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Sample records for achilles tendon rupture

  1. The roentgenographic findings of achilles tendon rupture

    International Nuclear Information System (INIS)

    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

  2. The roentgenographic findings of achilles tendon rupture

    Energy Technology Data Exchange (ETDEWEB)

    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.

  3. Micromechanical properties and collagen composition of ruptured human achilles tendon

    DEFF Research Database (Denmark)

    Hansen, Philip; Kovanen, Vuokko; Hölmich, Per;

    2013-01-01

    The Achilles tendon is one of the strongest tendons in the human body, and yet it frequently ruptures, which is a substantial clinical problem. However, the cause of ruptures remains elusive.......The Achilles tendon is one of the strongest tendons in the human body, and yet it frequently ruptures, which is a substantial clinical problem. However, the cause of ruptures remains elusive....

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

    OpenAIRE

    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.

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

    DEFF Research Database (Denmark)

    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...

  6. Use of fluroquinolone and risk of Achilles tendon rupture

    DEFF Research Database (Denmark)

    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...

  7. Achilles tendon rupture; assessment of nonoperative treatment

    DEFF Research Database (Denmark)

    Barfod, Kristoffer Weisskirchner

    2014-01-01

    ). 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. RESULTS: Study......-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

  8. Simultaneous reconstruction of quadriceps tendon rupture after TKA and neglected Achilles tendon rupture.

    Science.gov (United States)

    Lee, Yong Seuk; Min, Byoung-Hyun; Han, Kyeong-Jin; Cho, Jae Ho; Han, Seung Hwan; Lee, Doo-Hyung; Oh, Kyung Soo

    2010-05-12

    We report a case of simultaneous reconstruction of a quadriceps tendon rupture after total knee arthroplasty (TKA) and neglected Achilles tendon rupture, which occurred before TKA with an ipsilateral hamstring autograft. A 64-year-old woman presented with persistent right knee pain. She also had right heel pain and had received multiple steroid injections at the knee joint and heel. On examination, she showed osteoarthritis in the medial and lateral compartments of the knee joint and an Achilles tendon rupture in the ipsilateral limb. There was skin dimpling and the proximal portion of tendon was migrated. We performed TKA, and the postoperative course was satisfactory. She returned 3 months postoperatively, however, with skin dimpling around the suprapatellar area and weakness of knee extension. Her ankle symptoms were also aggravated because she could not use the knee joint freely. We performed simultaneous reconstruction of the quadriceps tendon and the Achilles tendon using an ipsilateral hamstring autograft.Hamstring autograft offers a good alternative treatment option for rupture repair, particularly with concommitant ruptures of multiple sites when primary repair is not possible or the viability of repaired tissue is poor.

  9. Functional rehabilitation of patients with acute Achilles tendon rupture

    DEFF Research Database (Denmark)

    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...

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

    Directory of Open Access Journals (Sweden)

    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.

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

    LENUS (Irish Health Repository)

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

    OpenAIRE

    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...

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

    OpenAIRE

    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...

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

    OpenAIRE

    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...

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

    Directory of Open Access Journals (Sweden)

    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.

  16. Nonoperative dynamic treatment of acute achilles tendon rupture

    DEFF Research Database (Denmark)

    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...

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

    Science.gov (United States)

    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

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

    Directory of Open Access Journals (Sweden)

    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.

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

    DEFF Research Database (Denmark)

    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...... tendons. Crimp angle did not display any region-specific differences, or any difference between the rupture and intact tendons. In conclusion, these data suggest that although crimp morphology is unchanged there appears to be a site-specific loss of larger fibrils in the core and periphery of the 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....

  20. Tendon Graft and Platelet Concentrate for Chronic Achilles Tendon Rupture. A Case Report

    Directory of Open Access Journals (Sweden)

    Yovanny Ferrer Lozano

    2015-12-01

    Full Text Available Achilles tendon is third most common tendon torn, following the rotator cuff and the quadriceps extensor mechanism. Ruptures can be partial or complete and their etiology is multifactorial. We present the case of a 63-year-old woman who attended the Orthopedics service because of discomfort when walking that had been present for several months and persistent pain in his right heel related to an acetonide triamcinolone injection into the back of the calcaneus. The gap in the tendon (hatchet strike defect and a Thompson test confirmed the Achilles tendon rupture. The tendon was repaired using a peroneus brevis tendon graft and the repair was reinforced with gastrocnemius aponeurosis. The skin flap necrosis led to conservative debridement, graft exposure, and daily application of a platelet lysate, which was subsequently alternated due to the successful formation of the scar tissue. Epithelialization was reached in the fourth postoperative week. Twelve weeks after surgery, the patient began to resume her normal life. The use of platelet concentrates as adjuvant therapy is rare in these patients. For this reason, we decided to publish this case.

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

    Directory of Open Access Journals (Sweden)

    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

  2. Death following bilateral complete Achilles tendon rupture in a patient on fluoroquinolone therapy: a case report

    Directory of Open Access Journals (Sweden)

    Gottschalk Andrew W

    2009-01-01

    Full Text Available Abstract Introduction Risk of tendon rupture, especially of the Achilles tendon, is one of the many potential side-effects of fluoroquinolone therapy. Achilles tendon rupture may be painful, debilitating or, as seen in our patient, devastating. While fluoroquinolone-induced tendon rupture typically accompanies other comorbidities (for example renal impairment or concurrent steroid therapy, our case represents a medical 'first' in that there were no such comorbidities and no steroid therapy. Furthermore, our case is remarkable in that tendon rupture was bilateral, complete, and resulted in a devastating outcome. Case presentation A healthy 91-year-old Caucasian man was placed on fluoroquinolone (levofloxacin therapy for a presumed bacterial pneumonitis. Subsequently, he developed bilateral heel pain, edema, and ecchymoses leading to a diagnosis of bilateral complete Achilles tendon rupture. This drug's side-effect was directly responsible for his subsequent physical and psychologic decline and unfortunate death. Conclusion Fluoroquinolones are a powerful and potent tool in the fight against bacterial infection. As a class, they are employed by primary care physicians as well as by subspecialty physicians in all areas of medical practice. However, as this case illustrates, the use of these drugs is not without risk. Attention must be paid to potential side-effects when prescribing any medication, and close follow-up with patients is a medical necessity to evaluate for these adverse reactions, especially with fluoroquinolones.

  3. New technical procedure involving Achilles tendon rupture treatment through transcutaneous suture.

    Science.gov (United States)

    TarniŢă, DănuŢ Nicolae; TarniŢă, Daniela; Grecu, Dan Cristian; Calafeteanu, Dan Marian; Căpitănescu, Bogdan

    2016-01-01

    The Achilles tendon is the widest tendon of the human body. Achilles tendon belongs to the extrasynovial tendons group and this allows it a faster recovery, thanks to local hematoma from the peritenon, necessary for the scarification. We concluded that in Achilles tendon rupture treatment it is essential to maintain the tendon covering skin integrity, the peritendinous integrity, to maintain the local hematoma formed during and after tendon rupture, reattaching the ruptured tendon heads and maintain them in this position by suturing them and by relaxing the sural triceps muscle. The percutaneous suture requires five pairs of mirror micro-incisions (5 mm) on one side and the other of the tendon. It is necessary for one of the pairs to be placed to the rupture level. With a surgical needle, we arm the proximal and distal heads of the tendon by different threads. By traction and muscular relaxation, we bring in contact the two ruptured heads and then we knot together the arming threads. The inferior member was cast immobilized in relaxing position for the sural triceps muscle for a 45 days period. Using this technique, we have operated 15 cases in our Clinic. In all the cases, we obtained a healing by first intention of the tegument micro-incisions. After the cast immobilization suppression, during 30 days the patients were in a recovery program. At the end of this program, they have recovered completely the dorsal and plantar flexion and the walking. In four months after the surgery, the esthetic of the area is completely restored, this technique being the only surgical technique that realizes this recovery.

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

    Directory of Open Access Journals (Sweden)

    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.

  5. Achilles tendon and sports

    International Nuclear Information System (INIS)

    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.)

  6. Physical activity modulates nerve plasticity and stimulates repair after Achilles tendon rupture.

    Science.gov (United States)

    Bring, Daniel K-I; Kreicbergs, Andris; Renstrom, Per A F H; Ackermann, Paul W

    2007-02-01

    In a rat model of tendon rupture using semiquantitative methodology, healing was assessed according to the diameter of newly organized collagen and the occurrence of the sensory neuropeptides (SP, CGRP) in relation to different levels of physical activity. Normally, innervation of the Achilles tendon is confined to the paratenon. After rupture new nerve fibers grow into the tendon proper, but disappear after healing. In a first experiment to establish peak tissue and nerve regeneration after rupture, tendon tissues from freely moving rats were collected consecutively over 16 weeks. A peak increase in organized collagen and nerve ingrowth was observed between week 2 to 4 post rupture. Therefore, in a second experiment week 4 was chosen to assess the effect of physical activity on tendon healing in three groups of rats, that is, wheel running, plaster treated, and freely moving (controls). In the wheel-running group, the diameter of newly organized collagen was 94% ( p = 0.001) greater than that in the plaster-treated group and 48% ( p = 0.02) greater than that in the controls. Inversely, the neuronal occurrence of CGRP in the tendon proper was 57% ( p = 0.02) lower in the wheel-running group than that in the plaster-treated group and 53% ( p = 0.02) lower than that in the controls, suggesting an earlier neuronal in-growth and disappearance in the more active group. Physical activity speeds up tendon healing, which may prove to be linked to accelerated neuronal plasticity.

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

    OpenAIRE

    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...

  8. Recurrent patellar tendon rupture in a patient after intramedullary nailing of the tibia: reconstruction using an Achilles tendon allograft.

    Science.gov (United States)

    Jagow, Devin M; Garcia, Branden J; Yacoubian, Stephan V; Yacoubian, Shahan V

    2015-05-01

    Various complications after intramedullary (IM) nailing of the tibia have been reported, the most common of which are anterior knee pain and symptoms similar to patella tendonitis. Complete rupture of the patellar tendon after IM nailing of the tibia has been reported on 2 occasions, in conjunction with predisposing patient factors, such as systemic disease or a proud tibial nail. Patellar tendon ruptures are disabling injuries that can be technically difficult to repair because of the poor quality of remaining tendon tissue, quadriceps muscle atrophy and/or contracture, and scar-tissue formation. Many methods have described the surgical reconstruction of the knee extensor mechanism, which is most commonly performed after total knee arthroplasty. We report the successful surgical and clinical outcome of patellar tendon reconstruction using an Achilles tendon allograft in a patient subject to late and recurrent ruptures after IM nailing of the tibia through a mid-patellar tendon-splitting approach. Seven months after tendon reconstruction, the patient exhibited full knee flexion, an extension lag of 10º, 4/5 quadriceps strength, and return to her baseline ambulatory status.

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

    Science.gov (United States)

    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. Surgical versus conservative treatment following acute rupture of the Achilles tendon: is there a pedobarographic difference?

    Directory of Open Access Journals (Sweden)

    Karaaslan F

    2016-08-01

    Full Text Available Fatih Karaaslan,1 Musa Uğur Mermerkaya,1 Alper Çıraklı,2 Sinan Karaoğlu,3 Fuat Duygulu21Department of Orthopaedics and Traumatology, Faculty of Medicine, Bozok University, Yozgat, Turkey; 2Department of Orthopaedics and Traumatology, Kayseri Training Hospital, Kayseri, Turkey; 3Department of Orthopaedics and Traumatology, Memorial Kayseri Hospital, Kayseri, TurkeyIntroduction: Controversy remains regarding the optimal treatment method and postoperative rehabilitation of acute Achilles tendon ruptures. In this study, pedobarographic assessments of surgical and conservative treatments were compared.Material and methods: A prospective assessment was made of 16 patients (eight surgical, eight conservative and eight healthy controls using a plantar pressure measurement system. Biomechanical gait parameters were obtained using the Footscan dynamic gait analysis system. Kruskal–Wallis and Mann–Whitney U-tests were used for the evaluation of data.Results: Nineteen males and five females were assessed, with an average age of 42.0±11.9 years. Follow-up was completed in 16 patients. No statistically significant difference was determined between the two treatment groups with regard to the gait analysis, but a difference was observed with the control group (P<0.001. All patients were able to resume their prior activities after 6 months and regained normal ranges of motion, with a high rate of satisfaction. Most of the patients (75% were able to return to their pre-injury level of activities.Conclusion: Satisfactory results were obtained through conservative treatment of acute ruptures of the Achilles tendon. No significant differences or complications were observed in the group managed conservatively versus the group treated surgically. Further studies including 3D gait analyses and tendon biomechanical research are required to further investigate this issue.Keywords: Achilles tendon, acute rupture, pedobarographic analysis

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

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    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

  12. Acute Achilles tendon rupture Treatment strategies and outcomes

    NARCIS (Netherlands)

    Metz, R.

    2009-01-01

    Based on the results of the studies presented in this thesis it is concluded that minimally invasive surgical treatment of acute AT ruptures with functional after-treatment allows patients to return to their original level of their professional and athletic activities and should be regarded best tre

  13. Nonoperative, dynamic treatment of acute achilles tendon rupture

    DEFF Research Database (Denmark)

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

    2015-01-01

    ° dorsiflexion, the stiffness during slow stretching, and the maximal strength were measured in both limbs. The stiffness of the plantar flexor muscle-tendon complex in the terminal part of dorsiflexion was significantly increased (p = .024) in the non-weightbearing group at 12 months. The peak passive torque...... was significantly lower for the affected limb at 6 months (91%; p = .01), and the stiffness was significantly lower for the affected limb during the early part of dorsiflexion at 6 (67%; p ... in the terminal part of dorsiflexion was found in the non-weightbearing group. The altered stiffness and strength in the affected limb could affect the coordination of gait and running....

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

    Institute of Scientific and Technical Information of China (English)

    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.

  15. Magnetic resonance imaging in acute tendon ruptures

    Energy Technology Data Exchange (ETDEWEB)

    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.

  16. Achilles Tendonitis

    Science.gov (United States)

    ... 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 ...

  17. Neglected Achilles Tendon Rupture Treated with Flexor Hallucis Longus transfer with two turndown gastrocnemius fascia flap and reinforced with plantaris tendon.

    Science.gov (United States)

    Mao, Haijiao; Shi, Zengyuan; Xu, Dachuan; Liu, Zhenxin

    2015-09-01

    Neglected Achilles Tendon Ruptures are commonly seen by orthopaedic surgeons. In cases resistant to conservative treatment, a variety of surgical procedures have been utilized in the past. The senior -surgeon at our institution has utilized a technique -employing two turndown fascia flaps fashioned from the proximal Achilles tendon augmented by a tenomyodesis of the flexor hallucis longus and plantaris tendon. The purpose of this study was to assess the clinical outcome of all patients who underwent this procedure. The medical records of 10 cases that underwent this procedure were retrospectively reviewed. We completed data collection sets using the American Orthopaedic Foot and Ankle Society ankle-hind foot scores, isokinetic evaluation, and postoperative magnetic resonance imaging (MRI) at 1 year of follow-up. The mean American Orthopaedic Foot and Ankle Society ankle-hind foot scores improved from 64.4±3.54. Isokinetic testing at 30º/sec and 120º/sec revealed an mean deficits of 24.5%, respectively, in the plantar flexion peak torque of the involved ankle than non-involved ankle. The flexor hallucis longus tendon, gastrocnemius fascia flap and plantaris were well -integrated into the Achilles tendon forming a homogenous tendon, which was confirmed in MRI. Our subjective and objective data indicate that the reconstructive technique using flexor hallucis longus transfer with two turndown gastrocnemius fascia flaps and plantaris tendon is a good option for repairing large gap defect of Achilles tendon.

  18. [Damage to large tendons: Achilles, patellar and quadriceps tendons].

    Science.gov (United States)

    Amlang, M H; Zwipp, H

    2006-07-01

    The etiology and mechanisms of Achilles, patellar and quadriceps tendon ruptures are very similar. Age dependent changes in tendon structure and disorders such gout, diabetes, rheumatic diseases and chronic renal failure are associated causes. The main mechanism of rupture is indirect trauma. Although clinical diagnosis is easy, ruptures are still frequently missed. Sonography is the main standard diagnostic tool. MRI is indicated only in special cases. Open operative repair is the most common treatment for quadriceps and patellar tendon ruptures. Treatment of Achilles tendon ruptures is moving towards an individualized choice of therapy. Percutaneous and other "minimally invasive" techniques will play an increasingly important role.

  19. 腓骨肌腱修复跟腱断裂24例的临床分析%Peroneal tendon repair achilles tendon rupture of 24 cases

    Institute of Scientific and Technical Information of China (English)

    黄春吉

    2009-01-01

    目的 分析腓骨长肌腱用于修复跟腱断裂的手术方法 和经验.方法 将腓骨长肌腱在远端处切断,经皮下隧道移位修复跟腱断裂24例.结果根据Arner-Lindholm评定标准,24例中优14例,良10例.未发生跟腱再次断裂.2例出现伤口感染,1例出现皮肤与跟腱粘连.结论 对疑有跟腱断裂的患者未进行认真的体检是导致跟腱断裂误诊的重要原因.避免误诊、尽早手术及循序渐进的术后康复锻炼是提高疗效的有效措施.用腓骨长肌腱重建陈旧性和某些急性跟腱断裂是一种安全可行、疗效满意的手术方法 .%Objective To conclude the method and experience of reconstruction of achilles tendon rupture with peroneus longus tendon transfer.Methods In 24 cases,reconstruction the achilles tendon ruptured by cutting the peroneus longus tendon at the distal end and transferred through subcutaneous tunnel.Results According to ArnerLindholm critera,14 cases were graded as excellent,10 cases as good.No rerupture of Achilles tendon occurred.There were 2 cases occurred wound infection and 1 conglutination.Conclusions The suspected Achilles tendon rupture in patients with a serious medical examination did not lead to an achilles tendon rupture is the major cause of misdiagnosis.Avoid misdiagnosis,as soon as possible after surgery and gradual rehabilitation exercise is to improve the efficacy of effective measures.The peroneus longus tendon transfer is a safe and satisfied way to reconstructing the old and certain fresh rupture of the Achilles tendon.

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

    Science.gov (United States)

    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

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

    Science.gov (United States)

    Bagnaninchi, P. O.; Yang, Y.; Bonesi, M.; Maffulli, G.; Phelan, C.; Meglinski, I.; El Haj, A.; Maffulli, N.

    2010-07-01

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

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

    International Nuclear Information System (INIS)

    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.

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

    OpenAIRE

    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...

  5. Reconstruction of achilles tendon recurrent ruptures%跟腱再断裂的修复重建

    Institute of Scientific and Technical Information of China (English)

    王碧菠; 徐向阳; 刘津浩; 朱渊

    2011-01-01

    目的 总结跟腱再断裂的原因,探讨“V-Y”推进瓣及(足母)长屈肌腱(flexor hallucis longus,FHL)转位修复重建跟腱再断裂的适应证、疗效及其相关并发症.方法 2006年3月至2010年1月手术修复重建跟腱再断裂患者16例16足,男12例,女4例;年龄35~72岁,平均50.9岁.再断裂距初次手术时间为6~49周(平均21.8周),随访时间6~52个月(平均27.5个月).充分清除断端瘢痕及坏死组织4例断端缺损<4 cm者采用腓肠肌腱膜“V-Y”推进瓣修补,12例断端缺损>4cm者采用FHL转位修复重建.结合患者病史、康复方式及再次手术术中所见跟腱形态,分析其发生再断裂原因.观察术后局部外观及功能恢复情况,并采用美国足踝外科协会踝-后足评分(American Orthopaedic Foot&Ankle Society-ankle and hindfoot score,AOFAS-AH)及Leppilahti跟腱修复评分进行疗效评价.结果 跟腱再断裂的原因主要为手术切口感染、术后跟腱愈合不良发生液化坏死、术后过早负重或活动不当致跌倒.采用“V-Y”推进瓣或FHL转位修复跟腱再断裂术后局部外观及功能恢复良好,AOFAS-AH评分从术前(70.2±8.5)分提高到(92.4±6.1)分;Leppilahti跟腱修复评分从术前(74.8±6.2)分提高到(91.7±4.8)分.踝部MRI显示跟腱部信号均匀,无撕裂或积液表现.结论 跟腱再断裂后需彻底清创,导致大范围缺损.腓肠肌腱膜“V-Y”推进瓣可修复<4cm的缺损,FHL转位可修复重建>4 cm的缺损,术后踝足部功能外形恢复良好.%Objective Recurrent rupture of Achilles tendon is a severe complication after primary repair.The optimal treatment remains controversial.This study was in aiming to explore the risk factors of recurrent ruptures of Achilles tendon,to evaluate the indication,outcome and complications of reconstructing Achilles tendon recurrent ruptures by V-Y advancement flap and Flexor Hallucis Longus tendon (FHL) transfer.Methods We retrospectively

  6. 闭合性跟腱撕裂磁共振诊断研究%MRI diagnosis of closed ruptures of achilles tendon

    Institute of Scientific and Technical Information of China (English)

    张超; 钟心; 穆学涛; 董玉茹; 马毅; 王宏

    2015-01-01

    To investigate the value of MRI for the diagnosis of achilles tendon closed rupture. 1.5T Maestro Class MRI scanner was used for the conventional scanning of 15 patients confirmed with achilles tendon closed ruptures by operation, and then the findings by imaging were compared with those by operation. The 15 patients proved with achilles tendon closed rupture, including 4 cases of incomplete rupture and 11 cases of complete rupture. MRI could display clearly the changes in morphology and signal of incomplete or complete closed ruptures of Achilles tendon, and the results were consistent with those by operation. MRI can make an accurate display of the lo-cation and extent of achilles tendon rupture.%目的:探讨磁共振成像(magnetic resonance imaging,MRI)对闭合性跟腱撕裂的诊断价值。方法:采用SIEMENS公司1.5T Maestro Class MRI扫描仪,对15例经手术证实的闭合性跟腱撕裂伤患者进行常规扫描,将影像学表现与手术结果进行对比。结果:15例均为闭合性跟腱撕裂,其中4例为不完全性撕裂,11例为完全性撕裂。MRI能够清晰显示闭合性完全性或不完全性跟腱撕裂的形态及信号的变化,并与术后结果相符。结论:MRI能够对跟腱撕裂的部位、程度作出准确的诊断,为临床提供更加丰富的信息。

  7. Differentially expressed proteins on postoperative 3 days healing in rabbit Achilles tendon rupture model after early kinesitherapy

    Institute of Scientific and Technical Information of China (English)

    Ainuer Jialili; Haxiaobieke Kasimu; Jiasharete Jielile; Shajidan Abudoureyimu; Gulnur Sabirhazi; Darebai Redati; Bai Jingping; Bin Liang; Sailike Duisabai; Jiangaguli Aishan

    2011-01-01

    Objectives: Surgical repair of Achilles tendon (AT) rupture should immediately be followed by active tendon mobilization. The optimal time as to when the mobilization should begin is important yet controversial.Early kinesitherapy leads to reduced rehabilitation period.However, an insight into the detailed mechanism of this process has not been gained. Proteomic technique can be used to separate and purify the proteins by differential expression profile which is related to the function of different proteins, but research in the area ofproteomic analysis of AT 3 days after repair has not been studied so far.Methods: Forty-seven New Zealand white rabbits were randomized into 3 groups. Group A (immobilization group,n=16) received postoperative cast immobilization; Group B (early motion group, n= 16) received early active motion treatments immediately following the repair of AT rupture from tenotomy. Another 15 rabbits served as control group (Group C). The AT samples were prepared 3 days following the microsurgery. The proteins were separated employing twodimensional polyacrylamide gel electrophoresis (2D-PAGE).PDQuest software version 8.0 was used to identify differentially expressed proteins, followed by peptide mass fingerprint (PMF) and tandem mass spectrum analysis, using the National Center for Biotechnology Information (NCBI) protein database retrieval and then for bioinformatics analysis.Results: Amean of 446.33,436.33 and 462.67 protein spots on Achilles tendon samples of 13 rabbits in Group A,14 rabbits in Group B and 13 rabbits in Group C were successfully detected in the 2D-PAGE. There were 40, 36 and 79unique proteins in Groups A, B and C respectively. Some differentially expressed proteins were enzyme with the gel,matrix-assisted laser-desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). We successfully identified 9 and 11 different proteins in Groups A and B,such as GAPDH, phosphoglycerate kinase 1, pro-alpha-1type 1 collagen

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

    Science.gov (United States)

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

    2016-01-01

    An ideal surgical treatment of acute Achilles tendon rupture includes restoring the original length of the tendon, minimizing possible adhesions with the surrounding tissues, minimizing the risk of repeat rupture, alleviating wound problems, and providing an acceptable cosmetic outcome. In the mini-open repair technique, unlike the percutaneous repair technique, the quality of the tenodesis can be visualized without disturbing the healing potential of the surrounding tissues, thus minimizing wound problems. The purpose of the present study was to assess the long-term results of the mini-open repair technique in patients with acute Achilles tendon rupture. A total of 20 consecutive patients with acute Achilles tendon rupture, admitted to our inpatient clinic from October 2003 to March 2008, were included in the present study. The patients underwent Achilles tenodesis with the mini-open repair technique, and each patient was followed up for 5 years. The study was completed in April 2013. The surgical procedure was performed with the assistance of a device designed in our orthosis laboratories, similarly to that defined by Assal et al. Of the 20 patients, 18 were male and 2 were female. Their mean age was 39.3 (range 21 to 55) years. The Achilles tendon rupture was located on the left side in 15 patients (75%) and on the right side in 5 patients (25%). The mean follow-up duration was 58.5 (range 18 to 60) months and no complications occurred during the follow-up period, including repeat rupture, wound site infection, and sural nerve injury. The mean American Orthopaedic Foot and Ankle Society scale score for the patients was 99.2 (range 94 to 100) points at the final follow-up visit. All our patients were able to return to work and sporting activities. According to the Trillat scores, the outcome was excellent in 19 patients and good in 1 patient at the 18th postoperative month. No complaint, such as pain or loss of function, that might have a negative effect on the

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

    Science.gov (United States)

    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

  10. Lubricin in human achilles tendon: The evidence of intratendinous sliding motion and shear force in achilles tendon.

    Science.gov (United States)

    Sun, Yu-Long; Wei, Zhuang; Zhao, Chunfeng; Jay, Gregory D; Schmid, Thomas M; Amadio, Peter C; An, Kai-Nan

    2015-06-01

    Achilles tendon is one of the most commonly injured tendons. Mechanical force is regarded as a major causative factor. However, the biomechanics of Achilles tendon and mechanical mechanism of the injuries are unclear. Lubricin expresses at regions exposed to sliding motion and shear force in a number of tissues. This study investigated the distribution and concentration of lubricin in human Achilles tendons for better understanding the biomechanics of Achilles tendon. Achilles tendons were harvested from nine cadavers. Lubricin was extracted from various locations proximal to the calcaneal insertion and quantified with ELISA. The distribution of lubricin was investigated with immunohistochemistry. Lubricin was mainly identified at the interfaces of tendon fascicles, especially in the mid-portion of the tendon. The concentration of lubricin in Achilles tendons varied by individual and the distance from its calcaneal insertion. The distal portion of the tendon had a higher concentration of lubricin than the proximal regions of the tendon. This study suggests the presence of intratendinous sliding motion of fascicles and shear force at interfaces of fascicles in human Achilles tendon. Shear force could be an important mechanical factor for the development of Achilles tendinopathy and rupture.

  11. Applications of CT spectral imaging and MRI in Achilles tendon rupture%CT能谱成像和MRI在跟腱撕裂诊断中的应用

    Institute of Scientific and Technical Information of China (English)

    李伟; 王新怡; 李爱银; 邓凯; 张成琪

    2012-01-01

    目的 初步探讨CT能谱成像和MRI在诊断跟腱撕裂中的影像特点,比较两种方法的应用价值.方法 跟腱区疼痛病史患者35例,通过手术确诊跟腱撕裂患者30例,分为完全性撕裂、不完全性撕裂和慢性局限性撕裂3种类型,根据跟腱形态、连续性、密度、信号改变,由影像科专家独立阅片,分析CT能谱成像和MRI影像特点,并对跟腱撕裂的CT能谱成像和MRI检出对照作统计学处理,P<0.05为差异具有统计学意义.结果 CT能谱成像主要表现为跟腱增粗、断端迂曲、密度减低.MRI表现为断端高信号,挛缩.对完全性或不完全性撕裂的诊断,CT能谱成像和MRI比较差异无统计学意义(x2=0,P>0.05),对慢性艰腱局限性撕裂的诊断,两种检查方法差异有统计学意义(x2=4.17,P <0.05).结论 CT能谱成像对跟腱完全或不完全性撕裂有较高的应用价值,而MRI 在显示慢性跟腱局限性撕裂方面较CT能谱成像有优势.%Objective To investigate the imaging features of CT spectral imaging and MRI in Achilles tendon rupture, and to compare the application value of the two methods. Methods CT spectral imaging and MRI were both performed in 35 cases with pain and limitation of motion in the Achilles tendon. 30 cases with rupture of the Achilles tendon were confirmed by operation and the patients were divided into complete rupture, incomplete rupture and chronic limitations rupture. Imaging features of the CT spectral imaging and MRI were independently compared and analyzed on the basis of shape, continuity, density, and signal changes of the Achilles tendon by two image experts. The CT spectral imaging and MRI images of the Achilles tendon were compared for statistical analysis. P<0.05 was considered statistically significant. Results CT spectral imaging signs of Achilles tendon rupture were thickening, circuity and density diminution. MRI signs were hyper-intensity and contracture of broken ends. CT spectral

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

    Directory of Open Access Journals (Sweden)

    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.

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

    DEFF Research Database (Denmark)

    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

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

    Institute of Scientific and Technical Information of China (English)

    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

  15. Percutaneous Achilles Tendon Lengthening

    Science.gov (United States)

    ... 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 ...

  16. Validation of a novel ultrasound measurement of achilles tendon length

    DEFF Research Database (Denmark)

    Barfod, Kristoffer Weisskirchner; Riecke, Anja Falk; Boesen, Anders;

    2014-01-01

    PURPOSE: A clinically applicable and accurate method for measuring Achilles tendon length is needed to investigate the influence of elongation of the Achilles tendon after acute rupture. The purpose of this study was to develop and validate an ultrasonographic (US) length measurement of the Achil......PURPOSE: A clinically applicable and accurate method for measuring Achilles tendon length is needed to investigate the influence of elongation of the Achilles tendon after acute rupture. The purpose of this study was to develop and validate an ultrasonographic (US) length measurement.......001). CONCLUSION: The novel ultrasound measurement showed good reliability and accuracy. For comparison between groups of non-injured subjects differences of more than 4 mm can be detected. For repeated assessment of individual subjects differences of more than 10 mm can be detected. The measurement needs...... to be further assessed in the setting of acute Achilles tendon rupture. CLINICAL RELEVANCE: This new ultrasound measurement might allow for length measurement of ruptured Achilles tendons in the acute and chronic state after rupture. LEVEL OF EVIDENCE: II....

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

    OpenAIRE

    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...

  18. Achilles Tendon Disorders

    Science.gov (United States)

    ... 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, ...

  19. Achilles tendon rupture - aftercare

    Science.gov (United States)

    ... 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 ...

  20. Outcome analysis of surgically treated Tendo Achilles rupture

    Directory of Open Access Journals (Sweden)

    Jambu Nageshwaram

    2015-01-01

    Full Text Available Background: The spectrum of Achilles tendon ruptures includes both acute and chronic injuries. Treatment options include operative repair with postoperative immobilization, operative repair with accelerated rehabilitation using early weight bearing, as well as non-operative treatment. Many surgeons advocate early operative repair of the ruptured Achilles tendon, citing decreased re-rupture rates and improved functional outcome while some surgeons treat them conservatively. In this article we are going to analyse the midterm outcome of surgically treated Tendo Achilles rupture. Methods: Prospective study of thirty cases of surgically managed Tendo Achilles injury treated in Sri Ramachandra medical college and research institute, Chennai, from June 2011 to June 2014. All the patients were followed up completely. Patients were followed periodically at 6 weeks, 12 weeks, 6 months and then yearly. Minimum follow up period was 12 months and maximum follow up period was 42 months. We have evolved our own scoring system and named it as comprehensive SRMC scoring system and all patients were followed using the scoring system. Results: We had 84% good results, 10% fair and 6% poor results as per comprehensive SRMC scoring system. Conclusion: SRMC scoring system for Tendo Achilles is a comprehensive one. It is specific for Tendo Achilles rupture. It includes all parameter for successful scoring system. Surgical treatment of Tendo Achilles gives good results. [Int J Res Med Sci 2015; 3(1.000: 161-164

  1. MRI of normal achilles tendon

    Energy Technology Data Exchange (ETDEWEB)

    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.

  2. 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

    Institute of Scientific and Technical Information of China (English)

    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.

  3. Curative analysis of suture anchors in repairing delayed Achilles tendon rupture%带线锚钉修复陈旧性跟腱断裂的疗效

    Institute of Scientific and Technical Information of China (English)

    祁洁; 卫文博; 段亮; 李伟伟

    2015-01-01

    目的 分析带线锚钉修复陈旧性跟腱断裂的临床疗效. 方法 选择2010年1月-2013年12月收治的陈旧性跟腱断裂患者23例,其中男19例,女4例;年龄35~ 53岁,平均43岁.均为单侧损伤,其中左足5例,右足18例.受伤至手术时间21 ~ 40 d,平均26.3 d.B超确诊10例,MRI确诊13例.所有患者均采用带线锚钉修复断裂跟腱,术后无须外支具固定,早期开始功能锻炼.观察伤口并发症情况,术后6,12,18,24个月计算踝关节屈伸范围、美国足踝外科协会踝-后足评分系统(AOFAS)评分、双侧小腿最大周径,观察跟腱再断裂和跛行步态,应用Lunsford-Perry提踵能力测试衡量跟腱肌力恢复情况. 结果 术后随访24个月,所有患者切口均Ⅰ期愈合,无腓肠神经损伤表现,跟腱修复部位与皮肤无粘连,无深部感染,随访期间无跟腱再断裂发生.术后6个月关节功能评估,踝背伸10.8°(9~ 15°),跖屈43.8°(40 ~48°),与健侧比较差异无统计学意义(P>0.05).AOFAS评分术前与术后比较差异有统计学意义(P<0.01).小腿最大周径,健侧为38.2 cm,患侧为35.8 cm,虽然差异有统计学意义,但差值小于3 cm.所有患者可以顺利完成25次提踵活动.4例患者行走时有轻微跛行,术后12个月所有患者步态正常,踝关节活动范围小腿最大周径与健侧差异无统计学意义(P>0.05). 结论 利用带线锚钉修复陈旧性跟腱断裂,断端吻合牢固,缝线切割力小,皮肤切口并发症少,无须外固定,术后可以早期开始功能锻炼,踝关节功能恢复快.%Objective To summarize the clinical efficacy of suture anchors in repairing the delayed Achilles tendon rupture.Methods From January 2010 to December 2013,23 patients with delayed Achilles tendon rupture were treated using the suture anchors.There were 19 males and 4 females,at mean age of 43 years (range,35-53 years).Injury on the left side occurred in 5 patients and right side in 18 patients.Mean time

  4. 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

    Institute of Scientific and Technical Information of China (English)

    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

  5. Clinical Research of Polypropylene Patch in Treating Tearing Rupture of the Closed Achilles Tendon%聚丙烯补片在跟腱闭合完全撕裂性断裂治疗中的临床研究

    Institute of Scientific and Technical Information of China (English)

    林世磅; 关术; 林广宜; 李日绍

    2013-01-01

      Objective:To study the effect and prognosis of polypropylene patch in treating tearing rupture of closed Achilles tendon,and reduce the Achilles tendon rupture again. Method:In the operation,the broken Achilles tendon was repaired by“Cream method”,Polypropylene patch was placed at Achilles tendon rupture ends the central,and was suture fixed. After the operation, the knees a splint fixed was used 2 weeks. Two weeks later,Ankle active,passive function were exercised. Follow-up results,review analysis.Result:All cases were got 2 to 7 years of follow-up,suture in the Achilles tendon healing skin were good,In polypropylene patch,the patient had no appear foreign body reaction,all can normal sports activities. 5 patients were able to original severe basketball,badminton sports,not happened again Achilles tendon rupture. According to the Amer-Lindholm curative effect evaluation standard,11 cases were optimal,1 case was good .Conclusion:Using polypropylene patch can obviously promote the healing of Achilles tendon tearing rupture,and prevent rupture again. It also can shorten patients’braking time. Patients can do functional exercise as soon as possible. The operation is simple.%  目的:研究聚丙烯补片在跟腱闭合完全撕裂性断裂中的治疗及预后,减少跟腱再次断裂。方法:术中应用“夹心饼法”修复跟腱断裂处:聚丙烯补片置入跟腱断裂两端中央并缝合固定,术后应用过膝位夹板外固定2周,2周后进行踝关节主、被动功能锻炼,并对随访结果进行回顾和分析。结果:所有病例随访2~7年,缝合跟腱处皮肤均愈合良好,置入聚丙烯补片未出现异物反应,患者均能进行正常体育活动,5例患者继续进行原来剧烈的篮球、羽毛球比赛体育活动,未再发生跟腱再次断裂。按Amer-Lindholm疗效标准进行评定,优11例,良1例,差0例。结论:应用聚丙烯补片可以明显促进跟腱撕裂性断裂

  6. 长屈肌腱转位手术治疗老年跟腱断裂的疗效分析%Clinical outcomes of flexor hallucis longus tendon transfer in elderly patients with Achilles tendon ruptures

    Institute of Scientific and Technical Information of China (English)

    朱尧卿; 徐向阳; 朱渊

    2014-01-01

    Background:Tendon transfer is essential to treat end-stage chronic Achilles tendon diseases. Flexor hallucis longus (FHL) tendon transfer is one of the most popular treatments. However, functional recovery and life style in elderly people are dif-ferent from others. Objective:This study is aiming to explore the outcomes of FHL tendon transfer in the elderly patients who suffered from Achilles tendon ruptures. Methods:We retrospectively studied 14 cases (16 feet) who underwent FHL tendon transfer for reconstruction of Achilles tendon between September 2007 and July 2012. Among them there were 7 males and 7 females aged from 60 to 83years (mean age, 67.1 years). American Orthopaedic Foot and Ankle Society ankle-hindfoot scale (AOFAS-AH), AOFAS hallux and metatarsophalangeal-interphalangeal scale (AOFAS-MTPIP), visual analogue scale (VAS), Achilles tendon rupture score (ATRS) were assessed before and after surgery to evaluate the functional recovery. Complications were recorded. Results: The duration of follow-up ranged from 21 to 67 months in the 14 patients. The average AOFAS-AH score in-creased from 68.2±6.2 preoperatively to 93.2±5.3 postoperatively;the average AOFAS-MTPIP score increased from 94.2± 2.9 preoperatively to 95.1±3.2 postoperatively. The average VAS score was 5.1±1.4 at the last follow-up, which was signifi-cantly lower than that before operation (1.0±0.7). ATRS increased from 52.7±9.3 preoperatively to 86.3±10.3 postoperative-ly. No complications, such as incision infection, pulmonary infection or venous thromboembolism happened. Conclusions:FHL tendon transfer is an efficient procedure for Achilles tendon ruptures in elderly people.%背景:慢性跟腱疾病发展到后期往往需要行肌腱转位治疗,长屈肌腱转位手术是常用的治疗方式。但老年患者的功能恢复、生活方式有别于其他人群。目的:探讨长屈肌腱转位手术治疗老年人跟腱断裂的临床效果。方法:回顾性分析2007年9

  7. Minimally invasive surgery for Achilles tendon pathologies

    Directory of Open Access Journals (Sweden)

    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

  8. Augmented repair of acute Achilles tendon ruptures with modified Lindholm turndown gastrocnemius fascia flap%改良Lindholm腓肠肌倒转腱膜瓣加强修复急性跟腱断裂

    Institute of Scientific and Technical Information of China (English)

    钮心刚; 鲍宏玮; 严立生

    2012-01-01

    Objective To find an effective operative method for acute rupture of the Achilles tendon and to discuss its treament result. Methods A modified Lindholm turndown gastrocnemius fascia flap technique was designed. 45 cases of acute Achilles ruptures operated upon this modified Lindholm technique were retrospectively included in this study. The achilles tendon stumps was repaired with the Kessler suture. Two 0. 5 cm X 7 cm turndown gastrocnemius fascia flaps were dissected and made into membrane to wrap and repair the Achilles tendon ends, recovering its shape. Results There was no complication of infection, wound necrosis, sural nerve injury and tendon rerupture. All the patients were followed up for 12 to 20 months. At one-year follow-up, the treatment result was evaluated with Amer-Lindholm rating scale as excellent in 43 cases, good in 2 cases. Conclusions This modified Lindholm technique is an effective method to repair and enhance the acute Achilles tendon ruptures.%目的 探讨治疗急性跟腱断裂的手术方法及疗效.方法 对Lindholm腓肠肌倒转腱膜瓣加强修复跟腱断裂术进行改良,修复45例急性跟腱断裂.用Kessler法缝合跟腱断端,改良术中切取大小为0.5 cm×7 cm 2条腓肠肌腱膜瓣,预制成腱膜片后倒转包裹修复跟腱缝合端,恢复外形.结果 术后无感染、切口坏死、腓肠神经损伤及跟腱再断裂等并发症,跟腱修复处外形良好.患者均获随访,时间12~20个月.术后1年根据Arner-Lindholm评定标准评价治疗效果:优43例,良2例.结论 改良Lindholm腓肠肌倒转腱膜瓣是加强修复急性跟腱断裂的有效手术方法.

