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Kim A, Knobloch A, Covey C. Insertional Achilles Tendinopathy Treated With Botulinum Toxin: A Case Report. Cureus 2024; 16:e66641. [PMID: 39258046 PMCID: PMC11386942 DOI: 10.7759/cureus.66641] [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: 08/06/2024] [Indexed: 09/12/2024] Open
Abstract
Chronic insertional Achilles tendinopathy (IAT) is a common cause of recalcitrant heel pain. Patients present with pain localized to the Achilles tendon insertion at the calcaneus and have tenderness to palpation in this area on physical exam. Conservative management often includes an exercise prescription focusing on eccentric loading with limited dorsiflexion. Extracorporeal shockwave therapy and injection therapies including hypertonic dextrose and platelet-rich plasma (PRP) have shown some therapeutic benefit but evidence for injections is limited. IAT can often be recalcitrant to non-operative treatments, and cases are often referred for surgical debridement and decompression. Botulinum toxin A (BTX-A) has been used to treat several different musculoskeletal injuries, but there have been no published studies assessing the efficacy of BTX-A injections specifically for Achilles tendinopathy. This is a case of recalcitrant IAT treated with ultrasound-guided BTX-A.
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Affiliation(s)
- Alexander Kim
- Sports Medicine, David Grant Medical Center, Fairfield, USA
| | | | - Carlton Covey
- Sports Medicine, David Grant Medical Center, Fairfield, USA
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Marzagalli M, Battaglia S, Raimondi M, Fontana F, Cozzi M, Ranieri FR, Sacchi R, Curti V, Limonta P. Anti-Inflammatory and Antioxidant Properties of a New Mixture of Vitamin C, Collagen Peptides, Resveratrol, and Astaxanthin in Tenocytes: Molecular Basis for Future Applications in Tendinopathies. Mediators Inflamm 2024; 2024:5273198. [PMID: 39108992 PMCID: PMC11303056 DOI: 10.1155/2024/5273198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 04/09/2024] [Accepted: 07/12/2024] [Indexed: 09/17/2024] Open
Abstract
Tendinopathy is one of the most frequent musculoskeletal disorders characterized by sustained tissue inflammation and oxidative stress, accompanied by extracellular matrix remodeling. Patients suffering from this pathology frequently experience pain, swelling, stiffness, and muscle weakness. Current pharmacological interventions are based on nonsteroidal anti-inflammatory drugs; however, the effectiveness of these strategies remains ambiguous. Accumulating evidence supports that oral supplementation of natural compounds can provide preventive, and possibly curative, effects. Vitamin C (Vit C), collagen peptides (Coll), resveratrol (Res), and astaxanthin (Asx) were reported to be endowed with potential beneficial effects based on their anti-inflammatory and antioxidant activities. Here, we analyzed the efficacy of a novel combination of these compounds (Mix) in counteracting proinflammatory (IL-1β) and prooxidant (H2O2) stimuli in human tenocytes. We demonstrated that Mix significantly impairs IL-6-induced IL-1β secretion, NF-κB nuclear translocation, and MMP-2 production; notably, a synergistic effect of Mix over the single compounds could be observed. Moreover, Mix was able to significantly counteract H2O2-triggered ROS production. Together, these results point out that Mix, a novel combination of Vit C, Coll, Resv, and Asx, significantly impairs proinflammatory and prooxidant stimuli in tenocytes, mechanisms that contribute to the onset of tendinopathies.
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Affiliation(s)
- Monica Marzagalli
- Department of Pharmacological and Biomolecular Sciences “Rodolfo Paoletti”University of Milano, Milano 20133, Italy
| | | | - Michela Raimondi
- Department of Pharmacological and Biomolecular Sciences “Rodolfo Paoletti”University of Milano, Milano 20133, Italy
| | - Fabrizio Fontana
- Department of Pharmacological and Biomolecular Sciences “Rodolfo Paoletti”University of Milano, Milano 20133, Italy
| | - Marco Cozzi
- R&D Department Kolinpharma S.p.A., Lainate 20045, Italy
| | | | - Roberto Sacchi
- Department of Earth and Environmental SciencesUniversity of Pavia, Pavia 27100, Italy
| | - Valeria Curti
- R&D Department Kolinpharma S.p.A., Lainate 20045, Italy
| | - Patrizia Limonta
- Department of Pharmacological and Biomolecular Sciences “Rodolfo Paoletti”University of Milano, Milano 20133, Italy
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3
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Trybulski R, Muracki J, Podleśny M, Vovkanych A, Kużdżał A. Effectiveness of Kinesiotherapy in the Treatment of Achilles Tendinopathy-A Narrative Review. Sports (Basel) 2024; 12:202. [PMID: 39195578 PMCID: PMC11360343 DOI: 10.3390/sports12080202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 07/17/2024] [Accepted: 07/19/2024] [Indexed: 08/29/2024] Open
Abstract
This narrative review of kinesiotherapy methods in the treatment of Achilles tendinopathy (AT) encompassed a diverse range of studies, including athletes and untrained people, healthy or injured, undergoing kinesiotherapy treatments. Most experimental studies (86%) reported results related to pain perception, 27% to the range of motion, and 27% to biomechanical assessment. However, the studies showed notable heterogeneity in the outcomes associated with the interventions, and, in this review of kinesiotherapy protocols for AT, a prominent observation emerged regarding their efficacy, suggesting a more favorable impact on pain and tendon stiffness management when comparing the measured parameters between the trained and untrained groups. The importance of tailoring the treatment approach based on the individual's athletic background and conditioning status is underscored. There is a need for personalized rehabilitation strategies in athletic populations. The average duration of kinesiotherapy in the treatment of tendinopathy was 15.3 weeks. This observation underscores the potential of kinesiotherapy interventions as a viable treatment option for individuals with Achilles tendon issues. These findings underscore the urgent need for further research to provide stakeholders with more comprehensive directions for future studies. The results may be helpful for doctors, physiotherapists, trainers, and researchers interested in this topic.
