Artikel
Enhancement of Rotator Cuff Healing by Sartans to Inhibit Transforming Growth Factor-Beta: A Case Control Matched Cohort Study
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Autoren
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Jan Dekena
- Centrum für Muskuloskeletale Chirurgie, Charité – Universitätsmedizin Berlin, Berlin, Germany
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Philipp Moroder
- Schulthess Klinik, Zürich, Switzerland
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Kerstina Menzel
- Centrum für Muskuloskeletale Chirurgie, Charité – Universitätsmedizin Berlin, Berlin, Germany
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Doruk Akgün
- Charité – Universitätsmedizin Berlin, Centrum für Muskuloskeletale Chirurgie, Berlin, Germany
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Kathi Thiele
- Centrum für Muskuloskeletale Chirurgie, Charité – Universitätsmedizin Berlin, Berlin, Germany
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Katrin Karpinski
- Martin-Luther-Krankenhausbetrieb GmbH, Klinik für Orthopädie und Unfallchirurgie, Berlin, Germany
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Johnny Huard
- Steadman Philippon Research Institute, Vail, United States
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Peter J. Millett
- The Steadman Clinic, Vail, United States
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Lucca Lacheta
- Centrum für Muskuloskeletale Chirurgie, Charité – Universitätsmedizin Berlin, Berlin, Germany
| Veröffentlicht: | 25. Oktober 2022 |
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Gliederung
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Objectives: Failure of healing or re-tears after surgical repair of the rotator cuff tendons remain a problem and can cause ongoing shoulder pain and dysfunction. Fibrosis of the torn tendons and muscle tendon units may lead to poor healing. Transforming growth factor-beta 1 (TGF- beta1) plays an important role in the cascade in the development of fibrosis. Sartans (antihypertensive drugs) have been shown to block TGF- beta1.
The purpose of this study was to compare the clinical outcomes and tendon integrity of patients after rotator cuff repair with and without sartans medication.
Methods: Patients who underwent arthroscopic rotator cuff repair (ARCR), had sartans in their medication, and were at least 2 years postoperative were included and matched with patients who underwent ARCR without having sartans (No-sartan group) by age, sex, involved tendon, and tear size. Patient-reported outcome (PRO) scores were collected at final follow-up including the Constant Murrey Score (CMS), Western Ontario Rotator Cuff Score (WORC), Simple Shoulder Test (SST), and visual analog scale (VAS). Tendon integrity (maintained continuity: yes/no) was assessed by ultrasound examination at final follow-up.
Results and conclusion: 26 patients (versus 26 matched-controls) were available for follow-up. There were 6 female (23%) and 20 male (77 %) patients with a mean age of 63.7 years (range, 40-74.8 years). No patient underwent revision surgery. Differences in mean PRO scores between sartan and No-sartan groups, respectively, were seen at final evaluation as follow: CMS: 81 (range, 54 - 100) versus 82 (range, 63 - 99) (P = .457); WORC: 38 (range, 0 - 156) versus 23 (range, 0 - 92) (P = .071); SST: 9.8 (range, 6 - 12) versus 10 (range, 6 - 12) (P = .187); and VAS: 1.8 (range, 0 - 8) versus 0.4 (range, 0 - 5) (P = .012*). Intact tendon insertion was observed in 100% (26/26) for sartans and 88% (23/26) for No-sartans groups, respectively (P = .041*).
Patients with torn rotator cuff tendons benefited similarly from ARCR concerning clinical presentation. An increased rate of tendon integrity was observed in patients with sartans in their medication, however, less pain in patients without sartans.
