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Panosso I, Senger D, Delabary MDS, Angioi M, Haas AN. Validated Tools Used to Assess Musculoskeletal Injuries in Dancers: A Systematic Review. J Dance Med Sci 2024:1089313X241272137. [PMID: 39169513 DOI: 10.1177/1089313x241272137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
Introduction: Dance is a physically demanding art form that often results in musculoskeletal injuries. To effectively treat these injuries, standardized and reliable assessment tools designed to the dancer's needs are required. Thus, the aim of this review is to identify studies that have employed validated tools to assess musculoskeletal injuries in ballet, modern, and contemporary dancers, focusing on describing the content and psychometric quality of the tools used. Methods: This systematic review is registered at PROSPERO (CRD42022306755). PubMed, Cochrane, LILACS, Web of Science and SPORTDiscus databases were searched by two independent reviewers. Articles assessing musculoskeletal injuries with validated tools in ballet, modern and/or contemporary dancers and written in English, Portuguese, or Spanish were included. Non-peer reviewed articles, books, conference abstracts, thesis/review articles, or case design studies were excluded. The original validation studies were compiled when necessary. Two independent reviewers conducted a standardized data extraction and evaluated the methodological quality using an adapted Downs and Black checklist. Results: From the 3933 studies screened, 172 were read to verify if they met the inclusion criteria, resulting in 37 studies included accounting for 16 unique validated tools. Two were imaging exams, one was an injury classification system, and 13 were self-reported injury questionnaires. Only four injury assessment tools were validated for dancers, emphasizing the need for further validation studies for the dance population. Most of the articles (57%) achieved high-quality methodological scores and the remaining (43%) reported medium-quality scores. Conclusions: Valid, reliable, and specific tools to assess dance injuries are lacking in general. For enhanced methodological rigor in future studies, the incorporation of validated tools is recommended to improve methodological quality and facilitate cross-study comparisons. Researchers may consider conducting validation studies, involving processes such as translation into another language, validation of modifications to the original tool, or reporting reliability within the article itself.
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Affiliation(s)
- Isabela Panosso
- Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Danrlei Senger
- Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | - Aline Nogueira Haas
- Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
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Hameed I, Farooq N, Haq A, Aimen I, Shanley J. Role of strengthening exercises in management and prevention of overuse sports injuries of lower extremity: a systematic review. J Sports Med Phys Fitness 2024; 64:807-815. [PMID: 38470015 DOI: 10.23736/s0022-4707.23.15470-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
INTRODUCTION Overuse injuries are common in sports involving jumping, running, and landing, due to the repetitive nature of these activities and the strain they place on the lower extremity. The objective of the study was to determine the role of strengthening exercises in the management of overuse sports injuries of lower extremity and its effects on prevention of injury recurrence. EVIDENCE ACQUISITION This study employed a systematic review design. The author extracted and reviewed the papers for this study in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, and then used the PEDro scale to rate the articles' quality. For the most recent and well-developed primary data, several electronic databases including Google Scholar, PubMed Central, MEDLINE, Cochrane Library, and PEDro were exhaustively searched. Inclusion criteria were based on PICO (T) model and included study population, intervention nature, outcome measures, time period, methodological quality, and linguistic extent. EVIDENCE SYNTHESIS The data synthesis involved analyzing randomized control/clinical trials on strengthening exercises for lower extremity overuse sports injuries in athletes, considering outcomes including muscle strength, pain scores, return to sports, and injury prevention. CONCLUSIONS The methodological quality of the recruited articles ranged from excellent to fair on PEDro scale. Three included studies investigated the effects of strengthening exercises on management of lower extremity injuries of athletes. Four studies evaluated its role on prevention from recurrence of injuries. This study has concluded that strength training plays a fundamental role in management and prevention of overuse injuries. It not only improves the muscle performance, fitness level, speed and agility in sports but also decreases the pain, and aids in early recovery from an injury.
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Affiliation(s)
- Iqra Hameed
- Postgraduate Course in Advancing Physiotherapy Practice, Coventry University, Coventry, UK -
| | - Nawal Farooq
- Department of Physical Therapy, Riphah International University, Lahore, Pakistan
| | - Ayesha Haq
- Department of Physical Therapy, Riphah International University, Lahore, Pakistan
| | - Ifra Aimen
- Department of Physical Therapy, Riphah International University, Lahore, Pakistan
| | - Jackie Shanley
- Postgraduate Course in Advancing Physiotherapy Practice, Coventry University, Coventry, UK
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Hansoulle T, Peters-Dickie JL, Mahaudens P, Nguyen AP. Do we underestimate the frequency of ankle sprains in running? A systematic review and meta-analysis. Phys Ther Sport 2024; 68:60-70. [PMID: 38963954 DOI: 10.1016/j.ptsp.2024.06.009] [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: 04/15/2024] [Revised: 06/28/2024] [Accepted: 06/29/2024] [Indexed: 07/06/2024]
Abstract
OBJECTIVE To provide a systematic review and meta-analysis of the proportion of ankle sprains in running practices. DESIGN Systematic review and meta-analysis. MAIN OUTCOME MEASURES We calculated the weighted summary proportion and conducted meta-analyses for runners, considering levels (elite/recreational) and disciplines (distance, track, cross-country, trail, and orienteering). RESULTS 32 studies were included in the systematic review and 19 were included in the meta-analysis with a level of quality ranging from poor to good. Proportion of ankle sprains in runners was 13.69% (95%CI = 7.40-21.54; I2 = 98.58%) in global, 12.20% (95%CI = 5.24-21.53; I2 = 89.31%) in elite, 19.40% (95%CI = 10.05-30.90; I2 = 99.09%) in recreational, 8.51% (95%CI = 4.22-14.12; I2 = 96.15%) in distance, 67.42% (95%CI = 0.50-82.85; I2 = 99.36%) in track, 27.07% (95%CI = 12.48-44.81; I2 = 97.97%) in cross-country, and 25.70% (95%CI = 19.87-32.14; I2 = 0.00) in orienteering. CONCLUSIONS Running practice results in significant proportion rate of ankle sprains. Recreational runners exhibit higher proportion than elite. Running disciplines, especially track, cross-country, and orienteering, influence reported ankle sprain rates, surpassing those of distance runners.
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Affiliation(s)
- Thomas Hansoulle
- Université catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Avenue Mounier 52, B-1200, Brussels, Belgium.
| | - Jean-Louis Peters-Dickie
- Université catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Avenue Mounier 52, B-1200, Brussels, Belgium; Katholieke Universiteit Leuven, Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, Spoorwegstraat 12, B-8200, Sint-Michiels, Belgium; KU Leuven, Universitary Hospital Pellenberg, Clinical Motion Analysis Laboratorium (CMAL), Weligerveld 1, B-3212, Lubbeek, Belgium.
| | - Philippe Mahaudens
- Université catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Avenue Mounier 52, B-1200, Brussels, Belgium.
| | - Anh Phong Nguyen
- Université catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Avenue Mounier 52, B-1200, Brussels, Belgium; The Running Clinic, lac Beauport, Quebec, Canada.
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Stumpner T, Recheis S, Gruber MS, Kindermann H, Mattausch D, Bock P, Pöchgraber P, Ortmaier R, Bischofreiter M. Achilles tendon debridement, calcaneoplasty and double-row tendon footprint reconstruction improve ankle function and athletic performance in patients with insertional Achilles tendinopathy. Foot Ankle Surg 2024:S1268-7731(24)00118-8. [PMID: 38871492 DOI: 10.1016/j.fas.2024.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 05/16/2024] [Accepted: 05/27/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Insertional Achilles tendinopathy is a frequent condition among physically active individuals. Extensive intratendinous pathologies may require partial tendon detachment, debridement and reconstruction of the tendon footprint. Positive functional outcomes are reported after the procedure, but literature on postoperative sport function is limited. METHODS Pre- and postoperative sports capability and ankle function were assessed in 25 patients undergoing Achilles tendon debridement and double-row footprint reconstruction. RESULTS The mean VAS score for pain during sport decreased significantly from 7.4 (SD, 2.5) to 1.2 (SD, 2.0) postoperatively (p < 0.001). Sports ability and subjective fitness levels increased significantly from 3.6 (SD 3.0) and 3.5 (2.2) to 8.8 (2.4) and 8.8 (2.2), respectively (p < 0.001). A trend from high-impact sports to low-impact sports was observed postoperatively. The subjective surgical outcome was good or excellent in 96 %. CONCLUSION Our study shows improvement in postoperative sports ability and high patient satisfaction after insertional Achilles tendon debridement, and double-row tendon footprint reconstruction. LEVEL OF EVIDENCE Level IV - retrospective case series.
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Affiliation(s)
- Thomas Stumpner
- Department of Orthopaedic Surgery, Ordensklinikum Linz Barmherzige Schwestern, Seilerstaette 4, 4010 Linz, Austria.
| | - Simon Recheis
- Department of Orthopaedic Surgery, Ordensklinikum Linz Barmherzige Schwestern, Seilerstaette 4, 4010 Linz, Austria
| | - Michael S Gruber
- Department of Orthopaedic Surgery, Ordensklinikum Linz Barmherzige Schwestern, Seilerstaette 4, 4010 Linz, Austria
| | - Harald Kindermann
- University of Applied Sciences Upper Austria, Roseggerstraße 15, 4600 Wels, Austria
| | - Dietmar Mattausch
- Department of Orthopaedic Surgery, Ordensklinikum Linz Barmherzige Schwestern, Seilerstaette 4, 4010 Linz, Austria
| | - Peter Bock
- Orthopoint Vienna, Mariahilfer Str. 49, 1060 Vienna, Austria
| | - Paul Pöchgraber
- Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Reinhold Ortmaier
- Department of Orthopaedic Surgery, Ordensklinikum Linz Barmherzige Schwestern, Seilerstaette 4, 4010 Linz, Austria
| | - Martin Bischofreiter
- Department of Orthopaedic Surgery, Ordensklinikum Linz Barmherzige Schwestern, Seilerstaette 4, 4010 Linz, Austria; Department of Orthopaedic and Trauma Surgery, Clinic Diakonissen Schladming, Salzburgerstraße 777, 8970 Schladming, Austria
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Nowak AS, Miro EW, Eby SF, Cushman DM. Identification of pre-race ultrasonographic abnormalities of the Achilles tendon and association with future injuries in runners. PHYSICIAN SPORTSMED 2024; 52:299-303. [PMID: 37550955 PMCID: PMC10858303 DOI: 10.1080/00913847.2023.2246179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 08/06/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVE To determine if specific morphological changes in ultrasonographic images of Achilles tendons are associated with the development of pain in distance runners. METHODS This study is a blinded, retrospective analysis of 276 Achilles tendon ultrasound images, which were used to determine if specific morphologic findings could positively or negatively predict future Achilles tendon pain development in distance runners. Pre-race ultrasound scans were performed on 138 asymptomatic half- and full marathon runners (276 tendons in total) who were followed for 12 months after their races. Specific patterns of morphologic abnormality were identified (location, size, and appearance of ultrasound abnormality within the tendon). Sonographic findings were blindly assessed by a medical student, a resident, and a physician who has significant sonographic imaging experience. These specific abnormalities were then compared to those who later did or did not develop tendon pain. RESULTS Three findings were found to have significant odds of association with the development of pain: 1) focal deep midsubstance intratendinous hypoechogenicity, 2) focal superficial midsubstance intratendinous hypoechogenicity, and 3) linear hyperechogenicity extending into middle of tendon from calcaneus. CONCLUSION These results suggest that the aforementioned specific morphologic abnormalities in the Achilles tendon may be associated with the future development of pain symptoms in distance runners in this cohort. Looking for these specific abnormalities may increase the specificity of identifying precursors to Achilles tendon pain development.
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Affiliation(s)
- Andrew S. Nowak
- Central Michigan University College of Medicine, Mount Pleasant, MI
| | - Emily W. Miro
- University of Utah, Department of Family and Preventive Medicine, Salt Lake City, UT
| | - Sarah F. Eby
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA
| | - Daniel M. Cushman
- University of Utah, Department of Physical Medicine & Rehabilitation, Salt Lake City, UT
- University of Utah, Department of Orthopaedics, Salt Lake City, UT
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Albarova-Corral I, Segovia-Burillo J, Malo-Urriés M, Ríos-Asín I, Asín J, Castillo-Mateo J, Gracia-Tabuenca Z, Morales-Hernández M. A New Quantitative Tool for the Ultrasonographic Assessment of Tendons: A Reliability and Validity Study on the Patellar Tendon. Diagnostics (Basel) 2024; 14:1067. [PMID: 38893594 PMCID: PMC11171978 DOI: 10.3390/diagnostics14111067] [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: 03/27/2024] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 06/21/2024] Open
Abstract
Ultrasound is widely used for tendon assessment due to its safety, affordability, and portability, but its subjective nature poses challenges. This study aimed to develop a new quantitative analysis tool based on artificial intelligence to identify statistical patterns of healthy and pathological tendons. Furthermore, we aimed to validate this new tool by comparing it to experts' subjective assessments. A pilot database including healthy controls and patients with patellar tendinopathy was constructed, involving 14 participants with asymptomatic (n = 7) and symptomatic (n = 7) patellar tendons. Ultrasonographic images were assessed twice, utilizing both the new quantitative tool and the subjective scoring method applied by an expert across five regions of interest. The database contained 61 variables per image. The robustness of the clinical and quantitative assessments was tested via reliability analyses. Lastly, the prediction accuracy of the quantitative features was tested via cross-validated generalized linear mixed-effects logistic regressions. These analyses showed high reliability for quantitative variables related to "Bone" and "Quality", with ICCs above 0.75. The ICCs for "Edges" and "Thickness" varied but mostly exceeded 0.75. The results of this study show that certain quantitative variables are capable of predicting an expert's subjective assessment with generally high cross-validated AUC scores. A new quantitative tool for the ultrasonographic assessment of the tendon was designed. This system is shown to be a reliable and valid method for evaluating the patellar tendon structure.
