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Sample records for achilles tendon surgery

  1. Minimally invasive surgery for Achilles tendon pathologies

    Nicola Maffulli

    2010-07-01

    Full Text Available Nicola Maffulli1, Umile Giuseppe Longo2, Filippo Spiezia2, Vincenzo Denaro21Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, London, England; 2Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University, Rome, ItalyAbstract: Minimally invasive trauma and orthopedic surgery is increasingly common, though technically demanding. Its use for pathologies of the Achilles tendon (AT hold the promise to allow faster recovery times, shorter hospital stays, and improved functional outcomes when compared to traditional open procedures, which can lead to difficulty with wound healing because of the tenuous blood supply and increased chance of wound breakdown and infection. We present the recent advances in the field of minimally invasive AT surgery for tendinopathy, acute ruptures, chronic tears, and chronic avulsions of the AT. In our hands, minimally invasive surgery has provided similar results to those obtained with open surgery, with decreased perioperative morbidity, decreased duration of hospital stay, and reduced costs. So far, the studies on minimally invasive orthopedic techniques are of moderate scientific quality with short follow-up periods. Multicenter studies with longer follow-up are needed to justify the long-term advantages of these techniques over traditional ones.Keywords: tendinopathy, rupture, percutanous repair, less invasive

  2. Achilles tendon healing

    This paper reports on symptomatic Achilles tendon abnormalities (rupture, tendinitis) evaluated with MR imaging during the healing phase after either surgical or conservative treatment. A total of 21 patients were studied. Fifteen of 21 underwent surgery (13 tendon ruptures) and six were managed conservatively (one rupture). MR studies were obtained before treatment in 11, at 3 months in eight, at 6 months in seven, and at 12 months in 12. The 1.5-T spin-echo and gradient-echo images were correlated with clinical results, planter reflex response times, and calf force measurements. Sequential T2 times were obtained from representative levels in the tendons

  3. Achilles Tendonitis

    ... Kids For Parents MORE ON THIS TOPIC Jumper's Knee Proximal Biceps Tendonitis Safety Tips: Basketball Safety Tips: Running Repetitive Stress Injuries Sports and Exercise Safety Dealing With Sports Injuries Stress Fractures Sports Center Plantar Fasciitis Contact Us Print Resources ...

  4. Percutaneous Achilles Tendon Lengthening

    ... require a more complex lengthening surgery. ​ Extent of ankle mobility before Achilles lengthening surgery . General Details of Procedure ... with strength and range of motion. ​ Extent of ankle mobility after Achilles lengthening surgery . Potential Complications There are ...

  5. Endoscopic adhesiolysis for extensive tibialis posterior tendon and Achilles tendon adhesions following compound tendon rupture

    Lui, Tun Hing

    2013-01-01

    Tendon adhesion is one of the most common causes of disability following tendon surgery. A case of extensive peritendinous adhesions of the Achilles tendon and tibialis posterior tendon after compound rupture of the tendons was reported. This was managed by endoscopic adhesiolysis of both tendons. The endoscopic approach allows early postoperative mobilisation which can relieve the tendon adhesion.

  6. Achilles tendon and sports

    Because of the rising popularity of recreational sports activities achillodynia is an often associated symptom with running, soccer and athletics. Therefore radiologist are frequently asked to image this tendon. The origin of the damage of the Achilles tendon is explained by numerous hypothesis, mainly a decreased perfusion and a mechanical irritation that lead to degeneration of the tendon. High-resolution technics such as sonography and magnetic resonance imaging show alterations in the structure of the tendon which can be graduated and classified. Manifestations like tendinosis, achillobursitis, rupture and Haglunds disease can summarized as the tendon overuse syndrom. A rupture of a tendon is mostly the result of a degeneration of the collagenfibres. The task of the radiologist is to acquire the intrinsic factors for a potential rupture. (orig.)

  7. [Achilles tendon rupture].

    Thermann, H; Hüfner, T; Tscherne, H

    2000-03-01

    The treatment of acute of Achilles tendon rupture experienced a dynamic development in the last ten years. Decisive for this development was the application of MRI and above all the ultrasonography in the diagnostics of the pathological changes and injuries of tendons. The question of rupture morphology as well as different courses of healing could be now evaluated objectively. These advances led consequently to new modalities in treatment concepts and rehabilitation protocols. The decisive input for improvements of the outcome results and particularly the shortening of the rehabilitation period came with introduction of the early functional treatment in contrast to immobilizing plaster treatment. In a prospective randomized study (1987-1989) at the Trauma Dept. of the Hannover Medical School could show no statistical differences comparing functional non-operative with functional operative therapy with a special therapy boot (Variostabil/Adidas). The crucial criteria for therapy selection results from the sonographically measured position of the tendon stumps in plantar flexion (20 degrees). With complete adaptation of the tendons' ends surgical treatment does not achieve better results than non-operative functional treatment in term of tendon healing and functional outcome. Regarding the current therapeutic standards each method has is advantages and disadvantages. Both, the operative and non-operative functional treatment enable a stable tendon healing with a low risk of re-rupture (1-2%). Meanwhile there is consensus for early functional after-treatment of the operated Achilles' tendons. There seems to be a trend towards non-operative functional treatment in cases of adequate sonographical findings, or to minimal invasive surgical techniques. PMID:10798233

  8. Achilles Tendon Disorders

    ... soft-tissue massage/mobilization, gait and running re-education, stretching and ultrasound therapy. When Is Surgery Needed? If nonsurgical approaches fail to restore the tendon to its normal condition, ...

  9. Ossification of the bilateral Achilles tendon: a rare entity

    Ossification of the Achilles tendon is a rare clinical entity comprising of one or more segments of variable sized ossified masses in the fibrocartilaginous substance of the tendon. The etiology of ossification of the Achilles tendon is multifactorial with recurrent trauma and surgery comprising major predisposing factors, with others being metabolic, systemic, and infectious diseases. The possibility of a genetic predisposition towards this entity has also been raised, but has not yet been proven. We present a rare case of ossification of the bilateral Achilles tendons without any history of trauma or surgery in a 48-year-old female patient

  10. Demonstration of Achilles tendon on CT

    Ligaments and tendons, including the Achilles tendon, show the highest density among normal soft tissue structures in the body. Traumatic and degenerative changes of the Achilles tendon are often associated with marked thickening and reduction in density associated with increased opacity of the space in front of the Achilles tendon. These changes are easily demonstrated by CT, whereas conventional radiological techniques only show non-specific changes. Twenty-five patients were examined, including nine with pain, seven following rupture of the Achilles tendon and nine post-operative controls; it was found that CT can add information important for the diagnosis and treatment planning of abnormalities of the Achilles tendon. (orig.)

  11. Active Achilles tendon kinesitherapy accelerates Achilles tendon repair by promoting neurite regeneration☆

    Jielile, Jiasharete; Aibai, Minawa; Sabirhazi, Gulnur; Shawutali, Nuerai; Tangkejie, Wulanbai; Badelhan, Aynaz; Nuerduola, Yeermike; Satewalede, Turde; Buranbai, Darehan; Hunapia, Beicen; Jialihasi, Ayidaer; Bai, Jingping; Kizaibek, Murat

    2012-01-01

    Active Achilles tendon kinesitherapy facilitates the functional recovery of a ruptured Achilles tendon. However, protein expression during the healing process remains a controversial issue. New Zealand rabbits, aged 14 weeks, underwent tenotomy followed immediately by Achilles tendon microsurgery to repair the Achilles tendon rupture. The tendon was then immobilized or subjected to postoperative early motion treatment (kinesitherapy). Mass spectrography results showed that after 14 days of mo...

  12. Minimally Invasive Approach to Achilles Tendon Pathology.

    Hegewald, Kenneth W; Doyle, Matthew D; Todd, Nicholas W; Rush, Shannon M

    2016-01-01

    Many surgical procedures have been described for Achilles tendon pathology; however, no overwhelming consensus has been reached for surgical treatment. Open repair using a central or paramedian incision allows excellent visualization for end-to-end anastomosis in the case of a complete rupture and detachment and reattachment for insertional pathologies. Postoperative wound dehiscence and infection in the Achilles tendon have considerable deleterious effects on overall functional recovery and outcome and sometimes require plastic surgery techniques to achieve coverage. With the aim of avoiding such complications, foot and ankle surgeons have studied less invasive techniques for repair. We describe a percutaneous approach to Achilles tendinopathy using a modification of the Bunnell suture weave technique combined with the use of interference screws. No direct end-to-end repair of the tendon is performed, rather, the proximal stump is brought in direct proximity of the distal stump, preventing overlengthening and proximal stump retraction. This technique also reduces the suture creep often seen with end-to-end tendon repair by providing a direct, rigid suture to bone interface. We have used the new technique to minimize dissection and exposure while restoring function and accelerating recovery postoperatively. PMID:26385574

  13. The roentgenographic findings of achilles tendon rupture

    To evaluate the diagnostic value of a lateral view of the ankles in Achilles tendon rupture. We performed a retrospective analysis of the roentgenographic findings of 15 patients with surgically proven Achilles tendon rupture. Four groups of 15 patients(normal, ankle sprain, medial lateral malleolar fracture, and calcaneal fracture) were analysed as reference groups. Plain radiographs were reviewed with regard to Kager's triangle, Arner's sign, Toygar's angle, ill defined radiolucent shadow through the Achilles tendon, sharpness of the anterior margin of Achilles tendon, and meniscoid smooth margin of the posterior skin surface of the ankle. Kager's triangle was deformed and disappeared after rupture of the Achilles tendon in nine patients(60%) with operative verification of the rupture, six patients(40%) had a positive Arner's sign, while none had a diminished Toygars angle. In 13 patients(87%) with a ruptured Achilles tendon, the thickness of this was nonuniform compared with the reference group. The anterior margin of the Achilles tendon became serrated and indistinct in 14 patients(93%) in whom this was ruptured. An abnormal ill defined radiolucent shadow through the Achilles tendon was noted in nine patient(60%), and nonparallelism between the anterior margin of the Achilles tendon and posterior skin surface of the ankle was detected in 11 patients(73%). The posterior skin surface of the ankle had a nodular surface margin in 13 patients(87%). A deformed Kager's triangle and Achilles tendon, and an abnormal ill defined radiolucent shadow through the Achilles tendon in a lateral view of the ankles are important findings for the diagnesis of in diagnosing achilles tendon rupture

  14. The roentgenographic findings of achilles tendon rupture

    Seouk, Kang Hyo; Keun, Rho Yong [Shilla General Hospital, Seoul (Korea, Republic of)

    1999-03-01

    To evaluate the diagnostic value of a lateral view of the ankles in Achilles tendon rupture. We performed a retrospective analysis of the roentgenographic findings of 15 patients with surgically proven Achilles tendon rupture. Four groups of 15 patients(normal, ankle sprain, medial lateral malleolar fracture, and calcaneal fracture) were analysed as reference groups. Plain radiographs were reviewed with regard to Kager's triangle, Arner's sign, Toygar's angle, ill defined radiolucent shadow through the Achilles tendon, sharpness of the anterior margin of Achilles tendon, and meniscoid smooth margin of the posterior skin surface of the ankle. Kager's triangle was deformed and disappeared after rupture of the Achilles tendon in nine patients(60%) with operative verification of the rupture, six patients(40%) had a positive Arner's sign, while none had a diminished Toygars angle. In 13 patients(87%) with a ruptured Achilles tendon, the thickness of this was nonuniform compared with the reference group. The anterior margin of the Achilles tendon became serrated and indistinct in 14 patients(93%) in whom this was ruptured. An abnormal ill defined radiolucent shadow through the Achilles tendon was noted in nine patient(60%), and nonparallelism between the anterior margin of the Achilles tendon and posterior skin surface of the ankle was detected in 11 patients(73%). The posterior skin surface of the ankle had a nodular surface margin in 13 patients(87%). A deformed Kager's triangle and Achilles tendon, and an abnormal ill defined radiolucent shadow through the Achilles tendon in a lateral view of the ankles are important findings for the diagnesis of in diagnosing achilles tendon rupture.

  15. Active Achilles tendon kinesitherapy accelerates Achilles tendon repair by promoting neurite regeneration

    Jiasharete Jielile; Beicen Hunapia; Ayidaer Jialihasi; Jingping Bai; Murat Kizaibek; Minawa Aibai; Gulnur Sabirhazi; Nuerai Shawutali; Wulanbai Tangkejie; Aynaz Badelhan; Yeermike Nuerduola; Turde Satewalede; Darehan Buranbai

    2012-01-01

    Active Achilles tendon kinesitherapy facilitates the functional recovery of a ruptured Achilles tendon. However, protein expression during the healing process remains a controversial issue. New Zealand rabbits, aged 14 weeks, underwent tenotomy followed immediately by Achilles tendon microsurgery to repair the Achilles tendon rupture. The tendon was then immobilized or subjected to postoperative early motion treatment (kinesitherapy). Mass spectrography results showed that after 14 days of motion treatment, 18 protein spots were differentially expressed, among which, 12 were up-regulated, consisting of gelsolin isoform b and neurite growth-related protein collapsing response mediator protein 2. Western blot analysis showed that gelsolin isoform b was up-regulated at days 7–21 of motion treatment. These findings suggest that active Achilles tendon kinesitherapy promotes the neurite regeneration of a ruptured Achilles tendon and gelsolin isoform b can be used as a biomarker for Achilles tendon healing after kinesitherapy.

  16. Low recurrence rate after mini surgery outside the tendon combined with short rehabilitation in patients with midportion Achilles tendinopathy

    Alfredson, Håkan

    2016-01-01

    Background There is a general opinion that a structured and specific rehabilitation is needed after treatment of midportion Achilles tendinopathy to minimize recurrence of the condition. There is sparse knowledge about the recurrence rates in large patient materials after specific treatments for midportion Achilles tendinopathy. Aim This study aimed to investigate the recurrence rates in a large number of patients with chronic painful midportion Achilles tendinopathy that had been surgically treated with the ultrasound (US) and Doppler (DP)-guided mini-surgical scraping technique. Postoperatively, a relatively simple rehabilitation protocol, including a range of movement exercises and gradually increased walking and biking before allowing free activity, was used. Materials and methods From a database, information about the recurrence rates after US + DP-guided mini-surgical scraping, performed by a single surgeon on 519 tendons with US + DP-verified chronic painful midportion Achilles tendinopathy, was obtained. Results Recurrence of painful midportion Achilles tendinopathy was found in 26 of 519 (5%) operated tendons, 13 from women and 13 from men. In 13 tendons, a close by located plantaris tendon was extirpated during the reoperation. Conclusion In this large material on patients treated with US + DP-guided mini-surgical scraping for midportion Achilles tendinopathy, there were few recurrences, although only a simple and nonspecific rehabilitation protocol was used. PMID:27274323

  17. MRI of normal achilles tendon

    To investigate the normal internal structure of tendons 11 volunteers without clinical evidence of tendinopathy were examined using conventional spin-echo T1-, T2- and proton-density weighted sequences. The Achilles tendon was chosen because of its high frequency of injury in athletic activity, large size, superficial position and because it is oriented nearly parallel to the static magnetic field, therefore minimizing the ''magic angle phenomenon''. The tendons exhibited areas of slighly increased signal in four T1-weighted and in all but one proton-density-weighted scans. No intratendinous signal was detected in T2-weighted images. The possible origin of these findings is discussed. We conclude that the knowledge of these normal signals may be useful to avoid incorrectly diagnosing as pathological. (orig.). With 2 figs

  18. MRI of normal achilles tendon

    Rollandi, G.A. [Institute of Radiology, Univ. of Genoa (Italy); Bertolotto, M. [Institute of Radiology, Univ. of Genoa (Italy); Perrone, R. [Institute of Radiology, Univ. of Genoa (Italy); Garlaschi, G. [Institute of Radiology, Univ. of Genoa (Italy); Derchi, L.E. [Institute of Radiology, Univ. of Genoa (Italy)

    1995-12-01

    To investigate the normal internal structure of tendons 11 volunteers without clinical evidence of tendinopathy were examined using conventional spin-echo T1-, T2- and proton-density weighted sequences. The Achilles tendon was chosen because of its high frequency of injury in athletic activity, large size, superficial position and because it is oriented nearly parallel to the static magnetic field, therefore minimizing the ``magic angle phenomenon``. The tendons exhibited areas of slighly increased signal in four T1-weighted and in all but one proton-density-weighted scans. No intratendinous signal was detected in T2-weighted images. The possible origin of these findings is discussed. We conclude that the knowledge of these normal signals may be useful to avoid incorrectly diagnosing as pathological. (orig.). With 2 figs.

  19. Achilles tendon: US diagnosis of pathologic conditions. Work in progress

    Twenty-three patients were prospectively examined with ultra-sound (US) for acute or recurrent Achilles tendon symptoms. Three types of pathologic conditions of the Achilles tendon were found: tendinitis/tenosynovitis, acute tendon trauma, and postoperative changes. US appears to enable differentiation of these conditions and to contribute to the diagnosis of a broad range of Achilles tendon disorders

  20. Achilles tendon: US diagnosis of pathologic conditions. Work in progress

    Blei, C.L.; Nirschl, R.P.; Grant, E.G.

    1986-06-01

    Twenty-three patients were prospectively examined with ultra-sound (US) for acute or recurrent Achilles tendon symptoms. Three types of pathologic conditions of the Achilles tendon were found: tendinitis/tenosynovitis, acute tendon trauma, and postoperative changes. US appears to enable differentiation of these conditions and to contribute to the diagnosis of a broad range of Achilles tendon disorders.

  1. The Achilles tendon resting angle as an indirect measure of Achilles tendon length following rupture, repair, and rehabilitation

    Michael R. Carmont

    2015-04-01

    Conclusion: The ATRA increases following injury, is reduced by surgery, and then increases again during initial rehabilitation. The angle also correlates with patient-reported symptoms early in the rehabilitation phase and with heel-rise height after 1 year. The ATRA might be considered a simple and effective means to evaluate Achilles tendon function 1 year after the rupture.

  2. Achilles tendon rupture; assessment of nonoperative treatment

    Barfod, Kristoffer Weisskirchner

    2014-01-01

    -related quality of life in the weight-bearing group (p=0.009). Compared to the unaffected limb, the affected limb had decreased stiffness (77%, p < 0.001) and strength (93%, p = 0.009) of the plantar flexor muscle-tendon complex. Study IV showed excellent intra-rater reliability (ICC 0.96, SEM 3.7 mm and MDC 10...... be clarified, particularly the role of weight-bearing during early rehabilitation. Also, there is a need for a clinically applicable and accurate measurement to detect patients in risk of developing Achilles tendon elongation. PURPOSE: The aim of this PhD thesis was to evaluate non...... trial (RCT). In study III, the effect of immediate weight-bearing on the biomechanical properties of the plantar flexor muscle-tendon complex was investigated in an RCT. In study IV, validity, reliability and agreement of a novel ultrasound measurement of Achilles tendon length and elongation was tested...

  3. Achilles tendon rupture; assessment of nonoperative treatment

    Barfod, Kristoffer Weisskirchner

    2014-01-01

    -related quality of life in the weight-bearing group (p=0.009). Compared to the unaffected limb, the affected limb had decreased stiffness (77%, p < 0.001) and strength (93%, p = 0.009) of the plantar flexor muscle-tendon complex. Study IV showed excellent intra-rater reliability (ICC 0.96, SEM 3.7 mm and MDC 10...... trial (RCT). In study III, the effect of immediate weight-bearing on the biomechanical properties of the plantar flexor muscle-tendon complex was investigated in an RCT. In study IV, validity, reliability and agreement of a novel ultrasound measurement of Achilles tendon length and elongation was tested...... Sweden. Immediate weight-bearing was found to be safe and recommendable in non-operative treatment of acute Achilles tendon rupture. The novel ultrasound measurement showed excellent reliability and acceptable validity and agreement....

  4. Use of fluroquinolone and risk of Achilles tendon rupture

    Sode, Jacob; Obel, Niels; Hallas, Jesper;

    2007-01-01

    OBJECTIVE: Several case-control studies have reported that the use of fluoroquinolone increases the risk of rupture of the Achilles tendon. Our aim was to estimate this risk by means of a population-based cohort approach. SETTING: Data on Achilles tendon ruptures and fluoroquinolone use were...... retrieved from three population-based databases that include information on residents of Funen County (population: 470,000) in primary and secondary care during the period 1991-1999. A study cohort of all 28,262 first-time users of fluoroquinolone and all incident cases of Achilles tendon ruptures were...... identified. MAIN OUTCOME MEASURES: The incidence rate of Achilles tendon ruptures among users and non-users of fluoroquinolones and the standardised incidence rate ratio associating fluoroquinolon use with Achilles tendon rupture were the main outcome measures. RESULTS: Between 1991 and 2002 the incidence of...

  5. Nonoperative biological treatment approach for partial Achilles tendon lesion.

    Filardo, Giuseppe; Presti, Mirco Lo; Kon, Elizaveta; Marcacci, Maurilio

    2010-02-01

    Tendon injuries, especially those of the Achilles tendon, are major concerns in sports medicine. The clinical presentation can be acute or chronic and the pathologic findings can range from peritendonitis to full-thickness tendon rupture. Nonsurgical treatment is not always successful; in particular, significant partial ruptures seem to respond poorly to conservative measures and do not improve with time. Surgery is most often considered the favored treatment option for this kind of lesion to obtain pain relief and full functionality with long-standing effects.This article describes a case of a partial tear of the Achilles tendon in a 34-year-old competitive athlete where surgical treatment was avoided in favor of a new biological approach. We applied autologous platelet growth factors through multiple platelet-rich plasma injections; approximately 6.5 billion platelets were injected into the lesion 3 times, 7 days apart. The treatment with platelet-rich plasma and a progressive rehabilitation program allowed the patient to play for 20 minutes in a basketball game 64 days after the trauma and in a full game 75 days after the trauma. To date, 18 months later, he has participated regularly in all the season's games and received no further treatment for his tendon.The fast tissue repair, confirmed by magnetic resonance and ultrasound imaging, allowed a swift return to full functionality and competitive sports activity, suggesting a possible role of platelet growth factors in promoting rapid tendon healing with high-quality tissue. This biological approach may represent a less-invasive therapeutic option even in cases where severe tendon lesions are candidates for surgical treatment. PMID:20192152

  6. Ipsilateral free semitendinosus tendon graft transfer for reconstruction of chronic tears of the Achilles tendon

    Gougoulias Nikolaos

    2008-07-01

    Full Text Available Abstract Background Many techniques have been developed for the reconstruction of the Achilles tendon in chronic tears. In presence of a large gap (greater than 6 centimetres, tendon augmentation is required. Methods We present our method of minimally invasive semitendinosus reconstruction for the Achilles tendon using one para-midline and one midline incision. Results The first incision is a 5 cm longitudinal incision, made 2 cm proximal and just medial to the palpable end of the residual tendon. The second incision is 3 cm long and is also longitudinal but is 2 cm distal and in the midline to the distal end of the tendon rupture. The distal and proximal Achilles tendon stumps are mobilised. After trying to reduce the gap of the ruptured Achilles tendon, if the gap produced is greater than 6 cm despite maximal plantar flexion of the ankle and traction on the Achilles tendon stumps, the ipsilateral semitendinosus tendon is harvested. The semitendinosus tendon is passed through small incisions in the substance of the proximal stump of the Achilles tendon, and it is sutured to the Achilles tendon. It is then passed beneath the intact skin bridge into the distal incision, and passed from medial to lateral through a transverse tenotomy in the distal stump. With the ankle in maximal plantar flexion, the semitendinosus tendon is sutured to the Achilles tendon at each entry and exit point Conclusion This minimally invasive technique allows reconstruction of the Achilles tendon using the tendon of semitendinosus preserving skin integrity over the site most prone to wound breakdown, and can be especially used to reconstruct the Achilles tendon in the presence of large gap (greater than 6 centimetres.

  7. Nonoperative, dynamic treatment of acute achilles tendon rupture

    Barfod, Kristoffer Weisskirchner; Bencke, Jesper; Lauridsen, Hanne Bloch;

    2015-01-01

    Acute Achilles tendon rupture alters the biomechanical properties of the plantar flexor muscle-tendon complex that can affect functional performance and the risk of repeat injury. The purpose of the present study was to compare the biomechanical properties of the plantar flexor muscle-tendon comp......Acute Achilles tendon rupture alters the biomechanical properties of the plantar flexor muscle-tendon complex that can affect functional performance and the risk of repeat injury. The purpose of the present study was to compare the biomechanical properties of the plantar flexor muscle...

  8. Achilles tendon of wistar rats treated with laser therapy and eccentric exercise

    Maria Verônica de Souza

    2015-10-01

    Full Text Available ABSTRACTIntroduction:Both laser therapy and eccentric exercises are used in tendon injuries. However, the association of these physiotherapeutic modalities is yet little investigated.Objective:To evaluate the effect of low-level laser therapy associated to eccentric exercise (downhill walking on Achilles tendinopathy of Wistar rats.Method:Eighteen Achilles tendon from 15 adult male Wistar rats were used. Tendons were distributed in six groups (laser, eccentric exercise, laser and eccentric exercise, rest, contralateral tendon, and healthy tendon. Unilateral tendinopathy was surgically induced by transversal compression followed by scarification of tendon fibers. The treatments laser therapy (904 nm, 3J/cm² and/or eccentric exercise (downhill walking; 12 m/min; 50 min/day; 15o inclination treadmill began 24 hours after surgery and remained for 20 days. Clinical and biomechanical analyzes were conducted. Achilles tendon was macroscopically evaluated and the transversal diameter measured. Euthanasia was performed 21 days after lesion induction. Tendons of both limbs were collected and frozen at -20°C until biomechanical analysis, on which the characteristic of maximum load (N, stress at ultimate (MPa and maximum extension (mm were analyzed.Results:Swelling was observed within 72 hours postoperative. No fibrous adhesions were observed nor increase in transversal diameter of tendons. Animals with the exercised tendons, but not treated with laser therapy, presented lower (p=0.0000 locomotor capacity. No difference occurred be-tween groups for the biomechanical characteristics maximum load (p=0.4379, stress at ultimate (p=0.4605 and maximum extension (p=0.3820 evaluated, even considering healthy and contralateral tendons.Conclusion:The concomitant use of low-level laser and the eccentric exercise of downhill walking, starting 24 hours after surgically induced tendinopathy, do not result in a tendon with the same biomechanical resistance or elasticity

  9. Finite Element Analysis of the Achilles Tendon While Running

    Anițaș Răzvan

    2013-02-01

    Full Text Available Introduction: The Achilles tendon is the most frequent recipient of traumatic injuries. The aim of this study is to identify and describe the varying load at ankle level and especially at the Achilles tendon’s insertion on the calcaneus.

  10. Quadriceps tendon allografts as an alternative to Achilles tendon allografts: a biomechanical comparison.

    Mabe, Isaac; Hunter, Shawn

    2014-12-01

    Quadriceps tendon with a patellar bone block may be a viable alternative to Achilles tendon for anterior cruciate ligament reconstruction (ACL-R) if it is, at a minimum, a biomechanically equivalent graft. The objective of this study was to directly compare the biomechanical properties of quadriceps tendon and Achilles tendon allografts. Quadriceps and Achilles tendon pairs from nine research-consented donors were tested. All specimens were processed to reduce bioburden and terminally sterilized by gamma irradiation. Specimens were subjected to a three phase uniaxial tension test performed in a custom environmental chamber to maintain the specimens at a physiologic temperature (37 ± 2 °C) and misted with a 0.9 % NaCl solution. There were no statistical differences in seven of eight structural and mechanical between the two tendon types. Quadriceps tendons exhibited a significantly higher displacement at maximum load and significantly lower stiffness than Achilles tendons. The results of this study indicated a biomechanical equivalence of aseptically processed, terminally sterilized quadriceps tendon grafts with bone block to Achilles tendon grafts with bone block. The significantly higher displacement at maximum load, and lower stiffness observed for quadriceps tendons may be related to the failure mode. Achilles tendons had a higher bone avulsion rate than quadriceps tendons (86 % compared to 12 %, respectively). This was likely due to observed differences in bone block density between the two tendon types. This research supports the use of quadriceps tendon allografts in lieu of Achilles tendon allografts for ACL-R. PMID:24414293

  11. Percutaneous, Minimally Invasive Repair of Traumatic and Simultaneous Rupture of Both Achilles Tendons: A Case Report.

    Zietek, Pawel; Karaczun, Maciej; Kruk, Bartosz; Szczypior, Karina

    2016-01-01

    Achilles injury is a common musculoskeletal disorder. Bilateral rupture of the Achilles tendon, however, is much less common and usually occurs spontaneously. Complete, traumatic, and bilateral ruptures are rare and typically require long periods of immobilization before the patient can return to full weightbearing. A 52-year-old male was hospitalized for bilateral traumatic rupture to both Achilles tendons. No risk factors for tendon rupture were found. Blood samples revealed no peripheral blood pathologic features. Both tendons were repaired with percutaneous, minimally invasive surgery using the Achillon(®) tendon suture system. Rehabilitation was begun 4 weeks later. An ankle-foot orthosis was prescribed to provide ankle support with an adjustable range of movement, and active plantar flexion was set at 0° to 30°. The patient remained non-weightbearing with the ankle-foot orthosis device and performed active range-of-motion exercises. At 8 weeks after surgery, we recommended that he begin walking with partial weightbearing using a foot-tibial orthosis with the range of motion set to 45° plantar flexion and 15° dorsiflexion. At 10 weeks postoperatively, he was encouraged to return to full weightbearing on both feet. Beginning rehabilitation as soon as possible after minimally invasive surgery, compared with 6 weeks of immobilization after surgery, provided a rapid resumption to full weightbearing. We emphasize the clinical importance of a safe, simple treatment program that can be followed for a patient with damage to the Achilles tendons. To our knowledge, ours is the first report of minimally invasive repair of bilateral simultaneous traumatic rupture of the Achilles tendon. PMID:26002678

  12. EMG monitoring during functional non-surgical therapy of Achilles tendon rupture.

    Hüfner, Tobias; Wohifarth, Kai; Fink, Matthias; Thermann, H; Rollnik, Jens D

    2002-07-01

    After surgical therapy of Achilles tendon rupture, neuromuscular changes may persist, even one year after surgery. We were interested whether these changes are also evident following a non-surgical functional therapy (Variostabil therapy boot/Adidas). Twenty-one patients with complete Achilles tendon rupture were enrolled in the study (mean age 38.5 years, range 24 to 60; 18 men, three women) and followed-up clinically and with surface EMG of the gastrocnemius muscles after four, eight, 12 weeks, and one year after rupture. EMG differences between the affected and non-affected side could only be observed at baseline and after four weeks following Achilles tendon rupture. The results from our study show that EMG changes are not found following non-surgical functional therapy. PMID:12146771

  13. Ultrasound and Magnetic Resonance Imaging in the postoperative follow-up of Achilles tendon rupture

    The diagnostic accuracy of US and Magnetic Resonance Imaging in the subcutaneous rupture of the Achilles tendon has already been assessed. The authors used both techniques to study the Achilles tendon during the postoperative repair process after surgery according to Bosworth. The results were compared and discussed in relation to clinical recovery. Clinical recovery appeared as a hyperechoic structure and a gross fibrillar pattern at US and as a hypointense structure with some small hyperintense areas at Magnetic Resonance Imaging. The authors believe that US is an appropriate technique for the postoperative follow-up of complex subcutaneous ruptures of the Achilles tendon. Additional Magnetic Resonance Imaging should be performed in all the cases where US findings are in disagreement with clinics

  14. Validity and Reliability of the Achilles Tendon Total Rupture Score

    Ganestam, Ann; Barfod, Kristoffer; Klit, Jakob;

    2013-01-01

    The best treatment of acute Achilles tendon rupture remains debated. Patient-reported outcome measures have become cornerstones in treatment evaluations. The Achilles tendon total rupture score (ATRS) has been developed for this purpose but requires additional validation. The purpose of the present...... study was to validate a Danish translation of the ATRS. The ATRS was translated into Danish according to internationally adopted standards. Of 142 patients, 90 with previous rupture of the Achilles tendon participated in the validity study and 52 in the reliability study. The ATRS showed moderately...... strong correlations with the physical subscores of the Medical Outcomes Study 36-item Short-Form Health Survey (r = .70 to .75; p <.0001) and Victorian Institute of Sports Assessment-Achilles questionnaire (r = .71; p <.0001). Test-retest of the ATRS showed no significant difference in the mean (2.41; p...

  15. Biomechanical characteristics of the eccentric Achilles tendon exercise

    Henriksen, Marius; Aaboe, Jens; Bliddal, Henning;

    2009-01-01

    although the tendon loads are similar, the tendon is vibrated at higher frequencies during the eccentric phase than during the concentric phases. This study provides data that may explain the mechanisms behind the effectiveness of eccentric exercises used in the treatment of Achilles tendinopathies....

  16. Reconstruction of neglected traumatic Achilles tendon rupture in a young girl

    Tudisco, C; Bisicchia, S.

    2012-01-01

    Posttraumatic neglected Achilles tendon ruptures in a young patient have not been described in the literature to our knowledge; indeed, neglected ruptures of the Achilles tendon have only rarely been described in adults. We present the case of a 7 year old girl with posttraumatic neglected rupture of the Achilles tendon that was operated on 8 weeks after the trauma.

  17. Ossification of the Achilles tendon: imaging abnormalities in 12 patients

    Ossification of the Achilles tendon is a rare clinical entity that is characterized by the presence of an ossific mass contained within the fibrocartilaginous substance of the tendon. Because the radiographic features of this condition have not been documented entirely and the magnetic resonance (MR) imaging findings have not been determined, a review of 16 affected tendons in 12 patients was performed in an attempt to characterize the imaging abnormalities associated with this process. MR imaging was performed in three Achilles tendons which demonstrated thickening of the tendons at the level of the ossifications and a lack of intratendinous signal abnormalities compatible with acute tendinitis. Signal intensity similar to that of bone marrow was present in the ossifications. (orig.)

  18. Ossification of the Achilles tendon: imaging abnormalities in 12 patients

    Yu, J.S. [Dept. of Radiology, Veterans Administration Medical Center, San Diego, CA (United States); Witte, D. [Dept. of Radiology, Veterans Administration Medical Center, San Diego, CA (United States); Resnick, D. [Dept. of Radiology, Veterans Administration Medical Center, San Diego, CA (United States); Pogue, W. [Dept. of Radiology, AMI Valley Medical Center, El Cajon, CA (United States)

    1994-02-01

    Ossification of the Achilles tendon is a rare clinical entity that is characterized by the presence of an ossific mass contained within the fibrocartilaginous substance of the tendon. Because the radiographic features of this condition have not been documented entirely and the magnetic resonance (MR) imaging findings have not been determined, a review of 16 affected tendons in 12 patients was performed in an attempt to characterize the imaging abnormalities associated with this process. MR imaging was performed in three Achilles tendons which demonstrated thickening of the tendons at the level of the ossifications and a lack of intratendinous signal abnormalities compatible with acute tendinitis. Signal intensity similar to that of bone marrow was present in the ossifications. (orig.)

  19. Tensile properties of fresh human calcaneal (Achilles) tendons.

    Louis-Ugbo, John; Leeson, Benjamin; Hutton, William C

    2004-01-01

    The purpose of this study was to measure the tensile properties of fresh human calcaneal (Achilles) tendons. Twenty fresh cadaveric (age range = 57-93 years) bone-Achilles tendon complexes were harvested within 24 hr postmortem. The calcaneus together with 15 cm of the Achilles tendon extending proximally from the insertion on the calcaneus was clamped and biomechanically tested. Each tendon was firmly fixed in clamps in an MTS Systems Corporation MTS testing machine and tension was applied at a displacement rate of 8 cm per minute until the tendon failed. The tensile force and tensile strain (as measured using an extensometer) were recorded and plotted using onboard software. The narrow age range of our donors prevented any meaningful correlation between age and tensile properties; however, the results showed that: 1) the average ultimate tensile strength (UTS) of the human Achilles tendon was 1189 N (range = 360-1,965), 2) there was a correlation between left and right legs for UTS, 3) there was a correlation between left and right legs in regard to cross sectional area, and 4) there was no correlation between UTS and cross-sectional area. PMID:14695585

  20. Motor responses to experimental Achilles tendon pain

    Henriksen, Marius; Aaboe, Jens; Graven-Nielsen, Thomas;

    2011-01-01

    Background Achilles tendinopathies are characterised by pain and reduced function, and heavy-load exercises have been shown to be effective in the treatment of painful chronic Achilles tendinopathies. However, basic information is needed on how the biomechanics and neuromuscular control of the...

  1. Magnetic resonance imaging of Achilles tendon xanthomas in familial hypercholesterolemia

    The demonstration of tendon xanthomas is helpful in diagnosing heterozygous familial hypercholesterolemia. We investigated the possibility the lipid element with magnetic resonance (MR) imaging in seven patients with familial hypercholesterolemia and six controls. Although the mean relative signal intensities measured on long TR/TE spin echo sequences of the tendon were significantly higher in patients than in controls, the lack of such elevation does not rule out the presence of such lesions. MR imaging and US provide equal information on the anatomy of the Achilles tendon; as an abnormally increased signal intensity within the xanthoma on MRI was found in only a minority of our patients, the value of MRI in the demonstration of Achilles tendon xanthomas is limited when using conventional T1 and T2 spin echo sequences. (orig./DG)

  2. Functional rehabilitation of patients with acute Achilles tendon rupture

    Mark-Christensen, Troels; Troelsen, Anders; Kallemose, Thomas;

    2014-01-01

    PURPOSE: The optimal treatment for acute Achilles tendon rupture (ATR) is continuously debated. Recent studies have proposed that the choice of either operative or non-operative treatment may not be as important as rehabilitation, suggesting that functional rehabilitation should be preferred over...

  3. Strain mapping in the Achilles tendon - A systematic review.

    Bogaerts, Stijn; Desmet, Hannelore; Slagmolen, Pieter; Peers, Koen

    2016-06-14

    Achilles tendinopathy remains one of the most prevalent overuse injuries in elite as well as recreational athletes. Regardless of the fact that the aetiology of tendinopathy has not been fully understood, therapeutic mechanical loading programs have emerged as being the treatment of choice. In this light, mechanical properties of the tendon and their response to changes in loading or unloading have been the subject of many previous investigations. One of these properties often investigated is strain, a measure of relative deformation. By means of a systematic review, an overview was given of research in this field, with a primary objective to list the methods used and secondary aim to synthesize data on strain mapping in the Achilles tendon. Following the guidelines of the PRISMA statement, 47 articles were found appropriate for qualitative assessment. Achilles tendon strain has been investigated across a variety of contexts, including the response to exercise, walking, unloading, ageing, hormonal changes and weight. Only three studies investigated the effect of the presence of tendinopathy on strain. Ultrasound was the most often used imaging modality to measure or estimate strain. Further methodological parameters, e.g. the location of measurement, differed greatly between all different studies. Nearly all studies considered global strain. Some studies investigated the transverse strain response of the Achilles tendon. Recently, however, the role of local - intratendinous - strain distribution has been found to be of critical importance and further studies should focus on imaging modalities to investigate these local changes. PMID:27113537

  4. Sonographic incidence of tendon microtears in athletes with chronic Achilles tendinosis

    Gibbon, W. W.; Cooper, J. R.; Radcliffe, G. S.

    1999-01-01

    OBJECTIVE: To assess the number and distribution of tendon microtears in asymptomatic controls and athletes with chronic Achilles tendinitis or partial thickness tears using high resolution ultrasound. METHODS: The mean number of microtears in three random tendon cross sections were recorded per tendon third in 19 asymptomatic volunteers, 16 athletes with symptomatic chronic Achilles tendinitis, and eight athletes with partial Achilles tendon rupture. RESULTS: Microtears were most numer...

  5. Human Achilles tendon glycation and function in diabetes.

    Couppé, Christian; Svensson, Rene Brüggebusch; Kongsgaard, Mads; Kovanen, Vuokko; Grosset, Jean-Francois; Snorgaard, Ole; Bencke, Jesper; Larsen, Jytte Overgaard; Bandholm, Thomas; Christensen, Tomas Møller; Boesen, Anders; Helmark, Ida Carøe; Aagaard, Per; Kjaer, Michael; Magnusson, Stig Peter

    2016-01-15

    Diabetic patients have an increased risk of foot ulcers, and glycation of collagen may increase tissue stiffness. We hypothesized that the level of glycemic control (glycation) may affect Achilles tendon stiffness, which can influence gait pattern. We therefore investigated the relationship between collagen glycation, Achilles tendon stiffness parameters, and plantar pressure in poorly (n = 22) and well (n = 22) controlled diabetic patients, including healthy age-matched (45-70 yr) controls (n = 11). There were no differences in any of the outcome parameters (collagen cross-linking or tendon stiffness) between patients with well-controlled and poorly controlled diabetes. The overall effect of diabetes was explored by collapsing the diabetes groups (DB) compared with the controls. Skin collagen cross-linking lysylpyridinoline, hydroxylysylpyridinoline (136%, 80%, P ratio (33%, P gait. The difference in foot pressure distribution may contribute to the development of foot ulcers in diabetic patients. PMID:26542519

  6. Longitudinal research of calf muscles functional changes for healthy and with Achilles tendon rupture subjects

    Aleknavičiūtė-Ablonskė, Vaida; Skurvydas, Albertas

    2013-01-01

    Sveikų ir Achilo sausgyslės plyšimą patyrusių asmenų, funkciniai blauzdos raumenų pokyčiai. Achilles tendon is the strongest tendon in human body, but despite that, it is also one of the common ruptured tendons. When the Achilles tendon rupture (ATR) occurs, strength of calf muscles, proprioception, and postural stability always decrease. It is well known that rehabilitation influences the greater recovery after Achilles tendon rupture, but despite that the probability of the Achilles tend...

  7. Achilles tendon rupture following surgical management for tendinopathy: a case report

    Maffulli Nicola; Carmont Michael R

    2007-01-01

    Abstract Background Achilles tendinopathy is understood to be a failed healing response. Operative management is utilised following the failure of non-operative methods. Case Presentation We present a case of Achilles tendon rupture, sustained whilst isometrically loading the Achilles tendon during an eccentric loading exercise programme. Conclusion: Bilateral surgical exploration and debridement had previously been performed after conservative management of bilateral Achilles tendinopathy ha...

  8. Biomechanical and immunohistochemical analysis of high hydrostatic pressure-treated Achilles tendons

    Reconstruction of bone defects caused by malignant tumors is carried out in different ways. At present, tumor-bearing bone segments are devitalized mainly by extracorporeal irradiation or autoclaving, but both methods have substantial disadvantages. In this regard, high hydrostatic pressure (HHP) treatment of the bone is a new, advancing technology that has been used in preclinical testing to inactivate normal cells and tumor cells without altering the biomechanical properties of the bone. The aim of this study was to examine the biomechanical and immunohistochemical properties of tendons after exposure to HHP and to evaluate whether preservation of the bony attachment of tendons and ligaments is possible. For this, 19 paired Achilles tendons were harvested from both hindlimbs of 4-month-old pigs. After preparation, the cross-sectional area of each tendon was determined by magnetic resonance imaging (MRI). For each animal, one of the two tendons was taken at random and exposed to a pressure of 300 MPa (n=9) or 600 MPa (n=10). The contralateral tendon served as an untreated control. The biomechanical properties of the tendons remained unchanged with respect to the tested parameters: Young's modulus (MPa) and tensile strength (MPa). This finding is in line with immunohistochemical labeling results, as no difference in the labeling pattern of collagen I and versican was observed when comparing the HHP group (at 600 MPa) to the untreated control group. We anticipate that during orthopedic surgery HHP can serve as a novel, promising methodical approach to inactivate Achilles tendon and bone cells without altering the biomechanical properties of the tendons. This should allow one to preserve the attachment of tendon and ligaments to the devitalized bone and to facilitate functional reconstruction. (author)

  9. MRI of the Achilles tendon: A comprehensive review of the anatomy, biomechanics, and imaging of overuse tendinopathies

    Pierre-Jerome, Claude; Moncayo, Valeria; Terk, Michael R. (Dept. of Radiology, Emory Univ. Orthopedics and Spine Center, Atlanta, GA (United States)), e-mail: cpierr3@emory.edu

    2010-05-15

    The Achilles tendon is the largest tendon in the body; it plays an important role in the biomechanics of the lower extremity. It can withstand great forces, especially during sporting exercises and pivoting. The pathologies related to the Achilles tendon are diverse and many carry undesirable consequences. We retrospectively analyzed the images of patients who underwent examinations of the ankle/foot region to review the anatomy of the Achilles tendon and its surroundings and to search for pathologies consistent with overuse injuries. The anatomy of the tendon is described from origin to insertion. The imaging characteristics of the Achilles tendon including pitfalls are reviewed. We also describe the Achilles overuse injuries: paratenonitis, tendinosis, tendon tear, atypical tear, tendon re-tear, retrocalcaneal bursitis, retro-Achilles bursitis, Haglund's deformity, and tendon calcification. We present other entities like tendon ossification and failed transplanted Achilles tendon, with emphasis on MRI

  10. MRI of the Achilles tendon: A comprehensive review of the anatomy, biomechanics, and imaging of overuse tendinopathies

    The Achilles tendon is the largest tendon in the body; it plays an important role in the biomechanics of the lower extremity. It can withstand great forces, especially during sporting exercises and pivoting. The pathologies related to the Achilles tendon are diverse and many carry undesirable consequences. We retrospectively analyzed the images of patients who underwent examinations of the ankle/foot region to review the anatomy of the Achilles tendon and its surroundings and to search for pathologies consistent with overuse injuries. The anatomy of the tendon is described from origin to insertion. The imaging characteristics of the Achilles tendon including pitfalls are reviewed. We also describe the Achilles overuse injuries: paratenonitis, tendinosis, tendon tear, atypical tear, tendon re-tear, retrocalcaneal bursitis, retro-Achilles bursitis, Haglund's deformity, and tendon calcification. We present other entities like tendon ossification and failed transplanted Achilles tendon, with emphasis on MRI

  11. Long-term functional outcome of bilateral spontaneous and simultaneous Achilles tendon ruptures.

    Ellanti, Prasad

    2012-10-01

    Bilateral simultaneous ruptures are rare comprising less than 1% of all Achilles tendon ruptures. Risk factors for bilateral ruptures include chronic diseases and medications such as corticosteroids and fluoroquinolones. There is little in the literature on the long-term functional outcome of bilateral Achilles tendon ruptures. This article present a series of 3 cases of simultaneous and spontaneous bilateral Achilles tendon ruptures with a minimum of 5-year follow up suggesting a good functional outcome.

  12. Ruptured Achilles tendon--preliminary results of a new treatment.

    Cetti, R.

    1988-01-01

    The preliminary results of a new treatment of ruptured Achilles tendons are presented. The new treatment consists of a new tendon suture and a new post-operative cast in which it is possible to make non-weight bearing movements of the ankle immediately after the operation. This makes it possible to walk the day after the operation, causes very little discomfort during the time in a cast, gives a quick return to normal mobility with normal plantar flexion strength and makes it possible to resu...

  13. Human Achilles tendon glycation and function in diabetes

    Couppe, Christian; Svensson, Rene Brüggebusch; Kongsgaard, Mads;

    2016-01-01

    Diabetic patients have an increased risk of foot ulcers, and glycation of collagen may increase tissue stiffness. We hypothesized that the level of glycemic control (glycation) may affect Achilles tendon stiffness, which can influence gait pattern. We therefore investigated the relationship between...... tissue cross-linking were greater in diabetic patients compared to controls. The higher foot pressure indicates that material stiffness of tendon and other tissue (e.g skin and joint capsule) may influence on foot gait. The difference in foot pressure distribution may contribute to the development of...... foot ulcers in diabetic patients....

  14. Biomechanical properties of Achilles tendon repair augmented with a bioadhesive-coated scaffold

    Brodie, Michael; Vollenweider, Laura; John L. Murphy; Xu, Fangmin; Lyman, Arinne; Lew, William D; Lee, Bruce P.

    2011-01-01

    The Achilles tendon is the most frequently ruptured tendon. Both acute and chronic (neglected) tendon ruptures can dramatically affect a patient’s quality of life, and require a prolonged period of recovery before return to pre-injury activity levels. This paper describes the use of an adhesive-coated biologic scaffold to augment primary suture repair of transected Achilles tendons. The adhesive portion consisted of a synthetic mimic of mussel adhesive proteins that can adhere to various surf...

  15. A Rare Case of Simultaneous Acute Bilateral Quadriceps Tendon Rupture and Unilateral Achilles Tendon Rupture

    Wei Yee Leong

    2013-07-01

    Full Text Available Introduction: There have been multiple reported cases of bilateral quadriceps tendon ruptures (QTR in the literature. These injuries frequently associated with delayed diagnosis, which results in delayed surgical treatment. In very unusual cases, bilateral QTRs can be associated with other simultaneous tendon ruptures. Case Report: We present a rare case of bilateral QTR with a simultaneous Achilles Tendon Rupture involving a 31 years old Caucasian man who is a semi-professional body builder taking anabolic steroids. To date bilateral QTR with additional TA rupture has only been reported once in the literature and to our knowledge this is the first reported case of bilateral QTR and simultaneous TA rupture in a young, fit and healthy individual. Conclusion: The diagnosis of bilateral QTR alone can sometimes be challenging and the possibility of even further tendon injuries should be carefully assessed. A delay in diagnosis could result in delay in treatment and potentially worse outcome for the patient. Keywords: Quadriceps tendon rupture; Achilles tendon rupture; Bilateral.

  16. Achilles tendon and sports; Die Achillessehne im Sport

    Ulreich, N.; Kainberger, F. [Univ.-Klinik fuer Radiodiagnostik Wien (Austria); Huber, W.; Nehrer, S. [Univ.-Klinik fuer Orthopaedie Wien (Austria)

    2002-10-01

    Because of the rising popularity of recreational sports activities achillodynia is an often associated symptom with running, soccer and athletics. Therefore radiologist are frequently asked to image this tendon. The origin of the damage of the Achilles tendon is explained by numerous hypothesis, mainly a decreased perfusion and a mechanical irritation that lead to degeneration of the tendon. High-resolution technics such as sonography and magnetic resonance imaging show alterations in the structure of the tendon which can be graduated and classified. Manifestations like tendinosis, achillobursitis, rupture and Haglunds disease can summarized as the tendon overuse syndrom. A rupture of a tendon is mostly the result of a degeneration of the collagenfibres. The task of the radiologist is to acquire the intrinsic factors for a potential rupture. (orig.) [German] Aufgrund des starken Anstiegs des Freizeitsportes sind Achillodynien ein besonders mit Laufsport, Fussball und Leichtathletik assoziiertes Symptom und die Indikation zur radiologischen Abklaerung wird oft gestellt. Die Entstehung von Sehnenschaeden wird durch eine Reihe von Hypothesen erklaert, wobei eine gestoerte Gewebeperfusion und eine mechanische Irritation als Hauptursachen angesehen werden, die zur Degeneration des Sehnengewebes und des umgebenden Gleitlagers fuehren. Sie koennen aufgrund sonographischer und MR-tomographischer Zeichen meist klar klassifiziert und graduiert werden, wobei hochaufloesende Techniken eine wesentliche Voraussetzung fuer die subtile Analyse der Sehnenstruktur darstellen. Die einzelnen klinischen Erscheinungsformen wie Tendinose, Achillobursitis, Haglund-Ferse und Sehnenruptur koennen unter dem Begriff des ''Sehnenueberlastungssyndroms'' (Tendon overuse syndrome) subsummiert werden. Rupturen der Achillessehne treten so gut wie immer bei bereits vorgeschaedigtem Kollagenfasergewebe auf, und der radiologischen Diagnostik kommt wesentliche Bedeutung dabei zu

  17. An experimental study of low-level laser therapy in rat Achilles tendon injury

    Joensen, Jon; Gjerdet, Nils Roar; Hummelsund, Steinar; Iversen, Vegard Vereide; Lopes-Martins, Rodrigo Álvaro Brandão; Bjordal, Jan Magnus

    2011-01-01

    The aim of this controlled animal study was to investigate the effect of low-level laser therapy (LLLT) administered 30 min after injury to the Achilles tendon. The study animals comprised 16 Sprague Dawley male rats divided in two groups. The right Achilles tendons were injured by blunt trauma using a mini guillotine, and were treated with LLLT or placebo LLLT 30 min later. The injury and LLLT procedures were then repeated 15 hours later on the same tendon. One group ...

  18. Collagen fibril size and crimp morphology in ruptured and intact Achilles tendons

    Magnusson, S P; Qvortrup, K; Larsen, Jytte Overgaard;

    2002-01-01

    The present study examined the hypothesis that collagen fibril diameter and crimp angle in ruptured human Achilles tendons differed from that of intact ones. Tissue samples were obtained from the central core (distal core) and the posterior periphery (distal superficial) at the rupture site, and ...... Achilles tendon rupture site. Moreover, the lack of symptoms prior to the rupture suggests that clinical tendinopathy is not an etiological factor in complete tendon ruptures....

  19. Diagnosing Achilles tendon injuries in the emergency department.

    Gibbons, Lynda

    2013-09-01

    Achilles tendon (AT) injury is an overuse injury often seen in professional and recreational athletes. It tends to affect men, particularly those in their thirties and forties, more than women, and is typically seen in people who are intermittently active. To ensure AT ruptures are identified and treated effectively, early intervention in emergency departments (EDs) is crucial. This article discusses how advanced nurse practitioners can use their comprehensive problem-solving, clinical decision-making and clinical judgement skills to manage patients who present with suspected AT injury. It also describes the anatomy of tendon rupture, the aetiology and mechanism of injuries, and the importance of assessment and diagnostic tools, therapeutic techniques and management strategies. Finally, it considers the psychological effect this injury can have on patients, while in the ED and after discharge. A case study is included as an example of ED management.

  20. Different distributions of operative diagnoses for Achilles tendon overuse injuries in Italian and Finnish athletes

    Johansson, Kristian; Lempainen, Lasse; Sarimo, Janne; Laitala-Leinonen, Tiina; Orava, Sakari

    2016-01-01

    Summary Background the origin of chronic Achilles tendinopathy (AT) is currently unclear and epidemiological factors, such as ethnicity, may be associated. Methods intraoperative findings from the treatment of 865 Finnish and 156 Italian athletic patients with chronic Achilles tendon related pain were evaluated, retrospectively. The mean age was 34 years (range, 18 to 65 years) in the Finnish and 29 years (range, 17–63 years) in the Italian patients. In total, 786 patients were males and 226 females of which 84 and 87% Finnish, respectively. Data were collected, retrospectively from patient records. The differences in the frequencies of operative findings were assessed for statistical significance. Results retrocalcaneal bursitis, partial tear and chronic paratenonitis were the most prevalent findings in patients with chronic AT undergoing surgery. Tendinosis and chronic paratenonitis were significantly (p=0.011) more common in Finnish athletes. Italian patients exhibited significantly (ptendinopathy (heel spurs) and prominent posterosuperior calcaneal corners (Haglund’s heel). Conclusion ethnicity appears to be associated with specific characteristics of overuse-related Achilles tendon pathology. This is an issue that should be considered in the planning of genetic research on AT. PMID:27331038

  1. Concurrent arthroscopic bicruciate ligament reconstruction using Achilles tendon-bone allografts: experience with 15 cases

    Shi De-hai; CAI Dao-zhang; WANG Kun; RONG Li-min; XU Yi-chun

    2008-01-01

    Objective: To evaluate the clinical outcome of arthroscopically assisted combined anterior and posterior cruciate ligament (ACL/PCL) reconstructions using Achil-les tendon-bone allografts. Methods: Associated meniscus injuries were treated according to established methods prior to ligament recon-structions during arthroscopic surgery. Thirty Achilles ten-don-bone allografts were used to reconstruct torn ACL and PCL in 15 knees. At postoperative follow-up, all knees were graded using the modified IKDC and the Lysholm scoring systems just as done preoperatively. Results were analyzed compared with the contralateral healthy knees. Results: Eleven men and 4 women with a minimum of 3-year follow-up (mean 38 months) were included in the study. Preoperatively, the group ratings by the modified IKDC standards were all severely abnormal. Twelve bicruciate reconstructions were performed in subacute or chronic stage (>3-8 weeks), 3 for acute ligamentous deficien-cies (≤ 3 weeks). The noticeable early complication was transitory local fever combined with joint effusion in one case. At postoperative follow-up, 9 knees were normal, 5 nearly normal and 1 abnormal. On Lysholm score the differ-ence was statistically significant (t- test, P<0.001) before and after operation. Conclusions: Achilles tendon-bone allograft offers an alternative for simultaneous arthroscopic ACL/PCL reconstructions. However, further investigation is needed to eradicate its potential immunogenicity for better use.

  2. Achilles tendon rupture: physiotherapy and endoscopy-assisted surgical treatment of a common sports injury

    Mahmut Nedim Doral

    2010-12-01

    Full Text Available Mahmut Nedim Doral1,2, Murat Bozkurt3, Egemen Turhan4, Gürhan Dönmez2, Murat Demirel5, Defne Kaya2, Kivanç Atesok7, Özgür Ahmet Atay1, Nicola Maffulli61Department of Orthopedics and Traumatology, 2Department of Sports Medicine, Hacettepe University School of Medicine, Sihhiye, Ankara, Turkey; 3Department of Orthopedics and Traumatology, Ankara Etlik Ihtisas Training and Research Hospital, Ankara, Turkey; 4Department of Orthopedics and Traumatology, Zonguldak Karaelmas University School of Medicine, Zonguldak, Turkey; 5Department of Orthopedics and Traumatology, Ankara Bayindir Medical Center, Ankara, Turkey; 6Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK; 7St. Michael's Hospital Division of Orthopaedics Musculoskeletal Research Lab, Toronto, Ontario, CanadaAbstract: Although the Achilles tendon (AT is the strongest tendon in the human body, rupture of this tendon is one of the most common sports injuries in the athletic population. Despite numerous nonoperative and operative methods that have been described, there is no universal agreement about the optimal management strategy of acute total AT ruptures. The management of AT ruptures should aim to minimize the morbidity of the injury, optimize rapid return to full function, and prevent complications. Since endoscopy-assisted percutaneous AT repair allows direct visualization of the synovia and protects the paratenon that is important in biological healing of the AT, this technique becomes a reasonable treatment option in AT ruptures. Furthermore, Achilles tendoscopy technique may decrease the complications about the sural nerve. Also, early functional postoperative physiotherapy following surgery may improve the surgical outcomes.Keywords: Achilles tendon rupture, percutaneous repair, endoscopic control, growth factors

  3. Evidence of accumulated stress in Achilles and anterior knee tendons in elite badminton players

    Boesen, Anders Ploug; Boesen, Morten Ilum; Koenig, Merete Juhl;

    2011-01-01

    vascular response as indicated by colour Doppler (CD) activity in both the Achilles and patella tendon after loading during high-level badminton matches. The Achilles tendon was subdivided into a mid-tendon, pre-insertional, and insertional region and the anterior knee tendons into a quadriceps-, patella......, there was a trend towards a stepwise increase in intra-tendinous flow. The preliminary results indicate that high amount of intra-tendinous flow was found in elite badminton players at baseline and was increased after repetitive loading, especially in the patella tendon (dominant leg). The colour...

  4. Blood flow in the peritendinous space of the human Achilles tendon during exercise

    Langberg, Henning; Bülow, J; Kjaer, M

    1998-01-01

    This study evaluated blood flow in the peritendinous space of the human Achilles tendon during rest and 40-min dynamical contraction of m. triceps surae. In 10 healthy volunteers 133Xe was injected in to the peritendinous space just ventrally to the Achilles tendon 2 and 5 cm proximal to the calc....... Lymph drainage from the area was found to be negligible both during rest and exercise. We conclude that dynamical calf muscle contractions result in increased peritendinous blood flow at the Achilles tendon in humans....

  5. Subcutaneous rupture of the Achilles tendon and ipsilateral fracture of the medial malleolus

    Richards Paula J

    2006-07-01

    Full Text Available Abstract Background Although ankle fractures and an Achilles tendon rupture are relatively frequent in isolation, their association in the same injury is uncommon. Case presentation A 38 year old male tree surgeon fell six meters from a tree, sustaining a subcutaneous rupture of the Achilles tendon and an ipsilateral closed fracture of the medial malleolus. The injuries were diagnosed following clinical examination and imaging. Conclusion This injury combination is infrequent, and management of the Achilles tendon rupture should take into account the necessity not to secondarily displace the fracture of the medial malleollus.

  6. The effect of dry needling and treadmill running on inducing pathological changes in rat Achilles tendon.

    Kim, Bom Soo; Joo, Young Chae; Choi, Byung Hyune; Kim, Kil Hwan; Kang, Joon Soon; Park, So Ra

    2015-11-01

    Achilles tendinopathy is a common degenerative condition without a definitive treatment. An adequate chronic animal model of Achilles tendinopathy has not yet been developed. The purpose of this study was to evaluate the individual and combined effects of dry needling and treadmill running on the Achilles tendon of rats. Percutaneous dry needling, designed to physically replicate microrupture of collagen fibers in overloaded tendons, was performed on the right Achilles tendon of 80 Sprague-Dawley rats. The rats were randomly divided into two groups: a treadmill group, which included rats that underwent daily uphill treadmill running (n = 40), and a cage group, which included rats that could move freely within their cages (n = 40). At the end of weeks 1 and 4, 20 rats from each group were sacrificed, and bilateral Achilles tendons were collected. The harvested tendons were subjected to mechanical testing and histological analysis. Dry needling induced histological and mechanical changes in the Achilles tendons at week 1, and the changes persisted at week 4. The needled Achilles tendons of the treadmill group tended to show more severe histological and mechanical changes than those of the cage group, although these differences were not statistically significant. Dry needling combined with free cage activity or treadmill running produced tendinopathy-like changes in rat Achilles tendons up to 4 weeks after injury. Dry needling is an easy procedure with a short induction period and a high success rate, suggesting it may have relevance in the design of an Achilles tendinopathy model. PMID:26076317

  7. Nonoperative dynamic treatment of acute achilles tendon rupture

    Barfod, Kristoffer Weisskirchner; Bencke, Jesper; Bloch Lauridsen, Hanne;

    2014-01-01

    BACKGROUND: Dynamic rehabilitation has been suggested to be an important part of nonoperative treatment of acute Achilles tendon rupture that results in functional outcome and rerupture rates comparable with those of operative treatment. However, the optimal role of weight-bearing during early...... Rupture Score (ATRS) after one year. Secondary outcomes included heel-rise work, health-related quality of life, and the rerupture rate. Outcome assessors were blinded to the intervention. RESULTS: Thirty patients were randomized to each group; twenty-nine in the weight-bearing group and twenty-seven in...... months, the total heel-rise work performed by the injured limb relative to that by the uninjured limb was 53% in the weight-bearing group and 58% in the control group (p = 0.37). There were three reruptures in the weight-bearing group and two in the control group (p = 1.0). CONCLUSIONS: The ATRS and heel...

  8. Practice Patterns in the Care of Acute Achilles Tendon Ruptures

    Sheth, Ujash; Wasserstein, David; Moineddin, Rahim; Jenkinson, Richard; Kreder, Hans; Jaglal, Susan

    2016-01-01

    Objectives: Over the last decade, there has been a growing body of level I evidence supporting non-operative management (focused on early range of motion and weight bearing) of acute Achilles tendon ruptures. Despite this emerging evidence, there have been very few studies evaluating its uptake. Our primary objective was to determine whether the findings from a landmark trial assessing the optimal management strategy for acute Achilles tendon ruptures influenced the practice patterns of orthopaedic surgeons in Ontario, Canada over a 12-year time period. As a second objective we examined whether patient and provider predictors of surgical repair utilization differed before and after dissemination of the landmark trial results. Methods: Using provincial health administrative databases, we identified Ontario residents ≥ 18 years of age with an acute Achilles tendon rupture from April 2002 to March 2014. The proportion of surgically repaired ruptures was calculated for each calendar quarter and year. A time series analysis using an interventional autoregressive integrated moving average (ARIMA) model was used to determine whether changes in the proportion of surgically repaired ruptures were chronologically related to the dissemination of results from a landmark trial by Willits et al. (first quarter, 2009). Spline regression was then used to independently identify critical time-points of change in the surgical repair rate to confirm our findings. A multivariate logistic regression model was used to assess for differences in patient (baseline demographics) and provider (hospital type) predictors of surgical repair utilization before and after the landmark trial. Results: In 2002, ˜19% of acute Achilles tendon ruptures in Ontario were surgically repaired, however, by 2014 only 6.5% were treated operatively. A statistically significant decrease in the rate of surgical repair (p < 0.001) was observed after the results from a landmark trial were presented at a major

  9. Concurrent deficits of soleus and gastrocnemius muscle fascicles and Achilles tendon post stroke

    Zhao, Heng; Ren, Yupeng; Roth, Elliot J.; Harvey, Richard L.; Zhang, Li-Qun

    2015-01-01

    Calf muscles and Achilles tendon play important roles in functional activities. However, it is not clear how biomechanical properties of the uniarticular soleus (SOL) and biarticular gastrocnemius muscle and Achilles tendon, including the fascicle length, pennation angle, and stiffness, change concurrently post stroke. Biomechanical properties of the medial gastrocnemius (GM) and soleus muscles were evaluated bilaterally in 10 hemiparetic stroke survivors using combined ultrasonography-biomec...

  10. Effect of Calendula officinalis cream on achilles tendon healing.

    Aro, A A; Perez, M O; Vieira, C P; Esquisatto, M A M; Rodrigues, R A F; Gomes, L; Pimentel, E R

    2015-02-01

    In recent years, the scientific community has undertaken research on plant extracts, searching for compounds with pharmacological activities that can be used in diverse fields of medicine. Calendula officinalis L. is known to have antioxidant, anti-inflammatory, antibacterial, and wound healing properties when used to treat skin burns. Therefore, the purpose of this study was to analyze the effects of C. officinalis on the initial phase of Achilles tendon healing. Wistar rats were separated in three groups: Calendula (Cal)-rats with a transected tendon were treated with topical applications of C. officinalis cream and then euthanized 7 days after injury; Control (C)-rats were treated with only vehicle after transection; and Normal (N)-rats without tenotomy. Higher concentrations of hydroxyproline (an indicator of total collagen) and non-collagenous proteins were observed in the Cal group in relation to the C group. Zymography showed no difference in the amount of the isoforms of metalloproteinase-2 and of metalloproteinase-9, between C and Cal groups. Polarization microscopy images analysis showed that the Cal group presented a slightly higher birefringence compared with the C group. In sections of tendons stained with toluidine blue, the transected groups presented higher metachromasy as compared with the N group. Immunocytochemistry analysis for chondroitin-6-sulfate showed no difference between the C and Cal groups. In conclusion, the topical application of C. officinalis after tendon transection increases the concentrations of collagen and non-collagenous proteins, as well as the collagen organization in the initial phase of healing. PMID:25266273

  11. Accelerated rehabilitation following Achilles tendon repair after acute rupture - Development of an evidence-based treatment protocol.

    Brumann, Mareen; Baumbach, Sebastian F; Mutschler, Wolf; Polzer, Hans

    2014-11-01

    The acute rupture of the Achilles tendon is a protracted injury. Surgery is only the beginning of a long rehabilitation period. Therefore, the rehabilitation protocol is an integral aspect to restore the pre-injury activity level. Despite several trials available comparing different treatment regimes, there is still no consensus regarding the optimal protocol. Consequently, the aim of our study was to systematically search the evidence available and define a precise rehabilitation programme after operative repair of acute Achilles tendon rupture based on the trials with the highest level of evidence. We performed a systematic literature search in Medline, Embase and Cochrane library. We identified twelve randomized controlled trials comparing different treatment regimes after operative repair of the Achilles tendon. Five trials compared full to non weight bearing, all applying immobilization in equinus. Immediate full weight bearing led to significant higher patient satisfaction, earlier ambulation and return to pre-injury activity. Four trials compared early ankle mobilization to immobilization. All trials found mobilization to be superior as it shortens time to return to work and sports significantly. Three trials compared the combination of full weight bearing and early ankle mobilization to immobilization. This combination was most beneficial. Patients showed significantly higher satisfaction, less use of rehabilitation resources, earlier return to pre-injury activities and further demonstrated significantly increased calf muscle strength, reduced atrophy and tendon elongation. No study found an increased rerupture rate for the more progressive treatment. In conclusion, the rehabilitation protocol after Achilles tendon repair should allow immediate full weight bearing. After the second postoperative week controlled ankle mobilization by free plantar flexion and limited dorsiflexion at 0° should be applied. PMID:25059505

  12. In-depth imaging and quantification of degenerative changes associated with Achilles ruptured tendons by polarization-sensitive optical coherence tomography

    Bagnaninchi, P O; Yang, Y; Maffulli, G; El Haj, A; Maffulli, N [Institute for Science and Technology in Medicine, Keele University, Thornburrow Drive, Hartshill, Stoke-on-Trent ST4 7QB (United Kingdom); Bonesi, M; Meglinski, I [Cranfield Health, Cranfield University, Cranfield MK43 0AL (United Kingdom); Phelan, C, E-mail: pierre.bagnaninchi@ed.ac.u [Department of Pathology, University Hospital of North Staffordshire, Stoke-on-Trent ST4 7QB (United Kingdom)

    2010-07-07

    The objective of this study was to develop a method based on polarization-sensitive optical coherent tomography (PSOCT) for the imaging and quantification of degenerative changes associated with Achilles tendon rupture. Ex vivo PSOCT examinations were performed in 24 patients. The study involved samples from 14 ruptured Achilles tendons, 4 tendinopathic Achilles tendons and 6 patellar tendons (collected during total knee replacement) as non-ruptured controls. The samples were imaged in both intensity and phase retardation modes within 24 h after surgery, and birefringence was quantified. The samples were fixed and processed for histology immediately after imaging. Slides were assessed twice in a blind manner to provide a semi-quantitative histological score of degeneration. In-depth micro structural imaging was demonstrated. Collagen disorganization and high cellularity were observable by PSOCT as the main markers associated with pathological features. Quantitative assessment of birefringence and penetration depth found significant differences between non-ruptured and ruptured tendons. Microstructure abnormalities were observed in the microstructure of two out of four tendinopathic samples. PSOCT has the potential to explore in situ and in-depth pathological change associated with Achilles tendon rupture, and could help to delineate abnormalities in tendinopathic samples in vivo.

