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Sample records for achilles tendon rupture

  1. Achilles tendon rupture rehabilitation

    PubMed Central

    Kearney, R. S.; Parsons, N.; Underwood, M.; Costa, M. L.

    2015-01-01

    Objectives The evidence base to inform the management of Achilles tendon rupture is sparse. The objectives of this research were to establish what current practice is in the United Kingdom and explore clinicians’ views on proposed further research in this area. This study was registered with the ISRCTN (ISRCTN68273773) as part of a larger programme of research. Methods We report an online survey of current practice in the United Kingdom, approved by the British Orthopaedic Foot and Ankle Society and completed by 181 of its members. A total of ten of these respondents were invited for a subsequent one-to-one interview to explore clinician views on proposed further research in this area. Results The survey showed wide variations in practice, with patients being managed in plaster cast alone (13%), plaster cast followed by orthoses management (68%), and orthoses alone (19%). Within these categories, further variation existed regarding the individual rehabilitation facets, such as the length of time worn, the foot position within them and weight-bearing status. The subsequent interviews reflected this clinical uncertainty and the pressing need for definitive research. Conclusions The gap in evidence in this area has resulted in practice in the United Kingdom becoming varied and based on individual opinion. Future high-quality randomised trials on this subject are supported by the clinical community. Cite this article: Bone Joint Res 2015;4:65–9 PMID:25868938

  2. Spontaneous Achilles tendon rupture in alkaptonuria

    PubMed Central

    Alajoulin, Omar A.; Alsbou, Mohammed S.; Ja’afreh, Somayya O.; Kalbouneh, Heba M.

    2015-01-01

    Alkaptonuria (AKU) is a rare inborn metabolic disease characterized by accumulation of homogentisic acid (HGA). Excretion of HGA in urine causes darkening of urine and its deposition in connective tissues causes dark pigmentation (ochronosis), early degeneration of articular cartilage, weakening of the tendons, and subsequent rupture. In this case report, we present a rare case of a patient presented with unilateral spontaneous rupture of Achilles tendon due to AKU. The patient developed most of the orthopedic manifestations of the disease earlier than typical presentations. Alkaptonuria patients should avoid strenuous exercises and foot straining especially in patients developing early orthopedic manifestations. PMID:26620992

  3. [Tendinosis and ruptures of the Achilles tendon].

    PubMed

    Amlang, M H; Zwipp, H

    2012-02-01

    Tendinosis of the Achilles tendon is a degenerative-reparative structural change of the tendon with microdefects, increases in cross-section due to cicatricial tendon regeneration, neoangiogenesis and reduction of elasticity. The previously used term tendinitis is only rarely used for the chronic form since signs of inflammation such as redness and hyperthermia or elevated levels of inflammatory parameters on laboratory testing are generally absent. Duplex sonography with visualization of the neovascularization has become a valuable supplement not only for diagnostics but also for therapy planning. The classic, conservative therapy for painful tendinosis consists of oral anti-inflammatory drugs, pain-adapted load reduction, raising the heel, stretching the calf musculature, and various physiotherapeutic interventions. When conservative treatment over a period of 4 - 6 months fails to produce any or non-adequate pain relief, an indication for surgical treatment should be considered. In the therapy for fresh ruptures of the Achilles tendon further developments in minimally invasive techniques have led to a worldwide paradigm change over the past 10 years. The decisive advantage of minimally invasive surgical techniques is the lower risk of wound infection as compared to the sutures of the open technique. When compared with conservative functional therapy the minimally invasive repair has the advantage of being less dependent on the compliance of the patient since, in the early phase of tendon healing the suture prevents a separation of the tendon ends upon controlled movements. However, not every patient with a ruptured Achilles tendon should be treated with a minimally invasive repair. Open tendon reconstruction and functional conservative therapy are still justified when the correct indication is given. PMID:22344862

  4. Vascular changes in the ruptured Achilles tendon and paratenon.

    PubMed

    Kvist, M; Józsa, L; Järvinen, M

    1992-01-01

    Thirty patients with ruptures of the Achilles tendon were studied. There were 21 men and 9 women with an average age of 36 years. Specimens from the tendon and paratenon in 24 were examined histologically. Tissue samples of 20 were studied by electron microscopy. Marked degenerative, obliterative and/or inflammatory vascular changes were found in all the ruptured tendons and their paratenon. Our findings indicate that poor vascularity play a role in the aetiology of rupture of the Achilles tendon. PMID:1473893

  5. Endoscopic adhesiolysis for extensive tibialis posterior tendon and Achilles tendon adhesions following compound tendon rupture

    PubMed Central

    Lui, Tun Hing

    2013-01-01

    Tendon adhesion is one of the most common causes of disability following tendon surgery. A case of extensive peritendinous adhesions of the Achilles tendon and tibialis posterior tendon after compound rupture of the tendons was reported. This was managed by endoscopic adhesiolysis of both tendons. The endoscopic approach allows early postoperative mobilisation which can relieve the tendon adhesion. PMID:24045762

  6. Acute Bilateral Traumatic Achilles Tendon Rupture – A Rare Presentation

    PubMed Central

    Jhaveri, Maulik; Golwala, Paresh; Merh, Aditya; Patel, Amit

    2016-01-01

    The Achilles tendon is the strongest tendon in the body, which is commonly ruptured in male athletes. Bilateral rupture of the Achilles tendon is a rare condition with very few reported cases in the literature. It poses a challenge in management, and hence, we report a case with traumatic bilateral Achilles tendon rupture in a young male patient and its management. One side was treated conservatively as the rupture was partial and the other side, which had a complete tear, was operated. At nine months follow-up, the patient has had a satisfactory result and is now bearing full weight without any problems. We suggest this method of treatment to be worthwhile for this unusual entity. PMID:27588227

  7. New finding in the radiographic diagnosis of Achilles tendon rupture

    SciTech Connect

    Newmark, H.; Mellon, W.S. Jr.; Malhotra, A.K.; Olken, S.M.; Halls, J.

    1982-06-01

    The authors describe a new radiographic sign of rupture of the Achilles tendon system. It is a fracture, with separation through an osteophyte at the insertion of this tendon. Previously reported signs are also discussed as well as the present case report.

  8. Miniopen Repair of Ruptured Achilles Tendon in Diabetic Patients

    PubMed Central

    2014-01-01

    Background. Acute degenerative Achilles tendons ruptures may be managed either operatively or nonoperatively with the superiority of the operative treatment in reducing the risk of rerupture. Acute rupture of Achilles tendon is commonly seen in diabetic patients. Open techniques for Achilles tendon repair have been associated with significant complications as deep infection and wound-related problems. Patients and Methods. Thirteen type II diabetic patients with acute degenerative rupture of the Achilles tendon were managed by miniopen repair augmented by peroneus brevis tendon. Results. All repairs healed successfully. The patients were able to return to preinjury level of activity after a mean of 5 months. The mean ATRS score improved from 15.1 preoperatively to 74.8 postoperatively. The mean Leppilahti ankle score was 59.6. Three patients suffered from superficial wound infection which was successfully managed. However, no patients suffered any major complications such as DVT, deep infection, or reruptures during the period of the study. Conclusion. Repair of acute degenerative tear of the Achilles tendon with peroneus brevis tendon augmentation could be successfully performed through a miniopen technique with minimization of wound complications in diabetic patients. PMID:27437478

  9. [Comprehensive treatment in Achilles tendon rupture].

    PubMed

    Matus-Jiménez, Juan; Avalos, Cecilia Henríquez

    2007-01-01

    Due to incapacity caused by calcaneal tendon injuries for the reintegration of patients back to their daily activities and/or sparts it is necessary to decrease the time of reinstatement of patients. At present these times have improved by a good surgical technique and an early rehabilitation, and the patient is returned quickly as he sees less disability. It is proposed in this paper a type of surgical treatment and an early rehabilitation program, which have shortened the time of disability and incorporation to their daily activities and sports to eight weeks in 10 patients with Achilles tendon plasty. PMID:18159917

  10. A Rare Case of Simultaneous Acute Bilateral Quadriceps Tendon Rupture and Unilateral Achilles Tendon Rupture

    PubMed Central

    Leong, Wei Yee; Gheorghiu, Daniel; Rao, Janardhan

    2013-01-01

    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. PMID:27298913

  11. Bilateral rupture of the Achilles tendon in patients on steroid therapy.

    PubMed Central

    Haines, J F

    1983-01-01

    Three patients are presented who sustained bilateral rupture of the Achilles tendon while on systemic steroid therapy for chest disease; a fourth patient with polymyalgia rheumatica on steroids is also presented. This is further evidence that tendon rupture can be a direct complication of steroid treatment. The English-language literature on bilateral Achilles tendon rupture is reviewed. PMID:6651370

  12. Open re-rupture of the Achilles tendon after surgical treatment.

    PubMed

    Hanada, Mitsuru; Takahashi, Masaaki; Matsuyama, Yukihiro

    2011-09-28

    The rate of re-rupture of Achilles tendon after surgical treatment were reported to 1.7-5.6% previously. Re-rupture of Achilles tendon generally occurs subcutaneously. We experienced two rare cases of the open re-ruptures of Achilles tendon with a transverse wound perpendicular to the primary surgical incision. Re-rupture occurred 4 and 13 weeks after surgical treatment. We suggest that open re-rupture correlates more closely with skin scaring and shortening. Another factor may be adhesion between the subcutaneous scar and the suture of the paratenon and Achilles tendon with post-operative immobilization. PMID:24765375

  13. Open re-rupture of the Achilles tendon after surgical treatment

    PubMed Central

    Hanada, Mitsuru; Takahashi, Masaaki; Matsuyama, Yukihiro

    2011-01-01

    The rate of re-rupture of Achilles tendon after surgical treatment were reported to 1.7–5.6% previously. Re-rupture of Achilles tendon generally occurs subcutaneously. We experienced two rare cases of the open re-ruptures of Achilles tendon with a transverse wound perpendicular to the primary surgical incision. Re-rupture occurred 4 and 13 weeks after surgical treatment. We suggest that open re-rupture correlates more closely with skin scaring and shortening. Another factor may be adhesion between the subcutaneous scar and the suture of the paratenon and Achilles tendon with post-operative immobilization. PMID:24765375

  14. [Achilles tendon rupture : Current diagnostic and therapeutic standards].

    PubMed

    Hertel, G; Götz, J; Grifka, J; Willers, J

    2016-08-01

    A superior life expectancy and an increased activity in the population result in an increase in degenerative diseases, such as Achilles tendon ruptures. The medical history and physical examinations are the methods of choice to diagnose Achilles tendon ruptures. Ultrasound and radiography represent reasonable extended diagnostic procedures. In order to decide on the medical indications for the therapy concept, the advantages and disadvantages of conservative and surgical treatment options have to be weighed up on an indivdual basis. There are explicit contraindications for both treatment options. For the surgical treatment concept open suture techniques, minimally invasive methods and reconstructive procedures are available. The postoperative management of the patient is as important as the choice of surgical technique. With the correct medical indications and supervision of the patient it is possible to achieve extremely satisfying results for the patient with both conservative and surgical treatment options. PMID:27405457

  15. Endoscopic Achilles tenolysis for management of heel cord pain after repair of acute rupture of Achilles tendon.

    PubMed

    Lui, Tun Hing

    2013-01-01

    Tendon pain after repair of an acute Achilles tendon rupture can result from suture granuloma formation, modification of the threshold of the pain receptors inside the tendon by scar tissue, expansion of the paratenon by tendon enlargement with secondary stimulation of mechanoreceptors, or underlying tendon degeneration. In the present technique report, an endoscopic technique of Achilles tenolysis for denervation and debulking is described that might be applicable in cases in which conservative treatment fails to alleviate the pain. PMID:23085384

  16. An Alternative Bundle-to-Bundle Suturing Technique for Repairing Fresh Achilles Tendon Rupture.

    PubMed

    Zhao, Jingjing; Yu, Bin; Xie, Ming; Huang, Ruokun; Xiao, Kai

    2016-01-01

    The main concern about conventional Achilles tendon repair surgical techniques is how to maintain the initial strength of the ruptured Achilles tendon through complicated suturing methods. The primary surgical problem lies in the properties of the soft tissue; the deterioration of the Achilles tendon, especially in its elasticity; and the surface lubricity of the local tissues. In the present study, we describe an innovative bundle-to-bundle suturing method that addresses these potential problems. PMID:26970908

  17. Type 1 Achilles tendon rupture caused by grooming trauma in a young dog

    PubMed Central

    Isaka, M.; Befu, M.; Matsubara, N.; Ishikawa, M.; Aono, H.; Namba, S.

    2014-01-01

    Achilles tendon rupture is uncommon in small animal practice. A 9-month-old, female, mixed breed dog (weighing 2.2kg) was referred to our hospital with a primary complaint of right hind limb lameness. Complete right Achilles tendon rupture was diagnosed by physical examination and radiography. The tendon was surgically repaired the next day by using a three-loop and single near-far-far-near suture methods. Complete healing was achieved by 97 days post-surgery. This report describes the surgical technique used for complete Achilles tendon rupture repair in a young dog. PMID:26623339

  18. Practice Patterns in the Care of Acute Achilles Tendon Ruptures

    PubMed Central

    Sheth, Ujash; Wasserstein, David; Moineddin, Rahim; Jenkinson, Richard; Kreder, Hans; Jaglal, Susan

    2016-01-01

    Objectives: Over the last decade, there has been a growing body of level I evidence supporting non-operative management (focused on early range of motion and weight bearing) of acute Achilles tendon ruptures. Despite this emerging evidence, there have been very few studies evaluating its uptake. Our primary objective was to determine whether the findings from a landmark trial assessing the optimal management strategy for acute Achilles tendon ruptures influenced the practice patterns of orthopaedic surgeons in Ontario, Canada over a 12-year time period. As a second objective we examined whether patient and provider predictors of surgical repair utilization differed before and after dissemination of the landmark trial results. Methods: Using provincial health administrative databases, we identified Ontario residents ≥ 18 years of age with an acute Achilles tendon rupture from April 2002 to March 2014. The proportion of surgically repaired ruptures was calculated for each calendar quarter and year. A time series analysis using an interventional autoregressive integrated moving average (ARIMA) model was used to determine whether changes in the proportion of surgically repaired ruptures were chronologically related to the dissemination of results from a landmark trial by Willits et al. (first quarter, 2009). Spline regression was then used to independently identify critical time-points of change in the surgical repair rate to confirm our findings. A multivariate logistic regression model was used to assess for differences in patient (baseline demographics) and provider (hospital type) predictors of surgical repair utilization before and after the landmark trial. Results: In 2002, ˜19% of acute Achilles tendon ruptures in Ontario were surgically repaired, however, by 2014 only 6.5% were treated operatively. A statistically significant decrease in the rate of surgical repair (p < 0.001) was observed after the results from a landmark trial were presented at a major

  19. Traumatic bilateral Achilles tendon rupture in a young athlete treated with percutaneous tenorrhaphy

    PubMed Central

    MACERA, ARMANDO; CARULLI, CHRISTIAN; MATASSI, FABRIZIO; VENEZIANI, CARLO; INNOCENTI, MASSIMO

    2015-01-01

    While rupture of the Achilles tendon is one of the most frequent injuries sustained in sports and physical activity, bilateral Achilles tendon rupture is uncommon. We present the case of a 33-year-old man who sustained a bilateral Achilles tendon rupture in the absence of predisposing factors. The lesions were managed by percutaneous tenorrhaphy and casting. Six months after surgery he was able to return to his daily-life activities and to perform light sports activity. The Authors review the current literature on the management of this rare condition in young people, with or without risk factors. PMID:26904529

  20. Achilles tendon repair with acellular tissue graft augmentation in neglected ruptures.

    PubMed

    Lee, Daniel K

    2007-01-01

    Neglected Achilles tendon rupture injuries present surgical challenges because of the quality and quantity of tendon tissue during repair combined with the magnitude of mechanical forces placed on this tendon. The purpose of this study was to evaluate the effects of an acellular human dermal tissue matrix, GRAFTJACKET, as an augmentation material in neglected Achilles tendon repair. Nine patients with neglected Achilles tendon ruptures were evaluated and followed up for a minimum of 20 months. Primary repair was followed by augmentation with the graft and suturing circumferentially around the tendon. Patients were placed in an early, functional rehabilitation program with postoperative evaluation at 3, 6, and 12 months. Outcome scores were calculated based on the American Orthopaedic Foot and Ankle Society ankle-hindfoot scoring system. At 20 to 30 months postoperative follow-up range, there has been no incidence of re-rupture or recurrent pain. The average return-to-activity time was 15.2 +/- 1.7 weeks. The results from this retrospective clinical series suggest that using an acellular human dermal tissue matrix to augment neglected Achilles tendon rupture primary repair offers desirable return-to-activity time points and viable surgical alternative over previously reported surgical options. PMID:17980842

  1. Achilles tendon: US examination

    SciTech Connect

    Fornage, B.D.

    1986-06-01

    Real-time ultrasonography (US) using linear-array probes and a stand-off pad as a ''waterpath'' was performed to evaluate the Achilles tendon in 67 patients (including 24 athletes) believed to have acute or chronic traumatic or inflammatory pathologic conditions. Tendons in 23 patients appeared normal on US scans. The 44 abnormal tendons comprised five complete and four partial ruptures, seven instances of postoperative change, and 28 cases of tendonitis. US depiction of the inner structure of the tendon resulted in the diagnosis of focal abnormalities, including partial ruptures, nodules, and calcifications. Tendonitis was characterized by enlargement and decreased echogenicity of the tendon. The normal US appearance of the Achilles tendon is described.

  2. Outcome evaluation after Achilles tendon ruptures. A review of the literature

    PubMed Central

    SPENNACCHIO, PIETRO; VASCELLARI, ALBERTO; CUCCHI, DAVIDE; CANATA, GIAN LUIGI; RANDELLI, PIETRO

    2016-01-01

    The optimal treatment and the best rehabilitation protocol after an acute Achilles tendon rupture (ATR) remain a matter of controversy in orthopaedic and sports medicine. The use of validated injury-specific outcome instruments is the only way to clarify these issues, in order to ensure that patients receive the best possible treatment. This article describes the most commonly reported outcome measures used to assess patients treated for ATR. On the basis of the available evidence, the Achilles tendon Total Rupture Score (ATRS) is the most appropriate outcome measure for evaluating the management of acute ATR. PMID:27386448

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

    PubMed

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

    2016-01-01

    Achilles injury is a common musculoskeletal disorder. Bilateral rupture of the Achilles tendon, however, is much less common and usually occurs spontaneously. Complete, traumatic, and bilateral ruptures are rare and typically require long periods of immobilization before the patient can return to full weightbearing. A 52-year-old male was hospitalized for bilateral traumatic rupture to both Achilles tendons. No risk factors for tendon rupture were found. Blood samples revealed no peripheral blood pathologic features. Both tendons were repaired with percutaneous, minimally invasive surgery using the Achillon(®) tendon suture system. Rehabilitation was begun 4 weeks later. An ankle-foot orthosis was prescribed to provide ankle support with an adjustable range of movement, and active plantar flexion was set at 0° to 30°. The patient remained non-weightbearing with the ankle-foot orthosis device and performed active range-of-motion exercises. At 8 weeks after surgery, we recommended that he begin walking with partial weightbearing using a foot-tibial orthosis with the range of motion set to 45° plantar flexion and 15° dorsiflexion. At 10 weeks postoperatively, he was encouraged to return to full weightbearing on both feet. Beginning rehabilitation as soon as possible after minimally invasive surgery, compared with 6 weeks of immobilization after surgery, provided a rapid resumption to full weightbearing. We emphasize the clinical importance of a safe, simple treatment program that can be followed for a patient with damage to the Achilles tendons. To our knowledge, ours is the first report of minimally invasive repair of bilateral simultaneous traumatic rupture of the Achilles tendon. PMID:26002678

  4. Achilles tendon rupture: physiotherapy and endoscopy-assisted surgical treatment of a common sports injury.

    PubMed

    Doral, Mahmut Nedim; Bozkurt, Murat; Turhan, Egemen; Dönmez, Gürhan; Demirel, Murat; Kaya, Defne; Ateşok, Kıvanç; Atay, Ozgür Ahmet; Maffulli, Nicola

    2010-01-01

    Although the Achilles tendon (AT) is the strongest tendon in the human body, rupture of this tendon is one of the most common sports injuries in the athletic population. Despite numerous nonoperative and operative methods that have been described, there is no universal agreement about the optimal management strategy of acute total AT ruptures. The management of AT ruptures should aim to minimize the morbidity of the injury, optimize rapid return to full function, and prevent complications. Since endoscopy-assisted percutaneous AT repair allows direct visualization of the synovia and protects the paratenon that is important in biological healing of the AT, this technique becomes a reasonable treatment option in AT ruptures. Furthermore, Achilles tendoscopy technique may decrease the complications about the sural nerve. Also, early functional postoperative physiotherapy following surgery may improve the surgical outcomes. PMID:24198562

  5. Surgical treatment of ruptures of the Achilles tendon: a review of long-term results.

    PubMed

    Krueger-Franke, M; Siebert, C H; Scherzer, S

    1995-06-01

    The rupture of the Achilles tendon is frequently sports-related. In the time from 1 January, 1978 until 31 December, 1988, we treated 358 men and 54 women with such an injury at the Staatliche Orthopaedische Klinik in Munich. The average age of these patients was 43 years. The site of the rupture was generally located between 3-5 cm proximal of the distal insertion of the tendon. In the follow-up examination of 122 patients with surgical treatment of tendo calcaneus ruptures 85% showed 'good' to 'very good' subjective results. Of the operated patients 97% would choose the same treatment under similar circumstances. The isokinetic studies demonstrated a loss of static and dynamic strength in plantar flexion of the ankle joint of 9.1%, and 16.7% respectively, when compared to the healthy contralateral side. The ultrasound examination revealed a thickening of the tendon and of the dorsal paratenon with changes in the internal structure of the injured Achilles tendon. In spite of these favourable results, the high complication rate of 15.1% shows the need for new and extensive studies regarding the various alternative treatment forms, such as functional, non-operative options, to finally resolve the debate about the optimal treatment of Achilles tendon ruptures. PMID:7551757

  6. Application of lariat lock catch knot suture in the achilles tendon rupture

    PubMed Central

    Wang, Baocang; Feng, Xiaona; Yan, Ming; Wang, Hui; Li, Yong

    2015-01-01

    The aim of this study was to summarize the clinical experience of repairing the Achilles tendon rupture by lariat lock catch knot suture. Between January 2011 and February, 2014, 32 cases of the Achilles tendon rupture were treated by lariat lock catch knot suture. There were 26 males and 6 females, with the average age of 39 years (range 17-53 years), including 13 left knees and 19 right knees. 29 wounds healed by first intention, and 3 cases who were performed local flap transfer due to necrosis of skin were healed by second intention. Thirty-two cases were followed up 10-25 months (13 months on average). No re-rupture of Achilles tendon or deep infection occurred during follow-up period. According to Arner-Lindholm assessment standard, the results were excellent in 19 cases and good in 13 cases, the excellent and good rate was 100%. Lariat lock catch knot suture is a safe and effective method for repairing Achilles tendon. PMID:26770612

  7. Influence of a lower leg brace on traction force in healthy and ruptured Achilles tendons

    PubMed Central

    Sandberg, Olof Helge; Dånmark, Ida; Eliasson, Pernilla; Aspenberg, Per

    2015-01-01

    Background we investigated how ruptured Achilles tendons are loaded in a brace. There is an ongoing discussion whether patients should be recommended to bear weight on the injured limb. However, little is known about the effects of bracing on tensional loading of the healing Achilles tendon: it is uncertain if load-bearing actually stresses the Achilles tendon inside a brace. Methods we measured plantar flexion moment inside the brace, in order to estimate tensional loading of the tendon, by use of an insole with pressure transducers. Results after wearing the brace for 1 hour, young healthy individuals reduced their maximum flexion moment during gait by half. Patients with Achilles tendon rupture showed no measurable flexion moment during gait with the brace, 4 or 7 weeks after injury. Only when specifically instructed, they could produce a considerable plantar flexion moment. We noted that gait speed with the brace at 4 weeks correlated with a heel-raise functional test at 1 year: the higher the spontaneous gait speed, the less the functional difference between the injured and the uninjured leg (r2=0.68; p=0.002). Conclusion the correlation with gait speed suggests that the patients’ general physical aptness has an impact on the end result. PMID:26261783

  8. A preliminary study on the effects of acellular tissue graft augmentation in acute Achilles tendon ruptures.

    PubMed

    Lee, Daniel K

    2008-01-01

    Acute Achilles tendon rupture injuries present surgical challenges because of the mechanical forces placed on this tendon. The purpose of this study was to evaluate the effectiveness of an acellular human dermal tissue matrix, GraftJacket Matrix (Wright Medical Technology, Inc., Arlington, TN), as an augmentation material in acute Achilles tendon repair. Eleven consecutive patients with acute tendon ruptures were evaluated and followed up (20-31 months). Primary repair was followed by augmentation with the graft sutured circumferentially around the tendon. Patients were placed in an early functional rehabilitation program with postoperative evaluation at 3, 6, and 12 months. Outcome scores were calculated based on the American Orthopaedic Foot and Ankle Society ankle-hindfoot scoring system. At 20-month postoperative follow-up, there have been no cases of rerupture or recurrent pain. The average return-to-activity time was 11.8 +/- 0.75 weeks. These retrospective clinical results suggest that with an acellular human dermal tissue matrix to augment acute Achilles tendon, primary repair offers a desirable return-to-activity time without any rerupture or complications. ACFAS Level of Clinical Evidence: 2c. PMID:18156058

  9. The seasonal variation of Achilles tendon ruptures in Vancouver, Canada: a retrospective study

    PubMed Central

    Scott, Alex; Grewal, Navdeep; Guy, Pierre

    2014-01-01

    Objective To examine the seasonal distribution of tendon ruptures in a large cohort of patients from Vancouver, Canada. Design Retrospective chart review. Setting Acute Achilles tendon rupture cases that occurred from 1987 to 2010 at an academic hospital in Vancouver, Canada. Information was extracted from an orthopaedic database. Participants No direct contact was made with the participants. The following information was extracted from the OrthoTrauma database: age, sex, date of injury and season (winter, spring, summer and autumn), date of surgery if date of injury was unknown and type of injury (sport related or non-sport related/unspecified). Only acute Achilles tendon rupture cases were included; chronic cases were excluded along with those that were conservatively managed. Primary and secondary outcomes The primary outcome was to determine the seasonal pattern of Achilles tendon rupture. Secondary outcomes, such as differences in gender and mechanism of sport (non-sport vs sport related), were also assessed. Results There were 543 cases in total; 83% of the cases were men (average age 39.3) and 17% were women (average age 37.3). In total, 76% of cases were specified as sport related. The distribution of injuries varied significantly across seasons (χ2, p<0.05), with significantly more cases occurring in spring. The increase in the number of cases in spring was due to sport-related injuries, whereas non-sport-related cases were distributed evenly throughout the year. Conclusions The seasonality of sport-related Achilles tendon ruptures should be considered when developing preventive strategies and when timing their delivery. PMID:24519875

  10. Evaluation of Elastic Stiffness in Healing Achilles Tendon After Surgical Repair of a Tendon Rupture Using In Vivo Ultrasound Shear Wave Elastography

    PubMed Central

    Zhang, Li-ning; Wan, Wen-bo; Wang, Yue-xiang; Jiao, Zi-yu; Zhang, Li-hai; Luo, Yu-kun; Tang, Pei-fu

    2016-01-01

    Background There has been no published report assessing the mechanical properties of a repaired Achilles tendon after surgery using shear wave elastography (SWE). The aim of this study was to investigate the changes in mechanical properties of the healing Achilles tendon after surgical repair of a tendon rupture using ultrasound SWE and how these changes correlate with tendon function. Material/Methods Twenty-six patients who underwent surgical repair for Achilles tendon rupture were examined with ultrasound SWE coupled with a linear array transducer (4–15 MHz). The elasticity values of the repaired Achilles tendon in a longitudinal view were measured at 12, 24, and 48 weeks postoperatively. Functional outcomes were assessed with the American Orthopedic Foot and Ankle Society (AOFAS) rating system at 12, 24, and 48 weeks postoperatively. General linear regression analysis and correlation coefficients were used to analyze the relationship between elasticity and the AOFAS score. Results There were significant differences with respect to the mean elasticity values and functional scores of the repaired Achilles tendon at 12, 24, and 48 weeks postoperatively (all P<0.05). Tendon function was positively correlated with the elasticity of the repaired Achilles tendon (P=0.0003). Conclusions Our findings suggest that SWE can provide biomechanical information for evaluating the mechanical properties of healing Achilles tendon and predict Achilles tendon function. PMID:27072885

  11. Surgical repair of the ruptured Achilles tendon. Analysis of 40 patients treated by the same surgeon.

    PubMed

    Quigley, T B; Scheller, A D

    1980-01-01

    Forty patients with acute ruptures of the Achilles tendon were treated surgically by the same physician (T.B.Q.) during a period of 1947 to 1971. The average followup was 19 years. Ninety percent of the patients were men (average age 37.5 years) who were engaged in recreational sport activities. The majority denied a physical conditioning program. The acute ruptures were treated by a surgical procedure which consisted of a 15-cm incision on the medial aspect of the tendon with either the plantaris muscle being woven through the Achilles tendon in a clockwise fashion or a pull-out wire, supplemented with silk mattress sutures, being used to repair the ruptured tendon. The wound was closed and the patient's leg was immobilized. The wire was removed at 6 weeks. The rehabilitation plan consisted of ambulation with a heel lift and elastic stocking (the height of the lift was gradually reduced) and toe exercises. The patients began walking downstairs backwards at 3 months and continued exercises until full range of motion was attained. Subjectively, the results were excellent as graded by the patients. Objectively, there were some minor deficits but they did not impede the overall function. On a scale of 1 (poor) to 4 (excellent), the clinical results were rated excellent (42%), good (36%), fair (15%), and poor (6%). This review has supported our contention that a positive Thompson test is a reliable indicator for a rupture of the Achilles tendon and that surgical treatment of complete ruptures is a successful mode by the procedure described followed by our rehabilitation program. PMID:7396055

  12. Physical activity modulates nerve plasticity and stimulates repair after Achilles tendon rupture.

    PubMed

    Bring, Daniel K-I; Kreicbergs, Andris; Renstrom, Per A F H; Ackermann, Paul W

    2007-02-01

    In a rat model of tendon rupture using semiquantitative methodology, healing was assessed according to the diameter of newly organized collagen and the occurrence of the sensory neuropeptides (SP, CGRP) in relation to different levels of physical activity. Normally, innervation of the Achilles tendon is confined to the paratenon. After rupture new nerve fibers grow into the tendon proper, but disappear after healing. In a first experiment to establish peak tissue and nerve regeneration after rupture, tendon tissues from freely moving rats were collected consecutively over 16 weeks. A peak increase in organized collagen and nerve ingrowth was observed between week 2 to 4 post rupture. Therefore, in a second experiment week 4 was chosen to assess the effect of physical activity on tendon healing in three groups of rats, that is, wheel running, plaster treated, and freely moving (controls). In the wheel-running group, the diameter of newly organized collagen was 94% ( p = 0.001) greater than that in the plaster-treated group and 48% ( p = 0.02) greater than that in the controls. Inversely, the neuronal occurrence of CGRP in the tendon proper was 57% ( p = 0.02) lower in the wheel-running group than that in the plaster-treated group and 53% ( p = 0.02) lower than that in the controls, suggesting an earlier neuronal in-growth and disappearance in the more active group. Physical activity speeds up tendon healing, which may prove to be linked to accelerated neuronal plasticity. PMID:17068813

  13. Clinical assessment is sufficient to allow outcome evaluation following surgical management of Achilles tendon ruptures

    PubMed Central

    Todorov, Atanas; Schaub, Frederic; Blanke, Fabian; Heisterbach, Patricia; Sachser, Franciska; Gösele, Andreas; Majewski, Martin

    2015-01-01

    Summary Study design cross-sectional study in otherwise healthy athletic adults with a unilateral Achilles tendon rupture. Objectives define the relationships of active range of motion, calf circumference or number of heel raises to a full set of isokinetic parameters. Background Achilles tendon ruptures commonly occur during sports and create a considerable amount of morbidity. The benefits of different treatments are difficult to determine. Complex and expensive isokinetic testing is often required. If a simple force measurement could replace this testing, large clinical trials would be more easily feasible. Methods 74 patients with acute Achilles tendon rupture and surgical treatment were evaluated retrospectively. Active range of motion (ROM), ratio of ROM, number of heel raises, ratio of heel raises, calf circumference and isokintetic measurements were recorded. Regression using a Bayesian elastic net showed the most important correlations. Results Active range of motion showed a significant correlation to peak torque angle at flexion and extension as well as increased sports activity. There was a negative correlation to percutaneous therapy. Active Heel raise showed a positive correlation to peak torque at dorsal extension and increased sports activity as well as a negative correlation to high postoperative pain, where as calf circumference was positive correlated to peak torque at dorsal extension and body height as well as negative correlated to female gender. Conclusion device independent measures, like range of Motion, and amount of Heel raise, are an excellent tool providing similar information compared to isokinetic testing and could be used to evaluate clinical outcome after Achilles tendon rupture. PMID:26261784

  14. Epidemiology and outcomes of Achilles tendon ruptures in the National Football League.

    PubMed

    Parekh, Selene G; Wray, Walter H; Brimmo, Olubusola; Sennett, Brian J; Wapner, Keith L

    2009-12-01

    The purpose of this study is to document the epidemiology of Achilles tendon ruptures in the National Football League (NFL) and to quantify the impact of these injuries on player performance. A retrospective review of several online NFL player registries identified 31 Achilles tendon ruptures in NFL players between 1997 and 2002. Nineteen percent of injuries occurred during preseason play, while another 18% occurred during the first month of the official season. There was a postinjury reduction of 88%, 83%, and 78% in power ratings for wide receivers, running backs, and tight ends, respectively, over a 3-year period. There was a 95%, 87%, and 64% postinjury reduction in power ratings for linebackers, cornerbacks, and defensive tackles over a 3-year period. On average, players experienced a greater than 50% reduction in their power ratings following such an injury. Thirty-two percent (n = 10) of NFL players who sustained an Achilles tendon rupture did not return to play in the NFL. PMID:20400426

  15. Fibronectin in the ruptured human Achilles tendon and its paratenon. An immunoperoxidase study.

    PubMed

    Lehto, M; Jozsa, L; Kvist, M; Järvinen, M; Balint, B J; Reffy, A

    1990-01-01

    The purpose of the present study was to examine the role and distribution of fibronectin--a major connective tissue protein--in normal and ruptured Achilles tendon and its paratenon using peroxidase antiperoxidase (PAP) method and conventional histology. Samples were taken intraoperatively 6 to 48 hours after rupture from 30 patients, and 4 male cadavers served as controls. In controls fibronectin could not be detected in the tendinous connective tissue or in the areolar tissue of the paratenon. In the ruptured tendons fibronectin was detected around the tenocytes and in the collagen fibres in the necrotic and mucinous degenerated areas, but also in the macroscopically healthy areas of the tendon. In the oedematous paratenon vascular walls were rich in fibronectin and fat cells were outlined by fibronectin. Areas of homogenous deposition of fibronectin were also frequently seen in the paratenon. A vast amount of fibronectin was observed also at the site of rupture. The present results indicate that there are striking changes in the composition of connective tissue in degenerated tendon and paratenon. These changes seem to have increased susceptibility of the tendon to rupture. PMID:2201247

  16. Medial malleolus fracture of the ankle combined with rupture of the Achilles tendon

    PubMed Central

    Lu, Jike; Maruo Holledge, Masumi

    2016-01-01

    A 59-year-old man fell off a 60-cm-high step, with his ankle in a twisted position, and sustained a closed fracture of the medial malleolus, with an ipsilateral complete Achilles tendon (TA) rupture. The TA rupture was initially missed but diagnosed by ultrasound examination, 2 weeks post-operatively. The ankle fracture was diagnosed from routine radiographs. Such a combination of injuries has been reported infrequently in the literature, but significant similarities have been described in the mechanism of injury and fracture patterns. Nevertheless, three of five reported cases with combined medial malleolus fractures were initially misdiagnosed. PMID:27141047

  17. Medial malleolus fracture of the ankle combined with rupture of the Achilles tendon.

    PubMed

    Lu, Jike; Maruo Holledge, Masumi

    2016-01-01

    A 59-year-old man fell off a 60-cm-high step, with his ankle in a twisted position, and sustained a closed fracture of the medial malleolus, with an ipsilateral complete Achilles tendon (TA) rupture. The TA rupture was initially missed but diagnosed by ultrasound examination, 2 weeks post-operatively. The ankle fracture was diagnosed from routine radiographs. Such a combination of injuries has been reported infrequently in the literature, but significant similarities have been described in the mechanism of injury and fracture patterns. Nevertheless, three of five reported cases with combined medial malleolus fractures were initially misdiagnosed. PMID:27141047

  18. Achilles tendon repair

    MedlinePlus

    ... ency/article/007643.htm Achilles tendon repair To use the sharing features on this page, please enable JavaScript. Your Achilles tendon joins your calf muscle to your heel. You can tear your Achilles tendon if you land hard on your heel during sports, from a ...

  19. [Treatment of an old Achilles tendon rupture with allografts. Report of case series].

    PubMed

    Matus-Jiménez, J; Martínez-Arredondo, H

    2011-01-01

    Rupture of Achilles tendon occurs at 2-6 cm from its attachment in the calcaneus; its frequency is estimated at 7-18 cases per 100,000 population in the United States and it occurs more frequently in males. The diagnosis is made clinically and with ultrasound or magnetic resonance imaging and treatment may be divided into acute or late. We present herein the use of allograft to treat patients with ruptures more than six weeks old; several techniques were used depending on the rupture site and the available allograft. Ten plasties were performed in ten patients with ruptures that occurred a mean of 8 months back; early rehabilitation was instituted and weight bearing was allowed at 4 weeks with a brace, which was removed at 12 weeks; patients could run at 12 weeks. Four wound dehiscence complications were reported, which resolved with second intention healing without the need for any other surgery, with good results and patient satisfaction. PMID:22512126

  20. Surgical versus conservative treatment following acute rupture of the Achilles tendon: is there a pedobarographic difference?

