Treatment Of Tendon Injuries Research Articles

The effects of dexamethasone on human patellar tendon stem cells: Implications for dexamethasone treatment of tendon injury

Injection of Dexamethasone (Dex) is commonly used in clinics to treat tendon injury such as tendinopathy because of its anti-inflammatory capabilities. However, serious adverse effects have been reported as a result of Dex treatment, such as impaired tendon healing and tendon rupture. Using both in vitro and in vivo approaches, this study was to determine the effects of Dex treatment on the proliferation and differentiation of human tendon stem cells (hTSCs), which can directly impact tendon healing. We found that Dex treatment stimulated cell proliferation at lower concentrations (<1,000 nM), whereas a high concentration (1,000 nM) decreased cell proliferation. Moreover, at all concentrations used (5, 10, 100, and 1,000 nM), Dex treatment induced non-tenocyte differentiation of hTSCs, as evidenced by a change in cell shape, a nearly complete suppression of collagen type I expression, and an upregulation of non-tenocyte related genes (PPARγ and Sox-9), which was especially evident when higher concentrations (>10 nM) of Dex were used. Implantation of Dex-treated hTSCs for a short time (3 weeks) resulted in the extensive formation of fatty tissues, cartilage-like tissues, and bony tissues. These findings suggest that Dex treatment in clinics may cause a paradoxical effect on the injured tendons it is supposed to treat: by inducing non-tenocyte differentiation of hTSCs, Dex treatment depletes the stem cell pool and leads to the formation of non-tendinous tissues (e.g., fatty and cartilage-like tissues), which make tendon susceptible to rupture.

Evaluation of the effect of static magnetic field in treatment of tendon injuries in dog

To assess the effect of magnetic field in experimental tendon injuries, ten clinically healthy adult indigenous dogs were divided into two equal groups (control and experimental). The left superficial digital flexor tendon was exposed and three windows of 6 mm thickness, 3 mm length, and 2 mm intervals were made under general anesthesia. In the experimental group, the dogs were subjected to a magnetic field of 6 × 800 G for 30 days. The tendon biopsy was collected from the site of operation on the postoperative day 30. Histomorphological changes indicated low rate of inflammatory cells, high rate of mature fibroblast, and increased normal collagen fibers, and these were better in the experimental group. The biomechanical test revealed that the tendons of the dogs in the experimental group were more resistant than tendons of the dogs in the control group. The result of this study indicated that magnetic field therapy reduced edema and local swelling, enhanced proliferation of fibroblasts, and regulated arrangement of collagen fibers, providing a good noninvasive physical therapy for tendinous injuries.

Smad8/BMP2‐engineered mesenchymal stem cells induce accelerated recovery of the biomechanical properties of the achilles tendon

Tendon tissue regeneration is an important goal for orthopedic medicine. We hypothesized that implantation of Smad8/BMP2-engineered MSCs in a full-thickness defect of the Achilles tendon (AT) would induce regeneration of tissue with improved biomechanical properties. A 2 mm defect was created in the distal region of murine ATs. The injured tendons were then sutured together or given implants of genetically engineered MSCs (GE group), non-engineered MSCs (CH3 group), or fibrin gel containing no cells (FG group). Three weeks later the mice were killed, and their healing tendons were excised and processed for histological or biomechanical analysis. A biomechanical analysis showed that tendons that received implants of genetically engineered MSCs had the highest effective stiffness (>70% greater than natural healing, p < 0.001) and elastic modulus. There were no significant differences in either ultimate load or maximum stress among the treatment groups. Histological analysis revealed a tendon-like structure with elongated cells mainly in the GE group. ATs that had been implanted with Smad8/BMP2-engineered stem cells displayed a better material distribution and functional recovery than control groups. While additional study is required to determine long-term effects of GE MSCs on tendon healing, we conclude that genetically engineered MSCs may be a promising therapeutic tool for accelerating short-term functional recovery in the treatment of tendon injuries.

