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Aufwerber S, Svedman S, Silbernagel KG, Ackermann PW. Long-term patient outcome is affected by deep venous thrombosis after Achilles tendon rupture repair. Knee Surg Sports Traumatol Arthrosc 2024; 32:2184-2193. [PMID: 38796725 DOI: 10.1002/ksa.12240] [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: 11/08/2023] [Revised: 04/05/2024] [Accepted: 04/24/2024] [Indexed: 05/28/2024]
Abstract
PURPOSE The aim of the study was to examine the impact of a deep venous thrombosis (DVT) on patient outcomes 3 years after Achilles tendon rupture (ATR) repair and if there were continued improvements between 1 and 3 years after surgery. A secondary aim was to determine risk factors associated with impaired patient outcomes in the long term. METHODS This cohort study consisted of 181 ATR-repaired patients, from two large randomized clinical trials, who attended a 3-year follow-up evaluation. Patients were postoperatively randomized to two different weight-bearing interventions compared with immobilization in a below-knee plaster cast for 2 weeks. During immobilization, screening for DVT was performed with Doppler ultrasound. At 1 and 3 years postoperatively, functional- and patient-reported outcomes were evaluated by the validated heel-rise test and self-reported questionnaire, Achilles tendon Total Rupture Score (ATRS). RESULTS In total, 76 out of 181 (42%) patients exhibited a DVT at the 2- or 6-week screening after ATR surgery. Suffering from a DVT during immobilization resulted at 3 years in a worse limb symmetry index (LSI) of heel-rise total work compared to patients without DVT, adjusted for age (DVT mean LSI 68% vs. no DVT 78%, p = 0.027). At 3 years, patients with a DVT during immobilization displayed lower ATRS (DVT median 88 vs. no DVT 93, p = 0.046), which was not significant after adjustment for age. However, patients with DVT exhibited an improvement in ATRS, LSI total work, and LSI maximum height between 1 and 3 years, which was not seen among patients without DVT. Independent risk factors for reduced patient functional outcomes at 3 years were older age, greater calf muscle hypotrophy, and suffering a DVT. CONCLUSIONS DVT during immobilization affects patients' long-term functional outcomes 3 years after ATR repair. Clinicians should adequately address risk factors contributing to impaired patient outcomes in the long term, including calf muscle hypotrophy, DVT, and older age. LEVEL OF EVIDENCE Level Ⅲ.
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Affiliation(s)
- Susanna Aufwerber
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Simon Svedman
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Trauma, Acute Surgery and Orthopaedics, Karolinska University Hospital, Stockholm, Sweden
| | | | - Paul W Ackermann
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Trauma, Acute Surgery and Orthopaedics, Karolinska University Hospital, Stockholm, Sweden
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Merkel MFR, Svensson RB, Jakobsen JR, Mackey AL, Schjerling P, Herzog RB, Magnusson SP, Konradsen L, Krogsgaard MR, Kjær M, Johannsen FE. Widespread Vascularization and Correlation of Glycosaminoglycan Accumulation to Tendon Pain in Human Plantar Fascia Tendinopathy. Am J Sports Med 2024; 52:1834-1844. [PMID: 38708721 DOI: 10.1177/03635465241246262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
BACKGROUND Plantar fasciitis is a painful tendinous condition (tendinopathy) with a high prevalence in athletes. While a healthy tendon has limited blood flow, ultrasound has indicated elevated blood flow in tendinopathy, but it is unknown if this is related to a de facto increase in the tendon vasculature. Likewise, an accumulation of glycosaminoglycans (GAGs) is observed in tendinopathy, but its relationship to clinical pain is unknown. PURPOSE To explore to what extent vascularization, inflammation, and fat infiltration were present in patients with plantar fasciitis and if they were related to clinical symptoms. STUDY DESIGN Descriptive laboratory study. METHODS Biopsy specimens from tendinopathic plantar fascia tissue were obtained per-operatively from both the primary site of tendon pain and tissue swelling ("proximal") and a region that appeared macroscopically healthy at 1 to 2 cm away from the primary site ("distal") in 22 patients. Biopsy specimens were examined with immunofluorescence for markers of blood vessels, tissue cell density, fat infiltration, and macrophage level. In addition, pain during the first step in the morning (registered during an earlier study) was correlated with the content of collagen and GAGs in tissue. RESULTS High vascularization (and cellularity) was present in both the proximal (0.89%) and the distal (0.96%) plantar fascia samples, whereas inconsistent but not significantly different fat infiltration and macrophage levels were observed. The collagen content was similar in the 2 plantar fascia regions, whereas the GAG content was higher in the proximal region (3.2% in proximal and 2.8% in distal; P = .027). The GAG content in the proximal region was positively correlated with the subjective morning pain score in the patients with tendinopathy (n = 17). CONCLUSION In patients with plantar fasciitis, marked tissue vascularization was present in both the painful focal region and a neighboring nonsymptomatic area. In contrast, the accumulation of hydrophilic GAGs was greater in the symptomatic region and was positively correlated with increased clinical pain levels in daily life. CLINICAL RELEVANCE The accumulation of GAGs in tissue rather than the extent of vascularization appears to be linked with the clinical degree of pain symptoms of the disease.
