1
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Lin RT, Osipov B, Steffen D, Chamberlin M, Pathak SJ, Christiansen BA, Paulussen KJM, Baar K. Saturated fatty acids negatively affect musculoskeletal tissues in vitro and in vivo. Matrix Biol Plus 2024; 23:100153. [PMID: 38882396 PMCID: PMC11179588 DOI: 10.1016/j.mbplus.2024.100153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/22/2024] [Accepted: 05/31/2024] [Indexed: 06/18/2024] Open
Abstract
Fish oils rank among the world's most popular nutritional supplements and are purported to have numerous health benefits. Previous work suggested that fish oils increase collagen production; however, the effect of fish oils on musculoskeletal health is poorly understood. Further, the divergent effects of omega-3 (Ω3FA) and saturated fatty acids (SFA) remains poorly understood. We tested the effects of Ω3FA and SFAs on in vitro-engineered human ligament (EHL) function. EHLs were treated with bovine serum albumin (BSA)-conjugated eicosapentaenoic acid (EPA, 20:5(n-3)), palmitic acid (PA, 16:0), or a BSA control for 6 days. EPA did not significantly alter, whereas PA significantly decreased EHL function and collagen content. To determine whether this was an in vitro artifact, mice were fed a control or high-lard diet for 14 weeks and musculoskeletal mass, insulin sensitivity, and the collagen content, and mechanics of tendon and bone were determined. Body weight was 40 % higher on a HFD, but muscle, tendon, and bone mass did not keep up with body weight resulting in relative losses in muscle mass, tendon, and bone collagen, as well as mechanical properties. Importantly, we show that PA acutely decreases collagen synthesis in vitro to a similar extent as the decrease in collagen content with chronic treatment. These data suggest that Ω3FAs have a limited effect on EHLs, whereas SFA exert a negative effect on collagen synthesis resulting in smaller and weaker musculoskeletal tissues both in vitro and in vivo.
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Affiliation(s)
- Ryan T Lin
- Department of Neurobiology, Physiology & Behavior, University of California Davis, 1 Shields Avenue, 195 Briggs Hall, Davis, CA 95616, USA
- University of Pittsburgh School of Medicine, 3550 Terrace St, Pittsburgh, PA, USA
| | - Benjamin Osipov
- Department of Orthopaedic Surgery, University of California Davis Health, Sacramento, CA, USA
| | - Danielle Steffen
- Department of Neurobiology, Physiology & Behavior, University of California Davis, 1 Shields Avenue, 195 Briggs Hall, Davis, CA 95616, USA
| | - Marin Chamberlin
- Department of Neurobiology, Physiology & Behavior, University of California Davis, 1 Shields Avenue, 195 Briggs Hall, Davis, CA 95616, USA
| | - Suraj J Pathak
- Department of Neurobiology, Physiology & Behavior, University of California Davis, 1 Shields Avenue, 195 Briggs Hall, Davis, CA 95616, USA
| | - Blaine A Christiansen
- Department of Orthopaedic Surgery, University of California Davis Health, Sacramento, CA, USA
| | - Kevin J M Paulussen
- Physiology and Membrane Biology, University of California Davis, Davis, CA, USA
| | - Keith Baar
- Department of Neurobiology, Physiology & Behavior, University of California Davis, 1 Shields Avenue, 195 Briggs Hall, Davis, CA 95616, USA
- Physiology and Membrane Biology, University of California Davis, Davis, CA, USA
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2
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Diener GL, Spahn G, Hofmann GO. Occupational Stress as a Possible Risk Factor for Rotator Cuff Damage - Systematic Review and Meta-analysis. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2024; 162:289-295. [PMID: 36473486 DOI: 10.1055/a-1957-6140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE In September 2021, the Federal Ministry of Labour and Social Affairs in Germany (BMAS) recommended recognising rotator cuff lesions caused by occupational long-term overhead work, repetitive movements, hand-arm-vibration and carrying and lifting heavy loads as an occupational disease. To gain a more detailed understanding of the correlation between occupational risk factors and lesions of the rotator cuff, a systematic literature review was carried out to determine their influence on the development of rotator cuff disease. MATERIAL AND METHOD A systematic literature review was used to search in the databases PubMed, Cochrane and Web-of-Science for papers dealing with occupational shoulder load and associated shoulder disorders. The influence of overhead work, repetitive movements, hand-arm-vibrations and carrying and lifting heavy loads were examined. RESULTS 58 studies were read in full text, of which 13 papers were included in the meta-analysis. In all risk factors, a significant association can be found with the strongest dose-response relationship in "overhead work" and "repetitive movements": overhead work: 2.23 (95% CI 1.98-2.52), repetitive movements: 2.17 (95% CI 1.92-2.46), hand-arm-vibration: 1.59 (95% CI 1.13-2.23), carrying and lifting heavy loads: 1.57 (95% CI 1.15-2.15). CONCLUSION Although a significant effect could be shown in our study for all the four risk factors examined, due to the low number of studies with high-quality study design and insufficient pathophysiological explanation for the development of a rotator cuff disease in these mechanical activities, no reliable correlation can currently be established.
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Affiliation(s)
- Greta-Linn Diener
- Praxisklinik für Unfallchirurgie und Orthopädie, Eisenach, Deutschland
| | - Gunter Spahn
- Praxisklinik für Unfallchirurgie und Orthopädie, Eisenach, Deutschland
- Klinik für Unfall,- Hand- und Wiederherstellungschirurgie, Universitatsklinikum Jena, Jena, Deutschland
| | - Gunther O Hofmann
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Friedrich-Schiller-Universität Jena, Jena, Deutschland
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Kliniken Bergmannstrost, Halle, Deutschland
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3
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Escriche-Escuder A, Nijs J, Silbernagel KG, van Wilgen CP, Plinsinga ML, Casaña J, Cuesta-Vargas AI. Pain neuroscience education in persistent painful tendinopathies: A scoping review from the Tendon PNE Network. Phys Ther Sport 2023; 63:38-49. [PMID: 37499463 DOI: 10.1016/j.ptsp.2023.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE to conduct and report a scoping review of the available evidence of the effects and content of pain neuroscience education for patients with persistent painful tendinopathies. METHODS PubMed, Embase, Web of Science, CINAHL, SPORTDiscus, and grey literature databases were searched from database inception to May 2022. Randomised and non-randomised controlled trials, non-controlled clinical trials, cohort studies, case series, case studies including people with persistent painful tendinopathy aged ≥18 years, a pain education intervention, and in English were included. Studies were excluded if they were cross-sectional studies, reviews, editorials, abstracts, or full-text not available or if included heterogeneous study cohorts, patients with tendon rupture, or patients with systemic diseases. RESULTS five studies (n = 164) were included. Pain neuroscience education entailed face-to-face discussion sessions or educational materials including videos, brochures, paper drawings, and review questions. All studies used pain neuroscience education in conjunction with other interventions, obtaining significant benefits in outcomes related to pain, physical performance, or self-reported function, among others. CONCLUSIONS The application of pain neuroscience education in conjunction with other interventions seemed to improve several outcomes. However, considering the current knowledge about tendon pain and the scarcity of well-designed trials studying pain neuroscience education in tendinopathy, additional research is needed.
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Affiliation(s)
- Adrian Escriche-Escuder
- Department of Physiotherapy, University of Malaga, Malaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain
| | - Jo Nijs
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium; Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Belgium; Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | | | - C Paul van Wilgen
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium; Transcare Transdisciplinary Pain Management Center, Groningen, the Netherlands
| | - Melanie L Plinsinga
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - José Casaña
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Antonio I Cuesta-Vargas
- Department of Physiotherapy, University of Malaga, Malaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain; School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.
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4
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De Starkey KR, Groth AM, Thyssen RR, Kernozek TW. Added mass increases Achilles tendon stress in female runners. Foot (Edinb) 2023; 56:102028. [PMID: 37011454 DOI: 10.1016/j.foot.2023.102028] [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] [Received: 01/03/2022] [Revised: 03/06/2023] [Accepted: 03/24/2023] [Indexed: 04/05/2023]
Abstract
CONTEXT Achilles tendon (AT) injuries are common in female runners and military personnel where increased AT loading may be a contributing factor. Few studies have examined AT stress during running with added mass. The purpose was to examine the stress, strain, and force placed on the AT, kinematics and temporospatial variable in running with different amounts of added mass. DESIGN Repeated measure design METHODS: Twenty-three female runners with a rear-foot strike pattern were participants. AT stress, strain, and force were measured during running using a musculoskeletal model that used kinematic (180 Hz) and kinetic data (1800 Hz) as input. Ultrasound data were used to measure AT cross sectional area. A repeated measures multivariate analysis of variance (α = 0.05) was used on AT loading variables, kinematics and temporospatial variables. RESULTS Peak AT stress, strain, and force were greatest during the 9.0 kg added load running condition (p < .0001). There was a 4.3% and 8.8% increase in AT stress and strain during the 4.5 kg and 9.0 kg added load conditions, respectively, compared to baseline. Kinematics at the hip and knee changed with added load but not at the ankle. Small changes in temporospatial variables were seen. CONCLUSION Added load increased stress on the AT during running. There may be an increased risk for AT injury with added load. Individuals may consider slowly progressing training with added load to allow for increased AT loading.
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Affiliation(s)
- Katelyn R De Starkey
- La Crosse Institute for Movement Science, Physical Therapy Program, Department of Health Professions, University of Wisconsin-La Crosse, La Crosse, USA
| | - Ashley M Groth
- La Crosse Institute for Movement Science, Physical Therapy Program, Department of Health Professions, University of Wisconsin-La Crosse, La Crosse, USA
| | - Ryan R Thyssen
- La Crosse Institute for Movement Science, Physical Therapy Program, Department of Health Professions, University of Wisconsin-La Crosse, La Crosse, USA
| | - Thomas W Kernozek
- La Crosse Institute for Movement Science, Physical Therapy Program, Department of Health Professions, University of Wisconsin-La Crosse, La Crosse, USA.
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5
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Azil AA, Yusof ZYM, Marhazlinda J. Clustering of Health and Oral Health-Compromising Behaviours in Army Personnel in Central Peninsular Malaysia. Healthcare (Basel) 2023; 11:healthcare11050640. [PMID: 36900645 PMCID: PMC10000684 DOI: 10.3390/healthcare11050640] [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: 01/03/2023] [Revised: 02/12/2023] [Accepted: 02/17/2023] [Indexed: 02/24/2023] Open
Abstract
Health- and oral health-compromising behaviours (HOHCBs) impact the health readiness of military personnel, resulting in decreased fitness performance, thus affecting combat readiness. This study aimed to identify the clustering patterns and number of HOHCBs in army personnel in Central Peninsular Malaysia. Thus, a cross-sectional study using a multistage sampling technique and a validated 42-item online questionnaire was conducted to assess ten health (medical screening, physical activity, sedentary lifestyle, smoking status, alcohol consumption, substance abuse, aggressive behaviours, sleep, and road safety habits) and five oral health behaviour domains (tooth brushing, fluoridated toothpaste use, flossing, dental visits, and bruxism). Each HOHCB was dichotomised into healthy and health-compromising behaviour and analysed using hierarchical agglomerative cluster analysis (HACA). With the majority being males (92.5%), of other ranks (96.8%), and healthy (83.9%), 2435 army members of a mean age of 30.3 years (SD = 5.9) participated, with a response rate of 100%. HACA identified two clustering patterns: (i) 'high-risk behaviours' (30 HOHCBs) and (ii) 'most common risk behaviours' (12 HOHCBs) with a mean clustering number of 14.1 (SD = 4.1). In conclusion, army personnel in Central Peninsular Malaysia displayed 2 broad HOHCB clustering patterns, 'high-risk' and 'most common risk', with an average of 14 HOHCB clusters per person.
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Affiliation(s)
- Ahmad Asyraf Azil
- Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur 50603, Malaysia
- Dental Services Section, Health Services Division Malaysian Armed Forces, Kuala Lumpur 50634, Malaysia
| | - Zamros Yuzadi Mohd Yusof
- Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur 50603, Malaysia
| | - Jamaludin Marhazlinda
- Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur 50603, Malaysia
- Correspondence: ; Tel.: +60-3-79674866
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6
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Maffulli N, Nilsson Helander K, Migliorini F. Tendon appearance at imaging may be altered, but it may not indicate pathology. Knee Surg Sports Traumatol Arthrosc 2023; 31:1625-1628. [PMID: 36800008 DOI: 10.1007/s00167-023-07339-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 01/30/2023] [Indexed: 02/18/2023]
Abstract
Both in tendon repair following a tear and in tendinopathy, recovery from pain and restoration of (acceptable) function does not go hand in hand with the appearance of the affected tendon at imaging. The tendon may remain altered for a long while and possibly forever, indicating a possible dissociation between morphology and symptoms. The predictive value of asymptomatic abnormal findings remains limited, and interventions in such instances are inappropriate and not supported by current evidence. Once an initial imaging investigation has depicted the condition of the tendon, additional imaging investigations are unlikely to provide further information or change prognosis in patients in whom abnormalities compatible with a diagnosis of tendinopathy have been identified by either ultrasonography or MRI. Patient education and close clinical monitoring are recommended. This is applicable to the patellar tendon, Achilles tendon, rotator cuff, for both tendon repair and tendinopathy. Given the modest risk of sonographic abnormalities to develop in symptomatic tendinopathy, planning and trying to implement any form of intervention may not be warranted. The current evidence mostly arises from low-quality studies, with heterogeneous risk factors and populations, and caution must be maintained when interpreting the significance of such incidental findings in athletes.
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Affiliation(s)
- Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy.
- School of Pharmacy and Bioengineering, Faculty of Medicine, Keele University, Stoke-on-Trent, ST4 7QB, England.
- Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, 275 Bancroft Road, London, E1 4DG, England.
| | - Katarina Nilsson Helander
- Department of Orthopaedics, Sahlgrenska University Hospital, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, 52074, Aachen, Germany
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, 52152, Simmerath, Germany
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7
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Vaidya R, Lake SP, Zellers JA. Effect of Diabetes on Tendon Structure and Function: Not Limited to Collagen Crosslinking. J Diabetes Sci Technol 2023; 17:89-98. [PMID: 35652696 PMCID: PMC9846394 DOI: 10.1177/19322968221100842] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Diabetes mellitus (DM) is associated with musculoskeletal complications-including tendon dysfunction and injury. Patients with DM show altered foot and ankle mechanics that have been attributed to tendon dysfunction as well as impaired recovery post-tendon injury. Despite the problem of DM-related tendon complications, treatment guidelines specific to this population of individuals are lacking. DM impairs tendon structure, function, and healing capacity in tendons throughout the body, but the Achilles tendon is of particular concern and most studied in the diabetic foot. At macroscopic levels, asymptomatic, diabetic Achilles tendons may show morphological abnormalities such as thickening, collagen disorganization, and/or calcific changes at the tendon enthesis. At smaller length scales, DM affects collagen sliding and discrete plasticity due to glycation of collagen. However, how these alterations translate to mechanical deficits observed at larger length scales is an area of continued investigation. In addition to dysfunction of the extracellular matrix, tendon cells such as tenocytes and tendon stem/progenitor cells show significant abnormalities in proliferation, apoptosis, and remodeling capacity in the presence of hyperglycemia and advanced glycation end-products, thus contributing to the disruption of tendon homeostasis and healing. Improving our understanding of the effects of DM on tendons-from molecular pathways to patients-will progress toward targeted therapies in this group at high risk of foot and ankle morbidity.
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Affiliation(s)
- Rachana Vaidya
- Washington University School of
Medicine, St. Louis, MO, USA
| | | | - Jennifer A. Zellers
- Washington University School of
Medicine, St. Louis, MO, USA
- Jennifer A. Zellers, PT, DPT, PhD,
Washington University School of Medicine, 4444 Forest Park Ave., Suite
1101, St. Louis, MO 63108, USA.
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8
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Giordano J, Partan M, Iturriaga C, Granata J, Katsigiorgis G, Cohn R, Bitterman A. The Relationship Between Patient Demographics, Tear Locations, and Operative Techniques on the Surgical Treatment of Acute Achilles Tendon Ruptures. Cureus 2022; 14:e28300. [PMID: 36168374 PMCID: PMC9506559 DOI: 10.7759/cureus.28300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Achilles tendon ruptures (ATRs) have classically been thought to affect the middle-aged “weekend warrior” participating in basketball, volleyball, soccer, or any ground sport; however, with a more active elderly population, these tears are becoming more common in older patients. We sought to examine the role of demographics, tear location, and operative technique for acute Achilles tendon ruptures treated surgically. Methods A retrospective query was performed to identify patients who presented with Achilles tendon ruptures. Inclusion data were primary end-to-end repairs, augmented repairs with flexor hallucis longus (FHL) transfers, augmented repairs with graft, augmented repairs with both FHL transfer and graft use, isolated FHL transfers, and revision Achilles tendon procedures. Demographics and tear locations were collected and analyzed. Results Midsubstance tears were the most common tear location occurring in 237 of 286 (82.9%) patients. Distal insertional tears of the Achilles tendon were treated in 35 (12.2%) patients, while 14 (4.9%) patients had a more proximal tear located at the myotendinous junction. Older patients (average age: 53.3±12.5) had significantly more distal insertional tears (p<0.001), while younger patients (average age: 35.1±7.4) presented with significantly more tears at the myotendinous junction (p<0.001). The average BMI was significantly higher (average BMI: 32.2±6.6; p<0.001) in patients with distal insertional tears compared to midsubstance and proximal tears (28.5±4.6 and 28.5±5.3, respectively). There was a higher percentage of diabetic patients who underwent operative treatment for distal insertional tears (20%) compared to midsubstance tears (7.2%). Conclusion The findings of our study suggest that a subset of patients, particularly those with advanced age and higher BMI, is more likely to present with a distal Achilles tendon rupture. Additionally, patients in our series who had distal tears more commonly required an augmented repair technique. Our results highlight the need for future research to further define the relationship between increasing age and higher BMI patients sustaining distal tears more often than midsubstance tears.
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9
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Oliva F, Marsilio E, Asparago G, Giai Via A, Biz C, Padulo J, Spoliti M, Foti C, Oliva G, Mannarini S, Rossi AA, Ruggieri P, Maffulli N. Achilles Tendon Rupture and Dysmetabolic Diseases: A Multicentric, Epidemiologic Study. J Clin Med 2022; 11:jcm11133698. [PMID: 35806982 PMCID: PMC9267833 DOI: 10.3390/jcm11133698] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/17/2022] [Accepted: 06/24/2022] [Indexed: 02/04/2023] Open
Abstract
Introduction: Achilles tendon ruptures are common. Metabolic disorders, such as diabetes mellitus, hypercholesterolemia, thyroid disorders, and obesity, impair tendons health, leading to Achilles tendinopathy and likely predisposing patients to Achilles tendon ruptures. Materials and methods: Patients who visited the Orthopedic Outpatient Clinics and the Accident and Emergency Departments of five different hospitals in Italy were recruited. Through telephone interviews, we administered a questionnaire to all the patients who had undergone surgical ATR repair, evaluating their past medical history, sport- and work-related activities, drug use, and post-operative rehabilitation outcomes. Results: “Return to work activities/sport” was negatively predicted by the presence of a metabolic disorder (β = −0.451; OR = 0.637) and ‘open’ surgery technique (β = −0.389; OR = 0.678). “Medical complications” were significantly predicted by metabolic disorders (β = 0.600 (0.198); OR = 1.822) and was negatively related to ‘mini-invasive’ surgery (i.e., not ‘open’ nor ‘percutaneous’) (β = −0.621; OR = 0.537). “Immediate weightbearing” and “immediate walking without assistance” were negatively predicted by ‘open’ technique (β = −0.691; OR = 0.501 and β = −0.359 (0.174; OR = 0.698)). Conclusions: Metabolic conditions can strongly affect post-operative outcomes following surgical repair of acute Achilles tendon tears.
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Affiliation(s)
- Francesco Oliva
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Italy; (F.O.); (G.A.); (N.M.)
| | - Emanuela Marsilio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Italy; (F.O.); (G.A.); (N.M.)
- Correspondence: ; Tel.: +39-3465115396
| | - Giovanni Asparago
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Italy; (F.O.); (G.A.); (N.M.)
| | - Alessio Giai Via
- Department of Orthopaedic Surgery and Traumatology, San Camillo-Forlanini Hospital, 00152 Rome, Italy;
| | - Carlo Biz
- Orthopaedics and Orthopaedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, 35128 Padova, Italy; (C.B.); (P.R.)
| | - Johnny Padulo
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20133 Milan, Italy;
| | - Marco Spoliti
- Orthopaedics and Traumatology Unit, Department of Emergency and Acceptance, Azienda Ospedaliera San Camillo-Forlanini, 00152 Rome, Italy;
| | - Calogero Foti
- Physical and Rehabilitation Medicine, Clinical Sciences and Translational Medicine Department, Tor Vergata University, 00133 Rome, Italy;
| | - Gabriella Oliva
- Department of Internal Medicine, Ospedale del Mare, ASL1, 80147 Napoli, Italy;
| | - Stefania Mannarini
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, 35128 Padova, Italy; (S.M.); (A.A.R.)
- Interdepartmental Center for Family Research, University of Padova, 35128 Padova, Italy
| | - Alessandro Alberto Rossi
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, 35128 Padova, Italy; (S.M.); (A.A.R.)
- Interdepartmental Center for Family Research, University of Padova, 35128 Padova, Italy
| | - Pietro Ruggieri
- Orthopaedics and Orthopaedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, 35128 Padova, Italy; (C.B.); (P.R.)
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Italy; (F.O.); (G.A.); (N.M.)
- School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Thornburrow Drive, Stoke on Trent ST4 7QB, UK
- Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, 275 Bancroft Road, London E1 4DG, UK
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10
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Pansiere ST, Oliveira ACD, Pochini ADC, Ejnisman B, Belangero PS, Andreoli CV. Lesão do manguito rotador e obesidade: Uma avaliação demográfica e metabólica. Rev Bras Ortop 2022; 57:282-288. [PMID: 35652021 PMCID: PMC9142253 DOI: 10.1055/s-0041-1729937] [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: 05/09/2020] [Accepted: 12/01/2020] [Indexed: 11/26/2022] Open
Abstract
Objective
To analyze the relationship between the presence and severity of rotator cuff (RC) injury with obesity and the time of exposure to obesity. Secondarily, to evaluate the relationship and prevalence of demographic and metabolic factors in obese individuals with RC injury.
Methods
This is a cross-sectional study with 235 obese patients (body mass index [BMI] ≥ 30 kg/m
2
). Demographic data (age and gender), metabolic data (hypertension, diabetes mellitus, lipid profile, and time of exposure to obesity), physical examination (weight, height, waist circumference, and clinical tests), and musculoskeletal ultrasound examination were used to analyze the results.
Results
There was no evidence of an association between RC injury and BMI (
p
= 0.82), time of exposure to obesity (
p
= 0.29), or abdominal circumference (
p
= 0.52). In the subgroup with injury, age (
p
< 0.001), presence of diabetes mellitus (
p
= 0.013), hypertension (
p
< 0.001), level of high-density lipoprotein (HDL) (
p
= 0.026), and time of exposure to obesity (
p
< 0.001) were significantly greater compared to the subgroup without injury. In the search for other parameters independently associated with RC injury, associations were observed with age (
p
= 0.0003) and hypertension (
p
= 0.004).
Conclusion
We did not evidence an association between obesity and the time of exposure to it with the occurrence and severity of RC injury. However, individuals with injury had a longer time of exposure to obesity and prevalence of metabolic disorders than individuals without RC injury. In addition, our findings suggest an association between systemic arterial hypertension (SAH) and advanced age with RC injury.
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Affiliation(s)
- Saulo Teixeira Pansiere
- Instituto de Pesquisa e Ensino do Hospital Ortopédico e Medicina Especializada (IPE-HOME), Brasília, DF, Brasil
- Centro de Traumato-ortopedia do Esporte (Cete), Universidade Federal de São Paulo (Unifesp), São Paulo, Brasil
| | - Arlane Carvalho de Oliveira
- Instituto de Pesquisa e Ensino do Hospital Ortopédico e Medicina Especializada (IPE-HOME), Brasília, DF, Brasil
| | - Alberto de Castro Pochini
- Centro de Traumato-ortopedia do Esporte (Cete), Universidade Federal de São Paulo (Unifesp), São Paulo, Brasil
| | - Benno Ejnisman
- Centro de Traumato-ortopedia do Esporte (Cete), Universidade Federal de São Paulo (Unifesp), São Paulo, Brasil
| | - Paulo Santoro Belangero
- Centro de Traumato-ortopedia do Esporte (Cete), Universidade Federal de São Paulo (Unifesp), São Paulo, Brasil
| | - Carlos Vicente Andreoli
- Centro de Traumato-ortopedia do Esporte (Cete), Universidade Federal de São Paulo (Unifesp), São Paulo, Brasil
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11
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Lehner C, Spitzer G, Langthaler P, Jakubecova D, Klein B, Weissenbacher N, Wagner A, Gehwolf R, Trinka E, Iglseder B, Paulweber B, Aigner L, Couillard-Després S, Weiss R, Tempfer H, Traweger A. Allergy-induced systemic inflammation impairs tendon quality. EBioMedicine 2022; 75:103778. [PMID: 35007819 PMCID: PMC8749446 DOI: 10.1016/j.ebiom.2021.103778] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 02/04/2023] Open
Abstract
Background Treatment of degenerating tendons still presents a major challenge, since the aetiology of tendinopathies remains poorly understood. Besides mechanical overuse, further known predisposing factors include rheumatoid arthritis, diabetes, obesity or smoking all of which combine with a systemic inflammation. Methods To determine whether the systemic inflammation accompanying these conditions contributes to the onset of tendinopathy, we studied the effect of a systemic inflammation induced by an allergic episode on tendon properties. To this end, we induced an allergic response in mice by exposing them to a timothy grass pollen allergen and subsequently analysed both their flexor and Achilles tendons. Additionally, we analysed data from a health survey comprising data from more than 10.000 persons for an association between the occurrence of an allergy and tendinopathy. Findings Biomechanical testing and histological analysis revealed that tendons from allergic mice not only showed a significant reduction of both elastic modulus and tensile stress, but also alterations of the tendon matrix. Moreover, treatment of 3D tendon-like constructs with sera from allergic mice resulted in a matrix-remodelling expression profile and the expression of macrophage-associated markers and matrix metalloproteinase 2 (MMP2) was increased in allergic Achilles tendons. Data from the human health study revealed that persons suffering from an allergy have an increased propensity to develop a tendinopathy. Interpretation Our study demonstrates that the presence of a systemic inflammation accompanying an allergic condition negatively impacts on tendon structure and function. Funding This study was financially supported by the Fund for the Advancement of Scientific Research at Paracelsus Medical University (PMU-FFF E-15/22/115-LEK), by the Land Salzburg, the Salzburger Landeskliniken (SALK, the Health Care Provider of the University Hospitals Landeskrankenhaus and Christian Doppler Klinik), the Paracelsus Medical University, Salzburg and by unrestricted grants from Bayer, AstraZeneca, Sanofi-Aventis, Boehringer-Ingelheim.
