1
|
Endo T, Takahata M, Koike Y, Fujita R, Yoneoka D, Kanayama M, Kadoya K, Hasegawa T, Terkawi MA, Yamada K, Sudo H, Ebata T, Ishii M, Iwasaki N. Ossification of the posterior longitudinal ligament is linked to heterotopic ossification of the ankle/foot tendons. J Bone Miner Metab 2024:10.1007/s00774-024-01518-2. [PMID: 38850283 DOI: 10.1007/s00774-024-01518-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 05/06/2024] [Indexed: 06/10/2024]
Abstract
INTRODUCTION Systemic osteogenesis has been speculated to be involved in the pathogenesis of ossification of the posterior longitudinal ligament (OPLL). Our purpose was to compare the radiologic prevalence and severity of heterotopic ossification in foot tendons of Japanese patients with OPLL and to determine their association with systemic heterotopic ossification. MATERIALS AND METHODS Clinical and radiographic data of 114 patients with OPLL were collected from 2020 to 2022. Control data were extracted from a medical database of 362 patients with ankle radiographs. Achilles and plantar tendon ossification were classified as grades 0-4, and the presence of osteophytes at five sites in the foot/ankle joint was assessed by radiography. Factors associated with the presence and severity of each ossification were evaluated by multivariable logistic regression and linear regression analysis. RESULTS The prevalence of Achilles and plantar tendon ossification (grade ≥ 2) was 4.0-5.5 times higher in patients with OPLL (40-56%) than in the controls (10-11%). The presence of Achilles tendon ossification was associated with OPLL, age, and coexisting plantar tendon ossification, and was most strongly associated with OPLL (standardized regression coefficient, 0.79; 95% confidence interval, 1.34-2.38). The severity of Achilles and plantar tendon ossification was associated with the severity of ossification of the entire spinal ligament. CONCLUSIONS The strong association of foot tendon ossification with OPLL suggests that patients with OPLL have a systemic osteogenesis background. These findings will provide a basis for exploring new treatment strategies for OPLL, including control of metabolic abnormalities.
Collapse
Affiliation(s)
- Tsutomu Endo
- Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
- Department of Orthopedics, Hakodate Central General Hospital, 33-2 Hon-cho, Hakodate, Hokkaido, 040-8585, Japan.
| | - Masahiko Takahata
- Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Yoshinao Koike
- Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Ryo Fujita
- Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Daisuke Yoneoka
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 2-7-2 Fujimi, Chiyoda-ku, Tokyo, 102-0071, Japan
| | - Masahiro Kanayama
- Department of Orthopedics, Hakodate Central General Hospital, 33-2 Hon-cho, Hakodate, Hokkaido, 040-8585, Japan
| | - Ken Kadoya
- Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Tomoka Hasegawa
- Developmental Biology of Hard Tissue, Graduate School of Dental Medicine, Faculty of Dental Medicine, Hokkaido University, Sapporo, 060-8586, Japan
| | - Mohamad Alaa Terkawi
- Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Katsuhisa Yamada
- Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Hideki Sudo
- Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Taku Ebata
- Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Misaki Ishii
- Department of Orthopedics, Hakodate Central General Hospital, 33-2 Hon-cho, Hakodate, Hokkaido, 040-8585, Japan
| | - Norimasa Iwasaki
- Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Kita-15 Nishi-7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| |
Collapse
|
2
|
Extensive Ossification of the Achilles Tendon with and without Acute Fracture: A Scoping Review. J Clin Med 2021; 10:jcm10163480. [PMID: 34441776 PMCID: PMC8396855 DOI: 10.3390/jcm10163480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/30/2021] [Accepted: 08/05/2021] [Indexed: 11/16/2022] Open
Abstract
Extensive Ossification of the Achilles Tendon (EOAT) is an uncommon condition characterized by the presence of heterotopic ossification within the substance of the Achilles Tendon and is distinct from other tendinopathies associated with tendon mineralization. The purpose of this scoping review of the literature on EOAT is to describe the pathogenesis, patient population, presentation, management, and outcomes of this rare condition. Fifty-four articles were included in the scoping review after screening and selection. According to the literature, EOAT often presents with pain and swelling around the Achilles Tendon and is frequently associated with acute trauma. EOAT is more common in men, and although the exact mechanisms of the pathology are not fully understood, EOAT may demonstrate specific molecular signaling patterns. The lack of knowledge regarding the molecular mechanism may be a significant hindrance to the management of the condition. Even though a standard treatment regimen for EOAT does not exist, conservative management for six months in patients without complications is recommended. Those who have an acute fracture of the ossification should be managed more aggressively and will often require surgical repair with autograft, although there is no standardized procedure at this time. Clinicians should be aware of the typical presentation, risk factors, and management options of patients with EOAT. Additionally, they should be cautious when selecting treatment strategies and conduct a thorough evaluation of long-term outcomes with various treatment modalities, which this review provides. Most important, this review highlights the need for further research to determine the best course of clinical treatment of EOAT injuries, in order to establish a standard treatment regimen.
