Tendon Group Research Articles

Comparison of the efficacy of LARS ligament and autogenous hamstring tendon plus high-strength suture in posterior cruciate ligament reconstruction

To compare the clinical efficacy of ligament advanced reinforcement system (LARS) and autogenous hamstring tendon plus high-strength suture in arthroscopic reconstruction of posterior cruciate ligament(PCL). A total of 96 patients with simple PCL injury treated with arthroscopic posterior cruciate ligament reconstructive surgery admitted to our hospital between August 2019 and December 2021 were selected for complete follow-up. There were 78 males and 18 females, 40 cases of left leg and 56 cases of right leg, the aged from 20 to 56 years old with an average of (32.50±8.68 ) years old. The transplants were divided into two groups:LARS group (52 cases) and autogenous hamstring tendon plus high-strength suture group (44 cases). In the LARS group, there were 42 males and 10 females;with an average age of (31.84±8.62) years old;body mass index (BMI) was (24.73±2.29) kg﹒m-2;7 mm LARS was used to reconstruct PCL. In the autologous tendon group, there were 36 males and 8 females, with an average age of (33.06±8.99) years old, BMI was (23.52±2.16) kg·m-2, and the PCL was reconstructed with four strands of hamstring tendons and three pieces of Ethibond suture. All patients underwent functional rehabilitation guided exercise and were followed up regularly after surgery to objectively evaluate the stability of the knee joint by KT-1000 measurement of knee relaxation, and subjective evaluation of knee function by Lysholm score, Tegner score, and International Knee Documentation Council (IKDC) score. Data from preoperative, 3, 6, and 12 month follow-up were collected and analyzed by SPSS software to compare postoperative recovery and ligament relaxation between the two groups of patients. Ninety-six patients were followed up for 12 months. KT-1000 measurement of knee joint in autogenous tendon group and LARS group before operation [(10.73±1.46) points vs (10.55±1.53) points], 6 months after operation[(3.02±0.75) points vs (2.35±0.60) points], 12 months after operation[(3.77±1.76) points vs (2.44±0.60) points]. There was significant difference between the two groups at 6 and 12 months after operation (P<0.05), but there was no significant difference between the two groups at 3 months after operation (P>0.05). In the autogenous tendon group and LARS group, before operation and 12 months after operation, total Lysholm score [(40.6±16.8), (91.25±6.35) points vs (51.92±18.52), (92.35±5.30) points], Tegner score[(1.8±0.7), (5.8±0.6) points vs(1.7±0.8)、(5.7±0.7) points] and total IKDC score[(54.50±6.33), (83.90±3.93) points vs (54.40±4.24), (83.62±3.64) points], the differences were statistically significant (P<0.05), indicating that the knee function of the two groups was improved after surgery. At 3 and 6 months after operation in the autogenous tendon group and LARS group, the total Lysholm score[(65.86±11.54), (74.60±6.46) points vs (73.46±6.42), (86.73±4.62) points], Tegner score[(2.5±0.6), (3.5±0.5) points vs (4.3±0.7), (5.0±1.4) points], the total scores of IKDC [(55.78±2.68), (70.62±4.74) points vs (65.31±4.60), (79.71±2.93) points]. The difference between two groups was statistically significant (P<0.05). The results showed that the function of the knee joint in the LARS group was better than that the autologous tendon group. However, at 12 months after the operation, there was no significant difference in the score of knee joint function between the two groups (P>0.05). The results showed that the stability of LARS group was better than that of autologous tendon group. Both the autogenous hamstring tendon plus high-strength suture and LARS reconstruction can significantly improve the knee function and stability, with satisfactory postoperative results. Howervr the LARS provides superior postoperative stability.

Can acute mobilization and oscillation training profit on the joint position sense and strength of the rotator cuff muscles in young tennis players?

The rotator cuff is a group of muscles and tendons that act to stabilize the human shoulder and allow for its extensive range of motion. This study aimed to compare the immediate effect and durability of mobilization and oscillation dumbbell (OD) training on the Joint Position Sense (JPS) and strength of rotator cuff muscles in young tennis players. Twenty-six tennis players were divided into two experimental groups. G1 only performed mobilization techniques while G2 only performed OD training, before, after and after one week of the protocols, the strength and JPS of the shoulder joint were measured with an isokinetic dynamometer. Repeated analysis of variance (RMANOVA) and Bonferroni post hoc test were used to examine the differences between the groups. The analysis of covariance was used to examine the differences between the groups. In general, the results showed a significant effect of both mobilization techniques and OD training programs on the JPS and internal and external rotation strength of young tennis players, but only one difference was observed between the two in external rotation for the eccentric/concentric action at 120°/sec (p=0009; ƞ2p= 0.32). Moreover, the main findings showed that mobilization techniques and OD improved internal and external rotations after the protocol and after one week when compared with baseline for the concentric/concentric and eccentric/concentric at 60°/sec and 120°/sec (p &lt; 0.05) with only one exception for the internal rotation concentric/concentric at 120°/sec for both groups (p &gt; 0.05). Based on this, it seems that in healthy tennis players, both one-session mobilization techniques and OD training can be used to improve JPS and strength. Keywords: Shoulder, Isokinetic, Torque, Resistance, Rotator cuff.

