th and Hamilton Walk, Philadelphia, Pennsylvania 19104 6081, USA
    J Orthop Res 29:1028-33. 2011
  7. pmc Decreased loading after rotator cuff tears leads to improved biceps tendon properties in a rat model
    Cathryn D Peltz
    McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, PA 19104 6081, USA
    J Shoulder Elbow Surg 20:698-707. 2011

Detail Information

Publications7

  1. pmc Effect of return to overuse activity following an isolated supraspinatus tendon tear on adjacent intact tendons and glenoid cartilage in a rat model
    Katherine E Reuther
    McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, 424 Stemmler Hall 36th Street and Hamilton Walk, Philadelphia, PA, USA
    J Orthop Res 31:710-5. 2013
    ..Our results help define the contributory roles of common mechanical injury mechanisms and provide a framework by which physicians could better prescribe long-term treatment strategies for patients...
  2. pmc Returning to overuse activity following a supraspinatus and infraspinatus tear leads to joint damage in a rat model
    Katherine E Reuther
    McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, PA, USA
    J Biomech 46:1818-24. 2013
    ..This study helps define the mechanical and biological mechanisms leading to joint damage and provides a framework for treating active cuff tear patients. ..
  3. pmc Biceps detachment decreases joint damage in a rotator cuff tear rat model
    Stephen J Thomas
    McKay Orthopaedic Research Laboratory, University of Pennsylvania, 424 Stemmler Hall, 36th Street and Hamilton Walk, Philadelphia, PA, 19104 6081, USA
    Clin Orthop Relat Res 472:2404-12. 2014
    ..Arthroscopic tenotomy is the most common treatment. However, the role of the long head of the biceps at the shoulder and the consequences of surgical detachment on the remaining shoulder structures remain unknown...
  4. pmc Disruption of the anterior-posterior rotator cuff force balance alters joint function and leads to joint damage in a rat model
    Katherine E Reuther
    McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
    J Orthop Res 32:638-44. 2014
    ..These results identify joint imbalance as a mechanical mechanism for joint damage and demonstrate the importance of preserving rotator cuff balance when treating active cuff tear patients...
  5. pmc The effect of altered loading following rotator cuff tears in a rat model on the regional mechanical properties of the long head of the biceps tendon
    Cathryn D Peltz
    McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, 424 Stemmler Hall, Philadelphia, PA 19104 6081, USA
    J Biomech 43:2904-7. 2010
    ....
  6. pmc Restoration of anterior-posterior rotator cuff force balance improves shoulder function in a rat model of chronic massive tears
    Jason E Hsu
    McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, 424 Stemmler Hall, 36th and Hamilton Walk, Philadelphia, Pennsylvania 19104 6081, USA
    J Orthop Res 29:1028-33. 2011
    ..Clinically, a partial repair of the posterior cuff after a two-tendon tear may be sufficient to restore adequate function. An in vivo model system for two-tendon repair of massive rotator cuff tears is presented...
  7. pmc Decreased loading after rotator cuff tears leads to improved biceps tendon properties in a rat model
    Cathryn D Peltz
    McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, PA 19104 6081, USA
    J Shoulder Elbow Surg 20:698-707. 2011
    ..In addition, we hypothesized that changes with altered loading will begin at the proximal insertion into bone and progress along the tendon length at later time points...