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Patience A, Steultjens M, Siebert S, Hendry G. Significant functional impairment and disability in individuals with psoriatic arthritis and Achilles tendon pain: a cross-sectional observational study. Rheumatol Int 2024; 44:1469-1479. [PMID: 38850322 PMCID: PMC11222213 DOI: 10.1007/s00296-024-05629-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 05/28/2024] [Indexed: 06/10/2024]
Abstract
The Achilles tendon (AT) insertion is the most common site of enthesitis in psoriatic arthritis (PsA). The structure and function of the AT in PsA, and the prevalence of mid-portion pathology, is unknown. To compare the structure and function of the AT in people with PsA with self-reported AT pain (PsA + AT), PsA without self-reported AT pain (PsA-AT) and healthy controls. A cross-sectional, observational study was conducted. The ATs were assessed by clinical and US examination (B-mode and Power Doppler), performance-based testing (bilateral heel raise test (HRT) and 10 m walk test), and patient-reported outcome measures (PROMs) (including the Victorian Institute of Sport Assessment-Achilles [VISA-A]). Between-group differences were described using descriptive statistics, Chi-squared testing, parametric (1-way ANOVA) and non-parametric (Mann-Whitney or Kruskal-Wallis) testing. 22 PsA (11 per group) and 11 healthy control participants who were comparable in terms of sex, age, and BMI (PsA-AT = longer PsA disease duration) were recruited. VISA-A scores were significantly worse in the PsA + AT group compared to the PsA-AT group and healthy controls (p < 0.001). Inflammatory US features were significantly more prevalent in the PsA + AT group (p < 0.001). Mid-portion AT pathology was observed in the PsA + AT group, irrespective of entheseal disease. Clinical examination alone missed 5/7 cases of 'active' US-confirmed AT enthesitis. AT functional deficits were significant in the PsA + AT group and both PsA groups had lower HRT repetition rates and walked slower compared to healthy controls. Less than 1/3 of the PsA + AT group had received podiatry or physiotherapy care. Significant differences in the structure and function of the AT in PsA were noted. Despite management in line with current guidance, AT pain appears to persist and can result in severe functional impairment.
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Affiliation(s)
- Aimie Patience
- Musculoskeletal Health Research Group, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- MSK Podiatry, NHS Ayrshire and Arran, Kilmarnock, UK
| | - Martijn Steultjens
- Musculoskeletal Health Research Group, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Stefan Siebert
- School of Infection and Immunity, University of Glasgow, Glasgow, UK
| | - Gordon Hendry
- Musculoskeletal Health Research Group, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
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Kilic E, Bingol O, Ozdemir G, Deveci A, Durgal A, Karahan TE. Comparison of Lateral and Central Achilles Tendon-Splitting Approaches in the Treatment of Haglund Deformity. Foot Ankle Int 2024; 45:845-851. [PMID: 38721829 DOI: 10.1177/10711007241250003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
BACKGROUND This study aimed to compare the complications and outcomes of lateral and central Achilles tendon-splitting approaches for the treatment of Haglund syndrome. METHODS Patients who underwent surgery for Haglund syndrome between June 2012 and June 2022 were included in the study. Patients undergoing lateral approach surgery were included in group 1, whereas patients undergoing central Achilles tendon-splitting approach surgery were included in group 2. Surgical outcomes of the patients were evaluated using the American Orthopaedic Foot & Ankle Society (AOFAS) ankle hindfoot scale, visual analog pain scale (VAS), and Victorian Institute of Sport Assessment-Achilles (VISAA) scores. In addition, preoperative and final follow-up scores were compared. RESULTS The study included 66 patients: 32 (14 females, 18 males) underwent surgery using the lateral approach in group 1, whereas in group 2, 34 patients (18 females, 16 males) underwent surgery using the central Achilles tendon-splitting approach. There was a significant statistical difference in the AOFAS, VISAA, and VAS scores between preoperative and final follow-up for both group 1 and group 2 (P < .001, P < .001, P < .001, P < .001, respectively). Group 1 had a small (0.76) relative increase in VAS score compared with group 2 (P = .033). There was no significant difference between the complication rates of group 1 and group 2. CONCLUSION In our study, we found the lateral approach and central Achilles tendon-splitting approaches to be safe and effective in the surgical treatment of Haglund syndrome without clinically meaningful differences in outcomes or complication rates.
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Affiliation(s)
- Enver Kilic
- Department of Orthopedics and Traumatology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Olgun Bingol
- Department of Orthopedics and Traumatology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Guzelali Ozdemir
- Department of Orthopedics and Traumatology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Alper Deveci
- Department of Orthopedics and Traumatology, Private Ortadogu Hospital, Ankara, Turkey
| | - Atahan Durgal
- Department of Orthopedics and Traumatology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Taha Esref Karahan
- Department of Orthopedics and Traumatology, Ankara Bilkent City Hospital, Ankara, Turkey
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Pasurka M, Falck T, Kubach J, Simon M, Söllner S, Strobel D, Perl M, Betsch M. Comparison of In Vivo Stiffness of Tendons Commonly Used for Anterior Cruciate Ligament Reconstruction - A Shear Wave Elastography Study. Acad Radiol 2024; 31:3297-3305. [PMID: 38378326 DOI: 10.1016/j.acra.2024.01.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/25/2024] [Accepted: 01/27/2024] [Indexed: 02/22/2024]
Abstract
RATIONALE AND OBJECTIVES There are currently no studies investigating the in vivo stiffness of the most commonly used autografts for anterior cruciate ligament reconstruction (ACLR) using Shear wave elastography (SWE). We hypothesize that there are differences regarding the elastic properties between the three tendons commonly used for ACLR and that they are influenced by patient-related factors. MATERIALS AND METHODS 80 healthy subjects (25 females, 55 males, age: 25.33 ± 4.76 years, BMI: 23.76 ± 3.14 kg/m2, 40 semiprofessional athletes, athlete group [AG], age: 25.51 [19-29]; 40 healthy controls, control group [CG], age: 25.50 [20-29]) were recruited as participants. In addition to patient reported outcome scores, every participant underwent a standardized multimodal ultrasound protocol consisting of B-mode-ultrasound (B-US), Color Doppler-ultrasound (CD-US) and a SWE examination of the bilateral quadriceps tendon (QT), patellar tendon (PT) and semitendinosus tendon (ST). RESULTS The highest shear wave velocity (SWV) were observed in ST (4.88 (4.35-5.52) m/s, ST vs QT, p = 0.005; ST vs PT, p < 0.001) followed by QT (4.61 (4.13-5.26) m/s, QT vs PT, p < 0.001) and PT (3.73 (3.30-4.68) m/s). Median QT, PT and ST stiffness was significantly higher in AG compared to CG. Male subjects tend to have stiffer QT and PT than female subjects. Positive correlation with SWV was obtained for age and activity level. CONCLUSION There are significant differences regarding in vivo tendon stiffness between the most frequently used autograft tendon options for ACLR. The quantitative information obtained by SWE could be of particular interest for graft choice for ACLR.
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Affiliation(s)
- Mario Pasurka
- Department of Orthopaedics and Trauma Surgery, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Krankenhausstrasse 12, 91054 Erlangen, Germany.
| | - Theo Falck
- Department of Orthopaedics and Trauma Surgery, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Krankenhausstrasse 12, 91054 Erlangen, Germany
| | - Joshua Kubach
- Department of Orthopaedics and Trauma Surgery, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Krankenhausstrasse 12, 91054 Erlangen, Germany
| | - Michael Simon
- Department of Orthopaedics and Trauma Surgery, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Krankenhausstrasse 12, 91054 Erlangen, Germany
| | - Stefan Söllner
- Department of Orthopaedics and Trauma Surgery, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Krankenhausstrasse 12, 91054 Erlangen, Germany
| | - Deike Strobel
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Ulmenweg 18, 91054 Erlangen, Germany
| | - Mario Perl
- Department of Orthopaedics and Trauma Surgery, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Krankenhausstrasse 12, 91054 Erlangen, Germany
| | - Marcel Betsch
- Department of Orthopaedics and Trauma Surgery, University Hospital of Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Krankenhausstrasse 12, 91054 Erlangen, Germany
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Bourke J, Munteanu S, Garofolini A, Taylor S, Malliaras P. Efficacy of heel lifts for mid-portion Achilles tendinopathy (the LIFT trial): study protocol for a randomised controlled trial. Trials 2024; 25:345. [PMID: 38790025 PMCID: PMC11127406 DOI: 10.1186/s13063-024-08185-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 05/20/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Mid-portion Achilles tendinopathy is a common condition, characterised by localised Achilles tendon load-related pain and dysfunction. Numerous non-surgical treatments have been proposed for the treatment of this condition, but many of these treatments have a poor or non-existent evidence base. Heel lifts have also been advocated as a treatment for Achilles tendinopathy, but the efficacy and mechanism of action of this intervention is unclear. This proposal describes a randomised controlled trial comparing the effectiveness of heel lifts versus sham heel lifts for reducing pain associated with mid-portion Achilles tendinopathy, with an embedded biomechanical analysis. METHODS One hundred and eight men and women aged 18 to 65 years with mid-portion Achilles tendinopathy (who satisfy the inclusion and exclusion criteria) will be recruited. Participants will be randomised, using the website Sealed Envelope, to either a control group (sham heel lifts) or an experimental group (heel lifts). Both groups will be provided with education regarding acceptable pain levels to ensure all participants receive some form of treatment. The participants will be instructed to use their allocated intervention for at least 8 h every day for 12 weeks. The primary outcome measure will be pain intensity (numerical rating scale) at its worst over the previous week. The secondary outcome measures will be additional measures of Achilles tendon pain and disability, participant-perceived global ratings of change, function, level of physical activity and health-related quality of life. Data will be collected at baseline and the primary endpoint (week 12). Data will be analysed using the intention-to-treat principle. In addition, the acute kinetic and kinematic effects of the interventions will be examined at baseline in a subpopulation of the participants (n = 40) while walking and running using three-dimensional motion analysis. DISCUSSION The LIFT trial (efficacy of heeL lIfts For mid-portion Achilles Tendinopathy) will be the first randomised trial to compare the efficacy of heel lifts to a sham intervention in reducing pain and disability in people with Achilles tendinopathy. The biomechanical analysis will provide useful insights into the mechanism of action of heel lifts. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, ACTRN12623000627651 . Registered 7 June 2023.
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Affiliation(s)
- Jaryd Bourke
- Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Victoria, Australia
| | - Shannon Munteanu
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Victoria, Australia
| | | | - Simon Taylor
- Institute for Health and Sport (IHES), Victoria University, Victoria, Australia
| | - Peter Malliaras
- Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Victoria, Australia
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Goldberg AJ, Masci L, O'Donnell P, Green R, Brooking D, Bassett P, Lowdell MW, Smith RKW. Autologous bone marrow derived mesenchymal stem cells are safe for the treatment of Achilles tendinopathy. Sci Rep 2024; 14:11421. [PMID: 38763976 PMCID: PMC11102920 DOI: 10.1038/s41598-024-61399-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 05/06/2024] [Indexed: 05/21/2024] Open
Abstract
Achilles tendinopathy is a disabling condition that affects more than 50% of runners. Pre-clinical studies in a large animal model of naturally-occurring tendinopathy similar to human Achilles tendinopathy has shown benefits of autologous bone marrow-derived mesenchymal stem cell (MSC) implantation. However, MSCs are advanced therapies medicinal products (ATMPs), with strict regulatory requirements. Guided by the regulator we carried out a first in man study to assess the safety and efficacy of autologous MSC injection in human patients with non-insertional Achilles tendinopathy. Ten patients, mean age 47 with mid-portion Achilles tendon pain and swelling for more than 6 months, underwent autologous cultured cell injections (median 12.2 × 106, range 5-19 × 106 cells) into their Achilles tendon. At 24 weeks follow-up, no serious adverse reactions or important medical events were observed. MOXFQ, EQ-5D-5L, and VISA-A scores improved clinically at 12 and 24 weeks. VAS pain improved increasingly at 6, 12 and 24 weeks. MOXFQ Pain and VISA-A Scores improved > 12 points from baseline to 24 weeks in 8 patients. Maximum anteroposterior tendon thickness as measured by greyscale US decreased by mean 0.8 mm at 24 weeks. This phase IIa study demonstrated the safety of autologous MSC injection for non-insertional Achilles tendinopathy and provides proof-of-concept of the technique in patients, all of whom had previously failed conservative treatments for chronic disease and leads the way for a larger randomised controlled trial.
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Affiliation(s)
- Andrew J Goldberg
- Division of Surgery, UCL Institute of Orthopaedics & Musculoskeletal Science, Royal Free Hospital, 9th Floor (East), 2QG, 10 Pond St, London, NW3 2PS, UK.
- Department of Research and Innovation, Royal National Orthopaedic Hospital (RNOH), Brockley Hill, Stanmore, Middlesex, UK.
- MSK Lab, Faculty of Medicine, Department of Surgery & Cancer, Imperial College London, Level 2, Faculty Building, South Kensington Campus, London, SW7 2AZ, UK.
- The London Ankle & Arthritis Centre, The Wellington Hospital, Wellington Place, London, NW8 9LE, UK.
| | - Lorenzo Masci
- Institute of Sport Exercise and Health, Tottenham Court Road, London, UK
| | - Paul O'Donnell
- Division of Surgery, UCL Institute of Orthopaedics & Musculoskeletal Science, Royal Free Hospital, 9th Floor (East), 2QG, 10 Pond St, London, NW3 2PS, UK
- Department of Radiology, Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore, HA7 4LP, UK
| | - Ruth Green
- Department of Radiology, Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore, HA7 4LP, UK
| | - Deirdre Brooking
- Department of Research and Innovation, Royal National Orthopaedic Hospital (RNOH), Brockley Hill, Stanmore, Middlesex, UK
| | - Paul Bassett
- Statsconsultancy Ltd., 40 Longwood Lane, Amersham, Bucks, HP7 9EN, UK
| | - Mark W Lowdell
- Centre for Cell, Gene & Tissue Therapeutics, Royal Free Hospital, Pond Street, London, NW3 2QG, UK
| | - Roger K W Smith
- Department of Veterinary Clinical Sciences and Services, The Royal Veterinary College, Hawkshead Lane, Hatfield, Hertfordshire, AL9 7TA, UK
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Alabau-Dasi R, Dominguez-Maldonado G, Gijon-Nogueron G, Ortega-Avila AB, Delacroix S. How susceptible are our Achilles Tendons? Sonoanatomical assessment. A cross-sectional study. J Tissue Viability 2023; 32:572-576. [PMID: 37722941 DOI: 10.1016/j.jtv.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/29/2023] [Accepted: 09/07/2023] [Indexed: 09/20/2023]
Abstract
OBJECTIVE the aim of this study is to observe whether there are ultrasound changes between men and women in the Achilles tendon at rest, at maximum passive force is applied and during walking. MATERIAL AND METHODS it was a cross-sectional study involving 27 healthy young participants recruited as volunteers between April to July 2022. A variety of data was recorded: (age, Body Mass Index, sex, smoking, current injury status, allergies, medications, previous surgeries, type of sport, and number of weekly workouts) and ultrasound measurements at rest and at passive force (Cross Sectional Area Achilles Tendon length, tendon thickness, Cross Sectional Area and pennation angle of the soleus muscle to the Achilles Tendon). RESULTS women demonstrated a statistically significant lower proximal and median thickness both at rest (4.5 vs 5.1 mm with p < 0.001 for proximal thickness; 4.4 vs 5.3 mm with p < 0.001 for median thickness) as well as during maximum eccentric contraction (4.3 vs 4.8 mm with p=<0.001 for proximal thickness; 4.1 vs 4.8 mm with p < 0.001 for median thickness). CONCLUSION there are significant sonoanatomical differences in vivo Achilles tendon between men and women.
