51
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de Girolamo L, Morlin Ambra LF, Perucca Orfei C, McQuilling JP, Kimmerling KA, Mowry KC, Johnson KA, Phan AT, Whited JL, Gomoll AH. Treatment with Human Amniotic Suspension Allograft Improves Tendon Healing in a Rat Model of Collagenase-Induced Tendinopathy. Cells 2019; 8:E1411. [PMID: 31717431 PMCID: PMC6912389 DOI: 10.3390/cells8111411] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 10/31/2019] [Accepted: 11/04/2019] [Indexed: 12/12/2022] Open
Abstract
Treatment of tendon injuries is challenging, with neither conservative nor surgical approaches providing full recovery. Placental-derived tissues represent a promising tool for the treatment of tendon injuries. In this study, human amniotic suspension allograft (ASA) was investigated in a pre-clinical model of Achilles tendinopathy. Collagenase type I was injected in the right hind limb of Sprague Dawley rats to induce disease. Contralateral tendons were either left untreated or injected with saline as controls. Seven days following induction, tendons were injected with saline, ASA, or left untreated. Rats were sacrificed 14 and 28 days post-treatment. Histological and biomechanical analysis of tendons was completed. Fourteen days after ASA injection, improved fiber alignment and reduced cell density demonstrated improvement in degenerated tendons. Twenty-eight days post-treatment, tendons in all treatment groups showed fewer signs of degeneration, which is consistent with normal tendon healing. No statistically significant differences in histological or biomechanical analyses were observed between treatment groups at 28 days independent of the treatment they received. In this study, ASA treatment was safe, well-tolerated, and resulted in a widespread improvement of the tissue. The results of this study provide preliminary insights regarding the potential use of ASA for the treatment of Achilles tendinopathy.
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Affiliation(s)
- Laura de Girolamo
- IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161 Milan, Italy;
| | - Luiz Felipe Morlin Ambra
- University Hospital São Paulo, Av. Prof. Lineu Prestes, 2565-Butantã, São Paulo, SP 05508-000, Brazil;
| | | | - John P. McQuilling
- Organogenesis, 2641 Rocky Ridge Lane, Birmingham, AL 35216, USA; (J.P.M.); (K.A.K.); (K.C.M.)
| | - Kelly A. Kimmerling
- Organogenesis, 2641 Rocky Ridge Lane, Birmingham, AL 35216, USA; (J.P.M.); (K.A.K.); (K.C.M.)
| | - Katie C. Mowry
- Organogenesis, 2641 Rocky Ridge Lane, Birmingham, AL 35216, USA; (J.P.M.); (K.A.K.); (K.C.M.)
| | - Kimberly A. Johnson
- Harvard Medical School, the Harvard Stem Cell Institute, and Department of Orthopedic Surgery, Brigham and Women’s Hospital, 7 Divinity Avenue, Cambridge, MA 02138, USA; (K.A.J.); (A.T.P.); (J.L.W.)
| | - Amy T. Phan
- Harvard Medical School, the Harvard Stem Cell Institute, and Department of Orthopedic Surgery, Brigham and Women’s Hospital, 7 Divinity Avenue, Cambridge, MA 02138, USA; (K.A.J.); (A.T.P.); (J.L.W.)
| | - Jessica L. Whited
- Harvard Medical School, the Harvard Stem Cell Institute, and Department of Orthopedic Surgery, Brigham and Women’s Hospital, 7 Divinity Avenue, Cambridge, MA 02138, USA; (K.A.J.); (A.T.P.); (J.L.W.)
| | - Andreas H. Gomoll
- Harvard Medical School, the Harvard Stem Cell Institute, and Department of Orthopedic Surgery, Brigham and Women’s Hospital, 7 Divinity Avenue, Cambridge, MA 02138, USA; (K.A.J.); (A.T.P.); (J.L.W.)
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
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52
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Xu H, Li H, Hua Y, Bai L, Chang F, Chen S, Chen W, Fang Z, Gui J, Guo Q, Hu Y, Huang H, Jiao C, Li Q, Li W, Liang X, Lu H, Lu L, Miao X, Qu J, Song W, Xu T, Wang Z, Wang X, Wei M, Wei S, Xiang D, Xu H, Yang M, Zhan J, Zhang F, Zhao F, Zhu Y, Tang K. Chinese Consensus on Insertional Achilles Tendinopathy. Orthop J Sports Med 2019; 7:2325967119879052. [PMID: 31656824 PMCID: PMC6791038 DOI: 10.1177/2325967119879052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: Insertional Achilles tendinopathy (IAT) is a common finding in the clinic. However, consensus on its mechanism, pathological process, diagnosis, treatment, and rehabilitation is lacking. Thus, the Chinese Society of Sports Medicine organized and invited experts representing the fields of ankle disease and tendinopathy to jointly develop an expert consensus on IAT. Study Design: A consensus statement of the Chinese Society of Sports Medicine. Methods: A total of 34 experts in the field of sports medicine and orthopaedics were invited to participate in the compilation of a consensus statement regarding IAT. Consensus was achieved according to the Delphi method. First, 10 working groups composed of 34 experts were established to compile draft statements about clinical problems related to IAT by reviewing and analyzing the available literature. An expert consensus meeting to discuss drafts was then arranged. Each statement was individually presented and discussed, followed by a secret vote. Consensus was reached when more than 50% of the experts voted in its favor. The strength of the proposed recommendation was classified based on the proportion of favorable votes: consensus, 51% to 74%; strong consensus, 75% to 99%; unanimity, 100%. Results: Of the 10 expert consensus statements on the clinical diagnosis and treatment of IAT, there was strong consensus for 8 statements and unanimity for 2 statements. Conclusion: This expert consensus focused on the concepts, causes, pathological process, clinical diagnosis, and treatment of IAT. Accepted recommendations in these areas which will assist clinicians in carrying out standardized management of related diseases.
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Affiliation(s)
- Chinese Society of Sports Medicine
- Yinghui Hua, MD, PhD, and Kanglai Tang, MD, PhD, No 12, Wulumuqi Zhong Road, Shanghai 200040, China & Gaotanyan Str. 30, Chongqing 400038, People’s Republic of China ( and )
| | | | | | - Yinghui Hua
- Yinghui Hua, MD, PhD, and Kanglai Tang, MD, PhD, No 12, Wulumuqi Zhong Road, Shanghai 200040, China & Gaotanyan Str. 30, Chongqing 400038, People’s Republic of China ( and )
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Kanglai Tang
- Yinghui Hua, MD, PhD, and Kanglai Tang, MD, PhD, No 12, Wulumuqi Zhong Road, Shanghai 200040, China & Gaotanyan Str. 30, Chongqing 400038, People’s Republic of China ( and )
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53
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Zhang C, Zhu J, Zhou Y, Thampatty BP, Wang JHC. Tendon Stem/Progenitor Cells and Their Interactions with Extracellular Matrix and Mechanical Loading. Stem Cells Int 2019; 2019:3674647. [PMID: 31737075 PMCID: PMC6815631 DOI: 10.1155/2019/3674647] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/04/2019] [Accepted: 08/17/2019] [Indexed: 12/11/2022] Open
Abstract
Tendons are unique connective tissues in the sense that their biological properties are largely determined by their tendon-specific stem cells, extracellular matrix (ECM) surrounding the stem cells, mechanical loading conditions placed on the tendon, and the complex interactions among them. This review is aimed at providing an overview of recent advances in the identification and characterization of tendon stem/progenitor cells (TSPCs) and their interactions with ECM and mechanical loading. In addition, the effects of such interactions on the maintenance of tendon homeostasis and the initiation of tendon pathological conditions are discussed. Moreover, the challenges in further investigations of TSPC mechanobiology in vitro and in vivo are outlined. Finally, future research efforts are suggested, which include using specific gene knockout models and single-cell transcription profiling to enable a broad and deep understanding of the physiology and pathophysiology of tendons.
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Affiliation(s)
- Chuanxin Zhang
- Joint Surgery and Sports Medicine Department, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jun Zhu
- Joint Surgery and Sports Medicine Department, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yiqin Zhou
- Joint Surgery and Sports Medicine Department, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Bhavani P. Thampatty
- MechanoBiology Laboratory, Departments of Orthopaedic Surgery, Bioengineering, and Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - James H-C. Wang
- MechanoBiology Laboratory, Departments of Orthopaedic Surgery, Bioengineering, and Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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54
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Chang W, Callan KT, Dragoo JL. The Behavior of Tendon Progenitor Cells from Tendinopathic Tendons: Implications for Treatment. Tissue Eng Part A 2019; 26:38-46. [PMID: 31111771 DOI: 10.1089/ten.tea.2019.0042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Tendinopathy remains a significant clinical challenge. Although there is some evidence that leukocyte-rich platelet-rich plasma can improve the symptoms of tendinopathy, more efficacious treatments will be required in the future to improve probability of successfully resolving this condition in athletes. Because optimal treatments are not currently available, there is a need to better understand the pathology of tendinopathy from the perspective of tendon progenitor cells (TPCs). TPCs isolated from normal and tendinopathy donors were characterized by their stem cell properties and proliferation capacities, along with their ability to become tenocytes under mechanical loading. The results showed a significant 2.6-fold increase in the viable cell population in tendinopathy versus normal donors. Although the percentage of self-renewing cells was similar, the total number of TPCs in tendinopathy was significantly higher (1.6-fold) than normal TPCs based on the colony formation assays. In contrast, TPCs from tendinopathy tissue showed significantly lower cellular proliferation rate by cumulative population doublings. Next, the expanded TPCs from both tissues successfully demonstrated the trilineage differentiation capabilities with specific gene markers, staining, and biochemical assays. To induce tenogenic differentiation, stretchable silicone wells were designed and fabricated, plus the creation of an adaptor platform used on a syringe pump for mechanical stretch. This economic design provided the adequate cyclic loading to drive tenogenic differentiation. With these devices, the stretch duration was optimized and showed the significant increase in scleraxis (SCX) and tenomodulin (TNMD) expression at 2.60 (fold change) and 3.86 (fold change in logarithm), respectively, by reverse transcription-quantitative polymerase chain reaction in normal TPCs after stretch. This assay also demonstrated the widespread cell reorientation following stretch in normal TPCs. In contrast, the mechanical loading did not increase the SCX gene expression; TNMD expression remained undetectable, and cell realignment was significantly less in tendinopathy TPCs. In addition, western blot analysis confirmed the elevated TNMD protein expression in normal TPCs following stretch and the lack of expression in tendinopathy TPCs. In summary, tendinopathy TPCs were unable to differentiate into tenocytes following mechanical stretch. Future studies may aim to reprogram tendinopathy TPCs to allow tenogenic induction. Impact Statement This article presents a model to distinguish between normal and tendinopathy progenitor cell behavior, which reveals insight into the pathophysiology of tendinopathy. With the design of a platform adaptor, mechanical stretch was applied to tendon progenitor cells (TPCs) that promoted tenogenic differentiation. This design provided programmable features for more flexible application with low cost. These devices successfully stimulated tenogenic differentiation of TPCs from normal, but not tendinopathic tendons under cyclic stretch. The scientific method provided in this article will allow testing of biologics, exosomes, and other treatment strategies to derive new, more efficient treatment of tendinopathy in the future.
