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Carlson JA, Shetye SS, Sun M, Weiss SN, Birk DE, Soslowsky LJ. Collagen V haploinsufficiency in female murine patellar tendons results in altered matrix engagement and cellular density, demonstrating decreased healing. J Orthop Res 2024; 42:950-960. [PMID: 37975633 PMCID: PMC11009080 DOI: 10.1002/jor.25740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 10/24/2023] [Accepted: 11/14/2023] [Indexed: 11/19/2023]
Abstract
Collagen V (Col5) is a quantitatively minor component of collagen fibrils comprising tendon, however, plays a crucial role in regulation of development and dynamic healing processes. Clinically, patients with COL5a1 haploinsufficiency, known as classic Ehlers-Danlos Syndrome (cEDS), present with hyperextensible skin, joint instability and laxity, with females more likely to be affected. Previous studies in Col5-deficient mice indicated that reduced Col5a1 expression leads to a reduction in stiffness, fibril deposition, and altered fibril structure. Additionally, Col5-deficient male tendons demonstrated altered healing compared to wild-type tendons, however female mice have not yet been studied utilizing this model. Along with clinical differences between sexes in cEDS patient populations, differences in hormone physiology may be a factor influencing tendon health. Therefore, the objective of this study was to utilize a Col5a1+/ - female mouse model, to determine the effect of Col5 on tendon cell morphology, cell density, tissue composition, and mechanical properties throughout healing. We hypothesized that reduction in Col5 expression would result in an abnormal wound matrix post-injury, resulting in reduced mechanical properties compared to normal tendons. Following patellar tendon surgery, mice were euthanized at 1, 3, and 6-week post-injury. Col5-deficient tendons demonstrated altered and decreased healing compared to WT tendons. The lack of resolution in cellularity by 6-week post-injury in Col5-deficient tendons influenced the decreased mechanical properties. Stiffness did not increase post-injury in Col5-deficient mice, and collagen fiber realignment was delayed during mechanical loading. Therefore, increased Col5a1 expression post-injury is necessary to re-establish matrix engagement and cellularity throughout tendon healing.
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Affiliation(s)
- Jaclyn A Carlson
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Snehal S Shetye
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mei Sun
- Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Stephanie N Weiss
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David E Birk
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Louis J Soslowsky
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Li B, Ding Z, She H. Fast T 2 mapping of short-T 2 tissues in knee using 3D radial dual-echo balanced steady-state free precession. Magn Reson Imaging 2024; 107:149-159. [PMID: 38278310 DOI: 10.1016/j.mri.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/26/2023] [Accepted: 01/22/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND T2 mapping of short-T2 tissues in the knee (meniscus, tendon, and ligament) is needed to aid the clinical MRI knee diagnosis, which is hard to realize using traditional clinical methods. PURPOSE To accelerate the acquisition of T2 values for short-T2 tissues in the knee by analyzing the signal equation of balanced steady-state free precession (bSSFP) sequence in MRI. METHODS Effect of half-radial acquisition on pixel bandwidth was analyzed mathematically. A modified 3D radial dual-echo bSSFP sequence was proposed for 0.53 mm isotropic resolution knee imaging with 2 different TEs at 3 T, which alleviated the problem of off-resonance artifacts caused by traditional half-radial acquisition scheme. A novel pixel-based optimization method was proposed for efficient T2 mapping of short-T2 tissues in the knee given off-resonance values. Simulation was conducted to evaluate the sensitivity of the proposed method to other parameters. Phantom results were compared with 2D spin-echo (SE), and in vivo results were compared with SE and previously studies. RESULTS Simulation showed that the proposed method is insensitive to T1 and B1 variations (estimation error < 1% for T1/B1 error of ±90%), avoiding the need for separated T1 and B1 scans. High isotropic resolution knee imaging was achieved using the modified dual-echo bSSFP. The total scan time was within 3.5 min, including a separate off-resonance scan for T2 measurement. Measured mean T2 values for phantoms correlated well with SE (R2 = 0.99), and no significant difference was observed (P = 0.45). In vivo meniscus T2 measurements and ligament T2 measurements agreed with the literature, while tendon T2 measurements were much lower (31.7% lower for patellar tendon, and 13.5% lower for quadriceps tendon), which might result in its bi-component property. CONCLUSIONS The proposed method provides an efficient way for fast, robust, high-resolution imaging and T2 mapping of short-T2 tissues in the knee.
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Affiliation(s)
- Bowen Li
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Zekang Ding
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Huajun She
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.
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Scattone Silva R, Song K, Hullfish TJ, Sprague A, Silbernagel KG, Baxter JR. Patellar Tendon Load Progression during Rehabilitation Exercises: Implications for the Treatment of Patellar Tendon Injuries. Med Sci Sports Exerc 2024; 56:545-552. [PMID: 37847102 PMCID: PMC10925836 DOI: 10.1249/mss.0000000000003323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
PURPOSE This study aimed to evaluate patellar tendon loading profiles (loading index, based on loading peak, loading impulse, and loading rate) of rehabilitation exercises to develop clinical guidelines to incrementally increase the rate and magnitude of patellar tendon loading during rehabilitation. METHODS Twenty healthy adults (10 females/10 males, 25.9 ± 5.7 yr) performed 35 rehabilitation exercises, including different variations of squats, lunge, jumps, hops, landings, running, and sports specific tasks. Kinematic and kinetic data were collected, and a patellar tendon loading index was determined for each exercise using a weighted sum of loading peak, loading rate, and cumulative loading impulse. Then the exercises were ranked, according to the loading index, into tier 1 (loading index ≤0.33), tier 2 (0.33 < loading index <0.66), and tier 3 (loading index ≥0.66). RESULTS The single-leg decline squat showed the highest loading index (0.747). Other tier 3 exercises included single-leg forward hop (0.666), single-leg countermovement jump (0.711), and running cut (0.725). The Spanish squat was categorized as a tier 2 exercise (0.563), as was running (0.612), double-leg countermovement jump (0.610), single-leg drop vertical jump (0.599), single-leg full squat (0.580), double-leg drop vertical jump (0.563), lunge (0.471), double-leg full squat (0.428), single-leg 60° squat (0.411), and Bulgarian squat (0.406). Tier 1 exercises included 20 cm step up (0.187), 20 cm step down (0.288), 30 cm step up (0.321), and double-leg 60° squat (0.224). CONCLUSIONS Three patellar tendon loading tiers were established based on a combination of loading peak, loading impulse, and loading rate. Clinicians may use these loading tiers as a guide to progressively increase patellar tendon loading during the rehabilitation of patients with patellar tendon disorders and after anterior cruciate ligament reconstruction using the bone-patellar tendon-bone graft.
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Affiliation(s)
- Rodrigo Scattone Silva
- Postgraduate Program in Rehabilitation Sciences, Postgraduate Program in Physical Therapy, Federal University of Rio Grande do Norte, Santa Cruz, BRAZIL
- Department of Physical Therapy, University of Delaware, Newark, DE
| | - Ke Song
- Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Todd J. Hullfish
- Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Andrew Sprague
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA
| | | | - Josh R. Baxter
- Department of Orthopaedic Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA
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Ma Y, Carl M, Tang Q, Moazamian D, Athertya JS, Jang H, Bukata SV, Chung CB, Chang EY, Du J. Whole knee joint mapping using a phase modulated UTE adiabatic T 1ρ (PM-UTE-AdiabT 1ρ ) sequence. Magn Reson Med 2024; 91:896-910. [PMID: 37755319 PMCID: PMC10843531 DOI: 10.1002/mrm.29871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/14/2023] [Accepted: 08/31/2023] [Indexed: 09/28/2023]
Abstract
PURPOSE To develop a 3D phase modulated UTE adiabatic T1ρ (PM-UTE-AdiabT1ρ ) sequence for whole knee joint mapping on a clinical 3 T scanner. METHODS This new sequence includes six major features: (1) a magnetization reset module, (2) a train of adiabatic full passage pulses for spin locking, (3) a phase modulation scheme (i.e., RF cycling pair), (4) a fat saturation module, (5) a variable flip angle scheme, and (6) a 3D UTE Cones sequence for data acquisition. A simple exponential fitting was used for T1ρ quantification. Phantom studies were performed to investigate PM-UTE-AdiabT1ρ 's sensitivity to compositional changes and reproducibility as well as its correlation with continuous wave-T1ρ measurement. The PM-UTE-AdiabT1ρ technique was then applied to five ex vivo and five in vivo normal knees to measure T1ρ values of femoral cartilage, meniscus, posterior cruciate ligament, anterior cruciate ligament, patellar tendon, and muscle. RESULTS The phantom study demonstrated PM-UTE-AdiabT1ρ 's high sensitivity to compositional changes, its high reproducibility, and its strong linear correlation with continuous wave-T1ρ measurement. The ex vivo and in vivo knee studies demonstrated average T1ρ values of 105.6 ± 8.4 and 77.9 ± 3.9 ms for the femoral cartilage, 39.2 ± 5.1 and 30.1 ± 2.2 ms for the meniscus, 51.6 ± 5.3 and 29.2 ± 2.4 ms for the posterior cruciate ligament, 79.0 ± 9.3 and 52.0 ± 3.1 ms for the anterior cruciate ligament, 19.8 ± 4.5 and 17.0 ± 1.8 ms for the patellar tendon, and 91.1 ± 8.8 and 57.6 ± 2.8 ms for the muscle, respectively. CONCLUSION The 3D PM-UTE-AdiabT1ρ sequence allows volumetric T1ρ assessment for both short and long T2 tissues in the knee joint on a clinical 3 T scanner.
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Affiliation(s)
- Yajun Ma
- Department of Radiology, University of California San Diego, CA, USA
| | | | - Qingbo Tang
- Department of Radiology, University of California San Diego, CA, USA
- Radiology Service, Veterans Affairs San Diego Healthcare System, CA, USA
| | - Dina Moazamian
- Department of Radiology, University of California San Diego, CA, USA
| | - Jiyo S Athertya
- Department of Radiology, University of California San Diego, CA, USA
| | - Hyungseok Jang
- Department of Radiology, University of California San Diego, CA, USA
| | - Susan V Bukata
- Department of Orthopaedic Surgery, University of California San Diego, CA, USA
| | - Christine B Chung
- Department of Radiology, University of California San Diego, CA, USA
- Radiology Service, Veterans Affairs San Diego Healthcare System, CA, USA
| | - Eric Y Chang
- Department of Radiology, University of California San Diego, CA, USA
- Radiology Service, Veterans Affairs San Diego Healthcare System, CA, USA
| | - Jiang Du
- Department of Radiology, University of California San Diego, CA, USA
- Radiology Service, Veterans Affairs San Diego Healthcare System, CA, USA
- Department of Bioengineering, University of California San Diego, CA, USA
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Hagen M, Chebly J, Dhaen B, Fassian N, Salvalaggio M, Catelli DS, Verschueren S, Vanrenterghem J. Peak patellar tendon force progressions during heavy load single-leg squats on level ground and decline board. Clin Biomech (Bristol, Avon) 2024; 112:106179. [PMID: 38219457 DOI: 10.1016/j.clinbiomech.2024.106179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 01/02/2024] [Accepted: 01/08/2024] [Indexed: 01/16/2024]
Abstract
BACKGROUND Progressive tendon loading programs for patellar tendinopathy typically include single-leg squats with heavy weights either on level ground or on a decline board. Changes in patellar tendon force due to variations of the heavy load single-leg squat have not yet been objectively quantified. The objective of this study was to investigate the influence of the mass of an external weight and the use of a decline board on the peak patellar tendon force during a heavy load single-leg squat. METHODS Twelve healthy participants performed single-leg back squats on a decline board and level ground at 70%, 80% and 90% of their one repetition maximum. Three-dimensional kinematics and ground reaction forces were measured and the peak patellar tendon force was calculated using musculoskeletal modelling. A two-way repeated measures ANOVA determined the main effects for the mass of the external weights and the use of a decline board as well as their interaction effect. FINDINGS Peak patellar tendon forces were significantly higher on the decline board compared to level ground (p < 0.05). Neither on the decline board, nor on level ground did the peak patellar tendon force increase significantly when increasing the external weights (p > 0.05). INTERPRETATION Progression in peak patellar tendon forces during a heavy load single-leg squat can only be obtained with a decline board. Increasing the mass of the external weight from 70% to 90% of the one repetition maximum does not result in a progressively higher peak patellar tendon force.
