Treatment Of Tendinopathy Research Articles

Efficacy of platelet-rich plasma injection for pain relief in injured athletes: a systematic review of randomized controlled trials.

Sports injuries involving bi-articular muscles like the hip flexors, hamstrings, quadriceps, and gastrocnemius significantly affect athletes' performance and quality of life. Comprehensive rehabilitation is crucial for a pain-free return to play (RTP). Over the past 15 years, platelet-rich plasma (PRP) has emerged for its potential in tissue regeneration. However, the effects in pain relief and early RTP remained debated. This systematic review of randomized controlled trials (RCTs) aimed to evaluate the efficacy of PRP in pain management for injured athletes. A systematic review searched on PubMed, Scopus, and Web of Science for randomized controlled trials (RCTs) on PRP injections in injured athletes up to May 28, 2024. Studies had to meet the following population, intervention, control and outcome (PICO) criteria: professional athletes treated with leukocyte-rich or leukocyte-poor PRP versus other treatments, with pain measured by visual analogue scale (VAS), numeric rating scale (NRS), or verbal rating scale (VRS) scales. Systematic review registered on PROSPERO (CRD42024552342). Out of total of 1675 articles, we included seven RCTs on PRP treatment for muscle injuries and tendinopathies in athletes. Two studies on hamstring injuries had conflicting results on PRP's efficacy; two studies on different muscles showed significant pain relief and quicker recovery with ultrasound-guided PRP, limited by small sample sizes and lack of double-blind protocols. For tendinopathies, an anterior cruciate ligament reconstruction study with autologous bone-patellar tendon-bone grafts showed significant pain improvements but had a small sample size. Another study on patellar tendinopathy found no PRP benefits over placebo. A third study found long-term improvement with PRP over shockwave therapy for patellar tendinitis, despite design limitations. This systematic review suggested that PRP might aid in pain management for athletes, but high-quality evidence is lacking. Further research with standardized methodologies is needed to confirm the PRP efficacy, which could complement multidisciplinary rehabilitation.

Injectable Nano-Micron AKBA Delivery Platform for Treatment of Tendinopathy in a Rat Model.

Tendinopathy is a disorder characterized by pain and reduced function due to a series of changes in injured or diseased tendons. Inflammation and collagen degeneration are key contributors to the onset and chronic nature of tendinopathy. Acetyl-11-keto-β-boswellic acid (AKBA) is an effective anti-inflammatory agent widely used in chronic inflammatory disorders and holds potential for tendinopathy treatment; however, its therapeutic efficacy is limited by poor aqueous solubility. Here, we fabricated AKBA-encapsulated cationic liposome-gelatin methacrylamide (GelMA) microspheres (GM-Lipo-AKBA) using thin-film hydration and microfluidic technology for drug delivery therapy. GM-Lipo-AKBA exhibited high encapsulation efficiency, extended AKBA release for over 4 weeks, and prolonged degradation. Invitro and invivo experiments demonstrated its effectiveness in improving inflammation and ECM remodeling in tendinopathy. In summary, the injectable nano-micron drug delivery platform provides a promising strategy for the sustained and localized delivery of AKBA for tendinopathy treatment.

Moderate- and High-Speed Treadmill Running Exercise Have Minimal Impact on Rat Achilles Tendon.

Exercise influences clinical Achilles tendon health in humans, but animal models of exercise-related Achilles tendon changes are lacking. Moreover, previous investigations of the effects of treadmill running exercise on rat Achilles tendon demonstrate variable outcomes. Our objective was to assess the functional, structural, cellular, and biomechanical impacts of treadmill running exercise on rat Achilles tendon with sensitive in and ex vivo approaches. Three running levels were assessed over the course of 8 weeks: control (cage activity), moderate-speed (treadmill running at 10 m/min, no incline), and high-speed (treadmill running at 20 m/min, 10° incline). We hypothesized that moderate-speed treadmill running would beneficially impact tendon biomechanics through increased tenocyte cellularity, metabolism, and anabolism whereas high-speed treadmill running would cause a tendinopathic phenotype with compromised tendon biomechanics due to pathologic tenocyte differentiation, metabolism, and catabolism. Contrary to our hypothesis, treadmill running exercise at these speeds had a nominal effect on the rat Achilles tendon. Treadmill running modestly influenced tenocyte metabolism and nuclear aspect ratio as well as viscoelastic tendon properties but did not cause a tendinopathic phenotype. These findings highlight the need for improved models of exercise- and loading-related tendon changes that can be leveraged to develop strategies for tendinopathy prevention and treatment.

