1
|
Hedlundh U, Karlsson J, Sernert N, Haag L, Movin T, Papadogiannakis N, Kartus J. Periprosthetic joint infection after total hip arthroplasty induces histological degeneration of the gluteus medius tendon. Bone Jt Open 2023; 4:628-635. [PMID: 37604496 PMCID: PMC10442177 DOI: 10.1302/2633-1462.48.bjo-2023-0074.r1] [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] [Indexed: 08/23/2023] Open
Abstract
Aims A revision for periprosthetic joint infection (PJI) in total hip arthroplasty (THA) has a major effect on the patient's quality of life, including walking capacity. The objective of this case control study was to investigate the histological and ultrastructural changes to the gluteus medius tendon (GMED) in patients revised due to a PJI, and to compare it with revision THAs without infection performed using the same lateral approach. Methods A group of eight patients revised due to a PJI with a previous lateral approach was compared with a group of 21 revised THAs without infection, performed using the same approach. The primary variables of the study were the fibril diameter, as seen in transmission electron microscopy (TEM), and the total degeneration score (TDS), as seen under the light microscope. An analysis of bacteriology, classification of infection, and antibiotic treatment was also performed. Results Biopsy samples from the GMED from infected patients revealed a larger fibril diameter than control patients, as seen in the TEM (p < 0.001). Uninfected patients were slightly older and had their revisions performed significantly later than the infected patients. Histologically, samples from infected patients revealed significantly more vascularity (p < 0.001), the presence of glycosaminoglycans (p < 0.001), and a higher TDS (p = 0.003) than the control patients. The majority of patients had staphylococcal infections of various species. Conclusion More histological degeneration in the GMED was found in patients undergoing THA revision surgery due to PJI than in patients undergoing THA revision surgery due to other reasons.
Collapse
Affiliation(s)
- Urban Hedlundh
- Orthopaedic Department NU Hospital Group, Uddevalla, Sweden
| | - Johanna Karlsson
- Department of Infectious Diseases NU Hospital Group, Trollhattan, Sweden
- Department of Infectious Diseases, University of Gothenburg Institute of Biomedicine, Goteborg, Sweden
| | - Ninni Sernert
- University of Gothenburg Institute of Clinical Sciences, Sahlgrenska Academy, Goteborg, Sweden
- Director Department of Research and Development, NU Hospital Group, Trollhattan, Sweden
| | - Lars Haag
- Department of Laboratory Medicine, Division of Pathology, Karolinska Institute, Stockholm, Sweden
| | - Tomas Movin
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Nikos Papadogiannakis
- Department of Laboratory Medicine, Division of Pathology, Karolinska Institute, Stockholm, Sweden
| | - Jüri Kartus
- University of Gothenburg Institute of Clinical Sciences, Sahlgrenska Academy, Goteborg, Sweden
- Head Department of Research and Development, NU Hospital Group, Trollhattan, Sweden
| |
Collapse
|
2
|
Lu V, Tennyson M, Zhang J, Khan W. Mesenchymal Stem Cell-Derived Extracellular Vesicles in Tendon and Ligament Repair-A Systematic Review of In Vivo Studies. Cells 2021; 10:cells10102553. [PMID: 34685532 PMCID: PMC8533909 DOI: 10.3390/cells10102553] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/18/2021] [Accepted: 09/22/2021] [Indexed: 12/23/2022] Open
Abstract
Tendon and ligament injury poses an increasingly large burden to society. This systematic review explores whether mesenchymal stem cell-derived extracellular vesicles (MSC-EVs) can facilitate tendon/ligament repair in vivo. On 26 May 2021, a systematic search was performed on PubMed, Web of Science, Cochrane Library, Embase, to identify all studies that utilised MSC-EVs for tendon/ligament healing. Studies administering EVs isolated from human or animal-derived MSCs into in vivo models of tendon/ligament injury were included. In vitro, ex vivo, and in silico studies were excluded, and studies without a control group were excluded. Out of 383 studies identified, 11 met the inclusion criteria. Data on isolation, the characterisation of MSCs and EVs, and the in vivo findings in in vivo models were extracted. All included studies reported better tendon/ligament repair following MSC-EV treatment, but not all found improvements in every parameter measured. Biomechanics, an important index for tendon/ligament repair, was reported by only eight studies, from which evidence linking biomechanical alterations to functional improvement was weak. Nevertheless, the studies in this review showcased the safety and efficacy of MSC-EV therapy for tendon/ligament healing, by attenuating the initial inflammatory response and accelerating tendon matrix regeneration, providing a basis for potential clinical use in tendon/ligament repair.
Collapse
Affiliation(s)
- Victor Lu
- School of Clinical Medicine, University of Cambridge, Cambridge CB2 0SP, UK; (V.L.); (J.Z.)
| | - Maria Tennyson
- Department of Trauma and Orthopaedic Surgery, Addenbrooke’s Hospital, University of Cambridge, Cambridge CB2 0QQ, UK;
| | - James Zhang
- School of Clinical Medicine, University of Cambridge, Cambridge CB2 0SP, UK; (V.L.); (J.Z.)
| | - Wasim Khan
- Department of Trauma and Orthopaedic Surgery, Addenbrooke’s Hospital, University of Cambridge, Cambridge CB2 0QQ, UK;
- Correspondence: ; Tel.: +44-(0)-7791-025554
| |
Collapse
|
3
|
Bennett K, Vincent T, Sakthi-Velavan S. The patellar ligament: A comprehensive review. Clin Anat 2021; 35:52-64. [PMID: 34554600 DOI: 10.1002/ca.23791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/15/2021] [Accepted: 09/17/2021] [Indexed: 01/25/2023]
Abstract
The patellar ligament (PL) is an epiphyseal ligament and is part of the extensor complex of the knee. The ligament has gained attention due to its clinical relevance to autograft and tendinopathy. A variety of anatomical variations of the PL such as aplasia, numerical variations, and vascularity are being reported recently by clinicians and anatomists. The aim of this literature was to review the available literature to provide a consensus regarding anatomic variations of the PL, neurovasculature surrounding the PL, histology of the PL, and various aspects of PL measurements with relevance to the surgical considerations and sex and age-related differences. A narrative review of the patellar ligament was performed by conducting a detailed literature search and review of relevant articles. A total of 90 articles on the patellar ligament were included and were categorized into studies based on anatomical variations, neurovasculature, morphometrics, microanatomy, sex and age-related difference, and ACL reconstruction. The anatomical variations and morphometrics of the PL were found to correlate with the frequency of strain injuries, tendinopathy, and efficacy of the PL autograft in anterior cruciate ligament reconstruction. The sex differences in PL measurements and the effect of estrogen on collagen synthesis explained a higher incidence of patellar tendinopathy in women. An awareness of its variations enables careful selection of surgical incisions, thereby avoiding complications related to nerve injury. Accurate knowledge of the PL microanatomy assists in understanding the mechanism of ligament degeneration, rupture, autograft harvesting, and ligamentization results.