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Affiliation(s)
- Max F R Merkel
- Department of Orthopaedic Surgery, Institute of Sports Medicine Copenhagen, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Rene B Svensson
- Department of Orthopaedic Surgery, Institute of Sports Medicine Copenhagen, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Jens R Jakobsen
- Department of Orthopaedic Surgery, Institute of Sports Medicine Copenhagen, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Orthopaedic Surgery, Section for Sports Traumatology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Abigail L Mackey
- Department of Orthopaedic Surgery, Institute of Sports Medicine Copenhagen, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Peter Schjerling
- Department of Orthopaedic Surgery, Institute of Sports Medicine Copenhagen, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Robert B Herzog
- Department of Physical and Occupational Therapy, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - S Peter Magnusson
- Department of Orthopaedic Surgery, Institute of Sports Medicine Copenhagen, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
- Department of Physical and Occupational Therapy, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Lars Konradsen
- Department of Orthopaedic Surgery, Section for Sports Traumatology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Michael R Krogsgaard
- Department of Orthopaedic Surgery, Section for Sports Traumatology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Michael Kjær
- Department of Orthopaedic Surgery, Institute of Sports Medicine Copenhagen, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Finn E Johannsen
- Department of Orthopaedic Surgery, Institute of Sports Medicine Copenhagen, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
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Liu M, Zheng Q, Zheng Y, Yao Y, Wang R, Ta D, Jiang L. Combined Assessment of 2-D Ultrasound and Real-Time Shear Wave Elastography of Low-Intensity Pulsed Ultrasound Therapy Efficacy in Rabbits with Achilles Tendinopathy. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:407-413. [PMID: 38129224 DOI: 10.1016/j.ultrasmedbio.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 11/13/2023] [Accepted: 12/01/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Low-intensity pulsed ultrasound (LIPUS) has been gradually used to treat Achilles tendinopathy. However, there are limited non-invasive and efficient instruments for monitoring LIPUS efficacy in Achilles tendinopathy. The purpose of this study was to assess the therapeutic effectiveness of LIPUS after Achilles tendinopathy by 2-D ultrasound and real-time shear wave elastography (SWE). METHODS Ninety New Zealand white rabbits were divided into control, sham and LIPUS groups after tendinopathy modeling. On days 1, 4, 7, 14 and 28, the Achilles tendon thickness and SWE Young's modulus on the long axis were measured. The tissues of the Achilles tendon were then evaluated histologically. RESULTS The mean SWE values increased while the average thickness and histologic scores decreased, especially in the LIPUS group (9.5% and 80.7% on day 28, respectively). The SWE values in the LIPUS group were significantly lower than those in the control group on day 1 (121.0 kPa vs. 177.6 kPa) and peaked on day 7 (173.7 kPa, p < 0.001). By day 28, the SWE value had approached that of the control (191.2 kPa vs. 192.4 kPa), and had been significantly higher than that in the sham group since day 7. SWE values and histologic scores were correlated (r = -0.792, p < 0.01). The average thickness decreased in the three groups but did not differ significantly. CONCLUSION Two-dimensional ultrasound is beneficial to the diagnosis of Achilles tendinopathy. SWE could quantify changes in Achilles tendon stiffness non-invasively during LIPUS treatment, enabling the study of early Achilles tendon healing after LIPUS treatment.
