» Regardless of recent advances in rotator cuff repair techniques, the rate of unhealed or recurrent rotator cuff tears remains high, with most recurrent rotator cuff tears occurring within the first 6 months after surgery. » Factors that can negatively affect tendon healing include older age, greater tear size, tendon retraction, and fatty infiltration. However, several clinical features that are often underestimated, including osteoporosis, diabetes, smoking, and hyperlipidemia, have proven to have an important influence on rotator cuff healing. » Recent meta-analyses that evaluated studies with Level-I and Level-II evidence have shown an overall increase in retear rates after single-row repair compared with double-row repair. However, to our knowledge, there are no Level-I clinical studies comparing different double-row configurations and, to date, no double-row repair technique has proven to be superior to the others. » The influence of postoperative rotator cuff healing on clinical outcomes is controversial. Although clinical differences may not be apparent in the short term, healed tendons have had better functional outcomes and greater strength in the midterm. » In general, a period of immobilization for 2 to 4 weeks, depending on tear size, is recommended. Graded supervised rehabilitation has proven to facilitate tendon healing without associated stiffness compared with early unprotected range of motion.

Rotator Cuff Retears.

The role of biologic agents in the management of common shoulder pathologies: current state and future directions.

Osteoporosis is a major public health problem affecting more than 200 million people worldwide. The use of different animal models, for the study of its pathophysiology and treatments, is important being actually the ovariectomized rat the most widely used; although this model has several problems due its small size, lack of true closure of epiphyseal plate and bone differences with humans. This review is aimed at summarizing the most common methods published for osteoporosis induction in rabbits as model for human disease with their advantages and disadvantages. The paper shows the advantages of the use of this specie compared with the rat. All the techniques seemed to achieve the osteoporotic condition, but the one which obtained the most consistent bone mineral reduction in less time was the combination of surgery and corticoid treatment. The conclusion of the review was that rabbits are promising as a model of osteoporosis research because of their size, haversian remodelling and closure of epiphyseal plate, which solve some of the problems of the rat model. There are different techniques in the literature used to achieve the osteoporotic condition with diverse results, but there is a lack of consensus as to the best one.

Rabbit as model for osteoporosis research

Purpose To examine any association between osteoporosis and the failure of arthroscopic rotator cuff repair (ARCR) leading to revision surgery and to investigate whether the use of bisphosphonates had any influence on the observed associations. Methods Patients who underwent ARCR with a diagnosis of osteoporosis were identified from the PearlDiver database and stratified according to whether there was a filled prescription for a bisphosphonate in the perioperative period. Patients with osteoporosis who underwent ARCR with bisphosphonate use were compared with age- and sex-matched patients who underwent ARCR with osteoporosis without a prescription for a bisphosphonate within 1 year of surgery and patients who underwent ARCR without a diagnosis of osteoporosis and no bisphosphonate use. The primary outcome measure was ipsilateral revision rotator cuff surgery, including revision repair, debridement for a diagnosis of a rotator cuff tear, or reverse shoulder arthroplasty. A multivariable logistic regression analysis was used to control for patient demographic characteristics and comorbidities during comparisons. Results We identified 2,706 patients, including 451 in the bisphosphonate study group; 902 in the osteoporosis, no-bisphosphonate control group; and 1,353 in the non-osteoporosis control group. Patients with osteoporosis, including those to whom bisphosphonates were prescribed, had a significantly higher rate of revision rotator cuff surgery (6.58%) than patients without osteoporosis (4.51%) (odds ratio, 1.60; 95% confidence interval, 1.30-1.97; P  = .008). No significant difference in the rate of revision surgery was found between patients with osteoporosis using bisphosphonates (6.65%) and age- and sex-matched patients with osteoporosis not using bisphosphonates (6.54%, P  = .718). Conclusions By using an administrative database, this study was able to show a substantial difference in the revision surgery rate after ARCR in patients with osteoporosis compared with matched controls. Level of Evidence Level III, retrospective cohort study.

The Association of Osteoporosis and Bisphosphonate Use With Revision Shoulder Surgery After Rotator Cuff Repair

BackgroundTo evaluate biological strategies that enhance tendon–bone healing in humans, it is imperative that suitable animal models accurately reproduce the pathological changes observed in the cl...

/pdf/supraspinatus-detachment-causes-musculotendinous-2fneodhjde.pdf

Supraspinatus detachment causes musculotendinous degeneration and a reduction in bone mineral density at the enthesis in a rat model of chronic rotator cuff degeneration

Introduction
An increased bone mineral density (BMD) in the proximity to tendon insertion can improve rotator cuff repair and healing. However, how a decrease of BMD in the humeral head affects the biomechanical properties of the rotator cuff tendon is still unclear. Previous studies have demonstrated ovariectomy in animals to lead to osteoporosis and decreased BMD, and Teriparatide (PTH) administration to improve BMD and strength of bone. This study aimed to explore the correlation between humeral head BMD and infraspinatus (ISP) tendon insertion strength, and if an increase in bone quantity of the humeral head can improve the strength of the rotator cuff.

/pdf/effect-of-bone-mineral-density-on-rotator-cuff-tear-an-21x862htsm.pdf

Effect of Bone Mineral Density on Rotator Cuff Tear: An Osteoporotic Rabbit Model

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Effect of Bone Mineral Density on Rotator Cuff Tear: An Osteoporotic Rabbit Model