    PubMed Central

    Karaaslan, Fatih; Mermerkaya, Musa Uğur; Çıraklı, Alper; Karaoğlu, Sinan; Duygulu, Fuat

    2016-01-01

    Introduction Controversy remains regarding the optimal treatment method and postoperative rehabilitation of acute Achilles tendon ruptures. In this study, pedobarographic assessments of surgical and conservative treatments were compared. Material and methods A prospective assessment was made of 16 patients (eight surgical, eight conservative) and eight healthy controls using a plantar pressure measurement system. Biomechanical gait parameters were obtained using the Footscan dynamic gait analysis system. Kruskal–Wallis and Mann–Whitney U-tests were used for the evaluation of data. Results Nineteen males and five females were assessed, with an average age of 42.0±11.9 years. Follow-up was completed in 16 patients. No statistically significant difference was determined between the two treatment groups with regard to the gait analysis, but a difference was observed with the control group (P<0.001). All patients were able to resume their prior activities after 6 months and regained normal ranges of motion, with a high rate of satisfaction. Most of the patients (75%) were able to return to their pre-injury level of activities. Conclusion Satisfactory results were obtained through conservative treatment of acute ruptures of the Achilles tendon. No significant differences or complications were observed in the group managed conservatively versus the group treated surgically. Further studies including 3D gait analyses and tendon biomechanical research are required to further investigate this issue. PMID:27621640

  1. Nintendo Wii related Achilles tendon rupture: first reported case and literature review of motion sensing video game injuries.

    PubMed

    Singh, Rohit; Manoharan, Gopikanthan; Moores, Thomas Steven; Patel, Amit

    2014-01-01

    Achilles tendon ruptures tend to occur more commonly in healthy men between the ages of 30 and 50 years who have had no previous injury or problem reported in the affected leg. The injury is usually due to sudden forced plantar flexion of the foot, unexpected dorsiflexion of the foot and violent dorsiflexion of a plantar flexed foot, all of which occur during high impact activities. We present the first reported case of interactive activity with Nintendo Wii games that have resulted in Achilles tendon rupture in a 46-year-old man. There have been no previous reports of Achilles tendon rupture with Nintendo Wii usage; it is a relatively uncommon mode of injury and is rare in terms of epidemiology of motion sensing video game injuries. PMID:24827648

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

    PubMed

    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. PMID:25317130

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

    PubMed Central

    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

  4. [Diseases of the Achilles tendon].

    PubMed

    Schönbauer, H R

    1986-01-01

    In this report diseases of the Achilles tendon are discussed. First an anatomical survey of this region is presented including anatomical variations together with the results of the author's own investigations on corpses. Certain positions and insertions of the plantaris tendon with respect to the Achilles tendon may have pathological influence. Pathological aspects are discussed after a review of the physiology of the Achilles tendon, including functional and tensile tests. The clinical picture changes according to the location of the pathological disorder--tendon, paratenon, insertion and bursae--and whether the disease is acute or chronic. There are various reasons for degenerative changes in the tendon, which can even lead to rupture. Surgical and non-surgical treatment and their indications are presented. In conclusion treatment methods and their results for 36 cases are given. PMID:3087066

  5. Comparison of Semi-Invasive "Internal Splinting" and Open Suturing Techniques in Achilles Tendon Rupture Surgery.

    PubMed

    Sarman, Hakan; Muezzinoglu, Umit Sefa; Memisoglu, Kaya; Aydin, Adem; Atmaca, Halil; Baran, Tuncay; Odabas Ozgur, Bahar; Ozgur, Turgay; Kantar, Cengizhan

    2016-01-01

    The goal of the present study was to evaluate the semi-invasive "internal splinting" (SIIS) method for repair of Achilles tendon rupture relative to open repair with Krakow sutures. Efficacy was evaluated based on the clinical and functional outcomes, postoperative magnetic resonance imaging measurements, isokinetic results, and surgical complication rates. Functional measurements included the Thermann and American Orthopaedic Foot and Ankle Society (AOFAS) ankle scores, bilateral ankle dorsiflexion, and plantar flexion measurements. Magnetic resonance imaging was used to compare the bilateral length and thickness of each Achilles tendon. The isokinetic outcomes were evaluated using a Biodex System 3 dynamometer. Of the 45 patients meeting the inclusion criteria, 24 were treated by SIIS and 21 by the open Krackow suture technique. The mean follow-up time for all patients was 43.7 (range 6 to 116) months. In the SIIS group, patients returned to normal daily activities after 7.2 (range 6 to 8) weeks compared with 14.3 (range 12 to 15) weeks in the open surgery group. The AOFAS ankle scores were 93.5 (range 82 to 100) points in the open repair group and 96.2 (range 86 to 100) points in the SIIS group. The Thermann scores were 80.4 (range 53 to 91) points for the open repair group and 87.9 (range 81 to 100) points for the SIIS method. The mean Achilles length on the operated side measured using magnetic resonance imaging was 175.06 (range 110 to 224) mm and 177.76 (range 149 to 214) mm for the open surgery and SIIS groups, respectively. Sensory impairment in the territory of the sural nerve was identified in 1 patient immediately after SIIS surgery, although this defect had completely resolved within 12 months. SIIS yielded better outcomes relative to the open surgery group according to the isokinetic measurements. Taken together, these data indicate the SIIS method for Achilles tendon ruptures performed better in terms of both functional and objective outcomes

  6. The Effect of Autologous Platelet Rich Plasma in the Treatment of Achilles Tendon Ruptures: An Experimental Study on Rabbits

    PubMed Central

    Şen, Baran; Güler, Serkan; Çeçen, Berivan; Kumtepe, Erdem; Bağrıyanık, Alper; Özkal, Sermin; Ali Özcan, M.; Özsan, Hayri; Şanlı, Namık; Tatari, M. Hasan

    2016-01-01

    Background: Achilles tendon ruptures are characterized by a long recovery period, high re-rupture rate and late return to work. To overcome these difficulties and augment tendon repair, many agents have been used. Aims: To determine the effect of autologous platelet rich plasma (PRP) in the treatment of Achilles tendon ruptures in rabbits. Study Design: Animal experimentation. Methods: The study included 14 New Zealand albino rabbits that were divided randomly into 2 groups, A and B, each containing seven rabbits. On day zero, all 28 Achilles tendons were tenotomized and repaired. In group A, the tendons were injected with PRP post-surgery, whereas those in group B were left untreated. On day 28, the right tendons in both groups were examined histopathologically via both light and electron microscopy, and the left tendons were subjected to biomechanical testing. Results: The histological and biomechanical findings in both light and electron microscopy in group A were better than those in group B, but the difference was not significant. According to Tang’s scale, the mean value in Group A was 3.57, while it was 3.0 in Group B. The mean value of Group A for the length of collagen bands was 48.09 nm while the mean value of Group B was 46.58 nm (p=0.406). In biomechanical tests, although stiffness values were higher in group A, the difference between groups was not significant. In addition, maximum load values did not differ between groups A and B. Conclusion: PRP had no effect on the healing process 28 days post-Achilles tendon rupture. PMID:26966624

  7. Achilles tendon disorders in runners--a review.

    PubMed

    Smart, G W; Taunton, J E; Clement, D B

    1980-01-01

    The Achilles tendon and the classification, etiology, diagnosis, treatment, and management of Achilles tendon disorders in runners are reviewed. Due to the presence of a paratenon sheath, the classification of Achilles tendon disease should be revised. Several etiological mechanisms have been proposed in Achilles tendon disease. The authors recognize: faulty foot biomechanics; poor lower leg flexibility; poorly designed athletic footwear; training surfaces; training intensity; overuse through excessive mileage; inactivity; local steroid injections; rheumatic conditions; and indirect violence. An accurate, thorough differential diagnosis is essential when the athlete presents with an Achilles tendon disorder. Except in total rupture and in extensive partial rupture, the authors do not recommend cast immobilization in the treatment of Achilles tendon disease. When the athlete presents with total rupture of the Achilles tendon, the authors believe that surgical repair is the treatment method of choice. Rehabilitation programs to follow successful treatment of Achilles tendon disease are also presented. PMID:6999281

  8. Accelerated rehabilitation following Achilles tendon repair after acute rupture - Development of an evidence-based treatment protocol.

    PubMed

    Brumann, Mareen; Baumbach, Sebastian F; Mutschler, Wolf; Polzer, Hans

    2014-11-01

    The acute rupture of the Achilles tendon is a protracted injury. Surgery is only the beginning of a long rehabilitation period. Therefore, the rehabilitation protocol is an integral aspect to restore the pre-injury activity level. Despite several trials available comparing different treatment regimes, there is still no consensus regarding the optimal protocol. Consequently, the aim of our study was to systematically search the evidence available and define a precise rehabilitation programme after operative repair of acute Achilles tendon rupture based on the trials with the highest level of evidence. We performed a systematic literature search in Medline, Embase and Cochrane library. We identified twelve randomized controlled trials comparing different treatment regimes after operative repair of the Achilles tendon. Five trials compared full to non weight bearing, all applying immobilization in equinus. Immediate full weight bearing led to significant higher patient satisfaction, earlier ambulation and return to pre-injury activity. Four trials compared early ankle mobilization to immobilization. All trials found mobilization to be superior as it shortens time to return to work and sports significantly. Three trials compared the combination of full weight bearing and early ankle mobilization to immobilization. This combination was most beneficial. Patients showed significantly higher satisfaction, less use of rehabilitation resources, earlier return to pre-injury activities and further demonstrated significantly increased calf muscle strength, reduced atrophy and tendon elongation. No study found an increased rerupture rate for the more progressive treatment. In conclusion, the rehabilitation protocol after Achilles tendon repair should allow immediate full weight bearing. After the second postoperative week controlled ankle mobilization by free plantar flexion and limited dorsiflexion at 0° should be applied. PMID:25059505

  9. Achilles tendon ruptures stratified by age, race, and cause of injury among active duty U.S. Military members.

    PubMed

    Davis, J J; Mason, K T; Clark, D A

    1999-12-01

    A total of 865 members of the U.S. military underwent repair of Achilles tendon ruptures at U.S. military hospitals during calendar years 1994, 1995, and 1996. The discharge summaries of these patients were analyzed for patient demographic information, including age, race, and causative activity. Patients were then stratified by age, race, and cause of injury. Blacks were at increased risk for undergoing repair of the Achilles tendon compared with nonblacks (overall relative risk = 4.15, 95% confidence interval [CI] = 3.63, 4.74; summary odds ratio controlling for age = 3.69, CI = 3.25, 4.19). Participation in the game of basketball accounted for 64.9% of all injuries in black patients and 34.0% of all injuries in nonblack patients. Among those injured, blacks had a significantly increased risk for injury related to playing basketball than nonblacks (relative risk = 1.82, CI = 1.58, 2.10). This finding suggests that there may be other predisposing factor(s) that result in a higher risk of Achilles tendon ruptures in black individuals. PMID:10628159

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

    NASA Astrophysics Data System (ADS)

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

    2010-07-01

    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.

  11. Early nerve regeneration after achilles tendon rupture--a prerequisite for healing? A study in the rat.

    PubMed

    Ackermann, Paul W; Ahmed, Mahmood; Kreicbergs, Andris

    2002-07-01

    Nerve regeneration during healing of Achilles tendon rupture in the rat was studied by immunohistochemistry including semi-quantitative assessment. Neuronal markers for regenerating and mature fibers, ie., growth associated protein 43 (GAP-43) and protein gene product 9.5 (PGP 9.5), respectively, were analyzed at different time points (1-16 weeks) post-rupture. In the paratenon, both the ruptured and intact contralateral tendon (control) consistently exhibited immunoreactivity to the two neuronal markers. However, in the proper tendinous tissue only the ruptured tendon showed immunoreactivity to GAP-43 and PGP 9.5. This expression was seen already at week 1 post-rupture to reach a peak at week 6 followed by a successive drop till week 16. Also the occurrence of sensory and autonomic fibers according to immunoreactivity for calcitonin gene-related peptide (CGRP) and neuropeptide Y (NPY), respectively, was analyzed. CGRP-positivity was abundantly seen from weeks 2-6 in both perivascular and sprouting free nerve endings in the proper tendon tissue undergoing healing. NPY appeared later, at weeks 6-8 post-rupture around blood vessels mainly located in the surrounding loose connective tissue. Apart from a role in vasoaction (CGRP, vasodilatory; NPY, vasoconstrictory). both neuropeptides have been implicated in fibroblast and endothelial cell proliferation required for angiogenesis. The present study shows that early healing of ruptured tendons is characterized by an orchestrated, temporal appearance of nerve fibers expressing peptides with different actions. The observed pattern of neuronal regeneration and neuropeptide expression may prove to be important for normal connective tissue healing. PMID:12168677

  12. Limited open repair of ruptured Achilles tendons with Bunnel-type sutures.

    PubMed

    Park, H G; Moon, D H; Yoon, J M

    2001-12-01

    A new method of repairing Achilles tendons, which uses a small medial skin incision with a Bunnel-type suture, was performed on 14 patients, and the clinical results were found satisfying. In order to restore the Achilles tendon to its original length, restore tensile strength in the suture site, and minimize injury to the sural nerve, an operative procedure has been devised which uses a limited open repair with a Bunnel-type suture. We followed 14 patients who had undergone the new procedure for a mean interval of 26 months after the injury. They returned to work in six weeks and to playing sports in 25 weeks. There were no cases of late rerupture nor injuries to the sural nerve. This technique approximated the preinjury length and resting tension of the musculo-tendinous apparatus and minimized sural nerve injury. PMID:11783926

  13. Blood supply of the Achilles tendon.

    PubMed

    Ahmed, I M; Lagopoulos, M; McConnell, P; Soames, R W; Sefton, G K

    1998-09-01

    The Achilles tendon is one of the most common sites of injury and rupture as a result of overuse. Evidence suggests that the pathogenesis of rupture could involve the pattern of its blood supply. With use of angiographic and histological techniques, the blood supply of the Achilles tendon was investigated in 12 human cadaveric specimens. Angiography confirmed Mayer's 1916 finding that the blood supply to the tendon is from three areas: the musculotendinous and osseotendinous junctions and the paratenon, with the posterior tibial artery providing the major contribution. However, qualitative and quantitative histological analyses in this study showed that the Achilles tendon has a poor blood supply throughout its length, as determined by the small number of blood vessels per cross-sectional area, which do not in general vary significantly along its length. In light of these findings, it is suggested that poor vascularity may prevent adequate tissue repair following trauma, leading to further weakening of the tendon. PMID:9820283

  14. Titanium anchors for the repair of distal Achilles tendon ruptures: preliminary report of a new surgical technique.

    PubMed

    Maniscalco, P; Bertone, C; Bonci, E; Donelli, L; Pagliantini, L

    1998-01-01

    From January 1995 to July 1996, the authors used Mitek GIV titanium anchors to treat seven patients with acute rupture of the Achilles tendon (four men, three women; average age 52.42 years; range, 33-62 years). All subjects had a total rupture of the most distal aspect of the tendon; none had an avulsion fracture. After dissection down to the paratenon, the reinsertion site was selected and a 2 to 3-cm-long trough carved through the cortex. Three holes were drilled at a distance of 0.5 cm one from the other and 1 cm parallel and distal to the trough. The anchors were then threaded, inserted into the holes, and engaged. Surgery was completed by resection of the frayed ends, reparation of the tendon, and insertion of the terminal end into the trough. At 6 months postoperative, a modified Mandelbaum and Pavanini clinical assessment indicated five excellent and two good outcomes. There were no cases of deep of superficial wound infection or skin necrosis. Despite the small number of patients and the short follow-up period, the authors believe this technique shows promise and that in selected cases the use of titanium anchors can facilitate the task of the surgeon and enable patients to return to normal and sports activities within 5 months after surgery. PMID:9571455

  15. Long-Term Results of Mini-Open Repair Technique in the Treatment of Acute Achilles Tendon Rupture: A Prospective Study.

    PubMed

    Taşatan, Ersin; Emre, Tuluhan Yunus; Demircioğlu, Demet Tekdöş; Demiralp, Bahtiyar; Kırdemir, Vecihi

    2016-01-01

    An ideal surgical treatment of acute Achilles tendon rupture includes restoring the original length of the tendon, minimizing possible adhesions with the surrounding tissues, minimizing the risk of repeat rupture, alleviating wound problems, and providing an acceptable cosmetic outcome. In the mini-open repair technique, unlike the percutaneous repair technique, the quality of the tenodesis can be visualized without disturbing the healing potential of the surrounding tissues, thus minimizing wound problems. The purpose of the present study was to assess the long-term results of the mini-open repair technique in patients with acute Achilles tendon rupture. A total of 20 consecutive patients with acute Achilles tendon rupture, admitted to our inpatient clinic from October 2003 to March 2008, were included in the present study. The patients underwent Achilles tenodesis with the mini-open repair technique, and each patient was followed up for 5 years. The study was completed in April 2013. The surgical procedure was performed with the assistance of a device designed in our orthosis laboratories, similarly to that defined by Assal et al. Of the 20 patients, 18 were male and 2 were female. Their mean age was 39.3 (range 21 to 55) years. The Achilles tendon rupture was located on the left side in 15 patients (75%) and on the right side in 5 patients (25%). The mean follow-up duration was 58.5 (range 18 to 60) months and no complications occurred during the follow-up period, including repeat rupture, wound site infection, and sural nerve injury. The mean American Orthopaedic Foot and Ankle Society scale score for the patients was 99.2 (range 94 to 100) points at the final follow-up visit. All our patients were able to return to work and sporting activities. According to the Trillat scores, the outcome was excellent in 19 patients and good in 1 patient at the 18th postoperative month. No complaint, such as pain or loss of function, that might have a negative effect on the

  16. A meta-analysis of randomised controlled trials comparing conventional to minimally invasive approaches for repair of an Achilles tendon rupture.

    PubMed

    McMahon, Samuel E; Smith, Toby O; Hing, Caroline B

    2011-12-01

    Achilles tendon ruptures are a common injury afflicting predominantly the young male occasional sportsman. Previous studies have shown that outcome is better with surgical repair for the young active patient. There is no consensus as to whether there is a difference in outcome between open and percutaneous minimally invasive surgery (MIS). A meta-analysis was undertaken to compare the clinical outcomes of MIS with conventional open surgical repair. Six randomised controlled trials of 277 Achilles tendon repairs were eligible for review. This included 136 minimally invasive repairs and 141 conventional open repairs. On analysis, there was no significant difference between the two surgical approaches in respect to the incidence of re-rupture, tissue adhesion, sural nerve injury, deep infection and deep vein thrombosis (p>0.05). However, MIS had a significantly reduced risk of superficial wound infection, with three times greater patient satisfaction for good to excellent results compared with conventional open surgical approaches. PMID:22017889

  17. Functional evaluation of professional athletes treated with a mini-open technique for achilles tendon rupture

    PubMed Central

    Vadalà, Antonio; Lanzetti, Riccardo Maria; Ciompi, Alessandro; Rossi, Cristina; Lupariello, Domenico; Ferretti, Andrea

    2014-01-01

    Summary Introduction: in this study we report the functional results of 36 professional athletes treated with a combined percutaneous and mini-open technique. Methods: patients were evaluated with Victorian Institute of Sports Assessment-Achilles questionnaire (VISA-A), the objective 100-points Hannover scale and the Ergo-jump Bosco System device. Results: at a mean 28- month follow-up no re-rupture cases were observed. Six patients had minor complications. The Ergo-jump Bosco System device showed no significant differences in the side-to-side evaluation in regard to strength (−0.94%) and elasticity (+2.44%), while a significant post-operative loss was detected in the endurance trials (−6.78%). The Hannover scale showed an average score of 94.5, while the VISA-A had an average of 93.1. Thirty-one patients resumed their pre-operative sports activity level within five months from surgery. Conclusions: our results showed that the combined mini-open and percutaneous repair is an effective treatment for professional athletes, with satisfactory clinical and functional results, lack of major complications and a quick return to professional sports activity. PMID:25332932

  18. Achilles Tendon Repair, A Modified Technique

    PubMed Central

    Keyhani, Sohrab; Mardani-Kivi, Mohsen; Abbasian, Mohammadreza; Emami-Moghaddam Tehrani, Mohammad; Lahiji, Farivar Abdollahzadeh

    2013-01-01

    Background: Wound complications following open repair for acute Achilles tendon ruptures (AATR) remain the subject of significant debate. The aim of this study is to investigate the effects of covering repaired AATR using well-nourished connective tissues (paratenon and deep fascia) to avoid complications after open repair. Methods: In this case series study, open repair was performed for 32 active young patients with AATR. After the tendon was repaired, the deep fascia and paratenon was used to cover the Achilles tendon. Patients were followed for two years and any wound complication was recorded. During the last visit, the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hind foot score was completed for all patients. Calf circumference and ankle range of motion were measured and compared with the contralateral side. Patients were asked about returning to previous sports activities and limitations with footwear. Results: Only, one patient developed deep wound infection (3%). None of the patients had any discomfort around the operation area, limitation with footwear, sural nerve injury, re-rupture, and skin adhesion. The AOFAS score averaged 92.5±6. Two patients (7%) were unable to return to previous sports activities because of moderate pain in heavy physical exercises. The calf circumference and ankle ROM were similar between healthy and operated sides. Conclusion: The present study showed that fascial envelope for full covering of the repaired Achilles tendon may help to prevent the occurrence of wound complications. PMID:25207295

  19. Achilles tendon reflex measuring system

    NASA Astrophysics Data System (ADS)

    Szebeszczyk, Janina; Straszecka, Joanna

    1995-06-01

    The examination of Achilles tendon reflex is widely used as a simple, noninvasive clinical test in diagnosis and pharmacological therapy monitoring in such diseases as: hypothyroidism, hyperthyroidism, diabetic neuropathy, the lower limbs obstructive angiopathies and intermittent claudication. Presented Achilles tendon reflect measuring system is based on the piezoresistive sensor connected with the cylinder-piston system. To determinate the moment of Achilles tendon stimulation a detecting circuit was used. The outputs of the measuring system are connected to the PC-based data acquisition board. Experimental results showed that the measurement accuracy and repeatability is good enough for diagnostics and therapy monitoring purposes. A user friendly, easy-to-operate measurement system fulfills all the requirements related to recording, presentation and storing of the patients' reflexograms.

  20. Tendon Ruptures Associated With Corticosteroid Therapy

    PubMed Central

    Halpern, Alan A.; Horowitz, Bruce G.; Nagel, Donald A.

    1977-01-01

    In five patients, tendon ruptures occurred in association with corticosteroid therapy, either systemic or local infiltration. The chronic nature of the pain in all of these patients suggests that what we often call tendinitis may in fact be early or partial ruptures of tendons. Patients who receive local infiltration of corticosteroids should perhaps be advised of the risk of a ruptured tendon. In addition, particularly when the Achilles tendon is involved, immobilization should be utilized initially for a presumed tendinitis or early rupture, to protect the tendon from further injury. ImagesFigure 1.Figure 2. PMID:919538

  1. Granuloma formation secondary to Achilles tendon repair with nonabsorbable suture

    PubMed Central

    Kara, Adnan; Celik, Haluk; Seker, Ali; Uysal, Mehmet Ali; Uzun, Metin; Malkoc, Melih

    2014-01-01

    INTRODUCTION Several complications can be observed after Achilles tendon repairs. In this study we aimed to report granuloma formation secondary to Achilles tendon repair with Ethibond (Ethicon INC, Somerville, New Jersey) suture. PRESENTATION OF CASE A 31 year-old man operated for Achilles tendon rupture. The Ethibond suture was used for primary repair. The patient attended to polyclinic with the complaints of swelling and discharge around the operation site four months after operation. A mass around distal portion of the Achilles tendon was detected. The granulomatous tissue was excised. Inside the mass Ethibond suture was detected. On histopathologic examination, typical findings of the foreign body reaction were observed. No microorganism was cultivated in the tissue culture. The patient has no complaint on the twelfth month control after surgery. DISCUSSION The results of primary repair of Achilles tendon are good but several complications were reported. In tendon repairs generally nonabsorbable sutures are used. The Ethibond is nonabsorbable, braided suture. In the literature, granuloma formations secondary to the suture materials such as polygylactine and braided polyethylen–polyester after Achilles tendon repair were reported but granuloma secondary to the Ethibond is very rare. CONCLUSION Although Ethibond suture is a strong and safe material for Achilles tendon repairs it may cause soft tissue problems such as granuloma. PMID:25212905

  2. Minimally Invasive Approach to Achilles Tendon Pathology.

    PubMed

    Hegewald, Kenneth W; Doyle, Matthew D; Todd, Nicholas W; Rush, Shannon M

    2016-01-01

    Many surgical procedures have been described for Achilles tendon pathology; however, no overwhelming consensus has been reached for surgical treatment. Open repair using a central or paramedian incision allows excellent visualization for end-to-end anastomosis in the case of a complete rupture and detachment and reattachment for insertional pathologies. Postoperative wound dehiscence and infection in the Achilles tendon have considerable deleterious effects on overall functional recovery and outcome and sometimes require plastic surgery techniques to achieve coverage. With the aim of avoiding such complications, foot and ankle surgeons have studied less invasive techniques for repair. We describe a percutaneous approach to Achilles tendinopathy using a modification of the Bunnell suture weave technique combined with the use of interference screws. No direct end-to-end repair of the tendon is performed, rather, the proximal stump is brought in direct proximity of the distal stump, preventing overlengthening and proximal stump retraction. This technique also reduces the suture creep often seen with end-to-end tendon repair by providing a direct, rigid suture to bone interface. We have used the new technique to minimize dissection and exposure while restoring function and accelerating recovery postoperatively. PMID:26385574

  3. Nonoperative, dynamic treatment of acute achilles tendon rupture: influence of early weightbearing on biomechanical properties of the plantar flexor muscle-tendon complex-a blinded, randomized, controlled trial.

    PubMed

    Barfod, Kristoffer Weisskirchner; Bencke, Jesper; Lauridsen, Hanne Bloch; Dippmann, Christian; Ebskov, Lars; Troelsen, Anders

    2015-01-01

    Acute Achilles tendon rupture alters the biomechanical properties of the plantar flexor muscle-tendon complex that can affect functional performance and the risk of repeat injury. The purpose of the present study was to compare the biomechanical properties of the plantar flexor muscle-tendon complex in patients randomized to early weightbearing or non-weightbearing in the nonoperative treatment of Achilles tendon rupture. A total of 60 patients were randomized to full weightbearing from day 1 of treatment or non-weightbearing for 6 weeks. After 6 and 12 months, the peak passive torque at 20° dorsiflexion, the stiffness during slow stretching, and the maximal strength were measured in both limbs. The stiffness of the plantar flexor muscle-tendon complex in the terminal part of dorsiflexion was significantly increased (p = .024) in the non-weightbearing group at 12 months. The peak passive torque was significantly lower for the affected limb at 6 months (91%; p = .01), and the stiffness was significantly lower for the affected limb during the early part of dorsiflexion at 6 (67%; p < .001) and 12 (77%; p < .001) months. In conclusion, an increased stiffness of the plantar flexor muscle-tendon complex in the terminal part of dorsiflexion was found in the non-weightbearing group. The altered stiffness and strength in the affected limb could affect the coordination of gait and running. PMID:25618802

  4. Faut-il préférer une technique chirurgicale dans le traitement des ruptures du tendon d'Achille?

    PubMed Central

    Hani, Redouane; Kharmaz, Mohammed; Berrada, Mohammed Saleh

    2015-01-01

    La rupture du tendon d'Achille est de plus en plus fréquente dans le monde et dans notre pays en raison du développement considérable des activités sportives, de l'accroissement de leur intensité et de l'absence de moyens de prévention. Notre travail porte sur une étude concernant 58 cas de rupture du tendon d'Achille, avec un recul moyen compris entre 5 mois et 80 mois. L’âge moyen était de 36 ans, tous les patients inclus ont tous bénéficier d'un traitement chirurgical. Le but de notre étude étant de souligner la supériorité d'une technique chirurgicale par rapport à une autre dans la prise en charge, ainsi qu'une mise au point sur les différents aspects épidémiologiques, cliniques, thérapeutiques et post-thérapeutiques de cette lésion. PMID:26161208

  5. Achilles Tendon Disorders

    MedlinePlus

    ... after periods of rest, then improves somewhat with motion but later worsens with increased activity. Tenderness, or ... foot and ankle and evaluate the range of motion and condition of the tendon. The extent of ...

  6. Achilles tendon rupture - aftercare

    MedlinePlus

    ... off the ground, to go from walking to running, or to running uphill for example Tripped and fell, or had ... will cover your foot and go to your knee. Your toes will be ... prevent further injury. You can walk once your doctor says it ...

  7. Achilles tendon rupture - aftercare

    MedlinePlus

    ... another accident Played a sport like tennis or basketball, with a lot of stopping and starting Most ... is OK for you to play tennis, racquetball, basketball, and other sports where you stop and start ...

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

    SciTech Connect

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

    1986-06-01

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

  9. Achilles tendon suture deteriorates tendon capillary blood flow with sustained tissue oxygen saturation – an animal study

    PubMed Central

    Kraemer, Robert; Lorenzen, Johan; Rotter, Robert; Vogt, Peter M; Knobloch, Karsten

    2009-01-01

    Background Treatment of ruptured Achilles tendons currently constitutes of conservative early functional treatment or surgical treatment either by open or minimal invasive techniques. We hypothesize that an experimental Achilles tendon suture in an animal model significantly deteriorates Achilles tendon microcirculation immediately following suturing. Methods Fifteen Achilles tendons of eight male Wistar rats (275–325 g) were included. After preparation of the Achilles tendon with a medial paratendinous approach, Achilles tendon microcirculation was assessed using combined Laser-Doppler and spectrophotometry (Oxygen-to-see) regarding: - tendinous capillary blood flow [arbitrary units AU] - tendinous tissue oxygen saturation [%] - tendinous venous filling pressure [rAU] The main body of the Achilles tendon was measured in the center of the suture with 50 Hz. 10 minutes after Achilles tendon suture (6-0 Prolene), a second assessment of microcirculatory parameters was performed. Results Achilles tendon capillary blood flow decreased by 57% following the suture (70 ± 30 AU vs. 31 ± 16 AU; p < 0.001). Tendinous tissue oxygen saturation remained at the same level before and after suture (78 ± 17% vs. 77 ± 22%; p = 0.904). Tendinous venous filling pressure increased by 33% (54 ± 16 AU vs. 72 ± 20 AU; p = 0.019) after suture. Conclusion Achilles tendon suture in anaesthetised rats causes an acute loss of capillary perfusion and increases postcapillary venous filling pressures indicating venous stasis. The primary hypothesis of this study was confirmed. In contrast, tendinous tissue oxygen saturation remains unchanged excluding acute intratendinous hypoxia within the first 10 minutes after suture. Further changes of oxygen saturation remain unclear. Furthermore, it remains to be determined to what extent reduced capillary blood flow as well as increased postcapillary stasis might influence tendon healing from a microcirculatory point of view in this animal setting

  10. Substantial creep in healing human Achilles tendons. A pilot study

    PubMed Central

    Aspenberg, Per; Schepull, Thorsten

    2015-01-01

    Summary Background healing after rupture of the Achilles tendon can be described in terms of mechanical properties of the new-formed tissue, constituting the tendon callus. In previous human studies, the elastic modulus and the density remained almost constant during 3 months after mobilization started, and then improved up to one year. So far, time-dependent deformation of the healing human tendon has not been reported. Methods in a series of 16 patients, operated with Achilles tendon suture, we implanted tantalum beads into the tendon and measured the distance between them repeatedly during 3 min of constant loading, using an ordinary image intensifier. The patients unloaded their leg for 30 min before the test. To avoid bias, all images were investigated in a randomized and blinded order. Results total strain during 3 min of constant loading at 7 weeks post injury amounted to 5%, and at 19 weeks to 3%. About half of the strain, after the loading was applied, occurred during the second and third min. Considerable strain also occurred just before loading, when the patient was told that a load would be applied, but before this was actually done. Conclusion the measurements were crude, and this study should be seen as a pilot. Still, visco-elastic properties seem to dominate the mechanical behavior the healing Achilles tendon from start of mobilization to 19 weeks, at least when tested after 30 min rest. This deserves further studies with more precise methods. PMID:26605187

  11. Percutaneous repair of the Achilles tendon in athletes.

    PubMed

    Martinelli, B

    2000-01-01

    The rupture of the Achilles tendon during amateur or professional sport-related activities is becoming more frequent, as is the request for treatments that enable the fastest possible recovery. This study includes 30 patients who sustained rupture of the Achilles tendon during various sport activities; for the last five years we have performed percutaneous suture repair by means of two parallel Dacron threads equipped with a harpoon and a malleable needle. This method alone enables immediate mobilization and an early load, preserves the blood supply of the paratenon, benefits from the motion which accelerates repair, without the well known complications produced both by the non-operative and by open surgical treatments. Excellent results have been achieved and all patients returned to their pre-injury level of sports activity after 120 to 150 days. PMID:11126717

  12. Management of achilles tendon injury: A current concepts systematic review.

    PubMed

    Gulati, Vivek; Jaggard, Matthew; Al-Nammari, Shafic Said; Uzoigwe, Chika; Gulati, Pooja; Ismail, Nizar; Gibbons, Charles; Gupte, Chinmay

    2015-05-18

    Achilles tendon rupture has been on the rise over recent years due to a variety of reasons. It is a debilitating injury with a protracted and sometimes incomplete recovery. Management strategy is a controversial topic and evidence supporting a definite approach is limited. Opinion is divided between surgical repair and conservative immobilisation in conjunction with functional orthoses. A systematic search of the literature was performed. Pubmed, Medline and EmBase databases were searched for Achilles tendon and a variety of synonymous terms. A recent wealth of reporting suggests that conservative regimens with early weight bearing or mobilisation have equivalent or improved rates of re-rupture to operative regimes. The application of dynamic ultrasound assessment of tendon gap may prove crucial in minimising re-rupture and improving outcomes. Studies employing functional assessments have found equivalent function between operative and conservative treatments. However, no specific tests in peak power, push off strength or athletic performance have been reported and whether an advantage in operative treatment exists remains undetermined. PMID:25992315

  13. Management of achilles tendon injury: A current concepts systematic review

    PubMed Central

    Gulati, Vivek; Jaggard, Matthew; Al-Nammari, Shafic Said; Uzoigwe, Chika; Gulati, Pooja; Ismail, Nizar; Gibbons, Charles; Gupte, Chinmay

    2015-01-01

    Achilles tendon rupture has been on the rise over recent years due to a variety of reasons. It is a debilitating injury with a protracted and sometimes incomplete recovery. Management strategy is a controversial topic and evidence supporting a definite approach is limited. Opinion is divided between surgical repair and conservative immobilisation in conjunction with functional orthoses. A systematic search of the literature was performed. Pubmed, Medline and EmBase databases were searched for Achilles tendon and a variety of synonymous terms. A recent wealth of reporting suggests that conservative regimens with early weight bearing or mobilisation have equivalent or improved rates of re-rupture to operative regimes. The application of dynamic ultrasound assessment of tendon gap may prove crucial in minimising re-rupture and improving outcomes. Studies employing functional assessments have found equivalent function between operative and conservative treatments. However, no specific tests in peak power, push off strength or athletic performance have been reported and whether an advantage in operative treatment exists remains undetermined. PMID:25992315

  14. Nonoperative biological treatment approach for partial Achilles tendon lesion.

    PubMed

    Filardo, Giuseppe; Presti, Mirco Lo; Kon, Elizaveta; Marcacci, Maurilio

    2010-02-01

    Tendon injuries, especially those of the Achilles tendon, are major concerns in sports medicine. The clinical presentation can be acute or chronic and the pathologic findings can range from peritendonitis to full-thickness tendon rupture. Nonsurgical treatment is not always successful; in particular, significant partial ruptures seem to respond poorly to conservative measures and do not improve with time. Surgery is most often considered the favored treatment option for this kind of lesion to obtain pain relief and full functionality with long-standing effects.This article describes a case of a partial tear of the Achilles tendon in a 34-year-old competitive athlete where surgical treatment was avoided in favor of a new biological approach. We applied autologous platelet growth factors through multiple platelet-rich plasma injections; approximately 6.5 billion platelets were injected into the lesion 3 times, 7 days apart. The treatment with platelet-rich plasma and a progressive rehabilitation program allowed the patient to play for 20 minutes in a basketball game 64 days after the trauma and in a full game 75 days after the trauma. To date, 18 months later, he has participated regularly in all the season's games and received no further treatment for his tendon.The fast tissue repair, confirmed by magnetic resonance and ultrasound imaging, allowed a swift return to full functionality and competitive sports activity, suggesting a possible role of platelet growth factors in promoting rapid tendon healing with high-quality tissue. This biological approach may represent a less-invasive therapeutic option even in cases where severe tendon lesions are candidates for surgical treatment. PMID:20192152

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

    PubMed

    Güngörmüş, Cansın; Kolankaya, Dürdane; Aydin, Erkin

    2015-05-01

    Tendon injuries in humans as well as in animals' veterinary medicine are problematic because tendon has poor regenerative capacity and complete regeneration of the ruptured tendon is never achieved. In the last decade there has been an increasing need of treatment methods with different approaches. The aim of the current study was to improve the regeneration process of rat Achilles tendon with tenocyte seeded decellularized tendon matrices. For this purpose, Achilles tendons were harvested, decellularized and seeded as a mixture of three consecutive passages of tenocytes at a density of 1 × 10(6) cells/ml. Specifically, cells with different passage numbers were compared with respect to growth characteristics, cellular senescence and collagen/tenocyte marker production before seeding process. The viability of reseeded tendon constructs was followed postoperatively up to 6 months in rat Achilles tendon by histopathological and biomechanical analysis. Our results suggests that tenocyte seeded decellularized tendon matrix can significantly improve the histological and biomechanical properties of tendon repair tissue without causing adverse immune reactions. To the best of our knowledge, this is the first long-term study in the literature which was accomplished to prove the use of decellularized matrix in a clinically relevant model of rat Achilles tendon and the method suggested herein might have important implications for translation into the clinic. PMID:25771002

  16. An unusual cause of Achilles tendon xanthoma.

    PubMed

    Parente, Fabienne; Vesnaver, Matthew; Massie, Rami; Baass, Alexis

    2016-01-01

    Tendinous xanthomas are often thought to be pathognomonic for familial hypercholesterolemia. In this report, we present the case of a young man with a normal lipid profile and Achilles tendon xanthoma. Biochemical and genetic studies confirmed the diagnosis of cerebrotendinous xanthomatosis in this patient. Cerebrotendinous xanthomatosis is a rare autosomal recessive disease associated with xanthoma in tendons and the brain as well as progressive neurologic deficits. Unfortunately, this rare form of reversible dementia is thought to be underdiagnosed. Early diagnosis and treatment of this disease with chenodeoxycholic acid is essential and has been shown to greatly improve the patient's symptoms and prognosis. PMID:27578138

  17. Cas rare de rupture bilatérale des tendons d'Achille sans notion de tendinopathie ou de chirurgie de la cheville chez un jeune sportif: à propos d'un cas et revue de la literature

    PubMed Central

    Belmoubarik, Amine; Abouchane, Merouane; Mahraoui, Mohamed Amine

    2015-01-01

    Les lésions du tendon d'Achille sont plus fréquentes que celles du tendon quadricipital ou patellaire. Les lésions bilatérales sont par contre plus rares et sont souvent associées à une notion de tendinopathie, d'injection de corticoïdes ou de maladies systémiques tels que le lupus érythémateux, l'ostéomalacie ou l'insuffisance rénale chronique. Nous rapportons le cas d'un patient de 34 ans victime d'une rupture bilatérale des tendons d'Achille suite à une réception de saut lors de la pratique de gymnastique. Le patient n’était pas suivi pour maladie de système ou mis sous corticothérapie ou fluoroquinolones. Le diagnostic a été suspecté devant une dépression anormalement creusant le relief sous cutané des deux tendons d'Achille avec une impossibilité de flexion dorsale des deux chevilles en association à un signe de Thompson bilatéralement positif. L’échographie a confirmé le diagnostic. Le patient a été traité par laçage et suture tendineuse à ciel ouvert. La rupture bilatérale du tendon d'Achille est rare. La plupart des patients rapportent une notion de maladie systémique ou un antécédent de chirurgie du genou. Nous rapportons le cas d'une lésion rare dans la littérature, une rupture bilatérale des tendons achiléens sans notions de maladies auto-immunes ni de traitement aux corticoïdes. Les lésions bilatérales présentent certaines particularités thérapeutiques et évolutives. En effet, deux difficultés sont à noter la première réside dans l'absence de référence comparative pour régler et apprécier l’équin physiologique lors de la réparation tendineuse. La deuxième difficulté est l'obligation de différer l'appui à 45 jours. Ce qui est contraignant pour le patient. La technique de réparation à ciel ouvert couplée à une immobilisation en équin protégeant la suture nous a donné des résultats satisfaisants. PMID:26140066

  18. In-vitro tensile testing machine for vibration study of fresh rabbit Achilles tendon

    NASA Astrophysics Data System (ADS)

    Revel, Gian M.; Scalise, Alessandro; Scalise, Lorenzo; Pianosi, Antonella

    2001-10-01

    A lot of people, overall athletic one suffer from tendinitis or complete rupture of the Achilles tendon. This structure becomes inflamed and damaged mainly from a variety of mechanical forces and sometimes due to metabolic problems, such as diabetes or arthritis. Over the past three decades extensive studies have been performed on the structural and mechanical properties of Achilles tendon trying to explain the constitutive equations to describe and foresee tendon behavior. Among the various mechanical parameters, the vibrational behavior is also of interest. Several investigations are performed in order to study how the Achilles tendon vibrations influence the response of the muscle proprioception and human posture. The present article describes how in vitro tensile experiments can be performed, taking into account the need to simulate physiological condition of Achilles tendon and thus approaching some opened problems in the design of the experimental set-up. A new system for evaluating tendon vibrations by non contact techniques is proposed. Preliminary simple elongation tests are made extracting the main mechanical parameters: stress and strain at different fixed stretches, in order to characterize the tissue. Finally, a vibration study is made at each pretensioned tendon level evaluating the oscillating curves caused by a small hammer.

