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Scientific Articles   |    
Human Growth Hormone May Be Detrimental When Used to Accelerate Recovery from Acute Tendon-Bone Interface Injuries
Keith M. Baumgarten, MD1; Harvey A. Oliver, BS2; Jack Foley4; Ding-Geng Chen, PhD3; Peter Autenried, DVM, MSc, PhD4; Shanzhong Duan, PhD5; Patrick Heiser, PA-C1
1 Orthopedic Institute, Section of Sports Medicine and Shoulder Surgery, 810 East 23rd Street, Sioux Falls, SD 57117. E-mail address for K.M. Baumgarten: Kbaumga@yahoo.com
2 Department of Surgery, University of South Dakota, Sanford School of Medicine, 1400 West 22nd Street, Sioux Falls, SD 57105
4 University of South Dakota, 414 Clark Street, Vermillion, SD 57069
3 Department of Biostatistics, Center of Research, School of Nursing, University of Rochester, Rochester, NY 14642
5 Department of Mechanical Engineering, Crothers Engineering Hall, South Dakota State University, Brookings, SD 57007-0294
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Investigation performed at the University of South Dakota, Vermillion, South Dakota

A commentary by Thomas D. Brown, PhD, is linked to the online version of this article at jbjs.org.



Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 May 01;95(9):783-789. doi: 10.2106/JBJS.L.00222
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Abstract

Background: 

There have been few scientific studies that have examined usage of human growth hormone to accelerate recovery from injury. The hypothesis of this study was that human growth hormone would accelerate tendon-to-bone healing compared with control animals treated with placebo in a rat model of acute rotator cuff injury repair.

Methods: 

Seventy-two rats underwent repair of acute rotator cuff injuries and were randomized into the following postoperative dosing regimens: placebo, and human growth hormone at 0.1, 1, 2, 5, and 10 mg/kg/day, administered subcutaneously once per day for fourteen days (Protocol 1). An additional twenty-four rats were randomized to receive either (1) placebo or (2) human growth hormone at 5 mg/kg, administered subcutaneously twice per day for seven days preoperatively and twenty-eight days postoperatively (Protocol 2). All rats were killed twenty-eight days postoperatively. Mechanical testing was performed. Ultimate stress, ultimate force, stiffness, energy to failure, and ultimate distension were determined.

Results: 

For Protocol 1, analysis of variance testing showed no significant difference between the groups with regard to ultimate stress, ultimate force, stiffness, energy to failure, or ultimate distension. In Protocol 2, ultimate force to failure was significantly worse in the human growth hormone group compared with the placebo group (21.1 ± 5.85 versus 26.3 ± 5.47 N; p = 0.035). Failure was more likely to occur through the bone than the tendon-bone interface in the human growth hormone group compared with the placebo group (p = 0.001). No significant difference was found for ultimate stress, ultimate force, stiffness, energy to failure, or ultimate distension between the groups in Protocol 2.

Conclusions: 

In this rat model of acute tendon-bone injury repair, daily subcutaneous postoperative human growth hormone treatment for fourteen days failed to demonstrate a significant difference in any biomechanical parameter compared with placebo. Furthermore, subcutaneous administration of 5 mg/kg of human growth hormone twice daily from seven days preoperatively until twenty-eight days postoperatively demonstrated lower loads to ultimate failure and a higher risk of bone fracture failure compared with placebo.

Clinical Relevance: 

This study suggests that human growth hormone treatment does not identifiably accelerate the strength of tendon-to-bone healing from acute injury and may have negative biomechanical consequences.

Figures in this Article

    Topics

    somatropin ; tendon
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    Accreditation Statement
    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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