WorldWideScience

Sample records for achilles tendon

  1. Achilles tendon repair

    Science.gov (United States)

    Achilles tendon rupture-surgery; Percutaneous Achilles tendon rupture repair ... To fix your torn Achilles tendon, the surgeon will: Make a cut down the back of your heel Make several small cuts rather than one large cut ...

  2. Percutaneous Achilles Tendon Lengthening

    Science.gov (United States)

    ... All Site Content AOFAS / FootCareMD / Treatments Percutaneous Achilles Tendon Lengthening Page Content ​ Pre-operative incision markings along ... What is the goal of a percutaneous Achilles tendon lengthening? The goal of this procedure is to ...

  3. Achilles tendon rupture - aftercare

    Science.gov (United States)

    Heel cord tear; Calcaneal tendon rupture ... MRI scan to see what type of Achilles tendon tear you have. An MRI is a type ... partial tear means at least some of the tendon is still OK. A full tear means your ...

  4. Complete Achilles tendon ruptures.

    Science.gov (United States)

    Landvater, S J; Renström, P A

    1992-10-01

    Achilles tendon ruptures can be treated nonsurgically in the nonathletic or low-end recreational athletic patient, particularly those more than 50 years of age, provided the treating physician does not delay in the diagnosis and treatment (preferably less than 48 hrs and possibly less than 1 week). The patient should be advised of the higher incidence of re-rupture of the tendon when treated nonsurgically. Surgical treatment is recommended for patients who are young and athletic. This is particularly true because the major criticism of surgical treatment has been the complication rate, which has decreased to a low level and to a mild degree, usually not significantly affecting the repair over time. Surgical treatment in these individuals seems to be superior not only in regard to re-rupture but also in assuring the correct apposition of the tendon ends and in placing the necessary tension on the tendon to secure appropriate orientation of the collagen fibers. This in turn allows them to regain full strength, power, endurance, and an early return to sports. Surgery is also recommended for late diagnosed ruptures where there is significant lengthening of the tendon. Surgical technique should involve a medial incision to avoid the sural nerve, absorbable suture, and augmentation with fascia or tendon where there is a gap or late rupture. Postoperatively, the immobilization should be 7 to 10 days in a splint. A walking boot with early motion in plantar flexion or a short leg cast with the tendon under slight tension should thereafter be used for 4 to 5 weeks. An early and well-supervised rehabilitation program should be initiated to restore the patient to the preinjury activity level.

  5. Achilles tendon rupture; assessment of nonoperative treatment

    DEFF Research Database (Denmark)

    Barfod, Kristoffer Weisskirchner

    2014-01-01

    BACKGROUND: Acute Achilles tendon rupture is a frequent and potentially disabling injury. Over the past decade a change in treatment of acute Achilles tendon rupture away from operative towards non-operative treatment has taken place. However, the optimal non-operative treatment protocol remains...... and Sweden. Immediate weight-bearing was found to be safe and recommendable in non-operative treatment of acute Achilles tendon rupture. The novel ultrasound measurement showed excellent reliability and acceptable validity and agreement....

  6. Achilles tendon rupture; assessment of nonoperative treatment

    DEFF Research Database (Denmark)

    Barfod, Kristoffer Weisskirchner; Troelsen, Anders

    2014-01-01

    BACKGROUND: Acute Achilles tendon rupture is a frequent and potentially disabling injury. Over the past decade a change in treatment ofacute Achilles tendon rupture away from operative towards non-operative treatment has taken place. However, the optimal non-operative treatment protocol remains...... and Sweden. Immediate weight-bearing was found to be safe and recommendable in non-operative treatment of acute Achilles tendon rupture. The novel ultrasound measurement showed excellent reliability and acceptable validity and agreement....

  7. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1986-06-01

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

  9. 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.

  10. [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.

  11. Rupture of Achilles Tendon : Usefulness of Ultrasonography

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Nam Hyeon; Ki, Won Woo; Yoon, Kwon Ha; Kim, Song Mun; Shin, Myeong Jin [Ulsan Medical College, Ulsan (Korea, Republic of); Kwon, Soon Tae [Chungnam University College of Medicine, Daejeon (Korea, Republic of)

    1996-06-15

    To differentiate a complete rupture of Achilles tendon from an incomplete one which is important because its treatment is quite different. And it is necessary to know the exact site of the rupture preoperatively. Fifteen cases of fourteen patients which were diagnosed as Achilles tendon rupture by ultrasonography and surgery were reviewed. We compared sonographic rupture site with surgical findings. Ultrasonographic criteria for differentiation of complete and incomplete rupture was defined as follows : the discreteness, which means the proximal intervening hypoechogenicity to the interface echogenicity of distal margin of ruptured tendon : the slant sign, which represents the interface of ruptured distal margin which was seen over the 3/4 of the thickness of the tendon without intervening low echogeneicity : the invagination sign, which means the echogenic invagination from Kager triangle into posterior aspect of Achilles tendon over the half thickness of the tendon. The sites of complete tendon rupture were exactly corresponded to surgical finding in four cases of ten complete ruptures. And the discrepancy between sonographic and surgical findings in the site of complete rupture was 1.2 {+-} 0.4 cm in six cases. Three of ten complete ruptures showed the discreteness sign, all of ten showed the slant sign and two of ten showed the invagination sign. It is helpful to differentiate a complete from incomplete rupture of the Achilles tendon and to localize the site of the complete rupture with the ultrasonographic evaluation

  12. 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....

  13. Finite Element Analysis of the Achilles Tendon While Running

    OpenAIRE

    Anițaș Răzvan; Lucaciu Do

    2013-01-01

    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.

  14. Achilles Tendon Repair, A Modified Technique

    Directory of Open Access Journals (Sweden)

    Sohrab Keyhani

    2013-12-01

    Full Text Available Background: Wound complications following open repair for acute Achilles tendon ruptures (AATR remain the subject of significant debate. The aim of this study is to investigate the effects of covering repaired AATR using well-nourished connective tissues (paratenon and deep fascia to avoid complications after open repair.   Methods: In this case series study, open repair was performed for 32 active young patients with AATR. After the tendon was repaired, the deep fascia and paratenon was used to cover the Achilles tendon. Patients were followed for two years and any wound complication was recorded. During the last visit, the American Orthopedic Foot and Ankle Society (AOFAS ankle-hind foot score was completed for all patients. Calf circumference and ankle range of motion were measured and compared with the contralateral side. Patients were asked about returning to previous sports activities and limitations with footwear. Results: Only, one patient developed deep wound infection (3%. None of the patients had any discomfort around the operation area, limitation with footwear, sural nerve injury, re-rupture, and skin adhesion. The AOFAS score averaged 92.5±6. Two patients (7% were unable to return to previous sports activities because of moderate pain in heavy physical exercises. The calf circumference and ankle ROM were similar between healthy and operated sides. Conclusion: The present study showed that fascial envelope for full covering of the repaired Achilles tendon may help to prevent the occurrence of wound complications.

  15. Achilles Tendon Repair, A Modified Technique

    Directory of Open Access Journals (Sweden)

    Sohrab Keyhani

    2013-12-01

    Full Text Available   Background: Wound complications following open repair for acute Achilles tendon ruptures (AATR remain the subject of significant debate. The aim of this study is to investigate the effects of covering repaired AATR using well-nourished connective tissues (paratenon and deep fascia to avoid complications after open repair.   Methods: In this case series study, open repair was performed for 32 active young patients with AATR. After the tendon was repaired, the deep fascia and paratenon was used to cover the Achilles tendon. Patients were followed for two years and any wound complication was recorded. During the last visit, the American Orthopedic Foot and Ankle Society (AOFAS ankle-hind foot score was completed for all patients. Calf circumference and ankle range of motion were measured and compared with the contralateral side. Patients were asked about returning to previous sports activities and limitations with footwear. Results: Only, one patient developed deep wound infection (3%. None of the patients had any discomfort around the operation area, limitation with footwear, sural nerve injury, re-rupture, and skin adhesion. The AOFAS score averaged 92.5±6. Two patients (7% were unable to return to previous sports activities because of moderate pain in heavy physical exercises. The calf circumference and ankle ROM were similar between healthy and operated sides. Conclusion: The present study showed that fascial envelope for full covering of the repaired Achilles tendon may help to prevent the occurrence of wound complications.

  16. 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.

  17. Motor responses to experimental Achilles tendon pain

    DEFF Research Database (Denmark)

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

    2011-01-01

    calculated. Results Compared with the control condition experimental Achilles tendon pain reduced the EMG activity in agonistic, synergistic and antagonistic muscles, and increased the ground reaction force frequency content around 10 Hz, during both eccentric and concentric movement phases. Conclusions...... different days separated by 1 week, three-dimensional ground reaction forces, ankle joint kinematics and surface electromyography (EMG) of the lower leg muscles were recorded during one-legged full weight-bearing ankle plantar (concentric) and dorsal (eccentric) flexion exercises. Measurements were done...... before, during and after either experimental Achilles tendon pain or a non-painful control condition. Pain was induced by intratendinous injections of hypertonic saline with isotonic saline injections as control. Joint kinematics, ground reaction force frequency contents and average EMG amplitudes were...

  18. 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...

  19. 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 Achilles tendon-aponeurosis complex. METHODS: Both legs of 19 non-injured subjects were examined by magnetic resonance imaging (MRI) and US. The length from calcaneus to the medial head of m. Gastrocnemius was measured by three independent US examiners. Repeated US measurements were performed and compared...... 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....

  20. 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.

  1. The role of tendon microcirculation in Achilles and patellar tendinopathy.

    Science.gov (United States)

    Knobloch, Karsten

    2008-04-30

    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 lidocaine.

  2. 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.

  3. 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.

  4. 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

  5. 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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1994-02-01

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

  7. Botulinum toxin improves reduced dorsiflexion after Achilles tendon surgery.

    Science.gov (United States)

    Reuter, Iris; Lorbach, Olaf; Mehnert, Sabine; Kaps, Manfred; Engelhardt, Martin

    2010-02-01

    Generally, outcome after surgical repair of complete Achilles tendon rupture is good. However, some patients have ongoing problems with dorsiflexion of the ankle joint. We report on eight patients, who did not achieve heel contact because of reduced ankle dorsiflexion 5 months after surgical repair of complete Achilles tendon rupture. All patients received at least three cycles of injections with 200-300 units of Botulinum toxin A (BOTOX) into the gastrocnemius and soleus muscle. Weakening of the triceps surae by Botulinum toxin allowed patients to perform the required exercises and to tolerate casting at night. Thus, all patients were able to tolerate plantigrade foot position 9 months after beginning of Botulinum toxin treatment. At final follow-up after 2 years, pain had significantly improved, and a mean dorsiflexion of 21 degrees was reached. In conclusion, treatment of the calf muscles with BOTOX is a safe and effective method to improve restricted dorsiflexion in patients after Achilles tendon repair.

  8. Could Ossification of the Achilles Tendon Have a Hereditary Component?

    Directory of Open Access Journals (Sweden)

    Chawki Cortbaoui

    2013-01-01

    Full Text Available Ossification of the Achilles tendon (OTA is an unusual clinical condition. It is characterized by the presence of an ossified mass within the fibrocartilaginous substance of the Achilles tendon. The etiology of the ossification of the Achilles tendon is unknown. Review of the literature suggests that its etiology is multifactorial. The major contributing factors are trauma and surgery with other minor causes such as systemic diseases, metabolic conditions, and infections. To our knowledge, no previous reports suggest any genetic/hereditary predisposition in OAT. We report 3 siblings who have OAT with no history of any of the aforementioned predisposing factors. Could OAT have a hereditary component as one of its etiologies?

  9. Nonoperative, dynamic treatment of acute achilles tendon rupture

    DEFF Research Database (Denmark)

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

    2015-01-01

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

  10. Heel pain and Achilles tendonitis -- aftercare

    Science.gov (United States)

    ... walking or standing on your foot References Achilles Tendinitis. In: Safran MR, Zachazewski J, Stone DA, eds. ... Related MedlinePlus Health Topics Heel Injuries and Disorders Tendinitis Browse the Encyclopedia A.D.A.M., Inc. ...

  11. [Treatment of traumatic sections of the Achilles tendon].

    Science.gov (United States)

    Orfanu, N

    1977-01-01

    The author maintains that the atrophy of the sural triceps muscle, the retraction of the Achille tendon and the osteoporosis of the calcaneum and of the tarsian bones, occurring after the traumatic sectioning of the Achille tendon, are the results of an inadequate treatment. The cause of these sequellae is the immobilization of the foot in an equinus position, which relaxes the sural triceps and as a result of the lack of mechanical traction factor, leads to local circulatory disturbances followed by a modification in the structure of the bone and of the muscle. On the basis of this pathophysiological concept the author has excluded post-operative immobilization in the equinus position, and in fact any type of immobilization, recommending in contrast a mobilization of the foot from the very first days after the suture of the tendon. The clinical results obtained confirm the value of the hypothesis.

  12. Treatment of A Case of Spontaneous Rupture of Achille's Tendon

    Institute of Scientific and Technical Information of China (English)

    张世筠

    2003-01-01

    @@ Mr. Guo, 51 years old, paid his first visit on November 7, 2001. The patient felt sudden pain in the right Achille's tendon in June 1999 with no apparent predisposing factors. Several months later he palpated a small pitting in the middle of the right Achille's tendon, which expanded gradually in size. In June 2000, two thirds of the tendon was diagnosed to be ruptured in a local hospital. Ten days later the tendon was ruptured completely when he felt sudden severe pain, numbness and distention, and he was unable to raise the heel. The lesion was healed three months later after being treated with a plaster model, but it was partially ruptured again 6 months later. Though the ruptured tendon was healed again with the help of a plaster model, he still suffered from local swelling and pain, which was aggravated during movement and made him difficult in walking, squatting down and standing up. During the examination, the right heel was found hyperemic and swollen with ecchymosis and tenderness. The tongue proper was dark red and the pulse thready and rapid. The condition was due to depletion and deficiency of liver-qi, stagnant blood with dampheat obstructing the collaterals. The principle of nourishing the liver and soothing the tendon was adopted, assisted by invigorating blood circulation and removing blood stasis, clearing heat and transforming dampness.

  13. 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

  14. 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.

  15. Biomechanical characteristics of the eccentric Achilles tendon exercise

    DEFF Research Database (Denmark)

    Henriksen, Marius; Aaboe, Jens; Bliddal, Henning

    2009-01-01

    muscles were recorded. Joint kinematics, GRF frequency contents, average EMG amplitudes, and Achilles tendon loads were calculated. FINDINGS: The eccentric movement phase was characterized by a higher GRF frequency content in the 8-12 Hz range, and reduced EMG activity in the lower leg muscles...... 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....... No differences in Achilles tendon loads were found. INTERPRETATION: This descriptive study demonstrates differences in the movement biomechanics between the eccentric and concentric phases of one-legged full weight bearing ankle dorsal and plantar flexion exercises. In particular, the findings imply...

  16. Variation in the human Achilles tendon moment arm during walking.

    Science.gov (United States)

    Rasske, Kristen; Thelen, Darryl G; Franz, Jason R

    2017-02-01

    The Achilles tendon (AT) moment arm is an important determinant of ankle moment and power generation during locomotion. Load and depth-dependent variations in the AT moment arm are generally not considered, but may be relevant given the complex triceps surae architecture. We coupled motion analysis and ultrasound imaging to characterize AT moment arms during walking in 10 subjects. Muscle loading during push-off amplified the AT moment arm by 10% relative to heel strike. AT moment arms also varied by 14% over the tendon thickness. In walking, AT moment arms are not strictly dependent on kinematics, but exhibit important load and spatial dependencies.

  17. 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....

  18. 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 calcaneal insertion of the tendon, respectively. Blood flow 5 cm proximal to the Achilles tendon insertion was found to increase 4-fold from rest to exercise whereas the exercise induced increase in blood flow was less pronounced, only 2.5-fold, when measured 2 cm proximal to the Achilles tendon insertion....... 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....

  19. [Achilles tendon rupture--early functional and surgical options with special emphasis on rehabilitation issues].

    Science.gov (United States)

    Knobloch, K; Thermann, H; Hüfner, T

    2007-03-01

    Achilles tendon ruptures are one end of a continuum starting with the healthy Achilles tendon via the thickened and painful tendinopathic Achilles tendon with neovascularisation to the complete tendon rupture. Often times chinolone antibiotics, cortisone therapy and valgus foot axis are associated risk factors. Incidence of Achilles tendon ruptures is estimated to be 10/100 000 per year with a mean age of 35-40 years. Physical activity is encountered in 75 % cases of Achilles tendon ruptures. Running is associated with Achilles tendinopathy as the predominant overuse injury in an analysis among 291 athletes with 10 million kilometers exposure. The Achilles tendinopathic rate was 0.016/1000 km differentiated in 0.008/1000 km mid-portion tendinopathy and 0.005/1000 km insertional tendinopathy. Achilles tendinopathy in running overuse injuries is followed by runner's knee (0.013/1000 km), shin splint (0.0104/1000 km) and plantar fasciitis (0.0054/1000 km). Dynamic ultrasound in 20 degrees plantar flexion is of utmost importance for therapeutic decision making. With an adaptation rate of 75 % or more of the ruptured tendon in 20 degrees plantar flexion and a high patient's compliance we perform an early functional conservative treatment regimen in Achilles tendon ruptures. In almost all other cases the percutaneous Achilles tendon repair is indicated, where nervus suralis lesions have to be appreciated. The vulnerable zone is 10-12 cm proximal to the calcaneus at the lateral border of the Achilles tendon with the sural nerve in close proximity with the tendon. Early functional rehabilitation is not associated with a higher risk of rerupture but with improved subjective assessments and should therefore be advocated.

  20. 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.

  1. Development of the human Achilles tendon enthesis organ.

    Science.gov (United States)

    Shaw, H M; Vázquez, Osorio T; McGonagle, D; Bydder, G; Santer, R M; Benjamin, M

    2008-12-01

    The attachment of the Achilles tendon is part of an 'enthesis organ' that reduces stress concentration at the hard-soft tissue interface. The organ also includes opposing sesamoid and periosteal fibrocartilages, a bursa and Kager's fat pad. In addition, the deep crural and plantar fasciae contribute to Achilles stress dissipation and could also be regarded as components. Here we describe the sequence in which these various tissues differentiate. Serial sections of feet from spontaneously aborted foetuses (crown rump lengths 22-322 mm) were examined. All slides formed part of an existing collection of histologically sectioned embryological material, obtained under Spanish law and housed in the Universidad Complutense, Madrid. From the earliest stages, it was evident that the Achilles tendon and plantar fascia had a mutual attachment to the calcaneal perichondrium. The first components of the enthesis organ to appear (in the 45-mm foetus) were the retrocalcaneal bursa and the crural fascia. The former developed by cavitation within the mesenchyme that later gave rise to Kager's fat pad. The tip of the putative fat pad protruded into the developing bursa in the 110-mm foetus and fully differentiated adipocytes were apparent in the 17-mm foetus. All three fibrocartilages were first recognisable in the 332-mm foetus--at which time adipogenesis had commenced in the heel fat pad. The sequence in which the various elements became apparent suggests that bursal formation and the appearance of the crural fascia may be necessary to facilitate the foot movements that subsequently lead to fibrocartilage differentiation. The later commencement of adipogenesis in the heel than in Kager's pad probably reflects the non-weight environment in utero. The direct continuity between plantar fascia and Achilles tendon that is characteristic of the adult reflects the initial attachment of both structures to the calcaneal perichondrium rather than to the skeletal anlagen itself.

  2. Ruptured human Achilles tendon has elevated metabolic activity up to 1 year after repair

    DEFF Research Database (Denmark)

    Eliasson, Pernilla; Couppé, Christian; Lonsdale, Markus;

    2016-01-01

    PURPOSE: Following Achilles tendon rupture, running is often allowed after 6 months. However, tendon healing is slow and the metabolic status of the tendon at this point is unknown. The purpose of this study was to investigate tendon metabolism (glucose uptake) and vascularization at 3, 6 and 12...... months after Achilles tendon rupture as measured using PET and power Doppler ultrasonography (PDUS). METHODS: The study group comprised 23 patients with surgically repaired Achilles tendon rupture who were investigated at 3 months (n = 7), 6 months (n = 7) and 12 months (n = 9) after surgery. The triceps...... surae complex was loaded over 20 min of slow treadmill walking while a radioactive tracer ((18)F-FDG) was administered prior to PET. Vascularization was measured in terms of PDUS flow activity, and patient-reported outcomes were scored using the Achilles tendon rupture score (ATRS) and sports assessment...

  3. 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

    and that adherence to evidence-based recommendations would not be as good as desired. The purpose of the present study was to investigate how acute Achilles tendon rupture is treated in Scandinavia. A questionnaire was distributed to all orthopedic departments treating acute Achilles tendon ruptures in Denmark...

  4. Augmented Repair of Acute Achilles Tendon Rupture Using an Allograft Tendon Weaving Technique.

    Science.gov (United States)

    Huang, Xiaowei; Huang, Gan; Ji, Ying; Ao, Rong guang; Yu, Baoqing; Zhu, Ya Long

    2015-01-01

    Achilles tendon rupture is a common injury, especially in those who are physically active. Although open surgery is a widely used option for the treatment of acute Achilles tendon rupture, the optimal treatment is still disputed. In our study, 59 patients with unilateral, closed, acute rupture of the Achilles tendon were treated by open surgery using an allograft weave to augment the repair. All the surgeries were performed within 1 to 4 days after injury. The mean American Orthopaedic Foot and Ankle Society ankle-hindfoot score was recorded as 91.20 (range 88 to 95), 95.34 (range 92 to 98), and 98.27 (range 97 to 99) at the 3-, 6-, and 12-month follow-up visit, respectively. At the final follow-up visit, the mean difference between the mid-calf circumference of the injured and uninjured legs was 0.19 (range -0.03 to 1.50) cm (p = .43). At the final follow-up visit, the mean difference between the vertical distances from the plantar surface of the heel to the ground for the injured and uninjured lower extremities was 0.44 (range -0.03 to 0.5) cm (p = .17). Augmented repair using the allograft tendon weaving technique provided satisfactory tendon strength and functional outcomes and a timely return to the patients' activities.

  5. Stretching for prevention of Achilles tendon injuries: a review of the literature.

    Science.gov (United States)

    Park, Don Young; Chou, Loretta

    2006-12-01

    Professional and recreational athletes commonly perform pre-exercise stretching to prevent musculoskeletal injuries. Little definitive evidence exists that clearly demonstrates the efficacy of stretching in reducing injury. Achilles tendon injuries are among the most common injuries affecting active individuals in the United States today. Clinicians commonly recommend stretching the Achilles tendon without concrete scientific evidence to support such a claim. Few studies have addressed the effect of stretching in Achilles tendon injuries, and it is unclear if the conclusions made for musculoskeletal injuries can be applied to the Achilles tendon. Biomechanical studies of the Achilles tendon and measurements of the tendon's reflex activity have demonstrated possible mechanisms for the potential benefit of stretching, including load-induced hypertrophy and increased tendon tensile strength. Recent prospective studies have contended that reductions in plantarflexor strength and increases in ankle dorsiflexion range of motion from stretching the Achilles tendon may increase the risk of injury. Studies examining stretching in injury prevention, the biomechanical properties of injuries to the Achilles tendon were compiled and reviewed. Although many theories have been published regarding the potential benefits and limitations of stretching, few studies have been able to definitively demonstrate its utility in injury prevention.

  6. Functional rehabilitation of patients with acute Achilles tendon rupture

    DEFF Research Database (Denmark)

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

    2014-01-01

    . RESULTS: Re-rupture rate, other complications, strength, range of motion, duration of sick leave, return to sport and patient satisfaction were examined. There were no statistically significant differences between groups. A trend favoring functional rehabilitation was seen regarding the examined outcomes....... CONCLUSION: Functional rehabilitation after acute Achilles tendon rupture does not increase the rate of re-rupture or other complications. A trend toward earlier return to work and sport, and increased patient satisfaction was found when functional rehabilitation was used. The present literature is of low...

  7. 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.

  8. 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.

  9. 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

  10. 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.

  11. 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.

  12. 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...... from nonruptured chronic tendinopathic Achilles tendons and healthy control tendons. In addition, to examine whether findings in baseline cell biopsy specimens can predict the long-term presence of Achilles tendon symptoms. STUDY DESIGN: Cross-sectional and case-control study; Level of evidence, 3....... METHODS: Fifty patients with nonruptured chronic Achilles tendinopathy and 15 healthy participants were included. At time of inclusion, an ultrasound examination was performed immediately before an ultrasound-guided Achilles tendon biopsy specimen was obtained. Tissue samples were evaluated...

  13. 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 repair of 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.

  14. Histopathological and biomechanical evaluation of tenocyte seeded allografts on rat Achilles tendon regeneration.

    Science.gov (United States)

    Güngörmüş, Cansın; Kolankaya, Dürdane; Aydin, Erkin

    2015-05-01

    Tendon injuries in humans as well as in animals' veterinary medicine are problematic because tendon has poor regenerative capacity and complete regeneration of the ruptured tendon is never achieved. In the last decade there has been an increasing need of treatment methods with different approaches. The aim of the current study was to improve the regeneration process of rat Achilles tendon with tenocyte seeded decellularized tendon matrices. For this purpose, Achilles tendons were harvested, decellularized and seeded as a mixture of three consecutive passages of tenocytes at a density of 1 × 10(6) cells/ml. Specifically, cells with different passage numbers were compared with respect to growth characteristics, cellular senescence and collagen/tenocyte marker production before seeding process. The viability of reseeded tendon constructs was followed postoperatively up to 6 months in rat Achilles tendon by histopathological and biomechanical analysis. Our results suggests that tenocyte seeded decellularized tendon matrix can significantly improve the histological and biomechanical properties of tendon repair tissue without causing adverse immune reactions. To the best of our knowledge, this is the first long-term study in the literature which was accomplished to prove the use of decellularized matrix in a clinically relevant model of rat Achilles tendon and the method suggested herein might have important implications for translation into the clinic.

  15. 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

  16. Nonoperative dynamic treatment of acute achilles tendon rupture

    DEFF Research Database (Denmark)

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

    2014-01-01

    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...... rehabilitation remains unclear. The purpose of this study was to compare immediate weight-bearing with non-weight-bearing in a nonoperative dynamic treatment protocol for Achilles tendon rupture. METHODS: The study was conducted as a blinded, randomized, controlled, parallel superiority trial. Patients eighteen......, 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-rise work...

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

    DEFF Research Database (Denmark)

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

    2013-01-01

    study was to validate a Danish translation of the ATRS. The ATRS was translated into Danish according to internationally adopted standards. Of 142 patients, 90 with previous rupture of the Achilles tendon participated in the validity study and 52 in the reliability study. The ATRS showed moderately...... = .07). The limits of agreement were ±18.53. A strong correlation was found between test and retest (intercorrelation coefficient .908); the standard error of measurement was 6.7, and the minimal detectable change was 18.5. The Danish version of the ATRS showed moderately strong criterion validity....... For study and follow-up purposes, the ATRS seems reliable for comparisons of groups of patients. Its usability is limited for repeated assessment of individual patients. The development of analysis guidelines would be desirable....

  18. Tendon mineralization is accelerated bilaterally and creep of contralateral tendons is increased after unilateral needle injury of murine achilles tendons.

    Science.gov (United States)

    O'Brien, Etienne John Ogilvy; Shrive, Nigel G; Rosvold, Joshua M; Thornton, Gail M; Frank, Cyril B; Hart, David A

    2013-10-01

    Heterotopic mineralization may result in tendon weakness, but effects on other biomechanical responses have not been reported. We used a needle injury, which accelerates spontaneous mineralization of murine Achilles tendons, to test two hypotheses: that injured tendons would demonstrate altered biomechanical responses; and that unilateral injury would accelerate mineralization bilaterally. Mice underwent left hind (LH) injury (I; n = 11) and were euthanized after 20 weeks along with non-injured controls (C; n = 9). All hind limbs were examined by micro computed tomography followed by biomechanical testing (I = 7 and C = 6). No differences were found in the biomechanical responses of injured tendons compared with controls. However, the right hind (RH) tendons contralateral to the LH injury exhibited greater static creep strain and total creep strain compared with those LH tendons (p ≤ 0.045) and RH tendons from controls (p ≤ 0.043). RH limb lesions of injured mice were three times larger compared with controls (p = 0.030). Therefore, despite extensive mineralization, changes to the responses we measured were limited or absent 20 weeks postinjury. These results also suggest that bilateral occurrence should be considered where tendon mineralization is identified clinically. This experimental system may be useful to study the mechanisms of bilateral new bone formation in tendinopathy and other conditions.

  19. Comparison of Achilles Tendon Loading Between Male and Female Recreational Runners

    Directory of Open Access Journals (Sweden)

    Andrew Greenhalgh

    2014-12-01

    Full Text Available Recreational running is an activity with multiple reported health benefits for both sexes, however, chronic injuries caused by excessive and/or repetitive loading of the Achilles tendon are common. Males have been identified as being at an increased risk of suffering an injury to the Achilles tendon and as such, knowledge of differences in loading between the sexes may provide further information to better understand why this is the case. The aim of the current investigation was to determine whether gender differences in the Achilles tendon load exist in recreational runners. Fifteen male (age 26.74 ± 5.52 years, body height 1.80 ± 0.11 m and body mass 74.22 ± 7.27 kg and fifteen female (age 25.13 ± 6.39 years, body height 1.68 ± 0.12 m and body mass 67.12 ± 9.11 kg recreational runners volunteered to take part in the current investigation. Participants completed 10 trials running at 4.0 m·s-1 ±5% striking a force platform (1000 Hz with their right foot. Ankle joint kinematics were synchronously recorded (250 Hz using an optoelectric motion capture system. Ankle joint kinetics were computed using Newton-Euler inverse-dynamics. Net external ankle joint moments were then calculated. To estimate Achilles tendon kinetics the plantarflexion moment calculated was divided by an estimated Achilles tendon moment arm of 0.05 m. Differences in Achilles tendon kinetics were examined using independent sample t-tests (p<0.05. The results indicate that males were associated with significantly (p<0.05 greater Achilles tendon loads than females. The findings from this study support the notion that male recreational runners may be at greater risk of Achilles tendon pathology.

  20. Modeling the tensile behavior of human Achilles tendon.

    Science.gov (United States)

    Lewis, G; Shaw, K M

    1997-01-01

    Uniaxial quasi-static tensile stress, sigma versus strain, epsilon, data were obtained from 29 cadaveric Achilles tendons (donor ages: 36 to 100 years), at a strain rate of either 10 or 100%/s. These results were then used in modeling the elastic component of the tensile deformational behavior of this tissue. Two approaches were taken. In the first, it was shown that the following constitutive relation provided an excellent fit to the elastic section of the sigma-epsilon curve, sigma = C epsilon exp[D epsilon + F epsilon 2], with C, D and F being material constants, whose values for the present dataset were found to be C = 2.00 +/- 0.99, D = 0.089 +/- 0.087 and F = -0.0047 +/- 0.0095. The values of these coefficients were not statistically significantly affected by either donor age or test strain rate. In the second approach, the value of the modulus of elasticity of a filamentary polymer matrix composite material was computed as a function of various combinations of values of the modulus of elasticity of the fiber, the modulus of elasticity of the matrix, and angle of orientation of the principal material axes with respect to the reference coordinate axes (theta) for a fiber volume fraction of 0.6 and a material Poisson's ratio of 0.4. By comparing these results with the experimentally-obtained values of the tangent modulus of elasticity of the tendons (defined as the slope of the linear section of the post-toe zone in the sigma-epsilon plot), and assuming that the tendon may be idealized as a filamentary polymer matrix composite material, the suggestion is made that the winding angle of the fibers (collagen fibrils) in the tendon (taken to be equal to theta) is about 6 degrees.

  1. Changes in Achilles tendon mechanical properties following eccentric heel drop exercise are specific to the free tendon.

    Science.gov (United States)

    Obst, S J; Newsham-West, R; Barrett, R S

    2016-04-01

    Mechanical loading of the Achilles tendon during isolated eccentric contractions could induce immediate and region-dependent changes in mechanical properties. Three-dimensional ultrasound was used to examine the immediate effect of isolated eccentric exercise on the mechanical properties of the distal (free tendon) and proximal (gastrocnemii) regions of the Achilles tendon. Participants (n = 14) underwent two testing sessions in which tendon measurements were made at rest and during a 30% and 70% isometric plantar flexion contractions immediately before and after either: (a) 3 × 15 eccentric heel drops or (b) 10-min rest. There was a significant time-by-session interaction for free tendon length and strain for all loading conditions (P eccentric exercise (P exercise compared with the gastrocnemii aponeurosis or tendon.

  2. 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

  3. Spontaneous rupture of the Achilles tendon in a patient with gout.

    OpenAIRE

    1981-01-01

    A 49-year-old man with long-standing gout suffered a spontaneous rupture of the Achilles tendon. Surgical repair was performed, and gouty tophi were found in the severed end of the tendon. The possible causes of this spontaneous rupture are discussed.

  4. Achilles tendon and plantar fascia in recently diagnosed type II diabetes: role of body mass index.

    Science.gov (United States)

    Abate, Michele; Schiavone, Cosima; Di Carlo, Luigi; Salini, Vincenzo

    2012-07-01

    Previous research has shown that plantar fascia and Achilles tendon thickness is increased in diabetes. The aims of present study were to assess whether tendon changes can occur in the early stages of the disease and to evaluate the extent of the influence of body mass index (BMI). The study population included 51 recent-onset type II diabetic subjects, who were free from diabetic complications, divided according to BMI into three groups (normal weight, overweight, and obese). Eighteen non-diabetic, normal-weight subjects served as controls. Plantar fascia and Achilles tendon thickness was measured by means of sonography. The groups were well balanced for age and sex. In all the diabetic subjects, plantar fascia and Achilles tendon thickness was increased compared to the controls (p fascia thickness and BMI values (r = 0.749, p fascia and Achilles tendon thickness is increased in the early stages of type II diabetes and that BMI is related more to plantar fascia than Achilles tendon thickness. Further longitudinal studies are needed to evaluate whether these early changes can overload the metatarsal heads and increase the stress transmitted to plantar soft tissues, thus representing an additional risk factor for foot ulcer development.

  5. Application of internal fixation of steel-wire limited loop in early Achilles tendon rupture

    Institute of Scientific and Technical Information of China (English)

    Zhe Chen; Jia-Sen Wei; Zhao-Yang Hou; Jiong Hu; Yan-Guang Cao; Qi-Xin Chen

    2013-01-01

    Objective:To explore the clinical effect and safety of internal fixation of steel-wire limited loop in earlyAchilles tendon rupture.Methods:Seventy-six patients respectively with early transected and avulsed types ofAchilles tendon rupture were selected and treated with internal fixation of steel-wire limited loop.The patients began to take exercise for their lower limbs through continous passive motion as early as possible after surgical repair, and the loops were removed after3-5 months.Six months later, the condition of complications includingAchilles tendon re-rupture, wound fistula, wound infection and skin necrosis, cutaneous sensation in sural nerve dominance region, time back to preinjury work or learning as well as time to physical activities were observed.One year later, the therapeutic effect was evaluated, and the maximum circumferences of bilateral legs and ruptured plane circumferences ofAchilles tendon were measured.Results:The wound of all patients healed well, no complications likeAchilles tendon re-rupture, wound fistula, wound infection and skin necrosis occured, and the cutaneous sensation in sural nerve dominance region was normal.The mean time back to preinjury workor learning as well as to pysical activities of all patients were respectively10 and22 weeks.Seventy out of76 patients(92.1%) achieved an excellent effect, and6(7.9%) good effect.The excellent and good rate came up to100%.The maximum circumference in the affected leg decreased to 2 mm averagely compared with the offside, while the ruptured plane circumferences ofAchilles tendon in the affected side increased to2.2 mm compared with the offside.Conclusions:For earlyAchilles tendon rupture, internal fixation of steel-wire limited loop can recover the ankle function better, return to the preinjury state in the shortest time, and has few complications.

  6. A minimally invasive "overwrapping" technique for repairing neglected ruptures of the Achilles tendon.

    Science.gov (United States)

    Lui, Tun Hing

    2014-01-01

    About 10% to 25% of acute ruptures of the Achilles tendon go undiagnosed for some time beyond what would be optimal for repair and a return to optimal function. Managing these chronic or neglected ruptures is a surgical challenge, because the tendon ends retract and atrophy and could develop a short, fibrous distal stump. In the present report, a patient with a ruptured right Achilles tendon, neglected for approximately 10 years, is described. The chronically injured tendon was successfully treated by overwrapping the interposed scar at the rupture site. This minimally invasive technique restored tension to the tendon, a prerequisite for which was the presence of functional triceps surae, confirmed by identification of gross contraction of the muscle during tiptoeing. The procedure is contraindicated when the scar tissue is not intact and does not have sufficient laxity to allow adequate dorsiflexion of the ankle after overwrapping the tendon or when the triceps surae are nonfunctional.

  7. 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

  8. Patellofemoral Joint and Achilles Tendon Loads During Overground and Treadmill Running.

    Science.gov (United States)

    Willy, Richard W; Halsey, Lisa; Hayek, Andrew; Johnson, Holly; Willson, John D

    2016-08-01

    Study Design Level 4, controlled laboratory study. Background Little is known regarding how the potential differences between treadmill and overground running may affect patellofemoral joint and Achilles tendon loading characteristics. Objectives To compare measures of loading of the patellofemoral joint and Achilles tendon across treadmill and overground running in healthy, uninjured runners. Methods Eighteen healthy runners ran at their self-selected speed on an instrumented treadmill and overground, while 3-D running mechanics were sampled. A musculoskeletal model derived peak load, rate of loading, and estimated cumulative load per 1 km of continuous running for the patellofemoral joint and Achilles tendon for each condition. Data were analyzed via paired t tests and Pearson correlations to detect differences and assess relationships, respectively, between the 2 running mediums. Results No differences (P>.05) were found between treadmill and overground running for peak load, rate of loading, or estimated cumulative patellofemoral joint stress per 1 km of continuous running. However, treadmill running resulted in 12.5% greater peak Achilles tendon force (P0.70) and moderate agreements (r>0.50) for most patellofemoral joint and Achilles measures, respectively, between treadmill and overground running. Conclusion No differences were observed in loading characteristics to the patellofemoral joint between running mediums; however, treadmill running resulted in greater Achilles tendon loading compared with overground running. Future investigations should examine whether sudden bouts of treadmill running may increase the risk of mechanical overload of the Achilles tendon in runners who habitually train overground. J Orthop Sports Phys Ther 2016;46(8):664-672. Epub 12 May 2016. doi:10.2519/jospt.2016.6494.

  9. Effect of Complications After Minimally Invasive Surgical Repair of Acute Achilles Tendon Ruptures Report on 211 Cases

    NARCIS (Netherlands)

    Metz, Roderik; van der Heijden, Geert J. M. G.; Verleisdonk, Egbert-Jan M. M.; Kolfschoten, Nicky; Verhofstad, Michiel H. J.; van der Werken, Christiaan

    2011-01-01

    Background: Complications of acute Achilles tendon rupture treatment are considered to negatively influence outcome, but the relevance of these effects is largely unknown. Purpose: The Achilles Tendon Total Rupture Score (ATRS) was used to determine level of disability in patients with minimally inv

  10. Human hamstring tenocytes survive when seeded into a decellularized porcine Achilles tendon extracellular matrix.

    Science.gov (United States)

    Lohan, Anke; Stoll, Christiane; Albrecht, Marit; Denner, Andreas; John, Thilo; Krüger, Kay; Ertel, Wolfgang; Schulze-Tanzil, Gundula

    2013-01-01

    Tendon ruptures and defects remain major orthopaedic challenges. Tendon healing is a time-consuming process, which results in scar tissue with an altered biomechanical competence. Using a xenogeneic tendon extracellular matrix (ECM) as a natural scaffold, which can be reseeded with autologous human tenocytes, might be a promising approach to reconstruct damaged tendons. For this purpose, the porcine Achilles (AS) tendons serving as a scaffold were histologically characterized in comparison to human cell donor tendons. AS tendons were decellularized and then reseeded with primary human hamstring tenocytes using cell centrifuging, rotating culture and cell injection techniques. Vitality testing, histology and glycosaminoglycan/DNA quantifications were performed to document the success of tendon reseeding. Porcine AS tendons were characterized by a higher cell and sulfated glycosaminoglycan content than human cell donor tendons. Complete decellularization could be achieved, but led to a wash out of sulfated glycosaminoglycans. Nevertheless, porcine tendon could be recellularized with vital human tenocytes. The recellularization led to a slight increase in cell number compared to the native tendon and some glycosaminoglycan recovery. This study indicates that porcine tendon can be de- and recellularized using adult human tenocytes. Future work should optimize cell distribution within the recellularized tendon ECM and consider tendon- and donor species-dependent differences.

  11. [Impingement lesion of the distal anterior Achilles tendon in sub-Achilles bursitis and Haglund-pseudoexostosis-a therapeutic challenge].

    Science.gov (United States)

    Lohrer, H; Arentz, S

    2003-12-01

    Retrocalcaneal bursitis in athletes is frequently misdiagnosed. Results of conservative treatment are not very promising. This investigation evaluates the results of 39 consecutive cases in 38 patients surgically treated due to chronic retrokalkaneal bursitis in a sport specific population. Preoperative MRI and ultrasound investigation showed corresponding lesions (focal degeneration, partial rupture) of the anterior Achilles tendon. This is possibly the result of a previously undescribed impingement lesion produced by the Haglund's bone and the chronically inflamed retrocalcaneal bursa. During operation this lesion was additionally addressed in 85% of the cases. Follow up was done after 32 months. Success rate was 54%. VISA-A Score at follow up was 80.6 points. Training and competition activities were started at 16 weeks and 9 months respectively. Unsatisfying results were analysed. In two cases Haglund's bone resection was incomplete and had to be removed in a reoperation. Additionally one deep wound infection had to be revised. Due to the distal Achilles tendon fiber extensions around the medial and lateral calcaneal bone, an unintended Achilles tendon lesion, induced by the edge of the osteotome seems to be possible. Two calcanear stress fractures complicated the postoperative rehabilitation.

  12. Age-related differences in Achilles tendon properties and triceps surae muscle architecture in vivo.

    Science.gov (United States)

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

    2012-11-01

    This study examined the concurrent age-related differences in muscle and tendon structure and properties. Achilles tendon morphology and mechanical properties and triceps surae muscle architecture were measured from 100 subjects [33 young (24 ± 2 yr) and 67 old (75 ± 3 yr)]. Motion analysis-assisted ultrasonography was used to determine tendon stiffness, Young's modulus, and hysteresis during isometric ramp contractions. Ultrasonography was used to measure muscle architectural features and size and tendon cross-sectional area. Older participants had 17% lower (P Triceps surae muscle size was smaller (P < 0.05) and gastrocnemius medialis muscle fascicle length shorter (P < 0.05) in old compared with young. Maximal plantarflexion force was associated with tendon stiffness and Young's modulus (r = 0.580, P < 0.001 and r = 0.561, P < 0.001, respectively). Comparison between old and young subjects with similar strengths did not reveal a difference in tendon stiffness. The results suggest that regardless of age, Achilles tendon mechanical properties adapt to match the level of muscle performance. Old people may compensate for lower tendon material properties by increasing tendon cross-sectional area. Lower tendon stiffness in older subjects might be beneficial for movement economy in low-intensity locomotion and thus optimized for their daily activities.

  13. 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.

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

    Science.gov (United States)

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

    2016-01-01

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

  15. 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....

  16. [Atypical Achilles tendon rupture in Haglund exostosis--a case report].

    Science.gov (United States)

    Porsch, M; Hackenbroch, M H; König, D P

    1998-01-01

    We report about an unusual case of a rupture of the Achilles tendon in a patient with Haglund's exostosis and long term achillodynia. Intraoperatively, we found a fresh superficial typically located tendon-rupture and an old deep round shaped rupture which was located directly over the cranial edge of the calcaneous bone spur. We presume that the sharp edge of Haglund's deformity was the cause of the deep tendon rupture, because the location of the round shaped rupture was near the exostosis. The additional superficial rupture, caused by an inadequate trauma, induced operative revision consisting of double layer transosseous suturing. In conclusion early operative resection of Haglund's deformity in cases of repeated irritations of the Achilles tendon should be performed to avoid mechanical damage, including the risk of rupture by the hypomochlion-like effect of the exostosis.

