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Palee S, Yener U, Abd-Elsayed A, Wahezi SE. Is Chronic Tendon Pain Caused by Neuropathy? Exciting Breakthroughs may Direct Potential Treatment. Curr Pain Headache Rep 2024:10.1007/s11916-024-01299-3. [PMID: 39028489 DOI: 10.1007/s11916-024-01299-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Tendinopathy significantly impacts the quality of life and imposes a high economic burden, accounting for a large proportion of sports and musculoskeletal injuries. Traditionally considered a collagen-related inflammatory disorder, emerging evidence suggests a critical role of neuropathic processes in chronic tendon pain. OBJECTIVE This review aims to evaluate the neuropathic mechanisms in tendinopathy and discuss innovative treatments targeting these pathways. METHODS We analyze recent studies highlighting the tendon innervation, pathological nerve sprouting neuronal ingrowth in tendinopathy, and the associated increase in pain and neuronal mediators. RESULTS Chronic tendinopathy exhibits nociceptive sprouting from paratenon into the fibrous tendon proper. Innovative treatments such as Percutaneous Ultrasound-Guided Tenotomy (PUT) or high-frequency ultrasound interventions show promise in targeting these neuropathic components by paratenon separation. These approaches focus on disrupting the pathological innervation cycle. CONCLUSION Chronic tendon pain may be predominantly neuropathic, driven by pathologic neuronal ingrowth from paratenon into the tendon proper. Interventions that accurately target and disrupt these nerve pathways could revolutionize the treatment of tendinopathy. Further research is required to validate these findings and refine treatment modalities to ensure safety and efficacy.
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Affiliation(s)
- Suwannika Palee
- Department of Rehabilitation Medicine, Faculty of Medicine, Naresuan University, Mueng Phitsanulok, Thailand
| | - Ugur Yener
- Department of Physical Medicine & Rehabilitation, Montefiore Medical Center, 1250 Waters Place, Tower #2 8th Floor, Bronx, NY, 10461, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin, Madison, Wisconsin, USA
| | - Sayed Emal Wahezi
- Department of Physical Medicine & Rehabilitation, Montefiore Medical Center, 1250 Waters Place, Tower #2 8th Floor, Bronx, NY, 10461, USA.
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2
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Dakkak M. Ultrasound-guided treatment of medial collateral ligament calcification of the knee with TenJet™: a case report. Pain Manag 2024; 14:29-33. [PMID: 38189140 DOI: 10.2217/pmt-2023-0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024] Open
Abstract
Calcification of the medial collateral ligament is a rare cause of medial knee pain along with functional impairment. Most cases are asymptomatic but those that are symptomatic typically respond to conservative management. However, in those instances with persistent symptoms that desire further intervention but want to minimize the risks associated with surgery, we present a novel approach for calcium removal with an ultrasound-guided percutaneous needle tenotomy with TenJet™ as a reasonable treatment modality.
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Affiliation(s)
- Michael Dakkak
- Orthopaedic surgery, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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3
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Luo J, Wang Z, Tang C, Yin Z, Huang J, Ruan D, Fei Y, Wang C, Mo X, Li J, Zhang J, Fang C, Li J, Chen X, Shen W. Animal model for tendinopathy. J Orthop Translat 2023; 42:43-56. [PMID: 37637777 PMCID: PMC10450357 DOI: 10.1016/j.jot.2023.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/18/2023] [Accepted: 06/30/2023] [Indexed: 08/29/2023] Open
Abstract
Background Tendinopathy is a common motor system disease that leads to pain and reduced function. Despite its prevalence, our mechanistic understanding is incomplete, leading to limited efficacy of treatment options. Animal models contribute significantly to our understanding of tendinopathy and some therapeutic options. However, the inadequacies of animal models are also evident, largely due to differences in anatomical structure and the complexity of human tendinopathy. Different animal models reproduce different aspects of human tendinopathy and are therefore suitable for different scenarios. This review aims to summarize the existing animal models of tendinopathy and to determine the situations in which each model is appropriate for use, including exploring disease mechanisms and evaluating therapeutic effects. Methods We reviewed relevant literature in the PubMed database from January 2000 to December 2022 using the specific terms ((tendinopathy) OR (tendinitis)) AND (model) AND ((mice) OR (rat) OR (rabbit) OR (lapin) OR (dog) OR (canine) OR (sheep) OR (goat) OR (horse) OR (equine) OR (pig) OR (swine) OR (primate)). This review summarized different methods for establishing animal models of tendinopathy and classified them according to the pathogenesis they simulate. We then discussed the advantages and disadvantages of each model, and based on this, identified the situations in which each model was suitable for application. Results For studies that aim to study the pathophysiology of tendinopathy, naturally occurring models, treadmill models, subacromial impingement models and metabolic models are ideal. They are closest to the natural process of tendinopathy in humans. For studies that aim to evaluate the efficacy of possible treatments, the selection should be made according to the pathogenesis simulated by the modeling method. Existing tendinopathy models can be classified into six types according to the pathogenesis they simulate: extracellular matrix synthesis-decomposition imbalance, inflammation, oxidative stress, metabolic disorder, traumatism and mechanical load. Conclusions The critical factor affecting the translational value of research results is whether the selected model is matched with the research purpose. There is no single optimal model for inducing tendinopathy, and researchers must select the model that is most appropriate for the study they are conducting. The translational potential of this article The critical factor affecting the translational value of research results is whether the animal model used is compatible with the research purpose. This paper provides a rationale and practical guide for the establishment and selection of animal models of tendinopathy, which is helpful to improve the clinical transformation ability of existing models and develop new models.
