101
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Common Musculoskeletal Disorders in the Elderly: The Star Triad. J Clin Med 2020; 9:jcm9041216. [PMID: 32340331 PMCID: PMC7231138 DOI: 10.3390/jcm9041216] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 04/09/2020] [Accepted: 04/22/2020] [Indexed: 12/15/2022] Open
Abstract
Musculoskeletal disorders are debilitating conditions that significantly impair the state of health, especially in elderly subjects. A pathological triad of inter-related disorders that are highly prevalent in the elderly consists of the following main “components”: sarcopenia, tendinopathies, and arthritis. The aim of this review is to critically appraise the literature relative to the different disorders of this triad, in order to highlight the pathophysiological common denominator and propose strategies for personalized clinical management of patients presenting with this combination of musculoskeletal disorders. Their pathophysiological common denominator is represented by progressive loss of (focal or generalized) neuromuscular performance with a risk of adverse outcomes such as pain, mobility disorders, increased risk of falls and fractures, and impaired ability or disability to perform activities of daily living. The precise management of these disorders requires not only the use of available tools and recently proposed operational definitions, but also the development of new tools and approaches for prediction, diagnosis, monitoring, and prognosis of the three disorders and their combination.
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102
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Influence of genetic factors in elbow tendon pathology: a case-control study. Sci Rep 2020; 10:6503. [PMID: 32300121 PMCID: PMC7162873 DOI: 10.1038/s41598-020-63030-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 03/18/2020] [Indexed: 11/09/2022] Open
Abstract
Elbow tendinopathy is a common pathology of the upper extremity that impacts both athletes and workers. Some research has examined the genetic component as a risk factor for tendinopathy, mainly in the lower limbs. A case-control study was designed to test for a relationship between certain collagen gene single nucleotide polymorphisms (SNPs) and elbow tendon pathology. A sample of 137 young adult athletes whose sports participation involves loading of the upper limb were examined for the presence of structural abnormalities indicative of pathology in the tendons of the lateral and medial elbow using ultrasound imaging and genotyped for the following SNPs: COL5A1 rs12722, COL11A1 rs3753841, COL11A1 rs1676486, and COL11A2 rs1799907. Anthropometric measurements and data on participants’ elbow pain and dysfunction were collected using the Disabilities of the Arm, Shoulder and Hand and the Mayo Clinic Performance Index for the Elbow questionnaires. Results showed that participants in the structural abnormality group had significantly higher scores in pain and dysfunction. A significant relationship between COL11A1 rs3753841 genotype and elbow tendon pathology was found (p = 0.024), with the CT variant associated with increased risk of pathology.
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103
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Tondelli T, Götschi T, Camenzind RS, Snedeker JG. Assessing the effects of intratendinous genipin injections: Mechanical augmentation and spatial distribution in an ex vivo degenerative tendon model. PLoS One 2020; 15:e0231619. [PMID: 32294117 PMCID: PMC7159246 DOI: 10.1371/journal.pone.0231619] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 03/29/2020] [Indexed: 11/25/2022] Open
Abstract
Background Tendinopathy is a common musculoskeletal disorder and current treatment options show limited success. Genipin is an effective collagen crosslinker with low cytotoxicity and a promising therapeutic strategy for stabilizing an intratendinous lesion. Purpose This study examined the mechanical effect and delivery of intratendinous genipin injection in healthy and degenerated tendons. Study design Controlled laboratory study Methods Bovine superficial digital flexor tendons were randomized into four groups: Healthy control (N = 25), healthy genipin (N = 25), degenerated control (N = 45) and degenerated genipin (N = 45). Degeneration was induced by Collagenase D injection. After 24h, degenerated tendons were subsequently injected with either 0.2ml of 80mM genipin or buffer only. 24h post-treatment, samples were cyclically loaded for 500 cycles and then ramp loaded to failure. Fluorescence and absorption assays were performed to analyze genipin crosslink distribution and estimate tissue concentration after injection. Results Compared to controls, genipin treatment increased ultimate force by 19% in degenerated tendons (median control 530 N vs. 633 N; p = 0.0078). No significant differences in mechanical properties were observed in healthy tendons, while degenerated tendons showed a significant difference in ultimate stress (+23%, p = 0.049), stiffness (+27%, p = 0.037), work to failure (+42%, p = 0.009), and relative stress relaxation (-11%, p < 0.001) after genipin injection. Fluorescence and absorption were significantly higher in genipin treated tendons compared to control groups. A higher degree of crosslinking (+45%, p < 0.001) and a more localized distribution were observed in the treated healthy compared to degenerated tendons, with higher genipin tissue concentrations in healthy (7.9 mM) than in degenerated tissue (2.3 mM). Conclusion Using an ex-vivo tendinopathy model, intratendinous genipin injections recovered mechanical strength to the level of healthy tendons. Measured by genipin tissue distribution, injection is an effective method for local delivery. Clinical relevance This study provides a proof of concept for the use of intratendinous genipin injection in the treatment of tendinopathy. The results demonstrate that a degenerated tendon can be mechanically augmented by a clinically viable method of local genipin delivery. This warrants further in vivo studies towards the development of a clinically applicable treatment based on genipin.
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Affiliation(s)
- Timo Tondelli
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Tobias Götschi
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Roland S. Camenzind
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
| | - Jess G. Snedeker
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
- * E-mail:
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104
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Effectiveness of Platelet-Rich Plasma Injection in Rotator Cuff Tendinopathy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Diagnostics (Basel) 2020; 10:diagnostics10040189. [PMID: 32231127 PMCID: PMC7235747 DOI: 10.3390/diagnostics10040189] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 03/24/2020] [Accepted: 03/27/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND To investigate the effectiveness of platelet-rich plasma (PRP) injection among patients with rotator cuff tendinopathy in comparison with sham injection, no injection, or physiotherapy alone. METHODS From the earliest records to November 1, 2018, all published or unpublished randomized controlled trial (RCTs) comparing PRP injection with a control group (sham injection, no injection, or physiotherapy alone) in patients with rotator cuff tendinopathy were included. Eligible trials were included from the search results of electronic databases including PubMed, EMBASE, Scopus, The Cochrane Library, as well as the bibliographies of relevant trials. Five RCTs were enrolled in our meta-analysis. Two authors independently assessed the quality of RCTs with the Cochrane risk of bias tool. We designated pain reduction as the primary outcome and functional improvement as the secondary outcome. Standardized mean difference (SMD) was applied for random-effect meta-analysis. RESULTS In the short term (3-6 weeks) and medium term (12 weeks), the effectiveness of PRP injection and control group was indistinguishable in terms of both outcomes (pain reduction and functional improvement). Nevertheless, PRP injection led to significant long-term (>24 weeks) pain relief (SMD: 0.42, 95% confidence interval (CI): 0.12-0.72, without heterogeneity). For functional improvement in the long term, PRP injection was not more effective than the control group (SMD: 1.20, 95% CI: -0.20-2.59, with heterogeneity). CONCLUSIONS PRP injection may provide benefit over the control group (sham injection, no injection, or physiotherapy alone) in reducing pain at long-term follow-up for patients with rotator cuff tendinopathy.
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105
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Bressler HB, Markus M, Bressler RP, Friedman SN, Friedman L. Temporal tendinosis: A cause of chronic orofacial pain. Curr Pain Headache Rep 2020; 24:18. [PMID: 32200454 DOI: 10.1007/s11916-020-00851-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE OF REVIEW Diverse musculoskeletal disorders and neuropathic symptoms of the face pose significant diagnostic challenges. In particular, temporal tendinosis is generally overlooked in the medical and dental literature and is therefore a poorly understood topic and often problematic cause of chronic orofacial pain. In this article, we explore temporal tendinosis as a cause of unresolved orofacial pain by reviewing the complex anatomy of the temporalis muscle, common presentations of temporal tendinosis, possible etiologies for injury and place a strong emphasis on required diagnostic evaluation and clinical management. RECENT FINDINGS Temporal tendinosis remains under diagnosed due to a combination of anatomical complexity and incomplete description in the majority of general anatomy medical textbooks. The two main presentations are unilateral facial pain with or without temporal headache and pain radiating from the distal temporalis tendon to the temporalis muscle. Diagnosis should be made with a combination of focused history, physical examination and specialised imaging, preferably with ultrasound but with MRI an alternate option. While many management options are available, optimal treatment remains unclear. Temporal tendinosis is an under-recognised and under-treated condition. Despite the fact that orofacial pain is one of the single most common complaints of patients presenting to physicians or dentists, it is widely acknowledged that training for diagnosis and manage of temporal tendinopathy among primary care physicians in both medical and dental professions is inadequate. This may result in extensive workups, leading to suboptimal management and chronic pain syndromes.
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Affiliation(s)
- Hart B Bressler
- Department of Family and Community Medicine, Mount Sinai Hospital, University of Toronto, 600 University Ave, Toronto, Ontario, M5G 1X5, Canada.
| | - Masad Markus
- Second Year, Schulich School of Medicine, University of Western Ontario, 1151 Richmond St, London, Ontario, N6A 5C1, Canada
| | - Rachel P Bressler
- Family Dental Centre, 110 N Front Street, Belleville, Ontario, K8P 5J8, Canada
| | - Saul N Friedman
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO, 63110, USA
| | - Lawrence Friedman
- Department of Medical Imaging, North York General Hospital, 4001 Leslie Street, Toronto, Ontario, M2K 1E1, Canada
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106
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Maffulli N, D'Addona A, Gougoulias N, Oliva F, Maffulli GD. Dorsally Based Closing Wedge Osteotomy of the Calcaneus for Insertional Achilles Tendinopathy. Orthop J Sports Med 2020; 8:2325967120907985. [PMID: 32232068 PMCID: PMC7082870 DOI: 10.1177/2325967120907985] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 12/03/2019] [Indexed: 11/15/2022] Open
Abstract
Background Surgical management may be indicated for patients with insertional Achilles tendinopathy (IAT) after failure of nonoperative management, and various surgical techniques have been described. Hypothesis We present the technique and results of modified dorsal closing wedge calcaneal osteotomy, performed in a cohort of 28 consecutive patients. We hypothesized that this will be a safe procedure that can improve hindfoot pain and function for most patients who will return to preoperative daily life and sports activities. Study Design Case series; Level of evidence, 4. Methods A modified dorsal closing wedge osteotomy was performed in 28 patients (mean age, 54.7 years) from November 2015 to December 2016. All patients were followed for at least 2 years postoperatively. Results All osteotomies united at a mean of 5 weeks. The mean anatomic change in calcaneal length was 4 mm (range, 3-6 mm). The overall complication rate was 10.7%. There were 2 superficial wound infections (7.1%) and 1 instance of sural nerve-related paresthesia (3.5%) reported. All patients returned to their presurgical level of activities at a mean of 23 ± 8.0 weeks. Further, 3 of 4 patients who participated in recreational sports activities returned to their preinjury level. Visual analog scale and Victorian Institute of Sports of Australia-Achilles scores significantly improved postoperatively (P < .001) and continued to improve for 24 months. Conclusion The modified dorsal closing wedge calcaneal osteotomy is a safe procedure and significantly improved pain and function in patients with IAT at 2 years after surgery.