  19. Ultrasound of the Achilles tendon after surgical repair: morphology and function.

    PubMed

    Rupp, S; Tempelhof, S; Fritsch, E

    1995-05-01

    Ultrasound is a well established method for the examination of the Achilles tendon. The objective of the study was to provide answers to the following questions: What ultrasonographic structural changes are long lasting after surgical repair? How important is ultrasound with regards to the functional evaluation of late results? 60 patients were examined at an average 11 years (2-19) after surgical repair of Achilles tendon rupture. In only four patients sonographic morphology of the tendon was according to the non-injured side. A variety of distinct basic alterations in ultrasound morphology was found: a hypoechogenic ribbon ventrally to the dorsal paratenon (n = 40), spots of hypoechogenic areas in the tendon (n = 18), dishomogeneous hyperechogenicity with preservation (n = 12) or dissolving (n = 22) of its fibrillar components along the longitudinal axis. In most of the cases the paratenon was thickened or could not be differentiated. In the dynamic ultrasound examination gliding mechanism of the achilles tendon was limited in 41 patients. Extensive functional subjective and objective parameters of all patients were evaluated in an Achilles tendon score. The results were rated as excellent (n = 18), good (n = 29), satisfactory (n = 12) and poor (n = 1). There was no statistical correlation between ultrasound morphology and clinical outcome. Therefore, it was concluded that ultrasound examination is able to reveal long-lasting alterations in echogenicity of the tendon but is only of limited value with regards to evaluation of the functional results after surgical repair. PMID:7788228

  20. The Effects of Irreversible Electroporation on the Achilles Tendon: An Experimental Study in a Rabbit Model

    PubMed Central

    Yan, Mingwei; Ding, Weidong; Xu, Kui; Fan, Qingyu; Li, Zhao

    2015-01-01

    Background To evaluate the potential effects of irreversible electroporation ablation on the Achilles tendon in a rabbit model and to compare the histopathological and biomechanical changes between specimens following electroporation ablation and radiofrequency ablation. Methods A total of 140 six-month-old male New Zealand rabbits were used. The animals were randomly divided into two groups, 70 in the radiofrequency ablation group and 70 in the electroporation group. In situ ablations were applied directly to the Achilles tendons of rabbits using typical electroporation (1800 V/cm, 90 pulses) and radiofrequency ablation (power control mode) protocols. Histopathological and biomechanical evaluations were performed to examine the effects of electroporation ablation and radiofrequency ablation over time. Results Both electroporation and radiofrequency ablation produced complete cell ablation in the target region. Thermal damage resulted in tendon rupture 3 days post radiofrequency ablation. In contrast, electroporation-ablated Achilles tendons preserved their biomechanical properties and showed no detectable rupture at this time point. The electroporation-ablated tendons exhibited signs of recovery, including tenoblast regeneration and angiogenesis within 2 weeks, and the restoration of their integral structure was evident within 12 weeks. Conclusions When applying electroporation to ablate solid tumors, major advantage could be that collateral damage to adjacent tendons or ligaments is minimized due to the unique ability of electroporation ablation to target the cell membrane. This advantage could have a significant impact on the field of tumor ablation near vital tendons or ligaments. PMID:26114962

  1. Biomechanical properties of Achilles tendon repair augmented with a bioadhesive-coated scaffold

    PubMed Central

    Brodie, Michael; Vollenweider, Laura; Murphy, John L; Xu, Fangmin; Lyman, Arinne; Lew, William D; Lee, Bruce P

    2011-01-01

    The Achilles tendon is the most frequently ruptured tendon. Both acute and chronic (neglected) tendon ruptures can dramatically affect a patient’s quality of life, and require a prolonged period of recovery before return to pre-injury activity levels. This paper describes the use of an adhesive-coated biologic scaffold to augment primary suture repair of transected Achilles tendons. The adhesive portion consisted of a synthetic mimic of mussel adhesive proteins that can adhere to various surfaces in a wet environment, including biologic tissues. When combined with biologic scaffolds such as bovine pericardium or porcine dermal tissues, these adhesive constructs demonstrated lap shear adhesive strengths significantly greater than that of fibrin glue, while reaching up to 60% of the strength of a cyanoacrylate-based adhesive. These adhesive constructs were wrapped around transected cadaveric porcine Achilles tendons repaired with a combination of parallel and three-loop suture patterns. Tensile mechanical testing of the augmented repairs exhibited significantly higher stiffness (22–34%), failure load (24–44%), and energy to failure (27–63%) when compared to control tendons with suture repair alone. Potential clinical implications of this novel adhesive biomaterial are discussed. PMID:21266745

  2. Quadriceps tendon allografts as an alternative to Achilles tendon allografts: a biomechanical comparison.

    PubMed

    Mabe, Isaac; Hunter, Shawn

    2014-12-01

    Quadriceps tendon with a patellar bone block may be a viable alternative to Achilles tendon for anterior cruciate ligament reconstruction (ACL-R) if it is, at a minimum, a biomechanically equivalent graft. The objective of this study was to directly compare the biomechanical properties of quadriceps tendon and Achilles tendon allografts. Quadriceps and Achilles tendon pairs from nine research-consented donors were tested. All specimens were processed to reduce bioburden and terminally sterilized by gamma irradiation. Specimens were subjected to a three phase uniaxial tension test performed in a custom environmental chamber to maintain the specimens at a physiologic temperature (37 ± 2 °C) and misted with a 0.9 % NaCl solution. There were no statistical differences in seven of eight structural and mechanical between the two tendon types. Quadriceps tendons exhibited a significantly higher displacement at maximum load and significantly lower stiffness than Achilles tendons. The results of this study indicated a biomechanical equivalence of aseptically processed, terminally sterilized quadriceps tendon grafts with bone block to Achilles tendon grafts with bone block. The significantly higher displacement at maximum load, and lower stiffness observed for quadriceps tendons may be related to the failure mode. Achilles tendons had a higher bone avulsion rate than quadriceps tendons (86 % compared to 12 %, respectively). This was likely due to observed differences in bone block density between the two tendon types. This research supports the use of quadriceps tendon allografts in lieu of Achilles tendon allografts for ACL-R. PMID:24414293

  3. [Microcirculation of the Achilles tendon and significance of the paratenon. A study with the plastination method].

    PubMed

    Graf, J; Schneider, U; Niethard, F U

    1990-05-01

    Rupture of a healthy Achilles tendon is disputed. A previous degenerative process with ischemia after recurrent microtraumas is usually held to be responsible. The vascular anatomy of eight human specimens was defined with a new method after perfusion through the femoral artery. This method allows exact analysis of the vessels even at a microscopic level. In contrast with the literature, the authors found a large number of anastomoses between the extra- and the intratendinous vessel system. The well-vascularized paratenon is therefore very important for the nutrition of the Achilles tendon. This fact must be taken into account during the surgical treatment of a rupture. The authors agree with the studies of the anatomist Lang who found a decrease of the intratendinous vascularization in an area 3 to 5 cm above the insertion in the os calcis. However a relationship between the frequency of rupture in this area and the vascular anatomy has not yet been shown. PMID:2198202

  4. A novel postoperative immobilization model for murine Achilles tendon sutures.

    PubMed

    Shibuya, Yoichiro; Takayama, Yuzo; Kushige, Hiroko; Jacinto, Sandra; Sekido, Mitsuru; Kida, Yasuyuki S

    2016-08-01

    The body's motion and function are all in part effected by a vital tissue, the tendon. Tendon injury often results in limited functioning after postoperative procedures and even for a long time after rehabilitation. Although numerous studies have reported surgical procedures using animal models which have contributed to both basic and clinical research, modeling of tendon sutures or postoperative immobilizations has not been performed on small experimental animals, such as mice. In this study we have developed an easy Achilles tendon suture and postoperative ankle fixation model in a mouse. Right Achilles tendons were incised and 10-0 nylons were passed through the proximal and distal ends using a modified Kessler method. Subsequently, the right ankle was immobilized in a plantarflexed position with novel splints, which were made from readily available extension tubes. Restriction of the tendon using handmade splints reduced swelling, as opposed to fixating with the usual plaster of Paris. Using this method, the usage of the right Achilles tendons began on postoperative days 13.5 ± 4.6, which indicated healing within two weeks. Therefore our simple short-term murine Achilles tendon suture procedure is useful for studying immediate tendon repair mechanisms in various models, including genetically-modified mice. PMID:26678297

  5. Unrecognized pediatric partial Achilles tendon injury followed by traumatic completion: a case report and literature review.

    PubMed

    Vasileff, William Kelton; Moutzouros, Vasilios

    2014-01-01

    Achilles tendon ruptures are a relatively common athletic injury but are exceedingly rare in the pediatric population. We describe the case of a 10-year-old ice hockey player who experienced an Achilles tendon injury from a laceration to the posterior leg from a skate blade that led to a partial tendon laceration. This tendon injury was initially unrecognized despite an emergency department evaluation. The patient continued to complain of weakness and paresthesia after the skin laceration had healed. A traumatic dorsiflexion injury while running several weeks later led to a traumatic complete tendon rupture. The clinical, operative, and physical therapy records were reviewed to complete the history, treatment, and rehabilitation progress. The initial laceration injury had occurred 6 weeks before presentation, and the traumatic dorsiflexion injury had occurred 2 days before referral to an acute orthopedics clinic. Open repair was performed several days after the traumatic completion of the laceration, and the patient was immobilized in a cast for 5 weeks. The patient had weaned off crutches by 10 weeks postoperatively and had returned to some activities and light skating at 5.5 months. A full return to running and ice hockey had been achieved by 8 months postoperatively. The optimal repair for this injury has not been well established in published studies. We have concluded that laceration injuries have the potential to mask tendon injuries and that prolonged symptoms after a laceration should suggest occult pathologic features. Open tendon repair is a viable treatment option in the pediatric patient with Achilles tendon ruptures. A return to activities within a reasonable period can be expected with robust physical therapy. PMID:24713492

  6. Biomechanical evaluation of acellular collagen matrix augmented Achilles tendon repair in sheep.

    PubMed

    Song, Lin; Olsen, Raymond E; Spalazzi, Jeffrey P; Davisson, Twana

    2010-01-01

    The rate of rerupture of repaired Achilles tendon in young and athletic populations remains high despite improvement in surgical techniques, suture design, and postsurgical management. Acellular biological matrices can be used to enhance the immediate strength of repaired tendons and to serve as scaffolds for cell in-growth and constructive tissue remodeling. A number of commercially available matrices have been used clinically, albeit with varying degrees of success and failure. The disparity is likely attributable to the different physical and biochemical properties of individual matrices. In this study, we investigated the biomechanical characteristics of 2 different acellular collagen matrices, namely TissueMend and GraftJacket, using a sheep Achilles tendon repair model. Static and cyclic creep, cyclic and linear construct stiffness, maximum load to failure, and displacement at maximum load were determined at time zero. We found that the maximum load to failure, displacement, and ultimate failure mode were similar between tendons augmented with either acellular collagen matrix; however, TissueMend augmentation yielded lower creep and smaller construct elongation than did GraftJacket. The results indicated that the strength of TissueMend-augmented tendons and GraftJacket-augmented tendons was not statistically significantly different, although tendons augmented with TissueMend displayed greater stiffness, which may be clinically advantageous in the restoration of ruptured tendons. PMID:20797586

  7. Quantitative ultrasound (QUS) assessment of tissue properties for Achilles tendons

    NASA Astrophysics Data System (ADS)

    Du, Yi-Chun; Chen, Yung-Fu; Chen, Pei-Jarn; Lin, Yu-Ching; Chen, Tainsong; Lin, Chii-Jeng

    2007-09-01

    Quantitative ultrasound (QUS) techniques have recently been widely applied for the characterization of tissues. For example, they can be used for the quantification of Achilles tendon properties based on the broadband ultrasound attenuation (BUA) and the speed of sound (SOS) when the ultrasound wave passes through the tissues. This study is to develop an integrated system to investigate the properties of Achilles tendons using QUS images from UBIS 5000 (DMS, Montpellier, France) and B-mode ultrasound images from HDI 5000 (ATL, Ultramark, USA). Subjects including young (32 females and 17 males; mean age: 23.7 ± 2.0) and middle-aged groups (8 female and 8 males; mean age: 47.3 ± 8.5 s) were recruited and tested for this study. Only subjects who did not exercise regularly and had no record of tendon injury were studied. The results show that the BUA is significantly higher for the young group (45.2 ± 1.6 dB MHz-1) than the middle-age group (40.5 ± 1.9 dB MHz-1), while the SOS is significantly lower for the young (1601.9 ± 11.2 ms-1) compared to the middle-aged (1624.1 ± 8.7 m s-1). On the other hand, the thicknesses of Achilles tendons for both groups (young: 4.31 ± 0.23 mm; middle age: 4.24 ± 0.23 mm) are very similar. For one patient who had an Achilles tendon lengthening (ATL) surgery, the thickness of the Achilles tendon increased from 4 mm to 4.33 mm after the surgery. In addition, the BUA increased by about 7.2% while the SOS decreased by about 0.6%. In conclusion, noninvasive ultrasonic assessment of Achilles tendons is useful for assisting clinical diagnosis and for the evaluation of a therapeutic regimen.

  8. Human Achilles tendon glycation and function in diabetes.

    PubMed

    Couppé, Christian; Svensson, Rene Brüggebusch; Kongsgaard, Mads; Kovanen, Vuokko; Grosset, Jean-Francois; Snorgaard, Ole; Bencke, Jesper; Larsen, Jytte Overgaard; Bandholm, Thomas; Christensen, Tomas Møller; Boesen, Anders; Helmark, Ida Carøe; Aagaard, Per; Kjaer, Michael; Magnusson, Stig Peter

    2016-01-15

    Diabetic patients have an increased risk of foot ulcers, and glycation of collagen may increase tissue stiffness. We hypothesized that the level of glycemic control (glycation) may affect Achilles tendon stiffness, which can influence gait pattern. We therefore investigated the relationship between collagen glycation, Achilles tendon stiffness parameters, and plantar pressure in poorly (n = 22) and well (n = 22) controlled diabetic patients, including healthy age-matched (45-70 yr) controls (n = 11). There were no differences in any of the outcome parameters (collagen cross-linking or tendon stiffness) between patients with well-controlled and poorly controlled diabetes. The overall effect of diabetes was explored by collapsing the diabetes groups (DB) compared with the controls. Skin collagen cross-linking lysylpyridinoline, hydroxylysylpyridinoline (136%, 80%, P < 0.01) and pentosidine concentrations (55%, P < 0.05) were markedly greater in DB. Furthermore, Achilles tendon material stiffness was higher in DB (54%, P < 0.01). Notably, DB also demonstrated higher forefoot/rearfoot peak-plantar-pressure ratio (33%, P < 0.01). Overall, Achilles tendon material stiffness and skin connective tissue cross-linking were greater in diabetic patients compared with controls. The higher foot pressure indicates that material stiffness of tendon and other tissue (e.g., skin and joint capsule) may influence foot gait. The difference in foot pressure distribution may contribute to the development of foot ulcers in diabetic patients. PMID:26542519

  9. Madelung Deformity and Extensor Tendon Rupture.

    PubMed

    Shahcheraghi, Gholam Hossain; Peyman, Maryam; Mozafarian, Kamran

    2015-07-01

    Extensor tendon rupture in chronic Madelung deformity, as a result of tendon attrition on the dislocated distal ulna, is a rare occurrence. It is, however, seen more often in rheumatoid arthritis. There are few case reports in the English-language literature on this issue. We report a case of multiple tendon ruptures in a previously undiagnosed Madelung deformity. PMID:26161772

  10. Spatial variations in Achilles tendon shear wave speed

    PubMed Central

    DeWall, Ryan J.; Slane, Laura C.; Lee, Kenneth S.; Thelen, Darryl G.

    2014-01-01

    Supersonic shear imaging (SSI) is an ultrasound imaging modality that can provide insight into tissue mechanics by measuring shear wave propagation speed, a property that depends on tissue elasticity. SSI has previously been used to characterize the increase in Achilles tendon shear wave speed that occurs with loading, an effect attributable to the strain-stiffening behavior of the tissue. However, little is known about how shear wave speed varies spatially, which is important, given the anatomical variation that occurs between the calcaneus insertion and the gastrocnemius musculotendon junction. The purpose of this study was to investigate spatial variations in shear wave speed along medial and lateral paths of the Achilles tendon for three different ankle postures: resting ankle angle (R, i.e. neutral), plantarflexed (P; R − 15 deg), and dorsiflexed (D; R + 15 deg). We observed significant spatial and posture variations in tendon shear wave speed in ten healthy young adults. Shear wave speeds in the Achilles free tendon averaged 12 ± 1.2 m/s in a resting position, but decreased to 7.2 ± 1.8 m/s with passive plantarflexion. Distal tendon shear wave speeds often reached the maximum tracking limit (16.3 m/s) of the system when the ankle was in the passively dorsiflexed posture (+15 deg from R). At a fixed posture, shear wave speeds decreased significantly from the free tendon to the gastrocnemius musculotendon junction, with slightly higher speeds measured on the medial side than on the lateral side. Shear wave speeds were only weakly correlated with the thickness and depth of the tendon, suggesting that the distal-to-proximal variations may reflect greater compliance in the aponeurosis relative to the free tendon. The results highlight the importance of considering both limb posture and transducer positioning when using SSI for biomechanical and clinical assessments of the Achilles tendon. PMID:24933528

  11. Analysis of collagen organization in mouse achilles tendon using high-frequency ultrasound imaging.

    PubMed

    Riggin, Corinne N; Sarver, Joseph J; Freedman, Benjamin R; Thomas, Stephen J; Soslowsky, Louis J

    2014-02-01

    Achilles tendon ruptures are traumatic injuries, and techniques for assessing repair outcomes rely on patient-based measures of pain and function, which do not directly assess tendon healing. Consequently, there is a need for a quantitative, in vivo measure of tendon properties. Therefore, the purpose of this study was to validate ultrasound imaging for evaluating collagen organization in tendons. In this study, we compared our novel, high-frequency ultrasound (HFUS) imaging and analysis method to a standard measure of collagen organization, crossed polarizer (CP) imaging. Eighteen mouse Achilles tendons were harvested and placed into a testing fixture where HFUS and CP imaging could be performed simultaneously in a controlled loading environment. Two experiments were conducted: (1) effect of loading on collagen alignment and (2) effect of an excisional injury on collagen alignment. As expected, it was found that both the HFUS and CP methods could reliably detect an increase in alignment with increasing load, as well as a decrease in alignment with injury. This HFUS method demonstrates that structural measures of collagen organization in tendon can be determined through ultrasound imaging. This experiment also provides a mechanistic evaluation of tissue structure that could potentially be used to develop a targeted approach to aid in rehabilitation or monitor return to activity after tendon injury. PMID:24356929

  12. The traumatic rupture of the Achilles’ tendon – an analysis of the modern methods of evaluation and treatment

    PubMed Central

    BARDAŞ, CIPRIAN; BENEA, HOREA; MARTIN, ARTUR; TOMOAIA, GHEORGHE

    2013-01-01

    Aims The main aim of this article is an analysis of both advantages and disadvantages of the modern solutions of treatment – percutaneous surgery, in comparison with the classic methods of treatments described in the surgery of Achilles’ tendon. Patients and method The study was conducted on 23 patients admitted to the Orthopedics and Traumatology Clinic of Cluj-Napoca between January 2011–June 2012. Nineteen (19) patients were diagnosed with a complete rupture of the Achilles tendon and 4 patients with a partial rupture. The diagnosis of traumatic Achilles tendon ruptures was usually clinical, the Ultrasound (common or 3D) and the MRI confirmed the lesion and determined its location and extension. We analyzed the diagnostic methods, the elapsed time before surgery, the treatment options depending on lesion’s location, technical difficulties, costs, postoperative care, the average healing time, complications. Results The Ultrasound was performed in 65.2% of the patients (15 patients) for confirming the extension of the lesion and it served for pre-operative planning. In most of the cases, the classical methods of Achilles tendon reconstruction were used (18 cases). The complications rate was about 8%. We diagnosed an iterative Achilles tendon rupture (the patient was initially treated using the percutaneous methods) and a delay in cicatrisation. Conclusions The percutaneous surgical techniques are a viable alternative for the acute ruptures of Achilles tendon, the classic intervention has clear indications in lesions diagnosed late, in the recurrent tendon ruptures. PMID:26527933

  13. Can transcutaneous electrical nerve stimulation improve achilles tendon healing in rats?

    PubMed Central

    Folha, Roberta A. C.; Pinfildi, Carlos E.; Liebano, Richard E.; Rampazo, Érika P.; Pereira, Raphael N.; Ferreira, Lydia M.

    2015-01-01

    BACKGROUND: Tendon injury is one of the most frequent injuries in sports activities. TENS is a physical agent used in the treatment of pain but its influence on the tendon's healing process is unclear. OBJECTIVE: To evaluate the influence of TENS on the healing of partial rupture of the Achilles tendon in rats. METHOD: Sixty Wistar rats were submitted to a partial rupture of the Achilles tendon by direct trauma and randomized into six groups (TENS or Sham stimulation) and the time of evaluation (7, 14, and 21 days post-injury). Burst TENS was applied for 30 minutes, 6 days, 100 Hz frequency, 2 Hz burst frequency, 200 µs pulse duration, and 300 ms pulse train duration. Microscopic analyses were performed to quantify the blood vessels and mast cells, birefringence to quantify collagen fiber alignment, and immunohistochemistry to quantify types I and III collagen fibers. RESULTS: A significant interaction was observed for collagen type I (p=0.020) where the TENS group presented lower percentage in 14 days after the lesion (p=0.33). The main group effect showed that the TENS group presented worse collagen fiber alignment (p=0.001) and lower percentage of collagen III (p=0.001) and the main time effect (p=0.001) showed decreased percentage of collagen III at 7 days (p=0.001) and 14 days (p=0.001) after lesion when compared to 21 days. CONCLUSIONS: Burst TENS inhibited collagen I and III production and impaired its alignment during healing of partial rupture of the Achilles tendon in rats. PMID:26647744

  14. Strain mapping in the Achilles tendon - A systematic review.

    PubMed

    Bogaerts, Stijn; Desmet, Hannelore; Slagmolen, Pieter; Peers, Koen

    2016-06-14

    Achilles tendinopathy remains one of the most prevalent overuse injuries in elite as well as recreational athletes. Regardless of the fact that the aetiology of tendinopathy has not been fully understood, therapeutic mechanical loading programs have emerged as being the treatment of choice. In this light, mechanical properties of the tendon and their response to changes in loading or unloading have been the subject of many previous investigations. One of these properties often investigated is strain, a measure of relative deformation. By means of a systematic review, an overview was given of research in this field, with a primary objective to list the methods used and secondary aim to synthesize data on strain mapping in the Achilles tendon. Following the guidelines of the PRISMA statement, 47 articles were found appropriate for qualitative assessment. Achilles tendon strain has been investigated across a variety of contexts, including the response to exercise, walking, unloading, ageing, hormonal changes and weight. Only three studies investigated the effect of the presence of tendinopathy on strain. Ultrasound was the most often used imaging modality to measure or estimate strain. Further methodological parameters, e.g. the location of measurement, differed greatly between all different studies. Nearly all studies considered global strain. Some studies investigated the transverse strain response of the Achilles tendon. Recently, however, the role of local - intratendinous - strain distribution has been found to be of critical importance and further studies should focus on imaging modalities to investigate these local changes. PMID:27113537

  15. Changes in the Achilles tendon reflexes following Skylab missions

    NASA Technical Reports Server (NTRS)

    Baker, J. T.; Nicogossian, A. E.; Hoffler, G. W.; Johnson, R. L.; Hordinsky, J. R.

    1977-01-01

    Postflight measurements of Achilles tendon reflex duration on Skylab crewmen indicate a state of disequilibrium between the flexor and extensor muscle groups with an initial decrease in reflex duration. As the muscles regain strength and mass there occurs an overcompensation reflected by increased reflex duration. Finally, when a normal neuromuscular state is reached the reflex duration returns to baseline value.

  16. Common Disorders of the Achilles Tendon

    MedlinePlus

    ... stress on the tendon too quickly, leading to micro-injury of the tendon fibers. Due to this ... with over-pronation or gait abnormalities, custom orthotic devices may be prescribed. Night splints. Night splints help ...

  17. Response of rabbit Achilles tendon to chronic repetitive loading.

    PubMed

    Archambault, J M; Hart, D A; Herzog, W

    2001-01-01

    The objective of this work was to assess the response of tendon to chronic repetitive loading. Controlled muscle stimulation was used to load the rabbit Achilles tendon at a frequency of 1.25 Hz for two hours per day, three days per week for a period of 11 weeks. Average peak tendon force was 26 N during the protocol. The loading protocol did not modify the gross morphology of the tissue, nor its water content or cellularity. Increases in mRNA expression of collagen Type III and MMPs were observed, but no signs of injury were detected by histologic examination of tendon and paratenon structures. The lack of a detectable injury response suggests that the tendons were not loaded beyond their capacity for repair. Factors additional to mechanical loading such as aging, illness or stress may be necessary to produce pathology. PMID:11696985

  18. Simultaneous and spontaneous bilateral quadriceps tendons rupture.

    PubMed

    Celik, Evrim Coşkun; Ozbaydar, Mehmet; Ofluoglu, Demet; Demircay, Emre

    2012-07-01

    Simultaneous and spontaneous bilateral quadriceps tendon rupture is an uncommon injury that is usually seen in association with multiple medical conditions and some medications. We report a case of simultaneous and spontaneous bilateral quadriceps tendon rupture that may be related to the long-term use of a statin. PMID:22561379

  19. Rat model of Achilles tendon disorder. A pilot study.

    PubMed

    Messner, K; Wei, Y; Andersson, B; Gillquist, J; Räsänen, T

    1999-01-01

    Three-month-old male rats were subjected 3 times weekly for 1 h to eccentric exercise of one triceps surae muscle (30 stimulations/min) under general anesthesia in order to induce Achilles tendon disorder corresponding to paratenonitis and tendinosis in man. Net muscle work during the sessions ranged between 0.67 and 4.37 mJ (mean 1.72, SD 0.77). After 9 and 13 sessions, respectively, 2 rats started to show gait alterations during the functional test which was performed 2-3 times weekly. These rats were killed after additional sessions which showed a worsening of the limp. The other trained rats and controls did not limp and were killed after 7-11 weeks. Histologic evaluation of the Achilles tendons from the exercised limb showed in the majority of the cases hypervascularization, increased number of nerve filaments and increased immunoreactivity for substance P and calcitonin gene-related peptide. The tendons from the nonstimulated limb looked normal. The distribution of collagen types I and II appeared normal in the tendon and its insertion to the calcaneus. Inflammation of the epi- and paratenon could be provoked in the rat, but tendon changes corresponding to chronic tendinosis did not develop within 11 weeks with the used training regime. The clinical relevance of this model for chronic tendon disease needs to be evaluated further. PMID:10460971

  20. The Gift Box Open Achilles Tendon Repair Method: A Retrospective Clinical Series.

    PubMed

    Labib, Sameh A; Hoffler, C Edward; Shah, Jay N; Rolf, Robert H; Tingan, Alexis

    2016-01-01

    Previous biomechanical studies have shown that the gift box technique for open Achilles tendon repair is twice as strong as a Krackow repair. The technique incorporates a paramedian skin incision with a midline paratenon incision, and a modification of the Krackow stitch is used to reinforce the repair. The wound is closed in layers such that the paratenon repair is offset from paramedian skin incision, further protecting the repair. The present study retrospectively reviews the clinical results for a series of patients who underwent the gift box technique for treatment of acute Achilles tendon ruptures from March 2002 to April 2007. The patients completed the Foot Function Index and the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale. The tendon width and calf circumference were measured bilaterally and compared using paired t tests with a 5% α level. A total of 44 subjects, mean age 37.5 ± 8.6 years, underwent surgery approximately 10.8 ± 6.5 days after injury. The response rate was 35 (79.54%) patients for the questionnaire and 20 (45.45%) for the examination. The mean follow-up period was 35.7 ± 20.1 months. The complications included one stitch abscess, persistent pain, and keloid formation. One (2.86%) respondent reported significant weakness. Five (14.29%) respondents indicated persistent peri-incisional numbness. The range of motion was full or adequate. The mean American Orthopaedic Foot and Ankle Society ankle-hindfoot scale score was 93.2 ± 6.8) and the mean Foot Function Index score was 7.0 ± 10.5. The calf girth and tendon width differences were statistically significantly between the limbs. The patients reported no repeat ruptures, sural nerve injuries, dehiscence, or infections. We present the outcomes data from patients who had undergone this alternative technique for Achilles tendon repair. The technique is reproducible, with good patient satisfaction and return to activity. The results compared well with the historical

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

    NASA Astrophysics Data System (ADS)

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

    2013-12-01

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

  2. Thicker Achilles tendons are a risk factor to develop Achilles tendinopathy in elite professional soccer players.

    PubMed

    Jhingan, Sachin; Perry, Mark; O'Driscoll, Gary; Lewin, Colin; Teatino, Raphael; Malliaras, Peter; Maffulli, Nicola; Morrissey, Dylan

    2011-04-01

    The primary aim of this prospective cohort study was to compare the incidence of Achilles tendinopathy symptoms in elite soccer players with and without baseline asymptomatic ultrasound abnormalities. This study also investigated the relationship between baseline tendon thickness and development of symptoms. Using ultrasonography, 18 players were examined in 2009 for the existence of hypoechoicity, paratenon blurring, focal thickening and/or neovascularisation, and anteroposterior tendon thickness was measured. Symptom development during the follow-up period was assessed by interview one year later. Baseline mid-tendon thickness was greater (p=0.041) in tendons that experienced symptoms [median (IQR): 0.53 (0.51-0.55) cm] in the following year than tendons remaining asymptomatic [0.48 (0.45-0.52) cm]. No association between the existence of baseline ultrasound signs and development of symptoms in the following year was observed (Chi-Square: 1.180, p=0.277). A thicker baseline mid-tendon thickness was identified as a risk indicator for the development of Achilles tendinopathy in elite soccer players. PMID:23738247

  3. Heel pain and Achilles tendonitis - aftercare

    MedlinePlus

    ... the length of the tendon when walking or running. Your pain and stiffness might increase in the ... or decrease activities that cause pain, such as running or jumping. Do activities that do not strain ...

  4. Management of subcalcaneal pain and Achilles tendonitis with heel inserts

    PubMed Central

    Maclellan, G. E.; Vyvyan, Barbara

    1981-01-01

    Soft tissue symptoms in the leg due to sporting activity are commonly associated with the force of heel strike. Conventional training shoes compromise between comfort and performance; few models are suitably designed for both considerations. Using a visco-elastic polymer insert the symptoms of heel pain and Achilles tendonitis have been largely or completely abolished in a preliminary study. Imagesp117-ap117-bp117-cp118-a PMID:7272653

  5. Achilles Tendon Reflex in Accidental Hypothermia and Hypothermic Myxoedema

    PubMed Central

    Maclean, D.; Taig, D. R.; Emslie-Smith, D.

    1973-01-01

    The photomotogram (P.M.G.) of the Achilles tendon reflex was studied in 26 patients with hypothermia (rectal temperature 33·3°C or less), 10 of whom also had myxoedema (serum protein bound iodine 2·8 μg/100 ml or less). No reflex could be elicited in eight (31%) of these patients, including three of those with myxoedema. Hypothermia increases both the contraction and the relaxation times of the reflex, the relaxation phase being particularly prolonged in those with myxoedema. In those patients from whom the reflex was elicited the ratio of the contraction time to the “half-relaxation time” in the P.M.G. was less than unity in six of the seven with myxoedema, and considerably greater than unity in eight of the 11 (73%) who were euthyroid. Thus, analysis of the Achilles tendon reflex P.M.G. correctly predicted the thyroid status in 14 of the 18 hypothermic patients in whom the Achilles tendon reflex was present (78%). The wider use of this rapid test of thyroid function would allow a more rational use of thyroid hormones in hypothermic patients and so lead to a better assessment of their value. PMID:4121692

  6. Effects of BMP-12-Releasing Sutures on Achilles Tendon Healing

    PubMed Central

    Chamberlain, Connie S.; Lee, Jae-Sung; Leiferman, Ellen M.; Maassen, Nicholas X.; Baer, Geoffrey S.