  17. 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.

  18. 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.

  19. A composite medial plantar flap for the repair of an achilles' tendon defect: a case report.

    Science.gov (United States)

    Dumont, C E; Kessler, J

    2001-12-01

    The surgical management of infected necrosis of the Achilles' tendon and overlying skin is very demanding, and reconstruction with vascularized tendon and skin flaps is considered the benchmark procedure. The authors report a 65-year-old man who sustained a chronic wound after operative repair of a chronic rupture of the Achilles' tendon. A pedicled medial plantar flap including the surrounding vascularized plantar aponeurosis was elevated. The plantar aponeurosis was split and used to bridge the 4-cm-long tendon defect. The flap donor site was covered with a thin skin graft. The flap survived completely without recurrence of the infection. At the 7-month follow-up, the reconstructed Achilles' tendon showed a good functional result and a normal range of dorsi- and plantar flexion of the foot. This technique is of great interest in comparison with free flaps because it does not require vascular anastomosis in a septic environment or a secondary debulking operation, yet it still provides both vascularized tendon and skin graft.

  20. 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.

  1. A review on animal models and treatments for the reconstruction of Achilles and flexor tendons.

    Science.gov (United States)

    Bottagisio, Marta; Lovati, Arianna B

    2017-03-01

    Tendon is a connective tissue mainly composed of collagen fibers with peculiar mechanical properties essential to functional movements. The increasing incidence of tendon traumatic injuries and ruptures-associated or not with the loss of tissue-falls on the growing interest in the field of tissue engineering and regenerative medicine. The use of animal models is mandatory to deepen the knowledge of the tendon healing response to severe damages or acute transections. Thus, the selection of preclinical models is crucial to ensure a successful translation of effective and safe innovative treatments to the clinical practice. The current review is focused on animal models of tendon ruptures and lacerations or defective injuries with large tissue loss that require surgical approaches or grafting procedures. Data published between 2000 and 2016 were examined. The analyzed articles were compiled from Pub Med-NCBI using search terms, including animal model(s) AND tendon augmentation OR tendon substitute(s) OR tendon substitution OR tendon replacement OR tendon graft(s) OR tendon defect(s) OR tendon rupture(s). This article presents the existing preclinical models - considering their advantages and disadvantages-in which translational progresses have been made by using bioactive sutures or tissue engineering that combines biomaterials with cells and growth factors to efficiently treat transections or large defects of Achilles and flexor tendons.

  2. Sonographic measurements of the achilles tendon, plantar fascia, and heel fat pad are reliable

    DEFF Research Database (Denmark)

    Johannsen, Finn; Jensen, Signe; Stallknecht, Sandra E

    2016-01-01

    PURPOSE: To determine intra- and interobserver reliability and precision of sonographic (US) scanning in measuring thickness of the Achilles tendon, plantar fascia, and heel fat pad in patients with heel pain. METHODS: Seventeen consecutive patients referred with heel pain were included. Two...

  3. The amplitude of the Achilles tendon reflex in infants is related to body position

    NARCIS (Netherlands)

    Bruggink, Janneke L. M.; Bos, Arend F.; vd Hoeven, Johannes H.; Brouwer, Oebele F.; Sollie, Krystyna M.; Sival, Deborah A.

    2006-01-01

    In this study, we investigated whether the Achilles tendon reflex (ATR) in healthy infants is modulated by changes in body position (prone vs. supine). The amplitude of the ATR was compared at postnatal day 1, months 2, 3 and 6, while infants were placed in prone and supine position. The ATR was con

  4. 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....

  5. 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 w...

  6. [Successive ruptures of patellar and Achilles tendons. Anabolic steroids in competitive sports].

    Science.gov (United States)

    Isenberg, J; Prokop, A; Skouras, E

    2008-01-01

    Derivatives of testosterone or of 19-nor-testosterone are used as anabolics for the purpose of improving performance although the effect of anabolics is known still to be under discussion. The use of anabolic steroids continues among competitive athletes despite increased controls and increasingly frequent dramatic incidents connected with them. Whereas metabolic dysfunction during anabolic use is well documented, ruptures of the large tendons are rarely reported. Within 18 months, a 29-year-old professional footballer needed surgery for rupture of the patellar tendon and of both Achilles tendons. Carefully directed questioning elicited confirmation that he had taken different anabolic steroids regularly for 3 years with the intention of improving his strength. After each operation anabolic steroids were taken again at a high dosage during early convalescence and training. Minimally invasive surgery and open suturing techniques led to complete union of the Achilles tendons in good time. Training and anabolic use (metenolon 300 mg per week) started early after suturing of the patellar tendon including bone tunnels culminated in histologically confirmed rerupture after 8 weeks. After a ligament reconstruction with a semitendinosus tendon graft with subsequent infection, the tendon and reserve traction apparatus were lost. Repeated warnings of impaired healing if anabolic use was continued had been given without success. In view of the high number of unrecorded cases in competitive and athletic sports, we can assume that the use of anabolic steroids is also of quantitative relevance in the operative treatment of tendon ruptures.

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

    Science.gov (United States)

    Dabak, T Kursat; Sertkaya, Omer; Acar, Nuray; Donmez, B Ozgur; Ustunel, Ismail

    2015-01-01

    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 (p 0.008). 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.

  8. Effect of muscle contraction levels on the force-length relationship of the human Achilles tendon during lengthening of the triceps surae muscle-tendon unit.

    Science.gov (United States)

    Sugisaki, Norihide; Kawakami, Yasuo; Kanehisa, Hiroaki; Fukunaga, Tetsuo

    2011-07-28

    Findings from animal experiments are sometimes contradictory to the idea that the tendon structure is a simple elastic spring in series with muscle fibers, and suggest influence of muscle contraction on the tendon mechanical properties. The purpose of the present study was to investigate the influence of muscle contraction levels on the force-length relationship of the human Achilles tendon during lengthening of the triceps surae muscle-tendon unit. For seven subjects, ankle dorsiflexion was performed without (passive condition) and with contraction of plantar flexor muscles (eccentric conditions, at 3 contraction levels) on an isokinetic dynamometer. Deformation of the Achilles tendon during each trial was measured using ultrasonography. The Achilles tendon force corresponding to the tendon elongation of 10mm in the passive condition was significantly smaller than those in the eccentric conditions (p<0.05 or p<0.01). Within the eccentric conditions, the Achilles tendon force corresponding to the tendon elongation of 10mm was significantly greater in the maximal contraction level than those in submaximal eccentric conditions (p<0.05 or p<0.01). In addition, the tendon stiffness was greater in higher contraction levels (p<0.05 or p<0.01). Present results suggest that the human tendon structure is not a simple elastic spring in series with muscle fibers.

  9. Experimental Diabetes Alters the Morphology and Nano-Structure of the Achilles Tendon

    Science.gov (United States)

    de Oliveira, Rodrigo Ribeiro; Medina de Mattos, Rômulo; Magalhães Rebelo, Luciana; Guimarães Meireles Ferreira, Fernanda; Tovar-Moll, Fernanda; Eurico Nasciutti, Luiz; de Castro Brito, Gerly Anne

    2017-01-01

    Although of several studies that associate chronic hyperglycemia with tendinopathy, the connection between morphometric changes as witnessed by magnetic resonance (MR) images, nanostructural changes, and inflammatory markers have not yet been fully established. Therefore, the present study has as a hypothesis that the Achilles tendons of rats with diabetes mellitus (DM) exhibit structural changes. The animals were randomly divided into two experimental groups: Control Group (n = 06) injected with a vehicle (sodium citrate buffer solution) and Diabetic Group (n = 06) consisting of rats submitted to intraperitoneal administration of streptozotocin. MR was performed 24 days after the induction of diabetes and images were used for morphometry using ImageJ software. Morphology of the collagen fibers within tendons was examined using Atomic Force microscopy (AFM). An increase in the dimension of the coronal plane area was observed in the diabetic group (8.583 ± 0.646 mm2/100g) when compared to the control group (4.823 ± 0.267 mm2/100g) resulting in a significant difference (p = 0.003) upon evaluating the Achilles tendons. Similarly, our analysis found an increase in the size of the transverse section area in the diabetic group (1.328 ± 0.103 mm2/100g) in comparison to the control group (0.940 ± 0.01 mm2/100g) p = 0.021. The tendons of the diabetic group showed great irregularity in fiber bundles, including modified grain direction and jagged junctions and deformities in the form of collagen fibrils bulges. Despite the morphological changes observed in the Achilles tendon of diabetic animals, IL1 and TNF-α did not change. Our results suggest that DM promotes changes to the Achilles tendon with important structural modifications as seen by MR and AFM, excluding major inflammatory changes. PMID:28095484

  10. Xenograft scaffold full-wrap reinforcement of Krackow achilles tendon repair.

    Science.gov (United States)

    Wisbeck, Jacob M; Parks, Brent G; Schon, Lew C

    2012-03-07

    Standard 4-strand repair of Achilles tendon tears is effective, but additional strength may be desirable in patients who are compromised or those with reruptures. Use of a xenograft scaffold has not been investigated biomechanically in Achilles tendon repair. This study compared stiffness, gap formation, and ultimate load to failure with Krackow repair vs Krackow repair augmented with xenograft scaffold in 6 matched pairs of fresh-frozen human lower extremities. The Achilles tendon was transected 4 cm above the calcaneal insertion. Specimens were randomized to receive standard Krackow repair or Krackow repair augmented with a porcine xenograft scaffold. The graft was wrapped around the repaired tendon, sutured to itself with 2-0 FiberWire (Arthrex, Naples, Florida), and attached to the tendon distally and proximally and then medially and laterally. Specimens were loaded for 200 cycles between 5 and 30 N. Load to 5-mm gapping and load to ultimate failure were measured. Xenograft scaffold augmentation of standard Krakow Achilles tendon repair was significantly stronger and stiffer than standard Krackow repair in a biomechanical model immediately after repair (39.0±8.8 vs 24.4±4.6 N/mm; P=.01). The augmented repair group had significantly higher load to ultimate failure than did the Krackow group (862.7±174.0 vs 479.5±65.5 N; P<.01). Biological factors remain to be investigated, but this augmentation method could provide additional strength in patients who are compromised or those with reruptures.

  11. Achilles Pain.

    Science.gov (United States)

    Connors, G. Patrick

    Five ailments which can cause pain in the achilles tendon area are: (1) muscular strain, involving the stretching or tearing of muscle or tendon fibers; (2) a contusion, inflammation or infection called tenosynovitis; (3) tendonitis, the inflammation of the tendon; (4) calcaneal bursitis, the inflammation of the bursa between the achilles tendon…

  12. 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.

  13. Surgical Correction of the Achilles Tendon for Diabetic Foot Ulcerations and Charcot Neuroarthropathy.

    Science.gov (United States)

    Ramanujam, Crystal L; Zgonis, Thomas

    2017-04-01

    Achilles tendon pathologic conditions are implicated in contributing to the development of many diabetic foot complications including diabetic foot ulceration and Charcot neuroarthropathy. Surgical correction of the diabetic equinus deformity has been studied as an isolated or adjunctive treatment when dealing with difficult-to-close diabetic foot ulcerations or when surgically addressing the diabetic Charcot neuroarthropathy foot or ankle. This article reviews the most common indications, complications, and surgical procedures for equinus correction by either a tendo-Achilles lengthening or gastrocnemius recession for the management of diabetic foot conditions.

  14. 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

  15. Collagen membrane alleviates peritendinous adhesion in the rat Achilles tendon injury model

    Institute of Scientific and Technical Information of China (English)

    ZHAO Huan; GUAN Hong-geng; GU Jun; LUO Zong-ping; ZHANG Wen; CHEN Bing; GU Qiao-li

    2013-01-01

    Background Tendon adhesion is one of the most common causes of disability following tendon surgery.Therefore,prevention of peritendinous adhesion after surgical repair of tendon is a major challenge.The aim of this study was to explore the possible application of a collagen membrane for the prevention or attenuation of peritendinous adhesions.Methods Sprague-Dawley (SD) rat Achilles tendon was cut and sutured by a modified Kessler's technique with or without the collagen membrane wrapped.Macroscopic,morphological and biomechanical evaluations were applied to examine the recovery of the injured tendon at 4 and 8 weeks after surgery.Results The surgery group wrapped by collagen membranes had a better outcome than the group with surgery repair only.In the collagen membrane-treated group,less adhesion appeared,stronger tensile strength was detected,and more tendon fibers and collagen I expression were observed morphologically.Conclusion Wrapping the tendon with a collagen membrane may be an efficient approach for tendon repair and preventing tendon adhesion after its ruptures.

  16. Characterization and comparison of post-natal rat Achilles tendon-derived stem cells at different development stages.

    Science.gov (United States)

    Chen, Jialin; Zhang, Wei; Liu, Zeyu; Zhu, Ting; Shen, Weiliang; Ran, Jisheng; Tang, Qiaomei; Gong, Xiaonan; Backman, Ludvig J; Chen, Xiao; Chen, Xiaowen; Wen, Feiqiu; Ouyang, Hongwei

    2016-03-14

    Tendon stem/progenitor cells (TSPCs) are a potential cell source for tendon tissue engineering. The striking morphological and structural changes of tendon tissue during development indicate the complexity of TSPCs at different stages. This study aims to characterize and compare post-natal rat Achilles tendon tissue and TSPCs at different stages of development. The tendon tissue showed distinct differences during development: the tissue structure became denser and more regular, the nuclei became spindle-shaped and the cell number decreased with time. TSPCs derived from 7 day Achilles tendon tissue showed the highest self-renewal ability, cell proliferation, and differentiation potential towards mesenchymal lineage, compared to TSPCs derived from 1 day and 56 day tissue. Microarray data showed up-regulation of several groups of genes in TSPCs derived from 7 day Achilles tendon tissue, which may account for the unique cell characteristics during this specific stage of development. Our results indicate that TSPCs derived from 7 day Achilles tendon tissue is a superior cell source as compared to TSPCs derived from 1 day and 56 day tissue, demonstrating the importance of choosing a suitable stem cell source for effective tendon tissue engineering and regeneration.

  17. 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

  18. 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

    Tendon-related injuries are a major problem, but the aetiology of tendinopathies is unknown. In tendinopathies as well as during unaccustomed loading, intra-tendinous flow can be detected indicating that extensive loading can provoke intra-tendinous flow. The aim of present study is to evaluate......- and tuberositas region. Intra-tendinous flow was measured using both a semi-quantitative grading system (CD grading) and a quantitative scoring system (CF) on colour Doppler. Intra-tendinous flow in the Achilles and anterior knee tendons was examined in fourteen single players before tournament and after 1st...... and 2nd match, respectively on both the dominant and non-dominant side. All players had abnormal intra-tendinous flow (Colour Doppler = grade 2) in at least one tendon in at least one scan during the tournament. At baseline, only two of the 14 players had normal flow in all the tendons examined. After 1...

  19. 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.

  20. 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...... density and diameter distribution of fibrils were analyzed using stereological techniques of digitized electron microscopy biopsy cross-sections, while crimp angle was measured by the changing banding pattern of collagen fibers when rotated between crossed polars. Nine of 10 persons with tendon ruptures...

  1. Application of Computed Tomography Processed by Picture Archiving and Communication Systems in the Diagnosis of Acute Achilles Tendon Rupture

    Directory of Open Access Journals (Sweden)

    Hai-Peng Xue

    2016-01-01

    Full Text Available The applications of CT examination in the diagnosis of the acute Achilles tendon rupture (AATR were investigated. A total of 36 patients with suspected acute Achilles tendon rupture were tested using physical examination, ultrasound, and 3DCT scanning, respectively. Then, surgery was performed for the patients who showed positive result in at least two of the three tests for AATR. 3DVR, MPR, and the other CT scan image processing and diagnosis were conducted in PACS (picture archiving and communication system. PACS was also used to measure the length of distal broken ends of the Achilles tendon (AT to tendon calcaneal insertion. Our study indicated that CT has the highest accuracy in diagnosis of acute Achilles tendon complete rupture. The length measurement is matched between PACS and those actually measured in operation. CT not only demonstrates more details directly in three dimensions especially with the rupture involved calcaneal insertion flap but also locates the rupture region for percutaneous suture by measuring the length of distal stump in PACS without the effect of the position of ankle. The accuracy of CT diagnosis for Achilles tendon partial rupture is yet to be studied.

  2. 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.

  3. Plantar fascia anatomy and its relationship with Achilles tendon and paratenon.

    Science.gov (United States)

    Stecco, Carla; Corradin, Marco; Macchi, Veronica; Morra, Aldo; Porzionato, Andrea; Biz, Carlo; De Caro, Raffaele

    2013-12-01

    Although the plantar fascia (PF) has been studied quite well from a biomechanical viewpoint, its microscopic properties have been overlooked: nothing is known about its content of elastic fibers, the features of the extracellular matrix or the extent of innervation. From a functional and clinical standpoint, the PF is often correlated with the triceps surae muscle, but the anatomical grounds for this link are not clear. The aim of this work was to focus on the PF macroscopic and microscopic properties and study how Achilles tendon diseases might affect it. Twelve feet from unembalmed human cadavers were dissected to isolate the PF. Specimens from each PF were tested with various histological and immunohistochemical stains. In a second stage, 52 magnetic resonance images (MRI) obtained from patients complaining of aspecific ankle or foot pain were analyzed, dividing the cases into two groups based on the presence or absence of signs of degeneration and/or inflammation of the Achilles tendon. The thickness of PF and paratenon was assessed in the two groups and statistical analyses were conducted. The PF is a tissue firmly joined to plantar muscles and skin. Analyzing its possible connections to the sural structures showed that this fascia is more closely connected to the paratenon of Achilles tendon than to the Achilles tendon, through the periosteum of the heel. The PF extended medially and laterally, continuing into the deep fasciae enveloping the abductor hallucis and abductor digiti minimi muscles, respectively. The PF was rich in hyaluronan, probably produced by fibroblastic-like cells described as 'fasciacytes'. Nerve endings and Pacini and Ruffini corpuscles were present, particularly in the medial and lateral portions, and on the surface of the muscles, suggesting a role for the PF in the proprioception of foot. In the radiological study, 27 of the 52 MRI showed signs of Achilles tendon inflammation and/or degeneration, and the PF was 3.43 ± 0.48 mm thick

  4. 陈旧性跟腱断裂的治疗体会%Treatment of Old Achilles Tendon Rupture

    Institute of Scientific and Technical Information of China (English)

    曾显荣

    2015-01-01

    Objective To explore the surgical effectiveness of old achilles tendon rupture. Methods 18 cases of old a-chilles tendon rupture were treated by operation, Bosworh method repaired achilles tendon, plaster external fixation after opera-tion, systematic functional exercise, evaluated function recovery. Results 18 cases in this group of patients, according to the Ar-ner-Lindholm score standard, excellent in 13 cases, good in 3 cases, poor in 2 cases, the excellent and good rate was 88. 8%. Conclusion Early diagnosis of achilles tendon rupture, early treatment is necessary, using Bosworh method to repair Achilles tendon have definite therapeutic effect.%目的 探讨陈旧性跟腱断裂的手术治疗效果. 方法 18例陈旧性跟腱断裂病例进行手术治疗,采用Bos-worh法修复跟腱,术后石膏固定,系统进行功能练习,评价功能恢复情况. 结果 本组18例患者,按Arner-Lindholm评分标准,优13例,良3例,差2例,优良率为88. 8%. 结论 跟腱断裂早期诊断,早期治疗十分必要,采用Bosworh法修复跟腱,疗效确切.

  5. A preliminary study on the effect of ultrasound therapy on the healing of surgically severed achilles tendons in five dogs.

    Science.gov (United States)

    Saini, N S; Roy, K S; Bansal, P S; Singh, B; Simran, P S

    2002-08-01

    This study was conducted on the left Achilles tendon in five clinically normal dogs. The Achilles tendon was surgically exposed and severed 3-4 cm proximal to the point of its insertion. Tenorrhaphy was undertaken by the application of three sutures on the various tendon units of the Achilles tendon using single locking-loop sutures with polyamide no. 1-0. The superficial digital flexor tendon was sutured with catgut using two horizontal mattress sutures. No ultrasound therapy was used in the animals of group I (control). Ultrasound therapy was given to the animals of group II (treated) starting from the third day post-operatively at 0.5 W/cm2 for 10 min daily for 10 days. A cortical screw was used for immobilization of the tibiotarsal joint which was removed 4 weeks after tenorrhaphy. Post-operatively, healing of the Achilles tendon was monitored using clinical observations, ultrasonography, gross and histomorphological observations at various intervals up to 120 days in both groups. Clinically, the dogs showed significant lameness for the first 4-5 days, which disappeared earlier in the ultrasound-treated (group II) animals than the controls (group I). Extension and flexion of the hock joint were found to be near normal at 6 weeks after the repair of the Achilles tendon. Ultrasonography showed anechoic to hypo-echoic echo-texture on days 3 and 7 after repair. By day 40, the echo-texture started to improve to hypo-echoic in group II, but in group I anechoic areas were still observed. However, the tendon showed near normal mottled hypo- to hyper-echoic texture in both groups by day 120. Gross observations suggested that the Achilles tendon in group II showed comparatively fewer adhesions than in group I animals. Histologically, in group II (treated), on day 40, the union was comparatively better without any inflammatory reaction. Bundle formation had begun in the ultrasound-treated animals which was not observed in the control animals. By day 90, more compact

  6. 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

  7. 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.

  8. 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.

  9. Analysis of the effect of phototherapy in model with traumatic Achilles tendon injury in rats.

    Science.gov (United States)

    Casalechi, Heliodora Leão; de Farias Marques, Anna Cristina; da Silva, Evela Aparecida Pereira; Aimbire, Flávio; Marcos, Rodrigo Labat; Lopes-Martins, Rodrigo A B; de Carvalho, Paulo de Tarso Camilo; Albertini, Regiane

    2014-05-01

    The aim of this study was to investigate the effect of low-intensity laser (LILT) infrared (830 nm) therapy in tendon inflammation, tendinitis induced by mechanical trauma in rat Achilles tendon. For this, we used 65 young male Wistar rats, weighing ± 300 g divided into different groups: C = control (n = 5) and experimental (n = 10/group), with two different times of sacrifice such as treated with L = laser, D = treated with diclofenac, and T = untreated injured. The tendon inflammation was induced by controlled contusion in the medial region of the Achilles tendon of the animals. The treated groups received some kind of intervention every 24 h, all groups were sacrificed on the 7th or 14th day after the trauma. The tendons were dissected, extracted, and sent for analysis. Histological analysis of the L group showed a decrease in the number of inflammatory cells in relation to other groups in both periods studied. The comparative results between the number of inflammatory cells in the control and treated groups at 7 and 14 days showed statistically significant differences. Qualitative analysis findings obtained by the picrosirius red technique under polarized light showed that in 7 days, the T group presented collagen types I and III in the same proportion; group D presented a predominance of type III fibers, while in group L, type I collagen predominated. The 14-day group D showed collagen types I and III in the same proportion, while in group L, there was a predominance of type I fibers. Biomechanical analysis showed that 7-day groups L and C showed similar stiffness and increased breaking strength. The 14-day groups L and C showed greater rupturing strength as well as increased stiffness angle. Group D showed a decrease of maximum traction strength and degree of rigidity. It was concluded that treatment with LIL in the parameters used and the times studied reduces migration of inflammatory cells and improves the quality of repair while reducing the functional

  10. Ipsi- and contralateral H-reflexes and V-waves after unilateral chronic Achilles tendon vibration.

    Science.gov (United States)

    Lapole, Thomas; Canon, Francis; Pérot, Chantal

    2013-09-01

    Chronic Achilles tendon vibration has previously shown its effectiveness in improving plantar flexor's strength and activation capacities. The present study investigated the related neural mechanisms by analyzing H-reflexes and V-waves of the soleus (SOL) and gastrocnemii (GM gastrocnemius medialis; GL gastrocnemius lateralis) muscles under maximal isometric plantar flexion. Moreover, recordings were conducted bilaterally to address potential crossed effects. 11 subjects were engaged in this study. Maximal voluntary contraction and superimposed H-reflexes and V-waves were quantified in both legs at baseline (PRE) and 2 weeks later to verify repeatability of data (CON). Then, subjects were retested after 14 days of daily unilateral Achilles tendon vibration (VIB; 1 h per day; frequency: 50 Hz). No changes were reported between PRE and CON data. In the VIB condition, there was an increase in MVC for both the vibrated (+9.1 %; p = 0.016) and non-vibrated (+10.2 %; p = 0.009) legs. The H-reflex increased by a mean 25 % in the vibrated SOL (p wave also increased in the vibrated limb (+43.3 %; p vibrated one (+41.9 %; p = 0.006). Furthermore, the GM V-wave increased by 37.8 % (p = 0.081) in the vibrated side and by 39.4 % (p = 0.03) in the non-vibrated side. However, no changes were reported for the GL muscles. While the present study confirmed the strength gains induced by chronic Achilles tendon vibration, the results indicated a cross-education phenomenon with differences in neural adaptations between the vibrated leg and non-vibrated leg.

  11. In vivo evaluation of the elastic anisotropy of the human Achilles tendon using shear wave dispersion analysis

    Science.gov (United States)

    Brum, J.; Bernal, M.; Gennisson, J. L.; Tanter, M.

    2014-02-01

    Non-invasive evaluation of the Achilles tendon elastic properties may enhance diagnosis of tendon injury and the assessment of recovery treatments. Shear wave elastography has shown to be a powerful tool to estimate tissue mechanical properties. However, its applicability to quantitatively evaluate tendon stiffness is limited by the understanding of the physics on the shear wave propagation in such a complex medium. First, tendon tissue is transverse isotropic. Second, tendons are characterized by a marked stiffness in the 400 to 1300 kPa range (i.e. fast shear waves). Hence, the shear wavelengths are greater than the tendon thickness leading to guided wave propagation. Thus, to better understand shear wave propagation in tendons and consequently to properly estimate its mechanical properties, a dispersion analysis is required. In this study, shear wave velocity dispersion was measured in vivo in ten Achilles tendons parallel and perpendicular to the tendon fibre orientation. By modelling the tendon as a transverse isotropic viscoelastic plate immersed in fluid it was possible to fully describe the experimental data (deviation<1.4%). We show that parallel to fibres the shear wave velocity dispersion is not influenced by viscosity, while it is perpendicularly to fibres. Elasticity (found to be in the range from 473 to 1537 kPa) and viscosity (found to be in the range from 1.7 to 4 Pa.s) values were retrieved from the model in good agreement with reported results.

  12. Quantitative ultrasound method for assessing stress-strain properties and the cross-sectional area of Achilles tendon

    Science.gov (United States)

    Du, Yi-Chun; Chen, Yung-Fu; Li, Chien-Ming; Lin, Chia-Hung; Yang, Chia-En; Wu, Jian-Xing; Chen, Tainsong

    2013-12-01

    The Achilles tendon is one of the most commonly observed tendons injured with a variety of causes, such as trauma, overuse and degeneration, in the human body. Rupture and tendinosis are relatively common for this strong tendon. Stress-strain properties and shape change are important biomechanical properties of the tendon to assess surgical repair or healing progress. Currently, there are rather limited non-invasive methods available for precisely quantifying the in vivo biomechanical properties of the tendons. The aim of this study was to apply quantitative ultrasound (QUS) methods, including ultrasonic attenuation and speed of sound (SOS), to investigate porcine tendons in different stress-strain conditions. In order to find a reliable method to evaluate the change of tendon shape, ultrasound measurement was also utilized for measuring tendon thickness and compared with the change in tendon cross-sectional area under different stress. A total of 15 porcine tendons of hind trotters were examined. The test results show that the attenuation and broadband ultrasound attenuation decreased and the SOS increased by a smaller magnitude as the uniaxial loading of the stress-strain upon tendons increased. Furthermore, the tendon thickness measured with the ultrasound method was significantly correlated with tendon cross-sectional area (Pearson coefficient = 0.86). These results also indicate that attenuation of QUS and ultrasonic thickness measurement are reliable and potential parameters for assessing biomechanical properties of tendons. Further investigations are needed to warrant the application of the proposed method in a clinical setting.

  13. Sport-Specific Capacity to Use Elastic Energy in the Patellar and Achilles Tendons of Elite Athletes

    Science.gov (United States)

    Wiesinger, Hans-Peter; Rieder, Florian; Kösters, Alexander; Müller, Erich; Seynnes, Olivier R.

    2017-01-01

    Introduction: During running and jumping activities, elastic energy is utilized to enhance muscle mechanical output and efficiency. However, training-induced variations in tendon spring-like properties remain under-investigated. The present work extends earlier findings on sport-specific profiles of tendon stiffness and cross-sectional area to examine whether years of distinct loading patterns are reflected by tendons' ability to store and return energy. Methods:Ultrasound scans were performed to examine the morphological features of knee extensor and plantar flexor muscle-tendon units in elite ski jumpers, distance runners, water polo players, and sedentary controls. Tendon strain energy and hysteresis were measured with combined motion capture, ultrasonography, and dynamometry. Results: Apart from the fractional muscle-to-tendon cross-sectional area ratio being lower in the knee extensors of ski jumpers (−31%) and runners (−33%) than in water polo players, no difference in the considered muscle-tendon unit morphological features was observed between groups. Similarly, no significant difference in tendon energy storage or energy return was detected between groups. In contrast, hysteresis was lower in the patellar tendon of ski jumpers (−33%) and runners (−30%) compared to controls, with a similar trend for the Achilles tendon (significant interaction effect and large effect sizes η2 = 0.2). Normalized to body mass, the recovered strain energy of the patellar tendon was ~50% higher in ski jumpers than in water polo players and controls. For the Achilles tendon, recovered strain energy was ~40% higher in ski jumpers and runners than in controls. Discussion: Advantageous mechanical properties related to tendon spring-like function are observed in elite athletes whose sport require effective utilization of elastic energy. However, the mechanisms underpinning the better tendon capacity of some athletes to retain elastic energy could not be ascribed to

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

    Directory of Open Access Journals (Sweden)

    Alfredson H

    2016-05-01

    Full Text Available Håkan Alfredson1,2 1Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden; 2Institute of Sport, Exercise and Health, University College London Hospitals, London, UKBackground: 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.Keywords: Achilles midportion, ultrasound, Doppler, mini-surgical scraping technique

  15. Adverse reactions of Achilles tendon xanthomas in three hypercholesterolemic patients after treatment intensification with niacin and bile acid sequestrants.

    Science.gov (United States)

    Lakey, Wanda C; Greyshock, Nicole; Guyton, John R

    2013-01-01

    Multiple cholesterol-reducing therapies have been shown to induce the regression of tendon xanthoma in patients with familial hypercholesterolemia. We present 3 cases of adverse reactions in Achilles tendon xanthomas after the addition of niacin and bile acid sequestrants to ongoing statin therapy. Reduction in tendon dimensions and marked softening of xanthomas were interpreted as cholesterol removal from heavily infiltrated tissue sites. In 2 cases, changes in the xanthomas occurred despite only minor lipoprotein improvements, raising the possibility of direct drug effects in cholesterol-infiltrated tissue. Intriguingly, recent studies have described niacin receptor-mediated effects in macrophages. In summary, although adverse reactions in Achilles tendon xanthomas appear to be infrequent, clinicians should be aware of this phenomenon in their patients after intensifying lipid treatments, especially with the use of niacin in patients with familial hypercholesterolemia. Xanthoma responses may provide clues to new pharmacologic effects in cholesterol-infiltrated tissues.

  16. 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.

  17. Treatment of open achilles tendon ruptures by Achillon minimally invasive achilles tendon suture system in cases%Achillon微创跟腱吻合器治疗开放性跟腱断裂23例疗效观察

    Institute of Scientific and Technical Information of China (English)

    黄崧; 陈翔宇; 任小宝; 郭国宁; 任鸿

    2012-01-01

    Objective To evaluate the clinical effect of Achillon minimal invasive achilles tendon suture system on repairing of acute open achilles tendon ruptures. Methods Twenty three patients with acute open achilles tendon ruptures were treated by Achillon minimal invasive achilles tendon suture system and the follow-up was conducted. This minimal invasive treatment was performed after the debride-ment. In all cases Achilles tendons were successfully explored through the original wounds. Achillon minimal invasive achilles tendon suture system was put in to hold the rupture end of achilles tendon. Then suture threads were introduced to both proximal and distal ends. The ankle was casted with gypsum for six weeks after the surgery. Results Twenty three cases were successfully followed up for 8 to 14 months ( 10 months in average ). Accoring to Arner-Lindholm score,the clinical effect was excellent in 21 cases ( 91. 3% ),good in 2 cases ( 8. 7% ). No case of infection, Achilles tendon mal-union,sural nerve damage,recurrent achillies tendon ruptures or suture rejection was found. Conclusion Repairing acute open Achilles tendon ruptures by Achillon minimal invasive achilles tendon suture system is reliable, minimal invasive , with fast recovery of the ankle function.%目的 探讨应用Achillon微创跟腱吻合器治疗新鲜开放性跟腱断裂的临床效果.方法 采用Achillon跟腱缝合器治疗23例急性开放性跟腱断裂患者并随访.在急诊清创后,采用原创口显露跟腱断端、清理残端后,置入Achillon吻合器夹持跟腱近侧断端,引入缝线;同法在跟腱断裂远端置入缝线,拉出缝线打结,术后石膏托外固定6周.结果 23例获得随访,时间8~14个月,平均10个月,按Arner-Lindholm疗效评定标准,优21例(91.3%),良2例(8.7%),无伤口感染、跟腱愈合不良、腓肠神经损伤、复发跟腱断裂或缝线排异.结论 开放性跟腱断裂在急诊清创后,采用原创口清理显露跟腱断端,

  18. 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.

  19. Reconstruction of defects involving the Achilles tendon and local soft tissues: a quick solution for a lingering problem.

    Science.gov (United States)

    Soons, J; Rakhorst, H A; Ruettermann, M; Luijsterburg, A J M; Bos, P K; Zöphel, O T

    2015-02-01

    A total of seven patients (six men and one woman) with a defect in the Achilles tendon and overlying soft tissue underwent reconstruction using either a composite radial forearm flap (n = 3) or an anterolateral thigh flap (n = 4). The Achilles tendons were reconstructed using chimeric palmaris longus (n = 2) or tensor fascia lata (n = 2) flaps or transfer of the flexor hallucis longus tendon (n = 3). Surgical parameters such as the rate of complications and the time between the initial repair and flap surgery were analysed. Function was measured objectively by recording the circumference of the calf, the isometric strength of the plantar flexors and the range of movement of the ankle. The Achilles tendon Total Rupture Score (ATRS) questionnaire was used as a patient-reported outcome measure. Most patients had undergone several previous operations to the Achilles tendon prior to flap surgery. The mean time to flap surgery was 14.3 months (2.1 to 40.7). At a mean follow-up of 32.3 months (12.1 to 59.6) the circumference of the calf on the operated lower limb was reduced by a mean of 1.9 cm (sd 0.74) compared with the contralateral limb (p = 0.042). The mean strength of the plantar flexors on the operated lower limb was reduced to 88.9% of that of the contralateral limb (p = 0.043). There was no significant difference in the range of movement between the two sides (p = 0.317). The mean ATRS score was 72 points (sd 20.0). One patient who had an initial successful reconstruction developed a skin defect of the composite flap 12 months after free flap surgery and this resulted in recurrent infections, culminating in transtibial amputation 44 months after reconstruction. These otherwise indicate that reconstruction of the Achilles tendon combined with flap cover results in a successful and functional reconstruction.

  20. 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.

  1. 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.

  2. 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.

  3. 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

  4. Effects of repeated Achilles tendon vibration on triceps surae stiffness and reflex excitability.

    Science.gov (United States)

    Lapole, Thomas; Pérot, Chantal

    2011-02-01

    Clinical studies frequently report an increase in stiffness and a loss of range of motion at joints placed in disuse or immobilization. This is notably the case for subjects maintained in bed for a long period, whilst their joints are not affected. Recently we documented on healthy subjects the benefit in terms of force and activation capacities of the triceps surae offered by vibrations applied to the Achilles tendon. Knowing that stiffness changes may contribute to force changes, the aim of the present study was to investigate the effects of tendon vibration on the triceps surae stiffness of healthy subjects. The vibration program consisted in 14 days of 1h daily Achilles tendon vibration applied at rest. Nineteen healthy students were involved in this study. Before and at the end of the vibration program, musculo-tendinous stiffness in active conditions was determined by use of a quick-release test. Passive stiffness was also analyzed by a flexibility test: passive torque-angle relationships were established from maximal plantar-flexion to maximal dorsiflexion. Passive stiffness indexes at 10°, 15° and 20° dorsiflexion were defined as the slope of the relationships at the corresponding angle. Tendinous reflex, influenced by stiffness values, was also investigated as well as the H reflex to obtain an index of the central reflex excitability. After the program, musculo-tendinous stiffness was significantly decreased (p=.01). At the same time, maximal passive dorsiflexion was increased (p=.005) and passive stiffness indexes at 10°, 15° and 20° dorsiflexion decreased (ptriceps surae parameters are diminished after the vibration program, it could be beneficial to immobilized persons as hypo-activity is known to increase muscular stiffness.

  5. 陈旧性跟腱断裂11例治疗分析%Clinical analysis for 11 cases of chronic achilles tendon rupture

    Institute of Scientific and Technical Information of China (English)

    王锐

    2012-01-01

      目的探讨陈旧性跟腱断裂的治疗方法与疗效.方法11例陈旧性跟腱断裂患者根据跟腱缺损长度选择相应的手术治疗方法.结果所有病例均得到随访,根据Amer-Lindholm疗效评定标准评估,优6例,良4例,差1例,优良率为90.9%.结论陈旧性跟腱断裂应根据跟腱缺损长度选择不同的治疗方法,腓肠肌腱瓣翻转法适用于跟腱缺损>6 cm的患者.%  Objective To investigate the treatment for Chronic Achilles tendon rupture. Methods 11 cases of rupture of Achilles tendon with Achilles tendon defect length was selected according to the corresponding operation treatment method. Results All cases were followed up, according to the Amer-Lindholm criteria for the evaluation of curative effect evaluation, excellent in 6 cases, good in 4 cases, and poor in 1 cases, the excellent and good rate was 90.9%. Conclusion The rupture of Achilles tendon Achilles tendon defect length according to different therapeutic methods, gastrocnemius tendon flap method is applied to the Achilles tendon defect with>6 cm.

  6. 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...

  7. Achilles Tendonitis

    Science.gov (United States)

    ... 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 Send ...

  8. Frequency characteristics of human muscle and cortical responses evoked by noisy Achilles tendon vibration.

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    Mildren, Robyn Lynne; Peters, Ryan M; Hill, Aimee J; Blouin, Jean-Sebastien; Carpenter, Mark Gregory; Inglis, J Timothy

    2017-02-16

    Noisy stimuli, along with linear systems analysis, have proven to be effective for mapping functional neural connections. We explored the use of noisy (10-115 Hz) Achilles tendon vibration to examine proprioceptive reflexes in the triceps surae muscles in standing healthy young adults (n = 8). We also examined the association between noisy vibration and electrical activity recorded over the sensorimotor cortex using electroencephalography. We applied two-minutes of vibration and recorded ongoing muscle activity of the soleus and gastrocnemii using surface electromyography (EMG). Vibration amplitude was varied to characterize reflex scaling and to examine how different stimulus levels affected postural sway. Muscle activity from the soleus and gastrocnemii were significantly correlated with the tendon vibration across a broad frequency range (~10-80 Hz), with a peak located at ~40 Hz. Vibration-EMG coherence positively scaled with stimulus amplitude in all three muscles, with soleus displaying the strongest coupling and steepest scaling. EMG responses lagged the vibration by ~38 ms, a delay that paralleled observed response latencies to tendon taps. Vibration-evoked cortical oscillations were observed at frequencies ~40-70 Hz (peak ~54 Hz) in most subjects, a finding in line with previous reports of sensory evoked γ-band oscillations. Further examination of the method revealed a) accurate reflex estimates could be obtained with <60 s of low-level (RMS=10 m/s(2)) vibration, b) responses did not habituate over two-minutes of exposure, and importantly c) noisy vibration had a minimal influence on standing balance. Our findings suggest noisy tendon vibration is an effective novel approach to characterize proprioceptive reflexes.

  9. 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.

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

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

    2013-01-28

    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 recreational athlete did not completely eliminate the consequences of the Achilles tendon rupture. The function muscle deficit is namely manifested by a lower net plantar flexion moment and a lower net-generated ankle joint power during the take-off in the stance phase. The greater dorsal flexion in the affected ankle joint at the first contact with the ground and consequently higher peaks of ground reaction forces during running are consequences of the longer Achilles tendon in the affected lower extremity and weakened calf muscles.

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

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    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  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.

  12. Influence of different training patterns on the biomechanical performance of the terminal region of the Achilles tendon in rabbits

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    Zhen-hai GUO

    2012-01-01

    Full Text Available Objective  To investigate the effects of the different training patterns on the biomechanical performance of the terminal region of the Achilles tendon for providing a scientific basis for improving the ability of anti-stress and preventing injury in military physical training. Methods  Fifty Japanese white rabbits were randomly assigned to four groups: control (n=5, 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 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 week, respectively. The terminal regions of the Achilles tendons in both sides were identified to determine the biomechanics. Results  At the sixth week, the limit stress and the elastic modulus reached the highest in the running group, and then reduced with the increase in training time. Meanwhile, in the jump group, the limit stress and elastic modulus reached the peak at the fourth week, and then decreased gradually. In the eighth week, no significant difference was observed when the groups were compared with the control group. In the cycle group, the limit stress and elastic modulus increased gradually with the increase in training time, reaching the peak value in the eighth week, and no decline was recorded during the training period. Conclusions  Running training can slowly improve the biomechanical performance of the tissues in the terminal region of the Achilles tendon, whereas jump training can rapidly increase it, although long-term excessive training will reduce the anti-injury ability. Meanwhile, cycle training can improve the biomechanical performance of the tissues in the terminal region of the Achilles tendon, enabling it to withstand more stress and thus its anti-injury ability is enhanced.

  13. Regional molecular and cellular differences in the female rabbit Achilles tendon complex: potential implications for understanding responses to loading.

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    Huisman, Elise S; Andersson, Gustav; Scott, Alexander; Reno, Carol R; Hart, David A; Thornton, Gail M

    2014-05-01

    The aim of this study was: (i) to analyze the morphology and expression of extracellular matrix genes in six different regions of the Achilles tendon complex of intact normal rabbits; and (ii) to assess the effect of ovariohysterectomy (OVH) on the regional expression of these genes. Female New Zealand White rabbits were separated into two groups: (i) intact normal rabbits (n = 4); and (ii) OVH rabbits (n = 8). For each rabbit, the Achilles tendon complex was dissected into six regions: distal gastrocnemius (DG); distal flexor digitorum superficialis; proximal lateral gastrocnemius (PLG); proximal medial gastrocnemius; proximal flexor digitorum superficialis; and paratenon. For each of the regions, hematoxylin and eosin staining was performed for histological evaluation of intact normal rabbit tissues and mRNA levels for proteoglycans, collagens and genes associated with collagen regulation were assessed by real-time reverse transcription-quantitative polymerase chain reaction for both the intact normal and OVH rabbit tissues. The distal regions displayed a more fibrocartilaginous phenotype. For intact normal rabbits, aggrecan mRNA expression was higher in the distal regions of the Achilles tendon complex compared with the proximal regions. Collagen Type I and matrix metalloproteinase-2 expression levels were increased in the PLG compared to the DG in the intact normal rabbit tissues. The tendons from OVH rabbits had lower gene expressions for the proteoglycans aggrecan, biglycan, decorin and versican compared with the intact normal rabbits, although the regional differences of increased aggrecan expression in distal regions compared with proximal regions persisted. The tensile and compressive forces experienced in the examined regions may be related to the regional differences found in gene expression. The lower mRNA expression of the genes examined in the OVH group confirms a potential effect of systemic estrogen on tendon.

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

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

    2015-01-01

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

  15. UTE-T2(⁎) Analysis of Diseased and Healthy Achilles Tendons and Correlation with Clinical Score: An In Vivo Preliminary Study.