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Affiliation(s)
- Isabel Albarova-Corral
- PhysiUZerapy Health Sciences Research Group, Department of Physiatry and Nursing, University of Zaragoza, 50009 Zaragoza, Spain
| | - José Segovia-Burillo
- Fluid Mechanics, Instituto de Investigación en Ingeniería de Aragón (I3A), University of Zaragoza, 50018 Zaragoza, Spain
| | - Miguel Malo-Urriés
- PhysiUZerapy Health Sciences Research Group, Department of Physiatry and Nursing, University of Zaragoza, 50009 Zaragoza, Spain
| | - Izarbe Ríos-Asín
- PhysiUZerapy Health Sciences Research Group, Department of Physiatry and Nursing, University of Zaragoza, 50009 Zaragoza, Spain
| | - Jesús Asín
- Modelos Estocásticos Research Group, Department of Statistical Methods, University of Zaragoza, 50009 Zaragoza, Spain
| | - Jorge Castillo-Mateo
- Modelos Estocásticos Research Group, Department of Statistical Methods, University of Zaragoza, 50009 Zaragoza, Spain
| | - Zeus Gracia-Tabuenca
- Modelos Estocásticos Research Group, Department of Statistical Methods, University of Zaragoza, 50009 Zaragoza, Spain
| | - Mario Morales-Hernández
- Fluid Mechanics, Instituto de Investigación en Ingeniería de Aragón (I3A), University of Zaragoza, 50018 Zaragoza, Spain
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Ortiz-Babilonia CD, Gupta A, Cartagena-Reyes MA, Xu AL, Raad M, Durand WM, Skolasky RL, Jain A. The Statistical Fragility of Trials Comparing Cervical Disc Arthroplasty and Anterior Cervical Discectomy and Fusion: A Meta Analysis. Spine (Phila Pa 1976) 2024; 49:708-714. [PMID: 37368958 DOI: 10.1097/brs.0000000000004756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 06/11/2023] [Indexed: 06/29/2023]
Abstract
STUDY DESIGN Meta-analysis. OBJECTIVE To assess the robustness of randomized controlled trials (RCTs) that compared cervical disc arthroplasty (CDA) and anterior cervical discectomy and fusion (ACDF) for the treatment of symptomatic degenerative cervical pathology by using fragility indices. SUMMARY OF BACKGROUND DATA RCTs comparing these surgical approaches have shown that CDA may be equivalent or even superior to ACDF due to better preservation of normal spinal kinematics. MATERIALS AND METHODS RCTs reporting clinical outcomes after CDA versus ACDF for degenerative cervical disc disease were evaluated. Data for outcome measures were classified as continuous or dichotomous. Continuous outcomes included: Neck Disability Index, overall pain, neck pain, radicular arm pain, and modified Japanese Orthopedic Association scores. Dichotomous outcomes included: any adjacent segment disease (ASD), superior-level ASD, and inferior-level ASD. The fragility index (FI) and continuous FI (CFI) were determined for dichotomous and continuous outcomes, respectively. The corresponding fragility quotient (FQ) and continuous FQ were calculated by dividing FI/CFI by sample size. RESULTS Twenty-five studies (78 outcome events) were included. Thirteen dichotomous events had a median FI of 7 [interquartile range (IQR): 3-10], and the median FQ was 0.043 (IQR: 0.035-0.066). Sixty-five continuous events had a median CFI of 14 (IQR: 9-22) and a median continuous FQ of 0.145 (IQR: 0.074-0.188). This indicates that, on average, altering the outcome of 4.3 patients out of 100 for the dichotomous outcomes and 14.5 out of 100 for continuous outcomes would reverse trial significance. Of the 13 dichotomous events that included a loss to follow-up data, 8 (61.5%) represented ≥7 patients lost. Of the 65 continuous events reporting the loss to follow-up data, 22 (33.8%) represented ≥14 patients lost. CONCLUSION RCTs comparing ACDF and CDA have fair to moderate statistical robustness and do not suffer from statistical fragility.
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Affiliation(s)
- Carlos D Ortiz-Babilonia
- Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, MD
- Department of Orthopedic Surgery, University of Puerto Rico, PR
| | - Arjun Gupta
- Department of Orthopedic Surgery, Rutgers University, New Jersey, NJ
| | | | - Amy L Xu
- Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, MD
| | - Micheal Raad
- Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, MD
| | - Wesley M Durand
- Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, MD
| | - Richard L Skolasky
- Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, MD
| | - Amit Jain
- Department of Orthopedic Surgery, Johns Hopkins University, Baltimore, MD
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Romero-Morales C, López-López D, Almazán-Polo J, Mogedano-Cruz S, Sosa-Reina MD, García-Pérez-de-Sevilla G, Martín-Pérez S, González-de-la-Flor Á. Prevalence, diagnosis and management of musculoskeletal disorders in elite athletes: A mini-review. Dis Mon 2024; 70:101629. [PMID: 37716840 DOI: 10.1016/j.disamonth.2023.101629] [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: 09/18/2023]
Abstract
Musculoskeletal injuries in elite sports are ones of the most impact issue because their remarkable impact on performance caused by drastic absence of training and competition and a progressive deterioration in physical health, emotional and social athletes' dimensions. Also, the prevalence of epidemiologic research found an incidence of musculoskeletal disorders vary within sports and in elite athletes which is even higher as a consequence of higher demand physical performance. This way, the loss of physical performance due to an sport injury impacts not only the individual economic sphere of the professional but also that ofsports entities, reaching, according to some studies, a loss estimated in the range of 74.7 million pounds. Thus, the purpose of this article is to review and to provide an overview of the most common musculoskeletal injuries in elite sports precipitating factors, clinical presentation, evidence-based diagnostic evaluation, and treatment recommendations with a view to preventing medical conditions or musculoskeletal injuries that may alter performance and general health in the elite athletes.
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Affiliation(s)
- Carlos Romero-Morales
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - Daniel López-López
- Research, Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Industrial Campus of Ferrol , Universidade da Coruña, 15403 Ferrol, Spain.
| | - Jaime Almazán-Polo
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - Sara Mogedano-Cruz
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - María Dolores Sosa-Reina
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | | | - Sebastián Martín-Pérez
- Faculty of Health Sciences, Universidad Europea de Canarias, La Orotava, Santa Cruz de Tenerife 38300, Spain
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Koshino Y, Ishida T, Taniguchi S, Samukawa M, Kasahara S, Tohyama H. Hip and knee kinematics, center of pressure position, and ground reaction force are associated with Achilles tendon force during jump landing. Scand J Med Sci Sports 2024; 34:e14510. [PMID: 37787026 DOI: 10.1111/sms.14510] [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: 04/11/2023] [Revised: 09/19/2023] [Accepted: 09/25/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE Jump-landing exercises are often performed during the rehabilitation of Achilles tendon (AT) injuries. However, the factors that affect the AT force (ATF) during landing are unclear. This study aimed to determine the kinematics and ground reaction force (GRF) variables associated with the peak ATF during a drop vertical jump (DVJ). METHODS The landing phase of DVJ was evaluated in 101 healthy participants (46 males, age: 21.2 ± 1.4 years old) using a three-dimensional motion analysis system with two force plates. ATF was estimated from the ankle flexion angle and moment. Univariate and multivariate regression analyses were performed with the peak ATF as the dependent variable. The vertical GRF (VGRF), center of pressure (COP), forward trunk leaning, hip/knee/ankle joint angles at peak ATF, and sex were used as independent variables. RESULTS In the univariate regression analysis, larger VGRF (β = 0.813), more anterior COP position (β = 0.214), smaller knee flexion (β = -0.251) and adduction (β = -0.252), smaller hip flexion (β = -0.407), smaller forward trunk lean (β = -0.492), and male sex (β = -0.282) were significantly associated with a larger peak ATF. Multivariate analysis revealed that larger VGRF (β = 1.018), more anterior COP position (β = 0.320), a larger knee (β = 0.442), and smaller hip flexion (β = -0.205) were associated with the larger peak ATF. CONCLUSIONS The VGRF, COP position, and knee and hip flexion were independently associated with ATF. Modifying these factors may be useful in managing tendon loading during jump-landing exercises.
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Affiliation(s)
- Yuta Koshino
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Tomoya Ishida
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | | | - Mina Samukawa
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
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Shiotani H, Mizokuchi T, Yamashita R, Naito M, Kawakami Y. Influence of Body Mass on Running-Induced Changes in Mechanical Properties of Plantar Fascia. J Strength Cond Res 2023; 37:e588-e592. [PMID: 37099441 PMCID: PMC10599803 DOI: 10.1519/jsc.0000000000004536] [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: 04/27/2023]
Abstract
ABSTRACT Shiotani, H, Mizokuchi, T, Yamashita, R, Naito, M, and Kawakami, Y. Influence of body mass on running-induced changes in mechanical properties of plantar fascia. J Strength Cond Res 37(11): e588-e592, 2023-Body mass is a major risk factor for plantar fasciopathy; however, evidence explaining the process between risk factors and injury development is limited. Long-distance running induces transient and site-specific reduction in plantar fascia (PF) stiffness, reflecting mechanical fatigue and microscopic damage within the tissue. As greater mechanical loads can induce greater reduction in tissue stiffness, we hypothesized that the degree of running-induced change in PF stiffness is associated with body mass. Ten long-distance male runners (age: 21 - 23 years, body mass: 55.5 ± 4.2 kg; mean ± SD ) and 10 untrained men (age: 20 - 24 years, body mass: 58.4 ± 5.6 kg) ran for 10 km. Before and immediately after running, the shear wave velocity (SWV) of PF at the proximal site, which is an index of tissue stiffness, was measured using ultrasound shear wave elastography. Although the PF SWV significantly decreased after running in runners (-4.0%, p = 0.010) and untrained men (-21.9%, p < 0.001), runners exhibited smaller changes ( p < 0.001). The relative changes in SWV significantly correlated with body mass in both runners ( r = -0.691, p = 0.027) and untrained individuals ( r = -0.723, p = 0.018). These results indicate that a larger body mass is associated with a greater reduction in PF stiffness. Our findings provide in vivo evidence of the biomechanical basis for body mass as a risk factor for plantar fasciopathy. Furthermore, group differences suggest possible factors that reduce the fatigue responses, such as adaptation enhancing the resilience of PF and running mechanics.
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Affiliation(s)
- Hiroto Shiotani
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
- Human Performance Laboratory, Comprehensive Research Organization, Waseda University, Tokyo, Japan
| | | | - Ryo Yamashita
- School of Sport Sciences, Waseda University, Saitama, Japan; and
| | - Munekazu Naito
- Human Performance Laboratory, Comprehensive Research Organization, Waseda University, Tokyo, Japan
- Department of Anatomy, Aichi Medical University, Aichi, Japan
| | - Yasuo Kawakami
- Faculty of Sport Sciences, Waseda University, Saitama, Japan
- Human Performance Laboratory, Comprehensive Research Organization, Waseda University, Tokyo, Japan
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Yan Y, Lu H, Zhang J, Yu X, Liu Y, Chen G, Xu H, Xu R. Talar coverage of the tibia plays a role in anterior ankle impingement: a retrospective cohort study. INTERNATIONAL ORTHOPAEDICS 2023; 47:2693-2698. [PMID: 37479892 DOI: 10.1007/s00264-023-05898-4] [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: 05/26/2023] [Accepted: 07/10/2023] [Indexed: 07/23/2023]
Abstract
PURPOSE Ankle impingement is generally characterised by limited range of motion and pain due to pathological contact between structures. Anterior ankle impingement is usually diagnosed by clinical examination and radiographic evidence of tibiotalar osteophytes. In addition to osteophytes, radiographs may show a correlation between the tibia and talus, which may further aid in the diagnosis of anterior ankle impingement. The purpose of this study is to investigate the relationship between the tibia and talus in anterior ankle impingement. METHODS In this retrospective cohort study, the tibial coverage of 22 patients with anterior ankle impingement was compared with that of 67 healthy subjects. RESULTS The percentage of tibial coverage was 0.674 ± 0.043 in the anterior ankle impingement group and 0.580 ± 0.032 in the control group. The difference between groups was statistically significant (P < 0.05). CONCLUSIONS In addition to existing criteria, the percentage of tibial coverage may provide valuable information for the diagnosis of anterior ankle impingement.
