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Tan L, Huyan C, Wang Y, Li M, Liu D, Liu M, Luo Z, Cai K, Hu Y. Mechanically Robust Hemostatic Hydrogel Membranes with Programmable Strain-Adaptive Microdomain Entanglement for Wound Treatment in Dynamic Tissues. ACS NANO 2024; 18:8360-8382. [PMID: 38457334 DOI: 10.1021/acsnano.3c12950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/10/2024]
Abstract
Supramolecular hydrogels emerge as a promising paradigm for sutureless wound management. However, their translation is still challenged by the insufficient mechanical robustness in the context of complex wounds in dynamic tissues. Herein, we report a tissue-adhesive supramolecular hydrogel membrane based on biocompatible precursors for dressing wounds in highly dynamic tissues, featuring robust mechanical resilience through programmable strain-adaptive entanglement among microdomains. Specifically, the hydrogels are synthesized by incorporating a long-chain polyurethane segment into a Schiff base-ligated short-chain oxidized cellulose/quaternized chitosan network via acylhydrazone bonding, which readily establishes interpenetrating entangled microdomains in dynamic cross-linked hydrogel matrices to enhance their tear and fatigue resistance against extreme mechanical stresses. After being placed onto dynamic tissues, the hydrogel dressing could efficiently absorb blood to achieve rapid hemostasis. Moreover, metal ions released from ruptured erythrocytes could be scavenged by the Schiff base linkers to form additional ionic bonds, which would trigger the cross-linking of the short-chain components and establish abundant crystalline microdomains, eventually leading to the in situ stiffening of the hydrogels to endure heavy mechanical loads. Benefiting from its hemostatic capacity and strain adaptable mechanical performance, this hydrogel wound dressing shows promise for the clinical management of various traumatic wounds.
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Affiliation(s)
- Lu Tan
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing 400044, China
| | - Chenxi Huyan
- School of Chemical Engineering and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi 710049, China
| | - Yanqiu Wang
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing 400037, China
| | - Menghuan Li
- School of Life Science, Chongqing University, Chongqing 400044, China
| | - Dong Liu
- School of Chemical Engineering and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi 710049, China
| | - Minghan Liu
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing 400037, China
| | - Zhong Luo
- School of Life Science, Chongqing University, Chongqing 400044, China
| | - Kaiyong Cai
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing 400044, China
| | - Yan Hu
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing 400044, China
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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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Zheng Q, Liu M, He M, Sun S, Liu C, Li Y, Jiang L, Ta D. Low-Intensity Pulsed Ultrasound Promotes the Repair of Achilles Tendinopathy by Downregulating the JAK/STAT Signaling Pathway in Rabbits. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2024; 71:141-152. [PMID: 38060355 DOI: 10.1109/tuffc.2023.3340721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Tendinopathy is a complex tendon injury or pathology outcome, potentially leading to permanent impairment. Low-intensity pulsed ultrasound (LIPUS) is emerging as a treatment modality for tendon disorders. However, the optimal treatment duration and its effect on tendons remain unclear. This study aims to investigate the efficacy of LIPUS in treating injured tendons, delineate the appropriate treatment duration, and elucidate the underlying treatment mechanisms through animal experiments. Ninety-six three-month-old New Zealand white rabbits were divided into normal control (NC) and model groups. The model group received Prostaglandin E2 (PGE2) injections to induce Achilles tendinopathy. They were then divided into model control (MC) and LIPUS treatment (LT) groups. LT received LIPUS intervention with a 1-MHz frequency, a pulse repetition frequency (PRF) of 1 kHz, and spatial average temporal average sound intensity ( [Formula: see text]) of 100 mW/cm2. MC underwent a sham ultrasound, and NC received no treatment. Assessments on 1, 4, 7, 14, and 28 days after LT included shear wave elastography (SWE), mechanical testing, histologic evaluation, ribonucleic acid sequencing (RNA-seq), polymerase chain reaction (PCR), and western blot (WB) analysis. SWE results showed that the shear modulus in the LT group was significantly higher than that in the MC group after LT for seven days. Histological results demonstrated improved tendon tissue alignment and fibroblast distribution after LT. Molecular analyses suggested that LIPUS may downregulate the Janus kinase/signal transducer and activator of transcription (JAK/STAT) signaling pathway and regulate inflammatory and matrix-related factors. We concluded that LT enhanced injured tendon elasticity and accelerated Achilles tendon healing. The study highlighted the JAK/STAT signaling pathway as a potential therapeutic target for LT of Achilles tendinopathy, guiding future research.
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Zhang G, Zhou X, Hu S, Jin Y, Qiu Z. Large animal models for the study of tendinopathy. Front Cell Dev Biol 2022; 10:1031638. [PMID: 36393858 PMCID: PMC9640604 DOI: 10.3389/fcell.2022.1031638] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/12/2022] [Indexed: 11/23/2022] Open
Abstract
Tendinopathy has a high incidence in athletes and the aging population. It can cause pain and movement disorders, and is one of the most difficult problems in orthopedics. Animal models of tendinopathy provide potentially efficient and effective means to develop understanding of human tendinopathy and its underlying pathological mechanisms and treatments. The selection of preclinical models is essential to ensure the successful translation of effective and innovative treatments into clinical practice. Large animals can be used in both micro- and macro-level research owing to their similarity to humans in size, structure, and function. This article reviews the application of large animal models in tendinopathy regarding injuries to four tendons: rotator cuff, patellar ligament, Achilles tendon, and flexor tendon. The advantages and disadvantages of studying tendinopathy with large animal models are summarized. It is hoped that, with further development of animal models of tendinopathy, new strategies for the prevention and treatment of tendinopathy in humans will be developed.
