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Ikeda K, Ogawa T, Ikumi A, Yoshii Y, Kohyama S, Ikeda R, Yamazaki M. Magnetic resonance imaging predicts outcomes of conservative treatment in patients with lateral epicondylitis. J Orthop Sci 2024; 29:795-801. [PMID: 37024365 DOI: 10.1016/j.jos.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/11/2023] [Accepted: 03/17/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND The clinical validity of positive magnetic resonance imaging findings in lateral epicondylitis is controversial. We hypothesized that magnetic resonance imaging could predict the outcome of conservative treatment. This study determined the relationship between magnetic resonance imaging-defined disease severity and treatment outcomes in patients with lateral epicondylitis. METHODS This retrospective single-cohort study included 43 conservatively managed and 50 surgically treated patients with lateral epicondylitis. The magnetic resonance imaging scores and clinical outcomes were examined six months post-treatment, and the former was compared between patients with good and poor treatment outcomes. We developed operating characteristic curves of magnetic resonance imaging scores for treatment outcomes, and divided patients into magnetic resonance imaging-mild and severe groups according to the obtained cut-off value of the scores. We compared the outcomes of conservative treatment with that of surgery for each magnetic resonance imaging severity. RESULTS Twenty-nine (67.4%) conservatively treated patients had good outcomes, while 14 (32.6%) had poor outcomes. The magnetic resonance imaging score was higher in patients with poor outcomes; the cut-off value was 6. Forty-three (86.0%) surgically treated patients had good outcomes, while 7 (14.0%) had poor outcomes. There was no significant difference in magnetic resonance imaging scores between patients with good and poor surgical outcomes. In the magnetic resonance imaging-mild group (score ≤ 5), the outcome showed no significant difference between the conservative and surgical treatment groups. In the magnetic resonance imaging-severe group (score≥6), the outcome of conservative treatment was significantly worse than that of surgical treatment. CONCLUSIONS The magnetic resonance imaging score was associated with conservative treatment outcomes. A treatment strategy that includes surgery should be considered for patients with severe magnetic resonance imaging findings; this is not recommended for those with mild magnetic resonance imaging findings. Magnetic resonance imaging is helpful in determining the best treatment strategies for patients with lateral epicondylitis. LEVEL OF EVIDENCE III, Retrospective cohort study.
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Affiliation(s)
- Kazuhiro Ikeda
- Department of Orthopedic Surgery, Kikkoman General Hospital, Noda-city, Chiba-Pref., Japan; Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba-city, Ibaraki-Pref., Japan
| | - Takeshi Ogawa
- Department of Orthopedic Surgery, Mito Medical Center, Ibaraki-town, Japan
| | - Akira Ikumi
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba-city, Ibaraki-Pref., Japan
| | - Yuichi Yoshii
- Department of Orthopedic Surgery, Tokyo Medical University Ibaraki Medical Center, Ami-town, Ibaraki-Pref., Japan.
