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Wang Z, Dong Z, Li Y, Jiao X, Liu Y, Chang H, Gan Y. Verapamil Attenuates the Severity of Tendinopathy by Mitigating Mitochondrial Dysfunction through the Activation of the Nrf2/HO-1 Pathway. Biomedicines 2024; 12:904. [PMID: 38672259 PMCID: PMC11048132 DOI: 10.3390/biomedicines12040904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 04/07/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
Tendinopathy is a prevalent condition in orthopedics patients, exerting a profound impact on tendon functionality. However, its underlying mechanism remains elusive and the efficacy of pharmacological interventions continues to be suboptimal. Verapamil is a clinically used medicine with anti-inflammation and antioxidant functions. This investigation aimed to elucidate the impact of verapamil in tendinopathy and the underlying mechanisms through which verapamil ameliorates the severity of tendinopathy. In in vitro experiments, primary tenocytes were exposed to interleukin-1 beta (IL-1β) along with verapamil at a concentration of 5 μM. In addition, an in vivo rat tendinopathy model was induced through the localized injection of collagenase into the Achilles tendons of rats, and verapamil was injected into these tendons at a concentration of 5 μM. The in vitro findings highlighted the remarkable ability of verapamil to attenuate extracellular matrix degradation and apoptosis triggered by inflammation in tenocytes stimulated by IL-1β. Furthermore, verapamil was observed to significantly suppress the inflammation-related MAPK/NFκB pathway. Subsequent investigations revealed that verapamil exerts a remediating effect on mitochondrial dysfunction, which was achieved through activation of the Nrf2/HO-1 pathway. Nevertheless, the protective effect of verapamil was nullified with the utilization of the Nrf2 inhibitor ML385. In summary, the in vivo and in vitro results indicate that the administration of verapamil profoundly mitigates the severity of tendinopathy through suppression of inflammation and activation of the Nrf2/HO-1 pathway. These findings suggest that verapamil is a promising therapeutic agent for the treatment of tendinopathy, deserving further and expanded research.
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Affiliation(s)
| | | | | | | | | | | | - Yaokai Gan
- Department of Orthopedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhi Zao Ju Road, Huangpu District, Shanghai 200011, China; (Z.W.); (Z.D.); (Y.L.); (X.J.); (Y.L.); (H.C.)
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Schroeter S, Heiss R, Hammer CM, Best R, Brucker P, Hinterwimmer S, Grim C, Engelhardt M, Hotfiel T. Pathogenesis and Diagnosis of Proximal Hamstring Tendinopathies. SPORTVERLETZUNG SPORTSCHADEN : ORGAN DER GESELLSCHAFT FUR ORTHOPADISCH-TRAUMATOLOGISCHE SPORTMEDIZIN 2024; 38:31-39. [PMID: 37348536 DOI: 10.1055/a-2010-8121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
The proximal hamstring complex is a highly vulnerable area that is especially prone to injury. Proximal hamstring tendinopathies (PHTs) remain challenging in diagnosis, treatment, rehabilitation, and prevention due to a large variety of different injuries, slow healing response, persistent symptoms, and functional impairments. PHTs are often misdiagnosed or underdiagnosed, leading to delayed treatment and therapy failure. In addition, many athletes are at a high risk of PHT recurrence, a leading cause of prolonged rehabilitation and impaired individual performance. Until now, there have been no clear criteria for the diagnosis and classification of PHT. Tendinopathies can be graded based on their symptoms and onset. Additionally, radiological characteristics exist that describe the severity of tendinopathies. The diagnosis usually includes a battery of pain provocation tests, functional tests, and imaging to ensure a proper classification. Understanding the specific tasks in the pathogenesis and diagnostic process of PHT requires knowledge of functional anatomy, injury pattern and pathophysiological mechanisms as well as examination and imaging techniques. This work provides a structured overview of the pathogenesis and diagnostic work-up of PHT, emphasizing structured examination and imaging to enable a reliable diagnosis and rapid treatment decisions.
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Affiliation(s)
- Sarah Schroeter
- Center for Muskuloskeletal Surgery Osnabrück (OZMC), Klinikum Osnabrück, Osnabrück, Germany
| | - Rafael Heiss
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Committee Muscle and Tendon, German-Austrian-Swiss Society for Orthopaedic Traumatologic Sports Medicine (GOTS), Germany
| | - Christian Manfred Hammer
- Institute of Functional and Clinical Anatomy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Anatomy Unit, Section of Medicine, University of Fribourg, Fribourg, Switzerland
| | - Raymond Best
- Committee Muscle and Tendon, German-Austrian-Swiss Society for Orthopaedic Traumatologic Sports Medicine (GOTS), Germany
- Department of Sports Medicine, University of Tuebingen, Tuebingen, Germany
- Department of Orthopaedic and Sports Trauma Surgery, Sportklinik Stuttgart GmbH, Stuttgart, Germany
| | | | | | - Casper Grim
- Center for Muskuloskeletal Surgery Osnabrück (OZMC), Klinikum Osnabrück, Osnabrück, Germany
- Department of Human Sciences Institute for Health Research and Education, University of Osnabrück, Osnabrück, Germany
| | - Martin Engelhardt
- Center for Muskuloskeletal Surgery Osnabrück (OZMC), Klinikum Osnabrück, Osnabrück, Germany
| | - Thilo Hotfiel
- Center for Muskuloskeletal Surgery Osnabrück (OZMC), Klinikum Osnabrück, Osnabrück, Germany
- Committee Muscle and Tendon, German-Austrian-Swiss Society for Orthopaedic Traumatologic Sports Medicine (GOTS), Germany
- Department of Orthopedic and Trauma Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Tharwat S, Saleh M, Elrefaey R, Nassar MK, Nassar MK. Clinical and Ultrasonographic Characteristics of the Achilles Tendon in Hemodialysis Patients. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2181. [PMID: 38138284 PMCID: PMC10744597 DOI: 10.3390/medicina59122181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/05/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: The early recognition of tendon alterations in chronic hemodialysis (HD) patients, an awareness of the factors that influence the condition, and active intervention have considerable clinical relevance. The aim of this study was to investigate the musculoskeletal ultrasound (MSUS) features of the Achilles tendon in chronic HD patients and determine the factors associated with tendon abnormalities. Materials and Methods: This study was conducted on 46 HD patients and 24 sex- and age-matched controls. All participants were evaluated clinically for any signs of Achilles tendon abnormalities. Then, the Achilles tendon was scanned bilaterally using MSUS. Results: Among the 92 Achilles tendons in the HD patients, there was tenderness and swelling of only two (2.2%). Regarding MSUS features, there were statistically significant higher thicknesses in the proximal end (p < 0.001), midpoint (p < 0.001), and distal end (p < 0.001) of the Achilles tendons in the HD patients when compared with the healthy controls. Tendinosis was found in 12 (13%) of the HD patients' Achilles tendons, which was statistically significant in comparison to the healthy controls (p = 0.008). There were statistically significant higher scores of structural abnormalities (p = 0.005), bone erosions (p = 0.017), and calcifications (p = 0.015) in the HD patients when compared to the healthy controls. According to the results of a univariate regression analysis, age and male gender were predictive for US abnormalities in HD patients (p = 0.002 and 0.025, respectively). Conclusions: The Achilles tendon in subjects on chronic HD showed frequent US abnormalities. These abnormalities in HD patients appear to be more related to age and gender and may be asymptomatic.
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Affiliation(s)
- Samar Tharwat
- Rheumatology & Immunology Unit, Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
- Department of Internal Medicine, Faculty of Medicine, Horus University, New Damietta 34517, Egypt;
| | - Marwa Saleh
- Mansoura Nephrology & Dialysis Unit (MNDU), Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt; (M.S.); (R.E.)
| | - Rabab Elrefaey
- Mansoura Nephrology & Dialysis Unit (MNDU), Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt; (M.S.); (R.E.)
| | - Mona Kamal Nassar
- Department of Radiology, Student Hospital, Mansoura University, Mansoura 35516, Egypt;
| | - Mohammed Kamal Nassar
- Department of Internal Medicine, Faculty of Medicine, Horus University, New Damietta 34517, Egypt;
- Mansoura Nephrology & Dialysis Unit (MNDU), Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt; (M.S.); (R.E.)
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Ortved KF. Equine Autologous Conditioned Serum and Autologous Protein Solution. Vet Clin North Am Equine Pract 2023; 39:443-451. [PMID: 37625916 DOI: 10.1016/j.cveq.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023] Open
Abstract
Orthobiologics are used with increasing frequency in equine musculoskeletal disease to improve the quality of the repair tissue and prevent reinjury. Autologous blood-based products, or hemoderivatives, are made by processing the patient's blood using different systems to produce a final therapeutic product. Autologous conditioned serum (ACS) and autologous protein solution (APS) are commonly used to treat joint disorders and can also be used treat tendon and ligament injuries. Hemoderivatives contain increased concentrations of anti-inflammatory and immunomodulatory cytokines, and growth factors that help direct tissue healing and repair. The specifics of ACS and APS for treatment of musculoskeletal injuries are discussed.
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Affiliation(s)
- Kyla F Ortved
- Clinical Studies-New Bolton Center, University of Pennsylvania, 382 West Street Road, Kennett Square, PA 19348, USA.
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van Dam L, Terink R, Mensink M, de Vos RJ, Zwerver J. The JUMPFOOD study: additional effect of hydrolyzed collagen and vitamin C to exercise treatment for patellar tendinopathy (jumper's knee) in athletes-study protocol for a double-blind randomized controlled trial. Trials 2023; 24:768. [PMID: 38017500 PMCID: PMC10685530 DOI: 10.1186/s13063-023-07783-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 11/06/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Patellar tendinopathy (PT) is a common problem in jumping athletes. Management can be challenging and treatment outcome is not always successful. In combination with tendon loading exercises, hydrolyzed collagen/vitamin C supplementation appears to have a promising effect on the recovery of tendinopathy. The aim of this study is to evaluate whether the use of oral supplementation of hydrolyzed collagen and vitamin C in combination with progressive tendon loading exercises (PTLE) is superior to PTLE and placebo on VISA-P score (which rates pain, function, sports participation) after 24 weeks for athletes with PT. METHODS The JUMPFOOD study is a double-blinded, two-armed randomized controlled trial, in which the effectiveness of oral supplementation of hydrolyzed collagen/vitamin C combined with PTLE compared to PTLE with placebo on pain and recovery of function in athletes with PT will be investigated. Seventy-six athletes aged 16-40 years, with symptoms of PT for at least 12 weeks, who play sports at least once a week will be included. All participants will receive education, advice with regard to load management and a PTLE program according to the Dutch guidelines for anterior knee pain. In addition, the intervention group will receive daily 10 g hydrolyzed collagen and 40 mg vitamin C supplementation for 24 weeks whereas the control group receives 10 g maltodextrin placebo supplementation. Measurements will take place at baseline and at 12 and 24 weeks' follow-up. Primary outcome is the VISA-P score, which evaluates pain, function, and sports participation. For secondary outcome measures, data with regard to pain during functional tests, flexibility measurements, blood withdrawals, imaging characteristics of the tendon, and health questionnaires will be collected. During the follow-up period, participants will register sports participation, amount of training and tendon load, pain during sports, co-medication, and side-effects in a digital weekly diary. DISCUSSION The JUMPFOOD study is the first large RCT to study the effectiveness of hydrolyzed collagen/vitamin C supplementation in combination with the PTLE program in athletes with patellar tendinopathy. If supplementation of collagen/vitamin C appears to be effective, this treatment can be implemented in daily sports medicine practice to improve the treatment outcome of patients with PT. TRIAL REGISTRATION ClinicalTrials.gov NCT05407194. Registered on 7 June 2022.
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Affiliation(s)
- L van Dam
- Department of Sports Medicine, SportsValley, Hospital Gelderse Vallei, Willy Brandtlaan 10, 6716 RP, Ede, The Netherlands.
- Division of Human Nutrition and Health, Wageningen University & Research (WUR), Wageningen, The Netherlands.
| | - R Terink
- Department of Sports Medicine, SportsValley, Hospital Gelderse Vallei, Willy Brandtlaan 10, 6716 RP, Ede, The Netherlands
| | - M Mensink
- Division of Human Nutrition and Health, Wageningen University & Research (WUR), Wageningen, The Netherlands
| | - R J de Vos
- Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - J Zwerver
- Department of Sports Medicine, SportsValley, Hospital Gelderse Vallei, Willy Brandtlaan 10, 6716 RP, Ede, The Netherlands
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Paula DD, França M, Leão L, Maciel A, Moura T, de Moraes S, Bahia C, Borges R, Batista E, Passos A, Oliveira K, Herculano A. Total rupture of Achilles tendon induces inflammatory response and glial activation on the spinal cord of mice. Braz J Med Biol Res 2023; 56:e12391. [PMID: 37851789 PMCID: PMC10578131 DOI: 10.1590/1414-431x2023e12391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 09/02/2023] [Indexed: 10/20/2023] Open
Abstract
Rupture of Achilles tendon is a common accident affecting professional and recreational athletes. Acute and chronic pain are symptoms commonly observed in patients with rupture. However, few studies have investigated whether Achilles tendon rupture is able to promote disorders in the central nervous system (CNS). Therefore, the current study aimed to evaluate nociceptive alterations and inflammatory response in the L5 lumbar segment of Balb/c mice spinal cord after Achilles tendon rupture. We found increased algesia in the paw of the ruptured group on the 7th and 14th days post-tenotomy compared with the control group. This phenomenon was accompanied by overexpression of cyclooxygenase-2 (COX-2) and inducible nitric oxide synthase-2 (NOS-2) as well as hyperactivation of astrocytes and microglia in nociceptive areas of L5 spinal cord as evidenced by intense GFAP and IBA-1 immunostaining, respectively. Biochemical studies also demonstrated increased levels of nitrite in the L5 spinal cord of tenotomized animals compared with the control group. Thus, we have demonstrated for the first time that total rupture of the Achilles tendon induced inflammatory response and nitrergic and glial activation in the CNS in the L5 spinal cord region.
