PM R 7 (2015) 1137-1141
www.pmrjournal.org
Original Research
Relationship of ABO Blood Type on Rotator Cuff Tears Doo-Hyung Lee, MD, Han-Dong Lee, MD, Seung-Hyun Yoon, MD, PhD
Abstract Background: ABO blood groups are associated with various diseases. A relationship between Achilles tendon ruptures and blood type O has been reported, although its pathogenesis was not clear. To the best of our knowledge, there is no published study describing the relationship between blood type and rotator cuff tendon tears. Objective: To determine whether patients with rotator cuff tear had a greater prevalence of blood type O than those without rotator cuff tear. Design: A cross-sectional study. Setting: Research hospital outpatient evaluation. Participants: A total of 316 subjects with shoulder pain were included and divided into “tear” and “no-tear” groups according to ultrasonographic examination. Main Outcome Measures: ABO blood group, gender, dominant arm, smoking history, trauma history, and age were compared between the 2 groups and the odds ratios of these factors were evaluated by logistic regression. Results: The tear group (38.6%) had more instances of blood type O than the healthy population (27.2%; P ¼ .002). The adjusted odds ratio for rotator cuff tear for blood type O to non-O was 2.38 (95% confidence interval 1.28-4.42). The odds ratios for rotator cuff tears for smoking, major trauma history, minor trauma history, and age were 2.08, 3.11, 2.29, and 1.06, respectively. Conclusion: Patients with rotator cuff tears were more likely to have blood type O. The odds ratios of factors for rotator cuff tears were high in the following order: major trauma history, blood type O, minor trauma history, and age.
Introduction Although traditionally regarded as red blood cell antigens, ABH antigens also are expressed on various other tissues, such as platelets, vascular endothelium, and epithelial surfaces [1]. The ABO blood group based on ABH antigens is associated with various diseases, such as colorectal adenocarcinoma, gallstone disease, risk of cardiovascular disease, and survival time after cardiac transplantation [2-6]. With more than 20 years’ followup, the blood group O was related with lower risk of development of coronary heart disease even after investigators adjusted for cardiovascular risk factors [4]. Blood type O donor graft was also related with poorer outcome after heart transplantation [5]. Musculoskeletal disorders such as tendinitis or tendon injury showed this relationship with the ABO blood group. In 1989, Jozsa et al [7] reported that blood type O occurred at a high frequency among patients with Achilles tendon rupture and multiple tendon injury such
as long head of biceps, extensor policis longus, or quadriceps femoris. The association between Achilles tendon rupture and ABO blood type also was supported by Kujala et al [8] They reported the relationship between chronic Achilles peritendinitis and ABO blood type. Blood type O is associated with reduced circulating levels of von Willebrand factor, which is a component of the intrinsic clotting pathway [9,10]. Subjects with blood type O are more likely to suffer from coagulopathy such as secondary posttonsillectomy hemorrhage and epistaxis [11,12]. The tendency to bleed associated with blood type O might be proposed to be the reason for Achilles tendon rupture [7,8]. Rotator cuff tendon is most common tendon showing tear, and its etiology is not clearly understood [13]. There has not been any research attempting to correlate blood type with rotator cuff tears, to the best of our knowledge. The present study was performed to determine the relationship of blood type O and known risk factors, including gender, dominant arm, smoking,
1934-1482/$ - see front matter ª 2015 by the American Academy of Physical Medicine and Rehabilitation http://dx.doi.org/10.1016/j.pmrj.2015.04.015
1138
Cuff Tears in ABO Blood Type
trauma history, and age, with rotator cuff tears. The following hypothesis was established that the patients with rotator cuff tear had a greater prevalence of blood type O than those without rotator cuff tear. Materials and Methods We prospectively recruited 357 patients with shoulder pain between October 2010 and October 2011. The inclusion criteria were duration of symptoms >3 months and >45 years of age. Patients were excluded if they did not consent to evaluation by ultrasonography for economic or other reasons (n ¼ 16) or had bilateral shoulder pain (n ¼ 25). In total, 316 subjects were enrolled in this study, which was approved by the ethics committee of our university. The healthy population used as a control group was from Korean Red Cross blood donors in 2012. The distribution of ABO blood type in the study group showed no significant difference compared with those in the healthy population (P ¼ .650). For differential diagnosis, all subjects underwent a thorough physical examination, which included range of motion testing of the shoulder, Neer and Hawkins impingement signs, motor strength