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Sample records for patellar tendinopathy caused

  1. Patellar Tendinopathy

    PubMed Central

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

    2015-01-01

    Context: Patellar tendinopathy is a common condition. There are a wide variety of treatment options available, the majority of which are nonoperative. No consensus exists on the optimal method of treatment. Evidence Acquisition: PubMed spanning 1962-2014. Study Design: Clinical review. Level of Evidence: Level 4. Results: The majority of cases resolve with nonoperative therapy: rest, physical therapy with eccentric exercises, cryotherapy, anti-inflammatories, corticosteroid injections, extracorporeal shockwave therapy, glyceryl trinitrate, platelet-rich plasma injections, and ultrasound-guided sclerosis. Refractory cases may require either open or arthroscopic debridement of the patellar tendon. Corticosteroid injections provide short-term pain relief but increase risk of tendon rupture. Anti-inflammatories and injectable agents have shown mixed results. Surgical treatment is effective in many refractory cases unresponsive to nonoperative modalities. Conclusion: Physical therapy with an eccentric exercise program is the mainstay of treatment for patellar tendinopathy. Platelet-rich plasma has demonstrated mixed results; evidence-based recommendations on its efficacy cannot be made. In the event that nonoperative treatment fails, surgical intervention has produced good to excellent outcomes in the majority of patients. PMID:26502416

  2. Patellar Tendinopathy

    PubMed Central

    Beebe, Justin A.; Cross, Patrick S.

    2013-01-01

    Background: Calcific deposits (CaDs) may be related to chronic postoperative pain and may affect function after patellar tendon surgery. Study Design: Cross-sectional. Hypothesis: We hypothesized that patients with CaDs (+CaDs) would rate lower than those without (−CaDs) on measures of knee function and quality of life. Methods: Patients completed the Tegner Lysholm Knee Scoring Scale (Lysholm), Knee Injury and Osteoarthritis Outcome Score (KOOS), the International Knee Documentation Committee Subjective Knee Form (IKDC), and the Tegner Activity Level Scale. Sixteen postsurgical and 16 age-matched controls were tested. Patients +CaDs were 5.6 years older than those patients −CaDs and had 4.2 years of longer elapse since surgery. Bilateral patellar tendons were examined for CaDs with musculoskeletal ultrasound imaging. One-way analysis of variance was used to determine if differences existed among patients +CaDs and −CaDs and healthy controls. Hierarchical logistic regressions were used to determine which variables best predicted the presence of CaDs. Results: CaDs were found in 44% (7 of 16) of postsurgical patients, who scored lower than controls on all dimensions of the Lysholm, KOOS, and IKDC. Patients +CaD had lower KOOS scores than controls (symptoms, activities of daily living, and quality of life). Age and time since surgery were both moderately related to the presence of CaDs, and both correctly predicted 71% of patients +CaDs. Conclusion: Calcific deposits were found in the patellar tendon of 44% of postsurgical patients, who rated themselves lower on all subjective measures of knee function and quality of life following surgery. Age is an important factor for developing CaDs postsurgery. Clinical Relevance: Calcific deposits may be present in patellar tendons following surgery, but their direct role in functional or clinical limitations remains unknown. PMID:24427392

  3. Patellar tendinopathy - recent developments toward treatment.

    PubMed

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

    2014-01-01

    Patellar tendinopathy (PT) is a clinical and chronic overuse condition of unknown pathogenesis and etiology marked by anterior knee pain typically manifested at the inferior pole of the patella. PT has been referred to as "jumper's knee" since it is particularly common among populations of jumping athletes, such as basketball and volleyball players. Due to its common refractory response to conservative treatment, a variety of new treatments have emerged recently that include dry-needling, sclerosing injections, platelet-rich plasma therapy, arthroscopic surgical procedures, surgical resection of the inferior patellar pole, extracorporeal shock wave treatment, and hyperthermia thermotherapy. Since PT has an unknown pathogenesis and etiology, PT treatment is more a result of physician experience than evidence-based science. This review will summarize the current literature on this topic, identify current research efforts aimed to understand the pathological changes in abnormal tendons, provide exposure to the emerging treatment techniques, and provide suggested direction for future research. PMID:25429390

  4. Clinical Applications of Platelet-Rich Plasma in Patellar Tendinopathy

    PubMed Central

    Jeong, D. U.; Lee, C.-R.; Lee, J. H.; Pak, J.; Kang, L.-W.; Jeong, B. C.

    2014-01-01

    Platelet-rich plasma (PRP), a blood derivative with high concentrations of platelets, has been found to have high levels of autologous growth factors (GFs), such as transforming growth factor-β (TGF-β), platelet-derived growth factor (PDGF), fibroblastic growth factor (FGF), vascular endothelial growth factor (VEGF), and epidermal growth factor (EGF). These GFs and other biological active proteins of PRP can promote tissue healing through the regulation of fibrosis and angiogenesis. Moreover, PRP is considered to be safe due to its autologous nature and long-term usage without any reported major complications. Therefore, PRP therapy could be an option in treating overused tendon damage such as chronic tendinopathy. Here, we present a systematic review highlighting the clinical effectiveness of PRP injection therapy in patellar tendinopathy, which is a major cause of athletes to retire from their respective careers. PMID:25136568

  5. Clinical applications of platelet-rich plasma in patellar tendinopathy.

    PubMed

    Jeong, D U; Lee, C-R; Lee, J H; Pak, J; Kang, L-W; Jeong, B C; Lee, S H

    2014-01-01

    Platelet-rich plasma (PRP), a blood derivative with high concentrations of platelets, has been found to have high levels of autologous growth factors (GFs), such as transforming growth factor-β (TGF-β), platelet-derived growth factor (PDGF), fibroblastic growth factor (FGF), vascular endothelial growth factor (VEGF), and epidermal growth factor (EGF). These GFs and other biological active proteins of PRP can promote tissue healing through the regulation of fibrosis and angiogenesis. Moreover, PRP is considered to be safe due to its autologous nature and long-term usage without any reported major complications. Therefore, PRP therapy could be an option in treating overused tendon damage such as chronic tendinopathy. Here, we present a systematic review highlighting the clinical effectiveness of PRP injection therapy in patellar tendinopathy, which is a major cause of athletes to retire from their respective careers. PMID:25136568

  6. Patellar tendinopathy: late-stage results from surgical treatment☆

    PubMed Central

    Cenni, Marcos Henrique Frauendorf; Silva, Thiago Daniel Macedo; do Nascimento, Bruno Fajardo; de Andrade, Rodrigo Cristiano; Júnior, Lúcio Flávio Biondi Pinheiro; Nicolai, Oscar Pinheiro

    2015-01-01

    Objective To evaluate the late-stage results from surgical treatment of patellar tendinopathy (PT), using the Visa score (Victorian Institute of Sport Tendon Study Group) and the Verheyden method. Methods This was a retrospective study in which the postoperative results from 12 patients (14 knees) who were operated between July 2002 and February 2011 were evaluated. The patients included in the study presented patellar tendinopathy that was refractory to conservative treatment, without any other concomitant lesions. Patients who were not properly followed up during the postoperative period were excluded. Results Using the Verheyden method, nine patients were considered to have very good results, two had good results and one had poor results. In relation to Visa, the mean was 92.4 points and only two patients had scores less than 70 points (66 and 55 points). Conclusion When surgical treatment for patellar tendinopathy is correctly indicated, it has good long-term results. PMID:26535202

  7. Ultrasound-Guided Scraping for Chronic Patellar Tendinopathy: A Case Presentation.

    PubMed

    Hall, Mederic M; Rajasekaran, Sathish

    2016-06-01

    Chronic patellar tendinopathy is a common complaint among athletes who repetitively stress the extensor mechanism of the knee. Multiple treatment options have been described, but evidence is lacking, specifically when eccentric loading has failed. Debate continues regarding the patho-etiology of chronic patellar tendon pain. There has been recent interest regarding the neurogenic influences involved in chronic tendinopathy, and interventions targeting neovessels and accompanying neonerves have shown promise. This is the first description of an ultrasound-guided technique in which the neovessels and accompanying neonerves in patellar tendinopathy were targeted using a needle scraping technique of the posterior surface of the patellar tendon. PMID:26548965

  8. Prevalence of Achilles and patellar tendinopathy and their association to intratendinous changes in adolescent athletes.

    PubMed

    Cassel, M; Baur, H; Hirschmüller, A; Carlsohn, A; Fröhlich, K; Mayer, F

    2015-06-01

    Achilles (AT) and patellar tendons (PT) are commonly affected by tendinopathy in adult athletes but prevalence of symptoms and morphological changes in adolescents is unclear. The study aimed to determine prevalence of tendinopathy and intratendinous changes in ATs and PTs of adolescent athletes. A total of 760 adolescent athletes (13.0 ± 1.9 years; 160 ± 13 cm; 50 ± 14 kg) were examined. History, local clinical examination, and longitudinal Doppler ultrasound analysis for both ATs and PTs were performed including identification of intratendinous echoic changes and vascularization. Diagnosis of tendinopathy was complied clinically in case of positive history of tendon pain and tendon pain on palpation. Achilles tendinopathy was diagnosed in 1.8% and patellar tendinopathy in 5.8%. Vascularizations were visible in 3.0% of ATs and 11.4% of PTs, hypoechogenicities in 0.7% and 3.2% as well as hyperechogenicities in 0% and 0.3%, respectively. Vascularizations and hypoechogenicities were statistically significantly more often in males than in females (P ≤ 0.02). Subjects with patellar tendinopathy had higher prevalence of structural intratendinous changes than those without PT symptoms (P ≤ 0.001). In adolescent athletes, patellar tendinopathy is three times more frequent compared with Achilles tendinopathy. Longitudinal studies are necessary to investigate physiological or pathological origin of vascularizations and its predictive value in development of tendinopathy. PMID:25212527

  9. [Tendinopathy of the patellar ligament secondary to transtendineal arthroscopy of the knee. Ultrasonographic evaluation].

    PubMed

    Martino, F; Ettorre, G C; Macarini, L; Tritto, D; Patella, V; Fracchiolla, M; Moretti, B; Cafaro, F

    1993-11-01

    During knee arthroscopy, the transtendinous approach best visualizes articular structures, even though it may cause patellar tendinitis, following the surgical procedures. Thirty patients (22 men and 8 women) who had undergone transtendinous arthroscopy of the knee were submitted to clinical and US follow-up at 3, 6, 12 months. This monitoring was aimed at correlating clinical and instrumental findings of the above iatrogenic condition. Painful symptoms were present in 30% of the cases in group I, in 10% of group II and in no patient in group III. US demonstrated thickening of the patellar tendon in all the three groups of patients, with reduced echogenicity and blurred margins at the arthroscopic portal, plus decreasing gravity over time. The US pattern of arthroscopic surgical gap was observed in all patients in group I, in 10% of patients in group II and in none of the patients in group III. In conclusion because of its clinical course and of its US findings, in our experience patellar tendinopathy following transtendinous arthroscopy of the knee is not to be considered as a iatrogenic inflammatory or degenerative sequela, but as a physiological cicatricial evolution of the surgical transtendinous breach. The US follow-up of the latter allows the correct assessment of the recovering process. PMID:8272543

  10. Platelet-rich plasma: evidence for the treatment of patellar and Achilles tendinopathy--a systematic review.

    PubMed

    Di Matteo, B; Filardo, G; Kon, E; Marcacci, M

    2015-04-01

    Platelet-rich plasma (PRP) has been introduced in the clinical practice to treat a growing number of different musculoskeletal pathologies. It is currently applied in the treatment of Achilles and patellar tendinopathies, which are common sport-related injuries very challenging to manage. Aim of the present paper was to review systematically the available clinical evidence concerning the application of PRP in the treatment of patellar and Achilles tendinopathy. A systematic review of the literature was performed according to the following inclusion criteria for relevant articles: (1) clinical reports of any level of evidence, (2) written in the English language, (3) with no time limitation and (4) on the use of PRP to treat conservatively Achilles and patellar tendinopathy. Twenty-two studies were included and analyzed. Two studies on patellar tendinopathy were randomized controlled trials (RCTs), whereas just one RCT was published on Achilles tendon. All the papers concerning patellar tendon reported positive outcome for PRP, which proved to be superior to other traditional approaches such as shock-wave therapy and dry needling. In the case of Achilles tendon, despite the encouraging findings reported by case series, the only RCT available showed no significant clinical difference between PRP and saline solution. The main finding of this study was the paucity of high-level literature regarding the application of PRP in the management of patellar and Achilles tendinopathy. However, the clinical data currently available, although not univocal, suggest considering PRP as a therapeutic option for recalcitrant patellar and Achilles tendinopathies. PMID:25323041

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

    PubMed

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

    2011-01-01

    Patellar tendinopathy is a common injury in jumping athletes. Little is known about work-related etiological factors for patellar tendinopathy and related work limitations. The aim of this study was to identify work-related etiological factors for patellar tendinopathy and to determine the relation between patellar tendinopathy and work limitations. Basketball and volleyball players between 18 and 35 years were invited to complete an online-questionnaire concerning knee complaints, etiological risk factors for patellar tendinopathy and related work limitations. A total of 1505 subjects were included in the analysis. Risk factors for patellar tendinopathy were gender and heavy physically demanding work. The odds for having patellar tendinopathy were significantly higher for heavy physically demanding occupations compared to mentally demanding occupations. 30% of subjects with patellar tendinopathy with a physically demanding job reported to be impaired in their work and 17% reported to be less productive. Basketball and volleyball players with heavy physically demanding work seem to have an increased risk for developing patellar tendinopathy. This finding has important clinical relevance in the treatment of this injury. Working activities should be adjusted in order to reduce the total load on the patellar tendon and help prevention and recovery. PMID:21248400

  12. Rehabilitation protocol for patellar tendinopathy applied among 16- to 19-year old volleyball players.

    PubMed

    Biernat, Ryszard; Trzaskoma, Zbigniew; Trzaskoma, Lukasz; Czaprowski, Dariusz

    2014-01-01

    The aim of the study was to investigate the efficacy of rehabilitation protocol applied during competitive period for the treatment of patellar tendinopathy. A total of 28 male volleyball players were divided into two groups. Fifteen from experimental group (E) and 13 from control group (C) fulfilled the same tests 3 times: before the training program started (first measurement), after 12 weeks (second measurement) and after 24 weeks (third measurement). The above-mentioned protocol included the following: USG imagining with color Doppler function, clinical testing, pain intensity evaluation with VISA-P questionnaire, leg muscle strength and power and jumping ability measurements. The key element of the rehabilitation program was eccentric squat on decline board with additional unstable surface. The essential factor of the protocol was a set of preventive functional exercises, with focus on eccentric exercises of hamstrings. Patellar tendinopathy was observed in 18% of the tested young volleyball players. Implementation of the presented rehabilitation protocol with eccentric squat on decline board applied during sports season lowered the pain level of the young volleyball players. Presented rehabilitation protocol applied without interrupting the competitive period among young volleyball players together with functional exercises could be an effective method for the treatment of patellar tendinopathy. PMID:23669814

  13. Physical therapists' role in prevention and management of patellar tendinopathy injuries in youth, collegiate, and middle-aged indoor volleyball athletes

    PubMed Central

    Kulig, Kornelia; Noceti-DeWit, Lisa M.; Reischl, Stephen F.; Landel, Rob F.

    2015-01-01

    Patellar tendinopathy is highly prevalent in all ages and skill levels of volleyball athletes. To illustrate this, we discuss the clinical, biomechanical, and ultrasound imaging presentation and the intervention strategies of three volleyball athletes at different stages of their athletic career: youth, middle-aged, and collegiate. We present our examination strategies and interpret the data collected, including visual movement analysis and dynamics, relating these findings to the probable causes of their pain and dysfunction. Using the framework of the EdUReP concept, incorporating Education, Unloading, Reloading, and Prevention, we propose intervention strategies that target each athlete's specific issues in terms of education, rehabilitation, training, and return to sport. This framework can be generalized to manage patellar tendinopathy in other sports requiring jumping, from youth to middle age, and from recreational to elite competitive levels. PMID:26537811

  14. Physical therapists' role in prevention and management of patellar tendinopathy injuries in youth, collegiate, and middle-aged indoor volleyball athletes.

    PubMed

    Kulig, Kornelia; Noceti-DeWit, Lisa M; Reischl, Stephen F; Landel, Rob F

    2015-01-01

    Patellar tendinopathy is highly prevalent in all ages and skill levels of volleyball athletes. To illustrate this, we discuss the clinical, biomechanical, and ultrasound imaging presentation and the intervention strategies of three volleyball athletes at different stages of their athletic career: youth, middle-aged, and collegiate. We present our examination strategies and interpret the data collected, including visual movement analysis and dynamics, relating these findings to the probable causes of their pain and dysfunction. Using the framework of the EdUReP concept, incorporating Education, Unloading, Reloading, and Prevention, we propose intervention strategies that target each athlete's specific issues in terms of education, rehabilitation, training, and return to sport. This framework can be generalized to manage patellar tendinopathy in other sports requiring jumping, from youth to middle age, and from recreational to elite competitive levels. PMID:26537811

  15. 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

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

    PubMed

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

    2016-07-01

    Gual, G, Fort-Vanmeerhaeghe, A, Romero-Rodríguez, D, and Tesch, PA. Effects of in-season inertial resistance training with eccentric overload in a sports population at risk for patellar tendinopathy. J Strength Cond Res 30(7): 1834-1842, 2016-Volleyball and basketball players can be considered as a population at risk for patellar tendinopathy. Given the paradox that eccentric training elicits therapeutic benefits yet might provoke such injury, we investigated the influence of a weekly bout of inertial squat resistance exercise offering eccentric overload on lower limb muscle power and patellar tendon complaints. Players of 8 (4 basketball and 4 volleyball) teams (38 women and 43 men) were randomly assigned to either the intervention (IG) or control (CG) group. Although IG and CG maintained scheduled in-season training routines over 24 weeks, IG, in addition, performed 1 weekly session of eccentric overload by 4 sets of 8 repetitions of the squat using flywheel inertial resistance. Victorian Institute of Sports Assessment patellar tendinopathy questionnaire (VISA-p), vertical countermovement jump, and squat power, both concentric (Squat-Con) and eccentric (Squat-Ecc), tests were performed before (T1), during (T2), and after (T3) the 24 weeks of intervention. Neither group suffered from patellar tendinopathy during the study period. VISA-p displayed no differences across groups at any measurement period. Countermovement jump scores significantly (p ≤ 0.05) differed between groups in favor of the IG. Both Squat-Con and Squat-Ecc mean scores from the IG were significantly (p < 0.01) higher than the CG. Adding a weekly eccentric overload squat training bout to a regular basketball and volleyball exercise routine enhances lower limb muscle power without triggering patellar tendon complaints. Future studies, using the current exercise paradigm, aim to explore its efficacy to prevent or combat patellar tendinopathy in sports calling for frequent explosive jumps. PMID

  17. Elevated corticospinal excitability in patellar tendinopathy compared with other anterior knee pain or no pain.

    PubMed

    Rio, E; Kidgell, D; Moseley, G L; Cook, J

    2016-09-01

    Anterior knee pain (AKP) is a frequent clinical presentation in jumping athletes and may be aggravated by sustained sitting, stair use, and loading of the quadriceps. Corticospinal activation of the quadriceps in athletes with AKP has not yet been investigated, but is important in guiding efficacious treatment. This cross-sectional study assessed corticospinal excitability (CSE) of the quadriceps in jumping athletes using transcranial magnetic stimulation (TMS). Groups consisted of Control (no knee pain); patellar tendinopathy (PT) [localized inferior pole pain on single-leg decline squat (SLDS)]; and other AKP (nonlocalized pain around the patella). SLDS (numerical score of pain 0-10), Victorian Institute of Sport Assessment Patellar tendon (VISA-P), maximal voluntary isometric contraction (MVIC), active motor threshold (AMT), CSE, and Mmax were tested. Twenty nine athletes participated; control n = 8, PT n = 11, AKP n = 10. There were no group differences in age (P = 0.23), body mass index (P = 0.16), MVIC (P = 0.38) or weekly activity (P = 0.22). PT had elevated CSE compared with controls and other AKP (P < 0.001), but no differences were detected between AKP and controls (P = 0.47). CSE appears to be greater in PT than controls and other AKP. An improved understanding of the corticospinal responses in different sources of knee pain may direct better treatment approaches. PMID:26369282

  18. Arthroscopic excision of giant cell tumor of the tendon sheath in the knee mimicking patellar tendinopathy: A case report

    PubMed Central

    GAO, KAI; CHEN, JIWU; CHEN, SHIYI; LI, YUNXIA

    2016-01-01

    Giant cell tumor of the tendon sheath (GCTTS) predominantly occurs in the tendon sheaths of the hand, but rarely in those of the knee. The current study reports the case of a 36-year-old male patient presenting with anterior knee pain. The patient was ultimately diagnosed with GCTTS in the knee mimicking patellar tendinopathy. To the best of our knowledge, this is the first case of its kind. Magnetic resonance imaging revealed a well-defined oval intra-articular lesion located at the proximal segment of the infrapatellar fat pad. The lesion was completely excised under arthroscopy and pathological examination confirmed the diagnosis of GCTTS. There was no evidence of recurrence at the 2-year follow-up examination. The findings of the present study suggest that, despite its rarity, GCTTS should be considered in the differential diagnosis of patellar tendinopathy. PMID:27123148

  19. One-year follow-up of platelet-rich plasma infiltration to treat chronic proximal patellar tendinopathies.

    PubMed

    Kaux, Jean-François; Bruyere, Olivier; Croisier, Jean-Louis; Forthomme, Bénédicte; Le Goff, Caroline; Crielaard, Jean-Michel

    2015-06-01

    Infiltration of Platelet-Rich Plasma (PRP) may be considered as a recent therapeutic option for chronic tendinopathies. The aim of this study is to evaluate the clinical status and the return to sports activities in patients with chronic proximal patellar tendinopathies. Twenty subjects with chronic proximal patellar tendinopathy benefited from 1 infiltration of PRP coupled with a standardized eccentric rehabilitation. The follow-up (up to 1 year) was assessed by means of a Visual Anologue Scale (VAS), the International Knee Documentation Committee (IKDC) form and the Victorian Institute of Sport Assessment (VISA-P) score. Moreover, subjects had to answer an information questionnaire concerning their life and sports activities. Seventy percents of the patients reported a favourable evolution with decrease of pain, and returned to sports activities. With time, VAS dropped significantly and both IKDC and VISA-P scores improved also significantly. This study confirms that a local injection of PRP coupled with a program of eccentric rehabilitation for treating a chronic jumper's knee, improves pain symptoms and the functionalities of the subjects' knee up to 1 year after injection. PMID:26280964

  20. Risk factors for patellar tendinopathy in basketball and volleyball players: a cross-sectional study.

    PubMed

    van der Worp, H; van Ark, M; Zwerver, J; van den Akker-Scheek, I

    2012-12-01

    Patellar tendinopathy (PT) has a multifactorial etiology, and many possible risk factors have been described in the literature. The findings are conflicting, though, and most research has been conducted on elite athletes. The aim of the current study is to determine the risk factors for PT in a large representative sample of basketball and volleyball players. Separate risk factors for men and women, basketball and volleyball players, and athletes with unilateral and bilateral PT were identified. All basketball and volleyball players between ages 18 and 35 from the Dutch Basketball Association and the Dutch Volleyball Association were invited to complete an online questionnaire on knee complaints and risk factors for PT. The logistic regression analyses included 2224 subjects. The risk factors for PT were age, playing at the national level, being male and playing volleyball (compared with playing basketball). The risk factors for men and women were comparable. Among volleyball players, outside hitters and middle blockers/hitters had an increased risk compared with setters. For basketball players, no risk factors could be identified. No differences in the risk factors were found between athletes with unilateral and bilateral PT. These findings should be taken into account for prevention and rehabilitation purposes. PMID:21496108

  1. Platelet-rich plasma as a treatment for chronic patellar tendinopathy: comparison of a single versus two consecutive injections

    PubMed Central

    Zayni, Rachad; Thaunat, Mathieu; Fayard, Jean-Marie; Hager, Jean-Philippe; Carrillon, Yannick; Clechet, Julien; Gadea, François; Archbold, Pooler; Sonnery Cottet, Bertrand

    2015-01-01

    Summary Background platelet-rich-plasma is increasingly used in chronic patellar tendinopathy. Ideal number of PRP injections needed is not yet established. This study compares the clinical outcomes of a single versus two consecutive PRP injections. Method between December 2009 and January 2012, 40 athletes with proximal patellar tendinopathy were treated by PRP injection. Patients received single (20 patients) or two PRP injections 2 weeks apart (20 patients). All patients underwent prospective clinical evaluation, including Victorian Institute of Sport Assessment-Patella (VISA-P) score, visual analog scale (VAS) for pain, and Tegner scale before PRP and after a minimum of 2 year follow-up. Results 9 patients failed PRP treatment and needed surgery. 1 patient was lost to follow-up. For the remaining patients, the VISA-P, VAS, and Tegner scores all significantly improved from 35.2 to 78.5 (p = 0.0001), 6.6 to 2.4 (p = 0.0001), and 4.8 to 6.9 (p = 0.0003). Patients who received two injections had better scores than those who received single injection with VAS of 1.07 versus 3.7 (p = 0.0005), Tegner score of 8.1 versus 5.9 (p = 0.0003) and VISA-P of 93.2 versus 65.7 (p = 0.0001). Conclusions two consecutive PRP injections in chronic patellar tendinopathy showed better improvement in outcomes when compared to single injection. Level of evidence randomized prospective consecutive series, Level 2. PMID:26261787

  2. Changes in Morphological and Elastic Properties of Patellar Tendon in Athletes with Unilateral Patellar Tendinopathy and Their Relationships with Pain and Functional Disability

    PubMed Central

    Zhang, Zhi Jie; Ng, Gabriel Yin-fat; Lee, Wai Chun; Fu, Siu Ngor

    2014-01-01

    Background Patellar tendinopathy (PT) is one of the most common knee disorders among athletes. Changes in morphology and elasticity of the painful tendon and how these relate to the self-perceived pain and dysfunction remain unclear. Objectives To compare the morphology and elastic properties of patellar tendons between athlete with and without unilateral PT and to examine its association with self-perceived pain and dysfunction. Methods In this cross-sectional study, 33 male athletes (20 healthy and 13 with unilateral PT) were enrolled. The morphology and elastic properties of the patellar tendon were assessed by the grey and elastography mode of supersonic shear imaging (SSI) technique while the intensity of pressure pain, self-perceived pain and dysfunction were quantified with a 10-lb force to the most painful site and the Victorian Institute of Sport Assessment-patella (VISA-P) questionnaire, respectively. Results In athletes with unilateral PT, the painful tendons had higher shear elastic modulus (SEM) and larger tendon than the non-painful side (p<0.05) or the dominant side of the healthy athletes (p<0.05). Significant correlations were found between tendon SEM ratio (SEM of painful over non-painful tendon) and the intensity of pressure pain (rho  = 0.62; p = 0.024), VISA-P scores (rho  = −0.61; p = 0.026), and the sub-scores of the VISA-P scores on going down stairs, lunge, single leg hopping and squatting (rho ranged from −0.63 to −0.67; p<0.05). Conclusions Athletes with unilateral PT had stiffer and larger tendon on the painful side than the non-painful side and the dominant side of healthy athletes. No significant differences on the patellar tendon morphology and elastic properties were detected between the dominant and non-dominant knees of the healthy control. The ratio of the SEM of painful to non-painful sides was associated with pain and dysfunction among athletes with unilateral PT. PMID:25303466

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

    PubMed

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

    2015-10-01

    Patellar tendinopathy (PT) is a common overuse injury of the patellar tendon in jumping athletes. In a recent large cross-sectional study from 2008 several factors were identified that may be associated with the etiology of PT. However, because of the study design no conclusions could be drawn about causal relations. The primary aim of the current study is to investigate whether the factors identified in the previous 2008 study can also be prospectively recognized as predictors of symptomatic PT in 2011. Nine hundred twenty-six Dutch elite and non-elite basketball and volleyball players from the previous study were invited again to complete an online survey about knee complaints and risk factors for PT in 2011. The logistic regression included 385 athletes of which 51 (13%) developed PT since 2008. Male gender [odds ratio (OR) 2.0, 95% confidence interval (CI) 1.1-3.5] was found to be a risk factor for developing PT. No sports-related variables could be identified to increase the risk of developing PT, but some evidence was found for performing heavy physically demanding work, like being a nurse or a physical education teacher (OR 2.3, 95% CI 0.9-6.3). These findings indicate that, when considering preventive measures, it is important to take into account the total tendon load. PMID:25091500

  4. Rehabilitation of Patellar Tendinopathy Using Hip Extensor Strengthening and Landing-Strategy Modification: Case Report With 6-Month Follow-up.

    PubMed

    Scattone Silva, Rodrigo; Ferreira, Ana Luisa G; Nakagawa, Theresa H; Santos, José E M; Serrão, Fábio V

    2015-11-01

    Study Design Case report. Background Although eccentric exercises have been a cornerstone of the rehabilitation of athletes with patellar tendinopathy, the effectiveness of this intervention is sometimes less than ideal. Athletes with patellar tendinopathy have been shown to have different jump-landing patterns and lower hip extensor strength compared to asymptomatic athletes. To our knowledge, the effectiveness of an intervention addressing these impairments has not yet been investigated. Case Description The patient was a 21-year-old male volleyball athlete with a 9-month history of patellar tendon pain. Pain was measured with a visual analog scale. Disability was measured with the Victorian Institute of Sport Assessment-patella questionnaire. These assessments were conducted before and after an 8-week intervention, as well as at 6 months after the intervention. Hip and knee kinematics and kinetics during drop vertical jump and isometric strength were also measured before and after the 8-week intervention. The intervention consisted of hip extensor muscle strengthening and jump landing strategy modification training. The patient did not interrupt volleyball practice/competition during rehabilitation. Outcomes After the 8-week intervention and at 6 months postintervention, the athlete was completely asymptomatic during sports participation. This favorable clinical outcome was accompanied by a 50% increase in hip extensor moment, a 21% decrease in knee extensor moment, and a 26% decrease in patellar tendon force during jump landing measured at 8 weeks. Discussion This case report provides an example of how an 8-week intervention of hip muscle strengthening and jump-landing modification decreased pain and disability and improved jump-landing biomechanics in an athlete with patellar tendinopathy. Level of Evidence Therapy, level 4. J Orthop Sports Phys Ther 2015;45(11):899-909. Epub 21 Sep 2015. doi:10.2519/jospt.2015.6242. PMID:26390271

  5. Spontaneous bilateral patellar tendon rupture: case report and review of fluoroquinolone-induced tendinopathy.

    PubMed

    Rosa, Bárbara; Campos, Pedro; Barros, André; Karmali, Samir; Gonçalves, Ricardo

    2016-07-01

    The present case emphasizes the importance of adhering to strict indications when prescribing fluoroquinolones. Although rare, drug-induced tendinopathy is not confined to fluoroquinolones. The patient's and physician's awareness should be increased to reduce fluoroquinolones-associated morbidity, particularly in patients with previously described risk factors. PMID:27386128

  6. 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

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

    PubMed Central

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

    2014-01-01

    Summary Aim: to show the effect of Intratissue Percutaneous Electrolysis (EPI®) combined with eccentric programme in the treatment of patellar tendinopathy. Methods: prospective study of 33 athlete-patients consecutively treated for insertional tendinopathy with Intratissue Percutaneous Electrolysis (EPI®) and followed for 2 years. Functional assessment was performed at the first visit, at three months and two years with the Tegner scale and VISA-P. Results: an average improvement in the VISA-P of 35 points was obtained. The mean duration of treatment was 4.5 weeks. Some 78.8% of the patients returned to the same level of physical activity as before the injury by the end of treatment, reaching 100% at two years. Conclusions: intratissue percutaneous electrolysis (EPI®) combined with an eccentric-based rehab program offers excellent results in terms of the clinical and functional improvement of the patellar tendon with low morbidity in a short-term period. Level of Evidence: Therapy, level 4. PMID:25332934

  8. Cross-cultural Adaptation and Validation of the Victorian Institute of Sport Assessment-Patella Questionnaire for French-Speaking Patients With Patellar Tendinopathy.

    PubMed

    Kaux, Jean-François; Delvaux, François; Oppong-Kyei, Julian; Beaudart, Charlotte; Buckinx, Fanny; Croisier, Jean-Louis; Forthomme, Bénédicte; Crielaard, Jean-Michel; Bruyère, Olivier

    2016-05-01

    Study Design Clinical measurement study. Background The Victorian Institute of Sport Assessment-Patella (VISA-P), originally developed in English, assesses the severity of patellar tendinopathy symptoms. To date, no French version of the questionnaire exists. Objectives The aim of our study was to translate the VISA-P into French and verify its psychometric properties. Methods The translation and cultural adaptation were performed according to international recommendations in 6 steps: initial translation, translation merging, back translation to the original language, use of an expert committee to reach a prefinal version, test of the prefinal version, and expert committee appraisal of a final version. Afterward, the psychometric properties of the final French version (VISA-PF) were assessed in 92 subjects, divided into 3 groups: pathological subjects (n = 28), asymptomatic subjects (n = 22), and sports-risk subjects (n = 42). Results All members of the expert committee agreed with the final version. On a scale ranging from 0 to 100, with 100 representing an asymptomatic subject, the average ± SD scores on the VISA-PF were 53 ± 17 for the pathological group, 99 ± 2 for the healthy group, and 86 ± 14 for the sports-risk group. The test-retest reliability of the VISA-PF was excellent, with good internal consistency. Correlations between the VISA-PF and divergent validity of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) were low, and the correlation coefficient values measured between the VISA-PF scores and converged items of the SF-36 were higher. Conclusion The VISA-PF is understandable, valid, and suitable for French-speaking patients with patellar tendinopathy. J Orthop Sports Phys Ther 2016;46(5):384-390. Epub 21 Mar 2016. doi:10.2519/jospt.2016.5937. PMID:26999409

  9. Eccentric training as a new approach for rotator cuff tendinopathy: Review and perspectives

    PubMed Central

    Camargo, Paula R; Alburquerque-Sendín, Francisco; Salvini, Tania F

    2014-01-01

    Excessive mechanical loading is considered the major cause of rotator cuff tendinopathy. Although tendon problems are very common, they are not always easy to treat. Eccentric training has been proposed as an effective conservative treatment for the Achilles and patellar tendinopathies, but less evidence exists about its effectiveness for the rotator cuff tendinopathy. The mechanotransduction process associated with an adequate dose of mechanical load might explain the beneficial results of applying the eccentric training to the tendons. An adequate load increases healing and an inadequate (over or underuse) load can deteriorate the tendon structure. Different eccentric training protocols have been used in the few studies conducted for people with rotator cuff tendinopathy. Further, the effects of the eccentric training for rotator cuff tendinopathy were only evaluated on pain, function and strength. Future studies should assess the effects of the eccentric training also on shoulder kinematics and muscle activity. Individualization of the exercise prescription, comprehension and motivation of the patients, and the establishment of specific goals, practice and efforts should all be considered when prescribing the eccentric training. In conclusion, eccentric training should be used aiming improvement of the tendon degeneration, but more evidence is necessary to establish the adequate dose-response and to determine long-term follow-up effects. PMID:25405092

  10. 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

  11. [Patellar osteochondral injury as onset of patellar instability].

    PubMed

    Cepero-Campà, S; Ullot-Font, R; Pérez-López, L M

    2012-01-01

    Patellar osteochondral fractures with no dislocation are uncommon and usually affect the centromedial facet of the patella. We present the case of a 10 year-old, overweight, female patient. She was seen in the emergency room after suffering an accidental fall, assessed as an osteochondral fracture-dislocation of the right patella with upper-outer displaced free fragments. By patient interview, she referred to no previous episodes of patellar dislocation. To complete the study, we performed an MRI which showed a medial facet patellar fracture, with two osteochondral fragments located in the sub-quadricipital recess, associated with other lesions suggesting patellar subluxation. We considered that the best treatment was surgery, so the following was performed: an open reduction and internal fixation with absorbable bars, lateral patellar release (Ficat technique), patellar coverage by medial portion of quadriceps (Insall technique) and internal moving of the lateral half of the patellar tendon (Goldwaith technique). The injury was checked one year later using arthroscopy. It confirmed a good reconstruction of the articular surface, and right patellar centering. At follow-up, during the physiotherapy period, the patient began to have repeated episodes of instability in the contralateral patella. The CT scan confirmed the patellar lateralisation (TAGT 17). Centering surgery was indicated due to the occurrence of multiple dislocation episodes. The patient currently carries out normal physical activity and she has a complete range of movement. Patellar osteochondral fracture is an injury frequently associated with patellar instability, which may onset in the first episode. The medial location of the lesions and the involvement of the system of medial knee stability is a fundamental finding. This fact reinforces the diagnosis of pre-fracture patellar dislocation. This is not a fracture-dislocation, but a dislocation-fracture. We may, therefore, treat the injury and its

  12. Advanced Ultrasound-Guided Interventions for Tendinopathy.

    PubMed

    Peck, Evan; Jelsing, Elena; Onishi, Kentaro

    2016-08-01

    Tendinopathy is increasingly recognized as an important cause of musculoskeletal pain and disability. Tendinopathy is thought to be principally a degenerative process, rather than inflammatory as was traditionally believed. Consequently, traditional tendinopathy treatments focused solely on decreasing inflammation have often been ineffective or even harmful. The advancement of ultrasonography as for guidance of outpatient musculoskeletal procedures has facilitated the development of novel percutaneous procedures for the treatment of tendinopathy, mostly by using mechanical intervention to stimulate regeneration. Several of these techniques, including percutaneous needle tenotomy, percutaneous ultrasonic tenotomy, high-volume injection, and percutaneous needle scraping, are reviewed in this article. PMID:27468675

  13. The effect of patellar button placement and femoral component design on patellar tracking in total knee arthroplasty.

    PubMed

    Yoshii, I; Whiteside, L A; Anouchi, Y S

    1992-02-01

    The effects of patellar button position and femoral component design on patellar tracking were investigated roentgenographically and arthroscopically using fresh-frozen adult anatomic specimen knees. Patellar tracking was evaluated for medial/lateral position and tilting angle deviation by comparing preoperative normal values to total knee replacement performance with the following variables: (1) femoral component design; symmetrical total condylar type with a 3-mm central patellar groove and a component with a 3-mm raised lateral patellar flange and 1-mm deepened patellar groove; and (2) patellar button placement; central insertion; and 10-mm medialized insertion. In the roentgenographic study, medialized position of the patellar button allowed the bony portion of the patella to assume its normal lateral position and tilt throughout the knee range of motion. A combination of medialized position of the patellar button and deepening of the patellar groove provided the most anatomically correct position and the most normal tilting of the bony structure of the patella. In the arthroscopic study, the centralized patellar position caused significant lateral tracking and subluxation relative to the femoral component, whereas the medialized position eliminated this tracking disorder. Deepening the patellar groove minimized the intraarticular tracking abnormality and constrained the patellar button in the patellar groove. These results show that the position of the patellar button and femoral component design exert a major influence on patellar tracking. PMID:1735216

  14. Proximal Hamstring Tendinopathy: Clinical Aspects of Assessment and Management.

    PubMed

    Goom, Thomas S H; Malliaras, Peter; Reiman, Michael P; Purdam, Craig R

    2016-06-01

    Synopsis Proximal hamstring tendinopathy (PHT) typically manifests as deep buttock pain at the hamstring common origin. Both athletic and nonathletic populations are affected by PHT. Pain and dysfunction are often long-standing and limit sporting and daily functions. There is limited evidence regarding diagnosis, assessment, and management; for example, there are no randomized controlled trials investigating rehabilitation of PHT. Some of the principles of management established in, for example, Achilles and patellar tendinopathy would appear to apply to PHT but are not as well documented. This narrative review and commentary will highlight clinical aspects of assessment and management of PHT, drawing on the available evidence and current principles of managing painful tendinopathy. The management outline presented aims to guide clinicians as well as future research. J Orthop Sports Phys Ther 2016;46(6):483-493. Epub 15 Apr 2016. doi:10.2519/jospt.2016.5986. PMID:27084841

  15. Exercise for tendinopathy

    PubMed Central

    Dimitrios, Stasinopoulos

    2015-01-01

    Tendinopathies are one of the most common sports/musculoskeletal injury in modern western societies. Many physiotherapy approaches have been recommended in the literature for the management of tendinopathy. The most effective treatment in the management of tendinopathy is the eccentric training. Load, speed and frequency of contractions are the three principles of eccentric exercises, discussed in this report. However, eccentric training is not effective for all patients with tendinopathy and the effectiveness of this approach when applied as monotherapy is lower than it is applied as part of the rehabilitation process. For this reason, clinicians combine eccentric training with other physiotherapy techniques such as stretching, isometric and lumbar stability exercises, electrotherapy, manual therapy, soft tissue manipulation techniques, taping and acupuncture in the management of tendinopathies. Further research is needed to find out which treatment strategy combined with eccentric training will provide the best results in the rehabilitation of tendinopathy. PMID:26140271

  16. Regional variations in human patellar trabecular architecture and the structure of the proximal patellar tendon enthesis

    PubMed Central

    Toumi, H; Higashiyama, I; Suzuki, D; Kumai, T; Bydder, G; McGonagle, D; Emery, P; Fairclough, J; Benjamin, M

    2006-01-01

    Proximal patellar tendinopathy occurs as an overuse injury in sport and is also characteristic of ankylosing spondylitis patients. It particularly affects the posteromedial part of the patellar tendon enthesis, although the reason for this is unclear. We investigated whether there are regional differences in the trabecular architecture of the patella or in the histology of the patellar tendon enthesis that could suggest unequal force transmission from bone to tendon. Trabecular architecture was analysed from X-rays taken with a Faxitron radiography system of the patellae of dissecting room cadavers and in magnetic resonance images of the knees of living volunteers. Structural and fractal analyses were performed on the Faxitron digital images using MatLab software. Regional differences at the enthesis in the thickness of the uncalcified fibrocartilage and the subchondral plate were evaluated histologically in cadaveric material. The radiological studies showed that the quantity of bone and the apparent trabecular thickness in the patella were greatest medially, and that in the lateral part of the patella there were fewer trabeculae which were orientated either antero-posteriorly or superiorly inferiorly. The histological study showed that the uncalcified fibrocartilage was most prominent medially and that the subchondral plate was thinner laterally. Overall, the results indicate that mechanical stress at the proximal patellar tendon enthesis is asymmetrically distributed and greater on the medial than on the lateral side. Thus, we suggest that the functional anatomy of the knee is closely related to regional variations in force transmission, which in turn relates to the posteromedial site of pathology in proximal patellar tendinopathy. PMID:16420378

  17. Current Opinions on Tendinopathy

    PubMed Central

    Kaux, Jean-François; Forthomme, Bénédicte; Goff, Caroline Le; Crielaard, Jean-Michel; Croisier, Jean-Louis

    2011-01-01

    Tendinopathy is characterized by pain in the tendon and impaired performance sometimes associated with swelling of the tendon. Its diagnosis is usually clinical but ultrasonography and magnetic resonance imaging can refine the diagnosis. Tendinopathy is highly prevalent and is one of the most frequently self reported musculoskeletal diseases in physical workers and sports people. Nevertheless, it is very difficult to carry out general epidemiologic studies on tendinopathy because of the varying sports cultures and sports habits in different countries. The aetiology of tendinopathy seems to be multi-factorial, involving intrinsic and extrinsic factors. The role of inflammation is still debated but the absence of inflammatory cells does not mean that inflammatory mediators are not implicated. Different theories have been advanced to explain pain and chronicity mechanisms, but these mechanisms remain largely unknown. “Conventional ”treatments are generally employed empirically to fight pain and inflammation but they do not modify the histological structure of the tendon. However, these treatments are not completely satisfactory and the recurrence of symptoms is common. Currently, eccentric training remains the treatment of choice for tendinopathy, even though some studies are contradictory. Moreover, many interesting new treatments are now being developed to treat tendinopathy, but there is little evidence to support their use in clinical practice. Key points The word “tendinopathy ”is the correct term for the clinical diagnosis of pain accompanied by impaired performance, and sometimes swelling in the tendon. The aetiology of tendinopathy seems to be a multi-factorial process, involving promoting factors that are intrinsic or extrinsic, working either alone or in combination. US (with color Doppler) and MRI are usually prescribed when tendinopathy is unresponsive to treatment and entails lingering symptoms. Eccentric training is currently considered to be the

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

    PubMed

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

    2016-02-01

    Patellar tendinopathy (jumper's knee) has a high prevalence in jumping athletes. Excessive load on the patellar tendon through high volumes of training and competition is an important risk factor. Structural changes in the tendon are related to a higher risk of developing patellar tendinopathy. The critical tendon load that affects tendon structure is unknown. The aim of this study was to investigate patellar tendon structure on each day of a 5-day volleyball tournament in an adolescent population (16-18 years). The right patellar tendon of 41 players in the Australian Volleyball Schools Cup was scanned with ultrasound tissue characterization (UTC) on every day of the tournament (Monday to Friday). UTC can quantify structure of a tendon into four echo types based on the stability of the echo pattern. Generalized estimating equations (GEE) were used to test for change of echo type I and II over the tournament days. Participants played between eight and nine matches during the tournament. GEE analysis showed no significant change of echo type percentages of echo type I (Wald chi-square = 4.603, d.f. = 4, P = 0.331) and echo type II (Wald chi-square = 6.070, d.f. = 4, P = 0.194) over time. This study shows that patellar tendon structure of 16-18-year-old volleyball players is not affected during 5 days of cumulative loading during a volleyball tournament. PMID:25694241

  19. Evidence of Nervous System Sensitization in Commonly Presenting and Persistent Painful Tendinopathies: A Systematic Review.

    PubMed

    Plinsinga, Melanie L; Brink, Michel S; Vicenzino, Bill; van Wilgen, C Paul

    2015-11-01

    Study Design Systematic review. Objectives To elucidate if there is sensitization of the nervous system in those with persistent rotator cuff (shoulder), lateral elbow, patellar, and Achilles tendinopathies. Background Tendinopathy can be difficult to treat, and persistent intractable pain and dysfunction are frequent. It is hypothesized that induction or maintenance of persistent pain in tendinopathy may be, at least in part, based on changes in the nervous system. Methods The PRISMA guidelines were followed. Relevant articles were identified through a computerized search in Embase, PubMed, and Web of Science, followed by a manual search of reference lists of retained articles. To be eligible, studies had to include quantitative sensory testing and evaluate individuals diagnosed with a persistent tendinopathy of the rotator cuff (shoulder), lateral elbow, patella, or Achilles tendon. Methodological quality assessment was evaluated with the Newcastle-Ottawa Scale. Results In total, 16 full-text articles met the criteria for inclusion, of which the majority were case-control studies with heterogeneous methodological quality. No studies on Achilles tendinopathy were found. Mechanical algometry was the predominant quantitative sensory testing used. Lowered pressure pain threshold was observed across different tendinopathies at the site of tendinopathy, as well as at other sites, the latter being suggestive of central sensitization. Conclusion Although more research on sensory abnormalities is warranted, it appears likely that there is an association between persistent tendon pain and sensitization of the nervous system. This evidence is primarily from studies of upper-limb tendinopathy, and caution should be exercised with inference to lower-limb tendinopathy. J Orthop Sports Phys Ther 2015;45(11):864-875. Epub 21 Sep 2015. doi:10.2519/jospt.2015.5895. PMID:26390275

  20. Tendinopathies and platelet-rich plasma (PRP): from pre-clinical experiments to therapeutic use

    PubMed Central

    Kaux, Jean-François; Drion, Pierre; Croisier, Jean-Louis; Crielaard, Jean-Michel

    2015-01-01

    Objectives: The restorative properties of platelets, through the local release of growth factors, are used in various medical areas. This article reviews fundamental and clinical research relating to platelet-rich plasma applied to tendinous lesions. Materials and method: Articles in French and English, published between 1 January 2012 and 31 December 2014. dealing with PRP and tendons were searched for using the Medline and Scopus data bases. Results: Forty-seven articles were identified which addressed pre-clinical and clinical studies: 27 relating to in vitro and in vivo animal studies and 20 relating to human studies. Of these, five addressed lateral epicondylitis, two addressed rotator cuff tendinopathies, ten dealt with patellar tendinopathies and three looked at Achilles tendinopathies. Conclusions: The majority of pre-clinical studies show that PRP stimulates the tendon’s healing process. However, clinical series remain more controversial and level 1, controlled, randomised studies are still needed. PMID:26195890

  1. Evaluation and Management of Elbow Tendinopathy

    PubMed Central

    Taylor, Samuel A.; Hannafin, Jo A.

    2012-01-01

    Context: Elbow tendinopathy is a common cause of pain and disability among patients presenting to orthopaedic surgeons, primary care physicians, physical therapists, and athletic trainers. Prompt and accurate diagnosis of these conditions facilitates a directed treatment regimen. A thorough understanding of the natural history of these injuries and treatment outcomes will enable the appropriate management of patients and their expectations. Evidence Acquisitions: The PubMed database was searched in December 2011 for English-language articles pertaining to elbow tendinopathy. Results: Epidemiologic data as well as multiple subjective and objective outcome measures were investigated to elucidate the incidence of medial epicondylitis, lateral epicondylitis, distal biceps and triceps ruptures, and the efficacy of various treatments. Conclusions: Medial and lateral epicondylitis are overuse injuries that respond well to nonoperative management. Their etiology is degenerative and related to repetitive overuse and underlying tendinopathy. Nonsteroidal anti-inflammatory drugs and localized corticosteroid injections yield moderate symptomatic relief in short term but do not demonstrate benefit on long-term follow-up. Platelet-rich plasma injections may be advantageous in cases of chronic lateral epicondylitis. If 6 to 12 months of nonoperative treatment fails, then surgical intervention can be undertaken. Distal biceps and triceps tendon ruptures, in contrast, have an acute traumatic etiology that may be superimposed on underlying tendinopathy. Prompt diagnosis and treatment improve outcomes. While partial ruptures confirmed with magnetic resonance imaging can be treated nonoperatively with immobilization, complete ruptures should be addressed with primary repair within 3 to 4 weeks of injury. PMID:23016111

  2. Acute traumatic patellar dislocation.

    PubMed

    Duthon, V B

    2015-02-01

    Inaugural traumatic patellar dislocation is most often due to trauma sustained during physical or sports activity. Two-thirds of acute patellar dislocations occur in young active patients (less than 20 years old). Non-contact knee sprain in flexion and valgus is the leading mechanism in patellar dislocation, accounting for as many as 93% of all cases. The strong displacement of the patella tears the medial stabilizing structures, and notably the medial patellofemoral ligament (MPFL), which is almost always injured in acute patellar dislocation, most frequently at its femoral attachment. Lateral patellar glide can be assessed with the knee in extension or 20° flexion. Displacement by more than 50% of the patellar width is considered abnormal and may induce apprehension. Plain X-ray and CT are mandatory to diagnose bony risk factors for patellar dislocation, such as trochlear dysplasia or increased tibial tubercle-trochlear groove distance (TT-TG), and plan correction. MRI gives information on cartilage and capsulo-ligamentous status for treatment planning: free bodies or osteochondral fracture have to be treated surgically. If patellar dislocation occurs in an anatomically normal knee and osteochondral fracture is ruled out on MRI, non-operative treatment is usually recommended. PMID:25592052

  3. Tendinopathy in Sport

    PubMed Central

    Ackermann, Paul W.; Renström, Per

    2012-01-01

    Context: Tendinopathy is increasing in prevalence and accounts for a substantial part of all sports injuries and occupational disorders. Despite the magnitude of the disorder, high-quality scientific data on etiology and available treatments have been limited. Evidence Acquisition: The authors conducted a MEDLINE search on tendinopathy, or “tendonitis” or “tendinosis” or “epicondylitis” or “jumpers knee” from 1980 to 2011. The emphasis was placed on updates on epidemiology, etiology, and recent patient-oriented Level 1 literature. Results: Repetitive exposure in combination with recently discovered intrinsic factors, such as genetic variants of matrix proteins, and metabolic disorders is a risk factor for the development of tendinopathy. Recent findings demonstrate that tendinosis is characterized by a fibrotic, failed healing response associated with pathological vessel and sensory nerve ingrowth. This aberrant sensory nerve sprouting may partly explain increased pain signaling and partly, by release of neuronal mediators, contribute to the fibrotic alterations observed in tendinopathy. The initial nonoperative treatment should involve eccentric exercise, which should be the cornerstone (basis) of treatment of tendinopathy. Eccentric training combined with extracorporeal shockwave treatment has in some reports shown higher success rates compared to any therapies alone. Injection therapies (cortisone, sclerosing agents, blood products including platelet-rich plasma) may have short-term effects but have no proven long-term treatment effects or meta-analyses to support them. For epicondylitis, cortisone injections have demonstrated poorer long-time results than conservative physiotherapy. Today surgery is less indicated because of successful conservative therapies. New minioperative procedures that, via the endoscope, remove pathologic tissue or abnormal neoinnervation demonstrate promising results but need confirmation by Level 1 studies. Conclusions

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

    PubMed Central

    2011-01-01

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

  5. Correlation between Magnetic Resonance Imaging Characteristics of the Patellar Tendon and Clinical Scores in Osgood-Schlatter Disease

    PubMed Central

    Lee, Dhong Won; Kim, Min Jeong; Kim, Woo Jong; Ha, Jeong Ku

    2016-01-01

    Purpose This study aims to evaluate magnetic resonance imaging (MRI) findings in young adults with symptomatic Osgood-Schlatter disease (OSD) and compare those in young adults without OSD. Materials and Methods We compared MRI findings between young adults with OSD (OS group, n=30) and the equivalent number of young adults without OSD (control group). Visual analog scale scores and Kujala scores were evaluated and correlation analysis was performed in the OS group. Results In the OS group, MRI revealed that the patellar tendon was attached to the tibia more widely, resulting in a reduced free tendon portion, and more proximally to the articular surface (p<0.001). The correlation analysis between MRI findings and clinical scores showed statistically significant correlations (p<0.01). In the OS group, 43% presented with patellar tendinopathy or bone marrow edema at the distal attachments. Conclusions Compared to the control group, the relatively small free portion and relatively proximal attachment of the patellar tendon were observed with MRI in the OS group. The free portion of the patellar tendon was positively correlated with the clinical scores. Patellar tendinopathy was also frequently encountered in the OS group. PMID:26955614

  6. Sonoelastography in the diagnosis of tendinopathies: an added value

    PubMed Central

    Galletti, Stefano; Oliva, Francesco; Masiero, Stefano; Frizziero, Antonio; Galletti, Riccardo; Schiavone, Cosima; Salini, Vincenzo; Abate, Michele

    2015-01-01

    Summary Background sonoelastography helps in the detection of abnormalities not yet evident on B-mode exam. Methods in this observational study, we report a collection of cases of symptomatic patients without alterations at ultrasound imaging but with evidence of pathological findings at sonoelastography. Patients, with clinical history suggestive for tendinopathies or surgically treated, and negative at the ultrasound exam, were submitted to sonoelastography. Out of 846, 632 patients with positive ultrasound exam were excluded. Sonoelastography was therefore performed in the remaining 214. Results the examination was positive in 168 cases: 78 patients were affected with shoulder diseases, while elbow pathology was observed in 31 subjects; patellar, Achilles and plantar fascia disorders were reported in 19, 27, and 13 patients, respectively. Conclusion sonoelastography can reveal tendon abnormalities of clinical relevance in a high percentage of cases, where the ultrasound exam was negative, making the method a complementary tool to ultrasound evaluation. PMID:26958544

  7. Endothelial dysfunction and tendinopathy: how far have we come?

    PubMed

    Papalia, R; Moro, L; Franceschi, F; Albo, E; D'Adamio, S; Di Martino, A; Vadalà, G; Faldini, C; Denaro, V

    2013-12-01

    Symptomatic tendon tears are one of the most important causes of pain and joint dysfunction. Among the intrinsic causes, vascularization recently gained a major role. Endothelial function is indeed a key factor, as well as vascular tone and thrombotic factors, in the regulation of vascular homeostasis and the composition of vascular wall. In this review, we studied systematically whether there is a relationship between endothelial dysfunction and tendinopathy. A literature search was performed using the isolated or combined keywords endothelial dysfunction and tendon,' 'nitric oxide (NO) and tendinopathy,' and 'endothelial dysfunction in tendon healing.' We identified 21 published studies. Of the selected studies, 9 were in vivo studies, 2 focusing on animals and 7 on humans, while 12 reported about in vitro evaluations, where 7 were carried out on humans and 5 on animals. The evidence about a direct relationship between tendinopathy and endothelial dysfunction is still poor. As recent studies have shown, there is no significant improvement in clinical and functional assessments after treatment with NO in patients suffering from tendinopathy in different locations. No significant differences were identified in the outcomes reported for experiment group when compared with controls treated with conventional surgical procedures or rehabilitation programs. Nitric oxide could be a marker to quantify the response of the endothelium to mechanical stress or hypoxia indicating the final balance between vasodilatating and vasoconstricting factors and their effects, but more ad stronger evidence is still needed to fully support this practice. PMID:23907599

  8. The Basic Science of Tendinopathy

    PubMed Central

    Xu, Yinghua

    2008-01-01

    Tendinopathy is a common clinical problem with athletes and in many occupational settings. Tendinopathy can occur in any tendon, often near its insertion or enthesis where there is an area of stress concentration, and is directly related to the volume of repetitive load to which the tendon is exposed. Recent studies indicate tendinopathy is more likely to occur in situations that increase the “dose” of load to the tendon enthesis – including increased activity, weight, advancing age, and genetic factors. The cells in tendinopathic tendon are rounder, more numerous, and show evidence of oxidative damage and more apoptosis. These cells also produce a matrix that is thicker and weaker with more water, more immature and cartilage-like matrix proteins, and less organization. There is now evidence of a population of regenerating stem cells within tendon. These studies suggest prevention of tendinopathy should be directed at reducing the volume of repetitive loads to below that which induces oxidative-induced apoptosis and cartilage-like genes. The management strategies might involve agents or cells that induce tendon stem cell proliferation, repair and restoration of matrix integrity. PMID:18478310

  9. Ultrasound characteristics of the patellar and quadriceps tendons among young elite athletes.

    PubMed

    Visnes, H; Tegnander, A; Bahr, R

    2015-04-01

    Tendons adapt in response to sports-specific loading, but sometimes develop tendinopathy. If the presence of ultrasound changes like hypoechoic areas and neovascularization in asymptomatic tendons precede (and predict) future tendon problems is unknown. The aim of this prospective cohort study was to investigate the relationship between the development of ultrasound changes in the patellar and quadriceps tendons and symptoms of jumper's knee, as well to examine the medium-term effects of intensive training on tendon thickness among adolescent athletes. Elite junior volleyball athletes were followed with semi-annual ultrasound and clinical examinations (average follow-up: 1.7 years). Of the 141 asymptomatic athletes included, 22 athletes (35 patellar tendons) developed jumper's knee. In a multivariate logistic regression analysis, a baseline finding of a hypoechoic tendon area (odds ratio 3.3, 95% confidence interval 1.1 to 9.2) increased the risk of developing symptoms of jumper's knee. Patellar tendon thickness among healthy athletes did not change (Wilk's lambda, P = 0.07) while quadriceps tendon thickness increased (P = 0.001). In conclusion, ultrasound changes at baseline were risk factors for developing symptoms of jumper's knee. Also, among healthy athletes, we observed a 7-11% increase in quadriceps tendon thickness, while there was no increase in patellar tendon thickness. PMID:24612006

  10. Treatment of comminuted patellar fracture with the nitinol patellar concentrator.

    PubMed

    Zhao, Quan-Ming; Yang, Hui-Lin; Wang, Ling; Liu, Zhong-Tang; Gu, Xiao-Feng

    2016-06-01

    Aim To evaluate the clinical effect of the nitinol (NiTi)-patellar concentrator (NT-PC) for the treatment of comminuted patellar fractures. Material and methods A total of 32 patients with acute comminuted patellar fracture accepted open reduction and internal fixation with the NT-PC, and the curative effects were evaluated using the Böstman clinical grading scale. Results All fractures were anatomically reduced by surgery and all cases were followed-up for six to 18 months. The mean score of patients according to the Böstman clinical grading scale was 25.6, with 29 of 32 (90.7%) patients achieving excellent or good results. Two patients had traumatic arthritis, one had slippage of the NT-PC, and all patients received pharmacotherapy. Conclusions The application of the NT-PC is a satisfactory approach to the treatment of comminuted patellar fractures. PMID:26796538

  11. Peritendinous elastase treatment induces tendon degeneration in rats: A potential model of tendinopathy in vivo.

    PubMed

    Wu, Yen-Ting; Wu, Po-Ting; Jou, I-Ming

    2016-03-01

    The purpose of this study was to investigate the role of elastase on tendinopathy, as well as to evaluate the potential for peritendinous injections of elastase into rats to cause tendinopathy. We first investigated the expression of elastase in the tendons of patients with tendinopathy, and then established the effects of elastase injection on the Achilles tendons of rats. Ultrasonographic and incapacitance testing was used to conduct tests for 8 weeks. Tendon tissues were collected for histological observation and protein levels of collagen type I and type III were detected using Western blotting. The percentage of elastase-positive cells increased in human specimens with grades II and III tendinopathy. The rat model demonstrated that the thickness of the tendon increased after elastase injection during Week 2-8. Hypercellularity and focal lesions were detected after Week 2. The expression of elastase was increased and elastin was decreased in Week 8. Collagen type I expression was decreased, but type III was increased in Week 4. These results suggested that elastase may be involved in the development of chronic tendinopathy, and that peritendinous injection of elastase may result in tendinopathy in rats. PMID:26291184

  12. Current Concepts for Patellar Dislocation

    PubMed Central

    Petri, Maximilian; Ettinger, Max; Stuebig, Timo; Brand, Stephan; Krettek, Christian; Jagodzinski, Michael; Omar, Mohamed

    2015-01-01

    Context: Patellar dislocation usually occurs to the lateral side, leading to ruptures of the Medial Patellofemoral Ligament (MPFL) in about 90% of the cases. Even though several prognostic factors are identified for patellofemoral instability after patellar dislocation so far, the appropriate therapy remains a controversial issue. Evidence Acquisition: Authors searched the Medline library for studies on both surgical and conservative treatment for patellar dislocation and patellofemoral instability. Additionally, the reference list of each article was searched for additional studies. Results: A thorough analysis of the anatomical risk factors with a particular focus on patella alta, increased Tibial Tuberosity-Trochlear Groove (TT-TG) distance, trochlear dysplasia as well as torsional abnormalities should be performed early after the first dislocation to allow adequate patient counseling. Summarizing the results of all published randomized clinical trials and comparing surgical and conservative treatment after the first-time patellar dislocation until today indicated no significant evident difference for children, adolescents, and adults. Therefore, nonoperative treatment was indicated after a first-time patellar dislocation in the vast majority of patients. Conclusions: Surgical treatment for patellar dislocation is indicated primarily in case of relevant concomitant injuries such as osteochondral fractures, and secondarily for recurrent dislocations. PMID:26566512

  13. Similar patient-reported outcomes and performance after total knee arthroplasty with or without patellar resurfacing.