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Affiliation(s)
- Raquel Alabau-Dasi
- Universidad de Malaga, Facultad de Ciencias de la Salud, Departamento de Enfermería y Podología, 29071, Malaga, Spain.
| | - Gabriel Dominguez-Maldonado
- Universidad de Malaga, Facultad de Ciencias de la Salud, Programa de Doctorado, Malaga, Spain; Universidad de Sevilla, Departamento de Podología, Spain.
| | - Gabriel Gijon-Nogueron
- Universidad de Malaga, Facultad de Ciencias de la Salud, Departamento de Enfermería y Podología, 29071, Malaga, Spain; Universidad de Malaga, Facultad de Ciencias de la Salud, Programa de Doctorado, Malaga, Spain; Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA platform BIONAND, Malaga, Spain.
| | - Ana Belen Ortega-Avila
- Universidad de Malaga, Facultad de Ciencias de la Salud, Departamento de Enfermería y Podología, 29071, Malaga, Spain; Universidad de Malaga, Facultad de Ciencias de la Salud, Programa de Doctorado, Malaga, Spain; Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA platform BIONAND, Malaga, Spain.
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Sneed D, Wong C. Platelet-rich plasma injections as a treatment for Achilles tendinopathy and plantar fasciitis in athletes. PM R 2023; 15:1493-1506. [PMID: 36929699 DOI: 10.1002/pmrj.12965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 02/06/2023] [Accepted: 02/10/2023] [Indexed: 03/18/2023]
Abstract
Platelet-rich plasma (PRP) injections represent a growing interest in the use of biologic therapies for treatment of musculoskeletal injuries. One possible application of PRP is in the management of overuse injuries commonly experienced by athletes. The aim of this review is to evaluate and summarize existing evidence regarding the efficacy of PRP in the treatment of Achilles tendinopathy and plantar fasciitis in athletes. Although many lower quality single-armed studies have demonstrated clinical improvement in athletes treated for Achilles tendinopathy with PRP, higher quality randomized controlled trials (RCTs) have shown no clear benefit in athletes. Existing data suggest PRP significantly improves clinical outcomes for plantar fasciitis in the general population, but very few studies and no RCTs are available that specifically analyze outcomes in athletic populations. More research is needed to evaluate how platelet concentration, leukocyte and erythrocyte presence, and sport type may interact to affect clinical outcomes in athletes.
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Affiliation(s)
- Dustin Sneed
- Central Virginia VA Health Care System, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Carmen Wong
- Central Virginia VA Health Care System, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
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Mohaddis M, Maqsood SA, Ago E, Singh S, Naim Z, Prasad S. Enhancing Functional Rehabilitation Through Orthotic Interventions for Foot and Ankle Conditions: A Narrative Review. Cureus 2023; 15:e49103. [PMID: 38024022 PMCID: PMC10659571 DOI: 10.7759/cureus.49103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2023] [Indexed: 12/01/2023] Open
Abstract
Non-surgical, conservative approaches to foot and ankle conditions are of important consideration. Orthotics play a significant role in treating these conditions, preventing progression, and alleviating pressure on affected areas, thereby promoting normal gait. This article aims to assess the utility and effectiveness of various orthotic treatments in different clinical scenarios. We reviewed 27 peer-reviewed articles using electronic databases, employing keywords such as "orthoses," "orthotic treatment," "arthritis," "neuropathy," and "foot and ankle trauma." Studies conducted in recent decades have explored the effectiveness of orthoses in various conditions, including connective tissue disorders, tendon and ligament injuries, foot arthritis, neuropathic and inflammatory wounds, and sports-related recurrent injuries. Orthotic management has proven effective across diverse foot and ankle conditions. Integrating orthotic treatment with systemic approaches benefits patients with foot and ankle disorders. We believe this review can be utilised by clinicians in the management of foot and ankle disorders.
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Affiliation(s)
- Momin Mohaddis
- Trauma and Orthopaedics, Warrington and Halton Hospitals NHS Trust, Liverpool, GBR
| | - Saad A Maqsood
- Trauma and Orthopaedics, Warrington and Halton Hospitals NHS Trust, Liverpool, GBR
| | - Emmanuel Ago
- Trauma and Orthopaedics, Warrington and Halton Hospitals NHS Trust, Liverpool, GBR
| | - Sushmit Singh
- Trauma and Orthopaedics, Warrington and Halton Hospitals NHS Trust, Liverpool, GBR
| | - Zahra Naim
- General Practice, Shadan Institute of Medical Sciences, Hyderabad, IND
| | - Seema Prasad
- Trauma and Orthopaedics, Warrington and Halton Hospitals NHS Trust, Liverpool, GBR
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Lee SH, Lee KB. Short-term results of endoscopic calcaneoplasty and retrocalcaneal bursectomy for insertional Achilles tendinopathy. Medicine (Baltimore) 2023; 102:e35349. [PMID: 37800833 PMCID: PMC10553144 DOI: 10.1097/md.0000000000035349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/01/2023] [Indexed: 10/07/2023] Open
Abstract
Although open surgery has traditionally been used as a surgical treatment for insertional Achilles tendinopathy, there is a possibility of serious complications (avulsion, scarring, contracture, sensory changes, and infection) due to the anatomical characteristics of the area. Endoscopic surgery has some advantages due to the smaller incision needed. The purpose of this study was to evaluate the effectiveness of endoscopic surgery in insertional Achilles tendinopathy. Twelve patients (15 feet) who underwent endoscopic surgery between 2015 and 2021 were included in this study. Clinical results were evaluated before and after surgery by visual analog scale (VAS) and, Ogilvie-Harris scores and complications. For radiological evaluation, the Fowler-Philip angle, and positive parallel pitch line were measured. VAS scores decreased from 7.6 preoperatively to 2.3 at the last postoperative follow-up, and Ogilvie-Harris values showed excellent results in 5 cases, good results in 8 cases, and fair results in 2 cases. In the radiographic results, there was no bone prominence above the Pavlov calcaneus pitch line in any case, and the Fowler-Philip angle decreased from an average of 57.5 degrees to 50.2 degrees. Only 1 patient underwent reoperation due to the recurrence of symptoms 33 months after the first surgery. After the second operation, the VAS score decreased to 3 points. No complications occurred. Endoscopic surgery is an effective and minimally invasive procedure, showing fewer complications and similar satisfaction as the open procedure. Therefore, it can be a good treatment option for patients with insertional Achilles tendinopathy as it provides the patient with a quick return to daily life.
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Affiliation(s)
- Se-Hwan Lee
- Department of Orthopedic Surgery, Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeon ju, South Korea
| | - Kwang-Bok Lee
- Department of Orthopedic Surgery, Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeon ju, South Korea
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Pierantoni M, Silva Barreto I, Hammerman M, Novak V, Diaz A, Engqvist J, Eliasson P, Isaksson H. Multimodal and multiscale characterization reveals how tendon structure and mechanical response are altered by reduced loading. Acta Biomater 2023; 168:264-276. [PMID: 37479155 DOI: 10.1016/j.actbio.2023.07.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/30/2023] [Accepted: 07/14/2023] [Indexed: 07/23/2023]
Abstract
Tendons are collagen-based connective tissues where the composition, structure and mechanics respond and adapt to the local mechanical environment. Adaptation to prolonged inactivity can result in stiffer tendons that are more prone to injury. However, the complex relation between reduced loading, structure, and mechanical performance is still not fully understood. This study combines mechanical testing with high-resolution synchrotron X-ray imaging, scattering techniques and histology to elucidate how reduced loading affects the structural properties and mechanical response of rat Achilles tendons on multiple length scales. The results show that reduced in vivo loading leads to more crimped and less organized fibers and this structural inhomogeneity could be the reason for the altered mechanical response. Unloading also seems to change the fibril response, possibly by altering the strain partitioning between hierarchical levels, and to reduce cell density. This study elucidates the relation between in vivo loading, the Achilles tendon nano-, meso‑structure and mechanical response. The results provide fundamental insights into the mechanoregulatory mechanisms guiding the intricate biomechanics, tissue structural organization, and performance of complex collagen-based tissues. STATEMENT OF SIGNIFICANCE: Achilles tendon properties allow a dynamic interaction between muscles and tendon and influence force transmission during locomotion. Lack of physiological loading can have dramatic effects on tendon structure and mechanical properties. We have combined the use of cutting-edge high-resolution synchrotron techniques with mechanical testing to show how reduced loading affects the tendon on multiple hierarchical levels (from nanoscale up to whole organ) clarifying the relation between structural changes and mechanical performance. Our findings set the first step to address a significant healthcare challenge, such as the design of tailored rehabilitations that take into consideration structural changes after tendon immobilization.
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Affiliation(s)
- Maria Pierantoni
- Department of Biomedical Engineering, Lund University, Box 118, 221 00 Lund, Sweden.
| | | | - Malin Hammerman
- Department of Biomedical Engineering, Lund University, Box 118, 221 00 Lund, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, 581 83 Linköping, Sweden
| | | | - Ana Diaz
- Paul Scherrer Institute, 5232 Villigen PSI, Switzerland
| | - Jonas Engqvist
- Department of Solid Mechanics, Lund University, Box 118, 221 00 Lund, Sweden
| | - Pernilla Eliasson
- Department of Biomedical and Clinical Sciences, Linköping University, 581 83 Linköping, Sweden; Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Hanna Isaksson
- Department of Biomedical Engineering, Lund University, Box 118, 221 00 Lund, Sweden
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Malinowski K, Koźlak M, Kennedy NI, Kim DW, Pękala PA, LaPrade RF, Mostowy M. ACL Mucoid Degeneration-Anterior and Posterior Arthroscopic Decompression for Combined Knee Flexion-Extension Deficit. Arthrosc Tech 2023; 12:e1495-e1505. [PMID: 37780665 PMCID: PMC10533682 DOI: 10.1016/j.eats.2023.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 04/18/2023] [Indexed: 10/03/2023] Open
Abstract
Mucoid degeneration of the ACL (MDACL, ACL ganglion cysts) is a disease involving ACL thickening due to accumulation of mucoid substance and fiber degeneration with possible formation of "ganglions". Clinically, it leads to anteroposterior impingement and painful limitation of knee range of motion due to impingement of the anterior portion of the thickened ACL with the intercondylar notch during knee extension and the thickened posterior part of the ligament with posterior structures of the knee in flexion. Different treatment methods have been described, including total or partial resection of the ACL degenerative fibers. However, these techniques do not allow for ACL preservation and are associated with a risk of postoperative instability. Also, most procedures treat anterior impingement only. Therefore, the aim of this technical note is to present an arthroscopic technique allowing for minimally invasive anteroposterior ACL decompression. The technique is focused on evacuation of the interfibrous mucoid substance, ganglions, and bony decompression, as well as maintenance of ligament integrity. Its greatest advantage is that it is safe and ACL-preserving yet allows for comprehensive treatment of all intra- and extra-ligamentous possible reasons of MDACL origin and promoting good healing conditions.
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Affiliation(s)
- Konrad Malinowski
- Department of Anatomy, Jagiellonian University Medical College, International Evidence-Based Anatomy Working Group, Kraków, Poland
- Artromedical Orthopedic Clinic, Belchatow, Poland
| | - Magdalena Koźlak
- Artromedical Orthopedic Clinic, Belchatow, Poland
- Nowa Ortopedia Orthopedic Clinic, Kraków, Poland
| | | | - Dong W. Kim
- Department of Anatomy, Jagiellonian University Medical College, International Evidence-Based Anatomy Working Group, Kraków, Poland
| | - Przemysław A. Pękala
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Kraków University, Kraków, Poland
- Lesser Poland Orthopedic and Rehabilitation Hospital, Kraków, Poland
| | | | - Marcin Mostowy
- Artromedical Orthopedic Clinic, Belchatow, Poland
- Orthopedic and Trauma Department, Veteran’s Memorial Teaching Hospital in Lodz, Medical University of Lodz, Lodz, Poland
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Tarantino D, Mottola R, Resta G, Gnasso R, Palermi S, Corrado B, Sirico F, Ruosi C, Aicale R. Achilles Tendinopathy Pathogenesis and Management: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6681. [PMID: 37681821 PMCID: PMC10487940 DOI: 10.3390/ijerph20176681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/09/2023] [Accepted: 08/25/2023] [Indexed: 09/09/2023]
Abstract
The Achilles tendon is the thickest and strongest tendon of the human body, and it is frequently injured during sports activity. The incidence of Achilles tendon pathologies has increased over recent decades, especially in the last few years, because of increased sports participation among the general population and due to the diffusion of competitive sports at a high level. Tendinopathies are common in athletes and in middle-aged overweight patients. The term "tendinopathy" refers to a condition characterised clinically by pain and swelling, with functional limitations of tendon and nearby structures, and consequently to chronic failure of healing response process. Tendinopathies can produce marked morbidity, and at present, scientifically validated management modalities are limited. Despite the constantly increasing interest and number of studies about Achilles tendinopathy (AT), there is still not a consensual point of view on which is the best treatment, and its management is still controversial. AT can be treated conservatively primarily, with acceptable results and clinical outcomes. When this approach fails, surgery should be considered. Several surgical procedures have been described for both conditions with a relatively high rate of success with few complications and the decision for treatment in patients with AT should be tailored on patient's needs and level of activity. The aim of this article is to give insights about the pathogenesis and most used and recent treatment options for AT.
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Affiliation(s)
- Domiziano Tarantino
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (R.M.); (R.G.); (S.P.); (B.C.); (F.S.); (C.R.)
| | - Rosita Mottola
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (R.M.); (R.G.); (S.P.); (B.C.); (F.S.); (C.R.)
| | - Giuseppina Resta
- Department of Orthopaedic and Trauma Surgery, Casa di Cura di Bernardini, 74121 Taranto, Italy;
| | - Rossana Gnasso
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (R.M.); (R.G.); (S.P.); (B.C.); (F.S.); (C.R.)
| | - Stefano Palermi
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (R.M.); (R.G.); (S.P.); (B.C.); (F.S.); (C.R.)
| | - Bruno Corrado
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (R.M.); (R.G.); (S.P.); (B.C.); (F.S.); (C.R.)
| | - Felice Sirico
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (R.M.); (R.G.); (S.P.); (B.C.); (F.S.); (C.R.)
| | - Carlo Ruosi
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (R.M.); (R.G.); (S.P.); (B.C.); (F.S.); (C.R.)
| | - Rocco Aicale
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084 Baronissi, Italy;
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13
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Peters MJ, Walsh K, Day C, Younger A, Salat P, Penner M, Wing K, Glazebrook M, Veljkovic A. Level of Evidence for the Treatment of Chronic Noninsertional Achilles Tendinopathy. Foot Ankle Spec 2023; 16:406-426. [PMID: 33749355 PMCID: PMC10422862 DOI: 10.1177/19386400211001261] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Noninsertional Achilles tendinopathy affects both athletes and sedentary individuals, and its incidence is rising. Conservative management is the mainstay of treatment, but a variety of operative techniques have been described to treat recalcitrant cases. We seek to outline the current available evidence for surgical management of noninsertional Achilles tendinopathy. STUDY DESIGN AND METHODS A systematic review was performed using the MEDLINE and EMBASE databases, and all articles were reviewed by at least 2 authors. Each article was assigned a level of evidence in accordance with the standards of Journal of Bone and Joint Surgery. The available data were reviewed and a level of evidence was assigned to each intervention of interest, based on the revised classifications of Wright. RESULTS AND CONCLUSION A total of 46 articles met inclusion and exclusion criteria. There is fair evidence (grade B) in support of open debridement with 1 level II study, 1 level III study, and 8 level IV studies. There is fair evidence (grade B) in support of arthroscopic or minimally invasive surgical techniques. There is poor evidence (grade C) in support of flexor hallucis longus transfer, longitudinal tenotomy, peritenolysis, gastrocnemius recession, and plantaris excision. There is insufficient evidence (grade I) to provide a recommendation about other surgical treatment methods for noninsertional Achilles tendinopathy.Levels of Evidence: Level III: Systematic review.