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Affiliation(s)
- Wenteh Chang
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California
| | - Kylie T Callan
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California
| | - Jason L Dragoo
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California
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55
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Souza M, Moraes SAS, de Paula DR, Maciel AA, Batista EJO, Silva DGF, Bahia CP, Oliveira KRHM, Herculano AM. Local treatment with ascorbic acid accelerates recovery of post-sutured Achilles tendon in male Wistar rats. ACTA ACUST UNITED AC 2019; 52:e8290. [PMID: 31482998 PMCID: PMC6719343 DOI: 10.1590/1414-431x20198290] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 07/04/2019] [Indexed: 01/04/2023]
Abstract
Tendon rupture is a very frequent accident involving average people and high-performance athletes. Clinical studies describe tendon recovery as a painful and slow process involving different biochemical and histological events. Ascorbic acid (AA) is a potent antioxidant as well as an important cofactor for collagen synthesis. In the current study, we evaluated if local treatment with AA is able to promote tendon repair in tenotomized rats. Animals were submitted to Achilles tendon rupture followed by surgical suture. Control and AA groups received in loco injection of saline solution (0.9% NaCl) and 30 mM AA, respectively. Histological and functional recovery of Achilles tendon tissue was evaluated at 7, 14, and 21 days post-surgery. Hematoxylin/eosin staining and collagen fluorescence analysis showed intense disarrangement of tendon tissue in the saline group. Tenotomized animals also showed hypercellularity in tendon tissue compared with non-tenotomized animals. The Achilles functional index (AFI) showed a significant decrease of tendon functionality in tenotomized animals at 7, 14, and 21 days post-surgery. AA accelerated tissue organization and the recovery of function of the Achilles tendons. The beneficial effect of AA treatment was also observed in the organization of the collagen network. Data presented in the current work showed that in loco treatment with AA accelerated the recovery of injured Achilles tendon post-surgery.
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Affiliation(s)
- M Souza
- Laboratório de Neurofarmacologia Experimental, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, Brasil
| | - S A S Moraes
- Laboratório de Neurofarmacologia Experimental, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, Brasil.,Instituto de Ciências da Saúde, Universidade Federal do Pará, Belém, Pará, Brasil
| | - D R de Paula
- Laboratório de Neurofarmacologia Experimental, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, Brasil.,Instituto de Ciências da Saúde, Universidade Federal do Pará, Belém, Pará, Brasil
| | - A A Maciel
- Laboratório de Neurofarmacologia Experimental, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, Brasil.,Instituto de Ciências da Saúde, Universidade Federal do Pará, Belém, Pará, Brasil
| | - E J O Batista
- Laboratório de Neurofarmacologia Experimental, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, Brasil.,Núcleo de Medicina Tropical, Universidade Federal do Pará, Belém, Pará, Brasil
| | - D G F Silva
- Laboratório de Neurofarmacologia Experimental, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, Brasil
| | - C P Bahia
- Instituto de Ciências da Saúde, Universidade Federal do Pará, Belém, Pará, Brasil
| | - K R H M Oliveira
- Laboratório de Neurofarmacologia Experimental, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, Brasil
| | - A M Herculano
- Laboratório de Neurofarmacologia Experimental, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, Brasil
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56
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Belkahla H, Mazarío E, Sangnier AP, Lomas JS, Gharbi T, Ammar S, Micheau O, Wilhelm C, Hémadi M. TRAIL acts synergistically with iron oxide nanocluster-mediated magneto- and photothermia. Theranostics 2019; 9:5924-5936. [PMID: 31534529 PMCID: PMC6735372 DOI: 10.7150/thno.36320] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 06/09/2019] [Indexed: 02/06/2023] Open
Abstract
Targeting TRAIL (Tumor necrosis factor (TNF)-Related Apoptosis-Inducing Ligand) receptors for cancer therapy remains challenging due to tumor cell resistance and poor preparations of TRAIL or its derivatives. Herein, to optimize its therapeutic use, TRAIL was grafted onto iron oxide nanoclusters (NCs) with the aim of increasing its pro-apoptotic potential through nanoparticle-mediated magnetic hyperthermia (MHT) or photothermia (PT). Methods: The nanovector, NC@TRAIL, was characterized in terms of size, grafting efficiency, and potential for MHT and PT. The therapeutic function was assessed on a TRAIL-resistant breast cancer cell line, MDA-MB-231, wild type (WT) or TRAIL-receptor-deficient (DKO), by combining complementary methylene blue assay and flow cytometry detection of apoptosis and necrosis. Results: Combined with MHT or PT under conditions of "moderate hyperthermia" at low concentrations, NC@TRAIL acts synergistically with the TRAIL receptor to increase the cell death rate beyond what can be explained by the mere global elevation of temperature. In contrast, all results are consistent with the idea that there are hotspots, close to the nanovector and, therefore, to the membrane receptor, which cause disruption of the cell membrane. Furthermore, nanovectors targeting other membrane receptors, unrelated to the TNF superfamily, were also found to cause tumor cell damage upon PT. Indeed, functionalization of NCs by transferrin (NC@Tf) or human serum albumin (NC@HSA) induces tumor cell killing when combined with PT, albeit less efficiently than NC@TRAIL. Conclusions: Given that magnetic nanoparticles can easily be functionalized with molecules or proteins recognizing membrane receptors, these results should pave the way to original remote-controlled antitumoral targeted thermal therapies.
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Affiliation(s)
- Hanene Belkahla
- Université de Paris, ITODYS, CNRS-UMR 7086, 15 rue J.-A. de Baïf, F-75013 Paris, France
- Nanomedicine, Imagery and Therapeutics, EA 4662, Université de Bourgogne Franche-Comté, UFR Sciences & Techniques, 16 Route de Gray, 25030 Besançon Cedex, France
- Lipides nutrition cancer, INSERM-UMR 1231, Université de Bourgogne Franche-Comté, UFR Science de Santé, 7 Bd Jeanne d'Arc, 21000 Dijon, France
| | - Eva Mazarío
- Université de Paris, ITODYS, CNRS-UMR 7086, 15 rue J.-A. de Baïf, F-75013 Paris, France
| | - Anouchka Plan Sangnier
- Laboratoire Matières et Systèmes Complexes, Université de Paris, CNRS-UMR 7057, 10 rue Alice Domon et Léonie Duquet, 75205 Paris Cedex 13, France
| | - John S. Lomas
- Université de Paris, ITODYS, CNRS-UMR 7086, 15 rue J.-A. de Baïf, F-75013 Paris, France
| | - Tijani Gharbi
- Nanomedicine, Imagery and Therapeutics, EA 4662, Université de Bourgogne Franche-Comté, UFR Sciences & Techniques, 16 Route de Gray, 25030 Besançon Cedex, France
| | - Souad Ammar
- Université de Paris, ITODYS, CNRS-UMR 7086, 15 rue J.-A. de Baïf, F-75013 Paris, France
| | - Olivier Micheau
- Lipides nutrition cancer, INSERM-UMR 1231, Université de Bourgogne Franche-Comté, UFR Science de Santé, 7 Bd Jeanne d'Arc, 21000 Dijon, France
| | - Claire Wilhelm
- Laboratoire Matières et Systèmes Complexes, Université de Paris, CNRS-UMR 7057, 10 rue Alice Domon et Léonie Duquet, 75205 Paris Cedex 13, France
| | - Miryana Hémadi
- Université de Paris, ITODYS, CNRS-UMR 7086, 15 rue J.-A. de Baïf, F-75013 Paris, France
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57
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Vlaic J, Josipovic M, Bohacek I, Jelic M. The plantaris muscle: too important to be forgotten. A review of evolution, anatomy, clinical implications and biomechanical properties. J Sports Med Phys Fitness 2019; 59:839-845. [PMID: 30936418 DOI: 10.23736/s0022-4707.18.08816-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Plantaris muscle (lat. musculus plantaris) is a fusiform muscle of the superficial posterior leg compartment, characterized with a small muscle belly and very long and slender tendon. Many anatomical variations of plantaris muscle have been reported previously, including its inconstancy. Evolutional studies strongly suggest that plantaris muscle is a rudimentary muscle that plays minor role in gait biomechanics. However, plantaris muscle seems to have very important proprioceptive role since it has very high density of muscle spindles. Clinically, plantaris muscle is involved in differential diagnosis of posterior leg pain and several pathological entities such as: plantaris muscle rupture, non-insertional Achilles tendinopathy and popliteal artery compression syndrome. Different surgical specialties have recognized plantaris muscle tendon as a valuable graft. However, literature on plantaris muscle tendon biomechanical properties is rather scant and inconsistent with several limitations for proper data comparison and interpretation. Further comparative studies are needed to properly define biomechanical properties of plantaris muscle tendon grafts for various ligament and tendon reconstructive procedures.
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Affiliation(s)
- Josip Vlaic
- Division of Pediatric Orthopedic Surgery, Children's Hospital Zagreb, Zagreb, Croatia
| | - Mario Josipovic
- Department of Orthopedic Surgery, University Hospital Center Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Ivan Bohacek
- Department of Orthopedic Surgery, University Hospital Center Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Mislav Jelic
- Department of Orthopedic Surgery, University Hospital Center Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia -
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58
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Freedman BR, Mooney DJ. Biomaterials to Mimic and Heal Connective Tissues. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2019; 31:e1806695. [PMID: 30908806 PMCID: PMC6504615 DOI: 10.1002/adma.201806695] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/27/2019] [Indexed: 05/11/2023]
Abstract
Connective tissue is one of the four major types of animal tissue and plays essential roles throughout the human body. Genetic factors, aging, and trauma all contribute to connective tissue dysfunction and motivate the need for strategies to promote healing and regeneration. The goal here is to link a fundamental understanding of connective tissues and their multiscale properties to better inform the design and translation of novel biomaterials to promote their regeneration. Major clinical problems in adipose tissue, cartilage, dermis, and tendon are discussed that inspire the need to replace native connective tissue with biomaterials. Then, multiscale structure-function relationships in native soft connective tissues that may be used to guide material design are detailed. Several biomaterials strategies to improve healing of these tissues that incorporate biologics and are biologic-free are reviewed. Finally, important guidance documents and standards (ASTM, FDA, and EMA) that are important to consider for translating new biomaterials into clinical practice are highligted.
