Ossification Of Tendon Research Articles

What understanding tendon cell differentiation can teach us about pathological tendon ossification.

Tendons are the structures that attach muscles to bones and transmit mechanical forces. Tendon cells are composed of mature tenocytes and a rare population of tendon stem cells. Both cell types ensure homeostasis and repair of tendon extracellular matrix to guarantee its specific mechanical properties. Moreover, tendon cells seem to present a marked potential for trans-differentiation, predominantly into the chondrocyte and osteoblast lineages. In this review article, we first present chronic tendon pathologies associated with abnormal ossification, such as spondyloarthritis and calcifying tendinopathy, and discuss how tendon cell differentiation and trans-differentiation may participate in these diseases. We moreover present the factors known to influence tendon cell differentiation and trans-differentiation, with a particular emphasis on extracellular environment, mechanical stimulation and several soluble factors that can tip the balance toward one or another lineage. A better understanding of the neglected tendon cell biology may be extremely useful to understand the pathological mechanisms of spondyloarthritis and calcifying tendinopathy.

開口障害を伴った進行性骨化性線維異形成症の1例

Fibrodysplasia ossificans progressiva (FOP) is a rare hereditary disease characterized by heterotopic ossification of skeletal muscles, tendons, and ligaments. In the oral and maxillofacial region, FOP leads to eating disorders caused by a limited range of mouth opening. At a late stage, respiratory function is impaired by limited movement of the thorax. We reported a rare case of FOP with trismus and discuss the related literature. A 28-year-old woman was referred to our hospital because of trismus in December 2011. She had heterotopic ossification in the left scapula and was given a diagnosis of FOP at the age of 17 years. Extraoral examination showed temporary pain extending from the left temporomandibular joint to the buccal region when she opened the mouth. A maximal mouth opening of 3 mm was confirmed. Intraoral examination showed an inflammatory reaction at the gingiva of the maxillary left third molar. Magnetic resonance imaging showed high intensity of the left lateral pterygoid muscle. Nonsteroidal anti-inflammatory drugs and injectable bisphosphonates were administered, followed by mouth opening training. Her maximal mouth opening markedly improved to 22 mm 1 year after initial presentation, without any recrudescence.

Fibrodysplasia ossificance progressiva: A familial presentation.

Fibrodysplasia ossificans progressiva is a rare disorder progressing to ossification of tissues causing disability. We report a case of father and daughter in a family presenting with this condition. The diagnosis was made with X-rays. However, Technetium-99m Methylene Diphosphonate bone scan showed extensive extra-osseous localization of tracer suggesting ossification of multiple ligaments, tendons, muscles and connective tissue.

Shortened stapedius tendon: a rare cause of conductive hearing loss

Anomalies of the stapedius tendon have been reported to cause conductive hearing loss; in theory, such anomalies limit the movement of the stapes. To demonstrate a rare cause of conductive hearing loss resulting from anomaly of the stapedius tendon and to compare the clinical findings of this patient to other stapedius tendon anomalies reported in the literature. Case report of a single case of shortened stapedius tendon and a review of the English literature on stapedius tendon anomalies. This is a case report of a 15-year-old boy with shortened stapedius tendon causing unilateral hearing loss, accompanied by a review of the literature. Contrary to other reported cases, this patient did not have an ossified tendon, but rather an extremely short tendon. The boy regained normal hearing following excision of the stapedius tendon. A shortened stapedius tendon is a very rare diagnosis, yet it should be considered as a possible cause of conductive hearing loss.

A case of partial tear of Achilles tendon caused by ossification of Achilles tendon

A case of partial tear of Achilles tendon caused by ossification of Achilles tendon

Pathological phalanges in a camarasaurid sauropod dinosaur and implications on behaviour

Several types of pathological bony overgrowth are known from various dinosaur taxa but, except for stress fractures, are rarely reported from appendicular elements. Herein we describe pathological manual and pedal phalanges of a camarasaurid sauropod (SMA 0002), which show features rarely recognised in non-avian dinosaurs. They include lateral osteophytes and smoothing of phalangeal articular surfaces, a deep pit, proximal enthesophytes in pedal unguals, distal overgrowth associated with a fracture, and a knob-like overgrowth lateral to the distal condyles of a pedal phalanx. Their causes were assessed by means of visual examination, CT scans, and bone histology, where possible. The lateral osteophytes are interpreted as symptoms of osteoarthritis. The ossified tendon insertions in the unguals are most probably the result of prolonged, heavy use of the pedal claws, possibly for scratch-digging. The distal overgrowth is interpreted to have developed due to changed stress regimes, and to be the cause for th...