Low‐level laser therapy in collagenase‐induced Achilles tendinitis in rats: Analyses of biochemical and biomechanical aspects

NSAIDs are widely prescribed and used over the years to treat tendon injuries despite its well-known long-term side effects. In the last years several animal and human trials have shown that low-level laser therapy (LLLT) presents modulatory effects on inflammatory markers, however the mechanisms involved are not fully understood. The aim of this study was to evaluate the short-term effects of LLLT or sodium diclofenac treatments on biochemical markers and biomechanical properties of inflamed Achilles tendons. Wistar rats Achilles tendons (n = 6/group) were injected with saline (control) or collagenase at peritendinous area of Achilles tendons. After 1 h animals were treated with two different doses of LLLT (810 nm, 1 and 3 J) at the sites of the injections, or with intramuscular sodium diclofenac. Regarding biochemical analyses, LLLT significantly decreased (p < 0.05) COX-2, TNF-α, MMP-3, MMP-9, and MMP-13 gene expression, as well as prostaglandin E(2) (PGE(2) ) production when compared to collagenase group. Interestingly, diclofenac treatment only decreased PGE(2) levels. Biomechanical properties were preserved in the laser-treated groups when compared to collagenase and diclofenac groups. We conclude that LLLT was able to reduce tendon inflammation and to preserve tendon resistance and elasticity.

Corticosteroids and Local Anesthetics Decrease Positive Effects of Platelet-Rich Plasma: An In Vitro Study on Human Tendon Cells

To determine the effects of mixing anesthetics or corticosteroids with platelet-rich plasma (PRP) on human tenocytes in vitro. Two separate protocols (double spin and single spin) were used to obtain homologous PRP from the blood of 8 healthy volunteers. Discarded tendon acquired during biceps tenodesis served as tendon specimens for all experiments. After cell isolation, tenocytes were treated in culture with PRP alone or in combination with corticosteroids and/or anesthetics. Fetal bovine serum in concentrations of 2% and 10% served as controls. Cell exposure times of 5, 10, and 30 minutes were used. Radioactive thymidine and luminescence assays were obtained to examine cell proliferation and viability. The presence of lidocaine, bupivacaine, or methylprednisolone resulted in significantly less proliferation than the negative 2% fetal bovine serum control (P < .05). When we compared groups, both lidocaine and bupivacaine had a greater inhibitory effect than methylprednisolone (P < .05). At all time points, viability was significantly decreased in the presence of lidocaine, bupivacaine, or methylprednisolone compared with the negative control (P < .05). The addition of either anesthetics or corticosteroids to PRP resulted in statistically significant decreases in tenocyte proliferation and cell viability. These results suggest that incorporation of anesthetics or corticosteroids, either alone or in combination, with PRP injection may compromise the potentially beneficial in vitro effects of isolated PRP on tendon cells and compromise cell viability at the site of tendon injury. Anesthetics or corticosteroids either alone or in combination should be used carefully to preserve the proposed positive effects of PRP in the treatment of tendon injury.

Umbilical Cord Perivascular Cells: A Mesenchymal Cell Source for Treatment of Tendon Injuries

Objective: To model the healing that umbilical cord perivascular cells effect in equines, we have used human umbilical cord perivascular cells (HUCPVCs) to repair tendon damage in a collagenase tendon injury model in immune- compromised rats. Animals: 48 Nude rats (Crl:NIH-Foxn1 rnu ) of 200-250 g weight were used. Procedure: The Achilles tendon was exposed by blunt dissection and, using a 30G needle, 30 µl of either a mixture of cells (2 x10 5 ) and collagenase, or collagenase alone, was injected close to the musculotendinous junction in the direction of the osteotendinous junction. Results: Harvested tendons showed the presence of HUCPVCs at the site of injury, whose morphology changed from ovoid to elongated over the 30 post-injury experimental time period. Human genes for collagen type 1 and β-actin were expressed at all time points and there was also a significant increase in tendon tensile strength and stiffness by 30 days post-injury in the experimental group. Conclusion: HUCPVCs facilitated regeneration in our model through changes in collagen organization; cell shape and orientation; and increase in mechanical properties over those of the untreated controls. Clinical Relevance: Cell therapy has been shown to be effective in treating tendon injuries, especially in equines. We have recently isolated a mesenchymal cell population from equine umbilical cords that is analogous to a well-characterized HUCPVC population. Our results indicate that HUCPVCs are a putative cell source for treating tendon injuries; and this model could explain the benefits of using analogous cells in equines.