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Affiliation(s)
- Benjamin R Freedman
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, 02138, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, 02115, USA
| | - David J Mooney
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, 02138, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, 02115, USA
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59
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Aynardi M, Zahoor T, Mitchell R, Loube J, Feltham T, Manandhar L, Paudel S, Schon L, Zhang Z. Orthotopic Transplantation of Achilles Tendon Allograft in Rats: With or without Incorporation of Autologous Mesenchymal Stem Cells. Cell Transplant 2019; 27:245-255. [PMID: 29637821 PMCID: PMC5898692 DOI: 10.1177/0963689717745891] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The biology and function of orthotopic transplantation of Achilles tendon allograft are unknown. Particularly, the revitalization of Achilles allograft is a clinical concern. Achilles allografts were harvested from donor rats and stored at -80 °C. Subcutaneous adipose tissue was harvested from the would-be allograft recipient rats for isolation of mesenchymal stem cells (MSCs). MSCs were cultured with growth differentiation factor-5 (GDF-5) and applied onto Achilles allografts on the day of transplantation. After the native Achilles tendon was resected from the left hind limb of the rats, Achilles allograft, with or without autologous MSCs, was implanted and sutured with calf muscles proximally and calcaneus distally. Animal gait was recorded presurgery and postsurgery weekly. The animals were sacrificed at week 4, and the transplanted Achilles allografts were collected for biomechanical testing and histology. The operated limbs had altered gait. By week 4, the paw print intensity, stance time, and duty cycle (percentage of the stance phase in a step cycle) of the reconstructed limbs were mostly recovered to the baselines recorded before surgery. Maximum load of failure was not different between Achilles allografts, with or without MSCs, and the native tendons. The Achilles allograft supplemented with MSCs had higher cellularity than the Achilles allograft without MSCs. Deposition of fine collagen (type III) fibers was active in Achilles allograft, with or without MSCs, but it was more evenly distributed in the allografts that were incubated with MSCs. In conclusion, orthotopically transplanted Achilles allograft healed with host tissues, regained strength, and largely restored Achilles function in 4 wk in rats. It is therefore a viable option for the reconstruction of a large Achilles tendon defect. Supplementation of MSCs improved repopulation of Achilles allograft, but large animal models, with long-term follow up and cell tracking, may be required to fully appreciate the functional benefits of MSCs.
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Affiliation(s)
| | | | - Reed Mitchell
- 3 MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Jeffrey Loube
- 3 MedStar Union Memorial Hospital, Baltimore, MD, USA
| | | | | | | | - Lew Schon
- 3 MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Zijun Zhang
- 3 MedStar Union Memorial Hospital, Baltimore, MD, USA
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60
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Abstract
In recent years, stem cell therapy has become a very promising and advanced scientific research topic. The development of treatment methods has evoked great expectations. This paper is a review focused on the discovery of different stem cells and the potential therapies based on these cells. The genesis of stem cells is followed by laboratory steps of controlled stem cell culturing and derivation. Quality control and teratoma formation assays are important procedures in assessing the properties of the stem cells tested. Derivation methods and the utilization of culturing media are crucial to set proper environmental conditions for controlled differentiation. Among many types of stem tissue applications, the use of graphene scaffolds and the potential of extracellular vesicle-based therapies require attention due to their versatility. The review is summarized by challenges that stem cell therapy must overcome to be accepted worldwide. A wide variety of possibilities makes this cutting edge therapy a turning point in modern medicine, providing hope for untreatable diseases.
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Affiliation(s)
- Wojciech Zakrzewski
- Department of Experimental Surgery and Biomaterials Research, Wroclaw Medical University, Bujwida 44, Wrocław, 50-345 Poland
| | - Maciej Dobrzyński
- Department of Conservative Dentistry and Pedodontics, Krakowska 26, Wrocław, 50-425 Poland
| | - Maria Szymonowicz
- Department of Experimental Surgery and Biomaterials Research, Wroclaw Medical University, Bujwida 44, Wrocław, 50-345 Poland
| | - Zbigniew Rybak
- Department of Experimental Surgery and Biomaterials Research, Wroclaw Medical University, Bujwida 44, Wrocław, 50-345 Poland
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61
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Aicale R, Tarantino D, Maffulli N. Overuse injuries in sport: a comprehensive overview. J Orthop Surg Res 2018; 13:309. [PMID: 30518382 PMCID: PMC6282309 DOI: 10.1186/s13018-018-1017-5] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 11/21/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The absence of a single, identifiable traumatic cause has been traditionally used as a definition for a causative factor of overuse injury. Excessive loading, insufficient recovery, and underpreparedness can increase injury risk by exposing athletes to relatively large changes in load. The musculoskeletal system, if subjected to excessive stress, can suffer from various types of overuse injuries which may affect the bone, muscles, tendons, and ligaments. METHODS We performed a search (up to March 2018) in the PubMed and Scopus electronic databases to identify the available scientific articles about the pathophysiology and the incidence of overuse sport injuries. For the purposes of our review, we used several combinations of the following keywords: overuse, injury, tendon, tendinopathy, stress fracture, stress reaction, and juvenile osteochondritis dissecans. RESULTS Overuse tendinopathy induces in the tendon pain and swelling with associated decreased tolerance to exercise and various types of tendon degeneration. Poor training technique and a variety of risk factors may predispose athletes to stress reactions that may be interpreted as possible precursors of stress fractures. A frequent cause of pain in adolescents is juvenile osteochondritis dissecans (JOCD), which is characterized by delamination and localized necrosis of the subchondral bone, with or without the involvement of articular cartilage. The purpose of this compressive review is to give an overview of overuse injuries in sport by describing the theoretical foundations of these conditions that may predispose to the development of tendinopathy, stress fractures, stress reactions, and juvenile osteochondritis dissecans and the implication that these pathologies may have in their management. CONCLUSIONS Further research is required to improve our knowledge on tendon and bone healing, enabling specific treatment strategies to be developed for the management of overuse injuries.
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Affiliation(s)
- R. Aicale
- Department of Musculoskeletal Disorders, School of Medicine and Dentistry, University of Salerno, Salerno, Italy
| | - D. Tarantino
- Department of Musculoskeletal Disorders, School of Medicine and Dentistry, University of Salerno, Salerno, Italy
| | - N. Maffulli
- Department of Musculoskeletal Disorders, School of Medicine and Dentistry, University of Salerno, Salerno, Italy
- Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, 275 Bancroft Road, London, E1 4DG England
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Abstract
Tendinopathies are challenging. The term "tendinopathy" refers to clinical condition characterized by pain, swelling, and functional limitations of tendons and nearby structures. Tendinopathies give rise to significant morbidity, and, at present, only limited scientifically proven management modalities exist. Achilles and patellar tendons are among the most vulnerable tendons, and among the most frequent lower extremity overuse injuries. Achilles and patellar tendinopathies can be managed conservatively and surgically. Several surgical procedures have been described for both conditions, and, if performed well, they lead to a relatively higher rate of success with low complication.
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63
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Maffulli N, Oliva F, Maffulli GD, Giai Via A, Gougoulias N. Minimally Invasive Achilles Tendon Stripping for the Management of Tendinopathy of the Main Body of the Achilles Tendon. J Foot Ankle Surg 2018; 56:938-942. [PMID: 28659242 DOI: 10.1053/j.jfas.2017.05.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Indexed: 02/03/2023]
Abstract
Achilles tendinopathy is a common cause of disability. New nerves fibers grow from the paratenon into the Achilles tendon, and they could play a central role in the development of pain. We report the results of minimally invasive Achilles tendon stripping for Achilles tendinopathy in 47 active patients. The Victorian Institute of Sports Assessment-Achilles questionnaire score improved from 53.8 preoperatively to 85.3 postoperatively (p < .001). After a mean follow-up period of 40.5 months, 41 patients had resumed sporting activities at an average of 3.5 months postoperatively. A sural nerve injury was recorded in 5 patients (10.6%), and all 5 complications occurred during the first 12 cases. As a result, the technique was slightly modified, and no sural nerve neuropathy was observed subsequently. One superficial infection (2.1%) was recorded. Minimally invasive Achilles tendon stripping seems to be an effective, technically simple, and inexpensive treatment of Achilles tendinopathy. Further randomized controlled trials involving more patients are needed to confirm these outcomes.
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Affiliation(s)
- Nicola Maffulli
- Professor, Department of Musculoskeletal Disorders, Faculty of Medicine, University of Salerno, Salerno, Italy; Professor, Queen Mary University of London, Barts, United Kingdom; Professor, The London School of Medicine and Dentistry, William Harvey Research Institute, Centre for Sports and Exercise Medicine, Mile End Hospital, London, United Kingdom.
| | - Francesco Oliva
- Orthopedist, Department of Orthopaedics and Traumatology, University of Rome Tor Vergata, Rome, Italy
| | - Gayle D Maffulli
- Assistant Professor, Surgical Trials Unit, Curis Consulting, London, United Kingdom
| | - Alessio Giai Via
- Orthopedist, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Milano, Italy
| | - Nikolaos Gougoulias
- Orthopedist, Department of Orthopaedics, Frimley Health National Health Service Foundation Trust, Frimley Park Hospital, Camberley, United Kingdom
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64
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Goldberg AJ, Zaidi R, Brooking D, Kim L, Korda M, Masci L, Green R, O'Donnell P, Smith R. Autologous Stem Cells in Achilles Tendinopathy (ASCAT): protocol for a phase IIA, single-centre, proof-of-concept study. BMJ Open 2018; 8:e021600. [PMID: 29764889 PMCID: PMC5961605 DOI: 10.1136/bmjopen-2018-021600] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Achilles tendinopathy (AT) is a cause of pain and disability affecting both athletes and sedentary individuals. More than 150 000 people in the UK every year suffer from AT.While there is much preclinical work on the use of stem cells in tendon pathology, there is a scarcity of clinical data looking at the use of mesenchymal stem cells to treat tendon disease and there does not appear to be any studies of the use of autologous cultured mesenchymal stem cells (MSCs) for AT. Our hypothesis is that autologous culture expanded MSCs implanted into an area of mid-portion AT will lead to improved pain-free mechanical function. The current paper presents the protocol for a phase IIa clinical study. METHODS AND ANALYSIS The presented protocol is for a non-commercial, single-arm, open-label, phase IIa proof-of-concept study. The study will recruit 10 participants and will follow them up for 6 months. Included will be patients aged 18-70 years with chronic mid-portion AT who have failed at least 6 months of non-operative management. Participants will have a bone marrow aspirate collected from the posterior iliac crest under either local or general anaesthetic. MSCs will be isolated and expanded from the bone marrow. Four to 6 weeks after the harvest, participants will undergo implantation of the culture expanded MSCs under local anaesthetic and ultrasound guidance. The primary outcome will be safety as defined by the incidence rate of serious adverse reaction. The secondary outcomes will be efficacy as measured by patient-reported outcome measures and radiological outcome using ultrasound techniques. ETHICS AND DISSEMINATION The protocol has been approved by the National Research Ethics Service Committee (London, Harrow; reference 13/LO/1670). Trial findings will be disseminated through peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER NCT02064062.