Driving Aid for Rotator Cuff Injured Patients using Hand Gesture Recognition

Gesture recognition is a way for computers to understand how humans move and express themselves without using traditional methods like typing or clicking. Instead of relying on text or graphics, gesture recognition focuses on reading body movements, such as those made by the hands or face. Currently, there is a specific interest in recognizing hand gestures by analyzing the veins on the back of the hand. Scientists have found that each person has a unique arrangement of veins beneath the skin of their hand. When the hand moves, the position of these veins changes, and this change is considered a gesture. These gestures are then translated into specific actions or tasks by coding the hand movements. This technology is particularly helpful for individuals with rotator cuff injuries. The rotator cuff is a group of muscles and tendons in the shoulder that can get injured, causing pain and limiting movement. People with these injuries may have difficulty steering a car, especially if their job or sport involves repetitive overhead motions. With gesture recognition technology, a person can control the car by simply moving their wrist, eliminating the need to use the shoulder. In summary, gesture recognition technology reads the unique patterns of hand veins to interpret hand movements, making it a practical solution for individuals with rotator cuff injuries who may struggle with certain tasks, like steering a car.

Patient Interest in Quadriceps Autograft Anterior Cruciate Ligament Reconstruction Is Increasing Over Other Autograft Options: A 12-Year Google Trends Analysis

PurposeThe purpose of this study was to use Google trends to explore differences in public interest among types of anterior cruciate ligament (ACL) autografts, specifically quadriceps tendon, patellar tendon, and hamstring tendon autografts between 2008 and 2019. MethodsData were obtained by querying Google Trends for key terms and phrases for online search data ranging from January 2008 to December 2019. Relative search volumes were created based on searches related to anterior cruciate ligament reconstruction with comparative analysis generated for search terms related to quadriceps ACL, patellar tendon ACL, and hamstring ACL autografts. Statistical analysis included linear regression analysis, comparison of quarterly search volume trends over time, and comparison of cumulative annual search volumes for 2008 versus 2019. ResultsLinear models for respective search terms terms were statistically significant for the quadriceps (p<0.001) and patellar (p 0.007) tendon autograft groups, but not the hamstring group (p 0.129). The quadriceps autograft group demonstrated a 12-year search volume trend change of 0.56, which was significantly greater than the hamstring (0.07; p <0.001) and patellar tendon (0.168; p<0.001) groups. There was no significant difference in the trend change between hamstring and patellar tendon groups (p 0.20). Percent change in cumulative relative annual search volumes between 2008 and 2019 was 112% for the quadriceps tendon group, 12.9% for the hamstring group, and 18.6% for the patellar tendon group. ConclusionThis study indicates a consistently increasing public interest in quadriceps tendon autograft for ACL reconstruction. The quadriceps autograft group demonstrated a significantly greater 12-year online search volume trend, greater linear correlation, and larger percent change between 2008 and 2019 when compared to patellar tendon or hamstring autograft groups.

Efficacy of allogeneic tendon material coracoclavicular ligament reconstruction combined with Kirschner wire and titanium alloy hook plate material fixation in the treatment of acromioclavicular joint dislocation.

To compare the effects of allogeneic tendon coracoclavicular ligament reconstruction combined with Kirschner wire fixation and clavicular hook plate fixation on early postoperative pain, postoperative shoulder joint function score and shoulder joint mobility in patients with acromioclavicular joint dislocation. From January 2020 to January 2023, 43 patients with acromioclavicular joint dislocation admitted to Xi 'an Honghui Hospital were included. Among them, 24 patients were treated with the clavicular hook plate technique (Hook Plate,HP) group, and 19 patients were treated with allogeneic tendon coracoclavicular ligament reconstruction combined with the Kirschner wire technique (Allogeneic Tendon, AT) group. The Constant-Murley score of shoulder joint function 6months after operation, postoperative shoulder joint activity, preoperative and postoperative pain, operation time, intraoperative blood loss and complications were compared between the two groups. All 43 patients were followed up for an average of 9.7 (9-12) months. The intraoperative blood loss in the allogeneic tendon group was less than in the hook plate group. The Constant-Murley shoulder function score was higher than that in the hook plate group 6 months after the operation. The abduction and lifting activity was greater than that in the hook plate group. The visual analogue scale scores at 3days and 14 days after operation were lower than those in the hook plate group. The difference was statistically significant (p < 0.001). There was 1 case (5.3%) of exudation around the Kirschner needle track in the allogeneic tendon reconstruction group, and 5 cases (20.8%) of complications in the hook plate group, including 1 case of internal fixation stimulation, 2 cases of acromion impingement syndrome, 1 case of acromioclavicular joint osteoarthritis, and 1 case of shoulder joint stiffness. The complication rate of the allogeneic tendon group was lower than that of the hook plate group. The clinical efficacy of allogeneic tendon coracoclavicular ligament reconstruction combined with Kirschner wire fixation in treating acromioclavicular joint dislocation (Rockwood type III-V) is better than hook plate internal fixation. The patients have less early postoperative pain and better recovery of shoulder joint function and shoulder joint mobility.