  13. In-depth imaging and quantification of degenerative changes associated with Achilles ruptured tendons by polarization-sensitive optical coherence tomography

    The objective of this study was to develop a method based on polarization-sensitive optical coherent tomography (PSOCT) for the imaging and quantification of degenerative changes associated with Achilles tendon rupture. Ex vivo PSOCT examinations were performed in 24 patients. The study involved samples from 14 ruptured Achilles tendons, 4 tendinopathic Achilles tendons and 6 patellar tendons (collected during total knee replacement) as non-ruptured controls. The samples were imaged in both intensity and phase retardation modes within 24 h after surgery, and birefringence was quantified. The samples were fixed and processed for histology immediately after imaging. Slides were assessed twice in a blind manner to provide a semi-quantitative histological score of degeneration. In-depth micro structural imaging was demonstrated. Collagen disorganization and high cellularity were observable by PSOCT as the main markers associated with pathological features. Quantitative assessment of birefringence and penetration depth found significant differences between non-ruptured and ruptured tendons. Microstructure abnormalities were observed in the microstructure of two out of four tendinopathic samples. PSOCT has the potential to explore in situ and in-depth pathological change associated with Achilles tendon rupture, and could help to delineate abnormalities in tendinopathic samples in vivo.

  14. An experimental study of low-level laser therapy in rat Achilles tendon injury

    Joensen, Jon; Gjerdet, Nils Roar; Hummelsund, Steinar; Iversen, Vegard; Lopes-Martins, Rodrigo Alvaro B.; Bjordal, Jan Magnus

    2011-01-01

    The aim of this controlled animal study was to investigate the effect of low-level laser therapy (LLLT) administered 30 min after injury to the Achilles tendon. The study animals comprised 16 Sprague Dawley male rats divided in two groups. The right Achilles tendons were injured by blunt trauma using a mini guillotine, and were treated with LLLT or placebo LLLT 30 min later. The injury and LLLT procedures were then repeated 15 hours later on the same tendon. One group received active LLLT (λ ...

  15. The Achilles tendon total rupture score: a study of responsiveness, internal consistency and convergent validity on patients with acute Achilles tendon ruptures

    Kearney Rebecca S

    2012-02-01

    Full Text Available Abstract Background The Achilles tendon Total Rupture Score was developed by a research group in 2007 in response to the need for a patient reported outcome measure for this patient population. Beyond this original development paper, no further validation studies have been published. Consequently the purpose of this study was to evaluate internal consistency, convergent validity and responsiveness of this newly developed patient reported outcome measure within patients who have sustained an isolated acute Achilles tendon rupture. Methods Sixty-four eligible patients with an acute rupture of their Achilles tendon completed the Achilles tendon Total Rupture Score alongside two further patient reported outcome measures (Disability Rating Index and EQ 5D. These were completed at baseline, six weeks, three months, six months and nine months post injury. The Achilles tendon Total Rupture Score was evaluated for internal consistency, using Cronbach's alpha, convergent validity, through correlation analysis and responsiveness, by analysing floor and ceiling effects and calculating its relative efficiency in comparison to the Disability Rating Index and EQ 5D scores. Results The Achilles tendon Total Rupture Score demonstrated high internal consistency (Cronbachs alpha > 0.8 and correlated significantly (p Conclusions A universally accepted outcome measure is imperative to allow comparisons to be made across practice. This is the first study to evaluate aspects of validity of this newly developed outcome measure, outside of the developing centre. The ATRS demonstrated high internal consistency and responsiveness, with limited convergent validity. This research provides further support for the use of this outcome measure, however further research is required to advocate its universal use in patients with acute Achilles tendon ruptures. Such areas include inter-rater reliability and research to determine the minimally clinically important difference

  16. In-vitro tensile testing machine for vibration study of fresh rabbit Achilles tendon

    Revel, Gian M.; Scalise, Alessandro; Scalise, Lorenzo; Pianosi, Antonella

    2001-10-01

    A lot of people, overall athletic one suffer from tendinitis or complete rupture of the Achilles tendon. This structure becomes inflamed and damaged mainly from a variety of mechanical forces and sometimes due to metabolic problems, such as diabetes or arthritis. Over the past three decades extensive studies have been performed on the structural and mechanical properties of Achilles tendon trying to explain the constitutive equations to describe and foresee tendon behavior. Among the various mechanical parameters, the vibrational behavior is also of interest. Several investigations are performed in order to study how the Achilles tendon vibrations influence the response of the muscle proprioception and human posture. The present article describes how in vitro tensile experiments can be performed, taking into account the need to simulate physiological condition of Achilles tendon and thus approaching some opened problems in the design of the experimental set-up. A new system for evaluating tendon vibrations by non contact techniques is proposed. Preliminary simple elongation tests are made extracting the main mechanical parameters: stress and strain at different fixed stretches, in order to characterize the tissue. Finally, a vibration study is made at each pretensioned tendon level evaluating the oscillating curves caused by a small hammer.

  17. Effects of 12-wk eccentric calf muscle training on muscle-tendon glucose uptake and SEMG in patients with chronic Achilles tendon pain

    Masood, Tahir; Kalliokoski, Kari; Magnusson, S Peter;

    2014-01-01

    Achilles tendon GU. A longitudinal study design with control (n = 10) and patient (n = 10) groups was used. Surface electromyography (SEMG) from four ankle plantar flexors and GU from the same muscles and the Achilles tendon were measured during submaximal intermittent isometric plantar flexion task. The...... within- or between-group differences. Eccentric rehabilitation was effective in decreasing subjective severity of Achilles tendinopathy. It also resulted in redistribution of relative electrical activity, but not metabolic activity, within the triceps surae muscle....

  18. Biomechanical properties of isolated fascicles of the Iliopsoas and Achilles tendons in African American and Caucasian men

    Hanson, P; Aagaard, P; Magnusson, S Peter

    2012-01-01

    OBJECTIVES: To investigate biomechanical properties of the Iliopsoas and Achilles tendons in young African American (AA) and Caucasian (CC) men, and attempt to clarify whether the difference in Achilles tendon ruptures between AA and CC can be explained by differences in material properties. METH...

  19. Stereological quantification of immune-competent cells in baseline biopsy specimens from achilles tendons

    Kragsnaes, Maja Skov; Fredberg, Ulrich; Stribolt, Katrine;

    2014-01-01

    BACKGROUND: Limited data exist on the presence and function of immune-competent cells in chronic tendinopathic tendons and their potential role in inflammation and tissue healing as well as in predicting long-term outcome. PURPOSE: To quantify subtypes of immune-competent cells in biopsy specimens....... METHODS: Fifty patients with nonruptured chronic Achilles tendinopathy and 15 healthy participants were included. At time of inclusion, an ultrasound examination was performed immediately before an ultrasound-guided Achilles tendon biopsy specimen was obtained. Tissue samples were evaluated......(+)) using a stereological technique. A follow-up examination was conducted more than 4 years (range, 4-9 years) after the biopsy procedure to evaluate the long-term presence of Achilles tendon symptoms. RESULTS: Macrophages, T lymphocytes, mast cells, and natural killer cells were observed in the majority...

  20. Treatment of Acute Achilles Tendon Rupture in Scandinavia Does Not Adhere to Evidence-based Guidelines

    Barfod, Kristoffer W; Nielsen, Fredrik; Helander, Katarina N;

    2013-01-01

    The best treatment of acute Achilles tendon rupture has been discussed for decades. During the past half decade, evidence has increased in favor of nonoperative treatment and dynamic and weightbearing rehabilitation. We hypothesized that the treatment strategies would show great variation and that...... adherence to evidence-based recommendations would not be as good as desired. The purpose of the present study was to investigate how acute Achilles tendon rupture is treated in Scandinavia. A questionnaire was distributed to all orthopedic departments treating acute Achilles tendon ruptures in Denmark......, Sweden, Norway, and Finland. The questionnaire was returned by 138 of 148 departments (response rate 93%). Two-way tables with Fisher's exact test were used for statistical analysis. In Denmark, Norway, Sweden, and Finland, 19 of 23 (83%), 44 of 48 (92%), 26 of 40 (65%), and 8 of 27 (30%) departments...

  1. Ultrasound Changes in Achilles Tendon and Gastrocnemius Medialis Muscle on Squat Eccentric Overload and Running Performance.

    Sanz-López, Fernando; Berzosa Sánchez, César; Hita-Contreras, Fidel; Cruz-Diaz, David; Martínez-Amat, Antonio

    2016-07-01

    Sanz-López, F, Berzosa Sánchez, C, Hita-Contreras, F, Cruz-Diaz, D, and Martínez-Amat, A. Ultrasound changes in Achilles tendon and gastrocnemius medialis muscle on squat eccentric overload and running performance. J Strength Cond Res XX(X): 000-000, 2015-Previous studies have proven the adaptation to load in the Achilles tendon and gastrocnemius muscle after different types of exercise, such as running, heel drop training, and a variety of sports. These findings have been applied to improve performance and in the treatment and prevention of overuse injuries. However, the effects that squat performance may have on the Achilles tendon and gastrocnemius muscle are still unknown. Squats are a widely used training exercise that involves calf-muscle activation. Similarly, no reports have been published regarding the adaptation to load of trained and untrained subjects during several consecutive days of running. The purpose of this study was to analyze changes in the Achilles tendon and in the pennation angles of the gastrocnemius medialis after eccentric overload training and within 3 days of running. Twenty healthy males who volunteered for this study were divided into 2 groups. Subjects in the eccentric overload training (ECC) group performed 6 weeks of eccentric overload training (twice weekly, 4 sets of 7 repetitions in a Yoyo squat device) before the running intervention. All participants, ECC and control (CONT) groups, ran on 3 consecutive days. After the eccentric training, an increase in the cross-sectional area of the Achilles tendon and in the pennation angle was observed. As for the running intervention, the behavior of tissues in both groups was similar. These results suggest that eccentric overload training with squats promotes changes in the Achilles tendon and in the pennation angle of the gastrocnemius medialis muscle. Nevertheless, significant changes in the tissue do not appear between the running performance of trained and untrained subjects. PMID

  2. Achillodynia. Radiological imaging of acute and chronic overuse injuries of the Achilles tendon

    In the past decades the incidence of acute and chronic disorders of the Achilles tendon associated with sport-induced overuse has steadily increased. Besides acute complete or partial ruptures, achillodynia (Achilles tendon pain syndrome), which is often associated with tendon degeneration, represents the most challenging entity regarding clinical diagnostics and therapy. Therefore, the use of imaging techniques to differentiate tendon disorders and even characterize structure alterations is of growing interest. This review article discusses the potential of different imaging techniques with respect to the diagnosis of acute and chronic tendon disorders. In this context, the most commonly used imaging techniques are magnetic resonance imaging (MRI), B-mode ultrasound, and color-coded Doppler ultrasound (US). These modalities allow the detection of acute tendon ruptures and advanced chronic tendon disorders. However, the main disadvantages are still the low capabilities in the detection of early-stage degeneration and difficulties in the assessment of treatment responses during follow-up examinations. Furthermore, differentiation between chronic partial ruptures and degeneration remains challenging. The automatic contour detection and texture analysis may allow a more objective and quantitative interpretation, which might be helpful in the monitoring of tendon diseases during follow-up examinations. Other techniques to quantify tendon-specific MR properties, e.g. based on ultrashort echo time (UTE) sequences, also seem to have great potential with respect to the precise detection of degenerative tendon disorders and their differentiation at a very early stage. (orig.)

  3. Fluoroquinolone-induced bilateral rupture of the Achilles tendon: clinical and sonographic findings

    P. Busilacchi

    2011-09-01

    Full Text Available The fluoroquinolones are antibiotics widely used in the clinical practice. The concomitant use of corticosteroids and fluoroquinolones in elderly patients is recognised as a risk factor for developing clinically relevant tendon lesions. Fluoroquinolone-induced tendinopathy is underreported in the literature. Clinical case. A 67-year-old man, came to our observation complaining of 5 days history of bilateral heel pain. The patient had a medical history of sarcoidosis and was treated with a daily dose of 5 mg of prednisone. He was initially given oral levofloxacin (500 mg/die for 10 days, because of an acute respiratory infection. Two days before the end of the antibiotic therapy, he developed bilateral heel pain. He denied any history of trauma. Physical examination revealed swelling and marked tenderness with mild palpation of the Achilles tendons at the calcaneal insertion. The ultrasound evaluation of the Achilles tendons revealed the following main abnormalities: diffuse thickening, loss of the “fibrillar” echotexture, blurred margins, and bilateral partial tendon tears. Discussion. Bilateral Achilles tendon pain and rupture has been described as a rare adverse effect of fluoroquinolone treatment. Most of the fluoroquinolone-induced tendinopathies of the Achilles tendon are due to ciprofloxacin. To the best of our knowledge, this is the first description of bilateral Achilles tendon rupture due to levofloxacin. The risk/benefit ratio of the fluoroquinolones should be carefully considered and these drugs should be prescribed cautiously in elderly patients treated with corticosteroids. This case can be regarded as a representative example of the potential clinical efficacy of sonography in daily rheumatological practise.

  4. Expression, content, and localization of insulin-like growth factor I in human achilles tendon

    Olesen, Jens L; Heinemeier, Katja M; Langberg, Henning;

    2006-01-01

    In animals insulin-like growth factor I (IGF-I) stimulates collagen production by fibroblasts and is expressed in tendons together with its binding protein 4 (IGFBP-4). However, the presence of IGF-I and IGFBP-4 in human tendon tissue is not described. Tissue IGF-I content was examined by...... immunoflourometric assay, real-time PCR, and immunohistochemistry used to localize and determine expression of IGF-I and IGFBP-4 in 6 postmortem human Achilles tendons. Tendon tissue concentrations of IGF-I were found to be 0.53 +/- 0.10 ng/g. Furthermore, we demonstrated that IGF-I and IGFBP-4 are localized around...... the tendon fibroblasts and that mRNA for IGF-I and IGFBP-4 can be determined in human tendon tissue. The present study adds support for the roles of IGF-I and IGFBP-4 in the regulation of tendon adaptive responses to mechanical loading....

  5. Gait characteristics following Achilles tendon elongation: the foot rocker perspective.

    Bober, Tadeusz; Dziuba, Alicja; Kobel-Buys, Krystyna; Kulig, Kornelia

    2008-01-01

    The action of three functional rockers, namely the heel, ankle and forefoot rocker, assist the progression of the leg over the supporting foot. The purpose of this case series was to analyze the occurrence of foot rockers during gait in three children with cerebral palsy (CP) who had undergone the tendo-Achilles lengthening (TAL), procedure followed by a clinic- or home-based intervention and in one child with CP without history of surgery. Self-selected gait was video-recorded in a laboratory during six testing sessions at half-year intervals rendering a 3 year period of observation. One child had pre- and post-surgical gait data and the other two had post surgical data only. Sagittal plane knee angular velocity, as well as foot to ground positions, and foot rocker occurrence were analyzed. In a child with history of CP, and without history of surgery, mean angular velocities of the 1st, 2nd and 3rd foot rocker were 3.7, 0.57 and 6.67 rad/s, respectively, and the step length and cadence were normal. In children who underwent TAL the 1st and 2nd rocker was absent, as the initial contact of the foot with the ground was either with foot-flat or forefoot. The mean velocity of the 3rd rocker in children who underwent TAL was lower by approximately 50-80% than that of the nonsurgical case. Furthermore, the characteristic pattern of the knee joint to foot-floor position during gait was not observed in these cases. Foot rocker analysis identified children with abnormal gait characteristics. Following surgery these gait characteristics remained abnormal. PMID:18634352

  6. Biomechanical properties of Achilles tendon repair augmented with a bioadhesive-coated scaffold

    Brodie, Michael; Vollenweider, Laura; Murphy, John L; Xu Fangmin; Lyman, Arinne; Lew, William D; Lee, Bruce P, E-mail: b-lee@nerites.com [Nerites Corporation, 505 S. Rosa Road, Suite 123, Madison, WI 53719 (United States)

    2011-02-15

    The Achilles tendon is the most frequently ruptured tendon. Both acute and chronic (neglected) tendon ruptures can dramatically affect a patient's quality of life, and require a prolonged period of recovery before return to pre-injury activity levels. This paper describes the use of an adhesive-coated biologic scaffold to augment primary suture repair of transected Achilles tendons. The adhesive portion consisted of a synthetic mimic of mussel adhesive proteins that can adhere to various surfaces in a wet environment, including biologic tissues. When combined with biologic scaffolds such as bovine pericardium or porcine dermal tissues, these adhesive constructs demonstrated lap shear adhesive strengths significantly greater than that of fibrin glue, while reaching up to 60% of the strength of a cyanoacrylate-based adhesive. These adhesive constructs were wrapped around transected cadaveric porcine Achilles tendons repaired with a combination of parallel and three-loop suture patterns. Tensile mechanical testing of the augmented repairs exhibited significantly higher stiffness (22-34%), failure load (24-44%), and energy to failure (27-63%) when compared to control tendons with suture repair alone. Potential clinical implications of this novel adhesive biomaterial are discussed.

  7. Lack of tissue renewal in human adult Achilles tendon is revealed by nuclear bomb C

    Heinemeier, Katja Maria; Schjerling, Peter; Heinemeier, J.; Magnusson, Stig Peter; Kjaer, Michael

    2013-01-01

    14C bomb-pulse method. This method takes advantage of the dramatic increase in atmospheric levels of 14C, produced by nuclear bomb tests in 1955-1963, which is reflected in all living organisms. Levels of 14C were measured in 28 forensic samples of Achilles tendon core and 4 skeletal muscle samples...... is revealed by nuclear bomb 14C....

  8. The influence of physical activity during youth on structural and functional properties of the Achilles tendon

    Lenskjold, A; Kongsgaard, M; Larsen, J O;

    2015-01-01

    Achilles tendinopathy is a highly prevalent sports injury. Animal studies show a growth response in tendons in response to loading in the immature phase but not after puberty maturation. The aim of this investigation was to examine the structural and material properties in long distance runners who...

  9. Comparison of structural anisotropic soft tissue models for simulating Achilles tendon tensile behaviour.

    Khayyeri, Hanifeh; Longo, Giacomo; Gustafsson, Anna; Isaksson, Hanna

    2016-08-01

    The incidence of tendon injury (tendinopathy) has increased over the past decades due to greater participation in sports and recreational activities. But little is known about the aetiology of tendon injuries because of our limited knowledge in the complex structure-function relationship in tendons. Computer models can capture the biomechanical behaviour of tendons and its structural components, which is essential for understanding the underlying mechanisms of tendon injuries. This study compares three structural constitutive material models for the Achilles tendon and discusses their application on different biomechanical simulations. The models have been previously used to describe cardiovascular tissue and articular cartilage, and one model is novel to this study. All three constitutive models captured the tensile behaviour of rat Achilles tendon (root mean square errors between models and experimental data are 0.50-0.64). They further showed that collagen fibres are the main load-bearing component and that the non-collagenous matrix plays a minor role in tension. By introducing anisotropic behaviour also in the non-fibrillar matrix, the new biphasic structural model was also able to capture fluid exudation during tension and high values of Poisson׳s ratio that is reported in tendon experiments. PMID:27108350

  10. Long-Term Results of Mini-Open Repair Technique in the Treatment of Acute Achilles Tendon Rupture: A Prospective Study.

    Taşatan, Ersin; Emre, Tuluhan Yunus; Demircioğlu, Demet Tekdöş; Demiralp, Bahtiyar; Kırdemir, Vecihi

    2016-01-01

    patients' business or social life was detected in 18 patients who were assessed at 5 years after surgery; 2 patients could not be reached at 5 years. In conclusion, as a technique combining percutaneous and open surgical techniques, mini-open repair of Achilles tendon rupture allows a satisfactory end-to-end approximation of the tendon just in the open surgery and provides the wound healing advantages of percutaneous surgery. PMID:27289216

  11. Experimental diabetes induces structural, inflammatory and vascular changes of Achilles tendons.

    Rodrigo R de Oliveira

    Full Text Available This study aims to demonstrate how the state of chronic hyperglycemia from experimental Diabetes Mellitus can influence the homeostatic imbalance of tendons and, consequently, lead to the characteristics of tendinopathy. Twenty animals were randomly divided into two experimental groups: control group, consisting of healthy rats and diabetic group constituted by rats induced to Diabetes Mellitus I. After twenty-four days of the induction of Diabetes type I, the Achilles tendon were removed for morphological evaluation, cellularity, number and cross-sectional area of blood vessel, immunohistochemistry for Collagen type I, VEGF and NF-κB nuclear localization sequence (NLS and nitrate and nitrite level. The Achilles tendon thickness (µm/100g of diabetic animals was significantly increased and, similarly, an increase was observed in the density of fibrocytes and mast cells in the tendons of the diabetic group. The average number of blood vessels per field, in peritendinous tissue, was statistically higher in the diabetic group 3.39 (2.98 vessels/field when compared to the control group 0.89 (1.68 vessels/field p = 0.001 and in the intratendinous region, it was observed that blood vessels were extremely rare in the control group 0.035 (0.18 vessels/field and were often present in the tendons of the diabetic group 0.89 (0.99 vessels/field. The immunohistochemistry analysis identified higher density of type 1 collagen and increased expression of VEGF as well as increased immunostaining for NFκB p50 NLS in the nucleus in Achilles tendon of the diabetic group when compared to the control group. Higher levels of nitrite/nitrate were observed in the experimental group induced to diabetes. We conclude that experimental DM induces notable structural, inflammatory and vascular changes in the Achilles tendon which are compatible with the process of chronic tendinopathy.

  12. The Effect of Phospholipids (Surfactant on Adhesion and Biomechanical Properties of Tendon: A Rat Achilles Tendon Repair Model

    T. Kursat Dabak

    2015-01-01

    Full Text Available Adhesion of the tendon is a major challenge for the orthopedic surgeon during tendon repair. Manipulation of biological environment is one of the concepts to prevent adhesion. Lots of biochemicals have been studied for this purpose. We aimed to determine the effect of phospholipids on adhesion and biomechanical properties of tendon in an animal tendon repair model. Seventy-two Wistar rats were divided into 4 groups. Achilles tendons of rats were cut and repaired. Phospholipids were applied at two different dosages. Tendon adhesion was determined histopathologically and biomechanical test was performed. At macroscopic evaluation of adhesion, there are statistically significant differences between multiple-dose phospholipid injection group and Control group and also hyaluronic acid group and Control group (p0.008. Ultimate strength was highest at hyaluronic acid injection group and lowest at multiple-dose phospholipid injection group. Single-dose phospholipids (surfactant application may have a beneficial effect on the tendon adhesion. Although multiple applications of phospholipids seem the most effective regime to reduce the tendon adhesion among groups, it deteriorated the biomechanical properties of tendon.

  13. Operative Treatment of Haglund Syndrome With Central Achilles Tendon-Splitting Approach.

    Ahn, Jae Hoon; Ahn, Chi-Young; Byun, Chu-Hwan; Kim, Yoon-Chung

    2015-01-01

    Haglund syndrome is characterized by chronic posterior heel pain associated with a posterosuperior calcaneal prominence. We assessed the clinical and radiologic outcomes after operative treatment of Haglund syndrome using the central tendon-splitting approach. Fifteen feet in 15 patients were investigated retrospectively after surgery. Of the 15 patients, 14 were males (93.3%) and 1 was female (6.7%). Their mean age was 33.1 ± 8.2 (range 20 to 50) years. The mean follow-up duration was 3.5 ± 1.5 years (range 24 to 90 months). The American Orthopaedic Foot and Ankle Society ankle-hindfoot Scale and Victorian Institute of Sport Assessment-Achilles scores were investigated to assess the clinical outcomes. Patient satisfaction was assessed at the latest follow-up visit. The lateral talo-first metatarsal angle, calcaneal pitch angle, Fowler-Philip angle, and parallel pitch line were measured to assess the foot shape and radiographic outcomes. Clinically, the mean American Orthopaedic Foot and Ankle Society ankle-hindfoot scale score increased from 62.1 ± 7.5 preoperatively to 92.5 ± 3.5 at the latest follow-up visit. The mean Victorian Institute of Sport Assessment-Achilles score increased from 53.2 ± 7.4 to 89.6 ± 3.4. All patients were satisfied with the operative results. Radiographically, all patients had cavus feet with an increased lateral talo-first metatarsal angle (mean +5.9° ± 5.0°) and calcaneal pitch angle (mean 26.0° ± 3.8°). The mean Fowler-Philip angle decreased from 58.9° ± 15.0° to 32.5° ± 7.2° postoperatively, and the positive parallel pitch line had changed to a negative value in all cases. Operative treatment with the central tendon-splitting approach appears to be safe and satisfactory for intractable Haglund syndrome. PMID:26232175

  14. A meta-analysis of randomised controlled trials comparing conventional to minimally invasive approaches for repair of an Achilles tendon rupture.

    McMahon, Samuel E; Smith, Toby O; Hing, Caroline B

    2011-12-01

    Achilles tendon ruptures are a common injury afflicting predominantly the young male occasional sportsman. Previous studies have shown that outcome is better with surgical repair for the young active patient. There is no consensus as to whether there is a difference in outcome between open and percutaneous minimally invasive surgery (MIS). A meta-analysis was undertaken to compare the clinical outcomes of MIS with conventional open surgical repair. Six randomised controlled trials of 277 Achilles tendon repairs were eligible for review. This included 136 minimally invasive repairs and 141 conventional open repairs. On analysis, there was no significant difference between the two surgical approaches in respect to the incidence of re-rupture, tissue adhesion, sural nerve injury, deep infection and deep vein thrombosis (p>0.05). However, MIS had a significantly reduced risk of superficial wound infection, with three times greater patient satisfaction for good to excellent results compared with conventional open surgical approaches. PMID:22017889

  15. Effects of tendon viscoelasticity in Achilles tendinosis on explosive performance and clinical severity in athletes.

    Wang, H-K; Lin, K-H; Su, S-C; Shih, T T-F; Huang, Y-C

    2012-12-01

    The aim was to compare viscoelastic properties of Achilles tendons between legs in elite athletes with unilateral tendinosis, and to investigate relationships between the properties and explosive performance and clinical severity. Seventeen male athletes (mean ± standard deviation age, 27.3 ± 2.0 years) who had unilateral, chronic middle-portion tendinopathy of the Achilles tendon were assessed by the Victorian Institute of Sport Assessment questionnaire, measurements of tendon viscoelastic properties, voluntary electromechanical delay (EMD), normalized rate of force development (RFD), and one-leg hopping distance. Compared with the non-injured leg, the tendinopathic leg showed reduced tendon stiffness (-19.2%. P mechanical hysteresis (+21.2%, P = 0.004), lower elastic energy storage and release (-14.2%, P = 0.002 and -19.1%, P < 0.001), lower normalized RFD at one-fourth (-16.3%, P = 0.02), 2/4 (-17.3%, P = 0.006), and three-fourths maximal voluntary contraction (-13.7%, P = 0.02), longer soleus and medial gastrocnemius voluntary EMD (+26.9%, P = 0.009 and +24.0%, P = 0.004), and shorter hopping distances (-34.1%, P < 0.001). Tendon stiffness was correlated with normalized RFD, voluntary EMD in the medial gastrocnemius, and hopping distances (r ranged from -0.35 to 0.64, P < 0.05). Hysteresis was correlated to the soleus voluntary EMD and hopping distances (r = 0.42 and -0.39, P < 0.05). We concluded that altered tendon viscoelastic properties in Achilles tendinosis affect explosive performance in athletes. PMID:22830527

  16. Magnetic resonance imaging of the Achilles tendon using ultrashort TE (UTE) pulse sequences

    Robson, M.D.; Benjamin, M.; Gishen, P.; Bydder, G.M. E-mail: gbydder@ucsd.edu

    2004-08-01

    AIM: To assess the potential value of imaging the Achilles tendon with ultrashort echo time (UTE) pulse sequences. MATERIALS AND METHODS: Four normal controls and four patients with chronic Achilles tendinopathy were examined in the sagittal and transverse planes. Three of the patients were examined before and after intravenous gadodiamide. RESULTS: The fascicular pattern was clearly demonstrated within the tendon and detail of the three distinct fibrocartilaginous components of an 'enthesis organ' was well seen. T2* measurements showed two short T2* components. Increase in long T2 components with reduction in short T2 components was seen in tendinopathy. Contrast enhancement was much more extensive than with conventional sequences in two cases of tendinopathy but in a third case, there was a region of reduced enhancement. CONCLUSION: UTE pulse sequences provide anatomical detail not apparent with conventional sequences, demonstrate differences in T2* and show patterns of both increased and decreased enhancement in tendinopathy.

  17. Primary gene response to mechanical loading in healing rat Achilles tendons

    Eliasson, Pernilla; Andersson, Therese; Hammerman, Malin;

    2013-01-01

    Loading can stimulate tendon healing. In healing rat Achilles tendons, we have found more than 150 genes upregulated or downregulated 3 h after one loading episode. We hypothesized that these changes were preceded by a smaller number of regulatory genes and thus performed a microarray 15 min after...... mechanical testing, microarray, and quantitative real-time polymerase chain reaction (qRT-PCR). Mechanical testing showed that 5 min of loading each day for 4 days created stronger tissue. The microarray analysis after one loading episode identified 15 regulated genes. Ten genes were analyzed in a repeat...

  18. Achilles tendon strain energy in distance running: consider the muscle energy cost

    Fletcher, Jared R.; MacIntosh, Brian R.

    2014-01-01

    The return of tendon strain energy is thought to contribute to reducing the energy cost of running (Erun). However, this may not be consistent with the notion that increased Achilles tendon (AT) stiffness is associated with a lower Erun. Therefore, the purpose of this study was to quantify the potential for AT strain energy return relative to Erun for male and female runners of different abilities. A total of 46 long distance runners [18 elite male (EM), 12 trained male (TM), and 16 trained f...

  19. Platelet-rich plasma (PRP) increases healing process of rats' Achilles tendons

    Kaux, Jean-François; Drion, Pierre; Pascon, Frédéric; Libertiaux, Vincent; Le Goff, Caroline; Gothot, André; CESCOTTO, Serge; Defraigne, Jean-Olivier; Rickert, Markus; Crielaard, Jean-Michel

    2010-01-01

    Introduction Some tendinopathies (epicondylitis, jumper’s knee or Achilles tendinopathy) are frequently considered as rebel to “classic” treatments such as rest, orthotics, NSAIs, electrotherapy, physiotherapy, corticosteroid infiltrations, extracorporeal shock waves… Recently, several studies, essentially in vitro, demonstrated the positive effects of platelets on the healing process of different tissues: bones, muscles and tendons. Objectives The aim of our experiment was to ascert...

  20. Plantarflexor muscle function in healthy and chronic Achilles tendon pain subjects evaluated by the use of EMG and PET imaging

    Masood, Tahir; Kalliokoski, Kari; Bojsen-Møller, Jens;

    2014-01-01

    BACKGROUND: Achilles tendon pathologies may alter the coordinative strategies of synergistic calf muscles. We hypothesized that both surface electromyography and positron emission tomography would reveal differences between symptomatic and asymptomatic legs in Achilles tendinopathy patients and...... between healthy controls. METHODS: Eleven subjects with unilateral chronic Achilles tendon pain (28 years) and eleven matched controls (28 years) were studied for triceps surae and flexor hallucis longus muscle activity in response to repetitive isometric plantarflexion tasks performed at 30% of maximal...... electromyography showed greater relative amplitude in the symptomatic leg, the results based on muscle glucose uptake suggested relatively similar behavior of both legs in the patient group. Higher glucose uptake in the symptomatic Achilles tendon suggests a higher metabolic demand....

  1. Changes in collagen fibril pattern and adhesion force with collagenase-induced injury in rat Achilles tendon observed via AFM.

    Lee, Gi-Ja; Choi, Samjin; Chon, Jinmann; Yoo, Seungdon; Cho, Ilsung; Park, Hun-Kuk

    2011-01-01

    The Achilles tendon consists mainly of type I collagen fibers that contain collagen fibrils. When the Achilles tendon is injured, it is inflamed. The collagenase-induced model has been widely used to study tendinitis. The major advantages of atomic force microscopy (AFM) over conventional optical and electron microscopy for bio-imaging include its non-requirement of a special coating and vacuum, and its capability to perform imaging in all environments. AFM force-distance measurements have become a fundamental tool in the fields of surface chemistry, biochemistry and materials science. Therefore, the changes in the ultrastructure and adhesion force of the collagen fibrils on the Achilles tendons of rats with Achilles tendinitis were observed using AFM. The changes in the structure of the Achilles tendons were evaluated based on the diameter and D-banding of the collagen fibrils. Collagenase-induced Achilles tendinitis was induced with the injection of 30 microl crude collagenase into 7-week-old male Sprague-Dawley rats. The animals were each sacrificed on the first, second, third, fifth and seventh day after the collagenase injection. The normal and injured Achilles tendons were fixed in 4% buffered formalin and dehydrated with increasing concentrations of ethanol. AFM was performed using the non-contact mode at the resolution of 512 x 512 pixels, with a scan speed of 0.8 line/sec. The adhesion force was measured via the force-distance curve that resulted from the interactions between the AFM tip and the collagen fibril sample using the contact mode. The diameter of the collagen fibrils in the Achilles tendons significantly decreased (p force decreased until the fifth day after the collagenase injection, but increased on the seventh day after the collagenase injection (p < 0.0001). PMID:21446543

  2. Magnetic Resonance Signal, Rather Than Tendon Volume, Correlates to Pain and Functional Impairment in Chronic Achilles Tendinopathy

    Gaerdin, A.; Bruno, J.; Movin, T.; Kristoffersen-Wiberg, M.; Shalabi, A. [Karolinska Univ. Hospital, Stockholm (Sweden). Depts. of Radiology and Orthopedics

    2006-09-15

    Purpose: To depict abnormal tendon matrix composition using magnetic resonance imaging (MRI) in chronic Achilles tendinopathy, and correlate intratendinous signal alterations to pain and functional impairment. Material and Methods: MRI of the Achilles tendon was performed on 25 patients with chronic Achilles tendinopathy (median age 50, range 37-71 years). All patients suffered from pain in the mid-portion of the Achilles tendon. Intratendinous signal was calculated from five different sagittal sequences, using a computerized 3D seed-growing technique. Pain and functional impairment were evaluated using a questionnaire completed by patients. Results: Severity of pain and functional impairment correlated to increased mean intratendinous signal in the painful tendon in all MR sequences (P 0.05). Difference in mean intratendinous signal between symptomatic and contralateral asymptomatic tendons was highly significant in all sequences (P <0.05) except on T2-weighted images (P = 0.6). Conclusion: Severity of pain and disability correlated to increased MR signal rather than to tendon volume in patients with unilateral mid-portion chronic Achilles tendinopathy.

  3. Clinical and biomechanical outcome of minimal invasive and open repair of the Achilles tendon

    Chan Alexander

    2011-12-01

    Full Text Available Abstract Introduction With evolutions in surgical techniques, minimally invasive surgical (MIS repair with Achillon applicator has been introduced. However, there is still a lack of literature to investigate into the clinical merits of MIS over open surgery. This study aims to investigate the correlation between clinical outcome, gait analysis and biomechanical properties comparing both surgical methods. Materials and methods A single centre retrospective review on all the consecutive operated patients between January 2004 and December 2008 was performed. Twenty-six patients (19 male and 7 female; age 40.4 ± 9.2 years had experienced a complete Achilles tendon rupture with operative repair. Nineteen of the patients, 10 MIS versus 9 open repairs (13 men with a mean age of 40.54 ± 10.43 (range 23-62 yrs and 6 women with a mean age of 45.33 ± 7.71 (range 35-57 yrs were further invited to attend a thorough clinical assessment using Holz's scale and biomechanical evaluation at a mean of 25.3 months after operation. This study utilized the Cybex II isokinetic dynamometer to assess the isokinetic peak force of plantar-flexion and dorsiflexion of both ankles. The patients were also invited to return to our Gait Laboratory for analysis. The eight-infrared camera motion capture system (VICON, UK was utilized for the acquisition of kinematic variables. Their anthropometric data was measured according to the Davis and coworkers' standard. Results The mean operative time and length of hospital stay were shorter in the MIS group. The operative time was 54.55 ± 15.15 minutes versus 68.80 ± 18.23 minutes of the MIS group and Open group respectively (p = 0.045, whereas length of stay was 3.36 ± 1.21 days versus 6.40 ± 3.70 days respectively (p = 0.039. There is statistically significant decrease (p = 0.005 in incision length in MIS group than the open surgery group, 3.23 ± 1.10 cm versus 9.64 ± 2.55 cm respectively. Both groups attained similar Holz

  4. Histological correlation of 7 T multi-parametric MRI performed in ex-vivo Achilles tendon

    Introduction: The goal of this in vitro validation study was to investigate the feasibility of biochemical MRI techniques, such as sodium imaging, T2 mapping, fast imaging with steady state precession (FISP), and reversed FISP (PSIF), as potential markers for collagen, glycosaminoglycan and water content in the Achilles tendon. Materials and methods: Five fresh cadaver ankles acquired from a local anatomy department were used in the study. To acquire a sodium signal from the Achilles tendon, a 3D-gradient-echo sequence, optimized for sodium imaging, was used with TE = 7.71 ms and TR = 17 ms. The T2 relaxation times were obtained using a multi-echo, spin-echo technique with a repetition time (TR) of 1200 ms and six echo times. A 3D, partially balanced, steady-state gradient echo pulse sequence was used to acquire FISP and PSIF images, with TR/TE = 6.96/2.46 ms. MRI parameters were correlated with each other, as well as with histologically assessed glycosaminoglycan and water content in cadaver Achilles tendons. Results: The highest relevant Pearson correlation coefficient was found between sodium SNR and glycosaminoglycan content (r = 0.71, p = 0.007). Relatively high correlation was found between the PSIF signal and T2 values (r = 0.51, p = 0.036), and between the FISP signal and T2 values (r = 0.56, p = 0.047). Other correlations were found to be below the moderate level. Conclusion: This study demonstrated the feasibility of progressive biochemical MRI methods for the imaging of the AT. A GAG-specific, contrast-free method (sodium imaging), as well as collagen- and water-sensitive methods (T2 mapping, FISP, PSIF), may be used in fast-relaxing tissues, such as tendons, in reasonable scan times

  5. Achilles tendon mechanical properties after both prolonged continuous running and prolonged intermittent shuttle running in cricket batting.

    Houghton, Laurence; Dawson, Brian; Rubenson, Jonas

    2013-08-01

    Effects of prolonged running on Achilles tendon properties were assessed after a 60 min treadmill run and 140 min intermittent shuttle running (simulated cricket batting innings). Before and after exercise, 11 participants performed ramp-up plantar flexions to maximum-voluntary-contraction before gradual relaxation. Muscle-tendon-junction displacement was measured with ultrasonography. Tendon force was estimated using dynamometry and a musculoskeletal model. Gradients of the ramp-up force-displacement curves fitted between 0-40% and 50-90% of the preexercise maximal force determined stiffness in the low- and high-force-range, respectively. Hysteresis was determined using the ramp-up and relaxation force-displacement curves and elastic energy storage from the area under the ramp-up curve. In simulated batting, correlations between tendon properties and shuttle times were also assessed. After both protocols, Achilles tendon force decreased (4% to 5%, P elastic energy. In simulated batting, Achilles tendon force and stiffness were both correlated to mean turn and mean sprint times (r = -0.719 to -0.830, P < .050). Neither protocol resulted in fatigue-related changes in tendon properties, but higher tendon stiffness and plantar flexion force were related to faster turn and sprint times, possibly by improving force transmission and control of movement when decelerating and accelerating. PMID:22923384

  6. Nintendo Wii related Achilles tendon rupture: first reported case and literature review of motion sensing video game injuries.

    Singh, Rohit; Manoharan, Gopikanthan; Moores, Thomas Steven; Patel, Amit

    2014-01-01

    Achilles tendon ruptures tend to occur more commonly in healthy men between the ages of 30 and 50 years who have had no previous injury or problem reported in the affected leg. The injury is usually due to sudden forced plantar flexion of the foot, unexpected dorsiflexion of the foot and violent dorsiflexion of a plantar flexed foot, all of which occur during high impact activities. We present the first reported case of interactive activity with Nintendo Wii games that have resulted in Achilles tendon rupture in a 46-year-old man. There have been no previous reports of Achilles tendon rupture with Nintendo Wii usage; it is a relatively uncommon mode of injury and is rare in terms of epidemiology of motion sensing video game injuries. PMID:24827648

  7. Statins induce biochemical changes in the Achilles tendon after chronic treatment.

    de Oliveira, Letícia Prado; Vieira, Cristiano Pedrozo; Da Ré Guerra, Flávia; de Almeida, Marcos dos Santos; Pimentel, Edson Rosa

    2013-09-15

    Statins have been widely prescribed as lipid-lowering drugs and are associated with tendon rupture. Therefore, this study aimed to evaluate the possible biochemical changes in the Achilles tendon of rats after chronic treatment with statins. Dosages of statins were calculated using allometric scaling with reference to the 80mg/day and 20mg/day, doses recommended for humans. The rats were divided into the following groups: treated with simvastatin (S-20 and S-80), treated with atorvastatin (A-20 and A-80), and the control group that received no treatment (C). Measurements of low-density lipoprotein (LDL) in the plasma were performed. The levels of non-collagenous proteins, glycosaminoglycans (GAGs) and hydroxyproline were quantified. Western blotting for collagen I was performed, and the presence of metalloproteinases (MMPs)-2 and -9 was investigated through zymography. The concentration of non-collagenous proteins in S-20 was less than the C group. There was a significant increase in pro-MMP-2 activity in A-80 group and in active MMP-2 in S-20 group compared to the C group. A significant increase in latent MMP-9 activity was observed in both the A-80 and S-20 groups when compared to C group. In the A-20 group, there was a lower amount of collagen I in relation to C group. In addition, a higher concentration of hydroxyproline was found in the S-20 group than the C group. The analysis of GAGs showed a significant increase in the A-20 group when compared to C group. The treatment induced remarkable alterations in the Achilles tendon and the response of the tissue seems to depend of the used statin dosage. The presence of MMP-2 and MMP-9 is evidence of the degradation and remodeling processes in the extracellular matrix of the tendons. Our results show that statins induce imbalance of extracellular matrix components and possibly induce microdamage in tendons. PMID:23831763

  8. 跟腱Haglund病的手术治疗%Surgical Treatment of Haglund's Syndrome of the Achilles Tendon

    焦晨; 郭秦炜; 陶昊; 陈临新; 谢兴; 杨渝平; 胡跃林

    2013-01-01

    目的:研究跟腱Haglund病的手术治疗效果.方法:21例跟腱Haglund病患者保守治疗无效后采用切开或关节镜手术治疗.术前测量Fowler-Phillip角和斜平行线,术前术后分别进行VAS评分、Tegner评分和VISA-A评分.结果:术后平均随访(47.5±16.7)个月(23 ~72个月),与术前相比,VAS评分显著降低,Tegner评分和VISA-A评分显著提高,优良率95.2%.结论:跟腱Haglund病手术治疗可获得良好的临床效果,但需根据跟腱的病变情况确定采取关节镜或切开手术.%Objective To study the surgical effect of Haglund's syndrome of the Achilles tendon. Methods Twenty-one cases underwent open or arthroscopic surgical treatment. The Fowler-Phillip angle and parallel pitch line were measured preoperatively. The visual analog scale (VAS),Tegner score and VISA-A score for Achilles tendinopathy were assessed preoperatively and postoperatively. Patients were followed up for average (47.5±16.7) months (23~72 months). Results VAS,Tegner score and VISA-A score improved significantly. 95.2% of patients presented excellent or good results. Conclusion Surgical treatment for Haglund's syndrome can reach satisfactory result. It depends on the Achilles tendinopathy to choose arthroscopic or open surgery.

  9. Medial malleolus fracture of the ankle combined with rupture of the Achilles tendon.

    Lu, Jike; Maruo Holledge, Masumi

    2016-01-01

    A 59-year-old man fell off a 60-cm-high step, with his ankle in a twisted position, and sustained a closed fracture of the medial malleolus, with an ipsilateral complete Achilles tendon (TA) rupture. The TA rupture was initially missed but diagnosed by ultrasound examination, 2 weeks post-operatively. The ankle fracture was diagnosed from routine radiographs. Such a combination of injuries has been reported infrequently in the literature, but significant similarities have been described in the mechanism of injury and fracture patterns. Nevertheless, three of five reported cases with combined medial malleolus fractures were initially misdiagnosed. PMID:27141047

  10. Medial gastrocnemius muscle fascicle active torque-length and Achilles tendon properties in young adults with spastic cerebral palsy.

    Barber, Lee; Barrett, Rod; Lichtwark, Glen

    2012-10-11

    Individuals with spastic cerebral palsy (CP) typically experience muscle weakness. The mechanisms responsible for muscle weakness in spastic CP are complex and may be influenced by the intrinsic mechanical properties of the muscle and tendon. The purpose of this study was to investigate the medial gastrocnemius (MG) muscle fascicle active torque-length and Achilles tendon properties in young adults with spastic CP. Nine relatively high functioning young adults with spastic CP (GMFCS I, 17±2 years) and 10 typically developing individuals (18±2 years) participated in the study. Active MG torque-length and Achilles tendon properties were assessed under controlled conditions on a dynamometer. EMG was recorded from leg muscles and ultrasound was used to measure MG fascicle length and Achilles tendon length during maximal isometric contractions at five ankle angles throughout the available range of motion and during passive rotations imposed by the dynamometer. Compared to the typically developing group, the spastic CP group had 33% lower active ankle plantarflexion torque across the available range of ankle joint motion, partially explained by 37% smaller MG muscle and 4% greater antagonistic co-contraction. The Achilles tendon slack length was also 10% longer in the spastic CP group. This study confirms young adults with mild spastic CP have altered muscle-tendon mechanical properties. The adaptation of a longer Achilles tendon may facilitate a greater storage and recovery of elastic energy and partially compensate for decreased force and work production by the small muscles of the triceps surae during activities such as locomotion. PMID:22867763

  11. Oedema and fatty degeneration of the soleus and gastrocnemius muscles on MR images in patients with achilles tendon abnormalities

    Hoffmann, Adrienne [University Hospital Balgrist Zuerich, Radiology Department, Zuerich (Switzerland); Hirslanden Klinik Aarau, Radiology Department, Aarau (Switzerland); Mamisch, Nadja; Buck, Florian M.; Pfirrmann, Christian W.A.; Zanetti, Marco [University Hospital Balgrist Zuerich, Radiology Department, Zuerich (Switzerland); Espinosa, Norman [University Hospital Balgrist Zuerich, Orthopedic Surgery Department, Zuerich (Switzerland)

    2011-09-15

    The purpose of this study was to evaluate the frequency of oedema and fatty degeneration of the soleus and gastrocnemius muscles in patients with Achilles tendon abnormalities. Forty-five consecutive patients (mean 51 years; range 14-84 years) with achillodynia were examined with magnetic resonance (MR) images of the calf. The frequency of oedema and fatty degeneration in the soleus and gastrocnemius muscles was determined in patients with normal tendons, tendinopathy and in patients with a partial tear or a complete tear of the Achilles tendon. Oedema was encountered in 35% (7/20) of the patients with tendinopathy (n = 20; range 13-81 years), and in 47% (9/19) of the patients with partial tears or complete tears (n = 19; 28-78 years). Fatty degeneration was encountered in 10% (2/20) of the patients with tendinopathy, and in 32% (6/19) of the patients with tears. The prevalence of fatty degeneration was significantly more common in patients with a partial or complete tear compared with the patients with a normal Achilles tendon (p = 0.032 and p = 0.021, respectively). Oedema and fatty degeneration of the soleus and gastrocnemius muscles are common in patients with Achilles tendon abnormalities. (orig.)

  12. Effect of low-level laser therapy on healing of tenotomized Achilles tendon in streptozotocin-induced diabetic rats.

    Nouruzian, Mohsen; Alidoust, Morteza; Bayat, Mohammad; Bayat, Mehernoush; Akbari, Mohammad

    2013-02-01

    Diabetes mellitus (DM) is associated with musculoskeletal damage. Investigations have indicated that healing of the surgically tenotomized Achilles tendon was considerably augmented following low-level laser therapy (LLLT) in non-diabetic, healthy animals. The aim of the present study was to evaluate the effect of LLLT on the Achilles tendon healing in streptozotocin-induced diabetic (STZ-D) rats via a biomechanical evaluating method. Thirty-three rats were divided into non-diabetic (n = 18) and diabetic (n = 15) groups. DM was induced in the rats by injections of STZ. The right Achilles tendons of all rats were tenotomized 1 month after STZ injections. The two experimental groups (n = 6 for each group) of non-diabetic rats were irradiated with a helium-neon (He-Ne) laser at 2.9 and 11.5 J/cm(2) for ten consecutive days. The two experimental groups of diabetic rats (n = 5 for each group) were irradiated with a He-Ne laser at 2.9 and 4.3 J/cm(2) for ten consecutive days. The tendons were submitted to a tensiometric test. Significant improvements in the maximum stress (MS) values (Newton per square millimeter) were found following LLLT at 2.9 J/cm(2) in both the non-diabetic (p = 0.031) and diabetic (p = 0.019) experimental groups when compared with their control groups. LLLT at 2.9 J/cm(2) to the tenotomized Achilles tendons in the non-diabetic and diabetic rats significantly increased the strength and MS of repairing Achilles tendons in our study. PMID:22370620

  13. Orthotic Heel Wedges Do Not Alter Hindfoot Kinematics and Achilles Tendon Force During Level and Inclined Walking in Healthy Individuals.

    Weinert-Aplin, Robert A; Bull, Anthony M J; McGregor, Alison H

    2016-04-01

    Conservative treatments such as in-shoe orthotic heel wedges to treat musculoskeletal injuries are not new. However, weak evidence supporting their use in the management of Achilles tendonitis suggests the mechanism by which these heel wedges works remains poorly understood. It was the aim of this study to test the underlying hypothesis that heel wedges can reduce Achilles tendon load. A musculoskeletal modeling approach was used to quantify changes in lower limb mechanics when walking due to the introduction of 12-mm orthotic heel wedges. Nineteen healthy volunteers walked on an inclinable walkway while optical motion, force plate, and plantar pressure data were recorded. Walking with heel wedges increased ankle dorsiflexion moments and reduced plantar flexion moments; this resulted in increased peak ankle dorsiflexor muscle forces during early stance and reduced tibialis posterior and toe flexor muscle forces during late stance. Heel wedges did not reduce overall Achilles tendon force during any walking condition, but did redistribute load from the medial to lateral triceps surae during inclined walking. These results add to the body of clinical evidence confirming that heel wedges do not reduce Achilles tendon load and our findings provide an explanation as to why this may be the case. PMID:26502456

  14. Central tendon splitting combined with SutureBridge double-row technique as a surgical treatment for insertional Achilles tendinopathy

    LIN Yuan; WANG Zhi-wei; ZHANG Bo; PAN Jiang; QU Tie-bing; HAI Yong

    2013-01-01

    Background Surgical treatment of insertional Achilles tendinopathy should be considered when a variety of conservative measures fail.To achieve a satisfactory outcome,thorough debridement of the Achilles tendon is critical,besides excision of the bursitis and the calcaneal exostosis.Central tendon-splitting provides straightforward access to the calcified or degenerative tissue within the Achilles tendon.For Achilles tendon reconstruction if detachment is present,several surgical techniques have been reported.Controversy surrounds the technique can provide maximum security for reattachment of the Achilles tendon.The SutureBridge double-row construct,initially used in rotator cuff repair,is probably a good choice.Methods Ten consecutive patients with insertional Achilles tendinopathy underwent tendon reattachment using the SutureBridge technique through a central tendon-splitting approach.We retrospectively evaluated the surgical outcomes,which included pre-and postoperative visual analog scale (VAS),postoperative Maryland Foot Score (MFS),postoperative range of motion of the affected ankle,and related complications.Follow-up was performed in the outpatient department.Results One patient was lost to follow-up.Nine patients (two male and seven female; 12 feet) were reviewed with a minimum follow-up of six months (range 6-30 months).The postoperative VAS pain scores were markedly lower than the preoperative scores.Postoperative MFS was 92.1±8.0 (range 74-100).No intra-or postoperative complications were found,except for one case of delayed healing incision.At last follow-up,all affected ankles achieved their normal range of motion,and patients were able to resume daily activities without any assistive device.Conclusions Although a randomized control trial with a larger sample may be necessary to compare the central tendonsplitting combined with the SutureBridge technique with other techniques,our results confirmed that it was a promising alternative for treatment of

  15. [Application of a new design of cryo-jaw and its biomechanical evaluation in rat achilles tendon in vitro].

    Liu, Erfu; Sun, Yanjun; Peng, Yongjin; Xu, Wei; Wang, Yequan; Xu, Kang; Mohanad, Khalid Ahmed; Lu, Yonggang; Yang, Li

    2014-06-01

    This study was aimed to design a new, accurate and easy-to-use water bath cryo-jaw, and try to solve the problems met in small animals achilles tendon mechanical testing. The muscle-tendon-bony units were fixed in the clamps. SD rats achilles tendon were randomly divided into group A and B. Group A was tested by the newly designed water bath cryo-jaw, while group B was treated by non-water bath cryo-jaw. The mechanical tests revealed that non of the samples of the newly-designed water bath cryo-jaw in group A slipped and fell off, and the achilles tendons were in a physiologically active state, but one of the group B samples slipped and fell off, and the others had the frozen phenomenon obviously. The maximum stress, fracture displacement and Young's modulus of the rats in group A were significantly different compared to those in group B (P tendon. PMID:25219256

  16. Characteristics of human infant primary fibroblast cultures from Achilles tendons removed post-mortem

    Rohde, Marianne Cathrine; Corydon, Thomas Juhl; Hansen, Jakob;

    2014-01-01

    Primary cell cultures were investigated as a tool for molecular diagnostics in a forensic setting. Fibroblast cultures had been established from human Achilles tendon resected at autopsies, from cases of sudden infant death syndrome and control infants who died in traumatic events (n=41). After...... isolation of primary cultures cells were stored at -135°C, and re-established up to 15 years later for experimental intervention. Growth characteristics in cultures were evaluated in relation to the age of the donor, the post mortem interval before sampling, and the storage interval of cells before entry...... cultures established from post-mortem tissue are renewable sources of biological material; they can be the foundation for genetic, metabolic and other functional studies and thus constitute a valuable tool for molecular and pathophysiological investigations in biomedical and forensic sciences....

  17. The microvascular volume of the achilles tendon is increased in patients with tendinopathy at rest and after a 1-hour treadmill run

    Pingel, Jessica; Harrison, Adrian; Simonsen, Lene;

    2013-01-01

    BACKGROUND:Achilles tendinopathy (AT) is initiated asymptomatically and is therefore often discovered at a very late stage. PURPOSE:To elucidate whether the microvascular volume (MV) of the Achilles tendon is elevated in patients with AT compared with healthy controls during pre-exercise rest...... tendinopathy. CLINICAL RELEVANCE:This study underlines that tendon flexibility is altered in patients with AT and that CEU is a promising tool to establish the early diagnosis of this condition....

  18. Achilles tendon loading patterns during barefoot walking and slow running on a treadmill: An ultrasonic propagation study.

    Wulf, M; Wearing, S C; Hooper, S L; Smeathers, J E; Horstmann, T; Brauner, T

    2015-12-01

    Measurement of tendon loading patterns during gait is important for understanding the pathogenesis of tendon "overuse" injury. Given that the speed of propagation of ultrasound in tendon is proportional to the applied load, this study used a noninvasive ultrasonic transmission technique to measure axial ultrasonic velocity in the right Achilles tendon of 27 healthy adults (11 females and 16 males; age, 26 ± 9 years; height, 1.73 ± 0.07 m; weight, 70.6 ± 21.2 kg), walking at self-selected speed (1.1 ± 0.1 m/s), and running at fixed slow speed (2 m/s) on a treadmill. Synchronous measures of ankle kinematics, spatiotemporal gait parameters, and vertical ground reaction forces were simultaneously measured. Slow running was associated with significantly higher cadence, shorter step length, but greater range of ankle movement, higher magnitude and rate of vertical ground reaction force, and higher ultrasonic velocity in the tendon than walking (P loading of the Achilles tendon than walking. PMID:25913324

  19. Single-Stage Reconstruction of Achilles Tendon and Overlying Tissue With the Extended Temporoparietal Fasciagaleal Flap-23-Year Follow-Up and the Review of the Literature.

    Dobke, Marek; Suliman, Ahmed; Mackert, Gina A; Herrera, Fernando A; Singer, Robert; Nelson, Jeffrey

    2016-05-01

    In the absence of an established "gold standard" for complex Achilles tendon and regional soft tissue defect reconstruction, many techniques have been advocated. Two cases describing a novel technique of successful repair with the review of literature are presented. The underlying problem consisted of Achilles tendon necrosis with local inflammation in the first case and tendon contracture with foot malposition due to a burn injury in the other. Each patient, upon debridement, had a 6-cm Achilles tendon defect with associated overlying soft tissue deficits reconstructed with an extended temporoparietal fasciagaleal flap and a split thickness skin graft. Both cases highlight the successful functional and aesthetic quality as well as the durability of concurrent vascularized tendon and soft tissue replacement and coverage in 2 distinct clinical scenarios. PMID:27070674

  20. Achilles tendon strain energy in distance running: consider the muscle energy cost.

    Fletcher, Jared R; MacIntosh, Brian R

    2015-01-15

    The return of tendon strain energy is thought to contribute to reducing the energy cost of running (Erun). However, this may not be consistent with the notion that increased Achilles tendon (AT) stiffness is associated with a lower Erun. Therefore, the purpose of this study was to quantify the potential for AT strain energy return relative to Erun for male and female runners of different abilities. A total of 46 long distance runners [18 elite male (EM), 12 trained male (TM), and 16 trained female (TF)] participated in this study. Erun was determined by indirect calorimetry at 75, 85, and 95% of the speed at lactate threshold (sLT), and energy cost per stride at each speed was estimated from previously reported stride length (SL)-speed relationships. AT force during running was estimated from reported vertical ground reaction force (Fz)-speed relationships, assuming an AT:ground reaction force moment arm ratio of 1.5. AT elongation was quantified during a maximal voluntary isometric contraction using ultrasound. Muscle energy cost was conservatively estimated on the basis of AT force and estimated cross-bridge mechanics and energetics. Significant group differences existed in sLT (EM > TM > TF; P TF > EM; P distance running the muscle energy cost is substantially higher than the strain energy release from the AT. PMID:25593218

  1. An Investigation of the Immediate Effect of Static Stretching on the Morphology and Stiffness of Achilles Tendon in Dominant and Non-Dominant Legs.

    Tsz-Chun Roxy Chiu

    Full Text Available This study was undertaken to investigate the immediate effect of static stretching on normal Achilles tendon morphology and stiffness, and the different effect on dominant and non-dominant legs; and to evaluate inter-operator and intra-operator reliability of using shear-wave elastography in measuring Achilles tendon stiffness.20 healthy subjects (13 males, 7 females were included in the study. Thickness, cross-sectional area and stiffness of Achilles tendons in both legs were measured before and after 5-min static stretching using grey-scale ultrasound and shear-wave elastography. Inter-operator and intra-operator reliability of tendon stiffness measurements of six operators were evaluated.Result showed that there was no significant change in the thickness and cross-sectional area of Achilles tendon after static stretching in both dominant and non-dominant legs (p > 0.05. Tendon stiffness showed a significant increase in non-dominant leg (p 0.05. The inter-operator reliability of shear-wave elastography measurements was 0.749 and the intra-operator reliability ranged from 0.751 to 0.941.Shear-wave elastography is a useful and non-invasive imaging tool to assess the immediate stiffness change of Achilles tendon in response to static stretching with high intra-operator and inter-operator reliability.

  2. Gene targeting of the transcription factor Mohawk in rats causes heterotopic ossification of Achilles tendon via failed tenogenesis.

    Suzuki, Hidetsugu; Ito, Yoshiaki; Shinohara, Masahiro; Yamashita, Satoshi; Ichinose, Shizuko; Kishida, Akio; Oyaizu, Takuya; Kayama, Tomohiro; Nakamichi, Ryo; Koda, Naoki; Yagishita, Kazuyoshi; Lotz, Martin K; Okawa, Atsushi; Asahara, Hiroshi

    2016-07-12

    Cell-based or pharmacological approaches for promoting tendon repair are currently not available because the molecular mechanisms of tendon development and healing are not well understood. Although analysis of knockout mice provides many critical insights, small animals such as mice have some limitations. In particular, precise physiological examination for mechanical load and the ability to obtain a sufficient number of primary tendon cells for molecular biology studies are challenging using mice. Here, we generated Mohawk (Mkx)(-/-) rats by using CRISPR/Cas9, which showed not only systemic hypoplasia of tendons similar to Mkx(-/-) mice, but also earlier heterotopic ossification of the Achilles tendon compared with Mkx(-/-) mice. Analysis of tendon-derived cells (TDCs) revealed that Mkx deficiency accelerated chondrogenic and osteogenic differentiation, whereas Mkx overexpression suppressed chondrogenic, osteogenic, and adipogenic differentiation. Furthermore, mechanical stretch stimulation of Mkx(-/-) TDCs led to chondrogenic differentiation, whereas the same stimulation in Mkx(+/+) TDCs led to formation of tenocytes. ChIP-seq of Mkx overexpressing TDCs revealed significant peaks in tenogenic-related genes, such as collagen type (Col)1a1 and Col3a1, and chondrogenic differentiation-related genes, such as SRY-box (Sox)5, Sox6, and Sox9 Our results demonstrate that Mkx has a dual role, including accelerating tendon differentiation and preventing chondrogenic/osteogenic differentiation. This molecular network of Mkx provides a basis for tendon physiology and tissue engineering. PMID:27370800

  3. Platelet-Rich Fibrin Promotes an Accelerated Healing of Achilles Tendon When Compared to Platelet-Rich Plasma in Rat

    Dietrich, Franciele; L. Duré, Gustavo; P. Klein, Caroline; F. Bampi, Vinícius; V. Padoin, Alexandre; D. Silva, Vinícius; Braga-Silva, Jefferson

    2015-01-01

    BACKGROUND Autologous platelet concentrate has been used to improve the function and regeneration of injured tissues. Tendinopathies are common in clinical practice, although long-term treatment is required. On the basis of lead time, we compared the effect of using platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) in repairing rat Achilles tendon. METHODS The effectiveness of using PRP and PRF was evaluated after 14 and 28 postoperative days by histological analysis. The quantificati...

  4. Automated volumetric assessment of the Achilles tendon (AVAT) using a 3D T2 weighted SPACE sequence at 3 T in healthy and pathologic cases

    Purpose: Achilles tendinopathy has been reported to be frequently associated with increasing volume of the tendon. This work aims at reliable and accurate volumetric quantification of the Achilles tendon using a newly developed contour detection algorithm applied on high resolution MRI data sets recorded at 3 T. Materials and methods: A total of 26 healthy tendons and 4 degenerated tendons were examined for this study. Automated identification (AI) of tendon boundaries was performed in transverse slices with isotropic resolution (0.8 mm) gained with a T2-weighted SPACE sequence at 3 T. For AI a snake algorithm was applied and compared to manual tracing (MT). Results: AI was feasible in all examined tendons without further correction. AI of both tendons was performed in each participant within 2 min (2 × 37 slices) compared to MT lasting 20 min. MT and AI showed excellent agreement and correlation (R2 = 0.99, p 3 vs. 0.5 cm3) and coefficient of variation (1% vs. 2%). Discussion: Compared to MT the AI allows assessment of tendon volumes in highly resolved MRI data in a more accurate and reliable time-saving way. Therefore automated volume detection is seen as a helpful clinical tool for evaluation of small volumetric changes of the Achilles tendon.

  5. In vivo quantification of the shear modulus of the human Achilles tendon during passive loading using shear wave dispersion analysis

    Helfenstein-Didier, C.; Andrade, R. J.; Brum, J.; Hug, F.; Tanter, M.; Nordez, A.; Gennisson, J.-L.

    2016-03-01

    The shear wave velocity dispersion was analyzed in the Achilles tendon (AT) during passive dorsiflexion using a phase velocity method in order to obtain the tendon shear modulus (C 55). Based on this analysis, the aims of the present study were (i) to assess the reproducibility of the shear modulus for different ankle angles, (ii) to assess the effect of the probe locations, and (iii) to compare results with elasticity values obtained with the supersonic shear imaging (SSI) technique. The AT shear modulus (C 55) consistently increased with the ankle dorsiflexion (N  =  10, p  clinical relevance of the shear wave dispersion analysis, for instance in the case of tendinopathy or tendon tear.

  6. Achillodynia. Radiological imaging of acute and chronic overuse injuries of the Achilles tendon; Achillodynie. Radiologische Bildgebung bei akuten und chronischen Ueberlastungsschaeden der Achillessehne

    Syha, R.; Springer, F.; Grosse, U. [Tuebingen Univ. (Germany). Diagnostic and Interventional Radiology; Tuebingen Univ. (Germany). Section on Experimental Radiology; Ketelsen, D.; Kramer, U.; Horger, M. [Tuebingen Univ. (Germany). Diagnostic and Interventional Radiology; Ipach, I. [University Hospital Tuebingen (Germany). Orthopaedic Surgery; Schick, F. [Tuebingen Univ. (Germany). Section on Experimental Radiology

    2013-11-15

    In the past decades the incidence of acute and chronic disorders of the Achilles tendon associated with sport-induced overuse has steadily increased. Besides acute complete or partial ruptures, achillodynia (Achilles tendon pain syndrome), which is often associated with tendon degeneration, represents the most challenging entity regarding clinical diagnostics and therapy. Therefore, the use of imaging techniques to differentiate tendon disorders and even characterize structure alterations is of growing interest. This review article discusses the potential of different imaging techniques with respect to the diagnosis of acute and chronic tendon disorders. In this context, the most commonly used imaging techniques are magnetic resonance imaging (MRI), B-mode ultrasound, and color-coded Doppler ultrasound (US). These modalities allow the detection of acute tendon ruptures and advanced chronic tendon disorders. However, the main disadvantages are still the low capabilities in the detection of early-stage degeneration and difficulties in the assessment of treatment responses during follow-up examinations. Furthermore, differentiation between chronic partial ruptures and degeneration remains challenging. The automatic contour detection and texture analysis may allow a more objective and quantitative interpretation, which might be helpful in the monitoring of tendon diseases during follow-up examinations. Other techniques to quantify tendon-specific MR properties, e.g. based on ultrashort echo time (UTE) sequences, also seem to have great potential with respect to the precise detection of degenerative tendon disorders and their differentiation at a very early stage. (orig.)

  7. Spectrum of Ultrasound Pathologies of Achilles Tendon, Plantar Aponeurosis and Flexor Digiti Brevis Tendon Heel Entheses in Patients with Clinically Suspected Enthesitis

    Enthesitis is considered a characteristic presentation of the second most common group of rheumatoid disorders, i.e. spondyloarthropathies (SpAs), particularly peripheral spondyloarthropathies. At the initial stages, enthesitis may be the only symptom of SpA, particularly in patients lacking the HLA-B27 receptor. In light of diagnostic difficulties with detecting enthesitis in clinical examinations and laboratory investigations, many studies point out the high specificity of imaging studies, and particularly ultrasonography. A total of 20% Achilles tendon entheses, 45% plantar aponeurosis entheses and 89.5% of flexor digiti brevis tendon entheses were unremarkable. In the remaining cases, the presentation of pathological lesions was not specific to enthesitis and might more likely correspond to degeneration or microinjuries of the entheses, beside the most obvious cases of achillobursitis or Kager’s fat pad inflammation. The studies demonstrated that ultrasound scans rarely confirm the clinical diagnosis of enthesitis

  8. The effect of running, strength, and vibration strength training on the mechanical, morphological, and biochemical properties of the Achilles tendon in rats

    Legerlotz, Kirsten; Schjerling, Peter; Langberg, Henning;

    2007-01-01

    mechanical, morphological, and biochemical properties of the Achilles tendon. Sixty-four female Sprague-Dawley rats were divided into five groups: nonactive age-matched control (AMC; n = 20), voluntary wheel running (RT; n = 20), vibration strength-trained (LVST; n = 12), high-vibration strength......-trained (HVST; n = 6), and high strength-trained (HST; n = 6) group. After a 12-wk-long experimental period, the Achilles tendon was tested mechanically and the cross-sectional area, the soleus and gastrocnemius muscle mass, and mRNA concentration of collagen I, collagen III, tissue inhibitor of...