Polarity effect of microcurrent electrical stimulation on tendon healing: Biomechanical and histopathological studies

The purpose of the current study was to investigate the effect of microcurrent electrical stimulation (MES) applied with different polarity on the biomechanical properties of injured tendons and to correlate results with histopathological studies. Ninety six male white New Zealand rabbits were used in the study. Six rabbits were kept as normal group with intact tendons and the remaining 90 rabbits with their right Achilles tendons tenotomized, sutured and immobilized. After that rabbits were allocated into equal three groups; cathodal, anodal and control. Each group was further subdivided into three subgroups according to the study period; 3, 5 and 8weeks. There were significant increases of all biomechanical measurements for cathodal and anodal groups than those of control group at all study periods. Furthermore there were significant increases of all biomechanical measurements in the cathodal group more than the anodal group at the 3week period, while there was significant increase of the anodal group more than the cathodal at 5 and 8week periods. The histopathological findings supported the biomechanical results. Tendons in cathode group showed better healing picture compared to those of anodal group at third week. While tendons in the anodal group showed better improvement at the 5 and 8week. MES improved the healing process of tendon and the polarity of MES could be an important factor to be considered in treating tendon injuries.

The effect of anisotropic collagen-GAG scaffolds and growth factor supplementation on tendon cell recruitment, alignment, and metabolic activity

Current surgical and tissue engineering approaches for treating tendon injuries have shown limited success, suggesting the need for new biomaterial strategies. Here we describe the development of an anisotropic collagen-glycosaminoglycan (CG) scaffold and use of growth factor supplementation strategies to create a 3D platform for tendon tissue engineering. We fabricated cylindrical CG scaffolds with aligned tracks of ellipsoidal pores that mimic the native physiology of tendon by incorporating a directional solidification step into a conventional lyophilization strategy. By modifying the freezing temperature, we created a homologous series of aligned CG scaffolds with constant relative density and degree of anisotropy but a range of pore sizes (55–243 μm). Equine tendon cells showed greater levels of attachment, metabolic activity, and alignment as well as less cell-mediated scaffold contraction, when cultured in anisotropic scaffolds compared to an isotropic CG scaffold control. The anisotropic CG scaffolds also provided critical contact guidance cues for cell alignment. While tendon cells were randomly oriented in the isotropic control scaffold and the transverse (unaligned) plane of the anisotropic scaffolds, significant cell alignment was observed in the direction of the contact guidance cues in the longitudinal plane of the anisotropic scaffolds. Scaffold pore size was found to significantly influence tendon cell viability, proliferation, penetration into the scaffold, and metabolic activity in a manner predicted by cellular solids arguments. Finally, the addition of the growth factors PDGF-BB and IGF-1 to aligned CG scaffolds was found to enhance tendon cell motility, viability, and metabolic activity in dose-dependent manners. This work suggests a composite strategy for developing bioactive, 3D material systems for tendon tissue engineering.

