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Clinical Efficacy of Glucosamine plus Sodium Hyaluronate for Osteoporosis Complicated by Knee Osteoarthritis and Its Influence on Joint Function and Bone Metabolic Markers. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:6078254. [PMID: 36081430 PMCID: PMC9448530 DOI: 10.1155/2022/6078254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/27/2022] [Accepted: 08/06/2022] [Indexed: 11/17/2022]
Abstract
Background. Osteoporosis (OP) associated with knee osteoarthritis (KOA) is common in older men and postmenopausal women, and it is important to find reliable and effective treatments for this disease to improve joint function and bone metabolism in this population. Objective. To clarify the clinical efficacy of glucosamine (GlcN) plus sodium hyaluronate (SH) for OP complicated by KOA (OP + KOA) and its influence on joint function and bone metabolic markers (BMMs). Methods. Admitted from July 2019 to July 2021, 126 patients with OP + KOA were selected, including 76 cases (observation group) treated with GlcN plus SH and 50 cases (control group) given GlcN alone. The pain, joint function, BMMs, and clinical efficacy were evaluated and compared. Pain and joint function assessments employed the Visual Analogue Scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) plus Lysholm Knee Scoring Scale, respectively. BMMs mainly measured bone gla protein (BGP), serum tartrate-resistant acid phosphatase variant (TRACP)-5b, type I collagen cross-linked C-telopeptide (CTX-1), and bone-specific alkaline phosphatase (BALP). Results. Higher posttreatment VAS scores were determined in observation group as compared to control group; observation group showed lower WOMAC scores of joint function and higher Lysholm scores than control group; in terms of BMMs, TRACP-5b and CTX-1 were lower while BGP and BALP were higher in observation group; the curative effect was also higher in observation group. All the above differences were statistically significant. Conclusions. GlcN plus SH has definite clinical efficacy in the treatment of OP + KOA, which can not only significantly improve patients’ joint function and bone metabolism but also relieve pain, with high clinical popularization value.
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The Impact of Hyaluronic Acid on Tendon Physiology and Its Clinical Application in Tendinopathies. Cells 2021; 10:cells10113081. [PMID: 34831304 PMCID: PMC8625461 DOI: 10.3390/cells10113081] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/01/2021] [Accepted: 11/05/2021] [Indexed: 01/17/2023] Open
Abstract
The physical-chemical, structural, hydrodynamic, and biological properties of hyaluronic acid within tendons are still poorly investigated. Medical history and clinical applications of hyaluronic acid for tendinopathies are still debated. In general, the properties of hyaluronic acid depend on several factors including molecular weight. Several preclinical and clinical experiences show a good efficacy and safety profile of hyaluronic acid, despite the absence of consensus in the literature regarding the classification according to molecular weight. In in vitro and preclinical studies, hyaluronic acid has shown physical-chemical properties, such as biocompatibility, mucoadhesivity, hygroscopicity, and viscoelasticity, useful to contribute to tendon healing. Additionally, in clinical studies, hyaluronic acid has been used with promising results in different tendinopathies. In this narrative review, findings encourage the clinical application of HA in tendinopathies such as rotator cuff, epicondylitis, Achilles, and patellar tendinopathy.
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Crimaldi S, Liguori S, Tamburrino P, Moretti A, Paoletta M, Toro G, Iolascon G. The Role of Hyaluronic Acid in Sport-Related Tendinopathies: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57101088. [PMID: 34684125 PMCID: PMC8537182 DOI: 10.3390/medicina57101088] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/20/2021] [Accepted: 10/04/2021] [Indexed: 02/05/2023]
Abstract
Tendinopathy is a complex clinical condition with a rising incidence and prevalence, particularly during sports practice. For the return to play in affected patients, adequate functional and structural recovery of the tendon is the ultimate goal, avoiding the high risk of recurrence. In this perspective, local therapies alongside exercise are showing promising results. Despite evidence suggesting hyaluronic acid (HA) injections as effective in the treatment of tendinopathy, current recommendations about the management of this condition do not include this intervention. HA seems to be an effective therapeutic option for the management of sport-related tendinopathies, but further studies with a larger sample size are needed to confirm available findings. In this narrative review, we analyzed available literature about the rationale of the use of HA in the management of tendon injury and, particularly, in sport-related tendinopathies.
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Affiliation(s)
- Sergio Crimaldi
- Humanitas Clinical and Research Center—IRCCS, 20900 Milan, Italy;
| | - Sara Liguori
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 80100 Naples, Italy; (A.M.); (M.P.); (G.T.); (G.I.)