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Affiliation(s)
- Christine Lehner
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, Paracelsus Medical University, Strubergasse 22, Salzburg 5020, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria.
| | - Gabriel Spitzer
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, Paracelsus Medical University, Strubergasse 22, Salzburg 5020, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Patrick Langthaler
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Centre for Cognitive Neuroscience, Affiliated member of the European Reference Network EpiCARE, Austria; Department of Mathematics, Paris Lodron University of Salzburg, Salzburg, Austria; Team Biostatistics and Big Medical Data, IDA Lab Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Dominika Jakubecova
- Institute of Experimental Neuroregeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Barbara Klein
- Institute of Molecular Regenerative Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Nadja Weissenbacher
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, Paracelsus Medical University, Strubergasse 22, Salzburg 5020, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Andrea Wagner
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, Paracelsus Medical University, Strubergasse 22, Salzburg 5020, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Renate Gehwolf
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, Paracelsus Medical University, Strubergasse 22, Salzburg 5020, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Eugen Trinka
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University and Centre for Cognitive Neuroscience, Affiliated member of the European Reference Network EpiCARE, Austria; Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria; Neuroscience Institute, Christian Doppler University Hospital, Paracelsus Medical University and Centre for Cognitive Neuroscience Salzburg, Austria
| | - Bernhard Iglseder
- Department of Geriatric Medicine, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Bernhard Paulweber
- Department of Internal Medicine, St. Johanns University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Ludwig Aigner
- Austrian Cluster for Tissue Regeneration, Vienna, Austria; Institute of Molecular Regenerative Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Sebastien Couillard-Després
- Austrian Cluster for Tissue Regeneration, Vienna, Austria; Institute of Experimental Neuroregeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Richard Weiss
- Department of Biosciences, Paris Lodron University of Salzburg, Salzburg, Austria
| | - Herbert Tempfer
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, Paracelsus Medical University, Strubergasse 22, Salzburg 5020, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Andreas Traweger
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center Salzburg, Paracelsus Medical University, Strubergasse 22, Salzburg 5020, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
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12
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Frizziero A, Vittadini F, Bigliardi D, Costantino C. Low Molecular Weight Hyaluronic Acid (500-730 Kda) Injections in Tendinopathies-A Narrative Review. J Funct Morphol Kinesiol 2021; 7:3. [PMID: 35076509 PMCID: PMC8788555 DOI: 10.3390/jfmk7010003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 12/23/2021] [Accepted: 12/27/2021] [Indexed: 11/25/2022] Open
Abstract
Tendinopathies are common causes of pain and disability in general population and athletes. Conservative treatment is largely preferred, and eccentric exercise or other modalities of therapeutic exercises are recommended. However, this approach requests several weeks of consecutive treatment and could be discouraging. In the last years, injections of different formulations were evaluated to accelerate functional recovery in combination with usual therapy. Hyaluronic acid (HA) preparations were proposed, in particular LMW-HA (500-730 kDa) for its unique molecular characteristics in favored extracellular matrix homeostasis and tenocyte viability. The purpose of our review is to evaluate the state-of-the-art about the role of 500-730 kDa in tendinopathies considering both preclinical and clinical findings and encourage further research on this emerging topic.
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Affiliation(s)
- Antonio Frizziero
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (D.B.); (C.C.)
| | - Filippo Vittadini
- Department of Physical and Rehabilitation Medicine, Casa di Cura Policlinico S. Marco, 30100 Venice, Italy;
| | - Davide Bigliardi
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (D.B.); (C.C.)
| | - Cosimo Costantino
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (D.B.); (C.C.)
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13
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Human Achilles tendon mechanical behavior is more strongly related to collagen disorganization than advanced glycation end-products content. Sci Rep 2021; 11:24147. [PMID: 34921194 PMCID: PMC8683434 DOI: 10.1038/s41598-021-03574-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 12/03/2021] [Indexed: 12/25/2022] Open
Abstract
Diabetes is associated with impaired tendon homeostasis and subsequent tendon dysfunction, but the mechanisms underlying these associations is unclear. Advanced glycation end-products (AGEs) accumulate with diabetes and have been suggested to alter tendon function. In vivo imaging in humans has suggested collagen disorganization is more frequent in individuals with diabetes, which could also impair tendon mechanical function. The purpose of this study was to examine relationships between tendon tensile mechanics in human Achilles tendon with accumulation of advanced glycation end-products and collagen disorganization. Achilles tendon specimens (n = 16) were collected from individuals undergoing lower extremity amputation or from autopsy. Tendons were tensile tested with simultaneous quantitative polarized light imaging to assess collagen organization, after which AGEs content was assessed using a fluorescence assay. Moderate to strong relationships were observed between measures of collagen organization and tendon tensile mechanics (range of correlation coefficients: 0.570-0.727), whereas no statistically significant relationships were observed between AGEs content and mechanical parameters (range of correlation coefficients: 0.020-0.210). Results suggest that the relationship between AGEs content and tendon tensile mechanics may be masked by multifactorial collagen disorganization at larger length scales (i.e., the fascicle level).
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14
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Bolam SM, Park YE, Konar S, Callon KE, Workman J, Monk AP, Coleman B, Cornish J, Vickers MH, Munro JT, Musson DS. Obesity Impairs Enthesis Healing After Rotator Cuff Repair in a Rat Model. Am J Sports Med 2021; 49:3959-3969. [PMID: 34694156 DOI: 10.1177/03635465211049219] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Being overweight or obese is associated with poor outcomes and an increased risk of failure after rotator cuff (RC) surgery. However, the effect of obesity on enthesis healing has not been well characterized. HYPOTHESES Diet-induced obesity (DIO) would result in inferior enthesis healing in a rat model of RC repair, and a dietary intervention in the perioperative period would improve enthesis healing. STUDY DESIGN Controlled laboratory study. METHODS Male Sprague-Dawley rats were divided into 3 weight-matched groups (n = 26 per group): control diet (CD), high-fat diet (HFD), or HFD until surgery and then CD thereafter (HF-CD). After 12 weeks, the left supraspinatus tendon was detached, followed by immediate repair. Animals were sacrificed, and RCs were harvested at 2 and 12 weeks after surgery for biomechanical and histological evaluations. Metabolic end points were assessed using dual-energy X-ray absorptiometry and plasma analyses. RESULTS DIO was established in the HFD and HF-CD groups before surgery and subsequently reversed in the HF-CD group after surgery. At 12 weeks after surgery, the body fat percentage (P = .0021) and plasma leptin concentration (P = .0025) were higher in the HFD group compared with the CD group. Histologically, the appearance of the repaired entheses was poorer in both the HFD and HF-CD groups compared with the CD group at 12 weeks after surgery, with semiquantitative scores of 6.20 (P = .0078), 4.98 (P = .0003), and 8.68 of 15, respectively. The repaired entheses in the HF-CD group had a significantly lower load to failure (P = .0278) at 12 weeks after surgery compared with the CD group, while the load to failure in the HFD group was low but not significantly different (P = .0960). There were no differences in the biomechanical and histological results between the groups at 2 weeks after surgery. Body mass at the time of surgery, plasma leptin concentration, and body fat percentage were negatively correlated with histology scores and plasma leptin concentration was correlated with load to failure at 12 weeks after surgery. CONCLUSION DIO impaired enthesis healing in this rat RC repair model, with inferior biomechanical and histological outcomes. Restoring a normal weight with dietary changes after surgery did not improve healing outcomes. CLINICAL RELEVANCE Obesity is a potentially modifiable factor that impairs RC healing and increases the risk of failure after surgery. Exploring interventions that improve the metabolic state of obese patients and counseling patients appropriately about their modest expectations after repair should be considered.
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Affiliation(s)
- Scott M Bolam
- Bone and Joint Research Laboratory, Department of Medicine, University of Auckland, Auckland, New Zealand.,Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Young-Eun Park
- Bone and Joint Research Laboratory, Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Subhajit Konar
- Bone and Joint Research Laboratory, Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Karen E Callon
- Bone and Joint Research Laboratory, Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Josh Workman
- Department of Chemical and Materials Engineering, University of Auckland, Auckland, New Zealand
| | - A Paul Monk
- Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand.,Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Brendan Coleman
- Department of Orthopaedic Surgery, Middlemore Hospital, Auckland, New Zealand
| | - Jillian Cornish
- Bone and Joint Research Laboratory, Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Mark H Vickers
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Jacob T Munro
- Bone and Joint Research Laboratory, Department of Medicine, University of Auckland, Auckland, New Zealand.,Department of Orthopaedic Surgery, Auckland City Hospital, Auckland, New Zealand
| | - David S Musson
- Bone and Joint Research Laboratory, Department of Medicine, University of Auckland, Auckland, New Zealand.,Department of Nutrition and Dietetics, University of Auckland, Auckland, New Zealand
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15
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Rhim HC, Kwon J, Park J, Borg-Stein J, Tenforde AS. A Systematic Review of Systematic Reviews on the Epidemiology, Evaluation, and Treatment of Plantar Fasciitis. Life (Basel) 2021; 11:life11121287. [PMID: 34947818 PMCID: PMC8705263 DOI: 10.3390/life11121287] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/17/2021] [Accepted: 11/19/2021] [Indexed: 12/20/2022] Open
Abstract
The number of systematic review and meta-analyses on plantar fasciitis is expanding. The purpose of this review was to provide a comprehensive summary of reviews on the topic pertaining to plantar fasciitis, identify any conflicting and inconsistent results, and propose future research direction. A qualitative review of all systematic reviews and meta-analyses related to plantar fasciitis up to February 2021 was performed using PubMed, Embase, Web of Science, and the Cochrane Database. A total of 1052 articles were initially identified and 96 met the inclusion criteria. Included articles were summarized and divided into the following topics: epidemiology, diagnosis, and treatment. While the majority of reviews had high level of heterogeneity and included a small number of studies, there was general consensus on certain topics, such as BMI as a risk factor for plantar fasciitis and extracorporeal shockwave therapy as an effective mode of therapy. A qualitative summary of systematic reviews and meta-analyses published on plantar fasciitis provides a single source of updated information for clinicians. Evidence on topics such as the epidemiology, exercise therapy, or cost-effectiveness of treatment options for plantar fasciitis are lacking and warrant future research.
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Affiliation(s)
- Hye Chang Rhim
- MetroWest Medical Center, Tufts University School of Medicine, Framingham, MA 01702, USA;
| | - Jangwon Kwon
- Department of Physical Therapy, University of Delware, Newark, DE 19716, USA;
| | - Jewel Park
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, USA;
| | - Joanne Borg-Stein
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02115, USA;
- Spaulding Rehabilitation Hospital, Charlestown, MA 02129, USA
| | - Adam S. Tenforde
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02115, USA;
- Spaulding Rehabilitation Hospital, Charlestown, MA 02129, USA
- Correspondence:
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16
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Crites S, Joumaa V, Rios JL, Sawatsky A, Hart DA, Reimer RA, Herzog W. Moderate aerobic exercise, but not dietary prebiotic fibre, attenuates losses to mechanical property integrity of tail tendons in a rat model of diet-induced obesity. J Biomech 2021; 129:110798. [PMID: 34700144 DOI: 10.1016/j.jbiomech.2021.110798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/26/2021] [Accepted: 10/03/2021] [Indexed: 10/20/2022]
Abstract
The purpose of this study was to investigate the alterations with obesity, and the effects of moderate aerobic exercise or prebiotic dietary-fibre supplementation on the mechanical and biochemical properties of the tail tendon in a rat model of high-fat/high-sucrose (HFS) diet-induced obesity. Thirty-two male Sprague-Dawley rats were randomized to chow (n = 8) or HFS (n = 24) diets. After 12-weeks, the HFS fed rats were further randomized into sedentary (HFS sedentary, n = 8), exercise (HFS + E, n = 8) or prebiotic fibre supplementation (HFS + F, n = 8) groups. After another 12-weeks, rats were sacrificed, and one tail tendon was isolated and tested. Stress-relaxation and stretch-to-failure tests were performed to determine mechanical properties (peak, steady-state, yield and failure stresses, Young's modulus, and yield and failure strains) of the tendons. The hydroxyproline content was also analyzed. The HFS sedentary and HFS + F groups had higher final body masses and fat percentages compared to the chow and HFS + E groups. Yield strain was reduced in the HFS sedentary rats compared to the chow rats. Peak and steady-state stresses, failure strain, Young's modulus, and hydroxyproline content were not different across groups. Although the HFS + E group showed higher failure stress, yield stress, and yield strain compared to the HFS sedentary group, HFS + F animals did not produce differences in the properties of the tail tendon compared to the HFS sedentary group. These results indicate that exposure to a HFS diet led to a reduction in the yield strain of the tail tendon and aerobic exercise, but not fibre supplementation, attenuated these diet-related alterations to tendon integrity.
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Affiliation(s)
- Stephanie Crites
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Venus Joumaa
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada.
| | - Jaqueline L Rios
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada; Regenerative Medicine Center Utrecht, University Medical Center Utrecht, Utrecht, Netherland
| | - Andrew Sawatsky
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
| | - David A Hart
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
| | - Raylene A Reimer
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada; Department of Biochemistry and Molecular Biology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Walter Herzog
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
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17
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Ahn HS, Kim HJ, Kang TU, Kazmi SZ, Suh JS, Young Choi J. Dyslipidemia Is Associated With Increased Risk of Achilles Tendon Disorders in Underweight Individuals to a Greater Extent Than Obese Individuals: A Nationwide, Population-Based, Longitudinal Cohort Study. Orthop J Sports Med 2021; 9:23259671211042599. [PMID: 34676271 PMCID: PMC8524716 DOI: 10.1177/23259671211042599] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 06/29/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The association between dyslipidemia and Achilles tendinopathy (AT) or Achilles tendon rupture (ATR) remains controversial, although some studies have examined this topic. PURPOSE To evaluate the correlation of dyslipidemia and the risk of AT or ATR, and its association with body mass index (BMI), by assessing data from a nationwide population-based cohort. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS We used the National Health Insurance database, which includes the entire population of the Republic of Korea, to evaluate participants in the National Health Screening Program between January 2009 and December 2010. Participants diagnosed with AT or ATR before December 31, 2017, were selected. The variables assessed were age, sex, frequency of high-intensity exercise per week, BMI, waist circumference, systolic blood pressure, and levels of low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and fasting blood glucose. Multivariate Cox proportional hazards regression was used for data analysis. RESULTS A total of 16,830,532 participants were included. Of these, 125,814 and 31,424 participants developed AT and ATR, respectively. A higher level of LDL-C was associated with an increased risk of AT (adjusted hazard ratio [HR], 1.16) and ATR (adjusted HR, 1.18). A slightly increased risk of AT was observed in participants with higher TG levels (adjusted HR, 1.03), whereas higher HDL-C level was associated with a slight risk reduction for AT (adjusted HR, 0.95). However, no significant association was observed between higher TG or HDL-C levels and ATR. In the underweight group (BMI <18.5 kg/m2), a higher LDL-C level was associated with an increased risk of AT and ATR by 37% and 116%, respectively, compared with lower LDL-C. Higher LDL-C level was associated with an increased risk of AT and ATR by 10% and 16%, respectively, in the obese group (BMI ≥25 kg/m2). CONCLUSION Dyslipidemia was related to the development of AT and ATR. The association of higher LDL-C levels with AT and ATR risk was more pronounced in underweight than in overweight and obese individuals.
