Higher fasting plasma glucose levels within the normoglycaemic range and rotator cuff tears.

OBJECTIVE: To determine the plasma glucose levels in non-diabetic patients with rotator cuff tear. DESIGN: Frequency-matched case-control study. SETTING: University Teaching Hospital. PARTICIPANTS: The study included 194 subjects who were operated on at our institution. Group 1 included 97 consecutive patients (36 men and 61 women; mean age: 62.9 years, range 37 to 82) who underwent arthroscopic repair of a rotator cuff tear in 2007 and 2008. Group 2 (control group) included 97 patients (36 men and 61 women; mean age: 61.6 years, range 36 to 80) who underwent arthroscopic meniscectomy for a meniscal tear in the same period, and had no evidence of shoulder pathology. These patients were frequency-matched by age (within 3 years) and gender with patients of Group 1. MAIN OUTCOME MEASURE: Measurement of fasting plasma glucose levels. RESULTS: Patients with rotator cuff tears (Group 1) showed statistically significantly higher fasting plasma glucose levels within the normoglycaemic range (p = 0.007) than patients with meniscal tear (Group 2). CONCLUSIONS: The present study suggests that normal, but in the high range of normal, increasing plasma glucose levels may be a risk factor for rotator cuff tear. An enhanced understanding of these factors holds the promise of new approaches to the prevention and management of rotator cuff tears.

Characteristics at haematoxylin and eosin staining of ruptures of the long head of the biceps tendon.

OBJECTIVE: To examine the relative prevalence of histological changes that have been found to be associated with the process of tendinopathy in lesions of the tendon of the long head of the biceps brachii and to evaluate the reliability of histopathological evaluation of tendon tissue in lesions of the tendon of the long head of the biceps. DESIGN: Tendon samples were taken from 51 patients (31 men, 20 women; mean age 63.2 years) who underwent arthroscopic release of the long head of the biceps tendon because of refractory biceps tendinopathy and from 5 male patients who died of cardiovascular events (mean age 69.6 years). Histological examination was performed using haematoxylin and eosin staining of sections, which were interpreted using a semiquantitative grading scale assessing fibre structure and arrangement, rounding of the nuclei, regional variations in cellularity, increased vascularity, decreased collagen staining and hyalinisation. RESULTS: The mean (SD) pathological sum score of ruptured tendons was greater than that of control tendons (15.76 (3.11) vs 3.4 (1.9), p<0.001). Within each specific category of tendon abnormalities, the chi(2) test showed significant differences between the control and ruptured tendons; all the variables were significantly different (Mann-Whitney U test 0.05, p<0.001). Using the kappa statistic, the agreement between the two readings ranged from 0.53 to 0.85. CONCLUSIONS: Unruptured tendons of the long head of the biceps, even at an advanced age and ruptured tendons of the long head of the biceps are clearly part of two distinct populations.

Circulating substance P levels and shoulder joint contracture after arthroscopic repair of the rotator cuff.

OBJECTIVE: To determine the plasma levels of substance P (SP) in patients with postoperative stiffness after arthroscopic rotator cuff repair. DESIGN: Plasma samples were obtained at 15 months from surgery from two groups of patients who underwent arthroscopic repair of a rotator cuff tear. In group 1, 30 subjects (14 men, 16 women; mean age 64.6 years, range 47 to 78) with shoulder stiffness 15 months after arthroscopic rotator cuff repair were recruited. In group 2, 30 patients (11 men, 19 women; mean age 57.8 years, range 45 to 77) were evaluated 15 months after successful arthroscopic rotator cuff repair. Immunoassays were performed with commercially available assay kits to measure the plasma levels of SP. RESULTS: Plasma levels of SP in patients with postoperative stiffness were significantly greater than those in the control group (mean 81.06 (SD 27.76) versus 23.49 (5.64), p<0.05). CONCLUSIONS: The plasma concentrations of substance P in patients with shoulder stiffness after arthroscopic rotator cuff repair are higher compared with plasma levels of SP in patients with a good postoperative outcome. The neuronal upregulation of SP shown in the plasma of patients with postoperative shoulder stiffness may underlie not only the symptoms but also its development of adhesive capsulitis.

Isolated tuberculosis of the patellar tendon.

Among the variety of differential diagnoses for chronic patellar tendinopathy, isolated tuberculosis is extremely rare. We report such a case, without any evident primary contiguous or distant focus, in a 31-year-old immunocompetent male.