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Affiliation(s)
| | - Kellen Walsh
- University of British Columbia, Vancouver, BC, Canada
| | - Chris Day
- University of British Columbia, Vancouver, BC, Canada
| | | | | | - Murray Penner
- University of British Columbia, Vancouver, BC, Canada
| | - Kevin Wing
- University of British Columbia, Vancouver, BC, Canada
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14
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Barton D, Manoharan A, Khwaja A, Sorenson J, Taylor M. Return to Play Following Achilles Tendon Rupture in NFL Players Based on Position. Foot Ankle Spec 2023; 16:427-436. [PMID: 34609159 DOI: 10.1177/19386400211040351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The purpose of this study was to determine the return-to-play (RTP) rate and postinjury performance after Achilles tendon (AT) ruptures in National Football League (NFL) skill position players. METHODS The study included NFL skill positions with an AT rupture between the 2009-2010 and 2015-2016 seasons. Performance data were collected and compared against a matched control group. RTP was defined as playing in at least 1 game after repair. RESULTS RTP rate was 57% for the study cohort. The tight ends (TEs) had the highest RTP rate at 71% while the wide receivers (WRs) had the lowest RTP rate at 38%. Compared with the control group, WRs with successful RTP had significantly less receptions per game (P = .01). For defensive players with RTP there were significant decreases in postrepair performance in tackles, passes defended, and fumbles forced/recovered compared with the control group. CONCLUSION A total of 57% of players achieved RTP with WRs and running backs (RBs) having the lowest RTP rates and TEs and linebackers (LBs) having the highest RTP rates. RBs, defensive backs (DBs), and LBs with successful RTP had decreased performance in all categories. This updated information may be helpful for athletes, physicians, scouts, and coaches in evaluating players with a history of AT rupture. LEVELS OF EVIDENCE Analytic, level 3, retrospective cohort study, Epidemiologic study.
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Affiliation(s)
- Dane Barton
- Department of Orthopaedic Surgery, University of Arizona, Tucson, Arizona
| | - Aditya Manoharan
- Department of Orthopaedic Surgery, University of Arizona, Tucson, Arizona
| | - Ansab Khwaja
- Department of Orthopaedic Surgery, University of Arizona, Tucson, Arizona
| | - Jacob Sorenson
- University of Arizona School of Medicine, Tucson, Arizona
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15
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Kunkle BF, Baxter NA, Caughman AM, Barcel JA, Scott DJ, Gross CE. Risk Factors for Failure of Conservative Management of Insertional Achilles Tendinosis. Foot Ankle Spec 2023; 16:370-376. [PMID: 35583105 DOI: 10.1177/19386400221090358] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION While many patients benefit from nonoperative treatment of insertional Achilles tendinopathy (IAT), some elect for surgical debridement and reconstruction. The purpose of this study is to determine the relationship of patient demographic characteristics, comorbidity profiles, and radiological parameters with failure of conservative management of IAT. METHODS A retrospective chart review was performed to identify patients who received either surgical or nonsurgical treatment of IAT at an academic institution from September 2015 to June 2019 (N = 226). Demographic and comorbidity data, and the presence and magnitude of relevant radiological parameters were collected and compared between the surgically (n = 48) and nonsurgically (n = 178) treated groups. RESULTS No significant differences could be detected between groups regarding demographic factors or previous procedures. The surgery group was significantly more likely to have evidence of Haglund's deformity on clinical exam (83% vs 69%, P = .005), lower SF-12 physical scores (25.5 vs 35.5, P < .001), higher VAS pain scores (6.3 vs 5.3, P = .033), any mental illness (33% vs 20%, P = .044), and depression (27% vs 12%, P = .012). DISCUSSION Patients who received surgery for IAT were significantly more likely to have evidence of Haglund's deformity on clinical exam, depression, higher VAS pain scores, and lower SF-12 physical scores. Both patients and surgeons should be aware of the higher rates of failure of conservative treatment in these patients. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Bryce F Kunkle
- Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Nicholas A Baxter
- Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Alexander M Caughman
- Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - John A Barcel
- Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Daniel J Scott
- Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, South Carolina
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16
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Adam NC, Smith CR, Herzog W, Amis AA, Arampatzis A, Taylor WR. In Vivo Strain Patterns in the Achilles Tendon During Dynamic Activities: A Comprehensive Survey of the Literature. SPORTS MEDICINE - OPEN 2023; 9:60. [PMID: 37466866 DOI: 10.1186/s40798-023-00604-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 07/02/2023] [Indexed: 07/20/2023]
Abstract
Achilles' tendon (AT) injuries such as ruptures and tendinopathies have experienced a dramatic rise in the mid- to older-aged population. Given that the AT plays a key role at all stages of locomotion, unsuccessful rehabilitation after injury often leads to long-term, deleterious health consequences. Understanding healthy in vivo strains as well as the complex muscle-tendon unit interactions will improve access to the underlying aetiology of injuries and how their functionality can be effectively restored post-injury. The goals of this survey of the literature with a systematic search were to provide a benchmark of healthy AT strains measured in vivo during functional activities and identify the sources of variability observed in the results. Two databases were searched, and all articles that provided measured in vivo peak strains or the change in strain with respect to time were included. In total, 107 articles that reported subjects over the age of 18 years with no prior AT injury and measured while performing functional activities such as voluntary contractions, walking, running, jumping, or jump landing were included in this review. In general, unclear anatomical definitions of the sub-tendon and aponeurosis structures have led to considerable confusion in the literature. MRI, ultrasound, and motion capture were the predominant approaches, sometimes coupled with modelling. The measured peak strains increased from 4% to over 10% from contractions, to walking, running, and jumping, in that order. Importantly, measured AT strains were heavily dependent on measurement location, measurement method, measurement protocol, individual AT geometry, and mechanical properties, as well as instantaneous kinematics and kinetics of the studied activity. Through a comprehensive review of approaches and results, this survey of the literature therefore converges to a united terminology of the structures and their common underlying characteristics and presents the state-of-knowledge on their functional strain patterns.
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Affiliation(s)
- Naomi C Adam
- Institute for Biomechanics, ETH Zürich, Leopold-Ruzicka-Weg 4, 8093, Zurich, Switzerland
| | - Colin R Smith
- Institute for Biomechanics, ETH Zürich, Leopold-Ruzicka-Weg 4, 8093, Zurich, Switzerland
| | - Walter Herzog
- Human Performance Laboratory, Faculty of Kinesiology, The University of Calgary, Calgary, Canada
| | - Andrew A Amis
- Department of Mechanical Engineering, Imperial College London, London, UK
| | - Adamantios Arampatzis
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, and Berlin School of Movement Science, Berlin, Germany
| | - William R Taylor
- Institute for Biomechanics, ETH Zürich, Leopold-Ruzicka-Weg 4, 8093, Zurich, Switzerland.
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17
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Lopes AD, Mascarinas A, Hespanhol L. Are alterations in running biomechanics associated with running injuries? A systematic review with meta-analysis. Braz J Phys Ther 2023; 27:100538. [PMID: 37651773 PMCID: PMC10480598 DOI: 10.1016/j.bjpt.2023.100538] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 08/09/2023] [Accepted: 08/16/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND No systematic review has investigated the main biomechanical variables as predictors of running-related injuries. OBJECTIVE To investigate the main biomechanical variables associated with running-related injuries. METHODS Medline via PubMed, EMBASE, SPORTDiscus, Web of Science, and CINAHL were searched from inception until 1 November 2021. Each study included must have investigated the association of at least one biomechanical variable (kinetics, kinematics, electromyography, or pressure distribution) with running injuries. The meta-analysis was conducted, and a modified version of the Downs and Black Quality Index was used for methodological quality evaluation. RESULTS Across the 82 studies included, 5465 runners were investigated. The meta-analysis was conducted with 11 biomechanical variables from 51 articles (n=2395). The peak hip adduction angle was the sole biomechanical variable associated with running injury and was found to be higher in injured runners (0.57, 95% CI 0.21, 0.94) compared to uninjured runners. However, this result was highly influenced by two studies (out of five studies) conducted by the same group of authors. CONCLUSION Clinicians, coaches, and runners should be aware that minimal evidence supports that alterations of running biomechanics are associated with running-related injuries. Heterogeneity in evaluation conditions and inconsistency in the naming and definitions of biomechanical variables make definitive conclusions challenging. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO, CRD42017068839.
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Affiliation(s)
- Alexandre Dias Lopes
- Department of Physical Therapy, Movement & Rehabilitation Sciences, Northeastern University, Boston, MA, USA.
| | | | - Luiz Hespanhol
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, Sao Paulo, SP, Brazil; Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health and the Amsterdam Public Health research institute, VU University Medical Center Amsterdam, Amsterdam, the Netherlands
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18
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Bruni DF, Pierson SR, Sarwar F, Ring D, Ramtin S. Are the Pathologic Features of Enthesopathy, Tendinopathy, and Labral and Articular Disc Disease Related to Mucoid Degeneration? A Systematic Review. Clin Orthop Relat Res 2023; 481:641-650. [PMID: 36563131 PMCID: PMC10013668 DOI: 10.1097/corr.0000000000002499] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 10/31/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Tendinopathy, enthesopathy, labral degeneration, and pathologic conditions of the articular disc (knee meniscus and ulnocarpal) are sometimes described in terms of inflammation or damage, while the histopathologic findings are often consistent with mucoid degeneration. A systematic review of the histopathology of these structures at diverse locations might reconceptualize these diseases as expected aspects of human aging. The potential benefits of this evolution might include healthier patient and clinician mindsets as well as a reduced likelihood of overdiagnosis and overtreatment resulting from greater awareness of base rates of pathology. QUESTION/PURPOSE In this systematic review of studies of surgical specimens, we asked: Are there are any differences in the histopathologic findings of structural soft tissue conditions (mucoid degeneration, inflammation, and vascularity) by anatomic site (foot, elbow, or knee) or structure (tendon body, muscle or tendon origin or insertion [enthesis], labrum, or articular disc)? METHODS Studies between 1980 and 2021 investigating the histopathologic findings of specimens from surgery for trigger digit, de Quervain tendinopathy, plantar fasciitis, lateral and medial elbow enthesopathy, rotator cuff tendinopathy, posterior tibial tendinopathy, patellar tendinopathy, Achilles tendinopathy, or disease of the hip labrum, ulnocarpal articular disc, or knee meniscus were searched for in the PubMed, EMBASE, and CINAHL databases. Inclusion criteria were the prespecified anatomic location or structure being analyzed histologically and any findings described with respect to inflammation, vascularity, or mucoid degeneration. Studies were excluded if they were nonhuman studies or review articles. Search terms included "anatomy," "pathology," and "histopathology." These terms were coupled with anatomic structures or disorders and included "trigger finger," "de Quervain," "fasciitis, plantar," "tennis elbow," "rotator cuff tendinopathy," "elbow tendinopathy," "patellar tendonitis," "posterior tibial tendon," and "triangular fibrocartilage." This resulted in 3196 studies. After applying the inclusion criteria, 559 articles were then assessed for eligibility according to our exclusion criteria, with 52 eventually included. We recorded whether the study identified the following histopathologic findings: inflammatory cells or molecular markers, greater than expected vascularity (categorized as quantitative count, with or without controls; molecular markers; or qualitative judgments), and features of mucoid degeneration (disorganized collagen, increased extracellular matrix, or chondroid metaplasia). In the absence of methods for systematically evaluating the pathophysiology of structural (collagenous) soft tissue structures and rating histopathologic study quality, all studies that interpreted histopathology results were included. The original authors' judgment regarding the presence or absence of inflammation, greater than expected vascularity, and elements of mucoid degeneration was recorded along with the type of data used to reach that conclusion. RESULTS Regarding differences in the histopathology of surgical specimens of structural soft tissue conditions by anatomic site, there were no differences in inflammation or mucoid degeneration, and the knee meniscus was less often described as having greater than normal vascularity. There were no differences by anatomic structure. Overall, 20% (10 of 51) of the studies that investigated for inflammation reported it (nine inflammatory cells and one inflammatory marker). Eighty-three percent (43 of 52) interpreted increased vascularity: 40% (17 of 43) using quantitative methods (14 with controls and three without) and 60% (26 of 43) using imprecise criteria. Additionally, 100% (all 52 studies) identified at least one element of mucoid degeneration: 69% (36 of 52) reported an increased extracellular matrix, 71% (37 of 52) reported disorganized collagen, and 33% (17 of 52) reported chondroid metaplasia. CONCLUSION Our systematic review of the histopathology of diseases of soft tissue structures (enthesopathy, tendinopathy, and labral and articular disc) identified consistent mucoid degeneration, minimal inflammation, and imprecise assessment of relative vascularity; these findings were consistent across anatomic sites and structures, supporting a reconceptualization of these diseases as related to aging (senescence or degeneration) rather than injury or activity. CLINICAL RELEVANCE This reconceptualization supports accommodative mindsets known to be associated with greater comfort and capability. In addition, awareness of the notable base rates of structural soft tissue changes as people age might reduce overdiagnosis and overtreatment of incidental, benign, or inconsequential signal changes and pathophysiology.