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Affiliation(s)
- Nicola Maffulli
- Department of Musculoskeletal Disorders, University of Salerno, Salerno, Italy.,Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, London, UK.,School of Pharmacy and Bioengineering, Keele University School of Medicine, Stoke on Trent, UK
| | - Alessio D'Addona
- Department of Public Health, Section of Orthopaedics and Trauma Surgery, School of Medicine and Surgery Federico II, A.O.U. Federico II, Naples, Italy
| | - Nikolaos Gougoulias
- Frimley Health NHS Foundation Trust, Frimley Park Hospital, Surrey, UK.,Private practice, Thessaloniki and Athens, Greece
| | - Francesco Oliva
- Department of Musculoskeletal Disorders, University of Salerno, Salerno, Italy
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107
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Liu YC, Wang HL, Huang YZ, Weng YH, Chen RS, Tsai WC, Yeh TH, Lu CS, Chen YL, Lin YW, Chen YJ, Hsu CC, Chiu CH, Chiu CC. Alda-1, an activator of ALDH2, ameliorates Achilles tendinopathy in cellular and mouse models. Biochem Pharmacol 2020; 175:113919. [PMID: 32194057 DOI: 10.1016/j.bcp.2020.113919] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 03/13/2020] [Indexed: 12/15/2022]
Abstract
Achilles tendinopathy has a high re-injury rate and poor prognosis. Development of effective therapy for Achilles tendinopathy is important. Excessive accumulation of ROS and resulting oxidative stress are believed to cause tendinopathy. Overproduction of hydrogen peroxide (H2O2), the most common ROS, could lead to the tendinopathy by causing oxidative damage, activation of endoplasmic reticulum (ER) stress and apoptotic death of tenocytes. Activation of mitochondrial aldehyde dehydrogenase 2 (ALDH2) is expected to alleviate oxidative stress and ER stress. Alda-1 is a selective and potent activator of ALDH2. In this study, we examined the cytoprotective benefit of Alda-1, an activator of ALDH2, on H2O2-induced Achilles tendinopathy in cellular and mouse models. We prepared cellular and mouse models of Achilles tendinopathy by treating cultured Achilles tenocytes and Achilles tendons with oxidative stressor H2O2. Subsequently, we studied the protective benefit of Alda-1 on H2O2-induced Achilles tendinopathy. Alda-1 pretreatment attenuated H2O2-induced cell death of cultured Achilles tenocytes. Treatment of Alda-1 prevented H2O2-induced oxidative stress and depolarization of mitochondrial membrane potential in tenocytes. Application of Alda-1 attenuated H2O2-triggered mitochondria- and ER stress-mediated apoptotic cascades in cultured tenocytes. Alda-1 treatment ameliorated the severity of H2O2-induced Achilles tendinopathy in vivo by preventing H2O2-induced pathological histological features of Achilles tendons, apoptotic death of Achilles tenocytes and upregulated expression of inflammatory cytokines IL-1β and TNF-α. Our results provide the evidence that ALDH2 activator Alda-1 ameliorates H2O2-induced Achilles tendinopathy. Alda-1 could be used for preventing and treating Achilles tendinopathy.
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Affiliation(s)
- Yu-Chuan Liu
- Landseed Sports Medicine Center, Landseed International Hospital, Taoyuan, Taiwan
| | - Hung-Li Wang
- Department of Physiology and Pharmacology, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Healthy Aging Research Center, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Neuroscience Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Division of Movement Disorders, Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Ying-Zu Huang
- Healthy Aging Research Center, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Neuroscience Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Division of Movement Disorders, Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Institute of Cognitive Neuroscience, National Central University, Taoyuan, Taiwan
| | - Yi-Hsin Weng
- Neuroscience Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Division of Movement Disorders, Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Rou-Shayn Chen
- Neuroscience Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Division of Movement Disorders, Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wen-Chung Tsai
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Tu-Hsueh Yeh
- Department of Neurology, Taipei Medical University Hospital, Taiwan
| | - Chin-Song Lu
- Neuroscience Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Ying-Ling Chen
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Yan-Wei Lin
- Neuroscience Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Yu-Jie Chen
- Neuroscience Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Chia-Chen Hsu
- Neuroscience Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Division of Movement Disorders, Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Chi-Han Chiu
- Neuroscience Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Division of Movement Disorders, Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Ching-Chi Chiu
- Neuroscience Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Division of Movement Disorders, Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan.
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108
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Sprague AL, Awokuse D, Pohlig RT, Cortes DH, Silbernagel KG. Relationship between mechanical properties (shear modulus and viscosity), age, and sex in uninjured Achilles tendons. TRANSLATIONAL SPORTS MEDICINE 2020; 3:321-327. [PMID: 33196016 DOI: 10.1002/tsm2.148] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Tendon mechanical properties have been proposed as a biomarker of tendon health to track response to injury and treatment. Prior to utilizing these properties in an injured population, it is critical to understand how these are influenced by age and sex in an uninjured population. A retrospective analysis was conducted of 118 uninjured Achilles tendons to evaluate the relationship between tendon mechanical properties, age and sex. Mechanical properties (shear modulus and viscosity) were assessed using continuous shear wave elastography. A moderator regression analysis was completed to examine the relationship between tendon mechanical properties, age and sex, after adjusting for body mass index and physical activity level. There was an interaction between age and sex for shear modulus (p=0.049, R2 change=0.034). Females had a negative relationship between age and shear modulus (p=0.030, β=-0.350) but no relationship was observed for males (p=0.78, β=0.031). A positive relationship was found between age and viscosity (p=0.034, β=0.214). Increased viscosity was related to increased age with no difference between sexes. The effect of aging on shear modulus differed between men and women and may help explain sex specific injury risks and their differing response to mechanical load.
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Affiliation(s)
- Andrew L Sprague
- Department of Physical Therapy, University of Delaware, Newark, DE.,Department of Biomechanics and Movement Science, University of Delaware, Newark, DE
| | - Daniel Awokuse
- Department of Physical Therapy, University of Delaware, Newark, DE
| | - Ryan T Pohlig
- College of Health Sciences, Biostatistics Core Facility, University of Delaware, Newark, DE
| | - Daniel H Cortes
- Department of Mechanical and Nuclear Engineering, Penn State University, State College, PA
| | - Karin Grävare Silbernagel
- Department of Physical Therapy, University of Delaware, Newark, DE.,Department of Biomechanics and Movement Science, University of Delaware, Newark, DE
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109
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Steinmann S, Pfeifer CG, Brochhausen C, Docheva D. Spectrum of Tendon Pathologies: Triggers, Trails and End-State. Int J Mol Sci 2020; 21:ijms21030844. [PMID: 32013018 PMCID: PMC7037288 DOI: 10.3390/ijms21030844] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/18/2020] [Accepted: 01/24/2020] [Indexed: 12/31/2022] Open
Abstract
The biggest compartment of the musculoskeletal system is the tendons and ligaments. In particular, tendons are dense tissues connecting muscle to bone that are critical for the integrity, function and locomotion of this system. Due to the increasing age of our society and the overall rise in engagement in extreme and overuse sports, there is a growing prevalence of tendinopathies. Despite the recent advances in tendon research and due to difficult early diagnosis, a multitude of risk factors and vague understanding of the underlying biological mechanisms involved in the progression of tendon injuries, the toolbox of treatment strategies remains limited and non-satisfactory. This review is designed to summarize the current knowledge of triggers, trails and end state of tendinopathies.
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Affiliation(s)
- Sara Steinmann
- Experimental Trauma Surgery, Department of Trauma Surgery, University Medical Center Regensburg, Am Biopark 9, 93053 Regensburg, Germany; (S.S.); (C.G.P.)
| | - Christian G. Pfeifer
- Experimental Trauma Surgery, Department of Trauma Surgery, University Medical Center Regensburg, Am Biopark 9, 93053 Regensburg, Germany; (S.S.); (C.G.P.)
- Department of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Christoph Brochhausen
- Institute of Pathology, University Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany;
| | - Denitsa Docheva
- Experimental Trauma Surgery, Department of Trauma Surgery, University Medical Center Regensburg, Am Biopark 9, 93053 Regensburg, Germany; (S.S.); (C.G.P.)
- Department of Medical Biology, Medical University-Plovdiv, 15A Vassil Aprilov Blvd., 4002 Plovdiv, Bulgaria
- Correspondence: ; Tel.: +49 941 943-1605
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Stoychev V, Finestone AS, Kalichman L. Dry Needling as a Treatment Modality for Tendinopathy: a Narrative Review. Curr Rev Musculoskelet Med 2020; 13:133-140. [PMID: 31942676 DOI: 10.1007/s12178-020-09608-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW Tendinopathy describes a combination of pain, swelling, and impaired performance of the tendon and around structures. There are various treatment options for tendinopathy with unclear efficacy. Dry needling involves inserting needles into the affected tendon, and it is thought to disrupt the chronic degenerative process and encourage localized bleeding and fibroblastic proliferation. The purpose of this review is to review the use of dry needling as a treatment modality for tendinopathy. RECENT FINDINGS The effectiveness of dry needling for treatment of tendinopathy has been evaluated in 3 systematic reviews, 7 randomized controlled trials, and 6 cohort studies. The following sites were studied: wrist common extensor origin, patellar tendon, rotator cuff, and tendons around the greater trochanter. There is considerable heterogeneity of the needling techniques, and the studies were inconsistent about the therapy used after the procedure. Most systematic reviews and randomized controlled trials support the effectiveness of tendon needling. There was a statistically significant improvement in the patient-reported symptoms in most studies. Some studies reported an objective improvement assessed by ultrasound. Two studies reported complications. Current research provides initial support for the efficacy of dry needling for tendinopathy treatment. It seems that tendon needling is minimally invasive, safe, and inexpensive, carries a low risk, and represents a promising area of future research. In further high-quality studies, tendon dry needling should be used as an active intervention and compared with appropriate sham interventions. Studies that compare the different protocols of tendon dry needling are also needed.
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Affiliation(s)
- Vladimir Stoychev
- Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.,Bait Balev Hospital, Bat Yam, Israel
| | - Aharon S Finestone
- Department of Orthopaedic Surgery, Shamir Medical Center, Zerifin, affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Leonid Kalichman
- Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
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111
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Wunderli SL, Blache U, Snedeker JG. Tendon explant models for physiologically relevant invitro study of tissue biology - a perspective. Connect Tissue Res 2020; 61:262-277. [PMID: 31931633 DOI: 10.1080/03008207.2019.1700962] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background: Tendon disorders increasingly afflict our aging society but we lack the scientific understanding to clinically address them. Clinically relevant models of tendon disease are urgently needed as established small animal models of tendinopathy fail to capture essential aspects of the disease. Two-dimensional and three-dimensional cell and tissue culture models are similarly limited, lacking many physiological extracellular matrix cues required to maintain tissue homeostasis or guide matrix remodeling. These cues reflect the biochemical and biomechanical status of the tissue, and encode information regarding the mechanical and metabolic competence of the tissue. Tendon explants overcome some of these limitations and have thus emerged as a valuable tool for the discovery and study of mechanisms associated with tendon homeostasis and pathophysiology. Tendon explants retain native cell-cell and cell-matrix connections, while allowing highly reproducible experimental control over extrinsic factors like mechanical loading and nutritional availability. In this sense tendon explant models can deliver insights that are otherwise impossible to obtain from in vivo animal or in vitro cell culture models. Purpose: In this review, we aimed to provide an overview of tissue explant models used in tendon research, with a specific focus on the value of explant culture systems for the controlled study of the tendon core tissue. We discuss their advantages, limitations and potential future utility. We include suggestions and technical recommendations for the successful use of tendon explant cultures and conclude with an outlook on how explant models may be leveraged with state-of-the-art biotechnologies to propel our understanding of tendon physiology and pathology.
