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Sample records for patellar tendon autograft

  1. Quadriceps tendon autograft for arthroscopic knee ligament reconstruction: use it now, use it often.

    Science.gov (United States)

    Sheean, Andrew J; Musahl, Volker; Slone, Harris S; Xerogeanes, John W; Milinkovic, Danko; Fink, Christian; Hoser, Christian

    2018-04-28

    Traditional bone-patellar tendon-bone and hamstring tendon ACL grafts are not without limitations. A growing body of anatomic, biomechanical and clinical data has demonstrated the utility of quadriceps tendon autograft in arthroscopic knee ligament reconstruction. The quadriceps tendon autograft provides a robust volume of tissue that can be reliably harvested, mitigating the likelihood of variably sized grafts and obviating the necessity of allograft augmentation. Modern, minimally invasive harvest techniques offer the advantages of low rates of donor site morbidity and residual extensor mechanism strength deficits. New data suggest that quadriceps tendon autograft may possess superior biomechanical characteristics when compared with bone-patella tendon-bone (BPTB) autograft. However, there have been very few direct, prospective comparisons between the clinical outcomes associated with quadriceps tendon autograft and other autograft options (eg, hamstring tendon and bone-patellar tendon-bone). Nevertheless, quadriceps tendon autograft should be one of the primary options in any knee surgeon's armamentarium. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  2. MRI of anterior cruciate ligament repair with patellar and hamstring tendon autografts

    International Nuclear Information System (INIS)

    Jansson, K.A.; Karjalainen, P.T.; Harilainen, A.; Sandelin, J.; Tallroth, K.; Soila, K.; Aronen, H.J.

    2001-01-01

    Objective. Several MRI sequences were used to evaluate the 2-year postoperative appearance of asymptomatic knee with a torn anterior cruciate ligament (ACL) reconstructed with bone-patellar tendon-bone (BTB) and semitendinosus and gracilis (STG) tendon autografts.Design and patients. Two groups with successful repair of ACL tear with BTB (n=10) or STG (n=10) autografts were imaged at 1.5 T with sagittal and oblique coronal proton density-, T2-weighted and sagittal STIR sequences and plain and contrast-enhanced oblique coronal T1-weighted sequences. The appearance of the graft and periligamentous tissues was evaluated.Results. In all 20 cases, the ACL graft showed homogeneous, low signal intensity with periligamentous streaks of intermediate signal intensity on T2-weighted images. In 10 cases, localised areas of intermediate signal intensity were seen in the intra-articular segment of the graft on proton density- and T1-weighted images. The graft itself did not show enhancement in either of the two groups, but mild to moderate periligamentous enhancement was detected in 10 cases.Conclusion. The MRI appearance of ACL autograft is variable on proton density- and T1-weighted images. Periligamentous tissue showing contrast enhancement is a typical MRI finding after clinically successful ACL reconstruction. (orig.)

  3. Anterior-Posterior Instability of the Knee Following ACL Reconstruction with Bone-Patellar Tendon-Bone Ligament in Comparison with Four-Strand Hamstrings Autograft

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    A. G. Angoules

    2013-01-01

    Full Text Available Purpose. To evaluate anterior-posterior knee laxity using two different autografts. Material-Methods. 40 patients, (34 males and 6 women, 17–54 years old (mean: 31, were included in the present study. Group A (4SHS = 20 underwent reconstruction using four-strand hamstrings, and group B (BPBT = 20 underwent reconstruction using bone-patellar tendon-bone autograft. Using the KT-1000 arthrometer, knee instability was calculated in both knees of all patients preoperatively and 3, 6, and 12 months after surgery at the ACL-operated knee. The contralateral healthy knee was used as an internal control group. Results. Anterior-posterior instability using the KT1000 Arthrometer was found to be increased after ACL insufficiency. The recorded laxity improved after arthroscopic ACL reconstruction in both groups. However, statistically significant greater values were detected in the bone-patellar tendon-bone group, which revealed reduction of anteroposterior stability values to an extent, where no statistical significance with the normal values even after 3 months after surgery was observed. Conclusions. Anterior-Posterior instability of the knee improved significantly after arthroscopic ACL reconstruction. The bone-patellar tendon-bone graft provided an obvious greater stability.

  4. An Isolated Medial Patellofemoral Ligament Reconstruction with Patellar Tendon Autograft

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    Dariusz Witoński

    2013-01-01

    Full Text Available The aim of the study was to evaluate the results of the medial patellofemoral ligament reconstruction with a medial strip of patellar tendon autograft after a minimum 2-year followup. Ten patients (10 knees were operated on by one surgeon, according to the modified technique, described by Camanho, without any bone plug at free graft end. The mean age of the patients was 27.2 years (ranging from 18 to 42 years. The mean follow-up period was 3 years and 7 months. All patients were reviewed prospectively. At the last follow-up visit, all the patients demonstrated a significant improvement in terms of patellofemoral joint stability, all aspects of the KOOS questionnaire, and Kujala et al.’s score (59.7 points preoperatively and 84.4 points at the last followup. No patient revealed recurrent dislocation. The SF-36 score revealed a significant improvement in bodily pain, general health, physical role functioning, social role functioning, and physical functioning domains. The described MPFL reconstruction with the use of the medial 1/3rd of patella tendon is an effective procedure that gives satisfactorily patellofemoral joint functions, improves the quality of life, and provides much pain relief. It is relatively simple, surgically not extensive, and economically cost-effective procedure.

  5. Anterior Cruciate Ligament Reconstruction using Bone Patellar Tendon Bone autograft in ACL deficient Knee

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    Navin Kumar Karn

    2015-12-01

    Full Text Available Background & Objectives: Injury to Anterior Cruciate Ligament (ACL reconstruction has increased because of increased interest in sports. There are various grafts used for reconstruction of ACL, for example, Bone Patellar Tendon Bone, Hamstring etc. The study was conducted to evaluate the results of Bone Patellar Tendon Bone graft used for reconstruction of Anterior Cruciate Ligament.Materials & Methods: 40 patients with chronic ACL deficient knee presenting to Neuro Hospital from July 2011 to June 2013 were included in the study. The patients with intraarticular fracture of knee, severe OA knee, local active or suspected infection and systemic disease that might influence the study results were excluded from the study. Bone patellar tendon bone graft was harvested from ipsilateral knee in all the cases. The patient was followed till 2 year with specified programme of rehabilitation. The pain was assessed using VAS and the function of the knee was assessed using Modified WOMAC knee index.Results: The long term satisfactory results in terms of functional stability, symptom relief and return to preinjury level of activity was seen in 32 cases (80%. Two knees got infected out of which one required arthroscopic debridement. Mean visual analogue scale was 8 and modified WOMAC knee score was 3 at 2 year follow up.Conclusion: Bone patellar tendon bone graft is useful in high demand patients and cost effective option with high patient satisfaction rate for reconstruction of ACL.JCMS Nepal. 2015;11(3:12-15.

  6. Clinical and radiological outcomes after a quasi-anatomical reconstruction of medial patellofemoral ligament with gracilis tendon autograft.

    Science.gov (United States)

    Monllau, Joan C; Masferrer-Pino, Àngel; Ginovart, Gerard; Pérez-Prieto, Daniel; Gelber, Pablo E; Sanchis-Alfonso, Vicente

    2017-08-01

    To analyse the clinical and radiological outcomes of a quasi-anatomical reconstruction of the medial patellofemoral ligament (MPFL) with a gracilis tendon autograft. Patients with objective recurrent patellar instability that were operated on from 2006 to 2012 were included. A quasi-anatomical surgical technique was performed using a gracilis tendon autograft. It was anatomically attached at the patella, and the adductor magnus tendon was also used as a pulley for femoral fixation (non-anatomical reconstruction). The IKDC, Kujala and Lysholm scores as well as Tegner and VAS for pain were collected preoperatively and at final follow-up. Radiographic measurements of patellar position tilt and signs of osteoarthritis (OA) as well as trochlear dysplasia were also recorded. Thirty-six patients were included. The mean age at surgery was 25.6 years. After a minimum 27 months of follow-up, all functional scores significantly improved (p patellofemoral surfaces at the short term, as shown by the absence of radiological signs of OA in the CT scan. The procedure has been shown to be safe and suitable for the treatment of chronic patellar instability, including in adolescents with open physis. A new effective, inexpensive and easy-to-perform technique is described to reconstruct MPFL in the daily clinical practice. Therapeutic case series, Level IV.

  7. Simultaneous bilateral patellar tendon rupture ?

    OpenAIRE

    Moura, Diogo Lino; Marques, Jos? Pedro; Lucas, Francisco Manuel; Fonseca, Fernando Pereira

    2016-01-01

    Bilateral patellar tendon rupture is a rare entity, often associated with systemic diseases and patellar tendinopathy. The authors report a rare case of a 34-year-old man with simultaneous bilateral rupture of the patellar tendon caused by minor trauma. The patient is a retired basketball player with no past complaints of chronic knee pain and a history of steroid use. Surgical management consisted in primary end-to-end tendon repair protected temporarily with cerclage wiring, followed by a s...

  8. Patellar Sleeve Fracture With Ossification of the Patellar Tendon.

    Science.gov (United States)

    Damrow, Derek S; Van Valin, Scott E

    2017-03-01

    Patellar sleeve fractures make up greater than 50% of all patellar fractures. They are essentially only seen in the pediatric population because of the thick periosteum and the distal patellar pole apophysis in this group. These fractures can lead to complications if not treated appropriately and in a timely fashion. Complications of missed or untreated patellar sleeve fractures include patella alta, anterior knee pain, and quadriceps atrophy. These can all result in severe limitations in activity. The authors describe a case of a 16-year-old boy who sustained a patellar sleeve fracture 3 years prior to presentation. On presentation, he had patella alta, diminished strength, 5° of extensor lag, and radiographs that revealed bone formation along the patellar tendon. Despite this, he was able to maintain a high level of activity. This case report explores how the patient could have maintained a high level of activity despite having a patellar sleeve fracture. Also, because of the delayed presentation, the patella was ossified and the quadriceps was retracted, which led to a novel approach to reconstructing his distal extensor mechanism. This approach included a V-Y advancement of the quadriceps tendon and patellar tendon reconstruction using the patient's hamstring tendon (semitendinosus). This technique, combined with physical therapy postoperatively, resulted in his return to varsity high school soccer. To the best of the authors' knowledge, this technique has not been reported for this rare condition. [Orthopedics. 2017; 40(2):e357-e359.]. Copyright 2016, SLACK Incorporated.

  9. Quadriceps Tendon Autograft in Anterior Cruciate Ligament Reconstruction: A Systematic Review.

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    Hurley, Eoghan T; Calvo-Gurry, Manuel; Withers, Dan; Farrington, Shane K; Moran, Ray; Moran, Cathal J

    2018-05-01

    To systematically review the current evidence to ascertain whether quadriceps tendon autograft (QT) is a viable option in anterior cruciate ligament reconstruction. A literature review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Cohort studies comparing QT with bone-patellar tendon-bone autograft (BPTB) or hamstring tendon autograft (HT) were included. Clinical outcomes were compared, with all statistical analyses performed using IBM SPSS Statistics for Windows, version 22.0, with P < .05 being considered statistically significant. We identified 15 clinical trials with 1,910 patients. In all included studies, QT resulted in lower rates of anterior knee pain than BPTB. There was no difference in the rate of graft rupture between QT and BPTB or HT in any of the studies reporting this. One study found that QT resulted in greater knee stability than BPTB, and another study found increased stability compared with HT. One study found that QT resulted in improved functional outcomes compared with BPTB, and another found improved outcomes compared with HT, but one study found worse outcomes compared with BPTB. Current literature suggests QT is a viable option in anterior cruciate ligament reconstruction, with published literature showing comparable knee stability, functional outcomes, donor-site morbidity, and rerupture rates compared with BPTB and HT. Level III, systematic review of Level I, II, and III studies. Copyright © 2018 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  10. Simultaneous bilateral patellar tendon rupture.

    Science.gov (United States)

    Moura, Diogo Lino; Marques, José Pedro; Lucas, Francisco Manuel; Fonseca, Fernando Pereira

    2017-01-01

    Bilateral patellar tendon rupture is a rare entity, often associated with systemic diseases and patellar tendinopathy. The authors report a rare case of a 34-year-old man with simultaneous bilateral rupture of the patellar tendon caused by minor trauma. The patient is a retired basketball player with no past complaints of chronic knee pain and a history of steroid use. Surgical management consisted in primary end-to-end tendon repair protected temporarily with cerclage wiring, followed by a short immobilization period and intensive rehabilitation program. Five months after surgery, the patient was able to fully participate in sport activities.

  11. Simultaneous bilateral patellar tendon rupture

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    Diogo Lino Moura

    Full Text Available ABSTRACT Bilateral patellar tendon rupture is a rare entity, often associated with systemic diseases and patellar tendinopathy. The authors report a rare case of a 34-year-old man with simultaneous bilateral rupture of the patellar tendon caused by minor trauma. The patient is a retired basketball player with no past complaints of chronic knee pain and a history of steroid use. Surgical management consisted in primary end-to-end tendon repair protected temporarily with cerclage wiring, followed by a short immobilization period and intensive rehabilitation program. Five months after surgery, the patient was able to fully participate in sport activities.

  12. Free Bone Plug Quadriceps Tendon Harvest and Suspensory Button Attachment for Anterior Cruciate Ligament Reconstruction.

    Science.gov (United States)

    Todor, Adrian; Caterev, Sergiu; Nistor, Dan Viorel; Khallouki, Youssef

    2016-06-01

    The most commonly used autografts for anterior cruciate ligament reconstruction are the bone-patellar tendon-bone and hamstring tendons. Each has its advantages and limitations. The bone-patellar tendon-bone autograft can lead to more donor-site morbidity, and the hamstring autograft can be unpredictable in size. The quadriceps tendon, with or without a bone block, has been described as an alternative graft source and has been used especially in revision cases, but in recent years, it has attracted attention even for primary cases. We report a technique for harvesting a free bone quadriceps tendon graft and attaching an extracortical button for femoral fixation for anterior cruciate ligament reconstruction.

  13. Radiographic Features of Acute Patellar Tendon Rupture.

    Science.gov (United States)

    Fazal, Muhammad Ali; Moonot, Pradeep; Haddad, Fares

    2015-11-01

    The purpose of our study was to assess soft tissue features of acute patellar tendon rupture on lateral knee radiograph that would facilitate early diagnosis. The participants were divided into two groups of 35 patients each. There were 28 men and seven women with a mean age of 46 years in the control group and 26 men and nine women with a mean age of 47 years in the rupture group. The lateral knee radiograph of each patient was evaluated for Insall-Salvati ratio for patella alta, increased density of the infrapatellar fat pad, appearance of the soft tissue margin of the patellar tendon and bony avulsions. In the rupture group there were three consistent soft tissue radiographic features in addition to patellar alta. These were increased density of infrapatellar fat pad; loss of sharp, well-defined linear margins of the patellar tendon and angulated wavy margin of the patellar tendon while in the control group these features were not observed. The soft tissue radiographic features described in the rupture group are consistent and reliable. When coupled with careful clinical assessment, these will aid in early diagnosis and further imaging will be seldom required. © 2015 Chinese Orthopaedic Association and Wiley Publishing Asia Pty Ltd.

  14. Sex Variation in Patellar Tendon Kinetics During Running

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    Sinclair Jonathan

    2015-06-01

    Full Text Available Purpose. The aim of the current investigation was to determine whether female recreational runners exhibit distinct patellar tendon loading patterns in relation to their male counterparts. Methods. Twelve male (age 26.55 ± 4.11 years, height 1.78 ± 0.11 m, mass 77.11 ± 5.06 kg and twelve female (age 26.67 ± 5.34 years, height 1.67 ± 0.12 m, mass 63.28 ± 9.75 kg runners ran over a force platform at 4.0 m · s-1. Lower limb kinematics were collected using an eight-camera optoelectric motion capture system which operated at 250 Hz. Patellar tendon loads were examined using a predictive algorithm. Sex differences in limb, knee and ankle joint stiffness were examined statistically using independent samples t tests. Results. The results indicate that patellar tendon force (male = 6.49 ± 2.28, female = 7.03 ± 1.35 and patelllar tendon loading rate (male = 92.41 ± 32.51, female = 111.05 ± 48.58 were significantly higher in female runners. Conclusions. Excessive tendon loading in female runners indicates that female runners may be at increased risk of patellar tendon pathologies.

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

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    ... Safe Videos for Educators Search English Español Jumper's Knee (Patellar Tendonitis) KidsHealth / For Parents / Jumper's Knee (Patellar ... prevent continued damage to the knee. How the Knee Works To understand how jumper's knee happens, it ...

  16. Mechanical Properties of Human Patellar Tendon at the Hierarchical levels of Tendon and Fibril

    DEFF Research Database (Denmark)

    Svensson, Rene Brüggebusch; 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...... that of tendon supports that fibrillar rather than interfibrillar properties govern sub-failure tendon response, making the fibrillar level a meaningful target of intervention. The lower modulus found in vitro suggests a possible adverse effect of removing the tissue from its natural environment. In addition...

  17. Differences in tendon properties in elite badminton players with or without patellar tendinopathy.

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    Couppé, C; Kongsgaard, M; Aagaard, P; Vinther, A; Boesen, M; Kjaer, M; Magnusson, S P

    2013-03-01

    The aim of this study was to examine the structural and mechanical properties of the patellar tendon in elite male badminton players with and without patellar tendinopathy. Seven players with unilateral patellar tendinopathy (PT group) on the lead extremity (used for forward lunge) and nine players with no current or previous patellar tendinopathy (CT group) were included. Magnetic resonance imaging was used to assess distal patellar tendon dimensions. Patellar tendon mechanical properties were assessed using simultaneous tendon force and deformation measurements. Distal tendon cross-sectional area (CSA) normalized for body weight (mm(2) /kg(2/3) ) was lower in the PT group compared with the CT group on both the non-lead extremity (6.1 ± 0.3 vs 7.4 ± 0.2, P < 0.05) and the lead extremity (6.5 ± 0.6 vs 8.4 ± 0.3, P < 0.05). Distal tendon stress was higher in the PT group compared with the CT group for both the non-lead extremity (31 ± 1 vs 27 ± 1 MPa, P < 0.05) and the lead extremity (32 ± 3 vs 21 ± 3 MPa, P < 0.01). Conclusively, the PT group had smaller distal patellar tendon CSA on both the injured (lead extremity) and the uninjured side (non-lead extremity) compared with the CT group. Subsequently, the smaller CSA yielded a greater distal patellar tendon stress in the PT group. Therefore, a small tendon CSA may predispose to the development of tendinopathy. © 2012 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd.

  18. Pain level after ACL reconstruction: A comparative study between free quadriceps tendon and hamstring tendons autografts.

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    Buescu, Cristian Tudor; Onutu, Adela Hilda; Lucaciu, Dan Osvald; Todor, Adrian

    2017-03-01

    The objective of this study was to compare the pain levels and analgesic consumption after single bundle ACL reconstruction with free quadriceps tendon autograft versus hamstring tendon autograft. A total of 48 patients scheduled for anatomic single-bundle ACL reconstruction were randomized into two groups: the free quadriceps tendon autograft group (24 patients) and the hamstring tendons autograft group (24 patients). A basic multimodal analgesic postoperative program was used for all patients and rescue analgesia was provided with tramadol, at pain scores over 30 on the Visual Analog Scale. The time to the first rescue analgesic, the number of doses of tramadol and pain scores were recorded. The results within the same group were compared with the Wilcoxon signed test. Supplementary analgesic drug administration proved significantly higher in the group of subjects with hamstring grafts, with a median (interquartile range) of 1 (1.3) dose, compared to the group of subjects treated with a quadriceps graft, median = 0.5 (0.1.25) (p = 0.009). A significantly higher number of subjects with a quadriceps graft did not require any supplementary analgesic drug (50%) as compared with subjects with hamstring graft (13%; Z-statistics = 3.01, p = 0.002). The percentage of subjects who required a supplementary analgesic drug was 38% higher in the HT group compared with the FQT group. The use of the free quadriceps tendon autograft for ACL reconstruction leads to less pain and analgesic consumption in the immediate postoperative period compared with the use of hamstrings autograft. Level I Therapeutic study. Copyright © 2017 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

  19. Factors associated with the presence of patellar tendon abnormalities in male athletes.

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    Mendonça, Luciana D; Verhagen, Evert; Bittencourt, Natália F N; Gonçalves, Gabriela G P; Ocarino, Juliana M; Fonseca, Sérgio T

    2016-05-01

    To investigate the association between lower limb alignment, range of motion/flexibility and muscle strength with the presence of patellar tendon abnormalities in male athletes. This was a cross-sectional study. Thirty-one male basketball and volleyball athletes were assessed for ankle dorsiflexion range of motion, shank-forefoot alignment, iliotibial band flexibility, hip external rotators and abductors isometric torque, passive hip internal rotation range of motion and frontal plane knee and patellar alignment (McConnell and Arno angles). Ultrasonographic evaluations of hypoechoic areas of the patellar tendons were performed in longitudinal and transverse planes. A receiver operating characteristic curve was used to determine clinically relevant cut-off point for each variable. When the area under the curve was statistically significant, Prevalence Ratio (PR) and 95% confidence intervals were calculated to indicate the strength of the association between the independent variable and the presence of patellar tendon abnormalities. Receiver operating characteristic curve showed that iliotibial band flexibility (p=0.006), shank-forefoot alignment (p=0.013) and Arno angle (p=0.046) were associated with patellar tendon abnormalities. Cut-off points were established and only the Prevalence Ratio of iliotibial band flexibility (cut-off point=-0.02°/kg; PR=5.26) and shank-forefoot alignment (cut-off point=24°; PR=4.42) were statistically significant. Athletes with iliotibial band or shank-forefoot alignment above the clinically relevant cut-off point had more chance to have patellar tendon abnormalities compared to athletes under the cut-off point values. These results suggest that such factors could contribute to patellar tendon overload, since patellar tendon abnormalities indicate some level of tissue damage. Both factors might be considered in future prospective studies. Copyright © 2015 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  20. Patellar tendinopathy in junior basketball players: a controlled clinical and ultrasonographic study of 268 patellar tendons in players aged 14-18 years.

    Science.gov (United States)

    Cook, J L; Khan, K M; Kiss, Z S; Griffiths, L

    2000-08-01

    Anterior knee pain is a common presenting complaint amongst adolescent athletes. We hypothesised that patellar tendinopathy may occur at a younger age than is generally recognised. Thus, we studied the patellar tendons in 134 elite 14- to 18-year-old female (n=64) and male (n=70) basketball players and 29 control swimmers (17 female, 12 male) clinically and with ultrasonography. We found that of 268 tendons, 19 (7%) had current patellar tendinopathy on clinical grounds (11% in males, 2% in females). Twenty-six percent of the basketball players' patellar tendons contained an ultrasonographic hypoechoic region. Ultrasonographic abnormality was more prevalent in the oldest tertile of players (17-18 years) than the youngest tertile (14-15.9 years). Of tendons categorised clinically as 'Never patellar tendinopathy', 22% had an ultrasonographic hypoechoic region nevertheless. This study indicates that patellar tendinopathy can occur in 14- to 18-year-old basketball players. Ultrasonographic tendon abnormality is 3 times as common as clinical symptoms.

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

    International Nuclear Information System (INIS)

    Berlin, R.C.; Levinsohn, E.M.; Chrisman, H.

    1991-01-01

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

  2. Decline eccentric squats increases patellar tendon loading compared to standard eccentric squats.

    Science.gov (United States)

    Kongsgaard, M; Aagaard, P; Roikjaer, S; Olsen, D; Jensen, M; Langberg, H; Magnusson, S P

    2006-08-01

    Recent studies have shown excellent clinical results using eccentric squat training on a 25 degrees decline board to treat patellar tendinopathy. It remains unknown why therapeutic management of patellar tendinopathy using decline eccentric squats offer superior clinical efficacy compared to standard horizontal eccentric squats. This study aimed to compare electromyography activity, patellar tendon strain and joint angle kinematics during standard and decline eccentric squats. Thirteen subjects performed unilateral eccentric squats on flat-and a 25 degrees decline surface. During the squats, electromyography activity was obtained in eight representative muscles. Also, ankle, knee and hip joint goniometry was obtained. Additionally, patellar tendon strain was measured in vivo using ultrasonography as subjects maintained a unilateral isometric 90 degrees knee angle squat position on either flat or 25 degrees decline surface. Patellar tendon strain was significantly greater (Psquat position on the decline surface compared to the standard surface. The stop angles of the ankle and hip joints were significantly smaller during the decline compared to the standard squats (Psquats (Psquats. The use of a 25 degrees decline board increases the load and the strain of the patellar tendon during unilateral eccentric squats. This finding likely explains previous reports of superior clinical efficacy of decline eccentric squats in the rehabilitative management of patellar tendinopathy.

  3. Atraumatic patellar prosthesis dislocation with patellar tendon injury following a total knee arthroplasty: a case report

    Directory of Open Access Journals (Sweden)

    Singh Alka

    2010-01-01

    Full Text Available Abstract Introduction Total knee arthroplasty is a well-established procedure with gratifying results. There is no consensus in the literature whether to routinely resurface the patella while performing total knee arthroplasty or not. Although an extremely rare occurrence in clinical practice, patellar prosthesis dislocation is a possible complication resulting from total knee arthroplasty. Case presentation We report a rare case of atraumatic spontaneous dislocation of patellar prosthesis in a 63-year-old Caucasian man of British origin with patellar tendon injury. The patient was treated successfully through a revision of the patellar component and tendon repair. In two years follow-up the patient is asymptomatic with no sign of loosening of his patellar prosthesis. Conclusions A thorough understanding of knee biomechanics is imperative in performing total knee arthroplasty in order to achieve a better functional outcome and to prevent early prosthetic failure.

  4. Regional strain variations in the human patellar tendon.

    Science.gov (United States)

    Pearson, Stephen J; Ritchings, Tim; Mohamed, Azlan S A

    2014-07-01

    Characteristics of localized tendon strain in vivo are largely unknown. The present study examines local tendon strain between the deep, middle, and surface structures at the proximal and distal aspects of the patellar tendon during ramped isometric contractions. Male subjects (age 28.0 ± 6.3 yr) were examined for patellar tendon excursion (anterior, midsection, and posterior) during ramped isometric voluntary contractions using real-time B-mode ultrasonography and dynamometry. Regional tendon excursion measurements were compared using an automated pixel tracking method. Strain was determined from the tendon delta length normalized to initial/resting segment length. Strain increased from 10% to 100% of force for all regions. Significantly greater mean strain was seen for the anterior proximal region compared to the posterior and mid layer of the tendon (7.5% ± 1.1% vs 3.7% ± 0.5% vs 5.5% ± 1.0%; P < 0.05). Similarly, the distal posterior region showed greater mean strain compared to the mid and anterior regions (7.9% ± 0.6% vs 5.0% ± 0.6% vs 5.4% ± 0.6%; P < 0.05). Relative changes in strain differences from 50% to 100% of force for the proximal region were greatest for the anterior to midline regions (4.6% ± 0.6% and 5.6% ± 0.6%, respectively) and those for the distal region were also greatest for the anterior to midline regions (4.4% ± 0.2% and 5.3% ± 0.2%, respectively). The largest mean strain for the proximal region was at the anterior layer (7.5% ± 1.1%) and that for the distal tendon region was at the posterior layer (7.9% ± 0.9%). This study shows significant regional differences in strain during ramped isometric contractions for the patellar tendon. Lower proximal strains in the posterior tendon compared to the anterior region may be associated with the suggestion of "stress shielding" as an etiological factor in insertional tendinopathy.

  5. In vivo Evaluation of Patellar Tendon Stiffness in Individuals with Patellofemoral Pain Syndrome

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    Hsin-Yi Liu

    2008-01-01

    Full Text Available The objective of this study was to utilise an ultrasonic technique to assess the effect of patellofemoral pain syndrome (PFPS on the mechanical properties of the patellar tendon. Seven subjects with PFPS and seven matched control subjects volunteered to participate in this study. Subjects were asked to perform isometric maximal voluntary contractions of the knee extensors while their knee extension torque was monitored and the displacement of the patellar tendon was recorded with an ultrasonic system. Our results showed significantly lower tendon stiffness (by ∼30% in the PFPS subjects. Although tendon secant modulus was lower by 34% in the PFPS subjects, the difference was not statistically significant. Therefore, we conclude that the ultrasonic technique was able to detect a decrease in the structural stiffness of the patellar tendon associated with PFPS. The decrease in tendon stiffness was moderately correlated with the length of symptoms in these individuals.

  6. Patellar tendon-lateral femoral condyle friction syndrome: MR imaging in 42 patients

    International Nuclear Information System (INIS)

    Chung, C.B.; Skaf, A.; Campos, J.; Stump, X.; Resnick, D.; Roger, B.

    2001-01-01

    Objective: To demonstrate the MR imaging findings that occur between the posterior inferolateral patellar tendon and the lateral femoral condyle in patients with chronic anterior and or lateral knee pain. Patients and design: A retrospective review of the MR images in 42 patients who presented with chronic anterior or lateral knee pain was performed by two musculoskeletal radiologists. In 15 patients, post-contrast images were available. Results: Sagittal and axial imaging planes best demonstrated the patellar tendon and its relationship with the lateral femoral condyle. In 40 patients, there was obliteration of the fat planes and abnormal signal intensity in the lateral soft tissues of the inferior patellofemoral joint. Enhancement after administration of gadolinium was noted in all cases in which contrast was administered. Eighteen patients showed cystic changes in the soft tissues adjacent to the lateral femoral condyle in addition to fat plane obliteration. In two patients, only cystic changes were noted in the lateral soft tissues. Abnormal patellar alignment was noted in 37 patients. Patellar tendon pathology was seen in nine patients. Conclusion: In evaluating anterior knee symptoms, MR imaging allows identification of changes that may be related to patellar tendon-lateral femoral condyle friction syndrome and that should be distinguished from other causes of anterior or lateral knee pain. (orig.)

  7. Patellar tendon-lateral femoral condyle friction syndrome: MR imaging in 42 patients

    Energy Technology Data Exchange (ETDEWEB)

    Chung, C.B.; Skaf, A.; Campos, J.; Stump, X.; Resnick, D. [Dept. of Radiology, University of California, San Diego (United States); Roger, B. [Service de Radiologie Polyvalente, Groupe Hospitalier Pitie-Salpetriere, Paris (France)

    2001-12-01

    Objective: To demonstrate the MR imaging findings that occur between the posterior inferolateral patellar tendon and the lateral femoral condyle in patients with chronic anterior and or lateral knee pain. Patients and design: A retrospective review of the MR images in 42 patients who presented with chronic anterior or lateral knee pain was performed by two musculoskeletal radiologists. In 15 patients, post-contrast images were available. Results: Sagittal and axial imaging planes best demonstrated the patellar tendon and its relationship with the lateral femoral condyle. In 40 patients, there was obliteration of the fat planes and abnormal signal intensity in the lateral soft tissues of the inferior patellofemoral joint. Enhancement after administration of gadolinium was noted in all cases in which contrast was administered. Eighteen patients showed cystic changes in the soft tissues adjacent to the lateral femoral condyle in addition to fat plane obliteration. In two patients, only cystic changes were noted in the lateral soft tissues. Abnormal patellar alignment was noted in 37 patients. Patellar tendon pathology was seen in nine patients. Conclusion: In evaluating anterior knee symptoms, MR imaging allows identification of changes that may be related to patellar tendon-lateral femoral condyle friction syndrome and that should be distinguished from other causes of anterior or lateral knee pain. (orig.)

  8. Reproducibility and clinical utility of tendon palpation to detect patellar tendinopathy in young basketball players

    Science.gov (United States)

    Cook, J; Khan, K; Kiss, Z; Purdam, C; Griffiths, L

    2001-01-01

    Background—Palpation is an important clinical test for jumper's knee. Objectives—To (a) test the reproducibility of palpation tenderness, (b) evaluate the sensitivity and specificity of palpation in subjects with clinical symptoms of jumper's knee, and (c) determine whether tenderness to palpation may serve as a useful screening test for patellar tendinopathy. The yardstick for diagnosis of patellar tendinopathy was ultrasonographic abnormality. Methods—In 326 junior symptomatic and asymptomatic athletes' tendons, palpation was performed by a single examiner before ultrasonographic examination by a certified ultrasound radiologist. In 58 tendons, palpation was performed twice to test reliability. Tenderness to palpation was scored on a scale from 0 to 3 where 0 represented no pain, and 1, 2, and 3 represented mild, moderate, and severe tenderness respectively. Results—Patellar tendon palpation was a reliable examination for a single examiner (Pearson r = 0.82). In symptomatic tendons, the positive predictive value of palpation was 68%. As a screening examination in asymptomatic subjects, the positive predictive value of tendon palpation was 36–38%. Moderate and severe palpation tenderness were better predictors of ultrasonographic tendon pathology than absent or mild tenderness (ppatellar tendinopathy in a preparticipation examination. In symptomatic tendons, palpation is a moderately sensitive but not specific test. Mild tenderness in the patellar tendons in asymptomatic jumping athletes should be considered normal. Key Words: patellar tendon; ultrasound; palpation; reliability; athletes PMID:11157466

  9. Patellar tendon load in different types of eccentric squats.

    Science.gov (United States)

    Frohm, A; Halvorsen, K; Thorstensson, A

    2007-07-01

    Differences in mechanical loading of the patellar tendon have been suggested as a reason for varying effects in rehabilitation of patellar tendinopathy using different eccentric squat exercises and devices. The aim was to characterize the magnitude and pattern of mechanical load at the knee and on the patellar tendon during four types of eccentric squat. Subjects performed squats with a submaximal free weight and with maximal effort in a device for eccentric overloading (Bromsman), on a decline board and horizontal surface. Kinematics was recorded with a motion-capture system, reaction forces with force plates, and electromyography from three leg muscles with surface electrodes. Inverse dynamics was used to calculate knee joint kinetics. Eccentric work, mean and peak patellar tendon force, and angle at peak force were greater (25-30%) for squats on decline board compared to horizontal surface with free weight, but not in Bromsman. Higher knee load forces (60-80%), but not work, were observed with Bromsman than free weight. Angular excursions at the knee and ankle were larger with decline board, particularly with free weight, and smaller in Bromsman than with free weight. Mean electromyography was greater on a decline board for gastrocnemius (13%) and vastus medialis (6%) with free weight, but in Bromsman only for gastrocnemius (7%). The results demonstrated clear differences in the biomechanical loading on the knee during different squat exercises. Quantification of such differences provides information that could be used to explain differences in rehabilitation effects as well as in designing more optimal rehabilitation exercises for patellar tendinopathy.

  10. Does the adolescent patellar tendon respond to 5 days of cumulative load during a volleyball tournament?

    NARCIS (Netherlands)

    van Ark, M.; Docking, S.I.; van den Akker-Scheek, I.; Rudavsky, A.; Rio, E.; Zwerver, J.; Cook, J.L.

    Patellar tendinopathy (jumper's knee) has a high prevalence in jumping athletes. Excessive load on the patellar tendon through high volumes of training and competition is an important risk factor. Structural changes in the tendon are related to a higher risk of developing patellar tendinopathy. The

  11. Does the adolescent patellar tendon respond to 5 days of cumulative load during a volleyball tournament?

    Science.gov (United States)

    van Ark, M; Docking, S I; van den Akker-Scheek, I; Rudavsky, A; Rio, E; Zwerver, J; Cook, J L

    2016-02-01

    Patellar tendinopathy (jumper's knee) has a high prevalence in jumping athletes. Excessive load on the patellar tendon through high volumes of training and competition is an important risk factor. Structural changes in the tendon are related to a higher risk of developing patellar tendinopathy. The critical tendon load that affects tendon structure is unknown. The aim of this study was to investigate patellar tendon structure on each day of a 5-day volleyball tournament in an adolescent population (16-18 years). The right patellar tendon of 41 players in the Australian Volleyball Schools Cup was scanned with ultrasound tissue characterization (UTC) on every day of the tournament (Monday to Friday). UTC can quantify structure of a tendon into four echo types based on the stability of the echo pattern. Generalized estimating equations (GEE) were used to test for change of echo type I and II over the tournament days. Participants played between eight and nine matches during the tournament. GEE analysis showed no significant change of echo type percentages of echo type I (Wald chi-square = 4.603, d.f. = 4, P = 0.331) and echo type II (Wald chi-square = 6.070, d.f. = 4, P = 0.194) over time. This study shows that patellar tendon structure of 16-18-year-old volleyball players is not affected during 5 days of cumulative loading during a volleyball tournament. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  12. Reproducibility and clinical utility of tendon palpation to detect patellar tendinopathy in young basketball players. Victorian Institute of Sport tendon study group.

    Science.gov (United States)

    Cook, J L; Khan, K M; Kiss, Z S; Purdam, C R; Griffiths, L

    2001-02-01

    Palpation is an important clinical test for jumper's knee. To (a) test the reproducibility of palpation tenderness, (b) evaluate the sensitivity and specificity of palpation in subjects with clinical symptoms of jumper's knee, and (c) determine whether tenderness to palpation may serve as a useful screening test for patellar tendinopathy. The yardstick for diagnosis of patellar tendinopathy was ultrasonographic abnormality. In 326 junior symptomatic and asymptomatic athletes' tendons, palpation was performed by a single examiner before ultrasonographic examination by a certified ultrasound radiologist. In 58 tendons, palpation was performed twice to test reliability. Tenderness to palpation was scored on a scale from 0 to 3 where 0 represented no pain, and 1, 2, and 3 represented mild, moderate, and severe tenderness respectively. Patellar tendon palpation was a reliable examination for a single examiner (Pearson r = 0.82). In symptomatic tendons, the positive predictive value of palpation was 68%. As a screening examination in asymptomatic subjects, the positive predictive value of tendon palpation was 36-38%. Moderate and severe palpation tenderness were better predictors of ultrasonographic tendon pathology than absent or mild tenderness (ppatellar tendinopathy in a preparticipation examination. In symptomatic tendons, palpation is a moderately sensitive but not specific test. Mild tenderness in the patellar tendons in asymptomatic jumping athletes should be considered normal.

  13. Fibrocartilage in the attachment zones of the quadriceps tendon and patellar ligament of man.

    OpenAIRE

    Evans, E J; Benjamin, M; Pemberton, D J

    1990-01-01

    Differences are reported in the quantities and distribution of uncalcified fibrocartilage at the attachment sites of the quadriceps tendon and the patellar ligament. The largest quantity of fibrocartilage was characteristic of the quadriceps tendon. A prominent wedge of fibrocartilage was seen in the proximal part of the tibial attachment of the patellar ligament, though there was no fibrocartilage in the most superficial fibres. Little fibrocartilage was seen at the patellar attachment of th...

  14. MRI of anterior cruciate ligament autografts

    International Nuclear Information System (INIS)

    Ogi, Shigeyuki; Ariizumi, Mitsuko; Yamagishi, Tsuneo; Agata, Toshihiko; Tada, Shinpei; Fukuda, Kunihiko

    2000-01-01

    The purpose of this study was to assess the usefulness of MRI in the evaluation of autografts after anterior cruciate ligament reconstruction. The subjects were 110 patients with anterior cruciate ligament reconstruction using patellar tendon autografts who underwent clinical examination, MRI, and arthroscopy of the knee. T1- and T2-weighted MR images were obtained in sagittal plane. Clinical findings were categorized into three groups: normal, borderline, and abnormal. The MRI appearances of the autografts were categorized into three types: straight continuous band (type I), interrupted band (type II) and generalized increased intensity band (type III). The clinical findings and MRI findings were compared with arthroscopic findings. Ninety-six percent of the type I showed no autograft tear on arthroscopy. In comparison with the clinical findings, MRI was found to be well correlated with arthroscopic findings. In conclusion, if the clinical findings are normal, patients are to be followed-up without MRI and arthroscopy. However, if clinical findings are either borderline or abnormal, MRI should be performed prior to arthroscopy. (author)

  15. Differences in tendon properties in elite badminton players with or without patellar tendinopathy

    DEFF Research Database (Denmark)

    Couppé, Christian; Kongsgaard, M; Aagaard, Per

    2013-01-01

    The aim of this study was to examine the structural and mechanical properties of the patellar tendon in elite male badminton players with and without patellar tendinopathy. Seven players with unilateral patellar tendinopathy (PT group) on the lead extremity (used for forward lunge) and nine players...

  16. A soft patellar tendon on ultrasound elastography is associated with pain and functional deficit in volleyball players.

    Science.gov (United States)

    Ooi, Chin Chin; Richards, Paula J; Maffulli, Nicola; Ede, David; Schneider, Michal E; Connell, David; Morrissey, Dylan; Malliaras, Peter

    2016-05-01

    To investigate the diagnostic performance of grey scale Ultrasound (US), power Doppler (PD) and US elastography for diagnosing painful patellar tendinopathy, and to establish their relationship with Victorian Institute of Sport Assessment-Patella (VISA-P) scores in a group of volleyball players with and without symptoms of patellar tendinopathy. Cross-sectional study. Thirty-five volleyball players (70 patellar tendons) were recruited during a national university volleyball competition. Players were imaged with conventional US followed by elastography. The clinical findings of painful patellar tendons were used as the reference standard for diagnosing patellar tendinopathy. In addition, all participants completed the VISA-P questionnaires. Of the 70 patellar tendons, 40 (57.1%) were clinically painful. The diagnostic accuracy of grey scale US, PD and elastography were 60%, 50%, 62.9%, respectively, with sensitivity/specificity of 72.5%/43.3%, 12.5%/100%, and 70%/53.3%, respectively. Combined US elastography and grey scale imaging achieved 82.5% sensitivity, 33.3% specificity and 61.4% accuracy while routine combination technique of PD and grey scale imaging revealed 72.5% sensitivity, 43.3% specificity and 60.0% accuracy. Tendons in players categorized as soft on elastography had statistically significantly greater AP thickness (p<0.001) and lower VISA-P scores (p=0.004) than those categorized as hard. There was no significant association between grey scale US abnormalities (hypoechogenicities and/or fusiform swelling) and VISA-P scores (p=0.098). Soft tendon properties depicted by US elastography may be more related to patellar tendon symptoms compared to grey scale US abnormalities. The supplementation of US elastography to conventional US may enhance the sensitivity for diagnosing patellar tendinopathy in routine clinical practice. Copyright © 2015 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  17. Fibril morphology and tendon mechanical properties in patellar tendinopathy: effects of heavy slow resistance training

    DEFF Research Database (Denmark)

    Kongsgaard, Mads; Qvortrup, Klaus; Larsen, Jytte Overgaard

    2010-01-01

    BACKGROUND: Patellar tendinopathy is characterized by pathologic abnormalities. Heavy slow resistance training (HSR) is effective in the management of patellar tendinopathy, but the underlying functional mechanisms remain elusive. PURPOSE: To investigate fibril morphology and mechanical properties...... assessed symptoms/function and maximal tendon pain during activity. Tendon biopsy samples were analyzed for fibril density, volume fraction, and mean fibril area. Tendon mechanical properties were assessed using force and ultrasonography samplings. RESULTS: Patients improved in symptoms/function (P = .02...... area decreased (-26% +/- 21%, P = .04) in tendinopathic tendons after HSR. CONCLUSION: Fibril morphology is abnormal in tendinopathy, but tendon mechanical properties are not. Clinical improvements after HSR were associated with changes in fibril morphology toward normal fibril density and mean fibril...

  18. Influence of acetaminophen and ibuprofen on in vivo patellar tendon adaptations to knee extensor resistance exercise in older adults

    DEFF Research Database (Denmark)

    Carroll, C C; Dickinson, J M; LeMoine, J K

    2011-01-01

    adults induces modest changes in the mechanical properties of the patellar tendon. Over-the-counter doses of acetaminophen, but not ibuprofen, have a strong influence on tendon mechanical and material property adaptations to resistance training. These findings add to a growing body of evidence......Millions of older individuals consume acetaminophen or ibuprofen daily and these same individuals are encouraged to participate in resistance training. Several in vitro studies suggest that cyclooxygenase-inhibiting drugs can alter tendon metabolism and may influence adaptations to resistance...... tendon properties were assessed with MRI [cross-sectional area (CSA) and signal intensity] and ultrasonography of patellar tendon deformation coupled with force measurements to obtain stiffness, modulus, stress, and strain. Mean patellar tendon CSA was unchanged (P > 0.05) with training in the placebo...

  19. Anthropometry, physical performance, and ultrasound patellar tendon abnormality in elite junior basketball players: a cross-sectional study.

    Science.gov (United States)

    Cook, J L; Kiss, Z S; Khan, K M; Purdam, C R; Webster, K E

    2004-04-01

    Patellar tendinopathy has been reported to be associated with many intrinsic risk factors. Few have been fully investigated. This cross-sectional study examined the anthropometric and physical performance results of elite junior basketball players with normal or abnormal patellar tendons to see if any measures were associated with changes in tendon morphology. Agility, leg strength, endurance, and flexibility were measured in 71 male and 64 female players. A blinded radiologist ultrasonographically examined their patellar tendons and athletes were grouped as having normal or abnormal tendons. One-way ANOVA was used to test for differences in anthropometric and physical performance data for athletes whose tendons were normal or abnormal (unilateral or bilateral tendinopathy) on ultrasound. Results show that females with abnormalities in their tendons had a significantly better vertical jump (50.9+/-6.8 cm) than those with normal tendons (46.1+/-5.4 cm) (p = 0.02). This was not found in males. In males, the mean sit and reach in those with normal tendons (13.2+/-6.7 cm) was greater (ptendinopathy (10.3+/-6.2 cm) or in bilateral tendinopathy (7.8+/-8.3 cm). In females, those with normal tendons (13.3+/-4.8 cm) and bilateral tendinopathy (15.8+/-6.2 cm) were distinctly different from those with unilateral tendinopathy (7.9+/-6.6 cm). Flexibility and vertical jump ability are associated with patellar tendinopathy and the findings warrant consideration when managing young, jumping athletes.

  20. Anthropometry, physical performance, and ultrasound patellar tendon abnormality in elite junior basketball players: a cross-sectional study

    OpenAIRE

    Cook, J; Kiss, Z; Khan, K; Purdam, C; Webster, K

    2004-01-01

    Objective: Patellar tendinopathy has been reported to be associated with many intrinsic risk factors. Few have been fully investigated. This cross-sectional study examined the anthropometric and physical performance results of elite junior basketball players with normal or abnormal patellar tendons to see if any measures were associated with changes in tendon morphology.

  1. The prevalence of Achilles and patellar tendon injuries in Australian football players beyond a time-loss definition.

    Science.gov (United States)

    Docking, S I; Rio, E; Cook, J; Orchard, J W; Fortington, L V

    2018-03-23

    Little is known about the prevalence and associated of morbidity of tendon problems. With only severe cases of tendon problems missing games, players that have their training and performance impacted are not captured by traditional injury surveillance. The aim of this study was to report the prevalence of Achilles and patellar tendon problems in elite male Australian football players using the Oslo Sports Trauma Research Centre (OSTRC) overuse questionnaire, compared to a time-loss definition. Male athletes from 12 professional Australian football teams were invited to complete a monthly questionnaire over a 9-month period in the 2016 pre- and competitive season. The OSTRC overuse injury questionnaire was used to measure the prevalence and severity of Achilles and patellar tendon symptoms and was compared to traditional match-loss statistics. A total of 441 participants were included. Of all participants, 21.5% (95% CI: 17.9-25.6) and 25.2% (95% CI 21.3-29.4) reported Achilles or patellar tendon problems during the season, respectively. Based on the traditional match-loss definition, a combined 4.1% of participants missed games due to either Achilles or patellar tendon injury. A greater average monthly prevalence was observed during the pre-season compared to the competitive season. Achilles and patellar tendon problems are prevalent in elite male Australian football players. These injuries are not adequately captured using a traditional match-loss definition. Prevention of these injuries may be best targeted during the off- and pre-season due to higher prevalence of symptoms during the pre-season compared to during the competitive season. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  2. Foot posture and patellar tendon pain among adult volleyball players.

    NARCIS (Netherlands)

    Groot, R. de; Malliaras, P.; Munteanu, S.; Payne, C.; Morrissey, D.; Maffulli, N.

    2012-01-01

    OBJECTIVE: We hypothesized that individuals with a normal foot posture would be less likely to experience patellar tendon pain and pathology than those with a pronated or supinated foot. DESIGN: Observational study. SETTING: Field-based study among competing athletes. PARTICIPANTS: Volleyball

  3. Foot Posture and Patellar Tendon Pain Among Adult Volleyball Players

    NARCIS (Netherlands)

    de Groot, Reinier; Malliaras, Peter; Munteanu, Shannon; Payne, Craig; Morrissey, Dylan; Maffulli, Nicola

    Objective: We hypothesized that individuals with a normal foot posture would be less likely to experience patellar tendon pain and pathology than those with a pronated or supinated foot. Design: Observational study. Setting: Field-based study among competing athletes. Participants: Volleyball

  4. Effect of prostaglandin E2 injection on the structural properties of the rat patellar tendon

    Directory of Open Access Journals (Sweden)

    Ferry Scott T

    2012-01-01

    Full Text Available Abstract Background Increased tendon production of the inflammatory mediator prostaglandin E2 (PGE2 has been suggested to be a potential etiologic agent in the development of tendinopathy. Repeated injection of PGE2 into tendon has been proposed as a potential animal model for studying treatments for tendinopathy. In contrast, nonsteroidal anti-inflammatory drugs (NSAIDs which inhibit PGE2 production and are commonly prescribed in treating tendinopathy have been shown to impair the healing of tendon after acute injury in animal models. The contradictory literature suggests the need to better define the functional effects of PGE2 on tendon. Our objective was to characterize the effects of PGE2 injection on the biomechanical and biochemical properties of tendon and the activity of the animals. Our hypothesis was that weekly PGE2 injection to the rat patellar tendon would lead to inferior biomechanical properties. Methods Forty rats were divided equally into four groups. Three groups were followed for 4 weeks with the following peritendinous injection procedures: No injection (control, 4 weekly injections of saline (saline, 4 weekly injections of 800 ng PGE2 (PGE2-4 wks. The fourth group received 4 weekly injections of 800 ng PGE2 initially and was followed for a total of 8 weeks. All animals were injected bilaterally. The main outcome measurements included: the structural and material properties of the patellar tendon under tensile loading to failure, tendon collagen content, and weekly animal activity scores. Results The ultimate load of PGE2-4 wks tendons at 4 weeks was significantly greater than control or saline group tendons. The stiffness and elastic modulus of the PGE2 injected tendons at 8 weeks was significantly greater than the control or saline tendons. No differences in animal activity, collagen content, or mean fibril diameter were observed between groups. Conclusions Four weekly peritendinous injections of PGE2 to the rat patellar

  5. Patellar Tendon Repair Augmentation With a Knotless Suture Anchor Internal Brace: A Biomechanical Cadaveric Study.

    Science.gov (United States)

    Rothfeld, Alex; Pawlak, Amanda; Liebler, Stephenie A H; Morris, Michael; Paci, James M

    2018-04-01

    Patellar tendon repair with braided polyethylene suture alone is subject to knot slippage and failure. Several techniques to augment the primary repair have been described. Purpose/Hypothesis: The purpose was to evaluate a novel patellar tendon repair technique augmented with a knotless suture anchor internal brace with suture tape (SAIB). The hypothesis was that this technique would be biomechanically superior to a nonaugmented repair and equivalent to a standard augmentation with an 18-gauge steel wire. Controlled laboratory study. Midsubstance patellar tendon tears were created in 32 human cadaveric knees. Two comparison groups were created. Group 1 compared #2 supersuture repair without augmentation to #2 supersuture repair with SAIB augmentation. Group 2 compared #2 supersuture repair with an 18-gauge stainless steel cerclage wire augmentation to #2 supersuture repair with SAIB augmentation. The specimens were potted and biomechanically loaded on a materials testing machine. Yield load, maximum load, mode of failure, plastic displacement, elastic displacement, and total displacement were calculated for each sample. Standard statistical analysis was performed. There was a statistically significant increase in the mean ± SD yield load and maximum load in the SAIB augmentation group compared with supersuture alone (mean yield load: 646 ± 202 N vs 229 ± 60 N; mean maximum load: 868 ± 162 N vs 365 ± 54 N; P augmented repairs (mean yield load: 495 ± 213 N vs 566 ± 172 N; P = .476; mean maximum load: 737 ± 210 N vs 697 ± 130 N; P = .721). Patellar tendon repair augmented with SAIB is biomechanically superior to repair without augmentation and is equivalent to repair with augmentation with an 18-gauge stainless steel cerclage wire. This novel patellar tendon repair augmentation is equivalent to standard 18-gauge wire augmentation at time zero. It does not require a second surgery for removal, and it is biomechanically superior to primary repair alone.

  6. Clinical improvements are not explained by changes in tendon structure on UTC following an exercise program for patellar tendinopathy.

    Science.gov (United States)

    van Ark, Mathijs; Rio, Ebonie; Cook, Jill; van den Akker-Scheek, Inge; Gaida, James E; Zwerver, Johannes; Docking, Sean

    2018-04-11

    The aim of this study was to investigate the effects of a 4-week in-season exercise program of isometric or isotonic exercises on tendon structure and dimensions as quantified by Ultrasound Tissue Characterization (UTC). Randomized clinical trial. Volleyball and basketball players (16-31 years, n=29) with clinically diagnosed patellar tendinopathy were randomized to a 4-week isometric or isotonic exercise program. The programs were designed to decrease patellar tendon pain. A baseline and 4-week UTC scan was used to evaluate change in tendon structure. No significant change in tendon structure or dimensions on UTC was detected after the exercise program, despite patellar tendinopathy symptoms improving. The percentage and mean cross-sectional area (mCSA) of aligned fibrillar structure (echo-types I+II) (Z=-0.414,p=0.679) as well as disorganized structure (echo-types III + IV) (Z=-0.370,p=0.711) did not change over the 4-week exercise program. Change in tendon structure and dimensions on UTC did not differ significantly between the groups. Structural properties and dimensions of the patellar tendon on UTC did not change after a 4-week isometric or isotonic exercise program for athletes with patellar tendinopathy in-season, despite an improvement of symptoms. It seems that structural improvements are not required for a positive clinical outcome.

  7. The effect of eccentric exercise on injured patellar tendon healing in rats: a gene expression study

    OpenAIRE

    Yagishita, Masafumi

    2011-01-01

    Recently, clinical studies have suggested that eccentric exercise can be beneficial for patellar tendinopathy. It is known that loading induces collagen synthesis in tendon, but the mechanisms responsible for mediating this effect are still unclear. We hypothesized that loading-induced expression of collagen depends on a specific contraction type. Eccentric exercise induces a more beneficial healing response than concentric exercise. Two longitudinal incisions were made in rat patellar tendon...

  8. [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.

  9. Do peak torque angles of muscles change following anterior cruciate ligament reconstruction using hamstring or patellar tendon graft?

    Science.gov (United States)

    Yosmaoğlu, Hayri Baran; Baltacı, Gül; Sönmezer, Emel; Özer, Hamza; Doğan, Deha

    2017-12-01

    This study aims to compare the effects of anterior cruciate ligament (ACL) reconstruction using autogenous hamstring or patellar tendon graft on the peak torque angle. The study included 132 patients (103 males, 29 females; mean age 29±9 year) who were performed ACL reconstruction with autogenous hamstring or patellar tendon graft. The peak torque angles in the quadriceps and hamstring muscles were recorded using an isokinetic dynamometer. Angle of peak knee flexion torque occurred significantly earlier within the range of motion on the operated side than nonoperated side at 180°/second in the hamstring tendon group. Angle of peak knee extension torque occurred significantly earlier within the range of motion on the operated side than nonoperated side at 180°/second in the patellar tendon group. There were no statistically significant differences in the flexion and extension peak torque angles between the operated and nonoperated knees at 60°/second in both groups. The angle of peak torque at relatively high angular velocities is affected after ACL reconstruction in patients with hamstring or patellar tendon grafts. The graft donor site directly influences this parameter. This finding may be important for clinicians in terms of preventing re-injury.

  10. Acute Traumatic Patellar Tendon Rupture at the Tibial Tuberosity Attachment without Avulsion Fracture

    Directory of Open Access Journals (Sweden)

    Shuichi Miyamoto

    2017-01-01

    Full Text Available Patellar tendon rupture in children is especially rare. The fact that the area of traumatic rupture has wide variations makes surgical treatment difficult. We present an 11-year-old boy with acute traumatic patellar tendon rupture at the tibial tuberosity attachment without avulsion fracture. Primary end-to-end repair and reinforcement using 1.5 mm stainless steel wires as a surgical strategy were undertaken. Early range of motion began with a functional knee brace and the reinforced stainless wire was removed 3 months after surgery. Knee function at the final follow-up was satisfactory. We suggest that this strategy may provide a useful option for surgical treatment.

  11. Immediate effects of whole body vibration on patellar tendon properties and knee extension torque.

    Science.gov (United States)

    Rieder, F; Wiesinger, H-P; Kösters, A; Müller, E; Seynnes, O R

    2016-03-01

    Reports about the immediate effects of whole body vibration (WBV) exposure upon torque production capacity are inconsistent. However, the changes in the torque-angle relationship observed by some authors after WBV may hinder the measurement of torque changes at a given angle. Acute changes in tendon mechanical properties do occur after certain types of exercise but this hypothesis has never been tested after a bout of WBV. The purpose of the present study was to investigate whether tendon compliance is altered immediately after WBV, effectively shifting the optimal angle of peak torque towards longer muscle length. Twenty-eight subjects were randomly assigned to either a WBV (n = 14) or a squatting control group (n = 14). Patellar tendon CSA, stiffness and Young's modulus and knee extension torque-angle relationship were measured using ultrasonography and dynamometry 1 day before and directly after the intervention. Tendon CSA was additionally measured 24 h after the intervention to check for possible delayed onset of swelling. The vibration intervention had no effects on patellar tendon CSA, stiffness and Young's modulus or the torque-angle relationship. Peak torque was produced at ~70° knee angle in both groups at pre- and post-test. Additionally, the knee extension torque globally remained unaffected with the exception of a small (-6%) reduction in isometric torque at a joint angle of 60°. The present results indicate that a single bout of vibration exposure does not substantially alter patellar tendon properties or the torque-angle relationship of knee extensors.

  12. Mechanical properties and collagen cross-linking of the patellar tendon in old and young men

    DEFF Research Database (Denmark)

    Couppé, C; Hansen, P; Kongsgaard, M

    2009-01-01

    were higher in OM than in YM (73 +/- 13 vs. 11 +/- 2 mmol/mol; P appreciably influence the dimensions or mechanical properties of the human patellar tendon in vivo. Collagen concentration was reduced, whereas both enzymatic......Age-related loss in muscle mass and strength impairs daily life function in the elderly. However, it remains unknown whether tendon properties also deteriorate with age. Cross-linking of collagen molecules provides structural integrity to the tendon fibrils and has been shown to change with age...... in animals but has never been examined in humans in vivo. In this study, we examined the mechanical properties and pyridinoline and pentosidine cross-link and collagen concentrations of the patellar tendon in vivo in old (OM) and young men (YM). Seven OM (67 +/- 3 years, 86 +/- 10 kg) and 10 YM (27 +/- 2...

  13. Effect of eccentric exercise on the healing process of injured patellar tendon in rats

    OpenAIRE

    Nakamura, Kenichi; Kitaoka, Katsuhiko; Tomita, Katsuro

    2008-01-01

    Background. Earlier studies have reported positive results from eccentric training in patients with tendon disorders. The reasons for the beneficial clinical effects of eccentric training are not known. Vascularization followed by regression of the vasculature enhances the healing response of injured tendons. Eccentric exercise induces a more beneficial healing response than concentric exercise. Methods. Sixty rats with patellar tendon injuries were divided into three groups: nonexercise cont...

  14. High volume ultrasound guided injections at the interface between the patellar tendon and Hoffa's body are effective in chronic patellar tendinopathy: A pilot study.

    Science.gov (United States)

    Crisp, Tom; Khan, Faisal; Padhiar, Nat; Morrissey, Dylan; King, John; Jalan, Rosy; Maffulli, Nicola; Frcr, Otto Chan

    2008-01-01

    To evaluate a novel conservative management modality for patellar tendinopathy. We recruited nine patients with patellar tendinopathy who had failed conservative management and showed evidence of neovascularisation on power Doppler scanning. A high volume ultrasound guided injection at the interface between the patellar tendon and Hoffa's body. The injection contained 10 ml 0.5% Bupivacaine, 25 mg Hydrocortisone, and between 12 and 40 ml normosaline. 100 mm visual analogue scales (VAS) for pain and for function, and Victorian Institute of Sport Assessment - Patellar tendon (VISA-P) questionnaires at an average of 9 months from the injection. All but one patient (whose pain was unchanged) improved (p = 0.028). The mean improvement in function 2 weeks after injection was 58 mm on VAS (interquartile range 27 - 88, p = 0.018). The mean improvement in pain 2 weeks after injection was 56 mm on a VAS scale (interquartile range 32 - 80, p = 0.018). At a mean follow up of 9 months, an improvement of 22 points from a baseline score of 46 on the VISA-P questionnaire (100 being normal) was established. High volume injections to mechanically disrupt the neovascularisation in patellar tendinopathy are helpful in the management of this condition. Controlled trials would be warranted to investigate in a more conclusive fashion this management modality.

  15. Changes on Tendon Stiffness and Clinical Outcomes in Athletes Are Associated With Patellar Tendinopathy After Eccentric Exercise.

    Science.gov (United States)

    Lee, Wai-Chun; Ng, Gabriel Yin-Fat; Zhang, Zhi-Jie; Malliaras, Peter; Masci, Lorenzo; Fu, Siu-Ngor

    2017-12-19

    Eccentric exercise is commonly used as a form of loading exercise for individuals with patellar tendinopathy. This study investigated the change of mechanical properties and clinical outcomes and their interrelationships after a 12-week single-legged decline-board exercise with and without extracorporeal shockwave therapy (ESWT). Randomized controlled trial. Outpatient clinic of a university. Thirty-four male in-season athletes with patellar tendinopathy for more than 3 months were randomized into exercise and combined groups. The exercise group received a 12-week single-legged decline-squat exercise, and the combined group performed an identical exercise program in addition to a weekly session of ESWT in the initial 6 weeks. Tendon stiffness and strain were examined using ultrasonography and dynamometry. Visual analog scale and Victoria Institute of Sports Assessment-patella (VISA-p) score were used to assess pain and dysfunction. These parameters were measured at preintervention and postintervention. Significant time effect but no significant group effect on the outcome measures; significant reduction in tendon stiffness (P = 0.02) and increase in tendon strain (P = 0.00); and reduction of intensity of pain (P = 0.00) and dysfunction (P = 0.00) were observed. Significant correlations between changes in tendon stiffness and VISA-p score (ρ = -0.58, P = 0.05); alteration in tendon strain, pain intensity (ρ = -0.63, P = 0.03); and VISA-p score (ρ = 0.60, P = 0.04) were detected after the exercise program. Eccentric exercise-induced modulation on tendon mechanical properties and clinical symptoms are associated in athletes with patellar tendinopathy.

  16. Mechanical properties of human bone-tendon-bone grafts preserved by different methods and radiation sterilised

    International Nuclear Information System (INIS)

    Kaminski, A.; Gut, G.

    2008-01-01

    Full text: Patellar tendon auto and allografts are commonly used in orthopaedic surgery for reconstruction of the anterior crucial ligaments (ACL). Autografts are mainly used for primary reconstruction, while allografts are useful for revision surgery. To avoid the risk of infection diseases transmission allografts should be radiation-sterilised. As radiation-sterilisation is supposed to decrease the mechanical strength of tendon tissue, it is important to establish methods of allografts preservation and sterilisation resulting in their best quality and safety. Therefore, the purpose of the study was to compare the tensile strength of the central one third of human patellar tendon (as used for ACL reconstruction), preserved by different methods (deep fresh freezing, lyophilisation) and subsequently radiation-sterilised with doses of 0 (control), 25, 50 or 100 kGy. Bone-tendon-bone grafts were prepared from cadaveric human patella tendon with both patellar and tibial attachments. BTB grafts were preserved by deep freezing, glicerolisation or lyophilisation and radiation-sterilised with doses of 0 (control), 25, 50 or 100 kGy. To estimate mechanical properties all samples were subjected to tensile tests to failure using Instron system. Before these tests all lyophilised grafts were rehydrated. We found decrease of tensile strength of irradiated grafts compared to non-irradiated controls. Obtained results of the mechanical testing of studied grafts indicate their potential usefulness for clinical applications.(Author)

  17. Reconstruction of medial patellofemoral ligament using quadriceps tendon combined with reconstruction of medial patellotibial ligament using patellar tendon: initial experience

    Directory of Open Access Journals (Sweden)

    Betina Bremer Hinckel

    2016-02-01

    Full Text Available ABSTRACT OBJECTIVE: To describe a surgical technique for anatomical reconstruction of the medial patellofemoral ligament using the quadriceps tendon, combined with reconstruction of the medial patellotibial ligament using the patellar tendon; and to present the initial results from a case series. METHOD: The proposed technique was used on a series of cases of patients with diagnoses of patellofemoral instability and indications for surgical treatment, who were attended by the Knee Group of HC-IOT, University of São Paulo. The following were evaluated before and after the operation: range of motion (ROM, apprehension test, lateral translation test, patellar inclination test, inverted J sign, subluxation upon extension, pain from compression of the patella and pain from contraction of the quadriceps. After the operation, the patients were asked whether any new episode of dislocation had occurred, what their degree of satisfaction with the surgery was (on a scale from 0 to 10 and whether they would be prepared to go through this operation again. RESULTS: Seven knees were operated, in seven patients, with a mean follow-up of 5.46 months (±2.07. Four patients who presented apprehension before the operation did not show this after the operation. The lateral translation test became normal for all the patients, while the patellar inclination test remained positive for two patients. The patients with an inverted J sign continued to be positive for this sign. Five patients were positive for subluxation upon extension before the operation, but all patients were negative for this after the operation. None of the patients presented any new episode of dislocation of the patella. All of them stated that they were satisfied: five gave a satisfaction score of 9 and two, a score of 10. All of them said that they would undergo the operation again. Only one patient presented a postoperative complication: dehiscence of the wound. CONCLUSION: Reconstruction of the

  18. Acute traumatic rupture of the patellar tendon in pediatric population: Case series and review of the literature.

    Science.gov (United States)

    Ali Yousef, Mohamed Abdelhamid; Rosenfeld, Scott

    2017-11-01

    Intact knee extensor mechanism is required for the normal function of the lower extremity. Patellar tendon rupture is a relatively rare injury with peak age incidence around 40 years and usually occurs midsubstance. The occurrence of pure patellar tendon rupture without bony avulsion is an extremely rare injury in the pediatric population with few cases reported in the literature with limited information regarding frequency, complications, and outcomes in children. However, due to increased participation in sports and high-energy recreational activities during childhood, the frequency of such injuries has progressively increased. To evaluate the frequency of pediatric patellar tendon rupture injuries and describe the radiological findings, treatment modalities, and outcome of such injuries. Demographic and clinical data on a series of patients who sustained patellar tendon rupture were reviewed. These data included age at time of injury, sex, laterality, mechanism of injury, associated injuries, complications, presence or absence of Osgood-Schlatter disease, diagnostic imaging such as plain radiographs and magnetic resonance images (MRI), surgical technique, method of fixation, period of postoperative immobilization, total duration of physiotherapy, time to return to sports activities and follow-up duration. Insall-Salvati ratio was calculated on the preoperative lateral x-ray. The functional outcome was evaluated with regard to final knee active range of motion (AROM), manual quadriceps muscle testing, and presence or the absence of terminal extension lag. Clinical outcome rating using knee society score (KSS) was performed and functional outcome was further classified according to the calculated score. Five male patients with patellar tendon rupture (7%) were identified among 71 pediatric patients who sustained acute traumatic injury of the knee extensor mechanism. The mean age at the time of injury was 13.6 years (range: 12-15 years). The injury occurred in

  19. Effects of a peracetic acid disinfection protocol on the biocompatibility and biomechanical properties of human patellar tendon allografts.

    Science.gov (United States)

    Lomas, R J; Jennings, L M; Fisher, J; Kearney, J N

    2004-01-01

    Patellar tendon allografts, retrieved from cadaveric human donors, are widely used for replacement of damaged cruciate ligaments. In common with other tissue allografts originating from cadaveric donors, there are concerns regarding the potential for disease transmission from the donor to the recipient. Additionally, retrieval and subsequent processing protocols expose the graft to the risk of environmental contamination. For these reasons, disinfection or sterilisation protocols are necessary for these grafts before they are used clinically. A high-level disinfection protocol, utilising peracetic acid (PAA), has been developed and investigated for its effects on the biocompatibility and biomechanics of the patellar tendon allografts. PAA disinfection did not render the grafts either cytotoxic or liable to provoke an inflammatory response as assessed in vitro . However, the protocol was shown to increase the size of gaps between the tendon fibres in the matrix and render the grafts more susceptible to digestion with collagenase. Biomechanical studies of the tendons showed that PAA treatment had no effect on the ultimate tensile stress or Young's modulus of the tendons, and that ultimate strain was significantly higher in PAA treated tendons.

  20. 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 η 2 = 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 intrinsic or

  1. Effects of habitual loading on patellar tendon mechanical and morphological properties in basketball and volleyball players.

