This Article Full Text Full Text (PDF) [Supplementary Material] Letters to the Editor: Submit a response Alert me when this article is cited Alert me when Letters to the Editor are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Biberthaler, P. Articles by Mutschler, W. Search for Related Content PubMed PubMed Citation Articles by Biberthaler, P. Articles by Mutschler, W. Social Bookmarking                   What's this?

Microcirculation Associated with Degenerative Rotator Cuff Lesions

In Vivo Assessment with Orthogonal Polarization Spectral Imaging During Arthroscopy of the Shoulder

Investigation performed at the Department of Surgery, University of Munich, Munich, Germany

Peter Biberthaler, MD
E. Wiedemann, MD
M. Kettler, MD
T. Mussack, MD
S. Deckelmann
W. Mutschler, MD
Surgical Department Munich Central, Ludwig-Maximilians-Universität Munich, Innenstadt, Nussbaumstrasse 20, 80336 Munich, Germany. E-mail address for P. Biberthaler: peter.biberthaler@ chi-i.med.uni-muenchen.de

A. Nerlich, MD
Institute for Pathology, Academic Teaching Hospital Munich Bogenhausen, Englschalkingerstrasse 77, 81925 Munich, Germany

In support of the research or preparation of this manuscript, one of the authors (P.B.) received a postdoctoral grant from the Deutsche Forschungsgemeinschaft Bi 675/1-1 and Bi 675/1-2. None of the authors received 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.

Background: Diminished vascular supply is associated with degenerative rotator cuff lesions. Orthogonal polarization spectral imaging allows noninvasive assessment of microcirculation without application of fluorescent contrast medium. The aim of our study was to visualize and quantify in vivo the microcirculation of the rotator cuff during arthroscopic surgery and to compare the results with the number of microvessels identified in vitro by immunostaining of biopsy specimens taken from the scanned areas.

Methods: Eleven patients with clinical signs of a degenerative rotator cuff lesion were studied. Prior to arthroscopic subacromial decompression, the superficial part of the supraspinatus tendon at the edge of the lesion as well as the unaffected tendon insertion was examined. Microvascular parameters established for the description of tissue perfusion with use of conventional intravital fluorescence microscopy (functional capillary density and capillary diameter) were assessed in vivo. Biopsy specimens were taken from the scanned areas, and the microvessels were localized by immunostaining for the endothelial surface marker CD31.

Results: In the region of the unaffected tendon insertion, the mean baseline functional capillary density (and standard deviation) was 106 ± 13 cm/cm ² and the mean capillary diameter was 10 ± 0.7 µm. In contrast, at the edge of the lesion, the functional capillary density was significantly reduced to 20 ± 14 cm/cm ² , whereas the diameter of the vessels that were present did not differ. The total number of vessels stained in vitro was also significantly reduced at the edge of the lesion compared with the number of vessels in the tendon insertion zone.

Conclusions: Quantitative in vivo analysis of human microcirculation during arthroscopy demonstrated that the functional capillary density at the edge of a degenerative rotator cuff lesion was significantly reduced compared with that in the control tissue. The capacity to assess microcirculatory flow in vivo may help to identify specific repair strategies based on knowledge of individual perfusion patterns.

CiteULike    Connotea    Del.icio.us    Facebook    Technorati    Twitter    What's this?

This article has been cited by other articles:

				J S Lewis Rotator cuff tendinopathy Br. J. Sports Med., April 1, 2009; 43(4): 236 - 241. [Abstract] [Full Text] [PDF]

				S. Fealy, R. S. Adler, M. C. Drakos, A. M. Kelly, A. A. Allen, F. A. Cordasco, R. F. Warren, and S. J. O'Brien Patterns of Vascular and Anatomical Response After Rotator Cuff Repair Am. J. Sports Med., January 1, 2006; 34(1): 120 - 127. [Abstract] [Full Text] [PDF]

				M. KJAeR Role of Extracellular Matrix in Adaptation of Tendon and Skeletal Muscle to Mechanical Loading Physiol Rev, April 1, 2004; 84(2): 649 - 698. [Abstract] [Full Text] [PDF]

Stanford University Libraries' HighWire Press (TM) assists in the publication of JBJS Online.
Copyright © 2003 by The Journal of Bone and Joint Surgery, Inc. Online ISSN: 1535-1386.
The Journal of Bone and Joint Surgery®, JBJS®, JB&JS®, and eJBJS® are registered in the U.S. Patent and Trademark Office.