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Nandrolone Decanoate and Load Increase Remodeling and Strength in Human Supraspinatus Bioartificial Tendons

Ioannis K. Triantafillopoulos, MD^*,, Albert J. Banes, PhD^,,, Karl F. Bowman, Jr^||, Melissa Maloney, MS^¶, William E. Garrett, Jr, MD, PhD^# and Spero G. Karas, MD^*,,**

From ^* the Shoulder and Elbow Service, University of North Carolina, Chapel Hill, North Carolina, Department of Orthopaedics, University of North Carolina, Chapel Hill, North Carolina, Flexcell International Corporation, Hillsborough, North Carolina, the Department of Biomedical Engineering, the ^|| School of Medicine, University of North Carolina, Chapel Hill, North Carolina, ^¶ Flexcell International Corporation, Hillsborough, North Carolina, and the ^# Department of Orthopaedics, Duke University, Durham, North Carolina

^** Address correspondence to Spero G. Karas, MD, Chief, Shoulder and Elbow Service, University of North Carolina, Department of Orthopaedics, CB#7055, Chapel Hill, NC 27599-7055 (e-mail: Spero_Karas{at}med.unc.edu).

Background: To date, no studies document the effect of anabolic steroids on rotator cuff tendons.

Study Design: Controlled laboratory study.

Hypothesis: Anabolic steroids enhance remodeling and improve the biomechanical properties of bioartificially engineered human supraspinatus tendons.

Methods: Bioartificial tendons were treated with either nandrolone decanoate (nonload, steroid, n = 18), loading (load, nonsteroid, n = 18), or both (load, steroid, n = 18). A control group received no treatment (nonload, nonsteroid [NLNS], n = 18). Bioartificial tendons’ remodeling was assessed by daily scanning, cytoskeletal organization by staining, matrix metalloproteinase–3 levels by ELISA assay, and biomechanical properties by load-to-failure testing.

Results: The load, steroid group showed the greatest remodeling and the best organized actin cytoskeleton. Matrix metallo-proteinase–3 levels in the load, steroid group were greater than those of the nonload, nonsteroid group (P < .05). Ultimate stress and ultimate strain in the load, steroid group were greater than those of the nonload, nonsteroid and nonload, steroid groups (P < .05). The strain energy density in the load, steroid group was greater when compared to other groups (P < .05).

Conclusions: Nandrolone decanoate and load acted synergistically to increase matrix remodeling and biomechanical properties of bioartificial tendons.

Clinical Relevance: Data suggest anabolic steroids may enhance production of bioartificial tendons and rotator cuff tendon healing in vitro. More research is necessary before such clinical use is recommended.

Key Words: anabolic steroids • supraspinatus tendon • mechanical loading • material properties • bioartificial tendons

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