Multiple Palpable Nodules: Do Not Miss the Great Toes

An 11-y-old boy presented with complaints of multiple nodules over upper back and suboccipital region for last 2.5 y. There was associated gradual limitation of movement of neck, followed by right shoulder. The child had received 8 mo of antitubercular therapy and 3 mo of Albendazole after a presumptive diagnosis of tuberculosis and cysticercosis was made elsewhere. On examination, the child had nontender nodules with bony consistency over the back, suboccipital region, chest and abdominal wall. No definitive diagnosis could be made even after consultation with pediatrician and pediatric orthopedician. At open diagnostic biopsy, well formed flat bones in paraspinal muscles with globular swelling which felt like partially calcified cartilage were noticed. The histopathological examination revealed mature bone. Skeletal survey revealed shortened first metatarsal and proximal phalanges of bilateral great toe with hallux valgus (Fig. 1). There was linear ossification in the muscles of back extending from the base of the skull till the sacrum (S1 level). Corroboration of clinical and histopathological features suggested a diagnosis of FOP (Fibrodysplasia ossificans progressive). Audiometry revealed bilateral mild conductive hearing loss. Fibrodysplasia ossificans progressive (FOP) is a progressive, debilitating disease with a prevalence of 0.61 per million but with no described effective treatment [1]. FOP can be diagnosed on the basis of a diagnostic triad: congenital skeletal malformation of the great toes; progressive heterotopic ossification of skeletal muscles, tendons, ligaments, and fascia and progression of disease activity in characteristic anatomic patterns (dorsal to ventral, axial to appendicular, cranial to caudal, and proximal to distal) [2]. Nearly 90 % of FOP patients worldwide are misdiagnosed, and 67 % undergo dangerous and unnecessary diagnostic procedures that lead to permanent harm and lifelong disability in more than 50 % of all affected individuals [3]. Biopsy or excision is useless as the heterotopic bone in FOP is indistinguishable histologically frommature skeletal bone [4]. The genetic defect in FOP (phenotype MIM no 135100) involves mutation in the gene encoding activin receptor IA (gene MIM no 102576) located on chromosome 2q and makes it amenable to genetic testing [5]. Regular assessment of the patient’s functional status by a physiotherapist and occupation therapist is needed to ensure that functionality is maintained. Deep soft issue trauma, intramuscular Fig. 1 Clinical photograph of the foot showing shortened bilateral great toe with hallux valgus

Investigating tendon mineralisation in the avian hindlimb: a model for tendon ageing, injury and disease

Mineralisation of the tendon tissue has been described in various models of injury, ageing and disease. Often resulting in painful and debilitating conditions, the processes underlying this mechanism are poorly understood. To elucidate the progression from healthy tendon to mineralised tendon, an appropriate model is required. In this study, we describe the spontaneous and non-pathological ossification and calcification of tendons of the hindlimb of the domestic chicken (Gallus gallus domesticus). The appearance of the ossified avian tendon has been described previously, although there have been no studies investigating the developmental processes and underlying mechanisms leading to the ossified avian tendon. The tissue and cells from three tendons - the ossifying extensor and flexor digitorum longus tendons and the non-ossifying Achilles tendon - were analysed for markers of ageing and mineralisation using histology, immunohistochemistry, cytochemistry and molecular analysis. Histologically, the adult tissue showed a loss of healthy tendon crimp morphology as well as markers of calcium deposits and mineralisation. The tissue showed a lowered expression of collagens inherent to the tendon extracellular matrix and presented proteins expressed by bone. The cells from the ossified tendons showed a chondrogenic and osteogenic phenotype as well as tenogenic phenotype and expressed the same markers of ossification and calcification as the tissue. A molecular analysis of the gene expression of the cells confirmed these results. Tendon ossification within the ossified avian tendon seems to be the result of an endochondral process driven by its cells, although the roles of the different cell populations have yet to be elucidated. Understanding the role of the tenocyte within this tissue and the process behind tendon ossification may help us prevent or treat ossification that occurs in injured, ageing or diseased tendon.

