Musculoskeletal Soft Tissue Research Articles

Diagnosed prevalence of Ehlers-Danlos syndrome and hypermobility spectrum disorder in Wales, UK: a national electronic cohort study and case–control comparison

ObjectivesTo describe the epidemiology of diagnosed hypermobility spectrum disorder (HSD) and Ehlers-Danlos syndromes (EDS) using linked electronic medical records. To examine whether these conditions remain rare and primarily affect the...

Tissue-specific changes in size and shape of the ligaments and tendons of the porcine knee during post-natal growth.

Prior studies have analyzed growth of musculoskeletal tissues between species or across body segments; however, little research has assessed the differences in similar tissues within a single joint. Here we studied changes in the length and cross-sectional area of four ligaments and tendons, (anterior cruciate ligament, patellar tendon, medial collateral ligament, lateral collateral ligament) in the tibiofemoral joint of female Yorkshire pigs through high-field magnetic resonance imaging throughout growth. Tissue lengths increased by 4- to 5-fold from birth to late adolescence across the tissues while tissue cross-sectional area increased by 10-20-fold. The anterior cruciate ligament and lateral collateral ligament showed allometric growth favoring change in length over change in cross-sectional area while the patellar tendon and medial collateral ligament grow in an isometric manner. Additionally, changes in the length and cross-sectional area of the anterior cruciate ligament did not increase as much as in the other ligaments and tendon of interest. Overall, these findings suggest that musculoskeletal soft tissue morphometry can vary within tissues of similar structure and within a single joint during post-natal growth.

Imaging musculoskeletal soft tissue infections

Musculoskeletal soft tissue infections are not uncommonly encountered in both the clinic and Emergency Department setting. The clinical diagnosis is not always evident as these infections can have variable presentations depending on the duration and depth of disease extension through the soft-tissue layers. Imaging often plays an important role in diagnosing the infection, defining the extent of involvement, directing tissue sampling, and in monitoring treatment response. After initial radiographs, ultrasound (US) is often the next modality utilized to evaluate patients with suspected soft tissue infections given its low cost, availability, portability, and potential for real-time guidance of fluid aspiration. The widespread use of cross-sectional imaging with magnetic resonance imaging (MRI) and computed tomography (CT) has greatly increased the radiological diagnosis in conditions where US may be limited. In addition, CT and MRI allow a thorough evaluation of disease extension, including assessment of joint spaces, tendons, and osseous changes indicative of bone involvement. This review will focus on the radiological findings of soft tissue infections on US, CT, and MRI.

Artificial intelligence: A tool for sports trauma prediction

Injuries exert an enormous impact on athletes and teams. This is seen especially in professional soccer, with a marked negative impact on team performance and considerable costs of rehabilitation for players. Existing studies provide some preliminary understanding of which factors are mostly associated with injury risk, but scientific systematic evaluation of the potential of statistical models in forecasting injuries is still missing. Some factors raise the risk of a sport injury, but there are also elements that predispose athletes to sports injuries. The biological mechanisms involved in non-contact musculoskeletal soft tissue injuries are poorly understood. Genetic risk factors may be associated with susceptibility to injuries, and may exert marked influence on recovery times. Athletes are complex systems, and depend on internal and external factors to attain and maintain stability of their health and their performance. Organisms, participants or traits within a dynamic system adapt and change when factors within that system change. Scientists routinely predict risk in a variety of dynamic systems, including weather, political forecasting and projecting traffic fatalities and the last years have started the use of predictive models in the human health industry. We propose that the use of artificial intelligence may well help in assessing risk and help to predict the occurrence of sport injuries.