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Affiliation(s)
- Stefania L Wunderli
- University Hospital Balgrist, University of Zurich, Zurich, Switzerland.,Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Ulrich Blache
- University Hospital Balgrist, University of Zurich, Zurich, Switzerland.,Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Jess G Snedeker
- University Hospital Balgrist, University of Zurich, Zurich, Switzerland.,Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
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CARVALHO ANGELAAM, MOURA FRANCYELLEBRDE, NOGUEIRA PEDROAUGUSTOS, GONÇALVES ALINEMARIAN, ARAÚJO FERNANDAA, ZANON RENATAG, TOMIOSSO TATIANACARLA. Swimming exercise changed the collagen synthesis and calcification in calcaneal tendons of mice. ACTA ACUST UNITED AC 2020; 92:e20181127. [DOI: 10.1590/0001-3765202020181127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 04/22/2019] [Indexed: 12/13/2022]
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113
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Effects of a patellar strap on knee joint kinetics and kinematics during jump landings: an exploration using a statistical parametric mapping and Bayesian approach. SPORT SCIENCES FOR HEALTH 2019. [DOI: 10.1007/s11332-019-00589-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Eliasson P, Dietrich-Zagonel F, Lundin AC, Aspenberg P, Wolk A, Michaëlsson K. Statin treatment increases the clinical risk of tendinopathy through matrix metalloproteinase release - a cohort study design combined with an experimental study. Sci Rep 2019; 9:17958. [PMID: 31784541 PMCID: PMC6884518 DOI: 10.1038/s41598-019-53238-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 10/30/2019] [Indexed: 02/07/2023] Open
Abstract
Recent experimental evidence indicates potential adverse effects of statin treatment on tendons but previous clinical studies are few and inconclusive. The aims of our study were, first, to determine whether statin use in a cohort design is associated with tendinopathy disorders, and second, to experimentally understand the pathogenesis of statin induced tendinopathy. We studied association between statin use and different tendon injuries in two population-based Swedish cohorts by time-dependent Cox regression analysis. Additionally, we tested simvastatin in a 3D cell culture model with human tenocytes. Compared with never-users, current users of statins had a higher incidence of trigger finger with adjusted hazard ratios (aHRs) of 1.50 for men (95% confidence interval [CI] 1.21-1.85) and 1.21 (1.02-1.43) for women. We also found a higher incidence of shoulder tendinopathy in both men (aHR 1.43; 1.24-1.65) and women (aHR 1.41; 0.97-2.05). Former users did not confer a higher risk of tendinopathies. In vitro experiments revealed an increased release of matrix metalloproteinase (MMP)-1 and MMP-13 and a weaker, disrupted matrix after simvastatin exposure. Current statin use seems to increase the risk of trigger finger and shoulder tendinopathy, possibly through increased MMP release, and subsequently, a weakened tendon matrix which will be more prone to injuries.
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Affiliation(s)
- Pernilla Eliasson
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
| | - Franciele Dietrich-Zagonel
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Anna-Carin Lundin
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Per Aspenberg
- Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Alicja Wolk
- National Institute of Environmental Medicine, Division of Nutritional Epidemiology, Karolinska Institute, Stockholm, Sweden
| | - Karl Michaëlsson
- Section of Orthopedics, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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Ahmad Z, Parkar A, Shepherd J, Rushton N. Revolving doors of tendinopathy: definition, pathogenesis and treatment. Postgrad Med J 2019; 96:94-101. [PMID: 31757873 DOI: 10.1136/postgradmedj-2019-136786] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 10/01/2019] [Accepted: 10/11/2019] [Indexed: 01/08/2023]
Abstract
The ultimate cure for the tendon pathology continues to elude current science. Despite great steps in technology, the causation and treatment is still not clear. The number of different theories and treatment modalities in the literature may confuse clinicians and patients. In this paper we outline the definitions, evolution of pathogenesis and treatment for tendinopathy. By highlighting these, the aim of this paper is to guide the practitioner in counselling and treating their patients.
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Affiliation(s)
- Zafar Ahmad
- Orthopaedic Research Unit, University of Cambridge, Cambridge, UK
| | - Asif Parkar
- Orthopaedics, Barking Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | | | - Neil Rushton
- Orthopaedic Research Unit, University of Cambridge, Cambridge, UK
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Abstract
To our knowledge, this case report describes the first known case of sternocleidomastoid tendinopathy, occurring in a pediatric athlete who had gone undiagnosed for a period of 2 yrs. She presented to our pain clinic with bilateral otalgia, occipital headaches, and occasional bouts of tinnitus and dizziness. An extensive workup by otolaryngology (ENT) including computed tomography imaging of the head, ear pressure equalization, and an attempt at therapeutic tonsillectomy left her with no diagnosis and no symptom relief. A clinical diagnosis of sternocleidomastoid tendinopathy was made at the initial visit based on history and physical examination findings, after excluding other diagnoses. Conservative treatment with physical therapy, acupuncture, and a short course of meloxicam and gabapentin resulted in total symptom resolution. This case is a unique reminder to clinicians that head, neck, and ear pain may precipitate from musculoskeletal origins. It emphasizes the importance of understanding local anatomy, obtaining a thorough history, and performing a detailed physical examination in arriving at an accurate diagnosis.
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Holt J, Preston G, Heindel K, Preston H, Hill G. Diagnosis and Management Strategies for Distal Biceps Rupture. Orthopedics 2019; 42:e492-e501. [PMID: 31355900 DOI: 10.3928/01477447-20190723-05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 12/12/2018] [Indexed: 02/03/2023]
Abstract
Rupture of the distal biceps tendon most commonly is secondary to mechanical overload during eccentric muscle contraction. Due to deficits of strength and endurance, surgical repair usually is recommended. Although both single- and double-incision approaches have been described, double-incision techniques have been shown to better re-create the native anatomic insertion. However, excellent and comparable clinical outcomes have been demonstrated with both techniques. Fixation with a cortical button and interference screw has been shown to be the strongest construct biomechanically; however, several modern constructs provide adequate strength. Surgical technique should focus on restoration of anatomy, early range of motion, and prevention of complications. [Orthopedics. 2019; 42(6):e492-e501.].
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Morgan G, Martin R, Welch H, Williams L, Morris K. Objective assessment of stiffness in the gastrocnemius muscle in patients with symptomatic Achilles tendons. BMJ Open Sport Exerc Med 2019; 5:e000622. [PMID: 31749983 PMCID: PMC6830464 DOI: 10.1136/bmjsem-2019-000622] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2019] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To establish quantitative values of stiffness for the gastrocnemius muscle in patients diagnosed with Achilles tendinopathy. DESIGN Case-control study with a single (cross sectional) time point of patients diagnosed with unilateral Achilles tendinopathy and an asymptomatic group. METHODS Sample of 50 participants: 25 participants with symptomatic unilateral Achilles tendinopathy (symptomatic group) with the asymptomatic side of this group used as a control (control group 1). A third group of 25 participants with asymptomatic Achilles tendons (control group 2). Mechanical stiffness parameters, including natural oscillation frequency (F), dynamic stiffness (S), mechanical stress relaxation time (R), logarithmic decrement (D) and creep (C), were assessed using the MyotonPRO. Measurements at the medial and lateral gastrocnemii were taken as non-weight bearing (NWB) and weight bearing (WB). RESULTS Significant (p<0.05) differences were observed between the mean symptomatic group and control groups 1 and 2 in the WB and NWB conditions for natural oscillation frequency (F), dynamic stiffness (S), and creep (C). There was a significant reduction in S WB and conversely a significant increase in S of the symptomatic group NWB. Creep (C) and mechanical stress relaxation time (R) were significantly (p<0.05) less in the symptomatic group NWB. Significant differences were observed between the NWB and WB data sets for logarithmic decrement (D). NWB D demonstrated significantly (p<0.05) higher scores than the WB condition. CONCLUSION This study demonstrated that there was a significant reduction in stiffness of the gastrocnemius muscle in participants with Achilles tendinopathy compared with the two control groups. The WB MyotonPRO measures for the symptomatic groups of F and S were significantly lower, indicating a decrease in the tonal properties (F) and dynamic stiffness (S) of the muscle. The application of MyotonPRO technology to measure changes in stiffness in the gastrocnemius muscle may be useful to measure as part of a rehabilitation programme where specific attention could be placed to increase the tonal properties of the muscle. Further studies are required to develop a robust clinical application of this technology, particularly with regard to Achilles tendinopathy.
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Affiliation(s)
- Gafin Morgan
- Podiatry, Cwm Taf Morgannwg University Health Board, Abercynon, UK
| | - Rhodri Martin
- Cwm Taf Morgannwg University Health Board, Abercynon, UK
| | - Helen Welch
- Cwm Taf Morgannwg University Health Board, Abercynon, UK
| | - Lisa Williams
- Orthopaedics, Cwm Taf Morgannwg University Health Board, Abercynon, UK
| | - Keith Morris
- Biomedical Sciences, Cardiff Metropolitan University, Cardiff, UK
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Min K, Lee JM, Kim MJ, Jung SY, Kim KS, Lee S, Choi YS. Restoration of Cellular Proliferation and Characteristics of Human Tenocytes by Vitamin D. J Orthop Res 2019; 37:2241-2248. [PMID: 31115927 DOI: 10.1002/jor.24352] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 05/14/2019] [Indexed: 02/04/2023]
Abstract
Vitamin D (Vit D) increases calcium absorption in the intestine after binding to the Vit D receptor (VDR). The VDR has also been identified in muscle cells. Vit D supplementation resulted in improved muscle strength. However, there is a paucity of studies of the role of Vit D on tenocytes. We investigated the effects of Vit D on damaged tenocytes. Human tenocytes were treated with dexamethasone (Dex) to induce cell injury. Expression of the tenocyte-related markers tenomodulin (Tnmd), tenascin C (Tnc), scleraxis (Scx), mohawk (Mkx), and collagen (Col) 1 and 3 were measured. Then, tenocytes were cotreated with Vit D. 1-α-Hydroxylase and VDR were explored in tenocytes. With 10 μM Dex, the growth of tenocytes was significantly inhibited, and the gene expression of Tnmd, Tnc, Scx, Mkx, Col 1 and 3 also decreased. When tenocytes were cotreated with Vit D, cell proliferation recovered in a dose-dependent manner, and the expression of TNMD and Col 1 improved. When studying the mechanisms of the effects of Vit D on tenocytes, reactive oxygen species produced by Dex decreased with Vit D, and the phosphorylation of extracellular signal-regulated kinase and p38 was stimulated by Vit D cotreatment. 1-α-Hydroxylase and VDR were found in tenocytes, indicating that the cells have the ability to use an inactive form of Vit D and interact with it. Vit D is known to perform diverse actions and its protective effects on tenocytes suggest its beneficial role in tendon in addition to muscle and bone. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2241-2248, 2019.
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Affiliation(s)
- Kyunghoon Min
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Ji Min Lee
- Department of Biotechnology, CHA University, Seongnam, 13488, Republic of Korea
| | - Mi Jin Kim
- Department of Biotechnology, CHA University, Seongnam, 13488, Republic of Korea
| | - Sang Youn Jung
- Department of Internal Medicine, Division of Rheumatology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Kyung-Soo Kim
- Department of Internal Medicine, Division of Endocrinology and Metabolism, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Soonchul Lee
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Yong-Soo Choi
- Department of Biotechnology, CHA University, Seongnam, 13488, Republic of Korea
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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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Reliability of a two-probe ultrasound imaging procedure to measure strain in the Achilles tendon. J Foot Ankle Res 2019; 12:49. [PMID: 31548870 PMCID: PMC6751664 DOI: 10.1186/s13047-019-0358-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 08/30/2019] [Indexed: 01/23/2023] Open
Abstract
Background Alteration in the strain properties of the Achilles tendon may lead to adaptations such as pathological stiffening. Stiff tendons have reduced adaptive ability, which may increase the risk for developing tendinopathy. Strain can be measured using musculoskeletal ultrasound imaging. A two-probe ultrasound procedure may reduce the measurement error associated with a one-probe procedure. However, the reliability of the two-probe procedure has not been established. This study aimed to determine the within-session intra- and inter-rater reliability and between-session reliability of a two-probe ultrasound procedure to measure Achilles tendon strain. Methods Participants were 29 healthy individuals (19 females, 10 males; mean age 33.6 years). Achilles tendon images were acquired with a two-probe ultrasound procedure as the ankle moved through a standardised range of motion (20° plantarflexion to 10° dorsiflexion). Both probes were positioned longitudinally, one over the musculotendinous junction and the second over the calcaneal insertion of the Achilles tendon. Repeat measurements were taken for all participants at the initial study visit, and for 10 participants in a second measurement session 4 weeks later. Strain measures were calculated from pre-captured images using Motion Analysis 2014v1 software by two independent raters. Within-session intra- and inter-rater reliability and between-session intra-rater reliability were calculated using intraclass correlation coefficients (ICC) with 95% confidence intervals. The standard error of measurement was also calculated. Results The two-probe procedure to measure Achilles tendon strain showed excellent within-session intra-rater (ICC = 0.84, p < 0.001) and inter-rater reliability (ICC = 0.88, p = 0.003), but poor between-session intra-rater reliability (ICC = 0.18, p = 0.397). Conclusion The two-probe procedure to measure Achilles tendon strain is reliable for repeated measurements on the same day. However, measurement error increased when strain was measured on different days, which may be attributable to a combination of examiner error and participant factors. Measurement of Achilles tendon strain offers an additional tool for evaluating the tendon's mechanical characteristics. The ability to reliably quantify strain may allow clinicians to identify those at risk for Achilles tendinopathy and formulate more effective management plans.