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Affiliation(s)
- David F. Bruni
- Department of Surgery and Perioperative Care, Dell Medical School, the University of Texas at Austin, Austin, TX, USA
| | - S. Ryan Pierson
- Department of Surgery and Perioperative Care, Dell Medical School, the University of Texas at Austin, Austin, TX, USA
| | - Faiza Sarwar
- Department of Surgery and Perioperative Care, Dell Medical School, the University of Texas at Austin, Austin, TX, USA
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, the University of Texas at Austin, Austin, TX, USA
| | - Sina Ramtin
- Department of Surgery and Perioperative Care, Dell Medical School, the University of Texas at Austin, Austin, TX, USA
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Thermann H, Fischer R, Gougoulias N, Cipollaro L, Maffulli N. Endoscopic debridement for non-insertional Achilles tendinopathy with and without platelet-rich plasma. JOURNAL OF SPORT AND HEALTH SCIENCE 2023; 12:275-280. [PMID: 32619656 PMCID: PMC10105028 DOI: 10.1016/j.jshs.2020.06.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/01/2020] [Accepted: 06/08/2020] [Indexed: 06/01/2023]
Abstract
BACKGROUND When non-operative management fails to improve symptoms in patients with non-insertional Achilles tendinopathy, surgery may be required. Various open and endoscopic techniques have been proposed, and platelet-rich plasma (PRP) injections have been proposed as an adjunct to aid tendon healing. METHODS Thirty-six patients with mid-portion Achilles tendinopathy were randomized to undergo endoscopic debridement alone (n = 19) or in combination with intraoperative PRP application (n = 17). Clinical outcome measures included the Visual Analogue Scale for pain, function, and satisfaction and the Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire. Patients were followed-up at 6 weeks, 3 months, 6 months, and 12 months after surgery. An MRI examination at 3 and 12 months was used to assess signal alterations within the tendon. RESULTS Both groups showed significant clinical improvement (p < 0.05) after surgery, with no difference between the 2 groups. Tendon diameter increased at 3 months and decreased at 12 months. The tendinopathy area increased at 3 months and decreased at 12 months below baseline level in both groups. There was no significant difference between the groups regarding the MRI parameters. Nodular thickening and MRI-detected signal alteration persisted after surgery, with no association between imaging and clinical outcome. Five minor complications were reported: 2 in the PRP group and 3 in the control group. CONCLUSION Endoscopic debridement of the Achilles tendon improved clinical outcomes in patients with mid-portion tendinopathy. The addition of PRP did not improve outcomes compared to debridement alone. MRI parameters showed no association with clinical outcomes.
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Affiliation(s)
- Hajo Thermann
- HKF-International Center for Hip, Foot and Knee Surgery, Bismarckstraße 9-15, 69115 Heidelberg, Germany
| | - Ralph Fischer
- HKF-International Center for Hip, Foot and Knee Surgery, Bismarckstraße 9-15, 69115 Heidelberg, Germany
| | | | - Lucio Cipollaro
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno 89100, Italy; Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi (SA), Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno 89100, Italy; Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi (SA), Italy; Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London E1 4DG, Queen Mary University of London, London, UK; School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Thornburrow Drive, Stoke on Trent, ST4 7QB, UK.
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Ko VMC, Cao M, Qiu J, Fong ICK, Fu SC, Yung PSH, Ling SKK. Comparative short-term effectiveness of non-surgical treatments for insertional Achilles tendinopathy: a systematic review and network meta-analysis. BMC Musculoskelet Disord 2023; 24:102. [PMID: 36750789 PMCID: PMC9903592 DOI: 10.1186/s12891-023-06170-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 01/16/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND The incidence of Achilles tendinopathy has risen over the past decades. Insertional Achilles tendinopathy is characterised by tissue degeneration of the Achilles tendon from its insertion in the calcaneus to up to 2 cm proximally. This clinical condition is accompanied by pain, loss of function and diminished exercise tolerance. Numerous conservative treatment modalities are available to participants with insertional Achilles tendinopathy, including eccentric exercises, extracorporeal shockwave therapy, laser therapy, cryotherapy, therapeutic ultrasound, and orthotics. Eccentric exercise and extracorporeal shockwave therapy may reduce pain in participants with non-calcified insertional Achilles tendinopathy. However, no specific treatment is recommended over another due to the low methodological quality of trials. Given the lack of standard or preferred non-surgical treatment and the potential risks of surgical treatment, there is an imminent need to reassess different non-surgical treatments based on the newest evidence. Thus, this systematic review aims to evaluate the clinical effectiveness of the various non-surgical treatments for insertional Achilles tendinopathy. METHODS AMED EBSCOhost, CINAHL, EBSCOhost, EMBASE, PEDro, PubMed, Web of Science, and Clinicaltrials.gov were searched from 1992 to 14th October 2022, randomised controlled trials of adults with insertional Achilles tendinopathy investigating non-surgical treatments compared with each other or no treatment, placebo/sham control. Two reviewers independently screened and extracted the data. Random effects of network meta-analysis immediately after treatments were used to report comparative treatment effects. The surface under the cumulative ranking probabilities was calculated to assess the relative ranking of treatments. RESULTS Nine trials (total n = 464 participants) were included. This review recommended the combination of eccentric exercise and soft tissue therapy to manage insertional Achilles tendinopathy. With the highest SUCRA values of 84.8, and the best mean rank of 1.9, Eccentric exercise plus soft tissue treatment ranked as the most effective treatment for short-term pain. CONCLUSIONS This is the first NMA of non-surgical treatment focusing on short-term pain control for IAT which eccentric exercise plus soft-tissue therapy was found to be the most effective treatment combination. However, the overall confidence in non-surgical treatments from all included trials was very low. No recommendation of the best treatment option can be made from this review.
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Affiliation(s)
- Violet Man-Chi Ko
- grid.10784.3a0000 0004 1937 0482Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong (CUHK), Hong Kong SAR, China
| | - Mingde Cao
- grid.10784.3a0000 0004 1937 0482Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong (CUHK), Hong Kong SAR, China
| | - Jihong Qiu
- grid.10784.3a0000 0004 1937 0482Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong (CUHK), Hong Kong SAR, China
| | - Isaac Chun-Kit Fong
- grid.10784.3a0000 0004 1937 0482Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong (CUHK), Hong Kong SAR, China
| | - Sai-Chuen Fu
- grid.10784.3a0000 0004 1937 0482Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong (CUHK), Hong Kong SAR, China
| | - Patrick Shu-Hang Yung
- grid.10784.3a0000 0004 1937 0482Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong (CUHK), Hong Kong SAR, China
| | - Samuel Ka-Kin Ling
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong (CUHK), Hong Kong SAR, China.
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21
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Demangeot Y, Whiteley R, Gremeaux V, Degache F. The load borne by the Achilles tendon during exercise: A systematic review of normative values. Scand J Med Sci Sports 2023; 33:110-126. [PMID: 36278501 DOI: 10.1111/sms.14242] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 08/29/2022] [Accepted: 09/30/2022] [Indexed: 01/11/2023]
Abstract
The Achilles tendon (AT) can be exposed to considerable stress during athletic activities and is often subject to pathologies such as tendinopathies. When designing a prevention or rehabilitation protocol, mechanical loading is a key factor to consider. This implies being able to accurately determine the load applied to the AT when performing exercises that stress this tendon. A systematic review was performed to synthesize the load borne by the AT during exercises/activities. Three databases (Pubmed, Embase and Cochrane) were searched for articles up to May 2021, and only the studies assessing the AT load in newtons relative to body-weight (BW) on humans during activities or exercises were included. Most of the 11 included studies assessed AT load when running or walking (N = 10), and only three tested exercises were usually performed during rehabilitation. The load on the tendon ranged from 2.7 to 3.95 BW when walking, from 4.15 to 7.71 BW when running, and from 0.41 to 7.3 BW according to the strengthening exercise performed. From the collected data, a progression of exercises progressively loading the Achilles tendon, as well as the possible connections with walking and running activities, could be defined. However, the trends highlighted in the relationship between tendon loading and walking or running speeds present some inconsistencies. Further research is still needed to clarify them, but also to complete the data set in healthy and injured people.
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Affiliation(s)
- Yoann Demangeot
- Therapeutic and Performance Sports Institute, MotionLab, Le Mont-sur-Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Rod Whiteley
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Vincent Gremeaux
- Unit of Sports Medicine, Swiss Olympic Medical Center, Lausanne University Hospital, Lausanne, Switzerland.,Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Francis Degache
- Therapeutic and Performance Sports Institute, MotionLab, Le Mont-sur-Lausanne, Switzerland
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22
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Wang L, Wen D, Yin Y, Zhang P, Wen W, Gao J, Jiang Z. Musculoskeletal Ultrasound Image-Based Radiomics for the Diagnosis of Achilles Tendinopathy in Skiers. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:363-371. [PMID: 35841273 PMCID: PMC10084008 DOI: 10.1002/jum.16059] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/10/2022] [Accepted: 06/23/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Our study aimed to develop and validate an efficient ultrasound image-based radiomic model for determining the Achilles tendinopathy in skiers. METHODS A total of 88 feet of skiers clinically diagnosed with unilateral chronic Achilles tendinopathy and 51 healthy feet were included in our study. According to the time order of enrollment, the data were divided into a training set (n = 89) and a test set (n = 50). The regions of interest (ROIs) were segmented manually, and 833 radiomic features were extracted from red, green, blue color channels and grayscale of ROIs using Pyradiomics, respectively. Three feature selection and three machine learning modeling algorithms were implemented respectively, for determining the optimal radiomics pipeline. Finally, the area under the receiver operating characteristic curve (AUC), consistency analysis, and decision analysis were used to evaluate the diagnostic performance. RESULTS By comparing nine radiomics analysis strategies of three color channels and grayscale, the radiomic model under the green channel obtained the best diagnostic performance, using the Random Forest selection and Support Vector Machine modeling, which was selected as the final machine learning model. All the selected radiomic features were significantly associated with the Achilles tendinopathy (P < .05). The radiomic model had a training AUC of 0.98, a test AUC of 0.99, a sensitivity of 0.90, and a specificity of 1, which could bring sufficient clinical net benefits. CONCLUSIONS Ultrasound image-based radiomics achieved high diagnostic performance, which could be used as an intelligent auxiliary tool for the diagnosis of Achilles tendinopathy.
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Affiliation(s)
- Likun Wang
- Department of UltrasoundThe First Affiliated Hospital of Hebei North UniversityZhangjiakou075000China
| | - Dehui Wen
- Department of UltrasoundThe First Affiliated Hospital of Hebei North UniversityZhangjiakou075000China
| | - Yanlin Yin
- Department of OrthopedicsThe First Affiliated Hospital of Hebei North UniversityZhangjiakou075000China
| | - Peinan Zhang
- Department of OrthopedicsThe First Affiliated Hospital of Hebei North UniversityZhangjiakou075000China
| | - Wen Wen
- Department of Ultrasound, West China HospitalSichuan UniversityChengdu610000China
| | - Jun Gao
- College of Computer ScienceSichuan UniversityChengdu610000China
| | - Zekun Jiang
- College of Computer ScienceSichuan UniversityChengdu610000China
- West China Biomedical Big Data Center, West China HospitalSichuan UniversityChengdu610000China
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23
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Arora NK, Sharma S, Sharma S, Arora IK. Physical modalities with eccentric exercise are no better than eccentric exercise alone in the treatment of chronic achilles tendinopathy: A systematic review and meta-analysis. Foot (Edinb) 2022; 53:101927. [PMID: 36037777 DOI: 10.1016/j.foot.2022.101927] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 04/05/2022] [Accepted: 04/16/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND To investigate the available evidence and conduct a systematic review with meta-analysis to determine the effectiveness of physical modalities combined with eccentric exercise (PMEE) with eccentric exercise (EE) alone for improvements in pain and function in individuals with chronic Achilles tendinopathy (AT) at short-term (4 weeks) and long-term (12-16 weeks) follow-ups. MATERIALS AND METHODS A systematic literature review identified 8 papers (from 6404 possible inclusions) that allowed the comparison of PMEE with EE alone, in the treatment of chronic AT. We extracted the mean and standard deviations for Victorian Institute of Sports Assessment Achilles Tendinopathy (VISA-A), Numerical Pain Rating Scale (NPRS), and load-induced pain (NRS). Standardized mean difference (SMD) of the included variables was presented, and all the studies had low risk of bias. RESULTS Non-significant results were achieved for short-term (pooled SMD = 0.03; 95% CI= -0.46 to 0.53, p = 0.89, I2 = 60%) and long- term follow-ups (pooled SMD =0.43; 95% CI= -0.05 to 0.92, p = 0.08, I2 = 82%) of VISA-A. Short-term (pooled SMD = -0.16; 95% CI= -0.72 to 0.40, p = 0.57, I2 = 40%) and long-term (pooled SMD = -0.39;95% CI= -1.11 to 0.32, p = 0.28, I2 = 62%) follow-up analysis of NPRS and long-term(pooled SMD = -0.46; 95% CI= -1.08 to 0.15, p = 0.14, I2 = 74%) follow-up of load induced pain also demonstrated non-significant improvements when comparing two groups. CONCLUSION Meta- analysis of the results published in the 8 papers that met theinclusion criteria showed no significant differences between PMEE and EE, in terms of load-induced pain (NRS) and numerical pain rating scales (NPRS) at 4 and 12-16 weeks. Thus, the meta-analysis reflects the other cited published work that PMEE shows no greater advantage than EE in the treatment of Chronic Achilles Tendinopathy.
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Affiliation(s)
- Nitin Kumar Arora
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, Acentral University, New Delhi, India; Hochschule fur Gesundheit Bochum, 44801, Germany
| | - Saurabh Sharma
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, Acentral University, New Delhi, India.
| | - Shalini Sharma
- Department of Physiotherapy, Geri Care Home, Melbourne, Victoria, Australia
| | - Ishant Kumar Arora
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, Acentral University, New Delhi, India
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24
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Johnson LG, Buck EH, Anastasio AT, Abar B, Fletcher AN, Adams SB. Efficacy of Platelet-Rich Plasma in Soft Tissue Foot and Ankle Pathology. JBJS Rev 2022; 10:01874474-202210000-00002. [PMID: 36191089 DOI: 10.2106/jbjs.rvw.22.00059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
➢ The preparation methodology for platelet-rich plasma (PRP) may have important clinical implications with varying effectiveness with leukocyte, platelet, and growth factor concentrations. ➢ There is high-quality evidence to support the superiority of PRP over corticosteroids in the case of chronic plantar fasciitis. ➢ There is moderate-quality to high-quality evidence for PRP's ability to increase tendon thickness with no capacity to decrease pain, increase function, or augment percutaneous tenotomy in Achilles tendinopathy. ➢ There is insufficient evidence to support PRP injections in the definitive treatment of Achilles tendon rupture. However, PRP may contribute to postoperative recovery after tendon rupture repair, but this requires further research. ➢ The biochemical theory supporting the clinical use of PRP must be reinforced with high-level evidence research. Based on the current literature, PRP may serve as a viable treatment method in chronic plantar fasciitis. Further high-quality, comparative studies with longer clinical follow-up are required to support recommendations for use of PRP in the treatment of Achilles tendon pathology.
