Tendon Research Articles

Skeletotopic landmarks of the points of fixation of the quadriceps femoral muscle in representatives of canids

The article presents skeletotopic landmarks of the points of fixation of the quadriceps femoral muscle in representatives of Canidae (shalayka and domestic dog), which are absent in the available literature. Thus, it was revealed that the straight head in the distal part of the shalaika is attached to the base of the cranial surface of the kneecap by tendon fibers, and in the domestic dog its muscle-tendon fixation was found. The research was carried out at the Department of Anatomy and Histology of Animals named after Professor A. F. Klimov of the Moscow State Academy of Veterinary Medicine and Biotechnology – MBA named after K. I. Scriabin. The material for the research was sectional material - pelvic limbs (n=16), selected from adult dogs and canine hybrids (shalayka), without external signs of musculoskeletal system pathologies. The methods of fine macro- and microanatomic dissection under the control of a Micromed HR 350 S binocular magnifier were used, followed by functional analysis of the studied structures and skeletotopic projection of muscle attachment points on the kneecap. When studying the structures located on the kneecap, it was found that the cranial head of the tailor's muscle and the wide fascia of the thigh, covering the cranial surface of the kneecap, connects to the underlying organs through loose connective tissue. However, at the top of the cranial tubercle, they closely fuse with the tendon of the rectus femoris muscle, as well as directly with the periosteum of the cranial tubercle of the kneecap, and then, covering the rectus ligament of the kneecap, continue into the fascia of the lower leg.

Suprascapular Nerve Pulsed Radiofrequency as an Effective Pain Relief Strategy in Supraspinatus Muscle Tendon Tears.

The supraspinatus muscle tendon is the most frequently rotator cuff muscle torn. Reliable shoulder pain relief strategies are needed for patients with severe pain, refractory to conservative management, and without surgical indication. We conducted a retrospective analysis in a Portuguese reference Rehabilitation Centreduring the 1st of January 2020 and the 30th of June 2021, including all patients with partial or complete supraspinatus tendon tear, older than 50 years, who presented with severe pain and who were submitted to suprascapular nerve pulsed radiofrequency. We included 32 patients in our retrospective analysis, mainly female (53%) with a mean age of 66.50 years old. Most of the patients reported right shoulder pain (21 patients, 66%). The mean baseline pain, reported on the numeric rating scale, was 8.00 ± 0.88. Compared to baseline, mean pain reduced 4.00 ± 3.19 at three months (p<0.001), 3.59 ± 3.13 at six months (p<0.001) and 2.94 ± 2.78 at 12 months (p<0.001). From the 3rd to the 12th month there was an increase of 1.06 ± 2.77 in mean pain (p=0.038). There was no difference (p>0.05) in average pain at 0, 3, 6, or 12 months between patients who were simultaneously submitted to an intra-articular shoulder injection. Our analysis revealed 36% average shoulder pain reduction for, at least, 12 months following suprascapular nerve pulsed radiofrequency, with a peak pain reduction of 50% at three months. Slow fading of pain reduction in the following nine months was seen, however, compared to baseline, pain reduction was always statistically significant. Cortico-anaesthetic intra-articular shoulder injections seem not to add benefit in shoulder pain reductionwhen performed simultaneously with suprascapular nerve pulsed radiofrequency. Suprascapular nerve pulsed radiofrequency seems to be an effective strategy for shoulder pain reduction, in patients with severe pain, refractory to other management modalities. Nonetheless, larger prospective studies, analyzing shoulder functionality and quality of life lost scores, besides pain reduction, should be pursued.

Association of Interosseous Tendon Inflammation in the Hand With Different Early Arthritides in a 10-Year Magnetic Resonance Imaging Study.

