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Chen J, Svensson J, Sundberg CJ, Ahmed AS, Ackermann PW. FGF gene expression in injured tendons as a prognostic biomarker of 1-year patient outcome after Achilles tendon repair. J Exp Orthop 2021; 8:20. [PMID: 33694106 PMCID: PMC7947072 DOI: 10.1186/s40634-021-00335-0] [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: 09/30/2020] [Accepted: 02/11/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Healing outcome after Achilles Tendon Rupture (ATR) is variable and unsatisfactory. Many ATR patients still exhibit pain, functional deficits and limitations in walking one-year post-surgery. The present study was designed to investigate the association between the expression of healing biomarkers and patient outcome after ATR. METHODS Tendon biopsies were collected from 25 ATR patients during surgery. At 1-year post surgery, all patients completed questionnaires; Achilles tendon Total Rupture Score (ATRS) and Foot and Ankle Outcome Score (FAOS), and were tested for functional outcomes by heel-rise test. In biopsies, FGF, COL III, FN, COL I and MMP-9 mRNA levels were assessed by quantitative RT-PCR while protein expression was studied by immunohistochemistry (IHC). RESULTS Our analysis confirmed the presence of FGF, COL III, FN, COL I and MMP-9 at mRNA and protein levels in tendon biopsies. FGF gene expression associated positively with improved total ATRS and better functional outcomes. Additionally, FGF mRNA levels were associated with less pain, less running limitations and less loss in physical activity. In addition, higher COL III mRNA expression was associated with more tendon strength. CONCLUSION Our findings indicate that FGF gene expression is associated with improved patient-reported outcome. FGF expression in surgical biopsies could potentially be used to assist the prognostic evaluation of patient outcome and may be used as a predictor for healing. However, further studies are needed to evaluate the role of FGF in Achilles tendon healing. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Junyu Chen
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 76, Stockholm, Sweden
| | - Joel Svensson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 76, Stockholm, Sweden
| | - Carl-Johan Sundberg
- Department of Physiology & Pharmacology, Karolinska Institutet, Stockholm, Sweden.,Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Aisha Siddiqah Ahmed
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 76, Stockholm, Sweden
| | - Paul W Ackermann
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 76, Stockholm, Sweden.
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Nguyen QT, Norelli JB, Graver A, Ekstein C, Schwartz J, Chowdhury F, Drakos MC, Grande DA, Chahine NO. Therapeutic Effects of Doxycycline on the Quality of Repaired and Unrepaired Achilles Tendons. Am J Sports Med 2017; 45:2872-2881. [PMID: 28759732 DOI: 10.1177/0363546517716637] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Achilles tendon tears are devastating injuries, especially to athletes. Elevated matrix metalloproteinase (MMP) activity after a tendon injury has been associated with deterioration of the collagen network and can be inhibited with doxycycline (Doxy). HYPOTHESIS Daily oral administration of Doxy will enhance the histological, molecular, and biomechanical quality of transected Achilles tendons. Additionally, suture repair will further enhance the quality of repaired tendons. STUDY DESIGN Controlled laboratory study. METHODS Randomized unilateral Achilles tendon transection was performed in 288 adult male Sprague-Dawley rats. The injured tendons were either unrepaired (groups 1 and 2) or surgically repaired (groups 3 and 4). Animals from groups 2 and 4 received Doxy daily through oral gavage, and animals from groups 1 and 3 served as controls (no Doxy). Tendons were harvested at 1.5, 3, 6, and 9 weeks after the injury (n = 18 per group and time point). The quality of tendon repair was evaluated based on the histological grading score, collagen fiber orientation, gene expression, and biomechanical properties. RESULTS In surgically repaired samples, Doxy enhanced the quality of tendon repair compared with no Doxy ( P = .0014). Doxy had a significant effect on collagen fiber dispersion, but not principal fiber angle. There was a significant effect of time on the gene expression of MMP-3, MMP-9 and TIMP1, and Doxy significantly decreased MMP-3 expression at 9 weeks. Doxy treatment with surgical repair increased the dynamic modulus at 6 weeks but not at 9 weeks after the injury ( P < .001). Doxy also increased the equilibrium modulus and decreased creep strain irrespective of the repair group. Doxy did not have a significant effect on the histology or biomechanics of unrepaired tendons. CONCLUSION The findings indicate that daily oral administration of Doxy accelerated matrix remodeling and the dynamic and equilibrium biomechanics of surgically repaired Achilles tendons, although such enhancements were most evident at the 3- to 6-week time points. CLINICAL RELEVANCE The inhibition of MMPs at the optimal stage of the repair process may accelerate Achilles tendon repair and improve biomechanical properties, especially when paired with surgical management.