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Affiliation(s)
- D.R. De Paula
- Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, Brasil
| | - M.S. França
- Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, Brasil
| | - L.K.R. Leão
- Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, Brasil
| | - A.A. Maciel
- Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, Brasil
| | - T.A.A. Moura
- Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, Brasil
| | - S.A.S. de Moraes
- Instituto de Ciências da Saúde, Universidade Federal do Pará, Belém, PA, Brasil
| | - C.P. Bahia
- Instituto de Ciências da Saúde, Universidade Federal do Pará, Belém, PA, Brasil
| | - R.S. Borges
- Instituto de Ciências da Saúde, Universidade Federal do Pará, Belém, PA, Brasil
| | - E.J.O. Batista
- Núcleo de Medicina Tropical, Universidade Federal do Pará, Belém, PA, Brasil
| | - A.C.F. Passos
- Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, Brasil
| | - K.R.H.M. Oliveira
- Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, Brasil
| | - A.M. Herculano
- Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, Brasil
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Escriche-Escuder A, Nijs J, Silbernagel KG, van Wilgen CP, Plinsinga ML, Casaña J, Cuesta-Vargas AI. Pain neuroscience education in persistent painful tendinopathies: A scoping review from the Tendon PNE Network. Phys Ther Sport 2023; 63:38-49. [PMID: 37499463 DOI: 10.1016/j.ptsp.2023.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE to conduct and report a scoping review of the available evidence of the effects and content of pain neuroscience education for patients with persistent painful tendinopathies. METHODS PubMed, Embase, Web of Science, CINAHL, SPORTDiscus, and grey literature databases were searched from database inception to May 2022. Randomised and non-randomised controlled trials, non-controlled clinical trials, cohort studies, case series, case studies including people with persistent painful tendinopathy aged ≥18 years, a pain education intervention, and in English were included. Studies were excluded if they were cross-sectional studies, reviews, editorials, abstracts, or full-text not available or if included heterogeneous study cohorts, patients with tendon rupture, or patients with systemic diseases. RESULTS five studies (n = 164) were included. Pain neuroscience education entailed face-to-face discussion sessions or educational materials including videos, brochures, paper drawings, and review questions. All studies used pain neuroscience education in conjunction with other interventions, obtaining significant benefits in outcomes related to pain, physical performance, or self-reported function, among others. CONCLUSIONS The application of pain neuroscience education in conjunction with other interventions seemed to improve several outcomes. However, considering the current knowledge about tendon pain and the scarcity of well-designed trials studying pain neuroscience education in tendinopathy, additional research is needed.
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Affiliation(s)
- Adrian Escriche-Escuder
- Department of Physiotherapy, University of Malaga, Malaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain
| | - Jo Nijs
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium; Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Belgium; Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | | | - C Paul van Wilgen
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium; Transcare Transdisciplinary Pain Management Center, Groningen, the Netherlands
| | - Melanie L Plinsinga
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - José Casaña
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Antonio I Cuesta-Vargas
- Department of Physiotherapy, University of Malaga, Malaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain; School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.
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Schmid T, Wegener F, Hotfiel T, Hoppe MW. Moderate evidence exists for four microRNAs as potential biomarkers for tendinopathies and degenerative tendon ruptures at the upper extremity in elderly patients: conclusion of a systematic review with best-evidence synthesis. J Exp Orthop 2023; 10:81. [PMID: 37563331 PMCID: PMC10415244 DOI: 10.1186/s40634-023-00645-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 07/22/2023] [Indexed: 08/12/2023] Open
Abstract
PURPOSE The aim of this systematic review was to investigate tendon-specific microRNAs (miRNAs) as biomarkers for the detection of tendinopathies or degenerative tendon ruptures. Also, their regulatory mechanisms within the tendon pathophysiology were summarized. METHODS A systematic literature research was performed using the PRISMA guidelines. The search was conducted in the Pubmed database. The SIGN checklist was used to assess the study quality of the included original studies. To determine the evidence and direction of the miRNA expression rates, a best-evidence synthesis was carried out, whereby only studies with at least a borderline methodological quality were considered for validity purposes. RESULTS Three thousand three hundred seventy studies were reviewed from which 22 fulfilled the inclusion criteria. Moderate evidence was found for miR-140-3p and miR-425-5p as potential biomarkers for tendinopathies as well as for miR-25-3p, miR-29a-3p, miR-140-3p, and miR-425-5p for the detection of degenerative tendon ruptures. This evidence applies to tendons at the upper extremity in elderly patients. All miRNAs were associated with inflammatory cytokines as interleukin-6 or interleukin-1ß and tumor necrosis factor alpha. CONCLUSIONS Moderate evidence exists for four miRNAs as potential biomarkers for tendinopathies and degenerative tendon ruptures at the upper extremity in elderly patients. The identified miRNAs are associated with inflammatory processes.
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Affiliation(s)
- Tristan Schmid
- Movement and Training Science, Leipzig University, Jahnallee 59, 04109, Leipzig, Germany.
| | - Florian Wegener
- Movement and Training Science, Leipzig University, Jahnallee 59, 04109, Leipzig, Germany
| | - Thilo Hotfiel
- Center for Musculoskeletal Surgery Osnabrück (OZMC), Klinikum Osnabrück, Am Finkenhügel 1, 49076, Osnabrueck, Germany
| | - Matthias W Hoppe
- Movement and Training Science, Leipzig University, Jahnallee 59, 04109, Leipzig, Germany
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Rodríguez-Sanz D, Losa-Iglesias ME, de Bengoa-Vallejo RB, Sánchez-Milá Z, Dorgham HAA, Elerian AE, Yu T, Calvo-Lobo C, Velázquez-Saornil J, Martínez Jimene EM. A New Test for Achilles Tendinopathy Based on Kager's Fat Pad Clinical Assessment Predictive Values. J Clin Med 2023; 12:5183. [PMID: 37629225 PMCID: PMC10455944 DOI: 10.3390/jcm12165183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 07/30/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023] Open
Abstract
Background This study aimed to check the diagnostic accuracy of a new test to identify Achilles tendinopathy. STUDY DESIGN Observational study. METHODS Seventy patients recruited from a private medical centre met the diagnostic criteria for unilateral Achilles tendinopathy (age, 45.1 ± 12.7 years; weight, 75.00 ± 10 kg; height, 1.75 ± 0.1 m) and were tested based on both Achilles tendons. Seventy patients with a unilateral Achilles tendinopathy ultrasound diagnosis were tested using David's test. RESULTS Most (86%) subjects demonstrated Kager's fat pad asymmetry in relation to the Achilles tendon in the complete passive dorsiflexion in the prone position (David's sign). No healthy tendons had David's sign. CONCLUSIONS The presence of asymmetry in Kager's fat pad in relation to the Achilles tendon during complete passive dorsiflexion is strongly indicative of ultrasound-diagnosed tendinopathy. David's test demonstrated a sensitivity of 85.71% (95% CI, 77.51% to 93.91%) and a specificity of 100% (95% CI, 100% to 100%), while noting the lack of blinding of the assessors and the uncertainty of the diagnostic measures (95% CI). Asymmetry of the fat pad could potentially serve as a characteristic marker for patients with Achilles tendinopathy.
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Affiliation(s)
- David Rodríguez-Sanz
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.B.d.B.-V.); (T.Y.); (C.C.-L.); (E.M.M.J.)
| | - Marta Elena Losa-Iglesias
- Faculty of Health Sciences, Universidad Rey Juan Carlos, 28933 Móstoles, Spain; (M.E.L.-I.); (J.V.-S.)
| | - Ricardo Becerro de Bengoa-Vallejo
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.B.d.B.-V.); (T.Y.); (C.C.-L.); (E.M.M.J.)
| | - Zacarías Sánchez-Milá
- Department of Physiotherapy, Faculty of Health Sciences, Universidad Católica de Ávila, 05005 Ávila, Spain;
| | | | - Ahmed Ebrahim Elerian
- Department of Basic Science for Physical Therapy, Faculty of Physical Therapy, Al Salam University, Tanta 31511, Egypt;
| | - Tian Yu
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.B.d.B.-V.); (T.Y.); (C.C.-L.); (E.M.M.J.)
| | - César Calvo-Lobo
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.B.d.B.-V.); (T.Y.); (C.C.-L.); (E.M.M.J.)
| | - Jorge Velázquez-Saornil
- Faculty of Health Sciences, Universidad Rey Juan Carlos, 28933 Móstoles, Spain; (M.E.L.-I.); (J.V.-S.)
| | - Eva María Martínez Jimene
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.B.d.B.-V.); (T.Y.); (C.C.-L.); (E.M.M.J.)
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10
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Götschi T, Held V, Klucker G, Niederöst B, Aagaard P, Spörri J, Passini FS, Snedeker JG. PIEZO1 gain-of-function gene variant is associated with elevated tendon stiffness in humans. J Appl Physiol (1985) 2023; 135:165-173. [PMID: 37227181 PMCID: PMC10625831 DOI: 10.1152/japplphysiol.00573.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 05/19/2023] [Accepted: 05/21/2023] [Indexed: 05/26/2023] Open
Abstract
Prolonged periods of increased physical demands can elicit anabolic tendon adaptations that increase stiffness and mechanical resilience or conversely can lead to pathological processes that deteriorate tendon structural quality with ensuing pain and potential rupture. Although the mechanisms by which tendon mechanical loads regulate tissue adaptation are largely unknown, the ion channel PIEZO1 has been implicated in tendon mechanotransduction, with human carriers of the PIEZO1 gain-of-function variant E756del displaying improved dynamic vertical jump performance compared with noncarriers. Here, we sought to examine whether increased tendon stiffness in humans could explain this increased performance. We assessed tendon morphological and mechanical properties with ultrasound-based techniques in 77 participants of Middle- and West-African descent, and we measured their vertical jumping performance to assess potential functional consequences in the context of high tendon strain-rate loading. Carrying the E756del gene variant (n = 30) was associated with 46.3 ± 68.3% (P = 0.002) and 45.6 ± 69.2% (P < 0.001) higher patellar tendon stiffness and Young's modulus compared with noncarrying controls, respectively. Although these tissue level measures strongly corroborate the initial postulate that PIEZO1 plays an integral part in regulating tendon material properties and stiffness in humans, we found no detectable correlation between tendon stiffness and jumping performance in the tested population that comprised individuals of highly diverse physical fitness level, dexterity, and jumping ability.NEW & NOTEWORTHY The E756del gene variant causes overactivity of the mechanosensitive membrane channel PIEZO1 and is suspected to upregulate tendon collagen cross linking. In human carriers of E756del, we found increased patellar tendon stiffness but similar tendon lengths and cross-sectional areas, directly supporting the premise that PIEZO1 regulates human tendon stiffness at the level of tissue material properties.
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Affiliation(s)
- Tobias Götschi
- Laboratory for Orthopaedic Biomechanics, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zürich, Switzerland
- Institute for Biomechanics, ETH Zurich, Zürich, Switzerland
| | - Victoria Held
- Institute for Biomechanics, ETH Zurich, Zürich, Switzerland
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zürich, Switzerland
| | - Gianna Klucker
- Institute for Biomechanics, ETH Zurich, Zürich, Switzerland
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zürich, Switzerland
| | - Barbara Niederöst
- Laboratory for Orthopaedic Biomechanics, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zürich, Switzerland
- Institute for Biomechanics, ETH Zurich, Zürich, Switzerland
| | - Per Aagaard
- Department of Orthopaedics, University Centre for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Zürich, Switzerland
| | - Jörg Spörri
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zürich, Switzerland
- Department of Orthopaedics, University Centre for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Zürich, Switzerland
| | - Fabian S Passini
- Laboratory for Orthopaedic Biomechanics, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zürich, Switzerland
- Institute for Biomechanics, ETH Zurich, Zürich, Switzerland
| | - Jess G Snedeker
- Laboratory for Orthopaedic Biomechanics, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zürich, Switzerland
- Institute for Biomechanics, ETH Zurich, Zürich, Switzerland
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11
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Eapen C, Rosita R, Sohani MS, Patel VD. A systematic review of the effectiveness of wrist manipulative therapy in patients with lateral epicondylitis. J Hand Ther 2023; 36:528-535. [PMID: 36918310 DOI: 10.1016/j.jht.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 10/05/2022] [Accepted: 10/09/2022] [Indexed: 03/16/2023]
Abstract
STUDY DESIGN Systematic review. INTRODUCTION Several treatment methods treat lateral epicondylitis, but there is no consensus regarding the most effective method. Research has suggested that joint mobilizations may help recover patients with lateral epicondylitis. PURPOSE OF THE STUDY To determine if wrist joint manipulations effectively improve pain, grip strength, ROM, and functional outcome in adults with lateral epicondylitis. METHODS Searches were performed in 6 databases to identify relevant clinical trials. Three reviewers independently extracted data and assessed the methodological quality using the PEDro scale. Standard data were extracted and summarized. RESULTS A total of 4 studies met the inclusion criteria. A best-evidence synthesis was used to summarize the results. The included studies found effectiveness in favor of wrist manipulations given for at least 3 weeks to reduce pain in lateral epicondylitis against comparison groups comprising ultrasound, laser, friction massage, and exercises. Functional outcomes varied considerably among studies. Grip strength showed varied results, and no effect was seen on wrist ROM. CONCLUSION The evidence is convincing that wrist joint manipulations positively affect pain in the short term, compared to comparison groups in the management of lateral epicondylitis. Future high-quality studies are recommended.
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Affiliation(s)
- Charu Eapen
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - Rachel Rosita
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Madhura S Sohani
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Vivek D Patel
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
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12
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Wasker SVZ, Challoumas D, Weng W, Murrell GAC, Millar NL. Is neurogenic inflammation involved in tendinopathy? A systematic review. BMJ Open Sport Exerc Med 2023; 9:e001494. [PMID: 36793930 PMCID: PMC9923261 DOI: 10.1136/bmjsem-2022-001494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2023] [Indexed: 02/11/2023] Open
Abstract
Neurogenic pain and inflammation have been hypothesised to play an important role in tendinopathy. This systematic review aimed to present and assess the evidence on neurogenic inflammation in tendinopathy. A systematic search was conducted through multiple databases to identify human case-control studies assessing neurogenic inflammation through the upregulation of relevant cells, receptors, markers and mediators. A newly devised tool was used for the methodological quality assessment of studies. Results were pooled based on the cell/receptor/marker/mediator assessed. A total of 31 case-control studies were eligible for inclusion. The tendinopathic tissue was obtained from Achilles (n=11), patellar (n=8), extensor carpi radialis brevis (n=4), rotator cuff (n=4), distal biceps (n=3) and gluteal (n=1) tendons. Through pooling the results of included studies based on the marker of neurogenic inflammation assessed, we identified possible upregulation of protein gene product 9.5 (PGP 9.5), N-methyl-D-aspartate Receptors, glutamate, glutamate receptors (mGLUT), neuropeptide Y (NPY) and adrenoreceptors in tendinopathic tissue versus control. Calcitonin gene-related peptide (CGRP) was not found to be upregulated, and the evidence was conflicting for several other markers. These findings show the involvement of the glutaminergic and sympathetic nervous systems and the upregulation of nerve ingrowth markers supporting the concept that neurogenic inflammation plays a role in tendinopathy.
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Affiliation(s)
- Shimon Vinay Zedeck Wasker
- Orthopaedic Research Institute, St George Hospital Sydney, University of New South Wales, Sydney, New South Wales, Australia
| | - Dimitris Challoumas
- School of Infection and Immunity, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Wai Weng
- Orthopaedic Research Institute, St George Hospital Sydney, University of New South Wales, Sydney, New South Wales, Australia
| | - George A C Murrell
- Orthopaedic Research Institute, St George Hospital Sydney, University of New South Wales, Sydney, New South Wales, Australia
| | - Neal L Millar
- School of Infection and Immunity, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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13
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Biceps Brachii Distal Tendon Ruptures: Conservative and Surgical Treatment Outcomes. TRAUMATOLOGY AND ORTHOPEDICS OF RUSSIA 2022. [DOI: 10.17816/2311-2905-1997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background. Interest in the study of the distal biceps brachii tendon ruptures in the recent decade has been caused by the development of instrumental diagnostic methods, the new sports disciplines appear and by the technological workplace environment complication. The main concepts of treatment depend on the injury term, the tendon tissue damage area, the patient functional needs and his/her professional activities, the comorbidity index (CCI), so the concepts are divided into two: conservative and surgical.