    PubMed

    Ali, Abdulemir; Lindstrand, Anders; Nilsdotter, Anna; Sundberg, Martin

    2016-06-01

    Background and purpose - Knee pain after total knee arthroplasty (TKA) is not uncommon. Patellar retention in TKA is one cause of postoperative knee pain, and may lead to secondary addition of a patellar component. Patellar resurfacing in TKA is controversial. Its use ranges from 2% to 90% worldwide. In this randomized study, we compared the outcome after patellar resurfacing and after no resurfacing. Patients and methods - We performed a prospective, randomized study of 74 patients with primary osteoarthritis who underwent a Triathlon CR TKA. The patients were randomized to either patellar resurfacing or no resurfacing. They filled out the VAS pain score and KOOS questionnaires preoperatively, and VAS pain, KOOS, and patient satisfaction 3, 12, and 72 months postoperatively. Physical performance tests were performed preoperatively and 3 months postoperatively. Results - We found similar scores for VAS pain, patient satisfaction, and KOOS 5 subscales at 3, 12, and 72 months postoperatively in the 2 groups. Physical performance tests 3 months postoperatively were also similar in the 2 groups. No secondary resurfacing was performed in the group with no resurfacing during the first 72 months Interpretation - Patellar resurfacing in primary Triathlon CR TKA is of no advantage regarding pain, physical performance, KOOS 5 subscales, or patient satisfaction compared to no resurfacing. None of the patients were reoperated with secondary addition of a patellar component within 6 years. According to these results, routine patellar resurfacing in primary Triathlon TKA appears to be unnecessary. PMID:27212102

  14. Similar patient-reported outcomes and performance after total knee arthroplasty with or without patellar resurfacing

    PubMed Central

    Ali, Abdulemir; Lindstrand, Anders; Nilsdotter, Anna; Sundberg, Martin

    2016-01-01

    Background and purpose Knee pain after total knee arthroplasty (TKA) is not uncommon. Patellar retention in TKA is one cause of postoperative knee pain, and may lead to secondary addition of a patellar component. Patellar resurfacing in TKA is controversial. Its use ranges from 2% to 90% worldwide. In this randomized study, we compared the outcome after patellar resurfacing and after no resurfacing. Patients and methods We performed a prospective, randomized study of 74 patients with primary osteoarthritis who underwent a Triathlon CR TKA. The patients were randomized to either patellar resurfacing or no resurfacing. They filled out the VAS pain score and KOOS questionnaires preoperatively, and VAS pain, KOOS, and patient satisfaction 3, 12, and 72 months postoperatively. Physical performance tests were performed preoperatively and 3 months postoperatively. Results We found similar scores for VAS pain, patient satisfaction, and KOOS 5 subscales at 3, 12, and 72 months postoperatively in the 2 groups. Physical performance tests 3 months postoperatively were also similar in the 2 groups. No secondary resurfacing was performed in the group with no resurfacing during the first 72 months Interpretation Patellar resurfacing in primary Triathlon CR TKA is of no advantage regarding pain, physical performance, KOOS 5 subscales, or patient satisfaction compared to no resurfacing. None of the patients were reoperated with secondary addition of a patellar component within 6 years. According to these results, routine patellar resurfacing in primary Triathlon TKA appears to be unnecessary. PMID:27212102

  15. Tendinopathies Around the Elbow Part 2: Medial Elbow, Distal Biceps and Triceps Tendinopathies

    PubMed Central

    Donaldson, Oliver; Vannet, Nicola; Gosens, Taco; Kulkarni, Rohit

    2013-01-01

    In the second part of this review article the management of medial elbow tendinopathy, distal biceps and distal triceps tendinopathy will be discussed. There is a scarcity of publications concerning any of these tendinopathies. This review will summarise the current best available evidence in their management. Medial elbow tendinopathy, also known as Golfer's elbow, is up to 6 times less common than lateral elbow tendinopathy. The tendinopathy occurs in the insertion of pronator teres and flexor carpi radialis. Diagnosis is usually apparent through a detailed history and examination but care must be made to exclude other conditions affecting the ulnar nerve or less commonly the ulnar collateral ligament complex. If doubt exists then MRI/US and electrophysiology can be used. Treatment follows a similar pattern to that of lateral elbow tendinopathy. Acute management is with activity modification and topical NSAIDs. Injection therapy and surgical excision are utilised for recalcitrant cases. Distal biceps and triceps tendinopathies are very rare and there is limited evidence published. Sequelae of tendinopathy include tendon rupture and so it is vital to manage these tendinopathies appropriately in order to minimise this significant complication. Their management and that of partial tears will be considered. PMID:27582910

  16. Patellar meniscus in total knee arthroplasty.

    PubMed

    Lavernia, Carlos J; Sheldon, Daniel A; Hernández, Victor H; D'Apuzzo, Michele R; Lee, David J; Krackow, Kenneth A; Hungerford, David S

    2007-04-01

    Twenty-four clinically successful, autopsy retrieved porous-coated anatomic total knee arthroplasty (TKA) specimens were evaluated to determine the structure and function of the patellar meniscus. Mean implant duration was 76 months (range: 11-135 months). Histological examination showed the patellar meniscus to be composed of dense fibrous tissue with scattered regions of chronic granulomatous response to polyethylene debris. Patellar wear and polyethylene exposed patellar surface area were correlated with implant duration (r = 0.47, P = .03; r = 0.52, P = .06). Postoperative patellar tilt was also associated with patellar component wear (r = 0.64, P = .03). No other clinical measures were significantly associated with patellar wear or exposed surface area. Additional research is needed to determine what role, if any, the patellar meniscus plays in TKA outcomes. PMID:17486906

  17. Proteomics Perspectives in Rotator Cuff Research: A Systematic Review of Gene Expression and Protein Composition in Human Tendinopathy

    PubMed Central

    Sejersen, Maria Hee Jung; Frost, Poul; Hansen, Torben Bæk; Deutch, Søren Rasmussen; Svendsen, Susanne Wulff

    2015-01-01

    Background Rotator cuff tendinopathy including tears is a cause of significant morbidity. The molecular pathogenesis of the disorder is largely unknown. This review aimed to present an overview of the literature on gene expression and protein composition in human rotator cuff tendinopathy and other tendinopathies, and to evaluate perspectives of proteomics – the comprehensive study of protein composition - in tendon research. Materials and Methods We conducted a systematic search of the literature published between 1 January 1990 and 18 December 2012 in PubMed, Embase, and Web of Science. We included studies on objectively quantified differential gene expression and/or protein composition in human rotator cuff tendinopathy and other tendinopathies as compared to control tissue. Results We identified 2199 studies, of which 54 were included; 25 studies focussed on rotator cuff or biceps tendinopathy. Most of the included studies quantified prespecified mRNA molecules and proteins using polymerase chain reactions and immunoassays, respectively. There was a tendency towards an increase of collagen I (11 of 15 studies) and III (13 of 14), metalloproteinase (MMP)-1 (6 of 12), -9 (7 of 7), -13 (4 of 7), tissue inhibitor of metalloproteinase (TIMP)-1 (4 of 7), and vascular endothelial growth factor (4 of 7), and a decrease in MMP-3 (10 of 12). Fourteen proteomics studies of tendon tissues/cells failed inclusion, mostly because they were conducted in animals or in vitro. Conclusions Based on methods, which only allowed simultaneous quantification of a limited number of prespecified mRNA molecules or proteins, several proteins appeared to be differentially expressed/represented in rotator cuff tendinopathy and other tendinopathies. No proteomics studies fulfilled our inclusion criteria, although proteomics technologies may be a way to identify protein profiles (including non-prespecified proteins) that characterise specific tendon disorders or stages of tendinopathy. Thus

  18. Fluoroquinolone-Associated Tendinopathy: Does Levofloxacin Pose the Greatest Risk?

    PubMed

    Bidell, Monique R; Lodise, Thomas P

    2016-06-01

    Fluoroquinolone antibiotics recently have gained increased national attention due to safety concerns. A well-described and serious adverse event associated with receipt of fluoroquinolones is tendinitis and tendon rupture. These tendon injuries can result in long-term sequelae, including chronic pain and mobility restrictions, and may warrant surgery. Due to the severity of these adverse events, a black box warning is included in the product labeling of all fluoroquinolones. In light of the mounting concerns surrounding fluoroquinolone-associated toxicities, the purpose of this clinical review is to provide a comprehensive summary of the risk of tendinopathy associated with levofloxacin, one of the most widely prescribed antibiotics in the United States, across in vitro, animal, and clinical studies, relative to other antibiotics. As part of this review, clinical presentation and onset, proposed mechanisms, patient-specific risk factors, and management of fluoroquinolone-induced tendon injury are summarized. Data were obtained from a comprehensive PubMed literature search and a review of U.S. Food and Drug Administration documents. Although tendinopathy is considered a fluoroquinolone class-wide toxicity, data from in vitro studies, animal studies, patient-level analyses, and large national and international surveillance reports suggest that levofloxacin, as well as its parent compound ofloxacin, possess higher propensities to cause tendon damage relative to other fluoroquinolones. Risk with ofloxacin and levofloxacin appears to be exposure dependent, with higher doses and longer durations being most commonly associated with tendinopathy. Other well-described patient risk factors for fluoroquinolone-associated tendinopathy include older age (older than 60 yrs), receipt of concomitant corticosteroid therapy, presence of renal dysfunction, and history of solid organ transplantation. Given widespread use of levofloxacin across patient care settings, knowledge of both

  19. Does platelet-rich plasma deserve a role in the treatment of tendinopathy?

    PubMed

    Nourissat, Geoffroy; Ornetti, Paul; Berenbaum, Francis; Sellam, Jérémie; Richette, Pascal; Chevalier, Xavier

    2015-07-01

    Although tendinopathies constitute a heterogeneous group of conditions, they are often treated by similar combinations of local and systemic symptomatic interventions. The vast number of causes, pathophysiological mechanisms, and histological changes that characterizes tendinopathies may explain that the standard treatment fails in some patients. Platelet-rich plasma (PRP), which contains a host of soluble mediators including growth factors, has been suggested as a second-line treatment for refractory tendinopathy, with the goal of expediting tendon healing or remodeling. Here, we report a systematic literature review of basic research data from humans and animals that support the clinical use of PRP in tendinopathies and of clinical studies in the most common tendinopathies (elbow, knee, shoulder, and Achilles tendon). Our objective is to clarify the role for this new injectable treatment, which is garnering increasing attention. The level of evidence remains low, as few well-designed randomized controlled trials have been published. The available scientific evidence does not warrant the use of PRP for the first-line treatment of tendinopathy. PRP therapy may deserve consideration in specific tendinopathy subtypes, after failure of ultrasound-guided corticosteroid injections. Nevertheless, further studies are needed to define these potential indications and the optimal treatment protocols. A key point is that the complexity of the tendon healing process cannot be replicated simply by injecting a subset of growth factors, whose effects may occur in opposite directions over time. Topics not discussed in this review are the regulatory framework for PRP therapy, PRP nomenclature, and precautions for use, which are described in a previous article (Does platelet-rich plasma have a role in the treatment of osteoarthritis, Ornetti P, et al. [1]). PMID:25881762

  20. The Use of Hyaluronic Acid after Tendon Surgery and in Tendinopathies

    PubMed Central

    Schiavone, Cosima; Salini, Vincenzo

    2014-01-01

    Viscosupplementation with hyaluronic acid is safe and effective in the management of osteoarthritis, but its use in the treatment of tendon disorders has received less attention. The aim of this review is to summarize the current knowledge on this topic, evaluating experimental and clinical trials. A search of English-language articles was performed using the key search terms “hyaluronic acid” or “viscosupplementation” combined with “tendon,” “tendinopathy,“ “adhesions,“ or “gliding,“ independently. In quite all the experimental studies, performed after surgical procedures for tendon injuries or in the treatment of chronic tendinopathies, using different hyaluronic acid compounds, positive results (reduced formation of scars and granulation tissue after tendon repair, less adhesions and gliding resistance, and improved tissue healing) were observed. In a limited number of cases, hyaluronic acid has been employed in clinical practice. After flexor tendon surgery, a greater total active motion and fingers function, with an earlier return to work and daily activities, were observed. Similarly, in patients suffering from elbow, patellar, and shoulder tendons disorders, pain was reduced, and function improved. The positive effect of hyaluronic acid can be attributed to the anti-inflammatory activity, enhanced cell proliferation, and collagen deposition, besides the lubricating action on the sliding surface of the tendon. PMID:24895610

  1. In vivo patellar tracking induced by individual quadriceps components in individuals with patellofemoral pain.

    PubMed

    Lin, Fang; Wilson, Nicole A; Makhsous, Mohsen; Press, Joel M; Koh, Jason L; Nuber, Gordon W; Zhang, Li-Qun

    2010-01-19

    Patellofemoral pain is a common knee disorder with a multi-factorial etiology related to abnormal patellar tracking. Our hypothesis was that the pattern of three-dimensional rotation and translation of the patella induced by selective activation of individual quadriceps components would differ between subjects with patellofemoral pain and healthy subjects. Nine female subjects with patellofemoral pain and seven healthy female subjects underwent electrical stimulation to selectively activate individual quadriceps components (vastus medialis obliquus, VMO; vastus medialis lateralis, VML; vastus lateralis, VL) with the knee at 0 degrees and 20 degrees flexion, while three-dimensional patellar tracking was recorded. Normalized direction of rotation and direction of translation characterized the relative amplitudes of each component of patellar movement. VMO activation in patellofemoral pain caused greater medial patellar rotation (distal patellar pole rotates medially in frontal plane) at both knee positions (p<0.01), and both VMO and VML activation caused increased anterior patellar translation (p<0.001) in patellofemoral pain compared to healthy subjects at 20 degrees knee flexion. VL activation caused more lateral patellar translation (p<0.001) in patellofemoral pain compared to healthy subjects. In healthy subjects the 3-D mechanical action of the VMO is actively modulated with knee flexion angle while such modulation was not observed in PFP subjects. This could be due to anatomical differences in the VMO insertion on the patella and medial quadriceps weakness. Quantitative evaluation of the influence of individual quadriceps components on patellar tracking will aid understanding of the knee extensor mechanism and provide insight into the etiology of patellofemoral pain. PMID:19878947

  2. In vivo patellar tracking induced by individual quadriceps components in individuals with patellofemoral pain

    PubMed Central

    Lin, Fang; Wilson, Nicole A.; Makhsous, Mohsen; Press, Joel M.; Koh, Jason L.; Nuber, Gordon W.; Zhang, Li-Qun

    2009-01-01

    Patellofemoral pain is a common knee disorders with a multi-factorial etiology related to abnormal patellar tracking. Our hypothesis was that the pattern of 3-dimensional rotation and translation of the patella induced by selective activation of individual quadriceps components would differ between subjects with patellofemoral pain and healthy subjects. Nine female subjects with patellofemoral pain and seven healthy female subjects underwent electrical stimulation to selectively activate individual quadriceps components (vastus medialis obliquus, VMO; vastus medialis lateralis, VML; vastus lateralis, VL) with the knee at 0° and 20° flexion, while three-dimensional patellar tracking was recorded. Normalized direction of rotation and direction of translation characterized the relative amplitudes of each component of patellar movement. VMO activation in patellofemoral pain caused greater medial patellar rotation (distal patellar pole rotates medially in frontal plane) at both knee positions (p<0.01), and both VMO and VML activation caused increased anterior patellar translation (p<0.001) in patellofemoral pain compared to healthy subjects at 20° knee flexion. VL activation caused more lateral patellar translation (p<0.001) in patellofemoral pain compared to healthy subjects. In healthy subjects the 3-D mechanical action of the VMO is actively modulated with knee flexion angle while such modulation was not observed in PFP subjects. This could be due to anatomical differences in the VMO insertion on the patella and medial quadriceps weakness. Quantitative evaluation of the influence of individual quadriceps components on patellar tracking will aid understanding of the knee extensor mechanism and provide insight into the etiology of patellofemoral pain. PMID:19878947

  3. IL-21 Receptor Expression in Human Tendinopathy

    PubMed Central

    Campbell, Abigail L.; Smith, Nicola C.; Reilly, James H.; Kerr, Shauna C.; Leach, William J.; Fazzi, Umberto G.; Rooney, Brian P.; Murrell, George A. C.; Millar, Neal L.

    2014-01-01

    The pathogenetic mechanisms underlying tendinopathy remain unclear, with much debate as to whether inflammation or degradation has the prominent role. Increasing evidence points toward an early inflammatory infiltrate and associated inflammatory cytokine production in human and animal models of tendon disease. The IL-21/IL-21R axis is a proinflammatory cytokine complex that has been associated with chronic inflammatory diseases including rheumatoid arthritis and inflammatory bowel disease. This project aimed to investigate the role and expression of the cytokine/receptor pair IL-21/IL-21R in human tendinopathy. We found significantly elevated expression of IL-21 receptor message and protein in human tendon samples but found no convincing evidence of the presence of IL-21 at message or protein level. The level of expression of IL-21R message/protein in human tenocytes was significantly upregulated by proinflammatory cytokines (TNFα/IL-1β) in vitro. These findings demonstrate that IL-21R is present in early human tendinopathy mainly expressed by tenocytes and macrophages. Despite a lack of IL-21 expression, these data again suggest that early tendinopathy has an inflammatory/cytokine phenotype, which may provide novel translational targets in the treatment of tendinopathy. PMID:24757284

  4. Animal models for the study of tendinopathy

    PubMed Central

    Warden, S J

    2007-01-01

    Tendinopathy is a common and significant clinical problem characterised by activity‐related pain, focal tendon tenderness and intratendinous imaging changes. Recent histopathological studies have indicated the underlying pathology to be one of tendinosis (degeneration) as opposed to tendinitis (inflammation). Relatively little is known about tendinosis and its pathogenesis. Contributing to this is an absence of validated animal models of the pathology. Animal models of tendinosis represent potential efficient and effective means of furthering our understanding of human tendinopathy and its underlying pathology. By selecting an appropriate species and introducing known risk factors for tendinopathy in humans, it is possible to develop tendon changes in animal models that are consistent with the human condition. This paper overviews the role of animal models in tendinopathy research by discussing the benefits and development of animal models of tendinosis, highlighting potential outcome measures that may be used in animal tendon research, and reviewing current animal models of tendinosis. It is hoped that with further development of animal models of tendinosis, new strategies for the prevention and treatment of tendinopathy in humans will be generated. PMID:17127722

  5. Pathogenesis of tendinopathies: inflammation or degeneration?

    PubMed Central

    Abate, Michele; Gravare-Silbernagel, Karin; Siljeholm, Carl; Di Iorio, Angelo; De Amicis, Daniele; Salini, Vincenzo; Werner, Suzanne; Paganelli, Roberto

    2009-01-01

    The intrinsic pathogenetic mechanisms of tendinopathies are largely unknown and whether inflammation or degeneration has the prominent role is still a matter of debate. Assuming that there is a continuum from physiology to pathology, overuse may be considered as the initial disease factor; in this context, microruptures of tendon fibers occur and several molecules are expressed, some of which promote the healing process, while others, including inflammatory cytokines, act as disease mediators. Neural in-growth that accompanies the neovessels explains the occurrence of pain and triggers neurogenic-mediated inflammation. It is conceivable that inflammation and degeneration are not mutually exclusive, but work together in the pathogenesis of tendinopathies. PMID:19591655

  6. Fluoroquinolones and Tendinopathy: A Guide for Athletes and Sports Clinicians and a Systematic Review of the Literature

    PubMed Central

    Lewis, Trevor; Cook, Jill

    2014-01-01

    Context: Fluoroquinolone antibiotics have been used for several decades and are effective antimicrobials. Despite their usefulness as antibiotics, a growing body of evidence has accumulated in the peer-reviewed literature that shows fluoroquinolones can cause pathologic lesions in tendon tissue (tendinopathy). These adverse effects can occur within hours of commencing treatment and months after discontinuing the use of these drugs. In some cases, fluoroquinolone usage can lead to complete rupture of the tendon and substantial subsequent disability. Objective: To discuss the cause, pharmacology, symptoms, and epidemiology of fluoroquinolone-associated tendinopathy and to discuss the clinical implications with respect to athletes and their subsequent physiotherapy. Data Sources: We searched MEDLINE, Cumulative Index to Nursing and Allied Health (CINAHL), Allied and Complementary Medicine Database (AMED), and SPORTDiscus databases for available reports of fluoroquinolone-related tendinopathy (tendinitis, tendon pain, or rupture) published from 1966 to 2012. Search terms were fluoroquinolones or quinolones and tendinopathy, adverse effects, and tendon rupture. Included studies were written in or translated into English. Non—English–language and non-English translations of abstracts from reports were not included (n = 1). Study Selection: Eligible studies were any available reports of fluoroquinolone-related tendinopathy (tendinitis, tendon pain, or rupture). Both animal and human histologic studies were included. Any papers not focusing on the tendon-related side effects of fluoroquinolones were excluded (n = 71). Data Extraction: Data collected included any cases of fluoroquinolone-related tendinopathy, the particular tendon affected, type of fluoroquinolone, dosage, and concomitant risk factors. Any data outlining the adverse histologic effects of fluoroquinolones also were collected. Data Synthesis: A total of 175 papers, including 89 case reports and 8

  7. Therapeutic Roles of Tendon Stem/Progenitor Cells in Tendinopathy

    PubMed Central

    Zhang, Xin; Lin, Yu-cheng; Rui, Yun-feng; Xu, Hong-liang; Chen, Hui; Wang, Chen; Teng, Gao-jun

    2016-01-01

    Tendinopathy is a tendon disorder characterized by activity-related pain, local edema, focal tenderness to palpation, and decreased strength in the affected area. Tendinopathy is prevalent in both athletes and the general population, highlighting the need to elucidate the pathogenesis of this disorder. Current treatments of tendinopathy are both conservative and symptomatic. The discovery of tendon stem/progenitor cells (TSPCs) and erroneous differentiation of TSPCs have provided new insights into the pathogenesis of tendinopathy. In this review, we firstly present the histopathological characteristics of tendinopathy and explore the cellular and molecular cues in the pathogenesis of tendinopathy. Current evidence of the depletion of the stem cell pool and altered TSPCs fate in the pathogenesis of tendinopathy has been presented. The potential regulatory factors for either tenogenic or nontenogenic differentiation of TSPCs are also summarized. The regulation of endogenous TSPCs or supplementation with exogenous TSPCs as therapeutic targets for the treatment of tendinopathy is proposed. Therefore, inhibiting the erroneous differentiation of TSPCs and regulating the differentiation of TSPCs into tendon cells might be important areas of future research and could provide new clinical treatments for tendinopathy. The current evidence suggests that TSPCs are promising therapeutic targets for the management of tendinopathy. PMID:27195010

  8. Ultrasound-guided platelet-rich plasma injection for distal biceps tendinopathy

    PubMed Central

    Bell, Simon N; Connell, David; Coghlan, Jennifer A

    2015-01-01

    Background Distal biceps tendinopathy is an uncommon cause of elbow pain. The optimum treatment for cases refractory to conservative treatment is unclear. Platelet-rich plasma has been used successfully for other tendinopathies around the elbow. Methods Six patients with clinical and radiological evidence of distal biceps tendinopathy underwent ultrasound-guided platelet-rich plasma (PRP) injection. Clinical examination findings, visual analogue score (VAS) for pain and Mayo Elbow Performance scores were recorded. Results The Mayo Elbow Performance Score improved from 68.3 (range 65 to 85) (fair function) to 95 (range 85 to 100) (excellent function). The VAS at rest improved from a mean of 2.25 (range 2 to 5) pre-injection to 0. The VAS with movement improved from a mean of 7.25 (range 5 to 8) pre-injection to 1.3 (range 0 to 2). No complications were noted. Discussion Ultrasound-guided PRP injection appears to be a safe and effective treatment for recalcitrant cases of distal biceps tendinopathy. Further investigation with a randomized controlled trial is needed to fully assess its efficacy.

  9. Patellar Dislocations and Reduction Procedure.

    PubMed

    Ramponi, Denise

    2016-01-01

    Acute patellar dislocations are a common injury occurring in adolescents involved in sports and dancing activities. This injury usually occurs when the knee is in full extension and sustains a valgus stress on the knee. The medial patellofemoral ligament is the medial restraint that assists in stabilizing the patella from lateral dislocations. The patella usually dislocates laterally and is usually not difficult to reduce after patient evaluation and prereduction radiographs. After postreduction radiographs confirm proper position of the patella postreduction and the absence of fractures, the patient is usually treated conservatively with initial immobilization, orthopedic referral, and physical therapy. PMID:27139130

  10. Lateral patellar burnishing in total knee arthroplasty following medialization of the patellar button.

    PubMed

    Doerr, T E; Eckhoff, D G

    1995-08-01

    This case report describes a total knee revision necessitated by painful contact between the exposed lateral facet of the patella and the femoral component. Pain was resolved following repositioning and enlarging the patellar component. The clinical significance of this report is that the contemporary practice of medializing the patellar component to improve patellar tracking should be performed in moderation to avoid overexposure of the lateral patella. In the setting of persistent anterior knee pain following total knee arthroplasty, the etiology of the pain may be identified as contact between the patellar and femoral component on the sunrise radiograph. PMID:8523016

  11. Selective hemiepiphyseodesis for patellar instability with associated genu valgum

    PubMed Central

    Kearney, Sean P.; Mosca, Vincent S.

    2015-01-01

    Background/Aims Patellar instability limits activity and promotes arthritis. Correcting genu valgum with selective hemiepiphyseodesis can treat patellar instability. Methods We retrospectively reviewed 26 knees with patellar instability and associated genu valgum that underwent hemiepiphyseodesis. Results Average anatomic lateral distal femoral angle (aLDFA) significantly corrected. Symptoms improved in all patients. All competitive athletes returned to sports. One complication occurred. Conclusions In genu valgum, the patella seeks an abnormal mechanical axis, resulting in patellar instability. By correcting the mechanical axis with hemiepiphyseodesis, patellar instability symptoms improve and patients return to sports. Complications are rare. Selective hemiepiphyseodesis is recommended when treating patellar instability with associated genu valgum. PMID:25829756

  12. Tendinopathies of the Hand and Wrist.

    PubMed

    Adams, Julie E; Habbu, Rohan

    2015-12-01

    Tendinopathies involving the hand and wrist are common. Many are diagnosed easily, and in many cases, the management is straightforward, provided the pathology and principles are understood. Common conditions involving the tendons of the hand and wrist include trigger finger, tenosynovitis of the first through sixth dorsal extensor compartments, and flexor carpi radialis tendonitis. Management strategies include nonsurgical treatments, such as splinting, injection, or therapy, and surgical techniques such as tendon release. PMID:26510626

  13. In vivo biological response to extracorporeal shockwave therapy in human tendinopathy.

    PubMed

    Waugh, C M; Morrissey, D; Jones, E; Riley, G P; Langberg, H; Screen, H R C

    2015-01-01

    Extracorporeal shock wave therapy (ESWT) is a non-invasive treatment for chronic tendinopathies, however little is known about the in-vivo biological mechanisms of ESWT. Using microdialysis, we examined the real-time biological response of healthy and pathological tendons to ESWT. A single session of ESWT was administered to the mid-portion of the Achilles tendon in thirteen healthy individuals (aged 25.7 ± 7.0 years) and patellar or Achilles tendon of six patients with tendinopathies (aged 39.0 ± 14.9 years). Dialysate samples from the surrounding peri-tendon were collected before and immediately after ESWT. Interleukins (IL)-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70, IL-17A, vascular endothelial growth factor and interferon-γ were quantified using a cytometric bead array while gelatinase activity (MMP-2 and -9) was examined using zymography. There were no statistical differences between the biological tissue response to ESWT in healthy and pathological tendons. IL-1β, IL-2, IL-6 and IL-8 were the cytokines predominantly detected in the tendon dialysate. IL-1β and IL-2 did not change significantly with ESWT. IL-6 and IL-8 concentrations were elevated immediately after ESWT and remained significantly elevated for four hours post-ESWT (p < 0.001). Pro-forms of MMP-2 and -9 also increased after ESWT (p < 0.003), whereas there were no significant changes in active MMP forms. In addition, the biological response to ESWT treatment could be differentiated between possible responders and non-responders based on a minimum 5-fold increase in any inflammatory marker or MMP from pre- to post-ESWT. Our findings provide novel evidence of the biological mechanisms underpinning ESWT in humans in vivo. They suggest that the mechanical stimulus provided by ESWT might aid tendon remodelling in tendinopathy by promoting the inflammatory and catabolic processes that are associated with removing damaged matrix constituents. The non-response of some individuals may help to

  14. Lateral patellar facetectomy and medial reefing in patients with lateral facet syndrome after patellar-retaining total knee arthroplasty.

    PubMed

    Pagenstert, Geert; Seelhoff, Juliane; Henninger, Heath B; Wirtz, Dieter C; Valderrabano, Victor; Barg, Alexej

    2014-11-01

    We analyzed clinical outcomes of partial lateral patellar facetectomy and medial reefing in patients with lateral patellar facet syndrome with painful patellar-retaining total knee arthroplasty. 34 patients were followed for a mean of 40 months. All 34 patients were matched with those having secondary patellar resurfacing without facetectomy. Both groups experienced significant pain relief and range of motion improvement. The facetectomy group had higher Kujala scores than those in patellar resurfacing group. Patients with facetectomy had significantly less pain postoperatively. There were significant differences in postoperative lateral patellar tilt and congruency angle in both groups. The mid-term results for LPF with medial reefing are promising to resolve pain in patients with lateral patellar facet syndrome in patellar-retaining TKA. Therapeutic level III (retrospective comparative study). PMID:25070901

  15. The effect of exercise on patellar tracking in lateral patellar compression syndrome.

    PubMed

    Doucette, S A; Goble, E M

    1992-01-01

    The influence of a physical therapy program on pain and patellar tracking was investigated clinically and radiologically with tangential views in 51 knees with lateral patellar compression syndrome. A pretest-posttest design was used to evaluate physical measurements of patellar alignment in subjects who had had patellofemoral pain for a minimum of 6 weeks. Eighty-four percent of the subjects were pain-free after an average of 8 weeks of rehabilitation or 11 physical therapy visits, with a mean quadriceps strength to total body weight ratio of 61% in women and 86% in men. The pretest-posttest difference in Merchant's congruence angle was significant at a probability of 0.0066 in the patients who were pain-free after exercise, demonstrating less lateral patellar tracking. The pretest-posttest difference in iliotibial band flexibility was significant at a probability of 0.0017, with the patients who were pain-free after exercise becoming more flexible. No significant differences were observed from before to after exercise in the patellofemoral index, Q angle, hamstring flexibility, thigh measurement, sclerotic subchondral bone, or sulcus angle. We were unable to predict which subjects would become pain-free with exercise by patellar position because the group that improved began more laterally tilted. The results of this study indicate that patellar tracking is improved with vastus medialis oblique strengthening, iliotibial band stretching, and joint mobility exercise in the majority of subjects with lateral patellar compression syndrome. PMID:1415887

  16. Medial patellofemoral ligament reconstruction in patellar instability

    PubMed Central

    Krishna Kumar, MS; Renganathan, Sankarram; Joseph, Clement J; Easwar, TR; Rajan, David V

    2014-01-01

    Background: Medial patellofemoral ligament (MPFL) is one of the major static medial stabilising structures of the patella. MPFL is most often damaged in patients with patellar instability. Reconstruction of MPFL is becoming a common surgical procedure in treating patellar instability. We hypothesised that MPFL reconstruction was adequate to treat patients with patellar instability if the tibial tubercle and the centre of the trochlear groove (TT-TG) value was less than 20 mm and without a dysplastic trochlea. Materials and Methods: 30 patients matching our inclusion criteria and operated between April 2009 and May 2011 were included in the study. MPFL reconstruction was performed using gracilis tendon fixed with endobutton on the patellar side and bio absorbable interference screw or staple on the femoral side. Patients were followed up with subjective criteria, Kujala score and Lysholm score. Results: The mean duration of followup was 25 months (range 14-38 months). The mean preoperative Kujala score was 47.5 and Lysholm score was 44.7. The mean postoperative Kujala score was 87 and Lysholm score was 88.06. None of the patients had redislocation. Conclusion: MPFL reconstruction using gracilis tendon gives excellent results in patients with patellar instability with no redislocations. Some patients may have persistence of apprehension. PMID:25298558

  17. Patellar Maltracking Correlates With Vastus Medialis Activation Delay in Patellofemoral Pain Patients

    PubMed Central

    Pal, Saikat; Draper, Christine E.; Fredericson, Michael; Gold, Garry E.; Delp, Scott L.; Beaupre, Gary S.; Besier, Thor F.

    2016-01-01

    Background Delayed onset of vastus medialis (VM) activity compared with vastus lateralis activity is a reported cause for patellofemoral pain. The delayed onset of VM activity in patellofemoral pain patients likely causes an imbalance in muscle forces and lateral maltracking of the patella; however, evidence relating VM activation delay to patellar maltracking is sparse. The aim of this study was to investigate the relationship between VM activation delay and patellar maltracking measures in pain-free controls and patellofemoral pain patients. Hypothesis Patellar tilt and bisect offset, measures of patellar tracking, correlate with VM activation delay in patellofemoral pain patients classified as maltrackers. Study Design Case control study; Level of evidence, 3. Methods Vasti muscle activations were recorded in pain-free (n = 15) and patellofemoral pain (n = 40) participants during walking and jogging. All participants were scanned in an open-configuration magnetic resonance scanner in an upright weightbearing position to acquire the position of the patella with respect to the femur. Patellar tilt and bisect offset were measured, and patellofemoral pain participants were classified into normal tracking and maltracking groups. Results Correlations between VM activation delay and patellar maltracking measures were statistically significant in only the patellofemoral pain participants classified as maltrackers with both abnormal tilt and abnormal bisect offset (R2 = .89, P < .001, with patellar tilt during walking; R2 = .75, P = .012, with bisect offset during jogging). There were no differences between the means of activation delays in pain-free and all patellofemoral pain participants during walking (P = .516) or jogging (P = .731). Conclusion There was a relationship between VM activation delay and patellar maltracking in the subgroup of patellofemoral pain participants classified as maltrackers with both abnormal tilt and abnormal bisect offset. Clinical

  18. 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

  19. Lateral elbow tendinopathy: Evidence of physiotherapy management

    PubMed Central

    Dimitrios, Stasinopoulos

    2016-01-01

    Lateral elbow tendinopathy (LET) is a common musculoskeletal/sports injury. A plethora of physiotherapy techniques has been proposed in the management of LET. The exercise programme is the most common treatment in the management of LET. The optimal protocol of exercise programme is still unknown. The effectiveness of the exercise programme is low when it is applied as monotherapy. Therefore, exercise programme is combined with other physiotherapy modalities such as soft tissue techniques, external support, acupuncture, manual therapy and electrotherapy, in the treatment of LET. Future research is needed to determine which treatment strategy combined with exercise programme will provide the best results in LET rehabilitation. PMID:27622145

  20. Lateral elbow tendinopathy: Evidence of physiotherapy management.

    PubMed

    Dimitrios, Stasinopoulos

    2016-08-18

    Lateral elbow tendinopathy (LET) is a common musculoskeletal/sports injury. A plethora of physiotherapy techniques has been proposed in the management of LET. The exercise programme is the most common treatment in the management of LET. The optimal protocol of exercise programme is still unknown. The effectiveness of the exercise programme is low when it is applied as monotherapy. Therefore, exercise programme is combined with other physiotherapy modalities such as soft tissue techniques, external support, acupuncture, manual therapy and electrotherapy, in the treatment of LET. Future research is needed to determine which treatment strategy combined with exercise programme will provide the best results in LET rehabilitation. PMID:27622145

  1. [Critical analysis of classical conservative treatments of tendinopathies].

    PubMed

    Kaux, J F; Croisier, J L; Forthomme, B; Crielaard, J M

    2015-09-01

    Classic "passive" therapeutics (anti-inflammatory drugs, infiltrations of corticosteroids...) of tendinopathies, which are used relatively empirically, reduce pain and inflammation, without fundamentally changing the tendon structure. The eccentric rehabilitation has been applied to chronic tendinopathies, not only due to the failure of conventional therapies but also due to a better pathophysiological understanding of tendinopathies. Various studies underscore the effectiveness of eccentric rehabilitation which, after 20-30 sessions, leads to healing and especially prevents the risk of chronicity. Shockwave therapy, amending the tendinous structure, would lead to a long term healing. PMID:26638447

  2. Instrumentation of the patellar osteotomy in total knee arthroplasty. The relationship of patellar thickness and lateral retinacular release.

    PubMed

    Greenfield, M A; Insall, J N; Case, G C; Kelly, M A

    1996-01-01

    This study investigates the influence of patellar thickness in total knee arthroplasty (TKA) with routine patellar resurfacing on the rate of lateral retinacular release. A study group comprised of 121 TKAs using surgical instrumentation allowing a measured resection of the patella was compared with a control group comprised of 100 TKAs using an "eye-ball" technique for patellar resurfacing without particular attention to patellar thickness. A composite without patellar thickness equal to or slightly less than the original patella was attempted in the study group. The average thickness difference of the patella in the study group was -1.58 mm. Lateral retinacular release for patellar maltracking was performed in 12.4% of knees in the study group compared with 55% of knees in the control group. The variation in patellar thickness in this series often led to a residual bone thickness < 15 mm. No clinical problems have been observed to date. PMID:8836354

  3. Kinematics and Mechanical Properties of Knees following Patellar Replacing and Patellar Retaining Total Knee Arthroplasty

    PubMed Central

    Huang, Rongying; Liu, Yanqiang; Zhu, Jun

    2015-01-01

    Knee injury is a common medical issue. A full understanding of the kinematics and mechanical properties of knees following total knee arthroplasty (TKA) repair utilizing patellar replacement (only the base of the patella is replaced) versus patellar retaining surgical techniques is still lacking. In the current paper, we investigated magnetic resonance (MR) imaging data from knees repaired by these two methods and evaluated total knee models created using imaging reconstruction technology that simulated gait conditions. Results revealed that patellar replacement had little influence on tibiofemoral kinematics, although the tibia-surface equivalent stress increased slightly. By contrast, patellar replacement had a significant influence on the patellofemoral joint; patellar internal rotation, external rotation, and medial-lateral translation were all increased. Moreover, the stress distribution on patellar prostheses was altered, resulting in an increased surface maximal equivalent stress on the corresponding area. Moreover, during the gait cycle, we found that the area with maximal equivalent stress shifted its position. Finally, the patellofemoral joint showed decreased motion stability. From the view of kinematics and mechanics, this paper suggests that patella should be retained during TKA if it is possible. The present study presented approaches and technologies for evaluating kinematics and mechanical properties of total knee joint after TKA under gait loads. PMID:27057134

  4. Kinematics and Mechanical Properties of Knees following Patellar Replacing and Patellar Retaining Total Knee Arthroplasty.

    PubMed

    Huang, Rongying; Liu, Yanqiang; Zhu, Jun

    2015-01-01

    Knee injury is a common medical issue. A full understanding of the kinematics and mechanical properties of knees following total knee arthroplasty (TKA) repair utilizing patellar replacement (only the base of the patella is replaced) versus patellar retaining surgical techniques is still lacking. In the current paper, we investigated magnetic resonance (MR) imaging data from knees repaired by these two methods and evaluated total knee models created using imaging reconstruction technology that simulated gait conditions. Results revealed that patellar replacement had little influence on tibiofemoral kinematics, although the tibia-surface equivalent stress increased slightly. By contrast, patellar replacement had a significant influence on the patellofemoral joint; patellar internal rotation, external rotation, and medial-lateral translation were all increased. Moreover, the stress distribution on patellar prostheses was altered, resulting in an increased surface maximal equivalent stress on the corresponding area. Moreover, during the gait cycle, we found that the area with maximal equivalent stress shifted its position. Finally, the patellofemoral joint showed decreased motion stability. From the view of kinematics and mechanics, this paper suggests that patella should be retained during TKA if it is possible. The present study presented approaches and technologies for evaluating kinematics and mechanical properties of total knee joint after TKA under gait loads. PMID:27057134

  5. Incidence of Peroneal Tendinopathy After Application of a Posterior Antiglide Plate for Repair of Supination External Rotation Lateral Malleolar Fractures.

    PubMed

    Ahn, Jungtae; Kim, Sehun; Lee, Jung-Soo; Woo, Kyungjei; Sung, Ki-Sun

    2016-01-01

    Posterior antiglide plating is widely used to treat lateral malleolar fractures caused by supination-external rotation injuries. Despite its widespread use, this technique can be associated with postoperative peroneal tendinopathy. The purpose of the present observational review was to report the incidence of peroneal tendinopathy after the use of posterior antiglide plating to treat lateral malleolar fractures caused by a supination-external rotation injury. A total of 70 patients were followed up for a minimum of 12 (mean 55, range 12 to 109) months. Bony union was obtained in all cases after a mean of 57 (range 37 to 81) days. The median number of screw holes in the plate was 4.9 (range 4 to 7), and the median number of screws used to fixate the fibula was 6.58 (range 5 to 10). The mean American Orthopaedic Foot and Ankle Society hindfoot-ankle score at the final follow-up examination was 90.8 (range 55 to 100). Clinically, 3 (4.29%) of the 70 patients had lateral or posterolateral ankle pain indicative of peroneal tendinopathy after the index surgery, without any objective evidence. Of the 70 patients, 41 (58.57%) underwent surgical removal of the fibular hardware, 2 (4.87%) because of lateral ankle discomfort. At removal, inspection of the peroneal tendon sheath and/or tendons showed no gross evidence of tendinopathy in any of the patients. We concluded that the incidence of clinically evident peroneal tendon symptoms associated with posterior antiglide plating is low (4.3%), and direct operative inspection revealed no gross evidence of tendinopathy. PMID:26342665

  6. Patellar malalignment treatment in total knee arthroplasty

    PubMed Central

    Gasparini, Giorgio; Familiari, Filippo; Ranuccio, Francesco

    2013-01-01

    Summary The patella, with or without resurfacing, plays a fundamental role in the success of a total knee arthroplasty (TKA). Patellofemoral joint complications are due to problems related to the patient, to the surgical technique, or to the design of the components. Patellar tracking is influenced by several factors: a severe preoperative valgus, the presence of pre-existing patellofemoral dysplasia, the design of the femoral component, the surgical approach, the Q angle, the mechanical alignment of the limb, the tightness of the lateral retinaculum, the positioning of the patellar component in the proximal-distal and medial-lateral directions, the patella height, the patella (native or resurfaced) thickness, the size of the femoral and the tibial components, and the alignment and rotation of the components. Several factors are crucial to prevent patellar maltracking in TKA: the use of an anatomical femoral component, a meticulous surgical technique, careful dynamic intraoperative assessment of patellar tracking, and, if necessary, the achievement of an adequate lateral release. PMID:25606506

  7. Achilles tendinopathy in amateur runners: role of adiposity (Tendinopathies and obesity)

    PubMed Central

    Abate, Michele; Oliva, Francesco; Schiavone, Cosima; Salini, Vincenzo

    2012-01-01

    Summary Obesity is an important risk factor for Achilles tendinopathy, and running is usually carried out to reduce excess body weight. Aim of this study was to evaluate the prevalence of Achilles tendinopathy in young over-weight amateur runners. Male runners and non runners were recruited and, in each category, divided in two groups: normal weight, and overweight. Data about Achilles tendon thickness, vascularisation and structural abnormalities were collected using a Power Doppler Ultrasonography device. Achilles tendon thickness was greater in both normal weight or overweight runners, but the difference was significant only in normal weight subjects. In non - runners, thickness was significantly higher only in over-weight subjects. Sonographic abnormalities were significantly prevalent in overweight runners. Running is associated to a physiologic hypertrophy of Achilles tendon in normal weight subjects. Overweight runners may precociously develop tendon abnormalities, due to the increased stress and the unfavourable milieu of repair. PMID:23738273

  8. Medial Patellofemoral Ligament Reconstruction for Patellar Dislocation

    PubMed Central

    Mackay, Nicola D.; Smith, Nicholas A.; Parsons, Nick; Spalding, Tim; Thompson, Peter; Sprowson, Andrew P.

    2014-01-01

    Background: With improved understanding of the biomechanical importance of the medial patellofemoral ligament (MPFL), its reconstruction for patellar dislocation has become increasingly popular. The aim of this systematic review was to critically determine the effectiveness of MPFL reconstruction for patellar dislocation. Hypothesis: MPFL reconstruction for patellar dislocation leads to a low redislocation rate with improved Kujala scores. Study Design: Systematic review; Level of evidence, 4. Methods: A literature search was performed using Embase and Medline (Ovid) databases. Inclusion criteria included first-time and recurrent patellar dislocation, subluxation, or persistent instability with a minimum follow-up of 12 months and documentation of postoperative redislocation rate or Kujala score. The studies were systematically appraised, and a meta-analysis was performed. Results: Twenty-two studies were included: 2 randomized controlled trials, 3 parallel case series, and 17 case series. There were a total of 655 knees in the review, with an age range at time of surgery from 11 to 52 years. The pooled postoperative redislocation rate from all 17 case series showed a mean of 2.44%. The pooled preoperative Kujala scores from 12 case series showed a mean of 51.6 (95% CI, 46.71-56.49). The pooled postoperative Kujala scores from 16 case series showed a mean of 87.77 (95% CI, 85.15-90.39). Conclusion: Although the studies were of low quality, the meta-analysis of 17 case series shows that MPFL reconstruction for recurrent patellar dislocation results in a significant improvement in Kujala scores, a low redislocation rate, and acceptable complication rate. Randomized trials would be needed to draw influences on the superiority of MPFL reconstruction compared with other treatments. PMID:26535352

  9. Symptomatic intratendinous ganglion cyst of the patellar tendon.

    PubMed

    Jose, Jean; O'Donnell, Kevin; Lesniak, Bryson

    2011-02-01

    Ganglion cysts have been previously described throughout the body, most commonly about the wrist, hand, knee, ankle, and feet. When symptomatic, they may interfere with joint mechanics, resulting in snapping, catching, and locking. Intratendinous ganglion cysts lack a synovial epithelial lining and are thought to develop from the mucoid degeneration of connective tissue caused by chronic irritation, chronic repetitive injury, and chronic ischemia. On magnetic resonance imaging, ganglion cysts originating from tendons, ligaments, tendon sheaths, menisci, or joint capsules appear as well-defined lobulated masses that follow simple or complex fluid signal intensity on all pulse sequences, with enhancing walls and internal septations on post-contrast images. There may be appreciable degeneration and partial tearing of the structure of origin, particularly if associated with tendons. On ultrasonography, they present as hypoechoic masses, with internal septations and lobulations of varying sizes, without significant vascularity on power or color Doppler sampling. A thin fluid neck extending from the structure of origin (tail sign), when present, is a reliable sign of a ganglion cyst. This article describes a sonographically guided technique to treat symptomatic ganglion cysts within the patellar tendon. Complete evacuation of the ganglion cyst, with disappearance of the tail sign, is considered the determining factor for a successful procedure. A similar technique can be used for the treatment of other symptomatic intratendinous ganglion cysts elsewhere in the body. To our knowledge, symptomatic intratendinous ganglion cysts within the patellar tendon and their treatment have not been previously reported. PMID:21323277

  10. Use of computed tomography to determine the risk of patellar dislocation in 921 patients with patellar instability

    PubMed Central

    Schueda, Marco Antonio; Astur, Diego Costa; Bier, Rodrigo Schueda; Bier, Debora Schueda; Astur, Nelson; Cohen, Moisés

    2015-01-01

    The purpose of this research was to identify reliable tomographic measurements that can detect patellofemoral abnormality and allow quantification of the risk of patellar dislocation in patients with potential patellar instability. A cross-sectional study in 921 patients with anterior pain or knee instability of at least 6 months’ duration was conducted from July 2001 to December 2009. All subjects were clinically evaluated and underwent radiography and computed tomography of their knees. According to their degree of dislocating patellar dysplasia, the subjects were classified into groups for statistical comparison. There was a statistically significant difference in all measurements when the groups were compared, except for external tibial torsion angle. The most sensitive and specific measurements for determining patellar instability were the trochlear groove angle, tibial tubercle-trochlear groove distance, average patellar tilt, and average patellar height. Patients with potential patellar instability, increased tibial tubercle-trochlear groove distance, and patellar height, tilt, and deviation measurements had a greater risk for patellar dislocation. The clinical relevance of this study is to determine measurements that are able to tell us about patellar dislocation risk. PMID:25784822

  11. The Accuracy of the VISA-P Questionnaire, Single-Leg Decline Squat, and Tendon Pain History to Identify Patellar Tendon Abnormalities in Adult Athletes.

    PubMed

    Mendonça, Luciana de Michelis; Ocarino, Juliana Melo; Bittencourt, Natália Franco Netto; Fernandes, Ludmila Maria Oliveira; Verhagen, Evert; Fonseca, Sérgio Teixeira

    2016-08-01

    Study Design Cross-sectional clinical assessment. Background Patellar tendinopathy is not always accompanied by patellar tendon abnormalities (PTAs). Thus, clinical screening tools to help identify patients with patellar tendon pain who have PTAs could enhance clinical decision making and patient prognosis. Objectives To test the diagnostic accuracy of the Victorian Institute of Sport Assessment-Patella (VISA-P) questionnaire, a single-leg decline squat (SLDS), tendon pain history, age, and years of sports participation to identify athletes with symptomatic patellar tendons who have PTAs confirmed on imaging. Methods Data provided by ultrasound examination, the VISA-P questionnaire, the SLDS, tendon pain history, age, and years of sport participation were collected in 43 athletes. A classification and regression tree (CART) model was developed to verify variables associated with PTA occurrence. Likelihood ratios (LRs) were computed for positive and negative tests. Results The SLDS, VISA-P questionnaire, and tendon pain history were associated with PTA occurrence. Athletes with negative results on all 3 tests (CART model) had a lower likelihood of having PTAs (negative LR = 0.3; 95% confidence interval [CI]: 0.2, 0.5). The isolated use of the SLDS or tendon pain history (positive LR = 4.2; 95% CI: 2.3, 7.14 and 4.5; 95% CI: 1.8, 11.1, respectively) had similar influence on probability of PTA presence compared to the CART model (positive LR = 4.1; 95% CI: 2.5, 6.3). Conclusion Although the objective was to investigate a clinical test to identify PTAs, the combined use of the tests had greater accuracy to identify individuals without PTAs. Level of Evidence Diagnosis, level 3b. J Orthop Sports Phys Ther 2016;46(8):673-680. Epub 3 Jul 2016. doi:10.2519/jospt.2016.6192. PMID:27374017

  12. Changes of Gait Parameters and Lower Limb Dynamics in Recreational Runners with Achilles Tendinopathy

    PubMed Central

    Kim, SungJoong; Yu, JaeHo

    2015-01-01

    This study aimed to clarify the mechanical gait changes caused by achilles tendinopathy by comparing gait parameters and changes in hip, knee, and ankle moments between an experimental group (EG) and a control group (CG). Twenty runners with achilles tendinopathy were included in the EG (male/female: 10/10, age: 27.00 ± 4.63), and 20 CG (male/female: 10/10, age: 27.25 ± 4.33) participants were recruited. Subjects walked a 13-m distance at their normal walking speed 5 times to obtain motion analysis and joint moment data. Gait parameter analysis showed significant differences in double-limb support (EG: 22.65 ± 4.26%, CG: 20.37 ± 4.46%), step length (EG: 0.58 ± 0.0 7m, CG: 0.64 ± 0.08 m), step width (EG: 0.16 ± 0.04 m, CG: 0.14 ± 0.05 m), stride time (EG: 1.09 ± 0.10 second, CG: 1.05 ± 0.08 second), and walking speed (EG: 1.09±0.18 m·s-1, CG: 1.23 ± 0.17 m·s-1) between the 2 groups (p < 0.05). Significant differences were found in hip joint moment for initial contact, mid-stance, terminal stance, and pre-swing phases; knee joint moment for initial contact and pre-swing phases; and ankle joint moment for pre-swing and terminal swing phases (p < 0.05). Gait parameters and hip, knee, and ankle moments were altered in runners with achilles tendinopathy. Thus, clinical features of gait changes should be understood for optimal treatment of achilles tendinopathy; further research is required in this field. Key points A reduction in gait parameters, namely, step length, stride length, and walking speed, and an increase in double-limb support occurs in runners with achilles tendinopathy. A reduction in the hip extension moment occurs during the initial contact, as well as a reduction in the knee flexion moment from the mid-stance to pre-swing phases, a continuous decrease in the knee flexion moment from the early stance phase, and a reduction in the extension moment during the terminal stance phase. A reduction in the ankle plantar flexion moment occurs from

  13. Changes of gait parameters and lower limb dynamics in recreational runners with achilles tendinopathy.

    PubMed

    Kim, SungJoong; Yu, JaeHo

    2015-06-01

    This study aimed to clarify the mechanical gait changes caused by achilles tendinopathy by comparing gait parameters and changes in hip, knee, and ankle moments between an experimental group (EG) and a control group (CG). Twenty runners with achilles tendinopathy were included in the EG (male/female: 10/10, age: 27.00 ± 4.63), and 20 CG (male/female: 10/10, age: 27.25 ± 4.33) participants were recruited. Subjects walked a 13-m distance at their normal walking speed 5 times to obtain motion analysis and joint moment data. Gait parameter analysis showed significant differences in double-limb support (EG: 22.65 ± 4.26%, CG: 20.37 ± 4.46%), step length (EG: 0.58 ± 0.0 7m, CG: 0.64 ± 0.08 m), step width (EG: 0.16 ± 0.04 m, CG: 0.14 ± 0.05 m), stride time (EG: 1.09 ± 0.10 second, CG: 1.05 ± 0.08 second), and walking speed (EG: 1.09±0.18 m·s(-1), CG: 1.23 ± 0.17 m·s(-1)) between the 2 groups (p < 0.05). Significant differences were found in hip joint moment for initial contact, mid-stance, terminal stance, and pre-swing phases; knee joint moment for initial contact and pre-swing phases; and ankle joint moment for pre-swing and terminal swing phases (p < 0.05). Gait parameters and hip, knee, and ankle moments were altered in runners with achilles tendinopathy. Thus, clinical features of gait changes should be understood for optimal treatment of achilles tendinopathy; further research is required in this field. Key pointsA reduction in gait parameters, namely, step length, stride length, and walking speed, and an increase in double-limb support occurs in runners with achilles tendinopathy.A reduction in the hip extension moment occurs during the initial contact, as well as a reduction in the knee flexion moment from the mid-stance to pre-swing phases, a continuous decrease in the knee flexion moment from the early stance phase, and a reduction in the extension moment during the terminal stance phase.A reduction in the ankle plantar flexion moment occurs from

  14. Chronic insertional Achilles tendinopathy: surgical outcomes

    PubMed Central

    Oshri, Yael; Palmanovich, Ezequiel; Brin, Yaron Shagra; Karpf, Ronen; Massarwe, Sabri; Kish, Benny; Nyska, Meir

    2012-01-01

    Summary Background and objective: insertional Achilles tendinopathy is a common condition among athletes and joggers. One fifth of the injuries involves the insertion of the tendon. The etiology is either due to mechanical overuse related to sports activity, or a systemic inflammatory disease. The clinical appearance includes pain and movement restriction. The primary treatment is conservative. The surgery referred to in this study (Calcaneal Osteotomy) is performed by decompression of the posterior margin of the calcaneus. If the tendon is degenerative, debridement is needed. There is controversy on the surgical outcome and the surgical approach. A retrospective analytic observational study. Methods: 20 patients who were diagnosed with IAT (21 feet) and were operated on between the years 2000–2007 by calcaneal osteotomy. Main outcome measures: the primary measure of success was diminished pain. It was demonstrated in the AOFAS score and in the VAS scale of pain. Results: the average grade in the AOFAS questionnaire improved by 20 points, and the average grading of pain in the VAS scale was decreased by 4.21. The median satisfaction rate was 8, the average was 5.81. 62% of the patients would repeat the surgery/recommend it. We found a significant relationship (p=0.022) between patients who avoided sports activity while suffering from insertional Achilles tendinopathy and the satisfaction rate from the surgery. Conclusions: using the calcaneal osteotomy technique as a surgical treatment for IAT is successful, and improves measures of pain and function. Low compliance with avoiding sports activity while suffering from an IAT might lead to a need for surgery. PMID:23738280

  15. Resection arthroplasty for failed patellar components

    PubMed Central

    Alcerro, Jose C.; Drakeford, Michael K.; Tsao, Audrey K.; Krackow, Kenneth A.; Hungerford, David S.

    2008-01-01

    A total of 1,401 primary total knee arthroplasties (TKA) were reviewed; 44 (3.2%) had at least the patellar component revised. Nine of these knees (eight patients) had insufficient bone stock to allow reimplantation of another patellar component. Clinical data on the nine knees were obtained with recent follow-up evaluation, review of their medical records and radiographs. Evaluation included Hospital for Special Surgery (HSS) scores. Average follow-up was 4 years and 7 months, 2-year range (2 months to 8 years and 4 months). Common factors found in these nine knees included: thin patella after primary TKR status, osteoarthritis, good range of motion and patella alta. Results were good to excellent in seven knees and fair in two. The untoward associations with patellectomy such as quadriceps lag, extension weakness and anterior knee pain were not experienced. Resection of the patellar component, without reimplantation, is an acceptable alternative in revision TKA lacking adequate remaining bone stock. PMID:18956182

  16. Expert opinion: diagnosis and treatment of proximal hamstring tendinopathy

    PubMed Central

    Lempainen, Lasse; Johansson, Kristian; Banke, Ingo J.; Ranne, Juha; Mäkelä, Keijo; Sarimo, Janne; Niemi, Pekka; Orava, Sakari

    2015-01-01

    Summary Background: proximal hamstring tendinopathy (PHT) is a disabilitating disease often causing underperformance in the athletically demanding patients. The main symptom of PHT is lower gluteal pain especially during running or while prolonged sitting. Mainly affecting athletically active individuals, PHT is a considerable challenge for treating health care professionals. Purpose: this paper aims to concisely present the literature on PHT to guide health care professionals treating these patients and doing research on the subject. Methods: we reviewed the literature on PHT through literature search of scientific journal databases. Conclusions: as a tendinopathic pathology, it is a rather recently discovered exertion injury. As with other chronic tendon overuse injuries, current treatment strategies are unspecific with uncertain outcomes due to the unknown etiology of the tendon degeneration. Diagnostic features as well as both operative and non-operative treatments are evaluated from a clinical perspective, providing up to date information for clinicians and sports medicine therapists dealing with hamstring problems. Level of evidence: V. PMID:25878983

  17. An Unusual Prepatellar Bursa Swelling: Patellar Button Dissociation and Migration

    PubMed Central

    Hester, Thomas; Moftah, Farid

    2016-01-01

    Implant loosening is not a new phenomenon, nor is implant migration; however they are rarely seen after knee arthroplasty surgery. Complications with patellar buttons have been reported before with peg failure, loosening, and patella fracture; however extra-articular migration is extremely rare. We report an unusual case of patellar button migration 11 years after total knee arthroplasty to the prepatellar bursa. PMID:26885422

  18. The chopstick-noodle twist: an easy technique of percutaneous patellar fixation in minimally displaced patellar fractures.

    PubMed

    Muzaffar, Nasir; Ahmad, Nawaz; Ahmad, Aejaz; Ahmad, Nissar

    2012-01-01

    We report six cases of minimally displaced two-part patellar fractures with skin injury over the patella that were treated with percutaneous K wire fixation and compression applied using stainless steel (SS) wire. This technique makes it possible to perform early operative treatment in cases where unhealthy skin is not amenable to conventional tension band wiring. The technique employs two K wires inserted through the two fracture fragments under local or regional anaesthesia. They are then compressed using simple SS wire knots at the two ends - making it look like noodles at the end of two chopsticks. The fixation is subsequently augmented with a cylindrical plaster-of-Paris cast. The technique is simple, cheap and does not cause soft tissue injury. PMID:22290109

  19. Efficacy of customised foot orthoses in the treatment of Achilles tendinopathy: study protocol for a randomised trial

    PubMed Central

    Munteanu, Shannon E; Landorf, Karl B; Menz, Hylton B; Cook, Jill L; Pizzari, Tania; Scott, Lisa A

    2009-01-01

    Background Achilles tendinopathy is a common condition that can cause marked pain and disability. Numerous non-surgical treatments have been proposed for the treatment of this condition, but many of these treatments have a poor or non-existent evidence base. The exception to this is eccentric calf muscle exercises, which have become a standard non-surgical intervention for Achilles tendinopathy. Foot orthoses have also been advocated as a treatment for Achilles tendinopathy, but the long-term efficacy of foot orthoses for this condition is unknown. This manuscript describes the design of a randomised trial to evaluate the efficacy of customised foot orthoses to reduce pain and improve function in people with Achilles tendinopathy. Methods One hundred and forty community-dwelling men and women aged 18 to 55 years with Achilles tendinopathy (who satisfy inclusion and exclusion criteria) will be recruited. Participants will be randomised, using a computer-generated random number sequence, to either a control group (sham foot orthoses made from compressible ethylene vinyl acetate foam) or an experimental group (customised foot orthoses made from semi-rigid polypropylene). Both groups will be prescribed a calf muscle eccentric exercise program, however, the primary difference between the groups will be that the experimental group receive customised foot orthoses, while the control group receive sham foot orthoses. The participants will be instructed to perform eccentric exercises 2 times per day, 7 days per week, for 12 weeks. The primary outcome measure will be the total score of the Victorian Institute of Sport Assessment - Achilles (VISA-A) questionnaire. The secondary outcome measures will be participant perception of treatment effect, comfort of the foot orthoses, use of co-interventions, frequency and severity of adverse events, level of physical activity and health-related quality of life (assessed using the Short-Form-36 questionnaire - Version two). Data will

  20. Gluteal Tendinopathy: Integrating Pathomechanics and Clinical Features in Its Management.

    PubMed

    Grimaldi, Alison; Fearon, Angela

    2015-11-01

    Synopsis Gluteal tendinopathy is now believed to be the primary local source of lateral hip pain, or greater trochanteric pain syndrome, previously referred to as trochanteric bursitis. This condition is prevalent, particularly among postmenopausal women, and has a considerable negative influence on quality of life. Improved prognosis and outcomes in the future for those with gluteal tendinopathy will be underpinned by advances in diagnostic testing, a clearer understanding of risk factors and comorbidities, and evidence-based management programs. High-quality studies that meet these requirements are still lacking. This clinical commentary provides direction to assist the clinician with assessment and management of the patient with gluteal tendinopathy, based on currently limited available evidence on this condition and the wider tendon literature and on the combined clinical experience of the authors. J Orthop Sports Phys Ther 2015;45(11):910-922. Epub 17 Sep 2015. doi:10.2519/jospt.2015.5829. PMID:26381486

  1. Treatment of supraspinatus tendinopathy with ultrasound guided dry needling

    PubMed Central

    Settergren, Roy

    2013-01-01

    Objective The purpose of this case study is to describe the treatment of a patient with tendinopathy using sonographically guided dry needling. Tendinopathies are a highly prevalent problem in musculoskeletal medicine, and no one form of treatment has gained universal acceptance as being superior to another. Clinical Features A 30-year-old woman with a 4-month history of anterolateral right shoulder pain was diagnosed with supraspinatus tendinopathy upon physical examination, which was confirmed with diagnostic sonography. Intervention and Outcome Sonography was used to guide an acupuncture needle into the pathologic tissue to induce a humoral healing response. Therapeutic exercise was also prescribed. At 10-day follow-up, increased echogenicity was found in the previously heterogenous hypoechoic areas. The patient also experienced a subjective resolution of her shoulder pain, which did not return with increased physical activity. Conclusions Sonographically guided dry needling was shown to be beneficial for this patient as evident by sonographic changes pre- and postprocedure. PMID:23997721

  2. Mid-portion Achilles tendinopathy: why painful? An evidence-based philosophy.

    PubMed

    van Sterkenburg, Maayke N; van Dijk, C Niek

    2011-08-01

    Chronic mid-portion Achilles tendinopathy is generally difficult to treat as the background to the pain mechanisms has not yet been clarified. A wide range of conservative and surgical treatment options are available. Most address intratendinous degenerative changes when present, as it is believed that these changes are responsible for the symptoms. Since up to 34% of asymptomatic tendons show histopathological changes, we believe that the tendon proper is not the cause of pain in the majority of patients. Chronic painful tendons show the ingrowth of sensory and sympathetic nerves from the paratenon with release of nociceptive substances. Denervating the Achilles tendon by release of the paratenon is sufficient to cause pain relief in the majority of patients. This type of treatment has the additional advantage that it is associated with a shorter recovery time when compared with treatment options that address the tendon itself. An evidence-based philosophy on the cause of pain in chronic mid-portion Achilles tendinopathy is presented. Level of evidence V. PMID:21567177

  3. The Dose That Works: Low Level Laser Treatment of Tendinopathy

    SciTech Connect

    Tumilty, Steve; Munn, Joanne; David Baxter, G.; McDonough, Suzanne; Hurley, Deirdre A.; Basford, Jeffrey R.

    2010-05-31

    Background: Low Level Laser Therapy (LLLT) is used in the treatment of tendon injuries. However, the clinical effectiveness of this modality remains controversial with limited agreement on the most efficacious dosage and parameter choices. Purpose: To assess the clinical effectiveness of LLLT in the treatment of tendinopathy and the validity of current dosage recommendations for treatment. Method: Medical databases were searched from inception to 1st August 2008. Controlled clinical trials evaluating LLLT as a primary intervention for any tendinopathy were included in the review. Methodological quality was classified using the PEDro scale. Appropriateness of treatment parameters were assessed using established guidelines. Results: Twenty five trials met the inclusion criteria. There was conflicting findings from multiple trials: 12 showed positive effects and 13 were inconclusive or showed no effect. Dosages used in the 12 positive studies support the existence of an effective dosage window that closely resembled current guidelines. Where pooling of data was possible, LLLT showed a positive effect size; in high quality studies of lateral epicondylitis, participants' grip strength was 9.59 Kg higher than the control group; for participants with Achilles tendinopathy, the effect was 13.6 mm less pain on a 100 mm visual analogue scale. Conclusion: This study found conflicting evidence as to the effectiveness of LLLT in the treatment of tendinopathy. However, an effective dosage window emerged showing benefit in the treatment of tendinopathy. Strong evidence exists from the 12 positive studies that positive outcomes are associated with the use of current dosage recommendations for the treatment of tendinopathy.

  4. The Dose That Works: Low Level Laser Treatment of Tendinopathy

    NASA Astrophysics Data System (ADS)

    Tumilty, Steve; Munn, Joanne; McDonough, Suzanne; Hurley, Deirdre A.; Basford, Jeffrey R.; David Baxter, G.

    2010-05-01

    Background: Low Level Laser Therapy (LLLT) is used in the treatment of tendon injuries. However, the clinical effectiveness of this modality remains controversial with limited agreement on the most efficacious dosage and parameter choices. Purpose: To assess the clinical effectiveness of LLLT in the treatment of tendinopathy and the validity of current dosage recommendations for treatment. Method: Medical databases were searched from inception to 1st August 2008. Controlled clinical trials evaluating LLLT as a primary intervention for any tendinopathy were included in the review. Methodological quality was classified using the PEDro scale. Appropriateness of treatment parameters were assessed using established guidelines. Results: Twenty five trials met the inclusion criteria. There was conflicting findings from multiple trials: 12 showed positive effects and 13 were inconclusive or showed no effect. Dosages used in the 12 positive studies support the existence of an effective dosage window that closely resembled current guidelines. Where pooling of data was possible, LLLT showed a positive effect size; in high quality studies of lateral epicondylitis, participants' grip strength was 9.59 Kg higher than the control group; for participants with Achilles tendinopathy, the effect was 13.6 mm less pain on a 100 mm visual analogue scale. Conclusion: This study found conflicting evidence as to the effectiveness of LLLT in the treatment of tendinopathy. However, an effective dosage window emerged showing benefit in the treatment of tendinopathy. Strong evidence exists from the 12 positive studies that positive outcomes are associated with the use of current dosage recommendations for the treatment of tendinopathy.

  5. Are occupational repetitive movements of the upper arm associated with rotator cuff calcific tendinopathies?

    PubMed

    Sansone, Valerio C; Meroni, Roberto; Boria, Paola; Pisani, Salvatore; Maiorano, Emanuele

    2015-02-01

    Calcifying tendinopathy (CT) of the shoulder is a common painful disorder, although the etiology and pathogenesis remain largely unknown. Recent theories about the role of excessive mechanical load in the genesis of CT have been proposed. Driven by the interest for these new theories, we investigated the hypothesis of a relationship between work-related repetitive movements of the upper arm, considered a potential cause of shoulder overload, and the presence of shoulder CT. A secondary aim was to obtain data on CT prevalence in a female sample from the working-age general population, as little data currently exist. 199 supermarket cashiers and 304 female volunteers recruited from the general population underwent a high-resolution ultrasonography of the rotator cuffs of both shoulders, and the presence of tendinopathies, with or without calcification, was recorded. The prevalence of calcific tendinopathy was 22.6 % in the cashiers group and 24.4 % in the control group. There were no statistically significant differences in the prevalence of calcifications between the two groups (p = 0.585), either for the dominant shoulder [OR = 0.841 (95 % CI 0.534-1.326)] or for the non-dominant shoulder [OR = 0.988 (95 % CI 0.582-1.326)]. We observed bilateral calcifications in 8.5 % of cashiers, and 9.6 % of controls, and an increase in prevalence of CT with age in both groups. Work-related repetitive movements of the upper arm did not induce a higher prevalence of shoulder CT compared with the female sample from the general population. If CT etiopathogenesis is related to mechanical load, CT onset may be influenced not only by loading history, but also by individual factors. Level of evidence Prognosis study, Level II. PMID:25000922

  6. BET 2: Do fluoroquinolones increase the incidence of tendinopathy?

    PubMed

    Baombe, Janos P; Ford, Rebecca

    2016-07-01

    A shortcut review of the literature was carried out to establish whether the use of fluoroquinolones was associated with an increased risk of tendinopathy in adult patients. 10 trials were found to be directly relevant to the three-part question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. The clinical bottom line is that there is an association between the use of fluoroquinolones and a broad range of tendinopathies. PMID:27330182

  7. Short-term effectiveness of bi-phase oscillatory waves versus hyperthermia for isolated long head biceps tendinopathy

    PubMed Central

    Oliva, Francesco; Via, Alessio Giai; Rossi, Silvio

    2011-01-01

    Summary Introduction: Long head biceps (LHB) tendinopathy is a common cause of anterior shoulder pain. Isolated LHB pathology is most common among younger people who practise overhead sports. The authors conducted a short-term prospective randomised study to test the effectiveness of two different methods for the treatment of isolated LHB tendinopathy: biphasic oscillatory waves and hyperthermia. Study design: The study is a prospective randomised study (Level II). Material and methods: The authors identified 20 patients who had clinical and ultrasound (US) evidence of LHB tendinopathy. No patient was a high-level athlete. The patients were randomly assigned to two groups. Group A (10 patients) was treated with bi-phasic oscillatory waves, while Group B received hyperthermia. During the treatment period, no other electromedical therapy, injections with corticosteroids, oral analgesics or nonsteroidal anti-inflammatory drugs were allowed. All the patients were assessed at baseline (T0), immediately after the end of the treatment period (T1) and 6 months after the end of treatment (T2) using a visual analogic scale (VAS) and Constant-Murley Score (CMS). Furthermore, all patients underwent US examinations at T0 and at T1. All the US examinations were performed by the same radiologist. Results: The VAS scores showed a highly statistically significant reduction of pain at T1 both in Group A (65%; p=0,004) and in Group B (50%; p=0,0002). The CMS also showed a statistically significant improvement between the pre-intervention, the post-treatment and the short-term follow-up in both groups. In addition, the peritendinous fluid evident on US examination at T0 was no longer present in all cases at T1. Conclusion: These findings suggest that both bi-phasic oscillatory waves and hyperthermia are able to relieve pain in patients with isolated LHB tendinopathy. This is a Class II level of evidence. PMID:23738257

  8. CALCIFYING TENDINOPATHY: A LOCAL OR A SYSTEMIC CONDITION?

    PubMed Central

    Ejnisman, Benno; Andreoli, Carlos Vicente; Monteiro, Gustavo Cará; Pocchini, Alberto de Castro; Cohen, Carina; Tortato, Simone; Franklin, Marcelo Marques Khede; Machado, Arthur Beber; Cohen, Moisés

    2015-01-01

    Objective: To evaluate the relationship between cases of calcifying tendinopathy of the shoulder and symptomatic metabolic diseases such as kidney stones, gallstones and gout. Methods: Calcifying tendinopathy of the shoulder was diagnosed in 63 patients between May 2007 and September 2011. All the patients were treated by the same orthopedic surgeon and were interviewed to gather the following data: age at diagnosis, sex, affected side, dominant side, body mass index (BMI), smoking status and previous histories of kidney stones, gallstones or gout. For statistical analysis, a control group of 63 patients with similar demographic characteristics was used. Results: Among the 63 patients with calcifying tendinopathy of the shoulder, 35 (56%) were male. The right side was affected in 38 patients (60%) and the average age was 48.2 years. Thirty-one patients (49%) had histories involving some of the metabolic diseases investigated: 20 patients (32%) reported kidney stones, six (9.5%) gallstones, four (6.3%) gout and one (2%) concurrent diagnoses of kidney stones and gout. In the control group, eleven patients (17%) had histories involving some of the metabolic diseases investigated: six patients (9.5%) reported kidney stones, four (6.3%) gallstones and one (1.6 %) gout. Conclusions: The high frequency of nephrolithiasis in patients with calcifying tendinopathy of the shoulder in our study suggests that there are common mechanisms in the pathophysiology of these disorders. Better understanding of these diseases may enable improvement of diagnostics and treatments. PMID:27047854

  9. Light and electron microscopic study of stress-shielding effects on rat patellar tendon.

    PubMed

    Muellner, T; Kwasny, O; Loehnert, V; Mallinger, R; Unfried, G; Schabus, R; Plenk, H

    2001-11-01

    In this second part of our study, the histomorphologic changes occurring in the patellar tendon (PT) of rats after sole stress-shielding were evaluated. In seven adult albino rats, both PTs were exposed by straight skin incision and then stress-shielded on one side by a cerclage, while the contralateral PT served as the sham-operated control. One animal died after the operation and was used as a negative control. After 10 weeks of otherwise unrestricted motion, the rats were killed, and the histomorphology of all PT specimen pairs compared by light and transmission electron microscopy. Light microscopy showed mid-portion thickening and irregularity of collagen bundles in the stress-shielded tendons. Intense remodelling was demonstrated by increased cellularity and vascularity, as well as by enrichment in acidic proteoglycans. Ultrastructural evaluation and morphometry revealed a predominance of large diameter (peak between 180 and 260 nm) collagen fibrils in the sham-operated controls, while in the stress-shielded tendons the number of apparently new, small-diameter (peak between 40 and 60 nm) collagen fibrils increased (up to 77% per cross-sectional field of view). The difference in peak diameters was statistically significant (p < 0.0005). This rat model demonstrated that sole stress-shielding not only causes biomechanical alterations, but also intense tissue remodelling and significant morphological changes in the collagen fibrils in the patellar tendon, comparable to so-called 'ligamentization' in experimental and clinical patellar tendon grafts for anterior cruciate ligament reconstruction. PMID:11768636

  10. Posttraumatic chronic patellar dislocation treated by distal femoral osteotomy and medial patellofemoral ligament reconstruction.