Collapse
|
3
|
Hatano M, Kitajima I, Yamamoto S, Nakamura M, Isawa K, Hirota Y, Suwabe T, Hoshino J, Sawa N, Ubara Y. New bone-like tissue formation in calcific tendinopathy: A case report. Bone Rep 2021; 14:101062. [PMID: 33898660 DOI: 10.1016/j.bonr.2021.101062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/27/2021] [Accepted: 03/29/2021] [Indexed: 10/21/2022] Open
Abstract
Currently, the pathogenesis of nontraumatic heterotopic ossification (HO), e.g., bone-like tissue in calcific tendinopathy remains unclear. Here, we report a 75-year-old, right-handed Japanese woman who had been on hemodialysis for 3 years and was admitted to our hospital to evaluate pain and swelling of the right forearm. She worked as a cook, and her main job over the 3 most recent years had been the frequent and continuous shredding of cabbage. A radiograph showed the highly radiopaque material on the dorsal aspect of the right wrist and in the right shoulder. The biopsy of this radiopaque material revealed HO with marrow, as well as calcified material. Histomorphometric analysis of the HO identified a severe type of osteitis fibrosa with a fibrous tissue volume to total volume of 19.8% (>0.5% required for diagnosis) and an osteoid volume to bone volume of 20.0% (>15% required for diagnosis). We found more woven bone-like tissue than lamellar bone-like tissue. However, the intact parathyroid hormone level was 3-times the normal upper limit with 203 pg/mL, but histomorphometric analysis of the right iliac crest revealed normal bone structure. These findings indicate that the frequent and continuous shredding action with the right hand contributed to the nontraumatic HO localized on the dorsal aspect of the right wrist.