  9. Uphill running improves rat Achilles tendon tissue mechanical properties and alters gene expression without inducing pathological changes

    Heinemeier, K M; Skovgaard, D; Bayer, M L;

    2012-01-01

    Overuse Achilles tendinopathy is a common and challenging problem in sports medicine. Little is known about the etiology of this disorder, and the development of a good animal model for overuse tendinopathy is essential for advancing insight into the disease mechanisms. Our aim was to test a...... tendinopathy, as the rats were able to adapt to 12 wk of uphill running without any signs of tendinopathy. Improved mechanical properties were observed, as well as changes in gene-expression that were distinctly different from what is seen in tendinopathy and in response to short-term tendon loading....

  10. Nintendo Wii related Achilles tendon rupture: first reported case and literature review of motion sensing video game injuries

    Singh, Rohit; Manoharan, Gopikanthan; Moores, Thomas Steven; Patel, Amit

    2014-01-01

    Achilles tendon ruptures tend to occur more commonly in healthy men between the ages of 30 and 50 years who have had no previous injury or problem reported in the affected leg. The injury is usually due to sudden forced plantar flexion of the foot, unexpected dorsiflexion of the foot and violent dorsiflexion of a plantar flexed foot, all of which occur during high impact activities. We present the first reported case of interactive activity with Nintendo Wii games that have resulted in Achill...

  11. The effect of ionizing radiation on dielectric properties of bovine achilles tendon collagen in the temperature range of thermal denaturation

    The effect of γ-irradiation, with doses from 102-2 x 103kGy, on the dielectric properties of solid-state collagen was studied. The temperature dependence of the constants ε' and ε'' revealed a decrease in the denaturation temperature with increasing dose of irradiation. Dielectric dispersion observed in the frequency range 10 Hz to 10 kHz was suggested to be due to Maxwell-Wagner-Sillars polarization. In addition, an increase in the irradiation dose resulted in increasing activation energy of bovine achilles tendon collagen. (author)

  12. Intradiurnal fluctuations of off-resonance saturation effects in healthy human achilles tendons assessed with a 3D ultrashort echo time MRI sequence at 3 tesla

    Grosse, U.; Syha, R.; Kessler, D.E.; Bongers, M.; Seith, F.; Nikolaou, K.; Springer, F. [University Hospital Tuebingen (Germany). Dept. of Diagnostic and Interventional Radiology; Partovi, S.; Robbin, M. [Case Western Reserve Univ., Cleveland, OH (United States). Dept. of Radiology; Schick, F. [University Hospital Tuebingen (Germany). Section on Experimental Radiology

    2015-11-15

    The purpose of this study was to evaluate whether gravitational interstitial fluid accumulation in healthy subjects has an impact on off-resonance saturation ratios (OSR) or the volume of the Achilles tendon after a prolonged time of reduced levels of physical activity. 7 healthy volunteers were repeatedly investigated on 3 consecutive days on a 3 T whole body MR scanner using an ultrashort echo time (UTE) imaging sequence with a Gaussian off-resonance saturation pulse at a frequency offset of 2000 Hz to calculate OSR values. For accurate volumetric quantification of the Achilles tendon, a newly developed contour detection snake algorithm was applied on high-resolution isotropic T2-weighted SPACE sequence datasets. Single-measure intraclass correlation coefficients (ICC) were calculated to estimate test-retest reliability. For OSR and tendon volume measurements on three consecutive days, excellent reproducibility could be achieved with ICC values above 0.96 and 0.97, respectively. Comparing the results of all three days, a statistically significant mean individual percentage decrease (-4.1 ± 1.5 %; p=0.001) of calculated tendon OSR values was found for the evening measurements. No statistically significant difference between tendon volumes in the morning and the evening could be detected (p=0.589). The results of this in-vivo study demonstrate a significant influence of gravitational interstitial fluid accumulation after reduced physical activity on OSR values in the Achilles tendon, but not on tendon volume. Taken together with the demonstrated excellent reproducibility, these findings are important for future studies investigating temporal changes of the Achilles tendon microstructure.

  13. In vivo quantification of the shear modulus of the human Achilles tendon during passive loading using shear wave dispersion analysis

    Helfenstein-Didier, C.; Andrade, R. J.; Brum, J.; Hug, F.; Tanter, M.; Nordez, A.; Gennisson, J.-L.

    2016-03-01

    The shear wave velocity dispersion was analyzed in the Achilles tendon (AT) during passive dorsiflexion using a phase velocity method in order to obtain the tendon shear modulus (C 55). Based on this analysis, the aims of the present study were (i) to assess the reproducibility of the shear modulus for different ankle angles, (ii) to assess the effect of the probe locations, and (iii) to compare results with elasticity values obtained with the supersonic shear imaging (SSI) technique. The AT shear modulus (C 55) consistently increased with the ankle dorsiflexion (N  =  10, p  SSI was always lower than C55 and the difference increased with the ankle dorsiflexion. However, shear modulus values provided by both methods were highly correlated (R  =  0.84), indicating that the conventional shear wave elastography technique (SSI technique) can be used to compare tendon mechanical properties across populations. Future studies should determine the clinical relevance of the shear wave dispersion analysis, for instance in the case of tendinopathy or tendon tear.

  14. Power Doppler ultrasonography of painful Achilles tendons and entheses in patients with and without spondyloarthropathy-a comparison with clinical examination and contrast-enhanced MRI

    Wiell, Charlotte; Szkudlarek, Marcin; Hasselquist, Maria;

    2013-01-01

    /or enthesis due to sports-related causes and 10 CTRLs were examined at the Achilles tendons and entheses with US, MRI and clinical assessment. Intratendinous changes, entheseal changes, bursitis and peritendonitis were assessed. An US interobserver substudy was performed in nine persons. US findings showed...

  15. A treatment algorithm for managing Achilles tendinopathy: new treatment options

    Alfredson, Håkan; Cook, J.

    2007-01-01

    Achilles tendinopathy affects athletes, recreational exercisers and even inactive people. The pathology is not inflammatory; it is a failed healing response. The source of pain in tendinopathy could be related to the neurovascular ingrowth seen in the tendon's response to injury. The treatment of Achilles tendinopathy is primarily conservative with an array of effective treatment options now available to the primary care practitioner. If conservative treatment is not successful, then surgery ...

  16. Age related blood flow around the Achilles tendon during exercise in humans

    Langberg, Henning; Olesen, J; Skovgaard, D;

    2001-01-01

    Injuries due to the overuse of tendons increase with age, and it has been suggested that this correlates with hypovascularity of the tendon. In the present study, the peritendinous blood flow was determined using xenon-133 washout at rest and during standardised intermittent exercise of the calf-muscle...

  17. Achilles Tendinitis

    ... to adjust to the new distance • Tight calf muscles—Having tight calf muscles and suddenly starting an aggressive exercise program ... is a surgical lengthening of the calf (gastrocnemius) muscles. Because tight calf muscles place increased stress on the Achilles tendon, ...

  18. Further proof of the existence of a non-neuronal cholinergic system in the human Achilles tendon: Presence of the AChRα7 receptor in tendon cells and cells in the peritendinous tissue.

    Forsgren, Sture; Alfredson, Håkan; Andersson, Gustav

    2015-11-01

    Human tendon cells have the capacity for acetylcholine (ACh) production. It is not known if the tendon cells also have the potential for ACh breakdown, nor if they show expression of the nicotinic acetylcholine receptor AChRα7 (α7nAChR). Therefore, tendon tissue specimens from patients with midportion Achilles tendinopathy/tendinosis and from normal midportion Achilles tendons were examined. Reaction for the degradative enzyme acetylcholinesterase (AChE) was found in some tenocytes in only a few tendinopathy tendons, and was never found in those of control tendons. Tenocytes displayed more regularly α7nAChR immunoreactivity. However, there was a marked heterogeneity in the degree of this reaction within and between the specimens. α7nAChR immunoreactivity was especially pronounced for tenocytes showing an oval/widened appearance. There was a tendency that the magnitude of α7nAChR immunoreactivity was higher in tendinopathy tendons as compared to control tendons. A stronger α7nAChR immunoreactivity than seen for tenocytes was observed for the cells in the peritendinous tissue. It is likely that the α7nAChR may be an important part of an auto-and paracrine loop of non-neuronal ACh that is released from the tendon cells. The effects may be related to proliferative and blood vessel regulatory functions as well as features related to collagen deposition. ACh can furthermore be of importance in leading to anti-inflammatory effects in the peritendinous tissue, a tissue nowadays considered to be of great relevance for the tendinopathy process. Overall, the findings show that tendon tissue, a tissue known to be devoid of cholinergic innervation, is a tissue in which there is a marked non-neuronal cholinergic system. PMID:25981114

  19. Tendon Transfer Surgery for People With Tetraplegia: An Overview.

    Dunn, Jennifer A; Sinnott, K Anne; Rothwell, Alastair G; Mohammed, Khalid D; Simcock, Jeremy W

    2016-06-01

    After cervical spinal cord injury, the loss of upper limb function is common. This affects an individual's ability to perform activities of daily living and participate in previous life roles. There are surgical procedures that can restore some of the upper limb function lost after cervical spinal cord injury. Tendon transfer surgery has been performed in the tetraplegic population since the early 1970s. The goals of surgery are to provide a person with tetraplegia with active elbow extension, wrist extension (if absent), and sufficient pinch and/or grip strength to perform activities of daily living without the need for adaptive equipment or orthoses. These procedures are suitable for a specific group, usually with spinal cord impairment of C4-8, with explicit components of motor and sensory loss. Comprehensive team assessments of current functioning, environment, and personal circumstances are important to ensure success of any procedure. Rehabilitation after tendon transfer surgery involves immobilization for tendon healing followed by specific, targeted therapy based on motor learning and goal-orientated training. Outcomes of tendon transfer surgery are not limited to the improvements in an individual's strength, function, and performance of activities but have much greater life affects, especially with regard to well-being, employment, and participation. This article will provide an overview of the aims of surgery, preoperative assessment, common procedures, postoperative rehabilitation strategies, and outcomes based on clinical experience and international published literature. PMID:27233594

  20. Could Low Total and Free Testosterone Levels be risk factor for Achilles Tendon Ruptures in Males

    Abebe, Ermias Shawel; Tarkin, Ivan; Prisk, Victor

    2013-01-01

    Objectives: Age related decline in sex hormone levels has been associated with decreased muscle mass, bone density, and changes in metabolism in both males and females[1-3]. Although the effect of estrogen levels on tendon size and architecture has been studied in females [4,5], the influence of testosterone levels on tendons in males is unknown. The purpose of the present study was to retrospectively compare free testosterone (FT) and total testosterone (TT) level in males diagnosed with Ach...

  1. Structural and biomechanical changes in the Achilles tendon after chronic treatment with statins.

    de Oliveira, L P; Vieira, C P; Guerra, F D; Almeida, M S; Pimentel, E R

    2015-03-01

    Cases of tendinopathy and tendon ruptures have been reported as side effects associated with statin therapy. This work assessed possible changes in the structural and biomechanical properties of the tendons after chronic treatment with statins. Wistar rats were divided into the following groups: treated with atorvastatin (A-20 and A-80), simvastatin (S-20 and S-80) and the group that received no treatment (C). The doses of statins were calculated using allometric scaling, based on the doses of 80 mg/day and 20 mg/day recommended for humans. The morphological aspect of the tendons in A-20, S-20 and S-80 presented signals consistent with degeneration. Both the groups A-80 and S-80 showed a less pronounced metachromasia in the compression region of the tendons. Measurements of birefringence showed that A-20, A-80 and S-80 groups had a lower degree of organization of the collagen fibers. In all of the groups treated with statins, the thickness of the epitenon was thinner when compared to the C group. In the biomechanical tests the tendons of the groups A-20, A-80 and S-20 were less resistant to rupture. Therefore, statins affected the organization of the collagen fibers and decreased the biomechanical strength of the tendons, making them more predisposed to ruptures. PMID:25544391

  2. Distal posterior tibial artery perforator flaps for the management of calcaneal and Achilles tendon injuries in diabetic and non-diabetic patients

    Ioannis A. Ignatiadis

    2011-08-01

    Full Text Available Management of Achilles tendon and heel area defects is a common challenge for the reconstructive surgeon due to the lack of soft tissue availability in that region. In this article, we present our experience in covering these defects by using the distal perforator propeller flaps based on the posterior tibial artery. Perforator flaps are based on cutaneous, small diameter vessels that originate from a main pedicle and perforate the fascia or muscle to reach the skin. Their development has followed the understanding of the blood supply from a source artery to the skin. Six patients (five males and one female underwent reconstruction by using the posterior tibial artery distal perforator flap for covering defects in the distal Achilles tendon region in patients with and without diabetes mellitus. Postoperative complications included a hypertrophic scar formation in one patient, partial marginal flap necrosis in another patient, and a wound infection in a third patient. All wounds were eventually healed by the last postoperative visit. In conclusion, perforator flaps based on the distal posterior tibial artery may be a reliable option for the coverage of small to moderate size defects of the Achilles tendon and heel area regions.

  3. 阔筋膜移植修复跟腱缺损的临床疗效%The clinical research of fascia graft to repair achilles tendon defect

    冯涛; 孙中建; 吴敬红; 李宏磊; 徐鹏

    2015-01-01

    Objective To discuss the clinical effect of fascia graft to repair Achilles tendon defect. Methods Adopt the method of broad fascia graft to repair Achilles tendon defect treatment of the patients (19 cases), rehabilitation plan and follow-up visit. Results 1 case in 19 patients lost follow-up, the rest of the 18 cases were followed up for 8 months to 5 years postoperatively, 3 years on average, according to standard Arner - Lindhobm evaluation decision, 8 cases were excellent, 10 cases were good. Conclusion The broad fascia graft to repair Achilles tendon defect, can obtain good clinical effect.%目的:探讨应用阔筋膜移植修复跟腱缺损的临床疗效。方法2002年5月-2010年9月,采用阔筋膜移植修复跟腱缺损19例,术后制定康复计划并随访疗效。结果19例中1例失访,其余18例术后随访8个月~5年,平均3年,按Arner-Lindhobm评定标准判定,优8例,良10例。结论采用阔筋膜移植修复跟腱缺损,可获得良好的临床效果。

  4. Bi-pedicled V-Y gastrocnemius myocutaneous flap for repairing Achilles tendon and overlying skin defect: the anatomic basis and clinical application

    XU Yong-qing; ZHU Yue-liang; YANG Jun; LI Jun; DING Jing; LU Sheng

    2007-01-01

    Objective: To study the anatomic basis of the bi-pedicled V-Y gastrocnemius myocutaneous flap for repairing the composite Achilles tendon defect. Methods: The pedicle anatomy of the bi-pedicled V-Y gastrocnemius myocutaneous flap was examined on 30 cadaver specimens. The sliding distances of the flap were measured at different knee flexion degrees. The bi-pedicled V-Y gastrocnemius myocutaneous flap was applied in 12 cases of Achilles tendon defect with simultaneous skin and soft tissue defect. Results: The sural arteries could be classified into four types. After cutting off the gastrocnemius origin with a "Z-shaped" incision, the sliding distance of the flap reached (3.7±0.5)cm when the knee flexed 0°,(4.9±0.7)cm when the knee flexed 30°,(6.7±0.7)cm when the knee flexed 60°and (9.2±0.9)cm when the knee flexed 90°. All the defects healed. The patients recovered ambulation with satisfactory knee and ankle function.The follow-up was 4 months -12 years. Conclusions: Different sural artery types should be noticed during the harvest of the bi-pedicled V-Y gastrocnemius myocutaneous flap. With 90°knee flexion,this flap is suitable for one-stage repair of composite Achilles tendon defect within 9.2 cm±0.9 cm.

  5. Application of different biomaterials in Achilles tendon repair%不同生物材料修复跟腱损伤的应用

    李敏; 李广杰

    2011-01-01

    背景:构建组织工程化肌腱的关键是寻找适于肌腱细胞黏附、生长及功能分化的支架材料.目的:评价不同生物材料在跟腱损伤修复中的效果.方法:以"生物材料,跟腱,修复" 为关键词在万方数据库中检索1985-01/2011-01关于生物材料治疗跟腱缺损的文章.结果与结论:陈旧性跟腱断裂难以自行愈合及修复,易遗留疼痛及功能障碍.长期以来,不少学者对跟腱缺损的治疗进行了较多的研究,从自体肌腱移植、同种异体肌腱移植到人工肌腱移植、组织工程肌腱移植等,实践证明这些方法手段都存在一定的优点和缺点.虽然肌腱组织工程中支架材料的研究与应用已经取得了一些成功,但是目前应用的材料或存在生物相容性问题、降解性问题或存在力学性能差、难加工成型等缺陷,与理想的支架材料还存在很大差距.%BACKGROUND: The key to construct tissue engineered tendon is to look for appropriate scaffold materials for tendon cell adhesion, growth and functional differentiation.OBJECTIVE: To assess the effects of different biomaterials on Achilles tendon injury.METHODS: “Biomaterial, Achilles tendon, repair” were used as keywords to retrieve articles about biomaterials for treatment of Achilles tendon injuries published 1985-01/2011-01 in Wanfang database.RESULTS AND CONCLUSION: Self-healing and repair of old Achilles tendon rupture is difficult, and pain and dysfunction easily occur. Over the years, there are many studies about treatment of Achilles tendon injuries from autologous tendon graft and tendon allograft to artificial tendon and tissue-engineered tendon. The above-mentioned methods have their own advantages and disadvantages. Although studies on scaffold materials for tissue-engineered tendon have achieved some results, the poor biocompatibility, degradation or mechanical properties as well as difficulty to molding lead to a great difference from ideal scaffold

  6. Outcomes and complications of operative versus non-operative treatment of acute Achilles tendon rupture: a meta-analysis

    ZHAO Hong-mou; YU Guang-rong; YANG Yun-feng; ZHOU Jia-qian; Ashwin Aubeeluck

    2011-01-01

    Background There is lack of consensus regarding the best option for the treatment of acute Achilles tendon ruptureoperation or non-operation.The purpose of this meta-analysis was to identify and summarize the randomized controlled trials comparing the operative and non-operative lines of treatment of acute Achilles tendon ruptures.Methods We searched multiple databases in English (including EMBASE,PubMed,and OVID) and in Chinese (including CNKI,WANFANG,and VIP),as well as reference lists of articles and main orthopaedic and sports medical journals.Two reviewers independently screened the studies for eligibility,evaluated the quality and extracted data from eligible studies,with confirmation by cross-checking.The major results and conclusions were concluded,and the different complication rates and functional outcomes were compared.Meta-analysis was processed by RevMan 5.0software.Results Eight randomized controlled trials (RCTs) involving 777 patients met the inclusion criteria.The rerupture rate in non-operative group was significantly higher (Z =3.33,P <0.01).However,the moderate (Z=4.27,P <0.01) and minor (Z=5.59,P <0.01) complication rate in the operative group were significantly higher.No significant difference in comparing the major and total complication rates.The return to work time in the operative group was shorter (Z=2.65,P <0.01).The inability to return to previous level sporting rate and ankle joint decreased range of motion (ROM) rate showed no significant difference in the two groups.Other functional outcomes were similar in the two groups.Conclusions Operation could significantly reduce the risk of rerupture; however,it was associated with a higher risk of other complications.The functional outcomes were similar in two treatment methods except an earlier return to work in patients treated operatively.Thus operative treatment is preferable for patients with good physical condition.Non-operative treatment is an acceptable alternative

  7. Regular physical activity reduces the effects of Achilles tendon vibration on postural control for older women.

    Maitre, J; Serres, I; Lhuisset, L; Bois, J; Gasnier, Y; Paillard, T

    2015-02-01

    The aim was to determine in what extent physical activity influences postural control when visual, vestibular, and/or proprioceptive systems are disrupted. Two groups of healthy older women: an active group (74.0 ± 3.8 years) who practiced physical activities and a sedentary group (74.7 ± 6.3 years) who did not, underwent 12 postural conditions consisted in altering information emanating from sensory systems by means of sensory manipulations (i.e., eyes closed, cervical collar, tendon vibration, electromyostimulation, galvanic vestibular stimulation, foam surface). The center of foot pressure velocity was recorded on a force platform. Results indicate that the sensory manipulations altered postural control. The sedentary group was more disturbed than the active group by the use of tendon vibration. There was no clear difference between the two groups in the other conditions. This study suggests that the practice of physical activities is beneficial as a means of limiting the effects of tendon vibration on postural control through a better use of the not manipulated sensory systems and/or a more efficient reweighting to proprioceptive information from regions unaffected by the tendon vibration. PMID:24853711

  8. Microtrauma stimulates rat Achilles tendon healing via an early gene expression pattern similar to mechanical loading

    Hammerman, Malin; Aspenberg, Per; Eliasson, Pernilla

    2014-01-01

    Mechanical loading increases the strength of healing tendons, but also induces small localized bleedings. Therefore, it is unclear if increased strength after loading is a response to mechanotransduction or microtrauma. We have previously found only five genes to be up-regulated 15 min after a si...

  9. Effect of recombinant human platelet-derived growth factor-BB-coated sutures on Achilles tendon healing in a rat model: A histological and biomechanical study

    Stephen H Cummings

    2012-07-01

    Full Text Available Purpose: Repairing tendon injuries with recombinant human platelet-derived growth factor-BB has potential for improving surgical outcomes. Augmentation of sutures, a critical component of surgical tendon repair, by coating with growth factors may provide a clinically useful therapeutic device for improving tendon repair. Therefore, the purpose of this study was to (a coat Vicryl sutures with a defined dose of recombinant human platelet-derived growth factor-BB without additional coating excipients (e.g. gelatin, (b quantify the recombinant human platelet-derived growth factor-BB released from the suture, and (c use the recombinant human platelet-derived growth factor-BB-coated sutures to enhance tendon repair in a rat Achilles tendon transection model. Methods: Vicryl sutures were coated with 0, 0.3, 1.0, and 10.0 mg/mL concentrations of recombinant human platelet-derived growth factor-BB using a dip-coating process. In vitro release was quantified by an enzyme-linked immunosorbent assay. Acutely transected rat Achilles tendons were repaired using one of the four suture groups (n = 12 per group. Four weeks following repair, the tensile biomechanical and histological (i.e. collagen organization and angiogenesis properties were determined. Results: A dose-dependent bolus release of recombinant human platelet-derived growth factor-BB occurred within the first hour in vitro, followed by a gradual release over 48 h. There was a significant increase in ultimate tensile strength (p < 0.01 in the two highest recombinant human platelet-derived growth factor-BB dose groups (1.9 ± 0.5 and 2.1 ± 0.5 MPa relative to controls (1.0 ± 0.2 MPa. The modulus significantly increased (p = 0.031 with the highest recombinant human platelet-derived growth factor-BB dose group (7.2 ± 3.8 MPa relative to all other groups (control: 3.5 ± 0.9 MPa. No significant differences were identified for the maximum load or stiffness. The histological collagen and angiogenesis

  10. Classification and arthroscopic surgery of chronic achilles tendinitis%慢性跟腱炎的分型与关节镜微创治疗

    刘玉杰; 朱娟利; 王晓; 王志刚; 陈旭; 李众利; 蔡谞; 齐玮; 李春宝; 魏民

    2010-01-01

    目的 观察慢性跟腱炎的分型与局部麻醉下关节镜微创治疗的效果.方法 2003年3月至2009年3月,采用局部麻醉下关节镜微创治疗慢性跟腱炎22例,男16例,女6例,年龄17~53岁,平均33.5岁.运动损伤16例,病因不明6例.术前根据X线片、MRI检查、CT扫描和临床特点,将其分为:增生肥大型(10例)、钙化结节型(5例)和纤维撕裂型(7例).分别采用局麻关节镜下等离子刀消融、刨削清理术治疗.结果 术后随访22例,平均随访14个月(9~54个月),采用制定的评定标准和VAS评分进行疗效评价,优:12例,良8例,可2例.无血管神经损伤、感染和跟腱断裂等并发症.结论 跟腱炎分型有助于临床诊断和治疗方案制定;局麻关节镜下微创治疗慢性跟腱炎方法可行,操作简便,疗效显著.%Objective To investigate the clinical classification of chronic achilles tendinitis and analyze the surgical technique and efficacy of arthroscopic surgery. Methods Twenty-two patients ( 16 males, 6 females) with chronic achilles tendinitis were recruited. The average age was 33.5 years old ( range: 17-53). Sixteen cases were caused by sport injury while 6 cases had no definite etiological factor.The Achilles tendinopathy was divided into three types according to clinical characteristics and the results of X ray, CT scan and MRI examination of ankle: Type 1, hypertrophy (n = 10); Type 2, calcified tubercle (n = 5 ); Type 3, fiber tear (n = 7 ). All cases were treated with endoscopic debridement of ventral neovascularized area, poritendineum and Achilles tendon by shaver and radiofrequency (RF) probe.Resuits The patients were followed-up for a mean of 14 months (range: 9-15). Evaluated by our criteria and visual analogue scale, the post-operative efficacy was excellent in 12 cases, good in 8 and fair in 2. No postoperative complications, such as neurovascular injury, infection and rupture of Achilles tendon, was recorded. Conclusion This scheme of

  11. Magnetization transfer in human achilles tendon assessed by a 3D ultrashort echo time sequence. Quantitative examinations in healthy volunteers at 3T

    Syha, R.; Grosse, U.; Springer, F. [Tuebingen Univ. (Germany). Diagnostic and Interventional Radiology; Tuebingen Univ. (Germany). Section on Experimental Radiology; Martirosian, P.; Schick, F. [Tuebingen Univ. (Germany). Section on Experimental Radiology; Ketelsen, D.; Claussen, C.D. [Tuebingen Univ. (Germany). Diagnostic and Interventional Radiology

    2011-11-15

    Magnetization transfer contrast (MTC) imaging provides insight into interactions between free and bounded water. Newly developed ultrashort echo time (UTE) sequences implemented on whole-body magnetic resonance (MR) scanners allow MTC imaging in tissues with extremely fast signal decay such as tendons. The aim of this study was to develop a technique for the quantification of the MT effect in healthy Achilles tendons in-vivo at 3 Tesla. 16 normal tendons of volunteers with no history of tendinopathy were examined using a 3D-UTE sequence with a rectangular on-resonant excitation pulse and a Fermi-shaped off-resonant MT preparation pulse. The frequency of the MT pulse was varied from 1 to 5 kHz. MT effects were calculated in terms of the MT ratio (MTR) between measurements without and with MT preparation. Direct saturation effects of MT preparation on the signal intensity were evaluated using numerical simulation of Bloch equations. One patient with tendinopathy was examined to exemplarily show changes of MTR under pathologic conditions. Calculation of MTR data was feasible in all examined tendons and showed a decrease from 0.53 {+-} 0.05 to 0.25 {+-} 0.03 (1 kHz to 5 kHz) for healthy volunteers. Evaluation of variation with gender and dominance of ankle revealed no significant differences (p > 0.05). In contrast, the patient with confirmed tendinopathy showed MTR values between 0.36 (1 kHz) and 0.19 (5 kHz). MT effects in human Achilles tendons can be reliably assessed in-vivo using a 3D UTE sequence at 3 T. All healthy tendons showed similar MTR values (coefficient of variation 10.0 {+-} 1.2 %). The examined patient showed a clearly different MT effect revealing a changed microstructure in the case of tendinopathy. (orig.)

  12. Direct Radiofrequency Application Improves Pain and Gait in Collagenase-Induced Acute Achilles Tendon Injury

    Yun-Pu Tsai

    2013-01-01

    Full Text Available Radiofrequency (RF is often used as a supplementary and alternative method to alleviate pain for chronic tendinopathy. Whether or how it would work for acute tendon injury is not addressed in the literatures. Through detailed pain and gait monitoring, we hypothesized that collagenase-induce acute tendinopathy model may be able to answer these questions. Gait parameters, including time, distance, and range of motion, were recorded and analyzed using a walking track equipped with a video-based system. Expression of substance P (SP, calcitonin gene related peptide (CGRP, and galanin were used as pain markers. Beta-III tubulin and Masson trichrome staining were used as to evaluate nerve sprouting, matrix tension, and degeneration in the tendon. Of fourteen analyzed parameters, RF significantly improved stance phase, step length, preswing, and intermediary toe-spread of gait. Improved gait related to the expression of substance P, CGRP, and reduced nerve fiber sprouting and matrix tension, but not galanin. The study indicates that direct RF application may be a valuable approach to improve gait and pain in acute tendon injury. Altered gait parameters may be used as references to evaluate therapeutic outcomes of RF or other treatment plan for tendinopathy.

  13. Mesh Achilles tendon lengthening--a new method to treat equinus deformity in patients with spastic cerebral palsy: surgical technique and early results.

    Lin, Cheng-Li; Lin, Chii-Jeng; Huang, Ming-Tung; Su, Wei-Ren; Wu, Tung-Tai

    2013-01-01

    Equinus of the ankle is a common deformity in spastic cerebral palsy. Many methods have been developed to lengthen the Achilles tendon to correct the deformity. A new mesh Achilles tendon lengthening (ATL) procedure that might decrease immobilization and promote recovery was performed in 36 tendons with equinus deformity (22 patients, average age=6.2). The results were compared with those of two other methods: the Vulpius group and the Z-lengthening group. The corrected dorsiflexion angle of the ankle at a subsequent 2-year follow-up of the mesh ATL and Vulpius groups matched (25.5±3.0 and 27.1±3.5°, respectively), whereas that of the Z-lengthening group was higher (33.9±3.8°). Nevertheless, statistics of the timing of each patient's readiness to begin rehabilitation and walking as well as gaining better stability for running and one-legged hopping indicated that the mesh ATL group recovered significantly quicker than the Vulpius and Z-lengthening groups. The mesh ATL procedure achieves a successful correction of the equinus deformity in spastic cerebral palsy comparable with that of the Vulpius procedure, with the advantage of preserving the gastrocnemius without a complete section. This confers greater antigravity stability and quicker recovery in patients. PMID:23192252

  14. MMP3 and TIMP2 gene variants as predisposing factors for Achilles tendon pathologies: Attempted replication study in a British case–control cohort

    El Khoury, Louis; Ribbans, William J.; Raleigh, Stuart M.

    2016-01-01

    Variants within the MMP3 (rs679620) and TIMP2 (rs4789932) genes have been associated with the risk of Achilles tendon pathology (ATP) in populations from South Africa and Australia. This study aimed to determine whether these variants were associated with the risk of ATP in British Caucasians. We recruited 118 cases with ATP, including a subset of 25 individuals with Achilles tendon rupture (RUP) and 131 controls. DNA samples were isolated from saliva and genotyped using qPCR. For the TIMP2 rs4789932 variant we found a significant (p = 0.038) difference in the genotype distribution frequency between males with ATP (CC, 39.4%; CT, 43.7%; TT, 16.9%) compared to male controls (CC, 20.7%; CT, 59.8%; TT, 19.5%). We also observed a difference in the TIMP2 rs4789932 genotype distribution between males with rupture compared to male controls (p = 0.038). The MMP3 rs679620 GG genotype was found to be overrepresented in the Achilles tendon rupture (RUP) group (AA, 24.0%; AG, 32.0%; GG, 44.0%) compared to controls (AA, 26.7%; AG, 54.2%; GG, 19.1%). In conclusion, the CT genotype of the TIMP2 rs4789932 variant was associated with lower risk of ATP in males. Furthermore, while we revealed differences for both variants in genotype distribution between the RUP and control groups, the sample size of the RUP group was small and confirmation would be required in additional cohorts. Finally, although both the TIMP2 rs4789932 and MMP3 rs679620 variants tentatively associated with ATP, there were differences in the direction of association compared to earlier work. PMID:27222816

  15. MMP3 and TIMP2 gene variants as predisposing factors for Achilles tendon pathologies: Attempted replication study in a British case-control cohort.

    El Khoury, Louis; Ribbans, William J; Raleigh, Stuart M

    2016-09-01

    Variants within the MMP3 (rs679620) and TIMP2 (rs4789932) genes have been associated with the risk of Achilles tendon pathology (ATP) in populations from South Africa and Australia. This study aimed to determine whether these variants were associated with the risk of ATP in British Caucasians. We recruited 118 cases with ATP, including a subset of 25 individuals with Achilles tendon rupture (RUP) and 131 controls. DNA samples were isolated from saliva and genotyped using qPCR. For the TIMP2 rs4789932 variant we found a significant (p = 0.038) difference in the genotype distribution frequency between males with ATP (CC, 39.4%; CT, 43.7%; TT, 16.9%) compared to male controls (CC, 20.7%; CT, 59.8%; TT, 19.5%). We also observed a difference in the TIMP2 rs4789932 genotype distribution between males with rupture compared to male controls (p = 0.038). The MMP3 rs679620 GG genotype was found to be overrepresented in the Achilles tendon rupture (RUP) group (AA, 24.0%; AG, 32.0%; GG, 44.0%) compared to controls (AA, 26.7%; AG, 54.2%; GG, 19.1%). In conclusion, the CT genotype of the TIMP2 rs4789932 variant was associated with lower risk of ATP in males. Furthermore, while we revealed differences for both variants in genotype distribution between the RUP and control groups, the sample size of the RUP group was small and confirmation would be required in additional cohorts. Finally, although both the TIMP2 rs4789932 and MMP3 rs679620 variants tentatively associated with ATP, there were differences in the direction of association compared to earlier work. PMID:27222816

  16. Achilles tendon Total Rupture Score at 3 months can predict patients' ability to return to sport 1 year after injury

    Hansen, Maria Swennergren; Christensen, Marianne; Budolfsen, Thomas;

    2016-01-01

    PURPOSE: To investigate how the Achilles tendon Total Rupture Score (ATRS) at 3 months and 1 year after injury is associated with a patient's ability to return to work and sports as well as to investigate whether sex and age influence ATRS after 3 months and 1 year. METHOD: This is a retrospective...... study analysing the data from the Danish Achilles tendon Database. A total of 366 patients were included. Logistic regression was conducted to describe the effect of ATRS on return to work and sports. The effect of age and sex on ATRS was analysed by linear regression. RESULTS: Three months after injury...... patients had a significantly increased chance of return to sport after 1 year with an increased ATRS (OR 1.06, p = 0.001) but a non-significant effect on return to work. After 1 year, patients had a significantly increased probability of having returned to sport (OR 1.11, p < 0.001) and also having...

  17. Magnetic resonance imaging in acute tendon ruptures

    Daffner, R.H.; Lupetin, A.R.; Dash, N.; Riemer, B.L.

    1986-11-01

    The diagnosis of acute tendon ruptures of the extensor mechanism of the knee or the Achilles tendon of the ankle may usually be made by clinical means. Massive soft tissue swelling accompanying these injuries often obscures the findings, however. Magnetic resonance imaging (MRI) can rapidly demonstrate these tendon ruptures. Examples of the use of MRI for quadriceps tendon, and Achilles tendon rupture are presented.

  18. Biomechanical testing with modified buckle transducer on Achilles tendon in vivo%应用改良的环扣式传感器进行在体跟腱生物力学测试

    明江华; 李皓桓; 李家元; 刘世清; 胡佑伦; 董峰

    2004-01-01

    BACKGROUND: Biomechanical measurement of Achilles tendon lacks domestically.OBJECTIVE: To investigate the biomechanics of Achilles tendon in vivo.DESIGN: A randomized controlled experimental study was conducted.SETTING and PARTICIPANTS: The experiment was conducted in the Laboratory of Biomedical Engineering, Wuhan University. Forty-five New Zealand rabbits of either sex, weighing 1.85 - 3.25 kg, were used as the subjects (supplied by the Animal Room, Medical College, Wuhan University ).INTERVENTION: Forty-five rabbits were randomly divided into 3 groups with 15 in each group: group of normal left-Achilles tendon(group A), group of normal right-Achilles tendon(group B), and group of left-Achilles tendon without innervation of tibial nerve(group C) . Biomechanical test with improved buckle tranducer was conducted. The experiment was conducted and the results were analyzed by two experienced specialists.MAIN OUTCOME MEASURES: Tension-curves and biomechanical parameters of Achilles tendon of rabbits in vivo.RESULTS: The tension-time curve can be mainly classified into four types ( Ⅰ, Ⅱ, Ⅲ, and Ⅳ ). The biomechanical parameters of Achilles tendon under non-innerva tion condition[F3 = (8.82 ± 3.75) N, impulse = (37.95 ±CONCLUSION: Modified buckle transducer can be used for measuring tension of Achilles tendon in vivo and is feasible, stable and sensitive.In condusion, modified buckle transducer can be used for measuring tension of Achilles tendon in vivo and is feasible, stable and sensitive.%背景:在体肌腱的生物力学测试国内报道较少.目的:探讨在体跟腱的生物力学行为.设计:随机对照实验研究.地点和对象:实验在武汉大学生物医学工程实验室完成,对象为新西兰大耳白兔45只,雌雄不限,体质量1.85~3.25kg(由武汉大学医学院动物室提供).干预:对环扣式传感器进行改良,选择45只兔随机分3组,正常左侧跟腱组,正常右侧跟腱组,失胫神经支配的左侧跟腱

  19. 30例球类活动中急性跟腱损伤的治疗%The Treatment for 30 Ballgames Wounded about Acute Achilles Tendon Ruptures

    李红

    2011-01-01

    This study explores therapeutic method for acute achilles tendon ruptures. Using acupuncture and rehabilitation for a combination treatment for 30 ballgames wounded. The results showed that this treatment is effective.%本研究探讨急性跟腱损伤的治疗方法,对30例球类活动导致急性跟腱损伤受试者采用针灸及运动康复相结合的方法进行治疗.结果显示该治疗方法是科学有效的不失为一种对急性跟腱损伤患者采取的好方法.

  20. Achilles tendon rupture - aftercare

    ... another accident Played a sport like tennis or basketball, with a lot of stopping and starting Most ... is OK for you to play tennis, racquetball, basketball, and other sports where you stop and start ...

  1. Ilizarov技术治疗创伤性跟腱挛缩%Ilizarov technique used for post-traumatic Achilles tendon contracture

    朱跃良; 张庆彬; 潘奇; 刘会民; 石健; 李阳; 徐永清

    2015-01-01

    目的 回顾性分析Ilizarov技术结合肌腱延长术治疗创伤性跟腱挛缩的临床效果. 方法 回顾性分析2011年3月至2014年12月收治的27例创伤性跟腱挛缩患者资料,男16例,女11例;年龄13 ~52岁,平均31.2岁;左侧13例,右侧14例.单纯性跟腱挛缩18例,合并有其他足畸形9例.小腿软组织和骨折创伤引起19例,缺血性挛缩后5例,另外有3例原因不明.根据患足X线片胫底角的不同进行分度治疗,手术方法包括Ilizarov环式外固定后推、前拉治疗,跟腱、胫骨后肌腱、躅长屈肌腱、趾长屈肌腱松解术,足部分关节融合术.术后第7天开始矫形,参考速度为1 mm/d.患者术后牵张矫形到踝背伸80°停止,矫形时间为15 ~32 d,平均23 d;到位后固定角度不变6周.拆除外固定支架,行石膏或支具固定3个月后拆除.结果 27例患者术后获6~36个月(平均20个月)随访,其中25例(92.6%)患者的胫底角均为90°,患者行走步态自然;2例(7.4%)患者胫底角反弹为105°,需要垫高后跟鞋垫后恢复自然行走.9例遗留足趾的屈趾畸形,未做进一步处理. 结论 以Ilizaroy技术为主,结合肌腱延长术治疗创伤性跟腱挛缩有效、安全、复发率低.%Objective To report treatment of post-traumatic Achilles tendon contracture with Ilizarov technique and tendon lengthening.Methods From March 2011 to December 2014,27 cases of post-traumatic Achilles tendon contracture were treated at our department.They were 16 males and 11 females,13 to 52 years of age (average,31.2 years).The left side was affected in 13 cases and the right side in 14.Eighteen cases had simple Achilles tendon contracture while the other 9 were complicated with other foot deformities.The causes were soft tissue injury and fracture at the leg in 19 cases,Volkmann's contracture in 5,and unknown in 3.Based on the X-ray tibio-sole angle of the affected foot,the treatment protocols included Ilizarov distraction,lengthening of

  2. A COMPARATIVE STUDY ON REPAIR OF ACUTE Achilles TENDON RUPTURE USING THREE OPERATING TECHNIQUES%三种手术方法治疗新鲜跟腱断裂比较研究

    王挺; 梅国华; 施忠民; 柴益民; 张长青; 侯春林

    2012-01-01

    目的 比较传统切开跟腱吻合术、经皮微创跟腱吻合术以及应用跟腱吻合器有限切开术治疗新鲜闭合性跟腱断裂的疗效,为临床治疗方式的选择提供参考依据.方法 2007年12月-2010年3月将69例符合纳入标准的新鲜闭合性跟腱断裂患者随机分为3组,其中采用传统切开跟腱吻合术23例(传统切开组),经皮微创跟腱吻合术23例(经皮微创组),应用跟腱吻合器有限切开治疗23例(有限切开组).3组患者性别、年龄、损伤机制、美国足踝外科协会(AOFAS)踝-后足评分等一般资料比较,差异均无统计学意义(P>0.05),具有可比性.结果 经皮微创组及有限切开组住院时间及失血量明显优于传统切开组(P<0.01).术后传统切开组发生2例(8.7%)切口感染坏死,其余两组患者切口均Ⅰ期愈合;传统切开组术后腱旁组织并发症发生率高于其余两组(P<0.05).经皮微创组及有限切开组各1例(4.3%)发生跟腱再断裂,传统切开组跟腱再断裂发生率(0)低于其余两组(P<0.05).69例均获随访,随访时间12~18个月,平均14.9个月.术后12个月3组踝关节AOFAS评分均>90分,较同组术前显著改善(P<0.05),组间比较差异无统计学意义(P> 0.05).结论 3种手术方式均能有效治疗新鲜跟腱断裂,有限切开或经皮微创手术方法创伤小,伤口愈合好,住院时间少,术后腱旁组织并发症少,但跟腱再断裂风险增加.%Objective To compare the effectiveness of the 3 methods (traditional open Achilles tendon anastomosis, minimally invasive percutaneous Achilles tendon anastomosis, and Achilles tendon anastomosis limited incision) for acute Achilles tendon rupture so as to provide a reference for the choice of clinical treatment plans. Methods Between December 2007 and March 2010, 69 cases of acute Achilles tendon rupture were treated by traditional open Achilles tendon anastomosis (traditional group, ?=23), by minimally invasive

  3. Avaliação morfométrica do tendão de Aquiles por ultra-sonografia Morphometric evaluation of Achilles tendon by ultrasound

    Ricardo Andrade Fernandes de Mello

    2006-06-01

    Full Text Available OBJETIVO: Determinar os valores normais dos diâmetros ântero-posterior e transversal do tendão de Aquiles na nossa população e correlacioná-los com sexo, faixa etária, cor da pele, grupo sanguíneo ABO e índice de massa corporal. MATERIAIS E MÉTODOS: Foi feita análise ultra-sonográfica de 100 tendões de Aquiles de 50 voluntários sadios, visando à mensuração dos diâmetros ântero-posterior e transversal desses tendões. Todos os exames foram realizados pelo mesmo examinador, em aparelho de ultra-sonografia com transdutor linear com freqüência de 10 MHz. RESULTADOS: Dos 50 voluntários estudados, 25 eram do sexo masculino e 25, do sexo feminino, com a faixa etária variando de 20 a 52 anos (média de 33,9 anos. O valor médio do diâmetro transversal do tendão de Aquiles foi de 13,3 ± 1,0 mm para o sexo feminino e 14,4 ± 1,4 mm para o sexo masculino; em relação ao diâmetro ântero-posterior, foi de 5,4 ± 0,5 mm para o sexo feminino e 5,6 ± 0,6 mm para o sexo masculino. Os diâmetros do tendão de Aquiles foram significativamente menores no sexo feminino (p OBJECTIVE: The aim of this study was to determine the normal values of the Achilles tendon thickness in the anteroposterior dimension and width in the transverse dimension in our population, correlating them with gender, age ranges, race, ABO blood group and body mass index. MATERIALS AND METHODS: Ultrasonographic examination was employed to evaluate 100 Achilles tendons of 50 healthy volunteers in order to measure the tendons thickness in the anteroposterior dimension and width in the transverse dimension. All examinations were performed by the same sonographer, using an ultrasound equipment with a 10 MHz linear transducer. RESULTS: Among the 50 volunteers studied, 25 were men and 25 were women, ranging from 20 to 52 years (average 33.9 years. The tendons average width was 13.3 ± 1.0 mm in the female group and 14.4 ± 1.4 mm in the male group; the average thickness

  4. Accuracy of MR findings in characterizing peroneal tendons disorders in comparison with surgery

    Park, Hee-Jin; Lee, So-Yeon; Rho, Myung-Ho; Chung, Eun-Chul; Kwag, Hyon-Joo [Dept. of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan Univ., School of Medicine, Suwon (Korea, Republic of); Park, Noh-Hyuck [Dept. of Radiology, Myongji Hospital, Kwandong Univ., Coll. of Medicine (Korea, Republic of)], e-mail: radiology11@hanmail.net

    2012-09-15

    Background: Previous studies have shown that magnetic resonance imaging (MRI) has a high sensitivity for peroneal tendon pathology but more studies with surgery as a reference standard are needed. Purpose: To evaluate the accuracy of MRI compared to surgery for characterizing chronic peroneal tendon pathology. Material and Methods: Ninety-seven patients (57 men, 40 women; mean age, 39 years; range, 15-64 years) with chronic lateral ankle instability underwent MRI followed by surgery, with a mean MR to surgery interval of 30 days. Sagittal, coronal, and axial T1-weighted spin-echo and fat-suppressed T2-weighted fast spin-echo images were obtained for all patients. Two blinded observers evaluated the MR images without clinical information, and the results were compared to surgical findings. The following peroneal injuries were observed: tendon split, interstitial tear, swelling of the tendon, fluid collection, superior peroneal retinaculum injury, and tendon dislocation. Results: Swelling of the peroneus longus tendon was the most common finding on MR imaging, followed by fluid collection and a split of the peroneus brevis tendon. Surgical findings showed that nine cases (9%) of interstitial tears were in the peroneus brevis and two cases (2%) were in the peroneus longus, with eight cases (8%) of splits in the peroneus brevis tendon. The sensitivity and specificity for detecting interstitial tears in the peroneus brevis were 44% and 99%, respectively. The sensitivity and specificity for detecting swelling in the peroneus brevis were 50% and 99%, respectively. The sensitivity and specificity for detecting interstitial tears for peroneus longus injuries were 50% and 96%, respectively. The sensitivity and specificity for detecting swelling in these injuries were and 100% and 96%, respectively. Conclusion: MRI findings of chronic peroneal tendon pathology are diagnostically specific but not sensitive. MRI showed high sensitivity for diagnosing tendon swelling in the

  5. The influence of freezing on the tensile strength of tendon grafts: a biomechanical study

    ARNOUT, NELE; Myncke, Jan; Vanlauwe, Johan; Labey, Luc; Lismont, Daniel; Bellemans, Johan

    2013-01-01

    We investigated the influence of freezing on the ­tensile strength of fresh frozen tendon grafts. The bio­mechanical characteristics of tendons that are less commonly used in knee surgery (tibialis anterior, tibialis posterior, peroneus longus and medial and ­lateral half of Achilles tendons) were compared to those of a semitendinosus and gracilis graft harvested from the same 10 multi-organ donors. All right side tendons constituted the study group and were frozen at –80°C and thawed at room...

  6. Clinical commentary of the evolution of the treatment for chronic painful mid-portion Achilles tendinopathy

    Håkan Alfredson

    2015-10-01

    Full Text Available ABSTRACTThe chronic painful Achilles tendon mid-portion was for many years, and still is in many countries, treated with intratendinous revision surgery. However, by coincidence, painful eccentric calf muscle training was tried, and it showed very good clinical results. This finding was unexpected and led to research into the pain mechanisms involved in this condition. Today we know that there are very few nerves inside, but multiple nerves outside, the ventral side of the chronic painful Achilles tendon mid-portion. These research findings have resulted in new treatment methods targeting the regions with nerves outside the tendon, methods that allow for a rapid rehabilitation and fast return to sports.

  7. Quantitative research on familial hypercholesterolemia achilles tendons by shear wave elastography%剪切波弹性成像定量评估家族性高胆固醇血症跟腱的初步研究

    张蕾; 勇强; 濮恬宁; 王明月; 史素君; 郑超

    2015-01-01

    目的:探讨应用剪切波弹性成像技术(SWE)定量评估家族性高胆固醇血症(FH)患者跟腱软硬度的临床价值。方法对11例 FH 患者和14例正常人跟腱进行检测。分别于跟腱近、中、远三段进行检查,常规超声显示跟腱的灰阶声像图,测量跟腱的厚度,SWE 检测获得跟腱的弹性成像图,测量平均弹性模量值,比较正常对照组和 FH 组跟腱的厚度、平均弹性模量值的差异。结果正常组近、中、远段跟腱厚度分别为(4.51±0.63)mm、(4.51±0.63)mm、(4.32±0.39)mm;灰阶超声表现为中低回声,其内可见交替分布的平行线状高回声;近、中、远段平均弹性模量值分别为(404.94±37.37)kPa、(412.78±36.65) kPa、(400.53±35.17)kPa。FH 组近、中、远段跟腱厚度分别为(5.45±1.92)mm、(8.46±4.55)mm、(6.44±1.90)mm;灰阶超声表现为低回声,其内线状高回声分布紊乱、结构不清晰,3条跟腱内部出现弧形强回声;近、中、远段平均弹性模量值分别为(287.43±39.77)kPa、(280.75±59.78)Pa、(260.37±39.09)kPa。正常组和 FH 组近、中、远段跟腱厚度、平均弹性模量值差异均有统计学意义(P 均<0.05)。结论灰阶超声可以评价跟腱厚度及其声像图特征,SWE 能对跟腱软硬度进行定量分析,为 FH 病情随访提供了新的影像学诊断信息。%Objective To assess the elasticity value of shear wave elastography (SWE)in quantitative evaluation the achilles tendons of familial hypercholesterolemia (FH).Methods Eleven patients with FH achilles tendons and 14 healthy volunteers were examined.Each achilles tendons were divided into the following 3 sections for grey scale ultrasound and SWE images evaluation,including proximal,middle and distal.The thickness and mean elasticity values obtained at different sections of achilles tendons were statistically analyzed.Results The thickness of proximal,middle and distal sections of achilles tendons in healthy volunteers

  8. Eccentric exercise in treatment of Achilles tendinopathy

    Nørregaard, J; Larsen, C C; Bieler, T;

    2007-01-01

    Prognosis and treatment of Achilles tendon pain (achillodynia) has been insufficiently studied. The purpose of the present study was to examine the long-term effect of eccentric exercises compared with stretching exercises on patients with achillodynia....

  9. Running biomechanics in a long-term monitored recreational athlete with a history of Achilles tendon rupture

    Jandacka, Daniel; Zahradnik, David; Foldyna, Karel; Hamill, Joseph

    2013-01-01

    This study represented a unique opportunity to understand changes in the human motion biomechanics during basic locomotion within a time interval of 4 years, when the monitored individual regained his original aerobic fitness, running performance and body mass index as prior to the injury. The participant visited the laboratory a month prior to the injury and during 4 years after the surgery. The surgery, subsequent rehabilitation and a 4-year running training programme in the studied recreat...

  10. 自体富含血小板血浆痛点注射治疗慢性跟腱炎15例分析%Platelet-rich plasma trigger point injection treatment for chronic achilles insertion tendonitis

    邹国友; 贾伟涛; 郑闽前; 徐小卒; 曹正春; 殷俊; 吴亚

    2013-01-01

    Retrospective analysis was performed for the clinical data of 15 chronic insertion achilles tendinitis patients undergoing platelet-rich plasma (PRP) trigger point injection.The scores of Validated Victorian Institute of Sports Assessment-Achilles (VAS-A) and foot function index (FFI) improved greatly versus pre-treatment (all P < 0.05).Tendon insertion structure inflammation decreased significantly on magnetic resonance imaging.At the last follow-up,all patients recovered normal gait and daily activity.The trigger point injection of PRP is efficacious for chronic insertion achilles tendinopathy.%回顾分析15例慢性跟腱炎采用自体富含血小板血浆(PRP)痛点注射治疗患者的临床资料.每例患者3~5个痛点共注射2 ml PRP[血小板浓度为(1643±180)×109/L],治疗后维多利亚医学院跟腱评分和足功能指数(FFI)与治疗前相比差异有统计学意义(均P<0.05);MRI显示跟腱炎周围的软组织炎症明显改善;患者恢复了正常步态和日常活动能力.

  11. Identifying factors related to Achilles tendon stress, strain, and stiffness before and after 6 months of growth in youth 10-14 years of age.

    Neugebauer, Jennifer M; Hawkins, David A

    2012-09-21

    The purposes of this study were (1) determine if youth peak Achilles tendon (AT) strain, peak AT stress, and AT stiffness, measured during an isometric plantar flexion, differed after six months (mos) of growth, and (2) determine if sex, physical activity level (Physical Activity Questionnaire (PAQ-C)), and/or growth rate (GR) were related to these properties. AT stress, strain, and stiffness were quantified in 20 boys (13.47±0.81 years) and 22 girls (11.18±0.82 years) at 2 times (0 and 6 mos). GR (change in height in 6 mos) was not significantly different between boys and girls (3.5±1.4 and 3.4±1.1cm/6 mos respectively). Peak AT strain and stiffness (mean 3.8±0.4% and 128.9±153.6N/mm, respectively) did not differ between testing sessions or sex. Peak AT stress (22.1±2.4 and 24.0±2.1MPa at 0 and 6 mos, respectively) did not differ between sex and increased significantly at 6 mos due to a significant decrease in AT cross-sectional area (40.6±1.3 and 38.1±1.6mm(2) at 0 and 6 mos, respectively) with no significant difference in peak AT force (882.3±93.9 and 900.3± 65.5N at 0 and 6 mos, respectively). Peak AT stress was significantly greater in subjects with greater PAQ-C scores (9.1% increase with 1 unit increase in PAQ-C score) and smaller in subjects with faster GRs (13.8% decrease with 1cm/6 mos increase in GR). These results indicate that of the AT mechanical properties quantified, none differed between sex, and only peak AT stress significantly differed after 6 months and was related to GR and physical activity. PMID:22877892

  12. Achilles and Patellar Tendinopathy Loading Programmes

    Malliaras, Peter; Barton, Christian J; Reeves, Neil D;

    2013-01-01

    performance was associated with Achilles but not patellar tendon clinical outcomes. The mechanisms associated with clinical benefit may vary between loading interventions and tendons. CONCLUSION: There is little clinical or mechanistic evidence for isolating the eccentric component, although it should be made...

  13. Tendinitis: the achilles heel of quinolones!

    Shortt, P; Wilson, R.; Erskine, I

    2006-01-01

    We present a case series of two patients who presented to the emergency department with spontaneous bilateral Achilles tendon rupture associated with the use of ciprofloxacin. Tendinitis and tendon rupture are now well recognised but rare complications of treatment with quinolone antimicrobials. The emergency department is an important setting for both surveillance and detection of adverse events associated with drug treatment.

  14. Imaging in chronic achilles tendinopathy: a comparison of ultrasonography, magnetic resonance imaging and surgical findings in 27 histologically verified cases

    Aastroem, M. [Department of Orthopaedics, Malmoe University Hospital (Sweden); Gentz, C.F. [Department of Radiology, Malmoe University Hospital (Sweden); Nilsson, P. [Department of Radiology, Malmoe University Hospital (Sweden); Rausing, A. [Department of Pathology, Malmoe University Hospital (Sweden); Sjoeberg, S. [Department of Radiology, Malmoe University Hospital (Sweden); Westlin, N. [Department of Orthopaedics, Malmoe University Hospital (Sweden)

    1996-10-01

    Objective. To compare information gained by ultrasonography and magnetic resonance imaging (MRI) in chronic achilles tendinopathy with regard to the nature and severity of the lesion. Design. Imaging of both achilles tendons with ultrasonography and MRI was performed prior to unilateral surgery. Operative findings and histological biopsies together served as a reference. Patients. Twenty-seven patients (22 men, 5 women; mean age 44 years; 21 athletes) suffering from chronic achilles tendinopathy participated in the study. Eighteen patients had unilateral and 9 had bilateral symptoms. Results and conclusions. Surgical findings included 4 partial ruptures, 21 degenerative lesions and 2 macroscopically normal cases. Microscopy revealed tendinosis (degeneration) in all tendon biopsies, including cases with a partial rupture, but only slight changes in the paratendinous tissues (paratenon). Ultrasonography was positive in 21 of 26 and MRI in 26 of 27 cases. Severe intratendinous abnormalities and a sagittal tendon diameter >10 mm suggested a partial rupture. In tendons with a false negative result histopathological changes were mild and a tendency towards a better clinical outcome was noted in the sonographic cases. Assessment of the paratenon was unreliable with both methods. Ultrasonography and MRI give similar information and may have their greatest potential as prognostic instruments. (orig.). With 2 figs., 1 tab.

  15. Effects of long-term immobilization and recovery on human triceps surae and collagen turnover in the Achilles tendon in patients with healing ankle fracture

    Christensen, Britt; Dyrberg, Eva; Aagaard, Per;

    2008-01-01

    The aim of the present study was to analyze how human tendon connective tissue responds to an approximately 7-wk period of immobilization and a remobilization period of a similar length, in patients with unilateral ankle fracture, which is currently unknown. Calf muscle cross-sectional area (CSA...... calf muscle CSA and strength was found in relation to 7 wk of immobilization. Immobilization increased both collagen synthesis and degradation in tendon near tissue. However, it cannot be excluded that the facture of the ankle in close proximity could have affected these data. Remobilization increased...... muscle size and strength and tendon synthesis and degradation decreased to baseline levels. These dynamic changes in tendon connective tissue turnover were not associated with macroscopic changes in tendon size....

  16. Achilles tendinitis

    Tendinitis of the heel ... foot. Rarely, it is caused by an injury. Tendinitis due to overuse is most common in younger ... occur in walkers, runners, or other athletes. Achilles tendinitis may be more likely to occur if: There ...

  17. Knee extension and flexion muscle power after anterior cruciate ligament reconstruction with patellar tendon graft or hamstring tendons graft: a cross-sectional comparison 3 years post surgery

    Ageberg, Eva; Roos, Harald; Silbernagel, Karin; Thomeé, Roland; Roos, Ewa

    2008-01-01

    Hamstring muscles play a major role in knee-joint stabilization after anterior cruciate ligament (ACL) injury. Weakness of the knee extensors after ACL reconstruction with patellar tendon (PT) graft, and in the knee flexors after reconstruction with hamstring tendons (HT) graft has been observed up...... to 2 years post surgery, but not later. In these studies, isokinetic muscle torque was used. However, muscle power has been suggested to be a more sensitive and sport-specific measures of strength. The aim was to study quadriceps and hamstring muscle power in patients with ACL injury treated with...... least 4 months, were assessed with reliable, valid, and responsive tests of quadriceps and hamstring muscle power at 3 years (SD 0.9, range 2-5) after surgery. The mean difference between legs (injured minus uninjured), the hamstring to quadriceps (H:Q, hamstring divided by quadriceps) ratio, and the...

  18. Using the Literature to Understand Achilles' Fate.

    Rakic, Vesna S

    2016-05-01

    According to Greek mythology, Achilles was fatally wounded in his heel, bled out, and died. Several unproven hypotheses mention poisoning, infection, allergy, hemophilia, thyrotoxic storm (ie, pain and stress), and suicide. The author, a plastic surgeon who often treats chronic wounds, proposes an additional scenario: Although not mortally wounded, Achilles was considered dead, because in his time a wounded hero was as good as a dead hero, so he lived out the remainder of his life as former hero with a chronic wound far away from everyone. To determine whether his injury was enough to cause fatal bleeding and quick death or if other factors might have been in play, a search of the literature was conducted to enhance what is known about Achilles, basically through the tale related in The Iliad and the clinical impact of an Achilles' injury. Search terms utilized included bleeding tibialis posterior artery (3 manuscripts were found) and chronic wound, Achilles tendon (631 manuscripts were located). Although science may not be able to explain how and why Achilles died, the literature supported the conjecture that Achilles probably had a chronic wound with skin and paratenon defect, de- vitalized tendon tissue, bleeding, granulation, and repeated infections. It is interesting to consider the state of his injury and his mind in the making of this legend. PMID:27192720

  19. Desequilíbrios musculares entre flexores dorsais e plantares do tornozelo após tratamento conservador e acelerado da ruptura do tendão calcâneo Muscle imbalance between ankle dorsiflexors and plantarflexors after conservative and accelerated treatment of Achilles tendon rupture

    Alexandre Mayer

    2010-06-01

    Full Text Available A ruptura do tendão calcâneo (TC reduz a sobrecarga mecânica dos flexores plantares (FP do tornozelo. Essa alteração muda o equilíbrio natural entre os FP e flexores dorsais (FD do tornozelo. O objetivo do estudo foi avaliar as razões isocinéticas concêntricas convencionais de torque de pacientes submetidos a tratamento cirúrgico de ruptura aguda do TC após dois protocolos diferentes de reabilitação. Após procedimento cirúrgico para reconstrução do TC, a amostra foi dividida de forma intencional em dois grupos: conservador (GC, 11 homens, 41,3±7,9 anos e grupo acelerado (GA, 13 homens, 43,5±13,7 anos. O GC permaneceu com imobilização gessada no tornozelo por seis semanas (tratamento tradicional, enquanto o GA usou uma órtese robofoot em posição neutra e, após duas semanas, iniciou mobilização e apoio precoce do tornozelo, com reabilitação por seis semanas. Após 3 meses de pós-operatório, a razão do torque concêntrico máximo dos FD pelos FP do tornozelo foi avaliada por dinamômetro isocinético. As razões de torque do lado operado se mantiveram superiores às do lado saudável mesmo após 3 meses de pós-operatório (pAchilles tendon rupture reduces ankle plantarflexor (PF muscles mechanical overload. This change in the ankle joint mechanics changes the natural muscle balance between dorsiflexor (DF and PF muscles. The purpose of this study was to assess such imbalance by concentric conventional isokinetic torque ratios of patients who underwent different rehabilitation protocols after surgical repair of the Achilles tendon. After surgery, subjects were assigned to either a conservative or to an accelerated rehabilitation group. The conservative group (11 men, 41.3±7.9 years old remained with a plaster cast for 6 weeks after surgery. The accelerated group (13 men, 43.5±13,7 years old used a"robofoot" cast for 2 weeks and underwent ankle mobilization and early weight bearing for a period of 6 weeks post

  20. Inflammatory and metabolic alterations of Kager's fat pad in chronic achilles tendinopathy

    Jessica Pingel; M Christine H Petersen; Ulrich Fredberg; Søren G Kjær; Bjørn Quistorff; Henning Langberg; Hansen, Jacob B.

    2015-01-01

    BACKGROUND: Achilles tendinopathy is a painful inflammatory condition characterized by swelling, stiffness and reduced function of the Achilles tendon. Kager's fat pad is an adipose tissue located in the area anterior to the Achilles tendon. Observations reveal a close physical interplay between Kager's fat pad and its surrounding structures during movement of the ankle, suggesting that Kager's fat pad may stabilize and protect the mechanical function of the ankle joint.AIM: The aim of this s...

  1. [Proximal and distal biceps tendon rupture--an indication for surgery?].

    Klonz, A; Eggers, C; Reilmann, H

    1998-09-01

    We reviewed 77 conservatively and 164 operatively treated cases of rupture of the long head of the biceps documented in the literature. Refixation offers a small but relatively constant improvement of flexion and supination power and thus reduces the number of cases with remaining light or marked weakness by one third. Deformity by the slipped muscle can be corrected effectively. As complications are uncommon surgery should be recommended to young and active patients and should at least be offered to less active patients. Thirteen patients were re-examined after operative repair for distal biceps tendon avulsion and 277 reported cases were reviewed. After conservative management (n = 20) the power of flexion remains reduced by 30%-40%, that of supination by more than 50%. The loss of flexion power, as well as the deformity can be nicely diminished by attachment of the distal biceps to the brachialis muscle (n = 22). There are no complications documented regarding this procedure. The anatomic reinsertion (n = 248) additionally reduces the loss of supination power to 0%-25%, but bears a higher risk of complications. The double-incision technique (n = 105 of 248) does not necessarily decrease this risk. There are as many nerve injuries reported as with the single-anterior approach. Additionally we are faced with the problem of radioulnar synostosis. The use of suture anchors provides a nice way of fixation of the tendon but does not facilitate the approach to the tuberosity. The distal biceps tendon rupture should be treated operatively. The adequate method of repair is to be determined individually. PMID:9816985

  2. Is tendon stiffness correlated to the dissipation coefficient?

    The assessment of Achilles tendon mechanical properties in vivo has received much attention in the literature. Many studies investigated mechanical properties by assessing tendon stiffness. Despite tendon dissipative properties being representative of a storage-recoil process, its determination has received minimal attention in the literature. The aim of this study was to determine if Achilles tendon stiffness is associated with dissipative properties. The cross-sectional area, stiffness and dissipation coefficient of the Achilles tendon were measured in 35 subjects. No significant correlation was found between stiffness and the dissipation coefficient, irrespective of stiffness normalization with cross-sectional area (P > 0.05). Thus, it appears that both stiffness and dissipative properties must be assessed to determine the storage-recoil process capacities of the Achilles tendon in order to precisely characterize changes in the tendon mechanical properties after chronic interventions or rehabilitation programs. (note)

  3. 跟腱延长、围距骨周围截骨联合Ilizarov技术矫治成人重度僵硬型马蹄内翻足畸形的体会%Experience of achilles tendon lengthening,osteotomy around the circumference of the talus combined with Ilizarov technique for the treatment of adult with severe rigid type of talipes equinovarus deformity

    孙锦波; 陈春; 颜晶晶; 谭国兵

    2015-01-01

    Objective:To investigate the experience of achilles tendon lengthening,osteotomy around the circumference of the talus combined with Ilizarov technique for the treatment of adult with severe rigid type of talipes equinovarus deformity.Methods:15 patients with 20 talipes equinovarus were selected.All patients underwent achilles tendon Z shaped extension,osteotomy around the circumference of the talus combined with Ilizarov technology(external fixation),some of the heavier patients were treated with the anterior tibial tendon transposition and plantar fascia release surgery on the basis of the above treatments at the same period.7 days after surgery we began to rotate corresponding thread threaded rods,gradually corrected within strephenopodia, adduction and drop foot deformity,meanwhile overtension appropriately in order to effectively correct the deformity.Results: Most of the patients with severe talipes equinovarus deformity after treatment got better correction and walking functional recovery. There was a significant difference compared with patients before the treatment,P<0.05 with statistical significance.All of the patients after treatment showed no skin necrosis,vascular and nerve injury.Conclusion:achilles tendon lengthening,osteotomy around the circumference of the talus combined with Ilizarov technique for the treatment of adult with severe rigid type of talipes equinovarus deformity not only has the characteristics of simple operation,minimally invasive and safe,but also has a good effect, but in therapy,appropriate treatment should be selected based on the actual condition of patients.%目的:探讨跟腱延长、围距骨周围截骨联合 Ilizarov 技术矫治成人重度僵硬型马蹄内翻足畸形的体会.方法:收治成人重度僵硬型马蹄内翻足畸形患者15例(20只马蹄足),所有患者均行跟腱Z形延长、围距骨周围截骨联合Ilizarov技术(外固定支架),其中一些较重的患者在此基础上同期加行胫前肌

  4. 小腿肌间海绵状血管瘤并跟腱挛缩强直畸形的手术治疗%Surgical Treatment of Achilles Tendon Contracture Deformity Caused by Cavernous Hemangioma of Calf Muscle in Children

    刘大看; 李艳敏; 马玉春; 孙斌; 雷红召; 董长宪

    2011-01-01

    Objective To explore the surgical treatment of the achilles tendon contracture deformity caused by calf muscle cavernous hemangioma in children. Methods Retrospective analysis was done in 21 cases (7 cases were male and 14 cases were female, aged 2 - 11 years old) of pediatric calf muscle cavernous hemangioma. Thirteen cases had the first operation in Henan Provincial People's Hospital and 8 cases had been treated in the other hospital. All cases had achilles tendon contracture deformity caused by cavernous hemangioma in gastrocnemius and scteus muscle. Clinical features had been surmnarized, and surgical treatment was discussed, hemangioma resection and Z - shaped achilles tendon lengthening surgical procedure was advanced. The surgical results were evaluated. Results Complete resection was done in 19 cases of calf muscle cavernous hemangioma. To preserve the normal function, partial resection was done in 2 patients with severe cavernous hemangioma. And all patients were done with Z - shaped achilles tendon lengthening surgical procedure. All 21 cases were followed up for 6 months to 1 year;the surgical success rate was 95.2% , all the patients could walk normally, and with normal function of the ankle joint,just in 2 patients with ankle joint range of motion was limited. Conclusions The hemangioma resection and Z - shaped achilles tendon lengthening surgical procedure can remove the hemangioma as soon as possible, correct the ankle joint function, and achilles tendon contracture deformity,provide opportunities for the children with achilles tendon contracture to maintain normal walking.%目的探讨小儿小腿肌间海绵状血管瘤导致跟腱挛缩畸形的手术治疗方法.方法 回顾性分析21例小腿肌间海绵状血管瘤患儿(男7例,女14例;年龄2~11岁)的临床资料,在本院首次手术13例,另8例曾在外院行手术治疗.均存在小腿腓肠肌及比目鱼肌肌间海绵状血管瘤导致跟腱挛缩强直畸形.均采用血管

  5. Achilles tendinopathy

    Wetke, E; Johannsen, F; Langberg, Henning

    2015-01-01

    In published efficacy studies on Achilles tendinopathy (AT) exercise alone results in improvement in 60-90% of the cases. However, this high success rate cannot be expected in usual clinical practice. We prospectively investigated the effectiveness of a treatment regimen consisting of home-based ...