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    Qiao, Yang; Tao, Hong-Yue; Ma, Kui; Wu, Zi-Ying; Qu, Jian-Xun; Chen, Shuang

    2017-01-01

    Objective. To compare T2(⁎) value of healthy and diseased Achilles tendons (AT) with a recently introduced three-dimensional ultrashort echo time (3D-UTE) sequence and analyze the correlation between T2(⁎) value and clinical scores. Methods. Ten patients with symptomatic Achilles tendon and ten healthy volunteers were investigated with 3D-UTE sequence on a 3T magnetic resonance (MR) scanner. T2(⁎) values of four regions in Achilles tendons were calculated. The clinical outcomes of patients were evaluated according to the American Orthopaedic Foot and Ankle Society (AOFAS) score and Achilles Tendon Rupture Score (ATRS). An independent sample t-test was used to compare the differences of T2(⁎) value and clinical scores between two groups. The Pearson correlation coefficient between clinical scores and T2(⁎) values was assessed. Results. The T2(⁎) values of Achilles tendon were statistically significantly different between patients and volunteers. The Pearson correlation coefficients between T2(⁎) and AOFAS or ATRS scores of patients were r = -0.733 and r = -0.634, respectively. Conclusion. The variability of T2(⁎) in healthy and pathologic AT can be quantified by UTE-T2(⁎). T2(⁎) may be a promising marker to detect and diagnose AT tendinopathy. UTE-T2(⁎) could give a precise guidance to clinical outcome.

  16. The medial gastrocnemius muscle with an achilles tendon sheath extension flap as a versatile myo-tendon sheath flap for coverage of the upper two-thirds of the tibia and pre-tibial area: a preliminary report.

    Science.gov (United States)

    Elghamry, Ashraf Hussein

    2014-02-01

    The idea of using the leg tendon sheath as a pedicled fascial flap was first described by the author in April 2003. To extend this new idea, the author studied the blood supply and gross features of the outer layer of the Achilles tendon sheath. The findings of that study supported the feasibility of using the medial gastrocnemius muscle with an Achilles tendon sheath extension flap to cover defects over the upper two-thirds of the tibia. Six flaps of the Achilles tendon sheath survived, and the split skin grafts over the tibia took; but, in one flap, the distal 1 cm was lost. The length of follow-up was 3 years for all cases. The results demonstrated safe elevation of up to 8 cm of distal extension.

  17. 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.

  18. [The echographic and clinical follow-up of patients operated on for subcutaneous rupture of the Achilles tendon].

    Science.gov (United States)

    Cinotti, A; Massari, L; Traina, G C; Mannella, P

    1996-01-01

    Thanks to its good long-term results, surgery is the method of choice to treat subcutaneous ruptures of the Achilles tendon. Reconstructed tendons present typical morphological and functional US patterns which depend partly on the kind of surgical reconstruction and partly on the time passed since surgery. The authors report the results of the clinical and US follow-up of a series of 62 surgical patients treated in 7 years for the subcutaneous rupture of the Achilles tendon. The patients were 55 men and 7 women, whose mean age was 36 years (range: 25-65 years). The left-hand side was affected in 38 patients and the right-hand side in 24 patients. All patients were operated on using an end-to-end suture and reinforcement plastic surgery pulling down a gastrocnemius tendon flap. To homogenize the results, all the US exams were performed by the same operator, in the presence of the orthopedic specialist and under the same conditions: both the involved and the contralateral Achilles tendons were studied, longitudinal and transverse scans were performed with the foot in max. plantar and dorsal flexion and, whenever possible, dynamic scans were also performed making the sural triceps contract against resistance. The following parameters were studied clinically: pain (which was absent in 39 patients, occasional in 11, after stress in 9 and on walking in 3 patients), skin scar trophism (which was eutrophic in 53.23% of patients, keloid in 27.42% and hypertrophic in 19.35% of patients), ankle joint excursion (plantar flexion was impaired in 32.3% and dorsal flexion in 36% of patients), walking on tiptoe (in all, 22.6% of patients complained of difficulties walking on tiptoe) and, finally, work activity resumption (which all patients achieved). US depicted the surgical tendons as much bigger than the contralateral ones (3-4 times on the average), which increase in volume lasted throughout the follow-up. In 75% of patients the echo structure of the surgical tendons was

  19. Evaluation of the stiffnesses of the Achilles tendon and soleus from the apparent stiffness of the triceps surae.

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    París-García, Federico; Barroso, Alberto; Doblaré, Manuel; Cañas, José; París, Federico

    2015-01-01

    The triceps surae plays an important role in the performance of many sports. Although the apparent average mechanical properties of the triceps surae may be a satisfactory parameter for estimating the training level of an athlete, a knowledge of the mechanical properties of the individual constituents of the triceps surae (in particular the Achilles tendon and soleus) permits a more detailed and in-depth control of the effects of training from more physically based parameters. The objective of this work is therefore the estimation of the individual viscoelastic properties (stiffness and viscosity) of soleus and Achilles tendon from the apparent properties of the triceps surae obtained by free vibration techniques. Different procedures have been developed and discussed, showing a high degree of robustness in the predictions. The results obtained for a non-oriented set of subjects present a high level of variability, depending on the training conditions and anthropometric features, although the corresponding average values compare well with data previously reported in the literature, particularly those associated with the tendon stiffness.

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

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    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.

  1. Knotless Repair of Achilles Tendon Rupture in an Elite Athlete: Return to Competition in 18 Weeks.

    Science.gov (United States)

    Byrne, Paul A; Hopper, Graeme P; Wilson, William T; Mackay, Gordon M

    Rupture of the Achilles tendon is an increasingly common injury, particularly in physically active males, and current evidence favors minimally invasive surgical repair. We describe the case of a 36-year-old male elite bobsled athlete with complete rupture of the Achilles tendon. He was treated with surgical repair of the ruptured tendon using an innovative, minimally invasive procedure based on an internal bracing concept and was able to undergo early mobilization and aggressive physiotherapy rehabilitation. His recovery was such that he returned to training at 13 weeks postoperatively and participated in an international competition at 18 weeks, winning a World Cup silver medal. He subsequently raced at the 2014 Winter Olympic Games at 29 weeks after surgery. At >2 years since his injury, he has experienced no complications or reinjury. This represents an exceptional recovery that far exceeds the standard expected for such injuries. The use of this technique for athletes could enable accelerated return to sporting activity and attainment of their preinjury activity levels.

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

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

    2013-11-15

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

  3. 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.

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

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

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    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

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

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    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

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

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    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

  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

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    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. Radial shock waves effectively introduced NF-kappa B decoy into rat achilles tendon cells in vitro.

    Science.gov (United States)

    Sugioka, Kaori; Nakagawa, Koichi; Murata, Ryo; Ochiai, Nobuyasu; Sasho, Takahisa; Arai, Momoko; Tsuruoka, Hiroaki; Ohtori, Seiji; Saisu, Takashi; Gemba, Takefumi; Takahashi, Kazuhisa

    2010-08-01

    The purpose of this study was to test if radial shock waves could enhance the introduction of nuclear factor-kappa B (NF-kappaB) decoy oligodeoxynucleotides, which is reported to markedly inhibit NF-kappaB activation and suppress pro-inflammatory cytokine gene expression, using rat Achilles tendon cells. In the presence of NF-kappaB decoy labeled with or without fluorescein isothiocyanate (FITC) in culture media, radial shock waves were applied to the tendon cells in variable conditions and cultivated for 24 h. The transfection rate was assessed by counting FITC-positive cells, and IL-1-induced NF-kappaB activation in the cells was assessed. Radial shock waves significantly enhanced introduction of NF-kappaB decoy-FITC into the tendon cells. IL-1-induced NF-kappaB activation was significantly inhibited by pretreatment of the cells with NF-kappaB decoy combined with radial shock wave exposure. The present study demonstrated the effectiveness of radial shock waves on introduction of NF-kappaB decoy into tendon cells. Radial shock wave treatment combined with local NF-kappaB decoy administration could be a novel therapeutic strategy for chronic tendinopathy.

  10. 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...

  11. Efficacy of early controlled motion of the ankle compared with no motion after non-operative treatment of an acute Achilles tendon rupture

    DEFF Research Database (Denmark)

    Barfod, Kristoffer Weisskirchner; Hansen, Maria Swennergren; Holmich, Per;

    2016-01-01

    BACKGROUND: Early controlled ankle motion is widely used in the non-operative treatment of acute Achilles tendon rupture, though its safety and efficacy have never been investigated in a randomized setup. The objectives of this study are to investigate if early controlled motion of the ankle affe...

  12. Depth-dependent variations in Achilles tendon deformations with age are associated with reduced plantarflexor performance during walking.

    Science.gov (United States)

    Franz, Jason R; Thelen, Darryl G

    2015-08-01

    The anatomical arrangement of the Achilles tendon (AT), with distinct fascicle bundles arising from the gastrocnemius and soleus muscles, may facilitate relatively independent behavior of the triceps surae muscles. A reduced capacity for sliding between adjacent tendon fascicles with age may couple gastrocnemius and soleus muscle behavior, thereby potentially contributing to diminished plantarflexor performance commonly observed in old adults. Nine healthy young (mean age, 23.9 yr) and eight healthy old (69.9 yr) adults walked at three speeds (0.75, 1.00, and 1.25 m/s) on a force-sensing treadmill. We coupled dynamic ultrasound imaging of the free AT with motion capture and inverse dynamic analyses to compute, in part: 1) depth-dependent variations in AT tissue displacements and elongations and 2) net ankle joint kinetics during push-off. The difference in displacements between superficial and deep AT regions, and in their corresponding elongations, did not differ between old and young adults at the slower two walking speeds (P > 0.61). However, old adults walked with 41% smaller depth-dependent variations in free AT displacements and elongations at 1.25 m/s (P = 0.02). These more uniform tendon deformations in old adults most strongly correlated with reduced peak ankle moment (R(2) = 0.40), but also significantly correlated with reduced peak power generation (R(2) = 0.15) and positive ankle work during push-off (R(2) = 0.19) (P > 0.01). Our findings: 1) demonstrate a potential role for nonuniform AT deformations in governing gastrocnemius and soleus muscle-tendon function and 2) allude to altered tendon behavior that may contribute to the age-related reduction in plantarflexor performance during walking.

  13. Differential strain patterns of the human Achilles tendon determined in vivo with freehand three-dimensional ultrasound imaging.

    Science.gov (United States)

    Farris, Dominic James; Trewartha, Grant; McGuigan, M Polly; Lichtwark, Glen A

    2013-02-15

    The human Achilles tendon (AT) has often been considered to act as a single elastic structure in series with the muscles of the triceps surae. As such it has been commonly modelled as a Hookean spring of uniform stiffness. However, the free AT and the proximal AT have distinctly different structures that lend themselves to different elastic properties. This study aimed to use three-dimensional freehand ultrasound imaging to determine whether the proximal AT and the free AT exhibit different elastic behaviour during sub-maximal, fixed-end contractions of the triceps surae. Six male and five female participants (mean ± s.d. age=27 ± 5 years) performed fixed position contractions of the plantar-flexors on an isokinetic dynamometer at 50% of their maximum voluntary contraction in this position. Freehand three-dimensional ultrasound imaging was used to reconstruct the free-tendon and proximal AT at rest and during contraction. The free-tendon exhibited significantly (P=0.03) greater longitudinal strain (5.2 ± 1.7%) than the proximal AT (2.6 ± 2.0%). The lesser longitudinal strain of the proximal AT was linked to the fact that it exhibited considerable transverse (orthogonal to the longitudinal direction) strains (5.0 ± 4%). The transverse strain of the proximal AT is likely due to the triceps surae muscles bulging upon contraction, and thus the level of bulging may influence the elastic behaviour of the proximal AT. This might have implications for the understanding of triceps surae muscle-tendon interaction during locomotion, tendon injury mechanics and previous measurements of AT elastic properties.

  14. 腓骨长肌腱移位修复陈旧性跟腱断裂%Long fibular muscle tendon transposition in repair of old Achilles tendon rupture

    Institute of Scientific and Technical Information of China (English)

    张胜强

    2013-01-01

    Objective To investigate the effect of peroneus longus tendon for treatment of old Achilles tendon rupture. Methods The peroneus longus tendon was cut near the ending point, and transposed via subcutaneous tunnel for repair of Achilles tendon rupture. Results 15 cases were followed up for 18 ~24 months. 2 cases got delayed wound healing. After rehabilitation, patients were allowed full weight-bearing on the 10th postoperative week. No recurrence of Achilles tendon rupture was found. According to Arner-Lindholm efficacy evaluation, the results were excellent in 10 cases, and good in 5 cases. Conclusions Long fibular muscle tendon transposition for repair of old rupture of Achilles tendon is effective for fast rehabilitation, and good effect.%目的 探讨腓骨长肌腱治疗陈旧性跟腱断裂的疗效.方法 腓骨长肌腱近止点处切断,经皮下隧道移位修复跟腱断裂.结果 15例均获随访,时间18~24 个月.2例出现伤口延迟愈合.经康复锻炼,患者均在术后10周左右弃拐完全负重行走,未发生跟腱断裂.疗效按Arner-Lindholm标准评定:优10 例,良5 例.结论 腓骨长肌腱移位修复陈旧性跟腱断裂,康复较快,疗效满意.

  15. 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

  16. 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

  17. 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.

  18. 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.

  19. 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

  20. 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

  1. Bilateral Achilles Tendon Ruptures Associated With Ciprofloxacin Use in the Setting of Minimal Change Disease: Case Report and Review of the Literature.

    Science.gov (United States)

    Kawtharani, Firas; Masrouha, Karim Z; Afeiche, Nadim

    2016-01-01

    Fluoroquinolones are widely used antibiotics; however, numerous side effects have been reported in published studies, including a spectrum of tendinopathies, affecting numerous anatomic sites. Several risk factors have been identified, including advanced age (>60 years), corticosteroid use, renal failure or dialysis, female sex, and nonobesity. We present the case of an elderly male with minimal change disease treated with glucocorticoids and acute kidney injury, who sustained spontaneous nontraumatic bilateral Achilles tendon tears 4 days after initiating ciprofloxacin.

  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.

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

    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。

  4. 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.

  5. 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

  6. 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 a si...

  7. 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.

  8. Evaluating the effect of low-level laser therapy on healing of tentomized Achilles tendon in streptozotocin-induced diabetic rats by light microscopical and gene expression examinations.

    Science.gov (United States)

    Aliodoust, Morteza; Bayat, Mohammad; Jalili, Mohammad Reza; Sharifian, Zainalabedin; Dadpay, Masoomeh; Akbari, Mohammad; Bayat, Mehrnoush; Khoshvaghti, Amir; Bayat, Homa

    2014-07-01

    Tendon healing is impaired in individuals diagnosed with diabetes mellitus (DM). According to research, there is considerable improvement in the healing of surgically tenotomized Achilles tendons following low-level laser therapy (LLLT) in non-diabetic, healthy animals. This study uses light microscopic (LM) and semi-quantitative reverse transcription PCR (RT-PCR) analyses to evaluate the ability of LLLT in healing Achilles tendons from streptozotocin-induced diabetic (STZ-D) rats. A total of 88 rats were randomly divided into two groups, non-diabetic and diabetic. DM was induced in the rats by injections of STZ. The right Achilles tendons of all rats were tenotomized 1 month after administration of STZ. Laser-treated rats were treated with a helium-neon (He-Ne) laser that had a 632.8-nm wavelength and 7.2-mW average power. Experimental group rats received a daily dose of 0.014 J (energy density, 2.9 J/cm(2)). Control rats did not receive LLLT. Animals were sacrificed on days 5, 10, and 15 post-operatively for semi-quantitative LM and semi-quantitative RT-PCR examinations of transforming growth factor-beta1 (TGF-β1) gene expression. The chi-square test showed that LLLT significantly reduced inflammation in non-diabetic rats compared with their non-diabetic controls (p = 0.02). LLLT significantly decreased inflammation in diabetic rats on days 5 (p = 0.03) and 10 (p = 0.02) compared to the corresponding control diabetic rats. According to the student's t test, LLLT significantly increased TGF-β1 gene expression in healthy (p = 0.000) and diabetic (p = 0.000) rats compared to their relevant controls. The He-Ne laser was effective in altering the inflammatory reaction and increasing TGF-β1 gene production.

  9. 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

  10. Imaging of the Achilles tendon in spondyloarthritis: a comparison of ultrasound and conventional, short and ultrashort echo time MRI with and without intravenous contrast

    Energy Technology Data Exchange (ETDEWEB)

    Hodgson, R.J.; Emery, P. [University of Leeds, Chapel Allerton Hospital, Leeds Musculoskeletal Biomedical Research Centre, Leeds (United Kingdom); Grainger, A.J.; O' Connor, P.J.; Evans, R. [Chapel Allerton Hospital, Leeds Musculoskeletal Biomedical Research Centre, Leeds (United Kingdom); Coates, L.; Marzo-Ortega, H.; Helliwell, P.; McGonagle, D. [University of Leeds, Leeds Institute for Molecular Medicine, Leeds (United Kingdom); Robson, M.D. [University of Oxford, Oxford Centre for Clinical Magnetic Resonance Research, Oxford (United Kingdom)

    2011-06-15

    To compare conventional MRI, ultrashort echo time MRI and ultrasound for assessing the extent of tendon abnormalities in spondyloarthritis. 25 patients with spondyloarthritis and Achilles symptoms were studied with MRI and ultrasound. MR images of the Achilles tendon were acquired using T1-weighted spin echo, gradient echo and ultrashort echo time (UTE) sequences with echo times (TE) between 0.07 and 16 ms, before and after intravenous contrast medium. Greyscale and power Doppler ultrasound were also performed. The craniocaudal extent of imaging abnormalities measured by a consultant musculoskeletal radiologist was compared between the different techniques. Abnormalities were most extensive on spoiled gradient echo images with TE=2 ms. Contrast enhancement after intravenous gadolinium was greatest on the UTE images (TE=0.07 ms). Fewer abnormalities were demonstrated using unenhanced UTE. Abnormalities were more extensive on MRI than ultrasound. Contrast enhancement was more extensive than power Doppler signal. 3D spoiled gradient echo images with an echo time of 2 ms demonstrate more extensive tendon abnormalities than the other techniques in spondyloarthritis. Abnormalities of vascularity are best demonstrated on enhanced ultrashort echo time images. (orig.)

  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. Achilles tendon rupture in an elite athlete following multiple injection therapies.

    Science.gov (United States)

    Hamilton, Bruce; Remedios, Denis; Loosemore, Mike; Maffulli, Nicola

    2008-11-01

    Achilles tendinopathy is common, and its management continues to be challenging, especially in elite athletes. Despite a wide range of novel management options, none guarantees a rapid return to high level sporting activity. Eccentric exercise has been shown to reduce symptoms and normalise imaging abnormalities, but time constraints on professional athletes often make this an unrewarding isolated management strategy. Eccentric exercises concurrent with ongoing training may not be as successful as eccentric training alone, reducing one's confidence in this modality for the "in-season" tendinopathy in the elite athlete. When a professional athlete is faced with a tendinopathy recalcitrant to eccentric exercise, manual therapy and orthotics, a more invasive approach is often attempted to expedite a return to unencumbered training. Numerous injection therapies are described, ranging from homeopathic products to glucocorticosteroids. The robustness of the literature surrounding these techniques is variable, but when an athlete is desperate to return to full training, clinicians working with elite athletes are often tempted to utilise more empirical management options. We present a patient who illustrates the potential dangers of injection therapy in the elite athlete, in particular sequential injection therapy involving vascular sclerosants, which to our knowledge has not previously been described. Written consent for the presentation of this case was obtained from the athlete concerned.

  13. Immunological characteristics of allogeneic tendon and achilles tendon after transplantation%异体肌腱及跟腱移植后移植物的免疫学特点

    Institute of Scientific and Technical Information of China (English)

    李敏; 王丽霞; 张瑞存

    2012-01-01

    BACKGROUND:Immune rejection of allogeneic transplantation is the most important issue for the successful transplantation.OBJECTIVE: To summarize the I mmunological characteristics of allogeneic tendon and achilles tendon transplantation for thetreatment of achilles tendon defects and cruciate ligament, respectively.METHODS: A computer-based research was conducted on the PubMed database and Wanfang database for the articles onallogeneic ahilles tendon transplantation or achilles tendon reconstruction published from January 1990 to January 2012. The keywords were “allograft, tendon, immunity, transplantation” in Chinese and English. A total of 83 articles were obtained.RESULTS AND CONCLUSION: The immune rejection of allogeneic tendon transplantation increased the risk of failure; however,the present studies have showed that deep-frozen processed allogeneic tendon is an ideal alternative material for the repair ofhuman tendon defects. It has the advantages of no normal tissue structure sacrifice and free from the individual constraints. Itcould ensure the success of the tendon transplantation and provide a reliable guarantee for the repair of achilles tendonre-rupture defects with the advantages of simple operation, small incision, less damage and reliable effects.%背景:异体移植的免疫排斥问题是移植能否成功的首要问题.目的:总结异体肌腱移植治疗跟腱缺损或异体跟腱移植治疗交叉韧带的免疫学特点.方法:应用计算机检索1990-01/2012-01 PubMed数据库及万方数据库有关异体跟腱移植或跟腱重建的相关文献.英文检索词"allograft,tendon,immunity,transplatation",中文检索词"异体,跟腱,移植,免疫".检索文献量总计83篇.结果与结论:腱组织的异体移植重建免疫排斥问题给手术增加了失败的危险性,但从目前研究来看经深低温冷冻处理的异体肌腱,是人体肌腱缺损修复的理想替代材料.它不以牺牲正常组织结构为代价,不受

  14. 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.

  15. Hoffmann reflex is increased after 14 days of daily repeated Achilles tendon vibration for the soleus but not for the gastrocnemii muscles.

    Science.gov (United States)

    Lapole, Thomas; Pérot, Chantal

    2012-02-01

    In a previous study, Achilles tendon vibrations were enough to improve the triceps surae (TS) activation capacities and also to slightly increase TS Hoffmann reflex (H-reflex) obtained by summing up soleus (Sol) and gastrocnemii (GM and GL) EMGs. The purpose of the present study was to analyze separately Sol and GM or GL reflexes to account for different effects of the vibrations on the reflex excitability of the slow soleus and of the gastrocnemii muscles. A control group (n = 13) and a vibration group (n = 16) were tested in pre-test and post-test conditions. The Achilles tendon vibration program consisted of 1 h of daily vibration (frequency: 50 Hz) applied during 14 days. Maximal Sol, GM and GL H-reflexes, and M-waves were recorded, and their H(max)/M(max) ratios gave the index of reflex excitability. After the vibration protocol, only Sol H(max)/M(max) was enhanced (p vibration is in favor of a decrease in the pre-synaptic inhibition due to the repeated vibrations and the high solicitation of the reflex pathway. Those results of a short period of vibration applied at rest may be limited to the soleus because of its high density in muscle spindles and slow motor units, both structures being very sensitive to vibrations.

  16. 改良膝降动脉为蒂大收肌腱骨皮瓣修跟复合组织缺损%Repair of Achilles tendon composite defect using osteocutaneous flap of adductor magnus tendon pedicled with

    Institute of Scientific and Technical Information of China (English)

    王海文; 顾荣; 江新明; 曾德庆; 江吉勇

    2011-01-01

    目的 探讨改良膝降动脉为蒂的大收肌腱骨皮瓣修复跟区跟腱复合组织缺损方法及效果.方法对3例外伤致足跟区跟腱止点伴跟骨及皮肤软组织缺损的患者,采用以膝降动脉为蒂的隐动脉穿支皮瓣修复跟区皮肤缺损,以膝降动脉关节支为蒂的大收肌腱骨瓣移植修复跟区复合组织缺损.其中跟区皮肤缺损面积为7 cm×9 cm~5 cm×7 cm,跟腱缺损长度为6~8 cm,切取皮瓣面积为8 cm×10cm~6 cm×8cm,大收肌腱切取长度为7~9cm.结果 3例复合组织瓣全部顺利成活,术后随访6~12个月,皮瓣感觉恢复S3-4,双足提踵试验及单足提踵试验均阴性,步态恢复均正常.结论应用隐动脉穿支设计皮瓣,皮瓣设计于大腿内侧,改良了隐动脉皮瓣设计于小腿内侧,造成切口过大,分离血管蒂较长等缺点,疗效可靠,是目前较理想修复方法.%Objective To evaluate clinical effects of osteocutaneous flap of adductor magnus tendon pedicled with descending genicular artery on repair of Achilles tendon composite defect. Methods Osteocutaneous flap of adductor magnus tendon pedicied with descending genicular artery were individually designed and surgically used on 3 Cases with traumatic Achilles tendon defects, combined with soft tissue and Calcaneal bone damage. The area of skin defect was ranged from 7 cmx9 cm to 5 Cm x7 cm, and the length of Achilles tendon defect was 6 - 8 cm. During the operation , the flaps was designed as ScmxlOcm to 6cmx 8cm, with the cutting length of the adductor magnus tendon 7~ 9 cm . Results: All 3 cases were followed-up for 6 to 12 months. The transplanted tissue flap survived well. The texture, appearance and function of the flap were excellent. Conclusions It is a ideal way to repair of Achilles tendon composite defect, using osteocutaneous flap of adductor magnus tendon pedicled with descending genicular artery, which avoiding the severe surgical trauma and the extended isolation of vessels.

  17. 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.

  18. Can Achilles tendon be used as a new distal landmark for coronal tibial component alignment in total knee replacement surgery? An observational MRI study

    Directory of Open Access Journals (Sweden)

    Tiftikçi U

    2017-01-01

    Full Text Available Uğur Tiftikçi,1 Sancar Serbest,1 Veysel Burulday2 1Department of Orthopaedics and Traumatology, 2Department of Radiology, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey Background: In total knee arthroplasty, it is better to use more than one reference point for correct alignment of the components. By measuring the distances of Achilles tendon (AT and other conventional landmarks from the mechanical axis in magnetic resonance imaging (MRI of the ankle, we aimed to demonstrate that, as a novel landmark which can help for correct alignment in the coronal plane, AT is a better option than other landmarks. Materials and methods: This retrospective study was done on 53 ankle MRIs that met the criteria for inclusion to the study among 158 ankle MRIs. After identification of the mechanical axis, the distances of distal landmarks, which were extensor hallucis longus tendon (EHLT, tibialis anterior tendon (TAT, dorsalis pedis artery (DPA, AT, extensor digitorum longus tendon (EDLT, and malleoli, were measured from the mechanical axis and were statistically evaluated. Results: In proximal measurements, the distances of the landmarks to the mechanical axis (on average were AT, 2.64±1.62 mm lateral; EHLT, 3.89±2.45 mm medial; DPA, 4.69±2.39 mm medial; TAT, 8.24±3.60 mm medial; and EDLT, 14.2±4.14 mm lateral (P<0.001. In distal measurements, the distances of the landmarks to the mechanical axis (on average were AT, 1.99±1.24 mm medial; EHLT, 4.27±2.49 mm medial; DPA, 4.79±2.10 mm medial; TAT, 12.9±4.07 mm medial; and EDLT, 12.18±4.17 mm lateral (P<0.001. Conclusion: In this study, the mechanical axis line, which is the center of talus, passes through the AT. Our MRI investigations showed that the AT, EHLT, DPA, and malleolar center (3–5 mm medial may help in correct alignment. Keywords: total knee arthroplasty, tibial component, alignment, distal references, landmark, MRI, Achilles tendon

  19. 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

    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....... The results indicated that the symptomatic leg was weaker (P eccentric rehabilitation. Additionally, the rehabilitation resulted in greater GU in both soleus (P ... within- or between-group differences. Eccentric rehabilitation was effective in decreasing subjective severity of Achilles tendinopathy. It also resulted in redistribution of relative electrical activity, but not metabolic activity, within the triceps surae muscle....

  20. 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

  1. Computed tomography angiography and magnetic resonance imaging performance of acute segmental single compartment syndrome following an Achilles tendon repair: A case report and literature review

    Institute of Scientific and Technical Information of China (English)

    Li-Feng Jiang; Hang Li; Zeng-Feng Xin; Li-Dong Wu

    2016-01-01

    Acute compartment syndrome of the lower extremity is a serious postinjury complication that requires emergency treatment.Early diagnosis is of paramount importance for a good outcome.Four muscle compartments in the calf (anterior,lateral,deep posterior,and superficial posterior) may be individually or collectively affected.Acute segmental single-compartment syndrome is an extremely rare condition characterized by high pressure in a single compartment space with threatening of the segmental tissue viability.In this case report,we describe a young man with Achilles tendon rupture who complained of postoperative pain in the anterior tibial region.Emergent computed tomography angiography and magnetic resonance imaging revealed local muscle edema.Segmental anterior compartment syndrome was diagnosed and fasciotomy was performed.

  2. Interaction between gastrocnemius medialis fascicle and Achilles tendon compliance: a new insight on the quick-release method.

    Science.gov (United States)

    Farcy, Stevy; Nordez, Antoine; Dorel, Sylvain; Hauraix, Hugo; Portero, Pierre; Rabita, Giuseppe

    2014-02-01

    The insufficient temporal resolution of imaging devices has made the analysis of very fast movements, such as those required to measure active muscle-tendon unit stiffness, difficult. Thus the relative contributions of tendon, aponeurosis, and fascicle to muscle-tendon unit compliance remain to be determined. The present study analyzed the dynamic interactions of fascicle, tendon, and aponeurosis in human gastrocnemius medialis during the first milliseconds of an ankle quick-release movement, using high-frame-rate ultrasonography (2,000 frames/s). Nine subjects performed the tests in random order at six levels of maximal voluntary contraction (MVC) (30% to 80% of MVC). These tests were carried out with the ultrasound probe placed on the muscle belly and on the myotendinous junction. Tendon, muscle fascicle, and aponeurosis length changes were quantified in relation to shortening of the muscle-tendon unit during the first few milliseconds following the release. The tendon was the main contributor (around 72%) to the shortening of the muscle-tendon unit, whereas the muscle fascicle and aponeurosis contributions were 18% and 10%, respectively. Because these structures can be considered in series, the quantified contributions can be regarded as relative contributions to muscle-tendon compliance. These contributions were not modified with the level of MVC or the time range used for the analysis between 10 and 25 ms. The constant contribution of tendon, muscle fascicle, and aponeurosis to muscle-tendon unit compliance may help to simplify the mechanism of compliance regulation and to maintain the important role of tendons in enhancing work output and movement efficiency.

  3. Can Achilles tendon be used as a new distal landmark for coronal tibial component alignment in total knee replacement surgery? An observational MRI study

    Science.gov (United States)

    Tiftikçi, Uğur; Serbest, Sancar; Burulday, Veysel

    2017-01-01

    Background In total knee arthroplasty, it is better to use more than one reference point for correct alignment of the components. By measuring the distances of Achilles tendon (AT) and other conventional landmarks from the mechanical axis in magnetic resonance imaging (MRI) of the ankle, we aimed to demonstrate that, as a novel landmark which can help for correct alignment in the coronal plane, AT is a better option than other landmarks. Materials and methods This retrospective study was done on 53 ankle MRIs that met the criteria for inclusion to the study among 158 ankle MRIs. After identification of the mechanical axis, the distances of distal landmarks, which were extensor hallucis longus tendon (EHLT), tibialis anterior tendon (TAT), dorsalis pedis artery (DPA), AT, extensor digitorum longus tendon (EDLT), and malleoli, were measured from the mechanical axis and were statistically evaluated. Results In proximal measurements, the distances of the landmarks to the mechanical axis (on average) were AT, 2.64±1.62 mm lateral; EHLT, 3.89±2.45 mm medial; DPA, 4.69±2.39 mm medial; TAT, 8.24±3.60 mm medial; and EDLT, 14.2±4.14 mm lateral (P<0.001). In distal measurements, the distances of the landmarks to the mechanical axis (on average) were AT, 1.99±1.24 mm medial; EHLT, 4.27±2.49 mm medial; DPA, 4.79±2.10 mm medial; TAT, 12.9±4.07 mm medial; and EDLT, 12.18±4.17 mm lateral (P<0.001). Conclusion In this study, the mechanical axis line, which is the center of talus, passes through the AT. Our MRI investigations showed that the AT, EHLT, DPA, and malleolar center (3–5 mm medial) may help in correct alignment. PMID:28144149

  4. 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

    tissue modulus (P collagen III and insulin-like growth factor I...... was increased, while collagen I was unchanged, and decreases were seen in noncollagen matrix components (fibromodulin and biglycan), matrix degrading enzymes, transforming growth factor-ß1, and connective tissue growth factor. In conclusion, the tested model could not be validated as a model for Achilles...

  5. 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

  6. Predicting tenocyte expression profiles and average molecular concentrations in Achilles tendon ECM from tissue strain and fiber damage.

    Science.gov (United States)

    Mehdizadeh, Arash; Gardiner, Bruce S; Lavagnino, Michael; Smith, David W

    2017-03-13

    In this study, we propose a method for quantitative prediction of changes in concentrations of a number of key signaling, structural and effector molecules within the extracellular matrix of tendon. To achieve this, we introduce the notion of elementary cell responses (ECRs). An ECR defines a normal reference secretion profile of a molecule by a tenocyte in response to the tenocyte's local strain. ECRs are then coupled with a model for mechanical damage of tendon collagen fibers at different straining conditions of tendon and then scaled up to the tendon tissue level for comparison with experimental observations. Specifically, our model predicts relative changes in ECM concentrations of transforming growth factor beta, interleukin 1 beta, collagen type I, glycosaminoglycan, matrix metalloproteinase 1 and a disintegrin and metalloproteinase with thrombospondin motifs 5, with respect to tendon straining conditions that are consistent with the observations in the literature. In good agreement with a number of in vivo and in vitro observations, the model provides a logical and parsimonious explanation for how excessive mechanical loading of tendon can lead to under-stimulation of tenocytes and a degenerative tissue profile, which may well have bearing on a better understanding of tendon homeostasis and the origin of some tendinopathies.

  7. Green Tea and Glycine Modulate the Activity of Metalloproteinases and Collagen in the Tendinitis of the Myotendinous Junction of the Achilles Tendon.

    Science.gov (United States)

    Vieira, Cristiano Pedrozo; De Oliveira, LetÍCia Prado; Da Ré Guerra, Flávia; Marcondes, Maria Cristina Cintra; Pimentel, Edson Rosa

    2016-07-01

    The myotendinous junction (MTJ) is the weakest element in the muscle-tendon unit of the heel, and thus the most susceptible to injuries. The scarcity of adequate treatments means that tendinitis is a major concern to athletes and other groups who depend on their physical fitness, although green tea and glycine have both been shown to have beneficial effects on the inflammation. The present study investigated the remodeling effects of green tea and glycine in the MTJ of rats with tendinitis. For this, male Wistar rats were divided into five groups: animals without tendinitis and animals with tendinitis; animals with tendinitis supplied with green tea; animals with tendinitis supplied with a glycine diet; animals with tendinitis supplied with a green tea and glycine diet. Tendinitis was induced and the treatment with green tea (700 mg/kg/day) and a 5% glycine diet lasted 7 days. The treatments regulated the activity of metalloproteinases (MMP)-2, -8, and -9, and induced the synthesis of type I collagen, glycosaminoglycans, and non-collagenous proteins. Changes were also noted in the compaction of the collagen molecules and the amount of tenocytes. When combined, green tea and glycine modulated the inflammatory process and induced the synthesis of the elements involved in the post-lesion recovery of the tissue. The data from the MTJ were different when compared with results already published using the whole Achilles tendon. These data indicate that each region of the inflamed tendon can exhibit different responses during the treatment and therefore, modify its extracellular matrix components to facilitate recovery and repair. Anat Rec, 299:918-928, 2016. © 2016 Wiley Periodicals, Inc.

  8. Fluoroquinolone-induced Achilles tendinitis.

    Science.gov (United States)

    Tam, P K; Ho, Carmen T K

    2014-12-01

    We report a case of Achilles tendinitis after intake of ciprofloxacin for treatment of respiratory tract infection. Fluoroquinolone-induced tendinopathy is an uncommon but increasingly recognised adverse effect of this antibiotic class. Most of the cases occur in the Achilles tendon and may lead to tendon rupture. Possible predisposing risk factors include use of steroid, patients with renal impairment or renal transplant, old age, and being an athlete. The drug should be stopped once this condition is suspected. Symptomatic treatment should be given and orthopaedic referral is desirable if tendon rupture occurs.

  9. Application of Gastrocnemius Aponeurosis Subvolution for the Reconstruction of the Old Achilles Tendon Rupture%腓肠肌腱膜翻转术在陈旧性跟腱断裂中的应用

    Institute of Scientific and Technical Information of China (English)

    李长民; 丁继龙; 许义方; 冯计富

    2011-01-01

    Objective To investigate the effects of gastrocnemius aponeurosis subvolution for repairing the old Achilles tendon. Methods 18 cases of old Achilles tendon rupture were repaired by gastrocnemius aponeurosis subvolution. An 8 ~ 10cm long and 3 cm wide gastrocnemius fascia flap pedicle was cut with fun-dus remaining 1.5 - 2cm above the broken ends of the Achilles tendon in the middle leg. In the center of the Achilles tendon, a vertical incision was made for the gastrocnemius fascia flap to be pulled through. And then the flap folded down on both sides around the Achilles tendon to the proximal and distal ends and the defects. Then the Achilles tendon was rebuilt by the Bunnell wire method with the ankle plantar flexion of about 20°. Results There were 3 cases suffered from the delayed healing, but no skin incision or tendon necrosis, no deep infection or further fracture case. All cases were followed up for 24 ~ 40 months, with an average of 26 months. According to the Amer-lindholms evaluation criteria, 13 got excellent results and 5 good. Conclusion It is a good method of the gastrocnemius aponeurosis subvolution for treating the old Achilles tendon rupture with advantages of simple manipulation, firm fixation, high union rate and low complications.%目的 探讨应用腓肠肌腱膜翻转法治疗陈旧性跟腱断裂的疗效.方法 对18例陈旧性跟腱断裂患者应用腓肠肌腱膜翻转术重建跟腱.术中于小腿中部腓肠肌腱膜-肌移行处切取一条长8~ l0 cm、宽3 cm带蒂腓肠肌筋膜瓣,其基底留在离断端上方约1.5~2 cm处,于蒂上方跟腱中心作一纵切口,把腱膜瓣从此切口中穿过,再反折向下,由跟腱两侧向浅面包绕跟腱远近端及其缺损.自跟骨结节撕脱者将跟骨结节咬成粗糙面,腱膜条拉紧,根据缺损长度修剪腱膜条远端,使之与跟骨结节相接触.然后用Bunnell抽出钢丝法将重建跟腱拉紧,使踝关节跖屈约20°.结果 本组有3例切口延迟愈

  10. Surgical treatment for hemophilia induced contracture of Achilles tendon%血友病性跟腱挛缩症的外科治疗

    Institute of Scientific and Technical Information of China (English)

    高鹏; 翁习生; 钱文伟; 李晔; 陈峰; 范彧

    2014-01-01

    背景:血友病性跟腱挛缩症是血友病的常见下肢合并症,可导致下肢不等长、活动受限等症状。在全面的围手术期凝血因子替代治疗下手术矫正跟腱挛缩可极大改善患者的生活质量。  目的:探讨外科治疗血友病性跟腱挛缩症的围术期处理方法、术式选择及疗效。  方法:回顾性分析1998年6月至2014年2月收治的血友病性跟腱挛缩患者15例(15足),均为男性;年龄18~41岁,平均24.6岁;左侧7例,右侧8例。其中甲型血友病11例,乙型血友病4例。病程11~84个月,平均30.2个月。术前根据美国矫形足踝协会(AOFAS)评分为(41.2±20.1)分,简明健康调查量表(SF-36量表)评分总分为(41.4±17.7)分。入院后行凝血因子预试验,制定围术期凝血因子替代治疗方案,均行跟腱Z型延长术。  结果:手术时间55~75 min,平均61 min;术中使用止血带,出血量均<20 ml,围术期均未输异体血。术后14例手术切口Ⅰ期愈合,1例伤口裂开,经换药后3周愈合。术后无感染、下肢深静脉血栓形成、神经损伤等并发症发生。患者均获得随访,随访时间为6个月~15年5个月,平均21个月。术后3个月及6个月随访时,AOFAS评分分别为(77.8±16.7)分和(79.8±12.5)分,SF-36量表评分分别为(73.6±13.8)分和(77.7±11.2)分,与术前相比均有统计学差异(P<0.05);术后3个月与术后6个月比较均无统计学差异(P>0.05)。  结论:手术治疗可以纠正血友病性跟腱挛缩患者的马蹄足畸形,改善足部负重及行走功能。术前行凝血因子预试验、围手术期行凝血因子替代治疗可降低术后大出血的发生率。%Background:Contracture of Achilles tendon is one of the common complications of hemophilia. It may result in leg length discrepancy and limitation of motion. The quality of life can effectively be

  11. 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.

