Tendinopathy Research Articles

MRI of foot pain in amateur marathoners and analysis of related factors

Objective To study the MRI manifestations of foot injuries in amateur marathoners and the diagnostic value of MRI for foot injuries. Methods Forty-eight amateur marathoners were prospectively recruited from October 2018 to March 2019. Participants were grouped according to the FASS criteria. All participants underwent bilateral foot MRI examinations. The MRI features of foot in amateur marathoners with and without foot pain were analyzed.The association with gender, age, time to participate in marathon, amount of running per week, number of times to complete the whole marathon and the symptoms of foot pain was studied. Results There were 28 sides in FASS in grade 0, including 8 males and 20 females, 8 hydrocele of the first metatarsophalangeal joint, 6 edema of bone marrow, 4 edema of soft tissue, 4 hydrocele of tendon sheath, and 6 without abnormal manifestations of MRI. There were 68 sides in FASS grade 1, including 42 males and 26 females, 38 Achilles tendinitis, 14 plantar fasciitis, 12 Achilles tendon bursitis and 4 posterior ankle impingement syndrome. The incidence of foot pain in amateur marathoners was related to gender (OR=1.060, P=0.043), unrelated to age (OR=0.248, P=0.078), number of marathons completed (OR=1.006, P=0.956), time to participate in marathon (OR=1.008, P=0.944), amount of running per week (OR=0.971, P=0.407). Conclusion Among amateur marathon runners, the foot pain is mainly caused by Achilles tendon and plantar fascia, while those without foot pain are mainly characterized by joint effusion, tendon sheath effusion and bone marrow edema. Gender is the only factor affecting the incidence of foot pain in amateur marathoners. MRI examination is an effective method to determine foot injury and has important clinical application value in the diagnosis and treatment of foot injury. Key words: Athletic injuries; Foot; Magnetic resonance imaging; Marathon

Clinical outcomes of modified reattachment of superior peroneal retinaculum for recurrent peroneal tendon dislocation

Objective To investigate clinical outcomes of modified reattachment of superior peroneal retinaculum (SPR) for patients with recurrent peroneal tendon dislocation. Methods A total of 24 cases with recurrent peroneal tendon dislocation from December 2012 to June 2017 were treated with modified reattachment of SPR. There were 20 males and 4 females. The average age was 24.9±9.3 years (14-48 years). The average BMI was 23.18±3.50 kg/m2 (15.8-32.2 kg/m2). A 4-5 cm incision was made along the lateral margin of the fibula and curved distally around the fibular tip in line with the peroneal excursion. The superior peroneal retinaculum, peroneus longus and peroneus brevis were exposed. The periosteum and SPR were stripped from the fibula. The false pouch was formed. Two suture anchors were inserted into the postero-lateral ridge of the lateral malleolus without damaging the cartilaginous ridge, after which the SPR was reattached to the lateral malleolus with the anchored suture. The inner layer of the false pouch was incised, while the outer layer (periosteum) was sutured with the SPR in a pants-over-vest style. The following items, including American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS), rate of return to previous sports level, time to return to sports activity, complication, and patients satisfaction were evaluated preoperatively and at the final follow-up. Results The average operation duration was 36.1±8.8 min (20-51 min). The blood loss was 1-10 ml, average 4.1±2.7 ml. The follow-up was carried out in 22 cases for mean 33.9±15.7 months (13-61 months). AOFAS score was improved from 77.8±7.8 points to 95.5±4.3 points significantly (t=-11.89, P<0.001). VAS score was reduced from 4.2±2.4 to 0.3±0.8 significantly (t=7.69, P<0.001). Mean duration return to sports activity was 5.0±1.9 months (3-10 months). A total of 20 patients (91%) returned to their previous sports level. Only one patient (5%) was found with limitation of range of motion, while two patients (9%) reported pain at the scar site without recurrence. The satisfaction rate was 91%. Conclusion Clinical outcomes of modified reattachment of SPR for patients with recurrent peroneal tendon dislocation was safe and effective. Key words: Tendinopathy; Dislocations; Wounds and injuries; Reconstructive surgical procedures

Association of Superoxide-Induced Oxidative Stress With Rotator Cuff Tears in Human Patients.