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Tendinopathy: Pathophysiology, Therapeutic Options, and Role of Nutraceutics. A Narrative Literature Review. ACTA ACUST UNITED AC 2019; 55:medicina55080447. [PMID: 31394838 PMCID: PMC6723894 DOI: 10.3390/medicina55080447] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 07/31/2019] [Accepted: 08/06/2019] [Indexed: 02/07/2023]
Abstract
Tendinopathies are very common in general population and a huge number of tendon-related procedures take place annually worldwide, with significant socio-economic repercussions. Numerous treatment options are commonly used for tendon disorders. Besides pharmacological and physical therapy, nutrition could represent an additional tool for preventing and treating this complex pathology that deserve a multidisciplinary approach. In recent years, nutraceutical products are growing up in popularity since these seem to favor the prevention and the healing processes of tendon injuries. This narrative literature review aims to summarize current understanding and the areas of ongoing research about the management of tendinopathies with the help of oral supplementation.
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Bäcker HC, Wong TT, Vosseller JT. MRI Assessment of Degeneration of the Tendon in Achilles Tendon Ruptures. Foot Ankle Int 2019; 40:895-899. [PMID: 31006268 DOI: 10.1177/1071100719845016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The extent of tendinosis along the entire tendon in Achilles tendon ruptures (ATRs) has not previously been assessed. MR images of acute ATRs were evaluated to assess this extent, even in areas distant from the rupture. METHODS Patients who had MR images for an ATR were reviewed. Each tendon was divided into a proximal, middle, and distal segment with the full tendon length defined as the length measured from the myotendinous junction to the insertion. The site of tendon rupture, presence of tendinosis and/or additional tearing, and largest anteroposterior (AP) diameter in the remaining segments were noted. In total, 45 MR iamges were included in our study. RESULTS The mean total tendon length was 9.93 cm, while the length from the insertion to the tear was 5.86 cm. Of the 45 ruptures, 20 (44.4%) were in the proximal third, 19 (42.2%) in the middle third, and 6 (13.3%) in the distal third. In all remaining segments where no ruptured tendon was observed, tendinosis was seen. Further, of the 90 segments of a tendon without rupture, 87 (96.7%) had an AP diameter greater than 6 mm. Of those 90 segments without rupture, 24 (26.7%) had a secondary partial-thickness tear in another third. CONCLUSION Tendinosis is a known precursor of an ATR that in the current study was not limited to the area of rupture. The finding of extensive tendon degeneration may have implications for the optimal surgical treatment. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Henrik C Bäcker
- 1 Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Tony T Wong
- 2 Department of Radiology, Columbia University Medical Center, New York, NY, USA
| | - J Turner Vosseller
- 1 Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
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Wada S, Lebaschi AH, Nakagawa Y, Carballo CB, Uppstrom TJ, Cong GT, Album ZM, Hall AJ, Ying L, Deng XH, Rodeo SA. Postoperative Tendon Loading With Treadmill Running Delays Tendon-to-Bone Healing: Immunohistochemical Evaluation in a Murine Rotator Cuff Repair Model. J Orthop Res 2019; 37:1628-1637. [PMID: 30977544 DOI: 10.1002/jor.24300] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 03/08/2019] [Indexed: 02/04/2023]
Abstract
Mechanical stress has an important effect on tendon-to-bone healing. The purpose of the present study was to compare tendon-to-bone healing in animals exposed to either tendon unloading (botulinum toxin injection) or excessive loading (treadmill running) in a murine rotator cuff repair model. Forty-eight C57BL/6 mice underwent unilateral supraspinatus tendon detachment and repair. Mice in the unloaded group were injected with botulinum toxin to the supraspinatus muscle. The contralateral shoulder of the unloaded group was used as a control. Mice were euthanized at 1, 2, and 4 weeks after surgery and evaluated with hematoxylin-eosin and immunohistochemical (IHC) staining for Ihh, Gli1, Wnt3a, and β-catenin. The positive staining area on IHC and the Modified Tendon Maturing Score were measured. The score of the unloaded group was significantly higher (better healing) than that of the treadmill group at 4 weeks. Ihh and the glioma-associated oncogene homolog 1 (Gli1) positive area in the unloaded group were significantly higher than those of the control group at 1 week. The peak time-points of the Ihh and Gli1 positive area was 1 week for the unloaded group and 2 weeks for the treadmill group. The Wnt3a positive area in the unloaded group was significantly higher than that of the control group at 2 weeks. The β-catenin positive area in the unloaded group was significantly higher than that of the treadmill group and the control group at 1 week. Our data indicated that the unloaded group has superior tendon maturation compared to the treadmill running group. Excessive tendon loading may delay the tendon healing process by affecting the activity of Ihh and Wnt/β-Catenin pathways. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1628-1637, 2019.
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Affiliation(s)
- Susumu Wada
- Laboratory for Joint Tissue Repair and Regeneration, Orthopedic Soft Tissue Research Program, The Hospital for Special Surgery, New York, New York
| | - Amir H Lebaschi
- Laboratory for Joint Tissue Repair and Regeneration, Orthopedic Soft Tissue Research Program, The Hospital for Special Surgery, New York, New York
| | - Yusuke Nakagawa
- Laboratory for Joint Tissue Repair and Regeneration, Orthopedic Soft Tissue Research Program, The Hospital for Special Surgery, New York, New York
| | - Camila B Carballo
- Laboratory for Joint Tissue Repair and Regeneration, Orthopedic Soft Tissue Research Program, The Hospital for Special Surgery, New York, New York
| | - Tyler J Uppstrom
- Laboratory for Joint Tissue Repair and Regeneration, Orthopedic Soft Tissue Research Program, The Hospital for Special Surgery, New York, New York
| | - Guang-Ting Cong
- Laboratory for Joint Tissue Repair and Regeneration, Orthopedic Soft Tissue Research Program, The Hospital for Special Surgery, New York, New York
| | - Zoe M Album
- Laboratory for Joint Tissue Repair and Regeneration, Orthopedic Soft Tissue Research Program, The Hospital for Special Surgery, New York, New York
| | - Arielle J Hall
- Laboratory for Joint Tissue Repair and Regeneration, Orthopedic Soft Tissue Research Program, The Hospital for Special Surgery, New York, New York
| | - Liang Ying
- Laboratory for Joint Tissue Repair and Regeneration, Orthopedic Soft Tissue Research Program, The Hospital for Special Surgery, New York, New York
| | - Xiang-Hua Deng
- Laboratory for Joint Tissue Repair and Regeneration, Orthopedic Soft Tissue Research Program, The Hospital for Special Surgery, New York, New York
| | - Scott A Rodeo
- Laboratory for Joint Tissue Repair and Regeneration, Orthopedic Soft Tissue Research Program, The Hospital for Special Surgery, New York, New York
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Jayaseelan DJ, Mischke JJ, Strazzulla RL. Eccentric Exercise for Achilles Tendinopathy: A Narrative Review and Clinical Decision-Making Considerations. J Funct Morphol Kinesiol 2019; 4:jfmk4020034. [PMID: 33467349 PMCID: PMC7739229 DOI: 10.3390/jfmk4020034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 05/29/2019] [Accepted: 06/04/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Achilles tendinopathy is a common health condition encountered in the orthopedic and sports medicine settings. Eccentric exercise is a common intervention in the management of pain and limited function for this patient population, although contemporary evidence suggests additional exercise methods may be effective as well. STUDY DESIGN Narrative review: Methods: A literature review was performed using the electronic databases Pubmed and PEDRO for articles through February 2019. Randomized clinical trials integrating eccentric exercise, with or without co-interventions, were evaluated. Outcomes related to pain and/or function were considered. A patient case is provided to highlight decision making processes related to clinical prescription of eccentrics for Achilles tendinopathy. RESULTS After screening titles and abstracts, seven studies were included for full review. Two articles compared eccentric exercise to a control group, four compared eccentrics to the use of modalities, while one used eccentric exercise as part of a multimodal intervention. In each case, eccentric exercise was effective in reducing pain and improving function. In comparison to other forms of exercise or additional interventions, eccentric exercise was frequently not more effective than other options. DISCUSSION Eccentric exercise has been associated with clinical benefit in improving pain and function for patients with Achilles tendinopathy. Despite the available evidence reporting effectiveness of eccentrics, other options may be equally useful. Appropriate load modification and exercise prescription for patients with Achilles tendinopathy requires systematic clinical reasoning and incorporation of patient values to optimize outcomes.
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Affiliation(s)
- Dhinu J. Jayaseelan
- Program in Physical Therapy, Department of Health, Human Function and Rehabilitation Sciences, The George Washington University, Washington, DC 20006, USA
- Correspondence: ; Tel.: +1-(202)-994-5495
| | - John J. Mischke
- School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, MT 59812, USA
| | - Raymond L. Strazzulla
- Program in Physical Therapy, Department of Health, Human Function and Rehabilitation Sciences, The George Washington University, Washington, DC 20006, USA
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Tendon and Ligament Injuries in Elite Rugby: The Potential Genetic Influence. Sports (Basel) 2019; 7:sports7060138. [PMID: 31167482 PMCID: PMC6628064 DOI: 10.3390/sports7060138] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 05/29/2019] [Accepted: 05/30/2019] [Indexed: 01/13/2023] Open
Abstract
This article reviews tendon and ligament injury incidence and severity within elite rugby union and rugby league. Furthermore, it discusses the biological makeup of tendons and ligaments and how genetic variation may influence this and predisposition to injury. Elite rugby has one of the highest reported injury incidences of any professional sport. This is likely due to a combination of well-established injury surveillance systems and the characteristics of the game, whereby high-impact body contact frequently occurs, in addition to the high intensity, multispeed and multidirectional nature of play. Some of the most severe of all these injuries are tendon and ligament/joint (non-bone), and therefore, potentially the most debilitating to a player and playing squad across a season or World Cup competition. The aetiology of these injuries is highly multi-factorial, with a growing body of evidence suggesting that some of the inter-individual variability in injury susceptibility may be due to genetic variation. However, little effort has been devoted to the study of genetic injury traits within rugby athletes. Due to a growing understanding of the molecular characteristics underpinning the aetiology of injury, investigating genetic variation within elite rugby is a viable and worthy proposition. Therefore, we propose several single nucleotide polymorphisms within candidate genes of interest; COL1A1, COL3A1, COL5A1, MIR608, MMP3, TIMP2, VEGFA, NID1 and COLGALT1 warrant further study within elite rugby and other invasion sports.
