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1

Patellar Tendon Tear  

MedlinePLUS

... tear is caused by a medical condition — like tendonitis — the tendon usually tears in the middle. Top ... Several things can lead to tendon weakness. Patellar tendonitis. Inflammation of the patellar tendon, called patellar tendonitis, ...

2

Supraspinatus tendon tears: comparison of US and MR arthrography with surgical correlation  

Microsoft Academic Search

The aim of this study was to compare the diagnostic reliability of US with MR arthrography in diagnosing supraspinatus tendon tears. Surgical findings were used as the gold standard in detecting tears. A total of 44 patients were assessed with transverse and longitudinal US scans with respect to the long axis of the rotator cuff tendons and then ex- amined

Francesco S. Ferrari; Simone Governi; Francesca Burresi; Francesco Vigni; Paolo Stefani

2002-01-01

3

Longitudinal tear of the tibialis anterior tendon.  

PubMed

Diagnosis and treatment of longitudinal tears of the tibialis anterior tendon are not well documented in the surgical literature. Described here is successful primary surgical repair of a longitudinally torn tibialis anterior tendon in a 60-year-old woman. PMID:16037556

Hamilton, Graham A; Ford, Lawrence A

2005-01-01

4

Isolated and Combined Tears of the Subscapularis Tendon  

Microsoft Academic Search

Background: Isolated and combined subscapularis tendon tears are rare and are described in the literature only in small numbers.Hypothesis: The outcome of surgical intervention for isolated and combined subscapularis tendon tears may be influenced by the tear pattern of the anterior rotator cuff and the period of time between trauma and surgical procedure.Study Design: Case series; Level of evidence, 4.Methods:

Peter C. Kreuz; Andreas Remiger; Christoph Erggelet; Stefan Hinterwimmer; Philipp Niemeyer; Andre Gächter

2005-01-01

5

Biomechanical analysis of tendon transfers for massive rotator cuff tears  

Microsoft Academic Search

Objective. To determine why certain tendon transfers are mechanically more effective than other tendon transfers for the treatment of a massive rotator cuff tear.Design. A tendon transfer procedure of latissimus dorsi, teres major or a combination of these two to the insertions of either teres minor, infraspinatus, supraspinatus, or subscapularis is simulated using a biomechanical musculoskeletal model of the upper

D. J. Magermans; E. K. J. Chadwick; H. E. J. Veeger; P. M. Rozing

2004-01-01

6

Abnormalities on MRI of the Subscapularis Tendon in the Presence of a Full-Thickness Supraspinatus Tendon Tear  

Microsoft Academic Search

OBJECTIVE. Our objective was to determine the association between size and chronicity of full-thickness supraspinatus tendon tears with subscapularis tendon abnormalities on MRI. MATERIALS AND METHODS. One hundred forty-two MRI examinations with full- thickness supraspinatus tendon tears were categorized on the basis of the supraspinatus muscle (SS): normal muscle (SSnormal), suggesting a recent or small tear; reduced muscle bulk without

Diane Bergin; Laurence Parker; Adam Zoga; William Morrison

2006-01-01

7

Triceps tendon tear in a middle-aged weightlifter.  

PubMed

The patient was a 47-year-old man who was evaluated by a physical therapist for a chief complaint of posterior right elbow pain. The patient routinely participated in weightlifting activities and reported a sudden onset of triceps weakness and posterior elbow pain while performing clap push-ups 3 days prior. A physician assistant ordered radiographs, which were initially interpreted as normal, and routine magnetic resonance imaging for the right elbow. Following examination by a physical therapist, due to concern for a triceps tendon tear, the previously ordered magnetic resonance imaging was expedited, which revealed a partial triceps tendon tear with partial tendon retraction medially. PMID:24175622

Molloy, Joseph M; Aberle, Curtis J; Escobar, Eduardo

2013-11-01

8

Repair of tears of the subscapularis tendon  

Microsoft Academic Search

Tears of the subscapularis are much less common than tears of the supraspinatus and infraspinatus. Subscapularislesions are usually traumatic in etiology and occur in younger patients. These lesions can be complete or limited to the superior insertion of the subscapularis, and they may be isolated or occur with other rotator cuff lesions. In most instances, treatment of subscapularis tears is

T. Bradley Edwards; Gilles Walch

2002-01-01

9

Endoscopic Transtendinous Repair for Partial-Thickness Proximal Hamstring Tendon Tears  

PubMed Central

Partial tears of the proximal hamstring tendon can successfully be managed with tendon repair in cases of failed conservative management. As in partial-thickness gluteus medius repair, a transtendinous technique can be used to repair partial-thickness undersurface tears of the hamstring origin. This report details an endoscopic transtendinous approach for the treatment of partial-thickness hamstring tendon tears.

Jackson, Timothy J.; Trenga, Anthony; Lindner, Dror; El-Bitar, Youseff; Domb, Benjamin G.

2014-01-01

10

Supraspinatus tendon organizational and mechanical properties in a chronic rotator cuff tear animal model  

Microsoft Academic Search

Rotator cuff tears of the shoulder are a common cause of pain and disability. The successful repair of rotator cuff tendon tears depends on the time from onset of injury to the time of surgical repair. However, the effect of time from injury to repair remains poorly understood. A rat model was used to investigate the supraspinatus tendon organizational and

Jonathan A. Gimbel; Jonathan P. Van Kleunen; Samir Mehta; Stephanie M. Perry; Gerald R. Williams; Louis J. Soslowsky

2004-01-01

11

Collagen ribbon augmentation of achilles tendon tears: a biomechanical evaluation.  

PubMed

Early motion of a repaired Achilles tendon has been accepted to improve both clinical and biomechanical outcomes. It has been postulated that augmenting a primary Achilles tendon repair with a collagen ribbon will improve the repair construct's initial strength, thereby facilitating early motion. The purpose of the present study was to compare the failure load of Achilles tendon defects repaired with suture, with or without augmentation with a collagen ribbon. Ten matched pairs of cadaveric feet and tibiae underwent simulated Achilles tendon tear in the watershed area and were then repaired with 4-strand Krackow sutures only or were sutured and augmented with a box weave collagen ribbon xenograft. The specimens were prepared for testing by keeping the insertion of the Achilles to the calcaneus intact and dissecting the gastrocnemius at its origin, leaving the repair undisturbed. The mean load at failure for the augmented (suture plus collagen ribbon) specimens was 392.4 ± 74.9 N. In contrast, the mean load at failure for the suture-only (control) construct was 98.0 ± 17.6 N (p < .001). The augmented specimens demonstrated a greater mean strength of 4.1 ± 0.9 N (range 3.2 to 5.6). After cyclic loading, the mean gap across the Achilles repair was significantly smaller in the augmented group than in the control group (p = .006). We have concluded that box weave collagen ribbon augmentation of the primary suture Achilles tendon repairs can provide enhanced gap resistance and strength under cyclic loading and ramped tensile testing. PMID:24666979

Berlet, Gregory C; Hyer, Christopher F; Lee, Thomas H; Blum, Barbara E

2014-01-01

12

The role of repair tension on tendon to bone healing in an animal model of chronic rotator cuff tears  

Microsoft Academic Search

Rotator cuff tendon tears are one of the most common shoulder injuries. Although surgical repair is typically beneficial, re-tearing of the tendons frequently occurs. It is generally accepted that healing is worse for chronic tears than acute tears, but the reasons for this are unknown. One potential cause may be the large tensions that are sometimes required to repair chronically

Jonathan A. Gimbel; Jonathan P. Van Kleunen; Spencer P. Lake; Gerald R. Williams; Louis J. Soslowsky

2007-01-01

13

US appearance of partial-thickness supraspinatus tendon tears: Application of the string theory. Pictorial essay.  