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Affiliation(s)
- Yongqing Yan
- Department of Orthopedics, HwaMei Hospital, University of Chinese Academy of Science, Province, Ningbo City Zhejiang, 315010, China
| | - Hao Lu
- Department of Orthopedics and Trauma, Peking University People's Hospital, Beijing, 100044, China
| | - Jingyu Zhang
- Department of Orthopaedics, Suzhou Municipal Hospital, The Affiliated Hospital of Nanjing Medical University, No. 26, Daoqian Street, Suzhou, Jiangsu Province, 215002, China
| | - Xiao Yu
- Department of Orthopaedics, Suzhou Municipal Hospital, The Affiliated Hospital of Nanjing Medical University, No. 26, Daoqian Street, Suzhou, Jiangsu Province, 215002, China
| | - Yubo Liu
- Department of Orthopaedics, Suzhou Municipal Hospital, The Affiliated Hospital of Nanjing Medical University, No. 26, Daoqian Street, Suzhou, Jiangsu Province, 215002, China
| | - Guangxiang Chen
- Department of Orthopaedics, Suzhou Municipal Hospital, The Affiliated Hospital of Nanjing Medical University, No. 26, Daoqian Street, Suzhou, Jiangsu Province, 215002, China
| | - Hailin Xu
- Department of Orthopedics and Trauma, Peking University People's Hospital, Beijing, 100044, China
| | - Renjie Xu
- Department of Orthopaedics, Suzhou Municipal Hospital, The Affiliated Hospital of Nanjing Medical University, No. 26, Daoqian Street, Suzhou, Jiangsu Province, 215002, China.
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12
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Sivrika AP, Papadamou E, Kypraios G, Lamnisos D, Georgoudis G, Stasinopoulos D. Comparability of the Effectiveness of Different Types of Exercise in the Treatment of Achilles Tendinopathy: A Systematic Review. Healthcare (Basel) 2023; 11:2268. [PMID: 37628466 PMCID: PMC10454459 DOI: 10.3390/healthcare11162268] [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: 06/10/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Achilles tendinopathy (AT) is a common condition both in athletes and the general population. The purpose of this study is to highlight the most effective form of exercise in managing pain-related symptoms and functional capacity as well as in a return to life activities, ensuring the quality of life of patients with AT, and creating a protocol to be used in rehabilitation. We conducted a systematic review of the published literature in Pubmed, Scopus, Science Direct, and PEDro for Randomised Controlled Trials concerning interventions that were based exclusively on exercise and delivered in patients 18-65 years old, athletes and non-athletes. An amount of 5235 research articles generated from our search. Five met our inclusion criteria and were included in the review. Research evidence supports the effectiveness of a progressive loading eccentric exercise program based on Alfredson's protocol, which could be modified in intensity and pace to fit the needs of each patient with AT. Future research may focus on the optimal dosage and load of exercise in eccentric training and confirm the effectiveness of other type of exercise, such as a combination of eccentric-concentric training or heavy slow resistance exercise. Pilates could be applied as an alternative, useful, and friendly tool in the rehabilitation of AT.
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Affiliation(s)
- Aikaterini Pantelis Sivrika
- Department of Physiotherapy, University of West Attica, 28 AgiouSpyridonos Str., Egaleo, 12243 Athens, Greece; (E.P.); (G.K.); (G.G.); (D.S.)
| | - Eleni Papadamou
- Department of Physiotherapy, University of West Attica, 28 AgiouSpyridonos Str., Egaleo, 12243 Athens, Greece; (E.P.); (G.K.); (G.G.); (D.S.)
| | - George Kypraios
- Department of Physiotherapy, University of West Attica, 28 AgiouSpyridonos Str., Egaleo, 12243 Athens, Greece; (E.P.); (G.K.); (G.G.); (D.S.)
| | - Demetris Lamnisos
- Department of Health Sciences, European University Cyprus, 6 Diogenous Str., Engomi, Nicosia 22006, Cyprus;
| | - George Georgoudis
- Department of Physiotherapy, University of West Attica, 28 AgiouSpyridonos Str., Egaleo, 12243 Athens, Greece; (E.P.); (G.K.); (G.G.); (D.S.)
| | - Dimitrios Stasinopoulos
- Department of Physiotherapy, University of West Attica, 28 AgiouSpyridonos Str., Egaleo, 12243 Athens, Greece; (E.P.); (G.K.); (G.G.); (D.S.)
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13
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Tabarestani TQ, Anastasio AT, Duruewuru A, Taylor JR, Bethell MA, Adams SB. Analyzing the quality and educational value of Achilles tendinopathy-related videos on TikTok. Foot Ankle Surg 2023; 29:350-354. [PMID: 37019747 DOI: 10.1016/j.fas.2023.03.007] [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: 10/27/2022] [Revised: 03/27/2023] [Accepted: 03/30/2023] [Indexed: 04/07/2023]
Abstract
BACKGROUND Social media platforms, like TikTok, have become popular options for the consumption and distribution of healthcare information. Due to the lack of scientific oversight, the consistency of healthcare-related videos has become a focus of the current literature. However, orthopaedic surgery has lagged behind other specialties in acknowledging the widespread utilization of TikTok videos for medical information. This study aims to assess the quality and educational benefits of Achilles tendinopathy-related TikTok videos. METHODS TikTok was queried using the hashtags "#achillestendonexercises", "achillestendonitisexercises", "achillestendinosisexercises", and "achillestendinopathyexercises". 100 videos (25 for each term) were included after applying the exclusion criteria. The number of views, likes, shares, comments, and favorites was recorded. The content was graded using DISCERN (a well-validated informational analysis tool) and ATEES (a self-designed tool for exercise evaluation). RESULTS The total number of views of the 100 videos was 1647,148, with a median of 7562.5 (IQR = 2,281- 19,575). The videos collectively received 73,765 likes, 1125 comments, 14,491 favorites and 6897 shares with a median of 283 (IQR= 73.8-957.8), 7 (IQR= 1.8-16.0), 61.5 (IQR= 8.8-184.3), and 18.5 (IQR= 2.0-49.8), respectively. General users uploaded slightly less (48%) when compared to healthcare professionals (52%). Healthcare professionals had more videos graded as "very poor" (43.4%) in comparison to the general users (36.2%). General users had more videos graded as "poor" (63.8%) in comparison to healthcare professionals (54.7%). However, there were no significant differences between the groups on either of the video grading scales. CONCLUSION Although TikTok is a powerful tool for information distribution, the educational value of the videos related to Achilles tendinopathy exercises was poor. With only 1% of videos receiving a grade of 'fair,' and no videos reaching a score of 'good' or 'excellent', healthcare professionals should be aware of the high viewership of low-quality content easily accessible on TikTok. LEVEL OF EVIDENCE: 3
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Affiliation(s)
| | - Albert T Anastasio
- Department of Orthopedic Surgery, Duke University Hospital, Durham, NC, USA.
| | | | | | | | - Samuel B Adams
- Department of Orthopedic Surgery, Duke University Hospital, Durham, NC, USA
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14
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Beekman KM, Kuijer PPFM, Maas M. Imaging of Overuse Injuries of the Ankle and Foot in Sport and Work. Radiol Clin North Am 2023; 61:307-318. [PMID: 36739147 DOI: 10.1016/j.rcl.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Overuse injuries of the ankle and foot are common injuries both in sport and in a work-related context. After clinical assessment, imaging is key for early diagnosis. In this overview article, we focus on imaging techniques, protocols, and imaging findings of overuse injuries of the ankle and foot; we emphasize the important role of structured reporting; and we discuss clinical symptoms, epidemiology, and risk factors in sports and in a work-related context.
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Affiliation(s)
- Kerensa M Beekman
- Department of Radiology and Nuclear Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
| | - P Paul F M Kuijer
- Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam Public Health, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Mario Maas
- Department of Radiology and Nuclear Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Academic Center for Evidence-based Sports Medicine (ACES), Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
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15
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Trikha R, Greig DE, Shi BY, Schroeder GG, Chernoff DJ, Jones KJ, Kremen TJ. Multicenter Analysis of the Epidemiology of Injury Patterns and Return to Sport in Collegiate Gymnasts. Orthop J Sports Med 2023; 11:23259671231154618. [PMID: 36860774 PMCID: PMC9969444 DOI: 10.1177/23259671231154618] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/08/2022] [Indexed: 03/03/2023] Open
Abstract
Background Gymnastics requires intense year-round upper and lower extremity strength training typically starting from an early age. As such, the injury patterns observed in these athletes may be unique. Purpose To characterize the types of injuries and provide return-to-sport data in male and female collegiate gymnasts. Study Design Descriptive epidemiology study. Methods A conference-specific injury database was utilized to perform a retrospective review of injuries for male and female National Collegiate Athletic Association (NCAA) Division I gymnasts within the Pacific Coast Conference between 2017 and 2020 (N = 673 gymnasts). Injuries were stratified by anatomic location, sex, time missed, and injury diagnoses. Relative risk (RR) was used to compare results between sexes. Results Of the 673 gymnasts, 183 (27.2%) experienced 1093 injuries during the study period. Injuries were sustained in 35 of 145 male athletes (24.1%) as compared with 148 of 528 female athletes (28.0%; RR, 0.86 [95% CI, 0.63-1.19]; P = .390). Approximately 66.1% (723/1093) of injuries occurred in a practice setting, compared with 84 of 1093 injuries (7.7%) occurring during competition. Overall, 417 of 1093 injuries (38.2%) resulted in no missed time. Shoulder injuries and elbow/arm injuries were significantly more common in male versus female athletes (RR, 1.99 [95% CI, 1.32-3.01], P = .001; and RR, 2.08 [95% CI, 1.05-4.13], P = .036, respectively). In total, 23 concussions affected 21 of 673 athletes (3.1%); 6 concussions (26.1%) resulted in the inability to return to sport during the same season. Conclusion For the majority of musculoskeletal injuries, the gymnasts were able to return to sport during the same season. Male athletes were more likely to experience shoulder and elbow/arm injuries, likely because of sex-specific events. Concussions occurred in 3.1% of the gymnasts, highlighting the need for vigilant monitoring. This analysis of the incidence and outcomes of injuries observed in NCAA Division I gymnasts may guide injury prevention protocols as well as provide important prognostic information.
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Affiliation(s)
- Rishi Trikha
- Department of Orthopaedic Surgery, David Geffen School of Medicine
at the University of California, Los Angeles, Los Angeles, California, USA.,Rishi Trikha, MD, UCLA Orthopaedic Surgery, 1225 15th Street,
Suite 2100, Santa Monica, CA 90404, USA (
)
| | - Danielle E. Greig
- Department of Orthopaedic Surgery, David Geffen School of Medicine
at the University of California, Los Angeles, Los Angeles, California, USA
| | - Brendan Y. Shi
- Department of Orthopaedic Surgery, David Geffen School of Medicine
at the University of California, Los Angeles, Los Angeles, California, USA
| | - Grant G. Schroeder
- Department of Orthopaedic Surgery, David Geffen School of Medicine
at the University of California, Los Angeles, Los Angeles, California, USA
| | - Daniel J. Chernoff
- Department of Orthopaedic Surgery, David Geffen School of Medicine
at the University of California, Los Angeles, Los Angeles, California, USA
| | - Kristofer J. Jones
- Department of Orthopaedic Surgery, David Geffen School of Medicine
at the University of California, Los Angeles, Los Angeles, California, USA
| | - Thomas J. Kremen
- Department of Orthopaedic Surgery, David Geffen School of Medicine
at the University of California, Los Angeles, Los Angeles, California, USA
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16
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Demangeot Y, Whiteley R, Gremeaux V, Degache F. The load borne by the Achilles tendon during exercise: A systematic review of normative values. Scand J Med Sci Sports 2023; 33:110-126. [PMID: 36278501 DOI: 10.1111/sms.14242] [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: 03/21/2022] [Revised: 08/29/2022] [Accepted: 09/30/2022] [Indexed: 01/11/2023]
Abstract
The Achilles tendon (AT) can be exposed to considerable stress during athletic activities and is often subject to pathologies such as tendinopathies. When designing a prevention or rehabilitation protocol, mechanical loading is a key factor to consider. This implies being able to accurately determine the load applied to the AT when performing exercises that stress this tendon. A systematic review was performed to synthesize the load borne by the AT during exercises/activities. Three databases (Pubmed, Embase and Cochrane) were searched for articles up to May 2021, and only the studies assessing the AT load in newtons relative to body-weight (BW) on humans during activities or exercises were included. Most of the 11 included studies assessed AT load when running or walking (N = 10), and only three tested exercises were usually performed during rehabilitation. The load on the tendon ranged from 2.7 to 3.95 BW when walking, from 4.15 to 7.71 BW when running, and from 0.41 to 7.3 BW according to the strengthening exercise performed. From the collected data, a progression of exercises progressively loading the Achilles tendon, as well as the possible connections with walking and running activities, could be defined. However, the trends highlighted in the relationship between tendon loading and walking or running speeds present some inconsistencies. Further research is still needed to clarify them, but also to complete the data set in healthy and injured people.
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Affiliation(s)
- Yoann Demangeot
- Therapeutic and Performance Sports Institute, MotionLab, Le Mont-sur-Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Rod Whiteley
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Vincent Gremeaux
- Unit of Sports Medicine, Swiss Olympic Medical Center, Lausanne University Hospital, Lausanne, Switzerland.,Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Francis Degache
- Therapeutic and Performance Sports Institute, MotionLab, Le Mont-sur-Lausanne, Switzerland
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17
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Prudêncio DA, Maffulli N, Migliorini F, Serafim TT, Nunes LF, Sanada LS, Okubo R. Eccentric exercise is more effective than other exercises in the treatment of mid-portion Achilles tendinopathy: systematic review and meta-analysis. BMC Sports Sci Med Rehabil 2023; 15:9. [PMID: 36698184 PMCID: PMC9878810 DOI: 10.1186/s13102-023-00618-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 01/16/2023] [Indexed: 01/27/2023]
Abstract
Achilles tendinopathy (AT) is one of the most frequent overuse injuries in the ankle. The evidence base for its conservative management AT continues to evolve, but there is still a gap in the evidence for the efficacy of any modality of treatment in high-quality studies. This systematic review and meta-analysis investigated the efficacy of EE in improving pain and function in adult patients with mid-portion Achilles tendinopathy compared to other forms of exercise. A search was performed in PubMed, BIREME, SportDiscus, Cinahl, Web of Science and PEDro, in November 2022. The methodological quality was evaluated using the Risk of Bias 2 tool (RoB2) of the Cochrane collaboration, and the meta-analysis was performed using the Review Manager 5.1 program. 2024 articles were identified and eight fulfilled the inclusion criteria. RoB2 presented a final score with 62.5% of the studies presented "some concerns", and 37.5% (five and three articles, respectively) presenting "high risk" of bias. EE was effective for the managment of AT. The only variable for which a meta-analysis was possible was pain (five articles), analysed with the visual analogue scale/numerical visual scale. The mean difference (MD) in treatment effect using EE was - 1.21 (- 2.72 to - 0.30) with a 95% of confidence interval (CI), thus identifying a significant positive effect for the improvement of pain in patients with AT in whom EE was used. EE is effective in the management of AT. The meta-analysis shows the need for appropriately powered randomized controlled trials with better design, the use of standard outcome measures and well-planned protocols for conservative management of AT.Level of evidence: Level 1.Registration: CRD42018118016.