Is Platelet-rich Plasma Effective in Treating Achilles Tendinopathy? A Meta-analysis of Randomized Clinical Trials.

Several meta-analyses have evaluated the use of platelet-rich plasma (PRP) in the treatment of Achilles tendinopathy. Although they generally did not find PRP to be effective, an updated meta-analysis containing all the available, high-quality randomized trial evidence that addresses the methodological shortcomings identified in earlier meta-analyses needs to be performed. This systematic review and meta-analysis aimed to evaluate the efficacy of PRP in improving (1) pain and function as assessed using the Victorian Institute of Sports Assessment-Achilles (VISA-A) score 3 months, 6 months, and 1 year after treatment and (2) VAS pain scores 3 months after treatment in patients with chronic Achilles tendinopathy. We conducted a systematic search of PubMed, Scopus, Embase, and Cochrane CENTRAL from their inception until June 2024, focusing on randomized clinical trials (RCTs) comparing PRP with placebo or other treatments for Achilles tendinopathy. Our search identified 1289 studies, of which 1262 were excluded after removing duplicates and screening titles and abstracts, leaving 27 studies for detailed review. Six RCTs met the inclusion criteria, encompassing 422 patients, with a predominance of participants who were men. Publication bias was suggested by funnel plot asymmetry, which suggested that, if anything, the results may have overstated the apparent benefit of PRP treatment. Risk of bias was evaluated using the Cochrane Risk of Bias tool for randomized trials, revealing an overall low or unclear risk of bias. The primary outcomes were pain relief and functional improvement, assessed using the VAS, scored 0 to 10, with higher scores representing more severe pain, and VISA-A score, scored 0 to 100, with higher scores representing better pain and function. Heterogeneity was assessed using the Cochran Q test and I2 statistics, and a random-effects model was applied due to substantial heterogeneity. Statistical analyses were performed using Review Manager 5.4 and RStudio, version 764. We found no benefit in terms of VISA-A scores favoring PRP over placebo at 3 months (mean difference 1.7 [95% confidence interval (CI) -1.8 to 5.2]; p = 0.34), 6 months (mean difference 0.5 [95% CI [-8.5 to 9.3]; p = 0.92), or 1 year (mean difference -7.9 [95% CI -27.3 to 11.6]; p = 0.43). PRP did not improve VAS pain scores at 3 months (mean difference -0.22 [95% CI -0.56 to 0.12]; p = 0.21). Sensitivity analyses confirmed these findings. PRP showed no difference compared with stromal vascular fraction and was less effective in the short term compared with high-volume injection. Until future high-quality RCTs show a clear clinical benefit, PRP should not be used to treat Achilles tendinopathy. Our analysis found that PRP does not improve pain or function compared with placebo, and potential publication bias suggests that the apparent benefits may be inflated. Surgeons should be cautious when considering PRP for this condition, and future research should focus on larger trials with standardized protocols to provide more definitive guidance. Level II, therapeutic study.

CCL4L2 participates in tendinopathy progression by promoting macrophage inflammatory responses: a single-cell analysis

