Aims.
Aims. Acquired heterotopic ossification (HO) is a debilitating disease characterized by abnormal extraskeletal bone formation within soft-tissues after injury. The exact pathogenesis of HO remains unknown. It was reported that BRD4 may contribute to osteoblastic differentiation. The current study aims to determine the role of BRD4 in the pathogenesis of HO and whether it could be a potential target for HO therapy. Methods.
While controversy remains as to the relative benefit of operative (OM) versus non-operative management (NOM) of Achilles tendon ruptures (ATR), few studies have examined the effect on high impact maneuvers such as jumping and hopping. The purpose of this study is to compare functional performance and musculotendinous morphology in patients following OM or NOM for acute ATR. Eligible patients were aged 18-65 years old with an ATR who underwent OM or NOM within three weeks of injury and were at least one-year post injury. Gastrocnemius muscle thickness and
Tendon is a bradytrophic and hypovascular tissue, hence, healing remains a major challenge. The molecular key events involved in successful repair have to be unravelled to develop novel strategies that reduce the risk of unfavourable outcomes such as non-healing, adhesion formation, and scarring. This review will consider the diverse pathophysiological features of tendon-derived cells that lead to failed healing, including misrouted differentiation (e.g. de- or transdifferentiation) and premature cell senescence, as well as the loss of functional progenitors. Many of these features can be attributed to disturbed cell-extracellular matrix (ECM) or unbalanced soluble mediators involving not only resident tendon cells, but also the cross-talk with immigrating immune cell populations. Unrestrained post-traumatic inflammation could hinder successful healing. Pro-angiogenic mediators trigger hypervascularization and lead to persistence of an immature repair tissue, which does not provide sufficient mechano-competence. Tendon repair tissue needs to achieve an ECM composition, structure, strength, and stiffness that resembles the undamaged highly hierarchically ordered tendon ECM. Adequate mechano-sensation and -transduction by tendon cells orchestrate ECM synthesis, stabilization by cross-linking, and remodelling as a prerequisite for the adaptation to the increased mechanical challenges during healing. Lastly, this review will discuss, from the cell biological point of view, possible optimization strategies for augmenting
Objectives. Inflammation of the retrocalcaneal bursa (RB) is a common clinical problem, particularly in professional athletes. RB inflammation is often treated with corticosteroid injections however a number of reports suggest an increased risk of
Aims. This prospective cohort study aims to determine if the size of
the tendon gap following acute rupture of the
Introduction and Objective.
Objectives. The aim of this study was to investigate the effect of hyperglycaemia on oxidative stress markers and inflammatory and matrix gene expression within tendons of normal and diabetic rats and to give insights into the processes involved in tendinopathy. Methods. Using tenocytes from normal Sprague-Dawley rats, cultured both in control and high glucose conditions, reactive oxygen species (ROS) production, cell proliferation, messenger RNA (mRNA) expression of NADPH oxidase (NOX) 1 and 4, interleukin-6 (IL-6), matrix metalloproteinase (MMP)-2, tissue inhibitors of matrix metalloproteinase (TIMP)-1 and -2 and type I and III collagens were determined after 48 and 72 hours in vitro. In an in vivo study, using diabetic rats and controls, NOX1 and 4 expressions in
Aims. The gold standard for percutaneous
Aim. Our collaborative study aims to demonstrate that acute partial
Insertional Achilles tendinitis with considerable degeneration that failed non-operative treatment typically requires tendon debridement and reattachment to bone. It is common practice for tendons to be reattached back with anchor sutures, but this poses a challenge to patients who are not able to afford them. Bony anchorage of tendons may be performed by passing sutures through tunnels, but the strength of repair compared to by using anchors is not known. We investigated the load at clinical and catastrophic failure of these two methods of reattachment. Sixteen paired
A total of seven patients (six men and one woman)
with a defect in the
We hypothesised that a minimally invasive peroneus
brevis tendon transfer would be effective for the management of
a chronic rupture of the
Aims. Our aim was to describe the mid-term appearances of the repair
process of the
The incidence of rupture of an
Tendon pathologies represent an unresolved clinical challenge where the patients suffer from pain and impaired mobility. One of the most frequently ruptured tendons is the
Objectives. The goals of this study were: 1) to determine if high-fat diet
(HFD) feeding in female mice would negatively impact biomechanical
and histologic consequences on the