    PubMed

    Purushothaman, Balaji; Agarwal, Amit; Dawson, Matt

    2012-11-01

    Chronic patellar dislocation is a rare condition where the patella remains dislocated throughout knee range of motion during flexion and extension. In adults, the delayed presentation of this condition is often due to symptoms caused by the onset of severe secondary osteoarthritis. To the authors' knowledge, all of the cases reported in the literature have been treated by patellofemoral or total knee replacements depending on patient age and the extent of the arthritis. This article describes a rare case of a 22-year-old woman who sustained a traumatic chronic patellar dislocation for 5 months. Clinical examination revealed a valgus deformity of the left leg secondary to childhood injury and that the patella lay lateral to the lateral femoral condyle throughout flexion and extension. Radiographs of the knee revealed patellar dislocation. Long-leg radiographs of the left leg showed an anatomic tibiofemoral angle of 17° valgus. The anatomical (74°) and mechanical (80°) lateral distal femoral angles were abnormal, whereas the medial proximal tibial angle (87°) was normal, confirming that the valgus deformity was due to the abnormal distal femur. The authors performed a distal femoral osteotomy to correct the valgus deformity. Medial patellofemoral ligament reconstruction using a hamstring autograft was performed to stabilize the patella. PMID:23127463

  11. Two-Tension-Band Technique in Revision Surgery for Fixation Failure of Patellar Fractures.

    PubMed

    Xue, Zichao; Qin, Hui; Ding, Haoliang; Xu, Haitao; An, Zhiquan

    2016-01-01

    BACKGROUND Failed patellar fracture fixation is rare, and is usually attributed to technical errors. There are no specific details available on how to address this problem. We present our two-tension-band technique for fixing patellar fractures. MATERIAL AND METHODS Between March 2010 and March 2013, 4 men and 2 women with failed fixation patellar fractures were treated in our department. Their average age was 34 years (range 23-49 years). The initial fracture type was C1 in 3, C2 in 1, and C3 in 2, according to the AO classification. The initial fracture patterns included 3 transverse and 3 comminuted fractures. There were no open fractures. All patients underwent internal fixation with a modified anterior tension band (MATB) supplemented with cerclage wiring. All failures were caused by tension bands sliding past the tip of the Kirschner wires. The mean time between the primary and revision operations was 16.2 months (range 2-63 months). We revised the fractures by two-separate-tension-band technique. RESULTS The mean follow-up was 52 months (range 31-67 months). All patients healed radiographically without complications at an average of 14.7 weeks (range 8-20 weeks). The Bostman knee score was excellent in 3 and good in 3. All patients regained full extension and the mean range of flexion was 147.5° (135-155°). CONCLUSIONS Use of this two-tension-band technique can avoid technical errors and provide more secure fixation. We recommend it for both primary and revision surgery of patellar fractures. PMID:27485104

  12. Two-Tension-Band Technique in Revision Surgery for Fixation Failure of Patellar Fractures

    PubMed Central

    Xue, Zichao; Qin, Hui; Ding, Haoliang; Xu, Haitao; An, Zhiquan

    2016-01-01

    Background Failed patellar fracture fixation is rare, and is usually attributed to technical errors. There are no specific details available on how to address this problem. We present our two-tension-band technique for fixing patellar fractures. Material/Methods Between March 2010 and March 2013, 4 men and 2 women with failed fixation patellar fractures were treated in our department. Their average age was 34 years (range 23–49 years). The initial fracture type was C1 in 3, C2 in 1, and C3 in 2, according to the AO classification. The initial fracture patterns included 3 transverse and 3 comminuted fractures. There were no open fractures. All patients underwent internal fixation with a modified anterior tension band (MATB) supplemented with cerclage wiring. All failures were caused by tension bands sliding past the tip of the Kirschner wires. The mean time between the primary and revision operations was 16.2 months (range 2–63 months). We revised the fractures by two-separate-tension-band technique. Results The mean follow-up was 52 months (range 31–67 months). All patients healed radiographically without complications at an average of 14.7 weeks (range 8–20 weeks). The Bostman knee score was excellent in 3 and good in 3. All patients regained full extension and the mean range of flexion was 147.5° (135–155°). Conclusions Use of this two-tension-band technique can avoid technical errors and provide more secure fixation. We recommend it for both primary and revision surgery of patellar fractures. PMID:27485104

  13. Patellar Articular Overlap on MRI Is a Simple Alternative to Conventional Measurements of Patellar Height

    PubMed Central

    Munch, Jacqueline L.; Sullivan, Jaron P.; Nguyen, Joseph T.; Mintz, Douglas; Green, Daniel W.; Shubin Stein, Beth E.; Strickland, Sabrina

    2016-01-01

    Background: Patella alta describes an abnormally high-riding patella in relationship to the femur and has been shown to correlate with patellofemoral pain, instability, chondromalacia, and arthrosis. Conventional measurements of patella alta involve multiple measurements and are often not defined on cross-sectional imaging as related to radiographs. Hypothesis: Patellar articular overlap on sagittal magnetic resonance imaging (MRI) will correlate well with conventional measurements of patella alta as measured by a standardized technique defined by our group. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: MRIs of 239 knees were reviewed by 3 attending surgeons with practices focusing on patellofemoral disease, as well as 2 sports medicine fellows and 1 musculoskeletal radiologist. Measurements included articular overlap, percentage of articular coverage, Caton-Deschamps index, Blackburne-Peel index, and modified Insall-Salvati index. Results: Interrater reliability was high for Caton-Deschamps, Blackburne-Peel, and modified Insall-Salvati indices (intraclass correlation coefficient [ICC], 0.877, 0.828, and 0.787, respectively). Articular overlap and percentage articular coverage correlated well with each other (ICC, 0.961; P < .001) and with the Caton-Deschamps (overlap r = –0.271, P < .001; coverage r = –0.131, P = .037) and Blackburne-Peel (overlap r = 0.343, P < .001; coverage r = –0.238, P < .001) indices. Articular overlap and percentage coverage failed to correlate with the modified Insall-Salvati index (overlap r = –0.117, P = .091; coverage r = 0.007, P = .918). Conclusion: Patellar articular overlap and percentage of patellar articular coverage show promise as a simpler alternative to conventional, ratio-based measurements of patellar height. Future studies are needed to evaluate the range of normal and the relationship to our traditionally used measurements. PMID:27482530

  14. 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

  15. Direct Repair without Augmentation of Patellar Tendon Avulsion following TKA

    PubMed Central

    Kumar, Nishikant; Yadav, Chandrashekhar; Kumar, Ashok

    2015-01-01

    Complications involving the extensor mechanism after TKA are potentially disastrous. We are reporting a case of patellar tendon rupture from tibial tuberosity following total knee arthroplasty. We managed it by direct repair with fiberwire using Krackow suture technique without augmentation. Our long term result has been very encouraging. Our method is a safe and better method of management of patellar tendon avulsion following TKA when it happens without any tissue loss. PMID:25632362

  16. Gluteal Tendinopathy: A Review of Mechanisms, Assessment and Management.

    PubMed

    Grimaldi, Alison; Mellor, Rebecca; Hodges, Paul; Bennell, Kim; Wajswelner, Henry; Vicenzino, Bill

    2015-08-01

    Tendinopathy of the gluteus medius and gluteus minimus tendons is now recognized as a primary local source of lateral hip pain. The condition mostly occurs in mid-life both in athletes and in subjects who do not regularly exercise. Females are afflicted more than males. This condition interferes with sleep (side lying) and common weight-bearing tasks, which makes it a debilitating musculoskeletal condition with a significant impact. Mechanical loading drives the biological processes within a tendon and determines its structural form and load-bearing capacity. The combination of excessive compression and high tensile loads within tendons are thought to be most damaging. The available evidence suggests that joint position (particularly excessive hip adduction), together with muscle and bone elements, are key factors in gluteal tendinopathy. These factors provide a basis for a clinical reasoning process in the assessment and management of a patient presenting with localized lateral hip pain from gluteal tendinopathy. Currently, there is a lack of consensus as to which clinical examination tests provide best diagnostic utility. On the basis of the few diagnostic utility studies and the current understanding of the pathomechanics of gluteal tendinopathy, we propose that a battery of clinical tests utilizing a combination of provocative compressive and tensile loads is currently best practice in its assessment. Management of this condition commonly involves corticosteroid injection, exercise or shock wave therapy, with surgery reserved for recalcitrant cases. There is a dearth of evidence for any treatments, so the approach we recommend involves managing the load on the tendons through exercise and education on the underlying pathomechanics. PMID:25969366

  17. Factors Associated with Operative Treatment of De Quervain Tendinopathy

    PubMed Central

    Kachooei, Amir Reza; Nota, Sjoerd P.F.T; Menendez, Mariano E; Dyer, George S.M.; Ring, David

    2015-01-01

    Background: Geographic and doctor-to-doctor variations in care are a focus of quality and safety efforts in medicine. This study addresses factors associated with variation in the rate of operative treatment of de Quervain tendinopathy. Methods: We used a database including all patient encounters at 2 large medical centers, to study the experience of 10 hand surgeons and 1 physiatrist working in a hand surgery office in the treatment of 2,513 patients with de Quervain tendinopathy over a 12-year period. Survival analysis using the Kaplan-Meier method was used to compare surgery rates and time to surgery. Cox multivariable regression analysis was applied to identify factors associated with operative treatment. Results: One hundred ninety nine (7.9%) patients had surgery. The odds of operative treatment were 1.7 times greater after corticosteroid injection and varied more than 10-fold among providers. There was substantial variation in the overall rate of surgery by provider. Corticosteroid injection delayed surgery slightly, but was associated with a higher rate of surgery. Conclusion: Providers have substantial influence on treatment of de Quervain tendinopathy. The use of decision aids and other methods that help involve the patient in decision-making merit investigation as interventions to help reduce doctor-to-doctor variation. PMID:26213704

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

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Knee joint patellar (hemi-knee) metallic... § 888.3580 Knee joint patellar (hemi-knee) metallic resurfacing uncemented prosthesis. (a) Identification. A knee joint patellar (hemi-knee) metallic resurfacing uncemented prosthesis is a device made...

  19. 21 CFR 888.3580 - Knee joint patellar (hemi-knee) metallic resurfacing uncemented prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Knee joint patellar (hemi-knee) metallic... § 888.3580 Knee joint patellar (hemi-knee) metallic resurfacing uncemented prosthesis. (a) Identification. A knee joint patellar (hemi-knee) metallic resurfacing uncemented prosthesis is a device made...

  20. 21 CFR 888.3580 - Knee joint patellar (hemi-knee) metallic resurfacing uncemented prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Knee joint patellar (hemi-knee) metallic... § 888.3580 Knee joint patellar (hemi-knee) metallic resurfacing uncemented prosthesis. (a) Identification. A knee joint patellar (hemi-knee) metallic resurfacing uncemented prosthesis is a device made...

  1. Patellar tendinitis: the significance of magnetic resonance imaging findings.

    PubMed

    Shalaby, M; Almekinders, L C

    1999-01-01

    We evaluated the significance of magnetic resonance imaging findings in patients with patellar tendinitis. Midline sagittal magnetic resonance images were taken of 12 knees from 10 patients and of 17 knees from 15 age- and activity-matched subjects who underwent imaging for reasons other than patellar tendinitis. Of the 12 magnetic resonance imaging scans of knees with clinical patellar tendinitis, 3 (25%) exhibited no defect and only 7 (58%) had unequivocal intratendinous lesions. Among the 17 scans of subjects without clinical patellar tendinitis, 5 (34%) showed no defect and 4 (24%) had unequivocal intratendinous lesions. Proximal tendon width was significantly larger for the tendinitis patient group (5.0 +/- 1.7 mm versus 3.9 +/- 1.0 mm), although considerable overlap was present. All subjects with unequivocal intratendinous signal changes had a significantly longer nonarticular inferior patellar pole and were significantly older (38.1 years versus 26.8 years). Only Blazina stage III lesions were associated with abnormal findings on magnetic resonance imaging. As a whole, the sensitivity and specificity of magnetic resonance imaging was 75% and 29%, respectively. In younger patients with relatively mild symptoms, magnetic resonance imaging did not show significant changes; in older, active patients changes may be present in asymptomatic knees. PMID:10352771

  2. Irreducible Lateral Patellar Dislocation: A Case Report and Literature Review

    PubMed Central

    Grewal, Balvinder; Elliott, Devlin; Daniele, Luca; Reidy, James

    2016-01-01

    Background: Acute patellar dislocation is a common injury in young people, especially in adolescent females and athletes. Lateral dislocation is the most common form of patellar dislocation and often reduces spontaneously or with simple manipulation and closed reduction. We report a rare circumstance in which the patella was irreducible and required manipulation and closed reduction in the operating room. Case Report: While dancing, a 32-year-old female was knocked by a fellow dancer on her left knee, and she fell to the nightclub floor. She was unable to stand or bear weight because of the pain, and her knee was in fixed flexion with lateral displacement of the patella. Multiple attempts at closed reduction under sedation failed in the emergency department. Computed tomography (CT) images revealed a medial border patellar fracture and lipohemarthrosis that required closed reduction and manipulation in the operating room. The patient was placed in a Richards splint for follow-up and referred to a physiotherapist for conservative management. Conclusion: This case highlights the fact that some lateral patellar dislocations are irreducible on initial attempts, particularly if a fracture is present or another mechanism of impingement impedes relocation. CT imaging is a valuable diagnostic tool, and manipulation under anesthesia or open reduction in the operating room may be necessary. Our review of the literature further highlights the complexity and potential problems associated with treatment of locked lateral patellar dislocations. PMID:27303231

  3. Current evidence of extracorporeal shock wave therapy in chronic Achilles tendinopathy.

    PubMed

    Gerdesmeyer, Ludger; Mittermayr, Rainer; Fuerst, Martin; Al Muderis, Munjed; Thiele, Richard; Saxena, Amol; Gollwitzer, Hans

    2015-12-01

    Chronic Achilles tendinopathy has been described as the most common overuse injury in sports medicine. Several treatment modalities such as activity modification, heel lifts, arch supports, stretching exercises, nonsteroidal anti-inflammatories, and eccentric loading are known as standard treatment mostly without proven evidence. After failed conservative therapy, invasive treatment may be considered. Extracorporeal shock wave therapy (ESWT) has been successfully used in soft-tissue pathologies like lateral epicondylitis, plantar fasciitis, tendinopathy of the shoulder and also in bone and skin disorders. Conclusive evidence recommending ESWT as a treatment for Achilles tendinopathy is still lacking. In plantar fasciitis as well as in calcific shoulder tendinopathy shock wave therapy is recently the best evaluated treatment option. This article analysis the evidence based literature of ESWT in chronic Achilles tendinopathy. Recently published data have shown the efficacy of focused and radial extracorporeal shock wave therapy. PMID:26327530

  4. Two cases of surgically treated feline patellar fractures.

    PubMed

    Guillaumot, P; Scotti, S; Carozzo, C; Bouvy, B; Genevois, J-P

    2008-01-01

    A transverse patellar fracture in a six-month-old cat was successfully treated by figure-of-eight dorsal wiring of the patella. A longitudinal patellar fracture with luxation of a large medial fragment in a 2.5-year-old cat was treated by lateral marginal patellectomy with a positive outcome. While adding material to the few veterinary reports in that species, in this brief communication, the authors discuss the aetiology, diagnosis, and the treatment of the presented cases with regards to findings in previously published feline cases. PMID:18545720

  5. Operative Management of Patellar Instability in the United States

    PubMed Central

    Arshi, Armin; Cohen, Jeremiah R.; Wang, Jeffrey C.; Hame, Sharon L.; McAllister, David R.; Jones, Kristofer J.

    2016-01-01

    Background: Treatment of patellofemoral instability has evolved as our understanding of the relevant pathoanatomy has improved. In light of these developments, current practice patterns and management trends have likely changed to reflect these advancements; however, this has not been evaluated in a formal study. Purpose: To determine nationwide patient demographics, surgical trends, and postoperative complications associated with the operative management of patellar instability surgery. Study Design: Descriptive epidemiological study. Methods: A large private-payer database (PearlDiver) comprising patients covered by Humana and United Healthcare insurance policies was retrospectively reviewed using Current Procedural Terminology (CPT) codes to identify patients who underwent surgery for patellar instability. The study cohort was established by querying for patients billed under CPT codes 27420, 27422, or 27427 while satisfying the diagnostic requirement of patellar instability (International Classification of Diseases–9th Revision codes 718.36, 718.86, or 836.3). Patient demographics, surgical trends, concomitant procedures, and postoperative complications were determined. Results: A total of 6190 patients underwent surgical management for patellar instability. Adolescents (age range, 10-19 years) represented 51.5% of cases, and 59.6% were female. The number of patellar instability procedures increased annually over the study period in both the Humana (P = .004, R 2 = 0.76) and United Healthcare (P = .097, R 2 = 0.54) cohorts. The most common concomitant procedures were lateral retinacular release (43.7%), chondroplasty (31.1%), tibial tubercle osteotomy (13.1%), removal of loose bodies (10.5%), osteochondral grafting (9.5%), and microfracture surgery (9.5%). Manipulation under anesthesia was required in 4.6% of patients within 1 year. Patellar fracture within 1 year and infection within 30 days occurred in 2.1% and 1.2% of patients, respectively. Conclusion

  6. Is There an Ideal Patellar Thickness Following Total Knee Arthroplasty?

    PubMed

    Pierce, Todd P; Jauregui, Julio J; Cherian, Jeffrey J; Elmallah, Randa K; Harwin, Steven F; Mont, Michael A

    2016-01-01

    Orthopedic surgeons resurface the patella during total knee arthroplasty to avoid complications such as pain, patello-femoral arthritis, and patellar maltracking and to reduce the risk for reoperation. However, many complications, such as decreased range of motion, increased fractures, and polyethylene wear, have been described with this procedure. One determinant when resurfacing a patella is the thickness of its cuts. This review aims to investigate the relationship between patellar thickness and outcome parameters such as range of motion, patient-reported outcomes, periprosthetic fractures, and reoperations. PMID:26726982

  7. Nutraceutical supplement in the management of tendinopathies: a systematic review

    PubMed Central

    Fusini, Federico; Bisicchia, Salvatore; Bottegoni, Carlo; Gigante, Antonio; Zanchini, Fabio; Busilacchi, Alberto

    2016-01-01

    Summary Background nutraceuticals are common support therapy for management of tendinopathies. Even if they are widely diffused, our knowledge is still poor. The aim of this systematic review is to analyze the most commonly used nutraceuticals and their effects on tendons. Methods glucosamine and chondroitin sulphate, vitamin C, hydrolazed type 1 collagen, arginine alpha-keto-glutarate, bromelain, curcumin, boswellic acid, and methil-sulfonil-methane were considered. During the last week of Dicember 2015 a comprehensive research of main databases for each substance was made in relation with tendinopathy. Repeated articles, articles not in English nor in Italian, not common nutraceuticals, and articles not related with tendons or tenocytes were excluded. Clinical article quality was assessed independently by two reviewers using the modified Coleman methodology score. Results preclinical and clinical data from 46 articles from all databases were analyzed. All these nutraceuticals demonstrated several effects on normal and pathological tendons. Preclinical and clinical studies showed a possible role on collagen synthesis, inflammation, mechanical properties, and maturation of collagen bundles, antioxidant effect, edema, and analgesia. The majority clinical studies had some methodological limitations with an average Modified Coleman Methodology Score of 51.3 points and SD of 20.5 points. In particular, there were very low values in power, error, outcome assessment, and clinical effect. Conclusion preclinical results are very encouraging, however they are not fully confirmed by clinical studies. There are few clinical papers on the use of nutraceuticals in tendon disorders, and their methodological quality is poor. Furthermore, in most of the studies more than one supplement was administered at the same time. This may bias the results, and the effect of each single component cannot be determined. Furthermore, the interactions between nutraceuticals and drugs, or other

  8. Posterior heel pain (retrocalcaneal bursitis, insertional and noninsertional Achilles tendinopathy).

    PubMed

    Aronow, Michael S

    2005-01-01

    The majority of patients with Achilles tendinopathy respond to nonoperative treatment. In patients with refractory symptoms, surgery can be considered. If paratenonitis is present, the paratenon is partially excised, and adhesions are released. Areas of symptomatic tendinosis are excised with repair of the residual defect in the Achilles tendon. An alternative for patients with tendinosis who are at increased risk for wound problems or who do not want a large open incision is percutaneous or endoscopic tenotomy. A symptomatic Haglund's deformity or inflamed retrocalcaneal bursa is excised. Augmentation of the Achilles tendon may be considered if debridement threatens the structural integrity of the tendon, in older patients, and in revision surgery. PMID:15555841

  9. Contractile dysfunction of the shoulder (rotator cuff tendinopathy): an overview

    PubMed Central

    Littlewood, Chris

    2012-01-01

    It is now over a decade since the features defining a contractile dysfunction of the shoulder were first reported. Since this time, some progress has been made to better understand this mechanical syndrome. In response to these developments, this narrative review will explore current understanding in relation to pathology, diagnosis, treatment, and prognosis of this syndrome with reference to literature specifically relating to contractile dysfunction but also literature relating to rotator cuff tendinopathy where necessary. The review not only identifies the strengths of the mechanical diagnosis and therapy approach with reference to a contractile dysfunction of the shoulder but also identifies where further progress needs to be made. PMID:24179329

  10. 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

  11. PHYSICAL THERAPY INTERVENTION FOR MEDIAL PATELLOFEMORAL LIGAMENT RECONSTRUCTION AFTER REPEATED LATERAL PATELLAR SUBLUXATION/DISLOCATION

    PubMed Central

    Mooney, Brianne; Vitale, Ashley; Apergis, Demitra; Wirth, Stephen; Grossman, Mark G.

    2016-01-01

    ABSTRACT Background The incidence of patellar subluxation or dislocation has been documented up to 43/100,000 with females more prevalent then males. There are many contributing factors involving the hip, knee, and ankle that lead to patellar subluxation. A patellar position of lateral tilt with lateral glide may indicate weakness of the vastus medialis oblique (VMO) and adductors, increased tightness in the iliotibial band, and overpowering of the vastus lateralis. Patella alta can predispose an individual to lateral dislocation due to the patella placement outside of the femoral trochlear groove with a disadvantage of boney stability. Other factors that may cause the patella to laterally sublux or dislocate during a functional activity or sporting activity include a position of femoral external rotation, tibial internal rotation, and excessive contraction of the vastus lateralis. The medial patellofemoral ligament (MPFL) aids in the prevention of a lateral patellar subluxation or dislocation. In cases where there is recurrent subluxation/dislocation and Magnetic Resonance Imaging confirms a MPFL tear, a reconstruction may be the treatment of choice. Purpose The purpose of this case series is to describe the post-surgical physical therapy management of MPFL reconstructions, outcomes using the Modified Cincinnati Knee Outcome Measure (MCKOM) and to propose staged physical therapy interventions for this pathology in the form of a treatment progression. Methods Post-operative management data and outcomes were retrospectively collected using a detailed chart review methodology from seven subjects who underwent MPFL reconstruction. Findings The Modified Cincinnati Knee Outcome Measure (MCKOM) was analyzed for each participant in four sections that were most important to the return and maintenance of participation in sport. At follow-up the mean scores for the seven subjects in Section 3 (instability) was 19.3/20, Section 4 (overall activity level) was 17.3/20, Section

  12. Patellar anomaly — a case review of quadripartite patella

    PubMed Central

    Grilliot, James R

    1985-01-01

    A case of quadripartite patella of the right knee is presented. Although multipartite patellar anomalous development is not uncommon, its differential diagnosis is critical to appropriate patient management. This case is somewhat unique in that it not only presented with multiple centers of nonunion, but was unilateral and symptomatic. ImagesFigure 1Figure 2

  13. Validation of Patellar Stabilization Surgical Algorithm Based on Congruence

    PubMed Central

    Kejriwal, Ritwik; Dalrymple, Rhydian; Annear, Peter

    2016-01-01

    Background: Multiple algorithms exist for proximal and/or distal stabilisation surgery for patellar instability with no consensus in the literature. Aim: To validate our surgical algorithm based on patellofemoral congruence for patellar instability. Algorithm: Once patellar stabilization surgery is clinically indicated, we determine patellofemoral congruence abnormality based on quadriceps active CT and intraoperative arthroscopic assessment. Arthroscopic lateral release is carried out if indicated. For patients with minimal incongruence post lateral release, MPFL reconstruction alone (MPFL group) is performed, and we perform tibial tubercle transfer and MPFL reconstruction (TTT group) for significant incongruence Methods: Retrospective study with prospective follow up of patients operated on between 2008 and 2015. We excluded patients with skeletal immaturity, previous patellofemoral surgery, and distalisation of tibial tubercle. Chart review, pre and post operative quadriceps active CT, Kujala score, and patient’s subjective stability analysed. Results: 98 patients were reviewed with mean follow up 37 weeks. 14 patients had MPFL alone. Recurrence of instability occurred in 4% of patients, all in TTT group. Reoperation rate was 19%, almost all in TTT group, with removal of hardware being the most common reason. There was no significant difference in TTTG between the two groups on pre operative CT measurement. Conclusion: Patellar stabilization surgical algorithm based on congruence is valid in preventing further instability. Reoperation rate is high due to majority of patients receiving TTT procedure.

  14. Pelvic limb alignment in small breed dogs: a comparison between affected and free subjects from medial patellar luxation.

    PubMed

    Olimpo, Matteo; Piras, Lisa Adele; Peirone, Bruno

    2016-03-31

    Small breed dogs are 12 times more likely to develop medial patellar luxation (MPL) than large breed dogs and breed predisposition has been reported. Many surgical techniques are available for correction of patellar luxation in dogs. However, recent studies reported an 8% incidence of reluxation when traditional techniques are used. The relatively high frequency of major complications and patellar reluxation may be partially caused by inadequate appreciation of the underlying skeletal deformity and subsequent incorrect selection and application of traditional techniques. The aims of this study were to report the normal values of the anatomic and mechanical joint angles of the femur and tibia in small breed dogs and to compare these data to a population of small breed dogs a ected by di erent degrees of MPL. Normal values of the anatomic and mechanical angles of the femur are similar to the ones reported in literature in Pomeranian dogs. Normal values of the anatomic and mechanical angles of the tibia have been described for the rst time. Signi cant di erences were found between normal population and dogs a ected by grade 4 MPL in relation to anatomical Lateral Distal Femoral Angle (aLDFA), mechanical Medial Proximal Tibial Angle (mMPTA), and mechanical Caudal Proximal Tibial Angle (mCaPTA). PMID:26681507

  15. High hamstring tendinopathy in 3 female long distance runners

    PubMed Central

    White, Kristin E.

    2011-01-01

    Objective The purpose of this case report is to describe and discuss the clinical presentation, diagnosis, and management of 3 female long distance runners with high hamstring tendinopathy. Clinical Features Three female runners presented to a chiropractic office with proximal hamstring pain that was aggravated by running. Increasing mileage, hills, and/or interval training preceded the onset of symptoms in each case. The subjects all displayed weakness of the hip abductors, pelvic joint dysfunction, hamstring tightness, and ischial tuberosity tenderness. Other clinical findings included overpronation, proprioceptive weakness, and lumbar dysfunction. Intervention and Outcome All 3 patients were treated with Graston Instrument Assisted Soft Tissue Mobilization, lumbopelvic manipulation, and electrical muscle stimulation with ultrasound. Active exercise focused on hamstring stretching and strengthening, gluteal strengthening, and proprioceptive training. The 3 runners seen in this clinic had resolution of hamstring pain in an average of 13 treatments and were able to continue competing without restriction. Conclusion Runners with high hamstring tendinopathy may respond favorably to conservative chiropractic treatment and active rehabilitation with minimal time off of training. PMID:22014863

  16. Conservative management of Achilles Tendinopathy: a case report

    PubMed Central

    Papa, John A.

    2012-01-01

    Objective: To chronicle the conservative treatment and management of a 77-year old female patient presenting with chronic pain of 8 months duration in the midportion of the achilles tendon diagnosed as achilles tendinopathy. Clinical features: The main clinical feature was pain in the midportion of the achilles tendon, 2 to 6 cm proximal to the calcaneal insertion. Symptom onset was gradual and unrelated to any acute trauma or overt injury mechanism. Intervention and outcome: The conservative treatment approach consisted of medical acupuncture with electrical stimulation, Graston Technique®, eccentric calf training, and rehabilitative exercise prescription. Outcome measures included verbal pain rating scale, lower extremity functional scale (LEFS), and a return to activities of daily living (ADLs). The patient attained long-term resolution of her complaint and at 12 month follow-up reported no recurrence of symptoms. Conclusion: A combination of conservative rehabilitation strategies may be used by chiropractors to treat midportion achilles tendinopathy and allow an individual to return to pain free ADLs in a timely manner. PMID:22997472

  17. Chronic Achilles tendinopathy. A survey of surgical and histopathologic findings.

    PubMed

    Aström, M; Rausing, A

    1995-07-01

    The surgical findings and the histopathology are reported for 163 patients (134 males, 29 females; mean age, 38 years; range, 13-72 years; 75% athletes) with chronic Achilles tendinopathy. Biopsy specimens from symptomatic (155 cases) and nonsymptomatic (90 cases) parts of the tendon and from the paratenon (97 cases) were obtained. Surgical reports were reviewed and histopathology was evaluated according to a standardized protocol. Eighteen tendons also were analyzed by immunofluorescence for fibrinogen, immunoglobulins, and complement. Degenerative changes (tendinosis) characterized by abnormal fiber structure, focal hypercellularity, and vascular proliferation were noted in 90% of biopsy specimens from symptomatic parts of the tendons and, to a lesser degree, in 20% from nonsymptomatic parts. Fibrinogen could be identified in most lesion biopsy specimens. Partial tendon ruptures were present in 19% of the patients and always occurred in areas afflicted with tendinosis. The paratenon was mostly normal or revealed only slight changes. Increasing age and male gender were associated with more pronounced histopathologic changes. Tendinosis, sometimes complicated by partial rupture, appears to be the major lesion in chronic Achilles tendinopathy; the paratenon is rarely involved. Important features are a lack of inflammatory cells and a poor healing response. PMID:7634699

  18. Towards an Understanding of the Genetics of Tendinopathy.

    PubMed

    September, Alison; Rahim, Masouda; Collins, Malcolm

    2016-01-01

    To date, more than 18 genomic intervals, which underpin the complex myriad of extracellular matrix interactions of tendons, have been implicated in risk models for tendinopathy. It is these relationships that most likely regulate the tissue's response to loading and unloading, thereby dictating the overall capacity of tendons and influencing injury susceptibility. The evidence suggesting a genetic contribution to the susceptibility of sustaining a tendon injury is growing. However, only a few of the loci have been repeated in independent studies, of which some have included a range of musculoskeletal soft tissues injuries. Case-control study designs can be effective in capturing risk, provided that the cases and controls are equally well-defined and carefully considered. The genome consists of 3.6 × 10(9) sequences and therefore we realise that we are far from decoding all the genomic signatures. We are indeed fortunate to be living in such exciting times where high-throughput technologies are at our disposal. Through collaboration, our chances of harnessing these "omics" technologies to further our clinical understanding of tendinopathy will increase. PMID:27535252

  19. Total knee arthroplasty in a patient with neglected congenital patellar dislocation.

    PubMed

    Tunay, Servet; Ozkan, Huseyin; Köse, Ozkan; Atik, Aziz; Basbozkurt, Mustafa

    2009-10-01

    Late presentation of congenital patellar dislocation with advanced osteoarthritis is rare. This article presents a case of 56-year-old woman with advanced osteoarthritis due to right neglected congenital patellar dislocation treated with total knee arthroplasty (TKA) with release of the lateral retinaculum and proximal extensor mechanism realignment. One year later, the patient had improvement of her Knee Society scores and painless function, stability, and better extensor strength. A literature search revealed a limited number of similar cases in which congenital patellar dislocation was treated with TKA. Total knee arthroplasty provides a valid treatment option for adults with congenital patellar dislocation who have absence of the femoral sulcus and associated osteoarthritis. Total knee arthroplasty has the ability to correct the pathologies seen with congenital patellar dislocation, eg, external tibial rotation, absence of femoral groove, and patellar hypoplasia. Realignment of extensor mechanism restores quadriceps strength, normal knee biomechanics, and may prevent complications such as dislocation. PMID:19824599

  20. Evaluation and Management of Patellar Instability in Pediatric and Adolescent Athletes

    PubMed Central

    Khormaee, Sariah; Kramer, Dennis E.; Yen, Yi-Meng; Heyworth, Benton E.

    2015-01-01

    Context: The rising popularity and intensity of youth sports has increased the incidence of patellar dislocation. These sports-related injuries may be associated with significant morbidity in the pediatric population. Treatment requires understanding and attention to the unique challenges in the skeletally immature patient. Evidence Acquisition: PubMed searches spanning 1970-2013. Study Design: Clinical review. Level of Evidence: Level 5. Results: Although nonoperative approaches are most often suitable for first-time patellar dislocations, surgical treatment is recommended for acute fixation of displaced osteochondral fractures sustained during primary instability and for patellar realignment in the setting of recurrent instability. While a variety of procedures can prevent recurrence, the risk of complications is not minimal. Conclusion: Patellar stabilization and realignment procedures in skeletally immature patients with recurrent patellar dislocation can effectively treat patellar instability without untoward effects on growth if careful surgical planning incorporates protection of growth parameters in the skeletally immature athlete. PMID:25984256

  1. 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

  2. Management of insertional Achilles tendinopathy through a Cincinnati incision

    PubMed Central

    Carmont, Michael R; Maffulli, Nicola

    2007-01-01

    Background About 10% of patients not responding to 3–6 months of conservative management for insertional Achilles tendinopathy undergo surgery. Traditionally, surgery of the Achilles tendon is performed through longitudinal extensile incisions. Such surgery is prone to the complications of wound healing, wound breakdown and iatrogenic nerve injury. Methods We describe our current method of exposure of the Achilles tendon insertion and debridement of the peritendinous and tendon tissue with osteotomy of the calcaneum through a transverse skin incision at the level of the Achilles insertion. Results This method has been used since 2002 on over 40 patients for exposure of the Achilles tendon insertion and the distal Achilles tendon. Conclusion The Cincinnati incision allows adequate exposure, has minimal risk of symptomatic iatrogenic nerve injury, and has minimal problems related to the scar. PMID:17697370

  3. Tendinopathies in the upper extremity: a paradigm shift.

    PubMed

    Ashe, Maureen C; McCauley, Tracey; Khan, Karim M

    2004-01-01

    Epicondylitis and de Quervain's tenosynovitis are two common diagnoses seen by hand therapists in clinical practice. Traditionally, these conditions have been viewed as being due to an inflammatory process and treated as such. New research shows that tendons exhibit areas of degeneration and a distinct lack of inflammatory cells. Tendinosis is degeneration of the collagen tissue due to aging, microtrauma, or vascular compromise. This article reviews key literature related to tendinopathies in the lower extremity and comments on the dearth of similar articles for the elbow and forearm. Hand therapists are encouraged to embrace this new terminology and to engage in research in this difficult area to improve treatment regimens and outcome measures. PMID:15273673

  4. 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

  5. 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

  6. Simulation of patella alta and the implications for in vitro patellar tracking in the ovine stifle joint.

    PubMed

    Bertollo, Nicky; Pelletier, Matthew H; Walsh, William R

    2012-11-01

    Patella alta is associated with adverse cartilage adaptations, patellofemoral pain, and instability. It is defined by a relatively long patellar tendon and patella positioned in a more proximal location within the patellar groove of the femur. This study used the ovine stifle joint model to investigate the effect of patellar tendon lengthening on the 3D passive kinematics of the patellofemoral and tibiofemoral joints. Eight patellar tendons were lengthened in 2 mm increments up to a maximum of 12 mm (20%) using a device placed in series with the transected patellar tendon. Three-dimensional kinematics were measured in the intact joint and at each increment of patellar tendon length (L(T)) during passively induced tibiofemoral flexion. Patellar flexion angle was linearly correlated with tibial flexion angle in the intact joint, and this correlation persisted after tendon lengthening (R = 0.897-0.965, p < 0.01). Patellofemoral kinematics expressed as a function of tibial flexion angle were significantly altered by L(T) increases >9%. In contrast, when patellofemoral kinematics were expressed as a function of patellar flexion angle they were not significantly altered by increases in L(T). Tibiofemoral kinematics were not affected by the L(T) increases. These results demonstrate that for a given tibial flexion angle, patellar tendon lengthening alters the patellar flexion angle. However, for a given patellar flexion angle, the orientation of the patella in the remaining five degrees of freedom is unchanged, implying a repeatable path of patellar motion. PMID:22581606

  7. Inflammatory and Metabolic Alterations of Kager's Fat Pad in Chronic Achilles Tendinopathy

    PubMed Central

    Fredberg, Ulrich; Kjær, Søren G.; Quistorff, Bjørn; Langberg, Henning; Hansen, Jacob B.

    2015-01-01

    Background Achilles tendinopathy is a painful inflammatory condition characterized by swelling, stiffness and reduced function of the Achilles tendon. Kager’s fat pad is an adipose tissue located in the area anterior to the Achilles tendon. Observations reveal a close physical interplay between Kager’s fat pad and its surrounding structures during movement of the ankle, suggesting that Kager’s fat pad may stabilize and protect the mechanical function of the ankle joint. Aim The aim of this study was to characterize whether Achilles tendinopathy was accompanied by changes in expression of inflammatory markers and metabolic enzymes in Kager’s fat pad. Methods A biopsy was taken from Kager’s fat pad from 31 patients with chronic Achilles tendinopathy and from 13 healthy individuals. Gene expression was measured by reverse transcription-quantitative PCR. Focus was on genes related to inflammation and lipid metabolism. Results Expression of the majority of analyzed inflammatory marker genes was increased in patients with Achilles tendinopathy compared to that in healthy controls. Expression patterns of the patient group were consistent with reduced lipolysis and increased fatty acid β-oxidation. In the fat pad, the pain-signaling neuropeptide substance P was found to be present in one third of the subjects in the Achilles tendinopathy group but in none of the healthy controls. Conclusion Gene expression changes in Achilles tendinopathy patient samples were consistent with Kager’s fat pad being more inflamed than in the healthy control group. Additionally, the results indicate an altered lipid metabolism in Kager’s fat pad of Achilles tendinopathy patients. PMID:25996876

  8. Presence of a long accessory flexor tendon of the toes in surgical treatment for tendinopathy of the insertion of the calcaneal tendon: case report☆

    PubMed Central

    Gomes Júnior, Nelson Pelozo; Andreoli, Carlos Vicente; Pochini, Alberto de Castro; Raduan, Fernando Cipolini; Ejnisman, Benno; Cohen, Moisés

    2015-01-01

    The presence of accessory tendons in the foot and ankle needs to be recognized, given that depending on their location, they may cause disorders relating either to pain processes or to handling of the surgical findings. We describe the presence of an accessory flexor tendon of the toes, seen in surgical exposure for transferring the long flexor tendon of the hallux to the calcaneus, due to the presence of a disorder of tendinopathy of the insertion of the calcaneal tendon in association with Haglund's syndrome. PMID:26962495

  9. 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

  10. Ultrasonograph and clinical quantitative characterization of tendinopathy by modified splitting in a goat model.

    PubMed

    Kavaguchi De Grandis, A; Boulocher, C; Viguier, E; Roger, T; Sawaya, S

    2012-01-01

    A tendinopathy is a clinical condition characterized by activity-related pain, focal tendons tenderness, and intratendinous imaging changes. This study characterizes a surgically induced tendinopathy in a goat model with a noninvasive in vivo longitudinal followup based on physical examination and US. Cross-sectional area (CSA) is the most objective feature for the evaluation of tendinopathy in correlation with clinical findings. The deep digital flexor tendon (DDFT) of the left hind limb of six goats was isolated and scarified by a modified splitting. Pain and lameness at walk and trot were evaluated. External width and thickness of tendon region were measured by calipers. CSA and the ratio lesion/tendon CSA were obtained at days 0, 7, 21, 42, and 84 by US. The highest value of global functional score was obtained at day 7, then decreased until day 40 and was not significantly different from day 0 at the end of the study. The external width recovered a normal value at the end of the study, but the external thickness was still significantly increased (P < 0.05). Peritendinous oedema was observed at day 7, but intratendinous lesions were visible only at day 21 as a focal hypo to anechoic area. At day 84, two tendons still presented visible lesions. US examination was reproducible, specific, and provided complementary information to the global functional score. A standardized focal tendinopathy was induced in goats. This experimental model of focal tendinopathy could be used to study the effect of different treatments. PMID:22997496

  11. Tendinopathy of the long head of the biceps tendon: histopathologic analysis of the extra-articular biceps tendon and tenosynovium

    PubMed Central

    Streit, Jonathan J; Shishani, Yousef; Rodgers, Mark; Gobezie, Reuben

    2015-01-01

    Background Bicipital tendinitis is a common cause of anterior shoulder pain, but there is no evidence that acute inflammation of the extra-articular long head of the biceps (LHB) tendon is the root cause of this condition. We evaluated the histologic findings of the extra-articular portion of the LHB tendon and synovial sheath in order to compare those findings to known histologic changes seen in other tendinopathies. Methods Twenty-six consecutive patients (mean age 45.4±13.7 years) underwent an open subpectoral biceps tenodesis for anterior shoulder pain localized to the bicipital groove. Excised tendons were sent for histologic analysis. Specimens were graded using a semiquantitative scoring system to evaluate tenocyte morphology, the presence of ground substance, collagen bundle characteristics, and vascular changes. Results Chronic inflammation was noted in only two of 26 specimens, and no specimen demonstrated acute inflammation. Tenocyte enlargement and proliferation, characterized by increased roundness and size of the cell and nucleus with proteoglycan matrix expansion and myxoid degenerative changes, was found in all 26 specimens. Abundant ground substance, collagen bundle changes, and increased vascularization were visualized in all samples. Conclusion Anterior shoulder pain attributed to the biceps tendon does not appear to be due to an inflammatory process in most cases. The histologic findings of the extra-articular portion of the LHB tendon and synovial sheath are similar to the pathologic findings in de Quervain tenosynovitis at the wrist, and may be due to a chronic degenerative process similar to this and other tendinopathies of the body. PMID:25792859

  12. Relationship between patellar tendon shortening and in vitro kinematics in the ovine stifle joint.

    PubMed

    Bertollo, Nicky; Pelletier, Matthew H; Walsh, William R

    2013-04-01

    Post-operative patellar tendon shortening induces a distal positioning of the patella in the femoral trochlear groove, which has been associated with pain and impeded mobility. An idealized in vitro model was used to examine the effects of shortening on patellar kinematics. The PT length was progressively reduced by up to 5 mm (1-mm instalments) using a device secured onto the tendon in n = 9 ovine stifles. In vitro 6 degrees-of-freedom motion data for the patellofemoral and tibiofemoral joints under conditions of passively induced flexion-extension was acquired electromagnetically. Patellar motion was analysed as a function of both tibial and patellar flexion angles relative to the femoral co-ordinate frame. Linear regression with contrasts was used to compare kinematic changes for each shortening level, with significance set at P<0.01. A mean maximum percentage length reduction of 8.2% was achieved. Patellar flexion was linearly correlated with tibial flexion angle in the intact joint, and this correlation persisted after tendon shortening (R = 0.977, P < 0.01). Patellar kinematics expressed as a function of tibial flexion angle were significantly altered by a mean length decrease of 8.2%, while flexion and proximo-distal shift patterns were significantly affected at lesser shortening levels of 3.1% and 4.7%, respectively. Patellar kinematics expressed as a function of patellar flexion angle remained unchanged. These results suggest that patellar motion within the trochlear groove in the ovine stifle joint follows a repeatable three-dimensional path and that patellar tendon shortening advances the position of the patella along this path, without significantly altering it. PMID:23637219

  13. Creating an Animal Model of Tendinopathy by Inducing Chondrogenic Differentiation with Kartogenin

    PubMed Central

    Yuan, Ting; Zhang, Jianying; Zhao, Guangyi; Zhou, Yiqin; Zhang, Chang-Qing; Wang, James H-C.

    2016-01-01

    Previous animal studies have shown that long term rat treadmill running induces over-use tendinopathy, which manifests as proteoglycan accumulation and chondrocytes-like cells within the affected tendons. Creating this animal model of tendinopathy by long term treadmill running is however time-consuming, costly and may vary among animals. In this study, we used a new approach to develop an animal model of tendinopathy using kartogenin (KGN), a bio-compound that can stimulate endogenous stem/progenitor cells to differentiate into chondrocytes. KGN-beads were fabricated and implanted into rat Achilles tendons. Five weeks after implantation, chondrocytes and proteoglycan accumulation were found at the KGN implanted site. Vascularity as well as disorganization in collagen fibers were also present in the same site along with increased expression of the chondrocyte specific marker, collagen type II (Col. II). In vitro studies confirmed that KGN was released continuously from KGN-alginate in vivo beads and induced chondrogenic differentiation of tendon stem/progenitor cells (TSCs) suggesting that chondrogenesis after KGN-bead implantation into the rat tendons is likely due to the aberrant differentiation of TSCs into chondrocytes. Taken together, our results showed that KGN-alginate beads can be used to create a rat model of tendinopathy, which, at least in part, reproduces the features of over-use tendinopathy model created by long term treadmill running. This model is mechanistic (stem cell differentiation), highly reproducible and precise in creating localized tendinopathic lesions. It is expected that this model will be useful to evaluate the effects of various topical treatments such as NSAIDs and platelet-rich plasma (PRP) for the treatment of tendinopathy. PMID:26848746

  14. Creating an Animal Model of Tendinopathy by Inducing Chondrogenic Differentiation with Kartogenin.

    PubMed

    Yuan, Ting; Zhang, Jianying; Zhao, Guangyi; Zhou, Yiqin; Zhang, Chang-Qing; Wang, James H-C

    2016-01-01

    Previous animal studies have shown that long term rat treadmill running induces over-use tendinopathy, which manifests as proteoglycan accumulation and chondrocytes-like cells within the affected tendons. Creating this animal model of tendinopathy by long term treadmill running is however time-consuming, costly and may vary among animals. In this study, we used a new approach to develop an animal model of tendinopathy using kartogenin (KGN), a bio-compound that can stimulate endogenous stem/progenitor cells to differentiate into chondrocytes. KGN-beads were fabricated and implanted into rat Achilles tendons. Five weeks after implantation, chondrocytes and proteoglycan accumulation were found at the KGN implanted site. Vascularity as well as disorganization in collagen fibers were also present in the same site along with increased expression of the chondrocyte specific marker, collagen type II (Col. II). In vitro studies confirmed that KGN was released continuously from KGN-alginate in vivo beads and induced chondrogenic differentiation of tendon stem/progenitor cells (TSCs) suggesting that chondrogenesis after KGN-bead implantation into the rat tendons is likely due to the aberrant differentiation of TSCs into chondrocytes. Taken together, our results showed that KGN-alginate beads can be used to create a rat model of tendinopathy, which, at least in part, reproduces the features of over-use tendinopathy model created by long term treadmill running. This model is mechanistic (stem cell differentiation), highly reproducible and precise in creating localized tendinopathic lesions. It is expected that this model will be useful to evaluate the effects of various topical treatments such as NSAIDs and platelet-rich plasma (PRP) for the treatment of tendinopathy. PMID:26848746

  15. Dose-Related and Time-Dependent Development of Collagenase-Induced Tendinopathy in Rats.

    PubMed

    Perucca Orfei, Carlotta; Lovati, Arianna B; Viganò, Marco; Stanco, Deborah; Bottagisio, Marta; Di Giancamillo, Alessia; Setti, Stefania; de Girolamo, Laura

    2016-01-01

    Tendinopathy is a big burden in clinics and it represents 45% of musculoskeletal lesions. Despite the relevant social impact, both pathogenesis and development of the tendinopathy are still under-investigated, thus limiting the therapeutic advancement in this field. The purpose of this study was to evaluate the dose-dependent and time-related tissue-level changes occurring in a collagenase-induced tendinopathy in rat Achilles tendons, in order to establish a standardized model for future pre-clinical studies. With this purpose, 40 Sprague Dawley rats were randomly divided into two groups, treated by injecting collagenase type I within the Achilles tendon at 1 mg/mL (low dose) or 3 mg/mL (high dose). Tendon explants were histologically evaluated at 3, 7, 15, 30 and 45 days. Our results revealed that both the collagenase doses induced a disorganization of collagen fibers and increased the number of rounded resident cells. In particular, the high dose treatment determined a greater neovascularization and fatty degeneration with respect to the lower dose. These changes were found to be time-dependent and to resemble the features of human tendinopathy. Indeed, in our series, the acute phase occurred from day 3 to day 15, and then progressed towards the proliferative phase from day 30 to day 45 displaying a degenerative appearance associated with a very precocious and mild remodeling process. The model represents a good balance between similarity with histological features of human tendinopathy and feasibility, in terms of tendon size to create lesions and costs when compared to other animal models. Moreover, this model could contribute to improve the knowledge in this field, and it could be useful to properly design further pre-clinical studies to test innovative treatments for tendinopathy. PMID:27548063

  16. Dose-Related and Time-Dependent Development of Collagenase-Induced Tendinopathy in Rats

    PubMed Central

    Viganò, Marco; Stanco, Deborah; Bottagisio, Marta; Di Giancamillo, Alessia; Setti, Stefania; de Girolamo, Laura

    2016-01-01

    Tendinopathy is a big burden in clinics and it represents 45% of musculoskeletal lesions. Despite the relevant social impact, both pathogenesis and development of the tendinopathy are still under-investigated, thus limiting the therapeutic advancement in this field. The purpose of this study was to evaluate the dose-dependent and time-related tissue-level changes occurring in a collagenase-induced tendinopathy in rat Achilles tendons, in order to establish a standardized model for future pre-clinical studies. With this purpose, 40 Sprague Dawley rats were randomly divided into two groups, treated by injecting collagenase type I within the Achilles tendon at 1 mg/mL (low dose) or 3 mg/mL (high dose). Tendon explants were histologically evaluated at 3, 7, 15, 30 and 45 days. Our results revealed that both the collagenase doses induced a disorganization of collagen fibers and increased the number of rounded resident cells. In particular, the high dose treatment determined a greater neovascularization and fatty degeneration with respect to the lower dose. These changes were found to be time-dependent and to resemble the features of human tendinopathy. Indeed, in our series, the acute phase occurred from day 3 to day 15, and then progressed towards the proliferative phase from day 30 to day 45 displaying a degenerative appearance associated with a very precocious and mild remodeling process. The model represents a good balance between similarity with histological features of human tendinopathy and feasibility, in terms of tendon size to create lesions and costs when compared to other animal models. Moreover, this model could contribute to improve the knowledge in this field, and it could be useful to properly design further pre-clinical studies to test innovative treatments for tendinopathy. PMID:27548063

  17. Thick-osteochondral Flap Deepening Trochleoplasty for Patellar Instability

    PubMed Central

    Donel, Simon; Ali, Khameinei; Smith, Dr. Tobi; McNamara, Iain

    2016-01-01

    Aims and Objectives: In patients with patellar instability and severe trochlear dysplasia, trochleoplasty has become increasingly used as part of the surgical management. The aim to report the mid-term results of this trochleoplasty including the sports and exercise activities of the cohort. Our hypothesis was that the operation would improve knee function and lead to an increase in sports participation in the patients. Materials and Methods: Between 1995 and 2010 the thick-flap deepening trochleoplasty was performed in 90 patients (107 knees) with severe trochlear dysplasia. Data was collected prospectively pre-operatively, at 6 weeks and 1-year follow-up. A standard pre-operative clinical assessment that included assessment of patellar apprehension , patellar tracking and patellofemoral crepitus. Post-operative outcome scores were performed by postal questionnaire and collected between June and December 2013, to determine the clinical and functional outcomes, including sports and exercise participation at a minimum of 2 years, with complete data available in 92%. Results: With a minimum follow-up of 2 years, average of 6 years (range 2 to 19 years). The Kujala score had a median and interquartile range (IQR) of 63 (47-75) pre-operatively rising to 79 (68-91) at 1 year follow-up and 84 (73-92) at final follow-up (p< 0.05). Seventy-two per cent were satisfied with their knee function at 1 year follow-up rising to 79% at final follow-up (p <0.0001). Sports and exercise participation increased from 36 patients (40%) pre-operatively to 60 (67%) at final follow-up. The numbers involved in competitions increased slightly from 10 (11%) to 11 (12%). Of those sports that involved twisting (e.g. soccer, cricket, badminton), participation increased from 16 (18%) to 22 (24%), whereas non-twisting sports (e.g. running, swimming, cycling) increased from 24 (27%) to 47 (52%) of whom 14 (16%) used walking as exercise. Conclusion: The thick-flap deepening trochleoplasty improves

  18. Simultaneous bilateral patellar tendon avulsion in an adolescent.

    PubMed

    Yee, P K; Poon, K C; Chiu, S Y

    2012-12-01

    A 13-year-old boy sustained an injury to both knees upon landing after a forceful jump in a soccer game. Plain radiography and magnetic resonance imaging demonstrated bilateral distal patellar tendon avulsions without fracture of the tibial tuberosities and the physes. To our knowledge, this particular injury has not been previously described in the literature. Open surgeries and internal fixation were performed with excellent functional outcome. This type of injury was similar to the well-recognised acute tibial tuberosity avulsion fracture in terms of the pathogenesis and treatment. We propose a further subtype of this injury pattern. PMID:23223656

  19. Increased Upper Trapezius Muscle Stiffness in Overhead Athletes with Rotator Cuff Tendinopathy

    PubMed Central

    Leong, Hio Teng; Hug, François; Fu, Siu Ngor

    2016-01-01

    Although excessive tension of the upper trapezius (UT) is thought to contribute to rotator cuff tendinopathy, no study examined UT tension in athletes with and without rotator cuff tendinopathy. Here we used UT shear modulus measured using ultrasound shear wave elastography as an index of muscle stiffness/tension. The aims of this study were twofold: 1) to determine whether the UT muscle shear modulus is altered in athletes with rotator cuff tendinopathy compared to asymptomatic athletes, and 2) to detect optimal cut-off points of UT shear modulus in identifying athletes with rotator cuff tendinopathy. Forty-three male volleyball players (17 asymptomatic and 26 with rotator cuff tendinopathy, mean age = 22.9±3.5 years) participated in the study. UT shear modulus was quantified during active arm holding at 30° and 60° of shoulder abduction and passive arm positioning at 0°, 30° and 60° of shoulder abduction. During the active tasks, the UT shear modulus was higher in athletes with rotator cuff tendinopathy than the asymptomatic athletes (p = 0.002), regardless the arm position. During the passive tasks, athletes with rotator cuff tendinopathy exhibited a higher UT shear modulus than asymptomatic athletes only at 0° of shoulder abduction (13.0±2.5 kPa vs 10.2±1.8 kPa, p = 0.001). When considering the active task, an optimal cut-off shear modulus of 12.0 kPa at 30° of shoulder abduction (sensitivity = 0.84, specificity = 0.57, AUC = 0.757, p = 0.008) and 9.5 kPa at 60° of shoulder abduction (sensitivity = 0.88, specificity = 0.67, AUC = 0.816, p = 0.002) was detected. When considering the passive task at 0° of shoulder abduction, a cut-off of 12.2 kPa was found (sensitivity = 0.73, AUC = 0.817, p = 0.001). Findings from the present study show that monitoring passive and active UT muscle shear modulus may provide important information for the prevention/rehabilitation of rotator cuff tendinopathy. PMID:27159276

  20. Reflections about the optimisation of the treatment of tendinopathies with PRP

    PubMed Central

    Kaux, Jean-François; Bouvard, Marc; Lecut, Christelle; Oury, Cécile; Gothot, André; Sanchez, Mikel; Crielaard, Jean-Michel

    2015-01-01

    Summary Background: platelet-rich plasma (PRP) infiltration represents a recent therapy for chronic tendinopathies. However, in the literature, this treatment remains controversial. Purpose: we suggest some ideas for improving this treatment. Methods: these suggestions were based on a review of published studies and our clinical experience. Conclusion: optimizing the technique for PRP collection is paramount. Different risk factors must be corrected before infiltration and chronic tendinopathies must be carefully selected. Finally, post-infiltration rehabilitation remains absolutely critical. Standardization of the use of PRP remains necessary in order to optimize the results. PMID:25878979

  1. Increased Upper Trapezius Muscle Stiffness in Overhead Athletes with Rotator Cuff Tendinopathy.

    PubMed

    Leong, Hio Teng; Hug, François; Fu, Siu Ngor

    2016-01-01

    Although excessive tension of the upper trapezius (UT) is thought to contribute to rotator cuff tendinopathy, no study examined UT tension in athletes with and without rotator cuff tendinopathy. Here we used UT shear modulus measured using ultrasound shear wave elastography as an index of muscle stiffness/tension. The aims of this study were twofold: 1) to determine whether the UT muscle shear modulus is altered in athletes with rotator cuff tendinopathy compared to asymptomatic athletes, and 2) to detect optimal cut-off points of UT shear modulus in identifying athletes with rotator cuff tendinopathy. Forty-three male volleyball players (17 asymptomatic and 26 with rotator cuff tendinopathy, mean age = 22.9±3.5 years) participated in the study. UT shear modulus was quantified during active arm holding at 30° and 60° of shoulder abduction and passive arm positioning at 0°, 30° and 60° of shoulder abduction. During the active tasks, the UT shear modulus was higher in athletes with rotator cuff tendinopathy than the asymptomatic athletes (p = 0.002), regardless the arm position. During the passive tasks, athletes with rotator cuff tendinopathy exhibited a higher UT shear modulus than asymptomatic athletes only at 0° of shoulder abduction (13.0±2.5 kPa vs 10.2±1.8 kPa, p = 0.001). When considering the active task, an optimal cut-off shear modulus of 12.0 kPa at 30° of shoulder abduction (sensitivity = 0.84, specificity = 0.57, AUC = 0.757, p = 0.008) and 9.5 kPa at 60° of shoulder abduction (sensitivity = 0.88, specificity = 0.67, AUC = 0.816, p = 0.002) was detected. When considering the passive task at 0° of shoulder abduction, a cut-off of 12.2 kPa was found (sensitivity = 0.73, AUC = 0.817, p = 0.001). Findings from the present study show that monitoring passive and active UT muscle shear modulus may provide important information for the prevention/rehabilitation of rotator cuff tendinopathy. PMID:27159276

  2. ACL reconstruction by patellar tendon. A comparison of length by magnetic resonance imaging.

    PubMed

    Högerle, S; Letsch, R; Sievers, K W

    1998-01-01

    In 50 knees the length of the anterior cruciate ligament (ACL), the patellar tendon, and the distance between the tibial tuberosity and the femoral origin of the ACL were evaluated by means of three-dimensional magnetic resonance imaging (MRI), which permits subsequent reconstruction of any sectional view. The measurements showed that the patellar tendon was always markedly longer than the ACL (mean 14.4 mm), but always shorter than the distance between the tibial tuberosity and the femoral insertion of the ACL (mean 19.2 mm). The mean lengths of the ACL and the patellar tendon were 38.2 mm and 52.6 mm, respectively. The mean distance between the femoral ACL origin and the tibial insertion of the patellar tendon was 71.8 mm. These results demonstrate that a distally based patellar tendon autograft alone (with the patellar bone block but without extension into the periosteum of the patella or the quadriceps tendon) cannot be placed anatomically correctly to the isometric femoral insertion of the ACL. When the patellar tendon is used for ACL reconstruction, it must be implanted as a free autograft. Nevertheless, considerable variations of length must be taken into account. PMID:9457339

  3. The influence of component alignment on patellar kinematics in total knee arthroplasty

    PubMed Central

    Keshmiri, Armin; Maderbacher, Günther; Baier, Clemens; Sendtner, Ernst; Schaumburger, Jens; Zeman, Florian; Grifka, Joachim; Springorum, Hans R

    2015-01-01

    Background and purpose Postoperative anterior knee pain is one of the most frequent complications after total knee arthroplasty (TKA). Changes in patellar kinematics after TKA relative to the preoperative arthritic knee are not well understood. We compared the patellar kinematics preoperatively with the kinematics after ligament-balanced navigated TKA. Patients and methods We measured patellar tracking before and after ligament-balanced TKA in 40 consecutive patients using computer navigation. Furthermore, the influences of different femoral and tibial component alignment on patellar kinematics were analyzed using generalized linear models. Results After TKA, the patellae shifted statistically significantly more laterally between 30° and 60°. The lateral tilt increased at 90° of flexion whereas the epicondylar distance decreased between 45° and 75° of flexion. Sagittal component alignment, but not rotational component alignment, had a significant influence on patellar kinematics. Interpretation There are major differences in patellar kinematics between the preoperative arthritic knee and the knee after TKA. Combined sagittal component alignment in particular appears to have a major effect on patellar kinematics. Surgeons should be especially aware of altering preoperative sagittal alignment until the possible clinical relevance has been investigated. PMID:25582349

  4. Medial Patellofemoral Ligament Reconstruction: A Technique With a “V”-Shaped Patellar Tunnel

    PubMed Central

    Ahmad, Riaz; Jayasekera, Narlaka; Schranz, Peter; Mandalia, Vipul

    2014-01-01

    Patellofemoral dislocation is a common problem affecting the young and active population. The medial patellofemoral ligament (MPFL) is torn when the patella dislocates as it acts as a checkrein to lateral displacement. This leads to patellar instability, and MPFL reconstruction is required if the dislocation recurs after a trial of rehabilitation. We describe a “V”-shaped patellar tunnel technique to reconstruct the MPFL using an autologous gracilis graft. This modification of the patellar tunnel does not breach the lateral cortex of the patella, and it allows a broader attachment of the tendon graft to the patella, which mimics the normal anatomic attachment of the MPFL to the patella. PMID:25473612

  5. 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

  6. Wrist circumference is related to patellar tendon thickness in healthy men and women.

    PubMed

    Nyland, John; Fried, Andrew; Maitra, Ranjan; Johnson, Darren L; Caborn, David N M

    2006-01-01

    The efficacy of dominant wrist circumference measurements to predict dominant lower extremity patellar tendon thickness at regions of interest for bone-patellar tendon-bone (BPTB) autograft harvest was studied among 24 healthy men and women. Dominant wrist circumference displayed good relationships with dominant lower extremity patellar tendon thickness as determined by two-dimensional diagnostic ultrasound. This initial screening method may assist surgeons as they consider graft selection for patients who may be at risk for developing or exacerbating preexisting patellofemoral joint or knee extensor mechanism conditions with BPTB autograft harvest. PMID:16919555

  7. 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

  8. Patellar dislocation with genu valgum treated by DFO.

    PubMed

    Kwon, Jae Ho; Kim, Jong In; Seo, Dong-Hyun; Kang, Kyung-Woon; Nam, Ji Ho; Nha, Kyung-Wook

    2013-06-01

    Congenital habitual patellar dislocation is a rare condition of the knee where the patella dislocates during flexion and relocates during extension. The congenital form is permanent, irreducible, and presents at birth. It is characterized by a short quadriceps and a major patellofemoral dysplasia and short height. This article presents a rare case of a 27-year-old woman with recurring bilateral habitual dislocation of the patella after a failed previous proximal and distal realignment procedure. Clinical examinations of both knees revealed genu valgus knees and lateral joint pain that recurred after several previous operations. Radiographs of both knees showed patellar dislocation and genu valgum associated with patellofemoral dysplasia and osteoarthritis of the lateral compartment. Long-leg standing radiographs showed an anatomic tibiofemoral angle of right 13° and left 6° valgus and a mechanical tibiofemoral angle of right 8° and left 2° valgus and weight-bearing line of 65% on the right and 48% on the left. The authors performed a distal femoral closing wedging osteotomy to correct the valgus deformity, and then percutaneous lateral release and medial reefing were performed to stabilize the patellas of both knees simultaneously. PMID:23746026

  9. Sports and exercise-related tendinopathies: a review of selected topical issues by participants of the second International Scientific Tendinopathy Symposium (ISTS) Vancouver 2012

    PubMed Central

    Scott, Alex; Docking, Sean; Vicenzino, Bill; Alfredson, Håkan; Zwerver, Johannes; Lundgreen, Kirsten; Finlay, Oliver; Pollock, Noel; Cook, Jill L; Fearon, Angela; Purdam, Craig R; Hoens, Alison; Rees, Jonathan D; Goetz, Thomas J; Danielson, Patrik

    2013-01-01

    In September 2010, the first International Scientific Tendinopathy Symposium (ISTS) was held in Umeå, Sweden, to establish a forum for original scientific and clinical insights in this growing field of clinical research and practice. The second ISTS was organised by the same group and held in Vancouver, Canada, in September 2012. This symposium was preceded by a round-table meeting in which the participants engaged in focused discussions, resulting in the following overview of tendinopathy clinical and research issues. This paper is a narrative review and summary developed during and after the second ISTS. The document is designed to highlight some key issues raised at ISTS 2012, and to integrate them into a shared conceptual framework. It should be considered an update and a signposting document rather than a comprehensive review. The document is developed for use by physiotherapists, physicians, athletic trainers, massage therapists and other health professionals as well as team coaches and strength/conditioning managers involved in care of sportspeople or workers with tendinopathy. PMID:23584762

  10. Sports and exercise-related tendinopathies: a review of selected topical issues by participants of the second International Scientific Tendinopathy Symposium (ISTS) Vancouver 2012.

    PubMed

    Scott, Alex; Docking, Sean; Vicenzino, Bill; Alfredson, Håkan; Murphy, Richard J; Carr, Andrew J; Zwerver, Johannes; Lundgreen, Kirsten; Finlay, Oliver; Pollock, Noel; Cook, Jill L; Fearon, Angela; Purdam, Craig R; Hoens, Alison; Rees, Jonathan D; Goetz, Thomas J; Danielson, Patrik

    2013-06-01

    In September 2010, the first International Scientific Tendinopathy Symposium (ISTS) was held in Umeå, Sweden, to establish a forum for original scientific and clinical insights in this growing field of clinical research and practice. The second ISTS was organised by the same group and held in Vancouver, Canada, in September 2012. This symposium was preceded by a round-table meeting in which the participants engaged in focused discussions, resulting in the following overview of tendinopathy clinical and research issues. This paper is a narrative review and summary developed during and after the second ISTS. The document is designed to highlight some key issues raised at ISTS 2012, and to integrate them into a shared conceptual framework. It should be considered an update and a signposting document rather than a comprehensive review. The document is developed for use by physiotherapists, physicians, athletic trainers, massage therapists and other health professionals as well as team coaches and strength/conditioning managers involved in care of sportspeople or workers with tendinopathy. PMID:23584762

  11. The use of magnetic resonance imaging in diagnosing equine deep digital flexor tendinopathies--own experience.

    PubMed

    Jaskólska, M; Adamiak, Z; Zhalniarovich, Y; Przyborowska, P; Peczyński, Z

    2014-01-01

    Deep digital flexor tendinopathy is a common problem in horses of different athletic disciplines. Nowadays, the use of magnetic resonance imaging is considered to be a noninvasive and superior choice for recognizing bone and soft tissue pathologies especially related to difficult to access structures within the hoof capsule. PMID:25286667

  12. IL-17A mediates inflammatory and tissue remodelling events in early human tendinopathy.

    PubMed

    Millar, Neal L; Akbar, Moeed; Campbell, Abigail L; Reilly, James H; Kerr, Shauna C; McLean, Michael; Frleta-Gilchrist, Marina; Fazzi, Umberto G; Leach, William J; Rooney, Brian P; Crowe, Lindsay A N; Murrell, George A C; McInnes, Iain B

    2016-01-01

    Increasingly, inflammatory mediators are considered crucial to the onset and perpetuation of tendinopathy. We sought evidence of interleukin 17A (IL-17A) expression in early human tendinopathy and thereafter, explored mechanisms whereby IL-17A mediated inflammation and tissue remodeling in human tenocytes. Torn supraspinatus tendon (established pathology) and matched intact subscapularis tendon (representing 'early pathology') along with control biopsies were collected from patients undergoing shoulder surgery. Markers of inflammation and IL-17A were quantified by RT-PCR and immunohistochemistry. Human tendon cells were derived from hamstring tendon obtained during ACL reconstruction. In vitro effects of IL-17A upon tenocytes were measured using RT-PCR, multiplex cytokine assays, apoptotic proteomic profiling, immunohistochemistry and annexin V FACS staining. Increased expression of IL-17A was detected in 'early tendinopathy' compared to both matched samples and non-matched control samples (p < 0.01) by RT-PCR and immunostaining. Double immunofluoresence staining revealed IL-17A expression in leukocyte subsets including mast cells, macrophages and T cells. IL-17A treated tenocytes exhibited increased production of proinflammatory cytokines (p < 0.001), altered matrix regulation (p < 0.01) with increased Collagen type III and increased expression of several apoptosis related factors. We propose IL-17A as an inflammatory mediator within the early tendinopathy processes thus providing novel therapeutic approaches in the management of tendon disorders. PMID:27263531

  13. Histopathological, biomechanical, and behavioral pain findings of Achilles tendinopathy using an animal model of overuse injury

    PubMed Central

    Jafari, Leila; Vachon, Pascal; Beaudry, Francis; Langelier, Eve

    2015-01-01

    Abstract Animal models of forced running are used to study overuse tendinopathy, a common health problem for which clear evidence for effective and accessible treatments is still lacking. In these models, pain evaluation is necessary to better understand the disease, help design and evaluate therapies, and ensure humane treatment of the animals. Therefore, the main objective of this study was to evaluate pain and pathologic findings in an animal model of moderate Achilles tendinopathy induced by treadmill running. Air puffs, instead of electrical shocks, were used to stimulate running so that pain associated with stimulation would be avoided. Pressure pain sensitivity was evaluated in vivo using a new instrumented plier, whereas spinal cord peptides were analyzed ex vivo with high‐performance liquid chromatography tandem mass spectrometry. Tendon histologic slides were semiquantitatively evaluated, using the Bonar score technique and biomechanical properties, using the traction test. After 8 weeks of treadmill running (2 weeks for adaptation and 6 weeks for the lesion protocol), the protocol was stopped because the air puffs became ineffective to stimulate running. We, nevertheless, observed some histologic changes characteristic of overuse tendinopathy as well as decreased mechanical properties, increased Substance P and dynorphin A peptides but without pressure pain sensitivity. These results suggest that air‐puffs stimulation is sufficient to induce an early stage tendinopathy to study new therapeutic drugs without inducing unnecessary pain. They also indicate that pain‐associated peptides could be related with movement evoked pain and with the sharp breakdown of the running performance. PMID:25602018

  14. Single ultrasound-guided platelet-rich plasma injection for treatment of supraspinatus tendinopathy in dogs

    PubMed Central

    Ho, Louisa K.; Baltzer, Wendy I.; Nemanic, Sarah; Stieger-Vanegas, Susanne M.