The aim of the study to identify the most effective method of treating patients with a biceps brachii distal tendon rupture.
Methods. The study included 58 patients (all men) with a biceps brachii distal tendon injury. They were divided into groups depending on the concept of treatment: a conservative treatment group 20 (34%) patients and a surgical treatment group 38 (66%). The surgical treatment group was also divided into subgroups according to surgical approaches, reinsertion methods and types of fixation. Patients underwent physical tests (ODriscoll, Ruland, et al.), ultrasound to compare the proximal radio-ulnar space, degree of muscle retraction, lacertus fibrosus involvement, and MRI of the elbow joint. The functional scales VAS, DASH and ASES were used to evaluate the obtained results. The results of instrumental diagnostic methods were evaluated with the L. Perera (2012) and J. Fuente (2018) classifications.
Results. Evaluation of the results in the groups of surgical (Ns) and conservative (Nc) treatment according to functional scales after 6 (VAS, DASH) and 36 months (ASES) revealed: a decrease in subjective pain score 1 point, a decrease in DASH to 21 and 43 points (statistically significant decrease in both groups p0.001, difference between groups p = 0.005), ASES: 91 and 71 points (dynamics in both groups and difference between groups p 0.001). Minimally invasive approaches compared with open access (nD) showed better functional outcomes according to the DASH scale: nBA vs nD p = 0.006; nMA vs nD p = 0.013 after 6 months, and according to the ASES scale: nBA vs nD p = 0.007; nBA vs nD p= 0.002 after 36 months. An reinsertion methods intragroup analysis revealed the achievement of peak indicators by 6 weeks without complications in the anatomical variant according to the VAS: nBA vs nMA p = 0.264; DASH: nBA vs nMA p = 0.856; ASES nBA vs nMA p = 0.179.
Conclusion. Comparison within subgroups made it possible to identify the most effective technique combination of minimally invasive access with an anatomical version of intracanal fixation with a cortical button. This technique has shown to have a low risk of postoperative complications.
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Verges J, Martínez N, Pascual A, Bibas M, Santiña M, Rodas G. Psychosocial and individual factors affecting Quality of Life (QoL) in patients suffering from Achilles tendinopathy: a systematic review. BMC Musculoskelet Disord 2022; 23:1114. [PMID: 36544133 PMCID: PMC9768977 DOI: 10.1186/s12891-022-06090-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Achilles tendinopathy (AT) is a joint condition that causes functional restrictions and pain. This condition negatively impacts patients' social connectedness and psychological well-being, reducing their quality of life (QoL). This review aims to summarise the current information on QoL in patients suffering from AT from different angles: compared to a healthy population, reported individual factors that influence it and the effects of some AT interventions on QoL. METHODS A systematic review was conducted at PubMed, Cochrane, Google Scholar, and PsycINFO using tendinopathy and QoL-related keywords up to November 2021. Articles were included if they compared QoL to demographic factors such as age or gender, lifestyle factors (physical activity levels), comorbidity factors (diabetes, obesity), and/or a control group. RESULTS Three hundred twenty-nine articles were reviewed; 23 met the inclusion criteria. SF-36, EQ-5D, and VISA-A were the most common instrument used. Patients with AT reported low QoL when compared to no AT population. When women were compared to men, women reported worse QoL. The patients who participated in different exercise programs (strengthening and stretching) showed improvements in QoL. Surgical AT intervention improved QoL, although results varied by age. CONCLUSION AT has a substantial impact on QoL. In AT patients, QoL is also influenced by specific individual factors, including gender and physical activity. Exercise, education, and surgical treatment improve QoL. We suggest more research on AT patients to better understand the aspects leading to poor QoL.
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Affiliation(s)
- Josep Verges
- Osteoarthritis Foundation International OAFI, Barcelona, Spain
| | - Nina Martínez
- Osteoarthritis Foundation International OAFI, Barcelona, Spain
| | - Aina Pascual
- Osteoarthritis Foundation International OAFI, Barcelona, Spain
| | - Marco Bibas
- Osteoarthritis Foundation International OAFI, Barcelona, Spain
| | - Manel Santiña
- Sociedad Española de Calidad Asistencial SECA, Oviedo, Spain
| | - Gil Rodas
- grid.498566.00000 0001 0805 9654Football Club Barcelona FCB, Barcelona, Spain
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Radovanović G, Bohm S, Peper KK, Arampatzis A, Legerlotz K. Evidence-Based High-Loading Tendon Exercise for 12 Weeks Leads to Increased Tendon Stiffness and Cross-Sectional Area in Achilles Tendinopathy: A Controlled Clinical Trial. SPORTS MEDICINE - OPEN 2022; 8:149. [PMID: 36538166 PMCID: PMC9768072 DOI: 10.1186/s40798-022-00545-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Assuming that the mechanisms inducing adaptation in healthy tendons yield similar responses in tendinopathic tendons, we hypothesized that a high-loading exercise protocol that increases tendon stiffness and cross-sectional area in male healthy Achilles tendons may also induce comparable beneficial adaptations in male tendinopathic Achilles tendons in addition to improving pain and function. OBJECTIVES We investigated the effectiveness of high-loading exercise in Achilles tendinopathy in terms of inducing mechanical (tendon stiffness, maximum strain), material (Young's modulus), morphological (tendon cross-sectional area (CSA)), maximum voluntary isometric plantar flexor strength (MVC) as well as clinical adaptations (Victorian Institute of Sports Assessment-Achilles (VISA-A) score and pain (numerical rating scale (NRS))) as the primary outcomes. As secondary outcomes, drop (DJ) and counter-movement jump (CMJ) height and intratendinous vascularity were assessed. METHODS We conducted a controlled clinical trial with a 3-month intervention phase. Eligibility criteria were assessed by researchers and medical doctors. Inclusion criteria were male sex, aged between 20 and 55 years, chronic Achilles tendinopathy confirmed by a medical doctor via ultrasound-assisted assessment, and a severity level of less than 80 points on the VISA-A score. Thirty-nine patients were assigned by sequential allocation to one of three parallel arms: a high-loading intervention (training at ~ 90% of the MVC) (n = 15), eccentric exercise (according to the Alfredson protocol) as the standard therapy (n = 15) and passive therapy (n = 14). Parameters were assessed pre- and-post-intervention. Data analysis was blinded. RESULTS Primary outcomes: Plantar flexor MVC, tendon stiffness, mean CSA and maximum tendon strain improved only in the high-loading intervention group by 7.2 ± 9.9% (p = 0.045), 20.1 ± 20.5% (p = 0.049), 8.98 ± 5.8% (p < 0.001) and -12.4 ± 10.3% (p = 0.001), respectively. Stiffness decreased in the passive therapy group (-7.7 ± 21.2%; p = 0.042). There was no change in Young's modulus in either group (p > 0.05). The VISA-A score increased in all groups on average by 19.8 ± 15.3 points (p < 0.001), while pain (NRS) dropped by -0.55 ± 0.9 points (p < 0.001). SECONDARY OUTCOMES CMJ height decreased for all groups (-0.63 ± 4.07 cm; p = 0.005). There was no change in DJ height and vascularity (p > 0.05) in either group. CONCLUSION Despite an overall clinical improvement, it was exclusively the high-loading intervention that induced significant mechanical and morphological adaptations of the plantar flexor muscle-tendon unit. This might contribute to protecting the tendon from strain-induced injury. Thus, we recommend the high-loading intervention as an effective (alternative) therapeutic protocol in Achilles tendinopathy rehabilitation management in males. CLINICAL TRIALS REGISTRATION NUMBER NCT02732782.
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Affiliation(s)
- Goran Radovanović
- grid.7468.d0000 0001 2248 7639Institute of Sports Sciences, Movement Biomechanics, Humboldt-Universität zu Berlin, Philippstr. 13, 10115 Berlin, Germany ,grid.11500.350000 0000 8919 8412Department Performance, Neuroscience, Therapy and Health, Medical School Hamburg, Faculty of Health Sciences, University of Applied Sciences and Medical University, 20457 Hamburg, Germany ,grid.11500.350000 0000 8919 8412Institute of Interdisciplinary Exercise Science and Sports Medicine, Medical School Hamburg, University of Applied Sciences and Medical University, 20457 Hamburg, Germany
| | - Sebastian Bohm
- grid.7468.d0000 0001 2248 7639Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, 10099 Berlin, Germany
| | - Kim Kristin Peper
- grid.6936.a0000000123222966Munich Institute of Robotics and Machine Intelligence, Technische Universität München, 80992 Munich, Germany
| | - Adamantios Arampatzis
- grid.7468.d0000 0001 2248 7639Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, 10099 Berlin, Germany
| | - Kirsten Legerlotz
- grid.7468.d0000 0001 2248 7639Institute of Sports Sciences, Movement Biomechanics, Humboldt-Universität zu Berlin, Philippstr. 13, 10115 Berlin, Germany
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16
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Lucado AM, Day JM, Vincent JI, MacDermid JC, Fedorczyk J, Grewal R, Martin RL. Lateral Elbow Pain and Muscle Function Impairments. J Orthop Sports Phys Ther 2022; 52:CPG1-CPG111. [PMID: 36453071 DOI: 10.2519/jospt.2022.0302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Although often described as a self-limiting condition and likely to resolve on its own, high recurrence rates and extended sick leave frame a need for effective non-surgical treatment for people with lateral elbow tendinopathy. The interrelationship of histological and structural changes to the tendon, the associated impairments in motor control, and potential changes in pain processing may all drive symptoms. This clinical practice guideline covers the epidemiology, functional anatomy and pathophysiology, risk factors, clinical course, prognosis, differential diagnosis, tests and measures, and interventions for managing lateral elbow tendinopathy in the physical therapy clinic. J Orthop Sports Phys Ther 2022;52(12):CPG1-CPG111. doi:10.2519/jospt.2022.0302.
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17
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Histologic grading correlates with inflammatory biomarkers in tibialis posterior tendon dysfunction. Foot Ankle Surg 2022; 28:1266-1271. [PMID: 35667952 DOI: 10.1016/j.fas.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 04/17/2022] [Accepted: 05/23/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND It has been theorized that tibialis posterior tendon dysfunction (TPTD) is a degenerative process unrelated to inflammation. The purpose of this study was to determine if inflammatory cytokines, matrix metalloproteases (MMPs), and glutamate were elevated in diseased tibialis posterior tendons (TPTs). METHODS Matched diseased TPT, TPT insertion, and flexor digitorum longus (FDL) samples were collected from 21 patients. The samples were individually incubated in media, which was analyzed for inflammatory cytokines, MMPs, and glutamate. Histology and statistical analyses were performed. RESULTS Diseased TPT and TPT insertion were significantly elevated compared to transferred FDL in eight inflammatory markers (p < 0.005). Only the diseased TPT was significantly elevated compared to the transferred FDL tendons for glutamate (p < 0.01). Histologic grading correlated with inflammatory cytokine levels. CONCLUSION Diseased TPT and TPT insertion demonstrated significantly elevated levels of inflammatory markers compared to the transferred tendons used as controls, suggesting a role for inflammation in the disease process. The amount of inflammation correlated with increased tendon degradation. LEVEL OF EVIDENCE Level III.
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18
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Wright L, Hernlund E, Fjordbakk C, Ytrehus B, Law E, Uhlhorn M, Rhodin M. Patellar ligament desmopathy in the horse – a review and comparison to human patellar tendinopathy (‘Jumper’s knee’). COMPARATIVE EXERCISE PHYSIOLOGY 2022. [DOI: 10.3920/cep220011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patellar ligament desmopathy in horses is regarded as an uncommon condition with unclear aetiology. Of the three patellar ligaments in the horse, the intermediate is the one most often diagnosed with desmopathy in horses presenting with chronic lameness. This structure corresponds to the patellar tendon in humans. As diagnostic imaging modalities continuously improve, changes in echogenicity of the patellar ligaments are identified ultrasonographically with increasing frequency. However, disruption of the normal fibre pattern may be present also in patellar ligaments in horses that show no signs of lameness. Similarly, there is a poor correlation between pain and diagnostic imaging findings in human patellar tendinopathy. Consequently, there appears to be a knowledge gap pertaining to normal ultrasonographic variation and diagnostic criteria for disease of the patellar ligaments in horses. Furthermore, local anaesthetic techniques to verify the diagnosis are poorly described, and due to the low number of treated cases, no specific treatment modality can be recommended on a scientific basis. The aim of this paper is to review the current knowledge regarding the pathogenesis, diagnosis and management of patellar ligament desmopathy in horses, compare this condition with patellar tendinopathy in humans, and identify areas for further research to increase the diagnostic accuracy in horses. We conclude that there is a profound need for better descriptions of ultrasonographic variation and pathological changes of the equine patellar ligaments. Identification of areas of maximal ligament strain and descriptions of early histopathological changes could render more information on the possible aetiology, preventive measurements and treatment options of desmopathy. Description of regional innervation could aid in development of methods for diagnostic anaesthesia to verify pain originating from the ligaments.
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Affiliation(s)
- L. Wright
- Department of Anatomy, Physiology and Biochemistry, Swedish University of Agricultural Sciences, P.O. Box 7011, 750 07 Uppsala, Sweden
| | - E. Hernlund
- Department of Anatomy, Physiology and Biochemistry, Swedish University of Agricultural Sciences, P.O. Box 7011, 750 07 Uppsala, Sweden
| | - C.T. Fjordbakk
- Department of Companion Animal Clinical Sciences, Faculty of Veterinary Medicine, Norwegian University of Life Sciences, Oluf Thesens vei 24, 1432 Ås, Norway
| | - B. Ytrehus
- Department of Biomedicine and Veterinary Public Health, Swedish University of Agricultural Sciences, P.O. Box 7028, 750 07 Uppsala, Sweden
| | - E. Law
- University Animal Hospital, P.O. Box 7040, 750 07 Uppsala, Sweden
| | - M. Uhlhorn
- University Animal Hospital, P.O. Box 7040, 750 07 Uppsala, Sweden
| | - M. Rhodin
- Department of Anatomy, Physiology and Biochemistry, Swedish University of Agricultural Sciences, P.O. Box 7011, 750 07 Uppsala, Sweden
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Ko KR, Han SH, Choi S, An HJ, Kwak EB, Jeong Y, Baek M, Lee J, Choi J, Kim IS, Lee S. Substance P Inhibitor Promotes Tendon Healing in a Collagenase-Induced Rat Model of Tendinopathy. Am J Sports Med 2022; 50:3681-3689. [PMID: 36197354 DOI: 10.1177/03635465221126175] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The substance P-neurokinin 1 receptor pathway has been proposed as a therapeutic target for tendinopathy. However, there is a lack of evidence regarding its practical applications. PURPOSE To investigate the therapeutic effects of substance P inhibitor (SPI) on inflamed tenocytes in vitro and in a collagenase-induced rat model of tendinopathy in vivo. STUDY DESIGN Controlled laboratory study. METHODS We analyzed the mRNA levels of inflammatory (cyclooxygenase [COX]-2 and interleukin [IL]-6) and tenogenic (Mohawk and scleraxis [SCX]) markers using reverse transcription quantitative polymerase chain reaction to demonstrate the effects of SPI on lipopolysaccharide-treated (inflamed) tenocytes. A collagenase-induced rat model of tendinopathy was created by injecting 20 µL of collagenase into the Achilles tendon. A behavior test using an incapacitance apparatus was performed to detect changes in postural equilibrium. The tendon specimens were obtained, and their gross findings were examined. The tensile strength was measured, and histopathological evaluation was performed (hematoxylin and eosin, alcian blue, and immunohistochemical staining). RESULTS The mRNA levels of COX-2, IL-6, Mohawk, and SCX differed significantly between inflamed tenocytes and those treated with SPI. SPI improved the weight burden in a rat model of tendinopathy in a behavioral test. The specimens of the SPI group showed a normal tendon-like appearance. In the biomechanical test, the tensile strength of the SPI group was significantly greater than that of the tendinopathy group. In the histopathological evaluation, the degree of collagen matrix breakdown was mild in the SPI group. In alcian blue staining, only small focal depositions of proteoglycans and glycosaminoglycans were observed in the SPI group. The SPI group showed decreased expression of IL-6 and neurokinin 1 receptor. CONCLUSION This study suggests that SPI has therapeutic effects on tendon healing and restoration in a collagenase-induced rat model of tendinopathy. CLINICAL RELEVANCE SPI is a promising agent for tendinopathy in humans.