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

    DEFF Research Database (Denmark)

    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...

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

    Science.gov (United States)

    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

  11. Diagnosing Achilles tendon injuries in the emergency department.

    LENUS (Irish Health Repository)

    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.

  12. Achilles tendon and sports; Die Achillessehne im Sport

    Energy Technology Data Exchange (ETDEWEB)

    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

  13. [Quadriceps and patellar tendon ruptures].

    Science.gov (United States)

    Grim, C; Lorbach, O; Engelhardt, M

    2010-12-01

    Ruptures of the quadriceps or patellar tendon are uncommon but extremely relevant injuries. Early diagnosis and surgical treatment with a stable suture construction are mandatory for a good postoperative clinical outcome. The standard methods of repair for quadriceps and patellar tendon injuries include the placement of suture loops through transpatellar tunnels. Reinforcement with either a wire cerclage or a PDS cord is used in patellar tendon repair. The PDS cord can also be applied as augmentation in quadriceps tendon repair. In secondary patellar tendon repair an autologous semitendinosus graft can be used. For chronic quadriceps tendon defects a V-shaped tendon flap with a distal footing is recommended. The different methods of repair should lead to early functional postoperative treatment. The clinical outcome after surgical treatment of patellar and quadriceps tendon ruptures is mainly good.

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

    International Nuclear Information System (INIS)

    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.)

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

    International Nuclear Information System (INIS)

    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

  16. Treatment of degenerative Achilles'tendon rupture using V-Y tendinous flap and transfer of flexor hallucis longus tendon%V-Y肌腱瓣结合屈(足母)长肌腱转移治疗退变的跟腱断裂

    Institute of Scientific and Technical Information of China (English)

    沈宇辉; 刘津浩; 徐向阳

    2008-01-01

    目的 介绍V-Y肌腱瓣结合屈(足母)长肌腱转移治疗退变的跟腱断裂的术式、手术指征及疗效.方法 2003年10月至2006年5月对21例跟腱断裂采用V-Y肌腱瓣结合屈躅长肌腱转移治疗,其中采用铆钉17例,界面螺钉4例.介绍该手术方法,并根据文献和实践总结手术指征. 结果 本组所有患者获得12~18个月(平均14个月)随访.根据Arner-Lindholm疗效评价标准:优19例,良2例.术后伤口均一期愈合,随访期间跟腱无再次断裂,无伤口感染,无皮肤坏死,踝关节活动好,无僵直,无神经血管损伤.行走步态基本正常,对前足推进影响不大.该术式修复强度允许跟腱早期功能锻炼. 结论 采用V-Y肌腱瓣结合足屈(足母)长肌腱治疗跟腱断裂疗效好,该术式适用于跟腱组织退变、炎症和部分缺损(<3cm)患者,术中单纯V-Y肌腱瓣修补强度不够可采用屈(足母)长肌腱转移.%Objective To introduce the technique.indication and outcome of treatment of degenerative Achilles'rupture with transfer of flexor hallucis longus tendon and V-Y tendinous flap. Methods From October 2003 to May 2006,21 cases of degenerative Achilles'tendon rupture were treated in our department using transfer of flexor hallucis longus tendon and V-Y tendinous flap.Rivets were used in 17 cases and surface screws in 4.They were followed up for 12 to 18 months(average,14). Results According to the Arner-Lindholm criteria for curative results,19 of the 21 cases were excellent and 2 good.Follow-ups revealed no Achilles'tendon re-rupture,infection,skin necrosis,stiff ankle,or injury to nerves and vessels.Walking gaits nearly recovered to normal.The repair strength allowed early functional exercise of the Achilles'tendon. Conclusion Transfer of flexor hallucis longus tendon combined with V-Y tendinous flap can cure the degenerative Achilles'tendon ruptures and defects of Achilles'tendon within 3 cm.

  17. Spontaneous bilateral quadriceps tendon rupture.

    Science.gov (United States)

    Vigneswaran, N; Lee, K; Yegappan, M

    2007-11-01

    Spontaneous bilateral quadriceps tendon ruptures are uncommon. We present a 30-year-old man with end-stage renal failure, who sustained this injury, and subsequently had surgical repair of both tendons on separate occasions. He has since regained full range of movement of both knees.

  18. An in-vivo experimental evaluation of He-Ne laser photostimulation in healing Achilles tendons.

    Science.gov (United States)

    Elwakil, Tarek F

    2007-03-01

    There is no method of treatment that has been proven to accelerate the rate of tendon healing or to improve the quality of the regenerating tendon. Low level laser photostimulation has gained a considerable attention for enhancing tissue repair in a wide spectrum of applications. However, there is controversy regarding the effectiveness of laser photostimulation for improvement of the healing process of surgically repaired tendons. Accordingly, the present study was conducted to evaluate the role of helium-neon (He-Ne) laser photostimulation on the process of healing of surgically repaired Achilles tendons. Thirty unilateral Achilles tendons of 30 Raex rabbits were transected and immediately repaired. Operated Achilles tendons were randomly divided into two equal groups. Tendons at group A were subjected to He-Ne laser (632.8 nm) photostimulation, while tendons at group B served as a control group. Two weeks later, the repaired Achilles tendons were histopathologically and biomechanically evaluated. The histopathological findings suggest the favorable qualitative pattern of the newly synthesized collagen of the regenerating tendons after He-Ne laser photostimulation. The biomechanical results support the same favorable findings from the functional point of view as denoted by the better biomechanical properties of the regenerating tendons after He-Ne laser photostimulation with statistical significance (p ruptured and injured tendons for a better functional outcome. It could be applied safely and effectively in humans, especially with respect to the proposed long-term clinical outcome.

  19. Finite Element Analysis of the Achilles Tendon While Running

    Directory of Open Access Journals (Sweden)

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  1. Rocker shoes reduce Achilles tendon load in running and walking in patients with chronic Achilles tendinopathy

    NARCIS (Netherlands)

    Sobhani, Sobhan; Zwerver, Johannes; van den Heuvel, Edwin; Postema, Klaas; Dekker, Rienk; Hijmans, Juha M.

    2015-01-01

    OBJECTIVES: Relative rest and pain relief play an important role in the management of Achilles tendinopathy, and might be achieved by reducing the load on the Achilles tendon. Previous studies have provided evidence that rocker shoes are able to decrease the ankle internal plantar flexion moment in

  2. Quadriceps and patellar tendon rupture.

    Science.gov (United States)

    Ramseier, L E; Werner, C M L; Heinzelmann, M

    2006-06-01

    Ruptures of the patellar and/or quadriceps tendon are rare injuries that require immediate repair to re-establish knee extensor continuity and to allow early motion. We evaluated 36 consecutive patients with quadriceps or patellar tendon rupture between 1993 and 2000. There were 37 primary ruptures, 3 reruptures, 21 quadriceps and 19 patellar tendon ruptures. Follow up examination (>24 months postoperatively) included the patient's history, assessment of risk factors, clinical examination of both knees, isometric muscle strength measurements and three specific knee scores, Hospital for Special Surgery Score, Knee Society Score and Turba Score, and a short form SF-36. We evaluated 29 patients (26 men) with 33 ruptures (16 patellar tendon, 17 quadriceps tendon). Seven patients were lost to follow up. We found no difference between the range of motion and muscle strength when the injured leg was compared to the non-injured leg. Risk factors did not influence the four scores, patient satisfaction, pain, muscle strength or range of motion. Multiple injured patients had a significant reduction in muscle strength and circumference, however patient satisfaction did not differ to the non-multiple injured patient group.

  3. [Simultaneous rupture of a patellar tendon and contralateral quadriceps tendon].

    Science.gov (United States)

    Horas, U; Ernst, S; Meyer, C; Halbsguth, A; Herbst, U

    2006-09-01

    The simultaneous bilateral rupture of the quadriceps tendon is a rare injury; only occasional reports exist about the bilateral simultaneous rupture of the patellar tendon. Degenerative changes of the tendon due to drugs or diseases lead to the rupture. We describe two cases of simultaneous rupture of the patellar and contralateral quadriceps tendons; only one patient had special risks. We report the management of therapy and the functional results using the Lysholm score and Knee Rating Scale.

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

    Science.gov (United States)

    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

  5. 肌肉包埋法旷置裸露跟腱并二期修复治疗伴皮肤缺损的跟腱断裂32例疗效观察%Initial muscle-enclosing protection of large segment of exposed Achilles tendon and second stage repair of Achilles tendon rupture complicated with cutaneous defect:observation of 32 cases

    Institute of Scientific and Technical Information of China (English)

    毕建耀; 张强; 曲伟; 李霞; 王永会; 张晓涛

    2016-01-01

    目的:探讨肌肉包埋法旷置大段裸露跟腱并二期修复治疗伴皮肤缺损的跟腱断裂的手术方法和疗效。方法对自2005年8月至2014年4月收治的32例伴皮肤缺损的跟腱断裂患者资料进行回顾性分析,其中男21例,女11例;年龄23~69岁,平均(46.2±3.5)岁,所有患者均伴有小腿后侧近踝部软组织碾挫伤、皮肤缺损,范围为3 cm ×4 cm ~5 cm ×12 cm,跟腱自止点近端2~4 cm 断裂、抽脱、游离,完全裸露。所有患者均采用小腿三头肌肌肉包埋法旷置大段裸露跟腱并二期修复跟腱断裂、同时转移皮瓣修复皮肤缺损,术后随访患者,按 Arner-Lindholm 疗效评定标准对其进行疗效评定。结果术后随访11~32个月,平均18个月。疗效评定,优22例,良7例,差3例,优良率为90.62%。结论肌肉包埋法旷置大段裸露跟腱并二期修复治疗伴严重皮肤缺损的跟腱断裂,有利于患者功能的及早恢复。%Objective To discuss the methods and evaluate the effects of initial muscle-enclosing protection of large segment of exposed Achilles tendon and second stage repair of Achilles tendon rupture complicated with cuta-neous defect.Methods Among patients treated between August 2005 to April 2014 in our hospital,there were 32 patients,who were diagnosed with Achilles tendon rupture complicated with cutaneous defect.Of the 32 patients, there are 21 male and 11 female.Their ages range from 23 to 69,with an average age of 46.2 ±3.5.In all the patients described above,there are soft tissue contusion injuries and cutaneous defects on their posterior lower legs near the ankles,with the area of skin defects ranging from 3cm ×4cm to 5 ×12cm,and the Achilles tendons were ruptured, extracted,dissociated and completely uncovered.All patients were initially treated with triceps surae muscle-enclosing method to put aside and protect the large segment of exposed Achilles tendon

  6. Histologic analysis of ruptured quadriceps tendons.

    Science.gov (United States)

    Trobisch, Per David; Bauman, Matthias; Weise, Kuno; Stuby, Fabian; Hak, David J

    2010-01-01

    Quadriceps tendon ruptures are uncommon injuries. Degenerative changes in the tendon are felt to be an important precondition for rupture. We retrospectively reviewed 45 quadriceps tendon ruptures in 42 patients. Quadriceps tendon ruptures occurred most often in the sixth and seventh decade of life. Men were affected six times as often as women. A tissue sample from the rupture-zone was obtained in 22 cases and histologic analysis was performed. Degenerative changes were present in only 14 (64%) of the 22 samples. We observed an increasing ratio of degenerative to nondegenerative tendons with increasing patient age. Our data suggests that quadriceps tendon rupture, especially in younger patients, can occur in the absence of pathologic tendon degeneration.

  7. Quadriceps tendon rupture - treatment results

    Directory of Open Access Journals (Sweden)

    Popov Iva

    2013-01-01

    Full Text Available Introduction. Quadriceps tendon rupture is a rare but rather serious injury. If this injury is not promptly recognized and early operated, it may lead to disability. This research was aimed at pointing out the results and complications of the quadriceps tendon rupture surgical treatment. Material and Methods. This retrospective multicentric study was conducted in a group of 29 patients (mostly elderly men. Lysholm knee scoring scale was used to evaluate the surgical results. The post-operative results were compared in relation to the type of tendon rupture reconstructions (acute or chronic, various surgical techniques, type of injuries (unilateral or bilateral as well as the presence or absence of comorbid risk factors in the patients. Results. The average value of a Lysholm score was 87.6. Excellent and satisfactory Lysholm score results dominated in our sample of patients. Better post-operative results were recorded in the group of patients without risk factors, in case of a bilateral injury, and in case of an acute injury. The best result was obtained after performing the reconstruction using anchors, and the worst result came after using Codivilla technique. Discussion and Conclusion. Early diagnosis and surgical treatment are an absolute imperative in management of this injury. We have not proven that a certain surgical technique has an advantage over the others. A comorbid risk factor is related to a lower Lysholm score. Despite a few cases of complications, we can conclude that the surgical treatment yields satisfactory results.

  8. Motor responses to experimental Achilles tendon pain

    DEFF Research Database (Denmark)

    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 ex...

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

    International Nuclear Information System (INIS)

    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)

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

    Science.gov (United States)

    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

  11. Quadriceps and patellar tendon ruptures.

    Science.gov (United States)

    Lee, Dennis; Stinner, Daniel; Mir, Hassan

    2013-10-01

    The diagnosis of quadriceps and patellar tendon ruptures requires a high index of suspicion and thorough history-taking to assess for medical comorbidities that may predispose patients to tendon degeneration. Radiographic assessment with plain films supplemented by ultrasound and magnetic resonance imaging when the work-up is equivocal further aids diagnosis; however, advanced imaging is often unnecessary in patients with functional extensor mechanism deficits. Acute repair is preferred, and transpatellar bone tunnels serve as the primary form of fixation when the tendon rupture occurs at the patellar insertion, with or without augmentation depending on surgeon preference. Chronic tears and disruptions following total knee arthroplasty are special cases requiring reconstructions with allograft, synthetic mesh, or autograft. Rehabilitation protocols generally allow immediate weight-bearing with the knee locked in extension and crutch support. Limited arc motion is started early with active flexion and passive extension and then advanced progressively, followed by full active range of motion and strengthening. Complications are few but include quadriceps atrophy, knee stiffness, and rerupture. Outcomes are excellent if repair is done acutely, with poorer outcomes associated with delayed repair.

  12. 拇长屈肌腱转位结合挤压螺钉重建KuwadaⅣ型陈旧性跟腱断裂%Flexor hallucis tendon transfer combined with an interference screw reconstruction for chronic Achilles tendon rup-ture of Kuwada IV

    Institute of Scientific and Technical Information of China (English)

    杜俊锋; 朱仰义

    2015-01-01

    Objective:To explore the clinical effect of interference screw and flexor hallucis longus tendon as augmenta⁃tion material in repair of chronic Achilles tendon rupture. Methods:From September 2010 to June 2012,26 patients with chronic Achilles tendon rupture were treated,including 18 males and 8 females with an average age of 44.2 years old(20 to 66 years old). All patients were unilateral damage. MRI showed the Achilles tendon ends' distance was 6.0 to 9.0 cm. The postoperative complications were observed. The curative effect was assessed by American Orthopedic Foot and Ankle Society and Leppilahti score. Results:All the 26 patients were followed up for 18 to 68 months(means 30.4 months). No neurological injury and infection of incision occurred,all patients were stage I incision healing. The shape and function of the ankle were re⁃covered well. The average AOFAS score increased from 52.27±12.30 preoperatively to 90.92±6.36 postoperatively. Leppilahti Achilles Tendon Repair score increased from 34.23 ± 12.86 preoperatively to 90.00 ± 5.10 postoperatively. Conclusion:The flexor hallucis tendon transfer with an interference screw technique for repairing the chronic Achilles tendon rupture of type IV of Kuwada had advantages of simple operation,quick recovery,firm tendon fixation,and less complications.%目的:探讨拇长屈肌腱转位后应用挤压螺钉重建陈旧性KuwadaⅣ型跟腱断裂的临床效果。方法:回顾性分析2010年9月至2012年6月,拇长屈肌腱转位后采用挤压螺钉固定重建26例陈旧性跟腱断裂患者的临床资料,其中男18例,女8例;年龄20~66岁,平均44.2岁。所有患者为单侧损伤。MRI显示跟腱断端距离为6.0~9.0 cm。观察术后并发症情况,并采用美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足评分及Leppilahti跟腱修复评分进行评价疗效。结果:26例获得随访,时间18~68个月,平均30.4个月。

  13. Simultaneous and spontaneous bilateral quadriceps tendons rupture.

    Science.gov (United States)

    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.

  14. Simultaneous and spontaneous bilateral quadriceps tendons rupture.

    Science.gov (United States)

    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

  15. Simultaneous bilateral patellar tendon rupture without

    Directory of Open Access Journals (Sweden)

    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

  16. Acute rupture of the tibialis posterior tendon without fracture: a case report.

    Science.gov (United States)

    Martinelli, Nicolò; Bonifacini, Carlo; Bianchi, Alberto; Moneghini, Laura; Scotto, Gennaro; Sartorelli, Elena

    2014-05-01

    The acute rupture of the tibialis posterior (TP) tendon, compared to an acute rupture of the Achilles tendon, is a quite uncommon disease to be diagnosed in the emergency department setting. In most cases symptoms related to a TP dysfunction, like weakness, pain along the course of the tendon, swelling in the region of the medial malleolus, and the partial or complete loss of the medial arch with a flatfoot deformity precede the complete rupture of the tendon. In this case report, we describe an acute rupture of the TP tendon following a pronation-external rotation injury of the ankle with no association of a medial malleolus fracture and with no history of a prior flatfoot deformity or symptoms. PMID:24901592

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

    Energy Technology Data Exchange (ETDEWEB)

    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

  18. Human Achilles tendon glycation and function in diabetes

    DEFF Research Database (Denmark)

    Couppé, Christian; Svensson, Rene Brüggebusch; Madsen, Mads Kongsgaard;

    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....

  19. Biomechanical characteristics of the eccentric Achilles tendon exercise

    DEFF Research Database (Denmark)

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

    2009-01-01

    into the biomechanics of the exercise may improve our understanding. METHODS: Sixteen healthy subjects performed one-legged full weight bearing ankle plantar and dorsiflexion exercises during which three-dimensional ground reaction forces (GRF), ankle joint kinematics and surface electromyography (EMG) of the lower leg...... that 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....

  20. Bilateral synchronous rupture of the quadriceps tendon.

    LENUS (Irish Health Repository)

    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.

  1. Synaptic failure: The achilles tendon of sphingolipidoses.

    Science.gov (United States)

    Cantuti-Castelvetri, Ludovico; Bongarzone, Ernesto R

    2016-11-01

    The presence of life-threatening neurological symptoms in more than two-thirds of lysosomal storage diseases (LSDs) underscores how vulnerable the nervous system is to lysosomal failure. Neurological dysfunction in LSDs has historically been attributed to the disruption of neuronal and glial homeostasis resulting from the progressive jamming of the endosomal/lysosomal pathway. In neurons, a dysfunctional endosomal-lysosomal system can elicit dire consequences. Given that neurons are largely postmitotic after birth, one can clearly understand that the inability of these cells to proliferate obliterates any possibility of diluting stored lysosomal material by means of cellular division. At its most advanced stage, this situation constitutes a terminal factor in neuronal life, resulting in cell death. However, synaptic deficits in the absence of classical neuronal cell death appear to be common features during the early stages in many LSDs, particularly sphingolipidoses. In essence, failure of synapses to convey their messages, even without major structural damage to the neuronal bodies, is a form of physiological death. This concept of dying-back neuropathology is highly relevant not only for understanding the dynamics of the neurological decline in these diseases, but, more importantly; it might also constitute an important target for molecular therapies to protect perhaps the "Achilles" point in the entire physiological architecture of the brain, thus avoiding an irreversible journey to neuronal demise. © 2016 Wiley Periodicals, Inc. PMID:27638588

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

    Science.gov (United States)

    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

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

    OpenAIRE

    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 ...

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

    DEFF Research Database (Denmark)

    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...

  5. Tendon rupture associated with simvastatin/ezetimibe therapy.

    Science.gov (United States)

    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

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

    DEFF Research Database (Denmark)

    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....

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

    Science.gov (United States)

    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

  8. Bilateral spontaneous rupture of flexor digitorum profundus tendons.

    LENUS (Irish Health Repository)

    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.

  9. Patellar tendon: From tendinopathy to rupture

    Directory of Open Access Journals (Sweden)

    Federica Rosso

    2015-10-01

    Full Text Available 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 the aetiology, diagnosis, and treatment of both patellar tendinopathy and rupture. We report the conservative treatments proposed for patellar tendinopathy and the surgical techniques described for its rupture.

  10. ggstThe role of tendon microcirculation in Achilles and patellar tendinopathy

    Directory of Open Access Journals (Sweden)

    Knobloch Karsten

    2008-04-01

    Full Text Available Abstract Tendinopathy is of distinct interest as it describes a painful tendon disease with local tenderness, swelling and pain associated with sonographic features such as hypoechogenic texture and diameter enlargement. Recent research elucidated microcirculatory changes in tendinopathy using laser Doppler flowmetry and spectrophotometry such as at the Achilles tendon, the patellar tendon as well as at the elbow and the wrist level. Tendon capillary blood flow is increased at the point of pain. Tendon oxygen saturation as well as tendon postcapillary venous filling pressures, determined non-invasively using combined Laser Doppler flowmetry and spectrophotometry, can quantify, in real-time, how tendon microcirculation changes over with pathology or in response to a given therapy. Tendon oxygen saturation can be increased by repetitive, intermittent short-term ice applications in Achilles tendons; this corresponds to 'ischemic preconditioning', a method used to train tissue to sustain ischemic damage. On the other hand, decreasing tendon oxygenation may reflect local acidosis and deteriorating tendon metabolism. Painful eccentric training, a common therapy for Achilles, patellar, supraspinatus and wrist tendinopathy decreases abnormal capillary tendon flow without compromising local tendon oxygenation. Combining an Achilles pneumatic wrap with eccentric training changes tendon microcirculation in a different way than does eccentric training alone; both approaches reduce pain in Achilles tendinopathy. The microcirculatory effects of measures such as extracorporeal shock wave therapy as well as topical nitroglycerine application are to be studied in tendinopathy as well as the critical question of dosage and maintenance. Interestingly it seems that injection therapy using color Doppler for targeting the area of neovascularisation yields to good clinical results with polidocanol sclerosing therapy, but also with a combination of epinephrine and

  11. Quadriceps tendon rupture through a superolateral bipartite patella.

    Science.gov (United States)

    Woods, G William; O'Connor, Daniel P; Elkousy, Hussein A

    2007-10-01

    We report a case of a quadriceps tendon rupture through a bipartite patella. Although quadriceps tendon ruptures and patella fractures are common, rupture through a bipartite patella fragment is rare. This case was managed similar to a quadriceps rupture with an excellent result.

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

    DEFF Research Database (Denmark)

    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...... did not appreciably influence the mechanical, structural, or biochemical properties of the Achilles tendon in adult long distance runners....

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

    OpenAIRE

    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...

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

    Science.gov (United States)

    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

  15. Comparison of Achilles tendon repair techniques in a sheep model using a cross-linked acellular porcine dermal patch and platelet-rich plasma fibrin matrix for augmentation.

    Science.gov (United States)

    Sarrafian, Tiffany L; Wang, Hali; Hackett, Eileen S; Yao, Jian Q; Shih, Mei-Shu; Ramsay, Heather L; Turner, A Simon

    2010-01-01

    The primary goal of this study was to evaluate a cross-linked acellular porcine dermal patch (APD), as well as platelet-rich plasma fibrin matrix (PRPFM), for repair of acute Achilles tendon rupture in a sheep model. The 2 surgically transected tendon ends were reapproximated in groups 1 and 2, whereas a gap was left between the tendon ends in group 3. APD was used to reinforce the repair in group 2, and autologous PRPFM was used to fill the gap, which was also reinforced with APD, in group 3. All sheep were humanely euthanized at 24 weeks after the repair, and biomechanical and histological testing were performed. Tensile strength testing showed a statistically significant difference in elongation between the operated limb and the unoperated contralateral limb in groups 1 and 3, but not in group 2. All operated tendons appeared healed with no apparent fibrosis under light and polarized microscopy. In group 1, all surgical separation sites were identifiable, and healing occurred via increasing tendon thickness. In group 2, healing occurred with new tendon fibers across the separation, without increasing tendon thickness in 2 out of 6 animals. Group 3 showed complete bridging of the gap, with no change in tendon thickness in 2 out of 6 animals. In groups 2 and 3, peripheral integration of the APD to tendon fibers was observed. These findings support the use of APD, alone or with PRPFM, to augment Achilles tendon repair in a sheep model.

  16. Sequential rupture of triceps and quadriceps tendons in a dialysis patient using hormone supplements.

    Science.gov (United States)

    Soo, I; Christiansen, J; Marion, D; Courtney, M; Luyckx, V A

    2011-02-01

    Spontaneous rupture of tendons is rare, and typically occurs in large weight bearing tendons such as the quadriceps, Achilles and patellar tendon, in the context of various chronic diseases including end-stage renal disease. In general, tendon rupture in dialysis patients is associated with hyperparathyroidism, long duration of dialysis, steroid and quinolone use. We present a case of a young man on chronic dialysis who presented with sequential rupture of triceps and quadriceps tendons requiring surgical repair, several months after initiating use of multiple hormone supplements including human growth hormone and androgens. The supplements were obtained over the internet with the aim of improving his kidney function. Although this patient did have hyperparathyroidism, it is likely his PTH elevation was exacerbated by use of human growth hormone, and tendon rupture risk increased by concurrent use of an androgen supplement. This case highlights the fact that dialysis patients do utilize alternative remedies and that there may be unexpected, dialysis-specific complications associated with their use.

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

    DEFF Research Database (Denmark)

    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...... (range, 52%-96%) of biopsy specimens from nonruptured chronic tendinopathic Achilles tendons. CD68-KP1(+) macrophages (0.29% vs 0; P = .005) and CD34(+) endothelial cells (3% vs 0.97%; P = .04) were significantly more numerous in tendinopathic tendons compared with healthy tendons. The presence of iron...... nonruptured chronic tendinopathic Achilles tendons. Macrophages and endothelial cells were significantly more numerous in tendinopathic tendons than in healthy tendons. The presence of iron(+) hemosiderophages in baseline biopsy specimens was associated with a good prognosis. CLINICAL RELEVANCE: New insight...

  18. Bilateral patellar tendon rupture associated with statin use.

    Science.gov (United States)

    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

  19. Gait analysis before and after achilles tendon surgical suture in a single-subject study: a case report.

    Science.gov (United States)

    Marcolin, Giuseppe; Buriani, Alessandro; Balasso, Alberto; Villaminar, Renato; Petrone, Nicola

    2015-01-01

    Achilles tendon rupture is a disabling injury that requires a long recovery time. We describe a unique case of a 46-year-old male who had undergone gait analysis as part of a personal physical examination and who, 16 months later, ruptured his left Achilles tendon while running. With gait kinematic and kinetic data available both before and after his injury, we determined the residual gait asymmetries on his uninjured side and compared the pre- and postinjury measurements. We analyzed his gait at 1, 4, and 7 weeks after his return to full weightbearing. Compared with the preinjury values, at 7 weeks he had almost complete range of motion in his left ankle (-2%) and a slight increase in gait velocity (+6%) and cadence (+3%). The peak power of his injured ankle was 90% of its preinjury value. In contrast, the unaffected ankle was at 118%. These observations suggest that measuring the asymmetries of the gait cycle, especially at the beginning of rehabilitation, can be used to improve treatment. We had the patient strengthen his ankle using a stationary bicycle before he returned to running. Kinetics also appears to be more powerful than kinematics in detecting functional asymmetries associated with reduced calf strength, even 15 weeks after surgery. Gait analysis could be used to predict the effectiveness of rehabilitation protocols and help calibrate and monitor the return to sports participation while preventing overloading muscle and tendon syndromes.

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

    Directory of Open Access Journals (Sweden)

    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

  1. Patellar tendon: From tendinopathy to rupture

    OpenAIRE

    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...

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

    OpenAIRE

    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 ...

  3. The enigmatic diagnosis of posterior tibialis tendon rupture.

    OpenAIRE

    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...

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

    Science.gov (United States)

    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

  5. Ultrasound Diagnosis of Bilateral Quadriceps Tendon Rupture After Statin Use

    Science.gov (United States)

    Nesselroade, Ryan D.; Nickels, Leslie Connor

    2010-01-01

    Simultaneous bilateral quadriceps tendon rupture is a rare injury. We report the case of bilateral quadriceps tendon rupture sustained with minimal force while refereeing a football game. The injury was suspected to be associated with statin use as the patient had no other identifiable risk factors. The diagnosis was confirmed using bedside ultrasound. PMID:21079697

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

    DEFF Research Database (Denmark)

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

    2006-01-01

    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......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...... 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....

  7. Lack of tissue renewal in human adult Achilles tendon is revealed by nuclear bomb (14)C.

    Science.gov (United States)

    Heinemeier, Katja Maria; Schjerling, Peter; Heinemeier, Jan; Magnusson, Stig Peter; Kjaer, Michael

    2013-05-01

    Tendons are often injured and heal poorly. Whether this is caused by a slow tissue turnover is unknown, since existing data provide diverging estimates of tendon protein half-life that range from 2 mo to 200 yr. With the purpose of determining life-long turnover of human tendon tissue, we used the (14)C bomb-pulse method. This method takes advantage of the dramatic increase in atmospheric levels of (14)C, produced by nuclear bomb tests in 1955-1963, which is reflected in all living organisms. Levels of (14)C were measured in 28 forensic samples of Achilles tendon core and 4 skeletal muscle samples (donor birth years 1945-1983) with accelerator mass spectrometry (AMS) and compared to known atmospheric levels to estimate tissue turnover. We found that Achilles tendon tissue retained levels of (14)C corresponding to atmospheric levels several decades before tissue sampling, demonstrating a very limited tissue turnover. The tendon concentrations of (14)C approximately reflected the atmospheric levels present during the first 17 yr of life, indicating that the tendon core is formed during height growth and is essentially not renewed thereafter. In contrast, (14)C levels in muscle indicated continuous turnover. Our observation provides a fundamental premise for understanding tendon function and pathology, and likely explains the poor regenerative capacity of tendon tissue.

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

    DEFF Research Database (Denmark)

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

    2012-01-01

    a previously proposed rat model for Achilles tendon overuse. Ten adult male Sprague-Dawley rats ran on a treadmill with 10° incline, 1 h/day, 5 days/wk (17-20 m/min) for 12 wk and were compared with 12 control rats. Histological, mechanical, and gene-expression changes were measured on the Achilles tendons...... after the intervention, and local tendon glucose-uptake was measured before and after the intervention with positron emission tomography. No differences were detected between runners and controls in tissue histology or in glucose uptake, indicating that tendon pathology was not induced. Greater tendon...

  9. Lack of tissue renewal in human adult Achilles tendon is revealed by nuclear bomb (14)C

    DEFF Research Database (Denmark)

    Heinemeier, Katja Maria; Schjerling, Peter; Heinemeier, Jan;

    2013-01-01

    the 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....

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

    Science.gov (United States)

    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

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

    Directory of Open Access Journals (Sweden)

    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

    Directory of Open Access Journals (Sweden)

    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. Bilateral patellar tendon rupture associated with statin use

    OpenAIRE

    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 ten...

  14. A rare knee extensor mechanism injury: Vastus intermedius tendon rupture

    Directory of Open Access Journals (Sweden)

    Engin Cetinkaya

    2015-01-01

    Conclusion: We report the first case of isolated rupture of the vastus intermedius tendon in the literature and we claim that disorder may be succesfully treated with conservative treatment and adequate physiotheraphy.

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

    International Nuclear Information System (INIS)

    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)

  16. Ultrasound Diagnosis of Bilateral Quadriceps Tendon Rupture After Statin Use

    Directory of Open Access Journals (Sweden)

    Nesselroade, Ryan D

    2010-09-01

    Full Text Available Simultaneous bilateral quadriceps tendon rupture is a rare injury. We report the case of bilateral quadriceps tendon rupture sustained with minimal force while refereeing a football game. The injury was suspected to be associated with statin use as the patient had no other identifiable risk factors.The diagnosis was confirmed using bedside ultrasound. [West J Emerg Med. 2010; 11(4:306-309.

  17. Strenuous Treadmill Running Induces a Chondrocyte Phenotype in Rat Achilles Tendons

    Science.gov (United States)

    Xu, Shao-Yong; Li, Shu-Fen; Ni, Guo-Xin

    2016-01-01

    Background Although tendinopathy is common, its underlying pathogenesis is poorly understood. This study aimed to investigate the possible pathogenesis of tendinopathy. Material/Methods In this study, a total of 24 rats were randomly and evenly divided into a control (CON) group and a strenuous treadmill running (STR) group. Animals in the STR group were subjected to a 12-week treadmill running protocol. Subsequently, all Achilles tendons were harvested to perform histological observation or biochemical analyses. Results Histologically, hypercellularity and round cells, as well as disorganized collagen fibrils, were presented in rat Achilles tendon sections from the STR group. Furthermore, our results showed that the expression of aggrecan, collagen type II (Col II), and Sex-Determining Region Y Box 9 (Sox 9) were markedly increased in the STR group compared with that in the CON group. Additionally, the mRNA expression of bone morphogenetic protein-2 (BMP-2) and biglycan was significantly up-regulated in the STR group in contrast to that in CON group. Conclusions These results suggest that a 12-week strenuous treadmill running regimen can induce chondrocyte phenotype in rat Achilles tendons through chondrogenic differentiation of tendon stem cells (TSCs) by BMP-2 signaling. PMID:27742920

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

    DEFF Research Database (Denmark)

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

    2014-01-01

    and 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......High-load eccentric exercises have been a key component in the conservative management of chronic Achilles tendinopathy. This study investigated the effects of a 12-wk progressive, home-based eccentric rehabilitation program on ankle plantar flexors' glucose uptake (GU) and myoelectric activity...

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

    DEFF Research Database (Denmark)

    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...... voluntary contraction using surface electromyography and glucose uptake using positron emission tomography. Additionally, Achilles tendon glucose uptake was quantified. FINDINGS: Normalized myoelectric activity of soleus was higher (P... despite lower absolute force level maintained (PElectromyography amplitude of flexor hallucis longus was also greater on the symptomatic side compared to the healthy leg (P

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  1. [Neglected ipsilateral simultaneous ruptures of patellar and quadriceps tendon].

    Science.gov (United States)

    Karahasanoğlu, İlker; Yoloğlu, Osman; Kerimoğlu, Servet; Turhan, Ahmet Uğur

    2015-01-01

    Neglected patellar and quadriceps tendon rupture is a rare injury, but ipsilateral simultaneous patellar and quadriceps tendon rupture was not described in the literature to our knowledge. In this article, we report a 40-year-old healthy male patient with neglected ipsilateral patellar and quadriceps tendon ruptures treated by peroneus longus tendon autograft. Patient had received some conservative and surgical treatments for patellar fracture before applying to our clinic. After our treatment using peroneus longus autograft and interference nails, patient was immobilized for six weeks in cylindrical cast. Flexion exercises and full weight bearing were started after cast removal. Patient had no complaint at postoperative second year. Patient was a neglected case. Surgical repair and early rehabilitation enabled us to achieve a satisfactory outcome.

  2. Rupture of adductor longus tendon due to ciprofloxacin.

    Science.gov (United States)

    Mouzopoulos, George; Stamatakos, Mihalis; Vasiliadis, George; Skandalakis, Panagiotis

    2005-12-01

    We present a rare case of spontaneous rupture of the adductor longus tendon induced by ciprofloxacin. A 35-year-old man was diagnosed with pneumonia and was recommended ciprofloxacin 500 mg iv twice a day for 7 days. Three days after receiving the initial dose, he developed discomfort in his left medial thigh, and pain and swelling in the same area followed ten days later. He consulted us when he noted a palpable mass on the medial side of his left thigh, and MRI study revealed adductor longus tendon rupture. There was no obvious underlying disease or other factor causing fragility of his adductor longus tendon. We review the pathophysiological mechanisms leading to fluoroquinolone-related tendon rupture as well as the risk factors and discuss proper management.

  3. Rabbit Achilles tendon full transection model - wound healing, adhesion formation and biomechanics at 3, 6 and 12 weeks post-surgery.

    Science.gov (United States)

    Meier Bürgisser, Gabriella; Calcagni, Maurizio; Bachmann, Elias; Fessel, Gion; Snedeker, Jess G; Giovanoli, Pietro; Buschmann, Johanna

    2016-01-01

    After tendon rupture repair, two main problems may occur: re-rupture and adhesion formation. Suitable non-murine animal models are needed to study the healing tendon in terms of biomechanical properties and extent of adhesion formation. In this study 24 New Zealand White rabbits received a full transection of the Achilles tendon 2 cm above the calcaneus, sutured with a 4-strand Becker suture. Post-surgical analysis was performed at 3, 6 and 12 weeks. In the 6-week group, animals received a cast either in a 180 deg stretched position during 6 weeks (adhesion provoking immobilization), or were re-casted with a 150 deg position after 3 weeks (adhesion inhibiting immobilization), while in the other groups (3 and 12 weeks) a 180 deg position cast was applied for 3 weeks. Adhesion extent was analyzed by histology and ultrasound. Histopathological scoring was performed according to a method by Stoll et al. (2011), and the main biomechanical properties were assessed. Histopathological scores increased as a function of time, but did not reach values of healthy tendons after 12 weeks (only around 15 out of 20 points). Adhesion provoking immobilization led to an adhesion extent of 82.7±9.7%, while adhesion inhibiting immobilization led to 31.9±9.8% after 6 weeks. Biomechanical properties increased over time, however, they did not reach full strength nor elastic modulus at 12 weeks post-operation. Furthermore, the rabbit Achilles tendon model can be modulated in terms of adhesion formation to the surrounding tissue. It clearly shows the different healing stages in terms of histopathology and offers a suitable model regarding biomechanics because it exhibits similar biomechanics as the human flexor tendons of the hand. PMID:27635037

  4. Rabbit Achilles tendon full transection model – wound healing, adhesion formation and biomechanics at 3, 6 and 12 weeks post-surgery

    Science.gov (United States)

    Meier Bürgisser, Gabriella; Calcagni, Maurizio; Bachmann, Elias; Fessel, Gion; Snedeker, Jess G.; Giovanoli, Pietro

    2016-01-01

    ABSTRACT After tendon rupture repair, two main problems may occur: re-rupture and adhesion formation. Suitable non-murine animal models are needed to study the healing tendon in terms of biomechanical properties and extent of adhesion formation. In this study 24 New Zealand White rabbits received a full transection of the Achilles tendon 2 cm above the calcaneus, sutured with a 4-strand Becker suture. Post-surgical analysis was performed at 3, 6 and 12 weeks. In the 6-week group, animals received a cast either in a 180 deg stretched position during 6 weeks (adhesion provoking immobilization), or were re-casted with a 150 deg position after 3 weeks (adhesion inhibiting immobilization), while in the other groups (3 and 12 weeks) a 180 deg position cast was applied for 3 weeks. Adhesion extent was analyzed by histology and ultrasound. Histopathological scoring was performed according to a method by Stoll et al. (2011), and the main biomechanical properties were assessed. Histopathological scores increased as a function of time, but did not reach values of healthy tendons after 12 weeks (only around 15 out of 20 points). Adhesion provoking immobilization led to an adhesion extent of 82.7±9.7%, while adhesion inhibiting immobilization led to 31.9±9.8% after 6 weeks. Biomechanical properties increased over time, however, they did not reach full strength nor elastic modulus at 12 weeks post-operation. Furthermore, the rabbit Achilles tendon model can be modulated in terms of adhesion formation to the surrounding tissue. It clearly shows the different healing stages in terms of histopathology and offers a suitable model regarding biomechanics because it exhibits similar biomechanics as the human flexor tendons of the hand. PMID:27635037

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

    Science.gov (United States)

    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

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

    Science.gov (United States)

    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

  7. Reconstruction of neglected patellar tendon ruptures using the quadriceps graft.

    Science.gov (United States)

    Gomes, João Luiz Ellera; de Oliveira Alves, Jairo André; Zimmermann, José Mauro

    2014-08-01

    Several techniques using different grafts have been described for reconstruction of the patellar tendon after a neglected rupture. Retraction of the quadriceps tendon may compromise repair integrity due to progressive stretching of the graft. The authors present a surgical technique using the central one-third of the quadriceps tendon. This is supported by the fact that the resistance to traction of this segment of the quadriceps tendon equals that of a double-looped semitendinosus graft and that the harvesting of this specific graft promotes muscle inhibition, thus protecting the reconstruction during the recovery period.