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Affiliation(s)
- Junchao Luo
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Zhejiang University, 310058, Hangzhou, Zhejiang, China
- Orthopedics Research Institute of Zhejiang University, 310058, Hangzhou City, Zhejiang Province, China
- Sports Medicine Institute of Zhejiang University, 310058, Hangzhou, Zhejiang, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, 315825, Hangzhou, Zhejiang, China
- Clinical Research Center of Motor System Disease of Zhejiang Province, 315825, Hangzhou, Zhejiang, China
- Dr. Li Dak Sum and Yip Yio Chin Center for Stem Cell and Regenerative Medicine, Zhejiang University, 310058, Hangzhou, Zhejiang, China
| | - Zetao Wang
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Zhejiang University, 310058, Hangzhou, Zhejiang, China
- Orthopedics Research Institute of Zhejiang University, 310058, Hangzhou City, Zhejiang Province, China
- Sports Medicine Institute of Zhejiang University, 310058, Hangzhou, Zhejiang, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, 315825, Hangzhou, Zhejiang, China
- Clinical Research Center of Motor System Disease of Zhejiang Province, 315825, Hangzhou, Zhejiang, China
- Dr. Li Dak Sum and Yip Yio Chin Center for Stem Cell and Regenerative Medicine, Zhejiang University, 310058, Hangzhou, Zhejiang, China
| | - Chenqi Tang
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Zhejiang University, 310058, Hangzhou, Zhejiang, China
- Orthopedics Research Institute of Zhejiang University, 310058, Hangzhou City, Zhejiang Province, China
- Sports Medicine Institute of Zhejiang University, 310058, Hangzhou, Zhejiang, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, 315825, Hangzhou, Zhejiang, China
- Clinical Research Center of Motor System Disease of Zhejiang Province, 315825, Hangzhou, Zhejiang, China
- Dr. Li Dak Sum and Yip Yio Chin Center for Stem Cell and Regenerative Medicine, Zhejiang University, 310058, Hangzhou, Zhejiang, China
- Binjiang Institute of Zhejiang University, Hangzhou, Zhejiang, China
| | - Zi Yin
- Orthopedics Research Institute of Zhejiang University, 310058, Hangzhou City, Zhejiang Province, China
- Sports Medicine Institute of Zhejiang University, 310058, Hangzhou, Zhejiang, China
- Dr. Li Dak Sum and Yip Yio Chin Center for Stem Cell and Regenerative Medicine, Zhejiang University, 310058, Hangzhou, Zhejiang, China
| | - Jiayun Huang
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Zhejiang University, 310058, Hangzhou, Zhejiang, China
- Orthopedics Research Institute of Zhejiang University, 310058, Hangzhou City, Zhejiang Province, China
- Sports Medicine Institute of Zhejiang University, 310058, Hangzhou, Zhejiang, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, 315825, Hangzhou, Zhejiang, China
- Clinical Research Center of Motor System Disease of Zhejiang Province, 315825, Hangzhou, Zhejiang, China
- Dr. Li Dak Sum and Yip Yio Chin Center for Stem Cell and Regenerative Medicine, Zhejiang University, 310058, Hangzhou, Zhejiang, China
| | - Dengfeng Ruan
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Zhejiang University, 310058, Hangzhou, Zhejiang, China
- Orthopedics Research Institute of Zhejiang University, 310058, Hangzhou City, Zhejiang Province, China
- Sports Medicine Institute of Zhejiang University, 310058, Hangzhou, Zhejiang, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, 315825, Hangzhou, Zhejiang, China
- Clinical Research Center of Motor System Disease of Zhejiang Province, 315825, Hangzhou, Zhejiang, China
- Dr. Li Dak Sum and Yip Yio Chin Center for Stem Cell and Regenerative Medicine, Zhejiang University, 310058, Hangzhou, Zhejiang, China
| | - Yang Fei
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Zhejiang University, 310058, Hangzhou, Zhejiang, China
- Orthopedics Research Institute of Zhejiang University, 310058, Hangzhou City, Zhejiang Province, China
- Sports Medicine Institute of Zhejiang University, 310058, Hangzhou, Zhejiang, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, 315825, Hangzhou, Zhejiang, China
- Clinical Research Center of Motor System Disease of Zhejiang Province, 315825, Hangzhou, Zhejiang, China
- Dr. Li Dak Sum and Yip Yio Chin Center for Stem Cell and Regenerative Medicine, Zhejiang University, 310058, Hangzhou, Zhejiang, China
| | - Canlong Wang
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Zhejiang University, 310058, Hangzhou, Zhejiang, China
- Orthopedics Research Institute of Zhejiang University, 310058, Hangzhou City, Zhejiang Province, China
- Sports Medicine Institute of Zhejiang University, 310058, Hangzhou, Zhejiang, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, 315825, Hangzhou, Zhejiang, China
- Clinical Research Center of Motor System Disease of Zhejiang Province, 315825, Hangzhou, Zhejiang, China
- Dr. Li Dak Sum and Yip Yio Chin Center for Stem Cell and Regenerative Medicine, Zhejiang University, 310058, Hangzhou, Zhejiang, China
| | - Xianan Mo
- Dr. Li Dak Sum and Yip Yio Chin Center for Stem Cell and Regenerative Medicine, Zhejiang University, 310058, Hangzhou, Zhejiang, China
| | - Jiajin Li
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Zhejiang University, 310058, Hangzhou, Zhejiang, China
- Orthopedics Research Institute of Zhejiang University, 310058, Hangzhou City, Zhejiang Province, China
| | - Jun Zhang
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Zhejiang University, 310058, Hangzhou, Zhejiang, China
- Orthopedics Research Institute of Zhejiang University, 310058, Hangzhou City, Zhejiang Province, China
- Sports Medicine Institute of Zhejiang University, 310058, Hangzhou, Zhejiang, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, 315825, Hangzhou, Zhejiang, China
- Clinical Research Center of Motor System Disease of Zhejiang Province, 315825, Hangzhou, Zhejiang, China
- Department of Orthopedics, Longquan People's Hospital, Zhejiang, 323799, China
| | - Cailian Fang
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Zhejiang University, 310058, Hangzhou, Zhejiang, China
- Orthopedics Research Institute of Zhejiang University, 310058, Hangzhou City, Zhejiang Province, China
- Sports Medicine Institute of Zhejiang University, 310058, Hangzhou, Zhejiang, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, 315825, Hangzhou, Zhejiang, China
- Clinical Research Center of Motor System Disease of Zhejiang Province, 315825, Hangzhou, Zhejiang, China
| | - Jianyou Li
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Zhejiang University, 310058, Hangzhou, Zhejiang, China
- Department of Orthopedics, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, Zhejiang University Huzhou Hospital, 313000, Huzhou, Zhejiang, China
| | - Xiao Chen
- Orthopedics Research Institute of Zhejiang University, 310058, Hangzhou City, Zhejiang Province, China
- Sports Medicine Institute of Zhejiang University, 310058, Hangzhou, Zhejiang, China
- Dr. Li Dak Sum and Yip Yio Chin Center for Stem Cell and Regenerative Medicine, Zhejiang University, 310058, Hangzhou, Zhejiang, China
| | - Weiliang Shen
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Zhejiang University, 310058, Hangzhou, Zhejiang, China
- Orthopedics Research Institute of Zhejiang University, 310058, Hangzhou City, Zhejiang Province, China
- Sports Medicine Institute of Zhejiang University, 310058, Hangzhou, Zhejiang, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, 315825, Hangzhou, Zhejiang, China
- Clinical Research Center of Motor System Disease of Zhejiang Province, 315825, Hangzhou, Zhejiang, China
- Dr. Li Dak Sum and Yip Yio Chin Center for Stem Cell and Regenerative Medicine, Zhejiang University, 310058, Hangzhou, Zhejiang, China
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4