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Affiliation(s)
- Andrew J Goldberg
- UCL Institute of Orthopaedics and Musculoskeletal Science (IOMS), Royal National Orthopaedic Hospital (RNOH), Stanmore, UK
| | - Razi Zaidi
- Princess Royal University Hospital, Orpington, UK
| | - Deirdre Brooking
- UCL Institute of Orthopaedics and Musculoskeletal Science (IOMS), Royal National Orthopaedic Hospital (RNOH), Stanmore, UK
| | - Louise Kim
- Joint Research and Enterprise Office, St George's, University of London, London, UK
| | | | | | - Ruth Green
- UCL Institute of Orthopaedics and Musculoskeletal Science (IOMS), Royal National Orthopaedic Hospital (RNOH), Stanmore, UK
| | - Paul O'Donnell
- UCL Institute of Orthopaedics and Musculoskeletal Science (IOMS), Royal National Orthopaedic Hospital (RNOH), Stanmore, UK
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Cross-cultural Adaptation of the Victorian Institute of Sport Assessment-Achilles (VISA-A) Questionnaire for Spanish Athletes With Achilles Tendinopathy. J Orthop Sports Phys Ther 2018; 48:111-120. [PMID: 29237355 DOI: 10.2519/jospt.2018.7402] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Clinical measurement study. Background Achilles tendinopathy is a prevalent sport-related injury. The Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire is a widely used patient-reported outcome to assess the severity of symptoms for this injury. Objective To adapt the VISA-A questionnaire into Spanish and to assess its psychometric properties. Methods Cross-cultural adaptation was conducted according to recommended guidelines. The Spanish VISA-A (VISA-A-Sp) questionnaire was administered to 210 subjects: 70 healthy students, 70 active at-risk subjects (participating in running and jumping), and 70 patients diagnosed with Achilles tendinopathy. Participants were assessed at baseline and after 3 to 5 days. The injured subjects were also evaluated with a quality-of-life questionnaire (Medical Outcomes Study 36-Item Short-Form Health Survey [SF-36]) and at discharge. The final VISA-A-Sp was evaluated for reliability, validity, and responsiveness. Results Cronbach alpha for the VISA-A-Sp was greater than .8. The intraclass correlation coefficient (model 2,1) was 0.993 (95% confidence interval: 0.991, 0.995; P<.05). In the confirmatory factor analysis, a 1-factor solution obtained a relatively good fit. Subjects with Achilles tendinopathy scored significantly lower than the other 2 groups (P<.001). The VISA-A-Sp score within the Achilles tendinopathy group showed significant correlations with SF-36 physical components (Spearman rho>0.5, P<.001). The standard error of the measurement was 2.53, and the minimal detectable change at the 95% confidence level was 7 points. The responsiveness indicators included an effect size of 2.16 and a standardized response mean of 1.92. Conclusion The VISA-A-Sp showed satisfactory psychometric properties that were comparable to the original English-language version. Therefore, it can be recommended for use in clinical practice and research for assessing the severity of symptoms in Spanish-speaking athletes who suffer from Achilles tendinopathy. J Orthop Sports Phys Ther 2018;48(2):111-120. Epub 13 Dec 2017. doi:10.2519/jospt.2018.7402.
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66
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High-Accuracy Positioning in Urban Environments Using Single-Frequency Multi-GNSS RTK/MEMS-IMU Integration. REMOTE SENSING 2018. [DOI: 10.3390/rs10020205] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Different Achilles Tendon Pathologies Show Distinct Histological and Molecular Characteristics. Int J Mol Sci 2018; 19:ijms19020404. [PMID: 29385715 PMCID: PMC5855626 DOI: 10.3390/ijms19020404] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 01/25/2018] [Accepted: 01/26/2018] [Indexed: 12/29/2022] Open
Abstract
Reasons for the development of chronic tendon pathologies are still under debate and more basic knowledge is needed about the different diseases. The aim of the present study was therefore to characterize different acute and chronic Achilles tendon disorders. Achilles tendon samples from patients with chronic tendinopathy (n = 7), chronic ruptures (n = 6), acute ruptures (n = 13), and intact tendons (n = 4) were analyzed. The histological score investigating pathological changes was significantly increased in tendinopathy and chronic ruptures compared to acute ruptures. Inflammatory infiltration was detected by immunohistochemistry in all tendon pathology groups, but was significantly lower in tendinopathy compared to chronic ruptures. Quantitative real-time PCR (qRT-PCR) analysis revealed significantly altered expression of genes related to collagens and matrix modeling/remodeling (matrix metalloproteinases, tissue inhibitors of metalloproteinases) in tendinopathy and chronic ruptures compared to intact tendons and/or acute ruptures. In all three tendon pathology groups markers of inflammation (interleukin (IL) 1β, tumor necrosis factor α, IL6, IL10, IL33, soluble ST2, transforming growth factor β1, cyclooxygenase 2), inflammatory cells (cluster of differentaition (CD) 3, CD68, CD80, CD206), fat metabolism (fatty acid binding protein 4, peroxisome proliferator-activated receptor γ, CCAAT/enhancer-binding protein α, adiponectin), and innervation (protein gene product 9.5, growth associated protein 43, macrophage migration inhibitory factor) were detectable, but only in acute ruptures significantly regulated compared to intact tendons. The study gives an insight into structural and molecular changes of pathological processes in tendons and might be used to identify targets for future therapy of tendon pathologies.
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68
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Ultrasound elastography in tendon pathology: state of the art. Skeletal Radiol 2017; 46:1643-1655. [PMID: 28765991 DOI: 10.1007/s00256-017-2726-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 06/30/2017] [Accepted: 07/10/2017] [Indexed: 02/02/2023]
Abstract
Elastography assesses the biomechanical and structural properties of tissues by measuring their stiffness. Despite promising results, elastography has not yet earned its place in the daily practice of musculoskeletal radiologists. The purpose of this article is to present and examine the data available to date on ultrasound elastography of the tendons through a review of the literature to provide musculoskeletal radiologists with an overview that may help them better understand and use elastography routinely. The most common techniques in ultrasound elastography are described. Then, the aspects of the physiologic and pathologic tendon are presented and discussed. One must make this technique one's own to better apprehend its contribution to the musculoskeletal imaging field, while bearing in mind that further research will be required before admitting elastography as a reliable and validated tool able to optimize our daily clinical practice.
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69
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Presentation, Diagnosis, and Nonsurgical Treatment Options of the Anterior Tibial Tendon, Posterior Tibial Tendon, Peroneals, and Achilles. Foot Ankle Clin 2017; 22:677-687. [PMID: 29078822 DOI: 10.1016/j.fcl.2017.07.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Disorders of the anterior tibial tendon (ATT) are rare, and relatively few series have been described in the literature. Ruptures of the ATT are more common than tendinopathies of the ATT. For those patients with a tendinopathy, initial treatment may include activity and shoe-wear modifications.
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70
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Usuelli FG, D'Ambrosi R, Manzi L, Indino C, Villafañe JH, Berjano P. Clinical Outcomes and Return to Sports in Patients with Chronic Achilles Tendon Rupture after Minimally Invasive Reconstruction with Semitendinosus Tendon Graft Transfer. JOINTS 2017; 5:212-216. [PMID: 29270558 PMCID: PMC5738487 DOI: 10.1055/s-0037-1608661] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objective The purpose of the study is to evaluate the clinical results and return to sports in patients undergoing reconstruction of the Achilles tendon after minimally invasive reconstruction with semitendinosus tendon graft transfer. Methods Eight patients underwent surgical reconstruction with a minimally invasive technique and tendon graft augmentation with ipsilateral semitendinosus tendon for chronic Achilles tendon rupture (more than 30 days after the injury and a gap of >6 cm). Patients were evaluated at a minimum follow-up of 24 months after the surgery through the American Orthopaedic Foot and Ankle Society (AOFAS), the Achilles Tendon Total Rupture Scores (ATRS), the Endurance test, the calf circumference of the operated limb, and the contralateral and the eventual return to sports activity performed before the trauma. Results The mean age at surgery was 50.5 years. Five men and three women underwent the surgery. The average AOFAS was 92, mean Endurance test was 28.1, and the average ATRS was 87. All patients returned to their daily activities, and six out of eight patients have returned to sports activities prior to the accident (two football players, three runners, one tennis player) at a mean of 7.0 (range: 6.7-7.2) months after the surgery. No patient reported complications or reruptures. Conclusion Our study confirms encouraging results for the treatment of Achilles tendon rupture with a minimally invasive technique with semitendinosus graft augmentation. The technique can be considered safe and allows patients to return to their sports activity. Level of Evidence Level IV, therapeutic case series.
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Affiliation(s)
| | - Riccardo D'Ambrosi
- Dipartimento di Scienze Biomediche per la Salute, IRCCS Istituto Ortopedico Galeazzi, Università degli Studi di Milano, Milan, Italy
| | - Luigi Manzi
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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71
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Fluoroquinolones and the Risk of Achilles Tendon Disorders: Update on a Neglected Complication. Urology 2017; 113:20-25. [PMID: 29074337 DOI: 10.1016/j.urology.2017.10.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 09/09/2017] [Accepted: 10/10/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the current evidence and to identify associated risk factors that increase the incidence of this complication. Fluoroquinolone (FQ) has been considered the first-line therapy for uncomplicated urinary infections. FQ has been associated with Achilles tendon disorders, especially during the first month of treatment. METHODS Data sources searched included PubMed, MEDLINE, and Scopus from January 1988 to June 2017. RESULTS A total of 79 articles were used, with ciprofloxacin representing the most common drug. CONCLUSION We found that male gender, advanced age, normal body mass index, chronic renal failure, and concurrent use of corticosteroids increase the risk of Achilles tendon disorders.