  12. 肌肉包埋法旷置大段裸露跟腱的初步报告%Muscle embedment spacer for large segmental exposed Achilles tendon: a preliminary report

    Institute of Scientific and Technical Information of China (English)

    王永会; 毕建耀; 孙占胜; 王伯珉

    2009-01-01

    Objective to access the therapeutic methods and results of muscle embedment spac-er for large segemental exposed achilles tendon. Methods There were 21 patients diagnosed as Achil-les tendon rupture combined with local cutaneous deficiency, of whom 16 patients were combined with comminuted tibial fractures and artery and nerve injury, 13 combined with shock, six combined with pel-vic fractures, two combined with open homolateral femoral fractures and three combined with hepatorrhexis and splenic rupture. All patients received fracture fixation and treatment for vascular and nural injuries, hepatorrhexis and splenic rupture. The ruptured Achilles tendons were embedded in the triceps surae muscle at one stage. The Achilles tendons and cutaneous deficiency were repaired at second stage. Re-suits The embedded Achilles tendons assumed a relatively fresh and tramosericeous adventitious coat and retained good tenacity, with no signs of necrosis, colliquation or infection. The follow-up time after second operation was 15-27 months (average 18 months), which showed excellent results in 15 patients, good in four and poor in two, with excellence rate of 90%. All skin flaps and residual wounds were pri-marily healed and no repaired Achilles tendons disrupted again. Conclusion The muscle embedment spacer method can largely avoid the ischemic necrosis of Achilles tendon due to long time exposure and hence provide adequate conditions for second stage operation.%目的 探讨肌肉包埋法旷置大段裸露跟腱的手术方法和疗效.方法 本组21例跟腱断裂合并跟区皮肤缺损,16例合并胫腓骨粉碎骨折及动脉、神经损伤,13例合并休克,6例合并骨盆骨折,2例合并同侧开放性股骨骨折,3例合并肝脾破裂.急诊手术固定骨折,修复动脉、神经损伤,修复肝脾破裂;清创后小腿三头肌包埋、旷置跟腱.二次手术修复跟腱和跟区皮肤缺损.结果 跟腱与肌肉组织紧密粘连,外膜新鲜有光泽,腱性组

  13. Treatment of achilles tendon contracture in 23 cases using Ilizarov and needle-knife technology%小针刀联合Ilizarov踝关节牵引器治疗跟腱挛缩23例

    Institute of Scientific and Technical Information of China (English)

    冷元曦; 支乐; 邓晖; 夏启水; 李强; 周雄

    2015-01-01

    目的 探讨小针刀联合Ilizarov踝关节牵引器治疗跟腱挛缩的疗效. 方法 我院2010年5月~2014年5月共收治符合条件的跟腱挛缩症患者23例.所有患者术前均测量被动背伸角度及Hannover跟腱评分,术中用小针刀联合Ilizarov踝关节牵引器治疗,术中先安装Ilizarov跨踝关节牵引器,然后用小针刀在跟腱不同平面切割1~4次,同时调整牵伸杆,直至踝关节达到中立位,8周后拆除牵引架. 术后随访4~8个月. 结果 末次随访测量踝关节被动背伸位角度(跖屈用负数表示):于背伸位0°~10°者12例,-4°~0°者6例,-8°~-5°者5例,平均背伸(5.83± 0.43)°,与术前比较,差异有统计学意义(P<0.05);术后Hannover跟腱评分为(87.2±5.6)分,与术前比较,差异有统计学意义(P<0.05);所有患者均未出现神经血管损伤及皮肤破损的并发症. 结论 小针刀联合Ilizarov踝关节牵引器治疗跟腱挛缩效果确切,软组织损伤小,能避免开放性跟腱延长术可能并发的创口不易愈合.%Objective To explore the effectiveness of needle-knife and Ilizarov technology used clinically in achilles tendon lengthening in the treatment of achilles contracture syndrome. Methods From May 2010 to May 2014,23 cases of achilles contracture syndrome got treated and clinically observed retrospectively.Needle-knife and Ilizarov technolo-gy,as a possible new method of mini-incision achilles tendon lengthening surgery,were synergistically used in all cas-es above.Ilizarov tractors over ankle were installed in the forefoot and calfs,then,using needle-knife 1 to 4 times, achilles tendon were cut in the different planes,synchronously,ankle was gradually adjusted to the neutral position by adjusting the metal threaded rod,8 weeks after surgery,the traction frames were dismantled.All patients were followed up for 4 to 8 months. Results The passive ankle dorsiflexion angles were measured in all patients at last follow-up.While 5 cases'ankle jiont were

  14. 局部注射肝素钠免跟腱系统生物力学性质的变化%Effects of heparin with local injection on the biomechanical properties of Achilles tendon system in rabbits

    Institute of Scientific and Technical Information of China (English)

    刘波

    2008-01-01

    背景: 跟腱腱围炎会导致跟腱生物力学特件的改变,日前以局部注射肝素钠治疗较为普遍,但其对跟腱生物力学特性影响的报道甚少.目的: 观察跟腱劳损后生物力学性质及黏弹性的变化,同时验证肝素钠对跟腱生物力学特性及黏弹性的影响.设计、时间及地点: 于2005-03/12存四川省骨科医院生物力学实验室完成随机对照动物实验.材料: 50只成年日本大耳白兔,体质量(4.10±0.23)kg,用于制备跟腱劳损动物模型.方法: 50只动物随机分为对照组(n=20)、训练组(n=12)和肝素钠组(n=18).动物3周运动训练后继续训练,同时开始跟腱腱围及跟腱止点的肝素局部注射,2次/周.6周后进行跟腱的循环蠕变和应力松弛测定,最后进行跟腱的断裂实验.主要观察指标: 测定不同运动后跟腱的生物力学特性及黏弹性的变化,包括跟腱的横截面积、循环蠕变、滞后环、应力松弛、强度特性和应力-应变.结果: 训练组和肝素钠组动物的滞后环明显减小,应力松弛加快.训练后跟腱的屈服载荷及能量、断裂能量、屈服应力、应变能力明显高于对照组.肝素钠组所有生物力学指标都得到改善.结论: 大强度运动可使跟腱的黏弹性下降,局部注射肝素钠可改善跟腱的强度特性和黏弹性.劳损后跟腱腱围和跟腱止点局部注射肝素钠对改善跟腱系统的强度特性和黏弹性有益.%BACKGROUND: Achilles peritendinitis can change characteristics of mechanical and viscoelastic properties in Achilles tendon, especially the biomechanical properties of Achilles tendon after heparin local injection. OBJECTIVE: To examine the changes of mechanical and viscoelastic properties in Achilles tendon of overuse injuries and the effects of heparin on the mechanical and viscoelastic properties in Achilles tendon. DESIGN, TIME AND SETTIMG: Control animal specimen study was performed at the Biomechanical Laboratory of

  15. Effect of Fire-needle Therapy on the Expressions of IL-6 and iNOS in Achilles Tendon Insertion of Rats with Achilles Tendon Enthesiopathy%火针治疗对跟腱末端病大鼠跟腱止点组织IL-6与iNOS表达的影响

    Institute of Scientific and Technical Information of China (English)

    史清钊; 方小芳; 周军; 郭佳佳

    2011-01-01

    纤维软骨区和治疗5组腱骨关节面IL-6阳性细胞数显著低于其各自对照组(P<0.05).(3)对照1、2、3、4、5组和治疗4、5组跟腱、纤维软骨区、钙化软骨区和腱骨关节面软骨中的iNOS阳性细胞数显著高于安静对照组(P<0.01,P<0.05);对照1、2、3组跟骨骨髓区iNOS阳性细胞数显著高于安静对照组(P<0.05).治疗4、5组跟腱区和治疗5组腱骨关节面iNOS阳性细胞数显著低于其各自对照组(P<0.05).结论:采用电击跳跃法成功建立大鼠跟腱末端病模型.火针治疗在一定程度上可降低跟腱末端病大鼠跟腱、纤维软骨区、腱骨关节面软骨区IL-6、iNOS阳性细胞表达的升高,但短时间内作用有限.%Objective To probe into the effect of fire-needle therapy on the 6 - IL and iNOS positive cells expressions in the Achilles tendon insertion of rats with Achilles tendon enthesiopathy. Methods Eighty eight l-month old male SD rats are divided into normal group (C, n = 8) and model group (M,n = 80) at random. Rats in group M were forced to jump using electric stimulation with gradually increasing voltage once a day, 6 days per week, for a total of 8 weeks; The jumping duration was 50 min with 10 min of resting interval. After 8-week jumping, rats in group M were regrouped randomly into 1-puncture treatment per day groups (1P) and their corresponding control groups; and 4--puncture treatment per day group (4P) and their corresponding control groups. Sampling started at day 1, day 2, day 3, and day 4 respectively after puncture for groups 1P; And at day 2 after punctures for group 4P. Sampling was performed at day 1 for control group. Morphological structure (stained with HE) and the expression changes in IL-6 and iNOS positive cells of Achilles tendon and its insertion of rat right rear foot was observed. Results ( 1 ) As compared with normal control group, typical enthesiopathy appeared in group M. (2) IL-6, iNOS positive cells mainly appeared in achilles tendon, fibro cartilage

  16. 儿童复杂跟腱缺损的修复重建%Repair of Complex Achilles Tendon Defect in Children

    Institute of Scientific and Technical Information of China (English)

    王季; 蔡锦方; 王建超; 李宗玉; 曹学成; 张继党

    2016-01-01

    Objective To observe the clinical effect of peroneal artery perforator flap combined gastrocnemius aponeurosis on repairing complex Achilles tendon defect in Children. Methods Between October 2009and December 2014,12 cases of complex Achilles tendon defects in children were repaired with peroneal artery perforator flap combined gastrocnemius aponeu-rosis. 5 cases were fresh injury,7 cases were old defects. The size of the wounds ranged from 22 cm2 to 64 cm2 . The length of tendon defect ranged from 3. 5 cm to 7. 0 cm. The clinical outcome was evaluated by Ankle joint dynamic degree,AOFAS score and SF36 score before and after operation. Results 8 cases were primary healed. 2 cases with skin necrosis and 2 cases with donor site necrosis. 1 cases experience recurrent infection. The plantar extension at 1 year was significantly better than that at 3 months after operation and pre-operation. The dorsal extension at 1 year was significantly better than that at 3 months after op-eration,but no significant difference was found between at 1 year and pre-operation. The AOFAS score and SF36 score at 1 year after operation were significantly larger than those at 3 months after operation and pre-operation. Conclusion Peroneal artery perforator flap with gastrocnemius aponeurosis is an ideal repair method in repairing complex achilles tendon defect in Chil-dren.%目的:了解应用带腓肠肌腱膜的腓动脉穿支皮瓣修复儿童复杂跟腱缺损的效果。方法2009年10月至2014年12月收治儿童复杂跟腱缺损12例,采用带腓肠肌腱膜的腓动脉穿支皮瓣进行修复。其中男7例,女5例;年龄3~13岁。车辆轮辐伤8例,砸伤2例,挤压伤1例,交通事故伤1例。5例为新鲜缺损,7例为陈旧性缺损。皮肤缺损范围22~64 cm2,跟腱缺损长度3.5~7.0 cm。统计手术前后踝关节动度、AOFAS 评分、SF36评分,对疗效进行评价。结果一期愈合8例,皮瓣表皮坏死2例,皮瓣远端坏死1

  17. Achilles Impingement Tendinopathy on Magnetic Resonance Imaging.

    Science.gov (United States)

    Bullock, Mark J; Mourelatos, Jan; Mar, Alice

    2017-02-28

    Haglund's syndrome is impingement of the retrocalcaneal bursa and Achilles tendon caused by a prominence of the posterosuperior calcaneus. Radiographic measurements are not sensitive or specific for diagnosing Haglund's deformity. Localization of a bone deformity and tendinopathy in the same sagittal section of a magnetic resonance imaging scan can assist with the diagnosis in equivocal cases. The aim of the present cross-sectional study was to determine the prevalence of Haglund's syndrome in patients presenting with Achilles tendinopathy and note any associated findings to determine the criteria for a diagnosis of Haglund's syndrome. We reviewed 40 magnetic resonance imaging scans with Achilles tendinopathy and 19 magnetic resonance imaging scans with Achilles high-grade tears and/or ruptures. Achilles tendinopathy was often in close proximity to the superior aspect of the calcaneal tuberosity, consistent with impingement (67.5%). Patients with Achilles impingement tendinopathy were more often female (p < .04) and were significantly heavier than patients presenting with noninsertional Achilles tendinopathy (p = .014) or Achilles tendon rupture (p = .010). Impingement tendinopathy occurred medially (8 of 20) and centrally (10 of 20) more often than laterally (2 of 20) and was associated with a posterior prominence or hyperconvexity with a loss of calcaneal recess more often than a superior projection (22 of 27 versus 8 of 27; p < .001). Haglund's deformity should be reserved for defining a posterior prominence or hyperconvexity with loss of calcaneal recess because this corresponds with impingement. Achilles impingement tendinopathy might be more appropriate terminology for Haglund's syndrome, because the bone deformity is often subtle. Of the 27 images with Achilles impingement tendinopathy, 10 (37.0%) extended to a location prone to Achilles tendon rupture. Given these findings, insertional and noninsertional Achilles tendinopathy are not mutually

  18. 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....

  19. 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.

  20. Open Achilles tendon defects:reconstructive surgeries and long term follow-up%开放性跟腱缺损一期重建的远期随访

    Institute of Scientific and Technical Information of China (English)

    朱跃良; 徐永清; 王家祥; 殷作明; 张西正; 吕乾; 浦绍全; 吴一芃; 赵泽雨

    2016-01-01

    Objective To explore the reconstructive surgeries for open Achilles tendon defects and their long term outcomes.Methods A retrospective review was performed on 31 patients with open Achilles tendon defects treated at our center.There were 19 males and 12 females with an average age of 23.1 years (range,4-55 years).There were 7 cases on left side and 24 on right.The injury causes included spoke injuries (18 cases),crash injuries (6 cases),machine injuries (6 cases),and cut injuries (1 case).The defect lengths of the Achilles tendons in the study ranged from 1 to 1 1cm and the soft tissue defects ranged from 3 cm×3 cm to 12 cm× 10 cm.There were 10 cases with calcaneus fractures.Surgeries for Achilles tendon defects included sliding the Achilles tendon stump down with the sliding gastrocnemius musculocutaneous flap (15 cases),suture at the plantar flexion (10 cases),tendon flap turndown (1 case),hamstring tendon autograft (1 case),fascia lata muscle reconstruction (1 case) and tendon allograft (3 cases).Free flaps (7 cases) and non-free flaps (24 cases) were used for the coverage of concomitant skin defects.The calcaneus fractures were fixed with screws (6 cases) or K-wires (4 cases).The treatment protocols were based on the defect length of the Achilles tendon.Results The follow up period was 1-6 years (average,1.8 years).There was no total flap failure or tendon re -rupture,while 7 cases who had partial flap loss 2-4 days after the surgeries.In the latest follow-up,all the cases had regained full walking abilities:19 cases (61.3%,19/31) even had regained the heel raising by the reconstructed foot while 12 cases (38.7%) cannot.Compared with the contralateral side,31 cases' (100.0%)reconstructed ankles had the maximum plantar flexion,while 21 cases (67.7%) had the maximum dorsal extention.Ten cases (32.2%) lost their maximum dorsal extension ranging from 5° to 25°.Conclusion There are many reconstructive surgeries available for open Achilles tendon

  1. 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.

  2. Investigation into the cyto-protective and wound healing properties of cryptic peptides from bovine Achilles tendon collagen.

    Science.gov (United States)

    Banerjee, Pradipta; Mehta, Alka; Shanthi, C

    2014-03-25

    Many proteins have concealed regions in their amino acid sequences that when liberated or exposed by conformational changes can exhibit bioactivity. Two such cryptic bioactive peptides, C2 (with cell adhesive properties) and E1 (with cell adhesive and antioxidant properties) have been isolated from bovine tendon collagen. This investigation deals with the efficacy of these peptides in countering externally generated stress and imparting cyto-protection in mammalian cell systems. The cell survival activity was studied with two cell lines, viz., HeLa and Vero, with varying concentrations of five oxidative stress-generating agents. The activities of the peptides in supporting cell adhesion and countering stress were determined in their coated and dissolved forms. C2 and E1 coated dishes registered 8 times (poxidative stress than collagen coated dishes. E1 increased stress tolerance levels by >100 times in dissolved form and C2, by 8 times in coated form. The peptides supported faster wound closure than collagen under normal as well as stressed condition. Maximum stress tolerance was observed on C2 coated dishes in the presence of E1 in the medium suggesting that both enhanced cell adhesion and antioxidative activities significantly contribute to the cell survival during stress. The present study emphasizes that collagen peptides, apart from providing a suitable surface for cell adhesion, also confer protection to cells against oxidative stress.

  3. Mini-invasive surgical treatment of acute Achilles tendon rupture by Achillon%急性闭合性跟腱断裂的微创手术治疗

    Institute of Scientific and Technical Information of China (English)

    徐海林; 王天兵; 党育; 芦浩; 姜保国

    2012-01-01

    目的 探讨采用Achillon行微创缝合治疗急性跟腱断裂的临床疗效. 方法 2010年12月至2011年5月收治7例7足急性跟腱断裂患者,男5例,女2例;年龄21~53岁,平均34 2岁.均为闭合性损伤,受伤至手术时间为1~11 d,平均3.8d.手术切口在跟腱断裂处内侧行2.0~3.5 cm长切口,以Achillon插入行微创手术缝合跟腱断端.术后康复锻炼.结果 所有患者伤口均获Ⅰ期愈合,所有患者获5~11个月(平均7.2个月)随访.术后3个月时患者均正常下地负重,无再发跟腱断裂,美国足踝外科协会(AOFAS)踝与后足评分93.2分,患处疼痛的视觉模拟评分为1.2分.结论 对急性跟腱断裂采用Achillon行微创手术缝合具有损伤小,并发症少,恢复快等优点,是跟腱修复方法的较好选择.%Objective To evaluate the clinical efficacy of Achillon,a novel guide for Achilles tendon suture produced by Newdeal Ltd in France,in the mini-invasive surgical treatment of acute Achilles tendon rupture. Methods Between December 2010 and March 2011,7 patients (7 feet) with acute Achilles tendon rupture were treated in our department.They were 5 males (5 feet) and 2 females (2 feet),with an average age of 34.2 years (range,21 to 53 years).The interval between injury and operation ranged from 1 to 11 days(3.8 days on average).A longitudinal incision approximately 2.0-3.5 cm in length was made around the ruptured Achilles tendon for minimally invasive repair after insertion of the Achillon.Postoperative rehabilitation was carried out. Results All the wounds healed at the first stage.All patients were followed up for 5 to 11 months, with an average of 7.2 months. All patients regained normal weight-bearing walking 3 months after operation without any re-rupture. According to the ankle-hindfoot scoring system of American Orthopaedic Foot and Ankle Society (AOFAS),they scored 93.2 points.By the visual analogue scale (VAS),they scored 1.2 points at the operation site

  4. Management of chronic Achilles tendinopathy.

    Science.gov (United States)

    2012-08-01

    Tendons transmit force between muscles and bones and, when stretched, store elastic energy that contributes to movement.(1) The tendinous portion of the gastrocnemius and soleus muscles merge to form the Achilles tendon, which is the largest and strongest in the body, but one of the most frequently injured.(2,3) Conservative management options for chronic Achilles tendinopathy include eccentric (lengthening) exercises, extracorporeal shockwave therapy (ESWT), topical nitroglycerin, low level laser therapy, orthoses, splints or injections (e.g. corticosteroids, hyperosmolar dextrose, polidocanol, platelet-rich plasma), while a minority of patients require surgery (using open, percutaneous or endoscopic methods).(4-8) Here we assess the management options for patients with chronic Achilles tendinopathy (lasting over 6 weeks).

  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. 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.

  7. 带线锚钉Krackow缝合法修复急性跟腱断裂临床研究%Depuy ditck quick anchor with Krackow repair for acute Achilles tendon rupture

    Institute of Scientific and Technical Information of China (English)

    徐海栋; 陈勇; 卢俊浩; 赵建宁

    2013-01-01

    Objective Acute Achilles tendon rupture is a common tendon injury. This stud)' was to investigate the clinical effect of depuy mitck quick anchor (GⅡ) with Krackow repair in the treatment acute Achilles tendon rupture. Methods Between November 2009 and May 2011, 30 patients with acute Achilles tendon rupture averaging 3. 0 cm from the fracture plane to the check point underwent GⅡ with Krackow repair(group A) and Krackow repair alone (group B), respectively, on a voluntary basis. Postoperative plaster cast immobilization of the cms lasted 6 weeks, followed by functional training. Results The patients were followed up for 12 -18 (mean 14) months. Within 6 months after surgery, the American Orthopedic Foot and Ankle Society (AOFAS) rating score was significantly higher in group A than in B (P<0.05), and so was the patients' satisfaction at 12 months after operation (P<0.05). Conclusion GⅡ with Krackow repair has sure positive effects in the treatment of acute Achilles tendon rupture, with its advantages of simple operation, reliable tendon repair and ankle function protection.%目的 急性跟腱断裂是常见的肌腱损伤,带线锚钉较传统修复方法具有简化手术操作、生物力学性能较优的特点.评估带线锚钉Krackow缝合法修复急性跟腱断裂临床疗效.方法 2009年11月至2011年5月,共收治急性新鲜跟腱断裂患者30例,断裂平面距离止点平均3.0cm,随机分为带线锚钉Krackow缝合法修复手术组和单纯Krackow缝合法修复手术组.术后小腿石膏固定6周,后期进行功能训练,进行临床疗效随访对比研究.结果 所有患者均获得随访,平均随访时间14个月,术后6个月内美国足踝外科功能评分带线锚钉Krackow缝合法修复手术组较单纯Krackow缝合法修复手术组高,2组差异有统计学意义(P<0.05),术后早期(术后1年)患者满意率前者也较优(P<0.05).结论 带线锚钉Krackow缝合法修复急性跟腱断裂临床疗效肯定,具有肌

  8. 19例异体跟腱关节镜下重建膝后交叉韧带临床分析%Posterior cruciate ligament reconstruction with allogenic achilles tendon under arthroscopy in 19 cases

    Institute of Scientific and Technical Information of China (English)

    孙英华; 王莉; 范晓华; 焦兆德

    2009-01-01

    目的 探讨关节镜下应用同种异体跟腱重建膝后交叉韧带(PCL)的方法及疗效.方法 回顾2004年1月至2008年1月在关节镜下应用同种异体跟腱重建PCL 19例,术中切取标准化的柱状跟骨,确保移植物在股骨及胫骨骨道内紧密固定,术前及术后12个月时用Lysholm评分评定膝关节功能.结果 随访19例患者术前平均评分61分(54~69分),术后12个月时92分(76~95分),总优良率89%.结论 关节镜下应用同种异体跟腱重建PCL可有效改善膝关节稳定性.术中股骨及胫骨骨道精确定位、术后系统康复治疗是确保手术疗效的关键.%Objective To evaluate the method and its effect of posterior cruciate ligament (PCL) reconstruction with allogenic achilles tendon under arthroscopy.Methods We reviewed ninteen patients who were underwent arthroscopic PCL reconstruction using the allogenic achilles tendon from January 2004 to January 2008.A special technique was allowed for the standardized harvest of cylindrical calcaneus bone,ensuring adequate press-fit fixation within the femoral and tibial tunnels,and the function of the knee joint was assessed according to the Lysholm score.Results Ninteen patients were followed up.Before operation,the mean Lysholm score was 61 points (54~69 points).Twelve months later after operation,the score was 92 points (76~95 points).The excellent and good results were obtained in 89%.Conclusion Our study indicates that arthroscopic PCL reconstruction with allogenic achilles tendon can effectively improve the stability of the knee joint.It is important to achieve favorable result that the precise position is taken in the femoral and tibial tunnels in operation,and systematic rehabilitation training is performed after operation.

  9. 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.

  10. Achilles tendinitis in ballet dancers.

    Science.gov (United States)

    Fernández-Palazzi, F; Rivas, S; Mujica, P

    1990-08-01

    Overuse injuries of tendons are known to occur in persons whose activities submit the tendon to excessive stress. Classical ballet dancers performing en pointe, demie point, or plié exert forces that, although normal in magnitude, are increased in frequency, thus overusing the Achilles tendon. In the present study all cases of Achilles tendinopathy seen in a period of three years in three ballet companies were reviewed by a special orthopedic clinic. The cause, whether by abnormal tension or incorrect use, development, and progression to chronic tendinopathy, as well as measures to prevent it, were analyzed in 19 cases. The methods of treatment, including conservative treatment with rest and refraining from dancing, local treatment such as ice and adhesive strapping, antiinflammatory drugs, local injections, thermotherapy, and laser therapy, were compared, and the time of recovery and ability to resume dancing were evaluated. Two cases required surgical treatment to subside, and the patients had to retire from professional dancing. The roentgenographic diagnosis of stage and progression of the tendinopathy is emphasized as a valuable accessory sign. The similarity in lesions between Achilles and patellar tendon problems was observed and confirmed.

  11. Functional reconstruction of complex tendo Achilles defect by free latissimus dorsi muscle flap

    Directory of Open Access Journals (Sweden)

    Divya N Upadhyaya

    2012-01-01

    Full Text Available Managing the complex tendo Achilles defect involves reconstructing the Achilles tendon as well as providing soft tissue cover to the heel area. The advent of microsurgery has revolutionised the reconstruction of this difficult defect providing a number of options to the reconstructive surgeon. We present a case of complex tendo Achilles defect reconstructed by the latissimus dorsi free flap.

  12. Repair of Chronic Achilles Ruptures Has a High Incidence of Venous Thromboembolism.

    Science.gov (United States)

    Bullock, Mark J; DeCarbo, William T; Hofbauer, Mark H; Thun, Joshua D

    2016-11-23

    Background Despite the low incidence of deep vein thrombosis (DVT) in foot and ankle surgery, some authors report a high incidence of symptomatic DVT following Achilles tendon rupture. The purpose of this study was to identify DVT risk factors inherent to Achilles tendon repair to determine which patients may benefit from prophylaxis. Methods One hundred and thirteen patient charts were reviewed following elective and nonelective Achilles tendon repair. For elective repair of insertional or noninsertional Achilles tendinopathy, parameters examined included lateral versus prone positioning and the presence versus absence of a flexor hallucis longus transfer. For nonelective repair, acute Achilles tendon ruptures were compared to chronic Achilles tendon ruptures. Results Of 113 Achilles tendon repairs, 3 venous thromboembolism (VTE) events (2.65%) occurred including 2 pulmonary emboli (1.77%). Seventeen of these repairs were chronic Achilles tendon ruptures, and all 3 VTE events (17.6%) occurred within this subgroup. Elevated body mass index was associated with VTE in patients with chronic Achilles ruptures although this did not reach significance (P = .064). No VTE events were reported after repair of 28 acute tendon ruptures or after 68 elective repairs of tendinopathy. Two patients with misdiagnosed partial Achilles tendon tears were excluded because they experienced a VTE event 3 weeks and 5 weeks after injury, prior to surgery. Conclusion In our retrospective review, chronic Achilles ruptures had a statistically significant higher incidence of VTE compared with acute Achilles ruptures (P = .048) or elective repair (P = .0069). Pharmaceutical anticoagulation may be considered for repair of chronic ruptures. Repair of acute ruptures and elective repair may not warrant routine prophylaxis due to a lower incidence of VTE.

  13. Achilles tendinitis

    Science.gov (United States)

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

  14. Infectious Achilles Tendinitis After Local Injection of Human Placental Extracts: A Case Report.

    Science.gov (United States)

    Kim, Yoon-Chung; Ahn, Jae Hoon; Kim, Man-Soo

    2015-01-01

    Local injections of corticosteroids or human placental extracts are sometimes used for the treatment of resistant tendinitis or fasciitis. We report a case of infectious Achilles tendinitis complicated by calcaneal osteomyelitis after injection of human placental extracts for the Achilles tendinitis. She was treated with excision of the infected bone and tendon, followed by V-Y lengthening of the proximal portion of the Achilles tendon in a single stage. At 2 years postoperative, she remained symptom free without any signs of recurrence, and the follow-up magnetic resonance imaging scan demonstrated a well-maintained Achilles tendon with normal signal intensity.

  15. 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

  16. Endoscopic posterior cruciate ligament reconstruction using achilles tendon allografts: single-bundle versus double-bundle%关节镜下异体跟腱单双束重建后交叉韧带的随机对照

    Institute of Scientific and Technical Information of China (English)

    张其亮; 滕学仁

    2011-01-01

    BACKGROUND: Endoscopic posterior cruciate ligament reconstruction using achilles tendon allografts has been primarily performed by single-bundle and dou ble-bundle types.OBJECTIVE: To compare the clinical outcome of single-bundle and dou ble-bundle endoscopic posterior cruciate ligament reconstruction using achilles tendon allograft.METHODS: A total of 70 patients with single posterior cruciate ligament injury who received treatment at the Department of Orthopedics, Qingdao Municipal Hospital between January 2006 and January 2009 were included in this study. Allpatients were randomly divided into two groups: single-bundle group and double-bundle group. The single-bundle group had single-bundle reconstruction using achilles tendon allograft, and the double-bundle group had double-bundle reconstruction.RESULTS AND CONCLUSION: After surgery, 52 patients were successfully healed and followed up. The surgery time and the number of patients who need joint puncture were greater in the dou ble-bundle group than in the single-bundle group (P < 0.05).At 18 months after surgery, the stability and range of motion of the knee joint, Lysholm and IKDC scores were improved in each group compared with prior to surgery (P < 0.05). The tibial backward distance tested by KNEELAX3 when the knee joint flexed at 30° and 90° was significantly improved compared with prior to surgery (P < 0.05). There was no significant difference in the range of motion of the knee joint, Lysholm and IKDC scores, and the tibial backward distance tested by KNEELAX3 when the knee joint flexed at 30° and 90° between the single-bundle and double-bundle groups (P > 0.05). Compared with single-bundle reconstruction , double-bundle reconstruction resulted in poor improvement in early clinical curative effects and greater surgical trauma, required long surgery time, and lead to swelling of the knee joint. Therefore, double-bundle reconstruction should not be the preferred protocol for posterior cruciate

  17. 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。

  18. 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

  19. Early functional rehabilitation versus postoperative immobilization for acute achilles tendon ruptures:a systematic review%急性跟腱断裂术后早期功能锻炼与制动的Meta分析

    Institute of Scientific and Technical Information of China (English)

    陈江涛; 荀传辉; 宋兴华; 加莎热特·杰力勒; 霍建军

    2012-01-01

    目的 对急性跟腱断裂术后早期功能锻炼与制动的疗效进行Meta分析. 方法 按照Cochrane系统评价方法,计算机检索MEDLINE(1966年至2011年1月)、EMbase(1966年至2011年1月),Cochrane图书馆(2011年第1期)、Cochrane协作网肌骨创伤组试验数据库(2011年1月)和中国生物医学文献数据库(1978年1月至2011年1月),手工检索中文骨科期刊的相关文献(创刊至2011年1月),收集急性跟腱断裂术后早期功能锻炼与制动的所有相关随机对照试验(RCTs)及半随机对照试验(CCTs),提取有效数据采用RevMan 4.2.8进行Meta分析,以比较急性跟腱断裂术后早期功能锻炼与制动的术后满意率、跟腱再次断裂发生率、感染率、并发症发生率、术后6周跟腱延长率、术后12周跟腱延长度的评价、小腿肌力、踝关节活动度的差异.结果 共纳入4个RCTs,3个CCTs.Meta分析显示,与术后制动相比,急性跟腱断裂术后早期功能锻炼的满意率增加(RR=1.27,95% CI(1.01,1.61),P=0.04),术后并发症发生率降低[RR =0.43,95% CI (0.22,0.83),P=0.01],差异有统计学意义;而两种方法术后跟腱再次断裂发生率[RR=0.59,95% CI (0.20,1.80),P=0.92]、术后感染率[RR=0.70,95% CI (0.26,1.86),P=0.48]、术后6周[SMD=1.50,95% CI(-3.40,6.40)]和12周跟腱延长度[SMD=- 0.25,95% CI(- 5.64,5.14)l及踝关节活动度无显著差异. 结论 与术后制动相比,急性跟腱断裂术后早期功能锻炼提高患者满意率,降低并发症发生率,且不会增加跟腱再次断裂和感染的风险,对术后6周和12周跟腱延长度、小腿肌力和踝关节活动度无明显影响.%Objective To evaluate the effectiveness of early functional rehabilitation versus postoperative immobilization for acute achilles tendon ruptures.Methods Randomized controlled trials (RCTs) and clinical controlled trials (CCTs) comparing early functional rehabilitation versus postoperative immobilization for acute achilles

  20. Extracorporeal shock wave combined with massage therapy in the treatment of Achilles tendon enthesitis%体外冲击波结合推拿治疗跟骨跟腱止点末端病的临床研究

    Institute of Scientific and Technical Information of China (English)

    周春龙; 蔡建浩; 许易

    2013-01-01

    Objective:To evaluate the clinical effects of the extracorporeal shock wave combined with massage therapy in the treatment of the Achilles tendon enthesitis. Methods:56 athletes majored in track and field,badminton or gymnastics with Achilles tendon enthesitis in our college were randomly divided into the treatment group and the control group with 28 cases in each group. The athletes in the treatment group received extracorporeal shock wave combined with massage therapy and those in the control group were treated with extracorporeal shock wave therapy alone. Each athlete received the treatment once every four days and the duration of the the treatment was forty days. The sports training was not terminated during the treatment with a support belt being used to protect the Achilles tendon. The triceps muscle of calf was passively stretched after the sports training. The soft tissue tension test and visual analogue scales (VAS) were used to access the clinical effects at the beginning and the end of the treatment and the last follow-up visit. Results:The improvement of VAS in the treatment group was both better than that in the control group at the end of the treatment and the last follow-up visit with statistical significance ( F = 59. 258 ,P <0. 001). The improvement of the soft tissue test in the treatment group was higher than that in the control group with statistical significance at the end of the treatment and the last follow-up visit ( F = 55. 615 , P < 0. 001) . Conclusion:The clinical improvement was gotten in both groups and the improvement in the treatment group was better than that in the control group. The extracorporeal shock wave combined with massage therapy was more effective than the extracorporeal shock wave therapy alone for Achilles tendon enthesitis.%目的:观察体外冲击波结合推拿治疗跟骨跟腱止点末端病的疗效.方法:将来自本学院田径、羽毛球和体操专业的56例跟骨跟腱止点末端病运动员随机分

  1. 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...

  2. Achille Campanile

    Directory of Open Access Journals (Sweden)

    Melani Malamut

    2009-12-01

    Full Text Available Achille Campanile (1899-1977 wrote plays, gags, sketches, novels and reviews in journals. A taste for the absurd, nonsense, misunderstanding and wordplay are all elements of his plays. After the most prolific period (1924-1935 came a creative pause, perhaps because of insufficient interest of the audience. Unfortunately the audience in the 1920s did not understand Campanile, so he remained on the sideline for therest of his life.

  3. 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

  4. 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

  5. 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.

  6. Aşil tendon yırtığının desteklenmiş tamiri

    OpenAIRE

    2006-01-01

    Objectives: Augmented repair techniques are used in defective Achilles tendon ruptures and provide excellent functional results in active individuals, but it carries an incidence of wound complications like tendon adhesion to the skin. Tendon adhesion is an important minor complication. We present an augmentation technique for Achilles tendon rupture that we believe prevents tendon adhesion to the skin. Material and methods: Four male patients with a mean age of 38 (29 to 56) were diagnose...

  7. Mini-invasive treatmentof acute closed Achilles tendon ruptures with the rivet with thread%微创带线铆钉治疗新鲜闭合性跟腱断裂

    Institute of Scientific and Technical Information of China (English)

    张楠; 丁亮华; 张晨然; 何双华; 张爱梁; 马文明

    2013-01-01

    ObjectiveTo analyze the clinical effects of the mini-invasive treatment of acute closed achilles tendon ruptures with the rivet with thread. MethodsTotally 32 case of acute closed achilles tendon ruptures were treated by the rivet with thread,including 27 males and 5 females. The plantar flexion angle was compared before and after operation. Postoperative follow-up including the healing of skin incision, improvement of heal pain and re-ruptures. AOFAS-AH score was used to evaluate the functional recovery of the sick ankle joint. ResultsThe process of the operation was smooth going without the injury of major vessel and nerve. All patients were followed up for 19-30 months(average 23.6±4.5). Wound heal well without infection and skin necrosis and there was no heel pain and re-ruptures occurred. All patients with good ankle flexion and extension. ConclusionThe clinical effects are valid because of its lesser incidence rate of complication such as re-ruptures, lesser invasive treatment, convenient for clinical application .%目的:探讨采用经皮带线铆钉治疗新鲜闭合性跟腱断裂的临床疗效。方法采用微创带线铆钉治疗新鲜闭合性跟腱断裂32例,其中男27例,女5例,术后随访伤口愈合、足跟疼痛、跟腱再断裂及患侧踝关节功能恢复情况,比较患者手术前后患足跖屈角度差异,采用美国足踝医师协会踝与后足功能评分(AOFAS-AH评分)评估手术前后踝关节功能。结果手术顺利,术中未发生重要血管、神经等组织结构的损伤,所有患者均得到随访,随访时间19~30个月(23.6±4.5)个月,伤口愈合良好未见感染及皮肤坏死,无足跟疼痛和跟腱再断裂发生,踝关节屈伸活动良好。手术前后患足跖屈角度及AOFAS评分差异有统计学意义(P<0.05)。结论经皮带线铆钉治疗急性闭合性跟腱断裂效果良好并可降低跟腱再断裂等并发症的发生率,其具有手术创伤小

  8. 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

  9. Tendon series elasticity in triceps surae muscles of mammalians

    NARCIS (Netherlands)

    Woittiez, R.D.; Heerkens, Y.F.; Holewijn, M.; Huijing, P.A.

    1985-01-01

    In literature little attention is paid to the functional and morphological relationship between muscle and tendon in a muscle-tendon complex. In the present study the Achilles tendon (AT) of man and rat was investigated with special attention to functional and morphological characteristics of the ga

  10. Achilles tendinopathy

    DEFF Research Database (Denmark)

    Wetke, E; Johannsen, F; Langberg, H

    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 exercises (concentric, eccentric, and stretching) and optional glucocorticosteroid (GCS) injections in patients with (AT) in a usual clinical setting. Patients unable to commence or progress in exercise were offered GCS, hypothesizing that the GCS would facilitate exercise. Ninety-three consecutive patients...... with AT referred to two outpatient rheumatology clinics were registered, and seen at five visits over a 6-month period. Exercises seemed to have a slow, but long-lasting effect with GCS having a dramatic short-term effect on symptoms. Twenty-six percent of the patients could proceed with training alone...

  11. 小切口微创治疗新鲜跟腱断裂%Limited incision for treatment of acute ruptures of achilles tendon

    Institute of Scientific and Technical Information of China (English)

    张丙磊; 余枫; 赵东升; 李爱民; 殷军; 赵玉麟; 张路

    2009-01-01

    [Objective]To evaluate the clinical effect of limited incision with an instrument to repair acute achiles tendon ruptures. [Method] Data on 26 consecutive patients who underwent limited incision with an instrument to repair achiles tendon ruptures and on a rehabilitation programme based on early range of motion exercise after surgery during March 2006 March 2008 were reviewed at an average follow-up of 21 months (range 12 -36 months). There were 24 males and 2 females with an average age of 37.6 (22 - 58) years. The American Orthopaedic Foot and Ankle Society (AOFAS) score was used to evaluate the treatment outcomes. Calf and ankle circumferences of the injured leg and the contralateral side, the return to work and sports activity time were evaluated. [Result]The patients had neither rerupture nor deep or superficial wound infection. Also.no patient had sensory disturbance with the ankle or fool in the sural nerve distribution. The mean AOFAS score at the time of the latest follow-up was 97 (86 - 100).Twenty-three patients returned to work at an average of 10 weeks (range,4-20 weeks) and to normal sports activities at 20 weeks (range, 18 -24 weeks). Calf and ankle circumferences decreased by 0.4 cm(0.2 -0.8cm)and increased by 0.5cm(0.3-0.7cm),respectively in the injured leg as compared with the contralateral leg. [ Conclusion] The limited incision with an instrument to repair acute achiles tendon ruptures and the early rehabilitation programme provide satisfactory result with low complication rates.%[目的]探讨通过小切口应用跟腱缝合引导器微创治疗新鲜跟腱断裂的临床效果.[方法]2006年3月-2008年3月,通过小切口应用跟腱缝合引导器微创治疗连续的26例新鲜跟腱断裂病人,术后早期功能锻练.男24例,女2例.年龄22~58岁,平均37.6岁.24例获得12~36个月(平均21个月)的随访.采用美国足与踝关节协会(AOFAS)踝与后足功能评分标准进行评分,测量双侧小腿最大周径及跟腱

  12. Nonsurgical Management of Midsubstance Achilles Tendinopathy.

    Science.gov (United States)

    McClinton, Shane; Luedke, Lace; Clewley, Derek

    2017-04-01

    Midsubstance Achilles tendinopathy is one of the most common lower leg conditions. Most patients can recover with nonsurgical treatment that focuses on tendon loading exercises and, when necessary, symptom modulating treatments such as topical, oral, or injected medication, ice, shoe inserts, manual therapy, stretching, taping, or low-level laser. If unresponsive to initial management, a small percentage of patients may consider shockwave or sclerosing treatment and possibly surgery.

  13. TWINFIX TI QUICK-T锚钉治疗跟腱止点撕脱的临床研究%The Clinical Study on the Use of TWINFIX TI QUICK-T Suture Anchor to Repair the Avulsion of the Bony Insertion of the Achilles Tendon at the Calcaneus

    Institute of Scientific and Technical Information of China (English)

    林忠勤; 王伟; 程少文; 张伟; 寇冬权; 彭磊

    2011-01-01

    Objective Using TWINFIX TI QUICK-T suture anchors to repair the Achilles tendon close to its insertion avulsion.Evaluating its efficacy,to provide reference for clinical treatment.Methods Total 16 with the avulsion of the bony insertion of the Achilles tendon at the calcaneus were treated with TWINFIX TI QUICK-T suture anchor from 2007 to now.10 males and 6 females ;aged 22 to 65 years ,mean 44.7 years old.7 cases the left side,right side in 9 cases.By AOFAS ankle and hindfoot scoring function evaluated.Results Followed up 6~24 months,average of 13 months.No one cases happened suture dehiscence ,wound infection occurred ,main blood vessel nerve injury,fixation failure and other complications after operation and were normal anatomic relations and the appearance and function are satisfactory.Among 16cases, 12cases had the excellent results, 2case had the good results, 2case had fair results.The total excellent and good rate was 87.5%.Conclusion More reasonable and secure fixation method is necessary in order to allow early functional rehabilitation.We use a technique to repair the Achilles tendon close to its insertion avulsion or tendon Achilles avulsion fracture (fix the avulsed fragment of Achilles tendon insertion) with TWINFIX TI QUICK-T suture anchors.This can neutralize the pull of the triceps surae and early post-operative rehabilitation program is allowed,it is conducive to a better recovery of the ankle joint function postoperative.%目的 应用TWINFIX TI QUICK-T治疗跟腱止点撕脱伤,评价其疗效,为临床治疗提供参考.方法 2007年9月至2010年5月采用TWINFIX TI QUICK-T锚钉治疗跟腱止点撕脱伤16例,男10例,女6例;平均44.7岁.左侧7例,右侧9例.按AOFAS踝与后足功能评分标准评价疗效.结果 随访6~24个月,平均13个月.术后无一例出现缝线裂开、切口感染、主要血管及神经损伤、内固定失效等并发症,术后恢复正常解剖关系及外观,踝关节功能恢复满意.本组16

  14. 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 fascicles...... adjacent collagen fascicles in human tendons is small or negligible, suggesting that tendon fascicles largely act as independent structures and that force transmission principally takes place within the individual fascicles....

  15. Curative Effect of Lengthening and Forward of Achilles Tendon on Treating Spastic Equinus of Children with Cerebral Palsy%跟腱延长前移术治疗脑性瘫痪痉挛型马蹄足的疗效

    Institute of Scientific and Technical Information of China (English)

    张天久; 俞松; 杨小红; 胡月光

    2012-01-01

    目的 评价跟腱延长前移术治疗儿童脑性瘫痪痉挛型马蹄足的疗效.方法 收集1998年5月- 2011年6月应用跟腱延长前移术治疗脑性瘫痪痉挛型马蹄足儿童53例85足.男28例45足,女25例40足;年龄2.5 ~14.0岁,平均6.8岁.痉挛程度按Ashworth 5级法评定:3级12足,4级38足,5级35足.患儿均能行走,智力发育及下肢肌力基本正常,伴不同程度肌张力增高,腱反射亢进,踝阵挛和Babinski征阳性,无明显内翻、外翻及平足畸形,X线片未提示明显骨性畸形.合并双髋内收畸形5例,双膝屈曲畸形2例,均在术前或同期行手术矫正.结果 患儿均获随访,随访时间0.5~11.2a,平均2.3a.1例于术后2周出现切口裂开、跟腱断裂,再次行跟腱吻合术,术后恢复良好;患儿术后均未发现小腿三头肌肌力较术前下降.53例85足均获满意疗效,优55足,良30足,优良率达100%.结论 跟腱延长前移术利用生物力学原理,在跟腱延长的基础上将跟腱止点前移至跟距关节后缘,缩短了跟腱至踝关节的力臂,平衡了踝关节背伸与跖屈肌肌力,远期效果良好,是儿童脑性瘫痪痉挛型马蹄足较好的治疗方法.%Objective To evaluate curative effect of lengthening and forward of achilles tendon on treating spastic equinus of children with cerebral palsy. Methods Fifty -three patients (85 feet) with spastic equinus caused by cerebral palsy in children, including 28 male (45 feet)and 25 female (40 feet) .were treated with lengthening and forward of achilles tendon from May 1998 to Jun. 2011. The ages of the patients ranged from 2.5 to 14.0 years. According to the Ashworth method for the evaluation of spastieity:12 feet belonged to level 3,38 feet level 4,and 35 feet level 5. All patients were able to walk,had normal intelligence and muscle strength of lower limbs,varying degrees of muscle tension,tendon reflexes hyperfunction, ankle clonus and Babinski sign positive,had not significant bone

  16. Imaging and Treatment of Chronic Midportion Achilles Tendinopathy

    NARCIS (Netherlands)

    R.J. de Vos (Robert-Jan)

    2010-01-01

    textabstractIntroduction: It is estimated that 30-50% of sports injuries are caused by tendon disorders. Chronic midportion Achilles tendinopathy is a frequent problem, particularly occurring in athletes but also affecting inactive people. Diagnosis is made based on clinical findings and currently t

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

    Science.gov (United States)

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

    2006-02-01

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

  18. Application of the achilles tendon elasticity distraction apparatus imitating ankle physiological movement in extension of the lower limbs%仿踝关节生理运动跟腱弹性牵伸器在小腿Ilizarov延长中的应用

    Institute of Scientific and Technical Information of China (English)

    彭爱民; 韩义连; 韩庆海; 郑学建; 梁捷予; 夏和桃

    2012-01-01

    [Objective] To research the achilles tendon elastic stretch instrument imitating the physiological movement of the ankle. Its structure, function and the impact of joint movement of the ankle was observed and summarized, and the prevention of complications of foot drop during and after the process of extension of the lower limbs was analyzed. [ Methods ] The control group included the ordinary achilles tendon distraction apparatus used for the extension of the lower limbs in our hospital from!998 to 2008. The lest group included the new type of bionics Achilles tendon ankle distraction apparatus was used from 2008 to 2010. The condition, surgical methods, postoperative management, the speed of extension, the training methods all kept the same level. After completion of treatment (removal of external fixator) , these two groups were evaluated through ankle deformity " symptoms, function and activity according to Kofoed score standards, the results were analyzed by SPSS 17. 0 statistical software. [Results] Ankle score: (79. 941 ± 3. 88) points in the control group while (91.84 ± 2. 40) points in the experimental group. Ankle function in the experimental group patients was significantly better than that in control group patients (P < 0. 05 ) . [ Conclusion] Bionic achilles tendon distraction apparatus imitating ankle physiological movement containes many advantages in the lower limbs extension cases, including facilitate to the surgeon operation, easy to postoperative functional exercise , better than the previous draft, not only is effective in preventing common complications of foot drop, varus, valgus deformity, but also greatly prevent the emergence of ankle stiffness complications.%[目的]研制模仿踝关节生理运动的跟腱弹性牵伸器.在小腿延长过程中和延长结束后其结构、功能对足踝关节运动的影响及足下垂并发症的预防进行观察总结.[方法]将1998 ~2008年小腿延长使用以往跟腱牵

  19. 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

  20. 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.