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Affiliation(s)
- Michiel Hagen
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.
| | - Joanna Chebly
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Bram Dhaen
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Noah Fassian
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | | | - Danilo S Catelli
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Department of Movement Sciences, KU Leuven, Leuven, Belgium
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Bosco F, Giai Via R, Giustra F, Ghirri A, Cacciola G, Massè A. Platelet-rich plasma for jumper's knee: a comprehensive review of efficacy, protocols, and future directions. Eur J Orthop Surg Traumatol 2024; 34:91-96. [PMID: 37668753 PMCID: PMC10771364 DOI: 10.1007/s00590-023-03713-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 08/22/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE This comprehensive review evaluates the current state of platelet-rich plasma (PRP) treatment for jumper's knee, also known as patellar tendinopathy. The aim is to assess the efficacy of PRP as a therapeutic option compared to other available procedures, investigate the benefits and potential drawbacks of PRP infiltration, and provide insights into the optimal protocols for PRP preparation and administration. METHODS A comprehensive literature search of English articles published up to June 2023 was conducted using PubMed and Scopus databases. Studies evaluating PRP for treating jumper's knee or patellar tendinopathy were analyzed to assess the current state of research in this field. RESULTS PRP has demonstrated promising results in promoting cellular remodeling and accelerating the healing process in the jumper's knee. It shows potential benefits in pain reduction, improved function, and accelerated recovery. However, the efficacy of PRP varies depending on patient characteristics, disease severity, and the specific administration methodology. Establishing standardized PRP preparation and administration protocols are necessary to optimize its effectiveness. Further research is needed to define appropriate patient selection criteria and refine the application of PRP therapy in patellar tendinopathy management. CONCLUSION Jumper's knee is commonly managed conservatively, but there is a lack of consensus on further treatment options. PRP treatment holds promise in promoting tissue healing and repair. However, standardized protocols for PRP preparation and administration, as well as optimal dosage and number of injections, require further investigation to enhance its efficacy. Continued research efforts are necessary to ascertain the precise role of PRP and its refinement in the management of patellar tendinopathy.
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Affiliation(s)
- Francesco Bosco
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy.
- Department of Orthopaedics and Traumatology, Ospedale San Giovanni Bosco di Torino - ASL Città di Torino, Turin, Italy.
| | - Riccardo Giai Via
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
- Department of Orthopaedics and Traumatology, Ospedale San Giovanni Bosco di Torino - ASL Città di Torino, Turin, Italy
| | - Fortunato Giustra
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
- Department of Orthopaedics and Traumatology, Ospedale San Giovanni Bosco di Torino - ASL Città di Torino, Turin, Italy
| | - Alessandro Ghirri
- Department of Orthopaedics and Traumatology, Ospedale San Giovanni Bosco di Torino - ASL Città di Torino, Turin, Italy
| | - Giorgio Cacciola
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
| | - Alessandro Massè
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
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Banks C, Jones GMC, Meeson RL. A mismatch of planning and achieved tibial plateau angle in cranial closing wedge surgery: An in silico and clinical evaluation of 100 cases. Vet Surg 2024; 53:113-121. [PMID: 37470173 DOI: 10.1111/vsu.13998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 06/03/2023] [Accepted: 06/27/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE (1) To determine whether Oxley's modified cranial closing wedge osteotomy (CCWO) results in a tibial plateau angle (TPA) of 5° in silico, (2) compare in silico to clinical postoperative TPA and (3) determine the impact of ostectomy distalization in silico. STUDY DESIGN Cross-sectional retrospective radiographic in silico study. SAMPLE POPULATION A total of 100 stifle radiographs; 90 dogs (small ≤25 kg = 84; large >25 kg = 16). METHODS Tibial plateau angles were measured preoperatively (TPAPre ), after in silico planning (TPAPlan ), and postoperatively (TPAPost ). Virtual ostectomies were evaluated for plate fit. Postoperative ostectomy position was measured. Virtual ostectomies were performed 5/7.5/10/15 mm from the patellar tendon insertion in 10 dogs from each preoperative TPA category (≤20°/21-25°/ 26-30°/31-35°/>35°). Comparisons for TPAPre , TPAPost , and TPAPlan were made between small and large dogs, and the outcome to the target 5° between TPA categories and ostectomy positions. RESULTS Mean ± SD TPAPre was 28.6 ± 6.2° and higher in small than large dogs. Mean TPAPlan was 7.6 ± 2.7°. Plate fit was appropriate in all. In silico, TPAs were greater than 5° except for cases with TPAPre > 35°. Median TPAPost was 5.5° (-4-21) and was higher in small (7°) than large (4.5°) dogs. Postoperative ostectomy position was more distal than Oxley's guidelines. When distalized >7.5 mm in silico, the magnitude of under-correction increased. CONCLUSIONS Oxley's modified CCWO did not result in TPA of 5° in most cases. Ostectomy distalization exacerbated under-correction. CLINICAL IMPACT Current guidelines should be modified to achieve 5° TPA postoperatively.
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Affiliation(s)
- Charlotte Banks
- Department of Clinical Science and Services, Queen Mother Hospital for Animals, Royal Veterinary College, London, UK
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Richards JA, Nyland J, Caborn DNM. Editorial Commentary: Proper Anterior Cruciate Ligament Graft Choice Mitigates Against the Need for Anterolateral Ligament Reconstruction. Arthroscopy 2023; 39:2525-2528. [PMID: 37981391 DOI: 10.1016/j.arthro.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 06/04/2023] [Indexed: 11/21/2023]
Abstract
It is not coincidence that fervor surrounding anterolateral ligament (ALL) reconstruction increased as double-bundle anterior cruciate ligament reconstruction (ACLR) enthusiasm cooled. But perhaps we shifted our focus too soon, or perhaps we shifted our focus too much. But we must remember that the ACL is primary. Increases in ACL graft diameter by 1 or 2 mm can significantly increase graft strength and decrease revision rate. Biomechanical and clinical evidence suggests that quadriceps tendon ACLR and patellar tendon ACLR demonstrates less pivot shift phenomena than hamstring ACLR. In addition, As biologically active suture tapes become more mainstream, augmented allografts are an increasingly attractive option. Proper ACL graft choice mitigates against the need for ALL reconstruction. Risk factors for anterolateral rotatory instability may include low body mass index and lateral meniscal pathology, in addition to the well-known risks such as age, gender, activity level, and revision cases. Perhaps lateral extra-articular tenodesis should be reserved for high-risk cases.
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Affiliation(s)
- Jarod A Richards
- University of Louisville (J.A.R., D.N.M.Z.) and University of Missouri (J.A.R.)
| | - John Nyland
- University of Louisville (J.A.R., D.N.M.Z.) and University of Missouri (J.A.R.)
| | - David N M Caborn
- University of Louisville (J.A.R., D.N.M.Z.) and University of Missouri (J.A.R.)
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Hagen M, Van Rossom S, Catelli DS, Verschueren S, Vanrenterghem J. External weight mass and carrying position influence peak patellar tendon force and patellofemoral joint contact force independently during forward lunge. Clin Biomech (Bristol, Avon) 2023; 110:106127. [PMID: 37856939 DOI: 10.1016/j.clinbiomech.2023.106127] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND The forward lunge is a common exercise in the rehabilitation of patellar tendinopathy and patellofemoral pain syndrome. External weights are frequently used to increase the peak patellar tendon force and patellofemoral joint contact force during this exercise. The weight's position might influence this relationship. The objective of this study was to investigate the combined effect of an external weight's mass and carrying position on the peak patellar tendon force and patellofemoral joint contact force during a forward lunge. METHODS Ten healthy individuals performed forward lunges holding external weights between 0.1 and 0.3 times body mass either in one hand at the ipsilateral or contralateral side of the leading leg, or in two hands at the side or in front of the trunk. Three-dimensional kinematic data and ground reaction forces were collected and peak patellar tendon force and patellofemoral joint contact force were calculated using musculoskeletal modelling. Two-way repeated measures ANOVA's determined the main effects for the external weight's mass and position as well as their interaction effect. FINDINGS Increasing the mass of the external weights increased both the peak patellar tendon force and patellofemoral joint contact force linearly and at the same rate in all positions. Both peak forces were larger in the one-hand ipsilateral and two-hand side positions. INTERPRETATION An external weight's mass and position both influence the peak patellar tendon force and patellofemoral joint contact force during a forward lunge. The rate of increase in peak forces with increasing mass was similar for all weight-carrying positions.
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Affiliation(s)
- Michiel Hagen
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.
| | - Sam Van Rossom
- Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Danilo S Catelli
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; Department of Movement Sciences, KU Leuven, Leuven, Belgium
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Cabizosu A, Marín-Pagán C, Martínez-Serrano A, Alcaraz PE, Martínez-Noguera FJ. Myotendinous Thermoregulation in National Level Sprinters after a Unilateral Fatigue Acute Bout-A Descriptive Study. Sensors (Basel) 2023; 23:9330. [PMID: 38067705 PMCID: PMC10708647 DOI: 10.3390/s23239330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023]
Abstract
In the last decade there has been a growing interest in infrared thermography in the field of sports medicine in order to elucidate the mechanisms of thermoregulation. The aim of this study was to describe bilateral variations in skin temperature of the anterior thigh and patellar tendon in healthy athletes and to provide a model of baseline tendon and muscle thermoregulation in healthy sprinters following a unilateral isokinetic fatigue protocol. Fifteen healthy national-level sprinters (eleven men and four women), with at least 3 years of athletic training experience of 10-12 h/week and competing in national-level competitions, underwent unilateral isokinetic force testing and electrostimulation in which their body temperature was measured before, during, and after the protocol using an infrared thermographic camera. ANOVA detected a significant difference in the time × side interaction for patellar temperature changes (p ≤ 0.001) and a significant difference in the time/side interaction for quadriceps temperature changes (p ≤ 0.001). The thermal challenge produces homogeneous changes evident in quadriceps areas, but not homogeneous in tendon areas. These data show that metabolic and blood flow changes may depend on the physical and mechanical properties of each tissue. Future research could be conducted to evaluate the predictive value of neuromuscular fatigue in the patellar tendon and quadriceps after exercise in order to optimize post-exercise recovery strategies.
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Affiliation(s)
- Alessio Cabizosu
- THERMHESC Group, Chair of Molina Ribera Hospital, C. Asociación, S/N, 30500 Molina de Segura, Spain;
- Research Center for High Performance Sport, Catholic University of Murcia (UCAM), Campus de los Jerónimos, Nº 135, 30107 Murcia, Spain; (A.M.-S.); (P.E.A.); (F.J.M.-N.)
| | - Cristian Marín-Pagán
- Research Center for High Performance Sport, Catholic University of Murcia (UCAM), Campus de los Jerónimos, Nº 135, 30107 Murcia, Spain; (A.M.-S.); (P.E.A.); (F.J.M.-N.)
| | - Antonio Martínez-Serrano
- Research Center for High Performance Sport, Catholic University of Murcia (UCAM), Campus de los Jerónimos, Nº 135, 30107 Murcia, Spain; (A.M.-S.); (P.E.A.); (F.J.M.-N.)
| | - Pedro E. Alcaraz
- Research Center for High Performance Sport, Catholic University of Murcia (UCAM), Campus de los Jerónimos, Nº 135, 30107 Murcia, Spain; (A.M.-S.); (P.E.A.); (F.J.M.-N.)
| | - Francisco Javier Martínez-Noguera
- Research Center for High Performance Sport, Catholic University of Murcia (UCAM), Campus de los Jerónimos, Nº 135, 30107 Murcia, Spain; (A.M.-S.); (P.E.A.); (F.J.M.-N.)
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Deng J, Breda SJ, Eygendaal D, Oei EHG, de Vos RJ. Association Between Physical Tests and Patients-Reported Outcomes in Athletes Performing Exercise Therapy for Patellar Tendinopathy: A Secondary Analysis of the JUMPER Study. Am J Sports Med 2023; 51:3523-3532. [PMID: 37815096 PMCID: PMC10623612 DOI: 10.1177/03635465231200241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/31/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Physical tests are commonly used in patellar tendinopathy to aid the clinical diagnosis, assess the prognosis, and monitor treatment. However, it is still unknown whether these physical measures are associated with patient-reported outcomes after exercise therapy. PURPOSE To identify the prognostic value of baseline physical test results and to determine the association between physical response after exercise therapy and clinical improvement over 24 weeks. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS This study recruited 76 consecutive athletes with patellar tendinopathy who were randomized to 2 different programs of exercise therapy for 24 weeks. Athletes underwent a range of physical tests before and during exercise therapy (12 and 24 weeks), including isometric muscle strength (quadriceps and hip abductors), muscle flexibility (quadriceps, hamstrings, soleus, and gastrocnemius), vertical jump height, and visual analog scale (VAS) scores by palpation, after 3 jump trials, and after single-leg squat (VAS-SLS). The Victorian Institute of Sports Assessment-Patella (VISA-P) questionnaire was used as the primary patient-reported outcome. Linear mixed-effect models were used to assess the prognostic value of baseline physical tests. The change in VISA-P score was further dichotomized into clinical responsiveness (≥14 points) and nonresponsiveness (<14 points). Multiple linear and logistic regression models were performed to evaluate associations between physical response and clinical improvement. RESULTS Of the 76 included patients, 67 (88%) had complete follow-ups. The estimated mean VISA-P score increased by 23 points (95% CI, 19-28 points) after 24 weeks. No association was found between any baseline physical test results and a 24-week change in VISA-P score (all Pinteraction > .2, using the likelihood ratio test). Improvement in VAS-SLS after exercise therapy was not associated with VISA-P improvement after adjustment (β = -1.76; P = .01; Bonferroni-corrected P = .10; R2 = 36.3%). No associations were found between changes in other physical test results and clinical improvement (all P > .05). CONCLUSION In patients with patellar tendinopathy, physical test results including strength and flexibility in the lower limb, jump performance, and pain levels during pain-provoking tests were not identified as prognostic factors for patient-reported outcomes after exercise therapy. Similarly, changes in physical test results were not associated with changes in patient-reported outcomes after adjustments. These results do not support using physical test results to estimate prognosis or monitor treatment response. REGISTRATION NCT02938143 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Jie Deng
- Department of Orthopedics and Sports Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Stephan J Breda
- Department of Orthopedics and Sports Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Denise Eygendaal
- Department of Orthopedics and Sports Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Edwin HG Oei
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Robert-Jan de Vos
- Department of Orthopedics and Sports Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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12
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Huang Q, Liao X. Patellar gout: An important mimic of patellar tumor. Int J Rheum Dis 2023; 26:2330-2331. [PMID: 37654118 DOI: 10.1111/1756-185x.14881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 09/02/2023]
Affiliation(s)
- Qi Huang
- Department of Nuclear Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Xin Liao
- Department of Endocrinology and Metabolic Diseases, Affiliated Hospital of Zunyi Medical University, Zunyi, China
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13
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Theodorou A, Komnos G, Hantes M. Patellar tendinopathy: an overview of prevalence, risk factors, screening, diagnosis, treatment and prevention. Arch Orthop Trauma Surg 2023; 143:6695-6705. [PMID: 37542006 PMCID: PMC10541843 DOI: 10.1007/s00402-023-04998-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 07/18/2023] [Indexed: 08/06/2023]
Abstract
Patellar tendinopathy (PT), or jumper's knee, is an overuse injury that occurs in professional, as well as recreational, athletes. This condition is a noncontact injury, typically characterized by gradually increasing pain in the patellar tendon. It is prevalent in participants of several sports, but it occurs mostly in jumping sports. The diagnosis of PT is primarily clinical; however, imaging techniques can be useful as well. Risk factors differ between sexes, playing conditions, the kind of sport, playing level and personal characteristics. Screening is an essential tool to assess PT. This condition affects athletic performance and often persists for years. The use of preventative methods is imperative because of the persistence of this condition, especially in elite athletes who sometimes end their career after long and failed treatments. There are a wide variety of treatment and rehabilitation options available, the majority of which are non-operative, such as eccentric exercises, cryotherapy, platelet-rich plasma (PRP) injections, and anti-inflammatory strategies. If conservative treatment fails, surgery is the next most preferable step. Even though there are many surgical treatment methods, there is no clear evidence on what is the most effective approach to address PT. Taking this into consideration, as well as the extent of this clinical entity, novel therapeutic techniques, as well as screening and prevention methods, are expected to emerge in the near future.