Quadriceps tendon autograft for primary anterior cruciate ligament reconstruction in comparison to hamstring tendon autografts

Purpose One of the pillars of successful anterior cruciate ligament (ACL) reconstruction is the choice of the ideal graft substitute. The central one-third of the quadriceps tendon is apparently a good autograft option, representing a modular reconstructive option with minimal donor site morbidity. The aim of this research is to compare the functional outcome of primary ACL reconstruction using quadriceps tendon autografts in comparison to the hamstring tendon autograft. Patients and methods This prospective, randomized clinical study included 60 patients with torn ACL randomly divided into group I (the control group), whereby ACL reconstruction was performed using the hamstring tendon autograft or group II (the study group), whereby ACL reconstruction was done using the central part of quadriceps tendon pure soft tissue autograft. The study was performed in our hospital between January 2016 and March 2018. The mean follow-up period was 2.2 ± 0.4 years. Assessment was done clinically using the IKDC 2000 subjective and objective scoring system. Objective laxity measurements were performed using the KT-1000 at the end of follow-up. Results Clinical assessment of the patients in the 6th month postoperatively and at the end of follow-up averaged 2.2 ± 0.4 years according to the IKDC 2000 Subjective and Objective Scoring System and revealed significantly better results for group II in early postoperative after 6 months, with comparable results at the end of follow-up. Objective laxity measurements at the end of follow-up revealed that the side-to-side difference is a little bit better in the quad group with no statistically significant results. Conclusion The central part of the quadriceps tendon is a viable autograft option for primary ACL reconstruction with good mid-term functional results, and minimal donor site morbidity as compared with the standard most commonly used hamstring tendon autograft; however, a longer term and multicenter studies are still needed to validate its routine use.

Comparison of patient Satisfaction of Return to Work in Early Post-operative Periods in patients with High Radial Nerve Injury undergoing Primary Nerve Repair Plus Tendon Transfer Versus Primary Nerve Repair Alone

Background: High radial nerve injuries present complex challenges in upper extremity reconstruction, impacting both motor and sensory functions. The decision-making process for choosing the appropriate surgical intervention involves careful consideration of various factors, including the type of nerve repair and the potential need for adjunct procedures like tendon transfer. Aim: To compare patient satisfaction outcomes between these two surgical approaches, assessing grip strength, pinch strength, Disabilities of the Arm, Shoulder, and Hand (DASH) scores, and Quality of Life (QOL) scores. Methodology: This prospective, comparative, and observational study included 62 participants, equally divided into two groups: Group 1 undergoing Primary Nerve Repair plus Tendon Transfer (n=31) and Group 2 undergoing Primary Nerve Repair Alone (n=31). Data collection involved patient interviews, medical records review, and standardized questionnaires, covering variables such as age, gender, occupation, type of surgery, duration of injury, post-operative pain levels, and patient-reported satisfaction scores. Statistical analysis using SPSS vr 23.0 included descriptive statistics, independent samples t-tests, and chi-square tests. Results: Results indicated significant improvements in grip strength (Mean ± SD: 35.2 ± 4.2 pounds, p &lt; 0.001), pinch strength (Mean ± SD: 7.9 ± 1.4 pounds, p = 1.081), DASH scores (Mean ± SD: 11.5 ± 2.9, p = 2.59), and QOL scores (Mean ± SD: 93.8 ± 7.3, p = 0.73) in both groups, emphasizing the positive impact of surgical interventions on functional outcomes and patient satisfaction. These findings contribute valuable insights into refining surgical strategies for high radial nerve injuries, emphasizing the enhancement of patient outcomes and satisfaction. Practical implication:The study's findings offer crucial guidance for surgeons in selecting optimal surgical strategies, ultimately leading to improved functional outcomes and higher patient satisfaction in individuals with high radial nerve injuries. Conclusion: Both surgical approaches demonstrated significant improvements in grip strength, pinch strength, disabilities of the arm, shoulder, and hand (DASH) scores, and Quality of Life (QOL) scores. Notably, grip strength showed a substantial increase (Mean ± SD: 35.2 ± 4.2 pounds, p &lt; 0.001) in both groups, emphasizing the positive impact of surgical interventions on upper limb function. While pinch strength and QOL scores showed non-significant changes, the overall findings underscore the effectiveness of both surgical strategies in enhancing functional outcomes and patient satisfaction in the early post-operative periods for high radial nerve injuries. Keywords: High radial nerve injury, nerve repair, tendon transfer, patient satisfaction, early return to work, observational study.