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Affiliation(s)
- Mengyao Liu
- Department of Ultrasound, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qian Zheng
- Center for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai, China
| | - Yiwen Zheng
- Department of Ultrasound, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yijing Yao
- Department of Ultrasound, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rui Wang
- Department of Ultrasound, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dean Ta
- Center for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai, China; Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Lixin Jiang
- Department of Ultrasound, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Kubo K, Yasuda A, Yajima H, Takayama M, Takakura N. Effects of acupuncture and acupressure of the acupoint compared to the tendon on the blood circulation of human tendon in vivo. Eur J Appl Physiol 2024; 124:269-279. [PMID: 37452889 PMCID: PMC10786965 DOI: 10.1007/s00421-023-05277-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE The purpose of this study was to compare the effects of acupuncture and acupressure of acupoints on tendon blood circulation with those of both types of stimulation of tendon itself. METHODS Before, during (except for acupressure), and after acupuncture and acupressure of the tendon and acupoint, blood circulation of the Achilles tendon was measured using red laser lights. RESULTS The blood volume of the treated and non-treated tendons increased after acupuncture of the tendon (effect of time p = 0.030), whereas that tended to increase after acupuncture of the acupoint (effect of time p = 0.063). In addition, no significant difference in the increases in blood volume was found among the four conditions, i.e., after acupuncture stimulation of the tendon and acupoint for the treated and non-treated tendons (p = 0.492). The blood volume of the treated tendon significantly increased after acupressure of the tendon (effect of time p < 0.001), but not of the acupoint (effect of time p = 0.260), whereas that of the non-treated tendon did not change after acupressure of both the tendon and acupoint. CONCLUSION These results suggested that acupuncture of the tendon and acupoint acted centrally to enhance blood circulation of both the treated and non-treated tendons during the recovery period, whereas acupressure of the tendon locally increased blood circulation of the treated tendon only, but not the non-treated tendon and both the treated and non-treated tendons after acupressure of acupoint.
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Affiliation(s)
- Keitaro Kubo
- Department of Life Science (Sports Sciences), The University of Tokyo, Komaba 3-8-1, Meguro-Ku, Tokyo, 153-8902, Japan.
| | - Ayaka Yasuda
- Department of Life Science (Sports Sciences), The University of Tokyo, Komaba 3-8-1, Meguro-Ku, Tokyo, 153-8902, Japan
| | - Hiroyoshi Yajima
- Department of Acupuncture and Moxibustion, Tokyo Ariake University of Medical and Health Sciences, Ariake 2-9-1, Koto-Ku, Tokyo, 135-0063, Japan
| | - Miho Takayama
- Department of Acupuncture and Moxibustion, Tokyo Ariake University of Medical and Health Sciences, Ariake 2-9-1, Koto-Ku, Tokyo, 135-0063, Japan
| | - Nobuari Takakura
- Department of Acupuncture and Moxibustion, Tokyo Ariake University of Medical and Health Sciences, Ariake 2-9-1, Koto-Ku, Tokyo, 135-0063, Japan
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Hart DA, Ahmed AS, Ackermann P. Optimizing repair of tendon ruptures and chronic tendinopathies: Integrating the use of biomarkers with biological interventions to improve patient outcomes and clinical trial design. Front Sports Act Living 2023; 4:1081129. [PMID: 36685063 PMCID: PMC9853460 DOI: 10.3389/fspor.2022.1081129] [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: 10/26/2022] [Accepted: 12/09/2022] [Indexed: 01/09/2023] Open
Abstract
Tendons are dense connective tissues of the musculoskeletal system that link bones with muscles to foster mobility. They have complex structures and exist in varying biomechanical, metabolic and biological environments. In addition, tendon composition and mechanical properties can change over the lifespan as an individual ages. Many tendons function in high stress conditions with a low vascular and neuronal supply, conditions often leading to development of chronic tendinopathies, and in some cases, overt rupture of the tissues. Given their essential nature for human mobility and navigation through the environment, the effective repair and regeneration of different tendons after injury or damage is critical for quality of life, and for elite athletes, the return to sport participation at a high level. However, for mainly unknown reasons, the outcomes following injury are not always successful and lead to functional compromise and risk for re-injury. Thus, there is a need to identify those patients who are at risk for developing tendon problems, as well those at risk for poor outcomes after injury and to design interventions to improve outcomes after injury or rupture to specific tendons. This review will discuss recent advances in the identification of biomarkers prognostic for successful and less successful outcomes after tendon injury, and the mechanistic implications of such biomarkers, as well as the potential for specific biologic interventions to enhance outcomes to improve both quality of life and a return to participation in sports. In addition, the implication of these biomarkers for clinical trial design is discussed, as is the issue of whether such biomarkers for successful healing of one tendon can be extended to all tendons or are valid only for tendons in specific biomechanical and biological environments. As maintaining an active lifestyle is critical for health, the successful implementation of these advances will benefit the large number of individuals at risk.