    Science.gov (United States)

    Zhang, Z J; Ng, G Y F; Fu, S N

    2015-11-01

    Tendon mechanical properties are linked to sports performance and tendon-related injuries, such as tendinopathy. Whether habitual loading, such as participation in regular jumping activities, would induce adaptation on tendon mechanical properties remains unclear. Forty healthy subjects (10 sedentary, 15 volleyball players, and 15 basketball players) aged between 18 and 35 years were recruited. Supersonic shearwave imaging was used to measure the shear elastic modulus and thickness and cross-sectional area (CSA) of the proximal patellar tendons of both knees at 30° of flexion. Significant group differences in tendon shear elastic modulus were found among the three groups. In the dominant leg, reduction in tendon shear elastic modulus by 18.9 % (p = 0.018) and 48.7 % (p = 0.000) were observed in the basketball and volleyball players, respectively, when compared with sedentary subjects. In the non-dominant leg, reduction in tendon shear elastic modulus were 27.3 % (p = 0.034) and 47.1 % (p = 0.02) in the basketball and volleyball players, respectively. The athlete groups were found to have larger CSA but with similar tendon thickness than sedentary group. The CSA were larger by 24-29 % and by 22-24 % in the basketball players and volleyball players, for the dominant and non-dominant legs, respectively (all p < 0.05). Age and body mass are related to tendon stiffness and CSA, particularly in the sedentary subjects. The proximal patellar tendon can undergo substantial adaptation on tendon mechanical and morphological properties when exposed in jumping sports. Intrinsic factors such as age and body mass could influence tendon properties.

  2. A comparison of revision and rerupture rates of ACL reconstruction between autografts and allografts in the skeletally immature.

    Science.gov (United States)

    Nelson, Ian R; Chen, Jason; Love, Rebecca; Davis, Brent R; Maletis, Gregory B; Funahashi, Tadashi T

    2016-03-01

    Anterior cruciate ligament reconstructions (ACLRs) in skeletally immature patients are increasing. The purpose of this study is to describe the demographics, graft usage, revision, and re-operation rates in skeletally immature ACLRs in the Kaiser Permanente healthcare system. Skeletally immature patients (type; bone-patellar-tendon-bone (BPTB) autograft, hamstring autograft, and any type of allograft. Age, gender, body mass index (BMI), and race were evaluated as confounders. Cox proportional hazard models stratified by surgeon were used to analyse the risk of revision and re-operation. A total of 534 primary ACLR cases were evaluated with a mean follow-up of 2.9 years. The majority were hamstring autografts (n = 388, 72.7%), male (n = 339, 63.9%), and White (n = 232, 43.4%). Median age was 14.9 years, and median BMI was 21.9 kg/m(2). There were 44 (8.2%) aseptic revisions and 48 (9.0%) same-knee re-operations. The incidence rate for revision was BPTB autograft 5.5%, hamstring autograft 7.5%, and allograft 13.2%. After adjusting for confounders and surgeon clustering effect, the risk of aseptic revision and revision between allograft and hamstring autograft did not reach statistical significance. Graft selection differs in skeletally immature patients with a preponderance of surgeries being performed with hamstring tendon autografts. High revision rates were identified for all graft types used, though differences in revision rates across different graft types did not reach statistical significance. Surgeons should be aware of high rates of revision in this skeletally immature young population, although type of graft used did not appear to make a difference. III.

  3. ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: A COMPARISON BETWEEN BONE PATELLAR TENDON BONE GRAFT AND LIPSCOMB PROCEDURE - A FOLLOWUP STUDY OF 7 YEARS

    Directory of Open Access Journals (Sweden)

    Vijayamohan S

    2016-07-01

    Full Text Available BACKGROUND Anterior Cruciate Ligament injury has become more common and the demand by the patients to return to pre-injury level of activity has made reconstruction of the ligament very crucial. Though there are various techniques in reconstructing the anterior cruciate ligament, in this study, we compare two most commonly used techniques to see whether there is any significant difference in the outcome. METHODS Study included 25 patients in the age group of 19-36 years, of which 23 were males. The patients were divided randomly into 2 groups, and 15 patients underwent Anterior Cruciate Ligament reconstruction using Bone Patellar Tendon Bone Graft and 10 patients had Hamstring graft. RESULTS Patients were followed up at regular intervals monthly for the first six months and then at three monthly intervals. Patients were assessed using Knee Scoring Scale of Lysholm and Gillquist and International Knee Documentation Committee (IKDC scoring system. In addition, activity level, harvest site pain, thigh atrophy, kneeling pain and hamstring pain were assessed. All patients were followed up for a minimum period of 2 years. 20% of both groups were able to return to strenuous activity level, and 67% of Patellar tendon group and 50% of the Hamstring tendon group were able to return to moderate level of activity. 55% of patients in the patellar tendon group and 20% of patients in the hamstring tendon group had donor site pain in the first 6 months. 73% of patients in the hamstring group had at least 10 mm of thigh wasting. Pain on kneeling was seen only in the patellar tendon group (35% while hamstring pain was found only in the hamstring group (20%. CONCLUSIONS Patients in the patellar tendon group had increased anterior stability and were able to return to strenuous occupation. The difference in thigh atrophy between the two groups was not significant. The hamstring group had lower graft harvest site morbidity. Lachman test was the single most accurate

  4. Effect of eccentric exercise on the healing process of injured patellar tendon in rats.

    Science.gov (United States)

    Nakamura, Kenichi; Kitaoka, Katsuhiko; Tomita, Katsuro

    2008-07-01

    Earlier studies have reported positive results from eccentric training in patients with tendon disorders. The reasons for the beneficial clinical effects of eccentric training are not known. Vascularization followed by regression of the vasculature enhances the healing response of injured tendons. Eccentric exercise induces a more beneficial healing response than concentric exercise. Sixty rats with patellar tendon injuries were divided into three groups: nonexercise controls (group N; n = 20); concentric exercise group (group C; n = 20); eccentric exercise group (group E; n = 20). Each rat was taught to run uphill or downhill for 14 days. Patellar tendons were removed 1, 4, 7, 10, and 14 days following injury. Vascular endothelial growth factor (VEGF), angiopoietin-1, and angiopoietin-2 were measured by reverse transcription polymerase chain reaction. In group C, VEGF mRNA was increased 1 and 4 days following injury but was decreased on days 7, 10, and 14. In group E, VEGF mRNA was elevated only on day 1. In group N, VEGF mRNA remained at a low level throughout all 14 days. The angiopoietin-2/angiopoietin-1 ratio was higher for group C than for group E. In the presence of VEGF, angiopoietin-1 promotes vessel stability, whereas angiopoietin-2 has the opposite effect. Eccentric exercise contributes to stabilized angiogenesis during the early phase of tendon injury. Conversely, concentric exercise, which induces destabilized angiogenesis, leads to a delayed healing response. Initiation of eccentric exercise immediately after tendon injury may help improve healing by reducing vascularity.

  5. Lower strength of the human posterior patellar tendon seems unrelated to mature collagen cross-linking and fibril morphology

    DEFF Research Database (Denmark)

    Hansen, Philip; Haraldsson, Bjarki Thor; Aagaard, Per

    2010-01-01

    The human patellar tendon is frequently affected by tendinopathy, but the etiology of the condition is not established, although differential loading of the anterior and posterior tendon may be associated with the condition. We hypothesized that changes in fibril morphology and collagen cross-lin...

  6. [Isokinetic assessment with two years follow-up of anterior cruciate ligament reconstruction with patellar tendon or hamstring tendons].

    Science.gov (United States)

    Condouret, J; Cohn, J; Ferret, J-M; Lemonsu, A; Vasconcelos, W; Dejour, D; Potel, J-F

    2008-12-01

    This retrospective multicentric study was designed to assess the outcome of quadriceps and hamstrings muscles two years after Anterior Cruciate Ligament (ACL) reconstruction and compare muscles recovery depending on the type of graft and individual variables like age, gender, level of sport, but also in terms of discomfort, pain and functional score. The results focused on the subjective and objective IKDC scores, SF36, the existence or not of subjective disorders and their location. The review included isokinetic muscle tests concentric and eccentric extensors/flexors but also internal rotators/external rotators with analysis of mean work and mean power. One hundred and twenty-seven patients were included with an average age 29 years (+/-10). They all had an ACL reconstruction with patellar tendon or hamstring tendon with single or double bundles. In the serie, the average muscles deficit at two years was 10% for the flexors and extensors but with a significant dispersion. Significant differences were not noted in the mean values of all parameters in term of sex or age (over 30 years or not), neither the type of sport, nor of clinical assessment (Class A and B of objective IKDC score), nor the existence of anterior knee pain. There was a relationship between the level of extensor or flexor recovery and the quality of functional results with minimal muscle deficits close to 5% if the IKDC score was over 90 and deficits falling to 15% in the group with IKDC score less than 90. The type of reconstruction (patellar tendon versus hamstrings) had an influence on the muscle deficit. For extensors, the recovery was the same in the two groups, more than 90% at two years and the distribution of these two populations by level of deficit was quite the same. For flexors, residual deficits were significantly higher in the hamstrings group on the three studied parameters whatever the speed and the type of contraction (concentric or eccentric) with an average deficit of 14 to 18

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

    DEFF Research Database (Denmark)

    Ageberg, Eva; Roos, Harald; Silbernagel, Karin

    2008-01-01

    Hamstring muscles play a major role in knee-joint stabilization after anterior cruciate ligament (ACL) injury. Weakness of the knee extensors after ACL reconstruction with patellar tendon (PT) graft, and in the knee flexors after reconstruction with hamstring tendons (HT) graft has been observed ...

  8. A mini-invasive adductor magnus tendon transfer technique for medial patellofemoral ligament reconstruction: a technical note.

    Science.gov (United States)

    Sillanpää, Petri J; Mäenpää, Heikki M; Mattila, Ville M; Visuri, Tuomo; Pihlajamäki, Harri

    2009-05-01

    Patellar dislocations are associated with injuries to the medial patellofemoral ligament (MPFL). Several techniques for MPFL reconstruction have been recently published with some disadvantages involved, including large skin incisions and donor site morbidity. Arthroscopic stabilizing techniques carry the potential of inadequate restoration of MPFL function. We present a minimally invasive technique for MPFL reconstruction using adductor magnus tendon autograft. This technique is easily performed, safe, and provides a stabilizing effect equal to current MPFL reconstructions. Skin incision of only 3-4 cm is located at the level of the proximal half of the patella. After identifying the distal insertion of the adductor magnus tendon, a tendon harvester is introduced to harvest the medial two-thirds of the tendon, while the distal insertion is left intact. The adductor magnus tendon is cut at 12-14 cm from its distal insertion and transferred into the patellar medial margin. Two suture anchors are inserted through the same incision at the superomedial aspect of the patella in the anatomic MPFL origin. The graft is tightened at 30 degrees knee flexion. Aftercare includes 4 weeks of brace treatment with restricted range of motion.

  9. Effect of androgenic-anabolic steroids and heavy strength training on patellar tendon morphological and mechanical properties.

    Science.gov (United States)

    Seynnes, Olivier R; Kamandulis, Sigitas; Kairaitis, Ramutis; Helland, Christian; Campbell, Emma-Louise; Brazaitis, Marius; Skurvydas, Albertas; Narici, Marco V

    2013-07-01

    Combined androgenic-anabolic steroids (AAS) and overloading affects tendon collagen metabolism and ultrastructure and is often associated with a higher risk of injury. The aim of this prospective study was to investigate whether such effects would be reflected in the patellar tendon properties of individuals with a history of long-term resistance training and AAS abuse (RTS group), compared with trained (RT) and untrained (CTRL) nonsteroids users. Tendon cross-sectional area (CSA), stiffness, Young's modulus, and toe limit strain were measured in vivo, from synchronized ultrasonography and dynamometry data. The patellar tendon of RT and RTS subjects was much stiffer and larger than in the CTRL group. However, stiffness and modulus were higher in the RTS group (26%, P < 0.05 and 30%, P < 0.01, respectively) than in the RT group. Conversely, tendon CSA was 15% (P < 0.05) larger in the RT group than in RTS, although differences disappeared when this variable was normalized to quadriceps maximal isometric torque. Yet maximal tendon stress was higher in RTS than in RT (15%, P < 0.05), without any statistical difference in maximal strain and toe limit strain between groups. The present lack of difference in toe limit strain does not substantiate the hypothesis of changes in collagen crimp pattern associated with AAS abuse. However, these findings indicate that tendon adaptations from years of heavy resistance training are different in AAS users, suggesting differences in collagen remodeling. Some of these adaptations (e.g., higher stress) could be linked to a higher risk of tendon injury.

  10. Tensile force transmission in human patellar tendon fascicles is not mediated by glycosaminoglycans

    DEFF Research Database (Denmark)

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

    2011-01-01

    suggested that the proteoglycan-associated glycosaminoglycans (GAGs) found on the surface of the collagen fibrils may be an important transmitter of load, but existing results are ambiguous and have not investigated human tendons. We have used a small-scale mechanical testing system to measure...... change the tendon modulus, relative energy dissipation, peak stress, or peak strain. The effect of deformation rate was not modulated by the treatment either, indicating no effect on viscosity. These results suggest that GAGs cannot be considered mediators of tensile force transmission in the human...... patellar tendon, and as such, force transmission must either take place through other matrix components or the fibrils must be mechanically continuous at least to the tested length of 7 mm....

  11. Quantitative Analysis of Patellar Tendon Abnormality in Asymptomatic Professional “Pallapugno” Players: A Texture-Based Ultrasound Approach

    Directory of Open Access Journals (Sweden)

    Kristen M. Meiburger

    2018-04-01

    Full Text Available Abnormalities in B-mode ultrasound images of the patellar tendon often take place in asymptomatic athletes but it is still not clear if these modifications forego or can predict the development of tendinopathy. Subclinical tendinopathy can be arbitrarily defined as either (1 the presence of light structural changes in B-mode ultrasound images in association with mild neovascularization (determined with Power Doppler images or (2 the presence of moderate/severe structural changes with or without neovascularization. Up to now, the structural changes and neovascularization of the tendon are evaluated qualitatively by visual inspection of ultrasound images. The aim of this study is to investigate the capability of a quantitative texture-based approach to determine tendon abnormality of “pallapugno” players. B-mode ultrasound images of the patellar tendon were acquired in 14 players and quantitative texture parameters were calculated within a Region of Interest (ROI of both the non-dominant and the dominant tendon. A total of 90 features were calculated for each ROI, including 6 first-order descriptors, 24 Haralick features, and 60 higher-order spectra and entropy features. These features on the dominant and non-dominant side were used to perform a multivariate linear regression analysis (MANOVA and our results show that the descriptors can be effectively used to determine tendon abnormality and, more importantly, the occurrence of subclinical tendinopathy.

  12. The effect of dynamic knee-extension exercise on patellar tendon and quadriceps femoris muscle glucose uptake in humans studied by positron emission tomography

    DEFF Research Database (Denmark)

    Kalliokoski, Kari K; Langberg, Henning; Ryberg, Ann Kathrine

    2005-01-01

    Both tendon and peritendinous tissue show evidence of metabolic activity, but the effect of acute exercise on substrate turnover is unknown. We therefore examined the influence of acute exercise on glucose uptake in the patellar and quadriceps tendons during dynamic exercise in humans. Glucose...... that tendon glucose uptake is increased during exercise. However, the increase in tendon glucose uptake is less pronounced than in muscle and the increases are uncorrelated. Thus tendon glucose uptake is likely to be regulated by mechanisms independently of those regulating skeletal muscle glucose uptake....... uptake was measured in five healthy men in the patellar and quadriceps tendons and the quadriceps femoris muscle at rest and during dynamic knee-extension exercise (25 W) using positron emission tomography and [18F]-2-fluoro-2-deoxy-D-glucose ([18F]FDG). Glucose uptake index was calculated by dividing...

  13. Proximal patellar tendinosis and abnormalities of patellar tracking

    International Nuclear Information System (INIS)

    Allen, G.M.; Tauro, P.G.; Ostlere, S.J.

    1999-01-01

    Objective. To assess whether an association exists between patellar tendinosis and abnormal patellar tracking. Design and patients. The MRI examinations of 630 patients (i.e. 860 knees) referred with anterior knee pain over a 4-year period were assessed in retrospect for the presence of patellar tendinosis and abnormal patellar tracking. The images of the patients with patellar tendinosis were reviewed and the location within the patellar tendon was recorded. Results. There were 44 knees with proximal patellar tendinosis. Twenty-four of these were considered to have normal patellar tracking and 20 to have abnormal patellar tracking. In the group of 816 knees without proximal patellar tendinosis, 581 were considered to have normal patellar tracking and 235 knees to have abnormal patellar tracking. When the two groups were compared there was a statistically significant difference in the ratio of patients with and without abnormal tracking. Conclusion. In patients referred with anterior knee pain or suspected abnormal patellar tracking there is a significant association between proximal patellar tendinosis and abnormal patellar tracking. (orig.)

  14. [Histomorphological analyse of accelerating the fibrocartilage layer repair of patella-patellar tendon junction in rabbits by low intensity pulsed ultrasound stimulation].

    Science.gov (United States)

    Zhang, Baoliang; Lü, Hongbin; Hu, Jianzhong; Xu, Daqi; Zhou, Jingyong; Wang, Ye

    2013-08-01

    To analyse the effect of low intensity pulsed ultrasound stimulation (LIPUS) on accelerating the fibrocartilage layer repair of patella-patellar tendon junction. A total of 60 mature female New Zealand white rabbits undergoing standard partial patellectomy were divided into 2 groups randomly. The control group was given comfort treatment and the treatment group was given LIPUS treatment starting from day 3 to the end of week 6 postoperatively. The scheduled time points of animal euthanization would be at week 6, week 12 and week 18 postoperatively. The patella-patellar tendon (PPT) complex would be harvested and cut into sections after decalcification for H&E staining, Safranine o/fast green staining. The thickness and gray value of fibrocartilage layer were analyzed by SANO Microscope Partner image analyzer. At week 6, week 12 and week 18 postoperatively, the fibrocartilage layer in the treatment group was significantly thicker than that in the control group (Pfibrocartilage layer was significantly smaller than that in the control group (Pfibrocartilage layer repair of patella-patellar tendon junction in rabbit models.

  15. Patellar tendon properties distinguish elite from non-elite soccer players and are related to peak horizontal but not vertical power.

    Science.gov (United States)

    Murtagh, Conall F; Stubbs, Michael; Vanrenterghem, Jos; O'Boyle, Andrew; Morgans, Ryland; Drust, Barry; Erskine, Robert M

    2018-06-02

    To investigate potential differences in patellar tendon properties between elite and non-elite soccer players, and to establish whether tendon properties were related to power assessed during unilateral jumps performed in different directions. Elite (n = 16; age 18.1 ± 1.0 years) and non-elite (n = 13; age 22.3 ± 2.7 years) soccer players performed vertical, horizontal-forward and medial unilateral countermovement jumps (CMJs) on a force plate. Patellar tendon (PT) cross-sectional area, elongation, strain, stiffness, and Young's modulus (measured at the highest common force interval) were assessed with ultrasonography and isokinetic dynamometry. Elite demonstrated greater PT elongation (6.83 ± 1.87 vs. 4.92 ± 1.88 mm, P = 0.011) and strain (11.73 ± 3.25 vs. 8.38 ± 3.06%, P = 0.009) than non-elite soccer players. Projectile range and peak horizontal power during horizontal-forward CMJ correlated positively with tendon elongation (r = 0.657 and 0.693, P < 0.001) but inversely with Young's modulus (r = - 0.376 and - 0.402; P = 0.044 and 0.031). Peak medial power during medial CMJ correlated positively with tendon elongation (r = 0.658, P < 0.001) but inversely with tendon stiffness (r = - 0.368, P = 0.050). Not only does a more compliant patellar tendon appear to be an indicator of elite soccer playing status but it may also facilitate unilateral horizontal-forward and medial, but not vertical CMJ performance. These findings should be considered when prescribing talent selection and development protocols related to direction-specific power in elite soccer players.

  16. [Reconstruction of medial patellofemoral ligament with transposition of great adductor muscular tendon for the treatment of teenagers' recurrent patellar dislocation].

    Science.gov (United States)

    Shao, Chuan-Qiang; Chen, Chang-Chun; Zhao, Chun-Cheng; Yang, Hong-Mei; Kang, Yan-Zhong

    2017-06-25

    To investigate surgical method and clinical curative effects of medial patellofemoral ligament (MPFL) reconstruction with great adductor muscular tendon in treating teenagers' recurrent patellar dislocation. From May 2012 to September 2014, 19 patients with recurrent dislocation of patellar, including 6 males and 13 females with an average of 16 years old (ranged from 13 to 17 years), the courses of disease ranged from 3 to 18 months(averaged 6 months). All patients were underwent great adductor muscular tendon transposition to reconstruct medial patellofemoral ligament. The curative effects were evaluated by preoperative and postoperative with Lysholm scores and Patellofemoral angle and Q angle. All patients were followed up from 12 to 18 months with an average of 16.5 months. Primary healing was achieved at stage I. No pain, swelling and patellar dislocation or subluxation occurred. Patellofemoral angle increased from preoperative (-3.8±4.9)° to (10.3±4.1)° postoperatively. Q angle decreased from preoperative(16.4±3.1)° to(10.5±1.2)° postoperatively; Lysholm scores were improved from preoperative (68.6±8.5) to (93.7±6.5) final follow-up ( P teenagers' recurrent patellar dislocation.

  17. Effect of patellar strap and sports tape on pain in patellar tendinopathy: A randomized controlled trial

    NARCIS (Netherlands)

    de Vries, A.; Zwerver, J.; Diercks, R.; Tak, I.; van Berkel, S.; van Cingel, R.; van der Worp, H.; van den Akker-Scheek, I.

    2016-01-01

    Numerous athletes with patellar tendinopathy (PT) use a patellar strap or sports tape during sports. This study's aim was to investigate the short-term effect of these orthoses on patellar tendon pain. Participants performed the single-leg decline squat, vertical jump test, and triple-hop test under

  18. Effect of patellar strap and sports tape on pain in patellar tendinopathy : A randomized controlled trial

    NARCIS (Netherlands)

    Vries , de A.; Zwerver, J.; Diercks, R.; Tak, I.; van Berkel, S.; van Cingel, R.; van der Worp, H.; van den Akker-Scheek, I.

    2016-01-01

    Numerous athletes with patellar tendinopathy (PT) use a patellar strap or sports tape during sports. This study's aim was to investigate the short-term effect of these orthoses on patellar tendon pain. Participants performed the single-leg decline squat, vertical jump test, and triple-hop test under

  19. A role for hedgehog signaling in the differentiation of the insertion site of the patellar tendon in the mouse.

    Directory of Open Access Journals (Sweden)

    Chia-Feng Liu

    Full Text Available Tendons are typically composed of two histologically different regions: the midsubstance and insertion site. We previously showed that Gli1, a downstream effector of the hedgehog (Hh signaling pathway, is expressed only in the insertion site of the mouse patellar tendon during its differentiation. To test for a functional role of Hh signaling, we targeted the Smoothened (Smo gene in vivo using a Cre/Lox system. Constitutive activation of the Hh pathway in the mid-substance caused molecular markers of the insertion site, e.g. type II collagen, to be ectopically expressed or up-regulated in the midsubstance. This was confirmed using a novel organ culture method in vitro. Conversely, when Smo was excised in the scleraxis-positive cell population, the development of the fibrocartilaginous insertion site was affected. Whole transcriptome analysis revealed that the expression of genes involved in chondrogenesis and mineralization was down-regulated in the insertion site, and expression of insertion site markers was decreased. Biomechanical testing of murine adult patellar tendon, which developed in the absence of Hh signaling, showed impairment of tendon structural properties (lower linear stiffness and greater displacement and material properties (greater strain, although the linear modulus of the mutant group was not significantly lower than controls. These studies provide new insights into the role of Hh signaling during tendon development.

  20. The patellar tendon in junior elite volleyball players and an Olympic elite weightlifter

    OpenAIRE

    Gisslén, Karl

    2006-01-01

    The principal aim of the present thesis was to prospectively follow (clinical status and ultrasound + Doppler findings) the patellar tendons in the young elite volleyball players at the Swedish National Centre for high school volleyball in Falköping. In an Olympic weightlifter with chronic painful jumper´s knee, the effects of treatment with sclerosing injections followed by early instituted very heavy weightlifting training, was also evaluated. First, in a prevalence study, we demonstrated t...

  1. Press-fit Femoral Fixation in ACL Reconstruction using Bone-Patellar Tendon-Bone Graft

    Directory of Open Access Journals (Sweden)

    Kaseb Mohammad Hasan

    2009-05-01

    Full Text Available Bone-patellar tendon auto graft is probably the most widely used graft for ACL reconstruction. Several methods for graft fixation have been described. To avoid intra-articular hardware we adopt biological fixation with a femoral trapezoidal press-fit fixation. A prospective study was performed on 30 consecutive active people who underwent ACL reconstruction with this technique by two surgeons between september2004 and march2007 (mean follow-up 15.2 months. Results were evaluated by an independent examiner using radiography, subjective and objective evaluation. Assessment using the IKDC knee scoring revealed 92% of the patients with a normal or nearly normal knee joint. Lysholm's score was 63.6(40- 86 preoperatively and 91.88(73-100 at the latest follow up (P < 0.005. No patient complained of instability at latest follow up. The quadriceps muscle showed mild atrophy at 3 and 6 months and at final follow-up. Five Patients complained of anterior knee pain and had a positive kneeling test. We found no graft displacement on follow up radiographs. All cases showed radiological evidence of graft osteointegration at last follow up. Our results show that press-fit fixation of trapezoidal bone graft in femoral tunnel is a simple, reliable, and cost-effective alternative for ACL recon-struction using bone-patellar tendon-bone graft.

  2. Patellar Tendinopathy.

    Science.gov (United States)

    Schwartz, Aaron; Watson, Jonathan N; Hutchinson, Mark R

    2015-01-01

    Patellar tendinopathy is a common condition. There are a wide variety of treatment options available, the majority of which are nonoperative. No consensus exists on the optimal method of treatment. PubMed spanning 1962-2014. Clinical review. Level 4. The majority of cases resolve with nonoperative therapy: rest, physical therapy with eccentric exercises, cryotherapy, anti-inflammatories, corticosteroid injections, extracorporeal shockwave therapy, glyceryl trinitrate, platelet-rich plasma injections, and ultrasound-guided sclerosis. Refractory cases may require either open or arthroscopic debridement of the patellar tendon. Corticosteroid injections provide short-term pain relief but increase risk of tendon rupture. Anti-inflammatories and injectable agents have shown mixed results. Surgical treatment is effective in many refractory cases unresponsive to nonoperative modalities. Physical therapy with an eccentric exercise program is the mainstay of treatment for patellar tendinopathy. Platelet-rich plasma has demonstrated mixed results; evidence-based recommendations on its efficacy cannot be made. In the event that nonoperative treatment fails, surgical intervention has produced good to excellent outcomes in the majority of patients. © 2015 The Author(s).

  3. Effect of acute resistance exercise and sex on human patellar tendon structural and regulatory mRNA expression

    DEFF Research Database (Denmark)

    Sullivan, B.E.; Carroll, C.C.; Jemiolo, B.

    2009-01-01

    Sullivan BE, Carroll CC, Jemiolo B, Trappe SW, Magnusson SP, Dossing S, Kjaer M, Trappe TA. Effect of acute resistance exercise and sex on human patellar tendon structural and regulatory mRNA expression. J Appl Physiol 106: 468-475, 2009. First published November 20, 2008; doi: 10.1152/japplphysiol.......91341.2008.-Tendon is mainly composed of collagen and an aqueous matrix of proteoglycans that are regulated by enzymes called matrix metalloproteinases ( MMPs) and tissue inhibitors of metalloproteinases (TIMPs). Although it is known that resistance exercise (RE) and sex influence tendon metabolism...... and mechanical properties, it is uncertain what structural and regulatory components contribute to these responses. We measured the mRNA expression of tendon's main fibrillar collagens (type I and type III) and the main proteoglycans (decorin, biglycan, fibromodulin, and versican) and the regulatory enzymes MMP...

  4. Achilles and patellar tendinopathy display opposite changes in elastic properties: A shear wave elastography study.

    Science.gov (United States)

    Coombes, B K; Tucker, K; Vicenzino, B; Vuvan, V; Mellor, R; Heales, L; Nordez, A; Hug, F

    2018-03-01

    To compare tendon elastic and structural properties of healthy individuals with those with Achilles or patellar tendinopathy. Sixty-seven participants (22 Achilles tendinopathy, 17 patellar tendinopathy, and 28 healthy controls) were recruited between March 2015 and March 2016. Shear wave velocity (SWV), an index of tissue elastic modulus, and tendon thickness were measured bilaterally at mid-tendon and insertional regions of Achilles and patellar tendons by an examiner blinded to group. Analysis of covariance, adjusted for age, body mass index, and sex was used to compare differences in tendon thickness and SWV between the two tendinopathy groups (relative to controls) and regions. Tendon thickness was included as a covariate for analysis of SWV. Compared to controls, participants with Achilles tendinopathy had lower SWV at the distal insertion (Mean difference MD; 95% CI: -1.56; -2.49 to -0.62 m/s; P < .001) and greater thickness at the mid-tendon (MD 0.19; 0.05-0.33 cm; P = .007). Compared to controls, participants with patellar tendinopathy had higher SWV at both regions (MD 1.25; 0.40-2.10 m/s; P = .005) and greater thickness proximally (MD 0.17; 0.06-0.29 cm; P = .003). Compared to controls, participants with Achilles and patellar tendinopathy displayed lower Achilles tendon elastic modulus and higher patellar tendon elastic modulus, respectively. More research is needed to explore whether maturation, aging, or chronic load underlie these findings and whether current management programs for Achilles and patellar tendinopathy need to be tailored to the tendon. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  5. Region-specific mechanical properties of the human patella tendon

    DEFF Research Database (Denmark)

    Haraldsson, B T; Aagaard, P; Krogsgaard, M

    2004-01-01

    The present study investigated the mechanical properties of tendon fascicles from the anterior and posterior human patellar tendon. Collagen fascicles from the anterior and posterior human patellar tendon in healthy young men (mean +/- SD, 29.0 +/- 4.6 yr, n = 6) were tested in a mechanical rig...... portion of the tendon, indicating region-specific material properties....

  6. The effects of test environment and cyclic stretching on the failure properties of human patellar tendons

    International Nuclear Information System (INIS)

    Haut, R.C.; Powlison, A.C.

    1990-01-01

    There is a need to document the mechanical properties of patellar tendon allografts used for reconstructive surgery of the damaged anterior cruciate ligament, especially the effects of irradiation sterilization. The purpose of this study was to investigate the influences of in vitro test environment and low-level cyclic stretching prior to failure tests on nonirradiated and irradiated human graft tissues. Bilateral patellar tendons were split and each half processed accordingly. Some graft tissues were stretched cyclically at 2.5 mm deformation before failure. Experiments were performed in a 37 degrees C saline bath or with tissues moistened with a drip of the same. The irradiated grafts relaxed less and generated less slack length in the drip environment than the nonirradiated controls. Cyclic stretching did not alter failure characteristics of either graft tissue. While no significant differences in the tensile responses or failure characteristics were noted for irradiated and nonirradiated grafts in the drip, in the bath environment the nonirradiated tissues had greater strength and modulus. This resulted in there being a significant difference between irradiated and nonirradiated tissue responses in a heated saline bath environment. These experimental results exemplify the need to control in vitro test environments in the evaluation of various sterilization and preservation protocols for soft tissue allografts

  7. Achilles and Patellar Tendinopathy Loading Programmes

    DEFF Research Database (Denmark)

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

    2013-01-01

    . 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...... mechanism that was consistently associated with improved clinical outcomes in both Achilles and patellar tendon rehabilitation was improved neuromuscular performance (e.g. torque, work, endurance), and Silbernagel-combined (Achilles) HSR loading (patellar) had an equivalent or higher level of evidence than...... isolated eccentric loading. In the Achilles tendon, a majority of studies did not find an association between improved imaging (e.g. reduced anteroposterior diameter, proportion of tendons with Doppler signal) and clinical outcomes, including all high-quality studies. In contrast, HSR loading...

  8. Influence of acetaminophen and ibuprofen on in vivo patellar tendon adaptations to knee extensor resistance exercise in older adults

    DEFF Research Database (Denmark)

    Carroll, Chad C; Dickinson, Jared M; Lemoine, Jennifer K

    2011-01-01

    Millions of older individuals consume acetaminophen or ibuprofen daily and these same individuals are encouraged to participate in resistance training. Several in vitro studies suggest that cyclooxygenase-inhibiting drugs can alter tendon metabolism and may influence adaptations to resistance...... training. Thirty-six individuals were randomly assigned to a Placebo (67±2y), Acetaminophen (64±1y; 4000mg(.)d(-1)), or Ibuprofen (64±1y; 1200mg(.)d(-1)) group in a double-blind manner and completed 12-weeks of knee extensor resistance-training. Before and after training in vivo patellar tendon properties......, and this response was not influenced with ibuprofen consumption. Mean tendon CSA increased with training in the Acetaminophen group (3%, p0.05) with training in the Placebo group. These responses were generally uninfluenced by ibuprofen consumption. In the Acetaminophen group, tendon deformation and strain...

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

    Directory of Open Access Journals (Sweden)

    Gaurav Sharma

    2016-07-01

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

  10. 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.

  11. MR evaluation of the knee following anterior cruciate ligament reconstruction

    International Nuclear Information System (INIS)

    Rak, K.M.; Gillogly, S.D.; Schaefer, R.A.; Yakes, W.F.

    1991-01-01

    This paper evaluates the role of MR imaging of the knee after anterior cruciate ligament (ACL) reconstruction. Seventy-five MR examinations were performed in 52 patients following ACL reconstruction with patellar tendon autografts. MR imaging demonstrated a well-defined autograft in 63 of 70 clinically stable autografts. Of 5 clinically lax reconstructions, none appeared will defined on MR images. Compared with the clinical examination, MR imaging was 90.7% accurate. MR imaging demonstrated time-related healing of the patellar tendon donor site, with persistent thickening indicative of tendinitis. Positions of the femoral and tibial bone tunnels could be assessed. Knee joint effusions tended to resolve completely within 7 months after operations, with the presence and degree of effusion in the earlier postoperative interval being unrelated to the clinical outcome. Ancillary disorders in the knee, such as meniscal tears and osteochondral defects, could also be evaluated in this postoperative population

  12. Outcomes of the patellar tendon and hamstring graft anterior cruciate ligament reconstructions in patients aged above 50 years

    Directory of Open Access Journals (Sweden)

    Tarun Bali

    2015-01-01

    Full Text Available Background: The treatment of anterior cruciate ligament (ACL injury consists of arthroscopic ACL reconstruction with patellar tendon or hamstring graft. Satisfactory results have been reported so far in the younger age group. Dilemma arises regarding the suitability of ACL reconstruction in the patients aged 50 years and above. This retrospective analyses the outcome of ACL reconstruction in patients aged 50 years and above at the time of presentation. Materials and Methods: 55 patients aged 50 years and above presented to our institution with symptomatic ACL tear and were managed with arthroscopic reconstruction with patellar tendon/hamstring graft. 22 patients underwent ACL reconstruction with bone- patellar tendon-bone graft and the remaining 33 with a hamstring graft. Evaluation of functional outcome was performed using International Knee Documentation Committee (IKDC and Lysholm scoring in the preoperative period, at the end of 1 year and at the final followup. Radiographic evaluation was performed using the Kellgren–Lawrence grading system. Results: The mean preoperative IKDC score was 39.7 ± 3.3. At the end of 1-year following the operation, the mean IKDC score was 73.6 ± 4.9 and at the final followup was 67.8 ± 7.7. The mean preoperative Lysholm score was 40.4 ± 10.3. At the end of 1-year following the intervention, the mean Lysholm score was 89.7 ± 2.1 and at final followup was 85.3 ± 2.5. Overall, 14 out of 42 patients who underwent radiographic assessment showed progression of osteoarthritis changes at the final followup after the intervention. Conclusion: In our study, there was a statistically significant improvement in the IKDC and Lysholm scores following the intervention. There was a slight deterioration in the scores at the final followup but the overall rate of satisfaction was still high and most of the patients were able to do their routine chores and light exercises suitable for their age group. Around one-third of

  13. Assessment of Patellar Tendon Reflex Responses Using Second-Order System Characteristics

    Directory of Open Access Journals (Sweden)

    Brett D. Steineman

    2016-01-01

    Full Text Available Deep tendon reflex tests, such as the patellar tendon reflex (PTR, are widely accepted as simple examinations for detecting neurological disorders. Despite common acceptance, the grading scales remain subjective, creating an opportunity for quantitative measures to improve the reliability and efficacy of these tests. Previous studies have demonstrated the usefulness of quantified measurement variables; however, little work has been done to correlate experimental data with theoretical models using entire PTR responses. In the present study, it is hypothesized that PTR responses may be described by the exponential decay rate and damped natural frequency of a theoretical second-order system. Kinematic data was recorded from both knees of 45 subjects using a motion capture system and correlation analysis found that the mean R2 value was 0.99. Exponential decay rate and damped natural frequency ranges determined from the sample population were −5.61 to −1.42 and 11.73 rad/s to 14.96 rad/s, respectively. This study confirmed that PTR responses strongly correlate to a second-order system and that exponential decay rate and undamped natural frequency are novel measurement variables to accurately measure PTR responses. Therefore, further investigation of these measurement variables and their usefulness in grading PTR responses is warranted.

  14. Pectoralis Major Tear with Retracted Tendon: How to Fill the Gap? Reconstruction with Hamstring Autograft and Fixation with an Interference Screw

    Directory of Open Access Journals (Sweden)

    L. Baverel

    2017-01-01

    Full Text Available Rupture of the pectoralis major tendon is considered an uncommon injury and a significant number of ruptures are missed or diagnosed late, leading to a chronic tear. We report an open reconstruction technique and its outcomes in a case of chronic and retracted PM tear. At the last follow-up (12 months, the patient was pain-free, with a visual analogic scale at 0 all the time. He was very satisfied concerning the cosmetic and clinical results. The constant score was 93%, the SST value 95%, and the Quick DASH score 4.5. MRI performed one year postoperatively confirmed the continuity between PM tendon and graft, even if the aspect of the distal tendon seemed to be thinner than normal PM tendon. The excellent clinical outcomes at one-year follow-up suggest that PM tear with major tendon retraction can be reliably reconstructed with hamstring autograft, using a bioabsorbable screw to optimize the fixation device. This technique has proven its simplicity and efficiency to fill the gap.

  15. Prospective imaging study of asymptomatic patellar tendinopathy in elite junior basketball players.

    Science.gov (United States)

    Cook, J L; Khan, K M; Kiss, Z S; Purdam, C R; Griffiths, L

    2000-07-01

    To evaluate the ability of ultrasonography to predict eventual symptoms in an at-risk population, 52 elite junior basketball players' patellar tendons were studied at baseline and again 16 months later. The group consisted of 10 study tendons (ultrasonographically hypoechoic at baseline) and 42 control tendons (ultrasonographically normal at baseline). By design, all tendons were asymptomatic at baseline. No differences were noted between subjects and controls at baseline for age, height, weight, training hours, and vertical jump. Functional (P patellar tendon changes may resolve, but this is not necessary for an athlete to become asymptomatic. Qualitative or quantitative analysis of baseline ultrasonographic images revealed it was not possible to predict which tendons would develop symptoms or resolve ultrasonographically.

  16. Patellar tendinopathy : physical therapy and injection treatments

    NARCIS (Netherlands)

    van Ark, Mathijs

    2015-01-01

    Patellar tendinopathy, commonly known as jumper’s knee, is an overuse injury of the patellar tendon. It is a frequent injury, particularly in jumping athletes such as volleyball and basketball players. Jumper’s knee is often a long-lasting injury and can have a major impact on sports and even work

  17. Anatomic single-bundle anterior cruciate ligament reconstruction improves walking economy: hamstrings tendon versus patellar tendon grafts.

    Science.gov (United States)

    Iliopoulos, Efthymios; Galanis, Nikiforos; Zafeiridis, Andreas; Iosifidis, Michael; Papadopoulos, Pericles; Potoupnis, Michael; Geladas, Nikolaos; Vrabas, Ioannis S; Kirkos, John

    2017-10-01

    Anterior cruciate ligament (ACL) injury is associated with a pathologic gait pattern and increased energy cost during locomotion. ACL reconstruction could improve the gait pattern. Hamstrings tendon (HAM) and bone-patellar tendon-bone (BPTB) grafts are usually used for reconstruction. The aim of this study was to compare the efficacy of anatomic ACL reconstruction with HAM and BPTB grafts on improving and normalizing the energy cost and physiologic reserves during flat, uphill, and downhill walking. Twenty male subjects with unilateral ACL injuries were randomly assigned to ACL reconstruction with a HAM (n = 10) or BPTB (n = 10) graft. Ten matched controls were also enrolled. All participants performed three 8-min walking tasks at 0, +10, and -10 % gradients before and 9 months after surgery. Energy cost (oxygen consumption, VO 2 ), heart rate (HR), and ventilation (VE) were measured. Lysholm/IKDC scores were recorded. Pre-operatively, VO 2 , HR, and VE were higher in the HAM and BPTB groups than in controls during walking at 0, +10, and -10 % gradients (p energy cost and nearly normalized locomotion economy and cardiorespiratory reserves during flat, uphill, and downhill walking. The improved locomotion economy is an additional benefit of anatomic ACL reconstruction, irrespective of the type of graft used, that the orthopaedic surgeons should consider. II.

  18. COMPARISON OF FUNCTIONAL ACTIVITIES ON STRUCTURAL CHANGES OF THE INFERIOR PATELLAR POLE

    Science.gov (United States)

    Wallmann, Harvey; Stalcup, Patrick; DiTommaso, Katie

    2017-01-01

    Background It is well known that eccentric and concentric exercise produce varied amounts of stress on the connective tissues. Diagnostic ultrasound has been used to measure these structural changes by observing fascicle length, angle, and thickness; however, there is a lack of evidence comparing the structural changes as it relates to eccentric, concentric, and stretching protocols. Purpose The purpose of this study was to compare the acute effects of static stretching, eccentric, concentric, and a combination of eccentric/concentric exercises on structural changes of the muscle tendon unit at the inferior patellar pole utilizing the diagnostic ultrasound. Study Design A repeated measures 2 × 4 within factorial study design with repeated measures on both factors was used to determine the differences in patellar tendon thickness within and between groups. Methods Forty-seven healthy subjects were screened for any lower extremity deficits or orthopaedic pathology. Forty-four (N=44) subjects completed all four protocols; the attrition was due to injuries to the lower extremity, occurring unrelated to the study. A baseline measurement of the anterior inferior patellar tendon was performed with the diagnostic ultrasound prior to each participant completing one of the four interventions per week over a four-week period. Interventions completed by each participant included static stretching, concentric, eccentric, and combined concentric and eccentric exercises. Immediately following each intervention, a post-intervention inferior patellar tendon measurement was recorded using the diagnostic ultrasound. Results Significant differences in anterior to posterior tendon thickness of the inferior patellar tendon were observed between pre (4.983 ± 0.041mm) and post (5.198 ± 0.055mm) measurements (peffect of time. However, no differences in tendon thickness were noted comparing each intervention to one another (p=0.351). Conclusion Differences in tendon thickness

  19. Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction With a Free Quadriceps Tendon Autograft.

    Science.gov (United States)

    Caterev, Sergiu; Nistor, Dan Viorel; Todor, Adrian

    2016-10-01

    Anatomic double-bundle anterior cruciate ligament (ACL) reconstruction aims to restore the 2 functional bundles of the ACL in an attempt to better reproduce the native biomechanics of the injured knee and promote long-term knee health. However, this concept is not fully accepted and is not performed on a standard basis. In addition, the superiority of this technique over the conventional single-bundle technique has been questioned, especially the long-term clinical results. One of the down sides of the double-bundle reconstruction is the complexity of the procedure, with increased risks, operative time, and costs compared with the single-bundle procedure. Also, the revision procedure, if necessary, is more challenging. We propose a technique that has some advantages over the traditional double-bundle procedure, using a single femoral tunnel, 2 tibial tunnels, and a free quadriceps tendon autograft.

  20. COMPARATIVE STUDY OF CLINICAL OUTCOME OF ARTHROSCOPIC ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION BONE PATELLAR TENDON BONE GRAFT V/S HAMSTRING GRAFT

    Directory of Open Access Journals (Sweden)

    Priyank

    2015-08-01

    fulfilling the predetermined inclusion and exclusion criteria were included in the study. STATISTICAL METHODS : Intergroup comparison was analysed by K - Independent sample t test. Intragroup comparison was analysed by Paired t - test. RESULTS : Patients were divided into two groups and treated with using Bone - patellar tendon - bone graft and Hamstring graft respectively. Mean age group of patients was 29.16 yrs. (range 16 - 51yrs and 30.88 yrs. (range 19 - 48yrs in group A and B respectively we found the incidence of ACL injury in 15 - 44 years age group to be greater than twice the general population. A mean delay in surgery of 4.66 months (range 2 - 12 months since the time of injury in group A and 4.46 months (range 2 - 7 months in group B was observed. Subjective IKDC evaluation was done at the end of 12 months. Ther e was no difference in both the groups in the terms of effusion, passive motion, knee compartment findings, ligament examination, X - ray findings. Functional test and IKDC grade of both the groups showed statistically very highly significant improvement. Ho wever, there was statistically very high Harvest site pathology in group A. CONCLUSION : We found that there is statistically no significant difference in the overall clinical outcome between hamstring autograft with transfix and bone - patellar tendon bone autograft with interference screw except that the patellar tendon group had a greater tendency of having donor site morbidity compared to the hamstring tendon group.

  1. Patellar tendinopathy: physical therapy and injection treatments

    OpenAIRE

    van Ark, Mathijs

    2015-01-01

    Patellar tendinopathy, commonly known as jumper’s knee, is an overuse injury of the patellar tendon. It is a frequent injury, particularly in jumping athletes such as volleyball and basketball players. Jumper’s knee is often a long-lasting injury and can have a major impact on sports and even work participation. The development of jumper’s knee and the best treatment for it are still unclear. The general aim of this thesis was to investigate the development and management of patellar tendinop...

  2. Injury to the Infrapatellar Branch of the Saphenous Nerve during ACL Reconstruction with Hamstring Tendon Autograft: A Comparison between Oblique and Vertical Incisions

    Directory of Open Access Journals (Sweden)

    Hamid Mousavi

    2018-01-01

    Full Text Available Background: Injury to the infrapatellar branch of the saphenous nerve (IPBSN is common after arthroscopic ACLreconstruction with hamstring tendon autograft, as reported in up to 88% of the cases. Due to close relationshipbetween the IPBSN with pes anserine tendons insertion skin incision may sever IPBSN while harvesting gracillis andsemitendinous tendons. As the IPBSN course at the anterior of knee is oblique, we hypothesized a parallel skin incisionwith nerve passage may decrease nerve injury.Methods: Vertical and oblique incisions were compared in 79 patients in this clinical trial. The sensory loss area andpatients’ complain of numbness were measured at 2 and 8 weeks as well as 6 months after surgery.Results: Both the sensory loss area and patients’ complain of numbness decreased significantly in the oblique incisiongroup (P

  3. When the tendon autograft is dropped accidently on the floor: A study about bacterial contamination and antiseptic efficacy.

    Science.gov (United States)

    Barbier, O; Danis, J; Versier, G; Ollat, D

    2015-10-01

    Inadvertent contamination of the autograft can occur during anterior cruciate ligament (ACL) reconstruction if the autograft is dropped on the floor during surgery. A study was undertaken to determine the incidence of contamination when a graft is dropped on the operating room floor and the efficacy of antimicrobial solutions to decontaminate it. Samples from 25 patients undergoing ACL reconstruction with a hamstring tendon were sectioned and dropped onto the floor. Cultures were taken after immersion in antiseptic solutions (a chlorhexidine gluconate solution (group 1), a povidone-iodine solution (group 2), and a sodium hypochlorite solution (group 3)). A fourth piece (group 0) was cultured without being exposed to any solution. Cultures of a floor swab were taken at the same time. The floor swab cultures were positive in 96% of cases. The rate of contamination was 40% in group 0, 8% in group 1, 4% in group 2, and 16% in group 3. There was a significant difference between groups 1 and 2 and group 0 (p<0.05) but not between groups 3 and 0. Immersing a graft dropped on the floor during surgery in a chlorhexidine gluconate solution or povidone-iodine solution significantly reduces contamination of the graft. Soaking of the hamstring autograft in one of these solutions is recommended in the case of inadvertent contamination. Laboratory investigation (level 2). Copyright © 2014 Elsevier B.V. All rights reserved.

  4. Patellar tendinopathy : Causes, consequences and the use of orthoses

    NARCIS (Netherlands)

    de Vries, Astrid Johanna

    2016-01-01

    Patellar tendinopathy (PT), also known as jumper’s knee, is a painful overuse injury of the patellar tendon. This injury is common in jumping athletes. There are numerous treatment options currently available for PT, yet none of them guarantee full recovery. As a result, many athletes have

  5. Iliotibial band autograft versus bone-patella-tendon-bone autograft, a possible alternative for ACL reconstruction

    DEFF Research Database (Denmark)

    Stensbirk, Frederik; Thorborg, Kristian; Konradsen, Lars

    2014-01-01

    PURPOSE: The long-term results after using the iliotibial band autograft (ITB) in anterior cruciate ligament (ACL) reconstruction are not fully known. If equal in quality to conventional methods, the ITB graft could be a useful alternative as a primary graft, in revision surgery or multi-ligament......PURPOSE: The long-term results after using the iliotibial band autograft (ITB) in anterior cruciate ligament (ACL) reconstruction are not fully known. If equal in quality to conventional methods, the ITB graft could be a useful alternative as a primary graft, in revision surgery or multi...

  6. Imaging patellar complications after knee arthroplasty

    International Nuclear Information System (INIS)

    Melloni, Pietro; Valls, Rafael; Veintemillas, Maite

    2008-01-01

    The purpose of this study is to describe complications affecting the patella in patients with total or partial knee arthroplasty. We respectively analysed plain-film radiographs, as well as ultrasound images when acquired, in a consecutive series of 1272 patients. The mean interval from knee replacement to patellar complications was 5 years and 7 months (range, 5 months to 14 years). The complications described include fracture, instability, dislocation or luxation, necrosis of the patella, infection of the patella, erosion of the patella, patellar impingement on the prosthesis and patellar or quadricipital tendon tear. We discuss the pathological imaging findings in the patella and their differential diagnosis after knee arthroplasty. Patellar complications after knee arthroplasty are uncommon but often potentially serious

  7. Imaging patellar complications after knee arthroplasty

    Energy Technology Data Exchange (ETDEWEB)

    Melloni, Pietro [Unitat de Imatge d' Alta Tecnologia, Centre Diagnostic, Corporacio Parc Tauli, Universitat Autonoma de Barcelona, Sabadell (Barcelona) (Spain)], E-mail: pmelloni@cspt.es; Valls, Rafael; Veintemillas, Maite [Unitat de Imatge d' Alta Tecnologia, Centre Diagnostic, Corporacio Parc Tauli, Universitat Autonoma de Barcelona, Sabadell (Barcelona) (Spain)

    2008-03-15

    The purpose of this study is to describe complications affecting the patella in patients with total or partial knee arthroplasty. We respectively analysed plain-film radiographs, as well as ultrasound images when acquired, in a consecutive series of 1272 patients. The mean interval from knee replacement to patellar complications was 5 years and 7 months (range, 5 months to 14 years). The complications described include fracture, instability, dislocation or luxation, necrosis of the patella, infection of the patella, erosion of the patella, patellar impingement on the prosthesis and patellar or quadricipital tendon tear. We discuss the pathological imaging findings in the patella and their differential diagnosis after knee arthroplasty. Patellar complications after knee arthroplasty are uncommon but often potentially serious.

  8. Anterior cruciate ligament reconstruction using bone plug-free quadriceps tendon autograft: intermediate-term clinical outcome after 24-36 months.

    Science.gov (United States)

    Schulz, Arndt P; Lange, Vivien; Gille, Justus; Voigt, Christine; Fröhlich, Susanne; Stuhr, Markus; Jürgens, Christian

    2013-01-01

    Although known as a possible graft option for decades, quadriceps tendon grafts have often been termed a second-line graft option. We report a consecutive case series using this method as the primary treatment line. The rationale for this study was to evaluate the midterm results of this method in a prospective and consecutive case series. The primary study question was to determine the clinical results 24-36 months after primary anterior cruciate ligament (ACL) reconstruction using a bone plug-free quadriceps tendon autograft fixed with bioabsorbable cross-pins. The study population included 55 patients, of whom 24 were female (43.6%). The mean age at the index procedure was 31.7 years (15-58 years). All patients received an ACL construction using a bone block-free quadriceps tendon graft fixed with resorbable cross-pins. The postoperative regimen included partial weight-bearing for 3 weeks and flexion limited to 90° for six weeks; an orthosis was not used. The mean follow-up duration was 29.5 months (24.3-38.5 months) after the index procedure. The International Knee Documentation Committee (IKDC) subjective score and examination form was assessed, as well as the Lysholm and Gillquist score and the Tegner activity index. The Rolimeter arthrometer was used to assess the anterior laxity of the knee. Graft harvesting was possible in all cases; a bony extension was never required. On average, graft length was measured at 8.8 cm (7.5-10 cm). The mean IKDC subjective score at follow-up was 80.44 points (55.17-100 points, standard deviation [SD] 12.05). The mean preinjury Tegner activity index was 4.98 (2-7) compared to a mean value of 4.16 (2-7, SD 0.8) at follow-up. There was a mean loss of 0.82 index points. The average Lysholm and Gillquist score was 89 points (65-100, SD 17.7). Of the results, 89.1% were in the good or very good groups; in one case (1.8%), the result was poor, while the rest were fair. ACL reconstruction using a bone plug-free quadriceps tendon

  9. Effect of acute exercise on patella tendon protein synthesis and gene expression

    DEFF Research Database (Denmark)

    Dideriksen, Kasper; Sindby, Ann Kathrine Ryberg; Krogsgaard, Michael

    2013-01-01

    Evidence suggests that habitual loading can result in patellar tendon hypertrophy, especially at the proximal and distal parts of the patellar tendon. The underlying protein kinetic changes and its regulation remains controversial and human data, investigating this topic, are limited. The present...

  10. Biology and augmentation of tendon-bone insertion repair

    Directory of Open Access Journals (Sweden)

    Lui PPY

    2010-08-01

    Full Text Available Abstract Surgical reattachment of tendon and bone such as in rotator cuff repair, patellar-patella tendon repair and anterior cruciate ligament (ACL reconstruction often fails due to the failure of regeneration of the specialized tissue ("enthesis" which connects tendon to bone. Tendon-to-bone healing taking place between inhomogenous tissues is a slow process compared to healing within homogenous tissue, such as tendon to tendon or bone to bone healing. Therefore special attention must be paid to augment tendon to bone insertion (TBI healing. Apart from surgical fixation, biological and biophysical interventions have been studied aiming at regeneration of TBI healing complex, especially the regeneration of interpositioned fibrocartilage and new bone at the healing junction. This paper described the biology and the factors influencing TBI healing using patella-patellar tendon (PPT healing and tendon graft to bone tunnel healing in ACL reconstruction as examples. Recent development in the improvement of TBI healing and directions for future studies were also reviewed and discussed.

  11. The prevalence and clinical significance of sonographic tendon abnormalities in asymptomatic ballet dancers: a 24-month longitudinal study.

    Science.gov (United States)

    Comin, Jules; Cook, Jill L; Malliaras, Peter; McCormack, Moira; Calleja, Michelle; Clarke, Andrew; Connell, David

    2013-01-01

    Sonographic abnormalities of the achilles and patellar tendons are common findings in athletes, and tendinopathy is a common cause of pain and disability in athletes. However, it is unclear whether the sonographic changes are pathological or adaptive, or if they predict future injury. We undertook a cohort study to determine what sonographic features of the achilles and patellar tendons are consistent with changes as a result of ballet training, and which may be predictive of future development of disabling tendon symptoms. The achilles and patellar tendons of 79 (35 male, 44 female) professional ballet dancers (members of the English Royal Ballet) were examined with ultrasound, measuring proximal and distal tendon diameters and assessing for the presence of hypoechoic change, intratendon defects, calcification and neovascularity. All subjects were followed for 24 months for the development of patellar tendon or achilles-related pain or injury severe enough to require time off from dancing. Sonographic abnormalities were common among dancers, both male and female, and in both achilles and patellar tendons. Disabling tendon-related symptoms developed in 10 dancers and 14 tendons: 7 achilles (3 right, 4 left) and 7 patellar (2 right, 5 left). The presence of moderate or severe hypoechoic defects was weakly predictive for the development of future disabling tendon symptoms (p=0.0381); there was no correlation between any of the other sonographic abnormalities and the development of symptoms. There was no relationship between achilles or patellar tendons' diameter, either proximal or distal, with an increased likelihood of developing tendon-related disability. The presence of sonographic abnormalities is common in ballet dancers, but only the presence of focal hypoechoic changes predicts the development of future tendon-related disability. This suggests that screening of asymptomatic individuals may be of use in identifying those who are at higher risk of developing

  12. Patellar tendinopathy in young elite soccer- clinical and sonographical analysis of a German elite soccer academy.

    Science.gov (United States)

    Bode, Gerrit; Hammer, Thorsten; Karvouniaris, N; Feucht, M J; Konstantinidis, L; Südkamp, N P; Hirschmüller, A

    2017-08-08

    The prevalence of patellar tendinopathy is elevated in elite soccer compared to less explosive sports. While the burden of training hours and load is comparably high in youth elite players (age soccer academy. One hundred nineteen male youth soccer players (age 15,97 ± 2,24 years, height 174, 60 ± 10,16 cm, BMI 21, 24 ± 2,65) of the U-13 to U-23 teams were part of the study. Data acquisition included sport specific parameters such as footwear, amount of training hours, leg dominance, history of tendon pathologies, and clinical examination for palpatory pain, indurations, muscular circumference, and range of motion. Subjective complaints were measured with the Victorian Institute of Sport Assessment Patellar (VISA-P) Score. Furthermore, sonographical examinations (Aplio SSA-770A/80; Toshiba, Tokyo, Japan) with 12-MHz multifrequency linear transducers (8-14 MHz) of both patellar tendons were performed with special emphasis on hyper- and hypo echogenic areas, diameter and neovascularization. The prevalence of patellar tendinopathies was 13.4%. Seventy-five percent of the players complained of pain of their dominant leg with onset of pain at training in 87.5%. The injured players showed a medium amount of 10.34 ± 3.85 training hours and a medium duration of symptoms of 11.94 ± 18.75 weeks. Two thirds of players with patellar tendinopathy were at the age of 15-17 (Odds ratio 1.89) while no differences between players of the national or regional league were observed. In case of patellar tendinopathy, VISA-P was significantly lower in comparison to healthy players (mean ± SD 76.80 ± 28.56 points vs. 95.85 ± 10.37). The clinical examination revealed local pain at the distal patella, pain at stretching, and thickening of the patellar tendon (p = 0.02). The mean tendon diameter measured 2 cm distally to the patella was 4.10 ± 0.68 mm with a significantly increased diameter of 0.15 mm in case of an underlying tendinopathy (p = 0.00). The

  13. Tendon neuroplastic training reduces tendon pain and muscle inhibition in-season: Changing the way we think about exercise

    NARCIS (Netherlands)

    Rio, E.; Kidgell, D.; Van Ark, M.; Zwerver, J; Sheek, I.; Moseley, G.L.; Gaida, J.; Docking, S.; Cook, J.

    2015-01-01

    Introduction: Patellar tendon pain is at its highest in-season but there are no published data of successful management when athletes are playing and training. Furthermore, there are changes to the cortical control of the quadriceps in patellar tendinopathy (including excess quadriceps inhibition)

  14. One-stage bilateral anterior cruciate ligament reconstruction with use of hamstring tendon autografts: a case report

    Directory of Open Access Journals (Sweden)

    Matjaž Sajovic

    2007-12-01

    Full Text Available Background: Bilateral ACL rupture is not a common clinical problem, but the incidence of the bilateral knee injuries is increasing especially within highly sports active population. Mechanism of the injury rarely causes simultaneous bilateral ACL tear. Usually unilateral injury of the knee has occurred and later on contralateral injury has taken place.Patient and methods: Case report presented an unusual problem of a patient with chronic bilateral ACL – deficient knees and constitutionally very thin patellar tendons. Author decided to perform onestage bilateral ACL reconstructions using hamstring tendon autographs so as not too weaken his quadriceps muscles by compromising his extensor mechanism.Results: At three years follow-up the patient’s opinion was that both ACL reconstructed knees had normal function, and he had returned to his preinjury activity level. The overall result of the Lysholm knee score for left knee was 100 and for right one 95. Both knees had full range of motion, Lachman and pivot shift signs were negative.Conclusions: Two-stage bilateral ACL reconstruction is much more time consuming for the patient and expensive for health insurance, so one-stage bilateral ACL reconstruction is a logical solution of the problem.

  15. X-ray computed tomography of the anterior cruciate ligament and patellar tendon

    Science.gov (United States)

    Shearer, Tom; Rawson, Shelley; Castro, Simon Joseph; Balint, Richard; Bradley, Robert Stephen; Lowe, Tristan; Vila-Comamala, Joan; Lee, Peter David; Cartmell, Sarah Harriet

    2014-01-01

    Summary The effect of phosphotungstic acid (PTA) and iodine solution (IKI) staining was investigated as a method of enhancing contrast in the X-ray computed tomography of porcine anterior cruciate ligaments (ACL) and patellar tendons (PT). We show that PTA enhanced surface contrast, but was ineffective at penetrating samples, whereas IKI penetrated more effectively and enhanced contrast after 70 hours of staining. Contrast enhancement was compared when using laboratory and synchrotron based X-ray sources. Using the laboratory source, PT fascicles were tracked and their alignment was measured. Individual ACL fascicles could not be identified, but identifiable features were evident that were tracked. Higher resolution scans of fascicle bundles from the PT and ACL were obtained using synchrotron imaging techniques. These scans exhibited greater contrast between the fascicles and matrix in the PT sample, facilitating the identification of the fascicle edges; however, it was still not possible to detect individual fascicles in the ACL. PMID:25332942

  16. 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...... was transversally cut while the other fascicle and the fascicular membrane were kept intact. Cycle 3: both fascicles were cut in opposite ends while the fascicular membrane was left intact. A decline in peak force of 45% and 55% from cycle 1 to cycle 2, and 93% and 92% from cycle 2 to cycle 3 was observed...... in the patellar and Achilles tendon fascicles, respectively. A decline in stiffness of 39% and 60% from cycle 1 to cycle 2, and of 93% and 100% from cycle 2 to cycle 3 was observed in the patellar and Achilles tendon fascicles, respectively. The present data demonstrate that lateral force transmission between...

  17. Extracorporeal shockwave therapy for patellar tendinopathy: a review of the literature.

    Science.gov (United States)

    van Leeuwen, M T; Zwerver, J; van den Akker-Scheek, I

    2009-03-01

    Extracorporeal shockwave therapy (EWST) has become a popular treatment for patellar tendinopathy. The purpose of this review was to study the effectiveness of ESWT treatment for patellar tendinopathy; to draft guidelines for an effective treatment protocol of ESWT treatment; and to identify topics for further research. A computerised search of the Medline and Embase databases was conducted on 1 August 2007, to identify studies dealing with the effectiveness of ESWT for patellar tendinopathy. Seven articles describing the effectiveness of ESWT on patellar tendinopathy, all published after 2000, were included. These studies included a total of 283 patients (298 tendons), 204 of whom (215 tendons) were assigned to ESWT treatment. The treatment results were positive but most studies had methodological deficiencies, small numbers and/or short follow-up periods. Method of application and shockwave generation, energy level, number and frequency of treatments, use of (local) anaesthesia and method of localisation were variable. ESWT seems to be a safe and promising treatment for patellar tendinopathy with a positive effect on pain and function. Based on current knowledge it is impossible to recommend a specific treatment protocol. Further basic and clinical research into the working mechanism and effectiveness of ESWT for patellar tendinopathy are necessary.

  18. Accuracy of MRI technique in measuring tendon cross-sectional area

    DEFF Research Database (Denmark)

    Couppé, Christian; Svensson, R. B.; Elbrønd (Bibs), Vibeke Sødring

    2014-01-01

    , but the accuracy in relation to actual tendon dimensions has never been investigated. The purpose of this study was to compare tendon CSA measured by MRI with that measured in vitro with the mould casting technique. The knee of a horse was MRI-scanned with 1.5 and 3 tesla, and two examiners measured the patellar...... tendon CSA. Thereafter, the patellar tendon of the horse was completely dissected and embedded in an alginate cast. The CSA of the embedded tendon was measured directly by optical imaging of the cast impression. 1.5 tesla grey tendon CSA and 3 tesla grey tendon CSA were 16.5% and 13.2% lower than...... the mould tendon CSA, respectively. Also, 3 tesla tendon CSA, based on the red-green border on the National Institute of Health (NIH) colour scale, was lower than the mould tendon CSA by 2.8%. The typical error between examiners was below 2% for all the measured CSA. The typical error between examiners...

  19. Quadriceps Tendon Autograft Medial Patellofemoral Ligament Reconstruction.

    Science.gov (United States)

    Fink, Christian; Steensen, Robert; Gföller, Peter; Lawton, Robert

    2018-06-01

    Critically evaluate the published literature related to quadriceps tendon (QT) medial patellofemoral ligament (MPFL) reconstruction. Hamstring tendon (HT) MPFL reconstruction techniques have been shown to successfully restore patella stability, but complications including patella fracture are reported. Quadriceps tendon (QT) reconstruction techniques with an intact graft pedicle on the patella side have the advantage that patella bone tunnel drilling and fixation are no longer needed, reducing risk of patella fracture. Several QT MPFL reconstruction techniques, including minimally invasive surgical (MIS) approaches, have been published with promising clinical results and fewer complications than with HT techniques. Parallel laboratory studies have shown macroscopic anatomy and biomechanical properties of QT are more similar to native MPFL than hamstring (HS) HT, suggesting QT may more accurately restore native joint kinematics. Quadriceps tendon MPFL reconstruction, via both open and MIS techniques, have promising clinical results and offer valuable alternatives to HS grafts for primary and revision MPFL reconstruction in both children and adults.

  20. Magnetic resonance evaluation of anterior cruciate ligament repair using the patellar tendon double bone block technique

    International Nuclear Information System (INIS)

    Autz, G.; Singson, R.D.; Goodwin, C.

    1991-01-01

    The magnetic resonance (MR) appearance of the anterior cruciate ligament reconstruction was determined in 20 clinically stable and 2 clinically unstable knees for a total of 22 examinations. All patients studied had undergone knee reconstruction using the patellar tendon as graft material. The reconstructed anterior cruciate ligament varies in appearance. It appeared as a thick, well-defined, low signal band on T1- and T2-weighted sagittal and coronal images in 14 of 22 examinations. The remaining 8 knees showed a graft having one or more thin and attenuated, low signal intensity bands in the sagittal and/or coronal plane. Arthroscopy confirmed an intact but lax graft in the clinically unstable knees. (orig.)

  1. Magnetic resonance evaluation of anterior cruciate ligament repair using the patellar tendon double bone block technique

    Energy Technology Data Exchange (ETDEWEB)

    Autz, G.; Singson, R.D. (St. Luke' s Roosevelt Hospital Center, New York, NY (United States). Dept. of Radiology); Goodwin, C. (St. Luke' s Roosevelt Hospital Center, New York, NY (United States). Dept. of Orthopedics)

    1991-11-01

    The magnetic resonance (MR) appearance of the anterior cruciate ligament reconstruction was determined in 20 clinically stable and 2 clinically unstable knees for a total of 22 examinations. All patients studied had undergone knee reconstruction using the patellar tendon as graft material. The reconstructed anterior cruciate ligament varies in appearance. It appeared as a thick, well-defined, low signal band on T1- and T2-weighted sagittal and coronal images in 14 of 22 examinations. The remaining 8 knees showed a graft having one or more thin and attenuated, low signal intensity bands in the sagittal and/or coronal plane. Arthroscopy confirmed an intact but lax graft in the clinically unstable knees. (orig.).

  2. Biology and augmentation of tendon-bone insertion repair

    OpenAIRE

    Lui, PPY; Zhang, P; Chan, KM; Qin, L

    2010-01-01

    Abstract Surgical reattachment of tendon and bone such as in rotator cuff repair, patellar-patella tendon repair and anterior cruciate ligament (ACL) reconstruction often fails due to the failure of regeneration of the specialized tissue ("enthesis") which connects tendon to bone. Tendon-to-bone healing taking place between inhomogenous tissues is a slow process compared to healing within homogenous tissue, such as tendon to tendon or bone to bone healing. Therefore special attention must be ...