Inflammation around the tendons of the hand interosseous muscles (interosseous tendon inflammation [ITI]) was recently identified on magnetic resonance imaging (MRI) in a set of patients with rheumatoid arthritis (RA) and arthralgia. We conducted a large MRI study to assess the prevalence of ITI at diagnosis of RA and of other arthritides, as well as its relationship with clinical signs. A total of 1,205 patients presenting with various types of early arthritis between 2010 and 2020 underwent contrast-enhanced hand MRI as part of the prospective Leiden Early Arthritis Cohort. MRI was evaluated with blinding for clinical data, for ITI lateral of metacarpophalangeal (MCP) joints 2-5, and for synovitis/tenosynovitis/osteitis. We assessed ITI presence at baseline per diagnosis and its relationship with clinical characteristics (ie, presence of hand arthritis, increased acute phase reactants, and local joint swelling and tenderness). Logistic regression and generalized estimating equations were used with adjustment for age and established local inflammation features (synovitis/tenosynovitis/osteitis). A total of 36% of patients with early RA (n=532) had ITI; this was similar in patients with anti-citrullinated protein antibody (ACPA)-negative RA (37%) and those with ACPA-positive RA (34%; P = 0.53). ITI occurred regularly in remitting seronegative symmetrical synovitis with pitting edema (60%) and connective tissue diseases (44%) and less frequently in undifferentiated arthritis (14%), psoriatic arthritis (14%), inflammatory osteoarthritis (8%), reactive arthritis (7%), crystal arthritis (7%), and peripheral spondylarthritis (4%). ITI occurred more often in diagnoses with frequent arthritis of the hands (P < 0.001) and increased acute-phase reactants (P < 0.001). Within RA, ITI occurred together with local MCP joint synovitis (odds ratio [OR] 2.4, 95% confidence interval [95% CI] 1.7-3.4), tenosynovitis (OR 2.4, 95% CI 1.8-3.3), and osteitis (OR 2.2, 95% CI 1.6-3.1) on MRI. Moreover, ITI presence was associated with local MCP joint tenderness (OR 1.6, 95% CI 1.2-2.1) and swelling (OR 1.8, 95% CI 1.3-2.6), independent of age and MRI-detected synovitis/tenosynovitis/osteitis. ITI occurs regularly in RA and other arthritides with preferential involvement of hand joints and increased acute-phase reactants. At the MCP joint level, ITI associates independently with joint tenderness and swelling. Hence, ITI is a newly identified inflamed tissue mainly found in arthritides with particularly extensive and symptomatic inflammation.

Comparison of the Effectiveness of Selected Physiotherapy Methods in the Treatment of Tennis Elbow Syndrome: a case report

Background: Tennis elbow is a common ailment with which patients present to the physiotherapy office. It is characterized by pain in the area of the attachment of the tendons of the extensor muscles of the wrist to the lateral epicondyle of the humerus and the proximal part of the extensor muscles of the wrist, reduced grip strength and limited function of the upper limb. The condition can result from trauma, but in most cases it is the result of overload, with factors such as degeneration and relative ischemia, repetitive grasping movements, scar tissue and contracture playing a role. In this case, there is a diagnosis including history, functional tests and palpation of structures within the lateral epicondyle of the humerus.Aim of the study: To compare and evaluate the effectiveness of selected physiotherapy methods used in the treatment of tendinopathy of the lateral epicondyle region of the humerus Case report: Medical cases of four men aged 40-55 years complaining of pain in the lateral epicondyle region of the humerus are presented. Palpation examination, functional tests and symptoms indicated that we were dealing with "tennis elbow syndrome." Treatment included low-energy laser ultrasound, low-frequency magnetic field, radial shock wave, nitrogen vapor cryotherapy, deep transverse massage (DTM) according to Cyriax.Conclusions: Among the selected physiotherapeutic methods, radial shock wave therapy and deep transverse massage according to Cyriax showed the greatest effectiveness.

Anatomical variations of peroneus tertius and its clinical implications: case report with systematic literature review.