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Affiliation(s)
- Andreas Theodorou
- Faculty of Medicine, University of Thessaly, 41500, Larissa, Greece.
| | - Georgios Komnos
- Faculty of Medicine, University of Thessaly, 41500, Larissa, Greece
| | - Michael Hantes
- Faculty of Medicine, University of Thessaly, 41500, Larissa, Greece
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14
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Frankewycz B, Bell R, Chatterjee M, Andarawis-Puri N. The superior healing capacity of MRL tendons is minimally influenced by the systemic environment of the MRL mouse. Sci Rep 2023; 13:17242. [PMID: 37821476 PMCID: PMC10567747 DOI: 10.1038/s41598-023-42449-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/10/2023] [Indexed: 10/13/2023] Open
Abstract
Murphy Roths Large mice (MRL) exhibit improved tendon healing and are often described as a "super-healer" strain. The underlying mechanisms that drive the superior healing response of MRL remain a controversial subject. We utilized a tendon transplantation model between MRL and "normal-healer" B6-mice to differentiate between the contribution of MRL's innate tendon and systemic environment to its improved healing capacity. Patellar tendons with a midsubstance punch injury were transplanted back into the same animal (autograft) or into an animal of the other strain (allograft). Findings at 4 weeks showed that the innate MRL tendon environment drives its improved healing capacity as demonstrated by improved stiffness and maximum load in MRL-grafts-in-B6-host-allografts compared to B6-autografts, and higher modulus in MRL-autografts compared to B6-graft-in-MRL-host-allografts. Groups with an MRL component showed an increase in pro-inflammatory cytokines in the 3 days after injury, suggesting an early enhanced inflammatory profile in MRL that ultimately resolves. A preserved range of motion of the knee joint in all MRL animals suggests a systemic "shielding effect" of MRL in regard to joint adhesiveness. Our findings 4-weeks post injury are consistent with previous studies showing tissue-driven improved healing and suggest that the systemic environment contributes to the overall healing process.
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Affiliation(s)
- Borys Frankewycz
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY, USA
- University Hospital Regensburg, Regensburg, Germany
| | - Rebecca Bell
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY, USA
| | | | - Nelly Andarawis-Puri
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY, USA.
- Hospital for Special Surgery, New York, NY, USA.
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15
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Marvin JC, Brakewood ME, Poon MLS, Andarawis-Puri N. Regenerative MRL/MpJ tendon cells exhibit sex differences in morphology, proliferation, mechanosensitivity, and cell-ECM organization. J Orthop Res 2023; 41:2273-2286. [PMID: 37004178 DOI: 10.1002/jor.25562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 02/10/2023] [Accepted: 03/24/2023] [Indexed: 04/03/2023]
Abstract
Clinical and animal studies have reported the influence of sex on the incidence and progression of tendinopathy, which results in disparate structural and biomechanical outcomes. However, there remains a paucity in our understanding of the sex-specific biological mechanisms underlying effective tendon healing. To overcome this hurdle, our group has investigated the impact of sex on tendon regeneration using the super-healer Murphy Roths Large (MRL/MpJ) mouse strain. We have previously shown that the scarless healing capacity of MRL/MpJ patellar tendons is associated with sexually dimorphic regulation of gene expression for pathways involved in fibrosis, cell migration, adhesion, and extracellular matrix (ECM) remodeling following an acute mid-substance injury. Thus, we hypothesized that MRL/MpJ scarless tendon healing is mediated by sex-specific and temporally distinct orchestration of cell-ECM interactions. Accordingly, the present study comparatively evaluated MRL/MpJ tendon cells on two-dimensional (2D; glass) and scaffold platforms to examine cell behavior under biochemical and topographical cues associated with tendon homeostasis and healing. Female MRL/MpJ cells showed reduced 2D migration and spreading area accompanied by enhanced mechanosensing, ECM alignment, and fibronectin-mediated cell proliferation compared to male MRL/MpJ cells. Interestingly, female MRL/MpJ cells cultured on isotropic scaffolds showed diminished cell-ECM organization compared to male MRL/MpJ cells. Lastly, MRL/MpJ cells elicited enhanced cytoskeletal elongation and alignment, ECM deposition and organization, and connexin 43-mediated intercellular communication compared to male B6 cells, regardless of culture condition or sex. These results provide insight into the cellular features conserved within the MRL/MpJ phenotype and potential sex-specific targets for the development of more equitable therapeutics.
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Affiliation(s)
- Jason C Marvin
- Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York, USA
| | - Molly E Brakewood
- Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York, USA
| | - Mong L S Poon
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, New York, USA
| | - Nelly Andarawis-Puri
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, New York, USA
- Hospital for Special Surgery, New York, New York, USA
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16
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Tsinman T, Huang Y, Ahmed S, Levillain A, Evans MK, Jiang X, Nowlan N, Dyment N, Mauck R. Lack of skeletal muscle contraction disrupts fibrous tissue morphogenesis in the developing murine knee. J Orthop Res 2023; 41:2305-2314. [PMID: 37408453 PMCID: PMC10528502 DOI: 10.1002/jor.25659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 06/22/2023] [Accepted: 07/01/2023] [Indexed: 07/07/2023]
Abstract
Externally applied forces, such as those generated through skeletal muscle contraction, are important to embryonic joint formation, and their loss can result in gross morphologic defects including joint fusion. While the absence of muscle contraction in the developing chick embryo leads to dissociation of dense connective tissue structures of the knee and ultimately joint fusion, the central knee joint cavitates whereas the patellofemoral joint does not in murine models lacking skeletal muscle contraction, suggesting a milder phenotype. These differential results suggest that muscle contraction may not have as prominent of a role in the growth and development of dense connective tissues of the knee. To explore this question, we investigated the formation of the menisci, tendon, and ligaments of the developing knee in two murine models that lack muscle contraction. We found that while the knee joint does cavitate, there were multiple abnormalities in the menisci, patellar tendon, and cruciate ligaments. The initial cellular condensation of the menisci was disrupted and dissociation was observed at later embryonic stages. The initial cell condensation of the tendon and ligaments were less affected than the meniscus, but these tissues contained cells with hyper-elongated nuclei and displayed diminished growth. Interestingly, lack of muscle contraction led to the formation of an ectopic ligamentous structure in the anterior region of the joint as well. These results indicate that muscle forces are essential for the continued growth and maturation of these structures during this embryonic period.
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Affiliation(s)
- T.K. Tsinman
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA
| | - Y. Huang
- Department of Bioengineering, Imperial College London, London, UK
| | - S. Ahmed
- Department of Bioengineering, Imperial College London, London, UK
| | - A.L. Levillain
- Department of Bioengineering, Imperial College London, London, UK
| | - MK. Evans
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA
| | - X. Jiang
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
| | - N.C. Nowlan
- Department of Bioengineering, Imperial College London, London, UK
- School of Mechanical and Materials Engineering, University College Dublin, Dublin, Ireland
- UCD Conway Institute, University College Dublin, Dublin, Ireland
| | - N.A. Dyment
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA
| | - R.L. Mauck
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA
- Translational Musculoskeletal Research Center, Corporal Michael Crescenz VA Medical Center, Philadelphia, PA
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17
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Hagen M, Vanmechelen A, Cloet E, Sellicaerts J, VAN Welden K, Verstraete J, Catelli DS, Verschueren S, Vanrenterghem J. Increasing Step Frequency Reduces Patellofemoral Joint Stress and Patellar Tendon Force Impulse More at Low Running Speed. Med Sci Sports Exerc 2023; 55:1555-1563. [PMID: 37093897 DOI: 10.1249/mss.0000000000003194] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
PURPOSE Patellofemoral pain syndrome and patellar tendinopathy are important running-related overuse injuries. This study investigated the interaction of running speed and step frequency alterations on peak and cumulative patellofemoral joint stress (PFJS) and patellar tendon force (PTF) parameters. METHODS Twelve healthy individuals completed an incremental running speed protocol on a treadmill at habitual, increased and decreased step frequency. Peak PFJS and PTF, peak rate of PFJS and PTF development, and PFJS and PTF impulse per kilometer (km) were calculated using musculoskeletal modeling. RESULTS With increasing running speed, peak PFJS ( P < 0.001) and PTF ( P < 0.001) and peak rate of PFJS ( P < 0.001) and PTF ( P < 0.001) development increased, whereas PFJS ( P < 0.001) and PTF ( P < 0.001) impulse per km decreased. While increasing step frequency by 10%, the peak PFJS ( P < 0.001) and PTF ( P < 0.001) and the PFJS ( P < 0.001) and PTF ( P < 0.001) impulse per kilometer decreased. No significant effect of step frequency alteration was found for the peak rate of PFJS ( P = 0.008) and PTF ( P = 0.213) development. A significant interaction effect was found for PFJS ( P < 0.001) and PTF ( P < 0.001) impulse per km, suggesting that step frequency alteration was more effective at low running speed. CONCLUSIONS The effectiveness of step frequency alteration on PFJS and PTF impulse per km is dependent on the running speed. With regard to peak PFJS and PTF, step frequency alteration is equally effective at low and high running speeds. Step frequency alteration was not effective for peak rate of PFJS and PTF development. These findings can assist the optimization of patellofemoral joint and patellar tendon load management strategies.
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Affiliation(s)
- Michiel Hagen
- Musculoskeletal Rehabilitation Research Group, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Leuven, BELGIUM
| | - Anna Vanmechelen
- Musculoskeletal Rehabilitation Research Group, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Leuven, BELGIUM
| | - Emile Cloet
- Musculoskeletal Rehabilitation Research Group, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Leuven, BELGIUM
| | - Jan Sellicaerts
- Musculoskeletal Rehabilitation Research Group, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Leuven, BELGIUM
| | - Kaat VAN Welden
- Musculoskeletal Rehabilitation Research Group, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Leuven, BELGIUM
| | - Jesper Verstraete
- Musculoskeletal Rehabilitation Research Group, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Leuven, BELGIUM
| | | | - Sabine Verschueren
- Musculoskeletal Rehabilitation Research Group, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Leuven, BELGIUM
| | - Jos Vanrenterghem
- Musculoskeletal Rehabilitation Research Group, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Leuven, BELGIUM
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18
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Mizuno Y, Nakase J, Yoshioka K, Sengoku T, Yoshimizu R, Kanayama T, Yanatori Y, Tsuchiya H. Differences in collagen types in the semitendinosus, quadriceps, and patellar tendons: A report using samples from an 11-year-old patient. Knee 2023; 43:241-242. [PMID: 37321946 DOI: 10.1016/j.knee.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 05/31/2023] [Indexed: 06/17/2023]
Affiliation(s)
- Yushin Mizuno
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan; Section of Rehabilitation, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Junsuke Nakase
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan.
| | - Kazuaki Yoshioka
- Department of Physiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, Japan
| | - Takuya Sengoku
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan; Section of Rehabilitation, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Rikuto Yoshimizu
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Tomoyuki Kanayama
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Yusuke Yanatori
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
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19
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Ma H, Zhang Y, Xu X. Regarding the article, Differences in collagen types in the semitendinosus, quadriceps, and patellar tendons: A report using samples from an 11-year-old patient. Knee 2023; 43:243-244. [PMID: 37442746 DOI: 10.1016/j.knee.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 05/22/2023] [Indexed: 07/15/2023]
Affiliation(s)
- Hui Ma
- Department of Joint Surgery and Sports Medicine, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, China
| | - Yuanmin Zhang
- Department of Joint Surgery and Sports Medicine, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, China
| | - Xiao Xu
- Department of Joint Surgery and Sports Medicine, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, China.