Rotator cuff degeneration is one of the factors contributing to rotator cuff tears. Oxidative stress is involved in tendon degeneration, and superoxide-induced oxidative stress plays a pathological role in regulating the balance between oxidation and reduction. The role of oxidative stress in rotator cuff tears, however, is unclear. This study, therefore, aimed to investigate the contribution of superoxide-induced oxidative stress to rotator cuff tears. Seventy patients were recruited and divided into two groups: patients with (Ruptured group) and those without (Unruptured group) a rotator cuff tear. Specimens from both groups were collected during surgery. Degeneration morphology was classified according to the degeneration score. Superoxide-induced oxidative stress was assessed according to dihydroethidium (DHE) relative fluorescence intensity, capacity for antioxidation according to superoxide dismutase (SOD) activity, and the balance between oxidation and reduction based on the redox ratio. Data were compared between groups. Correlations between the degeneration score and the oxidative stress factors were calculated. Degeneration score and DHE relative fluorescence intensity were significantly higher in the Ruptured than the Unruptured group. The SOD activity was not significantly different between groups. Degeneration score was positively correlated with both DHE relative fluorescence intensity and SOD activity. Thus, superoxide-induced oxidative stress and tendon degeneration were greater in rotator cuff tear tissues than in those with no tear, suggesting that oxidative imbalance may be involved in degenerative rotator cuff tears. Clinical Relevance: Understanding the mechanisms of superoxide-induced oxidative stress may lead to targeted tissue therapy for degenerative rotator cuff tears. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:212-218, 2020.

Avocado/Soybean Unsaponifiables, Glucosamine and Chondroitin Sulfate Combination Inhibits Proinflammatory COX-2 Expression and Prostaglandin E2 Production in Tendon-Derived Cells.

Tendinopathy, a common disorder in man and horses, is characterized by pain, dysfunction, and tendon degeneration. Inflammation plays a key role in the pathogenesis of tendinopathy. Tendon cells produce proinflammatory molecules that induce pain and tissue deterioration. Currently used nonsteroidal anti-inflammatory drugs are palliative but have been associated with adverse side effects prompting the search for safe, alternative compounds. This study determined whether tendon-derived cells' expression of proinflammatory cyclooxygenase (COX)-2 and production of prostaglandin E2 (PGE2) could be attenuated by the combination of avocado/soybean unsaponifiables (ASU), glucosamine (GLU), and chondroitin sulfate (CS). ASU, GLU, and CS have been used in the management of osteoarthritis-associated joint inflammation. Tenocytes in monolayer and microcarrier spinner cultures were incubated with media alone, or with the combination of ASU (8.3 μg/mL), GLU (11 μg/mL), and CS (20 μg/mL). Cultures were next incubated with media alone, or stimulated with interleukin-1β (IL-1β; 10 ng/mL) for 1 h to measure COX-2 gene expression, or for 24 h to measure PGE2 production, respectively. Tenocyte phenotype was analyzed by phase-contrast microscopy, immunocytochemistry, and Western blotting. Tendon-derived cells proliferated and produced extracellular matrix component type I collagen in monolayer and microcarrier spinner cultures. IL-1β-induced COX-2 gene expression and PGE2 production were significantly reduced by the combination of (ASU+GLU+CS). The suppression of IL-1β-induced inflammatory response suggests that (ASU+GLU+CS) may help attenuate deleterious inflammation in tendons.