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Affiliation(s)
- Lindsey G Johnson
- Orthopaedic Surgery Department, Duke University Medical Center, Durham, North Carolina
- Campbell University School of Osteopathic Medicine, Lillington, North Carolina
| | - Erin H Buck
- Campbell University School of Osteopathic Medicine, Lillington, North Carolina
| | - Albert T Anastasio
- Orthopaedic Surgery Department, Duke University Medical Center, Durham, North Carolina
| | - Bijan Abar
- Orthopaedic Surgery Department, Duke University Medical Center, Durham, North Carolina
| | - Amanda N Fletcher
- Orthopaedic Surgery Department, Duke University Medical Center, Durham, North Carolina
| | - Samuel B Adams
- Orthopaedic Surgery Department, Duke University Medical Center, Durham, North Carolina
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25
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Lewis TL, Yip GCK, Robertson K, Groom WD, Francis R, Singh S, Walker R, Abbasian A, Latif A. Health-related quality of life in patients with Achilles tendinopathy: Comparison to the general population of the United Kingdom. Foot Ankle Surg 2022; 28:1064-1068. [PMID: 35279393 DOI: 10.1016/j.fas.2022.02.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/31/2022] [Accepted: 02/26/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND There is little evidence available regarding the impact of Achilles Tendinopathy (AT) on health-related quality of life (HRQOL). The primary aim of this study was to quantify the clinical and health-related quality-of-life patient-reported outcome measures for a population presenting with either mid-substance or insertional Achilles tendinopathy. METHODS A prospective comparative observational study of consecutive patients with AT presenting for extracorporeal shockwave therapy (ESWT) at a large teaching hospital. The primary outcome was assessment of a validated health-related quality of life PROMs (Euroqol EQ-5D-5L) and comparison to 2 general UK population datasets. The secondary outcomes were Visual Analogue Pain Scale (VAS-Pain) and two validated foot-specific patient reported outcome measures (Foot Function Index (FFI) and Victorian Institute of Sports Assessment-Achilles (VISA-A)). RESULTS Between March 2014 and June 2021, 320 consecutive patients (125 male; 195 female) were diagnosed with AT and referred for a first course of ESWT. EQ-5D-5L PROMs were prospectively collected for 303 of these patients (94.7%). The mean age (± standard deviation(SD)) was 52.1 ± 11.4 years. The mean EQ-5D-5L Index score (mean±SD) for the AT cohort was 0.783 ± 0.131. Patients less than 55 years with AT had a statistically significantly worse quality of life compared with members of the same age group in the general population. The mean VAS-Pain, FFI, VISA-A clinical outcome scores were 6.0 ± 2.3, 49.5 ± 21.2 and 34.1 ± 14.4 respectively. There was a statistically significant moderate correlation between HRQOL and clinical PROMs (VAS-Pain and FFI vs EQ-5D) however there was no correlation with age. CONCLUSION This study demonstrates that patients under the age of 55 with AT have a significantly reduced quality of life compared with the general population. LEVEL OF EVIDENCE III.
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Affiliation(s)
- T L Lewis
- Guy's and St Thomas' NHS Foundation Trust, Maze Pond, London SE1 9RT, United Kingdom.
| | - G C K Yip
- Guy's and St Thomas' NHS Foundation Trust, Maze Pond, London SE1 9RT, United Kingdom
| | - K Robertson
- Guy's and St Thomas' NHS Foundation Trust, Maze Pond, London SE1 9RT, United Kingdom
| | - W D Groom
- Guy's and St Thomas' NHS Foundation Trust, Maze Pond, London SE1 9RT, United Kingdom
| | - R Francis
- Guy's and St Thomas' NHS Foundation Trust, Maze Pond, London SE1 9RT, United Kingdom
| | - S Singh
- Guy's and St Thomas' NHS Foundation Trust, Maze Pond, London SE1 9RT, United Kingdom
| | - R Walker
- Guy's and St Thomas' NHS Foundation Trust, Maze Pond, London SE1 9RT, United Kingdom
| | - A Abbasian
- Guy's and St Thomas' NHS Foundation Trust, Maze Pond, London SE1 9RT, United Kingdom
| | - A Latif
- Guy's and St Thomas' NHS Foundation Trust, Maze Pond, London SE1 9RT, United Kingdom
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26
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Lalumiere M, Bourbonnais D, Goyette M, Perrino S, Desmeules F, Gagnon DH. Unilateral symptomatic Achilles tendinopathy has limited effects on bilateral lower limb ground reaction force asymmetries and muscular synergy attributes when walking at natural and fast speeds. J Foot Ankle Res 2022; 15:66. [PMID: 36071465 PMCID: PMC9450385 DOI: 10.1186/s13047-022-00570-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 08/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Achilles tendinopathy (AT) may affect ground reaction force (GRF) and muscle synergy (MS) during walking due to pain, biological integrity changes in the tendon and neuroplastic adaptations. The objective of this study was to compare GRF asymmetries and MS attributes between symptomatic and asymptomatic lower limbs (LL) during walking at natural and fast speeds in adults with unilateral AT. METHODS A convenience sample consisting of twenty-eight participants walked on an instrumented treadmill at natural (1.3 m/s) and fast (1.6 m/s) speeds. Peak GRF were measured in mediolateral, anteroposterior and vertical directions. Individualized electromyography (EMG) activation profiles were time- and amplitude-normalized for three consecutive gait cycles and MS were extracted using non-negative matrix factorization algorithms. MS were characterized by the number, composition (i.e., weighting of each muscle) and temporal profiles (i.e., duration and amplitude) of the MS extracted during walking. Paired Student's t-tests assessed peak GRF and MS muscle weighting differences between sides whereas Pearson correlation coefficients characterized the similarities of the individualized EMG and MS activation temporal profiles within sides. RESULTS AT had limited effects on peak GRF asymmetries and the number, composition and temporal profiles of MS between symptomatic and asymptomatic LL while walking on a level treadmill at natural and fast speeds. In most participants, four MS with a specific set of predominantly activated muscles were extracted across natural (71 and 61%) and fast (54 and 50%) walking speeds for the symptomatic and asymptomatic side respectively. Individualized EMG activation profiles were relatively similar between sides (r = 0.970 to 0.999). As for MS attributes, relatively similar temporal activation profiles (r = 0.988 to 0.998) and muscle weightings (p < 0.05) were found between sides for all four MS and the most solicited muscles. Although the faster walking speed increased the number of merged MS for both sides, it did not significantly alter MS symmetry. CONCLUSION Faster walking speed increased peak GRF values but had limited effects on GRF symmetries and MS attribute differences between the LL. Corticospinal neuroplastic adaptations associated with chronic unilateral AT may explain the preserved quasi-symmetric LL motor control strategy observed during natural and fast walking among adults with chronic unilateral AT.
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Affiliation(s)
- Mathieu Lalumiere
- Faculty of Medicine, School of Rehabilitation, Université de Montréal, P.O. Box 6128, Station Centre-Ville, Montreal, QC, H3C 3J7, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
| | - Daniel Bourbonnais
- Faculty of Medicine, School of Rehabilitation, Université de Montréal, P.O. Box 6128, Station Centre-Ville, Montreal, QC, H3C 3J7, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
| | - Michel Goyette
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
| | - Sarah Perrino
- Faculty of Medicine, School of Rehabilitation, Université de Montréal, P.O. Box 6128, Station Centre-Ville, Montreal, QC, H3C 3J7, Canada
| | - François Desmeules
- Faculty of Medicine, School of Rehabilitation, Université de Montréal, P.O. Box 6128, Station Centre-Ville, Montreal, QC, H3C 3J7, Canada
- Centre de recherche de l'Hôpital Maisonneuve-Rosemont (CRHMR), Montreal, QC, Canada
| | - Dany H Gagnon
- Faculty of Medicine, School of Rehabilitation, Université de Montréal, P.O. Box 6128, Station Centre-Ville, Montreal, QC, H3C 3J7, Canada.
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada.
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27
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Merry K, Napier C, Waugh CM, Scott A. Foundational Principles and Adaptation of the Healthy and Pathological Achilles Tendon in Response to Resistance Exercise: A Narrative Review and Clinical Implications. J Clin Med 2022; 11:4722. [PMID: 36012960 PMCID: PMC9410084 DOI: 10.3390/jcm11164722] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/03/2022] [Accepted: 08/08/2022] [Indexed: 12/03/2022] Open
Abstract
Therapeutic exercise is widely considered a first line fundamental treatment option for managing tendinopathies. As the Achilles tendon is critical for locomotion, chronic Achilles tendinopathy can have a substantial impact on an individual's ability to work and on their participation in physical activity or sport and overall quality of life. The recalcitrant nature of Achilles tendinopathy coupled with substantial variation in clinician-prescribed therapeutic exercises may contribute to suboptimal outcomes. Further, loading the Achilles tendon with sufficiently high loads to elicit positive tendon adaptation (and therefore promote symptom alleviation) is challenging, and few works have explored tissue loading optimization for individuals with tendinopathy. The mechanism of therapeutic benefit that exercise therapy exerts on Achilles tendinopathy is also a subject of ongoing debate. Resultingly, many factors that may contribute to an optimal therapeutic exercise protocol for Achilles tendinopathy are not well described. The aim of this narrative review is to explore the principles of tendon remodeling under resistance-based exercise in both healthy and pathologic tissues, and to review the biomechanical principles of Achilles tendon loading mechanics which may impact an optimized therapeutic exercise prescription for Achilles tendinopathy.
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Affiliation(s)
- Kohle Merry
- Department of Physical Therapy, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Centre for Hip Health and Mobility, Vancouver, BC V5Z 1M9, Canada
| | - Christopher Napier
- Department of Physical Therapy, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Centre for Hip Health and Mobility, Vancouver, BC V5Z 1M9, Canada
| | - Charlie M. Waugh
- Department of Physical Therapy, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Centre for Hip Health and Mobility, Vancouver, BC V5Z 1M9, Canada
| | - Alex Scott
- Department of Physical Therapy, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Centre for Hip Health and Mobility, Vancouver, BC V5Z 1M9, Canada
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28
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Gundogdu K, Yilmaz Tasci S, Gundogdu G, Terim Kapakin KA, Totik Y, Demirkaya Miloglu F. Evaluation of cytokines in protective effect of docosahexaenoic acid in experimental achilles tendinopathy rat model induced with type-1 collagenase. Connect Tissue Res 2022; 63:393-405. [PMID: 34612118 DOI: 10.1080/03008207.2021.1982915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND We aimed to investigate the effectiveness of docosahexaenoic acid (DHA) as a treatment for Achilles tendinopathy (AT) induced with type-I collagenase in rats and compare it with collagen. METHODS The AT model was induced with type I collagenase, and animals were randomly assigned to groups. Group 1:AT, Group 2: Collagen (7.2 mg/kg/day), Group 3:DHA (300 mg/kg/day), and Group 4:DHA (100 mg/kg/day). Right tendons of Group1 were used as a healthy control (HC). Oral treatments were applied for eight weeks. Serum tumor necrosis factor-alpha(TNF-α), matrix metalloproteinase-13 (MMP-13), and interleukin-1 beta(IL-1β) concentrations were determined by ELISA. Tendon samples were taken for histopathological evaluation and examined immunohistochemically with antibodies specific for Col1A1, TNF-α, MMP-13, IL-1β, and nitric oxide synthase-2(NOS-2). The ultimate tensile force (UTF) yield force(YF) and stiffness were measured by biomechanical assessments. RESULTS UTF,YF and stiffness values were increased in all treatment groups compared to the AT control, a significant increase was found in Group 2 (p < 0.05). There was severe degeneration of tendon cells in the AT control. The tendon cells in samples from Groups 2-3 were less degraded, and this was statistically significant (p < 0.05). TNF-α, MMP-13, IL-1β, and NOS-2 expressions were significantly higher in the AT control compared to the HC. In all treatment groups, their concentrations were lower than in the AT control. Serum TNF-α, MMP-13, and IL-1β levels were lower in all treatment groups (Especially in Group3 (p < 0.001)) compared to Group1. CONCLUSION The efficacy of high-dose DHA as a treatment for AT was investigated from biochemical, histopathological, and biomechanical perspectives. The results showed that DHA could be an alternative treatment compound to collagen.
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Affiliation(s)
- Koksal Gundogdu
- Department of Orthopedics and Traumatology, Denizli State Hospital, Denizli, Turkey
| | | | - Gulsah Gundogdu
- Department of Physiology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Kubra Asena Terim Kapakin
- Department of Veterinary Pathology, Faculty of Veterinary Medicine, Ataturk University, Erzurum, Turkey
| | - Yasar Totik
- Department of Machine Engineering, Faculty of Engineering, Ataturk University, Erzurum, Turkey
| | - Fatma Demirkaya Miloglu
- Department of Analytical Chemistry, Faculty of Pharmacy, Ataturk University, Erzurum, Turkey
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29
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Park YH, Kim W, Kim JY, Choi GW, Kim HJ. Clinical Impact of Metabolic Syndrome on Eccentric Exercises for Chronic Insertional Achilles Tendinopathy. J Foot Ankle Surg 2022; 61:726-729. [PMID: 34887161 DOI: 10.1053/j.jfas.2021.03.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 01/21/2021] [Accepted: 03/07/2021] [Indexed: 02/08/2023]
Abstract
Metabolic syndrome is one factor known to contribute to the development of tendinopathies. The aim of this study was to compare the clinical outcomes of eccentric calf-muscle exercise for treatment of chronic insertional Achilles tendinopathy in patients with or without metabolic syndrome. Twenty-eight patients with chronic insertional Achilles tendinopathy and metabolic syndrome who performed eccentric calf-muscle exercise were retrospectively compared with 28 age- and sex-matched controls without metabolic syndrome. Comparisons between the 2 groups were made by evaluating the Visual Analog Scale for pain, patient satisfaction, and amount of pain medications needed during 3 months of follow-up. Two-way analysis of variance with repeated measures showed that the pain scales in the metabolic syndrome group were higher than those in the control group during the follow-up period (F[1,54] = 24.45, p < .001). The patient satisfaction ratings were lower and the amount of required pain medication was higher in the metabolic syndrome group (p < .001 and p < .001, respectively). Eccentric calf-muscle exercises for chronic insertional Achilles tendinopathy were less effective in patients with metabolic syndrome. Therefore, these patients should be managed with a combination of other treatment modalities rather than eccentric exercise alone.
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Affiliation(s)
- Young Hwan Park
- Department of Orthopedic Surgery, Korea University Guro Hospital, Seoul, Korea
| | - Woon Kim
- Department of Orthopedic Surgery, Korea University Guro Hospital, Seoul, Korea
| | - Jae Young Kim
- Department of Orthopedic Surgery, Korea University Guro Hospital, Seoul, Korea
| | - Gi Won Choi
- Department of Orthopedic Surgery, Korea University Ansan Hospital, Ansan, Korea
| | - Hak Jun Kim
- Department of Orthopedic Surgery, Korea University Guro Hospital, Seoul, Korea.
