Changes In Tendon Structure Research Articles

Evaluation of Patellar Tendon Structural Changes following Biological Treatments: Secondary Analysis of Double-Blinded Clinical Trial of Bone Marrow Mesenchymal Stromal Cells and Leukocyte-Poor Platelet-Rich Plasma.

Objective quantification of tendon structural changes through imaging is only achieved by evaluating tendon structure using ultrasound tissue characterization (UTC) technology. This study compares the effects of bone marrow mesenchymal stromal cells (BM-MSC) and leukocyte-poor platelet-rich plasma (Lp-PRP) on tendon structure and clinical outcomes in male patients with patellar tendinopathy measured with UTC at 3, 6, and 12 months after treatment. This is a double-blinded clinical trial with a randomized active control study with 20 male patients diagnosed with patellar tendinopathy who underwent BM-MSC and Lp-PRP. Bilateral ultrasound tissue characterization scans of the patellar tendon were carried out after 3, 6, and 12 months, as well as tests for strength and pain. UTC patellar tendon was analyzed at the insertion, proximal, and mid-tendon. BM-MSC showed a greater capacity to promote further positive changes than Lp-PRP. Lp-PRP presented higher disorganized echo-type II in the mid-tendon (p = 0.04; ES = 1.06) and III (p = 0.02; ES = -1.47) after 3 months in the Lp-PRP group. Similar results were seen after 6 and 12 months. Pain and strength data show improvement in the treated tendon. BM-MSC treatment demonstrates a superior capacity to promote tendon regeneration and organization, restore strength, and reduce pain compared to Lp-PRP, after 3, 6, and 12 months in male patients with patellar tendinopathy.

Widespread Pressure Pain Hyperalgesia Is Not Associated With Morphological Changes of the Wrist Extensor Tendon in Unilateral Lateral Epicondylalgia: A Case-Control Study.

The aims of the current study were to investigate the presence of widespread pressure hyperalgesia, the presence of structural changes in the wrist extensor tendon and muscle, and their association in people with lateral epicondylalgia (LE). Thirty-seven patients with LE (43% women; mean age = 45.5 [SD = 9.5] years) and 37 controls matched for age and sex and free of pain participated in this study. Pressure pain thresholds (PPTs) were assessed bilaterally over the symptomatic area (elbow), 2 segment-related areas (C5-C6 joint, second intermetacarpal space), and 1 remote area (tibialis anterior) in a blinded design. Ultrasound measurements (eg, cross-sectional area, thickness, and width) of the common wrist extensor tendon and extensor carpi radialis brevis muscle as well as the thickness of the supinator muscle were assessed. Patients with LE exhibited lower PPTs bilaterally at all points and lower PPTs at the lateral epicondyle and second intermetacarpal space on the symptomatic side as compared to the nonsymptomatic side (η2 from 0.123-0.369; large effects). Patients exhibited higher cross-sectional area and width of the common wrist extensor tendon (η2 from 0.268-0.311; large effects) than controls bilaterally, whereas tendon thickness was also higher (η2 = 0.039; small effects) on the painful side than on the nonpainful side. This study reported bilateral widespread pressure pain hyperalgesia and morphological changes in the tendon, but not the muscle, in LE. Pressure pain sensitivity and morphological changes were not associated in individuals with LE. Management of LE should consider altered nociceptive pain processing and structural tendon changes as 2 different phenomena in patients with LE.

The Immediate Effect of Cumulative Transverse Strain via Exercise on the Achilles Tendon in Individuals with and Without Flat Feet.