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Affiliation(s)
- Diego Ailton Prudêncio
- grid.412287.a0000 0001 2150 7271Department of Physiotherapy, Physiotherapy Postgraduation Program (PPGF), Santa Catarina State University, Florianópolis, Brazil
| | - Nicola Maffulli
- grid.11780.3f0000 0004 1937 0335Department of Orthopaedics, School of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy ,grid.9757.c0000 0004 0415 6205School of Pharmacy and Bioengineering, Faculty of Medicine, Keele University, Stoke On Trent, UK ,grid.4464.20000 0001 2161 2573Centre for Sports and Exercise Medicine at Queen, Mary University of London, London, UK
| | - Filippo Migliorini
- grid.412301.50000 0000 8653 1507Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Thiago Teixeira Serafim
- grid.412287.a0000 0001 2150 7271Department of Physiotherapy, Physiotherapy Postgraduation Program (PPGF), Santa Catarina State University, Florianópolis, Brazil
| | - Luis Felipe Nunes
- grid.411237.20000 0001 2188 7235Department of Pharmacy, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Luciana Sayuri Sanada
- grid.412287.a0000 0001 2150 7271Department of Physiotherapy, Physiotherapy Postgraduation Program (PPGF), Santa Catarina State University, Florianópolis, Brazil
| | - Rodrigo Okubo
- grid.412287.a0000 0001 2150 7271Department of Physiotherapy, Physiotherapy Postgraduation Program (PPGF), Santa Catarina State University, Florianópolis, Brazil
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18
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Smith EJ, Beaumont RE, McClellan A, Sze C, Palomino Lago E, Hazelgrove L, Dudhia J, Smith RKW, Guest DJ. Tumour necrosis factor alpha, interleukin 1 beta and interferon gamma have detrimental effects on equine tenocytes that cannot be rescued by IL-1RA or mesenchymal stromal cell-derived factors. Cell Tissue Res 2023; 391:523-544. [PMID: 36543895 PMCID: PMC9974687 DOI: 10.1007/s00441-022-03726-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 12/10/2022] [Indexed: 12/24/2022]
Abstract
Tendon injuries occur commonly in both human and equine athletes, and poor tendon regeneration leads to functionally deficient scar tissue and an increased frequency of re-injury. Despite evidence suggesting inadequate resolution of inflammation leads to fibrotic healing, our understanding of the inflammatory pathways implicated in tendinopathy remains poorly understood, meaning successful targeted treatments are lacking. Here, we demonstrate IL-1β, TNFα and IFN-γ work synergistically to induce greater detrimental consequences for equine tenocytes than when used individually. This includes altering tendon associated and matrix metalloproteinase gene expression and impairing the cells' ability to contract a 3-D collagen gel, a culture technique which more closely resembles the in vivo environment. Moreover, these adverse effects cannot be rescued by direct suppression of IL-1β using IL-1RA or factors produced by BM-MSCs. Furthermore, we provide evidence that NF-κB, but not JNK, P38 MAPK or STAT 1, is translocated to the nucleus and able to bind to DNA in tenocytes following TNFα and IL-1β stimulation, suggesting this signalling cascade may be responsible for the adverse downstream consequences of these inflammatory cytokines. We suggest a superior approach for treatment of tendinopathy may therefore be to target specific signalling pathways such as NF-κB.
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Affiliation(s)
- Emily J Smith
- Department of Clinical Sciences and Services, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts, AL9 7TA, UK.
| | - Ross E Beaumont
- Department of Clinical Sciences and Services, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts, AL9 7TA, UK
| | - Alyce McClellan
- Centre for Preventative Medicine, Animal Health Trust, Newmarket, Suffolk, CB8 7UU, UK
| | - Cheryl Sze
- Centre for Preventative Medicine, Animal Health Trust, Newmarket, Suffolk, CB8 7UU, UK
| | - Esther Palomino Lago
- Department of Clinical Sciences and Services, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts, AL9 7TA, UK
| | - Liberty Hazelgrove
- Department of Clinical Sciences and Services, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts, AL9 7TA, UK
- Kingston University, River House, 53-57 High Street, Kingston upon Thames, Surrey, KT1 1LQ, UK
| | - Jayesh Dudhia
- Department of Clinical Sciences and Services, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts, AL9 7TA, UK
| | - Roger K W Smith
- Department of Clinical Sciences and Services, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts, AL9 7TA, UK
| | - Deborah J Guest
- Department of Clinical Sciences and Services, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Herts, AL9 7TA, UK.
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19
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Park J, Lee SH, Seo BS, Kim DH, So YH, Kim M, Lee JH, Kim HC, Cho SB, Kim YJ, Choi W. Clinical Outcomes of Transarterial Embolization for Chronic Achilles Tendinopathy Refractory to Conservative Treatment: A Pilot Study. J Vasc Interv Radiol 2023; 34:63-70.e1. [PMID: 36216276 DOI: 10.1016/j.jvir.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 09/28/2022] [Accepted: 10/02/2022] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To evaluate the effectiveness and safety of transarterial embolization (TAE) for chronic Achilles tendinopathy (AT) refractory to conservative treatment. MATERIALS AND METHODS This retrospective study included 20 patients (12 men and 8 women; mean age, 30.3 years) who received TAE using imipenem/cilastatin sodium for refractory chronic AT from May 2019 to April 2021. Nine patients had bilateral involvement. A total of 29 procedures were performed (8 for nonathletes and 21 for athletes). If feasible, embolization was performed superselectively of the arterial branch demonstrating hypervascularity, early venous drainage, and/or supplying the pain site noted using a radiopaque marker. The visual analog scale (VAS, 0-10) score was used to assess pain symptoms at baseline and during the follow-up period (1 day; 1 week; 1, 3, and 6 months; and open period). Clinical success was defined as a decrease of >50% in the VAS score at 6 months when compared with baseline. RESULTS In 25 (86.2%) of 29 procedures, clinical success was achieved. Significant decreases in the VAS scores were noted at 1 day, 1 week, 1 month, 3 months, and 6 months (6.86 at the baseline vs 3.48, 3.41, 3.10, 2.55, and 1.62, respectively; all P < .01). For patients available for the 12- and 24-month follow-ups (n = 19 and 6, respectively), the mean VAS scores significantly decreased (6.84 vs 2.00 and 7.33 vs 1.17, respectively; all P < .01). No serious adverse events were observed during follow-up. CONCLUSIONS TAE may alleviate pain for patients with chronic AT refractory to the conservative treatment with a low risk of adverse events.
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Affiliation(s)
- Juil Park
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang Hwan Lee
- Department of Radiology, H Plus Yangji Hospital, Seoul, Republic of Korea.
| | - Beom-Seok Seo
- Department of Radiology, H Plus Yangji Hospital, Seoul, Republic of Korea
| | - Dong Hyun Kim
- Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Young Ho So
- Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Minuk Kim
- Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Jae Hwan Lee
- Department of Radiology, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Hyo-Cheol Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Soo Buem Cho
- Department of Radiology, Ewha Womans University Seoul Hospital, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Young Jae Kim
- Department of Biomedical Engineering, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Woosun Choi
- Department of Radilogy, Chung-Ang University Hospital, Chung-Ang College of Medicine, Seoul, Republic of Korea
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20
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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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Muacevic A, Adler JR, G SN, Karunakaran B, CP K, PK S, Ravichandran A, Raghunath G, Senthilkumar S, Begum Z. Morphometric Analysis of Achilles Tendon Structure and Its Significance: A Cadaveric Study. Cureus 2022; 14:e32172. [PMID: 36605058 PMCID: PMC9808123 DOI: 10.7759/cureus.32172] [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: 12/03/2022] [Indexed: 12/07/2022] Open
Abstract
INTRODUCTION Achilles tendon is crucial for gait, and chronic Achilles tendinopathy can have a substantial impact on an individual's work and active involvement in physical or sports activity, and overall quality of life. OBJECTIVES This research was to determine the macroscopic and microscopic anatomy of Achilles tendons in cadavers. MATERIALS AND METHODS This experimental study was conducted in the Department of Anatomy, Saveetha Medical College, Thandalam, from March to August 2022. A total of 60 formalin-perfused cadavers (38 males and 22 females) were dissected to study their morphometry (length, width, thickness) and histology. The data was tabulated in MS excel and analyzed statistically using unpaired 't-test and one-way ANOVA in SPSS Software 17.0 (IBM Corp., Armonk, NY). RESULTS The mean length of the Achilles tendon was significantly higher in males than in females and similarly, the length on the right side was significantly higher than on the left side (p<0.005). The width and circumference were statistically higher in females than, males whereas, the histological features were similar in both males and females. CONCLUSION The better understanding of Achilles tendon morphometry in cadavers always aids in the diagnosis and surgical repair of tendinopathy, rupture, and degenerative change. The knowledge will be helpful for the surgeons during the repair and reconstruction of the injured tendon.
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22
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Noriega DC, Cristo Á, León A, García-Medrano B, Caballero-García A, Córdova-Martinez A. Plantar Fasciitis in Soccer Players-A Systemic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14426. [PMID: 36361304 PMCID: PMC9653655 DOI: 10.3390/ijerph192114426] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
Soccer is one of the most popular sports in the world. Players often suffer a variety of injuries, the most common being injuries to muscles and tendons. It is striking that with soccer, being the most practiced sport, and considering that most injuries occur in the lower extremities, plantar fasciitis (PF) is not one of the most frequent injuries (at least in terms of clinical data collected). The purpose of this review was to provide a comprehensive update of the topic "plantar fasciitis" focusing on soccer players. The review was conducted in accordance with the PRISMA (Preferred Reportiog ltems for Systmiatic reviews and Meta-Analyses) statement. PubMed, Cochrane Library and Scopus were researched. PICO (Patient, Population or Problem; Intervention; Comparison; and Outcome) components were identified. The keywords used were "plantar fasciitis", "plantar fasciitis and sport", "plantar fasciitis risk factors", "plantar fasciitis soccer" and "plantar fasciitis football players". With respect to the objective proposed for the research, we found eight specific articles focused on soccer. Of these, five were general reviews discussing the different methods of treatment of this pathology, and we have only found three studies that focused on PF in soccer, with two of them referring to a clinical case whereby the report and discussion only dealt with the specific treatment followed by the soccer player. After reviewing the manuscripts included in this work, we were surprised that there is no data in which the Silfverskiöld test was performed, as this test explores the passive mobility of the ankle and the degree of dorsiflexion in the supine position. We concluded that soccer players suffer pain in the sole of the foot compatible with plantar fasciitis; however, as indicated by Suzue et al., it is often not diagnosed because the athlete does not consider performing the clinical examinations necessary for its diagnosis. The shortage of reported publications in soccer may mask other PF-associated injuries.