Mechanical properties of tissue formed in vivo are affected by 3D-bioplotted scaffold microarchitecture and correlate with ECM collagen fiber alignment

ABSTRACTPurpose: Musculoskeletal soft tissues possess highly aligned extracellular collagenous networks that provide structure and strength. Such an organization dictates tissue-specific mechanical properties but can be difficult to replicate by engineered biological substitutes. Nanofibrous electrospun scaffolds have demonstrated the ability to control cell-secreted collagen alignment, but concerns exist regarding their scalability for larger and anatomically relevant applications. Additive manufacturing processes, such as melt extrusion-based 3D-Bioplotting, allow fabrication of structurally relevant scaffolds featuring highly controllable porous microarchitectures.Materials and Methods: In this study, we investigate the effects of 3D-bioplotted scaffold design on the compressive elastic modulus of neotissue formed in vivo in a subcutaneous rat model and its correlation with the alignment of ECM collagen fibers. Polycaprolactone scaffolds featuring either 100 or 400 µm interstrand spacing were implanted for 4 or 12 weeks, harvested, cryosectioned, and characterized using atomic-force-microscopy-based force mapping.Results: The compressive elastic modulus of the neotissue formed within the 100 µm design was significantly higher at 4 weeks (p < 0.05), but no differences were observed at 12 weeks. In general, the tissue stiffness was within the same order of magnitude and range of values measured in native musculoskeletal soft tissues including the porcine meniscus and anterior cruciate ligament. Finally, a significant positive correlation was noted between tissue stiffness and the degree of ECM collagen fiber alignment (p < 0.05) resulting from contact guidance provided by scaffold strands.Conclusion: These findings demonstrate the significant effects of 3D-bioplotted scaffold microarchitectures in the organization and sub-tissue-level mechanical properties of ECM in vivo.

Parametric control of fiber morphology and tensile mechanics in scaffolds with high aspect ratio geometry produced via melt electrowriting for musculoskeletal soft tissue engineering

Melt electrowriting (MEW) is an additive manufacturing technique that has the potential to create fibrous scaffolds that reproduce the scale and organization of collagen fiber networks in musculoskeletal soft tissues. For musculoskeletal soft tissue engineering, it is useful for scaffolds to have a high aspect ratio (length to width ratio of 5:1 or higher). However, the relationship between MEW process variables and the structural and mechanical properties of such scaffolds is not well understood. In addition, prior studies have cut samples from larger MEW structures, resulting in test specimens with discontinuous fibers. In this study, MEW scaffolds with low (square, 12 mm × 12 mm) and high aspect ratio (rectangular, 35 mm × 5 mm) macroscale geometries were fabricated at varying stage translation speeds or melt extrusion temperatures. Fiber morphology in both geometries and mechanical properties of the continuous rectangular structures were then quantified. Fiber diameter in both square and rectangular scaffolds generally decreased with increasing stage speed, but increased with melt temperature, though the effect of the latter was greater in square scaffolds. Interfiber spacing in both geometries was closer to the intended value as stage speed increased. Spacing became less accurate in square scaffolds with increasing melt temperature but changed little in rectangular scaffolds. Transverse fiber angle in rectangular scaffolds improved with increasing stage speed and had a median value within 1.4% of the intended angle at all temperatures. Finally, apparent tensile modulus in rectangular scaffolds decreased with increasing speed and temperature. These findings highlight the need to tailor MEW process parameters in scaffolds with high aspect ratio geometry in order to consistently generate specific structural and mechanical properties. Because of the potential to reproduce the structural anisotropy, fiber size, and mechanical properties of collagenous extracellular matrix, MEW structures are promising as musculoskeletal soft tissue scaffolds.

Impact of Platelet-Rich Plasma Use on Pain in Orthopaedic Surgery: A Systematic Review and Meta-analysis.

Amid extensive debate, evidence surrounding the use of platelet-rich plasma (PRP) for musculoskeletal injuries has rapidly proliferated, and an overall assessment of efficacy of PRP across orthopaedic indications is required. (1) Does PRP improve patient-reported pain in musculoskeletal conditions? and (2) Do PRP characteristics influence its treatment effect? MEDLINE, EMBASE, Cochrane, CINAHL, SPORTDiscus, and Web of Science libraries were searched through February 8, 2017. Additional studies were identified from reviews, trial registries, and recent conferences. All English-language randomized trials comparing platelet-rich therapy with a control in patients 18 years or older with musculoskeletal bone, cartilage, or soft tissue injuries treated either conservatively or surgically were included. Substudies of previously reported trials or abstracts and conference proceedings that lacked sufficient information to generate estimates of effect for the primary outcome were excluded. Systematic review and meta-analysis. Level 1. All data were reviewed and extracted independently by 3 reviewers. Agreement was high between reviewers with regard to included studies. A total of 78 randomized controlled trials (5308 patients) were included. A standardized mean difference (SMD) of 0.5 was established as the minimum for a clinically significant reduction in pain. A reduction in pain was associated with PRP at 3 months (SMD, -0.34; 95% CI, -0.48 to -0.20) and sustained until 1 year (SMD, -0.60; 95% CI, -0.81 to -0.39). Low- to moderate-quality evidence supports a reduction in pain for lateral epicondylitis (SMD, -0.69; 95% CI, -1.15 to -0.23) and knee osteoarthritis (SMD, -0.91; 95% CI, -1.41 to -0.41) at 1 year. PRP characteristics did not influence results. PRP leads to a reduction in pain; however, evidence for clinically significant efficacy is limited. Available evidence supports the use of PRP in the management of lateral epicondylitis as well as knee osteoarthritis.