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Affiliation(s)
- Robert Trybulski
- Provita Żory Medical Center, 44-240 Żory, Poland;
- Medical Department Wojciech Korfanty, Upper Silesian Academy in Katowice, 40-659 Katowice, Poland
| | - Jarosław Muracki
- Institute of Physical Culture Sciences, Department of Physical Culture and Health, University of Szczecin, 70-453 Szczecin, Poland
| | | | - Andriy Vovkanych
- Department of Physical Therapy and Ergotherapy, Ivan Boberkyj Lviv State University of Physical Culture, 79007 Lviv, Ukraine
| | - Adrian Kużdżał
- Institute of Health Sciences, College of Medical Sciences, University of Rzeszów, 35-310 Rzeszów, Poland
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Nowak AS, Miro EW, Eby SF, Cushman DM. Identification of pre-race ultrasonographic abnormalities of the Achilles tendon and association with future injuries in runners. PHYSICIAN SPORTSMED 2024; 52:299-303. [PMID: 37550955 PMCID: PMC10858303 DOI: 10.1080/00913847.2023.2246179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 08/06/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVE To determine if specific morphological changes in ultrasonographic images of Achilles tendons are associated with the development of pain in distance runners. METHODS This study is a blinded, retrospective analysis of 276 Achilles tendon ultrasound images, which were used to determine if specific morphologic findings could positively or negatively predict future Achilles tendon pain development in distance runners. Pre-race ultrasound scans were performed on 138 asymptomatic half- and full marathon runners (276 tendons in total) who were followed for 12 months after their races. Specific patterns of morphologic abnormality were identified (location, size, and appearance of ultrasound abnormality within the tendon). Sonographic findings were blindly assessed by a medical student, a resident, and a physician who has significant sonographic imaging experience. These specific abnormalities were then compared to those who later did or did not develop tendon pain. RESULTS Three findings were found to have significant odds of association with the development of pain: 1) focal deep midsubstance intratendinous hypoechogenicity, 2) focal superficial midsubstance intratendinous hypoechogenicity, and 3) linear hyperechogenicity extending into middle of tendon from calcaneus. CONCLUSION These results suggest that the aforementioned specific morphologic abnormalities in the Achilles tendon may be associated with the future development of pain symptoms in distance runners in this cohort. Looking for these specific abnormalities may increase the specificity of identifying precursors to Achilles tendon pain development.
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Affiliation(s)
- Andrew S. Nowak
- Central Michigan University College of Medicine, Mount Pleasant, MI
| | - Emily W. Miro
- University of Utah, Department of Family and Preventive Medicine, Salt Lake City, UT
| | - Sarah F. Eby
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA
| | - Daniel M. Cushman
- University of Utah, Department of Physical Medicine & Rehabilitation, Salt Lake City, UT
- University of Utah, Department of Orthopaedics, Salt Lake City, UT
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Dyrek P, Tsitsilianos N, McInnis KC, Tenforde AS, Borg-Stein J. Staying in the Game: Interventions for Managing Achilles Tendinopathy in the In-Season Athlete. Curr Sports Med Rep 2024; 23:237-244. [PMID: 38838687 DOI: 10.1249/jsr.0000000000001174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
ABSTRACT Achilles tendinopathy is a common overuse injury that is traditionally managed with activity modification and a progressive eccentric strengthening program. This narrative review describes the available evidence for adjunctive procedural interventions in the management of midportion and insertional AT, specifically in the athletic population. Safety and efficacy data from available literature on extracorporeal shockwave therapy, platelet-rich plasma, high-volume injectate with or without tendon scraping, and percutaneous needle tenotomy are used to propose an algorithm for treatment of Achilles tendinopathy for the in-season athlete.
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Affiliation(s)
- Paige Dyrek
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, MA
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Joo Y, Choi W, Jung J, Kim H, Park S, Lee S, Lee S. Does Radial Extracorporeal Shockwave Therapy Applied to the Achilles Tendon Influence Ankle Functionality? J Funct Morphol Kinesiol 2024; 9:67. [PMID: 38651425 PMCID: PMC11036220 DOI: 10.3390/jfmk9020067] [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: 03/05/2024] [Revised: 04/04/2024] [Accepted: 04/04/2024] [Indexed: 04/25/2024] Open
Abstract
This study aimed to determine the effectiveness of radial extracorporeal shockwave therapy (rESWT) in enhancing ankle function in patients with Achilles tendon injuries. The choice of rESWT was based on previous success in the treatment of musculoskeletal conditions. The study involved an intervention group that received rESWT, and a control group that received sham therapy. The results revealed that rESWT led to significant improvements in single-leg vertical jump (d = 0.55, p < 0.05), indicating enhanced power generation and ankle functionality that were not observed in the control group. Additionally, the therapy resulted in increased ankle mobility, as observed by improvements in plantar flexion and heel-rise tests. Interestingly, these functional gains were not accompanied by changes in the Achilles tendon stiffness, suggesting that the benefits of rESWT may be more functional than structural. This study highlights rESWT as a promising tool for rehabilitation, particularly following Achilles tendon injuries. The study concluded that, although rESWT appears to improve certain aspects of ankle function, further studies with a larger and more diverse population over a longer period are necessary to confirm these findings and establish comprehensive treatment protocols.