Collapse
Affiliation(s)
- Karis Bennett
- Division of Biomedical Sciences, Marian University College of Osteopathic Medicine, Indianapolis, Indiana, USA
| | - Tanner Vincent
- Division of Biomedical Sciences, Marian University College of Osteopathic Medicine, Indianapolis, Indiana, USA
| | - Sumathilatha Sakthi-Velavan
- Division of Biomedical Sciences, Marian University College of Osteopathic Medicine, Indianapolis, Indiana, USA
| |
Collapse
|
4
|
Ibrahim M, Hedlundh U, Sernert N, Meknas K, Haag L, Movin T, Papadogiannakis N, Kartus JT. Histological and ultrastructural degenerative findings in the gluteus medius tendon after hip arthroplasty. J Orthop Surg Res 2021; 16:339. [PMID: 34039378 PMCID: PMC8152320 DOI: 10.1186/s13018-021-02434-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 04/20/2021] [Indexed: 12/04/2022] Open
Abstract
Background Despite gluteus medius (GMED) tendinosis being relatively common, its presence in association with hip osteoarthritis (OA) or total hip arthroplasty (THA) is not well studied. It was hypothesized that more tendon degeneration would be found in patients with OA of the hip and in those that had undergone THA than that in a control group. Methods One hundred patients were included between 2016 and 2019 and were included into 4 groups; the patients were undergoing revision surgery in two groups and primary THA in the other two groups; 22 patients had previously undergone primary THA through a direct lateral approach (involving sectioning of the GMED tendon), 24 patients had previously undergone primary THA through a posterior approach (leaving the GMED tendon intact), 29 patients had primary hip OA, and 25 patients who suffered a femoral neck fracture served as controls. Biopsies from the GMED tendon were obtained at the time of the primary THA or the hip revision surgery. The tendon biopsies were examined ultrastructurally and histologically. Results Ultrastructurally, the direct lateral and posterior revision groups had statistically significantly more collagen fibrils with smaller diameters compared with the fracture and primary THA groups. Moreover, the direct lateral revision group had more collagen fibrils with smaller diameters compared with the posterior revision group. Histologically, the direct lateral revision group had a higher total degeneration score (TDS) compared with the primary hip OA group. Conclusions The GMED tendon shows more ultrastructural degeneration in patients who undergo hip revision arthroplasty than in patients with primary OA of the hip and control patients, who had suffered a femoral neck fracture. Furthermore, patients who had previously undergone primary THA through a direct lateral approach revealed more histological GMED tendon degeneration than patients who suffer primary hip OA. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-021-02434-1.
Collapse
Affiliation(s)
- Mustafa Ibrahim
- Department of Orthopedics, Region Västra Götaland, NU Hospital Group, Trollhättan / Uddevalla, Sweden. .,University of Gothenburg, Gothenburg, Sweden.
| | - Urban Hedlundh
- Department of Orthopedics, Region Västra Götaland, NU Hospital Group, Trollhättan / Uddevalla, Sweden
| | - Ninni Sernert
- Department of Orthopedics, Region Västra Götaland, NU Hospital Group, Trollhättan / Uddevalla, Sweden.,Institution of Clinical Science, Sahlgrenska Academy, Gothenburg, Sweden
| | - Khaled Meknas
- Department of Orthopedics, University Hospital North Norway, N-9038, Tromsø, Norway.,Orthopedics Research Group, Institute of Clinical Medicine, the Arctic University of Norway, Tromsø, Norway
| | - Lars Haag
- Department of Laboratory Medicine, Division of Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Tomas Movin
- Department of Clinical Science, Intervention and Technology, Division of Orthopedics and Biotechnology, Karolinska Institutet, Stockholm, Sweden
| | - Nikos Papadogiannakis
- Department of Laboratory Medicine, Division of Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Jüri-Toomas Kartus
- Department of Orthopedics, Region Västra Götaland, NU Hospital Group, Trollhättan / Uddevalla, Sweden.,Institution of Clinical Science, Sahlgrenska Academy, Gothenburg, Sweden.,Department of Research and Development, NU Hospital Group, Trollhättan / Uddevalla, Sweden
| |
Collapse
|
5
|
Ibrahim M, Meknas K, Steigen SE, Olsen R, Sernert N, Ejerhed L, Kartus JT. No significant histological or ultrastructural tendinosis changes in the hamstring tendon in patients with mild to moderate osteoarthritis of the knee? Knee Surg Sports Traumatol Arthrosc 2021; 29:1067-1074. [PMID: 32504157 PMCID: PMC7973588 DOI: 10.1007/s00167-020-06066-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 05/14/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To investigate the periarticular degenerative changes of the knee joint in association with osteoarthritis (OA). More tendinosis was expected to be found in the semitendinosus tendon in patients with knee OA than in patients without knee OA. METHODS Samples from 41 patients were included between January 2016 and October 2017. Twenty-one patients median age 53 (33-63) years with mild to moderate OA underwent high tibial osteotomy (HTO) and 20 patients median age 38 (31-57) years without OA underwent anterior cruciate ligament reconstruction (ACLR). Biopsies from the semitendinosus tendon were obtained at the time of surgery and examined histologically, morphologically and ultrastructurally using light and electron microscope. RESULTS The histological evaluation of the semitendinosus tendon revealed the presence of more hemosiderin in the ACLR group. No significant morphological or ultrastructural differences were shown between patients in the HTO and ACLR group. CONCLUSION Patients with mild and moderate medial compartment knee OA displayed no more degenerative changes in their semitendinosus tendon than patients without OA, as seen in both the light and the electron microscope. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Mustafa Ibrahim
- Department of Orthopedics, NU Hospital Group, Trollhättan, Sweden. .,Institution of Clinical Science, Sahlgrenska Academy, Gothenburg, Sweden.
