Alice J S Fox1, Michael O Schär2, Florian Wanivenhaus2, Tony Chen3, Erik Attia2, Nikolaus B Binder2, Miguel Otero2, Susannah L Gilbert4, Joseph T Nguyen5, Salma Chaudhury2, Russell F Warren2, Scott A Rodeo2. 1. Laboratory for Soft Tissue Research, Hospital for Special Surgery, New York, New York, USA foxa@hss.edu ajsfox27@hotmail.com. 2. Laboratory for Soft Tissue Research, Hospital for Special Surgery, New York, New York, USA. 3. Laboratory for Soft Tissue Research, Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA. 4. Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA. 5. Healthcare Research Institute, Hospital for Special Surgery, New York, New York, USA.
Abstract
BACKGROUND: Recent studies suggest that fluoroquinolone antibiotics predispose tendons to tendinopathy and/or rupture. However, no investigations on the reparative capacity of tendons exposed to fluoroquinolones have been conducted. HYPOTHESIS: Fluoroquinolone-treated animals will have inferior biochemical, histological, and biomechanical properties at the healing tendon-bone enthesis compared with controls. STUDY DESIGN: Controlled laboratory study. METHODS: Ninety-two rats underwent rotator cuff repair and were randomly assigned to 1 of 4 groups: (1) preoperative (Preop), whereby animals received fleroxacin for 1 week preoperatively; (2) pre- and postoperative (Pre/Postop), whereby animals received fleroxacin for 1 week preoperatively and for 2 weeks postoperatively; (3) postoperative (Postop), whereby animals received fleroxacin for 2 weeks postoperatively; and (4) control, whereby animals received vehicle for 1 week preoperatively and for 2 weeks postoperatively. Rats were euthanized at 2 weeks postoperatively for biochemical, histological, and biomechanical analysis. All data were expressed as mean ± standard error of the mean (SEM). Statistical comparisons were performed using either 1-way or 2-way ANOVA, with P < .05 considered significant. RESULTS: Reverse transcriptase quantitative polymerase chain reaction (RTqPCR) analysis revealed a 30-fold increase in expression of matrix metalloproteinase (MMP)-3, a 7-fold increase in MMP-13, and a 4-fold increase in tissue inhibitor of metalloproteinases (TIMP)-1 in the Pre/Postop group compared with the other groups. The appearance of the healing enthesis in all treated animals was qualitatively different than that in controls. The tendons were friable and atrophic. All 3 treated groups showed significantly less fibrocartilage and poorly organized collagen at the healing enthesis compared with control animals. There was a significant difference in the mode of failure, with treated animals demonstrating an intrasubstance failure of the supraspinatus tendon during testing. In contrast, only 1 of 10 control samples failed within the tendon substance. The healing enthesis of the Pre/Postop group displayed significantly reduced ultimate load to failure compared with the Preop, Postop, and control groups. There was no significant difference in load to failure in the Preop group compared with the Postop group. Pre/Postop animals demonstrated significantly reduced cross-sectional area compared with the Postop and control groups. There was also a significant reduction in area between the Preop and control groups. CONCLUSION: In this preliminary study, fluoroquinolone treatment negatively influenced tendon healing. CLINICAL RELEVANCE: These findings indicate that there was an active but inadequate repair response that has potential clinical implications for patients who are exposed to fluoroquinolones before tendon repair surgery.
