Effect of Metabolic Syndrome in the incidence of Rotator Cuff Injury and Recovery following Surgical Repair

Abstract

Rotator cuff injuries are prevalent and have a plethora of risk factors that play a role in both the incidence of injury and recovery from surgical repair. One of the major contributors is metabolic syndrome, which has a variety of different elements that affect the issue under discussion such as hypertension, hyperglycemia, hyperlipidemia, and obesity, which are highly prevalent in patients troubled with this injury. The purpose of this article is to critically review the information from various scientific reports on the underlying cellular and molecular mechanisms of metabolic syndrome increasing the rate of injury and delaying recovery after repair. After critical examination of the findings from many publications in this area, it can be concluded that the factors associated with the metabolic syndrome play a negative role and support the underlying thesis on prolonged recovery with poor outcome following tendon repair in the shoulder. Diabetes Mellitus with elevated insulin levels increases inflammation and cell apoptosis, decreasing healing factors post-surgery. The occurrence of hyperlipidemia and obesity can increase the deposition of xanthomas and the release of adipokines, respectively, which has been proven to delay wound healing as well as increase the risk of reinjury. Studies have also shown that patients with metabolic syndrome who have had a rotator cuff repair tend to have prolonged hospital stays, a higher incidence of reinjury, and increased instances of rehospitalization. The findings together further emphasize the negative effect of metabolic syndrome and how its actions can affect the outcome of the recovery process and lifestyle of a patient post-surgery. These findings further establish the critical consideration of such factors as a cause for incidence, reinjury/rehospitalization, and prolongation of surgical recovery.

Keywords: Apoptosis; Diabetes; Hyperglycemia; Hyperlipidemia; Hypertension; Inflammation; Metabolic syndrome; Obesity; Rotator cuff injury; Tendon re-tear.

Figure 1:

This schematic diagram illustrates that diabetes mellitus, obesity, hyperlipidemia, and hypertension, which are the key factors of metabolic syndrome, play a critical role in increasing the likelihood of tendon injuries through the various mechanisms discussed within the text.

Figure 2:

This figure illustrates how hyperlipidemia can affect our tendons and shows the result of continuously elevated cholesterol levels.

Figure 3:

The figure illustrates the various factors that contribute to the prolongation of wound healing. The effects of hyperglycemia, vascular insufficiency, reactive oxygen species (ROS), impaired immune function, and inflammation can be detrimental to the rebuilding and remodeling of injuries such as rotator cuff tears and their repair.