Ascorbic acid mitigates the deleterious effects of nicotine on tendon stem cells

ABSTRACT Purpose: Nicotine causes tendon degeneration, whereas ascorbic acid imparts beneficial effects on tendon cells. Tendon stem cells (TSCs) play a vital role in maintaining tissue integrity and promoting restoration of structure and function after tendon injury. In the present study, cell culture experiments were performed to determine the effects of nicotine on TSCs and whether ascorbic acid supplementation could antagonize the action of high concentration nicotine. Methods: After treatment with nicotine and ascorbic acid, TSC proliferation, migration, stemness, apoptosis, and differentiation were analyzed. Results: TSC proliferation and expression of stem cell markers were significantly impaired by a high concentration of nicotine (1000 ng/mL), but a lower concentration (100 ng/mL) induced proliferative effects in TSCs. Moreover, the highest concentration of nicotine tested (1000 ng/mL) significantly inhibited the migratory ability of TSCs, while relatively high concentrations (100 and 1000 ng/mL) significantly (p < 0.05) up-regulated non-tenocyte genes. When ascorbic acid was added, the inhibitory effects of nicotine on the proliferation, migration, and stemness of TSCs were reversed. In addition, flow cytometry analysis showed that these nicotine concentrations could induce cell apoptosis, while the addition of ascorbic acid inhibited apoptosis. Conclusion: Addition of ascorbic acid partially reversed the inhibitory effect of a high concentration of nicotine. These findings indicate that while nicotine impairs the biological characteristics of TSCs, ascorbic acid can mitigate these deleterious effects and, therefore, may be useful for decreasing nicotine-induced tendon degeneration.

Researchers Search for Better Tendinosis Treatment

Lippincott's Bone and Joint Newsletter 25(8):p 91-92, September 2019. | DOI: 10.1097/01.BONEJ.0000579972.95355.41

Adult Acquired Flatfoot Deformity: Anatomy, Biomechanics, Staging, and Imaging Findings.

Adult acquired flatfoot deformity (AAFD) is a common disorder that typically affects middle-aged and elderly women, resulting in foot pain, malalignment, and loss of function. The disorder is initiated most commonly by degeneration of the posterior tibialis tendon (PTT), which normally functions to maintain the talonavicular joint at the apex of the three arches of the foot. PTT degeneration encompasses tenosynovitis, tendinosis, tendon elongation, and tendon tearing. The malaligned foot is initially flexible but becomes rigid and constant as the disorder progresses. Tendon dysfunction commonly leads to secondary damage of the spring ligament and talocalcaneal ligaments and may be associated with injury to the deltoid ligament, plantar fascia, and other soft-tissue structures. Failure of multiple stabilizers appears to be necessary for development of the characteristic planovalgus deformity of AAFD, with a depressed plantar-flexed talus bone, hindfoot and/or midfoot valgus, and an everted flattened forefoot. AAFD also leads to gait dysfunction as the foot is unable to change shape and function adequately to accommodate the various phases of gait, which require multiple rapid transitions in foot position and tone for effective ambulation. The four-tier staging system for AAFD emphasizes physical examination findings and metrics of foot malalignment. Mild disease is managed conservatively, but surgical procedures directed at the soft tissues and/or bones become necessary and progressively more invasive as the disease progresses. Although much has been written about the imaging findings of AAFD, this article emphasizes the anatomy and function of the foot's stabilizing structures to help the radiologist better understand this disabling disorder. Online supplemental material is available for this article. ©RSNA, 2019.

Advanced Glycation End-Products Suppress Mitochondrial Function and Proliferative Capacity of Achilles Tendon-Derived Fibroblasts