BackgroundTendinopathy is very common in clinical practice, which is highly prevalent in athletes, sports enthusiasts and other people involved in high-load weight-bearing activities. Common types of tendinopathy include rotator cuff injury, Achilles tendinitis, tennis elbow and so on. Macrophages (Macs) are key immune cells in the pathogenesis of tendinopathy. In this study, CCL4L2+ M1-related signaling pathways were screened by combining single-cell RNA sequencing (scRNA-seq) to explore their significance in tendinopathy treatment.MethodsImmune cell populations were screened by Uniform Manifold Approximation and Projection (UMAP) downscaling, and Mac cell subsets were annotated using cell marker genes. The cellular communication mechanism between different cellular subsets such as Macs and tendon stem/progenitor cells (TSPCs) was demonstrated by cellular communication analysis. Based on cell marker genes of CCL4L2 + M1, Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment were performed to compare the expression differences in M1 and M2 between the Disease and Healthy groups. Associations between CCL4L2+ M1 and TSPCs were inferred by cell-cell communication analysis. The effects of CCL4L2 on Mac polarization and TSPCs were verified by enzyme-linked immunosorbent assay (ELISA) and real-time fluorescence quantitative PCR (qPCR).ResultsThe proportions of TSPCs, endothelial cells (ECs), smooth muscle cells (SMCs), and immune cells were significantly elevated in the Disease group. The proportion of M1 cells in the Disease group was higher than that in the Healthy group, while the proportion of M2 cells was lower than that in the Healthy group. M1 differentially expressed genes (DEGs) were mainly enriched to disease-related and immunoinflammation-related signaling pathways. Signaling intensities between M1 and TSPCs in pathways related to immunoinflammation and ischemic injury were significantly increased in the Disease group. The proportion of CCL4L2 + M1 in the Disease group was significantly higher than in the Healthy group, and communications between CCL4L2 + M1 and TSPCs varied significantly. Compared with the Control group, the expression levels of inflammatory cytokines were higher in the CCL4L2 group, and the expression levels of tendon differentiation markers (Egr1, Mkx, Scx, Type 1 collagen, Tnmd) were significantly down-regulated.ConclusionThe present study analyzed the heterogeneous alterations in the Healthy and Disease groups by scRNA-seq data and found that there was a significant inflammatory infiltrate in the Disease group with markedly increased Mac activity, which was associated with activation of the CCL4L2 + M1-associated signaling pathways. CCL4L2 promotes M1 polarization and inhibits TSPC differentiation through activating M1-related inflammatory signaling pathways. These findings contribute to a more comprehensive understanding of tendon injury progression and provide potential targets for tendinopathy treatment.

Use of Infrared Thermography in Podiatry: Systematic Review and Meta-Analysis.

Background/Objectives: Infrared thermography is an advanced technique that detects infrared light emitted by the body to map thermal changes related to blood flow. It is recognized for being noninvasive, fast, and reliable and is employed in the diagnosis and prevention of various medical conditions. In podiatry, it is utilized for managing diabetic foot ulcers, musculoskeletal injuries such as Achilles tendinopathy, and onychomycosis, among others. The primary objective is to analyze the application of thermography in podiatry as a diagnostic evaluation tool. Secondary objectives include evaluating the use of thermography in diagnosing musculoskeletal injuries, determining its role in preventing diabetic foot ulcers and onychomycosis, assessing its utility in sports performance evaluation with plantar orthoses, and reviewing its cost-effectiveness in detecting common foot conditions and deformities. Methods: A systematic review and meta-analysis of the existing literature on the use of thermography in podiatry were conducted. Studies addressing various applications of thermography were included, focusing on its effectiveness, sensitivity, and specificity. Both studies comparing plantar temperature before and after interventions with orthoses and those exploring thermography in diagnosing specific pathologies were analyzed. Results: Ten randomized clinical trials on the use of infrared thermography in podiatric conditions were included, with participant ages ranging from 18 to 80 years (n = 10-223). Treatments for Achilles tendinopathy, diabetic foot ulcers, and peripheral arterial disease were explored. Infrared thermography was utilized to measure thermal changes, evaluate plantar orthoses, and diagnose onychomycosis. The findings underscore the potential of infrared thermography in preventing and diagnosing various podiatric pathologies. Conclusions: Infrared thermography is a noninvasive technique in podiatry that provides real-time imaging without radiation. It is useful for detecting musculoskeletal injuries, diabetic skin ulcers, and onychomycosis and contributes to enhancing sports performance. In conclusion, it is a valuable tool in podiatric practice to optimize therapeutic approaches.

Performance of Warmblood horses following tenoscopic desmotomy of the main part of the accessory ligament of the superficial digital flexor tendon for treatment of tendinopathy: 62 cases.