Flat feet change lower extremity alignment, and it may change the load distribution on Achilles tendon during exercise. The purpose of the present study was to investigate the immediate effect of cumulative transverse strain via resistive ankle plantarflexion exercise on the Achilles tendon in individuals with flat feet. Fourteen individuals with flat feet and 14 age-matched individuals with normal foot posture were enrolled in the present study. Achilles tendon thickness was measured by an ultrasonography device with a linear probe at 3 points: 1 cm (AT-1), 2 cm (AT-2), and 3 cm (AT-3) proximal to the superior aspect of the calcaneus. Ultrasonography measurements were performed before and after participants completed 90 repetitions of double-leg calf raise exercises which included moving the foot from full ankle dorsiflexion to full ankle plantarflexion. Achilles tendon thickness at all points measured was thinner in the flat feet group at both pre- and post-exercise conditions compared with that of the control group (p<0.05). Achilles tendon thickness at AT-1, AT-2, and AT-3 decreased after the exercise in both groups (p<0.001). The differences in Achilles tendon thickness at all points measured between pre- and post-exercise conditions were lower in individuals with flat feet than those of the control group (p<0.05). There was a significant decrease in Achilles tendon thickness after exercise in both groups; however, the tendon thickness markedly diminished in individuals with normal foot posture. The results are thought to result from changes in tendon structure and in load distribution on the Achilles tendon.

Overload in a Rat In Vivo Model of Synergist Ablation Induces Tendon Multiscale Structural and Functional Degeneration.

Tendon degeneration is typically described as an overuse injury with little distinction made between magnitude of load (overload) and number of cycles (overuse). Further, in vivo, animal models of tendon degeneration are mostly overuse models, where tendon damage is caused by a high number of load cycles. As a result, there is a lack of knowledge of how isolated overload leads to degeneration in tendons. A surgical model of synergist ablation (SynAb) overloads the target tendon, plantaris, by ablating its synergist tendon, Achilles. The objective of this study was to evaluate the structural and functional changes that occur following overload of plantaris tendon in a rat SynAb model. Tendon cross-sectional area (CSA) and shape changes were evaluated by longitudinal MR imaging up to 8 weeks postsurgery. Tissue-scale structural changes were evaluated by semiquantified histology and second harmonic generation microscopy. Fibril level changes were evaluated with serial block face scanning electron microscopy (SBF-SEM). Functional changes were evaluated using tension tests at the tissue and microscale using a custom testing system allowing both video and microscopy imaging. At 8 weeks, overloaded plantaris tendons exhibited degenerative changes including increases in CSA, cell density, collagen damage area fraction (DAF), and fibril diameter, and decreases in collagen alignment, modulus, and yield stress. To interpret the differences between overload and overuse in tendon, we introduce a new framework for tendon remodeling and degeneration that differentiates between the inputs of overload and overuse. In summary, isolated overload induces multiscale degenerative structural and functional changes in plantaris tendon.

Disorganised patellar tendon structure remains inert despite continued exposure to high loading environments

Introduction: Ultrasound tissue characterisation (UTC) is a unique imaging modality used to investigate structural changes of the patellar tendon. Adolescent athletes who load their knees may be susceptible to patellar tendon abnormality(s) (PTA), characterised by areas of structural disorganisation. Presence of a PTA is a risk factor for the development of pain and dysfunction. This longitudinal study aimed to investigate patellar tendon structural changes in adolescent athletes with PTA.

Muscle-tendon cross talk during muscle wasting.

In organisms from flies to mammals, the initial formation of a functional tendon is completely dependent on chemical signals from muscles (myokines). However, how myokines affect the maturation, maintenance, and regeneration of tendons as a function of age is completely unstudied. Here we discuss the role of four myokines-fibroblast growth factors (FGF), myostatin, the secreted protein acidic and rich in cysteine (SPARC) miR-29-in tendon development and hypothesize a role for these factors in the progressive changes in tendon structure and function as a result of muscle wasting (disuse, aging, and disease). Because of the close relationship between mechanical loading and muscle and tendon regulation, disentangling muscle-tendon cross talk from simple mechanical loading is experimentally quite difficult. Therefore, we propose an experimental framework that hopefully will be useful in demonstrating muscle-tendon cross talk in vivo. Though understudied, the promise of a better understanding of muscle-tendon cross talk is the development of new interventions that will improve tendon development, regeneration, and function throughout the lifespan.