PubMed

The supraspinatus tendon is composed of 5 different layers consisting of intertwining bundles. On a front portion of the tendon, the layers become coated bundles which insert on the trochanter. At the insertion, the superficial or bursal surface of the tendon corresponding to the tendon fibers in contact with the subacromial bursa can be distinguished from the deep surface corresponding to the fibers in contact with the glenohumeral joint. A tendon tear may involve partial or total disruption of the tendon fibers and is called full-thickness tear if it affects the entire tendon, and partial-thickness tear if it involves only part of the tendon. Partial-thickness tears of the supraspinatus tendon include lesions of the superficial, deep and central surface or tendon delamination.A contrast enhanced examination requires injection of contrast agent into the joint (arthrography followed by computed tomography (CT) or magnetic resonance imaging (MRI)) to study the deep surface, and injection into the subacromial bursa (bursography followed by CT) to study the superficial surface. MRI and ultrasound (US) examination allow the study of these different tendon layers without the use of contrast agent (which is not possible at CT). PMID:23396264

Guerini, H; Fermand, M; Godefroy, D; Feydy, A; Chevrot, A; Morvan, G; Gault, N; Drapé, J L

2012-02-01

14

US appearance of partial-thickness supraspinatus tendon tears: Application of the string theory. Pictorial essay  

PubMed Central

The supraspinatus tendon is composed of 5 different layers consisting of intertwining bundles. On a front portion of the tendon, the layers become coated bundles which insert on the trochanter. At the insertion, the superficial or bursal surface of the tendon corresponding to the tendon fibers in contact with the subacromial bursa can be distinguished from the deep surface corresponding to the fibers in contact with the glenohumeral joint. A tendon tear may involve partial or total disruption of the tendon fibers and is called full-thickness tear if it affects the entire tendon, and partial-thickness tear if it involves only part of the tendon. Partial-thickness tears of the supraspinatus tendon include lesions of the superficial, deep and central surface or tendon delamination. A contrast enhanced examination requires injection of contrast agent into the joint (arthrography followed by computed tomography (CT) or magnetic resonance imaging (MRI)) to study the deep surface, and injection into the subacromial bursa (bursography followed by CT) to study the superficial surface. MRI and ultrasound (US) examination allow the study of these different tendon layers without the use of contrast agent (which is not possible at CT).

Guerini, H.; Fermand, M.; Godefroy, D.; Feydy, A.; Chevrot, A.; Morvan, G.; Gault, N.; Drape, J.L.

2012-01-01

15

Interaction Between the Supraspinatus and Infraspinatus TendonsEffect of Anterior Supraspinatus Tendon Full-Thickness Tears on Infraspinatus Tendon Strain  

Microsoft Academic Search

Background: Rotator cuff tears are common and not well-understood shoulder problems. Structural and mechanical inhomogeneity of the supraspinatus tendon complicates accurate prediction of risk of tear propagation and may affect appropriate clinical treatment.Hypothesis: We propose that interactions between the supraspinatus and infraspinatus tendons are critical to load bearing at the glenohumeral joint and warrant investigation.Study Design: Controlled laboratory study.Methods: Principal

Nelly Andarawis-Puri; Eric T. Ricchetti; Louis J. Soslowsky

2009-01-01

16

Arthroscopic Repair of Full-Thickness Tears of the Supraspinatus: Does the Tendon Really Heal?  

Microsoft Academic Search

Background: Good functional results have been reported for arthroscopic repair of rotator cuff tears, but the rate of tendon-to-bone healing is still unknown. Our hypothesis was that arthroscopic repair of full-thickness supraspinatus tears achieves a rate of complete tendon healing equivalent to those reported in the literature with open or mini-open techniques. Methods: Sixty-five consecutive shoulders with a chronic full-thickness

PASCAL BOILEAU; NICOLAS BRASSART; DUNCAN J. WATKINSON; MICHEL CARLES; ARMODIOS M. HATZIDAKIS; SUMANT G. KRISHNAN

17

Effectiveness of tendon transfers for massive rotator cuff tears: a simulation study  

Microsoft Academic Search

Objective. To determine what the most effective tendon transfer is in the case of a dysfunctional rotator cuff.Design. A tendon transfer procedure of latissimus dorsi, teres major or a combination of these two to the insertions of either teres minor, infraspinatus, supraspinatus, or subscapularis is simulated using a biomechanical musculoskeletal model of the upper extremity.Background. Massive rotator cuff tears are

D. J. Magermans; E. K. J. Chadwick; H. E. J. Veeger; P. M. Rozing; F. C. T van der Helm

2004-01-01

18

Detection of partial-thickness tears in ligaments and tendons by Stokes-polarimetry imaging  

NASA Astrophysics Data System (ADS)

A Stokes polarimetry imaging (SPI) system utilizes an algorithm developed to construct degree of polarization (DoP) image maps from linearly polarized light illumination. Partial-thickness tears of turkey tendons were imaged by the SPI system in order to examine the feasibility of the system to detect partial-thickness rotator cuff tear or general tendon pathology. The rotating incident polarization angle (IPA) for the linearly polarized light provides a way to analyze different tissue types which may be sensitive to IPA variations. Degree of linear polarization (DoLP) images revealed collagen fiber structure, related to partial-thickness tears, better than standard intensity images. DoLP images also revealed structural changes in tears that are related to the tendon load. DoLP images with red-wavelength-filtered incident light may show tears and related organization of collagen fiber structure at a greater depth from the tendon surface. Degree of circular polarization (DoCP) images exhibited well the horizontal fiber orientation that is not parallel to the vertically aligned collagen fibers of the tendon. The SPI system's DOLP images reveal alterations in tendons and ligaments, which have a tissue matrix consisting largely of collagen, better than intensity images. All polarized images showed modulated intensity as the IPA was varied. The optimal detection of the partial-thickness tendon tears at a certain IPA was observed. The SPI system with varying IPA and spectral information can improve the detection of partial-thickness rotator cuff tears by higher visibility of fiber orientations and thereby improve diagnosis and treatment of tendon related injuries.

Kim, Jihoon; John, Raheel; Walsh, Joseph T.

2008-03-01

19

Histologic and biomechanical characteristics of the supraspinatus tendon: Reference to rotator cuff tearing.  

PubMed

A bursal- or joint-side incomplete thickness tearing of the rotator cuff is clinically important, because it is known that this tearing has the potential to develop into a complete tendon disruption. Normal cadaveric supraspinatus tendons were analyzed histologically and biomechanically to clarify the differences in pathomechanical causation of bursal- and joint-side incomplete tears. Histologically, the bursal-side layer was composed of tendon bundles with a decreasing muscular component toward the insertion. The joint-side layer was a complex of tendon, ligament, and joint capsule without transitional areas. Biomechanically, the bursal-side layer had greater deformation and tensile strength. When each layer was divided into three portions of equal length, the middle segment of the bursal-side layer elongated the most, whereas the entire joint-side layer increased evenly in length. We conclude that the joint-side layer is more vulnerable to a tensile load than the bursal-side layer. PMID:22959646

Nakajima, T; Rokuuma, N; Hamada, K; Tomatsu, T; Fukuda, H

1994-03-01

20

Diagnostic accuracy in detecting tears in the proximal biceps tendon using standard nonenhancing shoulder MRI  