High-Accuracy Hand Gesture Recognition on the Wrist Tendon Group Using Pneumatic Mechanomyography (pMMG)

Hand gesture recognition has received considerable attention as an intuitive interaction method in recent years. This research introduces a new wearable hand gesture recognition system that employs pneumatic mechanomyography (pMMG) to directly monitor the wrist tendon group, which transmits muscle force to the fingers. The experimental findings demonstrate that the proposed method provides raw observations proportional to the finger flexion force, with high R-squared values exceeding 0.94. The performance of the proposed system was evaluated by conducting a hand gesture experiment consisting of 28 hand gestures. The proposed method achieved an average accuracy of 98.12%, surpassing the surface electromyography (sEMG) system's accuracy of 93.89%. Furthermore, the fusion of pMMG and sEMG sensors yielded an accuracy of 99.18%. The results suggest that the proposed approach exhibits the potential to enhance the accuracy and efficiency of hand gesture recognition systems.

GLUTAMATE EXPRESSION IN SUBACROMIAL BURSA IS ASSOCIATED WITH ROTATOR CUFF TEAR AND WITH SHOULDER PAIN

Glutamate regulates the expression of apoptosis-related genes and triggers the apoptosis of fibroblasts in rotator cuff tendons. Subacromial bursitis is always accompanied by symptomatic rotator cuff tear (RCT). However, no study has been reported on the presence of glutamate in subacromial bursa and on its involvement of shoulder pain in patients who had RCT. The purposes of this study were to determine whether the glutamate expression in subacromial bursa is associated with the presence of RCT and with the severity of shoulder pain accompanying RCT.Subacromial bursal tissues were harvested from patients who underwent arthroscopic rotator cuff tendon repair or glenoid labral repair with intact rotator cuff tendon. Glutamate tissue concentrations were measured, using a glutamate assay kit. Expressions of glutamate and its receptors in subacromial bursae were histologically determined. The sizes of RCT were determined by arthroscopic findings, using the DeOrio and Cofield classification. The severity of shoulder pain was determined, using visual analog scale (VAS). Any associations between glutamate concentrations and the size of RCT were evaluated, using logistic regression analysis. The correlation between glutamate concentrations and the severity of pain was determined, using the Pearson correlation coefficient. Differences with a probability &lt;0.05 were considered statistically significant.Glutamate concentrations showed significant differences between the torn tendon group and the intact tendon group (P = 0.009). Concentrations of glutamate significantly increased according to increases in tear size (P &lt; 0.001). In histological studies, the expressions of glutamate and of its ionotropic and metabotropic receptors have been confirmed in subacromial bursa. Glutamate concentrations were significantly correlated with pain on VAS (Rho=0.56 and P =0.01).The expression of glutamate in subacromial bursa is significantly associated with the presence of RCT and significantly correlated with its accompanying shoulder pain.Acknowledgements: This research was supported by the Basic Science Research Program, through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2015R1D1A3A01018955 and 2017R1D1A1B03035232).

Understanding Fibrous Tissue in the Effective Healing of Rotator Cuff Injury.

The rotator cuff is a crucial group of muscles and tendons in the shoulder complex that plays a significant role in the stabilization of the glenohumeral joint and enabling a wide range of motion. Rotator cuff tendon tears can occur due to sudden injuries or degenerative processes that develop gradually over time, whether they are partial or full thickness. These injuries are common causes of shoulder pain and functional impairment, and their complex nature highlights the essential role of the rotator cuff in shoulder function. Scar formation is a crucial aspect of the healing process initiated following a rotator cuff tendon tear, but excessive fibrous tissue development can potentially lead to stiffness, discomfort, and movement limitations. Age is a critical risk factor, with the prevalence of these tears increasing among older individuals. This comprehensive review aims to delve deeper into the anatomy and injury mechanisms of the rotator cuff. Furthermore, it will inspect the signaling pathways involved in fibrous tissue development, evaluate the various factors affecting the healing environment, and discuss proactive measures aimed at reducing excessive fibrous tissue formation. Lastly, this review identifed gaps within existing knowledge to advance methods for better management of rotator cuff tendon injuries.

