Tendon to Bone Healing: Differences in Biomechanical, Structural, and Compositional Properties Due to a Range of Activity Levels

Little knowledge exists about the healing process of the tendon to bone insertion, and hence little can be done to improve tissue healing. The goal of this study is to describe the healing of the supraspinatus tendon to its bony insertion under a variety of loading conditions. Tendons were surgically detached and repaired in rats. Rat shoulders were then immobilized, allowed cage activity, or exercised. Shoulders that were immobilized demonstrated superior structural (significantly higher collagen orientation), compositional (expression of extracellular matrix genes similar to the uninjured insertion), and quasilinear viscoelastic properties (A=0.30±0.10 MPa vs. 0.16±0.08 MPa, B=17.4±2.9 vs. 15.1±0.9, and τ2=344±161s vs. 233±40 s) compared to those that were exercised, contrary to expectations. With this knowledge of the healing response, treatment modalities for rotator cuff tears can be developed.