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72
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Spatiotemporal variations in gene expression, histology and biomechanics in an ovine model of tendinopathy. PLoS One 2017; 12:e0185282. [PMID: 29023489 PMCID: PMC5638251 DOI: 10.1371/journal.pone.0185282] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 09/08/2017] [Indexed: 11/20/2022] Open
Abstract
Flexor tendinopathy is a common problem affecting humans and animals. Tendon healing is poorly understood and the outcomes of conservative and surgical management are often suboptimal. While often considered a localized injury, recent evidence indicates that in the short term, tendinopathic changes are distributed widely throughout the tendon, remote from the lesion itself. Whether these changes persist throughout healing is unknown. The aim of this study was to document gene expression, histopathological and biomechanical changes that occur throughout the superficial digital flexor tendon (SDFT) up to 16 weeks post-injury, using an ovine surgical model of tendinopathy. Partial tendon transection was associated with decreased gene expression for aggrecan, decorin, fibromodulin, tissue inhibitors of metalloproteinases (TIMPS 1, 2 and 3), collagen I and collagen II. Gene expression for collagen III, lumican and matrix metalloproteinase 13 (MMP13) increased locally around the lesion site. Expression of collagen III and MMP13 decreased with time, but compared to controls, collagen III, MMP13 and lumican expression remained regionally high throughout the study. An increase in TIMP3 was observed over time. Histologically, operated tendons had higher pathology scores than controls, especially around the injured region. A chondroid phenotype was observed with increased cellular rounding and marked proteoglycan accumulation which only partially improved with time. Biomechanically, partial tendon transection resulted in a localized decrease in elastic modulus (in compression) but only at 8 weeks postoperatively. This study improves our understanding of tendon healing, demonstrating an early ‘peak’ in pathology characterized by altered gene expression and notable histopathological changes. Many of these pathological changes become more localized to the region of injury during healing. Collagen III and MMP13 expression levels remained high close to the lesion throughout the study and may reflect the production of tendon tissue with suboptimal biomechanical properties. Further studies evaluating the long-term response of tendon to injury (6–12 months) are warranted to provide additional information on tendon healing and provide further understanding of the mechanisms underlying the pathology observed in this study.
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73
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Bordvik DH, Haslerud S, Naterstad IF, Lopes-Martins RAB, Leal Junior ECP, Bjordal JM, Joensen J. Penetration Time Profiles for Two Class 3B Lasers inIn SituHuman Achilles at Rest and Stretched. Photomed Laser Surg 2017; 35:546-554. [DOI: 10.1089/pho.2016.4257] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- Daniel Huseby Bordvik
- NorPhyPain Research Group, Faculty of Health and Social Sciences, Centre for Evidence Based Practice, Bergen University College, Bergen, Norway
- Physiotherapy Research Group, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Haugesund Rheumatological Hospital, Rehabilitation West A/S, Haugesund, Norway
| | - Sturla Haslerud
- NorPhyPain Research Group, Faculty of Health and Social Sciences, Centre for Evidence Based Practice, Bergen University College, Bergen, Norway
- Physiotherapy Research Group, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Ingvill Fjell Naterstad
- NorPhyPain Research Group, Faculty of Health and Social Sciences, Centre for Evidence Based Practice, Bergen University College, Bergen, Norway
- Physiotherapy Research Group, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Rodrigo Alvaro Brandão Lopes-Martins
- Nucleous of Technological Research—NPT, Post-Graduate Program in Biomedical Engineering, University of Mogi das Cruzes (UMC), Mogi das Cruzes, São Paulo, Brazil
| | | | - Jan Magnus Bjordal
- NorPhyPain Research Group, Faculty of Health and Social Sciences, Centre for Evidence Based Practice, Bergen University College, Bergen, Norway
- Physiotherapy Research Group, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Occupational Therapy, Physiotherapy and Radiography, Bergen University College, Bergen, Norway
| | - Jon Joensen
- NorPhyPain Research Group, Faculty of Health and Social Sciences, Centre for Evidence Based Practice, Bergen University College, Bergen, Norway
- Physiotherapy Research Group, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Occupational Therapy, Physiotherapy and Radiography, Bergen University College, Bergen, Norway
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74
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Autograft Reconstruction for Chronic Achilles Tendon Disorders. TECHNIQUES IN FOOT AND ANKLE SURGERY 2017. [DOI: 10.1097/btf.0000000000000154] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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75
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Chan O, Havard B, Morton S, Pritchard M, Maffulli N, Crisp T, Padhiar N, Perry JD, King J, Morrissey D. Outcomes of prolotherapy for intra-tendinous Achilles tears: a case series. Muscles Ligaments Tendons J 2017; 7:78-87. [PMID: 28717615 DOI: 10.11138/mltj/2017.7.1.078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The intra-tendinous tear is a new pathology that is defined as a discontinuity of fibres situated entirely within the tendon. Prolotherapy involves injecting an irritant, such as hyperosmolar dextrose, to stimulate a tissue healing response and ultimately reduce pain. METHODS 43 consecutive patients diagnosed with an intra-tendinous tear were included (27 males: 16 females, mean (SD) age 41 (11.3). Patients were injected with 0.4ml-1.5ml (mean 0.8ml) of 50% dextrose and 0.5% marcaine mixed in a 1:1 ratio. A 4-6 week period of walking boot immobilisation was followed by progressive rehabilitation (6-8 weeks). Outcomes were assessed with a VISA-A questionnaire at baseline, 3 months and a mean 12.6 (7.0) months post-treatment. Ultrasound scans were conducted before treatment and 5.2 (2.3) weeks later to assess sonographic changes. RESULTS 30 patients (70%) responded with VISA-A scores increasing by 31 (30.5) points after 3 months (f=0.62, p<0.05) and by 40 (29.3) points after 12.60 (7.0) months (f=0.87, p<0.05). After 5.2 (2.3) weeks, echogenicity was significantly reduced (p<0.05) and 27% of tears were no longer detectable. No significant differences were observed in remaining tears with respect to tear size, tendon thickness or neovascularisation. CONCLUSION Treatment resulted in clinically significant improvements and controlled trials are warranted. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Otto Chan
- BMI London Independent Hospital, Stepney Green, London, UK
| | - Ben Havard
- Centre for Sports and Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, Mile End Hospital, London, UK
| | - Sarah Morton
- Centre for Sports and Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, Mile End Hospital, London, UK
| | - Mel Pritchard
- BMI London Independent Hospital, Stepney Green, London, UK
| | | | - Tom Crisp
- BMI London Independent Hospital, Stepney Green, London, UK.,Centre for Sports and Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, Mile End Hospital, London, UK
| | - Nat Padhiar
- BMI London Independent Hospital, Stepney Green, London, UK.,Centre for Sports and Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, Mile End Hospital, London, UK
| | - Jeremy David Perry
- BMI London Independent Hospital, Stepney Green, London, UK.,Centre for Sports and Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, Mile End Hospital, London, UK
| | - John King
- BMI London Independent Hospital, Stepney Green, London, UK.,Centre for Sports and Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, Mile End Hospital, London, UK
| | - Dylan Morrissey
- BMI London Independent Hospital, Stepney Green, London, UK.,Centre for Sports and Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, Mile End Hospital, London, UK.,Bart's Health NHS Trust, London, UK
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76
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Testa S, Costantini M, Fornetti E, Bernardini S, Trombetta M, Seliktar D, Cannata S, Rainer A, Gargioli C. Combination of biochemical and mechanical cues for tendon tissue engineering. J Cell Mol Med 2017; 21:2711-2719. [PMID: 28470843 PMCID: PMC5661263 DOI: 10.1111/jcmm.13186] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 02/20/2017] [Indexed: 12/21/2022] Open
Abstract
Tendinopathies negatively affect the life quality of millions of people in occupational and athletic settings, as well as the general population. Tendon healing is a slow process, often with insufficient results to restore complete endurance and functionality of the tissue. Tissue engineering, using tendon progenitors, artificial matrices and bioreactors for mechanical stimulation, could be an important approach for treating rips, fraying and tissue rupture. In our work, C3H10T1/2 murine fibroblast cell line was exposed to a combination of stimuli: a biochemical stimulus provided by Transforming Growth Factor Beta (TGF-β) and Ascorbic Acid (AA); a three-dimensional environment represented by PEGylated-Fibrinogen (PEG-Fibrinogen) biomimetic matrix; and a mechanical induction exploiting a custom bioreactor applying uniaxial stretching. In vitro analyses by immunofluorescence and mechanical testing revealed that the proposed combined approach favours the organization of a three-dimensional tissue-like structure promoting a remarkable arrangement of the cells and the neo-extracellular matrix, reflecting into enhanced mechanical strength. The proposed method represents a novel approach for tendon tissue engineering, demonstrating how the combined effect of biochemical and mechanical stimuli ameliorates biological and mechanical properties of the artificial tissue compared to those obtained with single inducement.
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Affiliation(s)
- Stefano Testa
- Department of Biology, Tor Vergata Rome University, Rome, Italy
| | - Marco Costantini
- Department of Engineering, Università Campus Bio-Medico di Roma, Rome, Italy
| | | | | | - Marcella Trombetta
- Department of Engineering, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Dror Seliktar
- Department of Biomedical Engineering, Techion Institute, Haifa, Israel
| | - Stefano Cannata
- Department of Biology, Tor Vergata Rome University, Rome, Italy
| | - Alberto Rainer
- Department of Engineering, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Cesare Gargioli
- Department of Biology, Tor Vergata Rome University, Rome, Italy
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The Risk of Achilles Tendon Rupture in the Patients with Achilles Tendinopathy: Healthcare Database Analysis in the United States. BIOMED RESEARCH INTERNATIONAL 2017; 2017:7021862. [PMID: 28540301 PMCID: PMC5429922 DOI: 10.1155/2017/7021862] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 01/18/2017] [Accepted: 02/09/2017] [Indexed: 12/22/2022]
Abstract
Introduction. Disorders of the Achilles tendon can be broadly classified into acute and chronic entities. Few studies have established chronic Achilles tendinopathy as a precursor to acute Achilles ruptures. In this study, we assessed the relationship between Achilles tendinopathy and rupture, clarifying the incidence of rupture in the setting of underlying tendinopathy. Methods. The United Healthcare Orthopedic Dataset from the PearlDiver Patient Record Database was used to identify patients with ICD-9 codes for Achilles rupture and/or Achilles tendinopathy. The number of patients with acute rupture, chronic tendinopathy, and rupture following a prior diagnosis of tendinopathy was assessed. Results. Four percent of patients with an underlying diagnosis of Achilles tendinopathy went on to sustain a rupture (7,232 patients). Older patients with tendinopathy were most vulnerable to subsequent rupture. Conclusions. The current study demonstrates that 4.0% of patients who were previously diagnosed with Achilles tendinopathy sustained an Achilles tendon rupture. Additionally, older patients with Achilles tendinopathy were most vulnerable. These findings are important as they can help clinicians more objectively council patients with Achilles tendinopathy.
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Abstract
Non-insertional Achilles tendinopathy is a degenerative condition characterised by pain on activity.Eccentric stretching is the most effective treatment.Surgical treatment is reserved for recalcitrant cases.Minimally-invasive and tendinoscopic treatments are showing promising results. Cite this article: Pearce CJ, Tan A. Non-insertional Achilles tendinopathy. EFORT Open Rev 2016;1:383-390. DOI: 10.1302/2058-5241.1.160024.