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Affiliation(s)
- Hyeong Sik Ahn
- Department of Preventive Medicine, College of Medicine, Korea
University, Seoul, Republic of Korea
| | - Hyun Jung Kim
- Department of Preventive Medicine, College of Medicine, Korea
University, Seoul, Republic of Korea
| | - Tae Uk Kang
- Health Insurance Policy Research Institute, National Health
Insurance Service, Wonju-si, Gangwon-do, Republic of Korea
| | - Sayada Z. Kazmi
- Department of Preventive Medicine, College of Medicine, Korea
University, Seoul, Republic of Korea
| | - Jin Soo Suh
- Department of Orthopaedic Surgery, Inje University Ilsan Paik
Hospital, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Jun Young Choi
- Department of Orthopaedic Surgery, Inje University Ilsan Paik
Hospital, Goyang-si, Gyeonggi-do, Republic of Korea
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18
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Irianto KA, Bakri AH, Kloping NA. Platelet Rich Plasma Injection for Soft Tissue Musculoskeletal Pain. Malays Orthop J 2021; 15:96-100. [PMID: 34429828 PMCID: PMC8381679 DOI: 10.5704/moj.2107.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 02/19/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction Treating soft tissue injuries can be a challenge for physicians as it can be overlooked which can lead to more problems. In recent studies, the use of Platelet Rich Plasma (PRP) has been gaining popularity for soft tissue injuries because of its benefits and minimal side effects. This study aims to evaluate the effect of PRP injection on various musculoskeletal soft tissues inflammation. Material and Methods This is a retrospective study of patients with soft tissue injury who underwent PRP therapy between 2015 and 2018 at an orthopaedic and traumatology hospital. The study collected demographic data including the type of soft tissue injury and Visual Analog Scale (VAS) before and after the PRP injection. Those data were statistically analysed to identify the significance of PRP. Results Seventy-six patients were included, predominantly female, middle aged (40-69 years old) and class one obesity. Most of the complaints (61.8%) were in the lower extremity region. Pain improvements measured with mean VAS score were observed in both acute (3.06±1.28 to 0.8±0.65) and chronic (4±1.75 to 0.97±0.62) cases. There was a significant decrease of VAS score before and after the PRP injection (p < 0.000). Conclusion PRP injection is able to alleviate both acute and chronic pain in soft tissue injuries without additional analgesic.
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Affiliation(s)
- K A Irianto
- Department of Orthopaedics and Traumatology, Universitas Airlangga, Surabaya, Indonesia
| | - A H Bakri
- Department of Orthopaedics, Surabaya Orthopedic and Traumatology Hospital, Surabaya, Indonesia
| | - N A Kloping
- Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
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19
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Mascarenhas S, Couette N. A Systematic Review of the Inclusion of Non-Inflammatory Ultrasonographic Enthesopathy Findings in Enthesitis Scoring Indices. Diagnostics (Basel) 2021; 11:diagnostics11040669. [PMID: 33917826 PMCID: PMC8068272 DOI: 10.3390/diagnostics11040669] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/21/2021] [Accepted: 03/25/2021] [Indexed: 11/16/2022] Open
Abstract
Ultrasound has advanced the diagnosis and management of patients with inflammatory rheumatic conditions. It can be used to identify and monitor enthesitis, a cardinal feature of spondyloarthropthies. Several enthesitis scoring systems utilizing ultrasound to determine entheseal involvement have been developed. These scoring systems generally rely on determining the presence or absence of erosions, tendon enlargement, power Doppler signal, or enthesophytes. This systematic review identified ultrasound scoring systems that have been utilized for evaluating enthesitis and what key components derive the score. Review of these scoring systems, however, demonstrated confounding as some of the score components including enthesophytes may be seen in non-inflammatory conditions and some components including erosions can be seen from chronic damage, but not necessarily indicate active inflammatory disease. What is furthermore limiting is that currently there is not an agreed upon term to describe non-inflammatory enthesopathies, further complicating these scoring systems. This review highlights the need for a more comprehensive ultrasound enthesopathy scoring index.
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20
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Maffulli N, Oliva F, Maffulli GD, Migliorini F. Failed Surgery for Patellar Tendinopathy in Athletes: Midterm Results of Further Surgical Management. Orthop J Sports Med 2021; 9:2325967121994550. [PMID: 33855096 PMCID: PMC8013696 DOI: 10.1177/2325967121994550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 11/19/2020] [Indexed: 11/22/2022] Open
Abstract
Background: Tendon injuries are commonly seen in sports medicine practice. Many elite players involved in high-impact activities develop patellar tendinopathy (PT) symptoms. Of them, a small percentage will develop refractory PT and need to undergo surgery. In some of these patients, surgery does not resolve these symptoms. Purpose: To report the clinical results in a cohort of athletes who underwent further surgery after failure of primary surgery for PT. Study Design: Case series; Level of evidence, 4. Methods: A total of 22 athletes who had undergone revision surgery for failed surgical management of PT were enrolled in the present study. Symptom severity was assessed through the Victorian Institute of Sport Assessment Scale for Patellar Tendinopathy (VISA-P) upon admission and at the final follow-up. Time to return to training, time to return to competition, and complications were also recorded. Results: The mean age of the athletes was 25.4 years, and the mean symptom duration from the index intervention was 15.3 months. At a mean follow-up of 30.0 ± 4.9 months, the VISA-P score improved 27.8 points (P < .0001). The patients returned to training within a mean of 9.2 months. Fifteen patients (68.2%) returned to competition within a mean of 11.6 months. Of these 15 patients, a further 2 had decreased their performance, and 2 more had abandoned sports participation by the final follow-up. The overall rate of complications was 18.2%. One patient (4.5%) had a further revision procedure. Conclusion: Revision surgery was feasible and effective in patients in whom PT symptoms persisted after previous surgery for PT, achieving a statistically significant and clinically relevant improvement of the VISA-P score as well as an acceptable rate of return to sport at a follow-up of 30 months.
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Affiliation(s)
- Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
- Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, London, UK
- School of Pharmacy and Bioengineering, Keele University School of Medicine, Stoke on Trent, UK
- Nicola Maffulli, MD, MS, PhD, Department of Musculoskeletal Disorders, Faculty of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi (SA), Italy ()
| | - Francesco Oliva
- Department of Musculoskeletal Disorders, Faculty of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
| | | | - Filippo Migliorini
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany
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21
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Altered Central Pain Processing in Patients With Chronic Plantar Heel Pain: A Critically Appraised Topic. J Sport Rehabil 2021; 30:812-817. [PMID: 33596547 DOI: 10.1123/jsr.2020-0371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 11/05/2020] [Accepted: 12/02/2020] [Indexed: 11/18/2022]
Abstract
Clinical Scenario: Plantar heel pain is a common condition frequently associated with persistent symptoms and functional limitations affecting both the athletic and nonathletic populations. Common interventions target impairments at the foot and ankle and local drivers of symptoms. If symptoms are predominantly perpetuated by alterations in central pain processing, addressing peripheral impairments alone may not be sufficient. Clinical Question: Do individuals with chronic plantar heel pain demonstrate signs potentially associated with altered central pain processing? Summary of Key Findings: After searching 6 electronic databases (PubMed, CINAHL, Scopus, SportDiscus, Cochrane, and PEDro) and filtering titles based on predetermined inclusion and exclusion criteria, 4 case-control studies were included. All studies scored highly on the Newcastle-Ottawa Scale for quality assessment. Using pressure pain thresholds, each study found decreased pressure pain hypersensitivity locally and at a remote site compared to control groups, suggesting the presence, to some extent, of altered nociceptive pain processing. Clinical Bottom Line: In the studies reviewed, reported results suggest a possible presence of centrally mediated symptoms in persons with plantar heel pain. However, despite findings from these studies, limitations in appropriate matching based on body mass index and measures used suggest additional investigation is warranted. Strength of Recommendation: According to the Oxford Centre for Evidence-Based Medicine, there is evidence level C to suggest chronic plantar heel pain is associated with alterations in central pain processing.
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22
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Mascarenhas S. A Narrative Review of the Classification and Use of Diagnostic Ultrasound for Conditions of the Achilles Tendon. Diagnostics (Basel) 2020; 10:E944. [PMID: 33202763 PMCID: PMC7696236 DOI: 10.3390/diagnostics10110944] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/03/2020] [Accepted: 11/04/2020] [Indexed: 12/23/2022] Open
Abstract
Enthesitis is a cardinal feature of spondyloarthropathies. The Achilles insertion on the calcaneus is a commonly evaluated enthesis located at the hindfoot, generally resulting in hindfoot pain and possible tendon enlargement. For decades, diagnosis of enthesitis was based upon patient history of hindfoot or posterior ankle pain and clinical examination revealing tenderness and/or enlargement at the site of the tendon insertion. However, not all hindfoot or posterior ankle symptoms are related to enthesitis. Advanced imaging, including magnetic resonance imaging (MRI) and ultrasound (US), has allowed for more precise evaluation of hindfoot and posterior ankle conditions. Use of US in diagnosis has helped confirm some of these cases but also identified other conditions that may have otherwise been misclassified without use of advanced imaging diagnostics. Conditions that may result in hindfoot and posterior ankle symptoms related to the Achilles tendon include enthesitis (which can include retrocalcaneal bursitis and insertional tendonopathy), midportion tendonopathy, paratenonopathy, superficial calcaneal bursitis, calcaneal ossification (Haglund deformity), and calcific tendonopathy. With regard to classification of these conditions, much of the existing literature uses confusing nomenclature to describe conditions in this region of the body. Some terminology may imply inflammation when in fact there may be none. A more uniform approach to classifying these conditions based off anatomic location, symptoms, clinical findings, and histopathology is needed. There has been much debate regarding appropriate use of tendonitis when there is no true inflammation, calling instead for use of the terms tendinosis or tendonopathy. To date, there has not been clear examination of a similar overuse of the term enthesitis in conditions where there is no underlying inflammation, thus raising the need for more comprehensive taxonomy.
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Affiliation(s)
- Sheryl Mascarenhas
- Department of Internal Medicine, Division of Rheumatology, The Ohio State University Wexner Medical Center, 543 Taylor Ave, Columbus, OH 43203, USA
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23
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Seki Y, Katagiri H, Otabe K, Nakagawa Y, Miyatake K, Sekiya I, Koga H. Investigation of association between the preoperative intra-articular anesthetic test and persistent pain after total knee arthroplasty. J Orthop Sci 2020; 25:1055-1060. [PMID: 32107135 DOI: 10.1016/j.jos.2020.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 12/12/2019] [Accepted: 01/20/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND A better understanding of the etiology of persistent pain after total knee arthroplasty (TKA) is required to prevent unfavorable outcomes. The purpose of this study was to investigate the association of persistent pain after TKA, patient characteristics, and the remaining pain ratio per the preoperative intra-articular anesthetic test. METHODS This study included 89 patients who underwent TKA and underwent an intra-articular anesthetic test preoperatively. The remaining pain ratio out of 100 percent 30 min after intra-articular anesthetic injection and demographic data were also evaluated preoperatively. Numerical rating scale (NRS) scores for pain during movement (Q1), at rest (Q2), at first movement in the morning (Q3), and during climbing up and down stairs (Q4) were evaluated 1 year after TKA. Multiple linear regression analysis was performed to assess the impact of independent variables on the NRS score for questionnaire No.4. and the remaining pain ratio per the intra-articular anesthetic. RESULTS The mean remaining pain ratio per the preoperative intra-articular anesthetic test was 29.3%. The NRS score for Q4 was significantly higher than those for any of the other NRS questionnaires administered 1 year after TKA (Q1-Q4, Q2-Q4, P < 0.001; Q3-Q4, P < 0.05). The analysis found the weak correlation between the pain ratio of anesthetic test and the NRS score for Q4 after TKA (R = 0.28, P = 0.018). BMI and preoperative FTA were the major predictors of remaining pain ratio per the intra-articular anesthetic test (R = 0.40, P = 0.002). CONCLUSION This study revealed that the remaining pain ratio per the preoperative intra-articular anesthetic test was weakly correlated with persistent pain during climbing up and down stairs 1 year after TKA. In addition, BMI and preoperative FTA were associated with the remaining pain ratio per the preoperative intra-articular anesthetic test.