    2015-01-01

    Tendon healing is a complex coordinated event orchestrated by numerous biologically active proteins. Unfortunately, tendons have limited regenerative potential and as a result, repair may be protracted months to years. Current treatment strategies do not offer localized delivery of biologically active proteins, which may result in reduced therapeutic efficacy. Surgical sutures coated with nanostructured minerals may provide a potentially universal tool to efficiently incorporate and deliver biologically active proteins directly to the wound. Additionally, previous reports indicated that treatment with bone morphogenetic protein-12 (BMP-12) improved tendon healing. Based on this information, we hypothesized that mineral-coated surgical sutures may be an effective platform for localized BMP-12 delivery to an injured tendon. The objective of this study was, therefore, to elucidate the healing effects of mineral-coated sutures releasing BMP-12 using a rat Achilles healing model. The effects of BMP-12-releasing sutures were also compared with standard BMP-12 delivery methods, including delivery of BMP-12 through collagen sponge or direct injection. Rat Achilles tendons were unilaterally transected and repaired using BMP-12-releasing suture (0, 0.15, 1.5, or 3.0 μg), collagen sponge (0 or 1.5 μg BMP-12), or direct injection (0 or 1.5 μg). By 14 days postinjury, repair with BMP-12-releasing sutures reduced the appearance of adhesions to the tendon and decreased total cell numbers. BMP-12 released from sutures and collagen sponge also tended to improve collagen organization when compared with BMP-12 delivered through injection. Based on these results, the release of a protein from sutures was able to elicit a biological response. Furthermore, BMP-12-releasing sutures modulated tendon healing, and the delivery method dictated the response of the healing tissue to BMP-12. PMID:25354567

  7. Temporal Healing in Rat Achilles Tendon: Ultrasound Correlations

    PubMed Central

    Chamberlain, Connie S.; Duenwald-Kuehl, Sarah E.; Okotie, Gregory; Brounts, Sabrina H.; Baer, Geoffrey S.; Vanderby, Ray

    2012-01-01

    The purpose of this study was to explore whether a new ultrasound-based technique correlates with mechanical and biological metrics that describe the tendon healing. Achilles tendons in 32 rats were unilaterally transected and allowed to heal without repair. At 7, 9, 14, or 29 days post-injury, tendons were collected and examined for healing via ultrasound image analysis, mechanical testing, and immunohistochemistry. Consistent with previous studies, we observe that the healing tendons are mechanically inferior (ultimate stress, ultimate load, and normalized stiffness) and biologically altered (cellular and ECM factors) compared to contralateral controls with an incomplete recovery over healing time. Unique to this study, we report: 1) Echo intensity (defined by gray-scale brightness in the ultrasound image) in the healing tissue is related to stress and normalized stiffness. 2) Elongation to failure is relatively constant so that tissue normalized stiffness is linearly correlated with ultimate stress. Together, 1 and 2 suggest a method to quantify mechanical compromise in healing tendons. 3) The amount and type of collagen in healing tendons associates with their strength and normalized stiffness as well as their ultrasound echo intensity. 4) A significant increase of periostin in the healing tissues suggests an important but unexplored role for this ECM protein in tendon healing. PMID:23149902

  8. Quadriceps Tendon Rupture due to Postepileptic Convulsion

    PubMed Central

    Erkut, Adem; Guvercin, Yilmaz; Sahin, Rifat; Keskin, Davut

    2014-01-01

    We present a case of quadriceps tendon (QT) rupture. QT ruptures can occur in all ages. The cause is mostly traumatic in origin. Spontaneous ruptures that are thought to result from predisposing conditions are rare. Post-convulsion QT ruptures lacking traumas in their history can be overlooked in clinical examinations. This should be born in mind by the attending physician, as early diagnosis and treatment of the condition can lead to satisfactory outcomes. PMID:24944977

  9. Triceps tendon rupture: the knowledge acquired from the anatomy to the surgical repair.

    PubMed

    Celli, A

    2015-09-01

    Triceps injuries are relatively uncommon in most traumatic events, and the distal triceps tendon ruptures are rare. Recently, the knowledge of this tendon lesion has increased, and it seems to be related to more precise diagnostic and clinical assessments. The most common mechanism of injury remains a forceful eccentric contraction of the muscle, while several other risk factors have been studied as chronic renal failure, endocrine disorders, metabolic bone diseases as well as steroid use. Olecranon bursitis and local corticosteroid injections may also play a role. The commonest site of rupture is at the tendon's insertion into the olecranon and rarely at the myotendinous junction or intramuscularly. The surgical intervention is recommended in acute complete ruptures, and non-operative treatment is reserved for patients with major comorbidities, as well as for partial ruptures with little functional disability and in low demanding patients. Various techniques and approaches as the direct repair to bone, the tendon augmentation, the anconeus rotation flap and the Achilles tendon allograft have been proposed for the management of these challenging injuries. The goal of surgical management should be an anatomical repair of the injured tendon by selection of a procedure with a low complication rate and one that allows early mobilization. This manuscript focuses the triceps tendon ruptures starting from the anatomy to the diagnosis and entity of the triceps tendon injuries, as well as the indications and guidelines for the management. PMID:25957546

  10. Statins induce biochemical changes in the Achilles tendon after chronic treatment.

    PubMed

    de Oliveira, Letícia Prado; Vieira, Cristiano Pedrozo; Da Ré Guerra, Flávia; de Almeida, Marcos dos Santos; Pimentel, Edson Rosa

    2013-09-15

    Statins have been widely prescribed as lipid-lowering drugs and are associated with tendon rupture. Therefore, this study aimed to evaluate the possible biochemical changes in the Achilles tendon of rats after chronic treatment with statins. Dosages of statins were calculated using allometric scaling with reference to the 80mg/day and 20mg/day, doses recommended for humans. The rats were divided into the following groups: treated with simvastatin (S-20 and S-80), treated with atorvastatin (A-20 and A-80), and the control group that received no treatment (C). Measurements of low-density lipoprotein (LDL) in the plasma were performed. The levels of non-collagenous proteins, glycosaminoglycans (GAGs) and hydroxyproline were quantified. Western blotting for collagen I was performed, and the presence of metalloproteinases (MMPs)-2 and -9 was investigated through zymography. The concentration of non-collagenous proteins in S-20 was less than the C group. There was a significant increase in pro-MMP-2 activity in A-80 group and in active MMP-2 in S-20 group compared to the C group. A significant increase in latent MMP-9 activity was observed in both the A-80 and S-20 groups when compared to C group. In the A-20 group, there was a lower amount of collagen I in relation to C group. In addition, a higher concentration of hydroxyproline was found in the S-20 group than the C group. The analysis of GAGs showed a significant increase in the A-20 group when compared to C group. The treatment induced remarkable alterations in the Achilles tendon and the response of the tissue seems to depend of the used statin dosage. The presence of MMP-2 and MMP-9 is evidence of the degradation and remodeling processes in the extracellular matrix of the tendons. Our results show that statins induce imbalance of extracellular matrix components and possibly induce microdamage in tendons. PMID:23831763

  11. Tendon rupture associated with simvastatin/ezetimibe therapy.

    PubMed

    Pullatt, Raja C; Gadarla, Mamatha Reddy; Karas, Richard H; Alsheikh-Ali, Alawi A; Thompson, Paul D

    2007-07-01

    A case of spontaneous biceps tendon rupture in a physician during therapy with the combination of simvastatin and ezetimibe (Vytorin) is reported. Rechallenge produced tendinopathy in the contralateral biceps tendon that abated with drug discontinuation. Tendon rupture generally occurs in injured tendons. Physiological repair of an injured tendon requires degradation and remodeling of the extracellular matrix through matrix metalloproteinases (MMPs). Statins are known to inhibit MMPs. It was hypothesized that statins may increase the risk of tendon rupture by altering MMP activity. In conclusion, statins may increase the risk of tendon rupture by altering MMP activity. PMID:17599460

  12. Ultrasound diagnosis and percutaneous treatment of Achilles tendon tethering: a case series.

    PubMed

    He, Lulu; Genin, Jason; Delzell, Patricia

    2016-09-01

    The purpose of this article is to report 3 cases of Kager's fat pad scarring and tethering to the deep surface of the Achilles tendon in patients with Achilles tendinosis symptomatology. The 3 patients were diagnosed sonographically by the use of a dynamic maneuver we described and named the "Kager's squeeze" technique. The key finding for diagnosis is the deformation and bowing of the deep fibers of the Achilles tendon during dynamic squeezing of Kager's fat pad. After diagnosis, the patients were treated with ultrasound-guided hydrodissection and scar release to restore normal motion between Kager's fat pad and the Achilles tendon. All 3 patients experienced significant clinical improvement shortly after treatment. Therefore, we suspect that Kager's fat pad scarring with Achilles tendon tethering may mimic or exacerbate Achilles tendinosis symptomatology and should be considered a possible diagnosis when conservative treatments for Achilles tendinosis fail. We demonstrate that Kager's fat pad scarring with Achilles tendon tethering can be diagnosed and treated with a simple in-office hydrodissection technique, leading to improved patient outcomes. PMID:27311649

  13. Glycine improves biochemical and biomechanical properties following inflammation of the achilles tendon.

    PubMed

    Vieira, Cristiano Pedrozo; De Oliveira, Letícia Prado; Da Ré Guerra, Flávia; Dos Santos De Almeida, Marcos; Marcondes, Maria Cristina Cintra Gomes; Pimentel, Edson Rosa

    2015-03-01

    Tendinopathy of the Achilles tendon is a clinical problem that motivates the scientific community to search for treatments that assist in restoring its functional properties. Glycine has broad biological effects, acting as a modulator of the inflammatory cascade, and is the predominant amino acid in collagen. A 5% glycine diet provided beneficial effects against toxicity and inflammation since glycine may restructure the collagen molecules faster due to its broad anti-inflammatory effects. The purpose was analyze the effects of a 5% glycine diet in rats as a treatment for the inflammatory process. The experimental groups were as follows: C (control group), G1 and G3 (inflammatory group), and G2 and G4 (glycine+inflammatory group). G1 and G2 were euthanized 8 days following injury, and G3 and G4 were euthanized 22 days following injury. The concentrations of hydroxyproline, non-collagenous proteins, and glycosaminoglycans, as well as the activity of MMP-2 and -9 were analyzed. Biomechanical and morphological tests were employed. Higher concentrations of hydroxyproline and glycosaminoglycans were found in G4 and an increased activity of MMP-2 was found in G2. Higher birefringence was noted in group G2. The biomechanical results indicated that the tendon was more resistant to loading to rupture upon treatment with a glycine diet in group G4. Glycine induced the synthesis of important components of the tendon. A rapid remodeling was noted when compared with the inflamed-only groups. These data suggest that glycine may be a beneficial supplement for individuals with inflammation of the Achilles tendon. PMID:25156668

  14. The effect of dry needling and treadmill running on inducing pathological changes in rat Achilles tendon.

    PubMed

    Kim, Bom Soo; Joo, Young Chae; Choi, Byung Hyune; Kim, Kil Hwan; Kang, Joon Soon; Park, So Ra

    2015-11-01

    Achilles tendinopathy is a common degenerative condition without a definitive treatment. An adequate chronic animal model of Achilles tendinopathy has not yet been developed. The purpose of this study was to evaluate the individual and combined effects of dry needling and treadmill running on the Achilles tendon of rats. Percutaneous dry needling, designed to physically replicate microrupture of collagen fibers in overloaded tendons, was performed on the right Achilles tendon of 80 Sprague-Dawley rats. The rats were randomly divided into two groups: a treadmill group, which included rats that underwent daily uphill treadmill running (n = 40), and a cage group, which included rats that could move freely within their cages (n = 40). At the end of weeks 1 and 4, 20 rats from each group were sacrificed, and bilateral Achilles tendons were collected. The harvested tendons were subjected to mechanical testing and histological analysis. Dry needling induced histological and mechanical changes in the Achilles tendons at week 1, and the changes persisted at week 4. The needled Achilles tendons of the treadmill group tended to show more severe histological and mechanical changes than those of the cage group, although these differences were not statistically significant. Dry needling combined with free cage activity or treadmill running produced tendinopathy-like changes in rat Achilles tendons up to 4 weeks after injury. Dry needling is an easy procedure with a short induction period and a high success rate, suggesting it may have relevance in the design of an Achilles tendinopathy model. PMID:26076317

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

    PubMed

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

    2016-08-01

    Study Design Level 4, controlled laboratory study. Background Little is known regarding how the potential differences between treadmill and overground running may affect patellofemoral joint and Achilles tendon loading characteristics. Objectives To compare measures of loading of the patellofemoral joint and Achilles tendon across treadmill and overground running in healthy, uninjured runners. Methods Eighteen healthy runners ran at their self-selected speed on an instrumented treadmill and overground, while 3-D running mechanics were sampled. A musculoskeletal model derived peak load, rate of loading, and estimated cumulative load per 1 km of continuous running for the patellofemoral joint and Achilles tendon for each condition. Data were analyzed via paired t tests and Pearson correlations to detect differences and assess relationships, respectively, between the 2 running mediums. Results No differences (P>.05) were found between treadmill and overground running for peak load, rate of loading, or estimated cumulative patellofemoral joint stress per 1 km of continuous running. However, treadmill running resulted in 12.5% greater peak Achilles tendon force (P<.001), 15.6% greater loading rate of Achilles tendon force (P<.001), and 14.2% greater estimated cumulative Achilles tendon force per 1 km of continuous running (P<.001) compared with overground running. There were strong (r>0.70) and moderate agreements (r>0.50) for most patellofemoral joint and Achilles measures, respectively, between treadmill and overground running. Conclusion No differences were observed in loading characteristics to the patellofemoral joint between running mediums; however, treadmill running resulted in greater Achilles tendon loading compared with overground running. Future investigations should examine whether sudden bouts of treadmill running may increase the risk of mechanical overload of the Achilles tendon in runners who habitually train overground. J Orthop Sports Phys Ther 2016

  16. Concurrent deficits of soleus and gastrocnemius muscle fascicles and Achilles tendon post stroke

    PubMed Central

    Zhao, Heng; Ren, Yupeng; Roth, Elliot J.; Harvey, Richard L.

    2015-01-01

    Calf muscles and Achilles tendon play important roles in functional activities. However, it is not clear how biomechanical properties of the uniarticular soleus (SOL) and biarticular gastrocnemius muscle and Achilles tendon, including the fascicle length, pennation angle, and stiffness, change concurrently post stroke. Biomechanical properties of the medial gastrocnemius (GM) and soleus muscles were evaluated bilaterally in 10 hemiparetic stroke survivors using combined ultrasonography-biomechanical measurements. Biomechanical properties of the Achilles tendon including the length, cross-sectional area (CSA), stiffness, and Young's modulus were evaluated, together with calf muscle biomechanical properties. Gastrocnemius and SOL contributions were separated using flexed and extended knee positions. The impaired side showed decreased fascicle length (GM: 6%, P = 0.002 and SOL: 9%, P = 0.03, at full knee extension and 0° ankle dorsiflexion) and increased fascicular stiffness (GM: 64%, P = 0.005 and SOL: 19%, P = 0.012, at a common 50 N force level). In contrast, Achilles tendon on the impaired side showed changes in the opposite direction as the muscle fascicles with increased tendon length (5%, P < 0.001), decreased tendon CSA (5%, P = 0.04), decreased tendon stiffness (42%, P < 0.001) and Young's modulus (30%, P < 0.001) compared with the unimpaired side. The fascicle and tendon stiffness changes were correlated negatively to the corresponding fascicle and tendon length changes, and decrease in Achilles tendon stiffness was correlated to the increases of SOL and GM fascicular stiffness (P < 0.05). Characterizations of calf muscle fascicles and Achilles tendon biomechanical properties help us better understand concurrent changes of fascicles and tendon as part of the calf muscle-tendon unit and facilitate development of more effective treatments. PMID:25663670

  17. Controlled release of curcumin from curcumin-loaded nanomicelles to prevent peritendinous adhesion during Achilles tendon healing in rats

    PubMed Central

    Zhang, Weizhong; Li, Xuanyi; Comes Franchini, Mauro; Xu, Ke; Locatelli, Erica; Martin, Robert C; Monaco, Ilaria; Li, Yan; Cui, Shusen

    2016-01-01

    We introduced curcumin-loaded nanomicelles into a tendon-healing model to evaluate their effects on tendon healing and adhesion. Three groups consisting of 36 rats underwent rupture and repair of the Achilles tendon. The treatment group received an injection of curcumin-loaded nanomicelles (gold nanorods [GNRs]-1/curcumin in polymeric nanomicelles [curc@PMs] at a dosage of 0.44 mg curcumin/kg in 0.1 mL saline) into the surgical site and exposed to laser postoperatively at weeks 1, 2, and 3, for three times 10 seconds each, on the surgical site in the rats that underwent tendon rupture and repair, while the other two groups received 0.44 mg curcumin/kg in 0.1 mL saline and 0.1 mL of saline, respectively. The specimens were harvested at 4 weeks and subjected to biomechanical and histological evaluation. The scoring results of tendon adhesion indicated that GNRs-1/curc@PMs group was in the lowest grade of peritendinous adhesions compared to the other groups. Histological assessment further confirmed the preventive effect of GNRs-1/curc@PMs on tendon adhesion. These findings indicated greater tendon strength with less adhesion in the group treated with GNRs-1/curc@PMs combined with laser exposure, and that nanoparticle-based therapy may be applied to prevent adhesion in clinical patients. PMID:27382278

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

    PubMed

    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 < 0.05). Pairwise comparisons revealed a significant increase in free tendon length and strain at all contraction intensities after eccentric exercise (P < 0.05). There was no significant time-by-session interaction for the gastrocnemii (medial or lateral) aponeurosis or 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. PMID:25919320

  19. Using a Posterior Compartment Fasciotomy and Paratenon Closure in Acute Achilles Tendon Repair.

    PubMed

    Saper, David; Lybrand, Kyle; Creevy, William; Li, Xinning

    2016-07-01

    Soft tissue management, dissection, and handling are of paramount importance during Achilles tendon repair. Although surgical repairs of Achilles tendons have predictably excellent outcomes, complications including wound infection and stiffness are not uncommon. The authors' surgical technique for Achilles tendon repair includes tagging the posterior paratenon for later layered repair and incising the posterior fascia, exposing the flexor hallucis longus muscle belly. This posterior compartment fasciotomy allows for both hematoma evacuation away from the tenuous posterior skin and mobilization of the posterior paratendon for complete closure over the repaired Achilles tendon. With this modified technique, the authors report a 1% infection rate and a 1% failure rate. [Orthopedics. 2016; 39(4):e790-e793.]. PMID:27158828

  20. ggstThe role of tendon microcirculation in Achilles and patellar tendinopathy

    PubMed Central

    Knobloch, Karsten

    2008-01-01

    Tendinopathy is of distinct interest as it describes a painful tendon disease with local tenderness, swelling and pain associated with sonographic features such as hypoechogenic texture and diameter enlargement. Recent research elucidated microcirculatory changes in tendinopathy using laser Doppler flowmetry and spectrophotometry such as at the Achilles tendon, the patellar tendon as well as at the elbow and the wrist level. Tendon capillary blood flow is increased at the point of pain. Tendon oxygen saturation as well as tendon postcapillary venous filling pressures, determined non-invasively using combined Laser Doppler flowmetry and spectrophotometry, can quantify, in real-time, how tendon microcirculation changes over with pathology or in response to a given therapy. Tendon oxygen saturation can be increased by repetitive, intermittent short-term ice applications in Achilles tendons; this corresponds to 'ischemic preconditioning', a method used to train tissue to sustain ischemic damage. On the other hand, decreasing tendon oxygenation may reflect local acidosis and deteriorating tendon metabolism. Painful eccentric training, a common therapy for Achilles, patellar, supraspinatus and wrist tendinopathy decreases abnormal capillary tendon flow without compromising local tendon oxygenation. Combining an Achilles pneumatic wrap with eccentric training changes tendon microcirculation in a different way than does eccentric training alone; both approaches reduce pain in Achilles tendinopathy. The microcirculatory effects of measures such as extracorporeal shock wave therapy as well as topical nitroglycerine application are to be studied in tendinopathy as well as the critical question of dosage and maintenance. Interestingly it seems that injection therapy using color Doppler for targeting the area of neovascularisation yields to good clinical results with polidocanol sclerosing therapy, but also with a combination of epinephrine and lidocaine. PMID:18447938

  1. Middle-aged adults exhibit altered spatial variations in Achilles tendon wave speed

    PubMed Central

    Slane, Laura Chernak; DeWall, Ryan; Martin, Jack; Lee, Kenneth; Thelen, Darryl G.

    2016-01-01

    The purpose of this study was to investigate spatial variations in measured wave speed in the relaxed and stretched Achilles tendons of young and middle-aged adults. Wave speed was measured from the distal Achilles tendon, soleus aponeurosis, medial gastrocnemius aponeurosis and medial gastrocnemius muscle in healthy young (n = 15, aged 25 ± 4 years) and middle-aged (n = 10, aged 49 ± 4 years) adults in resting, dorsiflexed and plantarflexed postures. In both age groups, Achilles tendon wave speed decreased proximally, with the lowest wave speed measured in the gastrocnemius aponeurosis. Measured wave speed increased with passive dorsiflexion, reflecting the strain-stiffening behavior of tendons. There were no significant aging effects on wave speed in the free tendon or soleus aponeurosis. However, a significant, inverse relationship between gastrocnemius aponeurosis wave speed and age was observed in the dorsiflexed posture. We also observed significantly lower wave speeds in the gastrocnemius muscles of middle-aged adults when compared with young adults. These results suggest that Achilles tendon compliance increases in a distal-to-proximal pattern, with middle-aged adults exhibiting greater compliance in the distal gastrocnemius muscle and tendinous structures. An age-related change in the spatial variation in Achilles tendon compliance could affect localised tissue deformation patterns and injury potential within the triceps surae muscle-tendon units. PMID:26020294

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

    PubMed Central

    Andrew, Greenhalgh; Jonathan, Sinclair

    2014-01-01

    Recreational running is an activity with multiple reported health benefits for both sexes, however, chronic injuries caused by excessive and/or repetitive loading of the Achilles tendon are common. Males have been identified as being at an increased risk of suffering an injury to the Achilles tendon and as such, knowledge of differences in loading between the sexes may provide further information to better understand why this is the case. The aim of the current investigation was to determine whether gender differences in the Achilles tendon load exist in recreational runners. Fifteen male (age 26.74 ± 5.52 years, body height 1.80 ± 0.11 m and body mass 74.22 ± 7.27 kg) and fifteen female (age 25.13 ± 6.39 years, body height 1.68 ± 0.12 m and body mass 67.12 ± 9.11 kg) recreational runners volunteered to take part in the current investigation. Participants completed 10 trials running at 4.0 m·s−1 ±5% striking a force platform (1000 Hz) with their right foot. Ankle joint kinematics were synchronously recorded (250 Hz) using an optoelectric motion capture system. Ankle joint kinetics were computed using Newton-Euler inverse-dynamics. Net external ankle joint moments were then calculated. To estimate Achilles tendon kinetics the plantarflexion moment calculated was divided by an estimated Achilles tendon moment arm of 0.05 m. Differences in Achilles tendon kinetics were examined using independent sample t-tests (p<0.05). The results indicate that males were associated with significantly (p<0.05) greater Achilles tendon loads than females. The findings from this study support the notion that male recreational runners may be at greater risk of Achilles tendon pathology. PMID:25713676

  3. Effect of Calendula officinalis cream on achilles tendon healing.

    PubMed

    Aro, A A; Perez, M O; Vieira, C P; Esquisatto, M A M; Rodrigues, R A F; Gomes, L; Pimentel, E R

    2015-02-01

    In recent years, the scientific community has undertaken research on plant extracts, searching for compounds with pharmacological activities that can be used in diverse fields of medicine. Calendula officinalis L. is known to have antioxidant, anti-inflammatory, antibacterial, and wound healing properties when used to treat skin burns. Therefore, the purpose of this study was to analyze the effects of C. officinalis on the initial phase of Achilles tendon healing. Wistar rats were separated in three groups: Calendula (Cal)-rats with a transected tendon were treated with topical applications of C. officinalis cream and then euthanized 7 days after injury; Control (C)-rats were treated with only vehicle after transection; and Normal (N)-rats without tenotomy. Higher concentrations of hydroxyproline (an indicator of total collagen) and non-collagenous proteins were observed in the Cal group in relation to the C group. Zymography showed no difference in the amount of the isoforms of metalloproteinase-2 and of metalloproteinase-9, between C and Cal groups. Polarization microscopy images analysis showed that the Cal group presented a slightly higher birefringence compared with the C group. In sections of tendons stained with toluidine blue, the transected groups presented higher metachromasy as compared with the N group. Immunocytochemistry analysis for chondroitin-6-sulfate showed no difference between the C and Cal groups. In conclusion, the topical application of C. officinalis after tendon transection increases the concentrations of collagen and non-collagenous proteins, as well as the collagen organization in the initial phase of healing. PMID:25266273

  4. Microcirculation in healing and healthy Achilles tendon assessed with invasive laser doppler flowmetry

    PubMed Central

    Arverud, Erica Domeij; Persson-Lindell, Olof; Sundquist, Fredrik; Labruto, Fausto; Edman, Gunnar; Ackermann, Paul W.

    2016-01-01

    Summary Introduction Achilles tendon (AT) rupture exhibits a prolonged healing process with varying clinical outcome. Reduced blood flow to the AT has been considered an underlying factor to AT rupture (ATR) and impaired healing. In vivo measurements using laser Doppler flowmetry (LDF) may be a viable method to assess blood flow in healthy and healing AT. Methods 29 persons were included in the study; 9 being ATR patients and 20 healthy subjects without any prior symptoms from the AT. Invasive LDF was used to determine the post-occlusive reactive hyperemia (PORH) in the paratenon after 15 minutes of occlusion of the lower extremities. ATR patients were examined two weeks post-operatively. Results LDF-assessments demonstrated a significantly different (p < 0.001) PORH response in the healing- versus intact- and control AT. In the healing AT, a slow, flattened PORH was observed compared to a fast, high peak PORH in intact, healthy AT. Conclusion in vivo LDF appears to be a feasible method to assess alterations in blood flow in healing and intact AT. The healing ATs capability to react to an ischemic period is clearly impaired, which may be due to the trauma at injury and/or surgery or degenerative changes in the tendon. PMID:27331035

  5. Biomechanical and structural response of healing Achilles tendon to fatigue loading following acute injury

    PubMed Central

    Freedman, Benjamin R.; Sarver, Joseph J.; Buckley, Mark R.; Voleti, Pramod B.; Soslowsky, Louis J.

    2013-01-01

    Achilles tendon injuries affect both athletes and the general population, and their incidence is rising. In particular, the Achilles tendon is subject to dynamic loading at or near failure loads during activity, and fatigue induced damage is likely a contributing factor to ultimate tendon failure. Unfortunately, little is known about how injured Achilles tendons respond mechanically and structurally to fatigue loading during healing. Knowledge of these properties remains critical to best evaluate tendon damage induction and the ability of the tendon to maintain mechanical properties with repeated loading. Thus, this study investigated the mechanical and structural changes in healing mouse Achilles tendons during fatigue loading. Twenty four mice received bilateral full thickness, partial width excisional injuries to their Achilles tendons (IACUC approved) and twelve tendons from six mice were used as controls. Tendons were fatigue loaded to assess mechanical and structural properties simultaneously after 0, 1, 3, and 6 weeks of healing using an integrated polarized light system. Results showed that the number of cycles to failure decreased dramatically (37-fold, p<0.005) due to injury, but increased throughout healing, ultimately recovering after 6 weeks. The tangent stiffness, hysteresis, and dynamic modulus did not improve with healing (p<0.005). Linear regression analysis was used to determine relationships between mechanical and structural properties. Of tendon structural properties, the apparent birefringence was able to best predict dynamic modulus (R2=0.88–0.92) throughout healing and fatigue life. This study reinforces the concept that fatigue loading is a sensitive metric to assess tendon healing and demonstrates potential structural metrics to predict mechanical properties. PMID:24280564

  6. Dynamic creep and pre-conditioning of the Achilles tendon in-vivo.

    PubMed

    Hawkins, David; Lum, Corey; Gaydos, Diane; Dunning, Russell

    2009-12-11

    Warm-up exercises are often advocated prior to strenuous exercise, but the warm-up duration and effect on muscle-tendon behavior are not well defined. The gastrocnemius-Achilles tendon complexes of 18 subjects were studied to quantify the dynamic creep response of the Achilles tendon in-vivo and the warm-up dose required for the Achilles tendon to achieve steady-state behavior. A custom testing chamber was used to determine each subject's maximum voluntary contraction (MVC) during an isometric ankle plantar flexion effort. The subject's right knee and ankle were immobilized for one hour. Subjects then performed over seven minutes of cyclic isometric ankle plantar flexion efforts equal to 25-35% of their MVC at a frequency of 0.75 Hz. Ankle plantar flexion effort and images from dual ultrasound probes located over the gastrocnemius muscle-Achilles tendon and the calcaneus-Achilles tendon junction were acquired for eight seconds at the start of each sequential minute of the activity. Ultrasound images were analyzed to quantify the average relative Achilles tendon strain at 25% MVC force (epsilon(25%MVC)) for each minute. The epsilon(25%MVC) increased from 0.3% at the start of activity to 3.3% after seven minutes, giving a total dynamic creep of ~3.0%. The epsilon(25%MVC) increased by more than 0.56% per minute for the first five minutes and increased by less than 0.13% per minute thereafter. Therefore, following a period of inactivity, a low intensity warm-up lasting at least six minutes or producing 270 loading cycles is required for an Achilles tendon to reach a relatively steady-state behavior. PMID:19762028

  7. Sodium hyaluronate regulating angiogenesis during Achilles tendon healing.

    PubMed

    Halici, Mehmet; Karaoglu, Sinan; Canoz, Ozlem; Kabak, Sevki; Baktir, Ali

    2004-11-01

    The aim of this study was to evaluate the effect of SH (sodium hyaluronate-NaHA) on vascular endothelial growth factor (VEGF) and type IV collagen expression during the Achilles-tendon healing process. Adult New Zealand white rabbits (n=32) aged 4 months and weighing 2.7-3.9 kg were used. The rabbits were randomly divided into two groups, and each group was divided into two subgroups and monitored for 6 and 12 weeks. Tendo calcanei were incised transversely and repaired. An injection of 0.5 ml NaHA (15 mg/ml) was administered between the tendon and paratenon of the right leg and repeated twice at one-week intervals. Equal numbers of animals were sacrificed at the 6th and 12th weeks, and the repaired tissue was examined macroscopically and histologically for the presence of VEGF and type IV collagen expression every week. The decrease in the amount of adhesion tissue and the acceleration of tendon healing in the NaHA group were significantly high when compared with control groups at 6 and 12 weeks (p<0.001, p<0.05). In the NaHA group, due to vascular proliferation VEGF immunostaining was strongly positive in the 6th week (p<0.05), and remained positive in the 12th week (p<0.05). Similar immunostaining findings were detected for type IV collagen in the 6th week. However, there was a significant decline in immunostaining rate in the 12th week (p<0.05). The increases in VEGF and type IV collagen expression following SH administration might be an indication that SH may partly be involved in regulation of angiogenesis. PMID:15609066

  8. Acute Patellar Tendon Rupture after Total Knee Arthroplasty Revision

    PubMed Central

    Rhee, Seung Joon; Pham, The Hien

    2015-01-01

    Patellar tendon rupture is a catastrophic complication following total knee arthroplasty (TKA). Though revision TKA has been suspected of being a predisposing factor for the occurrence of patellar tendon rupture, there are few reports on patellar tendon rupture after revision TKA. Here, we present a case of acute patellar tendon rupture that occurred after TKA revision. In the patient, the patellar tendon was so thin and could not be repaired, and accordingly was sutured end to end. We used the anterior tibialis tendon allograft to augment the poor quality patellar tendon tissue. Fixation of the allograft was done by using the bone tunnel created through tibial tuberosity and suturing the allograft to the patellar tendon and quadriceps tendon. The patient was instructed to wear a full extension knee splint and was kept non-weight bearing for 6 weeks after operation. Full knee extension could be achieved 6 weeks postoperatively. PMID:26060612

  9. Bilateral patellar tendon rupture associated with statin use.

    PubMed

    Kearns, Marie C; Singh, Vinay K

    2016-01-01

    Patellar tendon rupture is an uncommon clinical presentation, which generally affects the under 40s who are active in sport. Bilateral rupture of both tendons is much rarer. It occurs most frequently in patients with predisposing factors such as corticosteroid use or systemic diseases. The authors present the case of a 56-year-old male on long-term statin therapy who sustained this injury following a fall on ice. He had no known risk factors for tendon rupture. Surgical treatment involved tendon repair using Krakow suture via bony tunnels in the patella. Statins have previously been associated with tendon ruptures at other sites but there have been no published cases of bilateral patellar tendon rupture linked to statin use. We review the literature regarding the association between statins and tendon rupture. PMID:27165749

  10. Bilateral patellar tendon rupture associated with statin use

    PubMed Central

    Kearns, Marie C.; Singh, Vinay K.

    2016-01-01

    Patellar tendon rupture is an uncommon clinical presentation, which generally affects the under 40s who are active in sport. Bilateral rupture of both tendons is much rarer. It occurs most frequently in patients with predisposing factors such as corticosteroid use or systemic diseases. The authors present the case of a 56-year-old male on long-term statin therapy who sustained this injury following a fall on ice. He had no known risk factors for tendon rupture. Surgical treatment involved tendon repair using Krakow suture via bony tunnels in the patella. Statins have previously been associated with tendon ruptures at other sites but there have been no published cases of bilateral patellar tendon rupture linked to statin use. We review the literature regarding the association between statins and tendon rupture. PMID:27165749

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

    PubMed

    Marcolin, Giuseppe; Buriani, Alessandro; Balasso, Alberto; Villaminar, Renato; Petrone, Nicola

    2015-01-01

    Achilles tendon rupture is a disabling injury that requires a long recovery time. We describe a unique case of a 46-year-old male who had undergone gait analysis as part of a personal physical examination and who, 16 months later, ruptured his left Achilles tendon while running. With gait kinematic and kinetic data available both before and after his injury, we determined the residual gait asymmetries on his uninjured side and compared the pre- and postinjury measurements. We analyzed his gait at 1, 4, and 7 weeks after his return to full weightbearing. Compared with the preinjury values, at 7 weeks he had almost complete range of motion in his left ankle (-2%) and a slight increase in gait velocity (+6%) and cadence (+3%). The peak power of his injured ankle was 90% of its preinjury value. In contrast, the unaffected ankle was at 118%. These observations suggest that measuring the asymmetries of the gait cycle, especially at the beginning of rehabilitation, can be used to improve treatment. We had the patient strengthen his ankle using a stationary bicycle before he returned to running. Kinetics also appears to be more powerful than kinematics in detecting functional asymmetries associated with reduced calf strength, even 15 weeks after surgery. Gait analysis could be used to predict the effectiveness of rehabilitation protocols and help calibrate and monitor the return to sports participation while preventing overloading muscle and tendon syndromes. PMID:25624039

  12. Cross-Linking in Collagen by Nonenzymatic Glycation Increases the Matrix Stiffness in Rabbit Achilles Tendon

    PubMed Central

    2004-01-01

    Nonenzymatic glycation of connective tissue matrix proteins is a major contributor to the pathology of diabetes and aging. Previously the author and colleagues have shown that nonenzymatic glycation significantly enhances the matrix stability in the Achilles tendon (Reddy et al., 2002, Arch. Biochem. Biophys., 399, 174–180). The present study was designed to gain further insight into glycation-induced collagen cross-linking and its relationship to matrix stiffness in the rabbit Achilles tendon. The glycation process was initiated by incubating the Achilles tendons (n = 6) in phosphate-buffered saline containing ribose, whereas control tendons (n = 6) were incubated in phosphate-buffered saline without ribose. Eight weeks following glycation, the biomechanical attributes as well as the degree of collagen cross-linking were determined to examine the potential associations between matrix stiffness and molecular properties of collagen. Compared to nonglycated tendons, the glycated tendons showed increased maximum load, stress, strain, Young's modulus of elasticity, and toughness indicating that glycation increases the matrix stiffness in the tendons. Glycation of tendons resulted in a considerable decrease in soluble collagen content and a significant increase in insoluble collagen and pentosidine. Analysis of potential associations between the matrix stiffness and degree of collagen cross-linking showed that both insoluble collagen and pentosidine exhibited a significant positive correlation with the maximum load, stress, and strain, Young's modulus of elasticity, and toughness (r values ranging from .61 to .94) in the Achilles tendons. However, the soluble collagen content present in neutral salt buffer, acetate buffer, and acetate buffer containing pepsin showed an inverse relation with the various biomechanical attributes tested (r values ranging from .22 to .84) in the Achilles tendons. The results of the study demonstrate that glycation-induced collagen cross

  13. Simultaneous rupture of the quadriceps tendon with contralateral rupture of the patellar tendon in an otherwise healthy athlete.

    PubMed Central

    Munshi, N I; Mbubaegbu, C E

    1996-01-01

    A case of a healthy athlete with simultaneous rupture of quadriceps tendon and rupture of the contralateral patella tendon is reported. Both tendons rupturing in the same patient is rare and this is the first reported case in a previously healthy person. Different mechanisms are implicated in the different ruptures. The rarity is because the simultaneous presence of contributory factors for either injury in the same person is uncommon. Images Fig. 2 PMID:8799608

  14. Pectoralis major tendon rupture. Surgical procedures review.

    PubMed Central

    Merolla, Giovanni; Paladini, Paolo; Campi, Fabrizio; Porcellini, Giuseppe

    2012-01-01

    Summary Pectoralis major (PM) muscle is the powerful dynamic stabiliser of the shoulder that acts as a flexor, adductor and internal rotator. The rupture of the PM tendon is a relatively rare injury that was firstly described in a French boy by Patissier in 1822 and later, in 1861, by Letenneur who reported another similiar case. To date, over 200 cases have been published. In this article we describe the clinical anatomy and the mechanism of injuries of PM and we review the surgical procedures for acute and chronic ruptures. PMID:23738281

  15. Deleterious effects of local corticosteroid injections on the Achilles tendon of rats.

    PubMed

    Tatari, H; Kosay, C; Baran, O; Ozcan, O; Ozer, E

    2001-06-01

    The purpose of this study was to examine the pathological changes in the Achilles tendon and its paratenon after intratendinous corticosteroid injections and to reveal the effects of this drug on healthy tendon. We also sought for the effects of these injections compared with compression with a clamp on the Achilles tendons of the rats. Fifty-two Achilles tendons in 26 male Wistar rats were included in the study. Betamethasone injections were applied to the left tendons at different intervals, while the right tendons served for compression with mosquito clamps for varied periods. At the end of 30 days, all of the tendons were excised and examined histopathologically according to a semiquantitative scoring system. Histopathologic evaluation demonstrated some degree of degeneration in both groups. Statistical analysis showed no significant difference among the two groups, but in macroscopic evaluation, the tendons in the betamethasone group demonstrated enlargement and strong adhesion to the subcutaneous tissue. We conclude that intratendinous betamethasone injections are as harmful as compression with a clamp and can be used as a degeneration-producing model in further studies. Enlargement of the tendon mass and strong adhesion to the subcutaneous tissue can be due to injection of the betamethasone partly outside the tendon. PMID:11482466

  16. A Fibre-Reinforced Poroviscoelastic Model Accurately Describes the Biomechanical Behaviour of the Rat Achilles Tendon

    PubMed Central

    Heuijerjans, Ashley; Matikainen, Marko K.; Julkunen, Petro; Eliasson, Pernilla; Aspenberg, Per; Isaksson, Hanna

    2015-01-01

    Background Computational models of Achilles tendons can help understanding how healthy tendons are affected by repetitive loading and how the different tissue constituents contribute to the tendon’s biomechanical response. However, available models of Achilles tendon are limited in their description of the hierarchical multi-structural composition of the tissue. This study hypothesised that a poroviscoelastic fibre-reinforced model, previously successful in capturing cartilage biomechanical behaviour, can depict the biomechanical behaviour of the rat Achilles tendon found experimentally. Materials and Methods We developed a new material model of the Achilles tendon, which considers the tendon’s main constituents namely: water, proteoglycan matrix and collagen fibres. A hyperelastic formulation of the proteoglycan matrix enabled computations of large deformations of the tendon, and collagen fibres were modelled as viscoelastic. Specimen-specific finite element models were created of 9 rat Achilles tendons from an animal experiment and simulations were carried out following a repetitive tensile loading protocol. The material model parameters were calibrated against data from the rats by minimising the root mean squared error (RMS) between experimental force data and model output. Results and Conclusions All specimen models were successfully fitted to experimental data with high accuracy (RMS 0.42-1.02). Additional simulations predicted more compliant and soft tendon behaviour at reduced strain-rates compared to higher strain-rates that produce a stiff and brittle tendon response. Stress-relaxation simulations exhibited strain-dependent stress-relaxation behaviour where larger strains produced slower relaxation rates compared to smaller strain levels. Our simulations showed that the collagen fibres in the Achilles tendon are the main load-bearing component during tensile loading, where the orientation of the collagen fibres plays an important role for the tendon

  17. Non-Uniform Displacements within the Achilles Tendon observed during Passive and Eccentric Loading

    PubMed Central

    Slane, Laura Chernak; Thelen, Darryl G.