  1. 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...... 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...... 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...

  2. Ultrasound-Based Tendon Micromorphology Predicts Mechanical Characteristics of Degenerated Tendons.

    Science.gov (United States)

    Kulig, Kornelia; Chang, Yu-Jen; Winiarski, Slawomir; Bashford, Gregory R

    2016-03-01

    The purpose of this study was to explore the relationship between tendon micro-morphology quantified from a sonogram and tendon mechanical characteristics measured in vivo. Nineteen adults (nine with unilateral Achilles tendinosis) participated. A commercial ultrasound scanner was used to capture longitudinal B-mode ultrasound images from the mid-portion of bilateral Achilles tendons and a custom image analysis program was used to analyze the spatial frequency content of manually defined regions of interest; in particular, the average peak spatial frequency of the regions of interest was acquired. In addition, a dynamometer and a motion analysis system indirectly measured the tendon mechanical (stiffness) and material (elastic modulus) properties. The peak spatial frequency correlated with tendon stiffness (r = 0.74, p = 0.02) and elastic modulus (r = 0.65, p = 0.05) in degenerated tendons, but not healthy tendons. This is the first study relating the mechanical characteristics of degenerated human Achilles tendon using a non-invasive micro-morphology analysis approach.

  3. An anatomic and clinical study of the adductor magnus tendon-descending genicular artery bone flap.

    Science.gov (United States)

    Huang, Dong; Wang, Hai-Wen; Xu, Da-Chuan; Wang, Hong-Gang; Wu, Wei-Zhi; Zhang, Hui-Ru

    2011-01-01

    The composite tissue flap of the descending genicular vessels with the adductor magnus tendon is a newly developed, reliable method to repair the Achilles tendon and relevant skin defects. The aim of this study was to evaluate the anatomy of the adductor magnus tendon-descending genicular artery bone flap, and the feasibility and value for the repair of the Achilles tendon and relevant skin defects. There were 34 adult specimens used for the anatomy of this flap. The descending genicular artery originates 10.5 ± 1.6 cm above the adductor tubercle, with a diameter of 1.8 ± 0.6 mm and a length of 1.2 ± 0.5 cm. Its articular branch is distributed in the adductor magnus tendon and the medial condyle of the femur. The saphenous branch has a diameter of 1.1 ± 0.3 mm and is distributed in the skin of the upper medial calf. A total of 16 cases of trauma-induced Achilles tendon damage and calcaneus and skin defects were repaired with the vascularized adductor magnus tendon bone flap, including the reconstruction of Achilles tendon insertion and repair of relevant skin defects. All of the composite tissue flaps were viable, the skin sensation of the flaps was recovered, and all patients walked with a normal gait. Our results suggested that the adductor magnus tendon-descending genicular artery bone flap is an alternative method to repair composite tissue defects of the Achilles tendon.

  4. Tendon repair

    Science.gov (United States)

    Repair of tendon ... Tendon repair can be performed using: Local anesthesia (the immediate area of the surgery is pain-free) ... a cut on the skin over the injured tendon. The damaged or torn ends of the tendon ...

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

    Science.gov (United States)

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

    2010-02-01

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

  6. Surgical tip: Repair of acute Achilles rupture with Krackow suture through a 1.5 cm medial wound.

    Science.gov (United States)

    Lui, T H

    2010-03-01

    Acute Achilles tendon ruptures is one of the commonest tendon injury of the foot and ankle. The management of this problem is still controversial. Treatment can be classified into non-surgical and surgical types. Surgical management can be subdivided into open repair, percutaneous with or without adjunct of arthroscopy. In compare with non-surgical management, surgical management will decrease the tendon re-rupture rate. However, the possible surgical complications including wound breakdown and sural nerve injury are still quite significant. Percutaneous repair technique has the advantage of less chance of wound breakdown, but the rate of tendon re-rupture is higher than that after open tendon repair, because the repair is usually weaker than that achieved in open repair. Lui have described an endoscopic assisted repair with the Krackow locking suture. However, the technique is complicated and six portal wounds are needed. A simpler way of applying the Krackow suture through the portal wound has been described for reattachment of Achilles tendon insertion after endoscopic calcaneoplasty. We describe a mini-open approach of Achilles tendon repair with the Krackow locking suture. By means of release of the medial edge of the investing fascia, the Achilles tendon can be mobilized easily and the Krackow locking suture can be applied through a 1.5cm medial wound. Hopefully, this can improve the strength of repair and maintaining the advantage of minimally invasive tendon repair.

  7. Growth hormone does not stimulate early healing in rat tendons

    OpenAIRE

    2012-01-01

    Growth Hormone stimulates bone growth and fracture repair. It acts mainly by increasing the systemic levels of IGF-1. Local treatment with IGF-1 appears to stimulate tendon healing. We therefore hypothesized that systemic treatment with Growth Hormone would also stimulate tendon healing. Rat Achilles tendons were transected and left to heal. 4 groups were studied. Intramuscular injections of botulinum toxin A (Botox) were used to reduce loading in 2 groups. The animals were randomized to twic...

  8. Dynamic viscoelastic behavior of lower extremity tendons during simulated running.

    Science.gov (United States)

    De Zee, M; Bojsen-Moller, F; Voigt, M

    2000-10-01

    The aim of this project was to see whether the tendon would show creep during long-term dynamic loading (here referred to as dynamic creep). Pig tendons were loaded by a material-testing machine with a human Achilles tendon force profile (1.37 Hz, 3% strain, 1,600 cycles), which was obtained in an earlier in vivo experiment during running. All the pig tendons showed some dynamic creep during cyclic loading (between 0.23 +/- 0.15 and 0.42 +/- 0.21%, means +/- SD). The pig tendon data were used as an input of a model to predict dynamic creep in the human Achilles tendon during running of a marathon and to evaluate whether there might consequently be an influence on group Ia afferent-mediated length and velocity feedback from muscle spindles. The predicted dynamic creep in the Achilles tendon was considered to be too small to have a significant influence on the length and velocity feedback from soleus during running. In spite of the characteristic nonlinear viscoelastic behavior of tendons, our results demonstrate that these properties have a minor effect on the ability of tendons to act as predictable, stable, and elastic force transmitters during long-term cyclic loading.

  9. Achilles tendinopathy: A review of the current concepts of treatment.

    Science.gov (United States)

    Roche, A J; Calder, J D F

    2013-10-01

    The two main categories of Achilles tendon disorder are broadly classified by anatomical location to include non-insertional and insertional conditions. Non-insertional Achilles tendinopathy is often managed conservatively, and many rehabilitation protocols have been adapted and modified, with excellent clinical results. Emerging and popular alternative therapies, including a variety of injections and extracorporeal shockwave therapy, are often combined with rehabilitation protocols. Surgical approaches have developed, with minimally invasive procedures proving popular. The management of insertional Achilles tendinopathy is improved by recognising coexisting pathologies around the insertion. Conservative rehabilitation protocols as used in non-insertional disorders are thought to prove less successful, but such methods are being modified, with improving results. Treatment such as shockwave therapy is also proving successful. Surgical approaches specific to the diagnosis are constantly evolving, and good results have been achieved.

  10. Utility of Ultrasonography in Assessing the Effectiveness of Extracorporeal Shock Wave Therapy in Insertional Achilles Tendinopathy

    Directory of Open Access Journals (Sweden)

    Yi Cheng

    2016-01-01

    Full Text Available Introduction. The aim of this study was to investigate the utility of ultrasonography (US for predicting and assessing the effectiveness of extracorporeal shock wave therapy (ESWT in insertional Achilles tendinopathy (IAT. Methods. A total of 42 patients with an established diagnosis of chronic IAT were examined by US before ESWT and at 4 weeks and 12 weeks after ESWT. The thickness and cross-sectional area (CSA of the Achilles tendon, size of calcific plaques, tendon structure score, and neovascularization score were measured at each time point. Results. After therapy, Victorian Institute of Sport Assessment-Achilles (VISA-A scores increased significantly, and the size of calcific plaques decreased (P<0.05. Neovascularization scores increased at the 4th week and then decreased at the 12th week (P<0.05. The thickness, CSA, and structure of the Achilles tendon did not change. Variables observed by US at baseline were not associated with changes in VISA-A scores at follow-up. However, the changes in calcific plaque size and neovascularization scores were related to the improvement of VISA-A scores between pre- and posttherapy (P<0.01. Conclusion. Ultrasonography can reveal some changes in the insertion of the Achilles tendon after ESWT, but the outcome of ESWT in IAT cannot be predicted by the variables observed by US.

  11. Utility of Ultrasonography in Assessing the Effectiveness of Extracorporeal Shock Wave Therapy in Insertional Achilles Tendinopathy

    Science.gov (United States)

    Zhang, Jian

    2016-01-01

    Introduction. The aim of this study was to investigate the utility of ultrasonography (US) for predicting and assessing the effectiveness of extracorporeal shock wave therapy (ESWT) in insertional Achilles tendinopathy (IAT). Methods. A total of 42 patients with an established diagnosis of chronic IAT were examined by US before ESWT and at 4 weeks and 12 weeks after ESWT. The thickness and cross-sectional area (CSA) of the Achilles tendon, size of calcific plaques, tendon structure score, and neovascularization score were measured at each time point. Results. After therapy, Victorian Institute of Sport Assessment-Achilles (VISA-A) scores increased significantly, and the size of calcific plaques decreased (P < 0.05). Neovascularization scores increased at the 4th week and then decreased at the 12th week (P < 0.05). The thickness, CSA, and structure of the Achilles tendon did not change. Variables observed by US at baseline were not associated with changes in VISA-A scores at follow-up. However, the changes in calcific plaque size and neovascularization scores were related to the improvement of VISA-A scores between pre- and posttherapy (P < 0.01). Conclusion. Ultrasonography can reveal some changes in the insertion of the Achilles tendon after ESWT, but the outcome of ESWT in IAT cannot be predicted by the variables observed by US. PMID:28004000

  12. Effect Research of Comprehensive Nursing on the Rehabilitation of Achilles Tendon Haglund Disease after Arthroscopic Debridement and Radiofrequency Ablation%综合护理对跟腱Haglund病关节镜下清理射频消融术后康复的影响研究

    Institute of Scientific and Technical Information of China (English)

    段莉香; 易红; 罗彩虹

    2015-01-01

    Objective: To investigate the effect of comprehensive nursing on the rehabilitation of achilles tendon haglund disease after arthroscopic debridement and radiofrequency ablation.Method:71 patients with achilles tendon haglund disease after arthroscopic debridement and radiofrequency ablation in our hospital were selected and randomly divided into two groups. 35 cases in the control group were given conventional nursing,36 cases in the observation group were given comprehensive nursing on the basis of conventional nursing.The effects of postoperative rehabilitation were compared between the two groups. Result: The excellent recovery rate of the observation group was significantly higher than that of the control group,the difference was statistically significant(P0.05).After nursing,Fowler-Philip angle of the observation group was significantly lower than pre-nursing, the spout height of calcaneus posterior superior and VAS scores of the two groups were significantly lower than pre-nursing,Tengner scores of the two groups were significantly higher than pre-nursing,the differences between pre-nursing and post-nursing were statistically significant(P0.05);护理后,观察组患者Fowler-Philip角明显低于护理前,全部患者跟骨后上突突起高度和VAS评分均明显低于护理前,Tengner评分明显高于护理前,护理前后比较差异均有统计学意义(P<0.05),观察组患者Fowler-Philip角、跟骨后上突突起高度和VAS评分均明显低于对照组,Tengner评分明显高于对照组,两组比较差异均有统计学意义(P<0.05),观察组护理满意率明显高于对照组,两组比较差异有统计学意义(P<0.05)。结论:综合护理有助于显著改善跟腱Haglund病关节镜下清理射频消融术后患者踝关节活动程度,降低疼痛程度,提高康复护理效果。

  13. Arthroscopy Cleaning Calcaneal Tubercle on Individualized Forming after Decompression Treat-ment of Intractable Haglund's Syndrome of the Achilles Tendon%内镜下跟骨后上结节成形减压术治疗顽固性 Haglund 综合征

    Institute of Scientific and Technical Information of China (English)

    王铭; 李海滨; 刘会欣; 付洪睿; 杨学桥; 潘洪阁

    2015-01-01

    Objective To study the surgical effect of arthroscopy calcaneal tubercle cleaning on individualized forming af-ter decompression treatment of intractable Haglund's syndrome of the Achilles tendon. Methods Twenty-two cases underwent arthroscopy cleaning calcaneal tubercle on individualized forming after decompression treatment. American Foot and Ankle Sur-gery Society(AOFAS)ankle-foot function score was assessed preoperatively and postoperatively. Results Patients were fol-lowed up for 13. 6 months(6 ~ 18months). American Foot and Ankle Surgery Society(AOFAS)ankle-foot function score im-proved significantly. 90. 9% of patients presented excellent or good results. Conclusion Arthroscopy cleaning of calcaneal tu-bercle on individualized form with decompression treatment of intractable Haglund's syndrome of the Achilles tendon can a-chieve satisfactory results.%目的:研究内镜下跟骨后上结节成形减压术治疗顽固性 Haglund 综合征的手术治疗效果。方法我科于2013年1月至2014年8月对22例顽固性 Haglund 综合征患者采用内镜下跟骨后上结节成形减压术治疗,其中男14例,女8例;年龄15~64岁,平均41.7岁。对22例患者术前、术后均进行美国足踝外科协会(American orthopaedic foot and ankle society,AOFAS)踝-后足功能评分。结果所有患者均获得随访,随访时间6~18个月,平均13.6个月。术前 AOFAS 踝-后足功能评分平均56分,术后平均86.4分,评分明显提高。优16例,良4例,可2例,优良率为90.9%。结论内镜下跟骨后上结节成形减压术治疗顽固性 Haglund 综合征可获得良好的临床效果。

  14. Cryotherapy suppresses tendon inflammation in an animal model

    Science.gov (United States)

    Zhang, Jianying; Pan, Tiffany; Wang, James H.-C.

    2015-01-01

    Summary Cryotherapy (or cold treatment) has been a popular treatment to relieve pain caused by injuries to tissues such as tendons. However, the exact mechanisms behind the beneficial effects of cryotherapy in tendons remain largely unclear. As prostaglandin E2 (PGE2) is known to be a major mediator of acute inflammation in tissues, which is related to tissue pain, we hypothesized that the beneficial effects of cryotherapy in tendons are mediated by downregulation of PGE2 levels. To test this hypothesis, we applied cold treatment to mouse patellar and Achilles tendons using two animal models: exhaustive mouse treadmill running and acute mouse tendon injury by needle penetration. We then measured the levels of PGE2 and protein expression levels of COX-2, an enzyme responsible for PGE2 production in tissues, under both experimental conditions. We found that treadmill running increased PGE2 levels in both patellar and Achilles tendons compared to control mice without running. Cold treatment for 30 min after treadmill running was sufficient to reduce PGE2 levels to near baseline control levels in both tendons. An extension of cold treatment to 60 min resulted only in a marginal decrease in patellar tendons, but a marked decrease in Achilles tendons. Moreover, COX-2 protein levels in both tendons were also lowered by cold treatment, suggesting that the reduction of PGE2 levels in tendons by cold treatment is at least in part due to the decreased COX-2 expression. Similarly, in the acutely injured tendons, 30 min of cold treatment after needle penetration reduced PGE2 levels when compared to the controls at room temperature (22°C). This decrease was sustained up to at least 3 h after the administration of cryotherapy. Given that PGE2 is a known pain sensitiser, the results of this study suggest that the ability of cold treatment to reduce pain may be attributable to its ability to decrease PGE2 production in tendons. PMID:26594634

  15. 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.

  16. 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

  17. 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

  18. Metabolic syndrome associated to non-inflammatory Achilles enthesopathy.

    Science.gov (United States)

    Abate, Michele; Di Carlo, Luigi; Salini, Vincenzo; Schiavone, Cosima

    2014-01-01

    Enthesopathies are frequently found in rheumatic inflammatory diseases, but can be observed also in absence of systemic inflammation. Aging, overuse, and microtraumas can be responsible for enthesis-degenerative phenomena. Despite that Achilles enthesis is the more frequently affected, no systematic study on the risk factors associated to this enthesopathy has been yet performed. The aim of this paper was to assess whether the metabolic syndrome could be associated to entheseal lesions. Forty-five subjects with symptomatic non-inflammatory Achilles enthesopathy were compared to 45 asymptomatic controls. An ultrasound study of the Achilles enthesis was carried out, and the presence/absence of lesions (morphologic abnormalities, calcific deposits, enthesophytes, cortical abnormalities, and adjacent bursitis) was assessed. On the basis of history, comorbidities (osteoarthritis, diabetes, and hypertension) were recorded. In each subject, body mass index (BMI), glucose, total, and HDL cholesterol were also evaluated. All symptomatic subjects showed at ultrasound evaluation at least one structural entheseal alteration; pathologic features in asymptomatic subjects were found in 6/45 (13.3 %) of cases. Higher values of BMI and glucose were found in subjects with symptomatic enthesopathy. At multiple logistic regression analysis, the presence of high values of BMI and glucose was related to a higher probability to detect entheseal lesions. Metabolic syndrome and overweight may have a role in the pathogenesis of Achilles enthesopathy due to their synergistic worsening effect on other pathogenetic factors of tendon degeneration, such age and overuse. Therefore, subjects with metabolic syndrome practicing sports and other activities stressing the Achilles tendon should receive advice for more frequent controls.

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

    Science.gov (United States)

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

    2013-12-01

    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 underlying chronic tendinopathy. Acute or chronic paratendinopathy may occur as a separate entity or combined with Achilles injury. In this article, the spectrum of athletic injuries of the plantar fascia and Achilles is described, illustrated by imaging findings from the London 2012 Olympic games.

  20. 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.

  1. Elastographic characteristics of the metacarpal tendons in horses without clinical evidence of tendon injury.

    Science.gov (United States)

    Lustgarten, Meghann; Redding, W Rich; Labens, Raphael; Morgan, Michel; Davis, Weston; Seiler, Gabriela S

    2014-01-01

    Tendon and ligament injuries are common causes of impaired performance in equine athletes. Gray-scale ultrasonography is the current standard method for diagnosing and monitoring these injuries, however this modality only provides morphologic information. Elastography is an ultrasound technique that allows detection and measurement of tissue strain, and may provide valuable mechanical information about equine tendon and ligament injuries. The purpose of this study was to determine the feasibility, reproducibility, and repeatability of elastography; and to describe elastographic characteristics of metacarpal tendons in sound horses. Nineteen legs for 17 clinically sound horses without evidence of musculoskeletal pathology were included. Elastographic images of the superficial and deep digital flexor tendons and the branches of the suspensory ligament (tendon of the interosseous muscle) were described quantitatively and qualitatively. There was no statistically significant difference between operators (P = 0.86) nor within operators (P = 0.93). For qualitative assessments, reproducibility (0.46) was moderate and repeatability (0.78) was good. Similar to human Achilles tendons, equine tendons were classified as predominantly hard using elastography. There was no statistically significant difference in stiffness of the flexor tendons (P = 0.96). No significant difference in stiffness was found with altered leg position during standing (P = 0.84) and while nonweight bearing (P = 0.61). The flexor tendons were softer when imaged in longitudinal versus transverse planes (P tendons and ligaments of the distal forelimb in horses.

  2. 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

  3. Mechanical properties of tendon and aponeurosis of human gastrocnemius muscle in vivo.

    Science.gov (United States)

    Muramatsu, T; Muraoka, T; Takeshita, D; Kawakami, Y; Hirano, Y; Fukunaga, T

    2001-05-01

    Load-strain characteristics of tendinous tissues (Achilles tendon and aponeurosis) were determined in vivo for human medial gastrocnemius (MG) muscle. Seven male subjects exerted isometric plantar flexion torque while the elongation of tendinous tissues of MG was determined from the tendinous movements by using ultrasonography. The maximal strain of the Achilles tendon and aponeurosis, estimated separately from the elongation data, was 5.1 +/- 1.1 and 5.9 +/- 1.6%, respectively. There was no significant difference in strain between the Achilles tendon and aponeurosis. In addition, no significant difference in strain was observed between the proximal and distal regions of the aponeurosis. The results indicate that tendinous tissues of the MG are homogeneously stretched along their lengths by muscle contraction, which has functional implications for the operation of the human MG muscle-tendon unit in vivo.

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

    Directory of Open Access Journals (Sweden)

    Alexandre Mayer

    2010-06-01

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

  6. 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

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

    DEFF Research Database (Denmark)

    Langberg, Henning; Ellingsgaard, H; Madsen, T

    2007-01-01

    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...... 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 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; P...

  8. 筋膜反转法和直接吻合法修复急性跟腱断裂的比较研究%Reverse flap of gastrocnemius-soleus fascia vs. direct anastomosis for treatment of Achilles tendon rupture

    Institute of Scientific and Technical Information of China (English)

    徐向阳; 刘津浩; 朱渊; 王碧菠

    2010-01-01

    Objective To retrospectively compare the advantages and disadvantages of reverse flap of gastrocnemius-soleus fascia and direct anastomosis for the repair of acute Achilles tendon rupture.Methods From January 2001 to October 2005, 73 cases of acute Achilles tendon rupture were treated with reverse flap of gastrocnemius-soleus fascia. They were 54 males and 19 females. Their average age was (47.6 ± 11.2) years old. From November 2005 to May 2009, 82 cases were treated with direct anastomosis.They were 65 males and 17 females. Their average age was (43.7 ± 8.4) years old. The time from injury to surgery was (6.2 ±4.2) days and (7.1 ±5.3) days respectively for the 2 groups, with no statistic differences. The patients were evaluated by the Ankle and Hindfoot score system American Orthopaedic Foot and Ankle Society(AOFAS) . The result was considered as positive when the range of dorsal or plantar flexion of the operated side was 50% smaller than the opposite, or when the single heel rise was less than 10 times.Results The follow-ups lasted 13 to 114 months (average, 63.5 months). The rates of re-rupture in the 2 groups were respectively 4. 1% and 2.4%. Disability in single heel rise was respectively 13.7% and 8.5%,in normal dorsal extension respectively 23.3% and 18.3%, and in normal plantar flexion respectively 12.3%and 6.1%. The satisfaction rates were respectively 82. 2% and 80. 5%. AOFAS scores were respectively 97.2 ± 9.4 and 94. 3 ± 12. 1. All the differences above were not statistically significant ( P > 0.05) . The delayed wound healing in the 2 groups were respectively 15.1% and 3.7%, with statistically significant differences ( t = 6. 119, P = 0. 013) . Conclusion The reverse fascia flap for repair of acute Achilles tendon rupture may not decrease the re-rupture rate but may increase the possibility of wound healing delay.%目的 回顾性比较筋膜反转法与直接吻合法修复急性跟腱断裂的优缺点.方法 2001年1月至2005年10

  9. 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.

  10. Tendon progenitor cells in injured tendons have strong chondrogenic potential: the CD105-negative subpopulation induces chondrogenic degeneration.

    Science.gov (United States)

    Asai, Shuji; Otsuru, Satoru; Candela, Maria Elena; Cantley, Leslie; Uchibe, Kenta; Hofmann, Ted J; Zhang, Kairui; Wapner, Keith L; Soslowsky, Louis J; Horwitz, Edwin M; Enomoto-Iwamoto, Motomi

    2014-12-01

    To study the cellular mechanism of the tendon repair process, we used a mouse Achilles tendon injury model to focus on the cells recruited to the injured site. The cells isolated from injured tendon 1 week after the surgery and uninjured tendons contained the connective tissue progenitor populations as determined by colony-forming capacity, cell surface markers, and multipotency. When the injured tendon-derived progenitor cells (inTPCs) were transplanted into injured Achilles tendons, they were not only integrated in the regenerating area expressing tenogenic phenotype but also trans-differentiated into chondrogenic cells in the degenerative lesion that underwent ectopic endochondral ossification. Surprisingly, the micromass culture of the inTPCs rapidly underwent chondrogenic differentiation even in the absence of exogenous bone morphogenetic proteins or TGFβs. The cells isolated from human ruptured tendon tissues also showed connective tissue progenitor properties and exhibited stronger chondrogenic ability than bone marrow stromal cells. The mouse inTPCs contained two subpopulations one positive and one negative for CD105, a coreceptor of the TGFβ superfamily. The CD105-negative cells showed superior chondrogenic potential in vitro and induced larger chondroid degenerative lesions in mice as compared to the CD105-positive cells. These findings indicate that tendon progenitor cells are recruited to the injured site of tendons and have a strong chondrogenic potential and that the CD105-negative population of these cells would be the cause for chondroid degeneration in injured tendons. The newly identified cells recruited to the injured tendon may provide novel targets to develop therapeutic strategies to facilitate tendon repair.

  11. Low-level laser therapy in collagenase-induced Achilles tendinitis in rats: analyses of biochemical and biomechanical aspects.

    Science.gov (United States)

    Marcos, Rodrigo Labat; Leal-Junior, Ernesto Cesar Pinto; Arnold, Gilles; Magnenet, Vincent; Rahouadj, Rachid; Wang, Xiong; Demeurie, Frank; Magdalou, Jacques; de Carvalho, Maria Helena Catelli; Lopes-Martins, Rodrigo Álvaro Brandão

    2012-12-01

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

  12. Tendon degeneration is not mediated by regulation of Toll-like receptors 2 and 4 in human tenocytes.

    NARCIS (Netherlands)

    Mos, M. de; Joosten, L.A.B.; Oppers-Walgreen, B.; Schie, J.T. van; Jahr, H.; Osch, G.J.V.M. van; Verhaar, J.A.N.

    2009-01-01

    We hypothesized that expression of Toll-like receptors (TLRs) 2 and 4 by tenocytes is involved in the catabolic processes of tendon degeneration. We investigated TLR2 and TLR4 expression by tenocytes in healthy and tendinotic Achilles tendons. We also investigated whether TLR2 and TLR4 could be upre

  13. Tendon's ultrastructure.

    Science.gov (United States)

    Tresoldi, Ilaria; Oliva, Francesco; Benvenuto, Monica; Fantini, Massimo; Masuelli, Laura; Bei, Roberto; Modesti, Andrea

    2013-01-01

    The structure of a tendon is an important example of complexity of ECM three-dimensional organization. The extracellular matrix (ECM) is a macromolecular network with both structural and regulatory functions. ECM components belong to four major types of macromolecules: the collagens, elastin, proteoglycans, and noncollagenous glycoproteins. Tendons are made by a fibrous, compact connective tissue that connect muscle to bone designed to transmit forces and withstand tension during muscle contraction. Here we show the ultrastructural features of tendon's components.

  14. Compromised Neurotrophic and Angiogenic Regenerative Capability during Tendon Healing in a Rat Model of Type-II Diabetes

    Science.gov (United States)

    Ahmed, Aisha S.; Li, Jian; Abdul, Alim M. D.; Ahmed, Mahmood; Östenson, Claes-Göran; Salo, Paul T.; Hewitt, Carolyn; Hart, David A.; Ackermann, Paul W.

    2017-01-01

    Metabolic diseases such as diabetes mellitus type-II (DM-II) may increase the risk of suffering painful connective tissue disorders and tendon ruptures. The pathomechanisms, however, by which diabetes adversely affects connective tissue matrix metabolism and regeneration, still need better definition. Our aim was to study the effect of DM-II on expressional changes of neuro- and angiotrophic mediators and receptors in intact and healing Achilles tendon. The right Achilles tendon was transected in 5 male DM-II Goto-Kakizaki (GK) and 4 age-matched Wistar control rats. The left Achilles tendons were left intact. At week 2 post-injury, NGF, BDNF, TSP, and receptors TrkA, TrkB and Nk1 gene expression was studied by quantitative RT-PCR (qRT-PCR) and their protein distribution by immunohistochemistry in intact and injured tendons. The expression of tendon-related markers, Scleraxis (SCX) and Tenomodulin (TNMD), was evaluated by qRT-PCR in intact and injured tendons. Injured tendons of diabetic GK rats exhibited significantly down-regulated Ngf and Tsp1 mRNA and corresponding protein levels, and down-regulated Trka gene expression compared to injured Wistar controls. Intact tendons of DM-II GK rats displayed reduced mRNA levels for Ngf, Tsp1 and Trkb compared to corresponding intact non-diabetic tendons. Up-regulated Scx and Tnmd gene expression was observed in injured tendons of normal and diabetic GK rats compared to intact Wistar controls. However, these molecules were not up-regulated in injured DM-II GK rats compared to their corresponding controls. Our results suggest that DM-II has detrimental effects on neuro- and angiotrophic pathways, and such effects may reflect the compromised repair seen in diabetic Achilles tendon. Thus, novel approaches for regeneration of injured, including tendinopathic, and surgically repaired diabetic tendons may include therapeutic molecular modulation of neurotrophic pathways such as NGF and its receptors. PMID:28122008

  15. 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.

  16. 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

  17. 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.

  18. Cryotherapy suppresses tendon inflammation in an animal model

    Directory of Open Access Journals (Sweden)

    Jianying Zhang

    2014-04-01

    Full Text Available Cryotherapy (or cold treatment has been a popular treatment to relieve pain caused by injuries to tissues such as tendons. However, the exact mechanisms behind the beneficial effects of cryotherapy in tendons remain largely unclear. As prostaglandin E2 (PGE2 is known to be a major mediator of acute inflammation in tissues, which is related to tissue pain, we hypothesized that the beneficial effects of cryotherapy in tendons are mediated by downregulation of PGE2 levels. To test this hypothesis, we applied cold treatment to mouse patellar and Achilles tendons using two animal models: exhaustive mouse treadmill running and acute mouse tendon injury by needle penetration. We then measured the levels of PGE2 and protein expression levels of COX-2, an enzyme responsible for PGE2 production in tissues, under both experimental conditions. We found that treadmill running increased PGE2 levels in both patellar and Achilles tendons compared to control mice without running. Cold treatment for 30 min after treadmill running was sufficient to reduce PGE2 levels to near baseline control levels in both tendons. An extension of cold treatment to 60 min resulted only in a marginal decrease in patellar tendons, but a marked decrease in Achilles tendons. Moreover, COX-2 protein levels in both tendons were also lowered by cold treatment, suggesting that the reduction of PGE2 levels in tendons by cold treatment is at least in part due to the decreased COX-2 expression. Similarly, in the acutely injured tendons, 30 min of cold treatment after needle penetration reduced PGE2 levels when compared to the controls at room temperature (22°C. This decrease was sustained up to at least 3 h after the administration of cryotherapy. Given that PGE2 is a known pain sensitiser, the results of this study suggest that the ability of cold treatment to reduce pain may be attributable to its ability to decrease PGE2 production in tendons.

  19. Effect of joint rotation correction when measuring elongation of the gastrocnemius medialis tendon and aponeurosis.

    Science.gov (United States)

    Arampatzis, Adamantios; Monte, Gianpiero De; Karamanidis, Kiros

    2008-06-01

    It is well known that during maximal plantar flexion contractions the ankle joint rotation overestimates the actual elongation of the tendon and aponeurosis. The aim of this study was to examine the influence of the curve length changes of the Achilles tendon on the joint rotation corrected elongation and strain of the gastrocnemius medialis (GM) tendon and aponeurosis. Nine subjects (age: 29.4+/-5.7 years, body mass: 78.8+/-6.8 kg, body height: 178+/-4 cm) participated in the study. The subjects performed maximal voluntary isometric plantarflexion contractions in the prone position on a Biodex-dynamometer. Ultrasonography (Aloka SSD 4000) was used to visualize the muscle belly of the GM muscle-tendon unit. To calculate the curve length changes of the Achilles tendon its surface contour was reconstructed using a series of small reflective skin markers having a diameter of 2.5mm. The elongation of the GM tendon and aponeurosis was calculated (a) as the difference of the measured and the passive (due to joint rotation) displacement of the tendon and aponeurosis and (b) as the difference of the measured displacement and the length changes of the reconstructed Achilles tendon surface contour. The absolute difference between the elongation obtained by both methods were 1.2+/-0.4mm. These differences were due to the higher changes in length obtained by the reconstruction of the tendon curved surface contour as compared to the changes observed in the passive displacement of the digitised point at the aponeurosis. Without correcting for angle joint rotation, the measured elongation clearly overestimates the actual elongation of the GM tendon and aponeurosis. After the passive displacement correction the calculated elongation still overestimates the actual elongation of the GM tendon and aponeurosis. However, this overestimation has a negligible effect on the examined in vivo strain ( approximately 0.3%) of the tendon and aponeurosis.

  20. Extra-corporeal pulsed-activated therapy ("EPAT" sound wave) for Achilles tendinopathy: a prospective study.

    Science.gov (United States)

    Saxena, Amol; Ramdath, Sona; O'Halloran, Patrick; Gerdesmeyer, Ludger; Gollwitzer, Hans

    2011-01-01

    Achilles tendinopathy is common and extracorporeal shockwaves have become a popular treatment for this condition, even though previous research has not provided conclusive results regarding its efficacy in cases of Achilles tendinopathy. Our aim was to evaluate 3 weekly shockwave treatments in patients with Achilles tendinopathy, as quantified by the Roles and Maudsley score. A total of 74 tendons in 60 patients were assessed at baseline and at least 1 year posttreatment, including 32 (43.24%) paratendinoses, 23 (31.08%) proximal tendinoses, and 19 (25.68%) insertional tendinoses. The mean age of the participants was 48.6 ± 12.94 years, and patients with paratendinosis (41.44 ± 14.01 years) were statistically significantly younger than those with proximal (53 ± 8.9 years) and insertional (54.26 ± 9.74 years) tendinopathy, and these differences were statistically significant (P = .0012 and P = .0063, respectively). Overall, 58 (78.38%) tendons improved by at least 1 year posttreatment, including 75% in the paratendinosis, 78.26% in the proximal tendinosis, and 84.21% in the insertional tendinosis groups, and no adverse effects were observed. The Roles and Maudsley score improved from 3.22 ± 0.55 to 1.84 ± 1.05 (P shockwave therapy serves as a safe, viable, and effective option for the treatment of Achilles tendinopathy.

  1. The Achilles heel of adults and children

    NARCIS (Netherlands)

    Wiegerinck, J.I.

    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

  2. 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.

  3. Anabolic androgenic steroids reverse the beneficial effect of exercise on tendon biomechanics: An experimental study

    OpenAIRE

    2014-01-01

    Background\\ud The effect of anabolic androgenic steroids on tendons has not yet been fully elucidated. Aim of the present study was the evaluation of the impact of anabolic androgenic steroids on the biomechanical and histological characteristics of Achilles tendons.\\ud Methods\\ud Twenty-four male Wistar rats were randomized into four groups with exercise and anabolic steroids (nandrolone decanoate) serving as variables. Protocol duration was 12 weeks. Following euthanasia, tendons’ biomechan...

  4. 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

  5. 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

  6. Fibroma of tendon sheath located within Kager's triangle.

    Science.gov (United States)

    Jacobs, Eva; Witlox, Marianne A; Hermus, Joris P S

    2014-01-01

    The formation of a fibroma of the tendon sheath, a rare, slow-growing, benign tumor, usually occurs in the upper extremities of young adult males. We present an extremely rare case of a fibroma of the tendon sheath arising adjacent to the Achilles tendon within Kager's triangle in a 41-year-old female. The patient presented with progressive pain localized to the posterior aspect of the left ankle. Complete excision and histopathologic analysis of the fibroma were performed. The patient experienced an uneventful recovery after the intervention and had no evidence of recurrence after 3 months of follow-up. Fibroma of the tendon sheath should be included in the differential diagnosis when a patient presents with a painful soft tissue mass in Kager's triangle.

  7. 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...

  8. Effectiveness of extracorporeal shockwave therapy in three major tendon diseases

    OpenAIRE

    Carulli, Christian; Tonelli, Filippo; Innocenti, Matteo; Gambardella, Bonaventura; Muncibì, Francesco; Innocenti, Massimo

    2015-01-01

    Background Extracorporeal shockwave therapy is a conservative treatment for several painful musculoskeletal disorders. The aim of the study was the assessment of the relief from pain by the shockwave therapy in a population of consecutive patients affected by specific pathologies. Materials and methods A group of consecutive patients were studied and treated. They were affected by calcific tendonitis of the shoulder (129 patients), chronic Achilles tendinopathy (102 patients), and lateral epi...

  9. 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.

  10. Production of PGE(2) increases in tendons subjected to repetitive mechanical loading and induces differentiation of tendon stem cells into non-tenocytes.

    Science.gov (United States)

    Zhang, Jianying; Wang, James H-C

    2010-02-01

    Whether tendon inflammation is involved in the development of tendinopathy or degenerative changes of the tendon remains a matter of debate. We explored this question by performing animal and cell culture experiments to determine the production and effects of PGE(2), a major inflammatory mediator in tendons. Mouse tendons were subjected to repetitive mechanical loading via treadmill running, and the effect of PGE(2) on proliferation and differentiation of tendon stem cells (TSCs) was assessed in vitro. Compared to levels in cage control mice, PGE(2) levels in mouse patellar and Achilles tendons were markedly increased in response to a bout of rigorous treadmill running. PGE(2) treatment of TSCs in culture decreased cell proliferation and induced both adipogenesis and osteogenesis of TSCs, as evidenced by accumulation of lipid droplets and calcium deposits, respectively. Effects of PGE(2) on both TSC proliferation and differentiation were apparently PGE(2)-dose-dependent. These findings suggest that high levels of PGE(2), which are present in tendons subjected to repetitive mechanical loading conditions in vivo as shown in this study, may result in degenerative changes of the tendon by decreasing proliferation of TSCs in tendons and also inducing differentiation of TSCs into adipocytes and osteocytes. The consequences of this PGE(2) effect on TSCs is the reduction of the pool of tenocytes for repair of tendons injured by mechanical loading, and production of fatty and calcified tissues within the tendon, often seen at the later stages of tendinopathy.

  11. 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.

  12. 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.

  13. Efficacy of a mesenchymal stem cell loaded surgical mesh for tendon repair in rats

    OpenAIRE

    Schon, Lew C.; Gill, Nicholas; Thorpe, Margaret; Davis, Joel; Nadaud, Joshua; Kim, Jooyoung; Molligan, Jeremy; Zhang, Zijun

    2014-01-01

    Objectives The purpose of this study was to investigate the efficacy of a composite surgical mesh for delivery of mesenchymal stem cells (MSCs) in tendon repair. Methods The MSC-loaded mesh composed of a piece of conventional surgical mesh and a layer of scaffold, which supported MSC-embedded alginate gel. A 3-mm defect was surgically created at the Achilles tendon-gastrocnemius/soleus junction in 30 rats. The tendon defects were repaired with either 1) MSC-loaded mesh; or 2) surgical mesh on...

  14. 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 < 0.001) larger in OC, OE, and OS, respectively. Among older groups, OS had significantly larger tendon CSA compared with OC (P = 0.033). No significant between-group differences were observed in Achilles tendon stiffness. In older groups, 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 < 0.05) and YC (P < 0.05). These data suggest that long-term running does not counteract the previously reported age-related increase in tendon CSA, but, instead, may have an additive effect. The greatest Achilles tendon CSA was observed in OS followed by OE and OC, suggesting that adaptation to running exercise is loading intensity dependent. Achilles tendon stiffness was maintained in older groups, even though all older groups displayed larger tendon CSA and lower tendon Young's modulus. Shorter soleus muscle fascicles in OE runners may be an adaptation to life

  15. Posterior Tibial Tendon Dysfunction

    Science.gov (United States)

    .org Posterior Tibial Tendon Dysfunction Page ( 1 ) Posterior tibial tendon dysfunction is one of the most common problems of the foot and ankle. It occurs when the posterior tibial tendon becomes inflamed or torn. As a result, the ...

  16. [Laser therapy of Achilles tendinitis].

    Science.gov (United States)

    Darre, E M; Klokker, M; Lund, P; Rasmussen, J D; Hansen, K; Vedtofte, P E

    1994-11-07

    The effects of low level laser treatment in soldiers with achilles tendinitis were studied in a prospective, randomized and double blind trial. Eighty-nine soldiers were enrolled in the study. Forty-six were randomized to treatment with active laser and 43 to treatment with placebo laser. No statistically significant differences in the number of consultations, morning stiffness, tenderness, crepitation, swelling, redness, VAS-score of pain and degree of unfitness for duty were found between the two treatment groups.

  17. 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.

  18. 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.

  19. Reduction in tendon elasticity from unloading is unrelated to its hypertrophy.

    Science.gov (United States)

    Kinugasa, Ryuta; Hodgson, John A; Edgerton, V Reggie; Shin, David D; Sinha, Shantanu

    2010-09-01

    Tendinous tissues respond to chronic unloading with adaptive changes in mechanical, elastic, and morphological properties. However, little is known about the changes in the detailed structures of the entire tendinous tissue and whether the change in tendon stiffness is related to morphology. We investigated changes in dimensional (volume, cross-sectional area, segmented lengths) and elastic (Young's modulus) properties of the Achilles tendon and distal aponeurosis in response to chronic unilateral lower limb suspension (ULLS) using velocity encoded phase contrast (VE-PC) and three-dimensional morphometric magnetic resonance imaging (MRI). Five healthy subjects underwent ULLS for 4 wk. Axial morphometric MRI was acquired along the entire length from the calcaneous to the medial gastrocnemius insertion. An oblique sagittal VE-PC MRI was also acquired. The Young's modulus could be calculated from this cine dynamic sequence of velocity encoded images from the slope of the stress-strain curve during the submaximal isometric plantar flexion. After 4 wk of ULLS, we found significant (46.7%) decrease in maximum plantar flexion torque. The total volumes of entire tendinous tissue (determined as the sum of the Achilles tendon and distal aponeurosis) increased significantly by 6.4% (11.9 vs. 12.7 ml) after ULLS. In contrast, Young's modulus decreased significantly by 10.4% (211.7 vs. 189.6 MPa) for the Achilles tendon and 29.0% for the distal aponeurosis (158.8 vs. 113.0 MPa) following ULLS. There was no significant correlation between relative change in volume and Young's modulus with 4 wk of ULLS. It is suggested that, although tendon hypertrophy can be expected to adversely affect tendon stiffness, the absence of any significant correlation between the magnitude of tendon hypertrophy and reduced Young's modulus indicates that dimensional factors were not critical to the elastic properties.

  20. Low-power-laser therapy used in tendon damage

    Science.gov (United States)

    Strupinska, Ewa

    1996-03-01

    The following paper covers evaluation of low-power laser therapy results in chronic Achilles tendon damage and external Epicondylalia (tennis elbow). Fifty patients with Achilles damage (18 women and 32 men, age average 30, 24 plus or minus 10, 39 years) and fifty patients having external Epicondyalgiae (31 women and 19 men, age average 44, 36 plus or minus 10, 88 years) have been examined. The patients were irradiated by semiconductor infrared laser wavelength 904 nm separately or together with helium-neon laser wavelength 632.8 nm. The results of therapy have been based on the patient's interviews and examinations of patients as well as on the Laitinen pain questionnaire. The results prove analgesic effects in usage of low- power laser radiation therapy can be obtained.

  1. 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.

  2. 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.

  3. Diseases of the tendons and tendon sheaths.

    Science.gov (United States)

    Steiner, Adrian; Anderson, David E; Desrochers, André

    2014-03-01

    Contracted flexor tendon leading to flexural deformity is a common congenital defect in cattle. Arthrogryposis is a congenital syndrome of persistent joint contracture that occurs frequently in Europe as a consequence of Schmallenberg virus infection of the dam. Spastic paresis has a hereditary component, and affected cattle should not be used for breeding purposes. The most common tendon avulsion involves the deep digital flexor tendon. Tendon disruptions may be successfully managed by tenorrhaphy and external coaptation or by external coaptation alone. Medical management alone is unlikely to be effective for purulent tenosynovitis.