  3. A lower limb assessment tool for athletes at risk of developing patellar tendinopathy.

    Science.gov (United States)

    Mann, Kerry J; Edwards, Suzi; Drinkwater, Eric J; Bird, Stephen P

    2013-03-01

    Patellar tendon abnormality (PTA) on diagnostic imaging is part of the diagnostic criteria for patellar tendinopathy. PTA and altered landing strategies are primary risk factors that increase the likelihood of asymptomatic athletes developing patellar tendinopathy. Therefore, the aim of this study was to examine the risk factors that are predictors of the presence and severity of a PTA in junior pre-elite athletes. Ten junior pre-elite male basketball athletes with a PTA were matched with 10 athletes with normal patellar tendons. Participants had patellar tendon morphology, Victorian Institute of Sport Assessment (VISA) score, body composition, lower limb flexibility, and maximum vertical jump height measured before performing five successful stop-jump tasks. During each stop-jump task, both two-dimensional and three-dimensional kinematics and ground reaction forces were recorded. Multiple regression analyses were used to identify factors for estimating PTA presence and severity, and discriminate analysis was used to classify PTA presence. Sixty-eight percent of variance for presence of a PTA was accounted for by hip joint range of motion (ROM) and knee joint angle at initial foot-ground contact (IC) during stop-jump task and quadriceps flexibility, whereas hip joint ROM during stop-jump task and VISA score accounted for 62% of variance for PTA severity. Prediction of the presence of a PTA was achieved with 95% accuracy and 95% cross-validation. An easily implemented, reliable, and valid movement screening tool composed of three criteria enables coaches and/or clinicians to predict the presence and severity of a PTA in asymptomatic athletes. This enables identification of asymptomatic athletes at higher risk of developing patellar tendinopathy, which allows the development of effective preventative measures to aid in the reduction of patellar tendinopathy injury prevalence.

  4. Floating knee injury associated with patellar tendon rupture: a case report and review of literature.

    Science.gov (United States)

    Vaidyanathan, Singaravadivelu; Panchanathan Ganesan, Jagannath; Moongilpatti Sengodan, Mugundhan

    2012-01-01

    Floating knee injuries are frequently associated with other concomitant injuries to the ipsilateral limb or other parts of body of which injury to the ipsilateral knee ligaments carries significance for various reasons. A middle-aged man sustained a floating knee injury following RTA. DCS fixation by bridge plating technique for the distal femur and lateral buttress plating by MIPO technique for proximal tibia were planned and executed under spinal anesthesia with image intensifier. In addition, there were patellar tendon rupture along with avulsion of VMO from the medial border of patella and torn MPFL, which we have missed initially. To the best of our knowledge no similar case has been reported in English literature so far. We have reviewed the literature and proposed a different interpretation of Blake and McBride classification.

  5. Floating Knee Injury Associated with Patellar Tendon Rupture: A Case Report and Review of Literature

    Directory of Open Access Journals (Sweden)

    Singaravadivelu Vaidyanathan

    2012-01-01

    Full Text Available Floating knee injuries are frequently associated with other concomitant injuries to the ipsilateral limb or other parts of body of which injury to the ipsilateral knee ligaments carries significance for various reasons. A middle-aged man sustained a floating knee injury following RTA. DCS fixation by bridge plating technique for the distal femur and lateral buttress plating by MIPO technique for proximal tibia were planned and executed under spinal anesthesia with image intensifier. In addition, there were patellar tendon rupture along with avulsion of VMO from the medial border of patella and torn MPFL, which we have missed initially. To the best of our knowledge no similar case has been reported in English literature so far. We have reviewed the literature and proposed a different interpretation of Blake and McBride classification.

  6. Changes in water content in response to an acute bout of eccentric loading in a patellar tendon with a history of tendinopathy: A case report.

    Science.gov (United States)

    Ho, Kai-Yu; Kulig, Kornelia

    2016-10-01

    This case-based report assessed resting water content and exercise-driven water exchange within a tendon with a history of tendinopathy and compared the response to that of a healthy uninvolved tendon. Case Report. University imaging center. The participant was a 27-year-old female basketball player 39 months following knee trauma. Patellar tendinopathy developed 12 months after the injury episode and was treated with eccentric exercises. Eighteen months from the beginning of the first eccentric training bout, the participant reported full resolution of symptoms and returned to her pre-injury sport participation without symptoms. Eccentric decline squat exercise. Tendon water content obtained from magnetic resonance imaging (MRI). MRI acquired 39 months post-injury demonstrated increased resting water content of the involved tendon (involved: 91.1% vs. uninvolved: 84.6%). Immediately after the eccentric squat maneuver, water content decreased on both involved and uninvolved tendons (involved: 89.5% vs. uninvolved: 83.3%). Elevated resting water content of the involved tendon found in this report may be indicative of reduced tendon stiffness. A similar amount of water content reduction was observed on both sides following mechanical loading, suggesting that the involved tendon may respond to the eccentric exercise similarly to the uninvolved tendon. Future investigations are needed to study the relationships among tendon water exchanges, mechanical properties, patient symptoms, and tissue injuries.

  7. Ablating hedgehog signaling in tenocytes during development impairs biomechanics and matrix organization of the adult murine patellar tendon enthesis.

    Science.gov (United States)

    Breidenbach, Andrew P; Aschbacher-Smith, Lindsey; Lu, Yinhui; Dyment, Nathaniel A; Liu, Chia-Feng; Liu, Han; Wylie, Chris; Rao, Marepalli; Shearn, Jason T; Rowe, David W; Kadler, Karl E; Jiang, Rulang; Butler, David L

    2015-08-01

    Restoring the native structure of the tendon enthesis, where collagen fibers of the midsubstance are integrated within a fibrocartilaginous structure, is problematic following injury. As current surgical methods fail to restore this region adequately, engineers, biologists, and clinicians are working to understand how this structure forms as a prerequisite to improving repair outcomes. We recently reported on the role of Indian hedgehog (Ihh), a novel enthesis marker, in regulating early postnatal enthesis formation. Here, we investigate how inactivating the Hh pathway in tendon cells affects adult (12-week) murine patellar tendon (PT) enthesis mechanics, fibrocartilage morphology, and collagen fiber organization. We show that ablating Hh signaling resulted in greater than 100% increased failure insertion strain (0.10 v. 0.05 mm/mm, p<0.01) as well as sub-failure biomechanical deficiencies. Although collagen fiber orientation appears overtly normal in the midsubstance, ablating Hh signaling reduces mineralized fibrocartilage by 32%, leading to less collagen embedded within mineralized tissue. Ablating Hh signaling also caused collagen fibers to coalesce at the insertion, which may explain in part the increased strains. These results indicate that Ihh signaling plays a critical role in the mineralization process of fibrocartilaginous entheses and may be a novel therapeutic to promote tendon-to-bone healing. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  8. Semitendinosus Tendon for Solitary Use in Anterior Cruciate ...

    African Journals Online (AJOL)

    The ANNALS of AFRICAN SURGERY | www.annalsofafricansurgery.com. The ANNALS of ... knee instability. Tendon allografts and autografts have been used successfully to reconstruct a torn. ACL. However, allografts have been associated with a higher rate of failure .... Semitendinosus Tendon to Prevent a. Postoperative ...

  9. Region specific patella tendon hypertrophy in humans following resistance training

    DEFF Research Database (Denmark)

    Kongsgaard, M.; Reitelseder, S; Pedersen, T.G.

    2007-01-01

    AIM: To examine if cross-sectional area (CSA) differs along the length of the human patellar tendon (PT), and if there is PT hypertrophy in response to resistance training. METHODS: Twelve healthy young men underwent baseline and post-training assessments. Maximal isometric knee extension strength...... (MVC) was determined unilaterally in both legs. PT CSA was measured at the proximal-, mid- and distal PT level and quadriceps muscle CSA was measured at mid-thigh level using magnetic resonance imaging. Mechanical properties of the patellar tendons were determined using ultrasonography. Subsequently....... CONCLUSIONS: To our knowledge, this study is the first to report tendon hypertrophy following resistance training. Further, the data show that the human PT CSA varies along the length of the tendon....

  10. Biceps Autograft Augmentation for Rotator Cuff Repair : A Systematic Review

    NARCIS (Netherlands)

    Veen, Egbert J D; Stevens, Martin; Diercks, Ronald L

    Purpose: To improve surgical outcomes in patients with massive cuff defects, different techniques and augmentations are proposed. The biceps tendon is easily available as an autograft. Our aim was to conduct a qualitative systematic review of various methods and surgical techniques that use a biceps

  11. Anterior cruciate ligament reconstruction using bone plug-free quadriceps tendon autograft: intermediate-term clinical outcome after 24–36 months

    Directory of Open Access Journals (Sweden)

    Schulz AP

    2013-11-01

    Full Text Available Arndt P Schulz,1 Vivien Lange,2 Justus Gille,1 Christine Voigt,3 Susanne Fröhlich,4 Markus Stuhr,1 Christian Jürgens5 1Department of Orthopedics, Trauma, and Sports Medicine, University Hospital Lübeck, Lübeck, Germany; 2Department of Rehabilitation, Sana Regio Klinikum, Wedel, Germany; 3Department of Sports Medicine and Arthroscopy, Diakoniekrankenhaus Friederikenstift, Hannover, Germany; 4Department of Orthopedics, University of Rostock, Rostock, Germany; 5Department of Orthopedics, Trauma, and Sports Medicine, BG Trauma Hospital Hamburg, Hamburg, Germany Introduction: Although known as a possible graft option for decades, quadriceps tendon grafts have often been termed a second-line graft option. We report a consecutive case series using this method as the primary treatment line. The rationale for this study was to evaluate the midterm results of this method in a prospective and consecutive case series. The primary study question was to determine the clinical results 24–36 months after primary anterior cruciate ligament (ACL reconstruction using a bone plug-free quadriceps tendon autograft fixed with bioabsorbable cross-pins. Materials and methods: The study population included 55 patients, of whom 24 were female (43.6%. The mean age at the index procedure was 31.7 years (15–58 years. All patients received an ACL construction using a bone block-free quadriceps tendon graft fixed with resorbable cross-pins. The postoperative regimen included partial weight-bearing for 3 weeks and flexion limited to 90° for six weeks; an orthosis was not used. The mean follow-up duration was 29.5 months (24.3–38.5 months after the index procedure. The International Knee Documentation Committee (IKDC subjective score and examination form was assessed, as well as the Lysholm and Gillquist score and the Tegner activity index. The Rolimeter arthrometer was used to assess the anterior laxity of the knee. Results: Graft harvesting was possible in all cases

  12. Anterior cruciate ligament reconstruction in a rabbit model using silk-collagen scaffold and comparison with autograft.

    Directory of Open Access Journals (Sweden)

    Fanggang Bi

    Full Text Available The objective of the present study was to perform an in vivo assessment of a novel silk-collagen scaffold for anterior cruciate ligament (ACL reconstruction. First, a silk-collagen scaffold was fabricated by combining sericin-extracted knitted silk fibroin mesh and type I collagen to mimic the components of the ligament. Scaffolds were electron-beam sterilized and rolled up to replace the ACL in 20 rabbits in the scaffold group, and autologous semitendinosus tendons were used to reconstruct the ACL in the autograft control group. At 4 and 16 weeks after surgery, grafts were retrieved and analyzed for neoligament regeneration and tendon-bone healing. To evaluate neoligament regeneration, H&E and immunohistochemical staining was performed, and to assess tendon-bone healing, micro-CT, biomechanical test, H&E and Russell-Movat pentachrome staining were performed. Cell infiltration increased over time in the scaffold group, and abundant fibroblast-like cells were found in the core of the scaffold graft at 16 weeks postoperatively. Tenascin-C was strongly positive in newly regenerated tissue at 4 and 16 weeks postoperatively in the scaffold group, similar to observations in the autograft group. Compared with the autograft group, tendon-bone healing was better in the scaffold group with trabecular bone growth into the scaffold. The results indicate that the silk-collagen scaffold has considerable potential for clinical application.

  13. Decline eccentric squats increases patellar tendon loading compared to standard eccentric squats

    DEFF Research Database (Denmark)

    Kongsgaard, M; Aagaard, P; Roikjaer, S

    2006-01-01

    Recent studies have shown excellent clinical results using eccentric squat training on a 25 degrees decline board to treat patellar tendinopathy. It remains unknown why therapeutic management of patellar tendinopathy using decline eccentric squats offer superior clinical efficacy compared...

  14. BIOMECHANICAL STUDY OF RISK FACTORS INVOLVED IN THE OCCURANCE OF PATELLAR TENDONITIS – APLICATIONS IN PERFORMANCE SPORT

    Directory of Open Access Journals (Sweden)

    Ilinca Ilona

    2009-03-01

    Full Text Available Aim – this study consists in the constructing of a tridimensional musculoskeletal model for the attack hit and the quantification of mechanical stress, in order to prevent traumatism in the knee joint.Goal: Minimizing the risk of patellar tendonitis through prophylactic exercises that improve the muscular pattern.Material and methods. This study was conducted for a 9 month period on the feminine batch pertaining to the volley team of the Sport Club “Universities Craiova”. For this research we used the AMTI MSA 6 force platformand the software application “Anybody”. By using the force platform AMTI MSA 6 it became possible todetermine the reaction force of the ground according to the position of the centre of gravity at the time of the jumping and landing, after executing an attack hit. The software “Anybody” allowed the 3D musculoskeletal modelling and the calculation of the forces of the muscles involved, prior and after the application of theprophylactic exercises.Conclusions. The improvement of the values of muscular forces demonstrates the efficiency of the prophylactic exercises: for the quadriceps femoris we obtain an increase of 13,79%, for gastrocnemius 14,76%, for hamstring muscles a value of 14%, for rectus femoris 15,06% and for the gluteus major 14,63%.For the entire experimental batch, at the moment of jumping, there was a reduction of the compression force by38,48% for the dominant inferior limb, by 34,06% for the non-dominant inferior limb.At the moment of landing, there was a difference of 38,51% for the dominant limb and a difference of 28,82% for the non-dominant limb. By analyzing the evolution of compression forces, after Z, at the level of knee joint, after the application of prophylactic program. We find a decreasing of pressure forces by a better distribution of this force for the entire inferior limb joint, decreasing in this way the risk of trauma production by overtraining.Key words - risk factors

  15. Risk factors for patellar tendinopathy in volleyball and basketball players : A survey-based prospective cohort study

    NARCIS (Netherlands)

    de Vries, A. J.; van der Worp, H.; Diercks, R. L.; van den Akker-Scheek, I.; Zwerver, J.

    2015-01-01

    Patellar tendinopathy (PT) is a common overuse injury of the patellar tendon in jumping athletes. In a recent large cross-sectional study from 2008 several factors were identified that may be associated with the etiology of PT. However, because of the study design no conclusions could be drawn about

  16. Metabolic and cytoprotective effects of in vivo peri-patellar hyaluronic acid injections in cultured tenocytes.

    Science.gov (United States)

    Salamanna, F; Frizziero, A; Pagani, S; Giavaresi, G; Curzi, D; Falcieri, E; Marini, M; Abruzzo, P M; Martini, L; Fini, M

    2015-02-01

    The purpose of this study was to investigate tenocyte mechanobiology after sudden-detraining and to examine the hypothesis that repeated peri-patellar injections of hyaluronic acid (HA) on detrained patellar tendon (PT) may reduce and limit detrained-associated damage in tenocytes. Twenty-four male Sprague-Dawley rats were divided into three groups: Untrained, Trained and Detrained. In the Detrained rats, the left tendon was untreated while the right tendon received repeated peri-patellar injections of either HA or saline (NaCl). Tenocyte morphology, metabolism and synthesis of C-terminal-propeptide of type I collagen, collagen-III, fibronectin, aggrecan, tenascin-c, interleukin-1β, matrix-metalloproteinase-1 and-3 were evaluated after 1, 3, 7 and 10 days of culture. Transmission-electronic-microscopy showed a significant increase in mitochondria and rough endoplasmic reticulum in cultured tenocytes from Detrained-HA with respect to those from Detrained-NaCl. Additionally, Detrained-HA cultures showed a significantly higher proliferation rate and viability, and increased synthesis of C-terminal-Propeptide of type I collagen, fibronectin, aggrecan, tenascin-c and matrix-metalloproteinase-3 with respect to Detrained-NaCl ones, whereas synthesis of matrix-metalloproteinase-1 and interleukin-1β was decreased. Our study demonstrates that discontinuing training activity in the short-term alters tenocyte synthetic and metabolic activity and that repeated peri-patellar infiltrations of HA during detraining allow the maintenance of tenocyte anabolic activity.

  17. Imaging the infrapatellar tendon in the elite athlete

    International Nuclear Information System (INIS)

    Peace, K.A.L.; Lee, J.C.; Healy, J.

    2006-01-01

    Extensor mechanism injuries constitute a major cause of anterior knee pain in the elite athlete. Sonography and magnetic resonance imaging (MRI) are the imaging methods of choice when assessing the infrapatellar tendon. A comprehensive imaging review of infrapatellar tendon normal anatomy, tendinopathy, and partial/full-thickness tendon tears is provided. The value of imaging the infrapatellar tendon in clinical practice, including whether sonography can predict symptoms in asymptomatic athletes, is discussed. Acute avulsion fractures, including periosteal sleeve avulsion, and chronic avulsion injuries, including Sinding-Larsen-Johansson and Osgood-Schlatter syndromes, are shown. Mimics of infrapatellar tendon pathology, including infrapatellar plica injury, patellar tendon-lateral femoral condyle friction syndrome, and Hoffa's syndrome, are illustrated

  18. Allogeneic versus autologous derived cell sources for use in engineered bone-ligament-bone grafts in sheep anterior cruciate ligament repair.

    Science.gov (United States)

    Mahalingam, Vasudevan D; Behbahani-Nejad, Nilofar; Horine, Storm V; Olsen, Tyler J; Smietana, Michael J; Wojtys, Edward M; Wellik, Deneen M; Arruda, Ellen M; Larkin, Lisa M

    2015-03-01

    The use of autografts versus allografts for anterior cruciate ligament (ACL) reconstruction is controversial. The current popular options for ACL reconstruction are patellar tendon or hamstring autografts, yet advances in allograft technologies have made allogeneic grafts a favorable option for repair tissue. Despite this, the mismatched biomechanical properties and risk of osteoarthritis resulting from the current graft technologies have prompted the investigation of new tissue sources for ACL reconstruction. Previous work by our lab has demonstrated that tissue-engineered bone-ligament-bone (BLB) constructs generated from an allogeneic cell source develop structural and functional properties similar to those of native ACL and vascular and neural structures that exceed those of autologous patellar tendon grafts. In this study, we investigated the effectiveness of our tissue-engineered ligament constructs fabricated from autologous versus allogeneic cell sources. Our preliminary results demonstrate that 6 months postimplantation, our tissue-engineered auto- and allogeneic BLB grafts show similar histological and mechanical outcomes indicating that the autologous grafts are a viable option for ACL reconstruction. These data indicate that our tissue-engineered autologous ligament graft could be used in clinical situations where immune rejection and disease transmission may preclude allograft use.

  19. Effect of a patellar strap on the joint position sense of the symptomatic knee in athletes with patellar tendinopathy.

    Science.gov (United States)

    de Vries, Astrid J; van den Akker-Scheek, Inge; Haak, Svenja L; Diercks, Ron L; van der Worp, Henk; Zwerver, Johannes

    2017-11-01

    The primary aim of this study was to investigate the effect of a patellar strap on the proprioception of the symptomatic leg in PT. Secondary aims were to investigate a possible difference in effectiveness between athletes with high and low proprioceptive acuity, and whether predictors of effectiveness could be found. Randomised cross-over pilot study. 24 athletes with PT (age 27.3±9.0, VISA-P 50.6±11.2) performed a joint position sense test with and without a patellar strap. The difference between both conditions was analysed using linear mixed-model analysis. No improvement in the joint position sense using the strap for the whole group was found, while those classified as having low proprioceptive acuity did improve using the strap (p=0.015, 17.2%). A larger knee girth, longer duration of symptoms and more tendon abnormalities were negatively associated with the strap's effectiveness. The use of a patellar strap improves the knee joint proprioception - measured with joint position sense - of the symptomatic leg in athletes with poor proprioceptive acuity. Especially athletes with relatively small knee girth, short duration of symptoms and small tendon abnormalities might benefit from the strap. As proprioception plays an important role in motor control, and deficits in proprioception may put an athlete at risk for (re-)injury, these findings may be relevant for prevention as well as rehabilitation purposes in those PT athletes with low proprioceptive acuity. Copyright © 2017 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  20. The effect of a patellar strap on knee joint proprioception in healthy participants and athletes with patellar tendinopathy.

    Science.gov (United States)

    de Vries, Astrid J; van den Akker-Scheek, Inge; Diercks, Ron L; Zwerver, Johannes; van der Worp, Henk

    2016-04-01

    The primary aim of this study is to investigate the effect of the use of a patellar strap on knee joint proprioception in both healthy participants and in patients with patellar tendinopathy (PT). Secondary aims are to examine whether there is a difference in effectiveness of the use of a patellar strap between participants with low and high proprioceptive acuity and if possible predictors of effectiveness can be determined. Case-control. The threshold to detect passive motion with and without a patellar strap was assessed in 22 healthy participants and 21 unilateral PT patients. The results from the mixed model analysis show that in both groups of participants a small but statistically significant improvement in proprioception was found, primarily in those who had low proprioceptive acuity. A notable finding was that in the symptomatic leg of the PT group no improvement in proprioception by wearing a strap could be determined. Male gender and having fewer symptoms were possible predictors of effectiveness in PT patients. As proprioception plays a role in optimising movements and reducing load to joint-related structures like tendons and ligaments, it is considered an important protection mechanism. Although the improvements in proprioception as a result of wearing the strap are small, it might be that the use of a patellar strap can potentially play a role in injury prevention since poor proprioception can be a risk factor for (re)-injury. Copyright © 2015 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  1. Ethinyl oestradiol administration in women suppresses synthesis of collagen in tendon in response to exercise

    DEFF Research Database (Denmark)

    Hansen, Mette; Koskinen, Satu O; Petersen, Susanne G

    2008-01-01

    24 h post-exercise through microdialysis catheters placed anterior to the patellar tendon in both legs and subsequently analysed for the amino-terminal propeptide of type I collagen (PINP), a marker of tendon collagen synthesis. To determine the long-term effect of OC usage, patellar tendon cross......-OC 24 h post-exercise is consistent with the hypothesis that oestradiol inhibits exercise-induced collagen synthesis in human tendon. The mechanism behind this is either a direct effect of oestradiol, or an indirect effect via a reduction in levels of free IGF-I. However, the data did not indicate any......Women are at greater risk than men of sustaining certain kinds of injury and diseases of collagen-rich tissues. To determine whether a high level of oestradiol has an acute influence on collagen synthesis in tendons at rest and in response to exercise, one-legged kicking exercise was performed...

  2. Novel strategies in tendon and ligament tissue engineering: Advanced biomaterials and regeneration motifs

    OpenAIRE

    Kuo Catherine K; Marturano Joseph E; Tuan Rocky S

    2010-01-01

    Abstract Tendon and ligaments have poor healing capacity and when injured often require surgical intervention. Tissue replacement via autografts and allografts are non-ideal strategies that can lead to future problems. As an alternative, scaffold-based tissue engineering strategies are being pursued. In this review, we describe design considerations and major recent advancements of scaffolds for tendon/ligament engineering. Specifically, we outline native tendon/ligament characteristics criti...

  3. Changes in tendon spatial frequency parameters with loading.

    Science.gov (United States)

    Pearson, Stephen J; Engel, Aaron J; Bashford, Gregory R

    2017-05-24

    To examine and compare the loading related changes in micro-morphology of the patellar tendon. Fifteen healthy young males (age 19±3yrs, body mass 83±5kg) were utilised in a within subjects matched pairs design. B mode ultrasound images were taken in the sagittal plane of the patellar tendon at rest with the knee at 90° flexion. Repeat images were taken whilst the subjects were carrying out maximal voluntary isometric contractions. Spatial frequency parameters related to the tendon morphology were determined within regions of interest (ROI) from the B mode images at rest and during isometric contractions. A number of spatial parameters were observed to be significantly different between resting and contracted images (Peak spatial frequency radius (PSFR), axis ratio, spatial Q-factor, PSFR amplitude ratio, and the sum). These spatial frequency parameters were indicative of acute alterations in the tendon micro-morphology with loading. Acute loading modifies the micro-morphology of the tendon, as observed via spatial frequency analysis. Further research is warranted to explore its utility with regard to different loading induced micro-morphological alterations, as these could give valuable insight not only to aid strengthening of this tissue but also optimization of recovery from injury and treatment of conditions such as tendinopathies. Copyright © 2017 Elsevier Ltd. All rights reserved.

  4. Neovascularity in patellar tendinopathy and the response to eccentric training: a case report using Power Doppler ultrasound.

    Science.gov (United States)

    McCreesh, Karen M; Riley, Sara J; Crotty, James M

    2013-12-01

    This report describes the case of an amateur soccer player with chronic patellar tendinopathy who underwent ultrasound imaging before and after engaging in an 8-week programme of eccentric exercise. On initial assessment, greyscale ultrasound imaging demonstrated tendon thickening and reduced echogenicity, while Power Doppler imaging demonstrated a large amount of neovascularity. After 8 weeks of an eccentric loading programme, the patient reported significantly improved symptoms and functional scores, while follow-up imaging demonstrated improvement in the echo appearance of the tendon and complete resolution of the neovascularity. The association between neovascularity and symptoms in tendinopathy research is conflicting, with a paucity of research in the area of patellar tendinopathy. While further research is needed to clarify the significance of greyscale and Power Doppler ultrasound changes in relation to symptoms in patellar tendinopathy, ultrasound imaging was shown to be a useful adjunct to diagnosis and outcome assessment in this case. Copyright © 2012 Elsevier Ltd. All rights reserved.

  5. Are unilateral and bilateral patellar tendinopathy distinguished by differences in anthropometry, body composition, or muscle strength in elite female basketball players?

    OpenAIRE

    Gaida, J; Cook, J; Bass, S; Austen, S; Kiss, Z

    2004-01-01

    Background: Overuse injury to the patellar tendon (patellar tendinopathy) is a major reason for interrupted training and competition for elite athletes. In both sexes, the prevalence of unilateral and bilateral tendinopathy has been shown to differ. It has been proposed that bilateral pathology may have a different aetiology from unilateral pathology. Investigation of risk factors that may be unique to unilateral and bilateral patellar tendinopathy in female athletes may reveal insights into ...

  6. The TOPSHOCK study : Effectiveness of radial shockwave therapy compared to focused shockwave therapy for treating patellar tendinopath - Design of a randomised controlled trial

    NARCIS (Netherlands)

    van der Worp, H.; Zwerver, J.; van den Akker-Scheek, I.; Diercks, R.L.

    2011-01-01

    Background: Patellar tendinopathy is a chronic overuse injury of the patellar tendon that is especially prevalent in people who are involved in jumping activities. Extracorporeal Shockwave Therapy is a relatively new treatment modality for tendinopathies. It seems to be a safe and promising part of

  7. The TOPSHOCK study: Effectiveness of radial shockwave therapy compared to focused shockwave therapy for treating patellar tendinopath - design of a randomised controlled trial

    OpenAIRE

    van der Worp, Henk; Zwerver, Johannes; van den Akker-Scheek, Inge; Diercks, Ron L

    2011-01-01

    Abstract Background Patellar tendinopathy is a chronic overuse injury of the patellar tendon that is especially prevalent in people who are involved in jumping activities. Extracorporeal Shockwave Therapy is a relatively new treatment modality for tendinopathies. It seems to be a safe and promising part of the rehabilitation program for patellar tendinopathy. Extracorporeal Shockwave Therapy originally used focused shockwaves. Several years ago a new kind of shockwave therapy was introduced: ...

  8. Previously identified patellar tendinopathy risk factors differ between elite and sub-elite volleyball players.

    Science.gov (United States)

    Janssen, I; Steele, J R; Munro, B J; Brown, N A T

    2015-06-01

    Patellar tendinopathy is the most common knee injury incurred in volleyball, with its prevalence in elite athletes more than three times that of their sub-elite counterparts. The purpose of this study was to determine whether patellar tendinopathy risk factors differed between elite and sub-elite male volleyball players. Nine elite and nine sub-elite male volleyball players performed a lateral stop-jump block movement. Maximum vertical jump, training history, muscle extensibility and strength, three-dimensional landing kinematics (250 Hz), along with lower limb neuromuscular activation patterns (1500 Hz), and patellar tendon loading were collected during each trial. Multivariate analyses of variance (P volleyball players. Interventions designed to reduce landing frequency and improve quadriceps extensibility are recommended to reduce patellar tendinopathy prevalence in volleyball players. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  9. 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-gener...

  10. Comparing the effects of eccentric training with eccentric training and static stretching exercises in the treatment of patellar tendinopathy. A controlled clinical trial.

    Science.gov (United States)

    Dimitrios, Stasinopoulos; Pantelis, Manias; Kalliopi, Stasinopoulou

    2012-05-01

    The aim of the present study was to investigate the effectiveness of eccentric training and eccentric training with static stretching exercises in the management of patellar tendinopathy. Controlled clinical trial. Rheumatology and rehabilitation centre. Forty-three patients who had patellar tendinopathy for at least three months. They were allocated to two groups by alternative allocation. Group A (n = 22) was treated with eccentric training of patellar tendon and static stretching exercises of quadriceps and hamstrings and Group B (n = 21) received eccentric training of patellar tendon. All patients received five treatments per week for four weeks. Pain and function were evaluated using the VISA-P score at baseline, at the end of treatment (week 4), and six months (week 24) after the end of treatment. At the end of treatment, there was a rise in VISA-P score in both groups compared with baseline (Peccentric training and static stretching exercises produced the largest effect (PEccentric training and static stretching exercises is superior to eccentric training alone to reduce pain and improve function in patients with patellar tendinopathy at the end of the treatment and at follow-up.

  11. Patellar tendinopathy - recent developments toward treatment.

    Science.gov (United States)

    Christian, Robert A; Rossy, William H; Sherman, Orrin H

    2014-01-01

    Patellar tendinopathy (PT) is a clinical and chronic overuse condition of unknown pathogenesis and etiology marked by anterior knee pain typically manifested at the inferior pole of the patella. PT has been referred to as "jumper's knee" since it is particularly common among populations of jumping athletes, such as basketball and volleyball players. Due to its common refractory response to conservative treatment, a variety of new treatments have emerged recently that include dry-needling, sclerosing injections, platelet-rich plasma therapy, arthroscopic surgical procedures, surgical resection of the inferior patellar pole, extracorporeal shock wave treatment, and hyperthermia thermotherapy. Since PT has an unknown pathogenesis and etiology, PT treatment is more a result of physician experience than evidence-based science. This review will summarize the current literature on this topic, identify current research efforts aimed to understand the pathological changes in abnormal tendons, provide exposure to the emerging treatment techniques, and provide suggested direction for future research.

  12. The Influence of External Load on Quadriceps Muscle and Tendon Dynamics during Jumping.

    Science.gov (United States)

    Earp, Jacob E; Newton, Robert U; Cormie, Prue; Blazevich, Anthony J

    2017-11-01

    Tendons possess both viscous (rate-dependent) and elastic (rate-independent) properties that determine tendon function. During high-speed movements external loading increases both the magnitude (FT) and rate (RFDT) of tendon loading. The influence of external loading on muscle and tendon dynamics during maximal vertical jumping was explored. Ten resistance-trained men performed parallel-depth, countermovement vertical jumps with and without additional load (0%, 30%, 60%, and 90% of maximum squat lift strength), while joint kinetics and kinematics, quadriceps tendon length (LT) and patellar tendon FT and RFDT were estimated using integrated ultrasound, motion analysis and force platform data and muscle tendon modelling. Estimated FT and RFDT, but not peak LT, increased with external loading. Temporal comparisons between 0% and 90% loads revealed that FT was greater with 90% loading throughout the majority of the movement (11%-81% and 87%-95% movement duration). However, RFDT was greater with 90% load only during the early movement initiation phase (8%-15% movement duration) but was greater in the 0% load condition later in the eccentric phase (27%-38% movement duration). LT was longer during the early movement (12%-23% movement duration) but shorter in the late eccentric and early concentric phases (48%-55% movement duration) with 90% load. External loading positively influenced peak FT and RFDT but tendon strain appeared unaffected, suggesting no additive effect of external loading on patellar tendon lengthening during human jumping. Temporal analysis revealed that external loading resulted in a large initial RFDT that may have caused dynamic stiffening of the tendon and attenuated tendon strain throughout the movement. These results suggest that external loading influences tendon lengthening in both a load- and movement-dependent manner.

  13. The occurrence of osteoarthritis at a minimum of ten years after reconstruction of the anterior cruciate ligament

    Directory of Open Access Journals (Sweden)

    Patt Thomas W

    2008-06-01

    Full Text Available Abstract Objective The objective of this study was to evaluate the incidence of radiographic osteoarthritis in the operated knee in comparison with the contralateral knee ten years after a bone-tendon bone patellar autograft ACL-reconstruction and to evaluate to which level patients regain activity ten years after reconstruction. Methods Fifty-three patients with ACL instability were operated arthroscopically using the central third of the patellar tendon as a bone-tendon-bone autograft. At a minimum of 10 year follow up 28/44 patients matched the inclusion criteria and could be reached for follow-up. Evaluation included a patient satisfaction evaluation using a Visual Analog Scale, physical examination (International Knee Documentation Committee score, Tegner score, Lysholm score, KT-1000 stabilometry and a radiological evaluation (Kellgren and Fairbanks classification. Results The patients' satisfaction, at a mean of 10,3 year follow-up, measured with a VAS score (0–10 was high with a mean of 8.5 (range 4 to 10. The KT 1000 arthrometer laxity measurements revealed in 55% of the patients an A rating (1–2 mm, in 29% a B rating (3–5 mm and in 16% a C rating (6–10 mm. According to the Tegner score 54% of the patients were able to perform at the same activity level as pre-operatively. The mean pre-operative Tegner score was 6.8 and the mean post-operative Tegner score was 6.0 at final follow up. The Lysholm score showed satisfactory results with a mean of 91 points (range 56 to 100. According to the Kellgren and Fairbank classifications, there is a significant difference (p Conclusion The patellar BTB ACL reconstruction does not prevent the occurrence of radiological OA after 10 years but does help the patient to regain the pre-operative level of activity.

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

    Directory of Open Access Journals (Sweden)

    Wang James

    2010-01-01

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

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

    International Nuclear Information System (INIS)

    Dallaudière, Benjamin; Lempicki, Marta; Pesquer, Lionel; Louedec, Liliane; Preux, Pierre Marie; Meyer, Philippe; Hess, Agathe; Durieux, Marie Hèlène Moreau; Hummel, Vincent; Larbi, Ahmed; Deschamps, Lydia

    2013-01-01

    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 ® (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

  16. 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.

  17. Doppler ultrasonography of the anterior knee tendons in elite badminton players: colour fraction before and after match.

    Science.gov (United States)

    Koenig, M J; Torp-Pedersen, S; Boesen, M I; Holm, C C; Bliddal, H

    2010-02-01

    Anterior knee tendon problems are seldom reported in badminton players although the game is obviously stressful to the lower extremities. Painful anterior knee tendons are common among elite badminton players. The anterior knee tendons exhibit colour Doppler activity. This activity increases after a match. Painful tendons have more Doppler activity than tendons without pain. Cohort study. 72 elite badminton players were interviewed about training, pain and injuries. The participants were scanned with high-end ultrasound equipment. Colour Doppler was used to examine the tendons of 64 players before a match and 46 players after a match. Intratendinous colour Doppler flow was measured as colour fraction (CF). The tendon complex was divided into three loci: the quadriceps tendon, the proximal patellar tendon and the insertion on the tibial tuberosity. Interview: Of the 72 players, 62 players had problems with 86 tendons in the lower extremity. Of these 86 tendons, 48 were the anterior knee tendons. Ultrasound: At baseline, the majority of players (87%) had colour Doppler flow in at least one scanning position. After a match, the percentage of the knee complexes involved did not change. CF increased significantly in the dominant leg at the tibial tuberosity; single players had a significantly higher CF after a match at the tibial tuberosity and in the patellar tendon both before and after a match. Painful tendons had the highest colour Doppler activity. Most elite badminton players had pain in the anterior knee tendons and intratendinous Doppler activity both before and after match. High levels of Doppler activity were associated with self-reported ongoing pain.

  18. Effects of In-Season Inertial Resistance Training With Eccentric Overload in a Sports Population at Risk for Patellar Tendinopathy.

    Science.gov (United States)

    Gual, Gabriel; Fort-Vanmeerhaeghe, Azahara; Romero-Rodríguez, Daniel; Tesch, Per A

    2016-07-01

    Gual, G, Fort-Vanmeerhaeghe, A, Romero-Rodríguez, D, and Tesch, PA. Effects of in-season inertial resistance training with eccentric overload in a sports population at risk for patellar tendinopathy. J Strength Cond Res 30(7): 1834-1842, 2016-Volleyball and basketball players can be considered as a population at risk for patellar tendinopathy. Given the paradox that eccentric training elicits therapeutic benefits yet might provoke such injury, we investigated the influence of a weekly bout of inertial squat resistance exercise offering eccentric overload on lower limb muscle power and patellar tendon complaints. Players of 8 (4 basketball and 4 volleyball) teams (38 women and 43 men) were randomly assigned to either the intervention (IG) or control (CG) group. Although IG and CG maintained scheduled in-season training routines over 24 weeks, IG, in addition, performed 1 weekly session of eccentric overload by 4 sets of 8 repetitions of the squat using flywheel inertial resistance. Victorian Institute of Sports Assessment patellar tendinopathy questionnaire (VISA-p), vertical countermovement jump, and squat power, both concentric (Squat-Con) and eccentric (Squat-Ecc), tests were performed before (T1), during (T2), and after (T3) the 24 weeks of intervention. Neither group suffered from patellar tendinopathy during the study period. VISA-p displayed no differences across groups at any measurement period. Countermovement jump scores significantly (p ≤ 0.05) differed between groups in favor of the IG. Both Squat-Con and Squat-Ecc mean scores from the IG were significantly (p training bout to a regular basketball and volleyball exercise routine enhances lower limb muscle power without triggering patellar tendon complaints. Future studies, using the current exercise paradigm, aim to explore its efficacy to prevent or combat patellar tendinopathy in sports calling for frequent explosive jumps.

  19. The impact of physically demanding work of basketball and volleyball players on the risk for patellar tendinopathy and on work limitations.

    Science.gov (United States)

    van der Worp, H; Zwerver, J; Kuijer, P P F M; Frings-Dresen, M H W; van den Akker-Scheek, I

    2011-01-01

    Patellar tendinopathy is a common injury in jumping athletes. Little is known about work-related etiological factors for patellar tendinopathy and related work limitations. The aim of this study was to identify work-related etiological factors for patellar tendinopathy and to determine the relation between patellar tendinopathy and work limitations. Basketball and volleyball players between 18 and 35 years were invited to complete an online-questionnaire concerning knee complaints, etiological risk factors for patellar tendinopathy and related work limitations. A total of 1505 subjects were included in the analysis. Risk factors for patellar tendinopathy were gender and heavy physically demanding work. The odds for having patellar tendinopathy were significantly higher for heavy physically demanding occupations compared to mentally demanding occupations. 30% of subjects with patellar tendinopathy with a physically demanding job reported to be impaired in their work and 17% reported to be less productive. Basketball and volleyball players with heavy physically demanding work seem to have an increased risk for developing patellar tendinopathy. This finding has important clinical relevance in the treatment of this injury. Working activities should be adjusted in order to reduce the total load on the patellar tendon and help prevention and recovery.

  20. Treatment of Patellar Lower Pole Fracture with Modified Titanium Cable Tension Band Plus Patellar Tibial Tunnel Steel "8" Reduction Band.

    Science.gov (United States)

    Li, Jiaming; Wang, Decheng; He, Zhiliang; Shi, Hao

    2018-01-08

    To determine the efficacy of modified titanium tension band plus patellar tendon tunnel steel 8 "reduction band" versus titanium cable tension band fixation for the treatment of patellar lower pole fracture. 58 patients with lower patella fracture were enrolled in this study, including 30 patients treated with modified titanium cable tension band plus patellar tibial tunnel wire "8" tension band internal fixation (modified group), and 28 patients with titanium cable tension band fixation. All patients were followed up for 9∼15 months with an average of 11.6 months. Knee flexion was significantly improved in the modified group than in the titanium cable tension band group (111.33 ± 13 degrees versus 98.21 ± 21.70 degrees, P = 0.004). The fracture healing time showed no significant difference. At the end of the follow-up, the improvement excellent rate was 93.33% in the modified group, and 82.14% in the titanium cable tension band group. Titanium cable tension band internal fixation loosening was found in 2 cases, including 1 case of treatment by two surgeries without loose internal fixation. The modified titanium cable tension band with "8" tension band fixation showed better efficacy for lower patella fractures than titanium cable tension band fixation.

  1. Assessment of rotatory instability after anterior cruciate ligament reconstruction with a bone-patellar tendon-bone graft

    International Nuclear Information System (INIS)

    Tashiro, Yasutaka; Okazaki, Ken; Miura, Hiromasa

    2010-01-01

    Anatomically oriented anterior cruciate ligament (ACL) reconstruction has been advocated recently, but its effect on rotatory instability remains to be cleared objectively. The purpose of this study was to quantitatively evaluate rotatory instability in ACL reconstructed knees with a bone-patellar tendon-bone (BTB) graft using an open MRI system. Eighteen subjects underwent arthroscopic ACL reconstruction with a BTB graft. The tibial tunnel was placed in the center of the ACL footprint. The femoral tunnel was drilled transtibially at the 10:00 to 10:30-o'clock position for the right knees. Subjects were examined using a Slocum anterolateral rotatory instability test in open MRI. Anterior tibial translation was measured at the medial and lateral compartments by evaluating sagittal images. Anterior knee stability was evaluated using the KT-2000 arthrometer. The clinical knee function was assessed with the Lysholm and Tegner scoring scales before and after the surgery. Side-to-side differences of anterolateral tibial translation was 0.1 mm. Side-to-side difference on KT-2000 arthrometer measurement was 1.8 mm. The Lysholm score improved to 96 and the latest Tegner score reached substantially the preinjury level. ACL reconstruction with a BTB graft was successful in restoring rotatory stability as well as anterior stability and knee function. (author)

  2. Bone anchors or interference screws? A biomechanical evaluation for autograft ankle stabilization.

    Science.gov (United States)

    Jeys, Lee; Korrosis, Sotiris; Stewart, Todd; Harris, Nicholas J

    2004-01-01

    Autograft stabilization uses free semitendinosus tendon grafts to anatomically reconstruct the anterior talofibular ligament. Study aims were to evaluate the biomechanical properties of Mitek GII anchors compared with the Arthrex Bio-Tenodesis Screw for free tendon reconstruction of the anterior talofibular ligament. There are no differences in load to failure and percentage specimen elongation at failure between the 2 methods. Controlled laboratory study using porcine models. Sixty porcine tendon constructs were failure tested. Re-creating the pull of the anterior talofibular ligament, loads were applied at 70 degrees to the bones. Thirty-six tendons were fixed to porcine tali and tested using a single pull to failure; 10 were secured with anchors and No. 2 Ethibond, 10 with anchors and FiberWire, 10 with screws and Fiberwire, and 6 with partially gripped screws. Cyclic preloading was conducted on 6 tendons fixed by anchors and on 6 tendons fixed by screws before failure testing. Two groups of 6 components fixed to the fibula were also tested. The talus single-pull anchor group produced a mean load of 114 N and elongation of 37% at failure. The talus single-pull screw group produced a mean load of 227 N and elongation of 22% at failure (P anchors. The improved biomechanics of interference screws suggests that these may be more suited to in vivo reconstruction of the anterior talofibular ligament than are bone anchors.

  3. The use of hamstring tendon graft for the anterior cruciate ligament reconstruction (benefi ts, problems and their solutions

    Directory of Open Access Journals (Sweden)

    V. V. Slastinin

    2017-01-01

    Full Text Available The search for optimal graft for anterior cruciate ligament reconstruction is going on. The donor site morbidity remains one of the major problems when using autografts. The article provides an overview of the advantages and disadvantages of using the hamstring tendon autografts for anterior cruciate ligament reconstruction, and the ways of solving the problems associated with using such types of grafts.

  4. 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.

  5. GH receptor blocker administration and muscle-tendon collagen synthesis in humans

    DEFF Research Database (Denmark)

    Nielsen, Rie Harboe; Doessing, Simon; Goto, Kazushige

    2011-01-01

    Collagen is the predominant structural protein in tendons and ligaments, and can be controlled by hormonal changes. In animals, injections of insulin-like growth factor I (IGF-I) has been shown to increase collagen synthesis in tendons and ligaments and to improve structural tissue healing......, but the effect of local IGF-I administration on tendon collagen synthesis in human has not been studied. The purpose of this study was to study whether local injections of IGF-I would have a stimulating effect on tendon collagen synthesis. Twelve healthy nonsmoking men [age 62 ± 1 years (mean ± SEM), BMI 27 ± 1......] participated. Two injections of either human recombinant IGF-I (0.1 mL Increlex©) or saline (control) into each patellar tendon were performed 24-h apart, respectively. Tendon collagen fractional synthesis rate (FSR) was measured by stable isotope technique in the hours after the second injection...

  6. Medial Patellofemoral Ligament Reconstruction Using the Hamstring Tendon for Patellofemoral Joint Instability in an 81-Year-Old Female.

    Science.gov (United States)

    Takahashi, Tsuneari; Takeshita, Katsushi

    2017-01-01

    Chronic patellofemoral instability occurs mainly in adolescent females and can also be induced by medial patellofemoral ligament (MPFL) injury. There are no case reports of MPFL reconstruction for chronic patellofemoral instability due to MPFL injury in aged populations. 81-year-old female presented with left knee pain, giving way, and patellar instability while climbing stairs, which continued for 18 months. Patellar apprehension test was positive, and roentgenogram showed lateral patellar subluxation. Conservative therapy was not successful; hence, we performed a lateral release and MPFL reconstruction surgery. After arthroscopic lateral release, the hamstring tendon was harvested, and a graft composite made of doubled hamstring tendon and polyester tape with a suspensory fixation device was prepared. Then, a femoral bone tunnel was constructed in a socket shape at the anatomical footprint of the MPFL. The graft was passed through the femoral tunnel, and free ends of the graft composite were sutured to the periosteum of the patella, using two suture anchors at 60° of knee flexion with patellar reduction. Physiotherapy was gradually started using a patella-stabilizing orthosis on the first postoperative day. Her Kujala score improved from 66 to 97 points, and Barthel index score improved from 70 to 100 points at 1 year after surgery. She neither developed patellofemoral joint OA nor had any recurrence of symptoms at the 5-year postoperative follow up. MPFL reconstruction using the hamstring tendon is an effective procedure for patients with chronic patellofemoral instability even after the age of 80 years.

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

    Directory of Open Access Journals (Sweden)

    Jianying Zhang

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

  8. The effect of mechanical stimulation on the maturation of TDSCs-poly(L-lactide-co-e-caprolactone)/collagen scaffold constructs for tendon tissue engineering.

    Science.gov (United States)

    Xu, Yuan; Dong, Shiwu; Zhou, Qiang; Mo, Xiumei; Song, Lei; Hou, Tianyong; Wu, Jinglei; Li, Songtao; Li, Yudong; Li, Pei; Gan, Yibo; Xu, Jianzhong

    2014-03-01

    Mechanical stimulation plays an important role in the development and remodeling of tendons. Tendon-derived stem cells (TDSCs) are an attractive cell source for tendon injury and tendon tissue engineering. However, these cells have not yet been fully explored for tendon tissue engineering application, and there is also lack of understanding to the effect of mechanical stimulation on the maturation of TDSCs-scaffold construct for tendon tissue engineering. In this study, we assessed the efficacy of TDSCs in a poly(L-lactide-co-ε-caprolactone)/collagen (P(LLA-CL)/Col) scaffold under mechanical stimulation for tendon tissue engineering both in vitro and in vivo, and evaluated the utility of the transplanted TDSCs-scaffold construct to promote rabbit patellar tendon defect regeneration. TDSCs displayed good proliferation and positive expressed tendon-related extracellular matrix (ECM) genes and proteins under mechanical stimulation in vitro. After implanting into the nude mice, the fluorescence imaging indicated that TDSCs had long-term survival, and the macroscopic evaluation, histology and immunohistochemistry examinations showed high-quality neo-tendon formation under mechanical stimulation in vivo. Furthermore, the histology, immunohistochemistry, collagen content assay and biomechanical testing data indicated that dynamically cultured TDSCs-scaffold construct could significantly contributed to tendon regeneration in a rabbit patellar tendon window defect model. TDSCs have significant potential to be used as seeded cells in the development of tissue-engineered tendons, which can be successfully fabricated through seeding of TDSCs in a P(LLA-CL)/Col scaffold followed by mechanical stimulation. Copyright © 2013 Elsevier Ltd. All rights reserved.

  9. Rotator cuff repair with a tendon-fibrocartilage-bone composite bridging patch.

    Science.gov (United States)

    Ji, Xiaoxi; Chen, Qingshan; Thoreson, Andrew R; Qu, Jin; An, Kai-Nan; Amadio, Peter C; Steinmann, Scott P; Zhao, Chunfeng

    2015-11-01

    To compare the mechanical performance of a rotator cuff repaired with a novel tendon-fibrocartilage-bone composite bridging patch vs the traditional Mason-Allen repair in an in vitro canine model. Twenty shoulders and 10 bridging patches from patellar tendon were harvested. The patches were trimmed and sliced into 2 layers. An infraspinatus tendon tear was created in each shoulder. Modified Mason-Allen sutures were used to repair the infraspinatus tendon to the greater tuberosity, with or without the bridging patch (bridging patch group and controls, respectively). Shoulders were loaded to failure under displacement control at a rate of 0.5mm/s. The ultimate tensile load was significantly higher in the bridging patch group than control (mean [SD], 365.46 [36.45] vs 272.79 [48.88] N; Pfibrocartilage-bone composite bridging patch achieved higher ultimate tensile load and stiffness at the patch-greater tuberosity repair site compared with traditional repair in a canine model. This composite tissue transforms the traditional tendon-to-bone healing interface (with dissimilar tissues) into a pair of bone-to-bone and tendon-to-tendon interfaces, which may improve healing quality and reduce retear rate. Copyright © 2015 Elsevier Ltd. All rights reserved.

  10. Reconstrucción y restauración de la rotura aguda del tendón rotuliano con aumento del tendon semitendinoso preservando su inserción distal. Reporte de un caso.[Reconstruction and repair of acute patellar tendon ruptures with semitendinosus autograft].

    Directory of Open Access Journals (Sweden)

    Víctor Andres Ciccarello

    2016-11-01

    Full Text Available Se presenta un caso de ruptura aguda de tendon rotuliano con mala calidad de tejido remanente , en la que se realiza una tecnica de restauración y aumentación con injerto del tendon semitendinoso ipsilateral , preservando su inseríón distal.

  11. Hydroxyapatite-doped polycaprolactone nanofiber membrane improves tendon-bone interface healing for anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Han, Fei; Zhang, Peng; Sun, Yaying; Lin, Chao; Zhao, Peng; Chen, Jiwu

    2015-01-01

    Hamstring tendon autograft is a routine graft for anterior cruciate ligament (ACL) reconstruction. However, ways of improving the healing between the tendon and bone is often overlooked in clinical practice. This issue can be addressed by using a biomimetic scaffold. Herein, a biomimetic nanofiber membrane of polycaprolactone/nanohydroxyapatite/collagen (PCL/nHAp/Col) is fabricated that mimics the composition of native bone tissue for promoting tendon-bone healing. This membrane has good cytocompatibility, allowing for osteoblast cell adhesion and growth and bone formation. As a result, MC3T3 cells reveal a higher mineralization level in PCL/nHAp/Col membrane compared with PCL membrane alone. Further in vivo studies in ACL reconstruction in a rabbit model shows that PCL/nHAp/Col-wrapped tendon may afford superior tissue integration to nonwrapped tendon in the interface between the tendon and host bone as well as improved mechanical strength. This study shows that PCL/nHAp/Col nanofiber membrane wrapping of autologous tendon is effective for improving tendon healing with host bone in ACL reconstruction.

  12. Tendon allograft sterilized by peracetic acid/ethanol combined with gamma irradiation.

    Science.gov (United States)

    Zhou, Mo; Zhang, Naili; Liu, Xiaoming; Li, Youchen; Zhang, Yumin; Wang, Xusheng; Li, Baoming; Li, Baoxing

    2014-07-01

    Research and clinical applications have demonstrated that the effects of tendon allografts are comparable to those of autografts when reconstructing injured tendons or ligaments, but allograft safety remains problematic. Sterilisation could eliminate or decrease the possibility of disease transmission, but current methods seldom achieve satisfactory sterilisation without affecting the mechanical properties of the tendon. Peracetic acid-ethanol in combination with low-dose gamma irradiation (PE-R) would inactivate potential deleterious microorganisms without affecting mechanical and biocompatible properties of tendon allograft. Controlled laboratory design. HIV, PPV, PRV and BVDV inactivation was evaluated. After verifying viral inactivation, the treated tendon allografts were characterised by optical microscopy, scanning electron microscopy and tensile testing, and the cytocompatibility was assessed with an MTT assay and by subcutaneous implantation. Effective and efficient inactivation of HIV, PPV, PRV and BVDV was observed. Histological structure and ultrastructure were unchanged in the treated tendon allograft, which also exhibited comparable biomechanical properties and good biocompatibility. The preliminary results confirmed our hypothesis and demonstrated that the PE-R tendon allograft has significant potential as an alternative to ligament/tendon reconstruction. Tendon allografts have been extensively used in ligament reconstruction and tendon repair. However, current sterilisation methods have various shortcomings, so PE-R has been proposed. This study suggests that PE-R tendon allograft has great potential as an alternative for ligament/tendon reconstruction. Sterilisation has been a great concern for tendon allografts. However, most sterilisation methods cannot inactivate viruses and bacteria without impairing the mechanical properties of the tendon allograft. Peracetic acid/ethanol with gamma irradiation can effectively inactivate viruses and bacteria

  13. Proximo-distal patellar position in three small dog breeds with medial patellar luxation.

    Science.gov (United States)

    Wangdee, C; Theyse, L F H; Hazewinkel, H A W

    2015-01-01

    Medial patellar luxation is thought to be associated with a high proximal position of the patella in the trochlear groove. To determine whether the ratio of patellar ligament length and patellar length (L:P) is influenced by the stifle angle (75°, 96°, 113°, 130°, and 148°) in small dog breeds and to compare the L:P ratio in dogs of three small dog breeds with and without medial patellar luxation. A mediolateral radiograph of the stifle joint was used to measure the L:P ratio in the stifle joints of dogs of three small breeds with and without medial patellar luxation. The L:P ratio was evaluated at five stifle angles (75°, 96°, 113°, 130°, and 148°) in 14 cadavers (26 stifle joints) of small dog breeds in order to identify the best stifle angle to measure the L:P ratio. Then the mean ± SD L:P ratio was calculated for normal stifles and stifles with medial patellar luxation grades 1, 2, and 3 in 194 Pomeranians, 74 Chihuahuas, and 41 Toy or Standard Poodles. The L:P ratio was the same for all five stifle angles in the cadavers (p = 0.195). It was also not significantly different in the three breeds (p = 0.135), in normal and medial patellar luxation-affected stifles overall (p = 0.354), and in normal and medial patellar luxation-affected joints within each breed (p = 0.19). We conclude that a proximo-distal patellar position is not associated with medial patellar luxation in Pomeranians, Chihuahuas, and Toy or Standard Poodles. Thus a longer patellar ligament length does not play a role in the pathophysiology of medial patellar luxation in these small dog breeds.

  14. Tendon Contraction After Cyclic Elongation Is an Age-Dependent Phenomenon: In Vitro and In Vivo Comparisons.

    Science.gov (United States)

    Lavagnino, Michael; Bedi, Asheesh; Walsh, Christopher P; Sibilsky Enselman, Elizabeth R; Sheibani-Rad, Shahin; Arnoczky, Steven P

    2014-06-01

    Tendons are viscoelastic tissues that deform (elongate) in response to cyclic loading. However, the ability of a tendon to recover this elongation is unknown. Tendon length significantly increases after in vivo or in vitro cyclic loading, and the ability to return to its original length through a cell-mediated contraction mechanism is an age-dependent phenomenon. Controlled laboratory study. In vitro, rat tail tendon fascicles (RTTfs) from Sprague-Dawley rats of 3 age groups (1, 3, and 12 months) underwent 2% cyclic strain at 0.17 Hz for 2 hours, and the percentages of elongation were determined. After loading, the RTTfs were suspended for 3 days under tissue culture conditions and photographed daily to determine the amount of length contraction. In vivo, healthy male participants (n = 29; age, 19-49 years) had lateral, single-legged weightbearing radiographs taken of the knee at 60° of flexion immediately before, immediately after, and 24 hours after completing eccentric quadriceps loading exercises on the dominant leg to fatigue. Measurements of patellar tendon length were taken from the radiographs, and the percentages of tendon elongation and subsequent contraction were calculated. In vitro, cyclic loading increased the length of all RTTfs, with specimens from younger (1 and 3 months) rats demonstrating significantly greater elongation than those from older (12 months) rats (P = .009). The RTTfs contracted to their original length significantly faster (P fashion, with younger animals contracting faster. In vivo, repetitive eccentric loading exercises significantly increased patellar tendon length (P 30 years). Cyclic tendon loading results in a significant increase in tendon elongation under both in vitro and in vivo conditions. Tendons in both conditions demonstrated an incomplete return to their original length after 24 hours, and the extent of this return was age dependent. The age- and time-dependent contraction of tendons, elongated after repetitive

  15. A pilot study of the eccentric decline squat in the management of painful chronic patellar tendinopathy.

    Science.gov (United States)

    Purdam, C R; Jonsson, P; Alfredson, H; Lorentzon, R; Cook, J L; Khan, K M

    2004-08-01

    This non-randomised pilot study investigated the effect of eccentric quadriceps training on 17 patients (22 tendons) with painful chronic patellar tendinopathy. Two different eccentric exercise regimens were used by subjects with a long duration of pain with activity (more than six months). (a) Nine consecutive patients (10 tendons; eight men, one woman; mean age 22 years) performed eccentric exercise with the ankle joint in a standard (foot flat) position. (b) Eight patients (12 tendons; five men, three women; mean age 28 years) performed eccentric training standing on a 25 degrees decline board, designed to increase load on the knee extensor mechanism. The eccentric training was performed twice daily, with three sets of 15 repetitions, for 12 weeks. Primary outcome measures were (a) 100 mm visual analogue scale (VAS), where the subject recorded the amount of pain during activity, and (b) return to previous activity. Follow up was at 12 weeks, with a further limited follow up at 15 months. Good clinical results were obtained in the group who trained on the decline board, with six patients (nine tendons) returning to sport and showing a significantly reduced amount of pain over the 12 week period. Mean VAS scores fell from 74.2 to 28.5 (p = 0.004). At 15 months, four patients (five tendons) reported satisfactory results (mean VAS 26.2). In the standard squat group the results were poor, with only one athlete returning to previous activity. Mean VAS scores in this group were 79.0 at baseline and 72.3 at 12 weeks (p = 0.144). In a small group of patients with patellar tendinopathy, eccentric squats on a decline board produced encouraging results in terms of pain reduction and return to function in the short term. Eccentric exercise using standard single leg squats in a similar sized group appeared to be a less effective form of rehabilitation in reducing pain and returning subjects to previous levels of activity.

  16. Repeated freeze-thaw cycles reduce the survival rate of osteocytes in bone-tendon constructs without affecting the mechanical properties of tendons.

    Science.gov (United States)

    Suto, Kaori; Urabe, Ken; Naruse, Kouji; Uchida, Kentaro; Matsuura, Terumasa; Mikuni-Takagaki, Yuko; Suto, Mitsutoshi; Nemoto, Noriko; Kamiya, Kentaro; Itoman, Moritoshi

    2012-03-01

    Frozen bone-patellar tendon bone allografts are useful in anterior cruciate ligament reconstruction as the freezing procedure kills tissue cells, thereby reducing immunogenicity of the grafts. However, a small portion of cells in human femoral heads treated by standard bone-bank freezing procedures survive, thus limiting the effectiveness of allografts. Here, we characterized the survival rates and mechanisms of cells isolated from rat bones and tendons that were subjected to freeze-thaw treatments, and evaluated the influence of these treatments on the mechanical properties of tendons. After a single freeze-thaw cycle, most cells isolated from frozen bone appeared morphologically as osteocytes and expressed both osteoblast- and osteocyte-related genes. Transmission electron microscopic observation of frozen cells using freeze-substitution revealed that a small number of osteocytes maintained large nuclei with intact double membranes, indicating that these osteocytes in bone matrix were resistant to ice crystal formation. We found that tendon cells were completely killed by a single freeze-thaw cycle, whereas bone cells exhibited a relatively high survival rate, although survival was significantly reduced after three freeze-thaw cycles. In patella tendons, the ultimate stress, Young's modulus, and strain at failure showed no significant differences between untreated tendons and those subjected to five freeze-thaw cycles. In conclusion, we identified that cells surviving after freeze-thaw treatment of rat bones were predominantly osteocytes. We propose that repeated freeze-thaw cycles could be applied for processing bone-tendon constructs prior to grafting as the treatment did not affect the mechanical property of tendons and drastically reduced surviving osteocytes, thereby potentially decreasing allograft immunogenecity.

  17. In-vivo patellar tracking in individuals with patellofemoral pain and healthy individuals.

    Science.gov (United States)

    Esfandiarpour, Fateme; Lebrun, Constance M; Dhillon, Sukhvinder; Boulanger, Pierre

    2018-02-28

    Understanding of the exact cause of patellofemoral pain has been limited by methodological challenges to evaluate in-vivo joint motion. This study compared six degree-of-freedom patellar motion during a dynamic lunge task between individuals with patellofemoral pain and healthy individuals. Knee joints of eight females with patellofemoral pain and ten healthy females were imaged using a CT scanner in supine lying position, then by a dual-orthogonal fluoroscope while they performed a lunge. To quantify patellar motion, the three-dimensional models of the knee bones, reconstructed from CT scans, were registered on the fluoroscopy images using the Fluomotion registration software. At full knee extension, the patella was in a significantly laterally tilted (PFP: 11.77° ± 7.58° vs. healthy: 0.86° ± 4.90°; p = 0.002) and superiorly shifted (PFP: 17.49 ± 8.44 mm vs. healthy: 9.47 ± 6.16 mm, p = 0. 033) position in the patellofemoral pain group compared with the healthy group. There were also significant differences between the groups for patellar tilt at 45°, 60°, and 75° of knee flexion, and for superior-inferior shift of the patella at 30° flexion (p ≤ 0.031). In the non-weight-bearing knee extended position, the patella was in a significantly laterally tilted position in the patellofemoral pain group (7.44° ± 6.53°) compared with the healthy group (0.71° ± 4.99°). These findings suggest the critical role of passive and active patellar stabilizers as potential causative factors for patellar malalignment/maltracking. Future studies should investigate the associations between patellar kinematics with joint morphology, muscle activity, and tendon function in a same sample for a thorough understanding of the causes of patellofemoral pain. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  18. CT patellar cortex tilt angle: A radiological method to measure patellar tilt

    International Nuclear Information System (INIS)

    Mirza Toluei, F.; Afshar, A.; Salarilak, S.; Sina, A.

    2005-01-01

    Background/Objectives: the role of patellar tilt in the anterior knee pain is indisputable. Traditionally. the lateral patello-femoral angle of Laurin has been defined in both the axial view and CT images for measuring the tilt of patella. We present a new angle. which is independent of the morphology of patella and directly relates to clinical assessment of the tilt. which is appreciated from palpation of the edges of the patella. Patients and Methods: 38 patients with anterior knee pain and forty normal control subjects were examined using CT scan of patello-femoral joint in 15 degrees of knee flexion. The amount of lateral patellar tilt was quantitatively assessed using the lateral patello-femoral angle, as described by Laurin et al, and the newly defined patellar cortex tilt angle. This angle is subtended by the line drawn along the posterior femoral condyles and the one parallel to the subchondral bone of patellar cortex. The fifteen-degree tilt was taken as normal cut-off point for patellar cortex tilt angle in the control group. Results: in patients, the average tilt of patella. using the patellar cortex tilt angle was 15.26 versus 7.05 in the control group. Using Student's t test, the difference between the two means was significant (P<0.001). The sensitivity and specificity of patellar cortex tilt angle were 40 and 90 percent, respectively There was a moderate agreement between our presented test and the lateral tilt angle test (kappa=0.40. P<0.001). Conclusion: our results indicate that patellar tilt can also be detected using patellar cortex tilt angle. We need more specific studies ta determine the validity of the test

  19. Patellar subluxation syndrome

    International Nuclear Information System (INIS)

    Yagi, Tomonori; Sasaki, Tetsuto; Susuda, Koichi; Moji, Junichi

    1983-01-01

    Clinical symptoms of patellar subluxation syndrome associated with pain were investigated for 24 knees of 20 patients, and the state of patella dislocation was observed by CT-scan. The patients had high incidence of an apprehension sign, showing their fear of patellar luxation. Many of them complained of patello-femoral joint pain due to chondromalacia patellae. In order to derive patellar subluxation, the method of CT-Q-contraction was carried out at the extended position of the patellar joint. In patients with patellar subluxation syndrome, the rate of shift in the diseased side was significantly higher than that of the other side, suggesting decreased muscular strength of the musculus vastus of the diseased side. Improvement of the symptoms was seen in all except one of 12 knees operated by the combined method of Green's method with Blauth's more than 6 months before. Availability of this operation was verified by the CT-Q-contraction. (Ueda, J.)

  20. Excessive lateral patellar translation on axial computed tomography indicates positive patellar J sign.

    Science.gov (United States)

    Xue, Zhe; Song, Guan-Yang; Liu, Xin; Zhang, Hui; Wu, Guan; Qian, Yi; Feng, Hua

    2018-03-20

    The purpose of the study was to quantify the patellar J sign using traditional computed tomography (CT) scans. Fifty-three patients (fifty-three knees) who suffered from recurrent patellar instability were included and analyzed. The patellar J sign was evaluated pre-operatively during active knee flexion and extension. It was defined as positive when there was obvious lateral patellar translation, and negative when there was not. The CT scans were performed in all patients with full knee extension; and the parameters including bisect offset index (BOI), patellar-trochlear-groove (PTG) distance, and patellar lateral tilt angle (PLTA) were measured on the axial slices. All the three parameters were compared between the J sign-positive group (study group) and the J sign-negative group (control group). In addition, the optimal thresholds of the three CT scan parameters for predicting the positive patellar J sign were determined with receiver operating characteristic (ROC) curves, and the diagnostic values were assessed by the area under the curve (AUC). Among the fifty-three patients (fifty-three knees), thirty-seven (70%) showed obvious lateral patellar translation, which were defined as positive J sign (study group), and the remaining sixteen (30%) who showed no lateral translation were defined as negative J sign (control group). The mean values of the three CT parameters in the study group were all significantly larger compared to the control group, including BOI (121 ± 28% vs 88 ± 12%, P = 0.038), PTG distance (5.2 ± 6.6 mm vs - 4.4 ± 5.2 mm, P J sign was 97.5% (Sensitivity = 83.3%, Specificity = 87.5%). In this study, the prevalence of positive patellar J sign was 70%. The BOI measured from the axial CT scans of the knee joint can be used as an appropriate predictor to differentiate the positive J sign from the negative J sign, highlighting that the excessive lateral patellar translation on axial CT scan indicates positive

  1. Tendon Adaptation to Sport-specific Loading in Adolescent Athletes.

    Science.gov (United States)

    Cassel, M; Carlsohn, A; Fröhlich, K; John, M; Riegels, N; Mayer, F

    2016-02-01

    Tendon adaptation due to mechanical loading is controversially discussed. However, data concerning the development of tendon thickness in adolescent athletes is sparse. The purpose of this study was to examine possible differences in Achilles (AT) and patellar tendon (PT) thickness in adolescent athletes while considering age, gender and sport-specific loading. In 500 adolescent competitive athletes of 16 different sports and 40 recreational controls both ATs and PTs were sonographically measured. Subjects were divided into 2 age groups (sport type categories (ball, combat, and water sports, combined disciplines, cycling, controls). In addition, 3 risk groups (low, moderate, high) were created according to the athlete's risk of developing tendinopathy. AT and PT thickness did not significantly differ between age groups (AT/PT:sports/cyclists and lowest in controls (p≤0.002). PT thickness was greatest in water sports and lowest in controls (p=0.02). High risk athletes presented slightly higher AT thickness compared to the low risk group (p=0.03). Increased AT and PT thickness in certain sport types compared to controls supports the hypothesis of structural tendon adaptation due to sport-specific loading. © Georg Thieme Verlag KG Stuttgart · New York.

  2. Postoperative US of leg tendon reconstruction

    International Nuclear Information System (INIS)

    Draghi, F.; Calliada, F.; Fulle, I.; Madonia, L.; Bottinelli, O.; Campani, R.

    1999-01-01

    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 [it

  3. Tendon Reattachment to Bone in an Ovine Tendon Defect Model of Retraction Using Allogenic and Xenogenic Demineralised Bone Matrix Incorporated with Mesenchymal Stem Cells.

    Directory of Open Access Journals (Sweden)

    Tanujan Thangarajah

    Full Text Available Tendon-bone healing following rotator cuff repairs is mainly impaired by poor tissue quality. Demineralised bone matrix promotes healing of the tendon-bone interface but its role in the treatment of tendon tears with retraction has not been investigated. We hypothesized that cortical demineralised bone matrix used with minimally manipulated mesenchymal stem cells will result in improved function and restoration of the tendon-bone interface with no difference between xenogenic and allogenic scaffolds.In an ovine model, the patellar tendon was detached from the tibial tuberosity and a complete distal tendon transverse defect measuring 1 cm was created. Suture anchors were used to reattach the tendon and xenogenic demineralised bone matrix + minimally manipulated mesenchymal stem cells (n = 5, or allogenic demineralised bone matrix + minimally manipulated mesenchymal stem cells (n = 5 were used to bridge the defect. Graft incorporation into the tendon and its effect on regeneration of the enthesis was assessed using histomorphometry. Force plate analysis was used to assess functional recovery.Compared to the xenograft, the allograft was associated with significantly higher functional weight bearing at 6 (P = 0.047, 9 (P = 0.028, and 12 weeks (P = 0.009. In the allogenic group this was accompanied by greater remodeling of the demineralised bone matrix into tendon-like tissue in the region of the defect (p = 0.015, and a more direct type of enthesis characterized by significantly more fibrocartilage (p = 0.039. No failures of tendon-bone healing were noted in either group.Demineralised bone matrix used with minimally manipulated mesenchymal stem cells promotes healing of the tendon-bone interface in an ovine model of acute tendon retraction, with superior mechanical and histological results associated with use of an allograft.

