Tendon Repair Research Articles

Biceps tenotomy vs. tenodesis in patients undergoing transtendinous repair of partial thickness rotator cuff tears

BackgroundPatients with partial-thickness rotator cuff tears (PTRCTs) often present with concurrent pathology of the long head of the biceps (LHB) tendon. To address both conditions simultaneously, LHB tenotomy or tenodesis can be performed at the time of arthroscopic rotator cuff repair (RCR). This study aims to compare postoperative shoulder active range of motion (AROM) and complications following transtendinous RCR with concurrent LHB tenodesis or tenotomy. MethodsA total of 90 patients with PTRCTs met inclusion criteria for this study. Patients who underwent tear-completion-and-repair, revision surgery, or open repair of the LHB tendon were excluded. Patients were stratified into tenotomy, arthroscopic suprapectoral tenodesis, or no biceps operation cohorts and were propensity matched 1:1:1 on age, sex, body mass index (BMI), and smoking status. Primary outcome measures included AROM in forward flexion, abduction, external rotation, and internal rotation at 6 weeks, 3 months, and 6 months postoperatively. The development of severe stiffness and rates of rotator cuff retear at final follow-up were recorded as secondary outcomes. ResultsWhen comparing the tenotomy and tenodesis cohorts, tenotomy patients were found to have increased AROM at 3 months in forward flexion (153.2° vs 130.1°, p=0.004), abduction (138.6° vs 114.2°, p=0.019), and external rotation (60.4° vs 43.8°, p=0.014), with differences in forward flexion remaining significant at 6 months (162.4° vs 149.4°, p=0.009). There were no significant differences in interval rates of recovery in any plane between cohorts. Additionally, there were no significant differences in rates of symptomatic retears between groups (p=0.458). Rates of severe postoperative stiffness approached but did not achieve statistical significance between tenotomy (4.2%) and tenodesis (29.2%) cohorts (p=0.066). Smoking status was a significant predictor of severe stiffness (odds ratio, 13.69; p=0.010). ConclusionDespite significant differences in absolute AROM between cohorts, the decision to perform tenotomy or tenodesis was not found to differentially affect rates of AROM recovery for patients undergoing arthroscopic transtendinous RCR for PTRCT. Notably, however, transient stiffness complications were more commonly observed in smokers, and data trends suggested an increased risk of stiffness for patients undergoing LHB tenodesis. Overall, postoperative stiffness is likely multifactorial and attributable to both patient- and procedure-specific factors, and LHB tenotomy may be more appropriate for patients with risk factors for developing stiffness postoperatively.

Optimizing pectoralis major tendon repair: a modified knotless suture anchor technique using high-strength suture and tape

BackgroundRupture of the pectoralis major tendon is infrequent but has shown an increased incidence in athletes, particularly weightlifters during bench presses. Various techniques for repair exist, yet no established gold standard has been defined. MethodsWe present a modified surgical technique utilizing knotless suture anchors for pectoralis major tendon repair. The technique involves bringing the tendon end superiorly and inferiorly to the decorticated bone surface, ensuring broader tendon-to-bone contact. Knotless anchors with a unique suture locking mechanism facilitate tension adjustment. Additionally, the repair's strength is reinforced by employing both surgical tape and high-strength suture. ResultsThe utilization of both surgical tape and high-strength suture in conjunction with knotless suture anchors provides a secure and stable construct. This approach minimizes the risk of failure, reduces the potential for neurovascular injury associated with bicortical drilling, preserves imaging quality due to the absence of metal artifacts, and helps avoid the risk of fracture associated with traditional methods. However, surgeons should be aware of a potential disadvantage of increased surgical costs compared to traditional techniques. ConclusionsOur modified technique offers multiple advantages, including increased tendon-to-bone contact, enhanced stability, reduced neurovascular risks, and avoidance of potential fractures. This makes it a valuable option for successful pectoralis major tendon repairs. Surgeons should consider its benefits and weigh them against the associated costs for optimal patient care.

Curcumin Improves Functional Recovery of Ruptured Tendon by Promoting Tenogenesis via PI3K/Akt Signaling.