The Accuracy of Diagnostic High Frequency Ultrasound Imaging For Musculoskeletal Soft Tissue Pathology

The Accuracy of Diagnostic High Frequency Ultrasound Imaging For Musculoskeletal Soft Tissue Pathology

Magnetic resonance imaging biomarkers in musculoskeletal soft tissue tumors: Review of conventional features and focus on nonmorphologic imaging.

The majority of peripheral musculoskeletal soft tissue masses encountered in routine clinical practice are benign and associated with an excellent prognosis, whereas a small proportion of soft tissue masses are malignant and are associated with higher morbidity and mortality. Owing to the excellent tissue contrast resolution provided, magnetic resonance imaging (MRI) is a primary modality for the diagnostic evaluation of soft tissue masses, particularly for defining the anatomic extent. MRI is also useful for the characterization of soft tissue masses; however, after the exclusion of cysts and lipomas, it is challenging to accurately categorize neoplastic lesions as benign or malignant with conventional anatomic MRI. Quantitative MRI biomarkers obtained with nonconventional pulse sequences are becoming increasingly available, and can improve the accuracy of determining the character of soft tissue masses. In this article we discuss established qualitative and emerging quantitative MRI-based biomarkers available with dynamic contrast-enhanced MRI, diffusion-weighted imaging, and MR spectroscopy and their utility for the characterization of untreated soft tissue masses. Level of Evidence: 5 Technical Efficacy Stage: 5 J. Magn. Reson. Imaging 2019;50:11-27.

Adiponectin gene rs1501299 polymorphism is associated with increased risk of anterior cruciate ligament rupture.

Anterior cruciate ligament (ACL) rupture is one the most common musculoskeletal soft tissue injuries of the knee. Although the exact mechanisms of this injury remain uncertain, genetic variants have been considered to be an intrinsic risk factor associated with ACL rupture. Therefore, the aim of the present study was to determine whether the adiponectin +276G/T polymorphism is associated with susceptibility to ACL rupture in a Thai population. Genotyping for rs1501299 was conducted in 98 participants with ACL rupture and 95 healthy controls by polymerase chain reaction-restriction fragment length polymorphism analysis. The results demonstrated that the GG genotype and G allele were significantly associated with an increased risk of ACL rupture [odds ratio (OR)=1.91, P=0.026; OR=1.89, P=0.004], whereas the TT genotype was significantly associated with a reduced risk of ACL rupture (OR=0.32, P=0.019). Furthermore, ACL injury patients with non-contact sports carrying the GG genotype and G allele exhibited a significantly higher risk of ACL rupture (OR=2.13, P=0.031; OR=1.84, P=0.029). In addition, overweight patients carrying the GG genotype and G allele had a significantly increased (8-fold) risk of ACL rupture (OR=8.00, P<0.001; OR=5.15, P<0.001), whereas overweight patients with the adiponectin +276G/T GT genotype had a significantly lower risk of ACL rupture (OR=0.13, P<0.001). Therefore, the adiponectin +276G/T polymorphism GG genotype and G allele were significantly associated with the risk of ACL rupture, particularly in overweight patients. These findings indicate that the adiponectin +276G/T polymorphism may play a role in the development of ACL rupture in the Thai population.