Bone regeneration in critical size calvarial defects using synthetic hydroxyapatite and mineralized bovine tendon base materials: a micro-computed tomography analysis

This investigation used materials based on synthetic hydroxyapatite and mineralized bovine tendon as a framework for bone regeneration and evaluated the osteoconductivity of these materials in the calvaria of Wistar rats in comparison to Bio-Oss/Geistlich. Micro-computed tomography (µ-CT) analyses were performed non-invasively using three-dimensional image reconstruction to evaluate new bone formation; in addition, conventional histological analysis was used. The µ-CT results showed that Bio-Oss resulted in higher volume, density and bone percentage than the other materials. Based on the three-dimensional reconstructed images, the lowest resorption rates were observed in the Bio-Oss group, and the materials remained in larger quantities inside the defect at thirty days. In the synthetic hydroxyapatite group, intense resorption of the material and slight bone formation on the defect margins were noted, yielding an irregular edge. The mineralized bovine tendon group showed discrete new bone formation, and the material was fully resorbed. The Bio-Oss and synthetic hydroxyapatite groups yielded similar amounts of blood vessels and osteoblastic cells, and these were higher than the amounts found in the mineralized bovine tendon group. Synthetic hydroxyapatite was present within the defect and exhibited osteoconductive properties that were similar to the commercial brand, Bio-Oss. Mineralized bovine tendon did not exhibit good osteoconductivity and is contraindicated for maintaining bone space. Moreover, µ-CT yielded lower specificity; that is, µ-CT was not able to distinguish bone tissue from Bio-Oss, although it exhibited high sensitivity. Based on these results, it appears that synthetic hydroxyapatite has great potential for use in filling bone defects, unlike mineralized bovine tendon

Analysis of clinical efficacy and risk factors of relapse in young patients with cervical instability treated by manipulation

To determine the clinical efficacy of different manipulation in the treatment of cervical instability in young people, and to analyze the risk factors of relapse of cervical instability in young people. From March 2021 to June 2022, the clinical data of 120 young patients with cervical instability were retrospectively analyzed. According to the different treatment methods, they were divided into rotation group (60 cases, 3 cases of loss) and tendon group (60 cases, 5 cases of loss). There were 25 males and 32 females in rotation-traction manipulation group;age ranged from 22 to 44 years old with a median of 28 years old;course of disease ranged from 0.17 to 120 months with amedian of 22 months. There were 22 males and 33 females in tendon-regulating manipulation group;age ranged from 21 to 42 years old with a median of 27 years old;course of disease ranged from 0.23 to 180 months with a median of 24 months. Both groups were treated for 2 weeks, once every other day for 7 times, and were followed up for 1 year. The clinical efficacy of the two groups was evaluated, and the visual analogue scale (VAS), neck disability index (NDI) were observed before and after treatment. One year after the course of treatment, patients with effective treatment were followed up to make statistics on recurrence. Patients with recurrence were included in the recurrence group, while those without recurrence were included in the non-recurrence group. Factors that may affect symptom recurrence were analyzed, and univariate and multivariate Logistic regression analysis were performed. The 13 patients who failed the treatment (4 cases in the rotation-traction manipulation group and 9 cases in the tendon-regulating manipulation group) were not followed up. All the 99 patients who were effective in treatment were followed up ranged from 303 to 406 days with a median of 359 days. No complications occurred in all patients. There were significant differences in VAS and NDI between the two groups after treatment and before treatment (P<0.05), and there were significant differences in VAS and NDI between the two groups after treatment (P<0.05). Ninety-nine patients achieved follow-up, 56 (56.57%) relapsed and 43 (43.43%) did not. Univariate correlation analysis showed that NDI index, the time spent at the desk every day, the time spent using electronic products every day and angular displacement of anterior flexion before treatment in the relapse group were significantly higher than those in the non-relapse group (P<0.05). Logistic regression analysis showed that the time spent at the desk every day [OR=2.447, 95%CI(1.255, 4.771)], the time spent using electronic products every day [OR=1.892, 95%CI(1.066, 3.358)] and the angular displacement of anterior flexion of the cervical before treatment [OR=1.246, 95%CI(1.045, 1.485) ]were the risk factors for relapse. Both rotation-traction manipulation and tendon-regulating manipulation can effectively treat cervical instability in young people, and rotation-traction manipulation has more advantages than tendon-regulating manipulation in improving cervical pain and cervical dysfunction in patients. The time spent at the desk every day, the time spent using electronic products every day, and the increase of cervical flexion angle displacement will increase the risk of relapse in patients.