PubMed Central

Background There is a paucity of data in the literature evaluating the performance of noncontrast MRI in the diagnosis of partial and complete tears of the proximal portion of the long head of the biceps (LHB) tendon. The objective of this study was to evaluate the accuracy of noncontrast magnetic resonance imaging (MRI) compared to arthroscopy for the diagnosis of pathology involving the intra-articular portion of the LHB tendon. Methods We conducted a retrospective review of 66 patients (mean age 57.8 years, range 43–70 years) who underwent shoulder arthroscopy and evaluation of the LHB tendon after having had a noncontrast MRI of the shoulder. Biceps pathology was classified by both MRI and direct arthroscopic visualization as either normal, partial tearing, or complete rupture, and arthroscopy was considered to be the gold standard. We then determined the sensitivity, specificity, and positive- and negative-predictive values of MRI for the detection of partial and complete LHB tears. Results MRI identified 29/66 (43.9%) of patients as having a pathologic lesion of the LHB tendon (19 partial and ten complete tears) while diagnostic arthroscopy identified tears in 59/66 patients (89.4%; 50 partial and 16 complete). The sensitivity and specificity of MRI for detecting partial tearing of the LHB were 27.7% and 84.2%, respectively (positive predictive value =81.2%, negative predictive value =32.0%). The sensitivity and specificity of MRI for complete tears of the LHB were 56.3% and 98.0%, respectively (positive predictive value =90.0%, negative predictive value =87.5%). Conclusion Standard noncontrast MRI of the shoulder is limited in detecting partial tears and complete ruptures of the intra-articular LHB tendon. Surgeons may encounter pathologic lesions of the LHB tendon during arthroscopy that are not visualized on preoperative MRI.

Dubrow, Samuel A; Streit, Jonathan J; Shishani, Yousef; Robbin, Mark R; Gobezie, Reuben

2014-01-01

21

Severe atrophy and fatty degeneration of the infraspinatus muscle due to isolated infraspinatus tendon tear.  

PubMed

Atrophy of both the supraspinatus and infraspinatus muscles is usually caused by chronic rotator cuff tear, but may also derive from suprascapular nerve entrapment at the spinoglenoid notch. Isolated infraspinatus muscle atrophy is uncommon, and typically associates with suprascapular nerve entrapment occurring distal to the spinoglenoid notch. However, isolated atrophy of the infraspinatus muscle due to insertional tear of the infraspinatus tendon may also occur. We present a case of a 43-year-old male with isolated infraspinatus muscle atrophy and fatty degeneration following an isolated full-thickness infraspinatus tendon tear at the insertion site on the humerus. While it is important to rule out other causes of infraspinatus muscle atrophy, such as concomitant rotator cuff tendon/muscle pathology or suprascapular nerve palsy, we present this case to increase awareness of this uncommon clinical presentation and the potential implications for treatment. PMID:21918868

Kolbe, Amy B; Collins, Mark S; Sperling, John W

2012-01-01

22

Supraspinatus tendon organizational and mechanical properties in a chronic rotator cuff tear animal model.  

PubMed

Rotator cuff tears of the shoulder are a common cause of pain and disability. The successful repair of rotator cuff tendon tears depends on the time from onset of injury to the time of surgical repair. However, the effect of time from injury to repair remains poorly understood. A rat model was used to investigate the supraspinatus tendon organizational and mechanical property changes that occur with time post-injury to understand the natural injury response in the absence of repair. It was hypothesized that increased time post-injury would result in increased detrimental changes to tendon organizational and mechanical properties. Tendons were detached at the insertion on the humerus without repair and the quantitative organizational and mechanical properties were analyzed at 1, 2, 4, 8, and 16 weeks post-detachment. Tendon detachment resulted in a dramatic decrease in mechanical properties initially followed by a progressive increase with time. The quantitative collagen fiber orientation results provided corroborating support to the mechanical property data. Based on similarities in histology and mechanical properties to rotator cuff tears in humans, the animal model presented here is promising for future investigations of the tendon's natural injury response in the absence of repair. PMID:15047003

Gimbel, Jonathan A; Van Kleunen, Jonathan P; Mehta, Samir; Perry, Stephanie M; Williams, Gerald R; Soslowsky, Louis J

2004-05-01

23

Incidence of familial tendon dysfunction in patients with full-thickness rotator cuff tears  

PubMed Central

Background A familial predisposition to the development of rotator cuff tearing has been previously reported. Very little information exists on the development of global tendon dysfunction in patients with rotator cuff tears. The purpose of the current study was to determine the incidence of global tendon dysfunction as well as the need for surgery for tendon dysfunction in patients with rotator cuff tears and their family members and compare them to age-matched controls. Methods Ninety two patients with full-thickness rotator cuff tears and 92 age-matched controls with no history of shoulder dysfunction or surgery responded to several questions regarding tendon diseases in themselves as well as their family members. Individuals were queried regarding the presence of tendon diseases other than the rotator cuff, the need for surgery on these other tendinopathies, the presence of family members having tendinopathies including rotator cuff disease, and the need for family members to have surgery for these problems. Chi-square analysis was performed to compare the incidences between cases and controls (P<0.05 was considered significant). Results The average age of patients in the rotator cuff tear group and control groups were 58.24±7.4 and 58.42±8.5 years, respectively (P=0.876). Results showed 32.3% of patients in the rotator cuff tear group reported that family members had a history of rotator cuff problems or surgery compared to only 18.3% of the controls (P=0.035), and 38.7% of patients in the rotator cuff tear group reported they had a history of other tendon problems compared to only 19.3% of individuals in the control group (P=0.005). Conclusion Individuals with rotator cuff tears report a higher incidence of family members having rotator cuff problems or surgery as well as a higher incidence of other tendinopathies compared to controls. This data further supports a familial predilection for the development of rotator cuff tearing and generalized tendinopathies.

Tashjian, Robert Z; Saltzman, Erik G; Granger, Erin K; Hung, Man

2014-01-01

24

Clinics in diagnostic imaging. 148. Bursal-sided partial-thickness supraspinatus tendon tear.  

PubMed

Rotator cuff injury comprises a continual spectrum of lesions ranging from tendinopathy, which may progress to partial- or full-thickness tear. This progression may be influenced by the interplay of extrinsic and intrinsic factors. We describe the case of a 29-year-man who presented with right shoulder pain for one year. His initial magnetic resonance (MR) arthrogram showed supraspinatus tendinopathy. Subsequent MR arthrogram, obtained after a road traffic accident, showed a bursal-sided partial-thickness tear of the supraspinatus tendon. In view of his worsening clinical symptoms, surgery was performed ten months later, revealing a full-thickness rotator cuff tear near the tendon insertion, with a tight subacromial space and bony protuberance of the humeral head. The pathogenesis of rotator cuff injuries, the roles of different imaging modalities in the diagnosis of rotator cuff injuries, as well as the advantages and limitations of various radiological modalities, are discussed. PMID:24068062

Bhagwani, Sanjeev; Peh, Wilfred C G

2013-09-01

25

Isolated tear of the tendon to the medial head of gastrocnemius presenting as a painless lump in the calf  

PubMed Central

We report on a case of isolated tear of the medial head of gastrocnemius tendon. The patient presented with a painless lump in the right calf and denied any prior history of trauma or strain to the leg. A longitudinal split of the tendon was demonstrated at ultrasound and magnetic resonance imaging (MRI). There were no other abnormalities and the gastrocnemius muscle was normal. There are no reports in the literature of isolated gastrocnemius tendon tear. To date the calf muscle complex injury described in this area is tearing of the medial head of gastrocnemius muscle, sometimes referred to as “tennis leg”. We conclude that an isolated tear of the tendon to the medial head of gastrocnemius should be considered in the differential diagnosis of a lump or swelling in the upper medial area of the calf and we recommend ultrasound or MRI as the investigations of choice.

