Aged Tendons Have Impaired Mechanosensitivity and Lower Thresholds for Injury under Dynamic Compression

Abstract

Rotator cuff tendinopathy is highly prevalent in aging populations, yet the mechanisms leading to age-dependent tendon degeneration are not well understood. In addition to tensile loading, tendons are subjected to compressive forces at certain anatomical sites (e.g., Achilles, rotator cuff), where altered adaptive responses may contribute to degenerative remodeling. The objective of this study was to investigate age-related differences in tendon responses to dynamic compressive loading using an ex vivo model. Murine flexor tendon explants from young and aged animals were cultured in a biaxial bioreactor and subjected to different levels of dynamic compressive loading. We then observed changes in metabolic activity, matrix composition, matrix biosynthesis, matrix structure, and gene expression. Young tendons exposed to moderate levels of compression maintained homeostasis, whereas high compression induced a robust adaptive response characterized by increased glycosaminoglycan accumulation, elevated collagen content, and upregulation of remodeling-associated genes including collagen I, decorin, and MMP-9, as well as inflammatory and apoptotic markers. In contrast, aged tendons demonstrated a qualitatively different response, with transcriptional downregulation of key remodeling markers alongside elevated secretion of matrix-degrading enzymes and pro-inflammatory cytokines, indicative of a maladaptive mechanobiological response even at low compressive levels. These findings reveal that impaired mechanosensitivity and a lower threshold for injury may predispose chronically loaded tissues to degenerative pathology associated with excessive compressive loading.