Equine embryonic stem‐like cells and mesenchymal stromal cells have different survival rates and migration patterns following their injection into damaged superficial digital flexor tendon

Injury to the superficial digital flexor tendon (SDFT) is common in racing and sport horses and poor tendon regeneration leads to high reinjury rates. Autologous mesenchymal stromal cells (MSCs) are being used clinically to improve tendon regeneration but they have some practical limitations. Embryonic stem cells (ESCs) may overcome these limitations but their fate following injection into the damaged SDFT is unknown. To inject MSCs and ESCs into distinct areas of damage in the SDFT and monitor their survival over a 3 month period. MSCs and ESCs expressing different reporter genes were injected into separate sites of mechanically induced damage in SDFTs. Cell survival and distribution were examined post mortem after 10, 30, 60 and 90 days and host immune responses determined. Neither MSCs nor ESCs produced signs of cell-mediated immune response or tumour formation. ESC survival was high and numbers were maintained at a constant level over 90 days. ESCs were present at all sites of damage. In contrast, MSCs showed <5% survival at 10 days and numbers declined over the course of the experiment. MSCs were detected only at the site into which they were injected. ESCs survived in greater numbers than MSCs in the damaged tendon and did not induce an immune response, or form tumours at the injection sites in the 90 day time period studied. ESCs also demonstrated an ability to migrate to other areas of damage within the same tendon, whereas MSCs did not. ESCs can be used allogeneically, therefore providing a possible 'off the shelf' source of cells for therapeutic use which overcomes the practical limitations of autologous MSCs. Furthermore, MSCs and ESCs have different survival rates and migration patterns in the damaged tendon, suggesting that they may produce different functional effects. This may have clinical relevance to treating tendon injuries in the horse.

Collagen changes and realignment induced by low‐level laser therapy and low‐intensity ultrasound in the calcaneal tendon

The treatment of calcaneal tendon injuries requires long-term rehabilitation. Ultrasound (US) and low-level laser therapy (LLLT) are the most used and studied physical agents in the treatment of tendon injuries; however, only a few studies examined the effects of the combination of US and LLLT. Therefore, the purpose of this study was to investigate which treatment (the exclusive or combined use of US and LLLT) most effectively contribute to tendon healing. This was a controlled laboratory study with 50 rats whose Achilles tendon was injured by direct trauma. The rats were randomly divided into five groups and treated for 5 consecutive days, as follows: group 1 (control) received no treatment; group 2 was treated with US alone; group 3 was treated with LLLT alone; group 4 was treated first with US followed by LLLT; and group 5 was treated first with LLLT followed by US. On the sixth post-injury day, the tendons were removed and examined by polarized light microscopy. The organization of collagen fibers was assessed by birefringence measurements. Picrosirius-stained sections were examined for the presence of types I and III collagen. There was a significantly higher organization of collagen fibers in group 2 (US) than in the control group (P = 0.03). The amount of type I collagen found in groups 2 (US), 3 (LLLT), and 5 (LLLT + US) was significantly higher than that in the control group (P <or= 0.01), but no significant differences were found between treatment groups. There were no differences in the amount of type III collagen between groups. Ultrasound, LLLT, and the combined use of LLLT and US resulted in greater synthesis of type I collagen; US was also effective in increasing collagen organization in the early stages of the healing process.

Low Level Laser Treatment of Tendinopathy: A Systematic Review with Meta-analysis

To assess the clinical effectiveness of Low Level Laser Therapy (LLLT) in the treatment of tendinopathy. Secondary objectives were to determine the relevance of irradiation parameters to outcomes, and the validity of current dosage recommendations for the treatment of tendinopathy. LLLT is proposed as a possible treatment for tendon injuries. However, the clinical effectiveness of this modality remains controversial, with limited agreement on the most efficacious dosage and parameter choices. The following databases were searched from inception to 1(st) August 2008: MEDLINE, PubMed, CINAHL, AMED, EMBASE, All EBM reviews, PEDro (Physiotherapy Evidence Database), SCOPUS. Controlled clinical trials evaluating LLLT as a primary intervention for any tendinopathy were included in the review. Methodological quality was classified as: high (> or =6 out of 10 on the PEDro scale) or low (<6) to grade the strength of evidence. Accuracy and clinical appropriateness of treatment parameters were assessed using established recommendations and guidelines. Twenty-five controlled clinical trials met the inclusion criteria. There were conflicting findings from multiple trials: 12 showed positive effects and 13 were inconclusive or showed no effect. Dosages used in the 12 positive studies would support the existence of an effective dosage window that closely resembled current recommended guidelines. In two instances where pooling of data was possible, LLLT showed a positive effect size; in studies of lateral epicondylitis that scored > or =6 on the PEDro scale, participants' grip strength was 9.59 kg higher than that of the control group; for participants with Achilles tendinopathy, the effect was 13.6 mm less pain on a 100 mm visual analogue scale. LLLT can potentially be effective in treating tendinopathy when recommended dosages are used. The 12 positive studies provide strong evidence that positive outcomes are associated with the use of current dosage recommendations for the treatment of tendinopathy.

