Management Of Tendon Injuries Research Articles

Mussel-derived Bioadaptive Artificial Tendon Facilitates the Cell Proliferation and Tenogenesis to Promote Tendon Functional Reconstruction.

Tendon injuries range from acute-related trauma to chronic-related injuries are prevalent and bring substantial pain, functional loss, and even disability to the patients. The management of tendon injuries is tricky due to the innate limited regenerative capability of the tendon. Currently, surgical intervention of tendon injuries with artificial tendons remains the standard of care. However, most of artificial tendons are manufactured with synthetic materials, which possess relatively poor biomimetic characteristics and inadequate inherent biodegradability, hence rendering limited cell proliferation and migration for tendon healing. To address these limitations, w e developed a mussel-derived artificial tendon based on double-crosslinked chitosan modification. In this design, decellularized artificial tendon serves as a natural biomimetic scaffold to facilitate the migration and adhesion of tendon repair cells. Additionally, as the cells proliferate, the artificial tendon can be degraded to facilitate tendon regeneration. Moreover, the chitosan cross-linking further enhances the mechanical strength of artificial tendon and offers a controllable degradation. The in vitro and in vivo experimental results demonstrated that mussel-derived artificial tendon not only accelerated the tendon functional reconstruction but also enabled harmless clearance at post-implantation. O ur finding provides a promising alternative to conventional artificial tendons and spurs a new frontier to explore nature-derived artificial tendons. This article is protected by copyright. All rights reserved.

Applications of functionally-adapted hydrogels in tendon repair.

Despite all the efforts made in tissue engineering for tendon repair, the management of tendon injuries still poses a challenge, as current treatments are unable to restore the function of tendons following injuries. Hydrogels, due to their exceptional biocompatibility and plasticity, have been extensively applied and regarded as promising candidate biomaterials in tissue regeneration. Varieties of approaches have designed functionally-adapted hydrogels and combined hydrogels with other factors (e.g., bioactive molecules or drugs) or materials for the enhancement of tendon repair. This review first summarized the current state of knowledge on the mechanisms underlying the process of tendon healing. Afterward, we discussed novel strategies in fabricating hydrogels to overcome the issues frequently encountered during the applications in tendon repair, including poor mechanical properties and undesirable degradation. In addition, we comprehensively summarized the rational design of hydrogels for promoting stem-cell-based tendon tissue engineering via altering biophysical and biochemical factors. Finally, the role of macrophages in tendon repair and how they respond to immunomodulatory hydrogels were highlighted.

Biological and Mechanical Factors and Epigenetic Regulation Involved in Tendon Healing.

Tendons are an important part of the musculoskeletal system. Connecting muscles to bones, tendons convert force into movement. Tendon injury can be acute or chronic. Noticeably, tendon healing requires a long time span and includes inflammation, proliferation, and remodeling processes. The mismatch between endogenous and exogenous healing may lead to adhesion causing further negative effects. Management of tendon injuries and complications such as subsequent adhesion formation are still challenges for clinicians. Due to numerous factors, tendon healing is a complex process. This review introduces the role of various biological and mechanical factors and epigenetic regulation processes involved in tendon healing.

The Role of Hyaluronic Acid in Sport-Related Tendinopathies: A Narrative Review.

Tendinopathy is a complex clinical condition with a rising incidence and prevalence, particularly during sports practice. For the return to play in affected patients, adequate functional and structural recovery of the tendon is the ultimate goal, avoiding the high risk of recurrence. In this perspective, local therapies alongside exercise are showing promising results. Despite evidence suggesting hyaluronic acid (HA) injections as effective in the treatment of tendinopathy, current recommendations about the management of this condition do not include this intervention. HA seems to be an effective therapeutic option for the management of sport-related tendinopathies, but further studies with a larger sample size are needed to confirm available findings. In this narrative review, we analyzed available literature about the rationale of the use of HA in the management of tendon injury and, particularly, in sport-related tendinopathies.