  4. Moderate treadmill running exercise prior to tendon injury enhances wound healing in aging rats.

    Science.gov (United States)

    Zhang, Jianying; Yuan, Ting; Wang, James H-C

    2016-02-23

    The effect of exercise on wound healing in aging tendon was tested using a rat moderate treadmill running (MTR) model. The rats were divided into an MTR group that ran on a treadmill for 4 weeks and a control group that remained in cages. After MTR, a window defect was created in the patellar tendons of all rats and wound healing was analyzed. We found that MTR accelerated wound healing by promoting quicker closure of wounds, improving the organization of collagen fibers, and decreasing senescent cells in the wounded tendons when compared to the cage control. MTR also lowered vascularization, increased the numbers of tendon stem/progenitor cells (TSCs) and TSC proliferation than the control. Besides, MTR significantly increased the expression of stem cell markers, OCT-4 and Nanog, and tenocyte genes, Collagen I, Collagen III and tenomodulin, and down-regulated PPAR-γ, Collagen II and Runx-2 (non-tenocyte genes). These findings indicated that moderate exercise enhances healing of injuries in aging tendons through TSC based mechanisms, through which exercise regulates beneficial effects in tendons. This study reveals that appropriate exercise may be used in clinics to enhance tendon healing in aging patients.

  5. Simultaneous MPFL and LPFL reconstruction for recurrent lateral patellar dislocation with medial patellofemoral instability

    Directory of Open Access Journals (Sweden)

    Masashi Kusano

    2014-01-01

    Full Text Available We report an extremely rare case of both recurrent lateral patella dislocation and medial patellofemoral instability, following prior operations to correct patella maltracking. Manual translation of the patella revealed medial and lateral instability with a positive apprehension sign. 3-D computer modelling of kinematics based on MRI data demonstrated that the patella deviated laterally at full extension and translated medially with knee flexion. The medial and lateral patellofemoral ligaments were reconstructed simultaneously with hamstring tendons, alleviating peripatellar pain and patellar instability in both directions.

  6. Mechanoactive scaffold induces tendon remodeling and expression of fibrocartilage markers.

    Science.gov (United States)

    Spalazzi, Jeffrey P; Vyner, Moira C; Jacobs, Matthew T; Moffat, Kristen L; Lu, Helen H

    2008-08-01

    Biological fixation of soft tissue-based grafts for anterior cruciate ligament (ACL) reconstruction poses a major clinical challenge. The ACL integrates with subchondral bone through a fibrocartilage enthesis, which serves to minimize stress concentrations and enables load transfer between two distinct tissue types. Functional integration thus requires the reestablishment of this fibrocartilage interface on reconstructed ACL grafts. We designed and characterized a novel mechanoactive scaffold based on a composite of poly-alpha-hydroxyester nanofibers and sintered microspheres; we then used the scaffold to test the hypothesis that scaffold-induced compression of tendon grafts would result in matrix remodeling and the expression of fibrocartilage interface-related markers. Histology coupled with confocal microscopy and biochemical assays were used to evaluate the effects of scaffold-induced compression on tendon matrix collagen distribution, cellularity, proteoglycan content, and gene expression over a 2-week period. Scaffold contraction resulted in over 15% compression of the patellar tendon graft and upregulated the expression of fibrocartilage-related markers such as Type II collagen, aggrecan, and transforming growth factor-beta3 (TGF-beta3). Additionally, proteoglycan content was higher in the compressed tendon group after 1 day. The data suggest the potential of a mechanoactive scaffold to promote the formation of an anatomic fibrocartilage enthesis on tendon-based ACL reconstruction grafts.

  7. Elastic modulus of muscle and tendon with shear wave ultrasound elastography: variations with different technical settings.

    Directory of Open Access Journals (Sweden)

    Brian Chin Wing Kot

    Full Text Available Standardization on Shear wave ultrasound elastography (SWUE technical settings will not only ensure that the results are accurate, but also detect any differences over time that may be attributed to true physiological changes. The present study evaluated the variations of elastic modulus of muscle and tendon using SWUE when different technical aspects were altered. The results of this study indicated that variations of elastic modulus of muscle and tendon were found when different transducer's pressure and region of interest (ROI's size were applied. No significant differences in elastic modulus of the rectus femoris muscle and patellar tendon were found with different acquisition times of the SWUE sonogram. The SWUE on the muscle and tendon should be performed with the lightest transducer's pressure, a shorter acquisition time for the SWUE sonogram, while measuring the mean elastic modulus regardless the ROI's size.

  8. Comparison of patellar distraction with patellar glides in female patients with patellofemoral pain syndrom

    International Nuclear Information System (INIS)

    Syed, S.; Chaudhary, M.A.; Noor, R.; Bashir, M.S.; Manzoor, B.

    2017-01-01

    To analyse effectiveness of patellar glides and patellar distraction in the patients with patellofemoral pain syndrome (PFPS). Methodology: This longitudinal interventional comparative study was conducted at Physiotherapy Department, Mayo Hospital Lahore, Pakistan from September 2015 to March 2016. A total of 70 patients were divided into 2 groups randomly; group A received hot pack, quadriceps strengthening exercises and patellar distraction whereas group B received hot pack, quadriceps strengthening exercises and patellar glides. Age of the female patients was 18-40 years. Visual Analogue Scale (VAS) and Knee Injury and osteoarthritis outcome score (KOOS) questionnaire were used to compare the effectiveness of both treatments. The data were analysed using SPSS v. 21.0. Results: There was reduction in pain at VAS and KOOS showed improvement in function as well as the range of motion also increased in both groups. Both treatment techniques were effective in reducing pain in PFPS (P <0.005). Pre-treatment KOOS score in patellar glides group was 34.77+10.84 and post-treatment KOOS score was 62.155+15.75 and for patellar distraction group pre-treatment KOOS score was 35.42+10.07 that increased to 55.77+14.66 after treatment which showed that patellar glides had better effect on PFPS. Conclusion: Both treatments were effective in managing PFPS in terms of decreasing pain and increasing ROM as there was no significant difference between two techniques, however patellar glides were superior as compared to patellar distraction in decreasing pain and increasing ROM. (author)

  9. Are unilateral and bilateral patellar tendinopathy distinguished by differences in anthropometry, body composition, or muscle strength in elite female basketball players?

    Science.gov (United States)

    Gaida, J E; Cook, J L; Bass, S L; Austen, S; Kiss, Z S

    2004-10-01

    Overuse injury to the patellar tendon (patellar tendinopathy) is a major reason for interrupted training and competition for elite athletes. In both sexes, the prevalence of unilateral and bilateral tendinopathy has been shown to differ. It has been proposed that bilateral pathology may have a different aetiology from unilateral pathology. Investigation of risk factors that may be unique to unilateral and bilateral patellar tendinopathy in female athletes may reveal insights into the aetiology of this condition. To examine whether anthropometry, body composition, or muscle strength distinguished elite female basketball players with unilateral or bilateral patellar tendinopathy. Body composition, anthropometry, and muscle strength were compared in elite female basketball players with unilateral (n = 8), bilateral (n = 7), or no (n = 24) patellar tendinopathy. Body composition was analysed using a dual energy x ray absorptiometer. Anthropometric measures were assessed using standard techniques. Knee extensor strength was measured at 180 degrees /s using an isokinetic dynamometer. z scores were calculated for the unilateral and bilateral groups (using the no tendinopathy group as controls). z scores were tested against zero. The tibia length to stature ratio was approximately 1.3 (1.3) SDs above zero in both the affected and non-affected legs in the unilateral group (ppatellar tendinopathy has identifiable risk factors whereas bilateral patellar tendinopathy may not. This suggests that the aetiology of these conditions may be different. However, interpretation must respect the limitation of small subject numbers.

  10. Isometric Contractions Are More Analgesic Than Isotonic Contractions for Patellar Tendon Pain: An In-Season Randomized Clinical Trial.

    Science.gov (United States)

    Rio, Ebonie; van Ark, Mathijs; Docking, Sean; Moseley, G Lorimer; Kidgell, Dawson; Gaida, Jamie E; van den Akker-Scheek, Inge; Zwerver, Johannes; Cook, Jill

    2017-05-01

    This study aimed to compare the immediate analgesic effects of 2 resistance programs in in-season athletes with patellar tendinopathy (PT). Resistance training is noninvasive, a principle stimulus for corticospinal and neuromuscular adaptation, and may be analgesic. Within-season randomized clinical trial. Data analysis was conducted blinded to group. Subelite volleyball and basketball competitions. Twenty jumping athletes aged more than 16 years, participating in games/trainings 3 times per week with clinically diagnosed PT. Two quadriceps resistance protocols were compared; (1) isometric leg extension holds at 60 degrees knee flexion (80% of their maximal voluntary isometric contraction) or (2) isotonic leg extension (at 80% of their 8 repetition maximum) 4 times per week for 4 weeks. Time under load and rest between sets was matched between groups. (1) Pain (0-10 numerical rating score) during single leg decline squat (SLDS), measured preintervention and postintervention sessions. (2) VISA-P, a questionnaire about tendon pain and function, completed at baseline and after 4 weeks. Twenty athletes with PT (18 men, mean 22.5 ± 4.7 years) participated (isotonic n = 10, isometric n = 10). Baseline median SLDS pain was 5/10 for both groups (isotonic range 1-8, isometric range 2-8). Isometric contractions produced significantly greater immediate analgesia (P < 0.002). Week one analgesic response positively correlated with improvements in VISA-P at 4 weeks (r = 0.64). Both protocols appear efficacious for in-season athletes to reduce pain, however, isometric contractions demonstrated significantly greater immediate analgesia throughout the 4-week trial. Greater analgesia may increase the ability to load or perform.

  11. Risk factors for patellar tendinopathy in volleyball and basketball players: A survey-based prospective cohort study.

    Science.gov (United States)

    de Vries, A J; van der Worp, H; Diercks, R L; van den Akker-Scheek, I; Zwerver, J

    2015-10-01

    Patellar tendinopathy (PT) is a common overuse injury of the patellar tendon in jumping athletes. In a recent large cross-sectional study from 2008 several factors were identified that may be associated with the etiology of PT. However, because of the study design no conclusions could be drawn about causal relations. The primary aim of the current study is to investigate whether the factors identified in the previous 2008 study can also be prospectively recognized as predictors of symptomatic PT in 2011. Nine hundred twenty-six Dutch elite and non-elite basketball and volleyball players from the previous study were invited again to complete an online survey about knee complaints and risk factors for PT in 2011. The logistic regression included 385 athletes of which 51 (13%) developed PT since 2008. Male gender [odds ratio (OR) 2.0, 95% confidence interval (CI) 1.1-3.5] was found to be a risk factor for developing PT. No sports-related variables could be identified to increase the risk of developing PT, but some evidence was found for performing heavy physically demanding work, like being a nurse or a physical education teacher (OR 2.3, 95% CI 0.9-6.3). These findings indicate that, when considering preventive measures, it is important to take into account the total tendon load. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  12. Randomized prospective study comparing tri-cortical iliac crest autograft to allograft in the lateral column lengthening component for operative correction of adult acquired flatfoot deformity.

    Science.gov (United States)

    Dolan, Christopher M; Henning, Jeffrey A; Anderson, John G; Bohay, Donald R; Kornmesser, Marc J; Endres, Terrence J

    2007-01-01

    Operative treatment of stage II posterior tibial tendon insufficiency (PTTI) is controversial. Many soft-tissue and bony procedures and various combinations of the two have been reported for treatment of stage II PTTI. Orthopaedists recognize the lateral column lengthening component of the procedure as a successful reconstructive technique. The use of cortical allograft for lateral column lengthening in the correction of pes planus in the pediatric patient population has been routine. In the adult population, however, tricortical iliac crest autograft has been the bone graft of choice. Harvest of this autograft can precipitate significant morbidity and cost. Therefore, we undertook this randomized controlled trial to compare graft incorporation and healing of allograft and autograft in the lateral column lengthening component of adult flatfoot reconstruction. Lateral column lengthening was done as a component of operative correction for stage II PTTI in adult patients (older than 18 years) by two surgeons using similar procedures. The patients were randomized to either the allograft or autograft procedures. The primary endpoint was graft incorporation and healing as assessed by radiographs. The study included 33 randomized feet in 31 patients. We followed 18 feet in the allograft group and 15 in the autograft group to the point of union. There were 21 women and 10 men. There were no delayed unions, nonunions, or hardware failures. All patients in both groups achieved bony union by the 12-week followup evaluation. Two superficial foot infections were successfully treated with oral antibiotics. Two patients in the autograft group continued to have hip donor site pain at 3 months. This study suggests that union rates of allograft and autograft (iliac crest bone graft) are equal. The use of allograft in the lateral column lengthening component of operative correction of adult stage II PTTI appears to be a viable alternative to the use of iliac crest autograft and

  13. Medial patellar ossification after patellar instability: a radiographic finding indicative of prior patella subluxation/dislocation

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    Jerabek, Seth A. [Harvard Combined Orthopaedic Surgery Residency Program, Boston, MA (United States); Asnis, Peter D.; Poon, Steven K.; Gill, Thomas J. [Massachusetts General Hospital, Department of Orthopaedic Surgery, Boston, MA (United States); Bredella, Miriam A.; Ouellette, Hugue A. [Massachusetts General Hospital, Department of Radiology, Boston, MA (United States)

    2009-08-15

    To describe the correlation between medial patellar ossification and prior patella subluxation and/or dislocation. A retrospective billing database search identified 544 patients who had been diagnosed with patellar instability over a 13-year period. One hundred twenty-eight patients met the inclusion criteria. After review by a staff orthopedic surgeon and two musculoskeletal radiologists, 28 patients were found to have medial patellar ossification. The size and location of medial patellar ossification was recorded. Of the 28 patients (20 males, eight females, age 13-66 years, mean 28 years) who were found to have medial patellar ossification, 22 had radiographs, 16 had magnetic resonance imaging, and ten had both. The medial patellar ossification ranged in size from 2 to 18 mm with an average of 6.8 mm. Twelve were located in the medial patellofemoral ligament (MPFL), 14 in the medial joint capsule, and two in both the MPFL and joint capsule. Twenty-seven of 28 patients had a single ossification, and one patient had two ossifications. The timing from injury to first imaging of the lesion ranged from 10 days to a chronic history ({>=}35 years) of patellar instability. Medial patellar ossification correlates with a history of prior patella subluxation and/or dislocation. The medial ossification can be seen within the MPFL or the medial joint capsule, suggesting remote injury to these structures. The presence of this lesion will prompt physicians to evaluate for patellar instability. (orig.)

  14. Medial patellar ossification after patellar instability: a radiographic finding indicative of prior patella subluxation/dislocation

    International Nuclear Information System (INIS)

    Jerabek, Seth A.; Asnis, Peter D.; Poon, Steven K.; Gill, Thomas J.; Bredella, Miriam A.; Ouellette, Hugue A.

    2009-01-01

    To describe the correlation between medial patellar ossification and prior patella subluxation and/or dislocation. A retrospective billing database search identified 544 patients who had been diagnosed with patellar instability over a 13-year period. One hundred twenty-eight patients met the inclusion criteria. After review by a staff orthopedic surgeon and two musculoskeletal radiologists, 28 patients were found to have medial patellar ossification. The size and location of medial patellar ossification was recorded. Of the 28 patients (20 males, eight females, age 13-66 years, mean 28 years) who were found to have medial patellar ossification, 22 had radiographs, 16 had magnetic resonance imaging, and ten had both. The medial patellar ossification ranged in size from 2 to 18 mm with an average of 6.8 mm. Twelve were located in the medial patellofemoral ligament (MPFL), 14 in the medial joint capsule, and two in both the MPFL and joint capsule. Twenty-seven of 28 patients had a single ossification, and one patient had two ossifications. The timing from injury to first imaging of the lesion ranged from 10 days to a chronic history (≥35 years) of patellar instability. Medial patellar ossification correlates with a history of prior patella subluxation and/or dislocation. The medial ossification can be seen within the MPFL or the medial joint capsule, suggesting remote injury to these structures. The presence of this lesion will prompt physicians to evaluate for patellar instability. (orig.)

  15. Bilateral simultaneous anterior cruciate ligament injury: a case report and national survey of orthopedic surgeon management preference

    Directory of Open Access Journals (Sweden)

    Ehsan Saadat

    2014-12-01

    Full Text Available Unilateral anterior cruciate ligament (ACL tear is a common injury seen by sports medicine orthopedic surgeons. However, a bilateral simultaneous ACL injury is extremely rare and has been reported only three times in the literature. We present a young female skier with simultaneous bilateral ACL tears that were managed with staged ACL reconstruction. We then conducted a nationwide survey (United States to determine the prevalence of simultaneous bilateral ACL tear and preferred management strategies by sports medicine orthopedic surgeons. Sports medicine fellowship directors were contacted and asked to send an 8-item survey to colleagues (sports medicine fellowship trained surgeons asking about overall number of ACL reconstructions performed, number of bilateral simultaneous ACL injuries seen and optimal management strategies of such an injury. Out of 43 responses, only 22 (51.2% surgeons had seen a bilateral simultaneous ACL injury. Of these, 16 (76.2% preferred staged reconstruction. Graft choice was mixed between autograft and allograft, but a large majority preferred either patellar tendon autograft (58% or hamstring autograft (41% were the most common choice. Staged reconstruction is the treatment of choice by surgeons surveyed in our study.

  16. Primary traumatic patellar dislocation

    Directory of Open Access Journals (Sweden)

    Tsai Chun-Hao

    2012-06-01

    Full Text Available Abstract Acute traumatic patellar dislocation is a common injury in the active and young adult populations. MRI of the knee is recommended in all patients who present with acute patellar dislocation. Numerous operative and non-operative methods have been described to treat the injuries; however, the ideal management of the acute traumatic patellar dislocation in young adults is still in debate. This article is intended to review the studies to the subjects of epidemiology, initial examination and management.

  17. Pullout strength of bone-patellar tendon-bone allograft bone plugs: a comparison of cadaver tibia and rigid polyurethane foam.

    Science.gov (United States)

    Barber, F Alan

    2013-09-01

    To compare the load-to-failure pullout strength of bone-patellar tendon-bone (BPTB) allografts in human cadaver tibias and rigid polyurethane foam blocks. Twenty BPTB allografts were trimmed creating 25 mm × 10 mm × 10 mm tibial plugs. Ten-millimeter tunnels were drilled in 10 human cadaver tibias and 10 rigid polyurethane foam blocks. The BPTB anterior cruciate ligament allografts were inserted into these tunnels and secured with metal interference screws, with placement of 10 of each type in each material. After preloading (10 N), cyclic loading (500 cycles, 10 to 150 N at 200 mm/min) and load-to-failure testing (200 mm/min) were performed. The endpoints were ultimate failure load, cyclic loading elongation, and failure mode. No difference in ultimate failure load existed between grafts inserted into rigid polyurethane foam blocks (705 N) and those in cadaver tibias (669 N) (P = .69). The mean rigid polyurethane foam block elongation (0.211 mm) was less than that in tibial bone (0.470 mm) (P = .038), with a smaller standard deviation (0.07 mm for foam) than tibial bone (0.34 mm). All BPTB grafts successfully completed 500 cycles. The rigid polyurethane foam block showed less variation in test results than human cadaver tibias. Rigid polyurethane foam blocks provide an acceptable substitute for human cadaver bone tibia for biomechanical testing of BPTB allografts and offer near-equivalent results. Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  18. Characterization of calcium and zinc spatial distributions at the fibrocartilage zone of bone-tendon junction by synchrotron radiation-based micro X-ray fluorescence analysis combined with backscattered electron imaging

    Science.gov (United States)

    Lu, Hongbin; Chen, Can; Wang, Zhanwen; Qu, Jin; Xu, Daqi; Wu, Tianding; Cao, Yong; Zhou, Jingyong; Zheng, Cheng; Hu, Jianzhong

    2015-09-01

    Tendon attaches to bone through a functionally graded fibrocartilage zone, including uncalcified fibrocartilage (UF), tidemark (TM) and calcified fibrocartilage (CF). This transition zone plays a pivotal role in relaxing load transfer between tendon and bone, and serves as a boundary between otherwise structurally and functionally distinct tissue types. Calcium and zinc are believed to play important roles in the normal growth, mineralization, and repair of the fibrocartilage zone of bone-tendon junction (BTJ). However, spatial distributions of calcium and zinc at the fibrocartilage zone of BTJ and their distribution-function relationship are not totally understood. Thus, synchrotron radiation-based micro X-ray fluorescence analysis (SR-μXRF) in combination with backscattered electron imaging (BEI) was employed to characterize the distributions of calcium and zinc at the fibrocartilage zone of rabbit patella-patellar tendon complex (PPTC). For the first time, the unique distributions of calcium and zinc at the fibrocartilage zone of the PPTC were clearly mapped by this method. The distributions of calcium and zinc at the fibrocartilage zone of the PPTC were inhomogeneous. A significant accumulation of zinc was exhibited in the transition region between UF and CF. The highest zinc content (3.17 times of that of patellar tendon) was found in the TM of fibrocartilage zone. The calcium content began to increase near the TM and increased exponentially across the calcified fibrocartilage region towards the patella. The highest calcium content (43.14 times of that of patellar tendon) was in the transitional zone of calcified fibrocartilage region and the patella, approximately 69 μm from the location with the highest zinc content. This study indicated, for the first time, that there is a differential distribution of calcium and zinc at the fibrocartilage zone of PPTC. These observations reveal new insights into region-dependent changes across the fibrocartilage zone of

  19. Effects of low-intensity pulsed ultrasound on new trabecular bone during bone-tendon junction healing in a rabbit model: a synchrotron radiation micro-CT study.

    Directory of Open Access Journals (Sweden)

    Hongbin Lu

    Full Text Available This study was designed to evaluate the effects of low-intensity pulsed ultrasound on bone regeneration during the bone-tendon junction healing process and to explore the application of synchrotron radiation micro computed tomography in three dimensional visualization of the bone-tendon junction to evaluate the microarchitecture of new trabecular bone. Twenty four mature New Zealand rabbits underwent partial patellectomy to establish a bone-tendon junction injury model at the patella-patellar tendon complex. Animals were then divided into low-intensity pulsed ultrasound treatment (20 min/day, 7 times/week and placebo control groups, and were euthanized at week 8 and 16 postoperatively (n = 6 for each group and time point. The patella-patellar tendon specimens were harvested for radiographic, histological and synchrotron radiation micro computed tomography detection. The area of the newly formed bone in the ultrasound group was significantly greater than that of control group at postoperative week 8 and 16. The high resolution three dimensional visualization images of the bone-tendon junction were acquired by synchrotron radiation micro computed tomography. Low-intensity pulsed ultrasound treatment promoted dense and irregular woven bone formation at week 8 with greater bone volume fraction, number and thickness of new trabecular bone but with lower separation. At week 16, ultrasound group specimens contained mature lamellar bone with higher bone volume fraction and thicker trabeculae than that of control group; however, there was no significant difference in separation and number of the new trabecular bone. This study confirms that low-intensity pulsed ultrasound treatment is able to promote bone formation and remodeling of new trabecular bone during the bone-tendon junction healing process in a rabbit model, and the synchrotron radiation micro computed tomography could be applied for three dimensional visualization to quantitatively evaluate

  20. Tendon protein synthesis rate in classic Ehlers-Danlos patients can be stimulated with insulin-like growth factor-I

    DEFF Research Database (Denmark)

    Nielsen, Rie Harboe; Holm, Lars; Jensen, Jacob Kildevang

    2014-01-01

    tissue protein turnover is unknown. We investigated whether cEDS affected the protein synthesis rate in skin and tendon, and whether this could be stimulated in tendon tissue with insulin-like growth factor-I (IGF-I). Five patients with cEDS and 10 healthy, matched controls (CTRL) were included. One...... patellar tendon of each participant was injected with 0.1 ml IGF-I (Increlex, Ipsen, 10 mg/ml) and the contralateral tendon with 0.1 ml isotonic saline as control. The injections were performed at both 24 and 6 h prior to tissue sampling. The fractional synthesis rate (FSR) of proteins in skin and tendon.......002 (cEDS) and 0.007 ± 0.002 (CTRL); tendon: 0.008 ± 0.001 (cEDS) and 0.009 ± 0.002 (CTRL) %/h, mean ± SE]. IGF-I injections significantly increased FSR values in cEDS patients but not in controls (delta values: cEDS 0.007 ± 0.002, CTRL 0.001 ± 0.001%/h). In conclusion, baseline protein synthesis rates...

  1. Successful fifth metatarsal bulk autograft reconstruction of thermal necrosis post intramedullary fixation.

    Science.gov (United States)

    Veljkovic, Andrea; Le, Vu; Escudero, Mario; Salat, Peter; Wing, Kevin; Penner, Murray; Younger, Alastair

    2018-03-21

    Reamed intramedullary (IM) screw fixation for proximal fifth metatarsal fractures is technically challenging with potentially devastating complications if basic principles are not followed. A case of an iatrogenic fourth-degree burn after elective reamed IM screw fixation of a proximal fifth metatarsal fracture in a high-level athlete is reported. The case was complicated by postoperative osteomyelitis with third-degree soft-tissue defect. This was successfully treated with staged autologous bone graft reconstruction, tendon reconstruction, and local bi-pedicle flap coverage. The patient returned to competitive-level sports, avoiding the need for fifth ray amputation. Critical points of the IM screw technique and definitive reconstruction are discussed. Bulk autograft reconstruction is a safe and effective alternative to ray amputation in segmental defects of the fifth metatarsal.Level of evidence V.

  2. Semiextended approach for intramedullary nailing via a patellar eversion technique for tibial-shaft fractures: Evaluation of the patellofemoral joint.

    Science.gov (United States)

    Yasuda, Tomohiro; Obara, Shu; Hayashi, Junji; Arai, Masayuki; Sato, Kaoru

    2017-06-01

    Intramedullary nail fixation is a common treatment for tibial-shaft fractures, and it offers a better functional prognosis than other conservative treatments. Currently, the primary approach employed during intramedullary nail insertion is the semiextended position is the suprapatellar approach, which involves a vertical incision of the quadriceps tendon Damage to the patellofemoral joint cartilage has been highlighted as a drawback associated with this approach. To avoid this issue, we perform surgery using the patellar eversion technique and a soft sleeve. This method allows the articular surface to be monitored during intramedullary nail insertion. We arthroscopically assessed the effect of this technique on patellofemoral joint cartilage. The patellar eversion technique allows a direct view and protection of the patellofemoral joint without affecting the patella. Thus, damage to the patellofemoral joint cartilage can be avoided. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. Increased signal intensity at the proximal patellar tendon: correlation between MR imaging and histology in eight cadavers and clinical MR imaging studies

    Energy Technology Data Exchange (ETDEWEB)

    Yun, Seong Jong; Jin, Wook; Yoon, So Hee; Park, So Young [Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Department of Radiology, Seoul (Korea, Republic of); Park, Yong-Koo [Kyung Hee University Medical Center, Department of Pathology, Seoul (Korea, Republic of); Kim, Gou Young [Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Department of Pathology, Seoul (Korea, Republic of); Lee, Jung Eun; Park, Ji Seon; Ryu, Kyung Nam [Kyung Hee University Medical Center, Department of Radiology, Seoul (Korea, Republic of)

    2015-10-15

    We set out to investigate the cause of persistently increased signal intensity (SI) in the posterior portion of the proximal patellar tendon (pPT) on T1-weighted images (T1WI). MR imaging was performed in eight cadavers, followed by gross histological examination. In addition, 84 patients without trauma history or anterior knee pain were included to compare the SI of the PTs. The patients were divided according to their age, sex, and Kellgren-Lawrence (KL) grades. The length and thickness of the increased SI portion in the pPT and whole PT (wPT) on T1WI were recorded. Histological specimens demonstrated that the adipose tissue, vessels, and perivascular connective tissue invaginated into the posterior portion of the pPT. This histological anatomy corresponded to the pPT signal change on MR imaging. There was linear and interdigitating increased SI of the pPT in all of the 84 patients (100 %). There were no differences in the lengths and thicknesses of the increased SI portion of pPTs and wPTs according to age, sex, and KL grade (all p > 0.05). The increased SI of the pPT on T1WI and fluid-sensitive MR images results from invaginating fat, vessels, and perivascular connective tissue. It is not pathological, but a normal and common finding. (orig.)

  4. Tendon and skeletal muscle matrix gene expression and functional responses to immobilisation and rehabilitation in young males

    DEFF Research Database (Denmark)

    Boesen, Anders Ploug; Dideriksen, Kasper; Couppé, Christian

    2013-01-01

    weeks followed by six weeks of strength training. Cross sectional area (CSA), maximal muscle strength (MVC) and biomechanical properties of m.quadriceps and patellar tendon were determined. Muscle and tendon biopsies were analysed for mRNA of collagen (COL-1A1/3A1), insulin-like growth factors (IGF-1Ea...... in both groups. Likewise, both groups increased in IGF-1Ea/Ec and COL-1A1/3A1 expression in muscle during re-training after immobilisation compared to baseline, and the rise was more pronounced when subjects recieved GH. The tendon CSA did not change during immobilisation, but increased in both groups...... during six weeks of rehabilitation (~14%). A decline in tendon stiffness after immobilisation was observed only in Plc, and an increase during six weeks rehabilitation was observed only in GH. IGF-1Ea and COL-1A1/3A1 mRNA increased with immobilisation in the GH group only, and LOX mRNA was after...

  5. Effect of tendon vibration during wide-pulse neuromuscular electrical stimulation (NMES) on muscle force production in people with spinal cord injury (SCI).

    Science.gov (United States)

    Bochkezanian, Vanesa; Newton, Robert U; Trajano, Gabriel S; Vieira, Amilton; Pulverenti, Timothy S; Blazevich, Anthony J

    2018-02-13

    Neuromuscular electrical stimulation (NMES) is commonly used in skeletal muscles in people with spinal cord injury (SCI) with the aim of increasing muscle recruitment and thus muscle force production. NMES has been conventionally used in clinical practice as functional electrical stimulation (FES), using low levels of evoked force that cannot optimally stimulate muscular strength and mass improvements, and thus trigger musculoskeletal changes in paralysed muscles. The use of high intensity intermittent NMES training using wide-pulse width and moderate-intensity as a strength training tool could be a promising method to increase muscle force production in people with SCI. However, this type of protocol has not been clinically adopted because it may generate rapid muscle fatigue and thus prevent the performance of repeated high-intensity muscular contractions in paralysed muscles. Moreover, superimposing patellar tendon vibration onto the wide-pulse width NMES has been shown to elicit further increases in impulse or, at least, reduce the rate of fatigue in repeated contractions in able-bodied populations, but there is a lack of evidence to support this argument in people with SCI. Nine people with SCI received two NMES protocols with and without superimposing patellar tendon vibration on different days (i.e. STIM and STIM+vib), which consisted of repeated 30 Hz trains of 58 wide-pulse width (1000 μs) symmetric biphasic pulses (0.033-s inter-pulse interval; 2 s stimulation train; 2-s inter-train interval) being delivered to the dominant quadriceps femoris. Starting torque was 20% of maximal doublet-twitch torque and stimulations continued until torque declined to 50% of the starting torque. Total knee extensor impulse was calculated as the primary outcome variable. Total knee extensor impulse increased in four subjects when patellar tendon vibration was imposed (59.2 ± 15.8%) but decreased in five subjects (- 31.3 ± 25.7%). However, there were no

  6. Expression of extracellular matrix components and related growth factors in human tendon and muscle after acute exercise

    DEFF Research Database (Denmark)

    Heinemeier, K M; Bjerrum, S S; Schjerling, P

    2013-01-01

    Acute kicking exercise induces collagen synthesis in both tendon and muscle in humans, but it is not known if this relates to increased collagen transcription and if other matrix genes are regulated. Young men performed 1 h of one-leg kicking at 67% of max workload. Biopsies were taken from...... the patellar tendon and vastus lateralis muscle of each leg at 2 (n = 10), 6 (n = 11), or 26 h (n = 10) after exercise. Levels of messenger ribonucleic acid mRNA for collagens, noncollagenous matrix proteins, and growth factors were measured with real-time reverse transcription polymerase chain reaction...

  7. Isometric Contractions Are More Analgesic Than Isotonic Contractions for Patellar Tendon Pain : An In-Season Randomized Clinical Trial

    NARCIS (Netherlands)

    Rio, Ebonie; van Ark, Mathijs; Docking, Sean; Moseley, G. Lorimer; Kidgell, Dawson; Gaida, Jamie E.; van den Akker-Scheek, Inge; Zwerver, Johannes; Cook, Jill

    Objective: This study aimed to compare the immediate analgesic effects of 2 resistance programs in in-season athletes with patellar tendinopathy (PT). Resistance training is noninvasive, a principle stimulus for corticospinal and neuromuscular adaptation, and may be analgesic. Design: Within-season

  8. Faster Movement Speed Results in Greater Tendon Strain during the Loaded Squat Exercise

    Science.gov (United States)

    Earp, Jacob E.; Newton, Robert U.; Cormie, Prue; Blazevich, Anthony J.

    2016-01-01

    Introduction: Tendon dynamics influence movement performance and provide the stimulus for long-term tendon adaptation. As tendon strain increases with load magnitude and decreases with loading rate, changes in movement speed during exercise should influence tendon strain. Methods: Ten resistance-trained men [squat one repetition maximum (1RM) to body mass ratio: 1.65 ± 0.12] performed parallel-depth back squat lifts with 60% of 1RM load at three different speeds: slow fixed-tempo (TS: 2-s eccentric, 1-s pause, 2-s concentric), volitional-speed without a pause (VS) and maximum-speed jump (JS). In each condition joint kinetics, quadriceps tendon length (LT), patellar tendon force (FT), and rate of force development (RFDT) were estimated using integrated ultrasonography, motion-capture, and force platform recordings. Results: Peak LT, FT, and RFDT were greater in JS than TS (p < 0.05), however no differences were observed between VS and TS. Thus, moving at faster speeds resulted in both greater tendon stress and strain despite an increased RFDT, as would be predicted of an elastic, but not a viscous, structure. Temporal comparisons showed that LT was greater in TS than JS during the early eccentric phase (10–14% movement duration) where peak RFDT occurred, demonstrating that the tendon's viscous properties predominated during initial eccentric loading. However, during the concentric phase (61–70 and 76–83% movement duration) differing FT and similar RFDT between conditions allowed for the tendon's elastic properties to predominate such that peak tendon strain was greater in JS than TS. Conclusions: Based on our current understanding, there may be an additional mechanical stimulus for tendon adaptation when performing large range-of-motion isoinertial exercises at faster movement speeds. PMID:27630574

  9. Neglected locked vertical patellar dislocation

    Science.gov (United States)

    Gupta, Rakesh Kumar; Gupta, Vinay; Sangwan, Sukhbir Singh; Kamboj, Pradeep

    2012-01-01

    Patellar dislocations occurring about the vertical and horizontal axis are rare and irreducible. The neglected patellar dislocation is still rarer. We describe the clinical presentation and management of a case of neglected vertical patellar dislocation in a 6 year-old boy who sustained an external rotational strain with a laterally directed force to his knee. Initially the diagnosis was missed and 2 months later open reduction was done. The increased tension generated by the rotation of the lateral extensor retinaculum kept the patella locked in the lateral gutter even with the knee in full extension. Traumatic patellar dislocation with rotation around a vertical axis has been described earlier, but no such neglected case has been reported to the best of our knowledge. PMID:23162154

  10. Neglected locked vertical patellar dislocation

    Directory of Open Access Journals (Sweden)

    Rakesh Kumar Gupta

    2012-01-01

    Full Text Available Patellar dislocations occurring about the vertical and horizontal axis are rare and irreducible. The neglected patellar dislocation is still rarer. We describe the clinical presentation and management of a case of neglected vertical patellar dislocation in a 6 year-old boy who sustained an external rotational strain with a laterally directed force to his knee. Initially the diagnosis was missed and 2 months later open reduction was done. The increased tension generated by the rotation of the lateral extensor retinaculum kept the patella locked in the lateral gutter even with the knee in full extension. Traumatic patellar dislocation with rotation around a vertical axis has been described earlier, but no such neglected case has been reported to the best of our knowledge.

  11. Preoperative cryotherapy use in anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Koyonos, Loukas; Owsley, Kevin; Vollmer, Emily; Limpisvasti, Orr; Gambardella, Ralph

    2014-12-01

    Unrelieved postoperative pain may impair rehabilitation, compromise functional outcomes, and lead to patient dissatisfaction. Preemptive multimodal analgesic techniques may improve outcomes after surgery. We hypothesized that patients using preoperative cryotherapy plus a standardized postoperative treatment plan will have lower pain scores and require less pain medication compared with patients receiving a standardized postoperative treatment plan alone after arthroscopically assisted anterior cruciate ligament reconstruction (ACLR). A total of 53 consecutive patients undergoing arthroscopically assisted ACLR performed by one of seven surgeons were randomly assigned to one of two groups. Group 1 received no preoperative cryotherapy and group 2 received 30 to 90 minutes of preoperative cryotherapy to the operative leg using a commercial noncompressive cryotherapy unit. Visual analog scale pain scores and narcotic use were recorded for the first 4 days postoperatively. Total hours of cold therapy and continuous passive motion (CPM) use and highest degree of flexion achieved were recorded as well. Group 1 consisted of 26 patients (15 allograft Achilles tendon and 11 autograft bone patellar tendon bone [BPTB]), and group 2 consisted of 27 patients (16 allograft Achilles tendon and 11 autograft BPTB). Group 2 patients reported less pain (average 1.3 units, p cryotherapy, hours of CPM use, or maximum knee flexion achieved. Complications did not occur in either group. This is the first report we are aware of showing the postoperative effects of preoperative cryotherapy. Our results support the safety and efficacy of preoperative cryotherapy in a multimodal pain regimen for patients undergoing ACL reconstruction. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  12. Outcomes of Reintervention on the Autograft After Ross Procedure.

    Science.gov (United States)

    Kumar, S Ram; Bansal, Neeraj; Wells, Winfield J; Starnes, Vaughn A

    2016-11-01

    After a Ross procedure, a small subset of patients requires reintervention for autograft dilatation or valve insufficiency. We sought to determine the indications, nature, and outcomes of autograft reinterventions in the left ventricular outflow tract after a Ross procedure. We retrospectively reviewed the charts of 316 consecutive patients, age 4 days to 70 years, who underwent a Ross procedure at our institution. Of these, 47 patients (15%) required autograft reintervention during a median follow-up of 8.2 years. Forty-seven patients, median age 26 years (interquartile range [IQR], 14.4 to 44.8 years), 32 (68%) men, required autograft reintervention a median 5.5 years (IQR, 1.8 to 9.4 years) after a Ross procedure. In 47% (22 of 47 patients), the autograft valve could be salvaged (15 valve-sparing aortic replacements, 7 valve repairs). The remaining 53% underwent replacement of the root (10 mechanical, 5 homograft) or valve alone (7 mechanical, 3 bioprosthetic). Twenty patients presented without autograft root dilatation 1 year (IQR, 0.5 to 2.9 years) after Ross. Fifteen of them (75%) required valve replacement. The 27 patients who demonstrated root dilatation presented 6.9 years (IQR, 4.5 to 9.7 years; p Ross, and 17 (63%) of these valves could be spared (p = 0.01). There was no surgical mortality and 5 (11%) major morbidity events. Patients were followed up for 4.9 years (IQR, 2.1 to 7 years) after left ventricular outflow tract reintervention. For patients whose autograft valve could be spared, 3-, 5-, and 8-year freedom from valve replacement was 92%, 86%, and 86%, respectively. At last follow-up, only 1 patient had greater than mild aortic insufficiency, and all but 1 had normal ejection fraction. Autograft reintervention after a Ross appears to follow a bimodal distribution. Patients with primary autograft leaflet problems tend to present early without root dilatation and frequently require valve replacement. The autograft valve can be salvaged in the

  13. Eccentric Training for Tendon Healing After Acute Lesion: A Rat Model.

    Science.gov (United States)

    Kaux, Jean-François; Libertiaux, Vincent; Leprince, Pierre; Fillet, Marianne; Denoel, Vincent; Wyss, Clémence; Lecut, Christelle; Gothot, André; Le Goff, Caroline; Croisier, Jean-Louis; Crielaard, Jean-Michel; Drion, Pierre

    2017-05-01

    The tendon is a dynamic entity that remodels permanently. Platelet-rich plasma (PRP) injection has been shown to have a beneficial effect on tendon healing after lesion in rats. Furthermore, eccentric exercise seems to improve the mechanical quality of the tendon. A combination of PRP injection and eccentric training might be more effective than either treatment alone. Controlled laboratory study. Adult male rats were anesthetized, an incision was performed in the middle of their left patellar tendon and an injection of physiological fluid (PF) or homologous PRP was randomly made at the lesion level. The rats were then divided into 2 groups: the eccentric group, undergoing eccentric training 3 times a week, and the untrained group, without any training. Thus, 4 groups were compared. After 5 weeks, the tendons were removed and their ultimate tensile strength and energy were measured. Tendons were frozen for proteomic analyses when all biomechanical tests were completed. Statistical analysis was performed with linear mixed effect models. No significant difference was found between the treatments using PF injection or PRP injection alone. However, the value of the ultimate tensile force at rupture was increased by 4.5 N (108% of control, P = .006) when eccentric training was performed. An intragroup analysis revealed that eccentric training significantly improved the ultimate force values for the PRP group. Proteomic analysis revealed that eccentric training led to an increase in abundance of several cytoskeletal proteins in the PF group, while a decrease in abundance of enzymes of the glycolytic pathway occurred in the PRP-treated groups, indicating that this treatment might redirect the exercise-driven metabolic plasticity of the tendon. Eccentric training altered the metabolic plasticity of tendon and led to an improvement of injured tendon resistance regardless of the treatment injected (PF or PRP). This study demonstrates the necessity of eccentric rehabilitation

  14. Whey protein hydrolysate augments tendon and muscle hypertrophy independent of resistance exercise contraction mode.

    Science.gov (United States)

    Farup, J; Rahbek, S K; Vendelbo, M H; Matzon, A; Hindhede, J; Bejder, A; Ringgard, S; Vissing, K

    2014-10-01

    In a comparative study, we investigated the effects of maximal eccentric or concentric resistance training combined with whey protein or placebo on muscle and tendon hypertrophy. 22 subjects were allocated into either a high-leucine whey protein hydrolysate + carbohydrate group (WHD) or a carbohydrate group (PLA). Subjects completed 12 weeks maximal knee extensor training with one leg using eccentric contractions and the other using concentric contractions. Before and after training cross-sectional area (CSA) of m. quadriceps and patellar tendon CSA was quantified with magnetic resonance imaging and a isometric strength test was used to assess maximal voluntary contraction (MVC) and rate of force development (RFD). Quadriceps CSA increased by 7.3 ± 1.0% (P tendon CSA increased by 14.9 ± 3.1% (P effect of contraction mode. MVC and RFD increased by 15.6 ± 3.5% (P effects. In conclusion, high-leucine whey protein hydrolysate augments muscle and tendon hypertrophy following 12 weeks of resistance training - irrespective of contraction mode. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  15. Early integration of a bone plug in the femoral tunnel in rectangular tunnel ACL reconstruction with a bone-patellar tendon-bone graft: a prospective computed tomography analysis.

    Science.gov (United States)

    Suzuki, Tomoyuki; Shino, Konsei; Nakagawa, Shigeto; Nakata, Ken; Iwahashi, Takehiko; Kinugasa, Kazutaka; Otsubo, Hidenori; Yamashita, Toshihiko

    2011-12-01

    The purpose of this prospective study was to evaluate how early the bone plug was integrated into the rectangular femoral tunnel after anatomical ACL reconstruction using a bone-patellar tendon-bone (BTB) graft via a rectangular tunnel (RT BTB ACL-R). Twenty consecutive patients who had undergone the reconstruction procedure were evaluated by CT scans at 4 and 8 weeks postoperatively. In each scan, 30 slices for multiplanar reconstruction were collected parallel to the long axis of the parallelepiped femoral tunnel and perpendicular to the tendinous plane of the bone plug. Each slice was classified as "complete," indicating no visible gap between the plug and the tunnel wall or trabecular continuity or "incomplete," showing a visible gap. Bone plug-tunnel integration was evaluated as "excellent," "good," "fair," or "poor" for >20, 11-20, 5-10, and values at the anterior interface between the bone plug and the tunnel wall were also measured on both scans. The mean changes in CT value at 8 weeks were significantly lower than those at 4 weeks. This study shows that bone plug-femoral tunnel integration was almost complete by 8 weeks after surgery using RT BTB ACL-R.

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

    International Nuclear Information System (INIS)

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

    2010-01-01

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

  17. Effect of administration of oral contraceptives in vivo on collagen synthesis in tendon and muscle connective tissue in young women

    DEFF Research Database (Denmark)

    Hansen, M; Miller, B F; Holm, L

    2009-01-01

    concentrations of estradiol and progesterone (control, n = 12). Subjects performed 1 h of one-legged kicking exercise. The next day collagen fractional synthesis rates (FSR) in tendon and muscle connective tissue were measured after a flooding dose of [(13)C]proline followed by biopsies from the patellar tendon......, body composition, and exercise-training status were included. The two groups were either habitual users of oral contraceptives exposed to a high concentration of synthetic estradiol and progestogens (OC, n = 11), or non-OC-users tested in the follicular phase of the menstrual cycle characterized by low...... bioavailability of IGF-I in OC. In conclusion, synthetic female sex hormones administered as OC had an inhibiting effect on collagen synthesis in tendon, bone, and muscle connective tissue, which may be related to a lower bioavailability of IGF-I....

  18. Trends in primary and revision anterior cruciate ligament reconstruction among National Basketball Association team physicians.

    Science.gov (United States)

    Mall, Nathan A; Abrams, Geoffrey D; Azar, Frederick M; Traina, Steve M; Allen, Answorth A; Parker, Richard; Cole, Brian J

    2014-06-01

    Anterior cruciate ligament (ACL) tears are common in athletes. Techniques and methods of treatment for these injuries continue to vary among surgeons. Thirty National Basketball Association (NBA) team physicians were surveyed during the NBA Pre-Draft Combine. Survey questions involved current and previous practice methods of primary and revision ACL reconstruction, including technique, graft choice, rehabilitation, and treatment of combined ACL and medial collateral ligament injuries. Descriptive parametric statistics, Fisher exact test, and logistic regression were used, and significance was set at α = 0.05. All 30 team physicians completed the survey. Eighty-seven percent indicated they use autograft (81% bone-patellar tendon-bone) for primary ACL reconstruction in NBA athletes, and 43% indicated they use autograft for revision cases. Fourteen surgeons (47%) indicated they use an anteromedial portal (AMP) for femoral tunnel drilling, whereas 5 years earlier only 4 (13%) used this technique. There was a significant (P = .009) positive correlation between fewer years in practice and AMP use. NBA team physicians' use of an AMP for femoral tunnel drilling has increased over the past 5 years.

  19. Ultrasound-guided sclerosis of neovessels in painful chronic patellar tendinopathy: a randomized controlled trial.

    Science.gov (United States)

    Hoksrud, Aasne; Ohberg, Lars; Alfredson, Håkan; Bahr, Roald

    2006-11-01

    Color Doppler ultrasound examination frequently reveals neovascularization in chronic painful Achilles and patellar tendinopathy. Sclerosing the area with vascular ingrowth using polidocanol has shown promising clinical results in patients with Achilles tendinopathy. To investigate sclerosing treatment using polidocanol on a group of elite athletes with patellar tendinopathy. Randomized controlled trial/cross-over study; Level of evidence, 1. The authors recruited 33 patients (42 tendons), mainly from the Norwegian elite divisions in basketball, team handball, and volleyball. Seventeen patients (23 knees) were randomized to the treatment group (polidocanol injections in the area of neovascularization) and 16 patients (20 knees) to the control group (similar injections with lidocaine/epinephrine). After 4 months of treatment, the control group was crossed over to active treatment. Pain and function were recorded using the Victorian Institute of Sport Assessment score before the start of treatment and 4, 8, and 12 months after the first injection. Victorian Institute of Sport Assessment scores between groups were compared using multivariate analysis of variance for repeated measures. The treatment group reported a significant improvement in Victorian Institute of Sport Assessment score from 51 to 62 after 4 months; there was no change for the control group (group by time interaction, P = .052). After 8 months, when the control group had also received active treatment with polidocanol, they had a greater improvement in Victorian Institute of Sport Assessment score (58-79) than did the treatment group (54-70; group by time interaction, P = .022; time effect, P patellar tendinopathy.

  20. Increase in tendon protein synthesis in response to insulin-like growth factor-I is preserved in elderly men

    DEFF Research Database (Denmark)

    Nielsen, Rie Harboe; Holm, Lars; Malmgaard-Clausen, Nikolaj Mølkjær

    2014-01-01

    the in vivo IGF-I stimulation of tendon protein synthesis in elderly compared with young men. We injected IGF-I in the patellar tendons of young (n = 11, 20-30 yr of age) and old (n = 11, 66-75 yr of age) men, and the acute fractional synthesis rate (FSR) of tendon protein was measured with the stable isotope.......01). This increase in protein synthesis was seen in both young and old men, with no differences between age groups. The old group had markedly lower serum IGF-I levels compared with young (165 ± 17 vs. 281 ± 27 ng/ml, P protein synthesis in both young and old men...... technique and compared with the contralateral side (injected with saline as control). We found that tendons injected with IGF-I had significantly higher protein FSR compared with controls (old group: 0.018 ± 0.015 vs. 0.008 ± 0.008, young group: 0.016 ± 0.009 vs. 0.009 ± 0.006%/h, mean ± SE, P

  1. The TOPGAME-study: effectiveness of extracorporeal shockwave therapy in jumping athletes with patellar tendinopathy. Design of a randomised controlled trial.

    Science.gov (United States)

    Zwerver, Johannes; Verhagen, Evert; Hartgens, Fred; van den Akker-Scheek, Inge; Diercks, Ron L

    2010-02-08

    Patellar tendinopathy is a major problem for many athletes, especially those involved in jumping activities. Despite its frequency and negative impact on athletic careers, no evidence-based guidelines for management of this overuse injury exist. Since functional outcomes of conservative and surgical treatments remain suboptimal, new diagnostic and therapeutic strategies have to be developed and evaluated. Extracorporeal shockwave therapy (ESWT) appears to be a promising treatment in patients with chronic patellar tendinopathy. ESWT is most often applied after the known conservative treatments have failed. However, its effectiveness as primary therapy has not been studied in athletes who keep playing sports despite having patellar tendon pain. The aim of this study is to determine the effectiveness of ESWT in athletes with patellar tendinopathy who are still in training and competition. The TOPGAME-study (Tendinopathy of Patella Groningen Amsterdam Maastricht ESWT) is a multicentre two-armed randomised controlled trial with blinded participants and outcome assessors, in which the effectiveness of patient-guided focussed ESWT treatment (compared to placebo ESWT) on pain reduction and recovery of function in athletes with patellar tendinopathy will be investigated. Participants are volleyball, handball and basketball players with symptoms of patellar tendinopathy for a minimum of 3 to a maximum duration of 12 months who are still able to train and compete. The intervention group receives three patient-guided focussed medium-energy density ESWT treatments without local anaesthesia at a weekly interval in the first half of the competition. The control group receives placebo treatment. The follow-up measurements take place 1, 12 and 22 weeks after the final ESWT or placebo treatment, when athletes are still in competition. Primary outcome measure is the VISA-P (Victorian Institute of Sport Assessment - patella) score. Data with regard to pain during function tests (jump

  2. The TOPGAME-study: effectiveness of extracorporeal shockwave therapy in jumping athletes with patellar tendinopathy. Design of a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Diercks Ron L

    2010-02-01

    Full Text Available Abstract Background Patellar tendinopathy is a major problem for many athletes, especially those involved in jumping activities. Despite its frequency and negative impact on athletic careers, no evidence-based guidelines for management of this overuse injury exist. Since functional outcomes of conservative and surgical treatments remain suboptimal, new diagnostic and therapeutic strategies have to be developed and evaluated. Extracorporeal shockwave therapy (ESWT appears to be a promising treatment in patients with chronic patellar tendinopathy. ESWT is most often applied after the known conservative treatments have failed. However, its effectiveness as primary therapy has not been studied in athletes who keep playing sports despite having patellar tendon pain. The aim of this study is to determine the effectiveness of ESWT in athletes with patellar tendinopathy who are still in training and competition. Methods/design The TOPGAME-study (Tendinopathy of Patella Groningen Amsterdam Maastricht ESWT is a multicentre two-armed randomised controlled trial with blinded participants and outcome assessors, in which the effectiveness of patient-guided focussed ESWT treatment (compared to placebo ESWT on pain reduction and recovery of function in athletes with patellar tendinopathy will be investigated. Participants are volleyball, handball and basketball players with symptoms of patellar tendinopathy for a minimum of 3 to a maximum duration of 12 months who are still able to train and compete. The intervention group receives three patient-guided focussed medium-energy density ESWT treatments without local anaesthesia at a weekly interval in the first half of the competition. The control group receives placebo treatment. The follow-up measurements take place 1, 12 and 22 weeks after the final ESWT or placebo treatment, when athletes are still in competition. Primary outcome measure is the VISA-P (Victorian Institute of Sport Assessment - patella score

  3. The TOPSHOCK study: Effectiveness of radial shockwave therapy compared to focused shockwave therapy for treating patellar tendinopath - design of a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Diercks Ron L

    2011-10-01

    Full Text Available Abstract Background Patellar tendinopathy is a chronic overuse injury of the patellar tendon that is especially prevalent in people who are involved in jumping activities. Extracorporeal Shockwave Therapy is a relatively new treatment modality for tendinopathies. It seems to be a safe and promising part of the rehabilitation program for patellar tendinopathy. Extracorporeal Shockwave Therapy originally used focused shockwaves. Several years ago a new kind of shockwave therapy was introduced: radial shockwave therapy. Studies that investigate the effectiveness of radial shockwave therapy as treatment for patellar tendinopathy are scarce. Therefore the aim of this study is to compare the effectiveness of focussed shockwave therapy and radial shockwave therapy as treatments for patellar tendinopathy. Methods/design The TOPSHOCK study (Tendinopathy Of Patella SHOCKwave is a two-armed randomised controlled trial in which the effectiveness of focussed shockwave therapy and radial shockwave therapy are directly compared. Outcome assessors and patients are blinded as to which treatment is given. Patients undergo three sessions of either focused shockwave therapy or radial shockwave therapy at 1-week intervals, both in combination with eccentric decline squat training. Follow-up measurements are scheduled just before treatments 2 and 3, and 1, 4, 7 and 12 weeks after the final treatment. The main outcome measure is the Dutch VISA-P questionnaire, which asks for pain, function and sports participation in subjects with patellar tendinopathy. Secondary outcome measures are pain determined with a VAS during ADL, sports and decline squats, rating of subjective improvement and overall satisfaction with the treatment. Patients will also record their sports activities, pain during and after these activities, and concurrent medical treatment on a weekly basis in a web-based diary. Results will be analysed according to the intention-to-treat principle. Discussion

  4. The TOPSHOCK study: effectiveness of radial shockwave therapy compared to focused shockwave therapy for treating patellar tendinopath - design of a randomised controlled trial.

    Science.gov (United States)

    van der Worp, Henk; Zwerver, Johannes; van den Akker-Scheek, Inge; Diercks, Ron L

    2011-10-11

    Patellar tendinopathy is a chronic overuse injury of the patellar tendon that is especially prevalent in people who are involved in jumping activities. Extracorporeal Shockwave Therapy is a relatively new treatment modality for tendinopathies. It seems to be a safe and promising part of the rehabilitation program for patellar tendinopathy. Extracorporeal Shockwave Therapy originally used focused shockwaves. Several years ago a new kind of shockwave therapy was introduced: radial shockwave therapy. Studies that investigate the effectiveness of radial shockwave therapy as treatment for patellar tendinopathy are scarce. Therefore the aim of this study is to compare the effectiveness of focussed shockwave therapy and radial shockwave therapy as treatments for patellar tendinopathy. The TOPSHOCK study (Tendinopathy Of Patella SHOCKwave) is a two-armed randomised controlled trial in which the effectiveness of focussed shockwave therapy and radial shockwave therapy are directly compared. Outcome assessors and patients are blinded as to which treatment is given. Patients undergo three sessions of either focused shockwave therapy or radial shockwave therapy at 1-week intervals, both in combination with eccentric decline squat training. Follow-up measurements are scheduled just before treatments 2 and 3, and 1, 4, 7 and 12 weeks after the final treatment. The main outcome measure is the Dutch VISA-P questionnaire, which asks for pain, function and sports participation in subjects with patellar tendinopathy. Secondary outcome measures are pain determined with a VAS during ADL, sports and decline squats, rating of subjective improvement and overall satisfaction with the treatment. Patients will also record their sports activities, pain during and after these activities, and concurrent medical treatment on a weekly basis in a web-based diary. Results will be analysed according to the intention-to-treat principle. The TOPSHOCK study is the first randomised controlled trial that

  5. Bifocal osseous avulsion of the patellar tendon from the distal patella and tibial tuberosity in a child

    DEFF Research Database (Denmark)

    Lykke Hermansen, Lars; Gade Freund, Knud

    2016-01-01

    This case report describes a 12-year-old boy, who suffered an injury to the right knee in a skateboard accident. Radiographs and surgery confirmed the extremely rare bifocal avulsion fracture including the distal patellar pole and tibial tuberosity. Open reduction and internal fixation was accomp...... was accomplished, and 4-month follow-up demonstrated a good outcome. © 2015, European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA)....

  6. Computed tomographic evaluation of realignment surgery for patellar subluxation

    International Nuclear Information System (INIS)

    Inoue, Masahiro; Shino, Konsei; Maeda, Akira; Nakata, Ken; Ono, Hiroo.

    1994-01-01

    Forty-two patients with patellar subluxation underwent realignment surgery of the knee extensor mechanism. The surgery included, lateral release, advancement and reefing of the vastus medialis and the medial capsule and tibial tubercle transfer (Elmslie-Trillat procedure). The effect of surgery was evaluated using computed tomograms of the pre- and post-operative knees at 0, 15, 30 and 45 degrees of knee flexion. The degree of patellofemoral incongruence on CT was expressed using two parameters of patellar tilt and patellar shift. Thirty-three volunteers without any patello-femoral symptoms served as controls. Postoperatively both the patellar tilt and the patellar shift improved significantly. The average patellar tilt and the patellar shift of the patient group at 45 degrees were comparable with those of controls. However, it was found by CT that the realignment surgery was less effective between 0 and 30 degrees of knee flexion. (author)

  7. Computed tomographic evaluation of realignment surgery for patellar subluxation

    Energy Technology Data Exchange (ETDEWEB)

    Inoue, Masahiro (Kansai Rosai Hospital, Amagasaki (Japan)); Shino, Konsei; Maeda, Akira; Nakata, Ken; Ono, Hiroo

    1994-01-01

    Forty-two patients with patellar subluxation underwent realignment surgery of the knee extensor mechanism. The surgery included, lateral release, advancement and reefing of the vastus medialis and the medial capsule and tibial tubercle transfer (Elmslie-Trillat procedure). The effect of surgery was evaluated using computed tomograms of the pre- and post-operative knees at 0, 15, 30 and 45 degrees of knee flexion. The degree of patellofemoral incongruence on CT was expressed using two parameters of patellar tilt and patellar shift. Thirty-three volunteers without any patello-femoral symptoms served as controls. Postoperatively both the patellar tilt and the patellar shift improved significantly. The average patellar tilt and the patellar shift of the patient group at 45 degrees were comparable with those of controls. However, it was found by CT that the realignment surgery was less effective between 0 and 30 degrees of knee flexion. (author).

  8. Conjunctival autograft for pterygium

    Science.gov (United States)

    Clearfield, Elizabeth; Muthappan, Valliammai; Wang, Xue; Kuo, Irene C

    2016-01-01

    Background A pterygium is a fleshy, wing-shaped growth from the conjunctiva, crossing over the limbus onto the cornea. Prevalence ranges widely around the world. Evidence suggests that ultraviolet light is a major contributor in the formation of pterygia. Pterygia impair vision, limit eye movements, and can cause eye irritation, foreign body sensation, and dryness. In some susceptible patients, the pterygium can grow over the entire corneal surface, blocking the visual axis. Surgery is the only effective treatment for pterygium, though recurrences are common. With simple excision techniques (that is, excising the pterygium and leaving bare sclera), the risk of recurrence has been reported to be upwards of 80%. Pterygium excision combined with a tissue graft has a lower risk of recurrence. In conjunctival autograft surgery, conjunctival tissue from another part of the person’s eye along with limbal tissue is resected in one piece and used to cover the area from which the pterygium was excised. Another type of tissue graft surgery for pterygium is amniotic membrane graft, whereby a piece of donor amniotic membrane is fixed to the remaining limbus and bare sclera area after the pterygium has been excised. Objectives The objective of this review was to assess the safety and effectiveness of conjunctival autograft (with or without adjunctive therapy) compared with amniotic membrane graft (with or without adjunctive therapy) for pterygium. We also planned to determine whether use of MMC yielded better surgical results and to assess the direct and indirect comparative costs of these procedures. Search methods We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (Issue 10, 2015), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to November 2015), EMBASE (January 1980 to November 2015), PubMed (1948 to November 2015), Latin American and Caribbean Health Sciences Literature

  9. Effectiveness of the Intratissue Percutaneous Electrolysis (EPI®) technique and isoinertial eccentric exercise in the treatment of patellar tendinopathy at two years follow-up.

    Science.gov (United States)

    Abat, Ferran; Diesel, Wayne-J; Gelber, Pablo-E; Polidori, Fernando; Monllau, Joan-Carles; Sanchez-Ibañez, Jose-Manuel

    2014-04-01

    to show the effect of Intratissue Percutaneous Electrolysis (EPI®) combined with eccentric programme in the treatment of patellar tendinopathy. prospective study of 33 athlete-patients consecutively treated for insertional tendinopathy with Intratissue Percutaneous Electrolysis (EPI®) and followed for 2 years. Functional assessment was performed at the first visit, at three months and two years with the Tegner scale and VISA-P. an average improvement in the VISA-P of 35 points was obtained. The mean duration of treatment was 4.5 weeks. Some 78.8% of the patients returned to the same level of physical activity as before the injury by the end of treatment, reaching 100% at two years. intratissue percutaneous electrolysis (EPI®) combined with an eccentric-based rehab program offers excellent results in terms of the clinical and functional improvement of the patellar tendon with low morbidity in a short-term period. Therapy, level 4.

  10. Moderate Exercise Mitigates the Detrimental Effects of Aging on Tendon Stem Cells.

    Science.gov (United States)

    Zhang, Jianying; Wang, James H-C

    2015-01-01

    Aging is known to cause tendon degeneration whereas moderate exercise imparts beneficial effects on tendons. Since stem cells play a vital role in maintaining tissue integrity, in this study we aimed to define the effects of aging and moderate exercise on tendon stem/progenitor cells (TSCs) using in vitro and in vivo models. TSCs derived from aging mice (9 and 24 months) proliferated significantly slower than TSCs obtained from young mice (2.5 and 5 months). In addition, expression of the stem cell markers Oct-4, nucleostemin (NS), Sca-1 and SSEA-1 in TSCs decreased in an age-dependent manner. Interestingly, moderate mechanical stretching (4%) of aging TSCs in vitro significantly increased the expression of the stem cell marker, NS, but 8% stretching decreased NS expression. Similarly, 4% mechanical stretching increased the expression of Nanog, another stem cell marker, and the tenocyte-related genes, collagen I and tenomodulin. However, 8% stretching increased expression of the non-tenocyte-related genes, LPL, Sox-9 and Runx-2, while 4% stretching had minimal effects on the expression of these genes. In the in vivo study, moderate treadmill running (MTR) of aging mice (9 months) resulted in the increased proliferation rate of aging TSCs in culture, decreased lipid deposition, proteoglycan accumulation and calcification, and increased the expression of NS in the patellar tendons. These findings indicate that while aging impairs the proliferative ability of TSCs and reduces their stemness, moderate exercise can mitigate the deleterious effects of aging on TSCs and therefore may be responsible for decreased aging-induced tendon degeneration.

  11. Tendon tissue engineering: Adipose 1 derived stem cell and GDF-5 mediated regeneration using electrospun matrix systems

    Science.gov (United States)

    James, R; Kumbar, S G; Laurencin, C T; Balian, G; Chhabra, A B

    2011-01-01

    Tendon tissue engineering with a biomaterial scaffold that mimics the tendon extracellular matrix (ECM) and is biomechanically suitable when combined with readily available autologous cells may provide successful regeneration of defects in tendon. Current repair strategies using suitable autografts and freeze-dried allografts lead to a slow repair process that is sub-optimal and fails to restore function, particularly in difficult clinical situations such as zone II flexor tendon injuries of the hand. We have investigated the effect of GDF-5 on cell proliferation and gene expression by primary rat adipose-derived stromal cells (ADSCs) that were cultured on poly(DL-lactide-co-glycolide) PLAGA fiber scaffold and compared to PLAGA 2D film scaffold. The electrospun scaffold mimics the collagen fiber bundles present in native tendon tissue, and supports the adhesion and proliferation of multipotent ADSCs. Gene expression of scleraxis, the neotendon marker was upregulated 7 – 8 fold at 1 week with GDF-5 treatment when cultured on 3D electrospun scaffold, and was significantly higher at 2 weeks compared to 2D films with or without GDF-5 treatment. Expression of the genes that encode the major tendon ECM protein, collagen type I, was increased by 4 fold starting at 1 week on treatment with 100ng/mL GDF-5, and at all time points the expression was significantly higher compared to 2D films irrespective of GDF-5 treatment. Thus stimulation with GDF-5 can modulate primary ADSCs on PLAGA fiber scaffold to produce a soft, collagenous musculoskeletal tissue that fulfills the need for tendon regeneration. PMID:21436509

  12. Patellar Tendinopathy: Diagnosis and Treatment.

    Science.gov (United States)

    Figueroa, David; Figueroa, Francisco; Calvo, Rafael

    2016-12-01

    Patellar tendinopathy is a common cause of pain in athletes' knees. Historically, it has been related to jumping sports, such as volleyball and basketball. Repetitive jumping generates a considerable load of energy in the extensor mechanism, leading to symptoms. The main pathophysiologic phenomenon in patellar tendinopathy is tendinosis, which is a degenerative disorder rather than an inflammatory disorder; therefore, the other popular term for this disease, tendinitis, is not appropriate. The nonsurgical treatment of patellar tendinopathy is focused on eccentric exercises and often has good results. Other experimental options, with variable levels of evidence, are available for recalcitrant cases. Surgical treatment is indicated for cases that are refractory to nonsurgical treatment. Open or arthroscopic surgery can be performed; the two methods are comparable, but arthroscopic surgery results in a faster recovery time.

  13. Tendon tissue engineering: adipose-derived stem cell and GDF-5 mediated regeneration using electrospun matrix systems

    International Nuclear Information System (INIS)

    James, R; Kumbar, S G; Laurencin, C T; Balian, G; Chhabra, A B

    2011-01-01

    Tendon tissue engineering with a biomaterial scaffold that mimics the tendon extracellular matrix (ECM) and is biomechanically suitable, and when combined with readily available autologous cells, may provide successful regeneration of defects in tendon. Current repair strategies using suitable autografts and freeze-dried allografts lead to a slow repair process that is sub-optimal and fails to restore function, particularly in difficult clinical situations such as zone II flexor tendon injuries of the hand. We have investigated the effect of GDF-5 on cell proliferation and gene expression by primary rat adipose-derived stem cells (ADSCs) that were cultured on a poly(dl-lactide-co-glycolide) PLAGA fiber scaffold and compared to a PLAGA 2D film scaffold. The electrospun scaffold mimics the collagen fiber bundles present in native tendon tissue, and supports the adhesion and proliferation of multipotent ADSCs. Gene expression of scleraxis, the neotendon marker, was upregulated seven- to eightfold at 1 week with GDF-5 treatment when cultured on a 3D electrospun scaffold, and was significantly higher at 2 weeks compared to 2D films with or without GDF-5 treatment. Expression of the genes that encode the major tendon ECM protein, collagen type I, was increased by fourfold starting at 1 week on treatment with 100 ng mL -1 GDF-5, and at all time points the expression was significantly higher compared to 2D films irrespective of GDF-5 treatment. Thus stimulation with GDF-5 can modulate primary ADSCs on a PLAGA fiber scaffold to produce a soft, collagenous musculoskeletal tissue that fulfills the need for tendon regeneration.

  14. Tendon tissue engineering: adipose-derived stem cell and GDF-5 mediated regeneration using electrospun matrix systems.