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Affiliation(s)
- Guorong Zhang
- School of Clinical Medicine, Changchun University of Chinese Medicine, Changchun, China
- School of Pharmacy, Changchun University of Chinese Medicine, Changchun, China
| | - Xuyan Zhou
- School of Pharmacy, Changchun University of Chinese Medicine, Changchun, China
| | - Shuang Hu
- School of Pharmacy, Changchun University of Chinese Medicine, Changchun, China
| | - Ye Jin
- School of Pharmacy, Changchun University of Chinese Medicine, Changchun, China
- *Correspondence: Ye Jin, ; Zhidong Qiu,
| | - Zhidong Qiu
- School of Pharmacy, Changchun University of Chinese Medicine, Changchun, China
- *Correspondence: Ye Jin, ; Zhidong Qiu,
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Quantitative Analysis of Contrast-Enhanced Ultrasound That Can Be Used to Evaluate Angiogenesis during Patellar Tendon Healing in Rats. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:6867743. [PMID: 36313964 PMCID: PMC9584743 DOI: 10.1155/2022/6867743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 09/15/2022] [Indexed: 01/26/2023]
Abstract
Objective To investigate the efficacy of contrast-enhanced ultrasound (CEUS) in quantitatively evaluating angiogenesis during patellar tendon healing in rats. Methods A total of 40 Sprague-Dawley rats were used in this study. The patellar tendons of 30 rats (60 limbs) that underwent incision and suture were treated as the operation group and monitored after 7, 14, and 28 days. The normal patellar tendons of 10 rats (20 limbs) were treated as the control group and monitored on day 0. The ultrasound examination was used to evaluate the structure and blood perfusion of the patellar tendon. Immunohistochemistry was used to assess angiogenesis, and the biomechanical test was used to verify functional recovery of the patellar tendon. Results The tendons in the operation group were significantly thickened compared with those in the control group (p < 0.01). The peak intensity (PI) in CEUS of the tendons showed a clear difference at each time point after the surgery (p < 0.01). PI increased in the operation group with a maximum on day 7, and then gradually decreased until day 28 when PI was close to the basic intensity (BI) in the control group (p > 0.05). It was consistent with the change of the CD31-positive staining areas representing angiogenesis of the injured patellar tendons. The PI was positively correlated with the CD31-positive staining area fraction (R = 0.849, p < 0.001). The failure load and tensile strength of the repaired patellar tendons in the operation group increased over time. The PI showed negative correlations with the failure load (R = -0.787, p < 0.001) and tensile strength (R = -0.714, p < 0.001). Conclusion The PI in CEUS could quantitatively reflect the time-dependent change in the blood supply of the healing site, and the PI correlated with histologic and biomechanical properties of the healing tendon. Quantitative analysis of contrast-enhanced ultrasound could be a useful method to evaluate angiogenesis in healing tendons.
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Guerri G, Palozzo A, Straticò P, Varasano V, Celani G, Di Francesco P, Vignoli M, Petrizzi L. 2D-SWE of the Metacarpophalangeal Joint Capsule in Horses. Vet Sci 2022; 9:vetsci9090478. [PMID: 36136694 PMCID: PMC9501397 DOI: 10.3390/vetsci9090478] [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: 07/05/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Two-dimensional shear wave elastography (2D-SWE) employs an ultrasound impulse to produce transversely oriented shear waves, which travel through the surrounding tissue according to the stiffness of the tissue itself. The study aimed to assess the reliability of 2D-SWE for evaluating the elastosonographic appearance of the distal attachment of the fetlock joint capsule (DJC) in sound horses and in horses with osteoarthritis (OA) (2). According to a thorough evaluation of metacarpophalangeal joint (MCPJ), adult horses were divided in a sound Group (H) and in OA Group (P). Thereafter, a 2D-SWE of MCPJs was performed. Shear wave velocity (m/sec) and Young’s modulus (kPa) were calculated independently by two operators at each selected ROI. Statistical analysis was performed with R software. (3) Results: 2D-SWE had good–excellent inter-CC and intra-CC in both groups. Differences in m/s and kPa between Groups H and P were found in transverse scans with lower values in Group P. No correlation with age or DJC thickness was found. (4) Conclusions: 2D-SWE was repeatable and reproducible. In Group H, DJC was statistically stiffer than in Group P only in transverse scan. The technique showed poor sensitivity and specificity in differentiating fetlocks affected by OA.