BACKGROUND: Recent studies suggest that fluoroquinolone antibiotics predispose tendons to tendinopathy and/or rupture. However, no investigations on the reparative capacity of tendons exposed to fluoroquinolones have been conducted. HYPOTHESIS: Fluoroquinolone-treated animals will have inferior biochemical, histological, and biomechanical properties at the healing tendon-bone enthesis compared with controls. STUDY DESIGN: Controlled laboratory study. METHODS: Ninety-two rats underwent rotator cuff repair and were randomly assigned to 1 of 4 groups: (1) preoperative (Preop), whereby animals received fleroxacin for 1 week preoperatively; (2) pre- and postoperative (Pre/Postop), whereby animals received fleroxacin for 1 week preoperatively and for 2 weeks postoperatively; (3) postoperative (Postop), whereby animals received fleroxacin for 2 weeks postoperatively; and (4) control, whereby animals received vehicle for 1 week preoperatively and for 2 weeks postoperatively. Rats were euthanized at 2 weeks postoperatively for biochemical, histological, and biomechanical analysis. All data were expressed as mean ± standard error of the mean (SEM). Statistical comparisons were performed using either 1-way or 2-way ANOVA, with P < .05 considered significant. RESULTS: Reverse transcriptase quantitative polymerase chain reaction (RTqPCR) analysis revealed a 30-fold increase in expression of matrix metalloproteinase (MMP)-3, a 7-fold increase in MMP-13, and a 4-fold increase in tissue inhibitor of metalloproteinases (TIMP)-1 in the Pre/Postop group compared with the other groups. The appearance of the healing enthesis in all treated animals was qualitatively different than that in controls. The tendons were friable and atrophic. All 3 treated groups showed significantly less fibrocartilage and poorly organized collagen at the healing enthesis compared with control animals. There was a significant difference in the mode of failure, with treated animals demonstrating an intrasubstance failure of the supraspinatus tendon during testing. In contrast, only 1 of 10 control samples failed within the tendon substance. The healing enthesis of the Pre/Postop group displayed significantly reduced ultimate load to failure compared with the Preop, Postop, and control groups. There was no significant difference in load to failure in the Preop group compared with the Postop group. Pre/Postop animals demonstrated significantly reduced cross-sectional area compared with the Postop and control groups. There was also a significant reduction in area between the Preop and control groups. CONCLUSION: In this preliminary study, fluoroquinolone treatment negatively influenced tendon healing. CLINICAL RELEVANCE: These findings indicate that there was an active but inadequate repair response that has potential clinical implications for patients who are exposed to fluoroquinolones before tendon repair surgery.
Authors: Olaf Lorbach; Mike H Baums; Tanja Kostuj; Stephan Pauly; Markus Scheibel; Andrew Carr; Nasim Zargar; Maristella F Saccomanno; Giuseppe Milano Journal: Knee Surg Sports Traumatol Arthrosc Date: 2015-01-09 Impact factor: 4.342
Authors: Jourdan M Cancienne; Stephen F Brockmeier; Scott A Rodeo; Chris Young; Brian C Werner Journal: Knee Surg Sports Traumatol Arthrosc Date: 2016-10-13 Impact factor: 4.342
Authors: Jorge H Assunção; Alexandre L Godoy-Santos; Maria Cristina L G Dos Santos; Eduardo A Malavolta; Mauro E C Gracitelli; Arnaldo A Ferreira Neto Journal: Clin Orthop Relat Res Date: 2017-02-03 Impact factor: 4.176
Authors: Benjamin R Freedman; Andrey Zuskov; Joseph J Sarver; Mark R Buckley; Louis J Soslowsky Journal: J Orthop Res Date: 2015-04-27 Impact factor: 3.494
Authors: Bradley L Young; Evan D Sheppard; Sierra Phillips; Trevor M Stubbs; Jun Kit He; Andrew Moon; Martim C Pinto; Gerald McGwin; Eugene William Brabston; Shawn R Gilbert; Brent A Ponce Journal: JSES Int Date: 2022-01-30
Authors: Krzysztof Michalak; Aleksandra Sobolewska-Włodarczyk; Marcin Włodarczyk; Justyna Sobolewska; Piotr Woźniak; Bogusław Sobolewski Journal: Oxid Med Cell Longev Date: 2017-09-25 Impact factor: 6.543
Authors: Finosh G Thankam; Zachary K Roesch; Matthew F Dilisio; Mohamed M Radwan; Anuradha Kovilam; R Michael Gross; Devendra K Agrawal Journal: Sci Rep Date: 2018-06-11 Impact factor: 4.379