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

    OpenAIRE

    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...

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

    DEFF Research Database (Denmark)

    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...

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

    Science.gov (United States)

    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

  11. A Rare Case of Bilateral Patellar Tendon Ruptures: A Case Report and Literature Review

    Science.gov (United States)

    Tarazi, Nadim; O'loughlin, Padhraig; Amin, Amin; Keogh, Peter

    2016-01-01

    Bilateral patellar tendon ruptures are rare. The majority of case reports describing bilateral patellar tendon ruptures have occurred in patients with predisposing factors to tendinopathy. We describe a case of bilateral patellar tendon rupture sustained following minimal trauma by a patient with no systemic disease or history of steroid use. Due to the rarity of this injury, clinical suspicion is low. It is reported that 38% of patellar tendon ruptures are misdiagnosed initially. Therefore careful history taking and physical examination is integral in ensuring a diagnosis is achieved for early primary repair. We discuss the aetiology of spontaneous tendon rupture and report a literature review of bilateral patellar tendon ruptures. PMID:27200200

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

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

    Science.gov (United States)

    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

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

    Institute of Scientific and Technical Information of China (English)

    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

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

    Directory of Open Access Journals (Sweden)

    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

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

    DEFF Research Database (Denmark)

    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...... rats received Botox into the calf muscle to reduce loading, and the Achilles tendon was transected. Ten rats were randomized to needling days 2-5. Mechanical testing on day 8 showed increased strength by 45% in the needling group. Next, another 24 rats were similarly unloaded, and 16 randomized....... Sixteen of the 19 genes were regulated after 3 h, in the same way as after loading. In conclusion, needling increased strength, and there was a striking similarity between the gene expression response to needling and mechanical loading. This suggests that the response to loading in early tendon healing...

  17. Subcutaneous rupture of the flexor hallucis longus tendon: a case report.

    Science.gov (United States)

    Noda, Daisuke; Yoshimura, Ichiro; Kanazawa, Kazuki; Hagio, Tomonobu; Naito, Masatoshi

    2012-01-01

    It is well known that rupture of the flexor hallucis longus tendon can be associated with open injuries and that closed rupture of the flexor hallucis longus tendon is rare. Tendon injuries of the foot can occur secondary to direct, indirect, or repetitive injury. Repetitive tendon injuries can cause tendinitis or stenosing tenosynovitis. Tendinitis is associated with internal tendon injury that can present with tendon thickening, mucinoid degeneration, nodule development, or in situ partial tears. Stenosing tenosynovitis is the development of tendon adhesions within the tendon sheath that interfere with tendon gliding, known as trigger toe. The flexor hallucis longus tendon is susceptible to injury along its entire course. A total of 35 cases of complete or partial closed ruptures of the flexor hallucis longus tendon have been reported. We present the case of complete subcutaneous rupture of the flexor hallucis longus tendon associated with trauma at the proximal phalangeal head. PMID:22153296

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

    Institute of Scientific and Technical Information of China (English)

    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.

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

    Science.gov (United States)

    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

  20. Traumatic rupture of the tibialis anterior tendon: A case report

    Directory of Open Access Journals (Sweden)

    Maria Elisa Rodrigues

    2013-06-01

    Full Text Available OBJECTIVE: The autors report a case of a traumatic rupture of the tibialis anterior tendon (TTA that was early diagnosed and treated in the emergency service. This is a rare clinical entity with few cases reported in the literature. CASE REPORT: A 66-year old female presented at the emergency service complaining about pain at the anterior aspect of her ankle and inability to walk normally, after a fall. Physical examination revealed clinical signs for TTA rupture, which was later confirmed by ultrasound. Surgical treatment was performed immediately â€" the tendon was anchored into the medial cuneiform with a soft tissue-to-bone anchor. The follow-up revealed good functional result. CONCLUSION: Physical examination and a high index of suspicion are important when facing a patient who had sustained an ankle trauma. The TTA rupture is a diagnosis to consider because unrecognized ruptures led to important functional deficits and poor functional results.

  1. The use of suture anchors to repair the ruptured quadriceps tendon.

    Science.gov (United States)

    Bushnell, Brandon D; Whitener, George B; Rubright, James H; Creighton, R Alexander; Logel, Kevin J; Wood, Mark L

    2007-07-01

    Quadriceps tendon rupture is an incapacitating injury that usually requires surgical repair. Traditional repair methods involve transpatellar suture tunnels, but recent reports have introduced the idea of using suture anchors to repair the ruptured tendon. We present 5 cases of our technique of using suture anchors to repair the ruptured quadriceps tendon.

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

    Science.gov (United States)

    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

  3. 微创跟腱延长术联合系统康复治疗跟腱挛缩畸形%Treatment of contracture of achilles tendon with minimally invasive achilles tendon lengthening and system rehabilitation

    Institute of Scientific and Technical Information of China (English)

    彭程; 孙大川; 黄淮; 胡春林

    2012-01-01

    Objective:To investigate the safety and efficacy of minimally invasive achilles tendon lengthening and system rehabilitation for the treatment of contracture of achilles tendon. Methods: From January 2002 to December 2010,27 patients (31 feet) with contracture of achilles tendon were treated with minimally invasive achilles tendon lengthening and system rehabilitation. There were 11 males and 16 females with an average age of 35.5 years (ranged 3 to 65 years). Right foot was in 13 cases, left foot was in 10 cases, both feet were in 4 cases. Course of disease was from 1 to 5 years with an average of 2.3 years. The cause of contracture included postoperative complication of tibia fractures treated with intramedullary nailing in 7 feet, sequelae of lower leg compartment syndrome in 11 feet,congenital talipes equinovarus in 13 feet (both feet in 4). Before operation , all the patients walked with limping, plantar flexion anomaly was from 15° to 50°with an average of 35.5°. The strength of quadriceps muscle of thigh was grade V in 27 feet, grade IV in 4 feet, the strength of musculus triceps surae was grade V in 24 feet,grade Ivin 7 feet. Results:All the patients were followed-up for 6-24 months with an average of 11.3 months. According to standard of Arner-Lindholm to evaluate function of ankle joint, 29 feet obtained excellent results and 2 feet good. No infection, re-rupture or re-contracture was found. Conclusion:Minimally invasive achilles tendon lengthening and system rehabilitation in treating contracture of achilles tendon has advantage such as simple operation,less complication,lower recurrence rate,which is favourable for thoroughly rehabilitation of patients. But,the case in which the strength of quadriceps muscle of thigh or musculus triceps surae still less than grade IE after preoperative rehabilitation care should not choose the method.%目的:分析微创跟腱延长术联合系统康复治疗跟腱挛缩患者的疗效和可行性.方法:2002年1

  4. Phaeohyphomycosis infection leading to flexor tendon rupture: a case report.

    Science.gov (United States)

    Chahal, Jaskarndip; Dhotar, Herman S; Anastakis, Dimitri J

    2009-09-01

    A rare previously unreported cause of flexor tendon rupture is described. A 66-year-old man presented with a fully extended left middle finger, accompanied by swelling and purulent drainage. Prior to presentation, he had received a steroid injection for left middle finger stenosing tenosynovitis and subsequently developed culture-proven phaeohyphomycosis fungal infection and secondary enterococcal bacterial infection, requiring pharmacotherapy and incision, drainage, and debridement for abscess formation. Clinical and magnetic resonance imaging findings were consistent with the diagnosis of closed flexor tendon rupture of the left middle finger. Antifungal and antibiotic therapy followed by two-stage flexor tendon reconstruction was performed. Six months postoperatively, full passive range of motion was achieved and the proximal interphalangeal and distal interphalangeal joints of the left middle finger actively flexed to 125 degrees and 90 degrees, respectively. PMID:19259746

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

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

    Science.gov (United States)

    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

  7. Imaging and simulation of Achilles tendon dynamics: Implications for walking performance in the elderly.

    Science.gov (United States)

    Franz, Jason R; Thelen, Darryl G

    2016-06-14

    The Achilles tendon (AT) is a complex structure, consisting of distinct fascicle bundles arising from each triceps surae muscle that may act as mechanically independent structures. Advances in tissue imaging are rapidly accelerating our understanding of the complexities of functional Achilles tendon behavior, with potentially important implications for musculoskeletal injury and performance. In this overview of our recent contributions to these efforts, we present the results of complementary experimental and computational approaches to investigate AT behavior during walking and its potential relevance to reduced triceps surae mechanical performance due to aging. Our experimental evidence reveals that older tendons exhibit smaller differences in tissue deformations than young adults between regions of the AT presumed to arise from the gastrocnemius and soleus muscles. These observations are consistent with a reduced capacity for inter-fascicle sliding within the AT, which could have implications for the mechanical independence of the triceps surae muscles. More uniform AT deformations are also correlated with hallmark biomechanical features of elderly gait - namely, a loss of net ankle moment, power, and positive work during push-off. Simulating age-related reductions in the capacity for inter-fascicle sliding in the AT during walking predicts detriments in gastrocnemius muscle-tendon mechanical performance coupled with underlying shifts in fascicle kinematics during push-off. AT compliance, also suspected to vary due to age, systematically modulates those effects. By integrating in vivo imaging with computational modeling, we have gained theoretical insight into multi-scale biomechanical changes due to aging, hypotheses regarding their functional effects, and opportunities for experiments that validate or invalidate these assertions. PMID:27209552

  8. Cyclic mechanical stimulation rescues achilles tendon from degeneration in a bioreactor system.

    Science.gov (United States)

    Wang, Tao; Lin, Zhen; Ni, Ming; Thien, Christine; Day, Robert E; Gardiner, Bruce; Rubenson, Jonas; Kirk, Thomas B; Smith, David W; Wang, Allan; Lloyd, David G; Wang, Yan; Zheng, Qiujian; Zheng, Ming H

    2015-12-01

    Physiotherapy is one of the effective treatments for tendinopathy, whereby symptoms are relieved by changing the biomechanical environment of the pathological tendon. However, the underlying mechanism remains unclear. In this study, we first established a model of progressive tendinopathy-like degeneration in the rabbit Achilles. Following ex vivo loading deprivation culture in a bioreactor system for 6 and 12 days, tendons exhibited progressive degenerative changes, abnormal collagen type III production, increased cell apoptosis, and weakened mechanical properties. When intervention was applied at day 7 for another 6 days by using cyclic tensile mechanical stimulation (6% strain, 0.25 Hz, 8 h/day) in a bioreactor, the pathological changes and mechanical properties were almost restored to levels seen in healthy tendon. Our results indicated that a proper biomechanical environment was able to rescue early-stage pathological changes by increased collagen type I production, decreased collagen degradation and cell apoptosis. The ex vivo model developed in this study allows systematic study on the effect of mechanical stimulation on tendon biology.

  9. Anterior cruciate ligament reconstruction with Achilles tendon allografts in revisions and in patients older than 30.

    Science.gov (United States)

    Grafe, Michael W; Kurzweil, Peter R

    2008-06-01

    We evaluated the results of anterior cruciate ligament (ACL) reconstruction using an Achilles tendon allograft in revisions and in patients older than 30. Results from 23 consecutive patients (mean age, 43 years) who underwent ACL reconstruction with fresh-frozen, irradiated (22/23) Achilles allografts were retrospectively reviewed. Seven cases were revisions. Patients were evaluated with physical examination, questionnaires, and x-rays. Twenty of the 23 patients were evaluated a mean of 28 months after surgery. There were 5 failures (21%); 3 acute failures were not evaluated at follow-up. One patient had an infection that required graft removal, 2 patients had mechanical failure of the grafts, and 2 had displacements of more than 5.5 mm as measured with a KT-1000 arthrometer. The 18 clinically successful cases had full motion, no thigh atrophy, and no effusion. Pivot shift scores were 55% A and 45% B on the International Knee Documentation Committee (IKDC) scale. Lachman scores were 40% A, 55% B, and 5% C on the IKDC scale. The KT-1000 difference was a mean of 2.9 mm at final follow-up. However, knees loosened a mean of 4.5 mm from the immediate postoperative measurements (Preconstructions with Achilles tendon allografts failed. Grafts deemed successful still had significant loosening at final follow-up. Allografts from donors older than 40 may have played a role in these failures. From the data in this study, it appears that surgeons should scrutinize the source of the allograft tissue and the age of the donor.

  10. Anterior cruciate ligament reconstruction with Achilles tendon allografts in revisions and in patients older than 30.

    Science.gov (United States)

    Grafe, Michael W; Kurzweil, Peter R

    2008-06-01

    We evaluated the results of anterior cruciate ligament (ACL) reconstruction using an Achilles tendon allograft in revisions and in patients older than 30. Results from 23 consecutive patients (mean age, 43 years) who underwent ACL reconstruction with fresh-frozen, irradiated (22/23) Achilles allografts were retrospectively reviewed. Seven cases were revisions. Patients were evaluated with physical examination, questionnaires, and x-rays. Twenty of the 23 patients were evaluated a mean of 28 months after surgery. There were 5 failures (21%); 3 acute failures were not evaluated at follow-up. One patient had an infection that required graft removal, 2 patients had mechanical failure of the grafts, and 2 had displacements of more than 5.5 mm as measured with a KT-1000 arthrometer. The 18 clinically successful cases had full motion, no thigh atrophy, and no effusion. Pivot shift scores were 55% A and 45% B on the International Knee Documentation Committee (IKDC) scale. Lachman scores were 40% A, 55% B, and 5% C on the IKDC scale. The KT-1000 difference was a mean of 2.9 mm at final follow-up. However, knees loosened a mean of 4.5 mm from the immediate postoperative measurements (Preconstructions with Achilles tendon allografts failed. Grafts deemed successful still had significant loosening at final follow-up. Allografts from donors older than 40 may have played a role in these failures. From the data in this study, it appears that surgeons should scrutinize the source of the allograft tissue and the age of the donor. PMID:18716694

  11. [Proximal and distal ruptures of the biceps brachii tendon].

    Science.gov (United States)

    Klonz, A; Loitz, D; Reilmann, H

    2003-09-01

    Proximal ruptures. Ruptures of the long head of the M. biceps humeri are commonly caused by degenerative changes within the tendon. Non-operative treatment gives good results, the loss of power regarding elbow flexion and supination amounts to only 8-21%. Refixation may be indicated for cosmetic reasons and offers a small but evident improvement of flexion and supination power. Deformity of the slipped muscle can be corrected effectively. Residual complaints after conservative treatment often result from associated subacromial problems. Distal ruptures. Ruptures of the distal tendon should be treated operatively. The loss of power after conservative treatment is evident (30-40% for flexion, >50% for supination). Extra-anatomical tenodesis to the brachialis muscle or anatomical fixation to the radial tuberosity can be applied. Flexion power and cosmesis can be addressed by both techniques. If supination strength is to be restored, the tendon has to be fixed anatomically. Preparation of the tuberosity bears the risk of heterotopic ossification or nerve damage. Mini-open techniques, using only a limited anterior approach, may decrease risks. PMID:14959750

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

    Science.gov (United States)

    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

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

    Science.gov (United States)

    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.

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

    Institute of Scientific and Technical Information of China (English)

    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. Spontaneous Rupture of the Patellar Tendon and the Contralateral Quadriceps Tendon, Associated with Lupus Erythematosus: Analysis of the Literature

    Directory of Open Access Journals (Sweden)

    Efthimios J. Karadimas

    2011-01-01

    Full Text Available Bilateral rupture of the patellar tendon is a rare injury. A case of a 67-year-old man with systemic lupus erythematosus under corticosteroid treatment for the last 10 years, who sustained spontaneous rupture of the patellar tendon and the contralateral quadriceps tendon, is herein presented. The patient was operated bilaterally, had an optimal outcome considering his age and the comorbidities, and was followed up for 24 months.

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

    Science.gov (United States)

    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

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

    Directory of Open Access Journals (Sweden)

    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.

  18. Bilateral quadriceps tendon rupture: a rare finding in a healthy man after minimal trauma.

    Science.gov (United States)

    Chiu, Michael; Forman, Edward S

    2010-03-01

    Quadriceps tendon rupture is an uncommon injury; the incidence of simultaneous bilateral quadriceps tendon rupture is extremely rare. Two distinct categories-individuals older than 50 years and between 27 and 54 years-have been described. Bilateral quadriceps tendon rupture is more common in patients older than 50 years and is thought to be the result of tendon weakening due to obesity and arteriosclerosis-induced fibrotic changes, or previous injury.In younger individuals, bilateral simultaneous quadriceps rupture is less frequent and has been associated with anabolic steroid use, but more frequently with underlying comorbid medical conditions such as chronic renal failure, hyperparathyroidism, endocrine disorder, gout, diabetes and obesity, which predispose the patients to tendon rupture. Our case report is unique because we report the simultaneous bilateral quadriceps tendon rupture following minor trauma in an otherwise healthy 43-year-old man with no predisposing comorbidity.

  19. Spontaneous distal biceps tendon ruptures: are they related to statin administration?

    Science.gov (United States)

    Savvidou, Christiana; Moreno, Rodrigo

    2012-01-01

    The purpose of this study is to identify a possible correlation between statin administration and incidence of spontaneous distal biceps tendon ruptures. We retrospectively reviewed 104 patients with distal biceps tendon rupture that were treated surgically from 2004 to 2010, 102 males and two females with mean age 47 years (range, 22-78). Patients were divided based on the mechanism of injury and statin administration. After statistical analysis, it was found nearly two times more likely to have spontaneous distal biceps tendon rupture with use of statins. Patients in Group 1 (spontaneous tendon rupture) compared to Group 2 (provoked tendon rupture) were older, had weaker postoperative strength but similar postoperative ROM. Patients taking statins compared to those that were not taking statins were older, had same postoperative strength and similar postoperative ROM. Based on the results of our study we conclude that there is a trend of association of spontaneous distal biceps tendon ruptures with statin administration. PMID:22745079

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

    DEFF Research Database (Denmark)

    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, af...

  1. Simultaneous traumatic rupture of the patellar tendon and the contralateral quadriceps tendon in a healthy individual.

    Science.gov (United States)

    Kumar, S; Rachakatla, N; Kerin, C; Kumar, R

    2010-11-05

    A simultaneous traumatic complete rupture of the patellar tendon and the contralateral quadriceps tendon is reported to occur in patients with renal failure and other inflammatory diseases, but is extremely rare in a healthy individual because of the different contributory factors and mechanisms of injury. We present a rare case report of such a combination of injuries in a 48-year-old healthy man. To our knowledge only three such cases have been reported in the English literature. This is an unusual combination and hence there is potential for missed diagnosis leading to suboptimal treatment.

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

    DEFF Research Database (Denmark)

    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....

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

    Science.gov (United States)

    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

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

    Science.gov (United States)

    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

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

    Directory of Open Access Journals (Sweden)

    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.

  6. Hazards of steroid injection: Suppurative extensor tendon rupture

    Directory of Open Access Journals (Sweden)

    Woon Colin

    2010-01-01

    Full Text Available Local steroid injections are often administered in the office setting for treatment of trigger finger, carpal tunnel syndrome, de Quervain′s tenosynovitis, and basal joint arthritis. If attention is paid to sterile technique, infectious complications are rare. We present a case of suppurative extensor tenosynovitis arising after local steroid injection for vague symptoms of dorsal hand and wrist pain. The progression of signs and symptoms following injection suggests a natural history involving bacterial superinfection leading to tendon rupture. We discuss the pitfalls of local steroid injection and the appropriate management of infectious extensor tenosynovitis arising in such situations.

  7. Closed rupture of the flexor tendons caused by carpal bone and joint disorders.

    Science.gov (United States)

    Yamazaki, H; Kato, H; Hata, Y; Nakatsuchi, Y; Tsuchikane, A

    2007-12-01

    We analysed 21 patients with closed rupture of the flexor tendons caused by carpal bone and joint disorders. The tendon that ruptured depended on the location of the bone perforation into the carpal tunnel. Radiocarpal arthrography was performed in 13 patients and capsular perforation was demonstrated by contrast medium leakage into the carpal canal in 11 patients. This proved a useful diagnostic test. The flexor tendon(s) were reconstructed with free tendon graft in 17 patients, cross-over transfer of flexor tendons from adjacent digits in two and buddying to an adjacent flexor tendon in one patient. Postoperative total active range of motion in the fingers after 13 free tendon graft reconstructions averaged 213 degrees (range 170-265 degrees ). The active range of motion of the thumb-interphalangeal joint after free tendon graft reconstruction in three cases improved from 0 degrees to 33 degrees on average (range 10 degrees -40 degrees ).

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

    OpenAIRE

    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...

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

    Science.gov (United States)

    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

  10. Simultaneous rupture of the quadriceps tendon and contralateral patellar tendon in a patient with chronic renal failure.

    Science.gov (United States)

    Muratli, Hasan Hilmi; Celebi, Levent; Hapa, Onur; Biçimoğlu, Ali

    2005-01-01

    Simultaneous quadriceps and patellar tendon rupture is rare. Mechanical factors and coexisting systemic and local factors are taken into consideration in the pathogenesis of these ruptures. In patients with some chronic systemic diseases, simultaneous rupture can occur spontaneously or with minor traumas. We present a case of simultaneous quadriceps and patellar tendon rupture in a 21-year-old man with chronic renal failure in this report. He was treated surgically by osseotendinous repair with suture anchors and supplemental cerclage wire fixation on both sides. He regained his normal knee joint functions 18 months after the operation.

  11. NEGLECTED PATELLAR TENDON RUPTURE : RECONSTRUCTION USING IPSILATERAL SEMITENDINOSUS AND GRACILIS TENDON GRAFTS AND ETHIBOND AUGMENTATION

    Directory of Open Access Journals (Sweden)

    Buchupalli Bharath Reddy

    2015-02-01

    Full Text Available INTRODUCTION: Neglected rupture of the patellar tendon is a rare disabling injury that is technically difficult to manage. Many different surgical techniques have been described for reconstruction of the disrupted extensor mechanism of the knee. In this study we describe an improved technique for the reconstruction of patellar tendon using semitendinosus and gracilis tendon grafts preserving their t ibial insertion distally and Ethibond suture augmentation instead of stainless steel wire having the added advantage of no further operative intervention needed for removal. MATERIALS AND METHODS: The study included 9 patients (7 male & 2 female with mean age of 40.2 years (+/ - 2 SD presented with pain, instability, difficulty in carrying out Activities of Daily Living (ADL associated with neglected patellar tendon injury. The time since injury ranged from 3months to 2years. All the patients had loss of a ctive extension, extensor lag between 30 0 to 50 0 with an average of 41.1 0 (+/ - 2 SD and severe functional limitation of ADL. All the patients underwent patellar tendon reconstruction using semitendinosus and gracilis tendon grafts. The functional outcome was assessed using Lysholm Knee Score, Visual Analogue Score (VAS and IKDC scoring system. RESULTS: Post - operatively with an average follow - up of 19 months (+/ - 2 SD all the patients had decreased amount of pain, stable knee with active extension of knee without any extension lag with flexion up to 110 0 (90 0 - 125 0 . Out of 9 patients 7 had good and two had fair functional outcome with improvement in ADL with the IKDC score of 83.5 (+/ - SD, Lysholm Knee Score 90.8 (+/ - SD and no/little pain on Visual Anal ogue Scale. CONCLUSION: The results of our study shows that the use of ipsilateral semitendinosus and gracilis tendon grafts preserving their insertions on tibia distally for reconstruction of neglected patellar tendon ruptures along with Ethibond suture a ugmentation provides good

  12. Bilateral simultaneous quadriceps tendon rupture in a patient with secondary hyperparathyroidism: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Yeon Soo; Son, Sang Beom; Han, Chang Whan; Kang, Si Won [Taejon St. Mary' s Hospital, The Catholic Univ. of Korea, Taejon (Korea, Republic of)

    2001-11-01

    Simultaneous bilateral rupture of the quadriceps tendon without a significant history of trauma may occur in association with chronic metabolic disorders such as chronic renal failure and secondary hyperparathyroidism, though has rarely been reported. We describe a case of spontaneous bilateral quadriceps tendon rupture in a 36-year-old female patient with secondary hyperparathyroidism.

  13. Use of a turndown quadriceps tendon flap for rupture of the patellar tendon after total knee arthroplasty.

    Science.gov (United States)

    Lin, Po-Chun; Wang, Jun-Wen

    2007-09-01

    Patellar tendon rupture is a devastating complication after total knee arthroplasty. The results of surgical treatment of this complication were discouraging in most of the reports. We describe a case of rupture of patellar tendon 7 weeks after total knee arthroplasty treated with a turndown quadriceps flap and circumferential wiring. Two years and 6 months after operation, the patient had no extension lag of the knee and knee flexion to 110 degrees .

  14. Extensor tendon rupture and three-dimensional computed tomography imaging of the rheumatoid wrist

    Energy Technology Data Exchange (ETDEWEB)

    Abe, Asami; Ishikawa, Hajime; Murasawa, Akira; Nakazono, Kiyoshi [Niigata Rheumatic Center, Department of Rheumatology, Shibata, Niigata (Japan)

    2010-04-15

    Extensor tendon rupture on the dorsum of the wrist is commonly seen in patients with rheumatoid arthritis (RA). The diagnosis of tendon rupture is usually straightforward, but it is sometimes difficult in the hand with complex deformity. The purposes of this study were to investigate the reliability of three-dimensional computed tomography (3DCT) imaging of extensor tendons in the rheumatoid wrist and in the normal wrist and to clarify the validity of its clinical application to the diagnosis of tendon rupture in the rheumatoid wrist. Preoperative 3DCT images of 48 wrists of 45 patients with RA and 3DCT images of 38 wrists of 38 healthy volunteers were reviewed retrospectively by six orthopaedic surgeons who were unaware of all other study data. Extensor tendon rupture was verified by operation on 20 rheumatoid wrists. Regarding interobserver and intra-observer reliabilities of 3DCT imaging of the extensor tendons, agreement with respect to tendon rupture in this study group was high, and Cohen's kappa ({kappa}) coefficient was variable, depending on the individual tendon. Positive predictive value (PPV) of tendon rupture in the extensor digiti minimi (EDM), extensor digitorum communis (EDC) V and IV and extensor pollicis longs (EPL) tendons was more than 60%, but those for the other extensor tendons were less than 50%. Negative predictive value (NPV) was more than 96% in all extensor tendons, in both rheumatoid and normal wrists. Extensor tendons in normal and rheumatoid wrists were well depicted by 3DCT imaging. In the rheumatoid wrists, extensors of the ring and little fingers and the thumb were depicted more accurately than those to the other fingers. 3DCT imaging was clinically applicable to wrists for which it was difficult to diagnose by physical examination a definite cause for the loss of extension of the fingers. (orig.)

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

    Science.gov (United States)

    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.

  16. Low-level laser therapy in IL-1β, COX-2, and PGE2 modulation in partially injured Achilles tendon.

    Science.gov (United States)

    de Jesus, Julio Fernandes; Spadacci-Morena, Diva Denelle; dos Anjos Rabelo, Nayra Deise; Pinfildi, Carlos Eduardo; Fukuda, Thiago Yukio; Plapler, Helio

    2015-01-01

    This study evaluated IL-1β, COX-2, and PGE2 modulation in partially injured Achilles tendons treated with low-level laser therapy (LLLT). Sixty-five male Wistar rats were used. Sixty were submitted to a direct injury on Achilles tendon and then distributed into six groups: LASER 1 (a single LLLT application), LASER 3 (three LLLT applications), and LASER 7 (seven LLLT applications) and Sham 1, 3, and 7 (the same injury but LLLT applications were simulated). The five remaining animals were allocated at control group (no procedure performed). LLLT (780 nm) was applied with 70 mW of mean power and 17.5 J/cm(2) of fluency for 10 s, once a day. The tendons were surgically removed and assessed immunohistochemically for IL-1β, COX-2, and PGE2. In comparisons with control (IL-1β: 100.5 ± 92.5 / COX-2: 180.1 ± 97.1 / PGE2: 187.8 ± 128.8) IL-1β exhibited (mean ± SD) near-normal level (p > 0.05) at LASER 3 (142.0 ± 162.4). COX-2 and PGE2 exhibited near-normal levels (p > 0.05) at LASER 3 (COX-2: 176.9 ± 75.4 / PGE2: 297.2 ± 259.6) and LASER 7 (COX-2: 259.2 ± 190.4 / PGE2: 587.1 ± 409.7). LLLT decreased Achilles tendon's inflammatory process.

  17. Proximal coracobrachialis tendon rupture, subscapularis tendon rupture, and medial dislocation of the long head of the biceps tendon in an adult after traumatic anterior shoulder dislocation

    Directory of Open Access Journals (Sweden)

    Bryan M Saltzman

    2015-01-01

    Full Text Available Rupture of the coracobrachialis is a rare entity, in isolation or in combination with other muscular or tendinous structures. When described, it is often a result of direct trauma to the anatomic area resulting in rupture of the muscle belly. The authors present a case of a 57-year-old female who suffered a proximal coracobrachialis tendon rupture from its origin at the coracoid process, with concomitant subscapularis tear and medial dislocation of the long head of biceps tendon after first time traumatic anterior shoulder dislocation. Two weeks after injury, magnetic resonance imaging suggested the diagnosis, which was confirmed during combined arthroscopic and open technique. Soft-tissue tenodesis of coracobrachialis to the intact short head of the biceps, tenodesis of the long head of biceps to the intertubercular groove, and double-row anatomic repair of the subscapularis were performed. The patient did well postoperatively, and ultimately at 6 months follow-up, she was without pain, and obtained 160΀ of active forward elevation, 45΀ of external rotation, internal rotation to T8, 5/5 subscapularis and biceps strength. Scoring scales had improved from the following preoperative to final follow-up: American Shoulder and Elbow Surgeons, 53.33-98.33; constant, 10-100; visual analogue scale-pain, 4-0. DASH score was 5.

  18. Surgical Treatment of Neglected Traumatic Quadriceps Tendon Rupture with Knee Ankylosis.

    Science.gov (United States)

    Lee, Seung-Hun; Song, Eun-Kyoo; Seon, Jong-Keun; Woo, Seong-Hwan

    2016-06-01

    Quadriceps tendon rupture is an uncommon injury. This disabling condition is the result of direct or indirect trauma. It requires surgical repair to avoid poor outcomes in cases of neglected or chronic rupture. In most acute cases, simple tendon suture or reinsertion is suitable for an extensor mechanism reconstruction of the knee joint. However, chronic lesions often require a tendon graft or flap reconstruction. We report a case of a 15-year-old male who was diagnosed with a chronic quadriceps rupture with a patellar superior pole fracture. We performed quadriceps reconstruction using tibialis anterior allograft tendon and additional screw fixation to reconstruct the extensor mechanism and recover knee joint range of motion to prevent a high-level functional restriction. The treatment was difficult and limited due to neglect for 9-months that led to ankylosis accompanied with nonunion of tibial fracture. Our surgical treatment using allograft tendon resulted in a very good outcome after 30 months of follow-up.

  19. Histomorphometric analysis of the Achilles tendon of Wistar rats treated with laser therapy and eccentric exercise

    Directory of Open Access Journals (Sweden)

    Maria V. de Souza

    2015-12-01

    Full Text Available Abstract: Low-level laser therapy is recommended for the treatment of tendinopathies despite the contradictory results related to the ideal dose of energy, wavelength and time of application. This study aimed to assess the effects of laser therapy and eccentric exercise on tendinopathy of the Achilles tendon of Wistar rats. Forty-eight adult male rats were randomly distributed into four groups (L= laser; E= eccentric exercise; LE = laser and eccentric exercise; and R= rest. Laser therapy (904nm/3J/cm2 and/or eccentric exercise (downhill walking; 15o incline treadmill; 12m/min; 50min/day was started 24h after induction of unilateral tendinopathy and remained for 20 days. At 3, 7, 14 and 21 days after lesion induction, three rats from each group were euthanized and the tendons were collected for histological and morphometric analyses. There was no difference among groups or among times for the characteristics hemorrhage (p=0.4154, fibrinous adhesion formation (p=0.0712, and organization of collagen fibers (p=0.2583 and of the connective tissue (p=0.1046. For these groups, regardless of the time, eccentric exercise led to epitenon thickening (p=0.0204, which was lower in the group treated with laser therapy. Histological analysis revealed differences (p=0.0032 in the number of inflammatory cells over time. They were more numerous in the group that only exercised. This result was confirmed by morphometric analysis, which showed a significant interaction (groups x time for this characteristic. Eccentric exercise increased (p=0.0014 the inflammatory infiltrate over time (3 and 21 days. However, association with laser therapy reduced inflammatory reaction. On the other hand, the combination of the treatments increased angiogenesis in morphometric (p=0.0000 and histological (p=0.0006 analyses compared with the other groups, while the isolated application of low-level laser reduced this characteristic over time. Animals maintained at rest presented the

  20. Tendon Derived Stem Cells Promote Platelet-Rich Plasma Healing in Collagenase-Induced Rat Achilles Tendinopathy

    Directory of Open Access Journals (Sweden)

    Lei Chen

    2014-12-01

    Full Text Available Background/Aims: Tendon injuries are common, difficult to cure and usually healed with fibrosis and scar tissue. The aim of this study was to evaluate tendon derived stem cells (TDSCs and platelet rich plasma (PRP in the treatment of collagenase induced Achilles tendinopathy in rat. Methods: Four and 8 weeks (n=18 after TDSCs, PRP, PRP with TDSC or PBS (control injection into collagenase or saline (sham injected rat Achilles tendon, tendon tissue was harvested and tendon quality was evaluated by histology and biomechanical testing. TDSCs were cultured and treated by 10% PRP, and the FAK/ERK1/2 signaling pathway and tenocyte-related genes were detected by western blot analysis. Results: Compared to the control, PRP treatment resulted in better healing of injured tendons with improved histological outcomes and biomechanical functions. The addition of TDSCs to PRP treatment significantly enhanced the effects of PRP treatment alone. TDSC injection alone had little effect on tendon healing. PRP and PRP with TDSC treatments of collagenase induced tendon injuries also increased the mRNA and protein expression of tenocyte-related genes (type I collagen, SCX, Tenascin C and activated the focal adhesion kinase (FAK and extracellular-regulated kinase (ERK 1/2 signaling pathways. Treatment of TDSCs in vitro with 10% PRP significantly increased the phosphorylation levels of FAK and ERK1/2 and the protein levels of tenocyte-related genes (Col I, SCX and Tenascin C. Inhibition of the FAK and ERK1/2 signaling pathways abolished the effect of PRP. Conclusion: This study concludes that PRP combined with TDSCs is potentially effective for the treatment of tendinopathy. The PRP induced, FAK and ERK1/2 dependent activation of tenocyte related genes in TDSCs in vitro suggests that the beneficial healing effect of the PRP with TDSC combination might occur by means of an improved TDSC differentiation toward the tenocyte lineage. Thus, a PRP with TDSC combination

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

    International Nuclear Information System (INIS)

    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

  2. Simultaneous bilateral patellar tendon rupture without predisposing systemic disease or steroid use: a case report

    Institute of Scientific and Technical Information of China (English)

    LU Hua-ding; CAI Dao-zhang; WANG Kun; ZENG Chun

    2012-01-01

    There is a dearth of case reports describing 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 tendon ruptures without any history of systemic disease or steroidal medication.We repaired and reattached the ruptured 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.

  3. Rheumatoid wrist deformity and risk of extensor tendon rupture evaluated by 3DCT imaging

    Energy Technology Data Exchange (ETDEWEB)

    Ishikawa, Hajime; Abe, Asami; Murasawa, Akira; Nakazono, Kiyoshi; Horizono, Hidehiro; Ishii, Katsushi; Seki, Eiko [Niigata Rheumatic Center, Department of Rheumatology, Shibata city, Niigata (Japan)

    2010-05-15

    Extensor tendon rupture on the dorsum of the wrist is commonly seen in patients with rheumatoid arthritis (RA). It causes immediate dysfunction of the hand and surgical reconstruction is usually required. The purpose of this study was to clarify the risk of extensor tendon rupture by quantifying wrist deformity on three-dimensional computed tomography (3DCT) images. Three-dimensional CT images of 108 wrists in 102 patients with RA and 38 wrists in 38 healthy volunteers were analyzed retrospectively. All of the rheumatoid wrists had caused persistent pain for more than 6 months despite ongoing medical treatment. Extensor tendon rupture was noted in 49 wrists in 47 patients, and no rupture was noted in 59 wrists in 56 patients. The dorsal subluxation ratio (DSR) of the ulnar head and the carpal supination angle (CSA) were measured utilizing a new technique. The average DSR and CSA in the rupture group (n = 49), the non-rupture group (n = 59), and the normal wrist group (n = 38) were 37%, 19%, and 26%, and 15 , 11 , and 6 respectively. The cut-off values for extensor tendon rupture in the wrists of patients with RA were 32% (sensitivity; 70%, specificity; 75%) in the DSR, and 14 (71%, 68%) in the CSA. By utilizing 3DCT imaging of the rheumatoid wrist, these parameters can help improve our ability to predict extensor tendon rupture. (orig.)

  4. Bilateral quadriceps tendon rupture as the presenting manifestation of chronic kidney disease

    OpenAIRE

    Wani, N A; Malla, H. A.; Kosar, T; Dar, I. M.

    2011-01-01

    Bilateral painful knees with loss of extension in a patient with chronic kidney disease (CKD) may be due to spontaneous quadriceps tendon rupture. This rare complication is usually seen in patients on long term dialysis. We present a case of bilateral spontaneous quadriceps tendon rupture demonstrated by magnetic resonance imaging in a 20-year-old woman who on evaluation was found to have CKD.

  5. [Rupture of the quadriceps tendon after lateral retinaculum release by arthroscopy].

    Science.gov (United States)

    Trobisch, P D; Baumann, M; Weise, K; Fischer, R

    2010-06-01

    Complications after arthroscopic surgery of the knee joint are infrequent. Quadriceps tendon ruptures after knee arthroscopy are rarities. Only two cases have been published in the medical literature. This article presents a case of a quadriceps tendon rupture that occurred in a 19-year-old patient 5 weeks after lateral release of the retinaculum by arthroscopy. The late occurrence differentiates this case from the other previously published cases.

  6. Acute Tibialis Posterior Tendon Rupture With Pronation-Type Ankle Fractures.

    Science.gov (United States)

    Bernstein, Derek T; Harris, Joshua D; Cosculluela, Pedro E; Varner, Kevin E

    2016-09-01

    Tibialis posterior tendon rupture in the setting of pronation-type ankle fractures can lead to long-term debility as a result of chronic tendon dysfunction. This rare injury pattern presents a diagnostic challenge because thorough preoperative examination of the function of the tendon is limited by pain, swelling, and inherent instability of the fracture. As such, a high index of suspicion is necessary in ankle fractures with radiographs showing a medial malleolus fracture with an associated suprasyndesmotic fibula fracture. This report describes 3 cases of tibialis posterior tendon rupture associated with pronation-type ankle fractures treated acutely with open reduction and internal fixation and primary tendon repair. Additionally, common features of this injury pattern are discussed based on the current literature. In accordance with this report, the typical mechanism of injury is high energy and includes forced pronation, external rotation, and dorsiflexion of the ankle, which places maximal stress on the tibialis posterior tendon. Rupture most commonly occurs in a relatively hypovascular area of the tendon located at the posteromedial extent of the medial malleolus fracture. In the operative treatment of pronation-type ankle fractures, direct inspection of the tibialis posterior tendon allows for timely diagnosis and treatment of associated ruptures. [Orthopedics.2016; 39(5):e970-e975.]. PMID:27248337

  7. Late quadriceps tendon rupture at the donor site following cruciate ligament reconstruction using central quadriceps tendon graft.

    Science.gov (United States)

    Pandey, Vivek; Madi, Sandesh; Joseph, Amy; Acharya, Kiran

    2015-10-16

    Central quadriceps tendon (CQT) graft has been successfully used as a viable autograft option in cruciate ligament reconstruction of the knee. The prime emphasis in the majority of the literature is given to surgical details of quadriceps graft harvesting and outcome of cruciate ligament reconstruction. There is less discussion about donor site morbidity in CQT graft, and it is less frequent as compared to that in bone patellar tendon bone graft. We report an extremely unusual case of late quadriceps tendon rupture at the donor site following anterior cruciate ligament reconstruction using CQT graft.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  9. Osteotendinous repair of bilateral spontaneous quadriceps tendon ruptures with the Krackow technique in two patients with chronic renal failure.