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Affiliation(s)
- David C. Noriega
- Department of Orthopedic Surgery, Clinic University Hospital of Valladolid, 47005 Valladolid, Spain
- Department of Surgery, Ophthalmology, Otorhinolaryngology and Physiotherapy, Faculty of Medicine, University of Valladolid, 47005 Valladolid, Spain
| | - Ángel Cristo
- Department of Orthopedic Surgery, Clinic University Hospital of Valladolid, 47005 Valladolid, Spain
| | - Alejandro León
- Department of Orthopedic Surgery, Clinic University Hospital of Valladolid, 47005 Valladolid, Spain
| | - Belén García-Medrano
- Department of Orthopedic Surgery, Clinic University Hospital of Valladolid, 47005 Valladolid, Spain
| | - Alberto Caballero-García
- Department of Anatomy and Radiology, Faculty of Health Sciences, GIR Physical Exercise and Aging University of Valladolid, University Campus Los Pajaritos, 42004 Soria, Spain
| | - Alfredo Córdova-Martinez
- Biochemistry, Molecular Biology and Physiology, Faculty of Health Sciences, GIR Physical Exercise and Aging, Campus Duques de Soria, University of Valladolid, 42004 Soria, Spain
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Khired Z, Najmi MH, Akkur AA, Mashhour MA, Bakri KA. The Prevalence and Risk Factors of Plantar Fasciitis Amongst the Population of Jazan. Cureus 2022; 14:e29434. [PMID: 36312600 PMCID: PMC9595252 DOI: 10.7759/cureus.29434] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2022] [Indexed: 11/29/2022] Open
Abstract
Background Plantar fasciitis develops as a consequence of irritation of the plantar fascia, which is responsible for supporting the arches and absorbing shock. Multiple factors can contribute to plantar fasciitis, but the most common factor is overuse stress. The classical presentation is a sharp pain that is felt at the plantar aponeurosis (near the area of its insertion on the medial process of the calcaneal tuberosity), and it is possible to find a heel spur (osteophyte) in some cases. Most treatments for plantar fasciitis are ineffective and unsatisfactory for patients. Objective To estimate the prevalence and assess risk factors for plantar fasciitis among the population of the Jazan region. Methods A cross-sectional online survey was conducted on the population of the Jazan region. An online Google form questionnaire was prepared and distributed to the study population. Data was then entered and analyzed using IBM SPSS (Statistical Package for the Social Sciences) Statistics, version 21.0. Results A total of 695 participants were enrolled in the study. Out of that, 350 (50.4%) of the participants were males, while 345 (49.6%) were females. About the age of the participants, 507 (72.9%) were younger than 40 years of age. Participants with hypertension were 43 (6.2%), and 37 (5.3%) participants had diabetes. In terms of occupation, 120 (17.3%) worked in healthcare, 187 (26.9%) taught, and 43 (6.2%) served in the military. A great quantity of standing or walking was necessary for the jobs for 127 people (18.3%), while moderate amounts were recorded for 273 people (39.3%). The most commonly reported lower limb conditions were: pes planus (low arches) in 26 (3.7%) participants; and weakness of the gastrocnemius, soleus, and intrinsic foot muscles. The most commonly reported exercises were walking for 499 (71.8%) participants and jogging for 97 (14%) participants. The prevalence of plantar fasciitis was found to be 37% of the participants. Regarding the Foot and Ankle Outcome Score (FAOS) survey, the mean symptoms subscale score was 57.81 + 11.28, the mean pain subscale score was 72.87±20.84, the mean daily living subscale score was 72.73 ± 22.25, the mean sports and recreation subscale score was 76.83 ± 23.06, and the mean quality of life subscale score was 70.23 ± 25.17. Multivariate logistic regression was done and the following factors predicted a higher rate of plantar fasciitis: being 40 to 55 years old (p < 0.001, odds ratio = 2.15), being 56 to 65 years old (p = 0.037, odds ratio = 3.58), being obese (p = 0.031, odds ratio = 2.16), having weakness of the gastrocnemius, soleus, and the intrinsic foot muscles (p = 0.003, odds ratio = 7.39), jobs requiring a great amount of time standing or walking (p < 0.001, odds ratio = 3.17), and jobs requiring a moderate amount of time standing or walking (p = 0.012, odds ratio = 1.83). Being male predicted a lower rate of plantar fasciitis (p < 0.001, odds ratio = 0.52). Conclusion Plantar fasciitis is a prevalent and disabling condition with considerable effects on quality of life. Jobs that require long hours of walking or standing were associated with an increased risk of developing plantar fasciitis. Middle age, prolonged exercise, and gastrocnemius muscle tightness were also associated with plantar fasciitis. Efforts should be directed towards health education of the population regarding the risk factors and management of plantar fasciitis.
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Seasonal Variation for Plantar Fasciitis: Evidence from Google Trends Search Query Data. Healthcare (Basel) 2022; 10:healthcare10091676. [PMID: 36141288 PMCID: PMC9498888 DOI: 10.3390/healthcare10091676] [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: 06/08/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 11/17/2022] Open
Abstract
We aimed to determine the seasonal trends in internet searches for plantar fasciitis and related symptoms in various countries using search engine query data on Google. We used Google Trends to obtain internet search query data from January 2009 to December 2019. We collected monthly search volumes for the query terms “plantar fasciitis” and “heel pain” in the USA, Canada, the U.K., Ireland, Australia, and New Zealand. Statistical analysis of the seasonal effects on plantar fasciitis was performed using a cosinor model. The cosinor analyses confirmed statistically significant seasonal patterns in the relative search volumes for the terms “plantar fasciitis” and “heel pain” in the USA, Canada, the U.K., Ireland, and Australia, with peaks during the summer and troughs during the winter. For New Zealand, the seasonal trend was statistically significant only for the term “plantar fasciitis”, while a similar trend for the term “heel pain” was present without achieving statistical significance for seasonality. This seasonality is thought to be related to more frequent occurrence of plantar fasciitis due to increased physical activity of people during the warmer months. In this study, the search query data using the terms “plantar fasciitis” and “heel pain” on Google Trends show significant seasonal variation across several countries, with a peak in the summer and a trough in the winter.
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Cushman DM, Petrin Z, Cummings K, Eby SF, English J, Teramoto M. Sonographic Screening of Distance Runners for the Development of Future Achilles and Patellar Tendon Pain. Clin J Sport Med 2022; 32:493-500. [PMID: 34759186 PMCID: PMC9085961 DOI: 10.1097/jsm.0000000000000984] [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] [Received: 04/14/2021] [Accepted: 09/30/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The 2 primary aims of this study were to identify ultrasonographic tendon abnormalities in asymptomatic runners and to examine the likelihood of developing pain in runners with ultrasound abnormalities compared with those without abnormalities. DESIGN Longitudinal, prospective cohort study. SETTING 2019 Salt Lake City Marathon. PARTICIPANTS Recreational half-marathon and full-marathon runners. ASSESSMENT OF RISK FACTORS The Achilles and patellar tendons of asymptomatic runners were examined with ultrasound imaging before a running event. Runners were monitored for self-reported outcomes of pain in the examined tendons at 1, 3, 6, and 12 months after the event. MAIN OUTCOME MEASURES Development of pain based on the presence of asymptomatic tendon abnormalities. RESULTS One hundred thirty-eight runners (36.2 ± 12.0 years, 49.3% men, and 31.2% full-marathon runners) were included. Ultrasound abnormalities of the Achilles and patellar tendons were identified in 24.6% and 39.1% of the runners before the race, respectively. Ultrasound abnormalities were significantly associated with approximately a 3-fold increase [hazard ratio (HR) = 2.55, P = 0.004] in the hazard of developing pain in the Achilles tendon and patellar tendon (HR = 1.67, P = 0.042) over the year after the race. Positive and negative predictive values of developing pain over the year were 34.1% and 87.2%, respectively, for abnormal findings in the Achilles tendon, and 22.9% and 85.0%, respectively, for the patellar tendon. CONCLUSIONS The presence of ultrasonographic abnormalities is associated with increased development of pain in the Achilles and patellar tendons within 1 year of a marathon or half marathon.
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Affiliation(s)
- Daniel M Cushman
- Division of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, Utah
| | - Ziva Petrin
- Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Bellevue, Washington
| | - Keith Cummings
- Proliance Orthopaedics & Sports Medicine, Bellevue, Washington; and
| | - Sarah F Eby
- Division of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, Utah
| | - Joy English
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
| | - Masaru Teramoto
- Division of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, Utah
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Chia L, Silva DDO, Whalan M, McKay MJ, Sullivan J, Fuller CW, Pappas E. Epidemiology of gradual-onset knee injuries in team ball-sports: A systematic review with meta-analysis of prevalence, incidence, and burden by sex, sport, age, and participation level. J Sci Med Sport 2022; 25:834-844. [DOI: 10.1016/j.jsams.2022.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 08/07/2022] [Accepted: 08/29/2022] [Indexed: 10/14/2022]
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Contreras-Hernandez I, Falla D, Martinez-Valdes E. Neuromuscular and structural tendon adaptations after 6 weeks of either concentric or eccentric exercise in individuals with non-insertional Achilles tendinopathy: protocol for a randomised controlled trial. BMJ Open 2022; 12:e058683. [PMID: 35906051 PMCID: PMC9345075 DOI: 10.1136/bmjopen-2021-058683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION There is limited evidence on the neural strategies employed by the central nervous system to control muscle force in the presence of non-insertional Achilles tendinopathy (NIAT). Additionally, the neuromuscular mechanisms by which exercise may help to resolve tendon pain remain unclear. OBJECTIVE This study aims to first establish changes in the gastrocnemius-soleus motor unit firing properties after applying a training protocol of 6 weeks based on either controlled eccentric or concentric contractions in individuals with NIAT. Second, we want to determine changes in the level of pain and function and mechanical and structural properties of the Achilles tendon after applying the same training protocol. Additionally, we want to compare these variables at baseline between individuals with NIAT and asymptomatic controls. METHODS AND ANALYSIS A total of 26 individuals with chronic (>3 months) NIAT and 13 healthy controls will participate in the study. Individuals with NIAT will be randomised to perform eccentric or concentric training for 6 weeks. Motor unit firing properties of the medial gastrocnemius, lateral gastrocnemius and soleus muscles will be assessed using high-density surface electromyography, as well as Achilles tendon length, cross-sectional area, thickness and stiffness using B-mode ultrasonography and shear wave elastography. Moreover, participants will complete a battery of questionnaires to document their level of pain and function. ETHICS AND DISSEMINATION Ethical approval (ERN-20-0604A) for the study was obtained from the Science, Technology, Engineering and Mathematics Ethical Review Committee of the University of Birmingham. The results of the study will be published in peer-review journals. TRIAL REGISTRATION NUMBER ISRCTN46462385.
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Affiliation(s)
- Ignacio Contreras-Hernandez
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Eduardo Martinez-Valdes
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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Funaro A, Shim V, Crouzier M, Mylle I, Vanwanseele B. Subject-Specific 3D Models to Investigate the Influence of Rehabilitation Exercises and the Twisted Structure on Achilles Tendon Strains. Front Bioeng Biotechnol 2022; 10:914137. [PMID: 35875495 PMCID: PMC9299361 DOI: 10.3389/fbioe.2022.914137] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/20/2022] [Indexed: 12/03/2022] Open
Abstract
The Achilles tendon (AT) is the largest tendon of the human body and has a primary role in locomotor activities. The complex structure of the AT includes twisting of three sub-tendons, non-uniform tissue deformations and differential triceps surae muscle forces. The main aim of this study was to investigate the impact of commonly used rehabilitation exercises (walking on heels, walking on toes, unilateral heel rise, heel drop with extended knee and heel drop with the knee bent) and different twists on AT strains. 3D freehand ultrasound based subject-specific geometry and subject-specific muscle forces during different types of rehabilitation exercises were used to determine tendon strains magnitudes and differences in strains between the sub-tendons. In addition, three Finite Element models were developed to investigate the impact of AT twist. While walking on heels developed the lowest average strain, heel drop with knee bent exhibited the highest average strain. The eccentric heel drop resulted in higher peak and average strain, compared to concentric heel rise for all the three models. The isolated exercises (heel rise and heel drop) presented higher average strains compared to the functional exercises (walking tasks). The amount of twist influences the peak strains but not the average. Type I consistently showed highest peak strains among the five rehabilitation exercises. The ranking of the exercises based on the AT strains was independent of AT twist. These findings might help clinicians to prescribe rehabilitation exercises for Achilles tendinopathy based on their impact on the AT strains.
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Affiliation(s)
- Alessia Funaro
- Human Movement Biomechanics Research Group, KU Leuven, Leuven, Belgium
| | - Vickie Shim
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Marion Crouzier
- Human Movement Biomechanics Research Group, KU Leuven, Leuven, Belgium
| | - Ine Mylle
- Human Movement Biomechanics Research Group, KU Leuven, Leuven, Belgium
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Schröder P, Molsberger A, Drabik A, Karst M, Merk H. Percutaneous Bioelectric Current Stimulation (PBCS) in the Treatment of Chronic Achilles tendinopathy. Protocol for a Double-Blind, Placebo-Controlled Randomized Multicenter Trial (Preprint). JMIR Res Protoc 2022; 11:e40894. [DOI: 10.2196/40894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/21/2022] [Accepted: 11/02/2022] [Indexed: 11/05/2022] Open
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Xu AL, Ortiz-Babilonia C, Gupta A, Rogers D, Aiyer AA, Vulcano E. The Statistical Fragility of Platelet-Rich Plasma as Treatment for Chronic Noninsertional Achilles Tendinopathy: A Systematic Review and Meta-analysis. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221119758. [PMID: 36051864 PMCID: PMC9424894 DOI: 10.1177/24730114221119758] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Randomized controlled trial (RCT) outcomes reaching statistical significance,
frequently determined by P <.05, are often used to guide
decision making. Noted lack of reproducibility of some RCTs has brought
special attention to the limitations of this approach. In this
meta-analysis, we assessed the robustness of RCTs evaluating platelet-rich
plasma (PRP) for the treatment of chronic noninsertional Achilles
tendinopathy (AT) by using fragility indices. Methods: The present study was a systematic review and meta-analysis of RCTs comparing
outcomes after PRP injection vs alternative treatment in patients with AT.
Representative data sets were generated for each reported continuous outcome
event using summary statistics. Fragility indices refer to the minimal
number of patients whose status would have to change from a nonevent to an
event to turn a statistically significant result into a nonsignificant
result, or vice versa. The fragility index (FI) and continuous FI (CFI) were
determined for dichotomous and continuous outcomes, respectively, by
manipulating each data set until reversal of significance (a=0.05) was
achieved. The corresponding fragility quotient (FQ) and continuous FQ (CFQ)
were calculated by dividing FI/CFI by sample size. Results: Of 432 studies screened, 8 studies (52 outcome events) were included in this
analysis. The 12 dichotomous outcomes had a median FI of 4.5 (FQ: 0.111),
and the 40 continuous outcomes had a median CFI of 5 (CFQ: 0.154). All 52
outcome events included lost-to-follow-up data, and 12 (23.1%) indicated a
greater number of patients lost to follow-up than the FI or CFI. Conclusion: Our findings suggest that RCTs evaluating PRP for AT therapy lack statistical
robustness, because changing only a small number of events may alter outcome
significance. Level of Evidence: Level II, therapeutic study.