  4. 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.

  5. Eccentric and concentric loading of the triceps surae: an in vivo study of dynamic muscle and tendon biomechanical parameters.

    Science.gov (United States)

    Chaudhry, Saira; Morrissey, Dylan; Woledge, Roger C; Bader, Dan L; Screen, Hazel R C

    2015-04-01

    Triceps surae eccentric exercise is more effective than concentric exercise for treating Achilles tendinopathy, however the mechanisms underpinning these effects are unclear. This study compared the biomechanical characteristics of eccentric and concentric exercises to identify differences in the tendon load response. Eleven healthy volunteers performed eccentric and concentric exercises on a force plate, with ultrasonography, motion tracking, and EMG applied to measure Achilles tendon force, lower limb movement, and leg muscle activation. Tendon length was ultrasonographically tracked and quantified using a novel algorithm. The Fourier transform of the ground reaction force was also calculated to investigate for tremor, or perturbations. Tendon stiffness and extension did not vary between exercise types (P = .43). However, tendon perturbations were significantly higher during eccentric than concentric exercises (25%-40% higher, P = .02). Furthermore, perturbations during eccentric exercises were found to be negatively correlated with the tendon stiffness (R2 = .59). The particular efficacy of eccentric exercise does not appear to result from variation in tendon stiffness or extension within a given session. However, varied perturbation magnitude may have a role in mediating the observed clinical effects. This property is subject-specific, with the source and clinical time-course of such perturbations requiring further research.

  6. 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.

  7. 3-D ultrastructure and collagen composition of healthy and overloaded human tendon

    DEFF Research Database (Denmark)

    Pingel, Jessica; Lu, Yinhui; Starborg, Tobias

    2014-01-01

    block face-scanning electron microscopy were made on two individuals. In the tendinopathic regions, compared with the flanking healthy tissue, we observed: (i) an increase in the ratio of collagen III : I proteins; (ii) buckling of the collagen fascicles in the ECM; (iii) buckling of tenocytes......Achilles tendinopathies display focal tissue thickening with pain and ultrasonography changes. Whilst complete rupture might be expected to induce changes in tissue organization and protein composition, little is known about the consequences of non-rupture-associated tendinopathies, especially...... with regards to changes in the content of collagen type I and III (the major collagens in tendon), and changes in tendon fibroblast (tenocyte) shape and organization of the extracellular matrix (ECM). To gain new insights, we took biopsies from the tendinopathic region and flanking healthy region of Achilles...

  8. Biologics for tendon repair.

    Science.gov (United States)

    Docheva, Denitsa; Müller, Sebastian A; Majewski, Martin; Evans, Christopher H

    2015-04-01

    Tendon injuries are common and present a clinical challenge to orthopedic surgery mainly because these injuries often respond poorly to treatment and require prolonged rehabilitation. Therapeutic options used to repair ruptured tendons have consisted of suture, autografts, allografts, and synthetic prostheses. To date, none of these alternatives has provided a successful long-term solution, and often the restored tendons do not recover their complete strength and functionality. Unfortunately, our understanding of tendon biology lags far behind that of other musculoskeletal tissues, thus impeding the development of new treatment options for tendon conditions. Hence, in this review, after introducing the clinical significance of tendon diseases and the present understanding of tendon biology, we describe and critically assess the current strategies for enhancing tendon repair by biological means. These consist mainly of applying growth factors, stem cells, natural biomaterials and genes, alone or in combination, to the site of tendon damage. A deeper understanding of how tendon tissue and cells operate, combined with practical applications of modern molecular and cellular tools could provide the long awaited breakthrough in designing effective tendon-specific therapeutics and overall improvement of tendon disease management.

  9. Achilles tendinosis: Changes in biochemical composition and collagen turnover rate

    NARCIS (Netherlands)

    Mos, M. de; El, B. van; Groot, J. de; Jahr, H.; Schie, H.T.M. van; Arkel, E.R. van; Tol, H.; Heijboer, R.; Osch, G.J.V.M. van; Verhaar, J.A.N.

    2007-01-01

    Background: Understanding biochemical and structural changes of the extracellular matrix in Achilles tendinosis might be important for developing mechanism-based therapies. Hypothesis: In Achilles tendinosis, changes occur in biochemical composition and collagen turnover rate. Study Design: Descript

  10. Achilles tendinosis - Changes in biochemical composition and collagen turnover rate

    NARCIS (Netherlands)

    de Mos, Marieke; van El, Benno; DeGroot, Jeroen; Jahr, Holger; van Schie, Hans T. M.; van Arkel, Ewoud R.; Tol, Hans; Heijboer, Rien; van Osch, Gerjo J. V. M.; Verhaar, Jan A. N.

    2007-01-01

    Background: Understanding biochemical and structural changes of the extracellular matrix in Achilles tendinosis might be important for developing mechanism-based therapies. Hypothesis: In Achilles tendinosis, changes occur in biochemical composition and collagen turnover rate. Study Design: Descript

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

    OpenAIRE

    Notarnicola, Angela; Moretti, Biagio

    2012-01-01

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

  12. Comparison of the inhibitory response to tendon and cutaneous afferent stimulation in the human lower limb.

    Science.gov (United States)

    Rogasch, Nigel C; Burne, John A; Türker, Kemal S

    2012-01-01

    A powerful early inhibition is seen in triceps surae after transcutaneous electrical stimulation of the Achilles tendon [tendon electrical stimulation (TES)]. The aim of the present study was to confirm results from surface electromyogram (SEMG) recordings that the inhibition is not wholly or partly due to stimulation of cutaneous afferents that may lie within range of the tendon electrodes. Because of methodological limitations, SEMG does not reliably identify the time course of inhibitory and excitatory reflex components. This issue was revisited here with an analysis of changes in single motor unit (SMU) firing rate [peristimulus frequencygram (PSF)] and probability [peristimulus time histogram (PSTH)] to reexamine the time course of inhibitory SMU events that follow purely cutaneous (superficial sural) nerve stimulation. Results were then compared with similar data from TES. When compared with the reflex response to TES, sural nerve stimulation resulted in a longer onset latency of the primary inhibition and a weaker effect on SMU firing probability and rate. PSF also revealed that decreased SMU firing rates persisted during the excitation phase in SEMG, suggesting that the initial inhibition was more prolonged than previously reported. In a further study, the transcutaneous SEMG Achilles tendon response was compared with that from direct intratendon stimulation with insulated needle electrodes. This method should attenuate the SEMG response if it is wholly or partly dependent on cutaneous afferents. However, subcutaneous stimulation of the tendon produced similar components in the SEMG, confirming that cutaneous afferents made little or no contribution to the initial inhibition following TES.

  13. Influence of acute and chronic streptozotocin-induced diabetes on the rat tendon extracellular matrix and mechanical properties

    DEFF Research Database (Denmark)

    Volper, Brent D; Huynh, Richard T; Arthur, Kathryn A;

    2015-01-01

    .05). In contrast, patellar tendon hydroxylysyl pyridinoline cross linking and collagen fibril organization were unchanged by diabetes or insulin (P > 0.05). Our findings suggest that 10 wk of streptozotocin-induced diabetes does not alter rat tendon mechanical properties even with an increase in collagen content......Diabetes is a major risk factor for tendinopathy, and tendon abnormalities are common in diabetic patients. The purpose of the present study was to evaluate the effect of streptozotocin (60 mg/kg)-induced diabetes and insulin therapy on tendon mechanical and cellular properties. Sprague-Dawley rats...... (n = 40) were divided into the following four groups: nondiabetic (control), 1 wk of diabetes (acute), 10 wk of diabetes (chronic), and 10 wk of diabetes with insulin treatment (insulin). After 10 wk, Achilles tendon and tail fascicle mechanical properties were similar between groups (P > 0.05). Cell...

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

    Directory of Open Access Journals (Sweden)

    CT Thorpe

    2013-01-01

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

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

    Science.gov (United States)

    Thorpe, C T; Udeze, C P; Birch, H L; Clegg, P D; Screen, H Rc

    2013-01-08

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

  16. FIBRILLINS IN TENDON

    Directory of Open Access Journals (Sweden)

    Betti Giusti

    2016-10-01

    Full Text Available Tendons among connective tissue, mainly collagen, contain also elastic fibres made of fibrillin 1, fibrillin 2 and elastin that are broadly distributed in tendons and represent 1-2% of the dried mass of the tendon. Only in the last years, studies on structure and function of elastic fibres in tendons have been performed. Aim of this review is to revise data on the organization of elastic fibres in tendons, in particular fibrillin structure and function, and on the clinical manifestations associated to alterations of elastic fibres in tendons. Indeed, microfibrils may contribute to tendon mechanics; therefore, their alterations may cause joint hypermobility and contractures which have been found to be clinical features in patients with Marfan syndrome and Beals syndrome. The two diseases are caused by mutations in genes FBN1 and FBN2 encoding fibrillin 1 and fibrillin 2, respectively.

  17. Common overuse tendon problems: A review and recommendations for treatment.

    Science.gov (United States)

    Wilson, John J; Best, Thomas M

    2005-09-01

    There is a common misconception that symptomatic tendon injuries are inflammatory; because of this, these injuries often are mislabeled as "tendonitis."' Acute inflammatory tendinopathies exist, but most patients seen in primary care will have chronic symptoms suggesting a degenerative condition that should be labeled as "tendinosus" or "tendinopathy." Accurate diagnosis requires physicians to recognize the historical features, anatomy, and useful physical examination maneuvers for these common tendon problems. The natural history is gradually increasing load-related localized pain coinciding with increased activity. The most common overuse tendinopathies involve the rotator cuff, medial and lateral elbow epicondyles, patellar tendon, and Achilles tendon. Examination should include thorough inspection to assess for swelling, asymmetry, and erythema of involved tendons; range-of-motion testing; palpation for tenderness; and examination maneuvers that simulate tendon loading and reproduce pain. Plain radiography, ultrasonography, and magnetic resonance imaging can be helpful if the diagnosis remains unclear. Most patients with overuse tendinopathies (about 80 percent) fully recover within three to six months, and outpatient treatment should consist of relative rest of the affected area, icing, and eccentric strengthening exercises. Although topical and systemic nonsteroidal anti-inflammatory drugs are effective for acute pain relief, these cannot be recommended in favor of other analgesics. Injected corticosteroids also can relieve pain, but these drugs should be used with caution. Ultrasonography, shock wave therapy, orthotics, massage, and technique modification are treatment options, but few data exist to support their use at this time. Surgery is an effective treatment that should be reserved for patients who have failed conservative therapy.

  18. Achilles Vivacqua: vida e obra

    Directory of Open Access Journals (Sweden)

    Juliana Cristina de Carvalho

    2016-09-01

    Full Text Available Este artigo trata de um projeto de inventariação e organização de fundos de escritor, que resultou do recebimento da doação, no Acervo de Escritores Mineiros da UFMG, de documentos de Achilles Vivacqua. A partir da análise dos documentos, descobriu-se o escritor, sua escrita e a contribuição de sua arte para o cenário literário mineiro. O aparato teórico utilizado se baseou em obras teórico-críticas sobre o modernismo e a literatura produzida em Minas, fortuna crítica sobre o autor, e estudos sobre a arquivística de estudiosos como Haydée Coelho, Reinaldo Marques e outros que refletem sobre pesquisas em fontes primárias. Por meio das escavações, constatamos que Vivacqua teve, em sua época, relevância para o cenário cultural do Brasil, tendo participado do movimento modernista mineiro. Outra conclusão a que chegamos é que muito se pode apreender sobre um escritor e seu projeto literário, o que reforça o valor da pesquisa em arquivos.

  19. JOINT MOBILIZATION IN THE MANAGEMENT OF PERSISTENT INSERTIONAL ACHILLES TENDINOPATHY: A CASE REPORT

    Science.gov (United States)

    Post, Andrew A.; Mischke, John J.; Sault, Josiah D.

    2017-01-01

    Background & Purpose Insertional Achilles tendinopathy (IAT) can be a challenging condition to manage conservatively. Eccentric exercise is commonly used in the management of chronic tendinopathy; however, it may not be as helpful for insertional tendon problems as compared to mid-portion dysfunction. While current evidence describing the physical therapy management of IAT is developing, gaps still exist in descriptions of best practice. The purpose of this case report is to describe the management of a patient with persistent IAT utilizing impairment-based joint mobilization, self-mobilization, and exercise. Case description A 51-year-old male was seen in physical therapy for complaints of posterior heel pain and reduced running capacity. He was seen by multiple physical therapists previously, but reported continued impairment, and functional restriction. Joint-based non-thrust mobilization and self-mobilization exercise were performed to enhance his ability to run and reduce symptoms. Outcomes The subject was seen for four visits over the course of two months. He made clinically significant improvements on the Foot and Ankle Activity Measure and Victorian Institute of Sport Assessment-Achilles tendon outcomes, was asymptomatic, and participated in numerous marathons. Improvements were maintained at one-year follow-up. Discussion Mobility deficits can contribute to the development of tendinopathy, and without addressing movement restrictions, symptoms and functional decline related to tendinopathy may persist. Joint-directed manual therapy may be a beneficial intervention in a comprehensive plan of care in allowing patients with chronic tendon changes to optimize function. Level of Evidence Therapy, Level 4 PMID:28217424

  20. Achilles and Patellar Tendinopathy Loading Programmes

    DEFF Research Database (Denmark)

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

    2013-01-01

    INTRODUCTION: Achilles and patellar tendinopathy are overuse injuries that are common among athletes. Isolated eccentric muscle training has become the dominant conservative management strategy for Achilles and patellar tendinopathy but, in some cases, up to 45 % of patients may not respond....... Eccentric-concentric progressing to eccentric (Silbernagel combined) and eccentric-concentric isotonic (heavy-slow resistance; HSR) loading have also been investigated. In order for clinicians to make informed decisions, they need to be aware of the loading options and comparative evidence. The mechanisms...... of loading also need to be elucidated in order to focus treatment to patient deficits and refine loading programmes in future studies. OBJECTIVES: The objectives of this review are to evaluate the evidence in studies that compare two or more loading programmes in Achilles and patellar tendinopathy...

  1. Repair of flexor tendon defects of rabbit with tissue engineering method

    Institute of Scientific and Technical Information of China (English)

    何清义; 李起鸿; 陈秉礼; 王智彪

    2002-01-01

    To repair rabbit tendon defects with tissue engineering method. Methods: The third passage of fetal skin fibroblast cells was labeled with 5-bromo-2' deoxyuridine (Brdu) and then seeded on human amnion extracellular matrix (HA-ECM). Using 1 cm-long-Achilles tendon .defects as repairing models in the experimental group, tendon defects were core bridged with polydioxanone (PDS) and then capsulated with the complex of fibroblasts-HA-ECM. In the control group I, defective tendons were sutured with PDS following the former procedure and capsulated with HA-ECM (without fibroblasts). In the control group Ⅱ,only PDS was applied to connect the defective tendons.Gross examination, light microscopy, scanning electronmicroscopy and biomechanical measurement of the repaired tendons were respectively performed at postoperative 1, 2, 3 month as well as immunohistochemical examination. Results: The optimal cell concentration for seeding fibroblasts was 3.5 × 106 cells/ml. Cells grew well and radiated or paralleled on HA-ECM. Immunohistochemistry showed that the labeled seed fibroblasts played an important role in tendonization. The results of light microscopy,electron microscopy, and biomechanical assessment suggested that the rate and quality of tendonization in the experimental group was superior to those of the control group Ⅰ and Ⅱ. The tensile strength in the experimental group was the greatest, the next was in the control group Ⅰ,and the worst in the control group Ⅱ ( P < 0.05). Conclusions: HA-ECM is the excellent carrier for fibroblasts. Fibroblasts-HA-ECM complex has the capability to repair tendon defect and to tendonize with rapid rate and good performance three months after operation. Its tensile strength is 81.8% of that of normal tendon.

  2. 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.

  3. Comparación entre la cirugía abierta y el método mínimamente invasivo para roturas agudas del tendón de Aquiles. [Comparison between open surgery and the minimally invasive method for acute Achilles tendon ruptures.

    Directory of Open Access Journals (Sweden)

    Ignacio Ricardo Arzac Ulla

    2016-11-01

    Full Text Available Introducción. La reparación quirúrgica puede realizarse mediante cirugía abierta o por técnicas mínimamente invasivas. La técnica percutánea combina las ventajas del tratamiento quirúrgico abierto con el tratamiento ortopédico. El objetivo de este trabajo es comparar la técnica mínimamente invasiva de Dresden descripto por Amlang con la cirugía abierta convencional. Material y métodos. Estudio comparativo de 15 casos de roturas de tendón de Aquiles operados con técnica abierta convencional y 15 casos operados con la técnica percutánea de Dresden. Se evaluaron características del intraoperatorio y hospitalización, resultados funcionales de acuerdo a score AOFAS, ARPS (achilles ruptura performance score, escala visual análoga y rango de movilidad de tobillo. Resultados. Se mencionan los resultados comparativos del tiempo quirúrgico, trofismo, longitud de cicatriz, diferencia comparativa en el perímetro del gemelo. El AOFAS a 5 meses: Grupo A: 90 puntos, y grupo B: 95 puntos. Retorno a la actividad laboral: Grupo A, 7 meses promedio, Grupo B: 3,53 meses promedio. Retorno a actividad deportiva: en el grupo A: media 12,22 meses; Grupo B: media 6,53 meses. Conclusión: La reparación percutánea de Dresden, es una buena opción para las roturas de tendón de Aquiles; con buena evolución clínico-funcional minimizando los riesgos de re rotura y lesiones del nervio sural.

  4. Ciprofloxacin-induced tendinopathy of the gluteal tendons.

    Science.gov (United States)

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

    2014-11-01

    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 decreased range of motion. MRI of the hips showed bilateral tendinopathy of the gluteal muscle insertion. A diagnosis of ciprofloxacin-induced tendinopathy was made based on her MRI and a Naranjo score of 7. Ciprofloxacin was stopped and her pain quickly resolved. Fluoroquinolones cause tendinopathy in 0.14 % to 0.4 % of patients using these agents. Fluoroquinolone-associated tendinopathy is a serious adverse reaction that can affect many tendons and should be considered in any patient presenting with new musculoskeletal complaints and in whom there is a history of fluoroquinolone use within the preceding 6 months.

  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. Camel Tendon Soup

    Institute of Scientific and Technical Information of China (English)

    1995-01-01

    Ingredients: about 400 grams of camel tendon Supplementary ingredients: mushrooms, green beans, winter bamboo shoots, cooking wine, sesame oil, salt, pepper, sugar, vinegar, Chinese onion and ginger. Directions: 1. Soak the tendons in water and take away the bone and hair, and boil the tendons in broth to remove the strong smell. Then cut the tendons, mushrooms and winter bamboo shoots into small cubes. 2. Heat oil in a wok and fry the pepper until it’s aromatic. Add mushrooms, winter bamboo shoots and green beans and stir.

  7. Calcific tendonitis : a model.

    Science.gov (United States)

    Gohr, Claudia M; Fahey, Mark; Rosenthal, Ann K

    2007-01-01

    Calcific tendonitis is a common clinical condition associated with high rates of tendon rupture, prolonged symptoms, and poor response to therapy. Little is known about the pathogenesis of calcifications in tendons and consequently few effective therapies are available. We hypothesized that tendon calcification, like pathologic calcification in other sites, was generated by extracellular organelles known as matrix vesicles and that isolated matrix vesicles would constitute the basis for a useful model of this process. Tendon matrix vesicles were isolated from adult porcine patellar tendons using enzymatic digestion and differential centrifugation. Vesicle morphology was examined with electron microscopy. Levels of calcium, phosphate, pyrophosphate, ATP, and mineralization-associated enzymes were measured and compared with articular cartilage vesicles from porcine articular cartilage. Vesicles were embedded in agarose gels with or without type I collagen or dermatan sulfate and incubated in calcifying salt solution trace labeled with (45)calcium. (45)Calcium in the vesicle fraction was measured after 5-7 days. The type of mineral formed was determined by micro-x-ray diffraction. Matrix vesicles isolated from adult porcine tendon were similar morphologically to those obtained from articular cartilage. They contained mineralization-related enzymes and formed hydroxyapatite mineral in vitro. Mineralization was suppressed by levamisole and modulated by extracellular matrix components. Matrix vesicles isolated from tendons mineralize in vitro. This model may aid in the study of the pathogenesis of calcific tendonitis as well as serve as a means to identify effective therapies for this common disorder.

  8. Hemispheric specificity for proprioception: Postural control of standing following right or left hemisphere damage during ankle tendon vibration.

    Science.gov (United States)

    Duclos, Noémie C; Maynard, Luc; Abbas, Djawad; Mesure, Serge

    2015-11-02

    Right brain damage (RBD) following stroke often causes significant postural instability. In standing (without vision), patients with RBD are more unstable than those with left brain damage (LBD). We hypothesised that this postural instability would relate to the cortical integration of proprioceptive afferents. The aim of this study was to use tendon vibration to investigate whether these changes were specific to the paretic or non-paretic limbs. 14 LBD, 12 RBD patients and 20 healthy subjects were included. Displacement of the Centre of Pressure (CoP) was recorded during quiet standing, then during 3 vibration conditions (80 Hz - 20s): paretic limb, non-paretic limb (left and right limbs for control subjects) and bilateral. Vibration was applied separately to the peroneal and Achilles tendons. Mean antero-posterior position of the CoP, variability and velocity were calculated before (4s), during and after (24s) vibration. For all parameters, the strongest perturbation was during Achilles vibrations. The Achilles non-paretic condition induced a larger backward displacement than the Achilles paretic condition. This condition caused specific behaviour on the velocity: the LBD group was perturbed at the onset of the vibrations, but gradually recovered their stability; the RBD group was significantly perturbed thereafter. After bilateral Achilles vibration, RBD patients required the most time to restore initial posture. The reduction in use of information from the paretic limb may be a central strategy to deal with risk-of-fall situations such as during Achilles vibration. The postural behaviour is profoundly altered by lesions of the right hemisphere when proprioception is perturbed.

  9. Sex Hormones and Tendon

    DEFF Research Database (Denmark)

    Hansen, Mette; Kjaer, Michael

    2016-01-01

    The risk of overuse and traumatic tendon and ligament injuries differ between women and men. Part of this gender difference in injury risk is probably explained by sex hormonal differences which are specifically distinct during the sexual maturation in the teenage years and during young adulthood....... The effects of the separate sex hormones are not fully elucidated. However, in women, the presence of estrogen in contrast to very low estrogen levels may be beneficial during regular loading of the tissue or during recovering after an injury, as estrogen can enhance tendon collagen synthesis rate. Yet...... has also been linked to a reduced responsiveness to relaxin. The present chapter will focus on sex difference in tendon injury risk, tendon morphology and tendon collagen turnover, but also on the specific effects of estrogen and androgens....

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. Inhibitory mechanisms following electrical stimulation of tendon and cutaneous afferents in the lower limb.

    Science.gov (United States)

    Khan, Serajul I; Burne, John A

    2010-01-13

    Electrical stimulation of the Achilles tendon (TES) produced strong reflex depression (duration>250 ms) of a small background contraction in both heads of gastrocnemius (GA) via large diameter electrodes localized to the tendon. The inhibitory responses were produced without electrical (M wave) or mechanical (muscle twitch) signs of direct muscle stimulation. In this study, the contribution of presynaptic and postsynaptic mechanisms to the depression was investigated by studying conditioning effects of tendon afferent stimulation on the mechanical tendon reflex (TR) and magnetic motor evoked potential (MEP). TES completely inhibited the TR over an ISI of 300 ms that commenced before and continued during and after the period of voluntary EMG depression. Tendon afferent conditioning stimuli also partially inhibited the MEP, but over a short time course confined to the period of voluntary EMG depression. The strength and extended time course of tendon afferent conditioning of the TR and its failure to produce a similar depression of the MEP are consistent with a mechanism involving presynaptic inhibition of Ia terminals. Cutaneous (sural nerve) afferent conditioning partially inhibited the TR and MEP over a short time course (ISI voluntary EMG. This was consistent with the postsynaptic origin of cutaneous inhibition of the motoneurons.

  15. 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.

  16. Tendon repair augmented with a novel circulating stem cell population.

    Science.gov (United States)

    Daher, Robert J; Chahine, Nadeen O; Razzano, Pasquale; Patwa, Sohum A; Sgaglione, Nicholas J; Grande, Daniel A

    2011-01-01

    Tendon ruptures are common sports-related injuries that are often treated surgically by the use of sutures followed by immobilization. However, tendon repair by standard technique is associated with long healing time and often suboptimal repair. Methods to enhance tendon repair time as well as the quality of repair are currently unmet clinical needs. Our hypothesis is that the introduction of a unique stem cell population at the site of tendon transection would result in an improved rate and quality of repair. Achilles tendons of fifty-one Sprague-Dawley rats were transected and suture-repaired. In half of the rats, a biodegradable scaffold seeded with allogenic circulating stem cells was placed as an onlay to the defect site in addition to the suture repair. The other half was treated with suture alone to serve as the control group. Animals were randomized to a two-, four-, or six-week time group. At the time of necropsy, tendons were harvested and prepared for either biomechanical or histological analysis. Histological slides were evaluated in a blinded fashion with the use of a grading scale. By two weeks, the experimental group demonstrated a significant improvement in repair compared to controls with no failures. Average histological scores of 0.6 and 2.6 were observed for the experimental and control group respectively. The experimental group demonstrated complete bridging of the transection site with parallel collagen fiber arrangement. By four weeks, both groups showed a continuing trend of healing, with the scaffold group exceeding the histological quality of the tissue repaired with suture alone. Biomechanically, the experimental group had a decreasing cross-sectional area with time which was also associated with a significant increase in the ultimate tensile strength of the tendons, reaching 4.2MPa by six weeks. The experimental group also achieved a significantly higher elastic toughness by six weeks and saw an increase in the tensile modulus, reaching

  17. 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.

  18. Local biochemical and morphological differences in human Achilles tendinopathy

    DEFF Research Database (Denmark)

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

    2012-01-01

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

  19. Influence of acute and chronic streptozotocin-induced diabetes on the rat tendon extracellular matrix and mechanical properties.

    Science.gov (United States)

    Volper, Brent D; Huynh, Richard T; Arthur, Kathryn A; Noone, Joshua; Gordon, Benjamin D; Zacherle, Emily W; Munoz, Eduardo; Sørensen, Mikkel A; Svensson, René B; Broderick, Tom L; Magnusson, S Peter; Howden, Reuben; Hale, Taben M; Carroll, Chad C

    2015-11-01

    Diabetes is a major risk factor for tendinopathy, and tendon abnormalities are common in diabetic patients. The purpose of the present study was to evaluate the effect of streptozotocin (60 mg/kg)-induced diabetes and insulin therapy on tendon mechanical and cellular properties. Sprague-Dawley rats (n = 40) were divided into the following four groups: nondiabetic (control), 1 wk of diabetes (acute), 10 wk of diabetes (chronic), and 10 wk of diabetes with insulin treatment (insulin). After 10 wk, Achilles tendon and tail fascicle mechanical properties were similar between groups (P > 0.05). Cell density in the Achilles tendon was greater in the chronic group compared with the control and acute groups (control group: 7.8 ± 0.5 cells/100 μm(2), acute group: 8.3 ± 0.4 cells/100 μm(2), chronic group: 10.9 ± 0.9 cells/100 μm(2), and insulin group: 9.2 ± 0.8 cells/100 μm(2), P collagen content was ∼32% greater in the chronic and acute groups compared with the control or insulin groups (control group: 681 ± 63 μg collagen/mg dry wt, acute group: 938 ± 21 μg collagen/mg dry wt, chronic: 951 ± 52 μg collagen/mg dry wt, and insulin group: 596 ± 84 μg collagen/mg dry wt, P collagen fibril organization were unchanged by diabetes or insulin (P > 0.05). Our findings suggest that 10 wk of streptozotocin-induced diabetes does not alter rat tendon mechanical properties even with an increase in collagen content. Future studies could attempt to further address the mechanisms contributing to the increase in tendon problems noted in diabetic patients, especially since our data suggest that hyperglycemia per se does not alter tendon mechanical properties.

  20. Effects of repeated concentric and eccentric contractions on tendon blood circulation.

    Science.gov (United States)

    Kubo, K

    2015-06-01

    Previous studies demonstrated that treatment involving eccentric training was effective in the conservative management of chronic tendinosis. However, the mechanisms for these phenomena are unknown. The purpose of this study was to compare changes in blood circulation of the tendons after the repeated concentric and eccentric contractions. 11 healthy males volunteered for this study. Subjects performed the repeated concentric (CON) and eccentric (ECC) contractions (5 sets of 10 maximal voluntary contractions) of the plantar flexors. During and after repeated contractions, oxyhemoglobin (Oxy), deoxyhemoglobin (Deoxy), total hemoglobin (THb), and oxygen saturation (StO2) of the Achilles tendons were measured using red laser lights. Oxy and THb increased during and after ECC, but not CON. Deoxy decreased during both CON and ECC. Increase in StO2 during and after ECC was greater than that during and after CON. These results suggested that changes in blood circulation of the Achilles tendon during and after repeated eccentric contractions were more remarkable than those during and after repeated concentric contractions.

  1. Tendon transfer or tendon graft for ruptured finger extensor tendons in rheumatoid hands.

    Science.gov (United States)

    Chung, U S; Kim, J H; Seo, W S; Lee, K H

    2010-05-01

    We evaluated the clinical outcome of tendon reconstruction using tendon graft or tendon transfer and the parameters related to clinical outcome in 51 wrists of 46 patients with rheumatoid arthritis with finger extensor tendon ruptures. At a mean follow-up of 5.6 years, the mean metacarpophalangeal (MP) joint extension lag was 8 degrees (range, 0-45) and the mean visual analogue satisfaction scale was 74 (range, 10-100). Clinical outcome did not differ significantly between tendon grafting and tendon transfer. The MP joint extension lag correlated with the patient's satisfaction score, but the pulp-to-palm distance did not correlate with patient satisfaction. We conclude that both tendon grafting and tendon transfer are reliable reconstruction methods for ruptured finger extensor tendons in rheumatoid hands.

  2. Regulation of tendon differentiation by scleraxis distinguishes force-transmitting tendons from muscle-anchoring tendons.

    Science.gov (United States)

    Murchison, Nicholas D; Price, Brian A; Conner, David A; Keene, Douglas R; Olson, Eric N; Tabin, Clifford J; Schweitzer, Ronen

    2007-07-01

    The scleraxis (Scx) gene, encoding a bHLH transcription factor, is expressed in the progenitors and cells of all tendon tissues. To determine Scx function, we produced a mutant null allele. Scx-/- mice were viable, but showed severe tendon defects, which manifested in a drastically limited use of all paws and back muscles and a complete inability to move the tail. Interestingly, although the differentiation of all force-transmitting and intermuscular tendons was disrupted, other categories of tendons, the function of which is mainly to anchor muscles to the skeleton, were less affected and remained functional, enabling the viability of Scx-/- mutants. The force-transmitting tendons of the limbs and tail varied in the severity to which they were affected, ranging from dramatic failure of progenitor differentiation resulting in the loss of segments or complete tendons, to the formation of small and poorly organized tendons. Tendon progenitors appeared normal in Scx-/- embryos and a phenotype resulting from a failure in the condensation of tendon progenitors to give rise to distinct tendons was first detected at embryonic day (E)13.5. In the tendons that persisted in Scx-/- mutants, we found a reduced and less organized tendon matrix and disorganization at the cellular level that led to intermixing of tenocytes and endotenon cells. The phenotype of Scx-/- mutants emphasizes the diversity of tendon tissues and represents the first molecular insight into the important process of tendon differentiation.

  3. 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...

  4. 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 meas...

  5. Plyometric Training Favors Optimizing Muscle–Tendon Behavior during Depth Jumping

    Science.gov (United States)

    Hirayama, Kuniaki; Iwanuma, Soichiro; Ikeda, Naoki; Yoshikawa, Ayumi; Ema, Ryoichi; Kawakami, Yasuo

    2017-01-01

    The purpose of the present study was to elucidate how plyometric training improves stretch–shortening cycle (SSC) exercise performance in terms of muscle strength, tendon stiffness, and muscle–tendon behavior during SSC exercise. Eleven men were assigned to a training group and ten to a control group. Subjects in the training group performed depth jumps (DJ) using only the ankle joint for 12 weeks. Before and after the period, we observed reaction forces at foot, muscle–tendon behavior of the gastrocnemius, and electromyographic activities of the triceps surae and tibialis anterior during DJ. Maximal static plantar flexion strength and Achilles tendon stiffness were also determined. In the training group, maximal strength remained unchanged while tendon stiffness increased. The force impulse of DJ increased, with a shorter contact time and larger reaction force over the latter half of braking and initial half of propulsion phases. In the latter half of braking phase, the average electromyographic activity (mEMG) increased in the triceps surae and decreased in tibialis anterior, while fascicle behavior of the gastrocnemius remained unchanged. In the initial half of propulsion, mEMG of triceps surae and shortening velocity of gastrocnemius fascicle decreased, while shortening velocity of the tendon increased. These results suggest that the following mechanisms play an important role in improving SSC exercise performance through plyometric training: (1) optimization of muscle–tendon behavior of the agonists, associated with alteration in the neuromuscular activity during SSC exercise and increase in tendon stiffness and (2) decrease in the neuromuscular activity of antagonists during a counter movement. PMID:28179885

  6. Plyometric Training Favors Optimizing Muscle-Tendon Behavior during Depth Jumping.

    Science.gov (United States)

    Hirayama, Kuniaki; Iwanuma, Soichiro; Ikeda, Naoki; Yoshikawa, Ayumi; Ema, Ryoichi; Kawakami, Yasuo

    2017-01-01

    The purpose of the present study was to elucidate how plyometric training improves stretch-shortening cycle (SSC) exercise performance in terms of muscle strength, tendon stiffness, and muscle-tendon behavior during SSC exercise. Eleven men were assigned to a training group and ten to a control group. Subjects in the training group performed depth jumps (DJ) using only the ankle joint for 12 weeks. Before and after the period, we observed reaction forces at foot, muscle-tendon behavior of the gastrocnemius, and electromyographic activities of the triceps surae and tibialis anterior during DJ. Maximal static plantar flexion strength and Achilles tendon stiffness were also determined. In the training group, maximal strength remained unchanged while tendon stiffness increased. The force impulse of DJ increased, with a shorter contact time and larger reaction force over the latter half of braking and initial half of propulsion phases. In the latter half of braking phase, the average electromyographic activity (mEMG) increased in the triceps surae and decreased in tibialis anterior, while fascicle behavior of the gastrocnemius remained unchanged. In the initial half of propulsion, mEMG of triceps surae and shortening velocity of gastrocnemius fascicle decreased, while shortening velocity of the tendon increased. These results suggest that the following mechanisms play an important role in improving SSC exercise performance through plyometric training: (1) optimization of muscle-tendon behavior of the agonists, associated with alteration in the neuromuscular activity during SSC exercise and increase in tendon stiffness and (2) decrease in the neuromuscular activity of antagonists during a counter movement.

  7. Biomechanical and biochemical protective effect of low-level laser therapy for Achilles tendinitis.

    Science.gov (United States)

    Marcos, Rodrigo Labat; Arnold, Gilles; Magnenet, Vincent; Rahouadj, Rachid; Magdalou, Jacques; Lopes-Martins, Rodrigo Álvaro Brandão

    2014-01-01

    For three decades, low level laser therapy (LLLT) has been used for treatment of tendinitis as well as other musculoskeletal diseases. Nevertheless, the biological mechanisms involved remain not completely understood. In this work, the effects of LLLT and of the widely used nonsteroidal anti-inflammatory drug, diclofenac, have been compared in the case of collagenase-induced Achilles tendinitis. Wistar rats were treated with diclofenac or laser therapy. The tensile behavior of tendons was characterized through successive loading-unloading sequences. The method considered 11 characteristic parameters to describe the mechanical behavior. It was shown that during the acute inflammatory process of the tendon, the mechanical properties were significantly correlated to the high levels of MMP-3, MMP-9 and MMP-13 expression presented in a previous paper (Marcos, R.L., et al., 2012). The treatment by non-steroidal anti-inflammatory drugs such as diclofenac sodium produces a low protective effect and can affect the short-term biochemical and biomechanical properties. On the contrary, it is shown that LLLT exhibits the best results in terms of MMPs reduction and mechanical properties recovery. Thus, LLLT looks to be a promising and consistent treatment for tendinopathies.

  8. [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.

  9. Is there a relation between AOFAS ankle-hindfoot score and SF-36 in evaluation of Achilles ruptures treated by percutaneous technique?

    Science.gov (United States)

    Ceccarelli, Francesco; Calderazzi, Filippo; Pedrazzi, Giuseppe

    2014-01-01

    The percutaneous technique of Achilles tendon repair seems to offer satisfactory clinical and functional results, although these results have been evaluated mainly using objective rating scales. Recently, some "subjective" rating scales have been combined to evaluate the results of various surgical treatments. The purpose of the present study was to compare the results of a percutaneous Achilles tendon repair evaluated objectively using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and subjectively using the Medical Outcomes Study, short-form, 36-item questionnaire (SF-36) questionnaire. A total of 17 consecutive patients were treated for acute Achilles tendon rupture using the modified percutaneous Ma and Griffith technique. We reviewed all patients with a follow-up of 24 to 64 months (mean 45.5). At the final follow-up visit, the AOFAS ankle-hindfoot score of each patient was compared with each 1 of the 8 domains of the SF-36 questionnaire, using the parametric Pearson correlation coefficient and the equivalent nonparametric Spearman rho correlation coefficient. The relation between the objective (AOFAS) and subjective (SF-36) results showed a significant correlation (Pearson's correlation coefficient) between the physical functioning (r = 0.597, p = .011) and bodily pain (r = 0.663, p = .004) SF-36 domains, and a nonstatistically significant correlation with the other SF-36 domains. Very similar results were found using the nonparametric Spearman rho correlation coefficient. These results suggest that regarding pain and function, the AOFAS ankle-hindfoot score and SF-36 provide complementary information; therefore, we believe that the SF-36 questionnaire should be used with the AOFAS ankle-hindfoot score for a more complete evaluation of the outcome.

  10. Tendon sheath fibroma of the medial canthal tendon.

    Science.gov (United States)

    Andrew, Nicholas; Dodd, Tom; Selva, Dinesh; Davis, Garry

    2013-01-01

    Fibromas of the tendon sheath are slow-growing, benign tumors most commonly found on the hands and wrist. A fibroma of the tendon sheath arising from the medial canthal tendon presented as an enlarging nodule that had been present for 40 years. The fibroma was identified by microscopy and immunohistochemistry, and surgical resection appears to have been curative.

  11. 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.

  12. [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.

  13. Novel methods for tendon investigations

    DEFF Research Database (Denmark)

    Kjaer, M; Langberg, H; Bojsen-Møller, J;

    2008-01-01

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

  14. Arthroscopic Treatment of Calcific Tendonitis

    OpenAIRE

    2014-01-01

    Calcific tendonitis, or calcifying tendonitis, is a common disorder characterized by the multifocal accumulation of basic calcium phosphate crystals within the rotator cuff tendons. In most cases, the multifocal calcifications are located 1 to 2 cm from the insertion of the supraspinatus tendon on the greater tuberosity. The initial treatment should be nonoperative including oral anti-inflammatory medication and physical therapy. If this is unsuccessful, arthroscopic debridement of the deposi...

  15. Tendon Driven Finger Actuation System

    Science.gov (United States)

    Ihrke, Chris A. (Inventor); Reich, David M. (Inventor); Bridgwater, Lyndon (Inventor); Linn, Douglas Martin (Inventor); Askew, Scott R. (Inventor); Diftler, Myron A. (Inventor); Platt, Robert (Inventor); Hargrave, Brian (Inventor); Valvo, Michael C. (Inventor); Abdallah, Muhammad E. (Inventor); Permenter, Frank Noble (Inventor); Mehling, Joshua S. (Inventor)

    2013-01-01

    A humanoid robot includes a robotic hand having at least one finger. An actuation system for the robotic finger includes an actuator assembly which is supported by the robot and is spaced apart from the finger. A tendon extends from the actuator assembly to the at least one finger and ends in a tendon terminator. The actuator assembly is operable to actuate the tendon to move the tendon terminator and, thus, the finger.

  16. Golgi tendon organ reflex inhibition following manually applied acute static stretching.

    Science.gov (United States)

    Miller, Kevin C; Burne, John A

    2014-01-01

    Golgi tendon organ disinhibition may contribute to exercise-associated muscle cramp (henceforth referred to as "cramps") genesis. Static stretching pre-exercise is prescribed to prevent cramps based on the assumption golgi tendon organ inhibition remains elevated post-stretching. We determined whether stretching increased gastrocnemius golgi tendon organ inhibition and, if so, the time course of this inhibition post-stretching. Twelve participants' dominant limb medial gastrocnemius inhibition was measured before, and at 1, 5, 10, 15 and 30 min after investigators applied three, 1-min duration stretches. Participants maintained voluntary contraction intensities of 5% of their maximum while the Achilles tendon was stimulated transcutaneously 50 times. Five-hundred millisecond epochs of raw electromyographic activity were band-pass filtered, full-wave rectified and averaged. An algorithm identified inhibitory points and calculated the area, maximum and duration of inhibition. Area of inhibition (F1,14 = 1.5, P = 0.25), maximum inhibition (F1,14 = 0.2, P = 0.72) and duration of inhibition (F1,14 = 1.5, P = 0.24) were unaffected by static stretching over the 30-min post-stretching period. If pre-stretching does prevent fatigue-induced cramping, the mechanism is unlikely to involve the autoinhibition produced by the golgi tendon organ reflex. Further empirical research is needed to validate the proposed link between static stretching and cramping and then to investigate alternative mechanisms.

  17. Reflex inhibition of normal cramp following electrical stimulation of the muscle tendon.

    Science.gov (United States)

    Khan, Serajul I; Burne, John A

    2007-09-01

    Muscle cramp was induced in one head of the gastrocnemius muscle (GA) in eight of thirteen subjects using maximum voluntary contraction when the muscle was in the shortened position. Cramp in GA was painful, involuntary, and localized. Induction of cramp was indicated by the presence of electromyographic (EMG) activity in one head of GA while the other head remained silent. In all cramping subjects, reflex inhibition of cramp electrical activity was observed following Achilles tendon electrical stimulation and they all reported subjective relief of cramp. Thus muscle cramp can be inhibited by stimulation of tendon afferents in the cramped muscle. When the inhibition of cramp-generated EMG and voluntary EMG was compared at similar mean EMG levels, the area and timing of the two phases of inhibition (I(1), I(2)) did not differ significantly. This strongly suggests that the same reflex pathway was the source of the inhibition in both cases. Thus the cramp-generated EMG is also likely to be driven by spinal synaptic input to the motorneurons. We have found that the muscle conditions that appear necessary to facilitate cramp, a near to maximal contraction of the shortened muscle, are also the conditions that render the inhibition generated by tendon afferents ineffective. When the strength of tendon inhibition in cramping subjects was compared with that in subjects that failed to cramp, it was found to be significantly weaker under the same experimental conditions. It is likely that reduced inhibitory feedback from tendon afferents has an important role in generating cramp.

  18. Acute tendon changes in intense CrossFit workout: an observational cohort study.

    Science.gov (United States)

    Fisker, F Y; Kildegaard, S; Thygesen, M; Grosen, K; Pfeiffer-Jensen, M

    2016-10-07

    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 the risk of tendinopathy. However, it remains unknown whether acute overload caused by strenuous, high-intensity exercise will exert changes in tendons and if these changes can be detected and described by ultrasonography. The aim of this study is to evaluate the effects of acute overload on tendon thickness using ultrasonography. Standardized ultrasound measurements of the patella, Achilles, and plantaris tendons were performed before and after a specific workout in 34 healthy subjects. Significant increases were observed in patella tendon thickness before (M = 4.5, SD = 0.6) and after (M = 5.0, SD = 0.7) highly intense strenuous exercise, with an estimated mean differences of 0.47 mm (95% CI: 0.35-0.59 mm; P CrossFit exercises. In order to understand the underlying mechanisms of the findings and possibly utilize this to gain a better understanding, further studies must be conducted.

