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Corticosteroids Reduce the Tensile Strength of Isolated Collagen Fascicles

Authors: Bjarki Thor Haraldsson, Henning Langberg, Per Aagaard, Anne-Marie Zuurmond, Benno van El, Jeroen DeGroot, Michael Kjær, and S. Peter Magnusson

References: Am J Sports Med 2006 34: 1992-1997

Abstract
Background: Overuse tendon injuries are frequent. Corticosteroid injections are commonly used as treatment, although their direct effects on the material properties of the tendon are poorly understood.

Purpose: To examine the influence of corticosteroids on the tensile strength of isolated collagen fascicles.

Study Design: Controlled laboratory study.

Methods: Single strands (300–500 µm) of rat-tail collagen fascicles were incubated in either high (1 mL of 40 mgmL–1 mixed with 0.5 mL saline 9%) or low (1 mL of 40 mgmL–1 mixed with 2 mL saline 9%) concentration of methylprednisolone acetate (Depomedrol) for 3 or 7 days, while the control segment from the same fascicle was kept in saline (N = 64). After the incubation period, the fascicles underwent displacement to failure in a mechanical test rig at 0.13 mm/s, and thereafter hydroxylysyl pyridinoline and lysyl pyridinoline cross-link content was evaluated in a high-performance liquid chromatography system. Data for each group were analyzed with a 2-way analysis of variance (time x incubation) for ultimate stress (mean ± standard deviation).

Results: In the high-concentration groups, strength was reduced after 3 (16.6 ± 4.6 MPa) and 7 (8.6 ± 1.7 MPa) days compared to the controls (30.2 ± 5.0 MPa and 25.6 ± 4.6 MPa, respectively; P < .05). In the low-concentration groups, strength was reduced after 3 (12.0 ± 3.1 MPa) and 7 days (10.9 ± 2.5 MPa) compared to the controls (31.5 ± 5.0 MPa and 32.4 ± 5.6 MPa, respectively; P < .05). The amount of cross-linking was unaffected by the intervention.

Conclusion:Data show that the tensile strength of isolated fascicles is markedly reduced after 3- and 7-day incubation in both high and low concentration of corticosteroids, although the observed effect on whole tendon remains unknown.

Clinical Relevance: Corticosteroids may weaken specific regions of the injected tendon and leave it more prone to rupture. This weakening effect is manifested in the individual collagen fascicles that constitute the tendon.

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