Thursday, December 8, 2011

Rotator cuff tears and Deca Durabolin Anabolic Steroids

A recent study in the Journal of Bone and Joint Surgery poses the question: can anabolic steroids prevent the muscle atrophy and fatty infiltration seen with an experimental rotator cuff tear in rabbits?

The abstract of the paper is reproduced here:

Background:
Muscles of the rotator cuff undergo retraction, atrophy, and fatty infiltration after a chronic tear, and a rabbit model has been used to investigate these changes. The purpose of this study was to test the hypothesis that the administration of anabolic steroids can diminish these muscular changes following experimental supraspinatus tendon release in the rabbit.

Methods:
The supraspinatus tendon was released in twenty New Zealand White rabbits. Musculotendinous retraction was monitored over a period of six weeks. The seven animals in group I had no additional intervention, the six animals in group II had local and systemic administration of nandrolone decanoate, and the seven animals in group III had systemic administration of nandrolone decanoate during the six weeks. Two animals (group III) developed a postoperative infection and were excluded from the analysis. At the time that the animals were killed, in vivo muscle performance as well as imaging and histological muscle changes were investigated.

Results:
The mean supraspinatus retraction was higher in group I (1.8 cm; 95% confidence interval: 1.64, 2.02 cm) than in group II (1.5 cm; 95% confidence interval: 1.29, 1.81 cm) or III (1.2 cm; 95% confidence interval: 0.86, 1.54 cm). Histologically, no fatty infiltration was measured in either treated group II (mean, 2.2%; range, 0% to 8%) or III (mean, 1%; range, 0% to 3.4%), but it was measured in the untreated group I (mean, 5.9%; range, 0% to 14.1%; p = 0.031). The radiographic cross-sectional area indicating atrophy and the work of the respective muscle during one standardized contraction with supramaximal stimulation decreased in all groups, but the work of the muscle was ultimately highest in group III.

Conclusions:
To our knowledge, this is the first documentation of partial prevention of important muscle alterations after retraction of the supraspinatus musculotendinous unit caused by tendon disruption. Nandrolone decanoate administration in the phase after tendon release prevented fatty infiltration of the supraspinatus muscle and reduced functional muscle impairment caused by myotendinous retraction in this rabbit rotator cuff model, but two of seven rabbits that received the drug developed infections.

Clinical Relevance:
This study provides a novel approach that may have potential to diminish the irreparable structural and functional changes of the musculotendinous unit associated with chronic rotator cuff tear, but complications of anabolic steroid use also need to be considered.

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This is indeed interesting. However, the clinical relevance of this work is unclear. Are we to consider administering anabolic steroids to patients with acute rotator cuff tears rather than promptly repairing them? Is the increased risk of infection offset by the reduced muscle atrophy? For now, we'll repair reparable cuff tears and leave androgens to those who really need them.




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