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Hogaboom N, Shaw J, Barrance P, Capella T, Malanga G. A pilot study testing an Achilles tendinopathy human cadaver model using intratendinous injection of collagenase. Clin Biomech (Bristol, Avon) 2023; 107:106034. [PMID: 37413812 DOI: 10.1016/j.clinbiomech.2023.106034] [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: 07/12/2022] [Revised: 01/26/2023] [Accepted: 06/26/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Achilles tendinopathy is one of the most frequently occurring soft-tissue injuries. Despite decades of research, there is still much that is unknown about the progression of tendinopathy. Animal models, such as collagenase injection, allow researchers to gain insight into disease progression and investigate clinical interventions, yet are limited in their direct application to humans. Establishment of a cadaver model of tendinopathy would provide another method of investigating clinical interventions in human tissues. The purpose of this study is to develop such a model and evaluate biomechanical changes in cadaveric Achilles tendons using ultrasound elastography. METHODS Achilles tendons of five female foot/ankle cadavers were injected with two different concentrations (three with 10 mg/mL, two 20 mg/mL) of collagenase and incubated for 24 h. Ultrasound elastography images were collected at baseline, 16 and 24 h post-injection. Elasticity of tendons was calculated using a custom image analysis program. FINDINGS Elasticity decreased over time in both dosage groups. In the 10 mg/mL group, mean elasticity decreased from 642 ± 246 kPa at baseline to 392 ± 38.3 kPa at 16 h and 263 ± 87.3 kPa at 24 h. In the 20 mg/mL group, mean elasticity decreased from 628 ± 206 kPa at baseline to 176 ± 152 kPa at 16 h and 188 ± 120 kPa at 24 h. INTERPRETATION Injection of collagenase into cadaveric Achilles tendons resulted in decreases in elasticity. Decreases were observed in tendons that received injections with both 10 and 20 mg/mL collagenase dosages. Further biomechanical and histological testing is needed to evaluate this cadaveric tendinopathy.
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Affiliation(s)
- Nathan Hogaboom
- Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA; Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, 183 South Orange Avenue, Suite F-1560, Newark, NJ 07101, USA.
| | - Jonathan Shaw
- Tendonova, 3050 Business Park Drive, Suite A-2, Norcross, GA 30071, USA
| | - Peter Barrance
- Kessler Foundation, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA; Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, 183 South Orange Avenue, Suite F-1560, Newark, NJ 07101, USA
| | - Teresa Capella
- New Jersey Regenerative Institute, 197 Ridgedale Avenue, Suite 210, Cedar Knolls, NJ 07927, USA
| | - Gerard Malanga
- Tendonova, 3050 Business Park Drive, Suite A-2, Norcross, GA 30071, USA; New Jersey Regenerative Institute, 197 Ridgedale Avenue, Suite 210, Cedar Knolls, NJ 07927, USA
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5
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Sung K, Raja AE, Tunis JG, Tunis BG, Zheng K, Sussman WI. Heterotopic Mineralization of the Medial Collateral Ligament: Our Experience Treating Two Cases of Calcific Versus Ossific Lesions With Ultrasonic Vacuum Debridement. Cureus 2023; 15:e36127. [PMID: 37065361 PMCID: PMC10100197 DOI: 10.7759/cureus.36127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2023] [Indexed: 03/18/2023] Open
Abstract
Chronic injury to the medial collateral ligament (MCL) is common following an acute knee injury. This case report presents two patients that failed to respond to conservative treatment with clinical evidence of an MCL injury and radiographic finding of a benign-appearing soft tissue lesion in the MCL. Calcified or ossified lesions have been described with chronic MCL injuries. Ossification and calcification of the MCL have been observed as potential causes of chronic MCL pain. Here, we detail the distinction between these two distinct intra-ligamentous heterotopic deposits and describe a novel treatment approach using ultrasonic percutaneous debridement, a technique that is typically reserved for tendinopathies. In both cases, pain improved, and they were able to return to their prior level of function.
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6
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Nakagawa H, Sung K, Ashkani-Esfahani S, Waryasz G, May T, Sussman WI. Plantar fasciitis: a comparison of ultrasound-guided fasciotomy with or without amniotic membrane allograft injection. Regen Med 2022; 17:931-940. [PMID: 36222008 DOI: 10.2217/rme-2022-0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: The purpose of this study was to evaluate the clinical response to augmenting an ultrasound-guided percutaneous plantar fasciotomy (UGPF) with an amniotic membrane (AM) allograft injection. Design: Retrospective, single-center, matched, case-controlled study. Methods: Patients underwent either an UGPF (n = 15) or a combined UGPF and AM injection (n = 16). Results: The UGPF plus AM group demonstrated a significant reduction in pain (p = 0.02) from baseline at the short-term follow-up, but there was no significant difference in pain or patient satisfaction between groups at the 52-week follow-up. Conclusion: Both groups demonstrated a significant reduction in pain and high level of patient satisfaction, but the combination of UGPF with an AM injection may provide a greater reduction in pain earlier in the post-operative period.
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Affiliation(s)
- Hirotaka Nakagawa
- Department of Orthopedics & Rehabilitation, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
| | - Kyungje Sung
- Department of Orthopedics & Rehabilitation, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
| | - Soheil Ashkani-Esfahani
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.,Department of Orthopedic Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Gregory Waryasz
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.,Department of Orthopedic Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Tabitha May
- Department of Radiation Oncology, UMass Chan Medical School, 55 N Lake Ave, Worcester, MA 01655, USA
| | - Walter I Sussman
- Department of Orthopedics & Rehabilitation, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
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7
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Abstract
Insertional Achilles tendinopathy can be a very challenging clinical syndrome with various nonoperative measures typically attempted before surgical intervention. Associated complications are known with surgical repair and can be limb altering. Owing to the longevity of clinical symptoms before clinical presentation, changing the pathophysiologic process and halting the inflammatory changes becomes paramount. Here we discuss nonoperative techniques and updates in the foot and ankle literature.
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Affiliation(s)
- Jeffrey E McAlister
- Phoenix Foot and Ankle Institute, 7301 East 2nd Street, Suite 206, Scottsdale, AZ 85251, USA.
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8
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Chronic Medial Collateral Ligament Sprain Treated With Percutaneous Ultrasonic Debridement: A Case Report. Clin J Sport Med 2022; 32:e175-e177. [PMID: 33852441 DOI: 10.1097/jsm.0000000000000909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 11/20/2020] [Indexed: 02/02/2023]
Abstract
The medial collateral ligament (MCL) is the most commonly injured ligament of the knee. Most grade I and II injuries respond to conservative management, but symptoms persist in some patients. In these cases, treatment options are limited. Percutaneous ultrasonic debridement is increasingly being used for tendinopathy and fasciopathy refractory to conservative management, but this has not been reported as a treatment for ligament injury. Here, we present a case of a chronic grade II MCL sprain successfully treated with percutaneous ultrasonic debridement.