Desmotomy of the accessory ligament of the superficial digital flexor tendon (AL-SDFT) has been described for the treatment of superficial digital flexor tendon (SDFT) tendinopathy in Thoroughbred and Standardbred racehorses, and in event horses. To our knowledge, the outcome of this procedure has not been described in a population of warmblood horses. To report on the outcome of treatment of SDFT tendinopathy in warmblood horses using tenoscopic desmotomy of the main part of the AL-SDFT. Prospective observational case series. All 62 horses included in the case series had uni- or bilateral SDFT tendinopathy within the metacarpal/carpal region. The following data were collected and analysed using crosstabulations: breed, age, sex, use, affected limb(s), duration of tendinopathy, lameness grade, type and size of the SDFT lesion, bi- or unilateral desmotomy, duration of surgery, intraoperative findings, intraoperative/post-operative complications, duration of hospitalisation and outcome 24 months after surgery. Forty-six horses (75%) were sound with 31 (51%) of these horses performing at the same level as prior to injury. Recurrent SDFT injuries or persistent lameness was observed in 15 (25%) horses. Two horses (3%) developed septic tenosynovitis post-operatively, one required euthanasia. Horses with lesions in the proximal third of the SDFT had a better outcome than those with lesions in the two distal thirds (OR = 4.71, 95% CI = 1.33-16.70). There were no control groups of horses with SDFT tendinopathy treated by conservative therapy, tenoscopic complete or conventional open desmotomy. Tenoscopic desmotomy of the main part of the AL-SDFT is a successful treatment for SDFT tendinopathy in warmblood horses, especially in proximal SDFT lesions.

Platelet-Rich Plasma-Induced Remodeling of the Abductor Pollicis Longus Tendon: A Treatment for Tendinopathy in the First Dorsal Compartment of the Wrist.

Platelet-Rich Plasma-Induced Remodeling of the Abductor Pollicis Longus Tendon: A Treatment for Tendinopathy in the First Dorsal Compartment of the Wrist.

Erroneous Differentiation of Tendon Stem/Progenitor Cells in the Pathogenesis of Tendinopathy: Current Evidence and Future Perspectives.

Tendinopathy is a condition characterized by persistent tendon pain, structural damage, and compromised functionality. Presently, the treatment for tendinopathy remains a formidable challenge, partly because of its unclear pathogenesis. Tendon stem/progenitor cells (TSPCs) are essential for tendon homeostasis, regeneration, remodeling, and repair. An innovative theory has been previously proposed, with insufficient evidence, that the erroneous differentiation of TSPCs may constitute one of the fundamental mechanisms underpinning tendinopathy. Over the past few years, there has been accumulating evidence for plausibility of this theory. In this review, we delve into alterations in the differentiation potential of TSPCs and the underlying mechanisms in the context of injury-induced tendinopathy, diabetic tendinopathy, and age-related tendinopathy to provide updated evidence on the erroneous differentiation theory. Despite certain limitations inherent in the existing body of evidence, the erroneous differentiation theory emerges as a promising and highly pertinent avenue for understanding tendinopathy. In the future, advanced methodologies will be harnessed to further deepen comprehension of this theory, paving the way for prospective developments in clinical therapies targeting TSPCs for the management of tendinopathy.

Monitoring Endoplasmic Reticulum Peroxynitrite Fluctuations in Primary Tendon-Derived Stem Cells and Insights into Tendinopathy.

Tendinopathy is one of the most prevalent musculoskeletal disorders, significantly affecting the quality of life of patients. Treatment outcomes can be improved with an early diagnosis and timely targeted interventions. Increasing evidence indicates that ROS and endoplasmic reticulum (ER) stress play key roles in modulating the differentiation processes of tendon-derived stem cells (TDSCs), thereby contributing to the initiation and progression of tendinopathy. However, the relationship between ONOO- and the differentiation process, as well as the various stages of tendinopathy, remains unexplored. Herein, we developed two highly specific and sensitive fluorescent probes (Rod-Cl and Rod-Br) for detecting ONOO- in the ER. Rod-Br can detect basal levels of ONOO- in the ER of TDSCs and measure ONOO- levels in primary TDSCs stimulated by interleukin-1β over various durations, allowing for comparisons between chondrogenic and osteogenic differentiation and ER stress levels. Additionally, we examined ONOO- variations in different stages of tendinopathy and treatment rat models in vivo and discussed the potential mechanisms. This research provides a robust tool for analyzing ONOO- dynamics in the tenogenic and osteogenic differentiation of TDSCs, offering new insights into the pathophysiology and treatment of tendinopathy.

Prolotherapy in the Treatment of Sports-Related Tendinopathies: A Systematic Review of Randomized Controlled Trials.

