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Apoptosis and rotator cuff tears: scientific evidence from basic science to clinical findings
Leonardo Osti1, Matteo Buda2, Angelo Del Buono3
1Unit of Arthroscopy and Sports Medicine, Hesperia Hospital, Via Arqua', Modena, Italy.
Introduction:
Excessive apoptosis has been hypothesized as possible cause of tendinopathy and tear in the tendons of the rotator cuff (RC). Different mechanisms and molecules play a key role in cell regulation. Biological interventions can affect the process of apoptosis to control the tendinopathy process, and may be useful to design new treatments.
Source Of Data:
We identified basic science, in vitro and in vivo preclinical and clinical studies listed in the Pubmed Google Scholar, CINAHL, Cochrane Central and Embase Biomedical databases in English, Spanish, Italian and French concerning the effects of apoptosis on RC tendons.
Areas Of Agreement:
The homeostasis between the apoptotic and inflammatory processes is dynamic and controlled by pro- and anti-apoptotic mechanisms and signals, with variable balance in different areas of the RC tendons in human specimens.
Areas Of Controversy:
Apoptosis can be identified along the whole tendon, not only in the area of the lesion. Therefore, it is not necessary to undertake wide debridement of the torn edges of the tendon when undertaking a repair.
Growing Points:
The identification of the various factors that control apoptosis and its mechanisms can help to design new treatments and exert positive effects in the recovery from tendon tears.
Areas Timely For Developing Research:
Further studies are needed to produce clear guidelines to determine how to balance the apoptosis process to reduce the failed healing response found in non-traumatic RC tears.
Insights
Excessive apoptosis, or programmed cell death, is linked to rotator cuff (RC) tendon tears. Understanding apoptosis mechanisms may lead to new treatments for RC tendinopathy and tears.
Area of Science:
- Orthopedics
- Cell Biology
- Biomedical Engineering
Background:
- Excessive apoptosis is a potential cause of rotator cuff (RC) tendinopathy and tears.
- Cell regulation involves various mechanisms and molecules influencing apoptosis.
- Biological interventions targeting apoptosis could manage tendinopathy and inform new treatments.
Purpose of the Study:
- To review the effects of apoptosis on rotator cuff tendons.
- To identify factors controlling apoptosis for improved treatment design.
- To explore the role of apoptosis in rotator cuff tears and tendinopathy.
Main Methods:
- Systematic literature search of multiple databases (PubMed, Google Scholar, CINAHL, Cochrane Central, Embase).
- Inclusion of basic science, in vitro, in vivo preclinical, and clinical studies.
- Studies reviewed in English, Spanish, Italian, and French.
Main Results:
- Apoptosis occurs throughout the RC tendon, not solely at the lesion site.
- The balance between apoptotic and inflammatory processes is dynamic and varies across RC tendon regions.
- Current understanding suggests wide debridement may not be necessary for tendon repair.
Conclusions:
- Identifying factors controlling apoptosis can aid in designing effective treatments for tendon tears.
- Further research is needed to establish guidelines for balancing apoptosis to improve healing in non-traumatic RC tears.