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Affiliation(s)
- Younglan Joo
- Minimal Pilates & Move, PH 24, UN Village-gil, Yongsan-gu, Seoul 04420, Republic of Korea
| | - Wonjae Choi
- Department of Physical Therapy, Joongbu University, 201, Daehak-ro, Chubu-myeon, Geumsan 32713, Republic of Korea
| | - Jihye Jung
- Institute of SMART Rehabilitation, Sahmyook University, 815, Hwarang-ro, Nowon-gu, Seoul 01795, Republic of Korea
| | - Hyunjoong Kim
- Department of Senior Exercise Prescription, Gwangju Health University, 73, Bungmun-daero 419beon-gil, Gwangju 62287, Republic of Korea
| | - Sungeon Park
- Department of Physical Therapy, Graduate School, Sahmyook University, 815, Hwarang-ro, Seoul 01795, Republic of Korea
| | - Sangbong Lee
- Department of Physical Therapy, Graduate School, Sahmyook University, 815, Hwarang-ro, Seoul 01795, Republic of Korea
| | - Seungwon Lee
- Institute of SMART Rehabilitation, Sahmyook University, 815, Hwarang-ro, Nowon-gu, Seoul 01795, Republic of Korea
- Department of Physical Therapy, Sahmyook University, 815, Hwarang-ro, Seoul 01795, Republic of Korea
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Bakaes Y, Hall S, Jackson JB, Johnson AH, Schipper ON, Vulcano E, Kaplan JRM, Gonzalez TA. Percutaneous vs Open Zadek Osteotomy for Treatment of Insertional Achilles Tendinopathy and Haglund's Deformity: A Systematic Review. FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114241241320. [PMID: 38617581 PMCID: PMC11015789 DOI: 10.1177/24730114241241320] [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] [Indexed: 04/16/2024] Open
Abstract
Background Percutaneous Zadek osteotomy (ZO) has emerged as a surgical treatment of insertional Achilles tendinopathy (IAT) over the last decade. Existing literature is limited regarding the comparison of this approach with the more established, open ZO technique. This systematic review aims to evaluate and compare the current data on open vs percutaneous ZO approaches to help set evidence-based guidelines. Methods A systematic literature search was performed using the keywords (Zadek osteotomy) OR (Keck and Kelly osteotomy) OR (dorsal closing wedge calcaneal osteotomy) OR (Haglund Deformity) OR (Haglund Syndrome) OR (Insertional Achilles Tendinopathy) and MeSH terms Osteotomy, Calcaneus, Syndrome, Insertional, Achilles tendon, and Tendinopathy. Our search included the following databases: PubMed, Embase, and the Cochrane Library. The PRISMA protocol and the Cochrane Handbook guidelines were followed. All studies included were published from 2009 to 2024 and included the use of open or percutaneous approaches of ZO for the treatment of IAT with at least a 12-month follow-up. The MINORS score criteria were used to evaluate the strength and quality of studies. Results A total of 17 studies were reviewed, including 611 subjects and 625 ZO procedures. Of these procedures, 81 (11%) subjects had a percutaneous and 544 (89%) subjects had an open ZO. The mean follow-up time was 16.1 months for patients treated with percutaneous ZO and 36.1 months for patients treated with open ZO. Both open and percutaneous studies included in this review showed postoperative improvements in AOFAS, FFI, VISA-A, and VAS scores in patients with IAT. The reported complication rate was 5.8% among patients treated with percutaneous ZO and 10.2% among patients treated with open ZO. Conclusion Percutaneous ZO is an emerging approach with substantially fewer documented cases compared with the open ZO. Both percutaneous and open ZO appear to be relatively effective treatments for insertional Achilles tendinopathy with Haglund's deformity. The lower complication rates reported for percutaneous ZO is encouraging. Further investigation with more subjects undergoing percutaneous ZO is clearly needed.
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Affiliation(s)
- Yianni Bakaes
- School of Medicine, University of South Carolina, Columbia, SC, USA
| | - SarahRose Hall
- School of Medicine, University of South Carolina, Columbia, SC, USA
| | - J. Benjamin Jackson
- School of Medicine, University of South Carolina, Columbia, SC, USA
- Prisma Health Orthopedics, Lexington, SC, USA
| | | | | | - Ettore Vulcano
- Columbia University Division of Orthopedics at Mount Sinai Medical Center, Miami Beach, FL, USA
| | | | - Tyler A. Gonzalez
- School of Medicine, University of South Carolina, Columbia, SC, USA
- Prisma Health Orthopedics, Lexington, SC, USA
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Ramos-Barbero M, Rufino-Palomares EE, Serrano-Carmona S, Hernández-Yera M, García-Salguero L, Lupiáñez JA, Pérez-Jiménez A. Effect of Nutraceutical Factors on Hepatic Intermediary Metabolism in Wistar Rats with Induced Tendinopathy. Int J Mol Sci 2024; 25:629. [PMID: 38203800 PMCID: PMC10779845 DOI: 10.3390/ijms25010629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/27/2023] [Accepted: 12/30/2023] [Indexed: 01/12/2024] Open
Abstract
Tendinopathy (TP) is a complex clinical syndrome characterized by local inflammation, pain in the affected area, and loss of performance, preceded by tendon injury. The disease develops in three phases: Inflammatory phase, proliferative phase, and remodeling phase. There are currently no proven treatments for early reversal of this type of injury. However, the metabolic pathways of the transition metabolism, which are necessary for the proper functioning of the organism, are known. These metabolic pathways can be modified by a number of external factors, such as nutritional supplements. In this study, the modulatory effect of four dietary supplements, maslinic acid (MA), hydroxytyrosol (HT), glycine, and aspartate (AA), on hepatic intermediary metabolism was observed in Wistar rats with induced tendinopathy at different stages of the disease. Induced tendinopathy in rats produces alterations in the liver intermediary metabolism. Nutraceutical treatments modify the intermediary metabolism in the different phases of tendinopathy, so AA treatment produced a decrease in carbohydrate metabolism. In lipid metabolism, MA and AA caused a decrease in lipogenesis at the tendinopathy and increased fatty acid oxidation. In protein metabolism, MA treatment increased GDH and AST activity; HT decreased ALT activity; and the AA treatment does not cause any alteration. Use of nutritional supplements of diet could help to regulate the intermediary metabolism in the TP.
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Affiliation(s)
- Marta Ramos-Barbero
- Department of Biochemistry and Molecular Biology I, Faculty of Science, University of Granada, 18071 Granada, Spain; (M.R.-B.); (L.G.-S.); (J.A.L.)
| | - Eva E. Rufino-Palomares
- Department of Biochemistry and Molecular Biology I, Faculty of Science, University of Granada, 18071 Granada, Spain; (M.R.-B.); (L.G.-S.); (J.A.L.)
| | | | - Manuel Hernández-Yera
- Department of Biochemistry and Molecular Biology I, Faculty of Science, University of Granada, 18071 Granada, Spain; (M.R.-B.); (L.G.-S.); (J.A.L.)
| | - Leticia García-Salguero
- Department of Biochemistry and Molecular Biology I, Faculty of Science, University of Granada, 18071 Granada, Spain; (M.R.-B.); (L.G.-S.); (J.A.L.)
| | - José Antonio Lupiáñez
- Department of Biochemistry and Molecular Biology I, Faculty of Science, University of Granada, 18071 Granada, Spain; (M.R.-B.); (L.G.-S.); (J.A.L.)