Conventional MR and diffusion-weighted imaging of musculoskeletal soft tissue malignancy: correlation with histologic grading.

To evaluate proven soft tissue musculoskeletal malignancies blinded to their Fédération Nationale des Centres de Lutte Contre le Cancer histologic grades to identify the predictive values of conventional MR findings and best fit region of interest (ROI) apparent diffusion coefficient (ADC) measurements. Fifty-one consecutive patients with different histologic grades were evaluated by four readers (R1-4) of different experience levels. Quantitatively, the maximum longitudinal size, tumor to muscle signal intensity ratios, and ADC measurements and, qualitatively, the spatial location of the tumor, its signal alterations, heterogeneity, intralesional hemorrhage or fat, and types of enhancement were assessed. Intraclass correlation, weighted kappa, ANOVA, and Fisher exact tests were used. There were 22/51 (43%) men (mean age ± SD = 52 ± 16years) and 29/51 (57%) women (mean age ± SD = 54± 17years), with the majority of tumors 38/51 (75%) in the lower extremities. Histologic grades were I in 8/51 (16%), II in 17/51 (33%), and III in 26/51 (51%), respectively. The longitudinal dimensions were different among three grades (p = 0.0015), largest with grade I. More central enhancements and deep locations were seen in grade III tumors (p = 0.0191, 0.0246). The ADC mean was significantly lower in grade III than in grade I or II (p < 0.0001 and p = 0.04). The ADC min was significantly lower in grade III than in grade I (p = 0.02). Good to excellent agreements were seen for T1/T2 tumor/muscle ratios, longitudinal dimension, and ADC (ICC = 0.60-0.98). Longitudinal tumor dimension, central enhancement, and ADC values differentiate histology grades in musculoskeletal soft tissue malignancy with good to excellent inter-reader reliability. • The longitudinal tumor dimension of grade III malignancy is smaller than that of grade I (p < 0.0001), and higher-grade tumors are located deeper (p = 0.0246). • The ADC mean is significantly lower in grade III than in grade I or grade II (p < 0.0001 and p = 0.04). • The ADC minimum is significantly lower in grade III than in grade I (p = 0.02).

Defining the molecular signatures of Achilles tendinopathy and anterior cruciate ligament ruptures: A whole-exome sequencing approach.

Musculoskeletal soft tissue injuries are complex phenotypes with genetics being one of many proposed risk factors. Case-control association studies using the candidate gene approach have predominately been used to identify risk loci for these injuries. However, the ability to identify all risk conferring variants using this approach alone is unlikely. Therefore, this study aimed to further define the genetic profile of these injuries using an integrated omics approach involving whole exome sequencing and a customised analyses pipeline. The exomes of ten exemplar asymptomatic controls and ten exemplar cases with Achilles tendinopathy were individually sequenced using a platform that included the coverage of the untranslated regions and miRBase miRNA genes. Approximately 200 000 variants were identified in the sequenced samples. Previous research was used to guide a targeted analysis of the genes encoding the tenascin-C (TNC) glycoprotein and the α1 chain of type XXVII collagen (COL27A1) located on chromosome 9. Selection of variants within these genes were; however, not predetermined but based on a tiered filtering strategy. Four variants in TNC (rs1061494, rs1138545, rs2104772 and rs1061495) and three variants in the upstream COL27A1 gene (rs2567706, rs2241671 and rs2567705) were genotyped in larger Achilles tendinopathy and anterior cruciate ligament (ACL) rupture sample groups. The CC genotype of TNC rs1061494 (C/T) was associated with the risk of Achilles tendinopathy (p = 0.018, OR: 2.5 95% CI: 1.2–5.1). Furthermore, the AA genotype of the TNC rs2104772 (A/T) variant was significantly associated with ACL ruptures in the female subgroup (p = 0.035, OR: 2.3 95% CI: 1.1–5.5). An inferred haplotype in the TNC gene was also associated with the risk of Achilles tendinopathy. These results provide a proof of concept for the use of a customised pipeline for the exploration of a larger genomic dataset. This approach, using previous research to guide a targeted analysis of the data has generated new genetic signatures in the biology of musculoskeletal soft tissue injuries.

Are TNC gene variants associated with anterior cruciate ligament rupture susceptibility?