Watura, Christopher; Harries, William

2009-01-01

26

Latissimus dorsi tendon transfer for irreparable rotator cuff tears: a modified technique using arthroscopy.  

PubMed

Latissimus dorsi transfer is a well-established method for the treatment of posterosuperior massive irreparable rotator cuff tears. We propose using an arthroscopically assisted technique that avoids insult to the deltoid. With the patient in the lateral decubitus position, an L-shaped incision is made along the anterior belly of the latissimus muscle and then along the posterior axillary line. The latissimus and teres major are identified and separated. The tendon insertion of the latissimus is isolated, and a FiberWire traction suture (Arthrex, Naples, FL) is placed, facilitating dissection of the muscle to the thoracodorsal neurovascular pedicle and subsequent mobilization. The interval deep to the deltoid and superficial to the teres minor is developed into a subdeltoid tunnel for arthroscopic tendon transfer. The latissimus tendon is then transferred and stabilized arthroscopically to the lateral aspect of the infraspinatus and supraspinatus footprints by multiple suture anchors. PMID:23767006

Villacis, Diego; Merriman, Jarrad; Wong, Karlton; Rick Hatch, George F

2013-02-01

27

Clinical results of a surgical technique using endobuttons for complete tendon tear of pectoralis major muscle: report of five cases  

PubMed Central

Background We herein describe a surgical technique for the repair of complete tear of the pectoralis major (PM) tendon using endobuttons to strengthen initial fixation. Methods Five male patients (3 judo players, 1 martial arts player, and 1 body builder) were treated within 2 weeks of sustaining complete tear of the PM tendon. Average age at surgery and follow-up period were 28.4 years (range, 23-33) and 28.8 months (range, 24-36). A rectangular bone trough (about 1 × 4 cm) was created on the humerus at the insertion of the distal PM tendon. The tendon stump was introduced into this trough, and fixed to the reverse side of the humeral cortex using endobuttons and non-absorbable suture. Clinical assessment of re-tear was examined by MRI. Shoulder range of motion (ROM), outcome of treatment, and isometric power were measured at final follow-up. Results There were no clinical re-tears, and MRI findings also showed continuity of the PM tendon in all cases at final follow-up. Average ROM did not differ significantly between the affected and unaffected shoulders. The clinical outcomes at final follow-up were excellent (4/5 cases) or good (1/5). In addition, postoperative isometric power in horizontal flexion of the affected shoulder showed complete recovery when compared with the unaffected side. Conclusions Satisfactory outcomes could be obtained when surgery using the endobutton technique was performed within 2 weeks after complete tear of the PM tendon. Therefore, our new technique appears promising as a useful method to treat complete tear of the PM tendon.

2011-01-01

28

Stress distribution in the supraspinatus tendon with partial-thickness tears: an analysis using two-dimensional finite element model.  

PubMed

The purpose of this study was to clarify the stress distribution in the rotator cuff tendon with 3 types of partial-thickness tears by use of 2-dimensional finite element analysis. In the finite element model of the normal human shoulder, a tendon defect was created on the articular surface, on the bursal surface, or in the midsubstance close to the insertion. A tensile force was applied to the proximal end of the tendon, and the stress distribution was calculated. In all 3 types of tears, a high stress concentration appeared around the articular surface at the insertion and at the site of the tear, which extended proximally. The maximum value of the von Mises stress increased with the presence of a partial-thickness tear. With the arm in abduction, a high stress concentration was also observed around the site of the tear. These biomechanical conditions of the supraspinatus tendon may eventually lead to a full-thickness tear at the critical zone. PMID:16414477

Sano, Hirotaka; Wakabayashi, Ikuko; Itoi, Eiji

2006-01-01

29

Latissimus dorsi tendon transfer for irreparable postero-superior cuff tears: current concepts, indications, and recent advances.  

PubMed

Latissimus dorsi tendon transfer is a method for surgical treatment of massive irreparable posterosuperior cuff tears. It partially restores active anteflexion, external rotation, and function of the shoulder but does not significantly increase strength of the shoulder. It is contraindicated in case of pseudoparalytic shoulder; associated irreparable subscapularis tear, deltoid palsy, and in case of associated osteoarthritis, as an isolated procedure. Results are inferior when performed as a secondary procedure compared with a primary procedure. However, latissimus dorsi tendon transfer is an attractive solution to improve shoulder mobility and function of young and non osteoarthritic patients whose previous surgical treatment of massive postero-superior irreparable rotator cuff tear failed. As a primary procedure, latissimus dorsi tendon transfer competes with debridement, biceps tenotomy, and partial cuff repair. In association with reverse shoulder arthroplasty, it restores active external rotation in osteoarthritic patients with active external rotation deficit. New arthroscopic assisted techniques might improve results in the future. PMID:24458942

Grimberg, Jean; Kany, Jean

2014-03-01

30

The effect of altered loading following rotator cuff tears in a rat model on the regional mechanical properties of the long head of the biceps tendon  

Microsoft Academic Search

Biceps tendon pathology is a common clinical problem often seen in conjunction with rotator cuff tears. A previous study found detrimental changes to biceps tendons in the presence of rotator cuff tears in a rat model. Therefore, the objective of this study was to utilize this model along with models of altered loading to investigate the effect of altered loading

Cathryn D. Peltz; Jason E. Hsu; Miltiadis H. Zgonis; Nicholas A. Trasolini; David L. Glaser; Louis J. Soslowsky

2010-01-01

31

Simultaneous Strain Measurements of Rotator Cuff Tendons at Varying Arm Positions and The Effect of Supraspinatus Tear: A Cadaveric Study  

Microsoft Academic Search

Aim: This study aims to measure strains on the different rotator cuff tendons simultaneously and demonstrate the effect of\\u000a supraspinatus tear on other cuff tendons with an intact glenohumeral joint.\\u000a \\u000a Methodology: Four fresh-frozen shoulders were tested on a purpose-built rig in preliminary tests. With 10 kg loaded at the\\u000a rotator cuff muscles, displacement variable reluctance transducers (DVRTs) were used to

J. M. Sheng; S. M. Chou; S. H. Tan; D. T. T. Lie; K. S. A. Yew

32

Peroneal Tendon Injuries  

MedlinePLUS

... peroneal tendon injuries are tendonitis, tears, and subluxation. Tendonitis is an inflammation of one or both tendons. ... trauma (such as an ankle sprain). Symptoms of tendonitis include: Pain Swelling Warmth to the touch Acute ...

33

A lateral meniscus tear incarcerated behind the popliteus tendon: a case report.  