    Science.gov (United States)

    James, R; Kumbar, S G; Laurencin, C T; Balian, G; Chhabra, A B

    2011-04-01

    Tendon tissue engineering with a biomaterial scaffold that mimics the tendon extracellular matrix (ECM) and is biomechanically suitable, and when combined with readily available autologous cells, may provide successful regeneration of defects in tendon. Current repair strategies using suitable autografts and freeze-dried allografts lead to a slow repair process that is sub-optimal and fails to restore function, particularly in difficult clinical situations such as zone II flexor tendon injuries of the hand. We have investigated the effect of GDF-5 on cell proliferation and gene expression by primary rat adipose-derived stem cells (ADSCs) that were cultured on a poly(DL-lactide-co-glycolide) PLAGA fiber scaffold and compared to a PLAGA 2D film scaffold. The electrospun scaffold mimics the collagen fiber bundles present in native tendon tissue, and supports the adhesion and proliferation of multipotent ADSCs. Gene expression of scleraxis, the neotendon marker, was upregulated seven- to eightfold at 1 week with GDF-5 treatment when cultured on a 3D electrospun scaffold, and was significantly higher at 2 weeks compared to 2D films with or without GDF-5 treatment. Expression of the genes that encode the major tendon ECM protein, collagen type I, was increased by fourfold starting at 1 week on treatment with 100 ng mL(-1) GDF-5, and at all time points the expression was significantly higher compared to 2D films irrespective of GDF-5 treatment. Thus stimulation with GDF-5 can modulate primary ADSCs on a PLAGA fiber scaffold to produce a soft, collagenous musculoskeletal tissue that fulfills the need for tendon regeneration.

  15. Tendon tissue engineering: adipose-derived stem cell and GDF-5 mediated regeneration using electrospun matrix systems

    Energy Technology Data Exchange (ETDEWEB)

    James, R [Department of Biomedical Engineering, University of Virginia, Charlottesville, VA 22908 (United States); Kumbar, S G; Laurencin, C T [Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT 06030 (United States); Balian, G; Chhabra, A B, E-mail: ac2h@hscmail.mcc.virginia.edu [Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA 22908 (United States)

    2011-04-15

    Tendon tissue engineering with a biomaterial scaffold that mimics the tendon extracellular matrix (ECM) and is biomechanically suitable, and when combined with readily available autologous cells, may provide successful regeneration of defects in tendon. Current repair strategies using suitable autografts and freeze-dried allografts lead to a slow repair process that is sub-optimal and fails to restore function, particularly in difficult clinical situations such as zone II flexor tendon injuries of the hand. We have investigated the effect of GDF-5 on cell proliferation and gene expression by primary rat adipose-derived stem cells (ADSCs) that were cultured on a poly(dl-lactide-co-glycolide) PLAGA fiber scaffold and compared to a PLAGA 2D film scaffold. The electrospun scaffold mimics the collagen fiber bundles present in native tendon tissue, and supports the adhesion and proliferation of multipotent ADSCs. Gene expression of scleraxis, the neotendon marker, was upregulated seven- to eightfold at 1 week with GDF-5 treatment when cultured on a 3D electrospun scaffold, and was significantly higher at 2 weeks compared to 2D films with or without GDF-5 treatment. Expression of the genes that encode the major tendon ECM protein, collagen type I, was increased by fourfold starting at 1 week on treatment with 100 ng mL{sup -1} GDF-5, and at all time points the expression was significantly higher compared to 2D films irrespective of GDF-5 treatment. Thus stimulation with GDF-5 can modulate primary ADSCs on a PLAGA fiber scaffold to produce a soft, collagenous musculoskeletal tissue that fulfills the need for tendon regeneration.

  16. The differential effects of leukocyte-containing and pure platelet-rich plasma (PRP) on tendon stem/progenitor cells - implications of PRP application for the clinical treatment of tendon injuries.

    Science.gov (United States)

    Zhou, Yiqin; Zhang, Jianying; Wu, Haishan; Hogan, MaCalus V; Wang, James H-C

    2015-09-15

    Platelet-rich plasma (PRP) is widely used to treat tendon injuries in clinics. These PRP preparations often contain white blood cells or leukocytes, and the precise cellular effects of leukocyte-rich PRP (L-PRP) on tendons are not well defined. Therefore, in this study, we determined the effects of L-PRP on tendon stem/progenitor cells (TSCs), which play a key role in tendon homeostasis and repair. TSCs isolated from the patellar tendons of rabbits were treated with L-PRP or P-PRP (pure PRP without leukocytes) in vitro, followed by measuring cell proliferation, stem cell marker expression, inflammatory gene expression, and anabolic and catabolic protein expression by using immunostaining, quantitative real-time polymerase chain reaction, Western blot, and enzyme-linked immunosorbent assay, respectively. Cell proliferation was induced by both L-PRP and P-PRP in a dose-dependent manner with maximum proliferation at a 10 % PRP dose. Both PRP treatments also induced differentiation of TSCs into active tenocytes. Nevertheless, the two types of PRP largely differed in several effects exerted on TSCs. L-PRP induced predominantly catabolic and inflammatory changes in differentiated tenocytes; its treatment increased the expression of catabolic marker genes, matrix metalloproteinase-1 (MMP-1), MMP-13, interleukin-1beta (IL-1β), IL-6 and tumor necrosis factor-alpha (TNF-α), and their respective protein expression and prostaglandin E2 (PGE 2) production. In contrast, P-PRP mainly induced anabolic changes; that is, P-PRP increased the gene expression of anabolic genes, alpha-smooth muscle actin (α-SMA), collagen types I and III. These findings indicate that, while both L-PRP and P-PRP appear to be "safe" in inducing TSC differentiation into active tenocytes, L-PRP may be detrimental to the healing of injured tendons because it induces catabolic and inflammatory effects on tendon cells and may prolong the effects in healing tendons. On the other hand, when P-PRP is used to

  17. Impact of oral contraceptive use and menstrual phases on patellar tendon morphology, biochemical composition and biomechanical properties in female athletes

    DEFF Research Database (Denmark)

    Hansen, Mette Damborg; Couppe, Christian; Hansen, Christina

    2013-01-01

    Introduction: Gender differences exist with regards to ligament and tendon injuries. Lower collagen synthesis has been observed in exercising females vs. males, and in users of oral contraceptives (OC) vs non-users, but it is unknown if OC will influence tendon biomechanics of females undergoing...

  18. Teaching enthesis ultrasound: experience of an ultrasound training workshop.

    Science.gov (United States)

    Miguel, Cláudia; De Miguel, Eugenio; Batlle-Gualda, Enrique; Rejón, Eduardo; Lojo, Leticia

    2012-12-01

    To evaluate a standardised enthesis ultrasound training method, a workshop was conducted to train rheumatologists on enthesis ultrasound. After a theoretical session about ultrasound elementary enthesis lesions (changes in tendon architecture/thickness, bone proliferation/erosion, bursitis or Doppler signal), a reading exercise of 28 entheses' ultrasonographic images (plantar fasciae, Achilles, origin and insertion of patellar tendon) was completed. Participants scored through an electronic multiple-choice device with six possible lesions in each enthesis. To assess the adequacy and efficacy of the workshop, we explored the following: (1) subjective outcomes: a 12-item structured satisfaction questionnaire (graded 1-5 using Likert scale) and (2) objective outcomes of reliability: sensitivity (Se), specificity (Sp) and percentage of correctly classified cases (CC). Forty-nine participants attended the workshop. The satisfaction questionnaire demonstrated a 4.7 mean global value. The inter-reader Kappa reliability coefficient was moderate for the plantar fascia (0.47), Achilles tendon (0.47), and distal patellar tendons (0.50) and good for the proximal patellar tendon (0.63). The whole group means comparing to teachers' consensus were as follows: (a) plantar fascia: Se, 73.2%; Sp, 87.7%; CC, 83.3%; (b) Achilles: Se, 66.9%; Sp, 85.0%; CC, 79.5%; (c) distal patellar tendon: Se, 74.6%; Sp, 85.3%; CC, 82.1%; and (d) proximal patellar tendon: Se, 82.2%; Sp, 90.6%; CC, 88%. The proposed learning method seemed to be simple, easily performed, effective and well accepted by the target audience.

  19. Patellofemoral arthrodesis as pain relief in extreme patella alta

    NARCIS (Netherlands)

    Venkatesan, S.; Kampen, A. van

    2014-01-01

    PURPOSE: There is no golden standard management for neglected, chronic patellar tendon rupture as they are fairly rare. Nevertheless, accompanying pain can be highly debilitating. By presenting a case of patellar tendon repair, the exceptional results of a patellofemoral arthrodesis are described.

  20. Characterization of calcium and zinc spatial distributions at the fibrocartilage zone of bone–tendon junction by synchrotron radiation-based micro X-ray fluorescence analysis combined with backscattered electron imaging

    International Nuclear Information System (INIS)

    Lu, Hongbin; Chen, Can; Wang, Zhanwen; Qu, Jin; Xu, Daqi; Wu, Tianding; Cao, Yong; Zhou, Jingyong; Zheng, Cheng; Hu, Jianzhong

    2015-01-01

    Tendon attaches to bone through a functionally graded fibrocartilage zone, including uncalcified fibrocartilage (UF), tidemark (TM) and calcified fibrocartilage (CF). This transition zone plays a pivotal role in relaxing load transfer between tendon and bone, and serves as a boundary between otherwise structurally and functionally distinct tissue types. Calcium and zinc are believed to play important roles in the normal growth, mineralization, and repair of the fibrocartilage zone of bone–tendon junction (BTJ). However, spatial distributions of calcium and zinc at the fibrocartilage zone of BTJ and their distribution–function relationship are not totally understood. Thus, synchrotron radiation-based micro X-ray fluorescence analysis (SR-μXRF) in combination with backscattered electron imaging (BEI) was employed to characterize the distributions of calcium and zinc at the fibrocartilage zone of rabbit patella–patellar tendon complex (PPTC). For the first time, the unique distributions of calcium and zinc at the fibrocartilage zone of the PPTC were clearly mapped by this method. The distributions of calcium and zinc at the fibrocartilage zone of the PPTC were inhomogeneous. A significant accumulation of zinc was exhibited in the transition region between UF and CF. The highest zinc content (3.17 times of that of patellar tendon) was found in the TM of fibrocartilage zone. The calcium content began to increase near the TM and increased exponentially across the calcified fibrocartilage region towards the patella. The highest calcium content (43.14 times of that of patellar tendon) was in the transitional zone of calcified fibrocartilage region and the patella, approximately 69 μm from the location with the highest zinc content. This study indicated, for the first time, that there is a differential distribution of calcium and zinc at the fibrocartilage zone of PPTC. These observations reveal new insights into region-dependent changes across the fibrocartilage

  1. Characterization of calcium and zinc spatial distributions at the fibrocartilage zone of bone–tendon junction by synchrotron radiation-based micro X-ray fluorescence analysis combined with backscattered electron imaging

    Energy Technology Data Exchange (ETDEWEB)

    Lu, Hongbin; Chen, Can; Wang, Zhanwen; Qu, Jin; Xu, Daqi [Department of Sports Medicine, Research Center of Sports Medicine, Xiangya Hospital, Central South University, Changsha 410008 (China); Wu, Tianding; Cao, Yong [Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha 410008 (China); Zhou, Jingyong; Zheng, Cheng [Department of Sports Medicine, Research Center of Sports Medicine, Xiangya Hospital, Central South University, Changsha 410008 (China); Hu, Jianzhong, E-mail: jianzhonghu@hotmail.com [Department of Sports Medicine, Research Center of Sports Medicine, Xiangya Hospital, Central South University, Changsha 410008 (China); Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha 410008 (China)

    2015-09-01

    Tendon attaches to bone through a functionally graded fibrocartilage zone, including uncalcified fibrocartilage (UF), tidemark (TM) and calcified fibrocartilage (CF). This transition zone plays a pivotal role in relaxing load transfer between tendon and bone, and serves as a boundary between otherwise structurally and functionally distinct tissue types. Calcium and zinc are believed to play important roles in the normal growth, mineralization, and repair of the fibrocartilage zone of bone–tendon junction (BTJ). However, spatial distributions of calcium and zinc at the fibrocartilage zone of BTJ and their distribution–function relationship are not totally understood. Thus, synchrotron radiation-based micro X-ray fluorescence analysis (SR-μXRF) in combination with backscattered electron imaging (BEI) was employed to characterize the distributions of calcium and zinc at the fibrocartilage zone of rabbit patella–patellar tendon complex (PPTC). For the first time, the unique distributions of calcium and zinc at the fibrocartilage zone of the PPTC were clearly mapped by this method. The distributions of calcium and zinc at the fibrocartilage zone of the PPTC were inhomogeneous. A significant accumulation of zinc was exhibited in the transition region between UF and CF. The highest zinc content (3.17 times of that of patellar tendon) was found in the TM of fibrocartilage zone. The calcium content began to increase near the TM and increased exponentially across the calcified fibrocartilage region towards the patella. The highest calcium content (43.14 times of that of patellar tendon) was in the transitional zone of calcified fibrocartilage region and the patella, approximately 69 μm from the location with the highest zinc content. This study indicated, for the first time, that there is a differential distribution of calcium and zinc at the fibrocartilage zone of PPTC. These observations reveal new insights into region-dependent changes across the fibrocartilage

  2. Optimal Contrast Agent Staining of Ligaments and Tendons for X-Ray Computed Tomography.

    Science.gov (United States)

    Balint, Richard; Lowe, Tristan; Shearer, Tom

    2016-01-01

    X-ray computed tomography has become an important tool for studying the microstructures of biological soft tissues, such as ligaments and tendons. Due to the low X-ray attenuation of such tissues, chemical contrast agents are often necessary to enhance contrast during scanning. In this article, the effects of using three different contrast agents--iodine potassium iodide solution, phosphotungstic acid and phosphomolybdic acid--are evaluated and compared. Porcine anterior cruciate ligaments, patellar tendons, medial collateral ligaments and lateral collateral ligaments were used as the basis of the study. Three samples of each of the four ligament/tendon types were each assigned a different contrast agent (giving a total of twelve samples), and the progression of that agent through the tissue was monitored by performing a scan every day for a total period of five days (giving a total of sixty scans). Since the samples were unstained on day one, they had been stained for a total of four days by the time of the final scans. The relative contrast enhancement and tissue deformation were measured. It was observed that the iodine potassium iodide solution penetrated the samples fastest and caused the least sample shrinkage on average (although significant deformation was observed by the time of the final scans), whereas the phosphomolybdic acid caused the greatest sample shrinkage. Equations describing the observed behaviour of the contrast agents, which can be used to predict optimal staining times for ligament and tendon X-ray computed tomography, are presented.

  3. All-Inside Single-Bundle Reconstruction of the Anterior Cruciate Ligament with the Anterior Half of the Peroneus Longus Tendon Compared to the Semitendinosus Tendon: A Two-Year Follow-Up Study.

    Science.gov (United States)

    Bi, Mingguang; Zhao, Chen; Zhang, Shuijun; Yao, Bin; Hong, Zheping; Bi, Qing

    2018-02-08

    The anterior half of the peroneus longus tendon (AHPLT) has been reported to be acceptable for ligament reconstruction with respect to strength and safety. However, there is little information regarding the clinical outcomes after using the AHPLT compared with other autograft tendons. A prospective randomized controlled study was performed to compare the results of 62 cases of all-inside anatomical single-bundle anterior cruciate ligament (ACL) reconstruction using the AHPLT and 62 cases using semitendinosus graft with an average of 30.0 ± 3.6 months' follow-up. Tunnel placements of enrolled cases were measured on three-dimensional (3D) computed tomography (CT) and X-ray imaging. Knee stability was assessed using the anterior drawer test, pivot shift test, and KT-1000. The International Knee Documentation Committee (IKDC) 2000 subjective score was used to evaluate functional outcomes. The American Orthopedic Foot and Ankle Score (AOFAS) and the assessment of eversion muscle strength were performed to evaluate the function of the ankle donor site. Tunnel positions, which were confirmed with 3D CT, were in the anatomical positions. At the final follow-up, there were no significant differences between the semitendinosus group and the AHPLT group in the IKDC score (90.4 ± 7.1 vs. 89.3. ± 8.4), KT 1000 measurements (1.71 ± 0.57 vs. 1.85 ± 0.77), pivot shift test, and Visual Analogue Scale (VAS) (0.15 ± 0.36 vs. 0.10 ± 0.30). No obvious ankle site complications were found at 24 months. The average AOFAS score of the AHPLT group was comparable to that of the semitendinosus tendon group (99.1 ± 1.40 vs. 99.5 ± 1.21). There was no significant difference in clinical outcomes or knee stability between the semitendinosus group and the AHPLT group at the 2-year follow-up. An AHPLT autograft may be a good alternative for all-inside ACL reconstruction with respect to its strength, safety, and donor site morbidity. Thieme Medical

  4. The effect of a patellar strap on knee joint proprioception in healthy participants and athletes with patellar tendinopathy

    NARCIS (Netherlands)

    de Vries, Astrid J.; van den Akker-Scheek, Inge; Diercks, Ron L.; Zwerver, Johannes; van der Worp, Henk

    Objectives: The primary aim of this study is to investigate the effect of the use of a patellar strap on knee joint proprioception in both healthy participants and in patients with patellar tendinopathy (PT). Secondary aims are to examine whether there is a difference in effectiveness of the use of

  5. Valve-sparing root replacement for freestanding pulmonary autograft aneurysm after the Ross procedure.

    Science.gov (United States)

    Ratschiller, Thomas; Eva, Sames-Dolzer; Schimetta, Wolfgang; Paulus, Patrick; Müller, Hannes; Zierer, Andreas; Mair, Rudolf

    2018-02-20

    Autograft dilatation is the main long-term complication following the Ross procedure using the freestanding root replacement technique. We reviewed our 25-year experience with the Ross procedure with a special emphasis on valve-sparing reoperations. From 1991 to 2016, 153 patients (29.6 ± 16.6 years; 29.4% pediatric) underwent a Ross operation at our institution with implantation of the autograft as freestanding root replacement. The follow-up is 98.7% complete with a mean of 12.2 ± 5.5 years. Mortality at 30-days was 2.0%. Echocardiography documented no or trivial aortic regurgitation in 99.3% of the patients at discharge. Survival probability at 20 years was 85.4%. No case of autograft endocarditis occurred. Autograft deterioration rate was 2.01% per patient-year, and freedom from autograft reoperation was 75.3% at 15 years. A reoperation for autograft aneurysm was required in 35 patients (22.9%) at a mean interval of 11.1 ± 4.6 years after the Ross procedure. A valve-sparing root replacement was performed in 77% of patients, including 10 David and 17 Yacoub procedures with no early mortality. Three patients required prosthetic valve replacement within 2 years after a Yacoub operation. At latest follow-up, 92% of all surviving patients still carry the pulmonary autograft valve. Freedom from autograft valve replacement was 92.1% at 15 years. Using the David or Yacoub techniques, the autograft valve can be preserved in the majority of patients with root aneurysms after the Ross procedure. Reoperations can be performed with no early mortality, a good functional midterm result, and an acceptable reintervention rate. Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  6. Study protocol: a double blind randomised control trial of high volume image guided injections in Achilles and patellar tendinopathy in a young active population.

    Science.gov (United States)

    Barker-Davies, Robert M; Nicol, Alastair; McCurdie, I; Watson, James; Baker, Polly; Wheeler, Patrick; Fong, Daniel; Lewis, Mark; Bennett, Alexander N

    2017-05-22

    Chronic tendinopathy is a significant problem particularly in active populations limiting sporting and occupational performance. The prevalence of patellar tendinopathy in some sports is near 50% and the incidence of lower limb tendinopathy is 1.4% p.a. in the UK Military. Management includes isometric, eccentric, heavy slow resistance exercises and extracorporeal shockwave therapy (ESWT). Often these treatments are inadequate yet there is no good evidence for injection therapies and success rates from surgery can be as low as 50%. High Volume Image Guided Injection (HVIGI) proposes to strip away the neovascularity and disrupt the nerve ingrowth seen in chronic cases and has shown promising results in case series. This study aims to investigate the efficacy of HVIGI in a randomised controlled trial (RCT). RCT comparing 40ml HVIGI, with or without corticosteroid, with a 3ml local anaesthetic sham-control injection. Ninety-six participants will be recruited. male, 18-55 years old, chronic Achilles or patellar tendinopathy of at least 6 months, failed conservative management including ESWT, and Ultrasound (US) evidence of neovascularisation, tendon thickening and echogenic changes. Outcome measures will be recorded at baseline, 6 weeks, 3, 6 and 12 months. Primary outcome measures include The Victoria Institute of Sport Assessments for Achilles and patellar tendinopathy (VISA-A and VISA-P) and VAS pain. Secondary outcome measures include Modified Ohberg score, maximum tendon diameter and assessment of hypoechoic appearance on US, and Functional Activity Assessment. Despite previous interventional trials and reviews there is still insufficient evidence to guide injectable therapy for chronic tendinopathy that has failed conservative treatment. The scant evidence available suggests HVIGI has the greatest potential however there is no level one RCT evidence to support this. Investigating the efficacy of HVIGI against control in a RCT and separating the effect of HVIGI

  7. Patellatendinopathie ('jumper's knee'); een veelvoorkomende en lastig te behandelen sportblessure

    NARCIS (Netherlands)

    Zwerver, J.

    2008-01-01

    Patellar tendinopathy is a common and difficult-to-treat overuse injury of the patellar tendon with a very negative impact on the careers of many athletes. It appears to involve a failed healing process in the tendon--not inflammation--and has consequences for the treatment strategy. Rehabilitation

  8. Characterising the proximal patellar tendon attachment and its relationship to skeletal maturity in adolescent ballet dancers

    DEFF Research Database (Denmark)

    Rudavsky, Aliza; Cook, Jillianne; Magnusson, Stig Peter

    2017-01-01

    gain an understanding of how and when the tendon attachment matures. Methods: Sixty adolescent elite ballet students (ages 11-18) and eight mature adults participated. Peak height velocity (PHV) estimated skeletal maturity. Ultrasound tissue characterisation (UTC) scan was taken of the left knee...

  9. Does patellar rim electrocautery have deleterious effects on patellar cartilage?

    Science.gov (United States)

    Namazi, Niloofar; Jaberi, Fereidoon Mojtahed; Pakbaz, Sara; Vosoughi, Amir Reza; Jaberi, Mahrad Mojtahed

    2014-03-01

    Circumpatellar electrocauterization to destroy pain receptors during total knee arthroplasty without patellar resurfacing is commonly used to decrease postoperative knee pain. We aimed to evaluate the effect of denervation with electrocauterization on patellar cartilage. Twenty rabbits were randomly assigned to two equally sized case and control groups. The rabbits in the case group underwent surgery via the anterior midline skin incision and medial parapatellar arthrotomy, followed by denervation electrocauterization at a depth of 1 mm and a distance of 3 mm from the outer border of the patella. In the control group, surgery was identical to that performed in the case group, but without patellar denervation. Twelve weeks after surgery, all rabbits were sacrificed. Range of motion, macroscopic evaluation of cartilage using modified Outerbridge scoring, and histopathological assessment using a modified histologic scoring system for cartilage were evaluated. Three rabbits died during the study. Nine cases and eight animals from the control group were included in the final evaluation. All rabbits had passive full range of motion. Mean Outerbridge score was 2.0 in the case group and 0.37 in the control group (p=0.002). There were statistically significant differences in cellularity (p=0.016), loss of matrix (p=0.004), and clustering of chondrocytes (p=0.008) between the two groups. Microscopic variables as a whole were statistically significant (p=0.001). Circumpatellar electrocauterization may result in cartilage destruction. So, we encourage caution in using routine electrocauterization in patients undergoing total knee arthroplasty. level II. Copyright © 2014 Elsevier B.V. All rights reserved.

  10. Patellar SPECT and planar imaging in orthopedic patients with knee pain

    International Nuclear Information System (INIS)

    Dehdashti, F.; Collier, B.D.; Johnson, R.P.; Isitman, A.T.; Hellman, R.S.; Carrera, G.F.; Krasnow, A.Z.

    1987-01-01

    Eighty-five painful knees in 56 patients were independently evaluated clinically, radiographically, and scintigraphically. All patients had an established final diagnosis of osteoarthritis or other predisposing conditions. Results of patellar bone scintigraphy were abnormal in 66 of 85 knees; there were ten isolated findings and 12 cases of medial, nine of lateral, and 35 of triple compartment involvement. Four-quadrant patellar analysis identified nine instances of isolated lateal patellar facet syndrome. Single-photon emission CT was of significant value in localizing patellar abnormalities. Radiographic evaluation disclosed osteoarthritis in 27 of 66 scintigraphically abnormal knees. Patellar bone scintigraphy is more valuable than radiography for evaluating adult orthopedic patients with knee pain

  11. Collagen V haploinsufficiency in a murine model of classic Ehlers-Danlos syndrome is associated with deficient structural and mechanical healing in tendons.

    Science.gov (United States)

    Johnston, Jessica M; Connizzo, Brianne K; Shetye, Snehal S; Robinson, Kelsey A; Huegel, Julianne; Rodriguez, Ashley B; Sun, Mei; Adams, Sheila M; Birk, David E; Soslowsky, Louis J

    2017-12-01

    Classic Ehlers-Danlos syndrome (EDS) patients suffer from connective tissue hyperelasticity, joint instability, skin hyperextensibility, tissue fragility, and poor wound healing due to heterozygous mutations in COL5a1 or COL5a2 genes. This study investigated the roles of collagen V in establishing structure and function in uninjured patellar tendons as well as in the injury response using a Col5a1 +/- mouse, a model for classic EDS. These analyses were done comparing tendons from a classic EDS model (Col5a1 +/- ) with wild-type controls. Tendons were subjected to mechanical testing, histological, and fibril analysis before injury as well as 3 and 6 weeks after injury. We found that Col5a1 +/- tendons demonstrated diminished recovery of mechanical competency after injury as compared to normal wild-type tendons, which recovered their pre-injury values by 6 weeks post injury. Additionally, the Col5a1 +/- tendons demonstrated altered fibril morphology and diameter distributions compared to the wild-type tendons. This study indicates that collagen V plays an important role in regulating collagen fibrillogenesis and the associated recovery of mechanical integrity in tendons after injury. In addition, the dysregulation with decreased collagen V expression in EDS is associated with a diminished injury response. The results presented herein have the potential to direct future targeted therapeutics for classic EDS patients. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2707-2715, 2017. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  12. Patellar calcar: MRI appearance of a previously undescribed anatomical entity

    International Nuclear Information System (INIS)

    Collins, Mark S.; Tiegs-Heiden, Christin A.; Stuart, Michael J.

    2014-01-01

    The femoral calcar is a constant anatomical structure within the proximal femur representing a condensation of bone trabeculae. It is our impression that a similar structure is present within the patella. The purpose of this retrospective study was to define the prevalence, appearance, location, and configuration of the patellar calcar on MRI examinations. One hundred consecutive unenhanced knee MRIs were retrospectively reviewed by two readers who were blinded to the clinical indication. The patellar calcar was defined as a dark signaling, linear or curvilinear structure subjacent to the patellar articular surface. If present, the patellar calcar was assigned to a ''well seen,'' ''moderately well seen,'' or ''faintly seen'' category. Location of the calcar within the patella, orientation, configuration, and thickness were recorded. Confounding variables, such as marrow edema, patellar chondromalacia, bipartite patella, or postoperative changes were also recorded. The patellar calcar was visualized in 81 out of 100 (81 %) MRIs. When detected, the calcar was well seen in 20 out of 81 (25 %), moderately well seen in 35 out of 81 (43 %), and faintly seen in 26 out of 81 (32 %). The anteroposterior width of the calcar measured at its thickest segment was: 1 mm in 10 out of 81 (12 %). The patellar calcar was seen in the majority of knee MRIs and had a consistent imaging appearance. The calcar may be obscured by degenerative arthrosis of the patella and rarely may mimic patellar stress fracture or osteochondritis dissecans. Radiologists and clinicians should be familiar with this normal anatomical structure. (orig.)

  13. Patellar osteochondroma: case report,

    Directory of Open Access Journals (Sweden)

    Frederico Barra de Moraes

    2014-04-01

    Full Text Available The aim was to report on a rare case of patellar osteochondroma. A 60-year-old man presented a tumor on his left patella that had developed over a 10-year period, which is a rare occurrence, considering the patient's age and the site at which the tumor appeared. The clinical condition comprised mild pain and the presence of a mass, without limitation of flexion-extension or any neurovascular deficit. The tumor dimensions were 8 cm longitudinally × 6 cm transversally × 3 cm anteroposteriorly. It was hardened and was adhering to the patellar bone plane. On radiographs and tomographic scans, we observed areas of greater density corresponding to bone and other less dense areas that could correspond to slow-growing cartilage, with irregularities on the patellofemoral joint surface. Simple resection of the tumor was performed, and the anatomopathological examination confirmed that it was a patellar osteochondroma. Osteochondroma, or osteocartilaginous exostosis, includes a large proportion of the benign bone tumors. It results from cell alterations that trigger unregulated production of spongy bone. It is basically treated by means of surgical removal of the tumor mass. This is not essential, but is recommended in order to avoid lesions caused by contiguity and the risk of malignant transformation.

  14. Signs of patellar chondromalacia on sagittal T2-weighted magnetic resonance imaging

    International Nuclear Information System (INIS)

    De Smet, A.A.; Monu, J.U.; Fisher, D.R.; Keene, J.S.; Graf, B.K.

    1992-01-01

    We incidentally noted distinctive high signal defects or fissures in the patellar articular cartilage on sagittal T2-weighted magnetic resonance (MR) images in 4 patients. At subsequent arthroscopy all 4 patients were found to have patellar chondromalacia. To determine the reliabilty of these signs, we retrospectively evaluated, in a blinded manner, sagittal T2-weighted MR images of the knee in 75 patients who were undergoing arthroscopic assessment of their patellar articular cartilage. We indentified high signal defects of fissures in the patellar cartilage of 5 patients. Patellar chondromalacia was noted at arthroscopy in all 5 patients. Arthroscopy demonstrated patellar chondromalacia in an additional 21 patients with normal MR images. We conclude that high signal defects or fissures on sagittal T2-weighted images are usefull signs of patellar chondromalacia. This single imaging sequence will, however, detect only a small number of the cartilage lesions that may be present. (orig.)

  15. Signs of patellar chondromalacia on sagittal T2-weighted magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    De Smet, A.A.; Monu, J.U.; Fisher, D.R. (Univ. of Wisconsin Hospital and Clinics, Dept. of Radiology, Madison, WI (United States)); Keene, J.S.; Graf, B.K. (Univ. of Wisconsin Hospital and Clinics, Div. of Orthopedic Surgery, Madison, WI (United States))

    1992-02-01

    We incidentally noted distinctive high signal defects or fissures in the patellar articular cartilage on sagittal T2-weighted magnetic resonance (MR) images in 4 patients. At subsequent arthroscopy all 4 patients were found to have patellar chondromalacia. To determine the reliabilty of these signs, we retrospectively evaluated, in a blinded manner, sagittal T2-weighted MR images of the knee in 75 patients who were undergoing arthroscopic assessment of their patellar articular cartilage. We indentified high signal defects of fissures in the patellar cartilage of 5 patients. Patellar chondromalacia was noted at arthroscopy in all 5 patients. Arthroscopy demonstrated patellar chondromalacia in an additional 21 patients with normal MR images. We conclude that high signal defects or fissures on sagittal T2-weighted images are usefull signs of patellar chondromalacia. This single imaging sequence will, however, detect only a small number of the cartilage lesions that may be present. (orig.).

  16. Use of smartphones and portable media devices for quantifying human movement characteristics of gait, tendon reflex response, and Parkinson's disease hand tremor.

    Science.gov (United States)

    LeMoyne, Robert; Mastroianni, Timothy

    2015-01-01

    Smartphones and portable media devices are both equipped with sensor components, such as accelerometers. A software application enables these devices to function as a robust wireless accelerometer platform. The recorded accelerometer waveform can be transmitted wireless as an e-mail attachment through connectivity to the Internet. The implication of such devices as a wireless accelerometer platform is the experimental and post-processing locations can be placed anywhere in the world. Gait was quantified by mounting a smartphone or portable media device proximal to the lateral malleolus of the ankle joint. Attributes of the gait cycle were quantified with a considerable accuracy and reliability. The patellar tendon reflex response was quantified by using the device in tandem with a potential energy impact pendulum to evoke the patellar tendon reflex. The acceleration waveform maximum acceleration feature of the reflex response displayed considerable accuracy and reliability. By mounting the smartphone or portable media device to the dorsum of the hand through a glove, Parkinson's disease hand tremor was quantified and contrasted with significance to a non-Parkinson's disease steady hand control. With the methods advocated in this chapter, any aspect of human movement may be quantified through smartphones or portable media devices and post-processed anywhere in the world. These wearable devices are anticipated to substantially impact the biomedical and healthcare industry.

  17. Treatment of recurrent patellar dislocation via knee arthroscopy combined with C-arm fluoroscopy and reconstruction of the medial patellofemoral ligament.

    Science.gov (United States)

    Li, Li; Wang, Hongbo; He, Yun; Si, Yu; Zhou, Hongyu; Wang, Xin

    2018-06-01

    Recurrent patellar dislocations were treated via knee arthroscopy combined with C-arm fluoroscopy, and reconstruction of the medial patellofemoral ligaments. Between October 2013 and March 2017, 52 cases of recurrent patellar dislocation [27 males and 25 females; age, 16-47 years (mean, 21.90 years)] were treated. Arthroscopic exploration was performed and patellofemoral joint cartilage injuries were repaired. It was subsequently determined whether it was necessary to release the lateral patellofemoral support belt. Pre-operative measurements were used to decide whether tibial tubercle osteotomy was required. Medial patellofemoral ligaments were reconstructed using autologous semitendinosus tendons. Smith and Nephew model 3.5 line anchors were used to double-anchor the medial patellofemoral margin. On the femoral side, the medial patellofemoral ligament was fixed using 7-cm, absorbable, interfacial compression screws. All cases were followed for 1-40 months (average, 21 months). The Q angle, tibial tuberosity trochlear groove distance, Insall-Salvati index, patellofemoral angle, lateral patellofemoral angle and lateral shift were evaluated on X-Ray images using the picture archiving and communication system. Subjective International Knee Documentation Committee (IKDC) knee joint functional scores and Lysholm scores were recorded. Post-operative fear was absent, and no patellar re-dislocation or re-fracture was noted during follow-up. At the end of follow-up, the patellofemoral angle (0.22±4.23°), lateral patellofemoral angle (3.44±1.30°), and lateral shift (0.36+0.14°) differed significantly from the pre-operative values (all, Ppatellofemoral ligament was effective.

  18. Bilateral patellar tuberculosis masquerading as infected infrapatellar bursitis.

    Science.gov (United States)

    Sreenivasan, Ravi; Haq, Rehan Ul

    2017-04-01

    A 30-year-old woman presented to our outpatient department with complaints of pain and swelling in bilateral infrapatellar regions and a discharging sinus in the right knee over the duration of one year. Radiographs showed lytic regions in bilateral patellae. Samples sent from material curetted from sinus yielded no organism but histopathology reported granulomatous inflammation. Following a fresh magnetic resonance imaging (MRI) scan that revealed the infrapatellar pad of fat communicating with the patellar lesions, an exploration and evacuation was done. Material sent revealed epithelioid cell granulomas with caseous necrosis consistent with tuberculosis (TB). The patient was put on first line anti-tubercular treatment (ATT) and has responded favourably with healing of sinus and patellar lesions. Bilateral infrapatellar bursitis is not rare. However patellar TB as a cause for OMIT is not a common diagnosis. A bilateral patellar involvement has not been reported in literature to the best of our knowledge.

  19. Repair of Medial Patellofemoral, Ligament Improves Patellar, Tracking in Total Knee Replacement.

    Science.gov (United States)

    Meneghini, R Michael; Ziemba-Davis, Mary; Smits, Shelly; Bicos, James

    2015-11-01

    The medial patellofemoral ligament (MPFL) is essential to maintain patella stability; however, its role in total knee replacement (TKR) has not been studied. Forty-six consecutive TKRs in 40 patients were reviewed. Standard closure was performed in 29 TKRs. The MPFL was isolated and anatomically re-approximated in 17 subsequent TKRs. Blinded radiographic evaluation of patellar tilt and subluxation was performed preoperatively and 4 months postoperatively. Despite greater preoperative lateral tilt, the MPFL repair group demonstrated greater correction in patellar tilt compared with the standard closure group (p = 0.02). Patellar tracking also was optimized in the MPFL group, despite equivalent preoperative lateral patellar subluxation in the two groups. Simple repair of the MPFL at arthrotomy closure appears to optimize patellar stability radiographically and may improve long-term results by minimizing patellar complications and wear.

  20. Aesthetically and functionally satisfying reconstruction of an Achilles tendon and overlying skin defect in a 15 year old girl: a case report.

    Science.gov (United States)

    Wurzer, Paul; Eberl, Robert; Kamolz, Lars-Peter; Parvizi, Daryousch; Rappl, Thomas; Spendel, Stephan

    2015-03-01

    Achilles tendon and overlying soft tissue reconstruction presents an interdisciplinary challenge. In the literature many possible procedures are described, but each reconstruction in this region has its specific demands. Single stage reconstruction is normally pursued, but it is not always the best procedure for the patient, either aesthetically or functionally. We present a case of a 15 year old girl who suffered a soft tissue defect of 10cm×6cm in size at the area of the Achilles tendon due to a contact burn by an exhaust pipe during a motorcycle accident. For this case, reconstruction of the soft tissue defect using a free temporoparietal fascial flap (TPFF) and a full-thickness skin autograft was the best means to provide a satisfying result for both the patient and the surgeon. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

  1. Effect of growth hormone on aging connective tissue in muscle and tendon - gene expression, morphology and function following immobilization and rehabilitation

    DEFF Research Database (Denmark)

    Boesen, Anders Ploug; Dideriksen, Kasper Juel; Couppe, Christian

    2014-01-01

    assigned to daily injections of recombinant GH(rhGH, n=6) or placebo(Plc, n=6). Cross sectional area(CSA), muscle strength(MVC) and biomechanical properties of m. quadriceps and patellar tendon were determined. Muscle and tendon biopsies were analyzed for gene expressions (mRNA) of collagen(COL1A1/3A1...... pronounced when GH was injected. Furthermore, tendon stiffness increased in GH group. Muscle CSA declined after immobilization in Plc but not in GH group. Muscle CSA increased during re-training with a significant larger increase in GH group compared to Plc. Both a time and group effect was seen for IGF-1Ea....../Ec and COL1A1/3A1 mRNA expression in muscle with a difference between GH and Plc. IGF-1Ea/Ec and COL-1A1/3A1 mRNA expression increased in muscle following immobilization and re-training in subjects receiving GH, whereas an increase in IGF-1Ec mRNA expression was seen in the Plc group only after re...

  2. Patellar calcar: MRI appearance of a previously undescribed anatomical entity

    Energy Technology Data Exchange (ETDEWEB)

    Collins, Mark S.; Tiegs-Heiden, Christin A. [Department of Radiology, Mayo Clinic, Rochester, Minnesota (United States); Stuart, Michael J. [Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota (United States)

    2014-02-15

    The femoral calcar is a constant anatomical structure within the proximal femur representing a condensation of bone trabeculae. It is our impression that a similar structure is present within the patella. The purpose of this retrospective study was to define the prevalence, appearance, location, and configuration of the patellar calcar on MRI examinations. One hundred consecutive unenhanced knee MRIs were retrospectively reviewed by two readers who were blinded to the clinical indication. The patellar calcar was defined as a dark signaling, linear or curvilinear structure subjacent to the patellar articular surface. If present, the patellar calcar was assigned to a ''well seen,'' ''moderately well seen,'' or ''faintly seen'' category. Location of the calcar within the patella, orientation, configuration, and thickness were recorded. Confounding variables, such as marrow edema, patellar chondromalacia, bipartite patella, or postoperative changes were also recorded. The patellar calcar was visualized in 81 out of 100 (81 %) MRIs. When detected, the calcar was well seen in 20 out of 81 (25 %), moderately well seen in 35 out of 81 (43 %), and faintly seen in 26 out of 81 (32 %). The anteroposterior width of the calcar measured at its thickest segment was: < 1 mm in 43 out of 81 (53 %), 1 mm in 28 out of 81 (35 %), and >1 mm in 10 out of 81 (12 %). The patellar calcar was seen in the majority of knee MRIs and had a consistent imaging appearance. The calcar may be obscured by degenerative arthrosis of the patella and rarely may mimic patellar stress fracture or osteochondritis dissecans. Radiologists and clinicians should be familiar with this normal anatomical structure. (orig.)

  3. Australian football players' Achilles tendons respond to game loads within 2 days: an ultrasound tissue characterisation (UTC) study.

    Science.gov (United States)

    Rosengarten, Samuel D; Cook, Jill L; Bryant, Adam L; Cordy, Justin T; Daffy, John; Docking, Sean I

    2015-02-01

    The Achilles tendon is a tissue that responds to mechanical loads at a molecular and cellular level. In vitro and in vivo studies have shown that the expression of anabolic and/or catabolic proteins can change within hours of loading and return to baseline levels within 72 h. These biochemical changes have not been correlated with changes in whole tendon structure on imaging. We examined the nature and temporal sequence of changes in Achilles tendon structure in response to competitive game loads in elite Australian football players. Elite male Australian football players with no history of Achilles tendinopathy were recruited. Achilles tendon structure was quantified using ultrasound tissue characterisation (UTC) imaging, a valid and reliable measure of intratendinous structure, the day prior to the match (day 0), and then reimaged on days 1, 2 and 4 postgame. Of the 18 participants eligible for this study, 12 had no history of tendinopathy (NORM) and 6 had a history of patellar or hamstring tendinopathy (TEN). Differences in baseline UTC echopattern were observed between the NORM and TEN groups, with the Achilles of the TEN group exhibiting altered UTC echopattern, consistent with a slightly disorganised tendon structure. In the NORM group, a significant reduction in echo-type I (normal tendon structure) was seen on day 2 (p=0.012) that returned to baseline on day 4. There was a transient change in UTC echopattern in the Achilles tendon as a result of an Australian football game in individuals without a history of lower limb tendinopathy. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  4. Tendon surveillance requirements - average tendon force

    International Nuclear Information System (INIS)

    Fulton, J.F.

    1982-01-01

    Proposed Rev. 3 to USNRC Reg. Guide 1.35 discusses the need for comparing, for individual tendons, the measured and predicted lift-off forces. Such a comparison is intended to detect any abnormal tendon force loss which might occur. Recognizing that there are uncertainties in the prediction of tendon losses, proposed Guide 1.35.1 has allowed specific tolerances on the fundamental losses. Thus, the lift-off force acceptance criteria for individual tendons appearing in Reg. Guide 1.35, Proposed Rev. 3, is stated relative to a lower bound predicted tendon force, which is obtained using the 'plus' tolerances on the fundamental losses. There is an additional acceptance criterion for the lift-off forces which is not specifically addressed in these two Reg. Guides; however, it is included in a proposed Subsection IWX to ASME Code Section XI. This criterion is based on the overriding requirement that the magnitude of prestress in the containment structure be sufficeint to meet the minimum prestress design requirements. This design requirement can be expressed as an average tendon force for each group of vertical hoop, or dome tendons. For the purpose of comparing the actual tendon forces with the required average tendon force, the lift-off forces measured for a sample of tendons within each group can be averaged to construct the average force for the entire group. However, the individual lift-off forces must be 'corrected' (normalized) prior to obtaining the sample average. This paper derives the correction factor to be used for this purpose. (orig./RW)

  5. Historical Patterns and Variation in Treatment of Injuries in NFL (National Football League) Players and NCAA (National Collegiate Athletic Association) Division I Football Players.

    Science.gov (United States)

    McCarty, Eric C; Kraeutler, Matthew J; Langner, Paula; Cook, Shane; Ellis, Byron; Godfrey, Jenna M

    We conducted a study to identify and contrast patterns in the treatment of common injuries that occur in National Football League (NFL) players and National Collegiate Athletic Association (NCAA) Division I football players. Orthopedic team physicians for all 32 NFL and 119 NCAA Division I football teams were asked to complete a survey regarding demographics and preferred treatment of a variety of injuries encountered in football players. Responses were received from 31 (97%) of the 32 NFL and 111 (93%) of the 119 NCAA team physicians. Although patellar tendon autograft was the preferred graft choice for both groups of team physicians, the percentage of NCAA physicians who allowed return to football 6 months or less after anterior cruciate ligament reconstruction was significantly (P = .03) higher than that of NFL physicians. Prophylactic knee bracing, which may prevent medial collateral ligament injuries, was used at a significantly (P football players.

  6. Collagenolytic activity is produced by rabbit ligaments and tendon

    International Nuclear Information System (INIS)

    Harper, J.; Amiel, D.; Harper, E.

    1986-01-01

    The authors examined the patellar tendon (PT), anterior cruciate ligament (ACL) and medial collateral ligament (MCL) from normal rabbits for collagenase activity. All three connective tissues contain large amounts of collagen and the catabolism of this structural protein is important to their integrity. The authors cultured each tissue in serum free medium for 14 days. Collagenase was produced by all three connective tissues after a lag period of up to 7 days, as detected by the 14 C-glycine peptide-release assay. Culture media that did not express enzyme the authors found to contain inhibitory activity. The collagenases and inhibitors from each tissue have been quantitated and characterized. After 9 days the collagenase activity for the rabbit periarticular tissues was 6.1 (PT), 4.4 (MCL) and 8.6 (ACL) units per milligram of secreted protein. The cleavage site of all three collagenases was found to be similar to that observed for rabbit skin collagenase, and generation of reaction products TC/sup A/ and TC/sup B/ was demonstrated by collagenases from PT, MCL and ACL. These results suggest that the metabolism of ligaments and tendon is regulated by the production of zymogen, active collagenase and inhibitor, similar to other connective tissues. The role of these components in joint injury and joint diseases is currently being investigated

  7. Epidemiology of Patellar Tendinopathy in Elite Male Soccer Players

    NARCIS (Netherlands)

    Hägglund, Martin; Zwerver, Johannes; Ekstrand, Jan

    Background: Patellar tendinopathy is common among athletes in jumping sports and in sports with prolonged repetitive stress of the knee extensor apparatus. The epidemiology in soccer is not well described. Purpose: This study was undertaken to investigate and describe the epidemiology of patellar

  8. T2 mapping in patellar chondromalacia

    International Nuclear Information System (INIS)

    Ruiz Santiago, Fernando; Pozuelo Calvo, Rocío; Almansa López, Julio; Guzmán Álvarez, Luis; Castellano García, María del Mar

    2014-01-01

    Objective: To study the correlation between the T2 relaxation times of the patellar cartilage and morphological MRI findings of chondromalacia. Methods: This prospective study comprises 50 patients, 27 men and 23 women suffering of anterior knee pain (mean age: 29.7, SD 8.3 years; range: 16–45 years). MRI of 97 knees were performed in these patients at 1.5 T magnet including sagittal T1, coronal intermediate, axial intermediate fat sat and T2 mapping. Chondromalacia was assessed using a modified version of Noyes classification. The relaxation time, T2, was studied segmenting the full thickness of the patellar cartilage in 12 areas: 4 proximal (external facet–proximal–lateral (EPL), external facet–proximal–central (EPC), internal facet–proximal–central (IPC), internal facet–proximal–medial (IPM), 4 in the middle section (external facet–middle–lateral (EML), external facet–middle–central (EMC), internal facet–middle–central (IMC), internal facet–middle–medial (IMM) and 4 distal (external facet–distal–lateral (EDL), external facet–distal–central (EDC), internal facet–distal–central (IDC), internal facet–distal–medial (IDM). Results: T2 values showed a significant increase in mild chondromalacia regarding normal cartilage in most of the cartilage areas (p < 0.05), except in the internal distal facet (IDC and IDM), EPC, EDL, and IMM. Severe chondromalacia was characterized by a fall of T2 relaxation times with loss of statistical significant differences in comparison with normal cartilage, except in EMC and IMC, where similar values as mild chondromalacia were maintained (p < 0.05). Conclusions: Steepest increase in T2 values of patellar cartilage occurs in early stages of patellar cartilage degeneration. Progression of morphologic changes of chondromalacia to more severe degrees is associated to a new drop of T2 relaxation times approaching basal values in most of the areas of the patellar cartilage, except in the

  9. T2 mapping in patellar chondromalacia

    Energy Technology Data Exchange (ETDEWEB)

    Ruiz Santiago, Fernando, E-mail: ferusan12@gmail.com [Department of Radiology, Traumatology Hospital, University Hospital Virgen de las Nieves, Granada (Spain); Pozuelo Calvo, Rocío [Department of Rehabilitation and Physical therapy, Traumatology Hospital, University Hospital Virgen de las Nieves, Granada (Spain); Almansa López, Julio [Department of Physic, University Hospital Virgen de las Nieves, Granada (Spain); Guzmán Álvarez, Luis; Castellano García, María del Mar [Department of Radiology, Traumatology Hospital, University Hospital Virgen de las Nieves, Granada (Spain)

    2014-06-15

    Objective: To study the correlation between the T2 relaxation times of the patellar cartilage and morphological MRI findings of chondromalacia. Methods: This prospective study comprises 50 patients, 27 men and 23 women suffering of anterior knee pain (mean age: 29.7, SD 8.3 years; range: 16–45 years). MRI of 97 knees were performed in these patients at 1.5 T magnet including sagittal T1, coronal intermediate, axial intermediate fat sat and T2 mapping. Chondromalacia was assessed using a modified version of Noyes classification. The relaxation time, T2, was studied segmenting the full thickness of the patellar cartilage in 12 areas: 4 proximal (external facet–proximal–lateral (EPL), external facet–proximal–central (EPC), internal facet–proximal–central (IPC), internal facet–proximal–medial (IPM), 4 in the middle section (external facet–middle–lateral (EML), external facet–middle–central (EMC), internal facet–middle–central (IMC), internal facet–middle–medial (IMM) and 4 distal (external facet–distal–lateral (EDL), external facet–distal–central (EDC), internal facet–distal–central (IDC), internal facet–distal–medial (IDM). Results: T2 values showed a significant increase in mild chondromalacia regarding normal cartilage in most of the cartilage areas (p < 0.05), except in the internal distal facet (IDC and IDM), EPC, EDL, and IMM. Severe chondromalacia was characterized by a fall of T2 relaxation times with loss of statistical significant differences in comparison with normal cartilage, except in EMC and IMC, where similar values as mild chondromalacia were maintained (p < 0.05). Conclusions: Steepest increase in T2 values of patellar cartilage occurs in early stages of patellar cartilage degeneration. Progression of morphologic changes of chondromalacia to more severe degrees is associated to a new drop of T2 relaxation times approaching basal values in most of the areas of the patellar cartilage, except in the

  10. Patellar Tendinopathy

    OpenAIRE

    Schwartz, Aaron; Watson, Jonathan N.; Hutchinson, Mark R.

    2015-01-01

    Context: Patellar tendinopathy is a common condition. There are a wide variety of treatment options available, the majority of which are nonoperative. No consensus exists on the optimal method of treatment. Evidence Acquisition: PubMed spanning 1962-2014. Study Design: Clinical review. Level of Evidence: Level 4. Results: The majority of cases resolve with nonoperative therapy: rest, physical therapy with eccentric exercises, cryotherapy, anti-inflammatories, corticosteroid injections, extrac...

  11. Comparative validation of the radiographic and tomographic measurement of patellar height

    Directory of Open Access Journals (Sweden)

    Marco Antonio Schueda

    2013-09-01

    Full Text Available OBJECTIVE: To evaluate and validate the radiographic measurement of patellar height with computerized tomography scans. METHODS: Measured the patellar height through the lateral radiographic image supported by one foot and sagittal tomographic view of the knee in extension, flexion of 20°, and quadriceps contraction of 40 patients (80 knees, asymptomatic and no history of knee injuries using Insall-Salvati index. There were 20 adult females and 20 adult males. RESULTS: The height patellar index was higher in women of all images taken, in proportion. There was no statistical difference of patellar height index between the radiographics and tomographics images. CONCLUSION: The Insall-Salvati index in females was higher in all cases evaluated. Furthermore, it is possible to measure the patellar height index during tomographic study without distorting the results obtained, using to define the presence of patella alta or patella baja.

  12. [Patellar instability : diagnosis and treatment].

    Science.gov (United States)

    Ngo, Trieu Hoai Nam; Martin, Robin

    2017-12-13

    The aim of this paper is to present recent advances in surgical management of patellar instability. Several anatomical factors were reported to promote instability. We propose to classify them in two groups. Extra articular factors are valgus and torsion deformity. Articular factors include trochlea and patella dysplasia, tibial tubercle lateralization and medial patellofemoral ligament (MPFL) insufficiency. Acute patellar dislocations are treated conservatively, with exception for osteochondral and MPFL avulsion fractures that require acute reinsertion. Surgery is considered for recurrent instability. As we aim for a correction of all contributing elements, we prefer a two stages approach. Extra articular factors are treated first by osteotomy, followed by articular factors after 4-6 months. This allows separate rehabilitation protocols.

  13. Anterior cruciate ligament reconstruction with 4-strand hamstring autograft and accelerated rehabilitation: a 10-year prospective study on clinical results, knee osteoarthritis and its predictors.

    Science.gov (United States)

    Janssen, Rob P A; du Mée, Arthur W F; van Valkenburg, Juliette; Sala, Harm A G M; Tseng, Carroll M

    2013-09-01

    Analysis of long-term clinical and radiological outcomes after anterior cruciate ligament (ACL) reconstruction with special attention to knee osteoarthritis and its predictors. A prospective, consecutive case series of 100 patients. Arthroscopic transtibial ACL reconstruction was performed using 4-strand hamstring tendon autografts with a standardized accelerated rehabilitation protocol. Analysis was performed preoperatively and 10 years postoperatively. Clinical examination included Lysholm and Tegner scores, IKDC, KT-1000 testing (MEDmetric Co., San Diego, CA, USA) and leg circumference measurements. Radiological evaluation included AP weight bearing, lateral knee, Rosenberg and sky view X-rays. Radiological classifications were according to Ahlbäck and Kellgren & Lawrence. Statistical analysis included univariate and multivariate logistic regressions. RESULTS CLINICAL OUTCOME: A significant improvement (p test, IKDC score and one-leg hop test. A pivot shift phenomenon (glide) was still present in 43 (50%) patients and correlated with lower levels of activity (p test. Transtibial ACL reconstruction with 4-strand hamstring autograft and accelerated rehabilitation restored anteroposterior knee stability. Clinical parameters and patient satisfaction improved significantly. At 10-year follow-up, radiological signs of OA were present in 53.5 % of the subjects. Risk factors for OA were meniscectomy prior to or at the time of ACL reconstruction and chondral lesions at the time of ACL reconstruction. II.

  14. Iliopsoas Tendon Reformation after Psoas Tendon Release

    Directory of Open Access Journals (Sweden)

    K. Garala

    2013-01-01

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

  15. Patellar subluxation syndrome. Observation of the patellofemoral joint using CT-scan

    Energy Technology Data Exchange (ETDEWEB)

    Yagi, Tomonori; Sasaki, Tetsuto; Susuda, Koichi; Moji, Junichi (Hokkaido Univ., Sapporo (Japan). School of Medicine)

    1983-10-01

    Clinical symptoms of patellar subluxation syndrome associated with pain were investigated for 24 knees of 20 patients, and the state of patella dislocation was observed by CT-scan. The patients had high incidence of an apprehension sign, showing their fear of patellar luxation. Many of them complained of patello-femoral joint pain due to chondromalacia patellae. In order to derive patellar subluxation, the method of CT-Q-contraction was carried out at the extended position of the patellar joint. In patients with patellar subluxation syndrome, the rate of shift in the diseased side was significantly higher than that of the other side, suggesting decreased muscular strength of the musculus vastus of the diseased side. Improvement of the symptoms was seen in all except one of 12 knees operated by the combined method of Green's method with Blauth's more than 6 months before. Availability of this operation was verified by the CT-Q-contraction.

  16. Electrospun meshes possessing region-wise differences in fiber orientation, diameter, chemistry and mechanical properties for engineering bone-ligament-bone tissues.

    Science.gov (United States)

    Samavedi, Satyavrata; Vaidya, Prasad; Gaddam, Prudhvidhar; Whittington, Abby R; Goldstein, Aaron S

    2014-12-01

    Although bone-patellar tendon-bone (B-PT-B) autografts are the gold standard for repair of anterior cruciate ligament ruptures, they suffer from drawbacks such as donor site morbidity and limited supply. Engineered tissues modeled after B-PT-B autografts are promising alternatives because they have the potential to regenerate connective tissue and facilitate osseointegration. Towards the long-term goal of regenerating ligaments and their bony insertions, the objective of this study was to construct 2D meshes and 3D cylindrical composite scaffolds - possessing simultaneous region-wise differences in fiber orientation, diameter, chemistry and mechanical properties - by electrospinning two different polymers from off-set spinnerets. Using a dual drum collector, 2D meshes consisting of an aligned polycaprolactone (PCL) fiber region, randomly oriented poly(lactide-co-glycolide) (PLGA) fiber region and a transition region (comprised of both PCL and PLGA fibers) were prepared, and region-wise differences were confirmed by microscopy and tensile testing. Bone marrow stromal cells (BMSCs) cultured on these meshes exhibited random orientations and low aspect ratios on the random PLGA regions, and high aspect ratios and alignment on the aligned PCL regions. Next, meshes containing an aligned PCL region flanked by two transition regions and two randomly oriented PLGA regions were prepared and processed into 3D cylindrical composite scaffolds using an interpenetrating photo-crosslinkable polyethylene glycol diacrylate hydrogel to recapitulate the shape of B-PT-B autografts. Tensile testing indicated that cylindrical composites were mechanically robust, and eventually failed due to stress concentration in the aligned PCL region. In summary, this study demonstrates a process to fabricate electrospun meshes possessing region-wise differences in properties that can elicit region-dependent cell responses, and be readily processed into scaffolds with the shape of B-PT-B autografts.

  17. Aortic root reoperations after pulmonary autograft implantation

    NARCIS (Netherlands)

    J.A. Bekkers (Jos); L.M.A. Klieverik (Loes Maria Anne); G. Bol-Raap (Goris); J.J.M. Takkenberg (Hanneke); A.J.J.C. Bogers (Ad)

    2010-01-01

    textabstractObjective: To report the results of aortic root reoperations after pulmonary autograft implantation. Methods: All consecutive patients in our prospective Ross research database were selected for analysis, and additional information for patients requiring reoperation was obtained from the

  18. 21 CFR 888.3580 - Knee joint patellar (hemi-knee) metallic resurfacing uncemented prosthesis.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Knee joint patellar (hemi-knee) metallic... § 888.3580 Knee joint patellar (hemi-knee) metallic resurfacing uncemented prosthesis. (a) Identification. A knee joint patellar (hemi-knee) metallic resurfacing uncemented prosthesis is a device made of...

  19. Inferior limbal conjunctival autografting in primary pterygium

    Directory of Open Access Journals (Sweden)

    Farouk M Othman

    2015-01-01

    In patients with primary pterygium, conjunctival limbal autografting from the lower bulbar conjunctiva is an effective technique with a low recurrence rate. It can be a suitable treatment for glaucomatous patients with pterygium to leave the upper bulbar conjunctiva untouched.

  20. Complications and Adverse Events of a Randomized Clinical Trial Comparing 3 Graft Types for ACL Reconstruction.

    Science.gov (United States)

    Mohtadi, Nicholas; Barber, Rhamona; Chan, Denise; Paolucci, Elizabeth Oddone

    2016-05-01

    Complications/adverse events of anterior cruciate ligament (ACL) surgery are underreported, despite pooled level 1 data in systematic reviews. All adverse events/complications occurring within a 2-year postoperative period after primary ACL reconstruction, as part of a large randomized clinical trial (RCT), were identified and described. Prospective, double-blind randomized clinical trial. Patients and the independent trained examiner were blinded to treatment allocation. University-based orthopedic referral practice. Three hundred thirty patients (14-50 years; 183 males) with isolated ACL deficiency were intraoperatively randomized to ACL reconstruction with 1 autograft type. Graft harvest and arthroscopic portal incisions were identical. Patients were equally distributed to patellar tendon (PT), quadruple-stranded hamstring tendon (HT), and double-bundle (DB) hamstring autograft ACL reconstruction. Adverse events/complications were patient reported, documented, and diagnoses confirmed. Two major complications occurred: pulmonary embolism and septic arthritis. Twenty-four patients (7.3%) required repeat surgery, including 25 separate operations: PT = 7 (6.4%), HT = 9 (8.2%), and DB = 8 (7.3%). Repeat surgery was performed for meniscal tears (3.6%; n = 12), intra-articular scarring (2.7%; n = 9), chondral pathology (0.6%; n = 2), and wound dehiscence (0.3%; n = 1). Other complications included wound problems, sensory nerve damage, muscle tendon injury, tibial periostitis, and suspected meniscal tears and chondral lesions. Overall, more complications occurred in the HT/DB groups (PT = 24; HT = 31; DB = 45), but more PT patients complained of moderate or severe kneeling pain (PT = 17; HT = 9; DB = 4) at 2 years. Overall, ACL reconstructive surgery is safe. Major complications were uncommon. Secondary surgery was necessary 7.3% of the time for complications/adverse events (excluding graft reinjury or revisions) within the first 2 years. Level 1 (therapeutic studies

  1. Inferior patellar pole fragmentation in children: just a normal variant?

    Energy Technology Data Exchange (ETDEWEB)

    Kan, J.H.; Vogelius, Esben S.; Orth, Robert C.; Guillerman, R.P.; Jadhav, Siddharth P. [Texas Children' s Hospital, E.B. Singleton Pediatric Radiology, Houston, TX (United States)

    2015-06-15

    Fragmentary ossification of the inferior patella is often dismissed as a normal variant in children younger than 10 years of age. The purpose of this study was to determine whether fragmentary inferior patellar pole ossification is a normal variant or is associated with symptoms or signs of pathology using MRI and clinical exam findings as reference. A retrospective review was performed on 150 patients ages 5-10 years who underwent 164 knee radiography and MRI exams (45.1% male, mean age: 7.8 years). The presence or absence of inferior patellar pole fragmentation on radiography was correlated with the presence or absence of edema-like signal on MR images. Clinical notes were reviewed for the presence of symptoms or signs referable to the inferior patellar pole. These data were compared with a 1:1 age- and sex-matched control group without inferior pole fragmentation. Statistical analysis was performed using two-tailed t-tests. Forty of 164 (24.4%) knee radiographs showed fragmentary ossification of the inferior patella. Of these 40 knees, 62.5% (25/40) had edema-like signal of the inferior patellar bone marrow compared with 7.5% (3/40) of controls (P = 0.035). Patients with fragmentary ossification at the inferior patella had a significantly higher incidence of documented focal inferior patellar pain compared with controls (20% vs. 2.5%, P = 0.015). Inferior patellar pole fragmentation in children 5 to 10 years of age may be associated with localized symptoms and bone marrow edema-like signal and should not be routinely dismissed as a normal variant of ossification. (orig.)

  2. Surface Area of Patellar Facets: Inferential Statistics in the Iraqi Population

    Directory of Open Access Journals (Sweden)

    Ahmed Al-Imam

    2017-01-01

    Full Text Available Background. The patella is the largest sesamoid bone in the body; its three-dimensional complexity necessitates biomechanical perfection. Numerous pathologies occur at the patellofemoral unit which may end in degenerative changes. This study aims to test the presence of statistical correlation between the surface areas of patellar facets and other patellar morphometric parameters. Materials and Methods. Forty dry human patellae were studied. The morphometry of each patella was measured using a digital Vernier Caliper, electronic balance, and image analyses software known as ImageJ. The patellar facetal surface area was correlated with patellar weight, height, width, and thickness. Results. Inferential statistics proved the existence of linear correlation of total facetal surface area and patellar weight, height, width, and thickness. The correlation was strongest for surface area versus patellar weight. The lateral facetal area was found persistently larger than the medial facetal area, the p value was found to be <0.001 (one-tailed t-test for right patellae, and another significant p value of < 0.001 (one-tailed t-test was found for left patellae. Conclusion. These data are vital for the restoration of the normal biomechanics of the patellofemoral unit; these are to be consulted during knee surgeries and implant designs and can be of an indispensable anthropometric, interethnic, and biometric value.

  3. Viability of osteocytes in bone autografts harvested for dental implantology

    International Nuclear Information System (INIS)

    Guillaume, Bernard; Gaudin, Christine; Georgeault, Sonia; Mallet, Romain; Basle, Michel F; Chappard, Daniel

    2009-01-01

    Bone autograft remains a very useful and popular way for filling bone defects. In maxillofacial surgery or implantology, it is used to increase the volume of the maxilla or mandible before placing dental implants. Because there is a noticeable delay between harvesting the graft and its insertion in the receiver site, we evaluated the morphologic changes at the light and transmission electron microscopy levels. Five patients having an autograft (bone harvested from the chin) were enrolled in the study. A small fragment of the graft was immediately fixed after harvesting and a second one was similarly processed at the end of the grafting period when bone has been stored at room temperature for a 20 min ± 33 s period in saline. A net increase in the number of osteocyte lacunae filled with cellular debris was observed (+41.5%). However no cytologic alteration could be observed in the remaining osteocytes. The viability of these cells is known to contribute to the success of autograft in association with other less well-identified factors.

  4. Outcome and clinical signs of arthroscopically graded patellar chondromalacia with or without lateral release.

    Science.gov (United States)

    Korkala, O L; Isotalo, T M; Lavonius, M I; Niskanen, R O

    1995-01-01

    In a follow-up study of 67 patients with an arthroscopically diagnosed patellar chondromalacia, we compared the results of plain conservative treatment with those after an open lateral retinacular release. The mean follow-up was 35 months. In Grade I chondromalacia the lateral release did not affect the result, which was in all cases good or excellent. In Grade II to IV chondromalacia the lateral release appeared beneficial, although the difference did not reach statistical significance. We also examined the validity of three clinical signs in arthroscopically verified patellar chondromalacia. Patellar inhibition and tracking tests were clearly more sensitive than the lateral apprehension test, which often gave a false negative result. If the patellar inhibition test is positive and a Grade II to IV chondromalacia of the patella is found at arthroscopy, lateral release should be considered among other procedures, like patellar shaving or patellar resurfacing.

  5. MRI of traumatic patellar dislocation in children

    Energy Technology Data Exchange (ETDEWEB)

    Zaidi, A.; Cole, W. [Hospital for Sick Children, Toronto (Canada). Diagnostic Imaging; Babyn, P. [Mater Children' s, Brisbane (Australia). Paediatric Orthopaedic Surgery; Astori, I. [Univ. of Toronto (Canada). Diagnostic Imaging; White, L. [Hospital for Sick Children, Toronto (Canada). Orthopaedic Surgery; Doria, A.

    2006-11-15

    Traumatic patellar dislocations (TPD) are common injuries in children, and MRI is useful in evaluation of pediatric musculoskeletal injuries. However, no pediatric studies on the MR features of TPD have been reported. To review the injuries after TPD in children. Patients with clinical or radiological recognition of TPD and those with suggestive MR findings were selected. Bone, cartilage and soft-tissue injuries and patellofemoral relationships were assessed. Results A total of 26 patients (age range 10-18 years) were identified. The following injuries were seen: bone bruising of the inferomedial patella (81% of patients) and the lateral femoral condyle (81% of patients), cartilage injuries of the inferomedial patella (38% of patients) and the lateral femoral condyle (38% of patients), osteochondral fragments (42% of patients) and injuries of the medial patellar restraints (81% of patients). Pediatric manifestations of TPD seen on MRI are similar to those in adults. TPD is often occult in children. Early recognition of bone bruising of the patella and lateral femoral condyle, associated osteochondral injuries, and medial patellar stabilizer injury is important for timely diagnosis.

  6. MRI of traumatic patellar dislocation in children

    International Nuclear Information System (INIS)

    Zaidi, A.; Cole, W.; Babyn, P.; Astori, I.; White, L.; Doria, A.

    2006-01-01

    Traumatic patellar dislocations (TPD) are common injuries in children, and MRI is useful in evaluation of pediatric musculoskeletal injuries. However, no pediatric studies on the MR features of TPD have been reported. To review the injuries after TPD in children. Patients with clinical or radiological recognition of TPD and those with suggestive MR findings were selected. Bone, cartilage and soft-tissue injuries and patellofemoral relationships were assessed. Results A total of 26 patients (age range 10-18 years) were identified. The following injuries were seen: bone bruising of the inferomedial patella (81% of patients) and the lateral femoral condyle (81% of patients), cartilage injuries of the inferomedial patella (38% of patients) and the lateral femoral condyle (38% of patients), osteochondral fragments (42% of patients) and injuries of the medial patellar restraints (81% of patients). Pediatric manifestations of TPD seen on MRI are similar to those in adults. TPD is often occult in children. Early recognition of bone bruising of the patella and lateral femoral condyle, associated osteochondral injuries, and medial patellar stabilizer injury is important for timely diagnosis

  7. Lateral patellar luxation: magnetic resonance findings

    International Nuclear Information System (INIS)

    Armesto, V.; Pulpeiro, J.R.