Patellar tendon ossification after anterior cruciate ligament reconstruction using bone – patellar tendon – bone autograft

BackgroundAmong the various complications described in literature, the patellar tendon ossification is an uncommon occurrence in anterior cruciate ligament (ACL) reconstruction using bone – patellar tendon – bone graft (BPTB). The heterotopic ossification is linked to knee traumatism, intramedullary nailing of the tibia and after partial patellectomy, but only two cases of this event linked to ACL surgery have been reported in literature.Case presentationWe present a case of a 42-year-old Caucasian man affected by symptomatic extended heterotopic ossification of patellar tendon after 20 months from ACL reconstruction using BPTB. The clinical diagnosis was confirmed by Ultrasound, X-Ray and Computed Tomography studies, blood tests were performed to exclude metabolic diseases then the surgical removal of the lesion was performed. After three years from surgery, the patient did not report femoro-patellar pain, there was not range of motion limitation and the clinical-radiological examinations resulted negative.ConclusionThe surgical removal of the ossifications followed by anti-inflammatory therapy, seems to be useful in order to relieve pain and to prevent relapses. Moreover, a thorough cleaning of the patellar tendon may reveal useful, in order to prevent bone fragments remain inside it and to reduce patellar tendon heterotopic ossification risk.

The role of the tenocyte in tendon ossification in an avian model

Tendon ossification, the deposit of bone‐like material within tendon tissue, is common amongst our aging population. Often resulting in painful and debilitating conditions, this ossification compounds damage on an already vulnerable tissue. Although tendon is a key component of the musculoskeletal unit, its repair when damaged is poor. Whereas human tendons may undergo this process through injury, age or even disease; the hindlimb tendons of the adult domestic chicken (Gallus gallus) undergo natural ossification. Little is known about the processes underlying this mechanism, yet it would stand to reason that tenocytes play an important role.The nature of tissue and cell components of the adult ossified avian tendon were analyzed and compared to the developing non‐ossified avian tendon. The role of the tenocyte and its potential plasticity was investigated both in vitro and in vivo. And the existence of multipotent cells within tendon tissue, Tendon Derived Stem‐like Cells (TDSCs), was explored.Analysis of the adult ossified avian tendon revealed an ossification process comparable to endochondral ossification. Tenocyte plasticity was analyzed and shown to be restricted to a population within tendon issue, TDSCs.Understanding the role of the tenocyte and the process behind tendon ossification may help prevent ossification occurring in injured or diseased tendon.Funded by The Anatomical SocietyGrant Funding Source: none

Could Ossification of the Achilles Tendon Have a Hereditary Component?

Ossification of the Achilles tendon (OTA) is an unusual clinical condition. It is characterized by the presence of an ossified mass within the fibrocartilaginous substance of the Achilles tendon. The etiology of the ossification of the Achilles tendon is unknown. Review of the literature suggests that its etiology is multifactorial. The major contributing factors are trauma and surgery with other minor causes such as systemic diseases, metabolic conditions, and infections. To our knowledge, no previous reports suggest any genetic/hereditary predisposition in OAT. We report 3 siblings who have OAT with no history of any of the aforementioned predisposing factors. Could OAT have a hereditary component as one of its etiologies?

Cesarean Section of a 25 3/7 Week Parturient with Fibrodysplasia Ossificans Progressiva: A Case Report

Fibrodysplasia ossificans progressiva (FOP) is a rare autosomal dominant disease characterized by progressive ossification of tendons, ligaments, fascia, and skeletal muscle. Ossification can occur either spontaneously or as a result of tissue trauma beginning in childhood. Joints typically ankylose and patients frequently become immobile in their 20s. Patient’s frequently die before their 40s because of restrictive pulmonary failure as a result of intercostal muscle involvement.(1) The temporomandibular joint (TMJ) and cervical spine also often ossify resulting in mmobilization of the jaw and neck, making traditional airway management impossible.(2) Although there are case reports relating to anesthesia for dental procedures, there are no case reports related to the anesthesia care of a parturient with FOP. Our patient is a 24 y.o. G1P0 who presented at 22 weeks for a prenatal consultation. Initial evaluation revealed a 5’0” tall, 58 kg female with a fetus developing appropriately. The patient was successfully delivered at 25 3/7 weeks under GETA, with awake nasal intubation, due to preterm labor and vaginal bleeding. Particular attention was made to prevent further muscular trauma to avoid exacerbation of the disease.