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Affiliation(s)
- Kyung Rae Ko
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Soo-Hong Han
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam-si, Republic of Korea
| | - Sujin Choi
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam-si, Republic of Korea
| | - Hyun-Ju An
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam-si, Republic of Korea
| | - Eun-Bee Kwak
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam-si, Republic of Korea
| | - Yunhui Jeong
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam-si, Republic of Korea
| | - Minjung Baek
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam-si, Republic of Korea
| | - Jusung Lee
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam-si, Republic of Korea
| | - Junwon Choi
- Department of Molecular Science and Technology, Ajou University, Suwon-si, Republic of Korea
| | - Il-Su Kim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Soonchul Lee
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam-si, Republic of Korea
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Markazi R, Soltani-Zangbar MS, Zamani M, Eghbal-Fard S, Motavalli R, Kamrani A, Dolati S, Ahmadi M, Aghebati-Maleki L, Mehdizadeh A, Eslamian F, Pishgahi A, Yousefi M. Platelet lysate and tendon healing: comparative analysis of autologous frozen-thawed PRP and ketorolac tromethamine in the treatment of patients with rotator cuff tendinopathy. Growth Factors 2022; 40:163-174. [PMID: 36026559 DOI: 10.1080/08977194.2022.2093198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Platelet-rich blood derivatives are being nowadays increasingly used in the treatment of tendon-related pathologies as a rich source of growth factors. We sought to ascertain if local application of platelet lysate (PL) to augment rotator cuff repair ameliorates patient outcomes compared to ketorolac tromethamine treated group. A total of forty patients, with clinical diagnosis of Rotator Cuff Tendinopathy were randomized to receive sub acromial injections of PL every week for a total of 3 injections and two injection of ketorolac tromethamine once every two weeks. Subjective assessments included VAS, SPADI and shoulder range of motion were assessed at baseline and at 1 and 6 months after injection. Taking both control and PL groups, it was vividly seen that the outcomes were identical at the initial state, as well as the short-term one; whereas, when considering the 6-month period, there is a seemingly remarkable superiority in PL group in all parameters.
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Affiliation(s)
- Raha Markazi
- Physical Medicine and Rehabilitation Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Sadegh Soltani-Zangbar
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Immunology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Majid Zamani
- Department of Medical Laboratory Sciences, Faculty of Allied Medicine, Infectious Diseases Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Shadi Eghbal-Fard
- Department of Immunology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Roza Motavalli
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amin Kamrani
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sanam Dolati
- Physical Medicine and Rehabilitation Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Majid Ahmadi
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Amir Mehdizadeh
- Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fariba Eslamian
- Physical Medicine and Rehabilitation Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Alireza Pishgahi
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mehdi Yousefi
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Immunology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Calderón-Díez L, Sánchez-Sánchez JL, Robles-García M, Belón-Pérez P, Fernández-de-las-Peñas C. Cadaveric and Ultrasound Validation of Percutaneous Electrolysis Approach at the Achilles Tendon as a Potential Treatment for Achilles Tendinopathy: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11906. [PMID: 36231206 PMCID: PMC9564456 DOI: 10.3390/ijerph191911906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 06/16/2023]
Abstract
Achilles tendon tendinopathy (AT) is a musculoskeletal condition characterized by pain in the Achilles tendon and impaired physical performance or sport activities. AT is difficult to treat, and the results are variable. Preliminary evidence suggests a positive effect for pain of percutaneous electrolysis in patients with tendinopathy. Our aim was to determine the validity and safety of a percutaneous electrolysis approach targeting the interphase between the Achilles tendon and the Kager's fat with ultrasound imaging in both healthy individuals and on a fresh cadaver model (not ultrasound guiding). A needle was inserted from the medial to the lateral side under the body of the Achilles tendon, just between the tendon and the Kager's triangle, about 5 cm from the insertion of tendon in the calcaneus in 10 healthy volunteers (ultrasound study) and 10 fresh cadaver legs. An accurate needle penetration of the interphase was observed in 100% of the approaches, in both human and cadaveric models. No neurovascular bundle of the sural nerve was pierced in any insertion. The distance from the tip of the needle to the sural nerve was 5.28 ± 0.7 mms in the cadavers and 4.95 ± 0.68 mms in the volunteer subjects, measured in both cases at a distance of 5 cm from the insertion of the Achilles tendon. The results of the current study support that percutaneous electrolysis can be safely performed at the Kager's fat-Achilles tendon interphase if it is US guided. In fact, penetration of the sural nerve was not observed in any needle approach when percutaneous needling electrolysis was performed by an experienced clinician. Future studies investigating the clinical effectiveness of the proposed intervention are needed.
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Affiliation(s)
- Laura Calderón-Díez
- Department of Physical Therapy, Universidad de Salamanca, 37008 Salamanca, Spain
| | | | - Miguel Robles-García
- Department of Anatomy and Histology, Faculty of Medicine, Universidad de Salamanca, 37008 Salamanca, Spain
| | | | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), 28922 Alcorcón, Spain
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
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22
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Freedman BR, Mooney DJ, Weber E. Advances toward transformative therapies for tendon diseases. Sci Transl Med 2022; 14:eabl8814. [PMID: 36070365 PMCID: PMC11041812 DOI: 10.1126/scitranslmed.abl8814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Approved therapies for tendon diseases have not yet changed the clinical practice of symptomatic pain treatment and physiotherapy. This review article summarizes advances in the development of novel drugs, biologic products, and biomaterial therapies for tendon diseases with perspectives for translation of integrated therapies. Shifting from targeting symptom relief toward disease modification and prevention of disease progression may open new avenues for therapies. Deep evidence-based clinical, cellular, and molecular characterization of the underlying pathology of tendon diseases, as well as therapeutic delivery optimization and establishment of multidiscipline interorganizational collaboration platforms, may accelerate the discovery and translation of transformative therapies for tendon diseases.
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Affiliation(s)
- Benjamin R. Freedman
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02138, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115, USA
| | - David J. Mooney
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02138, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115, USA
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23
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Al-Shudiefat AARS, AM Alzyoud J, Al Najjar SA, Talat S, Bustanji Y, Abu-Irmaileh B. The effects of some natural products compared to synthetic products on the metabolic activity, proliferation, viability, migration, and wound healing in sheep tenocytes. Saudi J Biol Sci 2022; 29:103391. [PMID: 35942163 PMCID: PMC9356204 DOI: 10.1016/j.sjbs.2022.103391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 07/17/2022] [Accepted: 07/17/2022] [Indexed: 11/30/2022] Open
Abstract
Background Tendinopathy or tendon injuries can affect many people, causing a huge impact on their movements and maintaining standing posture. Treatment options include physiotherapy, anti-inflammatory drugs, and alternative medicine. The use of physiotherapy or anti-inflammatory drugs may cause some side effects like pain and liver failure, respectively, therefore, alternative medicine will be a better choice. Method Tenocytes were isolated from sheep Achilles tendon and used in Alamar blue assay to assess the metabolic activity, proliferation, and viability of tenocytes over 24 hrs. and 48 hrs., using natural and synthetic products [i.e., olive oil, oleic acid, corn oil, Inula viscosa oil, Inula viscosa extract, Nigella sativa oil, naproxen sodium, and paracetamol and LED photobiomodulation]. Furthermore, tenocytes viability was assessed by FDA/PI stain. For migration and healing of a wound, the scratch assay was used. Results Alamar blue assay over 24 hrs. showed that Nigella sativa oil increased the metabolic activity, proliferation, and viability of tenocytes significantly, while Alamar blue over 48 hrs. showed that oleic acid, LED, and their combination increased these parameters for tenocytes significantly. Olive oil increased the viability of tenocytes significantly using FDA/PI stains. Scratch assay revealed that Inula viscosa oil, Inula viscosa extract, and paracetamol increased tenocyte migration and healing significantly. Conclusion Nigella sativa oil, olive oil, oleic acid, Inula viscosa oil, and Inula viscosa extract may be used as an alternative therapy for tendinopathy with less side effects.
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Affiliation(s)
- Abd Al-Rahman Salem Al-Shudiefat
- Department of Medical, Laboratory Sciences Faculty of Applied Medical Sciences, The Hashemite University, Zarqa 13133, Jordan
- Corresponding author at: Department of Medical Laboratory Sciences Faculty of Applied Medical Sciences, The Hashemite University, Zarqa 13133, Jordan.
| | - Jihad AM Alzyoud
- Department of Basic Medical Sciences, Faculty of Medicine, The Hashemite University, Zarqa 13133, Jordan
| | - Saleh A Al Najjar
- Jordan University Hospital, The University of Jordan, Amman 11942, Jordan
| | - Seham Talat
- Department of Medical laboratory Sciences , College of science, Mutah University, Karak 61710, Jordan
| | - Yasser Bustanji
- Department of Basic Medical Sciences, College of Medicine, University of Sharjah, Sharjah 27272, UAE
- School of Pharmacy, The University of Jordan, Amman 11942, Jordan
| | - Bashaer Abu-Irmaileh
- Hamdi Mango Centre for Scientific Research, The University of Jordan, Amman 11942, Jordan
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24
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Götschi T, Hanimann J, Schulz N, Huser S, Held V, Frey WO, Snedeker JG, Spörri J. Patellar Tendon Shear Wave Velocity Is Higher and has Different Regional Patterns in Elite Competitive Alpine Skiers than in Healthy Controls. Front Bioeng Biotechnol 2022; 10:858610. [PMID: 35757800 PMCID: PMC9218688 DOI: 10.3389/fbioe.2022.858610] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/18/2022] [Indexed: 11/13/2022] Open
Abstract
Competitive alpine skiers are exposed to enormous forces acting on their bodies–particularly on the knee joint and hence the patellar tendon - during both the off-season preparation and in-season competition phases. However, factors influencing patellar tendon adaptation and regional pattern differences between alpine skiers and healthy controls are not yet fully understood, but are essential for deriving effective screening approaches and preventative countermeasures. Thirty elite competitive alpine skiers, all members of the Swiss Alpine Ski Team, and 38 healthy age-matched controls were recruited. A set of two-dimensional shear wave elastography measurements of the PT was acquired and projected into three-dimensional space yielding a volumetric representation of the shear wave velocity profile of the patellar tendon. Multivariate linear models served to quantify differences between the two cohorts and effects of other confounding variables with respect to regional shear wave velocity. A significant (p < 0.001) intergroup difference was found between skiers (mean ± SD = 10.4 ± 1.32 m/s) and controls (mean ± SD = 8.9 ± 1.59 m/s). A significant sex difference was found within skiers (p = 0.024), but no such difference was found in the control group (p = 0.842). Regional SWV pattern alterations between skiers and controls were found for the distal region when compared to the mid-portion (p = 0.023). Competitive alpine skiers exhibit higher SWV in all PT regions than healthy controls, potentially caused by long-term adaptations to heavy tendon loading. The presence of sex-specific differences in PT SWV in skiers but not in controls indicates that sex effects have load-dependent dimensions. Alterations in regional SWV patterns between skiers and controls suggest that patellar tendon adaptation is region specific. In addition to the implementation of 3D SWE, deeper insights into long-term tendon adaptation and normative values for the purpose of preventative screening are provided.
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Affiliation(s)
- Tobias Götschi
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Jonas Hanimann
- Sports Medical Research Group, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,University Centre for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Nicole Schulz
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Simon Huser
- Sports Medical Research Group, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,University Centre for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Victoria Held
- Sports Medical Research Group, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,University Centre for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Walter O Frey
- Sports Medical Research Group, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,University Centre for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Jess G Snedeker
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Jörg Spörri
- Sports Medical Research Group, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,University Centre for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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25
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Götschi T, Franchi MV, Schulz N, Fröhlich S, Frey WO, Snedeker JG, Spörri J. Altered regional 3D shear wave velocity patterns in youth competitive alpine skiers suffering from patellar tendon complaints - A prospective case-control study. Eur J Sport Sci 2022; 23:1068-1076. [PMID: 35699187 DOI: 10.1080/17461391.2022.2088404] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractPatellar tendon (PT) complaints are frequent throughout the population, with increased occurrence in athletes and, particularly, in youth competitive alpine skiers. Timely detection and treatment might improve prospects of recovery. Diagnostic modalities in clinical use to date rely on pain symptoms, manual palpation, and potentially, magnetic resonance imaging (MRI); however, MRI-based imaging yields limited sensitivity. Quantitatively measuring the morphological and mechanical properties of PTs by means of B-mode ultrasound and shear wave elastography (SWE), instead, may allow improved diagnosis or even early detection. We performed B-mode scans and three-dimensional ultrasound shear wave velocity (SWV) mapping and MRI of the PT in 106 youth skiers. A prospective one-year survey on health problems combined with clinical assessments served to categorize symptomatic and asymptomatic youth skiers. Skiers suffering from distal or proximal tendon complaints showed lower SWV in the respective tendon region than asymptomatic skiers (p = 0.035 and p = 0.019, respectively). Youth skiers with distal tendon complaints additionally exhibited decreased SWV in the proximal region compared to asymptomatic counterparts (p = 0.020). Cross-validated analysis of retrospective prediction indicated sensitivity and specificity in detecting tendon complaints in the range of 0.606-0.621 and 0.536-0.650, respectively. MRI detected distal tendon complaints with a sensitivity of 0.410 (12/29) but failed to detect any proximal cases. This study agrees with the most recent literature in that SWE holds promise as a valuable adjunct modality for the diagnosis of PT complaints or even the detection of subclinical prestages. However, to evaluate its prospective predictive value, long-term studies are warranted.