    Science.gov (United States)

    Kara, Adnan; Sari, Seçkin; Şeker, Ali; Öztürk, Irfan

    2013-01-01

    Although unilateral traumatic quadriceps tendon rupture is a relatively frequent pathology, bilateral non-traumatic spontaneous ruptures are uncommon and are usually associated with chronic renal failure, hyperparathyroidism, gout, and systemic lupus erythematosus. This paper aimed to discuss two patients with chronic renal failure treated with the Krackow suture technique for spontaneous bilateral quadriceps tendon rupture.

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

    Science.gov (United States)

    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.

  11. Simultaneous bilateral quadriceps tendon rupture in patient with chronic renal failure.

    Science.gov (United States)

    Lee, Yunseok; Kim, Byounggook; Chung, Ju-Hwan; Dan, Jinmyoung

    2011-12-01

    Simultaneous bilateral spontaneous rupture of the quadriceps tendon is a very rare condition and only a few cases have been reported in the literature. The etiology is not clear yet. But it occurs infrequently in patients with chronic metabolic disorders. A 30-year-old female patient with simultaneous bilateral spontaneous quadriceps tendon rupture visited our hospital. She had chronic renal failure and her parathyroid hormone level was elevated due to parathyroid adenoma. We report a surgical repair of both quadriceps tendons of a patient with chronic renal failure as well as management of hyperparathyroidism.

  12. Suture anchor versus suture through tunnel fixation for quadriceps tendon rupture: a biomechanical study.

    Science.gov (United States)

    Lighthart, William A; Cohen, David A; Levine, Richard G; Parks, Brent G; Boucher, Henry R

    2008-05-01

    This biomechanical study compared suture anchors versus transosseous sutures for repair of quadriceps tendon ruptures using a force of 150 N at a frequency of 0.5 Hz. No significant difference in displacement was found between the 2 techniques with initial loading or with load or no load after 1000 cycles. Displacement after 1000 cycles for suture anchors and bone tunnels was 4.65 and 4.50 mm, respectively. These findings suggest a possible role for suture anchors in repairing quadriceps tendon ruptures. Suture anchors are relatively expensive but require less dissection over the patella and do not involve suture placement about the patella tendon.

  13. Partial isolated rupture of the popliteus tendon in a professional soccer player: a case report

    Directory of Open Access Journals (Sweden)

    Mariani Pier

    2009-07-01

    Full Text Available Abstract The complete isolated rupture of the popliteus tendon has been described as a rare injury and this report describes the case of a 31-year-old soccer player who sustained a partial rupture of the popliteus tendon during a game. The injury was suspected clinically and at MRI but confirmed only by the arthroscopic examination. The treatment consisted in open debridment with no tendon repair or augmentation. Seven weeks post-operation the patient was symptom-free and returned to competitive professional soccer at the same preinjury level. The clinical and arthroscopic findings of the case reported suggest a possible overuse disease with degenerative expression.

  14. Functional results after surgical repair of quadriceps tendon rupture.

    Science.gov (United States)

    De Baere, T; Geulette, B; Manche, E; Barras, L

    2002-04-01

    We present the long-term results of surgical repair of a traumatic rupture of the quadriceps tendon in a group of 24 patients with a mean age of 58 years. There were 21 male and 3 female patients. Fifteen patients were seen for clinical control after a mean follow-up of 75 months and they all presented with some quadriceps muscle atrophy. Twelve patients had normal knee mobility, three had a flexion deformity of 10 degrees and two had less than 120 degrees of knee flexion. Active knee extension was normal in all patients. Three patients experienced some decrease in stability of their knee joint. Subjectively all patients were satisfied with the result. Nine patients underwent a Cybex-test for evaluation of the isokinetic force of knee flexion and extension, with a comparison between the injured and the uninjured side. For concentric force there was a mean deficit at low speed of 36.1% for the quadriceps muscle; at high speed it was 28.2%. For the knee flexors, the deficits were 30.7% and 27.2% respectively. Regarding eccentric force, the mean deficit for knee extensors was 13.8% and 0.25% respectively and for knee flexors 6.5% and 5.5% respectively.

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

    DEFF Research Database (Denmark)

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

    2007-01-01

    on the 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...

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

    DEFF Research Database (Denmark)

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

    2013-01-01

    The objective of this study was to describe ultrasonography (US) and magnetic resonance imaging (MRI) findings at painful Achilles tendons and entheses in patients with and without spondyloarthropathy (SpA and non-SpA) and healthy control persons (CTRLs). Particularly, we aimed to investigate...

  17. Association between statin therapy and tendon rupture: a case-control study.

    Science.gov (United States)

    Beri, Abhimanyu; Dwamena, Francesca C; Dwamena, Ben A

    2009-05-01

    Although case reports of a possible association between statin therapy and tendon rupture have been published, no analytical studies exploring this relationship have been reported. We conducted a case-control study using the electronic medical records at Michigan State University from 2002 to 2007 to assess whether statin use is a risk factor for tendon rupture. We compared exposure to statins in 93 cases of tendon rupture with similar exposure in 279 sex- and age-matched controls. Exposure to statins was defined as documentation in the electronic medical record of statin use in the 12 months preceding tendon rupture. For controls, the exposure period was defined as 1 year preceding the last office visit. We used a multivariate logistic regression model, controlling for diabetes, renal disease, rheumatologic disease, and steroid use, to calculate the adjusted odds ratios (ORs). There was no significant difference between cases and controls in the rates of statin use, with either univariate [OR = 1.0, 95% confidence interval (CI) 0.54-1.84] or multivariate analyses (OR = 1.10, 95% CI 0.57-2.13). Based on predetermined subgroup analyses, statin exposure was found to be a significant risk factor for tendon rupture in women (adjusted OR = 3.76, 95% CI 1.11-12.75) but not in men (adjusted OR = 0.66, 95% CI 0.29-1.51). In conclusion, we found no overall association between statin use and tendon rupture, but subgroup analysis suggested that women with tendon rupture were more likely to be on statins. PMID:19454900

  18. Bilateral quadriceps tendon ruptures in a healthy, active duty soldier: case report and review of the literature.

    Science.gov (United States)

    Johnson, Anthony E; Rose, Stephen D

    2006-12-01

    Unilateral quadriceps tendon ruptures are not uncommon. These injuries have been reported to occur spontaneously and after seemingly trivial trauma in elderly individuals, patients undergoing renal dialysis, and patients with metabolic derangements such as hyperparathyroidism. In young patients, unilateral quadriceps tendon ruptures have been reported as complications of burns, anabolic steroid abuse, and elective orthopedic surgery. Bilateral quadriceps tendon ruptures in young healthy patients are rare injuries. We present the case of a young, healthy, active duty soldier who sustained bilateral quadriceps tendon ruptures after a relatively minor trauma.

  19. Is Statin Use Associated With Tendon Rupture? A Population-Based Retrospective Cohort Analysis.

    Science.gov (United States)

    Contractor, Tahmeed; Beri, Abhimanyu; Gardiner, Joseph C; Tang, Xiaoqin; Dwamena, Francesca C

    2015-01-01

    Previous case reports and small studies have suggested that 3-hydroxy-3-methylglutaryl-CoA reductase inhibitors (HMG-CoA-Is) may increase the risk of tendon rupture. We conducted a population-based retrospective cohort evaluation to better assess this relationship. From approximately 800,000 enrollees of a private insurance database, those who were aged ≤64 years with at least 1 year of continuous enrollment were selected. Exposure was defined as initiation of HMG-CoA-I after the beginning of the study period. Each exposed person was matched with 2 controls of similar age and gender. Baseline characteristics, including known risk factors for tendon rupture, were compared between exposed and control cohorts with fidelity to the study's matched design. After adjusting for differences in follow-up and baseline characteristics, incidence rate ratios for tendon rupture was assessed in HMG-CoA-I users and nonusers. A total of 34,749 exposed patients were matched with 69,498 controls. There was no difference in the occurrence of tendon ruptures in HMG-CoA-I users versus nonusers. The results remained unchanged after adjustment for age and gender. In conclusion, this population-based retrospective cohort evaluation suggests that use of HMG-CoA-Is as a group are not associated with tendon rupture. PMID:24451300

  20. Achilles Tendinitis

    Science.gov (United States)

    ... 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, ...

  1. New imaging methods for non-invasive assessment of mechanical, structural and biochemical properties of Human Achilles tendon: a mini review

    Directory of Open Access Journals (Sweden)

    Alexandre Fouré

    2016-07-01

    Full Text Available The mechanical properties of tendon play a fundamental role to passively transmit forces from muscle to bone, withstand sudden stretches and act as a mechanical buffer allowing the muscle to work more efficiently. The use of non-invasive imaging methods for the assessment of human tendon’s mechanical, structural and biochemical properties in vivo is relatively young in sports medicine, clinical practice and basic science. Non-invasive assessment of the tendon properties may enhance the diagnosis of tendon injury and the characterization of recovery treatments. While ultrasonographic imaging is the most popular tool to assess the tendon’s structural and, indirectly, mechanical properties, ultrasonographic elastography and ultra-high field magnetic resonance imaging (UHF MRI have recently emerged as potentially powerful techniques to explore tendon tissues. This paper highlights some methodological cautions associated with conventional ultrasonography and perspectives for in vivo human Achilles tendon assessment using ultrasonographic elastography and UHF MRI.

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

    Institute of Scientific and Technical Information of China (English)

    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.

  3. Rare causes of closed rupture of the flexor tendon

    NARCIS (Netherlands)

    Stenekes, Martin W.; Ruttermann, Mike; Werker, Paul M. N.

    2014-01-01

    Closed injuries to the flexor tendon are relatively rare. We present three rare causes of closed injury to the flexor tendon. Early recognition and adequate treatment by a specialised hand surgeon are crucial for the prognosis of such cases. Delayed diagnosis and treatment often require secondary re

  4. Surgical management of acute quadriceps tendon rupture (a case report with literature review).

    Science.gov (United States)

    Ennaciri, Badr; Montbarbon, Eric; Beaudouin, Emmanuel

    2015-01-01

    Quadriceps tendon rupture is uncommon and often overlooked in emergency. Tearing affects weakening tendon by systemic diseases or some medications. The mechanism is generally indirect. Inability to actively extend the knee associated to a supra-patellar defect evoke easily the diagnosis without other investigations. Surgical repair is realized in emergency to completely restore the extension. We report a case of a patient who has sustained of complete quadriceps tendon tear after a long period of tendon weakening by statin therapy, hypertension and diabetes. The repair has consisted on end-to-end Krackow sutures associated with bone suture to the proximal pole of the patella. Surgeons and emergency physicians must think to this form of extensor apparatus rupture, because early diagnosis leads to early treatment and to best outcomes.

  5. Surgical treatment of the adductor longus muscle's distal tendon total rupture in a soccer player.

    Science.gov (United States)

    Masionis, P; Popov, K; Kurtinaitis, J; Uvarovas, V; Porvaneckas, N

    2016-09-01

    Only a few cases of adductor longus tendon ruptures have been reported in the literature and - there are no clear criteria for conservative or surgical treatment. A case of traumatic rupture of the right distal adductor longus tendon is presented in an elite soccer player, which was surgically repaired. The condition was managed conservatively primarily. However, after 2 months, a palpable mass remained on the medial side of the thigh, and the patient had pain after moderate everyday load and insufficient strength of the right leg during physical exercise. It was decided to explore ruptured tendon surgically and reattach to the femur. Full function of the right leg was achieved at 3 months after surgical repair. At 6 months postoperatively, the patient had returned to soccer at the same level. PMID:27132783

  6. Spontaneous and simultaneous bilateral rupture of the quadriceps tendon in a patient with osteogenesis imperfecta: a case report.

    Science.gov (United States)

    Figueroa, David; Calvo, Rafael; Vaisman, Alex

    2006-03-01

    Bilateral rupture of the quadriceps tendon is an uncommon and serious injury that usually occurs in middle aged to elderly patients. It is frequently associated with chronic metabolic disorders like diabetes, hyperparathyroidism, gout, chronic renal failure or the chronic use of steroids. We report a case of spontaneous bilateral rupture of the quadriceps tendon in a patient with osteogenesis imperfecta.

  7. Suture anchor repair of quadriceps tendon rupture after total knee arthroplasty.

    Science.gov (United States)

    Kim, Tae Won B; Kamath, Atul F; Israelite, Craig L

    2011-08-01

    Disruption of the extensor mechanism after total knee arthroplasty (TKA) is a devastating complication, usually requiring surgical repair. Although suture anchor fixation is well described for repair of the ruptured native knee quadriceps tendon, no study has discussed the use of suture anchors in quadriceps repair after TKA. We present an illustrative case of successful suture anchor fixation of the quadriceps mechanism after TKA. The procedure has been performed in a total of 3 patients. A surgical technique and brief review of the literature follows. Suture anchor fixation of the quadriceps tendon is a viable option in the setting of rupture after TKA.

  8. Simultaneous Bilateral Quadriceps Tendon Rupture following Long-Term Low-Dose Nasal Corticosteroid Application

    Directory of Open Access Journals (Sweden)

    Mohamed Omar

    2013-01-01

    Full Text Available Simultaneous bilateral quadriceps tendon rupture is a very rare injury, which was previously only described in slightly more than 100 cases in the English literature. Occurrence after minor trauma is predominantly associated with certain medical conditions including chronic diseases and long-term use of certain drugs. We report the case of a 61-year-old healthy patient who sustained a simultaneous bilateral quadriceps tendon rupture following minor trauma. Medical history was completely clear except of a long-term nasal corticosteroid medication due to allergic rhinitis.

  9. Spontaneous and simultaneous bilateral rupture of the quadriceps tendon. A case report.

    Science.gov (United States)

    Alpantaki, Kaliopi; Papadokostakis, George; Katonis, Pavlos; Hadjpavlou, Alexander

    2004-02-01

    Simultaneous bilateral rupture of the quadriceps tendon has rarely been reported; it generally occurs in association with chronic metabolic disorders, such as chronic renal failure, obesity, diabetes mellitus and secondary hyperparathyroidism. The case presented here was in an 85-year-old man with no known risk factors, who sustained simultaneous and spontaneous rupture of both quadriceps tendons. The patient suffered from spinal stenosis and degenerative changes in the knee menisci. These findings suggest that instability of the knee due to meniscal damage, and quadriceps weakness as a result of spinal stenosis, may have played a significant role in the pathogenesis of this injury.

  10. [A simplified technique for repair of quadriceps tendon rupture by transpatellar PDS-cord].

    Science.gov (United States)

    Hosseini, H; Agneskirchner, J D; Lobenhoffer, P

    2005-06-01

    Quadriceps tendon ruptures are relatively unusual injuries caused by direct or more frequently indirect trauma. Since complete ruptures lead to loss of active extension of the knee joint, operative treatment is usually indicated. Several techniques are described in the literature. However, relatively little is known about the functional outcome after operative treatment of acute quadriceps tendon ruptures. We present a new operative technique using a 1.3-mm PDS cord passed through a transverse drill hole in the proximal pole of the patella. We operated ten consecutive cases of complete quadriceps tendon ruptures with the technique described between January 2000 and June 2003. Eight of ten patients were evaluated after a mean follow-up time of 38 months by physical examination, IKDC Subjective score, Lysholm and Tegner score as well as an isokinetic test of the quadriceps strength. No complications were noted in this period. The average postoperative scores were 87 (IKDC), 98 (Lysholm), and 4.5 (Tegner). Isokinetic testing showed an average of 25% quadriceps strength deficit. The operative treatment of complete quadriceps tendon ruptures using a PDS cord through a drill hole in the patella is a safe and effective technique permitting functional postoperative treatment.

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

    DEFF Research Database (Denmark)

    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...

  12. Attritional Rupture of the Little Finger Flexor Digitorum Profundus Tendon in the Carpal Tunnel in a Patient with Acromegaly.

    Science.gov (United States)

    Lee, Munn Yi Tina; Jin, Yeo Chong

    2016-02-01

    Spontaneous rupture of flexor tendons within the carpal tunnel is rare in the absence of rheumatoid arthritis. Other predisposing conditions such as gout, infection, pisotriquetrial osteoarthritis, as well as hook of hamate fracture non-union, have previously been reported. However, tendon ruptures of the hand in the presence of acromegaly, as well as spontaneous ruptures within the carpal tunnel, have not been described in the literature. PMID:27454510

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

    Institute of Scientific and Technical Information of China (English)

    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.

  14. 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

    Institute of Scientific and Technical Information of China (English)

    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。

  15. Pseudotendon formation causing painful tethering of ruptured flexor carpi radialis tendons.

    Science.gov (United States)

    Henry, Mark

    2013-06-01

    Six patients (five male, one female) between 51 and 64 years of age sustained ruptures of the right dominant flexor carpi radialis (FCR) tendon. Prior to rupture, within the past 3 months to 1 year, each had received one or two corticosteroid injections of the FCR tendon sheath for stenosing tenosynovitis. Three of six patients demonstrated radiographic findings but none had clinical symptoms of osteoarthritis at the scaphoid-trapezium-trapezoid joint. The pain and disability declared by these patients appeared out of proportion to the relatively innocuous nature of a ruptured FCR tendon, with an average pre-operative Disabilities of the Arm, Shoulder, and Hand (DASH) score of 32. In all patients there was a palpable, tender mass of retracted, ruptured FCR tendon around 6 cm proximal to the wrist crease as well as a palpable cord of pseudotendon formed within the residual sheath. Pain along the course of the pseudotendon was consistently provoked by wrist extension and gripping. The patients were initially treated non-surgically with stretching, manual therapy, ultrasound, and oral medications for 2-4 months. None obtained sufficient relief, and the patients requested more definitive care. The painful tethering of the ruptured FCR was solved by complete excision of both pseudotendon and the retracted tendon stump, resulting in complete relief of symptoms with an average post-operative DASH score of 3. Pre-operative and post-operative DASH scores were analyzed with the paired Student's t-test, using a p-value of 0.05, and found to have a statistically significant difference. PMID:24426661

  16. Synchronous quadriceps tendon rupture and unilateral ACL tear in a weightlifter, associated with anabolic steroid use.

    Science.gov (United States)

    Fenelon, Christopher; Dalton, David M; Galbraith, John G; Masterson, Eric L

    2016-01-01

    Synchronous quadriceps tendon rupture is rare. A 29-year-old man, an amateur weight lifter, taking androgenic-anabolic steroids (AAS), developed sudden onset bilateral pain and swelling of his anterior thighs when attempting to squat 280 kg (620 lb). Examination revealed gross swelling superior to the patella and palpable gaps in both quadriceps tendons. He underwent successful operative repair. MRI revealed a partial tear of the anterior cruciate ligament (ACL) of the right knee. This was not reconstructed. Only a few case reports of the association between AAS and quadriceps rupture exist in the literature, with none to the best of our knowledge in the past 10 years. ACL rupture coexisting is very rare, with only two reported cases. PMID:27154985

  17. Synchronous quadriceps tendon rupture and unilateral ACL tear in a weightlifter, associated with anabolic steroid use.

    Science.gov (United States)

    Fenelon, Christopher; Dalton, David M; Galbraith, John G; Masterson, Eric L

    2016-05-06

    Synchronous quadriceps tendon rupture is rare. A 29-year-old man, an amateur weight lifter, taking androgenic-anabolic steroids (AAS), developed sudden onset bilateral pain and swelling of his anterior thighs when attempting to squat 280 kg (620 lb). Examination revealed gross swelling superior to the patella and palpable gaps in both quadriceps tendons. He underwent successful operative repair. MRI revealed a partial tear of the anterior cruciate ligament (ACL) of the right knee. This was not reconstructed. Only a few case reports of the association between AAS and quadriceps rupture exist in the literature, with none to the best of our knowledge in the past 10 years. ACL rupture coexisting is very rare, with only two reported cases.

  18. Simultaneous bilateral quadriceps tendon rupture in a patient on chronic haemodialysis. (Short-term results of treatment with transpatellar sutures augmented with a quadriceps tendon flap).

    Science.gov (United States)

    Kayali, Cemil; Agus, Haluk; Turgut, Ali; Taskiran, Can

    2008-01-01

    Quadriceps tendon ruptures are rare orthopaedic injuries. Although they are generally seen after the age of 50, they may occur in younger patients with certain underlying conditions, including chronic haemodialysis. Several repair techniques have been proposed but the choice of the best method is still a matter of controversy. This paper presents the case of a renal failure patient with 10 years' history of haemodialysis treatment suffering from bilateral quadriceps tendon rupture. The treatment was with transpatellar sutures augmented with a reverse quadriceps tendon flap. His short-term clinical and radiological results are satisfactory.

  19. One-stage arthroscopic reconstruction of both cruciate ligaments using Achilles tendon-bone allografts%关节镜下同种异体跟腱骨一期重建膝关节前后交叉韧带

    Institute of Scientific and Technical Information of China (English)

    史德海; 李东会; 刘斌; 金文涛; 蔡道章

    2009-01-01

    Objective To evaluate one-stage arthroscopic reconstruction of anterior crueiate ligament (ACL)and posterior cruciate ligament(PCL)using Achilles tendon-bone allografts. Methods From July 2000 to February 2005.we treated 15 patients(11 males and 4 females)whose ACL and PCL were ruptured at one knee but the eontralateral knee was intact.Their associated meniscus injuries were treated arthroscopically according to established procedures prior to ligament reconstruction.Thirty Achilles tendon-bone allografts were used to reconstruct torn ACL and PCL in 15 knees at one stage.Reconstruction of both ligaments was performed at subacute or chronic phase(>3 to 8 weeks)in 12 casses,and at acute phase in 3 cases(3周)重建12例,急性期(<3周)重建3例.手术前后采用IKDC和Lysholm评分系统对患膝关节功能进行评估,随访结果与对侧健康膝火节进行比较.结果 所有患者均获得36~40个月(平均38个月)随访.根据IKDC评分,术前所有患膝关节功能都严重异常,术后9例患膝功能改善为止常,5例接近正常,1例异常.Lysholm评分由术前平均(56±5)分改善为术后(90±4)分,差异有统汁学意义(t=15.660,P<0.05.结论同种异体跟腱骨可用于关节镜下重建膝关节前后交叉韧带,疗效满意.

  20. Alcoholic extract of tarantula cubensis improves sharp ruptured tendon healing after primary repair in rabbits.

    Science.gov (United States)

    Oryan, Ahmad; Moshiri, Ali; Meimandi Parizi, Abdolhamid

    2012-12-01

    This study was designed to investigate the effects of tarantula cubensis (TC) on the superficial digital flexor tendon (SDFT) rupture after surgical anastomosis, on day 84-postinjury (DPI) in rabbits. Forty white New Zealand, mature, male rabbits were randomly and evenly divided into treated and control groups. After tenotomy and primary repair, the injured legs were immobilized for 2 weeks. TC was injected subcutaneously over the lesion on 3, 7, and 10 DPI. The control animals received subcutaneous injections of normal saline similarly. Animal's weight, tendon diameter, clinical status, radiographic and ultrasonographic evaluations were recorded at weekly intervals. The animals were euthanized on 84 DPI and the injured tendons and their normal contralaterals were evaluated for histopathologic, histomorphometric, ultrastructural, biomechanical, and percentage dry weight parameters. Treatment significantly improved the clinical performance, cell, collagen and tissue maturation, tissue alignment and remodeling, ultimate strength, stiffness, maximum stress, and dry weight content and decreased the tendon diameter, inflammation, adhesions and degeneration of the injured treated tendons compared to the injured control ones. The present findings showed that TC is effective on sharp ruptured SDFT in rabbits and it could be one of the novel therapeutic options in clinical trial studies. PMID:23431525

  1. Bilateral simultaneous rupture of the quadriceps tendon in a patient with psoriasis: a case report and review of the literature

    Directory of Open Access Journals (Sweden)

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

    Science.gov (United States)

    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

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    Cummings, Stephen H; Grande, Daniel A; Hee, Christopher K; Kestler, Hans K; Roden, Colleen M; Shah, Neil V; Razzano, Pasquale; Dines, David M; Chahine, Nadeen O

    2012-01-01

    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 scores

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

    OpenAIRE

    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...

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

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

    Directory of Open Access Journals (Sweden)

    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.

  8. Closed traumatic rupture of the flexor pollicis longus tendon in zone T I: a case report.

    Science.gov (United States)

    Uekubo, Kazuaki; Itoh, Soichiro; Yoshioka, Taro

    2015-01-01

    A healthy 41-year-old male suffered a direct blow on the palmar side of his right thumb when folding a table, which slipped along his thumb until it was stopped at the inter-phalangeal (IP) joint, resulting in a complete rupture of the flexor pollicis longus (FPL) tendon in zone T I. The proximal tendon stump was passed through the oblique pulley, fixed to the base of the distal phalanx with a pull-out wire technique and augmented on it using a part of the distal tendon remnant. After removal of the cast and the pull-out wire three weeks postoperatively, range of motion exercise was initiated and good functional recovery was obtained. PMID:25609290

  9. [Biceps tendon: diagnosis, therapy and results after proximal and distal rupture].

    Science.gov (United States)

    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

  10. Technical tip: Side-to-side tendon suture as escape plan during extensor indicis tendon plasty in distal extensor pollicis longus rupture

    Directory of Open Access Journals (Sweden)

    Schleh, Andrea Christina

    2015-11-01

    Full Text Available Objective: In case of a short distal recipient stump after extensor pollicis longus (EPL tendon rupture, transfer of the extensor indicis proprius (EIP tendon using a conventional Pulvertaft tendon-weaving technique may be difficult or impossible. The purpose of this paper is to provide a technical tip to manage this rare, but clinically important scenario of a very short distal EPL recipient tendon.Methods: A side-to-side tendon suture (SSTS was used for EIP transfer to restore thumb extension in 3 patients who had sustained a distal rupture of their extensor pollicis longus near the interphalangeal joint. The SSTS was performed with an overlap of 2 cm in 2 patients and in one patient.Results: A stable SSTS was achieved which allowed early active mobilization and resulted in good functional recovery of thumb extension after a mean follow-up of 8 months.Conclusion: Extensor indicis transfer using SSTS is a reliable and technically simple escape plan in a distal rupture of the EPL near the phalangeal joint. It provides very stable tendon-to-tendon attachment with high loading capacity and good gliding qualities.

  11. [Bilateral quadriceps tendon rupture and coexistent femoral neck fracture in a patient with chronic renal failure].

    Science.gov (United States)

    Kazimoğlu, Cemal; Yağdi, Serhan; Karapinar, Hasan; Sener, Muhittin

    2007-01-01

    Simultaneous bilateral quadriceps tendon rupture is a very rare injury mostly seen in patients with chronic renal failure or other systemic chronic diseases. Metabolic acidosis in chronic renal failure predisposes these patients to tendon degeneration. A 37-year-old woman who received hemodialysis for chronic renal failure for two years presented with complaints of severe pain in the left hip and inability to walk. She had a history of two consecutive falls in the past two months. On physical examination, there were joint spaces in both suprapatellar areas, active extension of both knees was inhibited, and movements of the left hip were quite painful. Knee ultrasonography and magnetic resonance imaging showed bilateral quadriceps tendon rupture from patellar attachment. At surgery, full-thickness quadriceps tendon tears were repaired with Tycron transpatellar suture anchors. Internal fixation was not considered for hip fracture due to the presence of chronic renal failure, so hemiarthroplasty with bipolar endoprosthesis was performed in the same session for femoral neck fracture. Six months after the operation, the patient was able to walk without support and almost regained her normal knee functions.

  12. Dislocation of a constrained total knee arthroplasty with patellar tendon rupture after trivial trauma

    Institute of Scientific and Technical Information of China (English)

    Raju Vaishya; Vipul Vijay; Abhishek Vaish

    2015-01-01

    Constrained total knee prostheses are used in knees with severe deformities and insufficiency of collaterals to provide stable and mobile knees.Dislocation after constrained knee prosthesis is an extremely rare and dreaded complication.When dislocation is associated with patellar tendon rupture,the management includes restoration of the extensor apparatus along with a stable knee.Repair of the patellar tendon is challenging due to poor soft tissue coverage in the area and a bulky repair can put tension on the wound closure.Ideal method of restoration of the extensor apparatus is a matter of debate.There are various modalities used ranging from primary end-to-end repair,augmentation by medial gastrocnemius flap,semitendinosus and synthetic implants and allograft tendoachilles.We report a rare case of a posterior dislocation of a constrained total knee arthroplasty in association with patellar tendon rupture due to a minor fall after a few weeks of surgery.The first episode was managed by reposition of the dislocation and V-Y plasty of the quadriceps and primary repair.The second episode of dislocation with re-rupture needed augmentation by semitendinosus along with the insertion of the thicker insert.The management of this complex problem along with the review of literature is discussed in this case report.

  13. [Quadriceps tendon insufficiency and rupture : Treatment options in total knee arthroplasty].

    Science.gov (United States)

    Thiele, K; von Roth, P; Pfitzner, T; Preininger, B; Perka, C

    2016-05-01

    Quadriceps tendon injuries and insufficiencies in total knee arthroplasty are rare, but are followed by a devastating complication that left untreated leads to a complete loss of function of the knee. This review article summarizes the functional anatomy, risk factors, and the prevalence and diagnosis of quadriceps tendon injuries, in addition to the possible management options for partial and complete ruptures. The treatment options are adapted according to the extent of the loss of function (partial, complete) and the duration of the injury (acute vs chronic). Furthermore, the choice of treatment should take into account the quality and availability of primary tissue, the patient's general health, along with their likely functional requirements. Conservative treatment is often justified in partial ruptures with good results. Complete ruptures require surgical intervention and multiple operative techniques are described. Treatment options for acute ruptures include direct primary repair with autogenous or synthetic tissue augmentation. In the case of chronic insufficiency and a lack of soft-tissue surroundings, reconstruction with the aid of a muscle flap or allograft tissue can be considered. All surgical intervention techniques used so far have been fraught with complications and rarely lead to satisfactory results. A new surgical approach to the reconstruction and augmentation of the extensor mechanism consists of the use of a synthetic mesh. The technique is described here in detail.

  14. Post-surgical care of a professional ballet dancer following calcaneal exostectomy and debridement with re-attachment of the left Achilles tendon

    Science.gov (United States)

    Kobsar, Bradley; Alcantara, Joel

    2009-01-01

    The extraordinary physical demands placed upon ballet dancers are only now being appreciated as comparable to that of other highly competitive athletic pursuits. The professional ballet dancer presents with an array of injuries associated with their physically vigorous performance requirements. In keeping with evidence-based practice, we describe the chiropractic care of a professional ballet dancer following surgical calcaneal exostectomy and debridement with re-attachment of the left Achilles tendon. The care provided involves an array of modalities from exercise and rehabilitation to spinal manipulative therapy. PMID:19421349

  15. Stress examination of flexor tendon pulley rupture in the crimp grip position: a 1.5-Tesla MRI cadaver study

    Energy Technology Data Exchange (ETDEWEB)

    Bayer, Thomas; Janka, Rolf [University of Erlangen-Nuremberg, Department of Radiology, Erlangen (Germany); Fries, Simon [Cantonal Hospital Lucerne, Orthopaedic Department, Wolhusen (Switzerland); Schweizer, Andreas [University of Zurich, Department of Orthopaedics, Balgrist, Zurich (Switzerland); Schoeffl, Isabelle [Klinikum Bamberg, Department of Pediatrics, Bamberg (Germany); Bongartz, Georg [University Basel, Department of Radiology, Basel (Switzerland)

    2015-01-15

    The objectives of this study were the evaluation of flexor tendon pulley rupture of the fingers in the crimp grip position using magnetic resonance imaging (MRI) and the comparison of the results with MRI in the neutral position in a cadaver study. MRI in the crimp grip position and in the neutral position was performed in 21 cadaver fingers with artificially created flexor tendon pulley tears (combined pulley rupture, n = 14; single pulley rupture, n = 7). Measurement of the distance between the tendon and bone was performed. Images were evaluated by two readers, first independently and in cases of discrepancy in consensus. Sensitivity and specificity for detecting combined pulley ruptures were calculated. Tendon bone distances were significantly higher in the crimp grip position than in the neutral position. Sensitivity and specificity for detecting combined pulley rupture were 92.86 % and 100 % respectively in the crimp grip position and 78.57 % and 85.71 % respectively in the neutral position. Kappa values for interobserver reliability were 0.87 in the crimp grip position and 0.59 in the neutral position. MRI examination in the crimp grip position results in higher tendon bone distances by subjecting the pulleys to a higher strain, which facilitates image evaluation with higher interobserver reliability, higher sensitivity, and higher specificity for combined pulley rupture compared with examination in the neutral position. (orig.)

  16. Rapid recovery from spontaneous and simultaneous bilateral quadriceps tendon rupture in an active, healthy individual.

    Science.gov (United States)

    Gaheer, Rajinder Singh; Hawkins, Amanda

    2010-07-01

    Bilateral spontaneous quadriceps rupture is an uncommon injury that is usually seen in association with multiple medical conditions and is frequently misdiagnosed. It is rarely seen in healthy, active individuals. This article presents a case of bilateral simultaneous and spontaneous rupture of the quadriceps tendon in a healthy, athletic, active and highly motivated patient with rapid recovery from injury and return to full sport activity within a relatively short period of time. A 65-year-old healthy man felt both knees give way while walking down stairs at home and collapsed, unable to bear weight. He was fit and well, not on any medications and basic laboratory screening was within normal limits. He was an active sportsman, horse rider, swimmer, and long-distance cyclist, and had completed a half marathon 1 month before his injury. He was diagnosed with bilateral quadriceps tendon ruptures. An ultrasound of both knees confirmed the diagnosis of full-thickness rupture. Surgical repair of both quadriceps tendons was performed 3 days after the injury. Bilateral locking brace in 10 degrees of flexion was used to immobilize both knees and protect the repair for 6 weeks. The patient remained nonweight bearing for 2 weeks, then gradual weight bearing was commenced, with full weight bearing at 6 weeks. Intensive isometric quadriceps exercises were started on the second postoperative day. Immobilization of both knees was maintained for 6 weeks, after which full active range of motion (ROM) was initiated. At 16 weeks after the injury he had bilateral ROM from 0 degrees to 120 degrees flexion, with no extension lag. He was horse riding, playing golf, swimming, and walking distances up to 2 miles at that time. PMID:20608622

  17. Rapid recovery from spontaneous and simultaneous bilateral quadriceps tendon rupture in an active, healthy individual.

    Science.gov (United States)

    Gaheer, Rajinder Singh; Hawkins, Amanda

    2010-07-13

    Bilateral spontaneous quadriceps rupture is an uncommon injury that is usually seen in association with multiple medical conditions and is frequently misdiagnosed. It is rarely seen in healthy, active individuals. This article presents a case of bilateral simultaneous and spontaneous rupture of the quadriceps tendon in a healthy, athletic, active and highly motivated patient with rapid recovery from injury and return to full sport activity within a relatively short period of time. A 65-year-old healthy man felt both knees give way while walking down stairs at home and collapsed, unable to bear weight. He was fit and well, not on any medications and basic laboratory screening was within normal limits. He was an active sportsman, horse rider, swimmer, and long-distance cyclist, and had completed a half marathon 1 month before his injury. He was diagnosed with bilateral quadriceps tendon ruptures. An ultrasound of both knees confirmed the diagnosis of full-thickness rupture. Surgical repair of both quadriceps tendons was performed 3 days after the injury. Bilateral locking brace in 10 degrees of flexion was used to immobilize both knees and protect the repair for 6 weeks. The patient remained nonweight bearing for 2 weeks, then gradual weight bearing was commenced, with full weight bearing at 6 weeks. Intensive isometric quadriceps exercises were started on the second postoperative day. Immobilization of both knees was maintained for 6 weeks, after which full active range of motion (ROM) was initiated. At 16 weeks after the injury he had bilateral ROM from 0 degrees to 120 degrees flexion, with no extension lag. He was horse riding, playing golf, swimming, and walking distances up to 2 miles at that time.

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

    DEFF Research Database (Denmark)

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

    2013-01-01

    , 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...... recommended surgical treatment (p used significantly less often in Denmark (5 of 23 [22%]), Norway (17 of 45 [38%]), and Sweden (11 of 40 [28%]) than in Finland (15 of 26 [58%]; p = .015). A significant difference was found among the countries in the educational level...... of the performing surgeons (p use across Scandinavia...

  19. The influence of stretching and warm-up exercises on Achilles tendon reflex activity.

    Science.gov (United States)

    Rosenbaum, D; Hennig, E M

    1995-12-01

    The aim of this study was to investigate the acute effects of prior exercise (warm-up and stretching) on the electromyographic and force output of mechanically elicited triceps surae reflexes. Fifty male subjects performed eight reflex experiments under each of three successive conditions in one session: (1) no prior exercise, (2) after static stretching of the passive triceps surae (3 min) and (3) after a 10-min warm-up run on a treadmill. Tendon tap reflex force was elicited in the triceps surae of the right leg by means of a standardized reflex hammer and measured in a custom-built fixture. Electromyographic (EMG) signals were recorded with surface electrodes over the medial head of the gastrocnemius (G) and the soleus (S). Low coefficients of variation within subjects contrasted with high between-subject variations, indicating highly individual reflex characteristics. After stretching, reductions in the peak force (-5%; P running, the peak force reached the values obtained without prior exercise (-2%; N.S.), the force rise rate and half relaxation rate increased by 8 and 12%, respectively (P run had a more pronounced influence with regard to improved force development and a decreased EMG activity, which can be viewed as a performance-enhancing effect.

  20. 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

    Institute of Scientific and Technical Information of China (English)

    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

  1. Multiple ruptures of the extensor tendons after volar fixation for distal radius fracture: a case report.

    Science.gov (United States)

    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

  2. Clinical outcomes after repair of quadriceps tendon rupture: a systematic review.

    Science.gov (United States)

    Ciriello, Vincenzo; Gudipati, Suribabu; Tosounidis, Theodoros; Soucacos, P N; Giannoudis, Peter V

    2012-11-01

    The existing evidence regarding the management of quadriceps tendon rupture remains obscure. The aim of the current review is to investigate the characteristics, the different techniques employed and to analyse the clinical outcomes following surgical repair of quadriceps tendon rupture. An Internet based search of the English literature of the last 25 years was carried out. Case reports and non-clinical studies were excluded. The methodological quality of the included studies was assessed using the Coleman Methodology Score. All data regarding mechanism and site of rupture, type of treatment, time elapsed between diagnosis and repair, patients' satisfaction, clinical outcome, return to pre-injury activities, complications and recurrence rates were extracted and analysed. Out of 474 studies identified, 12 met the inclusion criteria. The average of Coleman Methodology Score was 50.46/100. In total 319 patients were analysed with a mean age of 57 years (16-85). The mean time of follow-up was 47.5 months (3 months to 24 years). The most common mechanism of injury was simple fall (61.5%). Spontaneous ruptures were reported in 3.2% of cases. The most common sites of tear were noted between 1cm and 2 cm of the superior pole of the patella and, in the older people, at the osseotendinous junction. The most frequently used repair technique was patella drill holes (50% of patients). Simple sutures were used in mid-substance ruptures. Several reinforcement techniques were employed in case of poor quality or retraction of the torn ends of tendon. The affected limb was immobilised in a cast for a period of 3-10 weeks. Quadriceps muscular atrophy and muscle strength deficit were present in most of the cases. Worst results were noted in delayed repairs. Reported complications included heterotopic ossifications in 6.9% of patients, deep venous thrombosis or pulmonary embolism in 2.5%, superficial infection in 1.2% and deep infection in 1.1%. It appears that the type of surgical

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

    Science.gov (United States)

    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

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

    Science.gov (United States)

    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

  5. 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

    Institute of Scientific and Technical Information of China (English)

    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

  6. (足母)长屈肌腱移位替代跟腱治疗跟腱缺损的疗效分析%Evaluation of flexor hallucis longus tendon transfer as a treatment for Achilles tendon defects of more than 6 cm

    Institute of Scientific and Technical Information of China (English)

    孙超; 王智; 张建中

    2010-01-01

    Objective To evaluate the clinical results of flexor hallucis longus (FHL) tendon transfer in treatment of patients with Achilles tendon defects of more than 6 cm. Methods Between January 2005 to February 2009, 19 patients with Achilles tendon defects, 13 males and 6 females, were treated with FHL tendon transfer. Their ages ranged from 20 to 61 years, with an average of (42. 6 ± 8.2)years. Fifteen defects were found during tendonitis debridement, and 4 were old ruptures. Time from rupture to surgery ranged from 0 to 6 months (average, 2.6 months). Defects were 6 cm to 10 cm long. Procedures were performed in a two-incision manner. The postoperative ROM of ankle joint, American Orthopaedic Foot and Ankle Society(AOFAS) and visual analogue scale(VAS) scores were recorded at 3 months, 12 months,and the last follow-up. The results were statistically analyzed to evaluate the functional recovery. Results Follow-ups lasted from 12 to 48 months (average, 22. 2 months). At the last follow-up, the average ROM of ankle joint was 17.8°± 1.9° at dorsal flexion and 39.1°±2.3° at plantar flexion, and the last average AOFAS score was up to (91.8 ± 1.7), significantly different from those at 3 months after surgery (P<0.05), but not significantly different from those at 12 months (P>0.05). The difference were significant between the results of 3 months and 12 months (P<0.05). The last average VAS score was (1.0±0.7),significantly different from those at 3 months and 12 months(P<0.05) . There was also significant differences between the VAS scores of 3 months and 12 months (P<0.05). Patient's satisfaction was 100%.Conclusion FHL tendon transfer is an efficient procedure for long Achilles tendon ruptures associated with tendonitis in relieving pain and maintaining the function of ankle joint.%目的 探讨(足母)长屈肌腱移位替代跟腱治疗6 cm以上跟腱缺损的疗效.方法 2005年1月至2009年2月采用(足母)长屈肌腱移位替代跟腱治疗19

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

    Institute of Scientific and Technical Information of China (English)

    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

  8. Neglected rupture of the quadriceps tendon in a patient with chronic renal failure (case report and review of the literature).