Debilitating cases of tendon pain and degeneration affect the majority of diabetic individuals. The high rate of tendon degeneration persists even when glucose levels are well controlled, suggesting that other mechanisms may drive tendon degeneration in diabetic patients. The purpose of this study was to investigate the impact of advanced glycation end-products on tendon fibroblasts to further our mechanistic understanding of the development and progression of diabetic tendinopathy. We proposed that advanced glycation end-products would induce limitations to mitochondrial function and proliferative capacity in tendon-derived fibroblasts, restricting their ability to maintain biosynthesis of tendon extracellular matrix. Using an in-vitro cell culture system, rat Achilles tendon fibroblasts were treated with glycolaldehyde-derived advanced glycation end-products (0, 50, 100, and 200 μg/ml) for 48 hours in normal glucose (5.5 mM) and high glucose (25 mM) conditions. We demonstrate that tendon fibroblasts treated with advanced glycation end-products display reduced ATP production, electron transport efficiency, and proliferative capacity. These impairments were coupled with alterations in mitochondrial DNA content and expression of genes associated with extracellular matrix remodeling, mitochondrial energy metabolism, and apoptosis. Our findings suggest that advanced glycation end-products disrupt tendon fibroblast homeostasis and may be involved in the development and progression of diabetic tendinopathy.

Central Tendon-Splitting Approach and Double Row Suturing for the Treatment of Insertional Achilles Tendinopathy.

Background To assess the clinical outcomes of central tendon-splitting approach and double row anchor suturing for the treatment of insertional Achilles tendinopathy. Methods 28 patients (28 feet) diagnosed with insertional Achilles tendinopathy were included in this study. The inclusions were symptom of hindfoot pain around the insertion of the Achilles tendon, radiographic demonstration of calcification, or degeneration of the Achilles tendon, showing no symptom improvement even after standard nonsurgical treatment for more than six months. The X-ray revealed that patients had obvious posterior superior calcaneal exostosis with the possibility of friction with the Achilles tendon or intratendinous calcification. Surgical correction by the central tendon-splitting approach and double row Achilles tendon suturing was performed. The ankles were immobilized with plaster for four weeks postoperatively. The American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue score (VAS) were assessed preoperatively and at 2 years postoperatively. At final follow-up, the Manchester-Oxford Foot Questionnaire (MOXFQ) as patient-reported outcome measures (PROMs) was also evaluated. Results No complication, including postoperative wound infection and tendon rupture, was not found. All the patients resumed their daily activities with no high level of daily activities, such as jumping and jogging after 6 weeks postoperatively. 27 patients were available for follow-up for at least 2 years, while only one patient was lost to follow-up. At postoperative 2 years, the postoperative AOFAS score increased significantly, while the VAS score decreased statistically when compared with preoperative values. At final follow-up, 24 patients had complete alleviation of pain, whereas the remaining 3 patients complained of mild heel pain after walking for a long time. The MOXFQ score showed obvious relief of previous symptoms for all included cases. Conclusions Central tendon-splitting approach and double row Achilles tendon suture provide excellent intraoperative visual field, larger tendon-bone contact area, and stronger pullout strength and, thus, facilitate early rehabilitation. It can be a safe and effective method for the treatment of insertional Achilles tendinopathy.

Tendinopathy Education on the Achilles

Tendinopathy Education on the Achilles

Study of the Platelet-Rich Plasma Injections for the Treatment of Achilles Tendinopathy after Failure of Conservative Treatment

Achilles tendon disorders, chronic degenerative tendon disorders (tendinopathy) are a frequent pathology in the Orthopaedic ward and quite difficult to treat. The autors present the case of a number of 25 patients (18 females and 7 male), with mean age of 37.2 years,a group of young and active patients, with chronic unilateral Achilles tendinopathy (at least 6 months of symptoms) refractary to conservative treatment, including physical rest and physical theraphy. All study patients have no surgical treatment performed at the Achilles tendons, or any corticosteroids infiltrations in this region. Patients were treated with 3 PRP injections at one week interval. The patient were evaluated clinically and with the ultrasound at baseline, at 1 month and at 6 months, further results will be evaluated at 1 year and early after that. Scores used for evaluation were: Visual Analog Scale (VAS) and VISA A score. The study group that included 25 patients male and females were evaluated using the VAS score and the VISA A questionnaire referring to Achilles tendinopathy, pain symptoms and functionality. Results were assessed at 1 month and at 6 months, both scores improved significantly, and also the ultrasound imaging findings. The majority of the patients were symptoms free after the 3 step PRP local infiltrations showing stable results at 6 months, while 5 of the patients showed no clinical improvement of symptoms. The overall findings in our study show that repeated PRP injections for Achilles tendinopathy obtained good results in term of clinical symptom improvement and alo stable results in time at the 6 months evaluation. On this study group discussiond reffer mainly to the small gropup of patients, only 25, and to the short term follow up period, 6 months, with future data to be analysed at 12 months and 24 months on this study group.