Collapse
Key Words
- ALP, alkaline phosphatase
- BAP, bone alkaline phosphatase
- BFR/BV, bone formation rate per unit of bone volume
- BMPs, bone morphogenetic proteins
- BV/TV, trabecular bone volume to total volume
- Bone histomorphometry
- CKD-MBD, chronic kidney disease-mineral and bone disorder
- Calcific tendinopathy
- ES/BS, eroded surface to bone surface
- Fb.V/TV, fibrous tissue volume to total volume
- HO, heterotopic ossification
- Heterotopic ossification
- N.Oc/BS, number of osteoclasts to bone surface
- New bone-like tissue formation
- O.Th, osteoid thickness
- OS/BS, osteoid surface to bone surface
- OV/BV, osteoid volume to bone volume
- OV/TV, osteoid volume to tissue volume
- Ob.S/BS, osteoblasts surface to bone surface
- PTH, parathyroid hormone
- Tb.Th, trabecular thickness
- W.Th, trabecular unit wall thickness
Collapse
Affiliation(s)
- Masaki Hatano
- Department of Orthopaedic Surgery, Toranomon Hospital, Tokyo, Japan
| | - Izuru Kitajima
- Department of Orthopaedic Surgery, Toranomon Hospital, Tokyo, Japan
| | - Seizo Yamamoto
- Department of Orthopaedic Surgery, Toranomon Hospital, Tokyo, Japan
| | - Masaki Nakamura
- Department of Orthopaedic Surgery, Toranomon Hospital, Tokyo, Japan
| | - Kazuya Isawa
- Department of Orthopaedic Surgery, Toranomon Hospital, Tokyo, Japan
| | - Yutaka Hirota
- Department of Orthopaedic Surgery, Toranomon Hospital, Tokyo, Japan
| | - Tatsuya Suwabe
- Department of Nephrology Center, Toranomon Hospital, Tokyo, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Junichi Hoshino
- Department of Nephrology Center, Toranomon Hospital, Tokyo, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Naoki Sawa
- Department of Nephrology Center, Toranomon Hospital, Tokyo, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Yoshihumi Ubara
- Department of Nephrology Center, Toranomon Hospital, Tokyo, Japan.,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| |
Collapse
|
4
|
Sullivan D, Thurston M. Acute fracture of extensive Achilles tendon calcific tendinopathy. J Osteopath Med 2021; 121:523-524. [PMID: 33691351 DOI: 10.1515/jom-2020-0309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 01/26/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Daniel Sullivan
- Rocky Vista University College of Osteopathic Medicine, Ivins, UT, USA
| | - McKennan Thurston
- Rocky Vista University College of Osteopathic Medicine, Ivins, UT, USA
| |
Collapse
|
5
|
Liu H, Xu J, Jiang R. Mkx-Deficient Mice Exhibit Hedgehog Signaling-Dependent Ectopic Ossification in the Achilles Tendons. J Bone Miner Res 2019; 34:557-569. [PMID: 30458056 PMCID: PMC6535142 DOI: 10.1002/jbmr.3630] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 10/25/2018] [Accepted: 11/06/2018] [Indexed: 01/02/2023]
Abstract
Heterotopic ossification is the abnormal formation of mineralized bone in skin, muscle, tendon, or other soft tissues. Tendon ossification often occurs from acute tendon injury or chronic tendon degeneration, for which current treatment relies heavily on surgical removal of the ectopic bony tissues. Unfortunately, surgery creates additional trauma, which often causes recurrence of heterotopic ossification. The molecular mechanisms of heterotopic ossification are not well understood. Previous studies demonstrate that Mkx is a transcription factor crucial for postnatal tendon fibril growth. Here we report that Mkx-/- mutant mice exhibit ectopic ossification in the Achilles tendon within 1 month after birth and the tendon ossification deteriorates with age. Genetic lineage labeling revealed that the tendon ossification in Mkx-/- mice resulted from aberrant differentiation of tendon progenitor cells. Furthermore, tissue-specific inactivation of Mkx in tendon cells postnatally resulted in a similar ossification phenotype, indicating that Mkx plays a key role in tendon tissue homeostasis. Moreover, we show that Hedgehog signaling is ectopically activated at early stages of tendon ossification and that tissue-specific inactivation of Smoothened, which encodes the obligatory transducer of Hedgehog signaling, in the tendon cell lineage prevented or dramatically reduced tendon ossification in Mkx-/- mice. Together, these studies establish a new genetic mouse model of tendon ossification and provide new insight into its pathogenic mechanisms. © 2018 American Society for Bone and Mineral Research.