| | - Khaled Meknas
- Department of Orthopedics, University Hospital North Norway, Tromsø, Norway ,Orthopedics Research Group, Institute of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway
| | - Sonja E. Steigen
- Diagnostic Clinic-Clinical Pathology, University Hospital of Northern Norway, Tromsø, Norway ,Institute of Medical Biology, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway
| | - Randi Olsen
- Advanced Microscopy Core Facility, Institute of Medical Biology, UIT-The Arctic University of Norway, Tromsø, Norway
| | - Ninni Sernert
- Institution of Clinical Science, Sahlgrenska Academy, Gothenburg, Sweden ,Department of Research and Development, NU Hospital Group, Trollhättan, Sweden
| | - Lars Ejerhed
- Institution of Clinical Science, Sahlgrenska Academy, Gothenburg, Sweden ,Department of Research and Development, NU Hospital Group, Trollhättan, Sweden
| | - Jüri-Toomas Kartus
- Department of Orthopedics, NU Hospital Group, Trollhättan, Sweden ,Institution of Clinical Science, Sahlgrenska Academy, Gothenburg, Sweden ,Department of Research and Development, NU Hospital Group, Trollhättan, Sweden
| |
Collapse
|
6
|
Veronesi F, Giavaresi G, Bellini D, Casagranda V, Pressato D, Fini M. Evaluation of a new collagen-based medical device (ElastiCo®) for the treatment of acute Achilles tendon injury and prevention of peritendinous adhesions: An in vitro biocompatibility and in vivo investigation. J Tissue Eng Regen Med 2020; 14:1113-1125. [PMID: 32592610 DOI: 10.1002/term.3085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 05/05/2020] [Accepted: 06/01/2020] [Indexed: 01/05/2023]
Abstract
Tendon healing still represents a challenge for clinicians because it is slow and incomplete. The most injured is the Achilles tendon, and surgery is the therapeutic strategy often adopted because it provides a quicker functional recovery. Peritendinous adhesions are the main complication of surgery with hyperplasia and chemotaxis of fibroblasts. A biomaterial that blocks fibroblast migration, without interfering with the passage of cytokines and growth factors, might be useful. The present study evaluated the biocompatibility of a new Type I collagen-based scaffold (ElastiCo®) and its ability to promote Achilles tendon healing, inhibiting adhesion formation. After verifying in vitro biocompatibility, physical, and mechanical properties of the scaffold, an in vivo study was performed in 28 rats, operated to induce an acute lesion in both Achilles tendons. One tendon was treated with the suture only and the contralateral one with suture wrapped with ElastiCo® film. After 8 and 16 weeks, it was observed that ElastiCo® reduced internal and external peritendinous adhesions and Collagen III content and increased Collagen I. Elastic modulus increased with both treatments over time. Current results highlighted the clinical translationality of ElastiCo® that could improve the quality of life in patients affected by Achilles tendon lesions surgically treated.
Collapse
Affiliation(s)
- Francesca Veronesi
- Laboratory of Preclinical and Surgical Studies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Gianluca Giavaresi
- Laboratory of Preclinical and Surgical Studies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | | | | | - Milena Fini
- Laboratory of Preclinical and Surgical Studies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Kanamoto T, Tanaka Y, Yonetani Y, Kita K, Amano H, Okamoto K, Shino K, Horibe S. Sex Differences in the Residual Patellar Tendon After Harvesting Its Central Third for Anterior Cruciate Ligament Reconstruction. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:755-761. [PMID: 28945278 DOI: 10.1002/jum.14419] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 06/21/2017] [Accepted: 06/24/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Some studies have found that sex can affect the clinical results after anterior cruciate ligament reconstruction. We hypothesized that sex would significantly affect the healing of the postoperative patellar tendon. This study evaluated the patellar tendon after bone-patellar tendon-bone autograft harvest, specifically with regard to sex-dependent differences. METHODS At 6 months postoperatively, an ultrasonographic evaluation was performed. We measured the residual donor site gap width between tendon tissues and the thickness of newly formed nontendinous tissue in the gap. In addition, the cross-sectional area of tendon tissue was measured. The ratios between the operated and contralateral sides were calculated, and the sexes were compared. A paired Student t test was performed, with P < .05 considered statistically significant. RESULTS The population of 52 patients (32 male and 20 female) had a mean age ± SD of 23 ± 8 years. We observed no significant sex-dependent differences in the residual donor site gap and the thickness of newly formed nontendinous tissue when calculating ratios to the contralateral tendon. The mean cross-sectional area of tendon tissue was 101 ± 26 mm2 (male, 114 ± 26 mm2 ; female, 80 ± 16 mm2 ). When the ratios to the contralateral tendon were calculated, male patients had significantly higher cross-sectional area ratios than female patients (male, 124% ± 20%; female, 100% ± 19%, P = .024). CONCLUSIONS We have reported a dramatic increase in the cross-sectional area of patellar tendon tissue during the first 6 months after anterior cruciate ligament reconstruction with a bone-patellar tendon-bone autograft, which was more prominent in male patients than in female patients. This difference might have contributed to the sex-dependent variation in clinical outcomes.
Collapse
Affiliation(s)
- Takashi Kanamoto
- Department of Orthopedic Surgery, Hannan Chuo Hospital, Matsubara, Japan
| | | | - Yasukazu Yonetani
- Department of Orthopedic Surgery, Hoshigaoka Medical Center, Hirakata, Japan
| | - Keisuke Kita
- Sports Orthopedic Center, Yukioka Hospital, Osaka, Japan
| | | | | | - Konsei Shino
- Department of Orthopedic Surgery, Hoshigaoka Medical Center, Hirakata, Japan
| | - Shuji Horibe
- Faculty of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino, Japan
| |
Collapse
|
9
|
Farfaras S, Ejerhed LE, Hallström EK, Hultenby K, Meknas K, Movin T, Papadogiannakis N, Kartus JT. More histologic and ultrastructural degenerative signs in the subscapularis tendon and the joint capsule in male patients with shoulder impingement. Knee Surg Sports Traumatol Arthrosc 2018; 26:79-87. [PMID: 28255657 PMCID: PMC5754398 DOI: 10.1007/s00167-017-4442-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 01/20/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of the present study was to analyze biopsy samples from the subscapularis tendon and from the joint capsule from male patients with shoulder impingement syndrome (SAIS) and compare them with samples from male patients with post-traumatic recurrent shoulder instability. The hypothesis of the study was that patients with SAIS would have more histologic and ultrastructural degenerative changes in their subscapularis tendon and joint capsule than patients with post-traumatic recurrent shoulder instability. METHODS Male patients scheduled for surgery, with either subacromial decompression or Bankart reconstruction, were included. Four biopsies from each patient were obtained from the capsule and four from the subscapularis tendon during arthroscopic surgery. The histologic characteristics and the presence of glycosaminoglycans were assessed using the light microscope, and the ultrastructure was assessed using a transmission electron microscope. RESULTS Eight patients, median age 53 (45-74) years (p < 0.0001), were included in the impingement group, and 12 patients, median age 27 (22-48) years, were included in the instability group. The histologic assessment revealed significantly higher cellularity and total degeneration score in the capsule (p = 0.016 and p = 0.014 respectively) in patients with subacromial impingement compared with the instability patients. The corresponding finding was not made for the subscapularis tendon. The ultrastructural evaluation revealed that the instability patients had more fibrils with a large diameter (indicating less degeneration) in both the subscapularis tendon and the capsule compared with the impingement patients (p < 0.0001). CONCLUSION Male patients with subacromial impingement have more histologic and ultrastructural degenerative changes in their shoulder compared with patients with post-traumatic recurrent shoulder instability. CLINICAL RELEVANCE It appears that in patients with subacromial impingement, the whole shoulder joint is affected and not only the subacromial space. It is the opinion of the authors that intra-articular therapeutic injections could be tried more often in these patients. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Stefanos Farfaras
- Department of Orthopedics, NU-Hospital Group Trollhättan/Uddevalla, Uddevalla Sjukhus, 451, Uddevalla, Sweden. .,Gothenburg University-Sahlgrenska Academy, Gothenburg, Sweden.