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Affiliation(s)
- David A. Hart
- Department of Surgery, Faculty of Kinesiology, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada,Correspondence: David A. Hart
| | - Aisha S. Ahmed
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Paul Ackermann
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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6
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Earp JE, Gesick H, Angelino D, Adami A. Effects of isometric loading intensity on patellar tendon microvascular response. Scand J Med Sci Sports 2022; 32:1182-1191. [PMID: 35485297 PMCID: PMC9283377 DOI: 10.1111/sms.14175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 04/07/2022] [Accepted: 04/19/2022] [Indexed: 11/30/2022]
Abstract
Acute increases in tendon blood flow and oxygenation after stress (i.e., hyperemic response) can enhance tendon recovery. While loading intensity is a fundamental part of resistance training programs, its effects on tendon's hyperemic response are unknown. This study aimed to compare acute changes in total (total hemoglobin [THb]) and oxygenated hemoglobin (HbO2 ) concentrations in the patellar tendon after isometric exercise at different intensities. Thirteen participants performed 8 (5 s) isometric knee extensions at 25%, 50%, and 75% maximal load (maximal voluntarily isometric contraction [MVIC]), separated by 20 min recovery, prescribed in randomized and counterbalanced order. Changes in patellar tendon THb, HbO2 and deoxygenated hemoglobin (HHb) in response to exercise at each intensity were measured using near-infrared spectroscopy. Post-exercise, HbO2 increased with 50% ( η p 2 $$ {\eta}_p^2 $$ = 0.305, f = 5.26, p < 0.01) and 75% ( η p 2 $$ {\eta}_p^2 $$ = 0.245, f = 4.56, p < 0.01) but not 25% ( η p 2 $$ {\eta}_p^2 $$ = 0.088, f = 1.16, p = 0.339) MVIC, while THb increased in 50% ( η p 2 $$ {\eta}_p^2 $$ = 0.305, f = 5.26, p = 0.01) but not 25% ( η p 2 $$ {\eta}_p^2 $$ = 0.067, f = 0.865, p = 0.51) or 75% ( η p 2 $$ {\eta}_p^2 $$ = 0.126, f = 1.729, p = 0.14) MVIC. Additionally, increasing load from 25% to 50% MVIC resulted in greater THb (f = 2.459, p = 0.43), HbO2 (f = 3.389, p = 0.13) and HHb (f = 0.320, p = 0.01) post-exercise responses, but no differences were observed between 50% and 75% MVIC (THb: f = 0.748, p = 0.59; HbO2 : f = 0.825, p = 0.54; HHb: f = 0.713, p = 0.62). Our results suggest there is a loading threshold at ~50% MVIC at which the tendon hyperemic response is fully achieved. Training above this intensity is not expected to provide any additional change to the tendon microvascular response. Therefore, moderate loading seems to be sufficient to fully elicit the patellar tendon hyperemic response that's believed to stimulate tendon healing.