  6. Magnetic Resonance Imaging in Chronic Achilles Tendinopathy

    Shalabi, A. [Karolinska Institutet, Stockholm (Sweden). Center for Surgical Sciences Divisions of Radiology and Orthopedics

    2004-09-01

    The main objective of this thesis was to evaluate and monitor the morphological response following treatment interventions in patients with chronic Achilles tendinopathy by using different MRI techniques. For this purpose, we investigated different types of sequences, including gadolinium contrast medium-enhanced T1-WI images (CME T1-WI), and developed a precise method to measure tendon volume and mean intratendinous signal of the Achilles tendon. Study I aimed at evaluating 15 patients with chronic, painful Achilles tendinosis, before and 2 years after surgical treatment. There was marked regression of the intratendinous signal postoperatively. The most sensitive sequence for depicting an intratendinous lesion in this study was CME T1-WI images. They showed a regression of the intratendinous signal abnormality from 13/15 patients preoperatively to 4/15 postoperatively. The clinical outcome was excellent in eight, good in five, fair in one and poor in one patient. In study II, the early contrast agent enhancement in the dynamically enhanced MRI signal (DEMRI) was correlated with the histopathologic findings in 15 patients with chronic Achilles tendinopathy. Early contrast enhancement (within the first 72 s) was seen in DEMRI in the symptomatic Achilles tendons, with a significant difference compared to the asymptomatic contralateral tendons. Increased severity of tendon changes, including fiber structure abnormality, increased vascularity, rounding of nuclei, and increased amount of glycosaminoglycans, correlated to CME. In study III, we developed a computerized 3-D seed-growing MRI technique to measure tendon volume and mean intratendinous signal. This technique showed an excellent inter- and intra-observer reliability. The technique was also used to follow up prospectively the tendon adaptation and healing described in studies IV-VI. In study IV, using serial MRI during a period of 1 year, we evaluated the biological effect of tendon repair following iatrogenic

  7. Magnetic Resonance Imaging in Chronic Achilles Tendinopathy

    The main objective of this thesis was to evaluate and monitor the morphological response following treatment interventions in patients with chronic Achilles tendinopathy by using different MRI techniques. For this purpose, we investigated different types of sequences, including gadolinium contrast medium-enhanced T1-WI images (CME T1-WI), and developed a precise method to measure tendon volume and mean intratendinous signal of the Achilles tendon. Study I aimed at evaluating 15 patients with chronic, painful Achilles tendinosis, before and 2 years after surgical treatment. There was marked regression of the intratendinous signal postoperatively. The most sensitive sequence for depicting an intratendinous lesion in this study was CME T1-WI images. They showed a regression of the intratendinous signal abnormality from 13/15 patients preoperatively to 4/15 postoperatively. The clinical outcome was excellent in eight, good in five, fair in one and poor in one patient. In study II, the early contrast agent enhancement in the dynamically enhanced MRI signal (DEMRI) was correlated with the histopathologic findings in 15 patients with chronic Achilles tendinopathy. Early contrast enhancement (within the first 72 s) was seen in DEMRI in the symptomatic Achilles tendons, with a significant difference compared to the asymptomatic contralateral tendons. Increased severity of tendon changes, including fiber structure abnormality, increased vascularity, rounding of nuclei, and increased amount of glycosaminoglycans, correlated to CME. In study III, we developed a computerized 3-D seed-growing MRI technique to measure tendon volume and mean intratendinous signal. This technique showed an excellent inter- and intra-observer reliability. The technique was also used to follow up prospectively the tendon adaptation and healing described in studies IV-VI. In study IV, using serial MRI during a period of 1 year, we evaluated the biological effect of tendon repair following iatrogenic

  8. EFFECTS OF EXOGENOUS PROSTAGLANDIN E2 ON COLLAGEN CONTENT OF Achilles TENDON OF RABBITS IN VlVO%外源性前列腺素E2对兔跟腱胶原含量的影响

    李辉; 唐康来; 邓银栓; 谢美明; 常德海; 陶旭; 许建中

    2012-01-01

    tendinopathy by observing the changes of collagen content and proportion after the Achilles tendon of rabbits is repeatedly exposed to PGE2. Methods Twenty-four Japanese rabbits (aged 3-4 months, weighing 2.0-2.5 kg, and male or female) were equally randomized into 2 groups according to injection dose of PGE2: low dose group (50 ng) and high dose group (500 ng). Corresponding PGE2 (0.2 mL) was injected into the middle segment of the Achilles tendon of hindlimb, the same dose saline into the same site of the other side as controls once a week for 4 weeks or 8 weeks. The Achilles tendons were harvested at 4 and 8 weeks after injection. HE staining was used to observe the cell structure and matrix, and picric acid-sirius red staining to observe the distribution and types of collagen fibers, and transmission electron microscopy was used to measure the density of the unit area and diameter of collagen fibers. Results HE staining showed that collagen structural damage was observed in low dose and high dose groups. Picric acid-sirius red staining showed that the content of type I collagen significantly decreased while the content of type Ⅲ collagen significantly increased in experimental side of 2 groups at 4 and 8 weeks after injection when compared with control sides (P < 0.05). The content of type I collagen was significantly lower and the content of type Ⅲ collagen and ratio of type Ⅲ to type I were significantly higher in high dose group than in low dose group (P < 0.05). Transmission electron microscopy showed that the collagen fibers density of unit area was significantly lower and the diameter was significantly smaller in high dose and low dose groups than in the controls (P < 0.05), and in high dose group than in low dose group (P < 0.05). Conclusion Repeat exposure of the Achilles tendon of rabbit to PGE2 can cause the decrease of type I collagen, the increase of type Ⅲ collagen, the reverse ratio of type I to type Ⅲ, reduced unit density of collagen fibers, and

  9. Longitudinal microvascularity in achilles tendinopathy (power doppler ultrasound, magnetic resonance imaging time-intensity curves and the Victorian Institute of Sport Assessment-Achilles questionnaire): a pilot study

    To evaluate the imaging of the natural history of Achilles tendinopathy microvascularisation in comparison with symptoms, using a validated disease-specific questionnaire [the Victorian Institute of Sport Assessment-Achilles (VISA-A)]. A longitudinal prospective pilot study of nine patients with post-contrast magnetic resonance imaging (MRI), time-intensity curve (TIC) enhancement, ultrasound (US) and power Doppler (PD) evaluation of tendinopathy of the mid-Achilles tendon undergoing conservative management (eccentric exercise) over 1 year. There were five men and four women [mean age 47 (range 30-62) years]. Six asymptomatic tendons with normal US and MRI appearance showed less enhancement than the tibial metaphysis did and showed a flat, constant, but very low rate of enhancement in the bone and Achilles tendon (9-73 arbitrary TIC units). These normal Achilles tendons on imaging showed a constant size throughout the year (mean 4.9 mm). At baseline the TIC enhancement in those with tendinopathy ranged from 90 arbitrary units to 509 arbitrary units. Over time, 11 abnormal Achilles tendons, whose symptoms settled, were associated with a reduction in MRI enhancement mirrored by a reduction in the number of vessels on power Doppler (8.0 to 2.7), with an improvement in morphology and a reduction in tendon size (mean 15-10.6 mm). One tendon did not change its abnormal imaging features, despite improving symptoms. Two patients developed contralateral symptoms and tendinopathy, and one had more abnormal vascularity on power Doppler and higher MRI TIC peaks in the asymptomatic side. In patient with conservatively managed tendinopathy of the mid-Achilles tendon over 1 year there was a reduction of MRI enhancement and number of vessels on power Doppler, followed by morphological improvements and a reduction in size. Vessels per se related to the abnormal morphology and size of the tendon rather than symptoms. Symptoms improve before the Achilles size reduces and the

  10. Longitudinal microvascularity in achilles tendinopathy (power doppler ultrasound, magnetic resonance imaging time-intensity curves and the Victorian Institute of Sport Assessment-Achilles questionnaire): a pilot study

    Richards, Paula J. [University Hospital of North Staffordshire NHS Trust (UHNS), Stoke on Trent, Staffordshire (United Kingdom); Keele University, Keele, Staffordshire (United Kingdom); North Staffs. Royal Infirmary, X-ray Department, Stoke on Trent, Staffordshire (United Kingdom); McCall, Iain W. [Keele University, Keele, Staffordshire (United Kingdom); North Staffordshire NHS Trust, Stoke on Trent, Staffordshire (United Kingdom); Day, Christopher [University Hospital of North Staffordshire NHS Trust (UHNS), Stoke on Trent, Staffordshire (United Kingdom); Belcher, John [Cardiff University, Department of Primary Care and Public Health, North Wales Clinical School, Cardiff (United Kingdom); Maffulli, Nicola [Keele University, Keele, Staffordshire (United Kingdom)

    2010-06-15

    To evaluate the imaging of the natural history of Achilles tendinopathy microvascularisation in comparison with symptoms, using a validated disease-specific questionnaire [the Victorian Institute of Sport Assessment-Achilles (VISA-A)]. A longitudinal prospective pilot study of nine patients with post-contrast magnetic resonance imaging (MRI), time-intensity curve (TIC) enhancement, ultrasound (US) and power Doppler (PD) evaluation of tendinopathy of the mid-Achilles tendon undergoing conservative management (eccentric exercise) over 1 year. There were five men and four women [mean age 47 (range 30-62) years]. Six asymptomatic tendons with normal US and MRI appearance showed less enhancement than the tibial metaphysis did and showed a flat, constant, but very low rate of enhancement in the bone and Achilles tendon (9-73 arbitrary TIC units). These normal Achilles tendons on imaging showed a constant size throughout the year (mean 4.9 mm). At baseline the TIC enhancement in those with tendinopathy ranged from 90 arbitrary units to 509 arbitrary units. Over time, 11 abnormal Achilles tendons, whose symptoms settled, were associated with a reduction in MRI enhancement mirrored by a reduction in the number of vessels on power Doppler (8.0 to 2.7), with an improvement in morphology and a reduction in tendon size (mean 15-10.6 mm). One tendon did not change its abnormal imaging features, despite improving symptoms. Two patients developed contralateral symptoms and tendinopathy, and one had more abnormal vascularity on power Doppler and higher MRI TIC peaks in the asymptomatic side. In patient with conservatively managed tendinopathy of the mid-Achilles tendon over 1 year there was a reduction of MRI enhancement and number of vessels on power Doppler, followed by morphological improvements and a reduction in size. Vessels per se related to the abnormal morphology and size of the tendon rather than symptoms. Symptoms improve before the Achilles size reduces and the

  11. Lateral force transmission between human tendon fascicles

    Haraldsson, Bjarki T; Aagaard, Per; Qvortrup, Klaus;

    2008-01-01

    Whether adjacent collagen fascicles transmit force in parallel is unknown. The purpose of the present study was to examine the magnitude of lateral force transmission between adjacent collagen fascicles from the human patellar and Achilles tendon. From each sample two adjacent strands of fascicles...... patellar and Achilles tendon fascicles, respectively. A decline in stiffness of 39% and 60% from cycle 1 to cycle 2, and of 93% and 100% from cycle 2 to cycle 3 was observed in the patellar and Achilles tendon fascicles, respectively. The present data demonstrate that lateral force transmission between...... adjacent collagen fascicles in human tendons is small or negligible, suggesting that tendon fascicles largely act as independent structures and that force transmission principally takes place within the individual fascicles....

  12. Nanostructural and nanomechanical responses of collagen fibrils in the collagenase-induced Achilles tendinitis rat model.

    Lee, Gi-Ja; Choi, Samjin; Chon, Jinmann; Yoo, Seung Don; Kim, Hee-Sang; Park, Hun-Kuk; Chung, Joo Ho

    2013-11-01

    Achilles tendons are vulnerable to acute or chronic injuries that lead to inflammation. We investigated nanostructural and nanomechanical changes in collagen fibrils from rat Achilles tendons over a period of 9 weeks after injury using atomic force microscopy (AFM). To evaluate the nanostructural changes in Achilles tendons, we measured the diameter and D-banding of collagen fibrils by AFM. And the adhesion forces, which were related to cross-linking of collagen, were calculated from the retraction process of a force-distance curve. We successfully observed the time course of changes in collagen fibrils during healing using AFM. The diameters and D-banding in healed tendons were similar to those of uninjured tendons at 9 weeks after injury, but the adhesion forces remained different from those of uninjured tendons. Our AFM results depicted the minute changes in Achilles tendon surface by natural healing quite well, even drawbacks to naturally healed tendon. Understanding changes in collagen cross-linking and structure while healing will lead to better understanding of healing mechanisms and subsequent improvements in treatment. And AFM can be applied as powerful tool to evaluate structural and property changes in collagen fibrils before and after injury and/or treatment in Achilles tendon. PMID:24245243

  13. In-vivo Strain Measurement for Surgically Repaired Achilles Tendon under Isometric Contraction Using Real-time Ultrasound Imaging%实时超声测量用于等长收缩条件下修复跟腱应变的研究

    郑永平; 陈艳玲; 吴嘉豪; 丁赛君; 李添捷; 李曾慧平

    2011-01-01

    跟腱(Achilles tendon,AT)在人体运动中承受了巨大的应力,它的力学特性,尤其是撕裂后的力学特性,引起了大量的研究兴趣.在康复治疗中,运动的类型和强度是防止修复的肌腱受到再损伤的关键.治疗师通常根据肿胀、炎症反应等临床症状来定性评估病人的康复训练适当与否.本研究采用了7.5MHz的线阵型超声探头,对等长收缩下修复跟腱的应变进行了测量.实验中6名进行了跟腱修复手术的男性受试者的年龄介于28~51岁之间,撕裂距离跟腱附着点2~7cm.手术后12.8±1.3个星期进行测量,以受试者的健康脚为对照组.研究还对三位健康男性受试者惯用脚和非惯用脚跟腱弹性特征的差异进行了测试.超声图像取自沿肌腱方向的撕裂处,采用Cybex 6000同时在体采集等长收缩条件下跟腱的超声图像以及腓肠肌-比目鱼肌产生的扭矩.定制的踝足矫形器可用于超声成像平面与肌腱位置的校准,以便由超声图像提取肌腱特定部位的应变信息.实验利用成像技术对离体猪肌腱的测量,证明了超声测量的有效性.我们发现跟腱撕裂修复位置的应变较对侧健康腿小14.8%±12.6%,两者存在显著差异(p=0.017).今后可进一步研究沿肌腱方向上应变的分布以及康复过程中分布的变化.本研究将有助于跟腱修复手术后病人训练计划的制定和优化.%Achilles tendon is subjected to great streag during human locomotion, and hence its mechanical properties are of great interests especially after rupture. During rehabilitartion, the type and intensity of exercise are important and crucial to prevent further damage to the repaired tendon. Therapists usually base on clinical symptoms such as swelling, signs of inflammation to determine whether the given exercise is appropriate or not. In this study, ultrasound imaging with a 7.5 MHz linear-array probe was used to study the strains of the repaired Achilles

  14. Radial Nerve Tendon Transfers.

    Cheah, Andre Eu-Jin; Etcheson, Jennifer; Yao, Jeffrey

    2016-08-01

    Radial nerve palsy typically occurs as a result of trauma or iatrogenic injury and leads to the loss of wrist extension, finger extension, thumb extension, and a reduction in grip strength. In the absence of nerve recovery, reconstruction of motor function involves tendon transfer surgery. The most common donor tendons include the pronator teres, wrist flexors, and finger flexors. The type of tendon transfer is classified based on the donor for the extensor digitorum communis. Good outcomes have been reported for most methods of radial nerve tendon transfers as is typical for positional tendon transfers not requiring significant power. PMID:27387076

  15. Inflammatory and Metabolic Alterations of Kager's Fat Pad in Chronic Achilles Tendinopathy

    Pingel, Jessica; Petersen, M Christine H; Fredberg, Ulrich;

    2015-01-01

    BACKGROUND: Achilles tendinopathy is a painful inflammatory condition characterized by swelling, stiffness and reduced function of the Achilles tendon. Kager's fat pad is an adipose tissue located in the area anterior to the Achilles tendon. Observations reveal a close physical interplay between...... Kager's fat pad and its surrounding structures during movement of the ankle, suggesting that Kager's fat pad may stabilize and protect the mechanical function of the ankle joint. AIM: The aim of this study was to characterize whether Achilles tendinopathy was accompanied by changes in expression of...... inflammatory markers and metabolic enzymes in Kager's fat pad. METHODS: A biopsy was taken from Kager's fat pad from 31 patients with chronic Achilles tendinopathy and from 13 healthy individuals. Gene expression was measured by reverse transcription-quantitative PCR. Focus was on genes related to inflammation...

  16. Cavus Foot Surgery

    ... of their gastrocnemius muscle, one of the main muscles in the calf. This can increase the deformity or prevent a ... with a lengthening of a part of the calf muscle or Achilles tendon. This is often performed through ...

  17. 不同频率牵拉对兔跟腱组织学表现和Ⅰ型、Ⅲ型胶原蛋白表达的影响%Effects of stretch in different frequencies on histologic appearance and expressions of typeⅠand type Ⅲ collagen protein in Achilles tendon of rabbits

    吴子英; 陈世益; 李云霞; 陈疾忤; 华英汇

    2011-01-01

    Objective To investigate the effect of stretch in different frequencies on histologic appearance and expressions of type Ⅰ and type Ⅲ collagen protein in Achilles tendons of rabbits, so as to explore the relationship between stretch frequency and tendinopathy. Methods Fourty-five male New Zealand white rabbits were randomly divided into 3 groups, one was control group without electrical stimulus and the other two groups were electrically stimulated to drag Achilles tendon in the frequencies of 0.17 and 1 Hz, repetitively. The histologic appearance was observed under light microscopic, and expressions of type Ⅰ and type Ⅲ collagen protein were measured by immunohistochemistry staining.Results After 4 weeks of stretch, the expression of type Ⅰ collagen protein decreased, while the expression of type Ⅲ collagen protein increased, but total collagen protein expression decreased. After 6 weeks of stretch,Achilles tendon tissues presented typical tendinopathy in histology in 1 Hz group, and the expression of type Ⅰ collagen protein increased, while the expression of type Ⅲ collagen protein had no change in 0.17 Hz group. Conclusions High-frequency stretch results in tendinopathy in Achilles tendon, while low-frequency stretch may play a role in its repair.%目的 观察不同频率牵拉对兔跟腱组织学表现和Ⅰ型、Ⅲ型胶原蛋白表达的影响,探讨牵拉频率与腱病之间的关系.方法 45只雄性新西兰大白兔随机分成3组,其中一组作为对照组未施加电刺激,另两组施加电刺激腓肠肌以牵拉跟腱,电刺激频率分别为0.17和1 Hz.光镜下观察兔跟腱组织学变化,免疫组化检测Ⅰ型、Ⅲ型胶原蛋白的表达情况.结果 牵拉4周后,1 Hz组Ⅰ型胶原明显减少,Ⅲ型胶原表达明显增加,但胶原总量减少.牵拉6周后,1 Hz组跟腱组织呈现出腱病病理学特征;0.17 Hz组Ⅰ型胶原蛋白表达明显增加,而Ⅲ型胶原表达无明显变化.结论 高频率牵拉可

  18. Low level laser therapy reduces inflammation in activated Achilles tendinitis

    Bjordal, Jan M.; Iversen, Vegard; Lopes-Martins, Rodrigo Alvaro B.

    2006-02-01

    Objective: Low level laser therapy (LLLT) has been forwarded as therapy for osteoarthritis and tendinopathy. Results in animal and cell studies suggest that LLLT may act through a biological mechanism of inflammatory modulation. The current study was designed to investigate if LLLT has an anti-inflammatory effect on activated tendinitis of the Achilles tendon. Methods: Seven patients with bilateral Achilles tendonitis (14 tendons) who had aggravated symptoms by pain-inducing activity immediately prior to the study. LLLT (1.8 Joules for each of three points along the Achilles tendon with 904nm infrared laser) and placebo LLLT were administered to either Achilles tendons in a random order to which patients and therapist were blinded. Inflammation was examined by 1) mini-invasive microdialysis for measuring the concentration of inflammatory marker PGE II in the peritendinous tissue, 2) ultrasound with Doppler measurement of peri- and intratendinous blood flow, 3) pressure pain algometry and 4) single hop test. Results: PGE 2- levels were significantly reduced at 75, 90 and 105 minutes after active LLLT compared both to pre-treatment levels (p=0.026) and to placebo LLLT (p=0.009). Changes in pressure pain threshold (PPT) were significantly different (P=0.012) between groups. PPT increased by a mean value of 0.19 kg/cm2 [95%CI:0.04 to 0.34] after treatment in the active LLLT group, while pressure pain threshold was reduced by -0.20 kg/cm2 [95%CI:-0.45 to 0.05] after placebo LLLT. Conclusion: LLLT can be used to reduce inflammatory musculskeletal pain as it reduces inflammation and increases pressure pain threshold levels in activity-induced pain episodes of Achilles tendinopathy.

  19. Presence of lymphatics in a rat tendon lesion model.

    Tempfer, Herbert; Kaser-Eichberger, Alexandra; Korntner, Stefanie; Lehner, Christine; Kunkel, Nadja; Traweger, Andreas; Trost, Andrea; Strohmaier, Clemens; Bogner, Barbara; Runge, Christian; Bruckner, Daniela; Krefft, Karolina; Heindl, Ludwig M; Reitsamer, Herbert A; Schrödl, Falk

    2015-04-01

    Tendons lack sufficient blood supply and represent a bradytroph tissue with prolonged healing time under pathological conditions. While the role of lymphatics in wound/defect healing in tissues with regular blood supply is well investigated, its involvement in tendon defects is not clear. We here try to identify the role of the lymphatic system in a tendon lesion model with morphological methods. A rat Achilles tendon lesion model (n = 5) was created via surgical intervention. Two weeks after surgery, animals were killed and lesioned site removed and prepared for polarization microscopy (picrosirius red) and immunohistochemistry using the lymphatic markers PROX1, VEGFR3, CCL21, LYVE-1, PDPN, and the vascular marker CD31. Additionally, DAPI was applied. Untreated tendons served as controls, confocal laser-scanning microscopy was used for documentation. At the lesion site, polarization microscopy revealed a structural reintegration while immunohistochemistry detected band-like profiles immunoreactive for PDPN, VEGFR3, CCL21, LYVE1, and CD31, surrounding DAPI-positive nuclei. PROX1-positive nuclei were detected within the lesion forming lines and opposed to each other. These PROX1-positive nuclei were surrounded by LYVE-1- or VEGFR3-positive surfaces. Few CD31-positive profiles contained PROX1-positive nuclei, while the majority of CD31-positive profiles lacked PROX1-positive nuclei. VEGFR3-, PDPN-, and LYVE-1-positive profiles were numerous within the lesion site, but absent in control tissue. Within 2 weeks, a structural rearrangement takes place in this lesion model, with dense lymphatic supply. The role of lymphatics in tendon wound healing is unclear, and proposed model represents a good possibility to study healing dynamics and lymphangiogenesis in a tissue almost completely lacking lymphatics in physiological conditions. PMID:25371325

  20. Tendinography for diagnosing injuries to tendons and ligaments

    A radiographic method of tendinography is described. In rabbits no inflammatory reaction in the Achilles tendon was observed 12 to 15 days after injection of contrast medium. Effects of examination of two healthy subjects and a patient with a traumatic condition are described. Suitable amounts and concentrations of contrast medium for examinations of Achilies tendon and cruciate ligaments are discussed. (Auth.)

  1. Tennis elbow surgery - discharge

    ... surgery - discharge; Lateral tendinosis surgery - discharge; Lateral tennis elbow surgery - discharge ... had surgery to repair a tendon in your elbow . The surgeon made a cut (incision) over the ...

  2. Photoacoustic microscopy of collagenase-induced Achilles tendinitis in a mouse model

    Wang, Po-Hsun; Chen, Wen-Shiang; Li, Meng-Lin

    2010-02-01

    Assessments of vascularity are important when assessing inflammation changes in tendon injuries since Achilles tendinitis is often accompanied with neovascularization or hypervascularity. In this study, we have investigated the feasibility of photoacoustic imaging in noninvasive monitoring of morphological and vascular changes in Achilles tendon injuries. Collagenase-induced Achilles tendinitis model of mice was adopted here. During collagenase-induced tendinitis, a 25-MHz photoacoustic microscopy (PAM) was used to image micro-vascular changes in Achilles tendons longitudinally up to 23 days. The positions of vessels imaged by PAM were identified by co-registration of PAM Bmode images with 25-MHz ultrasound (USM) ones. Morphological changes in Achilles tendons due to inflammation and edema were revealed by the PAM and USM images. Proliferation of new blood vessels within the tendons was also observed. Observed micro-vascular changes during tendinitis were similar to the findings in the literatures. This study demonstrates that photoacoustic imaging, owning required sensitivity and penetration, has the potential for high sensitive diagnosis and assessment of treatment performance in tendinopathy.

  3. Isolated tear of the plantaris tendon: ultrasound and MRI appearance

    Bianchi, Stefano [CIM, Cabinet Imagerie Medicale, Geneva (Switzerland); Sailly, Matthieu [CIM, Cabinet Imagerie Medicale, Geneva (Switzerland); Health Center, ASPIRE, Doha (Qatar); Molini, Lucio [Ospedale Galliera, Struttura complessa di Radiodiagnostica, Genova (Italy)

    2011-07-15

    We report a retrospective analysis of the ultrasound and magnetic resonance imaging appearance of five patients with isolated plantaris tendon tears. Both imaging techniques allowed detection of the tear, assessment of its severity and of its location. Compared with magnetic resonance imaging, ultrasound resulted in a less expensive and time-consuming evaluation. Isolated plantaris tendon tears can clinically mimic Achilles tendon tears or thrombophlebitis. Unlike these conditions, plantaris tear has a benign outcome and does not need surgical treatment or anticoagulation. (orig.)

  4. Ciprofloxacin-Induced Tendinopathy of the Gluteal Tendons

    Shimatsu, Kaumakaokalani; Subramaniam, Somasundaram; Sim, Helen; Aronowitz, Paul

    2014-01-01

    Fluoroquinolone-induced tendinopathy most commonly affects the Achilles tendon; however, involvement of several other tendons has been described. This is a case report of ciprofloxacin-induced tendinopathy of the gluteal tendons with MRI findings. An obese 25-year-old woman with no significant past medical history was diagnosed with acute pyelonephritis and was treated with intravenous ciprofloxacin. Shortly after her first dose of ciprofloxacin, she developed severe left hip pain and decreas...

  5. Image-Guided Intervention of the Postoperative Foot and Ankle After Ligament and Tendon Repair.

    Khanna, Monica; Walker, Miny; Amiras, Dimitri; Rosenfeld, Peter

    2016-02-01

    This review article describes the potential range of image-guided interventional procedures performed following foot and ankle ligament and/or tendon repair. Diagnosis of the cause of recurrent or persistent pain/symptoms in this postoperative group is challenging and requires a coordinated clinical and radiologic assessment. This directs appropriate treatment including image-guided intervention that may be used both as a diagnostic tool and a therapeutic option. There is a paucity of high-quality studies on the role of image-guided intervention in the foot and ankle after ligament/tendon repair. Many of the procedures used in this group are extrapolated from other areas of the body or the preoperative scenario. We review the role of imaging to identify the cause of postsurgical symptoms and to direct appropriate image-guided intervention. The available injectables and their roles are discussed. Specific surgical procedures are described including lateral ligament repair, Achilles repair, posterior tibialis tendon surgery, and peroneal tendon surgery. PMID:27077592

  6. Imaging of plantar fascia and Achilles injuries undertaken at the London 2012 Olympics

    Elias, David A.; Carne, Andrew; Bethapudi, Sarath; Engebretsen, Lars; Budgett, Richard; O'Conor, Philip

    2013-01-01

    Plantar fascia and distal Achilles injuries are common in elite athletes. Acute athletic injuries of the plantar fascia include acute plantar fasciopathy and partial or complete tears. Underlying most acute injuries is a background of underlying chronic plantar fasciopathy. Injuries may affect the central or less commonly lateral portions of the fascia and acute tears are generally proximal. Athletic Achilles injuries may occur at the mid tendon or the distal insertion, and there may be an un...

  7. Deformação relativa e frouxidão do tendão calcanear durante mobilização articular passiva através de ultra-sonografia por imagem Strain and slackness of achilles tendon during passive joint mobilization via imaging ultrasonography

    CC Peixinho

    2008-10-01

    Full Text Available CONTEXTUALIZAÇÃO: O estudo do comportamento das propriedades mecânicas do tendão in vivo pode trazer avanços na avaliação do impacto de programas de intervenção para flexibilidade e força, nas áreas clínica e desportiva. OBJETIVO: O objetivo deste trabalho foi quantificar a deformação (strain e a frouxidão (slackness relativas do tendão calcanear, durante mobilização passiva para quatro ângulos articulares do tornozelo e dois do joelho. MATERIAIS E MÉTODOS: O deslocamento da junção miotendínea foi quantificado através de imagens ultra-sonográficas capturadas durante a mobilização passiva do tornozelo, com o auxílio de um eletrogoniômetro e um eletromiógrafo, para garantir as angulações requeridas e a inatividade muscular, respectivamente. RESULTADOS: Os valores de deformação relativa encontrados variaram de 4,28±2,37 a -0,94±1,58% para o joelho estendido e de 2,38±1,63 a -2,32±2,16% para o joelho fletido. CONCLUSÕES: Os valores encontrados ratificam os da literatura, demonstrando a participação do tendão calcanear na variação do comprimento da unidade músculo-tendão, durante movimentação passiva. Estes resultados sugerem que as propriedades mecânicas dos tecidos tendinosos afetam a relação entre o comprimento das fibras e o ângulo articular, até mesmo nesse tipo de movimento.BACKGROUND: In vivo study of the mechanical behavior of tendons may bring advances in evaluating the impact of intervention programs for flexibility and strength, in clinical practice and sports. OBJECTIVE: The aim of this study was to quantify the relative strain and slackness of achilles tendons during passive mobilization, for four ankle joint angles and two knee angles. METHODS: The displacement of the muscle-tendon junction was quantified by means of ultrasound images acquired during passive ankle mobilization, with the aid of an electrogoniometer and an electromyograph to ensure the achievement of the required angles

  8. Pathological tendons maintain sufficient aligned fibrillar structure on ultrasound tissue characterization (UTC).

    Docking, S I; Cook, J

    2016-06-01

    Structural disorganization in the tendon is associated with tendinopathy, with little research investigating whether disorganization overwhelms the overall structural integrity of the tendon. This study investigated the mean cross-sectional area (CSA) of aligned fibrillar structure as detected by ultrasound tissue characterization (UTC) in the pathological and normal Achilles and patellar tendons. Ninety-one participants had their Achilles and/or patellar tendons scanned using UTC to capture a three-dimensional image of the tendon and allow a semi-quantification of the echopattern. The mean CSA of aligned fibrillar structure (echo type I + II) and disorganized structure (echo type III + IV) was calculated based on UTC algorithms. Each tendon was classified as either pathological or normal based solely on gray-scale ultrasound. The mean CSA of aligned fibrillar structure was significantly greater (P ≤ 0.001) in the pathological tendon compared with the normal tendon, despite the pathological tendon containing greater amounts of disorganized structure (P ≤ 0.001). A significant relationship was observed between the mean CSA of disorganized structure and anteroposterior diameter of the Achilles (R(2)  = 0.587) and patellar (R(2)  = 0.559) tendons. This study is the first to show that pathological tendons have sufficient levels of aligned fibrillar structure. Pathological tendons may compensate for areas of disorganization by increasing in tendon thickness. PMID:26059532

  9. The role of hind limb tendons in gibbon locomotion: springs or strings?

    Vereecke, Evie E; Channon, Anthony J

    2013-11-01

    Tendon properties have an important effect on the mechanical behaviour of muscles, with compliant tendons allowing near-isometric muscle contraction and facilitating elastic energy storage and recoil. Stiff tendons, in contrast, facilitate rapid force transfer and precise positional control. In humans, the long Achilles tendon contributes to the mechanical efficiency of running via elastic energy storage and recovery, and its presence has been linked to the evolution of habitual bipedalism. Gibbons also possess relatively long hind limb tendons; however, their role is as yet unknown. Based on their large dimensions, and inferring from the situation in humans, we hypothesize that the tendons in the gibbon hind limb will facilitate elastic energy storage and recoil during hind-limb-powered locomotion. To investigate this, we determined the material properties of the gibbon Achilles and patellar tendon in vitro and linked this with available kinematic and kinetic data to evaluate their role in leaping and bipedalism. Tensile tests were conducted on tendon samples using a material testing machine and the load-displacement data were used to calculate stiffness, Young's modulus and hysteresis. In addition, the average stress-in-life and energy absorption capacity of both tendons were estimated. We found a functional difference between the gibbon Achilles and patellar tendon, with the Achilles tendon being more suitable for elastic energy storage and release. The patellar tendon, in contrast, has a relatively high hysteresis, making it less suitable to act as elastic spring. This suggests that the gibbon Achilles tendon might fulfil a similar function as in humans, contributing to reducing the locomotor cost of bipedalism by acting as elastic spring, while the high stiffness of the patellar tendon might favour fast force transfer upon recoil and, possibly, enhance leaping performance. PMID:23868842

  10. The effect of acute exercise on collagen turnover in human tendons

    Mørch, Lina Steinrud; Pingel, Jessica; Boesen, Mikael;

    2013-01-01

    Mechanical loading of human tendon stimulates collagen synthesis, but the relationship between acute loading responses and training status of the tendon is not clear. We tested the effect of prolonged load deprivation on the acute loading-induced collagen turnover in human tendons, by applying the...... the contra-lateral leg was used habitually. Following the procedure both Achilles tendons and calf muscles were loaded with the same absolute load during a 1-h treadmill run. Tissue collagen turnover was measured by microdialysis performed post-immobilization but pre-exercise around both Achilles...

  11. Case report: can sacroiliac joint dysfunction cause chronic Achilles tendinitis?

    Voorn, R

    1998-06-01

    This case study discusses the possible relationship between chronic Achilles tendinitis and sacroiliac joint dysfunction. The patient presented is an active pole jumper, competing at both the national and international levels. He suffered from chronic Achilles tendinitis during the 1994-95 season, and conservative treatment applied locally was not successful. The athlete discarded the possibility of operative debridement of the tendon. Instead, an evaluation of the kinetic chain of the lower extremity and pelvic-lumbar area was performed, and the athlete was diagnosed with sacroiliac joint dysfunction and Achilles tendinitis. Evaluation findings, treatment program, and treatment outcome are also presented. The literature regarding sacroiliac joint mechanics and biomechanics of the foot-knee-hip and pelvic area is discussed and used to support the author's thesis that sacroiliac joint dysfunction, in this case a backward rotation of the right ilium, may have changed the kinematic chain of the lower extremity and caused a tendinitis in the Achilles tendon of the affected leg. Sacroiliac joint function and dysfunction, the reliability of sacroiliac joint mobility tests, and the validity of treatment programs are still considered controversial, and more research is needed to understand these mechanisms. PMID:9617730

  12. Platelet-rich plasma: evidence for the treatment of patellar and Achilles tendinopathy--a systematic review.

    Di Matteo, B; Filardo, G; Kon, E; Marcacci, M

    2015-04-01

    Platelet-rich plasma (PRP) has been introduced in the clinical practice to treat a growing number of different musculoskeletal pathologies. It is currently applied in the treatment of Achilles and patellar tendinopathies, which are common sport-related injuries very challenging to manage. Aim of the present paper was to review systematically the available clinical evidence concerning the application of PRP in the treatment of patellar and Achilles tendinopathy. A systematic review of the literature was performed according to the following inclusion criteria for relevant articles: (1) clinical reports of any level of evidence, (2) written in the English language, (3) with no time limitation and (4) on the use of PRP to treat conservatively Achilles and patellar tendinopathy. Twenty-two studies were included and analyzed. Two studies on patellar tendinopathy were randomized controlled trials (RCTs), whereas just one RCT was published on Achilles tendon. All the papers concerning patellar tendon reported positive outcome for PRP, which proved to be superior to other traditional approaches such as shock-wave therapy and dry needling. In the case of Achilles tendon, despite the encouraging findings reported by case series, the only RCT available showed no significant clinical difference between PRP and saline solution. The main finding of this study was the paucity of high-level literature regarding the application of PRP in the management of patellar and Achilles tendinopathy. However, the clinical data currently available, although not univocal, suggest considering PRP as a therapeutic option for recalcitrant patellar and Achilles tendinopathies. PMID:25323041

  13. p38 MAPK signaling in postnatal tendon growth and remodeling.

    Andrew J Schwartz

    Full Text Available Tendon is a dynamic tissue whose structure and function is influenced by mechanical loading, but little is known about the fundamental mechanisms that regulate tendon growth and remodeling in vivo. Data from cultured tendon fibroblasts indicated that the p38 MAPK pathway plays an important role in tendon fibroblast proliferation and collagen synthesis in vitro. To gain greater insight into the mechanisms of tendon growth, and explore the role of p38 MAPK signaling in this process, we tested the hypotheses that inducing plantaris tendon growth through the ablation of the synergist Achilles tendon would result in rapid expansion of a neotendon matrix surrounding the original tendon, and that treatment with the p38 MAPK inhibitor SB203580 would prevent this growth. Rats were treated with vehicle or SB203580, and subjected to synergist ablation by bilateral tenectomy of the Achilles tendon. Changes in histological and biochemical properties of plantaris tendons were analyzed 3, 7, or 28 days after overload, and comparisons were made to non-overloaded animals. By 28 days after overload, tendon mass had increased by 30% compared to non-overloaded samples, and cross-sectional area (CSA increased by around 50%, with most of the change occurring in the neotendon. The expansion in CSA initially occurred through the synthesis of a hyaluronic acid rich matrix that was progressively replaced with mature collagen. Pericytes were present in areas of active tendon growth, but never in the original tendon ECM. Inhibition of p38 MAPK resulted in a profound decrease in IL6 expression, and had a modest effect on the expression of other ECM and cell proliferation genes, but had a negligible impact on overall tendon growth. The combined results from this study provided novel insights into tendon mechanobiology, and suggest that p38 MAPK signaling does not appear to be necessary for tendon growth in vivo.

  14. Achilles' death: anatomical considerations regarding the most famous trauma of the Trojan War.

    Anagnostopoulou, Sophia; Mavridis, Ioannis

    2013-03-01

    In Greek mythology, Achilles was a hero of the Trojan War, the central character and greatest warrior of Homer's Iliad. As Achilles died because of a small wound on his heel, the term "Achilles' heel" has come to mean a person's principal weakness. But is the human heel a really vulnerable part of our body? Could a non-poisonous arrow have caused Achilles' death? Should an arrow be necessarily poisonous in order to cause a lethal heel would? The purpose of this effort is to explain, from an anatomic point of view, how Achilles heel wounding could have led to his death. The Achilles tendon is the strongest, largest and thickest tendon in the human body and plays an important role in the biomechanics of the lower extremity. The blood supply of the tendon is from the peroneal and posterior tibial arteries. It is quite likely that the arrow which killed Achilles was poisoned. This supposition could be of course enough to cause his death. In case the arrow was not poisoned a rupture of the posterior tibial artery by the arrow could have caused a bleeding, but it seems unlikely for such a bleeding to be lethal. Moreover, a combination of these two theories could have also taken place, i.e. a poisoned arrow traumatizing the posterior tibial artery and hence causing rapid diffusion of the poison as well as bleeding. Furthermore, infectious and/or immunologic bases regarding Achilles' death could be considered. In our opinion, a poisoned arrow was probably the crucial factor leading to the famous inglorious death of this famous glorious Homeric hero. PMID:23425764

  15. 步兵踝关节肌力和跟腱横截面积与强化训练的关系%Correlation of the muscular strength of ankle joint and the cross-sectional area of achilles tendon with forced training in infantry soldiers

    艾进伟; 黄昌林; 韩叶萍; 曹玉净; 张建福; 李沛

    2007-01-01

    , healing and remodeling mechanisms of tendonopathy is still unclear, even the pain due to chronic tendon dysfunction should be further studied.OBJECTIVE: To evaluate the effect of forced training on the muscular strength of ankle joint and the cross-sectional area (CSA) of achilles tendon of infantry soldiers, and look for effective training methods.DESIGN: One-sample contrasting study.SETTING: Fourth Military Medical University of Chinese PLA; InStitute of Military Training-related Medical Sciences, the 150 Hospital of Chinese PLA.PARTICIPANTS: The study was carried out in the Institute of Military Training-related Medical Sciences, the 150 Hospital of Chinese PLA from March to June 2004. Thirty male light infantry recruits and thirty one-year-trained male soldiers were regarded as recruit group and one-year soldier group. The enlisted age ranged from 17 to 18 years. Recruits did not have the history of special training and injury of ankle joints. All of them were able to undertake routinely physical training.METHODS: The recruits participated in routinely physical trainings, such as grenade throwing and 5 km cross-country race, and forced trainings, such as dorsiflexors and plantarflexors on ankle joint, twice a day for each training item for 8 successive weeks. The forced training included calf raise for 50 times and sit-ups for 50 times on 45° arched board.Moreover, one-year soldiers were undertaken routinely physical trainings. Eight weeks later, the isokinetic testing of ankle joint and CSA of achilles tendon were measured before and after trainings.MAIN OUTCOME MEASURES: Comparisons of CSA of achilles tendon and changes of muscular strength of ankle joint between recruits before routine training and after 8-week forced training and one-year soldiers after routine training.RESULTS: All 60 soldiers were involved in the final analysis. Partial correlation was showed between CSA and body weight (r =0.446, P=0.015), and there was no difference in CSA before and after

  16. Imaging Findings in Two Cases of Fluoroquinolone-Induced Achilles Tendinopathy

    Sterne, Gregory M.; Richardson, Michael L.; Warren, Bill H.

    2015-01-01

    Tendonitis and tendon rupture are rare but recognized complications of fluoroquinolone therapy. Most reports of this problem have appeared in the rheumatology and pharmacology literature, and this topic has received little attention in the radiologic literature. We report two cases of fluoroquinolone-induced tendinopathy and describe their magnetic resonance (MR) and sonographic findings. Although Achilles tendinopathy is generally the result of repetitive injury, it is useful to keep other c...

  17. Tendon Innervation.

    Ackermann, Paul W; Salo, Paul; Hart, David A

    2016-01-01

    The regulation of tendon metabolism including the responses to loading is far from being well understood. During the last decade, however, accumulating data show that tendon innervation in addition to afferent functions, via efferent pathways has a regulatory role in tendon homeostasis via a wide range of neuromediators, which coordinate metabolic and neuro-inflammatory pathways.Innervation of intact healthy tendons is localized in the surrounding structures, i.e paratenon, endotenon and epitenon, whereas the tendon proper is practically devoid of neuronal supply. This anatomical finding reflects that the tendon metabolism is regulated from the tendon envelope, i.e. interfascicular matrix (see Chap. 1 ).Tendon innervation after injury and during repair, however, is found as extensive nerve ingrowth into the tendon proper, followed by a time-dependent emergence of different neuronal mediators, which amplify and fine-tune inflammatory and metabolic pathways in tendon regeneration. After healing nerve fibers retract to the tendon envelope.In tendinopathy innervation has been identified to consist of excessive and protracted nerve ingrowth in the tendon proper, suggesting pro-inflammatory, nociceptive and hypertrophic (degenerative) tissue responses.In metabolic disorders such as eg. diabetes impaired tendon healing has been established to be related to dysregulation of neuronal growth factors.Targeted approaches to the peripheral nervous system including neuronal mediators and their receptors may prove to be effective therapies for painful, degenerative and traumatic tendon disorders. PMID:27535247

  18. Case Study of Oriental Medicine Treatment with acupotomy Therapy of the Achilles Tendinitis

    Jang Eun-ha

    2008-12-01

    Full Text Available Purpose : In order to estimate clinical effects of Oriental Medicine Treatment with acupotomy therapy of Achilles Tendinitis Methods : From 4th August, 2008 to 14th August, 2008, 1 female patient diagnosed as Chronic Achilles Tendinitis (clinical diagnosed was treated with general oriental medicine therapy(acupuncture, moxibustion, cupping, physical therapy, herbal medication and acupotomy. Results : The patient's chief complaints- Lt. heel pain and stiffness, dorsi-flexion limitation, nodules in the achilles tendon- were notably improved. Conclusions : This study demonstrates that oriental medical treatment with acuputomy therapy has significant effect in improving symptoms of achilles tendinitis. as though we had not wide experience in this treatment, more research is needed.

  19. Tendon Transfer Surgery

    ... Symptom Picker Hand and Arm Conditions Carpal Tunnel Ganglion Cysts Trigger Finger Arthritis Base of the Thumb See ... Symptom Picker Hand and Arm Conditions Carpal Tunnel Ganglion Cysts Trigger Finger Arthritis Base of the Thumb See ...

  20. 活体生物发光成像追踪大鼠跟腱内移植干细胞**☆○%Monitoring transplanted stem cells in rat Achilles tendon by in vivo bioluminescent imaging

    黄德清; Gary Balian

    2013-01-01

      BACKGROUND: The mechanisms for the homing, migration, proliferation and differentiation of transplanted adipose tissue derived stem cel s remain unclear. The in vivo bioluminescent imaging system is a newly developed technique for directly detecting the biological behaviors of transplanted cel s in vivo. OBJECTIVE: To demonstrate the feasibility of using in vivo bioluminescent imaging system to monitor the genetical y modified adipose tissue derived stem cel s transplanted in Achil es tendon of rats. METHODS: Adipose tissue derived stem cel s isolated from the abdominal cavity of Sprague-Dawley rat were transduced with an adenovirus containing the luciferase reporter gene (3×1010/L), to observe the influence of transfection on the adipose tissue derived stem cel s. Subsequently, the transfected cel s were implanted into Achil es tendon defects in rats. The in vivo bioluminescent imaging system was used at days 1, 4, 7 and 14 fol owing transplantation to assess the luciferase expression. The cryosections of repaired Achil es tendon of rats were observed under fluorescence microscope at day 28 postoperatively. RESULTS AND CONCLUSION: No influence on the morphology and proliferation of adipose tissue derived stem cel s was observed after transducing in vitro (P > 0.05). On the repaired Achil es tendon, the luciferase gene expression detected with in vivo bioluminescent imaging system at days 1, 4, 7 and 14 was respectively (1.22±0.43)×106, (1.81±0.76)×106, (1.88±0.69)×106 and (0.89±0.26)×105 counts/s (n=6). Abundant adipose tissue derived stem cel s with luciferase expression were also seen in tendon cryosections of this side under fluorescence microscope at day 28. The luciferase gene expression was not detected in the control side. Experimental findings demonstrate that the in vivo bioluminescent imaging system can successful y monitor the fluorogene modified adipose tissue derived stem cel s that are implanted into the rat Achil es tendon, and

  1. Monitoring transplanted stem cells in rat Achilles tendon by in vivo bioluminescent imaging%活体生物发光成像追踪大鼠跟腱内移植干细胞**☆○

    黄德清; Gary Balian

    2013-01-01

    Achil es tendon of rats. METHODS: Adipose tissue derived stem cel s isolated from the abdominal cavity of Sprague-Dawley rat were transduced with an adenovirus containing the luciferase reporter gene (3×1010/L), to observe the influence of transfection on the adipose tissue derived stem cel s. Subsequently, the transfected cel s were implanted into Achil es tendon defects in rats. The in vivo bioluminescent imaging system was used at days 1, 4, 7 and 14 fol owing transplantation to assess the luciferase expression. The cryosections of repaired Achil es tendon of rats were observed under fluorescence microscope at day 28 postoperatively. RESULTS AND CONCLUSION: No influence on the morphology and proliferation of adipose tissue derived stem cel s was observed after transducing in vitro (P > 0.05). On the repaired Achil es tendon, the luciferase gene expression detected with in vivo bioluminescent imaging system at days 1, 4, 7 and 14 was respectively (1.22±0.43)×106, (1.81±0.76)×106, (1.88±0.69)×106 and (0.89±0.26)×105 counts/s (n=6). Abundant adipose tissue derived stem cel s with luciferase expression were also seen in tendon cryosections of this side under fluorescence microscope at day 28. The luciferase gene expression was not detected in the control side. Experimental findings demonstrate that the in vivo bioluminescent imaging system can successful y monitor the fluorogene modified adipose tissue derived stem cel s that are implanted into the rat Achil es tendon, and adipose tissue derived stem cel s are a potential seed cel s in tendon tissue engineering.

  2. Reproducibility of Ultrasound and Magnetic Resonance Imaging Measurements of Tendon Size

    Brushoej, C.; Henriksen, B.M.; Albrecht-Beste, E.; Hoelmich, P.; Larsen, K.; Bachmann Nielsen, M. [Rigshospitalet, Copenhagen (Denmark). Dept. of Radiology

    2006-11-15

    Purpose: To investigate the intra- and inter-tester reproducibility of measurements of the Achilles tendon, tibialis anterior tendon, and the tibialis posterior tendon in football players using ultrasound (US) and magnetic resonance imaging (MRI). Material and Methods: Eleven asymptomatic football players were examined. Using a standardized US scanning protocol, the tendons were examined by two observers with US for thickness, width, and cross-sectional area. One observer conducted the procedure twice. The subjects also underwent an MRI examination, and the assessment of tendon size was conducted twice by two observers. Results: The best reproducibility judged by coefficient of variation (CV) and 95% confidence interval was determined for the Achilles tendon on both US and MRI. The variability of US on measurements on the tibialis anterior and tibialis posterior tendons was less than that when using MRI. In 12 out of 18 measurements, there were systematic differences between observers as judged by one-sided F-test. Conclusion: The reproducibility of the three tendons was limited. Precaution should be taken when looking for minor quantitative changes, i.e., training-induced hypertrophy, and when doing so, the Achilles tendon should be used.

  3. Reproducibility of Ultrasound and Magnetic Resonance Imaging Measurements of Tendon Size

    Purpose: To investigate the intra- and inter-tester reproducibility of measurements of the Achilles tendon, tibialis anterior tendon, and the tibialis posterior tendon in football players using ultrasound (US) and magnetic resonance imaging (MRI). Material and Methods: Eleven asymptomatic football players were examined. Using a standardized US scanning protocol, the tendons were examined by two observers with US for thickness, width, and cross-sectional area. One observer conducted the procedure twice. The subjects also underwent an MRI examination, and the assessment of tendon size was conducted twice by two observers. Results: The best reproducibility judged by coefficient of variation (CV) and 95% confidence interval was determined for the Achilles tendon on both US and MRI. The variability of US on measurements on the tibialis anterior and tibialis posterior tendons was less than that when using MRI. In 12 out of 18 measurements, there were systematic differences between observers as judged by one-sided F-test. Conclusion: The reproducibility of the three tendons was limited. Precaution should be taken when looking for minor quantitative changes, i.e., training-induced hypertrophy, and when doing so, the Achilles tendon should be used

  4. In vitro and in vivo research on using Antheraea pernyi silk fibroin as tissue engineering tendon scaffolds

    In this paper, the feasibility of using Antheraea pernyi silk fibroin as tissue engineering tendon scaffold was investigated in vitro and in vivo, respectively, utilizing tenocytes and animal model. The animal model used here was an adult New Zealand White rabbit with a 15-mm gap defect in both sides of the Achilles tendon. The Achilles tendon defects in one side of hind legs were repaired using the braided A. pernyi silk fibroin scaffold in experimental group (n = 24), while the other side left untreated as negative group (n = 24). The recovery of the defect tendons were evaluated postoperatively at the 2nd, 6th, 12th, and 16th week using macroscopic, histological, immunohistochemical, scanning electron micrograph and biomechanical test techniques. In vitro results examined by scanning electron micrograph showed that A. pernyi silk fibroin promote the adhesion and propagation of the tenocytes. In vivo, at 16 weeks after implantation, morphological results showed that neo-tendons were formed, and bundles of collagen fibers in the neo-tendons were uniform and well oriented. Immunohistochemical results showed that collagen type in the regenerated tendons was predominantly type I. The maximum load of regenerated tendon at 16 weeks reached 55.46% of the normal tendon values. Preliminary, we concluded that A. pernyi silk fibroin promoted the recovery of Achilles tendon defect of rabbit and the application of A. pernyi silk fibroin as tissue engineering tendon scaffold is feasible.

  5. The experimental study of the tissue repair of achilles tendon disease by composite Salvia miltiorrhizae acupoint-injection%穴位注射复方丹参液对大鼠跟腱病组织修复的实验研究

    马玲; 郑志新; 蒋崇博; 王军

    2011-01-01

    目的:通过观察穴位注射复方丹参注射液对跟腱病大鼠步态改善情况,探讨穴位注射治疗跟腱病跟腱组织修复的影响,为跟腱病的临床应用提供理论依据.方法:从60只2月龄雄性SD大鼠中随机选出10只,设为空白对照组(Ⅰ组),对其余大鼠行跟腱病造模后随机分为阳性对照组(生理盐水对照组,Ⅱ组),复方丹参注射液治疗组(Ⅲ组),每组各25只,造模3周后Ⅱ组每只大鼠同样取阳陵泉、承山、昆仑三穴,注射生理盐水0.1 ml,穴,1次/2 d;Ⅲ组每只大鼠同样取阳陵泉、承山、昆仑三穴,行复方丹参注射液穴位注射,0.1 ml/穴,1次/2 d;Ⅰ组大鼠不予任何干预.于治疗20 d后,处死大鼠行步态检测,分别计算步长差比值(TOFF)、足长差比值(PLF)、全趾宽比值(TSF)和中间趾宽差比值(ITF),进行统计学分析,以评价跟腱病功能恢复情况.用HE染色观察组织学结构改变,作跟腱内成纤维细胞,纤维细胞总数计数后行统计分析,以评价跟腱病组织学恢复情况.结果:步态,TOFF,Ⅰ、Ⅱ组之间差异有统计学意义(p=0.0240.05);TSF,Ⅰ、Ⅱ组之间差异有统计学意义(P=0.0150.05);ITF,Ⅰ、Ⅱ组之间差异有统计学意义(P=0.0240.05).细胞计数,Ⅲ组与Ⅰ组相比,差异有统计学意义(P=0.035<0.05);Ⅱ组与Ⅰ组比较,差异有统计学意义(P=0.007<0.01).结论:复方丹参注射液能有效改善跟腱病大鼠步态,根据多项指标统计比较并结合形态学观察,应用复方丹参注射液穴位注射能有效缩短治疗时间并取得良好疗效.%Objective: To observe the efficacy of composie Salvia milyiorrhizae acupoint-injection on achilles tendinopathy by investigating suffering rats' gaits and histological changes of their achilles tendon, and to provide information for acupoint-injection therapy of achilles tendinopathy. Methods: 10 male SD rats (2 months old) were drawn out from sixty ones as blank control group (group Ⅰ , n=10

  6. Recurrence of Diabetic Pedal Ulcerations Following Tendo-Achilles Lengthening

    Richard D. Weiner

    2011-05-01

    Full Text Available Foot and ankle surgeons are frequently challenged by the devastating systemic consequences of diabetes mellitus manifested through neuropathy, integumentary and joint breakdown, delayed healing, decreased ability to fight infection, and fragile tendon/ligaments. Diabetic neuropathic pedal ulcerations lead to amputations at an alarming rate and also carry a high mortality rate. This article will discuss causes of diabetic pedal ulcerations that persist or recur after tendo-Achilles lengthening and will highlight areas that need to be addressed by the practitioner such as infection, vascular and nutritional status, glucose control, off-loading, biomechanics, and patient compliance.

  7. 跟腱延长及胫骨肌与肌腱移植修复脑瘫致马蹄内翻足:恢复踝关节及足功能的评价%Achilles tendon extension and tibialis transfer combined with tendon transposition for cerebral palsy-induced talipes equinovarus:ankle recovery and foot function evaluation

    郭景泉; 罗毅; 高宇; 任尚立; 郑紫磊

    2015-01-01

    背景:国内对于脑瘫致痉挛性马蹄内翻足治疗的方式有多种,包括物理治疗、矫形器治疗、全身性抗痉挛药物治疗、局部肌肉注射A型肉毒毒素以及各种外科手术治疗,针对不同的患儿畸形程度及年龄段,效果各有千秋。目的:探讨跟腱“Z”型延长胫骨前后肌联合肌腱转位移植修复脑瘫致痉挛性马蹄内翻足评价其改善外观,修复踝关节及足功能的作用。方法:于2012至2014年集中收治了22例脑瘫致痉挛性马蹄内翻足的患儿,均采用跟腱“Z”型延长胫骨前后肌联合肌腱转位手术方式进行治疗,术后行石膏外固定6周后,给予康复功能锻炼。结果与结论:22例患者均获得随访,随访平均时间为1至2年,依据秦泗河对足部畸形矫正程度及患者的满意程度进行评价,均获得满意疗效。结果表明,跟腱“Z”型延长胫骨前后肌联合肌腱转位治疗痉挛性脑瘫马蹄内翻足是治疗脑瘫致痉挛性马蹄内翻足的一种较好方法,具有良好的改善外观,踝关节及足的功能恢复良好的优点。%BACKGROUND:It has a variety of treatments for equinovarus in spastic cerebral palsy, including physical therapy, orthotic therapy, systemic anti-spasticity drug therapy, local intramuscular injection of botulinum toxin type A and a variety of surgical operations. These treatments aim at different severity of deformities and different age in children patients, and each has its own merits. OBJECTIVE:To investigate the therapeutic effect of Achiles tendon “Z”-type extension, tibialis anterior and posterior transfer combined with tendon transposition to treat equinovarus in spastic cerebral palsy. METHODS: Twenty-two children with spastic cerebral palsy combined with equinovarus were colected from 2012 to 2014, and then these children were subject to Achiles tendon “Z”-type extension, tibialis anterior and posterior transfer combined with

  8. Decellularized and Engineered Tendons as Biological Substitutes: A Critical Review

    Arianna B. Lovati

    2016-01-01

    Full Text Available Tendon ruptures are a great burden in clinics. Finding a proper graft material as a substitute for tendon repair is one of the main challenges in orthopaedics, for which the requirement of a biological scaffold would be different for each clinical application. Among biological scaffolds, the use of decellularized tendon-derived matrix increasingly represents an interesting approach to treat tendon ruptures. We analyzed in vitro and in vivo studies focused on the development of efficient protocols for the decellularization and for the cell reseeding of the tendon matrix to obtain medical devices for tendon substitution. Our review considered also the proper tendon source and preclinical animal models with the aim of entering into clinical trials. The results highlight a wide panorama in terms of allogenic or xenogeneic tendon sources, specimen dimensions, physical or chemical decellularization techniques, and the cell type variety for reseeding from terminally differentiated to undifferentiated mesenchymal stem cells and their static or dynamic culture employed to generate implantable constructs tested in different animal models. We try to identify the most efficient approach to achieve an optimal biological scaffold for biomechanics and intrinsic properties, resembling the native tendon and being applicable in clinics in the near future, with particular attention to the Achilles tendon substitution.

  9. The Achilles heel of adults and children

    J.I. Wiegerinck

    2014-01-01

    This thesis focuses on the imaging and treatment of the Achilles heel of adults and children. The figurative and literal Achilles heel consists of a number of pathologies: ankle impingement, Achilles tendinopathy, retrocalcaneal bursitis and calcaneal apophysitis. Research as well as diagnosis and t

  10. 18F-fluorodeoxyglucose and PET/CT for noninvasive study of exercise-induced glucose uptake in rat skeletal muscle and tendon

    Skovgaard, Dorthe; Kjaer, Michael; El-Ali, Henrik;

    2009-01-01

    unilateral isometric contractions of the calf muscle. (18)F-Fluorodeoxyglucose was administered and a PET/CT scan of the hindlimbs was performed. SUVs were calculated in both Achilles tendons and the triceps surae muscles. To exclude a spill-over effect the tendons and muscles from an ex vivo group of eight...

  11. Increased cellular proliferation in rat skeletal muscle and tendon in response to exercise

    Skovgaard, Dorthe; Bayer, Monika L; Mackey, Abigail;

    2010-01-01

    -derived standardized uptake values were calculated for Achilles tendons and calf muscles and compared to gene expression and immunohistochemical evaluations of Ki67. RESULTS: Treadmill running induced increased uptake of FLT uptake in calf muscles (30%; p < 0.001) and in Achilles tendon (21%, p < 0.001). The image......-derived results were supported by a correlation in calf muscle to Ki67 (protein and mRNA level), while this coherence was not found in tendon. CONCLUSION: FLT-PET seems to be a promising tool for imaging of exercise-induced cellular proliferation in musculo-tendinous tissue.......PURPOSE: The purpose of this study is to investigate exercise-induced cellular proliferation in rat skeletal muscle/tendon with the use of 3'-[F-18]fluoro-3'deoxythymidine (FLT) and to quantitatively study concomitant changes in the proliferation-associated factor, Ki67. PROCEDURES: Wistar rats (n...

  12. Ultrasound-guided retro-calcaneal bursa corticosteroid injection for refractory Achilles tendinitis in patients with seronegative spondyloarthropathy: efficacy and follow-up study.

    Srivastava, Puja; Aggarwal, Amita

    2016-06-01

    Ultrasound (US)-guided corticosteroid injection has been shown to be safe and effective for varied causes of plantar fasciitis; however, its use for Achilles tendinitis is controversial. We studied the efficacy and changes in US findings at Achilles enthesitis after corticosteroid injection in patients with spondyloarthropathy (SpA). Patients with SpA with symptomatic Achilles enthesitis, refractory to 6 weeks of full-dose NSAIDs, were offered US-guided local corticosteroid injection. Injected entheses were examined by US (both B mode and power Doppler) at baseline and 6 weeks after injection. Standard OMERACT definitions were used to define enthesitis. Achilles tendon thickness >5.29 mm, 2 cm proximal to insertion in long axis, was considered thickened. Twenty-seven symptomatic Achilles tendons (in 18 patients) were injected with 20 mg methylprednisolone under US guidance baseline, and 6-week follow-up US features were compared. All patients reported improvement in pain (VAS) in the affected tendon after injection (p < 0.0001). Simultaneously, improvement in local inflammatory changes were noted, in the form of significant reduction in tendon thickness (p < 0.0001), vascularity (p < 0.0001), peritendinous oedema (p = 0.001), bursitis and bursal vascularity (p < 0.001 and < 0.0001, respectively). There was no change in bone erosions and enthesophyte. None of the patients had tendon rupture or other injection-related complications at 6 weeks of follow-up. US-guided local corticosteroid injection is an effective and safe modality for refractory Achilles enthesitis in patients with SpA and leads to reversion of acute changes at entheseal site. PMID:26894910

  13. Tendon lesion and platelet-rich plasma (PRP) injection

    Kaux, Jean-François; Drion, Pierre; Renouf, Julien; Pascon, Frédéric; Libertiaux, Vincent; Colige, Alain; Le Goff, Caroline; Lambert, Charles; Nusgens, Betty; Gothot, André; CESCOTTO, Serge; Defraigne, Jean-Olivier; Rickert, Markus; Crielaard, Jean-Michel

    2010-01-01

    Introduction: For a few years, the positive effects of platelets on the healing process of different tissues (skin, bones...) were demonstrated. In fact platelets contain lots of growth factors which can be release locally and enhance the healing process. Thus the aim of our experiment was to ascertain by an original mechanical measure whether the use of PRP was of interest for accelerating the healing process of rats’ Achilles tendons after surgical induced lesion. Methods: A 5mm defect w...

  14. Arthroscopic treatment of chronic painful Achilles tendinopathy%关节镜治疗慢性疼痛性跟腱炎初步临床效果报告

    杨渝平; Hajo Thermann; 敖英芳

    2011-01-01

    Objective To decrease the postoperative complication rate of traditional open surgical treatment of chronic painful Achilles tendinopathy, we created and applied a kind of special arthroscopic technique in curing a series of patients diagnosed with it. Methods 8 consecutive patients (7 men and 1 woman, mean age 52 years) were included in this study and treated by arthroscopic debridement of the ventral neovascularized area, the peritendineum and the Achilles tendon. The visual analogue scale was used to assess the severity of Achilles tendon pain during tendon loading activity pre and postoperatively. Results All the patients were followed-up at 6 months after the surgeries. Every one of them felt immediate postoperative pain relief. And there were no postoperative complications. The median visual analogue score ( VAS) increased from 40 (10-60) (preoperatively) to 97. 5 (85-100) (follow-up at the sixth month ). In terms of Achilles tendon function, the median VAS are 22.5 (0-30) and 90 (80-95) respectively. Conclusion Treatment with arthroscopic technique of chronic painful Achilles tendinopathy can obviously reduce the incidence rate of postoperative complication. The short-term clinical results were satisfactory.%目的 探讨关节镜微创治疗慢性疼痛性跟腱炎的临床效果以及其在降低手术并发症发生率方面的作用.方法 8例(男7例,女1例,平均年龄52岁)经过常规保守治疗无效的慢性疼痛性跟腱炎患者,在德国海德堡ATOS医院接受关节镜下的清理手术.主要清理内容包括跟腱腹侧的神经血管区、腱围以及跟腱本身三个病变部分.术后6个月时进行随访,应用VAS主观疼痛评分表分别对术前和术后随访时患者的跟腱区疼痛程度进行评分.结果 所有患者在手术结束、麻醉作用消退后即感觉疼痛较术前有明显的缓解,而且未发生任何手术并发症.跟腱疼痛的VAS评分的均值从术前的40(10~60)分升至97.5(85~100)分.跟

  15. Human multipotent mesenchymal stem cells improve healing after collagenase tendon injury in the rat

    Machová-Urdzíková, Lucia; Sedláček, R.; Suchý, T.; Amemori, Takashi; Růžička, Jiří; Lesný, P.; Havlas, V.; Syková, Eva; Jendelová, Pavla

    2014-01-01

    Roč. 13, č. 42 (2014). ISSN 1475-925X R&D Projects: GA ČR GAP304/10/0326; GA MŠk(CZ) ED1.1.00/02.0109 Institutional support: RVO:68378041 Keywords : Achilles tendon * mesenchymal stromal cells * osteogenesis Subject RIV: FI - Traumatology, Orthopedics Impact factor: 1.427, year: 2014

  16. Effects of celecoxib on proliferation and tenocytic differentiation of tendon-derived stem cells

    Zhang, Kairui; Zhang, Sheng [Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou 510515 (China); Li, Qianqian [Cancer Research Institute, Southern Medical University, Guangzhou 510515 (China); Yang, Jun [Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou 510515 (China); Department of Orthopaedics, 421 Hospital of PLA, Guangzhou 510318 (China); Dong, Weiqiang [Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou 510515 (China); Department of Orthopaedics, The First Affiliated Hospital to Guangzhou Medical University, Guangzhou 510120 (China); Wang, Shengnan; Cheng, Yirong; Al-Qwbani, Mohammed [Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou 510515 (China); Wang, Qiang, E-mail: 1780468505@qq.com [Department of Orthopaedics, Subei People’s Hospital of Jiangsu Province (Clinical Medical College of Yangzhou University), Yangzhou, Jiangsu Province 225001 (China); Yu, Bin, E-mail: carryzhang1985@live.com [Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou 510515 (China)

    2014-07-18

    Highlights: • Celecoxib has no effects on TDSCs cell proliferation in various concentrations. • Celecoxib reduced mRNAs levels of tendon associated transcription factor. • Celecoxib reduced mRNAs levels of main tendon associated collagen. • Celecoxib reduced mRNAs levels of tendon associated molecules. - Abstract: NSAIDs are often ingested to reduce the pain and improve regeneration of tendon after tendon injury. Although the effects of NSAIDs in tendon healing have been reported, the data and conclusions are not consistent. Recently, tendon-derived stem cells (TDSCs) have been isolated from tendon tissues and has been suggested involved in tendon repair. Our study aims to determine the effects of COX-2 inhibitor (celecoxib) on the proliferation and tenocytic differentiation of TDSCs. TDSCs were isolated from mice Achilles tendon and exposed to celecoxib. Cell proliferation rate was investigated at various concentrations (0.1, 1, 10 and 100 μg/ml) of celecoxib by using hemocytometer. The mRNA expression of tendon associated transcription factors, tendon associated collagens and tendon associated molecules were determined by reverse transcription-polymerase chain reaction. The protein expression of Collagen I, Collagen III, Scleraxis and Tenomodulin were determined by Western blotting. The results showed that celecoxib has no effects on TDSCs cell proliferation in various concentrations (p > 0.05). The levels of most tendon associated transcription factors, tendon associated collagens and tendon associated molecules genes expression were significantly decreased in celecoxib (10 μg/ml) treated group (p < 0.05). Collagen I, Collagen III, Scleraxis and Tenomodulin protein expression were also significantly decreased in celecoxib (10 μg/ml) treated group (p < 0.05). In conclusion, celecoxib inhibits tenocytic differentiation of tendon-derived stem cells but has no effects on cell proliferation.