    Science.gov (United States)

    Hassani, Zouhir Ameziane; Boufettal, Moncef; Mahfoud, Moustapha; Elyaacoubi, Moradh

    2014-01-01

    Spontaneous ruptures of the quadriceps tendon are infrequent injuries, it is seen primarily in patients with predisposing diseases such as gout, rheumatoid arthritis and chronic renal failure. A 32-year-old man had a history of end stage renal disease and received regular hemodialysis treatment for more than 5 years. He was admitted in our service for total functional impotence of the right lower limb with knee pain after a common fall two months ago. The radiogram showed a ''patella baja" with suprapatellar calcifications. The ultrasound and MRI showed an aspect of rupture of the quadriceps tendon in its proximal end with retraction of 3 cm. Quadriceps tendon repair was performed with a lengthening plasty, and the result was satisfactory after a serial rehabilitation program. The diagnosis of quadriceps tendon ruptures needs more attention in patients with predisposing diseases. They should not be unknown because the treatment of neglected lesions is more difficult. We insist on the early surgical repair associated with early rehabilitation that can guarantee recovery of good active extension.

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

    Directory of Open Access Journals (Sweden)

    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

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  11. Bilateral consecutive rupture of the quadriceps tendon in a man with BstUI polymorphism of the COL5A1 gene.

    Science.gov (United States)

    Longo, Umile Giuseppe; Fazio, Vito; Poeta, Maria Luana; Rabitti, Carla; Franceschi, Francesco; Maffulli, Nicola; Denaro, Vincenzo

    2010-04-01

    A genetic component has been implicated in tendinopathies involving tendon rupture. Type V collagen, a quantitatively minor fibrillar collagen which forms heterotypic fibrils with type I collagen, plays a role in the regulation of the size and configuration of fibrils of the much more abundant component type I collagen. To date, no data on the genetic component of bilateral rupture of the quadriceps tendon have been reported. We describe the presence of BstUI polymorphism of the COL5A1 gene in a man with bilateral rupture of the quadriceps tendon. The COL5A1 (the variant rs12722, BstUI RFLP) can be a candidate gene associated with the development of bilateral quadriceps tendon rupture.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Science.gov (United States)

    Lovati, Arianna B.; Bottagisio, Marta; Moretti, Matteo

    2016-01-01

    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. PMID:26880985

  14. Delayed rupture of flexor tendons in zone V complicated by neuritis 18 years following Galeazzi fracture-dislocation.

    Science.gov (United States)

    Nagy, Mathias Thomas; Ghosh, Sabyasachi; Shah, Bhavik; Sankar, Thangasamy

    2014-04-16

    We report a rare case of an 84-year-old woman who presented with delayed, complete rupture of superficial (flexor digitorum superficialis) and deep flexor tendons (flexor digitorum profundus) of the third, fourth and fifth digits of the right hand in zone V of the flexor tendons. The patient, who was otherwise healthy, active and independent, incurred a closed fracture of her right wrist 18 years ago, which was treated conservatively. Current X-rays and operative findings confirmed a malunited Galeazzi fracture-dislocation with volar dislocation of the ulna from the distal radioulnar joint. She underwent surgical treatment to improve her hand function and agonising neuritis symptoms, as she was unable to use her middle, ring and little fingers and had developed severe neuritis of the ulnar nerve. Exploration and repair of the flexor tendons, nerve decompressions and Darrach procedure were performed. On follow-up, the patient showed improvement in hand function with the neuritis completely resolved.

  15. Rupture of the extensor pollicis longus tendon following dorsal entry flexible nailing of radial shaft fractures in children

    OpenAIRE

    Brooker, Ben; Harris, P. Christian; Donnan, Leo T.; Graham, H. Kerr

    2014-01-01

    Introduction Diaphyseal forearm fractures are common in children and adolescents. Intramedullary fixation with flexible nails has a high success rate. Complications related to the insertion of the radial nail include injury to the superficial branch of the radial nerve and rupture of the extensor pollicis longus (EPL) tendon. Materials and Methods We report a series of nine patients who sustained an EPL injury related to the insertion of an elastic intramedullary nail into the radius. Results...

  16. Closed Medial Malleolar Multifragment Fracture With a Posterior Tibialis Tendon Rupture: A Case Report and Review of the Literature.

    Science.gov (United States)

    Formica, Matteo; Santolini, Federico; Alessio-Mazzola, Mattia; Repetto, Ilaria; Andretta, Angelo; Stella, Marco

    2016-01-01

    Ankle fractures represent an exciting field of traumatology because of the wide variety of clinical presentations, injury mechanisms, and treatment options. Rupture of the posterior tibialis tendon (PTT) with ankle fracture can occur during trauma that involves pronation and external rotation of the foot or, less commonly, secondary to direct trauma to the ankle. This tendon injury is uncommon and probably misdiagnosed in many cases, because of the difficult clinical examination secondary to the pain and swelling. The identification and early treatment of PTT tears is essential for good functional outcomes to prevent the main mid- to long-term complication of disabling acquired flatfoot due to tendon failure. In the present report, we provide a review of the published data regarding ankle fractures associated with PTT rupture and describe our experience with a case of a multifragment medial malleolus fracture and complete rupture of the PTT diagnosed intraoperatively and surgically treated in a 34-year-old male, with 2.5 years of follow-up. PMID:25977150

  17. Flexor Carpi Radialis to Palmaris Longus Tendon Transfer for Spontaneous Rupture of the Flexor Carpi Radialis Tendon-A Review of an Uncommon Finding and Surgical Technique for Operative Correction.

    Science.gov (United States)

    Shearin, Jonathan Winkworth; Walters, Brian; Yang, S Steven

    2016-10-01

    Spontaneous ruptures of the flexor carpi radialis tendon (FCR) are rare and associated with systemic inflammatory diseases, localized tendinopathy related to scaphotrapezial-trapezoidal arthritis, or chronic immunosuppression from corticosteroids. While most cases do not require operative intervention, some patients develop weakness, impaired range of motion, and persistent pain. Previously reported surgical options include synovectomy, tendon stump resection, and osteophyte removal. We describe a surgical technique for patients with persistent symptomatology following FCR rupture in which the FCR is transposed end-to-side to the palmaris longus tendon. Three cases using this technique are presented with follow-up of 4-9 months that were collected at Lenox Hill Hospital. All three patients did well regarding specific outcome measures: grip strength, range of motion, and functional activity. FCR transfer to palmaris is an alternative to other surgical options for the spontaneous rupture of the FCR tendon in patients who remain symptomatic despite a course of non-operative therapy. PMID:27595965

  18. Flexor Hallucis Longus tendon rupture in RA-patients is associated with MTP 1 damage and pes planus

    Directory of Open Access Journals (Sweden)

    Buurke Jaap J

    2007-11-01

    Full Text Available Abstract Background To assess the prevalence of and relation between rupture or tenosynovitis of the Flexor Hallucis Longus (FHL tendon and range of motion, deformities and joint damage of the forefoot in RA patients with foot complaints. Methods Thirty RA patients with painful feet were analysed, their feet were examined clinically for the presence of pes planus and range of motion (ROM, radiographs were scored looking for the presence of forefoot damage, and ultrasound examination was performed, examining the presence of tenosyovitis or rupture of the FHL at the level of the medial malleolus. The correlation between the presence or absence of the FHL and ROM, forefoot damage and pes planus was calculated. Results In 11/60(18% of the feet, a rupture of the FHL was found. This was associated with a limited motion of the MTP1-joint, measured on the JAM (χ2 = 10.4, p = 0.034, a higher prevalence of pes planus (χ2 = 5.77, p = 0.016 and a higher prevalence of erosions proximal at the MTP-1 joint (χ2 = 12.3, p = 0.016, and joint space narrowing of the MTP1 joint (χ2 = 12.7, p = 0.013. Conclusion Rupture of the flexor hallucis longus tendon in RA-patients is associated with limited range of hallux motion, more erosions and joint space narrowing of the MTP-1-joint, as well as with pes planus.

  19. Simultaneous bilateral quadriceps tendon rupture in a patient with hyperparathyroidism undergoing long-term haemodialysis: a case report and literature review.

    Science.gov (United States)

    Gao, Mao-Feng; Yang, Hui-Lin; Shi, Wei-Dong

    2013-08-01

    Simultaneous bilateral quadriceps tendon rupture is a rare injury that represents quadriceps tendon ruptures. It is generally associated with chronic metabolic disorders and is seen in patients with uraemia undergoing maintenance haemodialysis. The present case was a 46-year-old man who presented with pain and the inability to extend his knees following a minor accident. A physical examination combined with X-radiography and magnetic resonance imaging investigations resulted in a diagnosis of bilateral quadriceps tendon rupture. He had a history of uraemia and had received regular haemodialysis for 7 years. He had high levels of serum parathyroid hormone and he was diagnosed with secondary hyperparathyroidism. Following surgical repair of both quadriceps tendons, in addition to management of the secondary hyperparathyroidism, the patient regained full active mobility of both knee joints and was able to participate in normal activities of daily living.

  20. 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

    Institute of Scientific and Technical Information of China (English)

    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

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

    Science.gov (United States)

    Yamamoto, Kenichi; Hojo, Hironori; Koshima, Isao; Chung, Ung-il; Ohba, Shinsuke

    2012-12-01

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

  2. Diagnostic Characteristics of Standard Radiographs and Magnetic Resonance Imaging of Ruptures of the Tibialis Posterior Tendon.

    Science.gov (United States)

    Ikoma, Kazuya; Ohashi, Suzuyo; Maki, Masahiro; Kido, Masamitsu; Hara, Yusuke; Kubo, Toshikazu

    2016-01-01

    The present study aimed to diagnose complete rupture (CR) and longitudinal rupture (LR) of the posterior tibial tendon (PTT) from the magnetic resonance imaging findings in patients with PTT dysfunction and to analyze and compare the radiographs from each group to identify radiographic indicators related to the progression of PTT injury that would allow the radiographic diagnosis of CR. We evaluated 32 feet in 27 patients with PTT dysfunction (mean age 66.5, range 49 to 82, years). Radiographs were used to acquire weightbearing anteroposterior images of the foot, which were used to measure the talonavicular coverage angle. Lateral images of the foot were also acquired with the patients in the standing position. These were used to measure the lateral talometatarsal angle, calcaneal pitch angle, and medial cuneiform-fifth metatarsal height. From the axial MRI findings, the patients were divided into a CR group and an LR group, and the radiographic attributes of the CR group were analyzed. Of the 32 feet in 27 patients, 12 feet (37.5%) in 11 patients displayed CR and 20 feet (62.5%) in 18 patients displayed LR. The talonavicular coverage angle was 48.3° ± 17.3° in the CR group and 33.6° ± 13.6° in the LR group (p = .012), and the talometatarsal angle was -28.8° ± 22.5° in the CR group and -25.4° ± 14.4° in the LR group (p = .596). The calcaneal pitch angle was 10.4° ± 6.7° in the CR group and 10.2° ± 8.0° in the LR group (p = .935). Finally, the medial cuneiform-fifth metatarsal height was -4.2 ± 7.1 mm in the CR group and 2.1 ± 4.7 mm in the LR group (p = .005). When a medial cuneiform-fifth metatarsal height of ≤0 mm or talonavicular coverage angle of ≥50° was used as the diagnostic criterion for CR on weightbearing radiographs, the sensitivity was 71.4%, specificity 88.9%, and diagnostic accuracy 81.3%; hence, we believe these to be satisfactory diagnostic criteria for CR. PMID:26872525

  3. Eccentric exercise in treatment of Achilles tendinopathy

    DEFF Research Database (Denmark)

    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.......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....

  4. Unusual location of a posttraumatic ganglion and rupture of the peroneus brevis tendon: a case report.

    Science.gov (United States)

    Waldecker, Ute

    2005-01-01

    The typical location of a peroneus brevis tendon tear has been described at the posterior margin of the fibula due to an entrapment mechanism or repetitive anterior subluxation of the tendon. A case of a posttraumatic intratendinous ganglion of the peroneus brevis tendon in the distal third of the peroneus brevis is reported. The ganglion developed from a longitudinal tear in the tendon substance after an inversion ankle sprain. This case is reported because of the unusual location. The clinical course and surgical treatment is also discussed. PMID:15768368

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

    Science.gov (United States)

    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

  6. The effects of tuina manipulation on the mechanical characteristics of contractual Achilles tendons of rabbits%推拿手法对兔挛缩跟腱力学特性的影响

    Institute of Scientific and Technical Information of China (English)

    汤小雨; 马燕红; 曹成福; 周军杰; 丁在成; 王伟

    2009-01-01

    Objective To investigate the effects of tuina manipulation on creep rate and maximal breaking stress of contractural Achilles tendons of rabbits. Methods Twenty-four rabbits were randomly divided into contrac-tural Achilles tendon model group, free activities group and tuina manipulation group. The opposite legs of model group were used as normal controls. Creep rate and maximal breaking stress of Achilles tendons were compared among the 4 groups. Results The average creep rate in tuina manipulation group approximated to that in normal group and was lower than that in model and free activities groups. The average maximal breaking stress in tuina manipulation group approximated to that in normal group and was higher than that in model and free activities groups. Conclusion Tuina manipulation can promote the creep rate and maximal breaking stress of contractura Achilles tendon approximately to normal level. Tuina manipulation may be useful in rehabilitation.%目的 探讨推拿手法对兔挛缩跟腱蠕变率和最大断裂应力的影响.方法 24只新西兰大白兔随机分为单纯造模组、自由活动组和推拿组,每组8只,另设单纯造模组的健侧作为正常对照组.观察4组的蠕变率和最大断裂应力并进行比较.结果 推拿组蠕变率数值低于自由活动组和单纯造模组,接近正常对照组水平;推拿组最大断裂应力高于单纯造模组和自由活动组,接近正常对照组水平.结论 推拿手法可以促进挛缩跟腱的蠕变率和最大应力负荷趋于正常水平,为临床康复治疗提供了一定的理论依据.

  7. 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

    Institute of Scientific and Technical Information of China (English)

    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.

  8. Bioactive, Elastic, and Biodegradable Emulsion Electrospun DegraPol Tube Delivering PDGF-BB for Tendon Rupture Repair.

    Science.gov (United States)

    Evrova, Olivera; Houska, Joanna; Welti, Manfred; Bonavoglia, Eliana; Calcagni, Maurizio; Giovanoli, Pietro; Vogel, Viola; Buschmann, Johanna

    2016-07-01

    Healing of tendon ruptures represents a major challenge in musculoskeletal injuries and combinations of biomaterials with biological factors are suggested as viable option for improved healing. The standard approach of repair by conventional suture leads to incomplete healing or rerupture. Here, a new elastic type of DegraPol® (DP), a polyester urethane, is explored as a delivery device for platelet-derived growth factor-BB (PDGF-BB) to promote tendon healing. Using emulsion electrospinning as an easy method for incorporation of biomolecules within polymers, DegraPol® supports loading and release of PDGF-BB. Morphological, mechanical and delivery device properties of the bioactive DP scaffolds, as well as differences arising due to different electrospinning parameters are studied. Emulsion electrospun DP scaffolds result in thinner fibers than pure DP scaffolds and experience decreased strain at break [%], but high enough for successful surgeon handling. PDGF-BB is released in a sustained manner from emulsion electrospun DP, but not completely, with still large amount of it being inside the polymeric fibers after 30 d. In vitro studies show that the bioactive scaffolds promote tenocyte proliferation in serum free and serum(+) conditions, demonstrating the potential of this surgeon-friendly bioactive delivery device to be used for tendon repair. PMID:27071839

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

    OpenAIRE

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

    OpenAIRE

    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...

  11. Achilles and Patellar Tendinopathy Loading Programmes

    DEFF Research Database (Denmark)

    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...

  12. [Ligament ruptures of the lower extremity in the elderly].

    Science.gov (United States)

    Herbort, M; Raschke, M J

    2011-08-01

    There is an increasing incidence of ligament ruptures of the lower extremities in older patients. This higher incidence is caused by the typical current demographic changes in the population and the higher level of activity and athletic motivation of the older people in our society. In this review we address the most important ligament ruptures of the lower extremity in the old patient. Quadriceps tendon and Achilles tendon ruptures are mostly the result of degenerative and abrasion changes. The ACL rupture on the other hand occurs spontaneously after adequate trauma and without former degenerative changes especially in highly active patients. For a differentiated treatment of the older patient with tendon ruptures, secondary diseases, an increased risk and complication profile and a potentially decreased compliance during rehabilitation must be taken into consideration before indicating operative or conservative therapy. There are no strict age-related limitations for indication of an operative treatment of tendon ruptures in the older patient. In this patient group a differentiated treatment decision is recommended. PMID:21766204

  13. Synthetic Augmented Suture Anchor Reconstruction for a Complete Traumatic Distal Triceps Tendon Rupture in a Male Professional Bodybuilder with Postoperative Biomechanical Assessment

    Directory of Open Access Journals (Sweden)

    Maria-Elissavet Nikolaidou

    2014-01-01

    Full Text Available Bodybuilding is a high-risk sport for distal triceps tendon ruptures. Management, especially in high-demanding athletes, is operative with suture anchor refixation technique being frequently used. However, the rate of rerupture is high due to underlying poor tendon quality. Thus, additional augmentation could be useful. This case report presents a reconstruction technique for a complete traumatic distal triceps tendon rupture in a bodybuilder with postoperative biomechanical assessment. A 28-year-old male professional bodybuilder was treated with a synthetic augmented suture anchor reconstruction for a complete triceps tendon rupture of his right dominant elbow. Postoperative biomechanical assessment included isokinetic elbow strength and endurance testing by using multiple angular velocities to simulate the “off-season” and “precompetition” phases of training. Eighteen months postoperatively and after full return to training, the biomechanical assessment indicated that the strength and endurance of the operated elbow joint was fully restored with even higher ratings compared to the contralateral healthy arm. The described reconstruction technique can be considered as an advisable option in high-performance athletes with underlying poor tendon quality due to high tensile strength and lack of donor site morbidity, thus enabling them to restore preinjury status and achieve safe return to sports.

  14. Synthetic augmented suture anchor reconstruction for a complete traumatic distal triceps tendon rupture in a male professional bodybuilder with postoperative biomechanical assessment.

    Science.gov (United States)

    Nikolaidou, Maria-Elissavet; Banke, Ingo J; Laios, Thomas; Petsogiannis, Konstantinos; Mourikis, Anastasios

    2014-01-01

    Bodybuilding is a high-risk sport for distal triceps tendon ruptures. Management, especially in high-demanding athletes, is operative with suture anchor refixation technique being frequently used. However, the rate of rerupture is high due to underlying poor tendon quality. Thus, additional augmentation could be useful. This case report presents a reconstruction technique for a complete traumatic distal triceps tendon rupture in a bodybuilder with postoperative biomechanical assessment. A 28-year-old male professional bodybuilder was treated with a synthetic augmented suture anchor reconstruction for a complete triceps tendon rupture of his right dominant elbow. Postoperative biomechanical assessment included isokinetic elbow strength and endurance testing by using multiple angular velocities to simulate the "off-season" and "precompetition" phases of training. Eighteen months postoperatively and after full return to training, the biomechanical assessment indicated that the strength and endurance of the operated elbow joint was fully restored with even higher ratings compared to the contralateral healthy arm. The described reconstruction technique can be considered as an advisable option in high-performance athletes with underlying poor tendon quality due to high tensile strength and lack of donor site morbidity, thus enabling them to restore preinjury status and achieve safe return to sports. PMID:24711944

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

    Science.gov (United States)

    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.

  16. Local biochemical and morphological differences in human Achilles tendinopathy

    DEFF Research Database (Denmark)

    Pingel, Jessica; Fredberg, U.; Qvortrup, Klaus;

    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 ex....... The expressions of growth factors, inflammatory mediators and tendon morphology were determined in both chronically diseased and healthy tendon parts.......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...

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

    Science.gov (United States)

    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

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

    Directory of Open Access Journals (Sweden)

    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.

  19. Twelve cases of the pectoralis major muscle tendon rupture with surgical treatment an average of 6.7-year follow-up

    Institute of Scientific and Technical Information of China (English)

    HE Zhen-ming; AO Ying-fang; WANG Jian-quan; HU Yue-lin; YIN Yu

    2010-01-01

    Background Pectoralis major tendon rupture is a relatively rare injury leading to both functional and cosmetic deficiency. The peak torque of the pectoralis major is significantly decreased after conservational treatment of a total rupture. We suppose that surgical intervention is better choice.Methods We retrospectively evaluated 12 patients who were diagnosed with distal pectoralis major muscle rupture and underwent operation in our institute from 1993 to 2007. All patients were male with a mean age of 32 (19-54) years. In 4 patients, tendon reconstruction was accomplished by fixing the tendon to the humerus using sutures passed through predrilled humeral bone tunnels. In 8 patients, tendon reconstruction was accomplished by directly suturing the muscle to the tendon. All patients followed an accelerated rehabilitation protocol. Treatment results were evaluated according to the following criteria: (1) visual analogue pain scale, (2) isokinetic strength measurements, (3) range of motion of shoulder joint, (4) cosmetic result, and (5) postoperative sports activity performance. In this study, we aimed to describe our surgical technique of reconstruction of the rupture of pectoralis major muscle and to summarize the clinical results of the operative treatment.Results At the final follow-up examination (6.5 years postoperatively), only nine patients were available for evaluation. Three of them had excellent results, and five had good results, while one had poor results. Eight of the patients were able to return to their preinjury level of sporting activity. In summary, 89% of the patients achieved excellent or good results. Conclusion Surgical treatment by anatomic tendon repair and accelerated rehabilitation can make recovery of strength and function of the pectoralis major muscle.

  20. 腓骨长肌前侧半重建修复陈旧性髌腱断裂的临床应用%Clinical application of anterior half of the peroneus longus tendon to reconstruct neglected patellar tendon rupture

    Institute of Scientific and Technical Information of China (English)

    孙超; 张康鑫; 李荣强

    2014-01-01

    目的:探讨利用腓骨长肌前侧半肌腱重建修复陈旧性髌腱断裂的治疗方法和疗效。方法采用腓骨长肌前侧半肌腱横穿胫骨隧道及纵穿髌骨隧道重建髌韧带并加用爱惜邦缝线减张固定方法治疗15例陈旧性髌韧带断裂患者。观察手术效果。结果手术时间60~80 min,术中出血20~50 ml,手术后切口甲级愈合14例,乙级愈合1例。住院时间10~14 d,15例患者均得到随访,随访时间18~24个月,均未出现髌腱再断裂。采用Lysholm评分评估手术效果,患膝功能均为优秀(平均92分)。结论采用自体腓骨长肌前侧半肌腱重建修复陈旧性髌腱断裂具有牢固可靠,可早期康复训练,无需内固定等优点,疗效确切,值得临床推广。%Objective To discuss the effect of anterior half of the peroneus longus tendon in reconstructing neglected patellar tendon rupture.Methods All 15 cases of neglected patellar tendon rupture were reconstructed with anterior half of the peroneus longus tendon, with the tendon crossing the patella and tibia tunnels, overlapping suture with patellar tendon and fixed by reducing tension of Ethibond, operation effect was observed.Results The operation time was 60~80 min, bleeding volume was 20~50 ml. The grade A healing incision was achieved in 14 cases, grade B healing in 1 case. The hospitalization time was 10~14 d. All 15 cases were followed up for 18~24 months and no rupture recurred. According to Lysholm score evaluation, knee function were excellent(average of 92 points).Conclusion Using the anterior half of the peroneus longus tendon to reconstruct neglected patellar tendon rupture is solid and reliable with definite curative effect and no need of internal fixation, so it is worthy of clinical application.

  1. MR imaging findings in flexed abducted supinated (FABS) position and clinical presentation following refixation of distal biceps tendon rupture using bioabsorbable suture anchors

    Energy Technology Data Exchange (ETDEWEB)

    Marnitz, T.; Steffen, I.G.; Denecke, T.; Elgeti, F.A. [Charite - Universitaetsmedizin Berlin (Germany). Klinik fuer Radiologie; Spiegel, D.; Hug, K.; Hueper, M.; Gerhardt, C; Greiner, S.; Scheibel, M. [Charite - Universitaetsmedizin Berlin (Germany). Centrum fuer Muskuloskeletale Chirurgie

    2012-05-15

    Purpose: To correlate MRI findings after suture anchor repair of distal biceps tendons with symptoms. Materials and Methods: 24 men with 25 distal biceps tendon ruptures (one bilateral) treated with suture anchor repair were retrospectively included. Follow-up after a mean of 31 months (range, 12 - 74) included clinical examination and MRI. The pain level and flexion strength compared to the uninvolved arm were recorded. MRI was performed at 1.5 T obtaining FABS position images (both elbows in 7 patients) and evaluated for artifacts, signal abnormalities, and rerupture by two experienced readers in consensus and blinded to symptoms. Pain and loss of flexion strength > 20 % were tested against MRI findings as dichotomous data using Fisher's exact chi-square tests (p < 0.05). Crosssectional areas of operated and uninvolved tendons were measured and evaluated with the Wilcoxon signed rank test (p < 0.05). Results: FABS views enabled good evaluation in 96 % of tendons. Rerupture was present in 3 of 25 elbows. Tendinous signal increase was seen in 59 % of intact tendons. We found activity-related pain or pain at rest in 32 % and a loss of flexion strength in 27 % of these cases. Testing revealed no significant correlation for any of the MRI features with any of the clinical parameters (p > 0.05). There was a 2.7-fold mean increase of the tendon cross-sectional area on the repaired side compared to the uninvolved contralateral tendon (p = 0.02). Conclusion: We found good MRI visualization of postoperative tendons, but no correlation between symptoms and MRI signal abnormalities or rerupture. The increase in caliber of the repaired tendon might promote an impingement in pronation. (orig.)

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

    Science.gov (United States)

    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

  3. MR imaging findings in flexed abducted supinated (FABS) position and clinical presentation following refixation of distal biceps tendon rupture using bioabsorbable suture anchors

    International Nuclear Information System (INIS)

    Purpose: To correlate MRI findings after suture anchor repair of distal biceps tendons with symptoms. Materials and Methods: 24 men with 25 distal biceps tendon ruptures (one bilateral) treated with suture anchor repair were retrospectively included. Follow-up after a mean of 31 months (range, 12 - 74) included clinical examination and MRI. The pain level and flexion strength compared to the uninvolved arm were recorded. MRI was performed at 1.5 T obtaining FABS position images (both elbows in 7 patients) and evaluated for artifacts, signal abnormalities, and rerupture by two experienced readers in consensus and blinded to symptoms. Pain and loss of flexion strength > 20 % were tested against MRI findings as dichotomous data using Fisher's exact chi-square tests (p 0.05). There was a 2.7-fold mean increase of the tendon cross-sectional area on the repaired side compared to the uninvolved contralateral tendon (p = 0.02). Conclusion: We found good MRI visualization of postoperative tendons, but no correlation between symptoms and MRI signal abnormalities or rerupture. The increase in caliber of the repaired tendon might promote an impingement in pronation. (orig.)

  4. Using the Literature to Understand Achilles' Fate.

    Science.gov (United States)

    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

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

    OpenAIRE

    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...

  6. Pitfalls during biomechanical testing - Evaluation of different fixation methods for measuring tendons endurance properties.

    Science.gov (United States)

    Hangody, Gy; Pánics, G; Szebényi, G; Kiss, R; Hangody, L; Pap, K

    2016-03-01

    The goal of the study was to find a proper technique to fix tendon grafts into an INSTRON loading machine. From 8 human cadavers, 40 grafts were collected. We removed the bone-patella tendon-bone grafts, the semitendinosus and gracilis tendons, the quadriceps tendon-bone grafts, the Achilles tendons, and the peroneus longus tendons from each lower extremity. We tested the tendon grafts with five different types of fixation devices: surgical thread (Premicron 3), general mounting clamp, wire mesh, cement fixation, and a modified clamp for an INSTRON loading machine. The mean failure load in case of surgical thread fixation was (381N ± 26N). The results with the general clamp were (527N ± 45N). The wire meshes were more promising (750N ± 21N), but did not reach the outcomes we desired. Easy slippages of the ends of the tendons from the cement encasements were observed (253N ± 18N). We then began to use Shi's clamp that could produce 977N ± 416N peak force. We combined Shi's clamp with freezing of the graft and the rupture of the tendon itself demonstrated an average force of 2198 N ± 773N. We determined that our modified frozen clamp fixed the specimens against high tensile forces.

  7. The outcome at 15 years of endoscopic anterior cruciate ligament reconstruction using hamstring tendon autograft for 'isolated' anterior cruciate ligament rupture.

    Science.gov (United States)

    Bourke, H E; Gordon, D J; Salmon, L J; Waller, A; Linklater, J; Pinczewski, L A

    2012-05-01

    The purpose of this study was to report the outcome of 'isolated' anterior cruciate ligament (ACL) ruptures treated with anatomical endoscopic reconstruction using hamstring tendon autograft at a mean of 15 years (14.25 to 16.9). A total of 100 consecutive men and 100 consecutive women with 'isolated' ACL rupture underwent four-strand hamstring tendon reconstruction with anteromedial portal femoral tunnel drilling and interference screw fixation by a single surgeon. Details were recorded pre-operatively and at one, two, seven and 15 years post-operatively. Outcomes included clinical examination, subjective and objective scoring systems, and radiological assessment. At 15 years only eight of 118 patients (7%) had moderate or severe osteo-arthritic changes (International Knee Documentation Committee Grades C and D), and 79 of 152 patients (52%) still performed very strenuous activities. Overall graft survival at 15 years was 83% (1.1% failure per year). Patients aged surgery and patients with > 2 mm of laxity at one year had a threefold increase in the risk of suffering a rupture of the graft (p = 0.002 and p = 0.001, respectively). There was no increase in laxity of the graft over time. ACL reconstructive surgery in patients with an 'isolated' rupture using this technique shows good results 15 years post-operatively with respect to ligamentous stability, objective and subjective outcomes, and does not appear to cause osteoarthritis.

  8. Muscular tendinous junction rupture of the posterior tibial tendon after closed bimalleolar ankle fracture.

    Science.gov (United States)

    Jasqui-Remba, Salomon; Rodriguez-Corlay, Ruy Ernesto

    2016-01-01

    In this case report, we present an acute rupture in the muscular tendinous junction of a posterior tibialis muscle in a bimalleolar closed ankle fracture after a high-energy trauma in a 30-year-old patient with no significant medical history. Fracture was confirmed by simple X-rays, and was treated with an open reduction in which both of the fractures were treated with osteosynthesis material and reparation of the syndesmosis. If left untreated, this uncommon finding can result in a bad postsurgical outcome; we believe this injury is more common but under-reported in the literature. The surgeon should be aware and look specifically for this type of lesion during the procedure. Finding and treating this injury requires special postoperative care, non-weight-bearing instructions and balanced physiotherapy. PMID:26843223

  9. Tendon Transfers in the Rheumatoid Hand for Reconstruction.

    Science.gov (United States)

    O'Sullivan, Michael Brody; Singh, Hardeep; Wolf, Jennifer Moriatis

    2016-08-01

    Long-standing rheumatoid arthritis can result in spontaneous tendon rupture caused by attrition of the tendons. Ruptures of the ulnar-sided extensor tendons, flexor pollicis longus, and the flexor digitorum profundus can be seen. Primary repair of these tendon ruptures is frequently not possible because of delayed presentation and tendon damage by the disease process. Tendon transfers are the preferred method of treatment in patients with rheumatoid arthritis. At surgery, it is critical to address the underlying cause of rupture to prevent future tendon ruptures. Rates of tendon rupture may decrease due to improved medications for rheumatoid arthritis. PMID:27387084

  10. Achilles tendinopathy

    DEFF Research Database (Denmark)

    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 ...

  11. Tendon, tendon healing, hyperlipidemia and statins

    Science.gov (United States)

    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

  12. 循环训练模式对兔跟腱末端区组织形态学的影响%Effect of cyclic training model on terminal structure of rabbit Achilles tendon: an experimental study

    Institute of Scientific and Technical Information of China (English)

    黄昌林; 高旺; 黄涛; 郭振海

    2012-01-01

    目的 观察循环训练对兔跟腱末端区组织形态学的影响,探讨循环训练对训练性末端病的预防作用.方法 72只日本大耳白兔随机分为正常对照组、跑步训练组、跳跃训练组、循环训练组(n=18),各组于第2、3、4、6、8、10周时随机处死3只动物,取双侧后足跟腱末端区组织,光镜下观察病理形态学变化,进行病理学评分及统计学分析.结果 光镜观察显示,跳跃训练模式下末端区组织腱纤维部分和纤维软骨部分受损严重;跑步训练模式下末端区组织腱纤维部分受损严重,纤维软骨部分受损较轻;与跳跃训练组及跑步训练组比较,循环训练模式下末端区组织损伤明显减轻.跳跃训练组第2、3、4、6、8、10周时跟腱末端区组织病理学评分分别为1.17±0.12、2.19±0.15、3.23±0.20、4.66±0.16、4.71±0.18、4.63±0.13,而跑步训练组分别为1.16±0.13、1.15±0.14、2.18±0.12、2.99±0.15、3.98±0.16、4.01±0.12,跳跃训练组病理学评分升高早于跑步训练组,且从第3周起其分值即明显高于跑步训练组(P<0.05),两组评分差异主要源于潮线的变化.循环训练组第2、3、4、6、8、10周时跟腱末端区组织病理学评分分别为1.13±0.14、1.16±0.17、1.15±0.13、2.18±0.13、2.17±0.12、2.92±0.11,早期阶段病理学评分与正常对照组比较无明显差异,在训练晚期(6周以后)评分升高,但其分值低于跳跃训练组及跑步训练组(P<0.05),且评分改变主要源于腱周组织和潮线的病理学变化.结论 循环训练可以为跟腱末端区组织塑形改建提供充分的修复时间,降低末端区组织受损程度.应用循环训练法不仅可有效预防末端病的发生,还可促进末端区组织的塑形改建,增强其抗损伤能力.%Objective To observe the effect of cyclic training on histomorphology of the terminal structure of rabbit Achilles tendon, and explore its preventive effect on training

  13. Atraumatic quadriceps tendon tear associated with calcific tendonitis.

    Science.gov (United States)

    Abram, Simon G F; Sharma, Akash D; Arvind, Chinnakonda

    2012-11-27

    Calcific tendonitis of the quadriceps tendon is an uncommon condition. We present the first case of a quadriceps tendon tear associated with calcific tendonitis. In this case, the patient presented with symptoms mimicking a rupture of the quadriceps tendon. This case illustrates that although calcific tendonitis of the quadriceps is a rare condition it is not benign and should be considered when investigating acute symptoms associated with the extensor mechanism of the knee.

  14. 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

    Institute of Scientific and Technical Information of China (English)

    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

  15. Is tendon stiffness correlated to the dissipation coefficient?

    International Nuclear Information System (INIS)

    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)

  16. Magnetic Resonance Imaging in Chronic Achilles Tendinopathy

    Energy Technology Data Exchange (ETDEWEB)

    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

  17. Well-aligned chitosan-based ultrafine fibers committed teno-lineage differentiation of human induced pluripotent stem cells for Achilles tendon regeneration.

    Science.gov (United States)

    Zhang, Can; Yuan, Huihua; Liu, Huanhuan; Chen, Xiao; Lu, Ping; Zhu, Ting; Yang, Long; Yin, Zi; Heng, Boon Chin; Zhang, Yanzhong; Ouyang, Hongwei

    2015-01-01

    Physical property of substrates such as stiffness and topography have been reported to induce mesenchymal stem cells differentiation into bone, muscle and neuron lineages. Human-induced pluripotent stem cells (hiPSCs) are a highly promising cell source for regenerative medicine. However, physical properties have not yet been reported to successfully induce pluripotent stem cells into specific lineages. This study aimed to develop a robust, stepwise topographic strategy to induce hiPSCs differentiate into teno-lineage. A novel spinning approach termed stable jet electrospinning (SJES), is utilized to fabricate continuous well-aligned ultrafine fibers (891 ± 71 nm), which mimic the native tendon's microstructure and mechanical properties. hiPSCs are first differentiated into MSCs on smooth plastic surface as confirmed by the differentiations into three mesenchymal lineages and expression of characteristic MSC surface markers through an EMT (Epithelial-Mesenchymal Transition) process. Subsequently, the hiPSC derived MSCs are seeded onto well-aligned fibers to differentiate into tenocyte-like cells through activating mechanic-signal pathway. The in situ tendon repair study further confirms that aligned fiber scaffold with hiPSC-MSCs had significant effect on improving the structural and mechanical properties of tendon injury repair. These findings indicate that the stepwise physical substrate change strategy can be adopted to induce hiPSCs differentiation for tendon tissue regeneration. PMID:25890767

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

    Science.gov (United States)

    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

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

    DEFF Research Database (Denmark)

    Pingel, Jessica; Petersen, Marie Christine Helby; 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...

  20. Magnetic resonance imaging of ankle ligaments and tendon injuries

    International Nuclear Information System (INIS)

    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.)

  1. 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

    Energy Technology Data Exchange (ETDEWEB)

    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

  2. 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

    Institute of Scientific and Technical Information of China (English)

    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

  3. Bilateral Simultaneous Quadriceps Tendon Rupture in a 24-Year-Old Obese Patient: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Fahad H. Abduljabbar

    2016-01-01

    Full Text Available Introduction. Simultaneous bilateral quadriceps tendon ruptures (SBQTR are uncommon knee injuries and most frequently occur in male patients, over 50 years of age. It can be associated with one or more predisposing risk factors like obesity, steroids use, and hyperparathyroidism. The main focus of this paper is to review SBQTR in obese patients. Case Report. We are reporting the youngest patient in the literature to date, a 24-year-old obese male patient, who presented to the emergency department complaining of bilateral knee pain and inability to walk after a fall during a basketball game. His clinical examination revealed the presence of a palpable suprapatellar gap and loss of knee extension bilaterally. Magnetic resonance imaging (MRI confirmed that both of his quadriceps tendons were ruptured. A day after his diagnosis, the patient underwent successful operative repair followed by rehabilitation. At the two-year follow-up, the patient had full strength of both quadriceps muscles with no extension lag. Conclusion. The diagnosis of SBQTR can be challenging. Early diagnosis and treatment are associated with better functional outcome compared to delayed treatment. Physicians should have a high index of clinical suspicion in order not to miss such an injury and achieve favourable outcomes.