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Affiliation(s)
- Amy L. Xu
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carlos Ortiz-Babilonia
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Orthopaedic Surgery, University of Puerto Rico Medical Sciences Campus, San Juan, PR
| | - Arjun Gupta
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Davis Rogers
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amiethab A. Aiyer
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ettore Vulcano
- Department of Orthopaedic Surgery, Columbia University Mount Sinai Medical Center, Miami, FL, USA
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Wiegand K, Tandy R, Freedman Silvernail J. Plantar fasciitis injury status influences foot mechanics during running. Clin Biomech (Bristol, Avon) 2022; 97:105712. [PMID: 35779463 DOI: 10.1016/j.clinbiomech.2022.105712] [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: 10/07/2021] [Revised: 06/17/2022] [Accepted: 06/24/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND The biomechanical factors related to plantar fasciitis are not well understood. A history of injury is considered a risk factor for subsequent injury, but it is unknown if differences in mechanics exist before, during, and after injury. This study compared gait mechanics among individuals with plantar fasciitis, resolved plantar fasciitis, and uninjured controls. METHODS Thirty male and female runners were divided into three groups: 1) plantar fasciitis (n = 10, age 43 ± 11 years); 2) resolved plantar fasciitis (n = 10, age 43 ± 13 years); and 3) control (n = 10, age 38 ± 11 years). Participants ran at preferred velocity and 3.3 m/s while kinematics and kinetics were collected. Variables of interest include vertical loading rate, foot, ankle, knee, and hip kinematics, arch height index, arch rigidity index, and arch drop. Group differences were analyzed at each velocity using one-way analysis of variance. FINDINGS The plantar fasciitis group exhibited less forefoot extension (P = 0.02), more midfoot inversion (P < 0.01), and more midfoot extension (P < 0.01) than the resolved plantar fasciitis group. Foot mechanics in controls did not differ. Sagittal knee range of motion was greater in the plantar fasciitis group than resolved or control (P = 0.01). No other variables were significantly different among groups. INTERPRETATION The plantar fasciitis group exhibited dynamic foot mechanics which suggest a lower, more flexible arch compared to the resolved group, although static measures of foot structure and ankle motion did not differ. The differences between these groups indicate that the motion of the forefoot and midfoot during gait are important to consider for plantar fasciitis.
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Affiliation(s)
- Kristyne Wiegand
- Eastern Washington University, 526 5(th) St, Cheney, WA 99004, United States; University of Nevada, Las Vegas, 4505 S Maryland Pkwy, Las Vegas, NV 89154, United States.
| | - Richard Tandy
- University of Nevada, Las Vegas, 4505 S Maryland Pkwy, Las Vegas, NV 89154, United States
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Park YH, Kim W, Kim JY, Choi GW, Kim HJ. Clinical Impact of Metabolic Syndrome on Eccentric Exercises for Chronic Insertional Achilles Tendinopathy. J Foot Ankle Surg 2022; 61:726-729. [PMID: 34887161 DOI: 10.1053/j.jfas.2021.03.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 01/21/2021] [Accepted: 03/07/2021] [Indexed: 02/08/2023]
Abstract
Metabolic syndrome is one factor known to contribute to the development of tendinopathies. The aim of this study was to compare the clinical outcomes of eccentric calf-muscle exercise for treatment of chronic insertional Achilles tendinopathy in patients with or without metabolic syndrome. Twenty-eight patients with chronic insertional Achilles tendinopathy and metabolic syndrome who performed eccentric calf-muscle exercise were retrospectively compared with 28 age- and sex-matched controls without metabolic syndrome. Comparisons between the 2 groups were made by evaluating the Visual Analog Scale for pain, patient satisfaction, and amount of pain medications needed during 3 months of follow-up. Two-way analysis of variance with repeated measures showed that the pain scales in the metabolic syndrome group were higher than those in the control group during the follow-up period (F[1,54] = 24.45, p < .001). The patient satisfaction ratings were lower and the amount of required pain medication was higher in the metabolic syndrome group (p < .001 and p < .001, respectively). Eccentric calf-muscle exercises for chronic insertional Achilles tendinopathy were less effective in patients with metabolic syndrome. Therefore, these patients should be managed with a combination of other treatment modalities rather than eccentric exercise alone.
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Affiliation(s)
- Young Hwan Park
- Department of Orthopedic Surgery, Korea University Guro Hospital, Seoul, Korea
| | - Woon Kim
- Department of Orthopedic Surgery, Korea University Guro Hospital, Seoul, Korea
| | - Jae Young Kim
- Department of Orthopedic Surgery, Korea University Guro Hospital, Seoul, Korea
| | - Gi Won Choi
- Department of Orthopedic Surgery, Korea University Ansan Hospital, Ansan, Korea
| | - Hak Jun Kim
- Department of Orthopedic Surgery, Korea University Guro Hospital, Seoul, Korea.
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Qiu F, Li J, Legerlotz K. Does Additional Dietary Supplementation Improve Physiotherapeutic Treatment Outcome in Tendinopathy? A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:1666. [PMID: 35329992 PMCID: PMC8950117 DOI: 10.3390/jcm11061666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/10/2022] [Accepted: 03/15/2022] [Indexed: 11/16/2022] Open
Abstract
A systematic review and meta-analysis of randomized controlled trials was performed to evaluate the effects of dietary supplements in addition to physiotherapeutic treatment on pain and functional outcomes. PubMed, The Cochrane Library, Web of Science, and Embase were searched from inception to November 2021 (Prospero registration: CRD42021291951). Studies were eligible if the interventions consisted of physiotherapeutic approaches that were combined with dietary supplementation and if they reported measures of pain and/or function. Six studies were included in the meta-analysis. Standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated and analysed using a Review Manager software. Subgroup analysis was performed to explore possible associations between the study characteristics and the effectiveness of the intervention. Additional dietary supplementation during physiotherapeutic treatment significantly improved the reduction in pain score (SMD = −0.74, 95% CI, −1.37 to −0.10; p < 0.05), while it had no effect on functional outcomes (SMD = 0.29, 95% CI, 0.00 to 0.58; p > 0.05). This systematic review and meta-analysis suggests that additional nutritional interventions may improve physiotherapeutic treatment outcomes in the management of tendinopathies.
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Affiliation(s)
- Fanji Qiu
- Institute of Sport Sciences, Humboldt-Universität zu Berlin, Unter den Linden 6, 10099 Berlin, Germany;
| | - Jinfeng Li
- Department of Kinesiology, Iowa State University, Ames, IA 50011, USA;
| | - Kirsten Legerlotz
- Institute of Sport Sciences, Humboldt-Universität zu Berlin, Unter den Linden 6, 10099 Berlin, Germany;
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Inter-strides variability affects internal foot tissue loadings during running. Sci Rep 2022; 12:4227. [PMID: 35273294 PMCID: PMC8913624 DOI: 10.1038/s41598-022-08177-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 03/02/2022] [Indexed: 01/05/2023] Open
Abstract
Running overuse injuries result from an imbalance between repetitive loadings on the anatomical structures and their ability to adapt to these loadings. Unfortunately, the measure of these in-vivo loadings is not easily accessible. An optimal amount of movement variability is thought to decrease the running overuse injury risk, but the influence of movement variability on local tissue loading is still not known. A 3D dynamic finite element foot model driven by extrinsic muscle forces was developed to estimate the stress undergone by the different internal foot structures during the stance phase. The boundary conditions of different trials with similar running speed were used as input. Variability in bone stress (10%) and cartilage pressure (16%) can be expected while keeping the overall running speed constant. Bone and cartilage stress were mainly influenced by the muscle force profiles rather than by ground reaction force. These findings suggest, first, that the analysis of a single trial only is not representative of the internal tissue loadings distribution in the foot and second, that muscle forces must be considered when estimating bone and cartilage loadings at the foot level. This model could be applied to an optimal clinical management of the overuse injury.
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Encarnación-Martínez A, García-Gallart A, Sanchis-Sanchis R, Jimenez-Perez I, Priego-Quesada JI, Pérez-Soriano P. Higher Hamstrings Strength and Stability Are Related to Lower Kinematics Alteration during Running after Central and Peripheral Fatigue. SENSORS 2022; 22:s22051990. [PMID: 35271137 PMCID: PMC8914827 DOI: 10.3390/s22051990] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 02/25/2022] [Accepted: 03/02/2022] [Indexed: 11/16/2022]
Abstract
Fatigue can be classified as peripheral or central depending on the extent of its effects. Muscle strength reduction, associated with the appearance of fatigue during running, produces kinetics and kinematics modifications which could lead to an increased risk of injury. This study aimed to analyze the effect of peripheral and central fatigue protocols in running kinematics and to investigate the relationship between isokinetic strength and dynamic stability in fatigue related changes. Eighteen male recreational runners participated in the study. The dynamic postural stability index (DPSI) and quadriceps and hamstring isokinetic strength were assessed before the fatigue test. Then, angular kinematics during treadmill running were evaluated in pre- and post-fatigue states (central and peripheral). The results showed that runners with higher hamstring isokinetic strength and better DPSI had lower modifications after central fatigue of stance time, knee flexion, vertical and leg stiffness, and ankle dorsiflexion during the absorption and propulsion phases (r > 0.400, p < 0.05). Moreover, small changes in ankle dorsiflexion at initial contact after peripheral fatigue are related to a better DPSI and higher hamstring isokinetic strength (r > 0.400, p < 0.05). In summary, high values of hamstring isokinetic concentric strength and dynamic stability are related to lower increases of range of movements during running after central and peripheral fatigue. So, fatigue may affect to a lesser extent the running technique of those runners with higher hamstring strength and stability values.
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Affiliation(s)
- Alberto Encarnación-Martínez
- Research Group in Sports Biomechanics (GIBD), Department of Physical Education and Sports, University of Valencia, 46010 Valencia, Spain; (R.S.-S.); (I.J.-P.); (J.I.P.-Q.); (P.P.-S.)
- Correspondence:
| | - Antonio García-Gallart
- The Civil Guard, Secretary of State for Security, Ministry of the Interior, 28010 Madrid, Spain;
| | - Roberto Sanchis-Sanchis
- Research Group in Sports Biomechanics (GIBD), Department of Physical Education and Sports, University of Valencia, 46010 Valencia, Spain; (R.S.-S.); (I.J.-P.); (J.I.P.-Q.); (P.P.-S.)
| | - Irene Jimenez-Perez
- Research Group in Sports Biomechanics (GIBD), Department of Physical Education and Sports, University of Valencia, 46010 Valencia, Spain; (R.S.-S.); (I.J.-P.); (J.I.P.-Q.); (P.P.-S.)
| | - Jose I. Priego-Quesada
- Research Group in Sports Biomechanics (GIBD), Department of Physical Education and Sports, University of Valencia, 46010 Valencia, Spain; (R.S.-S.); (I.J.-P.); (J.I.P.-Q.); (P.P.-S.)
| | - Pedro Pérez-Soriano
- Research Group in Sports Biomechanics (GIBD), Department of Physical Education and Sports, University of Valencia, 46010 Valencia, Spain; (R.S.-S.); (I.J.-P.); (J.I.P.-Q.); (P.P.-S.)
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Reeh FM, Sachse S, Wedekind L, Hofmann GO, Lenz M. Nonunions and Their Operative Treatment. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:869-875. [PMID: 36352531 PMCID: PMC9989962 DOI: 10.3238/arztebl.m2022.0300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 02/25/2022] [Accepted: 08/03/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Nonunions, which arise as a complication of fractures, are an impor - tant medical and socio-economic problem. The goal of this study was to analyze nonunions in Germany with respect to the patients' age and sex, the anatomical site of the lesions, and their operative treatment. METHODS The study was performed on the basis of DRG (diagnosis-related group) data acquired for billing purposes and collected by the German Federal Statistical Office. The administrative frequencies of nonunions and fractures treated in the inpatient setting, broken down by sex and age group, were calculated from the documentation of ICD codes. An investigation was also made of surgical treatments for nonunion, as they were categorized by the German procedure classification (Operationen- und Prozedurenschlüssel, OPS). RESULTS The administrative frequency of nonunion was 14.84 per 100 000 persons per year, with a 2% decline in case numbers over the period 2007-2019. Nonunions develop in 2% of fractures. Nonunions affect men more often than women (58% vs. 42%). In men, their incidence as a function of age is highest under age 30; in women, it rises steadily with increasing age. The most common type of surgical treatment is a combination of resection, bone transplantation, and osteosynthesis. CONCLUSION This is the first detailed nationwide study of diagnoses of nonunions in Germany and their surgical treatment. Despite a slow decline in their incidence, nonunions remain an important problem in the inpatient setting. The risk profile for nonunions is sex-, age-, and site-specific.