- Correspondence: ; Tel.: +39-081-566-5537
| | - Pasquale Tamburrino
- Azienda USL Frosinone—UOC Ortopedia e Traumatologia, 03100 Frosinone, Italy;
| | - Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 80100 Naples, Italy; (A.M.); (M.P.); (G.T.); (G.I.)
| | - Marco Paoletta
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 80100 Naples, Italy; (A.M.); (M.P.); (G.T.); (G.I.)
| | - Giuseppe Toro
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 80100 Naples, Italy; (A.M.); (M.P.); (G.T.); (G.I.)
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 80100 Naples, Italy; (A.M.); (M.P.); (G.T.); (G.I.)
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You T, Yuan S, Bai L, Zhang X, Chen P, Zhang W. Benzyl alcohol accelerates recovery from Achilles tendon injury, potentially via TGF-β1/Smad2/3 pathway. Injury 2020; 51:1515-1521. [PMID: 32409188 DOI: 10.1016/j.injury.2020.03.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 02/21/2020] [Accepted: 03/29/2020] [Indexed: 02/02/2023]
Abstract
Benzyl alcohol (BnOH) is a natural colorless liquid organic compound that plays an important role in bacteriostatic and anesthetic processes. It is also used to relieve the nerve and ganglionic pain. In this study, we assessed the effect of topical application of BnOH on the Achilles tendon healing process. Sprague Dawley rats were subjected to an experimentally induced wound in the tendon area and then randomized into four groups. Normal saline (0.5 mL) was applied to rats in control group, and BnOH at the concentrations of 0.5 mL 0.075%, 0.15%, 0.3% were applied to the BnOH treatment groups, respectively. Wound treatment with BnOH led to significantly faster functional recovery than with saline. Moreover, treatment of wounds with 0.3% BnOH accelerated the healing process faster than with 0.075% and 0.15% BnOH. Histological analysis of healed wounds that had been treated with BnOH showed more collagen and blood capillaries and fewer inflammatory cells compared to the control. To study the mechanism of the process, the expression of mRNA of TGF-β1, Smad2/3 and Smad7 and protein of TGF-β1, p-Smad2/3 and Smad7 were quantified by real-time PCR and Western blotting, respectively. Results of this study showed that wounds treated with BnOH significantly enhanced the expression of TGF-β1 and Smad2/3 and reduced the expression of Smad7. In general, the current study demonstrated that BnOH improved the recovery process of tendon healing through the promotion of collagen with angiogenesis and showed that TGF-β plays a role in BnOH treatment of tendon healing.
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Affiliation(s)
- Tian You
- Sports Medicine Department, Peking University Shenzhen Hospital, 1120th, Lianhua Road, Futian District Shenzhen 518000, Guangdong, China
| | - Shufang Yuan
- Ultrasonic imaging Department, Peking University Shenzhen Hospital, Shenzhen 518000, Guangdong, China
| | - Lu Bai
- Sports Medicine Department, Peking University Shenzhen Hospital, 1120th, Lianhua Road, Futian District Shenzhen 518000, Guangdong, China
| | - Xintao Zhang
- Sports Medicine Department, Peking University Shenzhen Hospital, 1120th, Lianhua Road, Futian District Shenzhen 518000, Guangdong, China
| | - Peng Chen
- Sports Medicine Department, Peking University Shenzhen Hospital, 1120th, Lianhua Road, Futian District Shenzhen 518000, Guangdong, China
| | - Wentao Zhang
- Sports Medicine Department, Peking University Shenzhen Hospital, 1120th, Lianhua Road, Futian District Shenzhen 518000, Guangdong, China
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Flores C, Balius R, Álvarez G, Buil MA, Varela L, Cano C, Casariego J. Efficacy and Tolerability of Peritendinous Hyaluronic Acid in Patients with Supraspinatus Tendinopathy: a Multicenter, Randomized, Controlled Trial. SPORTS MEDICINE-OPEN 2017; 3:22. [PMID: 28585109 PMCID: PMC5459785 DOI: 10.1186/s40798-017-0089-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 05/25/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Physical therapy and peritendinous hyaluronic acid (HA) injections have both shown promising results in the treatment of shoulder tendinopathies. However, the superiority of treatment combining physical therapy and HA is unclear. METHODS Patients with ultrasound-confirmed supraspinatus tendinopathy were randomized to receive either physical therapy + subacromial HA injections or physical therapy only. Treatment efficacy was assessed using a Visual Analog Scale (VAS) for pain and an Activities of Daily Living (ADL) scale. Other measures were the number of rehabilitation sessions and days needed for recovery, the Tampa Scale for Kinesiophobia (TSK), and the physician and patient's perception of efficacy and tolerability. Patients were followed up for 90 days. RESULTS Overall, VAS and ADL scores showed a progressive decrease during the follow-up (P < 0.01 at all visits for both groups), without significant differences between groups. The TSK score decreased significantly more in the HA group than in the control group (3.6 vs. 2.4; P < 0.001). Patients in the control group needed more rehabilitation sessions (28 vs. 22 in the HA group; P = 0.006) and more days for returning to their pre-injury activity (32 vs. 20 in the HA group; P = 0.013). Both patients and investigators perceived higher efficacy in the HA group than in the control group (P = 0.034). Both treatments were safe and well tolerated. CONCLUSIONS Subacromial HA injections combined with physical therapy have high efficacy in the treatment of supraspinatus tendinopathy, leading to an earlier return to pre-injury activity and the need for fewer rehabilitation sessions, which may benefit both patients and the healthcare system.
