Poor tendon repair is an unsolved issue in clinical practice, due to complex tendon structure. Tendon stem/progenitor cells (TSPCs) play key roles in homeostasis, regeneration, and inflammation regulation in acute tendon injuries, and rely on TGF-β signaling for recruitment into degenerative tendons. In this study, we aimed to develop an in vitro model for tenogenesis adopting a dynamic culture of a fibrin 3D scaffold, bioengineered with human TSPCs collected from both healthy and tendinopathic surgery explants (Review Board prot./SCCE n.151, 29 October 2020). 3D culture was maintained for 21 days under perfusion provided by a custom-made bioreactor, in a medium supplemented with hTGF-β1 at 20 ng/mL. The data collected suggested that the 3D in vitro model well supported survival of both pathological and healthy cells, and that hTGF-β signaling, coupled to a dynamic environment, promoted differentiation events. However, pathological hTSPCs showed a different expression pattern of tendon-related genes throughout the culture and an impaired balance of pro-inflammatory and anti-inflammatory cytokines, compared to healthy hTSPCs, as indicated by qRT-PCT and immunofluorescence analyses. Additionally, the expression of both tenogenic and cytokine genes in hTSPCs was influenced by hTGF-β1, indicating that the environment assembled was suitable for studying tendon stem cells differentiation. The study offers insights into the use of 3D cultures of hTSPCs as an in vitro model for investigating their behavior during tenogenic events and opens perspectives for following the potential impact on resident stem cells during regeneration and healing events.
We hypothesised that a minimally invasive peroneus
brevis tendon transfer would be effective for the management of
a chronic rupture of the Achilles tendon. In 17 patients (three
women, 14 men) who underwent minimally invasive transfer and tenodesis
of the peroneus brevis to the calcaneum, at a mean follow-up of
4.6 years (2 to 7) the modified Achilles tendon total rupture score
(ATRS) was recorded and the maximum circumference of the calf of
the operated and contralateral limbs was measured. The strength
of isometric plantar flexion of the gastrocsoleus complex and of
eversion of the ankle were measured bilaterally. Functional outcomes
were classified according to the four-point Boyden scale. At the latest review, the mean maximum circumference of the calf
of the operated limb was not significantly different from the pre-operative
mean value, (41.4 cm, 32 to 50 This procedure may be safely performed, is minimally invasive,
and allows most patients to return to pre-injury sport and daily
activities. Cite this article:
This is a prospective analysis on 30 physically
active individuals with a mean age of 48.9 years (35 to 64) with chronic
insertional tendinopathy of the tendo Achillis. Using a transverse
incision, the tendon was debrided and an osteotomy of the posterosuperior
corner of the calcaneus was performed in all patients. At a minimum
post-operative follow-up of three years, the Victorian Institute
of Sports Assessment scale – Achilles tendon scores were significantly
improved compared to the baseline status. In two patients a superficial
infection of the wound developed which resolved on antibiotics.
There were no other wound complications, no nerve related complications,
and no secondary avulsions of the tendo Achillis. In all, 26 patients
had returned to their pre-injury level of activity and the remaining
four modified their sporting activity. At the last appointment,
the mean pain threshold and the mean post-operative tenderness were
also significantly improved from the baseline (p <
0.001). In patients
with insertional tendo Achillis a transverse incision allows a wide
exposure and adequate debridement of the tendo Achillis insertion,
less soft-tissue injury from aggressive retraction and a safe osteotomy
of the posterosuperior corner of the calcaneum.
Postoperative complications, pain (visual analogue scale), clinical and functional outcome based on DASH score, grip strength, X-ray evaluation, time to return to work and activity level were evaluated and compared at 3, 6 and 12 months of prospective follow-up.
Thirty-eight patients were treated with scaphoid excision and 4-corner fusion using dorsal circular plate. Thirty-nine patients were treated with total wrist fusion using one single, dorsal, precontoured and tapered plate for osteosynthesis and third carpometacarpal joint (CMCJ-3) was included. All patients were immobilised in a cast for 4 weeks after surgery. Postoperative complications, pain (visual analogue scale), clinical and functional outcome based on Green and O’Brien score, grip strength, X-ray evaluation, time to return to work and activity level were evaluated and compared.
The average time to return to work was 17 weeks (4-corner) and 16,2 weeks (total fusion). All patients return to work. Twelve percent of four-corner fusion and 72% of total wrist fusion return to the same work level with restrictions (until 33% of activity). Twenty-two percent of 4-corner fusion and 28% of total wrist fusion were unable to return to their previous activity level, performing lower intensity work activities. Overall satisfaction was high in both groups with 85% (4corner) and 93% (total fusion).
Total wrist fusion had less surgical failures, better level of satisfaction, lesser lost of force than 4-corner fusion, with less potential for further deterioration with time. However, 4-corner fusion allows return to work with a similar activity level and preserve a functional range of motion in patients with high levels of activity.
Although modern operative intervention for calcaneal fractures has improved the outcome in many patients, there still is no real consensus on treatment, operative technique, or postoperative management. Vira® is a system for reconstruction-arthrodesis of severe calcaneal fractures, consisting in m The aim of our study was to elaborate a CPG to assist physiotherapists in decision making and to improve the efficacy and uniformity of care for patients with severe calcaneal fractures. The CPG was developed according to international methods of guideline development. To identify “best evidence” a structured search was performed. When no evidence was available, consensus between experts (physiotherapist and orthopaedic surgeons) was achieved to develop the guideline. To identify “best clinical experience” and “physiopathology reasoning” focus group of practicing physiotherapists was used. They reviewed the clinical applicability and feasibility of the guideline, and their comments were used to improve it. CPG include three phases determined from the physiopathology and biomechanical reasoning of surgical system (weeks after the surgery: 2a–5a, 5a–14a, 14a–+/−24a). Unfortunately, evidence related to the treatment of severe calcaneal fracture was sparse and often of poor methodologic quality. The recommendations that were included: early onset (2a week after the surgery) with early mobility and loading, program of home exercises, manual therapy (articular and miofascial techniques), walking in swimming pool, continuous electromagnetic fields of 99Hz with an intensity of 99 Gaussian during 30 min/day; electrotherapy of the intrinsic muscles of the feet (80Hz; 8:12, 20 mi), a program of active exercises of the feet (dorsiflexion and plantarflexion, not supination and pronation) and resistive exercises of triceps surae muscle (7a week), criotherapy and anti-inflammatory positions.
The hallux rigidus, first described by Nicoladoni in 1881 (1), is the painful and decreased motion, especially dorsiflexion at the metatarsophalangeal joint, of the great toe. The purposes of this report were to evaluate the mid-term results of the Sliding osteotomy technique(2,3,4). Thirty nine (46 feet) consecutive patients (mean age 38 years) with hallux rigidus of I and II grade were followed over a five-year period. All patients were evaluated clinically and radiographically preoperatively and post operatively. At the time of final follow-up, the mean AOFAS score was significantly improved: excellent 26 (56,5%); good 12 (26%); fair 6 (13%); poor 2 (4,5%). This clinical review suggest that this procedure as a safe, effective measure to treat in patients with hallux rigidus of I and II grade.
Pain, mobility and radiograhs were evaluated and also strength (isokinetics), functionality (DASH score) and, finally, the return to work at 3, 6 and 12 months.
The patients were assessed clinically (modified Mayo wrist score) and radiograhically. The grip and pinch strength were also studied.