  19. Clinical aspects of tendon healing

    NARCIS (Netherlands)

    J.C.H.M. van der Meulen (Jacques)

    1974-01-01

    textabstractWe know that healing of a tendon wound takes place by an invasion of fibreblasts from the surrounding tissues; the tendon itself has no intrinsic healing capacity. lt was Potenza (1962) who proved that a traumatic suture of the tendons within their sheath is followed by disintegration of

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

    DEFF Research Database (Denmark)

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

    2004-01-01

    Microdialysis studies indicate that mechanical loading of human tendon tissue during exercise or training can affect local synthesis and degradation of type I collagen. Degradation of collagen and other extracellular matrix proteins is controlled by an interplay between matrix metalloproteinases...... (MMPs) and their tissue inhibitors (TIMPs). However, it is unknown whether local levels of MMPs and TIMPs are affected by tendon loading in humans in vivo. In the present experiment, six healthy young men performed 1 h of uphill (3%) treadmill running. Dialysate was collected from microdialysis probes...... (placed in the peritendinous tissue immediately anterior to the Achilles tendon) before, immediately after, 1 day after, and 3 days after an exercise bout. MMP-2 and MMP-9 were measured in dialysate by gelatin zymography, and amounts were quantified by densitometry in relation to total protein...

  1. 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

  2. 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

  3. 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.

  4. Biologics for tendon repair ☆

    OpenAIRE

    2014-01-01

    Tendon injuries are common and present a clinical challenge to orthopedic surgery mainly because these injuries often respond poorly to treatment and require prolonged rehabilitation. Therapeutic options used to repair ruptured tendons have consisted of suture, autografts, allografts, and synthetic prostheses. To date, none of these alternatives has provided a successful long-term solution, and often the restored tendons do not recover their complete strength and functionality. Unfortunately,...

  5. 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.

  6. Low-level light-emitting diode therapy increases mRNA expressions of IL-10 and type I and III collagens on Achilles tendinitis in rats.

    Science.gov (United States)

    Xavier, Murilo; de Souza, Renato Aparecido; Pires, Viviane Araújo; Santos, Ana Paula; Aimbire, Flávio; Silva, José Antônio; Albertini, Regiane; Villaverde, Antonio Balbin

    2014-01-01

    The present study investigated the effects of low-level light-emitting diode (LED) therapy (880 ± 10 nm) on interleukin (IL)-10 and type I and III collagen in an experimental model of Achilles tendinitis. Thirty male Wistar rats were separated into six groups (n = 5), three groups in the experimental period of 7 days, control group, tendinitis-induced group, and LED therapy group, and three groups in the experimental period of 14 days, tendinitis group, LED therapy group, and LED group with the therapy starting at the 7th day after tendinitis induction (LEDT delay). Tendinitis was induced in the right Achilles tendon using an intratendinous injection of 100 μL of collagenase. The LED parameters were: optical power of 22 mW, spot area size of 0.5 cm(2), and irradiation time of 170 s, corresponding to 7.5 J/cm(2) of energy density. The therapy was initiated 12 h after the tendinitis induction, with a 48-h interval between irradiations. The IL-10 and type I and III collagen mRNA expression were evaluated by real-time polymerase chain reaction at the 7th and 14th days after tendinitis induction. The results showed that LED irradiation increased IL-10 (p < 0.001) in treated group on 7-day experimental period and increased type I and III collagen mRNA expression in both treated groups of 7- and 14-day experimental periods (p < 0.05), except by type I collagen mRNA expression in LEDT delay group. LED (880 nm) was effective in increasing mRNA expression of IL-10 and type I and III collagen. Therefore, LED therapy may have potentially therapeutic effects on Achilles tendon injuries.

  7. Arthroscopic treatment of calcific tendonitis.

    Science.gov (United States)

    Barber, F Alan; Cowden, Courtney H

    2014-04-01

    Calcific tendonitis, or calcifying tendonitis, is a common disorder characterized by the multifocal accumulation of basic calcium phosphate crystals within the rotator cuff tendons. In most cases, the multifocal calcifications are located 1 to 2 cm from the insertion of the supraspinatus tendon on the greater tuberosity. The initial treatment should be nonoperative including oral anti-inflammatory medication and physical therapy. If this is unsuccessful, arthroscopic debridement of the deposit is effective. The technique used is an arthroscopic localization and debridement without associated subacromial decompression. The rotator cuff should be evaluated for partial- and full-thickness tears before and after the debridement of calcifications. If a partial- or full-thickness rotator cuff tendon tear is identified, it should be treated in a fashion consistent with those without associated calcium deposits. In our hands, tears 5 mm or greater in depth are repaired using a tendon-to-tendon or tendon-to-bone technique. Tears with less depth are debrided and then left alone. Arthroscopic debridement of calcific tendonitis can yield excellent functional results and high patient satisfaction.

  8. Wide-Awake Primary Flexor Tendon Repair, Tenolysis, and Tendon Transfer

    OpenAIRE

    Tang, Jin Bo

    2015-01-01

    Tendon surgery is unique because it should ensure tendon gliding after surgery. Tendon surgery now can be performed under local anesthesia without tourniquet, by injecting epinephrine mixed with lidocaine, to achieve vasoconstriction in the area of surgery. This method allows the tendon to move actively during surgery to test tendon function intraoperatively and to ensure the tendon is properly repaired before leaving the operating table. I applied this method to primary flexor tendon repair ...

  9. Gastrocnemius tendon length and strain are different when assessed using straight or curved tendon model

    OpenAIRE

    Stosic, Jelena; Finni Juutinen, Taija

    2011-01-01

    The present study investigated the effects of tendon curvature on measurements of tendon length using 3D-kinematic analysis. Curved and straight tendon models were employed for assessing medial gastrocnemius tendon length and strain during hopping (N = 8). Tendon curvature was identified using small reflective markers placed on the skin surface along the length of the tendon and a sum of vectors between the markers from the calcaneous up to the marker at the origin of tendon was calculated. T...

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

    Directory of Open Access Journals (Sweden)

    Dimitriadis Dimitris

    2010-12-01

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

  11. Achilles tendinitis as a rare extraintestinal manifestation of ulcerative colitis.

    Science.gov (United States)

    Zenda, Takahiro; Araki, Ichiro; Nakamiya, Otoyuki; Tokuumi, Yuji; Shimada, Yuka; Komai, Keigo; Taniuchi, Yukie

    2016-06-01

    Patients with inflammatory bowel disease often have extraintestinal manifestations (EIMs) involving almost all organ systems, but little has been reported on Achilles tendinitis. Herein, we present a unique case of Achilles tendinitis, which manifested shortly after initiation of mesalazine therapy for ulcerative colitis. A 26-year-old Japanese woman with bloody diarrhea and abdominal cramps lasting for 7 days was referred to our hospital. The Lichtiger clinical activity index (CAI) score was 9 at the first visit. Based on the clinical symptoms and examination results, she was diagnosed with ulcerative pancolitis in the active phase, and treatment with mesalazine (2.4 g/day) and probiotics was initiated. Her symptoms resolved within 7 days of treatment (CAI 3). However, she then developed bilateral Achilles tendinitis without any apparent cause. The Achilles tendinitis subsided with conservative management within 2 weeks, despite continuation of mesalazine therapy. This case instructively suggests that Achilles tendinitis should be noted as an EIM of ulcerative colitis.

  12. 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

    Directory of Open Access Journals (Sweden)

    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.

  13. 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.

  14. Principles of tendon transfers.

    Science.gov (United States)

    Coulet, B

    2016-04-01

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

  15. Chronic alterations in growth hormone/insulin-like growth factor-I signaling lead to changes in mouse tendon structure.

    Science.gov (United States)

    Nielsen, R H; Clausen, N M; Schjerling, P; Larsen, J O; Martinussen, T; List, E O; Kopchick, J J; Kjaer, M; Heinemeier, K M

    2014-02-01

    The growth hormone/insulin-like growth factor-I (GH/IGF-I) axis is an important stimulator of collagen synthesis in connective tissue, but the effect of chronically altered GH/IGF-I levels on connective tissue of the muscle-tendon unit is not known. We studied three groups of mice; 1) giant transgenic mice that expressed bovine GH (bGH) and had high circulating levels of GH and IGF-I, 2) dwarf mice with a disrupted GH receptor gene (GHR-/-) leading to GH resistance and low circulating IGF-I, and 3) a wild-type control group (CTRL). We measured the ultra-structure, collagen content and mRNA expression (targets: GAPDH, RPLP0, IGF-IEa, IGF-IR, COL1A1, COL3A1, TGF-β1, TGF-β2, TGF-β3, versican, scleraxis, tenascin C, fibronectin, fibromodulin, decorin) in the Achilles tendon, and the mRNA expression was also measured in calf muscle (same targets as tendon plus IGF-IEb, IGF-IEc). We found that GHR-/- mice had significantly lower collagen fibril volume fraction in Achilles tendon, as well as decreased mRNA expression of IGF-I isoforms and collagen types I and III in muscle compared to CTRL. In contrast, the mRNA expression of IGF-I isoforms and collagens in bGH mice was generally high in both tendon and muscle compared to CTRL. Mean collagen fibril diameter was significantly decreased with both high and low GH/IGF-I signaling, but the GHR-/- mouse tendons were most severely affected with a total loss of the normal bimodal diameter distribution. In conclusion, chronic manipulation of the GH/IGF-I axis influenced both morphology and mRNA levels of selected genes in the muscle-tendon unit of mice. Whereas only moderate structural changes were observed with up-regulation of GH/IGF-I axis, disruption of the GH receptor had pronounced effects upon tendon ultra-structure.

  16. Evaluation of the Achilles Ankle Exoskeleton.

    Science.gov (United States)

    van Dijk, Wietse; Meijneke, Cory; van der Kooij, Herman

    2016-02-11

    This paper evaluates the Achilles exoskeleton. The exoskeleton is intended to provide push-off assistance for healthy subjects during walking. The assistance is provided by a series elastic actuator that has been optimized to provide maximal push-off power. The paper presents the control method of the exoskeleton and the evaluation of the exoskeleton. Benchtop tests evaluated the performance of the actuator and human experiments evaluated the working of the complete system. The actuator can track force reference signals with amplitudes of 1 N to 100 N with a bandwidth between 8.1 Hz and 20.6 Hz, and outputs a maximum mechanical power of 80.2 W. Based on these results the augmentation factor predicted that the exoskeleton can generate a 33 W decrease in metabolic cost. In contrast with this prediction, in the human experiments we found an increase in metabolic rate for assistance (21.2 W) and no assistance (22.7 W) compared to baseline.

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

    Directory of Open Access Journals (Sweden)

    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.

  18. 男青少年部分下肢肌肉肌腱形态 和运动能力的相关研究%Correlated Study of Partial Tendon Morphology on Male Teenager's Lower Extremities and Athletic Capacity

    Institute of Scientific and Technical Information of China (English)

    陈及治; 陆爱云; 陈佩杰; 段子才

    2001-01-01

    Using the ultrasonic fault scanner made in Japan, the aut hors made the thoroughgoing non-invasion antropometry of the biggest tendon in h uman body-the achilles tendon, gastrocnemius and soleus. Then a correlated analy sis was carried out on the athletic indices in partial tendon morphology and rea ction speed of male teenagers' lower extremities, as well as their explosive for ce. The results show that the longer a chilles tendon has no obvious significanc e to the athletic capacity of male teenagers, and the traditional method of meas uring the achilles tendon remains to be improved.%应用日本产超声波断层扫描仪,对人体内最粗大的肌 腱——跟腱及小腿三头肌,进行深入的无创性形态测量,并对青春期男性青少年部分下肢肌 肉肌腱形态和反映速度及下肢爆发力等运动指标,进行相关分析。结果发现,跟腱长与运动 能力相关不具显著性;跟腱测量的传统方法有待改进。

  19. 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

  20. Arthroscopiclly assisted radiofrequency probe to treat achilles tendinitis%关节镜下等离子刀治疗慢性跟腱炎

    Institute of Scientific and Technical Information of China (English)

    刘玉杰; 王志刚; 李众利; 蔡谞; 周密; 魏民; 朱娟丽

    2008-01-01

    目的 探讨关节镜下等离子刀(TOPAZ)微创治疗慢性跟腱炎的疗效.方法 采用局部浸润麻醉,关节镜辅助下等离子刀微创治疗慢性跟腱炎17例,其中男性11例,女性6例;年龄17~48岁.标记跟腱疼痛点,在跟腱两侧病灶以上5 mm处切开皮肤5 mm,插入肌腱剥离器,沿皮下组织与肌腱之间进行钝性分离,制作出20 mm×30 mm的工作腔隙,置入30°关节镜,观察其病理改变.采用微型刨削刀和等离子刀,清理跟腱表面增生杂乱的须状撕裂的腱性纤维组织和增厚的部分腱膜.再将TOPAZ电极置入病灶,启动等离子刀进行局部打孔,深达跟腱在跟骨附着处表面,孔间距离3~5 mm呈网眼状.结果 术后17例获得随访,随访时间9~35个月,平均13个月.术后疼痛症状完全解除15例,疼痛明显改善2例.VAS疼痛评分术前8.7分,术后1.6分.无术中和术后跟腱断裂、感染、血管神经损伤等并发症.结论 关节镜监视下等离子刀微创治疗跟腱炎创伤小,手术操作简便,有利于术后康复,疗效显著.%Objective To evaluate the effectivenss of microtenotomy using a radiofrequency(RF) probe to treat chronieity achilles tendinitis.Methods Seventeen cases of chronicity achilles tendinitis were treated by RF probe.Eleven cases were male,and 6 female.The average age of the patients was 25(17-48)years.Nine were athlete,4 sports activity and 4 students.Seven were in left side,and 10 righit side.Before receiving the RF therapia all patients had achilles tendinitis symptoms.The patients were treated with local anesthesia under arthroscopy by Arthrocare 2000 and TOPAZ.The operation were performed through a manmade lacouna under the subcutaneous tissue of achilles tend,insert arthroscope.The pathology test found the achilles tendon surface fibrous tissue hyperplasia and tear.The probe of RF to perforate just as meshwork,the space was 3-5 mm.Results Patients reported significantly reduced pain from 7 to 14 d

  1. The role of stretching in tendon injuries.

    Science.gov (United States)

    Witvrouw, E; Mahieu, N; Roosen, P; McNair, P

    2007-04-01

    The function of tendons can be classified into two categories: tensile force transmission, and storage and release of elastic energy during locomotion. The action of tendons in storing and releasing energy is mainly seen in sports activities with stretch-shortening cycles (SSCs). The more intense the SSC movements are (jumping-like activities), the more frequently tendon problems are observed. High SSC movements impose high loads on tendons. Consequently, tendons that frequently deal with high SSC motion require a high energy-absorbing capacity to store and release this large amount of elastic energy. As the elasticity of tendon structures is a leading factor in the amount of stored energy, prevention and rehabilitation programmes for tendon injuries should focus on increasing this tendon elasticity in athletes performing high SSC movements. Recently, it has been shown that ballistic stretching can significantly increase tendon elasticity. These findings have important clinical implications for treatment and prevention of tendon injuries.

  2. Chronic alterations in growth hormone/insulin-like growth factor-I signaling lead to changes in mouse tendon structure

    DEFF Research Database (Denmark)

    Nielsen, R H; Clausen, N M; Schjerling, P

    2014-01-01

    transgenic mice that expressed bovine GH (bGH) and had high circulating levels of GH and IGF-I, 2) dwarf mice with a disrupted GH receptor gene (GHR-/-) leading to GH resistance and low circulating IGF-I, and 3) a wild-type control group (CTRL). We measured the ultra-structure, collagen content and m......-/- mice had significantly lower collagen fibril volume fraction in Achilles tendon, as well as decreased mRNA expression of IGF-I isoforms and collagen types I and III in muscle compared to CTRL. In contrast, the mRNA expression of IGF-I isoforms and collagens in bGH mice was generally high in both tendon...

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2009-05-15

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

  4. Rectus Femoris Tendon Calcification

    Science.gov (United States)

    Zini, Raul; Panascì, Manlio; Papalia, Rocco; Franceschi, Francesco; Vasta, Sebastiano; Denaro, Vincenzo

    2014-01-01

    Background: Since it was developed, hip arthroscopy has become the favored treatment for femoroacetabular impingement. Due to recent considerable improvements, the indications for this technique have been widely extended. Injuries of the rectus femoris tendon origin, after an acute phase, could result in a chronic tendinopathy with calcium hydroxyapatite crystal deposition, leading to pain and loss of function. Traditionally, this condition is addressed by local injection of anesthetic and corticosteroids or, when conservative measures fail, by open excision of the calcific lesion by an anterior approach. Purpose: To assess whether arthroscopic excision of calcification of the proximal rectus is a safe and effective treatment. Study Design: Case series; Level of evidence, 4. Methods: Outcomes were studied from 6 top amateur athletes (age range, 30-43 years; mean, 32.6 years) affected by calcification of the proximal rectus who underwent arthroscopic excision of the calcification. Patients were preoperatively assessed radiographically, and diagnosis was confirmed by a 3-dimensional computed tomography scan. To evaluate the outcome, standardized hip rating scores were used pre- and postoperatively (at 6 and 12 months): the Hip disability and Osteoarthritis Outcome Score, Oxford Hip Score, and Modified Harris Hip Score. Moreover, visual analog scales (VAS) for pain, sport activity level (SAL), and activities of daily living (ADL) were also used. Results: One year after surgery, all patients reported satisfactory outcomes, with 3 of 6 rating their return-to-sport level as high as preinjury level, and the remaining 3 with a percentage higher than 80%. Five patients ranked their ability to carry on daily activities at 100%. Statistical analysis showed significant improvement of the Oxford Hip Score, the Modified Harris Hip Score, and all 3 VAS subscales (pain, SAL, and ADL) from pre- to latest postoperative assessment (P < .05). Conclusion: Arthroscopic excision of

  5. Ultrasonographic assessment of flexor tendon mobilization: Effect of different protocols on tendon excursion

    NARCIS (Netherlands)

    J.-W.H. Korstanje (Jan-Wiebe); J. Soeters (Johannes); A.R. Schreuders (Ton); P.C. Amadio (Peter ); S.E.R. Hovius (Steven); H.J. Stam (Henk); R.W. Selles (Ruud)

    2012-01-01

    textabstractBackground: Different mobilization protocols have been proposed for rehabilitation after hand flexor tendon repair to provide tendon excursion sufficient to prevent adhesions. Several cadaver studies have shown that the position of the neighboring fingers influences tendon excursions of

  6. V-Y肌腱瓣修补术治疗陈旧性跟腱断裂的应用解剖%Applied anatomy of treatment of old rupture of achillies tendon with V-Y tendinous flap

    Institute of Scientific and Technical Information of China (English)

    聂团文; 彭耀金

    2011-01-01

    Objective To provide anatomical data for surgical treatment of old rupture of Achillies tendon with V-Ytendinous flap.Methods The relevant anatomical data were measured on 20 cases of adult lower leg anatomy layer by layer specimens. Seven cases specimens of gastrocnemius tendon close to the average level of calf were made models of the Achilles tendon defect respectively 1,2,3,4,5,6,7 cm, they were firstly made a stump direct repair, furtherly made V-Ytendinous flap for repair surgery, to explore the application of the V-Ytendinous flap repair of old rupture of Achillies tendon. Results The narrowest location of Normal adults, Achilles tendon at an average width (13.25±2.73) mm, average thickness (6.26±2.04) mm, average distance to the top of the heel (39.52±1.25) mm. The Achilles tendon defect within 2 cm, The stump direct suture surgery can proceed smoothly; The Achilles tendon defect is to 3cm, the stump direct suture surgery is difficult to complete,it needs V-Y tendonous flap to repair. The Achilles tendon defect is to 7 cm, the V-Y tendinous flap repair is more difficult to complete. Conclusion V-Y tendinous flap repair is suitable for 3-6 cm within the Achilles tendon defect.%目的:探讨V-Y肌腱瓣修补术治疗陈旧性跟腱断裂的解剖学依据.方法:对20例成人小腿标本进行逐层解剖,测量相关解剖学数据;选取其中7例腓肠肌肌腱接近平均水平的小腿标本,制作成跟腱缺损分别为1、2、3、4、5、6、7 cm的模型,先进行断端直接吻合术,再进行V-Y肌腱瓣修补模拟手术,探讨V-Y肌腱瓣修补术的适用症.结果:正常成人跟腱最窄处平均宽度(13.25±2.73)mm,平均厚度(6.26±2.04)mm,与跟骨上方平均距离(39.52±1.25)mm.跟腱缺损2 cm以内,断端直接吻合手术能顺利进行,跟腱缺损达到3cm,直接吻合较困难,须V-Y肌腱瓣修补术才能顺利进行,缺损达到7 cm,V-Y肌腱瓣修补术完成较困难.结论.:V-Y肌腱瓣修补术适于3~6cm以内的跟腱缺损.

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

    Directory of Open Access Journals (Sweden)

    David M Hudson

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

  8. Physiological Achilles' heels of Enteropathogenic bacteria in livestock

    NARCIS (Netherlands)

    Becker, P.M.

    2005-01-01

    An elaborate feeding regimen of animals, which takes advantage of the Achilles' heels of enteropathogenic bacteria, can possibly enable prophylaxis in the intestinal tract, attenuate actual disease symptoms, accelerate recovery from a bacterial gastroenteritis or ensure food safety. There is a wide

  9. 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.

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

    Institute of Scientific and Technical Information of China (English)

    Jianying Zhang; James H-C Wang

    2014-01-01

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

  11. Management of Extensor Tendon Injuries

    Science.gov (United States)

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

    2012-01-01

    Extensor tendon injuries are very common injuries, which inappropriately treated can cause severe lasting impairment for the patient. Assessment and management of flexor tendon injuries has been widely reviewed, unlike extensor injuries. It is clear from the literature that extensor tendon repair should be undertaken immediately but the exact approach depends on the extensor zone. Zone I injuries otherwise known as mallet injuries are often closed and treated with immobilisaton and conservative management where possible. Zone II injuries are again conservatively managed with splinting. Closed Zone III or ‘boutonniere’ injuries are managed conservatively unless there is evidence of displaced avulsion fractures at the base of the middle phalanx, axial and lateral instability of the PIPJ associated with loss of active or passive extension of the joint or failed non-operative treatment. Open zone III injuries are often treated surgically unless splinting enable the tendons to come together. Zone V injuries, are human bites until proven otherwise requires primary tendon repair after irrigation. Zone VI injuries are close to the thin paratendon and thin subcutaneous tissue which strong core type sutures and then splinting should be placed in extension for 4-6 weeks. Complete lacerations to zone IV and VII involve surgical primary repair followed by 6 weeks of splinting in extension. Zone VIII require multiple figure of eight sutures to repair the muscle bellies and static immobilisation of the wrist in 45 degrees of extension. To date there is little literature documenting the quality of repairing extensor tendon injuries however loss of flexion due to extensor tendon shortening, loss of flexion and extension resulting from adhesions and weakened grip can occur after surgery. This review aims to provide a systematic examination method for assessing extensor injuries, presentation and management of all type of extensor tendon injuries as well as guidance on

  12. Muscle-tendon interaction and elastic energy usage in human walking

    DEFF Research Database (Denmark)

    Ishikawa, Masaki; Komi, Paavo V.; Grey, Michael James;

    2005-01-01

    The present study was designed to explore how the interaction between the fascicles and tendinous tissues is involved in storage and utilization of elastic energy during human walking. Eight male subjects walked with a natural cadence (1.4 +/- 0.1 m/s) on a 10-m-long force plate system. In vivo...... techniques were employed to record the Achilles tendon force and to scan real-time fascicle lengths for two muscles (medial gastrocnemius and soleus). The results showed that tendinous tissues of both medial gastrocnemius and soleus muscles lengthened slowly throughout the single-stance phase......-stance phase. In contrast, the soleus fascicles were lengthened until the end of the single-stance phase. These findings suggest that the elastic recoil takes place not as a spring-like bouncing but as a catapult action in natural human walking. The interaction between the muscle fascicles and tendinous...

  13. 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.

  14. Informing tendon tissue engineering with embryonic development

    OpenAIRE

    Glass, Zachary A.; Schiele, Nathan R.; Kuo, Catherine K

    2014-01-01

    Tendon is a strong connective tissue that transduces muscle-generated forces into skeletal motion. In fulfilling this role, tendons are subjected to repeated mechanical loading and high stress, which may result in injury. Tissue engineering with stem cells offers the potential to replace injured/damaged tissue with healthy, new living tissue. Critical to tendon tissue engineering is the induction and guidance of stem cells towards the tendon phenotype. Typical strategies hav...

  15. [Graft reconstruction of flexor tendons].

    Science.gov (United States)

    Pauchard, N; Pedeutour, B; Dautel, G

    2014-12-01

    The improvement of primary flexor tendon repair has limited the indications of secondary repairs to neglected initial wound care and deficiencies in the surgical technique or rehabilitation. The surgical and rehabilitation care is complex and prolonged, requiring full cooperation of the patient. That is why the surgeon must evaluate patient's ability to integrate instructions and to comply with a long and demanding protocol. The functional needs of the patient are important in treatment decisions and the surgeon should not hesitate to use an appropriate surgical alternative (tenodesis, arthrodesis, tendon transfer, etc.). After a brief historical review, the authors discuss the indications, technical procedures and finally the results of one-stage and two-stage flexor tendon graft, which despite mixed results keep a real place in our current armamentarium.

  16. Local injection of bone marrow mesenchymal stem cells versus triamcinolone acetonide for treatment of Achilles tendinitis in rabbits%局部注射骨髓间充质干细胞和曲安奈德治疗兔跟腱炎的效果对比

    Institute of Scientific and Technical Information of China (English)

    裘超; 洪建军; 毛诚晃; 卢晓郎

    2012-01-01

    背景:应用长效糖皮质激素局部封闭治疗跟腱炎在学术界一直很有争议.目的:对跟腱炎模型兔跟腱局部分别注射兔骨髓间充质干细胞和长效糖皮质激素曲安奈德,动态观察相关指标,观察骨髓间充质干细胞和曲安奈德对跟腱炎的组织结构和力学性能的影响.方法:将60只单侧跟腱炎新西兰大白兔模型随机等分4组,取其中2组分别于患侧跟腱局部注射骨髓间充质干细胞和曲安奈德1次;剩余2组则分别注射2次,注射间隔2周.结果与结论:相比1次曲安奈德组,局部注射骨髓间充质干细胞1次和2次的跟腱炎模型兔跟腱腱束整齐、致密,断裂少,成纤维细胞增多,跟腱组织羟脯氨酸含量、跟腱最大负荷拉力均增加(P < 0.05),2次注射的治疗效果更明显(P < 0.05).说明局部重复注射骨髓间充质干细胞移植治疗跟腱炎的效果优于长效糖皮质激素曲安奈德.%BACKGROUND: It remains to be disputed to apply long-lasting glucocorticoid for partial closure theray of AchillesOBJECTIVE: Bone marrow mesenchymal stem cells and long-lasting triamcmolone acetonide were respectively injected into the achilles tendon of a rabbit model of Achilles tendonitis to dynamically observe related indices and investigate the effects of bone marrow mesenchymal stem cells and long-lasting triamcinolone acetonide on tissue structure and mechanical performance of Achilles tendon with tendonitisMETHODS: Sixty rabbit models of unilateral Achilles tendinitis were randomly divided into four groups Two groups were locally administered bone marrow mesenchymal stem cells and tnamcmolone acetonide respectively once, and the remaining two groups were locally administered bone marrow mesenchymal stem cells and glucocortocoid respectively twice with a time interval of 2 weeksRESULTS AND CONCLUSION: Compared with tnamcmolone acetonide once group, rabbits in the bone marrow mesenchymal stem cells once or twice groups, rabbits

  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...

  18. Can PRP effectively treat injured tendons?

    Science.gov (United States)

    Wang, James H-C

    2014-01-01

    PRP is widely used to treat tendon and other tissue injuries in orthopaedics and sports medicine; however, the efficacy of PRP treatment on injured tendons is highly controversial. In this commentary, I reason that there are many PRP- and patient-related factors that influence the outcomes of PRP treatment on injured tendons. Therefore, more basic science studies are needed to understand the mechanism of PRP on injured tendons. Finally, I suggest that better understanding of the PRP action mechanism will lead to better use of PRP for the effective treatment of tendon injuries in clinics.

  19. 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.

  20. Hamstring tendon harvesting--Effect of harvester on tendon characteristics and soft tissue disruption; cadaver study.

    Science.gov (United States)

    Charalambous, C P; Alvi, F; Phaltankar, P; Gagey, O

    2009-06-01

    The purpose of this study was to determine whether the type of hamstring tendon harvester used can influence harvested tendon characteristics and soft tissue disruption. We compared two different types of tendon harvesters with regard to the length of tendon obtained and soft tissue disruption during hamstring tendon harvesting. Thirty six semitendinosus and gracilis tendons were harvested using either a closed stripper or a blade harvester in 18 paired knees from nine human fresh cadavers. Use of the blade harvester gave longer lengths of usable tendon whilst minimising the stripping of muscle and of any non-usable tendon. Our results suggest that the type of harvester per se can influence the length of tendon harvested as well as soft tissue disruption. Requesting such data from the industry prior to deciding which harvester to use seems desirable.

  1. What understanding tendon cell differentiation can teach us about pathological tendon ossification.

    Science.gov (United States)

    Magne, D; Bougault, C

    2015-08-01

    Tendons are the structures that attach muscles to bones and transmit mechanical forces. Tendon cells are composed of mature tenocytes and a rare population of tendon stem cells. Both cell types ensure homeostasis and repair of tendon extracellular matrix to guarantee its specific mechanical properties. Moreover, tendon cells seem to present a marked potential for trans-differentiation, predominantly into the chondrocyte and osteoblast lineages. In this review article, we first present chronic tendon pathologies associated with abnormal ossification, such as spondyloarthritis and calcifying tendinopathy, and discuss how tendon cell differentiation and trans-differentiation may participate in these diseases. We moreover present the factors known to influence tendon cell differentiation and trans-differentiation, with a particular emphasis on extracellular environment, mechanical stimulation and several soluble factors that can tip the balance toward one or another lineage. A better understanding of the neglected tendon cell biology may be extremely useful to understand the pathological mechanisms of spondyloarthritis and calcifying tendinopathy.

  2. Tendon and ligament fibrillar crimps give rise to left-handed helices of collagen fibrils in both planar and helical crimps.

    Science.gov (United States)

    Franchi, Marco; Ottani, Vittoria; Stagni, Rita; Ruggeri, Alessandro

    2010-03-01

    Collagen fibres in tendons and ligaments run straight but in some regions they show crimps which disappear or appear more flattened during the initial elongation of tissues. Each crimp is formed of collagen fibrils showing knots or fibrillar crimps at the crimp top angle. The present study analyzes by polarized light microscopy, scanning electron microscopy, transmission electron microscopy the 3D morphology of fibrillar crimp in tendons and ligaments of rat demonstrating that each fibril in the fibrillar region always twists leftwards changing the plane of running and sharply bends modifying the course on a new plane. The morphology of fibrillar crimp in stretched tendons fulfills the mechanical role of the fibrillar crimp acting as a particular knot/biological hinge in absorbing tension forces during fibril strengthening and recoiling collagen fibres when stretching is removed. The left-handed path of fibrils in the fibrillar crimp region gives rise to left-handed fibril helices observed both in isolated fibrils and sections of different tendons and ligaments (flexor digitorum profundus muscle tendon, Achilles tendon, tail tendon, patellar ligament and medial collateral ligament of the knee). The left-handed path of fibrils represents a new final suprafibrillar level of the alternating handedness which was previously described only from the molecular to the microfibrillar level. When the width of the twisting angle in the fibrillar crimp is nearly 180 degrees the fibrils appear as left-handed flattened helices forming crimped collagen fibres previously described as planar crimps. When fibrils twist with different subsequent rotational angles (< 180 degrees ) they always assume a left-helical course but, running in many different nonplanar planes, they form wider helical crimped fibres.

  3. Tissue specific characteristics of cells isolated from human and rat tendons and ligaments

    Directory of Open Access Journals (Sweden)

    Scutt A

    2008-07-01

    Full Text Available Abstract Background Tendon and ligament injuries are common and costly in terms of surgery and rehabilitation. This might be improved by using tissue engineered constructs to accelerate the repair process; a method used successfully for skin wound healing and cartilage repair. Progress in this field has however been limited; possibly due to an over-simplistic choice of donor cell. For tissue engineering purposes it is often assumed that all tendon and ligament cells are similar despite their differing roles and biomechanics. To clarify this, we have characterised cells from various tendons and ligaments of human and rat origin in terms of proliferation, response to dexamethasone and cell surface marker expression. Methods Cells isolated from tendons by collagenase digestion were plated out in DMEM containing 10% fetal calf serum, penicillin/streptomycin and ultraglutamine. Cell number and collagen accumulation were by determined methylene blue and Sirius red staining respectively. Expression of cell surface markers was established by flow cytometry. Results In the CFU-f assay, human PT-derived cells produced more and bigger colonies suggesting the presence of more progenitor cells with a higher proliferative capacity. Dexamethasone had no effect on colony number in ACL or PT cells but 10 nM dexamethasone increased colony size in ACL cultures whereas higher concentrations decreased colony size in both ACL and PT cultures. In secondary subcultures, dexamethasone had no significant effect on PT cultures whereas a stimulation was seen at low concentrations in the ACL cultures and an inhibition at higher concentrations. Collagen accumulation was inhibited with increasing doses in both ACL and PT cultures. This differential response was also seen in rat-derived cells with similar differences being seen between Achilles, Patellar and tail tendon cells. Cell surface marker expression was also source dependent; CD90 was expressed at higher levels by PT

  4. Hyperuricemic PRP in Tendon Cells

    Directory of Open Access Journals (Sweden)

    I. Andia

    2014-01-01

    Full Text Available Platelet-rich plasma (PRP is injected within tendons to stimulate healing. Metabolic alterations such as the metabolic syndrome, diabetes, or hyperuricemia could hinder the therapeutic effect of PRP. We hypothesise that tendon cells sense high levels of uric acid and this could modify their response to PRP. Tendon cells were treated with allogeneic PRPs for 96 hours. Hyperuricemic PRP did not hinder the proliferative actions of PRP. The gene expression pattern of inflammatory molecules in response to PRP showed absence of IL-1b and COX1 and modest expression of IL6, IL8, COX2, and TGF-b1. IL8 and IL6 proteins were secreted by tendon cells treated with PRP. The synthesis of IL6 and IL8 proteins induced by PRP is decreased significantly in the presence of hyperuricemia (P = 0.017 and P = 0.012, resp.. Concerning extracellular matrix, PRP-treated tendon cells displayed high type-1 collagen, moderate type-3 collagen, decorin, and hyaluronan synthase-2 expression and modest expression of scleraxis. Hyperuricemia modified the expression pattern of extracellular matrix proteins, upregulating COL1 (P = 0.036 and COMP (P = 0.012 and downregulating HAS2 (P = 0.012. Positive correlations between TGF-b1 and type-1 collagen (R = 0.905, P = 0.002 and aggrecan (R = 0.833, P = 0.010 and negative correlations between TGF-b1 and IL6 synthesis (R = −0.857, P = 0.007 and COX2 (R = −0.810, P = 0.015 were found.

  5. Effect of estrogen on tendon collagen synthesis, tendon structural characteristics, and biomechanical properties in postmenopausal women

    DEFF Research Database (Denmark)

    Hansen, M.; Kongsgaard, M; Holm, Lars

    2009-01-01

    in tendon NH(2)-terminal propeptide of type I collagen synthesis (P = 0.32). In ERT users, positive correlations between serum estradiol (s-estradiol) and tendon synthesis were observed, whereas change in tendon synthesis from rest to exercise was negatively correlated to s-estradiol. Tendon area, fibril...... therapy (ERT, n = 10) were studied at rest and in response to one-legged resistance exercise. Synthesis of tendon collagen was determined by stable isotope incorporation [fractional synthesis rate (FSR)] and microdialysis technique (NH(2)-terminal propeptide of type I collagen synthesis). Tendon area...... users (P exercise were negatively associated with s...

  6. Infrared (810 nm) low-level laser therapy in rat achilles tendinitis: a consistent alternative to drugs.

    Science.gov (United States)

    Marcos, Rodrigo Labat; Leal Junior, Ernesto Cesar Pinto; Messias, Felipe de Moura; de Carvalho, Maria Helena Catelli; Pallotta, Rodney Capp; Frigo, Lúcio; dos Santos, Rosângela Aparecida; Ramos, Luciano; Teixeira, Simone; Bjordal, Jan Magnus; Lopes-Martins, Rodrigo Álvaro Brandão

    2011-01-01

    Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used and can reduce musculoskeletal pain in spite of the cost of adverse reactions like gastrointestinal ulcers or cardiovascular events. The current study investigates if a safer treatment such as low-level laser therapy (LLLT) could reduce tendinitis inflammation, and whether a possible pathway could be through inhibition of either of the two-cyclooxygenase (COX) isoforms in inflammation. Wistar rats (six animals per group) were injected with saline (control) or collagenase in their Achilles tendons. Then, we treated them with three different doses of IR LLLT (810 nm; 100 mW; 10 s, 30 s and 60 s; 3.57 W cm(-2); 1 J, 3 J, 6 J) at the sites of the injections, or intramuscular diclofenac, a nonselective COX inhibitor/NSAID. We found that LLLT dose of 3 J significantly reduced inflammation through less COX-2-derived gene expression and PGE(2) production, and less edema formation compared to nonirradiated controls. Diclofenac controls exhibited significantly lower PGE(2) cytokine levels at 6 h than collagenase control, but COX isoform 1-derived gene expression and cytokine PGE(2) levels were not affected by treatments. As LLLT seems to act on inflammation through a selective inhibition of the COX-2 isoform in collagenase-induced tendinitis, LLLT may have potential to become a new and safer nondrug alternative to coxibs.

  7. Triple extensor digiti minimi tendon: An anatomic variation

    OpenAIRE

    Elif Sari

    2014-01-01

    This case report describes an unusual variation of the extensor digiti minimi tendon discovered during extensor tendon repair in the emergency room. Knowledge of this variation may be helpful for the tendon transfers and tendon surgery that need tendon graft. [Hand Microsurg 2014; 3(2.000): 56-58

  8. Informing tendon tissue engineering with embryonic development

    Science.gov (United States)

    Glass, Zachary A.; Schiele, Nathan R.; Kuo, Catherine K.

    2014-01-01

    Tendon is a strong connective tissue that transduces muscle-generated forces into skeletal motion. In fulfilling this role, tendons are subjected to repeated mechanical loading and high stress, which may result in injury. Tissue engineering with stem cells offers the potential to replace injured/damaged tissue with healthy, new living tissue. Critical to tendon tissue engineering is the induction and guidance of stem cells towards the tendon phenotype. Typical strategies have relied on adult tissue homeostatic and healing factors to influence stem cell differentiation, but have yet to achieve tissue regeneration. A novel paradigm is to use embryonic developmental factors as cues to promote tendon regeneration. Embryonic tendon progenitor cell differentiation in vivo is regulated by a combination of mechanical and chemical factors. We propose that these cues will guide stem cells to recapitulate critical aspects of tenogenesis and effectively direct the cells to differentiate and regenerate new tendon. Here, we review recent efforts to identify mechanical and chemical factors of embryonic tendon development to guide stem/progenitor cell differentiation toward new tendon formation, and discuss the role this work may have in the future of tendon tissue engineering. PMID:24484642

  9. Informing tendon tissue engineering with embryonic development.

    Science.gov (United States)

    Glass, Zachary A; Schiele, Nathan R; Kuo, Catherine K

    2014-06-27

    Tendon is a strong connective tissue that transduces muscle-generated forces into skeletal motion. In fulfilling this role, tendons are subjected to repeated mechanical loading and high stress, which may result in injury. Tissue engineering with stem cells offers the potential to replace injured/damaged tissue with healthy, new living tissue. Critical to tendon tissue engineering is the induction and guidance of stem cells towards the tendon phenotype. Typical strategies have relied on adult tissue homeostatic and healing factors to influence stem cell differentiation, but have yet to achieve tissue regeneration. A novel paradigm is to use embryonic developmental factors as cues to promote tendon regeneration. Embryonic tendon progenitor cell differentiation in vivo is regulated by a combination of mechanical and chemical factors. We propose that these cues will guide stem cells to recapitulate critical aspects of tenogenesis and effectively direct the cells to differentiate and regenerate new tendon. Here, we review recent efforts to identify mechanical and chemical factors of embryonic tendon development to guide stem/progenitor cell differentiation toward new tendon formation, and discuss the role this work may have in the future of tendon tissue engineering.

  10. Kosmos and Polis in the Shield of Achilles

    OpenAIRE

    Flórez Flórez, Alfonso; Pontificia Universidad Javeriana

    2011-01-01

    Stirred by the death of his friend and comrade Patroclus, Achilles returns to the battlefield in order to confront Hector, leader of the Trojan army. His armor, however, has been plundered from Patroclus’ corpse by Hector himself, his companion’s slayer. Given this situation, his immortal mother, Thetis, rushes to the workshop of Hephaestus, the famous god of craftsmanship, to ask him to fabricate a new armor for her son. In a night’s work, Hephaestus makes a complete armor, in which the shie...

  11. Multiple tendons of abductor pollicis longus

    Directory of Open Access Journals (Sweden)

    Mansur DI

    2010-02-01

    Full Text Available Anatomic variations of the tendons of the abductor pollicis longus (APL and its knowledge is important to assess the diseased and traumatized hand and when considering tendons for repair or graft. During routine dissection of a 63-year-old male cadaver, in the Department of Anatomy, Kasturba Medical College, Mangalore, Karnataka, India we came across an unusual APL in the right upper limb. The muscle had altogether 9 tendons and they were inserted to the lateral and anterolateral sides of the base of the 1st metacarpal bone, opponens pollicis (two tendons each, the abductor pollicis brevis, trapezium and thenar fascia (one tendon each. The number of accessory tendons of APL has functional significance in the development of de Quervain’s syndrome.

  12. Extensor tendon repair an overview

    Directory of Open Access Journals (Sweden)

    Mansoor Bin Fayed

    2015-04-01

    Full Text Available The incidence of extensor injuries is more than that of flexor tendon injuries. This is to a great extent because of the extensors being superficially placed and covered by skin and subcutaneous tissue over the distal part of the upper extremity. Thus they are more vulnerable to blunt and sharp trauma, the proximal and distal forearm present with laceration and cut with sharp weapon. Extensor tendon injuries are often taken lightly by many, repairs being taken-up at the ER. Repair is done in or if the retrieval of tendon ends is difficult or the wound is complicated with associated injuries such as fractures or in cases of tendon retraction. Delayed primary repair can be undertaken from 7-10 days. Assessment of the injured finger has to be very meticulous. Extension of finger is brought about by the interossei and lumbricals which are the short muscles of the hand. They extend the proximal interphalangeal joints and distal interphalangeal joints and flex metacarpophalangeal joint, these intrinsic muscles are innervated by the ulnar and median nerves. The long extensors are innervated by the radial nerve, they primarily extend the metacarpophalangeal joints and also interphalangeal joints. In cases of injury the intrinsic system may compensate for an extensor deficit. Closed injuries of zone I may be managed by splinting of the distal interphalangeal joints and open injuries in the zone I and II can be treated with tenodermodesis. Proximal interphalangeal joints and distal interphalangeal joints are immobilized in zone 3 and 4. Metacarpophalangeal joint is immobilized in full extension and the wrist in 10o extension.

  13. 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.

  14. 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.

  15. 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.

  16. Repair of full-thickness tendon injury using connective tissue progenitors efficiently derived from human embryonic stem cells and fetal tissues.

    Science.gov (United States)

    Cohen, Shahar; Leshansky, Lucy; Zussman, Eyal; Burman, Michael; Srouji, Samer; Livne, Erella; Abramov, Natalie; Itskovitz-Eldor, Joseph

    2010-10-01

    The use of stem cells for tissue engineering (TE) encourages scientists to design new platforms in the field of regenerative and reconstructive medicine. Human embryonic stem cells (hESC) have been proposed to be an important cell source for cell-based TE applications as well as an exciting tool for investigating the fundamentals of human development. Here, we describe the efficient derivation of connective tissue progenitors (CTPs) from hESC lines and fetal tissues. The CTPs were significantly expanded and induced to generate tendon tissues in vitro, with ultrastructural characteristics and biomechanical properties typical of mature tendons. We describe a simple method for engineering tendon grafts that can successfully repair injured Achilles tendons and restore the ankle joint extension movement in mice. We also show the CTP's ability to differentiate into bone, cartilage, and fat both in vitro and in vivo. This study offers evidence for the possibility of using stem cell-derived engineered grafts to replace missing tissues, and sets a basic platform for future cell-based TE applications in the fields of orthopedics and reconstructive surgery.