Treatment of mallet finger deformity by reconstruction of the terminal extensor tendon insertion with Endobutton CL BTB

Objective Purpose To introduce the treatment of mallet finger deformity by reconstruction of the terminal extensor tendon insertion with endobutton CL bone-tendon-bone (BTB), and discuss its clinical effects. Methods From January 2010 to August 2013, 21patients (male 15, female 6) with mallet finger deformity were retrospectively studied. The average age of patients was 31.3±5.3 years. The time from injury to surgery was 5.2±2.1 d. Extensor tendons were ruptured at the terminal insertion in all patients, and there were no avulsion fracture at the base of the distal phalanx.. the terminal extensor tendon insertion Awere surgical reconstructed with Endobutton CL BTB, via a dorsal S-shaped incision of distal interphalangeal joint. Dorsal base of the distal phalanx was drilled a hole and then the tendon suture line with Endobutton CL BTBwas inserted from the ventral finger to the dorsal base of the phalanx to suture the proximal extensor tendon. The function of the affected finger was evaluated according to the Crawford standard after operation and follow-up: the active flexion and extension range of motion of each joint of the affected finger and the contralateral healthy finger were measured, and the total active ranges of motion of the finger were recorded. Finger function was evaluated according to the total active range of motion (TAM) system of the American Association of hand Surgeons. Results All 21 cases were followed up and the follow-up period was 8 to 24 months, with an average of 18.6±5.1 months. The operation time of the patients was 20-40 min, with an average of 29.6±10.3 min. The intraoperative blood loss was 5-10ml, with an average of 7.5±2.6 ml. Mallet finger deformities were all corrected postoperatively. One case presented with limited dorsal extension with elongation of -20°. According to the Crawford evaluation standard, there were 18 excellent patients and 2 good patients, with the excellent and good rate was 95.2% (20/21). The degrees of active joint activity were: 91°±7° of the metacar-pophalangeal joint, 92°±4° of the proximal interphalangeal joint, 82°±8° of the distal interphalangeal joint, and 259°±15° of total active activity. The TAMs of the healthy side were 259°±15°, and the TAMs of the affected side were 268°±12°, the difference was statistically significant (t=2.147, P=0.038). Accorrding to TAM system assessment criteria: excellent in 18 patients, good in 2 patients, and the excellent and good rate was 95.2% (20/21). One case presented with dorsal extension limitation, one case suffered from discomfort of grip because of scar in ventral side of the finger. The postoperative dorsal extension was limited in 3 cases, and the postoperative dorsal extension function was gradually restored 6 months later. Conclusion The treatment of mallet finger deformity by reconstruction of the terminal extensor tendon insertion with Endobutton CL BTB was effective and easy-operating. Postoperative patients can perform early finger function exercise, satisfactory results, worthy of clinical promotion and application. Key words: Hand deformities, acquired; Tendinopathy; Reconstructive surgical procedures; Treatment outcome

Use of Human Placenta-Derived Cells in a Preclinical Model of Tendon Injury.