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9
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Ang BFH, Mohan PC, Png MA, Allen JC, Howe TS, Koh JSB, Lee BP, Morrey BF. Ultrasonic Percutaneous Tenotomy for Recalcitrant Lateral Elbow Tendinopathy: Clinical and Sonographic Results at 90 Months. Am J Sports Med 2021; 49:1854-1860. [PMID: 33956537 DOI: 10.1177/03635465211010158] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND In a study from our institution, ultrasonic percutaneous tenotomy of the brevis and the common extensor tendon for recalcitrant lateral elbow tendinopathy showed excellent safety profiles, high tolerability, efficiency, sustained pain relief, functional improvement, and sonographic evidence of tissue healing in 20 patients at 3 years' follow-up. PURPOSE To explore the long-term clinical and sonographic results of ultrasonic percutaneous tenotomy of the brevis and the common extensor tendon. STUDY DESIGN Case series; Level of evidence, 4. METHODS The same cohort of 20 patients was recalled after 7 years, and visual analog scale (VAS) for pain and Disabilities of the Arm, Shoulder and Hand (DASH) scores, need for secondary intervention, and overall satisfaction were assessed. They were also reassessed using ultrasound imaging of the brevis and the common extensor tendon to evaluate tendon hypervascularity, tendon thickness, and the progress or the recurrence of the hypoechoic scar tissue. RESULTS We successfully scored 19 patients and performed ultrasound on 16 patients with a median follow-up of 90 months (range, 86-102 months). There were no adverse outcomes and satisfaction remained at 100% (6 patients, satisfied; 13 patients, very satisfied). No patient developed a recurrence of symptoms and signs of lateral elbow tendinopathy, and therefore no secondary intervention was required. The improvement from baseline and early term scores was sustained (P < .001 for all). At 90 months, there was a significant improvement in VAS scores and DASH-Compulsory scores compared with preprocedure scores and all follow-up times until 3 months. There was no difference in VAS scores and DASH-Compulsory scores at 90 months compared with 6 and 36 months. For DASH-Work scores, there was a significant improvement at 90 months compared with preprocedure scores, but there was no difference between DASH-Work scores at 90 months and scores at all other points of follow-up. At 90 months, hypervascularity remained resolved in 79% of patients, while all patients had reduced tendon swelling and sustained resolution or reduction of the hypoechoic lesion. CONCLUSION At the long-term follow-up of 90 months, ultrasonic percutaneous tenotomy of the brevis and the common extensor tendon, previously shown to enhance recovery of lateral elbow tendinopathy, demonstrated good durability of pain relief and functional recovery that was previously achieved. This was accompanied by sustained sonographic tissue healing with no significant deterioration.
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Affiliation(s)
- Benjamin F H Ang
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - P Chandra Mohan
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | - Meng Ai Png
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | | | - Tet Sen Howe
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Joyce S B Koh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Brian P Lee
- Orthopaedic Associates Mount Elizabeth Hospital, Singapore
| | - Bernard F Morrey
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Orthopaedic Surgery, University of Texas Health Center, San Antonio, Texas, USA
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10
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Abstract
Background: Gluteal tendinopathy is a common cause of lateral hip pain. Percutaneous ultrasonic tenotomy (PUT) has been used successfully for the treatment of tendinopathy of the elbow, knee, and ankle, but its use in the hip has not been described. Purpose: To evaluate the efficacy of PUT in patients who did not respond to nonsurgical management of gluteal tendinopathy. Study Design: Case series; Level of evidence, 4. Methods: A total of 29 patients with gluteal tendinopathy (mean age, 62 years) who did not respond to nonsurgical treatment were enrolled in this prospective study and underwent ultrasound-guided PUT in an outpatient setting. Patients with a history of ipsilateral hip surgery were excluded. All patients initially underwent magnetic resonance imaging or a computed tomography arthrogram demonstrating tendinopathy and/or partial tearing of the gluteus minimus or medius tendon or both tendons. Outcomes were assessed with a visual analog scale (VAS) for pain, the Harris Hip Score evaluation, and the 12-Item Short Form Health Survey (SF-12) before the procedure and at subsequent follow-up visits or by telephone interviews at 3 weeks, 3 months, 6 months, and final follow-up (range, 18-30 months). Results: The mean final follow-up was at 22 months postoperatively. At final follow-up, VAS scores had improved from a preprocedural mean ± SD of 5.86 ± 1.73 to 2.82 ± 2.22 (P < .01). Harris Hip Scores improved from a preprocedural mean of 60.03 ± 10.86 to 77.47 ± 14.34 (P < .01). Total SF-12 scores improved from a mean of 29.93 ± 5.39 (51% optimal) to 34.41 ± 4.88 (64% optimal) (P < .01). No complications were reported. At final follow-up, when asked whether they would have the procedure again, 15 patients replied “yes definitely,” 3 replied “yes probably,” 3 replied “maybe,” 1 replied “likely not,” and 2 replied “definitely not.” There were 3 patients who eventually had hip abductor tendon repair, and their PUT procedures were considered failures. Conclusion: PUT is an effective treatment, with good results for patients with gluteal tendinopathy.
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Affiliation(s)
| | - J Ryan Mahoney
- Jack Hughston Memorial Hospital, Phenix City, Alabama, USA
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11
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de Girolamo L, Morlin Ambra LF, Perucca Orfei C, McQuilling JP, Kimmerling KA, Mowry KC, Johnson KA, Phan AT, Whited JL, Gomoll AH. Treatment with Human Amniotic Suspension Allograft Improves Tendon Healing in a Rat Model of Collagenase-Induced Tendinopathy. Cells 2019; 8:cells8111411. [PMID: 31717431 PMCID: PMC6912389 DOI: 10.3390/cells8111411] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 10/31/2019] [Accepted: 11/04/2019] [Indexed: 12/12/2022] Open
Abstract
Treatment of tendon injuries is challenging, with neither conservative nor surgical approaches providing full recovery. Placental-derived tissues represent a promising tool for the treatment of tendon injuries. In this study, human amniotic suspension allograft (ASA) was investigated in a pre-clinical model of Achilles tendinopathy. Collagenase type I was injected in the right hind limb of Sprague Dawley rats to induce disease. Contralateral tendons were either left untreated or injected with saline as controls. Seven days following induction, tendons were injected with saline, ASA, or left untreated. Rats were sacrificed 14 and 28 days post-treatment. Histological and biomechanical analysis of tendons was completed. Fourteen days after ASA injection, improved fiber alignment and reduced cell density demonstrated improvement in degenerated tendons. Twenty-eight days post-treatment, tendons in all treatment groups showed fewer signs of degeneration, which is consistent with normal tendon healing. No statistically significant differences in histological or biomechanical analyses were observed between treatment groups at 28 days independent of the treatment they received. In this study, ASA treatment was safe, well-tolerated, and resulted in a widespread improvement of the tissue. The results of this study provide preliminary insights regarding the potential use of ASA for the treatment of Achilles tendinopathy.