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McBeath R, Edwards RW, O’Hara BJ, Maltenfort MG, Parks SM, Steplewski A, Osterman AL, Shapiro IM. Tendinosis develops from age- and oxygen tension-dependent modulation of Rac1 activity. Aging Cell 2019; 18:e12934. [PMID: 30938056 PMCID: PMC6516173 DOI: 10.1111/acel.12934] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 01/16/2019] [Accepted: 02/07/2019] [Indexed: 12/20/2022] Open
Abstract
Age‐related tendon degeneration (tendinosis) is characterized by a phenotypic change in which tenocytes display characteristics of fibrochondrocytes and mineralized fibrochondrocytes. As tendon degeneration has been noted in vivo in areas of decreased tendon vascularity, we hypothesized that hypoxia is responsible for the development of the tendinosis phenotype, and that these effects are more pronounced in aged tenocytes. Hypoxic (1% O2) culture of aged, tendinotic, and young human tenocytes resulted in a mineralized fibrochondrocyte phenotype in aged tenocytes, and a fibrochondrocyte phenotype in young and tendinotic tenocytes. Investigation of the molecular mechanism responsible for this phenotype change revealed that the fibrochondrocyte phenotype in aged tenocytes occurs with decreased Rac1 activity in response to hypoxia. In young hypoxic tenocytes, however, the fibrochondrocyte phenotype occurs with concomitant decreased Rac1 activity coupled with increased RhoA activity. Using pharmacologic and adenoviral manipulation, we confirmed that these hypoxic effects on the tenocyte phenotype are linked directly to the activity of RhoA/Rac1 GTPase in in vitro human cell culture and tendon explants. These results demonstrate that hypoxia drives tenocyte phenotypic changes, and provide a molecular insight into the development of human tendinosis that occurs with aging.
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Affiliation(s)
- Rowena McBeath
- Department of Orthopaedic SurgeryThomas Jefferson UniversityPhiladelphiaPennsylvania
- Division of Orthopaedic Research, Department of Orthopaedic SurgeryThomas Jefferson UniversityPhiladelphiaPennsylvania
- Philadelphia Hand to Shoulder CenterPhiladelphiaPennsylvania
| | - Richard W. Edwards
- Division of Orthopaedic Research, Department of Orthopaedic SurgeryThomas Jefferson UniversityPhiladelphiaPennsylvania
| | - Brian J. O’Hara
- Department of Pathology, Anatomy and Cell BiologyThomas Jefferson University HospitalPhiladelphiaPennsylvania
| | - Mitchell G. Maltenfort
- The Applied Clinical Research Center, Department of Biomedical and Health InformaticsChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvania
| | - Susan M. Parks
- Division of Geriatric Medicine & Palliative Care, Department of Family & Community MedicineThomas Jefferson UniversityPhiladelphiaPennsylvania
| | - Andrzej Steplewski
- Division of Orthopaedic Research, Department of Orthopaedic SurgeryThomas Jefferson UniversityPhiladelphiaPennsylvania
| | - A. Lee Osterman
- Department of Orthopaedic SurgeryThomas Jefferson UniversityPhiladelphiaPennsylvania
- Philadelphia Hand to Shoulder CenterPhiladelphiaPennsylvania
| | - Irving M. Shapiro
- Division of Orthopaedic Research, Department of Orthopaedic SurgeryThomas Jefferson UniversityPhiladelphiaPennsylvania
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128
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Tibialis anterior tendinosis: Clinical characterization and surgical treatment. Foot (Edinb) 2019; 39:79-84. [PMID: 30978661 DOI: 10.1016/j.foot.2019.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 02/06/2019] [Accepted: 02/10/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Tibialis anterior (TA) tendinosis is rarely reported on in the literature. It is seen in patients older than 45 and causes weakness in dorsiflexion. This paper aims to describe surgical treatment and clinical outcomes. METHODS Between 2015 and 2018, nine patients (six females, three males) with severe TA tendinosis with no tear (2), partial (1), or complete (6) underwent operative treatment. Patients underwent debridement and direct repair without augmentation, direct repair with fiber tape augmentation, tibialis posterior tendon (PTT) transfer, or tibialis anterior tendon (TAT) augmentation with a tendon autograft (n=4). Autografts consisted of extensor digitalis longus (EDL) tendon, plantaris tendon, or both. RESULTS Mean postoperative follow-up was 21.3 (range 8-31) months. All patients had a concomitant gastrocnemius recession, and three had hindfoot arthrodesis. Preoperative dorsiflexion strength was 0/5 for all and improved to 5/5 postoperatively in seven. The only current smoker developed wound dehiscence 2 weeks postoperatively and healed by 4. One developed marginal skin necrosis 3 weeks postoperatively and was treated successfully with casting. CONCLUSION Surgery reestablished function in individuals with TA tendinosis and allowed high level of satisfaction. Direct repair is possible. If the tendon gap is too large an autograft of EDL and plantaris tendon can be utilized. LEVEL OF EVIDENCE Level III Retrospective Comparative Study.
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Lee TH, Kim SE, Lee JY, Kim JG, Park K, Kim HJ. Wrapping of tendon tissues with diclofenac-immobilized polycaprolactone fibrous sheet improves tendon healing in a rabbit model of collagenase-induced Achilles tendinitis. J IND ENG CHEM 2019. [DOI: 10.1016/j.jiec.2019.01.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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130
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Krabak BJ, Tenforde AS, Davis IS, Fredericson M, Harrast MA, d'Hemecourt P, Luke AC, Roberts WO. Youth Distance Running: Strategies for Training and Injury Reduction. Curr Sports Med Rep 2019; 18:53-59. [PMID: 30730342 DOI: 10.1249/jsr.0000000000000564] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Running is a popular sport for children in the United States. However, review of available literature on health effects and safety recommendations for youth running has not been previously conducted. Unique factors for injury include periods of growth during puberty and potential for growth plate injury. Youth runners may benefit from activities that incorporate high-impact loading and multidirectional movement for optimal bone maturation, exercises to strengthen tendons and muscles, and strategies aimed at improving running biomechanics to reduce risk of injury. In addition, addressing lifestyle factors, including nutrition and sleep is essential for a runner's general health. Similar to other sports, sports specialization should not be encouraged in youth runners. Reducing running-related injury in growing children and assessing readiness for running should be based on a combination of physical, emotional, psychological, social, and cognitive factors. Youth runners require individualized training and competition to safely participate in the sport.
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Affiliation(s)
- Brian J Krabak
- Rehabilitation, Orthopedics, and Sports Medicine, University of Washington and Seattle Children's Sports Medicine, Seattle, WA
| | - Adam S Tenforde
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Cambridge, MA
| | - Irene S Davis
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, MA.,Spaulding National Running Center, Cambridge, MA
| | - Michael Fredericson
- Department of Orthopedic Surgery, Stanford University School of Medicine, Stanford, CA
| | - Mark A Harrast
- Rehabilitation, Orthopedics, and Sports Medicine, University of Washington, Seattle, WA
| | | | - Anthony C Luke
- UCSF Primary Care Sports Medicine, UCSF Department of Orthopaedics, UCSF Department of Family and Community Medicine, San Francisco, CA
| | - William O Roberts
- Department of Family Medicine, University of Minnesota Medical School, Minneapolis, MN
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Jo CH, Lim HJ, Yoon KS. Characterization of Tendon-Specific Markers in Various Human Tissues, Tenocytes and Mesenchymal Stem Cells. Tissue Eng Regen Med 2019; 16:151-159. [PMID: 30989042 PMCID: PMC6439073 DOI: 10.1007/s13770-019-00182-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/10/2019] [Accepted: 01/25/2019] [Indexed: 10/27/2022] Open
Abstract
Background Unlike bone, cartilage, or muscle, tendon-specific markers are not well established. The purpose of the study was to investigate expression pattern and level of 6 well-known tendon-specific markers, in various human musculoskeletal tissues, tenocytes, and mesenchymal stem cells (MSCs). Methods Musculoskeletal tissue samples of tendon, bone, cartilage, nerve, muscle, and fat were obtained from patients undergoing orthopedic surgery. Tenocytes, MSCs from bone marrow, adipose tissue, and umbilical cord were isolated from each tissue and cultured. Six tendon-specific markers, scleraxis (Scx), tenomodulin (TNMD), thrombospondin-4 (TSP-4), tenascin-C (TNC), type I collagen (Col I), and type III collagen (Col III) were investigated in tendon tissue, tenocytes, and MSCs. Results mRNA levels of 6 tendon-specific markers were significantly higher in tendon tissue that in other connective tissues levels of Scx, TNMD, TSP-4, and Col III immediately decreased after plating tenocytes in culture dishes whereas those of TNC and Col I did not. In comparison with tendon tissue, mRNA levels pattern of Scx, TNMD, and TSP-4 in tenocytes were significantly higher than that in MSCs, but lower than in tendon tissue whereas expression pattern of TNC, Col I and III showed different pattern with each other. Conclusion This study demonstrated that 6 commonly used tendon-specific markers were mainly expressed in tendon tissue, but that expression level and pattern of the tendon-specific markers with respect to kinds of tissues, culture duration of tenocytes and sources of MSCs.
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Affiliation(s)
- Chris Hyunchul Jo
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, College of Medicine, Seoul National University, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061 Korea
- Department of Translational Medicine, College of Medicine, Seoul National University, Daehak-ro 103, Jongno-gu, Seoul, 03080 Korea
| | - Hyun-Ju Lim
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, College of Medicine, Seoul National University, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061 Korea
| | - Kang Sup Yoon
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, College of Medicine, Seoul National University, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061 Korea
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Liu Y, Feng L, Xu J, Yang Z, Wu T, Zhang J, Shi L, Zhu D, Zhang J, Li G. MiR-378a suppresses tenogenic differentiation and tendon repair by targeting at TGF-β2. Stem Cell Res Ther 2019; 10:108. [PMID: 30922407 PMCID: PMC6440014 DOI: 10.1186/s13287-019-1216-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 03/05/2019] [Accepted: 03/18/2019] [Indexed: 12/22/2022] Open
Abstract
Background Tendons are a crucial component of the musculoskeletal system and responsible for transmission forces derived from muscle to bone. Patients with tendon injuries are often observed with decreased collagen production and matrix degeneration, and healing of tendon injuries remains a challenge as a result of limited understanding of tendon biology. Recent studies highlight the contribution of miR-378a on the regulation gene expression during tendon differentiation. Methods We examined the tendon microstructure and tendon repair with using miR-378a knock-in transgenic mice, and the tendon-derived stem cells were also isolated from transgenic mice to study their tenogenic differentiation ability. Meanwhile, the expression levels of tenogenic markers were also examined in mouse tendon-derived stem cells transfected with miR-378a mimics during tenogenic differentiation. With using online prediction software and luciferase reporter assay, the binding target of miR-378a was also studied. Results Our results indicated miR-378a impairs tenogenic differentiation and tendon repair by inhibition collagen and extracellular matrix production both in vitro and in vivo. We also demonstrated that miR-378a exert its inhibitory role during tenogenic differentiation through binding at TGFβ2 by luciferase reporter assay and western blot. Conclusions Our investigation suggests that miR-378a could be considered as a new potential biomarker for tendon injury diagnosis or drug target for a possible therapeutic approach in future clinical practice. Electronic supplementary material The online version of this article (10.1186/s13287-019-1216-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yang Liu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.,Department of Molecular Medicine and Gene Therapy, Faculty of Medicine, Lund University, Lund, Sweden
| | - Lu Feng
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Jia Xu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.,Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Zhengmeng Yang
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Tianyi Wu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.,Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jiajun Zhang
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Liu Shi
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Dahai Zhu
- The State Key Laboratory of Medical Molecular Biology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Jinfang Zhang
- Key Laboratory of Orthopaedics and Traumatology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China. .,Lingnan Medical Research Center, Guangzhou University of Chinese Medicine, Guangzhou, China.
