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The Effect of Corticosteroid on Collagen Expression in Injured Rotator Cuff Tendon
Anthony S. Wei, MD1; John J. Callaci, PhD1; Dainius Juknelis, MD1; Guido Marra, MD1; Pietro Tonino, MD1; Kevin B. Freedman, MD, MSCE2; Frederick H. Wezeman, PhD1
1 Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153. E-mail address for A.S. Wei: awei@lumc.edu
2 Orthopaedic Specialists, 27 South Bryn Mawr Avenue, Bryn Mawr, PA 19010
View Disclosures and Other Information
Note: The authors thank Thomas Strandness for his contribution to this study.
In support of their research for or preparation of this manuscript, one or more of the authors received grants or outside funding from the Walgreen Foundation. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at the Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2006 Jun 01;88(6):1331-1338. doi: 10.2106/JBJS.E.00806
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Abstract

Background: Subacromial corticosteroid injections are commonly used in the nonoperative management of rotator cuff disease. The effects of corticosteroid injection on injured rotator cuff tendons have not been studied. Our aims were to characterize the acute response of rotator cuff tendons to injury through the analysis of the type-III to type-I collagen expression ratio, a tendon injury marker, and to examine the effects of corticosteroid on this response.

Methods: Sixty Sprague-Dawley rats were randomly assigned to four groups: control, tendon injury, steroid treatment, and tendon injury and steroid treatment. Six rats served as sham controls. Unilateral tendon injuries were created with full-thickness defects across 50% of the total width of the infraspinatus tendon, 5 mm from its humeral insertion. Steroid treatment with a single dose of methylprednisolone (0.6 mg/kg), equivalent to that given to humans, was injected into the subacromial space under direct visualization. Steroid treatment followed the creation of an injury in the rats in the injury and steroid treatment group. At one, three, and five weeks after the injury, the total RNA isolated from tendons was quantified with real-time polymerase chain reaction with use of primers for type-I and type-III collagen and ribosomal 18s RNA.

Results: The type-III to type-I collagen expression ratio remained at baseline at all time-points in the control and sham groups. At one week, the type-III to type-I collagen expression ratio increased more than fourfold above the control level in the tendon injury group (p = 0.017) and the tendon injury and steroid treatment group (p = 0.003). The ratio remained greater than twofold above the control at three weeks in both groups (p = 0.003 and p = 0.037) and returned to baseline at five weeks. Interestingly, the group that had steroid treatment only showed an increase of >4.5-fold (p = 0.001) in the type-III to type-I collagen expression ratio, without structural injury to the tendon. This ratio returned to baseline levels by three weeks.

Conclusions: A single dose of corticosteroid does not alter the acute phase response of an injured rotator cuff tendon in the rat. However, the same steroid dose in uninjured tendons initiates a short-term response equivalent to that of structural injury.

Clinical Relevance: These findings suggest that while a single corticosteroid dose may have no long-term effects on tendon collagen gene expression, collagen composition may be acutely altered by the injection. Therapy and activity recommendations following subacromial corticosteroid exposure should be made with the awareness of possible compromised rotator cuff tendon properties.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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