    1995-01-01

    The objective of this article is to present the magnetic resonance (MR) findings associated with lateral patellar luxation. The series consisted of eight patients, all of whom presented joint effusion, damage to the medical retinaculum and cortical contusion or fracture of medical aspect of the patella or of anterolateral surface of the outer condyle. Five patients also presented patellar sub luxation. Diagnosis depends on the technique employed, with axial planes being very useful. Thus, it is recommended that they be used as the standard plane, especially in pathologies that are clinically unsuspicious as in this case. MR can also provide information that leads to surgical treatment rather than the standard conservative treatment. (Author)

  8. Microsurgical head and neck tissue repair by visceral mini-autografting

    Directory of Open Access Journals (Sweden)

    A. D. Kaprin

    2015-01-01

    Full Text Available Objective. To minimize surgical trauma in patients with head and neck tumors during microsurgical plasty with visceral autografts.Subjects and methods. Clinical experience has been gained in the treatment of 53 patients with locally advanced craniofascial (n = 27 and oropharyngeal (n = 36 cancers. Abdominal organs were used for plastic closure of extensive defects after surgical resection. Paraumbilical incision allowing for an adequate approach into the abdominal cavity with minimal external trauma in the anterior abdominal wall was chosen as an access procedure. Video-assisted techniques were used to excise the midline aponeurosis. Donor organs, such as the omentum, greater curvature of the stomach, transverse colon, small intestine were taken through a mini-laparotomic incision to the anterior abdominal wall, then the vascular pedicle was exposed and a visceral autograft was made. After forming and cutting off the autograft, organ anastomoses were created extracorporeally.Results. Mini-access surgery could be completed in 50 of the 53 cases (4 patients had previously undergone abdominal interventions. Omental (n = 26, colo-omental (n = 15, gastro-omental (n = 7, and entero-omental (n = 5 flaps were made and prepared for autografting. No intra- or postoperative abdominal complications were found.Conclusion. Minimally invasive technologies used to create visceral authografts for head and neck tissue repair can minimize surgical trauma and reduce treatment duration. The indications for this access are the debilitating state of a cancer patient or the young age of a patient who does not wish to have an additional scar in the donor region.

  9. [Significance of lateral release in the therapy of patellar chondromalacia].

    Science.gov (United States)

    Krüger, T; Göbel, F; Huschenbett, A; Hein, W

    2002-10-01

    A retrospective study was performed in 26 patients who underwent an operation for femoro-patellar pain due to a patellar chondromalacia with or without minor patellar dislocation/lateral pressure syndrome. The average age of the patients was 28.5 (15-39) years. 22 of the 26 patients revealed minor chondral damages of the stages 1 and 2 according to Outerbridge. In 12 patients ("lavage" group), an arthroscopic joint debridement only was carried out, while an additional open, lateral retinaculum release was made in 14 patients ("lateral release" group). The patella's distance of dislocation according to Hepp was reduced on an average of 3.0 (0-7) mm (p = 0.0019). The results of Bentley's score obtained during the follow-up interval on an average of 30.1 (9 to 60) months were almost identical for both groups. "Good" and "very good" results were achieved in the "lavage" group (83.3 %) and "lateral release" group (78.6 % of the patients). Lateral release should be used in cases of patellar decentration between 5 and 10 mm and adequate pain symptoms. The post-operative distance of dislocation should be less than 5 mm. Under such conditions and with minor chondral damage, a combined approach by using an arthroscopic joint debridement and open lateral release is promising to treat a patellar dislocation/lateral pressure syndrome.

  10. Accidental ovarian autograft after a laparoscopic surgery: case report.

    Science.gov (United States)

    Marconi, G; Quintana, R; Rueda-Leverone, N G; Vighi, S

    1997-08-01

    To report an autograft of ovarian tissue in the incision of the surgical trocar during laparoscopic surgery and to assess the potentiality of grafting of ovarian parenchyma in nonpelvic tissue in humans. A case report. Instituto de Fertilidad y Ginecología de Buenos Aires (IFER), Buenos Aires, Argentina. Infertile patient undergoing surgery due to an endometriotic cyst of the left ovary. Laparoscopic cystectomy. Accidental retention of a portion of the capsule and adjacent ovarian tissue of the endometrioma in SC cellular tissue. Months after surgery, a SC tumor was formed under the surgical incision. It was subsequently excised. Observation of tumor growth during menstrual cycles and ovulation induction; anatomopathologic study of the tissue after its extirpation. The tumor grew spontaneously in the periovulatory period and during treatments of ovulation induction. The anatomopathologic report of the tumor, removed 15 months after the first surgery, revealed functioning ovarian tissue with vessels of neoformation. This is the first description of autografted ovarian tissue in humans. We describe that the ovary can maintain its ovulatory function even in the absence of its pedicel. Also, we suggest that extirpation of surgical material through the incision of the trocar is not recommended, as the possibility of "sowing" or of autografts may occur.

  11. Extracorporeal shockwave therapy for patellar tendinopathy : a review of the literature

    NARCIS (Netherlands)

    van Leeuwen, M. T.; Zwerver, J.; van den Akker-Scheek, I.

    Background and purpose: Extracorporeal shockwave therapy (EWST) has become a popular treatment for patellar tendinopathy. The purpose of this review was to study the effectiveness of ESWT treatment for patellar tendinopathy; to draft guidelines for an effective treatment protocol of ESWT treatment;

  12. A systematic review of the concept and clinical applications of bone marrow aspirate concentrate in tendon pathology

    Directory of Open Access Journals (Sweden)

    Imam Mohamed A.

    2017-01-01

    , augmentation of tendo-achilles tendon (n = 1, treatment of gluteal tendon injuries (n = 1, management of elbow epicondylitis (n = 2, management of patellar tendinopathy (n = 1 and complications related to BMAC (n = 5. Multiple experimental studies investigated the use of BMAC for tendon repair; nonetheless, there are only limited clinical studies available in this field. Unfortunately, due to the scarcity of studies, which were mainly case series, the current level of evidence is weak. We strongly recommend further future randomised controlled studies in this field to allow scientists and clinicians make evidence-based conclusions.

  13. A Novel Surgical Technique for Fixation of Recurrent Acromioclavicular Dislocations: AC Dog Bone Technique in Combination with Autogenous Semitendinosus Tendon Graft

    Directory of Open Access Journals (Sweden)

    Patrick Holweg

    2017-01-01

    Full Text Available Various surgical techniques have been described for the fixation of acromioclavicular (AC dislocations. However, recurrent dislocation is one of the main complications associated with the majority of these techniques. We report a case of postoperative AC joint redislocation. In order to overcome recurrent dislocation after revision surgery, a reconstruction of the conoid and trapezoid ligament with the use of a free tendon graft in combination with a FiberTape was provided within a novel surgical technique. After 12 months, the patient was very satisfied with the functional outcome. The patient achieved excellent results in the Constant (98 points, SPADI (0 points, and QuickDASH score (0 points. The described technique results in an anatomic reconstruction of the AC joint. The nonrigid nature of the intervention seems to restore the normal arthrokinematics by reconstructing the coracoclavicular ligaments with an autograft which is then protected by the AC Dog Bone artificial ligaments during the healing period. The arthroscopic approach to the AC joint with minimal exposure reduces the risks and complications of the intervention. This is the first case in literature that utilizes the artificial dog bone ligament securing the autograft in an anatomic AC reconstruction.

  14. Outcome of pregnancy in women after pulmonary autograft valve replacement for congenital aortic valve disease

    NARCIS (Netherlands)

    Yap, Sing-Chien; Drenthen, Willem; Pieper, Petronella G.; Moons, Philip; Mulder, Barbara J. M.; Klieverik, Loes M.; Vliegen, Hubert W.; van Dijk, Arie P. J.; Meijboom, Folkert J.; Roos-Hesselink, Jolien W.

    Background and aim of the study: The pulmonary autograft has been recommended as the valve of choice for aortic valve replacement (AVR) in young women contemplating pregnancy. However, current information on maternal and perinatal outcome of pregnancy in women with pulmonary autograft valve

  15. Outcome of pregnancy in women after pulmonary autograft valve replacement for congenital aortic valve disease

    NARCIS (Netherlands)

    Yap, Sing-Chien; Drenthen, Willem; Pieper, Petronella G.; Moons, Philip; Mulder, Barbara J. M.; Klieverik, Loes M.; Vliegen, Hubert W.; van Dijk, Arie P. J.; Meijboom, Folkert J.; Roos-Hesselink, Jolien W.

    2007-01-01

    Background and aim of the study: The pulmonary autograft has been recommended as the valve of choice for aortic valve replacement (AVR) in young women contemplating pregnancy. However, current information on maternal and perinatal outcome of pregnancy in women with pulmonary autograft valve

  16. Outcome of pregnancy in women after pulmonary autograft valve replacement for congenital aortic valve disease.

    NARCIS (Netherlands)

    Yap, S.C.; Drenthen, W.; Pieper, P.G.; Moons, P.; Mulder, B.J.M.; Klieverik, L.M.; Vliegen, H.W.; Dijk, A.P.J. van; Meijboom, F.J.; Roos-Hesselink, J.W.

    2007-01-01

    BACKGROUND AND AIM OF THE STUDY: The pulmonary autograft has been recommended as the valve of choice for aortic valve replacement (AVR) in young women contemplating pregnancy. However, current information on maternal and perinatal outcome of pregnancy in women with pulmonary autograft valve

  17. Placement of implant bridge anterior maxilla post autograft (Serial case

    Directory of Open Access Journals (Sweden)

    Rifaat Nurrahma

    2016-06-01

    Full Text Available An advanced technology with implants based has now been developed in recent years.Implant with the bridge superstructure method is employed after variety of considerations where it is expected to meet its function, aesthetics, and comfortability.The alveolar bone existed is one reason for the process of adding bone (bonegraft.This case report proposes to determine the successful insertion of a superstructure anterior implant bridge post autograft.Two female patients were asked to use dental implant anterior with bridge system.The first case, the autograft application is made for a 20-year-old woman with edentulous teeth 11, 21, 22. One year later it was then inserted in the area of dental implant fixture 11 and 22. After 9 months, the healing abutments and the superstructure were inserted too.2 weeks after, the abutments of bridge and crowns of teeth 11, 21 and 22 with a pontic in the teeth 21 had been inserted. The second case, a 46-year-old woman with edentulous 11,12,21,22.They want to change the denture because they did not feel comfortable with the removable denture acrylic.Fixture placement was done a year after autograft.Insertion of healing abutments and the superstructure printing can be done after 6 months.A month later implant abutments and crowns could be inserted.Labial fullness is corrected; an implant-retained in the region of 12 and 21, 12, and 22 used the pontic.Prosthodontic rehabilitation with a fixed denture using the implant bridge after autograft anterior maxilla is an alternative fixed denture placement with satisfactory results, aesthetic correction and comfortably.

  18. Cine MR imaging before and after realignment surgery for patellar maltracking - comparison with axial radiographs

    Energy Technology Data Exchange (ETDEWEB)

    Brossmann, J. [Klinik fuer Radiologische Diagnostik der Univ. Kiel (Germany); Muhle, C. [Klinik fuer Radiologische Diagnostik der Univ. Kiel (Germany); Buell, C.C. [Rheumaklinik, Bad Bramstedt (Germany); Zieplies, J. [Lubinus Klinik, Kiel (Germany); Melchert, U.H. [Klinik fuer Radiologische Diagnostik der Univ. Kiel (Germany); Brinkmann, G. [Klinik fuer Radiologische Diagnostik der Univ. Kiel (Germany); Schroeder, C. [Klinik fuer Radiologische Diagnostik der Univ. Kiel (Germany); Heller, M. [Klinik fuer Radiologische Diagnostik der Univ. Kiel (Germany)

    1995-04-01

    Comparison of motion-triggered cine magnetic resonance (MR) imaging and conventional radiographs for the assessment of operative results of patellar realignment. Fifteen patients with recurrent patellar dislocation or patellar subluxation were evaluated with conventional axial radiographs before and after realignment surgery by measuring the congruence angle (CA), lateral patellofemoral angle (LPFA), and lateral displacement (d). In eight patients the patellofemoral joint was additionally evaluated pre- and postoperatively with motion-triggered cine MR imaging by determining the bisect offset (BSO), lateral patellar displacement (LPD), and patellar tilt angle (PTA). Significant differences between the pre- and postoperative measurements were found for all MR imaging parameters (BSO, LPD, PTA: p<0.01) but not for the conventional X-ray parameters (CA: p=0.70, LPFA: p=0.56; d: p=0.04). Motion-triggered cine MR imaging was superior to conventional tangential radiographs for assessing the effectiveness of patellar realignment surgery. (orig.)

  19. Cine MR imaging before and after realignment surgery for patellar maltracking - comparison with axial radiographs

    International Nuclear Information System (INIS)

    Brossmann, J.; Muhle, C.; Buell, C.C.; Zieplies, J.; Melchert, U.H.; Brinkmann, G.; Schroeder, C.; Heller, M.

    1995-01-01

    Comparison of motion-triggered cine magnetic resonance (MR) imaging and conventional radiographs for the assessment of operative results of patellar realignment. Fifteen patients with recurrent patellar dislocation or patellar subluxation were evaluated with conventional axial radiographs before and after realignment surgery by measuring the congruence angle (CA), lateral patellofemoral angle (LPFA), and lateral displacement (d). In eight patients the patellofemoral joint was additionally evaluated pre- and postoperatively with motion-triggered cine MR imaging by determining the bisect offset (BSO), lateral patellar displacement (LPD), and patellar tilt angle (PTA). Significant differences between the pre- and postoperative measurements were found for all MR imaging parameters (BSO, LPD, PTA: p<0.01) but not for the conventional X-ray parameters (CA: p=0.70, LPFA: p=0.56; d: p=0.04). Motion-triggered cine MR imaging was superior to conventional tangential radiographs for assessing the effectiveness of patellar realignment surgery. (orig.)

  20. Miscellaneous conditions of tendons, tendon sheaths, and ligaments.

    Science.gov (United States)

    Dyson, S J; Dik, K J

    1995-08-01

    The use of diagnostic ultrasonography has greatly enhances our ability to diagnose injuries of tendons and tendon sheaths that were previously either unrecognized or poorly understood. For may of these injuries, there is currently only a small amount of follow-up data. This article considers injuries of the deep digital flexor tendon and its accessory ligament, the carpal tunnel syndrome soft tissue swellings on the dorsal aspect of the carpus, intertubercular (bicipital) bursitis and bicipital tendinitis, injuries of the gastrocnemius tendon, common calcaneal tendinitis, rupture of peroneus (fibularis tertius) and ligaments injuries of the back.

  1. Fracture of an uncemented tantalum patellar component

    Directory of Open Access Journals (Sweden)

    Nathan L. Grimm, MD

    2016-06-01

    Full Text Available A 62-year-old man presented with the acute, atraumatic onset of pain 3 years after uncemented right total knee arthroplasty. He complained of new mechanical locking with the knee held in extension on examination and unable to flex the knee. On the plain radiographs, the patellar component peg was fractured and the plate was dislocated. The knee was immobilized, and revision to a cemented 3-peg component was performed. Fracture of a single-peg, tantalum-backed uncemented patellar component has not been described. Clinical suspicion for this should be given in the setting of acute locking. We recommend revision with a cemented polyethylene component.

  2. Association between patellar cartilage defects and patellofemoral geometry: a matched-pair MRI comparison of patients with and without isolated patellar cartilage defects.

    Science.gov (United States)

    Mehl, Julian; Feucht, Matthias J; Bode, Gerrit; Dovi-Akue, David; Südkamp, Norbert P; Niemeyer, Philipp

    2016-03-01

    To compare the geometry of the patellofemoral joint on magnetic resonance images (MRI) between patients with isolated cartilage defects of the patella and a gender- and age-matched control group of patients without patellar cartilage defects. A total of 43 patients (17 female, 26 male) with arthroscopically verified grade III and IV patellar cartilage defects (defect group) were compared with a matched-pair control group of patients with isolated traumatic rupture of the anterior cruciate ligament without cartilage defects of the patellofemoral joint. Preoperative MRI images were analysed retrospectively with regard to patellar geometry (width, thickness, facet angle), trochlear geometry (dysplasia according to Dejour, sulcus angle, sulcus depth, lateral condyle index, trochlea facet asymmetry, lateral trochlea inclination) and patellofemoral alignment (tibial tuberosity-trochlear groove distance, patella height, lateral patella displacement, lateral patellofemoral angle, patella tilt, congruence angle). In addition to the comparison of group values, the measured values were compared to normal values reported in the literature, and the frequency of patients with pathologic findings was compared between both groups. The defect group demonstrated a significantly higher proximal chondral sulcus angle (p patellofemoral joint. In particular, a flat and shallow trochlea, trochlea dysplasia and patella alta seem to contribute to the development of patellar cartilage defects, which must be taken into consideration when planning to do surgical cartilage repair at the patella. III.

  3. In Vivo Patellar Tracking and Patellofemoral Cartilage Contacts during Dynamic Stair Ascending

    Science.gov (United States)

    Suzuki, Takashi; Hosseini, Ali; Li, Jing-Sheng; Gill, Thomas J; Li, Guoan

    2012-01-01

    The knowledge of normal patellar tracking is essential for understanding of the knee joint function and for diagnosis of patellar instabilities. This paper investigated the patellar tracking and patellofemoral joint contact locations during a stair ascending activity using a validated dual-fluoroscopic imaging system. The results showed that the patellar flexion angle decreased from 41.9° to 7.5° with the knee extension during stair ascending. During first 80% of the activity, the patella shifted medially about 3.9 mm and then slightly shifted laterally during the last 20% of the ascending activity. Anterior translation of 13 mm of the patella was measured at the early 80% of the activity and then slightly moved posteriorly by about 2 mm at the last 20% of the activity. The path of the cartilage contact points was slightly lateral on the cartilage surfaces of patella and femur. On the patellar cartilage surface, the cartilage contact locations were about 2 mm laterally from heel strike to 60% of the stair ascending activity and moved laterally and reached 5.3 mm at full extension. However, the cartilage contact locations were relatively constant on the femoral cartilage surface (~5 mm lateral). The patellar tracking pattern was consistent with the patellofemoral cartilage contact location pattern. These data could provide baseline knowledge for understanding of normal physiology of the patellofemoral joint and can be used as a reference for clinical evaluation of patellofemoral disorder symptoms. PMID:22840488

  4. Influence of patellar type and localization on chondromaliacia of patella, magnetic resonanse diagnostics

    OpenAIRE

    Žukauskas, Tomas

    2017-01-01

    Tomas Žukauskas Master’s thesis – influence of patellar type and localization on chondromaliacia of patella, magnetic resonanse diagnostics. Academic supervisor Prof. Eglė Monastyreckienė. Place of study was Lithuanian University of Health Sciences, Radiology department. The aim of study: to investigate the link between patellar type and localization with chondromaliacia of the patella using magnetic resonanse imaging. The objectives were: to investigate patellar type’s influence on its ch...

  5. Routine patellar resurfacing using an inset patellar technique.

    LENUS (Irish Health Repository)

    Hurson, Conor

    2012-02-01

    The management of the patella in total knee arthroplasty still causes controversy. Whether or not to resurface the patella in primary total knee arthroplasty remains unclear. In this study we examined 220 consecutive total knee replacements, by a single surgeon, where the patella was routinely resurfaced using the inset technique. All patellae were suitable for resurfacing. Patellar thickness was not altered in 54.5% of patellae. In 97.2% the patella was within 2 mm of the original thickness. There were no significant complications. In this study we have found that the inset technique of patella resurfacing in total knee replacement is a simple and safe resurfacing procedure.

  6. Biomechanical cadaveric comparison of patellar ligament suture protected by a steel cable versus a synthetic cable.

    Science.gov (United States)

    Bouget, P; Breque, C; Beranger, J S; Faure, J P; Khiami, F; Vendeuvre, T

    2017-12-01

    Purpose and hypothesis: Patellar ligament rupture is a rare disabling pathology requiring a surgical ligament suture protected by a frame. The gold standard is the steel cable, but its rigidity and the necessity of a surgical re-intervention for its removal render it unsatisfactory. The objective of this paper is to quantify the mechanical protection provided by the terylene® in comparison with steel. Twenty-four knees of 12 fresh frozen cadaveric subjects were divided into 2 homogeneous groups (terylene and steel) of 12 knees (mean age = 69.3 years). Proximal ligament repair was performed according to a three-tunnel transosseous reinsertion technique. Mechanical tests were performed in flexion to simulate movement of the knee. The interligament gap and the amplitude angulation of the knee were measured by a system of extensometer and optical goniometer. Mechanical analysis permitted calculation of flexion amplitude for a ligament gap of 1 and 2 mm taking as initial angle the adjusting angle of pretension of the protection frame. Study of deformations of frames was performed. Statistical analysis was performed with a Wilcoxon Mann Whitney test. There is no significant difference in protection of the ligament suture between the "terylene" and "steel" groups. Mean flexion amplitudes (mΔF) show no significant differences between the 2 groups for a distension of the suture of 1 mm (m ΔF terylene1 = 4.74 °; mΔF steel1 = 5.91°; p = 0.198) and 2 mm (mΔF terylene2 = 8.71°; mΔF steel2 = 10.41°; p = 0.114). Elastic deformation of terylene was significantly greater than that of steel (p = 0.0004). Suture protection of the patellar ligament by a terylene wire is not significantly different from that provided by steel frame. The elastic properties of terylene and absence of a need for re intervention to secure its removal lead us towards its use in acute ruptures of the patellar ligament. The main limits involve the properties of

  7. A Review on Biomechanics of Anterior Cruciate Ligament and Materials for Reconstruction

    Science.gov (United States)

    Marieswaran, M.; Jain, Ishita; Garg, Bhavuk; Sharma, Vijay

    2018-01-01

    the ACL focus largely on animal ACL than human ACL. Further, this review article summarizes the issues with autografts and synthetic grafts used so far. Autografts (patellar tendon and hamstring tendon) remains the gold standard as nearly all synthetic grafts introduced for clinical use have been withdrawn from the market. The mechanical strength during the ligamentization of autografts is also highlighted in this work. PMID:29861784

  8. Relationship between the trochlear groove angle and patellar cartilage morphology defined by 3D spoiled gradient-echo imaging

    Energy Technology Data Exchange (ETDEWEB)

    Harada, Yuko; Tokuda, Osamu; Matsunaga, Naofumi [Yamaguchi University Graduate School of Medicine, Department of Radiology, Yamaguchi (Japan); Fukuda, Kouji [Shunan Memorial Hospital, Division of Radiological Technology, Yamaguchi (Japan); Shiraishi, Gen; Motomura, Tetsuhisa [Shunan Memorial Hospital, Department of Orthopedics Surgery, Yamaguchi (Japan); Kimura, Motoichi [Customer Application Gr., GE Healthcare MR Sales and Marketing Department, Osaka (Japan)

    2012-05-15

    To examine whether the femoral trochlear groove angle (TGA) is a determinant of the patellar cartilage volume and patellar cartilage damage. Patellar cartilage was evaluated by MR imaging in 66 patients (22 males and 44 females) with knee pain. Fat-suppressed 3D spoiled gradient-echo images were used to calculate the cartilage volume and to grade the cartilage damage. The proximal and distal TGAs were measured from axial PD-weighted FSE MR images with fat suppression. For every increase in the TGA at the distal femur, the patellar cartilage volume was significantly increased by 6.07 x 10{sup -3} cm{sup 3} (95% CI: 1.27 x 10{sup -3}, 10.9 x 10{sup -3}) after adjustment for age, gender, and patellar bone volume (P < 0.05). The MR grade of medial patellar cartilage damage progressed as the distal TGA became narrower, although there was no significant correlation between the distal TGA and the MR grading of patellar cartilage damage. A more flattened distal TGA was associated with increased patellar cartilage volume. However, there was no association between TGA and patellar cartilage defects. (orig.)

  9. Effect of tendon vibration during wide-pulse neuromuscular electrical stimulation (NMES) on the decline and recovery of muscle force.

    Science.gov (United States)

    Bochkezanian, Vanesa; Newton, Robert U; Trajano, Gabriel S; Vieira, Amilton; Pulverenti, Timothy S; Blazevich, Anthony J

    2017-05-02

    Neuromuscular electrical stimulation (NMES) is commonly used to activate skeletal muscles and reverse muscle atrophy in clinical populations. Clinical recommendations for NMES suggest the use of short pulse widths (100-200 μs) and low-to-moderate pulse frequencies (30-50 Hz). However, this type of NMES causes rapid muscle fatigue due to the (non-physiological) high stimulation intensities and non-orderly recruitment of motor units. The use of both wide pulse widths (1000 μs) and tendon vibration might optimize motor unit activation through spinal reflex pathways and thus delay the onset of muscle fatigue, increasing muscle force and mass. Thus, the objective of this study was to examine the acute effects of patellar tendon vibration superimposed onto wide-pulse width (1000 μs) knee extensor electrical stimulation (NMES, 30 Hz) on peak muscle force, total impulse before "muscle fatigue", and the post-exercise recovery of muscle function. Tendon vibration (Vib), NMES (STIM) or NMES superimposed onto vibration (STIM + Vib) were applied in separate sessions to 16 healthy adults. Total torque-time integral (TTI), maximal voluntary contraction torque (MVIC) and indirect measures of muscle damage were tested before, immediately after, 1 h and 48 h after each stimulus. TTI increased (145.0 ± 127.7%) in STIM only for "positive responders" to the tendon vibration (8/16 subjects), but decreased in "negative responders" (-43.5 ± 25.7%). MVIC (-8.7%) and rectus femoris electromyography (RF EMG) (-16.7%) decreased after STIM (group effect) for at least 1 h, but not after STIM + Vib. No changes were detected in indirect markers of muscle damage in any condition. Tendon vibration superimposed onto wide-pulse width NMES increased TTI only in 8 of 16 subjects, but reduced voluntary force loss (fatigue) ubiquitously. Negative responders to tendon vibration may derive greater benefit from wide-pulse width NMES alone.

  10. One-stage Revision ACL reconstruction with hamstring autograft results in satisfactory outcome

    Science.gov (United States)

    Kejriwal, Ritwik; Buelow, Jens

    2017-01-01

    Objectives: Revision anterior cruciate ligament (ACL) reconstruction is associated with poorer outcomes and higher rerupture rates when compared to primary ACL reconstruction. There is also a significant heterogeneity in surgical technique, number of stages, and graft options. We report a large single surgeon case series with hamstring autograft as a graft option. Methods: Observational series of revision ACL reconstructions performed by the senior author between 2005 and 2015 was carried out. Chart reviews and clinic follow-ups were performed with the following recorded – re-rupture rate, radiographic grading of osteoarthritis, KT-1000 arthrometer test, IKDC outcome scores and knee range of motion. All patients underwent single bundle four-strand hamstring autograft performed in one stage with use of new tunnels in majority of the cases. Results: 66 patients underwent hamstring autograft one-stage revision ACL reconstruction by Dr Jens Buelow. Chart review was carried out on all patients, and 26 (39%) were followed up in clinic and/or by phone with a mean follow up of 4.7 years. Outcomes included re-rupture rate of 4.5%, reoperation rate of 12%, mean visual analogue scale score of 7.6, mean side-to-side difference of 2.6 mm for KT-1000 arthrometer test, and mean IKDC score of 79. Of the 17 patients with radiographs, 40% had moderate osteoarthritis (grade 2 or 3) at follow-up. Conclusion: Revision ACL reconstruction can result in a satisfactory outcome when performed with a hamstring autograft in one stage.

  11. The use of dermal autograft as an adjunct to breast reconstruction with tissue expanders.

    Science.gov (United States)

    Rinker, Brian

    2012-12-01

    Acellular dermal matrices are commonly used in breast reconstruction but add cost to the procedure and have been associated with complications. Dermal autograft may represent a useful alternative to matrices. Sixteen patients (26 breasts) underwent breast reconstruction using tissue expanders and dermal autograft. Their ages ranged from 41 to 66 years (median, 51 years). Autografts were harvested by wide excision of preexisting abdominal scars. Demographic data, clinical history, and harvest and preparation time were recorded. The initial fill volume, number of expansions, and complications were recorded and compared with published data for acellular dermal matrix-assisted reconstruction. Patients rated their satisfaction with scar appearance on a seven-point scale. Follow-up ranged from 6 to 16 months (mean, 10 months). Three patients were smokers. Mean body mass index was 30.5 (range, 19.1 to 48.8). Three patients received chemotherapy between reconstructive stages, and none required irradiation. The mean time of autograft harvest was 38 minutes, the mean initial fill was 190 cc, and the average number of expansions was 3.5. There were no implant losses. There were three minor complications (19 percent). Initial expander fill, number of expansions, and complication rate were equivalent to historical values for matrix-assisted breast reconstruction. Fourteen of 16 patients (88 percent) were "very satisfied" with their scars. The use of dermal autograft in tissue expander breast reconstruction offers the advantages of acellular dermal matrix, without the associated expense. The technique adds minimally to the operative time and morbidity and is associated with a low complication rate. Therapeutic, IV.

  12. Reducing Postoperative Pterygium Recurrence: Comparison of Free Conjunctival Auto-Graft and Conjunctival Rotation Flap Techniques

    International Nuclear Information System (INIS)

    Akhter, W.; Tayyab, A.; Kausar, A.; Masrur, A.

    2014-01-01

    Objective: To compare the recurrence of pterygium between free conjunctival auto-graft and conjunctival rotation flap following simple surgical excision of pterygium. Study Design: Quasi-experimental study. Place and Duration of Study: Shifa Foundation Community Health Clinic, Shifa College of Medicine, Islamabad, from January to November 2012. Methodology: Fifty seven cases aged above 18 years, with a pterygium corneal encroachment of 2 mm which was responsible for visual disability or was cosmetically undesirable were recruited for the study and randomly assigned to conjunctival auto-graft group and conjunctival rotation flap group. Cases with a history of glaucoma or glaucoma suspect, prior pterygium surgery, pterygium with concurrent ocular surface and lid disease, conjunctival inflammation and scarring, pseudo-pterygium or collagen vascular disease were excluded. After simple pterygium excision conjunctival auto-graft group (n=26) cases received a free conjunctival flap was transplanted, while conjunctival rotation flap group (n=31) cases received a conjunctival rotation flap. All cases were followed-up for 6 months after surgery for recurrence and complications. Frequency distribution and significance of association of recurrence using Fisher's exact test and Mann- Whitney U-test was carried out using Statistical Package for Social Sciences (SPSS) version 20. Results: The median (and inter-quartile range) age and surgery duration in conjunctival auto-graft group and conjunctival rotation flap group were 60 (51.50 - 63.00) and 57 (45.00 - 60.00) years, 28.50 (27.00 - 30.50) and 16.00 (15.00 - 17.00) minutes respectively. Recurrence was seen in 2 (7.96%) and 3 (9.76%) cases in auto-graft and rotation flap groups respectively. No significant difference was seen in postoperative complications between the two groups (p=0.60). Conclusion: The surgical time for conjunctival rotation flap procedure is less as compared to free auto-graft, while their recurrence and

  13. 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.

  14. Análise da correlação entre pico de torque, desempenho funcional e frouxidão ligamentar em indivíduos normais e com reconstrução do ligamento cruzado anterior Functional performance and knee laxity in normal individuals and in individuals submitted to anterior cruciate ligament reconstruction

    Directory of Open Access Journals (Sweden)

    Rodrigo Antunes de Vasconcelos

    2009-04-01

    Full Text Available OBJETIVO: Analisar a correlação entre os déficits musculares dos extensores e flexores do joelho através do pico de torque isocinético com os testes de salto monopodal, frouxidão ligamentar pós-operatória e questionário de função em indivíduos normais e indivíduos submetidos à reconstrução do LCA com enxerto autólogo do tendão patelar e dos tendões flexores. MÉTODOS: Foram recrutados 60 indivíduos, formando três grupos: 20 indivíduos sem lesões no joelho (grupo GC e dois grupos de 20 indivíduos submetidos à reconstrução do LCA com tendão patelar (grupo GTP ou tendões flexores (grupo GTF. RESULTADOS: Os resultados demonstraram correlação significativa entre déficits no pico de torque e testes funcionais no torque extensor nos grupos GTF e GC. Não foram observadas correlações significativas entre frouxidão ligamentar pós-operatória e questionário de Lysholm com os testes de salto e déficits no pico de torque. Em relação à diferença entre os grupos, foi observado que o grupo GTP demonstrou maior déficit do torque extensor, menor pontuação no questionário de Lysholm e maior percentagem dos indivíduos com índice de simetria entre membros (ISM OBJECTIVES: The aim of this study was to analyze the correlation between deficits in the isokinetic peak torque of the knee extensors and flexors with hop tests, postoperative knee laxity and functional scores in normal and ACL- reconstructed subjects with patellar tendon and hamstring tendon autografts. METHODS: Sixty male subjects were enrolled and subdivided into three groups: Twenty subjects without knee injuries (GC group and two groups of 20 subjects submitted to ACL reconstruction with patellar tendon (GTP group and hamstrings autograft (GTF group. RESULTS: The results showed significant correlation between knee extensors peak torque and performance in the hop tests for GTF and GC groups. There are no significantly correlations between post op knee laxity

  15. Life-long endurance running is associated with reduced glycation and mechanical stress in connective tissue

    DEFF Research Database (Denmark)

    Couppé, Christian; Svensson, René B; Grosset, Jean-Francois

    2014-01-01

    ) that is associated with aging and lifestyle-related diseases. We therefore examined two groups of healthy elderly men: 15 master athletes (64 ± 4 years) who had been engaged in life-long endurance running and 12 old untrained (66 ± 4 years) together with two groups of healthy young men; ten young athletes matched...... for running distance (26 ± 4 years), and 12 young untrained (24 ± 3 years). AGE cross-links (pentosidine) of the patellar tendon were measured biochemically, and in the skin, it was assessed by a fluorometric method. In addition, we determined mechanical properties and microstructure of the patellar tendon....... Life-long regular endurance runners (master athletes) had a 21 % lower AGE cross-link density compared to old untrained. Furthermore, both master athletes and young athletes displayed a thicker patellar tendon. These cross-sectional data suggest that life-long regular endurance running can partly...

  16. Viscoelastic behavior of discrete human collagen fibrils

    DEFF Research Database (Denmark)

    Svensson, Rene; Hassenkam, Tue; P, Hansen

    2010-01-01

    Whole tendon and fibril bundles display viscoelastic behavior, but to the best of our knowledge this property has not been directly measured in single human tendon fibrils. In the present work an atomic force microscopy (AFM) approach was used for tensile testing of two human patellar tendon fibr...

  17. Medium-term evaluation of total knee arthroplasty without patellar replacement

    Directory of Open Access Journals (Sweden)

    José Wanderley Vasconcelos

    2013-06-01

    Full Text Available OBJECTIVE: To mid-term evaluate patients who were submitted to total knee arthroplasty without patellar resurfacing. METHODS: It was realized a retrospective cross-sectional study of patients who were submitted to total knee arthroplasty without patellar resurfacing. In all patients clinical examination was done based on the protocol of the Knee Society Scoring System, which assessed pain, range of motion, stability, contraction, knee alignment and function, and radiological evaluation. RESULTS: A total of 36 patients were evaluated. Of these, 07 were operated only on left knee, 12 only on right knee and 17 were operated bilaterally, totaling 53 knees. Ages ranged from 26 to 84 years. Of the 53 knees evaluated, 33 (62.26% had no pain. The maximum flexion range of motion averaged 104.7°. No knee had difficulty in active extension. As to the alignment for anatomical axis twelve knees (22.64% showed deviation between 0° and 4° varus. Thirty-nine (75.49% knees showed pace without restriction and the femorotibial angle ranged between 3° varus and 13° valgus with an average of 5° valgus. The patellar index ranged from 0.2 to 1.1. CONCLUSION: Total knee arthroplasty whitout patellar resurfacing provides good results in mid-term evaluation.

  18. Relationship between patellar mobility and patellofemoral joint cartilage degeneration after anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Ota, Susumu; Kurokouchi, Kazutoshi; Takahashi, Shigeo; Yoda, Masaki; Yamamoto, Ryuichiro; Sakai, Tadahiro

    2017-11-01

    Patellofemoral cartilage degeneration is a potential complication of anterior cruciate ligament reconstruction (ACLR) surgery. Hypomobility of the patella in the coronal plane is often observed after ACLR. Few studies, however, have examined the relationship between cartilage degeneration in the patellofemoral joint and mobility after ACLR. The present study investigated 1) the coronal mobility of the patella after ACLR, 2) the relationship between patellar mobility and cartilage degeneration of the patellofemoral joint, and 3) the relationship between patellar mobility and knee joint function after ACLR. Forty patients who underwent medial hamstring-based ACLR participated in the study. Lateral and medial patellar displacements were assessed with a modified patellofemoral arthrometer, and the absolute values of the displacements were normalized to patient height. The International Cartilage Repair Society (ICRS) cartilage injury classification of the patellar and femoral (trochlear) surfaces, and the Lysholm Knee Scoring Scale were used to evaluate knee function. Lateral and medial patellar displacements were reduced compared with the non-operated knee at the second-look arthroscopy and bone staple extraction operation (second operation; 24.4 ± 7.9 months after ACLR, Ppatellofemoral joint (patella and trochlea) were significantly worse than those pre-ACLR. Neither lateral nor medial patellar mobility, however, were significantly correlated with the ICRS grade or the Lysholm score. Although patellar mobility at approximately 2 years after ACLR was decreased compared to the non-operated knee, small displacement of the patella was not related to cartilage degeneration or knee joint function at the time of the second operation.

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

    Science.gov (United States)

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

    2012-12-15

    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.

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

    Science.gov (United States)

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

    2012-01-01

    Active Achilles tendon kinesitherapy facilitates the functional recovery of a ruptured Achilles tendon. However, protein expression during the healing process remains a controversial issue. New Zealand rabbits, aged 14 weeks, underwent tenotomy followed immediately by Achilles tendon microsurgery to repair the Achilles tendon rupture. The tendon was then immobilized or subjected to postoperative early motion treatment (kinesitherapy). Mass spectrography results showed that after 14 days of 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. PMID:25317130

  1. Clinical outcome of combined conjunctival autograft transplantation and amniotic membrane transplantation in pterygium surgery

    OpenAIRE

    Tejsu Malla; Jing Jiang; Kai Hu

    2018-01-01

    AIM: To compare long-term outcome of primary and recurrent pterygium surgery with three different techniques: combined conjunctival autograft and overlay amniotic membrane transplantation (CAT with AMT), conjunctival autograft transplantation (CAT) alone and amniotic membrane transplantation (AMT) alone. METHODS: In this retrospective study, 142 eyes of 142 pterygium patients (104 primary, 38 recurrent) who underwent CAT (group A), AMT (group B) or CAT with AMT (group C) respectively follo...

  2. Production of functional sperm by subcutaneous auto-grafting of immature testes in rainbow trout.

    Science.gov (United States)

    Hayashi, Makoto; Sakuma, Daika; Yoshizaki, Goro

    2018-02-01

    Sexually mature individuals are indispensable for breeding programs. Salmonids require a long period before reaching sexual maturity, so we aimed to shorten the period required to obtain functional sperm by grafting immature testicular fragments into mature recipients, which we predicted would allow the grafted testicular fragments to skip the long pre-pubertal period. First, we demonstrated successful subcutaneous auto-grafting of testicular fragments in rainbow trout. Unilateral testectomy was performed, and the isolated immature testicular fragment was auto-grafted into the subcutaneous space along the back of recipient fish. The grafted testicular fragments developed synchronously with the recipients' testis remaining in its body cavity, and both eventually produced functional sperm. Next, immature testicular fragments were auto-grafted into the subcutaneous space of sexually mature males. We achieved this, without immune rejection, by isolating and cryopreserving testes from immature fish, and rearing these unilaterally testectomized fish until sexual maturity. The cryopreserved testes were then auto-grafted into the original, now spermiating fish. The grated immature testicular fragments differentiated and produced functional sperm within 5 months after grafting. By combining this grafting method with a technique to avoid immune rejection, we expect to develop a practical method for producing sperm in a shorter period in salmonids. © 2017 Wiley Periodicals, Inc.

  3. Jumper's Knee (Patellar Tendonitis)

    Science.gov (United States)

    ... Safe Videos for Educators Search English Español Jumper's Knee KidsHealth / For Teens / Jumper's Knee What's in this ... continued damage to the knee. How Does the Knee Work? To understand how jumper's knee happens, it ...

  4. Extracorporeal shockwave for chronic patellar tendinopathy.

    Science.gov (United States)

    Wang, Ching-Jen; Ko, Jih-Yang; Chan, Yi-Sheng; Weng, Lin-Hsiu; Hsu, Shan-Lin

    2007-06-01

    Chronic patellar tendinopathy is an overuse syndrome with pathologic changes similar to tendinopathies of the shoulder, elbow, and heel. Extracorporeal shockwave was shown effective in many tendinopathies. Extracorporeal shockwave therapy may be more effective than conservative treatment for chronic patellar tendinopathy. Randomized controlled clinical trial; Level of evidence, 2. This study consisted of 27 patients (30 knees) in the study group and 23 patients (24 knees) in the control group. In the study group, patients were treated with 1500 impulses of extracorporeal shockwave at 14 KV (equivalent to 0.18 mJ/mm(2) energy flux density) to the affected knee at a single session. Patients in the control group were treated with conservative treatments including nonsteroidal anti-inflammatory drugs, physiotherapy, exercise program, and the use of a knee strap. The evaluation parameters included pain score, Victorian Institute of Sports Assessment score, and ultrasonographic examination at 1, 3, 6, and 12 months and then once a year. At the 2- to 3-year follow-up, the overall results for the study group were 43% excellent, 47% good, 10% fair, and none poor. For the control group, the results were none excellent, 50% good, 25% fair, and 25% poor. The mean Victorian Institute of Sports Assessment scores were 42.57 +/- 10.22 and 39.25 +/- 10.85, respectively, before treatment (P = .129) and 92.0 +/- 10.17 and 41.04 +/- 10.96, respectively, after treatment (P Extracorporeal shockwave therapy appeared to be more effective and safer than traditional conservative treatments in the management of patients with chronic patellar tendinopathy.

  5. Kinematic MR imaging of the knee for evaluating patellar tracking

    International Nuclear Information System (INIS)

    Shellock, F.G.; Mink, J.H.; Fox, J.

    1988-01-01

    A new technique to evaluate patellar tracking uses MR imaging and a specially designed positioning device (MEDRAD). T1-weighted, axial plane imaging was performed on both knees at the following joint angles: 0 0 , 5 0 , 10 0 , 15 0 , 20 0 , 25 0 , and 30 0 . The total examination time was approximately 12 minutes. Images were viewed in a cine loop to produce a kinematic study that depicted the relationship of the patella to the trochlear groove during the different angles of knee flexion. To date, 102 subjects (204 knees) have been examined. Dislocation, subluxatino, lateral tilt, lateral and medial displacement of the patella, and normal patellar tracking could all be identified with this technique. Abnormal configurations of the patella and/or trochlear groove were also clearly demonstrated. In conclusion, kinematic MR imaging of the knee provided important clinical information concerning patellar tracking and other related abnormalities of the patellofemoral joint

  6. Results of a prospective randomized controlled trial of early ambulation for patients with lower extremity autografts.

    Science.gov (United States)

    Lorello, David John; Peck, Michael; Albrecht, Marlene; Richey, Karen J; Pressman, Melissa A

    2014-01-01

    It is common practice to keep those patients with lower extremity autografts immobile until post-operative day (POD) 5. There is however inherent risks associated with even short periods of immobility. As of now there are no randomized controlled trials looking at early ambulation of patients with lower extremity autografts in the burn community.The objective of this study was to show that patients who begin ambulation within 24 hours of lower extremity autografting will have no increased risk of graft failure than those patients who remain immobile until POD 5. Thirty-one subjects who received autografts to the lower extremity were randomized after surgery into either the early ambulation group (EAG;17 subjects) or the standard treatment group (STG;14 subjects). Those subjects randomized to the EAG began ambulating with physical therapy on POD 1. Subjects in the STG maintained bed rest until POD 5. There was no difference in the number of patients with graft loss in either the EAG or STG on POD 5, and during any of the follow-up visits. No subjects required regrafting. There was a significant difference in the mean minutes of ambulation, with the EAG ambulating longer than the STG (EAG 23.4 minutes [SD 12.03], STG 14.1 [SD 9.00], P=.0235) on POD 5. Burn patients with lower extremity autografts can safely ambulate on POD 1 without fear of graft failure compared with those patients that remain on bed rest for 5 days.

  7. Concurrent patellar fracture and lateral collateral ligament avulsion as a result of trauma in three horses.

    Science.gov (United States)

    McLellan, Jonathan; Plevin, Sarah; Taylor, Elizabeth

    2012-05-15

    3 horses were evaluated because of lameness and swelling of the stifle joint subsequent to trauma. All horses had characteristic clinical signs of stifle joint pain and effusion. A medial patellar fracture and lateral collateral ligament avulsion fracture were visible ultrasonographically in each. Radiography, including standard as well as flexed lateromedial, cranioproximal-craniodistal oblique (skyline patellar), and laterally stressed caudocranial views, revealed similar findings. Arthroscopic surgery to remove the patellar fracture was attempted in 1 horse with severe desmitis of the lateral collateral ligament; it remained lame afterward. The other 2 horses, with less severe collateral ligament damage, were managed conservatively and returned to athletic use, despite the lack of surgical intervention to repair the patellar fractures. Special radiographic views were necessary for diagnosis of medial patellar fracture and lateral collateral ligament avulsion fracture in the 3 horses. Ultrasonographic findings pertaining to the collateral ligament may be prognostically important in such situations. The severity of a fracture involving ligament avulsion may be the limiting factor in horses with this combined injury, and this factor should be considered prior to attempting surgical correction of patellar fractures.

  8. Influence of Total Knee Arthroplasty on Patellar Kinematics and Patellofemoral Pressure.

    Science.gov (United States)

    Tanikawa, Hidenori; Tada, Mitsunori; Harato, Kengo; Okuma, Kazunari; Nagura, Takeo

    2017-01-01

    Patellofemoral complications are one of the main problems after total knee arthroplasty (TKA). The design of the TKA component may affect the patellar biomechanics, which may be associated with this postoperative complication. The purpose of this study was to assess the influence of TKA and prosthesis designs on the patellar kinematics and patellofemoral pressure. Using fresh-frozen cadavers, we measured the patellofemoral pressure, patella offset, and patella tilt in the following 4 conditions: normal knee (patella replacement only), cruciate-retaining TKA, condylar-stabilizing TKA, and posterior-stabilized TKA. The patellofemoral pressure increased significantly after the cruciate-retaining TKA and condylar-stabilizing TKA compared with the normal knee. The patella offset in the normal knee decreased with increasing knee flexion angles, while the patella offset in the TKA knees did not change significantly through the full range of motion. The amount of lateral patella tilt in the normal knee was significantly larger than the TKA knees in the full range of motion. Although the femoral components are designed to reproduce an anatomical patellar tracking, the physiological patellar kinematics were not observed. Relatively high patellofemoral pressure and kinematic change after TKA may be associated with postoperative complications such as the anterior knee pain. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Impact of Patellar Tendinopathy on Knee Proprioception: A Cross-Sectional Study.

    Science.gov (United States)

    Torres, Rui; Ferreira, João; Silva, Diogo; Rodrigues, Elisa; Bessa, Isabel M; Ribeiro, Fernando

    2017-01-01

    To determine whether high-level athletes with patellar tendinopathy have diminished knee proprioceptive acuity. Cross-sectional study. University research laboratory (institutional). Twenty-one basketball and volleyball players with patellar tendinopathy (13 men and 8 women; mean age 24.5 ± 3.6; body mass index = 22.5 ± 2.0 kg/m) and an equal number of athletes without symptoms of patellar tendinopathy injury were included in this study. Participants underwent knee proprioception assessments on a single day. Furthermore, age, sex, height, weight, VISA-P (Victorian Institute of Sport Assessment) questionnaire sports participation, medical history, knee injuries, previous treatment, and medication were obtained. Knee proprioception was evaluated by assessing sense of resistance, using a weight discrimination protocol, and joint position sense (JPS). No significant differences were observed in JPS at 30 and 60 degrees of knee flexion between groups (P = 0.165 and 0.481, respectively). In regard to the ability to discriminate weight, significant differences between the 2 groups were found with the tendinopathy group showing a higher percentage of error (P = 0.009), namely when the set of incremental weights varied by 10% from the standard weight. Athletes with patellar tendinopathy have a diminished perception of force signals required for weight discrimination, whereas JPS remains unaffected in these athletes.

  10. Tendon Transfer Surgery

    Science.gov (United States)

    ... All Topics A-Z Videos Infographics Symptom Picker Anatomy Bones Joints Muscles Nerves Vessels Tendons About Hand Surgery What is ... Hand Therapist? Media Find a Hand Surgeon Home Anatomy ... DESCRIPTION The tendon is the strong cord at either end of a muscle that is attached to bone. Tendons , combined with ...

  11. 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.

  12. Overuse tendinosis, not tendinitis part 2: applying the new approach to patellar tendinopathy.

    Science.gov (United States)

    Cook, J L; Khan, K M; Maffulli, N; Purdam, C

    2000-06-01

    Patellar tendinopathy causes substantial morbidity in both professional and recreational athletes. The condition is most common in athletes of jumping sports such as basketball and volleyball, but it also occurs in soccer, track, and tennis athletes. The disorder arises most often from collagen breakdown rather than inflammation, a tendinosis rather than a tendinitis. Physicians must address the degenerative pathology underlying patellar tendinopathy because regimens that seek to minimize (nonexistent) inflammation would appear illogical. Suggestions for applying the 'tendinosis paradigm' to patellar tendinopathy management include conservative measures such as load reduction, strengthening exercises, and massage. Surgery should be considered only after a long-term and appropriate conservative regimen has failed.

  13. Extracorporeal shockwave therapy for patellar tendinopathy: a review of the literature

    OpenAIRE

    van Leeuwen, M. T.; Zwerver, J.; van den Akker-Scheek, I.

    2009-01-01

    Background and purpose: Extracorporeal shockwave therapy (EWST) has become a popular treatment for patellar tendinopathy. The purpose of this review was to study the effectiveness of ESWT treatment for patellar tendinopathy; to draft guidelines for an effective treatment protocol of ESWT treatment; and to identify topics for further research. Methods: A computerised search of the Medline and Embase databases was conducted on 1 August 2007, to identify studies dealing with the effectiveness of...

  14. Novel experimental surgical strategy to prevent traumatic neuroma formation by combining a 3D-printed Y-tube with an autograft.

    Science.gov (United States)

    Bolleboom, Anne; de Ruiter, Godard C W; Coert, J Henk; Tuk, Bastiaan; Holstege, Jan C; van Neck, Johan W

    2018-02-09

    OBJECTIVE Traumatic neuromas may develop after nerve injury at the proximal nerve stump, which can lead to neuropathic pain. These neuromas are often resistant to therapy, and excision of the neuroma frequently leads to recurrence. In this study, the authors present a novel surgical strategy to prevent neuroma formation based on the principle of centro-central anastomosis (CCA), but rather than directly connecting the nerve ends to an autograft, they created a loop using a 3D-printed polyethylene Y-shaped conduit with an autograft in the distal outlets. METHODS The 3D-printed Y-tube with autograft was investigated in a model of rat sciatic nerve transection in which the Y-tube was placed on the proximal sciatic nerve stump and a peroneal graft was placed between the distal outlets of the Y-tube to form a closed loop. This model was compared with a CCA model, in which a loop was created between the proximal tibial and peroneal nerves with a peroneal autograft. Additional control groups consisted of the closed Y-tube and the extended-arm Y-tube. Results were analyzed at 12 weeks of survival using nerve morphometry for the occurrence of neuroma formation and axonal regeneration in plastic semi-thin sections. RESULTS Among the different surgical groups, the Y-tube with interposed autograft was the only model that did not result in neuroma formation at 12 weeks of survival. In addition, a 13% reduction in the number of myelinated axons regenerating through the interposed autograft was observed in the Y-tube with autograft model. In the CCA model, the authors also observed a decrease of 17% in the number of myelinated axons, but neuroma formation was present in this model. The closed Y-tube resulted in minimal nerve regeneration inside the tube together with extensive neuroma formation before the entrance of the tube. The extended-arm Y-tube model clearly showed that the majority of the regenerating axons merged into the Y-tube arm, which was connected to the autograft

  15. Biomechanical properties of patellar and hamstring graft tibial fixation techniques in anterior cruciate ligament reconstruction: experimental study with roentgen stereometric analysis.

    Science.gov (United States)

    Adam, Frank; Pape, Dietrich; Schiel, Karin; Steimer, Oliver; Kohn, Dieter; Rupp, Stefan

    2004-01-01

    Reliable fixation of the soft hamstring grafts in ACL reconstruction has been reported as problematic. The biomechanical properties of patellar tendon (PT) grafts fixed with biodegradable screws (PTBS) are superior compared to quadrupled hamstring grafts fixed with BioScrew (HBS) or Suture-Disc fixation (HSD). Controlled laboratory study with roentgen stereometric analysis (RSA). Ten porcine specimens were prepared for each group. In the PT group, the bone plugs were fixed with a 7 x 25 mm BioScrew. In the hamstring group, four-stranded tendon grafts were anchored within a tibial tunnel of 8 mm diameter either with a 7 x 25 mm BioScrew or eight polyester sutures knotted over a Suture-Disc. The grafts were loaded stepwise, and micromotion of the graft inside the tibial tunnel was measured with RSA. Hamstring grafts failed at lower loads (HBS: 536 N, HSD 445 N) than the PTBS grafts (658 N). Stiffness in the PTBS group was much greater compared to the hamstring groups (3500 N/mm versus HBS = 517 N/mm and HSD = 111 N/mm). Irreversible graft motion after graft loading with 200 N was measured at 0.03 mm (PTBS), 0.38mm (HBS), and 1.85mm (HSD). Elasticity for the HSD fixation was measured at 0.67 mm at 100 N and 1.32 mm at 200 N load. Hamstring graft fixation with BioScrew and Suture-Disc displayed less stiffness and early graft motion compared to PTBS fixation. Screw fixation of tendon grafts is superior to Suture-Disc fixation with linkage material since it offers greater stiffness and less graft motion inside the tibial tunnel. Our results revealed graft motion for hamstring fixation with screw or linkage material at loads that occur during rehabilitation. This, in turn, may lead to graft laxity.

  16. Achilles Tendonitis

    Science.gov (United States)

    ... almost impossible. Achilles tendonitis is a very common running injury. But it can also affect basketball players, dancers, ... Proximal Biceps Tendonitis Safety Tips: Basketball Safety Tips: Running Repetitive Stress Injuries Sports and Exercise Safety Dealing With Sports Injuries ...

  17. Patellar denervation with electrocautery in total knee arthroplasty without patellar resurfacing: a meta-analysis.

    Science.gov (United States)

    Cheng, Tao; Zhu, Chen; Guo, Yongyuan; Shi, Sifeng; Chen, Desheng; Zhang, Xianlong

    2014-11-01

    The impact of patellar denervation with electrocautery in total knee arthroplasty (TKA) on post-operative outcomes has been under debate. This study aims to conduct a meta-analysis and systematic review to compare the benefits and risks of circumpatellar electrocautery with those of non-electrocautery in primary TKAs. Comparative and randomized clinical studies were identified by conducting an electronic search of articles dated up to September 2012 in PubMed, EMBASE, Scopus, and the Cochrane databases. Six studies that focus on a total of 849 knees were analysed. A random-effects model was conducted using the inverse-variance method for continuous variables and the Mantel-Haenszel method for dichotomous variables. There was no significant difference in the incidence of anterior knee pain between the electrocautery and non-electrocautery groups. In term of patellar score and Knee Society Score, circumpatellar electrocautery improved clinical outcomes compared with non-electrocautery in TKAs. The statistical differences were in favour of the electrocautery group but have minimal clinical significance. In addition, the overall complications indicate no statistical significance between the two groups. This study shows no strong evidence either for or against electrocautery compared with non-electrocautery in TKAs. Therapeutic study (systematic review and meta-analysis), Level III.

  18. Lower Extremity Kinematics During a Drop Jump in Individuals With Patellar Tendinopathy

    Science.gov (United States)

    Rosen, Adam B.; Ko, Jupil; Simpson, Kathy J.; Kim, Seock-Ho; Brown, Cathleen N.

    2015-01-01

    Background: Patellar tendinopathy (PT) is a common degenerative condition in physically active populations. Knowledge regarding the biomechanics of landing in populations with symptomatic PT is limited, but altered mechanics may play a role in the development or perpetuation of PT. Purpose: To identify whether study participants with PT exhibited different landing kinematics compared with healthy controls. Study Design: Controlled laboratory study. Methods: Sixty recreationally active participants took part in this study; 30 had current signs and symptoms of PT, including self-reported pain within the patellar tendon during loading activities for at least 3 months and ≤80 on the Victorian Institute of Sport Assessment Scale–Patella (VISA-P). Thirty healthy participants with no history of PT or other knee joint pathology were matched by sex, age, height, and weight. Participants completed 5 trials of a 40-cm, 2-legged drop jump followed immediately by a 50% maximum vertical jump. Dependent variables of interest included hip, knee, and ankle joint angles at initial ground contact, peak angles, and maximum angular displacements during the landing phase in 3 planes. Independent-samples t tests (P ≤ .05) were utilized to compare the joint angles and angular displacements between PT and control participants. Results: Individuals with PT displayed significantly decreased peak hip (PT, 59.2° ± 14.6°; control, 67.2° ± 13.9°; P = .03) and knee flexion angles (PT, 74.8° ± 13.2°; control, 82.5° ± 9.0°; P = .01) compared with control subjects. The PT group displayed decreased maximum angular displacement in the sagittal plane at the hip (PT, 49.3° ± 10.8°; control, 55.2° ± 11.4°; P = .04) and knee (PT, 71.6° ± 8.4°; control, 79.7° ± 8.3°; P plane, at both the knee and the hip. The altered movement patterns in those with PT may be perpetuating symptoms associated with PT and could be due to the contributions of the rectus femoris during dynamic

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

    International Nuclear Information System (INIS)

    Maeseneer, Michel de; Shahabpour, Maryam; Isacker, Tom van; Lenchik, Leon; Caillie, Marie-Astrid van

    2014-01-01

    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. (orig.)

  20. Achilles tendon and sports

    International Nuclear Information System (INIS)

    Ulreich, N.; Kainberger, F.; Huber, W.; Nehrer, S.

    2002-01-01

    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.) [de

  1. T2 mapping in patellar chondromalacia.

    Science.gov (United States)

    Ruiz Santiago, Fernando; Pozuelo Calvo, Rocío; Almansa López, Julio; Guzmán Álvarez, Luis; Castellano García, María Del Mar

    2014-06-01

    To study the correlation between the T2 relaxation times of the patellar cartilage and morphological MRI findings of chondromalacia. This prospective study comprises 50 patients, 27 men and 23 women suffering of anterior knee pain (mean age: 29.7, SD 8.3 years; range: 16-45 years). MRI of 97 knees were performed in these patients at 1.5T magnet including sagittal T1, coronal intermediate, axial intermediate fat sat and T2 mapping. Chondromalacia was assessed using a modified version of Noyes classification. The relaxation time, T2, was studied segmenting the full thickness of the patellar cartilage in 12 areas: 4 proximal (external facet-proximal-lateral (EPL), external facet-proximal-central (EPC), internal facet-proximal-central (IPC), internal facet-proximal-medial (IPM), 4 in the middle section (external facet-middle-lateral (EML), external facet-middle-central (EMC), internal facet-middle-central (IMC), internal facet-middle-medial (IMM) and 4 distal (external facet-distal-lateral (EDL), external facet-distal-central (EDC), internal facet-distal-central (IDC), internal facet-distal-medial (IDM). T2 values showed a significant increase in mild chondromalacia regarding normal cartilage in most of the cartilage areas (pchondromalacia was characterized by a fall of T2 relaxation times with loss of statistical significant differences in comparison with normal cartilage, except in EMC and IMC, where similar values as mild chondromalacia were maintained (pchondromalacia to more severe degrees is associated to a new drop of T2 relaxation times approaching basal values in most of the areas of the patellar cartilage, except in the central area of the middle section, where T2 values remain increased. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  2. Patient guided Piezo-electric Extracorporeal Shockwave Therapy as treatment for chronic severe patellar tendinopathy: A pilot study.

    Science.gov (United States)

    Zwerver, Johannes; Dekker, Femke; Pepping, Gert-Jan

    2010-01-01

    Patellar tendinopathy is a common overuse injury for which no evidence-based treatment guidelines exist. Extracorporeal Shock Wave Therapy (ESWT) seems to be an effective treatment for patellar tendinopathy but the most beneficial treatment strategies still need to be ascertained. Aim of this pilot study was to investigate if patient guided Piezo-electric, focused ESWT, without local anesthesia is a safe and well tolerated treatment which improves pain and function in patients with patellar tendinopathy. Nineteen male athletes with severe chronic patellar tendinopathy received 3 patient guided focused medium to high energy ESWT treatments at a weekly interval. Before and after 3 months VISA-P and VAS (pain) scores were recorded. Data on side effects and complications of treatment were also collected. No serious complications were reported and patients tolerated the treatment well. Mean VISA-P score improved from 36.1 to 50.1 (p patellar tendinopathy.

  3. Total knee arthroplasty in a pseudoachondroplastic dwarfism patient with bilateral patellar dislocation.

    Science.gov (United States)

    Oh, Kwang-Jun; Yoon, Jung-Ro; Yang, Jae-Hyuk

    2013-01-01

    Late presentation of congenital patellar dislocation with advanced osteoarthritis is rare. This article presents a case of a 59-year-old man with underlying pseudoachondroplastic dwarfism. Advanced osteoarthritis due to bilateral neglected congenital patellar dislocation was treated with total knee arthroplasty without patella relocation surgery. Two years later, the patient had an improvement in Knee Society scores, painless function, and stability. Copyright © 2012 Elsevier B.V. All rights reserved.

  4. Femoral neuropathy due to patellar dislocation in a theatrical and jazz dancer: a case report.

    Science.gov (United States)

    Shin, Chris S; Davis, Brian A

    2005-06-01

    This case report describes a teenage female, high-level modern dancer who suffered multiple left patellar dislocations. Her history is atypical in that after her fifth dislocation, her recovery was hindered secondary to persistent weakness and atrophy of her quadriceps out of proportion to disuse alone. Electrodiagnostic studies and magnetic resonance imaging showed evidence of a subacute femoral neuropathy correlating chronologically with her most recent patellar dislocation. This case suggests that further diagnostic study may be warranted in patients with persistent quadriceps weakness or atrophy after a patellar dislocation, because this may suggest the presence of a femoral neuropathy. This is important because the strength training goals and precautions differ in disuse atrophy and a neuropathy. We believe this is the first reported case of a femoral neuropathy associated with the mechanism of a patellar dislocation.

  5. Open versus closed kinetic chain exercises for patellar chondromalacia.

    Science.gov (United States)

    Bakhtiary, A H; Fatemi, E

    2008-02-01

    Conservative treatment of patellar chondromalacia has been the subject of several studies. One recommended treatment is a strengthening exercise of the quadriceps muscle, which may be performed in closed or open kinetic chains. This study was designed to compare the effect of straight leg raise (SLR) and semi-squat exercises on the treatment of patellar chondromalacia, which has not been done to date. 32 female university students with a diagnosis of patellar chondromalacia were randomly assigned to two experimental groups: SLR and semi-squat exercise. Before starting exercise protocols, Q angle, maximal isometric voluntary contraction force (MIVCF) of quadriceps, crepitation, circumference of thigh 5 and 10 cm above the patella and patellofemoral pain according to the visual analogue scale (VAS) were assessed. Both groups then followed a 3-week programme of quadriceps muscle strengthening exercises (SLR or semi-squat) starting with 20 exercises twice a day and increasing each session by 5 exercises every 2 days. All measurements were repeated at the end of each week and then again 2 weeks after the 3-week exercise programme. Reduced Q angle (mean differences (SD) 0.8 (0.3), p = 0.016) and crepitation (19.9 (8.5), p = 0.04), and an increase in the MIVCF of the quadriceps (15.8 (5.6), p = 0.01) and thigh circumference (1.5 (0.3), p = 0.001) were found in semi-squat group compared with SLR group. However, patellofemoral pain was decreased significantly in both groups. The results of this study indicate that semi-squat exercises (closed kinetic chain) are more effective than SLR exercise (open kinetic chain) in the treatment of patellar chondromalacia. More studies are needed to investigate the long-term effect of these types of exercise.

  6. [Experimental work: reconstruction of the pelvi-ureteric junction and ureter using testicular tunica vaginalis autograft].

    Science.gov (United States)

    Usupbaev, A Ch; Kurbanaliev, R M; Chernetsova, G S; Kolesnichenko, I V; Sultanov, B M; Myrzakanov, N M; Zolotukhin, A O; Vagner, N A

    2017-12-01

    To evaluate the results of surgical reconstruction of the upper urinary tract using an autograft of testicular tunica vaginalis in experimental animals. The article presents the results of partial replacement of the renal pelvis and ureter with an autograft in 25 male dogs. The grafts were harvested by resection of the parietal layer of the testicular tunica vaginalis, which was transplanted into the region of the pelvi-ureteric junction and the proximal ureter. The upper urinary tract was drained using a ureteral stent catheter. The results were evaluated at week 1 and months 1, 3 and six after the operation. The functional state of the kidneys and ureters was analyzed using excretory urography and ultrasound; the autograft biopsy specimens were examined histologically. In all cases, the viability of the autograft was completely preserved, there were no signs of secondary infection, necrosis and impaired patency in the anastomosis zone. Histological examination revealed signs of epithelialization, connective tissue substitution and neovasculogenesis in the implantation zone. The proposed surgical modality is an alternative method to restore normal urine flow in the upper urinary tract in obstructive urological diseases. The group of obstructive urological diseases was studied using the model of the strictures of the pelvi-ureteric junction in the intrarenal pelvis and ureteral strictures measuring up to 3-4 cm in length.

  7. Lower limb strength and flexibility in athletes with and without patellar tendinopathy.

    Science.gov (United States)

    Scattone Silva, Rodrigo; Nakagawa, Theresa H; Ferreira, Ana Luisa G; Garcia, Luccas C; Santos, José E M; Serrão, Fábio V

    2016-07-01

    To compare the hip, knee and ankle torques, as well as knee and ankle flexibility between athletes with patellar tendinopathy and asymptomatic controls. Cross-sectional study. Laboratory setting. Fourteen male volleyball, basketball or handball athletes, divided into 2 groups, patellar tendinopathy group (TG; n = 7) and asymptomatic control group (CG; n = 7). Hip, knee and ankle isometric torques were measured with a handheld dynamometer. Weight-bearing ankle dorsiflexion, hamstring and quadriceps flexibility were measured with a gravity inclinometer. The TG had 27% lower hip extensor torque when compared to the CG (P = 0.031), with no group differences in knee and ankle torques (P > 0.05). Also, the TG had smaller weight-bearing ankle dorsiflexion (P = 0.038) and hamstring flexibility (P = 0.006) when compared to the CG. Regarding quadriceps flexibility, no group differences were found (P = 0.828). Strength and flexibility deficits might contribute to a greater overload on the knee extensor mechanism, possibly contributing to the origin/perpetuation of patellar tendinopathy. Interventions aiming at increasing hip extensors strength as well as ankle and knee flexibility might be important for the rehabilitation of athletes with patellar tendinopathy. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. Vertical Patellar Dislocation: Reduction by the Push Up and Rotate Method, A Case Report and Literature Review.

    Science.gov (United States)

    Ahmad Khan, Hayat; Bashir Shah, Adil; Kamal, Younis

    2016-11-01

    Patellar dislocation is an emergency. Vertical patellar dislocation is rare, often seen in adolescents and mostly due to sports injuries or high-velocity trauma. Few cases have been reported in the literature. Closed or open reduction under general anesthesia is often needed. We report a case of vertical locked patellar dislocation in a 26-year-old male, which was reduced by a simple closed method under spinal anaesthesia. A literature review regarding the various methods of treatment is also discussed. A 26-year-old male experienced a trivial accident while descending stairs, sustaining patellar dislocation. The closed method of reduction was attempted, using a simple technique. Reduction was confirmed and postoperative rehabilitation was started. Follow-up was uneventful. Vertical patellar dislocations are encountered rarely in the emergency department. Adolescents are not the only victims, and high-velocity trauma is not the essential cause. Unnecessary manipulation should be avoided. The closed reduction method is simple, but the surgeon should be prepared for open reduction.

  9. Calcaneal tendon: imaging findings

    International Nuclear Information System (INIS)

    Montandon, Cristiano; Fonseca, Cristiano Rezio; Montandon Junior, Marcelo Eustaquio; Lobo, Leonardo Valadares; Ribeiro, Flavia Aparecida de Souza; Teixeira, Kim-Ir-Sen Santos

    2003-01-01

    We reviewed the radiological and clinical features of 23 patients with calcaneal tendon diseases, who were submitted to ultrasound or magnetic resonance imaging. The objective of this study was to characterize the lesions for a precise diagnosis of calcaneal tendon injuries. A wide range of calcaneal tendon diseases include degenerative lesions, inflammation of the peritendinous tissue such as peritendinitis and bursitis, and rupture. Imaging methods are essential in the diagnosis, treatment and follow-up of calcaneal tendon diseases. (author)

  10. Containment structure tendon investigation

    International Nuclear Information System (INIS)

    Fulton, J.F.; Murray, K.H.