  4. 改良法重建拇长伸肌腱功能的疗效观察%EFFECTIVENESS OF MODIFIED EXTENSOR INDICIS PROPRIUS TENDON TRANSFER FOR RECONSTRUCTION OF SPONTANEOUSLY RUPTURED EXTENSOR POLLICIS LONGUS TENDON

    Institute of Scientific and Technical Information of China (English)

    郑鑫; 安洪宾; 陈滔; 王海宝

    2012-01-01

    目的 通过与传统示指固有伸肌腱转移术比较,探讨改良法重建拇长伸肌腱功能的疗效. 方法 2009年1月-2011年12月,采用改良法重建拇长伸肌腱功能治疗11例拇长伸肌腱自发性断裂患者(改良组).手术在传统术式基础上,增加对拇长伸肌腱近侧断端与示指固有伸肌腱加固缝合,以及示指固有伸肌腱远端环绕拇短伸肌腱反折缝合.术后采用SEEM(specific EI-EPL evaluation method)评价方法评定手术疗效,并与同期采用传统示指固有伸肌腱转移术治疗的18例患者(传统组)进行比较.两组患者性别、年龄、病程及致伤原因等一般资料比较,差异均无统计学意义(P> 0.05),具有可比性. 结果 术后两组患者切口均Ⅰ期愈合.传统组5例失访,其余患者均获随访,随访时间8个月~2年6个月,平均1年6个月.末次随访时根据SEEM评价方法,改良组拇指抬高丢失及屈曲丢失均显著小于传统组,差异有统计学意义(P< 0.05);示指单独背伸丢失与传统组相似(P>0.05).改良组获优9例,良2例,优良率100%;传统组获优5例,良6例,可2例,优良率为84.6%;两组优良率比较,差异有统计学意义(x2=0.03,P=-0.03). 结论 与传统示指固有伸肌腱转移术相比,改良法重建拇长伸肌腱功能手术操作简便,增加了转移肌腱力量,近期疗效满意,但远期疗效需进一步随访.%Objective To investigate the effectiveness of modified extensor indicis proprius (EIP) tendon transfer for reconstruction of spontaneously ruptured extensor pollicis longus (EPL) tendon by comparing with the traditional EIP tendon transfer. Methods Between January 2009 and December 2011, 11 cases of spontaneously ruptured EPL tendon were treated by modified EIP tendon transfer to reconstruct extension function (modified group). On the base of traditional procedure, the proximal end of EPL tendon was sutured with EIP tendon and the distal end of EIP tendon was crossed round

  5. Rupture

    CERN Multimedia

    Association du personnel

    2006-01-01

    Our Director-General is indifferent to the tradition of concertation foreseen in our statutes and is "culturally" unable to associate the Staff Association with problem-solving in staff matters. He drags his heels as long as possible before entering into negotiations, presents "often misleading" solutions at the last minute which he only accepts to change once a power struggle has been established. Faced with this rupture and despite its commitment to concertation between gentlemen. The results of the poll in which the staff is invited to participate this week. We therefore need your support to state our claims to the Governing Bodies. The Staff Association proposes a new medium of communication and thus hopes to show that it is ready for future negotiations. The pages devoted to the Staff Association are presented in a more informative, reactive and factual manner and in line with the evolution of the social situation at CERN. We want to establish strong and continuous ties between the members of CERN and ou...

  6. Analysis of therapeutic effect of rehabilitation treatment improving function of knee joint following reconstruction anterior crucial ligament with allogenic achilles tendon under arthroscopy%跟腱重建前十字韧带术后康复治疗恢复膝关节功能的疗效分析

    Institute of Scientific and Technical Information of China (English)

    常青; 黄迅悟; 张晓鸥; 郑光新

    2002-01-01

    Objective Combining the reconstruction of anterior crucial ligament(ACL) with functional rehabilitation,we recover the injured knee as possible as can.Methods 38 patients received ACL reconstruction with allogenci Achilles tendon under arthroscopy.We reconstructed the injured ACL and the injured medial crucial ligament(MCL) by utilization of length of achiles tendon.Then we carried out different rehabilitations in accordance with special needs of the patients.Results The follow up was performed for more than 7 months in 34 cases.Lysholm method was used to evaluate patients' function before and after operation.Results showed average score was 53.8 preoperatively, and 84.2 postoperatively,the good rate was 84.4% .In the objective examination,anterior drawer test(ADT),31 cases were positive preoperatively,1 was positive postoperatively;lachman test:34 were positive preoperatively,1 was positive postoperatively;4 were weak positive postoperatively.There were 3 cases with pain of knee joints and 4 cases with limitation of activity of knee joints(5~ 20 degree) postopratively.Conclusion Combination of reconsgruction of ACL with allogenic achilles tendon and the functional rehabilitation can gain remarkable curative effect.

  7. 踇长屈肌腱转移术治疗陈旧性胫后肌腱断裂10例%The Treatment of Flexor Hallucis Longus Tendon Transfer for Chronic Posterior Tibial Tendon Rupture in 10 Cases

    Institute of Scientific and Technical Information of China (English)

    程贵元; 戴志刚; 刘金兰; 冯磊; 刘帅

    2013-01-01

      目的 观察踇长屈肌腱转移手术治疗陈旧性胫后肌腱断裂的疗效。方法 2008年5月~2011年4月对10例陈旧性胫后肌腱断裂患者行踇长屈肌腱转移术,术后随访6~26个月,测量术前、术后足最大内翻、跖屈角度,有无跖行步态等。结果 患者足内翻、跖屈功能较术前明显改善,内翻角度术前(0.100±3.604)°,术后(18.200±4.442)°,与术前相比内翻角度有显著差异(t=18.010,P<0.05);跖屈角度术前(0.600±3.893)°,术后(20.600±3.273)°,与术前相比跖屈角度有显著差异(t=15.000,P<0.05);跖行步态术前无,术后有。结论 踇长屈肌腱转移术是治疗陈旧性胫后肌腱断裂的有效方法。%Objective To evaluate the efficacy of the treatment of flexor hallucis longus tendon transfer for chronic posterior tibial tendon rupture .Methods Ten cases with chronic posterior tibial tendon rupture were selected be-tween May 2008 and April 2011.The treatment was all performed by flexor hallucis longus tendon transfer .All patients were followed up for 6 ~26 months,the preoperative angle and postoperative angle of maximum varus ,plantar flexion were measured,and presence of plantar line gait was observed .Results Maximum varus and plantar flexion function had been significantly improved compared with preoperative .Maximum varus angle from(0.100 ±3.604)degrees to(18.200 ±4.442)degrees,compared with the preoperative had significant difference (t=18.010,P<0.05);plantar flexion an-gle from(0.600 ±3.893)degrees to(20.600 ±3.273)degrees also had significant difference compared with the preoper-ative(t=15.000,P<0.05).Plantar line gait appeared after surgery.Conclusion Flexor hallucis longus tendon trans-fer is a effective method to treat chronic posterior tibial tendon rupture .

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

    Directory of Open Access Journals (Sweden)

    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. Changes in histoanatomical distribution of types I, III and V collagen promote adaptative remodeling in posterior tibial tendon rupture

    Directory of Open Access Journals (Sweden)

    Érika Satomi

    2008-01-01

    Full Text Available INTRODUCTION: Posterior tibial tendon dysfunction is a common cause of adult flat foot deformity, and its etiology is unknown. PURPOSE: In this study, we characterized the morphologic pattern and distribution of types I, III and V collagen in posterior tibial tendon dysfunction. METHOD: Tendon samples from patients with and without posterior tibial tendon dysfunction were stained by immunofluorescence using antibodies against types I, III and V collagen. RESULTS: Control samples showed that type V deposited near the vessels only, while surgically obtained specimens displayed type V collagen surrounding other types of collagen fibers in thicker adventitial layers. Type III collagen levels were also increased in pathological specimens. On the other hand, amounts of collagen type I, which represents 95% of the total collagen amount in normal tendon, were decreased in pathological specimens. CONCLUSION: Fibrillogenesis in posterior tibial tendon dysfunction is altered due to higher expression of types III and V collagen and a decreased amount of collagen type I, which renders the originating fibrils structurally less resistant to mechanical forces.

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

    Science.gov (United States)

    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

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

    OpenAIRE

    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 ...

  12. Diagnosis of 4 cases of spontaneous rupture of extensor tendon and treatment experience%伸肌腱自发性断裂的诊断及治疗体会(附4例报告)

    Institute of Scientific and Technical Information of China (English)

    张玮曾; 王玉栋; 董居明

    2014-01-01

    Objective To explore the diagnosis and treatment of spontaneous rupture of extensor tendon. Methods All 4 cases of spontaneous rupture of the extensor tendon underwent operation treatment, treatment effect were observed and analyzed.Results All 4 patients were followed up for 1~5 years, except for 1 case of extension limitation of about 20°, and 3 cases of normal function.Conclusion Misdiagnosis rate of spontaneous rupture of extensor tendon is high, the partial tendon transfer braided suture operation has good treatment effect.%目的:探讨伸肌腱自发性断裂的诊断及治疗方法。方法对4例伸肌腱自发性断裂患者行手术治疗,观察并分析其效果。结果本组4例患者,术后随访1~5年,除1例伸直受限约20°外,其余3例功能基本正常。结论伸肌腱自发性断裂临床诊断误诊率高,行局部伸肌腱转位编织缝合手术治疗效果良好。

  13. Cadaver study of the topography of the musculotendinous junction of the finger extensor muscles: applicability to tendon rupture following closed wrist trauma.

    Science.gov (United States)

    Lepage, D; Tatu, L; Loisel, F; Vuillier, F; Parratte, B

    2015-09-01

    Rupture of the extensor pollicis longus (EPL) tendon in the wrist is a delayed complication that can occur after wrist injury. Several etiology-related hypotheses have been made to explain these ruptures. The one most commonly accepted is necrosis at the musculotendinous junction of the EPL, which is compressed between the extensor retinaculum and dorsal aspect of the radius. To confirm this hypothesis, we performed an anatomical study to show the close relationship between the extensor retinaculum and the musculotendinous junction of the EPL muscle. We calculated the distance between the musculotendinous junction of the various finger extensor muscles and the proximal edge of the extensor retinaculum. We were able to show that this junction is located under the extensor retinaculum for the extensor indicis (EI) and EPL muscles, but the latter is in the third extensor compartment, which is a tight, confined space. Any pressure increase in this space following trauma, for example, can bring about compartment syndrome at this musculotendinous junction, which some authors have found to be poorly vascularized. PMID:25577541

  14. 保留止点自体肌腱移植治疗陈旧性髌韧带断裂%Autologous tendon graft with preserved distal insertions for the treatment of old patellar tendon rupture

    Institute of Scientific and Technical Information of China (English)

    朱华强; 刘云; 陈法; 刘德淮

    2013-01-01

    that would seriously affect the function of the knee joint. OBJECCTIVE:To explore the clinical efficacy of autologous tendon graft with preserved distal insertions on the treatment of old patel ar tendon rupture. METHODS:Eight patients with unilateral old patel ar tendon rupture underwent reconstruction using semitendinosus-gracilis tendons with preserved distal insertions. After patel ar ligament reconstruction, semi-circular gypsum was used for fixation and the knee joint was kept in flexion of 15° for 1 week. At 2 weeks after patel ar ligament reconstruction, surgical incision suture was removed, and 2 weeks later, gypsum was removed for quadriceps isometric and isotonic exercises. At 6 weeks after reconstruction, adjustable knee brace was used for the range of motion exercise, three times per day, and the flexion angle was increased for 10° every week. The patients had ful y weight-bearing walking at 3 months after patel ar ligament reconstruction. RESULTS AND CONCLUSION:Al patients had no complications after patel ar ligament reconstruction, and X-ray film showed that the patel a returned to normal height. Function of knee joint had general y returned to normal. No patient had knee discomfort after walking for two kilometers in 24 months. Compared with that before patel ar ligament reconstruction, Lysholm score of the patients at 24 months after reconstruction was increased significantly (P  方法:对8例单侧陈旧性髌韧带断裂的患者行保留止点的半肌腱、股薄肌重建髌韧带,髌韧带重建后行半环形石膏后托固定屈膝15°1周,髌韧带重建后2周拆除切口缝线,3周去除石膏行股四头肌等长等张练习,6周时佩戴可调节膝关节护具进行膝关节活动度锻炼,3次/d,每周增加10°。髌韧带重建3个月后允许完全负重行走。  结果与结论:所有患者髌韧带重建后无并发症,X射线示髌骨恢复正常高度。膝关节功能恢复良好。

  15. Tendon transfers for the drop foot.

    Science.gov (United States)

    Schweitzer, Karl M; Jones, Carroll P

    2014-03-01

    The paralytic drop foot represents a challenging problem for even the most experienced orthopedic surgeon. Careful patient selection, thorough preoperative examination and planning, and application of tendon transfer biomechanical and physiologic principles outlined in this article can lead to successful results, either through a posterior tibialis tendon transfer, Bridle transfer, or variations on these procedures. Achilles lengthening or gastrocnemius recession may also be needed at the time of tendon transfer. PMID:24548510

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

    Directory of Open Access Journals (Sweden)

    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.

  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

    Institute of Scientific and Technical Information of China (English)

    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. Are Sport-Specific Profiles of Tendon Stiffness and Cross-Sectional Area Determined by Structural or Functional Integrity?

    Directory of Open Access Journals (Sweden)

    Hans-Peter Wiesinger

    Full Text Available The present study aimed to determine whether distinct sets of tendon properties are seen in athletes engaged in sports with contrasting requirements for tendon function and structural integrity. Patellar and Achilles tendon morphology and force-deformation relation were measured by combining ultrasonography, electromyography and dynamometry in elite ski jumpers, distance runners, water polo players and sedentary individuals. Tendon cross-sectional area normalized to body mass2/3 was smaller in water polo players than in other athletes (patellar and Achilles tendon; -28 to -24% or controls (patellar tendon only; -9%. In contrast, the normalized cross-sectional area was larger in runners (patellar tendon only; +26% and ski jumpers (patellar and Achilles tendon; +21% and +13%, respectively than in controls. Tendon stiffness normalized to body mass2/3 only differed in ski jumpers, compared to controls (patellar and Achilles tendon; +11% and +27%, respectively and to water polo players (Achilles tendon only; +23%. Tendon size appears as an adjusting variable to changes in loading volume and/or intensity, possibly to preserve ultimate strength or fatigue resistance. However, uncoupled morphological and mechanical properties indicate that functional requirements may also influence tendon adaptations.

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

    DEFF Research Database (Denmark)

    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 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 tendons...... and compared to values obtained by 72-h post-exercise. Power Doppler was used to monitor alterations in intratendinous blood flow velocity of the Achilles tendon and MRI used to quantitate changes in tendon cross-section area. Acute loading resulted in an increased collagen synthesis 72 h after the run in both...

  20. A New Method to Control Tendon Tension in the Transfer of Extensor Indicis Proprius to Extensor Pollicis Longus Rupture.

    Science.gov (United States)

    Lee, Jae Hoon; Cho, Young Joo; Chung, Duke Whan

    2015-12-01

    This study evaluated the outcomes of extensor indicis proprius (EIP) transfer based on varying degrees of thumb extension after EIP transfer and elongation of the EIP. A total of 24 cases with extensor pollicis longus (EPL) ruptures who underwent EIP to EPL transfer were analyzed prospectively. The EIP transfer was performed with neutral wrist positioning. In group I (12 cases), EIP and EPL were sutured on the thumb in neutral state at interphalangeal joint, and the mean EIP elongation of this group measured 0.2 cm (range, -0.5 to 0.5 cm). In group II (12 cases), EIP and EPL were sutured on the thumb in full extension state at interphalangeal joint, and the mean EIP elongation measured 0.7 cm (range, 0.5-1.5 cm). The mean follow-up period was 13.5 months. The 2 groups were compared based on thumb motion, grip strength, pinch power, and the Disabilities of the Arm, Shoulder, and Hand questionnaire score. Extension of the thumb at the interphalangeal joint was -5.2° in group I and 7.2° in group II, demonstrating statistically significant differences. No significant differences were found between the 2 groups in other parameters. In EIP transfer, thumb in extension after transfer and EIP elongation is recommended for restoring thumb extension at the interphalangeal joint. PMID:26418770

  1. Quadriceps tendon rupture: a biomechanical comparison of transosseous equivalent double-row suture anchor versus transosseous tunnel repair.

    Science.gov (United States)

    Hart, Nathan D; Wallace, Matthew K; Scovell, J Field; Krupp, Ryan J; Cook, Chad; Wyland, Douglas J

    2012-09-01

    Quadriceps rupture off the patella is traditionally repaired by a transosseous tunnel technique, although a single-row suture anchor repair has recently been described. This study biomechanically tested a new transosseous equivalent (TE) double-row suture anchor technique compared with the transosseous repair for quadriceps repair. After simulated quadriceps-patella avulsion in 10 matched cadaveric knees, repairs were completed by either a three tunnel transosseous (TT = 5) or a TE suture anchor (TE = 5) technique. Double-row repairs were done using two 5.5 Bio-Corkscrew FT (fully threaded) (Arthrex, Inc., Naples, FL, USA) and two 3.5 Bio-PushLock anchors (Arthrex, Inc., Naples, FL, USA) with all 10 repairs done with #2 FiberWire suture (Arthrex, Inc., Naples, FL). Cyclic testing from 50 to 250 N for 250 cycles and pull to failure load (1 mm/s) were undertaken. Gap formation and ultimate tensile load (N) were recorded and stiffness data (N/mm) were calculated. Statistical analysis was performed using a Mann-Whitney U test and survival characteristics examined with Kaplan-Meier test. No significant difference was found between the TE and TT groups in stiffness (TE = 134 +/- 15 N/mm, TT = 132 +/- 26 N/mm, p = 0.28). The TE group had significantly less ultimate tensile load (N) compared with the TT group (TE = 447 +/- 86 N, TT = 591 +/- 84 N, p = 0.04), with all failures occurring at the suture eyelets. Although both quadriceps repairs were sufficiently strong, the transosseous repairs were stronger than the TE suture anchor repairs. The repair stiffness and gap formation were similar between the groups.

  2. 腓骨长肌腱转移术治疗陈旧性跟腱断裂%Treatment of neglected achilles tendon rupture with peroneus longus tendon transfer

    Institute of Scientific and Technical Information of China (English)

    何锦泉; 庞桂根; 贾鹏

    2008-01-01

    [目的]探讨利用腓骨长肌腱治疗陈旧性跟腱断裂的手术方法和经验. [方法]将腓骨长肌腱在远端处切断,经皮下隧道移位修复跟腱断裂. [结果]根据Arner-Lindholm评定标准,优11例,良10例.未发生跟腱再次断裂.2例出现伤口延迟愈合,经康复训练,所有患者均在术后10周左右弃拐完全负重行走. [结论]用腓骨长肌腱治疗断端缺损较多,或者肌腱在跟骨结节附近断裂的陈旧性跟腱断裂是一种疗效满意,康复较快的手术方法.

  3. 拇长屈肌腱转移修复陈旧性跟腱断裂%Flexor hallucis longus tendon transfer for repair of old rupture of Achilles tendon

    Institute of Scientific and Technical Information of China (English)

    程志军; 郭亮; 吴国正

    2012-01-01

    @@ 2007年9月~2010年9月,我科采用拇长屈肌腱转移修复陈旧性跟腱断裂10例,效果满意,报道如下. 1材料与方法 1.1病例资料本组10例,男7例,女3例,年龄20~53岁.左侧4例,右侧6例.跟腱断裂部位:止点部断裂3例,腱部断裂7例.均有明确的外伤史.MRI显示:跟腱异常信号,连续性中断.受伤至手术时间3周~1年.

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

    OpenAIRE

    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...

  5. Ciprofloxacin-Induced Tendinopathy of the Gluteal Tendons

    OpenAIRE

    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...

  6. Endoscopic-Assisted Flexor Hallucis Longus Transfer: Harvest of the Tendon at Zone 2 or Zone 3.

    Science.gov (United States)

    Lui, Tun Hing

    2015-12-01

    Flexor hallucis longus (FHL) tendon transfer is indicated for reconstruction of the Achilles tendon with a gap larger than 5 cm. The tendon can be harvested at zone 2 or zone 3 by minimally invasive techniques with the advantage of minimal soft-tissue dissection. The tendon can be harvested under the sustentaculum tali by zone 2 FHL tendoscopy. It is adequate for FHL transfer to the posterior calcaneal tubercle. If a double-thickness reconstruction of a huge gap of the Achilles tendon is indicated, the tendon can be harvested at the level of the hallux by means of a tendon stripper. However, the interconnection tendon of the master knot of Henry can be split together with the FHL or flexor digitorum longus tendon instead of being cut. Zone 2 FHL tendoscopy can be used to release the split tendon to complete the FHL harvest. PMID:27284516

  7. Lateral force transmission between human tendon fascicles

    DEFF Research Database (Denmark)

    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 fascicle...

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

    DEFF Research Database (Denmark)

    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 

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

    Science.gov (United States)

    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

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

    Science.gov (United States)

    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

  11. Partial tear of the quadriceps tendon in a child

    Energy Technology Data Exchange (ETDEWEB)

    Khanna, Geetika; El-Khoury, George [University of Iowa Hospitals and Clinics, Department of Radiology, Iowa City, IA (United States)

    2008-06-15

    We present a case of partial rupture of the quadriceps tendon in an 8-year-old girl. This is one of the youngest patients reported with a quadriceps tendon rupture, an entity seen predominantly in middle-aged people. The strength of the muscle tendon unit in a child makes tendon injuries extremely unusual as compared to apophyseal avulsions. The MR imaging findings of this unusual pediatric injury are illustrated. (orig.)

  12. Partial tear of the quadriceps tendon in a child.

    Science.gov (United States)

    Khanna, Geetika; El-Khoury, George

    2008-06-01

    We present a case of partial rupture of the quadriceps tendon in an 8-year-old girl. This is one of the youngest patients reported with a quadriceps tendon rupture, an entity seen predominantly in middle-aged people. The strength of the muscle tendon unit in a child makes tendon injuries extremely unusual as compared to apophyseal avulsions. The MR imaging findings of this unusual pediatric injury are illustrated.

  13. Eccentric rehabilitation exercise increases peritendinous type I collagen synthesis in humans with Achilles tendinosis.

    Science.gov (United States)

    Langberg, H; Ellingsgaard, H; Madsen, T; Jansson, J; Magnusson, S P; Aagaard, P; Kjaer, M

    2007-02-01

    It has been shown that 12 weeks of eccentric heavy resistance training can reduce pain in runners suffering from chronic Achilles tendinosis, but the mechanism behind the effectiveness of this treatment is unknown. The present study investigates the local effect of an eccentric training regime on elite soccer players suffering from chronic Achilles tendinosis on the turnover of the peritendinous connective tissue. Twelve elite male soccer players, of whom six suffered from unilateral tendinosis and six were healthy controls, participated in this study. All participants performed 12 weeks of heavy-resistance eccentric training apart from their regular training and soccer activity. Before and after the training period the tissue concentration of indicators of collagen turnover was measured by the use of the microdialysis technique. After training, collagen synthesis was increased in the initially injured tendon (n=6; carboxyterminal propeptide of type I collagen (PICP): pre 3.9+/-2.5 microg/L to post 19.7+/-5.4 microg/L, Pcollagen synthesis was unchanged in healthy tendons in response to training (n=6; PICP: pre 8.3+/-5.2 microg/L to post 11.5+/-5.0 microg/L, P>0.05). Collagen degradation, measured as carboxyterminal telopeptide region of type I collagen (ICTP), was not affected by training neither in the injured nor in the healthy tendons. The clinical effect of the 12 weeks of eccentric training was determined by using a standardized loading procedure of the Achilles tendons showing a decrease in pain in all the chronic injured tendons (VAS before 44+/-9, after 13+/-9; Peccentric training regime. The present study demonstrates that chronically injured Achilles tendons respond to 12 weeks of eccentric training by increasing collagen synthesis rate. In contrast, the collagen metabolism in healthy control tendons seems not to be affected by eccentric training. These findings could indicate a relation between collagen metabolism and recovery from injury in human

  14. Experimental study of the impact of different training patterns on the biomechanical performance of the terminal region of Achilles tendon%不同训练模式对兔跟腱末端区生物力学性能的影响

    Institute of Scientific and Technical Information of China (English)

    郭振海; 黄昌林; 高旺

    2012-01-01

    目的 研究不同训练模式对兔跟腱末端区组织生物力学性能的影响,为在军事体能训练中提高跟腱末端区抗应力及抗损伤能力提供科学依据.方法 日本大耳白兔50只,随机分为正常对照组(n=5)、跑步训练组(采用跑台跑步训练,n=15)、跳跃训练组(采用电击跳跃训练,n=15)、循环训练组(采用跑跳循环训练,n=15).正常对照组动物于实验开始时处死,各训练组分别于2、3、4、6、8周时随机处死3只,取双侧跟腱末端区,进行生物力学测定.结果 跑步训练组第6周时极限应力、弹性模量均达到最高,之后随着训练时间的延长有所下降;跳跃训练组在第4周时极限应力、弹性模量均达峰值,之后亦逐渐下降,第8周时与对照组比较无显著差异;循环训练组随训练时间延长,极限应力及弹性模量均逐步增加,8周时达到高峰,训练过程中无明显下降.结论 跑步训练可缓慢提高末端区组织的生物力学性能;跳跃训练可快速提高末端区组织的生物力学性能,但长期过度训练会降低其抗损伤能力;体育和训练可较快提高末端区组织的生物力学性能,使其能够承受更大的牵张应力并增强其抗损伤的能力.%Objective To investigate the effects of the different training patterns on the biomechanical performance of the terminal region of Achilles tendon in order to provide the scientific basis for improving the ability of withstanding stress and preventing injury in military physical training. Methods Fifty Japanese white rabbits were randomly assigned to four groups: control (n=S), running (running training on the running table, n=15), jump (jump training by electric shock, n=15), and cycle training (run and jump cycle, n=15). The animals in the normal control group were sacrificed at the start of the experiment. For the other training groups, three rabbits were sacrificed randomly in the second, third, fourth, sixth, and eighth

  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

    Institute of Scientific and Technical Information of China (English)

    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. p38 MAPK signaling in postnatal tendon growth and remodeling.

    Directory of Open Access Journals (Sweden)

    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.

  17. Updates in biological therapies for knee injuries: tendons

    OpenAIRE

    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...

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

    Directory of Open Access Journals (Sweden)

    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. Quadriceps tendon injuries

    Directory of Open Access Journals (Sweden)

    Ristić Vladimir

    2013-01-01

    Full Text Available Introduction. The aim of study was to analyze risk factors, mechanisms of injury, symptoms and time that elapsed from injury until operation of complete quadriceps tendon ruptures. Material and Methods. This retrospective multicenter study included 30 patients operated for this injury, of whom 28 (93.3% were men. The average age was 53.7 years (18-73. Twenty-six patients had reconstruction of unilateral rupture and four of bilateral one. Results. Eighty percent of them had some risk factors for rupture of the tendon with degenerative changes. Eight patients had diabetes, seven patients were on renal dialysis, two patients had secondary hyperparathyroidism, five patients were obese and two patients had former knee operations. These injuries occurred in 80% following minor trauma caused by falls on stairs, on flat surfaces and squatting. The most frequent symptoms were: pain, swelling, lack of extension of knee and defect above patella, and three cases were initially misdiagnosed. During the first 10 days after injury, acute and chronic ruptures were reconstructed in 22 (73.3% and 8 patients, respectively. Conclusion. Quadriceps tendon injuries most often happen to male patients with predisposing conditions in their fifth and sixth decade of life due to trivial trauma. Patients on renal dialysis are the most vulnerable population group.

  20. Prophylactic decompression of extensor pollicis longus to prevent rupture

    OpenAIRE

    Navaratnam, A V; Ball, S; Eckersley, R

    2013-01-01

    We present a case of a patient with spontaneous rupture of right extensor pollicis longus (EPL) tendon, who had also developed left wrist pain and weakness in his left EPL that MRI studies confirmed to be caused by tendinosis. Subsequently, decompression of left EPL and reconstruction of right EPL with palmaris longus tendon graft was undertaken. In this case, decompression of the left EPL tendon led to resolution of the patient's symptoms as well as preventing tendon rupture. We advocate the...

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

    Institute of Scientific and Technical Information of China (English)

    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

  2. Achilles tendon graft matches with bone tunnel of different sizes for anterior cruciate ligament reconstruction%跟腱移植物与不同大小骨隧道匹配重建前交叉韧带★

    Institute of Scientific and Technical Information of China (English)

    杨晓; 王跃; 吕波

    2013-01-01

    BACKGROUND:Anterior cruciate ligament is the important anatomic structure to maintain the knee joint stability. The tendon bone healing and clinical functional recovery after anterior cruciate ligament have attracted more attention. OBJECTIVE:To observe the healing of graft tendon and surrounding bone with histological method through the same diameter grafts matching with the bone tunnel of different sizes in the anterior cruciate ligament reconstruction surgery, and to detect the functional recovery with biomechanics. METHODS:Middle 1/3 of canine autologous tendon was selected as the anterior cruciate ligament graft, and then trimmed into the same diameter of 4 mm. Sixteen adult mongrel canine were randomly divided into four groups. The anterior cruciate ligament was resected completely, and the tibial and femoral tunnels were prepared on the end sites of tibia and femur with the diameters of 5, 4.5, 4 and 3.5 mm, then implanted into the tendon in prepared and linked into the bone tunnel. At 6 weeks after reconstruction, the experimental canine were sacrificed under general anesthesia to col ect the tissue and organs in the surgical area. Then the hematoxylin-eosin staining, biomechanical testing and statistical analysis were performed. RESULTS AND CONCLUSION:At 6 weeks after anterior cruciate ligament reconstruction, anatomical observation showed that there were no significant differences in growth of grafts and bone tunnels between groups;hematoxylin-eosin staining showed sharpey-like fibronectin could be seen in the tendon bone healing surface, and the col agen fibers in the 3.5 mm bone tunnel group were more compact and regular than those in the other groups;the biomechanical testing results in the 3.5 mm bone tunnel group were better than those in the other groups. The results indicate that during anterior cruciate ligament reconstruction, decreasing the diameter of bone tunnel that matched with grafts in order to make the tendon and the bone tunnel closely

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

    Directory of Open Access Journals (Sweden)

    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.

  4. 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**☆○

    Institute of Scientific and Technical Information of China (English)

    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.

  5. 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

    Institute of Scientific and Technical Information of China (English)

    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

  6. Tendon Innervation.

    Science.gov (United States)

    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

  7. The single-bundle and single-tunnel reconstruction of anterior cruciate ligament using achilles tendon allograft with attached calcaneus under arthroscopy%关节镜下带跟骨异体跟腱单束单隧道重建前交叉韧带

    Institute of Scientific and Technical Information of China (English)

    冯会成; 黄迅悟; 孙继桐; 常青; 毕龙; 余方圆

    2013-01-01

    Objective To investigate the effectiveness of anterior cruciate ligament (ACL) reconstruction using achilles tendon allograft with attached calcaneus in promoting the tendon-bone healing through comparing with that of ACL reconstruction using simple tendon allograft under arthroscopy. Methods From January 2008 to December 2009, 41 patients with ACL injuries in accordance with the inclusion criteria were treated. They were randomly divided into 2 groups according to different treatment methods. In the trial group, ACL reconstruction using achilles tendon allograft with attached calcaneus was performed on 21 patients. In the control group, ACL reconstruction using simple tendon allograft was performed on 20 patients. There were no significant differences in such general data as the age, gender, cause of injury, disease duration, preoperative functional score and so on between the 2 groups (P>0.05), which were comparable. The single-bundle and single-tunnel ACL reconstruction was performed in both groups. Results All the incisions in both groups were healed by the first intention 2 weeks postoperatively. The patients were followed up for an average period of 26 months (range; 24-28 months) in the trial group, and 28 months (range; 24-30 months) in the control group. 2 years after the operation, 15 cases (71.4%) were negative in the Lachman test, and 16 cases (76.2%) were negative in the anterior drawer test in the trail group. In contrast, 14 cases (70.0%) and 15 cases (75.0%) were negative respectively in the control group. There were no significant differences in the Lysholm score and International Knee Documentation Committee (IKDC) score between the 2 groups 2 years after the operation (P>0.05). The CT exam showed the bone tunnel diameter was enlarged in different degrees in both groups 2 years after the operation, when compared with that 1 month postoperatively. However, the rate of bone tunnel enlargement in the trial group (4/21, 19.0%) was obviously less than

  8. ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: CLINICAL OUTCOMES OF PATELLA TENDON AND HAMSTRING TENDON GRAFTS

    Directory of Open Access Journals (Sweden)

    Dawn T. Gulick

    2002-09-01

    Full Text Available An injury to the ACL can result in significant functional impairment. It has been estimated that more than 100,000 new ACL injuries occur each year. Surgeons employ numerous techniques for reconstruction of the ACL. Of critical importance is the source of the graft to replace the damaged ACL. The graft choices include autografts (the patient's own tissue, allografts (donor tendon, and synthetic/prosthetic ligaments. Tissue harvest sites for autografting include the middle third of the patella tendon, the quadriceps tendon, semitendinosus tendon, gracilis tendon, iliotibial band, tensor fascia lata, and the Achilles tendon. Selection of the type of graft material is predicated upon the tissue's ability to tolerate high levels of stress. Likewise, the clinical presentation and functional outcome is related to the graft material selected. This manuscript specifically examined the patella tendon and hamstring tendon grafts. Numerous manuscripts that studied the outcomes of these graft materials were compiled to help the clinician appreciate the advantages and disadvantages of each of the graft materials. Outcome measures such as thigh circumference, knee range of motion, isokinetic strength, knee stability, pain, and vertical jump/1-leg hop were incorporated. The purpose of this manuscript was to compare and contrast the clinical presentation of patients who underwent an ACL reconstruction using the patella tendon versus the hamstring tendons. This information can be valuable to the clinician when considering the rehabilitation protocol after ACL reconstruction

  9. Triceps tendon avulsion and associated injuries of the elbow

    OpenAIRE

    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.

  10. 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

    Institute of Scientific and Technical Information of China (English)

    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

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

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

    International Nuclear Information System (INIS)

    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.

  14. Calcaneal tendon: imaging findings; Tendao calcaneo: avaliacao por imagem

    Energy Technology Data Exchange (ETDEWEB)

    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)

  15. 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

    Institute of Scientific and Technical Information of China (English)

    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

  16. Delayed reconstruction of a quadriceps tendon.

    Science.gov (United States)

    Pocock, C A J; Trikha, S P; Bell, J S P

    2008-01-01

    Rupture of the quadriceps tendon is an uncommon injury and rapid diagnosis is important because delay in surgical repair generally is believed to adversely affect outcome. One study of 20 patients suggests repair should be done during the first 48 to 72 hours postinjury to achieve a successful outcome and late repair led to unsatisfactory recovery. Cases of delayed tendon repair have been reported, the longest to our knowledge being 11 months before surgical intervention. We present a case of successful outcome of a quadriceps tendon rupture reconstructed at least 8 years after occurrence and a review of the literature of delayed reconstructions. We show that successful restoration of extensor mechanism function can be achieved several years after tendon rupture.

  17. Ultrasonography as a prognostic and objective parameter in Achilles tendinopathy:

    DEFF Research Database (Denmark)

    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...... 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...... 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±2.3mm. Heterogeneity...

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

    OpenAIRE

    Majewski, M.; RM Porter; OB Betz; VM Betz; Clahsen, H. (Harald); Flückiger, R.; CH Evans

    2012-01-01

    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 transecte...

  19. Ten weeks of treadmill running decreases stiffness and increases collagen turnover in tendons of old mice.

    Science.gov (United States)

    Wood, Lauren K; Brooks, Susan V

    2016-02-01

    Increased tendon stiffness in response to mechanical loading is well established in young animals. Given that tendons stiffen with aging, we aimed to determine the effect of increased loading on tendons of old animals. We subjected 28-month-old mice to 10 weeks of uphill treadmill running; sedentary 8- and 28-month-old mice served as controls. Following training, plantaris tendon stiffness and modulus were reduced by approximately half, such that the values were not different from those of tendons from adult sedentary animals. The decrease in plantaris tendon stiffness was accompanied by a similar reduction in the levels of advanced glycation end-product protein adducts in tibialis anterior tendons of trained compared with sedentary old mice. In Achilles tendons, elevated mRNA levels for collagen type 1, matrix-metalloproteinase-8, and lysyl oxidase following training suggest that collagen turnover was likely also increased. The dramatic mechanical and structural changes induced by training occurred independent of changes in cell density or tendon morphology. Finally, Achilles tendon calcification was significantly reduced following exercise. These results demonstrate that, in response to exercise, tendons from old animals are capable of replacing damaged and dysfunctional components of extracellular matrix with tissue that is mechanically and structurally comparable to adult tissue.

  20. THE USE OF REVERSED APONEUROSIS FLAP OF THE TRICEPS MUSCLE OF CALF FOR REPAIRING CHRONIC ACHILLES TENDON RUPTURE%小腿三头肌逆行腱膜瓣治疗陈旧性跟腱断裂

    Institute of Scientific and Technical Information of China (English)

    郑木平; 吴增辉; 沈恒光; 任平; 王杰

    2005-01-01

    目的总结采用小腿三头肌逆行腱膜瓣治疗陈旧性跟腱断裂的疗效. 方法对58例患者采用小腿三头肌逆行腱膜瓣修复陈旧性跟腱断裂并随访. 结果全部病例均经2~3年,平均26个月的随访,按Arner-lindholm评定标准判定,临床优良率达94.8%. 结论小腿三头肌逆行腱膜瓣治疗陈旧性跟腱断裂是一种效果较好的方法.

  1. 趾长屈肌腱转位修复陈旧性跟腱断裂的临床应用%The Clinical Application of Transfer The Flexor Digitorum Longus to Repair The Rupture of Achilles Tendon

    Institute of Scientific and Technical Information of China (English)

    于绍斌; 於玮; 丰波; 陈欣

    2005-01-01

    目的:探讨趾长屈肌腱(flexor digitorum longus,FDL)修复陈旧性跟腱断裂的手术方法和疗效.方法:回顾分析9例应用FDL修复的陈旧性跟腱断裂患者,术后平均随访18个月,并用Arner-lindholm疗效评定标准进行评定.结果:9例中,因误诊或漏诊导致陈旧性跟腱断裂的占77.8%.按Arner-lindholm疗效评定标准,术后疗效优6例(66.7%),良2例(22.2%),差1例(11.1%),优良率88.9%.结论:陈旧性跟腱断裂多由漏诊或误诊所致,应用FDL转位修复陈旧性跟腱断裂可取得满意疗效.

  2. 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

    Institute of Scientific and Technical Information of China (English)

    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

  3. Sclerosing injections to treat midportion Achilles tendinosis: a randomised controlled study evaluating two different concentrations of Polidocanol.

    Science.gov (United States)

    Willberg, Lotta; Sunding, Kerstin; Ohberg, Lars; Forssblad, Magnus; Fahlström, Martin; Alfredson, Håkan

    2008-09-01

    Two to three ultrasound (US) and colour Doppler (CD)-guided injections of the sclerosing substance Polidocanol (5 mg/ml) have been demonstrated to give good clinical results in patients with chronic midportion Achilles tendinopathy. This study aimed to investigate if a higher concentration of Polidocanol (10 mg/ml) would lead to a less number of treatments, and lower volumes, needed for good clinical results. Fifty-two consecutive Achilles tendons (48 patients, mean age 49.6 years) with chronic painful midportion Achilles tendinopathy, were randomised to treatment with Polidocanol 5 mg/ml (group A) or 10 mg/ml (group B). The patients and treating physician were blinded to the concentration of Polidocanol injected. All patients had structural tendon changes and neovascularisation in the Achilles midportion. Treatment was US + CD-guided injections targeting the region with neovascularisation (outside ventral tendon). A maximum of three treatments (6-8 weeks in between) were given before evaluation. Patients not satisfied after three treatments were given additional treatment with Polidocanol 10 mg/ml, up to five treatments. For evaluation, the patients recorded the severity of Achilles tendon pain during activity on a visual analogue scale (VAS), before and after treatment. Patient satisfaction with treatment was also assessed. At follow-up (mean 14 months) after three treatments, 18/26 patients in group A and 19/26 patients in group B were satisfied with the treatment and had a significantly reduced level of tendon pain (P Polidocanol 10 mg/ml in the not satisfied patients resulted in 26/26 satisfied patients in both groups A and B. In summary, we found no significant differences in the number of satisfied patients, number of injections or volumes given, between patients treated with 5 or 10 mg/ml Polidocanol.

  4. Transosseous-Equivalent Repair for Distal Patellar Tendon Avulsion.

    Science.gov (United States)

    Galos, David K; Konda, Sanjit R; Kaplan, Daniel J; Ryan, William E; Alaia, Michael J

    2016-04-01

    Extensor mechanism disruptions are relatively uncommon injuries involving injury to the quadriceps tendon, patella, or patellar tendon. Patellar tendon avulsions from the tibial tubercle in adults are rare; as such, little technical information has been written regarding surgical management of this injury in the adult. Transosseous-equivalent repairs have been described in the management of several types of tendon ruptures, including rotator cuff and distal triceps tendon ruptures, but not previously in patellar injuries. We present a technique for repairing an avulsion injury of the patellar tendon from the tibial tubercle using suture anchors in a transosseous-equivalent manner. This technique for treating distal patellar tendon avulsion injuries likely increases contact area at the repair site while potentially improving fixation strength. PMID:27462538

  5. Arthroscopic quadriceps tendon repair: two case reports.

    Science.gov (United States)

    Saito, Hidetomo; Shimada, Yoichi; Yamamura, Toshiaki; Yamada, Shin; Sato, Takahiro; Nozaka, Koji; Kijima, Hiroaki; Saito, Kimio

    2015-01-01

    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.