PubMed

A 51-year-old male, sustained an injury to his left knee after being pinned between his motorcycle and a road barrier. In the ER, the patient complained of medial knee pain, and had a significant joint effusion. MRI demonstrated an ACL injury, medial meniscal tear, bone bruising and impaction at the lateral femoral condyle and tibial plateau, and a tear of the posterior horn of the lateral meniscus that was displaced behind the popliteus. Unfortunately, the patient also presented with a deep vein thrombosis and thus could not proceed to the operating room for two months. During this time, scar tissue developed around the lateral meniscus. The purpose of this report is to present an unusual variant of a common injury pattern previously unreported where the posterior horn of the lateral meniscus became incarcerated behind the popliteus tendon and was left in place. It is likely that our patient will develop osteoarthritis in the future, but considering the circumstances he received a favorable early clinical outcome. Early recognition and a mobile fragment are essential restoring a patient's original anatomical features and achieving an optimal clinical outcome. PMID:19897371

Eskander, Mark S; Drew, Jacob M; Osuch, Daniel B; Metzmaker, Jeff

2010-10-01

34

Successful return to high level sports following early surgical repair of complete tears of the proximal hamstring tendons  

PubMed Central

The purpose of this study was to investigate the outcome of surgical management of acute complete proximal hamstring tendon tears. This was a prospective review of a case series from a tertiary referral centre. Ten patients presenting with complete proximal hamstring tendon tears were confirmed on MRI. All patients underwent surgical exploration and repair of the torn tendons with the aim of returning to normal activities and sports. Isokinetic muscle testing was performed using a dynamometer. The Cybex dynamometer (Cybex International, Ronkonkowa, NY) testing revealed almost comparable readings for the operated versus the non-operated side. An average peak torque of the operated hamstring muscles of 82.78% (range 47.16–117.88%), compared to the contralateral leg, was noted at six months. An excellent outcome was found in terms of return to normal activities and sports. Early surgical repair and physiotherapy has been noted to be associated with a good outcome and enables an early return to high level sports after complete tear of the proximal hamstring tendons.

Haddad, Fares

2009-01-01

35

Successful return to high level sports following early surgical repair of complete tears of the proximal hamstring tendons.  

PubMed

The purpose of this study was to investigate the outcome of surgical management of acute complete proximal hamstring tendon tears. This was a prospective review of a case series from a tertiary referral centre. Ten patients presenting with complete proximal hamstring tendon tears were confirmed on MRI. All patients underwent surgical exploration and repair of the torn tendons with the aim of returning to normal activities and sports. Isokinetic muscle testing was performed using a dynamometer. The Cybex dynamometer (Cybex International, Ronkonkowa, NY) testing revealed almost comparable readings for the operated versus the non-operated side. An average peak torque of the operated hamstring muscles of 82.78% (range 47.16-117.88%), compared to the contralateral leg, was noted at six months. An excellent outcome was found in terms of return to normal activities and sports. Early surgical repair and physiotherapy has been noted to be associated with a good outcome and enables an early return to high level sports after complete tear of the proximal hamstring tendons. PMID:19252829

Konan, Sujith; Haddad, Fares

2010-02-01

36

Effect of supraspinatus tendon repair technique on the infraspinatus tendon.  

PubMed

Supraspinatus tendon tears are common and often propagate into larger tears that include the infraspinatus tendon, resulting in loss of function and increased pain. Previously, we showed that the supraspinatus and infraspinatus tendons mechanically interact through a range of rotation angles, potentially shielding the torn supraspinatus tendon from further injury while subjecting the infraspinatus tendon to increased risk of injury. Surgical repair of torn supraspinatus tendons is common, yet the effect of the repair on the infraspinatus tendon is unknown. Since we have established a relationship between strain in the supraspinatus and infraspinatus tendons the success of a supraspinatus tendon repair depends on its effect on the loading environment in the infraspinatus tendon. More specifically, the effect of transosseous supraspinatus tendon repair in comparison to one that utilizes suture anchors, as is commonly done with arthroscopic repairs, on this interaction through these joint positions will be evaluated. We hypothesize that at all joint positions evaluated, both repairs will restore the interaction between the two tendons. For both repairs, (1) increasing supraspinatus tendon load will increase infraspinatus tendon strain and (2) altering the rotation angle from internal to external will increase strain in the infraspinatus tendon. Strains were measured in the infraspinatus tendon insertion through a range of joint rotation angles and supraspinatus tendon loads, for the intact, transosseous, and suture anchor repaired supraspinatus tendons. Images corresponding to specific supraspinatus tendon loads were isolated for the infraspinatus tendon insertion for analysis. The effect of supraspinatus tendon repair on infraspinatus tendon strain differed with joint position. Altering the joint rotation did not change strain in the infraspinatus tendon for any supraspinatus tendon condition. Finally, increasing supraspinatus tendon load resulted in an increase in average maximum and decrease in average minimum principal strain in the infraspinatus tendon. There is a significant difference in infraspinatus tendon strain between the intact and arthroscopically (but not transosseous) repaired supraspinatus tendons that increases with greater loads. Results suggest that at low loads neither supraspinatus tendon repair technique subjects the infraspinatus tendon to potentially detrimental loads; however, at high loads, transosseous repairs may be more advantageous over arthroscopic repairs for the health of the infraspinatus tendon. Results emphasize the importance of limiting loading of the repaired supraspinatus tendon and that at low loads, both repair techniques restore the interaction to the intact supraspinatus tendon case. PMID:21303184

Andarawis-Puri, Nelly; Kuntz, Andrew F; Ramsey, Matthew L; Soslowsky, Louis J

2011-03-01

37

The role of repair tension on tendon to bone healing in an animal model of chronic rotator cuff tears.  

PubMed

Rotator cuff tendon tears are one of the most common shoulder injuries. Although surgical repair is typically beneficial, re-tearing of the tendons frequently occurs. It is generally accepted that healing is worse for chronic tears than acute tears, but the reasons for this are unknown. One potential cause may be the large tensions that are sometimes required to repair chronically torn tendons back to bone (i.e., repair tension). Therefore, the objective of this study was to utilize an animal model of chronic rotator cuff repairs to investigate the role of increased repair tension on tendon to bone healing. We hypothesized that an increase in repair tension would be related to detrimental changes to the healing insertion site. To test this hypothesis, the supraspinatus tendon of rats was surgically detached and then repaired immediately or after a delay of 2, 4, or 16 weeks. The repair tension was measured using a tensiometer and the mechanical properties, collagen organization, and protein expression of the healing insertion site were evaluated 4 and/or 16 weeks following repair. We found that the repair tension increased with time following detachment, and was related to a decrease in the failure properties and viscoelastic peak stress and an increase in cross-sectional area and stiffness of the insertion site. Therefore, repair tension should be minimized in the clinical setting. Future studies will include additional animal model studies involving the relationship between tension and muscle properties and a clinical study investigating the role of repair tension on repair failure. PMID:16600252

Gimbel, Jonathan A; Van Kleunen, Jonathan P; Lake, Spencer P; Williams, Gerald R; Soslowsky, Louis J

2007-01-01

38

Effect of Return to Overuse Activity Following an Isolated Supraspinatus Tendon Tear on Adjacent Intact Tendons and Glenoid Cartilage in a Rat Model  

PubMed Central

Rotator cuff tears are common conditions that can alter shoulder mechanics and may lead to damage of intact joint tissues. These injuries are of particular concern in populations who perform tasks requiring repetitive overhead activity (e.g., athletes and laborers) and who are likely to return to aggressive pre-injury activity levels despite limited understanding of the potentially damaging effects on the remaining tissues. Therefore, we investigated the effect of returning to overuse activity following a supraspinatus tear on shoulder function and the mechanical properties of the remaining intact tendons and glenoid cartilage. Forty rats underwent 4 weeks of overuse activity to create a tendinopathic condition followed by detachment of the supraspinatus tendon and were then randomized into two groups: continued overuse or cage activity. Ambulatory measurements were performed throughout the 8 weeks prior to euthaniasia, and properties of the adjacent tendons and cartilage were evaluated. Results demonstrated that shoulder function was not compromised in the return to overuse group. However, alterations of the glenoid cartilage and biceps tendon properties occurred. Our results help define the contributory roles of common mechanical injury mechanisms and provide a framework by which physicians could better prescribe long-term treatment strategies for patients.