Peroneus tertius (PT) or Fibularis tertius, a muscle of the anterior compartment of the leg is very distinctive to the Homo sapiens. This is because of the evolutionary acquisition of bipedal gait along with the eversion of the foot, which are unique to humans. It is considered as the fifth tendon of the extensor digitorum longus. Variations in the attachments of PT can cause stress fractures like the Jones fracture. PT has been extensively used in tendoplasty, tendon transfer and resection of the foot. The study aims to transpose the knowledge in variations of the morphology of PT from bench to bedside. Routine dissection of a 64-year-old male cadaver revealed bilateral variations in the insertion of PT. This was documented photographically. The findings prompted a systematic literature review on the morphological variations of PT. An exhaustive search was undertaken through PubMed and Google Scholar databases to identify the published literature related to variations in the morphology of PT. Related anatomical studies of the variations in peroneus tertius were identified and a review of the literature was performed. Variations in the insertion of PT were observed bilaterally in the cadaver dissected by us. Statistical analysis revealed the absence of PT in 7.03% of lower limbs. 10% of studies showed accessory and duplicated PT each. Out of 20 articles reviewed, 51 lower limbs showed variation in origin, 230 lower limbs showed variations in insertion and 161 lower limbs showed other variations. PT muscle flap and tendon grafts are used in correcting the laxity of the ankle joint and foot drop. Absence of PT plays a crucial role in altering the mechanics of stress fractures of the 5th metatarsal. Thus, knowledge of the morphology of PT is crucial for plastic surgeons and orthopedic surgeons.

A very rare case of a thoracobrachialis muscle

The anterior arm compartment includes the biceps brachii muscle, brachialis muscle, and coracobrachialis muscle, and they are characterized by different morphological variations. During standard anatomical dissection of right upper limb, an variant muscle was found. It originated from the fascia covering the long head of biceps brachii and from the tendon of pectoralis major muscle. It also connected to the brachial fascia. It also demonstrated a long thin tendon which was distally attached to the medial epicondyle of humerus. Knowledge about the morphological variations in this region is clinically important because of their direct correlation with neurovascular structures, which may lead to pathologies such as tingling, muscle weakness, paresthesia, and loss of sensation.

Effect of sex on muscle-tendon imbalances and tendon micromorphology in adolescent athletes-A longitudinal consideration.

Imbalances between muscle strength and tendon stiffness may cause high-level tendon strain during maximum effort muscle contractions and lead to tendon structural impairments and an increased risk for tendinopathy in adolescent athletes. However, it remains unclear whether the development of musculotendinous imbalances is influenced by sex. At four measurement time points during a competitive season, we measured quadriceps femoris muscle strength and patellar tendon mechanical properties in 15 female (14.3 ± 0.7 years) and 13 male (16.0 ± 0.6 years) elite handball players of similar maturity using dynamometry and ultrasonography. To estimate the tendon's structural integrity, the peak spatial frequency (PSF) of proximal tendon ultrasound scans was determined. Females demonstrated significantly lower muscle strength (p < 0.001) and patellar tendon stiffness (p < 0.001) than males with no significant changes over time (p > 0.05). Tendon strain during isometric maximum voluntary contractions and PSF neither differed between sexes nor changed significantly over time (p > 0.05). We found lower fluctuations in muscle strength (p < 0.001) in females during the season but no differences in the fluctuations of tendon strain, stiffness, and PSF (p > 0.05). Descriptively, there was a similar frequency (~40%) of athletes with high-level tendon strain (>9%) in both sexes. These findings suggest that the lower strength capacity of female athletes is paralleled by lower tendon stiffness. Thereby, muscle-tendon imbalances occur to a similar extent in both sexes leading to increased strain levels during the season, which indicates the need for specific tendon training.

American Society of Biomechanics Journal of Biomechanics Award 2022: Computer models do not accurately predict human muscle passive muscle force and fiber length: Evaluating subject-specific modeling impact on musculoskeletal model predictions

Musculoskeletal models are valuable for studying and understanding the human body in a variety of clinical applications that include surgical planning, injury prevention, and prosthetic design. Subject-specific models have proven to be more accurate and useful compared to generic models. Nevertheless, it is important to validate all models when possible. To this end, gracilis muscle–tendon parameters were directly measured intraoperatively and used to test model predictions. The aim of this study was to evaluate the benefits and limitations of systematically incorporating subject-specific variables into muscle models used to predict passive force and fiber length. The results showed that incorporating subject-specific values generally reduced errors, although significant errors still existed. Optimization of the modeling parameter “tendon slack length” was explored in two cases: minimizing fiber length error and minimizing passive force error. The results showed that using all subject-specific values yielded the most favorable outcome in both models and optimization cases. However, the trade-off between fiber length error and passive force error will depend on the specific circumstances and research objectives due to significant individual errors. Notably, individual fiber length and passive force errors were as high as 20% and 37% respectively. Finally, the modeling parameter “tendon slack length” did not correlate with any real-world anatomical length.