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Affiliation(s)
- César Flores
- Department of Orthopaedic Surgery and Sports Medicine, Clínica CEMTRO, Madrid, Spain
| | - Ramón Balius
- Department of Sports Medicine, Centre d'Estudis d'Alt Rendiment Esportiu (CEARE), Consell Català de l'Esport, Barcelona, Spain
| | - Guillermo Álvarez
- Department of Sports Medicine, AMS - Centro Médico del Ejercicio, Málaga, Spain
| | - Miguel A Buil
- Department of Sports Medicine, IVRE-Institut Valencià de Recuperació Esportiva, Valencia, Spain
| | - Luisa Varela
- Department of Clinical Research, OPKO Health Europe, Plaza Europa, 13-15, Hospitalet de Llobregat, 08908, Barcelona, Spain.
| | - Carlos Cano
- Department of Physical Therapy, AMS-Centro Médico del Ejercicio, Málaga, Spain
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The Effect of Sodium Hyaluronate on Ligamentation and Biomechanical Property of Tendon in Repair of Achilles Tendon Defect with Polyethylene Terephthalate Artificial Ligament: A Rabbit Tendon Repair Model. BIOMED RESEARCH INTERNATIONAL 2016; 2016:8684231. [PMID: 28105436 PMCID: PMC5220448 DOI: 10.1155/2016/8684231] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 10/16/2016] [Accepted: 11/01/2016] [Indexed: 01/13/2023]
Abstract
The Achilles tendon is the most common ruptured tendon of human body. Reconstruction with polyethylene terephthalate (PET) artificial ligament is recommended in some serious cases. Sodium hyaluronate (HA) is beneficial for the healing of tendon injuries. We aimed to determine the effect of sodium hyaluronate in repair of Achilles tendon defect with PET artificial ligament in an animal tendon repair model. Sixteen New Zealand White rabbits were divided into two groups. Eight rabbits repaired with PET were assigned to PET group; the other eight rabbits repaired with PET along with injection of HE were assigned to HA-PET group. All rabbits were sacrificed at 4 and 8 weeks postoperatively for biomechanical and histological examination. The HA-PET group revealed higher biomechanical property compared with the PET group. Histologically, more collagen tissues grew into the HA-PET group compared with PET group. In conclusion, application of sodium hyaluronate can improve the healing of Achilles tendon reconstruction with polyethylene terephthalate artificial ligament.
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Seo YK, Kim JH, Eo SR. Co-effect of silk and amniotic membrane for tendon repair. JOURNAL OF BIOMATERIALS SCIENCE-POLYMER EDITION 2016; 27:1232-47. [PMID: 27188627 DOI: 10.1080/09205063.2016.1188349] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The objective of the present study was to determine the feasibility and biocompatibility of a silk scaffold and a composite silk scaffold in terms of new tendon generation using a rabbit Achilles tendon model. The silk scaffold was constructed using a weaving machine, then soaked in a 1% collagen-hyaluronan (HA) solution and air-dried, whereas the composite silk scaffold was composed of a silk scaffold containing a lyophilized collagen-HA substrate. Tenocytes were cultured in vitro to compare cell populations in the two groups. The cellular densities on composite silk scaffolds were 40% higher on average than those on silk scaffolds in 30-day tenocyte cultures. The tendon scaffolds had implanted into Achilles tendon defects in 16 white New Zealand rabbits. Rabbits were randomly divided into the following three groups: group I, silk scaffold alone; group II, composite silk scaffold; and group III, composite silk scaffold wrapped by an amniotic membrane. Implants were harvested 2, 8, and 12 weeks post-implantation. Histological examinations were conducted using hematoxylin-eosin (H&E), Masson's trichrome, and by performing immunohistochemical staining for CD34. After 12 weeks, the three groups were distinguishable based on gross examination. The histological examination revealed more organized collagen fibrils in groups III, which showed a dense, parallel, linear organization of collagen bundles. CD34 staining revealed neoangiogenesis in groups III. The results of this research showed that collagen-HA substrates with amniotic membrane accelerate cellular migration and angiogenesis in neotendons.