Emerging data suggest that human cells derived from extraembryonic tissues may have favorable musculoskeletal repair properties. The purpose of this study was to determine whether the injection of human placenta-derived mesenchymal-like stromal cells, termed placental expanded cells (PLX-PAD), would improve tendon healing in a preclinical model of tendinopathy. Sixty male Sprague-Dawley rats underwent bilateral patellar tendon injection with either saline solution (control) or PLX-PAD cells (2 × 10 cells/100 µL) 6 days after collagenase injection to induce tendon degeneration. Animals were killed at specific time points for biomechanical, histological, and gene expression analyses of the healing patellar tendons. Biomechanical testing 2 weeks after the collagenase injury demonstrated better biomechanical properties in the tendons treated with PLX-PAD cells. The load to failure of the PLX-PAD-treated tendons was higher than that of the saline-solution-treated controls at 2 weeks (77.01 ± 10.51 versus 58.87 ± 11.97 N, p = 0.01). There was no significant difference between the 2 groups at 4 weeks. There were no differences in stiffness at either time point. Semiquantitative histological analysis demonstrated no significant differences in collagen organization or cellularity between the PLX-PAD and saline-solution-treated tendons. Gene expression analysis demonstrated higher levels of interleukin-1β (IL-1β) and IL-6 early in the healing process in the PLX-PAD-treated tendons. Human placenta-derived cell therapy induced an early inflammatory response and a transient beneficial effect on tendon failure load in a model of collagenase-induced tendon degeneration. Human extraembryonic tissues, such as the placenta, are an emerging source of cells for musculoskeletal repair and may hold promise as a point-of-care cell therapy for tendon injuries.

Lateral Epicondylitis Debridement and Repair Using Knotless Suture Anchor

Lateral epicondylitis, or tennis elbow, involves degeneration of the extensor carpi radialis brevis tendon and is often self-limiting, with surgery reserved for recalcitrant cases. Surgical management of tennis elbow consists primarily of either debridement alone or debridement with repair. Surgical repair is often performed using either a suture or a suture anchor. Good outcomes have been reported using standard repair methods; however, complications exist. Complications include potential loss of grip strength with debridement alone, as well as soft-tissue irritation caused by a prominent suture or knot stack after suture repair and suture anchor techniques. We describe a technique for debridement and repair of the extensor carpi radialis brevis tendon to the lateral epicondyle of the humerus using a knotless suture anchor, allowing for a watertight anatomic repair, maximum preservation of grip strength, and absence of a knot stack and resultant suture prominence.

The Histopathology of the Degenerative Proximal Biceps Tendon

Objectives Surgical treatment of proximal biceps tendinopathy remains a source of great controversy. Current surgical treatment debates center around the fixation location and not the quality of the tendon because little is known about the intra-tendinous pathology to guide this debate. Therefore, this study aims to evaluate two distinct anatomic regions of pathologic biceps tendons with regard to intra-tendinous architecture, painful neurotransmitters, and inflammatory modulators: the intra-articular portion and the extra-articular portion lying in the bicipital groove. Methods Eleven human degenerative biceps tendons were obtained post-tenodesis. They were divided into intra- and extra-articular portions. They underwent histologic staining with hematoxylin and eosin and Alcian blue as well as immunohistochemistry staining for substance P, tyrosine hydroxylase, and neurofilament. Tendon architecture was assessed according to the modified BONAR tendon score. Immunohistochemistry staining was quantified using ImageJ density analysis. Portions of the tendon sections were cultured for 48 hours and the resultant secretome was assessed for Substance P secretion with ELISA analysis. Results Composite BONAR scores demonstrated pathologic tendons with no significant difference between the intra-articular biceps tendon and the portion of the tendon within the bicipital groove (p= 0.31). Immunohistochemistry (IHC) analysis demonstrated significantly (p&lt;0.05) increased uptake of substance P in the bicipital groove tendon compared to the intra-articular tendon while tyrosine hydroxylase did not (p&gt;0.05). Stained substance P and tyr hydroxylase was intimately associated with intra-tendinous vascularity. ELISA results demonstrated significantly increased secretion of substance P in the bicipital groove tendon compared to the intraarticular portion. Conclusion This study shows abnormal architecture, increased release and staining of painful neurotransmitters, and secretion of substance P from the proximal biceps tendon up to the distal aspect of the bicipital groove. Despite varied surgical techniques for tenodesis, this study supports the removal of the entirety of the long head of the biceps to the distal portion of the bicipital groove. [Figure: see text][Figure: see text]