  6. Arthroscopic Quadriceps Tendon Repair: Two Case Reports

    Directory of Open Access Journals (Sweden)

    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.

  7. The Achilles heel of adults and children

    NARCIS (Netherlands)

    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

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

    OpenAIRE

    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...

  9. 18F-fluorodeoxyglucose and PET/CT for noninvasive study of exercise-induced glucose uptake in rat skeletal muscle and tendon

    DEFF Research Database (Denmark)

    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...

  10. 低密度脂蛋白胆固醇与跟腱厚度相关性的初步临床研究%Preliminary Research for the Relationship Between Serum Levels of Low Density Lipoprotein Cholesterol and Achilles Tendon Thickness

    Institute of Scientific and Technical Information of China (English)

    林玲; 王蓓; 潘丽丽; 何成毓; 万象新; 郑志昂; 黄正新; 邹朝宝; 符明昌

    2016-01-01

    Objective: To analyze the relationship between the serum levels of low density lipoprotein cholesterol (LDL-C) and achilles tendon thickness (ATT). Methods: We studied 154 patients with high serum level of LDL-C (LDL-C≥3.37 mmol/L) from 2014-03 to 2015-03, the patients were at (18-75) years of age. According to《Guidelines on Prevention and Treatment of Blood Lipid Abnormality in Chinese Adults 2007》, the patients were divided into 2 groups:Borderline high LDL-C (3.3-4.12 mmol/L) group n=50 and High LDL-C (≥4.14 mmol/L) group, n=104;in addition, there was a Normal control group (LDL-C Results: ATT levels in High LDL-C group (9.42 ± 3.63) mm was higher than Borderline high group (8.24±1.73) mm and Normal control group (6.05±0.28)mm, all P Conclusion: Our preliminary research showed that the higher serum level of LDL-C associated with thicker ATT, they had positive correlation. This phenomenon should be further conifrmed by large sample and multi-center investigation.%目的:研究血清低密度脂蛋白胆固醇(LDL-C)水平与跟腱厚度(ATT)之间的相关性。  方法:2014-03至2015-03期间收集18~75岁、血清LDL-C水平高于正常上限(≥3.37 mmol/L)的患者154例,根据《中国成人血脂异常防治指南(2007年)》,分为LDL-C边缘升高(3.37~4.12 mmol/L)组(n=50)和LDL-C升高(≥4.14 mmol/L)组(n=104);另以血清LDL-C水平正常(<3.37 mmol/L)者作为对照组(n=51)。采用标准化的直接数字化X线摄影术测量三组受试者的ATT,进行比较,并分析血清LDL-C水平与ATT之间的相关性。  结果:LDL-C升高组的ATT平均值[(9.42±3.63)mm]高于LDL-C边缘升高组[(8.24±1.73)mm]和对照组[(6.05±0.28)mm],三组受试者ATT间的差异均具有统计学意义(P均<0.05)。线性相关分析显示,血清LDL-C水平与ATT平均值的相关系数r=0.346(P  结论:本研究小样本初步观察发现,血清LDL-C水

  11. Rupture bilatérale des tendons rotuliens chez un sujet jeune sans notion de maladies systémiques ou de traitement par les corticostéroïdes: à propos d'un cas et revue de la literature

    Science.gov (United States)

    Chagou, Aniss; Rhanim, Abdelkarim; Berrady, Mohammed Ali; Lamrani, Moulay Omar; Oudghiri, Mohammed; Berrada, Mohammed Saleh; El Yaacoubi, Moradh

    2014-01-01

    Les lésions du tendon rotulien sont moins communes que celles du tendon quadricipital. Les lésions bilatérales sont encore plus rares et sont souvent associées à une notion de tendinopathie, d'injection de corticoïdes ou de maladies systémiques tels que le lupus érythémateux, l'ostéomalacie ou l'insuffisance rénale chronique. Nous rapportons le cas d'un patient de 26 ans victime d'une rupture bilatérale du tendon rotulien suite à une réception de saut. Le patient n'avait pas d'antécédents de tendinopathie ni de maladies systémiques. Le diagnostic a été suspecté devant une position anormalement haute des deux rotules avec une impossibilité d'extension active des deux jambes. L’échographie a confirmé le diagnostic. Le patient a été traité par la technique de laçage selon Judet protégée par un cadrage. La rupture bilatérale du tendon rotulien est rare. La plupart des patients rapportent une notion de maladie systémique ou un antécédents de chirurgie du genou. Nous rapportons le cas d'une lésion rare dans la littérature, une rupture bilatérale des tendons rotuliens sans notions de maladies auto-immunes ni de traitement avec des corticostéroïdes. Les lésions bilatérales présentent certaines particularités diagnostiques et thérapeutiques. En effet l'objectivation d'une rotule haute peut être rendu difficile par un aspect controlatéral semblable. Concernant le volet thérapeutique, deux difficultés sont à noter la première réside dans l'absence de référence comparative pour la hauteur patellaire. La deuxième difficulté est l'obligation de différer l'appui à 45 jours. Ce qui est contraignant pour le patient. La technique de laçage décrite par judet couplée à un cadrage provisoire protégeant la suture nous a donné des résultats satisfaisants. PMID:25667711

  12. Triceps tendon avulsion and associated injuries of the elbow

    Science.gov (United States)

    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. The role of animal models in tendon research

    OpenAIRE

    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...

  14. Association of Achilles tendinopathy and plantar spurs.

    Science.gov (United States)

    Vulcano, Ettore; Mani, Sriniwasan B; Mani, Sriniwasan; Do, Huong; Bohne, Walter H; Ellis, Scott J

    2014-10-01

    Plantar spurs and Achilles tendinopathy are common causes of heel pain. In the authors' practice, it was anecdotally noted that patients with Achilles tendinopathy often presented with plantar spurs. Nonetheless, there is a shortage of studies investigating whether Achilles tendinopathy and plantar spurs exist concomitantly. A better understanding of the association between the 2 pathologies might help physicians recognize and treat both conditions, educate patients about Achilles tendinopathy and plantar spurs, and ultimately investigate possible underlying causes of both pathologies that could be addressed together. The authors examined the prevalence of plantar spurs in patients diagnosed with Achilles tendinopathy as well as demographic differences within the unilateral and bilateral Achilles tendinopathy populations. A total of 785 patient records were retrospectively reviewed. Mean patient age was 56.2±15.5 years (46.9% men and 53.1% women). Seventy-two (9.2%) patients were affected bilaterally by Achilles tendinopathy. Lateral radiographs were reviewed by an orthopedic surgeon to identify the presence of plantar spurs. A total of 329 (41.9%) patients with Achilles tendinopathy were found to have a concomitant plantar spur. Patients with unilateral Achilles tendinopathy and a plantar spur were more likely to be women (58.7% vs 49.8%, P=.020) and older (62.7 vs 51.7 years, P<.001). In the bilateral Achilles tendinopathy group, there were 46 (63.9%) patients with at least one foot presenting with a plantar spur. The study's findings suggest a significant association between Achilles tendinopathy and plantar spurs. Older women with Achilles tendinopathy are at greater risk of being affected by plantar spurs. PMID:25275977

  15. Acute tendon changes in intense CrossFit workout

    DEFF Research Database (Denmark)

    Fisker, F Y; Kildegaard, S; Thygesen, M;

    2016-01-01

    CrossFit is a fitness program that has become increasingly popular in the Western world, but as in other sports, the risk of injury is present. Only a few studies have addressed health benefits and injuries in CrossFit. It is known that chronically overloaded tendons will thicken and increase.......01). However, there was no significant difference in fascia plantaris thickness before (M = 3.4, SD = 0.5) and after (M = 3.4, SD = 0.5) workout (P = 0.97). A significant increase in the thickness of the patellar and Achilles tendons was found in response to strenuous, highly intense CrossFit exercises...

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

    OpenAIRE

    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...

  17. Tendon reflex is suppressed during whole-body vibration.

    Science.gov (United States)

    Karacan, Ilhan; Cidem, Muharrem; Yilmaz, Gizem; Sebik, Oguz; Cakar, Halil Ibrahim; Türker, Kemal Sıtkı

    2016-10-01

    In this study we have investigated the effect of whole body vibration (WBV) on the tendon reflex (T-reflex) amplitude. Fifteen young adult healthy volunteer males were included in this study. Records of surface EMG of the right soleus muscle and accelerometer taped onto the right Achilles tendon were obtained while participant stood upright with the knees in extension, on the vibration platform. Tendon reflex was elicited before and during WBV. Subjects completed a set of WBV. Each WBV set consisted of six vibration sessions using different frequencies (25, 30, 35, 40, 45, 50Hz) applied randomly. In each WBV session the Achilles tendon was tapped five times with a custom-made reflex hammer. The mean peak-to-peak (PP) amplitude of T-reflex was 1139.11±498.99µV before vibration. It decreased significantly during WBV (ptapping between before and during vibration sessions. This study showed that T-reflex is suppressed during WBV. T-reflex suppression indicates that the spindle primary afferents must have been pre-synaptically inhibited during WBV similar to the findings in high frequency tendon vibration studies. PMID:27485766

  18. 关节镜下异体肌腱修复重建前后交叉韧带断裂的临床观察%Clinical Observation of Arthroscopic Reconstruction of Anterior Cruciate Ligament Rupture with Tendon Allograft

    Institute of Scientific and Technical Information of China (English)

    孙强; 才林; 艾光禹

    2016-01-01

    目的:探讨关节镜下异体肌腱修复重建前后交叉韧带断裂的临床效果。方法选取我院2013年9月-2014年9月经影像学、临床诊断为前后交叉韧带断裂患者18例,均采用深低温冷冻同种异体腱于关节镜下同期重建前后交叉韧带。记录Lachman试验、Lysholm评分结果进行治疗效果的评定。结果术后切口均I期愈合,术前存在的症状、阳性体征基本消失,患膝稳定性正常。其中Lachman试验测试均为阴性或I度阳性。关节活动度:17例达0°-130°,仅有1例0°-120°,手术前后的Lysholm、IKDC评分对比具有统计学意义(P<0.05)。结论关节镜下采用异体肌腱修复重建前后交叉韧带断裂能够恢复膝关节的稳定性及功能,疗效显著,值得临床推广应用。%Objective To investigate the clinical effect of arthroscopic reconstruction of anterior cruciate ligament.Methods 9 cases of -2014 in our hospital from September 2013 to 18 were diagnosed as anterior and anterior cruciate ligament rupture. The anterior and anterior cruciate ligaments were reconstructed with the same time of deep hypothermia and frozen allograft. Evaluation of therapeutic effect of Lachman test and Lysholm score.Results All the incisions healed by I, the symptoms and positive signs of the patients were disappeared, and the stability of the knee was normal. The Lachman test was negative or I positive. Joint mobility: 17 cases reached 0 degrees-130 degrees, only 0 cases of 1 degrees -120 degrees, Lysholm, IKDC before and after surgery, score compared with statistical significance (P<0.05).Conclusion Arthroscopic reconstruction of anterior cruciate ligament with allograft tendon repair can restore the stability and function of the knee joint, and the effect is remarkable. It is worth to be popularized.

  19. Physiological loading of tendons induces scleraxis expression in epitenon fibroblasts.

    Science.gov (United States)

    Mendias, Christopher L; Gumucio, Jonathan P; Bakhurin, Konstantin I; Lynch, Evan B; Brooks, Susan V

    2012-04-01

    Scleraxis is a basic helix-loop-helix transcription factor that plays a central role in promoting fibroblast proliferation and matrix synthesis during the embryonic development of tendons. Mice with a targeted inactivation of scleraxis (Scx(-/-)) fail to properly form limb tendons, but the role that scleraxis has in regulating the growth and adaptation of tendons of adult organisms is unknown. To determine if scleraxis expression changes in response to a physiological growth stimulus to tendons, we subjected adult mice that express green fluorescent protein (GFP) under the control of the scleraxis promoter (ScxGFP) to a 6-week-treadmill training program designed to induce adaptive growth in Achilles tendons. Age matched sedentary ScxGFP mice were used as controls. Scleraxis expression was sparsely observed in the epitenon region of sedentary mice, but in response to treadmill training, scleraxis was robustly expressed in fibroblasts that appeared to be emerging from the epitenon and migrating into the superficial regions of tendon fascicles. Treadmill training also led to an increase in scleraxis, tenomodulin, and type I collagen gene expression as measured by qPCR. These results suggest that in addition to regulating the embryonic formation of limb tendons, scleraxis also appears to play an important role in the adaptation of adult tendons to physiological loading.

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

    Science.gov (United States)

    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.

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

    International Nuclear Information System (INIS)

    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

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  3. Repair of ruptured quadriceps tendon after total knee arthroplasty:a preliminary report of 12 cases%全关节置换后股四头肌肌腱完全性断裂的修复--12例初步报告

    Institute of Scientific and Technical Information of China (English)

    史少敏; James T. Ninomiya; 史光禹

    2013-01-01

      目的观察改良V-Y翻转肌腱瓣修复膝关节置换术后股四头肌肌腱断裂的临床疗效.方法2005年至2010年,应用改良V-Y翻转肌腱瓣方法修复全膝关节置换术后股四头肌肌腱完全性断裂共12例患者,男4例,女8例;年龄45~77岁,平均62岁.术中通过切取全层肌腱瓣,松解股内、外侧肌远侧1/3,并将两侧肌肉缝合在一起,恢复股四头肌的完整性.术后采用膝关节评分标准评估患者功能恢复情况.结果所有患者均获得随访,随访时间12-54个月,平均24个月.术前所有患者行走需要助行器或轮椅帮助,术后则均可行走,无需协助.10例为优秀,2例良好.末次随访时,美国特种外科医院(The Hospital for Special Surgery,HSS)膝关节评分为75~100分,平均为90分.股四头肌肌力平均为4/5级(3~5/5级),关节活动度为0°~120°.术后无患者发生肌腱二次断裂和感染.结论全膝关节置换后股四头肌肌腱断裂的治疗具有挑战性,改良V-Y翻转肌腱瓣是一种有效、可靠的手术修复方法.%Objective To evaluate the clinical results of a modified V-Y turndown flap reconstruction technique for the treatment of ruptured quadriceps tendon after total knee arthroplasty. Methods From 2005 to 2010, 12 patients who had a quadriceps tendon rupture after total knee arthroplasty were treated with a modified V-Y turndown flap reconstruction at our institution. Among them, there were 4 males and 8 females, whose average age was 62 years old (range; 45-77 years). The modification involved harvesting the quadriceps tendon as a full thickness flap. The vastus medialis and lateralis muscles were released 1/3 distally and then sutured together to reinforce the repair without wires during the surgery. Postoperatively patients were evaluated with the knee joint surgery standard. Results All patients were followed up for a mean period of 24 months (range;12-54 months). Preoperatively all patients needed to use walking aid

  4. MOLECULAR PATHOBIOLOGICAL AND SCANNING ELECTRON MICROSCOPIC CHANGES IN HORSE TENDON CELLS TREA TED WITH ENROFLOXACIN

    OpenAIRE

    A. Khan1 and J. Halper

    2003-01-01

    Fluoroquinolone (FQNL) antibiotics have been used widely in horses because of their broad-spectrum bactericidal activity and relative safety, however, their use is not without risk. Tendonitis and spontaneous tendon rupture have been reported in people during or following therapy with FQNLs. To evaluate the potential damage of enrofloxacin (ENRO) on the equine superficial digital flexor tendon (SOFT), an equine cell culture system as an in vitro model of equine tendon injury and repair was de...

  5. Acute Pectoralis Major Rupture Captured on Video.

    Science.gov (United States)

    Ordas Bayon, Alejandro; Sandoval, Enrique; Valencia Mora, María

    2016-01-01

    Pectoralis major (PM) ruptures are uncommon injuries, although they are becoming more frequent. We report a case of a PM rupture in a young male who presented with axillar pain and absence of the anterior axillary fold after he perceived a snap while lifting 200 kg in the bench press. Diagnosis of PM rupture was suspected clinically and confirmed with imaging studies. The patient was treated surgically, reinserting the tendon to the humerus with suture anchors. One-year follow-up showed excellent results. The patient was recording his training on video, so we can observe in detail the most common mechanism of injury of PM rupture. PMID:27595030

  6. Acute Pectoralis Major Rupture Captured on Video

    Directory of Open Access Journals (Sweden)

    Alejandro Ordas Bayon

    2016-01-01

    Full Text Available Pectoralis major (PM ruptures are uncommon injuries, although they are becoming more frequent. We report a case of a PM rupture in a young male who presented with axillar pain and absence of the anterior axillary fold after he perceived a snap while lifting 200 kg in the bench press. Diagnosis of PM rupture was suspected clinically and confirmed with imaging studies. The patient was treated surgically, reinserting the tendon to the humerus with suture anchors. One-year follow-up showed excellent results. The patient was recording his training on video, so we can observe in detail the most common mechanism of injury of PM rupture.

  7. Spontaneous medial dislocation of the tendon of the long biceps brachii. An anatomic study of prevalence and pathomechanics.

    Science.gov (United States)

    Petersson, C J

    1986-10-01

    Medial displacement of the tendon of the long biceps brachii muscle was analyzed in a dissection study on autopsy in 77 subjects, 42 men and 35 women. The tendon was found to be medially displaced in five shoulders in five different subjects (6.5%). Medial displacement of the tendon was always found in connection with full-thickness supraspinatus tendon ruptures. It is a common belief that the tendon is always displaced medially to the lesser tubercle riding over the subscapularis tendon. In the present series, this condition was found only in one case; in the other shoulders the tendon had slipped medially to the lesser tubercle under the subscapularis tendon, which was partially internally ruptured. In patients with rotator cuff lesions, medial displacement of the long biceps tendon might be one reason for pain over the front of the shoulder. PMID:3769261

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  9. Tendon disorders attributed to fluoroquinolones : a study on 42 spontaneous reports in the period 1988 to 1998

    NARCIS (Netherlands)

    van der Linden, P D; van Puijenbroek, E P; Feenstra, J; Veld, B A; Sturkenboom, M C; Herings, R M; Leufkens, H G; Stricker, B H

    2001-01-01

    OBJECTIVE: Fluoroquinolone antibiotics have been associated with tendinitis and tendon rupture. In this paper we report on the followup of 42 spontaneous reports of fluoroquinolone-associated tendon disorders. METHODS: This study is based on cases of fluoroquinolone-associated tendon disorders repor

  10. Gastrocnemius myotendinous flap for patellar or quadriceps tendon repair, or both.

    Science.gov (United States)

    Rhomberg, M; Schwabegger, A H; Ninkovic, M; Bauer, T; Ninkovic, M

    2000-08-01

    The authors' experience with simultaneous reconstruction of the quadriceps femoris or patellar tendon or both and soft tissue defect using a musculotendinous unit of the gastrocnemius muscle is presented. Five patients with a partial or complete defect of the quadriceps or patellar tendon or both and additional large soft tissue defects underwent reconstruction applying this technique as a one-stage surgical procedure in different variations. In cases with a partial defect of the tendon or loss of tendon thickness, the thick aponeurosis from the deeper aspect of the gastrocnemius was dissected and transferred as a pedicled tendon flap to reconstruct the tendon defect. In cases with a complete defect of the tendon, the superficial layer of the Achilles tendon together with the deep aponeurotic layer of the gastrocnemius muscle served to reconstruct the tendon. In both procedures the gastrocnemius muscle belly provided soft tissue coverage and was covered with a split thickness skin graft. One patient had a marginal deep necrosis develop that had to be covered with the other gastrocnemius muscle in a second operation. One patient with chronic polyarthritis and infection of his knee prosthesis declined additional reconstruction surgery and had the leg amputated. The average followup was 3.5 years. All patients achieved good results in active extension of the knee with an extension deficit of only 5 degrees to 15 degrees. The range of flexion was at least 90 degrees. The surgical technique described in this report provides functional tendon reconstruction and adequate soft tissue repair simultaneously.

  11. 踇长屈肌腱转位联合腓肠肌瓣V-Y延长术治疗陈旧性跟腱断裂%Flexor hallucis tendon transfer combined with gastrocnemius flap V-Y lengthening for old Achilles tendon rupture

    Institute of Scientific and Technical Information of China (English)

    余春华; 杜俊锋; 朱仰义; 林炯

    2016-01-01

    目的 探索踇长屈肌腱转位联合腓肠肌瓣V-Y延长术治疗陈旧性跟腱断裂的疗效.方法 对2010年2月至2014年2月收治的21例陈旧性跟腱断裂患者(KuwadaⅢ型15例、KuwadaⅣ型6例)进行踇长屈肌腱转位联合腓肠肌瓣V-Y延长术重建跟腱,采用美国足踝外科协会(AOFAS)踝-后足评分系统、Leppilahti跟腱修复评分系统进行疗效评价.结果 对所有术后患者随访18~ 36个月,术后切口Ⅰ期愈合,未出现切口感染、跟腱再断裂、周围神经血管损伤、皮肤坏死等并发症.AOFAS踝-后足评分由术前(52.44±12.75)分明显提高至术后末次随访的(91.02±6.85)分(P<0.01),Leppilahti跟腱修复评分由术前(34.33±12.92)分明显提高至术后末次随访的(90.95±5.10)分(P<0.01).结论 踇长屈肌腱转位联合腓肠肌瓣V-Y延长术治疗Kuwada Ⅲ型、部分KuwadaⅣ型陈旧性跟腱断裂,能明显恢复踝关节功能,具有疗效确切、操作简单、并发症少等优点.

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

    Directory of Open Access Journals (Sweden)

    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.

  13. Expression of collagen and related growth factors in rat tendon and skeletal muscle in response to specific contraction types

    DEFF Research Database (Denmark)

    Heinemeier, K M; Olesen, J L; Haddad, F;

    2007-01-01

    Acute exercise induces collagen synthesis in both tendon and muscle, indicating an adaptive response in the connective tissue of the muscle-tendon unit. However, the mechanisms of this adaptation, potentially involving collagen-inducing growth factors (such as transforming growth factor-beta-1 (TGF......-9 per group) of the medial gastrocnemius, by stimulation of the sciatic nerve. RNA was extracted from medial gastrocnemius and Achilles tendon tissue 24 h after the last training bout, and mRNA levels for collagens I and III, TGF-beta-1, connective tissue growth factor (CTGF), lysyl oxidase (LOX...... induced in tendon, especially LOX (up to 37-fold), which could indicate a loading-induced increase in cross-linking of tendon collagen. In skeletal muscle, a similar regulation of gene expression was observed, but in contrast to the tendon response, the effect of eccentric training was significantly...

  14. The axial injury tolerance of the human foot/ankle complex and the effect of Achilles tension.

    Science.gov (United States)

    Funk, James R; Crandall, Jeff R; Tourret, Lisa J; MacMahon, Conor B; Bass, Cameron R; Patrie, James T; Khaewpong, Nopporn; Eppinger, Rolf H

    2002-12-01

    Axial loading of the foot/ankle complex is an important injury mechanism in vehicular trauma that is responsible for severe injuries such as calcaneal and tibial pilon fractures. Axial loading may be applied to the leg externally, by the toepan and/or pedals, as well as internally, by active muscle tension applied through the Achilles tendon during pre-impact bracing. The objectives of this study were to investigate the effect of Achilles tension on fracture mode and to empirically model the axial loading tolerance of the foot/ankle complex. Blunt axial impact tests were performed on forty-three (43) isolated lower extremities with and without experimentally simulated Achilles tension. The primary fracture mode was calcaneal fracture in both groups. However, fracture initiated at the distal tibia more frequently with the addition of Achilles tension (p sensors mounted to the bone demonstrated that fracture initiated at the time of peak local axial force. A survival analysis was performed on the injury data set using a Weibull regression model with specimen age, gender, body mass, and peak Achilles tension as predictor variables (R2 = 0.90). A closed-form survivor function was developed to predict the risk of fracture to the foot/ankle complex in terms of axial tibial force. The axial tibial force associated with a 50% risk of injury ranged from 3.7 kN for a 65 year-old 5th percentile female to 8.3 kN for a 45 year-old 50th percentile male, assuming no Achilles tension. The survivor function presented here may be used to estimate the risk of foot/ankle fracture that a blunt axial impact would pose to a human based on the peak tibial axial force measured by an anthropomorphic test device. PMID:12596644

  15. The effects of smoking on tendon thickness and degeneration in young amateur sportspeople

    Directory of Open Access Journals (Sweden)

    Banu ALICIOĞLU

    2009-03-01

    Full Text Available The aim of this study was to assess the effects of smoking on tendinopathies detected by ultrasound in active amateur sportspeople. Fourteen male, 19 female, total 33 amateur sportspeople (mean age, 20.5±2.5 were investigated. Both patellar and Achilles tendons were imaged by high resolution ultrasound. The antero-posterior thicknesses and pathologies (if present of the tendons were determined.Twenty two (66.7% of the sportsmen were nonsmokers and 11 (33.3% were smokers. The mean number of cigarettes smoked in a day was 9.4±4.5; mean duration of cigarette smoking was 3.7±1.6 years. 17 tendinopathies (12.9% of tendons were detected in 12 sportsmen (36.4% of sportsmen. No significant difference was found between the smoker and nonsmoker groups according to the incidence of tendinopathies (p>0.05. The thickness of the tendons did not differ according to smoking status for both patellar and Achilles tendons (p>0.05 for all comparisons. In conclusion, the tendon thickness and incidence of tendinous degeneration do not differ between smoker and nonsmoker sportsmen.

  16. Iliopsoas Tendon Reformation after Psoas Tendon Release

    Directory of Open Access Journals (Sweden)

    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.

  17. 高频超声诊断四肢肌腱损伤的价值探讨%Analysis on the Diagnosis of Tendon Injuries by Ultrasonography

    Institute of Scientific and Technical Information of China (English)

    朱楠; 彭洪

    2012-01-01

      Objective To investigate the impact factors on the diagnosis of tendon injuries by ultrasonography. Methods Data of 63 cases of tendon injuries from June 2008 to February 2012 were summarized.Then we take a comprehensive analysis of these sonographics. Results Simple tendon injury in 32 cases, 5 cases of partial rupture, complete rupture of the 8 cases of Achilles tendon, and 3 cases of partial rupture of the quadriceps tendon, long head of biceps tendon is completely rupture 7 cases, the extensor tendon partial rupture three cases, the combined muscle tear those 5 cases. Conclusion Ultrasound examination is a valuable tool to diagnose the injured tendon.%  目的探讨高频超声诊断四肢肌腱损伤的价值,以期用来指导临床治疗。方法 回顾性分析我院自2009年3月至2012年3月63例四肢肌腱损伤的超声诊断后的声像特征,综合分析所有的声像图特征。结果 单纯肌腱损伤者有32例,股四头肌肌腱部分断裂有3例,部分断裂有5例、肱二头肌长头腱完全断裂有7例,指伸肌腱部分断裂有3例,跟腱完全断裂8例,合并肌肉撕裂者5例。结论 高频超声能为四肢肌腱损伤提供有价值的诊疗信息。

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

    DEFF Research Database (Denmark)

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

    2009-01-01

    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 expression...

  19. The influence of the remote nursing intervention on compliance behavior of postoperative patients with finger flexor tendon rupture%远程护理干预对手指屈肌腱断裂吻合术后患者遵医行为的影响

    Institute of Scientific and Technical Information of China (English)

    余鑫; 张晓杰; 单欣刚; 李岩

    2014-01-01

    目的:探讨远程护理干预对手指屈肌腱断裂修复术后患者遵医行为的影响。方法将76例门诊行手指屈肌腱断裂修复术患者随机分为对照组与观察组,每组38例,对照组患者仅术后进行手指屈肌腱修复后的健康教育;观察组患者离院后,根据远程护理计划流程进行持续护理干预,分别于术后、第一次换药、拆线时及拆除石膏时发放调查问卷,评价两组患者在遵医行为、伤口愈合情况、二次手术率以及疼痛程度等方面的效果。结果远程护理干预后遵医行为、伤口愈合情况、行二次手术率方面观察组优于对照组(P<0.05),观察组疼痛管理方面干预后优于干预前(P<0.01)。结论远程护理干预能够提高手指屈肌腱断裂吻合术后患者的遵医行为,减少术后并发症,促进疾病早日康复。%Objective To study the effect of remote nursing intervention on compliance behavior for postoperative patients with finger flexor tendon rupture anastomosis .Method 76 outpatient with finger flexor tendon rupture was selected and randomly divided into control group and intervention group ,38 cases in each group .Patients in control group was given health education of finger flexor tendon repair only after operation .patient in remote nursing inter-vention group accept continuing nursing intervention according to the planning process after discharged from the hos-pital .questionnaires survey was conducted after the operation ,the first time dressing after operation ,take out stit-ches after surgery and demolition of gypsum .The medical behavior ,wound healing and secondary surgery rate as well as the effect of degree of pain was observed and compared between two group .Result After the remote nursing intervention ,The compliance behavior ,wound healing and secondary surgery rate the intervention group is better than the control group(P<0 .05) .The patient’s pain score after

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

    Directory of Open Access Journals (Sweden)

    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.

  1. 缝线锚钉修复肾功能衰竭伴自发性股四头肌腱断裂的临床研究%Clinical Research of Suture Anchor Nail Repair Renal Failure Associated with Spontaneous Femoral Quadriceps Tendon Rupture

    Institute of Scientific and Technical Information of China (English)

    杨瑞; 陈祥云; 颉朝阳; 韩晓军; 刘志鹏; 宋矿朋

    2015-01-01

    目的:评估缝线锚钉修复肾功能衰竭伴自发性股四头肌腱髌骨止点断裂的临床疗效。方法:2007年1月-2012年1月,对本院收治的21例肾功能衰竭伴自发性股四头肌腱断裂患者采用缝线锚钉行股四头肌腱髌骨止点修补缝合。术前常规实验室检查,拍摄患侧膝关节X线片及MRI;术后6周内支具保护,6周后行屈膝练习,术后2年测量患者屈膝角度。结果:21例患者均获得随访。随访结束,均未发生锚钉松动及脱出。术前术后均采用Lysholm和Kujala膝关节评分标准,评分差异有统计学意义(P<0.05)。结论:选择适当的病例,应用缝线锚钉是修复肾功能衰竭伴自发性股四头肌腱髌骨止点断裂的有效方法。%Objective: To assess the clinical efficacy of suture anchor nail repair renal failure associated with spontaneous femoral quadriceps tendon patellar check point of fracture.Method: From January 2007 to January 2012, 21 renal failure patients with spontaneous femoral quadriceps tendon rupture were given the nail line of patella femoral quadriceps tendon suture anchor check point repair suture. Preoperative routine laboratory examination was taken by lateral knee X-ray films and MRI. With a protection within 6 weeks, after 6 weeks bend knees practice was taken, and knees angle was measured 2 years later.Result: 21 patients were all followed up and in the end they were not loose bolts and emergence. The effect was evaluated by Kujala and Lysholm knee scoring standards and showed significant difference before and after operation (P<0.05).Conclusion: Selecting appropriate cases and using suture anchors is renal failure associated with spontaneous femoral quadriceps tendon patellar fracture effective method of check point.

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

    Science.gov (United States)

    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

  3. 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

    Institute of Scientific and Technical Information of China (English)

    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.

  4. Outcome of quadriceps tendon repair.

    Science.gov (United States)

    Puranik, Gururaj S; Faraj, Adnan

    2006-04-01

    Complete rupture of the quadriceps tendon is a well-described injury. There is a scarcity of literature relating to the outcome of patients with this injury after surgery. We undertook a retrospective analysis of patients who had surgical repair of their quadriceps tendon at our institution over a 13-year period, totalling 21 patients. Males were more commonly affected, with a male/female ratio of 4:1. The peak incidence was in the sixth decade of life. Assessment consisted of the completion of a functional knee questionnaire and a clinical examination. Symptomatic outcome following surgical repair was good with a mean symptom score generated of 19.16 out of a maximum of 25 using the Rougraff et al scoring system. Most of the patients returned to their pre-injury level of activity. Five degrees deficit and extension lag was present in three patients; these patients had the quadriceps repaired using transosseous sutures. Patients who had direct repair of the tendon using the Bunnell technique had lower Rougraff scores than the rest.

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

    OpenAIRE

    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...

  6. Tissue Engineering of Ligaments/tendons .Part I .Biomaterial and Mechanical Aspects

    Institute of Scientific and Technical Information of China (English)

    X.; WANG; C.; VAQUETTE; L.; ZHANG; S.; SLIMANI; S.; MULLER1

    2005-01-01

    1 IntroductionTendons and ligaments play important roles in the mediation of skeletal equilibrium and movement. Ruptures or tears of these tissues often result in a significant loss of joint function and long term problems such as degenerative diseases. The healing of some tendons and ligaments is a complex process, and in some cases (for exapmple,rupture the anterior cruciate ligament), no healing is possible, surgical implantation of grafts is necessary for the reparation. However, in surgical implantatio...

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

    OpenAIRE

    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...

  8. An Important Cause of Pes Planus: The Posterior Tibial Tendon Dysfunction

    OpenAIRE

    Kemal Erol; Ali Yavuz Karahan; Ülkü Kerimoğlu; Banu Ordahan; Levent Tekin; Muhammed Şahin; Ercan Kaydok

    2015-01-01

    Posterior tibial tendon dysfunction (PTTD) is an important cause of acquired pes planus that frequently observed in adults. Factors that play a role in the development of PTTD such as age-related tendon degeneration, inflammatory arthritis, hypertension, diabetes mellitus, obesity, peritendinous injections and more rarely acute traumatic rupture of the tendon. PTT is the primary dynamic stabilizer of medial arch of the foot. Plantar flexion and inversion of the foot occurs with contraction of...

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

    Science.gov (United States)

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

    2015-12-01

    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. Key pointsFrequent drop jump training induces activation mode dependent muscle torque depression late in the training period.No significant changes in the thickness of patellar and Achilles tendons are observed during frequent training, while CSA increases towards the end of training period.Longitudinal effect for jump height but not for muscle strength is evident after

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

    International Nuclear Information System (INIS)

    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

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  12. Transverse Compression of Tendons.

    Science.gov (United States)

    Salisbury, S T Samuel; Buckley, C Paul; Zavatsky, Amy B

    2016-04-01

    A study was made of the deformation of tendons when compressed transverse to the fiber-aligned axis. Bovine digital extensor tendons were compression tested between flat rigid plates. The methods included: in situ image-based measurement of tendon cross-sectional shapes, after preconditioning but immediately prior to testing; multiple constant-load creep/recovery tests applied to each tendon at increasing loads; and measurements of the resulting tendon displacements in both transverse directions. In these tests, friction resisted axial stretch of the tendon during compression, giving approximately plane-strain conditions. This, together with the assumption of a form of anisotropic hyperelastic constitutive model proposed previously for tendon, justified modeling the isochronal response of tendon as that of an isotropic, slightly compressible, neo-Hookean solid. Inverse analysis, using finite-element (FE) simulations of the experiments and 10 s isochronal creep displacement data, gave values for Young's modulus and Poisson's ratio of this solid of 0.31 MPa and 0.49, respectively, for an idealized tendon shape and averaged data for all the tendons and E = 0.14 and 0.10 MPa for two specific tendons using their actual measured geometry. The compression load versus displacement curves, as measured and as simulated, showed varying degrees of stiffening with increasing load. This can be attributed mostly to geometrical changes in tendon cross section under load, varying according to the initial 3D shape of the tendon. PMID:26833218

  13. Observation of tendon repair in animal model using second-harmonic-generation microscopy

    Science.gov (United States)

    Hase, Eiji; Minamikawa, Takeo; Sato, Katsuya; Takahashi, Mitsuhiko; Yasui, Takashi

    2016-03-01

    Tendon rupture is a trauma difficult to recover the condition before injury. In previous researches, tensile test and staining method have been widely used to elucidate the mechanism of the repair process from the viewpoints of the mechanical property and the histological findings. However, since both methods are destructive and invasive, it is difficult to obtain both of them for the same sample. If both the mechanical property and the histological findings can be obtained from the same sample, one may obtain new findings regarding mechanisms of tendon repairing process. In this paper, we used second-harmonic-generation (SHG) microscopy, showing high selectivity and good image contrast to collagen molecules as well as high spatial resolution, optical three-dimensional sectioning, deep penetration, and without additional staining. Since SHG light intensity sensitively reflects the structural maturity of collagen molecule and its aggregates, it will be a good indicator for the repairing degree of the ruptured tendon. From comparison of SHG images between the 4-weeks-repaired tendon and the sound tendon in the animal model, we confirmed that SHG light intensity of the repaired tendon was significantly lower than that of the sound tendon, indicating that the collagen structure in the repaired tendon is still immature. Furthermore, we performed both SHG imaging and the tensile test for the same sample, and confirmed a correlation between them. This result shows a potential of SHG light for an indicator of the histological and mechanical recovery of the ruptured tendon.

  14. Evaluation of finger A3 pulley rupture in the crimp grip position - a magnetic resonance imaging cadaver study

    Energy Technology Data Exchange (ETDEWEB)

    Bayer, Thomas; Uder, Michael; Janka, Rolf [University of Erlangen-Nuremberg, Department of Radiology, Erlangen (Germany); Adler, Werner [University of Erlangen-Nuremberg, Department of Biometry and Epidemiology, Erlangen (Germany); Schweizer, Andreas [Balgrist, University of Zurich, Department of Orthopaedics, Zurich (Switzerland); Schoeffl, Isabelle [Klinikum Bamberg, Department of Pediatrics, Bamberg (Germany)

    2015-09-15

    The correct diagnosis of an A3 pulley rupture is challenging for musculoskeletal radiologists. An A3 pulley rupture should in theory influence the shape of the proximal interphalangeal joint volar plate (VP) and the amount of bowstringing at level of the VP during finger flexion. The purpose of this study was to perform MRI with metric analysis of the VP configuration and VP bowstringing in cadaver fingers in the crimp grip position and to determine cut points for A3 pulley rupture. MRI in the crimp grip position was performed in 21 cadaver fingers with artificially created flexor tendon pulley tears (fingers with A3 pulley rupture n = 16, fingers without A3 pulley rupture n = 5). The distances of the translation of the VP relative to the middle phalanx base, the distances between the flexor tendons and the VP body, and the distances between the flexor tendon and bone (TB) were measured. Statistical analysis showed significantly lower VP translation distances and significantly higher VP tendon distances if the A3 pulley was ruptured. A2 TB and A4 TB distances did not differ significantly in specimens with and without A3 pulley rupture. The optimal cut points for A3 pulley rupture were a VP translation distance <2.8 mm and a VP tendon distance >1.4 mm. Reduction of the VP translation distance and augmentation of the VP tendon distance are suitable indirect signs of A3 pulley rupture. (orig.)

  15. Biomechanics of Tendon Transfers.

    Science.gov (United States)

    Livermore, Andrew; Tueting, Jonathan L

    2016-08-01

    The transfer of tendons in the upper extremity is a powerful technique to restore function to a partially paralyzed hand. The biomechanical principles of muscle tension and tendon excursion dictate motor function both in the native as well as transferred states. Appropriately tensioning transferred tendons to maximize the function of the associated muscle remains an area of focused research. Newer methods of tendon coaptation have proven similar in strength to the standard Pulvertaft weave, affording more options to the surgeon. PMID:27387073

  16. The tibialis posterior tendon

    OpenAIRE

    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...

  17. Bilateral akillesseneruptur hos nyretransplanterede

    DEFF Research Database (Denmark)

    Skovgaard, D; Feldt-Rasmussen, B F; Nimb, L;

    1996-01-01

    Increased incidence of tendinitis and tendon ruptures is reported in recipients of a kidney transplant. Two cases of bilateral achilles tendon rupture after minimal trauma are described. Tendon ruptures are more frequent in individuals with kidney disease in dialysis or after transplantation comp...

  18. Radial Nerve Tendon Transfers.

    Science.gov (United States)

    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

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

    Energy Technology Data Exchange (ETDEWEB)

    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. Tendon Structure and Composition.

    Science.gov (United States)

    Thorpe, Chavaunne T; Screen, Hazel R C

    2016-01-01

    Tendons are soft, fibrous tissues that connect muscle to bone. Their main function is to transfer muscle generated force to the bony skeleton, facilitating movement around a joint, and as such they are relatively passive, inelastic structures, able to resist high forces. Tendons are predominantly composed of collagen, which is arranged in a hierarchical manner parallel to the long axis of the tendon, resulting in high tensile strength. Tendon also contains a range of non-collagenous proteins, present in low amounts, which nevertheless have important functional roles. In this chapter, we describe general tendon composition and structure, and discuss how variations in composition and structure at different levels of the tendon hierarchy confer specific mechanical properties, which are related to tendon function. PMID:27535244

  1. Midportion Achilles Tendinopathy : Incidence, Imaging and Treatment

    NARCIS (Netherlands)

    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

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

    DEFF Research Database (Denmark)

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

    2009-01-01

    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 expression...