| | - Gang Li
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China. .,Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
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Farkash U, Avisar E, Volk I, Slevin O, Shohat N, El Haj M, Dolev E, Ashraf E, Luria S. First clinical experience with a new injectable recombinant human collagen scaffold combined with autologous platelet-rich plasma for the treatment of lateral epicondylar tendinopathy (tennis elbow). J Shoulder Elbow Surg 2019; 28:503-509. [PMID: 30487054 DOI: 10.1016/j.jse.2018.09.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 09/09/2018] [Accepted: 09/13/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Lateral epicondylitis is a tendinopathy of the common extensor origin at the elbow. When traditional conservative treatment fails, more effective therapies are needed. Vergenix Soft Tissue Repair (STR) Matrix (CollPlant Ltd., Ness-Ziona, Israel) is an injectable gel composed of cross-linked bioengineered recombinant human type I collagen combined with autologous platelet-rich plasma (STR/PRP). The complex forms a collagen-fibrin matrix that promotes cell migration and tissue repair. Based on positive outcomes from preclinical trials, this study is the first clinical trial of STR/PRP on tendinopathy. We hypothesized that STR/PRP would be a safe and effective treatment for lateral epicondylar tendinopathy. METHODS Patients with chronic lateral epicondylitis underwent treatment with STR/PRP. Outcome assessment included grip strength, functional disability, and changes in sonographic tendon appearance for up to 6 months after treatment. RESULTS The study enrolled 40 patients. No systemic or local severe adverse events were reported. Clinical evaluation revealed an improvement in the mean Patient-Rated Tennis Elbow Evaluation score from 64.8 before treatment and showed a 59% reduction at 6 months. The 12-Item Short-Form Health Survey questionnaire showed improvement from a mean score of 30.7 to 37.7 at the final follow-up. Grip strength increased from 28.8 kg at baseline to 36.8 kg at 6 months. Improvements in sonographic tendon appearance were evident among 68% of patients. CONCLUSION STR/PRP is a safe treatment that effectively induces clinically significant improvements in elbow symptoms and general well-being as well as objective measures of strength and imaging of the common extensor tendon within 6 months of treatment of elbow tendinopathy recalcitrant to standard treatments.
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Affiliation(s)
- Uri Farkash
- Department of Orthopedic Surgery, Assuta-Ashdod University Hospital, Ashdod, Israel, and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
| | - Erez Avisar
- Department of Orthopedic Surgery, Assaf Haroffeh Medical Center, Zrifin, Israel
| | - Ido Volk
- Department of Orthopedic Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Omer Slevin
- Department of Orthopedic Surgery, Meir Hospital, Kfar-Saba, Israel
| | - Noam Shohat
- Department of Orthopedic Surgery, Assaf Haroffeh Medical Center, Zrifin, Israel
| | - Madi El Haj
- Department of Orthopedic Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Eran Dolev
- Department of Orthopedic Surgery, Meir Hospital, Kfar-Saba, Israel
| | - Eran Ashraf
- Department of Orthopedic Surgery, Assaf Haroffeh Medical Center, Zrifin, Israel
| | - Shai Luria
- Department of Orthopedic Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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134
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Oliva F, Maffulli N, Gissi C, Veronesi F, Calciano L, Fini M, Brogini S, Gallorini M, Antonetti Lamorgese Passeri C, Bernardini R, Cicconi R, Mattei M, Berardi AC. Combined ascorbic acid and T 3 produce better healing compared to bone marrow mesenchymal stem cells in an Achilles tendon injury rat model: a proof of concept study. J Orthop Surg Res 2019; 14:54. [PMID: 30777116 PMCID: PMC6380036 DOI: 10.1186/s13018-019-1098-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 02/07/2019] [Indexed: 12/11/2022] Open
Abstract
Background This pilot study aimed to ascertain whether the local application of ascorbic acid (AA), of T3, and of rat (r) bone marrow mesenchymal stem cells (BMSCs), alone or in all possible combinations, promoted healing after an Achilles tendon injury in a rat model. Methods An Achilles tendon defect was produced in 24 6–8-week-old male inbred Lewis rats. The animals were then randomly divided into eight groups of three rats each. The tendon defect was filled with 50 μL of phosphate-buffered saline (PBS) containing (1) 50 μg/mL AA (AA group), (2) 10−7 M T3 (T3 group), (3) 4 × 106 rBMSCs (rBMSC group), (4) 50 μg/mL AA + 10−7 M T3 (AA + T3 group), (5) 4 × 106 rBMSCs + 50 μg/mL AA (rBMSC + AA group), (6) 4 × 106 rBMSCs + 10−7 M T3 (rBMSC + T3 group), (7) 4 × 106 rBMSCS + 50 μg/mL AA + 10−7 M T3 (rBMSC + AA + T3 group), and (8) PBS only (control group: CTRL). All treatments were administered by local injection immediately after the tendons had been damaged; additionally, AA was injected also on the second and fourth day from the first injection (for groups 1, 4, 5, and 7), and T3 was injected again every day for 4 days (for groups 2, 4, 6, and 7). At 30 days from initial treatment, tendon samples were harvested, and the quality of tendon repair was evaluated using histological and histomorphological analysis. The structure and morphology of the injured Achilles tendons were evaluated using the modified Svensson, Soslowsky, and Cook score, and the collagen type I and III ratio was calculated. Results The group treated with AA combined with T3 displayed the lowest Svensson, Soslowsky, and Cook total score value of all tissue sections at histopathological examination, with fiber structure close to regular orientation, normal-like tendon vasculature, and no cartilage formation. AA + T3 also showed the highest collagen I and the lowest collagen III values compared to all other treatments including the CTRL. Conclusion There are potential benefits using a combination of AA and T3 to accelerate tendon healing.
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Affiliation(s)
- Francesco Oliva
- Department of Orthopaedics and Traumatology, Surgery and Dentistry, Azienda Ospedaliera San Giovanni di Dio e Ruggi d'Aragona, University of Salerno School of Medicine, Salerno, Italy
| | - Nicola Maffulli
- Department of Orthopaedics and Traumatology, Surgery and Dentistry, Azienda Ospedaliera San Giovanni di Dio e Ruggi d'Aragona, University of Salerno School of Medicine, Salerno, Italy. .,Centre for Sports and Exercise Medicine, Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Mile End Hospital, London, UK. .,Institute of Science and Technology in Medicine, Keele University Medical School, Stoke on Trent, UK.
| | - Clarissa Gissi
- U.O.C. of Immunohaematology and Transfusion Medicine, Laboratory of Stem Cells, Spirito Santo Hospital, Pescara, Italy
| | - Francesca Veronesi
- Laboratory of Preclinical and Surgical Studies, Research Innovation and Technology Department (RIT), IRCCS Rizzoli Orthopedic Institute, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - Lucia Calciano
- Dipartimento di Sanità Pubblica e Medicina di Comunità, Sezione di Epidemiologia e Statistica Medica, Università di Verona, 37134, Verona, Italy
| | - Milena Fini
- Laboratory of Preclinical and Surgical Studies, Research Innovation and Technology Department (RIT), IRCCS Rizzoli Orthopedic Institute, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - Silvia Brogini
- Laboratory of Preclinical and Surgical Studies, Research Innovation and Technology Department (RIT), IRCCS Rizzoli Orthopedic Institute, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - Marialucia Gallorini
- Department of Medical, Oral and Biotechnological Sciences, University "G. d'Annunzio" Chieti-Pescara, Chieti, Italy
| | | | - Roberta Bernardini
- Interdepartmental Service Centre - Station for Animal Technology, University of Rome "Tor Vergata", Rome, Italy
| | - Rosella Cicconi
- Interdepartmental Service Centre - Station for Animal Technology, University of Rome "Tor Vergata", Rome, Italy
| | - Maurizio Mattei
- Interdepartmental Service Centre - Station for Animal Technology, University of Rome "Tor Vergata", Rome, Italy.,Department of Biology, University of Rome "Tor Vergata", Rome, Italy
| | - Anna Concetta Berardi
- U.O.C. of Immunohaematology and Transfusion Medicine, Laboratory of Stem Cells, Spirito Santo Hospital, Pescara, Italy
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Cardoso TB, Pizzari T, Kinsella R, Hope D, Cook JL. Current trends in tendinopathy management. Best Pract Res Clin Rheumatol 2019; 33:122-140. [DOI: 10.1016/j.berh.2019.02.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Abstract
In the United States, youth participation in sports continues to increase yearly. This increase in participation, in conjunction with the trend toward early sports specialization and year round training, has led to a similar increase in athletically developed injuries. These injuries vary in nature and acuity, with the type of injury often related to the athlete's age, sport, and level of training. Endurance athletes are at an elevated risk of injury as they frequently push their body to the limit during their arduous training. Pediatric endurance athletes can be particularly vulnerable, especially to overuse injuries, given their unique and ever-changing physiological state. It is important to understand the specific challenges facing not only the physical, but also the emotional well-being of these pediatric endurance athletes to maximize performance while minimizing injury and potential long-term sequelae.
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137
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Freed L, Ellis MB, Johnson K, Haddon TB. Fasciotomy and Surgical Tenotomy for Chronic Achilles Insertional Tendinopathy A Retrospective Study Using Ultrasound-Guided Percutaneous Microresection. J Am Podiatr Med Assoc 2019; 109:1-8. [PMID: 30964321 DOI: 10.7547/15-168] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Achilles insertional tendon pathology is a common condition affecting a broad range of patients. When conservative treatments are unsuccessful, the traditional open resection, debridement, and reattachment of the Achilles tendon is a variably reliable procedure with significant risk of morbidity. Fasciotomy and surgical tenotomy using ultrasound-guided percutaneous microresection is used on various tendons in the body, but the efficacy has not been examined specifically for the Achilles tendon. METHODS A retrospective review evaluated 26 procedures in 25 patients who underwent Achilles fasciotomy and surgical tenotomy. The Foot Function Index was used to quantify pain, disability, activity limitation, and overall scores. RESULTS Mean Foot Function Index scores were as follows: pain, 8.53%; disability, 7.91%; activity limitation, 2.50%; and overall, 6.97%. Twenty index procedures were successful, and two patients repeated the procedure successfully for an overall 84.6% success rate in patients with chronic insertional pathology with mean surveillance of 16 months. There were no infections or systemic complications. CONCLUSIONS Ultrasound-guided percutaneous microresection is a safe and minimally invasive percutaneous alternative that can be used before proceeding to a more invasive open procedure.
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Affiliation(s)
- Lewis Freed
- East Valley Foot and Ankle Specialists, Mesa, AZ
| | - Mark B. Ellis
- Department of Podiatry, George E. Wahlen VA Medical Center, Salt Lake City, UT
| | - Kate Johnson
- A Step Ahead Foot and Ankle Center, Fort Collins, CO
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139
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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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Norelli JB, Plaza DP, Stal DN, Varghese AM, Liang H, Grande DA. Tenogenically differentiated adipose-derived stem cells are effective in Achilles tendon repair in vivo. J Tissue Eng 2018; 9:2041731418811183. [PMID: 30542597 PMCID: PMC6236638 DOI: 10.1177/2041731418811183] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 10/11/2018] [Indexed: 12/20/2022] Open
Abstract
The purpose of this study was to characterize rat adipose-derived stem cells,
induce adipose-derived stem cell tenogenesis, and analyze adipose-derived stem
cell effects on tendon repair in vivo. Adipose-derived stem cells demonstrated
an immunomodulatory, pro-angiogenic, and pro-proliferatory profile in vitro.
Tenogenesis was induced for 1, 7, 14, and 21 days with 24 combinations of growth
differentiation factor-5, 6, and 7 and platelet-derived growth factor–BB.