What Are the Sonographic Outcomes of Acute Achilles Tendon Rupture? Nonoperative Versus Surgical Repair?

Introduction: The objective was to compare the two-year ultrasonographic outcomes in a consecutive series of patients with acute Achilles tendon rupture (ATr), either treated surgically or nonoperatively. Materials and Methods: This is a prospective, single-center, consecutive series. All patients presenting with acute ATr were included and divided into two groups: surgical or nonoperative groups. At two years, patients were evaluated clinically and sonographically. The parameters studied were length of the tendon on the rupture side (LTCR) and on the contralateral side (LTCS), ratio LTCR/LTCS, maximum anteroposterior diameter on the rupture side (DAPMR), maximum surface area on the rupture side (SMR), maximum anteroposterior diameter on the contralateral side (DAPMS), and maximum surface area on the contralateral side (SMS). Morphological changes in tendon structure were reported. Results: Thirty patients were included. No difference in functional score was observed between both groups. In the nonoperative group, there is a significant difference between: LTCR and LTCS; DAPMR and DAPMS. In the surgical group, there is a significant difference between: LTCR and LTCS; DAPMR and DAPMS; SMR and SMS. There is a significant difference when comparing SMR/SMS between both groups. In terms of morphological changes in tendon structure, there were differences. Conclusion: At two years, there was no difference in functional outcomes between the two groups. In both groups, AT were lengthened and thickened without differences between groups. There was a significant difference when comparing the ratio SMR/SMS between groups. Ultrasound examination demonstrated different morphological changes in tendon structure depending on the treatment performed.

Characterisation of Morphology in Musculus Semitendinosus Tendon Used for Anterior Cruciate Ligament Reconstruction: A Pilot Study

Summary Introduction Anterior cruciate ligament (ACL) rupture is very common in athletes. In the general population, incidence is approximately 33 per 100 000 people. Aim of the study The aim of the study was the evaluation of morphological changes in the musculus semitendinosus tendon used for the reconstruction of ACL to understand the quality of most common for surgery used material. Material and methods The materials were obtained from four ACL autologous hamstring reconstruction surgeries. The tissue was stained with hematoxyllin and eosin and with immunohistochemical (IMH) staining of PGP9.5, VEGF, collagen I and collagen III. The material was evaluated with semiquantitative method. Results Routine staining showed practically unchanged tendon structure, with one exception when sclerotic blood vessels were observed in endotenon. Collagen III IMH demonstrated moderate to numerous positive collagen fibres in two cases, but in other two there were only few positive structures seen. Collagen I IMH showed few to moderate number of positive collagen fibres in all cases. In two cases, moderate number of PGP9.5 positive nerve fibres was observed and in two other cases occasional to few number of positive structures was detected. PGP 9.5 marked higher number of nerve fibres in peritenon than in endotenon. Numerous VEGF positive endotheliocytes were observed in two cases, but in two other cases VEGF positive endotheliocytes were occasional. Conclusions Tendon of musculus semitendinosus displays two patterns of distribution of tissue ischemia, neuropeptide containing innervation and collagen I and III. Collagen III is thought to be evaluated as a response of tendon to the ischemia and intensive innervation, while increase of collagen I probably is related to the relatively unchanged vascularity and innervation. The pattern of musculus semitendinosus tendon structural changes seems to be connected to the individual homeostasis in patients persisting before the usage of tendon for the reconstruction.

Running a Marathon-Its Influence on Achilles Tendon Structure.