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Affiliation(s)
- Laura de Girolamo
- IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161 Milan, Italy;
| | - Luiz Felipe Morlin Ambra
- University Hospital São Paulo, Av. Prof. Lineu Prestes, 2565-Butantã, São Paulo, SP 05508-000, Brazil;
| | - Carlotta Perucca Orfei
- IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161 Milan, Italy;
- Correspondence: (C.P.O.); (A.H.G.); Tel.: +39-026-621-4067 (C.P.O.); +1-212-606-1775 (A.H.G.)
| | - John P. McQuilling
- Organogenesis, 2641 Rocky Ridge Lane, Birmingham, AL 35216, USA; (J.P.M.); (K.A.K.); (K.C.M.)
| | - Kelly A. Kimmerling
- Organogenesis, 2641 Rocky Ridge Lane, Birmingham, AL 35216, USA; (J.P.M.); (K.A.K.); (K.C.M.)
| | - Katie C. Mowry
- Organogenesis, 2641 Rocky Ridge Lane, Birmingham, AL 35216, USA; (J.P.M.); (K.A.K.); (K.C.M.)
| | - Kimberly A. Johnson
- Harvard Medical School, the Harvard Stem Cell Institute, and Department of Orthopedic Surgery, Brigham and Women’s Hospital, 7 Divinity Avenue, Cambridge, MA 02138, USA; (K.A.J.); (A.T.P.); (J.L.W.)
| | - Amy T. Phan
- Harvard Medical School, the Harvard Stem Cell Institute, and Department of Orthopedic Surgery, Brigham and Women’s Hospital, 7 Divinity Avenue, Cambridge, MA 02138, USA; (K.A.J.); (A.T.P.); (J.L.W.)
| | - Jessica L. Whited
- Harvard Medical School, the Harvard Stem Cell Institute, and Department of Orthopedic Surgery, Brigham and Women’s Hospital, 7 Divinity Avenue, Cambridge, MA 02138, USA; (K.A.J.); (A.T.P.); (J.L.W.)
| | - Andreas H. Gomoll
- Harvard Medical School, the Harvard Stem Cell Institute, and Department of Orthopedic Surgery, Brigham and Women’s Hospital, 7 Divinity Avenue, Cambridge, MA 02138, USA; (K.A.J.); (A.T.P.); (J.L.W.)
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
- Correspondence: (C.P.O.); (A.H.G.); Tel.: +39-026-621-4067 (C.P.O.); +1-212-606-1775 (A.H.G.)
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12
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Sussman WI, Hofmann K. Treatment of Insertional Peroneus Brevis Tendinopathy by Ultrasound-Guided Percutaneous Ultrasonic Needle Tenotomy: A Case Report. J Foot Ankle Surg 2019; 58:1285-1287. [PMID: 31679682 DOI: 10.1053/j.jfas.2019.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 01/13/2019] [Accepted: 04/01/2019] [Indexed: 02/03/2023]
Abstract
Insertional peroneus brevis tendinopathy is uncommon and treatment options for recalcitrant insertional lesions are rarely described in the literature. Ultrasound-guided percutaneous ultrasonic needle tenotomy has been described for the treatment of recalcitrant tendinopathy in the elbow, knee, and plantar fascia, but has not been described for the treatment of peroneal tendinopathy. We report a case of recalcitrant insertional peroneus brevis tendinopathy successfully treated with an ultrasound-guided percutaneous ultrasonic needle tenotomy. The treatment resulted in a rapid recovery, and the patient remained asymptomatic at the 6-month follow up. No complications were observed during follow up and the minimally invasive percutaneous procedures offers clear advantage over open techniques.
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Affiliation(s)
- Walter I Sussman
- Assistant Professor, Department of Physical Medicine & Rehabilitation, Tufts University, Boston, MA; Physician, Orthopedic Care Physician Network, North Easton, MA.
| | - Kurt Hofmann
- Physician, Orthopedic Care Physician Network, North Easton, MA; Assistant Professor, Department of Orthopedics, Tufts University, Boston, MA
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13
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Abstract
Tendinopathy is a common but disabling condition. The term describes a complex, multifaceted pathology of the tendon characterized by pain, decreased function, and reduced exercise tolerance. Tendinopathy accounts for up to 30% of general practice musculoskeletal consultations. Advances in understanding the disease process include inflammation as part of the early tendinopathy process. Once thought to not contribute to the early process of tendon degeneration, this hypothesis has been refuted. This allows guidance in conservative treatment. However, when conservative treatments fail, there are minimally invasive injections and ultrasonic debridement techniques that offer an intermediate treatment step with low reported morbidity.
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Affiliation(s)
- Meagan M Jennings
- Silicon Valley Foot and Ankle Reconstructive Surgery Fellowship, Palo Alto Medical Foundation, 701 E. El Camino Real South Wing, Mountain View, CA 94040, USA.
| | - Victoria Liew
- California College of Podiatric Medicine, Samuel Merritt University, 3100 Telegraph Ave, Oakland, CA 94609, USA
| | - Breana Marine
- California College of Podiatric Medicine, Samuel Merritt University, 3100 Telegraph Ave, Oakland, CA 94609, USA
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14
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Abstract
Minimally invasive treatment can offer an earlier recovery with less pain and scarring compared with traditional open surgeries. The goals of minimally invasive surgery are to debride degenerative tendon, stimulate healing, and, when appropriate, repair damaged tendon. Sclerotherapy and prolotherapy have been shown to reduce neovascularization and pain. Percutaneous stripping and endoscopic debridement are better options for diffuse tendinopathy. Plantaris release can be useful in diffuse disease in patients with primarily medial-sided Achilles pain. Overall, minimally invasive surgery provides similar benefits as open procedures with reduced complications and morbidity.
