{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T21:14:04Z","timestamp":1785273244770,"version":"3.55.0"},"reference-count":35,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Sports Med"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Compromised bone strength in proximal humerus osteoporosis predisposes patients with rotator cuff repair (RCR) to an increased anchor pull-out risk and healing failure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To explore the potential of locally administered alpha-ketoglutarate (\u03b1KG), a natural metabolite in the tricarboxylic acid cycle, to enhance rotator cuff healing by mitigating osteoporosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Controlled laboratory study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A total of 48 female Sprague-Dawley rats were assigned into 4 groups: normal control (sham surgery), ovariectomy (OVX) control, OVX\u2013rotator cuff tear (RCT) (RCR with fibrin application after OVX), and OVX-RCT-\u03b1KG (RCR with \u03b1KG-enriched fibrin treatment after OVX). Bilateral RCR was performed on rats in 2 RCT groups, with the respective application of fibrin or \u03b1KG-enriched fibrin gel at the tendon-bone interface (TBI). At 6 weeks and 12 weeks postoperatively, bone quality was evaluated using micro\u2013computed tomography (CT), while histology and immunohistochemistry were used to assess bone, TBI, and tendon quality. Biomechanical tests determined the strength of the tendon-to-bone complex.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Micro-CT analysis confirmed proximal humerus osteoporosis after OVX. Alpha-KG\u2013enriched fibrin leads to improved bone quality compared with OVX-RCT, more prominent at 12 weeks after surgery, as evidenced by the higher bone volume\/total volume fraction, trabecular number, and trabecular thickness. Histological and immunohistochemical analyses demonstrated enhanced bone regeneration and improved TBI integrity in the OVX-RCT-\u03b1KG group, which could be explained by decreased osteoclastic and increased osteoblastic activity. Biomechanical testing showed improved tendon-bone resilience, with higher ultimate failure load and stress after \u03b1KG treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Local supplementation of \u03b1KG, a natural metabolite, along with the repair surgery could effectively improve proximal humerus osteoporosis, thereby enhancing RCR. It holds great potential for preventing anchor pullout and improving RCT outcomes in patients with osteoporosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance:<\/jats:title>\n                    <jats:p>Alpha-KG supplementation along with surgery may enhance RCR for patients with osteoporosis complications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/03635465251393710","type":"journal-article","created":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T08:00:51Z","timestamp":1767254451000},"page":"152-161","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Alpha-Ketoglutarate, a Natural Endogenous Metabolite, Enhances Rotator Cuff Tendon\u2013to-Bone Healing by Mitigating Postmenopausal Osteoporosis"],"prefix":"10.1177","volume":"54","author":[{"given":"Xiaokang","family":"Wei","sequence":"first","affiliation":[{"name":"Department of Orthopedics, Shanghai Sixth People\u2019s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-1265-7572","authenticated-orcid":false,"given":"Haoyuan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Shanghai Sixth People\u2019s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0310-4919","authenticated-orcid":false,"given":"Chongyang","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Shanghai Sixth People\u2019s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4451-8376","authenticated-orcid":false,"given":"Lei","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Shanghai Sixth People\u2019s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7850-8705","authenticated-orcid":false,"given":"Zhiyi","family":"Xin","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Shanghai Sixth People\u2019s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-9246-2318","authenticated-orcid":false,"given":"Dian","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Shanghai Sixth People\u2019s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1948-3773","authenticated-orcid":false,"given":"Cheng","family":"Qu","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Shanghai Sixth People\u2019s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6551-2918","authenticated-orcid":false,"given":"Wenjun","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Shanghai Sixth People\u2019s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xianyou","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Shanghai Sixth People\u2019s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yueming","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Shanghai Fifth People\u2019s Hospital, Fudan University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,1,1]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41572-024-00492-3"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp1513724"},{"key":"e_1_3_2_4_2","article-title":"Hierarchical chiral calcium silicate hydrate films promote vascularization for tendon-to-bone healing","volume":"2024","author":"Cai Z","unstructured":"Cai Z, Qu C, Song W, et al. 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