Several studies have been conducted to better understand the effect of load on the Achilles tendon structure. However, the effect of a high cumulative load consisting of repetitive cyclic movements, such as those that occur during the running of a marathon, on Achilles tendon structure is not yet clear. Clinicians, coaches, and athletes will benefit from knowledge about the effects of a marathon on the structure of the Achilles tendon. To investigate the short-term response of the Achilles tendon structure to running a marathon. Case series (prospective). Sports medicine centers. Ten male nonelite runners who ran in a marathon. Tendon structure was assessed before and 2 and 7 days after a marathon using ultrasound tissue characterization (UTC), an imaging tool that quantifies tendon organization in 4 echo types (I-IV). Echo type I represents the most stable echo pattern, and echo type IV, the least stable. At 7 days postmarathon, both the insertional and midportion structure changed significantly. At both sites, the percentage of echo type II increased (insertion P < .01; midportion P = .02) and the percentages of echo types III and IV decreased (type III: insertion P = .01; midportion P = .02; type IV: insertion P = .01; midportion P < .01). Additionally, at the insertion, the percentage of echo type I decreased (P < .01). We observed the effects of running a marathon on the Achilles tendon structure 7 days after the event. Running the marathon combined with the activity performed shortly thereafter might have caused the changes in tendon structure. This result emphasizes the importance of sufficient recovery time after running a marathon to prevent overuse injuries.

Substantiating the Use of Ultrasound Tissue Characterization in the Analysis of Tendon Structure: A Systematic Review.

To determine the role of ultrasound tissue characterization (UTC) in predicting, diagnosing, and monitoring tendon structure and/or tendinopathy. In addition, this study aims to provide recommendations for standardized methodology of UTC administration and analysis. The PubMed, Embase, and Web of Science databases were searched (up to September 2018). All scientific literature concerning the use of UTC in assessing tendons was collected. The initial search resulted in a total of 1972 hits, and after screening by eligibility criteria, 27 articles were included. In total, 18 investigating the Achilles tendon, 5 the patellar tendon, and 4 both Achilles and patellar tendons were included. The methods of UTC administration and analysis differed and were not uniform. The studies showed that the use of UTC to predict Achilles tendinopathy (AT) is inconclusive, but that a higher amount of tendon disorganization increases the risk of developing patellar tendinopathy (PT). In terms of diagnosis, UTC might provide additional information in AT cases. In addition, promising results were found for the use of UTC in both AT and PT in monitoring the effect of load or treatment on tendon structure. More research regarding the use of UTC in predicting tendon pathology is required. Ultrasound tissue characterization seems useful as an adjunct diagnostic modality because it can be used to differentiate symptomatic from asymptomatic tendons. In addition, UTC is a promising device to be used to monitor changes in tendon structure in response to load or treatment. Moreover, we provide recommendations of a standardized protocol concerning the methods of UTC measurement and analysis.

Achilles Tendon Thickness and Stiffness Evaluation with Shear-Wave Elastography in Hemodialysis Patients

Background: Changes in tendon structure are expected in chronic renal failure (CRF) due to metabolic alterations. Shear-wave elastography (SWE) is a new elastography technique that determines soft tissue elasticity noninvasively. SWE may determine early tendon degeneration due to CRF. Objectives: We aim to determine Achilles tendon thickness and elasticity in CRF patients undergoing hemodialysis with B-mode and SWE ultrasonography (US). Patients and Methods: Thirty-four (23 male, 11 female) patients with CRF and 32 healthy individuals (24 male, eight female) were included in the study. Initially both Achilles tendons of patients were evaluated for structural abnormalities or focal lesions then tendon thickness was measured with B-mode US. Tendon stiffness was measured by SWE in kilopascal (kPa) units. Results: Mean Achilles tendon thickness in the patient group was significantly lower than the control group (4.16 ± 0.59 mm vs. 4.78 ± 0.61 mm, P < 0.001). The mean elasticity scores in the patient group was 26.00 ± 9.74 kPa and 24.64 ± 6.64 kPa in the control group which was not statistically significant. Conclusion: Achilles tendon is thinner in chronic renal failure patients compared to the control group. However, there was no significant difference between the groups in stiffness values of tendons measured by SWE.

