BACKGROUND: Fatty infiltration (FI) and muscle atrophy following rotator cuff (RC) tears are largely irreversible and are major determinants of poor surgical outcomes, increased re-tear risk, and long-term functional disability. No pharmacologic therapies have been validated to prevent or reverse these degenerative changes. Glucagon-like peptide-1 receptor agonists (GLP-1RAs), including liraglutide, have demonstrated anti-adipogenic and tissue-preserving effects in other organ systems, suggesting potential application in RC-related muscle degeneration.
PURPOSE: To evaluate the effects of systemic liraglutide administration on FI, muscle morphology, and functional outcomes in a rat model of chronic RC tear without tendon repair.
STUDY DESIGN: Controlled laboratory study.
METHODS: Adult male Sprague-Dawley rats underwent unilateral supraspinatus tendon transection with interposition of a silicone tube to prevent tendon-to-bone healing. Animals were randomly assigned to receive subcutaneous liraglutide (250 ㎍/kg/day) or saline for 4 weeks, starting 2 weeks post-injury. At 6 weeks post-surgery, FI was assessed using Oil Red O staining, muscle morphology was examined via hematoxylin-eosin histology, and passive shoulder range of motion (ROM) was measured with a goniometer. Neuromuscular function was evaluated through compound muscle action potential (CMAP) recordings, and FI was quantified as the percentage of red-stained FI area using ImageJ software with a uniform color-threshold algorithm.
RESULTS: GLP-1RA significantly reduced FI compared with controls (Oil Red O-positive area: 1.11 ± 0.75% vs 11.82 ± 3.89%, p < .001) and markedly decreased adipocyte deposition on H&E staining. Passive internal rotation was preserved (79 ± 38° vs 70 ± 2°, p < .001), as was external rotation (55 ± 2° vs 48 ± 3°, p < .001). CMAP amplitudes were significantly greater in the liraglutide group (19.43 ± 8.77 mV vs 7.61 ± 3.15 mV, p = .028).
CONCLUSION: Systemic liraglutide administration attenuated chronic muscle degeneration after RC tear by limiting FI, preserving muscle fiber morphology, maintaining joint mobility, and supporting neuromuscular function. These findings provide preclinical justification for therapeutic repositioning of GLP-1RAs in musculoskeletal disorders characterized by irreversible fatty degeneration.