In our previous study, we found that local release of curcumin from nanomicelles prevents peritendinous adhesion during Achilles tendon healing. The aim of this study is to further investigate the signaling integrated by curcumin to direct the tenogenetic program of tendon stem cells contributing to tendon healing. A surgical model of tendon rupture and repair (TRR) was established in rats. Peritendinous adhesion and inflammation, biomechanical function, and expression of β-catenin and epithelial cellular adhesion molecule (EpCAM) were determined. A dataset was analyzed to investigate differentially expressed genes and enriched genes related to the signaling pathways. Tendon stem cells were treated with curcumin to investigate the cellular and molecular events as well as the signaling pathway. In rat TRR model, curcumin treatment resulted in not only significantly decreased peritendinous inflammatory but also improved tendon functional recovery along with significantly increased expressions of EpCAM and β-catenin. Analysis of the dataset indicated that the enriched genes were positively related to differentiation pathways but negatively related to proliferation pathways. In rat tendon stem cells, curcumin treatment inhibited proliferation but promoted differentiation. Curcumin's antioxidative activity was associated with tenogenesis. The upregulated expression of tendon lineage-specific markers was dependent on phosphatidylinositol 3'-kinase/Akt (PI3K/Akt) pathway which could be a potential mechanism of tenogenesis of curcumin treatment. Curcumin could improve tendon functional recovery via promoting tenogenesis in addition to its antioxidant and anti-inflammatory activities. Curcumin induced differentiation of tendon stem/progenitor cell into tenocytes via PI3K/Akt signaling pathway. This finding provided evidence for the application of curcumin to prevent adhesion during tendon repair.

Differences in Clinical Outcomes Between Patients With Retear After Supraspinatus Tendon Repair and Those With Intact Repair at 5-Year Follow-up

Background: It is well known that rotator cuff repair is associated with an overall retear rate of 21% to 26%. However, a cuff retear may not necessarily be associated with poor clinical outcomes. Hypothesis: There would be no difference in clinical outcomes between patients with a cuff retear and those with an intact repair at a midterm follow-up of 5 years. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective study was conducted involving patients who received arthroscopic complete repair of the supraspinatus tendon between January 2009 and December 2017. Patients who did not have a postoperative magnetic resonance imaging (MRI) scan or who had a follow-up of <5 years were excluded. Clinical outcomes, including the visual analog scale (VAS) score, American Shoulder and Elbow Surgeons (ASES) score, and active forward flexion (FF) of the involved shoulder were assessed at the 2-year and 5-year follow-up points. Results: The study group included 105 patients with a mean follow-up of 85 months. MRI scans were performed at a mean of 20 months. Fourteen full-thickness cuff retears and 91 intact repairs were identified using postoperative MRI scans. Significant improvement in VAS score, ASES score, and FF were found between the preoperative assessment and the 2 designated follow-up points (2 years and 5 years) in both the cuff retear and the intact repair groups (P < .001). The VAS and ASES scores at the 2-year follow-up for the intact repair group were 1.8 ± 2.0 and 80.7 ± 18.1, respectively. The corresponding values for the retear group were 2.3 ± 2.2 and 71.9 ± 19.5, respectively. No significant difference was found between the 2 groups in the VAS and ASES scores at the 2-year follow-up. However, patients with an intact repair had a better VAS score (1.4 ± 1.8; P = .049) and ASES score (81.7 ± 17; P = .019) than those with a cuff retear at the 5-year assessment (3.0 ± 2.8 and 67.1 ± 22.9, respectively). In the intact repair group, 91% of patients achieved the minimal clinically important difference for the 5-year VAS score, compared with 54% in the cuff retear group (P < .001). The corresponding values for the 5-year ASES score were 80% and 54%, respectively (P = .044). FF measurements at the 5-year follow-up in patients with intact repair and those with a cuff retear were 161°± 23° and 144°± 37°, respectively (P = .059). Continuous improvement in VAS score and FF between the 2-year and 5-year follow-up was observed in the intact repair group (P = .005 and P = .04, respectively). Conclusion: The patients with an intact repair had better VAS and ASES scores compared with those who had a cuff retear at a midterm follow-up of 5 years. Between the 2-year and the 5-year follow-up, some further improvement was observed in the VAS score and FF in the intact repair group.