As sports have increased in popularity, the incidence of tendinopathy has also grown dramatically. Nonoperative techniques and treatments used to address these pathologies continue to evolve and improve. One such treatment, prolotherapy (PrT), has become increasingly popular and may provide patients with an alternative nonoperative treatment option. To review high-quality randomized controlled trials (RCTs) that analyzed PrT treatments for the most common tendinopathies. Specifically, this review aims to provide meaningful data regarding methods and outcomes for each condition treated and guide professionals who are considering PrT as a treatment option. Systematic review; Level of evidence, 2. All RCTs published in English between January 1, 1980, and July 30, 2021, and reported in Embase, Medline, and Web of Science databases were reviewed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. After the initial search, a total of 3264 articles were identified. Studies analyzing sports medicine injuries and musculoskeletal pathologies using an RCT design were included, while case-reports, case-studies, reviews, and observational studies were excluded. Two independent researchers reviewed the search results, and conflicts were resolved by discussion of inclusion and exclusion criteria among all authors. The articles' quality was evaluated using the Cochrane tool for assessing the risk of bias. Statistical analysis and graphical representations were performed using SPSS Version 28.00. A total of 20 articles, including 1136 patients, met the inclusion criteria and were included in the study. Overall, in 85% of the studies, PrT was found to be effective in the treatment of tendinopathy. Specifically, PrT was superior to or as effective as the control in 83% (10/12) of the studies analyzing lateral epicondylitis (LE) and rotator cuff (RC) tendinopathies and in 88% (7/8) of the studies on plantar fasciitis (PF), Osgood-Schlatter disease (OSD), and Achilles tendinosis (AT). LE, RC, and PF tendinopathies were the most studied conditions (17/20 studies), while AT and OSD were the least studied (3/20 studies). Of the studies, 95% (19/20) used dextrose solutions, with only 1 using solutions of 2.5% phenol, 25% glycerin, and 25% dextrose in sterile water. Our systematic review suggests that PrT appears to be a promising alternative treatment for common tendinopathies. Most studies used a hypertonic dextrose solution. Even though further, larger randomized controlled trials comparing PrT with other orthobiologics would be beneficial, based on this review, sports medicine physiciansmay safely pursue PrT as an additional component of conservative treatment.

Short-term Effects of Pulsed Electromagnetic Field Therapy for Achilles Tendinopathy: A Randomized Controlled Trial.

Pulsed electromagnetic field (PEMF) therapy is a potential nonoperative treatment for Achilles tendinopathy, but the current published literature on its effects is sparse. To evaluate the therapeutic efficacy of PEMF therapy and eccentric exercise for Achilles tendinopathy. Randomized controlled trial; Level of evidence, 1. A total of 65 participants met the inclusion criteria and were randomly assigned to either the active PEMF group (n = 33) or the sham group (n = 32). The PEMF group received biweekly PEMF therapy (10 minutes per session) for 8 weeks, plus eccentric exercise for 12 weeks. The sham group received the same eccentric exercise for 12 weeks minus active PEMF exposure. The primary outcome was the Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire. The secondary outcomes were numeric pain rating scale (NPRS) score, tendon neovascularity, and total time spent on sports per week. A physical therapist assessed all outcomes at baseline and then 4, 8, and 12 weeks after the commencement of the PEMF treatment. The level of tendon neovascularity was determined by the Öhberg score (range, 0-3). VISA-A scores improved significantly from baseline to 12 weeks posttreatment in both the PEMF group (from 57.9 to 71.7) and the sham group (from 55.1 to 66.8) (P < .001 for both), with no significant difference in scores between treatment groups throughout the 12 weeks (P = .527). NPRS scores during sports also improved significantly from baseline to 12 weeks for the PEMF group (from 6.05 to 2.95) and the sham group (from 6.45 to 3.85) (P < .001), with no group differences (P = .346). PEMF therapy, in addition to eccentric exercise, did not improve outcome scores or tendon neovascularity compared with eccentric exercise alone in participants with Achilles tendinopathy. NCT05316961 (ClinicalTrials.gov identifier).

Current Concepts in Orthobiologics for Achilles Tendon Injuries: A Critical Analysis Review.

» Platelet-rich plasma and hyaluronic acid are low-risk and potentially high-reward treatments for Achilles tendinopathy, although clinical studies have yielded mixed results with questionable methodological quality» Case series and reports have reported that bone marrow aspirate, stem cells, and amniotic membrane products can improve functional outcomes, alleviate pain, and facilitate return to sport and activities, but high-level evidence studies are lacking» Exosomes are a promising novel biologic with laboratory studies showing improved collagen organization and cell proliferation, greater tendon mechanical properties, and prevention of extracellular matrix breakdown.» Standardization of protocols with clear reporting is necessary for future studies evaluating orthobiologic therapies for Achilles tendon injuries.