  17. Effects of celecoxib on proliferation and tenocytic differentiation of tendon-derived stem cells

    Highlights: • Celecoxib has no effects on TDSCs cell proliferation in various concentrations. • Celecoxib reduced mRNAs levels of tendon associated transcription factor. • Celecoxib reduced mRNAs levels of main tendon associated collagen. • Celecoxib reduced mRNAs levels of tendon associated molecules. - Abstract: NSAIDs are often ingested to reduce the pain and improve regeneration of tendon after tendon injury. Although the effects of NSAIDs in tendon healing have been reported, the data and conclusions are not consistent. Recently, tendon-derived stem cells (TDSCs) have been isolated from tendon tissues and has been suggested involved in tendon repair. Our study aims to determine the effects of COX-2 inhibitor (celecoxib) on the proliferation and tenocytic differentiation of TDSCs. TDSCs were isolated from mice Achilles tendon and exposed to celecoxib. Cell proliferation rate was investigated at various concentrations (0.1, 1, 10 and 100 μg/ml) of celecoxib by using hemocytometer. The mRNA expression of tendon associated transcription factors, tendon associated collagens and tendon associated molecules were determined by reverse transcription-polymerase chain reaction. The protein expression of Collagen I, Collagen III, Scleraxis and Tenomodulin were determined by Western blotting. The results showed that celecoxib has no effects on TDSCs cell proliferation in various concentrations (p > 0.05). The levels of most tendon associated transcription factors, tendon associated collagens and tendon associated molecules genes expression were significantly decreased in celecoxib (10 μg/ml) treated group (p < 0.05). Collagen I, Collagen III, Scleraxis and Tenomodulin protein expression were also significantly decreased in celecoxib (10 μg/ml) treated group (p < 0.05). In conclusion, celecoxib inhibits tenocytic differentiation of tendon-derived stem cells but has no effects on cell proliferation

  18. Is there a role for ultrasound and electrical stimulation following injury to tendon and nerve?

    Michlovitz, Susan L

    2005-01-01

    Ultrasound (US) and electrical stimulation have been widely used in hand therapy to promote recovery after nerve and tendon injuries. There is support for the use of low-dosage continuous wave and pulsed US for carpal tunnel syndrome and tendonitis. Iontophoresis with dexamethasone sodium phosphate can relieve pain in acute elbow tendonitis, but there is no support for phonophoresis for any tendonitis. Animal model research supports the use of low-dosage US to improve the mechanical properties of the Achilles tendon when initiated immediately after tenorrhaphy. There are no studies available which have examined US applied to tendons in humans after repair. Electrical stimulation has been extensively studied in animal models after nerve axonotmesis and neurotmesis with nerve repair, with some support of enhancing recovery. There is a void in the literature on the use of electrical stimulation for humans after nerve transection and repair. PMID:15891986

  19. Principles of tendon transfers.

    Coulet, B

    2016-04-01

    Tendon transfers are carried out to restore functional deficits by rerouting the remaining intact muscles. Transfers are highly attractive in the context of hand surgery because of the possibility of restoring the patient's ability to grip. In palsy cases, tendon transfers are only used when a neurological procedure is contraindicated or has failed. The strategy used to restore function follows a common set of principles, no matter the nature of the deficit. The first step is to clearly distinguish between deficient muscles and muscles that could be transferred. Next, the type of palsy will dictate the scope of the program and the complexity of the gripping movements that can be restored. Based on this reasoning, a surgical strategy that matches the means (transferable muscles) with the objectives (functions to restore) will be established and clearly explained to the patient. Every paralyzed hand can be described using three parameters. 1) Deficient segments: wrist, thumb and long fingers; 2) mechanical performance of muscles groups being revived: high energy-wrist extension and finger flexion that require strong transfers with long excursion; low energy-wrist flexion and finger extension movements that are less demanding mechanically, because they can be accomplished through gravity alone in some cases; 3) condition of the two primary motors in the hand: extrinsics (flexors and extensors) and intrinsics (facilitator). No matter the type of palsy, the transfer surgery follows the same technical principles: exposure, release, fixation, tensioning and rehabilitation. By performing an in-depth analysis of each case and by following strict technical principles, tendon transfer surgery leads to reproducible results; this allows the surgeon to establish clear objectives for the patient preoperatively. PMID:27117119

  20. Nutritional research may be useful in treating tendon injuries.

    Curtis, Luke

    2016-06-01

    Tendon injures cause a great deal of disability and pain, and increase medical costs. However, relatively little is known about tendon biology and healing. Many tendon-related surgical procedures are not very successful and leave the patient with essentially a chronic injury. New therapeutic approaches for tendon injury are needed. Preliminary evidence suggests that various nutrients such as proteins, amino acids (leucine, arginine, glutamine), vitamins C and D, manganese, copper, zinc, and phytochemicals may be useful in improving tendon growth and healing. More research on nutrition and tendon health is needed. Because many nutrients are required for tendon health, nutritional interventions involving multiple nutrients may be more effective than single-nutrient strategies. In the future, ideal treatment regimens for tendon injuries may include a multifaceted "bundle" of nutrition, drugs, biologic products, extracellular matrix therapies, exercise/physical therapy, and possibly surgery. PMID:26921066

  1. Laser Therapy in the Treatment of Achilles Tendinopathy: A Randomised Controlled Trial

    Tumilty, Steve; Munn, Joanne; Haxby Abbott, J.; Mcdonough, Suzanne; Hurley, Deirdre A.; Basford, Jeffrey R.; David Baxter, G.

    2010-05-01

    Background: Low Level Laser Therapy (LLLT) has emerged as a possible treatment modality for tendinopathies. Human studies have investigated LLLT for Achilles Tendinopathy and the effectiveness remains contentious. Purpose: To assess the clinical effectiveness of Low-Level Laser Therapy (LLLT) in the management of Achilles Tendinopathy. Method: Forty patients were randomised into an active laser or placebo group; all patients, therapists and investigator were blinded to allocation. All patients were given an eccentric exercise program and irradiated 3 times per week for 4 weeks with either an active or placebo laser at 6 standardized points over the affected tendons. Irradiation parameters in the active laser group were: 810 nm, 100 mW, applied to 6 points on the tendon for 30 seconds giving a dose of 3 J per point and 18 J per session; power density 100 mW/cm2. Outcome measures were the VISA-A questionnaire and a visual analogue scale of pain. Patients were measured before treatment, at 4 and 12 weeks. ANCOVA was used to analyze data, using the effects of baseline measurements as a covariate. Results: Within groups, there were significant improvements (p0.05). Conclusion: This use of the above parameters demonstrated no added benefit of LLLT over that of eccentric exercise in the treatment of Achilles Tendinopathy.

  2. Radiofrequency preserves histoarchitecture and enhances collagen synthesis in experimental tendon injury.

    Akamatsu, Flavia Emi; Saleh, Samir Omar; Hojaij, Flávio; Martinez, Carlos Augusto Real; Andrade, Mauro; Teodoro, Walcy Rosolia; Jacomo, Alfredo Luiz

    2016-05-01

    We investigated the action of radiofrequency (RF) on the healing process after inducing experimental lesions of the Achilles tendon in rats. Wistar rats were surgically subjected to bilateral partial transverse sectioning of the Achilles tendon. The right tendon was treated with radiofrequency (RFT), whereas the left tendon served as a control (CT). On the third postoperative day, the rats were divided into three experimental groups consisting of ten rats each, which were treated with monopolar radiofrequency (Tonederm™) until they were sacrificed on the 7th, 14th or 28th days. The histological specimens were studied for inflammatory cell content, collagen types I and III, immunostaining and morphometry. Total collagen were biochemically analyzed and to evalute fibroblast and myofibroblast proliferation by vimentin and α-actin smooth muscle immunohistochemistry methods. Statistical analysis was performed using the Student's t-test, the sign test and the Kruskal-Wallis test to compare tendons treated with radiofrequency with the non-treated tendons (α=5%; α=10%). Larger amounts of collagen I with hydroxyproline content and myofibroblast cells were clearly evident within 7 days (p<0.05). No difference was observed in the inflammatory cell content between the groups. We found better collagen arrangement with RF administration across the entire time studied. Radiofrequency administration preserves histoarchitecture and enhances collagen synthesis during the initial phases of cicatrization, suggesting that the treatment can provide improved stiffness during the most vulnerable phases of tendon healing. Clinical studies may include RF among the therapeutic tools in tendinous lesion management. PMID:26337455

  3. Tendon, tendon healing, hyperlipidemia and statins

    Esenkaya, Irfan; Unay, Koray

    2011-01-01

    Summary Both hyperlipidemia and metabolic syndrome have adverse effect on tendon structure. Atorvastatin is most widely used antihyperlipidemic drug. Statins have adverse effects on the tendon. Many studies have analyzed the relationship between atorvastatin and skeletal muscles. Atorvastatin administered after the surgical repair of a ruptured tendon appears to affect revascularization, collagenization, inflammatory cell infiltration, and collagen construction. Therefore, further investigations on the effects of atorvastatin on tendon healing are needed. PMID:23738266

  4. Using your shoulder after surgery

    Shoulder surgery - using your shoulder; Shoulder surgery - after ... You had surgery on your shoulder to repair a muscle, tendon, or cartilage tear. The surgeon may have removed damaged tissue. You will need to know how ...

  5. Tendon, tendon healing, hyperlipidemia and statins

    Esenkaya, Irfan; Unay, Koray

    2012-01-01

    Both hyperlipidemia and metabolic syndrome have adverse effect on tendon structure. Atorvastatin is most widely used antihyperlipidemic drug. Statins have adverse effects on the tendon. Many studies have analyzed the relationship between atorvastatin and skeletal muscles. Atorvastatin administered after the surgical repair of a ruptured tendon appears to affect revascularization, collagenization, inflammatory cell infiltration, and collagen construction. Therefore, further investigations on t...

  6. Ultrasonography as a prognostic and objective parameter in Achilles tendinopathy: A prospective observational study

    Bakkegaard, Mads, E-mail: mbakkegaard@hotmail.com [Department of Rheumatology, Holbæk Hospital, Smedelundsgade 60, 4300 Holbæk (Denmark); Johannsen, Finn E., E-mail: f.e.johannsen@dadlnet.dk [Private Department of Rheumatology, Furesø-reumatologerne, Farum and ISMC, Institute of Sports Medicine Copenhagen, Bispebjerg Hospital, Bispebjerg Bakke 23, 2. Tværvej, Indgang 8, 1. sal, 2400 København NV (Denmark); Højgaard, Betina, E-mail: beho@kora.dk [Danish Institute for Local and Regional Government Research, Købmagergade 22, 1150 København K (Denmark); Langberg, Henning, E-mail: henninglangberg@gmail.com [Institute of Social Medicine, Department of Public Health and Centre for Healthy Ageing, Faculty of Heath Sciences, University of Copenhagen, Øster Farimagsgade 5, bygn. 24, postboks 2099, 1014 København (Denmark)

    2015-03-15

    Objectives: To study prospectively whether structural changes determined by ultrasound scanning (US) can be used as prognostic markers for outcome in patients with symptomatic Achilles tendinopathy (AT) and to investigate whether there exists an association between US findings and pain measured by visual analog scale (VAS) and a general assessment score (GA). Methods: 92 consecutive patients with AT symptoms were recruited from two outpatient clinics in rheumatology. The patients underwent a conservative treatment protocol consisting of reduced activities, controlled rehabilitation including eccentric exercises of the calf muscles and if needed supplemented with corticosteroid injections. The patients were examined clinically and by US (tendon thickness, hyper- and hypoechogenicity, calcification, bursitis, calcaneusspure, tenosynovitis, gray scale and color Doppler focusing on increased flow intra- or peritendinous). The clinical and US examination were performed at entry, 1, 2, 3 and at 6 month. Results: 42 women and 50 men were included (mean age of 47 years). They had symptoms for more than 13 months and a symptomatic Achilles tendon mean thickness of 7.4 ± 2.3 mm. Heterogeneity at the initial examination was found to be a prognostic marker for the clinical outcome. Tendon thickness, hypoechogenicity and increased flow at any time point were significantly correlated to pain at function, palpatory pain and morning pain at the same time points. A reduction in tendon thickness was statistically associated with a decrease in palpatory pain. Conclusion: Heterogeneity is a prognostic marker in AT. Tendon thickness, hypoechogenicity and increased Doppler activity can be used as objective outcome parameters for the treatment effect of AT.

  7. Ultrasonography as a prognostic and objective parameter in Achilles tendinopathy: A prospective observational study

    Objectives: To study prospectively whether structural changes determined by ultrasound scanning (US) can be used as prognostic markers for outcome in patients with symptomatic Achilles tendinopathy (AT) and to investigate whether there exists an association between US findings and pain measured by visual analog scale (VAS) and a general assessment score (GA). Methods: 92 consecutive patients with AT symptoms were recruited from two outpatient clinics in rheumatology. The patients underwent a conservative treatment protocol consisting of reduced activities, controlled rehabilitation including eccentric exercises of the calf muscles and if needed supplemented with corticosteroid injections. The patients were examined clinically and by US (tendon thickness, hyper- and hypoechogenicity, calcification, bursitis, calcaneusspure, tenosynovitis, gray scale and color Doppler focusing on increased flow intra- or peritendinous). The clinical and US examination were performed at entry, 1, 2, 3 and at 6 month. Results: 42 women and 50 men were included (mean age of 47 years). They had symptoms for more than 13 months and a symptomatic Achilles tendon mean thickness of 7.4 ± 2.3 mm. Heterogeneity at the initial examination was found to be a prognostic marker for the clinical outcome. Tendon thickness, hypoechogenicity and increased flow at any time point were significantly correlated to pain at function, palpatory pain and morning pain at the same time points. A reduction in tendon thickness was statistically associated with a decrease in palpatory pain. Conclusion: Heterogeneity is a prognostic marker in AT. Tendon thickness, hypoechogenicity and increased Doppler activity can be used as objective outcome parameters for the treatment effect of AT

  8. Iliopsoas Tendon Reformation after Psoas Tendon Release

    K. Garala

    2013-01-01

    Full Text Available Internal snapping hip syndrome, or psoas tendonitis, is a recognised cause of nonarthritic hip pain. The majority of patients are treated conservatively; however, occasionally patients require surgical intervention. The two surgical options for iliopsoas tendinopathy are step lengthening of the iliopsoas tendon or releasing the tendon at the lesser trochanter. Although unusual, refractory snapping usually occurs soon after tenotomy. We report a case of a 47-year-old active female with internal snapping and pain following an open psoas tenotomy. Postoperatively she was symptom free for 13 years. An MRI arthrogram revealed reformation of a pseudo iliopsoas tendon reinserting into the lesser trochanter. The pain and snapping resolved after repeat iliopsoas tendon release. Reformation of tendons is an uncommon sequela of tenotomies. However the lack of long-term studies makes it difficult to calculate prevalence rates. Tendon reformation should be included in the differential diagnosis of failed tenotomy procedures after a period of symptom relief.

  9. Characterization of differential properties of rabbit tendon stem cells and tenocytes

    Wang James

    2010-01-01

    Full Text Available Abstract Background Tendons are traditionally thought to consist of tenocytes only, the resident cells of tendons; however, a recent study has demonstrated that human and mouse tendons also contain stem cells, referred to as tendon stem/progenitor cells (TSCs. However, the differential properties of TSCs and tenocytes remain largely undefined. This study aims to characterize the properties of these tendon cells derived from rabbits. Methods TSCs and tenocytes were isolated from patellar and Achilles tendons of rabbits. The differentiation potential and cell marker expression of the two types of cells were examined using histochemical, immunohistochemical, and qRT-PCR analysis as well as in vivo implantation. In addition, morphology, colony formation, and proliferation of TSCs and tenocytes were also compared. Results It was found that TSCs were able to differentiate into adipocytes, chondrocytes, and osteocytes in vitro, and form tendon-like, cartilage-like, and bone-like tissues in vivo. In contrast, tenocytes had little such differentiation potential. Moreover, TSCs expressed the stem cell markers Oct-4, SSEA-4, and nucleostemin, whereas tenocytes expressed none of these markers. Morphologically, TSCs possessed smaller cell bodies and larger nuclei than ordinary tenocytes and had cobblestone-like morphology in confluent culture whereas tenocytes were highly elongated. TSCs also proliferated more quickly than tenocytes in culture. Additionally, TSCs from patellar tendons formed more numerous and larger colonies and proliferated more rapidly than TSCs from Achilles tendons. Conclusions TSCs exhibit distinct properties compared to tenocytes, including differences in cell marker expression, proliferative and differentiation potential, and cell morphology in culture. Future research should investigate the mechanobiology of TSCs and explore the possibility of using TSCs to more effectively repair or regenerate injured tendons.

  10. Transfer of either index finger extensor tendon to the extensor pollicis longus tendon

    Meads, Bryce M; Bogoch, Earl R

    2004-01-01

    BACKGROUND: Extensor pollicis longus (EPL) tendon ruptures have been treated succesfully with the transfer of the extensor indicis proprius (EIP) tendon. Situations exist in which, due to intraoperative observations, another tendon transfer may be considered preferable to the standard EIP transfer method. OBJECTIVES: To determine whether transfer of the extensor digitorum communis II (EDC II) tendon from the index finger to the EPL tendon, leaving the EIP tendon to the index finger intact, would serve as an equally efficient transfer and not adversely affect the function of the hand. METHODS: Two patients who had the EDC II tendon transferred to the ruptured EPL tendon, and two patients who had the EIP tendon transferred, were retrospectively reviewed. In each transfer type, one patient had suffered an EPL tendon rupture after a Colles’ fracture, and the other had rheumatoid arthritis. The rupture occurred on the non-dominant side in one patient in each transfer type. Each patient was examined and subjected to range of motion and power testing at least one year following surgery. RESULTS: All four patients showed a minimal extension lag with the lift off test, but there was no noticeable difference in range of motion, pinch grip and hand grip strength between the transfer types. Both EDC II transfer patients demonstrated an 8° to 15° loss of thumb interphalangeal joint flexion compared with the unoperated side; EIP transfer patients demonstrated less than a 5° loss. Three patients demonstrated a minor extension lag in the index finger and middle finger. Extension power of the thumb and index finger in all patients varied with wrist flexion and extension and ranged from 50% to 150% of the unoperated side. CONCLUSIONS: These case reports suggest that either index finger tendon may be successfully transferred in EPL tendon ruptures. PMID:24115870

  11. An algorithm for automated analysis of ultrasound images to measure tendon excursion in vivo.

    Lee, Sabrina S M; Lewis, Gregory S; Piazza, Stephen J

    2008-02-01

    The accuracy of an algorithm for the automated tracking of tendon excursion from ultrasound images was tested in three experiments. Because the automated method could not be tested against direct measurements of tendon excursion in vivo, an indirect validation procedure was employed. In one experiment, a wire "phantom" was moved a known distance across the ultrasound probe and the automated tracking results were compared with the known distance. The excursion of the musculotendinous junction of the gastrocnemius during frontal and sagittal plane movement of the ankle was assessed in a single cadaver specimen both by manual tracking and with a cable extensometer sutured to the gastrocnemius muscle. A third experiment involved estimation of Achilles tendon excursion in vivo with both manual and automated tracking. Root mean squared (RMS) error was calculated between pairs of measurements after each test. Mean RMS errors of less than 1 mm were observed for the phantom experiments. For the in vitro experiment, mean RMS errors of 8-9% of the total tendon excursion were observed. Mean RMS errors of 6-8% of the total tendon excursion were found in vivo. The results indicate that the proposed algorithm accurately tracks Achilles tendon excursion, but further testing is necessary to determine its general applicability. PMID:18309186

  12. IMPROVEMENT OF TENDON REPAIR USING MUSCLE GRAFTS TRANSDUCED WITH TGF-β1 cDNA

    Majewski, Martin; Porter, Ryan M.; Betz, Oliver B.; Betz, Volker M.; Clahsen, Harald; Flückiger, Rudolf; Evans, Christopher H.

    2015-01-01

    Tendon rupture is a common injury. Inadequate endogenous repair often leaves patients symptomatic, with tendons susceptible to re-rupture. Administration of certain growth factors improves tendon healing in animal models, but their delivery remains a challenge. Here we evaluated the delivery of TGF-β1 to tendon defects by the implantation of genetically modified muscle grafts. Rat muscle biopsies were transduced with recombinant adenovirus encoding TGF-β1 and grafted onto surgically transected Achilles tendons in recipient animals. Tissue regenerates were compared to those of controls by biomechanical testing as well as histochemical and immunohistochemical analyses. Healing was greatly accelerated when genetically modified grafts were implanted into tendon defects, with the resulting repair tissue gaining nearly normal histological appearance as early as 2 weeks postoperatively. This was associated with decreased deposition of type III collagen in favour of large fibre bundles indicative of type I collagen. These differences in tendon composition coincided with accelerated restoration of mechanical strength. Tendon thickness increased in gene-treated animals at weeks 1 and 2, but by week 8 became significantly lower than that of controls suggesting accelerated remodelling. Thus localised TGF-β1 delivery via adenovirus-modified muscle grafts improved tendon healing in this rat model and holds promise for clinical application. PMID:22354460

  13. Pentadecapeptide BPC 157 Enhances the Growth Hormone Receptor Expression in Tendon Fibroblasts

    Chung-Hsun Chang

    2014-11-01

    Full Text Available BPC 157, a pentadecapeptide derived from human gastric juice, has been demonstrated to promote the healing of different tissues, including skin, muscle, bone, ligament and tendon in many animal studies. However, the underlying mechanism has not been fully clarified. The present study aimed to explore the effect of BPC 157 on tendon fibroblasts isolated from Achilles tendon of male Sprague-Dawley rat. From the result of cDNA microarray analysis, growth hormone receptor was revealed as one of the most abundantly up-regulated genes in tendon fibroblasts by BPC 157. BPC 157 dose- and time-dependently increased the expression of growth hormone receptor in tendon fibroblasts at both the mRNA and protein levels as measured by RT/real-time PCR and Western blot, respectively. The addition of growth hormone to BPC 157-treated tendon fibroblasts dose- and time-dependently increased the cell proliferation as determined by MTT assay and PCNA expression by RT/real-time PCR. Janus kinase 2, the downstream signal pathway of growth hormone receptor, was activated time-dependently by stimulating the BPC 157-treated tendon fibroblasts with growth hormone. In conclusion, the BPC 157-induced increase of growth hormone receptor in tendon fibroblasts may potentiate the proliferation-promoting effect of growth hormone and contribute to the healing of tendon.

  14. Improvement of tendon repair using muscle grafts transduced with TGF-β1 cDNA

    M Majewski

    2012-02-01

    Full Text Available Tendon rupture is a common injury. Inadequate endogenous repair often leaves patients symptomatic, with tendons susceptible to re-rupture. Administration of certain growth factors improves tendon healing in animal models, but their delivery remains a challenge. Here we evaluated the delivery of TGF-β1 to tendon defects by the implantation of genetically modified muscle grafts. Rat muscle biopsies were transduced with recombinant adenovirus encoding TGF-β1 and grafted onto surgically transected Achilles tendons in recipient animals. Tissue regenerates were compared to those of controls by biomechanical testing as well as histochemical and immunohistochemical analyses. Healing was greatly accelerated when genetically modified grafts were implanted into tendon defects, with the resulting repair tissue gaining nearly normal histological appearance as early as 2 weeks postoperatively. This was associated with decreased deposition of type III collagen in favour of large fibre bundles indicative of type I collagen. These differences in tendon composition coincided with accelerated restoration of mechanical strength. Tendon thickness increased in gene-treated animals at weeks 1 and 2, but by week 8 became significantly lower than that of controls suggesting accelerated remodelling. Thus localised TGF-β1 delivery via adenovirus-modified muscle grafts improved tendon healing in this rat model and holds promise for clinical application.

  15. Proteomic analysis reveals age-related changes in tendon matrix composition, with age- and injury-specific matrix fragmentation.

    Peffers, Mandy J; Thorpe, Chavaunne T; Collins, John A; Eong, Robin; Wei, Timothy K J; Screen, Hazel R C; Clegg, Peter D

    2014-09-12

    Energy storing tendons, such as the human Achilles and equine superficial digital flexor tendon (SDFT), are highly prone to injury, the incidence of which increases with aging. The cellular and molecular mechanisms that result in increased injury in aged tendons are not well established but are thought to result in altered matrix turnover. However, little attempt has been made to fully characterize the tendon proteome nor determine how the abundance of specific tendon proteins changes with aging and/or injury. The aim of this study was, therefore, to assess the protein profile of normal SDFTs from young and old horses using label-free relative quantification to identify differentially abundant proteins and peptide fragments between age groups. The protein profile of injured SDFTs from young and old horses was also assessed. The results demonstrate distinct proteomic profiles in young and old tendon, with alterations in the levels of proteins involved in matrix organization and regulation of cell tension. Furthermore, we identified several new peptide fragments (neopeptides) present in aged tendons, suggesting that there are age-specific cleavage patterns within the SDFT. Proteomic profile also differed between young and old injured tendon, with a greater number of neopeptides identified in young injured tendon. This study has increased the knowledge of molecular events associated with tendon aging and injury, suggesting that maintenance and repair of tendon tissue may be reduced in aged individuals and may help to explain why the risk of injury increases with aging. PMID:25077967

  16. Noninvasive Cu-64-ATSM and PET/CT Assessment of Hypoxia in Rat Skeletal Muscles and Tendons During Muscle Contractions

    Skovgaard, D.; Kjaer, M.; Madsen, J.;

    2009-01-01

    during the first PET/CT scan. Standardized uptake values (SUVs) were calculated for the Achilles tendons and triceps surae muscles and were correlated to gene expression of HIF1 alpha and CAIII using real-time polymerase chain reaction. Results: Immediately after the contractions, uptake of Cu-64-ATSM...... was significantly increased, by approximately 1.5-fold in muscles and 1.3-fold in tendons, compared with resting conditions. The significant increase was maintained in late PET scans in stimulated muscles and tendons independently of cuff application. In muscles, SUV correlated significantly with gene...

  17. Arthroscopic Quadriceps Tendon Repair: Two Case Reports

    Hidetomo Saito

    2015-01-01

    Full Text Available Recently, although some studies of open repair of the tendon of the quadriceps femoris have been published, there have been no reports in the literature on primary arthroscopic repair. In our present study, we present two cases of quadriceps tendon injury arthroscopically repaired with excellent results. Case 1 involved a 68-year-old man who was injured while shifting his weight to prevent a fall. MRI showed complete rupture at the insertion of the patella of the quadriceps tendon. The rupture was arthroscopically repaired using both suture anchor and pull-out suture fixation methods via bone tunnels (hereafter, pull-out fixation. Two years after surgery, retearing was not observed on MRI and both Japan Orthopedic Association (JOA Knee and Lysholm scores had recovered to 100. Case 2 involved a 50-year-old man who was also injured when shifting his weight to prevent a fall. MRI showed incomplete superficial rupture at the insertion of the patella of the quadriceps tendon. The rupture was arthroscopically repaired using pull-out fixation of six strand sutures. One year after surgery, MRI revealed a healed tendon and his JOA and Lysholm scores were 95 and 100, respectively. Thus, arthroscopic repair may be a useful surgical method for repairing quadriceps tendon injury.

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

    Camillieri, Gianluca; Di Sanzo, Vincenzo; Ferretti, Matteo; Calderaro, Cosma; Calvisi, Vittorio

    2013-01-01

    Background Among the various complications described in literature, the patellar tendon ossification is an uncommon occurrence in anterior cruciate ligament (ACL) reconstruction using bone – patellar tendon – bone graft (BPTB). The heterotopic ossification is linked to knee traumatism, intramedullary nailing of the tibia and after partial patellectomy, but only two cases of this event linked to ACL surgery have been reported in literature. Case presentation We present a case of a 42-year-old ...

  19. Biomaterials for tendon repair

    Rupal Mehta

    2008-01-01

    Electrospinning biomaterials for tendon repair A single bundle of electrospun submicron polycaprolactone fibres. The team at The University of Manchester believes the material could aid regeneration in tendons. Scientists at The University of Manchester, UK, are investigating the use of electrospun polycaprolactone nanofibres to regenerate damaged tendons. Because the bundle of fibres replicates the morphology of tendon tissue, researchers envisage that the synthetic structure will...

  20. The tibialis posterior tendon

    Lhoste-Trouilloud, A.

    2012-01-01

    The tibialis posterior tendon is the largest and anteriormost tendon in the medial ankle. It produces plantar flexion and supination of the ankle and stabilizes the plantar vault. Sonographic assessment of this tendon is done with high-frequency, linear-array transducers; an optimal examination requires transverse retromalleolar, longitudinal retromalleolar, and distal longitudinal scans, as well as dynamic studies. Disorders of the posterior tibial tendon include chronic tendinopathy with pr...

  1. Changes of calf muscle-tendon biomechanical properties induced by passive-stretching and active-movement training in children with cerebral palsy

    Zhao, Heng; Wu, Yi-Ning; Hwang, Miriam; Ren, Yupeng; Gao, Fan; Gaebler-Spira, Deborah; Zhang, Li-Qun

    2011-01-01

    Biomechanical properties of calf muscles and Achilles tendon may be altered considerably in children with cerebral palsy (CP), contributing to childhood disability. It is unclear how muscle fascicles and tendon respond to rehabilitation and contribute to improvement of ankle-joint properties. Biomechanical properties of the calf muscle fascicles of both gastrocnemius medialis (GM) and soleus (SOL), including the fascicle length and pennation angle in seven children with CP, were evaluated usi...

  2. Acceleration of tendon healing using US guided intratendinous injection of bevacizumab: First pre-clinical study on a murine model

    Purpose: Tendinopathy shows early disorganized collagen fibers with neo-angiogenesis on histology. Peri-tendinous injection of corticosteroid is the commonly accepted strategy despite the abscence of inflammation in tendinosis. The aim of our study was to assess the potential of intratendinous injection of an anti-angiogenic drug (bevacizumab, AA) to treat tendinopathy in a murine model of patellar and Achilles tendinopathy, and to evaluate its local toxicity. Materials and method: Forty rats (160 patellar and Achilles tendons) were used for this study. We induced tendinosis (T+) in 80 tendons by injecting under ultrasonography (US) guidance Collagenase 1® (day 0 = D0, patellar = 40 and Achilles = 40). Clinical examination and tendon US were performed at D3, immediately followed by either AA (AAT+, n = 40) or physiological serum (PST+, n = 40, control) US-guided intratendinous injection. Follow-up at D6 and D13 using clinical, US and histology, and comparison between the 2 groups were performed. To study AA toxicity we compared the 80 remaining normal tendons (T−) after injecting AA in 40 (AAT−). Results: All AAT+ showed a better joint mobilization compared to PST+ at D6 (p = 0.004) with thinner US tendon diameters (p < 0.004), and less disorganized collagen fibers and neovessels on histology (p < 0.05). There was no difference at D13 regarding clinical status, US tendon diameter and histology (p > 0.05). Comparison between AAT− and T− showed no AA toxicity on tendon (p = 0.18). Conclusion: Our study suggests that high dose mono-injection of AA in tendinosis, early after the beginning of the disease, accelerates tendon's healing, with no local toxicity

  3. Acceleration of tendon healing using US guided intratendinous injection of bevacizumab: First pre-clinical study on a murine model

    Dallaudière, Benjamin, E-mail: bendallau64@hotmail.fr [Service de Radiologie, Hôpital universitaire Bichat, Paris (France); Inserm U698, Hôpital universitaire Bichat, Paris (France); Université de Médecine Paris Diderot (France); Lempicki, Marta [Service de Radiologie, Hôpital universitaire Bichat, Paris (France); Université de Médecine Paris Diderot (France); Pesquer, Lionel [Centre d’Imagerie Ostéo Articulaire, Clinique du Sport de Bordeaux-Mérignac (France); Louedec, Liliane [Inserm U698, Hôpital universitaire Bichat, Paris (France); Preux, Pierre Marie [Laboratoire de Biostatistiques, Faculté de médecine, Limoges (France); Meyer, Philippe [Centre d’Imagerie Ostéo Articulaire, Clinique du Sport de Bordeaux-Mérignac (France); Hess, Agathe [Service de Radiologie, Hôpital universitaire Bichat, Paris (France); Université de Médecine Paris Diderot (France); Durieux, Marie Hèlène Moreau [Centre d’Imagerie Ostéo Articulaire, Clinique du Sport de Bordeaux-Mérignac (France); Hummel, Vincent; Larbi, Ahmed [Service de Radiologie, Hôpital universitaire Bichat, Paris (France); Deschamps, Lydia [Service d’ Anatomopathologie, Hôpital universitaire Bichat, Paris (France); and others

    2013-12-01

    Purpose: Tendinopathy shows early disorganized collagen fibers with neo-angiogenesis on histology. Peri-tendinous injection of corticosteroid is the commonly accepted strategy despite the abscence of inflammation in tendinosis. The aim of our study was to assess the potential of intratendinous injection of an anti-angiogenic drug (bevacizumab, AA) to treat tendinopathy in a murine model of patellar and Achilles tendinopathy, and to evaluate its local toxicity. Materials and method: Forty rats (160 patellar and Achilles tendons) were used for this study. We induced tendinosis (T+) in 80 tendons by injecting under ultrasonography (US) guidance Collagenase 1{sup ®} (day 0 = D0, patellar = 40 and Achilles = 40). Clinical examination and tendon US were performed at D3, immediately followed by either AA (AAT+, n = 40) or physiological serum (PST+, n = 40, control) US-guided intratendinous injection. Follow-up at D6 and D13 using clinical, US and histology, and comparison between the 2 groups were performed. To study AA toxicity we compared the 80 remaining normal tendons (T−) after injecting AA in 40 (AAT−). Results: All AAT+ showed a better joint mobilization compared to PST+ at D6 (p = 0.004) with thinner US tendon diameters (p < 0.004), and less disorganized collagen fibers and neovessels on histology (p < 0.05). There was no difference at D13 regarding clinical status, US tendon diameter and histology (p > 0.05). Comparison between AAT− and T− showed no AA toxicity on tendon (p = 0.18). Conclusion: Our study suggests that high dose mono-injection of AA in tendinosis, early after the beginning of the disease, accelerates tendon's healing, with no local toxicity.

  4. Prevention of Simvastatin-Induced Inhibition of Tendon Cell Proliferation and Cell Cycle Progression by Geranylgeranyl Pyrophosphate.

    Tsai, Wen-Chung; Yu, Tung-Yang; Lin, Li-Ping; Cheng, Mei-Ling; Chen, Cheng-Lun; Pang, Jong-Hwei S

    2016-02-01

    Statins have been reported to induce tendinopathy and even tendon rupture. The present study was designed to investigate the potential molecular mechanism underlying the adverse effect of simvastatin on tendon cells. An in vitro tendon healing model was performed using tendon cells isolated from rat Achilles tendons. The viability of tendon cells and cell cycle progression were examined by the MTT assay and flow cytometric analysis, respectively. Immunofluorescent staining for Ki-67 was used to assess the proliferation activity of tendon cells. Western blot analysis and coimmunoprecipitation was used to determine the protein expression of cell cycle-related proteins. To investigate the potential mechanism underlying the effect of statins on tendon cells, mevalonate, farnesyl pyrophosphate (FPP), or geranylgeranyl pyrophosphate (GGPP) was added to simvastatin-treated tendon cells. Simvastatin inhibited the in vitro tendon healing model and tendon cell proliferation in a dose-dependent manner. Immunofluorescent staining demonstrated reduced ki-67 expression in simvastatin-treated tendon cells. Furthermore, simvastatin induced cell cycle arrest at the G1 phase. The expression levels of cdk1, cdk2, cyclin A, and cyclin E were downregulated by simvastatin in a dose-dependent manner. The inhibitory effect of simvastatin was proved to mediate the reduction of mevalonate, and the addition of exogenous GGPP completely prevented the inhibitory effect of simvastatin on tendon cells. The present study demonstrated, for the first time, the molecular mechanism underlying simvastatin-induced tendinopathy or tendon rupture. GGPP was shown to prevent the adverse effect of simvastatin in tendon cells without interfering with its cholesterol-reducing efficacy. PMID:26577051

  5. Research Progress of Integrated Traditional Chinese and Western Medicine in Treating Achilles Tendinopathy%跟腱病中西医治疗研究进展

    韩涛; 张成亮

    2012-01-01

    At home and abroad, the treatment of achilles tendon disease is in a deep study in recent years, according to experiences in the treatment of this disease, from etiology and pathogenesis, Chinese and Western medicine treatment of achilles tendon disease in recent years was detailed analyzed and systematic summarized.The researches on this disease have certain significance for the best treatment options.%目前国内外对跟腱病的诊疗有很深的研究,文章根据近几年对本病的治疗经验,从病因病机详细分析,中西医治疗跟腱病方案进行综述,系统总结了近几年本病的研究进展,对本病的最佳治疗方案选择有一定的意义.

  6. Triceps tendon rupture: the knowledge acquired from the anatomy to the surgical repair.

    Celli, A

    2015-09-01

    Triceps injuries are relatively uncommon in most traumatic events, and the distal triceps tendon ruptures are rare. Recently, the knowledge of this tendon lesion has increased, and it seems to be related to more precise diagnostic and clinical assessments. The most common mechanism of injury remains a forceful eccentric contraction of the muscle, while several other risk factors have been studied as chronic renal failure, endocrine disorders, metabolic bone diseases as well as steroid use. Olecranon bursitis and local corticosteroid injections may also play a role. The commonest site of rupture is at the tendon's insertion into the olecranon and rarely at the myotendinous junction or intramuscularly. The surgical intervention is recommended in acute complete ruptures, and non-operative treatment is reserved for patients with major comorbidities, as well as for partial ruptures with little functional disability and in low demanding patients. Various techniques and approaches as the direct repair to bone, the tendon augmentation, the anconeus rotation flap and the Achilles tendon allograft have been proposed for the management of these challenging injuries. The goal of surgical management should be an anatomical repair of the injured tendon by selection of a procedure with a low complication rate and one that allows early mobilization. This manuscript focuses the triceps tendon ruptures starting from the anatomy to the diagnosis and entity of the triceps tendon injuries, as well as the indications and guidelines for the management. PMID:25957546

  7. POSTOPRATIVE REHABILITATION PROTOKOL AFTER MPSH / MODIFIED PERCUTANEAL SUTURE / OF ACHILES TENDON.

    Martin Barnev; Pavlin Apostolov; Petar Milkov

    2012-01-01

    We present clinical study of 68 patients / male, mean age 38.5 yr / s applied early loading and functional treatment following percutaneous suture of Achilles tendon. Postoperatively were followed clinically and sonographic 3-6-12 meters of the results defined / visual analog scale / VSA in the score. In all patients, there are normal physical activity without significant differences in the mobility of the ankle joint. Not seen repeated ruptures. We agree that early mobilization and functiona...

  8. The biological effects of extracorporeal shock wave therapy (eswt) on tendon tissue

    Notarnicola, Angela; Moretti, Biagio

    2012-01-01

    There is currently great interest in the use of Extracorporeal Shock Wave Therapy (ESWT) and in clarifying the mechanisms of action in tendon pathologies. The success rate ranges from 60% to 80% in epicondylitis, plantar fasciitis, cuff tendinitis, trocanteritis, Achilles tendinitis or jumper’s knee. In contrast to urological treatments (lithotripsy), where shockwaves are used to disintegrate renal stones, in musculoskeletal treatments (orthotripsy), shockwaves are not being used to disintegr...

  9. A pilot study on biomarkers for tendinopathy: lower levels of serum TNF-α and other cytokines in females but not males with Achilles tendinopathy

    Jamie E Gaida; Alfredson, Håkan; Forsgren, Sture; Cook, Jill L

    2016-01-01

    Background Achilles tendinopathy is a painful musculoskeletal condition that is common among athletes, and which limits training capacity and competitive performance. The lack of biomarkers for tendinopathy limits research into risk factors and also the evaluation of new treatments. Cytokines and growth factors involved in regulating the response of tendon cells to mechanical load have potential as biomarkers for tendinopathy. Methods This case–control study compared serum concentration of cy...

  10. One-year follow-up of a randomised controlled trial on added splinting to eccentric exercises in chronic midportion Achilles tendinopathy

    Jonge, Suzan; de Vos, Robert-Jan; van Schie, Hans; Verhaar, Jan; Weir, Adam; Tol, Johannes

    2008-01-01

    textabstractOBJECTIVE: The study examined whether the addition of a night splint to eccentric exercises is beneficial for functional outcome in chronic mid-portion Achilles tendinopathy. DESIGN: One-year follow-up of a randomised controlled single blinded clinical trial. SETTING: Sports medicine department in a general hospital. PATIENTS: 58 patients (70 tendons) were included. INTERVENTIONS: All patients completed a 12-week heavy load eccentric training programme. One group received a night ...

  11. Capacity for sliding between tendon fascicles decreases with ageing in injury prone equine tendons: a possible mechanism for age-related tendinopathy?

    CT Thorpe

    2013-01-01

    Full Text Available Age-related tendinopathy is common in both humans and horses; the initiation and progression of which is similar between species. The majority of tendon injuries occur to high-strain energy storing tendons, such as the human Achilles tendon and equine superficial digital flexor (SDFT. By contrast, the low-strain positional human anterior tibialis tendon and equine common digital extensor (CDET are rarely injured. It has previously been established that greater extension occurs at the fascicular interface in the SDFT than in the CDET; this may facilitate the large strains experienced during locomotion in the SDFT without damage occurring to the fascicles. This study investigated the alterations in whole tendon, fascicle and interfascicular mechanical properties in the SDFT and CDET with increasing age. It was hypothesised that the amount of sliding at the fascicular interface in the SDFT would decrease with increasing horse age, whereas the properties of the interface in the CDET would remain unchanged with ageing. Data support the hypothesis; there were no alterations in the mechanical properties of the whole SDFT or its constituent fascicles with increasing age. However, there was significantly less sliding at the fascicular interface at physiological loads in samples from aged tendons. There was no relationship between fascicle sliding and age in the CDET. The increase in stiffness of the interfascicular matrix in aged SDFT may result in the fascicles being loaded at an earlier point in the stress strain curve, increasing the risk of damage. This may predispose aged tendons to tendinopathy.

  12. Return to athletic activity after foot and ankle surgery: a preliminary report on select procedures.

    Saxena, A

    2000-01-01

    One hundred thirty-eight "athletic" patients from the author's practice underwent retrospective review of their foot and ankle surgery that was performed from 1990 to 1997 to evaluate the time to return to activity. Athletes were defined as follows: professional, varsity college and high school, runners amassing more than 25 miles per week, or those involved in regular competition. No recreational athletes were included. Average follow-up for the group as a whole was 49.4 months, (range, 12-108 months). One hundred seventeen of the 138 patients were able to be contacted and/or had been evaluated by September 1998. One hundred thirteen patients considered their surgery a success. All but two patients were able to return to the desired level of performance. Twenty-three of the patients increased their activity level after surgery. Twenty-eight athletes underwent Achilles tendon-related surgery (average follow-up was 44.5 months). Runners undergoing peritenolyses had an average return to activity of 4.0 weeks (range, 3-6 weeks). Patients undergoing Achilles procedure involving bone resection had an average return to activity of 13.8 weeks (range, 10-20 weeks). Forty-four bunionectomy procedures were performed, including 31 first metatarsal osteotomies. The group's average follow-up was 52.9 months (range, 13-100 months), and average return to activity for the first metatarsal osteotomies was 8.9 weeks. There were 48 rearfoot procedures. Lateral ankle stabilization procedures returned to activity on an average of 10 weeks (range, 7-16 weeks), while excised ossicles (os tibiale externum, os trigonum) had an average return to activity of 9.1 weeks (range, 8-14 weeks). Seven neuroma patients (via dorsal approach) had a return to activity of 4.0 weeks (range, 2.5-6 weeks), sesamoidectomy 7.5 weeks (range, 4-10 weeks), and Valenti arthroplasty of 6.5 weeks (range, 4-12 weeks), respectively. There were minimal complications. Two patients in the Achilles surgery group

  13. Multiple variations of the tendons of the anatomical snuffbox

    Thwin, San San; Zaini, Fazlin; Than, Myo

    2014-01-01

    INTRODUCTION Multiple tendons of the abductor pollicis longus (APL) in the anatomical snuffbox of the wrist can lead to the development of de Quervain's syndrome, which is caused by stenosing tenosynovitis. A cadaveric study was performed to establish the variations present in the tendons of the anatomical snuffbox in a Malaysian population, in the hope that this knowledge would aid clinical investigation and surgical treatment of de Quervain's tenosynovitis. METHODS Routine dissection of ten upper limbs was performed to determine the variations in the tendons of the anatomical snuffbox of the wrist. RESULTS In all the dissected upper limbs, the APL tendon of the first extensor compartment was found to have several (3–14) tendon slips. The insertion of the APL tendon slips in all upper limbs were at the base of the first metacarpal bone, trapezium and fascia of the opponens pollicis muscle; however, in seven specimens, they were also found to be attached to the fleshy belly of the abductor pollicis brevis muscle. In two specimens, double tendons of the extensor pollicis longus located in the third extensor compartment were inserted into the capsule of the proximal interphalangeal joints before being joined to the extensor expansion. In two other specimens, the first extensor compartment had two osseofibrous tunnels divided by a septum that separated the APL tendon from the extensor pollicis brevis tendon. CONCLUSION Multiple variations were found in the anatomical snuffbox region of the dissected upper limbs. Knowledge of these variations would be useful in interventional radiology and orthopaedic surgery. PMID:24452976

  14. The effects of mechanical loading on tendons--an in vivo and in vitro model study.

    Jianying Zhang

    Full Text Available Mechanical loading constantly acts on tendons, and a better understanding of its effects on the tendons is essential to gain more insights into tendon patho-physiology. This study aims to investigate tendon mechanobiological responses through the use of mouse treadmill running as an in vivo model and mechanical stretching of tendon cells as an in vitro model. In the in vivo study, mice underwent moderate treadmill running (MTR and intensive treadmill running (ITR regimens. Treadmill running elevated the expression of mechanical growth factors (MGF and enhanced the proliferative potential of tendon stem cells (TSCs in both patellar and Achilles tendons. In both tendons, MTR upregulated tenocyte-related genes: collagen type I (Coll. I ∼10 fold and tenomodulin (∼3-4 fold, but did not affect non-tenocyte-related genes: LPL (adipocyte, Sox9 (chondrocyte, Runx2 and Osterix (both osteocyte. However, ITR upregulated both tenocyte (Coll. I ∼7-11 fold; tenomodulin ∼4-5 fold and non-tenocyte-related genes (∼3-8 fold. In the in vitro study, TSCs and tenocytes were stretched to 4% and 8% using a custom made mechanical loading system. Low mechanical stretching (4% of TSCs from both patellar and Achilles tendons increased the expression of only the tenocyte-related genes (Coll. I ∼5-6 fold; tenomodulin ∼6-13 fold, but high mechanical stretching (8% increased the expression of both tenocyte (Coll. I ∼28-50 fold; tenomodulin ∼14-48 fold and non-tenocyte-related genes (2-5-fold. However, in tenocytes, non-tenocyte related gene expression was not altered by the application of either low or high mechanical stretching. These findings indicate that appropriate mechanical loading could be beneficial to tendons because of their potential to induce anabolic changes in tendon cells. However, while excessive mechanical loading caused anabolic changes in tendons, it also induced differentiation of TSCs into non-tenocytes, which may lead to the development

  15. Noninvasive 64Cu-ATSM and PET/CT Assessment of Hypoxia in Rat Skeletal Muscles and Tendons During Muscle Contractions

    Skovgaard, Dorthe; Kjaer, Michael; Madsen, Jacob;

    2009-01-01

    during the first PET/CT scan. Standardized uptake values (SUVs) were calculated for the Achilles tendons and triceps surae muscles and were correlated to gene expression of HIF1alpha and CAIII using real-time polymerase chain reaction. RESULTS: Immediately after the contractions, uptake of (64)Cu......-ATSM was significantly increased, by approximately 1.5-fold in muscles and 1.3-fold in tendons, compared with resting conditions. The significant increase was maintained in late PET scans in stimulated muscles and tendons independently of cuff application. In muscles, SUV correlated significantly with gene...

  16. Nanostructured Tendon-Derived Scaffolds for Enhanced Bone Regeneration by Human Adipose-Derived Stem Cells.

    Ko, Eunkyung; Alberti, Kyle; Lee, Jong Seung; Yang, Kisuk; Jin, Yoonhee; Shin, Jisoo; Yang, Hee Seok; Xu, Qiaobing; Cho, Seung-Woo

    2016-09-01

    Decellularized matrix-based scaffolds can induce enhanced tissue regeneration due to their biochemical, biophysical, and mechanical similarity to native tissues. In this study, we report a nanostructured decellularized tendon scaffold with aligned, nanofibrous structures to enhance osteogenic differentiation and in vivo bone formation of human adipose-derived stem cells (hADSCs). Using a bioskiving method, we prepared decellularized tendon scaffolds from tissue slices of bovine Achilles and neck tendons with or without fixation, and investigated the effects on physical and mechanical properties of decellularized tendon scaffolds, based on the types and concentrations of cross-linking agents. In general, we found that decellularized tendon scaffolds without fixative treatments were more effective in inducing osteogenic differentiation and mineralization of hADSCs in vitro. When non-cross-linked decellularized tendon scaffolds were applied together with hydroxyapatite for hADSC transplantation in critical-sized bone defects, they promoted bone-specific collagen deposition and mineralized bone formation 4 and 8 weeks after hADSC transplantation, compared to conventional collagen type I scaffolds. Interestingly, stacking of decellularized tendon scaffolds cultured with osteogenically committed hADSCs and those containing human cord blood-derived endothelial progenitor cells (hEPCs) induced vascularized bone regeneration in the defects 8 weeks after transplantation. Our study suggests that biomimetic nanostructured scaffolds made of decellularized tissue matrices can serve as functional tissue-engineering scaffolds for enhanced osteogenesis of stem cells. PMID:27502160

  17. Periostin secreted by mesenchymal stem cells supports tendon formation in an ectopic mouse model.

    Noack, Sandra; Seiffart, Virginia; Willbold, Elmar; Laggies, Sandra; Winkel, Andreas; Shahab-Osterloh, Sandra; Flörkemeier, Thilo; Hertwig, Falk; Steinhoff, Christine; Nuber, Ulrike A; Gross, Gerhard; Hoffmann, Andrea

    2014-08-15

    True tendon regeneration in human patients remains a vision of musculoskeletal therapies. In comparison to other mesenchymal lineages the biology of tenogenic differentiation is barely understood. Specifically, easy and efficient protocols are lacking that might enable tendon cell and tissue differentiation based on adult (stem) cell sources. In the murine mesenchymal progenitor cell line C3H10T½, overexpression of the growth factor bone morphogenetic protein 2 (BMP2) and a constitutively active transcription factor, Smad8 L+MH2, mediates tendon cell differentiation in vitro and the formation of tendon-like tissue in vivo. We hypothesized that during this differentiation secreted factors involved in extracellular matrix formation exert a major impact on tendon development. Gene expression analyses revealed four genes encoding secreted factors that are notably upregulated: periostin, C-type lectin domain family 3 (member b), RNase A4, and follistatin-like 1. These factors have not previously been implicated in tendon biology. Among these, periostin showed a specific expression in tenocytes of adult mouse Achilles tendon and in chondrocytes within the nonmineralized fibrocartilage zone of the enthesis with the calcaneus. Overexpression of periostin alone or in combination with constitutively active BMP receptor type in human mesenchymal stem cells and subsequent implantation into ectopic sites in mice demonstrated a reproducible moderate tenogenic capacity that has not been described before. Therefore, periostin may belong to the factors contributing to the development of tenogenic tissue. PMID:24809660

  18. Variant course of extensor pollicis longus tendon in the second wrist extensor compartment.

    Kim, Young Jun; Lee, Jae Hoon; Baek, Jong Hun

    2016-05-01

    Among the muscles involved in thumb movement, the extensor pollicis longus (EPL) tendon of the hand is considered the most consistent structure with the least variation among individuals. There have been a few reports regarding different types of supernumerary tendons; however, an abnormal course of the EPL tendon is extremely rare. We describe a case of a variant course of a single EPL tendon appearing in the second extensor compartment of the wrist. This case was observed incidentally during wrist surgery, and demonstrates a unique variation of tendon course, which has not been reported previously. The knowledge of this anatomic variation is helpful in surgical planning and for making accurate diagnoses. PMID:26253859

  19. The long-term clinical and MRI results following eccentric calf muscle training in chronic Achilles tendinosis

    Gaerdin, Anna; Shalabi, Adel [Karolinska University Hospital/Huddinge, Departments of Radiology, Karolinska Institutet, Clintec, Stockholm (Sweden); Movin, Tomas [Karolinska University Hospital/Huddinge, Karolinska Institutet, Departments of Orthopedics, Stockholm (Sweden); Svensson, Leif [Karolinska Institutet, Karolinska University Hospital/Huddinge, Departments of Medical Physics, Stockholm (Sweden)

    2010-05-15

    To evaluate the long-term results following eccentric calf-muscle training in patients with chronic Achilles tendinopathy. A total of 24 patients with chronic Achilles tendinopathy were included in a study evaluating MRI findings and clinical symptoms before and after 3 months of daily eccentric calf-muscle strength training. Median duration of symptoms was 18 months (range 6-120). Four of the patients did not perform the prescribed treatment for different reasons and were followed for 14 months. The resulting 20 treated patients completed 4.2-year (range 29-58 months) follow up. Tendon volume was evaluated by using 3D seed growing technique and signal abnormalities were visually semi-quantitatively graded. Level of pain and performance was categorized using a questionnaire completed by the patient. In the symptomatic treated patients, median intensity level of pain decreased from moderate/severe at time of inclusion to mild at follow up (p < 0.05). Median level of performance increased from severe impairment at time of inclusion to normal at follow up (p < 0.05). 12 out of 20 patients had raised intratendinous signal at time of inclusion compared to 2 out of 20 patients at follow up (p < 0.001). Mean tendon-volume measured 6.7 cm{sup 3} (SD 2.0) at time of inclusion and 6.4 cm{sup 3} (SD 2.0) at follow up (p = 0.18). The four symptomatic non-treated tendons did not improve regarding pain, performance, intratendinous signal or tendon volume. We found decreased pain, improved performance and decreased intratendinous signal both compared to index examination and immediately after the 3 months training regimen in a 4.2-year clinical and MRI follow up, in a group of patients treated with heavy loaded eccentric calf-muscle training for chronic Achilles tendinopathy. The improvements were greater at 4.2-year follow up, despite no further active treatment, than immediately after the treatment. This may indicate a good long-term prognosis for Achilles tendinosis patients

  20. Three-dimensional video analysis of forearm rotation before and after combined pronator teres rerouting and flexor carpi ulnaris tendon transfer surgery in patients with cerebral palsy.

    Kreulen, M.; Veeger, H.E.J.; Hage, J.J.; Smeulders, M.J.C.; Horst, van der CM

    2004-01-01

    The effect of combined pronator teres rerouting and flexor carpi ulnaris transfer on forearm rotation was prospectively studied by comparison of pre- and postoperative three-dimensional analysis of forearm range of motion in ten patients with cerebral palsy. One year postoperatively, surgery had imp

  1. Co-effect of silk and amniotic membrane for tendon repair.

    Seo, Young-Kwon; Kim, Jun-Hyung; Eo, Su-Rak

    2016-08-01

    The objective of the present study was to determine the feasibility and biocompatibility of a silk scaffold and a composite silk scaffold in terms of new tendon generation using a rabbit Achilles tendon model. The silk scaffold was constructed using a weaving machine, then soaked in a 1% collagen-hyaluronan (HA) solution and air-dried, whereas the composite silk scaffold was composed of a silk scaffold containing a lyophilized collagen-HA substrate. Tenocytes were cultured in vitro to compare cell populations in the two groups. The cellular densities on composite silk scaffolds were 40% higher on average than those on silk scaffolds in 30-day tenocyte cultures. The tendon scaffolds had implanted into Achilles tendon defects in 16 white New Zealand rabbits. Rabbits were randomly divided into the following three groups: group I, silk scaffold alone; group II, composite silk scaffold; and group III, composite silk scaffold wrapped by an amniotic membrane. Implants were harvested 2, 8, and 12 weeks post-implantation. Histological examinations were conducted using hematoxylin-eosin (H&E), Masson's trichrome, and by performing immunohistochemical staining for CD34. After 12 weeks, the three groups were distinguishable based on gross examination. The histological examination revealed more organized collagen fibrils in groups III, which showed a dense, parallel, linear organization of collagen bundles. CD34 staining revealed neoangiogenesis in groups III. The results of this research showed that collagen-HA substrates with amniotic membrane accelerate cellular migration and angiogenesis in neotendons. PMID:27188627

  2. Midportion Achilles Tendinopathy : Incidence, Imaging and Treatment

    S. de Jonge (Suzan)

    2015-01-01

    markdownabstractAbstract The aim of this thesis was to elucidate the effect of different treatment options in midportion Achilles tendinopathy, with optimizing current diagnostic methods. For this purpose we conducted two randomised controlled trials, a case control study, a cadaveric study, and a

  3. Peroneal Tendon Injuries

    ... FootNotes Newsletter Current Issue Archive Subscribe Home » Foot & Ankle Conditions » Peroneal Tendon Injuries A A A | Print | Share Javascript is required ... cases, subluxation occurs following trauma, such as an ankle sprain. Damage or injury to the tissues that stabilize the tendons (retinaculum) ...

  4. Pectoralis Major Tendon Repair

    Cordasco, Frank A.; Degen, Ryan; Mahony, Gregory Thomas; Tsouris, Nicholas

    2016-01-01

    Objectives: Systematic reviews of the literature have identified 365 reported cases of Pectoralis Major Tendon (PMT) injuries. While surgical treatment has demonstrated improved outcomes compared to non-operative treatment, there is still relatively limited data on the functional outcome, return to sport and need for 2nd surgery in athletes following PMT repair. This study comprises the largest series of athletes following PMT repair reported to date. The Objective is to report on the functional outcomes, return to sport and need for 2nd surgery in a consecutive series of PMT tears. Methods: From 2009, 81 patients with PMT tears were enrolled in this prospective series. Baseline evaluation included patient demographics, mechanism of injury, physical examination and PMT specific MRI for confirmation of the diagnosis and analysis of the extent of injury. Each patient underwent surgical repair by the senior author utilizing a previously published surgical technique. Patients were then followed at 2 weeks, 6 weeks, 3 months and 6 months and further follow-up was conducted annually thereafter with functional outcome scores and adduction strength testing. The return to sport and incidence of 2nd surgery data were recorded. This study includes the first 40 athletes to reach the 2-year post-operative period. Results: All athletes were male, with an average age of 34.4 years (range 23-59). The patient cohort consisted of 4 professional NFL players and 36 recreational athletes. Average follow-up duration was 2.5 years (range 2 - 6.0 years). The most common mechanisms of injury occurred during the bench press (n=26) and contact sport participation (n=14). Sixteen injuries were complete avulsions involving both the clavicular and sternocostal heads, while 24 were isolated sternocostal head avulsions. Average pre-injury bench press of 396 lbs (range 170-500 lbs) was restored to 241 lbs post-operatively (range 140-550 lbs). Single Assessment Numeric Evaluation (SANE) scores

  5. Quadriceps Tendon Rupture and Contralateral Patella Tendon Avulsion Post Primary Bilateral Total Knee Arthroplasty: A Case Report

    Gaurav Sharma

    2016-07-01

    Full Text Available Background: Extensor mechanism failure secondary to knee replacement could be due to tibial tubercle avulsion, Patellar tendon rupture, patellar fracture or quadriceps tendon rupture. An incidence of Patella tendon rupture of 0.17% and Quadriceps tendon rupture of around 0.1% has been reported after Total knee arthroplasty. These are considered a devastating complication that substantially affects the clinical results and are challenging situations to treat with surgery being the mainstay of the treatment. Case Description: We report here an interesting case of a patellar tendon rupture of one knee and Quadriceps tendon rupture of the contralateral knee following simultaneous bilateral knee replacement in a case of inflammatory arthritis patient. End to end repair for Quadriceps tear and augmentation with Autologous Hamstring tendon graft was done for Patella tendon rupture. OUTCOME: Patient was followed up for a period of 1 year and there was no Extension lag with a flexion of 100 degrees in both the knees. DISCUSSION: The key learning points and important aspects of diagnosing these injuries early and the management techniques are described in this unique case of bilateral extensor mechanism disruption following knee replacements.

  6. The influence of atorvastatin on tendon healing: an experimental study on rabbits.

    Esenkaya, Irfan; Sakarya, Bulent; Unay, Koray; Elmali, Nurzat; Aydin, Nasuhi Engin

    2010-06-01

    Hyperlipidemia is a major risk factor for coronary heart disease. The most commonly used antihyperlipidemic drugs are 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase inhibitors (statins), of which atorvastatin is one of the most widely used. Little is known about the relationship between tendinopathy and HMG CoA reductase inhibitors (statins) or the effects of atorvastatin use on tendon healing following surgical repair of tendon rupture. We hypothesized that atorvastatin negatively affects this healing process. The Achilles tendons of 16 New Zealand rabbits were ruptured surgically and repaired with sutures. Eight of the rabbits were given oral atorvastatin. The other 8 served as a surgical control group. Six weeks postoperatively, all the rabbits were sacrificed, and the repaired tendons were removed. After standard histological preparation, fibroblastic activity, re-vascularization, collagenization, collagen construction, and inflammatory-cell infiltration were evaluated. On comparing the atorvastatin and surgical control groups, we observed no difference in fibroblastic activity. Although it did not reach statistical significance in our study, a difference was noted in revascularization, collagenization, and inflammatory cell infiltration; and a statistical difference was observed in collagen construction. Doubt remains about the adverse effect of atorvastatin use during tendon healing. Further investigations in animal and human models are needed on the effects of tendon healing when atorvastatin is administered for a longer time frame prior to the injury. PMID:20806777

  7. Ageing does not result in a decline in cell synthetic activity in an injury prone tendon.

    Thorpe, C T; McDermott, B T; Goodship, A E; Clegg, P D; Birch, H L

    2016-06-01

    Advancing age is a well-known risk factor for tendon disease. Energy-storing tendons [e.g., human Achilles, equine superficial digital flexor tendon (SDFT)] are particularly vulnerable and it is thought that injury occurs following an accumulation of micro-damage in the extracellular matrix (ECM). Several authors suggest that age-related micro-damage accumulates due to a failure of the aging cell population to maintain the ECM or an imbalance between anabolic and catabolic pathways. We hypothesized that ageing results in a decreased ability of tendon cells to synthesize matrix components and matrix-degrading enzymes, resulting in a reduced turnover of the ECM and a decreased ability to repair micro-damage. The SDFT was collected from horses aged 3-30 years with no signs of tendon injury. Cell synthetic and degradative ability was assessed at the mRNA and protein levels. Telomere length was measured as an additional marker of cell ageing. There was no decrease in cellularity or relative telomere length with increasing age, and no decline in mRNA or protein levels for matrix proteins or degradative enzymes. The results suggest that the mechanism for age-related tendon deterioration is not due to reduced cellularity or a loss of synthetic functionality and that alternative mechanisms should be considered. PMID:26058332

  8. Biomechanical Comparison Between Bashti Bone Plug Technique and Biodegradable Screw for Fixation of Grafts in Ligament surgery

    Kaveh Bashti

    2015-01-01

    Full Text Available   Background: Ligament reconstruction is a common procedure in orthopedic surgery. Although several popular techniques are currently in use, new methods are proposed for secure fixation of the tendon graft into the bone tunnel. Purposes: We sought to introduce our new technique of Bashti bone plug for fixation of soft tissue graft in anterior cruciate ligament (ACL reconstruction and to compare its biomechanical features with conventional absorbable interference screw technique in a bovine model. Methods: Twenty pairs of bovine knees were harvested after death. Soft tissue was removed and the Achilles tendon was harvested to be used as an ACL graft. It was secured into the bone tunnel on the tibial side via two different methods: Bashti Bone Plug technique and conventional screw method. Biomechanical strength was measured using 200 N and 300 N cyclic loading on the graft. Pull out strength was also tested until the graft fails. Results: No graft failure was observed after 200 N and 300 N cyclic loading in either fixation methods. When testing for pull out failure, 21 tendons (53% were torn and 19 tendons (48% slipped out. No fixation failure occurred, which did not reveal a significant difference between the bone plug or interference screw group (P=0.11. The mean pull out force until failure of the graft was 496±66 N in the screw group and 503±67 N in the bone plug group (P=0.76. Conclusions: Our suggested fixation technique of Bashti bone plug is a native, cheap, and feasible method that provides comparable biomechanical strength with interference screw when soft tissue fixation was attempted in bovine model.

  9. Low-intensity pulsed ultrasound therapy: a potential strategy to stimulate tendon-bone junction healing*

    Ying, Zhi-Min; Lin, Tiao; Yan, Shi-Gui

    2012-01-01

    Incorporation of a tendon graft within the bone tunnel represents a challenging clinical problem. Successful anterior cruciate ligament (ACL) reconstruction requires solid healing of the tendon graft in the bone tunnel. Enhancement of graft healing to bone is important to facilitate early aggressive rehabilitation and a rapid return to pre-injury activity levels. No convenient, effective or inexpensive procedures exist to enhance tendon-bone (T-B) healing after surgery. Low-intensity pulsed u...

  10. A review of current concepts in flexor tendon repair: physiology, biomechanics, surgical technique and rehabilitation.

    Rohit Singh; Ben Rymer; Peter Theobald; Thomas, Peter B.M.

    2015-01-01

    Historically, the surgical treatment of flexor tendon injuries has always been associated with controversy. It was not until 1967, when the paper entitled Primary repair of flexor tendons in no man’s land was presented at the American Society of Hand Surgery, which reported excellent results and catalyzed the implementation of this technique into worldwide practice. We present an up to date literature review using PubMed and Google Scholar where the terms flexor tendon, repair and rehabilitat...

  11. Risk Factors of Tendo-Achilles Injury in Football, Cricket and Badminton Players at Dhaka, Bangladesh.

    Khan, M J; Giasuddin, A S M; Khalil, M I

    2015-04-01

    Achilles tendon is the tendon connecting the heel with the calf muscles. Tendo-achilles injury (TAI) in players is common in games. The frequency of TAI is unknown and aetiology is controversial: The present descriptive cross-sectional study was done to determine the prevalence of TAI and associated factors contributing to it in football, cricket and badminton. From January to June 2012, male players (n = 131), age -17-35 years, were selected by purposive sampling technique from renowned sporting clubs at Dhaka, Bangladesh. TAI was diagnosed through structured questionnaire and interviewing the respondents. The analysis by Statistical Package for Social Sciences (SPSS) programme revealed that 11.5% players suffered from TAI, i.e. prevalence was 115 per 1000 respondents. Most injuries (70/131; 53.4%) occurred in the playground and (59/131; 45.3%) happened in practice field. Injuries among the players of third division were higher, i.e. about 36% (p = 0.000). TAI was significantly dependent on occupation (p = 0.046), BMI (p = 0.008), divisional status (p = 0.023), game type (p = 0.043), ground condition (p = 0.05) and injury severity (p = 0.000). The injured players referred for treatment to the physiotherapist was highest (9/15, i.e. 60%) followed by the physicians (5/15, i.e. 33%) (p = 0.000). The associations of TAI with various factors were discussed suggesting effective measures be taken and treatment, particularly physiotherapy, be given to injured players. However, there is a need of team work with sports medicine specialist also to enable the injured players to continue their professional games. PMID:27089630

  12. Posterior Tibial Tendon Dysfunction

    ... high-impact sports, such as basketball, tennis, or soccer, may have tears of the tendon from repetitive ... High-intensity or high-impact activities, such as running, can be very difficult. Some patients can have ...