Computerised analysis of standardised ultrasonographic images to monitor the repair of surgically created core lesions in equine superficial digital flexor tendons following treatment with intratendinous platelet rich plasma or placebo

The effectiveness of new therapies to treat tendon injuries is difficult to determine and is often based on semi-quantitative methods, such as grey level analysis of ultrasonographic images or subjective pain scores. The alternatives are costly and long-lasting end-stage studies using experimental animals. In this study, a method of ultrasonographic tissue characterisation (UTC), using mathematical analysis of contiguous transverse ultrasonographic images, was used for intra-vital monitoring of the healing trajectory of standardised tendon lesions treated with platelet rich plasma (PRP) or placebo. Using UTC it was possible to detect significant differences between the groups in the various phases of repair. At end stage, over 80% of pixels showed correct alignment in the PRP group, compared with just over 60% in the placebo group (P<0.05). UTC also showed significant differences in the course of the healing process between PRP treated and placebo treated animals throughout the experiment. It was concluded that computerised analysis of ultrasonographic images is an excellent tool for objective longitudinal monitoring of the effects of treatments for superficial digital flexor tendon lesions in horses.

Ultrasound Evaluation of Stem Cell Treated Tendon Injuries in the Horse: Repair or Regeneration?

Ultrasonography is widely used in the diagnosis and monitoring of equine tendon injuries. More recently it has been used to perform ultrasound guided intra-lesional administration of growth factor and cell based therapies including autologus bone marrow derived mesenchymal stem cells (BM-MSCs). Re-injury rates in horses following tendon injury are high with conventional treatment, however the use of BM-MSCs has resulted in a significant reduction in tendon re-injury in National Hunt racehorses. This article reviews the methods of tendon ultrasound used in the horse and the techniques used for BM-MSC therapy to treat tendon injury.

Dexamethasone induces apoptosis in proliferative canine tendon cells and chondrocytes

Dexamethasone (Dexa) has been commonly used in humans and domestic animals, particularly in the treatment of tendon injuries and cartilage degeneration. However, it is often associated with tendon rupture and impaired tendon and cartilage healing. In the present study, we investigated Dexa's in vitro effects on the growth of cell proliferation and the induction of apoptosis in canine Achilles tendon cells and chondrocytes. Cell proliferation after treatment with Dexa for two to six days was quantified by a 2,3-bis{2-methoxy-4-nitro-5-sulfophenyl}-2H-tetrazolium-5-carboxyanilide inner salt assay (XTT). The results showed that Dexa could inhibit the proliferation of tendon cells and chondrocytes at increasing concentrations (0.1-50 microg/ml) compared with untreated cells. Cell apoptosis was induced by Dexa, as evidenced by the typical nuclear apoptosis using Hoechst 33258 staining. Dexa increased the apoptosis of canine tendon cells and chondrocytes in a time-dependent manner. In canine tendon cells and chondrocytes that were treated with 25 and 50 microg/ml concentration of Dexa, the number of condensed apoptotic nuclei was significantly increased. In addition, culturing with Dexa and the glucocorticoid receptor blocker, mifepristone, significantly arrested apoptosis of tendon cells and chondrocytes. Based on our in vitro data, we hypothesized that in vivo treatment with glucocorticoids may diminish the proliferation of tendon and cartilage cells by increasing apoptosis and suppressing the proliferation. Our findings suggest that Dexa could be used with caution in dogs with articular or tendon problems.