ObjectivesTo investigate the role of inter-individual variations in a particular glycoprotein, TNC, and its potential contribution to anterior cruciate ligament (ACL) injury susceptibility in Polish Caucasian participants. ACL rupture is one of the most prevalent and severe knee injury that predominantly occurs during sports participation, primarily via a non-contact mechanism. Several polymorphisms in genes encoding glycoproteins either independently or as allelic combinations, modulate the risk of musculoskeletal soft tissue injuries. Specifically, the TNC rs1330363 (C>T), rs2104772 (T>A) and rs13321 (G>C) variants, independently or in haplotype combinations, were analysed in this context. DesignCase–control genetic association study. MethodsA group of 421 physically active, unrelated participants were recruited where 229 individuals with surgically diagnosed primary ACL rupture and 192 apparently healthy participants without any history of ACL injuries. Participants were genotyped for the above variants. ResultsGenotype and allele frequencies of TNC variants did not differ between cases and controls. Haplotype analysis revealed no association between TNC and predisposition to ACL rupture. ConclusionsOur analyses did not reveal a significant association between these TNC variants and risk of ACL rupture in Polish Caucasian participants.

Nanostructure-Driven Replication of Soft Tissue Biomechanics in a Thermoplastic Elastomer Hydrogel.

Synthesis of hydrogel networks capable of accurately replicating the biomechanical demands of musculoskeletal soft tissues continues to present a formidable materials science challenge. Current systems are hampered by combinations of limited moduli at biomechanically relevant strains, inefficiencies driven by undesirable hysteresis and permanent fatigue, and recovery dynamics too slow to accommodate rapid cycling prominent in most biomechanical loading profiles. Here, we report on a novel paradigm in hydrogel design based on prefabrication of an efficient nanoscale network architecture using the melt-state self-assembly of amphiphilic block copolymers. Rigorous characterization and mechanical testing reveal that swelling of these preformed networks produces hydrogels with physiologically relevant moduli and water compositions, negligible hysteresis, subsecond elastic recovery rates, and unprecedented resistance to fatigue over hundreds of thousands of compression cycles. Furthermore, by relying only on simple thermoplastic processing to form these nanostructured networks, the synthetic complexities common to most solution-based hydrogel fabrication strategies are completely avoided.

A double blind randomised control trial investigating the efficacy of platelet rich plasma versus placebo for the treatment of greater trochanteric pain syndrome (the HIPPO trial): a protocol for a randomised clinical trial

BackgroundGreater trochanteric pain syndrome (GTPS) is a painful condition characterised by pain around the greater trochanter usually affecting middle-aged women. The majority of patients will improve with conservative management such as physiotherapy and non-steroidal anti-inflammatory drugs (NSAIDs); however, if this fails then more invasive treatments including corticosteroid injections and surgery may be required. Platelet-rich plasma (PRP) is an autologous blood product, which has a higher concentration of growth factors postulated to provide enhanced healing and anti-inflammatory properties. There have been numerous studies on PRP’s efficacy in musculoskeletal soft tissue conditions with similar pathology to GTPS, with varying results, most promising being in plantar fasciopathy and patellar tendinopathy. Corticosteroids are the established second-line treatment, but do not always work long term. PRP may be a suitable alternative to corticosteroid in GTPS with longer-term effects; however, there are very limited reports. The Hip Injections PRP Vs Placebo (HIPPO) trial aims to assess the ability of PRP to improve symptoms and function in patients with GTPS.Methods/designHIPPO is a single-centre, double-blind randomized placebo-controlled study in patients with a radiologically confirmed diagnosis of gluteus medius or minimus tendinopathy with swelling within the tendon insertion with or without bursitis. We aim to randomise 102 patients with GTPS to either the PRP or placebo (normal saline injection) treatment arm. Participants will receive one ultrasound (US) guided PRP/placebo injection into the trochanteric bursa and surrounding gluteus medius/minimus tendons. The primary outcome measure is the International Hip Outcome Tool-12. Secondary outcome measures will include a visual analogue score for pain, the three-level version of the EuroQol five-dimensional questionnaire and the modified Harris Hip Score. Outcomes will be measured at baseline, 3, 6 and 12 months. Participants will have the option at 6 months to have a repeat blinded injection or cross over to PRP. Analyses of primary and secondary outcomes will be made according to the intention-to-treat principle. The trial reporting will comply with Consolidated Standards of Reporting Trials (CONSORT) guidelines.DiscussionThe HIPPO study has been designed to test the hypothesis that PRP is effective in treating GTPS in patients who have failed conservative management and to assess the duration of effect of PRP.Trial registrationClinicalTrials.gov, NCT03479190. Registered on 27 March 2018.