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Affiliation(s)
| | - Audrey Tan
- Jurong Health Services Pte Ltd, Singapore
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79
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Achilles Tendinopathy: Current Concepts about the Basic Science and Clinical Treatments. BIOMED RESEARCH INTERNATIONAL 2016; 2016:6492597. [PMID: 27885357 PMCID: PMC5112330 DOI: 10.1155/2016/6492597] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 09/20/2016] [Indexed: 12/30/2022]
Abstract
Achilles tendinopathy is one of the most frequently ankle and foot overuse injuries, which is a clinical syndrome characterized by the combination of pain, swelling, and impaired performance. The two main categories of Achilles tendinopathy are classified according to anatomical location and broadly include insertional and noninsertional tendinopathy. The etiology of Achilles tendinopathy is multifactorial including both intrinsic and extrinsic factors. Failed healing response and degenerative changes were found in the tendon. The failed healing response includes three different and continuous stages (reactive tendinopathy, tendon disrepair, and degenerative tendinopathy). The histological studies have demonstrated an increased number of tenocytes and concentration of glycosaminoglycans in the ground substance, disorganization and fragmentation of the collagen, and neovascularization. There are variable conservative and surgical treatment options for Achilles tendinopathy. However, there has not been a gold standard of these treatments because of the controversial clinical results between various studies. In the future, new level I researches will be needed to prove the effect of these treatment options.
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80
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Analysis of experimental tendinitis in rats treated with laser and platelet-rich plasma therapies by Raman spectroscopy and histometry. Lasers Med Sci 2016; 31:19-26. [PMID: 26498452 DOI: 10.1007/s10103-015-1819-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 10/13/2015] [Indexed: 01/25/2023]
Abstract
The objective of this controlled experimental study was to analyze the changes in the Achilles tendons of rats with experimentally induced tendinitis after treatment with platelet-rich plasma (PRP) and/or laser therapies by histometry to quantify fibroblasts and by Raman spectroscopy to determine the biochemical concentration of collagen types I and III. Fifty-four male Wistar rats were divided into six treatment groups: control (G1); PRP only (G2); irradiation with 660 nm laser (G3); irradiation with 830 nm laser (G4); PRP plus 660 nm laser irradiation (G5); and PRP plus 830 nm laser irradiation (G6). Injuries (partial tenotomy) were inflicted in the middle third of the Achilles tendon, with PRP added prior to suture in the appropriate experimental groups. A diode laser (model Laser Flash® III, DMC Equipamentos Ltda, São Carlos, SP, Brazil) that can be operated in two wavelengths 660 and 830 nm was used for irradiation treatments. The irradiation protocol was energy density of 70 J/cm², 20 s irradiation time, and 0.028 cm² spot area, per point in three points in the injured. The histometry was made in micrographical images of the H&E stained sections and evaluated by ImageJ (version 1.46r)®. Raman spectra were collected using a dispersive spectrometer at 830 nm excitation, 200 mW power, and 10 s integration time (P-1 Raman system, Lambda Solutions, Inc. MA, USA). The relative amount of type I collagen was significantly greater in the PRP plus 830 nm laser irradiation group (468 ± 188) than in the control (147 ± 137), 630 nm laser only (191 ± 117), and 830 nm laser only (196 ± 106) groups (p < 0.01), while the quantity of type III collagen was significantly greater in the PRP-only group compared to both irradiated groups without PRP (p < 0.05). Treatment with PRP combined with irradiation at 830 nm resulted in a larger number of fibroblasts and increased concentration of type I collagen, thus accelerating the healing of the injured tendon.
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81
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Bidell MR, Lodise TP. Fluoroquinolone-Associated Tendinopathy: Does Levofloxacin Pose the Greatest Risk? Pharmacotherapy 2016; 36:679-93. [DOI: 10.1002/phar.1761] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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82
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Wu YT, Wu PT, Jou IM. Peritendinous elastase treatment induces tendon degeneration in rats: A potential model of tendinopathy in vivo. J Orthop Res 2016; 34:471-7. [PMID: 26291184 DOI: 10.1002/jor.23030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 08/14/2015] [Indexed: 02/04/2023]
Abstract
The purpose of this study was to investigate the role of elastase on tendinopathy, as well as to evaluate the potential for peritendinous injections of elastase into rats to cause tendinopathy. We first investigated the expression of elastase in the tendons of patients with tendinopathy, and then established the effects of elastase injection on the Achilles tendons of rats. Ultrasonographic and incapacitance testing was used to conduct tests for 8 weeks. Tendon tissues were collected for histological observation and protein levels of collagen type I and type III were detected using Western blotting. The percentage of elastase-positive cells increased in human specimens with grades II and III tendinopathy. The rat model demonstrated that the thickness of the tendon increased after elastase injection during Week 2-8. Hypercellularity and focal lesions were detected after Week 2. The expression of elastase was increased and elastin was decreased in Week 8. Collagen type I expression was decreased, but type III was increased in Week 4. These results suggested that elastase may be involved in the development of chronic tendinopathy, and that peritendinous injection of elastase may result in tendinopathy in rats.
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Affiliation(s)
- Yen-Ting Wu
- Institute of Basic Medical Sciences, National Cheng Kung University, Tainan, Taiwan
| | - Po-Ting Wu
- Department of Orthopedics, National Cheng Kung University Hospital, Tainan, Taiwan
| | - I-Ming Jou
- Department of Orthopedics, National Cheng Kung University Hospital, Tainan, Taiwan
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83
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Benazzo F, Marullo M, Indino C, Zanon G. Achilles Tendinopathies. ARTHROSCOPY AND SPORT INJURIES 2016:69-76. [DOI: 10.1007/978-3-319-14815-1_9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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84
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A Proposed Return-to-Sport Program for Patients With Midportion Achilles Tendinopathy: Rationale and Implementation. J Orthop Sports Phys Ther 2015; 45:876-86. [PMID: 26390272 DOI: 10.2519/jospt.2015.5885] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Synopsis Achilles tendinopathy is a common overuse injury in athletes involved in running and jumping activities and sports. The intervention with the highest level of evidence is exercise therapy, and it is recommended that all patients initially be treated with exercise for at least 3 months prior to considering other treatment options. Recovery from Achilles tendinopathy can take up to a year, and there is a high propensity for recurrence, especially during the return-to-sport phase. The extent of the tendon injury, the age and sex of the athlete, the magnitude of pain/symptoms, the extent of impairments, and the demands of the sport all need to be considered when planning for return to sport. This clinical commentary describes an approach to return to sport for patients with midportion Achilles tendinopathy. The aim of the return-to-sport program is to facilitate the decision-making process in returning an athlete with midportion Achilles tendinopathy back to full sport participation and to minimize the chances for recurrence of the injury. J Orthop Sports Phys Ther 2015;45(11):876-886. Epub 21 Sep 2015. doi:10.2519/jospt.2015.5885.
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Abstract
Abstract
Disorders of the Achilles tendon, the largest tendon in the human body, are common and occur in both active and sedentary persons. A thorough history and physical examination allow primary care physicians to make an accurate diagnosis and to initiate appropriate management. Mismanaged or neglected injuries markedly decrease a patient’s quality of life. A growing body of related literature is the basis for current therapeutic regimens, which use a multimodal conservative approach, including osteopathic manipulative treatment. Although primary care physicians can manage most cases of Achilles tendon disorders, specialty care may be needed in certain instances. Procedural intervention should consider any comorbid conditions in addition to patients’ lifestyle to help guide decision making. When appropriately managed, Achilles tendon disorders generally carry a favorable prognosis.
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86
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Beyer R, Kongsgaard M, Hougs Kjær B, Øhlenschlæger T, Kjær M, Magnusson SP. Heavy Slow Resistance Versus Eccentric Training as Treatment for Achilles Tendinopathy: A Randomized Controlled Trial. Am J Sports Med 2015; 43:1704-11. [PMID: 26018970 DOI: 10.1177/0363546515584760] [Citation(s) in RCA: 193] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Previous studies have shown that eccentric training has a positive effect on Achilles tendinopathy, but few randomized controlled trials have compared it with other loading-based treatment regimens. PURPOSE To evaluate the effectiveness of eccentric training (ECC) and heavy slow resistance training (HSR) among patients with midportion Achilles tendinopathy. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS A total of 58 patients with chronic (>3 months) midportion Achilles tendinopathy were randomized to ECC or HSR for 12 weeks. Function and symptoms (Victorian Institute of Sports Assessment-Achilles), tendon pain during activity (visual analog scale), tendon swelling, tendon neovascularization, and treatment satisfaction were assessed at 0 and 12 weeks and at the 52-week follow-up. Analyses were performed on an intention-to-treat basis. RESULTS Both groups showed significant (P < .0001) improvements in Victorian Institute of Sports Assessment-Achilles and visual analog scale from 0 to 12 weeks, and these improvements were maintained at the 52-week follow-up. Concomitant with the clinical improvement, there was a significant reduction in tendon thickness and neovascularization. None of these robust clinical and structural improvements differed between the ECC and HSR groups. However, patient satisfaction tended to be greater after 12 weeks with HSR (100%) than with ECC (80%; P = .052) but not after 52 weeks (HSR, 96%; ECC, 76%; P = .10), and the mean training session compliance rate was 78% in the ECC group and 92% in the HSR group, with a significant difference between groups (P < .005). CONCLUSION The results of this study show that both traditional ECC and HSR yield positive, equally good, lasting clinical results in patients with Achilles tendinopathy and that the latter tends to be associated with greater patient satisfaction after 12 weeks but not after 52 weeks.
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Affiliation(s)
- Rikke Beyer
- Department of Physical Therapy, Musculoskeletal Rehabilitation Research Unit, Bispebjerg Hospital, Copenhagen, Denmark Institute of Sports Medicine, Bispebjerg Hospital and Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mads Kongsgaard
- Institute of Sports Medicine, Bispebjerg Hospital and Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Birgitte Hougs Kjær
- Department of Physical Therapy, Musculoskeletal Rehabilitation Research Unit, Bispebjerg Hospital, Copenhagen, Denmark
| | - Tommy Øhlenschlæger
- Institute of Sports Medicine, Bispebjerg Hospital and Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Michael Kjær
- Institute of Sports Medicine, Bispebjerg Hospital and Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - S Peter Magnusson
- Department of Physical Therapy, Musculoskeletal Rehabilitation Research Unit, Bispebjerg Hospital, Copenhagen, Denmark Institute of Sports Medicine, Bispebjerg Hospital and Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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87
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Freedman BR, Bade ND, Riggin CN, Zhang S, Haines PG, Ong KL, Janmey PA. The (dys)functional extracellular matrix. BIOCHIMICA ET BIOPHYSICA ACTA-MOLECULAR CELL RESEARCH 2015; 1853:3153-64. [PMID: 25930943 DOI: 10.1016/j.bbamcr.2015.04.015] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 04/11/2015] [Accepted: 04/13/2015] [Indexed: 10/23/2022]
Abstract
The extracellular matrix (ECM) is a major component of the biomechanical environment with which cells interact, and it plays important roles in both normal development and disease progression. Mechanical and biochemical factors alter the biomechanical properties of tissues by driving cellular remodeling of the ECM. This review provides an overview of the structural, compositional, and mechanical properties of the ECM that instruct cell behaviors. Case studies are reviewed that highlight mechanotransduction in the context of two distinct tissues: tendons and the heart. Although these two tissues demonstrate differences in relative cell-ECM composition and mechanical environment, they share similar mechanisms underlying ECM dysfunction and cell mechanotransduction. Together, these topics provide a framework for a fundamental understanding of the ECM and how it may vary across normal and diseased tissues in response to mechanical and biochemical cues. This article is part of a Special Issue entitled: Mechanobiology.