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Affiliation(s)
- Giulia Guerri
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, University of Teramo, Località Piano D’Accio, 64100 Teramo, Italy
| | - Adriana Palozzo
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, University of Teramo, Località Piano D’Accio, 64100 Teramo, Italy
| | - Paola Straticò
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, University of Teramo, Località Piano D’Accio, 64100 Teramo, Italy
- Correspondence:
| | - Vincenzo Varasano
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, University of Teramo, Località Piano D’Accio, 64100 Teramo, Italy
| | - Gianluca Celani
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, University of Teramo, Località Piano D’Accio, 64100 Teramo, Italy
| | | | - Massimo Vignoli
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, University of Teramo, Località Piano D’Accio, 64100 Teramo, Italy
| | - Lucio Petrizzi
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, University of Teramo, Località Piano D’Accio, 64100 Teramo, Italy
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Gong F, Li X, Zhang H, Wu J, Ma G, Zhang B, Gao J, Ding Y, Huang Y, Cheng S, Zhou X, Zhao F. Comparison of the Effects of Open Surgery and Minimally Invasive Surgery on the Achilles Tendon Rupture Healing Based on Angiogenesis. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:1447129. [PMID: 36093506 PMCID: PMC9458374 DOI: 10.1155/2022/1447129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/05/2022] [Accepted: 07/08/2022] [Indexed: 11/17/2022]
Abstract
Objective To compare the effect of three different surgical methods on rabbit Achilles tendon rupture. Methods The Achilles tendon transection model was constructed by cutting off the inner half of the Achilles tendon. Rabbits were divided into 4 groups: model group, open surgery (OS) group, minimally invasive surgery (MS) group, and conservative treatment (CT) group. Biomechanical evaluation, H&E, and Picrosirius Red staining were applied to evaluate the histological changes and healing. RT-qPCR, Western blot, ELISA, and IHC staining were used to detect the expression of COLIII, IL-1β, TNF-α, IL-6, CD31, VEGF, bFGF, and TGF-β1. Results Different surgery treatments significantly alleviated the histological changes in rabbits. The tension and elasticity of the Achilles tendon were significantly increased after surgery. In addition, surgery treatments notably alleviated the inflammatory responses in vivo via downregulation of IL-1β, TNF-α, and IL-6 and promoted the tube formation in tissues through upregulating VEGF, bFGF, TGF-β1, and CD31. Furthermore, MS exhibited best therapeutic efficiency on Achilles tendon rupture healing, compared with OS or CT. Conclusions Our research revealed the superiority of MS in Achilles tendon rupture treatment at the molecular level compared with OS or CT.
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Affiliation(s)
- Fan Gong
- Hand & Foot & Reconstruction Microsurgery, People's Hospital of Ningxia Hui Autonomous Region (The First Affiliated Hospital of Northwest University for Nationalities), Yinchuan 750002, Ningxia, China
| | - Xiaoliang Li
- Hand & Foot & Reconstruction Microsurgery, People's Hospital of Ningxia Hui Autonomous Region (The First Affiliated Hospital of Northwest University for Nationalities), Yinchuan 750002, Ningxia, China
| | - Hanling Zhang
- Hand & Foot & Reconstruction Microsurgery, People's Hospital of Ningxia Hui Autonomous Region (The First Affiliated Hospital of Northwest University for Nationalities), Yinchuan 750002, Ningxia, China
| | - Jianke Wu
- Hand & Foot & Reconstruction Microsurgery, People's Hospital of Ningxia Hui Autonomous Region (The First Affiliated Hospital of Northwest University for Nationalities), Yinchuan 750002, Ningxia, China
| | - Guoxu Ma
- Hand & Foot & Reconstruction Microsurgery, People's Hospital of Ningxia Hui Autonomous Region (The First Affiliated Hospital of Northwest University for Nationalities), Yinchuan 750002, Ningxia, China
| | - Bowen Zhang
- Hand & Foot & Reconstruction Microsurgery, People's Hospital of Ningxia Hui Autonomous Region (The First Affiliated Hospital of Northwest University for Nationalities), Yinchuan 750002, Ningxia, China
| | - Jian Gao
- Hand & Foot & Reconstruction Microsurgery, People's Hospital of Ningxia Hui Autonomous Region (The First Affiliated Hospital of Northwest University for Nationalities), Yinchuan 750002, Ningxia, China
| | - Yi Ding
- Hand & Foot & Reconstruction Microsurgery, People's Hospital of Ningxia Hui Autonomous Region (The First Affiliated Hospital of Northwest University for Nationalities), Yinchuan 750002, Ningxia, China
| | - Yonglu Huang
- Hand & Foot & Reconstruction Microsurgery, People's Hospital of Ningxia Hui Autonomous Region (The First Affiliated Hospital of Northwest University for Nationalities), Yinchuan 750002, Ningxia, China
| | - Suoli Cheng
- Hand & Foot & Reconstruction Microsurgery, People's Hospital of Ningxia Hui Autonomous Region (The First Affiliated Hospital of Northwest University for Nationalities), Yinchuan 750002, Ningxia, China
| | - Xuebing Zhou
- Hand & Foot & Reconstruction Microsurgery, People's Hospital of Ningxia Hui Autonomous Region (The First Affiliated Hospital of Northwest University for Nationalities), Yinchuan 750002, Ningxia, China
| | - Fei Zhao
- Hand & Foot & Reconstruction Microsurgery, People's Hospital of Ningxia Hui Autonomous Region (The First Affiliated Hospital of Northwest University for Nationalities), Yinchuan 750002, Ningxia, China
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Mlyniec A, Dabrowska S, Heljak M, Weglarz WP, Wojcik K, Ekiert-Radecka M, Obuchowicz R, Swieszkowski W. The dispersion of viscoelastic properties of fascicle bundles within the tendon results from the presence of interfascicular matrix and flow of body fluids. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 130:112435. [PMID: 34702520 DOI: 10.1016/j.msec.2021.112435] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 09/06/2021] [Accepted: 09/09/2021] [Indexed: 01/12/2023]
Abstract