Diffusion weighted MRI of soft tissue masses: Can measurement of ADC value help in the differentiation between benign and malignant lesions?

ObjectiveTo assess the ability of DWI & numerical ADC values associated with routine MRI in classification of different musculoskeletal soft tissue masses. Patient & method45 patients (32 females and 13 males) with known or clinically suspected to have musculoskeletal soft tissue masses were included. Their age ranging from (9–72) years, they all subjected to conventional MRI, DWI and ADC values were calculated, The diagnosis was confirmed by histologic biopsy. ResultsBenign neoplasms (except for lipomas) showed values of ADC above 1.275 × 10−3 mm2/s while malignant soft tissue tumors (except for high-grade myxofibrosarcoma) have ADC values below 1.1 × 10−3 mm2/s. Mean ADC values for benign and malignant soft tissue tumors were 1.53 ± 0.91 mm2/s and 0.84 ± 0.33 mm2/s respectively with cutoff value 1.235 mm2/s showing sensitivity, specificity & accuracy 73%, 91.7% & 80.3% respectively. Tru cut biopsy done in (28) patients (8 benign & 20 malignant masses), frozen sections confirmed diagnosis of other 10 benign masses and reconfirmed diagnosis of the previously biopsied 20 malignant masses, the last 7 patients couldn't be biopsied & were diagnosed from patient medical profile at our institute. ConclusionAddition of DWI &quantitative ADC mapping to routine MR examination is advised for evaluation of soft tissue tumors especially in the inconclusive cases.

The diagnostic value of diffusion-weighted magnetic resonance imaging in characterization of musculoskeletal soft tissue tumors

PurposeTo assess the utility of diffusion-weighted (DW) images and magnetic resonance imaging (MRI) in the detection and characterization of musculoskeletal soft tissue tumours (STTs) and in the determination of whether these tumours are benign or malignant. Patients and methodsA prospective study was performed between March 2016 and March 2017 that included all patients referred to the radio-diagnosis department for evaluation of musculoskeletal STTs. Contrast-enhanced MRI and DW images were performed for all included patients, and diagnoses were confirmed by biopsy and histopathological examination. ResultsThe apparent diffusion coefficient (ADC) of benign STTs was significantly higher than that of malignant (mean ± SD, −1.43 ± 0.56 × 10−3 mm2/s versus 0.74 ± 0.18 × 10−3 mm2/s, respectively (P < 0.001), ADC cut off value ≤1.10 × 10−3 mm2/s with a sensitivity of 83.3%, specificity of 72.7%, and PPV and NPP of 80%; the area under the receiver operating characteristic curve was = 0.892 (SE = 0.084, 95% CI (P < 0.001) and the Youden's index was calculated 58.4. ConclusionTo date, MRI has been considered the method of choice for the characterization of musculoskeletal STTs; however, DW-MRI with ADC mapping is a rapidly, valuable, non-invasive, non-contrast tool for reliably differentiating between benign and malignant STTs.

Effects of replacing soybean meal with chickpea seeds in the diet on mechanical and thermal properties of tendon tissue in broiler chicken