| | - Amalia Pérez-Jiménez
- Department of Zoology, Faculty of Science, University of Granada, 18071 Granada, Spain
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Di Gesù M, Alito A, Borzelli D, Romeo D, Bonomolo F, Calafiore D, de Sire A. Efficacy of ultrasound-guided galvanic electrolysis technique and physical therapy in patients with Achilles' tendinopathy: A pilot randomised controlled trial. J Back Musculoskelet Rehabil 2024; 37:1177-1188. [PMID: 38517770 DOI: 10.3233/bmr-230255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
BACKGROUND Ultrasound-guided galvanic electrolysis technique (USGET) is an innovative mini-invasive intervention with the potential to optimise outcomes in the treatment of Achille's tendinopathy (AT). OBJECTIVE The aim of this pilot study is to evaluate the efficacy of adding USGET to conventional eccentric exercise treatment in patients with chronic AT. METHODS Inclusion criteria were patients with unilateral non-insertional AT, pain lasting > 3 months, aged 25-60 years. Patients were randomised in two groups receiving the same physiotherapy treatment (2 sessions per week for 8 weeks). In addition, the experimental group received three USGET stimulations, one every 15 days. Outcome measures were assessment of Achilles tendinopathy severity using the Victorian Institute of Sport Assessment-Achilles (VISA-A) and pain intensity using the Visual Analogue Scale (VAS). Assessment points occurred at the onset of treatment (T0), its conclusion (T1), and subsequent follow-ups at one (T2) and two months (T3). RESULTS Out of the 52 patients who met the study inclusion criteria, two participants withdrew from the study, resulting in a total of 50 subjects who completed the research. None of the parameters showed a different distribution at T1 (p> 0.337). At T2, there was a statistical difference in VISA-A (p= 0.010) and its subscales and VAS (p= 0.002) in the USGET group. At T3, both groups improved with a statistical difference observed in VISA-A (p< 0.001) and its subscales Pain (p= 0.004), Function (p= 0.003) and Sport (p= 0.002), but the EG patients showed a greater improvement. No adverse events were reported. CONCLUSION The effect of USGET combined with eccentric exercise appears to be a safe and effective technique for achieving pain relief and functional recovery in the medium term, supporting the integrated use of USGET as a rehabilitative treatment option for patients with chronic AT.
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Affiliation(s)
| | - Angelo Alito
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Daniele Borzelli
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Domenico Romeo
- Physiocare: Physiotherapy Rehabilitation Center, Augusta, Italy
| | | | - Dario Calafiore
- Department of Neurosciences, Physical Medicine and Rehabilitation Unit, ASST Carlo Poma, Mantova, Italy
| | - Alessandro de Sire
- Department of Medical and Surgical Sciences, Physical and Rehabilitative Medicine, University of Catanzaro "Magna Graecia", Catanzaro, Italy
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro "Magna Graecia", Catanzaro, Italy
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Albright JA, Lou M, Rebello E, Ge J, Testa EJ, Daniels AH, Arcand M. Testosterone replacement therapy is associated with increased odds of Achilles tendon injury and subsequent surgery: a matched retrospective analysis. J Foot Ankle Res 2023; 16:76. [PMID: 37950322 PMCID: PMC10638827 DOI: 10.1186/s13047-023-00678-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 10/27/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Prescription of testosterone replacement therapy (TRT) has increased in the United States in recent years, and though anabolic steroids have been associated with tendon rupture, there is a paucity of literature evaluating the risk of Achilles tendon injury with TRT. This study aims to evaluate the associative relationship between consistent TRT, Achilles tendon injury, and subsequent surgery. METHODS This is a one-to-one matched retrospective cohort study utilizing the PearlDiver database. Records were queried for patients aged 35-75 who were prescribed at least 3 consecutive months of TRT between January 1, 2010 and December 31, 2019. Achilles tendon injuries and subsequent surgeries were identified using ICD-9, ICD-10, and CPT billing codes. Multivariable logistic regression was used to compare odds of Achilles tendon injury, Achilles tendon surgery, and revision surgery, with a p-value < 0.05 representing statistical significance. RESULTS A sample of 423,278 patients who filled a TRT prescription for a minimum of 3 consecutive months was analyzed. The 2-year incidence of Achilles tendon injury was 377.8 (95% CI, 364.8-391.0) per 100,000 person-years in the TRT cohort, compared to 245.8 (95% CI, 235.4-256.6) in the control (p < 0.001). The adjusted analysis demonstrated TRT to be associated with a significantly increased likelihood of being diagnosed with Achilles tendon injury (aOR = 1.24, 95% CI, 1.15-1.33, p < 0.001). Of those diagnosed with Achilles tendon injury, 287/3,198 (9.0%) of the TRT cohort subsequently underwent surgery for their injury, compared to 134/2,081 (6.4%) in the control cohort (aOR = 1.54, 95% CI, 1.19-1.99, p < 0.001). CONCLUSIONS There is a significant association between Achilles tendon injury and prescription TRT, with a concomitantly increased rate of undergoing surgical management. These results provide insight into the risk profile of TRT and further research into the science of tendon pathology in the setting of TRT is an area of continued interest.
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Affiliation(s)
- J Alex Albright
- Warren Alpert Medical School of Brown University, Providence, RI, 02903, USA.
| | - Mary Lou
- Warren Alpert Medical School of Brown University, Providence, RI, 02903, USA
| | - Elliott Rebello
- Warren Alpert Medical School of Brown University, Providence, RI, 02903, USA
| | - Jonathan Ge
- Warren Alpert Medical School of Brown University, Providence, RI, 02903, USA
| | - Edward J Testa
- Department of Orthopaedics, Brown University Warren Alpert Medical School, Providence, RI, 02912, USA
| | - Alan H Daniels
- Department of Orthopaedics, Brown University Warren Alpert Medical School, Providence, RI, 02912, USA
| | - Michel Arcand
- Department of Orthopaedics, Brown University Warren Alpert Medical School, Providence, RI, 02912, USA
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Vivekanantha P, de Sa D, Halai M, Daniels T, Del Balso C, Pinsker E, Shah A. Kinesiophobia contributes to worse functional and patient-reported outcome measures in Achilles tendinopathy: a systematic review. Knee Surg Sports Traumatol Arthrosc 2023; 31:5199-5206. [PMID: 37553554 DOI: 10.1007/s00167-023-07537-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/28/2023] [Indexed: 08/10/2023]
Abstract
PURPOSE To assess the effect of kinesiophobia or fear of reinjury on patient-reported outcome measures and physical performance measures in patients with chronic Achilles tendinopathy (AT). METHODS Three databases were systematically screened for studies from inception to May 22nd, 2023 for literature investigating the impact of kinesiophobia on PROMs or physical performance metrics in AT. The authors adhered to the PRISMA and R-AMSTAR guidelines as well as the Cochrane Handbook for Systematic Reviews of Interventions. Data on demographics, pain, level of activity, self-reported injury severity, quality of life, single-leg hop performance, and heel-raise performance were recorded. Data was presented primarily in a narrative summary fashion. The MINORS score was used for all studies to perform a quality assessment of included studies. RESULTS Six studies comprising 705 patients were included in this review. Variations of the Tampa Scale of Kinesiophobia (TSK-11 or TSK-17) were used in all studies. TSK scores were strongly correlated with the Pain Catastrophizing Score (PCS) and Visual Analogue Scale (VAS) scores and were correlated with decreased Victorian Institute of Sports Assessment Achilles (VISA-A) and Foot and Ankle Outcome Scores Quality of Life (FAOS-QoL) subscale scores. Kinesiophobia was associated with heel raise completion with conflicting evidence on correlations with hop test performance. CONCLUSION Increased kinesiophobia scores (> 35 points), measured by TSK are associated with worse PROMs, including increased pain, decreased quality of life, increased self-reported severity, and is also associated with poorer physical performance measures in patients with AT. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Prushoth Vivekanantha
- Michael DeGroote School of Medicine, McMaster University Medical Centre, 1200 Main Street West, 4E14, Hamilton, ON, L8N 3Z5, Canada.