tests, and Constant score. The subjects’ information, such as dominant arm, smoking history, and previous trauma history, were recorded through interviews, whereas ABO type was determined by blood tests. With respect to recording patient history of previous trauma, injuries such as slips, trips, heavy lifting at work, or low-energy impacts were considered minor trauma, and injuries sustained in traffic accidents, falls, or high-energy impacts were designated as major trauma. Subjects were evaluated via a standardized ultrasonographic (US) examination [14] performed by a single radiologist with 11 years of experience performing musculoskeletal US of the rotator cuff. The examinations were performed in real time with an iU 22 scanner (Philips, Eindhoven, The Netherlands) and a 7- to 10-MHz linear array transducer. Our criteria for US tear are following [15]: a full-thickness tear was confirmed when the rotator cuff could be invisible because of retraction and complete avulsion under the acromion or
when there was a focal defect in tendon made by a various degree of retraction of the torn tendon. In the latter case, either thickened bursal tissue or joint fluid and the deep surface of the deltoid muscle filled the defect made by the tear. The full-thickness tear was subgrouped according to the size of tear as small, medium, large, and massive (small: tear less than 1 cm long; medium: 1-3 cm; large: 3-5 cm; massive: more than 5 cm or more than 2 tendons involved). A partialthickness tear was confirmed when there was minimal flattening contour of the bursal-side rotator cuff (a bursal-side tear) or a clear hypoechoic or mixed hypoechoic and hyperechoic defect detected in both plane at the articular-side rotator cuff (an articular-side tear). The subjects were divided into a “tear” group and a “no-tear” group. Subjects with a partial- or fullthickness rotator cuff tear in US examination were assigned to the tear group regardless of impingement signs. The subjects without rotor cuff tear diagnosed as adhesive capsulitis, rotator cuff tendinopathy or subacromial bursitis, calcific tendinopathy, or arthritis were assigned to the no-tear group. The ABO blood type in study group was compared with those of the healthy population by proportion test. The t-test and Fisher exact test were used to determine the significance of differences in factors between tear and no-tear groups. The odds ratio (OR) and confidence interval (CI) of each factor were evaluated by logistic regression analysis. SAS ver. 9.2 (SAS Institute, Cary, NC) was used for statistical analyses.
Results Our results were compared with 2,711,056 healthy subjects (Table 1). The distribution of ABO blood type in the study group showed no significant difference with those in the healthy population (P ¼ .650); however there was a greater percentage of blood type O (38.6%) in the cuff tear group than the healthy population (27.2%; P ¼ .002) and no-tear group (19.9%; P ¼.008). In subgroups according to the tear size, the partial thickness and small- to medium- size full-thickness tear subgroups had a greater percentage of blood type
Table 1 Distribution of the ABO blood type in a healthy Korean population and the study group O Healthy population (n ¼ 2,711,056)* Study group (n ¼ 316) Tear group (n ¼ 140) Partial thickness (n ¼ 55) Small to medium (
www.pmrjournal.org
Original Research
Relationship of ABO Blood Type on Rotator Cuff Tears Doo-Hyung Lee, MD, Han-Dong Lee, MD, Seung-Hyun Yoon, MD, PhD
Abstract Background: ABO blood groups are associated with various diseases. A relationship between Achilles tendon ruptures and blood type O has been reported, although its pathogenesis was not clear. To the best of our knowledge, there is no published study describing the relationship between blood type and rotator cuff tendon tears. Objective: To determine whether patients with rotator cuff tear had a greater prevalence of blood type O than those without rotator cuff tear. Design: A cross-sectional study. Setting: Research hospital outpatient evaluation. Participants: A total of 316 subjects with shoulder pain were included and divided into “tear” and “no-tear” groups according to ultrasonographic examination. Main Outcome Measures: ABO blood group, gender, dominant arm, smoking history, trauma history, and age were compared between the 2 groups and the odds ratios of these factors were evaluated by logistic regression. Results: The tear group (38.6%) had more instances of blood type O than the healthy population (27.2%; P ¼ .002). The adjusted odds ratio for rotator cuff tear for blood type O to non-O was 2.38 (95% confidence interval 1.28-4.42). The odds ratios for rotator cuff tears for smoking, major trauma history, minor trauma history, and age were 2.08, 3.11, 2.29, and 1.06, respectively. Conclusion: Patients with rotator cuff tears were more likely to have blood type O. The odds ratios of factors for rotator cuff tears were high in the following order: major trauma history, blood type O, minor trauma history, and age.
