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More histologic and ultrastructural degenerative signs in the subscapularis tendon and the joint capsule in male patients with shoulder impingement

Artikel i vetenskaplig tidskrift
Författare Stefanos Farfaras
Lars Erik Ejerhed
Erling Hallström
Kjell Hultenby
Khaled Meknas
Tomas Movin
Nikos Papadogiannakis
Jüri Kartus
Publicerad i Knee Surgery, Sports Traumatology, Arthroscopy
Volym 26
Nummer/häfte 1
Sidor 79-87
ISSN 0942-2056
Publiceringsår 2018
Publicerad vid Institutionen för kliniska vetenskaper, Avdelningen för ortopedi
Sidor 79-87
Språk en
Länkar dx.doi.org/10.1007/s00167-017-4442-...
Ämnesord Biopsy, Degeneration, Shoulder instability, Shoulder joint capsule, Subacromial impingement, Subscapularis tendon
Ämneskategorier Ortopedi

Sammanfattning

Purpose: The purpose of the present study was to analyze biopsy samples from the subscapularis tendon and from the joint capsule from male patients with shoulder impingement syndrome (SAIS) and compare them with samples from male patients with post-traumatic recurrent shoulder instability. The hypothesis of the study was that patients with SAIS would have more histologic and ultrastructural degenerative changes in their subscapularis tendon and joint capsule than patients with post-traumatic recurrent shoulder instability. Methods: Male patients scheduled for surgery, with either subacromial decompression or Bankart reconstruction, were included. Four biopsies from each patient were obtained from the capsule and four from the subscapularis tendon during arthroscopic surgery. The histologic characteristics and the presence of glycosaminoglycans were assessed using the light microscope, and the ultrastructure was assessed using a transmission electron microscope. Results: Eight patients, median age 53 (45–74) years (p < 0.0001), were included in the impingement group, and 12 patients, median age 27 (22–48) years, were included in the instability group. The histologic assessment revealed significantly higher cellularity and total degeneration score in the capsule (p = 0.016 and p = 0.014 respectively) in patients with subacromial impingement compared with the instability patients. The corresponding finding was not made for the subscapularis tendon. The ultrastructural evaluation revealed that the instability patients had more fibrils with a large diameter (indicating less degeneration) in both the subscapularis tendon and the capsule compared with the impingement patients (p < 0.0001). Conclusion: Male patients with subacromial impingement have more histologic and ultrastructural degenerative changes in their shoulder compared with patients with post-traumatic recurrent shoulder instability. Clinical relevance: It appears that in patients with subacromial impingement, the whole shoulder joint is affected and not only the subacromial space. It is the opinion of the authors that intra-articular therapeutic injections could be tried more often in these patients. Level of evidence: III.

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