| | - Darren de Sa
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Mansur Halai
- Division of Orthopaedic Surgery, Department of Surgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Timothy Daniels
- Division of Orthopaedic Surgery, Department of Surgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Christopher Del Balso
- Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences Centre, London, ON, Canada
| | - Ellie Pinsker
- Division of Orthopaedic Surgery, Department of Surgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Ajay Shah
- Division of Orthopaedic Surgery, Postgraduate Medical Education, University of Toronto, Toronto, ON, Canada
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Ge Z, Yang M, Wei D, Wang D, Zhao R, Deng X, Tang Y, Fang Q, Xiong Z, Wang C, Wang G, Li W, Tang K. Inhibition of IKKβ via a DNA-Based In Situ Delivery System Improves Achilles Tendinopathy Healing in a Rat Model. Am J Sports Med 2023; 51:3533-3545. [PMID: 37804159 DOI: 10.1177/03635465231198501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/09/2023]
Abstract
BACKGROUND The inhibition of IKKβ by the inhibitor 2-amino-6-[2-(cyclopropylmethoxy)-6-hydroxyphenyl]-4-(4-piperidinyl)-3-pyridine carbonitrile (ACHP) is a promising strategy for the treatment of Achilles tendinopathy. However, the poor water solubility of ACHP severely hinders its in vivo application. Moreover, the effective local delivery of ACHP to the tendon and its therapeutic effects have not been reported. PURPOSE To investigate the therapeutic effects of IKKβ inhibition via injection of ACHP incorporated into a DNA supramolecular hydrogel in a collagenase-induced tendinopathy rat model. STUDY DESIGN Controlled laboratory study. METHODS Dendritic DNA, a Y-shaped monomer, and a crosslinking monomer were mixed with ACHP and self-assembled into an ACHP-DNA supramolecular hydrogel (ACHP-Gel). The effects of ACHP-Gel in tendon stem/progenitor cells were investigated via RNA sequencing and validated using quantitative reverse transcription polymerase chain reaction (qRT-PCR). A total of 120 collagenase-induced rats were randomly assigned to 5 groups: blank, phosphate-buffered saline (PBS), DNA-Gel, ACHP, and ACHP-Gel. Healing outcomes were evaluated using biomechanic and histologic evaluations at 4 and 8 weeks. RESULTS ACHP-Gel enhanced the solubility of ACHP and sustained its release for ≥21 days in vivo, which significantly increased the retention time of ACHP and markedly reduced the frequency of administration. RNA sequencing and qRT-PCR showed that ACHP effectively downregulated genes related to inflammation and extracellular matrix remodeling and upregulated genes related to tenogenic differentiation. The cross-sectional area (P = .024), load to failure (P = .002), stiffness (P = .039), and elastic modulus (P = .048) significantly differed between the ACHP-Gel and PBS groups at 8 weeks. The ACHP-Gel group had better histologic scores than the ACHP group at 4 (P = .042) and 8 weeks (P = .009). Type I collagen expression (COL-I; P = .034) and the COL-I/collagen type III ratio (P = .015) increased while interleukin 6 expression decreased (P < .001) in the ACHP-Gel group compared with the ACHP group at 8 weeks. CONCLUSION DNA supramolecular hydrogel significantly enhanced the aqueous solubility of ACHP and increased its release-retention time. Injection frequency was markedly reduced. ACHP-Gel suppressed inflammation in Achilles tendinopathy and promoted tendon healing in a rat model. CLINICAL RELEVANCE ACHP-Gel injection is a promising strategy for the treatment of Achilles tendinopathy in clinical practice.