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Affiliation(s)
- Jacob E Earp
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut, USA.,Department of Kinesiology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Haley Gesick
- Department of Kinesiology, University of Connecticut, Storrs, Connecticut, USA
| | - Domenic Angelino
- Department of Kinesiology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Alessandra Adami
- Department of Kinesiology, University of Rhode Island, Kingston, Rhode Island, USA
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7
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Merkel MFR, Hellsten Y, Magnusson SP, Kjaer M. Tendon blood flow, angiogenesis, and tendinopathy pathogenesis. TRANSLATIONAL SPORTS MEDICINE 2021. [DOI: 10.1002/tsm2.280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Max Flemming Ravn Merkel
- Institute of Sports Medicine Department of Orthopedic Surgery Copenhagen University Hospital ‐ Bispebjerg‐Frederiksberg University of Copenhagen Copenhagen Denmark
- Department of Nutrition, Exercise and Sports University of Copenhagen Copenhagen Denmark
| | - Ylva Hellsten
- Department of Nutrition, Exercise and Sports University of Copenhagen Copenhagen Denmark
| | - Stig Peter Magnusson
- Institute of Sports Medicine Department of Orthopedic Surgery Copenhagen University Hospital ‐ Bispebjerg‐Frederiksberg University of Copenhagen Copenhagen Denmark
- Center for Healthy Aging Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Michael Kjaer
- Institute of Sports Medicine Department of Orthopedic Surgery Copenhagen University Hospital ‐ Bispebjerg‐Frederiksberg University of Copenhagen Copenhagen Denmark
- Center for Healthy Aging Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
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Frosch S, Buchhorn G, Hawellek T, Walde TA, Lehmann W, Hubert J. Comparison of the double loop knot stitch and Kessler stitch for Achilles tendon repair: A biomechanical cadaver study. PLoS One 2020; 15:e0243306. [PMID: 33270745 PMCID: PMC7714161 DOI: 10.1371/journal.pone.0243306] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 11/18/2020] [Indexed: 12/28/2022] Open
Abstract
Tendon elongation after Achilles tendon (AT) repair is associated with the clinical outcome. Reliable suture techniques are essential to reduce gap formations and to allow early mobilization. Cyclic loading conditions represent the repetitive loading in rehabilitation. The aim of this study was to compare the Kessler stitch and double loop knot stitch (DLKS) in a cyclic loading program focussing on gap formation. Sixteen human cadaveric ATs were transected and sutured using either the Kessler stitch or DLKS (eight matched pairs). The suture-tendon configurations were subjected to cyclic loading and additional ultimate load to failure testing using the Zwick 1446 universal testing machine. Each AT survived cyclic loading, with a mean gap formation less than 5 mm after 1000 cycles. The mechanical properties of the Kessler stitch and DLKS were not significantly different after cyclic loading with a mean displacement of 4.57 mm (± 1.16) for the Kessler stitch and 4.85 mm (± 1.14) for the DLKS (P = .76). There were no significant differences in the ultimate load testing (P = .85). Both bioprotective techniques prevent excessive gaping in cyclic testing when tendon loading is moderate. Our data and those from literature of gap formation in cyclic and ultimate loading allow the conclusion, that early aggressive AT loading after repair (e.g. full weightbearing) overstrain simple as well as complex suture configurations. Initial intraoperative tightening of the knots (preloading) before locking is important to decrease postoperative elongation.
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Affiliation(s)
- Stephan Frosch
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Goettingen, Göttingen, Germany
- * E-mail:
| | - Gottfried Buchhorn
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Goettingen, Göttingen, Germany
| | - Thelonius Hawellek
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Goettingen, Göttingen, Germany
| | - Tim Alexander Walde
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Goettingen, Göttingen, Germany
| | - Wolfgang Lehmann
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Goettingen, Göttingen, Germany
| | - Jan Hubert
- Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Krogsgaard MR, Brodersen J, Jensen J, Hansen CF, Comins JD. Potential problems in the use of patient reported outcome measures (PROMs) and reporting of PROM data in sports science. Scand J Med Sci Sports 2020; 31:1249-1258. [PMID: 33231328 DOI: 10.1111/sms.13888] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 10/06/2020] [Accepted: 11/12/2020] [Indexed: 12/13/2022]
Abstract
To use an inadequate patient reported outcome measure (PROM) or use a PROM in an inappropriate way potentially influences the quality of measurement. The objectives of this study were to define potential inadequate uses of PROMs in sports research studies and estimate how often they occur. A consensus group consisting of medical researchers, statisticians, and psychometricians identified and defined potentially irregular applications of PROMs. Occurrence of these in 349 consecutive articles in sports medicine in which PROMs were used as primary outcomes was reviewed. In all, 14 different potential problems were defined, and one or several occurred in 172 of the articles (49%). These were as follows: using a PROM that was developed for a different patient group (100 cases), using two or more PROMs with identical questions (94), aggregation of domain sum scores (82), combinations of subjective and objective measures (27), using a PROM to diagnose or evaluate the individual patient (7), using a PROM for a single limb (3), recall bias (3), exclusion of domains or items (3), construction of a PROM for a specific occasion (2), categorization of the scale (2), and mixing different versions of a PROM (1). Adaption of scale scores (e. g., to percentage) when results are reported (144) carries a risk of miscalculation and distorted impression of results. Data related to uncertainty about completing the PROM and the handling of missing data were not provided in the manuscripts. In conclusion, potential problems in the use and reporting of PROMs are common in sports research, and this can influence the validity of reported results.