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20
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Walsh JA, Bos S, McAndrew DJ, Stapley PJ. Can eccentric cycling be used to treat patellar tendinopathy? Br J Sports Med 2023; 57:832-833. [PMID: 36963806 DOI: 10.1136/bjsports-2022-106498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 03/26/2023]
Affiliation(s)
- Joel A Walsh
- Faculty of Science, Medicine and Health, University of Wollongong School of Medical Indigenous and Health Sciences, Wollongong, New South Wales, Australia
| | - Sophie Bos
- Independent Occupational Therapy, University of Wollongong-Innovation Campus, North Wollongong, New South Wales, Australia
| | - Darryl J McAndrew
- Faculty of Science, Medicine and Health, University of Wollongong Graduate School of Medicine, Wollongong, New South Wales, Australia
| | - Paul J Stapley
- Faculty of Science, Medicine and Health, University of Wollongong School of Medical Indigenous and Health Sciences, Wollongong, New South Wales, Australia
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21
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Dong W, Beynnon BD. A prospective study of joint position sense after anterior cruciate ligament injury, reconstruction with a bone-patella tendon-bone graft, and rehabilitation. Knee 2023; 42:51-56. [PMID: 36893696 DOI: 10.1016/j.knee.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 01/12/2023] [Accepted: 02/10/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Disruption of the anterior cruciate ligament (ACL) is associated with significant biomechanical and neuromuscular changes including deficits in joint proprioception. While previous studies have assessed joint position sense (JPS) in ACL deficient knees, methods have varied and few have done so with prospective study designs. The specific aim of this investigation was to determine the effect(s) of ACL reconstruction and recovery time may have on JPS. METHODS In this prospective study, we assess the effects of ACL reconstruction and rehabilitation on joint position sense in a temporal study. Twelve patients with unilateral ACL injuries were assessed pre-operatively and at 2, 4, 8 months post-op. JPS measurements were performed, while the subject was standing, with passive-active (P-A) and active-active (A-A) tests. Comparisons between the injured/reconstructed and contralateral, uninjured knee were evaluated in terms of real and absolute mean errors. RESULTS There were no statistically significant differences between the injured/reconstructed and contralateral/normal side with P-A or A-A testing at 2, 4, or 8 months. CONCLUSION We conclude that there is no difference in joint position sense between the injured and contralateral leg after ACL disruption and reconstruction beginning as early as 2 months post-op. This study provides further evidence that knee proprioception is not altered by ACL injury and reconstruction. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Willie Dong
- Department Orthopaedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Bruce D Beynnon
- Department Orthopaedics and Rehabilitation, Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA; Department of Mechanical Engineering, University of Vermont, Burlington, Vermont, USA; Department of Electrical and Biomedical Engineering, University of Vermont, Burlington, Vermont, USA.
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22
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Gao J, Rosander A, Rubin JM. Quantitative Assessment of Tendon Backscatter Anisotropy in B-Mode Ultrasound. Ultrasound Med Biol 2023; 49:1408-1414. [PMID: 36878827 DOI: 10.1016/j.ultrasmedbio.2023.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 11/14/2022] [Accepted: 01/30/2023] [Indexed: 05/11/2023]
Abstract
To test the anisotropy of human tendons in conventional B-mode ultrasound, we prospectively performed ultrasound scans of 40 normal patella tendons and 24 patella tendons with chronic tendinopathy in adults. We scanned all tendons in longitudinal orientation (parallel to tendon fibers) using a linear array transducer (8.5 MHz) with beam steering at 0°, 5°, 10°, 15° and 20°. We used ImageJ histogram analysis to process B-mode images offline for assessing backscatter as a function of angle, known as backscatter anisotropy, between normal tendons and the subcutaneous tissues and between normal tendons and tendons with tendinopathy. We compared the results using the slopes of linear regression lines drawn through the angle-dependent data, and we concluded that the tissue anisotropy was significantly different if the 95% confidence intervals of the line slopes for different tissues did not overlap. We observed significant differences between normal tendons and both the adjacent subcutaneous tissues and tendons with tendinopathy. However, the difference in the regression slopes between tendons with tendinopathy and the adjacent subcutaneous soft tissues was not significant. It appears that changes in anisotropic backscatter could be used to detect tendon abnormalities and in assessing the significance of disease and the effectiveness of therapy.
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Affiliation(s)
- Jing Gao
- Rocky Vista University, Ivins, UT, USA; Weill Cornell Medicine, Department of Radiology, Cornell University, New York, NY, USA.
| | | | - Jonathan M Rubin
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
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23
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Pedaprolu K, Szczesny SE. Mouse Achilles tendons exhibit collagen disorganization but minimal collagen denaturation during cyclic loading to failure. J Biomech 2023; 151:111545. [PMID: 36944295 PMCID: PMC10069227 DOI: 10.1016/j.jbiomech.2023.111545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 02/21/2023] [Accepted: 03/08/2023] [Indexed: 03/14/2023]
Abstract
While overuse is a prominent risk factor for tendinopathy, the fatigue-induced structural damage responsible for initiating tendon degeneration remains unclear. Denaturation of collagen molecules and collagen fiber disorganization have been observed within certain tendons in response to fatigue loading. However, no studies have investigated whether these forms of tissue damage occur in Achilles tendons, which commonly exhibit tendinopathy. Therefore, the objective of this study was to determine whether mouse Achilles tendons undergo collagen denaturation and collagen fiber disorganization when cyclically loaded to failure. Consistent with previous testing of other energy-storing tendons, we found that cyclic loading of mouse Achilles tendons produced collagen disorganization but minimal collagen denaturation. To determine whether the lack of collagen denaturation is unique to mouse Achilles tendons, we monotonically loaded the Achilles and other mouse tendons to failure. We found that the patellar tendon was also resistant to collagen denaturation, but the flexor digitorum longus (FDL) tendon and tail tendon fascicles were not. Furthermore, the Achilles and patellar tendons had a lower tensile strength and modulus. While this may be due to differences in tissue structure, it is likely that the lack of collagen denaturation during monotonic loading in both the Achilles and patellar tendons was due to failure near their bony insertions, which were absent in the FDL and tail tendons. These findings suggest that mouse Achilles tendons are resistant to collagen denaturation in situ and that Achilles tendon degeneration may not be initiated by mechanically-induced damage to collagen molecules.
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Affiliation(s)
- Krishna Pedaprolu
- Department of Biomedical Engineering, Pennsylvania State University, University Park, PA, United States
| | - Spencer E Szczesny
- Department of Biomedical Engineering, Pennsylvania State University, University Park, PA, United States; Department of Orthopaedics and Rehabilitation, Pennsylvania State University, Hershey, PA, United States.
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Dong Z, Xu C, Yan L, Liu J, Wang F. Isolated medial patellofemoral ligament reconstruction is valid to stabilize patellofemoral joint but uncertain to reduce patellar height in setting of lateral patellar dislocation and patella alta. Arch Orthop Trauma Surg 2023; 143:1505-1512. [PMID: 35362817 DOI: 10.1007/s00402-022-04429-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 03/20/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Medial patellofemoral ligament reconstruction (MPFLR) is the most commonly used surgical treatment for patients with lateral patellar dislocation (LPD). It is still poorly understood whether or not MPFLR has a contributory effect on decreasing patellar height. MATERIALS AND METHODS Forty-five patients who underwent isolated MPFLR for LPD and patella alta were evaluated with a mean follow-up period of 24 months (22-25 months). Knee joint functions were evaluated by Banff patellofemoral instability instrument (BPII) 2.0 scores and Kujala scores. Patellofemoral engagement and stability were assessed by the patella tilt angle (PTA) and patellar congruence angle (PCA) measured by CT scans, and the patellar-glide test. Patellar height was calculated on lateral radiographs according to three methods: Caton-Deschamps ratios (CDR), Insall-Salvati ratios (ISR), and Blackburne-Peel ratios (BPR). A threshold value of p < 0.05 denoted a statistically significant difference. RESULTS Significant improvements were found in both BPII 2.0 scores, which increased from 41.7 to 77.8 (p < 0.001) and Kujala scores, which increased from 49.2 to 85.5 (p < 0.001). Post-operative PTAs and PCA decreased from 19.6 ± 8.8 to - 3.4 ± 6.2, and from 24.6 ± 7.3 to 13.1 ± 3.8 degrees respectively (p < 0.001). No patients showed lateral translation more than grade II in the patellar-glide test. Regarding patellar height, a tiny reduction (Δ = 0.02, Δ max = 0.09) was discovered in using CDR (p = 0.027), rather than ISR or BPR. All measurements of radiographic indices had an excellent intra- and inter-rater reliability (ICC > 0.75). CONCLUSIONS Isolated anatomic MPFLR is sufficient to achieve good clinical outcomes, as well as patellofemoral stability and high rates of return-to-sport. However, it is unclear if the reconstructed MPFL has a contributory effect on reducing patellar height.
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Affiliation(s)
- Zhenyue Dong
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Chenyue Xu
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Lirong Yan
- Basic Medicine of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Junle Liu
- Basic Medicine of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Fei Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China.
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Gervasi M, Benelli P, Venerandi R, Fernández-Peña E. Relationship between Muscle-Tendon Stiffness and Drop Jump Performance in Young Male Basketball Players during Developmental Stages. Int J Environ Res Public Health 2022; 19:17017. [PMID: 36554895 PMCID: PMC9778993 DOI: 10.3390/ijerph192417017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The relationship between stiffness and drop jump performance in athletes in various stages of development has yet to be fully investigated. The first aim of this study was to investigate the association between the stiffness of the patellar and quadriceps tendon (PT, QT), gastrocnemius-Achilles tendon unit (GAT), and rectus femoris (RF) using drop jump (DJ) performance in young basketball players. The second aim was to investigate possible variations in the stiffness levels of those tissues in different developmental stages. METHODS The stiffness levels of the GAT, PT, QT, and RF were measured in both limbs in 73 male basketball players aged 12 to 18 years. The reactive strength index (RSI), contact time (CT) and jump height (JH) during 30 and 40 cm DJs were also measured. RESULTS Pearson correlation coefficients showed a significant association between DJ performance and PT, QT, GAT, and RF dynamic stiffness. Moreover, the youngest subjects were found to have lower stiffness values than the older ones. CONCLUSIONS Tissue stiffness can affect athletic performance by modifying the stretch-shortening cycle in young basketball players. Stiffness of muscles and tendons increases during the maturation process. Further investigations could shed light on the effect of training on the stiffness of muscles and tendons.
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Affiliation(s)
- Marco Gervasi
- Department of Biomolecular Sciences, Division of Exercise and Health Sciences, University of Urbino Carlo Bo, 61029 Urbino, Italy
| | - Piero Benelli
- Department of Biomolecular Sciences, Division of Exercise and Health Sciences, University of Urbino Carlo Bo, 61029 Urbino, Italy
- US Victoria Libertas Basketball, 61122 Pesaro, Italy
| | | | - Eneko Fernández-Peña
- Department of Physical Education and Sport, University of the Basque Country UPV/EHU, 01007 Vitoria-Gasteiz, Spain
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Ito N, Capin JJ, Khandha A, Buchanan TS, Silbernagel KG, Snyder-Mackler L. Bone-Patellar Tendon-Bone Autograft Harvest Prolongs Extensor Latency during Gait 2 yr after ACLR. Med Sci Sports Exerc 2022; 54:2109-2117. [PMID: 35941514 PMCID: PMC9669131 DOI: 10.1249/mss.0000000000003009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Bone-patellar tendon-bone (BPTB) graft harvest for anterior cruciate ligament reconstruction alters patellar tendon properties, which inflict poor quadriceps neuromuscular function. BPTB autografts are associated with higher rates of posttraumatic osteoarthritis, which in turn is associated with pathological gait. The purpose of this study was to investigate the latency between the time of peak quadriceps activity and the peak knee flexion moment during gait, between those with BPTB grafts ( n = 23) and other graft types (hamstring autograft or allografts, n = 54), 5 ± 2 months and 2 yr (25 ± 3 months) after anterior cruciate ligament reconstruction. We hypothesized that longer latencies would be observed in the BPTB graft group in the involved limb. We expected latencies to shorten over time. METHODS Knee moments and quadriceps EMG were collected during gait, and vastus medialis, vastus lateralis, rectus femoris (RF), and quadriceps latencies were calculated. Linear mixed-effects models were used to compare latencies between graft types and over the two time points. RESULTS The main effects of graft type were observed for vastus medialis ( P = 0.005) and quadriceps ( P = 0.033) latencies with the BPTB graft group demonstrating longer latencies. No main effects of graft type were observed for vastus lateralis ( P = 0.051) and RF ( P = 0.080) latencies. Main effects of time were observed for RF latency ( P = 0.022). CONCLUSIONS Our hypothesis that the BPTB graft group would demonstrate longer extensor latency was supported. Contrary to our second hypothesis, however, latency only improved in RF and regardless of graft type, indicating that neuromuscular deficits associated with BPTB grafts may persist 2 yr after surgery. Persistent deficits may be mediated by changes in the patellar tendon's mechanical properties. Graft-specific rehabilitation may be warranted to address the long-term neuromechanical deficits that are present after BPTB graft harvest.