    2015-01-01

    The effect of a single platelet-rich plasma injection for supraspinatus tendinopathy was assessed in 10 dogs. Subjective (owner-assessed) improvement in lameness and function were seen in 40% of dogs with improved tendon heterogeneity and echogenicity in 60%. There were no significant changes in gait reaction forces 6 wk after treatment. PMID:26246631

  15. In vivo determination of knee kinematics in patients with a hamstring or patellar tendon ACL graft.

    PubMed

    Mahfouz, Mohamed R; Traina, Steven M; Komistek, Richard D; Dennis, Douglas A

    2003-10-01

    Video fluoroscopy was used to assess the in vivo kinematics for patients with a patellar-tendon-bone or double-looped semitendinosus gracilis anterior cruciate ligament (ACL) graft. Patients with a double-looped semitendinosus gracilis ACL graft experienced kinematic patterns more similar to the normal knee than patients with a patellar-tendon-bone reconstruction. Patients with a double-looped semitendinosus gracilis reconstruction also experienced more anterior contact at full extension and throughout the flexion cycle than patients with a patellar-tendon-bone reconstruction, which resulted in patients with double-looped semitendinosus gracilis grafts experiencing more posterior femoral rollback. Therefore, removal of the central third of the patella ligament leads to a decrease in quadriceps mechanism efficiency, which resulted in the more posterior contact positions demonstrated by the patients with patellar-tendon-bone grafts in this study. PMID:14584831

  16. Rotational knee strain resulting in patellar dislocation. An experimental study in rabbits.

    PubMed

    Finsterbush, A

    1982-09-01

    The right lower extremities of 64 young rabbits were immobilized by a plaster spica. The animals developed a gait pattern, which included internal tibial rotation and adduction of the left (unimmobilized) tibia. Twenty-one of the animals developed medial patellar dislocation in the unimmobilized lower extremity. The mechanism of the patellar dislocation in this experimental model was possibly overstretching of the lateral colateral ligament and the lateral side of the joint capsule, associated with medial rotation of the tibia and the tibial tubercle. The direction of patellar pull when gliding inferiorly during knee flexion was shifted medially, resulting in patellar dislocation and secondarily, in formation of an exostosis under the displaced patella. Hip arthrodesis in humans, as a course of rotational instability of the contralateral knee, resembles some aspects of this experimental condition. PMID:7105585

  17. Differences in Patellar Cartilage Thickness, Transverse Relaxation Time, and Deformational Behavior

    PubMed Central

    Farrokhi, Shawn; Colletti, Patrick M.; Powers, Christopher M.

    2016-01-01

    Background The origin of patellofemoral pain (PFP) may be associated with the inability of the patellofemoral joint cartilage to absorb and distribute patellofemoral joint forces. Hypothesis When compared with a pain-free control group, young active women with PFP will demonstrate differences in their baseline patellar cartilage thickness and transverse (T2) relaxation time, as well as a less adaptive response to an acute bout of joint loading. Study Design Controlled laboratory study; Level of evidence, 3. Methods Ten women between the ages of 23 to 37 years with PFP and 10 sex-, age-, and activity-matched pain-free controls participated. Quantitative magnetic resonance imaging of the patellofemoral joint was performed at baseline and after participants performed 50 deep knee bends. Differences in baseline cartilage thickness and T2 relaxation time, as well as the postexercise change in patellar cartilage thickness and T2 relaxation time, were compared between groups. Results Individuals with PFP demonstrated reductions in baseline cartilage thickness of 14.0% and 14.1% for the lateral patellar facet and total patellar cartilage, respectively. Similarly, individuals with PFP exhibited significantly lower postexercise cartilage thickness change for the lateral patellar facet (2.1% vs 8.9%) and the total patellar cartilage (4.4% vs 10.0%) when compared with the control group. No group differences in baseline or postexercise change in T2 relaxation time were found. Conclusion The findings suggest that a baseline reduction in patellar cartilage thickness and a reduced deformational behavior of patellar cartilage following an acute bout of loading are associated with presence of PFP symptoms. PMID:20962335

  18. Mechanical properties of the patellar tendon in adults and children.

    PubMed

    O'Brien, Thomas D; Reeves, Neil D; Baltzopoulos, Vasilios; Jones, David A; Maganaris, Constantinos N

    2010-04-19

    It is not currently known how the mechanical properties of human tendons change with maturation in the two sexes. To address this, the stiffness and Young's modulus of the patellar tendon were measured in men, women, boys and girls (each group, n=10). Patellar tendon force (F(pt)) was calculated from the measured joint moment during a ramped voluntary isometric knee extension contraction, the antagonist knee extensor muscle co-activation quantified from its electromyographical activity, and the patellar tendon moment arm measured from magnetic resonance images. Tendon elongation was imaged using the sagittal-plane ultrasound scans throughout the contraction. Tendon cross-sectional area was measured at rest from ultrasound scans in the transverse plane. Maximal F(pt) and tendon elongation were (mean+/-SE) 5453+/-307 N and 5+/-0.5 mm for men, 3877+/-307 N and 4.9+/-0.6 mm for women, 2017+/-170 N and 6.2+/-0.5 mm for boys and 2169+/-182 N and 5.9+/-0.7 mm for girls. In all groups, tendon stiffness and Young's modulus were examined at the level that corresponded to the maximal 30% of the weakest participant's F(pt) and stress, respectively; these were 925-1321 N and 11.5-16.5 MPa, respectively. Stiffness was 94% greater in men than boys and 84% greater in women than girls (p<0.01), with no differences between men and women, or boys and girls (men 1076+/-87 N/mm; women 1030+/-139 N/mm; boys 555+/-71 N/mm and girls 561.5+/-57.4 N/mm). Young's modulus was 99% greater in men than boys (p<0.01), and 66% greater in women than girls (p<0.05). There were no differences in modulus between men and women, or boys and girls (men 597+/-49 MPa; women 549+/-70 MPa; boys 255+/-42 MPa and girls 302+/-33 MPa). These findings indicate that the mechanical stiffness of tendon increases with maturation due to an increased Young's modulus and, in females due to a greater increase in tendon cross-sectional area than tendon length. PMID:20045111

  19. Combined Reconstruction of the Medial Patellofemoral Ligament With Quadricipital Tendon and the Medial Patellotibial Ligament With Patellar Tendon

    PubMed Central

    Hinckel, Betina Bremer; Gobbi, Riccardo Gomes; Demange, Marco Kawamura; Bonadio, Marcelo Batista; Pécora, José Ricardo; Camanho, Gilberto Luis

    2016-01-01

    Although the medial patellotibial ligament (MPTL) has been neglected regarding its function in patellar stability, recently, its importance in terminal extension and during flexion has been recognized. Indications for reconstruction of the medial patellofemoral ligament combined with the MPTL are extension subluxation, flexion instability, children with anatomic risk factors for patellar instability, and knee hyperextension associated with generalized laxity. We describe a combined reconstruction of the medial patellofemoral ligament with quadricipital tendon and reconstruction of the MPTL with patellar tendon autografts. PMID:27073782

  20. Lung hypoplasia and patellar agenesis in Ehlers-Danlos syndrome.

    PubMed

    Pradhan, P; Deb, J; Deb, R; Chakrabarti, S

    2009-12-01

    A 22-year-old male patient was admitted with severe cough associated with purulent expectoration, left-sided chest pain and breathlessness. There was a history of recurrent respiratory ailments since childhood. The patient appeared younger than his chronological age. His face and ears were both dysmorphic. Clinically, the patient was diagnosed with Ehlers-Danlos syndrome (EDS). Computed tomography of the thoracic region revealed hypoplasia of the left lung and hyperplasia of the right lung. Both the patellae were absent. However, ultrasonography of his abdomen, echocardiography and other routine blood and urine examination showed no gross abnormalities. Although other respiratory tract abnormalities with EDS are not uncommon, unilateral lung hypoplasia and patellar agenesis in EDS make this case unique. PMID:20087544

  1. Management of Acute Patellar Dislocation: A Case Report

    PubMed Central

    Enix, Dennis E.; Sudkamp, Kasey; Scali, Frank; Keating, Robbyn; Welk, Aaron

    2015-01-01

    Objective The purpose of this case study is to describe the evaluation and management of patellar dislocations and the different approaches used from providers in different countries. Clinical Features An individual dislocated her left patella while traveling abroad and received subsequent care in Thailand, China, and the United States. Intervention and Outcome Nonoperative treatment protocols including manual closed reduction of the patella, casting of the leg, and rehabilitation exercises were employed. Conclusion Receipt of care when abroad can be challenging. The patient’s knee range of motion and pain continued to improve when she was diligent about performing the home exercise program. This case highlights the importance of a thorough examination, a proper regimen of care, and patient counseling to ensure a full recovery and minimize the chance of re-injury. PMID:26778935

  2. MEDIAL PATELLOFEMORAL LIGAMENT RECONSTRUCTION TO TREAT RECURRENT PATELLAR DISLOCATION

    PubMed Central

    Gonçaives, Matheus Braga Jacques; Júnior, Lúcio Honório de Carvalho; Soares, Luiz Fernando Machado; Gonçaives, Tiago Jacques; dos Santos, Rogério Luciano; Pereira, Marcelo Lobo

    2015-01-01

    Objective: To present a new technique for reconstruction of the medial patellofemoral ligament (MPFL) in patients with recurrent patellar dislocation and to evaluate the clinical findings from this. Methods: Between January 2007 and January 2008, 23 patients underwent reconstruction of the MPFL with a free graft from the semitendinosus tendon. After a minimum of 24 months of follow-up, 22 patients were evaluated using the Kujala and Lysholm clinical protocols. Results: The mean follow up was 26.2 months. According to the Lysholm protocol, the patients had a mean score of 53.72 points preoperatively and 93.36 points postoperatively (p = 0.000006). According to the Kujala protocol, the mean score was 59.81 points preoperatively and 83.54 points postoperatively (p = 0.002173). Conclusion: Reconstruction of the medial patellofemoral ligament using the proposed technique showed excellent results over the short term, when evaluated by means of clinical protocols. PMID:27027005

  3. 'Lateral elbow tendinopathy' is the most appropriate diagnostic term for the condition commonly referred-to as lateral epicondylitis.

    PubMed

    Stasinopoulos, Dimitrios; Johnson, Mark I

    2006-01-01

    A plethora of terms that have been used to describe lateral epicondylitis including tennis elbow (TE), epicondylalgia, tendonitis, tendinosis and tendinopathy. These terms usually have the prefix extensor or lateral elbow. Lateral elbow tendinopathy seems to be the most appropriate term to use in clinical practice because other terms make reference to inappropriate aetiological, anatomical and pathophysiological terms. The correct diagnostic term is important for the right treatment. PMID:16843614

  4. Semantic interrogation of a multi knowledge domain ontological model of tendinopathy identifies four strong candidate risk genes

    PubMed Central

    Saunders, Colleen J.; Jalali Sefid Dashti, Mahjoubeh; Gamieldien, Junaid

    2016-01-01

    Tendinopathy is a multifactorial syndrome characterised by tendon pain and thickening, and impaired performance during activity. Candidate gene association studies have identified genetic factors that contribute to intrinsic risk of developing tendinopathy upon exposure to extrinsic factors. Bioinformatics approaches that data-mine existing knowledge for biological relationships may assist with the identification of candidate genes. The aim of this study was to data-mine functional annotation of human genes and identify candidate genes by ontology-seeded queries capturing the features of tendinopathy. Our BioOntological Relationship Graph database (BORG) integrates multiple sources of genomic and biomedical knowledge into an on-disk semantic network where human genes and their orthologs in mouse and rat are central concepts mapped to ontology terms. The BORG was used to screen all human genes for potential links to tendinopathy. Following further prioritisation, four strong candidate genes (COL11A2, ELN, ITGB3, LOX) were identified. These genes are differentially expressed in tendinopathy, functionally linked to features of tendinopathy and previously implicated in other connective tissue diseases. In conclusion, cross-domain semantic integration of multiple sources of biomedical knowledge, and interrogation of phenotypes and gene functions associated with disease, may significantly increase the probability of identifying strong and unobvious candidate genes in genetic association studies. PMID:26804977

  5. Semantic interrogation of a multi knowledge domain ontological model of tendinopathy identifies four strong candidate risk genes.

    PubMed

    Saunders, Colleen J; Jalali Sefid Dashti, Mahjoubeh; Gamieldien, Junaid

    2016-01-01

    Tendinopathy is a multifactorial syndrome characterised by tendon pain and thickening, and impaired performance during activity. Candidate gene association studies have identified genetic factors that contribute to intrinsic risk of developing tendinopathy upon exposure to extrinsic factors. Bioinformatics approaches that data-mine existing knowledge for biological relationships may assist with the identification of candidate genes. The aim of this study was to data-mine functional annotation of human genes and identify candidate genes by ontology-seeded queries capturing the features of tendinopathy. Our BioOntological Relationship Graph database (BORG) integrates multiple sources of genomic and biomedical knowledge into an on-disk semantic network where human genes and their orthologs in mouse and rat are central concepts mapped to ontology terms. The BORG was used to screen all human genes for potential links to tendinopathy. Following further prioritisation, four strong candidate genes (COL11A2, ELN, ITGB3, LOX) were identified. These genes are differentially expressed in tendinopathy, functionally linked to features of tendinopathy and previously implicated in other connective tissue diseases. In conclusion, cross-domain semantic integration of multiple sources of biomedical knowledge, and interrogation of phenotypes and gene functions associated with disease, may significantly increase the probability of identifying strong and unobvious candidate genes in genetic association studies. PMID:26804977

  6. Role of VEGF, Nitric Oxide, and Sympathetic Neurotransmitters in the Pathogenesis of Tendinopathy: A Review of the Current Evidences

    PubMed Central

    Vasta, Sebastiano; Di Martino, Alberto; Zampogna, Biagio; Torre, Guglielmo; Papalia, Rocco; Denaro, Vincenzo

    2016-01-01

    Chronic tendinopathy is a painful common condition affecting athletes as well as the general population undergoing to tendon overuse. Although its huge prevalence, little is known about tendinopathy pathogenesis, and even cloudier is its treatment. Traditionally, tendinopathy has been defined as a lack of tendon ability to overcome stressing stimuli with appropriate adaptive changes. Histologic studies have demonstrated the absence of inflammatory infiltrates, as a consequence conventional antinflammatory drugs have shown little or no effectiveness in treating tendinopathies. New strategies should be therefore identified to address chronic tendon disorders. Angiofibroblastic changes have been highlighted as the main feature of tendinopathy, and vascular endothelial growth factor (VEGF) has been demonstrated as one of the key molecules involved in vascular hyperplasia. More recently, attention has been focused on new peptides such as Substance P, nitric oxide, and calcitonin gene-related peptide (CGRP). Those new findings support the idea of a nerve-mediated disregulation of tendon metabolism. Each of those molecules could be a target for new treatment options. This study aimed to systematically review the current available clinical and basic science in order to summarize the latest evidences on the pathophysiology and its effect on treatment of chronic tendinopathy, and to spread suggestions for future research on its treatment. PMID:27555817

  7. 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

  8. Role of VEGF, Nitric Oxide, and Sympathetic Neurotransmitters in the Pathogenesis of Tendinopathy: A Review of the Current Evidences.

    PubMed

    Vasta, Sebastiano; Di Martino, Alberto; Zampogna, Biagio; Torre, Guglielmo; Papalia, Rocco; Denaro, Vincenzo

    2016-01-01

    Chronic tendinopathy is a painful common condition affecting athletes as well as the general population undergoing to tendon overuse. Although its huge prevalence, little is known about tendinopathy pathogenesis, and even cloudier is its treatment. Traditionally, tendinopathy has been defined as a lack of tendon ability to overcome stressing stimuli with appropriate adaptive changes. Histologic studies have demonstrated the absence of inflammatory infiltrates, as a consequence conventional antinflammatory drugs have shown little or no effectiveness in treating tendinopathies. New strategies should be therefore identified to address chronic tendon disorders. Angiofibroblastic changes have been highlighted as the main feature of tendinopathy, and vascular endothelial growth factor (VEGF) has been demonstrated as one of the key molecules involved in vascular hyperplasia. More recently, attention has been focused on new peptides such as Substance P, nitric oxide, and calcitonin gene-related peptide (CGRP). Those new findings support the idea of a nerve-mediated disregulation of tendon metabolism. Each of those molecules could be a target for new treatment options. This study aimed to systematically review the current available clinical and basic science in order to summarize the latest evidences on the pathophysiology and its effect on treatment of chronic tendinopathy, and to spread suggestions for future research on its treatment. PMID:27555817

  9. "Modified Adductor Sling Technique"- a surgical therapy for patellar instability in children and adolescents

    PubMed Central

    Alm, Lena; Frosch, Karl-Heinz; Preiss, Achim; Heitmann, Maximilian; Akoto, Ralph

    2016-01-01

    Aims and Objectives: Due to open femoral physis, the therapy of patellar instability in children and adolescents is challenging. We developed a surgical technique, modified form of the "Adductor-Sling-Technique" by Sillanpää which offers a surgical treatment to avoid damage to the femoral physis. The purpose of this study is to determine whether there is a benefit in the clinical outcome for patients operated by the "modified Adductor Sling Technique" in comparison to patients with other surgical procedures. Materials and Methods: Twenty "modified Adductor Sling" reconstructions in 19 patients (age 11-24) were included in the study until now, 15 patients with open physis and 4 patients with closed physis with special indications. Since 2010 "modified Adductor Sling" reconstruction was performed by looping the gracilis tendon around the adductor magnus tendon and attaching it at the medial facette of the patella. Clinical outcome was retrospectively evaluated at a mean follow-up period of 1.3 years (range 0.5-3.6). The evaluation also included Lysholm Score, Kujala Score and DGU score. Statistical analysis was performed using IBM®SPSS®Statistics Version 21. A P value less than 0.5 was considered significant. Results: The average age at the time of operation was 14.9 years (range 11.2-24.3). Recurrent dislocation occurred in 4 out of 20 cases (20%). It was noticeable that out of those 4 patients 2 patients had a lateral release in addition to the "modified Adductor Sling Technique" due to lateral hyperpression. No other patients had a lateral release in our patient population. Also, out of those 4 patients 3 patients had an additional maltracking of the patella, caused by a high TTTG, severe trochlea dysplasia or additional axial deformity. The overall Kujala Score was 87 (range 46-100) points, in patients without re-dislocation it was 94 (range 46-100) points. The overall Lysholm Score was 85 (range 39-100) points, in the group without re-dislocation 90 (range

  10. Influence of decorin on the mechanical, compositional, and structural properties of the mouse patellar tendon.

    PubMed

    Dourte, LeAnn M; Pathmanathan, Lydia; Jawad, Abbas F; Iozzo, Renato V; Mienaltowski, Michael J; Birk, David E; Soslowsky, Louis J

    2012-03-01

    The interactions of small leucine-rich proteoglycans (SLRPs) with collagen fibrils, their association with water, and their role in fibrillogenesis suggests that SLRPs may play an important role in tendon mechanics. Some studies have assessed the role of SLRPs in the mechanical response of the tendon, but the relationships between sophisticated mechanics, assembly of collagen, and SLRPs have not been well characterized. Decorin content was varied in a dose dependent manner using decorin null, decorin heterozygote, and wild type mice. Quantitative measures of mechanical (tension and compression), compositional, and structural changes of the mouse patellar tendon were evaluated. Viscoelastic, tensile dynamic modulus was increased in the decorin heterozygous tendons compared to wild type. These tendons also had a significant decrease in total collagen and no structural changes compared to wild type. Decorin null tendons did not have any mechanical changes; however, a significant decrease in the average fibril diameter was found. No differences were seen between genotypes in elastic or compressive properties, and all tendons demonstrated viscoelastic mechanical dependence on strain rate and frequency. These results suggest that decorin, a member of the SLRP family, plays a role in tendon viscoelasticity that cannot be completely explained by its role in collagen fibrillogenesis. In addition, reductions in decorin do not cause large changes in indentation compressive properties, suggesting that other factors contribute to these properties. Understanding these relationships may ultimately help guide development of tissue engineered constructs or treatment modalities. PMID:22482685

  11. PRP Treatment Efficacy for Tendinopathy: A Review of Basic Science Studies.

    PubMed

    Zhou, Yiqin; Wang, James H-C

    2016-01-01

    Platelet-Rich Plasma (PRP) has been widely used in orthopaedic surgery and sport medicine to treat tendon injuries. However, the efficacy of PRP treatment for tendinopathy is controversial. This paper focuses on reviewing the basic science studies on PRP performed under well-controlled conditions. Both in vitro and in vivo studies describe PRP's anabolic and anti-inflammatory effects on tendons. While some clinical trials support these findings, others refute them. In this review, we discuss the effectiveness of PRP to treat tendon injuries with evidence presented in basic science studies and the potential reasons for the controversial results in clinical trials. Finally, we comment on the approaches that may be required to improve the efficacy of PRP treatment for tendinopathy. PMID:27610386

  12. PRP Treatment Efficacy for Tendinopathy: A Review of Basic Science Studies

    PubMed Central

    2016-01-01

    Platelet-Rich Plasma (PRP) has been widely used in orthopaedic surgery and sport medicine to treat tendon injuries. However, the efficacy of PRP treatment for tendinopathy is controversial. This paper focuses on reviewing the basic science studies on PRP performed under well-controlled conditions. Both in vitro and in vivo studies describe PRP's anabolic and anti-inflammatory effects on tendons. While some clinical trials support these findings, others refute them. In this review, we discuss the effectiveness of PRP to treat tendon injuries with evidence presented in basic science studies and the potential reasons for the controversial results in clinical trials. Finally, we comment on the approaches that may be required to improve the efficacy of PRP treatment for tendinopathy. PMID:27610386

  13. THE ROLE AND IMPLEMENTATION OF ECCENTRIC TRAINING IN ATHLETIC REHABILITATION: TENDINOPATHY, HAMSTRING STRAINS, AND ACL RECONSTRUCTION

    PubMed Central

    Reiman, Michael

    2011-01-01

    The benefits and proposed physiological mechanisms of eccentric exercise have previously been elucidated and eccentric exercise has been used for well over seventy years. Traditionally, eccentric exercise has been used as a regular component of strength training. However, in recent years, eccentric exercise has been used in rehabilitation to manage a host of conditions. Of note, there is evidence in the literature supporting eccentric exercise for the rehabilitation of tendinopathies, muscle strains, and in anterior cruciate ligament (ACL) rehabilitation. The purpose of this Clinical Commentary is to discuss the physiologic mechanism of eccentric exercise as well as to review the literature regarding the utilization of eccentric training during rehabilitation. A secondary purpose of this commentary is to provide the reader with a framework for the implementation of eccentric training during rehabilitation of tendinopathies, muscle strains, and after ACL reconstruction. PMID:21655455

  14. Lower limb biomechanics during running in individuals with achilles tendinopathy: a systematic review

    PubMed Central

    2011-01-01

    Background Abnormal lower limb biomechanics is speculated to be a risk factor for Achilles tendinopathy. This study systematically reviewed the existing literature to identify, critique and summarise lower limb biomechanical factors associated with Achilles tendinopathy. Methods We searched electronic bibliographic databases (Medline, EMBASE, Current contents, CINAHL and SPORTDiscus) in November 2010. All prospective cohort and case-control studies that evaluated biomechanical factors (temporospatial parameters, lower limb kinematics, dynamic plantar pressures, kinetics [ground reaction forces and joint moments] and muscle activity) associated with mid-portion Achilles tendinopathy were included. Quality of included studies was evaluated using the Quality Index. The magnitude of differences (effect sizes) between cases and controls was calculated using Cohen's d (with 95% CIs). Results Nine studies were identified; two were prospective and the remaining seven case-control study designs. The quality of 9 identified studies was varied, with Quality Index scores ranging from 4 to 15 out of 17. All studies analysed running biomechanics. Cases displayed increased eversion range of motion of the rearfoot (d = 0.92 and 0.67 in two studies), reduced maximum lower leg abduction (d = -1.16), reduced ankle joint dorsiflexion velocity (d = -0.62) and reduced knee flexion during gait (d = -0.90). Cases also demonstrated a number of differences in dynamic plantar pressures (primarily the distribution of the centre of force), ground reaction forces (large effects for timing variables) and also showed reduced peak tibial external rotation moment (d = -1.29). Cases also displayed differences in the timing and amplitude of a number of lower limb muscles but many differences were equivocal. Conclusions There are differences in lower limb biomechanics between those with and without Achilles tendinopathy that may have implications for the prevention and management of the condition

  15. Laser Therapy in the Treatment of Achilles Tendinopathy: A Randomised Controlled Trial

    NASA Astrophysics Data System (ADS)

    Tumilty, Steve; Munn, Joanne; Haxby Abbott, J.; Mcdonough, Suzanne; Hurley, Deirdre A.; Basford, Jeffrey R.; David Baxter, G.

    2010-05-01

    Background: Low Level Laser Therapy (LLLT) has emerged as a possible treatment modality for tendinopathies. Human studies have investigated LLLT for Achilles Tendinopathy and the effectiveness remains contentious. Purpose: To assess the clinical effectiveness of Low-Level Laser Therapy (LLLT) in the management of Achilles Tendinopathy. Method: Forty patients were randomised into an active laser or placebo group; all patients, therapists and investigator were blinded to allocation. All patients were given an eccentric exercise program and irradiated 3 times per week for 4 weeks with either an active or placebo laser at 6 standardized points over the affected tendons. Irradiation parameters in the active laser group were: 810 nm, 100 mW, applied to 6 points on the tendon for 30 seconds giving a dose of 3 J per point and 18 J per session; power density 100 mW/cm2. Outcome measures were the VISA-A questionnaire and a visual analogue scale of pain. Patients were measured before treatment, at 4 and 12 weeks. ANCOVA was used to analyze data, using the effects of baseline measurements as a covariate. Results: Within groups, there were significant improvements (p<0.05) at 4 and 12 weeks for all outcome measures, except pain for the laser group at 4 weeks (p = 0.13). Between groups differences at both 4 and 12 weeks showed no significant difference between groups (p>0.05). Conclusion: This use of the above parameters demonstrated no added benefit of LLLT over that of eccentric exercise in the treatment of Achilles Tendinopathy.

  16. Major complications and risk factors associated with surgical correction of congenital medial patellar luxation in 124 dogs.

    PubMed

    Cashmore, R G; Havlicek, M; Perkins, N R; James, D R; Fearnside, S M; Marchevsky, A M; Black, A P

    2014-01-01

    Dogs treated for congenital medial patellar luxation were reviewed for the purpose of determining the incidence of postoperative major complications requiring surgical revision and the risk factors for their occurrence. Major complications occurred in 18.5% of the patellar luxation stabilization procedures with implant associated complications being the most frequent, patellar reluxation the second, and tibial tuberosity avulsion the third most common major complication. Other complications included patellar ligament rupture and trochlear wedge displacement. When recession trochleoplasty was performed in addition to tibial tuberosity transposition, a 5.1-fold reduction in the rate of patellar reluxation was observed. Release of the cranial belly of the sartorius muscle further reduced the incidence of patellar reluxation, while patella alta (pre- or postoperative) and patellar luxation grade were not found to influence the rate of reluxation. Tibial tuberosity avulsion was 11.1-times more likely when using a single Kirschner wire to stabilize a transposition, compared with two Kirschner wires. Independent to the number of Kirschner wires used, the more caudodistally the Kirschner wires were directed, the higher the risk for tibial tuberosity avulsion. Tension bands were used in 24.4% of the transpositions with no tuberosity avulsion occurring in stifles stabilized with a tension band. Overall, grade 1 luxations had a significantly lower incidence of major complications than other grades, while body weight, age, sex, and bilateral patellar stabilization were not associated with risk of major complication development. PMID:24817090

  17. Cross-Relaxation Imaging of Human Patellar Cartilage In-Vivo at 3.0T

    PubMed Central

    Sritanyaratana, Nade; Samsonov, Alexey; Mossahebi, Pouria; Wilson, John J.; Block, Walter F.; Kijowski, Richard

    2014-01-01

    Objective To compare quantitative magnetization transfer (qMT) parameters of patellar cartilage measured using cross relaxation imaging (CRI) in asymptomatic volunteers and patients with osteoarthritis. Design The study was performed with Institutional Review Board approval and with all subjects signing informed consent. CRI of the knee joint was performed at 3.0T on 20 asymptomatic volunteers and 11 patients with osteoarthritis. The fraction of macromolecular bound protons (f), the exchange rate constant between macromolecular bound protons and free water protons (k), and the T2 relaxation time of macromolecular bound protons (T2B) of patellar cartilage were measured. Mann-Whitney-Wilcoxon rank-sum tests were used to compare qMT parameters between asymptomatic volunteers and patients with osteoarthritis. Results Average f, k, and T2B of patellar cartilage was 12.46%, 7.22 s−1, and 6.49 μs respectively for asymptomatic volunteers and 12.80%, 6.13 s−1, and 6.80 μs respectively for patients with osteoarthritis. There were statistically significant differences between groups of subjects for k (p<0.01) and T2B (p<0.0001) but not f (p=0.38) of patellar cartilage. Conclusion Patients with osteoarthritis had significantly lower k and significantly higher T2B of patellar cartilage than asymptomatic volunteers which suggests that qMT parameters can detect changes in the macromolecular matrix of degenerative cartilage. Key Words: Cartilage; MRI; Osteoarthritis; Magnetization Transfer PMID:25278066

  18. PLATEAU-PATELLA ANGLE: AN OPTION FOR ASSESSING PATELLAR HEIGHT ON PROXIMAL TIBIA OSTEOTOMY

    PubMed Central

    BONADIO, MARCELO BATISTA; TORRES, JÚLIO AUGUSTO DO PRADO; MAZZARO, VICENTE; HELITO, CAMILO PARTEZANI; GOBBI, RICCARDO GOMES; DEMANGE, MARCO KAWAMURA

    2016-01-01

    ABSTRACT Objective: To compare the plateau-patella angle method to the methods already established for patellar height measurement in patients undergoing high tibial osteotomy. Methods: This is a retrospective study of 13 patients undergoing medial opening tibial osteotomy. The patellar height was measured in pre and post-operative radiographs by the methods from Insall-Salvati, Caton-Deschamps, Blackburne-Peel and patella-plateau angle, as well as the tibial slope and length of the patellar tendon. Measurements were performed by two knee surgeons at two different times. Results: The mean age was 41.33 ± 01.09 years old. The average rates of Caton-Deschamps, Blackburne-Peel, Insall-Salvati and plateau-patella angle were, respectively, 1.00; 0.89; 1.10; and 23.15° preoperatively, and 0.89; 0.78; 1.11; and 20.46°, postoperatively. The correlation of Caton-Deschamps, Blackburne-Pell, and Insall-Salvati indexes and plateau-patellar angle interobserver was 0.72 (p <0.001), 0:54 (p <0.001), 0.65 (p <0.001), and 0.67 (w <0.001), respectively. Conclusion: The plateau-patella angle method undergoes changes that are correlated with changes in tibial slope after osteotomy, unlike the classical methods. This fact may lead to overestimate the reduction of patellar height after osteotomy. Level of evidence IV. Case Series. PMID:27217812

  19. Effect of bone block removal and patellar prosthesis on stresses in the human patella.

    PubMed

    Friis, E A; Cooke, F W; McQueen, D A; Henning, C E

    1994-01-01

    Thermoelastic stress analysis was used to examine stresses on the anterior surface of patellae after patellar bone block excision for autogenous graft anterior cruciate ligament reconstruction. Complications of anterior cruciate ligament injury often lead to degenerative changes in the knee that can require total knee joint replacement. It was hypothesized that stresses in a bone block-compromised patella may be increased even further by insertion of a patellar prosthesis. All patellae were first tested intact and then were retested after a sequence of surgical modifications including patellar prosthesis implantation, tapered bone block excision, square bone block excision, and both shapes of excised bone blocks with a patellar prosthesis in place. Stresses in patellae with bone blocks excised were significantly greater than stresses in intact patellae. The anterior surface stress pattern in the loaded patella was significantly altered by excision of a bone block. There were no significant differences between maximum stress in patellae with tapered and square bone blocks excised. A finite element analysis showed that excision of a larger trapezoid-shaped bone block greatly increased maximum stress levels. Insertion of a patellar prosthesis did not significantly alter stress patterns or maximum stress levels in the patella. PMID:7810796

  20. Influence of Hyperlipidemia on the Treatment of Supraspinatus Tendinopathy With or Without Tear

    PubMed Central

    2016-01-01

    Objective To investigate the influence of hyperlipidemia on the treatment of supraspinatus tendinopathy, with or without tear. Methods We retrospectively reviewed the data of patients with shoulder pain and patients with supraspinatus tendinopathy, with or without tear, were included in the study. Exclusion criteria were prior shoulder surgery, prior steroid injection, neurological diseases that could lead to shoulder pain, and use of lipid-lowering medication. According to the serum lipid profiles, patients were assigned to either the hyperlipidemia or non-hyperlipidemia group. By analyzing the numeric rating scale (NRS) before treatment, and at 2 weeks and 8 weeks after treatment, we compared the difference in treatment effect between the two groups. Results No significant baseline difference was found among the two groups for age, gender, body mass index, duration of pain, side of pain, range of motion of affected shoulder, or physical examination. On the repeated-measures analysis of variance, NRS scores significantly decreased with time for both groups (p<0.001). When analyzing the effect of time between the subjects factor, there was significant difference in the treatment effect between the two groups (p<0.001), namely NRS was less decreased in the hyperlipidemia group. Conclusion We found that hyperlipidemia may be an adversely affecting factor in the treatment of supraspinatus tendinopathy with or without tear. PMID:27446783

  1. Treatment of Tendinopathy: What Works, What Does Not, and What is on the Horizon

    PubMed Central

    Murrell, George A. C.

    2008-01-01

    Tendinopathy is a broad term encompassing painful conditions occurring in and around tendons in response to overuse. Recent basic science research suggests little or no inflammation is present in these conditions. Thus, traditional treatment modalities aimed at controlling inflammation such as corticosteroid injections and nonsteroidal antiinflammatory medications (NSAIDS) may not be the most effective options. We performed a systematic review of the literature to determine the best treatment options for tendinopathy. We evaluated the effectiveness of NSAIDS, corticosteroid injections, exercise-based physical therapy, physical therapy modalities, shock wave therapy, sclerotherapy, nitric oxide patches, surgery, growth factors, and stem cell treatment. NSAIDS and corticosteroids appear to provide pain relief in the short term, but their effectiveness in the long term has not been demonstrated. We identified inconsistent results with shock wave therapy and physical therapy modalities such as ultrasound, iontophoresis and low-level laser therapy. Current data support the use of eccentric strengthening protocols, sclerotherapy, and nitric oxide patches, but larger, multicenter trials are needed to confirm the early results with these treatments. Preliminary work with growth factors and stem cells is promising, but further study is required in these fields. Surgery remains the last option due to the morbidity and inconsistent outcomes. The ideal treatment for tendinopathy remains unclear. Level of Evidence: Level II, systematic review. See the Guidelines for Authors for a complete description of levels of evidence. PMID:18446422

  2. Treatment of Calcified Insertional Achilles Tendinopathy by the Posterior Midline Approach.

    PubMed

    Miao, Xu-Dong; Jiang, Hongfei; Wu, Yong-Ping; Tao, Hui-Min; Yang, Di-Sheng; Hu, Hang

    2016-01-01

    The present study investigated the clinical outcomes of the posterior midline approach in the treatment of 34 patients with significantly calcified insertional Achilles tendinopathy. The posterior midline approach was applied for the surgical treatment of 34 patients with chronic significantly calcified insertional Achilles tendinopathy after failed conservative treatment. Gastrocnemius recession was performed simultaneously for patients with gastrocnemius contracture. The Fowler-Philip angle and parallel pitch lines were measured before surgery, and the visual analog scale, Tegner score, and Victorian Institute of Sport tendon study group score were recorded before and after surgery. The mean follow-up period was 45.2 ± 17.7 (range 24 to 84) months. After surgery, the visual analog scale score had decreased notably, and the Tegner score and Victorian Institute of Sport tendon study group score had increased significantly. The posterior midline approach can achieve satisfactory outcomes in the treatment of significantly calcified insertional Achilles tendinopathy, and gastrocnemius recession (Strayer procedure) should be performed for patients with gastrocnemius contracture to improve the surgical outcome. PMID:26874831

  3. IL-17A mediates inflammatory and tissue remodelling events in early human tendinopathy

    PubMed Central

    Millar, Neal L.; Akbar, Moeed; Campbell, Abigail L.; Reilly, James H.; Kerr, Shauna C.; McLean, Michael; Frleta-Gilchrist, Marina; Fazzi, Umberto G.; Leach, William J.; Rooney, Brian P.; Crowe, Lindsay A. N.; Murrell, George A. C.; McInnes, Iain B.

    2016-01-01

    Increasingly, inflammatory mediators are considered crucial to the onset and perpetuation of tendinopathy. We sought evidence of interleukin 17A (IL-17A) expression in early human tendinopathy and thereafter, explored mechanisms whereby IL-17A mediated inflammation and tissue remodeling in human tenocytes. Torn supraspinatus tendon (established pathology) and matched intact subscapularis tendon (representing ‘early pathology’) along with control biopsies were collected from patients undergoing shoulder surgery. Markers of inflammation and IL-17A were quantified by RT-PCR and immunohistochemistry. Human tendon cells were derived from hamstring tendon obtained during ACL reconstruction. In vitro effects of IL-17A upon tenocytes were measured using RT-PCR, multiplex cytokine assays, apoptotic proteomic profiling, immunohistochemistry and annexin V FACS staining. Increased expression of IL-17A was detected in ‘early tendinopathy’ compared to both matched samples and non-matched control samples (p < 0.01) by RT-PCR and immunostaining. Double immunofluoresence staining revealed IL-17A expression in leukocyte subsets including mast cells, macrophages and T cells. IL-17A treated tenocytes exhibited increased production of proinflammatory cytokines (p < 0.001), altered matrix regulation (p < 0.01) with increased Collagen type III and increased expression of several apoptosis related factors. We propose IL-17A as an inflammatory mediator within the early tendinopathy processes thus providing novel therapeutic approaches in the management of tendon disorders. PMID:27263531

  4. Normal values of patellar and ankle tendon reflex latencies.

    PubMed

    Frijns, C J; Laman, D M; van Duijn, M A; van Duijn, H

    1997-02-01

    The clinical value of latency measurement of tendon reflexes in neurological patients has been reported by several authors. However, normal values are not readily comparable. In the present study, latencies and amplitudes of patellar (PTR) and ankle tendon reflexes (ATR) were measured at rest and after facilitation in 102 normal controls. A manually operated reflex hammer, tipped with electrically conductive rubber, ensured an immediate start of the sweep of the oscilloscope. Latencies showed a significant correlation with height (r = 0.70 for PTR and r = 0.72 for ATR, P < 0.0001) and to a lesser degree with age (r = 0.16 and r = 0.30, P < 0.0001). While amplitudes were highly variable, rendering them less useful for diagnostic purposes, latencies showed minimal intra-individual variability (CV 1.5 and 0.8%, respectively). Correlation of ATR-latency with the H-reflex latency of the soleus muscle was very high (r = 0.97, P < 0.0001). Comparison with three other hammer types yielded corresponding results with a hammer supplied with a piezo-electric element; however, significantly shorter latencies were found with a hammer with a microswitch, and with another hammer with a spring-contact, due to a delay from the tap on the tendon until the start of the sweep of the monitor. PMID:9107465

  5. 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

  6. Use of radiographic measurements in the evaluation of dogs with medial patellar luxation

    PubMed Central

    Mortari, Ana C.; Rahal, Sheila C.; Vulcano, Luiz C.; da Silva, Vicente Colombi; Volpi, Reinaldo S.

    2009-01-01

    This prospective study used radiographic techniques to evaluate the inclination, Norberg, quadriceps and femoral varus angles, and the patellar position in dogs with developmental medial patellar luxation. The study also compared these measurements pre- and post-operatively to determine how they were affected by surgical procedures. Eighteen dogs with unilateral or bilateral luxation were used, and 4 groups were established according to luxation grade. Except for the quadriceps angle, there was no difference among the groups preoperatively. Significant differences for the quadriceps angle were observed between Grades 1 and 3, and between Grades 2 and 3. The Norberg and femoral varus angles and the patellar position showed no changes between pre- and postoperative groups. However, measurements of the preoperative quadriceps angle and postoperative inclination angle may be useful for evaluating dogs with grade-3 luxation. Further studies using other imaging techniques are required in dogs with severe grade-4 luxation due to the difficulty in obtaining a good radiographic position. PMID:20046606

  7. Use of radiographic measurements in the evaluation of dogs with medial patellar luxation.

    PubMed

    Mortari, Ana C; Rahal, Sheila C; Vulcano, Luiz C; da Silva, Vicente Colombi; Volpi, Reinaldo S

    2009-10-01

    This prospective study used radiographic techniques to evaluate the inclination, Norberg, quadriceps and femoral varus angles, and the patellar position in dogs with developmental medial patellar luxation. The study also compared these measurements pre- and post-operatively to determine how they were affected by surgical procedures. Eighteen dogs with unilateral or bilateral luxation were used, and 4 groups were established according to luxation grade. Except for the quadriceps angle, there was no difference among the groups preoperatively. Significant differences for the quadriceps angle were observed between Grades 1 and 3, and between Grades 2 and 3. The Norberg and femoral varus angles and the patellar position showed no changes between pre- and postoperative groups. However, measurements of the preoperative quadriceps angle and postoperative inclination angle may be useful for evaluating dogs with grade-3 luxation. Further studies using other imaging techniques are required in dogs with severe grade-4 luxation due to the difficulty in obtaining a good radiographic position. PMID:20046606

  8. PERI-INCISIONAL DYSESTHESIA FOLLOWING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION USING CENTRAL THIRD OF PATELLAR TENDON

    PubMed Central

    de Carvalho Júnior, Lúcio Honório; Machado, Soares Luiz Fernando; Gonçalves, Matheus Braga Jacques; Júnior, Paulo Randal Pires; Baumfeld, Daniel Soares; Pereira, Marcelo Lobo; Lessa, Rodrigo Rosa; Costa, Lincoln Paiva; Bisinoto, Henrique Barra

    2015-01-01

    Objective: To evaluate the prevalence and type of dysesthesia around the incision used to obtain the patellar tendon for anterior cruciate ligament (ACL) reconstruction surgery. Methods: Out of a population of 1368 ACL reconstructions using the central third of the patellar tendon, 102 patients (111 knees) were evaluated by means of telephone interview. Results: The mean follow-up was 52 months (ranging from 12 to 88 months). The patients' ages ranged from 16 to 58 years (mean: 34.7 years). There was some degree of peri-incisional dysesthesia in 66 knees (59.46%). In 40.54% of the knees, this condition was not found. In all the cases of dysesthesia, the type encountered was Highet's type II. Conclusion: Peri-incisional dysesthesia following ACL reconstruction using the central third of the patellar tendon is highly prevalent. It affected more than half of the cases in this series. PMID:27026983

  9. Combined Tibial Tubercle Avulsion Fracture and Patellar Avulsion Fracture: An Unusual Variant in an Adolescent Patient.

    PubMed

    Stepanovich, Matthew T; Slakey, Joseph B

    2016-01-01

    Traumatic extensor dysfunction of the knee in children is a rare injury, with the majority resulting from tibial tubercle avulsion fracture or patellar sleeve fracture. We report a rare case of combined patellar avulsion fracture and tibial tubercle fracture. With open anatomic reduction, both injuries were successfully treated. While many variations of tibial tubercle fracture have been reported, the authors believe this to be the first report in the English-language literature of this particular combined injury to the knee extensor mechanism in an adolescent. Advanced imaging with computed tomography provided vital information to aid with operative planning, especially since the majority of the unossified tubercle was not seen on plain radiographs, and all fracture fragments were originally believed to be from the tibial tubercle. Computed tomography distinguished the patellar fracture from the tibial tubercle fragments, verifying preoperatively the complexity of the injury. PMID:26761925

  10. Infra-patellar fat pad cysts: a case report and review of the literature

    PubMed Central

    Bisicchia, Salvatore; Savarese, Eugenio

    2012-01-01

    Summary Infra-patellar fat pad cysts are an uncommon type of intra-articular ganglia. We report a case of a young woman with a painful little mass in the anterior aspect of the left knee. Ultrasound revealed a multiloculate cyst, that was initially drained with a spinal needle. Four months later, she had a recurrence of symptoms and a ultrasound guided aspiration was performed. Cytological examination revealed synovial cells, synovial fluid, macrophages and debris: diagnosis was ganglion cyst. We reviewed the literature about infra-patellar fat pad cysts. Clinical diagnosis of an intraarticular cyst is very difficult, but sometimes an infra-patellar fat pad cyst could be suspected because it could be visible and palpable. MRI is the best diagnostic option in all cases. There are several treatment option, operative or conservative. In our opinion ultrasound guided aspiration is the treatment of choice in symptomatic ganglia, because it allows to drain all lacunae, preventing recurrence. PMID:23738315

  11. Imaging assessment of patellar instability and its treatment in children and adolescents.

    PubMed

    Meyers, Arthur B; Laor, Tal; Sharafinski, Mark; Zbojniewicz, Andrew M

    2016-05-01

    Transient patellar dislocation is a common entity in children and adolescents, characterized by lateral dislocation of the patella, usually with spontaneous reduction. Many predisposing conditions have been described, including trochlear dysplasia, excessive lateral patellar tilt, patella alta and lateralization of the tibial tuberosity. Associated injuries are bone bruises of the patella and lateral femoral condyle, tears of the medial retinaculum that include the medial patellofemoral ligament (MPFL), tears of the vastus medialis obliquus muscle, injuries of articular cartilage, and intra-articular bodies. Children who are refractory to conservative management, have a large cartilage defect, or are at substantial risk for recurrent dislocations are candidates for surgical procedures to prevent future dislocations. Procedures can include MPFL repair or reconstruction, tibial tubercle repositioning and lateral retinacular release. The purpose of this review is to illustrate the imaging findings of transient patellar dislocation in the acute setting, the normal imaging appearance after surgical intervention, and post-surgical complications. PMID:26860094

  12. Split Fracture: A Complication of Cerclage Wiring of Acute Patellar Fracture

    PubMed Central

    Lo, Cho Yau; Lui, Tun Hing; Sit, Yan Kit

    2014-01-01

    Introduction: Iatrogenic patellar fracture is reported as a complication of patella procedures, such as medial patellofemoral ligament reconstruction, reconstruction of the anterior cruciate ligament of the knee using bone-patellar tendon-bone technique, and resurfacing the patella in total knee arthroplasty. Case Presentation: A 65-year-old lady with right patella fracture was treated with open reduction and cerclage wiring. An iatrogenic split fracture was noted during tension of the cerclage wire and was successfully managed by screw fixation of the split fracture. Conclusions: Split fracture is a rare complication of circumferential cerclage wiring of patellar fracture. The surgeon should be aware of the contributing factors in order to avoid this complication. PMID:25593896

  13. The effect of patellar taping on some landing characteristics during counter movement jumps in healthy subjects.

    PubMed

    Cámara, Jesús; Díaz, Francisco; Anza, María Soledad; Mejuto, Gaizka; Puente, Asier; Iturriaga, Gorka; Fernández, Juan-Ramón

    2011-01-01

    The aim of the present study was to determine the effect of patellar taping (PT) on landing characteristics of the vertical ground reaction force (VGRF) and on flight time during a counter movement jump (CMJ). Eleven healthy male subjects (age: 31.1 ± 4.2 years) volunteered for the study. Each subject performed six CMJs under two different jumping conditions: with PT and without PT (WPT). The order of the two conditions was randomized. All of the measured variables had fair-to-good reliability (intra-class correlation coefficient > 0.75). When we compared the PT and WPT groups, we did not find a significant difference in the magnitude of the first (F1) and second (F2) peaks of the VGRF. We also did not find a significant difference in the time to production of these peaks (T1 and T2), and the time to stabilization (TTS) (p < 0. 05). Furthermore, the flight time was similar in the two groups (0.475 ± 0.046 and 0.474 ± 0.056 s, respectively, for PT and WPT). These results suggest that PT does not jeopardize performance during CMJ. Furthermore, it also does not soften the VGRF generated during the landing, indicating that PT may be of limited utility in preventing injuries associated with this type of movement. Key pointsWe investigated whether patellar taping interferes with athletic performance, as has been suggested by previous studies.We also explored the effect of patellar taping on the forces generated during the landing phase of counter movement jumps.Patellar taping had no effect on the flight time during counter movement jumps.Patellar taping also had no effect on the vertical ground reaction force variables measured during the landing phase of counter movement jumps.This information may be relevant to athletes and trainers who are concerned about the effects of patellar taping on performance. PMID:24149562

  14. The Effect of Patellar Taping on Some Landing Characteristics During Counter Movement Jumps in Healthy Subjects

    PubMed Central

    Cámara, Jesús; Díaz, Francisco; Anza, María Soledad; Mejuto, Gaizka; Puente, Asier; Iturriaga, Gorka; Fernández, Juan-Ramón

    2011-01-01

    The aim of the present study was to determine the effect of patellar taping (PT) on landing characteristics of the vertical ground reaction force (VGRF) and on flight time during a counter movement jump (CMJ). Eleven healthy male subjects (age: 31.1 ± 4.2 years) volunteered for the study. Each subject performed six CMJs under two different jumping conditions: with PT and without PT (WPT). The order of the two conditions was randomized. All of the measured variables had fair-to-good reliability (intra-class correlation coefficient > 0.75). When we compared the PT and WPT groups, we did not find a significant difference in the magnitude of the first (F1) and second (F2) peaks of the VGRF. We also did not find a significant difference in the time to production of these peaks (T1 and T2), and the time to stabilization (TTS) (p < 0. 05). Furthermore, the flight time was similar in the two groups (0.475 ± 0.046 and 0.474 ± 0.056 s, respectively, for PT and WPT). These results suggest that PT does not jeopardize performance during CMJ. Furthermore, it also does not soften the VGRF generated during the landing, indicating that PT may be of limited utility in preventing injuries associated with this type of movement. Key points We investigated whether patellar taping interferes with athletic performance, as has been suggested by previous studies. We also explored the effect of patellar taping on the forces generated during the landing phase of counter movement jumps. Patellar taping had no effect on the flight time during counter movement jumps. Patellar taping also had no effect on the vertical ground reaction force variables measured during the landing phase of counter movement jumps. This information may be relevant to athletes and trainers who are concerned about the effects of patellar taping on performance. PMID:24149562

  15. Joint line and patellar height restoration after revision total knee arthroplasty

    PubMed Central

    Seon, Jong-Keun; Song, Eun-Kyoo

    2016-01-01

    Background: Restoration of proper joint line (JL) position and patellar height in revision total knee arthroplasty (TKA) is essential in the recovery of knee function and kinematics. We determined whether the JL position and patellar height could be restored in patients undergoing septic and aseptic revision TKA. Materials and Methods: We retrospectively reviewed 70 patients (74 knees) who had revision TKA between September 2004 and December 2010. Forty seven knees had a two stage revision for infected TKA and 27 knees for aseptic failure. The JL position, patellar height and patellar tendon (PT) length were measured and compared between primary TKA and post revision. The clinical scores including a hospital for special surgery (HSS), Knee Society Score (KSS), Western Ontario and McMaster Universities (WOMAC) and range of motion (ROM) were compared. Results: The overall JL increased from 17.51 mm to 18.37 mm post revision, the Insall-Salvati (IS) ratio declined from 0.98 to 0.92, and the PT length declined from 42.92 mm to 39.45 mm. 9 of the 21 patellar baja knees improved to normal patellar height. After revision, the JL in the septic group (17.02 mm) was significantly lower than the aseptic group (20.74 mm). The changes of the JL position and IS ratio in the septic group were significantly larger than the aseptic groups (P < 0.05). JL position had a positive correlation to the IS ratio and PT length post revision. The knee function scores including HSS, KSS, WOMAC scores, and ROM all improved post revision compared to pre revision (P < 0.05), and the septic group had a lower knee function compared to the aseptic group. JL position and IS ratio post revision had no correlation to the HSS, KSS, WOMAC scores, and ROM. Conclusions: JL position can be sufficiently restored with appropriate distal femoral augment reconstruction after revision TKA, but the patellar height cannot be well improved, especially in the septic revision with obvious PT contracture. No

  16. Comparative evaluation of patellar height methods in the Brazilian population☆

    PubMed Central

    Behrendt, Christian; Zaluski, Alexandre; e Albuquerque, Rodrigo Pires; de Sousa, Eduardo Branco; Cavanellas, Naasson

    2015-01-01

    Objective The methods most used for patellar height measurement were compared with the plateau–patella angle method. Methods A cross-sectional study was conducted, in which lateral-view radiographs of the knee were evaluated using the three methods already established in the literature: Insall–Salvati (IS), Blackburne–Peel (BP) and Caton–Deschamps (CD). These were compared with the plateau–patella angle method. One hundred and ninety-six randomly selected patients were included in the sample. Results The data were initially evaluated using the chi-square test. This analysis was deemed to be positive with p < 0.0001. We compared the traditional methods with the plateau–patella angle measurement, using Fisher's exact test. In comparing the IS index with the plateau–patella angle, we did not find any statistically significant differences in relation to the proportion of altered cases between the two groups. The traditional methods were compared with the plateau–patella angle with regard to the proportions of cases of high and low patella, by means of Fisher's exact test. This analysis showed that the plateau–patella angle identified fewer cases of high patella than did the IS, BP and CD methods, but more cases of low patella. In comparing pairs, we found that the IS and CD indices were capable of identifying more cases of high patella than was the plateau–patella angle. In relation to the cases of low patella, the plateau–patella angle was capable of identifying more cases than were the other three methods. Conclusions The plateau–patella angle found more patients with low patella than did the classical methods and showed results that diverged from those of the other indices studied. PMID:26962492

  17. Revision Surgery in Permanent Patellar Dislocation in DiGeorge Syndrome

    PubMed Central

    Berruto, Massimo; Parente, Andrea; Ferrua, Paolo; Pasqualotto, Stefano; Uboldi, Francesco; Usellini, Eva

    2015-01-01

    A 29-year-old patient, suffering from DiGeorge syndrome, came to our attention with a history of persistent pain and patellar instability in the left knee after failure of arthroscopic lateral release and Elmslie-Trillat procedure. The patient was unable to walk without crutches and severely limited in daily living activities. Because of arthritic changes of the patellofemoral joint and the failure of previous surgeries it was decided to perform only an open lateral release and medial patellofemoral ligament (MPFL) reconstruction using a biosynthetic ligament in order to obtain patellofemoral stability. At one year post-op range of motion (ROM) was 0–120 with a firm end point at medial patellar mobilization; patella was stable throughout the entire ROM. All the scores improved and she could be able to perform daily activity without sensation of instability. Bilateral patellar subluxation and systemic hyperlaxity are characteristics of syndromic patients and according to literature can be also present in DiGeorge syndrome. MPFL reconstruction with lateral release was demonstrated to be the correct solution in the treatment of patellar instability in this complex case. The choice of an artificial ligament to reconstruct the MPFL was useful in this specific patient with important tissue laxity due to her congenital syndrome. PMID:26783479

  18. Bilateral spontaneous patellar tendon rupture in the absence of concomitant systemic disease or steroid use.

    PubMed

    Greenbaum, B; Perry, J; Lee, J

    1994-11-01

    A case of bilateral patellar tendon rupture in an otherwise healthy 41-year-old man is presented. This is the 15th case reported in the literature. The mechanism of injury is attributed to a flexion moment coupled with a contraction of the quadriceps muscle in nearly all reported cases. Surgical repair produces excellent results. PMID:7854842

  19. 21 CFR 888.3580 - Knee joint patellar (hemi-knee) metallic resurfacing uncemented prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... degenerative and posttraumatic patellar arthritis. (c) Date PMA or notice of completion of a PDP is required. A PMA or a notice of completion of a PDP is required to be filed with the Food and Drug Administration... uncemented prosthesis shall have an approved PMA or a declared completed PDP in effect before being placed...

  20. 21 CFR 888.3580 - Knee joint patellar (hemi-knee) metallic resurfacing uncemented prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... degenerative and posttraumatic patellar arthritis. (c) Date PMA or notice of completion of a PDP is required. A PMA or a notice of completion of a PDP is required to be filed with the Food and Drug Administration... uncemented prosthesis shall have an approved PMA or a declared completed PDP in effect before being placed...

  1. Can the patellar tendon moment arm be predicted from anthropometric measurements?

    PubMed

    Tsaopoulos, Dimitrios E; Maganaris, Constantinos N; Baltzopoulos, Vasilios

    2007-01-01

    The purpose of this study was to examine the relations between patellar tendon moment arm length and several relevant anthropometric characteristics of 22 healthy men. The patellar tendon moment arm length was measured using magnetic resonance imaging with two different methods: (1) measurement of patellar tendon moment arm length (d(PT)) with respect to the tibiofemoral contact point (d(PTCP)) and (2) measurement of d(PT) with respect to the intersection point of the anterior and posterior cruciate ligament (d(PTIP)). Pearson correlation coefficients and a stepwise linear regression analysis were used to examine the relationships between the d(PT) and anthropometric measurements taken. Furthermore, a Student's t-test was used to determine differences between the d(PTCP) and d(PTIP) values. Only knee circumference was a significant d(PTCP) predictor (P < 0.05) but with a very low R2 (0.139). None of the anthropometric parameters examined was found to be a significant d(PTIP) predictor. The correlation coefficients ranged from -0.04 to 0.42. The d(PTIP) values were significantly higher (by 0.84-1.89 cm) than the d(PTCP) values (P < 0.05). These results are in disagreement with previous in vitro findings that d(PT) variance may be explained by knee joint size differences. Hence, existing imaging-based methodologies remain necessary for accurate quantification of the patellar tendon moment arm. PMID:16542664

  2. The Results of Adductor Magnus Tenodesis in Adolescents with Recurrent Patellar Dislocation

    PubMed Central

    Malecki, Krzysztof; Fabis, Jaroslaw; Flont, Pawel; Niedzielski, Kryspin Ryszard

    2015-01-01

    Recurrent dislocation of the patella is a common orthopaedic problem which occurs in about 44% of cases after first-time dislocation. In most cases of first-time patellar dislocation, the medial patellofemoral ligament (MPFL) becomes damaged. Between 2010 and 2012, 33 children and adolescents (39 knees) with recurrent patellar dislocation were treated with MPFL reconstruction using the adductor magnus tendon. The aim of our study is to assess the effectiveness of this surgical procedure. The outcomes were evaluated functionally (Lysholm knee scale, the Kujala Anterior Knee Pain Scale, and isokinetic examination) and radiographically (Caton index, sulcus angle, congruence angle, and patellofemoral angle). Four patients demonstrated redislocation with MPFL graft failure, despite the fact that patellar tracking was found to be normal before the injury, and the patients had not reported any symptoms. Statistically significant improvements in Lysholm and Kujala scales, in patellofemoral and congruence angle, were seen (P < 0.001). A statistically significant improvement in the peak torque of the quadriceps muscle and flexor was observed for 60°/sec and 180°/sec angular velocities (P = 0.01). Our results confirm the efficacy of MPFL reconstruction using the adductor magnus tendon in children and adolescents with recurrent patellar dislocation. PMID:25785271

  3. Surgical treatment of chronic achilles tendinopathy: long-term results of the endoscopic technique.

    PubMed

    Maquirriain, Javier

    2013-01-01

    Surgery has long been established as a valid alternative for chronic Achilles tendinopathies that have failed conservative treatment. Endoscopic procedures have shown satisfactory preliminary results for managing such injuries. The aim of the present study was to evaluate the long-term clinical outcomes of endoscopic surgery in patients with chronic midportion Achilles tendinopathy. We evaluated 27 endoscopic procedures in 24 patients (mean age 45.5 ± 8.9 years; 12 males and 12 females) with chronic Achilles tendinopathy and at least 5 (mean 7.7, range 5 to 14) years of follow-up. All ambulatory procedures consisted of paratenon debridement and longitudinal tenotomies. The clinical evaluation included 2 specific functional rating systems (the Achilles Tendon Scoring System and the Victorian Institute Sport Assessment-Achilles questionnaire) and a pain visual analog scale. Patient satisfaction with the procedure was assessed using a patient global assessment response to therapy Likert scale score. All patients had an improved clinical outcome at the final follow-up visit. Both scoring systems showed significant improvement in all clinical outcomes at the last follow-up visit. The Victorian Institute Sport Assessment-Achilles questionnaire score had improved from 37.0 ± 4.9 points preoperatively to 97.5 ± 12.1 points postoperatively (p = .0006). The Achilles Tendon Scoring System score had improved from 32.6 ± 13.1 points preoperatively to 97.2 ± 12.3 points postoperatively (p = .000006). The pain visual analog scale score averaged 0.2 ± 1.1, and the patient global assessment response to therapy score was 0.25 ± 0.71. The percentage of patients with an excellent patient global assessment response to therapy score was 85.1%. Two postoperative problems were reported (7.4%): a delayed keloid lesion and a seroma with chronic fistula. The infection rate and systemic complication rate were 0%. In conclusion, endoscopic surgery provided a high rate of excellent

  4. 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

  5. The efficacy of therapeutic ultrasound for rotator cuff tendinopathy: A systematic review and meta-analysis.

    PubMed

    Desmeules, François; Boudreault, Jennifer; Roy, Jean-Sébastien; Dionne, Clermont; Frémont, Pierre; MacDermid, Joy C

    2015-08-01

    A systematic review and meta-analysis on the efficacy of therapeutic ultrasound (US) in adults suffering from rotator cuff tendinopathy. A literature search was conducted in four databases for randomized controlled trials (RCT) published until 12/2013, comparing the efficacy of US to any other interventions in adults suffering from rotator cuff tendinopathy. The Cochrane Risk of Bias tool was used to evaluate the risk of bias of included studies. Data were summarized qualitatively or quantitatively. Eleven RCTs with a low mean methodological score (50.0% ± 15.6%) were included. Therapeutic US did not provide greater benefits than a placebo intervention or advice in terms of pain reduction and functional improvement. When provided in conjunction with exercise, US therapy is not superior to exercise alone in terms of pain reduction and functional improvement (pooled mean difference of the Constant-Murley score: -0.26 with 95% confidence interval of -3.84 to 3.32). Laser therapy was found superior to therapeutic US in terms of pain reduction. Based on low to moderate level evidence, therapeutic US does not provide any benefit compared to a placebo or advice, to laser therapy or when combined to exercise. More methodologically sound studies on the efficacy of therapeutic US are warranted. PMID:25824429

  6. Optical properties of human tendons characterized by PSOCT and their relation to tendinopathy: a clinical study

    NASA Astrophysics Data System (ADS)

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

    2008-02-01

    Polarisation-sensitive optical coherence tomography (PSOCT) is a non destructive technique with great potential for tendinopathy diagnosis. Functional optical assessment can be used in operating theatres to delineate in depth the margin of the non-healthy area, and limit the amount of tissue to be removed. A clinical study of 21 patients has been undertaken to correlate the optical properties of tendons to their clinical conditions. Tendons were scanned ex vivo with a fibre based time domain PSOCT. The beam from a superluminescent diode with a bandwidth of 52nm is sent through a polarizer and a polarizer modulator, and split into a sample and reference arm. After passing through polarization beam splitter, the interferences fringes are detected with two balanced detectors, for horizontal and vertical polarization. Scattering, birefringence and in depth stokes vectors are extracted from the measurements. Direct microstructural variation and changes in scattering properties are correlated with different tendinopathy and presence of scar tissue, which is cross-validated by histology. Lack of tissue organization, detected as the disappearance of the bands of birefringence, is representative of tendon degeneration. Special attention is paid to the difference between crimp patterns of different patient's tendons. As in polarization microscopy, the crimp pattern appears as extinction bands, and is particularly important as its alteration is generally symptomatic and could be used as an early diagnosis. Its optical origin is investigated by varying polarization and scanning conditions.

  7. Ex vivo evaluation of the effect of various surgical procedures on blood delivery to the patellar tendon of dogs.

    PubMed

    Johnson, Matthew D; Shmon, Cindy L; Linn, Kathleen A; Singh, Baljit

    2016-05-01

    OBJECTIVE To determine the effect of arthrotomy alone or in combination with osteotomy of the proximal portion of the tibia on blood delivery to the patellar tendon of dogs. SAMPLE 24 canine cadavers. PROCEDURES One hind limb from each cadaver was assigned to 1 of 4 treatment groups: medial arthrotomy (MA; MA group), lateral arthrotomy (LA; LA group), MA and LA with tibial tuberosity transposition (MALA group), and MA with tibial plateau leveling osteotomy (TPLO; TPLO group). The contralateral hind limb served as the control sample. Contrast solution (barium [33%], India ink [17%], and saline [0.9% NaCl] solution [50%]) was injected through an 8F catheter inserted in the caudal portion of the abdominal aorta. Limbs were radiographed to allow examination of vascular filling. The patella, patellar tendon, and tibial crest were harvested, radiographed to allow examination of tissue vascular filling, and fixed in 4% paraformaldehyde. Vessels perfused with contrast solution were counted in sections obtained from the proximal, middle, and distal regions of each patellar tendon. RESULTS Vessel counts did not differ significantly among the 3 tendon regions. Compared with results for the control group, delivery of contrast solution to the patellar tendon was significantly decreased in the MALA and TPLO groups but was not changed in the MA or LA groups. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that surgical procedures used to treat cranial cruciate injuries (ie, TPLO) and patellar luxation decreased blood delivery to the patellar tendon of canine cadavers, at least acutely. PMID:27111023

  8. A Randomized controlled trial comparing patellar retention versus patellar resurfacing in primary total knee arthroplasty: 5–10 year follow-up

    PubMed Central

    2012-01-01

    Background The primary purpose of this randomized controlled trial (RCT) was to compare knee-specific outcomes (stiffness, pain, function) between patellar retention and resurfacing up to 10 years after primary total knee arthroplasty (TKA). Secondarily, we compared re-operation rates. Methods 38 subjects with non-inflammatory arthritis were randomized at primary TKA surgery to receive patellar resurfacing (n = 21; Resurfaced group) or to retain their native patella (n = 17; Non-resurfaced group). Evaluations were performed preoperatively, one, five and 10 years postoperatively by an evaluator who was blinded to group allocation. Self-reported knee-specific stiffness, pain and function, the primary outcomes, were measured by the Western Ontario McMaster Osteoarthritis Index (WOMAC). Revision rate was determined at each evaluation and through hospital record review. Results 30 (88%) and 23 (72%) of available subjects completed the five and 10-year review respectively. Knee-specific scores continued to improve for both groups over the 10-years, despite diminishing overall health with no significant group differences seen. All revisions occurred within five years of surgery (three Non-resurfaced subjects; one Resurfaced subject) (p = 0.31). Two revisions in the Non-resurfaced group were due to persistent anterior knee pain. Conclusions We found no differences in knee-specific results between groups at 5–10 years postoperatively. The Non-resurfaced group had two revisions due to anterior knee pain similar to rates reported in other studies. Knee-specific results provide useful postoperative information and should be used in future studies comparing patellar management strategies. ClinicalTrials.gov identifier NCT01500252 PMID:22676495

  9. Repair of fresh patellar tendon rupture: tension regulation at the suture line

    PubMed Central

    2009-01-01

    The reported complications of the repaired patellar tendon have been attributed to the influence of the mechanical environment on the healing process. This study postulates that the healing complications can be minimised through tension regulation at the suture line using an absorbable reinforcement device. Twelve patients with fresh patellar tendon rupture were included in the study. They were prospectively followed up for an average period of 45 months. The patients resumed their pre-injury activities at an average of 6.1 months. The active knee movement averaged 0–154.6° compared to 0–156.7° in the contralateral knee. Radiologically no patella alta, patella baja or degenerative changes in the patellofemoral joints were noted. The results support use of the absorbable reinforcement device for tension regulation at the suture line. PMID:19809813

  10. Patellar tendon rerupture in a footballer: our personal surgical technique and review of the literature.

    PubMed

    Moretti, L; Vicenti, G; Abate, A; Pesce, V; Moretti, B

    2014-02-01

    Patellar tendon rerupture is a relatively uncommon condition that severely compromises the function of the extensor mechanism of the knee. Few cases described in the literature does not show a unique mode of treatment for this type of lesion. We report the case of a young athlete with traumatic patellar tendon rerupture. The first rupture was treated with the use of Statak anchors. Following a second rerupture incident as a result of a sporting accodent, the tendon was reconstructed with the use of an autologous graft tendon of semitendinosus and biological augmentation with gracilis tendon. For both tendons the distal insertion part was preserved to facilitate the healing process. The treatment was completed with the application of a neutralization cerclage wire and with local injection of plateket reach plasma (PRP). At 12 months follow up, a full recovery of the structure and function of the extensor mechanism was observed and the patient was able to resume normal sports competitive activity. PMID:24314874

  11. Complications associated with corrective surgery for patellar luxation in 85 feline surgical cases.

    PubMed

    Rutherford, Lynda; Langley-Hobbs, Sorrel J; Whitelock, Richard J; Arthurs, Gareth Ian

    2015-04-01

    The objective was to review surgical techniques and postoperative complications of surgical correction for patellar luxation (PL) in cats. A retrospective study evaluating 85 surgeries in 71 cats was performed. The records from four referral centres were searched for cats with surgical management of PL. Signalment, history, PL grade and direction, corrective surgical techniques and outcome were retrieved. Binary logistic regression analysis was used to interrogate relationships between case features, surgical correction methods and outcomes. The outcomes were classified as minor and major complications (requiring revision surgery), including continued PL (reluxation). Postoperative complications occurred in 26% of cases; 20% had major complications, including 5% patellar reluxation, and 6% had minor complications. Cats with previous ipsilateral femoral fracture were significantly more likely to suffer complications, including minor (P = 0.02, odds ratio = 12.67), major (P = 0.03, OR = 7.2) and patellar reluxation (P = 0.01, OR = 19.25). Minor complications were significantly more likely with grade 4 PL (P = 0.03, OR = 8.5). Major complications were significantly more likely with tibial tuberosity transposition (TTT; P = 0.03, OR = 5.57). Patellar reluxation was significantly more likely if stifle surgery had been performed previously (P = 0.05, OR = 8.00). The presence of bilateral PL, hip dysplasia, grade 1, 2 or 3 PL, corrective surgery using an anti-rotational suture or femoral sulcoplasty did not influence complications. Complications were more likely for grade 4 PL, previous ipsilateral femoral fracture, if TTT was performed and for cases with previous stifle surgery. This information allows consideration of risks and complicating factors. PMID:24990869

  12. Patellar resurfacing in total knee arthroplasty: functional outcome differs with different outcome scores

    PubMed Central

    Aunan, Eirik; Næss, Grethe; Clarke-Jenssen, John; Sandvik, Leiv; Kibsgård, Thomas Johan

    2016-01-01

    Background and purpose — Recent research on outcomes after total knee arthroplasty (TKA) has raised the question of the ability of traditional outcome measures to distinguish between treatments. We compared functional outcomes in patients undergoing TKA with and without patellar resurfacing, using the knee injury and osteoarthritis outcome score (KOOS) as the primary outcome and 3 traditional outcome measures as secondary outcomes. Patients and methods — 129 knees in 115 patients (mean age 70 (42–82) years; 67 female) were evaluated in this single-center, randomized, double-blind study. Data were recorded preoperatively, at 1 year, and at 3 years, and were assessed using repeated-measures mixed models. Results — The mean subscores for the KOOS after surgery were statistically significantly in favor of patellar resurfacing: sport/recreation, knee-related quality of life, pain, and symptoms. No statistically significant differences between the groups were observed with the Knee Society clinical rating system, with the Oxford knee score, and with visual analog scale (VAS) for patient satisfaction. Interpretation — In the present study, the KOOS—but no other outcome measure used—indicated that patellar resurfacing may be beneficial in TKA. PMID:26540368

  13. Description of patellar movement by 3D parameters obtained from dynamic CT acquisition

    NASA Astrophysics Data System (ADS)

    de Sá Rebelo, Marina; Moreno, Ramon Alfredo; Gobbi, Riccardo Gomes; Camanho, Gilberto Luis; de Ávila, Luiz Francisco Rodrigues; Demange, Marco Kawamura; Pecora, Jose Ricardo; Gutierrez, Marco Antonio

    2014-03-01

    The patellofemoral joint is critical in the biomechanics of the knee. The patellofemoral instability is one condition that generates pain, functional impairment and often requires surgery as part of orthopedic treatment. The analysis of the patellofemoral dynamics has been performed by several medical image modalities. The clinical parameters assessed are mainly based on 2D measurements, such as the patellar tilt angle and the lateral shift among others. Besides, the acquisition protocols are mostly performed with the leg laid static at fixed angles. The use of helical multi slice CT scanner can allow the capture and display of the joint's movement performed actively by the patient. However, the orthopedic applications of this scanner have not yet been standardized or widespread. In this work we present a method to evaluate the biomechanics of the patellofemoral joint during active contraction using multi slice CT images. This approach can greatly improve the analysis of patellar instability by displaying the physiology during muscle contraction. The movement was evaluated by computing its 3D displacements and rotations from different knee angles. The first processing step registered the images in both angles based on the femuŕs position. The transformation matrix of the patella from the images was then calculated, which provided the rotations and translations performed by the patella from its position in the first image to its position in the second image. Analysis of these parameters for all frames provided real 3D information about the patellar displacement.