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Affiliation(s)
- Benjamin R Freedman
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Nathan D Bade
- Department of Chemical and Biomolecular Engineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Corinne N Riggin
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Sijia Zhang
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Philip G Haines
- Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Katy L Ong
- Department of Cell and Developmental Biology, University of Pennsylvania, Philadelphia, PA, USA
| | - Paul A Janmey
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA; Department of Physiology, University of Pennsylvania, Philadelphia, PA, USA.
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Abstract
We hypothesised that a minimally invasive peroneus brevis tendon transfer would be effective for the management of a chronic rupture of the Achilles tendon. In 17 patients (three women, 14 men) who underwent minimally invasive transfer and tenodesis of the peroneus brevis to the calcaneum, at a mean follow-up of 4.6 years (2 to 7) the modified Achilles tendon total rupture score (ATRS) was recorded and the maximum circumference of the calf of the operated and contralateral limbs was measured. The strength of isometric plantar flexion of the gastrocsoleus complex and of eversion of the ankle were measured bilaterally. Functional outcomes were classified according to the four-point Boyden scale. At the latest review, the mean maximum circumference of the calf of the operated limb was not significantly different from the pre-operative mean value, (41.4 cm, 32 to 50 vs 40.6 cm, 33 to 46; p = 0.45), and not significantly less than that of the contralateral limb (43.1 cm, 35 to 52; p = 0.16). The mean peak torque (244.6 N, 125 to 367) and the strength of eversion of the operated ankle (149.1 N, 65 to 240) were significantly lower (p < 0.01) than those of the contralateral limb (mean peak torque 289, 145 to 419; strength of eversion: 175.2, 71 to 280). The mean ATRS significantly improved from 58 pre-operatively (35 to 68) to 91 (75 to 97; 95% confidence interval 85.3 to 93.2) at the time of final review. Of 13 patients who practised sport at the time of injury, ten still undertook recreational activities. This procedure may be safely performed, is minimally invasive, and allows most patients to return to pre-injury sport and daily activities. Cite this article: Bone Joint J 2015;97-B:353–7.
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Affiliation(s)
- N. Maffulli
- University of Salerno, School
of Medicine and Surgery, Salerno, Italy
| | - F. Oliva
- University of Rome ‘Tor Vergata’ School
of Medicine, Viale Oxford 81, Rome, Italy
| | - V. Costa
- Campus Biomedico University , Via
Alvaro del Portillo, 200, 00128
Trigoria, Rome, Italy
| | - A. Del Buono
- Campus Biomedico University, Via
Alvaro del Portillo, 200, 00128
Trigoria, Rome, Italy
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89
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Sobhani S, Zwerver J, van den Heuvel E, Postema K, Dekker R, Hijmans JM. Rocker shoes reduce Achilles tendon load in running and walking in patients with chronic Achilles tendinopathy. J Sci Med Sport 2015; 18:133-8. [DOI: 10.1016/j.jsams.2014.02.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 01/07/2014] [Accepted: 02/06/2014] [Indexed: 11/16/2022]
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Habets B, van Cingel REH. Eccentric exercise training in chronic mid-portion Achilles tendinopathy: a systematic review on different protocols. Scand J Med Sci Sports 2015; 25:3-15. [PMID: 24650048 DOI: 10.1111/sms.12208] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2014] [Indexed: 11/27/2022]
Abstract
Although eccentric exercise training has shown favorable results in chronic mid-portion Achilles tendinopathy, the optimum dosage remains unknown. A systematic review of the literature was performed in accordance with the PRISMA guidelines, in order to describe different exercise protocols and to determine the most effective training parameters. An extensive search in MEDLINE, EMBASE, CINAHL, and CENTRAL revealed 14 randomized and clinical controlled trials. Strong evidence was found for the Alfredson exercise protocol. In this 12-week protocol, exercises are performed 3 × 15 repetitions twice daily, both with a straight and bent knee. Exercises are performed at slow speed, and load is increased when exercises are without pain. Strong evidence was also found for gradual onset of exercises during the first week of the Alfredson program, but no uniformity of protocols exists. Other exercise protocols did achieve similar results, but many studies had some methodological shortcomings or lacked a detailed description of their training parameters. Because of the heterogeneity of study populations and outcome measures, and lack of reporting of training compliance data, a definitive conclusion regarding the most effective training parameters could not be made. Further research comparing the content of different exercise protocols is warranted.
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Affiliation(s)
- B Habets
- Papendal Sports Medical Center, Arnhem, The Netherlands; Physical Therapy Sciences, Program in Clinical Health Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
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91
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Wheeler PC. The use of high-volume image-guided injections (HVIGI) for Achilles tendinopathy – A case series and pilot study. ACTA ACUST UNITED AC 2014. [DOI: 10.1179/1753615414y.0000000035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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92
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Nuttall C, Rasmussen R. Tendinopathy: Setting the Record Straight. J Nurse Pract 2014. [DOI: 10.1016/j.nurpra.2014.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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93
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Vulcano E, Mani SB, Do H, Bohne WH, Ellis SJ. Association of Achilles tendinopathy and plantar spurs. Orthopedics 2014; 37:e897-901. [PMID: 25275977 DOI: 10.3928/01477447-20140924-56] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 01/31/2014] [Indexed: 02/03/2023]
Abstract
Plantar spurs and Achilles tendinopathy are common causes of heel pain. In the authors' practice, it was anecdotally noted that patients with Achilles tendinopathy often presented with plantar spurs. Nonetheless, there is a shortage of studies investigating whether Achilles tendinopathy and plantar spurs exist concomitantly. A better understanding of the association between the 2 pathologies might help physicians recognize and treat both conditions, educate patients about Achilles tendinopathy and plantar spurs, and ultimately investigate possible underlying causes of both pathologies that could be addressed together. The authors examined the prevalence of plantar spurs in patients diagnosed with Achilles tendinopathy as well as demographic differences within the unilateral and bilateral Achilles tendinopathy populations. A total of 785 patient records were retrospectively reviewed. Mean patient age was 56.2±15.5 years (46.9% men and 53.1% women). Seventy-two (9.2%) patients were affected bilaterally by Achilles tendinopathy. Lateral radiographs were reviewed by an orthopedic surgeon to identify the presence of plantar spurs. A total of 329 (41.9%) patients with Achilles tendinopathy were found to have a concomitant plantar spur. Patients with unilateral Achilles tendinopathy and a plantar spur were more likely to be women (58.7% vs 49.8%, P=.020) and older (62.7 vs 51.7 years, P<.001). In the bilateral Achilles tendinopathy group, there were 46 (63.9%) patients with at least one foot presenting with a plantar spur. The study's findings suggest a significant association between Achilles tendinopathy and plantar spurs. Older women with Achilles tendinopathy are at greater risk of being affected by plantar spurs.
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Magnan B, Bondi M, Pierantoni S, Samaila E. The pathogenesis of Achilles tendinopathy: a systematic review. Foot Ankle Surg 2014; 20:154-9. [PMID: 25103700 DOI: 10.1016/j.fas.2014.02.010] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 02/07/2014] [Accepted: 02/23/2014] [Indexed: 02/04/2023]
Abstract
Achilles tendinopathy is a degenerative, not an inflammatory, condition. It is prevalent in athletes involved in running sports. A systematic literature review on Achilles tendon tendinopathy has been performed according to the intrinsic (age, sex, body weight, tendon temperature, systemic diseases, muscle strength, flexibility, previous injuries and anatomical variants, genetic predisposition and blood supply) and extrinsic risk factors (drugs and overuse), which can cause tendon suffering and degeneration. Different theories have been found: Neurogenic, Angiogenic, Impingement and "Iceberg" Hypotheses. Multiple databases were utilized for articles published between 1964 and 2013. The different hypothesis were analyzed, differently considering those concerning the pathogenesis of tendinopathy and those concerning the etiology of complaints in patients. This review of the literature demonstrates the heterogeneity of Achilles tendinopathy pathogenesis. Various risk factors have been identified and have shown an interaction between them such as genes, age, circulating and local cytokine production, sex, biomechanics and body composition.
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Affiliation(s)
- Bruno Magnan
- Orthopaedic Department, University of Verona (Italy), Surgical Center "P. Confortini", Piazzale A. Stefani 1, 37126 Verona, Italy.
| | - Manuel Bondi
- Orthopaedic Department, University of Verona (Italy), Surgical Center "P. Confortini", Piazzale A. Stefani 1, 37126 Verona, Italy
| | - Silvia Pierantoni
- Orthopaedic Department, University of Verona (Italy), Surgical Center "P. Confortini", Piazzale A. Stefani 1, 37126 Verona, Italy
| | - Elena Samaila
- Orthopaedic Department, University of Verona (Italy), Surgical Center "P. Confortini", Piazzale A. Stefani 1, 37126 Verona, Italy
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Jaque D, Martínez Maestro L, del Rosal B, Haro-Gonzalez P, Benayas A, Plaza JL, Martín Rodríguez E, García Solé J. Nanoparticles for photothermal therapies. NANOSCALE 2014; 6:9494-530. [PMID: 25030381 DOI: 10.1039/c4nr00708e] [Citation(s) in RCA: 1060] [Impact Index Per Article: 106.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
The current status of the use of nanoparticles for photothermal treatments is reviewed in detail. The different families of heating nanoparticles are described paying special attention to the physical mechanisms at the root of the light-to-heat conversion processes. The heating efficiencies and spectral working ranges are listed and compared. The most important results obtained in both in vivo and in vitro nanoparticle assisted photothermal treatments are summarized. The advantages and disadvantages of the different heating nanoparticles are discussed.
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Affiliation(s)
- D Jaque
- Fluorescence Imaging Group, Departamento de Física de Materiales e Instituto Nicolás Cabrera, Facultad de Ciencias, Universidad Autónoma de Madrid, Campus de Cantoblanco, Madrid 28049, Spain.