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Affiliation(s)
- Yoshie Seki
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Hiroki Katagiri
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan; Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Koji Otabe
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan; Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University (TMDU), Tokyo, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Yusuke Nakagawa
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan; Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Kazumasa Miyatake
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan; Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Ichiro Sekiya
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan; Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University (TMDU), Tokyo, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan; Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
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Aicale R, Oliviero A, Maffulli N. Management of Achilles and patellar tendinopathy: what we know, what we can do. J Foot Ankle Res 2020; 13:59. [PMID: 32993702 PMCID: PMC7523300 DOI: 10.1186/s13047-020-00418-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/28/2020] [Indexed: 02/07/2023] Open
Abstract
Tendinopathies are challenging conditions frequent in athletes and in middle-aged overweight patients with no history of increased physical activity. The term “tendinopathy” refers to a clinical condition characterised by pain, swelling, and functional limitations of tendons and nearby structures, the effect of chronic failure of healing response. Tendinopathies give rise to significant morbidity, and, at present, only limited scientifically proven management modalities exist. Achilles and patellar tendons are among the most vulnerable tendons, and among the most frequent lower extremity overuse injuries. Achilles and patellar tendinopathies can be managed primarily conservatively, obtaining good results and clinical outcomes, but, when this approach fails, surgery should be considered. Several surgical procedures have been described for both conditions, and, if performed well, they lead to a relatively high rate of success with few complications. The purpose of this narrative review is to critically examine the recent available scientific literature to provide evidence-based opinions on these two common and troublesome conditions.
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Affiliation(s)
- Rocco Aicale
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084, Baronissi, Italy.,Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, 84131, Salerno, Italy
| | - Antonio Oliviero
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084, Baronissi, Italy.,Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, 84131, Salerno, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084, Baronissi, Italy. .,Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, 84131, Salerno, Italy. .,Centre for Sports and Exercise Medicine, Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England. .,Institute of Science and Technology in Medicine, Keele University, School of Medicine, Guy Hilton Research Centre, Thornburrow Drive, Hartshill, Stoke-on-Trent, ST4 7QB, England.
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25
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Shavlovskaya OA, Gordeeva IE, Ansarov KS, Prokofyeva YS. [Chronic pain syndrome in diseases of periarticular tissues]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:109-118. [PMID: 32323952 DOI: 10.17116/jnevro2020120031109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The search for an effective method of treating diseases of the musculoskeletal system is a rather actual problem for a practicing physician nowadays in connection with the modern lifestyle of most people. A prolonged stay in the same position, as a rule, leads to overstrain of the capsule-joint complexes, and, as a consequence, to the development of degenerative changes in the joints and periarticular tissues. These changes can manifest themselves clinically in the form of a chronic or acute pain syndrome. One of the common diseases characterized by degenerative periarticular changes with a variety of clinical manifestations are periarthropathies. Periarthropathy or periarthrosis is still the subject of discussion by doctors of related specialties: neurologists, orthopedists, rheumatologists, etc. Pain in this case can be caused by the primary degenerative process in muscles and tendons in combination with their chronic microtraumatization, ischemia, and reactive inflammation. Periarthropathy can be considered as a «train» of any arthropathy, because pain always causes muscle spasm, a change in the motor stereotype, a limitation of motor activity in the joint, etc. In the absence of joint pathology, it should be considered as a primary disease. There is still no common understanding of this nosological unit, including pathogenesis, classification, diagnostic algorithms and therapy. Treatment is based on general recommendations: limiting the load on the damaged joint, massage (according to indications), exercise therapy, manual therapy, physiotherapy. Drug therapy includes intramuscular or intraarticular administration of glucocorticosteroids (GCS), non-steroidal anti-inflammatory drugs (NSAIDs) but these drugs have certain side-effects and contraindications. Treatment of peritropathy with chondroprotectors (chondrogard) is rapidly gaining momentum, as well as GCS and NSAIDs, they reduce pain and increase the functionality of the joints, but, unlike the latter, their safety profile is much higher. The authors summarize current findings on this issue.
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Affiliation(s)
- O A Shavlovskaya
- Sechenov First Moscow State Medical University (Sechenov University) Ministry of Health of Russia, Moscow, Russia
| | - I E Gordeeva
- Volgograd State Medical University Ministry of health Russia, Volgograd, Russia
| | - K Sh Ansarov
- Volgograd State Medical University Ministry of health Russia, Volgograd, Russia
| | - Yu S Prokofyeva
- Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, Moscow, Russia.,Spasokukotsky City Clinical Hospital, Moscow, Russia
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Macchi M, Spezia M, Elli S, Schiaffini G, Chisari E. Obesity Increases the Risk of Tendinopathy, Tendon Tear and Rupture, and Postoperative Complications: A Systematic Review of Clinical Studies. Clin Orthop Relat Res 2020; 478:1839-1847. [PMID: 32732565 PMCID: PMC7371074 DOI: 10.1097/corr.0000000000001261] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 03/25/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Inflammation and mechanical demands play a role in the development of tendon conditions and the dysregulation of tendon healing. In patients with obesity, high levels of pro-inflammatory cytokines and a high mechanical demand promote chronic low-grade inflammation. Although controversial results have been reported, we aimed to summarize current evidence while highlighting the role of obesity in tendinopathy. QUESTIONS/PURPOSES (1) Do patients with obesity have a greater risk of tendinopathy, stratified by upper and lower extremity sites, than patients who do not have obesity? (2) Is obesity associated with a higher risk of upper and lower extremity tendon tear and ruptures? (3) Is obesity associated with an increased risk of complications after upper and lower extremity tendon surgery? METHODS We performed a systematic review by searching the PubMed, Embase, and Cochrane Library databases, combining the term "tendon" with common terms for tendinopathy and rupture such as "tendon injury OR tendinopathy OR tendon rupture" and "obese" OR "obesity." We included studies with any level of evidence published from January 2000 to July 10, 2019 in peer-reviewed journals reporting clinical results. After we removed the duplicates, there were 365 records. Two independent authors screened these records and excluded 320 based on abstract and title screening. Of the remaining 45 studies, 23 were excluded because the topic did not address the research questions (n = 19), the article was outdated (n = 3), or because there was a serious risk of bias (n = 1). Finally, we included 22 studies with 49,914 participants (5984 with obesity), 31,100 (1884 with obesity) of whom had upper-extremity tendinopathy, while 18,814 (4010 with obesity) had lower-extremity tendinopathy. Obesity was defined as a BMI ≥ 30 kg/m according to the WHO's criteria. Data were extracted and analyzed critically. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were applied, and the risk of bias (ROBINS tool) of the studies was assessed, as was the methodological quality (Coleman score). The assessment was performed independently by two authors. Inter-rater agreement for the assessments of the risk of bias and methodological quality were 89% and 94%, respectively. All studies were observational, and most were retrospective case-control studies. Any discrepancy was discussed and solved by consensus. The articles had a moderate risk of bias (eight articles) or a low risk of bias (fourteen articles). We excluded one article because of a serious risk of bias. The mean (range) Coleman score was 53.5 (42-74). RESULTS Obesity was associated with a greater risk of upper extremity tendinopathy (rotator cuff: odds ratio 1.25 [95% confidence interval 1.12 to 1.40]; p < 0.001; medial epicondylitis: OR 1.9 [95% CI 1.0 to 3.7]; p < 0.05) and lower-extremity tendinopathy (Achilles tendon: OR 3.81 [95% CI 2.57 to 5.63]; OR 3.77 [95% CI 2.24 to 6.34]; OR 6.56 [95% CI 3.18 to 13.55], for obesity Classes I, II and III, respectively; patellar tendon: OR 1.10 [95% CI 1.05 to 1.90]; p = 0.001; plantar fascia: OR 2.97 [95% CI 1.64 to 5.37]; p = 0.004). Obesity was associated with a greater risk of upper extremity tendon tear (rotator cuff: OR 2.35 [95% CI 1.62 to 3.40]; p < 0.001) and rupture leading to tendon surgery (rotator cuff in men: OR 3.13 [95% CI 1.29 to 7.61]; p < 0.001 and women: OR 3.51 [95% CI 1.80 to 6.85]; p < 0.001). However, no association was found between BMI and lower extremity rupture (Achilles mean BMI: 27.77 kg/m [95% CI 26.94 to 28.49] versus control: 26.66 kg/m [95% CI 26.06 to 27.27]; p = 0.047). Upper extremity complications (n = 359) after tendon repair surgery had a weighted incidence of 13.27% and 8.13% for rotator cuff surgery in patients with and without obesity, respectively. In the lower extremity (n = 21,152), the weighted incidence for Achilles tendon surgery was 11.28% and 8.6% in patients with and without obesity, respectively. CONCLUSIONS Obesity is associated with a higher risk of tendinopathy, tendon tear and rupture, and complications after tendon surgery than non-obesity. However, the high heterogeneity and observational nature of the studies highlight the need to be cautious about the results of our study. We encourage researchers to perform clinical and preclinical studies to explore pathways related to the metabolic state of this population. LEVEL OF EVIDENCE Level IV, prognostic study.
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Affiliation(s)
- Marina Macchi
- M. Macchi, S. Elli, University of Milan, Milan, Italy
| | | | - Silvia Elli
- M. Macchi, S. Elli, University of Milan, Milan, Italy
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Migliorini F, Tingart M, Maffulli N. Progress with stem cell therapies for tendon tissue regeneration. Expert Opin Biol Ther 2020; 20:1373-1379. [DOI: 10.1080/14712598.2020.1786532] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany
| | - Markus Tingart
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
- School of Pharmacy and Bioengineering, Keele University School of Medicine, Stoke on Trent, UK
- Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, London, UK
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28
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Aicale R, Bisaccia RD, Oliviero A, Oliva F, Maffulli N. Current pharmacological approaches to the treatment of tendinopathy. Expert Opin Pharmacother 2020; 21:1467-1477. [DOI: 10.1080/14656566.2020.1763306] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Rocco Aicale
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno , Baronissi, Italy
- Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D’Aragona , Salerno, Italy
| | - Rocco Domenico Bisaccia
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno , Baronissi, Italy
- Department of Pharmacology, School of Medicine and Surgery, University of Salerno , Baronissi, Italy
| | - Antonio Oliviero
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno , Baronissi, Italy
- Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D’Aragona , Salerno, Italy
| | - Francesco Oliva
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno , Baronissi, Italy
- Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D’Aragona , Salerno, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno , Baronissi, Italy
- Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D’Aragona , Salerno, Italy
- Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Queen Mary University of London , London, UK
- Keele University, Faculty of Medicine, School of Pharmacology and Bioengineering, Guy Hilton Research Centre , Stoke-on-Trent, UK
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29
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Tolouei Azar J, Habibi Maleki A, Moshari S, Razi M. The effect of different types of exercise training on diet-induced obesity in rats, cross-talk between cell cycle proteins and apoptosis in testis. Gene 2020; 754:144850. [PMID: 32505844 DOI: 10.1016/j.gene.2020.144850] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/11/2020] [Accepted: 06/03/2020] [Indexed: 02/06/2023]
Abstract
Obesity is associated with germ cell apoptosis, spermatogenesis arrest, and testicular endocrine suppression. The aim of the present study was to investigate the crosstalk between germ cell apoptosis and cell cycle machinery in sedentary and obese rats after moderate-intensity continuous (MICT), high-intensity continuous (HICT) and High-intensity interval (HIIT) exercise trainings. Male Wistar rats (n = 30) were randomly divided into 5 groups; the control, sedentary high-fat diet (HFD)-received (HFD-sole), MICT, HICT and HIIT-induced HFD-received groups. The serum levels of LDL-C, HDL-C, triglyceride, and testosterone, mRNA and protein levels of Cyclin D1, Cdk4, p21, apoptotic cell number/mm2 of testicular tissue and testicular DNA fragmentation ratio were investigated. The obese animals in HFD-sole group represented a significant (p < 0.05) reduction in serum HDL-C and testosterone levels, Cyclin D1, Cdk4 expressions, and exhibited a remarkable (p < 0.05) increment in LDL-C, triglyceride, p21 expression, apoptotic cell number and DNA fragmentation ratio versus control animals. However, the animals in MICT, HICT, HIIT groups exhibited a significant (p < 0.05) increment in serum HDL-C and testosterone, Cyclin D1 and Cdk4 expressions and showed a significant (p < 0.05) reduction in serum LDL-C and triglyceride, p21 expression, apoptotic cell number and DNA fragmentation versus the HFD-sole group. In conclusion, a crosslink between cell cycle machinery and apoptosis of germ cells was revealed in the testicles of HFD-sole animals, and MICT, HICT and HIIT could ameliorate the obesity-induced impairments, respectively. This effect may be attributed to the effect of exercise training protocols on maintaining Cyclin D1 and Cdk4 and suppressing p21 expression levels in the testicles.
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Affiliation(s)
- Javad Tolouei Azar
- Department of Exercise Physiology and Corrective Exercises, Faculty of Sport Sciences, Urmia University, Urmia, Iran.
| | - Aref Habibi Maleki
- Department of Exercise Physiology and Corrective Exercises, Faculty of Sport Sciences, Urmia University, Urmia, Iran
| | - Sana Moshari
- Department of Basic Sciences, Faculty of Veterinary Medicine, Urmia University, Urmia, Iran; Andrology and in-vitro Fertilization Division, RASTA Research Center, West Azerbayjan Science and Technology Park (WASTP), Urmia, Iran
| | - Mazdak Razi
- Department of Basic Sciences, Faculty of Veterinary Medicine, Urmia University, Urmia, Iran
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30
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Post-operative MRI and US appearance of the Achilles tendons. J Ultrasound 2020; 23:387-395. [PMID: 32488649 DOI: 10.1007/s40477-020-00479-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/12/2020] [Indexed: 12/17/2022] Open
Abstract
The Achilles tendon is one of the most commonly ruptured tendons in the human body. Minimally invasive and open surgical repairs are commonly undertaken to manage acute Achilles ruptures. This article describes the postoperative imaging findings and their evolution after surgery. Ultrasound and magnetic resonance imaging provide crucial information regarding the morphology, structure, vascularization and mobility of the Achilles tendon on the surrounding planes. Morphologically, a repaired tendon is physiologically larger and wider than an intact one, with a loss of its fibrillary structure; the presence of surgical material in the context of the tendon is normal after the rupture has been repaired. After surgery, the tendon is more vascularized in power-Doppler imaging. Elastography and diffusion tensor Imaging are innovative tools which allow for the visualization of microstructural abnormalities not apprehensible using conventional imaging techniques. A treated Achilles tendon is unlikely to regain a normal imaging appearance, and the health care professional must distinguish between postoperative findings and actual pathological features. In this context, clinical examination still reigns supreme.