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Affiliation(s)
- Naoaki Ito
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE
- Department of Physical Therapy, University of Delaware, Newark, DE
| | - Jacob J. Capin
- Department of Physical Therapy, Marquette University, Milwaukee, WI
| | - Ashutosh Khandha
- Department of Biomedical Engineering, University of Delaware, Newark, DE
| | - Thomas S. Buchanan
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE
- Department of Biomedical Engineering, University of Delaware, Newark, DE
- Department of Mechanical Engineering, University of Delaware, Newark, DE
| | - Karin Grävare Silbernagel
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE
- Department of Physical Therapy, University of Delaware, Newark, DE
| | - Lynn Snyder-Mackler
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE
- Department of Physical Therapy, University of Delaware, Newark, DE
- Department of Biomedical Engineering, University of Delaware, Newark, DE
- Department of Mechanical Engineering, University of Delaware, Newark, DE
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Borrella-Andrés S, Malo-Urriés M, Pérez-Bellmunt A, Arias-Buría JL, Rodríguez-Sanz J, Albarova-Corral MI, González-Rueda V, Gallego-Sendarrubias GM, Fernández-de-las-Peñas C, López-de-Celis C. Application of Percutaneous Needle Electrolysis Does Not Elicit Temperature Changes: An In Vitro Cadaveric Study. Int J Environ Res Public Health 2022; 19:15738. [PMID: 36497812 PMCID: PMC9735625 DOI: 10.3390/ijerph192315738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/19/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
Percutaneous needle electrolysis (PNE) consists of the ultrasound-guided application of a galvanic electrical current through a solid filament needle. One proposed therapeutic mechanism for this intervention is a potential thermal effect. The aim of this study was to investigate if the application of PNE induces changes in temperature in different cadaveric musculoskeletal tissues. A repeated measure experimental cadaveric study was designed with 10 cryopreserved knees (5 men, 5 women). Sterile stainless-steel needles of 40 mm length and 0.30 mm caliber were used in this study. An ultrasound-guided needling puncture was performed in the targeted tissue (patellar tendon, infra-patellar fat, and vastus medialis muscle). Additionally, the tip of the needle was placed next to the thermometer sensor at the minimum possible distance without direct contact with it. The temperature differences before and after different applications were measured. The applications were: three applications for 3 s of 3 mA of intensity (3:3:3) when the tendon was the targeted tissue, three applications for 3 s of 1.5 mA of intensity (1.5:3:3) when the fat or muscle was the targeted tissue, and 24 s of 1 mA of intensity (1:24:1) in all tissues. No statistically significant Group*Time interactions were found in any tissue (tendon: F = 0.571, p = 0.459, ŋ2 = 0.03; fat pad: F = 0.093; p = 0.764, ŋ2 = 0.01; muscle: F = 0.681; p = 0.420, ŋ2 = 0.04). Overall, no changes in temperature were observed between both applications in the tendon (3:3:3 vs. 1:24:1) and fat/muscle (1.5:3:3 vs. 1:24:1) tissues. The application of two different percutaneous needle electrolysis protocols did not produce appreciable thermal changes in the tendon, fat, and muscle tissues of human cadavers. The results from the current cadaver study support that a thermal effect should not be considered as a mechanism of clinical action regardless of the targeted human tissue when applying percutaneous needle electrolysis since no changes in temperature after its application were observed.
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Affiliation(s)
| | | | - Albert Pérez-Bellmunt
- Faculty of Medicine and Health Science, Universitat Internacional de Catalunya, 08017 Barcelona, Spain
- ACTIUM Functional Anatomy Group, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallès, Spain
| | - José L. Arias-Buría
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
| | - Jacobo Rodríguez-Sanz
- Faculty of Medicine and Health Science, Universitat Internacional de Catalunya, 08017 Barcelona, Spain
- ACTIUM Functional Anatomy Group, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallès, Spain
| | | | - Vanessa González-Rueda
- Faculty of Medicine and Health Science, Universitat Internacional de Catalunya, 08017 Barcelona, Spain
- ACTIUM Functional Anatomy Group, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallès, Spain
- Department of Physical Therapy, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08007 Barcelona, Spain
| | | | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
| | - Carlos López-de-Celis
- Faculty of Medicine and Health Science, Universitat Internacional de Catalunya, 08017 Barcelona, Spain
- ACTIUM Functional Anatomy Group, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallès, Spain
- Department of Physical Therapy, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08007 Barcelona, Spain
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Bravo-Sánchez A, Abián P, Sánchez-Infante J, Ramírez-delaCruz M, Esteban-García P, Jiménez F, Abián-Vicén J. Five-Compressions Protocol as a Valid Myotonometric Method to Assess the Stiffness of the Lower Limbs: A Brief Report. Int J Environ Res Public Health 2022; 19:14425. [PMID: 36361308 PMCID: PMC9654301 DOI: 10.3390/ijerph192114425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/28/2022] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
The objective of this study was to evaluate the validity of a short assessment MyotonPRO protocol to measure the stiffness of the superficial muscles and tendons of the lower limbs. The stiffness of the dominant lower limb vastus lateralis (VL), rectus femoris (RF) and patellar tendon (PT) was evaluated in 52 healthy participants (26.9 ± 3.4 years) with two MyotonPRO protocols: the standard protocol (10 mechanical taps) and the short protocol (five mechanical taps). The myotonometry was performed at the midpoint of the length from the upper pole of the patella to the greater trochanter for the VL, and to the anterior superior iliac spine for the RF. The PT was evaluated 1 cm caudal from the inferior pole of the patella. Pearson's correlation coefficients were calculated to determine the relationships between protocols. The validity of the short protocol was evaluated with Student's t-test. High positive correlations were observed between the short and standard protocols in the stiffness of the VL (r = 0.959; p < 0.001), the RF (r = 0.967; p < 0.001) and the PT (r = 0.953; p < 0.001) and no differences were found between both protocols in the stiffness assessment of the VL, RF and PT (p > 0.05). Therefore, the five-compressions protocol is a valid protocol for the assessment of lower limb mechanical properties.
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Affiliation(s)
- Alfredo Bravo-Sánchez
- Faculty of Health Sciences, Universidad Francisco de Vitoria, 28223 Pozuelo de Alarcón, Spain
| | - Pablo Abián
- Faculty of Humanities and Social Sciences, Comillas Pontifical University, C. Alberto Aguilera 23, 28049 Madrid, Spain
| | | | - María Ramírez-delaCruz
- Performance and Sport Rehabilitation Laboratory (DEPORSALUD), Faculty of Sports Sciences, University of Castilla-La Mancha, Avda. Carlos III s/n, 45071 Toledo, Spain
| | - Paula Esteban-García
- Performance and Sport Rehabilitation Laboratory (DEPORSALUD), Faculty of Sports Sciences, University of Castilla-La Mancha, Avda. Carlos III s/n, 45071 Toledo, Spain
| | - Fernando Jiménez
- Performance and Sport Rehabilitation Laboratory (DEPORSALUD), Faculty of Sports Sciences, University of Castilla-La Mancha, Avda. Carlos III s/n, 45071 Toledo, Spain
| | - Javier Abián-Vicén
- Performance and Sport Rehabilitation Laboratory (DEPORSALUD), Faculty of Sports Sciences, University of Castilla-La Mancha, Avda. Carlos III s/n, 45071 Toledo, Spain
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Labanca L, Budini F, Cardinali L, Concilio G, Rocchi JE, Mariani PP, Laudani L, Macaluso A. A Countermovement Jump for the Midterm Assessment of Force and Power Exertion After Anterior Cruciate Ligament Reconstruction. Am J Phys Med Rehabil 2022; 101:1007-1013. [PMID: 35034062 DOI: 10.1097/phm.0000000000001954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The aim of this study was to assess force and power exertion during a countermovement jump after anterior cruciate ligament reconstruction using either semitendinosus and gracilis or bone-patellar tendon-bone graft. DESIGN One hundred-nineteen semitendinosus and gracilis and 146 bone-patellar tendon-bone participants performed a countermovement jump on two force platforms after 3 (T1) and 6-9 mos (T2) from surgery. Twenty-four healthy participants served as control group. Peak force of eccentric and concentric phases and peak power were obtained from the analysis of vertical components of the ground reaction forces. Asymmetry was quantified by means of limb symmetry index. RESULTS Eccentric peak force was significantly ( P < 0.05) lower than concentric peak force in both bone-patellar tendon-bone and semitendinosus and gracilis at T1 and T2. At T1, bone-patellar tendon-bone showed higher peak power, but lower limb symmetry index in eccentric and concentric compared with semitendinosus and gracilis. At T2, bone-patellar tendon-bone showed higher peak power than semitendinosus and gracilis, although there were no differences in limb symmetry index between the two groups, which however was significantly ( P < 0.05) lower in both groups when compared with control group. CONCLUSIONS Bone-patellar tendon-bone and semitendinosus and gracilis participants showed asymmetries in eccentric and concentric force during a countermovement jump. Bone-patellar tendon-bone showed greater asymmetries and a higher peak power respect to semitendinosus and gracilis participants.
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Affiliation(s)
- Luciana Labanca
- From the Department of Movement, Human and Health Sciences, University of Rome Foro Italico, Rome, Italy (L. Labanca, LC, GC, JER, PPM, AM); Institute of Human Movement Science, Sport and Health University of Graz, Graz, Austria (FB); Villa Stuart Sport Clinic-FIFA Medical Centre of Excellence, Rome, Italy (JER, PPM, AM); and Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom (L. Laudani)
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Leiphart RJ, Weiss SN, DiStefano MS, Mavridis AA, Adams SA, Dyment NA, Soslowsky LJ. Collagen V deficiency during murine tendon healing results in distinct healing outcomes based on knockdown severity. J Biomech 2022; 144:111315. [PMID: 36201909 PMCID: PMC10108665 DOI: 10.1016/j.jbiomech.2022.111315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/11/2022] [Accepted: 09/16/2022] [Indexed: 10/31/2022]
Abstract
Tendon function is dependent on proper organization and maintenance of the collagen I tissue matrix. Collagen V is a critical regulator of collagen I fibrils, and while prior studies have shown a negative impact of collagen V deficiency on tendon healing outcomes, these studies are confounded by collagen V deficiency through tendon development. The specific role of collagen V in regulating healing tendon properties is therefore unknown. By using inducible Col5a1 knockdown models and analyzing gene expression, fibril and histological tendon morphology, and tendon mechanical properties, this study defines the isolated role of collagen V through tendon healing. Patellar tendon injury caused large changes in tendon gene expression, and Col5a1 knockdown resulted in dysregulated expression of several genes through tendon healing. Col5a1 knockdown also impacted collagen fibril size and shape without observable changes in scar tissue formation. Surprisingly, heterozygous Col5a1 knockdown resulted in improved stiffness of healing tendons that was not observed with homozygous Col5a1 knockdown. Together, these results present an unexpected and dynamic role of collagen V deficiency on tendon healing outcomes following injury. This work suggests a model of tendon healing in which quasi-static mechanics may be improved through titration of collagen fibril size and shape with modulation of collagen V expression and activity.
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Affiliation(s)
- R J Leiphart
- McKay Orthopedic Research Laboratory, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - S N Weiss
- McKay Orthopedic Research Laboratory, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - M S DiStefano
- McKay Orthopedic Research Laboratory, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - A A Mavridis
- McKay Orthopedic Research Laboratory, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - S A Adams
- University of South Florida, Morsani College of Medicine, Tampa, FL 33612, USA
| | - N A Dyment
- McKay Orthopedic Research Laboratory, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - L J Soslowsky
- McKay Orthopedic Research Laboratory, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Martínez F, Abián P, Jiménez F, Abián-Vicén J. The Effects of Eccentric Contraction Execution Time on the Properties of the Patellar Tendon. Int J Environ Res Public Health 2022; 19:ijerph19159296. [PMID: 35954651 PMCID: PMC9367933 DOI: 10.3390/ijerph19159296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to assess the effects of eccentric contraction execution time on the morphological and elastic properties of the patellar tendon (PT) in a six-week, single-leg decline squat (SLDS) exercise training program. In addition, the effects of a six-week detraining period on the same variables were evaluated. Fifty participants were randomized into the control group (CG; n = 15), experimental group 1 (EG6s; n = 17; eccentric contraction execution time = 6 s) and experimental group 2 (EG3s; n = 18; eccentric contraction execution time = 3 s). The thickness and elastographic index (EI) in different regions of interest (ROIs) in the PT were measured after 6 weeks of eccentric training using the single-leg decline squat exercise (three sessions per week, 80% of the eccentric one-repetition maximum) and after 6 weeks of detraining. There was an increase in the thickness of the PT in the different ROIs analyzed in both experimental groups at the end of the training period. Especially worth noting was the increase in the thickness of the PT at the proximal level in EG3s (p = 0.001), and the increase at the distal level in EG6s (p = 0.001). On the other hand, there was a reduction in EI in EG6S at the end of the intervention program (p = 0.021), and both experimental groups increased EI in the three regions of interest analyzed after the detraining period (p < 0.01). In conclusion, the execution time of the eccentric contraction in the SLDS exercise determines the anatomical level of the morphological adaptations in the PT. These morphological adaptations are lost after 6 weeks of detraining, producing an increase in tendon stiffness.
