Risk Factors For Tendon Rupture Research Articles

Incidence and Risk Factors for Extensor Pollicis Longus Rupture in Elastic Stable Intramedullary Nailing of Pediatric Forearm Shaft Fractures.

Elastic stable intramedullary nailing (ESIN) is an effective means of fixation for unstable, pediatric forearm shaft fractures with the benefit of smaller incisions, less soft tissue manipulation, and ease of removal. This study was designed to evaluate the incidence of and risk factors for extensor pollicis longus (EPL) rupture after fixation of pediatric radial shaft fractures with ESIN. A retrospective review of all patients younger than 19 years who had a repair of a forearm fracture with flexible intramedullary nailing between 2006 and 2011 was performed. Nineteen consecutive patients were identified from the electronic medical record. All patients were treated with a titanium elastic nailing system using a dorsal approach to the radius. The patients were followed postoperatively for at least 2 years, and all fractures healed. An extensive chart review assessing for persistent pain, EPL function, and risk factors for EPL rupture was performed. Implants were removed in all but 1 patient. Seventeen records were available for review. Fourteen (82%) were male, and the mean age at time of fracture was 10 years old (range, 5 to 14 y). Follow-up averaged 5.5 years (range, 2.9 to 7.8 y). The mean weight was 32.7 kg for males and 50.6 kg for females corresponding to the 61st and 60th percentile respectively of weight-for-age (range, 8th to 99.9th percentile). Hardware was removed in all but 1 case, and the median time from surgery to hardware removal was 21 weeks (range, 8 to 63). Three of the 17 patients (18%) experienced rupture of the EPL. Two were treated with additional surgery following hardware removal, and one was untreated due to patient preference. None of the 17 patients (including those with rupture) had independent risk factors for tendon rupture: inflammatory arthritis, diabetes, or prior steroid use. Time to removal, patient age, and percentile of weight-for-age did not correlate with EPL rupture. Although ESIN of pediatric forearm shaft fractures has gained acceptance as a treatment option, our series of 17 patients revealed an 18% rate of EPL rupture. With this small patient cohort, no patient characteristics proved to be significant risk factors for predicting tendon rupture. However, awareness should be raised for an increased risk of EPL rupture with this fixation method. Level IV-Therapeutic.

Effect of simvastatin on rat supraspinatus tendon mechanical and histological properties in a diet-induced hypercholesterolemia model.

Hypercholesterolemia is a common condition and is a risk factor for tendon rupture, specifically in the supraspinatus tendon. In the clinic, statins are commonly prescribed to lower cholesterol, but little information is available examining the effect of statin treatment on the musculoskeletal system. Therefore, the objective of this study was to determine the biomechanical and histological effects of statin treatment in a diet-induced hypercholesterolemia model. We hypothesized that hypercholesterolemic rats treated with statins would have improved tendon biomechanical and histological properties compared to hypercholesterolemic rats not receiving daily statin treatment. Thirty adult male Sprague-Dawley rats ate either high-cholesterol (HC) diet (n = 20) or normal chow (CTL, n = 10). After 6 months, a subset of HC rats began daily oral simvastatin dosing (HC+S) at 20 mg/kg. All rats were sacrificed after a total of 9 months (3 months of statin treatment) and evaluated for histology and mechanics. For mechanics, at the insertion region, HC+S group had increased tendon cross-sectional area decreased and modulus. No differences were noted in mechanical properties at the midsubstance. For histology, no differences were noted in the insertion region. In the midsubstance region, HC+S group had more spindle shaped cells. Our results suggest that 3 months of simvastatin treatment in a diet-induced hypercholesterolemia rat model alters some tendon mechanical and histological properties, although a strong conclusion in support of improved parameters cannot be drawn. Therefore, we conclude that simvastatin treatment does not negatively affect tendon properties. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:2009-2015, 2016.