| | - Sho Kohyama
- Department of Orthopedic Surgery, Kikkoman General Hospital, Noda-city, Chiba-Pref., Japan
| | - Reimi Ikeda
- Department of Orthopedic Surgery, Moriya Daiichi General Hospital, Moriya-city, Ibaraki-Pref., Japan
| | - Masashi Yamazaki
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba-city, Ibaraki-Pref., Japan
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Ikeda K, Yoshii Y, Kohyama S, Ikumi A, Ogawa T, Ikeda R, Yamazaki M. Pathophysiology of sex difference in refractoriness in lateral epicondylitis: Biomechanical study of wrist torque. J Orthop Res 2024; 42:277-285. [PMID: 37646413 DOI: 10.1002/jor.25684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/11/2023] [Accepted: 08/24/2023] [Indexed: 09/01/2023]
Abstract
Eccentric contractions of the wrist extensors worsen lateral epicondylitis (LE), whose pathophysiology may involve sex differences in wrist torque. This study aimed to investigate sex differences in wrist torque in patients with LE. The wrist extension and flexion torques of 22 patients with LE (11 males and 11 females) were measured. Maximum muscle output over time was measured for 20 s, initial torque was defined as muscle strength, and the degree of eccentric contraction was quantified and defined as the eccentric contraction index (ECI). The affected/unaffected side ratio of the wrist extensor, extensor/flexor ratio of muscle strength, and affected/unaffected side difference of ECI between sexes were statistically analyzed. Furthermore, correlations between wrist extensor torque, ECI, and Visual Analog Scale of pain during the examination were evaluated. Females were found to display lower affected/unaffected side ratios of the wrist extensor and wrist extension/flexion ratios for the affected side, compared with males; however, no differences were found in the wrist extension/flexion ratios for the unaffected side in both sexes. Additionally, females presented with larger differences between the affected and unaffected sides in the ECI. Based on correlations between wrist torques, ECI, and pain, females tended to suppress muscle output to prevent pain from eccentric contraction of wrist extensors more than males, which would induce an imbalance in muscle strength of the wrist extensors and flexors. This imbalance may result in chronic eccentric contraction of the wrist extensors with gripping, exacerbating LE.
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Affiliation(s)
- Kazuhiro Ikeda
- Department of Orthopedic Surgery, Kikkoman General Hospital, Noda City, Japan
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba City, Japan
| | - Yuichi Yoshii
- Department of Orthopedic Surgery, Tokyo Medical University Ibaraki Medical Center, Ami Town, Japan
| | - Sho Kohyama
- Department of Orthopedic Surgery, Kikkoman General Hospital, Noda City, Japan
| | - Akira Ikumi
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba City, Japan
| | - Takeshi Ogawa
- Department of Orthopedic Surgery, Mito Medical Center, Ibarakimachi, Japan
| | - Reimi Ikeda
- Department of Orthopedic Surgery, Moriya Daiichi General Hospital, Moriya City, Japan
| | - Masashi Yamazaki
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba City, Japan
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Suito H, Fujikawa K, Ohsako M. Eccentric contractions during downhill running induce Osgood‒Schlatter disease in the tibial tuberosity in rats: a focus on histological structures. Sci Rep 2023; 13:9863. [PMID: 37332037 PMCID: PMC10277288 DOI: 10.1038/s41598-023-36914-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 06/12/2023] [Indexed: 06/20/2023] Open
Abstract
Osgood-Schlatter disease (OSD), a condition that affects adolescents, causes inflammation, pain, and prominence at the tibial tuberosity. The causes of OSD are not well understood, but eccentric contractions in the quadriceps have been suggested as a possible factor. To investigate this, a study was conducted in which 24 rats were divided into two groups: the downhill treadmill running (DR) group and the control (CO) group. The DR group underwent a preliminary running program for 1 week, followed by a main running program for 3 weeks. The results showed that the deep region of the tibial tuberosity in the DR group was larger than that in the CO group, and inflammatory cytokines involved in gene expression were upregulated in the DR group. The anterior articular cartilage and deep region in the DR group were also immunoreactive to substance P. Additionally, high-activity chondrocytes of small size were observed in the non-calcified matrix. Thus, the DR group exhibited symptoms similar to OSD, including inflammation, pain, and prominence. These findings suggest that eccentric contractions in the quadriceps may play a role in the development of OSD. Further research is needed to better understand the pathophysiology of this condition and develop effective treatment options.
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Affiliation(s)
- Hirai Suito
- Graduate School of Human Life Design, Toyo University, 1-7-11 Akabanedai, Kita-Ku 115-8650, Tokyo, Japan.
