Arthroscopic transosseous rotator cuff repair.

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Abstract

[Indexed for MEDLINE] 12. Sci Transl Med. 2024 Apr 24;16(744):eadd8273. doi: 10.1126/scitranslmed.add8273. Epub 2024 Apr 24. The subacromial bursa modulates tendon healing after rotator cuff injury in rats. Marshall BP(1)(2), Ashinsky BG(2), Ferrer XE(2), Kunes JA(3), Innis AC(2), Luzzi AJ(2), Forrester LA(2), Burt KG(1)(2), Lee AJ(1), Song L(2), Lisiewski LE(1)(2), Soni RK(4), Hung CT(1)(2), Levine WN(2), Kovacevic D(5), Thomopoulos S(1)(2). Author information: (1)Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA. (2)Department of Orthopedic Surgery, Columbia University, New York, NY 10032, USA. (3)Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA. (4)Proteomics and Macromolecular Crystallography Shared Resource, Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY 10032, USA. (5)New York Metropolitan Orthopaedics and Spine, New York, NY 10001, USA. Rotator cuff injuries result in more than 500,000 surgeries annually in the United States, many of which fail. These surgeries typically involve repair of the injured tendon and removal of the subacromial bursa, a synovial-like tissue that sits between the rotator cuff and the acromion. The subacromial bursa has been implicated in rotator cuff pathogenesis and healing. Using proteomic profiling of bursa samples from nine patients with rotator cuff injury, we show that the bursa responds to injury in the underlying tendon. In a rat model of supraspinatus tenotomy, we evaluated the bursa's effect on the injured supraspinatus tendon, the uninjured infraspinatus tendon, and the underlying humeral head. The bursa protected the intact infraspinatus tendon adjacent to the injured supraspinatus tendon by maintaining its mechanical properties and protected the underlying humeral head by maintaining bone morphometry. The bursa promoted an inflammatory response in injured rat tendon, initiating expression of genes associated with wound healing, including Cox2 and Il6. These results were confirmed in rat bursa organ cultures. To evaluate the potential of the bursa as a therapeutic target, polymer microspheres loaded with dexamethasone were delivered to the intact bursae of rats after tenotomy. Dexamethasone released from the bursa reduced Il1b expression in injured rat supraspinatus tendon, suggesting that the bursa could be used for drug delivery to reduce inflammation in the healing tendon. Our findings indicate that the subacromial bursa contributes to healing in underlying tissues of the shoulder joint, suggesting that its removal during rotator cuff surgery should be reconsidered. DOI: 10.1126/scitranslmed.add8273 PMCID: PMC11646107