Achilles Tendon Rupture and Abnormal Lipid Profile: A Descriptive Clinical Laboratory and Histology Study

Introduction: Several human and animal studies have revealed a link between abnormal serum lipid levels and Achilles tendon rupture. However, clinicians have not detected macroscopic amounts of fatty tissue during the repair of ruptured tendons.Material and Methods: A lipid profile and evaluation of tendon lipomatosis were performed in a group of 65 patients with Achilles tendon rupture recruited over a two-year period at two French hospitals. Cardiovascular and tendon rupture risk factors were inventoried.Results: Ten patients had a history of hypercholesterolemia, seven of whom were undergoing statin treatment (15%). Two patients had known risk factors for tendon rupture (3%): one was taking inhaled corticosteroids and the other suffered from hyperuricemia. Total cholesterol was normal in 63% of cases; triglycerides were normal in 67% of cases and HDL cholesterol was normal in 54% of cases. If cardiovascular risk factors were taken into account, the portion of high-LDL cholesterol went from 17% to 23%, but this was not significant. Pathology analysis found four cases of tendon lipomatosis among the 36 collected samples (11%).Discussion: Since this study did not include a control group, we cannot make any conclusions about the lack of relationship between abnormal lipid profile and tendon rupture. The prevalence of hypercholesterolemia in our study population was similar to that of the general population. Although high cholesterol levels have been implicated by some authors, cholesterol accumulation within the tendon is probably not directly responsible for weakening it; however, an increase in atheromatous plaque in tendon blood vessels may lead to hypoxia.

Is Statin Use Associated With Tendon Rupture? A Population-Based Retrospective Cohort Analysis

Previous case reports and small studies have suggested that 3-hydroxy-3-methylglutaryl-CoA reductase inhibitors (HMG-CoA-Is) may increase the risk of tendon rupture. We conducted a population-based retrospective cohort evaluation to better assess this relationship. From approximately 800,000 enrollees of a private insurance database, those who were aged ≤64 years with at least 1 year of continuous enrollment were selected. Exposure was defined as initiation of HMG-CoA-I after the beginning of the study period. Each exposed person was matched with 2 controls of similar age and gender. Baseline characteristics, including known risk factors for tendon rupture, were compared between exposed and control cohorts with fidelity to the study's matched design. After adjusting for differences in follow-up and baseline characteristics, incidence rate ratios for tendon rupture was assessed in HMG-CoA-I users and nonusers. A total of 34,749 exposed patients were matched with 69,498 controls. There was no difference in the occurrence of tendon ruptures in HMG-CoA-I users versus nonusers. The results remained unchanged after adjustment for age and gender. In conclusion, this population-based retrospective cohort evaluation suggests that use of HMG-CoA-Is as a group are not associated with tendon rupture.

Spontaneous Achilles Tendon Rupture in a Patient with Undergoing Long-Term Haemodialysis: a Case Report and Literature Review

Chronic kidney disease and hemodialysis are well known risk factors for tendon rupture, although this is a rare situation. The present case was a 70-year old male who presented with a sudden onset of painful disability in the left posterior ankle. This occurred while he was climbing the stairs. A physical examination and imaging resulted in a diagnosis of Achilles tendon rupture. The patient had received regular haemodialysis for 12 years. He developed secondary hyperparathyroidism as excepted sequelae of end stage renal disease. Following surgical repair, physiotherapy and management of associated risk factors, the patient regained full active mobility.

Percutaneous, Minimally Invasive Repair of Traumatic and Simultaneous Rupture of Both Achilles Tendons: A Case Report

Achilles injury is a common musculoskeletal disorder. Bilateral rupture of the Achilles tendon, however, is much less common and usually occurs spontaneously. Complete, traumatic, and bilateral ruptures are rare and typically require long periods of immobilization before the patient can return to full weightbearing. A 52-year-old male was hospitalized for bilateral traumatic rupture to both Achilles tendons. No risk factors for tendon rupture were found. Blood samples revealed no peripheral blood pathologic features. Both tendons were repaired with percutaneous, minimally invasive surgery using the Achillon® tendon suture system. Rehabilitation was begun 4 weeks later. An ankle–foot orthosis was prescribed to provide ankle support with an adjustable range of movement, and active plantar flexion was set at 0° to 30°. The patient remained non-weightbearing with the ankle–foot orthosis device and performed active range-of-motion exercises. At 8 weeks after surgery, we recommended that he begin walking with partial weightbearing using a foot–tibial orthosis with the range of motion set to 45° plantar flexion and 15° dorsiflexion. At 10 weeks postoperatively, he was encouraged to return to full weightbearing on both feet. Beginning rehabilitation as soon as possible after minimally invasive surgery, compared with 6 weeks of immobilization after surgery, provided a rapid resumption to full weightbearing. We emphasize the clinical importance of a safe, simple treatment program that can be followed for a patient with damage to the Achilles tendons. To our knowledge, ours is the first report of minimally invasive repair of bilateral simultaneous traumatic rupture of the Achilles tendon.