Adipose-derived stem cells expression of scleraxis and collagen type I increased
the most after 14 days of induction with growth differentiation factor-6 and
platelet-derived growth factor–BB. Achilles excision defects injected with
hydrogel alone (Gp2), with undifferentiated (Gp3) adipose-derived stem cells, or
tenogenically differentiated (Gp4) adipose-derived stem cells exhibited improved
tissue repair compared with untreated tendons (Gp1). Addition of adipose-derived
stem cells improved tissue cytoarchitecture and increased expression of collagen
type I and III, scleraxis, and tenomodulin. Adipose-derived stem cells
significantly improved biomechanical properties (ultimate load and elastic
toughness) over time more than hydrogel alone, while tenogenically
differentiated adipose-derived stem cells improved the mean histological score
and collagen fiber dispersion range closest to normal tendon. In addition,
tendon sections treated with GFP-adipose-derived stem cells exhibited green
fluorescence and positive GFP immunostaining on microscopy confirming the in
vivo survival of adipose-derived stem cells that were injected into tendon
defects to support the effects of adipose-derived stem cells on tissue up to
4.5 weeks post injury.
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Affiliation(s)
- Jolanta B Norelli
- Donald and Barbara Zucker School of
Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Orthopaedic Research Laboratory, The
Feinstein Institute for Medical Research, Manhasset, NY, USA
- Jolanta B Norelli, Orthopaedic Research
Laboratory, The Feinstein Institute for Medical Research, 350 Community Drive,
Manhasset, NY 11030, USA.
| | - Dawid P Plaza
- Orthopaedic Research Laboratory, The
Feinstein Institute for Medical Research, Manhasset, NY, USA
- Drexel University College of Medicine,
Philadelphia, PA, USA
| | - Drew N Stal
- Orthopaedic Research Laboratory, The
Feinstein Institute for Medical Research, Manhasset, NY, USA
- Department of Orthopedic Surgery,
Northwell Health, Manhasset, NY, USA
| | - Anish M Varghese
- Orthopaedic Research Laboratory, The
Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Haixiang Liang
- Orthopaedic Research Laboratory, The
Feinstein Institute for Medical Research, Manhasset, NY, USA
- Department of Orthopedic Surgery,
Northwell Health, Manhasset, NY, USA
| | - Daniel A Grande
- Donald and Barbara Zucker School of
Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Orthopaedic Research Laboratory, The
Feinstein Institute for Medical Research, Manhasset, NY, USA
- Department of Orthopedic Surgery,
Northwell Health, Manhasset, NY, USA
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141
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Kim SJ, Tatman PD, Song DH, Gee AO, Kim DH, Kim SJ. Nanotopographic cues and stiffness control of tendon-derived stem cells from diverse conditions. Int J Nanomedicine 2018; 13:7217-7227. [PMID: 30510414 PMCID: PMC6231514 DOI: 10.2147/ijn.s181743] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Tendon-derived stem cells (TDSCs) are key factors associated with regeneration and healing in tendinopathy. The aim of this study was to investigate the effects of mechanical stiffness and topographic signals on the differentiation of TDSCs depending on age and pathological conditions. Materials and methods We compared TDSCs extracted from normal tendon tissues with TDSCs from tendinopathic Achilles tendon tissues of Sprague Dawley rats in vitro and TDSCs cultured on nanotopographic cues and substrate stiffness to determine how to control the TDSCs. The tendinopathy model was created using a chemical induction method, and the tendon injury model was created via an injury-and-overuse method. Norland Optical Adhesive 86 (NOA86) substrate with 2.48 GPa stiffness with and without 800 nm-wide nanogrooves and a polyurethane substrate with 800 nm-wide nanogrooves were used. Results TDSCs from 5-week-old normal tendon showed high expression of type III collagen on the flat NOA86 substrate. In the 15-week normal tendon model, expression of type III collagen was high in TDSCs cultured on the 800 nm NOA86 substrates. However, in the 15-week tendon injury model, expression of type III collagen was similar irrespective of nanotopographic cues or substrate stiffness. The expression of type I collagen was also independent of nanotopographic cues and substrate stiffness in the 15-week normal and tendon injury models. Gene expression of scleraxis was increased in TDSCs cultured on the flat NOA86 substrate in the 5-week normal tendon model (P=0.001). In the 15-week normal tendon model, scleraxis was highly expressed in TDSCs cultured on the 800 nm and flat NOA86 substrate (P=0.043). However, this gene expression was not significantly different between the substrates in the 5-week tendinopathy and 15-week tendon injury models. Conclusion Development and maturation of tendon are enhanced when TDSCs from normal tendons were cultured on stiff surface, but not when the TDSCs came from pathologic models. Therapeutic applications of TDSCs need to be flexible based on tendon age and tendinopathy.
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Affiliation(s)
- Sun Jeong Kim
- Department of Physical and Rehabilitation Medicine, Stem Cell and Regenerative Medicine Institute, Samsung Medical Center, Seoul, Republic of Korea,
| | - Philip D Tatman
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Da-Hyun Song
- Department of Physical and Rehabilitation Medicine, Stem Cell and Regenerative Medicine Institute, Samsung Medical Center, Seoul, Republic of Korea,
| | - Albert O Gee
- Department of Orthopedic Surgery and Sports Medicine, University of Washington, Seattle, WA, USA
| | - Deok-Ho Kim
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Sang Jun Kim
- Department of Physical and Rehabilitation Medicine, Stem Cell and Regenerative Medicine Institute, Samsung Medical Center, Seoul, Republic of Korea,
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142
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Hullfish TJ, Baxter JR. A Reliable Method for Quantification of Tendon Structure Using B-Mode Ultrasound. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:2419-2424. [PMID: 29574900 PMCID: PMC7418711 DOI: 10.1002/jum.14592] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 01/04/2018] [Accepted: 01/06/2018] [Indexed: 06/08/2023]
Abstract
Structure is an important clinical marker of tendon health; however, current standards use qualitative scores that are not strongly reliable. Therefore, the purpose of this study was to establish the reliability of an image-processing technique that quantifies tendon collagen structure using B-mode ultrasound images. Longitudinal images of the Achilles tendon were collected in 12 healthy young adults, and intra- and inter-rater reliability was assessed over multiple image selections and multiple days. Intraclass correlation coefficients were strong (r ≥ 0.71) for all comparisons. These findings demonstrate that quantitative assessments of tendon structure using B-mode ultrasound are reliable.
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Affiliation(s)
- Todd J. Hullfish
- Human Motion Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA USA
| | - Josh R. Baxter
- Human Motion Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA USA
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143
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Wezenbeek E, De Clercq D, Mahieu N, Willems T, Witvrouw E. Activity-Induced Increase in Achilles Tendon Blood Flow Is Age and Sex Dependent. Am J Sports Med 2018; 46:2678-2686. [PMID: 30067065 DOI: 10.1177/0363546518786259] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Previous research of a young adult population identified a lower increase in Achilles tendon blood flow immediately after a running activity as a significant predictor for the development of Achilles tendinopathy (AT). Furthermore, advancing age is often mentioned as a risk factor for the development of AT, and the highest incidence for AT is reported to occur in middle-aged recreational male athletes. PURPOSE To investigate the effect of age, sex, and type of physical activity on the increase in Achilles tendon blood flow. STUDY DESIGN Controlled laboratory study. METHODS Blood flow measurements of 33 subjects aged 18 to 25 years and 30 subjects aged 40 to 55 years were obtained before and after 4 physical activities performed in randomized order: running, cycling, dynamic stretching, and rope skipping. Blood flow measurements of the Achilles tendon were performed before, immediately after, 5 minutes after, and 10 minutes after the physical activities. The effect of age, sex, and physical activities on the increase in blood flow was investigated with linear mixed models. RESULTS The results of this study identified that running, rope skipping, and cycling resulted in a significant increase in tendon blood flow ( P ≤ .001), whereas stretching did not. Prominent was the finding that the increase in blood flow after activity was significantly lower in the older population as compared with the younger population ( P < .001). Furthermore, male participants in the older group showed a significantly lower increase in tendon blood flow than did their female counterparts ( P = .019). CONCLUSION This study identified that sex and age significantly influence the increase in blood flow after activity, possibly explaining the increased risk for AT among middle-aged recreational athletes. CLINICAL RELEVANCE This study possibly identified one of the mechanisms explaining why an older male population is at increased risk for developing AT. Given that the lower increase in blood flow is an identified risk factor according to previous research, preventative measures should focus on improving this blood flow during physical activity in the physically active older male population. Registration: NCT03218605 ( ClinicalTrials.gov identifier).
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Affiliation(s)
- Evi Wezenbeek
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Dirk De Clercq
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
| | - Nele Mahieu
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Tine Willems
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Erik Witvrouw
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
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144
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Krill MK, Hoffman J, Yang J, Hodax JD, Owens BD, Hewett TE. Previous foot injuries associated with a greater likelihood of Achilles tendon ruptures in professional American football players. PHYSICIAN SPORTSMED 2018; 46:342-348. [PMID: 29860909 DOI: 10.1080/00913847.2018.1482188] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES The purpose of this study was to build on current understanding of Achilles tendon (AT) ruptures in football through the examination of lower extremity injury rates (IR) in the season prior to AT rupture. METHODS An online review was conducted to document AT ruptures in the National Football League (NFL) from the 2010-11 through 2016-17 seasons. Player-specific information was gathered through the online search, injury reports, or video analysis. Injury incidence was recorded for each season. Descriptive statistics were calculated for all variables. IRs per 1000 athlete-exposures with 95% confidence intervals (CI) were established. Injury rate ratios (IRR) with 95% CI were calculated to evaluate differences in IR with statistical significance established at p < 0.05. RESULTS From the 2010-11 to 2016-17 NFL seasons, 109 AT ruptures were identified. 36 athletes participated in the NFL the season prior and sustained a total of 40 injuries. Thirty-two (32/40, 80%) of the injuries involved the lower extremity. The most frequent body parts injured in the NFL season prior to AT rupture were the knee (n = 8, 22.5%), upper leg and thigh (n = 7, 17.5%), lower leg and shin (n = 5, 12.5%), and ankle (n = 5, 12.5%). The overall IR for the AT rupture group was not significantly different than the NFL group (IRR: 0.94, 0.68-1.31 95% CI, p = 0.73). The AT rupture group demonstrated a significantly increased rate of foot injuries compared to the NFL cohort (IRR: 2.58, 1.16-5.77 95% CI, p = 0.02). CONCLUSION There was an increased identified incidence of AT ruptures in the NFL from 2010 to 2017 compared to AT ruptures reported from 1997 to 2002. There was no significant difference in lower extremity IR the season prior to AT rupture. Only foot injuries demonstrated an increased IR the season prior to AT rupture compared to an NFL cohort. Eleven athletes sustained 2 AT ruptures and all 11 players sustained the subsequent AT rupture to the contralateral limb.
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Affiliation(s)
- Michael K Krill
- a James Crane Sports Medicine Institute, Motion Analysis and Performance Laboratory , The Ohio State University Wexner Medical Center , Columbus , OH , USA.,b Charles E. Schmidt College of Medicine , Florida Atlantic University , Boca Raton , FL , USA.,c Physical Medicine and Rehabilitation, Department of Neurology, Division of Neurorehabilitation , Washington University in St. Louis , St. Louis , MO , USA
| | - Joshua Hoffman
- a James Crane Sports Medicine Institute, Motion Analysis and Performance Laboratory , The Ohio State University Wexner Medical Center , Columbus , OH , USA
| | - JaeWon Yang
- d Warren Alpert Medical School of Brown University , Providence , RI
| | - Johnathan D Hodax
- e Department of Orthopaedic Surgery , Warren Alpert Medical School of Brown University , Providence , RI , USA
| | - Brett D Owens
- e Department of Orthopaedic Surgery , Warren Alpert Medical School of Brown University , Providence , RI , USA
| | - Timothy E Hewett
- f Sports Medicine Center , Mayo Clinic , Rochester , MN , USA.,g Department of Orthopedic Surgery , Mayo Clinic , Rochester , MN , USA.,h Department of Physiology and Biomedical Engineering , Mayo Clinic , Rochester , MN , USA.,i Department of Physical Medicine & Rehabilitation , Mayo Clinic , Rochester , MN , USA
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145
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Abstract
Achilles tendinopathy is a common cause of disability. Despite the economic and social relevance of the problem, the causes and mechanisms of Achilles tendinopathy remain unclear. Tendon vascularity, gastrocnemius-soleus dysfunction, age, sex, body weight and height, pes cavus, and lateral ankle instability are considered common intrinsic factors. The essence of Achilles tendinopathy is a failed healing response, with haphazard proliferation of tenocytes, some evidence of degeneration in tendon cells and disruption of collagen fibers, and subsequent increase in noncollagenous matrix. Tendinopathic tendons have an increased rate of matrix remodeling, leading to a mechanically less stable tendon which is more susceptible to damage. The diagnosis of Achilles tendinopathy is mainly based on a careful history and detailed clinical examination. The latter remains the best diagnostic tool. Over the past few years, various new therapeutic options have been proposed for the management of Achilles tendinopathy. Despite the morbidity associated with Achilles tendinopathy, many of the therapeutic options described and in common use are far from scientifically based. New minimally invasive techniques of stripping of neovessels from the Kager's triangle of the tendo Achillis have been described, and seem to allow faster recovery and accelerated return to sports, rather than open surgery. A genetic component has been implicated in tendinopathies of the Achilles tendon, but these studies are still at their infancy.