Stone Man: A Case Report

Fibrodysplasia ossificans progressiva (FOP) is a rare hereditary connective tissue disease characterized by the progressive ectopic ossification of ligaments, tendons, and facial and skeletal muscles throughout life. Symptoms begin in childhood as localized soft tissue swellings. Immobility and articular dysfunction appear with involvement of the spine and proximal extremities. The temporomandibular joint (TMJ) is a critical component involved in the maxillofacial region, resulting in severe limitation of masticatory function, although TMJ involvement is rare. The aim of this article is to present a 28-year-old man with dental problems and slowly progressive limitation of motion in the jaw, knees, shoulders and hips as well as neck distortion.

Descriptive Anatomy of the Pelvic Appendage Myology of the Endemic Chinese Grouse (Tetrastes sewerzowi)

The musculature of the pelvic appendage of the Chinese Grouse (Tetrastes sewerzowi) is described in detail. T. sewerzowi exhibits the same features as other tetraonids in the absence of M. adductor digiti II, and the relatively weak development of other intrinsic foot muscles, which are thought to be an adaptation to the extreme cold climate of the habitat of grouse. Myological modifications include weak development of the vincula between the flexor tendons to the digits (M. flexor perforans digiti III and M. flexor perforans et perforatus digiti III, M. flexor digitorum longus, and M. flexor hallus longus), the proximolateral insertion of M. flexor perforans digiti II, the well-developed middle head of M. flexor perforans digiti IV, and the ossification of the insertion tendon of M. extensor brevis digiti IV. These features are suggested to be associated with the requirement of finer control over the individual digits while moving on the tree, especially a thin branch.

Famotidine suppresses osteogenic differentiation of tendon cells in vitro and pathological calcification of tendon in vivo

Heterotopic ossification or calcification follows any type of musculoskeletal trauma and is known to occur after arthroplasties of hip, knee, shoulder, or elbow; fractures; joint dislocations; or tendon ruptures. Histamine receptor H2 (Hrh2) has been shown to be effective for reducing pain and decreasing calcification in patients with calcifying tendinitis, which suggested that H2 blockers were effective for the treatment of tendon ossification or calcification. However, the detailed mechanisms of its action on tendon remain to be clarified. We investigated the mechanisms underlying H2 blocker-mediated suppression of tendon calcification, with a focus on the direct action of the drug on tendon cells. Famotidine treatment suppressed the mRNA expressions of Col10a1 and osteocalcin, ossification markers, in a tendon-derived cell line TT-D6, as well as a preosteoblastic one MC3T3-E1. Both of the cell lines expressed Hrh2; histamine treatment induced osteocalcin expression in these cells. Famotidine administration suppressed calcification in the Achilles tendon of ttw mice, a mouse model of ectopic ossification. These data suggest that famotidine inhibits osteogenic differentiation of tendon cells in vitro, and this inhibition may underlie the anti-calcification effects of the drug in vivo. This study points to the use of H2 blockers as a promising strategy for treating heterotopic ossification or calcification in tendon, and provides evidence in support of the clinical use of famotidine.

Confirmation of the recurrent ACVR1 617G>A mutation in South Africans with fibrodysplasia ossificans progressiva

Fibrodysplasia ossificans progressiva (FOP) is a rare genetic condition in which progressive ossification of fibrous tissue, tendons and ligaments leads to severe physical handicap. Most affected individuals who have been studied have a recurrent 617G>A mutation in the ACVR1/ALK2 gene that codes for activin A type 1 receptor/activin-like kinase 2. The majority of publications on the genetics of FOP have concerned whites or Asians, and no genetic information is available concerning sub-Saharan blacks. The aim of the project was to determine whether or not this mutation is present in affected persons in South Africa. Molecular mutational analysis was undertaken on genomic DNA from peripheral blood leukocytes from 6 affected South African of different population groups (4 Xhosa, 1 coloured, 1 white). The 6 persons with FOP were all heterozygous for the ACVR1/ALK2 617G>A mutation. This mutation was absent in 6 controls. Confirmation of the presence of this recurrent mutation facilitates diagnostic accuracy in affected persons in South Africa, and allows researchers to narrow the search for molecular targets for rational intervention to the ACVR1/ALK2 domain.

The homology and origins of intermuscular bones in fishes: phylogenetic or biomechanical determinants?