    2014-01-01

    The goal of this study was to investigate Achilles tendon tissue displacement patterns under passive and eccentric loading conditions. Nine healthy young adults were positioned prone on an examination table with their foot secured to a rotating footplate aligned with the ankle. Subjects cyclically rotated their ankle over a 25 deg range of motion at 0.5 Hz. An inertial load geared to the footplate induced eccentric plantarflexor contractions with dorsiflexion. Passive cyclic ankle motion was also performed over the same angular range of motion. An ultrasound transducer positioned over the distal Achilles tendon was used to collect radiofrequency (RF) images at 70 frames/sec. Two-dimensional ultrasound elastographic analysis of the RF data was used to track tendon tissue displacements throughout the cyclic motion. Non-uniform tissue displacement patterns were observed in all trials, with the deeper portions of the Achilles tendon consistently exhibiting larger displacements than the superficial tendon (average of 0.9–2.6 mm larger). Relative to the passive condition, eccentric loading consistently induced smaller tissue displacements in all tendon regions, except for the superficial tendon in a flexed knee posture. Significantly greater overall tissue displacement was observed in a more extended knee posture (30 deg) relative to a flexed knee posture (90 deg). These spatial- and posture-dependent displacement patterns suggest that the tendon undergoes nonuniform deformation under in vivo loading conditions. Such behavior could reflect relative sliding between the distinct tendon fascicles that arise from the gastrocnemius and soleus muscles. PMID:25150898

  18. Biomechanical Evaluation of Posterior Cruciate Ligament Reconstruction With Quadriceps Versus Achilles Tendon Bone Block Allograft

    PubMed Central

    Forsythe, Brian; Haro, Marc S.; Bogunovic, Ljiljana; Collins, Michael J.; Arns, Thomas A.; Trella, Katie J.; Shewman, Elizabeth F.; Verma, Nikhil N.; Bach, Bernard R.

    2016-01-01

    Background: Long-term studies of posterior cruciate ligament (PCL) reconstruction suggest that normal stability is not restored in the majority of patients. The Achilles tendon allograft is frequently utilized, although recently, the quadriceps tendon has been introduced as an alternative option due to its size and high patellar bone density. Purpose/Hypothesis: The purpose of this study was to compare the biomechanical strength of PCL reconstructions using a quadriceps versus an Achilles allograft. The hypothesis was that quadriceps bone block allograft has comparable mechanical properties to those of Achilles bone block allograft. Study Design: Controlled laboratory study. Methods: Twenty-nine fresh-frozen cadaveric knees were assigned to 1 of 3 groups: (1) intact PCL, (2) PCL reconstruction with Achilles tendon allograft, or (3) PCL reconstruction with quadriceps tendon allograft. After reconstruction, all supporting capsular and ligamentous tissues were removed. Posterior tibial translation was measured at neutral and 20° external rotation. Each specimen underwent a preload, 2 cyclic loading protocols of 500 cycles, then load to failure. Results: Construct creep deformation was significantly lower in the intact group compared with both Achilles and quadriceps allograft (P = .008). The intact specimens reached the greatest ultimate load compared with both reconstructions (1974 ± 752 N, P = .0001). The difference in ultimate load for quadriceps versus Achilles allograft was significant (P = .048), with the quadriceps group having greater maximum force during failure testing. No significant differences were noted between quadriceps versus Achilles allograft for differences in crosshead excursion during cyclic testing (peak-valley [P-V] extension stretch), creep deformation, or stiffness. Construct stiffness measured during the failure test was greatest in the intact group (117 ± 9 N/mm, P = .0001) compared with the Achilles (43 ± 11 N/mm) and quadriceps (43

  19. Early changes in Achilles tendon behaviour in vivo following downhill backwards walking.

    PubMed

    Joseph, C W; Bradshaw, E J; Furness, T P; Kemp, J; Clark, R A

    2016-07-01

    Downhill backwards walking causes repeated, cyclical loading of the muscle-tendon unit. The effect this type of repeated loading has on the mechanical behaviour of the Achilles tendon is presently unknown. This study aimed to investigate the biomechanical response of the Achilles tendon aponeurosis complex following a downhill backwards walking protocol. Twenty active males (age: 22.3 ± 3.0 years; mass: 74.7 ± 5.6 kg; height: 1.8 ± 0.7 m) performed 60 min of downhill (8.5°), backwards walking on a treadmill at -0.67 m · s(-1). Data were collected before, immediately post, and 24-, 48- and 168-h post-downhill backwards walking. Achilles tendon aponeurosis elongation, strain and stiffness were measured using ultrasonography. Muscle force decreased immediately post-downhill backward walking (P = 0.019). There were increases in Achilles tendon aponeurosis stiffness at 24-h post-downhill backward walking (307 ± 179.6 N · mm(-1), P = 0.004), and decreases in Achilles tendon aponeurosis strain during maximum voluntary contraction at 24 (3.8 ± 1.7%, P = 0.008) and 48 h (3.9 ± 1.8%, P = 0.002) post. Repeated cyclical loading of downhill backwards walking affects the behaviour of the muscle-tendon unit, most likely by altering muscle compliance, and these changes result in tendon stiffness increases. PMID:26512914

  20. Ultrasound strain mapping of Achilles tendon compressive strain patterns during dorsiflexion.

    PubMed

    Chimenti, Ruth L; Flemister, A Samuel; Ketz, John; Bucklin, Mary; Buckley, Mark R; Richards, Michael S

    2016-01-01

    Heel lifts are commonly prescribed to patients with Achilles tendinopathy, yet little is known about the effect on tendon compressive strain. The purposes of the current study were to (1) develop a valid and reliable ultrasound elastography technique and algorithm to measure compressive strain of human Achilles tendon in vivo, (2) examine the effects of ankle dorsiflexion (lowering via controlled removal of a heel lift and partial squat) on compressive strain of the Achilles tendon insertion and (3) examine the relative compressive strain between the deep and superficial regions of the Achilles tendon insertion. All tasks started in a position equivalent to standing with a 30mm heel lift. An ultrasound transducer positioned over the Achilles tendon insertion was used to capture radiofrequency images. A non-rigid image registration-based algorithm was used to estimate compressive strain of the tendon, which was divided into 2 regions (superficial, deep). The bland-Altman test and intraclass correlation coefficient were used to test validity and reliability. One-way repeated measures ANOVA was used to compare compressive strain between regions and across tasks. Compressive strain was accurately and reliably (ICC>0.75) quantified. There was greater compressive strain during the combined task of lowering and partial squat compared to the lowering (P=.001) and partial squat (P<.001) tasks separately. There was greater compressive strain in the deep region of the tendon compared to the superficial for all tasks (P=.001). While these findings need to be examined in a pathological population, heel lifts may reduce tendon compressive strain during daily activities. PMID:26655590

  1. Achillon mini-open Achilles tendon repair: early outcomes and return to duty results in U.S. military service members.

    PubMed

    Orr, Justin D; McCriskin, Brendan; Dutton, Jason R

    2013-01-01

    The purpose of this article is to report short-term outcomes and return to duty rates in a cohort of active duty U.S. military personnel who underwent repair of acute Achilles tendon ruptures using the Achillon mini-open technique. Between October 2009 and March 2012, 15 consecutive patients underwent mini-open repair of acute Achilles tendon ruptures using the Achillon device by a single surgeon. Minor and major complications were recorded, and American Orthopaedic Foot and Ankle Society (AOFAS) and pain visual analog scores were recorded at regular follow-up intervals. At mean latest follow-up of 16.7 months postoperatively, all 15 patients had returned to full active duty status without major complications. Specifically, no patient experienced major wound complication, infection, or rerupture. Mean AOFAS score in 9 of 15 patients was 94.1; mean pain visual analog score in 12 of 15 patients was 1.4. The Achillon mini-open technique can be used for treatment of acute Achilles tendon ruptures in appropriately selected high-demand patient populations with the expectation of minimal adverse outcomes. PMID:23449051

  2. Does Achilles Tendon Cross Sectional Area Differ after Downhill, Level and Uphill Running in Trained Runners?

    PubMed Central

    Neves, Katy Andrews; Johnson, A. Wayne; Hunter, Iain; Myrer, J. William

    2014-01-01

    In this study we examined how hill running affects the Achilles tendon, a common location for injuries in runners. Twenty females ran for 10 min on each of three randomly ordered grades (-6%, 0 and +6%) at speeds selected to match the metabolic rates. Achilles tendon (AT) cross-sectional area (CSA) was imaged using Doppler ultrasound and peak vertical forces were analyzed using an instrumented treadmill. A metabolic cart and gas analyzer ensured a similar metabolic cost across grades. Data were analyzed using a forward selection regression. Results showed similar decreases in AT CSA from pre- to post-run for all three conditions of ~5 to 7% (p = 0.0001). Active peak vertical forces were different across grades (p = 0.0001) with the largest occurring during downhill running and smallest during uphill running. Since changes in AT CSA were not different between grades, each form of running appears equal and acceptable in regards to how the Achilles tendon reacts. That is, the results suggest that the Achilles tendon is affected by downhill, level, and uphill running and a decrease in CSA appears to be a normal response. Key Points Downhill (- 6%), level and uphill (+ 6%) running at different speeds each caused a statistically significant decrease in the Achilles tendon cross-sectional area in healthy, trained runners. The magnitude of change in Achilles tendon cross-sectional area did not differ between grades when metabolic cost of running was matched. Downhill running resulted in the largest peak vertical force, while uphill running resulted in the smallest. PMID:25435775

  3. Ultrasound Changes in Achilles Tendon and Gastrocnemius Medialis Muscle on Squat Eccentric Overload and Running Performance.

    PubMed

    Sanz-López, Fernando; Berzosa Sánchez, César; Hita-Contreras, Fidel; Cruz-Diaz, David; Martínez-Amat, Antonio

    2016-07-01

    Sanz-López, F, Berzosa Sánchez, C, Hita-Contreras, F, Cruz-Diaz, D, and Martínez-Amat, A. Ultrasound changes in Achilles tendon and gastrocnemius medialis muscle on squat eccentric overload and running performance. J Strength Cond Res XX(X): 000-000, 2015-Previous studies have proven the adaptation to load in the Achilles tendon and gastrocnemius muscle after different types of exercise, such as running, heel drop training, and a variety of sports. These findings have been applied to improve performance and in the treatment and prevention of overuse injuries. However, the effects that squat performance may have on the Achilles tendon and gastrocnemius muscle are still unknown. Squats are a widely used training exercise that involves calf-muscle activation. Similarly, no reports have been published regarding the adaptation to load of trained and untrained subjects during several consecutive days of running. The purpose of this study was to analyze changes in the Achilles tendon and in the pennation angles of the gastrocnemius medialis after eccentric overload training and within 3 days of running. Twenty healthy males who volunteered for this study were divided into 2 groups. Subjects in the eccentric overload training (ECC) group performed 6 weeks of eccentric overload training (twice weekly, 4 sets of 7 repetitions in a Yoyo squat device) before the running intervention. All participants, ECC and control (CONT) groups, ran on 3 consecutive days. After the eccentric training, an increase in the cross-sectional area of the Achilles tendon and in the pennation angle was observed. As for the running intervention, the behavior of tissues in both groups was similar. These results suggest that eccentric overload training with squats promotes changes in the Achilles tendon and in the pennation angle of the gastrocnemius medialis muscle. Nevertheless, significant changes in the tissue do not appear between the running performance of trained and untrained subjects. PMID

  4. Longitudinal and transverse deformation of human Achilles tendon induced by isometric plantar flexion at different intensities.

    PubMed

    Iwanuma, Soichiro; Akagi, Ryota; Kurihara, Toshiyuki; Ikegawa, Shigeki; Kanehisa, Hiroaki; Fukunaga, Tetsuo; Kawakami, Yasuo

    2011-06-01

    The present study determined in vivo deformation of the entire Achilles tendon in the longitudinal and transverse directions during isometric plantar flexions. Twelve young women and men performed isometric plantar flexions at 0% (rest), 30%, and 60% of the maximal voluntary contraction (MVC) while a series of oblique longitudinal and cross-sectional magnetic resonance (MR) images of the Achilles tendon were taken. At the distal end of the soleus muscle belly, the Achilles tendon was divided into the aponeurotic (ATapo) and the tendinous (ATten) components. The length of each component was measured in the MR images. The widths of the Achilles tendon were determined at 10 regions along ATapo and at four regions along ATten. Longitudinal and transverse strains were calculated as changes in relative length and width compared with those at rest. The ATapo deformed in both longitudinal and transverse directions at 30%MVC and 60%MVC. There was no difference between the strains of the ATapo at 30%MVC and 60%MVC either in the longitudinal (1.1 and 1.6%) or transverse (5.0∼11.4 and 5.0∼13.9%) direction. The ATten was elongated longitudinally (3.3%) to a greater amount than ATapo, while narrowing transversely in the most distal region (-4.6%). The current results show that the magnitude and the direction of contraction-induced deformation of Achilles tendon are different for the proximal and distal components. This may be related to the different functions of Achilles tendon, i.e., force transmission or elastic energy storage during muscle contractions. PMID:21415176

  5. Evidence of accumulated stress in Achilles and anterior knee tendons in elite badminton players.

    PubMed

    Boesen, Anders Ploug; Boesen, Morten Ilum; Koenig, Merete Juhl; Bliddal, Henning; Torp-Pedersen, Soren; Langberg, Henning

    2011-01-01

    Tendon-related injuries are a major problem, but the aetiology of tendinopathies is unknown. In tendinopathies as well as during unaccustomed loading, intra-tendinous flow can be detected indicating that extensive loading can provoke intra-tendinous flow. The aim of present study is to evaluate the vascular response as indicated by colour Doppler (CD) activity in both the Achilles and patella tendon after loading during high-level badminton matches. The Achilles tendon was subdivided into a mid-tendon, pre-insertional, and insertional region and the anterior knee tendons into a quadriceps-, patella- and tuberositas region. Intra-tendinous flow was measured using both a semi-quantitative grading system (CD grading) and a quantitative scoring system (CF) on colour Doppler. Intra-tendinous flow in the Achilles and anterior knee tendons was examined in fourteen single players before tournament and after 1st and 2nd match, respectively on both the dominant and non-dominant side. All players had abnormal intra-tendinous flow (Colour Doppler ≥ grade 2) in at least one tendon in at least one scan during the tournament. At baseline, only two of the 14 players had normal flow in all the tendons examined. After 1st match, tendencies to higher intra-tendinous flow were observed in both the dominant patella tendon and non-dominant quadriceps tendon (P-values n.s.). After 2nd match, intra-tendinous flow was significant increased in the dominant patella tendon (P = 0.009). In all other locations, there was a trend towards a stepwise increase in intra-tendinous flow. The preliminary results indicate that high amount of intra-tendinous flow was found in elite badminton players at baseline and was increased after repetitive loading, especially in the patella tendon (dominant leg). The colour Doppler measurement can be used to determine changes in intra-tendinous flow after repetitive loading. PMID:20652535

  6. Somatomedin C immunoreactivity in the Achilles tendon varies in a dynamic manner with the mechanical load.

    PubMed

    Hansson, H A; Engström, A M; Holm, S; Rosenqvist, A L

    1988-10-01

    Distribution of the trophic peptide somatomedin C (Sm-C; insulin-like growth factor I; IGF-I) immunoreactivity was mapped in normal Achilles and tibialis anterior tendons. The spindle-shaped tendon fibroblasts showed faint perinuclear staining. Fibroblasts in the paratenon mostly had a more intense IGF-I immunoreactivity, i.e. faint to moderate. When analysing either tendon in detail, areas with more intense IGF-I immunoreactivity could be recognized and seemed to correlate with areas of high mechanical stress. Increased mechanical load induced over 3 days elevated IGF-I immunoreactivity throughout the cytoplasm of tendon fibroblasts. Peak intensity was reached in 7 days, and thereafter the IGF-I immunoreactivity seemed to decrease irrespective of persistent high mechanical load. Training the animals on a treadmill for from 20 up to 60 min per day for 5 days induced after 3-5 days increased IGF-I immunoreactivity throughout the cytoplasm of the tendon and paratenon fibroblasts. Sudden curtailment of loading the Achilles tendon resulted in a marked reduction of the IGF-I immunoreactivity in most fibroblasts within 3 days. After a week only a small number of tendon fibroblasts showed any IGF-I immunoreactivity. The IGF-I immunoreactivity of tendon fibroblasts thus correlates to mechanical loading of the tendon. It is proposed that IGF-I may have a trophic influence on tendon and paratenon cells by autocrine and/or paracrine mechanisms. PMID:3067520

  7. Ultrasound Diagnosis of Bilateral Quadriceps Tendon Rupture After Statin Use

    PubMed Central

    Nesselroade, Ryan D.; Nickels, Leslie Connor

    2010-01-01

    Simultaneous bilateral quadriceps tendon rupture is a rare injury. We report the case of bilateral quadriceps tendon rupture sustained with minimal force while refereeing a football game. The injury was suspected to be associated with statin use as the patient had no other identifiable risk factors. The diagnosis was confirmed using bedside ultrasound. PMID:21079697

  8. Simultaneous bilateral quadriceps tendon rupture while playing basketball.

    PubMed

    Shah, M; Jooma, N

    2002-04-01

    Simultaneous bilateral quadriceps tendon rupture is an uncommon injury in healthy people and only a few cases have been reported in athletes. This is the first report of a patient with simultaneous bilateral quadriceps tendon rupture incurred while playing basketball. The injury was surgically repaired and the patient had a good functional outcome. PMID:11916903

  9. Lack of tissue renewal in human adult Achilles tendon is revealed by nuclear bomb (14)C.

    PubMed

    Heinemeier, Katja Maria; Schjerling, Peter; Heinemeier, Jan; Magnusson, Stig Peter; Kjaer, Michael

    2013-05-01

    Tendons are often injured and heal poorly. Whether this is caused by a slow tissue turnover is unknown, since existing data provide diverging estimates of tendon protein half-life that range from 2 mo to 200 yr. With the purpose of determining life-long turnover of human tendon tissue, we used the (14)C bomb-pulse method. This method takes advantage of the dramatic increase in atmospheric levels of (14)C, produced by nuclear bomb tests in 1955-1963, which is reflected in all living organisms. Levels of (14)C were measured in 28 forensic samples of Achilles tendon core and 4 skeletal muscle samples (donor birth years 1945-1983) with accelerator mass spectrometry (AMS) and compared to known atmospheric levels to estimate tissue turnover. We found that Achilles tendon tissue retained levels of (14)C corresponding to atmospheric levels several decades before tissue sampling, demonstrating a very limited tissue turnover. The tendon concentrations of (14)C approximately reflected the atmospheric levels present during the first 17 yr of life, indicating that the tendon core is formed during height growth and is essentially not renewed thereafter. In contrast, (14)C levels in muscle indicated continuous turnover. Our observation provides a fundamental premise for understanding tendon function and pathology, and likely explains the poor regenerative capacity of tendon tissue. PMID:23401563

  10. Development of cave foot deformity in failed repair of the Achilles tendon.

    PubMed

    Fortems, Y; Victor, J

    1993-01-01

    Two cases of failed primary repair of the Achilles tendon are reported. Cave foot deformity as an additional clinical sign of this condition is described. A possible biomechanical hypothesis is formulated, and a surgical procedure for correction of the symptoms is described. PMID:8323838

  11. Comparison of structural anisotropic soft tissue models for simulating Achilles tendon tensile behaviour.

    PubMed

    Khayyeri, Hanifeh; Longo, Giacomo; Gustafsson, Anna; Isaksson, Hanna

    2016-08-01

    The incidence of tendon injury (tendinopathy) has increased over the past decades due to greater participation in sports and recreational activities. But little is known about the aetiology of tendon injuries because of our limited knowledge in the complex structure-function relationship in tendons. Computer models can capture the biomechanical behaviour of tendons and its structural components, which is essential for understanding the underlying mechanisms of tendon injuries. This study compares three structural constitutive material models for the Achilles tendon and discusses their application on different biomechanical simulations. The models have been previously used to describe cardiovascular tissue and articular cartilage, and one model is novel to this study. All three constitutive models captured the tensile behaviour of rat Achilles tendon (root mean square errors between models and experimental data are 0.50-0.64). They further showed that collagen fibres are the main load-bearing component and that the non-collagenous matrix plays a minor role in tension. By introducing anisotropic behaviour also in the non-fibrillar matrix, the new biphasic structural model was also able to capture fluid exudation during tension and high values of Poisson׳s ratio that is reported in tendon experiments. PMID:27108350

  12. Neglected bilateral rupture of the patellar tendon: A case report.

    PubMed

    Cherrad, Taoufik; Louaste, Jamal; Kasmaoui, El Houcine; Bousbaä, Hicham; Rachid, Khaled

    2015-12-01

    Simultaneous bilateral rupture of the patellar tendon (PT) is extremely rare and is generally associated to some chronic diseases. When the rupture becomes chronic, it is more difficult to repair that as it remained untreated. The diagnosis, which is clinical, is often delayed, guided by standard radiography and confirmed by ultrasound or MRI. The management of a bilateral neglected, chronic patellar tendon rupture must address some serious difficulties: the proximally retracted patella, the reconstruction of the patellar tendon, finally, the temporary protection of this repair. We report a case of neglected bilateral rupture of the patellar tendon in a chronic hemodialysis patient, treated with a plastic surgery of the ipsilateral quadriceps tendon. PMID:26566349

  13. Fluoroquinolone-induced Achilles tendinitis.

    PubMed

    Tam, P K; Ho, Carmen T K

    2014-12-01

    We report a case of Achilles tendinitis after intake of ciprofloxacin for treatment of respiratory tract infection. Fluoroquinolone-induced tendinopathy is an uncommon but increasingly recognised adverse effect of this antibiotic class. Most of the cases occur in the Achilles tendon and may lead to tendon rupture. Possible predisposing risk factors include use of steroid, patients with renal impairment or renal transplant, old age, and being an athlete. The drug should be stopped once this condition is suspected. Symptomatic treatment should be given and orthopaedic referral is desirable if tendon rupture occurs. PMID:25488035

  14. The morphology and symptom history of the Achilles tendons of figure skaters: an observational study.

    PubMed

    Perry, Mark; Tillett, Eleanor; Mitchell, Sophie; Maffulli, Nicola; Morrissey, Dylan

    2012-04-01

    This cross-sectional study assessed the prevalence of Achilles tendinopathy symptoms and ultrasound (US) abnormalities in male and female ice skaters, and compared this to age-matched controls. The 20 skaters of mean (sd) age 17.3 (7.9) were recruited from British figure skating clubs. The 17 non-skaters of mean age 18.0 (3.7) were recruited from a secondary school and university. Each group had 12 females. All participants completed a questionnaire, and Achilles tendons were ultrasound-scanned for thickening, hypoechoic areas, paratenon blurring and neovascularization. Skaters experienced significantly more lifetime symptoms (p=0.012) than the control group but there were no differences in present symptoms. Mid-tendon longitudinal thickness and the coefficient of variation (CoV) for longitudinal tendon thickness were significantly greater in the skaters (p=0.001 and p=0.017 respectively). No other ultrasound abnormalities were detected in either group. Figure skaters may be at a greater risk of Achilles tendon problems than the general population and have adaptive changes in their tendons. PMID:23738283

  15. Gender and pregnancy affect neuropeptide responses of the rabbit Achilles tendon.

    PubMed

    Hart, D A; Kydd, A; Reno, C

    1999-08-01

    Tendons such as the Achilles tendon are complex structures that are hypocellular, hypovascular, and hyponeural. The development of pathophysiologic function in this tendon because of overuse is relatively common; however, the mechanisms responsible for the development of paratenonitis and tendinosis remain primarily undefined. To understand better a possible regulatory role for neuropeptides (substance P and calcitonin gene related peptide) known to be present in this tissue, the influence of substance P and calcitonin gene related peptide on messenger ribonucleic acid levels for numerous inflammatory molecules, growth factors, and proteinases and inhibitors have been assessed using a semiquantitative reverse transcription-polymerase chain reaction method and explants of paratenon and Achilles tendon midsubstance tissue from adolescent male and female rabbits and tissue from primigravida females. Most of the significant (p < 0.01) changes observed were at the level of the growth factor transcripts and transcripts for proteinases and inhibitors. Twenty-one significant differences in the responsiveness between tissues from male and female rabbits were observed, and 12 significant differences in responsiveness between virgin females and primigravida rabbits were seen. Differences between paratenon and midsubstance responsiveness to the neuropeptides also were observed within each group of animals. The midsubstance tissue from pregnant animals was hyporesponsive to both neuropeptides. These results indicate that neurotransmitter responsiveness of Achilles tendon tissue differs in a gender specific manner and is influenced by pregnancy associated factors. PMID:10627708

  16. The morphology and symptom history of the Achilles tendons of figure skaters: an observational study

    PubMed Central

    Perry, Mark; Tillett, Eleanor; Mitchell, Sophie; Maffulli, Nicola; Morrissey, Dylan

    2012-01-01

    Summary This cross-sectional study assessed the prevalence of Achilles tendinopathy symptoms and ultrasound (US) abnormalities in male and female ice skaters, and compared this to age-matched controls. The 20 skaters of mean (sd) age 17.3 (7.9) were recruited from British figure skating clubs. The 17 non-skaters of mean age 18.0 (3.7) were recruited from a secondary school and university. Each group had 12 females. All participants completed a questionnaire, and Achilles tendons were ultrasound-scanned for thickening, hypoechoic areas, paratenon blurring and neovascularization. Skaters experienced significantly more lifetime symptoms (p=0.012) than the control group but there were no differences in present symptoms. Mid-tendon longitudinal thickness and the coefficient of variation (CoV) for longitudinal tendon thickness were significantly greater in the skaters (p=0.001 and p=0.017 respectively). No other ultrasound abnormalities were detected in either group. Figure skaters may be at a greater risk of Achilles tendon problems than the general population and have adaptive changes in their tendons. PMID:23738283

  17. Extended field of view ultrasound imaging to evaluate Achilles tendon length and thickness: a reliability and validity study

    PubMed Central

    Silbernagel, Karin Gravare; Shelley, Kristen; Powell, Stephen; Varrecchia, Shaun

    2016-01-01

    Summary Background Achilles tendon structural changes are common after injury and correlate with recovery of function. Having simple, inexpensive, yet valid and reliable measures of Achilles tendon structure are useful both in research and clinical. The purpose of this study was to perform reliability and validity measures of extended field of view (EFOV) ultrasound (US) imaging of the Achilles tendon. Methods eight cadavers (16 tendons) were used for the validation study to compare Achilles tendon length measurements from US images with actual measured length from dissected tendons. Nine healthy subjects (18 tendons) were included in the test-retest evaluation. Results the correlation between the US images and cadaveric measurements was excellent (ICC=0.895) for the length between calcaneus and the gastrocnemius and good (ICC=0.744) for the length between the calcaneus and the soleus. The between-limb reliability was excellent (ICC 0.886–0.940) for the tendon length measurements with standard error of measurements (SEM) of 0.64 cm for calcaneus to soleus and 0.67 cm for calcaneus to gastrocnemius. Between-day test-retest reliability was also excellent (ICC=0.898–0.944). Conclusion this study supports the use of EFOV US imaging as a reliable and valid method to determine Achilles tendon length and thickness, and using the uninjured limb for comparison. PMID:27331037

  18. Rupture of the triceps tendon - A case series.

    PubMed

    Jaiswal, Atin; Kacchap, Naiman-Deep; Tanwar, Yashwant-Singh; Kumar, Devendra; Kumar, Birendra

    2016-08-01

    Triceps rupture is the least common among all tendon injuries. The usual mechanism of injury is a fall on an outstretched hand, although direct contact injuries have also been reported to cause this injury. The diagnosis of acute triceps tendon rupture may be missed, which can result in prolonged disability and delayed operative management. We presented three cases of acute triceps tendon rupture each at different site showing the spectrum of injury to the muscle and mechanism of injury and management were also discussed. PMID:27578383

  19. Longitudinal Slit Procedure in Addition to Negative Pressure Wound Therapy for a Refractory Wound With Exposed Achilles Tendon

    PubMed Central

    Ohata, Erika; Mishima, Yoshito; Matsuo, Kiyoshi

    2015-01-01

    Objective: This case report reviews features of negative pressure wound therapy, particularly for the exposed Achilles tendon, and describes an additional effective procedure. Methods: An 87-year-old man presented with a soft-tissue defect measuring 3×5 cm with the exposed Achilles tendon as a sequela of deep burn. The condition of his affected leg was ischemic because of arteriosclerosis. We used negative pressure wound therapy and made 2 longitudinal slits penetrating the tendon to induce blood flow from the ventral side to the dorsal surface. Results: By this combination therapy, the surface of the exposed Achilles tendon was completely epithelialized and the tendon was spared without disuse syndrome. Conclusions: The authors conclude that this combination therapy is useful for covering the widely exposed tendon in aged patients. PMID:25848445

  20. Achilles Pain.

    ERIC Educational Resources Information Center

    Connors, G. Patrick

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

  1. Acute tear of the fascia cruris at the attachment to the Achilles tendon: a new diagnosis

    PubMed Central

    Webborn, Nick; Morrissey, Dylan; Sarvananthan, Kasthuri; Chan, Otto

    2015-01-01

    Background The fascia cruris encloses the posterior structures of the calf and connects to the paratenon and the Achilles tendon. We describe the clinical presentation, ultrasound imaging characteristics and the time to the recovery of tears of the fascia cruris at the attachment to the Achilles tendon. Methods Retrospective review of 11 tears of the fascia cruris in the different legs as separate events in 9 patients (6 male and 3 female, mean age 35.52 years, range 11–48) identified using diagnostic ultrasound, after presenting with Achillodynia. Results 11 participants presented at a mean of 4.5 weeks (range 0.5–12) after onset of symptoms. The left Achilles was more commonly injured than the right (7 : 4) and the lateral side more than the medial (6 : 4) with one case with medial and lateral presentation. Clinically, there was swelling and tenderness over the medial or lateral border in the mid to upper portion of the Achilles. 7 of the 11 (63.6%) had functional overpronation. Ultrasound appearances of a tear were identified as hypoechoic area extending from the medial or lateral border of the Achilles extending along the anatomical plane of the fascia cruris. Average return to activity was 5.2 weeks (range 1–22). Participants presenting later had longer recovery but all participants returned to full activity (r=0.4). Conclusions This is the first description of the clinical details and sonographic findings of a tear to the fascia cruris at its attachment to the Achilles tendon. This needs to be considered as a cause of Achillodynia in athletes as recognition will affect the management. PMID:25202137

  2. Insulin-dependent diabetes impairs the inflammatory response and delays angiogenesis following Achilles tendon injury.

    PubMed

    Chbinou, Nadia; Frenette, Jérôme

    2004-05-01

    Although impaired wound healing associated with type 1 diabetes mellitus has been well studied in skin tissue, the influence of this metabolic disorder on tendon healing and recovery has not been extensively investigated. Because tendons are known to have limited repair potential, we studied the tendon-healing process by using a diabetic rat tendonitis model. We tested the hypothesis that diabetes influences the inflammatory response, cell proliferation, and angiogenesis in injured Achilles tendons. Diabetes was induced by injecting streptozotocin at 45 mg/kg body wt. Non-diabetic rats as well as diabetic and insulin-treated diabetic animals were then injected with collagenase. The accumulation of inflammatory cells was quantified in transversal sections of Achilles tendon by using immunohistochemical staining at days 0, 1, 3, 7, 14, and 28 posttrauma. The number of proliferative cells and the extent of neovascularization was also quantified in the paratenon and the core of the tendon at days 0, 3, 7, 14, and 28 posttrauma. Relative to nondiabetic and insulin-treated diabetic animals, the numbers of accumulated neutrophils and ED1(+) and ED2(+) macrophages in diabetic rats decreased by 46, 43, and 52%, respectively, in the first 3 days after injury compared with levels in nondiabetic and insulin-treated diabetic animals. The density of newly formed blood vessels decreased by 35 and 29% in the paratenon and the core of tendon, respectively, at days 3 and 7 after injury. Lastly, the concentration of proliferative cells decreased by 34% in the paratenon at day 7 posttrauma in injured tendons from diabetic rats relative to nondiabetic rats. These results indicate that alterations in inflammatory, angiogenic, and proliferative processes occurred in the diabetic state that might eventually perturb tendon healing and remodeling. PMID:14715491

  3. A rare knee extensor mechanism injury: Vastus intermedius tendon rupture

    PubMed Central

    Cetinkaya, Engin; Aydin, Canan Gonen; Akman, Yunus Emre; Gul, Murat; Arikan, Yavuz; Aycan, Osman Emre; Kabukcuoglu, Yavuz Selim

    2015-01-01

    Introduction Quadriceps tendon injuries are rare. There is a limited number of studies in the literature, reporting partial quadriceps tendon ruptures. We did not find any study reporting an isolated vastus intermedius tendon injury in the literature. Presentation of case A 22 years old professional rugby player with the complaints of pain in the right lower limb, decreased range of motion in right knee and a mass in the mid-anterior of the right thigh applied following an overloading on his hyperflexed knee during a rugby match. T2 sequence magnetic resonance images revealed discontinuity in the vastus intermedius tendon and intramuscular hematoma. The patient has been conservatively treated. Discussion Quadriceps tendon ruptures generally occur after the 4th decade in the presence of degenerative changes. Our case is a young professional rugby player. Isolated vastus intermedius tendon rupture is unusual. Conservative treatment is performed as the intermedius tendon is in the deepest layer of the quadriceps muscle. Conclusion We report the first case of isolated rupture of the vastus intermedius tendon in the literature and we claim that disorder may be succesfully treated with conservative treatment and adequate physiotheraphy. PMID:26298093

  4. Sustained Release of Amnion-Derived Cellular Cytokine Solution Facilitates Achilles Tendon Healing in Rats

    PubMed Central

    Kueckelhaus, Maximilian; Philip, Justin; Kamel, Rami A.; Canseco, Jose A.; Hackl, Florian; Kiwanuka, Elizabeth; Kim, Mi J.; Wilkie, Ryan; Caterson, Edward J.; Junker, Johan P. E.