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Affiliation(s)
- Young-Kwon Seo
- a Department of Medical Biotechnology , Dongguk University , Seoul , Korea
| | - Jun-Hyung Kim
- a Department of Medical Biotechnology , Dongguk University , Seoul , Korea
| | - Su-Rak Eo
- b Department of Plastic and Reconstructive Surgery, Dongguk University Medical Center , Dongguk University Graduate School of Medicine , Seoul , Korea
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Şen B, Güler S, Çeçen B, Kumtepe E, Bağrıyanık A, Özkal S, Ali Özcan M, Özsan H, Şanlı N, Tatari MH. The Effect of Autologous Platelet Rich Plasma in the Treatment of Achilles Tendon Ruptures: An Experimental Study on Rabbits. Balkan Med J 2016; 33:94-101. [PMID: 26966624 DOI: 10.5152/balkanmedj.2015.15549] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 06/03/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Achilles tendon ruptures are characterized by a long recovery period, high re-rupture rate and late return to work. To overcome these difficulties and augment tendon repair, many agents have been used. AIMS To determine the effect of autologous platelet rich plasma (PRP) in the treatment of Achilles tendon ruptures in rabbits. STUDY DESIGN Animal experimentation. METHODS The study included 14 New Zealand albino rabbits that were divided randomly into 2 groups, A and B, each containing seven rabbits. On day zero, all 28 Achilles tendons were tenotomized and repaired. In group A, the tendons were injected with PRP post-surgery, whereas those in group B were left untreated. On day 28, the right tendons in both groups were examined histopathologically via both light and electron microscopy, and the left tendons were subjected to biomechanical testing. RESULTS The histological and biomechanical findings in both light and electron microscopy in group A were better than those in group B, but the difference was not significant. According to Tang's scale, the mean value in Group A was 3.57, while it was 3.0 in Group B. The mean value of Group A for the length of collagen bands was 48.09 nm while the mean value of Group B was 46.58 nm (p=0.406). In biomechanical tests, although stiffness values were higher in group A, the difference between groups was not significant. In addition, maximum load values did not differ between groups A and B. CONCLUSION PRP had no effect on the healing process 28 days post-Achilles tendon rupture.
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Affiliation(s)
- Baran Şen
- Department of Orthopaedics and Traumatology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Serkan Güler
- Department of Orthopaedics and Traumatology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Berivan Çeçen
- Department of Biomechanics, Dokuz Eylül University Institute of Health Science, İzmir, Turkey
| | - Erdem Kumtepe
- Department of Biomechanics, Dokuz Eylül University Institute of Health Science, İzmir, Turkey
| | - Alper Bağrıyanık
- Department of Histology and Embriology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Sermin Özkal
- Department of Pathology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - M Ali Özcan
- Department of Hematology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Hayri Özsan
- Department of Hematology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Namık Şanlı
- Department of Hematology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - M Hasan Tatari
- Department of Orthopaedics and Traumatology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
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Osti L, Buda M, Buono AD, Osti R, Massari L. Clinical evidence in the treatment of rotator cuff tears with hyaluronic acid. Muscles Ligaments Tendons J 2016; 5:270-5. [PMID: 26958534 DOI: 10.11138/mltj/2015.5.4.270] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE the aim of this quantitative review is to document potential benefit and adverse effects of hyaluronic acid (HA) injection into the shoulder with rotator cuff tears. METHODS a systematic literature search was performed in english PubMed, Medline, Ovid, Google Scholar and Embase databases using the combined key words "hyaluronic acid", "rotator cuff tear", "hyaluronate", "shoulder", "viscosupplementation", with no limit regarding the year of publication. Articles were included if they reported data on clinical and functional outcomes, complications in series of patients who had undergone HA injection for management of rotator cuff tears. Two Authors screened the selected articles for title, abstract and full text in accordance with predefined inclusion and exclusion criteria. The papers were accurately analyzed focusing on objective rating scores reported. RESULTS a total of 11 studies, prospective, 7 were randomized were included by full text. A total of 1102 patients were evaluated clinically after different HA injection compare with corticosteroid injection, physically therapies, saline solution injection and control groups. The use of HA in patients with rotator cuff tears improve VAS and functional score in all trials that we have analyzed. CONCLUSION intra-articular injection with HA is effective in reducing pain and improving function in shoulder with rotator cuff tears and without severe adverse reaction. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- Leonardo Osti
- Unit of Arthroscopy and Sports Medicine, Hesperia Hospital, Modena, Italy
| | - Matteo Buda
- Department of Orthopaedic and Traumatology, University of Ferrara, Italy
| | - Angelo Del Buono
- Department of Orthopaedic and Trauma Surgery Hospital Sant'Anna, Como, Italy
| | - Raffaella Osti
- Department of Orthopaedic and Traumatology, University of Ferrara, Italy
| | - Leo Massari
- Department of Orthopaedic and Traumatology, University of Ferrara, Italy
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Drakonaki EE, Allen GM, Watura R. Ultrasound-guided intervention in the ankle and foot. Br J Radiol 2015; 89:20150577. [PMID: 26537692 DOI: 10.1259/bjr.20150577] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
In this comprehensive review, we discuss the main interventions performed in the foot and ankle for Achilles tendinopathy, Morton's neuromas and Plantar fasciitis as well as techniques for intra-articular and peritendinous injections. We present the different imaging techniques and injectable agents that can be used in clinical practice, trying to help the reader decide the most appropriate way of managing the patient with a problem in the ankle and foot.