| | - Lars Erik Ejerhed
- Department of Orthopedics, NU-Hospital Group Trollhättan/Uddevalla, Uddevalla Sjukhus, 451 Uddevalla, Sweden
| | - Erling K. Hallström
- Department of Orthopedics, NU-Hospital Group Trollhättan/Uddevalla, Uddevalla Sjukhus, 451 Uddevalla, Sweden ,Gothenburg University-Sahlgrenska Academy, Gothenburg, Sweden
| | - Kjell Hultenby
- Division of Clinical Research Center, Department of Laboratory Medicine, Karolinska Institute Stockholm, Stockholm, Sweden
| | - Khaled Meknas
- Bone and Joint Research Group, Department of Orthopedics, Institute of Clinical Medicine, University Hospital North Norway, The Arctic University of Norway, Tromsø, Norway
| | - Tomas Movin
- Department of Clinical Science, Karolinska Institute, Stockholm, Sweden
| | - Nikos Papadogiannakis
- Division of Pathology, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
| | - Jüri-Toomas Kartus
- Department of Orthopedics, NU-Hospital Group Trollhättan/Uddevalla, Uddevalla Sjukhus, 451 Uddevalla, Sweden ,Gothenburg University-Sahlgrenska Academy, Gothenburg, Sweden
| |
Collapse
|
10
|
Sandri M, Filardo G, Kon E, Panseri S, Montesi M, Iafisco M, Savini E, Sprio S, Cunha C, Giavaresi G, Veronesi F, Fini M, Salvatore L, Sannino A, Marcacci M, Tampieri A. Fabrication and Pilot In Vivo Study of a Collagen-BDDGE-Elastin Core-Shell Scaffold for Tendon Regeneration. Front Bioeng Biotechnol 2016; 4:52. [PMID: 27446909 PMCID: PMC4923187 DOI: 10.3389/fbioe.2016.00052] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 06/03/2016] [Indexed: 11/13/2022] Open
Abstract
The development of bio-devices for complete regeneration of ligament and tendon tissues is presently one of the biggest challenges in tissue engineering. Such device must simultaneously possess optimal mechanical performance, suitable porous structure, and biocompatible microenvironment. This study proposes a novel collagen-BDDGE-elastin (CBE)-based device for tendon tissue engineering, by the combination of two different modules: (i) a load-bearing, non-porous, “core scaffold” developed by braiding CBE membranes fabricated via an evaporative process and (ii) a hollow, highly porous, “shell scaffold” obtained by uniaxial freezing followed by freeze-drying of CBE suspension, designed to function as a physical guide and reservoir of cells to promote the regenerative process. Both core and shell materials demonstrated good cytocompatibility in vitro, and notably, the porous shell architecture directed cell alignment and population within the sample. Finally, a prototype of the core module was implanted in a rat tendon lesion model, and histological analysis demonstrated its safety, biocompatibility, and ability to induce tendon regeneration. Overall, our results indicate that such device may have the potential to support and induce in situ tendon regeneration.
Collapse
Affiliation(s)
- Monica Sandri
- Institute of Science and Technology for Ceramics, National Research Council , Faenza , Italy
| | - Giuseppe Filardo
- Biomechanics and Technology Innovation Laboratory, Rizzoli Orthopaedic Institute, II Orthopaedic and Traumatologic Clinic, Bologna, Italy; Nano-Biotechnology Laboratory, Rizzoli Orthopaedic Institute, II Orthopaedic and Traumatologic Clinic, Bologna, Italy
| | - Elizaveta Kon
- Biomechanics and Technology Innovation Laboratory, Rizzoli Orthopaedic Institute, II Orthopaedic and Traumatologic Clinic, Bologna, Italy; Nano-Biotechnology Laboratory, Rizzoli Orthopaedic Institute, II Orthopaedic and Traumatologic Clinic, Bologna, Italy
| | - Silvia Panseri
- Institute of Science and Technology for Ceramics, National Research Council , Faenza , Italy
| | - Monica Montesi
- Institute of Science and Technology for Ceramics, National Research Council , Faenza , Italy
| | - Michele Iafisco
- Institute of Science and Technology for Ceramics, National Research Council , Faenza , Italy
| | - Elisa Savini
- Institute of Science and Technology for Ceramics, National Research Council , Faenza , Italy
| | - Simone Sprio
- Institute of Science and Technology for Ceramics, National Research Council , Faenza , Italy
| | - Carla Cunha
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto , Porto , Portugal
| | - Gianluca Giavaresi
- Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopaedic Institute, Bologna, Italy; Laboratory of Biocompatibility, Technological Innovations and Advanced Therapies, Department RIT Rizzoli-Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Francesca Veronesi
- Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopaedic Institute , Bologna , Italy
| | - Milena Fini
- Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopaedic Institute, Bologna, Italy; Laboratory of Biocompatibility, Technological Innovations and Advanced Therapies, Department RIT Rizzoli-Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Luca Salvatore
- Department of Engineering for Innovation, University of Salento , Lecce , Italy
| | - Alessandro Sannino
- Department of Engineering for Innovation, University of Salento , Lecce , Italy
| | - Maurilio Marcacci
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto , Porto , Portugal
| | - Anna Tampieri
- Institute of Science and Technology for Ceramics, National Research Council , Faenza , Italy
| |
Collapse
|
11
|
Abstract
Synopsis Tendinopathy has become the accepted term to describe a spectrum of changes that occur in damaged and/or diseased tendons. Over the past 2 decades, there have been new insights into tendon pathophysiology of relevance to clinicians, including (1) better characterization of the overuse injury process and the resultant structural and functional disruption in chronically painful tendons, (2) improved understanding of the pathomechanics associated with chronic tendon injury, and (3) greater knowledge about the influence of lifestyle factors and drugs on tendon pathology. The implications of these new insights are discussed. J Orthop Sports Phys Ther 2015;45(11):833-841. Epub 21 Sep 2015. doi:10.2519/jospt.2015.5884.