Variations in the extensor indicis proprius muscle in the Burmese population: implications for hand reconstructive surgery

BackgroundThe use of extensor indicis proprius (EIP) muscle tendon for tendon grafting and transplantation in the management of hand injuries is common. Anatomical variations of the EIP tendons have been reported with variable prevalence and presentation in different populations worldwide. Knowledge of possible variation patterns is crucial in reconstructive surgery. The current study aims to describe the prevalence of anatomical variations of the EIP in the Burmese population. MethodsA total of 50 cadavers (39 males, and 11 females) were dissected. Both upper limbs of each cadaver were observed. The presence of the EIP, the number of tendons, the origin and insertion of the muscle and its relation with the extensor digitorum communis (EDC) were recorded and variations reported. ResultsOf the 100 limbs studied in the 50 cadavers, only 1/100 limb was reported to have an absent EIP muscle and tendon. Of the remaining 99/100 limbs examined, one of them consists of a double tendon, that is, EIP and extensor indicis et medii communis (EIMC) were inserted separately onto the index finger and middle finger respectively on the dorsum of the left hand. Further to this, there is one case in which an extra muscle belly was observed in the EIP tendon, this muscle is commonly known as the extensor digitorum brevis manus muscle. All the EIP variations were observed in the male cadavers only. ConclusionOf the 50 cadavers studied, 3/100 limbs exhibited EIP variations in the current studied population. Population-specific studies on these variations may aid in a better understanding of the different anatomical patterns of the muscles in the dorsum of the hand. This may lead to improved diagnosis and surgical management of injuries to the dorsum of the hand and for the use of the EIP tendon in surgical grafts and transplantations.

A review study on Jaal and it’s Modern Correlation

The Rachana Sharir is branch of Ayurveda in which human anatomy is explained according to Ayurved Samhita. The knowledge of human anatomy is very much important for treatment of disease and other surgical procedures. Paribhasha Sharir is concept of Ayurveda in which different anatomical structure are explained in Ayurvedic term. It’s one of the important contributions of Ayurveda in the medical field. It needs to be correlated with modern anatomy which further can be used in surgery purpose and also help in acupuncture or acupressure therapy. It will be the sort of proof that the structure present in modern anatomy were far ago explained in Ayurvedic Samhita. In Paribhasha Sharir a structure called Jaal or plexus is explained which means a binding structure which hold Maans (muscular plexus), Sira (vascular plexus), Snayu (ligamentum plexus) and Asthi (bony plexus) in one place and forming the network or Jaal like structure, there are 4 structure present in bilateral Miniband Sandhi i.e., wrist and Gulfa Sandhi i.e., ankle joint. In each joint there is involvement of four anatomical structure namely Maans, Sira, Snayu, Asthi. It can be correlated with human anatomical structure namely network of muscle tendons, palmer or planter arches, retinaculum, juncture of carpel and tarsal bones respectively.

Aponeurosis structure-function properties: Evidence of heterogeneity and implications for muscle function.