Accelerated knee osteoarthritis is associated with pre-radiographic degeneration of the extensor mechanism and cruciate ligaments: data from the Osteoarthritis Initiative

BackgroundTo determine if adults with incident accelerated knee osteoarthritis (KOA) are more likely to have degenerative knee ligaments or tendons compared to individuals with typical or no KOA.MethodsWe identified 3 sex-matched groups among Osteoarthritis Initiative participants who had a knee without radiographic KOA at baseline (Kellgren-Lawrence [KL] < 2): 1) accelerated KOA: at least 1 knee had KL grade ≥ 3 in ≤48 months, 2) typical KOA: at least 1 knee increased in radiographic scoring within 48 months, 3) no KOA: both knees had the same KL grade at baseline and 48 months. We evaluated knee magnetic resonance images up to 2 years before and after a visit when the accelerated or typical KOA criteria were met (index visit). Radiologists reported degenerative signal changes for cruciate and collateral ligaments, and extensor mechanism and proximal gastrocnemius tendons. We used generalized linear mixed models with 2 independent variables: group and time.ResultsStarting at least 2 years before onset, adults with accelerated KOA were twice as likely to have degenerative cruciate ligaments than no KOA (odds ratio = 2.10, 95% CI = 1.18, 3.74). A weaker association (not statistically significant) was detected for adults with accelerated versus typical KOA (OR = 1.72, 95%CI = 0.99, 3.02). Regardless of time, adults with accelerated (odds ratio = 2.13) or typical KOA (odds ratio = 2.16) were twice as likely to have a degenerative extensor mechanism than no KOA. No other structural features were statistically significant.ConclusionsDegenerative cruciate ligaments or extensor mechanism antedate radiographic onset of accelerated KOA. Hence, knee instability may precede accelerated KOA, which might help identify patients at high-risk for accelerated KOA and novel prevention strategies.

Risk Factors for Rotator Cuff Disease: An Experimental Study on Intact Human Subscapularis Tendons.

ABSTRACTAlthough several studies revealed a multifactorial pathogenesis of degenerative rotator cuff disorders, the impact and interaction of extrinsic variables is still poorly understood. Thus, this study aimed at uncovering the effect of patient‐ and pathology‐specific risk factors that may contribute to degeneration of the rotator cuff tendons. Between 2015 and 2018, 54 patients who underwent arthroscopic shoulder surgery at three specialized shoulder clinics were prospectively included. Using tendon samples harvested from the macroscopically intact subscapularis (SSC) tendon, targeted messenger RNA expression profile analysis was performed in the first cohort (n = 38). Furthermore, histological analyses were conducted on tendon tissue samples obtained from a second cohort (n = 16). Overall, both study cohorts were comparable concerning patient demographics. Results were then analyzed with respect to specific extrinsic factors, such as patient age, body mass index, current as well as previous professions and sport activities, smoking habit, and systemic metabolic diseases. While patient age, sports‐activity level, and preexisting rotator cuff lesions were considered to contribute most strongly to tendinopathogenesis, no further coherences were found. With regards to gene expression analysis, change in expression correlated most strongly with patient age and severity of the rotator cuff pathology. Further, chronic disorders increased overall gene expression variation. Taken together, our study provides further evidence that tendon degeneration is the consequence of a multifactorial process and pathological changes of the supraspinatus tendon affect the quality of SSC tendon and most likely vice versa. Therefore, the rotator cuff tendons need to be considered as a unit when managing rotator cuff pathologies. © 2019 The Authors. Journal of Orthopaedic Research ® published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society J Orthop Res 38:182–191, 2020

