Korean J Sports Med.  2020 Dec;38(4):217-224. 10.5763/kjsm.2020.38.4.217.

Biological Enhancement of Healing with Kartogenin Injection at the Tendon-to-Bone Interface in a Rat Rotator Cuff Tear Model

• Kim DH
• Min SG
• Kim HM
• Choi JH
• Lee HJ
• Park KH
• Yoon JP

• KMID: 2509020
• DOI: http://doi.org/10.5763/kjsm.2020.38.4.217

Abstract

Purpose
The purpose of this study was to investigate the effects of kartogenin (KGN) on the tendon-bone interface in a rat rotator cuff tear model.
Methods
Twenty male rats were divided into two equal groups; group 1 (repair only) and group 2 (KGN single injection). A rat rotator cuff rupture model was prepared, and KGN (500 μM) was injected into the repair site. The specimens were collected after 8 weeks, and biomechanical and histological analyses were performed. We assessed the healing quality of the tendon-to-bone repair site using six aspects of tendon tissue. The histological findings were classified semiquantitatively into four grades (grade 0, the poorest appearance; grade 1, poorer; grade 2, better; and grade 3, marked regeneration).
Results
Group 2 showed a higher mean ultimate load to failure than the control group (group 1: 25.78±31.38 N, group 2: 55.64±36.02 N; p=0.011). On histological analysis, group 2 exhibited a significantly greater total score (group 1: 7.20±2.14, group 2: 9.50±1.84; p=0.019), collagen fiber continuity (group 1: 1.20±0.42, group 2: 1.70±0.48; p=0.024), and collagen fiber density (group 1: 1.50±0.52, group 2: 2.20±0.63; p=0.080). Metachromasia were more intense in group 2 than in the control group.
Conclusion
A single injection of KGN reinforces biomechanical strength and the formation of collagen and fibrocartilage at the tendon-to-bone interface in a rat rotator cuff tear model.

Keyword

Collagen; Fibrocartilage; Kartogenin; Rotator cuff injuries

Figure

• 

  Fig. 1 The animal model and surgical procedures. (A, B) The deltoid muscle split and the supraspinatus tendon was exposed. (C) The supraspinatus tendon was isolated and transected at the end of the tendon insertion site. (D, E) Two bone tunnels were made at the greater tuberosity of the humeral head and single-row repair. The control group received repair only. (F) In the experimental group, kartogenin (500 μM) was injected into the bone-to-tendon interface.

• 

  Fig. 2 Histological evaluation at 8 weeks after repair. Group 1 received only supraspinatus repair; group 2 received supraspinatus repair with a single injection of kartogenin. (A) H&E staining, ×50. (B) Masson trichrome staining, ×50. (C) Picrosirius red staining, ×50. Continuity, orientation, and density of collagen fiber showed a higher average grading in group 2 compared with group 1. Group 2 showed better maturation and density of the tendon-to-bone interface structure (arrows) than group 1.

• 

  Fig. 3 Histological evaluation at 8 weeks after repair. (A) Group 1 received only supraspinatus repair; (B) group 2 received supraspinatus repair with a single injection of kartogenin. The arrows indicate the tendon-to-bone interface. This area is the supraspinatus enthesis, and fibrocartilaginous transition site and was stained with Toluidine blue (×50). The metachromasia were more intense in the supraspinatus enthesis of group 2 compared to the control group.

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