    1983-01-01

    The paper describes an investigation into the possible causes of lower-than-predicted tendon forces which were measured during past tendon surveillances for a concrete containment. The containment is post tensioned by vertical tendons which are anchored into a rock foundation. The tendons were originally stressed in 1969, and lift-off tests were performed on six occasions subsequent to this date over a period of 11 years. The tendon forces measured in these tests were generally lower than predicted, and by 1979 the prestress level in the containment was only marginally above the design requirement. The tendons were retensioned in 1980, and by this time an investigation into the possible causes was underway. Potential causes investigated include the rock anchors and surrounding rock, elastomeric pad creep, wire stresses, thermal effects, stressing equipment and lift-off procedures, and wire stress relaxation. The investigation activities included stress relaxation testing of wires pulled from actual tendons. The stress relaxation test program included wire specimens at several different temperature and initial stress levels and the effect of a varying temperature history on the stress relaxation property of the wires. For purpose of future force predictions of the retensioned tendons, the test program included tests to determine the effect on stress relaxation due to restressing the wires after they had relaxed for 1000 hours and 10,000 hours. (orig./GL)

  11. Highly Unusual Tendon Abnormality: Spontaneous Rupture of the Distal Iliopsoas Tendon

    Directory of Open Access Journals (Sweden)

    Gokcen Coban

    2014-06-01

    Full Text Available Iliopsoas tendon injuries are not common and usually occur due to avulsion of the iliopsoas tendon with detachment of the lesser trochanter, secondary to an athletic injury or trauma. In the absence of a trauma, avulsion of the lesser trochanter in an adult is regarded as a sign of metastatic disease until proven otherwise. Complete iliopsoas tendon tears have thus far only been described in elderly women, and without trauma or an underlying systemic disease, a hormonal basis may be a reason for the gender differences. In this article, we present an 87-year-old woman with spontaneous rupture of the left distal iliopsoas tendon unassociated with fracture of the lesser trochanter and in the absence of a recent trauma history. This elderly patient presented with acute groin pain and normal plain radiographs. Magnetic resonance imaging must be kept in mind as a modality of choice for identifying iliopsoas tendon abnormalities.

  12. [Achilles tendon rupture].

    Science.gov (United States)

    Thermann, H; Hüfner, T; Tscherne, H

    2000-03-01

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

  13. Effect of a patellar strap on the joint position sense of the symptomatic knee in athletes with patellar tendinopathy

    NARCIS (Netherlands)

    de Vries, Astrid J.; van den Akker-Scheek, Inge; Haak, Svenja L.; Diercks, Ron L.; van der Worp, Henk; Zwerver, Johannes

    2017-01-01

    Objectives: The primary aim of this study was to investigate the effect of a patellar strap on the proprioception of the symptomatic leg in PT. Secondary aims were to investigate a possible difference in effectiveness between athletes with high and low proprioceptive acuity, and whether predictors

  14. Number and Quality of Oocytes Collected from Heterotopic Autografted Mice Ovary after PMSG Induction

    Directory of Open Access Journals (Sweden)

    NURBARIAH

    2011-12-01

    Full Text Available Heterotopic grafting sites can be useful in producing oocytes for in vitro Fertilization, therefore, maximising the oocyte yield from the graft by gonadotrophin stimulation would be advantageous. The aim of this study was to investigate the number and quality of oocytes collected from heterotopic autografted ovary after Pregnant Mare Serum Gonadothropin (PMSG induction. Graft recipients were treated either with or without PMSG stimulation 48 hours prior to graft collection. Ovarian tissue from four weeks old mice (DDY strain were autotransplanted under the kidney capsule of the same ovariectomized mice and the oocytes were collected 21 days after autotransplantation. The results showed that the average number of oocytes collected from autografted ovaries without PMSG induction were 9.0. ± 2.8 not significantly different with those received PMSG induction, 10.9 ± 5.1. The percentage of matured and fertilized oocytes and the developed embryos from the autografted ovaries without PMSG induction were 52.4, 33.4, and 26.0%, respectively not significantly different with those received PMSG induction, 53.2, 35.1, and 29.9%, respectively. The number of oocytes and the capacity to matured, fertilized and developed were significantly lower (P < 0.05 compared to the superovulated nongrafted (control ovaries. In conclusion, PMSG induction on the graft recipients did not significantly increase oocytes yield from grafted heterotopic ovaries. The number and quality of oocytes produced from the autografted ovaries were lower than the superovulated nongrafted ovaries, but still can be used for in vitro embryo production after sequential in vitro maturation and fertilization.

  15. Allograft versus autograft in cervical and lumbar spinal fusions: an examination of operative time, length of stay, surgical site infection, and blood transfusions.

    Science.gov (United States)

    Murphy, Meghan E; McCutcheon, Brandon A; Grauberger, Jennifer; Shepherd, Daniel; Maloney, Patrick R; Rinaldo, Lorenzo; Kerezoudis, Panagiotis; Fogelson, Jeremy L; Nassr, Ahmad; Bydon, Mohamad

    2016-11-23

    Autograft harvesting for spine arthrodesis has been associated with longer operative times and increased blood loss. Allograft compared to autograft in spinal fusions has not been studied in a multicenter cohort. Patients enrolled in the ACS-NSQIP registry between 2012 and 2013 who underwent cervical or lumbar spinal fusion with either allograft or autograft through a separate incision were included for analysis. The primary outcomes of interest were operative time, length of stay, blood transfusion, and surgical site infection (SSI). A total of 6,790 and 6,718 patients received a cervical or lumbar spinal fusion, respectively. On unadjusted analysis in both cervical and lumbar cohorts, autograft was associated with increased rates of blood transfusion (cervical: 2.9% vs 1.0%, poperative time (cervical: 167 vs 128 minutes, poperative times (cervical: 27.8 minutes, 95% CI 20.7-35.0; and lumbar: 25.4 minutes, 95% CI 17.7-33.1) relative to allograft. Autograft was not associated with either length of stay or SSI. In a multicenter cohort of patients undergoing cervical or lumbar spinal fusion, autograft was associated with increased rates of blood transfusion and increased operative time relative to allograft.

  16. High-resolution MRI using a microscopy coil for the diagnosis of recurrent lateral patellar dislocation

    International Nuclear Information System (INIS)

    Iwata, Yuki; Fujii, Masahiko; Muratsu, Hirotsugu; Kurosaka, Masahiro; Kawamitsu, Hideaki; Sugimura, Kazuro; Shibanuma, Hitoshi

    2006-01-01

    Magnetic resonance imaging (MRI) has been commonly used for the preoperative evaluation of recurrent lateral patellar dislocation (RLPD). The purpose of this study was to determine the usefulness of high-resolution MRI (HR-MRI) with a microscopy coil for diagnosing RLPD. The study group consisted of 15 patients with clinically diagnosed RLPD and 10 normal volunteers. All studies were performed on a 1.5-T MR system. First, conventional MRIs of the whole knee joint were obtained using the knee coil. Then HR-MRI scans using a microscopy coil in the medial aspect of the patella were obtained at the level of the superior pole of the patella, targeting the medial patellofemoral ligament (MPFL). The acquired HR-MRIs with RLPD were reviewed concerning the MPFL injury and the patellar injury. The MPFL was distinguished as a separate ligament, and the layer structure of the patellar cartilage was visualized clearly in all volunteers. The MPFL injury was visualized in 12 cases (87%); it included discontinuity, thickening, and loosening. The patellar injury was visualized in 11 cases (73%), which included dissecans of the medial margin and cartilage injuries. HR-MRI with a microscopy coil provides precise information of the MPFL and patellar cartilage injury for the diagnosis of RLPD. (author)

  17. Structural tendon changes in patients with acromegaly: assessment of Achilles tendon with sonoelastography.

    Science.gov (United States)

    Onal, Eda Demil; Ipek, Ali; Evranos, Berna; Idilman, Ilkay Sedakat; Cakir, Bekir; Ersoy, Reyhan

    2016-03-01

    To describe the sonoelastographic appearance of the Achilles tendon in acromegalic patients and to determine whether the blood concentrations of growth hormone (GH) and insulin-like growth factor (IGF-1) are associated with the various sonographic elasticity types of Achilles tendons. Eighty-four Achilles tendons of 42 acromegaly patients and 84 Achilles tendons of 42 healthy volunteers were assessed with sonoelastography. The tendons were classified into two main types according to the elasticity features: type 1 blue/green (hard tissue) and type 2 yellow/red within green (intermediate-soft tissue). Two subtypes of these types were also defined. According to the definition, the elasticity of the tissue was in a spectrum ranging from hard to soft as the type progressed from 1a to 2b. The mean thickness of Achilles tendons in patients with acromegaly was significantly higher compared with healthy Achilles tendons (5.1+/-0.7 mm vs. 4.4+/-0.5, pacromegaly patients had type 2 sonoelastographic appearance of the Achilles tendon (124/252 third; 49.2% vs. 81/252 third; 32.1%, p=0.0001). Activity status of acromegaly and GH/IGF-I levels were similar in patients with different types of elasticity (p>0.05). Sonoelastography revealed structural changes in the tendinous tissue of patients with acromegaly, but it was not sensitive enough to reflect changes in the serum levels of GH/IGF-1.

  18. A Review on Biomechanics of Anterior Cruciate Ligament and Materials for Reconstruction

    Directory of Open Access Journals (Sweden)

    M. Marieswaran

    2018-01-01

    published reviews on the ACL focus largely on animal ACL than human ACL. Further, this review article summarizes the issues with autografts and synthetic grafts used so far. Autografts (patellar tendon and hamstring tendon remains the gold standard as nearly all synthetic grafts introduced for clinical use have been withdrawn from the market. The mechanical strength during the ligamentization of autografts is also highlighted in this work.

  19. MRI of tibialis anterior tendon rupture

    International Nuclear Information System (INIS)

    Gallo, Robert A.; DeMeo, Patrick J.; Kolman, Brett H.; Daffner, Richard H.; Sciulli, Robert L.; Roberts, Catherine C.

    2004-01-01

    Ruptures of the tibialis anterior tendon are rare. We present the clinical histories and MRI findings of three recent male patients with tibialis anterior tendon rupture aged 58-67 years, all of whom presented with pain over the dorsum of the ankle. Two of the three patients presented with complete rupture showing discontinuity of the tendon, thickening of the retracted portion of the tendon, and excess fluid in the tendon sheath. One patient demonstrated a partial tear showing an attenuated tendon with increased surrounding fluid. Although rupture of the tibialis anterior tendon is a rarely reported entity, MRI is a useful modality in the definitive detection and characterization of tibialis anterior tendon ruptures. (orig.)

  20. Histological Changes in the Proximal and Distal Tendon Stumps Following Transection of Achilles Tendon in the Rabbits.

    Science.gov (United States)

    Al-Qattan, Mohammad M; Mawlana, Ola Helmi; Mohammed Ahmed, Raeesa Abdel-Twab; Hawary, Khalid

    2016-05-01

    To determine tendon stump changes following unrepaired Achilles tendon lacerations in an animal model. An experimental study. King Saud University, Riyadh, Saudi Arabia, from October 2013 to January 2014. Arabbit model was developed and studied tendon retraction and histological changes in the proximal and distal stumps following transection of the Achilles tendon. Over a period of 12 weeks, retraction of the distal tendon stump was minimal (2 - 3 mm). In contrast, retraction of the proximal tendon stump peaked to reach 6 mm at 4 weeks post-injury and plateaued to reach 7 - 8 mm at the 12-week interval. Following complete transection of the Achilles tendon, tendon retraction correlated with the density of myofibroblast expression within the tendon stump. Further research is needed to investigate the pathophysiology of these findings.

  1. Novel methods for tendon investigations

    DEFF Research Database (Denmark)

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

    2008-01-01

    Purpose. Tendon structures have been studied for decades, but over the last decade, methodological development and renewed interest for metabolic, circulatory and tissue protein turnover in tendon tissue has resulted in a rising amount of investigations. Method. This paper will detail the various...... modern investigative techniques available to study tendons. Results. There are a variety of investigative methods available to study the correlations between mechanics and biology in tendons. Conclusion. The available methodologies not only allow for potential insight into physiological...... and pathophysiological mechanisms in tendon tissue, but also, to some extent, allow for more elaborate studies of the intact human tendon. Read More: http://informahealthcare.com/doi/full/10.1080/09638280701785403...

  2. MR imaging of patellar cartilage degeneration at 0.02 T

    International Nuclear Information System (INIS)

    Koskinen, S.K.; Komu, M.; Aho, H.J.; Kormano, M.; Turku University Hospital

    1991-01-01

    MR imaging with a 0.02 T resistive magnet was used to establish the correlation between the histologic grading of patellar cartilage degeneration and fat water separation images or T1- and T2-relaxation times. We examined 23 cadaveric patellae. There was a positive correlation between histologically graded cartilage degeneration and T1-relaxation time. Patellar cartilage was well differentiated from surrounding structures on chemical shift water proton images, and an evaluation of cartilage degeneration was possible. No correlation was found between cartilage degeneration damage and T2-relaxation time. Chemical shift imaging at 0.02 T is easy to perform and gives further information of cartilage disorders. (orig.)

  3. Primary patellar dislocations without surgical stabilization or recurrence: how well are these patients really doing?

    Science.gov (United States)

    Magnussen, Robert A; Verlage, Megan; Stock, Elizabeth; Zurek, Lauren; Flanigan, David C; Tompkins, Marc; Agel, Julie; Arendt, Elizabeth A

    2017-08-01

    While a significant research has gone into identifying patients at highest risk of recurrence following primary patellar dislocation, there has been little work exploring the outcomes of patients who do not have a recurrent patellar dislocation. We hypothesize that patients without recurrent dislocation episodes will exhibit significantly higher KOOSs than those who suffer recurrent dislocations, but lower scores than published age-matched normative data. A retrospective review of patients with nonoperatively treated primary lateral patellar dislocations was carried out, and patients were contacted at a mean of 3.4 years (range 1.3-5.5 years) post-injury. Information regarding subsequent treatment and recurrent dislocations along with patient-reported outcome scores and activity level was collected. One hundred and eleven patients (29.8 %) of 373 eligible patients agreed to study participation, seven of whom were excluded because they underwent subsequent patellar stabilization surgery on the index knee. Seventy-six patients (73.1 %) reported no further dislocation events, and the mean KOOS subscales at follow-up were: symptoms-80.2 ± 18.8, pain-81.8 ± 16.2, ADL-88.7 ± 15.9, sport/recreation-72.1 ± 24.4, and QOL-63.9 ± 23.8 at a mean follow-up of 3.3 years (range 1.3-5.5 years). No significant differences in any of the KOOS subscales were noted between these patients and the group that reported recurrent patellar dislocations. Only 26.4 % of the patients without further dislocations reported they were able to return to desired sport activities without limitations following their dislocation. Patients who do not report recurrent patellar dislocations following nonoperative treatment of primary patellar dislocations are in many cases limited by this injury 3 years following the initial dislocation event. Retrospective cohort study, Level III.

  4. Tendon 'turnover lengthening' technique.

    Science.gov (United States)

    Cerovac, S; Miranda, B H

    2013-11-01

    Tendon defect reconstruction is amongst the most technically challenging areas in hand surgery. Tendon substance deficiency reconstruction techniques include lengthening, grafting, two-stage reconstruction and tendon transfers, however each is associated with unique challenges over and above direct repair. We describe a novel 'turnover lengthening' technique for hand tendons that has successfully been applied to the repair of several cases, including a case of attritional flexor and traumatic extensor tendon rupture in two presented patients where primary tenorrhaphy was not possible. In both cases a good post-operative outcome was achieved, as the patients were happy having returned back to normal activities of daily living such that they were discharged 12 weeks post-operatively. Our technique avoids the additional morbidity and complications associated with grafting, transfers and two stage reconstructions. It is quick, simple and reproducible for defects not exceeding 3-4 cm, provides a means of immediate one stage reconstruction, no secondary donor site morbidity and does not compromise salvage by tendon transfer and/or two-stage reconstruction in cases of failure. To our knowledge no such technique has been previously been described to reconstruct such hand tendon defects. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

  5. Histological Changes in the Proximal and Distal Tendon Stumps Following Transection of Achilles Tendon in the Rabbits

    International Nuclear Information System (INIS)

    Al-Qattan, M. M.; Hawary, K.; Mawlana, O. H.; Ahmed, R. A. M.

    2016-01-01

    Objective: To determine tendon stump changes following unrepaired Achilles tendon lacerations in an animal model. Study Design: An experimental study. Place and Duration of Study: King Saud University, Riyadh, Saudi Arabia, from October 2013 to January 2014. Methodology: Arabbit model was developed and studied tendon retraction and histological changes in the proximal and distal stumps following transection of the Achilles tendon. Result: Over a period of 12 weeks, retraction of the distal tendon stump was minimal (2 - 3 mm). In contrast, retraction of the proximal tendon stump peaked to reach 6 mm at 4 weeks post-injury and plateaued to reach 7 - 8 mm at the 12-week interval. Conclusion: Following complete transection of the Achilles tendon, tendon retraction correlated with the density of myofibroblast expression within the tendon stump. Further research is needed to investigate the pathophysiology of these findings. (author)

  6. 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

  7. 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....

  8. 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 tendon length and strain at all contraction intensities after eccentric exercise (P tendon for any of the measured parameters. Immediate changes in Achilles tendon mechanical properties were specific to the free tendon and consistent with changes due to mechanical creep. These findings suggest that the mechanical properties of the free tendon may be more vulnerable to change with exercise compared with the gastrocnemii aponeurosis or tendon. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  9. Use of fibrin glue in the management of recurrent pterygium by conjunctival autograft

    International Nuclear Information System (INIS)

    Virendra K. Malik; Sandeep Kumar

    2010-01-01

    To evaluate whether use of fibrin glue instead of sutures for the treatment of recurrent pterygium with conjunctival auto-graft (CAG) further decreases its recurrence. A prospective, clinical open trial of 50 eyes of 50 patients with recurrent pterygium, who were randomly assigned to either, pterygium excision and CAG with fibrin glue (Group 1) or with 6 interrupted sutures (Group 2), was carried out from January 2009 to July 2010 at the outpatient department of Subharti Medical College, Meerut, North India. Both groups had 25 patients each. The groups were compared with regards to the surgical time taken, development of recurrence, postoperative symptoms (irritation, watering, and redness), and complications. Recurrence was seen in one (4%) eye in group I, and 3 (12%) eyes in group II after 9-13 months of follow up. The difference between the 2 groups was not statistically significant. The surgical time was significantly reduced, and postoperative inflammation and complications were less in group I. Postoperative symptoms were significantly more in group II patients. While conjunctival autograft with sutures for management of recurrent pterygium appears to be a safe and feasible modality, fibrin glue fixation of the autograft is a more viable option in terms of surgical ease, less time consuming, less postoperative complications, and less recurrence (Author).

  10. Tendinopatia patelar Patellar tendinopathy

    Directory of Open Access Journals (Sweden)

    Moisés Cohen

    2008-08-01

    Full Text Available A tendinopatia do patelar ou jumper's knee (joelho do saltador é uma afecção que acomete freqüentemente atletas praticantes de atividades de salto ou aquelas que exigem força de impacto repetitivo. Histologicamente, a sobrecarga excessiva no tendão pode provocar alterações na matriz extracelular, resultando em pequenas lesões que, cronicamente, poderão levar a um quadro de tendinose, principalmente na região do pólo inferior da patela. A dor na região anterior do joelho é o primeiro sintoma relatado pelo paciente portador dessa afecção. Seu início é insidioso e gradual, principalmente após atividade física, mas, com a progressão da doença, pode tornar-se freqüente durante ou já no início da atividade. O diagnóstico de tendinopatia do patelar é eminentemente clínico, caracterizado por dor à palpação no pólo inferior da patela e adjacências e, nos casos mais avançados, nódulo palpável e edema associado podem ser visualizados. Exames complementares, como radiografia, ultra-sonografia (US e ressonância magnética (RM auxiliam no diagnóstico. O US e a RM são os mais indicados, pois podem definir o local exato da lesão, sua extensão, como também identificar a presença ou não de alterações degenerativas, sendo a RM o que fornece melhor resolução. O tratamento inicial da tendinopatia é clínico, com repouso relativo, correção dos fatores etiológicos, além de crioterapia e medidas fisioterápicas. A utilização da medicação analgésica e antiinflamatória é controversa. Nos casos que não respondem ao tratamento clínico, o cirúrgico é opção, e várias técnicas são descritas, a literatura demonstrando índices variados de bons resultados.Patellar tendinopathy, or jumper's knee, is often seen in athletes that practice jumping modalities, or modalities that require repetitive impact strength. Histologically, the excessive load on the tendon may cause changes in the extracellular matrix and

  11. Effects of Patellar Taping on the Patella Position in Presence of Quadriceps Contraction in 20-40 Year-Old Women With Patellofemoral Pain Syndrome Using MRI

    Directory of Open Access Journals (Sweden)

    Mahboobeh Banejad

    2016-06-01

    Discussion: Kinesio taping plus quadriceps contraction reduced the PFCA and LPFA. Patellar taping is effective in the correction of the patellar position in contracted quadriceps. Therefore, both neuromuscular and mechanical effects of patellar taping affect the patellar position over a long period. The combination of patellar taping and exercise reduced pain and improved activity faster than either of the treatment alone.

  12. Imaging assessment of patellar instability and its treatment in children and adolescents

    Energy Technology Data Exchange (ETDEWEB)

    Meyers, Arthur B.; Sharafinski, Mark [Children' s Hospital of Wisconsin, Medical College of Wisconsin, Department of Radiology, P.O. Box 1997, Milwaukee, WI (United States); Laor, Tal; Zbojniewicz, Andrew M. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States)

    2016-05-15

    Transient patellar dislocation is a common entity in children and adolescents, characterized by lateral dislocation of the patella, usually with spontaneous reduction. Many predisposing conditions have been described, including trochlear dysplasia, excessive lateral patellar tilt, patella alta and lateralization of the tibial tuberosity. Associated injuries are bone bruises of the patella and lateral femoral condyle, tears of the medial retinaculum that include the medial patellofemoral ligament (MPFL), tears of the vastus medialis obliquus muscle, injuries of articular cartilage, and intra-articular bodies. Children who are refractory to conservative management, have a large cartilage defect, or are at substantial risk for recurrent dislocations are candidates for surgical procedures to prevent future dislocations. Procedures can include MPFL repair or reconstruction, tibial tubercle repositioning and lateral retinacular release. The purpose of this review is to illustrate the imaging findings of transient patellar dislocation in the acute setting, the normal imaging appearance after surgical intervention, and post-surgical complications. (orig.)

  13. Imaging assessment of patellar instability and its treatment in children and adolescents

    International Nuclear Information System (INIS)

    Meyers, Arthur B.; Sharafinski, Mark; Laor, Tal; Zbojniewicz, Andrew M.

    2016-01-01

    Transient patellar dislocation is a common entity in children and adolescents, characterized by lateral dislocation of the patella, usually with spontaneous reduction. Many predisposing conditions have been described, including trochlear dysplasia, excessive lateral patellar tilt, patella alta and lateralization of the tibial tuberosity. Associated injuries are bone bruises of the patella and lateral femoral condyle, tears of the medial retinaculum that include the medial patellofemoral ligament (MPFL), tears of the vastus medialis obliquus muscle, injuries of articular cartilage, and intra-articular bodies. Children who are refractory to conservative management, have a large cartilage defect, or are at substantial risk for recurrent dislocations are candidates for surgical procedures to prevent future dislocations. Procedures can include MPFL repair or reconstruction, tibial tubercle repositioning and lateral retinacular release. The purpose of this review is to illustrate the imaging findings of transient patellar dislocation in the acute setting, the normal imaging appearance after surgical intervention, and post-surgical complications. (orig.)

  14. Long-term results of bone-retinaculum-bone autograft for scapholunate instability.

    Science.gov (United States)

    Soong, Maximillian; Merrell, Gregory A; Ortmann, Fred; Weiss, Arnold-Peter C

    2013-03-01

    To report long-term follow-up of scapholunate interosseous ligament reconstruction with bone-retinaculum-bone autograft in patients with dynamic scapholunate instability. Of the 14 patients from the previously reported cohort who had bone-retinaculum-bone autograft for dynamic instability, 6 returned for clinical examination and radiographs, 3 were reached by telephone, and 2 were lost to follow-up. The remaining 3 had salvage procedures (2 total wrist arthrodeses and 1 proximal row carpectomy) between the prior report and the current study and thus reached an endpoint, at 2 to 4 years. For the 6 who returned, outcome measurements included scapholunate angle and gap, radiographic evidence of secondary arthritis, wrist extension and flexion, grip strength, and Mayo wrist score. Follow-up averaged 11.9 years (range, 10.7-14.1 y). Clinical and radiographic outcomes deteriorated moderately from the prior report. Mayo wrist score averaged 83. There were 3 failures, resulting in 1 proximal row carpectomy and 2 total wrist arthrodeses. Findings at repeat surgery in the failed group included an intact graft without any apparent abnormalities, a partially ruptured graft (after a subsequent re-injury), and a completely resorbed graft. Bone-retinaculum-bone autograft reconstruction is a viable treatment option for dynamic scapholunate instability in which the scaphoid and lunate can be reduced. Results may deteriorate but are similar to those reported previously from other techniques. Problems with graft strength or stiffness may necessitate further surgery. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  15. Avaliação do resultado da reconstrução artroscópica do ligamento cruzado anterior do joelho com enxerto dos tendões flexores Evaluation of the results of arthroscopic ACL reconstruction with autogenous flexor tendons

    Directory of Open Access Journals (Sweden)

    Alexandre Almeida

    2010-01-01

    Full Text Available OBJETIVO: Avaliar o resultado da reconstrução do ligamento cruzado anterior (LCA com o autoenxerto dos tendões flexores da coxa. Serão analisados os dados com relação ao sexo, ao índice de massa corporal (IMC e a associação com fratura no membro inferior (MI. MÉTODOS: Foi analisado um grupo de 265 pacientes submetidos à artroscopia do joelho para fins de reconstrução do LCA com enxerto ipsilateral dos tendões flexores da coxa no período de 6 de julho de 2000 a 19 de novembro de 2007. RESULTADOS: 176 pacientes foram avaliados com média de 34,95 ± 18,8 meses (mediana 31 meses (IIQ: 20-48 meses. A avaliação mínima foi aos 12 meses e a máxima aos 87 meses. Obtivemos 138 (78,4% pacientes com resultado excelente, 22 (12,5% com resultado bom, oito (4,5% com resultado regular e oito (4,5% pacientes apresentaram resultado ruim. Não foi considerada significativa a maior incidência de bons e excelentes resultados para o sexo masculino (p = 0,128, para os pacientes com IMC OBJETIVE: To evaluate the results of single band arthroscopic anterior cruciate ligament (ACL reconstruction with flexor tendon autografts. We analyzed data about sex, body mass index (BMI and lower limb fracture associated with the initial trauma. METHODS: Two hundred and sixty-five patients who underwent arthroscopic anterior cruciate ligament (ACL reconstruction with ipsilateral thigh flexor tendon autografts from July 6, 2000, to November 19, 2007, were evaluated. RESULTS: One hundred and seventy-six patients were evaluated at an average follow up time of 34.95 ± 18.8 months (Median 31 months (IIQ: 20 - 48 months. The minimum evaluation time was 12 months and the maximum 87 months. One hundred and thirty-eight (78.4% patients had excellent results, 22 (12.5% patients good, 8 (4.5% patients fair, and 8 (4.5% poor results. No statistical significance was found for the better results for males (p = 0.128, for patients with a BMI < 25 (p = 0.848, or for patients

  16. The reliability and validity of radiological assessment for patellar instability. A systematic review and meta-analysis

    Energy Technology Data Exchange (ETDEWEB)

    Smith, Toby O. [University of East Anglia, Faculty of Health, Norwich (United Kingdom); Davies, Leigh [Norfolk and Norwich University Hospital, Norwich (United Kingdom); Toms, Andoni P.; Donell, Simon T. [University of East Anglia, Faculty of Health, Norwich (United Kingdom); Norfolk and Norwich University Hospital, Norwich (United Kingdom); Hing, Caroline B. [St George' s Hospital, London (United Kingdom)

    2011-04-15

    To determine the discriminative validity and reliability of the evidence base using meta-analysis. A review of published sources using the databases AMED, CINHAL, EMBASE, MEDLINE, Scopus and the Cochrane Library, and for unpublished material was conducted. All studies assessing the reliability, validity, sensitivity or specificity of magnetic resonance imaging (MRI), computed tomography (CT) or ultrasound (US) of the patellofemoral joint of patients following patellar dislocation, subluxation or instability, were included. A meta-analysis was performed to assess the difference in radiological measurements between healthy controls and subjects with patellar instability in order to assess discrimination validity. A narrative assessment was used to evaluate the inter- and intra-observer reliability as well as the sensitivity and specificity of specific radiological measurements. A total of 27 studies were reviewed. The findings indicated that there was acceptable inter-observer and intra-observer reliability and validity for different methods of assessing patellar height and the sulcus angle with X-ray, MRI and CT methods, and the tibial tubercle-trochlear groove (TT-TG) assessed using CT. There was poor reliability or validity for the assessment of severity of trochlear dysplasia and the sulcus angle using US. There is insufficient evidence to determine the reliability, validity, sensitivity or specificity of tests such as the congruence angle, lateral patellar displacement, lateral patellar tilt, trochlear depth, boss height, the crossing sign or Wiberg patellar classification. A critical appraisal of the literature identified a number of recurrent methodological limitations. Further study is recommended to evaluate the reliability and validity of these radiological outcomes using well-designed radiological trials. (orig.)

  17. The reliability and validity of radiological assessment for patellar instability. A systematic review and meta-analysis

    International Nuclear Information System (INIS)

    Smith, Toby O.; Davies, Leigh; Toms, Andoni P.; Donell, Simon T.; Hing, Caroline B.

    2011-01-01

    To determine the discriminative validity and reliability of the evidence base using meta-analysis. A review of published sources using the databases AMED, CINHAL, EMBASE, MEDLINE, Scopus and the Cochrane Library, and for unpublished material was conducted. All studies assessing the reliability, validity, sensitivity or specificity of magnetic resonance imaging (MRI), computed tomography (CT) or ultrasound (US) of the patellofemoral joint of patients following patellar dislocation, subluxation or instability, were included. A meta-analysis was performed to assess the difference in radiological measurements between healthy controls and subjects with patellar instability in order to assess discrimination validity. A narrative assessment was used to evaluate the inter- and intra-observer reliability as well as the sensitivity and specificity of specific radiological measurements. A total of 27 studies were reviewed. The findings indicated that there was acceptable inter-observer and intra-observer reliability and validity for different methods of assessing patellar height and the sulcus angle with X-ray, MRI and CT methods, and the tibial tubercle-trochlear groove (TT-TG) assessed using CT. There was poor reliability or validity for the assessment of severity of trochlear dysplasia and the sulcus angle using US. There is insufficient evidence to determine the reliability, validity, sensitivity or specificity of tests such as the congruence angle, lateral patellar displacement, lateral patellar tilt, trochlear depth, boss height, the crossing sign or Wiberg patellar classification. A critical appraisal of the literature identified a number of recurrent methodological limitations. Further study is recommended to evaluate the reliability and validity of these radiological outcomes using well-designed radiological trials. (orig.)

  18. Osteocalcin expressing cells from tendon sheaths in mice contribute to tendon repair by activating Hedgehog signaling

    OpenAIRE

    Wang, Yi; Zhang, Xu; Huang, Huihui; Xia, Yin; Yao, YiFei; Mak, Arthur Fuk-Tat; Yung, Patrick Shu-Hang; Chan, Kai-Ming; Wang, Li; Zhang, Chenglin; Huang, Yu; Mak, Kingston King-Lun

    2017-01-01

    Both extrinsic and intrinsic tissues contribute to tendon repair, but the origin and molecular functions of extrinsic tissues in tendon repair are not fully understood. Here we show that tendon sheath cells harbor stem/progenitor cell properties and contribute to tendon repair by activating Hedgehog signaling. We found that Osteocalcin (Bglap) can be used as an adult tendon-sheath-specific marker in mice. Lineage tracing experiments show that Bglap-expressing cells in adult sheath tissues pos...

  19. The impact of physically demanding work of basketball and volleyball players on the risk for patellar tendinopathy and on work limitations

    NARCIS (Netherlands)

    van der Worp, H.; Zwerver, J.; Kuijer, P. P. F. M.; Frings-Dresen, M. H. W.; van den Akker-Scheek, I.

    2011-01-01

    Patellar tendinopathy is a common injury in jumping athletes. Little is known about work-related etiological factors for patellar tendinopathy and related work limitations. The aim of this study was to identify work-related etiological factors for patellar tendinopathy and to determine the relation

  20. The impact of physically demanding work of basketball and volleyball players on the risk for patellar tendinopathy and on work limitations

    NARCIS (Netherlands)

    Van Der Worp, H.; Zwerver, J.; Kuijer, P.P.F.M.; Frings-Dresen, M.H.W.; Van Den Akker-Scheek, I.

    Patellar tendinopathy is a common injury in jumping athletes. Little is known about work-related etiological factors for patellar tendinopathy and related work limitations. The aim of this study was to identify work-related etiological factors for patellar tendinopathy and to determine the relation

  1. Bioreactor Design for Tendon/Ligament Engineering

    OpenAIRE

    Wang, Tao; Gardiner, Bruce S.; Lin, Zhen; Rubenson, Jonas; Kirk, Thomas B.; Wang, Allan; Xu, Jiake; Smith, David W.; Lloyd, David G.; Zheng, Ming H.

    2012-01-01

    Tendon and ligament injury is a worldwide health problem, but the treatment options remain limited. Tendon and ligament engineering might provide an alternative tissue source for the surgical replacement of injured tendon. A bioreactor provides a controllable environment enabling the systematic study of specific biological, biochemical, and biomechanical requirements to design and manufacture engineered tendon/ligament tissue. Furthermore, the tendon/ligament bioreactor system can provide a s...

  2. Magnetic resonance imaging appearance of the flexor carpi radialis tendon after harvest in ligamentous reconstruction tendon interposition arthroplasty

    International Nuclear Information System (INIS)

    Beall, Douglas P.; Fish, Jon R.; Ritchie, Eric R.; Tran, Hoang N.; Ingari, John V.; Campbell, Scot E.; Grayson, David E.; Sanders, Timothy G.; Mundis, Gregory; Lehman, Thomas P.

    2006-01-01

    To determine whether the post-harvest magnetic resonance (MR) imaging appearance of flexor carpi radialis (FCR) tendons, harvested during ligamentous reconstruction tendon interposition (LRTI) of the thumb carpometacarpal (CMC) joint arthroplasty, is consistent with tendon regeneration. Operative reports and patient medical records for all patients undergoing LRTI arthroplasty between 1995 and 2003 at our institution were reviewed. MR images of the patients' forearms and wrists were obtained and interpreted by two musculoskeletal radiologists. Using the flexor carpi ulnaris (FCU) tendon as an internal standard, the extent of FCR tendon regeneration was expressed as a percentage by dividing the volume of regenerated FCR tendon by the volume of the FCU tendon. Fourteen patients who had the full thickness of the FCR tendon harvested and who were available for MR imaging were identified and included in the study. At least partial regeneration of the FCR tendon occurred in 11 of the 14 patients (79%). Of these, 2 patients (14%), demonstrated complete, or nearly complete regeneration. Partial regeneration of the FCR tendon was seen in 9 of the 14 patients (64%). In 3 patients (21%), there was no appreciable regeneration of the FCR tendon. Among patients who underwent full-thickness harvest of the FCR tendon for LRTI arthroplasty of the first CMC joint, the follow-up MR imaging appearance of the flexor carpi radialis tendon was consistent with tendon regeneration in 79% of those examined. (orig.)

  3. Flexing and downsizing the femoral component is not detrimental to patellofemoral biomechanics in posterior-referencing cruciate-retaining total knee arthroplasty.

    Science.gov (United States)

    Marra, Marco A; Strzelczak, Marta; Heesterbeek, Petra J C; van de Groes, Sebastiaan A W; Janssen, Dennis; Koopman, Bart F J M; Verdonschot, Nico; Wymenga, Ate B

    2018-03-20

    When downsizing the femoral component to prevent mediolateral overhang, notching of the anterior femoral cortex may occur, which could be solved by flexing the femoral component. In this study, we investigated the effect of flexion of the femoral component on patellar tendon moment arm, patellofemoral forces and kinematics in posterior-referencing CR-TKA. Our hypothesis was that flexion of the femoral component increases the patellar tendon moment arm, reduces the patellofemoral forces and provides stable kinematics. A validated musculoskeletal model of CR-TKA was used. The flexion of the femoral component was increased in four steps (0°, 3°, 6°, 9°) using posterior referencing, and different alignments were analysed in combination with three implant sizes (3, 4, 5). A chair-rising trial was analysed using the model, while simultaneously estimating quadriceps muscle force, patellofemoral contact force, tibiofemoral and patellofemoral kinematics. Compared to the reference case (size 4 and 0° flexion), for every 3° of increase in flexion of the femoral component the patellar tendon moment arm increased by 1% at knee extension. The peak quadriceps muscle force and patellofemoral contact force decreased by 2%, the patella shifted 0.8 mm more anteriorly and the remaining kinematics remained stable, with knee flexion. With the smaller size, the patellar tendon moment arm decreased by 6%, the quadriceps muscle force and patellofemoral contact force increased by 8 and 12%, and the patellar shifted 5 mm more posteriorly. Opposite trends were found with the bigger size. Flexing the femoral component with posterior referencing reduced the patellofemoral contact forces during a simulated chair-rising trial with a patient-specific musculoskeletal model of CR-TKA. There seems to be little risk when flexing and downsizing the femoral component, compared to when using a bigger size and neutral alignment. These findings provide relevant information to surgeons who wish to

  4. Optimization of human tendon tissue engineering: peracetic acid oxidation for enhanced reseeding of acellularized intrasynovial tendon.

    Science.gov (United States)

    Woon, Colin Y L; Pridgen, Brian C; Kraus, Armin; Bari, Sina; Pham, Hung; Chang, James

    2011-03-01

    Tissue engineering of human flexor tendons combines tendon scaffolds with recipient cells to create complete cell-tendon constructs. Allogenic acellularized human flexor tendon has been shown to be a useful natural scaffold. However, there is difficulty repopulating acellularized tendon with recipient cells, as cell penetration is restricted by a tightly woven tendon matrix. The authors evaluated peracetic acid treatment in optimizing intratendinous cell penetration. Cadaveric human flexor tendons were harvested, acellularized, and divided into experimental groups. These groups were treated with peracetic acid in varying concentrations (2%, 5%, and 10%) and for varying time periods (4 and 20 hours) to determine the optimal treatment protocol. Experimental tendons were analyzed for differences in tendon microarchitecture. Additional specimens were reseeded by incubation in a fibroblast cell suspension at 1 × 10(6) cells/ml. This group was then analyzed for reseeding efficacy. A final group underwent biomechanical studies for strength. The optimal treatment protocol comprising peracetic acid at 5% concentration for 4 hours produced increased scaffold porosity, improving cell penetration and migration. Treated scaffolds did not show reduced collagen or glycosaminoglycan content compared with controls (p = 0.37 and p = 0.65, respectively). Treated scaffolds were cytotoxic to neither attached cells nor the surrounding cell suspension. Treated scaffolds also did not show inferior ultimate tensile stress or elastic modulus compared with controls (p = 0.26 and p = 0.28, respectively). Peracetic acid treatment of acellularized tendon scaffolds increases matrix porosity, leading to greater reseeding. It may prove to be an important step in tissue engineering of human flexor tendon using natural scaffolds.

  5. Extensor Tendon Injuries

    Science.gov (United States)

    ... All Topics A-Z Videos Infographics Symptom Picker Anatomy Bones Joints Muscles Nerves Vessels Tendons About Hand Surgery What is a Hand Surgeon? What is a Hand Therapist? Media Find a Hand Surgeon Home Anatomy Extensor Tendon Injuries Email to a friend * required ...

  6. Magnetic resonance imaging-based morphological and alignment assessment of the patellofemoral joint and its relationship to proximal patellar tendinopathy

    Energy Technology Data Exchange (ETDEWEB)

    Crema, Michel D. [Hospital do Coracao (HCor) and Teleimagem, Department of Radiology, Sao Paulo, SP (Brazil); University Paris VI, Department of Radiology, Hopital Saint-Antoine, Paris (France); Boston University School of Medicine, Department of Radiology, Quantitative Imaging Center, Boston, MA (United States); Cortinas, Larissa G.; Lima, Giovanni B.P.; Skaf, Abdalla Y. [Hospital do Coracao (HCor) and Teleimagem, Department of Radiology, Sao Paulo, SP (Brazil); Abdalla, Rene Jorge; McNeill Ingham, Sheila Jean [Federal University of Sao Paulo, Department of Orthopaedic Surgery, School of Medicine, Sao Paulo (Brazil); Hospital do Coracao (HCor), Knee Institute, Sao Paulo, SP (Brazil)

    2018-03-15

    To assess the differences in morphology and alignment of the knee between patients with proximal patellar tendinopathy (PPT) and a control group, using MRI and focusing on the patellofemoral joint. We retrospectively included 35 patients with clinically diagnosed and unequivocal findings of PPT on knee MRI, the case group. For the control group, we included 70 patients who underwent knee MRI for other reasons, with no clinical or MRI evidence of PPT. Patients and controls were matched for age and gender, with all subjects reporting frequent physical activity. MRIs were evaluated by two musculoskeletal radiologists, who assessed parameters of patellar morphology, trochlear morphology, patellofemoral alignment, and tibiofemoral alignment. The differences in parameters between cases and controls were assessed using Student's t test. Logistic regression was applied to assess the associations between the MRI parameters and the presence of PPT. The patellar height Insall-Salvati ratio was different between cases and controls (1.37 ± 0.21 vs. 1.24 ± 0.19; p = 0.003). The subchondral Wiberg angle was higher in cases than controls (136.8 ± 7.4 vs. 131.7 ± 8.8; p = 0.004). After applying logistic regression, significant associations with PPT were found [odds ratios (95% CI)] for patellar morphology [1.1 (1.0, 1.2)] and patellar height [1.3 (1.0, 1.7)]. Patellar height and the subchondral patellar Wiberg angle were greater in patients with PPT and significantly associated with PPT. (orig.)

  7. Magnetic resonance imaging-based morphological and alignment assessment of the patellofemoral joint and its relationship to proximal patellar tendinopathy

    International Nuclear Information System (INIS)

    Crema, Michel D.; Cortinas, Larissa G.; Lima, Giovanni B.P.; Skaf, Abdalla Y.; Abdalla, Rene Jorge; McNeill Ingham, Sheila Jean

    2018-01-01

    To assess the differences in morphology and alignment of the knee between patients with proximal patellar tendinopathy (PPT) and a control group, using MRI and focusing on the patellofemoral joint. We retrospectively included 35 patients with clinically diagnosed and unequivocal findings of PPT on knee MRI, the case group. For the control group, we included 70 patients who underwent knee MRI for other reasons, with no clinical or MRI evidence of PPT. Patients and controls were matched for age and gender, with all subjects reporting frequent physical activity. MRIs were evaluated by two musculoskeletal radiologists, who assessed parameters of patellar morphology, trochlear morphology, patellofemoral alignment, and tibiofemoral alignment. The differences in parameters between cases and controls were assessed using Student's t test. Logistic regression was applied to assess the associations between the MRI parameters and the presence of PPT. The patellar height Insall-Salvati ratio was different between cases and controls (1.37 ± 0.21 vs. 1.24 ± 0.19; p = 0.003). The subchondral Wiberg angle was higher in cases than controls (136.8 ± 7.4 vs. 131.7 ± 8.8; p = 0.004). After applying logistic regression, significant associations with PPT were found [odds ratios (95% CI)] for patellar morphology [1.1 (1.0, 1.2)] and patellar height [1.3 (1.0, 1.7)]. Patellar height and the subchondral patellar Wiberg angle were greater in patients with PPT and significantly associated with PPT. (orig.)

  8. Magnetotherapy: The quest for tendon regeneration.

    Science.gov (United States)

    Pesqueira, Tamagno; Costa-Almeida, Raquel; Gomes, Manuela E

    2018-05-09

    Tendons are mechanosensitive tissues that connect and transmit the forces generated by muscles to bones by allowing the conversion of mechanical input into biochemical signals. These physical forces perform the fundamental work of preserving tendon homeostasis assuring body movements. However, overloading causes tissue injuries, which leads us to the field of tendon regeneration. Recently published reviews have broadly shown the use of biomaterials and different strategies to attain tendon regeneration. In this review, our focus is the use of magnetic fields as an alternative therapy, which has demonstrated clinical relevance in tendon medicine because of their ability to modulate cell fate. Yet the underlying cellular and molecular mechanisms still need to be elucidated. While providing a brief outlook about specific signalling pathways and intracellular messengers as framework in play by tendon cells, application of magnetic fields as a subcategory of physical forces is explored, opening up a compelling avenue to enhance tendon regeneration. We outline here useful insights on the effects of magnetic fields both at in vitro and in vivo levels, particularly on the expression of tendon genes and inflammatory cytokines, ultimately involved in tendon regeneration. Subsequently, the potential of using magnetically responsive biomaterials in tendon tissue engineering is highlighted and future directions in magnetotherapy are discussed. © 2018 Wiley Periodicals, Inc.

  9. Injury patterns of medial patellofemoral ligament after acute lateral patellar dislocation in children: Correlation analysis with anatomical variants and articular cartilage lesion of the patella

    International Nuclear Information System (INIS)

    Zhang, Guang-ying; Ding, Hong-yu; Zheng, Lei; Ji, Bing-jun; Shi, Hao; Feng, Yan

    2017-01-01

    To assess the relationship between injury patterns of medial patellofemoral ligament (MPFL) and anatomical variants and patellar cartilage lesions after acute lateral patellar dislocation (LPD) in children. MR images were obtained in 140 children with acute LPD. Images were acquired and evaluated using standardised protocols. Fifty-eight cases of partial MPFL tear and 75 cases of complete MPFL tear were identified. Injuries occurred at an isolated patellar insertion (PAT) in 52 cases, an isolated femoral attachment (FEM) in 42 cases and an isolated mid-substance (MID) in five cases. More than one site of injury was identified in 34 cases. Compared with Wiberg patellar type C, Wiberg patellar type B predisposed to complete MPFL tear (P = 0.042). No correlations were identified between injury patterns of MPFL and trochlear dysplasia, patellar height and tibial tuberosity-trochlear groove distance (P > 0.05). Compared with partial MPFL tear, complete MPFL tear predisposed to Grade-IV and Grade-V patellar chondral lesion (P = 0.02). There were no correlations between incidence of patellar cartilage lesion and injury locational-subgroups of MPFL (P = 0.543). MPFL is most easily injured at the PAT in children. Wiberg patellar type B predisposes to complete MPFL tear. Complete MPFL tear predisposes to a higher grade of patellar chondral lesion. (orig.)

  10. Injury patterns of medial patellofemoral ligament after acute lateral patellar dislocation in children: Correlation analysis with anatomical variants and articular cartilage lesion of the patella

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Guang-ying; Ding, Hong-yu [Shandong Provincial Qianfoshan Hospital of Shandong University, Department of Ultrasonography, Jinan (China); Zheng, Lei; Ji, Bing-jun [Shandong Provincial Corps Hospital of Chinese People' s Armed Police Force, Department of Radiology, Jinan (China); Shi, Hao [Shandong Provincial Qianfoshan Hospital of Shandong University, Department of Radiology, Jinan (China); Feng, Yan [Affiliated Hospital of Binzhou Medical College, Department of Radiology, Binzhou (China)

    2017-03-15

    To assess the relationship between injury patterns of medial patellofemoral ligament (MPFL) and anatomical variants and patellar cartilage lesions after acute lateral patellar dislocation (LPD) in children. MR images were obtained in 140 children with acute LPD. Images were acquired and evaluated using standardised protocols. Fifty-eight cases of partial MPFL tear and 75 cases of complete MPFL tear were identified. Injuries occurred at an isolated patellar insertion (PAT) in 52 cases, an isolated femoral attachment (FEM) in 42 cases and an isolated mid-substance (MID) in five cases. More than one site of injury was identified in 34 cases. Compared with Wiberg patellar type C, Wiberg patellar type B predisposed to complete MPFL tear (P = 0.042). No correlations were identified between injury patterns of MPFL and trochlear dysplasia, patellar height and tibial tuberosity-trochlear groove distance (P > 0.05). Compared with partial MPFL tear, complete MPFL tear predisposed to Grade-IV and Grade-V patellar chondral lesion (P = 0.02). There were no correlations between incidence of patellar cartilage lesion and injury locational-subgroups of MPFL (P = 0.543). MPFL is most easily injured at the PAT in children. Wiberg patellar type B predisposes to complete MPFL tear. Complete MPFL tear predisposes to a higher grade of patellar chondral lesion. (orig.)

  11. High incidence of acute and recurrent patellar dislocations

    DEFF Research Database (Denmark)

    Gravesen, Kasper Skriver; Kallemose, Thomas; Blønd, Lars

    2017-01-01

    PURPOSE: The purpose of this study was to investigate the Danish population as a whole from 1994 to 2013 to find the incidence of acute and recurrent patellar dislocation. METHODS: The study was performed as a descriptive epidemiological study. The Danish National Patient Registry was retrospecti...

  12. The Relationship of Static Tibial Tubercle-Trochlear Groove Measurement and Dynamic Patellar Tracking.

    Science.gov (United States)

    Carlson, Victor R; Sheehan, Frances T; Shen, Aricia; Yao, Lawrence; Jackson, Jennifer N; Boden, Barry P

    2017-07-01

    The tibial tubercle to trochlear groove (TT-TG) distance is used for screening patients with a variety of patellofemoral joint disorders to determine who may benefit from patellar medialization using a tibial tubercle osteotomy. Clinically, the TT-TG distance is predominately based on static imaging with the knee in full extension; however, the predictive ability of this measure for dynamic patellar tracking patterns is unknown. To determine whether the static TT-TG distance can predict dynamic lateral displacement of the patella. Cohort study (Diagnosis); Level of evidence, 2. The static TT-TG distance was measured at full extension for 70 skeletally mature subjects with (n = 32) and without (n = 38) patellofemoral pain. The dynamic patellar tracking patterns were assessed from approximately 45° to 0° of knee flexion by use of dynamic cine-phase contrast magnetic resonance imaging. For each subject, the value of dynamic lateral tracking corresponding to the exact knee angle measured in the static images for that subject was identified. Linear regression analysis determined the predictive ability of static TT-TG distance for dynamic patellar lateral displacement for each cohort. The static TT-TG distance measured with the knee in full extension cannot accurately predict dynamic lateral displacement of the patella. There was weak predictive ability among subjects with patellofemoral pain ( r 2 = 0.18, P = .02) and no predictive capability among controls. Among subjects with patellofemoral pain and static TT-TG distances 15 mm or more, 8 of 13 subjects (62%) demonstrated neutral or medial patellar tracking patterns. The static TT-TG distance cannot accurately predict dynamic lateral displacement of the patella. A large percentage of patients with patellofemoral pain and pathologically large TT-TG distances may have neutral to medial maltracking patterns.

  13. Diagnostic Accuracy of a Self-Report Measure of Patellar Tendinopathy in Youth Basketball.

    Science.gov (United States)

    Owoeye, Oluwatoyosi B A; Wiley, J Preston; Walker, Richard E A; Palacios-Derflingher, Luz; Emery, Carolyn A

    2018-04-27

    Study Design Prospective diagnostic accuracy validation study. Background Engaging clinicians for diagnosis of patellar tendinopathy in large surveillance studies is often impracticable. A self-report measure, the Oslo Sports Research Trauma Centre patellar tendinopathy (OSTRC-P) Questionnaire, an adaptation of the OSTRC Questionnaire may provide a viable alternative. Objectives To evaluate the diagnostic accuracy of the OSTRC-P Questionnaire in detecting patellar tendinopathy in youth basketball players when compared to clinical evaluation. Methods Following the Standards for Reporting of Diagnostic Accuracy Studies guidelines, 208 youth basketball players (aged 13-18 years) were recruited. Participants completed the OSTRC-P Questionnaire (index test) prior to a clinical evaluation (reference standard) by a physiotherapist blinded to OSTRC-P Questionnaire results. Sensitivity, specificity, predictive values (PVs), likelihood ratios (LRs) and posttest probabilities were calculated. Linear regression was used to examine the association between OSTRC-P Questionnaire severity score and patellar tendinopathy severity rating during single leg decline squat (SLDS). Results The final analysis included 169 players. The OSTRC-P Questionnaire had a sensitivity of 79% (95%CI: 65%, 90%), specificity of 98% (95%CI: 94%, 100%), positive PV of 95%, negative PV of 92%, positive LR of 48 and negative LR of 0.21. The posttest probabilities were 95% and 8% given positive and negative results, respectively. A positive association was found between OSTRC-P Questionnaire and SLDS rating [(β = .08 (95%CI: .03, .12) (p = .001)]. Conclusions The OSTRC-P Questionnaire is an acceptable alternative to clinical evaluation for self-reporting patellar tendinopathy and grading its severity in settings involving youth basketball players. Level of Evidence Diagnosis, level 1b. J Orthop Sports Phys Ther, Epub 27 Apr 2018. doi:10.2519/jospt.2018.8088.

  14. Achilles Tendon's Tear

    OpenAIRE

    F. Shahandeh

    2008-01-01

    Introduction: The achilles and plantaris tendons to-gether makeup the posterior grouptendons of ankle. Their seldom confusion in interpreting MR images of the achilles tendon. The achilles tendon should ap-pear informally straight and black on sagital T1 weighted images and on fluid sensitive images."nCase Presentation: After a heavy sport, a 55 year-old woman cannot walk with right foot."nDiscussion: The classic achilles tendon rupture occurs with forced dorsiflexion of planted foo...

  15. Bioreactor design for tendon/ligament engineering.

    Science.gov (United States)

    Wang, Tao; Gardiner, Bruce S; Lin, Zhen; Rubenson, Jonas; Kirk, Thomas B; Wang, Allan; Xu, Jiake; Smith, David W; Lloyd, David G; Zheng, Ming H

    2013-04-01

    Tendon and ligament injury is a worldwide health problem, but the treatment options remain limited. Tendon and ligament engineering might provide an alternative tissue source for the surgical replacement of injured tendon. A bioreactor provides a controllable environment enabling the systematic study of specific biological, biochemical, and biomechanical requirements to design and manufacture engineered tendon/ligament tissue. Furthermore, the tendon/ligament bioreactor system can provide a suitable culture environment, which mimics the dynamics of the in vivo environment for tendon/ligament maturation. For clinical settings, bioreactors also have the advantages of less-contamination risk, high reproducibility of cell propagation by minimizing manual operation, and a consistent end product. In this review, we identify the key components, design preferences, and criteria that are required for the development of an ideal bioreactor for engineering tendons and ligaments.

  16. Jumper's Knee or Lander's Knee? : A Systematic Review of the Relation between Jump Biomechanics and Patellar Tendinopathy

    NARCIS (Netherlands)

    van der Worp, Henk; de Poel, H. J.; Diercks, R. L.; van den Akker-Scheek, I.; Zwerver, J.

    Patellar tendinopathy (jumper's knee) is a common injury in sports that comprise jump actions. This article systematically reviews the literature examining the relation between patellar tendinopathy and take-off and landing kinematics in order to uncover risk factors and potential prevention

  17. [Reconstruction of the extensor pollicis longus tendon by transposition of the extensor indicis tendon].

    Science.gov (United States)

    Loos, A; Kalb, K; Van Schoonhoven, J; Landsleitner Dagger, B

    2003-12-01

    Rupture of the extensor pollicis longus-tendon (EPL) is a frequent complication after distal radius fractures. Other traumatic and non-traumatic reasons for this tendon lesion are known, including a theory about a disorder in the blood supply to the tendon itself. We examined 40 patients after reconstruction of the EPL-tendon in a mean follow-up time of 30 months. All patients were clinically examined and a DASH questionnaire was answered by all patients. The method to reconstruct the EPL-tendon was the transposition of the extensor indicis-tendon. After the operations the thumb was put in a splint for four weeks in a "hitch-hiker's-position". 31 ruptures of the tendon (77.5 %) were a result of trauma. In 20 of them (50 %) a distal radius fracture had occurred. Clinical examination included measurements of the movement of the thumb- and index-finger joints, the grip strength and the maximal span of the hand. Significant differences were not found. The isolated extension of the index finger was possible in all patients. But it was reduced in ten cases which represent 25 %. Our results were evaluated by the Geldmacher score to evaluate the reconstruction of the EPL-tendon. 20 % excellent, 65 % good, 12.5 % fair and 2.5 % poor results were reached. The Geldmacher score was used critically. We suggest its modification for the evaluation of thumb abduction. The DASH score reached a functional value of ten points which represents a very good result. In conclusion the extensor indicis-transposition is a safe method to reconstruct the EPL-tendon. Its substantial advantage is taking a healthy muscle as the motor, thereby avoiding the risk of using a degenerated muscle in late tendon reconstruction. A powerful extension of the index finger will be maintained by physical education. Generally, the loss of the extension of the index finger is negligible. It does not disturb the patients. But it has to be discussed with the patient before the operation.

  18. Optimal arm posture control and tendon traction forces of a coupled tendon-driven manipulator

    International Nuclear Information System (INIS)

    Ma, Shugen

    1997-01-01

    In this study, the optimum arm posture of a coupled tendon-driven multijoint manipulator arm (or CT Arm) at maximum payload output was derived and the corresponding tendon traction forces were also analyzed, during management of a heavy payload by the manipulator in a gravity environment. The CT Arm is special tendon traction transmission mechanism in which a pair of tendons used to drive a joint is pulled from base actuators via pulleys mounted on the base-side joints. This mechanism enables optimal utilization of the coupled drive function of tendon traction forces and thus enables the lightweight manipulator to exhibit large payload capability. The properties of the CT Arm mechanism are elucidated by the proposed optimal posture control scheme. Computer simulation was also executed to verify the validity of the proposed control scheme. (author)

  19. The Effect of Sodium Hyaluronate on Ligamentation and Biomechanical Property of Tendon in Repair of Achilles Tendon Defect with Polyethylene Terephthalate Artificial Ligament: A Rabbit Tendon Repair Model

    OpenAIRE

    Li, Shengkun; Ma, Kui; Li, Hong; Jiang, Jia; Chen, Shiyi

    2016-01-01

    The Achilles tendon is the most common ruptured tendon of human body. Reconstruction with polyethylene terephthalate (PET) artificial ligament is recommended in some serious cases. Sodium hyaluronate (HA) is beneficial for the healing of tendon injuries. We aimed to determine the effect of sodium hyaluronate in repair of Achilles tendon defect with PET artificial ligament in an animal tendon repair model. Sixteen New Zealand White rabbits were divided into two groups. Eight rabbits repaired w...

  20. Imaging assessment of anterior knee pain and patellar maltracking

    International Nuclear Information System (INIS)

    McNally, E.G.

    2001-01-01

    Anterior knee pain is a common complaint in the orthopaedic clinic. The differential diagnosis is wide and the principal goal of initial assessment is to detect remediable causes. The majority of patients do not have a specific disease and increasingly interest has focused on the role of patello-femoro-tibial morphology and of patellar maltracking in the aetiology of anterior knee pain. Classification in this group of patients is poor and there is no uniform agreement on which patient groups benefit from treatment and which treatment is best. Much of the literature involves relatively small numbers of patients, is poorly controlled and there is little agreement on outcome measures [1, 2]. The purpose of this review is to outline the current status of the imaging assessment of recalcitrant anterior knee pain with particular reference to patellar maltracking. (orig.)

  1. Patient guided Piezo-electric Extracorporeal Shockwave Therapy as treatment for chronic severe patellar tendinopathy : A pilot study

    NARCIS (Netherlands)

    Zwerver, J.; Dekker, F.; Pepping, G.J.

    2010-01-01

    Background and purpose: Patellar tendinopathy is a common overuse injury for which no evidence-based treatment guidelines exist. Extracorporeal Shock Wave Therapy (ESWT) seems to be an effective treatment for patellar tendinopathy but the most beneficial treatment strategies still need to be

  2. [Biomaterials for bone filling: comparisons between autograft, hydroxyapatite and one highly purified bovine xenograft].

    Science.gov (United States)

    Chappard, D; Zhioua, A; Grizon, F; Basle, M F; Rebel, A

    1993-12-01

    Bone grafts are becoming increasingly common in orthopaedics, neurosurgery and periodontology. Twenty one New Zealand rabbits were used in the present study comparing several materials usable as bone substitutes. A 4.5 mm hole was drilled in the inner femoral condyles. Holes were filled with either an autograft (from the opposite condyle), an hydroxylapatite (Bioapatite), or a highly purified bovine xenograft (T650 Lubboc). Animals were sacrificed at 1, 3 and 6 months post implantation and a quantitative analysis of newly-formed bone volume (BNF/IV) and remaining biomaterials (BMAT/IV) was done. In addition, some holes were left unfilled and served as controls. At 6 months, there was no tendency for spontaneous repair in the control animals. The autografted animals have repaired their trabecular mass and architecture within the first month. Hydroxylapatite appeared unresorbed at six months and only thin and scanty new trabeculae were observed. The xenograft induced woven bone trabeculae formation on the first month. This was associated with resorption of the material by two multinucleated cell populations. At six months, the epiphyseal architecture was restored and the biomaterial has disappeared in most cases. Xenografts appear a promising alternative to autografts and allografts, whose infectious risks and ethical problems should always be borne in mind.

  3. High-field MR imaging of the tendons

    International Nuclear Information System (INIS)

    Beltran, J.; Burk, J.M.; Herman, L.J.; Mosure, J.C.

    1987-01-01

    MR imaging was used to investigate normal anatomy and pathologic conditions of the tendons. Tendons of experimental animals, cadaver joints, normal volunteers, and patients with suspected tendon pathology were studied. Tendon anatomy is easily identified because of the hypointensity of the tendons contrasting with the hyperintendensity of the surrounding fat. Pathologic conditions including posttraumatic and postsurgical tendon rupture, peritendinous scarring, tendinitis, and tenosynovitis are well seen with MR imaging. A detailed study of normal and abnormal tendon anatomy of the finger, wrist, shoulder, knee, and ankle is displayed, including MR images, gross specimens, and line drawings

  4. 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

  5. [Treatment options for patellar tendinopathy].

    Science.gov (United States)

    Duthon, V B; Borloz, S; Ziltener, J-L

    2012-07-25

    Patellar tendinopathy is also called jumper's knee because of its high incidence in athletes with jumping or cutting activities as soccer, basketball, volleyball. Many different treatment methods have been described. However, no consensus exists regarding the optimal treatment for this condition. According to the literature, eccentric exercise-based physical therapy should be proposed first because of its strong scientific evidence. Shockwave therapy and injections may be useful but their real efficacy still has to be proven by randomized controlled study. For patients recalcitrant to more conservative options, operative management may be indicated.

  6. Iliac crest autograft versus alternative constructs for anterior cervical spine surgery: Pros, cons, and costs

    Science.gov (United States)

    Epstein, Nancy E.

    2012-01-01

    Background: Grafting choices available for performing anterior cervical diskectomy/fusion (ACDF) procedures have become a major concern for spinal surgeons, and their institutions. The “gold standard”, iliac crest autograft, may still be the best and least expensive grafting option; it deserves to be reassessed along with the pros, cons, and costs for alternative grafts/spacers. Methods: Although single or multilevel ACDF have utilized iliac crest autograft for decades, the implant industry now offers multiple alternative grafting and spacer devices; (allografts, cages, polyether-etherketone (PEEK) amongst others). While most studies have focused on fusion rates and clinical outcomes following ACDF, few have analyzed the “value-added” of these various constructs (e.g. safety/efficacy, risks/complications, costs). Results: The majority of studies document 95%-100% fusion rates when iliac crest autograft is utilized to perform single level ACDF (X-ray or CT confirmed at 6-12 postoperative months). Although many allograft studies similarly quote 90%-100% fusion rates (X-ray alone confirmed at 6-12 postoperative months), a recent “post hoc analysis of data from a prospective multicenter trial” (Riew KD et. al., CSRS Abstract Dec. 2011; unpublished) revealed a much higher delayed fusion rate using allografts at one year 55.7%, 2 years 87%, and four years 92%. Conclusion: Iliac crest autograft utilized for single or multilevel ACDF is associated with the highest fusion, lowest complication rates, and significantly lower costs compared with allograft, cages, PEEK, or other grafts. As spinal surgeons and institutions become more cost conscious, we will have to account for the “value added” of these increasingly expensive graft constructs. PMID:22905321

  7. The Anatomic Midpoint of the Attachment of the Medial Patellofemoral Complex.

    Science.gov (United States)

    Tanaka, Miho J; Voss, Andreas; Fulkerson, John P

    2016-07-20

    The medial patellofemoral ligament varies in attachment of its fibers to the patella and vastus intermedius tendon. Our aim was to identify and describe its anatomic midpoint. To account for the variability of the attachment site, we refer to it as the medial patellofemoral complex. Using AutoCAD software, we identified the midpoint of the medial patellofemoral complex attachment on photographs of 31 cadaveric knee dissections. The midpoint was referenced relative to the superior articular surface of the patella (P1) and was described in terms of the percentage of the patellar articular length distal to this point. A second point, at the junction of the medial border of the vastus intermedius tendon with the superior articular border of the patella, was identified (P2). The distances of the midpoint to P1 and P2 were calculated and were compared using paired t tests. Twenty-five images had appropriate quality and landmarks for digital analysis. The midpoint of the medial patellofemoral complex was located a mean (and standard deviation) of 2.3% ± 15.8% of the patellar articular length distal to the superior pole and was at or proximal to P1 in 12 knees. In all knees, the midpoint was at or proximal to P2. After exclusion of 2 knees with vastus intermedius tendon attachments only, the medial patellofemoral complex midpoint was closer to P2 (5.3% ± 8.6% of the patellar articular length) than to P1 (9.3% ± 8.5% of the patellar articular length) (p = 0.06). The midpoint of the medial patellofemoral complex was 2.3% of the articular length distal to the superior pole of the patella. Additionally, we describe an anatomic landmark at the junction of the medial border of the vastus intermedius tendon and the articular border of the patella that approximates the midpoint of this complex. Our study shows that the anatomic midpoint of the attachment of the medial patellofemoral complex is proximal to the junction of the medial vastus intermedius tendon and the articular

  8. Ia Afferent input alters the recruitment thresholds and firing rates of single human motor units.

    Science.gov (United States)

    Grande, G; Cafarelli, E

    2003-06-01

    Vibration of the patellar tendon recruits motor units in the knee extensors via excitation of muscle spindles and subsequent Ia afferent input to the alpha-motoneuron pool. Our first purpose was to determine if the recruitment threshold and firing rate of the same motor unit differed when recruited involuntarily via reflex or voluntarily via descending spinal pathways. Although Ia input is excitatory to the alpha-motoneuron pool, it has also been shown paradoxically to inhibit itself. Our second purpose was to determine if vibration of the patellar tendon during a voluntary knee extension causes a change in the firing rate of already recruited motor units. In the first protocol, 10 subjects voluntarily reproduced the same isometric force profile of the knee extensors that was elicited by vibration of the patellar tendon. Single motor unit recordings from the vastus lateralis (VL) were obtained with tungsten microelectrodes and unitary behaviour was examined during both reflex and voluntary knee extensions. Recordings from 135 single motor units showed that both recruitment thresholds and firing rates were lower during reflex contractions. In the second protocol, 7 subjects maintained a voluntary knee extension at 30 N for approximately 40-45 s. Three bursts of patellar tendon vibration were superimposed at regular intervals throughout the contraction and changes in the firing rate of already recruited motor units were examined. A total of 35 motor units were recorded and each burst of superimposed vibration caused a momentary reduction in the firing rates and recruitment of additional units. Our data provide evidence that Ia input modulates the recruitment thresholds and firing rates of motor units providing more flexibility within the neuromuscular system to grade force at low levels of force production.

  9. Endoscopic bursectomy for the treatment of septic pre-patellar bursitis: a case series.

    Science.gov (United States)

    Dillon, John P; Freedman, Ilan; Tan, James S M; Mitchell, David; English, Shaun

    2012-07-01

    Operative treatment for septic pre-patellar bursitis generally involves open debridement in addition to an extended course of intravenous antibiotics. Skin necrosis and wound breakdown are potential complications of this procedure in addition to scar sensitivity and a prolonged recovery. We report endoscopic bursectomy for the treatment of septic pre-patellar bursitis in eight patients over a 3-year period. All patients had microbiological confirmation of an infective process. The average age was 36 years (23-68 years). The average hospital stay was 6 days (4-9 days). No patient had a recurrence or complained of tenderness or hypoaesthesia around their wound. No patient experienced wound complications or skin necrosis. The average return to work time was 18 days (7-22 days). We conclude that endoscopic bursectomy is a safe and effective treatment for septic pre-patellar bursitis with a shortened hospital stay and a quicker return to work than conventional open debridement.

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

    Directory of Open Access Journals (Sweden)

    Wei Yee Leong

    2013-07-01

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

  11. Achilles tendon healing

    International Nuclear Information System (INIS)

    Dillon, E.H.; Pope, C.F.; Barber, V.; Jokl, P.; Lynch, K.