In this work, we investigate differences in the mechanical and structural properties of tendon fascicle bundles dissected from different areas of bovine tendons. The properties of tendon fascicle bundles were investigated by means of uniaxial tests with relaxation periods and hysteresis, dynamic mechanical analysis (DMA), as well as magnetic resonance imaging (MRI). Uniaxial tests with relaxation periods revealed greater elastic modulus, hysteresis, as well as stress drop during the relaxation of samples dissected from the posterior side of the tendon. However, the normalized stress relaxation curves did not show a statistically significant difference in the stress drop between specimens cut from different zones or between different strain levels. Using dynamic mechanical analysis, we found that fascicle bundles dissected from the anterior side of the tendon had lower storage and loss moduli, which could result from altered fluid flow within the interfascicular matrix (IFM). The lower water content, diffusivity, and higher fractional anisotropy of the posterior part of the tendon, as observed using MRI, indicates a different structure of the IFM, which controls the flow of fluids within the tendon. Our results show that the viscoelastic response to dynamic loading is correlated with fluid flow within the IFM, which was confirmed during analysis of the MRI results. In contrast to this, the long-term relaxation of tendon fascicle bundles is controlled by viscoplasticity of the IFM and depends on the spatial distribution of the matrix within the tendon. Comparison of results from tensile tests, DMA, and MRI gives new insight into tendon mechanics and the role of the IFM. These findings may be useful in improving the diagnosis of tendon injury and effectiveness of medical treatments for tendinopathies.
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Affiliation(s)
- Andrzej Mlyniec
- AGH University of Science and Technology, Faculty of Mechanical Engineering and Robotics, Krakow, Poland.
| | - Sylwia Dabrowska
- AGH University of Science and Technology, Faculty of Mechanical Engineering and Robotics, Krakow, Poland
| | - Marcin Heljak
- Warsaw University of Technology, Faculty of Materials Science and Engineering, Warsaw, Poland
| | | | - Kaja Wojcik
- AGH University of Science and Technology, Faculty of Mechanical Engineering and Robotics, Krakow, Poland
| | - Martyna Ekiert-Radecka
- AGH University of Science and Technology, Faculty of Mechanical Engineering and Robotics, Krakow, Poland
| | - Rafal Obuchowicz
- Jagiellonian University Collegium Medicum, Department of Radiology, Krakow, Poland
| | - Wojciech Swieszkowski
- Warsaw University of Technology, Faculty of Materials Science and Engineering, Warsaw, Poland
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Nocera NL, Burke CJ, Gyftopoulos S, Adler RS. Ultrasound-MRI Correlation for Healing of Rotator Cuff Repairs Using Power Doppler, Sonographic Shear Wave Elastography and MR Signal Characteristics: A Pilot Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:2055-2068. [PMID: 33258512 DOI: 10.1002/jum.15583] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 10/15/2020] [Accepted: 10/18/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To determine whether the healing response in rotator cuff repairs can be quantitatively characterized using a multimodality imaging approach with MR signal intensity, power Doppler and shear wave elastography (SWE). MATERIALS AND METHODS Patients scheduled for rotator cuff repair were prospectively enrolled between September 2013 and June 2016. A 12 patient cohort with unilateral, full-thickness, supraspinatus tendon tears underwent MRI and ultrasound both preoperatively and postoperatively (at 3 and 6 months post-surgery). The MR signal intensity ratio of tendon-to-deltoid muscle (TMR), vascularity score by power Doppler (PD) and shear wave velocity (SWV) were measured. Repaired and asymptomatic control shoulders were compared over time and between modalities. RESULTS TMR and vascularity of the tendon repair initially increased and then decreased postoperatively. Although not achieving statistical significance, postoperative SWV initially decreased and later increased, which negatively correlated with the TMR at 3 months (r = -0.73, p = 0.005). PD demonstrated a statistically significant change in tendon vascularity over time compared to the contralateral control (p = 0.009 at 3 months; p = 0.036 at 6 months). No significant correlation occurred between TMR and SWE at 6 months, or with PD at any time point. CONCLUSION Despite a small patient cohort, this prospective pilot study suggests a temporal relationship of MRI and ultrasound parameters that parallels the expected phases of healing in the repaired rotator cuff.
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Affiliation(s)
- Nicole L Nocera
- New York University Langone Orthopedic Center, New York, NY, USA
| | | | | | - Ronald S Adler
- New York University Langone Orthopedic Center, New York, NY, USA
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10
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Zhao J, Wang X, Han J, Yu Y, Chen F, Yao J. Boost Tendon/Ligament Repair With Biomimetic and Smart Cellular Constructs. Front Bioeng Biotechnol 2021; 9:726041. [PMID: 34532315 PMCID: PMC8438196 DOI: 10.3389/fbioe.2021.726041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/22/2021] [Indexed: 12/11/2022] Open
Abstract
Tendon and ligament are soft connective tissues that play essential roles in transmitting forces from muscle to bone or bone to bone. Despite significant progress made in the field of ligament and tendon regeneration over the past decades, many strategies struggle to recapitulate basic structure-function criteria of native ligament/tendon. The goal here is to provide a fundamental understanding of the structure and composition of ligament/tendon and highlight few key challenges in functional regeneration of these connective tissues. The remainder of the review will examine several biomaterials strategies including biomimetic scaffold with non-linear mechanical behavior, hydrogel patch with anisotropic adhesion and gene-activated scaffold for interactive healing of tendon/ligament. Finally, emerging technologies and research avenues are suggested that have the potential to enhance treatment outcomes of tendon/ligament injuries.