Usefulness of Ultrasonography in Diagnosis and Management of Tendon Injuries in Hand

Purpose: Tendon injuries in hand were one of the most frequent injuries caused by trauma. Although consequent tenorrhaphy is frequently conducted, in complete tendon rupture the location of retracted tendon stumps cannot be identified clearly, which causes difficulties in surgical management. Ultrasonography is known to be a fast, accurate, and cost-effective diagnostic method for tendon injury; therefore, the authors studied the usefulness of preoperative ultrasonography in diagnosis and management of tendon injuries in hand.Methods: Among the 34 patients who had hand tendon injuries and visited between January 2017 and March 2018, retrospective studies were conducted on six patients with unidentified tendon stumps. By identifying the location of the tendon injuries and ruptured tendon stumps through preoperative ultrasonography, the operation was conducted under a predetermined surgical plan. The authors compared the ultrasonography results and the surgical findings.Results: For diagnosis of the unidentified tendon injuries and location of ruptured tendon stumps, the ultrasonography results and the surgical findings were matched for all six patients. By prior planning of the operation incision line using the preoperative ultrasonography results, the length of the incision site was minimized without additional incision, and the operation time was shortened.Conclusion: For hand tendon injuries with unidentified tendon stumps, identifying the location of tendon stumps through preoperative ultrasonography is helpful for determining the incision range for the operation. Therefore, preoperative ultrasonography may be useful in the diagnosis and management of tendon injuries in hand.

Fight Bite with Tendon Laceration

Author(s): Chang, Michelle; Wei, Grant; Bryczkowski, Christopher; Yan, Sha; Shah, Chirag | Abstract: ABSTRACT: History of present illness: A 57-year-old male presented 24 hours after punching another individual in the mouth and injuring his right hand. He complained of pain and decreased range of motion in his 4th digit. On exam, the patient had a 1 cm laceration to his right 4th metacarpophalangeal joint with soft tissue swelling and limited extension of the digit against resistance. Significant findings: The video shows a water bath ultrasound of the right 4th digit, demonstrating soft tissue swelling with a hypoechoic region along the tendon consistent with edema and tendon disruption (see video and annotated still image). Discussion: Hand extensor tendon injuries can be caused by laceration, trauma, or overuse.1 Extensor tendon injuries are classified into eight zones.2 This patient suffered a Zone V partial tendon injury, commonly termed a “fight bite.” Management of tendon injuries is dependent on: partial vs full, closed vs open, and injury location.3,4 Closed tendon injuries require a volar extension splint with hand surgery follow-up within one week. Open tendon injuries involving g50% tendon width can be repaired in the emergency department, though some will require delayed repair.4 Ruptures involving l50% of tendon width should be placed in a volar extension splint, whereas ruptures involving g50% of tendon width should be sutured.3 Injuries to Zones II-IV and Zone VI may be repaired in the emergency department.4 However, injuries to other zones, the thumb, open fractures, neurovascular compromise, grossly contaminated wounds, or immunocompromised patients should be referred to a hand surgeon.5 “Fight bite” injuries should be treated with antibiotics and hand surgery consult for possible operative intervention.6After a normal X-ray, a bedside water-bath ultrasound was performed, revealing a Zone V extensor tendon rupture. The patient received tetanus prophylaxis, IV antibiotics, was splinted and admitted to the hand surgery service for operative washout of the wound and delayed tendon repair. Topics: Water bath ultrasound, tendon laceration, extensor tendon injury, fight bite, hand injury, orthopedics.

Can Shockwave Therapy Improve Tendon Metabolism?

Shockwave treatments are commonly used in the management of tendon injuries and there is increasing evidence for its clinical effectiveness. There is a paucity of fundamental (in vivo) studies investigating the biological action of shockwave therapy. Destruction of calcifications, pain relief and mechanotransduction-initiated tissue regeneration and remodeling of the tendon are considered to be the most important working mechanisms. The heterogeneity of systems (focussed shockwave therapy vs. radial pressurewave therapy), treatment protocols and study populations, and the fact that there seem to be responders and non-responders, continue to make it difficult to give firm recommendations with regard to the most optimal shockwave therapy approach. Specific knowledge with regard to the effects of shockwave therapy in patients with metabolic tendon disorders is not available. Further fundamental and clinical research is required to determine the value of shockwave therapy in the management of tendinopathy.

Blood Supply.

It has been suggested that blood circulation within the tendons contributes to repair of the tendon after the exercises. Recently, blood circulation of human tendons could be measured using red laser lights (Kubo et al. 2008b). Using this technique, we were able to measure changes in blood volume and oxygen saturation of human tendons by various treatments. During a 60-min heating, the blood volume and oxygen saturation of the tendon increased significantly from the resting level, and continued to increase by 35min. These changes in blood circulation of tendon were considerably different from the temperatures of muscle and skin. Furthermore, when the needle tip was moved up and down from the targeted depth (up-and-down manipulation) at approximately 1mm amplitude, the blood volume and oxygen saturation of the treated tendon increased significantly. After the removal of the acupuncture needle, the blood volume and oxygen saturation of the tendon increased gradually for the non-treated side. These results suggested that the change in blood circulation of the tendon during acupuncture with up-and-down manipulation was caused by axon reflex, and increase in blood flow in the tendons after the needle removal might be caused through the central nervous system. It is well known that heating and acupuncture treatments were quite effective in the management of tendon injuries. Therefore, these phenomena would be related to the changes in blood circulation of tendons due to heating and acupuncture treatments.