Collapse
|
12
|
Suijkerbuijk MAM, Reijman M, Lodewijks SJM, Punt J, Meuffels DE. Hamstring Tendon Regeneration After Harvesting: A Systematic Review. Am J Sports Med 2015; 43:2591-8. [PMID: 25548149 DOI: 10.1177/0363546514562169] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hamstring tendons are often used as autografts for anterior cruciate ligament (ACL) reconstruction. However, no systematic review has been performed describing consequences such as hamstring tendon regeneration rate and determinants of hamstring tendon regeneration. PURPOSE To summarize the current literature regarding hamstring tendon rate regeneration, the time course of regeneration, and determinants of hamstring regeneration. STUDY DESIGN Systematic review. METHODS A search was performed in the Embase, Medline (OvidSP), Web of Science, Cochrane, PubMed, and Google Scholar databases up to June 2014 to identify relevant articles. A study was eligible if it met the following inclusion criteria: tendons were harvested, regeneration at harvest site was assessed, population size was at least 10 human subjects, full-text article was available, and the study design was either a randomized controlled trial, prospective cohort study, retrospective cohort study, or case control study. A risk of bias assessment of the eligible articles was determined. Data describing hamstring tendon regeneration rates were pooled per time period. RESULTS A total of 18 publications met the inclusion criteria. The mean regeneration rate for the semitendinosus and gracilis tendons was, in all cases, 70% or higher. More than 1 year after harvesting, 79% (median [IQR], 80 [75.5-90]) of the semitendinosus tendons and 72% (median [IQR], 80 [61-88.5]) of the gracilis tendons were regenerated. No significant differences in regeneration rate could be found considering patient sex, age, height, weight, or duration of immobilization. Results did not clearly show whether absence of regeneration disadvantages the subsequent hamstring function. Five studies measured the regeneration rate at different moments in time. CONCLUSION Hamstring tendons regenerated in the majority of patients after ACL reconstruction. The majority of the hamstring tendon regeneration was found to occur between 1 month and 1 year after harvest. No significant determinants for hamstring tendon regeneration could be identified because of a lack of research. The function and strength of the regenerated hamstring remained unclear.
Collapse
Affiliation(s)
- Mathijs A M Suijkerbuijk
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Max Reijman
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Susanne J M Lodewijks
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Jorien Punt
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Duncan E Meuffels
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| |
Collapse
|
13
|
Åhlén M, Lidén M, Movin T, Papadogiannakis N, Rostgård-Christensen L, Kartus J. Histological Evaluation of Regenerated Semitendinosus Tendon a Minimum of 6 Years After Harvest for Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2014; 2:2325967114550274. [PMID: 26535362 PMCID: PMC4555632 DOI: 10.1177/2325967114550274] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background: Semitendinosus (ST) and/or gracilis (G) autografts are the most used grafts for anterior cruciate ligament (ACL) surgery. The tendons have been shown to be able to regenerate but with focal areas of scar tissue in the short term. There are no long-term histological studies of the regenerated tendons. Hypothesis: In the long term, the regenerated ST tendon normalizes and has a similar histology as the contralateral nonharvested tendon. Study Design: Case-control study; Level of evidence, 3. Methods: Eighteen patients (8 female, 10 male) who underwent ACL surgery using ipsilateral ST/G tendon autografts were included in this study. Percutaneous specimens were obtained from the regenerated ST tendon and the contralateral nonharvested ST tendon under ultrasonographic guidance at a median of 8.4 years (100.5 months; range, 77-129 months) after the harvest procedure. Specimens from the nonoperated side served as controls. The histology and presence of glycosaminoglycans (GAGs) were assessed using a light microscope and a semiquantitative grading system. Results: Thirty-six biopsies were obtained (2 biopsies from each patient). In 5 biopsies, the amount of tissue was too small to analyze in the light microscope, and 1 patient had been operated on bilaterally and was therefore excluded. In total, 24 biopsies were included in the histological analysis. In overall terms, there were no significant differences between the regenerated and nonharvested ST tendon in terms of fiber structure, cellularity, vascularity, and level of GAGs a minimum 6 years after harvest of the ST tendon. However, 3 of the regenerated tendons displayed a loss of fiber structure. Conclusion: The ST tendon regenerates and may regain a histological appearance similar to that of the nonharvested contralateral tendon, as seen in this study a median of 8.4 years after harvesting. However, in some tendons, loss of fiber structure was found.
Collapse
Affiliation(s)
- Martina Åhlén
- Department of Orthopedics, NU-Hospital Organization, Trollhättan/Uddevalla, Sweden. ; University of Gothenburg, Gothenburg, Sweden
| | - Mattias Lidén
- Department of Plastic Surgery, Sahlgrenska University Hospital, Sahlgrenska, Sweden
| | - Tomas Movin
- Department of Clinical Science, Intervention and Technology, Division of Orthopedics, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Jüri Kartus
- Department of Research and Development NU-Hospital Organization, Trollhättan/Uddevalla, Sweden
| |
Collapse
|
14
|
Franklin SL, Dean BJF, Wheway K, Watkins B, Javaid MK, Carr AJ. Up-regulation of Glutamate in Painful Human Supraspinatus Tendon Tears. Am J Sports Med 2014; 42:1955-62. [PMID: 24872365 DOI: 10.1177/0363546514532754] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Pain related to rotator cuff tendinopathy is a common problem, but little is known regarding the origin and cause of pain from the tendon substance. No study to date has looked at the association between tissue changes and patient outcomes. PURPOSE To describe the peripheral neuronal phenotype in painful rotator cuff tears and to determine correlations between tissue changes and clinical outcome measures. STUDY DESIGN Controlled laboratory study. METHODS Tissue samples of the supraspinatus were taken from patients undergoing surgery to repair a rotator cuff tendon tear. Patients were classified as having small/medium or large/massive tears. Control tissue was obtained from patients undergoing surgery for posttraumatic shoulder instability. Immunohistochemical techniques were performed using antibodies to known nociceptive and neuronal markers as well as general tissue structural markers. RESULTS There was no correlation between tissue changes and patient-reported outcomes. A significant increase in the expression of glutamate was seen in tendon tears. There were differences in the expression of metabotropic and ionotropic glutamate receptors. Expression changes were also observed for markers of the sensory and autonomic systems; however, no differences were found in neurotrophins. CONCLUSION Glutamate and the glutaminergic system play a key role in painful human tendon tears; however, the exact role is still uncertain, as glutamate is highly involved in both pain and metabolic pathways. CLINICAL RELEVANCE This study has identified a number of markers that could be potential therapeutic targets.