The efficiency of the musculoskeletal system of broiler chickens, in particular during locomotion and in ensuring its supportive function, depends directly on the adequate function and mechanical endurance of soft tissues, including tendons. However, little is known whether the properties of musculoskeletal soft tissues can be influenced by changes of dietary protein. We substituted soybean meal with raw chickpea seeds as the primary protein source in the diet and studied the effects it had on the mechanical and thermal properties of drumstick tendons in broiler Ross 308 chickens. In the experiment, 160 chicks were divided into 2 groups, receiving in their diet either soybean meal (n = 80) or chickpea seeds (n = 80). The experiment lasted 42 days. The physical condition of the drumstick tendons was analyzed on the basis of a tensile test and the results of thermal denaturation as measured by a differential scanning calorimetry. The mechanical evaluation of tendon tensile strength of the broilers fed with chickpea seeds demonstrated an increase in the ultimate strain (for over 22%, P < 0.04) and total energy absorbed by the tendon until rupture (for over 57%, P < 0.05) as when compared to the group fed with soybean meal. Thermal analysis demonstrated alterations in tendon collagen cross-linking as transition onset temperature decreased (from 63.8 to 61.8°C, P < 0.001), whereas the calorimetric enthalpy increased (from 16.2 to 22.1 J⋅g-1, P < 0.05) in the group fed with chickpea seeds. In summary, this study demonstrated that dietary protein source can impact the physical properties of tendons and showed that thermal analysis can be a useful tool for studying the effect of nutrition on the development and structural changes in tendons of broiler chickens.

MUSCULOSKELETAL ULTRASOUND ABNORMALITIES IN PATIENTS ON DIALYSIS, COMPARED TO PATIENTS WITH PRE-DIALYSIS STAGE CHRONIC KIDNEY DISEASE

Background. The musculoskeletal system is deeply involved in patients with CKD on dialysis. The studies that were done by now with regarding this subject mostly aimed the bone metabolism.So far, there is few data on the subject concerning the articular and abarticular abnormalities in dialysed patients(1). Objectives. To indentify the musculoskeletal soft tissue abnormities associated to dialysis and to evaluate whether or not they are more frequent. Also, we set ourselves to point out the importance of detecting these anomalies early in the evolution, in order to preserve the joint function and the quality of life, in a category of patients already severely affected. Materials and methods. This is a prospective study, ran on a period of 4 months. We included 55 patients ( 32 in the study group – on dialysis, 23 in the control group – late stage pre-dialysis chronic kidney disease). For each patient, we evaluated 68 joints using ultrasonography. Also, a visual analogue scale for pain was applied for each patient. Results. The findings vary from median nerve entrapment and tendon calcifications, to usual degenerative abnormalities, synovitis and tenosynovitis. The type of abnormalities does not vary between the two groups, but the percent of the affected patients was much higher in the study group. Conclusions. A great number of patients from the study group presented important articular and mostly abarticular abnormalities, sometimes with no correlation with the algofunctional symptoms.

Association between polymorphism rs12722 in COL5A1 and musculoskeletal soft tissue injuries: a systematic review and meta-analysis.

The rs12722 polymorphism in COL5A1 gene has been implicated in the etiology of musculoskeletal soft tissue injuries in several association studies with limited sample size and conflicting results. The purpose of the present systematic review and meta-analysis was to evaluate and synthesize the currently available data on the association between rs12722 and musculoskeletal soft tissue injuries. Five electronic databases including Pubmed, EMBASE, ISI Web of Science, CNKI and Wanfang were searched to identify relevant studies published before 15 May, 2017. Summary odds ratios (ORs) and corresponding 95% confidence intervals (95% CIs) were estimated using the RevMan 5.3 software. Nine studies comprising 1140 cases and 1410 healthy controls met the eligibility criteria. Recessive model was confirmed to be the optimum model (TT vs TC + CC). The results indicated that rs12722 SNP was significantly associated with musculoskeletal soft tissue injuries (OR 1.58, 95% CI 1.33, 1.89; P < 0.00001). When stratified by injury sites, modest but statistically significant association was found in Achilles tendon pathology (ATP), anterior cruciate ligament injuries (ACLI) and tennis elbow (TE). Subgroup-analysis by ethnicity suggested that TT genotype of rs12722 was associated with tendon and ligament injuries in Caucasians (OR 1.59, 95% CI 1.33, 1.90; P < 0.00001) but not in Asians (OR 1.46, 95% CI 0.46, 4.60; P = 0.52). Our findings indicated that rs12722 of COL5A1 was positively associated with tendon and ligament injuries, especially in Caucasian subjects. Individuals with TT genotype were predisposed to higher risk of ATP, ACLI and TE.