FRI170 Ultrasound-Based Evaluation Of Muscles And Tendons In Patients With Cushing Syndrome

Abstract Disclosure: B. Bolayir: None. F. Gogus: None. B. Demir: None. M.M. Yalcin: None. J. Meray: None. A. Altinova: None. F.S. Toruner: None. M.Y. Akturk: None. Background: Myopathy, being induced by antianabolic and catabolic effects of excess corticosteroids is one of the characteristic features of Cushing Syndrome (CS). Muscle thickness which has been shown to be correlated with muscle cross sectional area can be used as an indicator of muscle mass. Although many studies have demonstrated effects of corticosteroids on collagen metabolism and case reports documented rupture of tendons in patients with chronic exposure to corticosteroids, tendon changes of patients with endogenous hypercortisolism have not been studied. Ultrasound, although not studied well in this group of patients, can be an alternative imaging method that provides information about muscle and tendon thickness. The aim of this study was to investigate muscle, tendon thicknesses and serum levels of myostatin in patients with CS. Methods: Twenty-two patients with CS and nineteen healthy control subjects similar for age, sex, height and weight were enrolled. Lower extremity tendon and muscle groups’ thickness were evaluated by ultrasound. Serum myostatin levels were measured by ELISA. Results: Age, height, weight and body mass index were similar between groups (p&amp;gt;0.05). The thicknesses of rectus femoris, vastus medialis, vastus lateralis, gastrocnemius medialis and gastrocnemius lateralis were lower in the CS group than control group (p≤0.001). However, thickness of soleus muscle was not significantly different between the groups (p &amp;gt; 0.05). No significant difference was revealed between groups in terms of Achilles and patellar tendon thickness (p&amp;gt;0.05). Median serum myostatin levels were found to be lower in the CS group than the control group (p&amp;lt;0.001).Conclusions: Ultrasound based measurement of muscle thickness can be used to assess and monitor steroid-induced changes of muscle mass. The fact that the thickness of the proximal muscles of lower extremity was found to be lower by ultrasound in patients with CS in our study supports the proximal myopathy feature of CS. Besides that, it was shown that the gastrocnemius lateralis and medialis thicknesses, which are the distal muscles of the lower extremity, were also shown to be lower in the Cushing group. On the other hand, CS might not affect the thickness of the lower extremity tendons. Moreover, the mechanism of the decrease in the level of myostatin, the negative regulator of muscle growth, in patients with needs to be elucidated with CS further studies. Presentation: Friday, June 16, 2023

Fibroblast Growth Factor Soaked Collagen Membrane Shows No Biomechanical or Histological Advantages in the Treatment of Chronic Rotator Cuff Tears in a Rabbit Model

To investigate the histological and biomechanical effects of a fibroblast growth factor (FGF-2)-soaked collagen membrane used to treat a full-thickness chronic rotator cuff (RC) rupture in a rabbit model. Forty-eight shoulders from 24 rabbits were used. At the beginning of the procedure, 8 rabbits were killed to assess the control group (Group IT) with intact tendons. To establish a chronic RC tear model, a full-thickness subscapularis tear was created on both shoulders of the remaining 16 rabbits and left for 3 months. The transosseous mattress suture technique was used to repair tears in the left shoulder (Group R). The tears in the right shoulder (Group CM) were treated using the same approach, with an FGF-soaked collagen membrane inserted and sutured over the repair site. Three months after the procedure, all rabbits were killed. Biomechanical testing was performed on the tendons to determine failure load, linear stiffness, elongation intervals, and displacement. Histologically, the modified Watkins score was used to evaluate tendon-bone healing. There was no significant difference among the three groups in terms of failure load, displacement, linear stiffness, and elongation (P > .05). The total modified Watkins score was not affected by applying the FGF-soaked collagen membrane to the repair site (P > .05). Fibrocytes, parallel cells, large-diameter fibers, and the total modified Watkins score were significantly lower in both repair groups when compared to the intact tendon group (P < .05). In addition to tendon repair, FGF-2 soaked collagen membrane -application at the repair site provides neither biomechanical nor histological advantages in the treatment of chronic RC tears. FGF-soaked collagen membrane augmentation provides no impact on the chronic RC tear healing tissue. The need to investigate alternative methods that may have a positive effect on healing in chronic RC repairs continues.

Comparison of Peroneus Longus Tendon Autograft and Hamstring Tendon Autograft for Anterior Cruciate Ligament Reconstruction: A Systematic Review