Collapse
Affiliation(s)
- Sarah L Franklin
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Benjamin J F Dean
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Kim Wheway
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Bridget Watkins
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Muhammad K Javaid
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Andrew J Carr
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| |
Collapse
|
15
|
Murphy RJ, Floyd Dean BJ, Wheway K, Watkins B, Morrey ME, Carr AJ. A Novel Minimally Invasive Ultrasound-Guided Technique to Biopsy Supraspinatus Tendon. ACTA ACUST UNITED AC 2013. [DOI: 10.1053/j.oto.2013.05.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
16
|
Åhlén M, Lidén M, Bovaller Å, Sernert N, Kartus J. Bilateral magnetic resonance imaging and functional assessment of the semitendinosus and gracilis tendons a minimum of 6 years after ipsilateral harvest for anterior cruciate ligament reconstruction. Am J Sports Med 2012; 40:1735-41. [PMID: 22711582 DOI: 10.1177/0363546512449611] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Previous studies are contradictory in terms of the function, regeneration potential, insertion point, and cross-sectional area of the semitendinosus and gracilis tendons after harvest for anterior cruciate ligament (ACL) reconstruction. HYPOTHESES In the long term, the tendons will regenerate in most patients with a more proximal point of insertion, the cross-sectional area of the tendons will be smaller compared with the nonoperated contralateral side, and the patients will be weaker in terms of the internal rotation and deep flexion of the knee. STUDY DESIGN Case series; Level of evidence, 4. METHODS Nineteen patients (9 women and 10 men) who had undergone ACL reconstruction a minimum of 6 years earlier, median 8.5 years (range, 6-11 years), with ipsilateral semitendinosus and gracilis autografts, underwent bilateral magnetic resonance imaging (MRI) of their knees. An experienced, independent musculoskeletal radiologist evaluated all MRI examinations. To evaluate the function, strength measurements in deep knee flexion and internal rotation were performed using an isokinetic strength-testing machine. RESULTS The semitendinosus tendon had regenerated in 17 of 19 (89%) patients and the gracilis tendon in 18 of 19 (95%) patients, as seen on MRI. There were no significant differences between the point of insertion for the tendons on the operated and nonoperated sides. The cross-sectional areas of the regenerated tendons revealed no significant differences compared with the normal tendons on the contralateral side, as measured 4 cm above the joint line. The patients were significantly weaker in terms of deep knee flexion at 60 and 180 deg/sec, but they were stronger in terms of internal rotation of the tibia at 60 deg/sec in the operated leg compared with the nonoperated leg. CONCLUSION The semitendinosus and gracilis tendons regenerated in the majority of patients and regained an almost normal point of insertion on the pes anserinus a minimum of 6 years after harvest. The regenerated tendons had a cross-sectional area similar to that on the nonoperated contralateral side. The patients revealed a strength deficit in deep knee flexion but not in internal rotation.
Collapse
Affiliation(s)
- Martina Åhlén
- Department of Orthopedics, NU-Hospital Organization, SE-461 85 Trollhättan, Sweden.
| | | | | | | | | |
Collapse
|
17
|
Stener S, Ejerhed L, Movin T, Sernert N, Papadogiannakis N, Kartus J. The reharvested patellar tendon has the potential for ligamentization when used for anterior cruciate ligament revision surgery. Knee Surg Sports Traumatol Arthrosc 2012; 20:1168-74. [PMID: 22310901 DOI: 10.1007/s00167-012-1908-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 01/12/2012] [Indexed: 01/15/2023]
Abstract
PURPOSE The aim of the present study was to make an in-depth clinical, radiographical, and histological evaluation of patients who underwent anterior cruciate ligament (ACL) revision surgery with reharvested central third patellar tendon autograft. METHODS Four patients (two women and two men) underwent ACL revision surgery with reharvested patellar tendon autograft 71 (66-120) months after the primary reconstruction. The patients were followed prospectively and underwent a clinical examination and magnetic resonance imaging (MRI) at two and 10 years. Furthermore, they underwent a second-look arthroscopy involving a biopsy procedure from the reconstructed ACL 3 years after revision surgery. RESULTS The clinical results were poor both at two and 10 years, but the knees were stable and had a firm endpoint in all four patients in the Lachman test. At the second-look arthroscopy, the graft appeared macroscopically normal in all four patients. Histologically two patients had a normal or close to normal appearance of the reconstructed ACL with no or slight increase in cellularity and vascularity. Two patients had a marked increase in cellularity and vascularity, and the findings revealed that ligamentization was present in all four patients. CONCLUSIONS The clinical outcome 10 years after ACL revision surgery was poor in these four patients. In contrast, the reharvested patellar tendon appeared close to normal on MRI, and the second-look arthroscopy with the concomitant histological findings revealed that the grafts were viable 3 years after revision. Therefore, the reharvested patellar tendon seems to have the potential for ligamentization when used for ACL revision surgery. LEVEL OF EVIDENCE Case series, Level IV.