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Affiliation(s)
| | - Gina M Allen
- 2 Department of Radiology, Oxford University Hospitals NHS Trust and St Lukes Radiology, Oxford, UK
| | - Roland Watura
- 3 Department of Radiology, North Bristol NHS Trust, Bristol, UK
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The paratendineous tissues: an anatomical study of their role in the pathogenesis of tendinopathy. Surg Radiol Anat 2013; 36:561-72. [PMID: 24318515 DOI: 10.1007/s00276-013-1244-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 11/21/2013] [Indexed: 10/25/2022]
Abstract
The aim of this paper was to examine the macroscopic and microscopic characteristics of the paratendineous tissues (paratenon, epitenon and endotenon) of the calcaneal tendon to better understand their role in the pathogenesis of "tendinopathy". Ten non-embalmed legs from cadavers were used. Histological and immunohistochemical studies were done at the middle third of the tendon. Magnetic resonance images of the hind foot were made in 60 living subjects to analyze the morphological alterations of tendon and paratenon. The paratenon is a thick fibrous layer with few elastic fibers, continuous with the crural fascia, well vascularized and innervated. It forms a sheath around the tendon similar to a synovial layer, but less organized. Indeed, it has no complete epithelium, but only some cells producing hyaluronan, called fasciacytes. Crural fascia and paratenon can be clearly observed by MRI, appearing as homogeneous, low signal intensity bands, sharply defined in the context of subcutaneous tissue in T1-weighted sequences. The mean thickness of the crural fascia was 1.11 mm in healthy subjects and 1.30 mm in patients (p < 0.005). The mean value of paratenon thickness in patients was 1.34 mm, 0.85 in healthy (p < 0.0001). The paratenon is more highly vascularized and innervated than the tendon, supporting the hypothesis that it is the origin of pain in tendinopathy. The imaging study suggests that, an increase in the thickness of the paratenon more than 1.35 mm is predictive of paratendinopathy, even before tendon damage.
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Lee JH, Jeong BO. The effect of hyaluronate-carboxymethyl cellulose on bone graft substitute healing in a rat spinal fusion model. J Korean Neurosurg Soc 2011; 50:409-14. [PMID: 22259686 DOI: 10.3340/jkns.2011.50.5.409] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Revised: 07/26/2011] [Accepted: 11/14/2011] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the impact of sodium hyaluronate-sodium carboxymethyl cellulose (HA-CMC), an anti-adhesive material for spinal surgery, on bone fusion by applying it to rat spinal models after lumbar posterolateral fusion. METHODS Lumbar posterolateral fusion was performed at L4-5 using bone graft substitutes in 30 rats. HA-CMC was injected in 15 rats at a dose of 0.2 cc (HA-CMC group) and a saline solution of 0.2 cc in the other 15 rats (control group). Simple radiographs were taken until postoperative 9 weeks with an interval of one week. At postoperative 4 and 9 weeks, three dimensional computed tomography (3D CT) scanning was performed to observe the process of bone fusion. At 9 weeks, bone fusion was confirmed by gross examination and manual palpation. RESULTS There were no statistically significant differences in bone fusion between the two groups. 3D CT scanning did not reveal significant differences between the groups. The gross examination and manual palpation after autopsy performed at 9 weeks confirmed bone union in 93.3% of both groups. CONCLUSION The anti-adhesive material used for spinal surgery did not have adverse effects on spinal fusion in rats.