Quadriceps tendon rupture in maintenance haemodialysis patients: Results of surgical treatment and analysis of risk factors

BackgroundReports of spontaneous quadriceps ruptures in end-stage renal disease (ESRD) patients are scarce, and the assessment of risk factors for tendon rupture is poorly addressed in the majority of the studies. The purpose of the present study is to report a series of patients on haemodialysis with spontaneous quadriceps tendon ruptures operated at our institution. The results of the surgical treatment are described and the potential risk factors associated with the rupture are analyzed. MethodsOur study consisted of retrospective analysis of patient's charts. Clinical and laboratory findings of the operated group were compared to the ones of a control group of haemodialysis patients matched by age, gender, and time on haemodialysis, but without tendon rupture. ResultsBetween 1998 and 2010, six ESRD patients with 11 spontaneous ruptures of the quadriceps tendon were treated at our institution. On postoperative evaluation all patients were able to walk without crutches after six months of follow-up, and there were no new ruptures. Positive serology for Hepatitis C was present in two cases (33%) but in none of the controls (p=0.034). Mean serum levels of intact parathormone (iPTH) and alkaline phosphatase were both higher in cases (p=0.013 and p=0.034, respectively). In contrast, mean serum levels of albumin, ferritin and haemoglobin were all lower in cases (p=0.008, p=0.043 and p=0.016, respectively). ConclusionReconstructive surgery is a good way to restore knee function in ESRD patients with quadriceps tendon ruptures. Our cases exhibited higher levels of iPTH and alkaline phosphatase than control patients, reinforcing the role of secondary hyperparathyroidism in tendon weakening. They also had a higher frequency of hepatitis C and lower levels of albumin and haemoglobin compared to controls, possibly implicating chronic inflammation as a potential risk factor for tendon rupture.

Incidence and Clinical Outcomes of Tendon Rupture Following Distal Radius Fracture

To evaluate the incidence of tendon rupture after nonoperative and operative management of distal radius fractures, report clinical outcomes after tendon repair or transfer, and examine volar plate and dorsal screw prominence as a predictor of tendon rupture. We performed a retrospective chart review on patients treated for tendon rupture after distal radius fracture. We evaluated active range of motion, Disabilities of Arm, Shoulder, and Hand score, grip strength, and pain score, and performed radiographic evaluation of volar plate and dorsal screw prominence in both the study group and a matched control group. There were 6 tendon ruptures in 1,359 patients (0.4%) treated nonoperatively and 8 tendon ruptures in 999 patients (0.8%) treated with volar plate fixation. At the time of final follow-up, regardless of treatment, we noted that patients had minimal pain and excellent motion and grip strength. Mean Disabilities of the Shoulder, Arm, and Hand scores were 6 for patients treated nonoperatively and 4 for those treated with volar plating. We were unable to verify volar plate or dorsal screw prominence as independent risk factors for tendon rupture after distal radius fractures. However, we recommend continued follow-up and plate removal for symptomatic patients who have volar plate prominence or dorsal screw prominence. In the event of tendon rupture, we report excellent clinical outcomes after tendon repair or tendon transfer. Therapeutic IV.

Association Between Statin Therapy and Tendon Rupture: A Case-Control Study

Although case reports of a possible association between statin therapy and tendon rupture have been published, no analytical studies exploring this relationship have been reported. We conducted a case-control study using the electronic medical records at Michigan State University from 2002 to 2007 to assess whether statin use is a risk factor for tendon rupture. We compared exposure to statins in 93 cases of tendon rupture with similar exposure in 279 sex- and age-matched controls. Exposure to statins was defined as documentation in the electronic medical record of statin use in the 12 months preceding tendon rupture. For controls, the exposure period was defined as 1 year preceding the last office visit. We used a multivariate logistic regression model, controlling for diabetes, renal disease, rheumatologic disease, and steroid use, to calculate the adjusted odds ratios (ORs). There was no significant difference between cases and controls in the rates of statin use, with either univariate [OR = 1.0, 95% confidence interval (CI) 0.54-1.84] or multivariate analyses (OR = 1.10, 95% CI 0.57-2.13). Based on predetermined subgroup analyses, statin exposure was found to be a significant risk factor for tendon rupture in women (adjusted OR = 3.76, 95% CI 1.11-12.75) but not in men (adjusted OR = 0.66, 95% CI 0.29-1.51). In conclusion, we found no overall association between statin use and tendon rupture, but subgroup analysis suggested that women with tendon rupture were more likely to be on statins.