Platelet-Rich Plasma: Anatomical Application to Date: Does it Really Work?

Platelet-rich plasma is increasingly used in the management of tendon injury in sports, supposedly accelerating the healing process, tissue regeneration, and return to play. However, the scientific clinical evidence to support its use is scanty, and more level I studies need to be conducted to justify its widespread use.

Stem Cell and Tissue Engineering Applications in Orthopaedics and Musculoskeletal Medicine

Stem Cell and Tissue Engineering Applications in Orthopaedics and Musculoskeletal Medicine

Platelet Rich Plasma and Tendinopathy: State of the Art

Platelet-rich plasma (PRP) is increasingly used in the management of tendon injury in sports, supposedly accelerating the process of healing, tissue regeneration, and return to play. However, the scientific clinical evidence to support its use is scanty, and more level I studies need to be performed to justify its widespread use.

Tendon repair through stem cell intervention: Cellular and molecular approaches

Tendon injuries are common in either the workplace or sport activities, with some 3 to 5 million tendon and ligament injuries occurring annually worldwide. Management of tendon injury currently follows two routes: Conservative (rehabilitation and pain relief), or surgical. Irrespective of which of these primary treatment routes are followed, even if healing does occur, it may not result in a full gain of function. The inability of the tendon to self-repair and the relative inefficiency of current treatment regimens suggest that identifying alternative strategies is a priority. One such alternative is the use of stem cells to repair damage, either through direct application or in conjunction with scaffolding. We describe the current state of the art in terms of: (i) Molecular markers of tendon development, (ii) stem cell applicability to human tendon repair, (iii) scaffolding for in vitro tendon generation, and (iv) chemical/molecular approaches to both induce stem cell differentiation into tenocytes and maintain their proliferation in vitro.

Questions Hand Therapists Ask about Treatment of Tendon Injuries

Management of tendon injuries is a challenging responsibility for the surgeon and the hand therapist. Outcomes are improved by a clear understanding of concepts and indications that are pertinent to the clinical situation. We have given a comprehensive course, Surgical and Therapeutic Management of Flexor and Extensor Tendon Injuries, several times a year at various centers since 1998. The participants’ questions indicate their understanding but also confirm that some concepts are difficult to assimilate and implement. In this article, we address the most frequent questions put forth by therapists, residents, and surgeons. Our intention is to provide practical information that can be applied clinically.

Superficial Digital Flexor Tendon Healing: Ultrasonographic Evaluation of Therapies

Until recently, it was difficult to critically evaluate tendon healing in vivo. Superficial digital flexor tendon injuries were considered healed when the injured tendon was cold, non-painful, adequate time had passed for tendon healing to occur, and no recurrence of the injury was detected when the horse returned to athletic work. This article discusses how ultrasonography has revolutionized the diagnosis, treatment, and management of tendon injuries.

Principles of Rehabilitation After Chronic Tendon Injuries

This article describes a framework for the evaluation, diagnosis, and management of tendon injuries that result from repetitive microtrauma overload. These injuries are commonly called tendinitis injuries, but are more often degenerative lesions. The initial management of acute tendon injuries with rupture is usually quite different than that of chronic injuries, but the functional rehabilitation of the acute injuries can follow the same framework.

The management of tendon injuries in dogs

ABSTRACTAn account is provided of the management of 68 dogs with tendon injury. Of the 33 with Achilles rupture, 23 sustained tendon severance, seven had disrupted the gastrocnemius muscle/tendon junction, and in three an attachment of the gastrocnemius was avulsed. The standard operative procedure comprised fixing the hock in extension with a screw, and exploring the damaged structures with a view to repair and the introduction of carbon fibre implants. The majority regained normal limb use and the main complications concerned loosening or fracture of the screw.The 32 with digital flexor tendon severance had cuts, on a fore foot in nine and a hind foot in 23. Exploration and reconstruction were routinely practised and carbon fibre implants were frequently used. The standard of recovery was good in those dealt with fresh but was less satisfactory in chronic cases.The two dogs with digital extensor tendon and the one with flexor carpi ulnaris tendon severance responded well to repair.

The Principles of Management of Tendon Injuries to the Hand

The Principles of Management of Tendon Injuries to the Hand