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Affiliation(s)
- Zilu Ge
- Trauma Medical Center, Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Investigation performed at Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Mingyu Yang
- Department of Orthopedics/Sports Medicine Center, First Affiliated Hospital of Third Military Medical University [Army Medical University], Chongqing, China
- Investigation performed at Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Danfeng Wei
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
- Investigation performed at Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Dong Wang
- Trauma Medical Center, Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Investigation performed at Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Renliang Zhao
- Trauma Medical Center, Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Investigation performed at Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiangtian Deng
- Trauma Medical Center, Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Investigation performed at Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yunfeng Tang
- Trauma Medical Center, Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Investigation performed at Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qian Fang
- Trauma Medical Center, Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Investigation performed at Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhencheng Xiong
- Trauma Medical Center, Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Investigation performed at Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chengshi Wang
- Department of Endocrinology and Metabolism, Center for Diabetes and Metabolism Research, West China Hospital, Sichuan University, Chengdu, China
- Investigation performed at Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Guanglin Wang
- Trauma Medical Center, Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Investigation performed at Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wei Li
- Department of Endocrinology and Metabolism, Center for Diabetes and Metabolism Research, West China Hospital, Sichuan University, Chengdu, China
- Investigation performed at Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Kanglai Tang
- Department of Orthopedics/Sports Medicine Center, First Affiliated Hospital of Third Military Medical University [Army Medical University], Chongqing, China
- Investigation performed at Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Kurashina W, Takahashi T, Sasanuma H, Saitsu A, Takeshita K. Relationship Between Achilles Tendon Stiffness Using Myoton PRO and Translation Using a Tensile Testing Machine: A Biomechanical Study of a Porcine Model. Cureus 2023; 15:e49359. [PMID: 38146575 PMCID: PMC10749689 DOI: 10.7759/cureus.49359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2023] [Indexed: 12/27/2023] Open
Abstract
Background Achilles tendinopathy is a common ankle disorder in both the general population and athletes. This condition can alter the mechanical characteristics of the Achilles tendon (AT) by decreasing tendon stiffness. Achilles tendinopathy is primarily treated conservatively; however, few monitoring tools exist for evaluating the condition of the AT. The Myoton PRO (Myoton AS, Tallinn, Estonia) device is a handheld tool used to evaluate tissue stiffness. However, no basic studies have examined the validity of Myoton PRO for assessing the AT. This study aimed to assess the validity of Myoton PRO using animal ATs and to examine its clinical applicability. Methods We used 28 fresh porcine ankles and evaluated AT stiffness at the calcaneus insertion site (AT0) and 2.0 cm above the calcaneus (AT2) using Myoton PRO. We also measured changes in the AT length using a tensile testing machine during the cyclic loading test. We investigated the correlation between dynamic stiffness and length change. Furthermore, we assessed the difference in stiffness between AT0 and AT2. Results The dynamic stiffness was 717.6 ± 183.1 N/m at AT0 and 467.4 ± 152.3 N/m at AT2. The change in length during the cyclic loading test was 1.8 ± 0.7 mm. The correlation between dynamic stiffness and length change was as follows: AT0, r=-0.61; AT2, r=-0.64 (P<0.001). The dynamic stiffness at AT0 was significantly greater than that at AT2 (P<0.001). Conclusions AT assessment using Myoton PRO has potential clinical utility as an indicator of tissue stiffness.
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Affiliation(s)
- Wataru Kurashina
- Graduate School of Medicine, Jichi Medical University, Shimotsuke, JPN
- Department of Rehabilitation, Tochigi Medical Center Shimotsuga, Tochigi, JPN
| | - Tsuneari Takahashi
- Department of Orthopaedic Surgery, Ishibashi General Hospital, Shimotsuke, JPN
| | - Hideyuki Sasanuma
- Department of Orthopaedics, Jichi Medical University, Shimotsuke, JPN
| | - Akihiro Saitsu
- Department of Orthopaedics, Jichi Medical University, Shimotsuke, JPN
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14
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Li J, Zhou X, Chen J, Eliasson P, Kingham PJ, Backman LJ. Secretome from myoblasts statically loaded at low intensity promotes tenocyte proliferation via the IGF-1 receptor pathway. FASEB J 2023; 37:e23203. [PMID: 37732638 DOI: 10.1096/fj.202301097r] [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] [Received: 06/02/2023] [Revised: 08/16/2023] [Accepted: 09/05/2023] [Indexed: 09/22/2023]
Abstract
Exercise is widely recognized as beneficial for tendon healing. Recently, it has been described that muscle-derived molecules secreted in response to static exercise influence tendon healing. In this study, the optimal static loading intensity for tendon healing and the composition of secretome released by myoblasts in response to different intensities of static strain were investigated. In an in vitro coculture model, myoblasts were mechanically loaded using a Flexcell Tension System. Tenocytes were seeded on transwell inserts that allowed communication between the tenocytes and myoblasts without direct contact. Proliferation and migration assays, together with RNA sequencing, were used to determine potential cellular signaling pathways. The secretome from myoblasts exposed to 2% static loading increased the proliferation and migration of the cocultured tenocytes. RNA-seq analysis revealed that this loading condition upregulated the expression of numerous genes encoding secretory proteins, including insulin-like growth factor-1 (IGF-1). Confirmation of IGF-1 expression and secretion was carried out using qPCR and enzyme-linked immunosorbt assay (ELISA), revealing a statistically significant upregulation in response to 2% static loading in comparison to both control conditions and higher loading intensities of 5% and 10%. Addition of an inhibitor of the IGF-1 receptor (PQ401) to the tenocytes significantly reduced myoblast secretome-induced tenocyte proliferation. In conclusion, IGF-1 may be an important molecule in the statically loaded myoblast secretome, which is responsible for influencing tenocytes during exercise-induced healing.
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Affiliation(s)
- Junhong Li
- Department of Integrative Medical Biology, Umeå University, Umeå, Sweden
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Xin Zhou
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Jialin Chen
- School of Medicine, Southeast University, Nanjing, China
| | - Pernilla Eliasson
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Paul J Kingham
- Department of Integrative Medical Biology, Umeå University, Umeå, Sweden
| | - Ludvig J Backman
- Department of Integrative Medical Biology, Umeå University, Umeå, Sweden
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
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15
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Anastasio AT, Bagheri K, Adams SB. Contemporary Review: The Use of Adipocyte-Derived Mesenchymal Stem Cells in Pathologies of the Foot and Ankle. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231207643. [PMID: 37929076 PMCID: PMC10623921 DOI: 10.1177/24730114231207643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Affiliation(s)
| | - Kian Bagheri
- Department of Orthopedic Surgery, Duke University Hospital, Durham, NC, USA
- Campbell University School of Osteopathic Medicine, Lillington, NC, USA
| | - Samuel B. Adams
- Department of Orthopedic Surgery, Duke University Hospital, Durham, NC, USA
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16
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Dosal GC, Schroeder JD, Oh RC. Low-volume Hydrodissection for the Treatment of Chronic Achilles Tendinopathy. Mil Med 2023; 188:e3269-e3272. [PMID: 36515159 DOI: 10.1093/milmed/usac384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/03/2022] [Accepted: 11/18/2022] [Indexed: 12/15/2022] Open
Abstract
Chronic Achilles tendinopathy (AT) is a common ailment for many active duty service members that adversely affects readiness. Patients present with pain, swelling, and limited functional ability. Kager's fat pad is a mass of adipose tissue that protects the blood vessels supplying the Achilles tendon and preserves its function. A popular hypothesis is that scarring, tethering, and neovascularization play a significant role in the pathogenesis of AT. Current literature supports the effectiveness of high-volume (40-50 mL) hydrodissection, a procedure in which fluid is injected under ultrasound guidance into the tissues surrounding the Achilles tendon to mechanically separate the paratenon from the underlying Kager's fat pad. There may also be a beneficial effect of scar tissue and neoneurovascular breakdown. However, high-volume injections result in short-term discomfort and decreased mobility. Lowering injection volume (2-10 mL) may reduce this morbidity and facilitate use in limited-resource environments. This case report presents a 29-year-old active duty male with recalcitrant post-traumatic AT who achieved significant pain reduction and faster return to full service using low-volume hydrodissection. The use of 10 mL volume has not been described previously and provides additional support for using lower volumes in chronic AT. This technique is a direct adjunctive treatment option with rehabilitation at a military treatment facility or in the operational environment.
