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Journal of Bone and Joint Surgery - British Volume, Vol 89-B, Issue 5, 633-638.
doi: 10.1302/0301-620X.89B5.18905  
Copyright © 2007 by British Editorial Society of Bone and Joint Surgery
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In vivo measurement of tissue metabolism in tendons of the rotator cuff

IMPLICATIONS FOR SURGICAL MANAGEMENT

T. J. W. Matthews, BSc, MRCS, Research Fellow1; S. R. Smith, DPhil, Postdoctoral Research Scientist2; C. A. Peach, MRCS, Research Fellow1; J. L. Rees, MD, FRCS, Consultant Orthopaedic Surgeon1; J. P. G. Urban, PhD, Senior ARC Research Fellow2; and A. J. Carr, MCh, FRCS, Nuffield Professor of Orthopaedic Surgery1

1 Nuffield Department of Orthopaedic Surgery Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford OX3 7LD, UK.
2 Department of Physiology University of Oxford, Parks Road, Oxford OX1 3PT, UK.

Correspondence should be sent to Mr T. J. W. Matthews; e-mail: timothyandshiona{at}ntlworld.com

We have undertaken an in vivo assessment of the tissue metabolism and cellular activity in torn tendons of the rotator cuff. Cellular oxygen consumption was measured in 13 patients undergoing mini-open repair of small, medium, large and massive full-thickness tears. Measurements were also taken from three control patients who were undergoing open stabilisation of the shoulder with grossly normal tendons. The level of oxygen and nitrous oxide was measured amperometrically using silver needle microelectrodes at the apex of the tear and 1.5 cm from its edge. With nitrous oxide indicating the degree of perfusion, oxygen consumption was calculated at each location to reflect cellular activity.

All of the torn tendons had lower levels of cellular activity than the control group. This activity was lower still in the tissue nearest to the edge of the tear with the larger tears showing the lowest activity. This indicated reduced levels of tissue metabolism and infers a reduction in tendon viability.

Our findings suggest that surgical repair of torn tendons of the rotator-cuff should include the more proximal, viable tissue, and may help to explain the high rate of re-rupture seen in larger tears.




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eLetters:

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Importance of delay in the outcome of rotator cuff repair
Timothy E J Hems
J Bone Joint Surg Br Online, 28 Sep 2007 [Full text]
Authors' reply:
Timothy JW Matthews, et al.
J Bone Joint Surg Br Online, 15 Oct 2007 [Full text]

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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General