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Affiliation(s)
- Tobias Götschi
- Orthopaedic Biomechanics Laboratory, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland.,Institute for Biomechanics, ETH Zurich, Switzerland.,Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland
| | - Martino V Franchi
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland.,Institute of Physiology, Department of Biomedical Sciences, University of Padova, Padua, Italy
| | | | - Stefan Fröhlich
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland.,University Centre for Prevention and Sports Medicine, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland
| | - Walter O Frey
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland.,University Centre for Prevention and Sports Medicine, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland
| | - Jess G Snedeker
- Orthopaedic Biomechanics Laboratory, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland.,Institute for Biomechanics, ETH Zurich, Switzerland
| | - Jörg Spörri
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland.,University Centre for Prevention and Sports Medicine, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland
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26
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Xu H, Zhu Y, Xu J, Tong W, Hu S, Chen Y, Deng S, Yao H, Li J, Lee C, Chan HF. Injectable bioactive glass/sodium alginate hydrogel with immunomodulatory and angiogenic properties for enhanced tendon healing. Bioeng Transl Med 2022; 8:e10345. [PMID: 36684098 PMCID: PMC9842034 DOI: 10.1002/btm2.10345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/17/2022] [Accepted: 04/29/2022] [Indexed: 01/25/2023] Open
Abstract
Tendon healing is a complex process involving inflammation, proliferation, and remodeling, eventually achieving a state of hypocellularity and hypovascularity. Currently, few treatments can satisfactorily restore the structure and function of native tendon. Bioactive glass (BG) has been shown to possess immunomodulatory and angiogenic properties. In this study, we investigated whether an injectable hydrogel fabricated of BG and sodium alginate (SA) could be applied to enhance tenogenesis following suture repair of injured tendon. We demonstrated that BG/SA hydrogel significantly accelerated tenogenesis without inducing heterotopic ossification based on histological analysis. The therapeutic effect could attribute to increased angiogenesis and M1 to M2 phenotypic switch of macrophages within 7 days post-surgery. Morphological characterization demonstrated that BG/SA hydrogel partially reverted the pathological changes of Achilles tendon, including increased length and cross-sectional area (CSA). Finally, biomechanical test showed that BG/SA hydrogel significantly improved ultimate load, failure stress, and tensile modulus of the repaired tendon. In conclusion, administration of an injectable BG/SA hydrogel can be a novel and promising therapeutic approach to augment Achilles tendon healing in conjunction with surgical intervention.
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Affiliation(s)
- Hongtao Xu
- Musculoskeletal Research Laboratory, Department of Orthopedics and TraumatologyThe Chinese University of Hong KongHong Kong SARChina,Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory, Li Ka Shing Institute of Health SciencesThe Chinese University of Hong KongHong Kong SARChina,Department of OrthopedicsThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Yanlun Zhu
- Institute for Tissue Engineering and Regenerative Medicine, Faculty of MedicineThe Chinese University of Hong KongHong Kong SARChina,Key Laboratory for Regenerative Medicine of the Ministry of Education of China, School of Biomedical Sciences, Faculty of MedicineThe Chinese University of Hong KongHong Kong SARChina
| | - Jiankun Xu
- Musculoskeletal Research Laboratory, Department of Orthopedics and TraumatologyThe Chinese University of Hong KongHong Kong SARChina,Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory, Li Ka Shing Institute of Health SciencesThe Chinese University of Hong KongHong Kong SARChina
| | - Wenxue Tong
- Musculoskeletal Research Laboratory, Department of Orthopedics and TraumatologyThe Chinese University of Hong KongHong Kong SARChina,Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory, Li Ka Shing Institute of Health SciencesThe Chinese University of Hong KongHong Kong SARChina
| | - Shiwen Hu
- Musculoskeletal Research Laboratory, Department of Orthopedics and TraumatologyThe Chinese University of Hong KongHong Kong SARChina,Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory, Li Ka Shing Institute of Health SciencesThe Chinese University of Hong KongHong Kong SARChina,School of Materials Science and EngineeringLanzhou University of TechnologyLanzhouChina
| | - Yi‐Fan Chen
- The Ph.D. Program for Translational Medicine, College of Medical Science and TechnologyTaipei Medical UniversityTaipeiTaiwan,Graduate Institute of Translational Medicine, College of Medical Science and TechnologyTaipei Medical UniversityTaipeiTaiwan,International Ph.D. Program for Translational Science, College of Medical Science and TechnologyTaipei Medical UniversityTaipeiTaiwan,Master Program in Clinical Genomics and Proteomics, School of PharmacyTaipei Medical UniversityTaipeiTaiwan
| | - Shuai Deng
- Institute for Tissue Engineering and Regenerative Medicine, Faculty of MedicineThe Chinese University of Hong KongHong Kong SARChina,Key Laboratory for Regenerative Medicine of the Ministry of Education of China, School of Biomedical Sciences, Faculty of MedicineThe Chinese University of Hong KongHong Kong SARChina
| | - Hao Yao
- Musculoskeletal Research Laboratory, Department of Orthopedics and TraumatologyThe Chinese University of Hong KongHong Kong SARChina,Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory, Li Ka Shing Institute of Health SciencesThe Chinese University of Hong KongHong Kong SARChina
| | - Jie Li
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower HospitalThe Affiliated Hospital of Nanjing University Medical SchoolNanjingChina
| | - Chien‐Wei Lee
- Center for Translational Genomics ResearchChina Medical University Hospital, China Medical UniversityTaichungTaiwan
| | - Hon Fai Chan
- Institute for Tissue Engineering and Regenerative Medicine, Faculty of MedicineThe Chinese University of Hong KongHong Kong SARChina,Key Laboratory for Regenerative Medicine of the Ministry of Education of China, School of Biomedical Sciences, Faculty of MedicineThe Chinese University of Hong KongHong Kong SARChina,Hong Kong Branch of CAS Center for Excellence in Animal Evolution and GeneticsThe Chinese University of Hong KongHong Kong SARChina,Center for Neuromusculoskeletal Restorative MedicineHong Kong Science ParkHong Kong SARChina
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27
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Krogh TP, Jensen TT, Madsen MN, Fredberg U. An Isometric and Functionally Based 4-Stage Progressive Loading Program in Achilles Tendinopathy: A 12-Month Pilot Study. TRANSLATIONAL SPORTS MEDICINE 2022; 2022:6268590. [PMID: 38655172 PMCID: PMC11022783 DOI: 10.1155/2022/6268590] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/05/2022] [Accepted: 04/13/2022] [Indexed: 04/26/2024]
Abstract
Background Achilles tendinopathy (AT) is a common musculoskeletal disorder, and its management remains challenging. Hypothesis/Purpose. By conducting a pilot study, we aimed to assess the feasibility, safety, and clinical improvement of a new home-based 4-stage rehabilitation program with progressive loading including isometric exercises on a small scale prior to setting up a randomized controlled trial. Methods Ten recreational athletes with chronic midportion AT were included. The primary outcome was change in VISA-A score after 1, 2, 3, 6, and 12 months. Secondary outcomes included tenderness on palpation of the tendon and ultrasonographic changes after 6 months. Results Average VISA-A improvements of 26.9 points (P=0.004) and 35.4 points (P=0.006) were observed at 6- and 12-month follow-up, respectively. Tenderness on palpation of the tendon (0-10) was reduced from 5.5 to 2.5 (P < 0.001). Color Doppler ultrasound activity (0-4) was reduced by 50%, from an average of grade 2 to grade 1 (P=0.023). The hypoechoic cross-sectional area of the Achilles tendon was reduced from an average of 29.1% to 8.5% (P=0.001). Tendon thickness showed no statistically significant change (P=0.415). Conclusion Following the 4-stage rehabilitation program for AT based on isometric training and progressive loading, we observed improvement in both VISA-A score and ultrasonography in a group of athletes who had previously failed to benefit from standard AT rehabilitation. The study was feasible in terms of high adherence to the program and with no observed safety issues. The results of this pilot study support a further assessment of this specific approach for rehabilitation in a future randomized controlled trial.
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Affiliation(s)
- Thøger Persson Krogh
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
- Department of Sports Medicine, Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
- Center for Sports Medicine, Regional Hospital of Northern Denmark, Hjørring, Denmark
| | - Thomas Theis Jensen
- Department of Sports Medicine, Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Merete Nørgaard Madsen
- Interdisciplinary Research Unit, Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Ulrich Fredberg
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
- Center for Sports Medicine, Regional Hospital of Northern Denmark, Hjørring, Denmark
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
- Institute of Sports Medicine Copenhagen, Bispebjerg Hospital, Copenhagen, Denmark
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28
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Burton I, McCormack A. Resistance Training Interventions for Lower Limb Tendinopathies: A Scoping Review of Resistance Training Reporting Content, Quality, and Scientific Implementation. TRANSLATIONAL SPORTS MEDICINE 2022; 2022:2561142. [PMID: 38655173 PMCID: PMC11023730 DOI: 10.1155/2022/2561142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 01/26/2022] [Accepted: 02/11/2022] [Indexed: 04/26/2024]
Abstract
The objectives of this scoping review were as follows: (1) to describe what exercises and intervention variables are used in resistance training interventions for lower limb tendinopathy, (2) to assess the completeness of reporting as assessed by the Consensus on Exercise Reporting Template (CERT) and the Toigo and Boutellier framework, and (3) to assess the implementation of scientific resistance training principles. We searched MEDLINE, CINAHL, AMED, Embase, SPORTDiscus, and Cochrane Library databases. Randomized controlled trials, cohort studies, case series, case reports, and observational studies that reported using resistance exercises for lower limb tendinopathies were considered for inclusion, with 194 studies meeting the inclusion criteria. Completeness of the reporting of exercise descriptors and programme variables was assessed by the CERT and the Toigo and Boutellier framework. Reporting of exercise descriptor items from the Toigo and Boutellier framework ranged from 0 to 13, with an average score of 9/13, with only 9 studies achieving a full 13/13. Reporting of items from the CERT ranged from 0 to 18, with an average score of 13/19. No study achieved a full 19/19; however, 8 achieved 18/19. Scoring for resistance training principles ranged from 1 to 10, with only 14 studies achieving 10/10. Eccentric heel-drops were the most common exercise (75 studies), followed by isotonic heel raises (38), and single-leg eccentric decline squats (27). The reporting of exercise descriptors and intervention content was high across studies, with most allowing exercise replication, particularly for Achilles and patellar tendinopathy. However, reporting for some tendinopathies and content items such as adherence was poor, limiting optimal translation to clinical practice.
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Affiliation(s)
- Ian Burton
- MSK Service, Fraserburgh Physiotherapy Department, Fraserburgh Hospital, NHS Grampian, Aberdeen, UK
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29
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Leahy T, Nuss C, Evans MK, Fung A, Shetye S, Soslowsky LJ. Achilles Tendon Ruptures in Middle-Aged Rats Heal Poorly Compared With Those in Young and Old Rats [Formula: see text]. Am J Sports Med 2022; 50:170-181. [PMID: 34851182 PMCID: PMC8819270 DOI: 10.1177/03635465211055476] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Achilles tendon ruptures are painful and debilitating injuries and are most common in middle-aged patients. There is a lack of understanding of the underlying causes for increased rupture rates in middle-aged patients and how healing outcomes after a rupture might be affected by patient age. Therefore, the objective of this study was to define age-specific Achilles tendon healing by assessing ankle functional outcomes and Achilles tendon mechanical and histological properties after a rupture using a rat model. HYPOTHESIS Rats representing the middle-aged patient population would demonstrate reduced healing capability after an Achilles tendon rupture, as demonstrated by a slower return to baseline ankle functional properties and inferior biomechanical and histological tendon properties. STUDY DESIGN Controlled laboratory study. METHODS Fischer 344 rats were categorized by age to represent young, middle-aged, and old patients, and Achilles tendon ruptures were induced in the right hindlimb. Animals were allowed to heal and were euthanized at 3 or 6 weeks after the injury. In vivo functional assays and ultrasound imaging were performed throughout the healing period, and ex vivo tendon mechanical and histological properties were assessed after euthanasia. RESULTS Rats representing middle-aged patients displayed reduced healing potential compared with the other age groups, as they demonstrated decreased recovery of in vivo functional and ultrasound assessment parameters and inferior mechanical and histological properties after an Achilles tendon rupture. CONCLUSION These findings may help explain the increased rupture rate observed clinically in middle-aged patients by suggesting that there may be altered tendon responses to daily trauma. CLINICAL RELEVANCE The results provide novel data on age-specific healing outcomes after an Achilles tendon rupture, which underscores the importance of considering a patient's age during treatment and expectations for outcomes.
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Affiliation(s)
- Thomas Leahy
- McKay Orthopaedic Laboratory, University of Pennsylvania, Philadelphia, PA, USA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Courtney Nuss
- McKay Orthopaedic Laboratory, University of Pennsylvania, Philadelphia, PA, USA
| | - Mary Kate Evans
- McKay Orthopaedic Laboratory, University of Pennsylvania, Philadelphia, PA, USA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Ashley Fung
- McKay Orthopaedic Laboratory, University of Pennsylvania, Philadelphia, PA, USA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Snehal Shetye
- McKay Orthopaedic Laboratory, University of Pennsylvania, Philadelphia, PA, USA
| | - Louis J. Soslowsky
- McKay Orthopaedic Laboratory, University of Pennsylvania, Philadelphia, PA, USA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
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30
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The Effect of Age and Intrinsic Aerobic Exercise Capacity on the Expression of Inflammation and Remodeling Markers in Rat Achilles Tendons. Int J Mol Sci 2021; 23:ijms23010079. [PMID: 35008516 PMCID: PMC8744822 DOI: 10.3390/ijms23010079] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 12/19/2022] Open
Abstract
Old age, adiposity, and metabolic disorders are known as risk factors for chronic tendinopathy, which is a common problem in both athletes and the general population. However, the importance of these influencing factors has not yet been well understood. This study investigated alterations in gene expression and histology of Achilles tendons of young (10 weeks) and old (100 weeks) rats bred for low (low capacity runners, LCR) and high (high capacity runners, HCR) intrinsic aerobic exercise capacity. In this rat model, LCR displayed a phenotype of reduced exercise capacity, higher body weight, and metabolic dysfunctions compared to HCR. We hypothesized that the risk factors for tendinopathy in old LCR could lead to more pronounced impairments in Achilles tendon tissue. In quantitative real-time PCR (qPCR), age-related downregulation of tenocyte markers e.g., tenomodulin, genes related to matrix modeling and remodeling (e.g., collagens, elastin, biglycan, fibronectin, tenascin C) as well as transforming growth factor beta 3 (Tgfb3) have been detected. Inflammation marker cyclooxygenase 2 (Cox2) was downregulated in old rats, while microsomal prostaglandin E synthase 2 (Ptges2) was upregulated in old HCR and old LCR. In all groups, interleukin 6 (Il6), interleukin 1 beta (Il1b), and tumor necrosis factor alpha (Tnfa) showed no significant alteration. In histological evaluation, tendons of old rats had fewer and more elongated tenocyte nuclei than young rats. Even though a higher content of glycosaminoglycans, a sign of degeneration, was found in old HCR and LCR, no further signs of tendinopathy were detectable in tendons of old rats by histological evaluation. Low intrinsic aerobic exercise capacity and the associated phenotype did not show significant effects on gene expression and tendon histology. These findings indicate that aging seems to play a prominent role in molecular and structural alterations of Achilles tendon tissue and suggests that other risk factors associated with intrinsic aerobic exercise capacity are less influential in this rat model.