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15
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Kamineni S, Ruggles A, Ashfaq H. Ultrasonic debridement with stem cell therapy of suspensory branch desmitis in an equine patient. Open Vet J 2019; 9:54-57. [PMID: 31086767 PMCID: PMC6500858 DOI: 10.4314/ovj.v9i1.10] [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: 08/24/2018] [Accepted: 01/31/2019] [Indexed: 11/29/2022] Open
Abstract
Ultrasonic debridement as a treatment for tendinopathy and desmitis is a relatively new approach in orthopedic surgery. Previously only used in limited cases, this procedure shows promise for treating ligament-bone and tendon-bone interface injuries. We present a case study of a 2-yr-old thoroughbred male horse, unable to train due to recalcitrant symptoms after extensive conservative management of suspensory branch desmitis. It was then treated with ultrasonic debridement and concurrent manubrial stem cell autograft injection, to treat the ultrasound visualized lesion. Post-surgically, the patient recovered quickly, began training within 16 wk, and went onto win several races. Repeat ultrasound imaging reveals a complete restoration of the internal fiber architecture of the ligament. With a 3-yr follow-up, there has been consistent training and race performance with no re-injury. This study is the first to document the successful outcome of ultrasonic debridement with concurrent stem cell injection in the treatment of equine desmitis.
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Affiliation(s)
- Srinath Kamineni
- Department of Orthopedic Surgery and Sports Medicine, Elbow Shoulder Research Center, College of Medicine, University of Kentucky, Lexington KY, USA
| | - Alan Ruggles
- Rood and Riddle Equine Hospital, Lexington KY, USA
| | - Hamza Ashfaq
- Department of Orthopedic Surgery and Sports Medicine, Elbow Shoulder Research Center, College of Medicine, University of Kentucky, Lexington KY, USA
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16
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Hsieh YL, Lin MT, Hong CZ, Chen HS. Percutaneous soft tissue release performed using a blunt cannula in rabbits with chronic collagenase-induced Achilles tendinopathy. Foot Ankle Surg 2019; 25:186-192. [PMID: 29409286 DOI: 10.1016/j.fas.2017.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 10/12/2017] [Accepted: 10/12/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study investigated the effects of percutaneous soft tissue release (PSTR) performed using a blunt cannula on (1) the inflammatory cells-count, (2) expressions of calcitonin gene-related peptide (CGRP) and (3) substance P (SP) in rabbits with chronic phase of collagenase-induced Achilles tendinopathy. METHODS Thirty-two adult male New Zealand rabbits were randomly divided into four groups: (1) collagenase and PSTR treatment; (2) collagenase and sham-operated PSTR treatment; (3) vehicle-only injection and PSTR treatment; and (4) vehicle-only injection and sham-operated PSTR treatment. Achilles tendon of adult male rabbits was injected with 10μl of collagenase under ultrasonography localization. After 30 days, PSTR was performed using an 18G beauty cosmetic blunt tip micro cannula needle to release the soft tissue and paratenon above the inflamed Achilles tendon. The treated tendons and spinal cords of L5-S2 were harvested 5days after treatment for histological assessment and immunohistochemical analysis. RESULTS Histopathological examination revealed that PSTR achieved significant reduction in hypercellularity with pronounced infiltration of immune cells at the site of paratenon in tendons injected with collagenase compared with sham operation (p<0.05). Immunohistochemical analysis also showed marked decrease in expression of CGRP in tendon and SP in dorsal horns after PSTR (p<0.05). CONCLUSIONS This study showed positive effects in an animal model of chronic tendinopathy, and can be considered a treatment option, but that further research is necessary to determine its role in clinical practice.
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Affiliation(s)
- Yueh-Ling Hsieh
- Department of Physical Therapy, Graduate Institute of Rehabilitation Science, China Medical University, Taichung 40402, Taiwan.
| | - Ming-Ta Lin
- Kuan-Ta Rehabilitation and Pain Clinic, Taichung 40652, Taiwan
| | | | - Hsin-Shui Chen
- Department of Physical Medicine and Rehabilitation, China Medical University, Bei-Gang Hospital, Yun-Lin 65152, Taiwan; Department of Rehabilitation Medicine, School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan.
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17
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Mc Millan S, Faoao DO, Ford E. Treatment of an Insertional High Grade Partial Patellar Tendon Tear Utilizing a Bio-Inductive Implant. THE ARCHIVES OF BONE AND JOINT SURGERY 2019; 7:203-208. [PMID: 31211200 PMCID: PMC6510916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 09/03/2018] [Indexed: 06/09/2023]
Abstract
The management of recalcitrant patellar tendinopathies in the athletic population can be vexing to both the surgeon and patient. To date the majority of treatments for this disease pathology are non-surgical in nature. When surgical intervention is required, open debridement and/or tendon take-down with repair has been necessary. We propose a novel technique for the treatment of insertional patellar tendinopathies and symptomatic partial tearing utilizing a bio-inductive implant.
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Affiliation(s)
- Sean Mc Millan
- Lourdes Medical Associates, Burlington, New Jersey, USA
- Lourdes Medical Associates, Burlington, New Jersey, USA Our Lady of Lourdes Burlington Campus, Burlington, New Jersey, USA
- Lourdes Medical Associates, Burlington, New Jersey, USA Rowan University School of Osteopathic Medicine, Stratford, New Jersey, U.S.A.USA
- Research performed at Lourdes Medical Associates, New Jersey, USA
| | - D O Faoao
- Lourdes Medical Associates, Burlington, New Jersey, USA
- Lourdes Medical Associates, Burlington, New Jersey, USA Our Lady of Lourdes Burlington Campus, Burlington, New Jersey, USA
- Lourdes Medical Associates, Burlington, New Jersey, USA Rowan University School of Osteopathic Medicine, Stratford, New Jersey, U.S.A.USA
- Research performed at Lourdes Medical Associates, New Jersey, USA
| | - Elizabeth Ford
- Lourdes Medical Associates, Burlington, New Jersey, USA
- Lourdes Medical Associates, Burlington, New Jersey, USA Our Lady of Lourdes Burlington Campus, Burlington, New Jersey, USA
- Lourdes Medical Associates, Burlington, New Jersey, USA Rowan University School of Osteopathic Medicine, Stratford, New Jersey, U.S.A.USA
- Research performed at Lourdes Medical Associates, New Jersey, USA
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18
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19
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Sanchez PJ, Grady JF, Saxena A. Percutaneous Ultrasonic Tenotomy for Achilles Tendinopathy Is a Surgical Procedure With Similar Complications. J Foot Ankle Surg 2018; 56:982-984. [PMID: 28842108 DOI: 10.1053/j.jfas.2017.06.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Indexed: 02/03/2023]
Abstract
Percutaneous ultrasonic tenotomy is a relatively new treatment option for multiple types of tendinopathy. However, a paucity of high-level data is available on its use for chronic Achilles tendinosis. The present case series details the complications associated with the use of this technique. When considering percutaneous ultrasonic tenotomy, the surgeon should be cognizant that it is a surgical procedure with complications similar to those of other Achilles tendon surgeries.