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Affiliation(s)
- Fernando Martínez
- Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, 45071 Toledo, Spain; (F.M.); (F.J.)
| | - Pablo Abián
- Faculty of Humanities and Social Sciences, Comillas Pontifical University, 28049 Madrid, Spain;
| | - Fernando Jiménez
- Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, 45071 Toledo, Spain; (F.M.); (F.J.)
| | - Javier Abián-Vicén
- Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, 45071 Toledo, Spain; (F.M.); (F.J.)
- Correspondence: ; Tel.: +34-925268800 (ext. 5522)
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Abstract
OBJECTIVES Although exercise is considered the preferred approach for tendinopathies, the actual load that acts on the tendon in loading programmes is usually unknown. The objective of this study was to review the techniques that have been applied in vivo to estimate the forces and strain that act on the human tendon in dynamic exercises used during rehabilitation. DESIGN Scoping review. DATA SOURCES Embase, PubMed, Web of Science and Google Scholar were searched from database inception to February 2021. ELIGIBILITY CRITERIA Cross-sectional studies available in English or Spanish language were included if they focused on evaluating the forces or strain of human tendons in vivo during dynamic exercises. Studies were excluded if they did not evaluate tendon forces or strain; if they evaluated running, walking, jumping, landing or no dynamic exercise at all; and if they were conference proceedings or book chapters. DATA EXTRACTION AND SYNTHESIS Data extracted included year of publication, study setting, study population characteristics, technique used and exercises evaluated. The studies were grouped by the types of techniques and the tendon location. RESULTS Twenty-one studies were included. Fourteen studies used an indirect methodology based on inverse dynamics, nine of them in the Achilles and five in the patellar tendon. Six studies implemented force transducers for measuring tendon forces in open carpal tunnel release surgery patients. One study applied an optic fibre technique to detect forces in the patellar tendon. Four studies measured strain using ultrasound-based techniques. CONCLUSIONS There is a predominant use of inverse dynamics, but force transducers, optic fibre and estimations from strain data are also used. Although these tools may be used to make general estimates of tendon forces and strains, the invasiveness of some methods and the loss of immediacy of others make it difficult to provide immediate feedback to the individuals.
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Affiliation(s)
- Adrian Escriche-Escuder
- Department of Physiotherapy, University of Malaga, Malaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain
| | - Antonio I Cuesta-Vargas
- Department of Physiotherapy, University of Malaga, Malaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain
- Department of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jose Casaña
- Department of Physiotherapy, University of Valencia, Valencia, Spain
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Mutsuzaki H, Yoshida Y, Nakajima H. Periostin Contributes to Fibrocartilage Layer Growth of the Patella Tendon Tibial Insertion in Mice. Medicina (B Aires) 2022; 58:medicina58070957. [PMID: 35888676 PMCID: PMC9319934 DOI: 10.3390/medicina58070957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: The influence of periostin on the growth of the patella tendon (PT) tibial insertion is unknown. The research described here aimed to reveal the contribution of periostin to the growth of fibrocartilage layers of the PT tibial insertion using periostin knockout mice. Materials and Methods: In both the wild-type (WD; C57BL/6N, periostin +/+; n = 54) and periostin knockout (KO; periostin −/−; n = 54) groups, six mice were euthanized on day 1 and at 1, 2, 3, 4, 6, 8, 10, and 12 weeks of age. Chondrocyte proliferation and apoptosis, number of chondrocytes, safranin O-stained glycosaminoglycan (GAG) area, staining area of type II collagen, and length of the tidemark were investigated. Results: Chondrocyte proliferation and apoptosis in KO were lower than those in WD on day 1 and at 1, 4, and 8 weeks and on day 1 and at 4, 6, and 12 weeks, respectively. Although the number of chondrocytes in both groups gradually decreased, it was lower in KO than in WD on day 1 and at 8 and 12 weeks. In the extracellular matrix, the GAG-stained area in KO was smaller than that in WD on day 1 and at 1, 4, 8, 10, and 12 weeks. The staining area of type II collagen in KO was smaller than that in WD at 8 weeks. The length of the tidemark in KO was shorter than that in WD at 4 and 6 weeks. Conclusion: Loss of periostin led to decreased chondrocyte proliferation, chondrocyte apoptosis, and the number of chondrocytes in the growth process of the PT tibial insertion. Moreover, periostin decreased and delayed GAG and type II collagen production and delayed tidemark formation in the growth process of the PT tibial insertion. Periostin can, therefore, contribute to the growth of fibrocartilage layers in the PT tibial insertion. Periostin deficiency may result in incomplete growth of the PT tibial insertion.
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Affiliation(s)
- Hirotaka Mutsuzaki
- Department of Orthopedic Surgery, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami Ami-machi, Inashiki-gun, Ibaraki, Ami 300-0394, Japan
- Correspondence: ; Tel.: +81-29-888-4000
| | - Yuta Yoshida
- Department of Agriculture, Ibaraki University, 3-21-1 Chuo, Ibaraki, Ami 300-0393, Japan; (Y.Y.); (H.N.)
| | - Hiromi Nakajima
- Department of Agriculture, Ibaraki University, 3-21-1 Chuo, Ibaraki, Ami 300-0393, Japan; (Y.Y.); (H.N.)
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Catapano M, Babu AN, Tenforde AS, Borg-Stein J, McInnis KC. Knee Extensor Mechanism Tendinopathy: Evaluation, Treatment, and Prevention. Curr Sports Med Rep 2022; 21:205-212. [PMID: 35703747 DOI: 10.1249/jsr.0000000000000967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT Knee extensor mechanism tendinopathy, including patellar and quadriceps tendinopathy, is common among athletes and those involved in jumping sports. It is largely a clinical diagnosis that presents as anterior knee pain and stiffness with associated tenderness over the affected tendon. Imaging modalities, including ultrasound and/or magnetic resonance imaging, may be helpful with the diagnosis of difficult cases or in the planning of interventional procedures. Focused and structured rehabilitation using eccentric or heavy slow resistance exercise in conjunction with load management is important for recovery. Adjuvant therapies (e.g., injections or surgery) may be necessary in recalcitrant cases or those with insufficient response to rehabilitation efforts. Prevention strategies focus on improving biomechanics, landing mechanism and lower-extremity balance, flexibility, and strength.
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Affiliation(s)
| | | | - Adam S Tenforde
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA
| | - Joanne Borg-Stein
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA
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Zhang Y, Zhou J, Zheng XZ, Ding JP, Shu DB, Chen LL, Lin XY, Tian T. [Magnetic resonance imaging analysis on the effect of marathon on the dynamic changes of morphological characteristics of patellar tendon in amateur marathon runners after half marathon]. Zhonghua Yi Xue Za Zhi 2022; 102:636-641. [PMID: 35249306 DOI: 10.3760/cma.j.cn112137-20210722-01638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Objective: To explore the dynamic changes of morphological characteristics of patellar tendon (PT) in amateur athletes after a half-marathon using magnetic resonance imaging. Methods: A total of 19 male amateur marathon runners with 38 knee joints,aged from 26 to 53(41.5±7.9) years, running for 3 to 18 years, with a weekly running volume of 30-90 km and a monthly running volume of 100-300 km were enrolled and underwent 1.5T MRI scan before the half-marathon, within 3 hours after running and 3 days after running. Ten healthy male volunteers with 20 knee joints, who had never participated in marathon and exercised (including but not limited to running) per week for less than 150 minutes were recruited as the control group, aged from 26 to 54 (39.4±9.1) years. Firstly, the PT signal was qualitatively assessed on fat-suppressed proton density-weighted imaging (fs-PDWI) sequence to observe the presence of patellar tendinitis. Then, the length, proximal, middle and distal cross-sectional area (CSA), and volume of PT were measured using the post-processing tool ITK-SNAP, and the data were standardized. The independent sample t-test was used for comparing. One-way repeated measures analysis of variance was used to analyze the morphological changes of PT before and after half-marathon running. Results: The incidence of asymptomatic patellar tendinitis in amateur marathon runners was 26.3% (5/19). No significant MR signal changes of PT were observed in all runners after running. The proximal CSA in runners group was larger than that in controls [(4.20±0.62) mm2/kg3/4 vs (3.63±0.57) mm2/kg3/4, P<0.05], and there was no significant difference in length, medium and distal CSA and volume(all P>0.05). The length, proximal and distal CSA and volume of PT in runners group increased at 3 h after running [(47.35±3.22) mm vs (46.83±3.35) mm; (102.52±13.03) mm2 vs (98.98±13.14) mm2; (108.67±15.72) mm2 vs (100.27±14.37) mm2; (4 020.36±514.38) mm3 vs (3 826.57±499.23) mm3, all P<0.05]. There was no significant difference between before running and 3 days after running(all P>0.05). The middle CSA were not significantly different among different periods(all P>0.05). Conclusion: Marathon has effect on the normal PT morphology in male amateur marathon runners, showing an increase in proximal CSA. A half-marathon will cause reversible changes in PT length, regional CSA and volume.
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Affiliation(s)
- Y Zhang
- Department of Radiology, Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, China
| | - J Zhou
- Department of Radiology, Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, China
| | - X Z Zheng
- Department of Radiology, Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, China
| | - J P Ding
- Department of Radiology, Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, China
| | - D B Shu
- Department of Radiology, Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, China
| | - L L Chen
- Department of Radiology, Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, China
| | - X Y Lin
- Department of Radiology, Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, China
| | - T Tian
- Department of Radiology, Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, China
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Gaweł E, Zwierzchowska A. Therapeutic interventions in Osgood-Schlatter disease: A case report. Medicine (Baltimore) 2021; 100:e28257. [PMID: 34918694 PMCID: PMC8678013 DOI: 10.1097/md.0000000000028257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 11/25/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE The purpose of this case study was to identify factors of bilateral etiopathogenesis of Osgood-Schlatter disease (OSD) and those supporting the effectiveness of the therapeutic process in a 12-year-old elite female Olympic karateka. PATIENT CONCERNS The present case study concerns OSD female karateka who started her sport-specific training at the age of 4 years. DIAGNOSES The results of subjective palpation by the orthopedic surgeon and objective medical examination using ultrasonography, wall slide test, magnetic resonance imaging, and body height and weight measurements were collected. INTERVENTIONS The therapeutic intervention for the athlete's knee joints lasted 20 months (5 stages). Physical therapy, kinesiotherapy, and pharmacological treatment were administered, and physical activity was gradually introduced. OUTCOMES The developmental trajectory was uniform for body height and labile for body weight. OSD was diagnosed after the second growth spurt, and significant progression was reported during the subsequent height and weight gains and increased volume and intensity of sports training. The rate and dynamics of changes in the distance from the patellar ligament to the tibial apophysis were irregular, with dominance in the right knee with the highest rate of change (-3.3 mm) and twice the regression of the rate of change (-2.5 mm). The analyzed distance never exceeded the baseline value (5.5 mm), which was the case in the left knee. Return to sports competition was possible from the second month of therapy, in which kinesiotherapy and static stretching were the most effective. A relatively correct distance of the patellar ligament from the tibial apophysis was recorded at the time of stabilization of the body height and weight gain. No pathological changes were observed following OSD, and full recovery was observed. LESSONS In the case discussed in this study, growth spurt, the specificity of the sport practiced, and early specialization including high-volume and high-intensity training should be considered as factors causing OSD and its progression. Kinesiotherapeutic management and static stretching are crucial for the treatment of OSD. Quick return to sports competition was possible due to early therapeutic intervention, which could also lead to the absence of pathological changes in the tibial tubercle and the absence of recurrence of OSD.
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Ortega-Cebrián S, Navarro R, Seda S, Salas S, Guerra-Balic M. Patellar Tendon Structural Adaptations Occur during Pre-Season and First Competitive Cycle in Male Professional Handball Players. Int J Environ Res Public Health 2021; 18:ijerph182212156. [PMID: 34831912 PMCID: PMC8624795 DOI: 10.3390/ijerph182212156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/13/2021] [Accepted: 11/15/2021] [Indexed: 12/03/2022]
Abstract
Background: While there is evidence that tendon adapts to training load, structural alterations in the patellar tendon in response to training loads are still unclear. The aim of this study is to identify changes in patellar tendon structure throughout pre-season and after finalizing the first competitive cycle. Methods: Nineteen professional handball players participated in the aforesaid cross-sectional study, in which patellar tendon scan and counter movement jump (CMJ) performance were conducted. Measurements were taken on the first and last day of pre-season training, and at the end of the first competitive cycle. Results: The results revealed that variation on the tendon structure occurred, mainly at the end of pre-season training; for injured tendons this occurred at the proximal (Right p = 0.02), distal (Right p = 0.01), and (Left p = 0.02) tendon, while changes in healthy tendons occurred at the mid (Left p = 0.01) and distal tendon (Right p = 0.01). At the end of the first competitive cycle, changes were observed in the distal injured tendon (p = 0.02). Conclusion: Patellar tendon shows greater structural change after completing pre-season training than at the end of the first competitive cycle, from which it may be inferred that gradual loading during pre-season training allows the tendon to adapt and potentially decrease the onset of patellar tendinopathy.