Collapse
Affiliation(s)
- Sven Stener
- NU-Hospital Organization, Trollhättan/Uddevalla, Sweden.
| | | | | | | | | | | |
Collapse
|
18
|
Sharma A, Abraham T, Sampaio A, Cowan M, Underhill M, Scott A. Sodium cromolyn reduces expression of CTGF, ADAMTS1, and TIMP3 and modulates post-injury patellar tendon morphology. J Orthop Res 2011; 29:678-83. [PMID: 21437947 PMCID: PMC3951484 DOI: 10.1002/jor.21291] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Accepted: 10/04/2010] [Indexed: 02/04/2023]
Abstract
The purpose of this study was to determine whether administration of a mast cell inhibitor (sodium cromolyn, SC) would influence tendon repair and extracellular matrix gene expression following acute injury. CD1 mouse patellar tendons were unilaterally injured and mast cell prevalence was determined. The effect of SC injection on tendon hypercellularity, cross-sectional area, collagen organization, and expression of extracellular matrix-related genes was examined. Mast cell prevalence was markedly increased in injured patellar tendons (p = 0.009), especially at 8 weeks post-injury (p = 0.025). SC injection increased collagen organization compared to uninjected animals at 4 weeks and attenuated the development of tendon hypercellularity and tendon thickening post-injury. Expression of CTGF, ADAMTS1, and TIMP3 in injured tendon was reduced in the SC group. SC injections moderated the structural alterations of healing tendon in association with downregulation of several genes associated with tendon fibrosis. This work corroborates previous findings pointing to a role of mast cells in tendon repair.
Collapse
Affiliation(s)
- Aishwariya Sharma
- Department of Cellular and Physiological Sciences, University of British Columbia
| | - Thomas Abraham
- James Hogg Centre for Cardiovascular Research, St Paul’s Hospital
| | - Arthur Sampaio
- Department of Cellular and Physiological Sciences, University of British Columbia
| | - Matthew Cowan
- Biomedical Research Centre, University of British Columbia
| | - Michael Underhill
- Department of Cellular and Physiological Sciences, University of British Columbia
| | - Alex Scott
- Department of Physical Therapy, University of British Columbia,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute,Correspondence or reprint requests should be addressed to A Scott, Department of Physical Therapy, University of British Columbia, 212 - 2177 Wesbrook Mall, Vancouver, BC V6T 1Z3,
| |
Collapse
|
19
|
Hsu SL, Liang R, Woo SL. Functional tissue engineering of ligament healing. BMC Sports Sci Med Rehabil 2010; 2:12. [PMID: 20492676 PMCID: PMC2879239 DOI: 10.1186/1758-2555-2-12] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Accepted: 05/21/2010] [Indexed: 12/18/2022]
Abstract
Ligaments and tendons are dense connective tissues that are important in transmitting forces and facilitate joint articulation in the musculoskeletal system. Their injury frequency is high especially for those that are functional important, like the anterior cruciate ligament (ACL) and medial collateral ligament (MCL) of the knee as well as the glenohumeral ligaments and the rotator cuff tendons of the shoulder. Because the healing responses are different in these ligaments and tendons after injury, the consequences and treatments are tissue- and site-specific. In this review, we will elaborate on the injuries of the knee ligaments as well as using functional tissue engineering (FTE) approaches to improve their healing. Specifically, the ACL of knee has limited capability to heal, and results of non-surgical management of its midsubstance rupture have been poor. Consequently, surgical reconstruction of the ACL is regularly performed to gain knee stability. However, the long-term results are not satisfactory besides the numerous complications accompanied with the surgeries. With the rapid development of FTE, there is a renewed interest in revisiting ACL healing. Approaches such as using growth factors, stem cells and scaffolds have been widely investigated. In this article, the biology of normal and healing ligaments is first reviewed, followed by a discussion on the issues related to the treatment of ACL injuries. Afterwards, current promising FTE methods are presented for the treatment of ligament injuries, including the use of growth factors, gene delivery, and cell therapy with a particular emphasis on the use of ECM bioscaffolds. The challenging areas are listed in the future direction that suggests where collection of energy could be placed in order to restore the injured ligaments and tendons structurally and functionally.
Collapse
Affiliation(s)
- Shan-Ling Hsu
- Musculoskeletal Research Center, Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Orthopaedic Surgery, Chang Gung Memorial Hospital - Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Rui Liang
- Musculoskeletal Research Center, Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Savio Ly Woo
- Musculoskeletal Research Center, Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
20
|
Haasters F, Ockert B, Mutschler W, Kessler MA. [Late patellar tendon rupture 10 years after anterior cruciate ligament reconstruction using a bone-patellar tendon-bone graft]. Unfallchirurg 2009; 112:728-33. [PMID: 19506810 DOI: 10.1007/s00113-008-1555-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Autologous transplantation of the central third of the patella tendon with a bone-patellar tendon-bone (BTB) graft is one of the most commonly used techniques for anterior cruciate ligament (ACL) reconstruction. Frequently chosen alternative sources include semitendinosus and gracilis tendon autografts. The differences of opinion regarding graft sources mainly result from comparison of outcome and complications. Although higher donor site morbidity and postoperative extensor mechanism complications are postulated for bone-patellar tendon-bone grafts, patellar tendon ruptures following anterior cruciate ligament reconstruction are rarely reported in the literature. These predominantly occur during the early postoperative period. We present the case of a patellar tendon rupture in a healthy 36-year-old man, who suffered a skiing accident 10 years after uneventful ACL reconstruction with a BTB graft.
Collapse
Affiliation(s)
- F Haasters
- Abteilung Kniechirurgie, Chirurgische Klinik und Poliklinik, Campus Innenstadt, Klinikum der Ludwig-Maximilians-Universität München, Nussbaumstr. 20, 80336, München, Deutschland
| | | | | | | |
Collapse
|
21
|
Abstract
In our research center, we have developed and utilized a novel robotic/universal force-moment sensor testing system to gain quantitative data on multiple-degree-of-freedom kinematics of the knee simultaneously with data on the in situ forces in normal and repaired soft tissues. In particular, we have investigated the complex interaction of the anteromedial and posterolateral bundles of the anterior cruciate ligament as well as several key biomechanical variables in anterior cruciate ligament reconstruction, such as graft selection and femoral tunnel placement (both of which impact knee stability). For example, both the bone-patellar tendon-bone and quadrupled hamstrings tendon autografts restored anterior stability but were insufficient in gaining rotatory stability. In a follow-up study, we have shown that a more laterally placed graft was beneficial and could improve these outcomes. Such findings led to additional investigation in which the biomechanical advantages of double-bundle anterior cruciate ligament reconstruction were demonstrated. However, a more laterally placed autograft at the femoral insertion of the posterolateral bundle also worked well, especially when the knee was nearly at full extension (a position in which the anterior cruciate ligament is needed most). At present, we are moving forward by obtaining in vivo kinematics data and then repeating those kinematics exactly to obtain new data with use of the robotic/universal force-moment sensor testing system in order to gain further insight regarding the function of the anterior cruciate ligament and anterior cruciate ligament replacement grafts in vivo. In parallel, we are developing a mathematical model of the knee and validating the computational model with experimental data. The combined approach will yield new and relevant information, including the stress and strain distribution in the anterior cruciate ligament and anterior cruciate ligament grafts. This will facilitate a better understanding of the function of the anterior cruciate ligament and a scientifically based design of surgical procedures and postoperative rehabilitation protocols that will lead to better patient outcomes.