Comparative experimental study of biomechanical features of suture materials in tendon repair

Introduction Many different suture configurations and pathomorphology of tendon repair have been described for tendon repair over the past 20 years. However, the biomechanical properties of suture material at primary flexor tendon repair have not been sufficiently explored. A cyclic loading test is performed to evaluate the performance of the different sutures under repeated loading conditions simulating dynamic conditions in postoperative rehabilitation procedures.The objective was to compare the strength of suture materials under cyclic loading on a biological model of a tendon.Material and methods Eighty porcine digital flexor tendons were examined in a pilot study. The sutured tendons were tested with a universal testing machine. Tendon repair was produced using polypropylene in group I, braided polyamide suture in group II, complex polytetrafluoroethylene thread in group III and a thread of superelastic titanium nickelide in group IV. The standard Chang protocol was used for cyclic loading.Results The percentage of intact sutures was 25 % in group I and in group II, 80 % in group III and 85 % in group IV after completing the entire load cycle. A pairwise comparison showed suture disruption being more common for group I and group II as compared to group III and group IV. Irreversible gap was more common for group 1 as compared to group IV. Neither knot ruptures nor tissue cutting were seen in the groups.Discussion The topic of biomechanical properties of suture material remains poorly understood. Although static load testing is commonly used in current experimental studies and cyclic testing is suitable for simulating postoperative conditions. The search continues for the “ideal” suture material for flexor tendon repair to prevent tears and retain tensile properties until the repair reaches strength.Conclusion The threads of polytetrafluoroethylene and nickelide-titanium showed the best biomechanical properties for tendon repair in the form of linear strength, good elasticity and low plasticity of the suture material. There were no significant differences between polypropylene and braided polyamide threads.

Long-term results and complication following Achilles tendon rupture repair

Introduction Currently,there is no consensus regarding optimal treatment options of Achilles tendon rupture. The purpose of this study was to evaluate long term results of Achilles tendon repair using different surgical techniques, assess complication rate and subjective satisfactionMethods The study included patients treated for Achilles tendon rupture using minimally invasive and open surgical repair. Complications including re-rupture, infection, deep vein thrombosis and neuropraxia were identified. In order to evaluate the factors influencing the risk of postoperative complications, logistic regression analysis was performed. The Achilles Tendon Rupture Score (ATRS) and the American Orthopedic Foot and Ankle Score (AOFAS) evaluated subjective outcomes.Results 130 patients with Achilles tendon tear were enrolled (123 primary and 7 revision cases). In primary repairs percutaneous technique was used in 60 % of cases (74/123), mini open technique – in 16 % (19/123), and open technique – in 24 % (30/123). Re-rupture occurred in 2.4 % of patients treated with minimally invasive techniques. There were no repeated ruptures following open repairs. Predominant number of infections was registered after open repairs and made 10 %, while minimally invasive techniques had 3.2 % of infections. Logistic regression analyses showed that steroid injection, open repair, application of tapes and autografts increased the risk of infectious complications. There were no significant differences in ATRS and AOFAS scores between different primary Achilles tendon repair techniques (p &gt; 0.05).Discussion Results, obtained in the current study, are consistent with previously published data.Conclusions Open Achilles tendon repair showed a higher rate of infections, and lower rate of re-ruptures. The anamnesis of steroid injection, open repair, application of tapes and autografts increases the risk of infectious complications.

Optimizing tendon repair and regeneration: how does the in vivo environment shape outcomes following rupture of a tendon such as the Achilles tendon?

Risk for rupture of the Achilles tendon, and other tendons increases with age. Such injuries of tissues that function in high load environments generally are believed to heal with variable outcome. However, in many cases, the healing does not lead to a good outcome and the patient cannot return to the previous level of participation in active living activities, including sports. In the past few years, using proteomic approaches and other biological techniques, reports have appeared that identify biomarkers that are prognostic of good outcomes from healing, and others that are destined for poor outcomes using validated criteria at 1-year post injury. This review will discuss some of these recent findings and their potential implications for improving outcomes following connective tissue injuries, as well as implications for how clinical research and clinical trials may be conducted in the future where the goal is to assess the impact of specific interventions on the healing process, as well as focusing the emphasis on regeneration and not just repair.