Bone Marrow-Derived Mesenchymal Stem Cells Influence Early Tendon-Healing in a Rabbit Achilles Tendon Model

A repaired tendon needs to be protected for weeks until it has accrued enough strength to handle physiological loads. Tissue-engineering techniques have shown promise in the treatment of tendon and ligament defects. The present study tested the hypothesis that bone marrow-derived mesenchymal stem cells can accelerate tendon-healing after primary repair of a tendon injury in a rabbit model. Fifty-seven New Zealand White rabbits were used as the experimental animals, and seven others were used as the source of bone marrow-derived mesenchymal stem cells. The injury model was a sharp complete transection through the midsubstance of the Achilles tendon. The transected tendon was immediately repaired with use of a modified Kessler suture and a running epitendinous suture. Both limbs were used, and each side was randomized to receive either bone marrow-derived mesenchymal stem cells in a fibrin carrier or fibrin carrier alone (control). Postoperatively, the rabbits were not immobilized. Specimens were harvested at one, three, six, and twelve weeks for analysis, which included evaluation of gross morphology (sixty-two specimens), cell tracing (twelve specimens), histological assessment (forty specimens), immunohistochemistry studies (thirty specimens), morphometric analysis (forty specimens), and mechanical testing (sixty-two specimens). There were no differences between the two groups with regard to the gross morphology of the tendons. The fibrin had degraded by three weeks. Cell tracing showed that labeled bone marrow-derived mesenchymal stem cells remained viable and present in the intratendinous region for at least six weeks, becoming more diffuse at later time-periods. At three weeks, collagen fibers appeared more organized and there were better morphometric nuclear parameters in the treatment group (p < 0.05). At six and twelve weeks, there were no differences between the groups with regard to morphometric nuclear parameters. Biomechanical testing showed improved modulus in the treatment group as compared with the control group at three weeks (p < 0.05) but not at subsequent time-periods. Intratendinous cell therapy with bone marrow-derived mesenchymal stem cells following primary tendon repair can improve histological and biomechanical parameters in the early stages of tendon-healing.

Bone Marrow-Derived Mesenchymal Stem Cells Influence Early Tendon-Healing in a Rabbit Achilles Tendon Model

Background: A repaired tendon needs to be protected for weeks until it has accrued enough strength to handle physiological loads. Tissue-engineering techniques have shown promise in the treatment of tendon and ligament defects. The present study tested the hypothesis that bone marrow-derived mesenchymal stem cells can accelerate tendon-healing after primary repair of a tendon injury in a rabbit model. Methods: Fifty-seven New Zealand White rabbits were used as the experimental animals, and seven others were used as the source of bone marrow-derived mesenchymal stem cells. The injury model was a sharp complete transection through the midsubstance of the Achilles tendon. The transected tendon was immediately repaired with use of a modified Kessler suture and a running epitendinous suture. Both limbs were used, and each side was randomized to receive either bone marrow-derived mesenchymal stem cells in a fibrin carrier or fibrin carrier alone (control). Postoperatively, the rabbits were not immobilized. Specimens were harvested at one, three, six, and twelve weeks for analysis, which included evaluation of gross morphology (sixty-two specimens), cell tracing (twelve specimens), histological assessment (forty specimens), immunohistochemistry studies (thirty specimens), morphometric analysis (forty specimens), and mechanical testing (sixty-two specimens). Results: There were no differences between the two groups with regard to the gross morphology of the tendons. The fibrin had degraded by three weeks. Cell tracing showed that labeled bone marrow-derived mesenchymal stem cells remained viable and present in the intratendinous region for at least six weeks, becoming more diffuse at later time-periods. At three weeks, collagen fibers appeared more organized and there were better morphometric nuclear parameters in the treatment group (p < 0.05). At six and twelve weeks, there were no differences between the groups with regard to morphometric nuclear parameters. Biomechanical testing showed improved modulus in the treatment group as compared with the control group at three weeks (p < 0.05) but not at subsequent time-periods. Conclusions: Intratendinous cell therapy with bone marrow-derived mesenchymal stem cells following primary tendon repair can improve histological and biomechanical parameters in the early stages of tendon-healing. Clinical Relevance: The findings of the present study have clinical importance as the early time-period during tendon-healing is crucial in the treatment of tendon injuries.