A PROSPECTIVE STUDY OF SURGICAL MANAGEMENT OF CHRONIC NEGLECTED TENDOACHILLES RUPTURE USING PERONEUS BREVIS TENDON

Objective of the study is to find out functional outcome and complications associated with surgical reconstruction of chronic degenerative tendoachilles rupture using peroneus brevis tendon and role of local steroid injection in chronic rupture of tendon. We studied 10 cases with chronic degenerative Achilles tendon rupture who were treated with peroneus brevis tendon augmentation procedure. In 8 cases rupture of tendon was secondary to local corticosteroid injection given for retro calcaneal bursitis. Patients came to hospital with pain over the Achilles tendon and difficulty in walking, climbing stairs, diagnosed of Achilles tendon rupture through physical examination and subjected to USG for confirmation. Patients have undergone operative treatment in the form end to end suturing of ruptured tendon using Krakow technique and augmentation of tendon using peroneus brevis tendon as explained by Teuffer. Post operatively patient immobilized in above knee cast with foot in 15-20 plantar flexion and 45 degree of knee flexion. Suture removal done after 14 days of surgery. After 4 weeks cast converted to short leg cast. Mobilization started after 6 weeks on the cast. Cast discontinued after 8 weeks and full weight bearing started at 8-12 weeks. Follow up done for 18 months. Of 10 patients 7 patients were male and 3 were female. Age range was 30-60 years with mean age of 45 years. 7 patients had right tendon rupture, 3 had left tendon rupture. 8 patients gave previous history of corticosteroid injection given for retro calcaneal bursitis. Postoperatively 2 patients had skin necrosis which healed by secondary intention and scar. According to AOFAS scoring system for functional outcome of patients increased from preoperatively 65 to postoperatively 95(range 90-100). There is increased risk of Achilles tendon rupture after local steroid injection for inflammatory lesions of tendon or around the tendon, so it’s better to avoid giving local steroid injections in or around the Achilles tendon. Peroneus brevis can be easily used for Achilles tendon augmentation with good functional outcome. Keywords: Achilles tendon rupture, peroneus brevis tendon, corticosteroid, Teuffers technique, AOFAS scoring system.

ECRB Tendinopathy: Needling ± PRP After Failure of ESWT

ECRB Tendinopathy: Needling ± PRP After Failure of ESWT

Correlation of the Expression of IGF-1, TGF-β1 and BMP12 with Tendon Degeneration Caused by Overused Tendon of the Long Head of Biceps Brachii

Objective: To assess the association of the expression of insulin-like growth factor-1 (IGF-1), transforming growth factor beta-1 (TGF-β1) and bone morphogenetic protein-12 (BMP-12) with tendon degeneration in rats caused by overuse of biceps brachii long head tendon. Methods: Sixteen Sprague-Dawley (SD) rats were randomly divided into normal group (n = 8) and overuse group (n = 8). Rats were fed routinely in normal group and were treated by small animal treadmills for continuous 6 weeks of exercise at 1 h/day in overuse group followed by analysis of histological morphology of the tendon of the long head of biceps brachii by Hematoxylin-eosin (HE) staining, the expression levels of IGF-1, TGF-β1 and BMP-12 by Western blotting. Correlation analysis was used to analyze the correlation of the protein expression with the pathological score. Results: HE staining showed normal morphology of biceps brachii long head tendon in normal group (with dense structure, uniform arrangement and no fiber damage) and abnormal morphology in overuse group (with disordered structure, uneven arrangement and some of breakage fibers). The pathological score in overuse group was significantly higher than that in normal group (p &lt; 0.05). Compared with those in normal group, the protein levels of IGF-1, TGF-β1 and BMP-12 were significantly elevated in overuse group (p &lt; 0.05). Conclusion: The expression of IGF-1, TGF-β1 and BMP-12 in overused tendon of the long head of the biceps brachii are elevated, and positively correlated with tendon degeneration.