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Yanik EL, Colditz GA, Wright RW, Saccone NL, Evanoff BA, Jain NB, Dale AM, Keener JD. Risk factors for surgery due to rotator cuff disease in a population-based cohort. Bone Joint J 2020; 102-B:352-359. [PMID: 32114822 DOI: 10.1302/0301-620x.102b3.bjj-2019-0875.r1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIMS Few risk factors for rotator cuff disease (RCD) and corresponding treatment have been firmly established. The aim of this study was to evaluate the relationship between numerous risk factors and the incidence of surgery for RCD in a large cohort. METHODS A population-based cohort of people aged between 40 and 69 years in the UK (the UK Biobank) was studied. People who underwent surgery for RCD were identified through a link with NHS inpatient records covering a mean of eight years after enrolment. Multivariate Cox proportional hazards regression was used to calculate hazard ratios (HRs) as estimates of associations with surgery for RCD accounting for confounders. The risk factors which were considered included age, sex, race, education, Townsend deprivation index, body mass index (BMI), occupational demands, and exposure to smoking. RESULTS Of the 421,894 people who were included, 47% were male. The mean age at the time of enrolment was 56 years (40 to 69). A total of 2,156 people were identified who underwent surgery for RCD. Each decade increase in age was associated with a 55% increase in the incidence of RCD surgery (95% confidence interval (CI) 46% to 64%). Male sex, non-white race, lower deprivation score, and higher BMI were significantly associated with a higher risk of surgery for RCD (all p < 0.050). Greater occupational physical demands were significantly associated with higher rates of RCD surgery (HR = 2.1, 1.8, and 1.4 for 'always', 'usually', and 'sometimes' doing heavy manual labour vs 'never', all p < 0.001). Former smokers had significantly higher rates of RCD surgery than those who had never smoked (HR 1.23 (95% CI 1.12 to 1.35), p < 0.001), while current smokers had similar rates to those who had never smoked (HR 0.94 (95% CI 0.80 to 1.11)). Among those who had never smoked, the risk of surgery was higher among those with more than one household member who smoked (HR 1.78 (95% CI 1.08 to 2.92)). The risk of RCD surgery was not significantly related to other measurements of secondhand smoking. CONCLUSION Many factors were independently associated with surgery for RCD, including older age, male sex, higher BMI, lower deprivation score, and higher occupational physical demands. Several of the risk factors which were identified are modifiable, suggesting that the healthcare burden of RCD might be reduced through the pursuit of public health goals, such as reducing obesity and modifying occupational demands. Cite this article: Bone Joint J 2020;102-B(3):352-359.
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Affiliation(s)
- Elizabeth L Yanik
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA; Assistant Professor, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Graham A Colditz
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Rick W Wright
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Nancy L Saccone
- Department of Genetics and Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Bradley A Evanoff
- Division of General Medical Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Nitin B Jain
- Department of Physical Medicine and Rehabilitation and Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ann Marie Dale
- Division of General Medical Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jay D Keener
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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A systematic review of inflammatory cells and markers in human tendinopathy. BMC Musculoskelet Disord 2020; 21:78. [PMID: 32028937 PMCID: PMC7006114 DOI: 10.1186/s12891-020-3094-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 01/24/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND This article systematically reviews the current evidence regarding inflammation in Tendinopathy with the aim to increase understanding of a potential common pathophysiology. METHODS Following the PRISMA statements, the terms: (tendinopathy OR (tendons AND rupture)) AND (inflammation OR (inflammation AND cells) OR immune system OR inflammation mediators OR bacteria) were used. One thousand four hundred thirty-one articles were identified which was screened down to 53. RESULTS 39/53 studies mentioned inflammatory cells but had contradicting conclusions. Macrophages were the most common cell type and inflammatory markers were detectable in all the articles which measure them. CONCLUSIONS The included studies show different conclusions, but this heterogeneity is not unexpected since the clinical criteria of 'tendinopathy' encompass a huge clinical spectrum. Different 'tendinopathy' conditions may have different pathophysiology, and even the same clinical condition may be at different disease stages during sampling, which can alter the histological and biochemical picture. Control specimen sampling was suboptimal since the healthy areas of the pathological-tendon may actually be sub-clinically diseased, as could the contralateral tendon in the same subject. Detection of inflammatory cells is most sensitive using immunohistochemistry targeting the cluster of differentiation markers, especially when compared to the conventional haematoxylin and eosin staining methods. The identified inflammatory cell types favour a chronic inflammatory process; which suggests a persistent stimulus. This means NSAID and glucocorticoids may be useful since they suppress inflammation, but it is noted that they may hinder tendon healing and cause long term problems. This systematic review demonstrates a diversity of data and conclusions in regard to inflammation as part of the pathogenesis of Tendinopathy, ranging from ongoing or chronic inflammation to non-inflammatory degeneration and chronic infection. Whilst various inflammatory markers are present in two thirds of the reviewed articles, the heterogenicity of data and lack of comparable studies means we cannot conclude a common pathophysiology from this systematic review.
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CARVALHO ANGELAAM, MOURA FRANCYELLEBRDE, NOGUEIRA PEDROAUGUSTOS, GONÇALVES ALINEMARIAN, ARAÚJO FERNANDAA, ZANON RENATAG, TOMIOSSO TATIANACARLA. Swimming exercise changed the collagen synthesis and calcification in calcaneal tendons of mice. ACTA ACUST UNITED AC 2020; 92:e20181127. [DOI: 10.1590/0001-3765202020181127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 04/22/2019] [Indexed: 12/13/2022]
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Plachel F, Moroder P, Gehwolf R, Tempfer H, Wagner A, Auffarth A, Matis N, Pauly S, Tauber M, Traweger A. Risk Factors for Rotator Cuff Disease: An Experimental Study on Intact Human Subscapularis Tendons. J Orthop Res 2020; 38:182-191. [PMID: 31161610 PMCID: PMC6973132 DOI: 10.1002/jor.24385] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 05/28/2019] [Indexed: 02/04/2023]
Abstract
Although several studies revealed a multifactorial pathogenesis of degenerative rotator cuff disorders, the impact and interaction of extrinsic variables is still poorly understood. Thus, this study aimed at uncovering the effect of patient- and pathology-specific risk factors that may contribute to degeneration of the rotator cuff tendons. Between 2015 and 2018, 54 patients who underwent arthroscopic shoulder surgery at three specialized shoulder clinics were prospectively included. Using tendon samples harvested from the macroscopically intact subscapularis (SSC) tendon, targeted messenger RNA expression profile analysis was performed in the first cohort (n = 38). Furthermore, histological analyses were conducted on tendon tissue samples obtained from a second cohort (n = 16). Overall, both study cohorts were comparable concerning patient demographics. Results were then analyzed with respect to specific extrinsic factors, such as patient age, body mass index, current as well as previous professions and sport activities, smoking habit, and systemic metabolic diseases. While patient age, sports-activity level, and preexisting rotator cuff lesions were considered to contribute most strongly to tendinopathogenesis, no further coherences were found. With regards to gene expression analysis, change in expression correlated most strongly with patient age and severity of the rotator cuff pathology. Further, chronic disorders increased overall gene expression variation. Taken together, our study provides further evidence that tendon degeneration is the consequence of a multifactorial process and pathological changes of the supraspinatus tendon affect the quality of SSC tendon and most likely vice versa. Therefore, the rotator cuff tendons need to be considered as a unit when managing rotator cuff pathologies. © 2019 The Authors. Journal of Orthopaedic Research® published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society J Orthop Res 38:182-191, 2020.
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Affiliation(s)
- Fabian Plachel
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center SalzburgParacelsus Medical UniversitySalzburgAustria,Department of Orthopedics and TraumatologyParacelsus Medical UniversitySalzburgAustria,Center for Musculoskeletal SurgeryCharité UniversitaetsmedizinAugustenburger Platz 1Berlin13353Germany
| | - Philipp Moroder
- Center for Musculoskeletal SurgeryCharité UniversitaetsmedizinAugustenburger Platz 1Berlin13353Germany
| | - Renate Gehwolf
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center SalzburgParacelsus Medical UniversitySalzburgAustria,Austrian Cluster for Tissue RegenerationViennaAustria
| | - Herbert Tempfer
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center SalzburgParacelsus Medical UniversitySalzburgAustria,Austrian Cluster for Tissue RegenerationViennaAustria
| | - Andrea Wagner
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center SalzburgParacelsus Medical UniversitySalzburgAustria,Austrian Cluster for Tissue RegenerationViennaAustria
| | - Alexander Auffarth
- Department of Orthopedics and TraumatologyParacelsus Medical UniversitySalzburgAustria
| | - Nicholas Matis
- Department of Orthopedics and TraumatologyParacelsus Medical UniversitySalzburgAustria
| | - Stephan Pauly
- Center for Musculoskeletal SurgeryCharité UniversitaetsmedizinAugustenburger Platz 1Berlin13353Germany
| | - Mark Tauber
- Department of Orthopedics and TraumatologyParacelsus Medical UniversitySalzburgAustria,German Shoulder CentreATOS Clinic MunichMunichGermany
| | - Andreas Traweger
- Institute of Tendon and Bone Regeneration, Spinal Cord Injury & Tissue Regeneration Center SalzburgParacelsus Medical UniversitySalzburgAustria,Austrian Cluster for Tissue RegenerationViennaAustria
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Cox ER, Coombes JS, Keating SE, Burton NW, Coombes BK. Not a Painless Condition: Rheumatological and Musculoskeletal Symptoms in Type 2 Diabetes, and the Implications for Exercise Participation. Curr Diabetes Rev 2020; 16:211-219. [PMID: 31146662 DOI: 10.2174/1573399815666190531083504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/15/2019] [Accepted: 05/03/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES People with type 2 diabetes (T2D) are more likely to develop a range of rheumatological and musculoskeletal symptoms (RMS), and experience both chronic and widespread pain, compared with the general population. However, these symptoms are not commonly acknowledged by researchers, which hampers our understanding of the impact on this population. Since exercise is a key lifestyle management strategy for T2D and participation levels are typically low, understanding the potential impact of RMS on exercise participation is critical. The aim of this review is to summarise the literature regarding the prevalence and pathophysiology of RMS in T2D, the evidence for the benefits and risks associated with exercise on RMS, and the currently available tools for the reporting of RMS in both research studies and community settings. METHODS A narrative review. RESULTS There are numerous exercise trials in T2D, but few have sufficiently reported pain-related adverse events and even fewer have investigated the effects of exercise on RMS and chronic pain. DISCUSSION Recommendations for future research are provided.
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Affiliation(s)
- Emily R Cox
- School of Human Movement and Nutrition Sciences, The University of Queensland, St. Lucia, Queensland, Australia
| | - Jeff S Coombes
- School of Human Movement and Nutrition Sciences, The University of Queensland, St. Lucia, Queensland, Australia
| | - Shelley E Keating
- School of Human Movement and Nutrition Sciences, The University of Queensland, St. Lucia, Queensland, Australia
| | - Nicola W Burton
- School of Applied Psychology, Griffith University, Mt. Gravatt, Queensland, Australia
| | - Brooke K Coombes
- School of Allied Health Sciences, Griffith University, Nathan, Queensland, Australia
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Stania M, Juras G, Chmielewska D, Polak A, Kucio C, Król P. Extracorporeal Shock Wave Therapy for Achilles Tendinopathy. BIOMED RESEARCH INTERNATIONAL 2019; 2019:3086910. [PMID: 31950037 PMCID: PMC6948318 DOI: 10.1155/2019/3086910] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 11/05/2019] [Accepted: 11/11/2019] [Indexed: 12/14/2022]
Abstract
Extracorporeal shock wave therapy (ESWT) is among the conservative treatments for Achilles tendinopathy. Unfortunately, no optimal application parameters have been determined that would ensure ESWT effectiveness in this condition. The aim of the paper is to use research reports on ESWT in patients with Achilles tendinopathy to help practising physiotherapists establish the most effective intervention parameters. A search was conducted using the following databases: PubMed, Scopus, EBSCOhost, and Web of Science. The papers were checked for relevant content and were included based on the following criteria: full-text article published in English and including comprehensive description of shock wave application. Twenty-two articles met the inclusion criteria. Most studies on the effectiveness of ESWT for Achilles tendinopathy included in this narrative review were randomized controlled trials. Two case-control studies, a case series study, prospective audit, clinical trial protocol, and a pilot study were also considered. The majority were prospective studies. Only a few authors presented the findings from retrospective observations. The two modalities of shock wave therapy used for Achilles tendinopathy are focused shock waves and radial shock waves. The literature contains reports presenting mainly beneficial effects of ESWT in patients with Achilles tendinopathy.