    2014-01-01

    Objective: In the United States, around 50% of all musculoskeletal injuries are soft tissue injuries including ligaments and tendons. The objective of this study is to assess the role of amnion-derived cellular cytokine solution (ACCS) in carboxy-methyl cellulose (CMC) gel in the healing of Achilles tendon in a rat model, and to examine its effects on mechanical properties and collagen content. Methods: Achilles tendons of Sprague-Dawley rats were exposed and transected. The distal and proximal ends were injected with either saline or ACCS in CMC, in a standardized fashion, and then sutured using a Kessler technique. Tendons from both groups were collected at 1, 2, 4, 6, and 8 weeks postoperatively and assessed for material properties. Collagen studies were performed, including collagen content, collagen cross-linking, tendon hydration, and immunohistochemistry. Tendons were also evaluated histologically for cross-sectional area. Results: Mechanical testing demonstrated that treatment with ACCS in CMC significantly enhances breaking strength, ultimate tensile strength, yield strength, and Young's modulus in the tendon repair at early time points. In context, collagen content, as well as collagen cross-linking, was also significantly affected by the treatment. Conclusion: The application of ACCS in CMC has a positive effect on healing tendons by improving mechanical properties at early time points. Previous studies on onetime application of ACCS (not in CMC) did not show significant improvement on tendon healing at any time point. Therefore, the delivery in a slow release media like CMC seems to be essential for the effects of ACCS demonstrated in this study. PMID:25210571

  5. Increase in sensory neuropeptides surrounding the Achilles tendon in rats with adjuvant arthritis.

    PubMed

    Bring, Daniel K-I; Heidgren, Marie-Louise; Kreicbergs, Andris; Ackermann, Paul W

    2005-03-01

    The Achilles tendon in rats with adjuvant arthritis was analyzed by radioimmunoassay (RIA) and semi-quantitative immunohistochemistry for the occurrence of two sensory neuropeptides, substance P (SP) and calcitonin gene related peptide (CGRP), and a sensory modulating peptide, galanin (GAL). The tissue concentration of SP and CGRP in the Achilles tendon and its envelope, i.e. the paratenon and bony insertion, as assessed by RIA was increased by 22% and 71%, respectively, compared to normal controls, whereas the level of GAL was unchanged. Semi-quantitative immunohistochemistry applied to different regions of the tendon in arthritic rats disclosed an increased occurrence of SP and CGRP positive nerve fibers in the paratenon and bone tendinous junction, whereas GAL fibers were only increased at the bone tendinous junction. Notably, neither neuropeptides nor inflammatory cells were seen in the tendon proper. The increased occurrence of SP and CGRP in the tendon envelope presumably reflects inflammatory actions, whereas that of GAL implies an endogenous anti-inflammatory response. The observed SP and CGRP upregulation in the paratenon and bony insertion suggests a pathophysiological role in paratenonitis and enthesitis often seen in patients with rheumatoid arthritis. Presumably Achillodynia originates in the tendon envelope rather than the tendon proper. The observations could be used to define new pharmacological targets for mitigating symptoms from tendons in rheumatoid arthritis and possibly also in other disorders. Whether a neuronal pathogenic mechanism underlies tendon overuse disorders in non-arthritic tendinopathies and the development of degeneration, i.e. tendinosis, remains to be studied. PMID:15734239

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

    PubMed Central

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

    2016-01-01

    Tendon stem/progenitor cells (TSPCs) are a potential cell source for tendon tissue engineering. The striking morphological and structural changes of tendon tissue during development indicate the complexity of TSPCs at different stages. This study aims to characterize and compare post-natal rat Achilles tendon tissue and TSPCs at different stages of development. The tendon tissue showed distinct differences during development: the tissue structure became denser and more regular, the nuclei became spindle-shaped and the cell number decreased with time. TSPCs derived from 7 day Achilles tendon tissue showed the highest self-renewal ability, cell proliferation, and differentiation potential towards mesenchymal lineage, compared to TSPCs derived from 1 day and 56 day tissue. Microarray data showed up-regulation of several groups of genes in TSPCs derived from 7 day Achilles tendon tissue, which may account for the unique cell characteristics during this specific stage of development. Our results indicate that TSPCs derived from 7 day Achilles tendon tissue is a superior cell source as compared to TSPCs derived from 1 day and 56 day tissue, demonstrating the importance of choosing a suitable stem cell source for effective tendon tissue engineering and regeneration. PMID:26972579

  7. Regional differences in stem cell/progenitor cell populations from the mouse achilles tendon.

    PubMed

    Mienaltowski, Michael J; Adams, Sheila M; Birk, David E

    2013-01-01

    Specific niches may affect how cells from different regions contribute to tendon biology, particularly in regard to the healing of certain tendinopathies. The objectives of this study are to determine whether distinct subpopulations of stem/progenitor cells are found within the tendon proper and the epi- and paratenon, the peritenon, as well as to characterize these stem/progenitor cell populations. In this study, we hypothesized that tendon stem/progenitor cells exist in each region, that these populations possess distinct features, and that these populations while multipotent could have differing potentials. To test this hypothesis, stem/progenitor cells were isolated and characterized from the peritenon and tendon proper of mouse Achilles tendons. Colony-forming unit and multipotency assays, as well as flow cytometry, and real-time quantitative polymerase chain reaction analyses of stem cell markers were performed. Significantly, more stem/progenitor cell colonies were observed from cells derived from the tendon proper relative to the peritenon. Analysis of surface markers for stem/progenitor cells from both regions indicated that they were Sca1(+) (stem cell marker), Cd90(+) and Cd44(+) (fibroblast markers), Cd18(-) (leukocyte marker), Cd34(-) (hematopoietic and vascular marker), and Cd133(-) (perivascular marker). Tendon proper stem/progenitor cells had increased expression levels for tenomodulin (Tnmd) and scleraxis (Scx), indicative of enrichment of stem/progenitor cells of a tendon origin. In contrast, cells of the peritenon demonstrated relative increases in the vascular (endomucin) and pericyte (Cd133) markers relative to cells from the tendon proper. Stem/progenitor cells from both regions were multipotent (adipogenic, chondrogenic, osteogenic, and tenogenic). These findings demonstrated that different progenitor populations exist within discrete niches of the Achilles tendon-tendon proper versus peritenon. Overall, these data support the hypothesis that

  8. Effects of tendon viscoelasticity in Achilles tendinosis on explosive performance and clinical severity in athletes.

    PubMed

    Wang, H-K; Lin, K-H; Su, S-C; Shih, T T-F; Huang, Y-C

    2012-12-01

    The aim was to compare viscoelastic properties of Achilles tendons between legs in elite athletes with unilateral tendinosis, and to investigate relationships between the properties and explosive performance and clinical severity. Seventeen male athletes (mean ± standard deviation age, 27.3 ± 2.0 years) who had unilateral, chronic middle-portion tendinopathy of the Achilles tendon were assessed by the Victorian Institute of Sport Assessment questionnaire, measurements of tendon viscoelastic properties, voluntary electromechanical delay (EMD), normalized rate of force development (RFD), and one-leg hopping distance. Compared with the non-injured leg, the tendinopathic leg showed reduced tendon stiffness (-19.2%. P < 0.001), greater mechanical hysteresis (+21.2%, P = 0.004), lower elastic energy storage and release (-14.2%, P = 0.002 and -19.1%, P < 0.001), lower normalized RFD at one-fourth (-16.3%, P = 0.02), 2/4 (-17.3%, P = 0.006), and three-fourths maximal voluntary contraction (-13.7%, P = 0.02), longer soleus and medial gastrocnemius voluntary EMD (+26.9%, P = 0.009 and +24.0%, P = 0.004), and shorter hopping distances (-34.1%, P < 0.001). Tendon stiffness was correlated with normalized RFD, voluntary EMD in the medial gastrocnemius, and hopping distances (r ranged from -0.35 to 0.64, P < 0.05). Hysteresis was correlated to the soleus voluntary EMD and hopping distances (r = 0.42 and -0.39, P < 0.05). We concluded that altered tendon viscoelastic properties in Achilles tendinosis affect explosive performance in athletes. PMID:22830527

  9. Z-lengthening of the Achilles Tendon with Transverse Skin Incision

    PubMed Central

    Oh, Jong Seok; Lee, Jong Seo; Lee, Tae Hoon

    2014-01-01

    Background The risk of various complications after Achilles tendon lengthening is mainly related to the length of surgical exposure and the lengthening method. A comprehensive technique to minimize the complications is required. Methods The treatment of Achilles tendon tightness in 57 patients (95 ankles) were performed by using a short transverse incision on a skin crease of the heel and by Z-lengthening of the tendon. In the severe cases, two or three transverse incisions were required for greater lengthening of the tendon, and a serial cast or Ilizarov apparatus was applied for the gradual correction. The results of these 95 ankles were compared to those of 18 ankles, which underwent percutaneous sliding lengthening, and to the 19 ankles, which received Z-lengthening with a medial longitudinal incision. Results The functional and cosmetic satisfaction was achieved among those who underwent the tendon lengthening with the new technique. The mean American Orthopaedic Foot & Ankle Society (AOFAS) score improved from 56.1 to 81.8. The second operations to correct recurrence were performed in the two cerebral palsy patients. Conclusions The new technique has a low rate of complications such as scarring, adhesion, total transection, excessive lengthening, and recurrence of shortening. The excellent cosmesis and the short operation time are the additional advantages. PMID:24900904

  10. MMP3 and TIMP2 gene variants as predisposing factors for Achilles tendon pathologies: Attempted replication study in a British case–control cohort

    PubMed Central

    El Khoury, Louis; Ribbans, William J.; Raleigh, Stuart M.

    2016-01-01

    Variants within the MMP3 (rs679620) and TIMP2 (rs4789932) genes have been associated with the risk of Achilles tendon pathology (ATP) in populations from South Africa and Australia. This study aimed to determine whether these variants were associated with the risk of ATP in British Caucasians. We recruited 118 cases with ATP, including a subset of 25 individuals with Achilles tendon rupture (RUP) and 131 controls. DNA samples were isolated from saliva and genotyped using qPCR. For the TIMP2 rs4789932 variant we found a significant (p = 0.038) difference in the genotype distribution frequency between males with ATP (CC, 39.4%; CT, 43.7%; TT, 16.9%) compared to male controls (CC, 20.7%; CT, 59.8%; TT, 19.5%). We also observed a difference in the TIMP2 rs4789932 genotype distribution between males with rupture compared to male controls (p = 0.038). The MMP3 rs679620 GG genotype was found to be overrepresented in the Achilles tendon rupture (RUP) group (AA, 24.0%; AG, 32.0%; GG, 44.0%) compared to controls (AA, 26.7%; AG, 54.2%; GG, 19.1%). In conclusion, the CT genotype of the TIMP2 rs4789932 variant was associated with lower risk of ATP in males. Furthermore, while we revealed differences for both variants in genotype distribution between the RUP and control groups, the sample size of the RUP group was small and confirmation would be required in additional cohorts. Finally, although both the TIMP2 rs4789932 and MMP3 rs679620 variants tentatively associated with ATP, there were differences in the direction of association compared to earlier work. PMID:27222816

  11. MMP3 and TIMP2 gene variants as predisposing factors for Achilles tendon pathologies: Attempted replication study in a British case-control cohort.

    PubMed

    El Khoury, Louis; Ribbans, William J; Raleigh, Stuart M

    2016-09-01

    Variants within the MMP3 (rs679620) and TIMP2 (rs4789932) genes have been associated with the risk of Achilles tendon pathology (ATP) in populations from South Africa and Australia. This study aimed to determine whether these variants were associated with the risk of ATP in British Caucasians. We recruited 118 cases with ATP, including a subset of 25 individuals with Achilles tendon rupture (RUP) and 131 controls. DNA samples were isolated from saliva and genotyped using qPCR. For the TIMP2 rs4789932 variant we found a significant (p = 0.038) difference in the genotype distribution frequency between males with ATP (CC, 39.4%; CT, 43.7%; TT, 16.9%) compared to male controls (CC, 20.7%; CT, 59.8%; TT, 19.5%). We also observed a difference in the TIMP2 rs4789932 genotype distribution between males with rupture compared to male controls (p = 0.038). The MMP3 rs679620 GG genotype was found to be overrepresented in the Achilles tendon rupture (RUP) group (AA, 24.0%; AG, 32.0%; GG, 44.0%) compared to controls (AA, 26.7%; AG, 54.2%; GG, 19.1%). In conclusion, the CT genotype of the TIMP2 rs4789932 variant was associated with lower risk of ATP in males. Furthermore, while we revealed differences for both variants in genotype distribution between the RUP and control groups, the sample size of the RUP group was small and confirmation would be required in additional cohorts. Finally, although both the TIMP2 rs4789932 and MMP3 rs679620 variants tentatively associated with ATP, there were differences in the direction of association compared to earlier work. PMID:27222816

  12. Changes in collagen fibril pattern and adhesion force with collagenase-induced injury in rat Achilles tendon observed via AFM.

    PubMed

    Lee, Gi-Ja; Choi, Samjin; Chon, Jinmann; Yoo, Seungdon; Cho, Ilsung; Park, Hun-Kuk

    2011-01-01

    The Achilles tendon consists mainly of type I collagen fibers that contain collagen fibrils. When the Achilles tendon is injured, it is inflamed. The collagenase-induced model has been widely used to study tendinitis. The major advantages of atomic force microscopy (AFM) over conventional optical and electron microscopy for bio-imaging include its non-requirement of a special coating and vacuum, and its capability to perform imaging in all environments. AFM force-distance measurements have become a fundamental tool in the fields of surface chemistry, biochemistry and materials science. Therefore, the changes in the ultrastructure and adhesion force of the collagen fibrils on the Achilles tendons of rats with Achilles tendinitis were observed using AFM. The changes in the structure of the Achilles tendons were evaluated based on the diameter and D-banding of the collagen fibrils. Collagenase-induced Achilles tendinitis was induced with the injection of 30 microl crude collagenase into 7-week-old male Sprague-Dawley rats. The animals were each sacrificed on the first, second, third, fifth and seventh day after the collagenase injection. The normal and injured Achilles tendons were fixed in 4% buffered formalin and dehydrated with increasing concentrations of ethanol. AFM was performed using the non-contact mode at the resolution of 512 x 512 pixels, with a scan speed of 0.8 line/sec. The adhesion force was measured via the force-distance curve that resulted from the interactions between the AFM tip and the collagen fibril sample using the contact mode. The diameter of the collagen fibrils in the Achilles tendons significantly decreased (p < 0.05) after the collagenase injection, and the pattern of the D-banding of the collagen fibrils was similar to that of the diameter changes. The adhesion force decreased until the fifth day after the collagenase injection, but increased on the seventh day after the collagenase injection (p < 0.0001). PMID:21446543

  13. Three-dimensional morphology and strain of the human Achilles free tendon immediately following eccentric heel drop exercise.

    PubMed

    Obst, Steven J; Newsham-West, Richard; Barrett, Rod S

    2015-12-01

    Our understanding of the immediate effects of exercise on Achilles free tendon transverse morphology is limited to single site measurements acquired at rest using 2D ultrasound. The purpose of this study was to provide a detailed 3D description of changes in Achilles free tendon morphology immediately following a single clinical bout of exercise. Freehand 3D ultrasound was used to measure Achilles free tendon length, and regional cross-sectional area (CSA), medio-lateral (ML) diameter and antero-posterior (AP) diameter in healthy young adults (N=14) at rest and during isometric muscle contraction, immediately before and after 3×15 eccentric heel drops. Post-exercise reductions in transverse strain were limited to CSA and AP diameter in the mid-proximal region of the Achilles free tendon during muscle contraction. The change in CSA strain during muscle contraction was significantly correlated to the change in longitudinal strain (r=-0.72) and the change in AP diameter strain (r=0.64). Overall findings suggest the Achilles free tendon experiences a complex change in 3D morphology following eccentric heel drop exercise that manifests under contractile but not rest conditions, is most pronounced in the mid-proximal tendon and is primarily driven by changes in AP diameter strain and not ML diameter strain. PMID:26519510

  14. A Rare Case of Bilateral Patellar Tendon Ruptures: A Case Report and Literature Review

    PubMed Central

    Tarazi, Nadim; O'loughlin, Padhraig; Amin, Amin; Keogh, Peter

    2016-01-01

    Bilateral patellar tendon ruptures are rare. The majority of case reports describing bilateral patellar tendon ruptures have occurred in patients with predisposing factors to tendinopathy. We describe a case of bilateral patellar tendon rupture sustained following minimal trauma by a patient with no systemic disease or history of steroid use. Due to the rarity of this injury, clinical suspicion is low. It is reported that 38% of patellar tendon ruptures are misdiagnosed initially. Therefore careful history taking and physical examination is integral in ensuring a diagnosis is achieved for early primary repair. We discuss the aetiology of spontaneous tendon rupture and report a literature review of bilateral patellar tendon ruptures. PMID:27200200

  15. Multiparametric MR Imaging Depicts Glycosaminoglycan Change in the Achilles Tendon during Ciprofloxacin Administration in Healthy Men

    PubMed Central

    Juras, Vladimir; Winhofer, Yvonne; Szomolanyi, Pavol; Vosshenrich, Jan; Hager, Benedikt; Wolf, Peter; Weber, Michael; Luger, Anton; Trattnig, Siegfried

    2015-01-01

    Purpose To determine if quantitative magnetic resonance (MR) imaging techniques (sodium MR imaging, glycosaminoglycan [GAG] chemical exchange saturation transfer [CEST], and T2* mapping) could be used as potential markers for biochemical changes in the Achilles tendon induced by ciprofloxacin intake. Materials and Methods The ethics committee of the Medical University of Vienna approved the protocol (number 1225/2012), and all patients gave written informed consent. Fourteen ankles from seven men (mean age, 32 years ± 12 [standard deviation]) were included in the study. All patients underwent 7-T MR imaging examinations of the Achilles tendon at baseline and 10 days and 5 months after ciprofloxacin intake. Sodium signal and T2* maps were acquired with the variable echo-time sequence and the GAG CEST values were acquired with a three-dimensional radiofrequency spoiled gradient-recalled-echo sequence. Results The mean sodium signal was significantly decreased by 25% in the whole tendon (from baseline to 10 days after ciprofloxacin intake, 130 arbitrary units [au] ± 8 to 98 au ± 5, respectively; P = .023) and returned to baseline after 5 months (116 au ± 10), as observed also at the tendon insertion (baseline, 10 days after ciprofloxacin intake, and 5 months after ciprofloxacin intake, 134 au ± 8, 105 au ± 5, and 119 au ± 9, respectively; P = .034). The mean GAG CEST value in the whole tendon was parallel to the sodium signal with a decrease from baseline to 10 days after ciprofloxacin intake, 4.74% ± 0.75 to 4.50% ± 0.23, respectively (P = .028) and an increase at 5 months after ciprofloxacin intake to 4.88% ± 1.02. Conclusion In conclusion, this study demonstrates a ciprofloxacin-induced reversible reduction of the normalized sodium MR imaging signal and the GAG CEST effect in the Achilles tendon of healthy volunteers. Changes in sodium MR imaging and GAG CEST in men may reflect a decrease of GAG content in the Achilles tendon after ciprofloxacin intake

  16. Flexor Hallucis Longus Tendon Transfer for Calcific Insertional Achilles Tendinopathy.

    PubMed

    Howell, Michael A; Catanzariti, Alan R

    2016-01-01

    Calcific insertional Achilles tendinopathy can result in significant pain and disability. Although some patients respond to nonoperative therapy, many patients are at risk for long-term morbidity and unpredictable clinical outcomes. There is no evidence-based data to support the timing of operative invention, choice of procedures, or whether equinus requires treatment. This article suggests the need for a classification system based on physical examination and imaging to help guide treatment. There is an obvious need for evidence-based studies evaluating outcomes and for properly conducted scientific research to establish appropriate treatment protocols. PMID:26590729

  17. Ultrasound-targeted microbubble destruction enhances naked plasmid DNA transfection in rabbit Achilles tendons in vivo.

    PubMed

    Qiu, L; Zhang, L; Wang, L; Jiang, Y; Luo, Y; Peng, Y; Lin, L

    2012-07-01

    The study was to investigate the probability of increasing the transfection of the gene in tendons by ultrasound-targeted microbubble destruction (UTMD), and to search for the most suitable transfection conditions. A mixture of microbubbles and enhanced green fluorescent protein (EGFP) plasmids was injected into rabbit Achilles tendons by different administration routes and the tendons were ultrasound pulse by different ultrasonic conditions in order to determine the most appropriate conditions. Then, the rabbits were divided into four groups: (1) ultrasound + microbubbles + plasmid; (2) ultrasound+ plasmid; (3) microbubble + plasmid; (4) plasmid only. EGFP expression in the tendons and other tissues, and the damage to tendon and paratenon were all observed. The results showed that EGFP expression in the tendon was higher by ultrasound pulse with 2 W cm(-2) of output intensity and a 20% duty cycle for 10 min. Local injection was determined to be the better administration route. Among the four groups, EGFP expression in Group 1 was higher than that in other groups. EGFP expression was highest on seventh day, then it gradually decrease over time, and lasted more than 56 days. EGFP expression was not found in other tissues. There was no obvious injury caused by UTMD. Under suitable conditions, it is feasible to use UTMD as a safe and effective gene transfection therapy for tendon injuries. PMID:22033463

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

    PubMed Central

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

    2013-01-01

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

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

    PubMed

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

    2013-12-01

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

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

    PubMed Central

    Alfredson, Håkan

    2016-01-01

    Background There is a general opinion that a structured and specific rehabilitation is needed after treatment of midportion Achilles tendinopathy to minimize recurrence of the condition. There is sparse knowledge about the recurrence rates in large patient materials after specific treatments for midportion Achilles tendinopathy. Aim This study aimed to investigate the recurrence rates in a large number of patients with chronic painful midportion Achilles tendinopathy that had been surgically treated with the ultrasound (US) and Doppler (DP)-guided mini-surgical scraping technique. Postoperatively, a relatively simple rehabilitation protocol, including a range of movement exercises and gradually increased walking and biking before allowing free activity, was used. Materials and methods From a database, information about the recurrence rates after US + DP-guided mini-surgical scraping, performed by a single surgeon on 519 tendons with US + DP-verified chronic painful midportion Achilles tendinopathy, was obtained. Results Recurrence of painful midportion Achilles tendinopathy was found in 26 of 519 (5%) operated tendons, 13 from women and 13 from men. In 13 tendons, a close by located plantaris tendon was extirpated during the reoperation. Conclusion In this large material on patients treated with US + DP-guided mini-surgical scraping for midportion Achilles tendinopathy, there were few recurrences, although only a simple and nonspecific rehabilitation protocol was used. PMID:27274323

  1. Overweight and obesity alters the cumulative transverse strain in the Achilles tendon immediately following exercise.

    PubMed

    Wearing, Scott C; Hooper, Sue L; Grigg, Nicole L; Nolan, Gregory; Smeathers, James E

    2013-07-01

    This research evaluated the effect of obesity on the acute cumulative transverse strain of the Achilles tendon in response to exercise. Twenty healthy adult males were categorized into 'low normal-weight' (BMI <23 kg m(-2)) and 'overweight' (BMI >27.5 kg m(-2)) groups based on intermediate cut-off points recommended by the World Health Organization. Longitudinal sonograms of the right Achilles tendon were acquired immediately prior and following weight-bearing ankle exercises. Achilles tendon thickness was measured 20-mm proximal to the calcaneal insertion and transverse tendon strain was calculated as the natural log of the ratio of post- to pre-exercise tendon thickness. The Achilles tendon was thicker in the overweight group both prior to (t18 = -2.91, P = 0.009) and following (t18 = -4.87, P < 0.001) exercise. The acute transverse strain response of the Achilles tendon in the overweight group (-10.7 ± 2.5%), however, was almost half that of the 'low normal-weight' (-19.5 ± 7.4%) group (t18 = -3.56, P = 0.004). These findings suggest that obesity is associated with structural changes in tendon that impairs intra-tendinous fluid movement in response to load and provides new insights into the link between tendon pathology and overweight and obesity. PMID:23768275

  2. Proximal humerus shaft fracture after pectoralis major tendon rupture repair.

    PubMed

    Silverstein, Jeff A; Goldberg, Ben; Wolin, Preston

    2011-06-01

    Surgical repair of a complete pectoralis major tendon rupture at the humeral insertion has superior results compared to nonoperative treatment. To our knowledge, a proximal humerus shaft fracture occurring at the site of the bone trough and cortical drill holes after a pectoralis major tendon rupture repair has not been reported in the literature.A 45-year-old man sustained an acute left pectoralis major tendon rupture at the humeral insertion while performing a bench press maneuver. He underwent acute surgical repair. Approximately 8 weeks postoperatively, the patient fell from a standing height and sustained a proximal humerus shaft fracture through the repair site at the bone trough. Three days after the fracture, the patient underwent open reduction and internal fixation of the proximal humerus shaft fracture and exploration of the pectoralis major tendon repair. The fracture was found to be at the level of the repair site, and the pectoralis major tendon was completely intact to the distal fragment. The fracture healed uneventfully, and the patient regained full motion and strength of his extremity with no limitations.Any type of surgical fixation that creates a hole in the humerus or decreases the cross-sectional area such as a bone trough creates a stress riser. Patients undergoing pectoralis tendon repair that involves violating the humerus with a bone trough or hole have a slight risk of postoperative humerus fracture, especially if sustaining an early traumatic event such as a fall. PMID:21667914

  3. Macroscopic Anomalies and Pathological Findings in and Around the Achilles Tendon

    PubMed Central

    Johansson, Kristian; Lempainen, Lasse; Sarimo, Janne; Laitala-Leinonen, Tiina; Orava, Sakari

    2014-01-01

    Background: Nonsurgical treatments for chronic Achilles tendinopathy (AT) results in unpredictable success rates. Surgical treatment may be chosen as reports show mostly encouraging but variable success rates depending on the pathology. The distribution of surgically confirmed pathologies in AT is largely unknown. Purpose: To ascertain the distributions of macroscopically observed anomalies in participants undergoing surgical treatment for chronic AT. Study Design: Case series; Level of evidence, 4. Methods: The main macroscopic pathologies of 1661 chronic Achilles tendon overuse injuries, which were diagnosed and surgically treated by a single surgeon, were reviewed. The surgeries were performed on professional and recreational athletes during the years 1976-1980, 1986-1990, 1996-2000, and 2006-2010. Surgical diagnoses, along with age- and sport-specific characteristics, were collected retrospectively from patient records. Results: The relative proportion of tendinosis increased during the study period from 4.2% to 21%, and paratenonitis decreased from 50% to 26%. Retrocalcaneal pathologies were the most common surgically confirmed lesions at 30%, while the mean age at surgery increased by 11 years over the entire study period. Conclusion: Surgically confirmed pathologies in and around the Achilles tendon showed coherent changes, chronic paratenonitis, and retrocalcaneal problems as the most prevalent findings. The classification of midportion and insertional tendinopathy and retrocalcaneal bursitis in AT should strictly be used as a clinical diagnosis. During surgical evaluations, the diagnosis is further clarified as more specific pathologies may be identified. PMID:26535293

  4. Different distributions of operative diagnoses for Achilles tendon overuse injuries in Italian and Finnish athletes

    PubMed Central

    Johansson, Kristian; Lempainen, Lasse; Sarimo, Janne; Laitala-Leinonen, Tiina; Orava, Sakari

    2016-01-01

    Summary Background the origin of chronic Achilles tendinopathy (AT) is currently unclear and epidemiological factors, such as ethnicity, may be associated. Methods intraoperative findings from the treatment of 865 Finnish and 156 Italian athletic patients with chronic Achilles tendon related pain were evaluated, retrospectively. The mean age was 34 years (range, 18 to 65 years) in the Finnish and 29 years (range, 17–63 years) in the Italian patients. In total, 786 patients were males and 226 females of which 84 and 87% Finnish, respectively. Data were collected, retrospectively from patient records. The differences in the frequencies of operative findings were assessed for statistical significance. Results retrocalcaneal bursitis, partial tear and chronic paratenonitis were the most prevalent findings in patients with chronic AT undergoing surgery. Tendinosis and chronic paratenonitis were significantly (p=0.011) more common in Finnish athletes. Italian patients exhibited significantly (p<0.001) more insertional calcific tendinopathy (heel spurs) and prominent posterosuperior calcaneal corners (Haglund’s heel). Conclusion ethnicity appears to be associated with specific characteristics of overuse-related Achilles tendon pathology. This is an issue that should be considered in the planning of genetic research on AT. PMID:27331038

  5. Impact of drying and thiel embalming on mechanical properties of achilles tendons.

    PubMed

    Verstraete, Matthias André; Van Der Straeten, Catherine; De Lepeleere, Bram; Opsomer, Gert-Jan; Van Hoof, Tom; Victor, Jan

    2015-11-01

    Biomechanical research and orthopedic training is regularly carried out on human cadavers. Given the post-mortem decay, these cadavers were usually frozen or embalmed. The embalming method according to Dr. Thiel was often praised for the preservation of natural texture. The main aim of this article was to quantitatively analyze the impact of this embalming technique on the biomechanical properties. To that extent, Achilles tendons (calcaneal tendons) of seven cadavers have been tested. For each cadaver, a first tendon was tested following a fresh-frozen conservation, the other following the Thiel embalming process. The results indicated a significant difference in Young's modulus between both groups (P values = 0.046). The secondary aim of this article was to analyze the impact of exposure to room conditions and associated dehydration on the biomechanical properties of cadaver tissue. Therefore, each tendon was tested before and after 2 hr of exposure to room conditions. The resulting dehydration caused a significant increase of the Young's modulus for the thawed fresh-frozen tendons. The properties of the Thiel embalmed tendons were not significantly altered. In conclusion, this research promoted the use of fresh-frozen specimens for biomechanical testing. Effort should, however, be made to minimize dehydration of the tested specimens. PMID:26378610

  6. Three-dimensional reconstructions of the Achilles tendon insertion in man

    PubMed Central

    Milz, S; Rufai, A; Buettner, A; Putz, R; Ralphs, JR; Benjamin, M

    2002-01-01

    The distribution of type II collagen in sagittal sections of the Achilles tendon has been used to reconstruct the three-dimensional (3D) shape and position of three fibrocartilages (sesamoid, periosteal and enthesis) associated with its insertion. The results showed that there is a close correspondence between the shape and position of the sesamoid and periosteal fibrocartilages – probably because of their functional interdependence. The former protects the tendon from compression during dorsiflexion of the foot, and the latter protects the superior tuberosity of the calcaneus. When the zone of calcified enthesis fibrocartilage and the subchondral bone are mapped in 3D, the reconstructions show that there is a complex pattern of interlocking between pieces of calcified fibrocartilage and bone at the insertion site. We suggest that this is of fundamental importance in anchoring the tendon to the bone, because the manner in which a tendon insertion develops makes it unlikely that many collagen fibres pass across the tissue boundary from tendon to bone. When force is transmitted to the bone from a loaded tendon, it is directed towards the plantar fascia by a series of highly orientated trabeculae that are clearly visible in 3D in thick resin sections. PMID:11895112

  7. Patellar Tendinosis: Acute Patellar Tendon Rupture and Jumper's Knee.

    PubMed

    Depalma, Michael James; Perkins, Robert Harrison

    2004-05-01

    Patellar tendinopathy (jumper's knee) may affect athletes who engage in explosive lower-limb movements. An eccentric contraction of the quadriceps when landing after a jump may lead to acute patellar tendon rupture, the end-stage of patellar tendinopathy. Plain x-rays will usually confirm the diagnosis. Treatment centers around reducing the stress placed on the patellar tendon. Postoperative functional restoration and preventive measures must address biomechanic abnormalities that may predispose patients to disruptive patellar tendon strain. As this case report shows, counseling patients who have early-stage tendinopathy on appropriate flexibility and plyometric exercises may prevent more serious damage. PMID:20086412

  8. Macrophage depletion reduces cell proliferation and extracellular matrix accumulation but increases the ultimate tensile strength of injured Achilles tendons.

    PubMed

    de la Durantaye, Mélissa; Piette, Antoine Boulanger; van Rooijen, Nico; Frenette, Jérôme

    2014-02-01

    Macrophages are present in large numbers and display specific and distinct phenotypes during the various phases of tissue repair. However, their role following tendon injury and during repair has never been investigated. We injected C57BL/6 mice daily for 4 days with liposome-encapsulated clodronate to deplete circulating monocytes/macrophages. Placebo mice were injected with PBS. The left Achilles tendons of the mice were transversely sectioned and sutured using the 8-strand technique. Macrophage accumulation and cell proliferation were significantly lower in the tendons of clodronate-treated mice than in those of PBS-treated mice on days 3 and 7 post-injury. TGF-β1 staining was significantly more intense in the tendons of PBS-treated mice on day 7 post-injury. Edema and the dry mass of the Achilles tendons were also higher in the PBS-treated mice on days 7 and 14 post-injury. No differences in absolute strength and stiffness were observed, but Young's modulus and maximal stress were significantly greater for tendons from the clodronate-treated mice than those from PBS-treated mice after 14 days of tendon repair. Overall, our findings showed that macrophages promote cell proliferation and extracellular matrix accumulation but their presence leads to inferior ultimate tensile strength of the Achilles tendons. PMID:24307236

  9. Achilles tendon mechanical properties after both prolonged continuous running and prolonged intermittent shuttle running in cricket batting.

    PubMed

    Houghton, Laurence; Dawson, Brian; Rubenson, Jonas

    2013-08-01

    Effects of prolonged running on Achilles tendon properties were assessed after a 60 min treadmill run and 140 min intermittent shuttle running (simulated cricket batting innings). Before and after exercise, 11 participants performed ramp-up plantar flexions to maximum-voluntary-contraction before gradual relaxation. Muscle-tendon-junction displacement was measured with ultrasonography. Tendon force was estimated using dynamometry and a musculoskeletal model. Gradients of the ramp-up force-displacement curves fitted between 0-40% and 50-90% of the preexercise maximal force determined stiffness in the low- and high-force-range, respectively. Hysteresis was determined using the ramp-up and relaxation force-displacement curves and elastic energy storage from the area under the ramp-up curve. In simulated batting, correlations between tendon properties and shuttle times were also assessed. After both protocols, Achilles tendon force decreased (4% to 5%, P < .050), but there were no changes in stiffness, hysteresis, or elastic energy. In simulated batting, Achilles tendon force and stiffness were both correlated to mean turn and mean sprint times (r = -0.719 to -0.830, P < .050). Neither protocol resulted in fatigue-related changes in tendon properties, but higher tendon stiffness and plantar flexion force were related to faster turn and sprint times, possibly by improving force transmission and control of movement when decelerating and accelerating. PMID:22923384

  10. Effects of heel support banding using an elastic band on chronic pain at the achilles tendon in a mountaineer

    PubMed Central

    Yoo, Won-Gyu

    2016-01-01

    [Purpose] This study developed heel support banding (HSB) using an elastic band for flexible heel support and investigated its effect on chronic Achilles tendon pain of a mountaineer. [Subject] A 40-year-old male mountaineer with chronic Achilles tendon pain [Methods] Ankle dorsiflexion and plantar flexion angles, VISA-A questionnaire, load-induced pain, total pain threshold and tenderness at 3 kg of pressure were measured before and after applying HSB. [Results] After one month of applying HSB, the dorsiflexion and plantar flexion angles increased; the VISA-A questionnaire score increased; the load-induced pain assessment score decreased; the pain threshold increased; and tenderness at 3 kg decreased. [Conclusion] These results indicate that HSB use improves ankle range of motion, decreases pressure and pain, and could provide a new approach for effective intervention and management of chronic Achilles tendon pain. PMID:26957781

  11. Effects of heel support banding using an elastic band on chronic pain at the achilles tendon in a mountaineer.

    PubMed

    Yoo, Won-Gyu

    2016-01-01

    [Purpose] This study developed heel support banding (HSB) using an elastic band for flexible heel support and investigated its effect on chronic Achilles tendon pain of a mountaineer. [Subject] A 40-year-old male mountaineer with chronic Achilles tendon pain [Methods] Ankle dorsiflexion and plantar flexion angles, VISA-A questionnaire, load-induced pain, total pain threshold and tenderness at 3 kg of pressure were measured before and after applying HSB. [Results] After one month of applying HSB, the dorsiflexion and plantar flexion angles increased; the VISA-A questionnaire score increased; the load-induced pain assessment score decreased; the pain threshold increased; and tenderness at 3 kg decreased. [Conclusion] These results indicate that HSB use improves ankle range of motion, decreases pressure and pain, and could provide a new approach for effective intervention and management of chronic Achilles tendon pain. PMID:26957781

  12. An opioid system in connective tissue: a study of achilles tendon in the rat.

    PubMed

    Ackermann, P W; Spetea, M; Nylander, I; Ploj, K; Ahmed, M; Kreicbergs, A

    2001-11-01

    The occurrence of endogenous opioids and their receptors in rat achilles tendon was analyzed by immunohistochemistry (IHC), radioimmunoassay (RIA), and in vitro binding assays. The investigation focused on four enkephalins, dynorphin B, and nociceptin/orphanin FQ. Nerve fibers immunoreactive to all enkephalins (Met-enkephalin, Leu-enkephalin, Met-enkephalin-Arg-Gly-Lys, Met-enkephalin-Arg-Phe) were consistently found in the loose connective tissue and the paratenon, whereas dynorphin B and nociceptin/orphanin FQ could not be detected. The majority of enkephalin-positive nerve fibers exhibited varicosities predominantly seen in blood vessel walls. Measurable levels of Met-enkephalin-Arg-Phe and nociceptin/orphanin FQ were found in tendon tissue using RIA, whereas dynorphin B could not be detected. In addition to the endogenous opioids identified, delta-opioid receptors on nerve fibers were also detected by IHC. Binding assays to characterize the opioid binding sites showed that they were specific and saturable for [3H]-naloxone (Kd 7.01 +/- 0.98 nM; Bmax 23.52 +/- 2.23 fmol/mg protein). Our study demonstrates the occurrence of an opioid system in rat achilles tendon, which may be assumed to be present also in other connective tissues of the locomotor apparatus. This system may prove to be a useful target for pharmacological therapy in painful and inflammatory conditions by new drugs acting selectively in the periphery. PMID:11668192

  13. Structural and biomechanical changes in the Achilles tendon after chronic treatment with statins.

    PubMed

    de Oliveira, L P; Vieira, C P; Guerra, F D; Almeida, M S; Pimentel, E R

    2015-03-01

    Cases of tendinopathy and tendon ruptures have been reported as side effects associated with statin therapy. This work assessed possible changes in the structural and biomechanical properties of the tendons after chronic treatment with statins. Wistar rats were divided into the following groups: treated with atorvastatin (A-20 and A-80), simvastatin (S-20 and S-80) and the group that received no treatment (C). The doses of statins were calculated using allometric scaling, based on the doses of 80 mg/day and 20 mg/day recommended for humans. The morphological aspect of the tendons in A-20, S-20 and S-80 presented signals consistent with degeneration. Both the groups A-80 and S-80 showed a less pronounced metachromasia in the compression region of the tendons. Measurements of birefringence showed that A-20, A-80 and S-80 groups had a lower degree of organization of the collagen fibers. In all of the groups treated with statins, the thickness of the epitenon was thinner when compared to the C group. In the biomechanical tests the tendons of the groups A-20, A-80 and S-20 were less resistant to rupture. Therefore, statins affected the organization of the collagen fibers and decreased the biomechanical strength of the tendons, making them more predisposed to ruptures. PMID:25544391

  14. Reliability of the Achilles tendon tap reflex evoked during stance using a pendulum hammer.

    PubMed

    Mildren, Robyn L; Zaback, Martin; Adkin, Allan L; Frank, James S; Bent, Leah R

    2016-01-01

    The tendon tap reflex (T-reflex) is often evoked in relaxed muscles to assess spinal reflex circuitry. Factors contributing to reflex excitability are modulated to accommodate specific postural demands. Thus, there is a need to be able to assess this reflex in a state where spinal reflex circuitry is engaged in maintaining posture. The aim of this study was to determine whether a pendulum hammer could provide controlled stimuli to the Achilles tendon and evoke reliable muscle responses during normal stance. A second aim was to establish appropriate stimulus parameters for experimental use. Fifteen healthy young adults stood on a forceplate while taps were applied to the Achilles tendon under conditions in which postural sway was constrained (by providing centre of pressure feedback) or unconstrained (no feedback) from an invariant release angle (50°). Twelve participants repeated this testing approximately six months later. Within one experimental session, tap force and T-reflex amplitude were found to be reliable regardless of whether postural sway was constrained (tap force ICC=0.982; T-reflex ICC=0.979) or unconstrained (tap force ICC=0.968; T-reflex ICC=0.964). T-reflex amplitude was also reliable between experimental sessions (constrained ICC=0.894; unconstrained ICC=0.890). When a T-reflex recruitment curve was constructed, optimal mid-range responses were observed using a 50° release angle. These results demonstrate that reliable Achilles T-reflexes can be evoked in standing participants without the need to constrain posture. The pendulum hammer provides a simple method to allow researchers and clinicians to gather information about reflex circuitry in a state where it is involved in postural control. PMID:26454702

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

    NASA Astrophysics Data System (ADS)

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

    2014-02-01

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

  16. The effects of prolonged peritendinous administration of PGE1 to the rat Achilles tendon: a possible animal model of chronic Achilles tendinopathy.

