Diabetes mellitus impairs tendon-bone healing after rotator cuff repair

J Shoulder Elbow Surg. 2010 Oct;19(7):978-88. doi: 10.1016/j.jse.2009.11.045. Epub 2010 Mar 19.


Introduction: Studies have demonstrated a significant decrease in skeletal mass, bone mineral density, and impaired fracture healing in the diabetic population. However, the effect of sustained hyperglycemia on tendon-to-bone healing is unknown.

Materials and methods: Forty-eight male, Lewis rats underwent unilateral detachment of the supraspinatus tendon followed by immediate anatomic repair with transosseous fixation. In the experimental group (n = 24), diabetes was induced preoperatively via intraperitoneal injection of streptozotocin (STZ, 65 mg/kg) and confirmed with both pre- and post-STZ injection intraperitoneal glucose tolerance tests (IPGTT). Animals were sacrificed at 1 and 2 weeks postoperatively for biomechanical, histomorphometric, and immunohistochemical analysis. Serum hemoglobin A1c (HbA1c) levels were measured at 2 weeks postoperatively. Statistical comparisons were performed using Student t tests with significance set at P < .05.

Results: IPGTT analysis demonstrated a significant impairment of glycemic control in the diabetic compared to control animals (P < .05). Mean HbA1c level at 2 weeks postoperatively was 10.6 ± 2.7% and 6.0 ± 1.0% for the diabetic and control groups, respectively (P < .05). Diabetic animals demonstrated significantly less fibrocartilage and organized collagen, and increased AGE deposition at the tendon-bone interface (P < .05). The healing enthesis of diabetic animals demonstrated a significantly reduced ultimate load-to-failure (4.79 ± 1.33 N vs 1.60 ± 1.67 N and 13.63 ± 2.33 N vs 6.0 ± 3.24 N for control versus diabetic animals at 1 and 2 weeks, respectively) and stiffness compared to control animals (P < .05).

Discussion: Sustained hyperglycemia impairs tendon-bone healing after rotator cuff repair in this rodent model. These findings have significant clinical implications for the expected outcomes of soft tissue repair or reconstructive procedures in diabetic patients with poor glycemic control.

MeSH terms

  • Animals
  • Area Under Curve
  • Biophysics
  • Birefringence
  • Bone and Bones / physiopathology*
  • Collagen
  • Diabetes Mellitus, Experimental / physiopathology*
  • Fibrocartilage / metabolism
  • Glycated Hemoglobin / analysis
  • Glycation End Products, Advanced / metabolism
  • Hyperglycemia / physiopathology
  • Immunohistochemistry
  • Male
  • Rats
  • Rats, Inbred Lew
  • Rotator Cuff / physiopathology
  • Rotator Cuff Injuries*
  • Tendons / physiopathology*
  • Wound Healing / physiology*


  • Glycated Hemoglobin A
  • Glycation End Products, Advanced
  • Collagen