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30
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Lewis TL, Srirangarajan T, Patel A, Yip GCK, Hussain L, Walker R, Singh S, Latif A, Abbasian A. Clinical outcomes following surgical management of insertional Achilles tendinopathy using a double-row suture bridge technique with mean two-year follow-up. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2022; 33:1179-1184. [PMID: 35507118 DOI: 10.1007/s00590-022-03270-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/15/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The clinical outcomes following surgical management of insertional Achilles tendinopathy (IAT) vary depending on the surgical technique used to reattach the Achilles tendon following debridement. The aim of this study was to investigate the clinical outcomes of patients with IAT who underwent surgical management with a double-row suture bridge technique used to reattach the Achilles tendon. METHODS A retrospective review of consecutive patients diagnosed with IAT, who underwent surgical management utilising a double-row suture bridge technique (Arthex Speedbridge), and a minimum of 3-month follow-up were included. The primary outcome was the Manchester-Oxford Foot Questionnaire (MOXFQ) Index score which is a patient reported outcome measure (PROM). Secondary outcomes included EuroQol EQ-5D-5L health-related quality of life PROM and complication rates. RESULTS Between July 2013 and June 2020, 50 consecutive patients (23 male; 27 female) were included. The mean age (± standard deviation) was 52.3 ± 11.3 (range 29.0-84.3). Pre- and post-operative PROM data were available for all cases. The mean follow-up was 2.4 ± 1.9 years. The MOXFQ Index score improved from 48.5 to 12.4 (p < 0.01), EQ-5D-5L improved from 2.7 ± 0.46 to 1.2 ± 0.37 (p < 0.01), and EQ-VAS improved from 48.0 ± 18.4 to 84.1 ± 12.6 (p < 0.01). Four patients had complications which were of minimal clinical relevance and caused no deviation from routine recovery. There were no cases of tendon rupture. CONCLUSION This study has demonstrated that surgical management of IAT is safe and effective with clinical improvement in both clinical and general health-related quality of life outcome PROMs. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- T L Lewis
- Guy's and St Thomas' NHS Foundation Trust, Maze Pond, London, SE1 9RT, UK.
| | - T Srirangarajan
- Guy's and St Thomas' NHS Foundation Trust, Maze Pond, London, SE1 9RT, UK
| | - A Patel
- Guy's and St Thomas' NHS Foundation Trust, Maze Pond, London, SE1 9RT, UK
| | - G C K Yip
- Guy's and St Thomas' NHS Foundation Trust, Maze Pond, London, SE1 9RT, UK
| | - L Hussain
- Guy's and St Thomas' NHS Foundation Trust, Maze Pond, London, SE1 9RT, UK
| | - R Walker
- Guy's and St Thomas' NHS Foundation Trust, Maze Pond, London, SE1 9RT, UK
| | - S Singh
- Guy's and St Thomas' NHS Foundation Trust, Maze Pond, London, SE1 9RT, UK
| | - A Latif
- Guy's and St Thomas' NHS Foundation Trust, Maze Pond, London, SE1 9RT, UK
| | - A Abbasian
- Guy's and St Thomas' NHS Foundation Trust, Maze Pond, London, SE1 9RT, UK
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Abstract
Pediatric trigger thumbs present a conundrum for hand surgeons. Surgery for trigger thumbs has inherent risks, such as infection, nerve injury, and the risks of anesthesia, but will reliably solve the problem. But is surgical intervention necessary? Would these cases resolve spontaneously, eventually, without intervention? If not, what are the long-term consequences of the inability to fully extend the thumb interphalangeal joint? We present a pediatric trigger thumb that was symptomatic for 22 years, with complete resolution of symptoms after surgical intervention. This report illustrates at least some pediatric trigger thumbs will not resolve without surgical intervention, but treatment, even after 21 years, can result in normal thumb motion and function.
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Affiliation(s)
- Vinay Rao
- The Warren Alpert Medical School of Brown University, Providence, RI, USA,Vinay Rao, Division of Plastic Surgery, The Warren Alpert Medical School of Brown University, 2 Dudley Street, Suite 500, Providence, RI 02905, USA.
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32
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Wang F, Shan H, Song G, Chen S, Zhang C, Liu Y, Wu T. 17β-Estradiol attenuates inflammation and tendon degeneration in a rat model of Achilles tendinitis. Immunopharmacol Immunotoxicol 2022; 44:556-564. [PMID: 35404181 DOI: 10.1080/08923973.2022.2065639] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION 17β-Estradiol (E2) is an immune-regulatory agent with anti-inflammatory effects. However, it is still unknown whether E2 exerts pharmacological properties against Achilles tendinitis (AT). This study aims to investigate the effects of E2 on AT and its underlying mechanisms. MATERIALS AND METHODS The established model of Achilles tendinitis was intraperitoneally injected with E2 (10, 20, or 30 μg/kg/d). After 8 weeks, biomechanical properties of the Achilles tendon were determined. Hydroxyproline content and tendon degeneration-related biomarkers were determined. The levels of inflammatory cytokines and apoptotic-related biomarkers in tendon tissues were determined. Furthermore, western blotting was determined to detect the expressions of ER-α and the PI3K/Akt pathway in tendon tissues. RESULTS E2 relieved AT-related symptoms in a dose-dependent manner. E2 ameliorated tendon degeneration by regulating tendon degeneration-related biomarkers (e.g., collagen type I and III, Decorin (DCN), and tenascin-C). Besides, treatment with E2 suppressed inflammatory cytokines and increased anti-inflammatory cytokines. Treatment with E2 also regulated cell apoptosis in tendon tissues. The underlying mechanism study revealed that treatment with E2 activated ER-α and upregulated the PI3K/Akt pathway. CONCLUSION The regulatory effects of E2 on inflammation and tendon degeneration in a rat model of AT were associated with the ER-α and the PI3K/Akt signaling pathways.
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Affiliation(s)
- Feng Wang
- Department of Orthopaedical Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200000, China
| | - Haojie Shan
- Department of Orthopaedical Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200000, China
| | - Guoxun Song
- Department of Orthopaedical Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200000, China
| | - Song Chen
- Department of Orthopaedical Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200000, China
| | - Chengyuan Zhang
- Department of Orthopaedical Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200000, China
| | - Yingjie Liu
- Department of Orthopaedical Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200000, China
| | - Tianyi Wu
- Department of Orthopaedical Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200000, China
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Mercer NP, Gianakos AL, Kaplan DJ, Dankert JF, Kanakamedala A, Chen JS, Colasanti CA, Hurley ET, Stone JW, Kennedy JG. Achilles Paratenon Needle Tendoscopy in the Office Setting. Arthrosc Tech 2022; 11:e315-e320. [PMID: 35256969 PMCID: PMC8897562 DOI: 10.1016/j.eats.2021.10.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 10/28/2021] [Indexed: 02/03/2023] Open
Abstract
Achilles tendinopathy is a common inflammatory condition of the Achilles tendon prevalent in the athletic population in which patients present with pain, swelling, and reduced performance exacerbated by physical activity. Operative intervention using either open or percutaneous approaches has traditionally been performed after failure of nonoperative treatment, but less invasive modalities that include endoscopic approaches have been increasingly used. This Technical Note highlights our technique for Achilles paratenon needle tendoscopy in the wide-awake office setting, with accompanying indications for use, advantages, and technical pearls.
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Affiliation(s)
- Nathaniel P. Mercer
- NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York, U.S.A
| | - Arianna L. Gianakos
- Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Daniel J. Kaplan
- NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York, U.S.A
| | - John F. Dankert
- NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York, U.S.A
| | - Ajay Kanakamedala
- NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York, U.S.A
| | - Jeffrey S. Chen
- NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York, U.S.A
| | | | - Eoghan T. Hurley
- NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York, U.S.A
| | - James W. Stone
- Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - John G. Kennedy
- NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York, U.S.A
- Address correspondence to John G. Kennedy, M.D., M.Ch., M.M.Sc., F.F.S.E.M., F.R.C.S.(Orth), NYU Langone Health, NYU Langone Orthopedic Hospital, 171 Delancey St, Ste 259; New York, NY 10002, U.S.A.
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Cengiz B, Karaoglu S. Clinical results of the Keck and Kelly Wedge Osteotomy approach in Haglund's deformity: Minimum 3-year follow-up. Foot Ankle Surg 2022; 28:269-275. [PMID: 34674937 DOI: 10.1016/j.fas.2021.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/23/2021] [Accepted: 10/06/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND PURPOSE The Haglund's deformity, which may be difficult to treat non-surgically, is caused by a prominent bone hump in the posterosuperior region of the calcaneus and may be associated with bursitis and foot pain. Many surgical treatments for resistant Haglund deformities have been described. Here, we evaluate the AOFAS scores, pain and other characteristics of patients undergoing removal of the dorsally based wedge from the posterior calcaneus with the Keck and Kelly procedure. MATERIALS AND METHODS The study included 20 patients who had undergone the Keck and Kelly procedure at our center, from 2011 to 2019, and had attended follow-up for at least three years. Analyses were performed retrospectively. Preoperative (immediately before surgery) and postoperative (at last assessment) American Orthopedic Foot and Ankle Society (AOFAS) and visual analog pain scale scores (VAS) were determined, and calcaneal inclination angles were radiologically measured. Additionally, calcaneal pitch angle (CPA), Fowler and Philip angle (FPA), and Bohler angle were recorded. RESULTS Fourteen patients were female, and six were male, mean age was 45.8 ± 8.1 years. AOFAS scores were significantly increased, whereas VAS scores were significantly decreased after surgery. Postoperative AOFAS scores were correlated with preoperative VAS, CPA, and FPA values. Preoperative VAS scores were correlated with CPA, FPA, and Bohler angle values. FPA and CPA values were correlated positively. CONCLUSIONS It was found that ankle functions improved, and pain levels decreased after Keck and Kelly Wedge Osteotomy was applied for the treatment of Haglund's deformity. CPA and FPA were associated with both pain levels and ankle function. The Keck and Kelly Wedge Osteotomy procedure appears to be a preferable approach for the surgical treatment of Haglund's deformity.
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Affiliation(s)
- Bertan Cengiz
- Department of Orthopedics and Traumatology, Acibadem Kayseri Hospital, Kayseri, Turkey.
| | - Sinan Karaoglu
- Department of Orthopedics and Traumatology, Acibadem Kayseri Hospital, Kayseri, Turkey
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Exercise Effects on the Biomechanical Properties of the Achilles Tendon—A Narrative Review. BIOLOGY 2022; 11:biology11020172. [PMID: 35205039 PMCID: PMC8869522 DOI: 10.3390/biology11020172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/01/2022] [Accepted: 01/18/2022] [Indexed: 11/25/2022]
Abstract
Simple Summary The Achilles tendon influences the running economy because of its ability to store and release strain energy, and it remains one of the most vulnerable tendons among athletes and recreational runners. Exercised-related mechanical loading appears to induce changes in the Achilles tendon morphology and mechanical material properties. Both acute and relatively long-term exercise induces tendon adaptation, although biomechanical changes, e.g., cross-sectional area, plantarflexion moment, Young’s modulus, and stiffness, in response to exercise duration, type, and loading-regimes differ widely. Furthermore, a strong Achilles tendon can be developed by chronic exposure to habitual mechanical loading from daily exercise, which is associated with greater energy storage, release and overall health. Abstract The morphological and mechanical properties (e.g., stiffness, stress, and force) of the Achilles tendon (AT) are generally associated with its tendinosis and ruptures, particularly amongst runners. Interest in potential approaches to reduce or prevent the risk of AT injuries has grown exponentially as tendon mechanics have been efficiently improving. The following review aims to discuss the effect of different types of exercise on the AT properties. In this review article, we review literature showing the possibility to influence the mechanical properties of the AT from the perspective of acute exercise and long-term training interventions, and we discuss the reasons for inconsistent results. Finally, we review the role of the habitual state in the AT properties. The findings of the included studies suggest that physical exercise could efficiently improve the AT mechanical properties. In particular, relatively long-term and low-intensity eccentric training may be a useful adjunct to enhance the mechanical loading of the AT.
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Robinson DM, Tan CO, Tenforde AS. Functional Gains Using Radial and Combined Shockwave Therapy in the Management of Achilles Tendinopathy. J Foot Ankle Surg 2022; 61:99-103. [PMID: 34274243 DOI: 10.1053/j.jfas.2021.06.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/02/2021] [Accepted: 06/08/2021] [Indexed: 02/03/2023]
Abstract
Achilles tendinopathy is a common condition and many patients have functional limitations after initial conservative treatment. Shockwave therapy has been shown to improve function within patients; however, comparative outcomes for different forms of shockwave are poorly described. In this retrospective cohort study, we describe findings from a quality improvement initiative evaluating safety and functional outcomes after treatment with radial shockwave therapy (n = 58) or combined radial and focused shockwave therapy (n = 29) for patients with Achilles tendinopathy refractory to exercise therapy. All patients were prescribed an eccentric exercise program. We hypothesized both groups would see improvements in function quantified using the Victorian Institute of Sports Assessment-Achilles with similar safety outcomes. Overall, the minimal clinically important difference (defined at 7 for insertional and 12 for noninsertional Achilles tendinopathy) was met in a greater proportion of patients treated with combined shockwave compared to radial shockwave (26 [89.7%] vs 37 [63.8%], p = .022). The change in Victorian Institute of Sports Assessment-Achilles from baseline to final treatment was not different between combined and radial-only groups (23.3 ± 12.6 vs 19.9 ± 18.7, p = .2). Within group differences from baseline to final follow-up measures (mean duration 17.9 ± 14.8 weeks) demonstrated overall functional improvement for both groups (both p < .0001). No serious adverse effects were observed. Our findings suggest combined radial and focused shockwave therapy may provide more predictable functional gains for treatment of Achilles tendinopathy compared to radial shockwave therapy.
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Affiliation(s)
- David M Robinson
- Resident, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Charlestown, MA
| | - Can O Tan
- Assistant Professor, Spaulding Research Institute, Spaulding Rehabilitation Hospital, Boston, MA; Associate Professor, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Charlestown, MA
| | - Adam S Tenforde
- Associate Professor, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Charlestown, MA.
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He L, Yu T, Zhang W, Wang B, Ma Y, Li S. Causal Associations of Obesity With Achilles Tendinopathy: A Two-Sample Mendelian Randomization Study. Front Endocrinol (Lausanne) 2022; 13:902142. [PMID: 35774146 PMCID: PMC9238354 DOI: 10.3389/fendo.2022.902142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/11/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Achilles tendinopathy (AT) is associated with severe pain and is the cause of dysfunction and disability that are associated with significant reduction in social and economic benefits. Several potential risk factors have been proposed to be responsible for AT development; however, the results of observational epidemiological studies remain controversial, presumably because the designs of these studies are subject to residual confounding and reverse causality. Mendelian randomization (MR) can infer the causality between exposure and disease outcomes using genetic variants as instrumental variables, and identification of the causal risk factors for AT is beneficial for early intervention. Thus, we employed the MR strategy to evaluate the causal associations between previously reported risk factors (anthropometric parameters, lifestyle factors, blood biomarkers, and systemic diseases) and the risk of AT. METHODS Univariable MR was performed to screen for potential causal associations between the putative risk factors and AT. Bidirectional MR was used to infer reverse causality. Multivariable MR was conducted to investigate the body mass index (BMI)-independent causal effect of other obesity-related traits, such as the waist-hip ratio, on AT. RESULTS Univariable MR analyses with the inverse-variance weighted method indicated that the genetically predicted BMI was significantly associated with the risk of AT (P=2.0×10-3), and the odds ratios (95% confidence intervals) is 1.44 (1.14-1.81) per 1-SD increase in BMI. For the other tested risk factors, no causality with AT was identified using any of the MR methods. Bidirectional MR suggested that AT was not causally associated with BMI, and multivariable MR indicated that other anthropometric parameters included in this study were not likely to causally associate with the risk of AT after adjusting for BMI. CONCLUSIONS The causal association between BMI and AT risk suggests that weight control is a promising strategy for preventing AT and alleviating the corresponding disease burden.