    PubMed

    Sullo, A; Maffulli, N; Capasso, G; Testa, V

    2001-01-01

    We studied the effects of peritendinous Achilles tendon injections of prostaglandin E1 (PGE1) on the Achilles tendon of rats. Five groups of Sprague-Dawley rats (n = 24 each) were studied. Groups 1 to 4 received weekly peritendinous injections. In group 1, one side was injected with 800 ng of PGE1 in 0.5 ml of 0.9% NaCl and the contralateral side was injected with 0.5 ml of 0.9% NaCl. In group 2, one side was injected with 800 ng of PGE1. In group 3, one side was injected with 0.5 ml of 0.9% NaCl. In group 4, a syringe needle was inserted in the peritenon unilaterally, but no substances were administered. In groups 2, 3, and 4, the contralateral tendon was used as the control. In group 5, treatment was not administered. Eight rats in each group were killed at each time point, after 7, 21, and 35 days of treatment. On day 7, values for average water content and average wet weight of the tendons treated with PGE1 were significantly higher than those in the control tendons (analysis of variance [ANOVA]; P = 0.02), with a histological picture of acute inflammation. On day 21, approximately half of the PGE1-treated tendons showed fibrosis of the paratenon, with adhesions and intra-tendinous degeneration, with the other half still showing a picture of acute inflammation. On day 35, all of the PGE1-treated tendons showed fibrosis of the paratenon, with adhesions and intra-tendinous degeneration. At all time points, there was no evidence of pathology in the tendons that had not received PGE1. Sham peritendinous injections and injections of normal saline did not produce inflammation in the Achilles tendons. Initially, local administration of PGE1 produced acute inflammation of the tendon and its surrounding tissues. Prolonged PGE1 administration produced peri- and intra-tendinous degeneration, providing a cheap, reproducible model of Achilles tendinopathy, which would allow studies of the effects of conservative and surgical management of the condition. PMID:11479765

  17. Gait characteristics following Achilles tendon elongation: the foot rocker perspective.

    PubMed

    Bober, Tadeusz; Dziuba, Alicja; Kobel-Buys, Krystyna; Kulig, Kornelia

    2008-01-01

    The action of three functional rockers, namely the heel, ankle and forefoot rocker, assist the progression of the leg over the supporting foot. The purpose of this case series was to analyze the occurrence of foot rockers during gait in three children with cerebral palsy (CP) who had undergone the tendo-Achilles lengthening (TAL), procedure followed by a clinic- or home-based intervention and in one child with CP without history of surgery. Self-selected gait was video-recorded in a laboratory during six testing sessions at half-year intervals rendering a 3 year period of observation. One child had pre- and post-surgical gait data and the other two had post surgical data only. Sagittal plane knee angular velocity, as well as foot to ground positions, and foot rocker occurrence were analyzed. In a child with history of CP, and without history of surgery, mean angular velocities of the 1st, 2nd and 3rd foot rocker were 3.7, 0.57 and 6.67 rad/s, respectively, and the step length and cadence were normal. In children who underwent TAL the 1st and 2nd rocker was absent, as the initial contact of the foot with the ground was either with foot-flat or forefoot. The mean velocity of the 3rd rocker in children who underwent TAL was lower by approximately 50-80% than that of the nonsurgical case. Furthermore, the characteristic pattern of the knee joint to foot-floor position during gait was not observed in these cases. Foot rocker analysis identified children with abnormal gait characteristics. Following surgery these gait characteristics remained abnormal. PMID:18634352

  18. Viscoelastic Properties of Healthy Achilles Tendon are Independent of Isometric Plantar Flexion Strength and Cross-Sectional Area

    PubMed Central

    Suydam, Stephen M.; Soulas, Elizabeth M.; Elliott, Dawn M.; Silbernagel, Karin Gravare; Buchanan, Thomas S.; Cortes, Daniel H.

    2015-01-01

    Changes in tendon viscoelastic properties are observed after injuries and during healing as a product of altered composition and structure. Continuous Shear Wave Elastography is a new technique measuring viscoelastic properties of soft tissues using external shear waves. Tendon has not been studied with this technique, therefore, the aims of this study were to establish the range of shear and viscosity moduli in healthy Achilles tendons, determine bilateral differences of these parameters and explore correlations of viscoelasticity to plantar flexion strength and tendon area. Continuous Shear Wave Elastography was performed over the free portion of both Achilles tendons from 29 subjects. Isometric plantar flexion strength and cross sectional area were measured. The average shear and viscous moduli was 83.2kPa and 141.0Pa-s, respectively. No correlations existed between the shear or viscous modulus and area or strength. This indicates that viscoelastic properties can be considered novel, independent biomarkers. The shear and viscosity moduli were bilaterally equivalent (p=0.013,0.017) which allows determining pathologies through side-to-side deviations. The average bilateral coefficient of variation was 7.2% and 9.4% for shear and viscosity modulus, respectively. The viscoelastic properties of the Achilles tendon may provide an unbiased, non-subjective rating system of tendon recovery and optimizing treatment strategies. PMID:25882209

  19. Gastric pentadecapeptide BPC 157 accelerates healing of transected rat Achilles tendon and in vitro stimulates tendocytes growth.

    PubMed

    Staresinic, M; Sebecic, B; Patrlj, L; Jadrijevic, S; Suknaic, S; Perovic, D; Aralica, G; Zarkovic, N; Borovic, S; Srdjak, M; Hajdarevic, K; Kopljar, M; Batelja, L; Boban-Blagaic, A; Turcic, I; Anic, T; Seiwerth, S; Sikiric, P

    2003-11-01

    In studies intended to improve healing of transected Achilles tendon, effective was a stable gastric pentadecapeptide BPC 157 (GEPPPGKPADDAGLV, M.W. 1419). Currently in clinical trials for inflammatory bowel disease (PLD-116, PL 14736, Pliva), it ameliorates internal and external wound healing. In rats, the right Achilles tendon transected (5 mm proximal to its calcaneal insertion) presents with a large tendon defect between cut ends. Agents (/kg b.w., i.p., once time daily) (BPC 157 (dissolved in saline, with no carrier addition) (10 microg, 10 ng or 10 pg) or saline (5.0 ml)), were firstly applied at 30 min after surgery, the last application at 24 h before autopsy. Achilles functional index (AFI) was assessed once time daily. Biomechanical, microscopical and macroscopical assessment was on day 1, 4, 7, 10 and 14. Controls generally have severely compromised healing. In comparison, pentadecapeptide BPC 157 fully improves recovery: (i) biomechanically, increased load of failure, load of failure per area and Young's modulus of elasticity; (ii) functionally, significantly higher AFI-values; (iii) microscopically, more mononuclears and less granulocytes, superior formation of fibroblasts, reticulin and collagen; (iv) macroscopically, smaller size and depth of tendon defect, and subsequently the reestablishment of full tendon integrity. Likewise, unlike TGF-beta, pentadecapeptide BPC 157, presenting with no effect on the growth of cultured cell of its own, consistently opposed 4-hydroxynonenal (HNE), a negative modulator of the growth. HNE-effect is opposed in both combinations: BPC 157+HNE (HNE growth inhibiting effect reversed into growth stimulation of cultured tendocytes) and HNE+BPC 157(abolished inhibiting activity of the aldehyde), both in the presence of serum and serum deprived conditions. In conclusion, these findings, particularly, Achilles tendon transection fully recovered in rats, peptide stability suitable delivery, usefully favor gastric

  20. Medial gastrocnemius muscle fascicle active torque-length and Achilles tendon properties in young adults with spastic cerebral palsy.

    PubMed

    Barber, Lee; Barrett, Rod; Lichtwark, Glen

    2012-10-11

    Individuals with spastic cerebral palsy (CP) typically experience muscle weakness. The mechanisms responsible for muscle weakness in spastic CP are complex and may be influenced by the intrinsic mechanical properties of the muscle and tendon. The purpose of this study was to investigate the medial gastrocnemius (MG) muscle fascicle active torque-length and Achilles tendon properties in young adults with spastic CP. Nine relatively high functioning young adults with spastic CP (GMFCS I, 17±2 years) and 10 typically developing individuals (18±2 years) participated in the study. Active MG torque-length and Achilles tendon properties were assessed under controlled conditions on a dynamometer. EMG was recorded from leg muscles and ultrasound was used to measure MG fascicle length and Achilles tendon length during maximal isometric contractions at five ankle angles throughout the available range of motion and during passive rotations imposed by the dynamometer. Compared to the typically developing group, the spastic CP group had 33% lower active ankle plantarflexion torque across the available range of ankle joint motion, partially explained by 37% smaller MG muscle and 4% greater antagonistic co-contraction. The Achilles tendon slack length was also 10% longer in the spastic CP group. This study confirms young adults with mild spastic CP have altered muscle-tendon mechanical properties. The adaptation of a longer Achilles tendon may facilitate a greater storage and recovery of elastic energy and partially compensate for decreased force and work production by the small muscles of the triceps surae during activities such as locomotion. PMID:22867763

  1. Achilles detachment in rat and stable gastric pentadecapeptide BPC 157: Promoted tendon-to-bone healing and opposed corticosteroid aggravation.

    PubMed

    Krivic, Andrija; Anic, Tomislav; Seiwerth, Sven; Huljev, Dubravko; Sikiric, Predrag

    2006-05-01

    Stable gastric pentadecapeptide BPC 157 (BPC 157, as an antiulcer agent in clinical trials for inflammatory bowel disease; PLD-116, PL 14736, Pliva, no toxicity reported) alone (without carrier) ameliorates healing of tendon and bone, respectively, as well as other tissues. Thereby, we focus on Achilles tendon-to-bone healing: tendon to bone could not be healed spontaneously, but it was recovered by this peptide. After the rat's Achilles tendon was sharply transected from calcaneal bone, agents [BPC 157 (10 microg, 10 ng, 10 pg), 6alpha-methylprednisolone (1 mg), 0.9% NaCl (5 mL)] were given alone or in combination [/kg body weight (b.w.) intraperitoneally, once time daily, first 30-min after surgery, last 24 h before analysis]. Tested at days 1, 4, 7, 10, 14, and 21 after Achilles detachment, BPC 157 improves healing functionally [Achilles functional index (AFI) values substantially increased], biomechanically (load to failure, stiffness, and Young elasticity modulus significantly increased), macro/microscopically, immunohistochemistry (better organization of collagen fibers, and advanced vascular appearance, more collagen type I). 6alpha-Methylprednisolone consistently aggravates the healing, while BPC 157 substantially reduces 6alpha-methylprednisolone healing aggravation. Thus, direct tendon-to-bone healing using stabile nontoxic peptide BPC 157 without a carrier might successfully exchange the present reconstructive surgical methods. PMID:16583442

  2. [Application of a new design of cryo-jaw and its biomechanical evaluation in rat achilles tendon in vitro].

    PubMed

    Liu, Erfu; Sun, Yanjun; Peng, Yongjin; Xu, Wei; Wang, Yequan; Xu, Kang; Mohanad, Khalid Ahmed; Lu, Yonggang; Yang, Li

    2014-06-01

    This study was aimed to design a new, accurate and easy-to-use water bath cryo-jaw, and try to solve the problems met in small animals achilles tendon mechanical testing. The muscle-tendon-bony units were fixed in the clamps. SD rats achilles tendon were randomly divided into group A and B. Group A was tested by the newly designed water bath cryo-jaw, while group B was treated by non-water bath cryo-jaw. The mechanical tests revealed that non of the samples of the newly-designed water bath cryo-jaw in group A slipped and fell off, and the achilles tendons were in a physiologically active state, but one of the group B samples slipped and fell off, and the others had the frozen phenomenon obviously. The maximum stress, fracture displacement and Young's modulus of the rats in group A were significantly different compared to those in group B (P < 0.05). In conclusion, the new water bath cryo-jaw has more advantages than traditional ones. It exhibits a good simulation in vivo in the environmental conditions for testing the mechanical properties of the achilles tendon. PMID:25219256

  3. Transplantation of Achilles Tendon Treated With Bone Morphogenetic Protein 7 Promotes Meniscus Regeneration in a Rat Model of Massive Meniscal Defect

    PubMed Central

    Ozeki, Nobutake; Muneta, Takeshi; Koga, Hideyuki; Katagiri, Hiroki; Otabe, Koji; Okuno, Makiko; Tsuji, Kunikazu; Kobayashi, Eiji; Matsumoto, Kenji; Saito, Hirohisa; Saito, Tomoyuki; Sekiya, Ichiro

    2013-01-01

    Objective This study was undertaken to examine whether bone morphogenetic protein 7 (BMP-7) induces ectopic cartilage formation in the rat tendon, and whether transplantation of tendon treated with BMP-7 promotes meniscal regeneration. Additionally, we analyzed the relative contributions of host and donor cells on the healing process after tendon transplantation in a rat model. Methods BMP-7 was injected in situ into the Achilles tendon of rats, and the histologic findings and gene profile were evaluated. Achilles tendon injected with 1 μg of BMP-7 was transplanted into a meniscal defect in rats. The regenerated meniscus and articular cartilage were evaluated at 4, 8, and 12 weeks. Achilles tendon from LacZ-transgenic rats was transplanted into the meniscal defect in wild-type rats, and vice versa. Results Injection of BMP-7 into the rat Achilles tendon induced the fibrochondrocyte differentiation of tendon cells and changed the collagen gene profile of tendon tissue to more closely approximate meniscal tissue. Transplantation of the rat Achilles tendon into a meniscal defect increased meniscal size. The rats that received the tendon treated with BMP-7 had a meniscus matrix that exhibited increased Safranin O and type II collagen staining, and showed a delay in articular cartilage degradation. Using LacZ-transgenic rats, we determined that the regeneration of the meniscus resulted from contribution from both donor and host cells. Conclusion Our findings indicate that BMP-7 induces ectopic cartilage formation in rat tendons. Transplantation of Achilles tendon treated with BMP-7 promotes meniscus regeneration and prevents cartilage degeneration in a rat model of massive meniscal defect. Native cells in the rat Achilles tendon contribute to meniscal regeneration. PMID:23897174

  4. Successful management of bilateral patellar tendon rupture in a dog.

    PubMed

    Shipov, A; Shahar, R; Joseph, R; Milgram, J

    2008-01-01

    A seven-year-old, 41 kg, intact, cross breed dog, was presented with a history of bilateral hind limb lameness after falling from a height of 1 m. Clinical and radiographic findings were consistent with bilateral patellar tendon rupture. Surgical repair was performed bilaterally. The tendons were sutured primarily, and an internal splint of nylon leader was added. Good apposition of the severed tendon ends had been achieved intraoperatively; however, post operative radiographs showed supra-trochlear displacement of both patellae. The casts used to immobilize the stifle joints slipped distally and three days post operatively the tendon repair had broken down, bilaterally. Revision surgery was undertaken and the tendons were re-sutured. Nylon leader was placed through holes that had been drilled in the patellae and tibiae. The stifle joints were immobilized with type I external skeletal fixators (ESFs). Both freeform polymethylmethacrylate (PMMA) connecting bars were found to be broken at the level of the stifle joints two days later, without any disruption of the primary tendon repair. Each connecting bar was replaced with two connecting bars of PMMA reinforced with 3 mm steel wire. The dog was fully weight-bearing with a reduced range of motion in flexion immediately after removal of the ESFs at six weeks and was still sound 18 months post-operatively. Primary tendon repair in combination with adequate immobilization allowed for an excellent outcome in a complicated bilateral pathology. PMID:18545725

  5. Imaging and simulation of Achilles tendon dynamics: Implications for walking performance in the elderly.

    PubMed

    Franz, Jason R; Thelen, Darryl G

    2016-06-14

    The Achilles tendon (AT) is a complex structure, consisting of distinct fascicle bundles arising from each triceps surae muscle that may act as mechanically independent structures. Advances in tissue imaging are rapidly accelerating our understanding of the complexities of functional Achilles tendon behavior, with potentially important implications for musculoskeletal injury and performance. In this overview of our recent contributions to these efforts, we present the results of complementary experimental and computational approaches to investigate AT behavior during walking and its potential relevance to reduced triceps surae mechanical performance due to aging. Our experimental evidence reveals that older tendons exhibit smaller differences in tissue deformations than young adults between regions of the AT presumed to arise from the gastrocnemius and soleus muscles. These observations are consistent with a reduced capacity for inter-fascicle sliding within the AT, which could have implications for the mechanical independence of the triceps surae muscles. More uniform AT deformations are also correlated with hallmark biomechanical features of elderly gait - namely, a loss of net ankle moment, power, and positive work during push-off. Simulating age-related reductions in the capacity for inter-fascicle sliding in the AT during walking predicts detriments in gastrocnemius muscle-tendon mechanical performance coupled with underlying shifts in fascicle kinematics during push-off. AT compliance, also suspected to vary due to age, systematically modulates those effects. By integrating in vivo imaging with computational modeling, we have gained theoretical insight into multi-scale biomechanical changes due to aging, hypotheses regarding their functional effects, and opportunities for experiments that validate or invalidate these assertions. PMID:27209552

  6. Effect of low-level laser therapy on healing of tenotomized Achilles tendon in streptozotocin-induced diabetic rats.

    PubMed

    Nouruzian, Mohsen; Alidoust, Morteza; Bayat, Mohammad; Bayat, Mehernoush; Akbari, Mohammad

    2013-02-01

    Diabetes mellitus (DM) is associated with musculoskeletal damage. Investigations have indicated that healing of the surgically tenotomized Achilles tendon was considerably augmented following low-level laser therapy (LLLT) in non-diabetic, healthy animals. The aim of the present study was to evaluate the effect of LLLT on the Achilles tendon healing in streptozotocin-induced diabetic (STZ-D) rats via a biomechanical evaluating method. Thirty-three rats were divided into non-diabetic (n = 18) and diabetic (n = 15) groups. DM was induced in the rats by injections of STZ. The right Achilles tendons of all rats were tenotomized 1 month after STZ injections. The two experimental groups (n = 6 for each group) of non-diabetic rats were irradiated with a helium-neon (He-Ne) laser at 2.9 and 11.5 J/cm(2) for ten consecutive days. The two experimental groups of diabetic rats (n = 5 for each group) were irradiated with a He-Ne laser at 2.9 and 4.3 J/cm(2) for ten consecutive days. The tendons were submitted to a tensiometric test. Significant improvements in the maximum stress (MS) values (Newton per square millimeter) were found following LLLT at 2.9 J/cm(2) in both the non-diabetic (p = 0.031) and diabetic (p = 0.019) experimental groups when compared with their control groups. LLLT at 2.9 J/cm(2) to the tenotomized Achilles tendons in the non-diabetic and diabetic rats significantly increased the strength and MS of repairing Achilles tendons in our study. PMID:22370620

  7. [Proximal and distal ruptures of the biceps brachii tendon].

    PubMed

    Klonz, A; Loitz, D; Reilmann, H

    2003-09-01

    Proximal ruptures. Ruptures of the long head of the M. biceps humeri are commonly caused by degenerative changes within the tendon. Non-operative treatment gives good results, the loss of power regarding elbow flexion and supination amounts to only 8-21%. Refixation may be indicated for cosmetic reasons and offers a small but evident improvement of flexion and supination power. Deformity of the slipped muscle can be corrected effectively. Residual complaints after conservative treatment often result from associated subacromial problems. Distal ruptures. Ruptures of the distal tendon should be treated operatively. The loss of power after conservative treatment is evident (30-40% for flexion, >50% for supination). Extra-anatomical tenodesis to the brachialis muscle or anatomical fixation to the radial tuberosity can be applied. Flexion power and cosmesis can be addressed by both techniques. If supination strength is to be restored, the tendon has to be fixed anatomically. Preparation of the tuberosity bears the risk of heterotopic ossification or nerve damage. Mini-open techniques, using only a limited anterior approach, may decrease risks. PMID:14959750

  8. Ankle morbidity after autogenous Achilles tendon harvesting for anterior cruciate ligament reconstruction.

    PubMed

    Seo, Jai Gon; Yoo, Jae Chul; Moon, Young Wan; Chang, Moon Jong; Kwon, Jong Won; Kim, Jong Hyun; Kim, Mu Hyun

    2009-06-01

    Although several alternative autografts with reduced morbidity of harvest site have been introduced, no donor site is free of morbidity concerns. The authors report on ankle status after autogenous Achilles tendon harvesting with a minimum 10-year follow-up. From October 1994 to October 1996, a consecutive series of 47 ankles underwent harvesting of the medial third or half of the ipsilateral autogenous Achilles tendon for primary anterior cruciate ligament reconstruction. Donor site statuses were evaluated using a modified Thermann's scale. Postoperative isokinetic muscle strength testing was performed, and magnetic resonance images of donor sites were available for selected patients. Thirty-three ankles in the 32 patients were followed for more than 10 years. There were 27 men (84%) and 5 women (16%) with a mean age of 31 years (range 16-52 years) at the time of surgery. The mean duration of follow-up was 12 years and 1 month (range 10 years and 5 months to 13 years and 4 months). Mean postoperative modified Thermann's scale score was 87 (range 45-95; SD 14.3). Twenty-five (76%) ankles achieved very good or good results. A slight decrease in calf circumference <1 cm was seen in the ten ankles, 1-2 cm in the four ankles. Nine ankles were mildly hypersensitive to meteorological changes. Peak torque of ankle plantar flexion was slightly lower on the index limb at both velocities in nine selected patients who carried out performance tests. However, there were no significant differences (5.2% at 30 degrees /s and 2.7% at 120 degrees /s, P = n.s. and P = n.s.). Of the 12 available follow-up magnetic resonance images, the average cross-sectional area of the remaining tendon was 82.01 mm(2) (range 69.05-107.35; SD 10.3), and their average thickness was 7.4 mm (range 6-10.35; SD 1.1). After a minimum 10-year follow-up, the harvesting of autogenous Achilles tendons was not found to significantly jeopardize ankle status. However, it also could not be independent of donor

  9. Orthotic Heel Wedges Do Not Alter Hindfoot Kinematics and Achilles Tendon Force During Level and Inclined Walking in Healthy Individuals.

    PubMed

    Weinert-Aplin, Robert A; Bull, Anthony M J; McGregor, Alison H

    2016-04-01

    Conservative treatments such as in-shoe orthotic heel wedges to treat musculoskeletal injuries are not new. However, weak evidence supporting their use in the management of Achilles tendonitis suggests the mechanism by which these heel wedges works remains poorly understood. It was the aim of this study to test the underlying hypothesis that heel wedges can reduce Achilles tendon load. A musculoskeletal modeling approach was used to quantify changes in lower limb mechanics when walking due to the introduction of 12-mm orthotic heel wedges. Nineteen healthy volunteers walked on an inclinable walkway while optical motion, force plate, and plantar pressure data were recorded. Walking with heel wedges increased ankle dorsiflexion moments and reduced plantar flexion moments; this resulted in increased peak ankle dorsiflexor muscle forces during early stance and reduced tibialis posterior and toe flexor muscle forces during late stance. Heel wedges did not reduce overall Achilles tendon force during any walking condition, but did redistribute load from the medial to lateral triceps surae during inclined walking. These results add to the body of clinical evidence confirming that heel wedges do not reduce Achilles tendon load and our findings provide an explanation as to why this may be the case. PMID:26502456

  10. Achilles tendon displacement patterns during passive stretch and eccentric loading are altered in middle-aged adults

    PubMed Central

    Slane, Laura Chernak; Thelen, Darryl G

    2015-01-01

    The purpose of this study was to investigate middle-age effects on Achilles displacement patterns under passive stretch and eccentric loading. Healthy young (24.1±1.4 years, n=9) and middle-aged (49.0±3.1 years, n=9) adults were positioned prone and the ankle was cyclically (0.5 Hz, 25 deg range) dorsiflexed during passive stretch and active lengthening. Achilles displacements were tracked in cine ultrasound using 2D speckle tracking. Displacements were found to be non-uniform, with mid and deep portions of the tendon displacing more than superficial portions. However, the degree of non-uniformity was significantly reduced in middle-aged adults, suggesting a potential age-related reduction in inter-fascicle sliding or a shift in loading sharing between plantarflexors. Eccentric loading reduced displacement magnitudes, likely reflecting distal tendon stretch induced via active muscle contractions. Changes in tendon displacement with active loading were greater in middle-aged adults, which could reflect greater tendon compliance. The observed age-related changes in Achilles tendon behavior may have implications for both plantarflexor performance and injury risk. PMID:25962378

  11. The effect of butyric acid with autogenous omental graft on healing of experimental Achilles tendon injury in rabbits

    PubMed Central

    Jahani, S; Moslemi, H. R.; Dehghan, M. M.; Sedaghat, R; Mazaheri Nezhad, R; Rezaee Moghaddam, D

    2015-01-01

    In this study, the role of local injection of butyric acid (BA) with autogenous omental graft was evaluated in healing of experimental Achilles tendon injury in rabbits. Nine adult male New Zealand rabbits were anesthetized and a partial thickness tenotomy was created on both hindlimbs. In treated group, omental graft was secured in place using BA soaked polygalactin 910 suture. In control group, the graft was sutured without BA. Butyric acid and normal saline were injected daily to treatment and control groups for three days, respectively. Based on the findings, on day 15 after injury, the tendon sections showed that healing rate in BA treated group was higher than that in control group. Furthermore, at days 28 and 45, comparison between BA treated and control groups demonstrated that BA increased the healing rate but with no significance. In summary, results of this study show that application of BA with autogenous omental graft can improve healing process of damaged Achilles tendon. PMID:27175160

  12. Simultaneous traumatic rupture of the patellar tendon and the contralateral quadriceps tendon in a healthy individual

    PubMed Central

    Kumar, S; Rachakatla, N; Kerin, C; Kumar, R

    2010-01-01

    A simultaneous traumatic complete rupture of the patellar tendon and the contralateral quadriceps tendon is reported to occur in patients with renal failure and other inflammatory diseases, but is extremely rare in a healthy individual because of the different contributory factors and mechanisms of injury. We present a rare case report of such a combination of injuries in a 48-year-old healthy man. To our knowledge only three such cases have been reported in the English literature. This is an unusual combination and hence there is potential for missed diagnosis leading to suboptimal treatment. PMID:22791858

  13. Spontaneous distal biceps tendon ruptures: are they related to statin administration?

    PubMed

    Savvidou, Christiana; Moreno, Rodrigo

    2012-01-01

    The purpose of this study is to identify a possible correlation between statin administration and incidence of spontaneous distal biceps tendon ruptures. We retrospectively reviewed 104 patients with distal biceps tendon rupture that were treated surgically from 2004 to 2010, 102 males and two females with mean age 47 years (range, 22-78). Patients were divided based on the mechanism of injury and statin administration. After statistical analysis, it was found nearly two times more likely to have spontaneous distal biceps tendon rupture with use of statins. Patients in Group 1 (spontaneous tendon rupture) compared to Group 2 (provoked tendon rupture) were older, had weaker postoperative strength but similar postoperative ROM. Patients taking statins compared to those that were not taking statins were older, had same postoperative strength and similar postoperative ROM. Based on the results of our study we conclude that there is a trend of association of spontaneous distal biceps tendon ruptures with statin administration. PMID:22745079

  14. Biochemical and morphological modifications in rabbit Achilles tendon during maturation and ageing.

    PubMed Central

    Cetta, G; Tenni, R; Zanaboni, G; De Luca, G; Ippolito, E; De Martino, C; Castellani, A A

    1982-01-01

    1. Achilles tendons of foetal, newborn, adult and old rabbits were examined by electron microscopy after staining by conventional methods or with the periodate/silver/methenamine technique. 2. The mean diameter of collagen fibrils increased with age whereas silver/methenamine-positivity became less evident. 3. Biochemical analyses showed a great decrease of the concentration of glycoproteins and galactosamine-containing glycosaminoglycans. 4. Collagen content increased with maturation and ageing of the tissue. 5. The extent of glycosylation of collagen hydroxylysine residues was also age-dependent; the total amount of hydroxylysyl glycosides rapidly decreased in the last days of prenatal life and in the first months after birth, corresponding to the rapid growth in collagen fibre diameter. 6. The hydroxylysyl diglycoside concentration decreased more markedly than that of the monoglycoside, thus indicating a possible gradual removal of the monosaccharide units. A role for the extent of glycosylation of tropocollagen molecules in fibre organization was suggested. Images PLATE 1 PMID:7115331

  15. Treatment of Large Recurrent Bilateral Xanthomatosis of Achilles Tendon- A Case Report

    PubMed Central

    Senthil, L.; Jambu, N.; Chittaranjan, Samuel

    2015-01-01

    Introduction: Xanthomas of the Achilles tendon are a rare interesting orthopaedic condition. There are very few articles dealing with the treatment of recurrent xanthomatosis of tendoachilles. Here we report this patient with bilateral recurrent xanthomatosis of tendoachilles. Case Report: A 37 year old male patient presented with multiple lesions in the body with bilateral swelling in the tendoachilles. The swelling was excised before three years elsewhere and there was recurrence of the lesion after 6 months subsequently. There was ulceration on the right side. The patient was treated by total resection of the lesion and reconstruction using tensorfascialata graft. Conclusion: Complete excision of the lesion is needed to reduce recurrence. Reconstruction of the defect is a challenge due to the large defect. Tensorfascialata graft results in good functional outcome of the patient even in large defects.

  16. Low-Magnitude, High-Frequency Vibration Fails to Accelerate Ligament Healing but Stimulates Collagen Synthesis in the Achilles Tendon

    PubMed Central

    Thompson, William R.; Keller, Benjamin V.; Davis, Matthew L.; Dahners, Laurence E.; Weinhold, Paul S.

    2015-01-01

    Background: Low-magnitude, high-frequency vibration accelerates fracture and wound healing and prevents disuse atrophy in musculoskeletal tissues. Purpose: To investigate the role of low-magnitude, high-frequency vibration as a treatment to accelerate healing of an acute ligament injury and to examine gene expression in the intact Achilles tendon of the injured limb after low-magnitude, high-frequency vibration. Study Design: Controlled laboratory study. Methods: Complete surgical transection of the medial collateral ligament (MCL) was performed in 32 Sprague-Dawley rats, divided into control and low-magnitude, high-frequency vibration groups. Low-magnitude, high-frequency vibration started on postoperative day 2, and rats received vibration for 30 minutes a day for 12 days. All rats were sacrificed 2 weeks after the operation, and their intact and injured MCLs were biomechanically tested or used for histological analysis. Intact Achilles tendons from the injured limb were evaluated for differences in gene expression. Results: Mechanical testing revealed no differences in the ultimate tensile load or the structural stiffness between the control and vibration groups for either the injured or intact MCL. Vibration exposure increased gene expression of collagen 1 alpha (3-fold), interleukin 6 (7-fold), cyclooxygenase 2 (5-fold), and bone morphogenetic protein 12 (4-fold) in the intact Achilles tendon when compared with control tendons (P < .05). Conclusion: While no differences were observed in the mechanical or histological properties of the fully transected MCL after low-magnitude, high-frequency vibration treatment, significant enhancements in gene expression were observed in the intact Achilles tendon. These included collagen, several inflammatory cytokines, and growth factors critical for tendons. Clinical Relevance: As low-magnitude, high-frequency vibration had no negative effects on ligament healing, vibration therapy may be a useful tool to accelerate healing

  17. Acute Simultaneous Ruptures of the Anterior Cruciate Ligament and Patellar Tendon

    PubMed Central

    Lee, Gwang Chul; Park, Sung-Hae

    2014-01-01

    Acute simultaneous rupture of the anterior cruciate ligament (ACL) and patellar tendon is a rare injury. We present a case report of a 32-year-old male patient with ruptured ACL and ipsilateral patellar tendon rupture sustained while playing baseball. Surgery was performed on the patellar tendon and the ACL simultaneously. The clinical and radiological outcomes of the treatment were successful. We present this case with a review of the literatures. PMID:24639949

  18. Achilles Tendonitis

    MedlinePlus

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  19. Achilles tendon loading patterns during barefoot walking and slow running on a treadmill: An ultrasonic propagation study.

    PubMed

    Wulf, M; Wearing, S C; Hooper, S L; Smeathers, J E; Horstmann, T; Brauner, T

    2015-12-01

    Measurement of tendon loading patterns during gait is important for understanding the pathogenesis of tendon "overuse" injury. Given that the speed of propagation of ultrasound in tendon is proportional to the applied load, this study used a noninvasive ultrasonic transmission technique to measure axial ultrasonic velocity in the right Achilles tendon of 27 healthy adults (11 females and 16 males; age, 26 ± 9 years; height, 1.73 ± 0.07 m; weight, 70.6 ± 21.2 kg), walking at self-selected speed (1.1 ± 0.1 m/s), and running at fixed slow speed (2 m/s) on a treadmill. Synchronous measures of ankle kinematics, spatiotemporal gait parameters, and vertical ground reaction forces were simultaneously measured. Slow running was associated with significantly higher cadence, shorter step length, but greater range of ankle movement, higher magnitude and rate of vertical ground reaction force, and higher ultrasonic velocity in the tendon than walking (P < 0.05). Ultrasonic velocity in the Achilles tendon was highly reproducible during walking and slow running (mean within-subject coefficient of variation < 2%). Ultrasonic maxima (P1, P2) and minima (M1, M2) were significantly higher and occurred earlier in the gait cycle (P1, M1, and M2) during running than walking (P < 0.05). Slow running was associated with higher and earlier peaks in loading of the Achilles tendon than walking. PMID:25913324

  20. BILATERAL PATELLAR TENDON RUPTURE AT DIFFERENT SITES WITHOUT PREDISPOSING SYSTEMIC DISEASE OR STEROID USE

    PubMed Central

    Taylor, Benjamin C.; Tancev, Alex; Fowler, Ty

    2009-01-01

    Simultaneous bilateral patellar tendon ruptures are extremely rare, and even more rare in patients without systemic disease. We describe bilateral simultaneous patellar tendon disruptions in the absence of systemic disease or steroid usage, with one tendon disruption at the inferior pole and the other an intrasubstance tear. The different locations of the ruptures are also exceedingly rare, as only two cases of non-identical ruptures have ever been reported. We also review all bilateral patellar tendon rupture case reports from English and German literature. PMID:19742095

  1. Single-Stage Reconstruction of Achilles Tendon and Overlying Tissue With the Extended Temporoparietal Fasciagaleal Flap-23-Year Follow-Up and the Review of the Literature.

    PubMed

    Dobke, Marek; Suliman, Ahmed; Mackert, Gina A; Herrera, Fernando A; Singer, Robert; Nelson, Jeffrey

    2016-05-01

    In the absence of an established "gold standard" for complex Achilles tendon and regional soft tissue defect reconstruction, many techniques have been advocated. Two cases describing a novel technique of successful repair with the review of literature are presented. The underlying problem consisted of Achilles tendon necrosis with local inflammation in the first case and tendon contracture with foot malposition due to a burn injury in the other. Each patient, upon debridement, had a 6-cm Achilles tendon defect with associated overlying soft tissue deficits reconstructed with an extended temporoparietal fasciagaleal flap and a split thickness skin graft. Both cases highlight the successful functional and aesthetic quality as well as the durability of concurrent vascularized tendon and soft tissue replacement and coverage in 2 distinct clinical scenarios. PMID:27070674

  2. Effects of 12-wk eccentric calf muscle training on muscle-tendon glucose uptake and SEMG in patients with chronic Achilles tendon pain.