Influencing factors on effectiveness of reverse total shoulder arthroplasty

To summarize the influencing factors on the effectiveness of reverse total shoulder arthroplasty (RTSA), so as to provide reference for clinical treatment. The related research literature of RTSA at home and abroad was extensively consulted, and the factors that may affect the effectiveness were summarized from the aspects of surgical technique, muscle condition, general condition of patients, psychological expectation, and lifestyle. For surgical techniques, different surgical approaches have their own advantages. The glenoid notch, poor bone ingrowth, increased bone resorption, and infection would lead to the loosening of glenoid prosthesis. In addition, the neck shaft angle and inclination angle of humeral prosthesis affect the occurrence of glenoid notch and the range of motion of joint internal/external rotation after operation, respectively. For muscle condition, the quality of teres minor and deltoid muscle has an important influence on joint stability after operation. Moderate increase of deltoid muscle tension can improve joint mobility after operation, and suture repair of subscapular tendon during operation can relieve joint pain and improve function, range of motion, and strength. For the general condition of patients, gender, age, and body mass index are all related to postoperative joint function and complications, and different occupations and postoperative exercise levels affect the recovery. The patients with severe degenerative diseases, poor preoperative function, and long disease duration have lower expectations and higher satisfaction with the effectiveness, and bad lifestyle has a negative impact on the effectiveness. The effectiveness of RTSA is related to surgical technique, muscle condition, general condition of patients, psychological expectation, and lifestyle. In order to avoid the loosening of glenoid prosthesis, the operator should choose humeral prosthesis with small neck shaft angle and large glenoid ball and put them down and inclined inferiorly during operation, and choose appropriate approach to eliminate space with drainage to reduce the risk of infection. After operation, patients should avoid activities that generate high anterior and posterior shear forces. In addition, the humeral prosthesis with a inclination angle of 10°-20° can achieve the best balance between the range of internal rotation and external rotation after operation. Proper deltoid tension can maintain joint stability and good range of motion. Suture of subscapular tendon is recommended.

A Combined Treatment of BMP2 and Soluble VEGFR1 for the Enhancement of Tendon-Bone Healing by Regulating Injury-Activated Skeletal Stem Cell Lineage

Background: Bone morphogenetic protein 2 (BMP2) is an appealing osteogenic and chondrogenic growth factor for promoting tendon-bone healing. Recently, it has been reported that soluble vascular endothelial growth factor (VEGF) receptor 1 (sVEGFR1) (a VEGF receptor antagonist) could enhance BMP2-induced bone repair and cartilage regeneration; thus, their combined application may represent a promising treatment to improve tendon-bone healing. Moreover, BMP2 could stimulate skeletal stem cell (SSC) expansion and formation, which is responsible for wounded tendon-bone interface repair. However, whether the codelivery of BMP2 and sVEGFR1 increases tendon enthesis injury–activated SSCs better than does BMP2 alone needs further research. Purpose: To study the effect of BMP2 combined with sVEGFR1 on tendon-bone healing and injury-activated SSC lineage. Study Design: Controlled laboratory study. Methods: A total of 128 C57BL/6 mice that underwent unilateral supraspinatus tendon detachment and repair were randomly assigned to 4 groups: (1) untreated control group; (2) hydrogel group, which received a local injection of the blank hydrogel at the injured site; (3) BMP2 group, which received an injection of hydrogel with BMP2; and (4) BMP2 with sVEGFR1 group, which received an injection of hydrogel with BMP2 and sVEGFR1. Histology, micro–computed tomography, and biomechanical tests were conducted to evaluate tendon-bone healing at 4 and 8 weeks after surgery. In addition, flow cytometry was performed to detect the proportion of SSCs and their downstream differentiated subtypes, including bone, cartilage, and stromal progenitors; osteoprogenitors; and pro-chondrogenic progenitors within supraspinatus tendon enthesis at 1 week postoperatively. Results: The repaired interface in BMP2 with sVEGFR1 group showed a significantly improved collagen fiber continuity, increased fibrocartilage, greater newly formed bone, and elevated mechanical properties compared with the other 3 groups. There were more SSCs; bone, cartilage, and stromal progenitors; osteoprogenitors; and pro-chondrogenic progenitors in the BMP2 with sVEGFR1 group than that in the other groups. Conclusion: Our study suggests that the combined delivery of BMP2 and sVEGFR1 could promote tendon-bone healing and stimulate the expansion of SSCs and their downstream progeny within the injured tendon-bone interface. Clinical Relevance: Combining BMP2 with sVEGFR1 may be a good clinical treatment for wounded tendon enthesis healing.

Current clinical opinion on surgical approaches and rehabilitation of hand flexor tendon injury-a questionnaire study.