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Affiliation(s)
- Jianping Zhao
- Department of Orthopedics Trauma and Hand Surgery & Guangxi Key Laboratory of Regenerative Medicine, International Joint Laboratory on Regeneration of Bone and Soft Tissue, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.,Center for Materials Synthetic Biology, Institute of Synthetic Biology, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Xiang Wang
- Center for Materials Synthetic Biology, Institute of Synthetic Biology, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Jinyu Han
- Center for Materials Synthetic Biology, Institute of Synthetic Biology, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Yin Yu
- Center for Materials Synthetic Biology, Institute of Synthetic Biology, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Fei Chen
- Center for Materials Synthetic Biology, Institute of Synthetic Biology, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Jun Yao
- Department of Orthopedics Trauma and Hand Surgery & Guangxi Key Laboratory of Regenerative Medicine, International Joint Laboratory on Regeneration of Bone and Soft Tissue, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Serial Ultrasonographic and Real-Time Elastosonographic Assessment of the Ovine Common Calcaneal Tendon, after an Experimentally Induced Tendinopathy. Vet Sci 2021; 8:vetsci8040054. [PMID: 33806121 PMCID: PMC8064454 DOI: 10.3390/vetsci8040054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/17/2021] [Accepted: 03/19/2021] [Indexed: 12/31/2022] Open
Abstract
Real-time elastosonography (RTE) is a recently described, non-invasive, ultrasonographic technique developed to assess tissue elasticity. The main aim of this study was to investigate the ultrasonographic and elastosonographic appearance of the common calcaneal tendon (CCT) in an ovine model, and to monitor the progression of tendon healing after an experimentally-induced tendinopathy. Sound tendons were initially evaluated (T0) with a caliper and by a single operator with ultrasound. Ultrasonographic and elastosonographic images were then acquired. Subsequently, ultrasound-guided tendon lesions were induced by injecting 500 IU of Type IA collagenases proximally to the calcaneal tuberosity. Caliper measurement, ultrasonography and elastosonography were then repeated at 15 (T1), 30 (T2) and 60 (T3) days. Clinically measured width of the tendon, ultrasonographic thickness and width and percentage of hard (Elx-t%hrd) and soft (Elx-t%sft) tissue were recorded. Statistical analysis was performed on the data collected; statistical significance was set at p < 0.05. Intra-class correlation coefficient (ICC) revealed good (0.68) repeatability of elastosonographic evaluation of the CCT. The tendon width was significantly increased when comparing T0 with T1–2 and decreased when comparing T1–2 with T3. Ultrasound-assessed thickness was significantly increased between T0–T1 and decreased between T1-T2–3. Elx-t%hrd was significantly decreased at T1–2–3 and Elx-t%sft was significantly increased at T1–2–3. In conclusion, the ovine CCT is a highly stiff structure that undergoes a severe loss of stiffness during the healing process. Thickness and width of the tendon increased during the first 30 days and then reduced progressively along the subsequent 30 days. Ultrasonographic appearance of the tendon remained severely abnormal and the tendon showed severely reduced elastic proprieties 60 days after lesion induction.
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Cong Y, Fan Z, Dai Y, Zhang Z, Yan K. Application Value of Shear Wave Elastography in the Evaluation of Tumor Downstaging for Locally Advanced Rectal Cancer After Neoadjuvant Chemoradiotherapy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:81-89. [PMID: 32648968 DOI: 10.1002/jum.15378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/14/2020] [Accepted: 05/26/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES The aim of this study was to assess the application value of shear wave elastography in the evaluation of tumor downstaging for locally advanced rectal cancer after neoadjuvant chemoradiotherapy. METHODS A retrospective analysis was conducted using data from patients with locally advanced rectal cancer treated in our hospital who received endorectal ultrasound (ERUS) and shear wave elastographic examinations before and after chemoradiotherapy. The cases were grouped according to the postoperative pathologic tumor-staging scores. The lesions were divided into 2 groups: 1 showing and the other not showing tumor downstaging. The efficacy of ERUS in diagnosis of tumor downstaging was calculated. The differences in the mean and maximum values of the Young modulus of the lesions before and after chemoradiotherapy between the groups were calculated and compared. Receiver operating characteristic curves were constructed by using the differences in the 2 kinds of values of the Young modulus. RESULTS The mean and maximum values of the Young modulus before and after chemoradiotherapy were significantly different (P < .05). The differences in the mean and maximum values of the Young modulus of rectal lesions between groups were statistically significant (P < .05). The results of the receiver operating characteristic curve showed that a difference in the mean value at 34.7 kPa was the optimal diagnostic threshold. Compared with ERUS, this standard showed a significant difference in diagnosis of tumor downstaging (P < .05). CONCLUSIONS Shear wave elastography is an effective ultrasound elastographic technique to assist ERUS in evaluating lesions after chemoradiotherapy in rectal cancer. It can improve the diagnostic efficacy of tumor downstaging and provide effective imaging conclusions for clinical decision making.