    PubMed

    Masood, Tahir; Kalliokoski, Kari; Magnusson, S Peter; Bojsen-Møller, Jens; Finni, Taija

    2014-07-15

    High-load eccentric exercises have been a key component in the conservative management of chronic Achilles tendinopathy. This study investigated the effects of a 12-wk progressive, home-based eccentric rehabilitation program on ankle plantar flexors' glucose uptake (GU) and myoelectric activity and Achilles tendon GU. A longitudinal study design with control (n = 10) and patient (n = 10) groups was used. Surface electromyography (SEMG) from four ankle plantar flexors and GU from the same muscles and the Achilles tendon were measured during submaximal intermittent isometric plantar flexion task. The results indicated that the symptomatic leg was weaker (P < 0.05) than the asymptomatic leg at baseline, but improved (P < 0.001) with eccentric rehabilitation. Additionally, the rehabilitation resulted in greater GU in both soleus (P < 0.01) and lateral gastrocnemius (P < 0.001) in the symptomatic leg, while the asymptomatic leg displayed higher uptake for medial gastrocnemius and flexor hallucis longus (P < 0.05). While both patient legs had higher tendon GU than the controls (P < 0.05), there was no rehabilitation effect on the tendon GU. Concerning SEMG, at baseline, soleus showed more relative activity in the symptomatic leg compared with both the asymptomatic and control legs (P < 0.05), probably reflecting an effort to compensate for the decreased force potential. The rehabilitation resulted in greater SEMG activity in the lateral gastrocnemius (P < 0.01) of the symptomatic leg with no other within- or between-group differences. Eccentric rehabilitation was effective in decreasing subjective severity of Achilles tendinopathy. It also resulted in redistribution of relative electrical activity, but not metabolic activity, within the triceps surae muscle. PMID:24855138

  3. An Investigation of the Immediate Effect of Static Stretching on the Morphology and Stiffness of Achilles Tendon in Dominant and Non-Dominant Legs

    PubMed Central

    Chiu, Tsz-chun Roxy; Ngo, Hiu-ching; Lau, Lai-wa; Leung, King-wah; Lo, Man-him; Yu, Ho-fai; Ying, Michael

    2016-01-01

    Aims This study was undertaken to investigate the immediate effect of static stretching on normal Achilles tendon morphology and stiffness, and the different effect on dominant and non-dominant legs; and to evaluate inter-operator and intra-operator reliability of using shear-wave elastography in measuring Achilles tendon stiffness. Methods 20 healthy subjects (13 males, 7 females) were included in the study. Thickness, cross-sectional area and stiffness of Achilles tendons in both legs were measured before and after 5-min static stretching using grey-scale ultrasound and shear-wave elastography. Inter-operator and intra-operator reliability of tendon stiffness measurements of six operators were evaluated. Results Result showed that there was no significant change in the thickness and cross-sectional area of Achilles tendon after static stretching in both dominant and non-dominant legs (p > 0.05). Tendon stiffness showed a significant increase in non-dominant leg (p < 0.05) but not in dominant leg (p > 0.05). The inter-operator reliability of shear-wave elastography measurements was 0.749 and the intra-operator reliability ranged from 0.751 to 0.941. Conclusion Shear-wave elastography is a useful and non-invasive imaging tool to assess the immediate stiffness change of Achilles tendon in response to static stretching with high intra-operator and inter-operator reliability. PMID:27120097

  4. A new approach to the pathology, clinical features and treatment of stress tendinopathy of the Achilles tendon.

    PubMed

    Perugia, L; Ippolitio, E; Postacchini, F

    1976-04-01

    On the basis of clinical, anatomical, surgical, histological and pathological investigations, the authors propose a classification of the tendinopathies of the Achilles tendon associated with stress. These are particularly common in the field of sport. Three syndromes are identified: a) pure peritendinitis; b) peritendinitis associated with tendinosis; c) pure tendinosis. The symptoms and possible complications are described and the problem of treatment is discussed. In pure peritendinitis tenolysis is recommended, but in peritendinitis associated with tendinosis it should be combined with extensive scarification of the tendon in order to promote revitalisation. PMID:977317

  5. Gene targeting of the transcription factor Mohawk in rats causes heterotopic ossification of Achilles tendon via failed tenogenesis.

    PubMed

    Suzuki, Hidetsugu; Ito, Yoshiaki; Shinohara, Masahiro; Yamashita, Satoshi; Ichinose, Shizuko; Kishida, Akio; Oyaizu, Takuya; Kayama, Tomohiro; Nakamichi, Ryo; Koda, Naoki; Yagishita, Kazuyoshi; Lotz, Martin K; Okawa, Atsushi; Asahara, Hiroshi

    2016-07-12

    Cell-based or pharmacological approaches for promoting tendon repair are currently not available because the molecular mechanisms of tendon development and healing are not well understood. Although analysis of knockout mice provides many critical insights, small animals such as mice have some limitations. In particular, precise physiological examination for mechanical load and the ability to obtain a sufficient number of primary tendon cells for molecular biology studies are challenging using mice. Here, we generated Mohawk (Mkx)(-/-) rats by using CRISPR/Cas9, which showed not only systemic hypoplasia of tendons similar to Mkx(-/-) mice, but also earlier heterotopic ossification of the Achilles tendon compared with Mkx(-/-) mice. Analysis of tendon-derived cells (TDCs) revealed that Mkx deficiency accelerated chondrogenic and osteogenic differentiation, whereas Mkx overexpression suppressed chondrogenic, osteogenic, and adipogenic differentiation. Furthermore, mechanical stretch stimulation of Mkx(-/-) TDCs led to chondrogenic differentiation, whereas the same stimulation in Mkx(+/+) TDCs led to formation of tenocytes. ChIP-seq of Mkx overexpressing TDCs revealed significant peaks in tenogenic-related genes, such as collagen type (Col)1a1 and Col3a1, and chondrogenic differentiation-related genes, such as SRY-box (Sox)5, Sox6, and Sox9 Our results demonstrate that Mkx has a dual role, including accelerating tendon differentiation and preventing chondrogenic/osteogenic differentiation. This molecular network of Mkx provides a basis for tendon physiology and tissue engineering. PMID:27370800

  6. Use of Platelet Rich Plasma and Hyaluronic Acid in the Treatment of Complications of Achilles Tendon Reconstruction

    PubMed Central

    Gentile, Pietro; De Angelis, Barbara; Agovino, Annarita; Orlandi, Fabrizio; Migner, Alessandra; Di Pasquali, Camilla; Cervelli, Valerio

    2016-01-01

    BACKGROUND The platelet-rich plasma (PRP) and hyaluronic acid (HA) constitute a system of tissue growth that can regenerate damaged tissue. This study was performed to evaluate the effect of PRP and HA in treatment of complications of Achilles tendon reconstruction. METHODS We selected ten patients affected by Achilles tendon injuries resulting from post-surgical complications subsequent to tenorrhaphy and have treated them with autologous PRP in combination with HA to evaluate the improvement of lesions with wound closure. RESULTS The treatment with PRP and HA for post-surgical complications of Achilles tendon was effective in healing and regeneration of soft and hard tissues. The healing time was shortened, and the treated area preserved a satisfying strength in plantar flexion and extension of the ankle, denoting to a decisive improvement in texture and a more rapid healing and a good cutaneous elasticity, with a significant reduction of the costs of hospitalization and the pain already the immediate postoperatively. The functional rehabilitation in terms of deambulation and joint mobility was complete. CONCLUSION The treatment we proposed allowed an easier and more rapid wound closure with excellent aesthetic improvement. Furthermore, the minimally invasive technique is well tolerated by patients. PMID:27579267

  7. Combination of hormone replacement therapy and high physical activity is associated with differences in Achilles tendon size in monozygotic female twin pairs.

    PubMed

    Finni, T; Kovanen, V; Ronkainen, P H A; Pöllänen, E; Bashford, G R; Kaprio, J; Alén, M; Kujala, U M; Sipilä, S

    2009-04-01

    Estrogen concentration has been suggested to play a role in tendon abnormalities and injury. In physically active postmenopausal women, hormone replacement therapy (HRT) has been suggested to decrease tendon diameter. We hypothesized that HRT use and physical activity are associated with Achilles tendon size and tissue structure. The study applied cotwin analysis of fourteen 54- to 62-yr-old identical female twin pairs with current discordance for HRT use for an average of 7 yr. Achilles tendon thickness and cross-sectional areas were determined by ultrasonography, and tendon structural organization was analyzed from the images using linear discriminant analysis (LDA). Maximal voluntary and twitch torques from plantar flexor muscles were measured. Serum levels of estradiol, estrone, testosterone, and sex hormone binding globulin were analyzed. Total daily metabolic equivalent score (MET-h/day) was calculated from physical activity questionnaires. Results showed that, in five physically active (MET > 4) pairs, the cotwins receiving HRT had greater estradiol level (P = 0.043) and smaller tendon cross-sectional area than their sisters (63 vs. 71 mm(2), P = 0.043). Among all pairs, Achilles tendon thickness and cross-sectional area did not significantly differ between HRT using and nonusing twin sisters. Intrapair correlation for Achilles tendon thickness was high, despite HRT use discordance (r = 0.84, P < 0.001). LDA distinguished different tendon structure only from two of six examined twin pairs who had a similar level of physical activity. In conclusion, the effect of HRT on Achilles tendon characteristics independent of genetic confounding may be present only in the presence of sufficient physical activity. In physically active twin pairs, the higher level of estrogen seems to be associated with smaller tendon size. PMID:19164771

  8. Depiction of Achilles Tendon Microstructure In-Vivo Using High-Resolution 3D Ultrashort Echo-Time MRI at 7T

    PubMed Central

    Han, Misung; Larson, Peder E. Z.; Liu, Jing; Krug, Roland

    2014-01-01

    Objectives To demonstrate the feasibility of depicting the internal structure of the Achilles tendon in vivo using high-resolution 3D ultrashort echo-time (UTE) magnetic resonance imaging (MRI) at 7T. Materials and Methods For our UTE imaging, a minimum-phase radiofrequency pulse and an anisotropic field-of-view 3D radial acquisition were used to minimize the echo time and scan time. A fat saturation pulse was applied every eight spoke acquisitions to reduce blurring and chemical shift artifacts from fat and to improve dynamic range of the tendon signal. Five healthy volunteers and one patient were scanned with an isotropic spatial resolution of up to 0.6 mm. Fat-suppressed UTE images were qualitatively evaluated and compared to non-fat-suppressed UTE images and longer echo-time images. Results High-resolution UTE imaging was able to visualize the microstructure of the Achilles tendon. Fat suppression substantially improved the depiction of the internal structure. The UTE images revealed a fascicular pattern in the Achilles tendon and fibrocartilage at the tendon insertion. In a patient who had tendon elongation surgery after birth there was clear depiction of disrupted tendon structure. Conclusions High-resolution fat-suppressed 3D UTE imaging at 7T allows for evaluation of the Achilles tendon microstructure in vivo. PMID:24500089

  9. Reconstruction of chronic patellar tendon rupture with contralateral BTB autograft: a case report.

    PubMed

    Milankov, Miroslav Z; Miljkovic, Natasa; Stankovic, Milan

    2007-12-01

    Chronic patellar tendon rupture is a rare disabling injury that is technically difficult to repair. Many different surgical methods have been reported for the reconstruction of chronic patellar tendon ruptures. We are reporting the use of contralateral bone-tendon-bone (BTB) autograft for chronic patellar tendon rupture reconstruction followed by double-wire loop reinforcement and without postoperative immobilization. One year after the operation, our patient had full knee extension and up to 130 degrees of flexion. He had good quadriceps strength, and isokinetic muscle testing showed no deficit comparing to his right leg. Patient returned to playing basketball in his spare time, without having any limitation. PMID:17579835

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

    PubMed Central

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

    2014-01-01

    The aim of this study was: (i) to analyze the morphology and expression of extracellular matrix genes in six different regions of the Achilles tendon complex of intact normal rabbits; and (ii) to assess the effect of ovariohysterectomy (OVH) on the regional expression of these genes. Female New Zealand White rabbits were separated into two groups: (i) intact normal rabbits (n = 4); and (ii) OVH rabbits (n = 8). For each rabbit, the Achilles tendon complex was dissected into six regions: distal gastrocnemius (DG); distal flexor digitorum superficialis; proximal lateral gastrocnemius (PLG); proximal medial gastrocnemius; proximal flexor digitorum superficialis; and paratenon. For each of the regions, hematoxylin and eosin staining was performed for histological evaluation of intact normal rabbit tissues and mRNA levels for proteoglycans, collagens and genes associated with collagen regulation were assessed by real-time reverse transcription-quantitative polymerase chain reaction for both the intact normal and OVH rabbit tissues. The distal regions displayed a more fibrocartilaginous phenotype. For intact normal rabbits, aggrecan mRNA expression was higher in the distal regions of the Achilles tendon complex compared with the proximal regions. Collagen Type I and matrix metalloproteinase-2 expression levels were increased in the PLG compared to the DG in the intact normal rabbit tissues. The tendons from OVH rabbits had lower gene expressions for the proteoglycans aggrecan, biglycan, decorin and versican compared with the intact normal rabbits, although the regional differences of increased aggrecan expression in distal regions compared with proximal regions persisted. The tensile and compressive forces experienced in the examined regions may be related to the regional differences found in gene expression. The lower mRNA expression of the genes examined in the OVH group confirms a potential effect of systemic estrogen on tendon. PMID:24571598

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

    PubMed

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

    2014-05-01

    The aim of this study was: (i) to analyze the morphology and expression of extracellular matrix genes in six different regions of the Achilles tendon complex of intact normal rabbits; and (ii) to assess the effect of ovariohysterectomy (OVH) on the regional expression of these genes. Female New Zealand White rabbits were separated into two groups: (i) intact normal rabbits (n = 4); and (ii) OVH rabbits (n = 8). For each rabbit, the Achilles tendon complex was dissected into six regions: distal gastrocnemius (DG); distal flexor digitorum superficialis; proximal lateral gastrocnemius (PLG); proximal medial gastrocnemius; proximal flexor digitorum superficialis; and paratenon. For each of the regions, hematoxylin and eosin staining was performed for histological evaluation of intact normal rabbit tissues and mRNA levels for proteoglycans, collagens and genes associated with collagen regulation were assessed by real-time reverse transcription-quantitative polymerase chain reaction for both the intact normal and OVH rabbit tissues. The distal regions displayed a more fibrocartilaginous phenotype. For intact normal rabbits, aggrecan mRNA expression was higher in the distal regions of the Achilles tendon complex compared with the proximal regions. Collagen Type I and matrix metalloproteinase-2 expression levels were increased in the PLG compared to the DG in the intact normal rabbit tissues. The tendons from OVH rabbits had lower gene expressions for the proteoglycans aggrecan, biglycan, decorin and versican compared with the intact normal rabbits, although the regional differences of increased aggrecan expression in distal regions compared with proximal regions persisted. The tensile and compressive forces experienced in the examined regions may be related to the regional differences found in gene expression. The lower mRNA expression of the genes examined in the OVH group confirms a potential effect of systemic estrogen on tendon. PMID:24571598

  12. Patellar Tendon Rupture after Lateral Release without Predisposing Systemic Disease or Steroid Use

    PubMed Central

    De Giorgi, S.; Notarnicola, A.; Vicenti, G.; Moretti, B.

    2015-01-01

    Arthroscopic technique for lateral release is the most widely used procedure for the correction of recurrent dislocations of the patella. In the relevant literature, several complications of lateral release are described, but the spontaneous patellar tendon rupture has never been suggested as a possible complication of this surgical procedure. Patellar tendon rupture is a rather infrequent and often unilateral lesion. Nevertheless, in case of systemic diseases (LES, rheumatoid arthritis, and chronic renal insufficiency) that can weaken collagen structures, bilateral patellar tendon ruptures are described. We report a case of a 24-year-old girl with spontaneous rupture of patellar tendon who, at the age of 16, underwent an arthroscopic lateral release for recurrent dislocation of the patella. This is the first case of described spontaneous patellar tendon rupture that occurred some years after an arthroscopic lateral release. PMID:25960904

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

    PubMed

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

    2015-01-01

    Haglund syndrome is characterized by chronic posterior heel pain associated with a posterosuperior calcaneal prominence. We assessed the clinical and radiologic outcomes after operative treatment of Haglund syndrome using the central tendon-splitting approach. Fifteen feet in 15 patients were investigated retrospectively after surgery. Of the 15 patients, 14 were males (93.3%) and 1 was female (6.7%). Their mean age was 33.1 ± 8.2 (range 20 to 50) years. The mean follow-up duration was 3.5 ± 1.5 years (range 24 to 90 months). The American Orthopaedic Foot and Ankle Society ankle-hindfoot Scale and Victorian Institute of Sport Assessment-Achilles scores were investigated to assess the clinical outcomes. Patient satisfaction was assessed at the latest follow-up visit. The lateral talo-first metatarsal angle, calcaneal pitch angle, Fowler-Philip angle, and parallel pitch line were measured to assess the foot shape and radiographic outcomes. Clinically, the mean American Orthopaedic Foot and Ankle Society ankle-hindfoot scale score increased from 62.1 ± 7.5 preoperatively to 92.5 ± 3.5 at the latest follow-up visit. The mean Victorian Institute of Sport Assessment-Achilles score increased from 53.2 ± 7.4 to 89.6 ± 3.4. All patients were satisfied with the operative results. Radiographically, all patients had cavus feet with an increased lateral talo-first metatarsal angle (mean +5.9° ± 5.0°) and calcaneal pitch angle (mean 26.0° ± 3.8°). The mean Fowler-Philip angle decreased from 58.9° ± 15.0° to 32.5° ± 7.2° postoperatively, and the positive parallel pitch line had changed to a negative value in all cases. Operative treatment with the central tendon-splitting approach appears to be safe and satisfactory for intractable Haglund syndrome. PMID:26232175

  14. Effect of Footwear Modifications on Oscillations at the Achilles Tendon during Running on a Treadmill and Over Ground: A Cross-Sectional Study

    PubMed Central

    Meinert, Ilka; Brown, Niklas; Alt, Wilfried

    2016-01-01

    Background Achilles tendon injuries are known to commonly occur in runners. During running repeated impacts are transferred in axial direction along the lower leg, therefore possibly affecting the oscillation behavior of the Achilles tendon. The purpose of the present study was to explore the effects of different footwear modifications and different ground conditions (over ground versus treadmill) on oscillations at the Achilles tendon. Methods Oscillations were measured in 20 male runners using two tri-axial accelerometers. Participants ran in three different shoe types on a treadmill and over ground. Data analysis was limited to stance phase and performed in time and frequency space. Statistical comparison was conducted between oscillations in vertical and horizontal direction, between running shoes and between ground conditions (treadmill versus over ground running). Results Differences in the oscillation behavior could be detected between measurement directions with peak accelerations in the vertical being lower than those in the horizontal direction, p < 0.01. Peak accelerations occurred earlier at the distal accelerometer than at the proximal one, p < 0.01. Average normalized power differed between running shoes (p < 0.01) with harder damping material resulting in higher power values. Little to no power attenuation was found between the two accelerometers. Oscillation behavior of the Achilles tendon is not influenced by ground condition. Conclusion Differences in shoe configurations may lead to variations in running technique and impact forces and therefore result in alterations of the vibration behavior at the Achilles tendon. The absence of power attenuation may have been caused by either a short distance between the two accelerometers or high stiffness of the tendon. High stiffness of the tendon will lead to complete transmission of the signal along the Achilles tendon and therefore no attenuation occurs. PMID:27010929

  15. Achilles tendon strain energy in distance running: consider the muscle energy cost.

    PubMed

    Fletcher, Jared R; MacIntosh, Brian R

    2015-01-15

    The return of tendon strain energy is thought to contribute to reducing the energy cost of running (Erun). However, this may not be consistent with the notion that increased Achilles tendon (AT) stiffness is associated with a lower Erun. Therefore, the purpose of this study was to quantify the potential for AT strain energy return relative to Erun for male and female runners of different abilities. A total of 46 long distance runners [18 elite male (EM), 12 trained male (TM), and 16 trained female (TF)] participated in this study. Erun was determined by indirect calorimetry at 75, 85, and 95% of the speed at lactate threshold (sLT), and energy cost per stride at each speed was estimated from previously reported stride length (SL)-speed relationships. AT force during running was estimated from reported vertical ground reaction force (Fz)-speed relationships, assuming an AT:ground reaction force moment arm ratio of 1.5. AT elongation was quantified during a maximal voluntary isometric contraction using ultrasound. Muscle energy cost was conservatively estimated on the basis of AT force and estimated cross-bridge mechanics and energetics. Significant group differences existed in sLT (EM > TM > TF; P < 0.001). A significant group × speed interaction was found in the energy storage/release per stride (TM > TF > EM; P < 0.001), the latter ranging from 10 to 70 J/stride. At all speeds and in all groups, estimated muscle energy cost exceeded energy return (P < 0.001). These results show that during distance running the muscle energy cost is substantially higher than the strain energy release from the AT. PMID:25593218

  16. Achilles tendon strain energy in distance running: consider the muscle energy cost

    PubMed Central

    MacIntosh, Brian R.

    2014-01-01

    The return of tendon strain energy is thought to contribute to reducing the energy cost of running (Erun). However, this may not be consistent with the notion that increased Achilles tendon (AT) stiffness is associated with a lower Erun. Therefore, the purpose of this study was to quantify the potential for AT strain energy return relative to Erun for male and female runners of different abilities. A total of 46 long distance runners [18 elite male (EM), 12 trained male (TM), and 16 trained female (TF)] participated in this study. Erun was determined by indirect calorimetry at 75, 85, and 95% of the speed at lactate threshold (sLT), and energy cost per stride at each speed was estimated from previously reported stride length (SL)-speed relationships. AT force during running was estimated from reported vertical ground reaction force (Fz)-speed relationships, assuming an AT:ground reaction force moment arm ratio of 1.5. AT elongation was quantified during a maximal voluntary isometric contraction using ultrasound. Muscle energy cost was conservatively estimated on the basis of AT force and estimated cross-bridge mechanics and energetics. Significant group differences existed in sLT (EM > TM > TF; P < 0.001). A significant group × speed interaction was found in the energy storage/release per stride (TM > TF > EM; P < 0.001), the latter ranging from 10 to 70 J/stride. At all speeds and in all groups, estimated muscle energy cost exceeded energy return (P < 0.001). These results show that during distance running the muscle energy cost is substantially higher than the strain energy release from the AT. PMID:25593218

  17. Effects of Foot Strike and Step Frequency on Achilles Tendon Stress During Running.

    PubMed

    Lyght, Michael; Nockerts, Matthew; Kernozek, Thomas W; Ragan, Robert

    2016-08-01

    Achilles tendon (AT) injuries are common in runners. The AT withstands high magnitudes of stress during running which may contribute to injury. Our purpose was to examine the effects of foot strike pattern and step frequency on AT stress and strain during running utilizing muscle forces based on a musculoskeletal model and subject-specific ultrasound-derived AT cross-sectional area. Nineteen female runners performed running trials under 6 conditions, including rearfoot strike and forefoot strike patterns at their preferred cadence, +5%, and -5% preferred cadence. Rearfoot strike patterns had less peak AT stress (P < .001), strain (P < .001), and strain rate (P < .001) compared with the forefoot strike pattern. A reduction in peak AT stress and strain were exhibited with a +5% preferred step frequency relative to the preferred condition using a rearfoot (P < .001) and forefoot (P=.005) strike pattern. Strain rate was not different (P > .05) between step frequencies within each foot strike condition. Our results suggest that a rearfoot pattern may reduce AT stress, strain, and strain rate. Increases in step frequency of 5% above preferred frequency, regardless of foot strike pattern, may also lower peak AT stress and strain. PMID:26955843

  18. Achilles Tendon Reflex (ATR) in response to short exposures of microgravity and hypergravity

    NASA Technical Reports Server (NTRS)

    Fujii, M.; Jaweed, M.

    1992-01-01

    Previous studies indicate that latency and amplitude of the Achilles tendon reflex (ATR) are reduced after exposure to microgravity for 28 days. The objective of this study was to quantitatively measure the latency of ATR during brief (20 sec) exposure to microgravity in KC-135 parabolic flights. Methods: The ATR was elicited in ten men during parabolic flight with the ankle held neutrally, planarflexed, and dorsiflexed. During flight, the ATR was elicited during the zero G and 1.8 G phases. Postflight testing was performed flying back to the airfield. Latencies to onset of the ATR were calculated and analyses of variance were performed to determine the effect of gravity and ankle position on latency. Result: The mean latencies for zero-G, 1.8-G and postflight with the ankle in the neutral position were 32.7 plus or minus 0.5 ms, and 33.1 plus or minus 0.7 ms respectively, which were not significantly different. There was a trend toward prolongation of latencies postflight. The mean latency for those who were motion sick was 32.1 plus or minus 0.1 ms compared to 34.0 plus or minus 0.3 ms for those who were not sick. Conclusions: These studies indicate that neither the level of gravity nor ankle position significantly affected the latency of the ATR.

  19. Weft-knitted silk-poly(lactide-co-glycolide) mesh scaffold combined with collagen matrix and seeded with mesenchymal stem cells for rabbit Achilles tendon repair.

    PubMed

    Zhang, Wenyuan; Yang, Yadong; Zhang, Keji; Li, Ying; Fang, Guojian

    2015-02-01

    Natural silk fibroin fiber scaffolds have excellent mechanical properties, but degrade slowly. In this study, we used poly(lactide-co-glycolide) (PLGA, 10:90) fibers to adjust the overall degradation rate of the scaffolds and filled them with collagen to reserve space for cell growth. Silk fibroin-PLGA (36:64) mesh scaffolds were prepared using weft-knitting, filled with type I collagen, and incubated with rabbit autologous bone marrow-derived mesenchymal stem cells (MSCs). These scaffold-cells composites were implanted into rabbit Achilles tendon defects. At 16 weeks after implantation, morphological and histological observations showed formation of tendon-like tissues that expressed type I collagen mRNA and a uniformly dense distribution of collagen fibers. The maximum load of the regenerated Achilles tendon was 58.32% of normal Achilles tendon, which was significantly higher than control group without MSCs. These findings suggest that it is feasible to construct tissue engineered tendon using weft-knitted silk fibroin-PLGA fiber mesh/collagen matrix seeded with MSCs for rabbit Achilles tendon defect repair. PMID:25333819

  20. Proximal coracobrachialis tendon rupture, subscapularis tendon rupture, and medial dislocation of the long head of the biceps tendon in an adult after traumatic anterior shoulder dislocation.

    PubMed

    Saltzman, Bryan M; Harris, Joshua D; Forsythe, Brian

    2015-01-01

    Rupture of the coracobrachialis is a rare entity, in isolation or in combination with other muscular or tendinous structures. When described, it is often a result of direct trauma to the anatomic area resulting in rupture of the muscle belly. The authors present a case of a 57-year-old female who suffered a proximal coracobrachialis tendon rupture from its origin at the coracoid process, with concomitant subscapularis tear and medial dislocation of the long head of biceps tendon after first time traumatic anterior shoulder dislocation. Two weeks after injury, magnetic resonance imaging suggested the diagnosis, which was confirmed during combined arthroscopic and open technique. Soft-tissue tenodesis of coracobrachialis to the intact short head of the biceps, tenodesis of the long head of biceps to the intertubercular groove, and double-row anatomic repair of the subscapularis were performed. The patient did well postoperatively, and ultimately at 6 months follow-up, she was without pain, and obtained 160° of active forward elevation, 45° of external rotation, internal rotation to T8, 5/5 subscapularis and biceps strength. Scoring scales had improved from the following preoperative to final follow-up: American Shoulder and Elbow Surgeons, 53.33-98.33; constant, 10-100; visual analogue scale-pain, 4-0. DASH score was 5. PMID:25937715

  1. Proximal coracobrachialis tendon rupture, subscapularis tendon rupture, and medial dislocation of the long head of the biceps tendon in an adult after traumatic anterior shoulder dislocation

    PubMed Central

    Saltzman, Bryan M.; Harris, Joshua D.; Forsythe, Brian

    2015-01-01

    Rupture of the coracobrachialis is a rare entity, in isolation or in combination with other muscular or tendinous structures. When described, it is often a result of direct trauma to the anatomic area resulting in rupture of the muscle belly. The authors present a case of a 57-year-old female who suffered a proximal coracobrachialis tendon rupture from its origin at the coracoid process, with concomitant subscapularis tear and medial dislocation of the long head of biceps tendon after first time traumatic anterior shoulder dislocation. Two weeks after injury, magnetic resonance imaging suggested the diagnosis, which was confirmed during combined arthroscopic and open technique. Soft-tissue tenodesis of coracobrachialis to the intact short head of the biceps, tenodesis of the long head of biceps to the intertubercular groove, and double-row anatomic repair of the subscapularis were performed. The patient did well postoperatively, and ultimately at 6 months follow-up, she was without pain, and obtained 160° of active forward elevation, 45° of external rotation, internal rotation to T8, 5/5 subscapularis and biceps strength. Scoring scales had improved from the following preoperative to final follow-up: American Shoulder and Elbow Surgeons, 53.33-98.33; constant, 10-100; visual analogue scale-pain, 4-0. DASH score was 5. PMID:25937715

  2. Rupture of the posterior tibial tendon. Evaluation of injury of the spring ligament and clinical assessment of tendon transfer and ligament repair.

    PubMed

    Gazdag, A R; Cracchiolo, A

    1997-05-01

    Eighteen of twenty-two patients who were having a tendon transfer to treat rupture of the posterior tibial tendon had evidence of injury to the spring ligament. The injury consisted of a longitudinal tear in the ligament in seven patients, a lax ligament without a gross tear in seven, and a complete rupture of the ligament in four. The ruptured posterior tibial tendon was treated with transfer of the flexor digitorum longus in twenty of the twenty-two patients. A variety of methods were used to repair the ligament. It is essential to determine the status of the spring ligament when patients are managed for rupture of the posterior tibial tendon. Patients who have a torn or lax spring ligament in addition to the ruptured posterior tibial tendon may have more severe abnormalities of the hindfoot than those who have only a ruptured tendon. PMID:9160939

  3. Spontaneous, bilateral, quadriceps tendon rupture caused by local exposure to methidathion.

    PubMed

    Papastergiou, Stergios G; Koukoulias, Nikolaos E; Ziogas, Evangelos; Dimitriadis, Theofilos; Koumis, Panagiotis

    2009-01-01

    Spontaneous, bilateral, quadriceps tendon rupture is a rare injury. Many predisposing conditions have been reported that contribute to quadriceps tendon degeneration. We report a case of a 42-year-old farmer with spontaneous, bilateral, quadriceps tendon rupture and clear medical history. Clinical and laboratory investigations revealed no risk factors for tendon degeneration but the patient reported that he was exposed locally to methidathion 1 week before the rupture. Methidathion is an organophosphate insecticide commonly used in agriculture that is highly toxic via the dermal route. Methidathion induces lipid pre-oxidation and consequently alters quadriceps tendon blood supply and ultrastructure. The injury was treated with early surgical repair and final outcome was excellent 44 months postoperatively. PMID:22114623

  4. Spontaneous, bilateral, quadriceps tendon rupture caused by local exposure to methidathion

    PubMed Central

    Papastergiou, Stergios G; Koukoulias, Nikolaos E; Ziogas, Evangelos; Dimitriadis, Theofilos; Koumis, Panagiotis

    2009-01-01

    Spontaneous, bilateral, quadriceps tendon rupture is a rare injury. Many predisposing conditions have been reported that contribute to quadriceps tendon degeneration. We report a case of a 42-year-old farmer with spontaneous, bilateral, quadriceps tendon rupture and clear medical history. Clinical and laboratory investigations revealed no risk factors for tendon degeneration but the patient reported that he was exposed locally to methidathion 1 week before the rupture. Methidathion is an organophosphate insecticide commonly used in agriculture that is highly toxic via the dermal route. Methidathion induces lipid pre-oxidation and consequently alters quadriceps tendon blood supply and ultrastructure. The injury was treated with early surgical repair and final outcome was excellent 44 months postoperatively. PMID:22114623

  5. New Imaging Methods for Non-invasive Assessment of Mechanical, Structural, and Biochemical Properties of Human Achilles Tendon: A Mini Review

    PubMed Central

    Fouré, Alexandre

    2016-01-01

    The mechanical properties of tendon play a fundamental role to passively transmit forces from muscle to bone, withstand sudden stretches, and act as a mechanical buffer allowing the muscle to work more efficiently. The use of non-invasive imaging methods for the assessment of human tendon's mechanical, structural, and biochemical properties in vivo is relatively young in sports medicine, clinical practice, and basic science. Non-invasive assessment of the tendon properties may enhance the diagnosis of tendon injury and the characterization of recovery treatments. While ultrasonographic imaging is the most popular tool to assess the tendon's structural and indirectly, mechanical properties, ultrasonographic elastography, and ultra-high field magnetic resonance imaging (UHF MRI) have recently emerged as potentially powerful techniques to explore tendon tissues. This paper highlights some methodological cautions associated with conventional ultrasonography and perspectives for in vivo human Achilles tendon assessment using ultrasonographic elastography and UHF MRI. PMID:27512376

  6. Platelet-Rich Fibrin Promotes an Accelerated Healing of Achilles Tendon When Compared to Platelet-Rich Plasma in Rat

    PubMed Central

    Dietrich, Franciele; L. Duré, Gustavo; P. Klein, Caroline; F. Bampi, Vinícius; V. Padoin, Alexandre; D. Silva, Vinícius; Braga-Silva, Jefferson

    2015-01-01

    BACKGROUND Autologous platelet concentrate has been used to improve the function and regeneration of injured tissues. Tendinopathies are common in clinical practice, although long-term treatment is required. On the basis of lead time, we compared the effect of using platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) in repairing rat Achilles tendon. METHODS The effectiveness of using PRP and PRF was evaluated after 14 and 28 postoperative days by histological analysis. The quantification of collagen types I and III was performed by Sirius red staining. Qualitatively, the data were verified with hematoxylin-eosin (H&E) staining. RESULTS In Sirius red staining, no significant treatment differences were found between groups. Statistical difference was observed only between PRP (37.2% collagen) and the control group (16.2%) 14 days after treatment. Intra-groups compared twice showed a difference for collagen I (27.8% and 47.7%) and III (66.9% and 46.0%) in the PRF group. The control group showed differences only in collagen I (14.2% and 40.9%) and no other finding was observed in the PRP group. In H&E staining, PRF showed a better cellular organization when compared to the other groups at 28 days. CONCLUSION Our study suggests that PRF promotes accelerated regeneration of the Achilles tendon in rats, offering promising prospects for future clinical use. PMID:26284178

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

    PubMed

    Helfenstein-Didier, C; Andrade, R J; Brum, J; Hug, F; Tanter, M; Nordez, A; Gennisson, J-L

    2016-03-21

    The shear wave velocity dispersion was analyzed in the Achilles tendon (AT) during passive dorsiflexion using a phase velocity method in order to obtain the tendon shear modulus (C 55). Based on this analysis, the aims of the present study were (i) to assess the reproducibility of the shear modulus for different ankle angles, (ii) to assess the effect of the probe locations, and (iii) to compare results with elasticity values obtained with the supersonic shear imaging (SSI) technique. The AT shear modulus (C 55) consistently increased with the ankle dorsiflexion (N  =  10, p  <  0.05). Furthermore, the technique showed a very good reproducibility (all standard error of the mean values  <10.7 kPa and all coefficient of variation (CV) values  ⩽0.05%). In addition, independently from the ankle dorsiflexion, the shear modulus was significantly higher in the proximal location compared to the more distal one. The shear modulus provided by SSI was always lower than C55 and the difference increased with the ankle dorsiflexion. However, shear modulus values provided by both methods were highly correlated (R  =  0.84), indicating that the conventional shear wave elastography technique (SSI technique) can be used to compare tendon mechanical properties across populations. Future studies should determine the clinical relevance of the shear wave dispersion analysis, for instance in the case of tendinopathy or tendon tear. PMID:26948399

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

    NASA Astrophysics Data System (ADS)

    Helfenstein-Didier, C.; Andrade, R. J.; Brum, J.; Hug, F.; Tanter, M.; Nordez, A.; Gennisson, J.-L.

    2016-03-01

    The shear wave velocity dispersion was analyzed in the Achilles tendon (AT) during passive dorsiflexion using a phase velocity method in order to obtain the tendon shear modulus (C 55). Based on this analysis, the aims of the present study were (i) to assess the reproducibility of the shear modulus for different ankle angles, (ii) to assess the effect of the probe locations, and (iii) to compare results with elasticity values obtained with the supersonic shear imaging (SSI) technique. The AT shear modulus (C 55) consistently increased with the ankle dorsiflexion (N  =  10, p  <  0.05). Furthermore, the technique showed a very good reproducibility (all standard error of the mean values  <10.7 kPa and all coefficient of variation (CV) values  ⩽0.05%). In addition, independently from the ankle dorsiflexion, the shear modulus was significantly higher in the proximal location compared to the more distal one. The shear modulus provided by SSI was always lower than C55 and the difference increased with the ankle dorsiflexion. However, shear modulus values provided by both methods were highly correlated (R  =  0.84), indicating that the conventional shear wave elastography technique (SSI technique) can be used to compare tendon mechanical properties across populations. Future studies should determine the clinical relevance of the shear wave dispersion analysis, for instance in the case of tendinopathy or tendon tear.

  9. [Rupture of the tibialis anterior tendon--a rare sports injury].

    PubMed

    Ernst, S; Eisenbeis, K; Mockwitz, J

    1999-09-01

    Rupture of the anterior tibial tendon is a very rare injury in sports. The rupture is based on degeneration of the tendon and caused by a forced plantarflexion. Main symptoms of this often "missed injury" are impossibility of dorsal extension of the foot and a palpable gap. The diagnosis can be confirmed by sonography or MRI. A complete healing can only be reached by operation. The reconstruction is done by tendon suture or distal refixation. Postoperative the ankle is immobilized in a cast for 6 weeks. PMID:10609291

  10. Association between statin therapy and tendon rupture: a case-control study.

    PubMed

    Beri, Abhimanyu; Dwamena, Francesca C; Dwamena, Ben A

    2009-05-01

    Although case reports of a possible association between statin therapy and tendon rupture have been published, no analytical studies exploring this relationship have been reported. We conducted a case-control study using the electronic medical records at Michigan State University from 2002 to 2007 to assess whether statin use is a risk factor for tendon rupture. We compared exposure to statins in 93 cases of tendon rupture with similar exposure in 279 sex- and age-matched controls. Exposure to statins was defined as documentation in the electronic medical record of statin use in the 12 months preceding tendon rupture. For controls, the exposure period was defined as 1 year preceding the last office visit. We used a multivariate logistic regression model, controlling for diabetes, renal disease, rheumatologic disease, and steroid use, to calculate the adjusted odds ratios (ORs). There was no significant difference between cases and controls in the rates of statin use, with either univariate [OR = 1.0, 95% confidence interval (CI) 0.54-1.84] or multivariate analyses (OR = 1.10, 95% CI 0.57-2.13). Based on predetermined subgroup analyses, statin exposure was found to be a significant risk factor for tendon rupture in women (adjusted OR = 3.76, 95% CI 1.11-12.75) but not in men (adjusted OR = 0.66, 95% CI 0.29-1.51). In conclusion, we found no overall association between statin use and tendon rupture, but subgroup analysis suggested that women with tendon rupture were more likely to be on statins. PMID:19454900