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Affiliation(s)
- Jung Hee Lee
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
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13
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Seo YK, Park JK, Song KY, Kwon SY, Lee HS. Wound healing effect of collagen-hyaluronic acid implanted in partially injured anterior cruciate ligament of dog. BIOTECHNOL BIOPROC E 2010. [DOI: 10.1007/s12257-009-3082-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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14
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Adhesion, proliferation, and gene expression profile of human umbilical vein endothelial cells cultured on bilayered polyelectrolyte coatings composed of glycosaminoglycans. Biointerphases 2010; 5:FA53-62. [DOI: 10.1116/1.3483218] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Peng H, Zhou JL, Liu SQ, Hu QJ, Ming JH, Qiu B. Hyaluronic acid inhibits nitric oxide-induced apoptosis and dedifferentiation of articular chondrocytes in vitro. Inflamm Res 2010; 59:519-30. [PMID: 20077126 DOI: 10.1007/s00011-010-0156-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Revised: 12/27/2009] [Accepted: 01/04/2010] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Nitric oxide is an important mediator in Osteoarthritis (OA), and causes apoptosis and dedifferentiation in articular chondrocytes. Protein kinase Calpha is involved in modulating apoptosis and dedifferentiation of articular chondrocytes induced by nitric oxide. Hyaluronic acid is widely used in the treatment of osteoarthritis and exerts significant chondroprotective effects. The exact mechanisms of its chondroprotective action are not yet fully elucidated. The present study was performed to investigate the effects and mechanisms of hyaluronic acid in NO-induced apoptosis and dedifferentiation of chondrocytes. METHODS The ratio of apoptotic cell and cell viability was surveyed by TUNEL, MTT assay and flow cytometry. The expression of aggrecan, type II collagen, and PKCalpha were determined by real-time PCR and Western blot. The expression changes of caspase-3 and bcl-2 was detected by Western blot. The mitochondrial membrane potential (DeltaPsim) was evaluated by Rhodamine-123 fluorescence. RESULTS HA reduces the TUNEL positive cell, nuclei fragment and the impairment of DeltaPsim. NO-induced chondrocyte dedifferentiation was blocked by HA, which restores expression of aggrecan and type II collagen of chondrocytes and cell viability. HA can block inhibition of PKC-alpha by NO. CONCLUSION Our results show that HA blocks NO-induced apoptosis and dedifferentiation of articular chondrocytes by modulation of DeltaPsim and PKCalpha.
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Affiliation(s)
- Hao Peng
- Department of Orthopedics, Renmin Hospital of Wuhan University, Hubei, People's Republic of China
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Coban I, Satoğlu IS, Gültekin A, Tuna B, Tatari H, Fidan M. Effects of human amniotic fluid and membrane in the treatment of Achilles tendon ruptures in locally corticosteroid-induced Achilles tendinosis: an experimental study on rats. Foot Ankle Surg 2009; 15:22-7. [PMID: 19218061 DOI: 10.1016/j.fas.2008.06.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Revised: 06/03/2008] [Accepted: 06/11/2008] [Indexed: 02/04/2023]
Abstract
BACKGROUND To determine the effects of human amniotic fluid and membrane in the treatment of Achilles tendon ruptures, 72 tendons of 36 Wistar rats were injected with betamethasone sodium phosphate. METHODS By the end of fourth week, both tendons were tenotomized and repaired, then the samples were divided into three groups. The first group was left untreated after suturing. Human amniotic fluid was injected to the second and amniotic fluid and membrane were both administered to the third group. Twenty-four tendons were scored at the end of the first week, and 24 at the end of the second week histopathologically, and 24 biomechanically at the end of the third week. RESULTS There was a significant statistical difference only between the histopathological results of Groups 2 and 3 at the first week. CONCLUSIONS Human amniotic membrane and fluid do not add anything to the healing process of Achilles tendon ruptures in the early phase.
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Affiliation(s)
- Ibrahim Coban
- Dokuz Eylül University, School of Medicine, Department of Orthopaedics and Traumatology, Izmir, Turkey
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Effects of hyaluronan on vascular endothelial growth factor and receptor-2 expression in a rabbit osteoarthritis model. J Orthop Sci 2009; 14:313-9. [PMID: 19499299 DOI: 10.1007/s00776-009-1329-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2008] [Accepted: 01/22/2009] [Indexed: 01/19/2023]
Abstract
BACKGROUND Little is known about the expression of vascular endothelial growth factor (VEGF) and its receptor-2 (VEGFR-2) mRNA in the cartilage of a rabbit osteoarthritis model or the influence of intraarticular injection of hyaluronan (HA) on the expression of VEGF and VEGFR-2 in cartilage during the process of osteoarthritis (OA). The therapeutic mechanism of HA is not completely understood, and we hypothesize that the mechanism is through the effects of VEGF and VEGFR2. In this study, we determined the VEGF and VEGFR-2 mRNA expression in a rabbit OA model and assessed the therapeutic mechanism of HA against OA. METHODS We carried out this study at the Center Laboratory of Renmin Hospital at Wuhan University and the Key Laboratory of Respiratory Disease of the Ministry of Public Health, Huazhong University of Science and Technology. Between October 2006 and April 2008 a total of 24 mature New Zealand white rabbits were divided into three groups: normal controls, a no-HA group, and an HA group. The no-HA and HA groups underwent unilateral anterior cruciate ligament transection. At 4 weeks after the operation, animals in the HA group received intraarticular injections of 1% sodium hyaluronate (HA) once a week for 5 weeks as per the clinical treatment presently utilized. The no-HA rabbits were not given HA. At death, 11 weeks following surgery, cartilage was harvested and total RNA was extracted. VEGF and VEGFR mRNAs were analyzed using the reverse transcription-polymerase chain reaction (RT-PCR) and real-time PCR for each group. RESULTS Cartilage damage (both extent and grade) was less severe in the HA group than in the no-HA group. VEGF and VEGFR-2 mRNA expression was enhanced in the cartilage of the OA model. Intraarticular 1% sodium hyaluronate injection inhibited VEGFR-2 expression but had no effect on reducing the VEGF mRNA expression in cartilage. CONCLUSIONS These results suggested that VEGF and VEGFR-2 may be involved in the progression of OA and in the therapeutic mechanism of HA at least partly through the influence of VEGFR-2 expression during the development of OA.