Reuther, Katherine E.; Thomas, Stephen J.; Sarver, Joseph J.; Tucker, Jennica J.; Lee, Chang-Soo; Gray, Chancellor F.; Glaser, David L.; Soslowsky, Louis J.

2013-01-01

39

Transtendon arthroscopic repair of high grade partial-thickness articular surface tears of the rotator cuff with biceps tendon augmentation: technical note and preliminary results  

Microsoft Academic Search

Introduction  Partial articular surface of the rotator cuff tendon tears has been recognized as a source of treatable shoulder pain and\\u000a a precursory pathology for full-thickness tendon tears. Arthroscopic rotator cuff repair is a possible surgical method of\\u000a treatment. Recent data have shown that the treating partial-thickness rotator cuff repairs with transtendon technique shows\\u000a good clinical outcome. The use of this

Jong-Hun Ji; Mohamed Shafi; Jae-Jung Jeong; Yeon Soo Lee; Edward G. McFarland; Tae-Kwen Kim; Jun-Young Chung

40

The effect of altered loading following rotator cuff tears in a rat model on the regional mechanical properties of the long head of the biceps tendon.  

PubMed

Biceps tendon pathology is a common clinical problem often seen in conjunction with rotator cuff tears. A previous study found detrimental changes to biceps tendons in the presence of rotator cuff tears in a rat model. Therefore, the objective of this study was to utilize this model along with models of altered loading to investigate the effect of altered loading on the initiation of these detrimental changes. We created supraspinatus and infraspinatus rotator cuff tears in the rat and followed these tears with either increased or decreased loading. Mechanical properties were determined along the length of the biceps tendon 4 and 8 weeks following injury. At the insertion site, stiffness increased with decreased loading, while detrimental changes were seen with increased loading 4 weeks following detachments. Increased loading resulted in decreased mechanical properties along the entire tendon length at both time points. Decreased loading resulted in both increased and decreased tendon properties at different regions of the tendon at 4 weeks, but by 8 weeks, there were no differences between decreased loading and detachment alone. We could not conclude where changes begin in the tendon with altered loading, but did demonstrate that regional differences exist. These results support that there is an effect of altered loading, as decreased loading resulted in variable changes at 4 weeks that were no different from detachment alone by 8 weeks, and increased loading resulted in detrimental properties along the entire length at both 4 and 8 weeks. PMID:20719313

Peltz, Cathryn D; Hsu, Jason E; Zgonis, Miltiadis H; Trasolini, Nicholas A; Glaser, David L; Soslowsky, Louis J

2010-11-16

41

Acute Traumatic Tear of Gluteus Medius and Minimus Tendons in a Patient Without Antecedant Peritrochanteric Hip Pain  

PubMed Central

Morphologic similarities between the abductor mechanisms of the hip and shoulder have given rise to the term rotator cuff tear of the hip. Although the true incidence of gluteus medius and minimus tears in the general population is unknown, the association between these tears and recalcitrant lateral hip pain has been described as greater trochanteric pain syndrome. Historically, tears of the gluteus medius and minimus have been thought to be attritional, and associated with chronic peritrochanteric pain, found incidentally during fracture fixation or hip arthroplasty, or with failure of abductor repair following arthroplasty utilizing the anterolateral approach. The literature supports favorable clinical outcomes with operative repair utilizing either endoscopic or open techniques. To our knowledge, there has never been a reported case of an acute traumatic tear of the gluteus medius and minimus that occurred without antecedant peritrochanteric hip pain. In this case, the patient was treated with acute open repair of the gluteus medius and minimus tendons within 3 weeks of injury and excellent clinical results were obtained at 6-month follow-up. Of note, the patient was notified and gave consent for his case to be used in publication.

Stanton, Michael C.; Maloney, Michael D.; DeHaven, Kenneth E.; Giordano, Brian D.

2012-01-01

42

Quadriceps tendon free graft augmentation for a midsubstance tear of the medial collateral ligament during total knee arthroplasty.  

PubMed

Primary repair of a disrupted midsubstance MCL during TKA can provide satisfactory stability. However, in cases with poor soft tissue quality or a gap between the ligament ends, primary repair may not be feasible. In these cases, we have used an augmented repair. The purpose of this study is to describe the technique of augmented repair using a quadriceps tendon free graft and present our experience of five patients. A total of five patients underwent augmented repair of a transected MCL substance using a quadriceps tendon free graft. The patients were followed-up for a mean of 16 months. Augmented repair of the transected MCL substance was successful in all five patients, with a mean additional surgery time of 17 min, no coronal instability, a mean Knee Society Score of 87.0+/-2.7 (range, 85 to 90), and a mean function score of 85.0+/-3.5 (range, 80 to 90). There were no complications associated with the extensor mechanism. This data suggests that quadriceps tendon free graft augmentation might be a useful alternative for repairing midsubstance tears of the MCL in special situations, where the quality of the remaining tendon is poor, there is suspicion of stretching, and there is a small gap between both the repaired ligament ends resulting in late laxity. PMID:19464185

Jung, Kwang Am; Lee, Su Chan; Hwang, Seung Hyun; Jung, Soong Hyun

2009-12-01

43

Incomplete joint side tear of the subscapularis tendon with a small fragment in an adolescent tennis player: a case report  

PubMed Central

Case In this case report, we presented the case of an adolescent tennis player with avulsion injury of the subscapularis tendon of the right shoulder. Patients A 17-year-old right-hand-dominant male tennis player visited our hospital complaining of pain in the anterior aspect of the right shoulder. We performed X-ray and three-dimensional computed tomography (3D-CT) and magnetic resonance imaging (MRI) scans for the diagnosis. Results Plain radiographs did not reveal the presence of lesion; however, 3D-CT and MRI scans showed a small bony fragment located between the humeral head and the glenoid of the scapula and a high-intensity area of the subscapularis tendon. He was subsequently diagnosed with incomplete joint side tear of the subscapularis tendon with a small bony fragment. Subsequently, we performed arthroscopic excision of the bony fragment and repair of the subscapularis tendon. Conclusions This case highlighted the presence of an injury with minor trauma associated with repeated tennis strokes in a skeletally immature patient.

2012-01-01

44

Expression of matrix metalloproteinases 1, 3, and 9 in degenerated long head biceps tendon in the presence of rotator cuff tears: an immunohistological study  

PubMed Central

Background Long head biceps (LHB) degeneration, in combination with rotator cuff tears, can be a source of chronic shoulder pain. LHB tenotomy reduces pain and improves joint function although the pathophysiological context is not well understood. Tendon integrity depends on the extracellular matrix (ECM), which is regulated by matrix metalloproteinases (MMP). It is unclear which of these enzymes contribute to LHB but we chose to study MMP 1, 3, and 9 and hypothesized that one or more of them may be altered in LHB, whether diagnosed preoperatively or intraoperatively. We compared expression of these MMPs in both LHB and healthy tendon samples. Methods LHB samples of 116 patients with degenerative rotator cuff tears were harvested during arthroscopic tenotomy. Patients were assigned to 4 groups (partial thickness tear, full thickness tear, cuff arthropathy, or control) based upon intraoperative findings. Partial and full thickness tears were graded according to Ellman and Bateman's classifications, respectively. MMP expression was determined by immunohistochemistry. Results MMP 1 and 9 expression was significantly higher in the presence of rotator cuff tears than in controls whereas MMP 3 expression was significantly decreased. MMP 1 and 9 expression was significantly higher in articular-sided than bursal-sided partial thickness tears. No significant association was found between MMP 1 and 9 expression and full thickness tears, and the extent of the cuff tear by Bateman's classification. Conclusion Increased MMP 1 and 9 expression, and decreased MMP 3 expression are found in LHB degeneration. There is a significant association between the size and location of a rotator cuff tear and MMP expression.