  14. Dynamic medial patellofemoral ligament reconstruction in recurrent patellar instability: A surgical technique

    PubMed Central

    Kiran, Kopuri Ravi; Srikanth, I Muni; Chinnusamy, Lenin; Deepti, K

    2015-01-01

    The medial patellofemoral ligament (MPFL) is the primary stabilizer of the patellofemoral joint; its reconstruction has been recommended in adults over the past decade after recurrent patellar instability. However, there has been no standardized technique for reconstruction, therefore, ideal graft and technique for reconstruction are yet undetermined. However, dynamic MPFL reconstruction studies claim to be superior to other procedures as it is more anatomical. This preliminary study aims at assessing the outcomes of MPFL reconstruction in a dynamic pattern using hamstring graft. We performed this procedure in four consecutive patients with chronic patellar instability following trauma. MPFL reconstruction was done with hamstring tendons detached distally and secured to patellar periosteum after being passed through a bony tunnel in the patella without an implant and using the medial collateral ligament as a pulley. In all 4 knees, the MPFL reconstruction was isolated and was not associated with any other realignment procedures. No recurrent episodes of dislocation or subluxation were reported at 24 months followup. PMID:26806970

  15. The effect of in situ freezing on rabbit patellar tendon. A histologic, biochemical, and biomechanical analysis

    NASA Technical Reports Server (NTRS)

    Graf, B. K.; Fujisaki, K.; Vanderby, R. Jr; Vailas, A. C.

    1992-01-01

    Cell necrosis has been well documented as one of the many changes that occur in autogenous tendon when it is used to reconstruct the anterior cruciate ligament. The purpose of this experiment was to isolate cell necrosis as a variable and study its effect on the patellar tendon. To accomplish this, both knees of 25 New Zealand White rabbits were operated on. In one knee, a 5-mm wide band of patellar tendon was subjected to two rapid freeze-thaw cycles, while the other knee underwent sham surgery. Histologic evaluation showed a zone of necrosis at 2 and 4 weeks with cellular repopulation complete at 8 weeks. patellar tendon cross-sectional area was 0.118 cm2 at 8 weeks for the frozen specimens compared to 0.102 cm2 for the sham-operated controls. This difference was significant at the P = 0.025 level. Mechanical testing at 4 and 8 weeks revealed no significant changes in tendon length, maximum load, or stiffness. The collagen content was also unchanged at both 4 and 8 weeks.

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

    PubMed Central

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

    2015-01-01

    ABSTRACT Restoring the native structure of the tendon enthesis, where collagen fibers of the midsubstance are integrated within a fibrocartilaginous structure, is problematic following injury. As current surgical methods fail to restore this region adequately, engineers, biologists, and clinicians are working to understand how this structure forms as a prerequisite to improving repair outcomes. We recently reported on the role of Indian hedgehog (Ihh), a novel enthesis marker, in regulating early postnatal enthesis formation. Here, we investigate how inactivating the Hh pathway in tendon cells affects adult (12‐week) murine patellar tendon (PT) enthesis mechanics, fibrocartilage morphology, and collagen fiber organization. We show that ablating Hh signaling resulted in greater than 100% increased failure insertion strain (0.10 v. 0.05 mm/mm, p<0.01) as well as sub‐failure biomechanical deficiencies. Although collagen fiber orientation appears overtly normal in the midsubstance, ablating Hh signaling reduces mineralized fibrocartilage by 32%, leading to less collagen embedded within mineralized tissue. Ablating Hh signaling also caused collagen fibers to coalesce at the insertion, which may explain in part the increased strains. These results indicate that Ihh signaling plays a critical role in the mineralization process of fibrocartilaginous entheses and may be a novel therapeutic to promote tendon‐to‐bone healing. © 2015 The Authors. Journal of Orthopaedic Research published by Wiley Periodicals, Inc. on behalf of the Orthopaedic Research Society. J Orthop Res 33:1142–1151, 2015. PMID:25807894

  17. Treatment of Achilles Tendinopathy with Autologous Adipose-derived Stromal Vascular Fraction

    PubMed Central

    de Girolamo, Laura; Grassi, Miriam; Viganò, Marco; Orfei, Carlotta Perucca; Montrasio, Umberto Alfieri; Usuelli, Federico

    2016-01-01

    Objectives: Achilles tendinopathy commonly occurs in both active and inactive persons. It consists in the development of pain and inflammation in the early phases, with progression to the development of fibrotic tissue and degeneration of tendon matrix. Current conservative treatment approaches do not provide sustained satisfactory results, particularly in active patients, although platelet rich plasma (PRP) injection have shown to be effective in many cases. The therapeutic effect of adipose-derived mesenchymal stem cells (ASCs), either expanded or used directly within the stromal vascular fraction (SVF), have demonstrated to possess significant anti-inflammatory and immunomodulatory effects, mediated by the release of active factors, and thus potentially useful in the treatment of tendinopathy. Methods: Patients affected by non-insertional Achilles tendinopathy (range 18-55 y/o) were prospectively enrolled in this controlled study, and randomly assigned either to single PRP injection group (GPSIII kit, Biomet, USA) (n=28 tendons) or single adipose tissue SVF (FastKit, Corios, Italy) (n=28 tendons) injection group. All patients were assessed clinically pre-operatively and at 15, 30, 60, 120 and 180 days from treatment, using VAS Pain, VISA-A, AOFAS and SF-36 forms. Patients also underwent to US and MRI before treatment and then at 4 and 6 month-follow-ups. An aliquot of SVF of each patient was analyzed in vitro for mesenchymal stem cells (MSC) content, viability, proliferation rate, differentiation potential and immunomodulatory ability. Sample size of the study was calculated with a power analysis based on VISA-A score. All the results are expressed as mean ± standard deviation. A Wilcoxon test for paired data was performed to compare variables before and after surgery. Results: Population background data and pre-operative scores were similar in the two groups (p>0.05). At final follow up both patients group showed significantly improvements in all the scores in

  18. Insertional tendinopathy of the adductors and rectus abdominis in athletes: a review.

    PubMed

    Valent, Alessandro; Frizziero, Antonio; Bressan, Stefano; Zanella, Elena; Giannotti, Erika; Masiero, Stefano

    2012-04-01

    Insertional tendinopathy of the adductors and rectus abdominis is common in male athletes, especially in soccer players. It may be worsened by physical activity and it usually limits sport performance. The management goal in the acute phase consists of analgesic and anti-inflammatory drugs and physical rehabilitation. In the early stages of rehabilitation, strengthening exercises of adductors and abdominal muscles, such as postural exercises, have been suggested. In the sub-acute phase, muscular strength is targeted by overload training in the gym or aquatherapy; core stability exercises seem to be useful in this phase. Finally, specific sport actions are introduced by increasingly complex exercises along with a preventive program to limit pain recurrences. PMID:23738289

  19. Insertional tendinopathy of the adductors and rectus abdominis in athletes: a review

    PubMed Central

    Valent, Alessandro; Frizziero, Antonio; Bressan, Stefano; Zanella, Elena; Giannotti, Erika; Masiero, Stefano

    2012-01-01

    Summary Insertional tendinopathy of the adductors and rectus abdominis is common in male athletes, especially in soccer players. It may be worsened by physical activity and it usually limits sport performance. The management goal in the acute phase consists of analgesic and anti-inflammatory drugs and physical rehabilitation. In the early stages of rehabilitation, strengthening exercises of adductors and abdominal muscles, such as postural exercises, have been suggested. In the sub-acute phase, muscular strength is targeted by overload training in the gym or aquatherapy; core stability exercises seem to be useful in this phase. Finally, specific sport actions are introduced by increasingly complex exercises along with a preventive program to limit pain recurrences. PMID:23738289

  20. Ultrasound assessment for grading structural tendon changes in supraspinatus tendinopathy: an inter-rater reliability study

    PubMed Central

    Hjarbaek, John; Eshoej, Henrik; Larsen, Camilla Marie; Vobbe, Jette; Juul-Kristensen, Birgit

    2016-01-01

    Aim To evaluate the inter-rater reliability of measuring structural changes in the tendon of patients, clinically diagnosed with supraspinatus tendinopathy (cases) and healthy participants (controls), on ultrasound (US) images captured by standardised procedures. Methods A total of 40 participants (24 patients) were included for assessing inter-rater reliability of measurements of fibrillar disruption, neovascularity, as well as the number and total length of calcifications and tendon thickness. Linear weighted κ, intraclass correlation (ICC), SEM, limits of agreement (LOA) and minimal detectable change (MDC) were used to evaluate reliability. Results ‘Moderate—almost perfect’ κ was found for grading fibrillar disruption, neovascularity and number of calcifications (k 0.60–0.96). For total length of calcifications and tendon thickness, ICC was ‘excellent’ (0.85–0.90), with SEM(Agreement) ranging from 0.63 to 2.94 mm and MDC(group) ranging from 0.28 to 1.29 mm. In general, SEM, LOA and MDC showed larger variation for calcifications than for tendon thickness. Conclusions Inter-rater reliability was moderate to almost perfect when a standardised procedure was applied for measuring structural changes on captured US images and movie sequences of relevance for patients with supraspinatus tendinopathy. Future studies should test intra-rater and inter-rater reliability of the method in vivo for use in clinical practice, in addition to validation against a gold standard, such as MRI. Trial registration number NCT01984203; Pre-results. PMID:27221128

  1. Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Instability Using a Gracilis Autograft without Bone Tunnel

    PubMed Central

    Kim, Tae-Seong; Kim, Hee-June; Ra, In-Hoo

    2015-01-01

    Background Several tendon graft and fixation methods have been introduced in medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar dislocation. The purpose of this study was to evaluate the results of MPFL reconstruction using a gracilis autograft fixation without bone tunnel in patients with recurrent patellar instability. Methods Nine patients (four males and five females) diagnosed with recurrent patellar instability from July 2009 to January 2013 and had MPFL reconstruction using a gracilis autograft were included. The average age of the patients was 24.6 years (range, 13 to 48 years), and the average follow-up period was 19.3 months (range, 12 to 30 months). For every patient, femoral attachment was fixed using suture anchors securing the patella by suturing the periosteum and surrounding soft tissue. Clinical evaluation included the Kujala, Lysholm, and Tegner scores; in addition, patients were examined for any complication including recurrent dislocation. The congruence angle and patella alta were assessed radiologically before and after surgery. Results The Kujala score improved from an average of 42.7 ± 8.4 before surgery to 79.6 ± 13.6 (p = 0.008) at final follow-up; the Lysholm score improved from 45.8 ± 5.7 to 82.0 ± 10.5 (p = 0.008); and the Tegner score improved from 2.8 ± 0.8 to 5.6 ± 1.5 (p = 0.007). The Insall-Salvati ratio changed from 1.16 ± 0.1 (range, 0.94 to 1.35) before surgery to 1.14 ± 0.1 (range, 0.96 to 1.29; p = 0.233) at the final follow-up without significance. The congruence angle significantly improved from 26.5° ± 10.6° (range, 12° to 43°) before surgery to -4.0° ± 4.3° (range, -12° to 5°; p = 0.008) at final follow-up. Subluxation was observed in one patient and hemarthrosis occurred in another patient 2 years after surgery, but these patients were asymptomatic. Conclusions We achieved good results with a patellar fixation technique in MPFL reconstruction using a gracilis autograft employing

  2. Incidence of patellar clunk syndrome in fixed versus high-flex mobile bearing posterior-stabilized total knee arthroplasty.

    PubMed

    Snir, Nimrod; Schwarzkopf, Ran; Diskin, Brian; Takemoto, Richelle; Hamula, Mathew; Meere, Patrick A

    2014-10-01

    The geometry of the intercondylar box plays a significant role in the development of patellar clunk syndrome. We reviewed the incidence of patella clunk at mid-to-long-term follow-up of a rotating high-flex versus fixed bearing posterior stabilized TKA design. 188-mobile and 223-fixed bearing TKAs were reviewed for complications, incidence of patellar clunk, treatment, recurrence rates, range of motion, and patient satisfaction. Patellar clunk developed in 22 knees in the mobile (11.7%) and in 4 (1.8%) in the fixed bearing group (P<0.001). 23 out of 26 cases resolved with a single arthroscopic treatment and 2 resolved with a second procedure. The mean postoperative range of motion was 122.4°. All but one patient reported overall satisfaction with the index procedure. In contrast with other recent studies we found a significant incidence of patellar clunk in high-flex mobile bearings. Despite the high rate of patellar clunk syndrome, overall patients did well and were satisfied with their outcomes. PMID:24961894

  3. Total knee replacement with and without patellar resurfacing: a prospective, randomised trial using the profix total knee system.

    PubMed

    Smith, A J; Wood, D J; Li, M-G

    2008-01-01

    We have examined the differences in clinical outcome of total knee replacement (TKR) with and without patellar resurfacing in a prospective, randomised study of 181 osteoarthritic knees in 142 patients using the Profix total knee system which has a femoral component with features considered to be anatomical and a domed patellar implant. The procedures were carried out between February 1998 and November 2002. A total of 159 TKRs in 142 patients were available for review at a mean of four years (3 to 7). The patients and the clinical evaluator were blinded in this prospective study. Evaluation was undertaken annually by an independent observer using the knee pain scale and the Knee Society clinical rating system. Specific evaluation of anterior knee pain, stair-climbing and rising from a seated to a standing position was also undertaken. No benefit was shown of TKR with patellar resurfacing over that without resurfacing with respect to any of the measured outcomes. In 22 of 73 knees (30.1%) with and 18 of 86 knees (20.9%) without patellar resurfacing there was some degree of anterior knee pain (p = 0.183). No revisions related to the patellofemoral joint were performed in either group. Only one TKR in each group underwent a re-operation related to the patellofemoral joint. A significant association between knee flexion contracture and anterior knee pain was observed in those knees with patellar resurfacing (p = 0.006). PMID:18160498

  4. [Is the use of STABHA™ for supplementation of damaged extracellular matrix of soft tissues in the musculoskeletal system an effective treatment of acute injuries and tendinopathies?].

    PubMed

    Tomaszewski, Wiesław

    2015-01-01

    Viscosupplementation, or the intra articular administration of hyaluronic acid in order to stabilise synovial fluid chemistry and improve its functional quality, is now a popular therapeutic method whose efficacy, based on numerous published studies, makes it not only a form of symptomatic treatment, but also, to a considerable extent, a cause-oriented treatment. However, a possibly controversial aspect of this therapy is the use of “intra articular hyaluronate” in the treatment of post-traumatic or inflammatory soft-tissue lesions in in the musculoskeletal system. Inappropriate administration of this dosage form to the area of the injured soft tissue (Achilles tendon, periarticular tendon of tarsal joint or knee, tennis elbow, tendinopathy within the rotator cuff, etc.) may not only lead to a failure to achieve the desired therapeutic effect but can even increase the severity of the symptoms, including a rupture of the frayed tendon. The role and importance of hyaluronate in the process of natural regeneration of damaged soft tissue has been demonstrated unequivocally and beyond any doubt. Subsequent research aimed to produce forms of hyaluronic acid that would be characterised by a greater influence and support of the regeneration processes in musculoskeletal soft tissue after an acute or chronic injury, as well as to develop the technology to produce a formulation which would be biocompatible, efficient and adapted to the treatment of ligament and tendon injuries. Following administration, such formulation would also need to be identified by the body as a naturally produced hyaluronate, which plays an essential role in the repair of damaged tissue, beginning with the bleeding phase and involving in all phases of the healing process, as has been demonstrated in numerous scientific studies. The development of a technology for producing hyaluronic acid known as STABHA™ (Soft Tissue Adapted Biocompatible Hyaluronic Acid) in 2008 proved to be a significant

  5. Efficacy of betamethasone valerate medicated plaster on painful chronic elbow tendinopathy: a double-blind, randomized, placebo-controlled trial

    PubMed Central

    Frizziero, Antonio; Causero, Araldo; Bernasconi, Stefano; Papalia, Rocco; Longo, Mario; Sessa, Vincenzo; Sadile, Francesco; Greco, Pasquale; Tarantino, Umberto; Masiero, Stefano; Rovati, Stefano; Frangione, Valeria

    2016-01-01

    Summary Objective to investigate the efficacy and safety of a medicated plaster containing betamethasone valerate (BMV) 2.25 mg in patients with chronic elbow tendinopathy. Methods randomized, double-blind, placebo-controlled study with assignment 2:2:1:1 to BMV medicated plaster applied daily for 12 hours, daily for 24 hours or matched placebo. 62 patients aged ≥18 years with chronic lateral elbow tendinopathy were randomized. The primary efficacy variable was pain reduction (VAS) at day 28. Secondary objectives included summed pain intensity differences (SPID), overall treatment efficacy and tolerability. Results mean reduction in VAS pain score at day 28 was greater in both BMV medicated plaster groups, −39.35±27.69 mm for BMV12-h and −36.91±32.50 mm for BMV24-h, than with placebo, −20.20±27.32 mm. Considering the adjusted mean decreases, there was a statistically significant difference between BMV12-h and placebo (p=0.0110). Global pain relief (SPID) and overall treatment efficacy were significantly better with BMV. BMV and placebo plasters had similar local tolerability and there were few treatment-related adverse events. Conclusions BMV plaster was significantly more effective than placebo at reducing pain in patients with chronic elbow tendinopathies. The BMV plaster was safe and well tolerated. PMID:27331041

  6. Elbow tendinopathy.

    PubMed

    Pitzer, Michael E; Seidenberg, Peter H; Bader, Dov A

    2014-07-01

    Overuse injuries of the lateral and medial elbow are common in sport, recreational activities, and occupational endeavors. They are commonly diagnosed as lateral and medial epicondylitis; however, the pathophysiology of these disorders demonstrates a lack of inflammation. Instead, angiofibroblastic degeneration is present, referred to as tendinosis. As such, a more appropriate terminology for these conditions is epicondylosis. This is a clinical diagnosis, and further investigations are only performed to rule out other clinical entities after conventional therapy has failed. Yet, most patients respond to conservative measures with physical therapy and counterforce bracing. Corticosteroid injections are effective for short-term pain control but have not demonstrated long-term benefit. PMID:24994055

  7. Biceps tendinopathy

    PubMed Central

    Ibáñez, Maximiliano; Calvo, Ana Belén; Alvarez, Victoria; Lepore, Salvador; Ibáñez, Federico; Reybet, Juan Andrés

    2015-01-01

    Introduction: Tenodesis is the preferred technique in the treatment of the long head of the biceps tendon pathology in younger people, athletes, workers, and those wishing to avoid any cosmetic deformity. The aim of our study was to compare a group of patients who underwent all arthroscopic biceps tenodesis with a group of patients who underwent an open subpectoral procedure. A clinical assessment was performed and we also registered the occurrence of complications. Materials and Methods: We retrospectively reviewed 90 patients with lesions in the long head of the biceps tendon treated at our institution between January 2009 and January 2012. Group A underwent an arthroscopic technique while Group B was treated in an open fashion. Clinical assessment included appropriate scores (ASES, Rowe, Simple Shoulder Test, Constant Murley), and we also evaluated pain with Visual Analogue Scale (VAS), and personal satisfaction in terms of aesthetics and local pain at the scar. Results: Group A: Rowe 86 points, ASES 81 points, SST 9 points, Constant and Murley 87 points. VAS 2/10. Regarding scars of the portals patients were satisfied. Group B: Rowe 85 points, ASES 82 points, SST 8.5 points, Constant and Murley 85 points. VAS 3/10 (greater at the site of subpectoral approach). Aesthetic concerns about the scar was observed in 4 cases (4 women). Arm deformity (sign of Popeye) was not observed at the latest follow-up. Discussion: No statistical significant differences were found in clinical assessment between both procedures. Arthroscopic tenodesis is technically more challenging and requires an initial longer learning curve in order to perform a successful procedure. Open subpectoral tenodesis despite being a faster and simpler procedure reports discomfort regarding the scar site.

  8. Sex-Steroid Regulation of Relaxin Receptor Isoforms (RXFP1 & RXFP2) Expression in the Patellar Tendon and Lateral Collateral Ligament of Female WKY Rats

    PubMed Central

    Dehghan, Firouzeh; Muniandy, Sekaran; Yusof, Ashril; Salleh, Naguib

    2014-01-01

    The incidence of non-contact knee injury was found higher in female than in male and is related to the phases of the menstrual cycle. This raised the possibility that female sex-steroids are involved in the mechanism underlying this injury via affecting the expression of the receptors for relaxin, a peptide hormone known to modulate ligament laxity. Therefore, this study aims to investigate the effect of sex-steroids on relaxin receptor isoforms (RXFP1 & RXFP2) expression in the ligaments and tendons of the knee. Methods: Ovariectomized adult female WKY rats were treated with different doses of estrogen (0.2, 2, 20 μg/kg), progesterone (4mg) and testosterone (125 & 250μg/kg) for three consecutive days. At the end of the treatment, the animals were sacrificed and the patellar tendon and lateral collateral ligament were harvested for mRNA and protein expression analyses by Real Time PCR and Western blotting respectively. Results: RXFP1, the main isoform expressed in these knee structures and RXFP2 showed a dose-dependent increase in expression with estrogen. Progesterone treatment resulted in an increase while testosterone caused a dose-dependent decrease in the mRNA and protein expression of both relaxin receptor isoforms. Discussion: Progesterone and high dose estrogen up-regulate while testosterone down-regulates RXFP1 and RXFP2 expression in the patellar tendon and lateral collateral ligament of rat's knee. Conclusion: Relaxin receptor isoforms up-regulation by progesterone and high dose estrogen could provide the basis for the reported increase in knee laxity while down-regulation of these receptor isoforms by testosterone could explain low incidence of non-contact knee injury in male. PMID:24465164

  9. Patellar maltracking is prevalent among patellofemoral pain subjects with patella alta: an upright, weightbearing MRI study

    PubMed Central

    Pal, Saikat; Besier, Thor F.; Beaupre, Gary S.; Fredericson, Michael; Delp, Scott L.; Gold, Garry E.

    2012-01-01

    The purpose of this study is to determine if patellar maltracking is more prevalent among patellofemoral (PF) pain subjects with patella alta compared to subjects with normal patella height. We imaged 37 PF pain and 15 pain free subjects in an open-configuration magnetic resonance imaging scanner while they stood in a weightbearing posture. We measured patella height using the Caton-Deschamps, Blackburne-Peel, Insall-Salvati, Modified Insall-Salvati, and Patellotrochlear indices, and classified the subjects into patella alta and normal patella height groups. We measured patella tilt and bisect offset from oblique-axial plane images, and classified the subjects into maltracking and normal tracking groups. Patellar maltracking was more prevalent among PF pain subjects with patella alta compared to PF pain subjects with normal patella height (two-tailed Fisher’s exact test, p < 0.050). Using the Caton-Deschamps index, 67% (8/12) of PF pain subjects with patella alta were maltrackers, whereas only 16% (4/25) of PF pain subjects with normal patella height were maltrackers. Patellofemoral pain subjects classified as maltrackers displayed a greater patella height compared to the pain free and PF pain subjects classified as normal trackers (two-tailed unpaired t-tests with Bonferroni correction, p < 0.017). This study adds to our understanding of PF pain in two ways - 1) we demonstrate that patellar maltracking is more prevalent in PF pain subjects with patella alta compared to subjects with normal patella height; and 2) we show greater patella height in PF pain subjects compared to pain free subjects using four indices commonly used in clinics. PMID:23165335

  10. ASSESSMENT OF TIBIAL SLOPE ANGLE AND PATELLAR HEIGHT AFTER MEDIAL-OPENING TIBIAL OSTEOTOMY

    PubMed Central

    de Paula Mozella, Alan; Vieira Costa, Marcos Areias; de Araujo Barros Cobra, Hugo Alexandre

    2015-01-01

    Objective: To measure the variation in posterior tibial slope angle and patellar height in patients who underwent proximal tibial valgus-producing osteotomy using the medial-opening wedge technique. Methods: Anteroposterior panoramic radiographs of the lower limbs and lateral radiographs of the knee obtained before and after tibial valgus-producing osteotomy on 46 patients with unicompartmental arthrosis of the knee were analyzed. Results: In 23 patients, an external fixator was used to gradually apply a medial-opening wedge; and in the other 23, a blocked plate with a stop bar was applied as a fixation method. Patients with tricompartmental knee disease and those who underwent osteotomy to treat fracture sequelae were excluded from this study. After surgery, the mean increase in the tibial slope was 1.7 degrees (p < 0.01) in the group in which the blocked plate with a stop bar was used; and 2.7 degrees (p < 0.05) in the group in which the external fixator was used. There was no statistical difference between the groups regarding the increase in the posterior tibial slope. Conclusion: The patellar height did not present any change in the cases in which the plate was used, when measured using the Insall-Salvati method, but it presented a decrease in 11 cases (47.8%) when the Caton-Deschamps method was applied. The same tendency was observed regarding change in the patellar height in the cases in which the external fixator was used, such that a decrease was observed in eight cases (34.7%) only when measured using the Caton-Deschamps method. PMID:27047847

  11. 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

  12. Osteoarthritic cartilage lesions in the bovine patellar groove: a macroscopic, histological and immunohistological analysis.

    PubMed

    Heinola, T; Sukura, A; Virkki, L M; Sillat, T; Lekszycki, T; Konttinen, Y T

    2014-04-01

    A high percentage of osteoarthritis (OA)-like patellar groove lesions in the stifle joint in calcium-deficient bulls has been recently reported. The prevalence of these lesions in bulls deficient in or supplemented with calcium was compared to findings in culled and healthy bulls to determine whether they represent normal anatomical variations, developmental anomalies or OA. It was hypothesized that the patellar groove lesions may represent OA. Distal cartilage samples from 160 femurs were analysed using a macroscopic Société Française d'Arthroscopie (SFA) OA grading system. Samples representing different SFA grades were subjected to Osteoarthritis Research Society International (OARSI) histological and high-mobility group box 1 (HMGB1) immunohistological OA grading. For a qualitative analysis three OA samples were immunostained for interleukin (IL)-1β, matrix metalloproteinase (MMP)-13 and collagenase-produced COL2-3/4M neoepitopes. Patellar groove lesions were found in 48% of the femurs and were highest in calcium-deficient animals (71%, P<0.001). All three different grading systems disclosed OA in culled bulls, but no focal areas of cartilage necrosis. OARSI and HMGB1 grades were fairly concordant (Spearman's ρ=0.95, P<0.001; Cohen's κ=0.23, P<0.005), both with a slight disparity with the SFA grade (ρ=0.80 and 0.87, P<0.01; κ=0.36 and 0.46, P<0.001). IL-1β, MMP-13 and COL2-3/4M staining patterns were compatible with OA. The study showed that patellar groove lesions are common in bulls. In all SFA, OARSI and HMGB1 graded samples the lesions clearly demonstrated OA and showed OA-typical pathophysiology. Arthroscopic SFA grading showed similar changes in calcium-deficient and calcium-supplemented bulls, but in the absence of a time course study and histological data the primary nature of these lesions could not be established with certainty. PMID:24581814

  13. SURGICAL CORRECTION OF BILATERAL PATELLAR LUXATION IN AN AMERICAN BLACK BEAR CUB (URSUS AMERICANUS).

    PubMed

    Bennett, Katarina R; Desmarchelier, Marion R; Bailey, Trina R

    2015-06-01

    A wild orphaned male American black bear cub ( Ursus americanus ) presented with hind limb gait abnormalities and was found to have bilateral grade 3 laterally luxating patellas. There were no other significant abnormalities detected on neurologic, radiographic, or hematologic examinations. The trochlear grooves were deepened with a chondroplasty, and the redundant soft tissues imbricated. There was a marked improvement in the bear's gait postoperatively, with an apparent full return to function. To the authors' knowledge, patellar luxation has not been reported in the Ursidae family, and the success in this case suggests that this technique may be used in large wild or captive carnivore cubs. PMID:26056894

  14. Lateral femoral condyle osteochondral fracture combined to patellar dislocation: a case report.

    PubMed

    Callewier, A; Monsaert, A; Lamraski, G

    2009-02-01

    The authors report the case of an osteochondral fracture involving the weight-bearing portion of the lateral femoral condyle in a 23-year-old sportsman. The defect was concomitant to a lateral patellar dislocation involving a rare injury mechanism. Fixation of the osteochondral fragment was performed with bioabsorbable pins and healing was achieved within an acceptable time. Clinical and radiographic outcome at one year is highly satisfactory and bioabsorbable implant fixation reveals to be a worthwhile option in such a case. This rare lesion is diagnostically challenging and requires an adapted and prompt treatment. PMID:19251243

  15. Surgical treatment of simultaneous rupture of the anterior cruciate ligament and the patellar tendon.

    PubMed

    Chiba, Kyohei; Takahashi, Toshiaki; Hino, Kazunori; Watanabe, Seiji; Yamaoka, Gotaro; Shirakata, Haruo; Fujii, Yuko; Miura, Hiromasa

    2013-12-01

    Although the rupture of the anterior cruciate ligament (ACL) is a common sports injury, a simultaneous rupture of the patellar tendon (PT) is relatively rare. We experienced a case in which a patient simultaneously ruptured the ACL, the medial collateral ligament (MCL), and the PT while sliding during a baseball game. We sutured the PT and MCL during the acute stage, and 7 months later we conducted a double-bundle reconstruction of the ACL. To our knowledge, this is the first report of PT repair using only fiber wire thread, and two-phase double-bundle ACL reconstruction. PMID:23288727

  16. MECHANICAL RESISTANCE OF THE PATELLAR LIGAMENT AFTER REMOVAL OF THE MIDDLE THIRD THROUGH EITHER ONE LONGITUDINAL INCISION OR TWO MINI-TRANSVERSE INCISIONS

    PubMed Central

    De Lazari, Leandro Calil; Paccola, Cleber Antonio Jansen

    2015-01-01

    Objective: To evaluate the resistance and regeneration of the patellar ligament after harvesting a graft for reconstruction of the anterior cruciate ligament, using the traditional technique of a single longitudinal skin incision or a technique of two transverse mini-incisions, in sheep. Methods: Ten sheep were used. In the right knee, we removed the graft using the traditional method, and in the left knee, using the two-incision method. The animals were observed for six months. The specimens (patellar ligament, tibia and patella) were adapted to the mechanical test machine for ligament resistance tests. Results: No difference was found between the two proposed techniques in relation to the regeneration and resistance of the patellar ligament. However, we observed that shortening of the patellar ligament occurred in both groups, and that suturing of the superficial fascia of the patellar ligament did not influence the regeneration of the patellar ligament, according to the histology. Conclusion: The technique using two incisions in the skin presents the same patterns of regeneration and resistance of the remaining patellar ligament as shown by the traditional technique of a single, longitudinal incision. PMID:27022540

  17. Bi-linear mechanical property determination of acellular human patellar tendon grafts for use in anterior cruciate ligament replacement.

    PubMed

    Herbert, Anthony; Brown, Christopher; Rooney, Paul; Kearney, John; Ingham, Eileen; Fisher, John

    2016-06-14

    Anterior cruciate ligament rupture is rising in its prevalence amongst the young and those with physically active lifestyles. Acellular human patellar tendon (PT) grafts offer a promising restoration solution, returning knee joint stability and overcoming some of the current disadvantages of autologous or allogeneic grafts. However, it is necessary to ensure that the decellularisation bio-processes involved do not cause structural changes in the microstructure of the tendon tissue that may adversely affect the mechanical properties, particularly with respect to the physiological range of loading. Sixteen cadaveric human PT grafts were sourced and processed from eight donors, with full ethical approval and consent for use in research. Eight specimens were allocated for decellularisation, while the remaining eight contralateral specimens were used as native controls. Testing consisted of 12 preconditioning cycles followed by uniaxial extension until failure occurred. Stress-strain data was then fitted to a bi-linear model using least squares regression by a custom-written Matlab script. The elastic moduli for the toe region and linear region of each specimen were determined, in addition to the transition point co-ordinates and strain energy density for increasing strain. No significant differences were found between groups for all of the parameters investigated. Hence, the shape and magnitude of the stress-strain profile was found to be the same for both groups throughout loading. The results of this study indicated that decellularisation appeared to have no effect on the material properties of human PT grafts under quasistatic conditions. Therefore, acellular human PT grafts can offer a viable additional solution for ACL replacement compared to current autologous and allogeneic treatment options. PMID:27063250

  18. Volumetric characterization of human patellar cartilage matrix on phase contrast x-ray computed tomography

    NASA Astrophysics Data System (ADS)

    Abidin, Anas Z.; Nagarajan, Mahesh B.; Checefsky, Walter A.; Coan, Paola; Diemoz, Paul C.; Hobbs, Susan K.; Huber, Markus B.; Wismüller, Axel

    2015-03-01

    Phase contrast X-ray computed tomography (PCI-CT) has recently emerged as a novel imaging technique that allows visualization of cartilage soft tissue, subsequent examination of chondrocyte patterns, and their correlation to osteoarthritis. Previous studies have shown that 2D texture features are effective at distinguishing between healthy and osteoarthritic regions of interest annotated in the radial zone of cartilage matrix on PCI-CT images. In this study, we further extend the texture analysis to 3D and investigate the ability of volumetric texture features at characterizing chondrocyte patterns in the cartilage matrix for purposes of classification. Here, we extracted volumetric texture features derived from Minkowski Functionals and gray-level co-occurrence matrices (GLCM) from 496 volumes of interest (VOI) annotated on PCI-CT images of human patellar cartilage specimens. The extracted features were then used in a machine-learning task involving support vector regression to classify ROIs as healthy or osteoarthritic. Classification performance was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC). The best classification performance was observed with GLCM features correlation (AUC = 0.83 +/- 0.06) and homogeneity (AUC = 0.82 +/- 0.07), which significantly outperformed all Minkowski Functionals (p < 0.05). These results suggest that such quantitative analysis of chondrocyte patterns in human patellar cartilage matrix involving GLCM-derived statistical features can distinguish between healthy and osteoarthritic tissue with high accuracy.

  19. Single Shot Adductor Canal Block for Postoperative Analgesia of Pediatric Patellar Dislocation Surgery

    PubMed Central

    Chen, Jia-Yu; Li, Na; Xu, Yong-Qing

    2015-01-01

    Abstract Postoperative analgesia for the knee surgery in children can be challenging. Meanwhile acute pain management in pediatric patients is still often undertreated due to inadequate pain assessment or management. We reported the ultrasound-guided single-injection adductor canal block (ACB) with 0.2% ropivacaine and dexmedetomidine (0.5 μg/kg) in addition in a series of 6 children. Patients’ age was range from 7 to 15 years old with right or left habitual patellar dislocation needing an open reduction and internal refixation. Pain assessments using Numeric Rating Scale scores on the operative limb were made preoperatively and at 12, 24, 36, and 48 h postoperatively at rest. Medication consumption was calculated as well. The possible complications, such as hemodynamic changes, nausea, vomiting, and dysesthesia, were also recorded at 12, 24, 36, and 48 h postoperatively at rest. The pain scores were low, and analgesic medication consumption was minimal. Meanwhile, no adverse events were recorded in any of the subject. Single-injection ACB might be an optimal analgesia strategy for patellar dislocation surgery in pediatric patients. PMID:26632911

  20. An Algorithmic Approach to the Management of Recurrent Lateral Patellar Dislocation.

    PubMed

    Weber, Alexander E; Nathani, Amit; Dines, Joshua S; Allen, Answorth A; Shubin-Stein, Beth E; Arendt, Elizabeth A; Bedi, Asheesh

    2016-03-01

    High-level evidence supports nonoperative treatment for first-time lateral acute patellar dislocations. Surgical intervention is often indicated for recurrent dislocations. Recurrent instability is often multifactorial and can be the result of a combination of coronal limb malalignment, patella alta, malrotation secondary to internal femoral or external tibial torsion, a dysplastic trochlea, or disrupted and weakened medial soft tissue, including the medial patellofemoral ligament (MPFL) and the vastus medialis obliquus. MPFL reconstruction requires precise graft placement for restoration of anatomy and minimal graft tension. MPFL reconstruction is safe to perform in skeletally immature patients and in revision surgical settings. Distal realignment procedures should be implemented in recurrent instability associated with patella alta, increased tibial tubercle-trochlear groove distances, and lateral and distal patellar chondrosis. Groove-deepening trochleoplasty for Dejour type-B and type-D dysplasia or a lateral elevation or proximal recession trochleoplasty for Dejour type-C dysplasia may be a component of the treatment algorithm; however, clinical outcome data are lacking. In addition, trochleoplasty is technically challenging and has a risk of substantial complications. PMID:26935465

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

    SciTech Connect

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

    1990-07-01

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

  2. Avulsion fracture of the posterior cruciate ligament in an uncommon location associated with distal injury to the patellar ligament☆

    PubMed Central

    e Albuquerque, Rodrigo Pires; da Palma, Idemar Monteiro; Cobra, Hugo; de Paula Mozella, Alan; Vaques, Victor

    2015-01-01

    Avulsion fractures of the posterior cruciate ligament in unusual locations are rare injuries. We report the first case in the literature of an avulsion fracture of the posterior cruciate ligament associated with distal injury to the patellar ligament. The aim of this study was to present a novel case, the therapy used and the clinical follow-up. PMID:27218089

  3. Reconstruction of knee joint soft tissue and patellar tendon defects using a composite anterolateral thigh flap with vascularized fascia lata.

    PubMed

    Kuo, Yur-Ren; An, Po-Chung; Kuo, Mei-Hui; Kueh, Nai-Siong; Yao, Sheng-Fa; Jeng, Seng-Feng

    2008-01-01

    Reconstruction of a complex knee trauma with knee joint exposure and composite soft tissue and patellar tendon deficiency remains a challenging task. Multiple-stage reconstruction is time-consuming and produces considerable suffering for patients. Early mobilization following knee reconstruction has achieved good outcomes. Herein, we reported one-stage reconstruction with an ALT myocutaneous flap with vascularized fascia lata was utilized for one patient with a large complex knee joint soft tissue defect, and segmental deficiency of the patellar tendon. The fascia lata sheet was rolled to mimic a patellar tendon. The exposed knee joint was obturated by the vastus lateralis muscle of the ALT myocutaneous flap. The skin and soft tissue defect was reconstructed using the skin paddle of the ALT flap. The patient's postoperative course was uneventful. An MRI examination demonstrated good continuity of the reconstructed patellar tendon. The active ROM of the injured knee reached 100 degrees (extension deficiency 20 degrees and flexion 120 degrees ) at 5 years. Objective functional assessment of the patella-femoral joint utilized a kinetic communicator machine (Kin-Com 500H, Chattecx, Chattanooga, TN, USA) revealed still mild extension insufficiency. However, the patient reported that he was able to perform normal daily activities without difficulty at 5-year follow-up. PMID:18215803

  4. Kinematic Magnetic Resonance Imaging of the Effect of Bracing on Patellar Position: Qualitative Assessment Using an Extremity Magnetic Resonance System

    PubMed Central

    Shellock, Frank G.; Mullin, Michael; Stone, Kevin R.; Coleman, Mark; Crues, John V.

    2000-01-01

    Objective: To use an extremity magnetic resonance system to perform kinematic magnetic resonance imaging (MRI) of the patellofemoral joint to qualitatively assess the effect of bracing on patellar position. Design and Setting: Subjects underwent kinematic MRI of the symptomatic extremity with a 0.2-Tesla extremity magnetic resonance system. Images were obtained using a knee coil and a T1-weighted, spin echo pulse sequence. Subjects: Seven female patients with patellofemoral joint symptoms. Measurements: Four different axial sections were obtained for each position: extension and 3 positions of flexion up to 36°. An appropriate-sized patellofemoral brace was applied, and the kinematic MRI procedure was repeated. Results: Six patients had lateral displacement of the patella, and 1 patient had medial displacement of the patella. After application of the brace, 6 patients (5 with lateral displacement and 1 with medial displacement, 86%) exhibited correction (5) or improvement (1 with lateral displacement) in the abnormal patellar positions, and 1 patient had worsening of the abnormal position of the patella. Conclusions: We used kinematic MRI to determine the presence of abnormal patellar positioning. Application of the brace counteracted the abnormal patellar positions in most of the patients studied. ImagesFigure 2.Figure 3. PMID:16558607

  5. Evidence for an Environmental and Inherited Predisposition Contributing to the Risk for Global Tendinopathies or Compression Neuropathies in Patients With Rotator Cuff Tears

    PubMed Central

    Tashjian, Robert Z.; Farnham, James M.; Granger, Erin K.; Teerlink, Craig C.; Cannon-Albright, Lisa A.

    2016-01-01

    Background: Rotator cuff tearing has been found to be clinically associated with other tendinopathies and compression neuropathies; a significant excess of these phenotypes has been seen in patients with rotator cuff tears. It is unclear if the association is secondary to environmental or genetic influences. Purpose: To examine population-based data for comorbid association of rotator cuff tearing and tendinopathies and compression neuropathies and to determine whether the association extends to relatives of patients with rotator cuff tears, which could suggest a genetic contribution. Study Design: Cross-sectional study; Level of evidence, 3. Methods: The Utah Population Database (UPDB) contains health and genealogical data on over 2 million Utah residents. Current Procedural Terminology, Fourth Revision, codes (CPT 4) and International Classification of Diseases, Ninth Revision, codes (ICD-9) entered in patient records were used to identify patients with rotator cuff tearing and with comorbid tendinopathies and compression neuropathies. We tested the hypothesis of excess familial clustering of these other phenotypes with rotator cuff tearing using a well-established method (estimation of relative risks) in the overall study group of rotator cuff patients (N = 1889). Results: Significantly elevated risk for elbow, hand/wrist, foot/ankle, knee, and hip tendinopathies, as well as for all tendinopathies and compression neuropathies, was observed in rotator cuff tear cases themselves (P < 2.8e–13), in their spouses (P < .02), and in their first-degree relatives (P < 5.5e–4). A significant excess of elbow (P = .01), foot/ankle (P = .04), and all tendinopathies (P = 3.1e–3) was also observed in second-degree relatives, and a significant excess of compression neuropathies (P = .03) was observed in third-degree relatives. Conclusion: The current study shows strong evidence of familial clustering of rotator cuff tearing with other tendinopathies and with compression

  6. Quadriceps tendinosis and patellar tendinosis in professional beach volleyball players: sonographic findings in correlation with clinical symptoms.

    PubMed

    Pfirrmann, Christian W A; Jost, Bernhard; Pirkl, Christof; Aitzetmüller, Gernot; Lajtai, Georg

    2008-08-01

    The purpose was to assess quadriceps and patellar tendinosis in professional beach volleyball players and to correlate ultrasound findings with clinical symptoms. During a grand-slam beach volleyball tournaments all 202 athletes (100 men and 102 women) were invited to participate at this study. Sixty-one athletes (38 male, mean age 29.6, 23 female, mean age 27.1) were included. The dominant leg was right in 51 (84%) and left in ten athletes (16%). Lysholm knee score and pain during the game was assessed using a visual analogue scale. Sonography of the quadriceps tendon and the patellar tendon was performed by a blinded sonographer. Sonographic findings were compared between both legs and correlated to clinical findings using a regression analysis. Quadriceps tendinosis was diagnosed in 13 (21%, dominant leg)/21 (34%, non-dominant leg), patellar tendinosis in 13(21%)/18(30%). Only sonographic findings at the quadriceps tendon were significantly associated with pain: thickness of the quadriceps tendon (mean diameter 6.9 mm/7.1 mm, significant for both legs P = 0.011/P = 0.030), abnormal echo texture (11/16; P = 0.001/P = 0.228), areas with positive power Doppler signals (mean number 0.3/0.4; P = 0.049/0.346), calcifications (mean number: 0.9/1.1; P = 0.021/0.864). A relationship between findings at patellar tendon was not found. Quadriceps tendinosis is as common as patellar tendinosis in professional beach volleyball players. Thickening and structure alteration of the quadriceps tendon is associated with anterior knee pain during beach volleyball. PMID:18386014

  7. Surgical versus non-surgical management for primary patellar dislocations: an up-to-date meta-analysis.

    PubMed

    Zheng, Xiaozuo; Kang, Kai; Li, Tong; Lu, Bo; Dong, Jiangtao; Gao, Shijun

    2014-12-01

    The aim of this up-to-date meta-analysis was to compare the effects of surgical versus non-surgical treatment of patients following primary patellar dislocation and to provide the best evidence currently available. A comprehensive literature search was conducted using multiple databases, including Medline, Embase, and Cochrane Registry of Clinical Trials. All databases were searched from the earliest records to May 2013. Eligible studies were selected, and data were extracted by two independent investigators. The primary outcome variable was the frequency of recurrent patellar dislocation. The other outcomes included knee function scores, patient-rated outcomes, and radiographic examination. If appropriate, meta-analysis of these variables was performed. Nine independent trials were found to match the inclusion criteria. The pooled results demonstrated that the incidence of recurrent patellar dislocation and Hughston visual analog scale was significantly lower in the surgical treatment group than that in the non-surgical treatment group (P < 0.05). There was no statistically significant difference between the two treatment groups in frequency of subsequent surgical interventions, percentage of excellent or good subjective opinion, Kujala score, pain score on visual analog scale, and severity of patellofemoral joint osteoarthrosis (P > 0.05). This up-to-date meta-analysis indicates that surgical treatment was associated with a lower risk of recurrent patellar dislocation, but a lower Hughston VAS than non-surgical treatment for primary patellar dislocation. More large high-quality trials and further studies are needed to overcome the limitations of small sample sizes, and varieties of different surgical procedures or non-surgical management strategies adopted in the included trials. PMID:24390042

  8. Conservative Treatment of Subacute Proximal Hamstring Tendinopathy Using Eccentric Exercises Performed With a Treadmill: A Case Report

    PubMed Central

    CUSHMAN, DANIEL; RHO, MONICA E.

    2015-01-01

    STUDY DESIGN Case report. BACKGROUND Proximal hamstring tendinopathy in runners is characterized by pain with passive hip flexion with the knee extended, active hip extension, and pain with sitting. Relatively little literature exists on the condition, and publications on nonsurgical treatment protocols are even more scarce. Surgical intervention, which comprises the majority of literature for treatment of this condition, is an option for cases that fail to respond to nonsurgical treatment. CASE DESCRIPTION The patient was a 34-year-old, otherwise healthy male triathlete with unilateral proximal hamstring tendinopathy diagnosed by ultrasound, who had pain only with running and prolonged sitting. After he failed to respond to 4 weeks of eccentric knee flexion and lumbopelvic musculature strengthening exercises, an eccentric hip extensor strengthening program using a treadmill was initiated. This treadmill exercise was performed on a daily basis, in addition to a lumbopelvic musculature strengthening program. OUTCOMES The patient noted a decrease in pain within 2 weeks of initiating the new exercise, and was able to return to gradual running after 4 weeks and to speed training after 12 weeks. He returned to competition shortly thereafter and had no recurrence for 12 months after the initiation of therapy. His score on the Victorian Institute of Sport Assessment-proximal hamstring tendons improved from 23 on initial presentation to 83 at 12 weeks after the initiation of therapy. DISCUSSION We described the management of a triathlete with subacute proximal hamstring tendinopathy, who responded well to nonsurgical treatment using eccentric hip extension strengthening using a treadmill. LEVEL OF EVIDENCE Therapy, level 4. PMID:25996362

  9. 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

  10. Acute Calcific Bursitis After Ultrasound-Guided Percutaneous Barbotage of Rotator Cuff Calcific Tendinopathy: A Case Report.

    PubMed

    Kang, Bo-Sung; Lee, Seung Hak; Cho, Yung; Chung, Sun Gun

    2016-08-01

    Ultrasound-guided percutaneous barbotage is an effective treatment for rotator cuff calcific tendinopathy, providing rapid and substantial pain relief. We present the case of a 49-year-old woman with aggravated pain early after ultrasound-guided barbotage of a large calcific deposit in the supraspinatus tendon. Subsequent examination revealed a thick calcification spreading along the subacromial-subdeltoid bursa space, suggesting acute calcific bursitis complicated by barbotage. Additional barbotage alleviated her pain completely. Therefore, a high index of suspicion for acute calcific bursitis is required in patients with unresolved or aggravated pain after barbotage. Repeated barbotage could be effective for this condition. PMID:26902864

  11. Acute, simultaneous tear of patellar tendon and ACL: possible mechanism of injury and rationality of the two-stage surgical treatment

    PubMed Central

    Koukoulias, Nikolaos E; Koumis, Panagiotis; Papadopoulos, Alexis; Kyparlis, Dimitris; Papastergiou, Stergios G

    2011-01-01

    The authors report a case of a 47-year-old professional driver with an acute, simultaneous tear of patellar tendon and anterior cruciate ligament (ACL). The patient was treated in two stages. Acute patellar tendon repair and delayed (6-month postinjury) ACL reconstruction was performed. The authors discuss the possible mechanism of injury and the rationality of the two-stage surgical treatment. PMID:22687668

  12. Acute, simultaneous tear of patellar tendon and ACL: possible mechanism of injury and rationality of the two-stage surgical treatment.

    PubMed

    Koukoulias, Nikolaos E; Koumis, Panagiotis; Papadopoulos, Alexis; Kyparlis, Dimitris; Papastergiou, Stergios G

    2011-01-01

    The authors report a case of a 47-year-old professional driver with an acute, simultaneous tear of patellar tendon and anterior cruciate ligament (ACL). The patient was treated in two stages. Acute patellar tendon repair and delayed (6-month postinjury) ACL reconstruction was performed. The authors discuss the possible mechanism of injury and the rationality of the two-stage surgical treatment. PMID:22687668

  13. Patellar tendon or hamstring graft anterior cruciate ligament reconstructions in patients aged above 50 years

    PubMed Central

    Bali, Tarun; Nagraj, Raghu; Kumar, Malhar N; Chandy, Thomas

    2015-01-01

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

  14. Structure, ontogeny and evolution of the patellar tendon in emus (Dromaius novaehollandiae) and other palaeognath birds

    PubMed Central

    Pitsillides, Andrew A.; Hutchinson, John R.

    2014-01-01

    The patella (kneecap) exhibits multiple evolutionary origins in birds, mammals, and lizards, and is thought to increase the mechanical advantage of the knee extensor muscles. Despite appreciable interest in the specialized anatomy and locomotion of palaeognathous birds (ratites and relatives), the structure, ontogeny and evolution of the patella in these species remains poorly characterized. Within Palaeognathae, the patella has been reported to be either present, absent, or fused with other bones, but it is unclear how much of this variation is real, erroneous or ontogenetic. Clarification of the patella’s form in palaeognaths would provide insight into the early evolution of the patella in birds, in addition to the specialized locomotion of these species. Findings would also provide new character data of use in resolving the controversial evolutionary relationships of palaeognaths. In this study, we examined the gross and histological anatomy of the emu patellar tendon across several age groups from five weeks to 18 months. We combined these results with our observations and those of others regarding the patella in palaeognaths and their outgroups (both extant and extinct), to reconstruct the evolution of the patella in birds. We found no evidence of an ossified patella in emus, but noted its tendon to have a highly unusual morphology comprising large volumes of adipose tissue contained within a collagenous meshwork. The emu patellar tendon also included increasing amounts of a cartilage-like tissue throughout ontogeny. We speculate that the unusual morphology of the patellar tendon in emus results from assimilation of a peri-articular fat pad, and metaplastic formation of cartilage, both potentially as adaptations to increasing tendon load. We corroborate previous observations of a ‘double patella’ in ostriches, but in contrast to some assertions, we find independent (i.e., unfused) ossified patellae in kiwis and tinamous. Our reconstructions suggest a

  15. Structure, ontogeny and evolution of the patellar tendon in emus (Dromaius novaehollandiae) and other palaeognath birds.

    PubMed

    Regnault, Sophie; Pitsillides, Andrew A; Hutchinson, John R

    2014-01-01

    The patella (kneecap) exhibits multiple evolutionary origins in birds, mammals, and lizards, and is thought to increase the mechanical advantage of the knee extensor muscles. Despite appreciable interest in the specialized anatomy and locomotion of palaeognathous birds (ratites and relatives), the structure, ontogeny and evolution of the patella in these species remains poorly characterized. Within Palaeognathae, the patella has been reported to be either present, absent, or fused with other bones, but it is unclear how much of this variation is real, erroneous or ontogenetic. Clarification of the patella's form in palaeognaths would provide insight into the early evolution of the patella in birds, in addition to the specialized locomotion of these species. Findings would also provide new character data of use in resolving the controversial evolutionary relationships of palaeognaths. In this study, we examined the gross and histological anatomy of the emu patellar tendon across several age groups from five weeks to 18 months. We combined these results with our observations and those of others regarding the patella in palaeognaths and their outgroups (both extant and extinct), to reconstruct the evolution of the patella in birds. We found no evidence of an ossified patella in emus, but noted its tendon to have a highly unusual morphology comprising large volumes of adipose tissue contained within a collagenous meshwork. The emu patellar tendon also included increasing amounts of a cartilage-like tissue throughout ontogeny. We speculate that the unusual morphology of the patellar tendon in emus results from assimilation of a peri-articular fat pad, and metaplastic formation of cartilage, both potentially as adaptations to increasing tendon load. We corroborate previous observations of a 'double patella' in ostriches, but in contrast to some assertions, we find independent (i.e., unfused) ossified patellae in kiwis and tinamous. Our reconstructions suggest a single

  16. Temperature Changes in Human Patellar Tendon in Response to Therapeutic Ultrasound

    PubMed Central

    Chan, Alice K.; Myrer, J. William; Measom, Gary J.; Draper, David O.

    1998-01-01

    Objective: To determine the rate and magnitude of temperature change in response to ultrasound in human patellar tendon for two treatment sizes. Design and Setting: A thermistor was inserted into the medial aspect of each subject's right patellar tendon, and the baseline temperature was recorded. Using stratified random sampling and using a transducer head with an effective radiating area (ERA) of 4.5 cm2, we had eight subjects each undergo either the 2-or 4-ERA ultrasound treatment first. Each subject received a 3-MHz continuous ultrasound treatment at 1 W/cm2 for both the 2-and 4-ERA treatment sizes. Subjects: Sixteen subjects (8 males, 21.3 ± 1.9 years, and 8 females, 21.0 ± 2.8 years) participated. Measurements: We moved the sound head at a speed of 2 to 3 cm/sec while recording the tendon temperature every 30 seconds during, and for 20 minutes after, the 4-minute treatment. Twenty minutes after the treatment, we applied the second treatment to the other ERA treatment size. Results: At the end of the treatment, the mean temperature increase was significantly different (P = .006) between treatment sizes (8.3°C ± 1.7°C (2 × ERA) and 5.0°C ± 1.0°C (4 × ERA)). The rate of increase was also significantly different (P < .001). The heating rate per minute for the 2-ERA treatment was 2.1°C ± 0.4°C and 1.3°C ± 0.3°C for the 4-ERA treatment. There was a significant difference in the cooling between treatment sizes (P = .001). The rate of temperature decrease between treatment sizes was significantly different only during the first 5-minute interval post-treatment. Conclusion: Three-megahertz ultrasound at an intensity of 1 W/cm2 significantly increased patellar tendon temperature at both 2 and 4 × ERA, but our results confirm that the 2-ERA treatment size provided higher and longer heating than the 4-ERA treatment size. ImagesFig 1.Fig 2.Fig 3. PMID:16558499

  17. Retrospective study of sonographic findings in bone involvement associated with rotator cuff calcific tendinopathy: preliminary results of a case series*

    PubMed Central

    Nogueira-Barbosa, Marcello H.; Gregio-Junior, Everaldo; Lorenzato, Mario Muller

    2015-01-01

    Objective The present study was aimed at investigating bone involvement secondary to rotator cuff calcific tendonitis at ultrasonography. Materials and Methods Retrospective study of a case series. The authors reviewed shoulder ultrasonography reports of 141 patients diagnosed with rotator cuff calcific tendonitis, collected from the computer-based data records of their institution over a four-year period. Imaging findings were retrospectively and consensually analyzed by two experienced musculoskeletal radiologists looking for bone involvement associated with calcific tendonitis. Only the cases confirmed by computed tomography were considered for descriptive analysis. Results Sonographic findings of calcific tendinopathy with bone involvement were observed in 7/141 (~ 5%) patients (mean age, 50.9 years; age range, 42-58 years; 42% female). Cortical bone erosion adjacent to tendon calcification was the most common finding, observed in 7/7 cases. Signs of intraosseous migration were found in 3/7 cases, and subcortical cysts in 2/7 cases. The findings were confirmed by computed tomography. Calcifications associated with bone abnormalities showed no acoustic shadowing at ultrasonography, favoring the hypothesis of resorption phase of the disease. Conclusion Preliminary results of the present study suggest that ultrasonography can identify bone abnormalities secondary to rotator cuff calcific tendinopathy, particularly the presence of cortical bone erosion. PMID:26811551

  18. Eccentric Exercise Protocols for Patella Tendinopathy: Should we Really be Withdrawing Athletes from Sport? A Systematic Review

    PubMed Central

    Saithna, Adnan; Gogna, Rajiv; Baraza, Njalalle; Modi, Chetan; Spencer, Simon

    2012-01-01

    The 2007 review by Visnes and Bahr concluded that athletes with patella tendinopathy should be withdrawn from sport whilst engaging in eccentric exercise (EE) rehabilitation programs. However, deprivation of sport is associated with a number of negative psychological and physiological effects. Withdrawal from sport is therefore a decision that warrants due consideration of the risk/benefit ratio. The aim of this study was to determine whether sufficient evidence exists to warrant withdrawal of athletes from sport during an eccentric exercise rehabilitation program. A systematic review of the literature was performed to identify relevant randomised trials. Data was extracted to determine whether athletes were withdrawn from sport, what evidence was presented to support the chosen strategy and whether this affected the clinical outcome. Seven studies were included. None of these reported high quality evidence to support withdrawal. In addition, three studies were identified in which athletes were not withdrawn from sport and still benefited from EE. This review has demonstrated that there is no high quality evidence to support a strategy of withdrawal from sport in the management of patella tendinopathy. PMID:23248727

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

    PubMed Central

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

    2014-01-01

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

  20. Feasibility of utilizing the patellar ligament angle for assessing cranial cruciate ligament rupture in dogs

    PubMed Central

    Lee, Jung-ha

    2014-01-01

    The patellar ligament angle (PLA) was assessed in 105 normal stifle joints of 79 dogs and 33 stifle joints of 26 dogs with a ruptured cranial cruciate ligament (CrCL). The PLA of stifles with complete CrCL rupture was significantly lower than that of normal stifles, particularly at a flexion angle of 60~80° in both plain and stress views. If the PLA was <90.55° on the stress view with a 60~80° flexion angle, the dog was diagnosed with a complete rupture of the CrCL with a sensitivity of 83.9% and specificity of 100%. In conclusion, measuring the PLA is a quantitative method for diagnosing complete CrCL rupture in canines. PMID:24962409

  1. Studies on incidence and evaluation of the closed medial patellar desmotomy in lateral recumbency in bovines

    PubMed Central

    Singh, Ajit Kumar; Gangwar, A. K.; Devi, Kh. Sangeeta; Singh, H. N.

    2015-01-01

    Aim: The present study was conducted to find out the incidence and to evaluate the effectiveness of medial patellar desmotomy (MPD) in lateral recumbency in bovines. Material and Methods: One hundred and fifteen clinical cases of upward fixation of the patella in cattle and buffaloes were treated by closed MPD in lateral recumbency. Probable etiologies, symptoms and site of surgery including disease occurrence with respect to species, sex and season were also recorded. Results: In the present study, the highest incidence was reported in bullocks. A high success rate was obtained with the closed method in lateral recumbency. Conclusion: Based on the findings of this study, it can be concluded that the bullocks were more prone to upward fixation of patella and symptoms were exaggerated in winter season. Closed method of MPD was more suited in both cattle and buffaloes. PMID:27047077

  2. The Paratenon Contributes to Scleraxis-Expressing Cells during Patellar Tendon Healing

    PubMed Central

    Dyment, Nathaniel A.; Liu, Chia-Feng; Kazemi, Namdar; Aschbacher-Smith, Lindsey E.; Kenter, Keith; Breidenbach, Andrew P.; Shearn, Jason T.; Wylie, Christopher; Rowe, David W.; Butler, David L.

    2013-01-01

    The origin of cells that contribute to tendon healing, specifically extrinsic epitenon/paratenon cells vs. internal tendon fibroblasts, is still debated. The purpose of this study is to determine the location and phenotype of cells that contribute to healing of a central patellar tendon defect injury in the mouse. Normal adult patellar tendon consists of scleraxis-expressing (Scx) tendon fibroblasts situated among aligned collagen fibrils. The tendon body is surrounded by paratenon, which consists of a thin layer of cells that do not express Scx and collagen fibers oriented circumferentially around the tendon. At 3 days following injury, the paratenon thickens as cells within the paratenon proliferate and begin producing tenascin-C and fibromodulin. These cells migrate toward the defect site and express scleraxis and smooth muscle actin alpha by day 7. The thickened paratenon tissue eventually bridges the tendon defect by day 14. Similarly, cells within the periphery of the adjacent tendon struts express these markers and become disorganized. Cells within the defect region show increased expression of fibrillar collagens (Col1a1 and Col3a1) but decreased expression of tenogenic transcription factors (scleraxis and mohawk homeobox) and collagen assembly genes (fibromodulin and decorin). By contrast, early growth response 1 and 2 are upregulated in these tissues along with tenascin-C. These results suggest that paratenon cells, which normally do not express Scx, respond to injury by turning on Scx and assembling matrix to bridge the defect. Future studies are needed to determine the signaling pathways that drive these cells and whether they are capable of producing a functional tendon matrix. Understanding this process may guide tissue engineering strategies in the future by stimulating these cells to improve tendon repair. PMID:23555841

  3. The paratenon contributes to scleraxis-expressing cells during patellar tendon healing.

    PubMed

    Dyment, Nathaniel A; Liu, Chia-Feng; Kazemi, Namdar; Aschbacher-Smith, Lindsey E; Kenter, Keith; Breidenbach, Andrew P; Shearn, Jason T; Wylie, Christopher; Rowe, David W; Butler, David L

    2013-01-01

    The origin of cells that contribute to tendon healing, specifically extrinsic epitenon/paratenon cells vs. internal tendon fibroblasts, is still debated. The purpose of this study is to determine the location and phenotype of cells that contribute to healing of a central patellar tendon defect injury in the mouse. Normal adult patellar tendon consists of scleraxis-expressing (Scx) tendon fibroblasts situated among aligned collagen fibrils. The tendon body is surrounded by paratenon, which consists of a thin layer of cells that do not express Scx and collagen fibers oriented circumferentially around the tendon. At 3 days following injury, the paratenon thickens as cells within the paratenon proliferate and begin producing tenascin-C and fibromodulin. These cells migrate toward the defect site and express scleraxis and smooth muscle actin alpha by day 7. The thickened paratenon tissue eventually bridges the tendon defect by day 14. Similarly, cells within the periphery of the adjacent tendon struts express these markers and become disorganized. Cells within the defect region show increased expression of fibrillar collagens (Col1a1 and Col3a1) but decreased expression of tenogenic transcription factors (scleraxis and mohawk homeobox) and collagen assembly genes (fibromodulin and decorin). By contrast, early growth response 1 and 2 are upregulated in these tissues along with tenascin-C. These results suggest that paratenon cells, which normally do not express Scx, respond to injury by turning on Scx and assembling matrix to bridge the defect. Future studies are needed to determine the signaling pathways that drive these cells and whether they are capable of producing a functional tendon matrix. Understanding this process may guide tissue engineering strategies in the future by stimulating these cells to improve tendon repair. PMID:23555841

  4. Wear-Lines and Split-Lines of Human Patellar Cartilage: Relation to Tensile Biomechanical Properties

    PubMed Central

    Bae, Won C.; Wong, Van W.; Hwang, Jennifer; Antonacci, Jennifer M.; Nugent-Derfus, Gayle E.; Blewis, Megan E.; Temple-Wong, Michele M.; Sah, Robert L.