Bilateral changes in tendon structure of patients diagnosed with unilateral insertional or midportion achilles tendinopathy or patellar tendinopathy

PurposeChanges in tendon structure are commonly seen in patients with unilateral achilles (AT) or patellar (PT) tendinopathy but might also be present on the asymptomatic side, indicating a higher risk for developing symptoms. The aim of this study is to compare tendon structure of the symptomatic side with the asymptomatic side in AT and PT patients and control subjects.MethodsA total of 46 patients with unilateral AT (16 insertional and 30 midportion) and 38 with unilateral PT were included. For the control group, a total of 18 Achilles tendons and 25 patellar tendons were scanned. Tendon structure was assessed using ultrasound tissue characterisation (UTC), which quantifies tendon organisation dividing the structure into four different echo types (I–IV).ResultsThere were significant differences in echo types I, III, and IV between symptomatic and asymptomatic sides and controls. Additionally, there was a significant difference between the symptomatic and the asymptomatic side for all tendinopathy locations. In the insertional AT tendon portion, the symptomatic side showed a higher percentage of echo type III. For the midportion AT, the symptomatic side showed a lower percentage of echo type I and a higher percentage of echo types III and IV. For the patellar tendon, the symptomatic side showed a higher percentage of echo types III and IV. All differences were higher than the minimal detectable changes.ConclusionAlthough patients have symptoms unilaterally, the tendon structures are compromised on both sides. These results stress the importance of monitoring both symptomatic and asymptomatic tendon structures and in addition highlight that the asymptomatic side should not be used as reference in clinical practice.Level of evidenceIII.

Relationship between ultrasound detected tendon abnormalities, and sensory and clinical characteristics in people with chronic lateral epicondylalgia.

ObjectiveTo investigate the relationship between tendon structural changes determined by static ultrasound images (US) and sensory changes using quantitative sensory testing (QST), and clinical measures in lateral epicondylalgia.Materials and methodsBoth elbows of 66 adult participants with a clinical diagnosis of lateral epicondylalgia were investigated. Using a standardised ultrasound image rating scale, common extensor hypoechogenicity, heterogenicity, neovascularity, and bony abnormalities at the enthesis were scored, and tendon thickness (longitudinal and transverse plane) was measured by a trained assessor. Sensory measures of pressure, heat and cold pain thresholds and vibration detection threshold were recorded. Pain and function were assessed using the patient-rated tennis elbow (PRTEE), pain-free grip strength, pain visual analog scale (PVAS) and quality of life (EuroQoL EQ -5D). Univariate and multivariate linear regression analyses were used to explore the association between tendon structural, sensory and clinical variables which were adjusted for age, gender and duration of symptoms.ResultsA negative correlation was identified between the presence of neovascularity and cold pain threshold (P = 0.015). Multiple regression analyses revealed that a combination of female gender (P = 0.044) and transverse tendon thickness (P = 0.010) were significantly associated with vibration detection threshold in affected elbows, while gender (P = 0.012) and total ultrasound scale score (P = 0.024) were significantly associated with heat pain threshold and vibration detection threshold in unaffected elbows. Heat pain threshold and gender were significantly associated with pain and disability (PRTEE; P < 0.001), and pain-free grip strength (P < 0.001) respectively, in the affected elbows.ConclusionGenerally, structural and sensory measures were weakly correlated. However, neovascularity and transverse tendon thickness may be related to sensory system changes in LE.

Clinical Improvements Are Not Explained by Changes in Tendon Structure on Ultrasound Tissue Characterization After an Exercise Program for Patellar Tendinopathy.

