AJSM - 2026-06-10 - Journal Article
Revascularization of Transcortical Vessels Improves Tendon-to-Bone Healing for Rotator Cuff Repair.
Xia W, Shi Z, Wang X, Wu H, Lu J, Yu X, Shan H, Deng C, Cheng B, Li J
Topics
Key Takeaway
TCV-mediated revascularization via footprint freshening or oral D-sphingosine significantly improved rotator cuff tendon-to-bone biomechanical properties at 12 weeks compared to cortical bone preservation in a rat model (P < .05).
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Summary
This controlled laboratory study investigated whether transcortical vessel (TCV) revascularization influences tendon-to-bone healing after rotator cuff repair in a rat supraspinatus delayed-repair model across three footprint preparation conditions. Cortical bone preservation inhibited TCV formation and worsened healing, while freshening (cancellous bone exposure) and oral D-sphingosine both promoted TCV formation by reducing oxidative stress (P < .05). TCV revascularization reduced hypoxia and inflammation-associated chronic tendinopathy at 6 weeks and improved biomechanical repair properties at 12 weeks (P < .05).
Key Limitation
All findings are from a rat model; no human histologic, imaging, or clinical outcome data exist to confirm that TCV density or D-sphingosine dosing translates to meaningful retear rate reduction in humans.
Original Abstract
BACKGROUND
Rotator cuff tear is a prevalent musculoskeletal disorder with a high postoperative retear rate. Transcortical vessels (TCVs) are capillaries that cross cortical bone and represent key elements of bone microcirculation. However, the possible intervention and influence of TCVs for rotator cuff repair (RCR) have rarely been studied.
PURPOSE
To investigate the effect of TCV-mediated revascularization in RCR and the mechanism of potential intervention.
STUDY DESIGN
Controlled laboratory study.
METHODS
Sprague-Dawley rats (N = 135) with supraspinatus tendon tear and delayed repair were randomly assigned into 3 groups based on footprint preparation: (1) cortical bone freshening up by debridement to expose cancellous bone, (2) cortical bone preservation as the control group, and (3) cortical bone preservation with oral D-sphingosine as a TCV-stimulating factor. Oxidative stress was measured using fluorescent probes; hypoxia and inflammation levels were measured via immunosorbent assay; and RCR and TCVs were evaluated with biomechanical and immunostaining assays.
RESULTS
Cortical bone preservation inhibited the revascularization of TCVs during RCR ( P < .01), while freshening up or D-sphingosine treatment promoted TCV formation by reducing oxidative stress ( P < .05 for all). Revascularization of TCVs alleviated hypoxia and inflammation-derived chronic tendinopathy after 6 weeks ( P < .05 for all) and improved the biomechanical properties of rotator cuff at 12 weeks ( P < .05).
CONCLUSION
Footprint freshening up or D-sphingosine treatment improves tendon-to-bone healing, suggesting the importance of TCV-mediated revascularization for RCR.
CLINICAL RELEVANCE
Revascularization therapy such as cortical bone freshening up or D-sphingosine has the potential to improve RCR.