    2008-01-01

    Background Articular cartilage undergoes age-associated degeneration, resulting in both structural and functional biomechanical changes. At early stages of degeneration, wear-lines develop in the general direction of joint movement. With aging, cartilage exhibits a decrease in tensile modulus. The tensile modulus of cartilage has also been related to the orientation of the collagen network, as revealed by split-lines. Objective To determine the relative contribution of wear-line and split-line orientation on the tensile biomechanical properties of human patellar cartilage from different depths. Methods In human patellar cartilage, wear- and split-lines are aligned parallel to each other at the proximal facet, and perpendicular to each other at the medial facet. Using superficial, middle, and deep cartilage sections from these two sites, tensile samples were prepared in two orthogonal orientations. Thus, for each depth, there were four groups of samples, with their long axes were aligned either parallel or perpendicular to wear-line direction and also aligned parallel or perpendicular to split-line direction. Uniaxial tensile tests were performed to assess equilibrium and ramp moduli. Results Tensile equilibrium modulus varied with wear-line orientation (p<0.05) and depth (p<0.001), in an interactive manner (p<0.05), and tended to vary with split-line orientation (p=0.16). In the superficial layer, equilibrium and ramp modulus was higher when the samples were loaded parallel to wear-lines (p<0.05). Conclusion These results indicate that mild wear (i.e., wear-line formation) at the articular surface has deleterious functional effects on articular cartilage and represents an early aging associated degenerative change. The identification and recognition of functional biomechanical consequences of wear-lines is useful for planning and interpreting tensile biomechanical tests in human articular cartilage. PMID:18248747

  5. RANDOMIZED PROSPECTIVE STUDY ON TRAUMATIC PATELLAR DISLOCATION: CONSERVATIVE TREATMENT VERSUS RECONSTRUCTION OF THE MEDIAL PATELLOFEMORAL LIGAMENT USING THE PATELLAR TENDON, WITH A MINIMUM OF TWO YEARS OF FOLLOW-UP

    PubMed Central

    Bitar, Alexandre Carneiro; D'Elia, Caio Oliveira; Demange, Marco Kawamura; Viegas, Alexandre Christo; Camanho, Gilberto Luis

    2015-01-01

    Objective: The aim of this study was to compare the surgical results from reconstruction of the medial patellofemoral ligament (MPFL) with non-operative treatment of primary patellar dislocation. Methods: Thirty-nine patients (41 knees) with patellar dislocation were randomized into two groups. One group was treated conservatively (immobilization and physiotherapy) and other was treated surgically with reconstruction of the MPFL, and the results were evaluated with a minimum follow-up of two years. The Kujala questionnaire was applied to assess pain and quality of life, and recurrences were evaluated. Pearson's chi-square test and Fisher's exact test were used in the statistical evaluation. Results: The statistical analysis showed that the mean Kujala score was significantly lower in the conservative group (70.8), compared with the mean value in the surgical group (88.9), with p = 0.001. The surgical group presented a higher percentage of “good/excellent” Kujala score results (71.43%) than in the conservative group (25.0%), with p = 0.003. The conservative group presented a greater number of recurrences (35% of the cases), while in the surgical group there were no reports of recurrences and/or subluxation. Conclusions: Treatment with reconstruction of the medial patellofemoral ligament using the patellar tendon produced better results, based on the analysis of post-treatment recurrences and the better final results from the Kujala questionnaire after a minimum follow-up period of two years. PMID:27027072

  6. Circumferential electrocautery of the patella in primary total knee replacement without patellar replacement: a meta-analysis and systematic review

    PubMed Central

    Fan, Lihong; Ge, Zhaogang; Zhang, Chen; Li, Jia; Yu, Zefeng; Dang, Xiaoqian; Wang, Kunzheng

    2015-01-01

    The purpose of this meta-analysis and systematic review was to identify and assess whether circumferential electrocautery is useful for improving outcomes after primary total knee replacement(TKR). We searched MEDLINE, EMBASE, PubMed, SpringerLink, Web of Knowledge, OVID CINAHL, OVID EBM and Google Scholar and included articles published through January 2014. A total of 6 articles met the inclusion criteria. Of the 776 cases included in the analysis, 388 cases involved patellar denervation, and 388 cases were designated as the control group. The meta-analysis revealed no significant difference in the incidence of anterior knee pain (AKP, p = 0.18) or in the visual analogue scale score (VAS, p = 0.23) between the two groups. In addition, AKSS Function Score indicated no significant difference between the two groups (p = 0.28). However, the OKS (p = 0.02), patellar score (p = 0.01), AKSS-Knee Score (p = 0.004), range of motion (ROM, p < 0.0001) and WOMAC Score (p = 0.0003) indicated that circumpatellarelectrocautery improved clinical outcomes compared with non-electrocautery. The results indicate that circumferential electrocautery of the patella does not significantly improve AKP compared with non-electrocautery techniques but that circumferential electrocautery significantly improves patients' knee function after surgery. Therefore, we believe that circumferential electrocautery is beneficial to the outcome of primary TKR surgery without patellar replacement. PMID:25801456

  7. Circumferential electrocautery of the patella in primary total knee replacement without patellar replacement: a meta-analysis and systematic review

    NASA Astrophysics Data System (ADS)

    Fan, Lihong; Ge, Zhaogang; Zhang, Chen; Li, Jia; Yu, Zefeng; Dang, Xiaoqian; Wang, Kunzheng

    2015-03-01

    The purpose of this meta-analysis and systematic review was to identify and assess whether circumferential electrocautery is useful for improving outcomes after primary total knee replacement(TKR). We searched MEDLINE, EMBASE, PubMed, SpringerLink, Web of Knowledge, OVID CINAHL, OVID EBM and Google Scholar and included articles published through January 2014. A total of 6 articles met the inclusion criteria. Of the 776 cases included in the analysis, 388 cases involved patellar denervation, and 388 cases were designated as the control group. The meta-analysis revealed no significant difference in the incidence of anterior knee pain (AKP, p = 0.18) or in the visual analogue scale score (VAS, p = 0.23) between the two groups. In addition, AKSS Function Score indicated no significant difference between the two groups (p = 0.28). However, the OKS (p = 0.02), patellar score (p = 0.01), AKSS-Knee Score (p = 0.004), range of motion (ROM, p < 0.0001) and WOMAC Score (p = 0.0003) indicated that circumpatellarelectrocautery improved clinical outcomes compared with non-electrocautery. The results indicate that circumferential electrocautery of the patella does not significantly improve AKP compared with non-electrocautery techniques but that circumferential electrocautery significantly improves patients' knee function after surgery. Therefore, we believe that circumferential electrocautery is beneficial to the outcome of primary TKR surgery without patellar replacement.

  8. Long-Term Follow-Up of Nonoperatively and Operatively Treated Acute Primary Patellar Dislocation in Skeletally Immature Patients

    PubMed Central

    Mikkelsen, Christina; Janarv, Per-Mats

    2014-01-01

    Purpose. The present study reports a long-term follow-up of acute primary patellar dislocation in patients with open physes. The purpose of the study was to evaluate knee function and recurrence rates after surgical and nonsurgical treatment of patellar dislocation. Methods. A total of 51 patients, including 29 girls and 22 boys, who were 9–14 years of age at the time of injury, were retrospectively evaluated. The minimum follow-up time was 5 years. Thigh muscle torque, range of motion, the squat test, the knee injury and osteoarthritis outcome score (KOOS), the Kujala score, and the recurrence rate were registered. Radiological predisposing factors at the time of injury were determined. Results. Quality of life and sports/recreation were the most affected subscales, according to KOOS, and a reduced Kujala score was also observed in all treatment groups. The surgically treated patients had a significantly lower recurrence rate. Those patients also exhibited reduced muscle performance, with a hamstring to quadriceps ratio (H/Q) of 1.03. The recurrence rate was not correlated with knee function. Conclusions. Patellar dislocation in children influences subjective knee function in the long term. Surgery appears to reduce the recurrence rate, but subjective knee function was not restored. PMID:25485299

  9. Beneficial Effects of Autologous Bone Marrow-Derived Mesenchymal Stem Cells in Naturally Occurring Tendinopathy

    PubMed Central

    Smith, Roger Kenneth Whealands; Werling, Natalie Jayne; Dakin, Stephanie Georgina; Alam, Rafiqul; Goodship, Allen E.; Dudhia, Jayesh

    2013-01-01

    Tendon injuries are a common age-related degenerative condition where current treatment strategies fail to restore functionality and normal quality of life. This disease also occurs naturally in horses, with many similarities to human tendinopathy making it an ideal large animal model for human disease. Regenerative approaches are increasingly used to improve outcome involving mesenchymal stem cells (MSCs), supported by clinical data where injection of autologous bone marrow derived MSCs (BM-MSCs) suspended in marrow supernatant into injured tendons has halved the re-injury rate in racehorses. We hypothesized that stem cell therapy induces a matrix more closely resembling normal tendon than the fibrous scar tissue formed by natural repair. Twelve horses with career-ending naturally-occurring superficial digital flexor tendon injury were allocated randomly to treatment and control groups. 1X107 autologous BM-MSCs suspended in 2 ml of marrow supernatant were implanted into the damaged tendon of the treated group. The control group received the same volume of saline. Following a 6 month exercise programme horses were euthanized and tendons assessed for structural stiffness by non-destructive mechanical testing and for morphological and molecular composition. BM-MSC treated tendons exhibited statistically significant improvements in key parameters compared to saline-injected control tendons towards that of normal tendons and those in the contralateral limbs. Specifically, treated tendons had lower structural stiffness (p<0.05) although no significant difference in calculated modulus of elasticity, lower (improved) histological scoring of organisation (p<0.003) and crimp pattern (p<0.05), lower cellularity (p<0.007), DNA content (p<0.05), vascularity (p<0.03), water content (p<0.05), GAG content (p<0.05), and MMP-13 activity (p<0.02). Treatment with autologous MSCs in marrow supernatant therefore provides significant benefits compared to untreated tendon repair in

  10. Beneficial effects of autologous bone marrow-derived mesenchymal stem cells in naturally occurring tendinopathy.

    PubMed

    Smith, Roger Kenneth Whealands; Werling, Natalie Jayne; Dakin, Stephanie Georgina; Alam, Rafiqul; Goodship, Allen E; Dudhia, Jayesh

    2013-01-01

    Tendon injuries are a common age-related degenerative condition where current treatment strategies fail to restore functionality and normal quality of life. This disease also occurs naturally in horses, with many similarities to human tendinopathy making it an ideal large animal model for human disease. Regenerative approaches are increasingly used to improve outcome involving mesenchymal stem cells (MSCs), supported by clinical data where injection of autologous bone marrow derived MSCs (BM-MSCs) suspended in marrow supernatant into injured tendons has halved the re-injury rate in racehorses. We hypothesized that stem cell therapy induces a matrix more closely resembling normal tendon than the fibrous scar tissue formed by natural repair. Twelve horses with career-ending naturally-occurring superficial digital flexor tendon injury were allocated randomly to treatment and control groups. 1X10(7) autologous BM-MSCs suspended in 2 ml of marrow supernatant were implanted into the damaged tendon of the treated group. The control group received the same volume of saline. Following a 6 month exercise programme horses were euthanized and tendons assessed for structural stiffness by non-destructive mechanical testing and for morphological and molecular composition. BM-MSC treated tendons exhibited statistically significant improvements in key parameters compared to saline-injected control tendons towards that of normal tendons and those in the contralateral limbs. Specifically, treated tendons had lower structural stiffness (p<0.05) although no significant difference in calculated modulus of elasticity, lower (improved) histological scoring of organisation (p<0.003) and crimp pattern (p<0.05), lower cellularity (p<0.007), DNA content (p<0.05), vascularity (p<0.03), water content (p<0.05), GAG content (p<0.05), and MMP-13 activity (p<0.02). Treatment with autologous MSCs in marrow supernatant therefore provides significant benefits compared to untreated tendon repair in

  11. Electromechanical delay of the knee extensor muscles is not altered after harvesting the patellar tendon as a graft for ACL reconstruction: implications for sports performance.

    PubMed

    Georgoulis, A D; Ristanis, S; Papadonikolakis, A; Tsepis, E; Moebius, U; Moraiti, C; Stergiou, N

    2005-09-01

    Although the scar tissue, which heals the donor site defect, has different elasticity from the neighbouring patellar tissue, it remains unclear if this scar tissue can lead to the changes of the electromechanical delay (EMD) of the knee extensor muscles. If such changes do exist, they can possibly affect both the utilization of the stored energy in the series elastic component, as well as the optimal performance of the knee joint movement. The purpose of this study was to investigate the influence of harvesting the patellar tendon during anterior cruciate ligament (ACL) reconstruction and the associated patellar tendon scar tissue development on the EMD of the rectus femoris (RF) and vastus medialis (VM) muscles. Seventeen patients who underwent an ACL reconstruction using the medial third of the patellar tendon were divided in two groups based upon their post-operative time interval. Maximal voluntary contraction from the knee extensors, surface EMG activity, and ultrasonographic measurements of the patellar tendon cross-section area were obtained from both knees. Our results revealed that no significant changes for the maximal voluntary contraction of the knee extensors and for the EMD of the RF and the VM muscles due to patellar scar tissue development after harvesting the tendon for ACL reconstruction. The EMD, as a component of the stretch reflex, is important for the utilization of the stored energy in the series elastic component and thus, optimal sports performance. However, from our results, it can be implied that the ACL reconstruction using a patellar tendon graft would not impair sports performance as far as EMD is concerned. PMID:15968530

  12. Calcific Tendinopathy of the Gluteus Medius Mimicking Lumbar Radicular Pain Successfully Treated With Barbotage: A Case Report.

    PubMed

    Jo, Hannae; Kim, Gowun; Baek, Sora; Park, Hee-Won

    2016-04-01

    We report a case of calcific tendinopathy of the gluteus medius initially misdiagnosed as a lumbar herniated intervertebral disc. It was successfully treated with barbotage under ultrasonographic guidance finally. A 56-year-old woman was referred to interventional pain clinic for right hip pain due to an L5-S1 disc herniation. Serial L5 and S1 spinal nerve root blocks and epidural steroid injections were administered. However, pain relief was sustained only for a very short period. Plain radiography of the right hip revealed a solid calcific nodule at adjacent to the insertion site of the gluteus medius tendon. Physical modalities and extracorporeal shock wave therapy failed to improve the pain. Therefore, we attempted ultrasound-guided barbotage of the calcification. Barbotage was performed twice serially and her pain was considerably improved. At 6-month follow-up, the calcification was completely resolved. PMID:27152290

  13. Calcific Tendinopathy of the Gluteus Medius Mimicking Lumbar Radicular Pain Successfully Treated With Barbotage: A Case Report

    PubMed Central

    Jo, Hannae; Kim, Gowun; Baek, Sora

    2016-01-01

    We report a case of calcific tendinopathy of the gluteus medius initially misdiagnosed as a lumbar herniated intervertebral disc. It was successfully treated with barbotage under ultrasonographic guidance finally. A 56-year-old woman was referred to interventional pain clinic for right hip pain due to an L5-S1 disc herniation. Serial L5 and S1 spinal nerve root blocks and epidural steroid injections were administered. However, pain relief was sustained only for a very short period. Plain radiography of the right hip revealed a solid calcific nodule at adjacent to the insertion site of the gluteus medius tendon. Physical modalities and extracorporeal shock wave therapy failed to improve the pain. Therefore, we attempted ultrasound-guided barbotage of the calcification. Barbotage was performed twice serially and her pain was considerably improved. At 6-month follow-up, the calcification was completely resolved. PMID:27152290

  14. The additional value of a night splint to eccentric exercises in chronic midportion Achilles tendinopathy: a randomised controlled trial

    PubMed Central

    de Vos, R J; Weir, A; Visser, R J A; de Winter, ThC; Tol, J L

    2007-01-01

    Aim To assess whether the use of a night splint is of added benefit on functional outcome in treating chronic midportion Achilles tendinopathy. Methods This was a single‐blind, prospective, single centre, randomised controlled trial set in the Sports Medical Department, The Hague Medical Centre, The Netherlands. Inclusion criteria were: age 18–70 years, active participation in sports, and tendon pain localised at 2–7 cm from distal insertion. Exclusion criteria were: insertional disorders, partial or complete ruptures, or systemic illness. 70 tendons were included and randomised into one of two treatment groups: eccentric exercises with a night splint (night splint group, n = 36) or eccentric exercises only (eccentric group, n = 34). Interventions Both groups completed a 12‐week heavy‐load eccentric training programme. One group received a night splint in addition to eccentric exercises. At baseline and follow‐up at 12 weeks, patient satisfaction, Victorian Institute of Sport Assessment–Achilles questionnaire (VISA‐A) score and reported compliance were recorded by a single‐blind trained researcher who was blinded to the treatment. Results After 12 weeks, patient satisfaction in the eccentric group was 63% compared with 48% in the night splint group. The VISA‐A score significantly improved in both groups; in the eccentric group from 50.1 to 68.8 (p = 0.001) and in the night splint group from 49.4 to 67.0 (p<0.001). There was no significant difference between the two groups in VISA‐A score (p = 0.815) and patient satisfaction (p = 0.261). Conclusion A night splint is not beneficial in addition to eccentric exercises in the treatment of chronic midportion Achilles tendinopathy. PMID:17178774

  15. A randomised controlled feasibility study investigating the use of eccentric and concentric strengthening exercises in the treatment of rotator cuff tendinopathy

    PubMed Central

    Adams, Nicola

    2014-01-01

    Objectives: To conduct a feasibility study to compare concentric and eccentric rotator cuff strengthening exercises for rotator cuff tendinopathy. Methods: A total of 11 patients with rotator cuff tendinopathy who were on the waiting list for arthroscopic subacromial decompression surgery were randomised to perform eccentric rotator cuff strengthening exercises, concentric strengthening exercises or no exercises. Patients were evaluated in terms of levels of pain and function using the Oxford Shoulder Score and a Visual Analogue Scale initially, at 4 weeks and at 8 weeks. Results: The study design was found to be acceptable to patients and achieved a high level of 86% compliance. The drop-out rate was 0%. Two patients performing eccentric strengthening exercises improved sufficiently to cancel their planned surgery. Conclusion: Further research in this area is recommended. The study design was feasible and power calculations have been conducted to aid future research planning. PMID:26770702

  16. Patellar instability in Indian population: relevance of tibial tuberosity and trochlear groove distance

    PubMed Central

    Kulkarni, Sourabh; Shetty, Amith P.; Alva, Karan K.; Talekar, Saurabh; Shetty, Vijay D.

    2016-01-01

    Introduction: The tibial tuberosity to trochlear groove (TTTG) distance in the western population is extensively studied through various modalities such as X-rays, computerised tomography and magnetic resonance imaging. However, to our knowledge there is very little or no literature support to indicate that TTTG distance has been studied in the Indian population. Methods: We therefore undertook a study to measure the TTTG distance in 100 MRI scans of normal Indian knees. Patients with the following co-morbidities were excluded from the study; ligamentous laxity, patellofemoral instability, mal-alignment and osteoarthritis. We measured TTTG distance on the axial MRI slices using OsiriX software. Results: The mean value for females was found to be 14.07 mm and that for male was found to be 13.34 mm. Our study indicates that the TTTG distance, using MRI scans as measurement modality, in the Indian population is significantly different when compared to the published western data. Discussion: We believe that this study can form the basis for future studies on the relationship between TTTG distance and patellar instability in Indian population. PMID:27163103

  17. Comparison of grafts for anatomical reconstruction of the ACL: patellar versus semitendinosus/gracilis☆

    PubMed Central

    Bitun, Patrícia Barros; Miranda, Carlos Roberto; Escudero, Ricardo Boso; Araf, Marcelo; de Souza, Daphnis Gonçalves

    2015-01-01

    Objective To compare the functional results from surgical treatment for anatomical reconstruction of the anterior cruciate ligament (ACL) with a single band, using two types of autologous grafts. Methods Twenty-seven patients who underwent anatomical reconstruction of the ACL by means of the Chambat technique were evaluated prospectively. They were divided into two groups: A, with 14 patients, using grafts from flexor tendons; and B, with 13 patients, using grafts from the patellar tendon. In both groups, fixation was performed using an absorbable interference screw. Results Based on the Lysholm score, group A presented a mean score of 71.6 in the first month, while B presented 75. At the end of the sixth month, both groups presented 96.6. Evaluation of the total IKDC showed that in the first month, the majority of the patients, both in group A (85.7%) and in group B (76.9%), presented a knee assessment that was close to normal. In the sixth month, 92.9% of group A had normal presentations, and 100% of group B. Conclusion According to the Lysholm functional evaluation and the IKDC subjective assessment, there was no statistically significant difference in the results between the groups, and the results were better in the sixth month. PMID:26229896

  18. Whole-body vibration training induces hypertrophy of the human patellar tendon.

    PubMed

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

    2016-08-01

    Animal studies suggest that regular exposure to whole-body vibration (WBV) induces an anabolic response in bone and tendon. However, the effects of this type of intervention on human tendon properties and its influence on the muscle-tendon unit function have never been investigated. The aim of this study was to investigate the effect of WBV training on the patellar tendon mechanical, material and morphological properties, the quadriceps muscle architecture and the knee extension torque-angle relationship. Fifty-five subjects were randomized into either a vibration, an active control, or an inactive control group. The active control subjects performed isometric squats on a vibration platform without vibration. Muscle and tendon properties were measured using ultrasonography and dynamometry. Vibration training induced an increase in proximal (6.3%) and mean (3.8%) tendon cross-sectional area, without any appreciable change in tendon stiffness and modulus or in muscle architectural parameters. Isometric torque at a knee angle of 90° increased in active controls (6.7%) only and the torque-angle relation remained globally unchanged in all groups. The present protocol did not appreciably alter knee extension torque production or the musculo-tendinous parameters underpinning this function. Nonetheless, this study shows for the first time that WBV elicits tendon hypertrophy in humans. PMID:26173589

  19. Mechanical, compositional, and structural properties of the mouse patellar tendon with changes in biglycan gene expression.

    PubMed

    Dourte, Leann M; Pathmanathan, Lydia; Mienaltowski, Michael J; Jawad, Abbas F; Birk, David E; Soslowsky, Louis J

    2013-09-01

    Tendons have complex mechanical properties that depend on their structure and composition. Some studies have assessed the role of small leucine-rich proteoglycans (SLRPs) in the mechanical response of tendon, but the relationships between sophisticated mechanics, assembly of collagen and SLRPs have not been well characterized. In this study, biglycan gene expression was varied in a dose dependent manner using biglycan null, biglycan heterozygote and wild type mice. Measures of mechanical (tension and compression), compositional and structural changes of the mouse patellar tendon were evaluated. Viscoelastic, tensile dynamic modulus was found to be increased in the biglycan heterozygous and biglycan null tendons compared to wild type. Gene expression analyses revealed biglycan gene expression was closely associated in a dose-dependent allelic manner. No differences were seen between genotypes in elastic or compressive properties or quantitative measures of collagen structure. These results suggest that biglycan, a member of the SLRP family, plays a role in tendon viscoelasticity that cannot be completely explained by its role in collagen fibrillogenesis. PMID:23592048

  20. Mechanical, Compositional, and Structural Properties of the Mouse Patellar Tendon with Changes in Biglycan Gene Expression

    PubMed Central

    Dourte, LeAnn M.; Pathmanathan, Lydia; Mienaltowski, Michael J.; Jawad, Abbas F.; Birk, David E.; Soslowsky, Louis J.

    2013-01-01

    Tendons have complex mechanical properties that depend on their structure and composition. Some studies have assessed the role of small leucine-rich proteoglycans (SLRPs) in the mechanical response of tendon, but the relationships between sophisticated mechanics, assembly of collagen and SLRPs have not been well characterized. In this study, biglycan gene expression was varied in a dose dependent manner using biglycan null, biglycan heterozygote and wild type mice. Measures of mechanical (tension and compression), compositional and structural changes of the mouse patellar tendon were evaluated. Viscoelastic, tensile dynamic modulus was found to be increased in the biglycan heterozygous and biglycan null tendons compared to wild type. Gene expression analyses revealed biglycan gene expression was closely associated in a dose-dependent allelic manner. No differences were seen between genotypes in elastic or compressive properties or quantitative measures of collagen structure. These results suggest that biglycan, a member of the SLRP family, plays a role in tendon viscoelasticity that cannot be completely explained by its role in collagen fibrillogenesis. PMID:23592048

  1. Evaluation of the patellar tendon in transtibial amputees: a preliminary sonographic study.

    PubMed

    Ozçakar, Levent; Kömürcü, Erkam; Safaz, Ismail; Göktepe, Ahmet Salim; Yazicioğlu, Kamil

    2009-12-01

    This study aimed to provide sonographic imaging of the patellar tendon (PT) - one of the main weight bearing structures for prosthetic use - in transtibial amputees. Thirteen males, who had been under follow-up for unilateral traumatic transtibial amputations, were enrolled. After physical examination of the limb, pain was evaluated by visual analogue scale and Leeds Assessment of Neuropathic Symptoms and Signs. Sonographic evaluations were performed by using a linear array probe (Aloka UST-5524-7.5 MHz) on both sides. Measurements pertaining to the contralateral limbs were taken as controls. In three subjects (23.1%), two with a silicone liner and one with a pelite liner, cortical irregularities were detected at the tibial insertion of the PT on the amputated sides. PTs were found to be thicker on the amputated sides when compared with those of the contralateral sides (p = 0.03), and this increase in thickness correlated with disease duration (r = 0.67, p = 0.01). Overall, our preliminary results imply that after transtibial amputation, PTs of the amputated sides tend to become thicker by time. These findings need to be complemented with future studies. In this regard, sonography seems to be promising for imaging the soft tissue problems of the stump. PMID:19961293

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

    PubMed Central

    Steineman, Brett D.; Karra, Pavan; Park, Kiwon

    2016-01-01

    Deep tendon reflex tests, such as the patellar tendon reflex (PTR), are widely accepted as simple examinations for detecting neurological disorders. Despite common acceptance, the grading scales remain subjective, creating an opportunity for quantitative measures to improve the reliability and efficacy of these tests. Previous studies have demonstrated the usefulness of quantified measurement variables; however, little work has been done to correlate experimental data with theoretical models using entire PTR responses. In the present study, it is hypothesized that PTR responses may be described by the exponential decay rate and damped natural frequency of a theoretical second-order system. Kinematic data was recorded from both knees of 45 subjects using a motion capture system and correlation analysis found that the mean R2 value was 0.99. Exponential decay rate and damped natural frequency ranges determined from the sample population were −5.61 to −1.42 and 11.73 rad/s to 14.96 rad/s, respectively. This study confirmed that PTR responses strongly correlate to a second-order system and that exponential decay rate and undamped natural frequency are novel measurement variables to accurately measure PTR responses. Therefore, further investigation of these measurement variables and their usefulness in grading PTR responses is warranted. PMID:27041981

  3. Diagnostic performance of axial-strain sonoelastography in confirming clinically diagnosed Achilles tendinopathy: comparison with B-mode ultrasound and color Doppler imaging.

    PubMed

    Ooi, Chin Chin; Schneider, Michal Elisabeth; Malliaras, Peter; Chadwick, Martine; Connell, David Alister

    2015-01-01

    This primary aim of this study was to evaluate the diagnostic performance of axial-strain sonoelastography (ASE), B-mode ultrasound (US) and color Doppler US in confirming clinically symptomatic Achilles tendinopathy. The secondary aim was to establish the relationship between the strain ratio during sonoelastography and Victorian Institute of Sport Assessment-Achilles (VISA-A) scores. The VISA-A questionnaire is a validated clinical rating scale that evaluates the symptoms and dysfunction of the Achilles tendon. One hundred twenty Achilles tendons of 120 consecutively registered patients with clinical symptoms of Achilles tendinopathy and another 120 gender- and age-matched, asymptomatic Achilles tendons of 120 healthy volunteers were assessed with B-mode US, ASE and color Doppler US. Symptomatic patients had significantly higher strain ratio scores and softer Achilles tendon properties compared with controls (p < 0.001). The strain ratio was moderately correlated with VISA-A scores (r = -0.62, p < 0.001). The diagnostic accuracy of B-mode US, ASE and color Doppler US in confirming clinically symptomatic Achilles tendinopathy was 94.7%, 97.8% and 82.5% respectively. There was excellent correlation between the clinical reference standard and the grade of tendon quality on ASE (κ = 0.91, p < 0.05), compared with B-mode US (κ = 0.74, p < 0.05) and color Doppler imaging (κ = 0.49, p < 0.05). ASE is an accurate clinical tool in the evaluation of Achilles tendinopathy, with results comparable to those of B-mode US and excellent correlation with clinical findings. The strain ratio may offer promise as a supplementary tool for the objective evaluation of Achilles tendon properties. PMID:25438847

  4. Outcomes of patellar resurfacing versus nonresurfacing in total knee arthroplasty: a 9-year experience based on a case series of scorpio PS knees.

    PubMed

    Epinette, Jean-Alain; Manley, Michael T

    2008-10-01

    Patellar resurfacing during total knee arthroplasty (TKA) is an actively debated issue. This prospective study addresses fundamental questions regarding whether to resurface the patella. To do this, we compared clinical results of Scorpio PS knees with and without patellar resurfacing to determine whether there was any statistically significant difference in survivorship, function, pain, and radiographic analyses. Our study failed to demonstrate any statistical difference between the 2 groups (resurfaced versus nonresurfaced) according to knee pain, walking abilities, stair climbing, range of motion, and radiologic findings, as well as cross-correlations between patellar pain and age, gender, obesity, or etiology. Our radiologic findings did not reveal any failures of bony structures facing the metallic flange. Some knee designs can thus be seen as "patella friendly." Given the significant cost of patella resurfacing and the resulting well-known complications, we continue to avoid systematic resurfacing of the patella during Scorpio TKA. PMID:18979932

  5. COMPARATIVE STUDY OF ACL RECONSTRUCTION WITH ANATOMICAL POSITIONING OF THE TUNNELS USING THE PATELLAR TENDON VERSUS HAMSTRING TENDON

    PubMed Central

    de Pádua, Vitor Barion Castro; Maldonado, Hilário; Vilela, Júlio César Rodrigues; Provenza, Alexandre Ribeira; Monteiro, Cleverson; de Oliveira Neto, Heleno Cavalcante

    2015-01-01

    Objective: To compare ACL reconstruction with anatomical positioning of the tunnels using the hamstring or patellar tendons. Methods: We prospectively evaluated 52 patients who underwent ACL reconstruction using the Chambat's technique, with anatomical positioning of the tunnels drilled outside in. They were divided into group A, with 27 patients, using the patellar tendon as a graft, and group B, with 25 patients, using the hamstring. Results: In group A 26 patients were very satisfied or satisfied and 1 unhappy, in group B. 25 patients were very satisfied or satisfied with the procedure (p = 0.990). According to the Lysholm scale, group A had a mean score of 96.11 and group B, 95.32 (p=0.594). In relation to preoperative IKDC, 100% of the patients in group A and 92% of those in group B were IKDC C or D (p = 0.221); in the assessment with a minimum of two-year follow-up, 96% of group A and 92% of group B were IKDC A or B (p = 0.256). The Lachman test, pivot shift, return to sports activities, and the comparative difference in anterior translation (RolimeterTM) also showed no statistically significant difference. In group A, 5 patients (18.5%) were unable to kneel on a hard surface, whereas no patient in group B had this complaint. Conclusion: The anterior cruciate ligament reconstruction presents similar results using the hamstring or patellar tendon with anatomical positioning of the tunnels. Drilling the femoral tunnel outside in is a reproducible and accurate option in the correct placement the femoral tunnel. PMID:27027082

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

    PubMed Central

    Hinckel, Betina Bremer; Gobbi, Riccardo Gomes; Bonadio, Marcelo Batista; Demange, Marco Kawamura; Pécora, José Ricardo; Camanho, Gilberto Luis

    2016-01-01

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

  7. Fifteen Year Prospective Comparison of Patellar & Hamstring Tendon Grafts for ACL Reconstruction

    PubMed Central

    Roe, Justin; Salmon, Lucy; Kok, Alison; Linklater, James; Pinczewski, Leo

    2016-01-01

    Objective: This prospective longitudinal study compares isolated endoscopic ACL reconstruction utilizing 4-strand hamstring tendon (HT) or patellar tendon (PT) autograft over a 15-year period with respect to clinical outcomes and the development of osteoarthritis. Method: 90 consecutive patients with isolated ACL rupture were reconstructed with a PT autograft and 90 patients received HT autograft, with an identical surgical technique. Patients were assessed at 2, 5, 7, 10 and 15 years. Assessment included the IKDC Knee Ligament Evaluation including radiographic evaluation, KT1000, kneeling pain, and clinical outcomes. Results: Subjects who received the PT graft had significantly worse outcomes at 15 years for the variables of radiologically detectable osteoarthritis (p=0.001), motion loss (p=0.02), single leg hop test (p=0.002), participation in strenuous activity (p=0.03), knee related decrease in activity level (p=0.002) and kneeling pain (p=0.03). There was no significant difference between the HT and PT groups in overall IKDC grade (p=0.28). ACL graft rupture occurred in 16% of HT group and 8% of the PT group (p=0.10). Contralateral ACL rupture occurred in significantly more PT patients (24%) than HT patients (12%) (p=0.03). Conclusion: Significant differences have developed at 15 years after surgery which were not seen at earlier reviews. Compared to the HT Group, the PT group had significantly worse outcomes with respect to radiological osteoarthritis, range of motion and functional tests but no significant difference in laxity was identified. There was a high incidence of ACL injury after reconstruction, to both the reconstructed and the contralateral knee.

  8. Proteomic Differences between Male and Female Anterior Cruciate Ligament and Patellar Tendon

    PubMed Central

    Little, Dianne; Thompson, J. Will; Dubois, Laura G.; Ruch, David S.; Moseley, M. Arthur; Guilak, Farshid

    2014-01-01

    The risk of anterior cruciate ligament (ACL) injury and re-injury is greater for women than men. Among other factors, compositional differences may play a role in this differential risk. Patellar tendon (PT) autografts are commonly used during reconstruction. The aim of the study was to compare protein expression in male and female ACL and PT. We hypothesized that there would be differences in key structural components between PT and ACL, and that components of the proteome critical for response to mechanical loading and response to injury would demonstrate significant differences between male and female. Two-dimensional liquid chromatography-tandem mass spectrometry and a label-free quantitative approach was used to identify proteomic differences between male and female PT and ACL. ACL contained less type I and more type III collagen than PT. There were tissue-specific differences in expression of proteoglycans, and ACL was enriched in elastin, tenascin C and X, cartilage oligomeric matrix protein, thrombospondin 4 and periostin. Between male and female donors, alcohol dehydrogenase 1B and complement component 9 were enriched in female compared to male. Myocilin was the major protein enriched in males compared to females. Important compositional differences between PT and ACL were identified, and we identified differences in pathways related to extracellular matrix regulation, complement, apoptosis, metabolism of advanced glycation end-products and response to mechanical loading between males and females. Identification of proteomic differences between male and female PT and ACL has identified novel pathways which may lead to improved understanding of differential ACL injury and re-injury risk between males and females. PMID:24818782

  9. Recovery of gait pattern after medial patellofemoral ligament reconstruction for objective patellar instability.

    PubMed

    Carnesecchi, O; Philippot, R; Boyer, B; Farizon, F; Edouard, P

    2016-01-01

    Gait pattern alterations were previously reported in association with objective patellar instability (OPI). Gait pattern comparison between a series of patients having undergone medial patellofemoral ligament (MPFL) reconstruction and a sample of control subjects. Thirty patients at 6 months postoperatively after MPFL reconstruction and thirty control subjects were enrolled in the study for a clinical and biomechanical assessment including gait analysis at three selected walking rates using the GAITRite(®) system. The mean raw IKDC score was 73 (± 19), and the mean Kujala knee function was 84 (± 17.5). The study of gait did not demonstrate any significant difference between the two groups at a normal and fast walking rate. At a 10 km/h running speed, the single-support phase was significantly shortened by a mean 2.33% (p < 0.05), the swing phase by a mean 2.64% (p < 0.05) and the double-support phase by a mean 3.49% (p < 0.05) on the operated side. MPFL reconstruction reported good midterm functional and clinical results in the management of OPI. At 6 months postoperatively, the patient gait pattern was similar to that observed in healthy subjects at a normal and fast walking speed. However, our study revealed persistent gait abnormalities at a 10 km/h running speed. These gait alterations seemed to be related to the ligament reconstruction in itself due to the higher strain applied on the reconstructed MPFL during running cycle (10 km/h). Level of evidence IV. PMID:25274090

  10. Sodium cromolyn reduces expression of CTGF, ADAMTS1 and TIMP3 and modulates post-injury patellar tendon morphology

    PubMed Central

    Sharma, Aishwariya; Abraham, Thomas; Sampaio, Arthur; Cowan, Matthew; Underhill, Michael; Scott, Alex

    2014-01-01

    Objectives The purpose of this study was to determine whether administration of a mast cell inhibitor (sodium cromolyn, SC) would influence tendon repair and extracellular matrix gene expression following acute injury. Methods CD1 mouse patellar tendons were unilaterally injured and mast cell prevalence was determined. The effect of SC injection on tendon hypercellularity, cross-sectional area, collagen organization, and expression of extracellular matrix-related genes was examined. Results Mast cell prevalence was markedly increased in injured patellar tendons (p=0.009), especially at 8 weeks post injury (p=0.025). SC injection increased collagen organization compared to uninjected animals at 4 weeks and attenuated the development of tendon hypercellularity and tendon thickening post-injury. Expression of CTGF, ADAMTS1 and TIMP3 in injured tendon was reduced in the SC group. Conclusion SC injections moderated the structural alterations of healing tendon in association with downregulation of several genes associated with tendon fibrosis. This work corroborates previous findings pointing to a role of mast cells in tendon repair. PMID:21437947

  11. Phase contrast imaging X-ray computed tomography: quantitative characterization of human patellar cartilage matrix with topological and geometrical features

    NASA Astrophysics Data System (ADS)

    Nagarajan, Mahesh B.; Coan, Paola; Huber, Markus B.; Diemoz, Paul C.; Wismüller, Axel

    2014-03-01

    Current assessment of cartilage is primarily based on identification of indirect markers such as joint space narrowing and increased subchondral bone density on x-ray images. In this context, phase contrast CT imaging (PCI-CT) has recently emerged as a novel imaging technique that allows a direct examination of chondrocyte patterns and their correlation to osteoarthritis through visualization of cartilage soft tissue. This study investigates the use of topological and geometrical approaches for characterizing chondrocyte patterns in the radial zone of the knee cartilage matrix in the presence and absence of osteoarthritic damage. For this purpose, topological features derived from Minkowski Functionals and geometric features derived from the Scaling Index Method (SIM) were extracted from 842 regions of interest (ROI) annotated on PCI-CT images of healthy and osteoarthritic specimens of human patellar cartilage. The extracted features were then used in a machine learning task involving support vector regression to classify ROIs as healthy or osteoarthritic. Classification performance was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC). The best classification performance was observed with high-dimensional geometrical feature vectors derived from SIM (0.95 ± 0.06) which outperformed all Minkowski Functionals (p < 0.001). These results suggest that such quantitative analysis of chondrocyte patterns in human patellar cartilage matrix involving SIM-derived geometrical features can distinguish between healthy and osteoarthritic tissue with high accuracy.

  12. Effects of gamma irradiation on the initial mechanical and material properties of goat bone-patellar tendon-bone allografts

    SciTech Connect

    Gibbons, M.J.; Butler, D.L.; Grood, E.S.; Bylski-Austrow, D.I.; Levy, M.S.; Noyes, F.R. )

    1991-03-01

    The effects of {sup 60}Co gamma irradiation on the initial mechanical properties of the composite bone-patellar tendon-bone unit (CU) and the tendon midsubstance (TM) were studied. Frozen specimens were exposed to either 2 or 3 Mrad of gamma irradiation. Paired frozen specimens served as intraanimal controls. Treatment effects on the CU were assessed using four mechanical parameters. Effects on the TM were assessed using four material parameters measured using an optical surface-strain analysis system. The maximum force and strain energy to maximum force of the composite unit were significantly reduced 27% and 40%, respectively, after 3 Mrad of irradiation (p less than .05). Mechanical properties of the CU were not significantly altered, however, following 2 Mrad of irradiation. Based on individual paired contrasts between treatment and control, significant differences were also found in the material properties of the tendon midsubstance. The maximum stress, maximum strain, and strain energy density to maximum stress were significantly reduced following 3 Mrad, but not 2 Mrad, of irradiation. The results provide important time zero material property data, which will be useful for later anterior cruciate ligament reconstruction studies using irradiated allograft patellar tendons in the goat model and other animal models as well.

  13. Failure load of patellar tendon grafts at the femoral side: 10- versus 20-mm-bone blocks.

    PubMed

    Meuffels, Duncan E; Niggebrugge, Marnix J N; Verhaar, Jan A N

    2009-02-01

    The aim of the study was to investigate whether use of short bone blocks is safe in anterior cruciate ligament (ACL) reconstruction. Our hypothesis was that the smaller 10-mm-length bone blocks will fail at lower loads than 20-mm-bone blocks. Ten paired human cadaver knees were randomly assigned to the 10- or 20-mm group (group 1 and 2) and underwent bone-patellar tendon-bone femoral fixation with interference screw. Tensile tests were performed using a tensile testing machine (Instron). Stiffness, failure load and failure mode were recorded. Median stiffness was 72 N/mm (16-103) for 10-mm-bone blocks and 91 N/mm (40-130) for 20-mm-bone blocks. Median failure loads were 402 N (87-546) for 10-mm-long bone block and 456 N (163-636) for 20-mm-bone blocks. There was no statistically significant difference between groups (P = 0.35). All bone-patellar tendon-bone grafts were pulled out of the femoral tunnel with interference screw, due to slippage. We concluded that a 10-mm-long bone block was not significantly weaker than a 20-mm-long bone block. Failure loads of a 10-mm-bone block exceeded loading values at passive and active extension of the knee under normal conditions. Ten millimetre bone blocks offered sufficient fixation strength in ACL reconstruction. PMID:18839146

  14. COMPARISON BETWEEN THE RESULTS ACHIEVED IN ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH TWO KINDS OF AUTOLOGOUS GRAFTS: PATELLAR TENDON VERSUS SEMITENDINOUS AND GRACILIS

    PubMed Central

    Abdalla, Rene Jorge; Monteiro, Diego Antico; Dias, Leonardo; Correia, Dárcio Maurício; Cohen, Moisés; Forgas, Andrea

    2015-01-01

    Objective: this study aims to compare the arthrometric and isokinetic examination results from two types of autologous grafts: the central third of the patellar ligament and a graft formed by the tendons of the semitendinosus and gracilis muscles, within the same rehabilitation protocol, six months after the surgery. Methods: the results from examinations carried out on 63 patients were analyzed. These patients were divided in two groups: one group of 30 patients who received a patellar tendon graft and another group of 33 patients who received a graft from the tendons of the semitendinosus and gracilis muscles. Both the grafts were attached in the same way, with Endobutton™ for suspensory fixation to the femur and a bioabsorbable interference screw for fixation in the tibial tunnel. Results: arthrometry 30 did not present any statistical difference between the two study groups. On the other hand, the isokinetic evaluation showed that the patellar tendon group had a larger mean peak torque of flexion and greater extension deficit, while the semitendinosus/gracilis group had a better mean flexion/extension ratio and greater percentage of flexion deficit. There was no statistically significant difference between the groups when measuring peak torque extension. Conclusion: therefore, when the patellar tendon was used, there was greater extensor deficit and, when the semitendinosus/gracilis tendons were used, there was greater flexor deficit. PMID:27004173

  15. Autologous leukocyte-reduced platelet-rich plasma therapy for Achilles tendinopathy induced by collagenase in a rabbit model.

    PubMed

    González, Juan C; López, Catalina; Álvarez, María E; Pérez, Jorge E; Carmona, Jorge U

    2016-01-01

    Leukocyte-reduced platelet-rich plasma (LR-PRP) is a therapy for tendinopathy of the Achilles tendon (TAT); however, there is scarce information regarding LR-PRP effects in rabbit models of TAT. We compared, at 4 and 12 weeks (w), the LR-PRP and placebo (PBS) effects on ultrasonography, histology and relative gene expression of collagen types I (COL1A1) and III (COL3A1) and vascular endothelial growth factor (VEGF) in 24 rabbits with TAT induced by collagenase. The rabbits (treated with both treatments) were euthanatised after either 4 or 12 w. A healthy group (HG (n = 6)) was included. At 4 and 12 w, the LR-PRP group had a no statistically different histology score to the HG. At w 4, the COL1A1 expression was significantly higher in the LR-PRP group when compared to HG, and the expression of COL3A1 from both LR-PRP and PBS-treated tendons was significantly higher when compared to the HG. At w 12, the expression of COL3A1 remained significantly higher in the PBS group in comparison to the LR-PRP group and the HG. At w 4, the LR-PRP group presented a significantly higher expression of VEGF when compared to the PBS group and the HG. In conclusion, LR-PRP treatment showed regenerative properties in rabbits with TAT. PMID:26781753

  16. Autologous leukocyte-reduced platelet-rich plasma therapy for Achilles tendinopathy induced by collagenase in a rabbit model

    PubMed Central

    González, Juan C.; López, Catalina; Álvarez, María E.; Pérez, Jorge E.; Carmona, Jorge U.

    2016-01-01

    Leukocyte-reduced platelet-rich plasma (LR-PRP) is a therapy for tendinopathy of the Achilles tendon (TAT); however, there is scarce information regarding LR-PRP effects in rabbit models of TAT. We compared, at 4 and 12 weeks (w), the LR-PRP and placebo (PBS) effects on ultrasonography, histology and relative gene expression of collagen types I (COL1A1) and III (COL3A1) and vascular endothelial growth factor (VEGF) in 24 rabbits with TAT induced by collagenase. The rabbits (treated with both treatments) were euthanatised after either 4 or 12 w. A healthy group (HG (n = 6)) was included. At 4 and 12 w, the LR-PRP group had a no statistically different histology score to the HG. At w 4, the COL1A1 expression was significantly higher in the LR-PRP group when compared to HG, and the expression of COL3A1from both LR-PRP and PBS-treated tendons was significantly higher when compared to the HG. At w 12, the expression of COL3A1 remained significantly higher in the PBS group in comparison to the LR-PRP group and the HG. At w 4, the LR-PRP group presented a significantly higher expression of VEGF when compared to the PBS group and the HG. In conclusion, LR-PRP treatment showed regenerative properties in rabbits with TAT. PMID:26781753

  17. Genome-wide survey indicates involvement of loci on canine chromosomes 7 and 31 in patellar luxation in flat-coated retrievers

    PubMed Central

    2014-01-01

    Background Patellar luxation is an orthopedic disorder in which the patella moves out of its normal location within the femoral trochlea of the knee and it can lead to osteoarthritis, lameness, and pain. In dogs it is a heritable trait, with both environmental and genetic factors contributing to the phenotype. The prevalence of patellar luxation in the Dutch Flat-Coated Retriever population is 24%. In this study, we investigated the molecular genetics of the disorder in this population. Results Genome-wide association analysis of 15,823 single nucleotide polymorphisms (SNPs) in 45 cases and 40 controls revealed that patellar luxation was significantly associated with a region on chromosome CFA07, and possibly with regions on CFA03, CFA31, and CFA36. The exons of the genes in these regions, 0.5 Mb combined, were analyzed further. These exons from 15 cases and a pooled sample from 15 controls were enriched using custom genomic hybridization arrays and analyzed by massive parallel DNA sequencing. In total 7257 variations were detected. Subsequently, a selection of 144 of these SNPs were genotyped in 95 Flat-Coated Retrievers. Nine SNPs, in eight genes on CFA07 and CFA31, were associated with patellar luxation (P <10-4). Genotyping of these SNPs in samples from a variety of breeds revealed that the disease-associated allele of one synonymous SNP in a pseudogene of FMO6 was unique to Flat-Coated Retrievers. Conclusion Genome-wide association analysis followed by targeted DNA sequencing identified loci on chromosomes 7 and 31 as being involved in patellar luxation in the Flat-Coated Retriever breed. PMID:24886090

  18. A Retrospective Review of Anterior Cruciate Ligament Reconstruction Using Patellar Tendon

    PubMed Central

    Chahal, Jaskarndip; Lee, Andrew; Heard, Wendell; Bach, Bernard R.

    2013-01-01

    Background: The comparative data in the literature regarding rates of reoperation, revision ligament surgery, and contralateral surgery following anterior cruciate ligament reconstruction (ACLR) are variable and are often derived from studies with multiple surgeons, multiple centers, different surgical techniques, and a wide variety of graft choices. Purpose: To describe and analyze a single surgeon’s experience with ACLR using bone–patellar tendon–bone (BPTB) as the primary graft choice over a 25-year period. Study Design: Retrospective case series. Methods: All patients who underwent ACLR from 1986 to 2012 were identified from a prospectively maintained database. Traditional follow-up was only for patients who sought subsequent surgery with the index surgeon or presented with contralateral ACL injury. Covariates of interest included age, sex, time, and graft selection. Outcomes of interest included reoperation rates after primary/revision ACLR, rate of revision ACLR, success of meniscal repair with concomitant ACLR, and the proportion of patients undergoing contralateral surgery. Results: A total of 1981 patients (mean age, 29 years; 49% male) were identified. Of patients undergoing primary ACLR (n = 1809), 74% had BPTB autograft and 26% had a central third BPTB allograft. The mean age of patients undergoing autograft and allograft ACLR was 26 and 36 years, respectively (P < .05). Allograft tissue usage increased over time (P < .05). The rate of personal ACLR revision surgery was 1.7% (n = 30) for primary cases and 3.5% (n = 6) for revision cases. There were no significant differences in revision rates between primary autograft (1.6%) and allograft (2.0%) ACLR. With allograft use, the method of sterilization did not affect revision rates. The overall reoperation rate following primary ACLR was 10%; the 5-year reoperation rate was 7.7%. The reoperation rate was lower for primary cases reconstructed with allograft versus autograft (5% vs 12%) (P < .0001

  19. A Pilot Study Evaluating the Effectiveness of Platelet-Rich Plasma Therapy for Treating Degenerative Tendinopathies: A Randomized Control Trial with Synchronous Observational Cohort

    PubMed Central

    Wesner, Marni; Defreitas, Terry; Bredy, Heather; Pothier, Louisa; Qin, Ziling; McKillop, Ashley B.; Gross, Douglas P.

    2016-01-01

    Objective This pilot study aimed to inform future research evaluating the effectiveness of Platelet Rich Plasma (PRP) injection for tendinopathy. Design Randomized control trial (RCT) and synchronous observational cohort studies. For the RCT, consecutive consenting patients treated at an academic sports medicine clinic were randomly assigned to either a PRP or placebo control group. Setting The Glen Sather Sport Medicine Clinic, Edmonton, Canada. Patients The RCT included 9 participants with rotator cuff tendinopathy. The cohort study included 178 participants with a variety of tendinopathies. Interventions Patients receiving PRP were injected with 4 ml of platelets into the supraspinatus and/or infraspinatus, while patients in the placebo group were injected with 4ml of saline. All participants undertook a 3-month standardized, home-based, daily exercise program. Main Outcome Measures Participants in the RCT were re-evaluated 3, and 6 months post-injection. Change scores before and after injection on pain, disability and MRI-documented pathology outcomes were compared. In the cohort study, pain and disability were measured at 1, 2 and 3 months post-injection. Results For the RCT, 7 participants received PRP and 2 received placebo injections. Patients receiving PRP reported clinically important improvements in pain (>1.5/10 on VAS), disability (>15 point DASH change), and tendon pathology while those receiving placebo injections did not. In the observational cohort, statistically and clinically significant improvements in pain and disability were observed. Conclusion This pilot study provides information for planning future studies of PRP effectiveness. Preliminary results indicate intratendinous, ultrasound-guided PRP injection may lead to improvements in pain, function, and MRI-documented tendon pathology. Trial Registration Controlled-Trials.com ISRCTN68341698 PMID:26849812

  20. Platelet Rich Plasma Therapy in Non-insertional Achilles Tendinopathy: The Efficacy is Reduced in 60-years Old People Compared to Young and Middle-Age Individuals

    PubMed Central

    Salini, Vincenzo; Vanni, Daniele; Pantalone, Andrea; Abate, Michele

    2015-01-01

    Background: Platelet Rich Plasma (PRP) has shown positive and long-lasting effects in patients with tendinopathies. However, information about age-related differences in the clinical outcome is limited. Aim of this retrospective study was to compare the efficacy of PRP therapy in young and elderly subjects suffering for Achilles tendinopathy. Materials and method: Patients with recalcitrant non-insertional Achilles tendinopathy were enrolled. Clinical (VISA-A) and instrumental (ultrasonography) data were collected at baseline and after 1, 3, 6, and 12 months. PRP injections (once a week for 3 weeks) were performed in sterile conditions and under ultrasound (US) control. Results: Forty-four subjects (29 young: mean age 39.5 ± 6.9; 15 elderly: mean age 61.5 ± 5.3) were retrospectively evaluated. At baseline, no significant differences were observed in the clinical and US parameters. Throughout the whole length of the study, a significant increase of VISA-A score was seen in both groups (from 50.3 ± 8.8 to 76.1 ± 6.6 in the young group, and from 48.7 ± 7.6 to 61.1 ± 9.4 in the elderly group); however, the infra-groups comparison showed better results in young patients, compared to the aged counterpart. Conclusion: Our results show that PRP is less effective in aged people. This finding can be ascribed to several biochemical and biomechanical differences documented in tendons of young and elderly subjects (reduced number and functionality of tenocytes and tenoblasts), which becomes more evident in the long-term tissue healing. However, prospective trials, using different PRP preparations and enrolling a larger number of subjects, are needed to draw more sound and definitive conclusions. PMID:26696880

  1. Short-Term Effects of Patellar Kinesio Taping on Pain and Hop Function in Patients With Patellofemoral Pain Syndrome

    PubMed Central

    Freedman, Scott R.; Brody, Lori Thein; Rosenthal, Michael; Wise, Justin C.

    2014-01-01

    Background: Patellofemoral pain syndrome (PFPS) is the most prevalent orthopaedic condition among physically active individuals, contributing to an estimated 30% to 40% of all sports medicine visits. Techniques using Kinesio Tape (KT) have become increasingly popular; however, there has been scant research supporting its use on patients with PFPS. Hypothesis: The use of patellar KT to treat patients with PFPS will provide a statistically significant improvement in short-term pain and single-leg hop measures as compared with sham placement of KT. Study Design: Nonrandomized controlled clinical trial with repeated-measures design. Level of Evidence: Level 3. Methods: Forty-nine subjects (41 females, 8 males) between the ages of 12 and 24 years with PFPS participated in this study. Each subject underwent patellar kinesio taping with both experimental and sham applications while completing 4 functional tasks and the single-leg triple jump test (STJT). The treatment outcome was analyzed using separate paired t tests to measure improvement on a numeric pain rating scale. A 2-way, 2 × 2 analysis of variance was used to analyze the relationship between taping condition (experimental vs sham) and side (involved vs uninvolved) for STJT scores. Results: Separate paired t tests found step-up, step-down, and STJT pain improvement statistically significant between taping conditions. The 2-factor analysis of variance yielded a significant main effect for taping condition, but the main effect for side was not significant. The interaction between taping condition and side was significant. This showed there was little change in STJT distance between repeated measures performed on the untaped, noninvolved leg. However, subjects’ STJT distances were significantly greater for the experimental KT application than the sham application for the involved side. Conclusion: Patellar kinesio taping provided an immediate and statistically significant improvement in pain and single-leg hop

  2. The effect of freeze-thawing on magnetic resonance imaging T2* of freshly harvested bovine patellar tendon

    PubMed Central

    Pownder, Sarah L.; Shah, Parina H.; Potter, Hollis G.

    2015-01-01

    Background Analysis of fresh specimens in research studies is ideal; however, it is often necessary to freeze samples for evaluation at a later time. Limited evaluation of the effect of freeze-thawing of tendon tissue samples on inherent magnetic resonance imaging (MRI) parameters, such as ultrashort echo time (UTE) T2* values, have been performed to date. Methods This study performed UTE MRI on 14 bovine patellar tendons at harvest and after four consecutive freeze-thaw cycles. Results Results demonstrated a small but significant reduction (12%) in tendon T2* values after the first freeze thaw cycle, but not after successive cycles. Tendons from juvenile animals with open physis had a significant reduction of T2* following a single freeze thaw cycle, P<0.0001. Conclusions The results of this study emphasize the importance of using uniform tendon storage protocols when using UTE MRI in preclinical models. PMID:26029639

  3. Is the Patellar Pubic Percussion Test useful to diagnose only femur fractures or something else? Two case reports.

    PubMed

    Segat, M; Casonato, O; Margelli, M; Pillon, S

    2016-02-01

    In the literature, the utility of the Patellar Pubic Percussion Test (PPPT) to diagnose occult fractures of the femur is well described. However, up to now there are no studies demonstrating the efficacy of this test in recognizing fractures of the pelvis. In this two case report a positive PPPT allowed the therapist to recognize clinical conditions requiring caution, protecting patients from a potentially unsuitable treatment. Both patients had a negative pelvis and femur x-ray after a fall, but the clinical findings and a positive PPPT lead the physiotherapist to suggest further examinations. In these two cases the PPPT seemed to be a useful diagnostic tool to identify periacetabular, ileo-pubic and ischio-pubic ramus fractures. These findings suggest that PPPT could be positive even for a bone lesion in any of the transit points of the vibration, from the patella to the pubic symphysis. PMID:26403611

  4. Patellar segmentation from 3D magnetic resonance images using guided recursive ray-tracing for edge pattern detection

    NASA Astrophysics Data System (ADS)

    Cheng, Ruida; Jackson, Jennifer N.; McCreedy, Evan S.; Gandler, William; Eijkenboom, J. J. F. A.; van Middelkoop, M.; McAuliffe, Matthew J.; Sheehan, Frances T.

    2016-03-01

    The paper presents an automatic segmentation methodology for the patellar bone, based on 3D gradient recalled echo and gradient recalled echo with fat suppression magnetic resonance images. Constricted search space outlines are incorporated into recursive ray-tracing to segment the outer cortical bone. A statistical analysis based on the dependence of information in adjacent slices is used to limit the search in each image to between an outer and inner search region. A section based recursive ray-tracing mechanism is used to skip inner noise regions and detect the edge boundary. The proposed method achieves higher segmentation accuracy (0.23mm) than the current state-of-the-art methods with the average dice similarity coefficient of 96.0% (SD 1.3%) agreement between the auto-segmentation and ground truth surfaces.

  5. Effectiveness of Platelet-rich Plasma Injection for Rotator Cuff Tendinopathy: A Prospective Open-label Study

    PubMed Central

    Scarpone, Michael; Snell, Edward; DeMeo, Patrick; Ruppert, Kristine; Pritchard, Perry; Arbogast, Gennie; Wilson, John J.; Balzano, John F.

    2013-01-01

    Objective: Assess platelet rich plasma (PRP) injection for rotator cuff tendinopathy (RCT). Design: Prospective open label study with 1-year follow-up. Methods: Participants recruited from an outpatient sports medicine clinic had clinically and magnetic resonance image (MRI)—demonstrated RCT refractory to physical therapy and corticosteroid injection. They received one ultrasound-guided injection of 3.0 mL of 1% xylocaine followed by 3.5 mL of PRP at the lesion and surrounding tendon. Primary outcome: 0–10 visual analog scale (VAS; baseline, 8, 12, and 52 weeks). Secondary outcomes: functional shoulder tests assessing rotator cuff strength and endurance (at baseline and 8 and 12 weeks), MRI severity (1–5 points [at baseline and 4 and 8 weeks]), and patient satisfaction (52 weeks). Results: Eighteen participants with 19 assessed shoulders reported VAS pain score improvement from 7.5 ± 0.3 points to 0.5 ± 0.3 points by week 12 and 0.4 ± 0.2 (P = .0001) points at week 52. Functional outcomes significantly improved; the largest effect was seen in the external rotation test: 33.5 ± 5.7 seconds to 62.6 ± 7.2 seconds at week 12 (P = .0001). MRI appearance improved by 1 to 3 points in 16 of 18 assessed shoulders. Seventeen participants were “completely satisfied” (12) or “satisfied” (5). One participant was “unsatisfied.” Conclusions: A single ultrasound-guided, intralesional injection of PRP resulted in safe, significant, sustained improvement of pain, function, and MRI outcomes in participants with refractory RCT. Randomized multidisciplinary effectiveness trials that add ultrasound and validated clinical outcome measures are needed to further assess PRP for RCT. PMID:24416661

  6. Pilot experimental study on amniotic epithelial mesenchymal cell transplantation in natural occurring tendinopathy in horses. Ultrasonographic and histological comparison

    PubMed Central

    Muttini, Aurelio; Russo, Valentina; Rossi, Elisabetta; Mattioli, Mauro; Barboni, Barbara; Tosi, Umberto; Maffulli, Nicola; Valbonetti, Luca; Abate, Michele

    2015-01-01

    Summary Background: amnion-derived stem cells are considered a promising alternative source for tendon tissue regeneration. Purpose: aims of this paper were to illustrate the ultrasound and histological outcomes following the treatment of acute and chronic superficial digital flexor tendon spontaneous lesions in horses with ovine amniotic epithelial cells xenotransplantation. Methods: six adult horses suffering from unilateral acute (4 cases) and chronic (2 cases) tendinopathy (clinical and ultrasound diagnosis) were enrolled. At baseline, ovine amniotic epithelial cells were grafted, in sterile conditions and under ultra-sound control, into the most damaged area. Ultra-sound controls were performed at 30, 60, 90, 120, 150 and 180 days after cells implantation; after horse euthanasia (180 days) tendon samples were collected and submitted to histological examination (cellularity, extracellular matrix fiber organization, blood vessels). Results: at baseline, in the acute cases, the ultra-sound exam showed a focal, dis-homogeneous, hypo-echoic area into the superficial digital flexor tendon, with loss of the normal fibrillar pattern, while in the chronic cases the damaged tendon area appeared thickened and completely hyper-echoic. At the final follow-up tendon echotexture was more regular, the cross-sectional area similar to the contra-lateral limb, and the collagen fibers were oriented in parallel to the longitudinal axis of the tendon both in the acute and chronic cases, suggesting a positive healing response. These findings were supported by the histological analyses which showed an almost complete restoration of normal tendon architecture with an optimal alignment of tendon fibers. Conclusions: the present pilot study supports the hypothesis that amniotic epithelial cells are provided of an excellent healing potential and shows a very good correlation between the ultrasound findings and the histologic features. PMID:25878980

  7. Treatment of the calcific tendinopathy of the rotator cuff by ultrasound-guided percutaneous needle lavage. Two years prospective study

    PubMed Central

    Del Castillo-González, Federico; Ramos-Álvarez, Juan José; Rodríguez-Fabián, Guillermo; González-Pérez, José; Calderón-Montero, Javier

    2014-01-01

    Summary Purpose: to evaluate the short and long term effectiveness of ultrasonography (US)-guided percutaneous needle lavage in calcific tendinopathy of the rotator cuff. To study the evolution of the size of calcifications and pain in the two years after treatment. Methods: a 2 year longitudinal prospective study is carried out after applying the UGPL technique on a number of patients diagnosed with calcific tendinitis of the rotator cuff. Clinical, ultrasound and radiology follow-up controls were performed, 3 months, 6 months, one year and two years after the treatment. The Visual Analog Scale (VAS) was used to assess the pain. The degree and point of pain is selected on a 10cm line, arranged horizontally or vertically. The “0” represents no pain and “10” represents worst pain. The population studied was made up of 121 patients that required our service as a result of suffering from a painful shoulder. Results: the pain (VAS) and the size of the calcification significantly decreased with the application of the technique (p< 0,001 in both cases) and regardless of the sex (p: 0.384 for pain and p: 0.578 for the size of the calcification). This occurred from the first check-up (3 months) and was maintained for two year. Conclusion: we consider this technique to be a valid alternative as a first-choice treatment of calcific tendinitis of the shoulder. The intervention is simple, cost-effective, does not require hospitalization, involves no complications, rehabilitation treatment is not required and it shows very few side effects without sequelae, significantly reducing the size of the calcification and pain in the majority of patients. PMID:25767776

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

    PubMed

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

    2013-07-01

    Combined androgenic-anabolic steroids (AAS) and overloading affects tendon collagen metabolism and ultrastructure and is often associated with a higher risk of injury. The aim of this prospective study was to investigate whether such effects would be reflected in the patellar tendon properties of individuals with a history of long-term resistance training and AAS abuse (RTS group), compared with trained (RT) and untrained (CTRL) nonsteroids users. Tendon cross-sectional area (CSA), stiffness, Young's modulus, and toe limit strain were measured in vivo, from synchronized ultrasonography and dynamometry data. The patellar tendon of RT and RTS subjects was much stiffer and larger than in the CTRL group. However, stiffness and modulus were higher in the RTS group (26%, P < 0.05 and 30%, P < 0.01, respectively) than in the RT group. Conversely, tendon CSA was 15% (P < 0.05) larger in the RT group than in RTS, although differences disappeared when this variable was normalized to quadriceps maximal isometric torque. Yet maximal tendon stress was higher in RTS than in RT (15%, P < 0.05), without any statistical difference in maximal strain and toe limit strain between groups. The present lack of difference in toe limit strain does not substantiate the hypothesis of changes in collagen crimp pattern associated with AAS abuse. However, these findings indicate that tendon adaptations from years of heavy resistance training are different in AAS users, suggesting differences in collagen remodeling. Some of these adaptations (e.g., higher stress) could be linked to a higher risk of tendon injury. PMID:23620489

  9. Functional results from reconstruction of the anterior cruciate ligament using the central third of the patellar ligament and flexor tendons☆

    PubMed Central

    de Souza Leao, Marcos George; Pampolha, Abelardo Gautama Moreira; Orlando Junior, Nilton

    2015-01-01

    Objectives To evaluate knee function in patients undergoing reconstruction of the anterior cruciate ligament (ACL) using the central third of the patellar ligament or the medial flexor tendons of the knee, i.e. quadruple ligaments from the semitendinosus and gracilis (ST-G), by means of the Knee Society Score (KSS) and the Lysholm scale. Methods This was a randomized prospective longitudinal study on 40 patients who underwent arthroscopic ACL reconstruction between September 2013 and August 2014. They comprised 37 males and three females, with ages ranging from 16 to 52 years. The patients were numbered randomly from 1 to 40: the even numbers underwent surgical correction using the ST-G tendons and the odd numbers, using the patellar tendon. Functional evaluations were made using the KSS and Lysholm scale, applied in the evening before the surgical procedure and six months after the operation. Results From the statistical analysis, it could be seen that the patients’ functional capacity was significantly greater after the operation than before the operation. There was strong evidence that the two forms of therapy had similar results (p = >0.05), in all the comparisons. Conclusions The results from the ACL reconstructions were similar with regard to functional recovery of the knee and improvement of quality of life, independent of the type of graft. It was not possible to identify the best method of surgical treatment. The surgeon's clinical and technical experience and the patient are the factors that determine the choice of graft type for use in ACL surgery. PMID:27218084

  10. Combined lateral retinacular release with drilling chondroplasty for treatment of patellofemoral osteoarthritis associated with patellar malalignment in elderly patients.

    PubMed

    Wu, Chi-Chuan

    2011-01-01

    This paper described a less invasive surgical technique that was performed for treatment of elderly patients with isolated patellofemoral (PF) osteoarthritis (OA) associated with patellar malalignment, although their tibiofemoral joints are minimally osteoarthritic. Two hundred and thirty-four knees in 126 consecutive elderly patients (average, 72 yrs) diagnosed with combined disorders were treated by lateral retinacular release with drilling chondroplasty. The inclusion criteria were patient age ≥ 65 yrs, isolated stage 2 or 3 PF-OA (modified Iwano staging by radiology), and a laterally subluxed patella shown on a Merchant's axial radiograph. Outcome was judged by three parameters: clinical PF function (modified Kujala scoring), congruence angle, and PF-OA staging. Two hundred and one knees in 107 patients were followed-up for an average of 4.2 yrs (range, 2.1-7.5 yrs) and 19 patients were lost to follow-up. No surgical complications occurred through the course of treatment. Clinical PF function improved in knees that showed unsatisfactory performance (modified Kujala scoring < 32) preoperatively, with 78.1% of the knees showing satisfactory performance (modified Kujala scoring ≥ 32) at the latest follow-up. Congruence angle improved in 85.6% of the knees and PF-OA staging improved in 77.1% of the knees. Combined lateral retinacular release with drilling chondroplasty is a feasible alternative for treatment of PF-OA associated with patellar malalignment in elderly patients where knee arthroplasty cannot be performed by various reasons. Advantages of this combined surgical technique include a less invasive procedure, minimal complication rate, and an acceptable success rate (78%, modified Kujala scoring≥32). PMID:20171107

  11. The Effect of an Exercise Program in Conjunction With Short-Period Patellar Taping on Pain, Electromyogram Activity, and Muscle Strength in Patellofemoral Pain Syndrome

    PubMed Central

    Kaya, Defne; Callaghan, Michael James; Ozkan, Huseyin; Ozdag, Fatih; Atay, Ozgur Ahmet; Yuksel, Inci; Doral, Mahmut Nedim

    2010-01-01

    Background: McConnell recommended that patellar tape be kept on all day, until patients learn how to activate their vastus medialis obliquus (VMO) during an exercise program. This application may pose problems because prolonged taping may be inadvisable for some patients or even contraindicated owing to skin discomfort, irritation, or allergic reaction. Hypothesis: Wearing patellofemoral tape for a shorter duration during an exercise program would be just as beneficial as a prolonged taping application. Study Design: Prospective cohort. Methods: Twelve patients and 16 healthy people participated. Patients underwent short-period patellar taping plus an exercise program for 3 months. Numeric pain rating, muscle strength of the knee extensors, and electromyogram activity of the vastus lateralis and VMO were evaluated. Results: There were significant differences in electromyogram activity (P = .04) and knee extensor muscle strength (P = .03) between involved and uninvolved sides before treatment. After treatment, pain scores decreased, and there were no significant differences between involved and uninvolved sides in electromyogram activity (P = .68) and knee extensor strength (P = .62). Before treatment, mean VMO activation started significantly later than that of vastus lateralis, as compared with the matched healthy control group (P = .01). After treatment, these differences were nonsignificant (P = .08). Conclusion: Short-period patellar taping plus an exercise program improves VMO and vastus lateralis activation. Clinical Relevance: A shorter period of taping for the exercise program may be as beneficial as a prolonged taping application. PMID:23015969

  12. Iliotibial band release as an adjunct to the surgical management of patellar stress fracture in the athlete: a case report and review of the literature

    PubMed Central

    Keeley, Anthony; Bloomfield, Paul; Cairns, Peter; Molnar, Robert

    2009-01-01

    Stress fracture of the patella is rare. In this report, a case of patellar stress fracture occurring in an amateur athlete is presented, and an operative adjunct to the surgical management of this condition is proposed. A review of the English literature identified 21 previous cases of stress fracture of the patella, the majority in young athletes. None of these reports discussed treatment addressing the pathological process contributing to patellar stress fracture. The subject of this case report is a young male netballer who presented with a transverse stress fracture in the inferior third of his patella, on a background of patellofemoral overload. The patient underwent open reduction and internal fixation of his patella, combined with release of the iliotibial band. He returned to training after 6 weeks. The previous literature suggests that operative fixation is indicated for the treatment of displaced patellar stress fractures. Iliotibial band release, as a surgical adjunct to this treatment, may address the pathology of these fractures, and facilitate a return to sport at the highest level. PMID:19642974

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

    PubMed

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

    2008-12-01

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

  14. Lipids, adiposity and tendinopathy: is there a mechanistic link? Critical review.

    PubMed

    Scott, Alex; Zwerver, Johannes; Grewal, Navi; de Sa, Agnetha; Alktebi, Thuraya; Granville, David J; Hart, David A

    2015-08-01

    Being overweight or obese is associated with an elevated risk of tendon pathology. However, for sportspeople the epidemiological data linking weight or adiposity on one hand, and risk of tendon pathology on the other, are less consistent. Indeed, the mechanistic links between diet, adiposity and tendon pathology remain largely unexamined. Recent studies have begun to examine the effects of dietary interventions on outcomes such as tendon biomechanics or pain. Oxidised low-density lipoprotein has been shown to (A) accumulate in the tendon tissues of mice that eat a fatty diet and (B) induce a pathological phenotype in human tendon cells. This paper addresses the current debate: is excessive body mass index (causing increased load and strain on tendon tissue) per se the underlying mechanism? Or do local or systemic influences of fat on tendons predispose to tendon pathology? This narrative review argues that excessive blood lipids may be an important avenue for clinical investigations. PMID:25488953

  15. Lipids, adiposity and tendinopathy: is there a mechanistic link? Critical review

    PubMed Central

    Scott, Alex; Zwerver, Johannes; Grewal, Navi; de Sa, Agnetha; Alktebi, Thuraya; Granville, David J; Hart, David A

    2015-01-01

    Being overweight or obese is associated with an elevated risk of tendon pathology. However, for sportspeople the epidemiological data linking weight or adiposity on one hand, and risk of tendon pathology on the other, are less consistent. Indeed, the mechanistic links between diet, adiposity and tendon pathology remain largely unexamined. Recent studies have begun to examine the effects of dietary interventions on outcomes such as tendon biomechanics or pain. Oxidised low-density lipoprotein has been shown to (A) accumulate in the tendon tissues of mice that eat a fatty diet and (B) induce a pathological phenotype in human tendon cells. This paper addresses the current debate: is excessive body mass index (causing increased load and strain on tendon tissue) per se the underlying mechanism? Or do local or systemic influences of fat on tendons predispose to tendon pathology? This narrative review argues that excessive blood lipids may be an important avenue for clinical investigations. PMID:25488953

  16. A Comparison of Two Different High-Volume Image-Guided Injection Procedures for Patients With Chronic Noninsertional Achilles Tendinopathy: A Pragmatic Retrospective Cohort Study.