The aim of this study was to investigate the effects of a 4-wk in-season exercise program of isometric or isotonic exercises on tendon structure and dimensions as quantified by ultrasound tissue characterization (UTC). This was a randomized clinical trial. Volleyball and basketball players (16-31 yrs, n = 29) with clinically diagnosed patellar tendinopathy were randomized to a 4-wk isometric or isotonic exercise program. The programs were designed to decrease patellar tendon pain. A baseline and 4-wk UTC scan was used to evaluate change in tendon structure. No significant change in tendon structure or dimensions on UTC was detected after the exercise program despite patellar tendinopathy symptoms improving. The percentage and mean cross-sectional area of aligned fibrillar structure (echo types I + II) (Z = -0.414, P = 0.679) as well as disorganized structure (echo types III + IV) (Z = -0.370, P = 0.711) did not change over the 4-wk exercise program. Change in tendon structure and dimensions on UTC did not differ significantly between the groups. Structural properties and dimensions of the patellar tendon on UTC did not change after a 4-wk isometric or isotonic exercise program for athletes with patellar tendinopathy in-season, despite an improvement in symptoms. It seems that structural improvements are not required for a positive clinical outcome.

Achilles tendon structure differs between competitive distance runners and nonrunners despite no clinical signs or symptoms of midsubstance tendinopathy.

Achilles tendinopathy affects many running athletes and often leads to chronic pain and functional deficits. Although changes in tendon structure have been linked with tendinopathy, the effects of distance running on tendon structure are not well understood. Therefore, the purpose of this study was to characterize structural differences in the Achilles tendons in healthy young adults and competitive distance runners using quantitative ultrasound analyses. We hypothesized that competitive distance runners with no clinical signs or symptoms of tendinopathy would have quantitative signs of tendon damage, characterized by decreased collagen alignment and echogenicity, in addition to previous reports of thicker tendons. Longitudinal ultrasound images of the right Achilles tendon midsubstance were acquired in competitive distance runners and recreationally active adults. Collagen organization, mean echogenicity, and tendon thickness were quantified using image processing techniques. Clinical assessments confirmed that runners had no signs or symptoms of tendinopathy, and controls were only included if they had no history of Achilles tendon pain or injuries. Runner tendons were 40% less organized, 48% thicker, and 41% less echogenic compared with the control tendons ( P < 0.001). Young adults engaged in competitive distance running have structurally different tendons than recreationally active young adults. NEW & NOTEWORTHY In this study, we quantified the Achilles tendon substructure in distance runners, and a control group of young adults, to determine whether distance running elicits structural adaptations of the tendon. We found that competitive distance runners have structurally compromised Achilles tendons despite not showing any clinical signs or symptoms of tendon injury. These findings suggest that distance running may stimulate structural changes as a protective mechanism against tendon pain and dysfunction.

Comparison of Photobiomodulation and Anti-Inflammatory Drugs on Tissue Repair on Collagenase-Induced Achilles Tendon Inflammation in Rats

Tendinopathy is characterized by pain, edema, and structural changes in tendon tissue. In this animal study we decided to compare the short- and medium-term effects of low-level laser therapy (LLLT), dexamethasone, and diclofenac on inflammation and tendon tissue repair in collagenase-induced tendinitis. Two hundred five female Wistar rats were randomly divided into five groups. Animals in the control group were given a saline injection and the experimental groups received a collagenase injection (100 μg/tendon) in the peritendinous Achilles and received no treatment, LLLT (3 J, 810 nm, 100 mW), diclofenac (1.1 mg/kg), or dexamethasone (0.02 mg/kg). Histological analyses were performed at 10 time points up to 60 days (n = 5/group each time point), and included an assessment of the severity of inflammation, collagen fiber content, and organization. Collagenase injection induced a severe inflammatory reaction with significant reduction in collagen content for 48 h, and disorientation of collagen fibers lasting between 14 and 21 days. Diclofenac and dexamethasone reduced inflammatory signs during the first 2 days, although there was prolongation of the inflammatory phase and slower normalization of tendon quality, particularly in the dexamethasone group. LLLT prevented hemorrhage, reduced inflammation severity, and preserved tendon morphology compared with the other groups. LLLT showed a significant superiority over commonly used anti-inflammatory pharmaceutical agents in acute collagenase-induced tendinitis.