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Seo YK, Yoon HH, Song KY, Kwon SY, Lee HS, Park YS, Park JK. Increase in cell migration and angiogenesis in a composite silk scaffold for tissue-engineered ligaments. J Orthop Res 2009; 27:495-503. [PMID: 18924141 DOI: 10.1002/jor.20752] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The purpose of this study was to evaluate the biocompatibility of silk and collagen-hyaluronan (HA) in vitro by assessing anterior cruciate ligament (ACL) cell and T-lymphocyte cultures on scaffolds. The use of composite scaffolds as artificial ligaments in ACL reconstruction and their effects on angiogenesis were evaluated in vivo. The silk scaffold was knitted by hand and dry coated with collagen-HA, whereas the composite silk scaffold was made by covering a silk scaffold with a lyophilized collagen-HA substrate. The initial attachment and proliferation of human ACL cells on the composite silk scaffold was superior to the attachment and proliferation observed on the silk scaffold. The immune response was higher in both scaffolds after 72 h (p < 0.05) compared with the control culture condition without scaffolding, as assessed by T-lymphocyte cultures in vitro. There was no significant difference in the immune response in vitro between the silk and composite silk scaffolds. Silk and composite silk scaffolds were implanted as artificial ligaments in ACLs removed from the knees of dogs, and they were harvested 6 weeks after implantation. On gross examination, the onset of an inflammatory tissue reaction, such as synovitis, was seen in both the silk scaffold and the composite silk scaffold groups. An histological evaluation of the artificial ligament implants revealed the presence of monocytes in the silk composite scaffold and the absence of giant cells in all cases. MT staining in the composite silk scaffold-grafted group showed granulation tissue consisting of fibroblasts, lymphocytes, monocytes, and collagen fibers. In addition, CD31 staining revealed the formation of new blood vessels. On the other hand, no reparative tissues, such as blood vessels, collagen, and cells, were observed in the silk scaffold-grafted group. These results suggest that the lyophilized collagen-HA substrate is biocompatible in vitro and enhances new blood vessel and cell migration in vivo.
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Affiliation(s)
- Young-Kwon Seo
- Department of Chemical and Biochemical Engineering, Dongguk University, Phil-Dong, Seoul, Korea
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Hsieh JL, Shen PC, Shiau AL, Jou IM, Lee CH, Teo ML, Wang CR, Chao J, Chao L, Wu CL. Adenovirus-Mediated Kallistatin Gene Transfer Ameliorates Disease Progression in a Rat Model of Osteoarthritis Induced by Anterior Cruciate Ligament Transection. Hum Gene Ther 2009; 20:147-58. [DOI: 10.1089/hum.2008.096] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jeng-Long Hsieh
- Department of Nursing, Chung Hwa University of Medical Technology, Tainan Hsien 717, Taiwan
| | - Po-Chuan Shen
- Department of Orthopedic Surgery, Tainan Hospital, Department of Health, Executive Yuan, Tainan 70034, Taiwan
| | - Ai-Li Shiau
- Department of Microbiology and Immunology, National Cheng Kung University Medical College, Tainan 70101, Taiwan
| | - I-Ming Jou
- Department of Orthopedics, National Cheng Kung University Medical College, Tainan 70101, Taiwan
| | - Che-Hsin Lee
- Department of Microbiology and Immunology, National Cheng Kung University Medical College, Tainan 70101, Taiwan
| | - Min-Li Teo
- Department of Microbiology and Immunology, National Cheng Kung University Medical College, Tainan 70101, Taiwan
| | - Chrong-Reen Wang
- Section of Rheumatology and Immunology, Department of Internal Medicine, National Cheng Kung University Medical College, Tainan 70101, Taiwan
| | - Julie Chao
- Department of Biochemistry and Molecular Biology, Medical University of South Carolina, Charleston, SC 29425
| | - Lee Chao
- Department of Biochemistry and Molecular Biology, Medical University of South Carolina, Charleston, SC 29425
| | - Chao-Liang Wu
- Department of Biochemistry and Molecular Biology, National Cheng Kung University Medical College, Tainan 70101, Taiwan