2010-01-01

45

Tears of the supraspinatus tendon associated with "hidden" lesions of the rotator interval.  

PubMed

Exploration of the rotator interval during repair of 116 apparently "isolated" supraspinatus tendon lesions have revealed "hidden lesions" of the coracohumeral ligament, the superior glenohumeral ligament, and the superior portion of the subscapularis tendon in 19 cases. Epidemiologic characteristics were comparable with other series with the exception of involvement of the dominant shoulder in 95%. Arthroscopic computed tomography documented the lesion in 85% of the cases. At surgery the superficial layer of the coracohumeral ligament was always intact. After splitting of the rotator interval the lesion was visible and consisted of a local disinsertion of the common insertion of the superior glenohumeral ligament and the coracohumeral ligament and the deep superior fibers of the subscapularis tendon. It measured 1 to 2 cm in the superior-inferior direction. The biceps tendon was ruptured in 2 cases, subluxated in 14, and in its normal position in 5. The treatment consisted of intraosseous reinsertion of the supraspinatus tendon, recentering of the biceps, and reinsertion of the torn structures to reconstruct a functional pulley system. The patients have been reviewed with a mean follow-up of 20 months (range 12 to 36 months). A secondary rupture of the long head of the biceps has been observed in 25% of the cases after recentering of the tendon. PMID:22958839

Walch, G; Nove-Josserand, L; Levigne, C; Renaud, E

1994-11-01

46

Tendonitis  

MedlinePLUS

... aged adults are most susceptible, but tendonitis or tendinopathy can occur across many age groups. WHAT ARE ... Daniel Solomon, MD References: Ackermann PW, Renstrom P. Tendinopathy in sport. Sports Health. May 2012;4(3): ...

47

The effects of chronic unloading and gap formation on tendon-to-bone healing in a rat model of massive rotator cuff tears.  

PubMed

The objective of this study was to understand the effect of pre-repair rotator cuff chronicity on post-repair healing outcomes using a chronic and acute multi-tendon rat rotator cuff injury model. Full-thickness dual tendon injuries (supra- and infraspinatus) were created unilaterally in adult male Sprague Dawley rats, and left chronically detached for 8 or 16 weeks. After chronic detachment, tears were repaired and acute dual tendon injuries were created and immediately repaired on contralateral shoulders. Tissue level outcomes for bone, tendon, and muscle were assessed 4 or 8 weeks after repair using histology, microcomputed tomography, biomechanical testing, and biochemical assays. Substantial gap formation was seen in 35% of acute repairs and 44% of chronic repairs. Gap formation negatively correlated with mechanical and structural outcomes for both healing time points regardless of injury duration. Bone and histomorphometry, as well as biomechanics, were similar between acute and chronic injury and repair regardless of chronicity and duration of healing. This study was the first to implement a multi-tendon rotator cuff injury with surgical repair following both chronic and acute injuries. Massive tear in a rodent model resulted in gap formation regardless of injury duration which had detrimental effects on repair outcomes. PMID:24243733

Killian, Megan L; Cavinatto, Leonardo; Shah, Shivam A; Sato, Eugene J; Ward, Samuel R; Havlioglu, Necat; Galatz, Leesa M; Thomopoulos, Stavros

2014-03-01

48

Full-thickness rotator cuff tears. A biomechanical comparison of suture versus bone anchor techniques.  

PubMed

We performed a biomechanical comparison of two rotator cuff repair techniques using fresh-frozen human cadavers. Nine pairs of cadaveric shoulders had standardized full-thickness tears made at the supraspinatus tendon insertion. One of each pair of the cadaveric shoulders was repaired by pulling the tendon into a bone trough in the humeral head using standard sutures. The remaining half of the pairs was repaired using anchor sutures. The repairs were tested using a servohydraulically operated material testing system. The anchor suture repair was significantly stronger than the standard suture technique irrespective of bone quality. Failure occurred predominantly through bone in the suture repairs and as a result of suture breakage in the anchor repairs. The anchors should be placed into the edge of the subchondral bone adjacent to the articular surface. The surgeon should direct the anchor so that the direction of the pull is approximately 90 degrees to the anchor, with the humerus at 30 degrees of abduction. PMID:8638752

Reed, S C; Glossop, N; Ogilvie-Harris, D J

1996-01-01

49

Modified L’Episcopo Tendon Transfers for Irreparable Rotator Cuff Tears: 5-year Followup  

Microsoft Academic Search

\\u000a Abstract  Patients with posterosuperior cuff tears lose functional external rotation of the shoulder. Latissimus dorsi and teres major\\u000a transfer is performed to restore external rotation. Twenty patients with a mean age was 55.8 ± 6 years underwent this procedure\\u000a and were examined at averages of 24.7 (n = 17) and 70.6 (n = 13) months. Two patients did not improve presumably because of\\u000a failure of the transfer. The

Christian Gerhardt; Lars Lehmann; Sven Lichtenberg; Peter Magosch; Peter Habermeyer

2010-01-01

50

Rat supraspinatus muscle atrophy after tendon detachment  

Microsoft Academic Search

Rotator cuff tears are one of the most common tendon disorders found in the healthy population. Tendon tears not only affect the biomechanical properties of the tendon, but can also lead to debilitation of the muscles attached to the damaged tendons. The changes that occur in the muscle after tendon detachment are not well understood. A rat rotator cuff model

Elisabeth R. Barton; Jonathan A. Gimbel; Gerald R. Williams; Louis J. Soslowsky

2005-01-01

51

Detection of partial-thickness supraspinatus tendon tears: is a single direct MR arthrography series in ABER position as accurate as conventional MR arthrography?  

Microsoft Academic Search

Purpose  The purpose of this study was to retrospectively evaluate sensitivity and specificity of a single magnetic resonance (MR)\\u000a arthrography series in abduction external rotation (ABER) position compared with conventional MR arthrography for detection\\u000a of supraspinatus tendon tears, with arthroscopy as gold standard, and to assess interobserver variability.\\u000a \\u000a \\u000a \\u000a Materials and methods  Institutional review board approval was obtained; informed consent was waived. MR

Saskia A. Schreinemachers; Victor P. M. van der Hulst; W. Jaap Willems; Shandra Bipat; Henk-Jan van der Woude

2009-01-01

52

A biomechanical comparison between the central one-third patellar tendon and the residual tendon.  

PubMed Central

The purpose of this study was to compare the tensile strength of the central one third patellar tendon--as used for reconstruction of the anterior cruciate ligament--to that of the residual patellar tendon. Ten matched pairs of human cadaveric knees were used for this study, each specimen consisting of an intact patella-patellar tendon-proximal tibial unit. One knee from each pair was randomly selected for removal of both the medial and lateral one third of the patellar tendon, leaving the central one third intact. The contralateral knee of each pair underwent removal of the central one third of the patellar tendon, leaving the residual two thirds intact. Each specimen was then mounted in a materials testing machine and tensile tested to failure at a strain rate of 100%.s-1. The most important result to emerge from these experiments was that there was no significant difference in maximum force to failure for the residual patellar tendon compared to the central one third. Thus any thought that removal of the central one third as a graft still leaves a tendon twice as wide and therefore twice as strong as a graft is dispelled by these experiments. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5

Matava, M J; Hutton, W C

1995-01-01

53

Distal biceps tendon repair: Comparison of surgical techniques  

Microsoft Academic Search

Purpose: Various surgical repair techniques for distal biceps tendon ruptures have been reported, however, the optimal technique is unknown. Methods: Over a 4-year period 19 distal biceps tendon ruptures were repaired: 9 using a single anterior incision and 10 using a modified 2-incision Boyd and Anderson technique. The patients were followed-up prospectively and independently reviewed. Results: Patient-rated elbow evaluation and

Ron El-Hawary; Joy C. MacDermid; Kenneth J. Faber; Stuart D. Patterson; Graham J. W. King

2003-01-01

54

Rupture of the subscapularis tendon (isolated or in combination with supraspinatus tear): when is a repair indicated?  