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Savva C, Karagiannis C, Korakakis V, Efstathiou M. The analgesic effect of joint mobilization and manipulation in tendinopathy: a narrative review. J Man Manip Ther 2021; 29:276-287. [PMID: 33769226 PMCID: PMC8491707 DOI: 10.1080/10669817.2021.1904348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective: To summarize the available literature with regards to the potential analgesic effect and mechanism of joint mobilization and manipulation in tendinopathy. Results: The effect of these techniques in rotator cuff tendinopathy and lateral elbow tendinopathy, applied alone, compared to a placebo intervention or along with other interventions has been reported in some randomized controlled trials which have been scrutinized in systematic reviews. Due to the small randomized controlled trials and other methodological limitations of the evidence base, including short-term follow-ups, small sample size and lack of homogenous samples further studies are needed. Literature in other tendinopathies such as medial elbow tendinopathy, de Quervain's disease and Achilles tendinopathy is limited since the analgesic effect of these techniques has been identified in few case series and reports. Therefore, the low methodological quality renders caution in the generalization of findings in clinical practice. Studies on the analgesic mechanism of these techniques highlight the activation of the descending inhibitory pain mechanism and sympathoexcitation although this area needs further investigation. Conclusion: Study suggests that joint mobilization and manipulation may be a potential contributor in the management of tendinopathy as a pre-conditioning process prior to formal exercise loading rehabilitation or other proven effective treatment approaches.
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Affiliation(s)
- Christos Savva
- Department of Health Science, European University, Nicosia, Cyprus
| | | | | | - Michalis Efstathiou
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
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Jiang K, Li Y, Xiang C, Xiong Y, Jia J. TGF-β3 regulates adhesion formation through the JNK/c-Jun pathway during flexor tendon healing. BMC Musculoskelet Disord 2021; 22:843. [PMID: 34592976 PMCID: PMC8485513 DOI: 10.1186/s12891-021-04691-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 09/03/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The injured flexor tendon has poor healing ability, which is easy to cause tendon adhesion. It can affect the recovery of tendon function, which is still a long-term and difficult task for surgeons. Transforming growth factor β (TGF-β) has been widely considered to play an important role in flexor tendon repair in recent years. AIM This work was to investigate the anti-adhesion and anti-inflammatory effects of TGF-β3 on flexor digitorum longus (FDL) tendon repair rats. METHOD Anastomosis models of tendon laceration in the flexion toes of rats were delivered with no treatment, vehicle, or TGF-β3 -overexpressed adenovirus vector (ad-TGF-β3) locally to the injured tendon area from day 3 to 8. Subsequently, the expression of TGF-β3, TGF-β1/2, Smad3, Smad7, JNK, phosphorylation (p)-JNK, c-Jun, and phosphorylation (p)-c-Jun were detected by western blot, the expression of Mmp9 and Mmp2 by RT-qPCR, the Range of motion (ROM) and gliding resistance by adhesion formation testing, the mechanical strength of tendon healing by biomechanical testing, the pathologic changes of flexor tendon tissues by HE staining, the expression of collagen type III by immunohistochemical staining, and the levels of IL-6, TNF-α, COX2 and IL-1β in serum by ELISA, respectively. RESULTS Rat models treated with no treatment showed a lower elevation of TGF-β3 and Smad7 expression, and a higher elevation of TGF-β1/2 and Smad3 expression, during day 14 to day 28. Besides, under the treatment of ad-TGF-β3, a significantly increase was reflected in the expression of TGF-β3 and Smad7, ROM, as well as mechanical strength of flexor tendon, whereas significantly reduction was shown in gliding resistance, the content of inflammatory cytokines, the ratio of p-JNK/JNK, p-c-Jun/c-Jun, as well as the expression of TGF-β1/2, Smad3, Mmp9, and Mmp2 genes, as compared to those from vehicle treatment. Meanwhile, TGF-β3 demonstrated a better pathologic recovery process with no obvious necrosis or fracture of collagen fibers. Besides, TGF-β3 revealed a significant reduction of collagen type-III expression in the flexor tendon healing tissues. CONCLUSION These findings suggested that TGF-β3 effectively protected against flexor tendon injury via regulating adhesion formation.
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Affiliation(s)
- Ke Jiang
- Department of Orthopaedics, Affilliated Hospital of North Sichuan Medical College, 63 Wenhua Road, Nanchong, Sichuan, 637000, People's Republic of China
- Key Laboratory of Emergency and Trauma, Ministry of Education, College of Emergency and Trauma, Hainan Medical University, Haikou, 571199, People's Republic of China
| | - Yuling Li
- Department of Orthopaedics, Affilliated Hospital of North Sichuan Medical College, 63 Wenhua Road, Nanchong, Sichuan, 637000, People's Republic of China.
| | - Chao Xiang
- Department of Orthopaedics, Affilliated Hospital of North Sichuan Medical College, 63 Wenhua Road, Nanchong, Sichuan, 637000, People's Republic of China
| | - Yan Xiong
- Department of Orthopaedics, Daping Hospital, Army Medical University, Chongqing, 400042, People's Republic of China
| | - Jiameng Jia
- Department of Rehabilitation, Affilliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, 637000, People's Republic of China
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Kim SK, Nguyen C, Jones KB, Tashjian RZ. A genome-wide association study for shoulder impingement and rotator cuff disease. J Shoulder Elbow Surg 2021; 30:2134-2145. [PMID: 33482370 DOI: 10.1016/j.jse.2020.11.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 11/15/2020] [Accepted: 11/19/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of the study was to identify genetic variants associated with rotator cuff disease by performing a genome-wide association study (GWAS) for shoulder impingement using the UK Biobank (UKB) cohort and then combining the GWAS data with a prior GWAS for rotator cuff tears. The loci identified by the GWAS and meta-analysis were examined for changes in expression following rotator cuff tearing using RNA sequencing. METHODS A GWAS was performed using data from UKB with 3864 cases of shoulder impingement. The summary statistics from shoulder impingement and a prior study on rotator cuff tears were combined in a meta-analysis. Also, the previous association of 2 single-nucleotide polymorphisms (SNPs) with shoulder impingement from a published GWAS using the UKB was tested. Rotator cuff tendon biopsies were obtained from 24 patients with full-thickness rotator cuff tears who underwent arthroscopic rotator cuff repair (cases) and 9 patients who underwent open reduction internal fixation for a proximal humeral fracture (controls). Total RNA was extracted and differential gene expression was measured by RNA sequencing for genes with variants associated with rotator cuff tearing. RESULTS The shoulder impingement GWAS identified 4 new loci: LOC100506457, LSP1P3, LOC100506207, and MIS18BP1/LINC00871. Combining data with a prior GWAS for rotator cuff tears in a meta-analysis resulted in the identification of an additional 7 loci: SLC39A8/UBE2D3, C5orf63, ASTN2, STK24, FRMPD4, ACOT9/SAT1, and LINC00890/ALG13. Many of the identified loci have known biologic functions or prior associations with diseases, suggesting possible biologic pathways leading to rotator cuff disease. RNA sequencing experiments show that expression of STK24 increases whereas expression of SAT1 and UBE2D3 decreases following rotator cuff tearing. Two SNPs previously reported to show an association with shoulder impingement from a prior UKB GWAS were not validated in our study. CONCLUSION This is the first GWAS for shoulder impingement in which new data from UKB enabled the identification of 4 loci showing a genetic association. A meta-analysis with a prior GWAS for rotator cuff tearing identified an additional 7 loci. The known biologic roles of many of the 11 loci suggest plausible biologic mechanisms underlying the etiology of rotator cuff disease. The risk alleles from each of the genetic loci can be used to assess the risk for rotator cuff disease in individual patients, enabling preventative or restorative actions via personalized medicine.
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Affiliation(s)
- Stuart K Kim
- Department of Developmental Biology, Stanford University Medical School, Stanford, CA, USA
| | - Condor Nguyen
- Department of Developmental Biology, Stanford University Medical School, Stanford, CA, USA
| | - Kevin B Jones
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Robert Z Tashjian
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, UT, USA.
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Bravo-Sánchez A, Abián P, Sánchez-Infante J, Jimenez F, Abián-Vicén J. Influence of Bias in the Assessment of Patellar Tendon Stiffness: A Systematic Review and Meta-analysis. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:1151-1162. [PMID: 33589353 DOI: 10.1016/j.ultrasmedbio.2021.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/13/2021] [Accepted: 01/13/2021] [Indexed: 06/12/2023]
Abstract
The aim of the present study was to provide a systematic review and meta-analysis of the main biases in practical applications of the different types of elastography in assessment of the stiffness of healthy patellar tendons. A literature search on four databases (Scopus, Web of Science, Pubmed and SportDiscus) was conducted on March 25, 2020. After analysis of 1,052 resultant articles, studies were included if they met two inclusion criteria: (1) studies were observational or randomized controlled trials; (2) studies included outcomes of patellar tendon stiffness. Twenty-one studies met the inclusion criteria and were included in this meta-analysis. Four meta-analyses were performed with respect to assessment procedure and participant characteristics. This meta-analysis found a low effect of examined portion of patellar tendon (standardized mean difference [SMD] = 0.27, 95% confidence interval [CI]: 0.01-0.54, n = 379, Z = 2.01, p = 0.04) and a high effect of knee flexion angle during assessment (SMD = -2.12; 95% CI: -2.67 to -1.58, n = 97, Z = 7.68, p < 0.01) in stiffness outcomes. The risk of bias was generally low, but the heterogenicity of the results downgraded the level of evidence. There is evidence in the elastography assessment of patellar tendon suggesting that the knee position and patellar tendon portion evaluated influence stiffness outcomes for patellar tendon in healthy volunteers.
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Affiliation(s)
- Alfredo Bravo-Sánchez
- Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, Toledo, Spain
| | - Pablo Abián
- Faculty of Humanities and Social Sciences, Comillas Pontifical University, Madrid, Spain
| | - Jorge Sánchez-Infante
- Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, Toledo, Spain
| | - Fernando Jimenez
- Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, Toledo, Spain
| | - Javier Abián-Vicén
- Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, Toledo, Spain.
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Burton I, McCormack A. Autoregulated and individualised resistance training versus predetermined and standardised resistance training in tendinopathy: A systematic review protocol. Musculoskeletal Care 2021; 19:533-539. [PMID: 33687141 DOI: 10.1002/msc.1551] [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: 02/01/2021] [Revised: 02/19/2021] [Accepted: 02/20/2021] [Indexed: 01/06/2023]
Abstract
REVIEW OBJECTIVE To synthesise the best available evidence on the effectiveness of interventions that have used autoregulated and individualised resistance training versus predetermined and standardised resistance training in treating any tendinopathy. INTRODUCTION Recent evidence suggests that individualised exercise may be more effective than standardised exercise for musculoskeletal disorders such as tendinopathy. However, no systematic reviews have been conducted on the topic and optimal treatment protocols and clinical recommendations are lacking. INCLUSION CRITERIA Randomised controlled trials assessing the effectiveness of autoregulated and individualised resistance training versus predetermined and standardised resistance training for tendinopathy in adults will be included. METHODS The authors will search for a wide range of sources to find both published and unpublished studies via EBSCOhost, including, but not limited to, MEDLINE, SPORTDiscus, CINAHL, Cochrane Central Register of Controlled Trials and Allied and Complementary Medicine Database. Studies published in a language other than English will only be considered if a translation is available. The Joanna Briggs Institute systematic review methodology will be followed when conducting the review. Data synthesis will be conducted using meta-analysis or narrative synthesis, where appropriate.
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Affiliation(s)
- Ian Burton
- Angus Physiotherapy Department, Arbroath Infirmary, NHS Tayside, Arbroath, UK
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Götschi T, Schulz N, Snedeker JG, Hanimann J, Franchi MV, Spörri J. Three-Dimensional Mapping of Shear Wave Velocity in Human Tendon: A Proof of Concept Study. SENSORS 2021; 21:s21051655. [PMID: 33673664 PMCID: PMC7957754 DOI: 10.3390/s21051655] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 12/25/2022]
Abstract
Ultrasound-based shear wave elastography (SWE) provides the means to quantify tissue mechanical properties in vivo and has proven valuable in detecting degenerative processes in tendons. Its current mode of use is for two-dimensional rendering measurements, which are highly position-dependent. We therefore propose an approach to create a volumetric reconstruction of the mechano-acoustic properties of a structure of interest based on optically tracking the ultrasound probe during free-hand measurement sweeps. In the current work, we aimed (1) to assess the technical feasibility of the three-dimensional mapping of unidirectional shear wave velocity (SWV), (2) to evaluate the possible artefacts associated with hand-held image acquisition, (3) to investigate the reproducibility of the proposed technique, and (4) to study the potential of this method in detecting local adaptations in a longitudinal study setting. Operative and technical feasibility as well as potential artefacts associated with hand-held image acquisition were studied on a synthetic phantom containing discrete targets of known mechanical properties. Measurement reproducibility was assessed based on inter-day and inter-reader scans of the patellar, Achilles, and supraspinatus tendon of ten healthy volunteers and was compared to traditional two-dimensional image acquisition. The potential of this method in detecting local adaptations was studied by testing the effect of short-term voluntary isometric loading history on SWV along the tendon long axis. The suggested approach was technically feasible and reproducible, with a moderate to very good reliability and a standard error of measurement in the range of 0.300-0.591 m/s for the three assessed tendons at the two test-retest modalities. We found a consistent variation in SWV along the longitudinal axis of each tendon, and isometric loading resulted in regional increases in SWV in the patellar and Achilles tendons. The proposed method outperforms traditional two-dimensional measurement with regards to reproducibility and may prove valuable in the objective assessment of pathological tendon changes.
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Affiliation(s)
- Tobias Götschi
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland;
- Institute for Biomechanics, ETH Zurich, 8093 Zurich, Switzerland;
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland; (J.H.); (M.V.F.); (J.S.)
- Correspondence: ; Tel.: +41-44-386-11-11
| | - Nicole Schulz
- Institute for Biomechanics, ETH Zurich, 8093 Zurich, Switzerland;
| | - Jess G. Snedeker
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland;
- Institute for Biomechanics, ETH Zurich, 8093 Zurich, Switzerland;
| | - Jonas Hanimann
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland; (J.H.); (M.V.F.); (J.S.)
| | - Martino V. Franchi
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland; (J.H.); (M.V.F.); (J.S.)
- Institute of Physiology, Department of Biomedical Sciences, University of Padova, 35121 Padova, Italy
| | - Jörg Spörri
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland; (J.H.); (M.V.F.); (J.S.)