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Seo YK, Yoon HH, Park YS, Song KY, Lee WS, Park JK. Correlation between scaffold in vivo biocompatibility and in vitro cell compatibility using mesenchymal and mononuclear cell cultures. Cell Biol Toxicol 2008; 25:513-22. [DOI: 10.1007/s10565-008-9105-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2008] [Accepted: 09/25/2008] [Indexed: 10/21/2022]
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de Sá VK, Canavez FC, Silva IA, Srougi M, Leite KRM. Isoforms of hyaluronidases can be a predictor of a prostate cancer of good prognosis. Urol Oncol 2008; 27:377-81. [PMID: 18639473 DOI: 10.1016/j.urolonc.2008.04.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2008] [Revised: 04/11/2008] [Accepted: 04/17/2008] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Hyaluronidases (HAases) are enzymes related to cancer progression. Isoforms of HAases have been described as products of alternative splicing responsible for differences in enzyme activity. The heterogeneity of HAase expression has been identified in tumors and could be related to the differences in their biological behavior. METHODS Thirty-seven patients subjected to radical prostatectomy for prostate cancer were divided into 2 groups for the analyses: Low (< or =6-18) and high (> or =7-19) Gleason score and tumor behavior; recurrence 15 and nonrecurrence 22, mean follow-up 52.6 months. CONCLUSION A profile of HAase related to low Gleason score and non-tumor recurrence was characterized by expression of HYAL3-v1, HYAL1-v3, and HYAL3-v2. More studies should be made in order to confirm with larger series.
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Affiliation(s)
- Vanessa K de Sá
- Laboratory of Medical Investigation-LIM55 Medical School, Urology Department, São Paulo University, São Paulo, Brazil
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Ozturk AM, Yam A, Chin SI, Heong TS, Helvacioglu F, Tan A. Synovial cell culture and tissue engineering of a tendon synovial cell biomembrane. J Biomed Mater Res A 2008; 84:1120-6. [DOI: 10.1002/jbm.a.31738] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Yamada T, Gotoh M, Nakama K, Mitsui Y, Higuchi F, Nagata K. Effects of hyaluronan on cell proliferation and mRNA expression of procollagens alpha 1 (I) and alpha 1 (III) in tendon-derived fibroblasts from patients with rotator cuff disease: an in vitro study. Am J Sports Med 2007; 35:1870-6. [PMID: 17687119 DOI: 10.1177/0363546507305015] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hyaluronan (HA) improves postoperative recovery after flexor tendon surgery, preventing postoperative adhesion. However, its influence on the rotator cuff tendon after cuff repair has not yet been clarified in detail. HYPOTHESIS Hyaluronan is likely to modulate cell proliferation and mRNA expression of procollagens alpha1 (I) and alpha1 (III) in tendon-derived fibroblasts in patients with rotator cuff disease. STUDY DESIGN Controlled laboratory study. METHODS The study subjects were 10 patients with rotator cuff disease, with an average age of 62 years (range, 44-72). Various concentrations of HA (1.0-5.0 mg/mL) were added to monolayer-cultured tendon-derived fibroblasts from these patients. Hyaluronan binding and CD44 expression on the tendon-derived fibroblasts were evaluated by confocal microscopy using fluorescein-conjugated HA and antihuman CD44 antibody (OS/37). Cell proliferation was evaluated by recording changes in cell number. The levels of expression of procollagen alpha1 (I) and alpha1 (III) mRNA were measured by real-time reverse transcriptase polymerase chain reaction. RESULTS Immunofluorescence cytochemistry detected constitutive binding of HA and CD44 expression on the tendon-derived cells. Treatment with various concentrations of HA significantly inhibited cell proliferation and decreased the expression level of procollagen alpha1 (III) mRNA, but not that of procollagen alpha1 (I) mRNA, in the tendon-derived fibroblasts. CONCLUSION Hyaluronan modulates cell proliferation and the expression level of procollagen alpha1 (III) mRNA, but not that of pro-collagen alpha1 (I), in fibroblasts from patients with rotator cuff disease. CLINICAL RELEVANCE Postoperative use of exogenous HA may allow the healing of a repaired rotator cuff tendon with minimal adhesion.
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Affiliation(s)
- Tetsu Yamada
- Department of Orthopedic Surgery, Kurume University, Kurume, Fukuoka, Japan
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