Introduction: Tendon lengthening is an important cause of morbidity after Achilles tendon rupture. However, direct measurement of the tendon length is difficult. Ankle dorsiflexion has therefore been used as a surrogate measure, on the assumption that it is the
Early identification of patients at risk for impaired tendon healing and corresponding novel therapeutic approaches are urgent medical needs. This study aimed to clarify the role of CD3+ T-cells during acute
Objectives. After an injury, the biological reattachment of tendon to bone is a challenge because healing takes place between a soft (tendon) and a hard (bone) tissue. Even after healing, the transition zone in the enthesis is not completely regenerated, making it susceptible to re-injury. In this study, we aimed to regenerate
Summary Statement. Subject specific FE models of human
Surgical treatment of recurrent dislocation after total hip arthroplasty (THA) is challenging with often disappointing results. The influence of the posterior hip capsule is important, and restoration of its function is a major goal of treatment. We describe our experience using an
Introduction. Growing evidence in the literature suggests better clinical and functional outcomes and lower re-rupture rates with repair compared to non-operative treatment of ruptured
Tendon healing is a complex process that often results in compromised healing of the tendon tissue. It has recently been shown that temporal changes in the expression profile and the histological tissue quality of the tendons occur during the early healing process after acute Achilles tendon rupture. Whether these changes are accompanied by an altered healing process, is not yet known and was the aim of the present study. Tendon biopsies were obtained from 24 patients with acute Achilles tendon rupture at the time of surgery (2–9 days after rupture) and examined histologically as well as on RNA level. Histologically, the tendon architecture, the amount of aligned collagen, glycosaminoglycan and fat as well as the cellularity, vascularity and immune cell infiltration were determined. On RNA level the expression of markers for the modeling/remodeling (MMPs and TIMPs), collagens (1, 3, 5), tendon markers (scleraxis, tenomodulin), pro- and anti-inflammatory markers (IL-1beta, IL6, IL10, IL33, TNFa, TGF-beta1, COX2) and immune cell markers (CD3, CD68, CD80, CD206) were analyzed by Real-Time PCR. To determine the clinical outcome, the patients were followed up 12 months after the operation and the following scores were recorded: Subjective score, Tegner score, Visual Analog Scale (VAS) pain, VAS function, Matles Test,
Achilles tendon rupture may lead to significant functional deficits, which mechanisms are poorly understood. The primary aim was to investigate if the
Achilles tendinitis can result, through inflammatory procedures, to tendon degeneration with microtears and nodules. Current conservative or surgical treatment of this lesion proved to be not effective enough. The reason for this is the absence of sufficient oxygenation in the area. In this study we report the results of a novel technique which tries to improve local vascularity. We operated on 15 mature rabbits after they were anasthetized. Soleus fibers were trasplanted in the right
Introduction:. The insertion footprint of the different muscles tendon fascicles of the
Introduction and Objectives: Acute ruptures of the
Background. Recent meta-analyses have shown reduced re-rupture rates for the surgical management of Achilles ruptures. However percutaneous repair has been demonstrated to lead to improved function, patient satisfaction but greater complications than open repair. In the current economic climate, we believe it is reasonable to consider the financial cost of rupture management for both the patient and the provider. We aimed to determine the cost effectiveness of operative treatment of ruptures of the
The
Introduction: The acute rupture of
Thirteen patients with ruptures of the
Introduction: Neglected Achilles tendon ruptures are a management challenge. Several surgical techniques have been described. A two centre, two surgeon, two year longitudinal study was undertaken to report the results of reconstruction of neglected Achilles tendon rupture using a free autologous gracilis tendon graft. Methods: Fourteen patients underwent surgery for a neglected rupture of the
Introduction: As Achilles tendon ruptures are healing slowly, many attempts are made trying to improve the healing after injury. Rat experiments have shown that injection of platelets improves tendon healing. A clinical study on patients has also shown a better outcome after injecting platelets into the rupture area. Therefore we wanted to verify the effect of platelets by measuring the mechanical properties of the healing