Purpose: The aim of this study is to compare the outcomes between peroneus longus tendon autograft versus hamstring tendon autograft for anterior cruciate ligament reconstruction such as International Knee Documentation Committee (IKDC), Lysholm score, Modified cincinnati score, Tegner activity scale, and donor site morbidity. Methods: This systematic review uses Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Multiple databases were searched for studies that compared functional outcomes of ACL reconstruction with peroneus longus tendon autograft versus hamstring tendon autografts with a minimum 1 year follow-up. Result: We analyzed 5 studies that included direct comparison of the peroneus longus tendon (106 patients) versus the hamstring tendon (137 patients). There was no significant difference comparison of the outcome such as Modified Cincinnati, Tegner scale activity, and Lysholm score. On IKDC score, 1 study reported there was a significant difference between peroneus longus tendon autograft 87.4 (67.8- 100) versus hamstring tendon autograft 78.2 (35.6-95.6) with p=0. Two studies reported donor site morbidity mostly occurred in hamstring tendon autograft (11.4 ± 3.6) were higher than peroneus longus tendon (2.5 ± 0.5) (P=0.002). The knee flexion of donor site morbidity in the peroneus longus tendon group (41.97 ± 1.98) is higher than the hamstring tendon group (40.65 ± 1.74) (P=0.02). Conclusion: This study concluded there was no significant difference of comparison between the peroneus longus group and the hamstring group after ACL reconstruction but the IKDC score after a reconstruction could be affected by gender and graft size. Donor site morbidity most occurred in hamstring group than peroneus longus group after ACL reconstruction

Biomechanical Comparison of Distal Radioulnar Joint Reconstruction Graft Preparation Techniques.

Background Graft preparation techniques for the Adams-Berger distal radioulnar joint (DRUJ) reconstruction vary among surgeons with insufficient evidence to support any specific technique. Questions/Purposes We compared survival with cyclic loading, absolute elongation, elongation rate, and modes of failure of four graft preparation techniques. Methods Fifteen porcine extensor tendons were divided into three equal groups: tendon only; tendon augmented along its full length with nonlocking 2-0 FiberLoop suture spaced at 6 mm intervals; and tendon with suture at 12 mm intervals. Suture only was also tested. Samples were woven through custom radius- and ulna-simulating jigs mounted on a mechanical testing machine. Samples underwent a staircase cyclic loading protocol and were then inspected visually for the mode of failure. Survival with cyclic loading, absolute elongation, and elongation rate was compared. Results Average survival with cyclic loading of suture-augmented tendon was significantly higher than tendon only. All tendon groups had significantly higher survival compared with suture only. Absolute elongation was subject to variability due to initial nonlinear elongation behavior of samples. The elongation rate was significantly lower with suture compared with all tendon groups. Modes of failure included rupture of the tendon and/or suture at the simulated graft-bone interface and elongation of the entire construct without rupture. Conclusions In this biomechanical study, augmentation of porcine tendons with suture spaced at either 6 or 12 mm for DRUJ reconstruction significantly increased survival to a staircase cyclic loading protocol Clinical Relevance For the Adams-Berger reconstruction, tendon grafts augmented along their entire length by nonabsorbable braided suture are biomechanically superior to tendon alone.

SMART BIOACTIVE PERSONALIZED AND IMPLANTABLE 3D-PRINTED SCAFFOLD FOR TENDON REGENERATION: PRELIMINARY RESULTS OF TRITONE PROJECT

Traumatic acute or chronic tendon injuries are a wide clinical problem in modern society, resulting in important economic burden to the health system and poor quality of life in patients. Due to the low cellularity and vascularity of tendon tissue the repair process is slow and inefficient, resulting in mechanically, structurally, and functionally inferior tissue.Tissue engineering and regenerative medicine are promising alternatives to the natural healing process for tendon repair, especially in the reconstruction of large damaged tissues. The aim of TRITONE project is to develop a smart, bioactive implantable 3D printed scaffold, able to reproduce the structural and functional properties of human tendon, using FDA approved materials and starting from MSC and their precursor, MPC cell mixtures from human donors.Total cohort selected in the last 12 months was divided in group 1 (N=20) of subjects with tendon injury and group 2 (N=20) of healthy subject. Groups were profiled and age and gender matched. Inclusion criteria were age&gt;18 years and presence of informed consent. Ongoing pregnancy, antihypertensive treatment, cardiovascular diseases, ongoing treatment with anti-aggregants, acetylsalicylic-acid or lithium and age&lt;18 years were exclusion criteria.Firstly, we defined clinical, biological, nutritional life style and genetic profile of the cohort. The deficiency of certain nutrients and sex hormonal differences were correlated with tendon-injured patients. It was established the optimal amount of MPC/MSC human cell (collected from different patients during femoral neck osteotomy). Finally, most suitable biomaterials for tendon regeneration and polymer tendon-like structure were identified. Hyaluronic acid, chemical surface and soft-molecular imprinting (SOFT-MI) was used to functionalize the scaffold.These preliminary results are promising. It will be necessary to enroll many more patients to identify genetic status connected with the onset of tendinopathy. The functional and structural characterization of smart bioactive tendon in dynamic environment will represent the next project step.