Classification of distinct tendinopathy subtypes for precision therapeutics

Rotator cuff tendinopathy is the most common tendinopathy type with the worst prognosis. Conventional treatments often elicit heterogeneous drug responses due to the diversity of tendinopathy. Hence, this study attempted a classification of 126 diseased tendons into three distinct subtypes with opposite pathogenic mechanisms based on transcriptomic and clinical features. The hypoxic atrophic subtype with white appearance (Hw) exhibits downregulated neovascularization pathways. The inflammatory proliferative subtype with white appearance (Iw) shows a moderate upregulation of inflammatory characteristics. The inflammatory proliferative subtype with red appearance (Ir) exhibits the highest levels of upregulated neovascularization and inflammatory pathways, along with severe joint dysfunction. We then established research models, including subtype-specific simulations in animal models and clinical data analysis. These revealed that glucocorticoid, a controversial commonly used drug, was only effective in treating the Ir subtype. Hence, the tendinopathy subtypes elucidated in this study have significant implications for developing precision treatment of tendinopathy.

Effects of Conditioned Media From Human Umbilical Cord-Derived Mesenchymal Stem Cells on Tenocytes From Degenerative Rotator Cuff Tears in an Interleukin 1β-Induced Tendinopathic Condition.

Evidence suggests that mesenchymal stem cells (MSCs) are safe for treating different tendinopathies. Synovial fluid is a pooled environment of biomarkers from the inflammatory and degenerative joint cavity. Understanding the effects of synovial fluid on MSCs is important, as it is the first microenvironment that administered MSCs encounter. Several studies have reported that exposure to osteoarthritic synovial fluid-activated MSCs increased the release of soluble factors; however, the paracrine effects of shoulder synovial fluid-stimulated umbilical cord-derived MSCs (SF-UC-MSCs) on tendinopathy have yet to be investigated. To assess the effects of the conditioned media from SF-UC-MSCs on tenocytes from degenerative rotator cuff tears in an interleukin-1β (IL-1β)-induced tendinopathic condition. Controlled laboratory study. UC-MSCs were isolated and cultured from healthy, full-term deliveries by cesarean section. Tenocytes were isolated and cultured from patients with degenerative rotator cuff tears. Conditioned media were obtained from UC-MSCs stimulated with synovial fluid. To evaluate the gene expression of proinflammatory and anti-inflammatory cytokines, enzymes and their inhibitors, matrix molecules, and growth factors, the tenocytes were cultured with IL-1β and 50% of the conditioned media from the SF-UC-MSCs; quantitative, real-time, reverse transcriptase polymerase chain reaction was also performed. A prostaglandin E2 (PGE2) assay was performed to investigate the PGE2 level secreted by the tenocytes. Western blotting was performed to examine protein synthesis of collagen type I and III. Cell viability, senescence, and apoptosis assays were also performed. The conditioned media from the SF-UC-MSCs interfered with the inflammatory gene expression on tenocytes induced by IL-1β, but it increased the gene expression of tissue inhibitor of metalloproteinase (TIMP)-1 and TIMP-3. Meanwhile, the conditioned media decreased the PGE2 level on cells induced by IL-1β. It did increase the type I/III ratio of gene expression and protein synthesis, mainly through the induction of type I collagen. Conditioned media of SF-UC-MSCs reversed senescence and apoptosis induced by IL-1β. Study findings indicated that the conditioned media from SF-UC-MSCs had anti-inflammatory effects and cytoprotective effects on IL-1β-treated tenocytes from degenerative rotator cuff tears. UC-MSCs have useful potential for the treatment of tendinopathy in practice.

