Purpose
The purpose of this study was to assess the effect of smoking on supraspinatus tendon
degeneration, including cellular alterations, proliferation, and apoptosis of tendon
cells.
Methods
Supraspinatus tendon samples of 10 smokers and 15 nonsmokers with full-thickness tears
were compared, focusing on the severity of tendon histopathology including apoptosis
(programmed cell death), cellularity, and proliferation. Immunohistochemistry was
used to assess the density of apoptotic cells and proliferation. The extent of tendon
degeneration was classified according to a revised version of the Bonar tendon histopathology
score.
Results
The smokers were younger (P = .01). The symptom duration among smokers was longer (P < .05). The supraspinatus tendons from the smokers presented significantly more advanced
degenerative changes (Bonar score, 13.5 [interquartile range, 1.4] v 9 [interquartile range, 3]; P < .001). The smokers' tendons showed increased density of apoptotic cells (0.108
[SE, 0.038] v 0.0107 [SE, 0.007]; P = .024) accompanied by reduced tenocyte density (P = .019) and upregulation of proliferative activity (P < .0001).
Conclusions
Smoking is associated with worsened supraspinatus tendon histopathology and increased
apoptosis.
Clinical Relevance
Pronounced degenerative changes, reduced tendon cellularity, and increased apoptosis
may indicate reduced tendon healing capacity in smokers.
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Article info
Publication history
Published online: May 23, 2014
Accepted:
March 21,
2014
Received:
October 17,
2013
Footnotes
The authors report the following potential conflict of interest or source of funding: A.S. receives support from Heel Corp, University of British Columbia, UpToDate, CIHR, NSERC, MSFHR, WorksafeBC, and AOSSM. A.F. receives support from the Centre for Hip Health and Mobility. L.E. receives support from Sophies Minde grant, Arthrex, Smith & Nephew, Norwegian NIH, Health South East (grant #2013122).
Identification
Copyright
© 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