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

    Directory of Open Access Journals (Sweden)

    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

  4. Treatment of Tendon Injuries of the Lower Limb with Growth Factors Associated with Autologous Fibrin Scaffold or Collagenous Scaffold.

    Science.gov (United States)

    Giannotti, Stefano; Dell'Osso, Giacomo; Bottai, Vanna; Ghilardi, Marco; Bugelli, Giulia; Lazzerini, Ilaria; Guido, Giulio

    2015-05-01

    Tendon injuries are an increasing problem in orthopedics as we are faced with a growing demand in sports and recreation and an aging population. Tendons have poor spontaneous regenerative capacity, and often, complete recovery after injury is not achieved. Once injured, tendons do not completely re-acquire the biological and biomechanical properties of normal tendons due to the formation of adhesions and scarring, and often these abnormalities in the arrangement and structure are risk factors for re-injury. These problems associated with the healing of tendon injuries are a challenge for clinicians and surgeons. This study examined 9 cases of subcutaneous injuries including quadriceps tendon (2 cases), patellar tendon (1 case), and Achilles tendon (6 cases), incomplete and complete, treated consecutively. The surgical technique has provided, as appropriate, the termino-terminal tenorraphy, techniques of plastics of rotation flap, reinsertion with suture anchors, and in one case tendon augmentation with cadaver tissue. In cases where we needed mechanical support to the suture, we used preloaded growth factors on porcine collagen scaffold; in cases where we needed only one biological support, we used fibrin scaffold. PMID:26055027

  5. [Application of silk-based tissue engineering scaffold for tendon / ligament regeneration].

    Science.gov (United States)

    Hu, Yejun; Le, Huihui; Jin, Zhangchu; Chen, Xiao; Yin, Zi; Shen, Weiliang; Ouyang, Hongwei

    2016-03-01

    Tendon/ligament injury is one of the most common impairments in sports medicine. The traditional treatments of damaged tissue repair are unsatisfactory, especially for athletes, due to lack of donor and immune rejection. The strategy of tissue engineering may break through these limitations, and bring new hopes to tendon/ligament repair, even regeneration. Silk is a kind of natural biomaterials, which has good biocompatibility, wide range of mechanical properties and tunable physical structures; so it could be applied as tendon/ligament tissue engineering scaffolds. The silk-based scaffold has robust mechanical properties; combined with other biological ingredients, it could increase the surface area, promote more cell adhesion and improve the biocompatibility. The potential clinical application of silk-based scaffold has been confirmed by in vivo studies on tendon/ligament repairing, such as anterior cruciate ligament, medial collateral ligament, achilles tendon and rotator cuff. To develop novel biomechanically stable and host integrated tissue engineered tendon/ligament needs more further micro and macro studies, combined with product development and clinical application, which will give new hope to patients with tendon/ligament injury.

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

    Science.gov (United States)

    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

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

    Science.gov (United States)

    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

  8. Principles of Tendon Transfer.

    Science.gov (United States)

    Wilbur, Danielle; Hammert, Warren C

    2016-08-01

    Tendon transfers provide a substitute, either temporary or permanent, when function is lost due to neurologic injury in stroke, cerebral palsy or central nervous system lesions, peripheral nerve injuries, or injuries to the musculotendinous unit itself. This article reviews the basic principles of tendon transfer, which are important when planning surgery and essential for an optimal outcome. In addition, concepts for coapting the tendons during surgery and general principles to be followed during the rehabilitation process are discussed. PMID:27387072

  9. Engaging Stem Cells for Customized Tendon Regeneration

    Directory of Open Access Journals (Sweden)

    Hatim Thaker

    2012-01-01

    Full Text Available The need for a consistent therapeutic approach to tendon injury repair is long overdue. Patients with tendon microtears or full ruptures are eligible for a wide range of invasive and non invasive interventions, often subjectively decided by the physician. Surgery produces the best outcomes, and while studies have been conducted to optimize graft constructs and to track outcomes, the data from these studies have been inconclusive on the whole. What has been established is a clear understanding of healthy tendon architecture and the inherent process of healing. With this knowledge, tissue regeneration efforts have achieved immense progress in scaffold design, cell line selection, and, more recently, the appropriate use of cytokines and growth factors. This paper evaluates the plasticity of bone-marrow-derived stem cells and the elasticity of recently developed biomaterials towards tendon regeneration efforts. Mesenchymal stem cells (MSCs, hematopoietic progenitor cells, and poly(1,8-octanediol co-citrate scaffolds (POC are discussed in the context of established grafting strategies. With POC scaffolds to cradle the growth of MSCs and hematopoietic progenitor cells, developing a fibroelastic network guided by cytokines and growth factors may contribute towards consistent graft constructs, enhanced functionality, and better patient outcomes.

  10. A new strategy for the decellularisation of large equine tendons as biocompatible tendon substitutes.

    Science.gov (United States)

    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

  11. Murine patellar tendon biomechanical properties and regional strain patterns during natural tendon-to-bone healing after acute injury

    Science.gov (United States)

    Gilday, Steven D.; Casstevens, E. Chris; Kenter, Keith; Shearn, Jason T.; Butler, David L.

    2014-01-01

    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 natural PT-to-bone healing have not been well characterized. Thus, in this study, we analyzed the global biomechanical properties and regional strain patterns of both normal and naturally healing murine PT at three time points (2, 5, and 8 weeks) following acute surgical rupture of the tibial enthesis. Normal murine PT exhibited distinct regional variations in tissue strain, with the insertion region experiencing approximately 2.5 times greater strain than the midsubstance at failure (10.80 ± 2.52% vs. 4.11 ± 1.40%; mean ± SEM). Injured tendons showed reduced structural (ultimate load and linear stiffness) and material (ultimate stress and linear modulus) properties compared to both normal and contralateral sham-operated tendons at all healing time points. Injured tendons also displayed increased local strain in the insertion region compared to contralateral shams at both physiologic and failure load levels. 93.3% of injured tendons failed at the tibial insertion, compared to only 60% and 66.7% of normal and sham tendons, respectively. These results indicate that 8 weeks of natural tendon-to-bone healing does not restore normal biomechanical function to the murine PT following injury. PMID:24210849

  12. Clinical recovery of two hip adductor longus ruptures

    DEFF Research Database (Denmark)

    Thorborg, Kristian; Petersen, Jesper; Nielsen, Michael Bachmann;

    2013-01-01

    BACKGROUND: Non-operative treatment of acute hip adductor longus ruptures in athletes has been described in the literature. However, very limited information concerning the recovery of this type of injury exists. This case represented a unique possibility to study the recovery of two acute adductor...... was evaluated using hip-strength assessments, self-report and ultrasonography until complete muscle-strength recovery of the hip adductors had occurred. The player was able to participate in a full soccer training session without experiencing pain 15 weeks after the first rupture, and 12 weeks after the second...... rupture. Full hip adductor muscle-strength recovery was obtained 52 weeks after the first rupture and 10 weeks after the second rupture. The adductor longus injuries, as verified by initial ultrasonography (10 days post-injury), showed evidence of a complete tendon rupture in both cases, with an almost...

  13. Functional Assessment of the Foot Undergoing Percutaneous Achilles Tenotomy in Term of Gait Analysis

    Directory of Open Access Journals (Sweden)

    Yu-Bin Liu

    2016-01-01

    Full Text Available Background. This study was designed to evaluate the function of the foot undergoing the procedure of percutaneous Achilles tenotomy (PAT in case of clubfoot management in terms of gait analysis. Methods. Nineteen patients with unilateral clubfeet were retrospectively reviewed from our database from July 2012 to June 2016. The result in all the cases was rated as excellent according to the scale of International Clubfoot Study Group (ICSG. The affected sides were taken as Group CF and the contralateral sides as Group CL. Three-dimensional gait analysis was applied for the functional evaluation of the involved foot. Results. Statistical difference was found in physical parameters of passive ankle dorsiflexion and plantar-flexion. No statistical difference was found in temporal-spatial parameters. There was statistical difference in kinematic parameters of total ankle rotation, ankle range of motion, and internal foot progression angle and in kinetic parameters of peak ankle power. No statistical difference was found in other kinematic and kinetic parameters. Conclusions. It is demonstrated that the procedure of PAT is safe and efficient for correcting the equinus deformity in case of clubfoot management and preserving the main function of Achilles tendon at the minimum of four-year follow-up.

  14. Extensor pollicis brevis tendon can hyperextend thumb interphalangeal joint in absence of extensor pollicis longus: Case report and review of the literature

    Science.gov (United States)

    Strauch, Robert J; Strauch, Carolyn B

    2016-01-01

    We are reporting a case of extensor pollicis longus tendon rupture which did not require tendon transfer owing to the ability of the intact extensor pollicis brevis (EPB) to fully hyperextend the thumb interphalangeal joint. The thumb metacarpophalangeal joint was also able to be fully actively extended by the EPB. Previous anatomical studies have demonstrated that the insertional anatomy of the EPB tendon is highly variable and sometimes inserts onto the extensor hood and distal phalanx, which is likely the mechanism by which our patient was able to fully extend the thumb interphalangeal joint. Despite the potential for the EPB to extend the IP joint of the thumb, virtually all previously reported cases of extensor pollicis longus (EPL) tendon rupture had deficits of thumb IP extension requiring tendon transfer. This case highlights the potential ability of the EPB tendon to completely substitute for the function of the EPL tendon in providing thumb IP joint extension. PMID:27458556

  15. Extensor pollicis brevis tendon can hyperextend thumb interphalangeal joint in absence of extensor pollicis longus: Case report and review of the literature.

    Science.gov (United States)

    Strauch, Robert J; Strauch, Carolyn B

    2016-07-18

    We are reporting a case of extensor pollicis longus tendon rupture which did not require tendon transfer owing to the ability of the intact extensor pollicis brevis (EPB) to fully hyperextend the thumb interphalangeal joint. The thumb metacarpophalangeal joint was also able to be fully actively extended by the EPB. Previous anatomical studies have demonstrated that the insertional anatomy of the EPB tendon is highly variable and sometimes inserts onto the extensor hood and distal phalanx, which is likely the mechanism by which our patient was able to fully extend the thumb interphalangeal joint. Despite the potential for the EPB to extend the IP joint of the thumb, virtually all previously reported cases of extensor pollicis longus (EPL) tendon rupture had deficits of thumb IP extension requiring tendon transfer. This case highlights the potential ability of the EPB tendon to completely substitute for the function of the EPL tendon in providing thumb IP joint extension. PMID:27458556

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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

  18. What the Tortoise said to Achilles.

    Science.gov (United States)

    Diamond, George A; Kaul, Sanjay

    2010-08-15

    Practitioners and investigators often view clinical trials from very different perspectives-the former in terms of individuals and the latter in terms of groups. The following whimsical dialogue highlights the philosophical foundations of these contrasting perspectives and illustrates their potential impact on patient care and public policy. The title alludes to a piece by Lewis Carroll regarding Zeno's paradox, purportedly proving that the fleet-footed Achilles cannot outrun the plodding Tortoise in a foot race.

  19. Shock wave therapy for Achilles tendinopathy

    OpenAIRE

    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...

  20. Traumatic quadriceps rupture in a patient with patellectomy: a case report

    Directory of Open Access Journals (Sweden)

    Shanmugam Chezhiyan

    2007-11-01

    Full Text Available Abstract Introduction Acute traumatic, unilateral, quadriceps rupture after patellectomy is rare. Case presentation We present a 42-year old male who experienced a unilateral left quadriceps tendon rupture following assault by four people. Twenty-seven years before this injury, the patient had suffered ipsilateral femur and comminuted patellar fractures, which were managed by intramedullary nailing and patellectomy respectively. We performed primary end to end repair of the torn tendon. Postoperatively, histology revealed findings consistent with pre-existent degenerative changes. The patient made good recovery, and returned to his former occupation which was reliant on his ability to drive. Conclusion Degenerative changes of the tendon of the extensor mechanism of knee following patellectomy may predispose the quadriceps tendon to traumatic rupture. Early operative intervention and protracted rehabilitation are required to obtain the best functional results.

  1. Peroneal Tendon Injuries

    Science.gov (United States)

    ... 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) ...

  2. Tendon Transfers for Tetraplegia.

    Science.gov (United States)

    Bednar, Michael S

    2016-08-01

    It is estimated that 65% to 75% of patients with cervical spinal cord injuries could benefit from upper extremity tendon transfer surgery. The goals of surgery are to restore elbow extension, as well as hand pinch, grasp, and release. Patients who have defined goals, actively participate in therapy, and understand expected outcomes, appear to have the highest satisfaction following tendon transfer procedures. PMID:27387082

  3. Synthetic Mesh Augmentation of Acute and Subacute Quadriceps Tendon Repair.

    Science.gov (United States)

    Morrey, Matthew C; Barlow, Jonathan D; Abdel, Matthew P; Hanssen, Arlen D

    2016-01-01

    Quadriceps tendon rupture is an uncommon injury. To date, surgical results have been less than favorable. A novel repair technique that uses Marlex mesh (C R Bard, Murray Hill, New Jersey) has been developed. Use of this repair may allow earlier range of motion and functional restoration of extension. The authors sought to evaluate the technical feasibility, durability, and postoperative function of this repair. This study retrospectively analyzed 8 knees (7 patients) operated on with this technique from 1990 to 2011. Mean follow-up was 9 years. Average age at the time of injury was 69 years. Mean operative time was 130 minutes. No perioperative complications occurred, no patients had clinical evidence of failure, and no patients required subsequent reoperation. Mean flexion at final follow-up was 100°. Of the 8 knees, 7 knees had no extensor lag at final follow-up. Marlex mesh augmentation for quadriceps tendon ruptures has promising clinical results, despite significant comorbidities. The results showed that the technique was feasible, with low cost and reasonable operative time. The clinical results were durable, with no intraoperative complications, no re-ruptures, rare extension lag, and good range of motion. Therefore, synthetic mesh augmentation is a feasible option in acute quadriceps tendon ruptures.

  4. The wrinkled patellar tendon: An indication of abnormality in the extensor mechanism of the knee

    Energy Technology Data Exchange (ETDEWEB)

    Berlin, R.C.; Levinsohn, E.M. (State Univ. of New York, Syracuse, NY (USA). Dept. of Radiology); Chrisman, H. (State Univ. of New York, Syracuse, NY (USA). Coll. of Medicine)

    1991-04-01

    Rupture of the quadriceps tendon is an uncommon condition which requires early diagnosis and treatment to avert prolonged disability. In four patients who had surgically confirmed quadriceps tendon rupture, lateral radiographs of the knee and/or sagittal magnetic resonance (MR) images demonstrated a corrugated appearance to the patellar tendon. Sagittal MR images of the knee following patellectomy in one patient and radiographs of a transverse fracture of the patella in another also demonstrated this appearance. MRI has superb contrast resolution which provides optimal visualization of the contour of the patellar tendon on sagittal images. A retrospective review of 50 consecutive knee MRI examinations was carried out to evaluate the appearance of the normal patellar tendon. In 49 of 50 patients, the sagittal images demonstrated a straight or nearly straight patellar tendon. A corrugated appearance of the patellar tendon on sagittal images indicates a reduction in the normal tensile force applied to it and indicates the need for careful evaluation of the patella and quadriceps tendon mechanism. (orig.).

  5. Sclerosing polidocanol injections of small vessels to treat the chronic painful tendon.

    Science.gov (United States)

    Alfredson, H; Lorentzon, R

    2007-04-01

    The chronic painful tendon (tendinopathy, tendinosis) is generally considered difficult to treat, not seldom causing long-term disability and sometimes ending the sports or work carreér. Most common sites for tendinopathy are the Achilles-, patellar-, extensor carpi radialis brevis (ERCB)-, and supraspinatus tendons. The origin of pain has for many years been unknown, but recently, by using ultrasound (US) + colour Doppler (CD), immunohistochemical analyses of tendon biopsies, and diagnostic injections of local anaestesia, we found a close relationship between areas with vasculo-neural ingrowth and tendon pain. Sensory nerves (Substance-P-SP and Calcitonin Gene Related Peptide-CGRP) were found inside and outside the vascular wall. In following clinical studies we have demonstrated good short-and mid-term clinical results using treatment with US+CD-guided sclerosing polidocanol injections, targeting the area with neovessels outside the tendon. Two-year follow ups have showed remaining good clinical results, and sonographically signs of remodelling with a significantly thinner tendon with a more normal structure. Whether the effects of polidocanol are mediated through destruction of neovessels, activity on nerves or a combination, is under evaluation. PMID:17430133

  6. Developmental Stage-dependent Regulation of Prolyl 3-Hydroxylation in Tendon Type I Collagen.

    Science.gov (United States)

    Taga, Yuki; Kusubata, Masashi; Ogawa-Goto, Kiyoko; Hattori, Shunji

    2016-01-01

    3-Hydroxyproline (3-Hyp), which is unique to collagen, is a fairly rare post-translational modification. Recent studies have suggested a function of prolyl 3-hydroxylation in fibril assembly and its relationships with certain disorders, including recessive osteogenesis imperfecta and high myopia. However, no direct evidence for the physiological and pathological roles of 3-Hyp has been presented. In this study, we first estimated the overall alterations in prolyl hydroxylation in collagens purified from skin, bone, and tail tendon of 0.5-18-month-old rats by LC-MS analysis with stable isotope-labeled collagen, which was recently developed as an internal standard for highly accurate collagen analyses. 3-Hyp was found to significantly increase in tendon collagen until 3 months after birth and then remain constant, whereas increased prolyl 3-hydroxylation was not observed in skin and bone collagen. Site-specific analysis further revealed that 3-Hyp was increased in tendon type I collagen in a specific sequence region, including a previously known modification site at Pro(707) and newly identified sites at Pro(716) and Pro(719), at the early ages. The site-specific alterations in prolyl 3-hydroxylation with aging were also observed in bovine Achilles tendon. We postulate that significant increases in 3-Hyp at the consecutive modification sites are correlated with tissue development in tendon. The present findings suggest that prolyl 3-hydroxylation incrementally regulates collagen fibril diameter in tendon.

  7. Tendon gradient mineralization for tendon to bone interface integration.

    Science.gov (United States)

    Qu, Jin; Thoreson, Andrew R; Chen, Qingshan; An, Kai-Nan; Amadio, Peter C; Zhao, Chunfeng

    2013-11-01

    Tendon-to-bone integration is a great challenge for tendon or ligament reconstruction regardless of use of autograft or allograft tendons. We mineralized the tendon, thus transforming the tendon-to-bone into a "bone-to-bone" interface for healing. Sixty dog flexor digitorum profundus (FDP) tendons were divided randomly into five groups: (1) normal FDP tendon, (2) CaP (non-extraction and mineralization without fetuin), (3) CaPEXT (Extraction by Na2 HPO4 and mineralization without fetuin), (4) CaPFetuin (non-extraction and mineralization with fetuin), and (5) CaPEXTFetuin (extraction and mineralization with fetuin). The calcium and phosphate content significantly increased in tendons treated with combination of extraction and fetuin compared to the other treatments. Histology also revealed a dense mineral deposition throughout the tendon outer layers and penetrated into the tendon to a depth of 200 µm in a graded manner. Compressive moduli were significantly lower in the four mineralized groups compared with normal control group. No significant differences in maximum failure strength or stiffness were found in the suture pull-out test among all groups. Mineralization of tendon alters the interface from tendon to bone into mineralized tendon to bone, which may facilitate tendon-to-bone junction healing following tendon or ligament reconstruction.

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

    DEFF Research Database (Denmark)

    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...

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

    Directory of Open Access Journals (Sweden)

    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.

  10. A rare complication of scaphoid nonunion: Multiple flexor tendon lesions. A case report and review of literature.

    Science.gov (United States)

    Pierrart, J; Rétoré, J-Y; Leclercq, C

    2016-04-01

    This case report describes a patient who presented with a complete rupture of the flexor pollicis longus (FPL) tendon and partial rupture of the flexor digitorum profundus of the index finger, secondary to scaphoid nonunion. This is a rare, late complication that deserves to be described because of the potential diagnostic confusion with anterior interosseous nerve palsy. No case has been reported since 1999 in the literature. The mechanism was an attrition rupture due to sharp osteophytes. The scaphoid osteophytes were removed and the FPL was repaired by tendon transfer. The results were satisfactory at the last follow-up. PMID:27117128

  11. Posterior Tibial Tendon Dysfunction

    Science.gov (United States)

    ... 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 ...

  12. Magnetic resonance imaging of the elbow. Part II: Abnormalities of the ligaments, tendons, and nerves

    Energy Technology Data Exchange (ETDEWEB)

    Kijowski, Richard; Tuite, Michael; Sanford, Matthew [University of Wisconsin Hospital, Department of Radiology, Madison, WI (United States)

    2005-01-01

    Part II of this comprehensive review on magnetic resonance imaging of the elbow discusses the role of magnetic resonance imaging in evaluating patients with abnormalities of the ligaments, tendons, and nerves of the elbow. Magnetic resonance imaging can yield high-quality multiplanar images which are useful in evaluating the soft tissue structures of the elbow. Magnetic resonance imaging can detect tears of the ulnar collateral ligament and lateral collateral ligament of the elbow with high sensitivity and specificity. Magnetic resonance imaging can determine the extent of tendon pathology in patients with medial epicondylitis and lateral epicondylitis. Magnetic resonance imaging can detect tears of the biceps tendon and triceps tendon and can distinguishing between partial and complete tendon rupture. Magnetic resonance imaging is also helpful in evaluating patients with nerve disorders at the elbow. (orig.)

  13. Evaluation of the symptomatic supraspinatus tendon - a comparison of ultrasound and arthroscopy

    Energy Technology Data Exchange (ETDEWEB)

    Venu, K.M.; Howlett, D.C.; Garikipati, R.; Anderson, H.J.; Bonnici, A.V

    2002-11-01

    Purpose: A prospective study was undertaken to determine the accuracy of ultrasound compared with arthroscopy in the evaluation of the symptomatic supraspinatus tendon, and to identify whether ultrasound diagnosis was helpful in pre-operative planning. Methods: A total of 276 consecutive patients with shoulder impingement symptoms underwent ultrasound examination of the supraspinatus tendon. Of these patients, 41 proceeded to open or arthroscopic surgical procedure on clinical grounds, and in this group direct comparison with ultrasound findings was made. Results: There was full correlation between ultrasound and arthroscopy in the diagnosis of a normal supraspinatus tendon, full-thickness tear, tendinopathy and tendon rupture. There was some discrepancy between the two techniques. Two patients with partial thickness tear on ultrasound had a full thickness tear at arthroscopy. Ultrasound was able to identify intra-substance partial thickness tears in three patients with supraspinatus tendon said to be normal at arthroscopy. Ultrasound helped plan the surgical approach and operative time needed in cases of supraspinatus tendon rupture and full thickness tear. Conclusion: In this study ultrasound was effective in the evaluation of the symptomatic supraspinatus tendon, and was also able to diagnose intra-tendinous lesions not visible at arthroscopy.

  14. Evaluation of the symptomatic supraspinatus tendon - a comparison of ultrasound and arthroscopy

    International Nuclear Information System (INIS)

    Purpose: A prospective study was undertaken to determine the accuracy of ultrasound compared with arthroscopy in the evaluation of the symptomatic supraspinatus tendon, and to identify whether ultrasound diagnosis was helpful in pre-operative planning. Methods: A total of 276 consecutive patients with shoulder impingement symptoms underwent ultrasound examination of the supraspinatus tendon. Of these patients, 41 proceeded to open or arthroscopic surgical procedure on clinical grounds, and in this group direct comparison with ultrasound findings was made. Results: There was full correlation between ultrasound and arthroscopy in the diagnosis of a normal supraspinatus tendon, full-thickness tear, tendinopathy and tendon rupture. There was some discrepancy between the two techniques. Two patients with partial thickness tear on ultrasound had a full thickness tear at arthroscopy. Ultrasound was able to identify intra-substance partial thickness tears in three patients with supraspinatus tendon said to be normal at arthroscopy. Ultrasound helped plan the surgical approach and operative time needed in cases of supraspinatus tendon rupture and full thickness tear. Conclusion: In this study ultrasound was effective in the evaluation of the symptomatic supraspinatus tendon, and was also able to diagnose intra-tendinous lesions not visible at arthroscopy

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

    Directory of Open Access Journals (Sweden)

    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

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

    Science.gov (United States)

    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

  17. Triceps surae muscle-tendon properties in older endurance- and sprint-trained athletes.

    Science.gov (United States)

    Stenroth, Lauri; Cronin, Neil J; Peltonen, Jussi; Korhonen, Marko T; Sipilä, Sarianna; Finni, Taija

    2016-01-01

    Previous studies have shown that aging is associated with alterations in muscle architecture and tendon properties (Morse CI, Thom JM, Birch KM, Narici MV. Acta Physiol Scand 183: 291-298, 2005; Narici MV, Maganaris CN, Reeves ND, Capodaglio P. J Appl Physiol 95: 2229-2234, 2003; Stenroth L, Peltonen J, Cronin NJ, Sipila S, Finni T. J Appl Physiol 113: 1537-1544, 2012). However, the possible influence of different types of regular exercise loading on muscle architecture and tendon properties in older adults is poorly understood. To address this, triceps surae muscle-tendon properties were examined in older male endurance (OE, n = 10, age = 74.0 ± 2.8 yr) and sprint runners (OS, n = 10, age = 74.4 ± 2.8 yr), with an average of 42 yr of regular training experience, and compared with age-matched [older control (OC), n = 33, age = 74.8 ± 3.6 yr] and young untrained controls (YC, n = 18, age = 23.7 ± 2.0 yr). Compared with YC, Achilles tendon cross-sectional area (CSA) was 22% (P = 0.022), 45% (P = 0.001), and 71% (P Young's modulus was 31-44%, and maximal tendon stress 44-55% lower, than in YC (P ≤ 0.001). OE showed shorter soleus fascicle length than both OC (P Young's modulus. Shorter soleus muscle fascicles in OE runners may be an adaptation to life-long endurance running.

  18. Autologous hamstring tendon used for revision of quadiceps tendon tears.

    Science.gov (United States)

    McCormick, Frank; Nwachukwu, Benedict U; Kim, Jaehon; Martin, Scott D

    2013-04-01

    A paucity of literature exists on quadriceps tendon reruptures. Failed quadriceps tendon repair can cause significant morbidity and disability. Surgical management of quadriceps tendon rerupture can be challenging due to tissue degeneration, tendon retraction, muscle atrophy, and poor bone fixation. A lack of guidance in the literature exists on the appropriate surgical techniques for managing quadriceps tendon reruptures.This article describes the case of a male recreational athlete with a failed primary quadriceps tendon repair who presented 10 months after rerupture. Examination was significant for morbid obesity, assisted ambulation, and a significant defect at the superior pole of the patella on the affected side. Intraoperative findings were consistent with a 2.0- to 4.5-cm tendon defect across the extensor mechanism with complete retinaculi tears. The authors performed a novel surgical approach for revision of quadriceps tears using a bilateral hamstring autograft through a quadriceps tendon weave and a transosseous patellar repair. Tendon length was restored, and extensor mechanism tension was reapproximated. Postoperatively, the patient achieved a good outcome and had returned to full, painless, sport participation at 2-year follow-up.This surgical technique is suitable for revision quadriceps tendon repairs of large tendon gap defects, repairs desiring tendon-to-bone in-growth, and repairs requiring large-force transmission across the repair.

  19. Novel methods for tendon investigations

    DEFF Research Database (Denmark)

    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...... and pathophysiological mechanisms in tendon tissue, but also, to some extent, allow for more elaborate studies of the intact human tendon. Read More: http://informahealthcare.com/doi/full/10.1080/09638280701785403...

  20. 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

    Institute of Scientific and Technical Information of China (English)

    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 .

  1. Posterior Tibial Tendon Transfer.

    Science.gov (United States)

    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

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

    Science.gov (United States)

    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

  3. Late extensor pollicis longus rupture following plate fixation in Galeazzi fracture dislocation

    Directory of Open Access Journals (Sweden)

    Dhananjaya Sabat

    2014-01-01

    Full Text Available Late rupture of extensor pollicis longus (EPL tendon after Galeazzi fracture dislocation fixation is an unknown entity though it is a well-established complication following distal radius fractures. We report the case of a 55-year old male who presented with late EPL tendon rupture 4 months following internal fixation of Galeazzi fracture dislocation with a Locking Compression Plate (LCP. He was managed with extensor indicis proprius (EIP transfer to restore thumb extension. At 4 years followup, functional result of the transfer was good. We identify possible pitfalls with this particular patient and discuss how to avoid them in future.

  4. Late extensor pollicis longus rupture following plate fixation in Galeazzi fracture dislocation.

    Science.gov (United States)

    Sabat, Dhananjaya; Dabas, Vineet; Dhal, Anil

    2014-07-01

    Late rupture of extensor pollicis longus (EPL) tendon after Galeazzi fracture dislocation fixation is an unknown entity though it is a well-established complication following distal radius fractures. We report the case of a 55-year old male who presented with late EPL tendon rupture 4 months following internal fixation of Galeazzi fracture dislocation with a Locking Compression Plate (LCP). He was managed with extensor indicis proprius (EIP) transfer to restore thumb extension. At 4 years followup, functional result of the transfer was good. We identify possible pitfalls with this particular patient and discuss how to avoid them in future.

  5. Prepatellar continuation rupture: Report of an unusual case.

    Science.gov (United States)

    Majeed, Haroon; dos Remedios, Ian; Datta, Praveen; Griffiths, David

    2014-10-01

    In anatomical studies the deepest soft tissue layer, related to the deep rectus femoris tendinous fibers, has been described as the "prepatellar quadriceps continuation". We present an unusual case of an isolated prepatellar continuation rupture, which to our knowledge is the first described case in the literature. Injuries to the extensor mechanism may include isolated rupture of the prepatellar continuation with intact quadriceps and patellar tendons. Diagnosis may be difficult with ultrasound scan and requires MRI scan for confirmation. Appropriate clinical assessment and regular physiotherapy lead to a full functional recovery.

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

    OpenAIRE

    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.

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

    Science.gov (United States)

    Naziri, Qais; Williams, Nadine; Hayes, Westley; Kapadia, Bhaveen H.; Chatterjee, Dipal; Urban, William P.

    2016-01-01

    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. PMID:27163106

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Science.gov (United States)

    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

  10. Traumatic Thumb Radial Sagittal Band Injury Mimicking EPL Rupture.

    Science.gov (United States)

    Dissanayake, Ravi M; Moore, Peter; McCarten, Gregory M

    2016-06-01

    We present the case of a closed traumatic disruption of the thumb radial sagittal band (RSB) that sonographically mimicked rupture of the extensor pollicis longus (EPL) tendon. This injury was treated with primary repair of the RSB and lead to a good functional outcome for the patient. This case report highlights how early recognition and treatment can lead to a good functional outcome. PMID:27454647

  11. Isolated Total Rupture of Extraocular Muscles.

    Science.gov (United States)

    Chen, Jingchang; Kang, Ying; Deng, Daming; Shen, Tao; Yan, Jianhua

    2015-09-01

    Total rupture of extraocular muscles is an infrequent clinical finding. Here we conducted this retrospective study to evaluate their causes of injury, clinical features, imaging, surgical management, and final outcomes in cases of isolated extraocular muscle rupture at a tertiary center in China. Thirty-six patients were identified (24 men and 12 women). Mean age was 34 years (range 2-60). The right eye was involved in 21 patients and the left 1 in 15. A sharp object or metal hook was the cause of this lesion in 16 patients, sinus surgery in 14 patients, traffic accident in 3 patients, orbital surgery in 2 patients, and conjunctive tumor surgery in 1 patient. The most commonly involved muscles were medial (18 patients) and inferior rectus muscles (13 patients). The function of the ruptured muscles revealed a scale of -3 to -4 defect of ocular motility and the amount of deviation in primary position varied from 10 to 140 PD (prism diopter). Computerized tomography (CT) confirmed the presence of ruptured muscles. An end-to-end muscle anastomosis was performed and 3 to 5 mm of muscle was resected in 23 patients. When the posterior border of the injured muscle could not be identified (13 patients), a partial tendon transposition was performed, together with recession of the antagonist in most patients, whereas a recession of the antagonist muscle plus a resection of the involved muscle with or without nasal periosteal fixation was performed in the remaining patients. After an average of 16.42 months of follow-up an excellent result was achieved in 23 patients and results of 13 patients were considered as a failure. In most patients, the posterior border of the ruptured muscle can be identified and an early surgery can be performed to restore function. Alternatively, a partial tendon transposition should be performed. When muscular rupture is suspected, an early orbital CT is required to confirm this possibility, which can then verify the necessity for an early surgical

  12. Influence of low intensity laser therapy (AsGa) on the cicatrization process of mechanic tendon injury in wistar rats

    Science.gov (United States)

    Lima, J. G. M.; Oliveira Filho, G. R.; Lima, M. T. B. R. M.; Ferreira, A. S.; Silva, J. G.

    2012-09-01

    The aim of this study was to compare the effect of the low level Laser therapy (AsGa) in the experimental tendon injury. Low level Laser therapy has been used in several studies to observe the regenerative quality and tecidual cicatrization. Forty Wistar rats (male) were divided into 4 groups: control group (C-group); injury group (L-group); treated group with Laser therapy 3 J/cm2 (3J-group); and treated group with Laser therapy 6 J/cm2 (6J-group). Groups L, 3J, and 6J were submitted to a mechanic Achilles tendon injury with a Kocher Forceps for 10 s. The animals were sacrificed after ten days of treatment. Histopathological evaluation using hematoxylin-eosin and Picro-Sirius staining showed a decreased ( p < 0.05) of collagen in L-group (353.12 ± 9.85 μm2/field) compared to C-group (215.13 ± 22.63 μm2/field). Animals treated with Laser showed a significant increase in collagen fibers despite the applied dosage (3J-group: 375.89 ± 26.99 μm2/field; 6J group: 400.34 ± 62.92 μm2/field; p < 0.05). These data suggest that low-level Laser therapy was efficient for the treatment of mechanics Achilles tendon injury in Wistar rats.

  13. An important cause of pes planus: the posterior tibial tendon dysfunction

    Directory of Open Access Journals (Sweden)

    Kemal Erol

    2015-02-01

    Full Text Available Posterior tibial tendon dysfunction (PTTD is an important cause of acquired pes planus that frequently observed in adults. Factors that play a role in the development of PTTD such as age-related tendon degeneration, inflammatory arthritis, hypertension, diabetes mellitus, obesity, peritendinous injections and more rarely acute traumatic rupture of the tendon. PTT is the primary dynamic stabilizer of medial arch of the foot. Plantar flexion and inversion of the foot occurs with contraction of tibialis posterior tendon, and arch of the foot becomes elaveted while midtarsal joints are locked and midfoot-hindfoot sets as rigid. Thus, during the walk gastrocnemius muscle works more efficiently. If the PTT does not work in the order, other foot ligaments and joint capsule would be increasingly weak and than pes planus occurs. We present a 10-yearold female patient diagnosed as PTTD and conservative treatment with review of the current literature.

  14. An important cause of pes planus: the posterior tibial tendon dysfunction.

    Science.gov (United States)

    Erol, Kemal; Karahan, Ali Yavuz; Kerimoğlu, Ülkü; Ordahan, Banu; Tekin, Levent; Şahin, Muhammed; Kaydok, Ercan

    2015-01-28

    Posterior tibial tendon dysfunction (PTTD) is an important cause of acquired pes planus that frequently observed in adults. Factors that play a role in the development of PTTD such as age-related tendon degeneration, inflammatory arthritis, hypertension, diabetes mellitus, obesity, peritendinous injections and more rarely acute traumatic rupture of the tendon. PTT is the primary dynamic stabilizer of medial arch of the foot. Plantar flexion and inversion of the foot occurs with contraction of tibialis posterior tendon, and arch of the foot becomes elaveted while midtarsal joints are locked and midfoot-hindfoot sets as rigid. Thus, during the walk gastrocnemius muscle works more efficiently. If the PTT does not work in the order, other foot ligaments and joint capsule would be increasingly weak and than pes planus occurs. We present a 10-year-old female patient diagnosed as PTTD and conservative treatment with review of the current literature. PMID:25918629

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

    Science.gov (United States)

    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

  16. Delaying Shoulder Motion and Strengthening and Increasing Achilles Allograft Thickness for Glenoid Resurfacing Did Not Improve the Outcome for a 30-Year-Old Patient with Postarthroscopic Glenohumeral Chondrolysis

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    John G. Skedros

    2014-01-01

    Full Text Available Although interposition soft-tissue (biologic resurfacing of the glenoid with humeral hemiarthroplasty has been considered an option for end-stage glenohumeral arthritis, the results of this procedure are highly unsatisfactory in patients less than 40 years old. Achilles tendon allograft is popular for glenoid resurfacing because it can be made robust by folding it. But one reason that the procedure might fail in younger patients is that the graft is not initially thick enough for the young active patient. Most authors report folding the graft only once to achieve two-layer thickness. We report the case of a 30-year-old male who had postarthroscopic glenohumeral chondrolysis that was treated with Achilles tendon allograft resurfacing of the glenoid and humeral hemiarthroplasty. An important aspect of our case is that the tendon was folded so that it was 50–100% thicker than most allograft constructs reported previously. We also used additional measures to enhance allograft resiliency and bone incorporation: (1 multiple nonresorbable sutures to attach the adjacent graft layers, (2 additional resorbable suture anchors and nonresorbable sutures in order to more robustly secure the graft to the glenoid, and (3 delaying postoperative motion and strengthening. However, despite these additional measures, our patient did not have an improved outcome.

  17. Sonography findings in tears of the extensor pollicis longus tendon and correlation with CT, MRI and surgical findings

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    Ruiz Santiago, Fernando [Hospital of Traumatology - Ciudad Sanitaria Virgen de las Nieves, Carretera de Jaen SN, 18013 Granada (Spain)], E-mail: ferusan@telefonica.net; Garofano Plazas, Pilar; Fernandez, Juan Miguel Tristan [Hospital of Traumatology - Ciudad Sanitaria Virgen de las Nieves, Carretera de Jaen SN, 18013 Granada (Spain)

    2008-04-15

    We present our experience in the diagnosis of extensor pollicis longus tendon tears using different imaging methods. In the past 2 years, 12 patients (7 males, 5 females) with extension deficit of distal phalanx of thumb were diagnosed with extensor pollicis longus tendon (EPL) rupture by means of different imaging methods. The ultrasound pattern consisted of a gap between tendon stumps occupied by a continuous (eight cases) or discontinuous (four cases) attenuated hypoechoic string. In nine cases, the tendon ends were identified as a thickened stump-like structure. In the other three cases, tendon stumps were attenuated and mixed with atrophic muscle or wrist subcutaneous fat. All ultrasound findings were confirmed by CT, MR and/or surgical findings.

  18. Resurfacing with chemically modified hyaluronic acid and lubricin for flexor tendon reconstruction.

    Science.gov (United States)

    Zhao, Chunfeng; Hashimoto, Takahiro; Kirk, Ramona L; Thoreson, Andrew R; Jay, Gregory D; Moran, Steven L; An, Kai-Nan; Amadio, Peter C

    2013-06-01

    We assessed surface coating with carbodiimide derivatized hyaluronic acid combined with lubricin (cd-HA-Lubricin) as a way to improve extrasynovial tendon surface quality and, consequently, the functional results in flexor tendon reconstruction, using a canine in vivo model. The second and fifth flexor digitorum profundus tendons from 14 dogs were reconstructed with autologs peroneus longus (PL) tendons 6 weeks after a failed primary repair. One digit was treated with cd-HA-Lubricin, and the other was treated with saline as the control. Six weeks following grafting, the digits and graft tendons were functionally and histologically evaluated. Adhesion score, normalized work of flexion, graft friction in zone II, and adhesion breaking strength at the proximal repair site in zone III were all lower in the cd-HA-Lubricin treated group compared to the control group. The strength at the distal tendon/bone interface was decreased in the cd-HA-Lubricin treated grafts compared to the control grafts. Histology showed inferior healing in the cd-HA-Lubricin group at both proximal and distal repair sites. However, cd-HA-Lubricin treatment did not result in any gap or rupture at either the proximal or distal repair sites. These results demonstrate that cd-HA-Lubricin can eliminate graft adhesions and improve digit function, but that treatment may have an adverse effect on tendon healing.

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

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    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.

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

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    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. S