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Affiliation(s)
| | - John F Grady
- Residency Director, Advocate Christ Medical Center, Oak Lawn, IL
| | - Amol Saxena
- Fellowship Director, Department of Sports Medicine, Palo Alto Medical Foundation, Palo Alto, CA
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20
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Efficacy of Percutaneous Ultrasonic Ablation of Soft Tissue (Tenex) in Tendinopathy and Fasciopathy. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2018. [DOI: 10.1007/s40141-018-0186-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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21
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Lin CY, Ooi CC, Chan E, Chew KT. Emerging Technological Advances in Musculoskeletal Ultrasound. PM R 2018; 10:112-119. [PMID: 29413117 DOI: 10.1016/j.pmrj.2017.08.444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 08/21/2017] [Accepted: 08/27/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Cindy Y Lin
- Sports and Spine Division, Department of Rehabilitation Medicine, University of Washington Medical Center, Seattle, WA; Sports, Spine, and Orthopaedic Health, University of Washington Husky Stadium Sports Medicine Center, 3800 Montlake Blvd NE, Seattle, WA 98195.,Department of Radiology, Singapore General Hospital, Singapore.,Singhealth Family Medicine, Singapore.,Department of Sports Medicine, Changi General Hospital, Singapore
| | - Chin Chin Ooi
- Sports and Spine Division, Department of Rehabilitation Medicine, University of Washington Medical Center, Seattle, WA; Sports, Spine, and Orthopaedic Health, University of Washington Husky Stadium Sports Medicine Center, 3800 Montlake Blvd NE, Seattle, WA 98195.,Department of Radiology, Singapore General Hospital, Singapore.,Singhealth Family Medicine, Singapore.,Department of Sports Medicine, Changi General Hospital, Singapore
| | - Eric Chan
- Sports and Spine Division, Department of Rehabilitation Medicine, University of Washington Medical Center, Seattle, WA; Sports, Spine, and Orthopaedic Health, University of Washington Husky Stadium Sports Medicine Center, 3800 Montlake Blvd NE, Seattle, WA 98195.,Department of Radiology, Singapore General Hospital, Singapore.,Singhealth Family Medicine, Singapore.,Department of Sports Medicine, Changi General Hospital, Singapore
| | - Kelvin T Chew
- Sports and Spine Division, Department of Rehabilitation Medicine, University of Washington Medical Center, Seattle, WA; Sports, Spine, and Orthopaedic Health, University of Washington Husky Stadium Sports Medicine Center, 3800 Montlake Blvd NE, Seattle, WA 98195.,Department of Radiology, Singapore General Hospital, Singapore.,Singhealth Family Medicine, Singapore.,Department of Sports Medicine, Changi General Hospital, Singapore
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22
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Gong F, Cui L, Zhang X, Zhan X, Gong X, Wen Y. Piperine ameliorates collagenase-induced Achilles tendon injury in the rat. Connect Tissue Res 2018; 59:21-29. [PMID: 28165813 DOI: 10.1080/03008207.2017.1289188] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Tendinopathy is a common clinical pathology found in athletes and workers with mixed treatment results. Piperine, a major alkaloid found in the black and long pepper, has been demonstrated to have variety of pharmacological properties such as analgesic and anti-inflammatory effects. The present study was designed to investigate the effects of piperine on collagenase-induced Achilles tendon injury. Rats were intratendineously injected with collagenase in the right Achilles tendon, followed by intragastrical administration of piperine (100 mg/kg). Morphological structure and biochemical analysis of glycosaminoglycans, hydroxyproline, collagen III, and the activity of matrix metallopeptidases in the tendon tissues were performed. Our results showed that collagenase injection resulted in clear degenerative changes in the tendon. Administration of piperine improved the morphological structure of tendon, increased glycosaminoglycans and hydroxyproline levels, and inhibited the expression and activities of MMP-2 and MMP-9. Furthermore, piperine inhibited the activation of ERK and p38 signaling pathways in injured tendon. These results indicate a beneficial role of piperine against collagenase-induced tendon injury.
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Affiliation(s)
- Fengyan Gong
- a Department of Gynaecology and Obstetrics , The First Hospital of Jilin University , Changchun , China
| | - Lifeng Cui
- a Department of Gynaecology and Obstetrics , The First Hospital of Jilin University , Changchun , China
| | - Xiaona Zhang
- b Department of Anesthesiology , The First Hospital of Jilin University , Changchun , China
| | - Xiangbo Zhan
- c Department of Gynaecology and Obstetrics , Qingyuan People's Hospital , Qingyuan , China
| | - Xu Gong
- d Department of Hand and Foot Surgery , The First Hospital of Jilin University , Changchun , China
| | - Yan Wen
- a Department of Gynaecology and Obstetrics , The First Hospital of Jilin University , Changchun , China
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23
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Percutaneous Ultrasonic Tenotomy for Refractory Common Extensor Tendinopathy After Failed Open Surgical Release: A Report of Two Cases. PM R 2017; 10:313-316. [DOI: 10.1016/j.pmrj.2017.07.077] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 07/24/2017] [Accepted: 07/30/2017] [Indexed: 01/26/2023]
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24
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Smith WB, Melton W, Davies J. Midsubstance Tendinopathy, Percutaneous Techniques (Platelet-Rich Plasma, Extracorporeal Shock Wave Therapy, Prolotherapy, Radiofrequency Ablation). Clin Podiatr Med Surg 2017; 34:161-174. [PMID: 28257672 DOI: 10.1016/j.cpm.2016.10.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The focus of this article is to present the current options available for noninvasive and percutaneous treatment options for noninsertional Achilles tendinopathy. An attempt is made to offer recommendations for both the treatment techniques as well as postprocedure protocols to be considered. Additionally, because there are numerous treatment options in this category, the different techniques are summarized in a chart format with a short list of pros and cons as well as the levels of evidence in the literature to support the different modalities.