Factors influencing surgical treatment of De Quervain's tendinopathy: A retrospective cross-sectional observational study

BackgroundThe literature surrounding how different patient, sociodemographic, and anatomical factors influence surgical treatment of De Quervain's tendinopathy (DQT) is limited. PurposeWe hypothesised that different patient, anatomical, or sociodemographic factors influence the management of DQT with regard to non-operative vs. surgical management. MethodsThis retrospective cross-sectional study reviewed 155 cases of patients with DQT seen over a 10 year period. Patient-specific factors included age, gender, hand affected, dominant hand, steroid injection given and mean number of injections. Sociodemographic factors included ethnicity, employment, and deprivation, were measured using deprivation quintiles through The Index of Multiple Deprivation. Anatomical factors included the presence of subcompartmentalization, number of APL and EPB tendon slips, tendon thickening, exudative tenosynovitis, hypervascularization, and the presence of a sheath ganglion Patients were categorized into either non-operative or surgical cohort. Bivariate analysis was used to compare factors between the cohorts, and significant factors (p < 0.05) were included in the logistic regression model, used to predict factors influencing surgical management. ResultsBivariate analysis detected a significant difference in the mean number of steroids given between the non-operative and surgical cohort (p = 0.001) patient factors. For sociodemographic factors, a significant difference was found between deprivation quintiles (p = 0.02). From the anatomical factors, the surgical cohort had more patients with multiple APL tendon slips (p = 0.02) and the presence of a tendon ganglion sheath ganglion (p = 0.02). For patient and sociodemographic factors, logistic regression identified that the number of steroids (per patient) and being in deprivation quintile 4 were associated with surgical treatment. For anatomical factors, multiple APL tendon slips and the presence of a tendon sheath ganglion were associated with the surgical treatment. ConclusionThis study suggests that several factors are associated with the need for surgical treatment of DQT, including the number of steroid injections received, social deprivation, and anatomical factors, such as the presence of multiple tendon slips and a tendon sheath ganglion. Our findings add to the growing body of literature exploring factors that may influence treatment pathways for patients with DQT.

Multiple ASC-dependent inflammasomes drive differential pro-inflammatory cytokine production in a mouse model of tendinopathy.

Inflammasomes are multiprotein complexes that regulate the bioactive production of IL-1β and IL-18, being implicated in the inflammatory response of different diseases. The inflammasome formed by the cytosolic sensor NLRP3 is highly promiscuous, as it could be activated by different pathogen- and sterile-signals. However, few models have studied the implication of NLRP3 in tissue damage-induced inflammation, particularly the implication of NLRP3 in tendinopathies. Here, we aimed to investigate the implication of NLRP3 in a mouse model of tendinopathy by collagenase degradation of the extracellular matrix in the Achilles' mice tendon. We found that NLRP3 was involved in the production of IL-1β, but another ASC-dependent inflammasome was required to produce IL-18 during sterile tissue damage. Our study suggests that in the immune response to extracellular matrix degradation different inflammasomes, probably expressed in different cell compartments, were able to differentially control IL-1β and IL-18 production in vivo. These results suggest the potential use of therapies targeting ASC as beneficial in the treatment of tendinopathies.

Treating Chronic Tendinopathy: Physical Therapy, Surgery and Other Form of Therapy

Introduction: The term "tendinopathy" refers to pathological changes in tendons. The previously used term "tendonitis" does not fully capture the nature of the condition, as inflammatory changes, when present, are secondary to degenerative damage. Tendinopathies are quite common in the general population. Aim: The aim of this review is to characterize various types of tendinopathies, with a focus on both conservative and surgical treatment methods, in order to organize available information that may be helpful for clinicians in their practice. State of Knowledge: Chronic tendinopathies develop as a result of multiple factors. The most significant include improper exercise techniques, excessive strain, and musculoskeletal system abnormalities. Summary (Conclusions): The approach to tendinopathy treatment should vary depending on the patient's clinical condition and provoking factors. Physiotherapy plays the most important role, along with supportive methods such as analgesic pharmacotherapy and cryotherapy. Surgical intervention may be necessary in cases where conservative treatment fails.