Introduction. Exercise increases tendon collagen synthesis and cross-link formation. Exercise also increases the expression of TGF-β. 1. TGF-β. 1. may contribute to the upregulation of tendon collagen synthesis during exercise, but this relationship has not been established in vivo. The purpose of this study was to evaluate the effects of TGF-β. 1. receptor inhibition on tendon collagen. Materials and Methods. Male Wistar rats were divided into sedentary (SED, n = 9) or exercised (RUN, n=15) groups. Exercised animals completed four days of treadmill exercise (60 minutes/days). The peritendinous space of one
Background: The
Introduction. The dichotomy between surgical repair and conservative management of acute Achilles tendon ruptures has been eliminated through appropriate functional management. The orthoses used within functional management however, remains variable. Functional treatment works on the premise that the ankle/hindfoot is positioned in sufficient equinus to allow for early weight-bearing on a ‘shortened’
Introduction and purpose:
Purpose of the study: Wounds of the
Complete rupture of the
Hip arthroscopy rates continue to increase. As a result, there is growing interest in capsular management techniques. Without careful preservation and surgical techniques, failure of the repair result in capsular deficiency, contributing to iatrogenic instability and persistent post-operative pain. In this setting, capsular reconstruction may be indicated, however there is a paucity of objective evidence comparing surgical techniques to identify the optimal method. Therefore, the objective of this study was to evaluate the biomechanical effect of capsulectomy and two different capsular reconstruction techniques (iliotibial band [ITB] autograft and
Tendon disease causes widespread morbidity ranging from mild pain to catastrophic end-stage rupture. The pathophysiology of tendon disease is not certain. An overuse exercise model was developed using rats with the aim of developing tissue with histological, biochemical and biomechanical features similar to those in human tendinosis. Results indicate that the biological response to over-exercise of the rat
Percutaneous repair of a ruptured
Percutaneous repair of a ruptured
Estrogen fluctuations have been implicated in the soft tissue injury gender-bias due to the hormones effect on the viscoelastic properties. The isolated effect of estrogen on the mechanical behaviour of human tendon is unknown. The purpose of this study was to elucidate the effect of circulating levels of estrogen on the strain properties of the human
Background: The
We have reviewed 106 patients after treatment for spontaneous rupture of the
The
Objective: Bone-patellar tendon-bone (BPTB) and
Introduction: We studied prospectively two groups of patients treated operatively for acute achilles tendon rupture admitted in our institution in order to compare post operative morbidity, usage of hospital resources and immobilisation regimen involving immediate weight-bearing with traditional non-weight-bearing. The aim was to assess the benefit of instrument guided surgical method, which reduces hospitalisation cost, post operative wound care cost and reduce requirement of post-operative analgesics together with improved rehabilitation and return to normal activity for young patients [age below 45] with a rupture of the
Background: Abductor failure after total hip arthroplasty is a rare but debilitating problem. The diagnosis is difficult, and when recognized, there are few successful treatment options. The purpose of this study is to review our experience with a new surgical technique using fresh-frozen
Introduction. Traditionally Plantaris has been considered of little clinical importance and absent in 8–20% of the population. Recent evidence indicates that it is present in 98–100% of the population and that it may have a contributing role in Achilles tendinopathy due to its close anatomical relationship. The aim of this study was to establish whether Plantaris was present in a sample of cadaveric limbs, to establish its position in relation to the
To evaluate the clinical outcome of arthroscopic treatment of ACL with an
Introduction: The treatment of the recently ruptured
Spastic muscles show permanent contraction but also paradoxical muscular weakness. Compartmental muscular pressure in normal subjects oscillates between 0 and 5 mmHg. To study compartmental pressure in the posterior superficial compartment of the leg in children with spastic paralysis, to identify its variations after a percutaneous tenotomy of the
Functional Ultrasound Elastography (FUSE) of Tendo Achilles is an ultrasound technique utilising controlled, measurable movement of the foot to non-invasively evaluate TA elastic and load-deformation properties. The study purpose is to assess
Acute
Aims. Flexor hallucis longus (FHL) tendon transfer is a well-recognized
technique in the treatment of the neglected tendo Achillis (TA)
rupture. Patients and Methods. We report a retrospective review of 20/32 patients who had undergone
transtendinous FHL transfer between 2003 and 2011 for chronic TA
rupture. Their mean age at the time of surgery was 53 years (22
to 83). The mean time from rupture to surgery was seven months (1
to 36). The mean postoperative follow-up was 73 months (29 to 120).