Introduction Although traditionally regarded as red blood cell antigens, ABH antigens also are expressed on various other tissues, such as platelets, vascular endothelium, and epithelial surfaces [1]. The ABO blood group based on ABH antigens is associated with various diseases, such as colorectal adenocarcinoma, gallstone disease, risk of cardiovascular disease, and survival time after cardiac transplantation [2-6]. With more than 20 years’ followup, the blood group O was related with lower risk of development of coronary heart disease even after investigators adjusted for cardiovascular risk factors [4]. Blood type O donor graft was also related with poorer outcome after heart transplantation [5]. Musculoskeletal disorders such as tendinitis or tendon injury showed this relationship with the ABO blood group. In 1989, Jozsa et al [7] reported that blood type O occurred at a high frequency among patients with Achilles tendon rupture and multiple tendon injury such
as long head of biceps, extensor policis longus, or quadriceps femoris. The association between Achilles tendon rupture and ABO blood type also was supported by Kujala et al [8] They reported the relationship between chronic Achilles peritendinitis and ABO blood type. Blood type O is associated with reduced circulating levels of von Willebrand factor, which is a component of the intrinsic clotting pathway [9,10]. Subjects with blood type O are more likely to suffer from coagulopathy such as secondary posttonsillectomy hemorrhage and epistaxis [11,12]. The tendency to bleed associated with blood type O might be proposed to be the reason for Achilles tendon rupture [7,8]. Rotator cuff tendon is most common tendon showing tear, and its etiology is not clearly understood [13]. There has not been any research attempting to correlate blood type with rotator cuff tears, to the best of our knowledge. The present study was performed to determine the relationship of blood type O and known risk factors, including gender, dominant arm, smoking,
1934-1482/$ - see front matter ª 2015 by the American Academy of Physical Medicine and Rehabilitation http://dx.doi.org/10.1016/j.pmrj.2015.04.015
1138
Cuff Tears in ABO Blood Type
trauma history, and age, with rotator cuff tears. The following hypothesis was established that the patients with rotator cuff tear had a greater prevalence of blood type O than those without rotator cuff tear. Materials and Methods We prospectively recruited 357 patients with shoulder pain between October 2010 and October 2011. The inclusion criteria were duration of symptoms >3 months and >45 years of age. Patients were excluded if they did not consent to evaluation by ultrasonography for economic or other reasons (n ¼ 16) or had bilateral shoulder pain (n ¼ 25). In total, 316 subjects were enrolled in this study, which was approved by the ethics committee of our university. The healthy population used as a control group was from Korean Red Cross blood donors in 2012. The distribution of ABO blood type in the study group showed no significant difference compared with those in the healthy population (P ¼ .650). For differential diagnosis, all subjects underwent a thorough physical examination, which included range of motion testing of the shoulder, Neer and Hawkins impingement signs, motor strength tests, and Constant score. The subjects’ information, such as dominant arm, smoking history, and previous trauma history, were recorded through interviews, whereas ABO type was determined by blood tests. With respect to recording patient history of previous trauma, injuries such as slips, trips, heavy lifting at work, or low-energy impacts were considered minor trauma, and injuries sustained in traffic accidents, falls, or high-energy impacts were designated as major trauma. Subjects were evaluated via a standardized ultrasonographic (US) examination [14] performed by a single radiologist with 11 years of experience performing musculoskeletal US of the rotator cuff. The examinations were performed in real time with an iU 22 scanner (Philips, Eindhoven, The Netherlands) and a 7- to 10-MHz linear array transducer. Our criteria for US tear are following [15]: a full-thickness tear was confirmed when the rotator cuff could be invisible because of retraction and complete avulsion under the acromion or
when there was a focal defect in tendon made by a various degree of retraction of the torn tendon. In the latter case, either thickened bursal tissue or joint fluid and the deep surface of the deltoid muscle filled the defect made by the tear. The full-thickness tear was subgrouped according to the size of tear as small, medium, large, and massive (small: tear less than 1 cm long; medium: 1-3 cm; large: 3-5 cm; massive: more than 5 cm or more than 2 tendons involved). A partialthickness tear was confirmed when there was minimal flattening contour of the bursal-side rotator cuff (a bursal-side tear) or a clear hypoechoic or mixed hypoechoic and hyperechoic defect detected in both plane at the articular-side rotator cuff (an articular-side tear). The subjects were divided into a “tear” group and a “no-tear” group. Subjects with a partial- or fullthickness rotator cuff tear in US examination were assigned to the tear group regardless of impingement signs. The subjects without rotor cuff tear diagnosed as adhesive capsulitis, rotator cuff tendinopathy or subacromial bursitis, calcific tendinopathy, or arthritis were assigned to the no-tear group. The ABO blood type in study group was compared with those of the healthy population by proportion test. The t-test and Fisher exact test were used to determine the significance of differences in factors between tear and no-tear groups. The odds ratio (OR) and confidence interval (CI) of each factor were evaluated by logistic regression analysis. SAS ver. 9.2 (SAS Institute, Cary, NC) was used for statistical analyses.
Results Our results were compared with 2,711,056 healthy subjects (Table 1). The distribution of ABO blood type in the study group showed no significant difference with those in the healthy population (P ¼ .650); however there was a greater percentage of blood type O (38.6%) in the cuff tear group than the healthy population (27.2%; P ¼ .002) and no-tear group (19.9%; P ¼.008). In subgroups according to the tear size, the partial thickness and small- to medium- size full-thickness tear subgroups had a greater percentage of blood type
Table 1 Distribution of the ABO blood type in a healthy Korean population and the study group O Healthy population (n ¼ 2,711,056)* Study group (n ¼ 316) Tear group (n ¼ 140) Partial thickness (n ¼ 55) Small to medium (