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Affiliation(s)
- Magdalena Stania
- Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education, Mikolowska 72A, 40-065 Katowice, Poland
| | - Grzegorz Juras
- Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education, Mikolowska 72A, 40-065 Katowice, Poland
| | - Daria Chmielewska
- Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, Mikolowska 72A, 40-065 Katowice, Poland
- Electromyography and Pelvic Floor Muscles Laboratory, The Jerzy Kukuczka Academy of Physical Education, Mikolowska 72A, 40-065 Katowice, Poland
| | - Anna Polak
- Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, Mikolowska 72A, 40-065 Katowice, Poland
- Rehabilitation Center Technomex, Szparagowa 19, 44-141 Gliwice, Poland
| | - Cezary Kucio
- Institute of Physiotherapy and Health Sciences, The Jerzy Kukuczka Academy of Physical Education, Mikolowska 72A, 40-065 Katowice, Poland
- Department of Internal Disease at the Multispecialty Hospital, Chelmonskiego 28, 43-600 Jaworzno, Poland
| | - Piotr Król
- Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education, Mikolowska 72A, 40-065 Katowice, Poland
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Zellers JA, Bley BC, Pohlig RT, Alghamdi NH, Silbernagel KG. FREQUENCY OF PATHOLOGY ON DIAGNOSTIC ULTRASOUND AND RELATIONSHIP TO PATIENT DEMOGRAPHICS IN INDIVIDUALS WITH INSERTIONAL ACHILLES TENDINOPATHY. Int J Sports Phys Ther 2019; 14:761-769. [PMID: 31598414 PMCID: PMC6769280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Insertional tendinopathy is likely caused by different pathologies. This variation could account for the recalcitrant nature of this condition to treatment. Ultrasound imaging may assist in identifying underlying pathology to inform patient management. HYPOTHESIS/PURPOSE The primary purpose of this study was to quantify the presence of underlying pathology using ultrasound in individuals with a clinical diagnosis of insertional Achilles tendinopathy. Secondarily, we sought to examine the relationship of abnormal ultrasound findings to age and body mass index (BMI). STUDY DESIGN Cross-sectional study. METHODS Fifty-six individuals with insertional tendinopathy were included in this study. B-mode ultrasound imaging was used to descriptively and quantitatively describe tendon pathology. RESULTS A greater proportion of bone defect (p<0.001), intratendinous calcifications (p = 0.01) and midportion tendinosis (p<0.001) were observed on the injured side compared to the uninjured side. Higher BMI was associated with presence of bone deformity, intratendinous calcifications and distal tendinosis (p = 0.001-0.04); adding age did not significantly improve the regression model. CONCLUSION Patients with insertional tendinopathy present with multiple underlying pathologies. This may account for variable response to treatment. It may be helpful to include imaging to better identify underlying pathology when trying to determine an appropriate treatment strategy. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
| | | | - Ryan T. Pohlig
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
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Hutchison MK, Houck J, Cuddeford T, Dorociak R, Brumitt J. Prevalence of Patellar Tendinopathy and Patellar Tendon Abnormality in Male Collegiate Basketball Players: A Cross-Sectional Study. J Athl Train 2019; 54:953-958. [PMID: 31424974 DOI: 10.4085/1062-6050-70-18] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Patellar tendinopathy (PT) is a degenerative condition known to affect athletes who participate in sports such as basketball and volleyball. Patellar tendinopathy is a challenging condition to treat and may cause an athlete to prematurely retire from sport. The prevalence of PT in male collegiate basketball players is unknown. OBJECTIVE To determine the prevalence of PT and patellar tendon abnormality (PTA) in a population of male collegiate basketball players. DESIGN Cross-sectional study. SETTING National Collegiate Athletic Association Divisions II and III, National Association of Intercollegiate Athletics, and Northwest Athletic Conference male collegiate basketball teams were assessed in a university laboratory setting. PATIENTS OR OTHER PARTICIPANTS Ninety-five male collegiate basketball players (age = 20.0 ± 1.7 years). MAIN OUTCOME MEASURE(S) A diagnostic ultrasound image of an athlete's patellar tendon was obtained from each knee. Patellar tendinopathy was identified based on a player's symptoms (pain with palpation) and the presence of a hypoechoic region on an ultrasonographic image. RESULTS A majority of participants, 53 of 95 (55.8%), did not present with pain during palpation or ultrasonographic evidence of PTA. Thirty-two basketball players (33.7%) displayed ultrasonographic evidence of PTA in at least 1 knee; 20 of those athletes (21.1%) had PT (pain and tendon abnormality). Nonstarters were 3.5 times more likely to present with PTA (odds ratio = 3.5, 95% confidence interval = 1.3, 9.6; P = .017) and 4 times more likely to present with PT (odds ratio = 4.0, 95% confidence interval = 1.1, 14.8; P = .038) at the start of the season. CONCLUSIONS One in 3 male collegiate basketball players presented with either PT or PTA. Sports medicine professionals should evaluate basketball athletes for PT and PTA as part of a preseason screening protocol.
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Affiliation(s)
| | - Jeff Houck
- School of Physical Therapy, George Fox University, Newberg, OR
| | - Tyler Cuddeford
- School of Physical Therapy, George Fox University, Newberg, OR
| | - Robin Dorociak
- School of Physical Therapy, George Fox University, Newberg, OR.,Northwest Biomechanics, LLC, Portland, OR
| | - Jason Brumitt
- School of Physical Therapy, George Fox University, Newberg, OR
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Taş S, Çetin A. An investigation of the relationship between plantar pressure distribution and the morphologic and mechanic properties of the intrinsic foot muscles and plantar fascia. Gait Posture 2019; 72:217-221. [PMID: 31260859 DOI: 10.1016/j.gaitpost.2019.06.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 06/04/2019] [Accepted: 06/25/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The purpose of this study was to investigate the relationship between plantar pressure distribution and the stiffness, thickness, and cross-sectional area of the plantar fascia (PF) and abductor hallucis (AbH), flexor hallucis brevis (FHB), and flexor digitorum brevis (FDB) muscles. METHODS The present study included a total of 41 healthy females between the ages of 20 and 34 years. Plantar pressure during static standing position was measured using a pedobarography system (MatScan, Tekscan, Inc., South Boston, Massachusetts, USA). Peak pressure, mean pressure, maximum force (Max-F), contact area (Con-A), pressure time integral, and force time integral (FTI) were measured. The thickness, cross-sectional area and stiffness of the intrinsic foot muscles and PF were measured using an ACUSON S3000 Ultrasound System and a 9L4 probe (4-9 MHz) (Siemens Medical Solution, Mountain View, CA, USA). Shear Wave Velocity (SWV) of the intrinsic foot muscles and PF was measured using a customized software program (Virtual Touch Imaging and Quantification; Siemens Medical Solution). RESULTS Con-A had a moderate correlation with the thickness and cross-sectional area of PF, AbH, FHB, and FDB. A fair to moderate correlation was found between heel Max-F and the thickness and cross-sectional area of PF, AbH, FHB, and FDB. There is no significant correlation between the SWV of the assessed tissues and plantar pressure distribution parameters. Body mass and BMI had a fair to good correlation with Mean-P, Con-A, heel Max-F, midfoot Max-F, metatarsal Max-F, FTI, thickness, and cross-sectional area of the PF and assessed muscles SIGNIFICANCE: The results suggest that abnormal force, contact area, and higher body mass may cause hypertrophy of the PF and foot intrinsic muscles.
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Affiliation(s)
- Serkan Taş
- Toros University, School of Health Sciences, Department of Physiotherapy and Rehabilitation, 33140, Mersin, Turkey.
| | - Alp Çetin
- Hacettepe University, Faculty of Medicine, Department of Physical Medicine and Rehabilitation, 06100, Ankara, Turkey.
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Nichols AEC, Best KT, Loiselle AE. The cellular basis of fibrotic tendon healing: challenges and opportunities. Transl Res 2019; 209:156-168. [PMID: 30776336 PMCID: PMC6545261 DOI: 10.1016/j.trsl.2019.02.002] [Citation(s) in RCA: 115] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 01/30/2019] [Accepted: 02/04/2019] [Indexed: 12/11/2022]
Abstract
Tendon injuries are common and can dramatically impair patient mobility and productivity, resulting in a significant socioeconomic burden and reduced quality of life. Because the tendon healing process results in the formation of a fibrotic scar, injured tendons never regain the mechanical strength of the uninjured tendon, leading to frequent reinjury. Many tendons are also prone to the development of peritendinous adhesions and excess scar formation, which further reduce tendon function and lead to chronic complications. Despite this, there are currently no treatments that adequately improve the tendon healing process due in part to a lack of information regarding the contributions of various cell types to tendon healing and how their activity may be modulated for therapeutic value. In this review, we summarize recent efforts to identify and characterize the distinct cell populations involved at each stage of tendon healing. In addition, we examine the mechanisms through which different cell populations contribute to the fibrotic response to tendon injury, and how these responses can be affected by systemic factors and comorbidities. We then discuss gaps in our current understanding of tendon fibrosis and highlight how new technologies and research areas are shedding light on this clinically important and intractable challenge. A better understanding of the complex cellular environment during tendon healing is crucial to the development of new therapies to prevent fibrosis and promote tissue regeneration.
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Affiliation(s)
- Anne E C Nichols
- Department of Orthopedics & Rehabilitation, Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, New York
| | - Katherine T Best
- Department of Orthopedics & Rehabilitation, Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, New York
| | - Alayna E Loiselle
- Department of Orthopedics & Rehabilitation, Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, New York.
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dos Santos Franco YR, Miyamoto GC, Franco KFM, de Oliveira RR, Cabral CMN. Exercise therapy in the treatment of tendinopathies of the lower limbs: a protocol of a systematic review. Syst Rev 2019; 8:142. [PMID: 31202282 PMCID: PMC6570954 DOI: 10.1186/s13643-019-1058-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 05/30/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Tendinopathies are specific degenerative conditions of the tendon characterized by pain and disability. The most common tendinopathies of the lower limbs are patellar, Achilles, gluteal, and proximal tendinopathy of the hamstring muscles. Exercise therapy has been studied for the treatment of these tendinopathies; however, different types of muscle contraction, exercise, dose, and intensity are found in the literature, which can make choosing the best treatment option difficult. The purpose of this systematic review is to analyze the available evidence about the effectiveness of exercise therapy in the treatment of patients with lower limb tendinopathies and the effects of different types of exercise therapy in the treatment of these patients. METHODS The search strategy will be performed in the following databases: CENTRAL, MEDLINE, EMBASE, PEDro, SPORTDiscus, and CINAHL. The inclusion criteria of the studies will be randomized controlled trials with patients with one of the following tendinopathies: patellar, Achilles, gluteal, and proximal tendinopathy of the hamstring muscles. The primary outcomes will be pain and disability. The intervention will be exercise therapy, and the comparators will be different types of exercise, control groups, or any other type of intervention. DISCUSSION Other systematic reviews have been published about the prescription of exercise therapy in the treatment of tendinopathies of the lower limbs. However, the results of these reviews are limited to only one type of tendinopathy or specific exercise. Because some of these reviews are also outdated, this systematic review will investigate whether exercise therapy is more effective than any other type of intervention and if there is a best form of exercise therapy, considering modality, dose, and intensity, for the treatment of lower limb tendinopathies. Furthermore, this study will present data related to the sample size, recruitment period, methodological quality, and visibility of the eligible studies. SYSTEMATIC REVIEW REGISTRATION PROSPERO ( CRD42018093011 ).
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Affiliation(s)
- Yuri Rafael dos Santos Franco
- Master’s and Doctoral Program in Physical Therapy of Universidade Cidade de São Paulo, Rua Cesário Galeno, 475, Tatuapé, SP Brazil
| | - Gisela Cristiane Miyamoto
- Master’s and Doctoral Program in Physical Therapy of Universidade Cidade de São Paulo, Rua Cesário Galeno, 475, Tatuapé, SP Brazil
| | - Katherinne Ferro Moura Franco
- Master’s and Doctoral Program in Physical Therapy of Universidade Cidade de São Paulo, Rua Cesário Galeno, 475, Tatuapé, SP Brazil
| | | | - Cristina Maria Nunes Cabral
- Master’s and Doctoral Program in Physical Therapy of Universidade Cidade de São Paulo, Rua Cesário Galeno, 475, Tatuapé, SP Brazil
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Costa-Almeida R, Reis RL, Gomes ME. Metabolic Disease Epidemics: Emerging Challenges in Regenerative Medicine. Trends Endocrinol Metab 2019; 30:147-149. [PMID: 30704823 DOI: 10.1016/j.tem.2019.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/11/2018] [Accepted: 01/03/2019] [Indexed: 12/11/2022]
Abstract
The interplay between cell/tissue damage caused by metabolic dysfunction and regenerative potential remains elusive. The tissue engineering and regenerative medicine (TERM) field is now facing a worldwide epidemic of obesity. This Forum article uncovers prospective questions to be addressed in TERM toward the development of effective regenerative therapies adjusted to these new demands.
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Affiliation(s)
- Raquel Costa-Almeida
- 3B's Research Group, I3Bs - Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017 Barco, Guimarães, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Rui L Reis
- 3B's Research Group, I3Bs - Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017 Barco, Guimarães, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal; The Discoveries Centre for Regenerative and Precision Medicine, Headquarters at University of Minho, Avepark, 4805-017 Barco, Guimarães, Portugal
| | - Manuela E Gomes
- 3B's Research Group, I3Bs - Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017 Barco, Guimarães, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal; The Discoveries Centre for Regenerative and Precision Medicine, Headquarters at University of Minho, Avepark, 4805-017 Barco, Guimarães, Portugal.
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Abstract
Pain significantly restricts the quality of life and well-being of older adults. With our increasingly ageing population, it is important to examine whether differing classes of biopsychosocial risk factors can predict the development of pain in older adults. Latent class analysis provides a model-based approach to identifying underlying subgroups in a population, based on some measured characteristics. In this study, latent class analysis was used to identify biopsychosocial risk classes in people aged 50 years and older, from The Irish Longitudinal Study on Ageing, who reported not often being troubled by pain at wave 1 and completed the 2-year follow-up at wave 2 (n = 4458). Four classes were identified based on 11 potential risk factors at wave 1. These classes were characterised as "Low Risk," "Physical Health Risk," "Mental Health Risk," and "High Risk." The Low-Risk class accounted for over half the sample (51.2%), whereas the High-Risk class represented 7.8% of the sample. At follow-up (wave 2), 797 (17.9%) participants reported being troubled by pain. Associations between the biopsychosocial risk classes and developing pain were examined using logistic regression, adjusting for sociodemographic variables. The High-Risk class was more likely to develop pain compared with the Low-Risk class (adjusted OR = 3.16, 95% CI = 2.40-4.16). These results add to existing data in other populations supporting the role of a range of biopsychosocial risk factors that increase the risk of developing pain. These findings have important implications for the identification, and potential moderation, of these risk factors.