    PubMed

    Wheeler, Patrick C; Mahadevan, Dev; Bhatt, Raj; Bhatia, Maneesh

    2016-01-01

    We undertook a comparison evaluation of outcomes after 2 different high-volume image-guided injection (HVIGI) procedures performed under direct ultrasound guidance in patients with chronic noninsertional Achilles tendinopathy. In group A, the HVIGI involved high-volume (10 mL of 1% lidocaine combined with 40 mL of saline) and no dry needling. In group B, the HVIGI involved a smaller volume (10 mL of 1% lidocaine combined with 20 mL of saline) and dry needling of the Achilles tendon. A total of 34 patients were identified from the clinical records, with a mean overall age of 50.6 (range 26 to 83) years and an overall mean follow-up duration of 277 (range 49 to 596) days. The change between the preinjection and postinjection Victorian Institute of Sports Assessment-Achilles scores of 33.4 ± 22.5 points in group A and 6.94 ± 22.2 points in group B, was statistically significant (p = .002). In group A, 3 patients (16.7%) required surgical treatment compared with 6 patients (37.5%) in group B requiring surgical treatment (p = .180). Our results indicated that a higher volume without dry needling compared with a lower volume with dry needling resulted in greater improvement in noninsertional Achilles tendinopathy. However, confounding factors mean it is not possible to categorically state that this difference was solely due to different injection techniques. PMID:27286927

  17. THE RELATIONSHIPS AMONG SPATIOTEMPORAL COLLAGEN GENE EXPRESSION, HISTOLOGY, AND BIOMECHANICS FOLLOWING FULL-LENGTH INJURY IN THE MURINE PATELLAR TENDON

    PubMed Central

    Dyment, Nathaniel A; Kazemi, Namdar; Aschbacher-Smith, Lindsey E; Barthelery, Nicolas J.; Kenter, Keith; Gooch, Cynthia; Shearn, Jason T; Wylie, Christopher; Butler, David L

    2011-01-01

    Tendon injuries are major orthopaedic problems that worsen as the population ages. Type-I (Col1) and type-II (Col2) collagens play important roles in tendon midsubstance and tendon-to-bone insertion healing, respectively. Using double transgenic mice, this study aims to spatiotemporally monitor Col1 and Col2 gene expression, histology and biomechanics up to 8 weeks following a full-length patellar tendon injury. Gene expression and histology were analyzed weekly for up to 5 weeks while mechanical properties were measured at 1, 2, 5, and 8 weeks. At week 1, the healing region displayed loose granulation tissue with little Col1 expression. Col1 expression peaked at 2 weeks, but the ECM was highly disorganized and hypercellular. By 3 weeks, Col1 expression had reduced and by 5 weeks, the ECM was generally aligned along the tendon axis. Col2 expression was not seen in the healing midsubstance or insertion at any time point. The biomechanics of the healing tissue was inadequate at all time points, achieving ultimate loads and stiffnesses of 48% and 63% of normal values by 8 weeks. Future studies will further characterize the cells within the healing midsubstance and insertion using tenogenic markers and compare these results to those of tendon cells during normal development. PMID:21698662

  18. Human iPSC-Derived Neural Crest Stem Cells Promote Tendon Repair in a Rat Patellar Tendon Window Defect Model

    PubMed Central

    Xu, Wei; Wang, Yequan; Liu, Erfu; Sun, Yanjun; Luo, Ziwei; Xu, Zhiling; Liu, Wanqian; Zhong, Li; Lv, Yonggang; Wang, Aijun; Tang, Zhenyu; Li, Song

    2013-01-01

    Induced pluripotent stem cells (iPSCs) hold great potential for cell therapy and tissue engineering. Neural crest stem cells (NCSCs) are multipotent that are capable of differentiating into mesenchymal lineages. In this study, we investigated whether iPSC-derived NCSCs (iPSC-NCSCs) have potential for tendon repair. Human iPSC-NCSCs were suspended in fibrin gel and transplanted into a rat patellar tendon window defect. At 4 weeks post-transplantation, macroscopical observation showed that the repair of iPSC-NCSC-treated tendons was superior to that of non-iPSC-NCSC-treated tendons. Histological and mechanical examinations revealed that iPSC-NCSCs treatment significantly enhanced tendon healing as indicated by the improvement in matrix synthesis and mechanical properties. Furthermore, transplanted iPSC-NCSCs produced fetal tendon-related matrix proteins, stem cell recruitment factors, and tenogenic differentiation factors, and accelerated the host endogenous repair process. This study demonstrates a potential strategy of employing iPSC-derived NCSCs for tendon tissue engineering. PMID:23815150

  19. Validation of an empirical damage model for aging and in vivo injury of the murine patellar tendon.

    PubMed

    Buckley, Mark R; Dunkman, Andrew A; Reuther, Katherine E; Kumar, Akash; Pathmanathan, Lydia; Beason, David P; Birk, David E; Soslowsky, Louis J

    2013-04-01

    While useful models have been proposed to predict the mechanical impact of damage in tendon and other soft tissues, the applicability of these models for describing in vivo injury and age-related degeneration has not been investigated. Therefore, the objective of this study was to develop and validate a simple damage model to predict mechanical alterations in mouse patellar tendons after aging, injury, or healing. To characterize baseline properties, uninjured controls at age 150 days were cyclically loaded across three strain levels and five frequencies. For comparison, damage was induced in mature (120 day-old) mice through either injury or aging. Injured mice were sacrificed at three or six weeks after surgery, while aged mice were sacrificed at either 300 or 570 days old. Changes in mechanical properties (relative to baseline) in the three week post-injury group were assessed and used to develop an empirical damage model based on a simple damage parameter related to the equilibrium stress at a prescribed strain (6%). From the derived model, the viscoelastic properties of the 300 day-old, 570 day-old, and six week post-injury groups were accurately predicted. Across testing conditions, nearly all correlations between predicted and measured parameters were statistically significant and coefficients of determination ranged from R² = 0.25 to 0.97. Results suggest that the proposed damage model could exploit simple in vivo mechanical measurements to predict how an injured or aged tendon will respond to complex physiological loading regimens. PMID:24231900

  20. MRI-based inverse finite element approach for the mechanical assessment of patellar articular cartilage from static compression test.

    PubMed

    Knecht, Sven; Luechinger, Roger; Boesiger, Peter; Stüssi, Edgar

    2008-12-01

    The mechanical property of articular cartilage determines to a great extent the functionality of diarthrodial joints. Consequently, the early detection of mechanical and, thus, functional changes of cartilage is crucial for preventive measures to maintain the mobility and the quality of life of individuals. An alternative to conventional mechanical testing is the inverse finite element approach, enabling non-destructive testing of the tissue. We evaluated a method for the assessment of the equilibrium material properties of the patellar cartilage based on magnetic resonance imaging during patellofemoral compression. We performed ex vivo testing of two equine patellas with healthy cartilage, one with superficial defects, and one with synthetically degenerated cartilage to simulate a pre-osteoarthritic stage. Static compression with 400 N for 2 h resulted in morphological changes comparable to physiological in vivo deformations in humans. We observed a decrease of the equilibrium Young's modulus of the degenerated cartilage by -59%, which was in the range of the results from indentation (-74%) and confined compression tests (-58%). With the reported accuracy of magnetic resonance imaging and its reproducibility, the results indicate the potential to measure differences in Young's modulus with regard to cartilage degeneration and consequently to distinguish between healthy and pre-osteoarthritic cartilage. PMID:19037871

  1. Patellar Shape-Memory Fixator for the Treatment of Comminuted Fractures of the Inferior Pole of the Patella

    NASA Astrophysics Data System (ADS)

    Liu, Xin-Wei; Shang, Hui-Juan; Xu, Shuo-Gui; Wang, Zhi-Wei; Zhang, Chun-Cai; Fu, Qing-Ge

    2011-07-01

    Comminuted and displaced fractures of the inferior pole of the patella are not easy to reduce and it is difficult to fix the fragments soundly enough to allow early movement of the knee. The purpose of this study is to evaluate the clinical effectiveness of the internal fixation technique with Patellar Shape-Memory Fixator (PSMF) in acute comminuted fractures of the inferior pole of the patella. We retrospectively studied 25 patients with comminuted fractures of the inferior pole of the patella who were treated with PSMF and followed up for a mean period of 26 months (14 to 60). All the fractures healed at a mean of 6 weeks (5 to 7). The mean grading at the final follow-up was 29.5 points (27 to 30) using the Bostman score, with no observable restriction of movement. No breakage of the PSMF or infection occurred. No delayed union, nonunion, and infection were seen. This technique preserved the length of the patella, reduced the comminuted fragments of the inferior pole and avoided long-term immobilization of the knee.

  2. Reconstruction of the medial patellofemoral ligament using autologous graft from quadriceps tendon to treat recurrent patellar dislocation☆

    PubMed Central

    Calapodopulos, Constantino Jorge; Nogueira, Marcelo Corvino; Eustáquio, José Martins Juliano; Calapodopulos Júnior, Constantino Jorge; Rodrigues, Oreston Alves

    2016-01-01

    Objective The objective of this study was to evaluate the efficacy of the surgical technique using the quadriceps tendon as a graft in static reconstruction of the medial patellofemoral ligament. Methods This was a prospective case series study in which the participants were 22 patients with a diagnosis of recurrent patellar dislocation without any other anatomical alterations that required surgical treatment. The functional results from the technique were evaluated using clinical data and the Lysholm questionnaire, one year after the operation. Results It was observed that the patients were predominantly female (86%) and under 21 years of age (73%), just like in the literature. At the first annual return after the surgery, there was no significant pain on medium efforts, no loss of range of motion and a positive apprehension test. According to the questionnaire used, the results were graded as good. The patients who reported having severe pain on greater effort were involved in employment-related legal disputes. Conclusion This technique showed low morbidity and good functional results over the short term. PMID:27069888

  3. Effect of Intraoperative Platelet-Rich-Plasma Treatment on Post Operative Donor Site Knee Pain in Patellar Tendon Autograft ACL Reconstruction

    PubMed Central

    Walters, Brian L.; Hobart, Sarah; Porter, David; Hogan, Daniel E.; McHugh, Malachy P.; Bedford, Benjamin B.; Nicholas, Stephen J.; Klein, Devon; Harousseau, Kendall

    2016-01-01

    Objectives: Donor site morbidity in the form of anterior knee pain is a frequent complication after bone-patellar tendon-bone (BPTB) autograft ACL reconstruction. The purpose of this Level I study was to examine the effect of the intraoperative administration of platelet-rich plasma on post operative knee pain and patellar defect healing. Methods: Fifty-nine patients (29±12 y/o) undergoing BPTB ACL reconstruction and eligible to enter the study, were randomized to the treatment (PRP; n=31) or non treatment (sham n=28) arms of the study just prior to surgery. In either case, 10 cc of venous blood was drawn prior to the induction of anesthesia and either discarded (sham) or processed (PRP) for preparation of a PRP gel to be later mixed with donor site bone chips and inserted into the patellar defect. At 12 weeks and 6 months after surgery, patients completed IKDC forms and VAS pain scores for ADLs and kneeling (0-10 scale). Healing indices at the donor site were assessed by MRI at 6 months and included the following measurements taken from axial sequences: AP tendon dimensions at the level of the superior tibial cortex, roof of the intercondylar notch and width at the largest patella graft deficit. Mixed model ANOVA was used to assess the effect of PRP on patient symptoms and MRI indices of donor site healing. The primary dependent variable was VAS kneeling pain. It was estimated that with 25 patients per group there would be 80% power to detect a 1.5-point difference in kneeling pain between treatments at P<0.05. A between group difference of 1.5-points in VAS for kneeling pain was deemed to represent a clinically relevant difference. Results: VAS Kneeling Pain at 12 weeks tended to be lower in the PRP versus placebo group (4.5±3.6 vs. 6.2±2.4, P=0.051) but no difference was apparent at 6 months (3.7±3.2 vs. 4.4±2.9, P=0.41). Kneeling pain decreased from 12 weeks to 6 months (P<0.001) with a trend for a greater decrease in the placebo group (Time by Treatment P

  4. Temporal and Spatial Expression of TGF-b1 in the Early Phase of Patellar Tendon Healing after Application of Platelet Rich Plasma

    PubMed Central

    Lyras, Dimitris N.; Kazakos, Konstantinos; Tilkeridis, Konstantinos; Kokka, Anna; Ververidis, Athanasios; Botaitis, Sotirios; Agrogiannis, George

    2016-01-01

    Background: The aim of this study is to find out the spatial and temporal expression of TGF-b1 during the tendon healing, after application of Platelet Rich Plasma (PRP). Methods: A patellar tendon defect model in rabbits was used for this purpose. 48 skeletally mature New Zealand White rabbits, weighing 3.5 kg, were used for this study. Equal numbers of animals from both groups were sacrificed at 4 different time points (1st, 2nd, 3rd, and 4th week). A full thickness patellar tendon substance in the right limb of each animal was excised from its central portion during the operation. PRP with a gel form was applied and filled the tendon defect in PRP group. No PRP was applied in the tendon defect of controls. Histological sections with hematoxylin-eosin and immunohistochemical sections with an anti-TGF-b1 primary antibody were made for the evaluation of the results. Results: A differentiation of the healing process was observed in the PRP group in comparison with the control group. TGF-b1 expression was detected in various cell populations (inflammatory cells, endothelial cells, macrophages, and tenocytes). Both cytoplasmic and nuclear expressions were present. The larger amounts of immunoexpression were localized in epitenon and in the repair site. PRP group showed stronger and more extensive staining at 1st and 2nd week (P<0.0001), whereas control group showed more extensive staining at the 3rd and 4th week (P<0.0001). Conclusions: Our study demonstrates that locally application of PRP result in an alteration of TGF-b1 expression during the healing of a patellar tendon defect. PMID:27200395

  5. Outcome of medial patellar ligament desmoplasty for treatment of intermittent upward fixation of the patella in 24 horses (2005–2012)

    PubMed Central

    Peitzmeier, Maggie D.; Koontz, Zachary D.; Lynch, Timothy M.; Hughes, Faith E.; Slone, Donnie E.

    2015-01-01

    This retrospective study provides long-term results of medial patellar ligament (MPL) desmoplasty in horses with intermittent upward fixation of the patella (UFP) that were treated at a single referral hospital over a 7-year period. Follow-up interviews were conducted with owners, trainers, or referring veterinarians using a standardized questionnaire. Overall, 71% of horses returned to their intended use with only 18% at a higher level. Recurrence of UFP was noted in 33% of cases. Satisfaction with the procedure was generally low, with only 50% of owners being completely satisfied. Further investigation is warranted to determine appropriate medical and/or surgical therapy. PMID:25694670

  6. Murine patellar tendon biomechanical properties and regional strain patterns during natural tendon-to-bone healing after acute injury

    PubMed Central

    Gilday, Steven D.; Casstevens, E. Chris; Kenter, Keith; Shearn, Jason T.; Butler, David L.

    2014-01-01

    Tendon-to-bone healing following acute injury is generally poor and often fails to restore normal tendon biomechanical properties. In recent years, the murine patellar tendon (PT) has become an important model system for studying tendon healing and repair due to its genetic tractability and accessible location within the knee. However, the mechanical properties of native murine PT, specifically the regional differences in tissue strains during loading, and the biomechanical outcomes of natural PT-to-bone healing have not been well characterized. Thus, in this study, we analyzed the global biomechanical properties and regional strain patterns of both normal and naturally healing murine PT at three time points (2, 5, and 8 weeks) following acute surgical rupture of the tibial enthesis. Normal murine PT exhibited distinct regional variations in tissue strain, with the insertion region experiencing approximately 2.5 times greater strain than the midsubstance at failure (10.80 ± 2.52% vs. 4.11 ± 1.40%; mean ± SEM). Injured tendons showed reduced structural (ultimate load and linear stiffness) and material (ultimate stress and linear modulus) properties compared to both normal and contralateral sham-operated tendons at all healing time points. Injured tendons also displayed increased local strain in the insertion region compared to contralateral shams at both physiologic and failure load levels. 93.3% of injured tendons failed at the tibial insertion, compared to only 60% and 66.7% of normal and sham tendons, respectively. These results indicate that 8 weeks of natural tendon-to-bone healing does not restore normal biomechanical function to the murine PT following injury. PMID:24210849

  7. Outcomes and complications following surgical correction of grade IV medial patellar luxation in dogs: 24 cases (2008-2014).

    PubMed

    Dunlap, Anna E; Kim, Stanley E; Lewis, Daniel D; Christopher, Scott A; Pozzi, Antonio

    2016-07-15

    OBJECTIVE To determine short- and long-term outcomes and complications of dogs undergoing surgical correction of grade IV medial patellar luxation (MPL). DESIGN Retrospective case series. ANIMALS 24 dogs (29 stifle joints) that underwent surgical correction of grade IV MPL between March 2008 and April 2014. PROCEDURES Medical records of all dogs were reviewed. When available, long-term follow-up information was obtained for each dog via the orthopedic surgeon (results of orthopedic examination and radiographic interpretation) and the dog's owner (responses to a questionnaire regarding postsurgical outcomes). Types of postsurgical complications and intervals to follow-up data collection were recorded. Recurrence of MPL was recorded separately. Successful outcome was defined as one without catastrophic complication, with owner-reported full or acceptable return to function and a surgeon- and owner-assigned pain or lameness score < 3. RESULTS 24% (7/29) of stifle joints had major complications, and 21% (6) of joints required surgical revision. Grade II to IV recurrence of MPL was identified in 21% (6) of stifle joints. One dog had a catastrophic complication requiring limb amputation. For all other dogs, owner-reported return to function was full or acceptable. Surgeon-assigned pain and lameness scores for all dogs at the final follow-up evaluation were < 2/5 (0 = pain or lameness free). Surgical correction of grade IV MPL had an overall success rate of 93% (27/29). CONCLUSIONS AND CLINICAL RELEVANCE Surgical correction of grade IV MPL in dogs had a favorable overall success rate; however, owners should be counseled regarding the high rate of complications associated with surgery. PMID:27379597

  8. Computer-aided diagnosis for phase-contrast X-ray computed tomography: quantitative characterization of human patellar cartilage with high-dimensional geometric features.

    PubMed

    Nagarajan, Mahesh B; Coan, Paola; Huber, Markus B; Diemoz, Paul C; Glaser, Christian; Wismüller, Axel

    2014-02-01

    Phase-contrast computed tomography (PCI-CT) has shown tremendous potential as an imaging modality for visualizing human cartilage with high spatial resolution. Previous studies have demonstrated the ability of PCI-CT to visualize (1) structural details of the human patellar cartilage matrix and (2) changes to chondrocyte organization induced by osteoarthritis. This study investigates the use of high-dimensional geometric features in characterizing such chondrocyte patterns in the presence or absence of osteoarthritic damage. Geometrical features derived from the scaling index method (SIM) and statistical features derived from gray-level co-occurrence matrices were extracted from 842 regions of interest (ROI) annotated on PCI-CT images of ex vivo human patellar cartilage specimens. These features were subsequently used in a machine learning task with support vector regression to classify ROIs as healthy or osteoarthritic; classification performance was evaluated using the area under the receiver-operating characteristic curve (AUC). SIM-derived geometrical features exhibited the best classification performance (AUC, 0.95 ± 0.06) and were most robust to changes in ROI size. These results suggest that such geometrical features can provide a detailed characterization of the chondrocyte organization in the cartilage matrix in an automated and non-subjective manner, while also enabling classification of cartilage as healthy or osteoarthritic with high accuracy. Such features could potentially serve as imaging markers for evaluating osteoarthritis progression and its response to different therapeutic intervention strategies. PMID:24043594

  9. Improved Biomechanical and Biological Outcomes in the MRL/MpJ Murine Strain Following a Full-Length Patellar Tendon Injury

    PubMed Central

    Lalley, Andrea L.; Dyment, Nathaniel A.; Kazemi, Namdar; Kenter, Keith; Gooch, Cynthia; Rowe, David W.; Butler, David L.; Shearn, Jason T.

    2016-01-01

    Musculoskeletal injuries greatly affect the U.S. population and current clinical approaches fail to restore long-term native tissue structure and function. Tissue engineering is a strategy advocated to improve tendon healing; however, the field still needs to establish biological benchmarks for assessing the effectiveness of tissue-engineered structures. Investigating superior healing models, such as the MRL/MpJ, offers the opportunity to first characterize successful healing and then apply experimental findings to tissue-engineered therapies. This study seeks to evaluate the MRL/MpJ’s healing response following a central patellar tendon injury compared to wildtype. Gene expression and histology were assessed at 3, 7, and 14 days following injury and mechanical properties were measured at 2, 5, and 8 weeks. Native patellar tendon biological and mechanical properties were not different between strains. Following injury, the MRL/MpJ displayed increased mechanical properties between 5 and 8 weeks; however, early tenogenic expression patterns were not different between the strains. Furthermore, expression of the cyclin-dependent kinase inhibitor, p21, was not different between strains, suggesting an alternative mechanism may be driving the healing response. Future studies will investigate collagen structure and alignment of the repair tissue and characterize the complete healing transcriptome to identify mechanisms driving the MRL/MpJ response. PMID:25982892

  10. The relationship of vascularity and water content to tensile strength in a patellar tendon replacement of the anterior cruciate in dogs.

    PubMed

    McFarland, E G; Morrey, B F; An, K N; Wood, M B

    1986-01-01

    The methods and materials for ACL reconstruction are important issues for the practicing orthopaedic surgeon. In this study a model was developed to study the biological and biomechanical characteristics of a patellar tendon autograft used for ACL reconstruction. Specifically it was hypothesized that since vascularity of these grafts reflects their "healthiness," strength and vascularity should be inversely related in the early period after implantation. Using an over the top technique, a patellar tendon graft was placed in three groups of dogs and studied at 37, 57, and 120 days. Vascularity of the grafts was measured using technetium-tagged red blood cells, and percent water by weight was determined by dessication. Tensile testing to failure was performed using an MTS machine. The grafts became more vascular, more hydrated, less stiff, and less strong (by 4 weeks) than controls. By 16 weeks the vascular response was subsiding but the grafts remained only 40% as strong as controls. Percent water increased significantly over controls for all time periods. Decrease in strength correlated poorly with vascularity but correlated well with increase in percent water. These findings suggest that the change in strength of an intraarticular ACL replacement relates more to a basic rearrangement of its collagen-ground substance relationships, and that vascularity may reflect the inflammatory response bringing about these changes. The model developed in this study serves as a basis for further studies, and the findings reveal important information about the behavior of ACL grafting materials. PMID:3541655

  11. Patellar Subluxation With Early-Phase Synovial Chondromatosis of the Knee.

    PubMed

    Bashaireh, Khaldoon M

    2016-01-01

    Primary synovial chondromatosis is a rare, benign, monoarticular disease process that affects the synovial membrane of the joint, the synovial sheath, or the bursa around the joint. The etiology is unknown, but it has been associated with trauma in some cases. Although it is a benign lesion, if left untreated, it may lead to early secondary osteoarthritis of the joint. The knee joint is affected in 50% to 65% of cases, followed by the elbow and the hip. This article reports a 30-year-old active woman who presented to the author's clinic with a large infrapatellar mass that caused lateral subluxation of the patella, swelling, and episodic pain with crepitations 14 months after direct trauma to the knee. Clinical examination, magnetic resonance imaging, and arthroscopy revealed a large infrapatellar mass causing lateral subluxation of the patella with no loose bodies. Hoffa's disease, para-articular osteochondroma, and early-phase synovial chondromatosis were considered in the differential diagnosis. The histopathologic and clinical features were consistent with early synovial chondromatosis. The patient underwent local excision of the mass through a medial parapatellar arthrotomy. At 5 years of follow-up, she had no recurrence of the lesion or progression of the disease. Early diagnosis of synovial chondromatosis with local excision offers a reliable cure. However, long-term follow-up is advised because of the high recurrence rates as well as the risk of metaplastic transformation. PMID:26726983

  12. Acute patellar dislocation with multiple ligament injuries after knee dislocation and single session reconstruction.

    PubMed

    Gormeli, Gokay; Gormeli, Cemile Ayse; Karakaplan, Mustafa; Gurbuz, Sukru; Ozdemir, Zeynep; Ozer, Mustafa

    2016-06-01

    Knee dislocation is a relatively rare condition of all orthopaedic injuries. Accompanying multiple ligament injuries are common after knee dislocations. A 41-year-old male presented to the emergency department suffering from right knee dislocation in June 2013. The patient had anterior cruciate ligament, medial collateral ligament (MCL), medial patellofemoral ligament (MPFL) rupture, and lateral meniscal tear. A single-bundle anatomic reconstruction, medial collateral ligament reconstruction, medial patellofemoral ligament reconstruction and meniscus repair were performed in single session. At twelve months follow-up; there was 160º flexion and 10° extension knee range of motion. Lysholm knee score was 90. Extensive forces can cause both MCL and MPFL injury due to overload and the anatomical relationship between these two structures. Therefore, patients with valgus instability should be evaluated for both MPFL and MCL tears to facilitate successful treatment. PMID:27339584

  13. Scx-transduced tendon-derived stem cells (tdscs) promoted better tendon repair compared to mock-transduced cells in a rat patellar tendon window injury model.

    PubMed

    Tan, Chunlai; Lui, Pauline Po Yee; Lee, Yuk Wa; Wong, Yin Mei

    2014-01-01

    We hypothesized that the transplantation of Scx-transduced tendon-derived stem cells (TDSCs) promoted better tendon repair compared to the transplantation of mock-transduced cells. This study thus aimed to investigate the effect of Scx transduction on the expression of lineage markers in TDSCs and the effect of the resulting cell line in the promotion of tendon repair. Rat non-GFP or GFP-TDSCs were transduced with Scx or empty lentiviral vector (Mock) and selected by blasticidin. The mRNA expressions of Scx and different lineage markers were examined by qRT-PCR. The effect of the transplantation of GFP-TDSC-Scx on tendon repair was then tested in a rat unilateral patellar tendon window injury model. The transplantation of GFP-TDSC-Mock and scaffold-only served as controls. At week 2, 4 and 8 post-transplantation, the repaired patellar tendon was harvested for ex vivo fluorescent imaging, vivaCT imaging, histology, immunohistochemistry and biomechanical test. GFP-TDSC-Scx consistently showed higher expressions of most of tendon- and cartilage- related markers compared to the GFP-TDSC-Mock. However, the effect of Scx transduction on the expressions of bone-related markers was inconclusive. The transplanted GFP-TDSCs could be detected in the window wound at week 2 but not at week 4. Ectopic mineralization was detected in some samples at week 8 but there was no difference among different groups. The GFP-TDSC-Scx group only statistically significantly improved tendon repair histologically and biomechanically compared to the Scaffold-only group and the GFP-TDSC-Mock group at the early stage of tendon repair. There was significant higher expression of collagen type I in the window wound in the GFP-TDSC-Scx group compared to the other two groups at week 2. The transplantation of GFP-TDSC-Scx promoted healing at the early stage of tendon repair in a rat patellar tendon window injury model. PMID:24831949

  14. Femoral press-fit fixation in ACL reconstruction using bone-patellar tendon-bone autograft: results at 15 years follow-up

    PubMed Central

    2012-01-01

    Background If anterior cruciate ligament (ACL) reconstruction is to be performed, decision regarding graft choice and its fixation remains one of the most controversial. Multiple techniques for ACL reconstruction are available. To avoid disadvantages related to fixation devices, a hardware-free, press-fit ACL reconstruction technique was developed. The aim of this study was to evaluate clinical outcome and osteoarthritis progression in long term after ACL reconstruction with central third patellar-tendon autograft fixed to femur by press-fit technique. Methods Fifty two patients met inclusion/excusion criteria for this study. The patients were assessed preoperatively and at 15 years after surgery with International Knee Documentation Committee Knee Ligament Evaluation Form, Lysholm knee score, Tegner activity scale and radiographs. Results Good overall clinical outcomes and self-reported assessments were documented, and remained good at 15 years. The mean Lysholm and Tegner scores improved from 59.7 ± 18.5 and 4.2 ± 1.0 preoperatively to 86.4 ± 5.6 (p = 0.004) and 6.9 ± 1.4 (p = 0.005) respectively at follow-up. The IKDC subjective score improved from 60.1 ± 9.2 to 80.2 ± 8.1 (p = 0.003). According to IKDC objective score, 75% of patients had normal or nearly normal knee joints at follow-up. Grade 0 or 1 results were seen in 85% of patients on laxity testing. Degenerative changes were found in 67% of patients. There was no correlation between arthritic changes and stability of knee and subjective evaluation (p > 0.05). Conclusions ACL reconstruction with patellar tendon autograft fixed to femur with press-fit technique allows to achieve good self-reported assessments and clinical ligament evaluation up to 15 years. Advantages of the bone-patellar-tendon-bone (BPTB) press-fit fixation include unlimited bone-to-bone healing, cost effectiveness, avoidance of disadvantages associated with hardware, and ease for

  15. Jaundice causes

    MedlinePlus

    ... liver is unable to properly move into the digestive tract. Conditions that can cause jaundice include: Infections of the liver from a virus ( hepatitis A , hepatitis B , hepatitis C , hepatitis D , ...

  16. Comparison of femoral and tibial pullout forces in bone-patellar tendon-bone anterior cruciate ligament reconstructions with a new interference fixation device.

    PubMed

    Seitz, H; Vécsei, V; Menth-Chiari, W A; Pichl, W; Wielke, B; Marlovits, S

    1999-03-01

    Interference screws have become the standard method for fixing bone-patellar tendon-bone (BPTB) grafts. To avoid the inherent pitfalls and complications of interference screws, a 28-mm long and from 5 to 7 mm spreadable metal bolt with nontapping threads was developed for this study. The technical applicability and biomechanical characteristics of this new BPTB interference fixation device were investigated by dissection or tensile testing of 48 cadaveric knee specimens from young donors. No problems occurred with respect to bone plug anchoring during insertion of the spreading bolts. The clinically important linear load was 920+/-283 N for the femoral and 635+/-247 N for the tibial fixation site. Bone plug pullout was the mode of failure in all specimens. The results of this study indicate that the spreading bolt is a reasonable alternative to interference screws. PMID:10210075

  17. Enhancing FTIR imaging capabilities with two-dimensional correlation spectroscopy (2DCOS): A study of concentration gradients of collagen and proteoglycans in human patellar cartilage

    NASA Astrophysics Data System (ADS)

    Jiang, Eric Y.; Rieppo, Jarno

    2006-11-01

    This paper explores a new application of two-dimensional correlation spectroscopy (2DCOS) in FTIR spectroscopic imaging analysis of biological samples. A particular example demonstrated in this paper is the characterization of concentration gradients of collagen and proteoglycans in human patellar cartilage. A focal plane array detector-based FTIR imaging system has been proven to be an efficient tool to detect early collagen and proteoglycans degradation in developing osteoarthrosis through evaluating compositional changes of osteoarthritic cartilage along the depth. However, the closely overlapped bands of collagen and proteoglycans make normal spectral and spatial analysis difficult. With 2DCOS analysis of the imaging data, it is possible to enhance the spectral resolution and reveal distinctive compositional changes that are normally hidden with conventional approaches. The combined technique, FTIR imaging enhanced with 2DCOS, provides new possibilities to solve challenging problems in the analysis of complex biological systems.

  18. Mechanoreceptors and length of the patellar ligament after Ho-YAG laser treatment: a long-term follow-up in rabbits.

    PubMed

    Takahashi, Toshiaki; Wada, Yukihisa; Tanaka, Masanobu; Yamanaka, Norio; Yamamoto, Hiroshi

    2002-12-01

    We studied the shortening and the number of mechanoreceptors in the patellar ligament up to 18 months after Ho-YAG irradiation of the ligament's surface in 35 rabbits. The ligaments shortened an average 13% immediately after irradiation. After treatment, we divided the rabbits into a mobilized or immobilized group. At 2 weeks and 12 months after treatment both groups showed no shortening of the ligament, as compared to the intact ligament while that in the mobilized group had elongated at 12 months. Fewer Pacinian and Ruffini corpuscles were found in the irradiated ligaments than in the intact ones at 2 weeks after treatment, but we found no difference between irradiated and intact ligaments at 18 months after treatment. PMID:12553512

  19. Effect of combined administration of transforming growth factor-b1 and insulin-like growth factor I on the mechanical properties of a patellar tendon defect model in rabbits.

    PubMed

    Lyras, Dimitrios N; Kazakos, Konstantinos; Verettas, Dionysios; Chronopoulos, Efstathios; Folaranmi, Semiu; Agrogiannis, George

    2010-06-01

    The aim of this study was to test the hypothesis that combined administration of TGF-b1 and IGF-I in a patellar tendon defect model could enhance the mechanical properties of the healed tendon. Twenty four New Zealand white rabbits were used for this purpose. In each animal, the right knee was used for the application of the growth factors, whereas the left knee served as an untreated control. The growth factors were mixed with fibrin sealant as a delivery vehicle. Two groups of rabbits were sacrificed after 2 weeks and 6 weeks respectively. Application of the growth factors resulted in a significant increase in force at failure, ultimate stress, stiffness, and energy uptake at 2 weeks, whereas none of the parameters revealed any significant difference between the two groups at 6 weeks. This study provides valuable information on the effect of the two growth factors on this patellar tendon defect model. PMID:20698461

  20. Jumper's Knee (Patellar Tendonitis)

    MedlinePlus

    ... Fitness Diseases & Conditions Infections Q&A School & Jobs Drugs & Alcohol Staying Safe Recipes En Español Making a Change – Your Personal Plan Hot Topics Meningitis Choosing Your Mood Prescription Drug Abuse Healthy School Lunch Planner How Can I ...

  1. 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

  2. STRENGTH EXERCISES COMBINED WITH DRY NEEDLING WITH ELECTRICAL STIMULATION IMPROVE PAIN AND FUNCTION IN PATIENTS WITH CHRONIC ROTATOR CUFF TENDINOPATHY: A RETROSPECTIVE CASE SERIES

    PubMed Central

    2016-01-01

    ABSTRACT Background and Purpose Rotator cuff tendinopathy (RTCT) is regularly treated by the physical therapist. Multiple etiologies for RTCT exist, leading an individual to seek treatment from their provider of choice. Strengthening exercises (SE) have been reported to be effective in the treatment of RTCT, but there is limited evidence on the effectiveness of dry needing (DN) for this condition. The purpose of this retrospective case series was to investigate DN to various non-trigger point-based anatomical locations coupled with strengthening exercises (SE) as a treatment strategy to decrease pain and increase function in healthy patients with chronic RTC pathology. Case Descriptions Eight patients with RTCT were treated 1-2 times per week for up to eight weeks, and no more than sixteen total treatment sessions of SE and DN. Outcomes were tested at baseline and upon completion of therapy. A long-term outcome measure follow up averaging 8.75 months (range 3 to 20 months) was also performed. The outcome measures included the Visual Analog Scale (VAS) and the Quick Dash (QD). Outcomes Clinically meaningful improvements in disability and pain in the short term and upon long-term follow up were demonstrated for each patient. The mean VAS was broken down into best (VASB), current (VASC), and worst (VASW) rated pain levels and the mean was calculated for the eight patients. The mean VASB improved from 22.5 mm at the initial assessment to 2.36 mm upon completion of the intervention duration. The mean VASC improved from 28.36 mm to 5.0 mm, and the mean VASW improved from 68.88 mm to 13.25 mm. At the long-term follow up (average 8.75 months), The mean VASB, VASC, and VASW scores were 0.36 mm, 4.88 mm, and 17.88 mm respectively. The QDmean for the eight patients improved from 43.09 at baseline to 16.04 at the completion of treatment. At long-term follow-up, the QDmean was 6.59. Conclusion Clinically meaningful improvements in pain and disability were

  3. Hyperuricemia in Tendons.

    PubMed

    Andia, Isabel; Abate, Michele

    2016-01-01

    Hyperuricemia, particularly gout, and the immune inflammatory response are highly integrated. Both, long standing hyperuricemia and monosodium urate (MSU) crystal deposition can challenge tendon homeostasis because of their potential to cause inflammation to the host. Knowledge is emerging from clinical imaging research depicting where MSU crystals deposit, including patellar tendon, triceps and quadriceps tendons. Remarkably, subclinical tendon inflammation and damage are also present in asymptomatic hyperuricemia. Monosodium urate crystals act as danger activating molecular patterns (DAMPs), activating the inflammasome and inducing the secretion of IL-1beta, a key mediator of the inflammatory response. The crucial role of IL-1beta in driving the inflammatory events during gout attacks is supported by the clinical efficacy of IL-1beta blockade. Some data implicating IL-1beta as an initiator of tendinopathy exist, but the link between hyperuricemia and the development of tendinopathy remains to be validated. Further knowledge about the interactions of uric acid with both innate immune and tendon cells, and their consequences may help to determine if there is a subclass of hyperuricemic-tendinopathy. PMID:27535254

  4. Poly L-lactide co-glycolide/β-tricalcium phosphate interference screw fixation for bone-patellar tendon bone anterior cruciate ligament reconstruction.

    PubMed

    Barber, F Alan; Hrnack, Scott A

    2013-12-01

    The objective of this study was to prospectively evaluate the clinical effectiveness and radiographic response of a poly (l-lactide co-glycolide)/β-tricalcium phosphate (PlLA/PGA/β-TCP) interference screw used in bone-patellar tendon-bone (BPTB) anterior cruciate ligament (ACL) reconstruction. A prospective, consecutive series of 104 patellar tendon bone-tendon-bone ACL reconstructions fixed with PLLA/PGA/β-TCP biocomposite screws were studied. After receiving the approval from the Institutional Review Board, the following data were collected preoperatively from all patients: physical examination, Lysholm score, Cincinnati, and International Knee Documentation Committee (IKDC) activity scores, and standard knee radiographs. In addition to these, follow-up assessments included Lachman and pivot-shift tests, Tegner scores, and KT side-to-side differences. Surgical failure was defined by a 2+ Lachman test, positive pivot-shift test, side-to-side KT difference of greater than 5 mm or subsequent ACL revision surgery. Approximately 95% of patients (99 of 104) with an average follow-up of 36 months (range, 24 to 68) are reported. The average age was 30 years (range, 13 to 57 years). Postoperatively, four patients demonstrated +1 Lachman score and one patient demonstrated a +2 Lachman score. Postoperative pivot-shift tests were a trace positive in one patients and +1 in two patients. The average KT side-to-side difference was 0.65 mm. All, but five patients, demonstrated KT side-to-side measurements of 3 mm or less and those five demonstrated measurements of 5 mm or less. No revision reconstructions were performed. Significant improvements in Cincinnati score (41 to 85 postoperative) and Lysholm score (46 to 90) were observed. The average postoperative Tegner score was 7. IKDC activity score increased from 2.3 to 3.1. Approximately 4% of patients (4 of 99) met the criteria for failure. A PLLA/PGA/β-TCP biocomposite interference fixation screw provides good graft

  5. Proprioception in the ACL-ruptured knee: the contribution of the medial collateral ligament and patellar ligament. An in vivo experimental study in the cat.

    PubMed

    Bonsfills, N; Raygoza, J J; Boemo, E; Garrido, J; Núñez, A; Gómez-Barrena, E

    2007-01-01

    In the absence of anterior cruciate ligament (ACL), secondary restraints such as menisci, ligaments, and tendons restrict anterior knee laxity. Strain detection at these sites could define the contribution of this alternative signalling system to knee proprioception after ACL injury. The hypothesis in this study questions if measurements of anterior tibial translation (ATT) from surface strain gauges on the insertions of the medial collateral ligament (MCL) and the patellar tendon (PT) are sufficiently sensitive and specific to differentiate normal, stable knees from acutely unstable knees due to ACL section. Twelve cats received miniaturized strain gauges on the surface of MCL and PT distal insertions. A purpose-made receiver transformed into measurements any voltage variation obtained during passive knee flexion-extension and anterior tibial translation manoeuvres. Variables under evaluation included first peak latency, normalized amplitude, and slope of voltage along time. Femorotibial displacements were video recorded, digitized, and used as the ATT reference. The proposed system detected significant changes in the slope of the voltage/time signal, with higher specificity and sensitivity during ATT after experimental ACL section. Changes were not significant during flexion or extension. It was found that a pattern of earlier and more intense strain in MCL and PT distal insertions was found during ATT in the ACL deficient knee. Enhanced pattern recognition learning from these structures could be a future target for proprioceptive training after ACL injury. PMID:17070686

  6. Patellar tendon and hamstring moment-arms and cross-sectional area in patients with anterior cruciate ligament reconstruction and controls.

    PubMed

    Kellis, Eleftherios; Karagiannidis, Evaggelos; Patsika, Glykeria

    2015-08-01

    The purpose of this study was to examine the moment-arm and cross-sectional area (CSA) of the patellar tendon (PT) and the hamstrings after anterior cruciate ligament (ACL) reconstruction. The right knee of five males who underwent ACL reconstruction with a PT graft and five age-matched controls was scanned using magnetic resonance image scans. Based on three-dimensional (3D) solids of the PT, CSAs and moment-arms of semitendinous (ST), biceps femoris (BF) long head and semimembranosus (SM) were estimated. Analysis of variance indicated no significant group differences in muscle moment-arms (p>0.05). 3D moment-arms of PT, ST and BF were significantly lower than the corresponding 2D values (p < 0.05). The ACL group displayed a significantly higher maximum BF CSA, a lower ST CSA (p < 0.05) but similar PT and SM CSAs compared with controls. It is concluded that any alterations in PT properties 1 year after harvesting do not affect knee muscle moment-arms compared with age-matched controls. Moment-arm estimation differed between 3D and 2D data, although it did not affect comparisons between ACL reconstruction group and controls. Design of rehabilitation programmes should take into consideration a potential alteration in hamstring morphology following surgery with a PT graft. PMID:24460238

  7. Use of the Patellar-Pubic Percussion Test in the Diagnosis and Management of a Patient with a Non-Displaced Hip Fracture

    PubMed Central

    Borgerding, Leah J.; Kikillus, Pamela J.; Boissonnault, William G.

    2007-01-01

    This case report describes the diagnosis and subsequent medical and physical therapy management of a 68-year-old patient with an undiagnosed non-displaced hip fracture. Initial plain film radiographs and a computed tomography (CT) scan of the involved hip were both interpreted as negative. One of the findings on the physical examination included a positive patellar-pubic percussion test (PPPT). This finding in a female patient of this age raised the suspicion of an occult hip fracture and she was referred back to her primary care physician. Repeat radiographs revealed a non-displaced hip fracture and the patient was treated surgically. The PPPT is an easy-to-implement clinical examination tool that may be extremely useful in physical therapy practice to guide the decision-making process for patients with suspected hip fractures. The utilization of the PPPT by the treating physical therapist for the patient in this case report contributed to a timely diagnosis, potentially preventing the disabling sequelae associated with a displaced femoral fracture. PMID:19066665

  8. A meta-analysis of hamstring autografts versus bone-patellar tendon-bone autografts for reconstruction of the anterior cruciate ligament.

    PubMed

    Li, ShuZhen; Su, Wei; Zhao, Jinmin; Xu, Yinglong; Bo, Zhandong; Ding, Xiaofei; Wei, Qingjun

    2011-10-01

    The objective of this study was to evaluate the effectiveness of hamstring (HT) autografts versus bone-patellar tendon-bone (BPTB) autografts for reconstruction of the anterior cruciate ligament (ACL). We searched the Cochrane Library, MEDLINE, EMBASE and the Chinese Biomedicine Database (CBM) for published randomised clinical trials (RCTs) relevant to ACL reconstruction comparing HT and BPTB autografts. Data analyses were performed with Cochrane Collaboration's RevMan 5.0. A total of 23 reports of 19 randomised controlled trials (RCTs) (1643 patients) met the inclusion criteria. Outcomes favouring BPTB autografts were found in terms of KT-1000 arithmometer values, negative rates of Lachman tests and negative rates of Pivot tests. Outcome measures that favoured HT autografts included anterior knee pain, kneeling pain and extension loss. There was no statistical difference of postoperative graft failure. Overall, postoperative complications of the knee joint were lower for HT autografts than for BPTB autografts, and BPTB autografts were superior to HT autografts in resuming stability of the knee joint, but four-strand HT combined with application of the modern endobutton HT graft-fixation technique could increase knee-joint stability. PMID:20850327

  9. Concurrent Validation of the Banff Patella Instability Instrument to the Norwich Patellar Instability Score and the Kujala Score in Patients With Patellofemoral Instability

    PubMed Central

    Hiemstra, Laurie A.; Kerslake, Sarah; Lafave, Mark; Mohtadi, Nicholas G.

    2016-01-01

    Background: The Banff Patella Instability Instrument (BPII) is a disease-specific, patient-reported, quality-of-life outcome measure designed to assess patients with patellofemoral instability. The iterative assessment of the validity, reliability, and responsiveness of a health-related patient-reported outcome measure is vital to the development of a high-quality evaluation tool. Purpose: To assess the concurrent validity of the BPII to the Norwich Patellar Instability (NPI) score and the Kujala score. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 74 patients with a confirmed diagnosis of recurrent patellofemoral instability completed the BPII, NPI, and Kujala scores at the initial orthopaedic consultation. A Pearson r correlation coefficient was computed to determine the relationship between each of these patient-reported outcomes. Results: There were statistically significant correlations between the BPII and the NPI score (r = −0.53; P < .001) as well as the BPII and the Kujala score (r = 0.50; P < .001). Conclusion: This study demonstrated a moderately strong correlation of the BPII to other outcome measures used to evaluate patients with patellofemoral instability. This study adds further validity to the BPII in accordance with the COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) guidelines. PMID:27231700

  10. Does Choosing Autograft Hamstring vs. Patellar Tendon by Gender, Sport, Level of Competition or Laxity in High School and College Aged Athletes Improve KOOS, IKDC or Marx?

    PubMed Central

    Huston, Laura J.; Reinke, Emily; Kattan, Michael W.; Chagin, Kevin; Spindler, Kurt P.

    2016-01-01

    Objectives: Physicians’ and patients’ decision-making process between autograft hamstring (HG) vs. patellar tendon (BTB) for ACL reconstruction (ACLR) may be influenced by patient gender, laxity level, sport played, and/or competition level in the young, active athlete. ACLR specific to high school and college-aged athletes with these aforementioned factors in mind has not been evaluated. Therefore, our objectives were twofold: first, to develop a simple web-based risk calculator as a decision-making aid to provide the best estimate of expected 2-year KOOS, IKDC, and Marx outcomes by gender, sport, level of competition, and knee laxity. Second, to identify whether autograft HG or BTB is the optimal graft choice given any combination of the aforementioned variables. Methods: Our inclusion criteria in the MOON cohort were patients aged 11-22 who were injured in sport (football, soccer, basketball, other), who were due to have a unilateral primary ACLR with either an autograft HG or BTB, and who had a contralateral normal knee. Excluded were revisions, allografts, those with a contralateral ACLR and concomitant MCL/LCL/PCL surgery. Laxity was graded as increased (Lachman > 10 mm or a pivot lock) or normal based on the EUA. Our modeling controlled for BMI, ethnicity, and baseline measures of patient-reported outcomes. Our two year outcomes were the KOOS knee related quality of life subscale, KOOS sports and recreation subscale, IKDC, and Marx activity level. Our multivariable modeling for risk online calculator and nomograms was generated in two ways. The performances for our models were measured using R squared, calibration curves, and bootstrapping. Results: 937 patients were eligible, 809 (86%) had 2 year follow-up data. The average age was 17, with 50% females, and the distribution of HG to BTB was 301/508 respectively. First, in evaluating our models for ACLR autograft choice, neither KOOS subscale models performed better than chance. The IKDC and Marx models

  11. Arthroscopically assisted anterior cruciate ligament reconstruction with bone-patellar tendon-bone autograft without wound drainage: short- to middle-term outcome

    PubMed Central

    Witoński, Dariusz; Kęska, Rafał; Cyranowski, Rafał

    2016-01-01

    Introduction Several studies have suggested that anterior cruciate ligament reconstruction (ACLR) without wound drainage has no impact on long-term follow-up. Aim To investigate a prospective patient series as measured by the patient-administered disease-specific questionnaire Knee injury and Osteoarthritis Outcome Score (KOOS). Material and methods The study included 101 consecutive patients (71 men and 30 women) with a mean age of 30 years (SD 10, range: 15–62 years), who had undergone primary single incision arthroscopic bone-patellar tendon-bone autograft (BPTB) ACLR without wound drainage. All patients completed KOOS questionnaires, preoperatively and at a mean follow-up of 1.4 years (range: 0.4–3.4). Satisfactory clinical outcome (function recovery – FR) was defined as the lower threshold for the 95% CI of 18–34-year old males and corresponded to a KOOS score > 90 for Pain, 84 for Symptoms, 91 for Activities of Daily Living (ADL), 80 for Sports/Recreation, and 81 for Quality of Life (QOL). A non-satisfactory result was defined as treatment failure (TF) and corresponded to a QOL score < 44. Results All patients achieved 90° of knee flexion on the first postoperative day and full extension 2 weeks postoperatively. A full range of motion was achieved in less than 6 weeks postoperatively. No postoperative complications were reported. Score improvement at follow-up was observed in the KOOS subscales Pain, Symptoms and ADL. Criteria for FR were fulfilled by 52% of patients for Pain, 47% for Symptoms, 62% for ADL, 34% for Sports/Recreation and 15% for QOL, whereas criteria for TF were fulfilled by 29% of patients. Conclusions The study demonstrated that the primary ACLRs without wound drainage did not have any negative impact for patient-reported recovery. PMID:27458486

  12. Integrating Dimension Reduction and Out-of-Sample Extension in Automated Classification of Ex Vivo Human Patellar Cartilage on Phase Contrast X-Ray Computed Tomography

    PubMed Central

    Nagarajan, Mahesh B.; Coan, Paola; Huber, Markus B.; Diemoz, Paul C.; Wismüller, Axel

    2015-01-01

    Phase contrast X-ray computed tomography (PCI-CT) has been demonstrated as a novel imaging technique that can visualize human cartilage with high spatial resolution and soft tissue contrast. Different textural approaches have been previously investigated for characterizing chondrocyte organization on PCI-CT to enable classification of healthy and osteoarthritic cartilage. However, the large size of feature sets extracted in such studies motivates an investigation into algorithmic feature reduction for computing efficient feature representations without compromising their discriminatory power. For this purpose, geometrical feature sets derived from the scaling index method (SIM) were extracted from 1392 volumes of interest (VOI) annotated on PCI-CT images of ex vivo human patellar cartilage specimens. The extracted feature sets were subject to linear and non-linear dimension reduction techniques as well as feature selection based on evaluation of mutual information criteria. The reduced feature set was subsequently used in a machine learning task with support vector regression to classify VOIs as healthy or osteoarthritic; classification performance was evaluated using the area under the receiver-operating characteristic (ROC) curve (AUC). Our results show that the classification performance achieved by 9-D SIM-derived geometric feature sets (AUC: 0.96 ± 0.02) can be maintained with 2-D representations computed from both dimension reduction and feature selection (AUC values as high as 0.97 ± 0.02). Thus, such feature reduction techniques can offer a high degree of compaction to large feature sets extracted from PCI-CT images while maintaining their ability to characterize the underlying chondrocyte patterns. PMID:25710875

  13. Integrating dimension reduction and out-of-sample extension in automated classification of ex vivo human patellar cartilage on phase contrast X-ray computed tomography.

    PubMed

    Nagarajan, Mahesh B; Coan, Paola; Huber, Markus B; Diemoz, Paul C; Wismüller, Axel

    2015-01-01

    Phase contrast X-ray computed tomography (PCI-CT) has been demonstrated as a novel imaging technique that can visualize human cartilage with high spatial resolution and soft tissue contrast. Different textural approaches have been previously investigated for characterizing chondrocyte organization on PCI-CT to enable classification of healthy and osteoarthritic cartilage. However, the large size of feature sets extracted in such studies motivates an investigation into algorithmic feature reduction for computing efficient feature representations without compromising their discriminatory power. For this purpose, geometrical feature sets derived from the scaling index method (SIM) were extracted from 1392 volumes of interest (VOI) annotated on PCI-CT images of ex vivo human patellar cartilage specimens. The extracted feature sets were subject to linear and non-linear dimension reduction techniques as well as feature selection based on evaluation of mutual information criteria. The reduced feature set was subsequently used in a machine learning task with support vector regression to classify VOIs as healthy or osteoarthritic; classification performance was evaluated using the area under the receiver-operating characteristic (ROC) curve (AUC). Our results show that the classification performance achieved by 9-D SIM-derived geometric feature sets (AUC: 0.96 ± 0.02) can be maintained with 2-D representations computed from both dimension reduction and feature selection (AUC values as high as 0.97 ± 0.02). Thus, such feature reduction techniques can offer a high degree of compaction to large feature sets extracted from PCI-CT images while maintaining their ability to characterize the underlying chondrocyte patterns. PMID:25710875

  14. Secure fixation of femoral bone plug with a suspensory button in anatomical anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft

    PubMed Central

    TAKETOMI, SHUJI; INUI, HIROSHI; NAKAMURA, KENSUKE; YAMAGAMI, RYOTA; TAHARA, KEITARO; SANADA, TAKAKI; MASUDA, HIRONARI; TANAKA, SAKAE; NAKAGAWA, TAKUMI

    2015-01-01

    Purpose the efficacy and safety of using a suspensory button for femoral fixation in anatomical anterior cruciate ligament (ACL) reconstruction with bone-patellar tendon-bone (BPTB) graft have not been established. The purpose of the current study was to evaluate bone plug integration onto the femoral socket and migration of the bone plug and the EndoButton (EB) (Smith & Nephew, Andover, MA, USA) after rectangular tunnel ACL reconstruction with BPTB autograft. Methods thirty-four patients who underwent anatomical rectangular ACL reconstruction with BPTB graft using EB for femoral fixation and in whom three-dimensional (3D) computed tomography (CT) was performed one week and one year after surgery were included in this study. Bone plug integration onto the femoral socket, bone plug migration, soft tissue interposition, EB migration and EB rotation were evaluated on 3D CT. The clinical outcome was also assessed and correlated with the imaging outcomes. Results the bone plug was integrated onto the femoral socket in all cases. The incidence of bone plug migration, soft tissue interposition, EB migration and EB rotation was 15, 15, 9 and 56%, respectively. No significant association was observed between the imaging outcomes. The postoperative mean Lysholm score was 97.1 ± 5.0 points. The postoperative side-to-side difference, evaluated using a KT-2000 arthrometer, averaged 0.5 ± 1.3 mm. There were no complications associated with EB use. Imaging outcomes did not affect the postoperative KT side-to-side difference. Conclusions the EB is considered a reliable device for femoral fixation in anatomical rectangular tunnel ACL reconstruction with BPTB autograft. Level of evidence Level IV, therapeutic case series. PMID:26889465

  15. Sex-differences of the healthy infra-patellar (Hoffa) fat pad in relation to intermuscular and subcutaneous fat content--data from the Osteoarthritis Initiative.

    PubMed

    Diepold, J; Ruhdorfer, A; Dannhauer, T; Wirth, W; Steidle, E; Eckstein, F

    2015-07-01

    The infra-patellar fat pad (IPFP) is composed of intra-articular adipose tissue; it represents a potential source of pro-inflammatory cytokines and has been associated with osteoarthritis of the knee. Yet, to what extent the size of the IPFP differs between healthy men and women, and how sex differences compare to those in inter-muscular and subcutaneous fat tissue content is unknown. We studied healthy reference subjects from the Osteoarthritis Initiative, without knee pain, without radiographic signs or without risk factors of femorotibial osteoarthritis. Sagittal magnetic resonance images (MRIs) of 99 right knees were used to segment the IPFP; in a subset, axial images of the thigh were available to segment inter-muscular and subcutaneous fat. Healthy men (n=40) displayed a 41% greater (p<0.001) IPFP volume and a 9% greater (p<0.01) ratio of IPFP volume/body weight than women (n=59). Men (n=13) displayed 15% greater intermuscular fat content (not significant), and a 50% lesser (p<0.01) subcutaneous fat content than women (n=12); when related to total thigh cross-sectional areas, these sex differences were +2% (not significant) and -53% (p<0.001). This is the first study to explore quantitative measures of the IPFP in healthy men and women, and to relate these to sex differences of inter-muscular and subcutaneous fat tissue content. Men displayed a significantly greater ratio of IPFP volume/body weight than women, similar amounts of inter-muscular fat, and strikingly less subcutaneous fat. These data provide a basis for further systematic studies of the variability of the IPFP with the body mass index and its role in knee osteoarthritis. PMID:25723518

  16. Corrigendum.

    PubMed

    2016-07-01

    Dragoo JL, Wasterlain AS, Braun HJ, Nead KT. Platelet-rich plasma as a treatment for patellar tendinopathy: a double-blind, randomized controlled trial. Am J Sports Med. 2014;42(3):610-618. (Original DOI: 10.1177/0363546513518416). PMID:27371679

  17. What Causes Cardiomyopathy?

    MedlinePlus

    ... and can damage the organs, including the heart. Sarcoidosis : A disease that causes inflammation and can affect ... believe that an abnormal immune response may cause sarcoidosis. This abnormal response causes tiny lumps of cells ...

  18. Common Cause Failure Modeling

    NASA Technical Reports Server (NTRS)

    Hark, Frank; Britton, Paul; Ring, Robert; Novack, Steven

    2015-01-01

    Space Launch System (SLS) Agenda: Objective; Key Definitions; Calculating Common Cause; Examples; Defense against Common Cause; Impact of varied Common Cause Failure (CCF) and abortability; Response Surface for various CCF Beta; Takeaways.

  19. What Causes Pericarditis?

    MedlinePlus

    ... this page from the NHLBI on Twitter. What Causes Pericarditis? In many cases, the cause of pericarditis (both acute and chronic) is unknown. Viral infections are likely a common cause of pericarditis, although the virus may never be ...

  20. Uncommon causes of anterior knee pain: a case report of infrapatellar contracture syndrome.

    PubMed

    Ellen, M I; Jackson, H B; DiBiase, S J

    1999-01-01

    The uncommon causes of anterior knee pain should always be considered in the differential diagnosis of a painful knee when treatment of common origins become ineffective. A case is presented in which the revised diagnosis of infrapatellar contracture syndrome was made after noting delayed progress in the rehabilitation of an active female patient with a presumed anterior horn medial meniscus tear and a contracted patellar tendon. The patient improved after the treatment program was augmented with closed manipulation under arthroscopy and infrapatellar injection of both corticosteroids and a local anesthetic. Infrapatellar contraction syndrome and other uncommon sources of anterior knee pain, including arthrofibrosis, Hoffa's syndrome, tibial collateral ligament bursitis, saphenous nerve palsy, isolated ganglions of the anterior cruciate ligament, slipped capital femoral epiphysis, and knee tumors, are subsequently discussed. Delayed functional advancement in a rehabilitation program requires full reassessment of the patient's diagnosis and treatment plan. Alternative diagnoses of knee pain are not always of common origins. Ample knowledge of uncommon causes of anterior knee pain is necessary to form a full differential diagnosis in patients with challenging presentations. PMID:10418845

  1. Bilateral patellar tendon-bearing Symes-type prostheses in a severe case of Freeman-Sheldon syndrome in a 21-year-old woman presenting with uncorrectable equinovarus.

    PubMed

    McCormick, Rodger J; Poling, Mikaela I; Chamberlain, Robert L

    2015-01-01

    Described is the use of bilateral patellar tendon-bearing Symes-type prostheses in a severe case of Freeman-Sheldon syndrome (FSS) in a 21-year-old woman presenting with uncorrectable equinovarus and multiple surgical sequela of the lower extremities. FSS is considered a type of myopathic distal arthrogryposis; diagnosis requires the following: microstomia, whistling-face appearance, H-shaped chin dimpling, nasolabial folds, and multiple contractures of the hands and feet. Spinal deformities, metabolic and gastroenterological problems, other dysmorphic craniofacial characteristics, and visual and auditory impairments, are frequent findings. We highlight what we believe to be a unique approach to enhancing the patient's ability to ambulate and engage in physical activity, particularly critical determinates of wellness and long-term functional outcome in FSS, when the feet are non-correctable but not amputated. Important implications exist for physiatrists, other rehabilitation providers and surgeons regarding this likely under-diagnosed syndrome. PMID:26178231

  2. Prosthetic joint infection caused by Trueperella bernardiae.

    PubMed

    Gilarranz, Raul; Chamizo, Francisco; Horcajada, Iballa; Bordes-Benítez, Ana

    2016-09-01

    Trueperella bernardiae is a Gram-positive coryneform bacilli which role as human pathogen is unknown because it has been usually considered a contaminant. Furthermore its identification by biochemical test was difficult. We describe a prosthetic joint infection in a women who years ago underwent a total knee replacement with superinfection and necrosis of the patellar tendon as major complications. In the sample of synovial fluid collected grew a gram-positive bacilli which was identified by matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) as T. bernardiae. The patient was treated with ciprofloxacin and currently preserves the prosthesis without signs of infection. PMID:26964529

  3. Patellar subluxation. A recent history.

    PubMed

    Hughston, J C

    1989-04-01

    For 15 years (1955 to 1970), I was plowing "new ground" pretty much by myself. When you plow behind an old mule and hit a stump hole full of cottonmouth moccasins, you have to get on the move in a hurry and figure out some solution to the predicament or you won't get your corn planted. So, I was not treating the overweight, knock-kneed, loose-jointed, teenaged girl, but the young boy or girl who thought that he or she was an athlete and had dreams of being a star. If rehabilitation did not work, then I thought a lateral release, an Elmslie, and nothing short of a full reconstruction would solve the problem. One had to develop as much vastus medialis obliquus power as this dysplastic muscle could generate, had to transfer the strong vastus lateralis to a more central pull, and, with the distal reconstruction, correct any patella alta and Q-angle abnormality. One had to give the knee every possible advantage in order to serve an athlete. As Hippocrates so wisely noted, one needed to study the athlete to know, with appropriate modifications, what is best for every patient, young or old. In the late 1960s and early 1970s, many fine young orthopedists were stimulated by the information of the AAOS postgraduate courses in sports medicine. They, after having gained further through their own experiences, have become the major contributors to our increasing knowledge of the patellofemoral joint, especially in athletes, and many of these fine "young" (now a little older) orthopedists are now the contributors to this issue. They are giving you their experiences, knowledge, and lessons. A close and repeated study of their information must be combined with compassion for your patient. Then, only experience will develop the desired fine tuning. PMID:2752433

  4. Coracoid syndrome: a neglected cause of anterior shoulder pain

    PubMed Central

    GIGANTE, ANTONIO; BOTTEGONI, CARLO; BARBADORO, PAMELA

    2016-01-01

    Purpose the present prospective open-label study was designed to gain further insights into a condition thought to constitute a neglected but not uncommon syndrome characterized by anterior shoulder pain and tenderness to palpation over the apex of the coracoid process, not related to rotator cuff or pectoralis minor tendinopathy, long head of the biceps tendon disorders, or instability. The aim was to clarify its prevalence, clinical characteristics, differential diagnosis and response to corticosteroid injections. Methods patients with primary anterior shoulder pain precisely reproduced by deep pressure on the apex of the coracoid process were recruited. Patients with clinical or instrumental signs of other shoulder disorders were excluded. Patients were given an injection of triamcinolone acetonide 40 mg/ml 1 ml at the coracoid trigger point. They were evaluated after 15, 30 and 60 days and at 2 years using Equal Visual Analog Scale (EQ-VAS) and the Italian version of the Simple Shoulder Test (SST). Results between January 1 and December 31 2010, we treated 15 patients aged 26–66 years. The majority were women (86.67%). At 15 days, 6 (40%) patients reported complete resolution of their symptoms, while 9 (60%) complained of residual symptoms and received another injection. At 30 days, 14 (93.33%) patients were pain-free and very satisfied. At 2 years, the 14 patients who had been asymptomatic at 30 days reported that they had experienced no further pain or impaired shoulder function. The analysis of variance for repeated measures showed a significant effect of time on EQ-VAS and SST scores. Conclusions the present study documents the existence, and characteristics, of a “coracoid syndrome” characterized by anterior shoulder pain and tenderness to palpation over the apex of the coracoid process and showed that the pain is usually amenable to steroid treatment. This syndrome should be clearly distinguished from anterior shoulder pain due to other causes, in

  5. What Causes Anemia?

    MedlinePlus

    ... page from the NHLBI on Twitter. What Causes Anemia? The three main causes of anemia are: Blood ... the blood and can lead to anemia. Aplastic Anemia Some infants are born without the ability to ...

  6. What Causes Sarcoidosis?

    MedlinePlus

    ... page from the NHLBI on Twitter. What Causes Sarcoidosis? The cause of sarcoidosis isn't known. More ... Content: NEXT >> Featured Video Living With and Managing Sarcoidosis 05/18/2011 This video—presented by the ...

  7. What Causes Pulmonary Hypertension?

    MedlinePlus

    ... from the NHLBI on Twitter. What Causes Pulmonary Hypertension? Pulmonary hypertension (PH) begins with inflammation and changes in the ... different types of PH. Group 1 pulmonary arterial hypertension (PAH) may have no known cause, or the ...

  8. What Causes Atherosclerosis?

    MedlinePlus

    ... page from the NHLBI on Twitter. What Causes Atherosclerosis? The exact cause of atherosclerosis isn't known. ... Rate This Content: NEXT >> Featured Video What is atherosclerosis? 05/22/2014 Describes how the build-up ...

  9. What Causes Cystic Fibrosis?

    MedlinePlus

    ... What Causes Cystic Fibrosis? A defect in the CFTR gene causes cystic fibrosis (CF). This gene makes ... and very salty sweat. Research suggests that the CFTR protein also affects the body in other ways. ...

  10. What Causes Cancer?

    MedlinePlus

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  11. What Causes Polycythemia Vera?

    MedlinePlus

    ... this page from the NHLBI on Twitter. What Causes Polycythemia Vera? Primary Polycythemia Polycythemia vera (PV) also ... in the body's JAK2 gene is the main cause of PV. The JAK2 gene makes a protein ...

  12. What Causes Menstrual Irregularities?

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    ... menstrual flow Smoking Depression Never having given birth Endometriosis Chronic uterine infection Additional causes of menstrual irregularity include 1 : Endometriosis Endocrine gland-related causes Poorly controlled diabetes Polycystic ...

  13. What Causes Cardiogenic Shock?

    MedlinePlus

    ... page from the NHLBI on Twitter. What Causes Cardiogenic Shock? Immediate Causes Cardiogenic shock occurs if the heart suddenly can't pump ... to the body. The most common cause of cardiogenic shock is damage to the heart muscle from a ...