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Affiliation(s)
- Michael R Krogsgaard
- Section for Sports Traumatology M51, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - John Brodersen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Primary Health Care Research Unit, Region Zealand, Denmark
| | - Jonas Jensen
- Section for Sports Traumatology M51, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Christian Fugl Hansen
- Section for Sports Traumatology M51, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Jonathan D Comins
- Section for Sports Traumatology M51, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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10
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Chen J, Sheng D, Ying T, Zhao H, Zhang J, Li Y, Xu H, Chen S. MOFs-Based Nitric Oxide Therapy for Tendon Regeneration. NANO-MICRO LETTERS 2020; 13:23. [PMID: 34138189 PMCID: PMC8187533 DOI: 10.1007/s40820-020-00542-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 09/29/2020] [Indexed: 05/06/2023]
Abstract
Tendon regeneration is still a great challenge due to its avascular structure and low self-renewal capability. The nitric oxide (NO) therapy emerges as a promising treatment for inducing the regeneration of injured tendon by angiogenesis. Here, in this study, a system that NO-loaded metal-organic frameworks (MOFs) encapsulated in polycaprolactone (PCL)/gelatin (Gel) aligned coaxial scaffolds (NMPGA) is designed and prepared for tendon repair. In this system, NO is able to be released in vitro at a slow and stable average speed of 1.67 nM h-1 as long as 15 d without a burst release stage in the initial 48 h. Furthermore, NMPGA can not only improve the tubular formation capability of endothelial cells in vitro but also obviously increase the blood perfusion near the injured tendon in vivo, leading to accelerating the maturity of collagen and recovery of biomechanical strength of the regenerated tendon tissue. As a NO-loaded MOFs therapeutic system, NMPGA can promote tendon regeneration in a shorter healing period with better biomechanical properties in comparison with control group by angiogenesis. Therefore, this study not only provides a promising scaffold for tendon regeneration, but also paves a new way to develop a NO-based therapy for biomedical application in the future.
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Affiliation(s)
- Jun Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, People's Republic of China
| | - Dandan Sheng
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, People's Republic of China
| | - Ting Ying
- College of Chemistry and Materials Science, Shanghai Normal University, Shanghai, 200234, People's Republic of China
| | - Haojun Zhao
- Department of Ultrasound, Jing'an District Center Hospital, Fudan University, Shanghai, 200040, People's Republic of China
| | - Jian Zhang
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, People's Republic of China
| | - Yunxia Li
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, People's Republic of China
| | - He Xu
- College of Chemistry and Materials Science, Shanghai Normal University, Shanghai, 200234, People's Republic of China.
| | - Shiyi Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, People's Republic of China.
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Svedman S, Edman G, Ackermann PW. Deep venous thrombosis after Achilles tendon rupture is associated with poor patient-reported outcome. Knee Surg Sports Traumatol Arthrosc 2020; 28:3309-3317. [PMID: 32313988 PMCID: PMC7511273 DOI: 10.1007/s00167-020-05945-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 03/17/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE The aim of this study was to investigate whether patient subjective and functional outcomes after Achilles tendon rupture (ATR) are related to deep venous thrombosis (DVT) during leg immobilization. METHODS A cohort study with prospectively collected randomized data was conducted between 2010 and 2017. Two-hundred and fifty-one Patients with an Achilles tendon rupture (mean age = 41 ± 8), treated with uniform surgical techniques, were retrospectively analyzed. DVT incidence at 2 and 6 weeks was assessed using compression duplex ultrasound. At 12 months patient-reported outcomes were assessed using the Achilles tendon Total Rupture Score (ATRS), Foot- and Ankle Outcome Score (FAOS), Physical Activity Scale (PAS) and functional outcome with the calf-muscle endurance test. ANOVA analyses were used and adjusted for assumed confounding factors (patient age, sex, BMI and rehabilitation). RESULTS The total DVT incidence was 122 out of 251 (49%). Patients suffering a DVT exhibited significantly lower ATRS at 1 year compared to patients without DVT (mean 76 vs 83, 95% CI 71-79 vs 80-87; p < 0.01). Sixty-seven percent (95% CI 57-77%) of the patients devoid of DVT reported a good outcome (ATRS > 80) compared to 51% (95% CI 41-61%) of the patients sustaining a DVT (p < 0.05). Quality of life displayed significantly better outcome in the non-DVT versus DVT patients (mean = 75 (95% CI 71-79) vs. mean = 68 (95% CI 64-72); p < 0.05). A significant difference in total concentric work was observed between non-DVT and DVT patients (median = 1.9 kJ (IQR = 0.9 kJ) vs. median = 1.6 kJ (IQR = 1.0 kJ); p < 0.01). CONCLUSION Sustaining a DVT during leg immobilization significantly impairs patient-reported outcome at 1 year after surgical repair of ATR. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Simon Svedman
- Integrative Orthopedic Laboratory, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska Universitetssjukhuset, 171 76, Stockholm, Sweden.