Six patients experienced postoperative wound complications. Results. The mean postoperative
Purpose. Functional ultrasound Elastography (FUSE) of Tendo Achilles is an ultrasound technique utilising controlled, measurable movement of the foot to non-invasively evaluate TA elastic and load-deformation properties. The study purpose is to assess
The microvascular anatomy of the
Tendinosis is a common problem causing wide spread morbidity ranging from mild symptoms of pain and limited mobility to catastrophic end stage rupture. The structural and mechanical properties of the rat
Achilles tendinopathy is a common cause of disability. Despite the economic and social relevance of the problem, the causes and mechanisms of Achilles tendinopathy remain unclear. Tendon vascularity, gastrocnemius-soleus dysfunction, age, gender, body weight and height, pes cavus, and lateral ankle instability are considered common intrinsic factors. The essence of Achilles tendinopathy is a failed healing response, with haphazard proliferation of tenocytes, some evidence of degeneration in tendon cells and disruption of collagen fibres, and subsequent increase in non-collagenous matrix. Tendinopathic tendons have an increased rate of matrix remodelling, leading to a mechanically less stable tendon which is more susceptible to damage. The diagnosis of Achilles tendinopathy is mainly based on a careful history and detailed clinical examination. The latter remains the best diagnostic tool. Over the past few years, various new therapeutic options have been proposed for the management of Achilles tendinopathy. Despite the morbidity associated with Achilles tendinopathy, many of the therapeutic options described and in common use are far from scientifically based. New minimally invasive techniques of stripping of neovessels from the Kager's triangle of the tendo Achillis have been described, and seem to allow faster recovery and accelerated return to sports, rather than open surgery. A genetic component has been implicated in tendinopathies of the
Acute
The best management for acute rupture of the
We report the use of a simple new technique for the repair of recent and old, neglected disruptions of the
We performed two independent randomised controlled trials to assess the potential benefits of immediate weight-bearing mobilisation for Achilles tendon ruptures. The first trial on surgically treated patients provides strong evidence of improved functional outcome for patients mobilised fully weight-bearing after operative repair of their Achilles tendon rupture. The two cases of re-rupture in the treatment group suggest that careful patient selection may be required as patients need to follow a structured rehabilitation regime. The second trial performed upon non-operatively treated patients provides only weak evidence of a functional benefit from immediate weight-bearing mobilisation. However, the practical advantages of immediate weight-bearing did not predispose the patients to a higher complication rate. In particular there was no evidence of tendon lengthening or a higher re-rupture rate. We would therefore advocate the use of immediate weight-bearing mobilisation for the rehabilitation of all patients with rupture of the
Purpose of the study: The aim of this work was to compare the long-term clinical, ultrasonographic and iso-kinetic results obtained with two approaches to repair of the torn
A new method of repair of the
Purpose: Percutaneous suture of the
Summary. Silver nanoparticles improve the tensile property of the repaired
Ruptures of the
Purpose: Purpose of that paper is the presentation of our experience and the evaluation of the results we had, using our method in the treatment of acute raptures of the