Collapse
Affiliation(s)
- Savio L-Y. Woo
- Musculoskeletal Research Center, Swanson School of Engineering, Department of Bioengineering, 405 Center for Bioengineering, 300 Technology Drive, Pittsburgh, PA 15219. E-mail address for S.L-Y. Woo:
| | - Matthew B. Fisher
- Musculoskeletal Research Center, Swanson School of Engineering, Department of Bioengineering, 405 Center for Bioengineering, 300 Technology Drive, Pittsburgh, PA 15219. E-mail address for S.L-Y. Woo:
| |
Collapse
|
22
|
Abstract
Overuse tendinopathy remains a major clinical burden for sports medicine and general practitioners. Recent studies have highlighted the role of sensory and autonomic nerves in generating or perpetuating the symptoms and tissue abnormalities associated with tendinopathy. We outline the neuroanatomy and potential roles of nerves and associated neuropeptides in tendinopathy. In addition, intriguing new data is reviewed which suggests that there may be a substantial intrinsic source of neuropeptides within tendons - namely, the tenocytes themselves. The potential roles of Substance P and mast cells are highlighted in particular. We discuss the implications for conservative management including sclerosing injections and exercise training.
Collapse
Affiliation(s)
- Alexander Scott
- Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, Canada.
| | | |
Collapse
|
23
|
Lidén M, Movin T, Ejerhed L, Papadogiannakis N, Blomén E, Hultenby K, Kartus J. A histological and ultrastructural evaluation of the patellar tendon 10 years after reharvesting its central third. Am J Sports Med 2008; 36:781-8. [PMID: 18192494 DOI: 10.1177/0363546507311092] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE This study was undertaken to evaluate the histologic and ultrastructural characteristics of the patellar tendon 10 years after reharvesting its central third. HYPOTHESIS In the long term, after its central third is reharvested, the patellar tendon does not regain a normal histological and ultrastructural appearance. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Twelve consecutive patients (4 women, 8 men) who underwent anterior cruciate ligament revision surgery using reharvested ipsilateral patellar tendon autografts were included in the study. Percutaneous biopsy samples were obtained from the central and lateral parts of the patellar tendon under ultrasonographic guidance at a median of 116 months (range, 102-127 months) after the revision procedure. Eleven biopsy specimens from asymptomatic patellar tendons obtained from open anterior cruciate ligament reconstructions served as controls. The histologic characteristics and the presence of glycosaminoglycans were assessed using a light microscope, and the ultrastructure was assessed using a transmission electron microscope. RESULTS The histological evaluation revealed deterioration in fiber structure, increased cellularity, and increased vascularity in both the central and peripheral parts of the reharvested patellar tendon specimens compared with normal tendon specimens. No difference in the amount of glycosaminoglycans was seen in specimens from either part of the reharvested patellar tendons and the control specimens. The ultrastructural evaluation revealed that all the control specimens had a normal morphologic appearance and a compact extracellular matrix with regularly oriented collagen fibrils. Furthermore, in the control specimens, the fibril diameter was heterogeneous, with all fibril size classes present. Specimens from the central and the lateral part of the reharvested tendon displayed pathological cell appearance and a more heterogeneous extracellular matrix. The lateral specimens from the reharvested tendons also displayed all fibril size classes but with a more homogeneous distribution. In the central specimens, the largest fibril size class was absent. CONCLUSION Ten years after its central third was reharvested for anterior cruciate ligament revision surgery, the patellar tendon had not normalized in terms of its histological and ultrastructural appearance.
Collapse
Affiliation(s)
- Mattias Lidén
- Department of Plastic Surgery, Sahlgrenska University Hospital, SE-413 45 Göteborg, Sweden.
| | | | | | | | | | | | | |
Collapse
|
24
|
Svensson M, Movin T, Rostgård-Christensen L, Blomén E, Hultenby K, Kartus J. Ultrastructural collagen fibril alterations in the patellar tendon 6 years after harvesting its central third. Am J Sports Med 2007; 35:301-6. [PMID: 17099242 DOI: 10.1177/0363546506293898] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Clinically, donor site problems are common, even in the long term after anterior cruciate ligament reconstruction using patellar tendon autograft. However, there is a lack of knowledge in terms of the mid- and long-term ultrastructural appearance of the previously harvested tendon in humans. HYPOTHESIS The patellar tendon does not regain normal ultrastructure 6 years after harvesting its central third and leaving the defect open. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Thirteen patients were included in the study. Biopsy specimens were obtained from the central and lateral thirds of the patellar tendon under ultrasound guidance 71 months (range, 68-73 months) after the reconstruction. Ten biopsy specimens from other subjects with asymptomatic patellar tendons served as controls. The sections were evaluated using transmission electron microscopy. Longitudinal sections were used for morphological evaluation, and the fibril diameter was measured on the transverse sections and grouped into 5 diameter classes. RESULTS All control specimens were found to have a compact extracellular matrix with regularly oriented collagen fibrils. Specimens from the lateral part of the harvested tendons displayed a more heterogeneous extracellular matrix. In 3 specimens, the extracellular matrix was different from that of the control specimens. Specimens from the central part of the harvested tendons displayed an even more heterogeneous extracellular matrix, with 8 specimens judged as heterogeneous. The fibril diameter in control specimens displayed the most heterogeneous pattern, and all 5 fibril classes were present. All fibril classes were found in the lateral biopsy specimens from the previously harvested tendons, but the 2 smallest fibril classes (0-30 and 31-60 nm) were significantly more dominant compared with control specimens (P < .0001). In the central specimens from the previously harvested tendons, only the 3 smallest size classes were found (P < .0001 vs controls). CONCLUSION Six years after harvesting its central third and leaving the defect open, the patellar tendon revealed a "more heterogeneous matrix" with changes in ultrastructural morphology and relative fibril diameter distribution compared with normal control tendon.
Collapse
Affiliation(s)
- Michael Svensson
- Department of Orthopaedics, Norra Alvsborg/Uddevalla Hospital, SE-461 85 Trollhättan, Sweden
| | | | | | | | | | | |
Collapse
|