- Japan Society for the Promotion of Science Research Fellowships DC, Tokyo, Japan.
| | - Kaoru Fujikawa
- Department of Oral Anatomy and Developmental Biology, Showa University School of Density, Tokyo, Japan
| | - Masafumi Ohsako
- Graduate School of Health and Sports Science, Toyo University, Tokyo, Japan
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Ozone K, Minegishi Y, Oka Y, Sato M, Kanemura N. The Effects of Downhill Running and Maturation on Histological and Morphological Properties of Tendon and Enthesis in Mice. BIOLOGY 2023; 12:biology12030456. [PMID: 36979148 PMCID: PMC10045940 DOI: 10.3390/biology12030456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 03/17/2023]
Abstract
To date, it remains unclear how overuse affects the tendons and entheses at different stages of maturation. Therefore, we evaluated histological and morphological changes in the tendons and entheses in adolescent (4-week-old) and adult mice (8-week-old) by performing flat-land and downhill running exercises. The mice were divided into the Sedentary, High Flat (flat-land high-speed running; concentric-contraction exercise), Low Down (downhill low-speed running; eccentric-contraction exercise), and High Down (downhill high-speed running; eccentric-contraction exercise) groups. Histological changes and inflammatory factor expressions were compared in the entheses and tendons after 4 weeks of exercise. Downhill, but not flat-land high-speed running, induced muscle–tendon complex hypertrophy in both adolescent and adult mice. Histological enthesis changes were induced in both groups during downhill running but were less pronounced in adult mice. Conversely, no significant cell aggregation or fiber orientation changes were observed in the tendon, but increased inflammatory factors were observed in both groups, with significantly higher expression in the tendons of adult mice. Downhill running induced histological and morphological enthesis changes and inflammatory factor increase in the tendons, regardless of running speed variations. These results may help elucidate the pathogenesis of enthesopathy and tendinopathy, which have different pathophysiologies despite having the same pathogenetic factors.
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Affiliation(s)
- Kaichi Ozone
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Koshigaya 343-8540, Japan; (K.O.)
- Department of Rehabilitation, University of Tsukuba Hospital, Tsukuba 305-8576, Japan
| | - Yuki Minegishi
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Koshigaya 343-8540, Japan; (K.O.)
- Japan Society for the Promotion of Science, Tokyo 102-0083, Japan
| | - Yuichiro Oka
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Koshigaya 343-8540, Japan; (K.O.)
| | - Michiaki Sato
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Koshigaya 343-8540, Japan; (K.O.)
| | - Naohiko Kanemura
- Department of Physical Therapy, Health and Social Services, Saitama Prefectural University, Koshigaya 343-8540, Japan
- Correspondence: ; Tel.: +81-48-971-0500
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Ozone K, Minegishi Y, Takahata K, Takahashi H, Yoneno M, Hattori S, Xianglan L, Oka Y, Murata K, Kanemura N. Eccentric contraction-dominant exercise leads to molecular biological changes in enthesis and enthesopathy-like morphological changes. J Orthop Res 2023; 41:511-523. [PMID: 35716158 DOI: 10.1002/jor.25399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 06/02/2022] [Accepted: 06/15/2022] [Indexed: 02/04/2023]
Abstract
Entheses, which are tendon-to-bone attachment sites in the musculoskeletal system, play important roles in optimizing the mechanical stress and force transmitted from the muscle to the bone. Sports-related enthesopathy shows pathological features, including hyperplasia of the fibrocartilage (FC) region in the enthesis. The amount of exercise and type of muscle contraction during movement is involved in the pathogenesis of sports-related enthesopathy; however, the details of this condition are unclear. Here we examined the molecular pathways involved in the morphological changes of the muscle-tendon-enthesis complex and enthesis FC region in the supraspinatus muscle enthesis of mice under different exercise conditions. Following intervention, morphological changes in the muscle-tendon-enthesis complex were initiated in the eccentric contraction-dominant exercise group at 2 weeks, with activation of the transforming growth factor-β (TGFβ) superfamily pathway predicted by proteome and ingenuity pathway analyses. Histological and molecular biological analyses confirmed the activation of the TGFβ/bone morphogenetic protein (BMP)-Smad pathway. The concentric contraction-dominant exercise group showed no change in the morphology of the muscle-tendon-enthesis complex or activation of the TGFβ/BMP-Smad pathway, despite overuse exercise. Statement of Clinical Significance: These results suggest that eccentric contraction-dominant exercise induces sports-related enthesopathy-like morphological changes in the early stages as well as molecular biological changes, mainly in the transforming growth factor-β superfamily pathway in enthesis. Statement of Clinical Significance: These results suggest that eccentric contraction-dominant exercise induces sports-related enthesopathy-like morphological changes in the early stages as well as molecular biological changes, mainly in the transforming growth factor-β superfamily pathway in enthesis.