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Affiliation(s)
- Lijuan He
- DongFang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Tingting Yu
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Wei Zhang
- Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China
| | - Baojian Wang
- Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China
| | - Yufeng Ma
- Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China
- *Correspondence: Sen Li, ; Yufeng Ma,
| | - Sen Li
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
- *Correspondence: Sen Li, ; Yufeng Ma,
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38
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Leahy T, Nuss C, Evans MK, Fung A, Shetye S, Soslowsky LJ. Achilles Tendon Ruptures in Middle-Aged Rats Heal Poorly Compared With Those in Young and Old Rats [Formula: see text]. Am J Sports Med 2022; 50:170-181. [PMID: 34851182 PMCID: PMC8819270 DOI: 10.1177/03635465211055476] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Achilles tendon ruptures are painful and debilitating injuries and are most common in middle-aged patients. There is a lack of understanding of the underlying causes for increased rupture rates in middle-aged patients and how healing outcomes after a rupture might be affected by patient age. Therefore, the objective of this study was to define age-specific Achilles tendon healing by assessing ankle functional outcomes and Achilles tendon mechanical and histological properties after a rupture using a rat model. HYPOTHESIS Rats representing the middle-aged patient population would demonstrate reduced healing capability after an Achilles tendon rupture, as demonstrated by a slower return to baseline ankle functional properties and inferior biomechanical and histological tendon properties. STUDY DESIGN Controlled laboratory study. METHODS Fischer 344 rats were categorized by age to represent young, middle-aged, and old patients, and Achilles tendon ruptures were induced in the right hindlimb. Animals were allowed to heal and were euthanized at 3 or 6 weeks after the injury. In vivo functional assays and ultrasound imaging were performed throughout the healing period, and ex vivo tendon mechanical and histological properties were assessed after euthanasia. RESULTS Rats representing middle-aged patients displayed reduced healing potential compared with the other age groups, as they demonstrated decreased recovery of in vivo functional and ultrasound assessment parameters and inferior mechanical and histological properties after an Achilles tendon rupture. CONCLUSION These findings may help explain the increased rupture rate observed clinically in middle-aged patients by suggesting that there may be altered tendon responses to daily trauma. CLINICAL RELEVANCE The results provide novel data on age-specific healing outcomes after an Achilles tendon rupture, which underscores the importance of considering a patient's age during treatment and expectations for outcomes.
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Affiliation(s)
- Thomas Leahy
- McKay Orthopaedic Laboratory, University of Pennsylvania, Philadelphia, PA, USA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Courtney Nuss
- McKay Orthopaedic Laboratory, University of Pennsylvania, Philadelphia, PA, USA
| | - Mary Kate Evans
- McKay Orthopaedic Laboratory, University of Pennsylvania, Philadelphia, PA, USA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Ashley Fung
- McKay Orthopaedic Laboratory, University of Pennsylvania, Philadelphia, PA, USA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Snehal Shetye
- McKay Orthopaedic Laboratory, University of Pennsylvania, Philadelphia, PA, USA
| | - Louis J. Soslowsky
- McKay Orthopaedic Laboratory, University of Pennsylvania, Philadelphia, PA, USA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
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Frizziero A, Vittadini F, Bigliardi D, Costantino C. Low Molecular Weight Hyaluronic Acid (500-730 Kda) Injections in Tendinopathies-A Narrative Review. J Funct Morphol Kinesiol 2021; 7:3. [PMID: 35076509 PMCID: PMC8788555 DOI: 10.3390/jfmk7010003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 12/23/2021] [Accepted: 12/27/2021] [Indexed: 11/25/2022] Open
Abstract
Tendinopathies are common causes of pain and disability in general population and athletes. Conservative treatment is largely preferred, and eccentric exercise or other modalities of therapeutic exercises are recommended. However, this approach requests several weeks of consecutive treatment and could be discouraging. In the last years, injections of different formulations were evaluated to accelerate functional recovery in combination with usual therapy. Hyaluronic acid (HA) preparations were proposed, in particular LMW-HA (500-730 kDa) for its unique molecular characteristics in favored extracellular matrix homeostasis and tenocyte viability. The purpose of our review is to evaluate the state-of-the-art about the role of 500-730 kDa in tendinopathies considering both preclinical and clinical findings and encourage further research on this emerging topic.
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Affiliation(s)
- Antonio Frizziero
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (D.B.); (C.C.)
| | - Filippo Vittadini
- Department of Physical and Rehabilitation Medicine, Casa di Cura Policlinico S. Marco, 30100 Venice, Italy;
| | - Davide Bigliardi
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (D.B.); (C.C.)
| | - Cosimo Costantino
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (D.B.); (C.C.)
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40
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Matthews W, Ellis R, Furness J, Hing WA. The clinical diagnosis of Achilles tendinopathy: a scoping review. PeerJ 2021; 9:e12166. [PMID: 34692248 PMCID: PMC8485842 DOI: 10.7717/peerj.12166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/25/2021] [Indexed: 12/13/2022] Open
Abstract
Background Achilles tendinopathy describes the clinical presentation of pain localised to the Achilles tendon and associated loss of function with tendon loading activities. However, clinicians display differing approaches to the diagnosis of Achilles tendinopathy due to inconsistency in the clinical terminology, an evolving understanding of the pathophysiology, and the lack of consensus on clinical tests which could be considered the gold standard for diagnosing Achilles tendinopathy. The primary aim of this scoping review is to provide a method for clinically diagnosing Achilles tendinopathy that aligns with the nine core health domains. Methodology A scoping review was conducted to synthesise available evidence on the clinical diagnosis and clinical outcome measures of Achilles tendinopathy. Extracted data included author, year of publication, participant characteristics, methods for diagnosing Achilles tendinopathy and outcome measures. Results A total of 159 articles were included in this scoping review. The most commonly used subjective measure was self-reported location of pain, while additional measures included pain with tendon loading activity, duration of symptoms and tendon stiffness. The most commonly identified objective clinical test for Achilles tendinopathy was tendon palpation (including pain on palpation, localised tendon thickening or localised swelling). Further objective tests used to assess Achilles tendinopathy included tendon pain during loading activities (single-leg heel raises and hopping) and the Royal London Hospital Test and the Painful Arc Sign. The VISA-A questionnaire as the most commonly used outcome measure to monitor Achilles tendinopathy. However, psychological factors (PES, TKS and PCS) and overall quality of life (SF-12, SF-36 and EQ-5D-5L) were less frequently measured. Conclusions There is significant variation in the methodology and outcome measures used to diagnose Achilles tendinopathy. A method for diagnosing Achilles tendinopathy is proposed, that includes both results from the scoping review and recent recommendations for reporting results in tendinopathy.
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Affiliation(s)
- Wesley Matthews
- Bond Institute of Health and Sport, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Richard Ellis
- Active Living and Rehabilitation: Aotearoa New Zealand, Health and Rehabilitation Research Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand.,Department of Physiotherapy, School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - James Furness
- Bond Institute of Health and Sport, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Wayne A Hing
- Bond Institute of Health and Sport, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
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Savva C, Karagiannis C, Korakakis V, Efstathiou M. The analgesic effect of joint mobilization and manipulation in tendinopathy: a narrative review. J Man Manip Ther 2021; 29:276-287. [PMID: 33769226 PMCID: PMC8491707 DOI: 10.1080/10669817.2021.1904348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective: To summarize the available literature with regards to the potential analgesic effect and mechanism of joint mobilization and manipulation in tendinopathy. Results: The effect of these techniques in rotator cuff tendinopathy and lateral elbow tendinopathy, applied alone, compared to a placebo intervention or along with other interventions has been reported in some randomized controlled trials which have been scrutinized in systematic reviews. Due to the small randomized controlled trials and other methodological limitations of the evidence base, including short-term follow-ups, small sample size and lack of homogenous samples further studies are needed. Literature in other tendinopathies such as medial elbow tendinopathy, de Quervain's disease and Achilles tendinopathy is limited since the analgesic effect of these techniques has been identified in few case series and reports. Therefore, the low methodological quality renders caution in the generalization of findings in clinical practice. Studies on the analgesic mechanism of these techniques highlight the activation of the descending inhibitory pain mechanism and sympathoexcitation although this area needs further investigation. Conclusion: Study suggests that joint mobilization and manipulation may be a potential contributor in the management of tendinopathy as a pre-conditioning process prior to formal exercise loading rehabilitation or other proven effective treatment approaches.
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Affiliation(s)
- Christos Savva
- Department of Health Science, European University, Nicosia, Cyprus
| | | | | | - Michalis Efstathiou
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
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Ruan D, Fei Y, Qian S, Huang Z, Chen W, Tang C, Xiang X, Xu J, Yin Z, Chen X, Heng BC, Liu W, Shen W, Ouyang H. Early-Stage Primary Anti-inflammatory Therapy Enhances the Regenerative Efficacy of Platelet-Rich Plasma in a Rabbit Achilles Tendinopathy Model. Am J Sports Med 2021; 49:3357-3371. [PMID: 34549620 DOI: 10.1177/03635465211037354] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Tendinopathy is a pervasive clinical problem that afflicts both athletes and the general public. Although the inflammatory changes in tendinopathy are well characterized, how the therapeutic effects of platelet-rich plasma (PRP) on tendinopathy are being modulated by the inflammatory environment is not well defined. PURPOSE/HYPOTHESIS In this study, we aimed to compare the therapeutic effects of PRP alone versus a combination of PRP with a primary glucocorticoid (GC) injection at the early stage of tendinopathy. We hypothesized that PRP treatment could promote better tendon regeneration through the suppression of inflammation with GC. STUDY DESIGN Controlled laboratory study. METHODS The gene expression profile of tendon stem/progenitor cells (TSPCs) cultured with PRP was analyzed with RNA sequencing. To evaluate the cell viability, senescence, and apoptosis of TSPCs under different conditions, TSPCs were treated with 0.1 mg/mL triamcinolone acetonide (TA) and/or 10% PRP in an IL1B-induced inflammatory environment. To further verify the effects of the sequential therapy of GCs and PRP, an early tendinopathy animal model was established through a local injection of collagenase in the rabbit Achilles tendon. The tendinopathy model was then treated with isopycnic normal saline (NS group), TA (TA group), PRP (PRP group), or TA and PRP successively (TA+PRP group). At 8 weeks after treatment, the tendons were assessed with magnetic resonance imaging (MRI), histological examination, transmission electron microscopy (TEM), and mechanical testing. RESULTS Gene Ontology enrichment analysis indicated that PRP treatment of TPSCs induced an inflammatory response, regulated cell migration, and remodeled the extracellular matrix. Compared with the sole use of PRP, successive treatment with TA followed by PRP yielded similar results in cell viability and senescence but less cell apoptosis in vitro. In vivo experiments demonstrated that the TA+PRP group achieved significantly better tendon regeneration, as confirmed by MRI, histological examination, TEM, and mechanical testing. CONCLUSION This study showed that the primary use of GCs did not exert any obvious deleterious side effects on the treated tendon but instead enhanced the regenerative effects of PRP in early inflammatory tendinopathy. CLINICAL RELEVANCE The sequential therapy of GCs followed by PRP provides a promising treatment strategy for tendinopathy in clinical practice. PRP combined with the primary use of GCs appears to promote tendon regeneration in early inflammatory tendinopathy.
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Affiliation(s)
- Dengfeng Ruan
- Department of Orthopedic Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Orthopedics Research Institute, Zhejiang University, Hangzhou, China; Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China; Institute of Sports Medicine, Zhejiang University, Hangzhou, China; China Orthopedic Regenerative Medicine Group, Hangzhou, China
| | | | | | | | - Weishan Chen
- Department of Orthopedic Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Orthopedics Research Institute, Zhejiang University, Hangzhou, China; Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China; Institute of Sports Medicine, Zhejiang University, Hangzhou, China
| | - Chenqi Tang
- Department of Orthopedic Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Orthopedics Research Institute, Zhejiang University, Hangzhou, China; Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China; Institute of Sports Medicine, Zhejiang University, Hangzhou, China; Dr Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China; Key Laboratory of Tissue Engineering and Regenerative Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Xinyu Xiang
- Zhejiang University-University of Edinburgh Institute, Zhejiang University School of Medicine, Haining, China
| | - Jialu Xu
- Department of Infectious Diseases, First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China; Hepatology Institute, Wenzhou Medical University, Wenzhou, China; Key Laboratory of Hepatology, Wenzhou Medical University, Wenzhou, China
| | - Zi Yin
- Dr Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China; Department of Orthopedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China; Key Laboratory of Tissue Engineering and Regenerative Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China; China Orthopedic Regenerative Medicine Group, Hangzhou, China
| | - Xiao Chen
- Dr Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China; Department of Orthopedic Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Key Laboratory of Tissue Engineering and Regenerative Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China; China Orthopedic Regenerative Medicine Group, Hangzhou, China
| | | | - Wanlu Liu
- Department of Orthopedic Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Zhejiang University-University of Edinburgh Institute, Zhejiang University School of Medicine, Haining, China; Dr Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Weiliang Shen
- Department of Orthopedic Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Orthopedics Research Institute, Zhejiang University, Hangzhou, China; Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China; Institute of Sports Medicine, Zhejiang University, Hangzhou, China; Dr Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China; Key Laboratory of Tissue Engineering and Regenerative Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China; China Orthopedic Regenerative Medicine Group, Hangzhou, China; Department of Sports Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Hongwei Ouyang
- Dr Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China; Department of Orthopedic Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Zhejiang University-University of Edinburgh Institute, Zhejiang University School of Medicine, Haining, China; Key Laboratory of Tissue Engineering and Regenerative Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China; Department of Sports Medicine, Zhejiang University School of Medicine, Hangzhou, China; China Orthopedic Regenerative Medicine Group, Hangzhou, China.,Investigation performed at the Department of Orthopedic Surgery, Second Affiliated Hospital; Zhejiang University-University of Edinburgh Institute; and School of Basic Medical Sciences; Zhejiang University School of Medicine, Hangzhou, China
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James S, Schuijers J, Daffy J, Cook J, Samiric T. Ciprofloxacin reduces tenocyte viability and proteoglycan synthesis in short-term explant cultures of equine tendon. PeerJ 2021; 9:e12003. [PMID: 34540363 PMCID: PMC8411937 DOI: 10.7717/peerj.12003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/27/2021] [Indexed: 11/20/2022] Open
Abstract
Fluoroquinolones are an effective, broad-spectrum antibiotic used to treat an array of bacterial infections. However, they are associated with an increased risk of tendinopathy and tendon rupture even after discontinuation of treatment. This condition is known as fluoroquinolone-associated tendinopathy, the underlying mechanisms of which are poorly understood. While many factors may be involved in the pathophysiology of tendinopathies in general, changes in tenocyte metabolism and viability, as well as alteration of proteoglycan metabolism are prominent findings in the scientific literature. This study investigated the effects of ciprofloxacin, a common fluoroquinolone, on cell viability, proteoglycan synthesis, and proteoglycan mRNA expression in equine superficial digital flexor tendon explants after 96 h treatment with between 1–300 µg/mL ciprofloxacin, and again after 8 days discontinuation of treatment. Ciprofloxacin caused significant reductions in cell viability by between 25–33% at all dosages except 10 µg/mL, and viability decreased further after 8 days discontinuation of treatment. Proteoglycan synthesis significantly decreased by approximately 50% in explants treated with 100 µg/mL and 300 µg/mL, however this effect reversed after 8 days in the absence of treatment. No significant mRNA expression changes were observed after the treatment period with the exception of versican which was down-regulated at the highest concentration of ciprofloxacin. After the recovery period, aggrecan, biglycan and versican genes were all significantly downregulated in explants initially treated with 1–100 µg/mL. Results from this study corroborate previously reported findings of reduced cell viability and proteoglycan synthesis in a whole tissue explant model and provide further insight into the mechanisms underlying fluoroquinolone-associated tendinopathy and rupture. This study further demonstrates that certain ciprofloxacin induced cellular changes are not rapidly reversed upon cessation of treatment which is a novel finding in the literature.