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Affiliation(s)
- Gerardo Capo Dosal
- Department of Family Medicine,Madigan Army Medical Center, Joint Base Lewis-McChord, WA 98431, USA
| | - Jeremy D Schroeder
- Department of Family Medicine,Madigan Army Medical Center, Joint Base Lewis-McChord, WA 98431, USA
| | - Robert C Oh
- Department of Education, US Department of Veterans Affairs,VA Puget Sound Health System, Seattle, WA 98108, USA
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17
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Fu W, Yang R, Li J. Single-cell and spatial transcriptomics reveal changes in cell heterogeneity during progression of human tendinopathy. BMC Biol 2023; 21:132. [PMID: 37280595 DOI: 10.1186/s12915-023-01613-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 05/03/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Musculoskeletal tissue degeneration impairs the life quality and motor function of many people, especially seniors and athletes. Tendinopathy is one of the most common diseases associated with musculoskeletal tissue degeneration, representing a major global healthcare burden that affects both athletes and the general population, with the clinical presentation of long-term recurring chronic pain and decreased tolerance to activity. The cellular and molecular mechanisms at the basis of the disease process remain elusive. Here, we use a single-cell and spatial RNA sequencing approach to provide a further understanding of cellular heterogeneity and molecular mechanisms underlying tendinopathy progression. RESULTS To explore the changes in tendon homeostasis during the tendinopathy process, we built a cell atlas of healthy and diseased human tendons using single-cell RNA sequencing of approximately 35,000 cells and explored the variations of cell subtypes' spatial distributions using spatial RNA sequencing. We identified and localized different tenocyte subpopulations in normal and lesioned tendons, found different differentiation trajectories of tendon stem/progenitor cells in normal/diseased tendons, and revealed the spatial location relationship between stromal cells and diseased tenocytes. We deciphered the progression of tendinopathy at a single-cell level, which is characterized by inflammatory infiltration, followed by chondrogenesis and finally endochondral ossification. We found diseased tissue-specific endothelial cell subsets and macrophages as potential therapeutic targets. CONCLUSIONS This cell atlas provides the molecular foundation for investigating how tendon cell identities, biochemical functions, and interactions contributed to the tendinopathy process. The discoveries revealed the pathogenesis of tendinopathy at single-cell and spatial levels, which is characterized by inflammatory infiltration, followed by chondrogenesis, and finally endochondral ossification. Our results provide new insights into the control of tendinopathy and potential clues to developing novel diagnostic and therapeutic strategies.
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Affiliation(s)
- Weili Fu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Runze Yang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Jian Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
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18
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Stania M, Pawłowski M, Marszałek W, Juras G, Słomka KJ, Król P. A preliminary investigation into the impact of shock wave therapy and sonotherapy on postural control of stepping tasks in patients with Achilles tendinopathy. Front Neurol 2023; 14:1157335. [PMID: 37332988 PMCID: PMC10272772 DOI: 10.3389/fneur.2023.1157335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/11/2023] [Indexed: 06/20/2023] Open
Abstract
Objective The outcomes of physical therapy are commonly assessed with subjective scales and questionnaires. Hence, a continuous search to identify diagnostic tests that would facilitate objective assessment of symptom reduction in those patients with Achilles tendinopathy who undergo mechanotherapy. The main aim of this study was to evaluate and compare the effectiveness of shock wave and ultrasound treatments, using objective posturographic assessment during step-up and step-down initiation. Materials and methods The patients with non-insertional Achilles tendinopathy and pain lasting for more than 3 months were randomly assigned to one of the experimental groups, i.e., radial shock wave therapy (RSWT), ultrasound therapy, or placebo ultrasound. All groups also received deep friction massage as the primary therapy. The transitional locomotor task was performed with the affected and unaffected limb in random order, on two force platforms under two conditions (step-up and step-down). The recording of center of foot pressure displacements was divided into three phases: quiet standing before step-up/step-down, transit, and quiet standing until measurement completion. Pre-intervention measurements were performed and then short-term follow-ups at weeks 1 and 6 post-therapy. Results The three-way repeated measures ANOVA showed few statistically significant two-factor interactions between therapy type, time point of measurement and the type of the locomotor task. Significant increases in postural sway were observed in the entire study population throughout the follow-up period. Three-way ANOVAs revealed a group effect (shock wave vs. ultrasound) on almost all variables of the quiet standing phase prior to step-up/step-down initiation. Overall, postural stability before the step-up and step-down tasks appeared to be more efficient in patients who had undergone RSWT compared to the ultrasound group. Conclusion Objective posturographic assessment during step-up and step-down initiation did not demonstrate therapeutic superiority of any of the three therapeutic interventions used in patients with non-insertional Achilles tendinopathy.Clinical Trial Registration: The trial was prospectively registered in the Australian and New Zealand Clinical Trials Registry (no. ACTRN12617000860369; registration date: 9.06.2017).