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96
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Yang G, Rothrauff BB, Tuan RS. Tendon and ligament regeneration and repair: clinical relevance and developmental paradigm. ACTA ACUST UNITED AC 2014; 99:203-222. [PMID: 24078497 DOI: 10.1002/bdrc.21041] [Citation(s) in RCA: 258] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Revised: 07/27/2013] [Accepted: 07/27/2013] [Indexed: 12/18/2022]
Abstract
As dense connective tissues connecting bone to muscle and bone to bone, respectively, tendon and ligament (T/L) arise from the somitic mesoderm, originating in a recently discovered somitic compartment, the syndetome. Inductive signals from the adjacent sclerotome and myotome upregulate expression of Scleraxis, a key transcription factor for tenogenic and ligamentogenic differentiation. Understanding T/L development is critical to establishing a knowledge base for improving the healing and repair of T/L injuries, a high-burden disease due to the intrinsically poor natural healing response. Current treatment of the three most common tendon injuries-tearing of the rotator cuff of the shoulder, flexor tendon of the hand, and Achilles tendon-include mostly surgical repair and/or conservative approaches, including biophysical modalities such as rehabilitation and cryotherapy. Unfortunately, the fibrovascular scar formed during healing possesses inferior mechanical and biochemical properties, resulting in compromised tissue functionality. Regenerative approaches have sought to augment the injured tissue with cells, scaffolds, bioactive agents, and mechanical stimulation to improve the natural healing response. The key challenges in restoring full T/L function following injury include optimal combination of these biological agents as well as their delivery to the injury site. A greater understanding of the molecular mechanisms involved in T/L development and natural healing, coupled with the capability of producing complex biomaterials to deliver multiple biofactors with high spatiotemporal resolution and specificity, should lead to regenerative procedures that more closely recapitulate T/L morphogenesis, thereby offering future patients the prospect of T/L regeneration, as opposed to simple tissue repair.
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Affiliation(s)
- Guang Yang
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15219, USA
| | - Benjamin B Rothrauff
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15219, USA
| | - Rocky S Tuan
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15219, USA
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Gunes T, Bilgic E, Erdem M, Bostan B, Koseoglu RD, Sahin SA, Sen C. Effect of radiofrequency microtenotomy on degeneration of tendons: an experimental study on rabbits. Foot Ankle Surg 2014; 20:61-6. [PMID: 24480503 DOI: 10.1016/j.fas.2013.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 10/09/2013] [Accepted: 11/04/2013] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Radiofrequency microtenotomy is used to enhance healing by increasing vascularity in the degenerated tendon. In the present study, the effect of radiofrequency microtenotomy (Rf-mt) treatment on tendon degeneration was investigated. MATERIALS AND METHODS A total of 32 New Zealand rabbits were enrolled in the current study. Experimental degeneration was performed by injecting prostaglandin E1 (PGE1) into the bilateral Achilles tendons of rabbits. After excluding 4 rabbits with an infection on the injection site, 4 other rabbits were sacrificed to define the histopathologic changes in the tendons. The remaining 24 rabbits were divided into 2 groups: the control group and the Rf-mt group. In the control group, the Rf-mt device was only applied to the Achilles tendon without running the device. In the Rf-mt group, the Rf-mt device was applied bilaterally at the fourth energy level for 500ms to an area within 2cm proximal to the insertion site at 0.5cm intervals in order to form a grid. Six rabbits from each group were sacrificed at 6 and 12 weeks. The Achilles tendons were evaluated histopathologically by a modified Movin scale and by immunohistopathologic staining for vascular endothelial growth factor and type 4 collagen. RESULTS After the PGE1 injection, findings similar to chronic degenerative tendinopathy were observed. The Rf-mt group showed significant improvement in vascularity in the histopathological and immunohistochemical examination (P<0.05). However, there was no significant difference in healing between the control and Rf-mt groups (P>0.05). CONCLUSIONS Rf-mt treatment increases vascularity in degenerated tendons but does not create difference to facilitate the healing process comparing control group.
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Affiliation(s)
- Taner Gunes
- Gaziosmanpasa University School of Medicine, Department of Orthopaedics and Traumatology, Tokat, Turkey.
| | - Erkal Bilgic
- Gaziosmanpasa University School of Medicine, Department of Orthopaedics and Traumatology, Tokat, Turkey
| | - Mehmet Erdem
- Sakarya University School of Medicine, Department of Orthopaedics and Traumatology, Sakarya, Turkey
| | - Bora Bostan
- Gaziosmanpasa University School of Medicine, Department of Orthopaedics and Traumatology, Tokat, Turkey
| | - Resit Dogan Koseoglu
- Gaziosmanpasa University School of Medicine, Department of Pathology, Tokat, Turkey
| | - Seyyid Ahmet Sahin
- Erbaa State Hospital, Clinic of Orthopaedics and Traumatology, Erbaa, Tokat, Turkey
| | - Cengiz Sen
- Istanbul University, Istanbul Medical School, Department of Orthopaedics and Traumatology, Istanbul, Turkey
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98
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Dakin SG, Dudhia J, Smith RKW. Resolving an inflammatory concept: the importance of inflammation and resolution in tendinopathy. Vet Immunol Immunopathol 2014; 158:121-7. [PMID: 24556326 PMCID: PMC3991845 DOI: 10.1016/j.vetimm.2014.01.007] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 12/19/2013] [Accepted: 01/06/2014] [Indexed: 01/01/2023]
Abstract
Injuries to the superficial digital flexor tendon (SDFT) are an important cause of morbidity and mortality in equine athletes, but the healing response is poorly understood. One important drive for the healing of connective tissues is the inflammatory cascade, but the role of inflammation in tendinopathy has been contentious in the literature. This article reviews the processes involved in the healing of tendon injuries in natural disease and experimental models. The importance of inflammatory processes known to be active in tendon disease is discussed with particular focus on recent findings related specifically to the horse. Whilst inflammation is necessary for debridement after injury, persistent inflammation is thought to drive fibrosis, a perceived adverse consequence of tendon healing. Therefore the ability to resolve inflammation by the resident cell populations in tendons at an appropriate time would be crucial for successful outcome. This review summarises new evidence for the importance of resolution of inflammation after tendon injury. Given that many anti-inflammatory drugs suppress both inflammatory and resolving components of the inflammatory response, prolonged use of these drugs may be contraindicated as a therapeutic approach. We propose that these findings have profound implications not only for current treatment strategies but also for the possibility of developing novel therapeutic approaches involving modulation of the inflammatory process.
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Affiliation(s)
- Stephanie G Dakin
- Royal Veterinary College, Department of Clinical Sciences and Services, North Mymms, Hatfield, Hertfordshire AL9 7TA, United Kingdom.
| | - Jayesh Dudhia
- Royal Veterinary College, Department of Clinical Sciences and Services, North Mymms, Hatfield, Hertfordshire AL9 7TA, United Kingdom
| | - Roger K W Smith
- Royal Veterinary College, Department of Clinical Sciences and Services, North Mymms, Hatfield, Hertfordshire AL9 7TA, United Kingdom
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99
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Dean BJF, Franklin SL, Carr AJ. The peripheral neuronal phenotype is important in the pathogenesis of painful human tendinopathy: a systematic review. Clin Orthop Relat Res 2013; 471:3036-46. [PMID: 23609815 PMCID: PMC3734433 DOI: 10.1007/s11999-013-3010-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 04/16/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND The pathogenesis of tendinopathy is complex and incompletely understood. Although significant advances have been made in terms of understanding the pathological changes in both the extracellular matrix and the cells involved, relatively little is known about the role of neuronal regulation in tendinopathy. The frequent mismatch between tendon pathology and pain may be explained, in part, by differences in the peripheral neuronal phenotype of patients. QUESTIONS/PURPOSES The primary purpose of this review was to determine whether evidence exists of changes in the peripheral neuronal phenotype in painful human tendinopathy and, if so, to identify the associated histological and molecular changes. The secondary purpose was to determine if any changes in the peripheral neuronal phenotype reported correlate with pain symptoms. METHODS We conducted a systematic review of the scientific literature using the PRISMA and Cochrane guidelines. The Medline and Embase databases were searched using specific search criteria. Only studies analyzing the peripheral tissue of patients with the clinical diagnosis of tendinopathy were included. Inclusion was agreed on by two independent researchers on review of abstracts or full text. RESULTS Overall in the 27 included studies, there was clear evidence of changes in the peripheral neuronal phenotype in painful human tendinopathy. The excitatory glutaminergic system was significantly upregulated in seven studies, there was a significant increase in sensory neuropeptide expression in four studies, and there were significant changes in the molecular morphology of tenocytes, blood vessels, and nerves. In rotator cuff tendinopathy, substance P has been shown to correlate with pain and the neural density in the subacromial bursa has been shown to correlate with rest pain. CONCLUSIONS The peripheral neuronal phenotype is an important factor in the pathogenesis of painful human tendinopathy. Further research in this area specifically correlating tissue changes to clinical scores has great potential in further developing our understanding of the disease process.
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Affiliation(s)
- Benjamin John Floyd Dean
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Institute of Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Windmill Road, Oxford, OX3 7LD UK
| | - Sarah L. Franklin
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Institute of Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Windmill Road, Oxford, OX3 7LD UK
| | - Andrew Jonathan Carr
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Institute of Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Windmill Road, Oxford, OX3 7LD UK
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100
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Moraes SAS, Oliveira KRM, Crespo-López ME, Picanço-Diniz DLW, Herculano AM. Local NO synthase inhibition produces histological and functional recovery in Achilles tendon of rats after tenotomy: tendon repair and local NOS inhibition. Cell Tissue Res 2013; 353:457-63. [PMID: 23839241 DOI: 10.1007/s00441-013-1662-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 05/06/2013] [Indexed: 11/30/2022]
Abstract
Repair of injured tendon is a very slow process and involves the release of many molecules, including nitric oxide. We investigate the influence of local nitrergic inhibition in histological and functional recovery of injured Achilles tendon. A standard murine model of tendon injury by rupture was used. The animals were divided into three experimental groups: control, injury + vehicle (normal saline) and injury + Nω-nitro-L-arginine methyl ester (L-NAME). The products were injected into the paratendinous region every 2 days and body weight gain and Achilles functional index (AFI) were evaluated on days 0, 7, 14 and 21 after tendon injury. On day 21 post-injury, the animals were killed to evaluate nitric oxide production and tissue organization. We observed that tendon surgical division led to increased tissue nitrite levels, which were reduced in L-NAME-treated rats. The AFI revealed functional recovery of L-NAME-treated animals on day 21 post-injury, which was not observed in the saline-treated group. Microscopic analysis of hematoxylin-eosin staining and collagen autofluorescence showed that L-NAME-treated rats had more aligned areas of collagen fibers and that the diameter of newly organized collagen in this group was also greater than that in the vehicle-treated one. We demonstrate that local treatment with L-NAME significantly improves the functional parameters and accelerates histomorphological recovery.
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Affiliation(s)
- Suellen A S Moraes
- Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, Brazil.
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