  17. Lubricin Surface Modification Improves Tendon Gliding After Tendon Repair in a Canine Model in Vitro

    Science.gov (United States)

    Taguchi, Manabu; Sun, Yu-Long; Zhao, Chunfeng; Zobitz, Mark E.; Cha, Chung-Ja; Jay, Gregory D.; An, Kai-Nan; Amadio, Peter C.

    2011-01-01

    This study investigated the effects of lubricin on the gliding of repaired flexor digitorum profundus (FDP) tendons in vitro. Canine FDP tendons were completely lacerated, repaired with a modified Pennington technique, and treated with one of the following solutions: saline, carbodiimide derivatized gelatin/hyaluronic acid (cd-HA-gelatin), carbodiimide derivatized gelatin to which lubricin was added in a second step (cd-gelatin + lubricin), or carbodiimide derivatized gelatin/HA + lubricin (cd-HA-gelatin + lubricin). After treatment, gliding resistance was measured up to 1,000 cycles of simulated flexion/extension motion. The increase in average and peak gliding resistance in cd-HA-gelatin, cd-gelatin + lubricin, and cd-HA-gelatin + lubricin tendons was less than the control tendons after 1,000 cycles (p < 0.05). The increase in average gliding resistance of cd-HA-gelatin + lubricin treated tendons was also less than that of the cd-HA-gelatin treated tendons (p < 0.05). The surfaces of the repaired tendons and associated pulleys were assessed qualitatively with scanning electron microscopy and appeared smooth after 1,000 cycles of tendon motion for the cd-HA-gelatin, cd-gelatin + lubricin, and cd-HA-gelatin + lubricin treated tendons, while that of the saline control appeared roughened. These results suggest that tendon surface modification can improve tendon gliding ability, with a trend suggesting that lubricin fixed on the repaired tendon may provide additional improvement over that provided by HA and gelatin alone. PMID:18683890

  18. Tendon sheath fibroma in the thigh.

    Science.gov (United States)

    Moretti, Vincent M; Ashana, Adedayo O; de la Cruz, Michael; Lackman, Richard D

    2012-04-01

    Tendon sheath fibromas are rare, benign soft tissue tumors that are predominantly found in the fingers, hands, and wrists of young adult men. This article describes a tendon sheath fibroma that developed in the thigh of a 70-year-old man, the only known tendon sheath fibroma to form in this location. Similar to tendon sheath fibromas that develop elsewhere, our patient's lesion presented as a painless, slow-growing soft tissue nodule. Physical examination revealed a firm, nontender mass with no other associated signs or symptoms. Although the imaging appearance of tendon sheath fibromas varies, our patient's lesion appeared dark on T1- and bright on T2-weighted magnetic resonance imaging. It was well marginated and enhanced with contrast.Histologically, tendon sheath fibromas are composed of dense fibrocollagenous stromas with scattered spindle-shaped fibroblasts and narrow slit-like vascular spaces. Most tendon sheath fibromas can be successfully removed by marginal excision, although 24% of lesions recur. No lesions have metastasized. Our patient's tendon sheath fibroma was removed by marginal excision, and the patient remained disease free 35 months postoperatively. Despite its rarity, tendon sheath fibroma should be included in the differential diagnosis of a thigh mass on physical examination or imaging, especially if it is painless, nontender, benign appearing, and present in men.

  19. Technique for and an anatomic guide to forearm tendon repair.

    Science.gov (United States)

    Burnham, Jeremy M; Hollister, Anne M; Rush, David A; Avallone, Thomas J; Shi, Runhua; Jordan, Jenee' C

    2011-06-01

    Forearm lacerations involving muscle bellies are usually treated by repairing muscle fascia. Repair of tendons themselves is stronger and restores normal muscle anatomy better. Tendon repair requires good knowledge of forearm muscle and tendon anatomy. We have made cadaver measurements to produce graphical maps of locations of individual muscles tendons of origin and insertion, some practical guides for finding tendon ends and a simple grasping stitch for intramuscular tendons.

  20. 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

    expression of 2 hypoxia-related genes, hypoxia-inducible factor 1 alpha (HIF1 alpha) and carbonic anhydrase III (CAIII). Methods: Two groups of Wistar rats performed 1-leg contractions of the calf muscle by electrostimulation of the sciatic nerve. After 10 min of muscle contractions, Cu-64-ATSM was injected...... and contractions were continued for 20 min. PET/CT of both hind limbs was performed immediately and 1 h after the contractions. The exercise group (n = 8) performed only muscle contractions as described, whereas the other group, exercise plus cuff (n = 8), in addition underwent cuff-induced hypoxia during...... the first PET/CT scan. Standardized uptake values (SUVs) were calculated for the Achilles tendons and triceps surae muscles and were correlated to gene expression of HIF1 alpha and CAIII using real-time polymerase chain reaction. Results: Immediately after the contractions, uptake of Cu-64-ATSM...

  1. Single-stage reconstruction of flexor tendons with vascularized tendon transfers.

    Science.gov (United States)

    Cavadas, P C; Pérez-García, A; Thione, A; Lorca-García, C

    2015-03-01

    The reconstruction of finger flexor tendons with vascularized flexor digitorum superficialis (FDS) tendon grafts (flaps) based on the ulnar vessels as a single stage is not a popular technique. We reviewed 40 flexor tendon reconstructions (four flexor pollicis longus and 36 finger flexors) with vascularized FDS tendon grafts in 38 consecutive patients. The donor tendons were transferred based on the ulnar vessels as a single-stage procedure (37 pedicled flaps, three free flaps). Four patients required composite tendon and skin island transfer. Minimum follow-up was 12 months, and functional results were evaluated using a total active range of motion score. Multiple linear regression analysis was performed to evaluate the factors that could be associated with the postoperative total active range of motion. The average postoperative total active range of motion (excluding the thumbs) was 178.05° (SD 50°). The total active range of motion was significantly lower for patients who were reconstructed with free flaps and for those who required composite tendon and skin island flap. Age, right or left hand, donor/motor tendon and pulley reconstruction had no linear effect on total active range of motion. Overall results were comparable with a published series on staged tendon grafting but with a lower complication rate. Vascularized pedicled tendon grafts/flaps are useful in the reconstruction of defects of finger flexor tendons in a single stage, although its role in the reconstructive armamentarium remains to be clearly established.

  2. Simulation of tendon energy storage in pedaling

    DEFF Research Database (Denmark)

    Rasmussen, John; Damsgaard, Michael; Christensen, Søren Tørholm

    2001-01-01

    The role of elastic energy stored in tendons during pedaling is investigated by means of numerical simulation using the AnyBody body modeling system. The loss of metabolic energy due to tendon elasticity is computed and compared to the mechanical work involved in the process. The AnyBody simulation...

  3. Duplication of the extensor carpi ulnaris tendon.

    Science.gov (United States)

    Barfred, T; Adamsen, S

    1986-05-01

    Three cases are presented, in which an anomalous tendon slip between the extensor carpi ulnaris tendon and the extensor apparatus of the fifth finger was found. One of the patients was a violinist, who had serious impairment of the left wrist joint and the small finger due to the anomaly. The symptoms disappeared after excision.

  4. 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.

  5. Recent advances in flexor tendon repair

    NARCIS (Netherlands)

    J.C.H.M. van der Meulen (Jacques)

    1971-01-01

    markdownabstractThe prognosis for restoration of good function after the treatment of a tendon lesion in 'no-man's land' is influenced by a number of factors which may be summarized as follows: - The nature of the injury. - The amplitude of the tendon excursion. - The motility of the hand. -

  6. 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.

  7. Less promising results with sclerosing ethoxysclerol injections for midportion achilles tendinopathy: a retrospective study

    NARCIS (Netherlands)

    M.N. van Sterkenburg; M.C. de Jonge; I.N. Sierevelt; C.N. van Dijk

    2010-01-01

    BACKGROUND: Local injections of the sclerosing substance polidocanol (Ethoxysclerol) have shown good clinical results in patients with chronic midportion Achilles tendinopathy. After training by the inventors of the technique, sclerosing Ethoxysclerol injections were applied on a group of patients i

  8. 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

  9. Mactaquac intake tendons removal and replacement

    Energy Technology Data Exchange (ETDEWEB)

    Campbell, I. [NB Power Generation Corp., Mactaquac Generating Station, Keswick Ridge, NB (Canada); Mee, A. [Hatch Energy, Niagara Falls, ON (Canada)

    2007-07-01

    In 1988 and 1989, multi-strand tendons were installed in the intake structure of the Mactaquac generating station. In order to control displacements caused by alkali aggregate reaction (AAR), they were installed in preparation for a slot cutting program in the intake structure to guard against the possibility of a sliding failure of a section of the structure along a plane coincident with the bottom of the water passage. Unique problems for the designers were present in the expansion affect of AAR that were compounded by field conditions that resulted in further difficulties. For example, concrete expansion required the installation of a thick shim pack under the upper anchor head and the periodic testing of the tendons. Once tested, shims could be gradually removed to maintain the correct load over the life of the tendon. However, during the first round of testing and de-stressing five years after the original installation, it was found that some of the tendons had already failed. Over half of the tendons have been replaced in the 20 years since the installation. This paper discussed the original design considerations and examined the conditions that contributed to the premature failure of the tendons. It outlined the history of tendon testing procedures, tendon failure modes and tendon replacement methods. Specifically, the paper discussed the remedial techniques that were employed and the iterations that lead to the current repair approach, while considering the unique field conditions. The application of various corrosion protection schemes and installation and testing methodologies were discussed. It was concluded that tendons were successfully installed in numerous concrete dams around the world but have needed replacement for a variety of reasons. 1 ref., 10 figs.

  10. Ultrasound guided electrocoagulation in patients with chronic non-insertional Achilles tendinopathy

    DEFF Research Database (Denmark)

    Boesen, M Ilum; Torp-Pedersen, S; Koenig, M Juhl;

    2006-01-01

    High resolution colour Doppler ultrasound shows intratendinous Doppler activity in patients with chronic Achilles tendinopathy. Treatment of this neovascularisation with sclerosing therapy seems to relieve the pain. However, the procedure often has to be repeated.......High resolution colour Doppler ultrasound shows intratendinous Doppler activity in patients with chronic Achilles tendinopathy. Treatment of this neovascularisation with sclerosing therapy seems to relieve the pain. However, the procedure often has to be repeated....

  11. Serial superficial digital flexor tendon biopsies for diagnosing and monitoring collagenase-induced tendonitis in horses

    Directory of Open Access Journals (Sweden)

    José C. de Lacerda Neto

    2013-06-01

    Full Text Available The purpose of this investigation was to demonstrate the feasibility of a biopsy technique by performing serial evaluations of tissue samples of the forelimb superficial digital flexor tendon (SDFT in healthy horses and in horses subjected to superficial digital flexor tendonitis induction. Eight adult horses were evaluated in two different phases (P, control (P1 and tendonitis-induced (P2. At P1, the horses were subjected to five SDFT biopsies of the left forelimb, with 24 hours (h of interval. Clinical and ultrasonographic (US examinations were performed immediately before the tendonitis induction, 24 and 48 h after the procedure. The biopsied tendon tissues were analyzed through histology. P2 evaluations were carried out three months later, when the same horses were subjected to tendonitis induction by injection of bacterial collagenase into the right forelimb SDFT. P2 clinical and US evaluations, and SDFT biopsies were performed before, and after injury induction at the following time intervals: after 24, 48, 72 and 96 h, and after 15, 30, 60, 90, 120 and 150 days. The biopsy technique has proven to be easy and quick to perform and yielded good tendon samples for histological evaluation. At P1 the horses did not show signs of localised inflammation, pain or lameness, neither SDFT US alterations after biopsies, showing that the biopsy procedure per se did not risk tendon integrity. Therefore, this procedure is feasible for routine tendon histological evaluations. The P2 findings demonstrate a relation between the US and histology evaluations concerning induced tendonitis evolution. However, the clinical signs of tendonitis poorly reflected the microscopic tissue condition, indicating that clinical presentation is not a reliable parameter for monitoring injury development. The presented method of biopsying SDFT tissue in horses enables the serial collection of material for histological analysis causing no clinical signs and tendon damage seen

  12. Hamstring tendons insertion - an anatomical study

    Directory of Open Access Journals (Sweden)

    Cristiano Antonio Grassi

    2013-09-01

    Full Text Available OBJECTIVE: To study the anatomy of the hamstring tendons insertion and anatomical rela-tionships. METHODS: Ten cadaver knees with medial and anterior intact structures were selected. The dissection was performed from anteromedial access to exposure of the insertion of the flexor tendons (FT, tibial plateau (TP and tibial tuberosity (TT. A needle of 40 × 12 and a caliper were used to measure the distance of the tibial plateau of the knee flexor tendons insertion at 15 mm from the medial border of the patellar tendon and tibial tuberosity to the insertion of the flexor tendons of the knee. The angle between tibial plateau and the insertion of the flexor tendons of the knee (A-TP-FT was calculated using Image Pro Plus software. RESULTS: The mean distance TP-FT was 41 ± 4.6 mm. The distance between the TT-FT was 6.88 ± 1 mm. The (A-TP-FT was 20.3 ± 4.9°. CONCLUSION: In the anterior tibial flexor tendons are about 40 mm from the plateau with an average of 20°.

  13. PRP and Metaplasia in repaired tendon

    Institute of Scientific and Technical Information of China (English)

    Kamal Seyed-Forootan; Hamid Karimi; Ahmad-Reza Dayani

    2014-01-01

    Objective:To evaluate effects ofPRP injection in strengthening of repaired tendon.Methods:This study was conducted in animal lab of our hospital on20 rats.The animals were divided into two groups randomly and distal third of leftAchillis tendons were cut and then repaired with Vicryl2/0.The first group was control group and in the second group0.5 cc ofPRP was injected into the repair site.After4 weeks all of the rats were executed and70% of tendons were sent randomly for tensilometry and the force that required to rupture the tendons were measured.In next stage the tendons were sent for pathological exam.Results:The force that was needed to rupture the tendon were not significantly different in the two groups.Neovascularization were more prevalent inPRP group but not statistically significant.There were two cases ofCartilage Metaplasia inPRP group.Conclusion:It seems that usingPRP has no effect on strengthening the tendons repair and may have some adverse effects.It usage needs further studies to evaluate their probable adverse side effects.

  14. Distal biceps tendon injuries: diagnosis and management.

    Science.gov (United States)

    Ramsey, M L

    1999-01-01

    Rupture of the distal biceps tendon occurs most commonly in the dominant extremity of men between 40 and 60 years of age when an unexpected extension force is applied to the flexed arm. Although previously thought to be an uncommon injury, distal biceps tendon ruptures are being reported with increasing frequency. The rupture typically occurs at the tendon insertion into the radial tuberosity in an area of preexisting tendon degeneration. The diagnosis is made on the basis of a history of a painful, tearing sensation in the antecubital region. Physical examination demonstrates a palpable and visible deformity of the distal biceps muscle belly with weakness in flexion and supination. The ability to palpate the tendon in the antecubital fossa may indicate partial tearing of the biceps tendon. Plain radiographs may show hypertrophic bone formation at the radial tuberosity. Magnetic resonance imaging is generally not required to diagnose a complete rupture but may be useful in the case of a partial rupture. Early surgical reattachment to the radial tuberosity is recommended for optimal results. A modified two-incision technique is the most widely used method of repair, but anterior single-incision techniques may be equally effective provided the radial nerve is protected. The patient with a chronic rupture may benefit from surgical reattachment, but proximal retraction and scarring of the muscle belly can make tendon mobilization difficult, and inadequate length of the distal biceps tendon may necessitate tendon augmentation. Postoperative rehabilitation must emphasize protected return of motion for the first 8 weeks after repair. Formal strengthening may begin as early as 8 weeks, with a return to unrestricted activities, including lifting, by 5 months.

  15. Fibroma of the tendon sheath of the long head of the biceps tendon.

    Science.gov (United States)

    De Maeseneer, Michel; Van Isacker, Tom; Lenchik, Leon; Van Caillie, Marie-Astrid; Shahabpour, Maryam

    2014-03-01

    Fibroma of the tendon sheath is a benign tumor that is less common than giant cell tumor of the tendon sheath. Both tumors may present as a painless, slowly enlarging mass. Radiological findings may be similar for both tumors. Histologically, fibroma of the tendon sheath lacks the hemosiderin-laden macrophages that are typical for giant cell tumor of the tendon sheath. We report on a 49-year-old woman with fibroma of the tendon sheath of the long head of the biceps tendon. In our case, on MR images, we observed band-like hypointense areas centrally in the tumor, mild patchy contrast enhancement, and most importantly, no decrease of signal intensity on gradient echo images. These characteristics reflected histological findings.

  16. Fibroma of the tendon sheath of the long head of the biceps tendon

    Energy Technology Data Exchange (ETDEWEB)

    Maeseneer, Michel de; Shahabpour, Maryam [Universitair Ziekenhuis Brussel, Department of Radiology, Brussels (Belgium); Isacker, Tom van [Sint-Lucas Hospital, Department of Orthopedic Surgery, Brugge (Belgium); Lenchik, Leon [Wake Forest School of Medicine, Department of Radiology, Winston Salem, NC (United States); Caillie, Marie-Astrid van [Sint-Lucas Hospital, Department of Pathology, Brugge (Belgium)

    2014-03-15

    Fibroma of the tendon sheath is a benign tumor that is less common than giant cell tumor of the tendon sheath. Both tumors may present as a painless, slowly enlarging mass. Radiological findings may be similar for both tumors. Histologically, fibroma of the tendon sheath lacks the hemosiderin-laden macrophages that are typical for giant cell tumor of the tendon sheath. We report on a 49-year-old woman with fibroma of the tendon sheath of the long head of the biceps tendon. In our case, on MR images, we observed band-like hypointense areas centrally in the tumor, mild patchy contrast enhancement, and most importantly, no decrease of signal intensity on gradient echo images. These characteristics reflected histological findings. (orig.)

  17. Mechanical properties of human patellar tendon at the hierarchical levels of tendon and fibril

    DEFF Research Database (Denmark)

    Svensson, René B; Hansen, Philip; Hassenkam, Tue;

    2012-01-01

    Tendons are strong hierarchical structures, but how tensile forces are transmitted between different levels remains incompletely understood. Collagen fibrils are thought to be primary determinants of whole tendon properties, and therefore we hypothesized that the whole human patellar tendon and its...... distinct collagen fibrils would display similar mechanical properties. Human patellar tendons (n = 5) were mechanically tested in vivo by ultrasonography. Biopsies were obtained from each tendon, and individual collagen fibrils were dissected and tested mechanically by atomic force microscopy. The Young......'s modulus was 2.0 ± 0.5 GPa, and the toe region reached 3.3 ± 1.9% strain in whole patellar tendons. Based on dry cross-sectional area, the Young's modulus of isolated collagen fibrils was 2.8 ± 0.3 GPa, and the toe region reached 0.86 ± 0.08% strain. The measured fibril modulus was insufficient to account...

  18. Local trauma in human patellar tendon leads to widespread changes in the tendon gene expression

    DEFF Research Database (Denmark)

    Heinemeier, Katja Maria; Lorentzen, Marc P; Kildevang Jensen, Jacob;

    2016-01-01

    Low cellular activity and slow tissue turnover in human tendon may prolong resolution of tendinopathy. This may be stimulated by moderate localized traumas such as needle penetrations, but whether this results in a widespread cellular response in tendons is unknown. In an initial hypothesis......-generating study, a trauma-induced tendon cell activity (increased total RNA and collagen I mRNA) was observed after repeated patellar tendon biopsies in young men. In a subsequent controlled study, 25 young men were treated with two 0.8 mm diameter needle penetrations (n=13, needle-group (NG)) or one 2.1 mm...... diameter needle biopsy (n=12, biopsy-group (BG)) in one patellar tendon. Four weeks later biopsies were taken from treated (5 mm lateral from trauma site) and contralateral tendons for analyses of RNA content (ribogreen assay), DNA content (PCR based), and gene expression for relevant target genes (Real...

  19. Local trauma in human patellar tendon leads to widespread changes in the tendon gene expression

    DEFF Research Database (Denmark)

    Heinemeier, Katja M; Lorentzen, Marc P; Jensen, Jacob K;

    2016-01-01

    Low cellular activity and slow tissue turnover in human tendon may prolong resolution of tendinopathy. This may be stimulated by moderate localized traumas such as needle penetrations, but whether this results in a widespread cellular response in tendons is unknown. In an initial hypothesis-gener...... and their matrix protein expression. The findings have implications for design of studies on human tendon and may provide perspectives in future treatment strategies in tendinopathy....

  20. Multi-Layer Electrospun Membrane Mimicking Tendon Sheath for Prevention of Tendon Adhesions

    Directory of Open Access Journals (Sweden)

    Shichao Jiang

    2015-03-01

    Full Text Available Defect of the tendon sheath after tendon injury is a main reason for tendon adhesions, but it is a daunting challenge for the biomimetic substitute of the tendon sheath after injury due to its multi-layer membrane-like structure and complex biologic functions. In this study, a multi-layer membrane with celecoxib-loaded poly(l-lactic acid-polyethylene glycol (PELA electrospun fibrous membrane as the outer layer, hyaluronic acid (HA gel as middle layer, and PELA electrospun fibrous membrane as the inner layer was designed. The anti-adhesion efficacy of this multi-layer membrane was compared with a single-layer use in rabbit flexor digitorum profundus tendon model. The surface morphology showed that both PELA fibers and celecoxib-loaded PELA fibers in multi-layer membrane were uniform in size, randomly arrayed, very porous, and smooth without beads. Multi-layer membrane group had fewer peritendinous adhesions and better gliding than the PELA membrane group and control group in gross and histological observation. The similar mechanical characteristic and collagen expression of tendon repair site in the three groups indicated that the multi-layer membrane did not impair tendon healing. Taken together, our results demonstrated that such a biomimetic multi-layer sheath could be used as a potential strategy in clinics for promoting tendon gliding and preventing adhesion without poor tendon healing.

  1. Traumatic tibialis anterior tendon rupture: treatment with a two-stage silicone tube and an interposition hamstring tendons graft protocol.

    Science.gov (United States)

    Kontogeorgakos, Vasileios; Koutalos, Antonios; Hantes, Michael; Manoudis, Gregory; Badras, Leonidas; Malizos, Konstantinos

    2015-03-01

    A novel technique for managing ruptured tibialis anterior tendon complicated by infection and tendon substance loss in a young adult is described. A two-stage reconstruction technique with a silicon tube and tendon autograft was performed. At first, after local control of the infection, scar excision and placement of a silicone tube was performed. Ten weeks later, ipsilateral hamstrings tendons were harvested and bridged the 7 cm tendon gap. Eighteen months later, the patient has excellent clinical and functional outcome.

  2. [Tendon ruptures of the shoulder].

    Science.gov (United States)

    Habermeyer, P

    1989-08-01

    Common sports, involving raising the arms above the head, i.e., throwing, racquet games and swimming, often result in rotator cuff tendinitis. During the throwing motion, the humeral head and its overlying biceps tendon and rotator cuff must pass rapidly under the coraco-acromial arch. Damage to these structures can occur by several mechanism. First, an increase in the size of the structures passing underneath the arch may lead to impingement. This can occur either by way of hypertrophy of the musculotendinous cuff or by way of inflammation of the cuff. Second, a decreased space available underneath the arch secondary to osteophyte formation of the acromion and fibrosis of the subacromial space may lead to impingement. Third, weakness or incompetence of the rotator cuff allows the humerus to ride up and impinge on the coracoacromial arch with motion of the shoulder. Tendinitis can be combined with increased laxity of the glenohumeral joint and/or acquired instability due to a labral tear. Prevention of overuse injuries is a cornerstone of our treatment concept. The muscle tendon unit requires passive and neuromuscular facilitated streching after warming-up exercises. Muscular imbalance and weakness are prevented by balanced eccentric strenthening with particular attention to the external rotators and scapular muscles. Knowledge of the mechanics of the pitching motion, tennis serve, swimming stroke, etc. is of paramount importance in the prevention of injuries. As the onset of shoulder problems contributes to a particularly fatiguing situation, extreme fatique performance severity should be avoided. Every effort must be made to apply conservative treatment when overuse problems arise in the athlete's shoulder.(ABSTRACT TRUNCATED AT 250 WORDS)

  3. Jumper's Knee (Patellar Tendonitis) (For Parents)

    Science.gov (United States)

    ... Preventing Jumper's Knee en español Rodilla de saltador (tendinitis rotuliana) Jumper's knee — also known as patellar tendonitis or patellar tendinopathy — is an inflammation or injury of the patellar ...

  4. 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.

  5. Position Control of Tendon-Driven Fingers

    Science.gov (United States)

    Abdallah, Muhammad E.; Platt, Robert, Jr.; Hargrave, B.; Pementer, Frank

    2011-01-01

    Conventionally, tendon-driven manipulators implement some force control scheme based on tension feedback. This feedback allows the system to ensure that the tendons are maintained taut with proper levels of tensioning at all times. Occasionally, whether it is due to the lack of tension feedback or the inability to implement sufficiently high stiffnesses, a position control scheme is needed. This work compares three position controllers for tendon-driven manipulators. A new controller is introduced that achieves the best overall performance with regards to speed, accuracy, and transient behavior. To compensate for the lack of tension feedback, the controller nominally maintains the internal tension on the tendons by implementing a two-tier architecture with a range-space constraint. These control laws are validated experimentally on the Robonaut-2 humanoid hand. I

  6. In vitro investigation of a tissue-engineered cell-tendon complex mimicking the transitional architecture at the ligament-bone interface.

    Science.gov (United States)

    Wang, Zhibing; Zhang, Yuan; Zhu, Jie; Dong, Shiwu; Jiang, Tao; Zhou, Yue; Zhang, Xia

    2015-03-01

    Restoration of the transitional ligament-bone interface is critical for graft-bone integration. We postulated that an allogenic scaffold mimicking the fibrogenic, chondrogenic, and osteogenic transition gradients could physiologically promote ligament-bone incorporation. The aim of this study was to construct and characterize a composite tendon scaffold with a continuous and heterogeneous transition region mimicking a native ligament insertion site. Genetically modified heterogeneous cell populations were seeded within specific regions of decellularized rabbit Achilles tendons to fabricate a stratified scaffold containing three biofunctional regions supporting fibrogenesis, chondrogenesis, and osteogenesis. The observed morphology, architecture, cytocompatibility, and biomechanics of the scaffolds demonstrated their improved bio-physico-chemical properties. The formation of the transitional regions was augmented via enhanced delivery of two transcription factors, sex determining region Y-box 9 and runt-related transcription factor 2, which also triggered early up-regulated expression of cartilage- and bone-relevant markers, according to quantitative PCR and immunoblot analyses. Gradient tissue-specific matrix formation was also confirmed within the predesignated regions via histological staining and immunofluorescence assays. These results suggest that a transitional interface could be replicated on an engineered tendon through stratified tissue integration. The scaffold offers the advantages of a multitissue transition involving controlled cellular interactions and matrix heterogeneity, which can be applied for the regeneration of the ligament-bone interface.

  7. Grasp Assist Device with Shared Tendon Actuator Assembly

    Science.gov (United States)

    Ihrke, Chris A. (Inventor); Bergelin, Bryan J. (Inventor); Bridgwater, Lyndon (Inventor)

    2015-01-01

    A grasp assist device includes a glove with first and second tendon-driven fingers, a tendon, and a sleeve with a shared tendon actuator assembly. Tendon ends are connected to the respective first and second fingers. The actuator assembly includes a drive assembly having a drive axis and a tendon hook. The tendon hook, which defines an arcuate surface slot, is linearly translatable along the drive axis via the drive assembly, e.g., a servo motor thereof. The flexible tendon is routed through the surface slot such that the surface slot divides the flexible tendon into two portions each terminating in a respective one of the first and second ends. The drive assembly may include a ball screw and nut. An end cap of the actuator assembly may define two channels through which the respective tendon portions pass. The servo motor may be positioned off-axis with respect to the drive axis.

  8. Tension Distribution in a Tendon-Driven Robotic Finger

    Science.gov (United States)

    Abdallah, Muhammad E. (Inventor); Platt, Robert (Inventor); Wampler, II, Charles W. (Inventor)

    2013-01-01

    A method is provided for distributing tension among tendons of a tendon-driven finger in a robotic system, wherein the finger characterized by n degrees of freedom and n+1 tendons. The method includes determining a maximum functional tension and a minimum functional tension of each tendon of the finger, and then using a controller to distribute tension among the tendons, such that each tendon is assigned a tension value less than the maximum functional tension and greater than or equal to the minimum functional tension. The method satisfies the minimum functional tension while minimizing the internal tension in the robotic system, and satisfies the maximum functional tension without introducing a coupled disturbance to the joint torques. A robotic system includes a robot having at least one tendon-driven finger characterized by n degrees of freedom and n+1 tendons, and a controller having an algorithm for controlling the tendons as set forth above.

  9. 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.

  10. 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.

  11. Efficient decellularization for tissue engineering of the tendon-bone interface with preservation of biomechanics

    Science.gov (United States)

    Foehr, Peter; Kuempel, Katharina; Wagner, Alexandra; Tuebel, Jutta; Deimling, Constantin V.; Burgkart, Rainer H.

    2017-01-01

    Interfaces between tendon/ligament and bone (“entheses”) are highly specialized tissues that allow for stress transfer between mechanically dissimilar materials. Entheses show very low regenerative capacity resulting in high incidences of failure after surgical repair. Tissue engineering is a promising approach to recover functionality of entheses. Here, we established a protocol to decellularize porcine entheses as scaffolds for enthesis tissue engineering. Chemical detergents as well as physical treatments were investigated with regard to their efficiency to decellularize 2 mm thick porcine Achilles tendon entheses. A two-phase approach was employed: study 1 investigated the effect of various concentrations of sodium dodecyl sulfate (SDS) and t-octylphenoxypolyethoxy-ethanol (Triton X-100) as decellularization agents. The most efficient combination of SDS and Triton was then carried forward into study 2, where different physical methods, including freeze-thaw cycles, ultrasound, perfusion, and hydrostatic washing were used to enhance the decellularization effect. Cell counts, DNA quantification, and histology showed that washing with 0.5% SDS + 1% Triton X-100 for 72 h at room temperature could remove ~ 98% cells from the interface. Further investigation of physical methods proved that washing under 200 mmHg hydrostatic pressure shortened the detergent exposing time from 72 h to 48 h. Biomechanical tensile testing showed that the biomechanical features of treated samples were preserved. Washing under 200 mmHg hydrostatic pressure with 0.5% SDS + 1% Triton X-100 for 48 h efficiently decellularized entheses with preservation of matrix structure and biomechanical features. This protocol can be used to efficiently decellularize entheses as scaffolds for tissue engineering. PMID:28170430

  12. MR Imaging and US of the Wrist Tendons.

    Science.gov (United States)

    Plotkin, Benjamin; Sampath, Srihari C; Sampath, Srinath C; Motamedi, Kambiz

    2016-10-01

    The tendons of the wrist are commonly symptomatic. They can be injured, infected, or inflamed. Magnetic resonance imaging and ultrasonography are useful tools for evaluating the wrist. Pathologic conditions of the wrist tendons include de Quervain tenosynovitis, extensor carpi ulnaris tendinopathy, rheumatoid tenosynovitis, infectious synovitis, tendon tears, hydroxyapatite deposition disease, intersection syndrome, tenosynovial giant cell tumor, and fibroma of the tendon sheath. In this article, we review the normal appearance of the wrist tendons, discuss relevant anatomy, and give an overview of common pathologic conditions affecting the wrist tendons. Online supplemental material is available for this article. (©)RSNA, 2016.

  13. Avoiding the Achilles heel of network-centric enterprises

    Science.gov (United States)

    McVey, Michelle; Dryer, Jay E.; Randall, Lance

    2003-08-01

    Corporate, government and military bodies focus significant resources to develop sophisticated and capable information-based systems. The concept of people and resources connected by a robust network capable of extremely high rates of information exchange is very attractive because it allows smaller groups to coordinate together and focus effects from geographically diverse locations. However, there is also a hidden danger that comes with such advanced technology. For example, in the case of the U.S. Military, clearly United States holds a technological advantage over our adversaries and that this advantage is still expanding. This technology gap has resulted in the emergence of potent asymmetrical warfare. All too often in science fiction movies, we see a small group of humans defeat a technologically superior alien race by striking at a hidden weakness that renders all of their advanced weapons as useless, as a result of pervasive connectivity and interdependence. The analogy holds for any large network-centric enterprise, corporate or governmental. This paper focuses on specific technologies and methods that preempt this Achilles Heal scenario.

  14. COX-2 in Cancer: Gordian knot or Achilles heel?

    Directory of Open Access Journals (Sweden)

    Ioannis eStasinopoulos

    2013-03-01

    Full Text Available The networks of blood and lymphatic vessels and of the extracellular matrix and their cellular and structural components, that are collectively termed the tumor microenvironment, are frequently co-opted and shaped by cancer cells to survive, invade and form distant metastasis. With an enviable capacity to adapt to continually changing environments, cancer represents the epitome of functional chaos, a stark contrast to the hierarchical and organized differentiation processes that dictate the development and life of biological organisms. The consequences of changing landscapes such as hypoxia and acidic extracellular pH in and around tumors create a cascade of, or themselves are results of, changes in multiple pathways and networks that become apparent only several years later as recurrence and metastasis. These molecular and phenotypic changes approach the complexities of a ‘Gordian Knot’. We review evidence from our studies and from literature suggesting that COX-2 biology presents a nodal point in cancer biology and an ‘Achilles heel’ of COX-2-dependent tumors.

  15. Novel Model of Tendon Regeneration Reveals Distinct Cell Mechanisms Underlying Regenerative and Fibrotic Tendon Healing

    Science.gov (United States)

    Howell, Kristen; Chien, Chun; Bell, Rebecca; Laudier, Damien; Tufa, Sara F.; Keene, Douglas R.; Andarawis-Puri, Nelly; Huang, Alice H.

    2017-01-01

    To date, the cell and molecular mechanisms regulating tendon healing are poorly understood. Here, we establish a novel model of tendon regeneration using neonatal mice and show that neonates heal via formation of a ‘neo-tendon’ that differentiates along the tendon specific lineage with functional restoration of gait and mechanical properties. In contrast, adults heal via fibrovascular scar, aberrant differentiation toward cartilage and bone, with persistently impaired function. Lineage tracing identified intrinsic recruitment of Scx-lineage cells as a key cellular mechanism of neonatal healing that is absent in adults. Instead, adult Scx-lineage tenocytes are not recruited into the defect but transdifferentiate into ectopic cartilage; in the absence of tenogenic cells, extrinsic αSMA-expressing cells persist to form a permanent scar. Collectively, these results establish an exciting model of tendon regeneration and uncover a novel cellular mechanism underlying regenerative vs non-regenerative tendon healing. PMID:28332620

  16. Arthroscopic treatment of calcifying tendonitis of subscapularis and supraspinatus tendon: a case report.

    Science.gov (United States)

    Ifesanya, Adeleke; Scheibel, Markus

    2007-12-01

    Reports concerning the surgical treatment of calcifying tendinits of the subscapularis tendon are rare. We present the case of a symptomatic calcifying tendonitis involving the subscapularis and supraspinatus tendons. The patient was treated with an arthroscopic removal of the calcific deposits. One year after the surgical procedure the patient was completely pain free, had full range-of-motion and negative supraspinatus and subscapularis signs on manual muscle testing. The overall constant score was 93 points. Radiographic evaluation revealed a complete removal of the calcific deposits immediately after the procedure without recurrence after 1 year. We conclude that a combined arthroscopic removal of the calcific deposits of the subscapularis and supraspinatus tendons can lead to an excellent clinical outcome without compromising the functional integrity of the rotator cuff tendons.

  17. Removal of a silicone tendon prosthesis six years after insertion for flexor tendon reconstruction: a case report

    Directory of Open Access Journals (Sweden)

    Tolga Eryilmaz

    2012-04-01

    Full Text Available Two-staged flexor tendon repair rely on the effect of the pseudo-tendon sheath that developed by the effect of the silicone tendon prosthesis. The second stage of the reconstruction is performed 1 to 6 months after the first operation by removal of the silicone tendon prosthesis and tendon grafting. In this study, we are presenting a removal of silicone prosthesis 6 years after insertion for flexor tendon reconstruction. [Hand Microsurg 2012; 1(1.000: 40-42

  18. Current evidence of extracorporeal shock wave therapy in chronic Achilles tendinopathy.

    Science.gov (United States)

    Gerdesmeyer, Ludger; Mittermayr, Rainer; Fuerst, Martin; Al Muderis, Munjed; Thiele, Richard; Saxena, Amol; Gollwitzer, Hans

    2015-12-01

    Chronic Achilles tendinopathy has been described as the most common overuse injury in sports medicine. Several treatment modalities such as activity modification, heel lifts, arch supports, stretching exercises, nonsteroidal anti-inflammatories, and eccentric loading are known as standard treatment mostly without proven evidence. After failed conservative therapy, invasive treatment may be considered. Extracorporeal shock wave therapy (ESWT) has been successfully used in soft-tissue pathologies like lateral epicondylitis, plantar fasciitis, tendinopathy of the shoulder and also in bone and skin disorders. Conclusive evidence recommending ESWT as a treatment for Achilles tendinopathy is still lacking. In plantar fasciitis as well as in calcific shoulder tendinopathy shock wave therapy is recently the best evaluated treatment option. This article analysis the evidence based literature of ESWT in chronic Achilles tendinopathy. Recently published data have shown the efficacy of focused and radial extracorporeal shock wave therapy.

  19. Postoperative US of leg tendon reconstruction; Valutazione dei risultati della ricostruzione dei tendini della gamba. Aspetti ecografici

    Energy Technology Data Exchange (ETDEWEB)

    Draghi, F.; Calliada, F.; Fulle, I.; Madonia, L.; Bottinelli, O.; Campani, R. [Pavia Policlinico S. Matteo, Pavia (Italy)

    1999-05-01

    The role of ultrasound (US) in the postoperative assessment of tendon reconstruction is not clearly defined and there is non systematic arrangement of US patterns. The authors examined 34 patients submitted to surgery or conservative treatment for total/partial tear or musculotendinous detachment of patellar or Achilles tendon in the last 5 years. All patients underwent physical and US examinations. The surgical tendon exhibited the same US patterns in 23/28 patients: it was markedly enlarged (three-/fourfold the normal diameter) and more rounded, with inhomogeneous and hypoechoic appearance not only at the tear/surgical site but also above and below it, for some cm. Small hyperechoic images, mainly dots, were seen in 19 cases, which were referable to small calcifications and stitches. More and larger calcifications were found in 8 patients, where they were associated with anechoic degeneration areas. Color Doppler US showed moderate or strong hypervascularization around the tear in the first months post injury. US patterns did not correlate with physical findings, but color Doppler patterns did. In 6 cases of musculotendinous detachment submitted to conservative treatment, US showed enlargement and hypoechogenicity in the injury site only, with no involvement of the remaining tendon. US was also used to time and guide drainage of perilesional hematomas, which were often quite large. US is the method of choice in the postoperative follow-up of tendon tears and musculotendinous detachments because it shows abnormal signs which are missed at clinics and provides additional information needed for treatment planning. [Italian] Il ruolo dell'ecografia nel controllo post-chirurgico delle rotture tendinee non e' ancora del tutto definito e non esiste trattazione sistematica degli aspetti ecografici dopo terapia. Sono stati esaminati, mediante esame clinico ed ecografico, 34 pazienti sottoposti a trattamento chirurgico o conservativo per rottura parziale, totale

  20. Management of acute open tendo-achilles injuries in Indian lavatory pans

    Directory of Open Access Journals (Sweden)

    Chatterjee Sasanka

    2006-01-01

    Full Text Available Injuries to the Tendo-achilles are common but rarely do they present directly to plastic surgeons. Eighteen patients with acute tendo-achilles injury due to fall in the lndian type of lavatory pan came directly to the emergency department of Institute of Post Graduate Medical Education and Research, Kolkata and subsequently were treated in the Department of Plastic Surgery. Direct repair with prolene or stainless steel (SS wires with or without flap cover were performed for management. Exercises were started 1 month later with gradual increase in activity. Complications were minor and temporary in nature. Long term results in the form of performing previous activities were excellent.

  1. 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

    expression of 2 hypoxia-related genes, hypoxia-inducible factor 1alpha (HIF1alpha) and carbonic anhydrase III (CAIII). METHODS: Two groups of Wistar rats performed 1-leg contractions of the calf muscle by electrostimulation of the sciatic nerve. After 10 min of muscle contractions, (64)Cu-ATSM was injected...... and contractions were continued for 20 min. PET/CT of both hind limbs was performed immediately and 1 h after the contractions. The exercise group (n = 8) performed only muscle contractions as described, whereas the other group, exercise plus cuff (n = 8), in addition underwent cuff-induced hypoxia during...... the first PET/CT scan. Standardized uptake values (SUVs) were calculated for the Achilles tendons and triceps surae muscles and were correlated to gene expression of HIF1alpha and CAIII using real-time polymerase chain reaction. RESULTS: Immediately after the contractions, uptake of (64)Cu...

  2. The effect of tendon surface treatment on cell attachment for potential enhancement of tendon graft healing: an ex vivo model.

    Science.gov (United States)

    Hashimoto, Takahiro; Sun, Yu-Long; An, Kai-Nan; Amadio, Peter C; Zhao, Chunfeng

    2012-12-01

    For both tendon allografts and autografts, the surface, initially optimized for gliding, may not be ideal to facilitate tissue integration for graft healing to host tendon or bone. As a prelude to studying tendon-bone integration, we investigated the effect of surface treatments with trypsin or mechanical abrasion on cell attachment to the tendon surface in a canine ex vivo intrasynovial tendon tissue culture model. Intrasynovial tendon allograft surfaces were seeded with cells after the following treatments: (1) no treatment, (2) mechanical abrasion, (3) trypsin, and (4) abrasion and trypsin. The area covered by cells was determined using confocal laser microscopy at one and two weeks. Results were compared to untreated extrasynovial tendon. Additional tendons were characterized with scanning electron microscopy. Tendons with trypsin treatment had significantly more surface coverage with cells than the other groups, after both one and two weeks of culture. In terms of the cellular shape and size, cells on tendons with trypsin treatment spread more and were more polygonal in shape, whereas tendons with mechanical abrasion with/without trypsin treatment contained smaller, more spindle-like cells. Surface roughening can affect cell behavior with topographical stimulation. Trypsin surface digestion exposes a mesh-like structure on the tendon surface, which could enhance cell adherence and, possibly, tendon/bone healing.

  3. Robot Arm with Tendon Connector Plate and Linear Actuator

    Science.gov (United States)

    Ihrke, Chris A. (Inventor); Diftler, Myron A. (Inventor); Bridgwater, Lyndon (Inventor); Nguyen, Vienny (Inventor); Millerman, Alexander (Inventor)

    2014-01-01

    A robotic system includes a tendon-driven end effector, a linear actuator, a flexible tendon, and a plate assembly. The linear actuator assembly has a servo motor and a drive mechanism, the latter of which translates linearly with respect to a drive axis of the servo motor in response to output torque from the servo motor. The tendon connects to the end effector and drive mechanism. The plate assembly is disposed between the linear actuator assembly and the tendon-driven end effector and includes first and second plates. The first plate has a first side that defines a boss with a center opening. The second plate defines an accurate through-slot having tendon guide channels. The first plate defines a through passage for the tendon between the center opening and a second side of the first plate. A looped end of the flexible tendon is received within the tendon guide channels.

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

    Science.gov (United States)

    Curtis, Luke

    2016-06-01

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

  5. No Telescoping Effect with Dual Tendon Vibration.

    Directory of Open Access Journals (Sweden)

    Valeria Bellan

    Full Text Available The tendon vibration illusion has been extensively used to manipulate the perceived position of one's own body part. However, findings from previous research do not seem conclusive sregarding the perceptual effect of the concurrent stimulation of both agonist and antagonist tendons over one joint. On the basis of recent data, it has been suggested that t