  13. Inflamed shoulder tendons (image)

    Tearing and inflammation of the tendons of the shoulder muscles can occur in sports which require the ... pitching, swimming, and lifting weights. Most often the shoulder will heal if a break is taken from ...

  14. Shock wave therapy for Achilles tendinopathy

    Wilson, Michelle; Stacy, Jason

    2010-01-01

    Achilles tendinopathy has been reported as the most common overuse injury in sports medicine clinics (Clement et al. Am J Sports Med 12: 179–184, 1984). Standard treatment regimens include activity modification, heel lifts, arch supports, stretching exercises, nonsteroidal anti-inflammatories, and eccentric loading. There is a lack of consensus regarding treatment. Even so, most athletes will respond to this regimen. However, conservative management will prove to be inadequate for a subset of...

  15. Magnetic resonance imaging of ankle ligaments and tendon injuries

    Today MRI allows evaluation of the integrity of injured ankle ligaments. The major difficulty in MRI is inconsistency in visualization by inadequate appreciation of the three-dimensional orientation of each ankle ligament. Using this technique, 52 patients with sprained ankles underwent MRI. The integrity of rupture of the collateral lateral ligaments was obtained in all 52 ankles. Full-lenght visualization is essential for evaluation of the ankle ligaments with MRI. In these 52 patients the angle of tilt on the stress X-ray was compared with the rate of MRI findings showing an injury affecting two ligaments. We found that none of the patients in whom the angle of lateral tilt was less than 5 had rupture of two laterial ligaments, while 32% of patients with angles of tilt of 6-14 and 42% of those with angles of tilt over 15 on stress X-ray had two ruptured lateral ligaments. The advantages of MRI are that it offers the best visualization of the extent of the tendon lesion. MRI, however, seems to be superior to US in detecting and quantifying lesions of the Achilles tendon. Therefore, MRI may be indicated in particularly difficult cases of tendons injuries in the foot. (orig.)

  16. Changes in Indirect Markers of Muscle Damage and Tendons After Daily Drop Jumping Exercise with Rapid Load Increase

    Vidas Paleckis, Mantas Mickevičius, Audrius Snieckus, Vytautas Streckis, Mati Pääsuke, Saulius Rutkauskas, Rasa Steponavičiūtė, Albertas Skurvydas, Sigitas Kamandulis

    2015-12-01

    Full Text Available The aim of this study was to assess changes in indirect markers of muscle damage and type I collagen degradation, as well as, patellar and Achilles tendon morphological differences during nine daily drop-jumps sessions with constant load alternated with rapid increases in load to test the hypothesis that frequent drop-jump training results in negative muscular and tendon adaptation. Young men (n = 9 performed daily drop jump workouts with progression every 3 days in terms of number of jumps, platform height and squat amplitude. Voluntary and electrically evoked knee extensor torque, muscle soreness, blood plasma creatine kinase (CK activity and carboxyterminal cross-linked telopeptide (ICTP, patellar and Achilles tendon thickness and cross-sectional area (CSA were assessed at different time points during the training period and again on days 1, 3, 10 and 17 after the training. The findings were as follows: (1 steady decline in maximal muscle strength with major recovery within 24 hours after the first six daily training sessions; (2 larger decline in electrically induced muscle torque and prolonged recovery during last three training sessions; (3 increase in patellar and Achilles tendons CSA without change in thickness towards the end of training period; (4 increase in jump height but not in muscle strength after whole training period. Our findings suggest that frequent drop-jump sessions with constant load alternated with rapid increases in load do not induce severe muscle damage or major changes in tendons, nonetheless, this type of loading is not advisable for muscle strength improvement.

  17. Closed ruptures of the flexor digitorum tendons: MRI evaluation

    Objective. To assess the MRI findings in cases of closed rupture of the flexor digitorum tendons (FDT). Patients and design. Ten patients with a clinical suspicion of rupture of FDT underwent MRI before surgery. None of the patients presented a skin injury. Fingers were imaged using axial T1-weighted SE sequences, three-dimensional GE images, and curved reconstructions. Results. Twelve FDT had surgical confirmation of rupture. Flexor digitorum profundus (FDP) and flexor pollicis longus (FPL) tendons were more frequently ruptured (n=8) than flexor digitorum superficialis (FDS) tendons (n=4). MR images accurately depicted the level of the rupture. The gap between the tendon ends (mean 45 mm, range 21-70 mm) was assessed best with curved reconstructions and was well correlated with the surgical findings. The proximal end mainly retracted into the palm or the carpal tunnel (n=8), and less frequently into the digital canal (n=4). In two cases, the proximal end curled up in the palm, clinically simulating a rupture of a lumbrical muscle in one case. MRI also showed the appearance of the adjacent tendons. Conclusion. MRI accurately depicted the level of rupture and the gap between the tendon ends, which assisted the surgical choice between suture, graft or tendon transfer. (orig.)

  18. Successful management of bilateral patellar tendon rupture in a dog.

    Shipov, A; Shahar, R; Joseph, R; Milgram, J

    2008-01-01

    A seven-year-old, 41 kg, intact, cross breed dog, was presented with a history of bilateral hind limb lameness after falling from a height of 1 m. Clinical and radiographic findings were consistent with bilateral patellar tendon rupture. Surgical repair was performed bilaterally. The tendons were sutured primarily, and an internal splint of nylon leader was added. Good apposition of the severed tendon ends had been achieved intraoperatively; however, post operative radiographs showed supra-trochlear displacement of both patellae. The casts used to immobilize the stifle joints slipped distally and three days post operatively the tendon repair had broken down, bilaterally. Revision surgery was undertaken and the tendons were re-sutured. Nylon leader was placed through holes that had been drilled in the patellae and tibiae. The stifle joints were immobilized with type I external skeletal fixators (ESFs). Both freeform polymethylmethacrylate (PMMA) connecting bars were found to be broken at the level of the stifle joints two days later, without any disruption of the primary tendon repair. Each connecting bar was replaced with two connecting bars of PMMA reinforced with 3 mm steel wire. The dog was fully weight-bearing with a reduced range of motion in flexion immediately after removal of the ESFs at six weeks and was still sound 18 months post-operatively. Primary tendon repair in combination with adequate immobilization allowed for an excellent outcome in a complicated bilateral pathology. PMID:18545725

  19. Closed ruptures of the flexor digitorum tendons: MRI evaluation

    Drape, J.-L.; Chevrot, A. [Service de Radiologie B, Hopital Cochin, Paris (France); Tardif-Chastenet de Gery, S.; Silbermann-Hoffman, O.; Benacerraf, R. [Department of Skeletal Radiology, Hopital Bichat, Paris (France); Houvet, P.; Alnot, J.-Y. [Department of Orthopedics, Hopital Bichat, Paris (France)

    1998-11-01

    Objective. To assess the MRI findings in cases of closed rupture of the flexor digitorum tendons (FDT). Patients and design. Ten patients with a clinical suspicion of rupture of FDT underwent MRI before surgery. None of the patients presented a skin injury. Fingers were imaged using axial T1-weighted SE sequences, three-dimensional GE images, and curved reconstructions. Results. Twelve FDT had surgical confirmation of rupture. Flexor digitorum profundus (FDP) and flexor pollicis longus (FPL) tendons were more frequently ruptured (n=8) than flexor digitorum superficialis (FDS) tendons (n=4). MR images accurately depicted the level of the rupture. The gap between the tendon ends (mean 45 mm, range 21-70 mm) was assessed best with curved reconstructions and was well correlated with the surgical findings. The proximal end mainly retracted into the palm or the carpal tunnel (n=8), and less frequently into the digital canal (n=4). In two cases, the proximal end curled up in the palm, clinically simulating a rupture of a lumbrical muscle in one case. MRI also showed the appearance of the adjacent tendons. Conclusion. MRI accurately depicted the level of rupture and the gap between the tendon ends, which assisted the surgical choice between suture, graft or tendon transfer. (orig.) With 7 figs., 2 tabs., 40 refs.

  20. Biological fixation in anterior cruciate ligament surgery

    Chih-Hwa Chen

    2014-04-01

    Full Text Available Successful anterior cruciate ligament (ACL reconstruction with tendon graft requires extensive tendon-to-bone healing in the bone tunnels and progressive graft ligamentization for biological, structural, and functional recovery of the ACL. Improvement in graft-to-bone healing is crucial for facilitating early, aggressive rehabilitation after surgery to ensure an early return to pre-injury activity levels. The use of various biomaterials for enhancing the healing of tendon grafts in bone tunnels has been developed. With the biological enhancement of tendon-to-bone healing, biological fixation of the tendon graft in the tunnel can be achieved in ACL reconstruction.

  1. Local biochemical and morphological differences in human Achilles tendinopathy

    J, Pingel; Fredberg, Ulrich; K, Qvortrup;

    2012-01-01

    The incidence of Achilles tendinopathy is high and underlying etiology as well as biochemical and morphological pathology associated with the disease is largely unknown. The aim of the present study was to describe biochemical and morphological differences in chronic Achilles tendinopathy. The...

  2. A Review of Current Concepts in Flexor Tendon Repair: Physiology, Biomechanics, Surgical Technique and Rehabilitation.

    Singh, Rohit; Rymer, Ben; Theobald, Peter; Thomas, Peter B M

    2015-12-28

    Historically, the surgical treatment of flexor tendon injuries has always been associated with controversy. It was not until 1967, when the paper entitled Primary repair of flexor tendons in no man's land was presented at the American Society of Hand Surgery, which reported excellent results and catalyzed the implementation of this technique into worldwide practice. We present an up to date literature review using PubMed and Google Scholar where the terms flexor tendon, repair and rehabilitation were used. Topics covered included functional anatomy, nutrition, biome-chanics, suture repair, repair site gapping, and rehabilitation. This article aims to provide a comprehensive and complete overview of flexor tendon repairs. PMID:26793293

  3. The victorian institute of sports assessment - achilles questionnaire (visa-a) - a reliable tool for measuring achilles tendinopathy

    Iversen, Jonas Vestergård; Bartels, Else Marie; Langberg, Henning

    2012-01-01

    Achilles tendinopathy (AT) is a common pathology and the aetiology is unknown. For valid and reliable assessment The Victorian Institute of Sports Assessment has designed a self-administered Achilles questionnaire, the VISA-A. The aim of the present study was to evaluate VISA-A as an outcome meas...

  4. The victorian institute of sports assessment - achilles questionnaire (visa-a) - a reliable tool for measuring achilles tendinopathy

    Iversen, Jonas Vestergård; Bartels, Else Marie; Langberg, Henning

    2012-01-01

    Achilles tendinopathy (AT) is a common pathology and the aetiology is unknown. For valid and reliable assessment The Victorian Institute of Sports Assessment has designed a self-administered Achilles questionnaire, the VISA-A. The aim of the present study was to evaluate VISA-A as an outcome...

  5. Effects of denervation and immobilization on collagen synthesis in rat skeletal muscle and tendon.

    Savolainen, J; Myllylä, V; Myllylä, R; Vihko, V; Väänänen, K; Takala, T E

    1988-06-01

    The activities of prolyl 4-hydroxylase (PH) and galactosylhydroxylysyl glucosyltransferase (GGT), both enzymes of collagen biosynthesis, and the concentration of hydroxyproline (HYP) were measured in the gastrocnemius, soleus, and tibialis anterior muscles of rats after sciatic nerve neurectomy combined with cast immobilization of the denervated limb for 1 and 3 wk. PH and GGT were also observed in Achilles and tibialis anterior tendons after cast immobilization without neurectomy. After neurectomy the specific PH activity in the denervated gastrocnemius muscle increased by 215% (P less than 0.001). The specific GGT activity increased by 92-110% (P less than 0.01) in the denervated gastrocnemius, soleus, and tibialis anterior muscles. Elevation of the muscular HYP concentration by 118-170% (P less than 0.001) in the denervated muscles was observed. The PH, GGT, and HYP responses of the denervated muscles immobilized at a lengthened or shortened position during denervation atrophy did not generally differ significantly from those of the unfixed denervated ones. The specific PH and GGT activities of the disused tendons decreased by 62 (P less than 0.01) and 25% (P less than 0.001), respectively, in tendons immobilized in a chronically shortened position. The results suggest that denervation atrophy of skeletal muscle is associated with both an increased level of muscular collagen biosynthesis and with an increased muscular collagen concentration. The PH and GGT responses of the cast-immobilized tendons suggest adaptive changes in collagen biosynthesis of the disused tendon. PMID:2837917

  6. In Vivo Finger Flexor Tendon Force while Tapping on a Keyswitch

    Dennerlein, Jack Tigh; Diao, Edward; Mote, C. D.; Rempel, David M.

    1999-01-01

    Force may be a risk factor for musculoskeletal disorders of the upper extremity associated with typing and keying. However, the internal finger flexor tendon forces and their relationship to fingertip forces during rapid tapping on a keyswitch have not yet been measured in vivo. During the open carpal tunnel release surgery of five human subjects, a tendon-force transducer was inserted on the flexor digitorum super-ficialis of the long finger. During surgery, subjects tapped with the long fin...

  7. Clinical and morphological evaluation of snake venom derived fibrin glue on the tendon healing in dogs

    G. C. Ferraro

    2005-12-01

    Full Text Available The aim of this study was to evaluate the effect of snake venom derived fibrin glue on the healing of the deep digital flexor tendon, during three periods. The tendon of the 2nd digit of 30 thoracic limbs of dogs was partially sectioned for glue application. Biopsies were performed 7, 15, and 30 days post surgery for the clinical and morphological study of tendons. Analysis of the results showed that 73.3% of the tendons showed stump retraction and 16.6% moderate to excessive adherence, which affected sliding. There was a significant difference in the number of inflammatory cells among the three studied periods, being the highest on day 15. The morphological analysis revealed a typical tendon healing process with a lower level of inflammation in the acute phase, facilitating the cicatricial maturation phase. Snake venom derived fibrin glue promotes the healing in dog flexor tendon.

  8. POSTOPRATIVE REHABILITATION PROTOKOL AFTER MPSH / MODIFIED PERCUTANEAL SUTURE / OF ACHILES TENDON.

    Martin Barnev

    2012-04-01

    Full Text Available We present clinical study of 68 patients / male, mean age 38.5 yr / s applied early loading and functional treatment following percutaneous suture of Achilles tendon. Postoperatively were followed clinically and sonographic 3-6-12 meters of the results defined / visual analog scale / VSA in the score. In all patients, there are normal physical activity without significant differences in the mobility of the ankle joint. Not seen repeated ruptures. We agree that early mobilization and functional treatment did not increase the risk of reruptured and leads to excellent early function parameters of plantar flexione.

  9. Posterior Tibial Tendon Transfer.

    Shane, Amber M; Reeves, Christopher L; Cameron, Jordan D; Vazales, Ryan

    2016-01-01

    When performed correctly with the right patient population, a tibialis posterior muscle/tendon transfer is an effective procedure. Many different methods have been established for fixating the tendon, each of which has its' own indications. Passing through the interosseous membrane is the preferred and recommended method and should be used unless this is not possible. Good surgical planning based on patient needs and expectations, along with excellent postoperative care including early range of motion and physical therapy minimizes risk of complications and allows for the optimal outcome to be achieved. PMID:26590722

  10. Effects of a Dynamic Warm-Up, Static Stretching or Static Stretching with Tendon Vibration on Vertical Jump Performance and EMG Responses

    Yapicioglu, Bulent; Colakoglu, Muzaffer; Colakoglu, Zafer; Gulluoglu, Halil; Bademkiran, Fikret; Ozkaya, Ozgur

    2013-01-01

    The purpose of this study was to investigate the short-term effects of static stretching, with vibration given directly over Achilles tendon, on electro-myographic (EMG) responses and vertical jump (VJ) performances. Fifteen male, college athletes voluntarily participated in this study (n=15; age: 22±4 years old; body height: 181±10 cm; body mass: 74±11 kg). All stages were completed within 90 minutes for each participant. Tendon vibration bouts lasted 30 seconds at 50 Hz for each volunteer. ...

  11. Bilateral flexor tendon contracture following onychectomy in 2 cats.

    Cooper, Maureen A; Laverty, Peter H; Soiderer, Emily E

    2005-03-01

    Two cats presented with bilateral flexor tendon contracture following onychectomy. This previously unreported complication proved to be painful and debilitating. Deep digital flexor tenectomy successfully resolved the problem. Twelve months after surgery, the first cat remains free of complications. The second cat recovered full limb function, but died of unrelated causes. PMID:15884646

  12. Bilateral flexor tendon contracture following onychectomy in 2 cats

    Cooper, Maureen A; Laverty, Peter H.; Soiderer, Emily E.

    2005-01-01

    Two cats presented with bilateral flexor tendon contracture following onychectomy. This previously unreported complication proved to be painful and debilitating. Deep digital flexor tenectomy successfully resolved the problem. Twelve months after surgery, the first cat remains free of complications. The second cat recovered full limb function, but died of unrelated causes.

  13. Cross-cultural adaptation and validation of the VISA-A questionnaire for German-speaking Achilles tendinopathy patients

    Nauck Tanja

    2009-10-01

    Full Text Available Abstract Background Achilles tendinopathy is the predominant overuse injury in runners. To further investigate this overload injury in transverse and longitudinal studies a valid, responsive and reliable outcome measure is demanded. Most questionnaires have been developed for English-speaking populations. This is also true for the VISA-A score, so far representing the only valid, reliable, and disease specific questionnaire for Achilles tendinopathy. To internationally compare research results, to perform multinational studies or to exclude bias originating from subpopulations speaking different languages within one country an equivalent instrument is demanded in different languages. The aim of this study was therefore to cross-cultural adapt and validate the VISA-A questionnaire for German-speaking Achilles tendinopathy patients. Methods According to the "guidelines for the process of cross-cultural adaptation of self-report measures" the VISA-A score was cross-culturally adapted into German (VISA-A-G using six steps: Translation, synthesis, back translation, expert committee review, pretesting (n = 77, and appraisal of the adaptation process by an advisory committee determining the adequacy of the cross-cultural adaptation. The resulting VISA-A-G was then subjected to an analysis of reliability, validity, and internal consistency in 30 Achilles tendinopathy patients and 79 asymptomatic people. Concurrent validity was tested against a generic tendon grading system (Percy and Conochie and against a classification system for the effect of pain on athletic performance (Curwin and Stanish. Results The "advisory committee" determined the VISA-A-G questionnaire as been translated "acceptable". The VISA-A-G questionnaire showed moderate to excellent test-retest reliability (ICC = 0.60 to 0.97. Concurrent validity showed good coherence when correlated with the grading system of Curwin and Stanish (rho = -0.95 and for the Percy and Conochie grade of

  14. 3-D ultrastructure and collagen composition of healthy and overloaded human tendon

    Pingel, Jessica; Lu, Yinhui; Starborg, Tobias;

    2014-01-01

    Achilles tendinopathies display focal tissue thickening with pain and ultrasonography changes. Whilst complete rupture might be expected to induce changes in tissue organization and protein composition, little is known about the consequences of non-rupture-associated tendinopathies, especially with...... tendons of six individuals with clinically diagnosed tendinopathy who had no evidence of cholesterol, uric acid and amyloid accumulation. Biochemical analyses of collagen III/I ratio were performed on all six individuals, and electron microscope analysis using transmission electron microscopy and serial...... nuclei; and (iv) an increase in the ratio of small-diameter : large-diameter collagen fibrils. In summary, load-induced non-rupture tendinopathy in humans is associated with localized biochemical changes, a shift from large- to small-diameter fibrils, buckling of the tendon ECM, and buckling of the cells...

  15. Architecture and functional ecology of the human gastrocnemius muscle-tendon unit.

    Butler, Erin E; Dominy, Nathaniel J

    2016-04-01

    The gastrocnemius muscle-tendon unit (MTU) is central to human locomotion. Structural variation in the human gastrocnemius MTU is predicted to affect the efficiency of locomotion, a concept most often explored in the context of performance activities. For example, stiffness of the Achilles tendon varies among individuals with different histories of competitive running. Such a finding highlights the functional variation of individuals and raises the possibility of similar variation between populations, perhaps in response to specific ecological or environmental demands. Researchers often assume minimal variation in human populations, or that industrialized populations represent the human species as well as any other. Yet rainforest hunter-gatherers, which often express the human pygmy phenotype, contradict such assumptions. Indeed, the human pygmy phenotype is a potential model system for exploring the range of ecomorphological variation in the architecture of human hindlimb muscles, a concept we review here. PMID:26712532

  16. Acromioclavicular joint reconstruction using a tendon graft: a biomechanical study comparing a novel “sutured throughout” tendon graft to a standard tendon graft

    Naziri Qais

    2016-01-01

    Full Text Available Background: With a recurrence rate of over 30%, techniques that offer stronger acromioclavicular (AC joint reconstruction through increased graft strength may provide longevity. The purpose of our study was to determine the biomechanical strength of a novel tendon graft sutured throughout compared to a native tendon graft in Grade 3 anatomical AC joint reconstruction. Methods: For this in vitro experiment, nine paired (n = 18 embalmed cadaveric AC joints of three males and six females (age 86 years, range 51–94 years were harvested. Anatomic repair with fresh bovine Achilles tendon grafts without bone block was simulated. Specimens were divided into two groups; with group 1 using grafts with ultra-high molecular-weight polyethylene (UHMWPE suture ran throughout the entire length. In group 2, reconstruction with only native allografts was performed. The distal scapula and humerus were casted in epoxy compound and mounted on the mechanical testing machine. Tensile tests were performed using a mechanical testing machine at the rate of 50 mm/min. Maximum load and displacement to failure were collected. Results: The average load to failure was significantly higher for group 1 compared to group 2, with mean values of 437.5 N ± 160.7 N and 94.4 N ± 43.6 N, (p = 0.001. The average displacement to failure was not significantly different, with 29.7 mm ± 10.6 mm in group 1 and 25 mm ± 9.1 mm in group 2 (p = 0.25. Conclusion: We conclude that a UHMWPE suture reinforced graft can provide a 3.6 times stronger AC joint reconstruction compared to a native graft.

  17. 体外冲击波治疗跟腱腱病的临床疗效研究%The treatment with extracorporeal shock waves for Achilles tendinopathy

    黄合琴; 杨柳; 段小军; 陈光兴; 郭林; 何锐

    2015-01-01

    could be released with rest .Before the treatment ,routine checkups were performed including X‐ray of ankle joint with normal side and MRI ,which brought out a definite diagnosis and evacuated other reasons resulting pain .The treatment of blast was 2 000 pulse per time ,once a week and four times in total .During the treatment period ,patients were suggested to prevent from strenuous exercise and had the anodyne on the evening of the first day when they underwent the shock waves .VAS and AO‐FAS was used to evaluate the effectiveness with the records ,before the treatment ,after four‐time treatment ,after three‐month treatment .Patients′complications and follow‐ups were recorded and VAS results were assessed with statistical analysis .Results 32 patients had full follow‐ups .22 of them had insertion tendopathy .10 patients had non‐insertion tendopathy .8 patients had bilat‐eral lesion and 24 patients had unilateral lesion .Part of erythema appeared in five patients and could be relieved after rest .One pa‐tient achieved pain release after four‐time treatment ,but fell down going downstairs and resulted rupture of tendon .All patients had VAS assessment for three times ,with the score 8 .2 ± 1 .5 before the treatment(P0 .05) .The score of AOFAS were 72 .2 ± 5 .1 ,86 .3 ± 5 .2 and 91 .3 ± 3 .5(P<0 .01) .Conclusion When treating on Achilles tendopathy ,extracorporeal shock wave can improve the local symptoms .With minor trauma and reliable outcome ,it brings patients benefits that treat tendon disease without surgery or postponing the surgery .

  18. Repaired supraspinatus tendons in clinically improving patients: Early postoperative findings and interval changes on MRI

    Lee, Jung Eun; Park, Ji Seon; Ryu, Kyung Nam; Rhee, Yong Girl [Kyung Hee University Hospital, Seoul (Korea, Republic of); Yoon, So Hee; Park, So Young; Jin Wook [Dept. of Radiology, Kyung Hee University Hospital at Gangdong, Seoul (Korea, Republic of)

    2015-04-15

    To demonstrate and further determine the incidences of repaired supraspinatus tendons on early postoperative magnetic resonance imaging (MRI) findings in clinically improving patients and to evaluate interval changes on follow-up MRIs. Fifty patients, who showed symptomatic and functional improvements after supraspinatus tendon repair surgery and who underwent postoperative MRI twice with a time interval, were included. The first and the second postoperative MRIs were obtained a mean of 4.4 and 11.5 months after surgery, respectively. The signal intensity (SI) patterns of the repaired tendon on T2-weighted images from the first MRI were classified into three types of heterogeneous high SI with fluid-like bright high foci (type I), heterogeneous high SI without fluid-like bright high foci (type II), and heterogeneous or homogeneous low SI (type III). Interval changes in the SI pattern, tendon thickness, and rotator cuff interval thickness between the two postoperative MRIs were evaluated. The SI patterns on the first MRI were type I or II in 45 tendons (90%) and type III in five (10%). SI decreased significantly on the second MRI (p < 0.050). The mean thickness of repaired tendons and rotator cuff intervals also decreased significantly (p < 0.050). Repaired supraspinatus tendons exhibited high SI in 90% of clinically improving patients on MRI performed during the early postsurgical period. The increased SI and thickness of the repaired tendon decreased on the later MRI, suggesting a gradual healing process rather than a retear.

  19. Management of Extensor Tendon Injuries

    Griffin, M; Hindocha, S; Jordan, D.; Saleh, M; Khan, W.

    2012-01-01

    Extensor tendon injuries are very common injuries, which inappropriately treated can cause severe lasting impairment for the patient. Assessment and management of flexor tendon injuries has been widely reviewed, unlike extensor injuries. It is clear from the literature that extensor tendon repair should be undertaken immediately but the exact approach depends on the extensor zone. Zone I injuries otherwise known as mallet injuries are often closed and treated with immobilisaton and conservati...

  20. Inspection of tendons

    There is no reliable inspection method of tendons in use in Finland. In this research an inspection method was developed which can be applied when the sheath is of metallic material. The sheath is first revealed using a core cutter. A hole is then picked on the sheath and the condition of the injection grout and the tendons are inspected using an endoscope. A camera may be attached to the endoscope. To prevent the sheath from damaging during drilling a protective voltage is connected to the drill and the sheath is earthed. When the cutting edge hits the sheath the electric current is disconnected automatically. Experiments were made with the inspection method on three bridges one of which was still under construction and had no superstructure, one had just been constructed and one was 29 years old. The drillings for inspection were carried out on the top of the decks. The method worked as planned in all cases. In section 6 an example of corrosion classification is given which may be used when estimating whether the corrosion weakens the bearing capacity of the inspected tendons or not. (au) (1 ref., 25 figs.)

  1. Novel methods for tendon investigations

    Kjær, Michael; Langberg, Henning; Bojsen-Møller, J.;

    2008-01-01

    Purpose. Tendon structures have been studied for decades, but over the last decade, methodological development and renewed interest for metabolic, circulatory and tissue protein turnover in tendon tissue has resulted in a rising amount of investigations. Method. This paper will detail the various...... modern investigative techniques available to study tendons. Results. There are a variety of investigative methods available to study the correlations between mechanics and biology in tendons. Conclusion. The available methodologies not only allow for potential insight into physiological and...

  2. Association between distal ulnar morphology and extensor carpi ulnaris tendon pathology

    The purpose of this study was to evaluate the association between distal ulnar morphology and extensor carpi ulnaris (ECU) tendon pathology. We retrospectively reviewed 71 adult wrist MRI studies with ECU tendon pathology (tenosynovitis, tendinopathy, or tear), and/or ECU subluxation. Subjects did not have a history of trauma, surgery, infection, or inflammatory arthritis. MRI studies from 46 subjects without ECU tendon pathology or subluxation were used as controls. The following morphological parameters of the distal ulna were measured independently by two readers: ulnar variance relative to radius, ulnar styloid process length, ECU groove depth and length. Subjects and controls were compared using Student's t test. Inter-observer agreement (ICC) was calculated. There was a significant correlation between negative ulnar variance and ECU tendon pathology (reader 1 [R1], P = 0.01; reader 2 [R2], P 0.64 for all parameters. Distal ulnar morphology may be associated with ECU tendon abnormalities. (orig.)

  3. Achilles tendinopathy in amateur runners: role of adiposity (Tendinopathies and obesity)

    Abate, Michele; Oliva, Francesco; Schiavone, Cosima; Salini, Vincenzo

    2012-01-01

    Obesity is an important risk factor for Achilles tendinopathy, and running is usually carried out to reduce excess body weight. Aim of this study was to evaluate the prevalence of Achilles tendinopathy in young over-weight amateur runners.

  4. A Comparison of Two Different High-Volume Image-Guided Injection Procedures for Patients With Chronic Noninsertional Achilles Tendinopathy: A Pragmatic Retrospective Cohort Study.

    Wheeler, Patrick C; Mahadevan, Dev; Bhatt, Raj; Bhatia, Maneesh

    2016-01-01

    We undertook a comparison evaluation of outcomes after 2 different high-volume image-guided injection (HVIGI) procedures performed under direct ultrasound guidance in patients with chronic noninsertional Achilles tendinopathy. In group A, the HVIGI involved high-volume (10 mL of 1% lidocaine combined with 40 mL of saline) and no dry needling. In group B, the HVIGI involved a smaller volume (10 mL of 1% lidocaine combined with 20 mL of saline) and dry needling of the Achilles tendon. A total of 34 patients were identified from the clinical records, with a mean overall age of 50.6 (range 26 to 83) years and an overall mean follow-up duration of 277 (range 49 to 596) days. The change between the preinjection and postinjection Victorian Institute of Sports Assessment-Achilles scores of 33.4 ± 22.5 points in group A and 6.94 ± 22.2 points in group B, was statistically significant (p = .002). In group A, 3 patients (16.7%) required surgical treatment compared with 6 patients (37.5%) in group B requiring surgical treatment (p = .180). Our results indicated that a higher volume without dry needling compared with a lower volume with dry needling resulted in greater improvement in noninsertional Achilles tendinopathy. However, confounding factors mean it is not possible to categorically state that this difference was solely due to different injection techniques. PMID:27286927

  5. Split tendon transfers for the correction of spastic varus foot deformity: a case series study

    Dimitriadis Dimitris

    2010-12-01

    Full Text Available Abstract Background Overactivity of anterior and/or posterior tibial tendon may be a causative factor of spastic varus foot deformity. The prevalence of their dysfunction has been reported with not well defined results. Although gait analysis and dynamic electromyography provide useful information for the assessment of the patients, they are not available in every hospital. The purpose of the current study is to identify the causative muscle producing the deformity and apply the most suitable technique for its correction. Methods We retrospectively evaluated 48 consecutive ambulant patients (52 feet with spastic paralysis due to cerebral palsy. The average age at the time of the operation was 12,4 yrs (9-18 and the mean follow-up 7,8 yrs (4-14. Eigtheen feet presented equinus hind foot deformity due to gastrocnemius and soleus shortening. According to the deformity, the feet were divided in two groups (Group I with forefoot and midfoot inversion and Group II with hindfoot varus. The deformities were flexible in all cases in both groups. Split anterior tibial tendon transfer (SPLATT was performed in Group I (11 feet, while split posterior tibial tendon transfer (SPOTT was performed in Group II (38 feet. In 3 feet both procedures were performed. Achilles tendon sliding lengthening (Hoke procedure was done in 18 feet either preoperatively or concomitantly with the index procedure. Results The results in Group I, were rated according to Hoffer's clinical criteria as excellent in 8 feet and satisfactory in 3, while in Group II according to Kling's clinical criteria were rated as excellent in 20 feet, good in 14 and poor in 4. The feet with poor results presented residual varus deformity due to intraoperative technical errors. Conclusion Overactivity of the anterior tibial tendon produces inversion most prominent in the forefoot and midfoot and similarly overactivity of the posterior tibial tendon produces hindfoot varus. The deformity can be

  6. Tendon patch grafting using the long head of the biceps for irreparable massive rotator cuff tears

    Surgical treatment of massive rotator cuff tears is challenging for shoulder surgeons. The purpose of this study was to investigate both clinical outcomes and cuff integrity after tendon patch grafting using the long head of the biceps (LHB) tendon for irreparable massive rotator cuff tears. A short deltoid splitting approach was used to expose the torn cuff tendon stump. After tenodesis of the LHB tendon, its intraarticular portion was resected. If the size of the harvested tendon was smaller than that of the cuff defect, it was split into two layers. Then, the LHB tendon was sutured to the remnant cuff tendons and fixed to the footprint using the transosseous suture technique. A total of 14 patients (12 men, 2 women; average age 64 years) underwent this procedure. The average postoperative follow-up period was 28 months (range 12-51 months). Active elevation angle of the shoulder as well as the Japanese Orthopaedic Association (JOA) score were assessed before surgery and at the time of follow-up. Postoperative cuff integrity was assessed using T2-weighted magnetic resonance imaging (MRI). All cuff defects were successfully closed with this technique. Average active elevation angle improved from 69deg to 149deg. Total JOA score also improved from 54.7 points to 83.1 points. Thirteen shoulders showed no re-tearing on T2-weighted MRI; a minor discontinuity of the repaired cuff tendon was observed in the other shoulder. The LHB tendon is available in case tenodesis or tenotomy is needed. The resected tendon may be used as a graft for rotator cuff repair without any additional skin incision, which could reduce both the surgical invasion and the risk of infection. The LHB tendon patch grafting may be one of the useful options for surgical treatment of irreparable massive rotator cuff tears. (author)

  7. Effects of corticosteroids and hyaluronic acid on torn rotator cuff tendons in vitro and in rats.

    Nakamura, Hidehiro; Gotoh, Masafumi; Kanazawa, Tomonoshin; Ohta, Keisuke; Nakamura, Keiichirou; Honda, Hirokazu; Ohzono, Hiroki; Shimokobe, Hisao; Mitsui, Yasuhiro; Shirachi, Isao; Okawa, Takahiro; Higuchi, Fujio; Shirahama, Masahiro; Shiba, Naoto; Matsueda, Satoko

    2015-10-01

    Corticosteroids (CS) or hyaluronic acid (HA) is used in subacromial injection for the conservative treatment of rotator cuff tears (RCT); this study addresses the question of how CS and HA affect the tendon tissue and fibroblasts in vitro and in rats. Cell proliferation assays were performed in human tendon fibroblasts from RCT. Rats underwent surgery to create RCT, and the surgical sites were injected with CS or HA. The rotator cuff tendons were subjected to biomechanical testing, microscopic and immunohistochemical analysis of proliferating cell nuclear antigen (PCNA), and ultrastructural analysis. Cell proliferation was significantly decreased with CS in vitro (p site. PMID:26174562

  8. Extrusion of bone anchor suture following flexor digitorum profundus tendon avulsion injury repair.

    Tiong, William H C

    2011-09-01

    Flexor digitorum profundus (FDP) zone I tendon avulsion injury is traditionally repaired with a pullout suture technique. More recently, bone anchor sutures have been used as a viable alternative and have largely replaced areas in hand surgery where pullout suture technique was once required. To date, there have been very few complications reported related to bone anchor suture use in FDP tendon reattachment to the bone. We report a very unusual case of extrusion of bone anchor through the nailbed, 6 years after zone I FDP tendon avulsion injury repair and a brief review of literature.

  9. Adipose derived stromal vascular fraction improves early tendon healing: an experimental study in rabbits

    Mehdi Behfar

    2011-11-01

    Full Text Available Tendon never restores the complete biological and mechanical properties after healing. Bone marrow and recently adipose tissue have been used as the sources of mesenchymal stem cells, which have been proven to enhance tendon healing. Stromal vascular fraction (SVF, derived from adipose tissue by an enzymatic digestion, represents an alternative source of multipotent cells, which undergo differentiation into multiple lineages to be used in regenerative medicine. In the present study, we investigated potentials of this source on tendon healing. Twenty rabbits were divided into control and treatment groups. Five rabbits were used as donors of adipose tissue. The injury model was unilateral complete transection through the middle one third of deep digital flexor tendon. Immediately after suture repair, either fresh stromal vascular fraction from enzymatic digestion of adipose tissue or placebo was intratendinously injected into the suture site in treatments and controls, respectively. Cast immobilization was continued for two weeks after surgery. Animals were sacrificed at the third week and tendons underwent histological, immunohistochemical, and mechanical evaluations. By histology, improved fibrillar organization and remodeling of neotendon were observed in treatment group. Immunohistochemistry revealed an insignificant increase in collagen type III and I expression in treatments over controls. Mechanical testing showed significant increase in maximum load and energy absorption in SVF treated tendons. The present study showed that intratendinous injection of uncultured adipose derived stromal vascular fraction improved structural and mechanical properties of repaired tendon and it could be an effective modality for treating tendon laceration.

  10. Ovine tendon collagen: Extraction, characterisation and fabrication of thin films for tissue engineering applications.

    Fauzi, M B; Lokanathan, Y; Aminuddin, B S; Ruszymah, B H I; Chowdhury, S R

    2016-11-01

    Collagen is the most abundant extracellular matrix (ECM) protein in the human body, thus widely used in tissue engineering and subsequent clinical applications. This study aimed to extract collagen from ovine (Ovis aries) Achilles tendon (OTC), and to evaluate its physicochemical properties and its potential to fabricate thin film with collagen fibrils in a random or aligned orientation. Acid-solubilized protein was extracted from ovine Achilles tendon using 0.35M acetic acid, and 80% of extracted protein was measured as collagen. SDS-PAGE and mass spectrometry analysis revealed the presence of alpha 1 and alpha 2 chain of collagen type I (col I). Further analysis with Fourier transform infrared spectrometry (FTIR), X-ray diffraction (XRD) and energy dispersive X-ray spectroscopy (EDS) confirms the presence of triple helix structure of col I, similar to commercially available rat tail col I. Drying the OTC solution at 37°C resulted in formation of a thin film with randomly orientated collagen fibrils (random collagen film; RCF). Introduction of unidirectional mechanical intervention using a platform rocker prior to drying facilitated the fabrication of a film with aligned orientation of collagen fibril (aligned collagen film; ACF). It was shown that both RCF and ACF significantly enhanced human dermal fibroblast (HDF) attachment and proliferation than that on plastic surface. Moreover, cells were distributed randomly on RCF, but aligned with the direction of mechanical intervention on ACF. In conclusion, ovine tendon could be an alternative source of col I to fabricate scaffold for tissue engineering applications. PMID:27524008

  11. Mini-open repair of achilles rupture in the national football league.

    McCullough, Kirk A; Shaw, Christopher M; Anderson, Robert B

    2014-01-01

    Tears of the Achilles tendon in professional athletes are an infrequent yet devastating injury. Historical studies have demonstrated not only a poor rate of return to competitive play but have also noted significant declines in performance for those able to return. While classic treatment of these injuries in the competitive athlete has been an open, locked suture repair, this article reports on a consecutive series of professional football athletes who underwent mini-open repair. All athletes returned to professional football, with seven out of nine (78%) returning to National Football League (NFL) competition. Average return to play was 273 days (8.9 months), with one athlete returning at 166 days (5.4 months). There have been no reruptures and no sural nerve or wound healing complications. Although limited in number currently, mini-open repair in NFL athletes has allowed successful return to competitive play with no reruptures and a trend toward faster return to play compared with historical open repair outcomes. PMID:25785466

  12. A STUDY TO COMPARE THE EFFICACY OF ULTRASOUND WITH ECCENTRIC EXERCISES AND ULTRASOUND WITH CONCENTRIC EXERCISES ON TENDO ACHILLES TENDINITIS IN ATHELETES

    Ravish

    2014-02-01

    Full Text Available In a previous uncontrolled pilot study we demonstrated very good clinical results with eccentric calf muscle training on patients with painful chronic Achilles tendinosis located at the 2-6 cm level in the tendon. In the present prospective study patients with painful chronic Achilles tendinosis at the 2-6 cm level in the tendon were randomized to treatment with either an eccentric or a concentric training regimen for the calf muscles with therapeutic ultrasound. The study included 60 patients, with 30 in each group mean age 30 years in each treatment group. The amount of pain during activity (jogging or walking was recorded by the patients on a visual analogue scale, and patient satisfaction was assessed before and after treatment. The patients were instructed to perform their eccentric or concentric training regimen on a daily basis for 12 weeks. In both types of treatment regimen the patients were told to do their exercises despite experiencing pain or discomfort in the tendon during exercise. The results showed that after the eccentric training regimen 80% of the patients (24/30 were satisfied and had resumed their previous activity level (before injury, compared to 63% of the patients (19/30 who were treated with the concentric training regimen with therapeutic ultrasound as the common modality. The results of means of pain is (0.902 is significant, for range of motion is (0.042 which is not significant and foot ankle ability measure is (0.311 is significant after treatment with eccentric training was significantly better than after concentric training.

  13. Autologous leukocyte-reduced platelet-rich plasma therapy for Achilles tendinopathy induced by collagenase in a rabbit model

    González, Juan C.; López, Catalina; Álvarez, María E.; Pérez, Jorge E.; Carmona, Jorge U.

    2016-01-01

    Leukocyte-reduced platelet-rich plasma (LR-PRP) is a therapy for tendinopathy of the Achilles tendon (TAT); however, there is scarce information regarding LR-PRP effects in rabbit models of TAT. We compared, at 4 and 12 weeks (w), the LR-PRP and placebo (PBS) effects on ultrasonography, histology and relative gene expression of collagen types I (COL1A1) and III (COL3A1) and vascular endothelial growth factor (VEGF) in 24 rabbits with TAT induced by collagenase. The rabbits (treated with both treatments) were euthanatised after either 4 or 12 w. A healthy group (HG (n = 6)) was included. At 4 and 12 w, the LR-PRP group had a no statistically different histology score to the HG. At w 4, the COL1A1 expression was significantly higher in the LR-PRP group when compared to HG, and the expression of COL3A1from both LR-PRP and PBS-treated tendons was significantly higher when compared to the HG. At w 12, the expression of COL3A1 remained significantly higher in the PBS group in comparison to the LR-PRP group and the HG. At w 4, the LR-PRP group presented a significantly higher expression of VEGF when compared to the PBS group and the HG. In conclusion, LR-PRP treatment showed regenerative properties in rabbits with TAT. PMID:26781753

  14. Tibialis posterior tendon transfer for drop foot deformity

    Bekler, Halil; Beyzadeoglu, Tahsin; Gokce, Alper

    2004-01-01

    Objectives: We evaluated tibialis posterior tendon (TPT) transfers in patients with drop foot deformity. Methods: Eight patients with drop foot deformity (2 females, 6 males; mean age 40 years; range 15 to 75 years) underwent TPT transfer to the dorsum of the foot. The deformity was on the left in three patients and on the right in five patients. Etiology was traumatic peroneal nerve injuries in six patients, and upper-level nerve injuries after hip and lumbar surgery in two patients. For ...

  15. {sup 18}F-fluorodeoxyglucose and PET/CT for noninvasive study of exercise-induced glucose uptake in rat skeletal muscle and tendon

    Skovgaard, Dorthe [University of Copenhagen, Cluster for Molecular Imaging, Faculty of Health Sciences, Copenhagen (Denmark); Bispebjerg Hospital, Institute of Sports Medicine, Copenhagen, NV (Denmark); Kjaer, Michael [Bispebjerg Hospital, Institute of Sports Medicine, Copenhagen, NV (Denmark); El-Ali, Henrik [University of Copenhagen, Cluster for Molecular Imaging, Faculty of Health Sciences, Copenhagen (Denmark); Kjaer, Andreas [University of Copenhagen, Cluster for Molecular Imaging, Faculty of Health Sciences, Copenhagen (Denmark); Rigshospitalet, Department Clinical Physiology, Nuclear Medicine and PET, Center of Diagnostic Investigations, Copenhagen (Denmark)

    2009-05-15

    To investigate exercise-related glucose uptake in rat muscle and tendon using PET/CT and to study possible explanatory changes in gene expression for the glucose transporters (GLUT1 and GLUT4). The sciatic nerve in eight Wistar rats was subjected to electrostimulation to cause unilateral isometric contractions of the calf muscle. {sup 18}F-Fluorodeoxyglucose was administered and a PET/CT scan of the hindlimbs was performed. SUVs were calculated in both Achilles tendons and the triceps surae muscles. To exclude a spill-over effect the tendons and muscles from an ex vivo group of eight rats were cut out and scanned separately (distance{>=}1 cm). Muscle contractions increased glucose uptake approximately sevenfold in muscles (p<0.001) and 36% in tendons (p<0.01). The ex vivo group confirmed the increase in glucose uptake in intact animals. GLUT1 and GLUT4 were expressed in both skeletal muscle and tendon, but no changes in mRNA levels could be detected. PET/CT can be used for studying glucose uptake in rat muscle and tendon in relation to muscle contractions; however, the increased uptake of glucose was not explained by changes in gene expression of GLUT1 and GLUT4. (orig.)

  16. 18F-fluorodeoxyglucose and PET/CT for noninvasive study of exercise-induced glucose uptake in rat skeletal muscle and tendon

    To investigate exercise-related glucose uptake in rat muscle and tendon using PET/CT and to study possible explanatory changes in gene expression for the glucose transporters (GLUT1 and GLUT4). The sciatic nerve in eight Wistar rats was subjected to electrostimulation to cause unilateral isometric contractions of the calf muscle. 18F-Fluorodeoxyglucose was administered and a PET/CT scan of the hindlimbs was performed. SUVs were calculated in both Achilles tendons and the triceps surae muscles. To exclude a spill-over effect the tendons and muscles from an ex vivo group of eight rats were cut out and scanned separately (distance≥1 cm). Muscle contractions increased glucose uptake approximately sevenfold in muscles (p<0.001) and 36% in tendons (p<0.01). The ex vivo group confirmed the increase in glucose uptake in intact animals. GLUT1 and GLUT4 were expressed in both skeletal muscle and tendon, but no changes in mRNA levels could be detected. PET/CT can be used for studying glucose uptake in rat muscle and tendon in relation to muscle contractions; however, the increased uptake of glucose was not explained by changes in gene expression of GLUT1 and GLUT4. (orig.)

  17. Physical exercise can influence local levels of matrix metalloproteinases and their inhibitors in tendon-related connective tissue

    Koskinen, S O A; Heinemeier, K M; Olesen, J L;

    2004-01-01

    Microdialysis studies indicate that mechanical loading of human tendon tissue during exercise or training can affect local synthesis and degradation of type I collagen. Degradation of collagen and other extracellular matrix proteins is controlled by an interplay between matrix metalloproteinases...... (placed in the peritendinous tissue immediately anterior to the Achilles tendon) before, immediately after, 1 day after, and 3 days after an exercise bout. MMP-2 and MMP-9 were measured in dialysate by gelatin zymography, and amounts were quantified by densitometry in relation to total protein...... in the dialysate. TIMP-1 and TIMP-2 were analyzed by reverse gelatin zymography and semiquantitated visually. Pro-MMP-9 increased markedly after exercise and remained high for 3 days after exercise. Pro-MMP-2 dropped from the basal level immediately after exercise and remained low 1 day after exercise...

  18. Calcific tendonitis of the tibialis posterior tendon at the navicular attachment

    Harries, Luke; Kempson, Susan; Watura, Roland

    2011-01-01

    Calcific tendinosis (tendonosis/tendonitis) is a condition which results from the deposition of calcium hydroxyapatite crystals in any tendon of the body. Calcific tendonitis usually presents with pain, which can be exacerbated by prolonged use of the affected tendon. We report a case of calcific tendinosis in the posterior tibialis tendon at the navicular insertion. The pathology is rare in the foot, and extremely rare in the tibialis posterior tendon, indeed there are only 2 reported in the...

  19. Evolutionary origins of C-terminal (GPPn 3-hydroxyproline formation in vertebrate tendon collagen.

    David M Hudson

    Full Text Available Approximately half the proline residues in fibrillar collagen are hydroxylated. The predominant form is 4-hydroxyproline, which helps fold and stabilize the triple helix. A minor form, 3-hydroxyproline, still has no clear function. Using peptide mass spectrometry, we recently revealed several previously unknown molecular sites of 3-hydroxyproline in fibrillar collagen chains. In fibril-forming A-clade collagen chains, four new partially occupied 3-hydroxyproline sites were found (A2, A3, A4 and (GPPn in addition to the fully occupied A1 site at Pro986. The C-terminal (GPPn motif has five consecutive GPP triplets in α1(I, four in α2(I and three in α1(II, all subject to 3-hydroxylation. The evolutionary origins of this substrate sequence were investigated by surveying the pattern of its 3-hydroxyproline occupancy from early chordates through amphibians, birds and mammals. Different tissue sources of type I collagen (tendon, bone and skin and type II collagen (cartilage and notochord were examined by mass spectrometry. The (GPPn domain was found to be a major substrate for 3-hydroxylation only in vertebrate fibrillar collagens. In higher vertebrates (mouse, bovine and human, up to five 3-hydroxyproline residues per (GPPn motif were found in α1(I and four in α2(I, with an average of two residues per chain. In vertebrate type I collagen the modification exhibited clear tissue specificity, with 3-hydroxyproline prominent only in tendon. The occupancy also showed developmental changes in Achilles tendon, with increasing 3-hydroxyproline levels with age. The biological significance is unclear but the level of 3-hydroxylation at the (GPPn site appears to have increased as tendons evolved and shows both tendon type and developmental variations within a species.

  20. Evolutionary origins of C-terminal (GPP)n 3-hydroxyproline formation in vertebrate tendon collagen.

    Hudson, David M; Werther, Rachel; Weis, MaryAnn; Wu, Jiann-Jiu; Eyre, David R

    2014-01-01

    Approximately half the proline residues in fibrillar collagen are hydroxylated. The predominant form is 4-hydroxyproline, which helps fold and stabilize the triple helix. A minor form, 3-hydroxyproline, still has no clear function. Using peptide mass spectrometry, we recently revealed several previously unknown molecular sites of 3-hydroxyproline in fibrillar collagen chains. In fibril-forming A-clade collagen chains, four new partially occupied 3-hydroxyproline sites were found (A2, A3, A4 and (GPP)n) in addition to the fully occupied A1 site at Pro986. The C-terminal (GPP)n motif has five consecutive GPP triplets in α1(I), four in α2(I) and three in α1(II), all subject to 3-hydroxylation. The evolutionary origins of this substrate sequence were investigated by surveying the pattern of its 3-hydroxyproline occupancy from early chordates through amphibians, birds and mammals. Different tissue sources of type I collagen (tendon, bone and skin) and type II collagen (cartilage and notochord) were examined by mass spectrometry. The (GPP)n domain was found to be a major substrate for 3-hydroxylation only in vertebrate fibrillar collagens. In higher vertebrates (mouse, bovine and human), up to five 3-hydroxyproline residues per (GPP)n motif were found in α1(I) and four in α2(I), with an average of two residues per chain. In vertebrate type I collagen the modification exhibited clear tissue specificity, with 3-hydroxyproline prominent only in tendon. The occupancy also showed developmental changes in Achilles tendon, with increasing 3-hydroxyproline levels with age. The biological significance is unclear but the level of 3-hydroxylation at the (GPP)n site appears to have increased as tendons evolved and shows both tendon type and developmental variations within a species. PMID:24695516

  1. Smart Tendon Actuated Flexible Actuator

    Md. Masum Billah; Raisuddin Khan

    2015-01-01

    We investigate the kinematic feasibility of a tendon-based flexible parallel platform actuator. Much of the research on tendon-driven Stewart platforms is devoted either to the completely restrained positioning mechanism (CRPM) or to one particular type of the incompletely restrained positioning mechanism (IRPM) where the external force is provided by the gravitational pull on the platform such as in cable-suspended Stewart platforms. An IRPM-based platform is proposed which uses the external...

  2. Hyaluronic acid and tendon lesions

    Kaux, Jean-François; Samson, Antoine; Crielaard, Jean-Michel

    2015-01-01

    Summary Introduction recently, the viscoelastic properties of hyaluronic acid (HA) on liquid connective tissue have been proposed for the treatment of tendinopathies. Some fundamental studies show encouraging results on hyaluronic acid’s ability to promote tendon gliding and reduce adhesion as well as to improve tendon architectural organisation. Some observations also support its use in a clinical setting to improve pain and function. This literature review analyses studies relating to the use of hyaluronic acid in the treatment of tendinopathies. Methods this review was constructed using the Medline database via Pubmed, Scopus and Google Scholar. The key words hyaluronic acid, tendon and tendinopathy were used for the research. Results in total, 28 articles (in English and French) on the application of hyaluronic acid to tendons were selected for their relevance and scientific quality, including 13 for the in vitro part, 7 for the in vivo animal part and 8 for the human section. Conclusions preclinical studies demonstrate encouraging results: HA permits tendon gliding, reduces adhesions, creates better tendon architectural organisation and limits inflammation. These laboratory observations appear to be supported by limited but encouraging short-term clinical results on pain and function. However, controlled randomised studies are still needed. PMID:26958533

  3. Biomechanical comparison of the four-strand cruciate and Strickland techniques in animal tendons

    Raquel Bernardelli Iamaguchi

    2013-12-01

    Full Text Available OBJECTIVE: The objective of this study was to compare two four-strand techniques: the traditional Strickland and cruciate techniques. METHODS: Thirty-eight Achilles tendons were removed from 19 rabbits and were assigned to two groups based on suture technique (Group 1, Strickland suture; Group 2, cruciate repair. The sutured tendons were subjected to constant progressive distraction using a universal testing machine (Kratos®. Based on data from the instrument, which were synchronized with the visualized gap at the suture site and at the time of suture rupture, the following data were obtained: maximum load to rupture, maximum deformation or gap, time elapsed until failure, and stiffness. RESULTS: In the statistical analysis, the data were parametric and unpaired, and by Kolmogorov-Smirnov test, the sample distribution was normal. By Student's t-test, there was no significant difference in any of the data: the cruciate repair sutures had slightly better mean stiffness, and the Strickland sutures had longer time-elapsed suture ruptures and higher average maximum deformation. CONCLUSIONS: The cruciate and Strickland techniques for flexor tendon sutures have similar mechanical characteristics in vitro.

  4. Kartogenin induces cartilage-like tissue formation in tendon-bone junction

    Jianying Zhang; James H-C Wang

    2014-01-01

    Tendon-bone junctions (TBJs) are frequently injured, especially in athletic settings. Healing of TBJ injuries is slow and is often repaired with scar tissue formation that compromises normal function. This study explored the feasibility of using kartogenin (KGN), a biocompound, to enhance the healing of injured TBJs. We first determined the effects of KGN on the proliferation and chondrogenic differentiation of rabbit bone marrow stromal cells (BMSCs) and patellar tendon stem/progenitor cells (PTSCs) in vitro. KGN enhanced cell proliferation in both cell types in a concentration-dependent manner and induced chondrogenic differentiation of stem cells, as demonstrated by high expression levels of chondrogenic markers aggrecan, collagen II and Sox-9. Besides, KGN induced the formation of cartilage-like tissues in cell cultures, as observed through the staining of abundant proteoglycans, collagen II and osteocalcin. When injected into intact rat patellar tendons in vivo, KGN induced cartilage-like tissue formation in the injected area. Similarly, when KGN was injected into experimentally injured rat Achilles TBJs, wound healing in the TBJs was enhanced, as evidenced by the formation of extensive cartilage-like tissues. These results suggest that KGN may be used as an effective cell-free clinical therapy to enhance the healing of injured TBJs.

  5. Kartogenin induces cartilage-like tissue formation in tendon-bone junction.

    Zhang, Jianying; Wang, James H-C

    2014-01-01

    Tendon-bone junctions (TBJs) are frequently injured, especially in athletic settings. Healing of TBJ injuries is slow and is often repaired with scar tissue formation that compromises normal function. This study explored the feasibility of using kartogenin (KGN), a biocompound, to enhance the healing of injured TBJs. We first determined the effects of KGN on the proliferation and chondrogenic differentiation of rabbit bone marrow stromal cells (BMSCs) and patellar tendon stem/progenitor cells (PTSCs) in vitro. KGN enhanced cell proliferation in both cell types in a concentration-dependent manner and induced chondrogenic differentiation of stem cells, as demonstrated by high expression levels of chondrogenic markers aggrecan, collagen II and Sox-9. Besides, KGN induced the formation of cartilage-like tissues in cell cultures, as observed through the staining of abundant proteoglycans, collagen II and osteocalcin. When injected into intact rat patellar tendons in vivo, KGN induced cartilage-like tissue formation in the injected area. Similarly, when KGN was injected into experimentally injured rat Achilles TBJs, wound healing in the TBJs was enhanced, as evidenced by the formation of extensive cartilage-like tissues. These results suggest that KGN may be used as an effective cell-free clinical therapy to enhance the healing of injured TBJs. PMID:25419468

  6. Effect of partial-thickness tear on loading capacities of the supraspinatus tendon: a finite element analysis.

    Engelhardt, Christoph; Ingram, David; Müllhaupt, Philippe; Farron, Alain; Becce, Fabio; Pioletti, Dominique; Terrier, Alexandre

    2016-06-01

    Partial-thickness tears of the supraspinatus tendon frequently occur at its insertion on the greater tubercule of the humerus, causing pain and reduced strength and range of motion. The goal of this work was to quantify the loss of loading capacity due to tendon tears at the insertion area. A finite element model of the supraspinatus tendon was developed using in vivo magnetic resonance images data. The tendon was represented by an anisotropic hyperelastic constitutive law identified with experimental measurements. A failure criterion was proposed and calibrated with experimental data. A partial-thickness tear was gradually increased, starting from the deep articular-sided fibres. For different values of tendon tear thickness, the tendon was mechanically loaded up to failure. The numerical model predicted a loss in loading capacity of the tendon as the tear thickness progressed. Tendon failure was more likely when the tendon tear exceeded 20%. The predictions of the model were consistent with experimental studies. Partial-thickness tears below 40% tear are sufficiently stable to persist physiotherapeutic exercises. Above 60% tear surgery should be considered to restore shoulder strength. PMID:26290956

  7. Physiological Achilles' heels of Enteropathogenic bacteria in livestock

    Becker, P.M.

    2005-01-01

    An elaborate feeding regimen of animals, which takes advantage of the Achilles' heels of enteropathogenic bacteria, can possibly enable prophylaxis in the intestinal tract, attenuate actual disease symptoms, accelerate recovery from a bacterial gastroenteritis or ensure food safety. There is a wide

  8. Isolated HLA-B27 associated Achilles tendinitis.

    I. Olivieri; Gemignani, G; Gherardi, S; Grassi, L.; M.L. Ciompi

    1987-01-01

    The case of a 37 year old man with a longstanding HLA-B27 associated bilateral Achilles tendinitis without seronegative spondyloarthropathy is reported. This case suggests that heel enthesopathy may for a long time be the only clinical manifestation of the HLA-B27 associated disease process.

  9. Elastic properties of Thiel-embalmed human ankle tendon and ligament.

    Liao, Xiaochun; Kemp, Sandy; Corner, George; Eisma, Roos; Huang, Zhihong

    2015-10-01

    Thiel embalming is recommended as an alternative to formalin-based embalming because it preserves tissue elasticity, color, and flexibility in the long term, with low infection and toxicity risk. The degree to which Thiel embalming preserves elasticity has so far been assessed mainly by subjective scoring, with little quantitative verification. The aim of this study is to quantify the effect of Thiel embalming on the elastic properties of human ankle tendons and ligament. Biomechanical tensile tests were carried out on six Thiel-embalmed samples each of the peroneus longus, peroneus brevis, and calcaneal tendons, and the calcaneofibular ligament, with strain rates of 0.25%s(-1), 2%s(-1), and 8%s(-1). The stress-strain relationship was calculated from the force-extension response with cross-sectional area and gauge length. Young's modulus was determined from the stress-strain curve. The results showed that the tendon and ligament elasticity were lower after Thiel embalming than the literature values for fresh nonembalmed tendons and ligament. The biomechanical tensile test showed that the measured elasticity of Thiel-embalmed tendons and ligaments increased with the strain rate. The Thiel embalming method is useful for preserving human ankle tendons and ligaments for anatomy and surgery teaching and research, but users need to be aware of its softening effects. The method retains the mechanical strain rate effect on tendons and ligament. PMID:25707906

  10. Ultrasound elasticity imaging of human posterior tibial tendon

    Gao, Liang

    Posterior tibial tendon dysfunction (PTTD) is a common degenerative condition leading to a severe impairment of gait. There is currently no effective method to determine whether a patient with advanced PTTD would benefit from several months of bracing and physical therapy or ultimately require surgery. Tendon degeneration is closely associated with irreversible degradation of its collagen structure, leading to changes to its mechanical properties. If these properties could be monitored in vivo, it could be used to quantify the severity of tendonosis and help determine the appropriate treatment. Ultrasound elasticity imaging (UEI) is a real-time, noninvasive technique to objectively measure mechanical properties in soft tissue. It consists of acquiring a sequence of ultrasound frames and applying speckle tracking to estimate displacement and strain at each pixel. The goals of my dissertation were to 1) use acoustic simulations to investigate the performance of UEI during tendon deformation with different geometries; 2) develop and validate UEI as a potentially noninvasive technique for quantifying tendon mechanical properties in human cadaver experiments; 3) design a platform for UEI to measure mechanical properties of the PTT in vivo and determine whether there are detectable and quantifiable differences between healthy and diseased tendons. First, ultrasound simulations of tendon deformation were performed using an acoustic modeling program. The effects of different tendon geometries (cylinder and curved cylinder) on the performance of UEI were investigated. Modeling results indicated that UEI accurately estimated the strain in the cylinder geometry, but underestimated in the curved cylinder. The simulation also predicted that the out-of-the-plane motion of the PTT would cause a non-uniform strain pattern within incompressible homogeneous isotropic material. However, to average within a small region of interest determined by principal component analysis (PCA

  11. A possible link between loading, inflammation and healing: Immune cell populations during tendon healing in the rat.

    Blomgran, Parmis; Blomgran, Robert; Ernerudh, Jan; Aspenberg, Per

    2016-01-01

    Loading influences tendon healing, and so does inflammation. We hypothesized that the two are connected. 48 rats underwent Achilles tendon transection. Half of the rats received Botox injections into calf muscles to reduce mechanical loading. Cells from the regenerating tissue were analyzed by flow cytometry. In the loaded group, the regenerating tissue contained 83% leukocytes (CD45(+)) day 1, and 23% day 10. The M1/M2 macrophage ratio (CCR7/CD206) peaked at day 3, while T helper (CD3(+)CD4(+)) and Treg cells (CD25(+) Foxp3(+)) increased over time. With Botox, markers associated with down-regulation of inflammation were more common day 5 (CD163, CD206, CD25, Foxp3), and M1 or M2 macrophages and Treg cells were virtually absent day 10, while still present with full loading. The primary variable, CCR7/CD206 ratio day 5, was higher with full loading (p = 0.001) and the Treg cell fraction was lower (p < 0.001). Free cage activity loading is known to increase size and strength of the tendon in this model compared to Botox. Loading now appeared to delay the switch to an M2 type of inflammation with more Treg cells. It seems a prolonged M1 phase due to loading might make the tendon regenerate bigger. PMID:27405922

  12. A review of current concepts in flexor tendon repair: physiology, biomechanics, surgical technique and rehabilitation.

    Rohit Singh

    2015-12-01

    Full Text Available Historically, the surgical treatment of flexor tendon injuries has always been associated with controversy. It was not until 1967, when the paper entitled Primary repair of flexor tendons in no man’s land was presented at the American Society of Hand Surgery, which reported excellent results and catalyzed the implementation of this technique into world-wide practice. We present an up to date literature review using PubMed and Google Scholar where the terms flexor tendon, repair and rehabilitation were used. Topics covered included functional anatomy, nutrition, biomechanics, suture repair, repair site gapping, and rehabilitation. This article aims to provide a comprehensive and complete overview of flexor tendon repairs.

  13. Extensive Loss of Tibialis Anterior Tendon: Surgical Repair With Split Tendon Transfer of Tibialis Posterior Tendon: A Case Report.

    Miyazaki, Tsuyoshi; Uchida, Kenzo; Kokubo, Yasuo; Inukai, Tomoo; Sakamoto, Takumi; Yamagishi, Atsushi; Kitade, Makoto; Baba, Hisatoshi

    2016-01-01

    Extensive damage of the tibialis anterior tendon is rare and mainly caused by trauma. Surgical treatment of these injuries can become challenging owing to the limited availability of autogenous graft resources for reconstruction of the defect. In the present case report, we describe a large defect in the midfoot soft tissue after a traffic injury, which included complete loss of the tibialis anterior tendon. The tendon was reconstructed by split tendon transfer of the tibialis posterior tendon without sacrificing function, which was confirmed by the follow-up examination at 6 years after injury. We believe split tendon transfer of the tibialis posterior tendon can be one of the treatment options for patients with extensive disruption of the tibialis anterior tendon. PMID:26213163

  14. Gliding characteristics of flexor tendon and tenosynovium in carpal tunnel syndrome: a pilot study.

    Ettema, Anke M; Zhao, Chunfeng; Amadio, Peter C; O'Byrne, Megan M; An, Kai-Nan

    2007-04-01

    The characteristic pathological finding in carpal tunnel syndrome (CTS) is noninflammatory fibrosis of the synovium. How this fibrosis might affect tendon function, if at all, is unknown. The subsynovial connective tissue (SSCT) lies between the flexor tendons and the visceral synovium (VS) of the ulnar tenosynovial bursa. Fibrosis of the SSCT may well affect its gliding characteristics. To investigate this possibility, the relative motion of the flexor tendon and VS was observed during finger flexion in patients undergoing carpal tunnel surgery, and for comparison in hands without CTS, in an in vitro cadaver model. We used a camera to document the gliding motion of the middle finger flexor digitorum superficialis (FDS III) tendon and SSCT in three patients with CTS during carpal tunnel release and compared this with simulated active flexion in three cadavers with no antemortem history of CTS. The data were digitized with the use of Analyze Software (Biomedical Imaging Resource, Mayo Clinic, Rochester, MN). In the CTS patients, the SSCT moved en bloc with the tendon, whereas, in the controls the SSCT moved smoothly and separately from the tendon. The ratio of VS to tendon motion was higher for the patients than in the cadaver controls. These findings suggest that in patients with CTS the synovial fibrosis has altered the gliding characteristics of the SSCT. The alterations in the gliding characteristics of the SSCT may affect the ability of the tendons in the carpal tunnel to glide independently from each other, or from the nearby median nerve. These abnormal tendon mechanics may play a role in the etiology of CTS. PMID:16944527

  15. Association between distal ulnar morphology and extensor carpi ulnaris tendon pathology

    Chang, Connie Y.; Huang, Ambrose J.; Bredella, Miriam A.; Kattapuram, Susan V.; Torriani, Martin [General Hospital and Harvard Medical School, Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts, Boston, MA (United States)

    2014-06-15

    The purpose of this study was to evaluate the association between distal ulnar morphology and extensor carpi ulnaris (ECU) tendon pathology. We retrospectively reviewed 71 adult wrist MRI studies with ECU tendon pathology (tenosynovitis, tendinopathy, or tear), and/or ECU subluxation. Subjects did not have a history of trauma, surgery, infection, or inflammatory arthritis. MRI studies from 46 subjects without ECU tendon pathology or subluxation were used as controls. The following morphological parameters of the distal ulna were measured independently by two readers: ulnar variance relative to radius, ulnar styloid process length, ECU groove depth and length. Subjects and controls were compared using Student's t test. Inter-observer agreement (ICC) was calculated. There was a significant correlation between negative ulnar variance and ECU tendon pathology (reader 1 [R1], P = 0.01; reader 2 [R2], P < 0.0001; R1 and R2 averaged data, P < 0.0001) and ECU tendon subluxation (P = 0.001; P = 0.0001; P < 0.0001). In subjects with ECU tendon subluxation there was also a trend toward a shorter length (P = 0.3; P <0.0001; P = 0.001) and a shallower ECU groove (P = 0.01; P = 0.03; P = 0.01; R1 and R2 averaged data with Bonferroni correction, P = 0.08). ECU groove depth (P = 0.6; P = 0.8; P = 0.9) and groove length (P = 0.1; P = 0.4; P = 0.7) showed no significant correlation with ECU tendon pathology, and length of the ulnar styloid process showed no significant correlation with ECU tendon pathology (P = 0.2; P = 0.3; P = 0.2) or subluxation (P = 0.4; P = 0.5; P = 0.5). Inter-observer agreement (ICC) was >0.64 for all parameters. Distal ulnar morphology may be associated with ECU tendon abnormalities. (orig.)

