Proprioceptive neuromuscular facilitation improves tendon-bone healing in a rat model of rotator cuff tear: a comparative study with traditional electroacupuncture and infrared therapy

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Background: To compare the therapeutic effects of proprioceptive neuromuscular facilitation (PNF) versus traditional rehabilitation (electroacupuncture combined with infrared irradiation) on tendon-bone healing in a rat model of rotator cuff tear. Methods: Thirty-two male SD rats were randomly divided into four groups (n=8 each): sham operation (Sham), rotator cuff tear model without treatment (Model), traditional treatment (Traditional: electroacupuncture + infrared), and PNF treatment (PNF: daily passive stretching with resistance). The rotator cuff tear model was established by transverse incision of 1/2 of the supraspinatus tendon. After 4 weeks of intervention, tendon-bone healing was evaluated by biomechanical testing (maximum failure load), ELISA (IL-1β, IL-6, TNF-α), qPCR (inflammatory gene expression), histology (H&E, Safranin O, Sirius Red, Masson's trichrome), immunohistochemistry (collagen type I), and Western blot (VEGF, TGF-β). Results: PNF treatment significantly increased the maximum failure load of the tendon-bone interface compared to the Model and Traditional groups (p < 0.05). Both PNF and Traditional treatments reduced pro-inflammatory cytokine levels (IL-1β, IL-6, TNF-α) at both protein and mRNA levels, with PNF showing a more pronounced anti-inflammatory effect. Histologically, PNF group exhibited better-organized collagen fibers (Masson's trichrome), increased fibrocartilage regeneration (Safranin O), and a higher ratio of mature type I to type III collagen (Sirius Red under polarized light) compared to the Traditional group. Immunohistochemistry revealed stronger type I collagen deposition in the PNF group. Western blot demonstrated that PNF upregulated VEGF and TGF-β expression more effectively than Traditional treatment. Conclusion: PNF therapy outperforms traditional electroacupuncture combined with infrared therapy in promoting tendon-bone healing after rotator cuff tear in rats, as evidenced by superior biomechanical strength, enhanced collagen maturation, and better modulation of inflammation and growth factors. PNF is a promising non-invasive rehabilitation approach that warrants further clinical investigation in patients with chronic rotator cuff injury.

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