- Department of Orthopedics, Karolinska University Hospital, Stockholm, Sweden.
| | - Gunnar Edman
- Department of Psychiatry, Tiohundra AB, Norrtälje, Sweden
| | - Paul W Ackermann
- Integrative Orthopedic Laboratory, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska Universitetssjukhuset, 171 76, Stockholm, Sweden
- Department of Orthopedics, Karolinska University Hospital, Stockholm, Sweden
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Wang PY, Shih KS, Ma HL, Chiang H, Chen PY, Chao YH, Rolf C, Wang HK. Acute and Long-Term Effects of Mechanotherapy on the Outcome After an Achilles Repair: A Prospective Cohort Study With Historical Controls. Arch Phys Med Rehabil 2019; 100:2046-2052. [PMID: 31082379 DOI: 10.1016/j.apmr.2019.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 03/23/2019] [Accepted: 03/27/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the effects of vibration on Achilles' tendon microcirculation and characteristics following surgical repair of Achilles' tendon rupture. DESIGN Cohort study with historical controls. SETTING A university institute. PARTICIPANTS Participants (N=32), including 19 (16 men, 3 women; median [range] age: 43.0 [25.0-57.0] years) and 13 (10 men, 3 women; 44.00 [29.0-60.0] years) in the vibration (application to the ball of the foot, 30Hz, 2mm amplitude, 4kg pressure, and self-administration) and control groups, respectively, who underwent unilateral Achilles' tendon repairs were recruited. INTERVENTION A 4-week vibration intervention in the vibration group. MAIN OUTCOME MEASUREMENTS The tendon microcirculation was measured after the first session of vibration. The participants were evaluated repeatedly with bilateral follow-up measurements of tendon stiffness, 3 functional outcome tests, and a questionnaire survey. RESULTS Acute effects of the vibration were observed immediately after the 5-minute vibration (P≤.001). Lower total hemoglobin and oxygen saturation were respectively observed (P=.043) in the repaired legs 3 and 6 months postsurgery in the vibration group as compared with the control group. The vibration group also showed greater tendon stiffness, heel raising height and hopping distance 3 or 6 months postoperation in both the repaired and noninjured legs (all P<.05). The microcirculatory characteristics 2 months postoperation were correlated with the outcomes at 6 months postoperation. CONCLUSIONS Differences in microcirculatory characteristics and better rehabilitation outcomes were observed in the legs with an Achilles repair that underwent the early vibration intervention.
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Affiliation(s)
- Pei-Yun Wang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan, ROC; Center of Physical Therapy, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Kao-Shang Shih
- Department of Orthopedic Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, ROC
| | - Hsiao-Li Ma
- Sport Medicine Department, Orthopedic Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Medical School, National Yang-Ming University Taipei, Taiwan, ROC
| | - Hongsen Chiang
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan, ROC; College of Medicine, National Taiwan University, Taipei, Taiwan, ROC
| | - Pei-Yu Chen
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan, ROC; College of Medicine, National Taiwan University, Taipei, Taiwan, ROC
| | - Yuan-Hung Chao
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan, ROC; Center of Physical Therapy, National Taiwan University Hospital, Taipei, Taiwan, ROC
| | - Christer Rolf
- Department of Orthopaedics, Clintec, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Hsing-Kuo Wang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan, ROC; Center of Physical Therapy, National Taiwan University Hospital, Taipei, Taiwan, ROC.
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