  16. Muscle-tendon interaction and elastic energy usage in human walking

    Ishikawa, Masaki; Komi, Paavo V.; Grey, Michael James; Lepola, Vesa; Bruggemann, Gert-Peter

    2005-01-01

    techniques were employed to record the Achilles tendon force and to scan real-time fascicle lengths for two muscles (medial gastrocnemius and soleus). The results showed that tendinous tissues of both medial gastrocnemius and soleus muscles lengthened slowly throughout the single-stance phase and then......The present study was designed to explore how the interaction between the fascicles and tendinous tissues is involved in storage and utilization of elastic energy during human walking. Eight male subjects walked with a natural cadence (1.4 +/- 0.1 m/s) on a 10-m-long force plate system. In vivo......-stance phase. In contrast, the soleus fascicles were lengthened until the end of the single-stance phase. These findings suggest that the elastic recoil takes place not as a spring-like bouncing but as a catapult action in natural human walking. The interaction between the muscle fascicles and tendinous...

  17. Rerouting extensor pollicis longus tendon transfer.

    Colantoni Woodside, Julie; Bindra, Randip R

    2015-04-01

    Following radial nerve palsy, loss of the extensor pollicis longus (EPL), abductor pollicis longus and extensor pollicis brevis tendons results in loss of thumb extension and radial abduction. Multiple tendon transfers are described to address the loss of thumb extension following radial palsy utilizing the palmaris longus or flexor digitorum sublimis transferred to the EPL tendon. Owing to its ulnar vector of pull, the EPL tendon is a secondary adductor of the thumb, and in order to mitigate the tendency for thumb adduction, the EPL tendon is divided at the wrist and brought subcutaneously to the radial side of the wrist for repair to the donor tendon to improve the line of pull for the donor tendon. We describe the use of a technique to reroute the EPL tendon through the first compartment in a retrograde fashion prior to repair with the donor tendon on the radial side of the wrist. The use of the first dorsal compartment provides a pulley to maintain the position of the transfer and to prevent potential bowstringing of the tendon as wrist flexion and thumb extension are attempted. because the repair is performed proximal to the extensor retinaculum, the donor tendon length is not compromised. Because the tendon is redirected through the first dorsal compartment and inserts into the distal phalanx, a single transfer attempts to restores both thumb extension and radial abduction. PMID:25746145

  18. Pathophysiology of overuse tendon injury

    Overuse tendon injury is one of the most common injuries in sports.The etiology as well as the pathophysilogical mechanisms leading to tendinopathy are of crucial medical importance.At the moment intrinsic and extrinsic factors are assumed as mechanisms of overuse tendon injury. Except for the acute, extrinsic trauma, the chronic overuse tendon injury is a multifactorial process. There are many other factors, such as local hypoxia, less of nutrition, impaired metabolism and local inflammatory that may also contribute to the development of tissue damage.The exact interaction of these factors cannot be explained entirely at the moment.Further studies will be necessary in order to get more information. (orig.)

  19. Effects of knee immobilization on morphological changes in the semitendinosus muscle-tendon complex after hamstring harvesting for anterior cruciate ligament reconstruction. Evaluation using three-dimensional computed tomography

    It is desirable to maintain the morphology of the semitendinosus muscle-tendon complex after tendon harvesting for anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to evaluate the effect of knee immobilization on morphological changes in the semitendinosus muscle-tendon complex. In total, 39 patients who underwent ACL reconstruction with autologous semitendinosus tendons were included in this study. After surgery, the knee was immobilized for 3 days in 1 group of patients (group 1; 24 patients; control group) and for a longer period (10-14 days) in the other group (group 2; 15 patients). Three-dimensional computed tomography (3D CT) examination was performed at 6 and/or 12 months after the surgery for all patients. Morphological changes in the semitendinosus muscle-tendon complex (proximal shift of the semitendinosus muscle-tendon junction, width of the regenerated semitendinosus tendons, re-insertion sites of the regenerated tendons, and rate of semitendinosus tendon regeneration) were evaluated. Successful regeneration of the semitendinosus tendon was confirmed in all patients in group 2. In group 1, 3D CT showed that regeneration of the semitendinosus tendon was unsuccessful in 1 of the 24 patients. The average length of the proximal shift of the semitendinosus muscle-tendon junction was 7.3±2.5 cm in group 1 and 7.2±1.9 cm in group 2. There were no significant differences between the 2 groups with regard to the morphological changes in the semitendinosus muscle-tendon complex. This study showed that the structure of regenerated tendons could be clearly identified in 38 of 39 cases (97.4%) after ACL reconstruction. However, prolonged knee immobilization (10-14 days) could not prevent morphological changes in the semitendinosus muscle-tendon complex. (author)

  20. MR for assessing anterior cruciate ligament reconstructions by tendon grafts

    150 patients were examined via magnetic resonance (MR) after anterior cruciate (ACL) ligament reconstruction (76 patellar tendon grafts, 53 semitendinosous tendon grafts and 21 sutures). The results of MR were compared with clinical tests (Lachman, pivot-shift and anterior drawer test), in 2 cases with the operative findings, and in one case with arthroscopy findings. In 91% of patients with a clinically stable knee we found a continuous low-intensity ligamental structure. 10 patients were examined twice or more between 8 days and 6 months after surgery. Ligamental structures of low signal intensity did not significantly change their MR characteristics. MR is a valuable noninvasive method for evaluating ligament reconstructions. (orig./GDG)

  1. Postoperative MR imaging of the foot and ankle: tendon repair, ligament repair, and Morton's neuroma resection.

    Zanetti, Marco; Saupe, Nadja; Espinosa, Norman

    2010-09-01

    This review article describes the postoperative magnetic resonance (MR) findings relating to surgery after tendon repair, ligament repair, and Morton's neuroma resection. The normal postoperative tendon is commonly thickened, showing signal changes that are most pronounced 3 to 6 months after surgery. Two years after tendon suture, the signal intensity should be low on T2-weighted images. The focus of the postoperative MR imaging after ankle repair is to detect the normal condition after the various surgical procedures (e.g., Broström, Watson-Jones, Evans, or Chrisman-Snook). The repaired ligament has to be visible, low signal intense on T2-weighted MR images, and the shape should be homogeneous. A high rate (26%) of so-called Morton's neuroma recurrences is seen in asymptomatic individuals after Morton's neuroma resection. Postoperatively, intermetatarsal bursitis MR abnormalities are more commonly encountered in symptomatic intermetatarsal spaces than in asymptomatic intermetatarsal spaces. PMID:20539960

  2. Tibialis Anterior Tendon Transfer for Posterior Tibial Tendon Insufficiency.

    Ramanujam, Crystal L; Stapleton, John J; Zgonis, Thomas

    2016-01-01

    The Cobb procedure is useful for addressing stage 2 posterior tibial tendon dysfunction and is often accompanied by a medial displacement calcaneal osteotomy and/or lateral column lengthening. The Cobb procedure can also be combined with selected medial column arthrodesis and realignment osteotomies along with equinus correction when indicated. PMID:26590721

  3. Transverse Carpal Ligament and Forearm Fascia Release for the Treatment of Carpal Tunnel Syndrome Change the Entrance Angle of Flexor Tendons to the A1 Pulley: The Relationship between Carpal Tunnel Surgery and Trigger Finger Occurence

    Nazım Karalezli

    2013-01-01

    Full Text Available Purpose. The appearance of trigger finger after decompression of the carpal tunnel without a preexisting symptom has been reported in a few articles. Although, the cause is not clear yet, the loss of pulley action of the transverse carpal ligament has been accused mostly. In this study, we planned a biomechanical approach to fresh cadavers. Methods. The study was performed on 10 fresh amputees of the arm. The angles were measured with (1 the transverse carpal ligament and the distal forearm fascia intact, (2 only the transverse carpal ligament incised, (3 the distal forearm fascia incised to the point 3 cm proximal from the most proximal part of the transverse carpal ligament in addition to the transverse carpal ligament. The changes between the angles produced at all three conditions were compared to each other. Results. We saw that the entrance angle increased in all of five fingers in an increasing manner from procedure 1 to 3, and it was seen that the maximal increase is detected in the middle finger from procedure 1 to procedure 2 and the minimal increase is detected in little finger. Discussion. Our results support that transverse carpal ligament and forearm fascia release may be a predisposing factor for the development of trigger finger by the effect of changing the enterance angle to the A1 pulley and consequently increase the friction in this anatomic area. Clinical Relevance. This study is a cadaveric study which is directly investigating the effect of a transverse carpal ligament release on the enterance angle of flexor tendons to A1 pulleys in the hand.

  4. TRACE assessment of the ACHILLES ISP-25 reflood transient

    The purpose of this paper is to assess the capability of the best estimate thermal-hydraulic code TRACE Version 5.211 to predict the reflood process in a rod bundle test section using ACHILLES experimental data from the ISP-25 reflood transient. For the purpose of this assessment study, two detailed TRACE models representing the entire ACHILLES test section without the downcomer were developed and applied to simulate the ISP-25 transient. The TRACE models differed only in the hydrodynamic components, VESSEL and PIPE, which were used to represent the rod bundle region of the test section. Code predictions were compared against ISP-25 test measurements for both local- and integral-type quantities. These measurements included rod surface temperatures for individual rods at various axial elevations, sub-channel steam temperatures at different axial elevations, test section exit liquid and steam mass flow rates, quench front location, test section collapsed liquid level, test section overall pressure drop, and differential pressure drops across various axial sections of the test bundle. Considering the involvement of a non-uniform axial power profile combined with radial temperature variations among individual rods in the experimental rod surface temperature data, TRACE exhibited reasonable capability in predicting the ACHILLES ISP-25 reflood transient implementing an average-rod test bundle modeling approach. Consistent with other reflood simulations obtained with recent TRACE code versions, major differences between ACHILLES ISP-25 simulation results and experimental data for rod surface temperatures were observed mainly for the upper part of test section, also caused by lack of spacer grid models in TRACE. (author)

  5. Ultrasonography as a prognostic and objective parameter in Achilles tendinopathy:

    Bakkegaard, Mads; Johannsen, Finn E; Højgaard, Betina;

    2015-01-01

    eccentric exercises of the calf muscles and if needed supplemented with corticosteroid injections. The patients were examined clinically and by US (tendon thickness, hyper- and hypoechogenicity, calcification, bursitis, calcaneusspure, tenosynovitis, gray scale and color Doppler focusing on increased flow...

  6. Smart Tendon Actuated Flexible Actuator

    Md. Masum Billah

    2015-01-01

    Full Text Available We investigate the kinematic feasibility of a tendon-based flexible parallel platform actuator. Much of the research on tendon-driven Stewart platforms is devoted either to the completely restrained positioning mechanism (CRPM or to one particular type of the incompletely restrained positioning mechanism (IRPM where the external force is provided by the gravitational pull on the platform such as in cable-suspended Stewart platforms. An IRPM-based platform is proposed which uses the external force provided by a compliant member. The compliant central column allows the configuration to achieve n DOFs with n tendons. In particular, this investigation focuses on the angular deflection of the upper platform with respect to the lower platform. The application here is aimed at developing a linkable module that can be connected to one another so as to form a “snake robot” of sorts. Since locomotion takes precedence over positioning in this application, a 3-DOF Stewart platform is adopted. For an arbitrary angular displace of the end-effector, the corresponding length of each tendon can be determined through inverse kinematics. Mathematical singularities are investigated using the traditional analytical method of defining the Jacobian.

  7. Effects of flunixin meglumine on experimental tendon wound healing: A histopathological and mechanical study in rabbits

    Mehdi Behfar

    2014-12-01

    Full Text Available Tendons are frequently targets of injury in sports and work. Whether nonsteroidal anti-inflammatory drugs (NSAIDs have beneficial effects on tendon healing is still a matter of debate. This study was conducted to evaluate effects of flunixin meglumine (FM on tendon healing after experimentally induced acute trauma. Twenty eight adult male New Zealand White rabbits were subjected to complete transection of deep digital flexor tendons followed by suture placement. Treatment group received intramuscular injection of FM for three days, and controls received placebo. Subsequently, cast immobilization was continued for two weeks. Animals were sacrificed four weeks after surgery and tissue samples were taken. The histological evaluations revealed improved structural characteristics of neotendon formation including fibrillar linearity, fibrillar continuity and neovascularization in treatment group compared to those of controls (p 0.05. Mechanical evaluation revealed significant increase in load-related material properties including ultimate load, yield load, energy absorption and ultimate stress in treatment group compared to those of control group (p 0.05. The present study showed that intramuscular injection of FM resulted in improved structural and mechanical properties of tendon repairs and it could be an effective treatment for acute tendon injuries like severance and laceration.

  8. Hyperuricemic PRP in Tendon Cells

    I. Andia

    2014-01-01

    Full Text Available Platelet-rich plasma (PRP is injected within tendons to stimulate healing. Metabolic alterations such as the metabolic syndrome, diabetes, or hyperuricemia could hinder the therapeutic effect of PRP. We hypothesise that tendon cells sense high levels of uric acid and this could modify their response to PRP. Tendon cells were treated with allogeneic PRPs for 96 hours. Hyperuricemic PRP did not hinder the proliferative actions of PRP. The gene expression pattern of inflammatory molecules in response to PRP showed absence of IL-1b and COX1 and modest expression of IL6, IL8, COX2, and TGF-b1. IL8 and IL6 proteins were secreted by tendon cells treated with PRP. The synthesis of IL6 and IL8 proteins induced by PRP is decreased significantly in the presence of hyperuricemia (P = 0.017 and P = 0.012, resp.. Concerning extracellular matrix, PRP-treated tendon cells displayed high type-1 collagen, moderate type-3 collagen, decorin, and hyaluronan synthase-2 expression and modest expression of scleraxis. Hyperuricemia modified the expression pattern of extracellular matrix proteins, upregulating COL1 (P = 0.036 and COMP (P = 0.012 and downregulating HAS2 (P = 0.012. Positive correlations between TGF-b1 and type-1 collagen (R = 0.905, P = 0.002 and aggrecan (R = 0.833, P = 0.010 and negative correlations between TGF-b1 and IL6 synthesis (R = −0.857, P = 0.007 and COX2 (R = −0.810, P = 0.015 were found.

  9. Mechanical properties of human bone-tendon-bone grafts preserved by different methods and radiation sterilised

    Full text: Patellar tendon auto and allografts are commonly used in orthopaedic surgery for reconstruction of the anterior crucial ligaments (ACL). Autografts are mainly used for primary reconstruction, while allografts are useful for revision surgery. To avoid the risk of infection diseases transmission allografts should be radiation-sterilised. As radiation-sterilisation is supposed to decrease the mechanical strength of tendon tissue, it is important to establish methods of allografts preservation and sterilisation resulting in their best quality and safety. Therefore, the purpose of the study was to compare the tensile strength of the central one third of human patellar tendon (as used for ACL reconstruction), preserved by different methods (deep fresh freezing, lyophilisation) and subsequently radiation-sterilised with doses of 0 (control), 25, 50 or 100 kGy. Bone-tendon-bone grafts were prepared from cadaveric human patella tendon with both patellar and tibial attachments. BTB grafts were preserved by deep freezing, glicerolisation or lyophilisation and radiation-sterilised with doses of 0 (control), 25, 50 or 100 kGy. To estimate mechanical properties all samples were subjected to tensile tests to failure using Instron system. Before these tests all lyophilised grafts were rehydrated. We found decrease of tensile strength of irradiated grafts compared to non-irradiated controls. Obtained results of the mechanical testing of studied grafts indicate their potential usefulness for clinical applications.(Author)

  10. Relaxin Receptor RXFP1 and RXFP2 Expression in Ligament, Tendon, and Shoulder Joint Capsule of Rats.

    Kim, Jae Hyung; Lee, Sang Kwang; Lee, Seong Kyu; Kim, Joo Heon; Fredericson, Michael

    2016-06-01

    Numerous musculoskeletal disorders are caused by thickened ligament, tendon stiffness, or fibrosis of joint capsule. Relaxin, a peptide hormone, can exert collagenolytic effect on ligamentous and fibrotic tissues. We hypothesized that local injection of relaxin could be used to treat entrapment neuropathy and adhesive capsulitis. Because hormonal effect depends on the receptor of the hormone on the target cell, it is important to confirm the presence of such hormonal receptor at the target tissue before the hormone therapy is initiated. The aim of this study was to determine whether there were relaxin receptors in the ligament, tendon, and joint capsular tissues of rats and to identify the distribution of relaxin receptors in these tissues. Transverse carpal ligaments (TCLs), inguinal ligaments, anterior cruciate ligaments (ACLs), Achilles tendons, and shoulder joint capsules were obtained from male Wistar rats. Western blot analysis was used to identify relaxin receptor isoforms RXFP1 and RXFP2. The distribution of relaxin receptors was determined by immunohistochemical staining. The RXFP1 isoform was found in all tissues examined. The RXFP2 isoform was present in all tissues but the TCLs. Its expression in ACLs tissues was relatively weak compared to that in other tissues. Our results revealed that RXFP1 and RXFP2 were distributed in distinctly different patterns according to the type of tissue (vascular endothelial cells, fibroblast-like cells) they were identified. PMID:27247510

  11. Multiple ruptures of the extensor tendons after volar fixation for distal radius fracture: a case report.

    Caruso, Giancarlo; Vitali, Andrea; del Prete, Ferdinando

    2015-12-01

    A 62-year-old woman was admitted to our hospital after a bicycle accident with a displaced left (non-dominant) distal radius fracture. After closed reduction a long cast was applied. Due to loss of reduction, twenty-four days later open reduction internal fixation with locking compression plate (LCP) was performed. The patient returned to her normal activities but nineteen months after surgery showed functional impairment of the left thumb for Extensor Pollicis Longus (EPL) injury for which she necessitated transposition surgery. Twenty-six months after ORIF, functional deficit of the extension of the third and fourth left finger was noted secondary to injury of extensor tendons. Ultrasound and CT scan showed protrusion of the angular stability screws in LCP plate that caused a progressive wear resulting in rupture of the extensor tendons. Another tendon transposition surgery was performed with dorsal approach while the plate was removed utilising the original volar incision. Reconstruction of distal radius fractures with volar plating, requires accurate plate application with precise measurement of the length of the screws in order to prevent dorsal protrusion and thus avoiding tendon injuries. PMID:26738455

  12. Tendon Force Transmission at the Nanoscale

    Svensson, René

    2013-01-01

    difficult to tackle. The tendon hierarchy ranges from molecules (2 nm) over fibrils (200 nm), fibers (2 μm) and fascicles (200 μm) to tendons (10 mm), and to derive the mechanisms of force transmission it is necessary to know the mechanical behavior at each hierarchical level. The aim of the present work...... was to elucidate the mechanisms of force transmission in tendons primarily by investigating the mechanical behavior at the hierarchical level of collagen fibrils. To do so we have developed an atomic force microscopy (AFM) method for tensile testing of native collagen fibrils. The thesis contains five...... connective tissue function that are poorly understood. One such aspect is the microscopic mechanisms of force transmission through tendons over macroscopic distances. Force transmission is at the heart of tendon function, but the large range of scales in the hierarchical structure of tendons has made it...

  13. Extensor tendon repair an overview

    Mansoor Bin Fayed

    2015-04-01

    Full Text Available The incidence of extensor injuries is more than that of flexor tendon injuries. This is to a great extent because of the extensors being superficially placed and covered by skin and subcutaneous tissue over the distal part of the upper extremity. Thus they are more vulnerable to blunt and sharp trauma, the proximal and distal forearm present with laceration and cut with sharp weapon. Extensor tendon injuries are often taken lightly by many, repairs being taken-up at the ER. Repair is done in or if the retrieval of tendon ends is difficult or the wound is complicated with associated injuries such as fractures or in cases of tendon retraction. Delayed primary repair can be undertaken from 7-10 days. Assessment of the injured finger has to be very meticulous. Extension of finger is brought about by the interossei and lumbricals which are the short muscles of the hand. They extend the proximal interphalangeal joints and distal interphalangeal joints and flex metacarpophalangeal joint, these intrinsic muscles are innervated by the ulnar and median nerves. The long extensors are innervated by the radial nerve, they primarily extend the metacarpophalangeal joints and also interphalangeal joints. In cases of injury the intrinsic system may compensate for an extensor deficit. Closed injuries of zone I may be managed by splinting of the distal interphalangeal joints and open injuries in the zone I and II can be treated with tenodermodesis. Proximal interphalangeal joints and distal interphalangeal joints are immobilized in zone 3 and 4. Metacarpophalangeal joint is immobilized in full extension and the wrist in 10o extension.

  14. Changes in cortical relative power in patients submitted to a tendon transfer: a pre and post surgery study Alterações na potência relativa cortical em pacientes submetidos a transferência de tendão: estudo pré e pós-cirurgico

    Julio Guilherme Silva

    2007-09-01

    Full Text Available The aim of this study is analyze possible modifications in the cerebral cortex, through quantitative electroencephalography (qEEG in patients submitted to a tendon transfer procedure (posterior tibialis by the Srinivasan's technique. Four subjects (2 men and 2 women, 49.25 age average (SD±21.4 were studied. All subjects have been through surgical procedure due to leprosy and had, at least, two years of drop foot condition. The qEEG measured the electrocortical activity (relative power between 8 and 25 Hz frequencies pre and post surgery. A paired t test analyzed all data (pO objetivo deste estudo é analisar possíveis modificações no córtex cerebral, através da electrencefalografia quantitativa (EEGq, em pacientes submetidos a um procedimento de transferência de tendão (tibial posterior pela técnica de Srinivasan. Quatro sujeitos (2 homens e 2 mulheres, com média de idade de 49,25 anos (±21,4 DP foram estudados. Todos os sujeitos realizaram o procedimento cirúrgico devido a hanseníase e tinham, pelo menos, dois anos de pé caído. O EEGq mediu a atividade electrocortical (potencia relativa entre freqüências de 8 e 25 Hz, no pré e pós-operatório. Um teste t pareado analisou todos os dados (p<0,05. Os resultados mostram alterações significativas na potência relativa em alfa, nos elétrodos F7 (p=0,01 e F8 (p=0,021. Baseados em recentes achados na literatura, podemos concluir que o procedimento de transferência de tendão sugere alterações eletrocorticais sensíveis às freqüên-cias específicas do EEGq.

  15. Staged tendon grafts and soft tissue coverage

    David Elliot

    2011-01-01

    Full Text Available The objective of the two-staged flexor tendon method is to improve the predictability of final results in difficult problems dealing with tendon reconstruction. This article reviews the evolution and benefits of this procedure. It also considers the use of the technique to help deal with problems requiring pulley and skin reconstruction simultaneously with re-constituting the flexor tendon system.

  16. Prestressed BFRP tendons in concrete beams

    Björgvin Smári Jónsson

    2011-01-01

    Concrete structures are normally reinforced with steel tendons. In marine or chemical environment steel has its limitations. Replacing steel with FRP reinforcement has been practiced for many years but using basalt fiber reinforcement polymer tendons (BFRP) as a structural material is rather new. Tension strength of BFRP tendon is about twice the tension strength of steel reinforcement but the elastic modulus is only 40-50 GPa while steel has 200 GPa. Therefore elastic lengthening of BFRP ten...

  17. Intratendinous ganglion cyst of the semimembranosus tendon

    Kim, S K; Park, J. M.; Choi, J E; Rhee, S K; Shim, S. I.

    2010-01-01

    Intratendinous ganglion cyst is a very rare lesion with an unknown aetiology that originates within the tendon. We encountered a case of 43-year-old woman who complained of a palpable, non-tender mass in the thigh with increasing swelling. An intratendinous ganglion cyst in the semimembranosus tendon of the lower extremity was diagnosed and located by ultrasound and MRI. Nine months after a surgical excision, there were recurrent ganglion cysts along the semimembranosus tendon. We describe th...

  18. Multiple tendons of abductor pollicis longus

    Mansur DI; Krishnamurthy A; Nayak SR; Kumar CG; Rai R; Sujatha D’costa S; Mansur DI, Krishnamurthy A, Nayak SR, Kumar CG, Rai R, Sujatha D’costa S, Prabhu LV.; Prabhu LV

    2010-01-01

    Anatomic variations of the tendons of the abductor pollicis longus (APL) and its knowledge is important to assess the diseased and traumatized hand and when considering tendons for repair or graft. During routine dissection of a 63-year-old male cadaver, in the Department of Anatomy, Kasturba Medical College, Mangalore, Karnataka, India we came across an unusual APL in the right upper limb. The muscle had altogether 9 tendons and they were inserted to the lateral and anterolateral sides of th...

  19. Simulation of tendon energy storage in pedaling

    Rasmussen, John; Damsgaard, Michael; Christensen, Søren Tørholm

    2001-01-01

    The role of elastic energy stored in tendons during pedaling is investigated by means of numerical simulation using the AnyBody body modeling system. The loss of metabolic energy due to tendon elasticity is computed and compared to the mechanical work involved in the process. The AnyBody simulation system is based on inverse dynamics, where the redundancy problem is solved by a minimum fatigue criterion guaranteeing maximuminter-muscular collaboration. The tendons are assumed to be linearly e...

  20. Subscapularis Tendon Repair Using Suture Bridge Technique

    Park, Yong Bok; Park, Young Eun; Koh, Kyoung Hwan; Lim, Tae Kang; Shon, Min Soo; Yoo, Jae Chul

    2015-01-01

    The subscapularis tendon plays an essential role in shoulder function. Although subscapularis tendon tears are less common than other rotator cuff tears, tears of the subscapularis tendon have increasingly been recognized with the advent of magnetic resonance imaging and arthroscopy. A suture bridge technique for the treatment of posterosuperior rotator cuff tears has provided the opportunity to improve the pressurized contact area and mean footprint pressure. However, suture bridge fixation ...

  1. Bilateral simultaneous rupture of the quadriceps tendon in a patient with psoriasis: a case report and review of the literature

    Radha Sarkell

    2011-07-01

    Full Text Available Abstract Introduction Bilateral quadriceps tendon rupture is not common in the absence of systemic disease. Patients with chronic systemic diseases such as uremia and systemic lupus erythematosus and patients who are being treated with systemic steroids or local steroid injections are more prone to tendon rupture. The tendon can rupture spontaneously or as a result of trauma. We report an unusual case of simultaneous bilateral traumatic quadriceps tendon rupture in a patient with psoriasis who was being treated with topical steroid preparations. Case presentation A 57-year-old Caucasian man with a known history of psoriasis, for which he was being treated with topical steroid preparations, presented to our hospital with clinical signs of bilateral quadriceps tendon rupture after he fell while walking down stairs. The diagnosis was confirmed by bilateral ultrasound scans of the thighs. The patient underwent surgery to repair both quadriceps tendons. Post-operatively, the patient was immobilized first in bilateral cylinder casts for six weeks, then in knee braces for the next four weeks. His knees were actively mobilized during physiotherapy. Conclusion Bilateral quadriceps tendon rupture is a rare occurrence in patients with psoriasis who are being treated with topical steroids.

  2. Biology and augmentation of tendon-bone insertion repair

    Lui PPY; Zhang P; KM, Chan; Qin L

    2010-01-01

    Abstract Surgical reattachment of tendon and bone such as in rotator cuff repair, patellar-patella tendon repair and anterior cruciate ligament (ACL) reconstruction often fails due to the failure of regeneration of the specialized tissue ("enthesis") which connects tendon to bone. Tendon-to-bone healing taking place between inhomogenous tissues is a slow process compared to healing within homogenous tissue, such as tendon to tendon or bone to bone healing. Therefore special attention must be ...

  3. EFFECTS OF ELECTRIC STIMULATION ON THE HEALING OF TENDON OF THE GASTROCNEMIUS MUSCLE IN RABBITS (Oryctolagus cunicullus EFEITOS DA ESTIMULAÇÃO ELÉTRICA NA CICATRIZAÇÃO DO TENDÃO DO MÚSCULO GASTROCNÊMIO EM COELHOS (Oryctolagus cunicullus

    Weslay Souza de Oliveira

    2009-09-01

    Full Text Available The aim of this study was to evaluate the effect of transcutaneous electrical stimulation with alternate electrical current on gastrocnemius muscle tendon healing, in rabbits submitted to experimental tenotomy and tenorrhaphy. Twenty-four male rabbits, New Zealand breed, were divided into four groups of the same number, in order to evaluate the cicatricial tendon repair at 7, 15, 21 and 30 days post-surgery. The middle third of the tendon of the gastocnemius muscle was sectioned transversall and submitted to a synthesis with Kessler modified suture. After 24 hours, daily at the same schedule, were done near the cutaneous wound of the right pelvic member, applications of 2 mA of alternative current, during six minutes, at a frequence of 100 Hz. The material collected was examined by light microscopy. Significant difference wasn´t found between the treated member and the control. Transcutaneous electrotherapy was used in our experimental protocol, despite not leading to tissue damage and being less invasive in comparison to other methods, was incapable to promote a more efficient healing response on the gastrocnemius muscle tendon repair in rabbits.

    KEY WORDS: Achilles tendon, electrotherapy, surgery, tenotomy, tissue repair. Este trabalho teve como objetivo avaliar o efeito da estimulação elétrica transcutânea de corrente alternada na regeneração do tendão do músculo gastrocnêmio, em coelhos submetidos à tenotomia e tenorrafia experimental. Dividiram-se vinte e quatro coelhos adultos da raça Nova Zelândia em quatro grupos iguais para avaliação da cicatrização tendínea aos sete, quinze, vinte e um e trinta dias de pós-operatório. Após incisão cutânea de aproximadamente três centímetros, o terço médio do tendão do músculo gastrocnêmio foi individualizado, seccionado transversalmente e suturado com sutura de Kessler modificada. Decorridas 24 horas, diariamente em um mesmo horário aplicaram-se, próxima

  4. FUNCTIONAL OUTCOME OF ARTHROSCOPY ASSISTED ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION USING BONE PATELLAR TENDON BONE AUTOGRAFT

    Vinod Kumar

    2015-04-01

    Full Text Available INTRODUCTION: The anterior cruciate ligament (ACL is one of the most frequently injured ligaments in the human body. 1 The Anterior Cruciate ligament (ACL is the primary stabilizer of the knee and prevents the knee against anterior translation. 2 It is also important in counteracting rotational and valgus stress. 1 The middle third of the patellar tendon autograft for ACL reconstruction can be readily procured and firmly fixed. 3 It can tolerate the loads produced by an intensive rehabilitation programme. 3 Fixation of bone plugs using interference screws provides sufficient stability to meet the demand of a vigorous postoperative protocol. 3 It remains the gold standard for ACL reconstruction. 3 This study is to assess the functional outcome of arthroscopy assisted anterior cruciate ligament reconstruction using bone patellar tendon bone autograft. METHODS: This study was conducted in Kempegowda Institute of Medical Sciences Hospital from November 2012 to April 2014. During this period 20 cases of adult patients with ACL deficient patients were selected according to the inclusion criteria. Study aims to assess the functional outcome of arthroscopy assisted anterior cruciate ligament reconstruction using bone - patellar tendon - bone autograft in terms of range of motion, postoperative knee stability, graft site morbidity and subjective knee functions. RESULTS: Results of our study showed that arthroscopy assisted anterior cruciate ligament reconstruction with bone - patellar tendon - bone autograft could effectively improve knee stability and functions after surgery without any complication. CONCLUSION : Arthroscopy assisted anterior cruciate l igament reconstruction with bone - patellar tendon - bone autograft is an excellent treatment option for anterior cruciate ligament deficient knees. It provides a stable knee and reduces postoperative morbidity and enables early rehabilitation. The functional outcome of arthroscopy assisted anterior

  5. Heavy Slow Resistance Versus Eccentric Training as Treatment for Achilles Tendinopathy

    Beyer, Rikke; Kongsgaard, Mads; Hougs Kjær, Birgitte;

    2015-01-01

    BACKGROUND: Previous studies have shown that eccentric training has a positive effect on Achilles tendinopathy, but few randomized controlled trials have compared it with other loading-based treatment regimens. PURPOSE: To evaluate the effectiveness of eccentric training (ECC) and heavy slow...... resistance training (HSR) among patients with midportion Achilles tendinopathy. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: A total of 58 patients with chronic (>3 months) midportion Achilles tendinopathy were randomized to ECC or HSR for 12 weeks. Function and symptoms...... tendinopathy and that the latter tends to be associated with greater patient satisfaction after 12 weeks but not after 52 weeks....

  6. Bilateral synchronous rupture of the quadriceps tendon.

    Ellanti, P

    2012-09-01

    Bilateral simultaneous rupture of the quadriceps tendon is a rare entity. They are often associated with degenerative changes of the tendons and predisposing conditions such as diabetes or excessive steroid use. They most commonly tend to occur in patients of 40 years of age or older.

  7. Simulation of tendon energy storage in pedaling

    Rasmussen, John; Damsgaard, Michael; Christensen, Søren Tørholm

    2001-01-01

    The role of elastic energy stored in tendons during pedaling is investigated by means of numerical simulation using the AnyBody body modeling system. The loss of metabolic energy due to tendon elasticity is computed and compared to the mechanical work involved in the process. The AnyBody simulation...

  8. Simultaneous and spontaneous bilateral quadriceps tendons rupture.

    Celik, Evrim Coşkun; Ozbaydar, Mehmet; Ofluoglu, Demet; Demircay, Emre

    2012-07-01

    Simultaneous and spontaneous bilateral quadriceps tendon rupture is an uncommon injury that is usually seen in association with multiple medical conditions and some medications. We report a case of simultaneous and spontaneous bilateral quadriceps tendon rupture that may be related to the long-term use of a statin. PMID:22561379

  9. Augmentation of tendon-to-bone healing.

    Atesok, Kivanc; Fu, Freddie H; Wolf, Megan R; Ochi, Mitsuo; Jazrawi, Laith M; Doral, M Nedim; Lubowitz, James H; Rodeo, Scott A

    2014-03-19

    Tendon-to-bone healing is vital to the ultimate success of the various surgical procedures performed to repair injured tendons. Achieving tendon-to-bone healing that is functionally and biologically similar to native anatomy can be challenging because of the limited regeneration capacity of the tendon-bone interface. Orthopaedic basic-science research strategies aiming to augment tendon-to-bone healing include the use of osteoinductive growth factors, platelet-rich plasma, gene therapy, enveloping the grafts with periosteum, osteoconductive materials, cell-based therapies, biodegradable scaffolds, and biomimetic patches. Low-intensity pulsed ultrasound and extracorporeal shockwave treatment may affect tendon-to-bone healing by means of mechanical forces that stimulate biological cascades at the insertion site. Application of various loading methods and immobilization times influence the stress forces acting on the recently repaired tendon-to-bone attachment, which eventually may change the biological dynamics of the interface. Other approaches, such as the use of coated sutures and interference screws, aim to deliver biological factors while achieving mechanical stability by means of various fixators. Controlled Level-I human trials are required to confirm the promising results from in vitro or animal research studies elucidating the mechanisms underlying tendon-to-bone healing and to translate these results into clinical practice. PMID:24647509

  10. Simultaneous bilateral patellar tendon rupture without

    LU Hua-ding

    2012-04-01

    Full Text Available 【Abstract】There is a dearth of case reports de-scribing simultaneous bilateral patellar tendon ruptures in the medical literature. These ruptures are often associated with systemic disorders such as lupus erythematosus or chronic steroid use. The author describes a case of a 24-year-old man who sustained traumatic bilateral patellar ten-don ruptures without any history of systemic disease or steroidal medication. We repaired and reattached the rup-tured tendons to the patella and augmented our procedure with allogeneic tendon followed by wire loop reinforcement. One year after operation, the patient regained a satisfactory range of motion of both knees with good quadriceps strength and no extensor lag. The recurrent microtrauma from a history of intense sports activity and a high body mass index may have played an important role in this trauma event. Key words: Patella; Patellar ligament; Rupture; Ten-don injuries; Knee

  11. Modeling Implantable Passive Mechanisms for Modifying the Transmission of Forces and Movements Between Muscle and Tendons.

    Homayouni, Taymaz; Underwood, Kelsey N; Beyer, Kamin C; Martin, Elon R; Allan, Christopher H; Balasubramanian, Ravi

    2015-09-01

    This paper explores the development of biomechanical models for evaluating a new class of passive mechanical implants for orthopedic surgery. The proposed implants take the form of passive engineered mechanisms, and will be used to improve the functional attachment of muscles to tendons and bone by modifying the transmission of forces and movement inside the body. Specifically, we present how two types of implantable mechanisms may be modeled in the open-source biomechanical software OpenSim. The first implant, which is proposed for hand tendon-transfer surgery, differentially distributes the forces and movement from one muscle across multiple tendons. The second implant, which is proposed for knee-replacement surgery, scales up the forces applied to the knee joint by the quadriceps muscle. This paper's key innovation is that such mechanisms have never been considered before in biomechanical simulation modeling and in surgery. When compared with joint function enabled by the current surgical practice of using sutures to make the attachment, biomechanical simulations show that the surgery with 1) the differential mechanism (tendon network) implant improves the fingers' ability to passively adapt to an object's shape significantly during grasping tasks (2.74× as measured by the extent of finger flexion) for the same muscle force, and 2) the force-scaling implant increases knee-joint torque by 84% for the same muscle force. The critical significance of this study is to provide a methodology for the design and inclusion of the implants into biomechanical models and validating the improvement in joint function they enable when compared with current surgical practice. PMID:25850081

  12. The effects of laparoscopic mesh fixation device on bone, costo-chondral junction and tendon site.

    Ekçi, Baki; Altinli, Ediz; Dervisoglu, Sergülen; Demir, Mustafa; Tasci, Ihsan

    2011-01-01

    Osteitis pubis is one of the important complications of inguinal hernia repair surgery occurring with the placement of sutures through the periosteum. The aim of this study is to evaluate scintigraphic and histopathological alterations associated with the use of mesh fixation device on pelvic bone, cartilage and tendons in an experimental animal model. Twenty New-Zealand young male rabbits were used. A mesh fixation device was inserted at each animal's costa-chondral junction, superior anterior iliac crest, and achiles tendon. One week prior to the surgery and 16 weeks after the operation, scintigraphic evaluation was performed. Histopathological evaluation was performed at the end of study. No nuclear activity or pathological change was found at bone site (p > 0.05). Foreign body reaction was evident at the tendon and costa-chondral site (p = 0.001). In conclusion; the mesh fixation device leads to foreign body reaction in costa-chondral junction and tendon. It does not cause any nuclear activity increase. PMID:21657163

  13. Robotic surgery

    Robot-assisted surgery; Robotic-assisted laparoscopic surgery; Laparoscopic surgery with robotic assistance ... Robotic surgery is similar to laparoscopic surgery. It can be performed through smaller cuts than open surgery. ...

  14. Scar remodeling after strabismus surgery.

    Ludwig, I H

    1999-01-01

    PURPOSE: Patients with overcorrected strabismus (and several patients with undercorrection after extraocular muscle resection) underwent exploration of previously operated muscles, with the intention of advancing their tendons to prevent the need for surgery on additional muscles. Unexpectedly, it was found that, in many cases, an elongated scar segment of variable length was interposed between the muscle and its insertion site on the sclera. Laboratory investigations were carried out to eluc...

  15. Serial superficial digital flexor tendon biopsies for diagnosing and monitoring collagenase-induced tendonitis in horses

    José C. de Lacerda Neto

    2013-06-01

    Full Text Available The purpose of this investigation was to demonstrate the feasibility of a biopsy technique by performing serial evaluations of tissue samples of the forelimb superficial digital flexor tendon (SDFT in healthy horses and in horses subjected to superficial digital flexor tendonitis induction. Eight adult horses were evaluated in two different phases (P, control (P1 and tendonitis-induced (P2. At P1, the horses were subjected to five SDFT biopsies of the left forelimb, with 24 hours (h of interval. Clinical and ultrasonographic (US examinations were performed immediately before the tendonitis induction, 24 and 48 h after the procedure. The biopsied tendon tissues were analyzed through histology. P2 evaluations were carried out three months later, when the same horses were subjected to tendonitis induction by injection of bacterial collagenase into the right forelimb SDFT. P2 clinical and US evaluations, and SDFT biopsies were performed before, and after injury induction at the following time intervals: after 24, 48, 72 and 96 h, and after 15, 30, 60, 90, 120 and 150 days. The biopsy technique has proven to be easy and quick to perform and yielded good tendon samples for histological evaluation. At P1 the horses did not show signs of localised inflammation, pain or lameness, neither SDFT US alterations after biopsies, showing that the biopsy procedure per se did not risk tendon integrity. Therefore, this procedure is feasible for routine tendon histological evaluations. The P2 findings demonstrate a relation between the US and histology evaluations concerning induced tendonitis evolution. However, the clinical signs of tendonitis poorly reflected the microscopic tissue condition, indicating that clinical presentation is not a reliable parameter for monitoring injury development. The presented method of biopsying SDFT tissue in horses enables the serial collection of material for histological analysis causing no clinical signs and tendon damage seen

  16. Outpatient Surgery

    ... and Anesthesia Seniors and Anesthesia Surgery Risks Anesthesia Awareness Obesity and Anesthesia Sleep Apnea and Anesthesia Smoking and Anesthesia Outpatient Surgery Outpatient Surgery Surgery does ...

  17. CHELT therapy in the treatment of chronic insertional Achilles tendinopathy.

    Notarnicola, Angela; Maccagnano, Giuseppe; Tafuri, Silvio; Forcignanò, Maria Immacolata; Panella, Antonio; Moretti, Biagio

    2014-05-01

    The application of laser therapy on soft tissue is used for pain relief, anti-inflammation action and biostimulation. The efficiency of High Energy Laser Therapy has not yet been studied on Achilles tendinopathy. The aim of the study is to evaluate the effectiveness of a flow of Cold air and High Energy Laser Therapy (CHELT) versus Extracorporeal Shock Waves Therapy (ESWT) in the treatment of Achilles tendinopathy. In this prospective, clinical trial, 60 subjects affected by insertional Achilles tendinopathy were enrolled and randomized to CHELT (30 subjects) or to ESWT (30 subjects). In CHELT group the patients received ten daily sessions of 1,200 J and 12 W of laser therapy (wavelength of 1,084, 810 and 980 nm) added to a flow of cold air at -30 °C. In the ESWT group, the patients received three sessions at 3- to 4-day intervals of 1,600 impulses with an energy flux density (EFD) of 0.05-0.07 mJ/mm(2). Both groups of participants performed stretching and eccentric exercises over a 2-month period. The visual analogue scale (VAS), the Ankle-Hindfoot Scale, and the Roles and Maudsley Score were measured before treatment (T0), and at end of the treatment session (T1) and 2 (T2) and 6 months (T3) after treatment during the follow-up examinations. In both groups, we found a statistically significant improvement of the VAS at T1, T2 and T3 (p < 0.01). The difference between the two groups was statistically significant in favour of the CHELT group (p < 0.001). At 2 months, the CHELT group was statistically better for Ankle-Hindfoot Scale and the Roles and Maudsley Score (p < 0.05) and at 6 months only for the Roles and Maudsley Score (p < 0.001). High Energy Laser Therapy gave quicker and better pain relief. It also gave the patient a full functional recovery and greater satisfaction. PMID:24352875

  18. High-field MR imaging of the tendons

    MR imaging was used to investigate normal anatomy and pathologic conditions of the tendons. Tendons of experimental animals, cadaver joints, normal volunteers, and patients with suspected tendon pathology were studied. Tendon anatomy is easily identified because of the hypointensity of the tendons contrasting with the hyperintendensity of the surrounding fat. Pathologic conditions including posttraumatic and postsurgical tendon rupture, peritendinous scarring, tendinitis, and tenosynovitis are well seen with MR imaging. A detailed study of normal and abnormal tendon anatomy of the finger, wrist, shoulder, knee, and ankle is displayed, including MR images, gross specimens, and line drawings

  19. Tendon rupture associated with simvastatin/ezetimibe therapy.

    Pullatt, Raja C; Gadarla, Mamatha Reddy; Karas, Richard H; Alsheikh-Ali, Alawi A; Thompson, Paul D

    2007-07-01

    A case of spontaneous biceps tendon rupture in a physician during therapy with the combination of simvastatin and ezetimibe (Vytorin) is reported. Rechallenge produced tendinopathy in the contralateral biceps tendon that abated with drug discontinuation. Tendon rupture generally occurs in injured tendons. Physiological repair of an injured tendon requires degradation and remodeling of the extracellular matrix through matrix metalloproteinases (MMPs). Statins are known to inhibit MMPs. It was hypothesized that statins may increase the risk of tendon rupture by altering MMP activity. In conclusion, statins may increase the risk of tendon rupture by altering MMP activity. PMID:17599460

  20. Ultrasound guided electrocoagulation in patients with chronic non-insertional Achilles tendinopathy

    Boesen, M Ilum; Torp-Pedersen, S; Koenig, M Juhl;

    2006-01-01

    High resolution colour Doppler ultrasound shows intratendinous Doppler activity in patients with chronic Achilles tendinopathy. Treatment of this neovascularisation with sclerosing therapy seems to relieve the pain. However, the procedure often has to be repeated.......High resolution colour Doppler ultrasound shows intratendinous Doppler activity in patients with chronic Achilles tendinopathy. Treatment of this neovascularisation with sclerosing therapy seems to relieve the pain. However, the procedure often has to be repeated....

  1. Case Study of Oriental Medicine Treatment with acupotomy Therapy of the Achilles Tendinitis

    Jang Eun-ha; Lim Na-ra; Na Won-min; Kim Sung-chul

    2008-01-01

    Purpose : In order to estimate clinical effects of Oriental Medicine Treatment with acupotomy therapy of Achilles Tendinitis Methods : From 4th August, 2008 to 14th August, 2008, 1 female patient diagnosed as Chronic Achilles Tendinitis (clinical diagnosed) was treated with general oriental medicine therapy(acupuncture, moxibustion, cupping, physical therapy, herbal medication) and acupotomy. Results : The patient's chief complaints- Lt. heel pain and stiffness, dorsi-flexion limitation...

  2. Changes in the distal phalanx in foals with deep digital flexor tendon contraction

    Nine foals, aged 4–7 months, suffering from contracted deep digital flexor tendon were radiographed for changes in the distal phalanx. Varying degrees of osteolysis in the distal part of the distal phalanx were observed. The foals with the most pronounced clinical signs also displayed the most prominent radiologic changes. Tenotomy of the check ligament of the deep digital flexor tendon was performed. In severely affected foals, a shoe with a long toepart was used after surgery. Programmed exercise on hard ground was started 1 week after surgery. Control radiography was performed on three of the foals 1–1½years after treatment. At that time, the colts had normal distal phalanges and their function and mobility were normal. Of the remaining six animals, three had been sold as being healthy and were not available for examination. The remaining three had been examined for the first time within the last 3 months, and long-term evaluation was not possible

  3. Viscoelasticity of Tendons Under Transverse Compression.

    Paul Buckley, C; Samuel Salisbury, S T; Zavatsky, Amy B

    2016-10-01

    Tendons are highly anisotropic and also viscoelastic. For understanding and modeling their 3D deformation, information is needed on their viscoelastic response under off-axis loading. A study was made, therefore, of creep and recovery of bovine digital extensor tendons when subjected to transverse compressive stress of up to ca. 100 kPa. Preconditioned tendons were compression tested between glass plates at increasing creep loads. The creep response was anomalous: the relative rate of creep reduced with the increasing stress. Over each ca. 100 s creep period, the transverse creep deformation of each tendon obeyed a power law dependence on time, with the power law exponent falling from ca. 0.18 to an asymptote of ca. 0.058 with the increasing stress. A possible explanation is stress-driven dehydration, as suggested previously for the similar anomalous behavior of ligaments. Recovery after removal of each creep load was also anomalous. Relative residual strain reduced with the increasing creep stress, but this is explicable in terms of the reducing relative rate of creep. When allowance was made for some adhesion occurring naturally between tendon and the glass plates, the results for a given load were consistent with creep and recovery being related through the Boltzmann superposition principle (BSP). The tendon tissue acted as a pressure-sensitive adhesive (PSA) in contact with the glass plates: explicable in terms of the low transverse shear modulus of the tendons. PMID:27496279

  4. Stem cell therapy: a promising biological strategy for tendon-bone healing after anterior cruciate ligament reconstruction.

    Hao, Zi-Chen; Wang, Shan-Zheng; Zhang, Xue-Jun; Lu, Jun

    2016-04-01

    Tendon-bone healing after anterior cruciate ligament (ACL) reconstruction is a complex process, impacting significantly on patients' prognosis. Natural tendon-bone healing usually results in fibrous scar tissue, which is of inferior quality compared to native attachment. In addition, the early formed fibrous attachment after surgery is often not reliable to support functional rehabilitation, which may lead to graft failure or unsatisfied function of the knee joint. Thus, strategies to promote tendon-bone healing are crucial for prompt and satisfactory functional recovery. Recently, a variety of biological approaches, including active substances, gene transfer, tissue engineering and stem cells, have been proposed and applied to enhance tendon-bone healing. Among these, stem cell therapy has been shown to have promising prospects and draws increasing attention. From commonly investigated bone marrow-derived mesenchymal stem cells (bMSCs) to emerging ACL-derived CD34+ stem cells, multiple stem cell types have been proven to be effective in accelerating tendon-bone healing. This review describes the current understanding of tendon-bone healing and summarizes the current status of related stem cell therapy. Future limitations and perspectives are also discussed. PMID:26929145

  5. Trypanosome resistance to human innate immunity: targeting Achilles' heel.

    Stephens, Natalie A; Kieft, Rudo; Macleod, Annette; Hajduk, Stephen L

    2012-12-01

    Trypanosome lytic factors (TLFs) are powerful, naturally occurring toxins in humans that provide sterile protection against infection by several African trypanosomes. These trypanocidal complexes predominantly enter the parasite by binding to the trypanosome haptoglobin/hemoglobin receptor (HpHbR), trafficking to the lysosome, causing membrane damage and, ultimately, cell lysis. Despite TLF-mediated immunity, the parasites that cause human African Trypanosomiasis (HAT), Trypanosoma brucei rhodesiense and Trypanosoma brucei gambiense, have developed independent mechanisms of resistance to TLF killing. In this review we describe the parasite defenses that allow trypanosome infections of humans and discuss how targeting these apparent strengths of the parasite may reveal their Achilles' heel, leading to new approaches in the treatment of HAT. PMID:23059119

  6. The Malaria Parasite's Achilles' Heel: Functionally-relevant Invasion Structures.

    Patarroyo, Manuel E; Alba, Martha P; Reyes, Cesar; Rojas-Luna, Rocio; Patarroyo, Manuel A

    2016-01-01

    Malaria parasites have their Achilles' heel; they are vulnerable in small parts of their relevant molecules where they can be wounded and killed. These are sporozoite and merozoite protein conserved high activity binding peptides (cHABPs), playing a critical role in binding to and invasion of host cells (hepatocytes and erythrocytes, respectively). cHABPs can be modified by specific amino acid replacement, according to previously published physicochemical rules, to produce analogues (mHABPs) having left-handed polyproline II (PPIIL)-like structures which can modulate an immune response due to fitting perfectly into the HLA-DRβ1* peptide binding region (PBR) and having an appropriate presentation to the T-cell receptor (TCR). PMID:25830771

  7. Updates in biological therapies for knee injuries: tendons

    Demange, Marco Kawamura; de Almeida, Adriano Marques; Rodeo, Scott A.

    2014-01-01

    Tendons are subjected to tendinopathies caused by inflammation, degeneration, and weakening of the tendon, due to overuse and trauma, which may eventually lead to tendon rupture. Recently, there has been increasing interest in biological approaches to augment tissue healing. Tendon healing occurs through a dynamic process with inflammation, cellular proliferation, and tissue remodeling. In this review article, we discuss the more frequently proposed biological therapies for tendon injuries as...

  8. Local trauma in human patellar tendon leads to widespread changes in the tendon gene expression

    Heinemeier, Katja Maria; Lorentzen, Marc P; Kildevang Jensen, Jacob;

    2016-01-01

    Low cellular activity and slow tissue turnover in human tendon may prolong resolution of tendinopathy. This may be stimulated by moderate localized traumas such as needle penetrations, but whether this results in a widespread cellular response in tendons is unknown. In an initial hypothesis......-generating study, a trauma-induced tendon cell activity (increased total RNA and collagen I mRNA) was observed after repeated patellar tendon biopsies in young men. In a subsequent controlled study, 25 young men were treated with two 0.8 mm diameter needle penetrations (n=13, needle-group (NG)) or one 2.1 mm...... diameter needle biopsy (n=12, biopsy-group (BG)) in one patellar tendon. Four weeks later biopsies were taken from treated (5 mm lateral from trauma site) and contralateral tendons for analyses of RNA content (ribogreen assay), DNA content (PCR based), and gene expression for relevant target genes (Real...

  9. Stem Cells for Augmenting Tendon Repair

    Lawrence V. Gulotta

    2012-01-01

    Full Text Available Tendon healing is fraught with complications such as reruptures and adhesion formation due to the formation of scar tissue at the injury site as opposed to the regeneration of native tissue. Stem cells are an attractive option in developing cell-based therapies to improve tendon healing. However, several questions remain to be answered before stem cells can be used clinically. Specifically, the type of stem cell, the amount of cells, and the proper combination of growth factors or mechanical stimuli to induce differentiation all remain to be seen. This paper outlines the current literature on the use of stem cells for tendon augmentation.

  10. Minimally Invasive Harvest of a Quadriceps Tendon Graft With or Without a Bone Block

    Fink, Christian; Herbort, Mirco; Abermann, Elisabeth; Hoser, Christian

    2014-01-01

    The quadriceps tendon (QT) as a graft source for anterior cruciate ligament (ACL) and posterior cruciate ligament reconstruction has recently achieved increased attention. Although many knee surgeons have been using the QT as a graft for ACL revision surgery, it has never gained universal acceptance for primary ACL reconstruction. The QT is a very versatile graft that can be harvested in different widths, thicknesses, and lengths. Conventionally, the QT graft is harvested by an open technique...

  11. Comparison of functional outcomes of two anterior cruciate ligament reconstruction methods with hamstring tendon graft

    Yosmaoglu, Hayri Baran; Baltaci, Gul; Kaya, Defne; Ozer, Hamza; Atay, Ahmet

    2011-01-01

    Objective: The aim of this study was to compare the effects of Endobutton post-fixation and femoral (TransFix) transfixation in ACL reconstruction on lower extremity muscle strength, joint position sense, and knee stability. Methods: Subjects who had undergone ACL reconstruction with hamstring tendon using Endobutton post-fixation (n=20, mean age: 26.5 years) or femoral transfixation (n=20, mean age: 29.9 years) were recruited to an ACL rehabilitation program. Twelve months after surgery,...

  12. Clinical results of a surgical technique using endobuttons for complete tendon tear of pectoralis major muscle: report of five cases

    Uchiyama Yoshiyasu

    2011-09-01

    Full Text Available Abstract Background We herein describe a surgical technique for the repair of complete tear of the pectoralis major (PM tendon using endobuttons to strengthen initial fixation. Methods Five male patients (3 judo players, 1 martial arts player, and 1 body builder were treated within 2 weeks of sustaining complete tear of the PM tendon. Average age at surgery and follow-up period were 28.4 years (range, 23-33 and 28.8 months (range, 24-36. A rectangular bone trough (about 1 × 4 cm was created on the humerus at the insertion of the distal PM tendon. The tendon stump was introduced into this trough, and fixed to the reverse side of the humeral cortex using endobuttons and non-absorbable suture. Clinical assessment of re-tear was examined by MRI. Shoulder range of motion (ROM, outcome of treatment, and isometric power were measured at final follow-up. Results There were no clinical re-tears, and MRI findings also showed continuity of the PM tendon in all cases at final follow-up. Average ROM did not differ significantly between the affected and unaffected shoulders. The clinical outcomes at final follow-up were excellent (4/5 cases or good (1/5. In addition, postoperative isometric power in horizontal flexion of the affected shoulder showed complete recovery when compared with the unaffected side. Conclusions Satisfactory outcomes could be obtained when surgery using the endobutton technique was performed within 2 weeks after complete tear of the PM tendon. Therefore, our new technique appears promising as a useful method to treat complete tear of the PM tendon.

  13. IFSSH Flexor Tendon Committee report 2014: from the IFSSH Flexor Tendon Committee (Chairman: Jin Bo Tang).

    Tang, Jin Bo; Chang, James; Elliot, David; Lalonde, Donald H; Sandow, Michael; Vögelin, Esther

    2014-01-01

    Hand surgeons continue to search for the best surgical flexor tendon repair and treatment of the tendon sheaths and pulleys, and they are attempting to establish postoperative regimens that fit diverse clinical needs. It is the purpose of this report to present the current views, methods, and suggestions of six senior hand surgeons from six different countries - all experienced in tendon repair and reconstruction. Although certainly there is common ground, the report presents provocative views and approaches. The report reflects an update in the views of the committee. We hope that it is helpful to surgeons and therapists in treating flexor tendon injuries. PMID:23962872

  14. Cosmetic Surgery

    ... Body Looking and feeling your best Cosmetic surgery Cosmetic surgery Teens might have cosmetic surgery for a number ... about my body? What are the risks of cosmetic surgery? top People who have cosmetic surgery face many ...

  15. Nose Surgery

    ... is as high a priority as appearance. Can Cosmetic Nasal Surgery Create A "Perfect" Nose? Aesthetic nasal surgery (rhinoplasty) ... Cover Nasal Surgery? Insurance usually does not cover cosmetic surgery. However, surgery to correct or improve breathing function, ...

  16. Cosmetic Surgery

    ... Submit Home > Body Image > Cosmetic surgery Body Image Cosmetic surgery ASPS list of inappropriate candidates for surgery ... their appearance. Return to top Additional resources on cosmetic surgery Breast surgery Explore other publications and websites ...

  17. Investigations related to failure of prestressing tendons

    Kozloduy NPP units 5 and 6 containment cladding shells are prestressed by the use of tendons 450 φ 5, made of high strength wires, class B-II. The prestressing force for each tendon is 10000 kN and the calculated breakdown force - 14000 kN. There are 96 tendons in the cylindrical part of the shell and 36 ones located in the containment dome. They are located in channel forming tubes of inner diameter of 200 mm, made of dense polyethylene. In order to assure biaxial prestressed condition, the prestressing tendons are located on screw shaped lines, both left and right, with declination to the horizon 35 degrees and 15 minutes. Each prestressing tendon initially forms a knee and following the bending at elevation + 10.80 m forms the other knee, in such a way, that its two ends are anchored in one and the same area-in a common or adjacent upper anchor boxes. The prestressing tendons in the containment dome are located in two perpendicular rows. Both ends of each tendon are anchored in a common fixing, the tendon being bent to the opposite side of the dome. During construction and operation of units 5 and 6, it was found, that the design prestressing force of 10000 kN can not be reached with some tendons, due to separate wires ruptures or due to the anchoring screw spent thread. The 1992 preliminary wires tests on a failed tendon found out deformation properties, different from the systematically obtained ones for the initial steel. Taking into consideration this fact, together with the IAEA regional project, concerning WWER-1000 seismic safety and items 4 and 6 of Kozloduy NPP Technical Council decisions of 10 June 1993, brought to delegation to the Research Construction Institute the performance of the technical analysis of the applied system for shell prestressing of containments of of units 5 and 6. The analysis comprises physical-mechanical and rheological properties of the high strength wires, used for containment shell prestressing and the over all technological

  18. Structure of the tendon connective tissue.

    Kannus, P

    2000-12-01

    Tendons consist of collagen (mostly type I collagen) and elastin embedded in a proteoglycan-water matrix with collagen accounting for 65-80% and elastin approximately 1-2% of the dry mass of the tendon. These elements are produced by tenoblasts and tenocytes, which are the elongated fibroblasts and fibrocytes that lie between the collagen fibers, and are organized in a complex hierarchical scheme to form the tendon proper. Soluble tropocollagen molecules form cross-links to create insoluble collagen molecules which then aggregate progressively into microfibrils and then into electronmicroscopically clearly visible units, the collagen fibrils. A bunch of collagen fibrils forms a collagen fiber, which is the basic unit of a tendon. A fine sheath of connective tissue called endotenon invests each collagen fiber and binds fibers together. A bunch of collagen fibers forms a primary fiber bundle, and a group of primary fiber bundles forms a secondary fiber bundle. A group of secondary fiber bundles, in turn, forms a tertiary bundle, and the tertiary bundles make up the tendon. The entire tendon is surrounded by a fine connective tissue sheath called epitenon. The three-dimensional ultrastructure of tendon fibers and fiber bundles is complex. Within one collagen fiber, the fibrils are oriented not only longitudinally but also transversely and horizontally. The longitudinal fibers do not run only parallel but also cross each other, forming spirals. Some of the individual fibrils and fibril groups form spiral-type plaits. The basic function of the tendon is to transmit the force created by the muscle to the bone, and, in this way, make joint movement possible. The complex macro- and microstructure of tendons and tendon fibers make this possible. During various phases of movements, the tendons are exposed not only to longitudinal but also to transversal and rotational forces. In addition, they must be prepared to withstand direct contusions and pressures. The above

  19. No Telescoping Effect with Dual Tendon Vibration

    Bellan, Valeria; Wallwork, Sarah B.; Tasha R Stanton; Reverberi, Carlo; Gallace, Alberto; Moseley, G. Lorimer

    2016-01-01

    The tendon vibration illusion has been extensively used to manipulate the perceived position of one’s own body part. However, findings from previous research do not seem conclusive sregarding the perceptual effect of the concurrent stimulation of both agonist and antagonist tendons over one joint. On the basis of recent data, it has been suggested that this paired stimulation generates an inconsistent signal about the limb position, which leads to a perceived shrinkage of the limb. However, t...

  20. Clinical results of a surgical technique using endobuttons for complete tendon tear of pectoralis major muscle: report of five cases

    Uchiyama Yoshiyasu; Miyazaki Seiji; Tamaki Tetsuro; Shimpuku Eiji; Handa Akiyoshi; Omi Hiroko; Mochida Joji

    2011-01-01

    Abstract Background We herein describe a surgical technique for the repair of complete tear of the pectoralis major (PM) tendon using endobuttons to strengthen initial fixation. Methods Five male patients (3 judo players, 1 martial arts player, and 1 body builder) were treated within 2 weeks of sustaining complete tear of the PM tendon. Average age at surgery and follow-up period were 28.4 years (range, 23-33) and 28.8 months (range, 24-36). A rectangular bone trough (about 1 × 4 cm) was crea...

  1. Effect of estrogen on tendon collagen synthesis, tendon structural characteristics, and biomechanical properties in postmenopausal women

    Hansen, M.; Kongsgaard, M; Holm, Lars;

    2009-01-01

    The knowledge about the effect of estradiol on tendon connective tissue is limited. Therefore, we studied the influence of estradiol on tendon synthesis, structure, and biomechanical properties in postmenopausal women. Nonusers (control, n = 10) or habitual users of oral estradiol replacement the...

  2. Magnetic resonance imaging appearance of the flexor carpi radialis tendon after harvest in ligamentous reconstruction tendon interposition arthroplasty

    To determine whether the post-harvest magnetic resonance (MR) imaging appearance of flexor carpi radialis (FCR) tendons, harvested during ligamentous reconstruction tendon interposition (LRTI) of the thumb carpometacarpal (CMC) joint arthroplasty, is consistent with tendon regeneration. Operative reports and patient medical records for all patients undergoing LRTI arthroplasty between 1995 and 2003 at our institution were reviewed. MR images of the patients' forearms and wrists were obtained and interpreted by two musculoskeletal radiologists. Using the flexor carpi ulnaris (FCU) tendon as an internal standard, the extent of FCR tendon regeneration was expressed as a percentage by dividing the volume of regenerated FCR tendon by the volume of the FCU tendon. Fourteen patients who had the full thickness of the FCR tendon harvested and who were available for MR imaging were identified and included in the study. At least partial regeneration of the FCR tendon occurred in 11 of the 14 patients (79%). Of these, 2 patients (14%), demonstrated complete, or nearly complete regeneration. Partial regeneration of the FCR tendon was seen in 9 of the 14 patients (64%). In 3 patients (21%), there was no appreciable regeneration of the FCR tendon. Among patients who underwent full-thickness harvest of the FCR tendon for LRTI arthroplasty of the first CMC joint, the follow-up MR imaging appearance of the flexor carpi radialis tendon was consistent with tendon regeneration in 79% of those examined. (orig.)

  3. Magnetic resonance imaging appearance of the flexor carpi radialis tendon after harvest in ligamentous reconstruction tendon interposition arthroplasty

    Beall, Douglas P.; Fish, Jon R. [Oklahoma University Health Sciences Center, Department of Radiology, Oklahoma City, OK (United States); Ritchie, Eric R.; Tran, Hoang N.; Ingari, John V. [Wilford Hall Medical Center, Department of Orthopedic Surgery, Lackland AFB, TX (United States); Campbell, Scot E.; Grayson, David E. [Wilford Hall Medical Center, Department of Radiology, Lackland AFB, TX (United States); Sanders, Timothy G. [University of Oklahoma Health Sciences Center, Department of Orthopedic Surgery and Rehabilitation, Oklahoma City, OK (United States); Mundis, Gregory; Lehman, Thomas P. [Uniform Services University, Department of Radiology, Bethesda, MD (United States)

    2006-03-15

    To determine whether the post-harvest magnetic resonance (MR) imaging appearance of flexor carpi radialis (FCR) tendons, harvested during ligamentous reconstruction tendon interposition (LRTI) of the thumb carpometacarpal (CMC) joint arthroplasty, is consistent with tendon regeneration. Operative reports and patient medical records for all patients undergoing LRTI arthroplasty between 1995 and 2003 at our institution were reviewed. MR images of the patients' forearms and wrists were obtained and interpreted by two musculoskeletal radiologists. Using the flexor carpi ulnaris (FCU) tendon as an internal standard, the extent of FCR tendon regeneration was expressed as a percentage by dividing the volume of regenerated FCR tendon by the volume of the FCU tendon. Fourteen patients who had the full thickness of the FCR tendon harvested and who were available for MR imaging were identified and included in the study. At least partial regeneration of the FCR tendon occurred in 11 of the 14 patients (79%). Of these, 2 patients (14%), demonstrated complete, or nearly complete regeneration. Partial regeneration of the FCR tendon was seen in 9 of the 14 patients (64%). In 3 patients (21%), there was no appreciable regeneration of the FCR tendon. Among patients who underwent full-thickness harvest of the FCR tendon for LRTI arthroplasty of the first CMC joint, the follow-up MR imaging appearance of the flexor carpi radialis tendon was consistent with tendon regeneration in 79% of those examined. (orig.)

  4. Isolated dislocation of the posterior tibial tendon in an amateur snowboarder: a case report.

    Gambardella, Gabriel V; Donegan, Ryan; Caminear, David S

    2014-01-01

    Isolated dislocation of the posterior tibial tendon is an uncommon pathologic entity that typically occurs in the setting of acute trauma. The diagnosis remains challenging and is often delayed second to the rarity of the injury and symptoms similar to that of medial ankle sprains and other routinely diagnosed injuries about the ankle. The factors that predispose this tendon to dislocation include a hypoplastic retromalleolar groove, flexor retinaculum insufficiency, chronic repetitive trauma, and a structural abnormality from a previous medial malleolar fracture, or a combination thereof. Dislocation has also been cited as a complication of multiple local steroid injections and tarsal tunnel release. The mechanism of injury appears to involve forced dorsiflexion and eversion of the ankle when the posterior tibial tendon is contracted. Most cases do not respond well to conservative treatment and will require surgery to restore function and eliminate symptoms. We report a case of posterior tibial tendon dislocation related to a snowboarding injury and offer our technique for surgical correction. PMID:24361009

  5. Isolated talonavicular arthrodesis in patients with rheumatoid arthritis of the foot and tibialis posterior tendon dysfunction

    Pokorný David

    2010-02-01

    Full Text Available Abstract Background The foot is often affected in patients with rheumatoid arthritis. Subtalar joints are involved more frequently than ankle joints. Deformities of subtalar joints often lead to painful flatfoot and valgus deformity of the heel. Major contributors to the early development of foot deformities include talonavicular joint destruction and tibialis posterior tendon dysfunction, mainly due to its rupture. Methods Between 2002 and 2005 we performed isolated talonavicular arthrodesis in 26 patients; twenty women and six men. Tibialis posterior tendon dysfunction was diagnosed preoperatively by physical examination and by MRI. Talonavicular fusion was achieved via screws in eight patients, memory staples in twelve patients and a combination of screws and memory staples in six cases. The average duration of immobilization after the surgery was four weeks, followed by rehabilitation. Full weight bearing was allowed two to three months after surgery. Results The mean age of the group at the time of the surgery was 43.6 years. MRI examination revealed a torn tendon in nine cases with no significant destruction of the talonavicular joint seen on X-rays. Mean of postoperative followup was 4.5 years (3 to 7 years. The mean of AOFAS Hindfoot score improved from 48.2 preoperatively to 88.6 points at the last postoperative followup. Eighteen patients had excellent results (none, mild occasional pain, six patients had moderate pain of the foot and two patients had severe pain in evaluation with the score. Complications included superficial wound infections in two patients and a nonunion developed in one case. Conclusions Early isolated talonavicular arthrodesis provides excellent pain relief and prevents further progression of the foot deformities in patients with rheumatoid arthritis and tibialis posterior tendon dysfunction.