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Affiliation(s)
- Freya M Reeh
- Department for Trauma, Hand and Reconstructive Surgery, University Hospital Jena, FriedrichSchiller University of Jena; Institute for Medical Statistics, Computer and Data Sciences, University Hospital of Jena, Friedrich-Schiller-University of Jena
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Sichting F, Kram NC, Legerlotz K. An Identical Twin Study on Human Achilles Tendon Adaptation: Regular Recreational Exercise at Comparatively Low Intensities Can Increase Tendon Stiffness. Front Physiol 2022; 12:777403. [PMID: 35069241 PMCID: PMC8766644 DOI: 10.3389/fphys.2021.777403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022] Open
Abstract
Achilles tendon adaptation is a key aspect of exercise performance and injury risk prevention. However, much debate exists about the adaptation of the Achilles tendon in response to exercise activities. Most published research is currently limited to elite athletes and selected exercise activities. Also, existing studies on tendon adaptation do not control for genetic variation. Our explorative cross-sectional study investigated the effects of regular recreational exercise activities on Achilles tendon mechanical properties in 40 identical twin pairs. Using a handheld oscillation device to determine Achilles tendon mechanical properties, we found that the Achilles tendon appears to adapt to regular recreational exercise at comparatively low intensities by increasing its stiffness. Active twins showed a 28% greater Achilles tendon stiffness than their inactive twin (p < 0.05). Further, our research extends existing ideas on sport-specific adaptation by showing that tendon stiffness seemed to respond more to exercise activities that included an aerial phase such as running and jumping. Interestingly, the comparison of twin pairs revealed a high variation of Achilles tendon stiffness (305.4–889.8 N/m), and tendon adaptation was only revealed when we controlled for genetic variance. Those results offer new insights into the impact of genetic variation on individual Achilles tendon stiffness, which should be addressed more closely in future studies.
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Affiliation(s)
- Freddy Sichting
- Department of Human Locomotion, Chemnitz University of Technology, Chemnitz, Germany
| | - Nicolai C Kram
- Department of Human Locomotion, Chemnitz University of Technology, Chemnitz, Germany
| | - Kirsten Legerlotz
- Movement Biomechanics, Institute of Sport Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
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Robinson DM, Tan CO, Tenforde AS. Functional Gains Using Radial and Combined Shockwave Therapy in the Management of Achilles Tendinopathy. J Foot Ankle Surg 2022; 61:99-103. [PMID: 34274243 DOI: 10.1053/j.jfas.2021.06.014] [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] [Received: 10/15/2020] [Revised: 02/02/2021] [Accepted: 06/08/2021] [Indexed: 02/03/2023]
Abstract
Achilles tendinopathy is a common condition and many patients have functional limitations after initial conservative treatment. Shockwave therapy has been shown to improve function within patients; however, comparative outcomes for different forms of shockwave are poorly described. In this retrospective cohort study, we describe findings from a quality improvement initiative evaluating safety and functional outcomes after treatment with radial shockwave therapy (n = 58) or combined radial and focused shockwave therapy (n = 29) for patients with Achilles tendinopathy refractory to exercise therapy. All patients were prescribed an eccentric exercise program. We hypothesized both groups would see improvements in function quantified using the Victorian Institute of Sports Assessment-Achilles with similar safety outcomes. Overall, the minimal clinically important difference (defined at 7 for insertional and 12 for noninsertional Achilles tendinopathy) was met in a greater proportion of patients treated with combined shockwave compared to radial shockwave (26 [89.7%] vs 37 [63.8%], p = .022). The change in Victorian Institute of Sports Assessment-Achilles from baseline to final treatment was not different between combined and radial-only groups (23.3 ± 12.6 vs 19.9 ± 18.7, p = .2). Within group differences from baseline to final follow-up measures (mean duration 17.9 ± 14.8 weeks) demonstrated overall functional improvement for both groups (both p < .0001). No serious adverse effects were observed. Our findings suggest combined radial and focused shockwave therapy may provide more predictable functional gains for treatment of Achilles tendinopathy compared to radial shockwave therapy.
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Affiliation(s)
- David M Robinson
- Resident, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Charlestown, MA
| | - Can O Tan
- Assistant Professor, Spaulding Research Institute, Spaulding Rehabilitation Hospital, Boston, MA; Associate Professor, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Charlestown, MA
| | - Adam S Tenforde
- Associate Professor, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Charlestown, MA.
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Rodriguez Sanz D, LOSA IGLESIAS MARTA, BECERRO DE BENGOA VALLEJO RICARDO, SORIANO MEDRANO ALFREDO, MORALES PONCE ANGEL, CALVO LOBO CESAR, San Antolin M, Ramirez Navarro PC, Garcia Garcia D. Actualización científica en ecografía y tendinopatía aquilea. Implicaciones anatómicas relacionadas, abordaje terapéutico y nuevas perspectivas basadas en la evidencia. REVISTA ESPAÑOLA DE PODOLOGÍA 2022. [DOI: 10.20986/revesppod.2022.1632/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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40
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Rhim HC, Kwon J, Park J, Borg-Stein J, Tenforde AS. A Systematic Review of Systematic Reviews on the Epidemiology, Evaluation, and Treatment of Plantar Fasciitis. Life (Basel) 2021; 11:life11121287. [PMID: 34947818 PMCID: PMC8705263 DOI: 10.3390/life11121287] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/17/2021] [Accepted: 11/19/2021] [Indexed: 12/20/2022] Open
Abstract
The number of systematic review and meta-analyses on plantar fasciitis is expanding. The purpose of this review was to provide a comprehensive summary of reviews on the topic pertaining to plantar fasciitis, identify any conflicting and inconsistent results, and propose future research direction. A qualitative review of all systematic reviews and meta-analyses related to plantar fasciitis up to February 2021 was performed using PubMed, Embase, Web of Science, and the Cochrane Database. A total of 1052 articles were initially identified and 96 met the inclusion criteria. Included articles were summarized and divided into the following topics: epidemiology, diagnosis, and treatment. While the majority of reviews had high level of heterogeneity and included a small number of studies, there was general consensus on certain topics, such as BMI as a risk factor for plantar fasciitis and extracorporeal shockwave therapy as an effective mode of therapy. A qualitative summary of systematic reviews and meta-analyses published on plantar fasciitis provides a single source of updated information for clinicians. Evidence on topics such as the epidemiology, exercise therapy, or cost-effectiveness of treatment options for plantar fasciitis are lacking and warrant future research.
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Affiliation(s)
- Hye Chang Rhim
- MetroWest Medical Center, Tufts University School of Medicine, Framingham, MA 01702, USA;
| | - Jangwon Kwon
- Department of Physical Therapy, University of Delware, Newark, DE 19716, USA;
| | - Jewel Park
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, USA;
| | - Joanne Borg-Stein
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02115, USA;
- Spaulding Rehabilitation Hospital, Charlestown, MA 02129, USA
| | - Adam S. Tenforde
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02115, USA;
- Spaulding Rehabilitation Hospital, Charlestown, MA 02129, USA
- Correspondence:
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Cushman DM, Petrin Z, Eby S, Clements ND, Haight P, Snitily B, Teramoto M. Ultrasound evaluation of the patellar tendon and Achilles tendon and its association with future pain in distance runners. PHYSICIAN SPORTSMED 2021; 49:410-419. [PMID: 33153352 PMCID: PMC8648045 DOI: 10.1080/00913847.2020.1847004] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objectives: To examine whether asymptomatic ultrasonographic abnormalities in the Achilles and patellar tendons in runners are associated with an increased risk of pain development.Methods: This is a longitudinal, prospective cohort study with 139 runners recruited at a half and full marathon race. Ultrasound examination of the Achilles and patellar tendons was performed bilaterally the day prior to the race. Self-reported injury data were collected at 1, 3, 6 and 12 months. 104 (74.8%) runners were included in the data analysis.Results: Ultrasonographic tendon abnormalities were found in 24.1% of the Achilles and in 23.1% of the patellar tendons prior to the race. Runners with tendon abnormality were 2-3 times more likely to develop pain within 12 months than those without (relative risk = 3.14, p = 0.010 for Achilles; relative risk = 2.52, p = 0.008 for patellar tendon). After adjusting for gender, age, years of running, average miles per week of running over a year, and pre-race pain, runners with ultrasound abnormality were about 3 times (hazard ratio = 2.89, p = 0.039 for Achilles; hazard ratio = 2.73, p = 0.030 for patellar tendon) more likely to develop pain after the race. Tendon delamination was most strongly associated with pain in both the Achilles (relative risk = 6.00; p = 0.001) and patellar tendons (relative risk = 3.81; p = 0.001).Conclusions: Structural changes in asymptomatic tendons were found in almost 25% of runners. Presence of structural changes was associated with increased development of Achilles and patellar tendon pain within one year.
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Affiliation(s)
- Daniel M Cushman
- University of Utah Division of Physical Medicine & Rehabilitation
| | - Ziva Petrin
- Rutgers New Jersey Medical School, Department of Physical Medicine & Rehabilitation
| | - Sarah Eby
- University of Utah Division of Physical Medicine & Rehabilitation
| | - Nathan D. Clements
- University of Texas, San Antonio, Department of Physical Medicine & Rehabilitation
| | | | | | - Masaru Teramoto
- University of Utah Division of Physical Medicine & Rehabilitation
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Nezu S, Saito T, Yoshida A, Narazaki S, Shimamura Y, Furumatsu T, Ozaki T. Effect of difference in fixation methods of tendon graft and the microfracture procedure on tendon-bone junction healing. JSES Int 2021; 6:155-166. [PMID: 35141691 PMCID: PMC8811408 DOI: 10.1016/j.jseint.2021.10.001] [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] [Indexed: 12/02/2022] Open
Abstract
Background There are generally two methods of fixation for tendon grafts used in ligament reconstruction: bone tunnel fixation and anchor fixation. The microfracture (Mf) procedure is a technique to induce bleeding from the bone marrow, and the bleeding may contain cells with differentiation potential. However, few studies have compared the effects of the Mf procedure with those of the fixation methods. This study aimed to evaluate the effectiveness of the Mf procedure on two tendon graft fixation methods: histological, gene expression, tendon graft thickness, and mechanical. We especially focused our investigation on junction healing of tendon grafts and bone in the two fixation methods. Methods We used 20 rabbits to evaluate tendon and bone healing in a peroneal tendon graft model. The rabbit models were divided into five groups according to the combination of peroneal tendon graft fixation method and Mf technique as follows: control group (C, n = 4), bone tunnel fixation without Mf procedure group (BT − Mf, n = 4), bone tunnel fixation with Mf procedure group (BT + Mf, n = 4), anchor fixation without Mf procedure group (A − Mf, n = 4), and anchor fixation with Mf procedure group (A + Mf, n = 4). All animals were sacrificed at 4 weeks postoperatively. The specimens underwent histological evaluation, mRNA analysis, tendon graft thickness at the tendon-bone junction, and biomechanical testing. Results Histological evaluation of the BT + Mf and A + Mf groups showed healing with fibrocartilage formation at the tendon graft-bone junction. The mRNA expression showed significant increase in type 2 collagen, Scleraxis, and SRY-box9 in the BT + Mf and A + Mf groups. In biomechanical tests, the BT + Mf and A + Mf groups showed significantly increased tensile strength compared with the BT − Mf and A − Mf groups (BT + Mf group, 21.6 ± 1.7 N; A + Mf group, 22.5 ± 2.3 N vs. BT − Mf group, 12.3 ± 2.4 N; A − Mf group, 11 ± 2.3 N). Conclusion The Mf procedure resulted in fibrocartilage formation at the tendon-bone junction in the BT and anchor fixation and improved the fixation strength at 4 weeks.
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Affiliation(s)
- Satoshi Nezu
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Taichi Saito
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
- Corresponding author: Taichi Saito, MD, PhD, Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine Dentistry, and Pharmaceutical Sciences, Okayama, Japan, 2-5-1, Shikatacho, Kitaku, Okayama City, 700-8558.
| | - Aki Yoshida
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Shinji Narazaki
- Department of Orthopaedic Surgery, Okayama Saiseikai General Hospital, Okayama, Okayama, Japan
| | - Yasunori Shimamura
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takayuki Furumatsu
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Chang R, Tsang RCC, Jiang D, Liu D, Ruan B, Lin G, Liu C, Gao Q. Cross-cultural adaptation and measurement properties of the VISA-A questionnaire for Chinese patients with Achilles Tendinopathy. Phys Ther Sport 2021; 52:256-262. [PMID: 34662806 DOI: 10.1016/j.ptsp.2021.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/09/2021] [Accepted: 10/12/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To culturally adapt the VISA-A into a simplified Chinese version (VISA-A-CHN) and test its measurement properties. DESIGN Methodological study; SETTING: Hospital and university laboratory. PARTICIPANTS 240 subjects were divided into the healthy (n = 80), at-risk (n = 80), and tendinopathy groups (n = 80). MAIN OUTCOMES MEASURES The internal consistency, test-retest reliability, construct validity, and the floor and ceiling effect of the VISA-A-CHN. RESULTS The VISA-A-CHN showed adequate internal consistency (Cronbach's α = 0.73, 95% CI 0.63 to 0.81), excellent test-retest reliability (ICC3A,1 = 0.97, 95%CI = 0.95 to 0.98), standard error of measurement of 2.2 points, minimum detectable change of 6.0 points, with no floor and ceiling effects. Two factors (pain/symptoms and physical function/activity) were extracted in exploratory factor analysis. There were moderate associations of VISA-A-CHN score with scores of Lower Extremity Functional Scale and SF-36 physical components (rs = 0.53-0.74, P < 0.01) but low associations with SF-36 mental components (rs = 0.12-0.22, P > 0.05). VISA-A-CHN mean score of Achilles tendinopathy group was significantly lower than those of healthy and at-risk groups (P < 0.01). CONCLUSIONS The VISA-A-CHN is equivalent to the original version in terms of language and measurement properties. It can be used as the outcome measure for Chinese patients with Achilles tendinopathy.
