Abstract
PurposeHealing outcome after Achilles Tendon Rupture (ATR) is variable and unsatisfactory. Many ATR patients still exhibit pain, functional deficits and limitations in walking one-year post-surgery. The present study was designed to investigate the association between the expression of healing biomarkers and patient outcome after ATR.MethodsTendon biopsies were collected from 25 ATR patients during surgery. At 1-year post surgery, all patients completed questionnaires; Achilles tendon Total Rupture Score (ATRS) and Foot and Ankle Outcome Score (FAOS), and were tested for functional outcomes by heel-rise test. In biopsies, FGF, COL III, FN, COL I and MMP-9 mRNA levels were assessed by quantitative RT-PCR while protein expression was studied by immunohistochemistry (IHC).ResultsOur analysis confirmed the presence of FGF, COL III, FN, COL I and MMP-9 at mRNA and protein levels in tendon biopsies. FGF gene expression associated positively with improved total ATRS and better functional outcomes. Additionally, FGF mRNA levels were associated with less pain, less running limitations and less loss in physical activity. In addition, higher COL III mRNA expression was associated with more tendon strength.ConclusionOur findings indicate that FGF gene expression is associated with improved patient-reported outcome. FGF expression in surgical biopsies could potentially be used to assist the prognostic evaluation of patient outcome and may be used as a predictor for healing. However, further studies are needed to evaluate the role of FGF in Achilles tendon healing.Level of evidenceII
Highlights
Achilles tendon rupture (ATR) is a common injury which is increasing in incidence worldwide [21, 22, 32]
Growth factors released from bloodderived cells at the site of injury activate tissue-derived cells such as fibroblasts to start the production of extracellular matrix (ECM) proteins and proteases
Achilles tendon Total Rupture Score (ATRS) subscales indicated that 35% of patients experienced pain to a small extent while more than 80% of the patients suffered from tiredness and stiffness in the tendon and experienced limitations in strength and jumping at 1-year post-surgery (Table 2)
Summary
Achilles tendon rupture (ATR) is a common injury which is increasing in incidence worldwide [21, 22, 32]. Achilles tendon repair is a complex process which involves variety of cytokines, growth factors, proteases and collagens [38]. Growth factors released from bloodderived cells at the site of injury activate tissue-derived cells such as fibroblasts to start the production of extracellular matrix (ECM) proteins and proteases. Fibroblast growth factor (FGF), an inflammatory mediator released by blood-derived cells, is crucial for the initiation of healing processes in tendons mainly by stimulating proliferation of fibroblasts [30]. FGF plays an important role in the synthesis of ECM protein and formation of granulation tissue in injured tendon [17]
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