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Affiliation(s)
- Yue Cong
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Zhihui Fan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Ying Dai
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Zhongyi Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Kun Yan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing, 100142, China
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Quack V, Betsch M, Hellmann J, Eschweiler J, Schrading S, Gatz M, Rath B, Tingart M, Laubach M, Kuhl CK, Dirrichs T. Evaluation of Postoperative Changes in Patellar and Quadriceps Tendons after Total Knee Arthroplasty-A Comprehensive Analysis by Shear Wave Elastography, Power Doppler and B-mode Ultrasound. Acad Radiol 2020; 27:e148-e157. [PMID: 31526688 DOI: 10.1016/j.acra.2019.08.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 08/12/2019] [Accepted: 08/13/2019] [Indexed: 02/04/2023]
Abstract
RATIONALE AND OBJECTIVES Up to now, the diagnosis of tendinopathies is based on conventional B-mode-ultrasound (B-US), Power Doppler-ultrasound (PD-US), and magnetic resonance imaging. In the past decade, Shear Wave Elastography (SWE) has been introduced in tendon imaging, for example in athletes or patients suffering from tendinopathy. SWE allows real-time quantification of tissue stiffness, and, by this, the assessment of the mechanical properties of a tendon and its changes during acute disease and tendon healing. So far there are no ultrasound-based studies that have evaluated postoperative tendon changes, anatomical and mechanical properties and tendon healing of the patellar, and quadriceps tendon following Total Knee Arthroplasty (TKA). The purpose of this prospective study was two-fold: first to analyze morphologic, vascular, and mechanical properties of patellar and quadriceps tendons in patients following TKA; and, second to evaluate possible changes thereof and their visibility in the course of time. MATERIALS AND METHODS Observational cross-sectional, IRB-approved study in 63 postoperative patients with a total of 76 total knee arthroplasties (50 unilateral, 13 bilateral) and 50 nonoperated knees for comparison, resulting in 152 postoperative patellar- and quadriceps and 100 nonoperated patellar- and quadriceps-tendons for comparative analysis. For further examination, we divided the 63 patients into two groups according to the duration since surgery (group A < 24 months; group B > 24 months). All patients completed a standardized questionnaire, furthermore the Knee Society score and the Knee Society function score. The amount of experienced pain was assessed using the ordinal numeric rating scale and the presence of anterior knee pain was examined. Subsequently every participant underwent a standardized multimodal ultrasound protocol consisting of B-US, PD-US, and SWE of the left and right patellar and quadriceps tendons. RESULTS Using the different US-modalities, operated patellar, and quadriceps tendons (n = 152) were significantly more frequent classified as pathological (B-US) (p < 0.001), the mean Ohberg score was significantly higher (PD-US) (p < 0.001), and the tendons were significantly softer (SWE) than their nonoperated counterparts (n = 100). Mean SWE-value of postoperative patellar tendons was 45.66 ± 14.84 kPa versus 60.08 ± 19.13 kPa in nonoperated knees (p < 0.001). Mean SWE-value of postoperative quadriceps tendons was 35.73 ± 15.66 kPa versus 52.69 ± 16.20 kPa in nonoperated knees (p < 0.001). Comparing the two postoperative groups (group A and B), we recognized a significant decrease of pathologically classified patellar and quadriceps tendons (B-US and PD-US) in group B. The early postoperatively reduced SWE values slightly increased during the course of time. CONCLUSION After TKA, patellar, and quadriceps tendons show significant measurable alterations in B-US, PD-US, and SWE. Especially a significant decrease of tendon stiffness in operated knees, as assessed by SWE, might be a surrogate marker for changed mechanical properties. These alterations improve, the longer ago the surgery was. The quantitative information obtained by SWE could be of particular interest in follow-up and therapy monitoring after TKA. Knowledge about tendon stiffness and it's varieties in different population groups (e.g. athletes, elderly, postoperative patients) is crucial to sonographically rate a tendon as "healthy" or "diseased."
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Affiliation(s)
- Valentin Quack
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Marcel Betsch
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Julian Hellmann
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Jörg Eschweiler
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Simone Schrading
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, Aachen 52074, Germany
| | - Matthias Gatz
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Björn Rath
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Markus Tingart
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Markus Laubach
- Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany
| | - Christiane K Kuhl
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, Aachen 52074, Germany
| | - Timm Dirrichs
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, Aachen 52074, Germany.
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Zardi EM, Pipita ME, Giorgi C, Afeltra A, Maffulli N, Franceschi F. Strain Ultrasound Elastography in the Achilles Tendon of Ankylosing Spondylitis Patients Treated With Anti-TNF-α: A Preliminary Study. In Vivo 2020; 33:1635-1640. [PMID: 31471416 DOI: 10.21873/invivo.11648] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/11/2019] [Accepted: 06/12/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND/AIM To compare patients affected by ankylosing spondylitis (AS) treated with anti-TNF-α for two years with controls in terms of Achilles tendon stiffness, ultrasound structure and thickness. PATIENTS AND METHODS B-mode ultrasound evaluation and strain ultrasound elastography were performed in longitudinal and transverse planes on 22 Achilles tendons of 11 AS patients and 26 of 13 controls. RESULTS There were no significant differences in thickness and stiffness of the Achilles tendon between AS patients and controls, except for an increased thickness in the middle third of the tendon in the AS patients (p=0.04). The Achilles tendon stiffness ratio of AS patients was 1.02±0.36 vs. 1.14±0.38 in the controls (p=0.2). CONCLUSION AS patients had an Achilles tendon thickness greater than controls at the middle third, but no difference in the stiffness was found among them. Strain ultrasound elastography may be useful to exclude early changes in mechanical properties of tendons.
