Sports Medicine Research: In the Lab & In the Field: Rotator Cuff Tears and their Linkage to Genetic Testing to Further Predict Tears (Sports Med Res)
Tuesday, December 1, 2015

Rotator Cuff Tears and their Linkage to Genetic Testing to Further Predict Tears

Genome-wide Association Study For Rotator Cuff Tears Identifies Two Significant Single-Nucleotide Polymorphisms

Tashjian RZ, Granger EK, Farnham JM, Cannon-Albright LA, Teerlink CC. J Shoulder Elbow Surg. 2015. doi:10.1016/j.jse.2015.07.005.

Take Home Message: Variations in two genes that are associated with cellular apoptosis may help identify individuals at risk for rotator cuff injury.  

The underlying cause of rotator cuff tears remains unclear, which limits our ability to identify individuals at risk for a tear and develop prevention strategies. A person’s genetics could influence the structure of a tendon but little research has examined whether variations in a person’s genetic code could be related to rotator cuff tears. The purpose of this study was to identify specific genes or genetic variations related to rotator cuff tears. The authors assessed 311 patients between the ages of 30 and 80 years with full thickness supraspinatus or infraspinatus tears. To identify specific genes, the researchers used a “genome-wide association study”. The included patients provided blood sample so the authors could determine their genetic variations. For comparison, the researchers selected 2,641 controls from a database of individuals who previously provided genetic data to other studies. All of the patients and controls were white. The researchers assessed over 250,000 genetic variations and found two genetic variations that were associated with rotator cuff tears. These variations were found in two genes that are related to cell death/apoptosis (SAP30BP on chromosome 17 and SASH1 on chromosome 6).

This study is important because the authors identified genetic variations on two chromosomes associated with cell death that may indicate that rotator cuff tears are at least partially heritable. Knowing who is at risk because of certain genetic variations, would allow of early intervention and prevention techniques. This knowledge could help clinicians explain to patients the risk factors for a rotator cuff tear and motivate patients to be cautious and explore prevention programs. While the results are novel this line of research should be continued. For example, future studies should recruit individuals from various ethnic backgrounds so we can determine if these findings are applicable to individuals other than whites with European ancestry. A larger sample size may also help researchers identify other genetic variations that may relate to different types of tears. For example, with chronic tears, we may find variations in genes related to degeneration (e.g., cell death) while a traumatic tear may be related to genes that alter the tensile strength of a tendon. Despite the need for future research, these findings may eventually help clinicians identify high-risk patients and prevent catastrophic or even career-ending injuries. In the meantime, this study provides information to clinicians that they can use to educate patients about why some people get rotator cuff tears.

Questions for Discussions: How do you make the decision to recommend genetic testing? What are the ethical implications of such testing?

Written by Meredith Bland, Siaura Saville
Reviewed by: Jeffrey Driban

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Tashjian, R., Granger, E., Farnham, J., Cannon-Albright, L., & Teerlink, C. (2015). Genome-wide association study for rotator cuff tears identifies two significant single-nucleotide polymorphisms Journal of Shoulder and Elbow Surgery DOI: 10.1016/j.jse.2015.07.005

2 comments:

Christina Hollis said...

This study is exactly the direction research needs to go in, preventing injuries is the best form of health care we can provide. Just like any other risk factor, if we know that an athlete is high-risk for rotator cuff tear we can suggest different sports, positions and training programs to prevent a traumatic event. If there is a family history of rotator cuff tear genetic testing would be recommended. Also if the athlete is experiencing tendinopathies in other joints they may want to get tested. It is unethical because this would not be an option for all athletes. It would depend on competition level and socioeconomic status. For both of these reasons it is unethical to suggest genetic testing for one athlete when a similar athlete does not have the opportunity for genetic testing. This was a great article and a little peak into our future.

Jeffrey Driban said...

Thanks for the comment Christina. You raise a good point. Just to play devil's advocate for a moment: Assuming these genetics tests become validated predictors of who is at risk for tendon injury would it be ethical to not offer a patient a prognostic test (essentially, to withhold care) that could help prevent their injury b/c another patient might not have access to the test?

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