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Affiliation(s)
- Silvia Ortega-Cebrián
- Physiotherapy Department, Facultat Fisioteràpia, Universitat Internacional de Catalunya (UIC), Carrer Josep Trueta, Sant Cugat de Vallès, 08017 Barcelona, Spain
- Futbol Club Barcelona, Medical Department, Ciutat Esportiva Joan Gamper, Avinguda, Once Setembre, Sant Joan Despí, 08970 Barcelona, Spain; (R.N.); (S.S.); (S.S.)
- Correspondence: ; Tel.: +34-932541800
| | - Ramon Navarro
- Futbol Club Barcelona, Medical Department, Ciutat Esportiva Joan Gamper, Avinguda, Once Setembre, Sant Joan Despí, 08970 Barcelona, Spain; (R.N.); (S.S.); (S.S.)
| | - Sergi Seda
- Futbol Club Barcelona, Medical Department, Ciutat Esportiva Joan Gamper, Avinguda, Once Setembre, Sant Joan Despí, 08970 Barcelona, Spain; (R.N.); (S.S.); (S.S.)
| | - Sebastià Salas
- Futbol Club Barcelona, Medical Department, Ciutat Esportiva Joan Gamper, Avinguda, Once Setembre, Sant Joan Despí, 08970 Barcelona, Spain; (R.N.); (S.S.); (S.S.)
| | - Myriam Guerra-Balic
- Faculty of Psychology, Education and Sports Sciences, University Ramon Llull, Spain FPCEE-Blanquerna, 08022 Barcelona, Spain;
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Brund RBK, Waagepetersen R, O. Nielsen R, Rasmussen J, Nielsen MS, Andersen CH, de Zee M. How Precisely Can Easily Accessible Variables Predict Achilles and Patellar Tendon Forces during Running? Sensors (Basel) 2021; 21:s21217418. [PMID: 34770725 PMCID: PMC8587337 DOI: 10.3390/s21217418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/05/2021] [Accepted: 11/05/2021] [Indexed: 11/23/2022]
Abstract
Patellar and Achilles tendinopathy commonly affect runners. Developing algorithms to predict cumulative force in these structures may help prevent these injuries. Importantly, such algorithms should be fueled with data that are easily accessible while completing a running session outside a biomechanical laboratory. Therefore, the main objective of this study was to investigate whether algorithms can be developed for predicting patellar and Achilles tendon force and impulse during running using measures that can be easily collected by runners using commercially available devices. A secondary objective was to evaluate the predictive performance of the algorithms against the commonly used running distance. Trials of 24 recreational runners were collected with an Xsens suit and a Garmin Forerunner 735XT at three different intended running speeds. Data were analyzed using a mixed-effects multiple regression model, which was used to model the association between the estimated forces in anatomical structures and the training load variables during the fixed running speeds. This provides twelve algorithms for predicting patellar or Achilles tendon peak force and impulse per stride. The algorithms developed in the current study were always superior to the running distance algorithm.
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Affiliation(s)
- René B. K. Brund
- Sport Sciences–Performance and Technology, Department of Health Science and Technology, Aalborg University, 9220 Aalborg, Denmark; (M.S.N.); (C.H.A.); (M.d.Z.)
- Correspondence: ; Tel.: +45-6024-8860
| | | | - Rasmus O. Nielsen
- Department of Public Health, Aarhus University, 8000 Aarhus, Denmark;
- Research Unit for General Practice, 8000 Aarhus, Denmark
| | - John Rasmussen
- Department of Materials and Production, Aalborg University, 9220 Aarhus, Denmark;
| | - Michael S. Nielsen
- Sport Sciences–Performance and Technology, Department of Health Science and Technology, Aalborg University, 9220 Aalborg, Denmark; (M.S.N.); (C.H.A.); (M.d.Z.)
| | - Christian H. Andersen
- Sport Sciences–Performance and Technology, Department of Health Science and Technology, Aalborg University, 9220 Aalborg, Denmark; (M.S.N.); (C.H.A.); (M.d.Z.)
| | - Mark de Zee
- Sport Sciences–Performance and Technology, Department of Health Science and Technology, Aalborg University, 9220 Aalborg, Denmark; (M.S.N.); (C.H.A.); (M.d.Z.)
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Olesen JL, Hansen M, Turtumoygard IF, Hoffner R, Schjerling P, Christensen J, Mendias CL, Magnusson PS, Kjaer M. No Treatment Benefits of Local Administration of Insulin-like Growth Factor-1 in Addition to Heavy Slow Resistance Training in Tendinopathic Human Patellar Tendons: A Randomized, Double-Blind, Placebo-Controlled Trial With 1-Year Follow-up. Am J Sports Med 2021; 49:2361-2370. [PMID: 34138667 DOI: 10.1177/03635465211021056] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Heavy slow resistance (HSR) training is currently recommended as part of the treatment of patellar tendon tendinopathy. However, treatment success is not reached in all patients, and combinations of different treatments could be beneficial. Local administration of insulin-like growth factor-1 (IGF-1) in humans has been shown to quickly stimulate tendon collagen synthesis. PURPOSE To study whether IGF-1 injections combined with HSR training enhance tendon synthesis, tissue structure, and patient satisfaction versus saline injection combined with HSR training in patients with patellar tendinopathy. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS Forty patients (age 18-50 years) with unilateral patellar tendinopathy undertook HSR training (3 times a week for 12 weeks) and received intratendinous IGF-1 injections (1 mg IGF-1 per dose) or isotonic saline injections (sham injections) at baseline and after 1 and 2 weeks of training. The primary outcome was collagen synthesis parameters after 12 weeks (primary endpoint). The secondary outcomes were patient-reported outcomes (scores on the Victorian Institute of Sport Assessment-Patella [VISA-P] and visual analog scale [VAS] for pain) and structural changes before the initiation of treatment and at week 3, week 12, and 1 year after the initiation of treatment. RESULTS Analysis of the patellar tendon biopsy specimens at 12 weeks showed that collagen mRNA and total RNA were increased in the tendinopathic tendons compared with the contralateral healthy tendons regardless of treatment with IGF-1 or saline. Similarly, no difference between the groups was seen in tendon thickness and Doppler activity at week 12 or at 1-year follow-up. The combination of HSR training and IGF-1 injections significantly improved VISA-P and VAS pain scores after 3 weeks, whereas the overall responses after 12 weeks and at 1-year follow-up were identical in the 2 groups. CONCLUSION Although a small, immediate clinical response to IGF-1 injections was seen when combined with training, no additional long-term effect of intratendinous IGF-1 was observed on structural and clinical outcomes in patients with patellar tendinopathy. REGISTRATION NCT01834989 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Jens L Olesen
- Center for General Practice at Aalborg University, Aalborg, Denmark
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery M81, Bispebjerg Hospital, Copenhagen, Denmark
| | - Mette Hansen
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery M81, Bispebjerg Hospital, Copenhagen, Denmark
- Section of Sport Science, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Ida F Turtumoygard
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery M81, Bispebjerg Hospital, Copenhagen, Denmark
| | - Rikke Hoffner
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery M81, Bispebjerg Hospital, Copenhagen, Denmark
- Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Peter Schjerling
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery M81, Bispebjerg Hospital, Copenhagen, Denmark
- Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jan Christensen
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Christopher L Mendias
- Hospital for Special Surgery, New York, New York, USA
- Department of Physiology and Biophysics, Weill Cornell Medical College, New York, New York, USA
| | - Peter S Magnusson
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery M81, Bispebjerg Hospital, Copenhagen, Denmark
- Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Michael Kjaer
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery M81, Bispebjerg Hospital, Copenhagen, Denmark
- Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Abián P, Martínez F, Jiménez F, Abián-Vicén J. Morphology of the Patellar Tendon and the Contractility Response of the Quadriceps: Symmetry and Gender Analysis. Int J Environ Res Public Health 2021; 18:ijerph18105309. [PMID: 34067639 PMCID: PMC8156345 DOI: 10.3390/ijerph18105309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/13/2021] [Accepted: 05/14/2021] [Indexed: 01/24/2023]
Abstract
The purpose of the study was to describe the differences between the dominant and non-dominant leg regarding contractility response and quadriceps strength and the morphology and stiffness of the patellar tendon (PT) in a group of physically active men and women. Fifty physically active subjects (36 men and 14 women) were evaluated for morphology and stiffness of the PT, contractility response of the rectus femoris of the quadriceps, isometric strength of the quadriceps and hamstrings, and isokinetic strength (concentric and eccentric) at 60°/s of the knee extensors. The measurements were made on the subject's dominant and non-dominant leg. The men showed a greater thickness of the PT in both legs compared to the women. Regarding the contractility response, the women recorded a 10.1 ± 16.2% (p = 0.038) greater contraction time (ct) in the dominant versus the non-dominant leg and the men recorded 11.9% (p = 0.040) higher values in the dominant leg compared to the women. In all the absolute strength measurements the men recorded higher values (p < 0.05) than the women, however, when the values were normalised with respect to the muscle mass of the leg these differences disappeared. The dominant leg showed values of isometric strength and eccentric strength at 60°/s (p < 0.05) greater than the non-dominant leg. The reference values provided in this study of the knee extensors and PT may be useful for detecting possible muscular or tendinous anomalies.
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Affiliation(s)
- Pablo Abián
- Faculty of Humanities and Social Sciences, Comillas Pontifical University, 28049 Madrid, Spain;
| | - Fernando Martínez
- Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, 45071 Toledo, Spain; (F.M.); (F.J.)
| | - Fernando Jiménez
- Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, 45071 Toledo, Spain; (F.M.); (F.J.)
| | - Javier Abián-Vicén
- Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, 45071 Toledo, Spain; (F.M.); (F.J.)
- Correspondence: ; Tel.: +34-925268800 (ext. 5522)
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Kabir SJ, Rahman MM, Islam NA, Saha MK, Islam MS, Islam MA, Rahman MM, Hossain MZ, Sayed A, Islam MN, Kabir KM, Hossain A. Anterior Cruciate Ligament Reconstruction using Bone Patellar Tendon Bone Autograft in ACL Deficient Knee. Mymensingh Med J 2020; 29:815-822. [PMID: 33116082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
More than 120,000 anterior cruciate ligament (ACL) injuries occur every year in the United States, mostly during the high school and college years. The incidence of these injuries is slowly increasing, especially in females. This is likely caused by their increasing participation in high school and other organized sports. In addition, several studies have shown that female athletes are at an increased risk of ACL injury in sex comparable sports. The goal of this study was to evaluate the functional outcome of Arthroscopic anterior cruciate ligament reconstruction using Bone-Patellar tendon- Bone autograft. 25 patients with chronic ACL deficient knee presenting to Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh from January 2018 to December 2019 were included in the study. The patients with severe osteoarthritis (OA) knee, local active infection and systemic disease, intraarticular fracture of knee that might influence the study results were excluded from the study. Bone patellar tendon bone graft was harvested from ipsilateral knee. The patient was followed till 6 months with specified program of rehabilitation. Results were evaluated by an independent examiner using radiography, subjective and objective evaluation. Assessment using Lysholm's score was 50 (42-63) preoperatively and 90.8 (63-97) at the latest follow up (p<0.005). No patient complained of instability at latest follow up. The quadriceps muscle showed atrophy at final follow-up. Five Patients complained of anterior knee pain. We found no graft displacement on follow up radiographs. Osteo-integration occurred in all cases. ACLR with a BPTB graft can stabilize the knee without loss of motion by closely mimicking the native ACL without any hazards and additional complications. It is useful in high demand patients and cost effective option with high patient satisfaction rate for reconstruction of ACL.
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Affiliation(s)
- S J Kabir
- Dr Shah Jawaher Jahan Kabir, Associate Professor & Head, Department of Orthopaedics, Mymensingh Medical College (MMC), Mymensingh, Bangladesh; E-mail:
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Wang K, Hosseinnejad SH, Jabran A, Baltzopoulos V, Ren L, Qian Z. A biomechanical analysis of 3D stress and strain patterns in patellar tendon during knee flexion. Int J Numer Method Biomed Eng 2020; 36:e3379. [PMID: 32564478 DOI: 10.1002/cnm.3379] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 01/19/2020] [Accepted: 06/07/2020] [Indexed: 06/11/2023]
Abstract
Patellar tendinopathy is among the most widespread patellar tendon diseases in athletes that participate in activities involving running and jumping. Although their symptoms can be detected, especially at the inferior pole of the patella, their biomechanical cause remains unknown. In this study, a three-dimensional finite element model of knee complex was developed to investigate principal stress and strain distributions in the patellar tendon during 0° to 90° knee flexion and slow and fast level-ground walking. Results indicate that the patellar tendon is subjected to tensile stress and strains during all three activities. During flexion, its central proximal posterior region exhibited highest peak stress and strain, followed by central distal posterior, central distal anterior and central proximal anterior region. Similar trends and magnitudes were reported during slow and fast walking. The region with highest principal stresses and strains, central proximal anterior region, also corresponds to the most commonly reported patellar tendinopathy lesion site, suggesting that principal stress and strain are good indicators of lesion site location. Additional factors such as regional variations in material properties and frequency and duration of cyclic loading also need to be considered when determining the biomechanical aetiology of patellar tendinopathy.