Tendon Tissue Engineering and Gene Transfer: The Future of Surgical Treatment

Technologic improvements in the field of tissue engineering are leading to new potential developments in the currently used approaches to treat tendon injuries including difficult clinical scenarios such as zone II flexor tendon injuries of the hand and the mutilated hand with extensive tendon defects. A combination of mesenchymal (adult stem) cells, growth factors, and bioresorbable polymers can provide a solution for the treatment of difficult tendon injuries. Extensive research is needed to show that the extracellular matrix produced in response to the cell/growth factor/polymer composites in vivo is effective and functional as a regenerate tissue. Further exciting advances are foreseen in cell-based genetic engineering with the transfer of DNA to the site of tendon lacerations. These treatment modalities require improved safety precautions to reduce the risks and enhance the benefits of gene therapy.

Glucocorticoids inhibit tenocyte proliferation and Tendon progenitor cell recruitment

Corticosteroid injection is commonly used to treat tendon injuries but is often associated with tendon rupture and impaired tendon healing. The effects of dexamethasone on tenocytes have been studied in vitro but only using high concentrations of dexamethasone in monolayer cultures of tenocytes over short periods of time. We have therefore investigated the effects of physiological and pharmacological concentrations of dexamethasone on monolayer cultures of tenocytes over extended time periods. We have also used fibroblastic-colony forming unit cultures to examine the effects of dexamethasone on a progenitor cell population located in tendons. Culturing tenocytes in the presence of dexamethasone for a period of 24 days resulted in a concentration-related decrease in cell number and collagen synthesis as compared to control cultures. This effect was time dependent with cell number in both dexamethasone-treated and control cultures leveling off after 14 days with the control cultures reaching higher cell densities. In contrast in control cultures, collagen accumulation continued to increase until week 4, whereas in the presence of dexamethasone, this tended to level off after 14 days. To study the role of progenitor cell recruitment, the effects of dexamethasone were investigated using the fibroblastic-colony forming unit assay. Treatment with dexamethasone at concentrations of 0.1 nM to 10 microM leads to a progressive reduction in mean colony size as compared to control cultures. Colony number remained constant at concentrations below 10 nM but fell progressively at concentrations above this. In conclusion, dexamethasone reduces both cell number and collagen synthesis in tenocyte cultures in a concentration-dependent manner by both direct effects on tenocyte proliferation and collagen accumulation, and also by modulating the recruitment of tendon progenitor cells.

Questions Hand Therapists Ask about Treatment of Tendon Injuries

Management of tendon injuries is a challenging responsibility for the surgeon and the hand therapist. Outcomes are improved by a clear understanding of concepts and indications that are pertinent to the clinical situation. We have given a comprehensive course, Surgical and Therapeutic Management of Flexor and Extensor Tendon Injuries, several times a year at various centers since 1998. The participants’ questions indicate their understanding but also confirm that some concepts are difficult to assimilate and implement. In this article, we address the most frequent questions put forth by therapists, residents, and surgeons. Our intention is to provide practical information that can be applied clinically.

The Use of Growth Factors on Tendon Injuries

Tendon injuries continue to be a vexing clinical problem faced by the upper extremity surgeon. These injuries often lead to disability and dissatisfaction for both the patient and treating physician. Advances throughout the century have focused largely on improvements in surgical techniques and therapy protocols. Recently, attention has been turned to the biologic pathways by which tendons heal and the growth factors involved in this process have been identified. There is great hope that these growth factors may one day be used to treat tendon injuries. This article provides a summary of the use of growth factors on tendon injuries including contemporary research, delivery methods, and future directions in this field.