- University Centre for Prevention and Sports Medicine, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
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Agergaard AS, Malmgaard-Clausen NM, Svensson RB, Nybing JD, Boesen M, Kjaer M, Magnusson SP, Hansen P. UTE T2* mapping of tendinopathic patellar tendons: an MRI reproducibility study. Acta Radiol 2021; 62:215-224. [PMID: 32340475 DOI: 10.1177/0284185120918807] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is currently a lack of imaging modalities that can be used as a sensitive measure in tendinopathy. Recent findings suggest the applicability of ultra-short echo time (UTE) magnetic resonance imaging (MRI) T2* mapping in tendons, but the reproducibility remains unknown. PURPOSE To evaluate test-retest reproducibility of UTE MRI T2* mapping of tendinopathic patellar tendons and to evaluate the intra- and inter-observer reproducibility of the measurement. MATERIAL AND METHODS Fifteen patients with chronic patellar tendinopathy were evaluated with UTE MRI twice in a 3.0-T scanner on the same day. Manual segmentation of the patellar tendon was performed by two blinded investigators and automated T2*map reconstruction was performed in custom-made software. RESULTS There was a significant and numerically small difference in test-retest T2* values (T2*meandiff = 0.06 ± 0.07 ms ≈ 3.7%; P = 0.006) with an ICC = 0.91 (95% confidence interval [CI] 0.58-0.98; typical error of 3.0%). The intra- and inter-observer reproducibility showed no significant bias (P = 0.493 and P = 0.052), and generally substantial reproducibility was demonstrated for T2* (intra-observer ICC = 0.99; 95% CI 0.98-1.00 and inter-observer ICC = 0.99; 95% CI 0.96-1.00, and typical error 1.3% and 1.3%, respectively). CONCLUSION These data demonstrate a small bias between repeated measurements for UTE T2*, but with a very low associated mean difference (3.7%) between the two tests. The high ICC values and low typical error % demonstrate reproducibility of repeated T2*-mapping sessions. Further, the method showed substantial intra- and inter-observer reproducibility for T2* values proving feasibility for use of UTE T2* mapping in research and clinical practice.
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Affiliation(s)
- Anne-Sofie Agergaard
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Center for Healthy Aging, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Nikolaj M Malmgaard-Clausen
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Center for Healthy Aging, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rene B Svensson
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Center for Healthy Aging, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Janus D Nybing
- Department of Radiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Mikael Boesen
- Department of Radiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Michael Kjaer
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Center for Healthy Aging, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - S. Peter Magnusson
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Center for Healthy Aging, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Philip Hansen
- Department of Radiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
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Millar NL, Silbernagel KG, Thorborg K, Kirwan PD, Galatz LM, Abrams GD, Murrell GAC, McInnes IB, Rodeo SA. Tendinopathy. Nat Rev Dis Primers 2021; 7:1. [PMID: 33414454 DOI: 10.1038/s41572-020-00234-1] [Citation(s) in RCA: 267] [Impact Index Per Article: 89.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 12/14/2022]
Abstract
Tendinopathy describes a complex multifaceted pathology of the tendon, characterized by pain, decline in function and reduced exercise tolerance. The most common overuse tendinopathies involve the rotator cuff tendon, medial and lateral elbow epicondyles, patellar tendon, gluteal tendons and the Achilles tendon. The prominent histological and molecular features of tendinopathy include disorganization of collagen fibres, an increase in the microvasculature and sensory nerve innervation, dysregulated extracellular matrix homeostasis, increased immune cells and inflammatory mediators, and enhanced cellular apoptosis. Although diagnosis is mostly achieved based on clinical symptoms, in some cases, additional pain-provoking tests and imaging might be necessary. Management consists of different exercise and loading programmes, therapeutic modalities and surgical interventions; however, their effectiveness remains ambiguous. Future research should focus on elucidating the key functional pathways implicated in clinical disease and on improved rehabilitation protocols.
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Affiliation(s)
- Neal L Millar
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK.
| | | | - Kristian Thorborg
- Institute of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Paul D Kirwan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Leesa M Galatz
- Department of Orthopaedic Surgery, Icahn School of Medicine, Mount Sinai Health System, New York, NY, USA
| | - Geoffrey D Abrams
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Iain B McInnes
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
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Karamanidis K, Epro G. Monitoring Muscle-Tendon Adaptation Over Several Years of Athletic Training and Competition in Elite Track and Field Jumpers. Front Physiol 2020; 11:607544. [PMID: 33391022 PMCID: PMC7772406 DOI: 10.3389/fphys.2020.607544] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 11/27/2020] [Indexed: 12/20/2022] Open
Abstract
Differences in muscle and tendon responsiveness to mechanical stimuli and time courses of adaptive changes may disrupt the interaction of the musculotendinous unit (MTU), increasing the risk for overuse injuries. We monitored training-induced alterations in muscle and tendon biomechanical properties in elite jumpers over 4 years of athletic training to detect potential non-synchronized adaptations within the triceps surae MTU. A combined cross-sectional and longitudinal investigation over 4 years was conducted by analyzing triceps surae MTU mechanical properties in both legs via dynamometry and ultrasonography in 67 elite track and field jumpers and 24 age-matched controls. Fluctuations in muscle and tendon adaptive changes over time were quantified by calculating individual residuals. The cosine similarity of the relative changes of muscle strength and tendon stiffness between sessions served as a measure of uniformity of adaptive changes. Our cross-sectional study was unable to detect clear non-concurrent differences in muscle strength and tendon stiffness in elite jumpers. However, when considering the longitudinal data over several years of training most of the jumpers demonstrated greater fluctuations in muscle strength and tendon stiffness and hence tendon strain compared to controls, irrespective of training period (preparation vs. competition). Moreover, two monitored athletes with chronic Achilles tendinopathy showed in their affected limb lower uniformity in MTU adaptation as well as higher fluctuations in tendon strain over time. Habitual mechanical loading can affect the MTU uniformity in elite jumpers, leading to increased mechanical demand on the tendon over an athletic season and potentially increased risk for overuse injuries.
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Affiliation(s)
- Kiros Karamanidis
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, London, United Kingdom
| | - Gaspar Epro
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, London, United Kingdom
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Porter KN, Talpey S, Pascoe D, Blanch PD, Walker HM, Shield AJ. The effect of swimming volume and intensity on changes in supraspinatus tendon thickness. Phys Ther Sport 2020; 47:173-177. [PMID: 33310584 DOI: 10.1016/j.ptsp.2020.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 11/30/2020] [Accepted: 12/02/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To compare the change in supraspinatus tendon thickness (STT) following a high volume (HV) and high intensity (HI) swimming practice in shoulders of elite swimmers. DESIGN Cohort Study. SETTING Non-clinical, state swim team training facility. PARTICIPANTS A convenience sample of eight non-injured state and national level swimmers from a regional swim team were recruited for this study. MAIN OUTCOME MEASURES Ultrasound measures of STT were collected in response to the two swimming practice sessions. Measures were taken prior to each swim practice; immediately after practice; 6-hours post practice and 24-hours post practice. RESULTS A significant increase in STT resulted from both the HI and HV (p < 0.05) practice immediately post practice. For the HI practice, the STT remained significantly thicker than pre-practice measures at the 6-hour post practice test (p < 0.05) however no longer significant 24-hours post practice. The difference in the change in STT between the HI and HV practice was significantly different immediately post practice and 6-hours post practice (p < 0.05) however no longer significant 24-hour post practice. CONCLUSION Ultrasound measures of STT following different swimming volumes and intensities may provide information on shoulder tendon loads.
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Affiliation(s)
- Kirsten N Porter
- School of Science, Psychology and Sport, Federation University Australia, Ballarat, Australia; School of Allied Health, Australian Catholic University, Ballarat, Australia.
| | - Scott Talpey
- School of Science, Psychology and Sport, Federation University Australia, Ballarat, Australia
| | - Deborah Pascoe
- School of Science, Psychology and Sport, Federation University Australia, Ballarat, Australia
| | - Peter D Blanch
- School of Allied Health Sciences, Brisbane Lions Football Club, Woolloongabba, Australia; School of Allied Health Sciences, Griffith University, Gold Coast, Australia
| | - Helen M Walker
- School of Exercise and Nutrition Science, Physio4athletes, Melbourne, Australia
| | - Anthony J Shield
- School of Exercise and Nutrition Science, Queensland University of Technology, Brisbane, Australia
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Klich S, Ficek K, Krymski I, Klimek A, Kawczyński A, Madeleine P, Fernández-de-Las-Peñas C. Quadriceps and Patellar Tendon Thickness and Stiffness in Elite Track Cyclists: An Ultrasonographic and Myotonometric Evaluation. Front Physiol 2020; 11:607208. [PMID: 33381054 PMCID: PMC7767861 DOI: 10.3389/fphys.2020.607208] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/25/2020] [Indexed: 12/12/2022] Open
Abstract
Track cyclists are required to perform short- and long-term efforts during sprint and endurance race events, respectively. The 200 m flying sprint races require maximal power output and anaerobic capacity, while the 4,000 m pursuit cyclists demand a high level of aerobic capacity. Our goal was to investigate spatial changes in morphological and mechanical properties displayed using 3D topographical maps of the quadriceps muscle and tendons after 200 m flying start and 4,000 m individual pursuit race in elite track cyclists. We hypothesized a non-uniform distribution of the changes in the quadriceps muscle stiffness (QMstiff), and acute alterations in quadriceps tendon (QTthick) and patellar tendon (PTthick) thickness. Fifteen men elite sprint and 15 elite men endurance track cyclists participated. Sprint track cyclists participated in a 200 m flying start, while endurance track cyclists in 4,000 m individual pursuit. Outcomes including QTthick (5–10–15 mm proximal to the upper edge of the patella), PTthick (5–10–15–20 mm inferior to the apex of the patella)—using ultrasonography evaluation, QMstiff, and quadriceps tendon stiffness (QTstiff) were measured according to anatomically defined locations (point 1–8) and patellar tendon stiffness (PTstiff)—using myotonometry, measured in a midway point between the patella distal and the tuberosity of tibial. All parameters were assessed before and after (up to 5 min) the 200 m or 4,000 m events. Sprint track cyclists had significantly larger QTthick and PTthick than endurance track cyclists. Post-hoc analysis showed significant spatial differences in QMstiff between rectus femoris, vastus lateralis, and vastus medialis in sprint track cyclists. At before race, sprint track cyclists presented significantly higher mean QTthick and PTthick, and higher QMstiff and the QTstiff, as compared with the endurance track cyclists. The observed changes in PTThick and QTThick were mostly related to adaptation-based vascularity and hypertrophy processes. The current study suggests that assessments using both ultrasonography and myotonometry provides crucial information about tendons and muscles properties and their acute adaptation to exercise. Higher stiffness in sprint compared with endurance track cyclists at baseline seems to highlight alterations in mechanical properties of the tendon and muscle that could lead to overuse injuries.
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Affiliation(s)
- Sebastian Klich
- Department of Paralympic Sport, University School of Physical Education in Wrocław, Wrocław, Poland
| | - Krzysztof Ficek
- Department of Physiotherapy, Academy of Physical Education in Katowice, Katowice, Poland.,Galen Orthopedic Center, Bieruń, Poland
| | | | - Andrzej Klimek
- Biomedical Science Institute, University School of Physical Education in Kraków, Kraków, Poland
| | - Adam Kawczyński
- Department of Paralympic Sport, University School of Physical Education in Wrocław, Wrocław, Poland
| | - Pascal Madeleine
- Department of Health Science and Technology, Sport Sciences-Performance and Technology, Aalborg University, Aalborg, Denmark
| | - Cesar Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation, and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain.,Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, Alcorcón, Spain
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Docking SI, Girdwood MA, Cook J, Fortington LV, Rio E. Reduced Levels of Aligned Fibrillar Structure Are Not Associated With Achilles and Patellar Tendon Symptoms. Clin J Sport Med 2020; 30:550-555. [PMID: 30067515 DOI: 10.1097/jsm.0000000000000644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate whether the mean cross-sectional area (mCSA) of aligned fibrillar structure (AFS) was associated with the presence and severity of symptoms. DESIGN Prospective cohort study. PARTICIPANTS One hundred seventy-five elite male Australian football players completed monthly Oslo Sports Trauma Research Center overuse injury questionnaires for both the Achilles and patellar tendon over the season to ascertain the presence and severity of symptoms. At the start of the preseason, participants underwent ultrasound tissue characterization (UTC) imaging of the Achilles and patellar tendon. MAIN OUTCOME MEASURES Images were classified as normal or abnormal based on gray-scale ultrasound. Based on UTC quantification, the mCSA of AFS was compared between those with and without current symptoms. RESULTS No difference in the mCSA of AFS was observed between those with or without tendon symptoms (P < 0.05). Similar to previous findings, 80% to 92% of abnormal tendons had similar amounts of mCSA of AFS compared with normal tendon. If reduced mCSA of AFS was present, it was not associated with the presence or severity of symptoms. CONCLUSIONS The prevalence, development, or severity of symptoms was not associated with decreased levels of AFS in the Achilles or patellar tendon. This suggests that a lack of structural integrity is not linked to symptoms and questions the rationale behind regenerative medicine. Most tendons are able to compensate for areas of disorganization and maintain tissue homeostasis.
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Affiliation(s)
- Sean I Docking
- La Trobe Sport and Exercise Medicine Research Center, College of Science, Health and Engineering; La Trobe University; Australia; and
- Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Federation University, Ballarat, Australia
| | - Michael A Girdwood
- La Trobe Sport and Exercise Medicine Research Center, College of Science, Health and Engineering; La Trobe University; Australia; and
- Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Federation University, Ballarat, Australia
| | - Jill Cook
- La Trobe Sport and Exercise Medicine Research Center, College of Science, Health and Engineering; La Trobe University; Australia; and
- Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Federation University, Ballarat, Australia
| | - Lauren V Fortington
- Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Federation University, Ballarat, Australia
| | - Ebonie Rio
- La Trobe Sport and Exercise Medicine Research Center, College of Science, Health and Engineering; La Trobe University; Australia; and
- Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Federation University, Ballarat, Australia
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Krogh TP, Fredberg U, Ammitzbøll C, Ellingsen T. Clinical Value of Ultrasonographic Assessment in Lateral Epicondylitis Versus Asymptomatic Healthy Controls. Am J Sports Med 2020; 48:1873-1883. [PMID: 32484714 DOI: 10.1177/0363546520921949] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Ultrasonography (US) is often used in the assessment of lateral epicondylitis (LE). The strength of evidence supporting its role is, however, not well-documented. PURPOSE To describe and compare the US tendinopathic changes observed in patients with LE and the general population, including any correlation between patient characteristics and US outcomes. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Tendon thickness, color Doppler activity, and bone spur were assessed by US in 264 participants with healthy elbows and 60 patients with chronic LE. In addition to patient characteristics, Patient-Rated Tennis Elbow Evaluation (PRTEE) score, pain, and disability were recorded. RESULTS Depending on the measurement technique used, mean LE tendon thickness increased by 0.53 mm (10.2%) or 0.70 mm (14.5%) as compared with the contralateral arm and 0.40 mm (7.9%) or 0.41 mm (8.5%) as compared with the general population. Mean color Doppler activity (scale, 0-4) was 3.47 in the LE arm versus 0.13 in the contralateral asymptomatic arm and 0.26 in the general population. Bone spur was observed in 78% of the LE arms as opposed to 45% in the contralateral arms and 50% in the general population. In the LE group and the general population, the prevalence of bone spur increases with age. No correlations were observed with pain, disability, PRTEE, and disease duration. CONCLUSION Increased common extensor tendon thickness is part of the tendinopathic changes observed in LE. However, given the marked variation in natural tendon thickness and small increases in tendon thickness in patients with LE, this technique cannot be used as a stand-alone diagnostic tool but rather as a supplement to the overall assessment. The contralateral elbow (if asymptomatic) is a better tendon thickness comparator than a general population mean value. Color Doppler activity is an indicator of ongoing tendinopathy and supports the LE diagnosis, but it is not pathognomonic for the condition. Absence of Doppler activity in a patient with suspected LE should raise suspicion of other diagnoses. Identification of a bone spur is of very limited clinical value given the high prevalence in the general population. The important outcomes of pain, disability, PRTEE, and disease duration did not correlate with any of the investigated US techniques.