Fish body muscles are arranged along the vertebral column in three-dimensional W-shaped blocks, called myomeres. Each myomere is separated from its neighbours by a collagenous sheet, the myoseptum, and embedded in these myosepta and in positions that are conserved throughout gnathostome evolution are distinct tendons. Within teleosts these tendons often ossify. Ossification is usually intramembranous but cartilaginous structures within the tendons have also been reported. Ossified myoseptal tendons are homologous to intermuscular bones and appear only in teleosts. The phylogenetic signal of myoseptal tendon ossfication has not been tested previously, although the presence and morphology of intermuscular bones have been used to infer phylogenetic relationships. We sample over a broad phylogenetic range of teleost fishes to test for (1) the effects of phylogenetic history on the presence of intermuscular bones and (2) morphological correlations with the presence of intermuscular bones. Body shape and fin position as well as vertebral number and aspect ratio are characters that are likely to affect the distribution of stresses along myoseptal tendons, and are therefore good functional predictors of myoseptal tendon ossification. We use the summary information by Patterson & Johnson for a list of species with intermuscular bones and reanalyse the homology of intermuscular bones to myoseptal tendons. We find that there is a phylogenetic signal in the distribution of four out of six ossified tendons, but that after correcting for phylogenetic relationships there are still morphological predictors for the presence of all ossified tendons. © 2012 The Linnean Society of London, Biological Journal of the Linnean Society, 2012, 106, 607‐622.

Unusually severe limitation of the jaw attributable to fibrodysplasia ossificans progressiva: a case report with cone-beam computed tomography findings

Fibrodysplasia ossificans progressiva (FOP) is a rare hereditary connective tissue disease characterized by the progressive ectopic ossification of ligaments, tendons, and facial and skeletal muscles throughout life. Symptoms begin in childhood as localized soft tissue swellings. Immobility and articular dysfunction appear with involvement of the spine and proximal extremities. The temporomandibular joint (TMJ) is a critical component involved in the maxillofacial region, resulting in severe limitation of masticatory function, although TMJ involvement is rare. We report a case of FOP presenting as severely limited TMJ movements owing to ectopic calcification of the left coronoid process. In addition to the clinical examination, panoramic radiography and cone-beam computed tomography images were obtained. The case is presented and the clinical and imaging findings, differential diagnosis, and treatment modalities are discussed.

Homology and Architecture of the Caudal Basket of Pachycephalosauria (Dinosauria: Ornithischia): The First Occurrence of Myorhabdoi in Tetrapoda

BackgroundAssociated postcranial skeletons of pachycephalosaurids, most notably those of Stegoceras and Homalocephale, reveal enigmatic osseous structures not present in other tetrapod clades. The homology and functional significance of these structures have remained elusive as they were originally interpreted to be abdominal ribs or gastralia, and more recently have been interpreted as de novo structures in the tail.Principal FindingsAnalysis of these structures in nearly all pachycephalosaurid skeletons has facilitated a complete description of their architecture, and the establishment of patterns consistent with those of myorhabdoid ossifications — ossifications of the myoseptal tendons associated with myomeres. The presence and structure of myorhabdoid ossifications are well established for teleost fish, but this marks their first recognition within Tetrapoda. These elements are both structurally and histologically distinct from the deep, paraxial ossified tendon bundles of other ornithischian clades, although they may have performed a similar function in the stiffening of the tail.Conclusions/SignificanceThese myorhabdoi are not de novo structures, but are instead ossifications (and therefore more amenable to fossilization) of the normally unossified plesiomorphic caudal myosepta of vertebrates. The ubiquitous ossification of these structures in pachycephalosaurids (all specimens preserving the tail also exhibit myorhabdoid ossifications) suggests it is a likely synapomorphic condition for Pachycephalosauria.

A new Messel rail from the Early Eocene Fur Formation of Denmark (Aves, Messelornithidae)

A new fossil bird is described from the Early Eocene Fur Formation of Denmark. Pellornis mikkelseni gen. et sp. nov. is represented by a single specimen that consists of three-dimensionally preserved elements of the wing and pectoral girdle together with associated parts of the left hindlimb. Comparisons based on general morphology and particular characters of the wing and most elements of the pectoral girdle indicate that the new specimen is morphologically similar to the extinct taxon Messelornithidae (Messel rails). This similarity is also expressed by a phylogenetic analysis, which supports a close relationship between the new fossil and Messel rails. The morphology of the sternum, in particular, shows that the new fossil is distinguishable from other Messelornithidae. An interesting aspect of its morphology is the presence of limb specializations such as the extensive ossification of tendons—well known among running birds—that suggest the new Danish fossil may have been a ground bird with cursorial habits, a condition that was also previously hypothesized as typical for other Messel rails.