title: Neer Award 2007: Reversion of structural muscle changes caused by chronic rotator cuff tears using continuous musculotendinous traction. An experimental study in sheep.
abstract: OBJECTIVE
  Chronic rotator cuff tears are associated with irreversible architectural muscle changes and a high rate of repair failure. The changes observed in man and their irreversibility with a single stage repair can be reproduced in sheep. It was the purpose of this experiment to test the hypothesis that slow, continuous elongation of a retracted musculotendinous unit allows reversal of the currently irreversible structural muscle changes.
  
  
  METHODS
  The infraspinatus tendon of 12 sheep was released using a greater tuberosity osteotomy and allowed to retract for 4 months. Then, a new device was mounted on the scapular spine and used to extend the infraspinatus muscuculotendinous unit transcutaneously by 1 mm per day. Thereafter, the tendon was repaired back to the greater tuberosity. We assessed the muscular architecture using magnetic resonance imaging, macroscopic dissection, histology, and electron microscopy. Fatty infiltration (in Hounsfield units 1/4 HU) and muscular cross-sectional area (in % of the control side) were monitored with computed tomography at tendon release, initiation of elongation, repair, and at sacrifice.
  
  
  RESULTS
  Sixteen weeks after tendon release, the mean tendon retraction was 29 +/- 6 mm (14% of original length, P = .008). In 8 sheep, elongation was achieved as planned (group I), but in 4, the elongation failed technically (group II). The mean traction time was 24 +/- 6 days with a mean traction distance of 19 +/- 4 mm. At sacrifice, the mean pennation angle in the infraspinatus of group I was not different from the control side (29.8 degrees +/-7.5 degrees vs. 30 degrees +/-6 degrees , P = .575). In group II, the pennation angle had increased from 30 degrees +/-6 degrees to 55 degrees +/-14 degrees (P = .035). There was no fatty infiltration at the time of tendon release. After retraction, there was a significant increase in fatty infiltration of the infraspinatus muscle and a decrease of its cross-sectional area to 57% of the contralateral side (P = .0001). During traction, the degree of fatty infiltration remained unchanged (36 HU to 38 HU, P = .381), and atrophy improved to a muscle square area of 78% of the contralateral side (P = .0001) in group I. In group II, an increase of fatty infiltration was measured from 36 HU to 28 HU; however, this increase was not significant (P = .144). Atrophy did not change in group II (57-55%, P = .946). At sacrifice, the remaining muscle mass was 64% in group I and 46% in group II (P = .019).
  
  
  CONCLUSIONS
  Our preliminary results document, that continuous elongation of a retracted, fatty infiltrated and atrophied musculotendinous unit is technically feasible.
  
  
  CONCLUSIONS
  In the sheep, continuous elongation can lead to restoration of normal muscle architecture, to partial reversal of muscle atrophy, and to arrest of the progression of fatty infiltration.
  
  
  METHODS
  Basic science level 2; Prospective comparative therapeutic study.
authors.affiliation: Department of Orthopaedics, University of Zurich, Balgrist, Zürich, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Gerber
authors.forename: Dominik C
authors.initials: DC
authors.lastname: Meyer
authors.forename: Eric
authors.initials: E
authors.lastname: Frey
authors.forename: Brigitte
authors.initials: B
authors.lastname: von Rechenberg
authors.forename: Hans
authors.initials: H
authors.lastname: Hoppeler
authors.forename: Robert
authors.initials: R
authors.lastname: Frigg
authors.forename: Bernhard
authors.initials: B
authors.lastname: Jost
authors.forename: Matthias A
authors.initials: MA
authors.lastname: Zumstein
mesh_terms: D000818:Animals; D001284:Atrophy; D002908:Chronic Disease; D008279:Magnetic Resonance Imaging; D017006:Rotator Cuff / Q000473:pathology / Q000502:physiology*; D000070636:Rotator Cuff Injuries; D012756:Sheep; D013710:Tendons / Q000502:physiology; D014057:Tomography, X-Ray Computed; D014143:Traction