Aponeurosis is a sheath-like connective tissue that aids in force transmission from muscle to tendon and can be found throughout the musculoskeletal system. The key role of aponeurosis in muscle-tendon unit mechanics is clouded by a lack of understanding of aponeurosis structure-function properties. This work aimed to determine the heterogeneous material properties of porcine triceps brachii aponeurosis tissue with materials testing and evaluate heterogeneous aponeurosis microstructure with scanning electron microscopy. We found that aponeurosis may exhibit more microstructural collagen waviness in the insertion region (near the tendon) compared to the transition region (near the muscle midbelly) (1.20 versus 1.12, p = 0.055), which and a less stiff stress-strain response in the insertion versus transition regions (p< 0.05). We also showed that different assumptions of aponeurosis heterogeneity, specifically variations in elastic modulus with location can alter the stiffness (by more than 10x) and strain (by approximately 10% muscle fiber strain) of a finite element model of muscle and aponeurosis. Collectively, these results suggest that aponeurosis heterogeneity could be due to variations in tissue microstructure and that different approaches to modeling tissue heterogeneity alters the behavior of computational models of muscle-tendon units. STATEMENT OF SIGNIFICANCE: Aponeurosis is a connective tissue found in many muscle tendon units that aids in force transmission, yet little is known about the specific material properties of aponeurosis. This work aimed to determine how the properties of aponeurosis tissue varied with location. We found that aponeurosis exhibits more microstructural waviness near the tendon compared to near the muscle midbelly, which was associated with differences in tissue stiffness. We also showed that different variations in aponeurosis modulus (stiffness) can alter the stiffness and stretch of a computer model of muscle tissue. These results show that assuming uniform aponeurosis structure and modulus, which is common, may lead to inaccurate models of the musculoskeletal system.

Differentiation between Chondrosarcoma and Synovial Chondromatosis of the Temporomandibular Joint Using CT and MR Imaging.

Chondrosarcoma and synovial chondromatosis of the temporomandibular joint share overlapping clinical and histopathologic features. We aimed to identify CT and MR imaging features to differentiate chondrosarcoma from synovial chondromatosis of the temporomandibular joint. The CT and MR images of 12 and 35 patients with histopathologically confirmed chondrosarcoma and synovial chondromatosis of the temporomandibular joint, respectively, were retrospectively reviewed. Imaging features including lesion size, center, enhancement, destruction/sclerosis of surrounding bone, infiltration into the tendon of the lateral pterygoid muscle, calcification, periosteal reaction, and osteophyte formation were assessed. A comparison between chondrosarcoma and synovial chondromatosis was performed with a Student t test for quantitative variables and the Fisher exact test or linear-by-linear association test for qualitative variables. Receiver operating characteristic analysis was performed to determine the diagnostic performance for differentiation of chondrosarcoma and synovial chondromatosis based on a composite score obtained by assigning 1 point for each of 9 imaging features. High-risk imaging features for chondrosarcoma were the following: lesion centered on the mandibular condyle, destruction of the mandibular condyle, no destruction/sclerosis of the articular eminence/glenoid fossa, infiltration into the tendon of the lateral pterygoid muscle, absent or stippled calcification, periosteal reaction, internal enhancement, and size of ≥30.5 mm. The best cutoff value to discriminate chondrosarcoma from synovial chondromatosis was the presence of any 4 of these high-risk imaging features, with an area under the curve of 0.986 and an accuracy of 95.8%. CT and MR imaging features can distinguish chondrosarcoma from synovial chondromatosis of the temporomandibular joint with improved diagnostic performance when a subcombination of 9 imaging features is used.

Outcome of Primary Anterior Cruciate Ligament Reconstruction with Peroneus Longus and Bone–Patellar Tendon–Bone Autografts: A Clinical Comparative Study