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Affiliation(s)
- Kunyang Wang
- Key Laboratory of Bionic Engineering, Ministry of Education, Jilin University, Changchun, People's Republic of China
- School of Mechanical, Aerospace and Civil Engineering, University of Manchester, Manchester, UK
| | - Soroosh H Hosseinnejad
- School of Mechanical, Aerospace and Civil Engineering, University of Manchester, Manchester, UK
| | - Ali Jabran
- School of Mechanical, Aerospace and Civil Engineering, University of Manchester, Manchester, UK
| | - Vasilios Baltzopoulos
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Lei Ren
- Key Laboratory of Bionic Engineering, Ministry of Education, Jilin University, Changchun, People's Republic of China
- School of Mechanical, Aerospace and Civil Engineering, University of Manchester, Manchester, UK
| | - Zhihui Qian
- Key Laboratory of Bionic Engineering, Ministry of Education, Jilin University, Changchun, People's Republic of China
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Sullivan JP. In ACL Reconstruction with Patellar Tendon Autograft, Adductor Canal Nerve Blockade Reduced Quadriceps Function Deficits Compared with Femoral Nerve Blockade, but Did Not Differ for Postoperative Pain. J Bone Joint Surg Am 2019; 101:2061. [PMID: 31764369 DOI: 10.2106/jbjs.19.00985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Rickaby R, El Khoury LY, Samiric T, Raleigh SM. Epigenetic Status of The Human MMP11 Gene Promoter is Altered in Patellar Tendinopathy. J Sports Sci Med 2019; 18:155-159. [PMID: 30787663 PMCID: PMC6370951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 01/23/2019] [Indexed: 06/09/2023]
Abstract
Patellar tendinopathy (PT) is a debilitating condition that often affects those who are physically active. Gene variation is known to contribute to human tendinopathy but the role of DNA methylation, as an epigenetic factor, has only recently been discovered. Using a case-control approach, we sought to determine whether differences existed between the methylation status of the MMP11 gene promoter in patellar tendinopathy compared to healthy tendon. We used PCR and pyrosequencing to interrogate the methylation profiles of 4 CpG sites (areas of the genome rich in C/G nucleotides) upstream of the MMP11 gene in DNA from males with PT (n = 10) and those with healthy tendon (n = 10). We also conducted a correlation analysis to establish whether age influenced methylation in the PT patients and controls. We found a significant (p = 0.045) difference in the methylation status of a single CpG site 65 base pairs (bp) upstream of the MMP11 promoter between the PT group and controls. There were no other differences in the extent of MMP11 promoter methylation between the two groups. Interestingly, we also found that in controls the degree of methylation at a second CpG site, 55 bp upstream of the first exon, tentatively correlated (r = 0.77, p = 0.009) with age. However, the correlation did not reach significance when a potential outlier was removed. This is the first study to show an epigenetic alteration to a member of the MMP gene family in human patellar tendinopathy. The data add to our understanding of how epigenetics should be considered when developing appropriate risk models.
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Affiliation(s)
- Rebecca Rickaby
- Faculty of Health and Society, University of Northampton, UK
- Faculty of Science, School of Pharmacy, University of Nottingham, UK
| | - Louis Y El Khoury
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN, USA
| | - Tom Samiric
- School of Life Sciences, La Trobe University, Melbourne, Victoria, Australia
| | - Stuart M Raleigh
- Centre for Sport, Exercise and Life Sciences, Coventry University, UK
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Graham HK, Thomason P, Sangeux M. Is the Knee the Key to Long-Term Gait Function in Cerebral Palsy?: Commentary on an article by Elizabeth R. Boyer, PhD, et al.: "Long-Term Outcomes of Distal Femoral Extension Osteotomy and Patellar Tendon Advancement in Individuals with Cerebral Palsy". J Bone Joint Surg Am 2018; 100:e6. [PMID: 29298270 DOI: 10.2106/jbjs.17.01357] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Zaffagnini S, Roberti di Sarsina T. Editorial Commentary: The Medial Patellar Ligaments: A Step Closer to the Knee Surgeon's "Rubik's Cube" Solution. Arthroscopy 2017; 33:1874-1875. [PMID: 28969822 DOI: 10.1016/j.arthro.2017.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 07/21/2017] [Indexed: 02/02/2023]
Abstract
Recent cadaveric research analyzing the medial patellar ligaments and their contribution to patellar stability points out not only the need for reconstruction of the medial patellofemoral ligament, but also the medial tibiofemoral ligament to restore normal patellar stability and biomechanics.
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Tsukamoto I, Akagi M, Mori S, Inoue S, Asada S, Matsumura F. Anteroposterior Rotational References of the Tibia for Medial Unicompartmental Knee Arthroplasty in Japanese Patients. J Arthroplasty 2017; 32:3169-3175. [PMID: 28559197 DOI: 10.1016/j.arth.2017.04.052] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 03/14/2017] [Accepted: 04/24/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND In unicompartmental knee arthroplasty (UKA), there is no consensus regarding how to determine the anteroposterior (AP) reference of the tibia. A number of surgeons in Japan perform the sagittal saw cut using the medial intercondylar ridge (MIR) of the tibia according to surgical manuals. However, there is no theoretical basis for this practice. METHODS Preoperative computed tomography data from 32 lower limbs of 31 Japanese patients who received UKA were used. First, the angles between the surgical epicondylar axis and the MIR and the substitute AP (sAP) line connecting the medial border of the patellar tendon at the articular surface level and the medial intercondylar tubercle were measured. Next, the mediolateral (ML)/AP ratio of the tibial cut surface was measured when cut parallel to the MIR and sAP line. Finally, the ML/AP ratio of the tibial component was investigated in 4 contemporary UKA implants. RESULTS The MIR and sAP line were externally rotated 94.9° ± 4.1° and 90.4° ± 3.6° relative to the surgical epicondylar axis, respectively. Compared with a cut parallel to the MIR, the mean ML/AP ratio of the cut surface was significantly larger, and the ML/AP ratio was closer to the ML/AP ratio of the components for a cut parallel to the sAP line. CONCLUSION Obtaining the tibial AP orientation is one of the key steps not only in total knee arthroplasty but also in UKA. The sagittal cut referencing the sAP line provides better AP rotation and fitting of the tibia in UKA than referencing the MIR.
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Affiliation(s)
- Ichiro Tsukamoto
- Department of Orthopaedic Surgery, Kindai University Hospital, Osaka-Sayama City, Osaka, Japan
| | - Masao Akagi
- Department of Orthopaedic Surgery, Kindai University Hospital, Osaka-Sayama City, Osaka, Japan
| | - Shigeshi Mori
- Department of Orthopaedic Surgery, Kindai University Hospital, Osaka-Sayama City, Osaka, Japan
| | - Shinji Inoue
- Department of Orthopaedic Surgery, Kindai University Hospital, Osaka-Sayama City, Osaka, Japan
| | - Shigeki Asada
- Department of Orthopaedic Surgery, Kindai University Hospital, Osaka-Sayama City, Osaka, Japan
| | - Fuminori Matsumura
- Department of Orthopaedic Surgery, Kindai University Hospital, Osaka-Sayama City, Osaka, Japan; Department of Orthopaedic Surgery, Sakurakai Hospital, Osaka-Sayama City, Osaka, Japan
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Ludwig EK, Byron CR. Femoral head ostectomy and medial patellar ligament desmotomy to treat a pregnant miniature horse with coxofemoral joint luxation and upward fixation of the patella. Can Vet J 2017; 58:498-502. [PMID: 28487594 PMCID: PMC5394608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A 2-year-old, 8-weeks pregnant, non-weight bearing miniature horse mare was treated for a 6-day-old left coxofemoral joint luxation with a femoral head ostectomy. The procedure had no negative effects on pregnancy or parturition and 23 months following surgery the horse had minimal lameness.
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Everhart JS, Cole D, Sojka JH, Higgins JD, Magnussen RA, Schmitt LC, Flanigan DC. Treatment Options for Patellar Tendinopathy: A Systematic Review. Arthroscopy 2017; 33:861-872. [PMID: 28110807 DOI: 10.1016/j.arthro.2016.11.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 10/24/2016] [Accepted: 11/03/2016] [Indexed: 02/07/2023]
Abstract
PURPOSE To compare the efficacy of common invasive and noninvasive patellar tendinopathy (PT) treatment strategies. METHODS A systematic search was performed in PubMed, Google Scholar, CINAHL, UptoDate, Cochrane Reviews, and SPORTDiscus. Fifteen studies met the following inclusion criteria: (1) therapeutic outcome trial for PT, and (2) Victorian Institute of Sports Assessment was used to assess symptom severity at follow-up. Methodological quality and reporting bias were evaluated with a modified Coleman score and Begg's and Egger's tests of bias, respectively. RESULTS A total of 15 studies were included. Reporting quality was high (mean Coleman score 86.0, standard deviation 9.7), and there was no systematic evidence of reporting bias. Increased duration of symptoms resulted in poorer outcomes regardless of treatment (0.9% decrease in improvement per additional month of symptoms; P = .004). Eccentric training with or without core stabilization or stretching improved symptoms (61% improvement in the Victorian Institute of Sports Assessment score, 95% confidence interval [CI] 53% to 69%). Surgery in patients refractory to nonoperative treatment also improved symptoms (57%, 95% CI 52% to 62%) with similar outcomes among arthroscopic and open approaches. Results from shockwave (54%, 95% CI 22% to 87%) and platelet-rich plasma (PRP) studies (55%, 95% CI 5% to 105%) varied widely though PRP may accelerate early recovery. Finally, steroid injection provided no benefit (20%, 95% CI -20% to 60%). CONCLUSIONS Initial treatment of PT can consist of eccentric squat-based therapy, shockwave, or PRP as monotherapy or an adjunct to accelerate recovery. Surgery or shockwave can be considered for patients who fail to improve after 6 months of conservative treatment. Corticosteroid therapy should not be used in the treatment of PT. LEVEL OF EVIDENCE Level IV, systematic review of Level II-IV studies.
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Affiliation(s)
- Joshua S Everhart
- Department of Orthopaedics, The Ohio State University, Columbus, Ohio, U.S.A.; College of Medicine, The Ohio State University, Columbus, Ohio, U.S.A
| | - Devon Cole
- College of Medicine, The Ohio State University, Columbus, Ohio, U.S.A
| | - John H Sojka
- College of Medicine, The Ohio State University, Columbus, Ohio, U.S.A
| | - John D Higgins
- College of Medicine, The Ohio State University, Columbus, Ohio, U.S.A
| | - Robert A Magnussen
- Department of Orthopaedics, The Ohio State University, Columbus, Ohio, U.S.A.; College of Medicine, The Ohio State University, Columbus, Ohio, U.S.A
| | - Laura C Schmitt
- Department of Orthopaedics, The Ohio State University, Columbus, Ohio, U.S.A.; College of Medicine, The Ohio State University, Columbus, Ohio, U.S.A.; Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, U.S.A
| | - David C Flanigan
- Department of Orthopaedics, The Ohio State University, Columbus, Ohio, U.S.A.; College of Medicine, The Ohio State University, Columbus, Ohio, U.S.A.; Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, U.S.A.; Cartilage Restoration Center, The Ohio State University, Columbus, Ohio, U.S.A..
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Pillard P, Livet V, Cabon Q, Bismuth C, Sonet J, Remy D, Fau D, Carozzo C, Viguier E, Cachon T. Evaluation of a new method to determine the tibial tuberosity advancement distance required to reduce the patellar tendon-tibial plateau angle to 90° with the modified Maquet technique in dogs. Am J Vet Res 2017; 78:517-528. [PMID: 28345997 DOI: 10.2460/ajvr.78.4.517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess use of a new radiographic method to determine the distance by which the tibial tuberosity should be advanced to reduce the patellar tendon-tibial plateau angle (PTA) to 90° by means of the modified Maquet technique (MMT) in dogs. SAMPLE 24 pelvic limbs from 12 adult medium-sized to large-breed canine cadavers. PROCEDURES Radiographs of stifle joints at 135° extension in true lateral position were used to determine tibial tuberosity advancement distances for use in the MMT. A method was devised to incorporate the planned osteotomy axis; distal patellar translations of 0, 3, 5, or 10 mm; and advancement cage implant application level along the osteotomy site in advancement planning measurements. Concordance correlation coefficients (CCCs) were calculated to compare these adjusted advancement measurements with true advancement measurements obtained for the same joints in another study after treatment by MMT. Intraobserver, interobserver, and total agreement for selected measurements were determined by assessment of CCCs for results obtained by 3 blinded observers. RESULTS Agreement between true advancement measurements and measurements obtained with osteotomy axis and cage position method calculations that incorporated a 5-mm distal patellar translation distance was excellent (CCC, 0.96). Intraobserver and interobserver agreements for the planning measurements evaluated were good to excellent (CCC, 0.83 to 0.96). CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that the osteotomy axis and cage position method incorporating a 5-mm distal patellar translation distance has the potential to improve success rates for achieving a PTA of 90° in medium-sized to large-breed dogs undergoing MMT for treatment of cranial cruciate ligament rupture. Further research is warranted.
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