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Affiliation(s)
- Enrico M Zardi
- Internistic Ultrasound Service "Campus Bio-Medico" University, Rome, Italy
| | - Maria Elena Pipita
- Internistic Ultrasound Service "Campus Bio-Medico" University, Rome, Italy
| | - Chiara Giorgi
- Radiology Department, S. Maria della Misericordia Hospital, Urbino, Italy
| | | | - Nicola Maffulli
- Department of Musculoskeletal Disorders, School of Medicine and Surgery, University of Salerno, Salerno, Italy.,Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, Barts and the London School of Medicine and Dentistry, London, U.K.,School of Medicine, Institute of Science and Technology in Medicine, Guy Hilton, Keele University, Newcastle, U.K
| | - Francesco Franceschi
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico University, Rome, Italy
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Abstract
Traumatic and overuse hip injuries occur frequently in amateur and professional athletes. After clinical assessment, imaging plays an important role in diagnosis and in defining care management of these injuries. Ultrasonography (US) is being increasingly used in assessment of hip injuries because of the wide availability of US machines, the lower cost, and the unique real-time imaging capability, which allows both static and dynamic evaluation as well as guidance of point-of-care interventions such as fluid aspiration and steroid injection. Accurate diagnosis of hip injuries is often challenging, given the complex soft-tissue anatomy of the hip and the wide spectrum of injuries that can occur. To conduct a skillful US evaluation of hip injuries, physicians must have pertinent knowledge of the normal anatomy and should make judicious use of surface anatomy landmarks while using a compartmentalized diagnostic approach. In this article, common sports-related injuries of the anterior, lateral, and posterior hip compartments are discussed. This review includes assessment of joint effusion, acetabular labral tear, acute and chronic tendon injuries including tendinopathy, partial and full-thickness tears, snapping hip syndromes, relevant US-guided procedures, and some other conditions such as Morel-Lavallée lesion and perineal nodular induration. Principles of care management and current knowledge on imaging findings that may affect return to activity are also presented. Using an oriented US examination technique and having knowledge of the normal hip anatomy will help physicians characterize US findings of common sports-related hip injuries and make accurate diagnoses. Online supplemental material is available for this article. ©RSNA, 2018.
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Affiliation(s)
- Eugen Lungu
- From the Department of Radiology (E.L., N.J.B.), Department of Medicine (J.M.), and Research Center (N.J.B.), Centre Hospitalier de l'Université de Montréal, 1000 rue Saint-Denis, Montreal, QC, Canada H2X 0C1
| | - Johan Michaud
- From the Department of Radiology (E.L., N.J.B.), Department of Medicine (J.M.), and Research Center (N.J.B.), Centre Hospitalier de l'Université de Montréal, 1000 rue Saint-Denis, Montreal, QC, Canada H2X 0C1
| | - Nathalie J Bureau
- From the Department of Radiology (E.L., N.J.B.), Department of Medicine (J.M.), and Research Center (N.J.B.), Centre Hospitalier de l'Université de Montréal, 1000 rue Saint-Denis, Montreal, QC, Canada H2X 0C1
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Prado-Costa R, Rebelo J, Monteiro-Barroso J, Preto AS. Ultrasound elastography: compression elastography and shear-wave elastography in the assessment of tendon injury. Insights Imaging 2018; 9:791-814. [PMID: 30120723 PMCID: PMC6206379 DOI: 10.1007/s13244-018-0642-1] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 05/22/2018] [Accepted: 06/21/2018] [Indexed: 12/27/2022] Open
Abstract
Ultrasound elastography (USE) is a recent technology that has experienced major developments in the past two decades. The assessment of the main mechanical properties of tissues can be made with this technology by characterisation of their response to stress. This article reviews the two major techniques used in musculoskeletal elastography, compression elastography (CE) and shear-wave elastography (SWE), and evaluates the studies published on major electronic databases that use both techniques in the context of tendon pathology. CE accounts for more studies than SWE. The mechanical properties of tendons, particularly their stiffness, may be altered in the presence of tendon injury. CE and SWE have already been used for the assessment of Achilles tendons, patellar tendon, quadriceps tendon, epicondylar tendons and rotator cuff tendons and muscles. Achilles tendinopathy is the most studied tendon injury with USE, including the postoperative period after surgical repair of Achilles rupture tendon. In relation to conventional ultrasound (US), USE potentially increases the sensitivity and diagnostic accuracy in tendinopathy, and can detect pathological changes before they are visible in conventional US imaging. Several technical limitations are recognised, and standardisation is necessary to ensure repeatability and comparability of the results when using these techniques. Still, USE is a promising technique under development and may be used not only to promote an early diagnosis, but also to identify the risk of injury and to support the evaluation of rehabilitation interventions. KEY POINTS: • USE is used for the assessment of the mechanical properties of tissues, including the tendons. • USE increases diagnostic performance when coupled to conventional US imaging modalities. • USE will be useful in early diagnosis, tracking outcomes and monitoring treatments of tendon injury. • Technical issues and lack of standardisation limits USE use in the assessment of tendon injury.