Background: The aim of this study is to compare the mid-term outcomes of primary tear of the anterior cruciate ligament (ACL) reconstruction via the use of peroneus longus tendon (PLT) and bone–patellar tendon–bone (BPTB) autografts. Methods: 53 patients (group 1) received ACL reconstruction via BPTB, whereas 55 patients (group 2) received arthroscopic ACL reconstruction using PLT autograft. Results: In group 1, the mean preoperative and postoperative scores on the Lysholm Knee Questionnaire (LKQ) scale resulted in 69.2 ± 10.7 points and −92.2 ± 6.4 points, respectively. The average preoperative and postoperative value on the International Knee Documentation Committee (IKDC) scale was 68.2 ± 10.6% and −90.1 ± 9.5%, respectively. For KT-1000, according to the results of surgical treatment, it is −3.7 ± 1.4 mm, and for the American Orthopaedic Foot &amp; Ankle Society (AOSAF) it is −95.3 ± 4.5%. The autograft ruptured within 2 years after operation in 4 of 50 patients. In group 2, the mean score on the LKQ scale before the operation was 70.2 ± 11.6 points, after −94.3 ± 0.5 points. The average value on the IKDC scale before surgery was 68.6 ± 8.7%, after −91.5 ± 8.2%. KT-1000 −3.4 ± 1.2 mm. Conclusion: The results in both groups can be assessed as good; peroneus longus muscle tendon autograft is an alternative graft for the primary reconstruction of ACL, preserving the dynamic stabilizers of the knee and has no effect on the formation of flat feet and other disease in the postoperative period.

Muscle morphology and architecture of the medial gastrocnemius between typically developing children with different ancestral background.

Muscle ultrasonography is frequently used to improve the understanding of musculoskeletal impairments in children with spastic cerebral palsy (SCP). So far, most studies on muscle morphology and architecture have included typically developing children and children with SCP with similar ancestry, being mainly Caucasian. Less is known about differences in muscle morphology between children with different ancestral backgrounds. Therefore, the aim of this study was to compare muscle morphology and architecture of the medial gastrocnemius in typically developing children with African, South Asian and Southeast Asian descent from Suriname. This explorative cohort study identified children as Maroon (Ghana, African descent), Hindustani (India, South Asian) or Javanese (Indonesia, Southeast Asian), aged 5-10 years. Using 3D freehand ultrasound with the subject prone, the following medial gastrocnemius parameters were defined: muscle tendon unit (MTU) length, muscle belly length, tendon length, muscle volume, muscle thickness, anatomical cross-sectional area (ACSA), fascicle length, pennation angle, and physiological cross-sectional area (PCSA). In addition, differences between ancestral groups were assessed for the length of the MTU, muscle, tendon and fascicles in two passive stretch conditions corresponding to an externally applied joint torque of 1Nm and 4Nm. One-way ANOVA with post hoc t-tests were used to investigate differences between the ancestral groups. In total, 100 Hindustani (n = 34), Javanese (n = 34) and Maroon (n = 32) children were included. For statistical analyses, we matched the children by age, which resulted in groups of 25 children per ancestral group (n = 75). There were no differences found in MTU length, muscle belly length, ACSA, PCSA and muscle volume. Tendon length, fascicle length and pennation angle were different between ancestral groups. Compared to Javanese children, tendon length was longer (p = 0.001) and pennation angle (p = 0.001) was larger in Maroon children and fascicle length was shorter in both Maroon and Hindustani children (p < 0.001). While there was a difference found in MTU length at different conditions of passive stretch between ancestries, no differences were found in the muscle, tendon and fascicles. This is the first study that investigated macroscopic morphological and architectural parameters for the medial gastrocnemius in one extended cohort of typically developing children, stratified in three ancestral subgroups. The current results imply that ancestry-specific reference data for children are needed, especially for tendon length, fascicle length and pennation angle when investigating altered muscle morphology in neurological or neuromuscular pathologies, such as SCP. Future studies should report the ancestral background when describing muscle morphology and architecture of children and ancestral specifications should be included in normative databases.

Elastic ankle exoskeletons influence soleus fascicle dynamics during unexpected perturbations

Spring-based passive ankle exoskeletons have been designed to emulate the energy conservation and power amplification roles of biological muscle–tendon units during locomotion. Yet, it remains unknown if similar assistive devices can serve the other elastomechanical role of biological muscle–tendon units — power attenuation. Here we explored the effect of bilateral passive ankle exoskeletons on neuromuscular control and muscle fascicle dynamics in the ankle plantarflexors during rapid, unexpected vertical perturbations. We recorded muscle activation and soleus fascicle length changes during hopping with and without exoskeleton assistance (0 and 76 Nm rad−1) on elevated platforms (20 cm), which were removed at an unknown time. Our results demonstrate that exoskeleton assistance leads to a reduction in soleus muscle activation, increases in fascicle length change and decreases in muscle forces during perturbed hopping. These changes have competing effects on the mechanics and energetics of lower limb muscles, likely limiting the capacity for series elastic tissues to absorb energy. As we strive towards the design of wearable assistive devices for everyday locomotion, information regarding real-time muscle–tendon behavior may enable tunable assistance that adapts to both the user and the environment.