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Clinical Measures and Their Contribution to Dysfunction in Individuals With Patellar Tendinopathy. J Sport Rehabil 2019; 28:165-170. [PMID: 29140160 DOI: 10.1123/jsr.2017-0196] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
CONTEXT Patellar tendinopathy (PT) is prevalent in physically active populations, and it affects their quality of living, performance of activity, and may contribute to the early cessation of their athletic careers. A number of previous studies have identified contributing factors for PT; however, their contributions to self-reported dysfunction remain unclear. OBJECTIVE The purpose of this investigation was to determine if strength, flexibility, and various lower-extremity static alignments contributed to self-reported function and influence the severity of PT. DESIGN Cross-sectional research design. SETTING University laboratory. PARTICIPANTS A total of 30 participants with PT volunteered for this study (age: 23.4 [3.6] y, height: 1.8 [0.1] m, mass: 80.0 [20.3] kg, body mass index: 25.7 [4.3]). MAIN OUTCOME MEASURES Participants completed 7 different patient-reported outcomes. Isometric knee extension and flexion strength, hamstring flexibility and alignment measures of rearfoot angle, navicular drop, tibial torsion, q-angle, genu recurvatum, pelvic tilt, and leg length differences were assessed. Pearson's correlation coefficients were assessed to determine significantly correlated outcome variables with each of the patient-reported outcomes. The factors with the highest correlations were used to identify factors that contribute the most to pain and dysfunction using backward selection, linear regression models. RESULTS Correlation analysis found significant relationships between questionnaires and body mass index (r = -.35-.46), normalized knee extension (r = .38-.50) and flexion strength (r = -.34-.50), flexibility (r = .32-.38, q-angle (r = .38-.56), and pelvic tilt (r = -.40). Regression models (R2 = .22-.54) identified thigh musculature strength and supine q-angle to have greatest predictability for severity in patient-reported outcomes. CONCLUSIONS These findings put an emphasis of bodyweight management, improving knee extensor and flexor strength, and posterior flexibility in PT patients.
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Wang EH, Yu ZL, Bu YJ, Xu PW, Xi JY, Liang HY. Grape seed proanthocyanidin extract alleviates high-fat diet induced testicular toxicity in rats. RSC Adv 2019; 9:11842-11850. [PMID: 35517006 PMCID: PMC9063472 DOI: 10.1039/c9ra01017c] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 04/09/2019] [Indexed: 11/25/2022] Open
Abstract
The present study aimed to investigate the protective effects of grape seed proanthocyanidin extract (GSPE) on high-fat diet (HFD) induced testicular damage, oxidative stress, and apoptotic germ cell death. Male rats (n = 40) were randomly divided into four groups: the control group (treated with physiological saline), HFD group, HFD + GSPE (100 mg kg−1) group and HFD + GSPE (300 mg kg−1) group. Compared with the HFD group the rats of the GSPE-treated group showed improved serum testosterone levels, sperm quality and histological appearance of the testis tissue. Significant elevation of antioxidant enzyme (SOD, GSH, and GSH-Px) activities and remarkable reduction in MDA were also observed by GSPE administration, indicating that GSPE can decrease testicular oxidative stress. Finally, a significant reduction in spermatogenic cell apoptosis was detected by TUNEL assay. In summary, these results indicated that GSPE can suppress testicular dysfunction and this effect may be attributed to its antioxidant and anti-apoptotic properties. The current study indicates that GSPE can be considered a promising candidate for use as a drug or a food supplement to alleviate HFD-induced testicular dysfunction. GSPE alleviates high-fat diet induced testicular toxicity in rats by promoting anti-apoptotic activity.![]()
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Affiliation(s)
- Er Hui Wang
- Department of Nutrition and Food Hygiene
- College of Public Health
- Xinxiang Medical University
- Xinxiang 453003
- China
| | - Zeng Li Yu
- Department of Nutrition and Food Hygiene
- College of Public Health
- Xinxiang Medical University
- Xinxiang 453003
- China
| | - Yong Jun Bu
- Department of Nutrition and Food Hygiene
- College of Public Health
- Xinxiang Medical University
- Xinxiang 453003
- China
| | - Peng Wei Xu
- Department of Nutrition and Food Hygiene
- College of Public Health
- Xinxiang Medical University
- Xinxiang 453003
- China
| | - Jin Yan Xi
- Department of Nutrition and Food Hygiene
- College of Public Health
- Xinxiang Medical University
- Xinxiang 453003
- China
| | - Hai Yan Liang
- Department of Nutrition and Food Hygiene
- College of Public Health
- Xinxiang Medical University
- Xinxiang 453003
- China
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Central adiposity and mechanical, perceptual and physiological loading during long duration, repetitive lifting. Clin Biomech (Bristol, Avon) 2018; 60:170-176. [PMID: 30380444 DOI: 10.1016/j.clinbiomech.2018.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 09/05/2018] [Accepted: 10/10/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is an absence of information regarding the impact of central adiposity on loading during long duration, repetitive lifting, and very limited information of the impact of elevated body mass on mechanical loading of the lumbar spine. This information is important in evaluation of the validity of injury prevention standards and interventional approaches in this segment of the population. METHODS This study evaluated the mechanical, physiological, and perceptual loading during repetitive lifting in participants with central adiposity compared to participants with normal body mass index. Videography, accelerometry, heart rate and perceived exertion measures were used to examine alternations in kinematic, kinetic, and exertional parameters during a 1-hour lifting task (3 × 20-min sets; 4 lifts/min; self-selected mass). FINDINGS Low back torque [+69.1 (11.5) Nm], compressive force [+1036.6 (153.6) N] and heart rate [+7.0 (3.5)%] were substantially elevated in participants with central adiposity, however perceived exertion and self-selected mass did not differ between groups. With central adiposity a compensatory mechanism was observed, involving a reduction in trunk vertical displacement [-5.8 (1.9) cm], hip flexion [-6.4 (3.1) deg] and lower-trunk flexion [-10.0 (2.7) deg], which attenuated expected increases to work [9.8 (2.3)%], power [9.5 (4.0)%] and physiological effort. INTERPRETATION While mechanical loading increases secondary to elevated body mass are expected, these results provide new insight into origins of such increases for individuals with a central adiposity somatotype. The differences in mechanical, physiological and perceived loading support provision of individual-specific injury prevention strategies, as well as revision of existing mechanical- and physiological-based ergonomic standards.
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Choi R, Smith M, Clarke E, Little C. Cellular, matrix, and mechano-biological differences in load-bearing versus positional tendons throughout development and aging: a narrative review. Connect Tissue Res 2018; 59:483-494. [PMID: 30231648 DOI: 10.1080/03008207.2018.1504929] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE Summarise available evidence comparing the cellular, biochemical, structural and biomechanical properties, and the changes that occur in these parameters in response to stimuli, in differentially loaded tendons across different stages of life. METHODS The PubMed database was searched for literature pertaining to differences between tendons using the term "tendon" or "tendinopathy", plus one or more of the following descriptors: "loading", "positional", "weight- or load-bearing", and "energy-storing". The abstracts were reviewed and relevant full-length articles retrieved and used to assemble a narrative review. RESULTS The incidence and prevalence of tendon disorders ("tendinopathies") is increasing in Western societies, with limited evidence that currently available treatments have any significant long-term effect on the disease course. A key emerging hypothesis is that disease in different tendons and even different regions within a tendon may be distinct. The available literature indicates that there are phenotypic differences, not only in the constitutive compositional and material properties but also in resident cells of positional compared with load-bearing tendons. Evident during early tendon growth, such differences have become well established by adulthood. CONCLUSIONS The pheno-endotype of tendinopathy may be distinct between load-bearing tendons compared to positional tendons, which has translational implications with regard to preventing and managing tendinopathy. Better understanding of the molecular, cellular, and biomechanical pathophysiology underlying disease phenotypes, will allow more targeted/personalised treatment and therefore improve outcomes.
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Affiliation(s)
- Rachel Choi
- a Raymond Purves Bone and Joint Research Laboratories, Institute of Bone and Joint Research and Kolling Institute, Sydney Medical School , University of Sydney, at Royal North Shore Hospital , St Leonards , Australia.,b Murray Maxwell Biomechanics Laboratory, Institute of Bone and Joint Research and Kolling Institute, Sydney Medical School , University of Sydney, at Royal North Shore Hospital , St Leonards , Australia
| | - Margaret Smith
- a Raymond Purves Bone and Joint Research Laboratories, Institute of Bone and Joint Research and Kolling Institute, Sydney Medical School , University of Sydney, at Royal North Shore Hospital , St Leonards , Australia
| | - Elizabeth Clarke
- b Murray Maxwell Biomechanics Laboratory, Institute of Bone and Joint Research and Kolling Institute, Sydney Medical School , University of Sydney, at Royal North Shore Hospital , St Leonards , Australia
| | - Christopher Little
- a Raymond Purves Bone and Joint Research Laboratories, Institute of Bone and Joint Research and Kolling Institute, Sydney Medical School , University of Sydney, at Royal North Shore Hospital , St Leonards , Australia
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The Calcaneal Crescent in Patients With and Without Plantar Fasciitis: An Ankle MRI Study. AJR Am J Roentgenol 2018; 211:1075-1082. [PMID: 30160979 DOI: 10.2214/ajr.17.19399] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The bundled, crescent-shaped trabeculae within the calcaneal tuberosity-which we term and refer to here as the "calcaneal crescent"-may represent a structural adaption to the prevailing forces. Given Wolff law, we hypothesized that the calcaneal crescent would be more robust in patients with plantar fasciitis, a syndrome in part characterized by overload of the Achilles tendon-calcaneal crescent-plantar fascia system, than in patients without plantar fasciitis. MATERIALS AND METHODS MR images of 37 patients (27 women and 10 men; mean age ± SD, 51 ± 13 years; mean body mass index [BMI, weight in kilograms divided by the square of height in meters], 26.8 ± 6.3) referred for workup of foot or ankle pain were retrospectively evaluated by two blinded readers in this study. Patients were assigned to two groups: group A, which was composed of 15 subjects without clinical signs or MRI findings of Achilles tendon-calcaneal crescent-plantar fascia system abnormalities, or group B, which was composed of 22 patients with findings of plantar fasciitis. The thickness and cross-sectional area (CSA) of the Achilles tendon, calcaneal crescent, and plantar fascia were measured on proton density (PD)-weighted MR images. The entire crescent volume was manually measured using OsiriX software on consecutive sagittal PD-weighted images. Additionally, contrast-to-noise ratio (CNR) as a surrogate marker for trabecular density and the mean thickness of the calcaneal crescent were determined on PD-weighted MR images. The groupwise difference in the morphologic measurements were evaluated using ANOVA with BMI as a covariate. Partial correlation was used to assess the relationships of measurements for the group with plantar fasciitis (group B). Intraclass correlation coefficient (ICC) statistics were performed. RESULTS Patients with plantar fasciitis had a greater CSA and volume of the calcaneal crescent and had lower CNR (i.e., denser trabeculae) than those without Achilles tendon-calcaneal crescent-plantar fascia system abnormalities (CSA, 100.2 vs 73.7 mm2, p = 0.019; volume, 3.06 vs 1.99 cm3, p = 0.006; CNR, -28.40 vs -38.10, p = 0.009). Interreader agreement was excellent (ICC = 0.85-0.99). CONCLUSION In patients with plantar fasciitis, the calcaneal crescent is enlarged compared with those without abnormalities of the Achilles tendon-calcaneal crescent-plantar fascia system. An enlarged and trabeculae-rich calcaneal crescent may potentially indicate that abnormally increased forces are being exerted onto the Achilles tendon-calcaneal crescent-plantar fascia system.
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Yang Y, Lu H, Qu J. Tendon pathology in hypercholesterolaemia patients: Epidemiology, pathogenesis and management. J Orthop Translat 2018; 16:14-22. [PMID: 30723677 PMCID: PMC6350019 DOI: 10.1016/j.jot.2018.07.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 07/04/2018] [Accepted: 07/12/2018] [Indexed: 01/18/2023] Open
Abstract
Tendon pathology is a general term used to describe a group of musculoskeletal conditions related to tendons and surrounding structures. There is only limited evidence available regarding the exact aetiology and natural history of tendon pathology. In hypercholesterolaemia environments, lipids could accumulate within the extracellular matrix of the tendon and thus affect the mechanical properties of the tendon. Current evidence suggested that hypercholesterolaemia was an important risk factor in the development and progression of tendon pathology. The severity of hypercholesterolaemia was correlated with the severity of tendon pathology. The translational potential of this article: Hypercholesterolaemia lead to the structural, inflammatory and mechanical changes in tendons, which predispose hypercholesterolaemia patients to a greater risk of tendon pathology. Measurements of serum cholesterol are suggested to be performed in patients presenting with tendon pathology. The strict control of hypercholesterolaemia would mitigate the development and progression of tendon pathology.
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Affiliation(s)
- Yang Yang
- Department of Cardiovascular Disease, The Second Xiangya Hospital, Central South University, Changsha 410011, PR China
| | - Hongbin Lu
- Department of Sports Medicine, Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Xiangya Hospital, Central South University, Changsha 410008, PR China
| | - Jin Qu
- Department of Sports Medicine, Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Xiangya Hospital, Central South University, Changsha 410008, PR China
- Corresponding author. Department of Sports Medicine, Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Xiangya Hospital, Central South University, Changsha 410008, PR China.
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Kaplan K, Hanney WJ, Cheatham SW, Masaracchio M, Liu X, Kolber MJ. Rotator Cuff Tendinopathy: An Evidence-Based Overview for the Sports Medicine Professional. Strength Cond J 2018. [DOI: 10.1519/ssc.0000000000000364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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