    1990-01-01

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

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

    Directory of Open Access Journals (Sweden)

    T. Kursat Dabak

    2015-01-01

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

  13. MRI findings of achilles tendon rupture

    International Nuclear Information System (INIS)

    Zhang Xuezhe

    2009-01-01

    Objective: To evaluate the MRI findings of achilles tendon rupture. Methods: The MRI data of 7 patients with achilles tendon rupture were retrospectively analysed. All 7 patients were male with the age ranging from 34 to 71 years. Routine MR scanning was performed in axial and sagittal planes, including T 1 WI, T 2 WI and a fat suppression MRI (SPIR). Results: Among 7 patients, complete achilles tendon rupture was seen in 6 cases, partial achilles tendon rupture 1 case. The site of tendon disruption were 2.6-11.0 cm( mean 5.4 cm) proximal to the insertion in the calcaneus. The MRI findings of a partial or complete rupture of the achilles tendon included enlarged and thickened achilles tendon (7 cases), wavy lax achilles tendon (2 cases), discontinuity of some or all of its fibers and intratendinous regions of increased signal intensity (7 cases). In the cases of complete tendon rupture, the size of the tendinous gap varied from 3.0-8.0 mm, which was filled with blood and appeared as edema of increase signal intensity on T 2 WI and SPIR. In all 7 patients, MR scanning showed medium signal intensity (7 cases) on T 1 WI, or medium signal intensity (1 cases), medium-high signal intensity (3 cases ), high signal intensity (3 cases) on T 2 WI, and medium-high signal intensity (2 cases), high signal intensity (5 cases) on fat suppression MRI. The preachilles fat pad showed obscure in 6 cases of complete achilles tendon rupture. Conclusion: MRI is an excellent method for revealing achilles tendon rupture and confirming the diagnosis. (authors)

  14. 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.

  15. Extensor Mechanism Disruption after Total Knee Arthroplasty: A Case Series and Review of Literature.

    Science.gov (United States)

    Vaishya, Raju; Agarwal, Amit Kumar; Vijay, Vipul

    2016-02-04

    Extensor mechanism disruption following total knee arthroplasty (TKA) is a rare but devastating complication. These patients may require revision of the implants, but even then, it may not be possible to restore the normal function of the knee after the disruption. The patterns of extensor mechanism disruption can broadly be classified into three types: suprapatellar (quadriceps tendon rupture), transpatellar (patellar fracture), or infrapatellar (patellar tendon rupture). Infrapatellar tendon ruptures are the worst injuries, as they carry maximum morbidity and are challenging to manage. The disruption of the extensor mechanism may occur either intra-operatively or in the immediate postoperative period due to an injury. The treatment of extensor mechanism complications after TKA may include either nonsurgical management or surgical intervention in the form of primary repair or reconstruction with autogenous, allogeneic, or synthetic substitutes. We have provided an algorithm for the management of extensor mechanism disruption after TKA.

  16. Lateral patellar retinacular release: changes over the last ten years

    Directory of Open Access Journals (Sweden)

    Leonardo Pini Rosalem Marciano da Fonseca

    Full Text Available ABSTRACT Lateral retinacular release is a useful resource in knee surgery that can be used for disorders of the extensor mechanism. For many years, it was indiscriminately used in the treatment of the various patellofemoral joint alterations, with conflicting functional results. This study aimed to analyze the changes that have occurred in the indications and clinical effectiveness of lateral retinacular release by reviewing the relevant literature of the past ten years, comparing it to the classic literature on the subject. It was found that less extensive releases decompress the lateral patellar facet, helping with pain control, while decreasing the risks of medial subluxation. Nowadays, there is clear evidence for its indication in the lateral patellar hypercompression syndrome associated with anterior knee pain, as long as there is no related instability; furthermore, it will normally play an adjuvant role in extensor mechanism alignment surgeries for cases of recurrent patellar instability. The initial results for symptomatic patellofemoral osteoarthritis are promising when lateral release is combined with cartilage debridement; in total knee replacement, it is more commonly used for the correction of valgus deformity in order to improve the components’ congruency. Finally, distinguishing the different patellofemoral joint pathologies is seen as crucial in order to indicate this procedure. Further randomized control trials that compare surgical techniques with long-term results are still needed.

  17. Relationship between landing strategy and patellar tendinopathy in volleyball

    NARCIS (Netherlands)

    Bisseling, Rob W.; Hof, At L.; Bredeweg, Steef W.; Zwerver, Johannes; Mulder, Theo

    Objective: The aetiology of patellar tendinopathy ( jumper's knee) remains unclear. To see whether landing strategy might be a risk factor for the development of this injury, this study examined whether landing dynamics from drop jumps differed among healthy volleyball players ( CON) and volleyball

  18. Measuring Regional Changes in Damaged Tendon

    Science.gov (United States)

    Frisch, Catherine Kayt Vincent

    Mechanical properties of tendon predict tendon health and function, but measuring these properties in vivo is difficult. An ultrasound-based (US) analysis technique called acoustoelastography (AE) uses load-dependent changes in the reflected US signal to estimate tissue stiffness non-invasively. This thesis explores whether AE can provide information about stiffness alteration resulting from tendon tears both ex vivo and in vivo. An ex vivo ovine infraspinatus tendon model suggests that the relative load transmitted by the different tendon layers transmit different fractions of the load and that ultrasound echo intensity change during cyclic loading decreases, becoming less consistent once the tendon is torn. An in vivo human tibialis anterior tendon model using electrically stimulated twitch contractions investigated the feasibility of measuring the effect in vivo. Four of the five subjects showed the expected change and that the muscle contraction times calculated using the average grayscale echo intensity change compared favorably with the times calculated based on the force data. Finally an AE pilot study with patients who had rotator cuff tendon tears found that controlling the applied load and the US view of the system will be crucial to a successful in vivo study.

  19. 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. Copyright 2012, SLACK Incorporated.

  20. Chondromalacia induced by patellar subluxation: morphological and morphometrical aspects in rabbits.

    Science.gov (United States)

    Sant'Anna, M M S; Apfel, M I R

    2002-01-01

    The purpose of this study was to describe morphologically and quantify the changes of the articular cartilage in chondromalacia, concerning both the chondrocytes and extracellular matrix. Eight rabbits were submitted daily to patellar subluxation, causing chondromalacia after two weeks. The knee fragments obtained were processed by the standard methods. These experimental conditions caused degenerative alterations of the articular cartilage, varying from a slight decrease of proteoglycans, to fibrillations, clefts, and horizontal splitting. The results showed a significantly increase number of chondrocytes (p < 0,000139), although smaller in size (p < 0,000109). The immobilization for 2 weeks and the intermittent passive daily motion afterwards for a period of 2 weeks, was effective to cause patellar chrondomalacia in rabbits.

  1. The Effect of Iliac Crest Autograft on the Outcome of Fusion in the Setting of Degenerative Spondylolisthesis

    Science.gov (United States)

    Radcliff, Kristen; Hwang, Raymond; Hilibrand, Alan; Smith, Harvey E.; Gruskay, Jordan; Lurie, Jon D.; Zhao, Wenyan; Albert, Todd; Weinstein, James

    2012-01-01

    Background: There is considerable controversy about the long-term morbidity associated with the use of posterior autologous iliac crest bone graft for lumbar spine fusion procedures compared with the use of bone-graft substitutes. The hypothesis of this study was that there is no long-term difference in outcome for patients who had posterior lumbar fusion with or without iliac crest autograft. Methods: The study population includes patients enrolled in the degenerative spondylolisthesis cohort of the Spine Patient Outcomes Research Trial who underwent lumbar spinal fusion. Patients were divided according to whether they had or had not received posterior autologous iliac crest bone graft. Results: There were 108 patients who had fusion with iliac crest autograft and 246 who had fusion without iliac crest autograft. There were no baseline differences between groups in demographic characteristics, comorbidities, or baseline clinical scores. At baseline, the group that received iliac crest bone graft had an increased percentage of patients who had multilevel fusions (32% versus 21%; p = 0.033) and L5-S1 surgery (37% versus 26%; p = 0.031) compared with the group without iliac crest autograft. Operative time was higher in the iliac crest bone-graft group (233.4 versus 200.9 minutes; p case-by-case basis for lumbar spinal fusion. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence. PMID:22878599

  2. Repair of sheep long bone cortical defects filled with COLLOSS, COLLOSS E, OSSAPLAST, and fresh iliac crest autograft.

    Science.gov (United States)

    Huffer, William E; Benedict, James J; Turner, A S; Briest, Arne; Rettenmaier, Robert; Springer, Marco; Walboomers, X F

    2007-08-01

    COLLOSS and COLLOSS E are osteoinductive bone void fillers consisting of bone collagen and noncollagenous proteins from bovine and equine bone, respectively. The aim of this study was to compare COLLOSS, COLLOSS E, iliac bone autograft, sintered beta tricalcium phosphate (beta-TCP; OSSAPLAST), and COLLOSS E plus OSSAPLAST. Materials were placed for 4, 8, or 24 weeks in 5-mm cortical bone defects in sheep long bones. Histological sections in a plane perpendicular to the long axis of the bone were used to measure the total repair area (original defect plus callus) and the area of bone within the total repair area. The incidence of defect union was also evaluated. At 4 and 8 weeks, defects treated with COLLOSS and COLLOSS E with or without OSSAPLAST had total repair and bone areas equivalent to autograft, and larger than OSSAPLAST-treated defects. At 8 weeks, the incidence of defect union was higher in defects treated with autograft or COLLOSS E plus OSSAPLAST than in untreated defects. At 24 weeks, the incidence of union was 100% in all treatment groups and 0% in untreated defects. The incidence of union was related to the degree of remodeling between 8 and 24 weeks. This was greater in all treated than nontreated defects. In conclusion, COLLOSS and COLLOSS E were equivalent to each other and to autograft, and superior to beta-TCP, in this study model.

  3. Adolescent patellar instability: current concepts review.

    Science.gov (United States)

    Clark, D; Metcalfe, A; Wogan, C; Mandalia, V; Eldridge, J

    2017-02-01

    Patellar instability most frequently presents during adolescence. Congenital and infantile dislocation of the patella is a distinct entity from adolescent instability and measurable abnormalities may be present at birth. In the normal patellofemoral joint an increase in quadriceps angle and patellar height are matched by an increase in trochlear depth as the joint matures. Adolescent instability may herald a lifelong condition leading to chronic disability and arthritis. Restoring normal anatomy by trochleoplasty, tibial tubercle transfer or medial patellofemoral ligament (MPFL) reconstruction in the young adult prevents further instability. Although these techniques are proven in the young adult, they may cause growth arrest and deformity where the physis is open. A vigorous non-operative strategy may permit delay of surgery until growth is complete. Where non-operative treatment has failed a modified MPFL reconstruction may be performed to maintain stability until physeal closure permits anatomical reconstruction. If significant growth remains an extraosseous reconstruction of the MPFL may impart the lowest risk to the physis. If minor growth remains image intensifier guided placement of femoral intraosseous fixation may impart a small, but acceptable, risk to the physis. This paper presents and discusses the literature relating to adolescent instability and provides a framework for management of these patients. Cite this article: Bone Joint J 2017;99-B:159-70. ©2017 The British Editorial Society of Bone & Joint Surgery.

  4. Bone growth into a revised porous-coated patellar implant

    DEFF Research Database (Denmark)

    Jensen, L N; Lund, B; Gotfredsen, K

    1990-01-01

    A noncemented and clinically stable porous-coated patellar component (PCA) was removed from a patient after 11 months because of infection. It was sectioned and examined histologically in undecalcified, thin-ground sections. The bone ingrowth into the porous space was measured at eight levels. Ea...

  5. Role of tissue-engineered artificial tendon in healing of a large Achilles tendon defect model in rabbits.

    Science.gov (United States)

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

    2013-09-01

    Treatment of large Achilles tendon defects is technically demanding. Tissue engineering is an option. We constructed a collagen-based artificial tendon, covered it with a polydioxanon (PDS) sheath, and studied the role of this bioimplant on experimental tendon healing in vivo. A 2-cm tendon gap was created in the left Achilles tendon of rabbits (n = 120). The animals were randomly divided into 3 groups: control (no implant), treated with tridimensional-collagen, and treated with tridimensional-collagen-bidimensional-PDS implants. Each group was divided into 2 subgroups of 60 and 120 days postinjury (DPI). Another 50 pilot animals were used to study the host-implant interaction. Physical activity of the animals was scored and ultrasonographic and bioelectrical characteristics of the injured tendons were investigated weekly. After euthanasia, macro, micro, and nano morphologies and biophysical and biomechanical characteristics of the healing tendons were studied. Treatment improved function of the animals, time dependently. At 60 and 120 DPI, the treated tendons showed significantly higher maximum load, yield, stiffness, stress, and modulus of elasticity compared with controls. The collagen implant induced inflammation and absorbed the migrating fibroblasts in the defect area. By its unique architecture, it aligned the fibroblasts and guided their proliferation and collagen deposition along the stress line of the tendon and resulted in improved collagen density, micro-amp, micro-ohm, water uptake, and delivery of the regenerated tissue. The PDS-sheath covering amplified these characteristics. The implants were gradually absorbed and replaced by a new tendon. Minimum amounts of peritendinous adhesion, muscle atrophy, and fibrosis were observed in the treated groups. Some remnants of the implants were preserved and accepted as a part of the new tendon. The implants were cytocompatible, biocompatible, biodegradable, and effective in tendon healing and regeneration. This

  6. Microstructural stress relaxation mechanics in functionally different tendons.

    Science.gov (United States)

    Screen, H R C; Toorani, S; Shelton, J C

    2013-01-01

    Tendons experience widely varying loading conditions in vivo. They may be categorised by their function as either positional tendons, which are used for intricate movements and experience lower stress, or as energy storage tendons which act as highly stressed springs during locomotion. Structural and compositional differences between tendons are thought to enable an optimisation of their properties to suit their functional environment. However, little is known about structure-function relationships in tendon. This study adopts porcine flexor and extensor tendon fascicles as examples of high stress and low stress tendons, comparing their mechanical behaviour at the micro-level in order to understand their stress relaxation response. Stress-relaxation was shown to occur predominantly through sliding between collagen fibres. However, in the more highly stressed flexor tendon fascicles, more fibre reorganisation was evident when the tissue was exposed to low strains. By contrast, the low load extensor tendon fascicles appears to have less capacity for fibre reorganisation or shearing than the energy storage tendon, relying more heavily on fibril level relaxation. The extensor fascicles were also unable to sustain loads without rapid and complete stress relaxation. These findings highlight the need to optimise tendon repair solutions for specific tendons, and match tendon properties when using grafts in tendon repairs. Copyright © 2012 IPEM. Published by Elsevier Ltd. All rights reserved.

  7. Do Changes in Patellofemoral Joint Offset Lead to Adverse Outcomes in Total Knee Arthroplasty With Patellar Resurfacing? A Radiographic Review.

    Science.gov (United States)

    Matz, Jacob; Howard, James L; Morden, David J; MacDonald, Steven J; Teeter, Matthew G; Lanting, Brent A

    2017-03-01

    Patellofemoral joint biomechanics contribute to anterior knee pain, instability, and dysfunction following total knee arthroplasty (TKA). Information about specific factors leading to anterior knee pain and dysfunction is currently limited. Changes in patellofemoral joint offset (PFO) refers to a mismatch between the preoperative and postoperative anteroposterior geometry of the patellofemoral joint. It remains unclear whether these changes lead to adverse outcomes in TKA. A retrospective radiographic review of 970 knees pre-TKA and post-TKA was completed to correlate the radiographic and clinical outcomes of changing the PFO using a posterior-stabilized single knee design with patellar resurfacing. A total of 970 patients were reviewed. Postoperatively, the anterior femoral offset, anteroposterior femoral size, and anterior patellar offset were changed in 40%, 60%, and 71% of knees, respectively, compared to preoperative values. The Western Ontario and McMasters Osteoarthritis Index total score as well as subscale scores for pain and function were not significantly affected by an increase or decrease in PFO. Similarly, Knee Society Scores and range of motion were not significantly affected. Increased anterior patellar offset was, however, associated with increased postoperative patellar tilt. Postoperative patellar tilt was not correlated with adverse patient satisfaction scores or loss of range of motion. Changes in PFO (decreased, maintained, or increased) are common post-TKA and are not associated with a difference in clinical outcomes. Increases in anterior patellar offset led to increased patellar tilt, which was not associated with adverse patient satisfaction scores. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Proximal hamstring reconstruction using semitendinosus and gracilis autograft: a novel technique.

    Science.gov (United States)

    Muellner, Thomas; Kumar, Sandeep; Singla, Amit

    2017-01-01

    The complete proximal hamstring avulsion is relatively uncommon injury and predominantly occurs in young athletes but causes significant functional impairment. In chronic cases, the muscle mass is so much retracted that primary repair is not possible. A surgical technique for reconstruction of chronic proximal hamstring avulsion using contralateral semitendinosus and gracilis autograft is described in this case report. V.

  9. Structural and in vivo mechanical characterization of canine patellar cartilage: a closed chondromalacia patellae model.

    Science.gov (United States)

    LaBerge, M; Audet, J; Drouin, G; Rivard, C H

    1993-01-01

    The purpose of this project was to study the relationship between the structure of the patellar cartilage and its response to static compressive loading with a closed chondromalacia patellae model. An animal model was used to induce degeneration of the patella that was monitored quantitatively and qualitatively as a function of time. Ten adult mongrel dogs had their left patellofemoral groove replaced by a customized metallic implant covered with a thin film of polyethylene for periods of 3 months (five dogs) and 6 months (five dogs). An indenter was designed to perform mechanical indentation testing on the patellar cartilage in situ. The animals were anesthetized and the response of patellar cartilage to a static compressive load of 4.5 MPa was monitored for 20 min and its relaxation after load removal for 20 min. Indentation tests were performed every 3 months of the implantation period. At the end of the implantation period, the patellae were processed for histology, and sections were stained with Safranin-O indicative of the proteoglycans content. Macroscopically, no apparent degeneration or fibrillation of the patellar surfaces was observed after 3 or 6 months of implantation. However, the patellar surface showed a change in coloration after 6 months. A 17 +/- 3% and 37 +/- 8% deformation of the cartilage were calculated for the 3-month and 6-month specimens, respectively. Histologically, a progressive loss of proteoglycans was observed in the matrix as a function of implantation time. These results indicated that an increase in cartilage compliance is associated with an intrinsic remodeling of the cartilage matrix and that these changes might occur without external signs of degeneration and can be quantified.

  10. A clinical case of single-stage correction of penetration combined orofacial defect with two microsurgical autografts

    Directory of Open Access Journals (Sweden)

    A. D. Kaprin

    2015-01-01

    Full Text Available After surgical treatment for locally advanced oral tumors with resection of soft tissues, mucosal membrane, and facial skeletal structures, there are penetration combined defects, removal of which is a challenge for reconstructive surgeons. Mandibular repair is one of the problems in the correction of combined oral defects. Surgeons use different grafts to remove mandibular defects. One-flap transplantation does not always solve all reconstruction problems and ensure the repair of the mucosal membrane, a soft-tissue component, skin integuments, and facial skeleton.The authors describe a clinical case of successful single-stage correction of penetration combined orofacial defect after resection of the tongue, mouth floor, en bloc resection of the lower jaw and mental soft tissues, bilateral cervical supramyochoroidal lymphadenectomy, stage LCL CM mandibular defect formation after J. Boyd, by using two microsurgical autografts (a peroneal skin-muscle-skin autograft and a radial skin-fascia one in a 39-year-old female patient clinically diagnosed with carcinoma of the left mandibular alveolar ridge mucosa, Stage IVA (T4аN0M0.The Department of Microsurgery, P.A. Herzen Moscow Oncology Research Institute, Ministry of Health of Russia, has gained experience in comprehensively correcting extensive combined maxillofacial defects with two or more grafts in 27 patients who underwent autografting with a total of 73 flaps. The most functionally incapacitating and life-incompatible defect was removed at Stage 1 of reconstructive treatment. Delayed reconstruction was made after a complex of specialized antitumor therapy and assessment of treatment results in the absence of progressive growth. A great problem during multi-stage defect correction is presented by the lack of recipient vessels after cervical lymphadenectomy, the presence of soft tissue scar changes, trismus, temporomandibular joint ankylosis, contractures and displacement of the edges of the

  11. Bone bruise in acute traumatic patellar dislocation: volumetric magnetic resonance imaging analysis with follow-up mean of 12 months

    International Nuclear Information System (INIS)

    Paakkala, Antti; Paakkala, Timo; Sillanpaeae, Petri; Maeenpaeae, Heikki; Huhtala, Heini

    2010-01-01

    The aim of the study was to assess volumetric analysis of bone bruises in acute primary traumatic patellar dislocation by magnetic resonance imaging (MRI) and resolving resolution of bruises in follow-up MRI. MRI was performed in 23 cases. A follow-up examination was done at a mean of 12 months after dislocation. Volumes of patellar and femur bruises for every patient were evaluated separately by two musculoskeletal radiologists, and mean values of the bruises were assessed. Other MRI findings were evaluated, together with agreement by consensus. Bone bruise volumes were compared with other MR findings. In the acute study 100% of patients showed bruising of the lateral femoral condyle and 96% bruising of the patella. The bruise was located at the medial femoral condyle in 30% and at the patellar median ridge in 74% of patients. The median volume of the femoral bruise was 25,831 mm 3 and of the patellar bruise 2,832 mm 3 . At the follow-up study 22% of patients showed bruising of the lateral femoral condyle and 39% bruising of the patella, the median volumes of the bruises being 5,062 mm 3 and 1,380 mm 3 , respectively. Larger patellar bruise volume correlated with larger femur bruise volume in the acute (r=0.389, P=0.074) and the follow-up (r=1.000, P<0.01) studies. Other MRI findings did not correlate significantly with bone bruise volumes. Bone bruising is the commonest finding in cases of acute patellar dislocation, being seen even 1 year after trauma and indicating significant bone trabecular injury in the patellofemoral joint. A large bruise volume may be associated with subsequent chondral lesion progression at the patella. We concluded that the measurement of bone bruise volume in patients with acute patellar dislocation is a reproducible method but requires further studies to evaluate its clinical use. (orig.)

  12. Estudo prospectivo randomizado sobre a luxação traumática de patela: tratamento conservador versus reconstrução do ligamento femoropatelar medial com tendão patelar - mínimo de dois anos de seguimento Randomized prospective study on traumatic patellar dislocation: conservative treatment versus reconstruction of the medial patellofemoral ligament using the patellar tendon, with a minimum of two years of follow-up

    Directory of Open Access Journals (Sweden)

    Alexandre Carneiro Bitar

    2011-01-01

    results were evaluated with a minimum follow-up of two years. The Kujala questionnaire was applied to assess pain and quality of life, and recurrences were evaluated. Pearson's chi-square test and Fisher's exact test were used in the statistical evaluation. RESULTS: The statistical analysis showed that the mean Kujala score was significantly lower in the conservative group (70.8, compared with the mean value in the surgical group (88.9, with p = 0.001. The surgical group presented a higher percentage of "good/excellent" Kujala score results (71.43% than in the conservative group (25.0%, with p = 0.003. The conservative group presented a greater number of recurrences (35% of the cases, while in the surgical group there were no reports of recurrences and/or subluxation. CONCLUSIONS: Treatment with reconstruction of the medial patellofemoral ligament using the patellar tendon produced better results, based on the analysis of post-treatment recurrences and the better final results from the Kujala questionnaire after a minimum follow-up period of two years.

  13. Clinical evaluation of bone- patellar tendon- bone grafts for anterior cruciate ligament injury

    International Nuclear Information System (INIS)

    Nakamura, Yasuhiro

    2011-01-01

    One thousand and thirty-eight cases of Anterior Cruciate Ligament (ACL) rupture were treated between January 2002 and November 2010. Eight hundred sixty-six cases (83.9%) were observed for at least six months. All cases were reconstructed with a bone to tendon to bone (BTB) graft from the patella. Much effort was made to return the patient to a competitive sports activity level within one year. The age at suffering from the initial injury ranged from 9 to 74 years old with a mean of 24.7 years old. There were 493 female (50.7%) and 427 male (49.3%) cases. The injured side was right in 408 cases and left in 458 cases. The mean postoperative observation period was 449.2 days. The number of patients who felt 80% or more certain that they could return to competitive sports activities was 538 (61.9%). From the MRI findings, continuity of the reconstructed graft was observed in 793 cases (98.5%). Arthroscopy after reconstruction was performed in 775 cases (89.5%). The reconstructed ACL was observed to be covered with an adequate synovium in 629 cases (81.2%). The medial meniscus and lateral meniscus showed no changes in 657 cases (84.8%) and 666 cases (85.9%) respectively. Reconstructions performed less than two weeks after injury showed no significant differences in terms of Range Of Motion (ROM), arthroscopic findings, or the number of patients who could return to competitive sports activities. Statistically significantly more patients who underwent their reconstruction at an age over forty experienced a loss motion of five degree in extension or ten degree in flexion and resumed a lower level of sports activities. Patients who underwent the reconstruction could return to exercises for muscle strengthening and ROMs within 2 weeks. Patients over forty years old who underwent their reconstruction could prevent their menisci from fraying, tearing, or undergoing osteoarthritic changes. (author)

  14. The roentgenographic findings of achilles tendon rupture

    Energy Technology Data Exchange (ETDEWEB)

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

    1999-03-01

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

  15. The roentgenographic findings of achilles tendon rupture

    International Nuclear Information System (INIS)

    Seouk, Kang Hyo; Keun, Rho Yong

    1999-01-01

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

  16. Tendon Force Transmission at the Nanoscale

    DEFF Research Database (Denmark)

    Svensson, René

    2013-01-01

    of connective tissue function that are poorly understood. One such aspect is the microscopic mechanisms of force transmission through tendons over macroscopic distances. Force transmission is at the heart of tendon function, but the large range of scales in the hierarchical structure of tendons has made...... it difficult to tackle. The tendon hierarchy ranges from molecules (2 nm) over fibrils (200 nm), fibers (2 μm) and fascicles (200 μm) to tendons (10 mm), and to derive the mechanisms of force transmission it is necessary to know the mechanical behavior at each hierarchical level. The aim of the present work...... was to elucidate the mechanisms of force transmission in tendons primarily by investigating the mechanical behavior at the hierarchical level of collagen fibrils. To do so we have developed an atomic force microscopy (AFM) method for tensile testing of native collagen fibrils. The thesis contains five papers...

  17. Combined Conjunctival Autograft and Overlay Amniotic Membrane Transplantation; a Novel Surgical Treatment for Pterygium

    Directory of Open Access Journals (Sweden)

    Siamak Zarei Ghanavati

    2014-01-01

    Full Text Available The authors report the long-term results of combined conjunctival autograft and overlay amniotic membrane transplantation (AMT for treatment of pterygium as a new surgical technique. Nineteen patients including 12 male and 7 female subjects with pterygium (primary, 14 cases; recurrent, 5 cases underwent combined conjunctival autograft and overlay AMT and were followed from 10 to 26 months. Mean age was 44.21±12.49 (range, 29.0-73.0 years. In one patient with grade T3 primary pterygium, the lesion recurred (5.2%, recurrence rate. No intra-and postoperative complication developed. This procedure seems a safe and effective surgical technique for pterygium treatment. Protection of the ocular surface during the early postoperative period reduces the friction-induced inflammation and might be helpful to prevent the recurrence.

  18. Evolution of the patellar sesamoid bone in mammals

    Directory of Open Access Journals (Sweden)

    Mark E. Samuels

    2017-03-01

    Full Text Available The patella is a sesamoid bone located in the major extensor tendon of the knee joint, in the hindlimb of many tetrapods. Although numerous aspects of knee morphology are ancient and conserved among most tetrapods, the evolutionary occurrence of an ossified patella is highly variable. Among extant (crown clade groups it is found in most birds, most lizards, the monotreme mammals and almost all placental mammals, but it is absent in most marsupial mammals as well as many reptiles. Here, we integrate data from the literature and first-hand studies of fossil and recent skeletal remains to reconstruct the evolution of the mammalian patella. We infer that bony patellae most likely evolved between four and six times in crown group Mammalia: in monotremes, in the extinct multituberculates, in one or more stem-mammal genera outside of therian or eutherian mammals and up to three times in therian mammals. Furthermore, an ossified patella was lost several times in mammals, not including those with absent hindlimbs: once or more in marsupials (with some re-acquisition and at least once in bats. Our inferences about patellar evolution in mammals are reciprocally informed by the existence of several human genetic conditions in which the patella is either absent or severely reduced. Clearly, development of the patella is under close genomic control, although its responsiveness to its mechanical environment is also important (and perhaps variable among taxa. Where a bony patella is present it plays an important role in hindlimb function, especially in resisting gravity by providing an enhanced lever system for the knee joint. Yet the evolutionary origins, persistence and modifications of a patella in diverse groups with widely varying habits and habitats—from digging to running to aquatic, small or large body sizes, bipeds or quadrupeds—remain complex and perplexing, impeding a conclusive synthesis of form, function, development and genetics across

  19. Bone marrow-derived mesenchymal stem cells influence early tendon-healing in a rabbit achilles tendon model.

    Science.gov (United States)

    Chong, Alphonsus K S; Ang, Abel D; Goh, James C H; Hui, James H P; Lim, Aymeric Y T; Lee, Eng Hin; Lim, Beng Hai

    2007-01-01

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

  20. The Effect of Antagonist Muscle Sensory Input on Force Regulation.

    Directory of Open Access Journals (Sweden)

    Tanya Onushko

    Full Text Available The purpose of this study was to understand how stretch-related sensory feedback from an antagonist muscle affects agonist muscle output at different contraction levels in healthy adults. Ten young (25.3 ± 2.4 years, healthy subjects performed constant isometric knee flexion contractions (agonist at 6 torque levels: 5%, 10%, 15%, 20%, 30%, and 40% of their maximal voluntary contraction. For half of the trials, subjects received patellar tendon taps (antagonist sensory feedback during the contraction. We compared error in targeted knee flexion torque and hamstring muscle activity, with and without patellar tendon tapping, across the 6 torque levels. At lower torque levels (5%, 10%, and 15%, subjects produced greater knee torque error following tendon tapping compared with the same torque levels without tendon tapping. In contrast, we did not find any difference in torque output at higher target levels (20%, 30%, and 40% between trials with and without tendon tapping. We also observed a load-dependent increase in the magnitude of agonist muscle activity after tendon taps, with no associated load-dependent increase in agonist and antagonist co-activation, or reflex inhibition from the antagonist tapping. The findings suggest that at relatively low muscle activity there is a deficiency in the ability to correct motor output after sensory disturbances, and cortical centers (versus sub-cortical are likely involved.

  1. Arthrography of the biceps tendon

    International Nuclear Information System (INIS)

    Ahovuo, J.; Linden, H.; Hovi, I.; Paavolainen, P.; Bjoerkenheim, J.M.

    1988-01-01

    The purpose of this study was to analyse the factors having an influence on the arthrographic imaging of the biceps tendon. The study comprised 174 patients suffering from chronic shoulder pain. They underwent conventional shoulder arthrography with sodium meglumine metrizoate or metrizamide as a contrast medium. In the patients with a full-thickness tear of the rotator cuff, the biceps tendon sheath failed to fill with contrast medium more often than in those with an intact tendinous cuff. Metrizamide filled the biceps tendon sheath more readily than sodium meglumine metrizoate in patients with a full-thickness tear of the ortator cuff. The volume of the contrast medium injected had no influence on the imaging of the biceps tendon. (orig.)

  2. Comparative diagnostic imaging of a partial patellar ligament tear in ...

    African Journals Online (AJOL)

    Ibrahim Eldaghayes

    2018-04-27

    Apr 27, 2018 ... of the patellar or tibial insertion, and soft tissue opacity at the cranial aspect of the joint. ... the exclusion of microfracture and distal PL avulsion, but did not add information ..... angles and under stress (Hodgson et al., 2012).

  3. Flexor digitorum profundus tendon anatomy in the forearm

    Directory of Open Access Journals (Sweden)

    Teoman Dogan

    2012-04-01

    Methods: We used 11 forearms belonging to cadavers and fixed with formaldehyde. The forearms numbered 1, 2, 8, 9, 10, 11 were the left and right arms of the same cadavers. Those numbered 3, 4, 5, 6, 7 belonged to different cadavers. Dissections were made by using the atraumatic surgical technique. The tendons were studied to identify the structure and number of the fibers forming them. Results: The presence of a large common tendon was found in 10 of the 11 forearms. In 4 of these, the common tendon included the tendons of all four fingers. While the common tendon included 3 fingers in four forearms, it only included tendons belonging to 2 fingers in two forearms. It was not possible in one forearm to separate the common tendon into its fibers. In another forearm, tendons belonging to each digit were separate and independent starting at the muscle-tendon junction to the attachment points. Conclusion: The majority of the cadaver forearms used in the study displayed a single large FDP tendon in the zone between the muscle-tendon joint to the carpal tunnel entry prior to being distributed into each index. This anatomical feature should be considered in choosing materials and surgical technique for Zone V FDP tendon injuries, as well as in planning the rehabilitation process. [Hand Microsurg 2012; 1(1.000: 25-29

  4. PATELLAR REALIGNMENT AND FUNCTIONAL PERFORMANCE IN PATIENTS WITH PATELLOFEMORAL PAIN SYNDROME

    Directory of Open Access Journals (Sweden)

    Abeer Farag Hanafy

    2016-02-01

    Full Text Available Background: Patellar taping is used for pain relief in patients with patello-femoral pain syndrome (PFPS. Yet, there is lack of knowledge regarding its effect on the functional performance. The purpose of the study was to examine the effects of therapeutic patellar taping on the Visual Analogue Scale (VAS pain scores, number of bilateral squats, and stair climbing time in patients with PFPS. Methods: 30 female patients with PFPS with mean age 20.3± 1.46 years, weight 66.1± 9.68 kg, height 165.83 ± 3.89 cm and BMI 23.91 ± 3.50kg/m2 participated in the study. The subjects were tested randomly under three taping conditions;namely therapeutic, placebo and no-tape. The tested limb was determined to be the affected limb in patients with unilateral affection, and the symptomatic limb in patients with bilateral affection. Data was collected using the Visual Analogue Scale (VAS, Bilateral Squat Test and Timed Stair Ambulation Test. Results: Repeated measures Multivariate Analysis of Variance (MANOVA revealed that the number of bilateral squats increased significantly (p0.05 in between for the number of bilateral squats and stair climbing time. Conclusion: The findings indicated that therapeutic patellar taping is effective in improving functional performance and reducing pain in patients with patellofemoral pain syndrome (PFPS.

  5. Low range of ankle dorsiflexion predisposes for patellar tendinopathy in junior elite basketball players: a 1-year prospective study.

    Science.gov (United States)

    Backman, Ludvig J; Danielson, Patrik

    2011-12-01

    Patellar tendinopathy (PT) is one of the most common reasons for sport-induced pain of the knee. Low ankle dorsiflexion range might predispose for PT because of load-bearing compensation in the patellar tendon. The purpose of this 1-year prospective study was to analyze if a low ankle dorsiflexion range increases the risk of developing PT for basketball players. Cohort study (prognosis); Level of evidence, 2. Ninety junior elite basketball players were examined for different characteristics and potential risk factors for PT, including ankle dorsiflexion range in the dominant and nondominant leg. Data were collected over a 1-year period and follow-up, including reexamination, was made at the end of the year. Seventy-five players met the inclusion criteria. At the follow-up, 12 players (16.0%) had developed unilateral PT. These players were found to have had a significantly lower mean ankle dorsiflexion range at baseline than the healthy players, with a mean difference of -4.7° (P = .038) for the dominant limb and -5.1° (P = .024) for the nondominant limb. Complementary statistical analysis showed that players with dorsiflexion range less than 36.5° had a risk of 18.5% to 29.4% of developing PT within a year, as compared with 1.8% to 2.1% for players with dorsiflexion range greater than 36.5°. Limbs with a history of 2 or more ankle sprains had a slightly less mean ankle dorsiflexion range compared to those with 0 or 1 sprain (mean difference, -1.5° to -2.5°), although this was only statistically significant for nondominant legs. This study clearly shows that low ankle dorsiflexion range is a risk factor for developing PT in basketball players. In the studied material, an ankle dorsiflexion range of 36.5° was found to be the most appropriate cutoff point for prognostic screening. This might be useful information in identifying at-risk individuals in basketball teams and enabling preventive actions. A history of ankle sprains might contribute to reduced ankle

  6. IFSSH Flexor Tendon Committee report 2014: from the IFSSH Flexor Tendon Committee (Chairman: Jin Bo Tang).

    Science.gov (United States)

    Tang, Jin Bo; Chang, James; Elliot, David; Lalonde, Donald H; Sandow, Michael; Vögelin, Esther

    2014-01-01

    Hand surgeons continue to search for the best surgical flexor tendon repair and treatment of the tendon sheaths and pulleys, and they are attempting to establish postoperative regimens that fit diverse clinical needs. It is the purpose of this report to present the current views, methods, and suggestions of six senior hand surgeons from six different countries - all experienced in tendon repair and reconstruction. Although certainly there is common ground, the report presents provocative views and approaches. The report reflects an update in the views of the committee. We hope that it is helpful to surgeons and therapists in treating flexor tendon injuries.

  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. The Effect of Sodium Hyaluronate on Ligamentation and Biomechanical Property of Tendon in Repair of Achilles Tendon Defect with Polyethylene Terephthalate Artificial Ligament: A Rabbit Tendon Repair Model.

    Science.gov (United States)

    Li, Shengkun; Ma, Kui; Li, Hong; Jiang, Jia; Chen, Shiyi

    2016-01-01

    The Achilles tendon is the most common ruptured tendon of human body. Reconstruction with polyethylene terephthalate (PET) artificial ligament is recommended in some serious cases. Sodium hyaluronate (HA) is beneficial for the healing of tendon injuries. We aimed to determine the effect of sodium hyaluronate in repair of Achilles tendon defect with PET artificial ligament in an animal tendon repair model. Sixteen New Zealand White rabbits were divided into two groups. Eight rabbits repaired with PET were assigned to PET group; the other eight rabbits repaired with PET along with injection of HE were assigned to HA-PET group. All rabbits were sacrificed at 4 and 8 weeks postoperatively for biomechanical and histological examination. The HA-PET group revealed higher biomechanical property compared with the PET group. Histologically, more collagen tissues grew into the HA-PET group compared with PET group. In conclusion, application of sodium hyaluronate can improve the healing of Achilles tendon reconstruction with polyethylene terephthalate artificial ligament.

  9. The Effect of Sodium Hyaluronate on Ligamentation and Biomechanical Property of Tendon in Repair of Achilles Tendon Defect with Polyethylene Terephthalate Artificial Ligament: A Rabbit Tendon Repair Model

    Directory of Open Access Journals (Sweden)

    Shengkun Li

    2016-01-01

    Full Text Available The Achilles tendon is the most common ruptured tendon of human body. Reconstruction with polyethylene terephthalate (PET artificial ligament is recommended in some serious cases. Sodium hyaluronate (HA is beneficial for the healing of tendon injuries. We aimed to determine the effect of sodium hyaluronate in repair of Achilles tendon defect with PET artificial ligament in an animal tendon repair model. Sixteen New Zealand White rabbits were divided into two groups. Eight rabbits repaired with PET were assigned to PET group; the other eight rabbits repaired with PET along with injection of HE were assigned to HA-PET group. All rabbits were sacrificed at 4 and 8 weeks postoperatively for biomechanical and histological examination. The HA-PET group revealed higher biomechanical property compared with the PET group. Histologically, more collagen tissues grew into the HA-PET group compared with PET group. In conclusion, application of sodium hyaluronate can improve the healing of Achilles tendon reconstruction with polyethylene terephthalate artificial ligament.

  10. THE EFFECTS OF EXTRACORPOREAL SHOCKWAVE THERAPY (ESWT) AND CRYOTHERAPY IN TREATING PATELLAR TENDINOPATHIES IN PROFESSIONAL ATHLETES

    OpenAIRE

    Dobreci Iulian

    2014-01-01

    Aim: this paper tries to optimize the existent classical treatments for patellar tendinopathies that are resistant to classical forms of therapy, in professional athletes. Hypotheses: this research wants to highlight the effectiveness of the ESWT and cryotherapy in treating patellar tendinopathies in professional athletes who previously underwent classical treatments that had no positive results. Material: the research was conducted at the Bacau Spinal Care Rehabilitation Clinic, where the sy...

  11. Thompson Test in Achilles Tendon Rupture

    Directory of Open Access Journals (Sweden)

    Spencer Albertson

    2016-07-01

    Full Text Available HPI: A 26-year old male presented to the emergency department after experiencing the acute onset of left ankle pain while playing basketball. Upon jumping, he felt a “pop” in his left posterior ankle, followed by pain and difficulty ambulating. His exam was notable for a defect at the left Achilles tendon on palpation. The practitioner performed a Thompson test, which was positive (abnormal on the left. Significant Findings: The left Achilles tendon had a defect on palpation, while the right Achilles tendon was intact. When squeezing the right (unaffected calf, the ankle spontaneously plantar flexed, indicating a negative (normal Thompson test. Upon squeeze of the left (affected calf, the ankle did not plantar flex, signifying a positive (abnormal Thompson test. The diagnosis of left Achilles tendon rupture was confirmed intraoperatively one week later. Discussion: The Achilles tendon (also: calcaneal tendon or heel cord is derived from the medial and lateral heads of the gastrocnemius muscle, as well as the soleus muscle. Rupture of the Achilles tendon most commonly occurs in the distal tendon, approximately 2-6 cm from its attachment to the calcaneal tuberosity, in an area of hypovascularity known as the “watershed” or “critical” zone.1-3 The Thompson test (also: Simmonds-Thompson test, described by Simmonds in 1957 and Thompson in 1962, is done while the patient is in the prone position, with feet hanging over the end of a table/gurney, or with the patient kneeling on a stool or chair.4-5 Squeezing the calf of an unaffected limb will cause the ankle to plantar flex, but squeezing the calf of a limb with an Achilles tendon rupture will cause no motion. The sensitivity of the Thompson’s test for the diagnosis of a complete Achilles tendon rupture is 96-100% and the specificity is 93-100%, but data is limited.6-8

  12. [Reconstruction of chronic Achilles tendon rupture with flexor hallucis longus tendon harvested using a minimally invasive technique].

    Science.gov (United States)

    Miao, Xudong; Wu, Yongping; Tao, Huimin; Yang, Disheng

    2011-07-01

    To evaluate the effectiveness of flexor hallucis longus tendon harvested using a minimally invasive technique in reconstruction of chronic Achilles tendon rupture. Between July 2006 and December 2009, 22 patients (22 feet) with chronic Achilles tendon rupture were treated, including 16 males and 6 females with a median age of 48 years (range, 28-65 years). The disease duration was 27-1,025 days (median, 51 days). Twenty-one patients had hooflike movement's history and 1 patient had no obvious inducement. The result of Thompson test was positive in 22 cases. The score was 53.04 +/- 6.75 according to American Orthopedic Foot and Ankle Society (AOFAS) ankle and hindfoot score system. MRI indicated that the gap of the chronic Achilles tendon rupture was 4.2-8.0 cm. A 3 cm-long incision was made vertically in the plantar aspect of the midfoot and a 1 cm-long transverse incision was made in a plantar flexor crease at the base of the great toe to harvest flexor hallucis longus tendon. The flexor hallucis longus tendon was 10.5-13.5 cm longer from tuber calcanei to the end of the Achilles tendon, and then the tendon was fixed to the tuber calcanei using interface screws or anchor nail after they were woven to form reflexed 3-bundle and sutured. Wound healed by first intention in all patients and no early complication occurred. Twenty-two patients were followed up 12-42 months (mean, 16.7 months). At 12 months after operation, The AOFAS ankle and hindfoot score was 92.98 +/- 5.72, showing significant difference when compared with that before operation (t= -40.903, P=0.000). The results were excellent in 18 cases, good in 2 cases, and fair in 2 cases with an excellent and good rate of 90.9%. No sural nerve injury, posterior tibial nerve injury, plantar painful scar, medial plantar nerve injury, and lateral plantar nerve injury occurred. Chronic Achilles tendon rupture reconstruction with flexor hallucis longus tendon harvested using a minimally invasive technique offers a

  13. Non-metallic implant for patellar fracture fixation: A systematic review.

    Science.gov (United States)

    Camarda, Lawrence; Morello, Salvatore; Balistreri, Francesco; D'Arienzo, Antonio; D'Arienzo, Michele

    2016-08-01

    Despite good clinical outcome proposals, there has been relatively little published regarding the use of non-metallic implant for patellar fracture fixation. The purpose of the study was to perform a systematic literature review to summarize and evaluate the clinical studies that described techniques for treating patella fractures using non-metallic implants. A comprehensive literature search was systematically performed to evaluate all studies included in the literature until November 2015. The following search terms were used: patellar fracture, patella suture, patella absorbable, patella screw, patella cerclage. Two investigators independently reviewed all abstracts and the selection of these abstracts was then performed based on inclusion and/or exclusion criteria. A total of 9 studies involving 123 patients were included. Patients had a mean age of 33.7 years and were followed up for a mean of 18.9 months. The most common method for fracture fixations included the use of suture material. Good clinical outcomes were reported among all studies. Thirteen patients (10.5%) presented complications, while 4 patients (3.2%) required additional surgery for implant removal. There is a paucity of literature focused on the use of non-metallic implant for patellar fracture fixation. However, this systematic review showed that non-metallic implants are able to deliver good clinical outcomes reducing the rate of surgical complications and re-operation. These results may assist surgeons in choosing to use alternative material such as sutures to incorporate into their routine practice or to consider it, in order to reduce the rate of re-operation. Copyright © 2016 Elsevier Ltd. All rights reserved.

  14. Hip proprioceptors preferentially modulate reflexes of the leg in human spinal cord injury

    Science.gov (United States)

    Onushko, Tanya; Hyngstrom, Allison

    2013-01-01

    Stretch-sensitive afferent feedback from hip muscles has been shown to trigger long-lasting, multijoint reflex responses in people with chronic spinal cord injury (SCI). These reflexes could have important implications for control of leg movements during functional activities, such as walking. Because the control of leg movement relies on reflex regulation at all joints of the limb, we sought to determine whether stretch of hip muscles modulates reflex activity at the knee and ankle and, conversely, whether knee and ankle stretch afferents affect hip-triggered reflexes. A custom-built servomotor apparatus was used to stretch the hip muscles in nine chronic SCI subjects by oscillating the legs about the hip joint bilaterally from 10° of extension to 40° flexion. To test whether stretch-related feedback from the knee or ankle would be affected by hip movement, patellar tendon percussions and Achilles tendon vibration were delivered when the hip was either extending or flexing. Surface electromyograms (EMGs) and joint torques were recorded from both legs. Patellar tendon percussions and Achilles tendon vibration both elicited reflex responses local to the knee or ankle, respectively, and did not influence reflex responses observed at the hip. Rather, the movement direction of the hip modulated the reflex responses local to the joint. The patellar tendon reflex amplitude was larger when the perturbation was delivered during hip extension compared with hip flexion. The response to Achilles vibration was modulated by hip movement, with an increased tonic component during hip flexion compared with extension. These results demonstrate that hip-mediated sensory signals modulate activity in distal muscles of the leg and appear to play a unique role in modulation of spastic muscle activity throughout the leg in SCI. PMID:23615544

  15. Biomechanical and histologic comparison of Achilles tendon ruptures reinforced with intratendinous and peritendinous plantaris tendon grafts in rabbits: an experimental study.

    Science.gov (United States)

    Ilhami, Kuru; Gokhan, Maralcan; Ulukan, Inan; Eray, Bozan M; Levent, Altinel; Ciğdem, Tokyol

    2004-11-01

    We hypothesized that the closer the reinforcing graft was to the repair zone, the more strength the healed tendon would achieved. Therefore, we compared the ruptured rabbit Achilles tendons reinforced with intratendinous and peritendinous plantaris grafts. The experimental study was performed on Achilles tendons of 20 rabbits. First, they were divided into two groups: group I (n=10) underwent intratendinous graft and end-to-end tenorraphy, and group P (n=10) were repaired end-to-end and then reinforced with a peritendinous plantaris graft. An above-knee cast was applied during 6 weeks postoperatively. The two groups were compared to each other biomechanically and histologically. Seven randomly selected rabbits from each group were used for biomechanical evaluation. The remaining six rabbits (three from each group) were used for histologic comparison. Non-operated sides (n=20) served as the control group. The mean maximum load at rupture of the repaired and control groups was 159.9+/-31 N, 83+/-7.5 N, and 207.5+/-35 N for group I, group P, and the control group, respectively. Values between groups were significantly different considering maximum load and absorbed energy to rupture. There was no significant difference between groups I and P in respect to strain. Control group tendons (groups I-C and P-C) had significantly more lengthening capability than operated tendons. Macroscopically, group I tendons were thicker and stiffer than group P tendons. Histologically, differences between the group I and group P specimens revealed that the healing process was faster in tendons augmented intratendinously. In reinforcing Achilles tendon repair, the site of the tendon graft affected the result. When the graft was used intratendinously, the healed tendon was more similar biomechanically to normal tendon and had more graft-tendon orientation histologically than the tendon augmented peritendinously.

  16. [Simultaneous Traumatic Rupture of Patellar Ligament and Contralateral Rupture of Quadriceps Femoris Muscle].

    Science.gov (United States)

    Hladký, V; Havlas, V

    2017-01-01

    Our paper presents a unique case of a 64-year-old patient after a fall, treated with oral antidiabetic drugs for type II diabetes mellitus. Following a series of examinations, a bilateral injury was diagnosed - patellar ligament tear on the right side and rupture of quadriceps femoris muscle on the left side. It is a rare injury, complicated by simultaneous involvement of both knee joints. The used therapy consisted of a bilateral surgery followed by gradual verticalisation, first with the support of a walking frame and later with the use of forearm crutches. During the final examination, the patient demonstrated full flexion at both knees, while an extension deficit of approx. 5 degrees was still present on the left side. The right knee X-ray showed a proper position of the patella after the removal of temporary tension band wire. Although the clinical results of operative treatment of both the patellar ligament rupture and rupture of quadriceps femoris muscle are in most cases good, early operative treatment, proper technique and post-operative rehabilitation are a prerequisite for success. Key words: knee injuries, patellar ligament, quadriceps muscle, rupture.

  17. The computed tomographic evaluation of patellofemoral joint in patellar fractures treated with open reduction and internal fixation

    International Nuclear Information System (INIS)

    Benli, I.T.; Akalin, S.; Mumcu, E.F.; Citak, M.; Kilic, M.; Pasaoglu, E.

    1992-01-01

    In this study, we examined 97 patella fractures in which open reduction and internal fixation had been performed at the 1st Orthopaedics and Trauma Clinic of Social Security Ankara Hospital between January 1983 and December 1988. After 24 to 96 months, on an average of 48.4 months follow-up period, the cases were evaluated clinically for knee function complaints and by CT and roentgenography for patellofemoral articulation. In 11 of the patients (11.5%) there was patellar displacement, 2 of the patients had patellar tilt (2.1%) and in 14 patients (14.5%) there was malalignment in which 1 patient (1.1%) had both patellar tilt and displacement. This data was obtained by measuring femoral trochlear angle (FTA) and patellar tilt angle (PTA) by CT at various degrees of knee flexion. Thirty three patients (34%) had slight and 19 patients (19.6%) had severe degenerative changes in the patellofemoral articulation. It is found that there is close relation between the variability of the pain complaints of the patients and the type of the fracture and the time of management and the postoperative rehabilitation. (author)

  18. The computed tomographic evaluation of patellofemoral joint in patellar fractures treated with open reduction and internal fixation

    Energy Technology Data Exchange (ETDEWEB)

    Benli, I.T.; Akalin, S.; Mumcu, E.F.; Citak, M.; Kilic, M.; Pasaoglu, E. (Ankara Social Security Hospital (Turkey))

    1992-08-01

    In this study, we examined 97 patella fractures in which open reduction and internal fixation had been performed at the 1st Orthopaedics and Trauma Clinic of Social Security Ankara Hospital between January 1983 and December 1988. After 24 to 96 months, on an average of 48.4 months follow-up period, the cases were evaluated clinically for knee function complaints and by CT and roentgenography for patellofemoral articulation. In 11 of the patients (11.5%) there was patellar displacement, 2 of the patients had patellar tilt (2.1%) and in 14 patients (14.5%) there was malalignment in which 1 patient (1.1%) had both patellar tilt and displacement. This data was obtained by measuring femoral trochlear angle (FTA) and patellar tilt angle (PTA) by CT at various degrees of knee flexion. Thirty three patients (34%) had slight and 19 patients (19.6%) had severe degenerative changes in the patellofemoral articulation. It is found that there is close relation between the variability of the pain complaints of the patients and the type of the fracture and the time of management and the postoperative rehabilitation. (author).

  19. Bone bruise in acute traumatic patellar dislocation: volumetric magnetic resonance imaging analysis with follow-up mean of 12 months

    Energy Technology Data Exchange (ETDEWEB)

    Paakkala, Antti; Paakkala, Timo [Tampere University Hospital, Department of Radiology, Tampere (Finland); Sillanpaeae, Petri; Maeenpaeae, Heikki [Tampere University Hospital, Department of Orthopaedics and Traumatology, Tampere (Finland); Huhtala, Heini [University of Tampere, School of Public Health, Tampere (Finland)

    2010-07-15

    The aim of the study was to assess volumetric analysis of bone bruises in acute primary traumatic patellar dislocation by magnetic resonance imaging (MRI) and resolving resolution of bruises in follow-up MRI. MRI was performed in 23 cases. A follow-up examination was done at a mean of 12 months after dislocation. Volumes of patellar and femur bruises for every patient were evaluated separately by two musculoskeletal radiologists, and mean values of the bruises were assessed. Other MRI findings were evaluated, together with agreement by consensus. Bone bruise volumes were compared with other MR findings. In the acute study 100% of patients showed bruising of the lateral femoral condyle and 96% bruising of the patella. The bruise was located at the medial femoral condyle in 30% and at the patellar median ridge in 74% of patients. The median volume of the femoral bruise was 25,831 mm{sup 3} and of the patellar bruise 2,832 mm{sup 3}. At the follow-up study 22% of patients showed bruising of the lateral femoral condyle and 39% bruising of the patella, the median volumes of the bruises being 5,062 mm{sup 3} and 1,380 mm{sup 3}, respectively. Larger patellar bruise volume correlated with larger femur bruise volume in the acute (r=0.389, P=0.074) and the follow-up (r=1.000, P<0.01) studies. Other MRI findings did not correlate significantly with bone bruise volumes. Bone bruising is the commonest finding in cases of acute patellar dislocation, being seen even 1 year after trauma and indicating significant bone trabecular injury in the patellofemoral joint. A large bruise volume may be associated with subsequent chondral lesion progression at the patella. We concluded that the measurement of bone bruise volume in patients with acute patellar dislocation is a reproducible method but requires further studies to evaluate its clinical use. (orig.)

  20. No effect of extracorporeal shockwave therapy on patellar tendinopathy in jumping athletes during the competitive season : A randomized clinical trial

    NARCIS (Netherlands)

    Zwerver, Johannes; Hartgens, Fred; Verhagen, Evert; van der Worp, Henk; van den Akker-Scheek, Inge; Diercks, Ronald

    Background: Patellar tendinopathy is a common overuse injury among jumping athletes. No evidence-based treatment guidelines exist. Extracorporeal shockwave therapy (ESWT) appears to be a promising treatment but its effectiveness has not been studied in athletes with patellar tendinopathy who have

  1. Human syndromes with congenital patellar anomalies and the underlying gene defects.

    NARCIS (Netherlands)

    Bongers, E.M.H.F.; Kampen, A. van; Bokhoven, J.H.L.M. van; Knoers, N.V.A.M.

    2005-01-01

    Genetic disorders characterized by congenital patellar aplasia or hypoplasia belong to a clinically diverse and genetically heterogeneous group of lower limb malformations. Patella development involves different molecular and cellular mechanisms regulating dorso-ventral patterning, cartilage and

  2. Chondromalacia induced by patellar subluxation in the rabbit

    DEFF Research Database (Denmark)

    Møller, B.N.; Møller-Larsen, F.; Frich, Lars Henrik

    1989-01-01

    A unilateral patellar malalignment was induced in 20 young and 20 mature rabbits by lateral displacement of the tibial tuberosity, the other knee serving as osteotomized in situ control. At 6 weeks, all the knees appeared macroscopically normal, but histologically definite cartilage degeneration ...... produces changes resembling chondromalacia patellae and early arthrotic changes suggesting the importance of malalignment in the development of patellofemoral cartilage degeneration....

  3. The interfascicular matrix enables fascicle sliding and recovery in tendon, and behaves more elastically in energy storing tendons.

    Science.gov (United States)

    Thorpe, Chavaunne T; Godinho, Marta S C; Riley, Graham P; Birch, Helen L; Clegg, Peter D; Screen, Hazel R C

    2015-12-01

    While the predominant function of all tendons is to transfer force from muscle to bone and position the limbs, some tendons additionally function as energy stores, reducing the cost of locomotion. Energy storing tendons experience extremely high strains and need to be able to recoil efficiently for maximum energy storage and return. In the equine forelimb, the energy storing superficial digital flexor tendon (SDFT) has much higher failure strains than the positional common digital extensor tendon (CDET). However, we have previously shown that this is not due to differences in the properties of the SDFT and CDET fascicles (the largest tendon subunits). Instead, there is a greater capacity for interfascicular sliding in the SDFT which facilitates the greater extensions in this particular tendon (Thorpe et al., 2012). In the current study, we exposed fascicles and interfascicular matrix (IFM) from the SDFT and CDET to cyclic loading followed by a test to failure. The results show that IFM mechanical behaviour is not a result of irreversible deformation, but the IFM is able to withstand cyclic loading, and is more elastic in the SDFT than in the CDET. We also assessed the effect of ageing on IFM properties, demonstrating that the IFM is less able to resist repetitive loading as it ages, becoming stiffer with increasing age in the SDFT. These results provide further indications that the IFM is important for efficient function in energy storing tendons, and age-related alterations to the IFM may compromise function and predispose older tendons to injury. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  4. TGIF1 Gene Silencing in Tendon-Derived Stem Cells Improves the Tendon-to-Bone Insertion Site Regeneration

    Directory of Open Access Journals (Sweden)

    Liyang Chen

    2015-11-01

    Full Text Available Background/Aims: The slow healing process of tendon-to-bone junctions can be accelerated via implanted tendon-derived stem cells (TDSCs with silenced transforming growth interacting factor 1 (TGIF1 gene. Tendon-to-bone insertion site is the special form of connective tissues derivatives of common connective progenitors, where TGF-β plays bidirectional effects (chondrogenic or fibrogenic through different signaling pathways at different stages. A recent study revealed that TGF-β directly induces the chondrogenic gene Sox9. However, TGIF1 represses the expression of the cartilage master Sox9 gene and changes its expression rate against the fibrogenesis gene Scleraxis (Scx. Methods: TGIF1 siRNA was transduced or TGIF1 was over-expressed in tendon-derived stem cells. Following suprapinatus tendon repair, rats were either treated with transduced TDSCs or nontransduced TDSCs. Histologic examination and Western blot were performed in both groups. Results: In this study, the silencing of TGIF1 significantly upregulated the chondrogenic genes and markers. Similarly, TGIF1 inhibited TDSC differentiation into cartilage via interactions with TGF-β-activated Smad2 and suppressed the phosphorylation of Smad2. The area of fibrocartilage at the tendon-bone interface was significantly increased in the TGIF1 (- group compared with the control and TGIF1-overexpressing groups in the early stages of the animal model. The interface between the tendon and bone showed a increase of new bone and fibrocartilage in the TGIF1 (- group at 4 weeks. Fibrovascular scar tissue was observed in the TGIF1-overexpressing group and the fibrin glue only group. Low levels of fibrocartilage and fibrovascular scar tissue were found in the TDSCs group. Conclusion: Collectively, this study shows that the tendon-derived stem cell modified with TGIF1 gene silencing has promising effects on tendon-to-bone healing which can be further explored as a therapeutic tool in regenerative medicine.

  5. FRP tendon anchorage in post-tensioned concrete structures

    DEFF Research Database (Denmark)

    Schmidt, Jacob Wittrup; Täljsten, Björn; Bennitz, Anders

    2008-01-01

    effective Young´s modulus and the high stress capacity in the linear elastic range of the material. The use of external tendons increases the requirements on the anchorage systems. This is in particular important when using un-bonded tendon systems, where the anchorage and deviators are the only force...... transfer points. The demand for high capacity anchorage tendons is fulfilled for steel tendons, but no competitive mechanical anchor has yet been developed for FRP tendon. A new small, reliable and more user friendly anchor has to be developed, before FRP tendons can be utilized with all of its capacity...

  6. 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.

  7. Alternatives to Autograft Evaluated in a Rabbit Segmental Bone Defect

    Science.gov (United States)

    2015-07-09

    mesenchymal stem cells for off-the-shelf bone tissue engineering application. Biomaterials 33(9):2656–2672. doi:10.1016/j.biomaterials.2011.12.025 14...segmental bone defects in the rabbit with vascularized tissue engineered bone . Biomaterials 31(6):1171– 1179. doi:10.1016/j.biomaterials.2009.10.043 International Orthopaedics (SICOT) ...ORIGINAL PAPER Alternatives to autograft evaluated in a rabbit segmental bone defect Jennifer S. McDaniel1 & Marcello Pilia1 & Vivek Raut2 & Jeffrey

  8. The reliability of four widely used patellar height ratios.

    Science.gov (United States)

    van Duijvenbode, Dennis; Stavenuiter, Michel; Burger, Bart; van Dijke, Cees; Spermon, Jacco; Hoozemans, Marco

    2016-03-01

    The objective of this study was to evaluate the inter-observer reliability and the intra-observer reliability of four patellar height ratios: Insall-Salvati (IS), modified Insall-Salvati (MIS), Blackburne-Peel (BP) and Caton-Deschamps (CD). The patellar height ratios were assessed by four independent examiners using weight-bearing lateral knee radiographs in 30° flexion. Intra-class correlation coefficients and Fleiss' kappa's were determined. The inter-observer reliability was excellent for the IS and moderate for the other ratios. When the ratio values were categorized, the inter-observer reliability was strong for the IS, moderate for the MIS and BP, and poor for the CD. The intra-observer reliability was excellent for the IS, MIS and CD, and strong for the BP. When the ratio values were categorized, the intra-observer reliability was strong for the IS and MIS, and moderate for the other ratios. Although the IS showed best reliability, we advise to use the MIS as it showed the second best reliability but is, according to the literature, associated with better validity.

  9. Repair of Achilles tendon defect with autologous ASCs engineered tendon in a rabbit model.

    Science.gov (United States)

    Deng, Dan; Wang, Wenbo; Wang, Bin; Zhang, Peihua; Zhou, Guangdong; Zhang, Wen Jie; Cao, Yilin; Liu, Wei

    2014-10-01

    Adipose derived stem cells (ASCs) are an important cell source for tissue regeneration and have been demonstrated the potential of tenogenic differentiation in vitro. This study explored the feasibility of using ASCs for engineered tendon repair in vivo in a rabbit Achilles tendon model. Total 30 rabbits were involved in this study. A composite tendon scaffold composed of an inner part of polyglycolic acid (PGA) unwoven fibers and an outer part of a net knitted with PGA/PLA (polylactic acid) fibers was used to provide mechanical strength. Autologous ASCs were harvested from nuchal subcutaneous adipose tissues and in vitro expanded. The expanded ASCs were harvested and resuspended in culture medium and evenly seeded onto the scaffold in the experimental group, whereas cell-free scaffolds served as the control group. The constructs of both groups were cultured inside a bioreactor under dynamic stretch for 5 weeks. In each of 30 rabbits, a 2 cm defect was created on right side of Achilles tendon followed by the transplantation of a 3 cm cell-seeded scaffold in the experimental group of 15 rabbits, or by the transplantation of a 3 cm cell-free scaffold in the control group of 15 rabbits. Animals were sacrificed at 12, 21 and 45 weeks post-surgery for gross view, histology, and mechanical analysis. The results showed that short term in vitro culture enabled ASCs to produce matrix on the PGA fibers and the constructs showed tensile strength around 50 MPa in both groups (p > 0.05). With the increase of implantation time, cell-seeded constructs gradually form neo-tendon and became more mature at 45 weeks with histological structure similar to that of native tendon and with the presence of bipolar pattern and D-periodic structure of formed collagen fibrils. Additionally, both collagen fibril diameters and tensile strength increased continuously with significant difference among different time points (p tendon tissue with fibril structure observable only at 45 weeks

  10. Peroneal tendon displacement accompanying intra-articular calcaneal fractures.

    Science.gov (United States)

    Toussaint, Rull James; Lin, Darius; Ehrlichman, Lauren K; Ellington, J Kent; Strasser, Nicholas; Kwon, John Y

    2014-02-19

    Peroneal tendon displacement (subluxation or dislocation) accompanying an intra-articular calcaneal fracture is often undetected and under-treated. The goals of this study were to determine (1) the prevalence of peroneal tendon displacement accompanying intra-articular calcaneal fractures, (2) the association of tendon displacement with fracture classifications, (3) the association of tendon displacement with heel width, and (4) the rate of missed diagnosis of the tendon displacement on radiographs and computed tomography (CT) scans and the resulting treatment rate. A retrospective radiographic review of all calcaneal fractures presenting at three institutions from June 30, 2006, to June 30, 2011, was performed. CT imaging of 421 intra-articular calcaneal fractures involving the posterior facet was available for review. The prevalence of peroneal tendon displacement was noted and its associations with fracture classification and heel width were evaluated. Peroneal tendon displacement was identified in 118 (28.0%) of the 421 calcaneal fracture cases. The presence of tendon displacement was significantly associated with joint-depression fractures compared with tongue-type fractures (p displacement had been identified in the radiology reports. Although sixty-five (55.1%) of the fractures with tendon displacement had been treated with internal fixation, the tendon displacement was treated surgically in only seven (10.8%) of these cases. Analysis of CT images showed a 28% prevalence of peroneal tendon displacement accompanying intra-articular calcaneal fractures. Surgeons and radiologists are encouraged to consider this association.

  11. MRI evaluation of the patellar articular cartilage in patients with subluxation of the patella

    International Nuclear Information System (INIS)

    Nakanishi, Katsuyuki; Inoue, Masahiro; Harada, Koushi; Murakami, Takamichi; Kim, Shougen; Fujita, Norihiko; Sakurai, Kousuke; Kozuka, Takahiro

    1991-01-01

    In patients with subluxation of the patella, injury of the patellar articular cartilage is frequently observed and correct evaluation is important to manage these patients. We examined 11 patients with subluxation of the patella and five normal volunteers. In 12 patellofemoral joints of seven patients with subluxation of the patella, the abnormalities observed on MRI were compared with those on arthroscopy and/or at operation. MRI was performed with a Magnetom 1.5 T (Siemens) using the round surface coil. Pulse sequences were SE (TR 400 ms/TE 19 ms), FLASH(TR 320 ms/TE 15 ms FA 90deg and 40deg), and SE (TR 2000 ms/TE 26, 70 ms). We analysed MR findings of the 12 abnormal joints and 10 normal joints according to the following classification of abnormalities observed on arthroscopy; normal appearance (n=3 joints), softening and fibrillation (n=6), fragmentation (n=3), and erosion to bone (n=0). In only one of the six cases with softening and fibrillation observed on arthroscopy, MRI could visualize the thickening of patellar articular cartilage, but in all three cases with fragmentation observed on arthroscopy, MRI could visualize the thin inhomogeneous cartilage with irregular surface. The combination of SE (TR 400 ms/TE 19 ms) and FLASH (TR 320 ms/TE 15 ms FA 90deg) are extremely effective pulse sequence to detect the abnormalities of patellar articular cartilage. We conclude that MRI is a useful noninvasive method of detecting advanced changes in patellar articular cartilage. (author)

  12. MRI evaluation of the patellar articular cartilage in patients with subluxation of the patella

    Energy Technology Data Exchange (ETDEWEB)

    Nakanishi, Katsuyuki; Inoue, Masahiro; Harada, Koushi; Murakami, Takamichi; Kim, Shougen; Fujita, Norihiko; Sakurai, Kousuke; Kozuka, Takahiro (Osaka Univ. (Japan). Faculty of Medicine)

    1991-04-01

    In patients with subluxation of the patella, injury of the patellar articular cartilage is frequently observed and correct evaluation is important to manage these patients. We examined 11 patients with subluxation of the patella and five normal volunteers. In 12 patellofemoral joints of seven patients with subluxation of the patella, the abnormalities observed on MRI were compared with those on arthroscopy and/or at operation. MRI was performed with a Magnetom 1.5 T (Siemens) using the round surface coil. Pulse sequences were SE (TR 400 ms/TE 19 ms), FLASH(TR 320 ms/TE 15 ms FA 90deg and 40deg), and SE (TR 2000 ms/TE 26, 70 ms). We analysed MR findings of the 12 abnormal joints and 10 normal joints according to the following classification of abnormalities observed on arthroscopy; normal appearance (n=3 joints), softening and fibrillation (n=6), fragmentation (n=3), and erosion to bone (n=0). In only one of the six cases with softening and fibrillation observed on arthroscopy, MRI could visualize the thickening of patellar articular cartilage, but in all three cases with fragmentation observed on arthroscopy, MRI could visualize the thin inhomogeneous cartilage with irregular surface. The combination of SE (TR 400 ms/TE 19 ms) and FLASH (TR 320 ms/TE 15 ms FA 90deg) are extremely effective pulse sequence to detect the abnormalities of patellar articular cartilage. We conclude that MRI is a useful noninvasive method of detecting advanced changes in patellar articular cartilage. (author).

  13. Ectopic bone formation in bone marrow stem cell seeded calcium phosphate scaffolds as compared to autograft and (cell seeded allograft

    Directory of Open Access Journals (Sweden)

    J O Eniwumide

    2007-08-01

    Full Text Available Improvements to current therapeutic strategies are needed for the treatment of skeletal defects. Bone tissue engineering offers potential advantages to these st