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146
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Han SH, Kim HK, Ahn JH, Lee DH, Baek M, Ye G, Lee JM, Min K, Oh C, Lee S. A Protocol to Acquire the Degenerative Tenocyte from Humans. J Vis Exp 2018. [PMID: 29939181 DOI: 10.3791/57634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Tendinopathy, a painful condition that develops in response to tendon degeneration, is on the rise in the developed world due to increasing physical activity and longer life expectancy. Despite its increasing prevalence, the underlying pathogenesis still remains unclear, and treatment is generally symptomatic. Recently, numerous therapeutic options, including growth factors, stem cells, and gene therapy, were investigated in hopes of enhancing the healing potency of the degenerative tendon. However, the majority of these research studies were conducted only on animal models or healthy human tenocytes. Despite some studies using pathological tenocytes, to the best of our knowledge there is currently no protocol describing how to obtain human degenerative tenocytes. The aim of this study is to describe a standard protocol for acquiring human degenerative tenocytes. Initially, the tendon tissue was harvested from a patient with lateral epicondylitis during surgery. Then biopsy samples were taken from the extensor carpi radialis brevis tendon corresponding to structural changes observed at the time of surgery. All of the harvested tendons appeared to be dull, gray, friable, and edematous, which made them visually distinct from the healthy ones. Tenocytes were cultured and used for experiments. Meanwhile, half of the harvested tissues were analyzed histologically, and it was shown that they shared the same key features of tendinopathy (angiofibroblastic dysplasia or hyperplasia). A secondary analysis by immunocytochemistry confirmed that the cultured cells were tenocytes with the majority of the cells having positive stains for mohawk and tenomodulin proteins. The qualities of the degenerative nature of tenocytes were then determined by comparing the cells with the healthy control using a proliferation assay or qRT-PCR. The degenerative tenocyte displayed a higher proliferation rate and similar gene expression patterns of tendinopathy that matched previous reports. Overall, this new protocol might provide a useful tool for future studies of tendinopathy.
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Affiliation(s)
- Soo-Hong Han
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine
| | - Hyung Kyung Kim
- Department of Pathology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine
| | - Jong-Ho Ahn
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine
| | - Dong Hyeon Lee
- Department of Physiology, CHA University School of Medicine
| | - Minjung Baek
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine
| | - Geunhee Ye
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine
| | - Joong-Myung Lee
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine
| | - Kyunghoon Min
- Department of Rehabilitation, CHA Bundang Medical Center, CHA University School of Medicine
| | - Chihoon Oh
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine
| | - Soonchul Lee
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine;
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147
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Lacheta L, Siebenlist S. Anatomy, Biomechanics, and Pathology of the Distal Biceps Tendon. OPER TECHN SPORT MED 2018. [DOI: 10.1053/j.otsm.2018.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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148
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Lin MT, Chiang CF, Wu CH, Hsu HH, Tu YK. Meta-analysis Comparing Autologous Blood-Derived Products (Including Platelet-Rich Plasma) Injection Versus Placebo in Patients With Achilles Tendinopathy. Arthroscopy 2018; 34:1966-1975.e5. [PMID: 29685839 DOI: 10.1016/j.arthro.2018.01.030] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 01/18/2018] [Accepted: 01/18/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the effectiveness of autologous blood-derived products (ABP) injection with that of placebo (sham injection, no injection, or physiotherapy alone) in patients with Achilles tendinopathy. METHODS Electronic databases, including PubMed, Scopus, EMBASE, and Cochrane Library were searched up to June 2017. All published or unpublished randomized controlled trials (RCTs) were included. Two independent raters assessed the risk of bias of RCTs with the Cochrane Risk of Bias Tool. The primary outcome was Victorian Institute of Sports Assessment-Achilles (VISA-A) score. Weighted mean differences (WMDs) were used for random effect meta-analysis. RESULTS Seven RCTs were enrolled in meta-analysis. The ABP injection and placebo revealed equal effectiveness in VISA-A score improvement at 4 to 6 weeks (short term, WMD 2.29, 95% confidence interval [CI]: -1.69, 6.27), 12 weeks (medium term, WMD 2.63, 95% CI: -1.72, 6.98), 24 weeks (long term, WMD 4.61, 95% CI: -1.25, 10.47), and 48 weeks (very long term, WMD 4.16, 95% CI: -6.82, 15.14). In meta-regression, there was no association between change in VISA-A score and duration of symptoms at 4 to 6 weeks (short term), 12 weeks (medium term), and 24 weeks (long term). CONCLUSIONS This meta-analysis revealed that ABP injection was not more effective than placebo (sham injection, no injection, or physiotherapy alone) in Achilles tendinopathy and that no association was found between therapeutic effects and duration of symptoms. LEVEL OF EVIDENCE Level I, meta-analysis of Level I studies.
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Affiliation(s)
- Meng-Ting Lin
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ching-Fang Chiang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chueh-Hung Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Hui-Hsuan Hsu
- Graduate Institute of Epidemiology and Preventive Medicine, National Taiwan University College of Public Health, Taipei, Taiwan
| | - Yu-Kang Tu
- Graduate Institute of Epidemiology and Preventive Medicine, National Taiwan University College of Public Health, Taipei, Taiwan
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149
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Chen E, Yang L, Ye C, Zhang W, Ran J, Xue D, Wang Z, Pan Z, Hu Q. An asymmetric chitosan scaffold for tendon tissue engineering: In vitro and in vivo evaluation with rat tendon stem/progenitor cells. Acta Biomater 2018; 73:377-387. [PMID: 29678676 DOI: 10.1016/j.actbio.2018.04.027] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 04/08/2018] [Accepted: 04/16/2018] [Indexed: 01/02/2023]
Abstract
The poor healing capacity and typically incomplete regeneration of injured tendons has made tendon repair as a primary clinical concern. Several methods for repairing injured tendons have been developed in the last decade. Tendon regeneration using current tissue engineering techniques requires advanced biomaterials to satisfy both microstructural and mechanical criteria. In this study, a novel chitosan (CS)-based scaffold with asymmetric structure was fabricated using a self-deposition technique. The fabricated scaffolds were assessed with regard to the microstructural and mechanical demands of cell ingrowth and the prevention of peritendinous adhesion. In vitro studies showed that rat tendon stem/progenitor cells (TSPCs) seeded onto the CS scaffold displayed higher levels of tenogenic specific genes expression and protein production. Four and six weeks after the implantation of CS scaffolds on full-site Achilles tendon defects, in vivo tendon repair was evaluated by histology, immunohistochemistry, immunofluorescence, and mechanical measurements. The production of collagen I (COL1) and collagen III (COL3) demonstrated that the CS scaffolds were capable of inducing conspicuous tenogenic differentiation, higher tenomodulin (TNMD) production, and superior phenotypic maturity, compared with the empty defect group. The introduction of TSPCs into the CS scaffold resulted in a synergistic effect on tendon regeneration and yielded better-aligned collagen fibers with elongated, spindle-shaped cells. These findings indicated that the application of TSPC-seeded CS scaffolds would be a feasible approach for tendon repair. STATEMENT OF SIGNIFICANCE The poor healing capacity of injured tendons and inevitable peritendinous adhesion has made tendon regeneration a clinical priority. In this study, an asymmetric chitosan scaffold was developed to encapsulate rat tendon stem/progenitor cells (TSPCs), which could induce higher levels of tenogenic specific genes and protein expression. Remarkably, the introduction of TSPCs into the asymmetric chitosan scaffold generated a synergistic effect on in vivo tendon regeneration and lead to better-aligned collagen fibers compared with asymmetric chitosan scaffold alone. This work can provide new guidelines for the structure and property design of cell-seeded scaffolds for tendon regeneration.
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Affiliation(s)
- Erman Chen
- Department of Orthopedics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, China; Orthopedics Research Institute, Zhejiang University, Hangzhou 310000, China
| | - Ling Yang
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou 310027, China
| | - Chenyi Ye
- Department of Orthopedics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, China; Orthopedics Research Institute, Zhejiang University, Hangzhou 310000, China
| | - Wei Zhang
- Department of Orthopedics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, China; Orthopedics Research Institute, Zhejiang University, Hangzhou 310000, China
| | - Jisheng Ran
- Department of Orthopedics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, China; Orthopedics Research Institute, Zhejiang University, Hangzhou 310000, China
| | - Deting Xue
- Department of Orthopedics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, China; Orthopedics Research Institute, Zhejiang University, Hangzhou 310000, China
| | - Zhengke Wang
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou 310027, China.
| | - Zhijun Pan
- Department of Orthopedics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, China; Orthopedics Research Institute, Zhejiang University, Hangzhou 310000, China.
| | - Qiaoling Hu
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou 310027, China.
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150
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Gender associated muscle-tendon adaptations to resistance training. PLoS One 2018; 13:e0197852. [PMID: 29787583 PMCID: PMC5963774 DOI: 10.1371/journal.pone.0197852] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 05/09/2018] [Indexed: 01/20/2023] Open
Abstract
Purpose To compare the relative changes in muscle-tendon complex (MTC) properties following high load resistance training (RT) in young males and females, and determine any link with circulating TGFβ-1 and IGF-I levels. Methods Twenty-eight participants were assigned to a training group and subdivided by sex (T males [TM] aged 20±1 year, n = 8, T females [TF] aged 19±3 year, n = 8), whilst age-matched 6 males and 6 females were assigned to control groups (ConM/F). The training groups completed 8 weeks of resistance training (RT). MTC properties (Vastus Lateralis, VL) physiological cross-sectional area (pCSA), quadriceps torque, patella tendon stiffness [K], Young’s modulus, volume, cross-sectional area, and length, circulating levels of TGFβ-1 and IGF-I were assessed at baseline and post RT. Results Post RT, there was a significant increase in the mechanical and morphological properties of the MTC in both training groups, compared to ConM/F (p<0.001). However, there were no significant sex-specific changes in most MTC variables. There were however significant sex differences in changes in K, with females exhibiting greater changes than males at lower MVC (Maximal Voluntary Contraction) force levels (10% p = 0.030 & 20% MVC p = 0.032) and the opposite effect seen at higher force levels (90% p = 0.040 & 100% MVC p = 0.044). There were significant increases (p<0.05) in IGF-I in both TF and TM following training, with no change in TGFβ-1. There were no gender differences (p>0.05) in IGF-I or TGFβ-1. Interestingly, pooled population data showed that TGFβ-1 correlated with K at baseline, with no correlations identified between IGF-I and MTC properties. Conclusions Greater resting TGFβ-1 levels are associated with superior tendon mechanical properties. RT can impact opposite ends of the patella tendon force-elongation relationship in each sex. Thus, different loading patterns may be needed to maximize resistance training adaptations in each sex.
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