The management of flexor tendon injury has seen many iterations over the years, but more substantial innovations in practice have been sadly lacking. The aim of this study was to investigate the current practice of flexor tendon injury management, and variation in practice from the previous reports, most troublesome complications, and whether there was a clinical interest in potential innovative tendon repair technologies. An online survey was distributed via the British Society for Surgery of the Hand (BSSH) and a total of 132 responses were collected anonymously. Results showed that although most surgeons followed the current medical recommendation based on the literature, a significant number of surgeons still employed more conventional treatments in clinic, such as general anesthesia, ineffective tendon retrieval techniques, and passive rehabilitation. Complications including adhesion formation and re-rupture remained persistent. The interest in new approaches such as use of minimally invasive instruments, biodegradable materials and additive manufactured devices was not strong, however the surgeons were potentially open to more effective and economic solutions.

Low Tensile Strength Suture With Transosseous Tunnels and Suture Anchors 5 mm in Diameter or Greater Are Associated With Higher Failure Rates in Primary Patellar Tendon Repair

To determine the rate of and risk factors for clinical failure and return to military duty following primary patellar tendon repair with either transosseous trunnel repair or suture anchor repair. The Military Health System Data Repository (MDR) was queried to identify all adult patients undergoing surgical treatment of a patellar tendon rupture in the Military Health System from 2014 to 2018. Patients who underwent either transosseous tunnel repair or suture anchor repair were included. Health records were examined to collect additional data. Univariate analysis and multivariate logistic regression models were used to determine independent risk factors for rerupture. A total of 450 knees in 437 patients were included. Transosseous tunnel repair was the most frequently used technique (314/450, 77%), followed by suture anchor repair (113/450, 25%). Rerupture occurred in 33 knees (7%). There was no difference in rerupture rate between transosseous tunnel repair and suture anchor repair (P= .15), and this result persisted within the multivariate logistic regression model. Among transosseous tunnel repairs, use of low tensile strength suture was an independent risk factor for repair failure (odds ratio [OR], 3.4; P= .016). Among suture anchor repairs, use of anchors 5.0 mm in diameter or greater (OR, 12.0; P= .027) was an independent risk factor for repair failure. There is no statistically significant difference in failure rate between transosseous tunnel repair and suture anchor repair in primary patellar tendon ruptures. However, the use of low tensile strength suture with transosseous tunnels and the use of suture anchors 5.0 mm in diameter or greater resulted in significantly higher failure rates. These data suggest that use of high tensile strength suture in transosseous tunnel repair and use of suture anchors less than 5.0 mm in diameter in suture anchor repair result in lower failure rate in primary patellar tendon repair. Level III, retrospective cohort study.

The essential role of aligned architecture in decellularized tendon matrix mediated stem cell tenogenic differentiation and tendon repair

Decellularized tendon matrix (DTM) has shown great potential for inducing tenogenic differentiation and facilitating tendon repair. In which, the retained native tendon-derived matrix in DTM is considered as the main factor for these effects. However, whether preservation of the highly aligned architecture of DTM is also essential for tenogenic differentiation and tendon repair has not been well investigated yet. In this study, we prepared aligned DTM (A-DTM), in which the native aligned architecture was preserved and random DTM (R-DTM), in which the native architecture was disrupted. In vitro study indicated that after decellularization procedures, both A- and R-DTM retained most of the tendon extracellular matrix (ECM). In addition, A-DTM exhibited an inherent aligned architecture, whilst, R-DTM showed a random arranged surface topography. Both DTM materials exhibited good biocompatibility for tendon stem/progenitor cells (TSPCs) and adipose stem cells (ASCs). They were able to adhere and proliferate on the DTM materials and maintain high viability. Interestingly, A-DTM promoted longitudinally oriented growth pattern of TSPCs and ASCs, whereas, cells grown on the R-DTM showed a random spreading. Furthermore, both DTM materials induced tenogenic differentiation of TSPCs and ASCs without the addition of any exotic growth factors. However, A-DTM demonstrated a stronger pro-tendon differentiation compared to R-DTM. In vivo study demonstrated that A-DTM combined with TSPCs or ASCs significantly promoted functional repair of injured Achilles tendon while reducing fibrovascular scar and heterotopic ossification (HO) formation. Taken together, these results indicated that aligned architecture of DTM is essential for stem cell tenogenic differentiation and tendon repair. Thus, for the application of DTM, it is very important to preserve its native aligned architecture. In another scenario, when DTM was used to prepared a composite biomaterial, a tendon-mimic topography should be re-constructed.

A human acellular dermal matrix coated with zinc oxide nanoparticles accelerates tendon repair in patients with hand flexor tendon injuries in zone 5 of the hand.