Brachial Biceps Tendon Rupture: About A Case and Review of the Literature

Distal ruptures of the biceps brachial tendon are rare, estimated at 1.2 ruptures per 100,000 patients per year, in a male population between 40 and 50 years old. The mechanism is most of the time post-traumatic by excentric contraction of the biceps and results in its disinsertion from radial tuberosity. Sometimes trauma can be minor due to tendon histological changes observed after 35 years, which weaken the tendon insertions and the presence of a hypo vascularized zone in the terminal part of the biceps brachial tendon. The absence of surgical reinsertion of the distal tendon of the brachial biceps muscle leads to little clinical outcome satisfactory with loss of strength in flexion and supination of the forearm and sometimes disabling residual pain.

Revision anterior cruciate ligament reconstruction using the ipsilateral Quadriceps tendon autograft: a modular reconstructive option.

Failed ACL reconstruction is a common occurrence nowadays due to the increased incidence of ACL surgeries and return to full activities following the surgery. Several challenges might stand in the face of this revision surgery particularly the graft harvest and its suitability to the situation with possible widening of the tunnel and the avoidance of additional morbidity at the contralateral side or anterior knee pain as in patellar tendon harvest. The aim of this study is to evaluate the ipsilateral quadriceps tendon as a source of autograft in revision ACL surgery which constitutes a viable option that can potentially decrease the morbidity of the procedure, and meanwhile provide a graft substitute that can be tailored to suit the dilated tunnels commonly encountered in revision surgery, thus giving the patients a good potential for better functional outcome. Revision anterior cruciate ligament reconstruction was done in 30 patients using the ipsilateral quad tendon as a pure soft tissue or with a bony fragment. The mean subjective international Knee Documentation Committee score (IKDC score) at twoyears follow-up was 65.83 ± 7.20. There is statistically significant improvement of the objective as well as the subjective IKDC scores at the end of follow-up when compared to the preoperative as well as the 6-month evaluation figures. The KT1000 arthrometer recorded a mean of 4.50 ± 1.07. Significant improvement of the limb symmetry index was at twoyears duration. The quadriceps tendon can be a solution for several challenges that might appear during the revision ACL surgery with comparable results to other tendons and with minimal morbidity on the function of the harvested muscle tendon.

The use of the Classic and Modified Transfer of the Lower Trapezius Muscle (Elhassan Transfer) as a Primary or Secondary Method for Surgical Reconstruction of the Abduction and External Rotation of the Shoulder in Brachial Plexus Injury

Background. Brachial plexus injury (BPI) leads to severe dysfunction of the upper extremity (UE). Elbow flexion and multiaxial movements in glenohumeral joint (MGHJ) are prioritized in reconstruction strategy. Time-dependent (&lt; 6 months) nerve transfers (NT) allow effective restoring of MGHJ. Late (&gt; 6 months) reconstruction of MGHJ remains completely dependent on transfers of the functional tendon-muscle complexes.&#x0D; Objective: to compare the outcomes of the classic Elhassan (c) and modified (m) transfer of the lower trapezius muscle (LTT) on recovery of monoaxial MGHJ.&#x0D; Materials and Methods. Patient (P.) #3 with M4+ recovery of the deltoid muscle (DM) after NT and P. #4 without spontaneous recovery (SR) of DM – forward flexion (FF) was 170° and 0°, respectively, received cLTT. Patient #1 with M4+ recovery of DM after NT and P. #2 with M4+ SR of DM (FF was 160° and 50°, respectively), received mLTT – distal fixation point has been changed from the tendon of the infraspinatus to the tendon of supraspinatus muscle.&#x0D; Results. Shoulder abduction (ABD) has been restored to 50° in P. #1 and P. #2, while the recovery of the external rotation (ER) has not been achieved – upper arm remained internally rotated (IR). ABD has been restored to 40° and 80° in P. #3 and P. #4; simultaneously +15° and +70° of ER has been restored.&#x0D; Conclusions. The use of mLTT leads to more effective recovery of monoaxial MGHJ – ABD – 50° vs. 40° after cLTT. The use of cLTT leads to more effective recovery of another monoaxial MGHJ – ER – +15° and +70° vs. IR after mLTT; LTT should only be considered as a complementary surgical procedure, which utilization should cohere with a patient’s requirements to the MGHJ.