Collapse
Affiliation(s)
- Han Liu
- Division of Developmental Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jingyue Xu
- Division of Developmental Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Rulang Jiang
- Division of Developmental Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Division of Plastic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Shriners Hospitals for Children-Cincinnati, Cincinnati, OH, USA
| |
Collapse
|
6
|
Manfreda F, Ceccarini P, Corzani M, Petruccelli R, Antinolfi P, Rinonapoli G, Caraffa A. A silent massive ossification of Achilles tendon as a suspected rare late effect of surgery for club foot. SAGE Open Med Case Rep 2018; 6:2050313X18775587. [PMID: 29785267 PMCID: PMC5954578 DOI: 10.1177/2050313x18775587] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 04/16/2018] [Indexed: 11/17/2022] Open
Abstract
We report the case of a 66-year-old male patient with massive ossification of the distal portion of the Achilles tendon, as a late consequence of a surgical release for club foot conducted in his childhood. The singularity of the case report derives from its clinical features: the bone mass was of abnormal dimensions, almost substituting the entire tendon; the condition had always been asymptomatic, without deficits in range of motion, in absence of either pain or biomechanical defects with age. In fact, the condition was diagnosed just recently as a consequence of a tear. Despite an ultrasound diagnosis after the injury, only during the surgical treatment, a proper evaluation of the entity of the pathology was possible. Although the ossification of Achilles tendon is a rare clinical condition with a complex multifactorial etiology, in our case report, some of the elements in the patient's medical history could be useful for the pathogenesis and early diagnosis of the disease. The aim of this case report is to emphasize the importance both of a correct evaluation of clinical history and of an accurate diagnosis, in order to conduct a proper management of this pathology.
Collapse
Affiliation(s)
- Francesco Manfreda
- Department of Orthopedics and Traumatology, University of Perugia, Perugia, Italy
| | - Paolo Ceccarini
- Division of Orthopedics and Trauma Surgery, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Marco Corzani
- Department of Orthopedics and Traumatology, University of Perugia, Perugia, Italy
| | - Rosario Petruccelli
- Department of Orthopedics and Traumatology, University of Perugia, Perugia, Italy
| | - Pierluigi Antinolfi
- Division of Orthopedics and Trauma Surgery, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Giuseppe Rinonapoli
- Department of Orthopedics and Traumatology, University of Perugia, Perugia, Italy.,Division of Orthopedics and Trauma Surgery, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Auro Caraffa
- Department of Orthopedics and Traumatology, University of Perugia, Perugia, Italy.,Division of Orthopedics and Trauma Surgery, Santa Maria della Misericordia Hospital, Perugia, Italy
| |
Collapse
|
7
|
Lees-Shepard JB, Goldhamer DJ. Stem cells and heterotopic ossification: Lessons from animal models. Bone 2018; 109:178-186. [PMID: 29409971 PMCID: PMC5866227 DOI: 10.1016/j.bone.2018.01.029] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 01/22/2018] [Accepted: 01/24/2018] [Indexed: 12/21/2022]
Abstract
Put most simply, heterotopic ossification (HO) is the abnormal formation of bone at extraskeletal sites. HO can be classified into two main subtypes, genetic and acquired. Acquired HO is a common complication of major connective tissue injury, traumatic central nervous system injury, and surgical interventions, where it can cause significant pain and postoperative disability. A particularly devastating form of HO is manifested in the rare genetic disorder, fibrodysplasia ossificans progressiva (FOP), in which progressive heterotopic bone formation occurs throughout life, resulting in painful and disabling cumulative immobility. While the central role of stem/progenitor cell populations in HO is firmly established, the identity of the offending cell type(s) remains to be conclusively determined, and little is known of the mechanisms that direct these progenitor cells to initiate cartilage and bone formation. In this review, we summarize current knowledge of the cells responsible for acquired HO and FOP, highlighting the strengths and weaknesses of animal models used to interrogate the cellular origins of HO.
Collapse
Affiliation(s)
- John B Lees-Shepard
- Department of Molecular & Cell Biology, University of Connecticut Stem Cell Institute, University of Connecticut, Storrs, CT 06269, United States
| | - David J Goldhamer
- Department of Molecular & Cell Biology, University of Connecticut Stem Cell Institute, University of Connecticut, Storrs, CT 06269, United States.
| |
Collapse
|