Flexor tendon injuries are common and require surgery. Acellular dermal matrix (ADM) is a natural graft used to repair tissues, though infections represent the primary cause of its therapeutic failure. In this study, zinc oxide nanoparticles (ZnO-NPs) were coated on the ADM in order to add antibacterial potential as well as enhance healing properties. Also, the produced ADM/ZnO-NPs graft was applied to accelerate fifth zone flexor tendon repair following the reconstructive surgery. Morphological, mechanical, cell viability, and antibacterial tests were performed to evaluate the physical and biological properties of the fabricated ADM/ZnO-NPs graft. For clinical evaluations, 20 patients with a flexor tendon injury in zone 5 were randomly divided into control and treatment with ADM/ZnO-NPs groups (n=10 each). The control group had routine reconstructive surgery, while the other group received the ADM/ZnO- NPs graft during their surgery. Postoperative functional outcomes were evaluated 4, 6, and 8 weeks following the tendon repair surgery according to the Buck-Gramcko II criteria. The ADM/ZnO-NPs had natural derm specifications as well as dense and integrated morphology with intermediate antibacterial properties. According to the Buck- Gramcko II criteria, the postoperative functional outcome scores were significantly higher in the ADM/ZnO-NPs group in comparison with the control group at 4 (P<0.01), 6 (P<0.01), and 8 (P<0.001) weeks after the surgery. The present findings revealed that the ADM/ZnO-NPs graft can accelerate the healing of the damaged tendon without common post-operative functional complications and adhesions following the tendon repair surgery. However, more comprehensive clinical trials are still needed.

Smokers Achieved Minimal Clinically Important Difference for Visual Analog Scale and American Shoulder and Elbow Surgeons Scores at a Lower Rate Than Nonsmokers Even When Repaired Supraspinatus Tendons Were Intact on Postoperative Magnetic Resonance Imaging

To investigate the impact of smoking on clinical outcomes after repair of supraspinatus tendon in patients who had an intact repair found on postoperative magnetic resonance imaging. Patients who received primary complete repair of supraspinatus tendon tear between 2014 and 2020 were retrospectively identified. Patients were excluded if a postoperative magnetic resonance imaging scan was not available or if the follow-up was less than 2 years. Visual analog score (VAS), American Shoulder and Elbow Surgeons (ASES) score, and active forward flexion were assessed at the 2-year follow-up. The percentage of patients acquiring minimal clinically important difference (MCID) was reported. One hundred primary supraspinatus tendon repairs were included. The healing rate was 77% in smokers and 90% in nonsmokers. Smoking was the independent predictor of a poorer 2-year VAS (P < .001) and ASES (P < .001) scores. Significant improvement in clinical outcomes was observed between preoperation and the 2-year follow-up, regardless of the integrity of the repair or smoking status (P < .001). When the repaired tendon was intact, nonsmokers had a greater chance of achieving MCID in 2-year VAS and ASES scores than smokers. Ninety-nine percent of nonsmokers, compared with 82% of smokers, achieved MCID in VAS at the 2-year follow-up (P= .023). The corresponding figures for ASES were 98% and 71%, respectively (P= .004). In this study, smoking was associated with poorer clinical outcomes, including a greater 2-year VAS pain score and a lower 2-year ASES score, when compared with nonsmokers, even in cases in which there was no full-thickness retear of the repaired supraspinatus tendon. Level III, retrospective cohort study.

Ultrasound Percutaneous Tenotomy: An Intervention for Managing Lateral Epicondylitis: A Narrative Review

A growing emphasis is being focused on percutaneous ultrasonic tenotomy for expedited recovery from lateral epicondylitis (LE) and enhanced functionality. The TX1 tissue removal system, also known as the Tenex device from Tenex device (Tenex Health Inc., Lake Forest, CA, USA), notably excels in the management of chronic LE. Utilizing ultrasonic energy, this device offers three tips, namely, TX1, TX2, and TXBone-introducing novel avenues, for determining the previously inaccessible tendon pathology. The procedure disrupts degenerated segments, which creates fenestrations that induce local hemorrhage and the release of vasoactive substances. The overarching goal of Tenex is to boost vascularity through the initiation of tendon repair via the deposition of new collagen and elimination of necrotic tissues. This review assesses Tenex’s effectiveness though gathering information, aiming to understand how it helps doctors and other healthcare professionals in their work.