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Affiliation(s)
- William Bret Smith
- Department of Orthopedics, University of South Carolina, 2 Medical Park, Columbia, SC, USA.
| | - Will Melton
- Department of Orthopedics, University of South Carolina, 2 Medical Park, Columbia, SC, USA
| | - James Davies
- Department of Orthopedics, University of South Carolina, 2 Medical Park, Columbia, SC, USA
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25
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Peck E, Jelsing E, Onishi K. Advanced Ultrasound-Guided Interventions for Tendinopathy. Phys Med Rehabil Clin N Am 2017; 27:733-48. [PMID: 27468675 DOI: 10.1016/j.pmr.2016.04.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Tendinopathy is increasingly recognized as an important cause of musculoskeletal pain and disability. Tendinopathy is thought to be principally a degenerative process, rather than inflammatory as was traditionally believed. Consequently, traditional tendinopathy treatments focused solely on decreasing inflammation have often been ineffective or even harmful. The advancement of ultrasonography as for guidance of outpatient musculoskeletal procedures has facilitated the development of novel percutaneous procedures for the treatment of tendinopathy, mostly by using mechanical intervention to stimulate regeneration. Several of these techniques, including percutaneous needle tenotomy, percutaneous ultrasonic tenotomy, high-volume injection, and percutaneous needle scraping, are reviewed in this article.
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Affiliation(s)
- Evan Peck
- Section of Sports Health, Department of Orthopaedic Surgery, Cleveland Clinic Florida, 525 Okeechobee Boulevard, Suite 1400, West Palm Beach, FL 33401, USA; Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, USA.
| | - Elena Jelsing
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Mayo Clinic Sports Medicine Center, Minneapolis, MN 55403, USA
| | - Kentaro Onishi
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
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26
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Perucca Orfei C, Lovati AB, Viganò M, Stanco D, Bottagisio M, Di Giancamillo A, Setti S, de Girolamo L. Dose-Related and Time-Dependent Development of Collagenase-Induced Tendinopathy in Rats. PLoS One 2016; 11:e0161590. [PMID: 27548063 PMCID: PMC4993508 DOI: 10.1371/journal.pone.0161590] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 08/08/2016] [Indexed: 12/20/2022] Open
Abstract
Tendinopathy is a big burden in clinics and it represents 45% of musculoskeletal lesions. Despite the relevant social impact, both pathogenesis and development of the tendinopathy are still under-investigated, thus limiting the therapeutic advancement in this field. The purpose of this study was to evaluate the dose-dependent and time-related tissue-level changes occurring in a collagenase-induced tendinopathy in rat Achilles tendons, in order to establish a standardized model for future pre-clinical studies. With this purpose, 40 Sprague Dawley rats were randomly divided into two groups, treated by injecting collagenase type I within the Achilles tendon at 1 mg/mL (low dose) or 3 mg/mL (high dose). Tendon explants were histologically evaluated at 3, 7, 15, 30 and 45 days. Our results revealed that both the collagenase doses induced a disorganization of collagen fibers and increased the number of rounded resident cells. In particular, the high dose treatment determined a greater neovascularization and fatty degeneration with respect to the lower dose. These changes were found to be time-dependent and to resemble the features of human tendinopathy. Indeed, in our series, the acute phase occurred from day 3 to day 15, and then progressed towards the proliferative phase from day 30 to day 45 displaying a degenerative appearance associated with a very precocious and mild remodeling process. The model represents a good balance between similarity with histological features of human tendinopathy and feasibility, in terms of tendon size to create lesions and costs when compared to other animal models. Moreover, this model could contribute to improve the knowledge in this field, and it could be useful to properly design further pre-clinical studies to test innovative treatments for tendinopathy.
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Affiliation(s)
- Carlotta Perucca Orfei
- Orthopaedic Biotechnology Laboratory, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
- Department of Drug Sciences, University of Pavia, Pavia, Italy
| | - Arianna B. Lovati
- Cell and Tissue Engineering Laboratory, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
| | - Marco Viganò
- Orthopaedic Biotechnology Laboratory, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
- Department of Biotechnology and Biosciences, University of Milano-Bicocca, Milan, Italy
| | - Deborah Stanco
- Orthopaedic Biotechnology Laboratory, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
| | - Marta Bottagisio
- Cell and Tissue Engineering Laboratory, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
- Department of Veterinary Medicine (DiMeVet), University of Milan, Milan, Italy
| | | | | | - Laura de Girolamo
- Orthopaedic Biotechnology Laboratory, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
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27
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Seng C, Mohan PC, Koh SBJ, Howe TS, Lim YG, Lee BP, Morrey BF. Ultrasonic Percutaneous Tenotomy for Recalcitrant Lateral Elbow Tendinopathy: Sustainability and Sonographic Progression at 3 Years. Am J Sports Med 2016; 44:504-10. [PMID: 26602153 DOI: 10.1177/0363546515612758] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A previously published study found positive outcomes for a novel technique for ultrasound-guided percutaneous ultrasonic tenotomy, showing good tolerability, safety, and early efficacy within an office setting. PURPOSE In this follow-up study, all 20 members of the original cohort were contacted after 3 years to explore the sustainability of symptomatic relief, functional improvement, and sonographic soft tissue response for percutaneous ultrasonic tenotomy. STUDY DESIGN Case series; Level of evidence, 4. METHODS All 20 subjects of the clinical trial that was performed from June to November 2011 were further assessed at 36 months after the procedure in terms of visual analog scale for pain, Disabilities of the Arm, Shoulder and Hand (DASH)-Compulsory/Work scores, need for adjunct procedures, and overall satisfaction. Importantly, all 20 were reassessed with ultrasound imaging at 36 months, and evidence of the common extensor tendon response was assessed in terms of tendon hypervascularity, tendon thickness, and the progress of the hypoechoic scar tissue. RESULTS A 100% clinical follow-up was achieved, inclusive of ultrasonographic assessment. None of the subjects required further treatment procedures, and 100% expressed satisfaction. Previous improvements in visual analog scale (current median ± SD, 0 ± 0.9; range, 0-3) and DASH-Work scores (current median, 0 ± 0) were sustained with conformity to a linear pattern on polynomial measures. There was further reduction in DASH-Compulsory scores to a median of 0 ± 0.644 (range, 0-2) with a significant decrease on repeated measures (P = .008). Tendon hypervascularity was resolved in 94% of patients, and 100% had reduction in tendon thickness. Overall reduction in the hypoechoic scar tissue was observed in all subjects, with a 90% response achieved by 6 months. Between 6 and 36 months, further reduction in the scar was observed in around 60% of patients, with 20% of patients having complete resolution of the hypoechoic scar. CONCLUSION Minimally invasive percutaneous ultrasonic tenotomy provided sustained pain relief and functional improvement for recalcitrant tennis elbow at 3-year follow-up. It is one of the few procedures to demonstrate positive sonographic evidence of tissue-healing response and is an attractive alternative to surgical intervention for definitive treatment of recalcitrant elbow tendinopathy.
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Affiliation(s)
- Chusheng Seng
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - P Chandra Mohan
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | | | - Tet Sen Howe
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Yee Gen Lim
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Brian P Lee
- Orthopaedic Associates Mount Elizabeth Hospital, Singapore
| | - Bernard F Morrey
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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