We found an increased natural expression of the growth factors bFGF, BMP-12, VEGF, and TGF-b1 during tendon healing of rat Achilles tendons. External application of these growth factors improved the tendons failure load in the early healing phase. Tendon ruptures recover slowly and the healing of injuries can be devastating. Growth factors are known to influence tendon healing. However, only little is understood about growth factors in a healing tendon. Aim of this study was to investigate the influence of growth factors on tendon healing of rats following their natural expression.Summary
Introduction
A review of the literature showed a discrepancy between biomechanical and clinical studies on fracture fixation failure in patients with poor bone quality. The objective of the present study is to assess the influence of local bone status on complications after surgical treatment of proximal humerus fractures. A prospective cohort study was initiated in 2007. The inclusion criteria were closed displaced fractures of the proximal humerus, primary fracture treatment with a Philos plate, patients aged 50 to 90, normal pre-trauma function of both shoulders in accordance to age, and monotrauma. There was active follow-up for one year with radiological assessment at clinical centers from four countries. Bone quality at the proximal humerus was determined preoperatively for the contralateral side of the fracture by CT scan, and at the contralateral radius within six weeks post-surgery by DXA. The occurrence of complications was monitored up to one year post-surgery. Independent x-ray evaluation and final classification of all complications will be performed at the end by a study review board using anonymous data and x-rays.Introduction
Methods
We examined 52 patients with acute Achilles tendon rupture (ATR), 43 men and 9 women, with a median age of 43 (28–68) years after percutaneous Achilles tendon repair with early functional therapy. 11 patients were treated in a cast (C) and 41 had a specially designed shoed (S). The mean follow-up was 56 (36–95) months. Patients suffering from health problems, which could affect their gait and balance (e.g. OA, spinal stenosis,…), as well as patients suffering from complications postoperatively, were excluded from the study. The mean Hannover Achilles Tendon Score was 81 (50 – 95) points (C = 81, S = 81). Their calf muscle function studied three to eight years after treatment were found to have a significantly impaired dynamic muscle function of the calf muscles when tested in a specially constructed heel-raise test device. The Wilcoxon matched-pairs signed-ranks test showed a two-tailed P value of <
0,0001. The average calf size was 38 (31–46,5) cm on the uninjured side and 36 (32–44,5) cm on the injured side. Only two patients had an equal calf size. Comparing the uninjured and injured side the two-tailed P value was found to be extremely significant <
0,0001. The correlation between the maximum force and functional heel raise testing to the calf size on the injured side was weak with a Spearman correlation coefficient (r) = 0,33–38. There was no difference found between the patients treated in a cast and the patients treated in a shoe with percutaneous Achilles tendon repair and early functional therapy. The principle finding in the present study was that the impact of an ATR is of great importance for the functional outcome than the treatment that is given. The difference in flexion strength and endurance between the injured and the uninjured side remained even after a 56 months follow-up. Therefore, calf size and functional muscle testing is a good tool to test functional outcome after Achilles tendon rupture. However, there was only a weak correlation between the size of atrophy and the amount of force reduction.