Pickleball- and Paddleball-Related Injuries in the Lower Extremity: Description, Treatment Options, and Return to Play.

Background Pickleball and paddleball are the fastest-growing sports in the United States. However, there are limited studies on the types of lower extremity injuries and treatment options in an outpatient clinic setting. Hypothesis/purpose This study reports the incidence rate, treatments, and return-to-play (RTP) outcomes for patients presenting to a single orthopedic outpatient center with pickleball- and paddleball-related lower extremity injuries. Study design This study is a retrospective case series, with level IV evidence. Methods A database search of our multispecialty electronic medical record (EMR) system from 2015 to 2023 identified 166 patients with outpatient pickleball- and paddleball-related lower extremity injuries. The retrospective data were reviewed for patient demographics, injury type, mechanism of injury,surgical or non-surgical treatment, and return-to-play recommendations. Results We observed that the majority of the patients with pickleball- and paddleball-related injuries in the lower extremities were over 60 years of age, with more males. Additionally, most injuries encountered were ankle sprain/strain from a twisting mechanism, which was treated non-surgically.Additionally, a significant number of patients suffered an Achilles tendon rupture (12.0%), which was treated surgically with an Achilles tendon repair (88.1%), accounting for the most common surgical treatment performed in this study. Of the 166 patients who were seen and treated, 68 (40.9%) returned to play, and 93 (56.3%) were lost to follow-up. Conclusion Most of these injuries were seen in the older population and caused by a sprain or strain due to sudden changes in direction, which were treated non-surgically. The most common surgical treatment was an Achilles tendon repair due to an Achilles tendon rupture. Although a relatively good number of patients were cleared to return to play, some patients were lost to follow-up. Meanwhile, some patients were advised to stop playing pickleball or paddleball due to the severity of their injuries. As this sport continues to rise in popularity and with the incidence rate of lower extremity injuries increasing over time, orthopedic surgeons should be aware of the types of injuries, treatment options, and outcomes, as well as ways to advise patients on prevention. Therefore, further research on the standard treatments and outcomes of pickleball- and paddleball-related injuries in the lower extremities is encouraged.

In Situ Construction of Morphologically Different Hydroxyapatite-Mineralized Structures on a Three-Dimensional Bionic Chitin Scaffold.

Slow healing at the tendon-bone interface is a prominent factor in the failure of tendon repair surgeries. The development of functional biomaterials with 3D gradient structures is urgently needed to improve tendon-bone integration. The crystalline form of hydroxyapatite (HAP) has a crucial impact on cell behavior, which directly influences protein adsorption, such as bone morphogenetic protein 2, the adhesion, proliferation, and osteogenic differentiation with cells. This work aimed to generate gradient mineral structures in situ by stabilizing calcium and phosphate ions using a polymer-induced liquid precursor process. To regulate the crystalline growth of HAP at the interface of β-chitin, this work made use of the surface properties of the organic matrix found in cuttlefish bone. These techniques allowed us to prepare an organic-inorganic composite gradient scaffold comprising plate-like HAP mineralized in situ on the surface of the scaffold and fibrous HAP in the scaffold's interior. Organic-inorganic composite gradient materials are anticipated for use in tendon-bone healing produced via the in situ construction of gradient-distributed HAP mineralization layers having varying crystalline morphologies on chitin scaffolds that possess a three-dimensional bionic structure.

Treatment of Tendon Injuries in the Servicemember Population across the Spectrum of Pathology: From Exosomes to Bioinductive Scaffolds.

Tendon injuries in military servicemembers are one of the most commonly treated nonbattle musculoskeletal injuries (NBMSKIs). Commonly the result of demanding physical training, repetitive loading, and frequent exposures to austere conditions, tendon injuries represent a conspicuous threat to operational readiness. Tendon healing involves a complex sequence between stages of inflammation, proliferation, and remodeling cycles, but the regenerated tissue can be biomechanically inferior to the native tendon. Chemical and mechanical signaling pathways aid tendon healing by employing growth factors, cytokines, and inflammatory responses. Exosome-based therapy, particularly using adipose-derived stem cells (ASCs), offers a prominent cell-free treatment, promoting tendon repair and altering mRNA expression. However, each of these approaches is not without limitations. Future advances in tendon tissue engineering involving magnetic stimulation and gene therapy offer non-invasive, targeted approaches for improved tissue engineering. Ongoing research aims to translate these therapies into effective clinical solutions capable of maximizing operational readiness and warfighter lethality.