Biomechanical, Healing and Therapeutic Effects of Stretching: A Comprehensive Review

Characterized in biomedical terms, stretching exercises have been defined as movements applied by external and/or internal forces to increase muscle and joint flexibility, decrease muscle stiffness, elevate the joint range of motion (ROM), increase the length of the “muscle–tendon” morpho-functional unit, and improve joint, muscle, and tendon movements, contraction, and relaxation. The present review examines and summarizes the initial and recent literature data related to the biomechanical, physiological, and therapeutic effects of static stretching (SS) on flexibility and other physiological characteristics of the main structure and the “joint–ligament–tendon–muscle” functional unit. The healing and therapeutic effects of SS, combined with other rehabilitation techniques (massage, foam rolling with and without vibrations, hot/cold therapy, etc.), are discussed in relation to the creation of individual (patient-specific) or group programs for the treatment and prevention of joint injuries, as well as for the improvement of performance in sports. From a theoretical point of view, the role of SS in positively affecting the composition of the connective tissue matrix is pointed out: types I–III collagen syntheses, hyaluronic acid, and glycosaminoglycan (GAG) turnover under the influence of the transforming growth factor beta-1 (TGF-β-1). Different variables, such as collagen type, biochemistry, elongation, and elasticity, are used as molecular biomarkers. Recent studies have indicated that static progressive stretching therapy can prevent/reduce the development of arthrogenic contractures, joint capsule fibrosis, and muscle stiffness and requires new clinical applications. Combined stretching techniques have been proposed and applied in medicine and sports, depending on their long- and short-term effects on variables, such as the ROM, EMG activity, and muscle stiffness. The results obtained are of theoretical and practical interest for the development of new experimental, mathematical, and computational models and the creation of efficient therapeutic programs. The healing effects of SS on the main structural and functional unit—“joint–ligament–tendon–muscle”—need further investigation, which can clarify and evaluate the benefits of SS in prophylaxis and the treatment of joint injuries in healthy and ill individuals and in older adults, compared to young, active, and well-trained persons, as well as compared to professional athletes.

A female-specific role for trigeminal dynorphin in orofacial pain comorbidity.

Migraine is commonly reported in patients with temporomandibular disorders (TMDs), but little is known about the mechanisms underlying the comorbid condition. Here, we prepared a mouse model to investigate this comorbidity, in which masseter muscle tendon ligation (MMTL) was performed to induce a myogenic TMD, and the pre-existing TMD enabled a subthreshold dose of nitroglycerin (NTG) to produce migraine-like pain in mice. RNA sequencing followed by real-time quantitative polymerase chain reaction confirmation showed that MMTL plus NTG treatment increased prodynorphin ( Pdyn ) mRNA expression in the spinal trigeminal nucleus caudalis (Sp5C) of female mice but not in male mice. Chemogenetic inhibition of Pdyn -expressing neurons or microinjection of antidynorphin antiserum in the Sp5C alleviated MMTL-induced masseter hypersensitivity and diminished the MMTL-enabled migraine-like pain in female mice but not in male mice. Moreover, chemogenetic activation of Pdyn -expressing neurons or microinjection of dynorphin A (1-17) peptide in the Sp5C enabled a subthreshold dose of NTG to induce migraine-like pain in female mice but not in male mice. Taken together, our results suggest that trigeminal dynorphin has a female-specific role in the modulation of comorbid TMDs and migraine.