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Affiliation(s)
- Quynhhoa T Nguyen
- Bioengineering-Biomechanics Laboratory, The Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Jolanta B Norelli
- Orthopaedic Research Laboratory, The Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York, USA.,Hofstra Northwell School of Medicine, Hofstra University, Hempstead, New York, USA
| | - Adam Graver
- Department of Orthopaedic Surgery, Long Island Jewish Medical Center, New Hyde Park, New York, USA
| | - Charles Ekstein
- Department of Orthopaedic Surgery, Long Island Jewish Medical Center, New Hyde Park, New York, USA
| | - Johnathan Schwartz
- Orthopaedic Research Laboratory, The Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Farzana Chowdhury
- Bioengineering-Biomechanics Laboratory, The Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Mark C Drakos
- Department of Orthopaedic Surgery, Long Island Jewish Medical Center, New Hyde Park, New York, USA.,Hospital for Special Surgery, New York, New York, USA
| | - Daniel A Grande
- Orthopaedic Research Laboratory, The Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York, USA.,Hofstra Northwell School of Medicine, Hofstra University, Hempstead, New York, USA.,Department of Orthopaedic Surgery, Long Island Jewish Medical Center, New Hyde Park, New York, USA
| | - Nadeen O Chahine
- Bioengineering-Biomechanics Laboratory, The Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York, USA.,Hofstra Northwell School of Medicine, Hofstra University, Hempstead, New York, USA
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Zietek P, Karaczun M, Kruk B, Szczypior K. Percutaneous, Minimally Invasive Repair of Traumatic and Simultaneous Rupture of Both Achilles Tendons: A Case Report. J Foot Ankle Surg 2015; 55:642-4. [PMID: 26002678 DOI: 10.1053/j.jfas.2015.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Indexed: 02/03/2023]
Abstract
Achilles injury is a common musculoskeletal disorder. Bilateral rupture of the Achilles tendon, however, is much less common and usually occurs spontaneously. Complete, traumatic, and bilateral ruptures are rare and typically require long periods of immobilization before the patient can return to full weightbearing. A 52-year-old male was hospitalized for bilateral traumatic rupture to both Achilles tendons. No risk factors for tendon rupture were found. Blood samples revealed no peripheral blood pathologic features. Both tendons were repaired with percutaneous, minimally invasive surgery using the Achillon(®) tendon suture system. Rehabilitation was begun 4 weeks later. An ankle-foot orthosis was prescribed to provide ankle support with an adjustable range of movement, and active plantar flexion was set at 0° to 30°. The patient remained non-weightbearing with the ankle-foot orthosis device and performed active range-of-motion exercises. At 8 weeks after surgery, we recommended that he begin walking with partial weightbearing using a foot-tibial orthosis with the range of motion set to 45° plantar flexion and 15° dorsiflexion. At 10 weeks postoperatively, he was encouraged to return to full weightbearing on both feet. Beginning rehabilitation as soon as possible after minimally invasive surgery, compared with 6 weeks of immobilization after surgery, provided a rapid resumption to full weightbearing. We emphasize the clinical importance of a safe, simple treatment program that can be followed for a patient with damage to the Achilles tendons. To our knowledge, ours is the first report of minimally invasive repair of bilateral simultaneous traumatic rupture of the Achilles tendon.
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Affiliation(s)
- Pawel Zietek
- Orthopedist, Department of Orthopaedics and Traumatology, Pomeranian Medical University, Szczecin, Poland.
| | - Maciej Karaczun
- Orthopedist, Department of Orthopaedics and Traumatology, Pomeranian Medical University, Szczecin, Poland
| | - Bartosz Kruk
- Orthopedist, Department of Orthopaedics and Traumatology, Pomeranian Medical University, Szczecin, Poland
| | - Karina Szczypior
- Physiotherapist, Department of Orthopaedics and Traumatology, Pomeranian Medical University, Szczecin, Poland
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