Investigation of the barriers to and functional outcomes of telerehabilitation in patients with hand injury

BackgroundTelerehabilitation is an approach that is growing in importance and rapidly becoming more prevalent. However, the potential barriers to this approach and its effectiveness relative to face-to-face treatment still need to be determined. PurposeThe aim of this study was to investigate the technology and access barriers, implementation and organizational challenges, and communication barriers faced by patients undergoing postoperative telerehabilitation after hand tendon repair surgery. It also aimed to investigate the effect of telerehabilitation on pain, kinesiophobia, and functional outcomes. Study designProspective, open-label, nonrandomized comparative clinical study. MethodsThe study was conducted with 44 patients who underwent tendon repair surgery due to tendon injuries of the extrinsic muscles of the hand. Participants were divided into two groups (face-to-face group and telerehabilitation group). All participants received three physiotherapy sessions per week for 8 weeks from their surgery (via video conference using mobile phones to the telerehabilitation group). An early passive motion protocol was applied for flexor tendon and zone 5-7 extensor tendon repairs. Mallet finger rehabilitation was performed for zone 2 extensor tendon repairs, while an early active short arc approach was used for zone 3-4 repairs. The telerehabilitation and face-to-face groups received the same treatment protocols three times a week. In the eighth week of treatment (in the 24th session), the Turkish version of the Arm, Shoulder, and Hand Injury Questionnaire (DASH-T) and Tampa Scale for Kinesiophobia were administered to all patients. The telerehabilitation group also underwent a barrier questionnaire. A pretreatment assessment could not be conducted. The independent-sample t-test was used for DASH-T data, and the Mann-Whitney U-test was used for Tampa Scale for Kinesiophobia to compare groups. ResultsIn the study, there were 24 participants (age: 31.58 ± 12.02 years) in the face-to-face group and 20 participants (age: 39.25 ± 12.72 years) in the telerehabilitation group. The two groups were similar in terms of DASH-T and pain (p = 0.103, effect size = 0.647, and p = 0.086, effect size = 0.652, respectively) in the 8 weeks. However, the telerehabilitation group had a higher fear of movement (p = 0.017, effect size = 3.265). The most common barriers to telerehabilitation practices were the fear of damaging the tendon repair and the need for help during the treatment. ConclusionsWe determined that face-to-face treatment in acute physiotherapy for patients who have undergone tendon repair may be more effective compared to telerehabilitation, as it appears to be less likely to induce kinesiophobia. However, in situations where face-to-face treatment is not possible (such as lockdown), telerehabilitation can also be preferred after at least one in-person session to teach and perform exercises.

Biomechanical and histological evaluation of aspirin in rotator cuff tear rat model.

Background: Aspirin is a representative non-steroidal anti-inflammatory drug (NSAIDs) and has been commonly used for the treatment of tendinopathy in clinical practice. In this study, we aimed to evaluate the biomechanical and histological healing effects of aspirin on the healing of the tendon-to-bone interface after rotator cuff tear repair. Methods: A total of 20 male Sprague-Dawley rats were randomly divided into two groups of 10 rats each. Group-C performed repaironly, and group-aspirin treated with aspirin after tendon repair. Group-aspirin rat were intraperitoneally injected with aspirin at 10mg/kg every 24h for 7days. Eight weeks after surgery, the left shoulder of each rat was used for histological analysis and the right shoulder for biomechanical analysis. Results: In the biomechanical analysis, there was no significant difference in load-to-failure (group-C: 0.61 ± 0.32N, group-aspirin: 0.74 ± 0.91N; p = .697) and ultimate stress (group-C: 0.05 ± 0.01MPa, group-aspirin: 0.29 ± 0.43MPa; p = .095). For the elongation (group-C: 222.62 ± 57.98%, group-aspirin: 194.75 ± 75.16%; p = .028), group-aspirin confirmed a lower elongation level than group-C. In the histological evaluation, the Bonar score confirmed significant differences in collagen fiber density (group-C: 1.60 ± 0.52, group-aspirin: 2.60 ± 0.52, p = .001) and vascularity (group-C: 1.00 ± 0.47, group-aspirin: 2.20 ± 0.63, p = .001) between the groups. Conclusions: Aspirin injection after rotator cuff tear repair may enhance the healing effect during the early remodeling phase of tendon healing.