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Affiliation(s)
- Kaichi Ozone
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Koshigaya, Saitama, Japan.,Japan Society for the Promotion of Science, Tokyo, Japan
| | - Yuki Minegishi
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Koshigaya, Saitama, Japan.,Japan Society for the Promotion of Science, Tokyo, Japan
| | - Kei Takahata
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Koshigaya, Saitama, Japan
| | - Haruna Takahashi
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Koshigaya, Saitama, Japan
| | - Moe Yoneno
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Koshigaya, Saitama, Japan
| | - Shinya Hattori
- Nanotechnology Innovation Station, National Institute for Materials Science, Tsukuba, Japan
| | - Li Xianglan
- Nanotechnology Innovation Station, National Institute for Materials Science, Tsukuba, Japan
| | - Yuichiro Oka
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Koshigaya, Saitama, Japan
| | - Kenji Murata
- Department of Physical Therapy, Health and Social Services, Saitama Prefectural University, Koshigaya, Saitama, Japan
| | - Naohiko Kanemura
- Department of Physical Therapy, Health and Social Services, Saitama Prefectural University, Koshigaya, Saitama, Japan
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Ikeda K, Yoshii Y, Kohyama S, Ikumi A, Ikeda R, Yamazaki M. Sex differences in wrist torque and endurance-Biomechanical factors associated with developing lateral epicondylitis of the humerus. J Orthop Res 2022. [PMID: 36573481 DOI: 10.1002/jor.25506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 11/10/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022]
Abstract
Since eccentric contractions contribute to the development of tendinopathy, sex differences in wrist torque and endurance may be involved in the pathophysiology of lateral epicondylitis and its refractoriness. Therefore, the present study investigated sex differences in wrist torque and endurance. The wrist extension and flexion torques of the 100 wrists of 25 males and 25 females were measured. The following parameters were assessed: muscle strength at the starting- and end point for the measurement, Δ muscle strength, that is, the amount of a loss over time, and the muscle endurance ratio, that is, the decrease rate over time. Each parameter in males and females was statistically analyzed. In wrist extension, muscle strength at the starting point was 6.1 Nm for males and 3.3 Nm for females (p < 0.001); Δ Muscle strength was -0.052 Nm/s for males and -0.038 Nm/s for females (p = 0.036); The muscle endurance ratio was 99.1%/s for males and 98.8%/s for females (p = 0.015). In wrist flexion, muscle strength at the starting point and absolute value of Δ muscle strength were significantly larger in males than in females; No significant difference was observed in the muscle endurance ratio in wrist flexion between males and females. These results revealed sex differences in wrist torque and endurance. The muscle endurance ratio of the wrist extensors was lower in females than in males, which suggests that females need to exert more effort to maintain the wrist extension position under resistance. This may predispose the wrist extensor muscles in females to eccentric contractions.
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Affiliation(s)
- Kazuhiro Ikeda
- Department of Orthopedic Surgery, Kikkoman General Hospital, Noda, Chiba Prefecture, Japan.,Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki Prefecture, Japan
| | - Yuichi Yoshii
- Department of Orthopedic Surgery, Tokyo Medical University Ibaraki Medical Center, Inashiki, Ibaraki Prefecture, Japan
| | - Sho Kohyama
- Department of Orthopedic Surgery, Kikkoman General Hospital, Noda, Chiba Prefecture, Japan
| | - Akira Ikumi
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki Prefecture, Japan
| | - Reimi Ikeda
- Department of Orthopedic Surgery, Moriya Daiichi General Hospital, Moriya, Ibaraki Prefecture, Japan
| | - Masashi Yamazaki
- Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki Prefecture, Japan
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