Clinical and radiologic outcomes after tendon insertion medialized repair of large-to-massive rotator cuff tears

To evaluate the effectiveness of tendon insertion medialized repair in treatment of large-to-massive rotator cuff tears (L/MRCT). The clinical and imaging data of 46 L/MRCT patients who underwent arthroscopic insertion medialized repair between October 2015 and June 2019 were retrospectively analyzed. There were 26 males and 20 females with an average age of 57.7 years (range, 40-75 years). There were 20 cases of large rotator cuff tears and 26 cases of massive rotator cuff tears. Preoperative imaging evaluation included fatty infiltration (Goutallier grade), tendon retraction (modified Patte grade), supraspinatus tangent sign, acromiohumeral distance (AHD), and postoperative medializaiton length and tendon integrity. The clinical outcome was evaluated by visual analogue scale (VAS) score, American Society for Shoulder and Elbow Surgery (ASES) score, shoulder range of motion (including anteflexion and elevation, lateral external, and internal rotation) and anteflexion and elevation muscle strength before and after operation. The patients were divided into two groups (the intact tendon group and the re-teared group) according to the integrity of the tendon after operation. According to the medializaiton length, the patients were divided into group A (medialization length ≤10 mm) and group B (medialization length >10 mm). The clinical function and imaging indexes of the patients were compared. All patients were followed up 24-56 months, with an average of 31.8 months. At 1 year after operation, MRI showed that the medializaiton length of supraspinatus tendon was 5-15 mm, with an average of 10.26 mm, 33 cases in group A and 13 cases in group B. Eleven cases (23.91%) had re-teared, including 5 cases (45.45%) of Sugaya type Ⅳ and 6 cases (54.55%) of Sugaya type Ⅴ. At last follow-up, the VAS score, ASES score, shoulder anteflexion and elevation range of motion, lateral external rotation range of motion, and anteflexion and elevation muscle strength significantly improved when compared with those before operation ( P<0.05); there was no significant difference in internal rotation range of motion between pre- and post-operation ( P>0.05). The Goutallier grade and modified Patte grade of supraspinatus muscle in the re-teared group were significantly higher than those in the intact tendon group, and the AHD was significantly lower than that in the intact tendon group ( P<0.05). There was no significant difference in other baseline data between the two groups ( P>0.05). Except that the ASES score of the intact tendon group was significantly higher than that of the re-teared group ( P<0.05), there was no significant difference in the other postoperative clinical functional indicators between the two groups ( P>0.05). There was no significant difference in the incidence of re-tear, VAS score, ASES score, range of motion of shoulder joint, and anteflexion and elevation muscle strength between group A and group B ( P>0.05). Tendon insertion medialized repair may be useful in cases with L/MRCT, and shows good postoperative shoulder function. Neither tendon integrity nor medialization length shows apparent correlations with postoperative shoulder function.

The AIUM Practice Parameter for the Performance of the Musculoskeletal Ultrasound Examination.

The AIUM Practice Parameter for the Performance of the Musculoskeletal Ultrasound Examination.

Repair of tendons treated with peracetic acid-ethanol and gamma irradiation by EDC combined with NHS: a morphological, biochemical and biomechanical study in vitro.

The purpose of this study was to investigate whether 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide (EDC) combined with n-hydroxysuccinimide (NHS) can repair tendon damage caused by peracetic acid-ethanol and gamma irradiation sterilization. The semitendinosus tendons of 15 New Zealand white rabbits were selected as experimental materials, and the tendons were sterilized in a solution containing 1% (v/w) peracetic acid and 24% (v/w) ethanol. After 15kGy gamma irradiation sterilization, the tendons were randomly divided into three groups (n = 10). The tendons were repaired with EDCs of 0, 2.5 and 5mM combined with 5mM NHS for 6h, the tendons were temporarily stored at - 80 ± °C. The arrangement and spatial structure of collagen fibers were observed by light microscopy and scanning electron microscopy, the collagen type and collagen crimp period were observed under a polarizing microscope, and the collagen fibril diameter and its distribution were measured by transmission electron microscopy, from which the collagen fibril index and mass average diameter were calculated. The resistance of collagen to enzymolysis was detected by the free hydroxyproline test, and tensile fracture and cyclic loading tests of each group of tendons were carried out, from which the elastic modulus, maximum stress, maximum strain, strain energy density and cyclic creep strain were calculated. The obtained results showed that the gap between loose collagen fibers in the 0mM control group was wider, the parallel arrangement of tendons in the 2.5 and 5mM groups was more uniform and regular and the fiber space decreased, the crimp period in the 5mM group was lower than that in the 0mM group (P < 0.05), and the concentration of hydroxyproline in the 5mM group (711.64 ± 77.95μg/g) was better than that in the control group (1150.57 ± 158.75μg/g). The elastic modulus of the 5mM group (424.73 ± 150.96MPa) was better than that of the 0mM group (179.09 ± 37.14MPa). Our results show that EDC combined with NHS can repair damaged tendons after peracetic acid-ethanol and gamma radiation treatment, and 5mM EDC has better morphological performance, anti-enzymolysis ability and biomechanical properties than 2.5mM EDC.