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Affiliation(s)
- Rui Prado-Costa
- Department of Physical and Rehabilitation Medicine, Centro Hospitalar São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - João Rebelo
- Department of Radiology, Centro Hospitalar São João, Porto, Portugal.
| | - João Monteiro-Barroso
- Department of Physical and Rehabilitation Medicine, Centro Hospitalar São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Ana Sofia Preto
- Department of Radiology, Centro Hospitalar São João, Porto, Portugal
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Lungu E, Grondin P, Tétreault P, Desmeules F, Cloutier G, Choinière M, Bureau NJ. Ultrasound-guided tendon fenestration versus open-release surgery for the treatment of chronic lateral epicondylosis of the elbow: protocol for a prospective, randomised, single blinded study. BMJ Open 2018; 8:e021373. [PMID: 29886446 PMCID: PMC6009557 DOI: 10.1136/bmjopen-2017-021373] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Chronic lateral epicondylosis (CLE) of the elbow is a prevalent condition among middle-aged people with no consensus on optimal care management but for which surgery is generally accepted as a second intention treatment. Among conservative treatment options, ultrasound (US)-guided fenestration has shown encouraging results that should be explored before surgery is considered. The primary objective of this study is to compare the efficacy of US-guided fenestration with open-release surgery in patients with failure to improve following a minimum 6 months of conservative treatment. METHODS AND ANALYSIS This study protocol entails a two-arm, single-blinded, randomised, controlled design. Sixty-four eligible patients with clinically confirmed CLE will be assigned to either US-guided fenestration or open-release surgery. Fisher's exact test will be used to compare the proportion of patients reporting a change of 11/100 points or more in the Patient Rated Tennis Elbow Evaluation score at 6 months, according to an intention-to-treat analysis. Secondary analyses will compare the two treatment groups in terms of pain and disability, functional limitations at work, pain-free grip strength, medication burden, patients' global impression of change and level of satisfaction at 6 weeks, 3, 6 and 12 months, using mixed linear models for repeated measures or Fisher's exact test, as appropriate. Finally, recursive partitioning analyses will investigate US and elastography parameters as predictors of treatment success at 6 and 12 months. This data will contribute to evidence-based treatment guidelines for CLE and explore the value of imaging biomarkers to improve risk stratification plans and assist clinicians. ETHICS AND DISSEMINATION The study has been approved by the Research Ethics Board of our institution on 23 March 2016 (REB 15.327). In case of important protocol modifications, a new version of the protocol with appropriate amendments will be submitted to the REB for approval. Study results will be published in peer-reviewed journals and presented at local, national and international conferences. TRIAL REGISTRATION NUMBER NCT02710682.
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Affiliation(s)
- Eugen Lungu
- Department of Radiology, Centre Hospitalier de L'Universite de Montreal (CHUM), Montreal, Quebec, Canada
- Department of Radiology, Radio-oncology and Nuclear Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Philippe Grondin
- Department of Surgery, Centre Hospitalier de L'Universite de Montreal (CHUM), Montreal, Quebec, Canada
- Department of Surgery, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Patrice Tétreault
- Department of Surgery, Centre Hospitalier de L'Universite de Montreal (CHUM), Montreal, Quebec, Canada
- Department of Surgery, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - François Desmeules
- Research Center, Hôpital Maisonneuve-Rosemont, University of Montreal, Montreal, Quebec, Canada
- School of Rehabilitation, Faculty of Medicine, Université de Montreal, Montreal, Quebec, Canada
| | - Guy Cloutier
- Department of Radiology, Radio-oncology and Nuclear Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Research Center, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Manon Choinière
- Research Center, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
- Department of Anesthesiology, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Nathalie J Bureau
- Department of Radiology, Centre Hospitalier de L'Universite de Montreal (CHUM), Montreal, Quebec, Canada
- Department of Radiology, Radio-oncology and Nuclear Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Research Center, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
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Lee KS, Martin J, Thelen D. Science to Practice: Quantitative US Elastography Can Be Used to Quantify Mechanical and Histologic Tendon Healing in a Rabbit Model of Achilles Tendon Transection. Radiology 2017; 283:311-313. [PMID: 28418825 DOI: 10.1148/radiol.2017170126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Compression-based ultrasonographic (US) elastography is associated with time-dependent mechanical and histologic changes of the healing tendon in a transected rabbit model of the Achilles tendon. This finding will lead to continued development of quantitative US, which can be used to objectively assess a diseased or healing tendon. With advances in the method used, clinical translation of tendon elastography may enable clinicians to diagnose tendon damage and track healing, which should improve both treatment and outcome.
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Affiliation(s)
- Kenneth S Lee
- Department of Radiology University of Wisconsin School of Medicine & Public Health 600 Highland Ave Madison, WI 53792
| | - Jack Martin
- Department of Radiology University of Wisconsin School of Medicine & Public Health 600 Highland Ave Madison, WI 53792
| | - Darryl Thelen
- Department of Radiology University of Wisconsin School of Medicine & Public Health 600 Highland Ave Madison, WI 53792
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