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19
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Stania M, Juras G, Marszałek W, Król P. Analysis of pain intensity and postural control for assessing the efficacy of shock wave therapy and sonotherapy in Achilles tendinopathy - A randomized controlled trial. Clin Biomech (Bristol, Avon) 2023; 101:105830. [PMID: 36469960 DOI: 10.1016/j.clinbiomech.2022.105830] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/01/2022] [Accepted: 11/25/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND The troublesome symptoms of Achilles tendinopathy prompt patients to seek effective forms of conservative treatment. The main aim of the study was to determine the therapeutic efficacy of shock wave and ultrasound therapies for Achilles tendinopathy in reducing pain intensity. Treatment efficacy was also assessed using objective posturographic measurements. METHODS Thirty-nine patients patients were randomly allocated to one of three experimental groups that received shock wave therapy (group A), ultrasound therapy (group B) and placebo ultrasound (group C). Posturographic measurements and subjective assessment of pain intensity were taken prior to therapy and at weeks 1 and 6 of therapy completion. FINDINGS A comparison of percentage change in activity-related pain from baseline to 6 weeks post-therapy revealed a significantly greater pain reduction in group A compared to group B. The three-way ANOVA demonstated an effect of treatment type on all posturographic variables. The Bonferroni post-hoc test showed the means of all variables were significantly smaller for group A than group B. Limb condition also had an effect on the center-of-pressure trajectories in anteroposterior plane; the post-hoc test showed the mean values of the variables were significantly greater for the non-affected compared to affected limb. INTERPRETATION Shock wave therapy was significantly more effective than sonotherapy for alleviation of activity-related pain of Achilles tendinopathy. An association was also shown between shock wave therapy and more efficient postural control in patients with Achilles tendinopathy. The parameters of center-of-pressure trajectories in the sagittal plane were significantly greater for the non-affected compared to affected limb. The trial was prospectively registered in the Australian and New Zealand Clinical Trials Registry (no. ACTRN12617000860369; registration date: 9.06.2017).
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Affiliation(s)
- Magdalena Stania
- Institute of Sport Sciences, Academy of Physical Education, Mikołowska 72a, 40-065 Katowice, Poland.
| | - Grzegorz Juras
- Institute of Sport Sciences, Academy of Physical Education, Mikołowska 72a, 40-065 Katowice, Poland
| | - Wojciech Marszałek
- Institute of Sport Sciences, Academy of Physical Education, Mikołowska 72a, 40-065 Katowice, Poland
| | - Piotr Król
- Institute of Sport Sciences, Academy of Physical Education, Mikołowska 72a, 40-065 Katowice, Poland
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20
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Iuso AM, Pacik D, Martin J, Oakes D, Malanga GA. Adipose cellular injection in the treatment of an intrasubstance Achilles tendon defect: a case report. Regen Med 2022; 17:835-843. [PMID: 36068962 DOI: 10.2217/rme-2021-0157] [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
Our patient presented with a 1-year history of right sided Achilles tendon pain and weakness due to partial intrasubstance tear. The injury was refractory to conservative treatment, leading to a trial injection of microfragmented adipose tissue. Progressive healing and improved function were documented on physical exam and sonographically at subsequent follow-up appointments. About 4 weeks following the injection, the patient was able to return to his regular activity level. At the 6 month follow-up appointment, the patient continued to be pain free and had resumed all prior activities without limitations. This case highlights the potential microfragmented adipose tissue has as a regenerative treatment modality for the management of partial Achilles tendon tears.
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Affiliation(s)
- Anthony M Iuso
- Touro College of Osteopathic Medicine, 230 W 125th St 3rd Floor, New York, NY 10027, USA
| | - Deborah Pacik
- Department of Rehabilitation, Montefiore Medical Center, 150 East 210th Street, Bronx, NY 10467, USA.,Currently at Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, 5 E 98th St 6th Floor, New York, NY 10003, USA
| | - Joshua Martin
- New Jersey Regenerative Institute LLC, 197 Ridgedale Avenue, Suite 210, Cedar Knolls, NJ 07927, USA.,Currently at Regenerative Orthopedics & Sports Medicine, 1145 19th St NW, Unit 410, Washington, DC 20036, USA
| | - Devin Oakes
- Department of Rehabilitation, Montefiore Medical Center, 150 East 210th Street, Bronx, NY 10467, USA
| | - Gerard A Malanga
- New Jersey Regenerative Institute LLC, 197 Ridgedale Avenue, Suite 210, Cedar Knolls, NJ 07927, USA.,Department of Physical Medicine & Rehabilitation, New Jersey Medical School, Rutgers University, Newark, NJ 07103, USA
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21
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Chang CK, Chien WC, Hsu WF, Chiao HY, Chung CH, Tzeng YS, Huang SW, Ou KL, Wang CC, Chen SJ, Wang DS. Positive Association Between Fluoroquinolone Exposure and Tendon Disorders: A Nationwide Population-Based Cohort Study in Taiwan. Front Pharmacol 2022; 13:814333. [PMID: 35387340 PMCID: PMC8978711 DOI: 10.3389/fphar.2022.814333] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 02/23/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction: Fluoroquinolone exposure is reportedly associated with a higher risk of tendon disorders, tendonitis, or tendon rupture. However, studies in East Asian populations have not confirmed these risks in patients with comorbidities or concomitant medication use. This cohort study was designed to investigate the associations among fluoroquinolone exposure, comorbidities, medication use, and tendon disorders in Taiwan. Materials and Methods: This population-based, nationwide, observational, cohort study used data from the National Health Insurance Research database in Taiwan, a nationwide claims database that covers more than 99% of the Taiwanese population. The study period was from January 2000 to December 2015, and the median follow-up time was 11.05 ± 10.91 years. Patients who were exposed to fluoroquinolones for more than three consecutive days were enrolled, and patients without fluoroquinolone exposure who were matched by age, sex, and index year were enrolled as controls. The associations of comorbidities and concomitant medication use with tendon disorder occurrence were analyzed using Cox regression models. Results: The incidence of tendon disorders were 6.61 and 3.34 per 105 person-years in patients with and without fluoroquinolone exposure, respectively (adjusted hazard ratio, 1.423; 95% confidence interval [1.02,1.87]; p = 0.021). Sensitivity analyses yielded similar results. Patients under 18 and over 60 years with fluoroquinolone exposure; those with chronic kidney disease, diabetes, rheumatologic disease, cardiac disease, lipid disorder, or obesity; and those who concomitantly used statins, aromatase inhibitors, or glucocorticoids, had a significantly higher risk of tendon disorders. Conclusion: The long-term risk of tendon disorders was higher in patients with fluoroquinolone exposure than in those without fluoroquinolone exposure. Clinicians should assess the benefits and risks of fluoroquinolone use in patients at high risk of tendon disorders who require fluoroquinolone administration.
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Affiliation(s)
- Chun-Kai Chang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Department of Surgery, Zouying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Wan-Fu Hsu
- Department of Pediatrics, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Hao-Yu Chiao
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
| | - Yuan-Sheng Tzeng
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shao-Wei Huang
- Department of Pediatrics, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Kuang-Ling Ou
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Chien Wang
- Department of Pediatrics, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Shyi-Jou Chen
- Department of Pediatrics, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Der-Shiun Wang
- Department of Pediatrics, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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