Effects of Estrogen-Deficient State on Rotator Cuff Healing

Background: Rotator cuff retears after surgical repair are a concern, despite advances in operative techniques, but few studies have investigated the effects of the estrogen-deficient state on tendon-to-bone healing at the repair site. Purpose: We evaluated the effect of the estrogen-deficient state on tendon-to-bone healing after rotator cuff repair in an ovariectomized rat model. Study Design: Controlled laboratory study. Methods: Female Sprague Dawley rats underwent detachment and immediate repair of the supraspinatus tendon. Surgery was performed in 24 rats at 4.5 weeks of age 17 weeks after ovariectomy (OVX group) and in 24 age-matched control rats without ovariectomy (control group). Animals were sacrificed at 2, 4, 8, and 12 weeks after surgery for biomechanical and histological evaluations of reattachment. Bone mineral density (BMD) at the insertion site and cancellous bone in the humeral head was assessed by micro–computed tomography. Results: BMD was significantly lower both at the insertion site and in cancellous area in the OVX group than in the control group at weeks 2 to 12. Ultimate load to failure, ultimate stress, linear stiffness, and the Young modulus were significantly lower in the OVX group than in the control group at 2 and 4 weeks, but the difference was no longer significant at 8 and 12 weeks. At 2 and 4 weeks, relatively immature granulation tissue was observed in the OVX group compared with the control group. At 8 and 12 weeks after surgery, there were differences in the tendon-bone interface in the 2 groups: Direct insertion with well-established chondroid tissue was seen in the control group, and indirect insertion without chondroid tissue was seen in the OVX group. Consistently, the amount of chondroid tissue was greater and collagen organization was better in the control group than in the OVX group. Cells expressing cathepsin K were significantly more numerous both at the insertion site and in cancellous bone in the OVX group than in the control group. Conclusion: The estrogen-deficient state by ovariectomy, compared with control rats, led to decreased biomechanical properties and poor development of chondroid tissue that influenced the repair of the tendon insertion after surgery. Clinical Relevance: Agents that modulate bone metabolism might improve tendon-to-bone healing in patients with an estrogen-deficient state, such as postmenopausal women who undergo rotator cuff surgery.

Cartilaginous metaplasia of varicose veins: a case report

Cartilaginous metaplasia of superficial veins was found in a 64-year-old woman who underwent surgery for varicose veins. At operation, some varicose veins of the medial thigh were semi-rigid and fibroelastic to the touch. Histology revealed that half the lumen was occupied by chondroid tissue. The other half was obliterated by fibrous tissue, typical of post-thrombotic involution. Possible causes of cartilaginous metaplasia are briefly discussed.

CYSTIC KIDNEY DYSPLASIA IN INFANTS

Cystic kidney dysplasia (CKD) in infants is a rare congenital pathology, associated with connective tissue dysplasia. Three autopsy cases of CKD reveals disturbance proportions of connective, fat, chondroid tissue with dominance cells and fibers of connective tissue. Kidney cysts formation with CKD, under our opinion, is secondary process due to compression few kidney tubules by undeveloped mesenchymal tissue.

Periosteal chondroma of the pediatric cervical spine

Periosteal chondromas located in the spine are rare. The authors document an even more infrequent occurrence of a recurrent periosteal chondroma in the cervical spine of a 6-year-old boy. During the operation, a giant (> 7 cm in diameter) periosteal chondroma with involvement of the C-5 and C-6 vertebral bodies was resected. The vertebral column was reconstructed with anterior-posterior instrumentation. The pathological examination revealed that the tumor consisted of chondroid tissue with typical chondrocytes, confirming the diagnosis of periosteal chondroma.