Introduction: Calcaneal lengthening osteotomy as a treatment for severe flat foot was described by Evans (1975) and his indications were expanded by Mosca (1995). Materials and methods: We reviewed 28 feet operated on in 21 patients with neuromuscular processes (17) and with flat foot-valgus associated with congenital short
Using a comparative, longitudinal study design, we studied the effects of early weight bearing and ankle mobilisation following acute repair of ruptured
Thirty-three consecutive patients with complete ruptures of the
We have studied the use of filamentous polyglycolic acid (Dexon) for the induction of neotendon in the
Treatment of chronic Achilles tendon ruptures can be technically demanding due to tendon retraction, atrophy and short distal stumps. Although rare, re-rupture following surgical treatment is a major late complication. Biomechanical studies on the strength of reconstructed
The current standard of care in Calgary, Alberta for management of a ruptured
The aim of this study was to test the efficacy of shock-wave therapy for chronic Achilles pain. Forty-nine patients with
The percutanous repair of the
Magnetic resonance imaging was performed on 28 patients with suspected
We describe a new method for reconstructing the patellar tendon following combined injury to the patellar tendon and anterior cruciate ligament (ACL). Combined injuries to the patellar tendon and the ACL represent a rare and potentially serious injury pattern. The injury to the patellar tendon can often go undiagnosed at primary presentation. Reconstructive options for the patellar tendon are described but can be technically difficult, particularly if ipsilateral hamstring has been used for anterior cruciate ligament reconstruction. Evidence suggests combined injuries generally lead to poor long term outcome. We describe a case of a 26 year old male who presented with a reconstructed ACL and a patellar tendon deficient knee. Diagnosis was confirmed on Magnetic Resonance Imaging (MRI). Ipsilateral hamstrings had been used as donor for ACL reconstruction. An
This is the largest detailed study of conservative management of Achilles tendon rupture in the literature to date. We assessed 140 subjects who had a complete rupture of their
1. This case is presented to illustrate two etiological factors in tendon rupture occurring in one patient. 2. The rupture of the long head of the biceps brachii muscle appears to have been of acute traumatic origin. 3. Bilateral simultaneous rupture of the
This study aims to evaluate the functional outcomes of early weight-bearing in a functional orthosis for conservatively managed, complete AT ruptures. Also we tried to evaluate the patient reported outcome with this form of treatment. In this prospective study, we have analysed data from 41 patients with ultrasound diagnosed compete AT ruptures, with a gap of less than 5 cm. Every patient was treated in a functional weight-bearing orthosis (VACOped®) for 8 weeks with early weight-bearing following a specific treatment protocol, followed by rehabilitation with a trained physiotherapist.Abstract
Objectives
Design
Purpose: This work revealed the advantages of percutaneous suture of the
Introduction: Treatment for ruptured
Achilles Tendon lengthening was carried out on six patients for the treatment of long standing neuropathic plantar ulcers in the diabetic foot. The results were reviewed after an average of 13 months. Alteration in gait pattern, mobility &
resolution of ulcers were assessed. At the time of review, all patients showed complete ulcer healing, none reported any difficulty in mobilisation, despite off loading of the forefoot in each case.