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Affiliation(s)
- Thøger P Krogh
- Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Ulrich Fredberg
- Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark.,Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | | | - Torkell Ellingsen
- Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark.,Department of Rheumatology, Odense University Hospital, Odense, Denmark
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Arampatzis A, Mersmann F, Bohm S. Individualized Muscle-Tendon Assessment and Training. Front Physiol 2020; 11:723. [PMID: 32670094 PMCID: PMC7332733 DOI: 10.3389/fphys.2020.00723] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 06/02/2020] [Indexed: 01/27/2023] Open
Abstract
The interaction of muscle and tendon is of major importance for movement performance and a balanced development of muscle strength and tendon stiffness could protect athletes from overuse injury. However, muscle and tendon do not necessarily adapt in a uniform manner during a training process. The development of a diagnostic routine to assess both the strength capacity of muscle and the mechanical properties of tendons would enable the detection of muscle-tendon imbalances, indicate if the training should target muscle strength or tendon stiffness development and allow for the precise prescription of training loads to optimize tendon adaptation. This perspective article discusses a framework of individualized muscle-tendon assessment and training and outlines a methodological approach for the patellar tendon.
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Affiliation(s)
- Adamantios Arampatzis
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Falk Mersmann
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sebastian Bohm
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
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Ilaltdinov AW, Gong Y, Leong DJ, Gruson KI, Zheng D, Fung DT, Sun L, Sun HB. Advances in the development of gene therapy, noncoding RNA, and exosome-based treatments for tendinopathy. Ann N Y Acad Sci 2020; 1490:3-12. [PMID: 32501571 DOI: 10.1111/nyas.14382] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 05/08/2020] [Accepted: 05/12/2020] [Indexed: 12/16/2022]
Abstract
Tendinopathy is a common musculoskeletal disorder characterized by chronic low-grade inflammation and tissue degeneration. Tendons have poor innate healing ability and there is currently no cure for tendinopathy. Studies elucidating mechanisms underlying the pathogenesis of tendinopathy and mechanisms mediating the genesis of tendons during development have provided novel targets and strategies to enhance tendon healing and repair. This review summarizes the current understanding and treatments for tendinopathy. The review also highlights recent advances in gene therapy, the potential of noncoding RNAs, such as microRNAs, and exosomes, which are nanometer-sized extracellular vesicles secreted from cells, for the treatment of tendinopathy.
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Affiliation(s)
- Angela Wang Ilaltdinov
- Department of Orthopaedic Surgery, Albert Einstein College of Medicine, Bronx, New York.,Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, New York.,Department of Biomedical Engineering, City College of New York, New York, New York.,New York R&D Center for Translational Medicine and Therapeutics, Inc., New Rochelle, New York
| | - Yubao Gong
- Department of Orthopaedic Surgery, Albert Einstein College of Medicine, Bronx, New York.,Department of Orthopaedic Surgery, The First Hospital of Jilin University, Changchun, China
| | - Daniel J Leong
- Department of Orthopaedic Surgery, Albert Einstein College of Medicine, Bronx, New York.,Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, New York.,New York R&D Center for Translational Medicine and Therapeutics, Inc., New Rochelle, New York
| | - Konrad I Gruson
- Department of Orthopaedic Surgery, Albert Einstein College of Medicine, Bronx, New York
| | - Deyou Zheng
- Department of Genetics, Albert Einstein College of Medicine, Bronx, New York.,Department of Neurology, Albert Einstein College of Medicine, Bronx, New York.,Department of Neuroscience, Albert Einstein College of Medicine, Bronx, New York
| | - David T Fung
- New York R&D Center for Translational Medicine and Therapeutics, Inc., New Rochelle, New York
| | - Li Sun
- New York R&D Center for Translational Medicine and Therapeutics, Inc., New Rochelle, New York
| | - Hui B Sun
- Department of Orthopaedic Surgery, Albert Einstein College of Medicine, Bronx, New York.,Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, New York.,New York R&D Center for Translational Medicine and Therapeutics, Inc., New Rochelle, New York
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Torgutalp ŞŞ, Babayeva N, Taş S, Dönmez G, Korkusuz F. Effects of hyperlipidemia on patellar tendon stiffness: A shear wave elastography study. Clin Biomech (Bristol, Avon) 2020; 75:104998. [PMID: 32335470 DOI: 10.1016/j.clinbiomech.2020.104998] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 03/13/2020] [Accepted: 03/17/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Recent studies presented that increased adiposity and hyperlipidemia may cause tendon pathology. The aim of this study was to evaluate the effect of hyperlipidemia on the patellar tendon stiffness by shear wave elastography. METHODS A total of 51 participants (19 female, 32 male) were included. Participants were divided into two groups, according to their low-density lipoprotein levels, as the study group (hyperlipidemia, n = 24) and the control group (non-hyperlipidemia, n = 27). The patellar tendon and rectus femoris muscle shear wave velocities were measured by shear wave elastography. FINDINGS Patellar tendon shear wave velocities was 5.02 (SD: 0.78) m/s in the control group and 5.98 (SD: 1.19) m/s in the hyperlipidemia group (ES = 0.95, P = .001). There was a positive moderate statistically significant correlation between patellar tendon shear wave velocity and low-density lipoprotein (r = 0.432, p < .002). In the multiple linear regression analysis, only low-density lipoprotein was found as a significant predictor of patellar tendon shear wave velocity (CI: 0.005-0.028, P = .007). INTERPRETATION We evaluated the effects of hyperlipidemia and body mass index on patellar tendon mechanical properties with shear wave elastography. We found that the blood low-density lipoprotein level had an impact on patellar tendon stiffness independently of body mass index. Accordingly, it is important to evaluate individuals' low-density lipoprotein levels when examining risk factors for tendon pathology.
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Affiliation(s)
- Şerife Şeyma Torgutalp
- Hacettepe University, Faculty of Medicine, Department of Sports Medicine, 06100 Ankara, Turkey.
| | - Naila Babayeva
- Hacettepe University, Faculty of Medicine, Department of Sports Medicine, 06100 Ankara, Turkey
| | - Serkan Taş
- Toros University, School of Health Sciences, Department of Physiotherapy and Rehabilitation, 33140, Mersin, Turkey
| | - Gürhan Dönmez
- Hacettepe University, Faculty of Medicine, Department of Sports Medicine, 06100 Ankara, Turkey
| | - Feza Korkusuz
- Hacettepe University, Faculty of Medicine, Department of Sports Medicine, 06100 Ankara, Turkey
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Abstract
BACKGROUND Achilles Tendinopathy (AT) is essentially a failed healing response with haphazard proliferation of tenocytes, abnormalities in tenocytes with disruption of collagen fibers, and subsequent increase in non-collagenous matrix. METHODS The diagnosis of Achilles tendinopathy is clinical, and MRI and utrasound imaging can be useful in differential diagnosis. Conservative manegement, open surgery or minimally invasive techniques are available. Injections and physical therapy are also vauable options. RESULTS Eccentric exercises are useful tools to manage the pathology. If the condition does not ameliorate, shock wave therapy, or nitric oxide patches might be considered. Peritendinous injections or injections at the interface between the Achilles tendon and Kager's triangle could be considered if physical therapy should fail. Surgery is indicated after 6 months of non-operative management. CONCLUSIONS The clinical diagnosis and management of AT are not straightforward. Hence, patients should understand that symptoms may recur with either conservative or surgical approaches.
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48
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Skovlund SV, Aagaard P, Larsen P, Svensson RB, Kjaer M, Magnusson SP, Couppé C. The effect of low‐load resistance training with blood flow restriction on chronic patellar tendinopathy — A case series. TRANSLATIONAL SPORTS MEDICINE 2020. [DOI: 10.1002/tsm2.151] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Sebastian V. Skovlund
- Department of Orthopaedic Surgery M Faculty of Health and Medical Sciences Bispebjerg Hospital and Center for Healthy Aging Institute of Sports Medicine University of Copenhagen Copenhagen Denmark
- Department of Physical and Occupational Therapy Bispebjerg Hospital Kobenhavn Denmark
| | - Per Aagaard
- Muscle Physiology and Biomechanics Research Unit Department of Sports Sciences and Clinical Biomechanics University of Southern Denmark Odense Denmark
| | - Patricia Larsen
- Department of Orthopaedic Surgery M Faculty of Health and Medical Sciences Bispebjerg Hospital and Center for Healthy Aging Institute of Sports Medicine University of Copenhagen Copenhagen Denmark
- Department of Physical and Occupational Therapy Bispebjerg Hospital Kobenhavn Denmark
| | - Rene B. Svensson
- Department of Orthopaedic Surgery M Faculty of Health and Medical Sciences Bispebjerg Hospital and Center for Healthy Aging Institute of Sports Medicine University of Copenhagen Copenhagen Denmark
| | - Michael Kjaer
- Department of Orthopaedic Surgery M Faculty of Health and Medical Sciences Bispebjerg Hospital and Center for Healthy Aging Institute of Sports Medicine University of Copenhagen Copenhagen Denmark
| | - Stig P. Magnusson
- Department of Orthopaedic Surgery M Faculty of Health and Medical Sciences Bispebjerg Hospital and Center for Healthy Aging Institute of Sports Medicine University of Copenhagen Copenhagen Denmark
- Department of Physical and Occupational Therapy Bispebjerg Hospital Kobenhavn Denmark
| | - Christian Couppé
- Department of Orthopaedic Surgery M Faculty of Health and Medical Sciences Bispebjerg Hospital and Center for Healthy Aging Institute of Sports Medicine University of Copenhagen Copenhagen Denmark
- Department of Physical and Occupational Therapy Bispebjerg Hospital Kobenhavn Denmark
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Ager AL, Roy JS, Gamache F, Hébert LJ. The Effectiveness of an Upper Extremity Neuromuscular Training Program on the Shoulder Function of Military Members With a Rotator Cuff Tendinopathy: A Pilot Randomized Controlled Trial. Mil Med 2020; 184:e385-e393. [PMID: 30423137 DOI: 10.1093/milmed/usy294] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/26/2018] [Accepted: 10/15/2018] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Shoulder pain, a leading reason to consult a physician or physiotherapist, continues to be a challenge to rehabilitate, particularly with a military population. A rotator cuff (RC) tendinopathy, the most important source of shoulder pain, is one of the leading reasons for sick leave or a discharge from active military service. Research encourages the use of exercise prescription for the management of a RC tendinopathy, however the ideal method of delivery (group setting versus one-on-one) remains uncertain. The purpose of this single-blind (evaluator) pilot randomized clinical trial was to compare two 6-week rehabilitation programs, a newly developed group-supervised neuromuscular training program and usual one-on-one physiotherapy care, on the pain and symptoms of Canadian soldiers affected by a RC tendinopathy. MATERIALS AND METHODS Thirty-one soldiers with the Canadian Armed Forces were randomly assigned to (1) a group-supervised neuromuscular training program (UPEx-NTP) or; (2) one-on-one usual physiotherapy care (UPC). The primary outcome was the Disability of Arm, Hand and Shoulder (DASH) questionnaire. Secondary outcomes included the Western Ontario Rotator Cuff (WORC) Index, pain levels at rest, and maximum isometric voluntary contractions (MIVC) of the abductors and external (lateral) rotators of the affected shoulder. Both were assessed at baseline (T0), 6 (T6) and 12 (T12) weeks. Analysis included two-way repeated measures of variance for intention-to-treat (ITT) and per-protocol analyses. RESULTS Eighty military members with a RC tendinopathy were contacted, resulting in 31 participants who were randomized for their active intervention, in the UPEx-NTP or UPC, respectively. No significant group (p ≥ 0.16) or group × time interactions (p ≥ 0.11) were found for either ITT or per-protocol analyses. A statistically significant time effect (p < 0.001) was established for the DASH and WORC, showing that both groups improved over time. CONCLUSIONS Our preliminary data demonstrates that both rehabilitation approaches, grounded in active exercises, were not statistically different from each other, and derived similar benefits over time for a military population. This suggests that a group intervention for a RC tendinopathy has potential to be just as effective as a one-on-one approach for a military population, an interesting avenue for an active working population. Larger sample sizes and further investigation are warranted regarding the cost and clinical resource benefits of a supervised group approach.
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Affiliation(s)
- Amanda L Ager
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Rehabilitation Institute, Quebec City, Quebec, Canada.,Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec, Canada
| | - Jean-Sébastien Roy
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Rehabilitation Institute, Quebec City, Quebec, Canada.,Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec, Canada
| | - France Gamache
- Physiotherapy Department, Valcartier Garrison, Canadian Armed Forces, Quebec, Canada
| | - Luc J Hébert
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Rehabilitation Institute, Quebec City, Quebec, Canada.,Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec, Canada.,Department of Radiology/Nuclear Medicine, Faculty of Medicine, Laval University, Quebec, Canada.,1 Canadian Field Hospital, Detachment Ottawa, Ottawa, Ontario, Canada
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Tendon and ligament mechanical loading in the pathogenesis of inflammatory arthritis. Nat Rev Rheumatol 2020; 16:193-207. [PMID: 32080619 DOI: 10.1038/s41584-019-0364-x] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2019] [Indexed: 12/18/2022]
Abstract
Mechanical loading is an important factor in musculoskeletal health and disease. Tendons and ligaments require physiological levels of mechanical loading to develop and maintain their tissue architecture, a process that is achieved at the cellular level through mechanotransduction-mediated fine tuning of the extracellular matrix by tendon and ligament stromal cells. Pathological levels of force represent a biological (mechanical) stress that elicits an immune system-mediated tissue repair pathway in tendons and ligaments. The biomechanics and mechanobiology of tendons and ligaments form the basis for understanding how such tissues sense and respond to mechanical force, and the anatomical extent of several mechanical stress-related disorders in tendons and ligaments overlaps with that of chronic inflammatory arthritis in joints. The role of mechanical stress in 'overuse' injuries, such as tendinopathy, has long been known, but mechanical stress is now also emerging as a possible trigger for some forms of chronic inflammatory arthritis, including spondyloarthritis and rheumatoid arthritis. Thus, seemingly diverse diseases of the musculoskeletal system might have similar mechanisms of immunopathogenesis owing to conserved responses to mechanical stress.
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