An Analysis of the Outcomes and Complications of Ultrasound Guided Corticosteroid Injection on Tendinopathy in the Foot and Ankle

Category: Ankle; Other Introduction/Purpose: Corticosteroid injections are commonly used in the clinical setting for the treatment of foot and ankle tendinopathy, although there is limited research into their efficacy and rate of complications. The purpose of this study is to examine the patient-reported outcomes and complications, specifically tendon rupture, associated with ultrasound-guided corticosteroid injections for foot and ankle tendinopathy. Methods: A retrospective review was conducted of patients who underwent corticosteroid injection into the extensor hallucis longus, extensor digitorum longus, flexor digitorum longus, posterior tibial, anterior tibial, peroneal, or Achilles tendons for the treatment of foot and ankle tendinopathy between June 2020 and September 2022. Demographic information, incidence of complications, incidence of surgical intervention, and patient-reported outcomes were recorded. A total of 131 patients were included in the study population, with 73 (55.7%) patients receiving a posterior tibial tendon injection, 53 (40.6%) receiving a peroneal tendon injection, and 6 (4.6%) receiving an injection of a different tendon. The average follow-up was 27.8 weeks (range: 3.4 to 111.3). Continuous and categorical data were expressed as a mean and percentage, respectively. Paired Student’s t-test was utilized to compare pre- and post-procedure patient-reported outcomes. Multivariable analysis was utilized to control for confounding variables. All p&lt; 0.05 were considered statistically significant. Results: There were 2 (1.6%) reported ruptures, both of which involved the peroneal tendon, and 22 (16.8%) patients who required surgical treatment of their affected tendons following their injection. Multivariable analysis demonstrated no specific patient or procedure factors were significantly associated with an increase in the tendon rupture rate. Overall, patients who received a corticosteroid injection had significant improvements in their pain interference (63.3 vs 58.7, p&lt; 0.001), physical function (38.9 vs 41.3, p=0.032), and mobility (37 vs 39.7, p=0.006) scores. There was no significant difference in the amount of improvement between those receiving a posterior tibial tendon and peroneal tendon injection regarding pain interference (4.6 vs 4.9, p=0.805), physical function (3.2 vs 1.9, p=0.294), and mobility (3.4 vs 3.1, p=0.865) scores. Conclusion: There is a lack of efficacy and safety data surrounding corticosteroid injections for use in foot and ankle pathology. This study demonstrates patients receiving a corticosteroid injection for the treatment of foot and ankle tendinopathy had significant improvements in their patient-reported outcomes with a 1.6% tendon rupture rate. These results demonstrate corticosteroid injections are an effective treatment for foot and ankle tendinopathy, but further research is necessary to fully categorize the safety of this procedure.

Clinical Outcomes and Tendon Structure at 3- to 4-Year Follow-up After Exercise-Based Treatment of Patellar Tendinopathy: A Prospective Study.

The long-term recovery (in years) of patellar tendinopathy treated with loading-based rehabilitation remains largely unknown. To examine the clinical outcome and tendon structure years after exercise-based treatment of chronic patellar tendinopathy. Case series; Level of evidence, 4. This was a 3- to 4-year follow-up evaluation of participants (N = 28) from a previous randomized clinical trial by the author group. All participants received loading-based rehabilitation for 12 weeks with either moderate-slow resistance (55% of 1 repetition maximum) or heavy-slow resistance (up to 90% of 1 repetition maximum). Both groups showed similar improvements after 3 and 12 months and were therefore collapsed in the present analysis. Function and symptoms (the Victorian Institute of Sport Assessment-Patella [VISA-P] questionnaire), tendon pain (numeric rating scale [NRS] during activity and during a single-leg decline squat test), and tendon structure (tendon vascularization and thickness on ultrasound) were assessed. The mean follow-up was 3.6 ± 0.4 years after the baseline assessment in the original clinical trial. The VISA-P score was 83.9 ± 11.9 (95% CI, 79.3-88.5) at the latest follow-up and did not differ from the 1-year follow-up score (P = .54). Similarly, NRS score during preferred sport (1.6 ± 1.7; 95% CI, 0.9-2.2) and single-leg decline squat (1.0 ± 1.8; 95% CI, 0.3-1.7) did not differ from the 1-year values and remained elevated. Power Doppler area and tendon thickness decreased significantly from 1 year to latest follow-up (P < .0001 and P = .02, respectively), but power Doppler area >1 mm2 was still present in 43% of the participants after 3 to 4 years, and the tendon thickness was still mildly elevated (6.4 ± 1.8 mm; 95% CI, 5.7-7.1 mm). Sports participation after 3 to 4 years (3.9 ± 2.7 h/wk; 95% CI, 2.9-7.1 h/wk) was significantly lower compared with preinjury levels (P < .0001). Clinical symptoms remained even years after loading-based treatment for patellar tendinopathy, whereas some but not all tendon structures normalized in this longer term follow-up.