Relationship between ultrasound detected tendon abnormalities, sensory system changes and clinical measures of pain and function in lateral epicondylalgia

Background: Local tendon pathology, sensory system changes and motor impairments are associated with lateral epicondylalgia. The aim of the study was to investigate the interrelationship between ultrasound detected tendon structural changes, sensory measures using quantitative sensory testing (QST), and self-reported pain and function in lateral epicondylalgia.

El continuum de la patología de tendón: concepto actual e implicaciones clínicas

Cook and Purdam first proposed the Continuum model in 2009, with the aim of improving the understanding of the complexity of tendon pathologies. The Continuum is based on three states of tendon structure: reactive tendon, tendon disrepair and degenerative tendon. In contrast to other proposals, the Continuum model describes continuous changes in tendon structure. Each state of tendon structure represents a particular clinical presentation and requires a particular type of management. Evidence seen in histopathological studies, imaging and clinical studies all support the Continuum model for the analysis of tendon pathologies.

Effects of eccentric overload training on patellar tendon and vastus lateralis in three days of consecutive running

BackgroundThe analysis of structural changes in patellar tendon and muscle of healthy subjects in response to mechanical loads provides useful insight into the mechanism underlying overuse injuries. MethodsChanges produced in tendon and muscles structures after eccentric overload training and three consecutive running days were examined. Twenty healthy subjects were recruited and divided into two groups. One group (ECC) performed eccentric overload squat training (six weeks). After such training, the ECC group performed three running sessions on consecutive days, as did the control group (CONT). The structure of their patellar tendons and vastus lateralis muscles was quantified using ultrasound and Doppler imaging. Images were obtained before and after eccentric training for the ECC group and on every day of running performance for both groups. ResultsAfter eccentric training, the ECC group experienced an increase in cross-sectional area (CSA) of patellar tendon (P=0.012). After every day of running, the ECC group experienced a decrease in CSA (P=0.027). In the CONT group, after one day of running a significant increase was observed in anteroposterior width of their patellar tendon (P=0.028), as well as a decrease in pennation angle of vastus lateralis muscle (P=0.028) within three days of running sessions. ConclusionsEccentric overload training brought about changes in the patellar tendon consistent with an improvement in the quality of the tissue. The ECC group in our study showed a more normalised pattern than the CONT group in the running performance, in agreement with previous research. Level of evidenceLevel 3, controlled trial.

Achilles Tendons Total Rupture, Open Surgical Treatment with PRF Augmentation: Clinical, Morphological and Functional Evaluation

Background: Changes in tendon structure after its rupture may also affect the likelihood of re-injury or strain injury to the musculotendinous complex of the plantar flexor.Purpose: The aim of our study is to investigate ankle biomechanical properties and clinical features of acute rupture of the Achilles tendon treated with open suture and PRF augmentation.Study design: Cohort study (NRS).Methods: This study has been conducted on twenty patients, divided in two groups; one group underwent conventional open repair of the Achilles tendon using the Krackow technique only, while the other group underwent surgery with Platelet-Rich-Fibrin (PRF) augmentation. We performed a clinical evaluation at 3 months, 6 months, and after 1 year. Morphological and functional tendons properties were analyzed by ultrasound and Gait Analysis.Results: The results obtained by the ultrasonographic assessment showed in the PRF group a statistically significant increasing of treated tendons the antero-posterior diameter, medio-lateral diameter. Statistically significant differences between the two groups have emerged in gait analysis performed with regard to network (Wnet). Furthermore, the network of healthy side and treated side was significantly different only in the group of patients not treated with PRF. Statistically significant values have emerged through the analysis of Pearson’s correlation between the diameter of the ultrasound treated tendon and the network, walking speed, swing speed and stride period.Conclusion: Treatment with suture and PRF shows significant morphological modifications and functional improvements compared to the results achieved with Achilles tendon suture without PRF.