  6. Direct repair of chronic distal biceps tendon tears

    Bernardo Barcellos Terra

    2016-06-01

    Full Text Available ABSTRACT OBJECTIVE: To present the results from direct tendon repair using EndoButton and interference screws in patients with lesions of the distal biceps that had evolved over a period of more than 28 days. METHODS: Between January 2012 and November 2013, eleven patients (all male with a torn distal biceps and a time interval between injury and surgery of more than 28 days were evaluated. The patients' mean age was 46 years and the most common mechanism of injury was eccentric loading with the elbow flexed and supinated. RESULTS: A subjective analysis on pain and function was conducted using a visual analog scale of pain (VAS and the Mayo Elbow Performance Score (MEPS, before and after surgery. The VAS showed a decrease of 5 points to 0.8 points on average. The MEPS improved from 69.3 points before the operation to 97.5 points afterwards. The mean flexion was 133.1° on the operated side, versus 134.3°. The mean extension was -2.5° and 0° (operated side versus non-operated. Supination was 88.2° versus 89.5° and pronation was 82.5° versus 84.1°, comparing the operated side versus the non-operated side. Flexion and supination strengths were evaluated with the aid of a dynamometer, and the mean flexion and supination strengths were found to be respectively 78.57% and 89.65% of the strength of the non-operated limb. CONCLUSION: Use of the technique of direct tendon repair using EndoButton and interference screws was shown to be a safe and effective alternative for repairing chronic lesions of the distal biceps.

  7. Reconstruction of medial patellofemoral ligament using quadriceps tendon combined with reconstruction of medial patellotibial ligament using patellar tendon: initial experience

    Betina Bremer Hinckel

    2016-02-01

    Full Text Available ABSTRACT OBJECTIVE: To describe a surgical technique for anatomical reconstruction of the medial patellofemoral ligament using the quadriceps tendon, combined with reconstruction of the medial patellotibial ligament using the patellar tendon; and to present the initial results from a case series. METHOD: The proposed technique was used on a series of cases of patients with diagnoses of patellofemoral instability and indications for surgical treatment, who were attended by the Knee Group of HC-IOT, University of São Paulo. The following were evaluated before and after the operation: range of motion (ROM, apprehension test, lateral translation test, patellar inclination test, inverted J sign, subluxation upon extension, pain from compression of the patella and pain from contraction of the quadriceps. After the operation, the patients were asked whether any new episode of dislocation had occurred, what their degree of satisfaction with the surgery was (on a scale from 0 to 10 and whether they would be prepared to go through this operation again. RESULTS: Seven knees were operated, in seven patients, with a mean follow-up of 5.46 months (±2.07. Four patients who presented apprehension before the operation did not show this after the operation. The lateral translation test became normal for all the patients, while the patellar inclination test remained positive for two patients. The patients with an inverted J sign continued to be positive for this sign. Five patients were positive for subluxation upon extension before the operation, but all patients were negative for this after the operation. None of the patients presented any new episode of dislocation of the patella. All of them stated that they were satisfied: five gave a satisfaction score of 9 and two, a score of 10. All of them said that they would undergo the operation again. Only one patient presented a postoperative complication: dehiscence of the wound. CONCLUSION: Reconstruction of the

  8. Reconstruction of medial patellofemoral ligament using quadriceps tendon combined with reconstruction of medial patellotibial ligament using patellar tendon: initial experience☆

    Hinckel, Betina Bremer; Gobbi, Riccardo Gomes; Bonadio, Marcelo Batista; Demange, Marco Kawamura; Pécora, José Ricardo; Camanho, Gilberto Luis

    2016-01-01

    Objective To describe a surgical technique for anatomical reconstruction of the medial patellofemoral ligament using the quadriceps tendon, combined with reconstruction of the medial patellotibial ligament using the patellar tendon; and to present the initial results from a case series. Method The proposed technique was used on a series of cases of patients with diagnoses of patellofemoral instability and indications for surgical treatment, who were attended by the Knee Group of HC-IOT, University of São Paulo. The following were evaluated before and after the operation: range of motion (ROM), apprehension test, lateral translation test, patellar inclination test, inverted J sign, subluxation upon extension, pain from compression of the patella and pain from contraction of the quadriceps. After the operation, the patients were asked whether any new episode of dislocation had occurred, what their degree of satisfaction with the surgery was (on a scale from 0 to 10) and whether they would be prepared to go through this operation again. Results Seven knees were operated, in seven patients, with a mean follow-up of 5.46 months (±2.07). Four patients who presented apprehension before the operation did not show this after the operation. The lateral translation test became normal for all the patients, while the patellar inclination test remained positive for two patients. The patients with an inverted J sign continued to be positive for this sign. Five patients were positive for subluxation upon extension before the operation, but all patients were negative for this after the operation. None of the patients presented any new episode of dislocation of the patella. All of them stated that they were satisfied: five gave a satisfaction score of 9 and two, a score of 10. All of them said that they would undergo the operation again. Only one patient presented a postoperative complication: dehiscence of the wound. Conclusion Reconstruction of the medial patellofemoral ligament

  9. Optimal arm posture control and tendon traction forces of a coupled tendon-driven manipulator

    In this study, the optimum arm posture of a coupled tendon-driven multijoint manipulator arm (or CT Arm) at maximum payload output was derived and the corresponding tendon traction forces were also analyzed, during management of a heavy payload by the manipulator in a gravity environment. The CT Arm is special tendon traction transmission mechanism in which a pair of tendons used to drive a joint is pulled from base actuators via pulleys mounted on the base-side joints. This mechanism enables optimal utilization of the coupled drive function of tendon traction forces and thus enables the lightweight manipulator to exhibit large payload capability. The properties of the CT Arm mechanism are elucidated by the proposed optimal posture control scheme. Computer simulation was also executed to verify the validity of the proposed control scheme. (author)

  10. More is not always better: modeling the effects of elastic exoskeleton compliance on underlying ankle muscle–tendon dynamics

    Development of robotic exoskeletons to assist/enhance human locomotor performance involves lengthy prototyping, testing, and analysis. This process is further convoluted by variability in limb/body morphology and preferred gait patterns between individuals. In an attempt to expedite this process, and establish a physiological basis for actuator prescription, we developed a simple, predictive model of human neuromechanical adaptation to a passive elastic exoskeleton applied at the ankle joint during a functional task. We modeled the human triceps surae–Achilles tendon muscle tendon unit (MTU) as a single Hill-type muscle, or contractile element (CE), and series tendon, or series elastic element (SEE). This modeled system was placed under gravitational load and underwent cyclic stimulation at a regular frequency (i.e. hopping) with and without exoskeleton (Exo) assistance. We explored the effect that both Exo stiffness (kExo) and muscle activation (Astim) had on combined MTU and Exo (MTU + Exo), MTU, and CE/SEE mechanics and energetics. Model accuracy was verified via qualitative and quantitative comparisons between modeled and prior experimental outcomes. We demonstrated that reduced Astim can be traded for increased kExo to maintain consistent MTU + Exo mechanics (i.e. average positive power ( P-bar mech+) output) from an unassisted condition (i.e. kExo=0 kN⋅m−1). For these regions of parameter space, our model predicted a reduction in MTU force, SEE energy cycling, and metabolic rate ( P-bar met), as well as constant CE P-bar mech+ output compared to unassisted conditions. This agreed with previous experimental observations, demonstrating our model’s predictive ability. Model predictions also provided insight into mechanisms of metabolic cost minimization, and/or enhanced mechanical performance, and we concluded that both of these outcomes cannot be achieved simultaneously, and that one must come at the detriment of the other in a spring

  11. Exploiting elasticity: Modeling the influence of neural control on mechanics and energetics of ankle muscle-tendons during human hopping.

    Robertson, Benjamin D; Sawicki, Gregory S

    2014-07-21

    We present a simplified Hill-type model of the human triceps surae-Achilles tendon complex working on a gravitational-inertial load during cyclic contractions (i.e. vertical hopping). Our goal was to determine the role that neural control plays in governing muscle, or contractile element (CE), and tendon, or series elastic element (SEE), mechanics and energetics within a compliant muscle-tendon unit (MTU). We constructed a 2D parameter space consisting of many combinations of stimulation frequency and magnitude (i.e. neural control strategies). We compared the performance of each control strategy by evaluating peak force and average positive mechanical power output for the system (MTU) and its respective components (CE, SEE), force-length (F-L) and -velocity (F-V) operating point of the CE during active force production, average metabolic rate for the CE, and both MTU and CE apparent efficiency. Our results suggest that frequency of stimulation plays a primary role in governing whole-MTU mechanics. These include the phasing of both activation and peak force relative to minimum MTU length, average positive power, and apparent efficiency. Stimulation amplitude was primarily responsible for governing average metabolic rate and within MTU mechanics, including peak force generation and elastic energy storage and return in the SEE. Frequency and amplitude of stimulation both played integral roles in determining CE F-L operating point, with both higher frequency and amplitude generally corresponding to lower CE strains, reduced injury risk, and elimination of the need for passive force generation in the CE parallel elastic element (PEE). PMID:24641822

  12. Avoiding the Achilles heel of network-centric enterprises

    McVey, Michelle; Dryer, Jay E.; Randall, Lance

    2003-08-01

    Corporate, government and military bodies focus significant resources to develop sophisticated and capable information-based systems. The concept of people and resources connected by a robust network capable of extremely high rates of information exchange is very attractive because it allows smaller groups to coordinate together and focus effects from geographically diverse locations. However, there is also a hidden danger that comes with such advanced technology. For example, in the case of the U.S. Military, clearly United States holds a technological advantage over our adversaries and that this advantage is still expanding. This technology gap has resulted in the emergence of potent asymmetrical warfare. All too often in science fiction movies, we see a small group of humans defeat a technologically superior alien race by striking at a hidden weakness that renders all of their advanced weapons as useless, as a result of pervasive connectivity and interdependence. The analogy holds for any large network-centric enterprise, corporate or governmental. This paper focuses on specific technologies and methods that preempt this Achilles Heal scenario.

  13. Robot Arm with Tendon Connector Plate and Linear Actuator

    Ihrke, Chris A. (Inventor); Diftler, Myron A. (Inventor); Bridgwater, Lyndon (Inventor); Nguyen, Vienny (Inventor); Millerman, Alexander (Inventor)

    2014-01-01

    A robotic system includes a tendon-driven end effector, a linear actuator, a flexible tendon, and a plate assembly. The linear actuator assembly has a servo motor and a drive mechanism, the latter of which translates linearly with respect to a drive axis of the servo motor in response to output torque from the servo motor. The tendon connects to the end effector and drive mechanism. The plate assembly is disposed between the linear actuator assembly and the tendon-driven end effector and includes first and second plates. The first plate has a first side that defines a boss with a center opening. The second plate defines an accurate through-slot having tendon guide channels. The first plate defines a through passage for the tendon between the center opening and a second side of the first plate. A looped end of the flexible tendon is received within the tendon guide channels.

  14. Rotator Interval Lesion and Damaged Subscapularis Tendon Repair in a High School Baseball Player

    Tomoyuki Muto

    2015-01-01

    Full Text Available In 2013, a 16-year-old baseball pitcher visited Nobuhara Hospital complaining of shoulder pain and limited range of motion in his throwing shoulder. High signal intensity in the rotator interval (RI area (ball sign, injured subscapularis tendon, and damage to both the superior and middle glenohumeral ligaments were identified using magnetic resonance imaging (MRI. Repair of the RI lesion and partially damaged subscapularis tendon was performed in this pitcher. During surgery, an opened RI and dropping of the subscapularis tendon were observed. The RI was closed in a 90° externally rotated and abducted position. To reconfirm the exact repaired state of the patient, arthroscopic examination was performed from behind. However, suture points were not visible in the >30° externally rotated position, which indicates that the RI could not be correctly repaired with the arthroscopic procedure. One year after surgery, the patient obtained full function of the shoulder and returned to play at a national convention. Surgical repair of the RI lesion should be performed in exactly the correct position of the upper extremity.

  15. No Telescoping Effect with Dual Tendon Vibration

    Bellan, Valeria; Wallwork, Sarah B.; Stanton, Tasha R.; Reverberi, Carlo; Gallace, Alberto; Moseley, G. Lorimer

    2016-01-01

    The tendon vibration illusion has been extensively used to manipulate the perceived position of one’s own body part. However, findings from previous research do not seem conclusive sregarding the perceptual effect of the concurrent stimulation of both agonist and antagonist tendons over one joint. On the basis of recent data, it has been suggested that this paired stimulation generates an inconsistent signal about the limb position, which leads to a perceived shrinkage of the limb. However, this interesting effect has never been replicated. The aim of the present study was to clarify the effect of a simultaneous and equal vibration of the biceps and triceps tendons on the perceived location of the hand. Experiment 1 replicated and extended the previous findings. We compared a dual tendon stimulation condition with single tendon stimulation conditions and with a control condition (no vibration) on both ‘upward-downward’ and ‘towards-away from the elbow’ planes. Our results show a mislocalisation towards the elbow of the position of the vibrated arm during dual vibration, in line with previous results; however, this did not clarify whether the effect was due to arm representation contraction (i.e., a ‘telescoping’ effect). Therefore, in Experiment 2 we investigated explicitly and implicitly the perceived arm length during the same conditions. Our results clearly suggest that in all the vibration conditions there was a mislocalisation of the entire arm (including the elbow), but no evidence of a contraction of the perceived arm length. PMID:27305112

  16. No Telescoping Effect with Dual Tendon Vibration.

    Valeria Bellan

    Full Text Available The tendon vibration illusion has been extensively used to manipulate the perceived position of one's own body part. However, findings from previous research do not seem conclusive sregarding the perceptual effect of the concurrent stimulation of both agonist and antagonist tendons over one joint. On the basis of recent data, it has been suggested that this paired stimulation generates an inconsistent signal about the limb position, which leads to a perceived shrinkage of the limb. However, this interesting effect has never been replicated. The aim of the present study was to clarify the effect of a simultaneous and equal vibration of the biceps and triceps tendons on the perceived location of the hand. Experiment 1 replicated and extended the previous findings. We compared a dual tendon stimulation condition with single tendon stimulation conditions and with a control condition (no vibration on both 'upward-downward' and 'towards-away from the elbow' planes. Our results show a mislocalisation towards the elbow of the position of the vibrated arm during dual vibration, in line with previous results; however, this did not clarify whether the effect was due to arm representation contraction (i.e., a 'telescoping' effect. Therefore, in Experiment 2 we investigated explicitly and implicitly the perceived arm length during the same conditions. Our results clearly suggest that in all the vibration conditions there was a mislocalisation of the entire arm (including the elbow, but no evidence of a contraction of the perceived arm length.

  17. Acellular Dermal Matrix in Rotator Cuff Surgery.

    Cooper, Joseph; Mirzayan, Raffy

    2016-01-01

    The success of rotator cuff repair (RCR) surgery can be measured clinically (validated outcome scores, range of motion) as well as structurally (re-tear rates using imaging studies). Regardless of repair type or technique, most studies have shown that patients do well clinically. However, multiple studies have also shown that structurally, the failure rate can be very high. A variety of factors, including poor tendon quality, age over 63 years, smoking, advanced fatty infiltration into the muscle, and the inability of the tendon to heal to bone, have been implicated as the cause of the high re-tear rate in RCRs. The suture-tendon interface is felt to be the weakest link in the RCR construct, and suture pullout through the tendon is believed to be the most common method of failure. This review of the published literature seeks to determine if there is support for augmentation of RCR with acellular dermal matrices to strengthen the suture-tendon interface and reduce the re-tear rate. PMID:27552454

  18. Cataract Surgery

    ... Uveitis Focus On Pediatric Ophthalmology Education Center Oculofacial Plastic Surgery Center Laser Surgery Education Center Redmond Ethics Center ... Uveitis Focus On Pediatric Ophthalmology Education Center Oculofacial Plastic Surgery Center Laser Surgery Education Center Redmond Ethics Center ...

  19. Current evidence of extracorporeal shock wave therapy in chronic Achilles tendinopathy.

    Gerdesmeyer, Ludger; Mittermayr, Rainer; Fuerst, Martin; Al Muderis, Munjed; Thiele, Richard; Saxena, Amol; Gollwitzer, Hans

    2015-12-01

    Chronic Achilles tendinopathy has been described as the most common overuse injury in sports medicine. Several treatment modalities such as activity modification, heel lifts, arch supports, stretching exercises, nonsteroidal anti-inflammatories, and eccentric loading are known as standard treatment mostly without proven evidence. After failed conservative therapy, invasive treatment may be considered. Extracorporeal shock wave therapy (ESWT) has been successfully used in soft-tissue pathologies like lateral epicondylitis, plantar fasciitis, tendinopathy of the shoulder and also in bone and skin disorders. Conclusive evidence recommending ESWT as a treatment for Achilles tendinopathy is still lacking. In plantar fasciitis as well as in calcific shoulder tendinopathy shock wave therapy is recently the best evaluated treatment option. This article analysis the evidence based literature of ESWT in chronic Achilles tendinopathy. Recently published data have shown the efficacy of focused and radial extracorporeal shock wave therapy. PMID:26327530

  20. The effect of foot position on Power Doppler Ultrasound grading of Achilles enthesitis.

    Zappia, Marcello; Cuomo, Giovanna; Martino, Maria Teresa; Reginelli, Alfonso; Brunese, Luca

    2016-06-01

    The aim of this study was to determine whether foot position could modify power Doppler grading in evaluation of the Achilles enthesis. Eighteen patients with clinical Achilles enthesitis were studied with power Doppler ultrasound (PDUS) in five different positions of the foot: active and passive dorsiflexion, neutral position, active and passive plantar flexion. The Doppler signal was graded in any position and compared with the others. The Doppler signal was higher with the foot in plantar flexion and decreased gradually, sometimes till to disappear, while increasing dorsiflexion. The Doppler signal was always less during the active keeping of the position of the joint, than during the passive. The PDUS examination of the Achilles enthesis should be performed also with the foot in passive plantar flexion, in order not to underestimate the degree of vascularization. PMID:27002715

  1. Calcaneal tendon: imaging findings; Tendao calcaneo: avaliacao por imagem

    Montandon, Cristiano; Fonseca, Cristiano Rezio; Montandon Junior, Marcelo Eustaquio [Colegio Brasileiro de Radiologia e Diagnostico por Imagem, Sao Paulo, SP (Brazil)]. E-mail: crismontandon@hotmail.com; Lobo, Leonardo Valadares; Ribeiro, Flavia Aparecida de Souza; Teixeira, Kim-Ir-Sen Santos [Goias Univ., Goiania, GO (Brazil). Hospital de Clinicas. Dept. de Diagnostico por Imagem e Anatomia Patologica

    2003-12-01

    We reviewed the radiological and clinical features of 23 patients with calcaneal tendon diseases, who were submitted to ultrasound or magnetic resonance imaging. The objective of this study was to characterize the lesions for a precise diagnosis of calcaneal tendon injuries. A wide range of calcaneal tendon diseases include degenerative lesions, inflammation of the peritendinous tissue such as peritendinitis and bursitis, and rupture. Imaging methods are essential in the diagnosis, treatment and follow-up of calcaneal tendon diseases. (author)

  2. Engineering Tendon: Scaffolds, Bioreactors, and Models of Regeneration

    Youngstrom, Daniel W.; Jennifer G Barrett

    2016-01-01

    Tendons bridge muscle and bone, translating forces to the skeleton and increasing the safety and efficiency of locomotion. When tendons fail or degenerate, there are no effective pharmacological interventions. The lack of available options to treat damaged tendons has created a need to better understand and improve the repair process, particularly when suitable autologous donor tissue is unavailable for transplantation. Cells within tendon dynamically react to loading conditions and undergo p...

  3. True stress and Poisson's ratio of tendons during loading

    VERGARI, Claudio; Pourcelot, Philippe; HOLDEN, Laurène; RAVARY-PLUMIOEN, Bérangère; GERARD, Guillaume; Laugier, Pascal; Mitton, David; Crevier-Denoix, Nathalie

    2011-01-01

    Excessive axial tension is very likely involved in the aetiology of tendon lesions, and the most appropriate indicator of tendon stress state is the true stress, the ratio of instantaneous load to instantaneous cross-sectional area (CSA). Difficulties to measure tendon CSA during tension often led to approximate true stress by assuming that CSA is constant during loading (i.e. by the engineering stress) or that tendon is incompressible, implying a Poisson's ratio of 0.5, although these hypoth...

  4. Triceps tendon avulsion and associated injuries of the elbow

    Canbora, Kerem; Ozyurek, Selahattin; Gumussuyu, Gurkan; Kose, Ozkan

    2013-01-01

    A rupture or avulsion of the triceps tendon is very rare but concomitant elbow injuries with avulsion of the triceps tendon are even rarer. In this study, an extraordinary and unusual injury combination (radial head and trochlear fracture associated with triceps tendon avulsion), which happened during a fall onto the elbow with outstretched hand, was identified and has been discussed in the literature.

  5. Intratendinous Tophaceous Gout Imitating Patellar Tendonitis in an Athletic Man

    Gililland, Jeremy M.; Webber, Nicholas P.; Jones, Kevin B.; Randall, R. Lor; Aoki, Stephen K.

    2011-01-01

    Patellar tendon-related pain is common in the athletic patient. When it occurs in skeletally mature patients participating in running, jumping, or kicking sports, the diagnosis of jumper’s knee patellar tendonitis is usually made. If patellar tendon pain is associated with a mass, the differential diagnosis should be broadened to include crystalline arthropathy.

  6. Bilateral spontaneous rupture of flexor digitorum profundus tendons.

    O'Sullivan, S T

    2012-02-03

    Spontaneous tendon rupture is an unusual condition usually associated with underlying disease processes such as rheumatoid arthritis, chronic renal failure or bony abnormalities of the hand. We report a case of spontaneous, non-concurrent bilateral rupture of flexor profundus tendons in an otherwise healthy individual. Treatment was successful and consisted of a two-stage reconstruction of the ruptured tendon.

  7. 21 CFR 888.3025 - Passive tendon prosthesis.

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Passive tendon prosthesis. 888.3025 Section 888...) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3025 Passive tendon prosthesis. (a) Identification. A passive tendon prosthesis is a device intended to be implanted made of silicon elastomer or...

  8. Magnetic resonance imaging findings after rectus femoris transfer surgery

    Gold, Garry E. [Department of Radiology, Stanford University, Stanford, CA (United States); Asakawa, Deanna S.; Blemker, Silvia S. [Department of Mechanical Engineering, Stanford University, Stanford, CA (United States); Delp, Scott L. [Department of Mechanical Engineering, Stanford University, Stanford, CA (United States); Department of Bioengineering, Stanford University, Stanford, CA (United States)

    2004-01-01

    We describe the magnetic resonance (MR) imaging appearance of the knee flexor and extensor tendons after bilateral rectus femoris transfer and hamstring lengthening surgery in five patients (10 limbs) with cerebral palsy. Three-dimensional models of the path of the transferred tendon were constructed in all cases. MR images of the transferred and lengthened tendons were examined and compared with images from ten non-surgical subjects. The models showed that the path of the transferred rectus femoris tendon had a marked angular deviation near the transfer site in all cases. MR imaging demonstrated irregular areas of low signal intensity near the transferred rectus femoris and around the hamstrings in all subjects. Eight of the ten post-surgical limbs showed evidence of fluid near or around the transferred or lengthened tendons. This was not observed in the non-surgical subjects. Thus, MR imaging of patients with cerebral palsy after rectus femoris transfer and hamstring-lengthening surgery shows evidence of signal intensity and contour changes, even several years after surgery. (orig.)

  9. Magnetic resonance imaging findings after rectus femoris transfer surgery

    We describe the magnetic resonance (MR) imaging appearance of the knee flexor and extensor tendons after bilateral rectus femoris transfer and hamstring lengthening surgery in five patients (10 limbs) with cerebral palsy. Three-dimensional models of the path of the transferred tendon were constructed in all cases. MR images of the transferred and lengthened tendons were examined and compared with images from ten non-surgical subjects. The models showed that the path of the transferred rectus femoris tendon had a marked angular deviation near the transfer site in all cases. MR imaging demonstrated irregular areas of low signal intensity near the transferred rectus femoris and around the hamstrings in all subjects. Eight of the ten post-surgical limbs showed evidence of fluid near or around the transferred or lengthened tendons. This was not observed in the non-surgical subjects. Thus, MR imaging of patients with cerebral palsy after rectus femoris transfer and hamstring-lengthening surgery shows evidence of signal intensity and contour changes, even several years after surgery. (orig.)

  10. Deltoid muscle and tendon tears in patients with chronic rotator cuff tears

    Ilaslan, Hakan; Recht, Michael P. [Cleveland Clinic, Musculoskeletal Radiology/A21, Division of Radiology, Cleveland, OH (United States); Iannotti, Joseph P. [Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, OH (United States)

    2007-06-15

    To describe the magnetic resonance imaging (MRI) appearances of tears of the deltoid muscle and tendon in patients with rotator cuff tears and without a prior history of shoulder surgery. Deltoid tears diagnosed on MR examinations were prospectively recorded between February 2003 through June 2004. The images of these patients were then retrospectively reviewed to determine the location of the deltoid tear, the presence of rotator cuff tears, tendon retraction, muscle atrophy, degree of humeral head subluxation, bony erosive changes involving the undersurface of the acromion, and the presence of edema or fluid-like signal intensity in the deltoid muscle and overlying subcutaneous tissues. There were 24 (0.3%) patients with deltoid tears; nine men and 15 women. The age range was 54 to 87 (average 73) years. The right side was involved in 20 cases, and the left in four cases. Fifteen patients had full thickness and nine had partial thickness tears of the deltoid. Shoulder pain was the most common presenting symptom. The physical examination revealed a defect in the region of the deltoid in two patients. Nineteen patients had tears in the muscle belly near the musculotendinous junction, and five had avulsion of the tendon from the acromial origin. Full thickness rotator cuff tears were present in all of the patients, and 22 patients had associated muscle atrophy. Subcutaneous edema and fluid-like signal was present in 15 patients. Tears of the deltoid muscle or tendon is an unusual finding, but they can be seen in patients with chronic massive rotator cuff tears. Partial thickness tears tend to involve the undersurface of the deltoid muscle and tendon. Associated findings such as intramuscular cyst or ganglion in the deltoid muscle belly and subcutaneous edema or fluid-like signal overlying the deltoid in a patient with a rotator cuff tear should raise the suspicion of a deltoid tear. (orig.)

  11. [Biceps tendon: diagnosis, therapy and results after proximal and distal rupture].

    Klonz, A; Reilmann, H

    2000-03-01

    Ruptures of the long head of the M. biceps humeri are commonly caused by degenerative changes within the tendon. They are associated with pathologies of the subacromial space. The loss of power regarding elbow flexion and supination amounts to 8 to 21% after conservative treatment. Refixation offers a small but evident improvement of flexion and supination power. Especially endurance is improved. The number of cases with remaining light or marked weakness is reduced by more than 50%. Deformity by the slipped muscle can be corrected effectively. Function of the glenohumeral joint can only be improved if associated subacromial problems are identified and treated simultaneously. As complications are uncommon surgery should be recommended to young and active patients and should at least be offered to less active patients. Ruptures of the distal tendon are less common. Thirteen patients were re-examined after operative repair for distal biceps tendon avulsion and 277 reported cases were reviewed. After conservative management (n = 20) the power of flexion will remain reduced by 30%-40%, that of supination by more than 50%. The loss of flexion power, as well as the deformity can be diminished by attachment of the distal biceps to the brachialis muscle (n = 22). The anatomic re-insertion (n = 248) additionally reduces the loss of supination power to 0%-25%, but bears a higher risk of complications. Using the 'double-incision technique' (n = 105 of 248) does not decrease the risk of naval lesions but increases the incidence of radioulnar synostosis. The use of suture anchors provides a nice way of fixation of the tendon but does not facilitate the approach to the tuberosity. The distal biceps tendon rupture should be treated operatively. The adequate method of repair is to be determined individually. PMID:10798230

  12. Effects of Non-Steroidal Anti-Inflammatory Drugs onFlexor Tendon Rehabilitation after Repair

    Alireza Rouhani

    2013-09-01

    Full Text Available   Background: Peritendinous adhesions after repairing an injury to the digital flexor tendons are a major problem in hand surgery. Non-steroidal anti-inflammatory drug therapy may affect tendon healing and the development of peritendinous adhesions. The aim of this study was to evaluate ibuprofen effect in patients function after flexor tendon surgical repair.   Method: Thirty-five patients, who had sharp-edge lacerations of hand-zone II requiring flexor tendons repair, participated in this randomized double-blind clinical trial study. The patients were randomly classified into two parallel and matched groups (21 patients in the intervention group and 14 patients in the control group. The groups were matched considering age, gender, and laceration size. The control group received a placebo with the same appearance and dosage. In the intervention group, ibuprofen was prescribed at a high dosage (2400 mg/day. The range of motion improvement rate of the involved fingers and the patients’ performance after their follow-up period were compared. Results: There was a statistically significant difference between the two groups for range of motion of the involved finger joints (P=0.03. According to the DASH score, there was a statistically significant difference between the final performance of the patients, such that it was 11±2.4 and 18.4±6.3 in the intervention and control groups, respectively (P=0.01. There was not any case of re-tear or need to re-operate in the intervention and control groups. Conclusion: Our findings reveal that ibuprofen with an anti-inflammatory dose was effective in improving the range of motion of the involved fingers joints after flexor tendon injury.

  13. Effects of Non-Steroidal Anti-Inflammatory Drugs onFlexor Tendon Rehabilitation after Repair

    Alireza Rouhani

    2013-09-01

    Full Text Available Background: Peritendinous adhesions after repairing an injury to the digital flexor tendons are a major problem in hand surgery. Non-steroidal anti-inflammatory drug therapy may affect tendon healing and the development of peritendinous adhesions. The aim of this study was to evaluate ibuprofen effect in patients function after flexor tendon surgical repair.   Method: Thirty-five patients, who had sharp-edge lacerations of hand-zone II requiring flexor tendons repair, participated in this randomized double-blind clinical trial study. The patients were randomly classified into two parallel and matched groups (21 patients in the intervention group and 14 patients in the control group. The groups were matched considering age, gender, and laceration size. The control group received a placebo with the same appearance and dosage. In the intervention group, ibuprofen was prescribed at a high dosage (2400 mg/day. The range of motion improvement rate of the involved fingers and the patients’ performance after their follow-up period were compared. Results: There was a statistically significant difference between the two groups for range of motion of the involved finger joints (P=0.03. According to the DASH score, there was a statistically significant difference between the final performance of the patients, such that it was 11±2.4 and 18.4±6.3 in the intervention and control groups, respectively (P=0.01. There was not any case of re-tear or need to re-operate in the intervention and control groups. Conclusion: Our findings reveal that ibuprofen with an anti-inflammatory dose was effective in improving the range of motion of the involved fingers joints after flexor tendon injury.

  14. Tendons Arrangement Effects on Reinforced Concrete Frames

    Ayad B. Bahnam

    2013-05-01

    Full Text Available  The tendons arrangement effects on the response of reinforced concrete frame experiencing blast loads is investigated in this paper. The structure is modeled using nonlinear finite elements employing a bilinear hysteretic model. So that elements are used so that yielding of the structures could be accurately modeled and captured. The frame is analyzed using a non-linear, elastic-plastic finite element program written in code MATLAB. Six tendon architectures were investigated. A single tendon was placed between different floors and its effects investigated. From the obtained results, the ideal case which causes a reduction in the maximum displacement and the amount of permanent deflection without increase in the maximum structural shear forces greatly is obtained.

  15. Classification and Analysis of Pathology of the Long Head of the Biceps Tendon in Complete Rotator Cuff Tears

    Kuo-Yao Hsu

    2012-06-01

    Full Text Available Background: Pathology of the long head of the biceps tendon (LHB is commonly associated with rotator cuff tears (RCTs. Superior labral anterior-posterior (SLAP lesions can also occur with RCTs. The purpose of this study was to include SLAP lesions as part of LHB pathology in surgical cases of RCT and define the role of SLAP lesions in RCTs.Methods: We retrospectively evaluated clinical data from 176 cases of complete RCT undergoing surgery. During surgery, the LHB was arthroscopically examined. A modified 6-type classification was used to describe the LHB pathology in these cases: tendinitis, subluxation, dislocation, partial tear, complete rupture and SLAP lesions. The relationship of LHB pathology to different characteristics of RCTs was statistically analyzed.Results: Of RCT cases, 33% had Type 1 (tendinitis, 11% had Type 2 (subluxation, 9% had Type 3 (dislocation, 16% had Type 4 (partial tear, 7% had Type 5 (complete rupture and 6% had Type 6 (SLAP lesions. The remaining 18% of cases had no obvious LHB pathology. LHB pathology were associated with RCTs of a long duration (> 3 months, large area (> 5 cm2, and multiple or subscapularis tendon involvement. Seventy four percent of patients with affected shoulders underwent simultaneous surgery for both LHB pathology and RCTs.Conclusion: Most patient with RCTs with chronic, massive, and multiple or subscapularis tendon involvement also had LHB injury. SLAP lesions, which we classified as a subgroup of LHB pathology, should be identified during rotator cuff surgery and treated appropriately.

  16. Surgical treatment of simple syndactylism with secondary deep digital flexor tendon contracture in a Basset Hound.

    Towle, H; Friedlander, K; Ko, R; Aper, R; Breur, G

    2007-01-01

    A five-month-old, female Basset Hound was presented for lameness associated with a fused 3rd and 4th digital pad on the left hind limb (simple incomplete syndactyly), and secondary contracture of the deep digital flexure tendon of the 3rd and 4th digit. An onychectomy of the third phalanx of the third and fourth digits was performed. Following the operation, the dog gained good use of the affected limb for one month until intermittent non-weight bearing lameness developed. A second surgery was performed six months later, partially removing the second phalanx of digits three and four. Follow-up reports indicate that the dog is doing well and is without lameness. This is the first report of deep digital flexor tendon contracture and surgical treatment of this complication in canine simple syndactylism. PMID:17846689

  17. Patellar and Achilles tendinopathy : sclerosing injections and ultrasound guided arthroscopic shaving

    Willberg, Lotta

    2013-01-01

    Chronic painful tendinopathy is a common cause for elite- and recreational athletes to stop or decrease the level of their sports activity. Recent research on innervation patterns, histopathology and possible pain mechanisms in tendons has led to an increased knowledge about the chronic painful tendon. Ultrasound (US) and colourDoppler (CD) examination showing localized high blood flow, inside and outside regions with structural tendon abnormalities, has been shown to be of importance for ten...

  18. Murine patellar tendon biomechanical properties and regional strain patterns during natural tendon-to-bone healing after acute injury

    Gilday, Steven D.; Casstevens, E. Chris; Kenter, Keith; Jason T Shearn; David L Butler

    2013-01-01

    Tendon-to-bone healing following acute injury is generally poor and often fails to restore normal tendon biomechanical properties. In recent years, the murine patellar tendon (PT) has become an important model system for studying tendon healing and repair due to its genetic tractability and accessible location within the knee. However, the mechanical properties of native murine PT, specifically the regional differences in tissue strains during loading, and the biomechanical outcomes of natura...

  19. The interfascicular matrix enables fascicle sliding and recovery in tendon, and behaves more elastically in energy storing tendons

    Thorpe, Chavaunne T.; Godinho, Marta S.C.; Riley, Graham P; Birch, Helen L.; Clegg, Peter D.; Screen, Hazel R. C.

    2015-01-01

    While the predominant function of all tendons is to transfer force from muscle to bone and position the limbs, some tendons additionally function as energy stores, reducing the cost of locomotion. Energy storing tendons experience extremely high strains and need to be able to recoil efficiently for maximum energy storage and return. In the equine forelimb, the energy storing superficial digital flexor tendon (SDFT) has much higher failure strains than the positional common digital extensor te...

  20. Ultrasound diagnostics of muscle and tendon injuries

    Stević Ruža

    2009-01-01

    Full Text Available Introduction. Sonography is a useful technique for the investigation of a number of musculoskeletal disorders. The most common indication for ultrasonography of muscles and tendons is the diagnosis of traumatic lesions, distinguishing them from other disorders and follow-up of healing process. Objective. The purpose of this paper is to show the importance of ultrasound in the diagnosis of muscle and tendon injuries. Methods. The study included 170 patients (148 male and 22 female, mean age 29.6 years (range 14-60 years. All examinations were performed by linear transducer of 7.5-10 MHz, with longitudinal and transverse scanning. Ultrasound examination followed physical examination. Results. Traumatic lesions of muscles were diagnosed in 113 patients (66.7% and tendon injuries in 57 cases (33.2%. The muscle changes detected by ultrasonography were the following: 70 (61.9% partial and two (1.76% complete ruptures, 22 (19.46% haematoma, 9 (7.96% strains grade I, 4 fibroses and 4 ossifying myositis 4 (3.5%, respectively. Complications of muscle injuries were diagnosed in two cases, a muscular hernia and an arteriovenous fistula. Among tendon injuries, 21 (33.8% ruptures and 36 (66.1% tendinitis were diagnosed. Accompanying effusion in the bursa of patients with tendon injuries was found in 9 cases. Conclusion. Ultrasonography allowed visualization and objective assessment of the type and the extent of traumatic pathomorphological changes of muscles and tendons. Such diagnostic possibilities of ultrasonography are especially important in the choice of appropriate therapy.

  1. Minimally invasive surgery for diabetic plantar foot ulcerations

    Caio Nery

    2011-11-01

    Full Text Available Complications of diabetes mellitus constitute the most common indications for hospitalization and non-traumatic amputations in the USA. The most important risk factors for the development of diabetic foot ulcerations include the presence of peripheral neuropathy, vasculopathy, limited joint mobility, and pre-existing foot deformities. In our study, 500 diabetic patients treated for plantar forefoot ulcerations were enrolled in a prospective study from 2000 to 2008 at the Federal University of São Paulo, Brazil. Fifty-two patients in the study met the criteria and underwent surgical treatment consisting of percutaneous Achilles tendon lengthening to treat plantar forefoot ulcerations. The postoperative follow-up demonstrated prevention of recurrent foot ulcerations in 92% of these diabetic patients that maintained an improved foot function. In conclusion, our study supports that identification and treatment of ankle equinus in the diabetic population may potentially lead to decreased patient morbidity, including reduced risk for both reulceration, and potential lower extremity amputation.

  2. Glutaraldehyde Cross-Linking of TendonMechanical Effects at the Level of the Tendon Fascicle and Fibril

    Hansen, P.; Svensson, R.B.; Aagaard, P.;

    2009-01-01

    allowed for a detailed characterization of the effect of cross-linking in rat-tail tendon. The cross-link inducing agent glutaraldehyde augmented the tensile strength of tendon fascicles. Stress at failure increased from 8 MPa to 39 MPa. The mechanical effects of glutaraldehyde at the tendon fibril level...

  3. Ultrasound Guidance in Performing a Tendoscopic Surgery to Treat Posterior Tibial Tendinitis: A Useful Tool?

    Akinobu Nishimura

    2016-01-01

    Full Text Available A 25-year-old man with a pronation-external rotation type of fracture was surgically treated using a fibular plate. Five years later, he underwent resection of bone hyperplasia because of the ankle pain and limitation of range of motion. Thereafter, the left ankle became intermittently painful, which persisted for about one year. He presented at the age of 43 with persistent ankle pain. Physical and image analysis findings indicated a diagnosis of posttraumatic posterior tibial tendinitis, which we surgically treated using tendoscopy. Endoscopic findings showed tenosynovitis and fibrillation on the tendon surface. We cleaned and removed the synovium surrounding the tendon and deepened the posterior tibial tendon groove to allow sufficient space for the posterior tibial tendon. Full weight-bearing ambulation was permitted one day after surgery and he returned to his occupation in the construction industry six weeks after surgery. The medial aspect of the ankle was free of pain and symptoms at a review two years after surgery. Although tendoscopic surgery for stage 1 posterior tibial tendon dysfunction has been reported, tendoscopic surgery to treat posttraumatic posterior tibial tendinitis has not. Our experience with this patient showed that tendoscopic surgery is useful not only for stage 1 posterior tibial dysfunction, but also for posttraumatic posterior tibial tendinitis.

  4. Modified arthroscopic transfer of the long head of the biceps tendon to the conjoint tendon

    MA Yong; CUI Guo-qing; AO Ying-fang; XIAO Jian; YAN Hui; YANG Yu-ping; XIE Xing

    2009-01-01

    @@ The long head of the biceps tendon (LHBT) pathology has been implicated as a common source of shoulder pain. The patients may be more resistant to conservative treatment than those with isolated subacromial impingement.1 Even though, the surgical options of this disease remain controversial. It has been reported that tenotomy and tenodesis of the biceps tendon were usually utilized. However, persistent pain, deformity, and muscle cramping were frequently observed.1-5

  5. Bilateral patellar tendon rupture associated with statin use.

    Kearns, Marie C; Singh, Vinay K

    2016-01-01

    Patellar tendon rupture is an uncommon clinical presentation, which generally affects the under 40s who are active in sport. Bilateral rupture of both tendons is much rarer. It occurs most frequently in patients with predisposing factors such as corticosteroid use or systemic diseases. The authors present the case of a 56-year-old male on long-term statin therapy who sustained this injury following a fall on ice. He had no known risk factors for tendon rupture. Surgical treatment involved tendon repair using Krakow suture via bony tunnels in the patella. Statins have previously been associated with tendon ruptures at other sites but there have been no published cases of bilateral patellar tendon rupture linked to statin use. We review the literature regarding the association between statins and tendon rupture. PMID:27165749

  6. FRP tendon anchorage in post-tensioned concrete structures

    Schmidt, Jacob Wittrup; Täljsten, Björn; Bennitz, Anders; Henning, Pedersen

    Strengthening of building structures by the use of various external post-tensioning steel tendon systems, is known to be a very efficient method. However, FRP as material in external post-tensioning projects has been investigated during the last decade. The advantages for this material are the high...... effective Young´s modulus and the high stress capacity in the linear elastic range of the material. The use of external tendons increases the requirements on the anchorage systems. This is in particular important when using un-bonded tendon systems, where the anchorage and deviators are the only force...... transfer points. The demand for high capacity anchorage tendons is fulfilled for steel tendons, but no competitive mechanical anchor has yet been developed for FRP tendon. A new small, reliable and more user friendly anchor has to be developed, before FRP tendons can be utilized with all of its capacity...

  7. Can Shockwave Therapy Improve Tendon Metabolism?

    Zwerver, Johannes; Waugh, Charlotte; van der Worp, Henk; Scott, Alex

    2016-01-01

    Shockwave treatments are commonly used in the management of tendon injuries and there is increasing evidence for its clinical effectiveness. There is a paucity of fundamental (in vivo) studies investigating the biological action of shockwave therapy. Destruction of calcifications, pain relief and me

  8. Eccentric overload training in patients with a chronic Achilles tendinopathy: a systematic review.

    Kingma, J.J.; Knikker, R. de; Wittink, H.M.; Takken, T.

    2007-01-01

    Background: Eccentric overload training seems to be a promising conservative intervention in patients with chronic Achilles tendinopathy. The efficacy of eccentric overload training on the outcome measures of pain and physical functioning are not exactly clear. Study design: Systematic review of the

  9. Mineral distributions at the developing tendon enthesis.

    Andrea G Schwartz

    Full Text Available Tendon attaches to bone across a functionally graded interface, "the enthesis". A gradient of mineral content is believed to play an important role for dissipation of stress concentrations at mature fibrocartilaginous interfaces. Surgical repair of injured tendon to bone often fails, suggesting that the enthesis does not regenerate in a healing setting. Understanding the development and the micro/nano-meter structure of this unique interface may provide novel insights for the improvement of repair strategies. This study monitored the development of transitional tissue at the murine supraspinatus tendon enthesis, which begins postnatally and is completed by postnatal day 28. The micrometer-scale distribution of mineral across the developing enthesis was studied by X-ray micro-computed tomography and Raman microprobe spectroscopy. Analyzed regions were identified and further studied by histomorphometry. The nanometer-scale distribution of mineral and collagen fibrils at the developing interface was studied using transmission electron microscopy (TEM. A zone (∼20 µm exhibiting a gradient in mineral relative to collagen was detected at the leading edge of the hard-soft tissue interface as early as postnatal day 7. Nanocharacterization by TEM suggested that this mineral gradient arose from intrinsic surface roughness on the scale of tens of nanometers at the mineralized front. Microcomputed tomography measurements indicated increases in bone mineral density with time. Raman spectroscopy measurements revealed that the mineral-to-collagen ratio on the mineralized side of the interface was constant throughout postnatal development. An increase in the carbonate concentration of the apatite mineral phase over time suggested possible matrix remodeling during postnatal development. Comparison of Raman-based observations of localized mineral content with histomorphological features indicated that development of the graded mineralized interface is linked

  10. Plastic Surgery

    ... How Can I Help a Friend Who Cuts? Plastic Surgery KidsHealth > For Teens > Plastic Surgery Print A ... her forehead lightened with a laser? What Is Plastic Surgery? Just because the name includes the word " ...

  11. Robotic surgery

    Robot-assisted surgery; Robotic-assisted laparoscopic surgery; Laparoscopic surgery with robotic assistance ... computer station and directs the movements of a robot. Small surgical tools are attached to the robot's ...

  12. Laser surgery

    ... need. Alternative Names Surgery using a laser Images Laser therapy Lasik eye surgery - series References James WD, Berger TG, Elston DM. Cutaneous laser surgery. In: James WD, Berger TG, Elston DM, ...

  13. Foot Surgery

    ... in the toe to maintain realignment. Neuroma Surgery: Neuroma surgery involves removing a benign enlargement of a nerve, usually between the metatarsal heads in the ball of the foot. This soft tissue surgery tends to have a ...

  14. A new strategy for the decellularisation of large equine tendons as biocompatible tendon substitutes.

    Bottagisio, M; Pellegata, A F; Boschetti, F; Ferroni, M; Moretti, M; Lovati, A B

    2016-01-01

    Tendon ruptures and/or large losses remain to be a great clinical challenge and often require full replacement of the damaged tissue. The use of auto- and allografts or engineered scaffolds is an established approach to restore severe tendon injuries. However, these grafts are commonly related to scarce biocompatibility, site morbidity, chronic inflammation and poor biomechanical properties. Recently, the decellularisation techniques of allo- or xenografts using specific detergents have been studied and have been found to generate biocompatible substitutes that resemble the native tissue. This study aims to identify a novel decellularisation protocol for large equine tendons that would produce an extracellular matrix scaffold suitable for the regeneration of injured tendons in humans. Specifically, equine tendons were treated either with tri (n-butyl) phosphate alone, or associated to multiple concentrations of peracetic acid (1, 3 and 5 %), which has never before been tested in vitro.Samples were then analysed by histology and with biochemical, biomechanical, and cytotoxicity tests. The best decellularisation protocol, resulting from these examinations, was selected and the chosen scaffold was re-seeded with murine fibroblasts. Resulting grafts were tested for cell viability, histologic analysis, DNA and collagen content. The results identified 1 % tri (n-butyl) phosphate combined with 3 % peracetic acid as the most suitable decellularised matrix in terms of biochemical and biomechanical properties. Moreover, the non-cytotoxic nature of the decellularised matrix allowed for good fibroblast reseeding, thus demonstrating a biocompatible matrix that will be suitable for tendon tissue engineering and hopefully as substitutes in severe tendon damages. PMID:27386840

  15. Low-intensity pulsed ultrasound therapy: a potential strategy to stimulate tendon-bone junction healing

    Zhi-min YING; Tiao LIN; Shi-gui YAN

    2012-01-01

    Incorporation of a tendon graft within the bone tunnel represents a challenging clinical problem.Successful anterior cruciate ligament (ACL) reconstruction requires solid healing of the tendon graft in the bone tunnel.Enhancement of graft healing to bone is important to facilitate early aggressive rehabilitation and a rapid return to pre-injury activity levels.No convenient,effective or inexpensive procedures exist to enhance tendon-bone (T-B) healing after surgery.Low-intensity pulsed ultrasound (LIPUS) improves local blood perfusion and angiogenesis,stimulates cartilage maturation,enhances differentiation and proliferation of osteoblasts,and motivates osteogenic differentiation of mesenchymal stem cells (MSCs),and therefore,appears to be a potential non-invasive tool for T-B healing in early stage of rehabilitation of ACL reconstruction.It is conceivable that LIPUS could be used to stimulate T-B tunnel healing in the home,with the aim of accelerating rehabilitation and an earlier return to normal activities in the near future.The purpose of this review is to demonstrate how LIPUS stimulates T-B healing at the cellular and molecular levels,describe studies in animal models,and provide a future direction for research.

  16. Low-intensity pulsed ultrasound therapy: a potential strategy to stimulate tendon-bone junction healing.

    Ying, Zhi-min; Lin, Tiao; Yan, Shi-gui

    2012-12-01

    Incorporation of a tendon graft within the bone tunnel represents a challenging clinical problem. Successful anterior cruciate ligament (ACL) reconstruction requires solid healing of the tendon graft in the bone tunnel. Enhancement of graft healing to bone is important to facilitate early aggressive rehabilitation and a rapid return to pre-injury activity levels. No convenient, effective or inexpensive procedures exist to enhance tendon-bone (T-B) healing after surgery. Low-intensity pulsed ultrasound (LIPUS) improves local blood perfusion and angiogenesis, stimulates cartilage maturation, enhances differentiation and proliferation of osteoblasts, and motivates osteogenic differentiation of mesenchymal stem cells (MSCs), and therefore, appears to be a potential non-invasive tool for T-B healing in early stage of rehabilitation of ACL reconstruction. It is conceivable that LIPUS could be used to stimulate T-B tunnel healing in the home, with the aim of accelerating rehabilitation and an earlier return to normal activities in the near future. The purpose of this review is to demonstrate how LIPUS stimulates T-B healing at the cellular and molecular levels, describe studies in animal models, and provide a future direction for research. PMID:23225850

  17. Monitoring tissue formation and organization of engineered tendon by optical coherence tomography

    Bagnaninchi, P. O.; Yang, Y.; Maffulli, N.; Wang, R. K.; El Haj, A.

    2006-02-01

    The uniaxial orientation and bundle formation of collagen fibres determine the mechanical properties of tendons. Thus the particular challenge of tendon tissue engineering is to build the tissue with a highly organized structure of collagen fibres. Ultimately the engineered construct will be used as autologous grafts in tendon surgery, withstanding physiological loading. We grew pig tenocytes in porous chitosan scaffolds with multiple microchannels of 250-500 μm. The cell proliferation and production of extra-cellular matrix (ECM) within the scaffolds have been successfully monitored by Optical Coherence Tomography (OCT), a bench-top OCT system equipped with a broadband light source centred at 1300 nm. Under sterile condition, the measurements were performed on-line and in a non-destructive manner. In addition, a novel method based on OCT imaging, which calculates the occupation ratio of the microchannel derived from the scattered intensity has been developed. It is confirmed that the occupation ratio is correlated to cell proliferation and ECM production in the scaffolds. Thus this method has been utilised to assess the effect of different culture conditions on the tissue formation. The use of a perfusion bioreactor has resulted in a significantly (p<1e -3) higher cell proliferation and matrix production.

  18. A 5-year follow-up study of Alfredson's heel-drop exercise programme in chronic midportion Achilles tendinopathy

    2011-01-01

    Background Eccentric exercises have the most evidence in conservative treatment of midportion Achilles tendinopathy. Although short-term studies show significant improvement, little is known of the long-term (>3 years) results. Aim To evaluate the 5-year outcome of patients with chronic midportion Achilles tendinopathy treated with the classical Alfredson's heel-drop exercise programme. Study design Part of a 5-year follow-up of a previously conducted randomised controlled trial. Methods 58 p...

  19. A 5-year follow-up study of Alfredson's heel-drop exercise programme in chronic midportion Achilles tendinopathy

    Plas, J.F.A.N.; Jonge, Suzan; Vos, Robert-Jan; Van der Heide, H.J.L.; Verhaar, Jan; Weir, Adam; Tol, Johannes

    2012-01-01

    textabstractBackground: Eccentric exercises have the most evidence in conservative treatment of midportion Achilles tendinopathy. Although short-term studies show significant improvement, little is known of the long-term (>3 years) results. Aim: To evaluate the 5-year outcome of patients with chronic midportion Achilles tendinopathy treated with the classical Alfredson's heel-drop exercise programme. Study design: Part of a 5-year follow-up of a previously conducted randomised controlled tria...

  20. Imaging the infrapatellar tendon in the elite athlete

    Extensor mechanism injuries constitute a major cause of anterior knee pain in the elite athlete. Sonography and magnetic resonance imaging (MRI) are the imaging methods of choice when assessing the infrapatellar tendon. A comprehensive imaging review of infrapatellar tendon normal anatomy, tendinopathy, and partial/full-thickness tendon tears is provided. The value of imaging the infrapatellar tendon in clinical practice, including whether sonography can predict symptoms in asymptomatic athletes, is discussed. Acute avulsion fractures, including periosteal sleeve avulsion, and chronic avulsion injuries, including Sinding-Larsen-Johansson and Osgood-Schlatter syndromes, are shown. Mimics of infrapatellar tendon pathology, including infrapatellar plica injury, patellar tendon-lateral femoral condyle friction syndrome, and Hoffa's syndrome, are illustrated

  1. Imaging the infrapatellar tendon in the elite athlete

    Peace, K.A.L. [Department of Radiology, Chelsea and Westminster Hospital, London (United Kingdom)]. E-mail: kalpeace@hotmail.com; Lee, J.C. [Department of Radiology, Chelsea and Westminster Hospital, London (United Kingdom); Healy, J. [Department of Radiology, Chelsea and Westminster Hospital, London (United Kingdom)

    2006-07-15

    Extensor mechanism injuries constitute a major cause of anterior knee pain in the elite athlete. Sonography and magnetic resonance imaging (MRI) are the imaging methods of choice when assessing the infrapatellar tendon. A comprehensive imaging review of infrapatellar tendon normal anatomy, tendinopathy, and partial/full-thickness tendon tears is provided. The value of imaging the infrapatellar tendon in clinical practice, including whether sonography can predict symptoms in asymptomatic athletes, is discussed. Acute avulsion fractures, including periosteal sleeve avulsion, and chronic avulsion injuries, including Sinding-Larsen-Johansson and Osgood-Schlatter syndromes, are shown. Mimics of infrapatellar tendon pathology, including infrapatellar plica injury, patellar tendon-lateral femoral condyle friction syndrome, and Hoffa's syndrome, are illustrated.

  2. Tenotomy versus Tenodesis in the treatment of the long head of biceps brachii tendon lesions

    Galasso Olimpio

    2012-10-01

    Full Text Available Abstract Background The superiority of tenotomy vs. tenodesis for surgery on lesions of the long head of the biceps brachii tendon is still under debate. Indeed, high-quality evidence is lacking, mainly because of methodological problems, such as retrospective design, population sample size or lack of patient randomization. Methods/Design The study will be a two-center, double-blind, randomized, controlled trial to compare patients treated with biceps tenotomy or tenodesis for lesions of the long head of the biceps brachii tendon over a 2-year follow-up period. The study participants will be 128 adults with biceps brachii tendinopathy and supraspinatus tendon tears. The primary end point will be the postoperative difference in the Constant-Murley score (CMS between the 2 groups at the two-year follow-up. A comparison of the mean improvement with standard age- and gender-related CMS will be performed. The secondary end point will be evaluation of the postoperative general health of patients, as evaluated with Short Form 36 (SF-36 scores. The number and severity of complications associated with use of the different surgical techniques will be assessed. Discussion This study will be the first randomized and appropriately powered clinical trial to directly compare tenotomy and biceps tenodesis. The results of this study will help to establish clinical practice guidelines for patients suffering from lesions of the long head of the biceps brachii tendon, providing important information to patients and health care providers about the possible complications, outcome predictors and effectiveness of the targeted interventions. Trial Registration Current Controlled Trials ISRCTN38839558

  3. Supraspinatus tendon tears: comparison of 3D US and MR arthrography with surgical correlation

    The objective of the study was to compare the diagnostic reliability of 3D US with MR arthrography in diagnosing supraspinatus tendon tears, with arthroscopic findings used as the standard. In a prospective study 50 patients who later underwent arthroscopic surgery of the rotator cuff were examined pre-operatively by 3D US with MR arthrography. The presence or absence of a full- or partial-thickness supraspinatus tendon tear and the tear size as demonstrated by each imaging and arthroscopy was recorded. The tear size was divided into three grades: small (3 cm). The arthroscopic diagnosis was a full-thickness tear in 40 patients, partial-thickness tears in 5, and intact supraspinatus tendon in 5. 3D US correctly diagnosed 35 out of 40 full-thickness tears and MR arthrography 39 out of 40 full-thickness tears. Regarding partial-thickness tears, 3D US underestimated 2 cases as no tear and overestimated 1 case as a full-thickness tear. MR arthrography underestimated 1 case as a partial-thickness tear and overestimated 2 cases as full-thickness and partial-thickness tears respectively. 3D US and MR arthrography yield a sensitivity for full-thickness tears of 87.5% and 97.5% with specificity of 90.0% and 90.0%. Based on the grading system, 3D US measurements correctly predicted the tear size of 23 (65.7%) of the 35 full-thickness tears and MR arthrography 30 (75.0%) of the 39 full-thickness tears. Three-dimensional ultrasound seems to be a promising imaging modality comparable to MR arthrography for the assessment of the supraspinatus tendon tears. (orig.)

  4. Engineers Create Bone that Blends into Tendons

    2008-01-01

    @@ Engineers at Georgia Tech have used skin cells to create artificial bones that mimic the ability of natural bone to blend into other tissues such as tendons or ligaments. The artificial bones display a gradual change from bone to softer tissue rather than the sudden shift of previously developed artificial tissue, providing better integration with the body and allowing them to handle weight more successfully.

  5. Patellar tendon: From tendinopathy to rupture

    Federica Rosso; Davide Edoardo Bonasia; Umberto Cottino; Federico Dettoni; Matteo Bruzzone; Roberto Rossi

    2015-01-01

    Patellar tendinopathy is very common in patients complaining of anterior knee pain. Its aetiology is still unclear, but neovascularisation seems to play a role. Different treatments have been proposed overtime, from rehabilitation to platelet-rich-plasma injections, but there is no agreement on the best treatment protocol. The final stage of patellar tendinopathy is patellar tendon rupture. In these cases surgical treatment is often required. The aim of this literature review is to focus on t...

  6. Model and control of tendon actuated robots

    Palli, Gianluca

    2007-01-01

    The use of tendons for the transmission of the forces and the movements in robotic devices has been investigated from several researchers all over the world. The interest in this kind of actuation modality is based on the possibility of optimizing the position of the actuators with respect to the moving part of the robot, in the reduced weight, high reliability, simplicity in the mechanic design and, finally, in the reduced cost of the resulting kinematic chain. After a brie...

  7. Rehabilitating Psoas Tendonitis: A Case Report

    Edelstein, Jaime

    2008-01-01

    This case report describes the examination and physical therapy intervention for a woman with anterior hip pain whose medical diagnosis following magnetic resonance imaging (MRI) was bilateral labral tears and psoas tendinitis. Her physical therapy evaluation revealed findings consistent with psoas tendonitis. Utilizing theories of neuromuscular patterning and knowledge of normal muscle function, the patient was successfully treated in physical therapy following six physical therapy sessions,...

  8. COMPLICATIONS OF JOINT, TENDON, AND MUSCLE INJECTIONS

    Cheng, Jianguo; Abdi, Salahadin

    2007-01-01

    Prevention of complications is one of the most important aspects of patient care in pain management. The objective of this study is to review documented complications in medical literature that are associated with interventional pain management, specifically those associated with joint, tendon, and muscle injections. We conducted Medline research from 1966 to November 2006 using keywords complication, injection, radiofrequency, closed claim, facet, zygophyseal joint, sacroiliac joint, shoulde...

  9. Tendon lesion and VEGF-111 injection

    Kaux, Jean-François; Drion, Pierre; Libertiaux, Vincent; Pascon, Frédéric; Colige, Alain; Le Goff, Caroline; Lambert, Charles; Janssen, Lauriane; Nusgens, Betty; Gothot, André; CESCOTTO, Serge; Defraigne, Jean-Olivier; Rickert, Markus; Crielaard, Jean-Michel

    2010-01-01

    Introduction: Tendon lesion is one of the most frequent pathology in sports and by physical workers. This pathology often becomes chronic. For this reason, it is of interest to develop new treatments. Injection of platelet-rich plasma (PRP) seems to be a promising one by releasing growth factors (GF) locally. Among all the GF released by activated platelets, the vascular endothelial growth factor-A (VEGF-A) is known to induce positive effects on vascular function and angiogenesis, and could b...

  10. 缪刺对大鼠跟腱病恢复的实验研究%Experimental Study on the Effect of Healthy Side Acupuncture for Rat's Achilles Tendinopathy

    王泉巅; 赵勇

    2014-01-01

    Objective:To observe the effect of electro-acupuncture on Achilles tendinopathy by stimulating some related points of rat's healthy lower limb and to provide information for healthy side acupuncture treatment of achilles tendinopathy.Methods:Six male SD (2months old) rats were at random drown out from thirty-six rats as blank contrast group (K group).The models of rat's achilles tendinopathy were set up by 1% collagenase injection into the left achilles tendons of the other thirty rats.The model rats were divided into controlled group (Y group),healthy side acupuncture group (M group).Group Y was divided into three subgroups (Y0,Y1,Y2group) and group M were respectively divided into two groups (M1,M2group).After three weeks of setting up the model,M1and M2group were treated respectively by electro-acupuncturing the healthy limbs points Yanglingquan,Zusanli,Chengshan,Taixi,once a day.Each time lasted 15minutes.A treating process was 10days.After resting two days,the second treating process started.Group K and Y had no treatment.Group K and group Y0were executed after three weeks of setting up the model.Groups Y1,Mland Y2,M2were executed at the end of the first and second treating process.For all achilles tendons specimen,histological and immunohistochemical observation were obtained.The number of the fibroblasts was counted and statistically analysis by Microsoft excel.The effect of transforming growth factor betar1was obtained and compared with the histological observation to study the recovery of achilles tendinopathy.Results:(①)After the fist treating process,the fibroblast counts of the group M1were significantly higher than the group Y1and showed significantly difference between the group M1and Y1.After the second treating process,the fibroblast counts of the group M2were significantly lower than the group Y2and showed significantly difference between the groups M2and Y2.②)TGF-β1was not detected in the group K,TGF-β1expressed in the group Y and

  11. Torque control of underactuated tendon-driven fingers

    M. E. Abdallah; Wampler, C. W.

    2011-01-01

    Given an underactuated tendon-driven finger, the finger posture is underdetermined and can move freely ("flop") in a region of slack tendons. This work shows that such an underactuated finger can be operated in tendon force control (rather than position control) with effective performance. The force control eliminates the indeterminate slack while commanding a parameterized space of desired torques. The torque will either push the finger to the joint limits or wrap around an external object w...

  12. Triceps tendon avulsion and associated injuries of the elbow

    Canbora, Kerem; Ozyurek, Selahattin; Gumussuyu, Gurkan; Kose, Ozkan

    2013-01-01

    A rupture or avulsion of the triceps tendon is very rare but concomitant elbow injuries with avulsion of the triceps tendon are even rarer. In this study, an extraordinary and unusual injury combination (radial head and trochlear fracture associated with triceps tendon avulsion), which happened during a fall onto the elbow with outstretched hand, was identified and has been discussed in the literature. PMID:23667221

  13. Endoscopic Resection of Lipoma of the Patellar Tendon

    Lui, Tun Hing; Lee, Man Wai

    2015-01-01

    Synovial lipoma of the patellar tendon is a very rare entity. It can be associated with rupture of the patellar tendon. We present a case of synovial lipoma that was successfully resected endoscopically. The other indications for patellar tendoscopy include chronic patellar tendinitis and tendinosis, recalcitrant bursitis around the tendon, Osgood-Schlatter disease, and jumper's knee. The major potential danger of this endoscopic procedure is iatrogenic damage to the patellar insertion during...

  14. The role of animal models in tendon research

    Hast, M. W.; Zuskov, A.; Soslowsky, L. J.

    2014-01-01

    Tendinopathy is a debilitating musculoskeletal condition which can cause significant pain and lead to complete rupture of the tendon, which often requires surgical repair. Due in part to the large spectrum of tendon pathologies, these disorders continue to be a clinical challenge. Animal models are often used in this field of research as they offer an attractive framework to examine the cascade of processes that occur throughout both tendon pathology and repair. This review discusses the stru...

  15. The enigmatic diagnosis of posterior tibialis tendon rupture.

    Marcus, R E; Pfister, M. E.

    1993-01-01

    Posterior tibialis tendon rupture is a diagnosis that is often missed. This is thought to be secondary to nonspecific clinical findings and the lack of any laboratory or radiographic test to reliably confirm the diagnosis. We report sixteen cases of surgically confirmed posterior tibialis tendon rupture. Based on our review of these patients, the diagnosis of posterior tibialis tendon rupture should be strongly suspected in the adult patient presenting with a history of a twisting ankle injur...

  16. Region specific patella tendon hypertrophy in humans following resistance training

    Kongsgaard, M.; Reitelseder, S; Pedersen, T.G.;

    2007-01-01

    AIM: To examine if cross-sectional area (CSA) differs along the length of the human patellar tendon (PT), and if there is PT hypertrophy in response to resistance training. METHODS: Twelve healthy young men underwent baseline and post-training assessments. Maximal isometric knee extension strength...... legs. CONCLUSIONS: To our knowledge, this study is the first to report tendon hypertrophy following resistance training. Further, the data show that the human PT CSA varies along the length of the tendon....

  17. Peroneal tendons well vascularized: results from a cadaveric study

    van Dijk, Pim A. D.; Madirolas, F. Xavier; Carrera Burgaya, Ana; Kerkhoffs, Gino M. M. J.; Reina de la Torre, Francisco

    2016-01-01

    Purpose Peroneal tendon tears are relatively common injuries that seem to have a poor healing tendency. The discussion goes that peroneal tendons have avascular zones, contributing to the poor healing of those tears. The purpose of this study was to provide evidence on the vascularization pattern of the peroneal tendons. Methods Ten adult fresh-frozen cadavers were obtained from a university-affiliated body donation programme. The femoral artery was injected with natural coloured latex at the...

  18. Platelet-rich plasma (PRP) and tendon healing: animal model

    Kaux, Jean-François; Drion, Pierre; Renouf, Julien; Pascon, Frédéric; Libertiaux, Vincent; Colige, Alain; Le Goff, Caroline; Lambert, Charles; Nusgens, Betty; Gothot, André; CESCOTTO, Serge; Defraigne, Jean-Olivier; Rickert, Markus; Crielaard, Jean-Michel

    2011-01-01

    Introduction: The tendon is a tissue which does not heal easily. Recently, several studies have demonstrated the positive effects of platelets on the healing process of tendons. A local injection of platelet–rich plasma (PRP), which releases in situ many growth factors, has the potentiality to enhance the tendon healing process. The aim of our experiment was to ascertain by an original mechanical measure whether the use of PRP was of interest for accelerating the healing process of rats’ Achi...

  19. Use of the semitendinosus tendon for foot and ankle tendon reconstructions,

    Frederico Lutti Guerra de Aguiar Zink

    2014-10-01

    Full Text Available Objective:To demonstrate the results obtained from foot and ankle tendon reconstructions using the tendon of the semitendinosus muscle. The clinical results, the patient's degree of satisfaction and complications in the graft donor and recipient areas were evaluated.Methods:This was a retrospective study in which the medical files of 38 patients who underwent this surgical procedure between 2006 and 2010 were surveyed. The functional results from this technique, the complications in the donor and recipient areas and the patients' degree of satisfaction were evaluated.Results:Three patients presented complications in the recipient area (skin necrosis; one patient showed complications in the donor area (pain and insensitivity; and all patients had satisfactory functional results, with complete range of motion.Conclusion:The semitendinosus muscle is a good option for treatments for foot and ankle tendon injuries.

  20. Nanoparticles for Tendon Healing and Regeneration: Literature Review.

    Parchi, Paolo D; Vittorio, Orazio; Andreani, Lorenzo; Battistini, Pietro; Piolanti, Nicola; Marchetti, Stefano; Poggetti, Andrea; Lisanti, Michele

    2016-01-01

    Tendon injuries are commonly met in the emergency department. Unfortunately, tendon tissue has limited regeneration potential and usually the consequent formation of scar tissue causes inferior mechanical properties. Nanoparticles could be used in different way to improve tendon healing and regeneration, ranging from scaffolds manufacturing (increasing the strength and endurance or anti-adhesions, anti-microbial, and anti-inflammatory properties) to gene therapy. This paper aims to summarize the most relevant studies showing the potential application of nanoparticles for tendon tissue regeneration. PMID:27597828