For equinus deformity in spastic hemiplegia, correction by the White slide technique has been studied in a group of 35 patients followed up for 14 to 20 years. It is a simple, effective method of lengthening the
Introduction: Percutaneous repairs of Achilles tendon ruptures has gained popularity due the reduced incidence of wound complications, however its use is still limited by the high incidence of sural nerve injuries associated with these repairs. The only technique described to avoid this adverse event is to surgically expose the nerve peri – operatively. Materials &
Methods: In our study we describe and validate a clinical technique to identify the sural nerve. The technique describes flexing the knee to 90°, and supinating the forefoot and inverted the hindfoot. The sural nerve is at its greatest tension in this position and thus the nerve can be palpated along its path. The sural nerve was mapped using this technique both clinically and by US in a cohort of male subjects with intact
Introduction In this institution a structured program of conservative management of Achilles tendon rupture has been developed combining a conservative and orthotic treatment regime with a view to adding the advantages of a removable orthosis to traditional non-operative therapy. This study compares the results of this protocol to published surgical results. This is the largest detailed study of conservative management of Achilles tendon rupture in the literature to date. Methods We assessed 140 subjects who had a complete rupture of their
Purpose: Orthopaedic treatment of
Purpose: Several techniques have been described for tenotomy of the
Introduction. Tendon cross-sectional area (CSA) and stiffness increase in men during chronic exercise. The increase in tendon CSA and stiffness is not evident in women. In men, exercise increases tendon production of MMPs, IGF-1, and IL-6, which presumably contribute to tendon remodeling during chronic exercise. The purpose of this study was to determine if exercise-induced production of MMPs, IGF-1, and IL-6 are limited in women when compared to men. Materials and Methods. Young men (n=9, 27±1 y) and women (n=8, 26±1 y) performed a single bout of calf press exercise (8 sets of 15 repetitions at 70% of 15-RM). A microdialysis fiber (3000 kDa cut-off) was inserted into the space anterior to the
Irreparable tendon ruptures constitute a grave clinical problem. Especially for large rotator cuff tears, there often is no primary causal therapy available. As a sad result, the development of a rotator cuff tear arthropathy is more often than not inevitable. Our study investigates the effects of scaffold based tendon regeneration with special focus on mesenchymal stem cells in a rat model. We used ‘native’ bone marrow stromal cells and cultivated mesenchymal stem cells from male rats that were implanted into female rats. As scaffolds polyglycol acid (PGA) and a collagen I were used. A full-thickness-defect of 2–3 mm in the middle third of the rats
BACKGROUND and AIM: There is no consensus on the best treatment for acute Achilles tendon ruptures. There is no single, uniformly accepted surgical technique, and the surgical options include open repair with or without augmentation and percutaneous techniques. A retrospective analysis was conducted to compare different surgical procedures for the treatment of the rupture of the
In order to regain preinjury activities following an Achilles tendon rupture while reducing the potential complications of open surgery and non-operative treatment, we developed a new protocol that involved the use of a modified local anaesthetic technique, percutaneous repair and early function. We prospectively treated 32 patients with acute Achilles tendon ruptures according to our protocol with a 12 month minimal follow-up. Surgery was performed on an outpatient basis and within 48 hours from rupture for all cases. Our local anaesthetic technique allowed us to have a comprehensive control over sural nerve location by the definition of a “safe area” (video will be shown) and has proved to be effective to avoid sural nerve damage during surgery. The 28 male and 4 female patients had a mean age of 35 years (range, 26 to 47 years). The percutaneous repair was performed with a #2 nonabsorbable monofilament. Patients began range-of-motion exercise at 48 hours, used a posterior splint for 2 weeks, and then began ambulation with crutches and a 2 cm heel wedge incorporated on sport shoes or alternatively country boots. At 5 weeks, the wedge shoe was discontinued, full weight-bearing was allowed, and progressive resistive exercises were initiated. There were no reruptures, wound infections, sural nerve damage, recurrent pain, or skin necrosis in our group of patients. One patient (with an hemathological disorder) developed a deep venous thrombosis that resolved uneventfully. Mean AOFAS score was 80 at 6 months and reached 98 at 12 months. High-demand patients (police officer, firemen, athletes, professional soccer player) returned to their activities by 5–6 months. Patients were very satisfied with the procedure and subjetive evaluation turned to be very good or excellent for all cases.
Purpose. Platelet-Rich Plasma (PRP), an autologous derivative of whole blood that contains a supraphysiological concentration of platelets and growth factors. Most published studies have investigated the effect of PRP-conditioned media on cell cultures. We are not aware of any study that has investigated whole PRP with its cellular components on human tissue cultures. This study aims to investigate the effect of PRP on cell migration from human