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Affiliation(s)
- Rui Chang
- Department of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | | | - Dong Jiang
- Department of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Dongsen Liu
- Department of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Bin Ruan
- Department of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Guohui Lin
- Department of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Chunlong Liu
- Department of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Qi Gao
- Department of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China.
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Vosoughi AR, Fereidooni R, Shirzadi S, Zomorodian SA, Hoveidaei AH. Different patterns and characteristics of Talar injuries at two main orthopedic trauma centers in Shiraz, south of Iran. BMC Musculoskelet Disord 2021; 22:609. [PMID: 34229641 PMCID: PMC8261937 DOI: 10.1186/s12891-021-04486-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/18/2021] [Indexed: 11/10/2022] Open
Abstract
Background Categorizing different injury patterns of the talus, describing demographic data, mechanisms of injury and associated fractures are important issues in orthopedic trauma surgeries. Injuries of the talus require careful attention with appropriate treatment approaches in order to reduce possible complications. Methods In a cross-sectional study, the demographic characteristics, mechanism of injury, fracture type, and associated fractures were compiled from all patients’ files and operation notes with diagnosis of talar injuries from January 2014 to December 2019. Results Among 367 patients, 317 (86.4%) males and 50 (13.6%) females with mean age of 31.8 ± 11.6 years were identified. There were three (0.8%) patients with bilateral talar fractures. The most common mechanism of injury was motor vehicle accident (MVA) (46.1%), followed by falls (43.3%), direct trauma (6.2%) and sport injuries (4.4%). About half of the patients injured in MVAs were motorcyclists. Isolated talar body fractures (21.9%) were more common than isolated talar neck (19.2%) or combined body & neck fractures (14.6%). Isolated lateral process fracture is the most frequent fractured process of the talus (14.3%). Hawkin type IIA (39.2%) was the most common type of talar neck, followed by Hawkin type III (22.3%), type I (21.5%), type IIB (14.6%) and type IV (2.3%). Medial malleolus, fibula and calcaneus were the most common associated fractures, respectively. Conclusions The population that is most affected by talar injury are active young men who are involved in motor vehicle accidents, especially motorcycle crashes, with fracture of body and/or neck of talus being the most common type.
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Affiliation(s)
- Amir Reza Vosoughi
- Orthopedic Foot and Ankle Surgeon, Department of Orthopedic Surgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Fereidooni
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saeedreza Shirzadi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Amir Human Hoveidaei
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran. .,Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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Lo Presti M, Costa GG, Agrò G, Vasco C, Zunarelli P, Zaffagnini S. Adipose-derived Stromal Vascular Fraction Injection in a Competitive High-level Athlete Affected by Insertional Achilles Tendinopathy. J Foot Ankle Surg 2021; 60:626-629. [PMID: 33551230 DOI: 10.1053/j.jfas.2020.04.019] [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: 03/27/2020] [Revised: 04/08/2020] [Accepted: 04/16/2020] [Indexed: 02/03/2023]
Abstract
Achilles tendinopathy is one of the most common ankle and foot overuse injuries, especially among athletes. Despite this, the management of this injury lacks an evidence-based support, and patients are at risk of long-term morbidity with unpredictable clinical outcome. Recently, injective approach has gained more and more attention, and in particular the intratendinous injection with adipose-derived stromal vascular fraction. We report a case of an insertional Achilles tendinopathy in a high-level professional athlete, who was treated avoiding surgical treatment in favor of this innovative biological approach. Patient's satisfaction and return to play was prospectively evaluated for a period of 6 months of follow-up. An improvement of all functional scores was yet appreciated after 1 month from the treatment, with a crescent trend until the last 6-month follow-up. The patient was able to return to train after 34 days, and returned to match after 68 days, playing 20 minutes. She returned to the complete full game 72 days after treatment. However subsequent ultrasound and MRI evaluations failed to show any substantial changes in the characteristics of the lesion from the preoperative images. This case report opens a new window for the treatment of insertional Achilles tendinopathy in competitive athletes. The current outcome deserves further investigation with higher quality studies in order to confirm the validity of this fascinating therapeutic option.
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Affiliation(s)
- Mirco Lo Presti
- Physician, II Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Giuseppe Agrò
- Physician, II Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Cosimo Vasco
- Physician, II Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Pierpaolo Zunarelli
- Physician, Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Stefano Zaffagnini
- Physician and Full Professor, II Orthopaedic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Cole BJ, Gilat R, DiFiori J, Rodeo SA, Bedi A. The 2020 NBA Orthobiologics Consensus Statement. Orthop J Sports Med 2021; 9:23259671211002296. [PMID: 34017878 PMCID: PMC8114275 DOI: 10.1177/23259671211002296] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/14/2020] [Indexed: 12/26/2022] Open
Abstract
This 2020 NBA Orthobiologics Consensus Statement provides a concise summary of available literature and practical clinical guidelines for team physicians and players. We recognize that orthobiologic injections are a generally safe treatment modality with a significant potential to reduce pain and expedite early return to play in specific musculoskeletal injuries. The use of orthobiologics in sports medicine to safely reduce time loss and reinjury is of considerable interest, especially as it relates to the potential effect on a professional athlete. While these novel substances have potential to enhance healing and regeneration of injured tissues, there is a lack of robust data to support their regular use at this time. There are no absolutes when considering the implementation of orthobiologics, and unbiased clinical judgment with an emphasis on player safety should always prevail. Current best evidence supports the following: Key Points There is support for the use of leukocyte-poor platelet-rich plasma in the treatment of knee osteoarthritis. There is support for consideration of using leukocyte-rich platelet-rich plasma for patellar tendinopathy. The efficacy of using mesenchymal stromal cell injections in the management of joint and soft tissue injuries remains unproven at this time. There are very few data to suggest that current cell therapy treatments lead to any true functional tissue regeneration. Meticulous and sterile preparation guidelines must be followed to minimize the risk for infection and adverse events if these treatments are pursued.Given the high variability in orthobiologic formulations, team physicians must stay up-to-date with the most recent peer-reviewed literature and orthobiologic preparation protocols for specific injuries.Evidence-based treatment algorithms are necessary to identify the optimal orthobiologic formulations for specific tissues and injuries in athletes.Changes in the regulatory environment and improved standardization are required given the exponential increase in utilization as novel techniques and substances are introduced into clinical practice.
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Affiliation(s)
- Brian J Cole
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Ron Gilat
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA.,Department of Orthopaedic Surgery, Shamir Medical Center and Tel Aviv University, Tel Aviv, Israel
| | - John DiFiori
- Hospital for Special Surgery, New York, New York, USA
| | - Scott A Rodeo
- Hospital for Special Surgery, New York, New York, USA
| | - Asheesh Bedi
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA
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47
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Lytle JB, Parikh KB, Tarakemeh A, Vopat BG, Mulcahey MK. Epidemiology of Foot and Ankle Injuries in NCAA Jumping Athletes in the United States During 2009-2014. Orthop J Sports Med 2021; 9:2325967121998052. [PMID: 33948444 PMCID: PMC8053761 DOI: 10.1177/2325967121998052] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/02/2020] [Indexed: 11/15/2022] Open
Abstract
Background Foot and ankle injuries comprise a significant proportion of all injuries sustained by National Collegiate Athletic Association (NCAA) athletes. In particular, sports that combine jumping and rapid changes in direction are associated with increased lower extremity injuries. Purpose To describe the epidemiology of foot and ankle injuries in men's and women's jumping sports, including NCAA men's and women's basketball, women's volleyball, and women's gymnastics, during the 2009-2010 through 2013-2014 seasons. Study Design Descriptive epidemiology study. Methods Injury-surveillance data were obtained from the NCAA Injury Surveillance Program for the 2009-2010 through 2013-2014 seasons. Injuries were examined by mechanism, activity during injury, and participation restriction time. Injury rates per 1000 athlete-exposures (AEs), injury rate ratios, and risk ratios with 95% CIs were calculated. Reported sex differences were calculated for men's and women's basketball. All 95% CIs not containing 1.0 were considered statistically significant. Results A total of 1136 players sustained foot and ankle injuries (483 male and 653 female) over 612,680 AEs. These injuries resulted in a combined rate of 1.85 per 1000 AEs (95% CI, 1.75-1.97). Ankle sprains were the most common injury (63.7%), with lateral ligamentous complex injuries making up 77.1% of all ankle sprains. The most common foot injury varied based on sport and sex. Ankle injury rates were higher in male versus female basketball players (injury rate ratio, 1.33 [95% CI, 1.13-1.57]), but foot injury rates did not differ. Among basketball and volleyball players, player contact during jumping was the most common injury mechanism. Female gymnasts had higher overuse injury rates than other athletes (0.49/1000 AEs [95% CI, 0.30-0.74]; P < .002). Overall, female basketball players were 1.81 times more likely to sustain an overuse injury than male basketball players (95% CI, 1.02-3.20; P = .02). Conclusion The most common foot and ankle injury sustained in collegiate jumping sports was a lateral ligamentous complex ankle sprain. Injury-prevention programs focusing on ankle flexibility, strength, and proprioception may help to alleviate the injury burden and lessen severity. Improving the anticipation of contact during jumping and landing may reduce injury rates and increase player safety. The increased prevalence of overuse injuries in female collegiate athletes competing in jumping sports necessitates further investigation to reduce injury rates through prevention and training programs.
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Affiliation(s)
- Joseph B Lytle
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kisan B Parikh
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Armin Tarakemeh
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Bryan G Vopat
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Mary K Mulcahey
- Department of Orthopaedics, Tulane University School of Medicine, New Orleans, Louisiana, USA
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48
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DeCarbo WT. Biologics in the Treatment of Achilles Tendon. Clin Podiatr Med Surg 2021; 38:235-244. [PMID: 33745654 DOI: 10.1016/j.cpm.2020.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The treatment of Achilles tendinitis from conservative to minimally invasive to surgery gives patients a wide range of treatment options for this common pathology. The use and role of biologics to augment this treatment is emerging. The use of biologics may enhance the healing potential of the Achilles tendon when conservative treatment fails. There are a handful of biologics being investigated to obtain if improved outcomes can be maximized.
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Affiliation(s)
- William T DeCarbo
- St. Clair Orthopedic Associates, 1050 Bower Hill Road, Suite 105, Pittsburgh, PA 14243, USA.
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49
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Abstract
CONTEXT Injections are commonly used by health care practitioners to treat foot and ankle injuries in athletes despite ongoing questions regarding efficacy and safety. EVIDENCE ACQUISITION An extensive literature review was performed through MEDLINE, Google Scholar, and EBSCOhost from database inception to 2021. Keywords searched were injections, athletes, sports, foot and ankle, corticosteroids, platelet-rich plasma, and placental tissue. Search results included articles written in the English language and encompassed reviews, case series, empirical studies, and basic science articles. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 4. RESULTS Corticosteroids, platelet-rich plasma/autologous blood, anesthetic, and placental tissue injections are commonly used in the treatment of foot and ankle injuries. Primary indications for injections in athletes include plantar fasciitis, Achilles tendinosis, isolated syndesmotic injury, and ankle impingement with varying clinical results. CONCLUSIONS Despite promising results from limited case series and comparative studies, the data for safety and efficacy of injections for foot and ankle injuries in athletes remain inconclusive.
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Affiliation(s)
- Jonathan K Ochoa
- Department of Orthopaedic Surgery, University of California-Irvine, Orange, California
| | - Christopher E Gross
- Department of Orthopaedics, Medical University of South Carolina, Charleston, South Carolina
| | - Robert B Anderson
- Bellin Health Titletown Sports Medicine and Orthopedics, Green Bay, Wisconsin
| | - Andrew R Hsu
- Department of Orthopaedic Surgery, University of California-Irvine, Orange, California
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50
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Sahillioglu A, Cerrahoglu L. The relationship of the foot and ankle structure with overuse injuries in licensed footballers: a prospective cohort study. J Sports Med Phys Fitness 2020; 61:1499-1508. [PMID: 33337111 DOI: 10.23736/s0022-4707.20.11780-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Foot and ankle are some of the most frequently injured places in football players' bodies. Overuse injuries have an insidious onset and can restrain athletes from sports temporary or even permanently. This study aimed to investigate the relationship between the clinical evaluation of the foot and ankle and findings obtained from foot plantar pressure measurements with the development of overuse injury, during the one-year follow-up. METHODS One hundred licensed football players were included in the study. Presence of joint hypermobility, foot posture assessment, ankle and first metatarsophalangeal joint range of motion measurements, pedobarographic plantar pressure assessment of foot was carried out. Then, the footballers were followed for 12 months for the development of new foot and ankle overuse injuries, and the clinical and pedobarographic data of the footballers with at least one injury were compared with the group without injury. RESULTS We found asymmetric pressure distribution between the preferred and non-preferred foot in the group who had an injury in the pedobarographic static foot plantar pressure measurements (P=0.040). A statistically significant limitation was found in the ankle eversion, first metatarsophalangeal joint dorsiflexion and ankle plantar flexion degrees in the injured group compared to the uninjured group (P=0.029, P=0.023, P=0.044, respectively). CONCLUSIONS These findings suggest that impairments in foot plantar pressure distribution and limitations in ankle and foot joint range of motion may be risk factors for the development of foot and ankle overuse injury.
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Affiliation(s)
- Ali Sahillioglu
- Unit of Physiatry, Department of Physical Medicine and Rehabilitation, Sisli Hamidiye Etfal Teaching and Research Hospital, University of Health Sciences, Istanbul, Turkey -
| | - Lale Cerrahoglu
- Celal Bayar University Medical School, Department of Physical Medicine and Rehabilitation, Manisa, Turkey
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