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Affiliation(s)
- Stuart James
- Department of Physiology, Anatomy, and Microbiology, La Trobe University, Melbourne, Victoria, Australia
| | - Johannes Schuijers
- Department of Physiology, Anatomy, and Microbiology, La Trobe University, Melbourne, Victoria, Australia
| | - John Daffy
- Department of Infectious Diseases, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Jill Cook
- Sports and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Tom Samiric
- Department of Physiology, Anatomy, and Microbiology, La Trobe University, Melbourne, Victoria, Australia
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Kim DK, Ahn J, Kim SA, Go EJ, Lee DH, Park SC, Shetty AA, Kim SJ. Improved Healing of Rabbit Patellar Tendon Defects After an Atelocollagen Injection. Am J Sports Med 2021; 49:2924-2932. [PMID: 34343026 DOI: 10.1177/03635465211030508] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patellar tendinopathy is a common cause of limitations in daily life activities in young and/or active people. The patellar tendon consists of a complex of collagen fibers; therefore, collagen could be used as a scaffold in the treatment of patellar tendinopathy. PURPOSE To evaluate the healing capacity of injected atelocollagen as a treatment scaffold for patellar tendon defect and, hence, its potential for the treatment of patellar tendinopathy. STUDY DESIGN Controlled laboratory study. METHODS After receiving a full-thickness patellar tendon defect, 24 New Zealand White rabbits were divided into a control group (without treatment) and an experimental group that received an atelocollagen injection into the defect. Six rabbits from each group were subsequently used for either histologic scoring or biomechanical testing. The Mann-Whitney U test was used to compare histologic evaluation scores and load to failure between the 2 groups. Statistical significance was set at P < .05. RESULTS The experimental group showed excellent repair of the damaged patellar tendon and good remodeling of the defective area. In contrast, the control group showed defective healing with loose, irregular matrix fibers and adipose tissue formation. A statistically significant difference was found between the 2 groups in both histologic scores and biomechanical tests at postoperative week 12. CONCLUSION Injection of atelocollagen significantly improved the regeneration of damaged patellar tendons. CLINICAL RELEVANCE Atelocollagen gel injections could be used to treat patellar tendinopathy in outpatient clinic settings.
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Affiliation(s)
- Duck Kyu Kim
- Department of Orthopaedic Surgery, Barosun Hospital, Seoul, Republic of Korea
| | - Jiyong Ahn
- Department of Orthopaedic Surgery, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Seon Ae Kim
- Department of Orthopaedic Surgery, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Eun Jeong Go
- Department of Orthopaedic Surgery, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Dong Hwan Lee
- Department of Orthopaedic Surgery, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Seung Chan Park
- Department of Orthopaedic Surgery, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Asode Ananthram Shetty
- Institute of Medical Sciences, Faculty of Medicine and Social Care, Canterbury Christ Church University, Canterbury, Kent, UK
| | - Seok Jung Kim
- Department of Orthopaedic Surgery, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
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Mitchkash M, Robinson D, Tenforde AS. Efficacy of Extracorporeal Pulse-Activated Therapy in the Management of Lower-Extremity Running-Related Injuries: Findings From a Large Case Cohort. J Foot Ankle Surg 2021; 59:795-800. [PMID: 32340839 DOI: 10.1053/j.jfas.2020.02.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 02/03/2023]
Abstract
Running is one of the most popular sports worldwide, with many health benefits. Injuries are also common, with running-related injuries reported in up to 79% of runners annually. Extracorporeal shockwave treatment can be used to treat soft tissue conditions, with the strongest level of evidence for management of plantar fasciitis. However, most studies have focused on nonathletes or studied a single condition, and few investigations have reported outcomes for extracorporeal pulse-activated therapy. In this case series, we evaluated the outcomes of 94 runners receiving extracorporeal pulse-activated therapy for lower-extremity running-related injuries, including plantar fasciitis and lower-extremity tendinopathy (Achilles, posterior tibialis, patellar, hamstring). We hypothesized that most runners with foot and ankle injuries would respond favorably to treatment and that success rates would be similar across conditions. Overall, 74 runners (79%) met their respective minimal clinically important difference for functional outcome measures, with no differences in response by age, sex, body mass index, or chronicity of condition. Further, no differences were noted in proportion achieving the minimal clinically important difference between foot and ankle (Achilles, posterior tibialis, and plantar fascia) compared with proximal injuries (53 [84.3%] versus 31 [72%], p = .15). A mean of 4 treatments resulted in achieving the minimal clinically important difference, with 95% achieving it by 5 treatments. No differences in bars of pressure, frequency, or other aspects of treatments were observed to predict response. Our findings suggest that a majority of runners with lower-extremity injuries respond favorably to extracorporeal pulse-activated therapy, including those with foot and ankle injuries.
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Affiliation(s)
- Matthew Mitchkash
- Resident, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Charlestown, MA
| | - David Robinson
- Resident, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Charlestown, MA
| | - Adam S Tenforde
- Assistant Professor, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Charlestown, MA.
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Güler Y, Birinci M, Hakyemez ÖS, Buyukdogan K, Çaçan MA, Arslanoglu F, Mermerkaya MU. Achilles tendon-splitting approach and double-row suture anchor repair for Haglund syndrome. Foot Ankle Surg 2021; 27:421-426. [PMID: 32792246 DOI: 10.1016/j.fas.2020.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 05/14/2020] [Accepted: 05/21/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Haglund syndrom is characterized as a painful posterosuperior deformity of the heel with possible causes as tight Achilles tendon, high-arched foot and tendency to walk on the outside of the heel. Surgical treatment may be recommended in cases where of insufficient response to nonoperative treatment. This study aims to evaluate the clinical and radiographic results of central Achilles tendon splitting and double-row suture anchor technique in the surgical treatment of patients with Haglund syndrome. METHODS 27 patients with Haglund syndrome who underwent central Achilles tendon splitting and double-row suture anchor were retrospectively evaluated. The results were evaluated by the pre- and post-operative American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale and visual analogue scale (VAS). All patients were evaluated radiographically to assess lateral talus-first metatarsal angle (TMTA), Calcaneal pitch angle (CPA), and the Fowler-Philip angle (FPA) preoperatively and postoperatively. RESULTS The mean preoperative AOFAS score was 47 ± 7 points; at the end of the follow-up period, it increased to 92 ± 4 points (p < 0.001). The mean preoperative VAS score was 9 ± 0.9 points; at the end of the follow-up period, it was 2 ± 0.6 points (p < 0.001). The lateral TMTA (preoperative: 5° ± 2°; follow-up: 4° ± 2°; p < 0.001), CPA (preoperative: 21° ± 5°; follow-up: 20° ± 5°; p = 0.005) and FPA (preoperative: 55° ± 6°; follow-up: 32° ± 3°; p < 0.001) values decreased at the end of the follow-up period. CONCLUSION In the absence of an improvement to nonoperative treatment methods, central Achilles tendon-splitting approach appears to be an effective and safe treatment option. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Yasin Güler
- Medipol University, Medical School, Department of Orthopaedics and Traumatology, İstanbul, Turkey
| | - Murat Birinci
- Medipol University, Medical School, Department of Orthopaedics and Traumatology, İstanbul, Turkey.
| | - Ömer Serdar Hakyemez
- Medipol University, Medical School, Department of Orthopaedics and Traumatology, İstanbul, Turkey
| | - Kadir Buyukdogan
- Koc University, Medical School, Department of Orthopaedics and Traumatology, İstanbul, Turkey
| | - Mehmet Akif Çaçan
- Medipol University, Medical School, Department of Orthopaedics and Traumatology, İstanbul, Turkey
| | - Fatih Arslanoglu
- Medipol University, Medical School, Department of Orthopaedics and Traumatology, İstanbul, Turkey
| | - Musa Uğur Mermerkaya
- Medipol University, Medical School, Department of Orthopaedics and Traumatology, İstanbul, Turkey
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Khor BYC, Woodburn J, Newcombe L, Barn R. Plantar soft tissues and Achilles tendon thickness and stiffness in people with diabetes: a systematic review. J Foot Ankle Res 2021; 14:35. [PMID: 33910602 PMCID: PMC8080343 DOI: 10.1186/s13047-021-00475-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/15/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Diabetes mellitus is associated with changes in soft tissue structure and function. However, the directionality of this change and the extent to which either tissue thickness or stiffness contributes to the pathogenesis of diabetes-related foot ulcerations is unclear. Hence, this systematic review aims to summarise the existing evidence for soft tissue structural differences in the feet of people with and without diabetes. METHODS In compliance with MOOSE and PRISMA guidelines, AMED, CINAHL, MEDLINE, ProQuest Health & Medical Collection, ProQuest Nursing & Allied Health Database, and Web of Science electronic databases were systematically searched for studies published from database inception until 1st October 2020 [Prospero CRD42020166614]. Reference lists of included studies were further screened. Methodological quality was appraised using a modified critical appraisal tool for quantitative studies developed by McMaster University. RESULTS A total of 35 non-randomised observational studies were suitable for inclusion. Within these, 20 studies evaluated plantar tissue thickness, 19 studies evaluated plantar tissue stiffness, 9 studies evaluated Achilles tendon thickness and 5 studies evaluated Achilles tendon stiffness outcomes. No significant differences in plantar tissue thickness were found between people with and without diabetes in 55% of studies (11/20), while significantly increased plantar tissue stiffness was found in people with diabetes in 47% of studies (9/19). Significantly increased Achilles tendon thickness was found in people with diabetes in 44% of studies (4/9), while no significant differences in Achilles tendon stiffness were found between people with and without diabetes in 60% of studies (3/5). CONCLUSIONS This systematic review found some evidence of soft tissue structural differences between people with and without diabetes. However, uncertainty remains whether these differences independently contribute to diabetes-related foot ulcerations. The heterogeneity of methodological approaches made it difficult to compare across studies and methodological quality was generally inadequate. High-quality studies using standardised and validated assessment techniques in well-defined populations are required to determine more fully the role of structural tissue properties in the pathogenesis of diabetes-related foot ulcerations.
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Affiliation(s)
- Benedictine Yen Chen Khor
- Department of Podiatry and Radiography, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, G4 0BA, Scotland, UK.
| | - James Woodburn
- Department of Podiatry and Radiography, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, G4 0BA, Scotland, UK
- School of Health Sciences and Social Work, Griffith University, Queensland, Australia
| | - Lisa Newcombe
- Department of Podiatry and Radiography, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, G4 0BA, Scotland, UK
| | - Ruth Barn
- Department of Podiatry and Radiography, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, G4 0BA, Scotland, UK
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Morphological Characteristics of Passive and Active Structures of the Foot Across Populations With Different Levels of Physical Activity. J Sport Rehabil 2021; 30:935-941. [PMID: 33662932 DOI: 10.1123/jsr.2020-0423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 12/30/2020] [Accepted: 12/30/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Imaging diagnosis plays a fundamental role in the evaluation and management of injuries suffered in sports activities. OBJECTIVE To analyze the differences in the thickness of the Achilles tendon, patellar tendon, plantar fascia, and posterior tibial tendon in the following levels of physical activity: persons who run regularly, persons otherwise physically active, and persons with a sedentary lifestyle. DESIGN Cross-sectional and observational. PARTICIPANTS The 91 volunteers recruited from students at the university and the Triathlon Club from December 2016 to June 2019. The data were obtained (age, body mass index, and visual analog scale for quality of life together with the ultrasound measurements). RESULTS Tendon and ligament thickness was greater in the runners group than in the sedentary and active groups with the exception of the posterior tibial tendon. The thickness of the Achilles tendon was greater in the runners than in the other groups for both limbs (P = .007 and P = .005). This was also the case for the cross-sectional area (P < .01) and the plantar fascia at the heel insertion in both limbs (P = .034 and P = .026) and for patellar tendon thickness for the longitudinal measurement (P < .01). At the transversal level, however, the differences were only significant in the right limb (P = .040). CONCLUSION The thickness of the Achilles tendon, plantar fascia, and patellar tendon is greater in runners than in persons who are otherwise active or who are sedentary.
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Fares MY, Khachfe HH, Salhab HA, Zbib J, Fares Y, Fares J. Achilles tendinopathy: Exploring injury characteristics and current treatment modalities. Foot (Edinb) 2021; 46:101715. [PMID: 33039245 DOI: 10.1016/j.foot.2020.101715] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 06/19/2020] [Accepted: 07/03/2020] [Indexed: 02/04/2023]
Abstract
Achilles tendinopathy is a prevalent overuse injury to the Achilles tendon causing prominent pain and reduction in quality of life. Several biomechanical and anatomical properties govern the pathology of the Achilles tendinopathy, and as a result, choosing the optimal treatment option is challenging. The aim of this review is to study the anatomical and biomechanical characteristics of this injury and explore the available treatment options in order to extrapolate the most suitable option with the best prognosis. Treatment modalities for Achilles tendinopathy vary and include non-operative and operative options. Non-operative treatment modalities include physical therapy, extracorporeal shockwave therapy, injectable agents, and bracing and taping. Operative treatment modalities include surgical procedures, both percutaneous and open. Treatment should be catered to the individual patient. Further research is required in order to confirm the efficacy of the available treatment options, test the viability of novel techniques and approaches, and discover possible new therapeutic modalities.
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Affiliation(s)
- Mohamad Y Fares
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon; Neuroscience Research Center, Faculty of Medicine, Lebanese University, Beirut, Lebanon; College of Medical, Veterinary, and Life Sciences, University of Glasgow, Glasgow, Scotland, UK.
| | - Hussein H Khachfe
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon; Neuroscience Research Center, Faculty of Medicine, Lebanese University, Beirut, Lebanon
| | - Hamza A Salhab
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon; Neuroscience Research Center, Faculty of Medicine, Lebanese University, Beirut, Lebanon
| | - Jad Zbib
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Youssef Fares
- Neuroscience Research Center, Faculty of Medicine, Lebanese University, Beirut, Lebanon
| | - Jawad Fares
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
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50
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Gonera B, Kurtys K, Paulsen F, Polguj M, LaPrade RF, Grzelecki D, Karauda P, Olewnik Ł. The plantaris muscle - Anatomical curiosity or a structure with important clinical value? - A comprehensive review of the current literature. Ann Anat 2021; 235:151681. [PMID: 33561523 DOI: 10.1016/j.aanat.2021.151681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/15/2020] [Accepted: 12/23/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE Although the plantaris muscle is vestigial in humans, it is far too important to remain omitted. The aim of this study is to provide a comprehensive review of the existing literature focused on plantaris muscle clinical value, grafting usefulness and its morphological variations. Hopefully this study will be of great use for every medical practitioner due to its clarity and conciseness despite such broaden scope of this article. MATERIAL AND METHODS The article is written based on 100 studies published since 1868 until 2020. During careful selection process 12 papers were dismissed due to their insufficient sample size, wrong methods used or results that were previously discovered. RESULTS Many aspects concerning the plantaris muscle are already well examined, summarized and described. However this study has shown how much we still do not know and which fields require further investigations. CONCLUSION The anatomical variations of plantaris muscle morphology may cause mid-portion Achilles tendinopathy, tennis leg syndrome or increase the risk of failure while harvesting the tendons.
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Affiliation(s)
- Bartosz Gonera
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland.
| | - Konrad Kurtys
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - Friedrich Paulsen
- Institute of Functional and Clinical Anatomy, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany; Sechenov University, Department of Topographic Anatomy and Operative Surgery, Moscow, Russia
| | - Michał Polguj
- Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, Poland
| | | | - Dariusz Grzelecki
- Centre of Postgraduate Medical Education, Department of Orthopedics and Rheumoorthopedics, Otwock, Poland
| | - Piotr Karauda
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
| | - Łukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
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