  14. Do Allergies Cause Asthma?

    MedlinePlus

    ... Help a Friend Who Cuts? Do Allergies Cause Asthma? KidsHealth > For Teens > Do Allergies Cause Asthma? Print A A A Text Size en español ¿Las alergias provocan asma? Do allergies cause asthma? The answer to that question is: yes and ...

  15. Causes and effects.

    PubMed

    Cone, Carol L; Feldman, Mark A; DaSilva, Alison T

    2003-07-01

    Most companies make charitable donations, but few approach their contributions with an eye toward enhancing their brands. Those that do take such an approach commit talent and know-how, not just dollars, to a pressing but carefully chosen social need and then tell the world about the cause and their service to it. Through the association, both the business and the cause benefit in ways they could not otherwise. Organizations such as Avon, ConAgra Foods, and Chevrolet have recognized that a sustained cause-branding program can improve their reputations, boost their employees' morale, strengthen relations with business partners, and drive sales. And the targeted causes receive far more money than they could have from direct corporate gifts alone. The authors examine these best practices and offer four principles for building successful cause-branding programs. First, they say, a company should select a cause that advances its corporate goals. That is, unless the competitive logic for supporting the cause is clear, a company shouldn't even consider putting its finite resources behind it. Second, a business should commit to a cause before picking its charitable partners. Otherwise, a cause-branding program may become too dependent on its partners. Third, a company should put all its assets to work, especially its employees. It should leverage the professional skills of its workers as well as its other assets such as distribution networks. And fourth, a company should promote its philanthropic initiatives through every possible channel. In addition to using the media, it should communicate its efforts through the Web, annual reports, direct mail, and so on. Cause branding is a way to turn the obligations of corporate citizenship into a valuable asset. When the cause is well chosen, the commitment genuine, and the program well executed, the cause helps the company, and the company helps the cause. PMID:12858714

  16. What Causes Angina?

    MedlinePlus

    ... blocks the arteries, reducing blood flow to the heart muscle. Some plaque is hard and stable and causes the arteries ... This can greatly reduce blood flow to the heart and cause angina. Other plaque is soft and more likely to rupture (break ...

  17. What Causes Bad Breath?

    MedlinePlus

    ... I Help a Friend Who Cuts? What Causes Bad Breath? KidsHealth > For Teens > What Causes Bad Breath? Print A A A Text Size en ... Qué es lo que provoca el mal aliento? Bad breath, or halitosis , can be a major problem, ...

  18. Arthroscopic anterior cruciate ligament surgery: results of autogenous patellar tendon graft versus the Leeds-Keio synthetic graft five year follow-up of a prospective randomised controlled trial.

    PubMed

    Ghalayini, S R A; Helm, A T; Bonshahi, A Y; Lavender, A; Johnson, D S; Smith, R B

    2010-10-01

    We conducted a prospective, randomised controlled trial comparing anterior cruciate ligament reconstruction using middle third patellar tendon graft (PT) to synthetic Leeds-Keio (LK) ligament. The patients were randomised (26 PT, 24 LK). Subjective knee function was classified (Lysholm, Tegner activity, IKDC scores), laxity was measured (Lachman test, Stryker laxometer), and functional ability was assessed (one-hop test). There were no significant differences between Lysholm or IKDC scores at any stage by 5 years. Significant differences were found between the groups at 2 years for Tegner activity scores, laxity and one-hop testing. By 5 years there were no significant differences. Clinical equivalence was demonstrated between the two groups for the Lysholm score and one-hop test but not for the Tegner activity score at 5 years. The use of the LK ligament has been largely abandoned due to reports of its insufficiency. Our results demonstrate that it is not as inferior as one might expect. We conclude that the results of LK ligament ACL reconstruction are as acceptable as those using PT. It may provide an additional means of reconstruction where no suitable alternative is present. PMID:19861236

  19. Leading Causes of Blindness

    MedlinePlus

    ... of this page please turn Javascript on. Feature: Vision Leading Causes of Blindness Past Issues / Winter 2012 ... of the lenses in your eyes. They affect vision and are very common in older people. More ...

  20. Dyslexia: Causes, Symptoms, Definition.

    ERIC Educational Resources Information Center

    Shannon, Albert J.

    1986-01-01

    The article reviews proposed causes and observable symptoms that characterize dyslexia, concluding that individualized analysis and specialized treatments are required and that, until an operational definition can be agreed upon, use of the label "dyslexia" is counterproductive. (DB)

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  2. What Causes Bronchitis?

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  5. What Causes Varicose Veins?

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  7. Causes of Ataxia

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  8. Causes of Paralysis

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  11. Leading Causes of Blindness

    MedlinePlus

    ... Navigation Bar Home Current Issue Past Issues Feature: Vision Leading Causes of Blindness Past Issues / Summer 2008 ... of the lenses in your eyes. They affect vision and are very common in older people. More ...

  12. What Causes Respiratory Failure?

    MedlinePlus

    ... easily move oxygen into your blood and remove carbon dioxide from your blood (gas exchange). This can cause a low oxygen level or high carbon dioxide level, or both, in your blood. Respiratory failure ...

  13. [Does vaccination cause disease?].

    PubMed

    Zingg, W

    2005-10-01

    Not many inventions in medical history have influenced our society as much as vaccination. The concept is old and simple. When Edward Jenner published his work on cowpox, "variolation" was quite common. In this procedure, pus of patients with mild smallpox was transferred to healthy individuals. Meanwhile smallpox has been eradicated worldwide. Diseases such as poliomyelitis, diphtheria or tetanus almost disappeared in industrialized countries. The same happened with epiglottitis and meningitis due to Haemophilus influenzae type b (Hib) after vaccination against Hib was introduced in Switzerland in 1990. This success was possible because of routine vaccination. Immunization is a save procedure and adverse events are much lower than complications in the natural course of the prevented diseases. However vaccinations were accused to cause diseases themselves such as asthma, multiple sclerosis, diabetes mellitus, chronic arthritis or autism. Hitherto no large cohort study or case-control-study was able to proof responsibility of vaccines in any of these diseases. Public media are eager to publish early data from surveillance reports or case reports which are descriptive and never a principle of cause and effect. In large controlled trials there was no proof that vaccination causes asthma, hepatitis-B-vaccination causes multiple sclerosis or macrophagic myofasciitis, Hib-vaccination causes diabetes mellitus, rubella-vaccination causes chronic arthritis, measles-mumps-rubella-vaccination causes gait disturbance or thiomersal causes autism. These results are rarely published in newspapers or television. Thus, many caring parents are left with negative ideas about immunization. Looking for the best for their children they withhold vaccination and give way to resurgence of preventable diseases in our communities. This must be prevented. There is more evidence than expected that vaccination is safe and this can and must be told to parents. PMID:16277033

  14. Secondary causes of dyslipidemia.

    PubMed

    Vodnala, Deepthi; Rubenfire, Melvyn; Brook, Robert D

    2012-09-15

    The causes of the lipid disorders in patients referred to specialty clinics for difficult-to-treat dyslipidemias are likely multifactorial. However, the importance of evaluating for secondary causes is unclear. The investigators performed a chart review of new patients referred to the University of Michigan Lipid Clinic from January 2004 to June 2011 (n = 824) to evaluate for the prevalence of several secondary causes of dyslipidemia. In addition to lipoproteins, new patients were assessed for secondary dyslipidemias by a standardized protocol consisting of laboratory testing, a nutritional evaluation, and medical history. These data were evaluated to determine the prevalence of several secondary causes of dyslipidemia. A total of 363 separate factors were identified in the 824 patients that were thought to be potential secondary causes of dyslipidemia. Because some patients (n = 83 [10%]) had multiple conditions, there were 230 (28% of the cohort) with ≥1 potential secondary dyslipidemias. The most common conditions were excessive alcohol intake (n = 82 [10%]), uncontrolled diabetes mellitus (n = 68 [8%]), and overt albuminuria. Although other causes occurred less frequently (each individually found in <5% of patients), altogether they were present in a substantial portion of patients (n = 102 [12%]). In conclusion, nearly 1/3 of patients referred to a specialty clinic had identifiable secondary conditions plausibly contributing to their dyslipidemia. Numerous disorders were identified, with diabetes mellitus and excessive alcohol being the most common. PMID:22658245

  15. Drying of open animal joints in vivo subsequently causes cartilage degeneration

    PubMed Central

    Paterson, S. I.; Eltawil, N. M.; Simpson, A. H. R. W.; Amin, A. K.

    2016-01-01

    Objectives During open orthopaedic surgery, joints may be exposed to air, potentially leading to cartilage drying and chondrocyte death, however, the long-term effects of joint drying in vivo are poorly understood. We used an animal model to investigate the subsequent effects of joint drying on cartilage and chondrocytes. Methods The patellar groove of anaesthetised rats was exposed (sham-operated), or exposed and then subjected to laminar airflow (0.25m/s; 60 minutes) before wounds were sutured and animals recovered. Animals were monitored for up to eight weeks and then sacrificed. Cartilage and chondrocyte properties were studied by histology and confocal microscopy, respectively. Results Joint drying caused extensive chondrocyte death within the superficial regions of cartilage. Histology of dried cartilage demonstrated a loss of surface integrity at four weeks, fibrillations at eight weeks, and an increased modified Mankin score (p < 0.001). Cartilage thickness increased (p < 0.001), whereas chondrocyte density decreased at four weeks (p < 0.001), but then increased towards sham-operated levels (p < 0.01) at eight weeks. By week eight, chondrocyte pairing/clustering and cell volume increased (p < 0.05; p < 0.001, respectively). Conclusions These in vivo results demonstrated for the first time that as a result of laminar airflow, cartilage degeneration occurred which has characteristics similar to those seen in early osteoarthritis. Maintenance of adequate cartilage hydration during open orthopaedic surgery is therefore of paramount importance. Cite this article: Dr A. Hall. Drying of open animal joints in vivo subsequently causes cartilage degeneration. Bone Joint Res 2016;5:137–144. DOI: 10.1302/2046-3758.54.2000594. PMID:27114348

  16. Rare causes of osteoporosis

    PubMed Central

    Marcucci, Gemma; Brandi, Maria Luisa

    2015-01-01

    Summary Osteoporosis is a metabolic bone disease characterized by loss of bone mass and strength, resulting in increased risk of fractures. It is classically divided into primary (post-menopausal or senile), secondary and idiopathic forms. There are many rare diseases, that cause directly or indirectly osteoporosis. The identification and classification of most of these rare causes of osteoporosis is crucial for the specialists in endocrinology and not, in order to prevent this bone complication and to provide for an early therapy. Several pathogenic mechanisms are involved, including various aspects of bone metabolism such as: decreased bone formation, increased bone resorption, altered calcium, phosphorus and/or vitamin D homeostasis, and abnormal collagen synthesis. In this review, less common forms of primary and secondary osteoporosis are described, specifying, if applicable: genetic causes, epidemiology, clinical features, and pathogenic mechanisms causing osteoporosis. A greater awareness of all rare causes of osteoporosis could reduce the number of cases classified as idiopathic osteoporosis and allow the introduction of appropriate and timely treatments. PMID:26604941

  17. Champions of a cause

    SciTech Connect

    McChesney, S.

    1995-03-01

    As customer choice becomes more and more of an issue, utilities are looking at ways to differentiate their company and service. This article describes one tactic - cause-related marketing - for building customer loyalty to the utility brand. As utilities focus on marketing and are less able to justify short-term philanthropy, cause-related marketing may help them at once meet a social need and create competitive advantage. It may even help break down the organizational boundaries that inhibit the communication, flexibility, and creativity needed to succeed in a competitive market. Successful utilities likely will have service packages that are customized for different groups of customers. One or several of those groups, for example, may respond particularly to the utility`s attitude to the community or a particular cause.

  18. Common Cause Failure Modes

    NASA Technical Reports Server (NTRS)

    Wetherholt, Jon; Heimann, Timothy J.; Anderson, Brenda

    2011-01-01

    High technology industries with high failure costs commonly use redundancy as a means to reduce risk. Redundant systems, whether similar or dissimilar, are susceptible to Common Cause Failures (CCF). CCF is not always considered in the design effort and, therefore, can be a major threat to success. There are several aspects to CCF which must be understood to perform an analysis which will find hidden issues that may negate redundancy. This paper will provide definition, types, a list of possible causes and some examples of CCF. Requirements and designs from NASA projects will be used in the paper as examples.

  19. What Causes Thyroid Cancer?

    MedlinePlus

    ... not yet known. Certain changes in a person’s DNA can cause thyroid cells to become cancerous. DNA is the chemical in each of our cells ... parents because they are the source of our DNA. But DNA affects more than just how we ...

  20. What Causes Rett Syndrome?

    MedlinePlus

    ... is caused by mutations in X-linked MECP2 . Nature Genetics , Oct;23(2), 185–188. [top] Schollen, ... 1581. Retrieved June 23, 2012, from http://www.nature.com/ejhg/journal/v17/n12/full/ejhg200995a.html [ ...

  1. [Myopathy caused by hypothyroidism].

    PubMed

    Paiva, C; Mouro, A M; Luís, M L; Fonseca, F; Quina, M

    1991-01-01

    The authors report a case of primary hypothyroidism where the main symptoms were caused by muscular lesions and disappeared after treatment with L-thyroxine. Based on this case study the authors then review both the clinical aspects and the diagnostical methods of hypothyroidism myopathy, noting its frequency, be it in terms of isolated laboratory changes or in terms of functional changes. PMID:1807095

  2. Landslides - Cause and effect

    USGS Publications Warehouse

    Radbruch-Hall, D. H.; Varnes, D.J.

    1976-01-01

    Landslides can cause seismic disturbances; landslides can also result from seismic disturbances, and earthquake-induced slides have caused loss of life in many countries. Slides can cause disastrous flooding, particularly when landslide dams across streams are breached, and flooding may trigger slides. Slope movement in general is a major process of the geologic environment that places constraints on engineering development. In order to understand and foresee both the causes and effects of slope movement, studies must be made on a regional scale, at individual sites, and in the laboratory. Areal studies - some embracing entire countries - have shown that certain geologic conditions on slopes facilitate landsliding; these conditions include intensely sheared rocks; poorly consolidated, fine-grained clastic rocks; hard fractured rocks underlain by less resistant rocks; or loose accumulations of fine-grained surface debris. Field investigations as well as mathematical- and physical-model studies are increasing our understanding of the mechanism of slope movement in fractured rock, and assist in arriving at practical solutions to landslide problems related to all kinds of land development for human use. Progressive failure of slopes has been studied in both soil and rock mechanics. New procedures have been developed to evaluate earthquake response of embankments and slopes. The finite element method of analysis is being extensively used in the calculation of slope stability in rock broken by joints, faults, and other discontinuities. ?? 1976 International Association of Engineering Geology.

  3. Teacher Dismissal for Cause

    ERIC Educational Resources Information Center

    Allison, Brad; Schumacher, Gary; Hammonds, Craig

    2013-01-01

    This case presents a discussion of events that led to the dismissal of a teacher for cause. A first year high school principal is confronted with teacher behavior that creates a dangerous situation for students. The decision process to determine the appropriate organizational response involves a number of individuals and systems. The…

  4. Anaphylaxis caused by banana.

    PubMed

    Savonius, B; Kanerva, L

    1993-04-01

    An anaphylactic reaction following ingestion of banana occurred in a 32-year-old female cook. The sensitization to banana occurred simultaneously with the development of occupational asthma caused by grain flour. The patient was sensitized to a wide range of airborne and ingestible proteins but not to rubber latex. PMID:8506993

  5. What Causes Rainbows?

    ERIC Educational Resources Information Center

    Beck, John

    2004-01-01

    If one looks at a rain cloud with the Sun behind one's back, the sunlight and water drops may interact just right, revealing the familiar arc of red, orange, yellow, green, blue, indigo, and violet. Many of people have been pleasantly surprised to see a rainbow in the sky, but probably have not considered why they occur. Rainbows are caused by…

  6. Common Cause Failure Modeling

    NASA Technical Reports Server (NTRS)

    Hark, Frank; Britton, Paul; Ring, Rob; Novack, Steven D.

    2015-01-01

    Common Cause Failures (CCFs) are a known and documented phenomenon that defeats system redundancy. CCFS are a set of dependent type of failures that can be caused by: system environments; manufacturing; transportation; storage; maintenance; and assembly, as examples. Since there are many factors that contribute to CCFs, the effects can be reduced, but they are difficult to eliminate entirely. Furthermore, failure databases sometimes fail to differentiate between independent and CCF (dependent) failure and data is limited, especially for launch vehicles. The Probabilistic Risk Assessment (PRA) of NASA's Safety and Mission Assurance Directorate at Marshall Space Flight Center (MFSC) is using generic data from the Nuclear Regulatory Commission's database of common cause failures at nuclear power plants to estimate CCF due to the lack of a more appropriate data source. There remains uncertainty in the actual magnitude of the common cause risk estimates for different systems at this stage of the design. Given the limited data about launch vehicle CCF and that launch vehicles are a highly redundant system by design, it is important to make design decisions to account for a range of values for independent and CCFs. When investigating the design of the one-out-of-two component redundant system for launch vehicles, a response surface was constructed to represent the impact of the independent failure rate versus a common cause beta factor effect on a system's failure probability. This presentation will define a CCF and review estimation calculations. It gives a summary of reduction methodologies and a review of examples of historical CCFs. Finally, it presents the response surface and discusses the results of the different CCFs on the reliability of a one-out-of-two system.

  7. Common Cause Failure Modeling

    NASA Technical Reports Server (NTRS)

    Hark, Frank; Britton, Paul; Ring, Rob; Novack, Steven D.

    2016-01-01

    Common Cause Failures (CCFs) are a known and documented phenomenon that defeats system redundancy. CCFS are a set of dependent type of failures that can be caused by: system environments; manufacturing; transportation; storage; maintenance; and assembly, as examples. Since there are many factors that contribute to CCFs, the effects can be reduced, but they are difficult to eliminate entirely. Furthermore, failure databases sometimes fail to differentiate between independent and CCF (dependent) failure and data is limited, especially for launch vehicles. The Probabilistic Risk Assessment (PRA) of NASA's Safety and Mission Assurance Directorate at Marshal Space Flight Center (MFSC) is using generic data from the Nuclear Regulatory Commission's database of common cause failures at nuclear power plants to estimate CCF due to the lack of a more appropriate data source. There remains uncertainty in the actual magnitude of the common cause risk estimates for different systems at this stage of the design. Given the limited data about launch vehicle CCF and that launch vehicles are a highly redundant system by design, it is important to make design decisions to account for a range of values for independent and CCFs. When investigating the design of the one-out-of-two component redundant system for launch vehicles, a response surface was constructed to represent the impact of the independent failure rate versus a common cause beta factor effect on a system's failure probability. This presentation will define a CCF and review estimation calculations. It gives a summary of reduction methodologies and a review of examples of historical CCFs. Finally, it presents the response surface and discusses the results of the different CCFs on the reliability of a one-out-of-two system.

  8. 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

  9. Atypical causes of cholestasis

    PubMed Central

    Nguyen, Ken D; Sundaram, Vinay; Ayoub, Walid S

    2014-01-01

    Cholestatic liver disease consists of a variety of disorders. Primary sclerosing cholangitis and primary biliary cirrhosis are the most commonly recognized cholestatic liver disease in the adult population, while biliary atresia and Alagille syndrome are commonly recognized in the pediatric population. In infants, the causes are usually congenital or inherited. Even though jaundice is a hallmark of cholestasis, it is not always seen in adult patients with chronic liver disease. Patients can have “silent” progressive cholestatic liver disease for years prior to development of symptoms such as jaundice and pruritus. In this review, we will discuss some of the atypical causes of cholestatic liver disease such as benign recurrent intrahepatic cholestasis, progressive familial intrahepatic cholestasis, Alagille Syndrome, biliary atresia, total parenteral nutrition induced cholestasis and cholestasis secondary to drug induced liver injury. PMID:25071336

  10. Particles causing lung disease

    SciTech Connect

    Kilburn, K.H.

    1984-04-01

    The lung has a limited number of patterns of reaction to inhaled particles. The disease observed depends upon the location: conducting airways, terminal bronchioles and alveoli, and upon the nature of inflammation induced: acute, subacute or chronic. Many different agents cause narrowing of conducting airways (asthma) and some of these cause permanent distortion or obliteration of airways as well. Terminal bronchioles appear to be particularly susceptible to particles which cause goblet cell metaplasia, mucous plugging and ultimately peribronchiolar fibrosis. Cancer is the last outcome at the bronchial level and appears to depend upon continuous exposure to or retention of an agent in the airway and failure of the affected cells to be exfoliated which may be due to squamous metaplasia. Alveoli are populated by endothelial cells, Type I or pavement epithelial cells and metabolically active cuboidal Type II cells that produce the lungs specific surfactant, dipalmytol lecithin. Disturbances of surfactant lead to edema in distal lung while laryngeal edema due to anaphylaxis or fumes may produce asphyxia. Physical retention of indigestible particles or retention by immune memory responses may provoke hyaline membranes, stimulate alveolar lipoproteinosis and finally fibrosis. This later exuberant deposition of connective tissue has been best studied in the occupational pneumoconioses especially silicosis and asbestosis. In contrast emphysema a catabolic response appears frequently to result from leakage or release of lysosomal proteases into the lung during processing of cigarette smoke particles. 164 references, 1 figure, 2 tables.

  11. Ischemia causes muscle fatigue.

    PubMed

    Murthy, G; Hargens, A R; Lehman, S; Rempel, D M

    2001-05-01

    The purpose of this investigation was to determine whether ischemia, which reduces oxygenation in the extensor carpi radialis (ECR) muscle, causes a reduction in muscle force production. In eight subjects, muscle oxygenation (TO2) of the right ECR was measured noninvasively and continuously using near infrared spectroscopy (NIRS) while muscle twitch force was elicited by transcutaneous electrical stimulation (1 Hz, 0.1 ms). Baseline measurements of blood volume, muscle oxygenation and twitch force were recorded continuously, then a tourniquet on the upper arm was inflated to one of five different pressure levels: 20, 40, 60 mm Hg (randomized order) and diastolic (69 +/- 9.8 mm Hg) and systolic (106 +/- 12.8 mm Hg) blood pressures. Each pressure level was maintained for 3-5 min, and was followed by a recovery period sufficient to allow measurements to return to baseline. For each respective tourniquet pressure level, mean TO2 decreased from resting baseline (100% TO2) to 99 +/- 1.2% (SEM), 96 +/- 1.9%, 93 +/- 2.8%, 90 +/- 2.5%, and 86 +/- 2.7%, and mean twitch force decreased from resting baseline (100% force) to 99 +/- 0.7% (SEM), 96 +/- 2.7%, 93 +/- 3.1%, 88 +/- 3.2%, and 86 +/- 2.6%. Muscle oxygenation and twitch force at 60 mm Hg tourniquet compression and above were significantly lower (P < 0.05) than baseline value. Reduced twitch force was correlated in a dose-dependent manner with reduced muscle oxygenation (r = 0.78, P < 0.001). Although the correlation does not prove causation, the results indicate that ischemia leading to a 7% or greater reduction in muscle oxygenation causes decreased muscle force production in the forearm extensor muscle. Thus, ischemia associated with a modest decline in TO2 causes muscle fatigue. PMID:11398857

  12. Particles causing lung disease.

    PubMed Central

    Kilburn, K H

    1984-01-01

    The lung has a limited number of patterns of reaction to inhaled particles. The disease observed depends upon the location: conducting airways, terminal bronchioles and alveoli, and upon the nature of inflammation induced: acute, subacute or chronic. Many different agents cause narrowing of conducting airways (asthma) and some of these cause permanent distortion or obliteration of airways as well. Terminal bronchioles appear to be particularly susceptible to particles which cause goblet cell metaplasia, mucous plugging and ultimately peribronchiolar fibrosis. Cancer is the last outcome at the bronchial level and appears to depend upon continuous exposure to or retention of an agent in the airway and failure of the affected cells to be exfoliated which may be due to squamous metaplasia. Alveoli are populated by endothelial cells, Type I or pavement epithelial cells and metabolically active cuboidal Type II cells that produce the lungs specific surfactant, dipalmytol lecithin. Disturbances of surfactant lead to edema in distal lung while laryngeal edema due to anaphylaxis or fumes may produce asphyxia. Physical retention of indigestible particles or retention by immune memory responses may provoke hyaline membranes, stimulate alveolar lipoproteinosis and finally fibrosis. This later exuberant deposition of connective tissue has been best studied in the occupational pneumoconioses especially silicosis and asbestosis. In contrast emphysema a catabolic response, appears frequently to result from leakage or release of lysosomal proteases into the lung during processing of cigarette smoke particles. The insidious and probably most important human lung disease due to particles is bronchiolar obstruction and obliteration, producing progressive impairment of air flow. The responsible particle is the complex combination of poorly digestive lipids and complex carbohydrates with active chemicals which we call cigarette smoke. More research is needed to perfect, correct and

  13. Ischemia causes muscle fatigue

    NASA Technical Reports Server (NTRS)

    Murthy, G.; Hargens, A. R.; Lehman, S.; Rempel, D. M.

    2001-01-01

    The purpose of this investigation was to determine whether ischemia, which reduces oxygenation in the extensor carpi radialis (ECR) muscle, causes a reduction in muscle force production. In eight subjects, muscle oxygenation (TO2) of the right ECR was measured noninvasively and continuously using near infrared spectroscopy (NIRS) while muscle twitch force was elicited by transcutaneous electrical stimulation (1 Hz, 0.1 ms). Baseline measurements of blood volume, muscle oxygenation and twitch force were recorded continuously, then a tourniquet on the upper arm was inflated to one of five different pressure levels: 20, 40, 60 mm Hg (randomized order) and diastolic (69 +/- 9.8 mm Hg) and systolic (106 +/- 12.8 mm Hg) blood pressures. Each pressure level was maintained for 3-5 min, and was followed by a recovery period sufficient to allow measurements to return to baseline. For each respective tourniquet pressure level, mean TO2 decreased from resting baseline (100% TO2) to 99 +/- 1.2% (SEM), 96 +/- 1.9%, 93 +/- 2.8%, 90 +/- 2.5%, and 86 +/- 2.7%, and mean twitch force decreased from resting baseline (100% force) to 99 +/- 0.7% (SEM), 96 +/- 2.7%, 93 +/- 3.1%, 88 +/- 3.2%, and 86 +/- 2.6%. Muscle oxygenation and twitch force at 60 mm Hg tourniquet compression and above were significantly lower (P < 0.05) than baseline value. Reduced twitch force was correlated in a dose-dependent manner with reduced muscle oxygenation (r = 0.78, P < 0.001). Although the correlation does not prove causation, the results indicate that ischemia leading to a 7% or greater reduction in muscle oxygenation causes decreased muscle force production in the forearm extensor muscle. Thus, ischemia associated with a modest decline in TO2 causes muscle fatigue.

  14. Pharmacological causes of hyperprolactinemia

    PubMed Central

    Torre, Daria La; Falorni, Alberto

    2007-01-01

    Hyperprolactinemia is a common endocrinological disorder that may be caused by several physiological and pathological conditions. Several drugs may determine a significant increase in prolactin serum concentration that is frequently associated with symptoms. The so-called typical antipsychotics are frequently responsible for drug-related hyperprolactinemia. Risperidone is one of the atypical neuroleptics most likely to induce hyperprolactinemia, while other atypical drugs are unfrequenlty and only transiently associated with increase of prolactin levels. Women are more sensitive than men to the hyperprolactinemic effect of antipsychotics. Classical and risperidone-induced hyperprolactinemia may be revert when a gradual antipsychotic drug discontinuation is combined with olanzapine or clozapine initiation. Antidepressant drugs with serotoninergic activity, including selective serotonin reuptake inhibitors (SSRI), monoamine oxidase inhibitors (MAO-I) and some tricyclics, can cause hyperprolactinemia. A long list of other compounds may determine an increase in prolactin levels, including prokinetics, opiates, estrogens, anti-androgens, anti-hypertensive drugs, H2-receptor antagonists, anti-convulsivants and cholinomimetics. Finally, hyperprolactinemia has also been documented during conditioning and after autologous blood stem-cell transplantation and during chemotherapy, even though disturbances of prolactin seem to occur less frequently than impairments of the hypothalamus-pituitary-gonad/thyroid axis after intensive treatment and blood marrow transplantation. PMID:18473017

  15. Biceps Tendinitis or Tendinopathy (Beyond the Basics)

    MedlinePlus

    ... with your fingertips. Starting with the arms outstretched, parallel to the floor, walk the fingers up and ... only by loading the software on a single computer (i.e., within a single CPU) at a ...

  16. Imaging of rectus femoris proximal tendinopathies.

    PubMed

    Pesquer, Lionel; Poussange, Nicolas; Sonnery-Cottet, Bertrand; Graveleau, Nicolas; Meyer, Philippe; Dallaudiere, Benjamin; Feldis, Matthieu

    2016-07-01

    The rectus femoris is the most commonly injured muscle of the anterior thigh among athletes, especially soccer players. Although the injury pattern of the muscle belly is well documented, less is known about the anatomy and specific lesions of the proximal tendons. For each head, three distinctive patterns may be encountered according to the location of the injury, which can be at the enthesis, within the tendon, or at the musculotendinous junction. In children, injuries correspond most commonly to avulsion of the anteroinferior iliac spine from the direct head and can lead to subspine impingement. Calcific tendinitis and traumatic tears may be encountered in adults. Recent studies have shown that traumatic injuries of the indirect head may be underdiagnosed and that injuries of both heads may have a surgical issue. Finally, in the case of tears, functional outcome and treatment may vary if the rupture involves one or both tendons and if the tear is partial or complete. Thus, it is mandatory for the radiologist to know the different ultrasound and magnetic resonance imaging (MRI) patterns of these lesions in order to provide accurate diagnosis and treatment. The purpose of this article is to recall the anatomy of the two heads of rectus femoris, describe a reliable method of assessment with ultrasound and MRI and know the main injury patterns, through our own experience and literature review. PMID:26956398

  17. Methanol shutdowns cause anxiety

    SciTech Connect

    Thomas, N.

    1996-10-23

    European methanol players face an anxious few weeks as unscheduled outages combine with planned turnarounds to make an increasingly tight market. Global markets are also described as tightening, with production problems widely reported in North America. Several European producers were in the middle of shutdown periods when problems at Condea`s 400,000-m.t./year unit at Wesseling, Germany reportedly caused production to run at only 50% of capacity. In addition, the methanol plant at the Leuna refinery is said to be operating at only 60% of capacity, and one producer has had to extend a turnaround period. River levels in Germany are also low, putting pressure on shipments from Rotterdam. {open_quotes}This is a very difficult situation and we`re living hand to mouth,{close_quotes} says one producer. Producer sources report bids from consumers up to DM280/m.t. T2 fob Rotterdam, but they are unable to obtain extra product. Derivatives makers may also face problems: One methyl tert-butyl ether producer predicts prices {open_quotes}may hit the roof{close_quotes} once feedstock sourcing problems hit home.

  18. Burns caused by carburetors.

    PubMed

    Still, Joseph; Law, Edward; Orlet, Hermann; Wilson, Joan

    2003-01-01

    During a 10-year period 4645 patients were admitted to the Joseph M. Still Burn Center with acute burns. Of these, 83 (1.79%) were caused by carburetor-related accidents. There were 79 males and 4 females. Ages ranged from 10 to 72 years. Burn size ranged from 1 to 97.5% (mean, 12.3%). There was one death in the group. Eighteen patients required only topical care; 65 patients required a total of 108 operations for debridement and grafting. Length of stay ranged from 1 to 63 days (mean, 11 days). The mechanism of injury was usually the same; in 81 cases the accident occurred while someone was pouring gasoline into a carburetor. In 63 cases the vehicle was an automobile or pickup truck. Explosions resulted in 12 instances; in 65 instances fires were started. These injuries are serious, expensive, fairly common, and may be life threatening. Proper handling of gasoline is stressed. Newer vehicles have fuel injector systems, which may gradually eliminate the problem over time, because pouring gasoline is not required. PMID:12543992

  19. [Relapse: causes and consequences].

    PubMed

    Thomas, P

    2013-09-01

    Relapse after a first episode of schizophrenia is the recurrence of acute symptoms after a period of partial or complete remission. Due to its variable aspects, there is no operational definition of relapse able to modelise the outcome of schizophrenia and measure how the treatment modifies the disease. Follow-up studies based on proxys such as hospital admission revealed that 7 of 10 patients relapsed after a first episode of schizophrenia. The effectiveness of antipsychotic medications on relapse prevention has been widely demonstrated. Recent studies claim for the advantages of atypical over first generation antipsychotic medication. Non-adherence to antipsychotic represents with addictions the main causes of relapse long before some non-consensual factors such as premorbid functioning, duration of untreated psychosis and associated personality disorders. The consequences of relapse are multiple, psychological, biological and social. Pharmaco-clinical studies have demonstrated that the treatment response decreases with each relapse. Relapse, even the first one, will contribute to worsen the outcome of the disease and reduce the capacity in general functionning. Accepting the idea of continuing treatment is a complex decision in which the psychiatrist plays a central role besides patients and their families. The development of integrated actions on modifiable risk factors such as psychosocial support, addictive comorbidities, access to care and the therapeutic alliance should be promoted. Relapse prevention is a major goal of the treatment of first-episode schizophrenia. It is based on adherence to the maintenance treatment, identification of prodromes, family active information and patient therapeutical education. PMID:24084426

  20. Strategies for the prevention of volleyball related injuries

    PubMed Central

    Reeser, J C; Verhagen, E; Briner, W W; Askeland, T I; Bahr, R

    2006-01-01

    Although the overall injury rate in volleyball and beach volleyball is relatively low compared with other team sports, injuries do occur in a discipline specific pattern. Epidemiological research has revealed that volleyball athletes are, in general, at greatest risk of acute ankle injuries and overuse conditions of the knee and shoulder. This structured review discusses both the known and suspected risk factors and potential strategies for preventing the most common volleyball related injuries: ankle sprains, patellar tendinopathy, and shoulder overuse. PMID:16799111

  1. Strategies for the prevention of volleyball related injuries.

    PubMed

    Reeser, J C; Verhagen, E; Briner, W W; Askeland, T I; Bahr, R

    2006-07-01

    Although the overall injury rate in volleyball and beach volleyball is relatively low compared with other team sports, injuries do occur in a discipline specific pattern. Epidemiological research has revealed that volleyball athletes are, in general, at greatest risk of acute ankle injuries and overuse conditions of the knee and shoulder. This structured review discusses both the known and suspected risk factors and potential strategies for preventing the most common volleyball related injuries: ankle sprains, patellar tendinopathy, and shoulder overuse. PMID:16799111

  2. Causes for "ghost" manifolds

    NASA Astrophysics Data System (ADS)

    Borok, S.; Goldfarb, I.; Gol'dshtein, V.

    2009-05-01

    ;71:359-82; Flockerzi D. Tutorial: intrinsic low-dimensional manifolds and slow attractors. Magdeburg: Max-Planck-Institut; 2001-2005. ; Flockerzi D, Heineken W. Comment on "Identification of low order manifolds: validating the algorithm of Maas and Pope". Chaos 1999;9:108-23; Flockerzi D, Heineken W. Comment on "Identification of low order manifolds: validating the algorithm of Maas and Pope". Chaos 2006;16:048101]. The present work studies the causes for the "ghost" manifolds appearance for the case of a two-dimensional singularly perturbed system.

  3. Drugs that may cause impotence

    MedlinePlus

    Impotence caused by medications; Drug-induced erectile dysfunction; Prescription medicines and impotence ... Many medicines and recreational drugs can affect a man's sexual arousal and sexual performance. What causes impotence in one ...

  4. Drugs that may cause impotence

    MedlinePlus

    Impotence caused by medications; Drug-induced erectile dysfunction; Prescription medicines and impotence ... Many medicines and recreational drugs can affect a man's sexual ... What causes impotence in one man may not affect another man. ...

  5. Causes of chronic bronchitis (image)

    MedlinePlus

    ... is caused most often by exposure to airborne pollutants such as cigarette smoke, excessive dust in the ... becomes inflamed and the constant exposure to such pollutants begins to cause damage in the bronchioles (the ...

  6. What Causes Sickle Cell Disease?

    MedlinePlus

    ... from the NHLBI on Twitter. What Causes Sickle Cell Disease? Abnormal hemoglobin, called hemoglobin S , causes sickle cell ... that hemoglobin works. ( See Overview. ) How Is Sickle Cell Disease Inherited? When the hemoglobin S gene is inherited ...

  7. What Causes Coronary Microvascular Disease?

    MedlinePlus

    ... Living With Clinical Trials Links Related Topics Angina Atherosclerosis Coronary Heart Disease Coronary Heart Disease Risk Factors ... Microvascular Disease? The same risk factors that cause atherosclerosis may cause coronary microvascular disease. Atherosclerosis is a ...

  8. Other Causes of Leg Pain

    MedlinePlus

    ... Past Issues Special Section Other Causes of Leg Pain Past Issues / Summer 2008 Table of Contents For ... a crowd of people walking. Photo: iStock Leg pain can come from a variety of causes. Your ...

  9. Endocrine causes of calcium disorders.

    PubMed

    Greco, Deborah S

    2012-11-01

    Endocrine diseases that may cause hypercalcemia and hypocalcemia include hyperparathyroidism, hypoparathyroidism, thyroid disorders, hyperadrenocorticism, hypoadrenocorticism, and less commonly pheochromocytoma and multiple endocrine neoplasias. The differential diagnosis of hypercalcemia may include malignancy (lymphoma, anal sac carcinoma, and squamous cell carcinoma), hyperparathyroidism, vitamin D intoxication, chronic renal disease, hypoadrenocorticism, granulomatous disorders, osteolysis, or spurious causes. Hypocalcemia may be caused by puerperal tetany, pancreatitis, intestinal malabsorption, ethlyene glycol intoxication, acute renal failure, hypopararthyroidism, hypovitaminosis D, hypomagnesemia, and low albumin. This article focuses on the endocrine causes of calcium imbalance and provides diagnostic and therapeutic guidelines for identifying the cause of hypercalcemia and hypocalcemia in veterinary patients. PMID:23415381

  10. System Safety Common Cause Analysis

    Energy Science and Technology Software Center (ESTSC)

    1992-03-10

    The COMCAN fault tree analysis codes are designed to analyze complex systems such as nuclear plants for common causes of failure. A common cause event, or common mode failure, is a secondary cause that could contribute to the failure of more than one component and violates the assumption of independence. Analysis of such events is an integral part of system reliability and safety analysis. A significant common cause event is a secondary cause common tomore » all basic events in one or more minimal cut sets. Minimal cut sets containing events from components sharing a common location or a common link are called common cause candidates. Components share a common location if no barrier insulates any one of them from the secondary cause. A common link is a dependency among components which cannot be removed by a physical barrier (e.g.,a common energy source or common maintenance instructions).« less

  11. Windsurfing hazard caused by needlefish.

    PubMed

    Rouvillain, J L; Donica, A; Gane, C; Zekhnini, C; Garron, E; Uzel, A P

    2013-11-01

    Very amusing and entertaining for the traveler, marine activities in tropical countries can be dangerous. More and more trauma caused by hazardous marine animals have been reported in recent years in the world, after maritime accidents including water sports like windsurfing, kite surfing, swimming, diving, and injuries caused by sting or contact with a marine animal. Rays and stone-fish frequently cause trauma, but there are not many cases of injury by needlefish. This case reports a case of penetrating wound of the left foot caused by a Caribbean needlefish occurred during a session of windsurfing in Martinique. PMID:23412165

  12. Covering Causes of Social Upheaval.

    ERIC Educational Resources Information Center

    Martindale, Carolyn

    Noting that not much research has addressed critics' observations that the press devotes little attention to the underlying causes of social protest and upheaval, a study was conducted to examine five newspapers' coverage of civil rights protests--and their causes--during the 1960s. Four leading newspapers from different geographical areas--the…

  13. Deaths: Leading Causes for 2014.

    PubMed

    Heron, Melonie

    2016-06-01

    Objectives-This report presents final 2014 data on the 10 leading causes of death in the United States by age, sex, race, and Hispanic origin. Leading causes of infant, neonatal, and postneonatal death are also presented. This report supplements "Deaths: Final Data for 2014," the National Center for Health Statistics' annual report of final mortality statistics. PMID:27376998

  14. Keratomycosis caused by Cylindrocarpon lichenicola.

    PubMed

    Mangiaterra, M; Giusiano, G; Smilasky, G; Zamar, L; Amado, G; Vincentín, C

    2001-02-01

    We present a case of keratomycosis caused by Cylindrocarpon lichenicola in a 30-year-old immunocompetent male patient living in a rural area of Formosa Province (north-eastern Argentina). No ocular trauma is reported in his case history. There are no previous reports of infections caused by this fungus in Argentina. PMID:11270403

  15. Bacteremia caused by Desulfovibrio fairfieldensis.

    PubMed

    Urata, Teruo; Kikuchi, Mitsuru; Hino, Taro; Yoda, Yusuke; Tamai, Kiyoko; Kodaira, Yoshiya; Hitomi, Shigemi

    2008-10-01

    Desulfovibrio species are anaerobic gram-negative, pleomorphic bacilli rarely causing infection in humans. In the present report, we describe a case of bacteremia caused by Desulfovibrio fairfieldensis. The patient, for whom biapenem was administered, rapidly improved without any sequelae. As far as we know, this is the first case report of infection by Desulfovibrio species in Japan. PMID:18936890

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

    MedlinePlus

    ... regularly play sports that involve a lot of repetitive jumping — like track and field (particularly high-jumping), basketball, volleyball, gymnastics, running, and soccer — can put a lot of strain on their knees. Jumper's knee can seem like a minor injury that isn't really that serious. Because of ...

  17. Patellar nomenclature: the Tower of Babel revisited.

    PubMed

    Grelsamer, Ronald P

    2005-07-01

    Because we communicate mainly through words, it is important that terms be understood in the same manner by all readers. Unfortunately, the study of the patellofemoral joint is complicated by the use of expressions that hold different meanings for different readers. Ideally, the community of musculoskeletal physicians should agree on a single definition of terms, but until then, authors and speakers should define their terms clearly. Some terms, such as chondromalacia and patellofemoral syndrome, should be abandoned altogether. I propose a glossary of confusing terms pertaining to the patellofemoral joint, the various interpretations of these terms, and possible resolutions of these conflicts. Words and terms included in this review include chondromalacia, patellofemoral syndrome, anterior knee pain, subluxation, malalignment, proximal realignment, Roux procedure, and "normal." PMID:15995421

  18. Acoustic trauma caused by lightning.

    PubMed

    Mora-Magaña, I; Collado-Corona, M A; Toral-Martiñòn, R; Cano, A

    1996-03-01

    Lesions produced by exposure to noise are frequent in everyday life. Injuries may be found in all systems of the human body, from the digestive to the endocrine, from the cardiovascular to the nervous system. Many organs may be damaged, the ear being one of them. It is known that noise produced by factories, airports, musical instruments and even toys can cause auditory loss. Noises in nature can also cause acoustic trauma. This report is the case history of acoustic trauma caused by lightning. The patient was studied with CAT scan, electroencephalogram, and brain mapping, impedance audiometry with tympanogram and acoustic reflex, audiometry and evoked otoacoustics emissions: distortion products and transients. PMID:8882110

  19. Meningococcal Disease: Causes and Transmission

    MedlinePlus

    ... Vaccine Campaign Podcast: Meningitis Immunization for Adolescents Meningitis Sepsis Causes & Transmission Recommend on Facebook Tweet Share Compartir ... Vaccine Campaign Podcast: Meningitis Immunization for Adolescents Meningitis Sepsis File Formats Help: How do I view different ...

  20. Causes of secondary headache (image)

    MedlinePlus

    Temporomandibular joint, or TMJ, dysfunction, can be a cause of secondary headache. Secondary headaches result from underlying disorders which produce pain as a symptom. The TMJ may become painful and dysfunctional as a result ...

  1. What Causes Sudden Cardiac Arrest?

    MedlinePlus

    ... a few minutes. Other problems with the heart's electrical system also can cause SCA. For example, SCA can occur if the rate of the heart's electrical signals becomes very slow and stops. SCA also ...

  2. Onychomycosis caused by Fusarium proliferatum.

    PubMed

    Hattori, N; Shirai, A; Sugiura, Y; Li, W; Yokoyama, K; Misawa, Y; Okuzumi, K; Tamaki, K

    2005-09-01

    Fusarium infections in humans are usually opportunistic, but the fungus sometimes infects healthy persons, causing keratomycosis or onychomycosis. Onychomycosis is usually caused by F. solani or F. oxysporum. We report the first two cases of onychomycosis caused by F. proliferatum, and discuss methods of diagnosis and effective treatment. Nail samples from the two patients were examined by direct microscopy, cultured, and identified morphologically and genetically as F. proliferatum. Both patients were treated successfully with oral itraconazole, even though the minimum inhibitory concentration of itraconazole was relatively high in Patient 1. This is the first report of F. proliferatum as an agent of onychomycosis. Itraconazole may be effective in the treatment of onychomycosis caused by F. proliferatum. PMID:16120158

  3. What Causes Thrombocythemia and Thrombocytosis?

    MedlinePlus

    ... Causes Who Is at Risk Signs & Symptoms Diagnosis Treatments Prevention Living With Clinical Trials Links Related Topics Hemolytic Anemia Iron-Deficiency Anemia Stroke Von Willebrand Disease Send a link ...

  4. What Causes High Blood Pressure?

    MedlinePlus

    ... page from the NHLBI on Twitter. Causes of High Blood Pressure Changes, either from genes or the environment, in ... and blood vessel structure and function. Biology and High Blood Pressure Researchers continue to study how various changes in ...

  5. Dementia due to metabolic causes

    MedlinePlus

    ... may cause confusion and changes in thinking or reasoning. These changes may be short-term or lasting. ... Jankovic J, Mazziotta JC, eds. Bradley's Neurology in Clinical Practice. 6th ed. Philadelphia, Pa: Elsevier Saunders; 2012: ...

  6. Chronic Fatigue Syndrome (CFS): Causes

    MedlinePlus

    ... Ross River Fever, a mosquito-borne tropical disease Coxiella burnetti , the agent that causes Q fever Human ... with Epstein-Barr virus, Ross River virus, and Coxiella burnetti will lead to a post-infective condition ...

  7. Endometriosis: Does It Cause Infertility?

    MedlinePlus

    ... Website of the American Society for Reproductive Medicine Endometriosis: Does It Cause Infertility? This fact sheet was ... with The Society of Reproductive Surgeons What is endometriosis? When tissue like the tissue that normally lines ...

  8. What Causes Thrombotic Thrombocytopenic Purpura?

    MedlinePlus

    ... the NHLBI on Twitter. What Causes Thrombotic Thrombocytopenic Purpura? A lack of activity in the ADAMTS13 enzyme ( ... This leads to hemolytic anemia . Inherited Thrombotic Thrombocytopenic Purpura In inherited TTP, the ADAMTS13 gene is faulty. ...

  9. Research Areas: Causes of Cancer

    Cancer.gov

    Understanding the exposures and risk factors that cause cancer, as well as the genetic abnormalities associated with the disease, has helped us to reduce certain exposures and to ameliorate their harmful effects.

  10. Symptoms and Causes of Constipation

    MedlinePlus

    ... slow movement of stool through the colon delayed emptying of the colon from pelvic disorders, especially in ... can cause constipation include antacids —used to neutralize stomach acid—that contain aluminum and calcium anticholinergics —used ...

  11. Science 101: What Causes Wind?

    ERIC Educational Resources Information Center

    Robertson, William C.

    2010-01-01

    There's a quick and easy answer to this question. The Sun causes wind. Exactly how the Sun causes wind takes a bit to explain. We'll begin with what wind is. You've no doubt heard that wind is the motion of air molecules, which is true. Putting aside the huge leap of faith it takes for us to believe that we are experiencing the motion of millions…

  12. Shockwave treatment for musculoskeletal diseases and bone consolidation: qualitative analysis of the literature.

    PubMed

    Kertzman, Paulo; Lenza, Mario; Pedrinelli, André; Ejnisman, Benno

    2015-01-01

    Shockwave treatment is an option within orthopedics. The exact mechanism through which shockwaves function for treating musculoskeletal diseases is unknown. The aim of this study was to make a qualitative analysis on the effectiveness of shockwave treatment among patients with musculoskeletal pathological conditions and pseudarthrosis. Searches were conducted in the Cochrane Library, Medline and Lilacs databases. Thirty-nine studies that reported using shockwave treatment for musculoskeletal diseases were found. Their results varied greatly, as did the types of protocol used. The studies that evaluated the effectiveness of shockwave treatment for lateral epicondylitis, shoulder tendinopathy, knee osteoarthrosis, femoral head osteonecrosis and trochanteric bursitis reported inconsistent results for most of their patients. Those that evaluated patients with calcifying tendinopathy, plantar fasciitis, Achilles tendinopathy, patellar tendinopathy and pseudarthrosis showed benefits. Shockwave treatment is a safe and non-invasive method for chronic cases in which conventional techniques have been unsatisfactory and should be used in association with other treatment methods for tendinopathy. Further quality studies are needed. PMID:26229889

  13. Shockwave treatment for musculoskeletal diseases and bone consolidation: qualitative analysis of the literature☆

    PubMed Central

    Kertzman, Paulo; Lenza, Mario; Pedrinelli, André; Ejnisman, Benno

    2015-01-01

    Shockwave treatment is an option within orthopedics. The exact mechanism through which shockwaves function for treating musculoskeletal diseases is unknown. The aim of this study was to make a qualitative analysis on the effectiveness of shockwave treatment among patients with musculoskeletal pathological conditions and pseudarthrosis. Searches were conducted in the Cochrane Library, Medline and Lilacs databases. Thirty-nine studies that reported using shockwave treatment for musculoskeletal diseases were found. Their results varied greatly, as did the types of protocol used. The studies that evaluated the effectiveness of shockwave treatment for lateral epicondylitis, shoulder tendinopathy, knee osteoarthrosis, femoral head osteonecrosis and trochanteric bursitis reported inconsistent results for most of their patients. Those that evaluated patients with calcifying tendinopathy, plantar fasciitis, Achilles tendinopathy, patellar tendinopathy and pseudarthrosis showed benefits. Shockwave treatment is a safe and non-invasive method for chronic cases in which conventional techniques have been unsatisfactory and should be used in association with other treatment methods for tendinopathy. Further quality studies are needed. PMID:26229889

  14. Achromobacter causing a thrombophlebitis and osteomyelitis combination: a rare cause.

    PubMed

    Pamuk, Gizem; Aygun, Deniz; Barut, Kenan; Kasapcopur, Ozgur

    2015-01-01

    Achromobacter xylosoxidans is a Gram-negative, aerobic bacillus, present in normal human flora of the skin and gastrointestinal tract. Infections due to Achromobacter are infrequent and have mostly been reported in immunocompromised patients. Rarely, however, the microorganism can cause soft tissue infections even in healthy subjects with a history of trauma. We report thrombophlebitis complicated with osteomyelitis secondary to Achromobacter in a 15-year-old girl with a history of purulent discharge from the ankle due to local trauma caused by tight fitting shoes. PMID:26347234

  15. Infections Caused by Scedosporium spp.

    PubMed Central

    Cortez, Karoll J.; Roilides, Emmanuel; Quiroz-Telles, Flavio; Meletiadis, Joseph; Antachopoulos, Charalampos; Knudsen, Tena; Buchanan, Wendy; Milanovich, Jeffrey; Sutton, Deanna A.; Fothergill, Annette; Rinaldi, Michael G.; Shea, Yvonne R.; Zaoutis, Theoklis; Kottilil, Shyam; Walsh, Thomas J.

    2008-01-01

    Scedosporium spp. are increasingly recognized as causes of resistant life-threatening infections in immunocompromised patients. Scedosporium spp. also cause a wide spectrum of conditions, including mycetoma, saprobic involvement and colonization of the airways, sinopulmonary infections, extrapulmonary localized infections, and disseminated infections. Invasive scedosporium infections are also associated with central nervous infection following near-drowning accidents. The most common sites of infection are the lungs, sinuses, bones, joints, eyes, and brain. Scedosporium apiospermum and Scedosporium prolificans are the two principal medically important species of this genus. Pseudallescheria boydii, the teleomorph of S. apiospermum, is recognized by the presence of cleistothecia. Recent advances in molecular taxonomy have advanced the understanding of the genus Scedosporium and have demonstrated a wider range of species than heretofore recognized. Studies of the pathogenesis of and immune response to Scedosporium spp. underscore the importance of innate host defenses in protection against these organisms. Microbiological diagnosis of Scedosporium spp. currently depends upon culture and morphological characterization. Molecular tools for clinical microbiological detection of Scedosporium spp. are currently investigational. Infections caused by S. apiospermum and P. boydii in patients and animals may respond to antifungal triazoles. By comparison, infections caused by S. prolificans seldom respond to medical therapy alone. Surgery and reversal of immunosuppression may be the only effective therapeutic options for infections caused by S. prolificans. PMID:18202441

  16. Verminous aneurysm caused by filaria.

    PubMed

    Toledo, F V; de Araújo, A P; da Cunha, A M; Sidow, J R; Pavão, S G; de Araújo, E D

    1983-06-01

    Aneurysms caused by atherosclerosis are relatively frequent, as a consequence of the high incidence of this degenerative disease of the arteries. Other types of aneurysm, for example, those of infectious etiology, are more uncommon. Bacterias and fungi are able to cause aneurysms in several parts of the arterial tree. Stengel et al (1943), in a review of world literature described 217 cases of mycotic aneurysms. The Stedman's Medical Dictionary refers to a special type of aneurysm observed in horses, caused by intra-vascular migration of a worm, the Strongylus vulgaris. It has been named verminous aneurysm and generally involves the mesenteric arteries. We haven't found in medical literature any similar observations refering to human cases. The purpose of this paper is to describe a case of aneurysm the etiology of which we have imputed to the filaria (Wuchereria bancrofti). This case was observed in Marcilio Dias Naval Hospital, Rio de Janeiro, Brazil. PMID:6346961

  17. Sciatica caused by pseudomyxoma peritonei.

    PubMed

    Lin, Hung-Lin; Chen, Jung-Tsung; Liu, Yu-Fang; Cho, Der-Yang

    2009-01-01

    Many etiologies may cause sciatica, and intra-abdominal masses usually affect the lumbosacral plexus by local invasion or distal metastases. Lumbosacral plexopathy caused by compression of intra-abdominal tumors instead of invasion is rarely seen. A 67-year-old woman had a 3-month history of progressive neurogenic claudication, lumbago and left L5 radiculopathy with foot drop. Nocturia and progressive abdominal distension with voiding dysfunction were also noted. Imaging studies showed a huge pelvic mass with severe compression of the left lumbosacral trunk. There was no direct invasion of the lumbosacral plexus by the pelvic mass noted in the preoperative imaging studies or intraoperative findings. Bilateral ovarian borderline mucinous cystic tumor with pseudomyxoma peritonei (PMP) was diagnosed, and the sciatica was improved dramatically after subsequent abdominal debulking surgery. Although rare, neural compression caused by PMP and intra-abdominal masses needs to be considered in the differential diagnosis of sciatica. PMID:19181596

  18. Estimating avoidable causes of cancer.

    PubMed Central

    Davis, D L; Muir, C

    1995-01-01

    Evidence that much cancer is preventable derives from observations of time trends and geographic patterns of cancer, birth cohort changes, high risks in groups with well-defined exposures, and experimental studies. In an effort to identify additional opportunities for reducing the impact of cancer on society, this conference assessed avoidable causes of cancer. The magnitude and extent of preventable causes of cancer are subjects of intense debate, with discrepancies often related to the use of different time frames and different weights for epidemiologic and toxicologic evidence. There is much agreement, however, about the exposures that increase risk, notably tobacco, alcohol, diet, radiation, medications, occupational exposures, general environmental exposures, and infectious agents. Interactions between carcinogenic exposures and genetic susceptibility are also important. Concerted efforts are needed to identify avoidable causes of cancer and to apply knowledge already obtained to reduce the cancer burden. PMID:8741803

  19. Pediatric genetic diseases causing glaucoma

    PubMed Central

    Ichhpujani, Parul; Singh, Rohan B.

    2014-01-01

    Glaucomatous optic neuropathy may be considered as an endpoint of multiple systemic factors. Genetic conditions commonly causing glaucoma in children and adolescents include Axenfeld-Reiger syndrome, aniridia, Marfan syndrome, Weill-Marchessani syndrome, Sturge-Weber syndrome, Rubinstein-Taybi syndrome, nevus of Ota, congenital rubella and neurofibromatosis type 1. In the recent years, with the advancements in genetic research our understanding of the fundamental causes of glaucoma associated with inherited disorders has improved. In addition to intraocular pressure reduction, it is important for the clinician to be familiar with the multiple systemic associations with glaucoma, to re-evaluate treatment frequently, and to target the underlying disease process, if present.

  20. Muscle Deoxygenation Causes Muscle Fatigue

    NASA Technical Reports Server (NTRS)

    Murthy, G.; Hargens, A. R.; Lehman, S.; Rempel, D.

    1999-01-01

    Muscle fatigue is a common musculoskeletal disorder in the work place, and may be a harbinger for more disabling cumulative trauma disorders. Although the cause of fatigue is multifactorial, reduced blood flow and muscle oxygenation may be the primary factor in causing muscle fatigue during low intensity muscle exertion. Muscle fatigue is defined as a reduction in muscle force production, and also occurs among astronauts who are subjected to postural constraints while performing lengthy, repetitive tasks. The objectives of this research are to: 1) develop an objective tool to study the role of decreased muscle oxygenation on muscle force production, and 2) to evaluate muscle fatigue during prolonged glovebox work.

  1. Occupational asthma caused by ethanolamines.

    PubMed

    Savonius, B; Keskinen, H; Tuppurainen, M; Kanerva, L

    1994-12-01

    Amino alcohols are used in various industries, often as minor constituents of compounds to modify the properties of the compound. Generally, they are considered to be safe, but they have been known to cause local skin irritation at higher concentrations in solutions. We report on three cases of occupational asthma caused by ethanolamines: two metal workers exposed to a cutting fluid containing triethanolamine, and one cleaner exposed to a detergent containing monoethanolamine. The diagnosis was based on work-related symptoms and on a chamber challenge with the suspected agent. Persistence of the symptoms after exposure ended was a common feature of the three cases. PMID:7709998

  2. Bacteremia Caused by Kerstersia gyiorum

    PubMed Central

    Zhang, Cecelia; Manninen, Katja; Touchberry, Joanne; Greene, Shermalyn R.; Holland, Thomas L.

    2015-01-01

    Kerstersia spp. are an unusual cause of human infections. We report the first known case of bacteremia and sepsis due to Kerstersia gyiorum, in a patient with chronic lower-extremity ulcers, and we review the literature on this uncommon pathogen. PMID:25809974

  3. Orbital Causes of Incomitant Strabismus

    PubMed Central

    Lueder, Gregg T.

    2015-01-01

    Strabismus may result from abnormal innervation, structure, or function of the extraocular muscles. Abnormalities of the orbital bones or masses within the orbit may also cause strabismus due to indirect effects on the extraocular muscles. This paper reviews some disorders of the orbit that are associated with strabismus, including craniofacial malformations, orbital masses, trauma, and anomalous orbital structures. PMID:26180465

  4. Cyberbullying: Causes, Effects, and Remedies

    ERIC Educational Resources Information Center

    Hoff, Dianne L.; Mitchell, Sidney N.

    2009-01-01

    Purpose: The purpose of this paper is to present research exploring the pervasiveness and causes of cyberbullying, the psychological impact on students, and the responses to cyberbullying from students and administrators. The goal is to give school leaders a greater understanding of this phenomenon and suggest steps to deal with this challenging…

  5. Acid Precipitation: Causes and Consequences.

    ERIC Educational Resources Information Center

    Babich, Harvey; And Others

    1980-01-01

    This article is the first of three articles in a series on the acid rain problem in recent years. Discussed are the causes of acid precipitation and its consequences for the abiotic and biotic components of the terrestrial and aquatic ecosystems, and for man-made materials. (Author/SA)

  6. Other Causes of Leg Pain

    MedlinePlus

    ... in the same position for a long time Injuries caused by: A torn or overstretched muscle (strain) Hairline crack in the bone (stress fracture) Inflamed tendon (tendinitis) Shin splints—pain in the front of your leg related to overuse or repetitive pounding Deep vein thrombosis (DVT) , which occurs when ...

  7. Disease Outbreaks Caused by Water.

    ERIC Educational Resources Information Center

    Craun, Gunther F.

    1978-01-01

    Presents a literature review of the disease outbreaks caused by drinking polluted water, covering publications of 1976-77. Some of the waterborn outbreaks included are: (1) cholera; (2) gastroenteritis; (3) giardiasis; and (4) typhoid fever and salmonellosis. A list of 66 references is also presented. (HM)

  8. Disturbance caused by aircraft noise

    NASA Technical Reports Server (NTRS)

    Josse, R.

    1980-01-01

    Noise pollution caused by the presence of airfields adjacent to residential areas is studied. Noise effects on the sleep of residents near airports and the degree of the residents noise tolerance are evaluated. What aircraft noises are annoying and to what extent the annoyance varies with sound level are discussed.

  9. Science 101: What Causes Friction?

    ERIC Educational Resources Information Center

    Robertson, Bill

    2014-01-01

    Defining friction and asking what causes it might seem like a trivial question. Friction seems simple enough to understand. Friction is a force between surfaces that pushes against things that are moving or tending to move, and the rougher the surfaces, the greater the friction. Bill Robertson answers this by saying, "Well, not exactly".…

  10. Organizational Conflict: Causes and Manifestations.

    ERIC Educational Resources Information Center

    Sacks, Eugene

    1979-01-01

    No group (within an organization) can be entirely harmonious, but conflict is not an altogether disruptive factor. A delicate balance is required to obtain the advantages and restrict the disadvantages of organizational conflict. The causes and forms of organizational conflict are examined. (JMD)

  11. Pyorrhoea as cause of pyrexia.

    PubMed Central

    Berry, E; Silver, J

    1976-01-01

    Three patients with fever and malaise, one of whom also had joint pains, were extensively investigated before their condition was attributed to dental sepsis. Each patient recovered fully after appropriate dental treatment. Dental sepsis should be added to the list of possible causes of pyrexia of undetermined origin, and a routine dental examination should be carried out in each case. PMID:1000197

  12. Endocarditis Caused by Rhodotorula Infection

    PubMed Central

    Simon, Matthew S.; Somersan, Selin; Singh, Harjot K.; Hartman, Barry; Wickes, Brian L.; Jenkins, Stephen G.; Walsh, Thomas J.

    2014-01-01

    Rhodotorula is an emerging opportunistic fungal pathogen that is rarely reported to cause endocarditis. We describe a case involving a patient who developed endocarditis due to Rhodotorula mucilaginosa and Staphylococcus epidermidis, proven by culture and histopathology. The case illustrates the unique diagnostic and therapeutic challenges relevant to Rhodotorula spp. PMID:24197888

  13. What Caused the Great Depression?

    ERIC Educational Resources Information Center

    Caldwell, Jean; O'Driscoll, Timothy G.

    2007-01-01

    Economists and historians have struggled for almost 80 years to account for the American Great Depression, which began in 1929 and lasted until the early years of World War II. In this article, the authors discuss three major schools of thought on the causes of the Great Depression and the long failure of the American economy to return to full…

  14. Water Pollution (Causes, Mechanisms, Solution).

    ERIC Educational Resources Information Center

    Strandberg, Carl

    Written for the general public, this book illustrates the causes, status, problem areas, and prediction and control of water pollution. Water pollution is one of the most pressing issues of our time and the author communicates the complexities of this problem to the reader in common language. The purpose of the introductory chapter is to show what…

  15. Can Infections Cause Alzheimer's Disease?

    PubMed Central

    Mawanda, Francis; Wallace, Robert

    2013-01-01

    Late-onset Alzheimer's disease (AD) is the most prevalent cause of dementia among older adults, yet more than a century of research has not determined why this disease develops. One prevailing hypothesis is that late-onset AD is caused by infectious pathogens, an idea widely studied in both humans and experimental animal models. This review examines the infectious AD etiology hypothesis and summarizes existing evidence associating infectious agents with AD in humans. The various mechanisms through which different clinical and subclinical infections could cause or promote the progression of AD are considered, as is the concordance between putative infectious agents and the epidemiology of AD. We searched the PubMed, Web of Science, and EBSCO databases for research articles pertaining to infections and AD and systematically reviewed the evidence linking specific infectious pathogens to AD. The evidence compiled from the literature linking AD to an infectious cause is inconclusive, but the amount of evidence suggestive of an association is too substantial to ignore. Epidemiologic, clinical, and basic science studies that could improve on current understanding of the associations between AD and infections and possibly uncover ways to control this highly prevalent and debilitating disease are suggested. PMID:23349428

  16. Causes of chronic orthostatic hypotension

    NASA Technical Reports Server (NTRS)

    Robertson, D.; Robertson, R. M.

    1994-01-01

    OBJECTIVE: To determine the frequency of various causes of orthostatic hypotension. DESIGN: Survey. SETTING: Tertiary referral center. PATIENTS: One hundred patients with moderate to severe orthostatic hypotension. RESULTS: Twenty-seven percent of the patients had primary autonomic failure, 35% had secondary autonomic failure, and 38% had hypotension without evidence of generalized autonomic degeneration. CONCLUSIONS: In a tertiary referral center, only a minority of patients with severe orthostatic hypotension will have Shy-Drager syndrome or Bradbury-Eggleston syndrome as their primary disease. Occasional patients who initially appear to have Bradbury-Eggleston syndrome ultimately prove to have Shy-Drager syndrome or paraneoplastic autonomic failure. Antidepressant drugs, even in low doses, remain a major overlooked cause of orthostatic hypotension.

  17. ROOT CAUSE ANALYSIS PROGRAM MANUAL

    SciTech Connect

    Gravois, Melanie C.

    2007-05-02

    Root Cause Analysis (RCA) identifies the cause of an adverse condition that, if corrected, will preclude recurrence or greatly reduce the probability of recurrence of the same or similar adverse conditions and thereby protect the health and safety of the public, the workers, and the environment. This procedure sets forth the requirements for management determination and the selection of RCA methods and implementation of RCAs that are a result of significant findings from Price-Anderson Amendments Act (PAAA) violations, occurrences/events, Significant Adverse Conditions, and external oversight Corrective Action Requests (CARs) generated by the Office of Enforcement (PAAA headquarters), the U.S. Environmental Protection Agency, and other oversight entities against Lawrence Berkeley National Laboratory (LBNL). Performance of an RCA may result in the identification of issues that should be reported in accordance with the Issues Management Program Manual.

  18. Radiation recall reaction causing cardiotoxicity.

    PubMed

    Masri, Sofia Carolina; Misselt, Andrew James; Dudek, Arkadiusz; Konety, Suma H

    2014-01-01

    Radiation recall phenomenon is a tissue reaction that develops within a previously irradiated area, precipitated by the subsequent administration of certain chemotherapeutic agents. It commonly affects the skin, but can also involve internal organs with functional consequences. To our best knowledge, this phenomenon has never been reported as a complication on the heart and should be consider as a potential cause of cardiotoxicity. PMID:24755097

  19. Earthquakes - Volcanoes (Causes and Forecast)

    NASA Astrophysics Data System (ADS)

    Tsiapas, E.

    2009-04-01

    EARTHQUAKES - VOLCANOES (CAUSES AND FORECAST) ELIAS TSIAPAS RESEARCHER NEA STYRA, EVIA,GREECE TEL.0302224041057 tsiapas@hol.gr The earthquakes are caused by large quantities of liquids (e.g. H2O, H2S, SO2, ect.) moving through lithosphere and pyrosphere (MOHO discontinuity) till they meet projections (mountains negative projections or projections coming from sinking lithosphere). The liquids are moved from West Eastward carried away by the pyrosphere because of differential speed of rotation of the pyrosphere by the lithosphere. With starting point an earthquake which was noticed at an area and from statistical studies, we know when, where and what rate an earthquake may be, which earthquake is caused by the same quantity of liquids, at the next east region. The forecast of an earthquake ceases to be valid if these components meet a crack in the lithosphere (e.g. limits of lithosphere plates) or a volcano crater. In this case the liquids come out into the atmosphere by the form of gasses carrying small quantities of lava with them (volcano explosion).

  20. Occupational causes of constrictive bronchiolitis

    PubMed Central

    Kreiss, Kathleen

    2015-01-01

    Purpose of review New literature from 2009 to 2012 regarding occupational constrictive bronchiolitis challenges textbook descriptions of this disease, formerly thought to be limited to fixed airflow limitation arising in the wake of accidental overexposure to noxious chemicals. Indolent evolution of dyspnea without a recognized hazardous exposure is a more common presentation. Recent findings Biopsy-confirmed case series of constrictive bronchiolitis from US soldiers, Iranian survivors of sulfur mustard gassing, hospital-based studies, and flavoring-related cases document that indolent constrictive bronchiolitis cases can have normal spirometry or either restrictive or obstructive abnormalities. High-resolution computerized tomography studies can be normal or reflect air-trapping and mosaic attenuation on expiratory films. Thus, in the absence of noninvasive abnormalities, the diagnosis in dyspneic patients may require thoracoscopic biopsy in settings in which exposure risk has not been recognized. Many workers with occupational constrictive bronchiolitis stabilize with cessation of exposures causing bronchiolar epithelial necrosis. Summary Clinicians need a high index of suspicion for constrictive bronchiolitis in young patients with rapidly progressing exertional dyspnea, regardless of spirometric and radiologic findings. Identification of novel causes and exposure-response relations for known causes are needed to provide guidance for protecting workers at risk for this largely irreversible lung disease. PMID:23407121