PubMed

Ruptures of the subscapularis tendon, isolated or combined, are rare, and the treatment modalities are controversial. Of 1345 patients who underwent rotator cuff repair in a 7-year period, 73 had either an isolated rupture of the subscapularis or a subscapularis rupture combined with rupture of the supraspinatus. All reconstructions were performed through a deltopectoral approach. Reinsertion of the subscapularis was combined with reconstruction of the supraspinatus in 32 patients. Of the patients, 63 (86%) were re-examined at a mean follow-up of 35 months. The modified Constant score improved from 62% preoperatively to 91% at follow-up. Isolated or combined reconstructions did not result in significant differences with respect to the Constant score. Of the patients, 62 (98%) were satisfied with the operation. Rerupture was found by ultrasound in 8 subscapularis tendons (13%) and 4 supraspinatus tendons (13%). The rerupture rate showed a significant correlation with the Goutallier stage of fatty degeneration and the interval between injury and operation. PMID:17055750

Flury, Matthias P; John, M; Goldhahn, J; Schwyzer, H-K; Simmen, B R

2006-01-01

55

Tendon structure, disease, and imaging  

PubMed Central

Summary Tendon imaging plays a critical role in evaluating tendon diseases and injuries including mechanical, degenerative, and overuse disease, inflammatory enthesitis, as well as partial and full thickness tears. Ultrasound and magnetic resonance imaging (MRI), each with unique benefits and limitations, are commonly utilized to assist in diagnosing these diseases and conditions. This review delineates important structural properties of tendon and biochemical changes occurring in tendon pathology. This review also examines commonly injured tendons including tendons of the elbow, tendons of the rotator cuff of the shoulder, hip abductor tendons, patellar tendons, and the Achilles tendon to help clinicians better recognize tendon disease. Finally, this paper introduces several emerging imaging techniques including T2 mapping, ultra-short echo time MRI, and sonoelastography as ways in which tendon imaging and evaluation may be improved.

Weinreb, Jeffrey H.; Sheth, Chirag; Apostolakos, John; McCarthy, Mary-Beth; Barden, Benjamin; Cote, Mark P.; Mazzocca, Augustus D.

2014-01-01

56

Biomechanical analysis of bursal-sided partial thickness rotator cuff tears  

Microsoft Academic Search

Background: Treatment of partial thickness supraspinatus tendon tears is controversial with no clearly defined treatment algorithms based on severity of tears. This study aims to evaluate the relationship between depth of partial thickness tears and strain. Methods: Bursal-sided partial thickness tears were created at 1 mm increments in depth at the anterior portion of the supraspinatus tendon to 3\\/4 tendon

Scott Yang; Hyung-Soon Park; Steven Flores; Steven D. Levin; Mohsen Makhsous; Fang Lin; Jason Koh; Gordon Nuber; Li-Qun Zhang

2009-01-01

57

[Diagnostic ability of ultrasonography for the rotator cuff tear: comparison with ultrasonography and MRI findings].  

PubMed

Ultrasonography (US) is a non-invasive method which can assess not only solid tissue organs but also soft tissues such as tendons and nerves. However, it has not been fully understood that US is a useful tool for the depiction of periarticular structure. We compared the diagnostic accuracies between US and magnetic resonance imaging (MRI) in the patients with rotator cuff tear (RCT). Seventy patients, who underwent arthroscopic surgery, preoperative US and MRI examinations at Gifu University Hospital from January 2010 to April 2013 (49 male, 21 female, mean age 59.7 +/- 15.9) were included in this study. The diagnostic accuracy, sensitivity and specificity of US and MRI were 94.3% and 94.3%, 95.8% and 97.9%, 90.9% and 84.6%, respectively, when the intraoperative finding was regarded as a gold standard. These results suggest that US is useful for the diagnosis of RCT as equal as MRI. PMID:24724424

Nabetani, Yosuke; Watanabe, Tsuneo; Terabayashi, Nobuo; Hirose, Ayumi; Nohisa, Yuzuru; Shinoda, Koichi; Furuta, Nobuyuki; Ito, Hiroyasu; Matsuoka, Toshio; Seishima, Mitsuru

2014-01-01

58

Inhomogeneous mechanical behavior of the human supraspinatus tendon under uniaxial loading  

Microsoft Academic Search

Disorders of the rotator cuff, particularly tears of the rotator cuff tendons, cause significant shoulder disability. Among numerous factors thought to be responsible for the initiation and progression of supraspinatus tears are those related to the tendon’s biomechanical properties. We hypothesized that in supraspinatus tendons subjected to tensile loading a strain gradient (difference) exists between the articular and bursal tendon

Chun-Yuh Huang; Vincent M. Wang; Robert J. Pawluk; John S. Bucchieri; William N. Levine; Louis U. Bigliani; Van C. Mow; Evan L. Flatow

2005-01-01

59

Comparison of the Tendon Damage Caused by Four Different Anchor Systems Used in Transtendon Rotator Cuff Repair  

PubMed Central

Objectives. The objective of this study was to compare the damage to the rotator cuff tendons caused by four different anchor systems. Methods. 20 cadaveric human shoulder joints were used for transtendon insertion of four anchor systems. The Healix Peek, Fastin RC, Bio-Corkscrew Suture, and Healix Transtend anchors were inserted through the tendons using standard transtendon procedures. The areas of tendon damage were measured. Results. The areas of tendon damage (mean?±?standard deviation, n = 7) were 29.1?±?4.3?mm2 for the Healix Peek anchor, 20.4?±?2.3?mm2 for the Fastin RC anchor, 23.4?±?1.2?mm2 for the Bio-Corkscrew Suture anchor, 13.7?±?3.2?mm2 for the Healix Transtend anchor inserted directly, and 9.1 ± 2.1?mm2 for the Healix Transtend anchor inserted through the Percannula system (P < 0.001 or P < 0.001, compared to other anchors). Conclusions. In a cadaver transtendon rotator cuff repair model, smaller anchors caused less damage to the tendon tissues. The Healix Transtend implant system caused the least damage to the tendon tissues. Our findings suggest that smaller anchors should be considered when performing transtendon procedures to repair partial rotator cuff tears.

Zhang, Qing-Song; Liu, Sen; Zhang, Qiuyang; Xue, Yun; Ge, Dongxia; O'Brien, Michael J.; Savoie, Felix H.; You, Zongbing

2012-01-01

60

Arthroscopic Treatment of Calcific Tendonitis  

PubMed Central

Calcific tendonitis, or calcifying tendonitis, is a common disorder characterized by the multifocal accumulation of basic calcium phosphate crystals within the rotator cuff tendons. In most cases, the multifocal calcifications are located 1 to 2 cm from the insertion of the supraspinatus tendon on the greater tuberosity. The initial treatment should be nonoperative including oral anti-inflammatory medication and physical therapy. If this is unsuccessful, arthroscopic debridement of the deposit is effective. The technique used is an arthroscopic localization and debridement without associated subacromial decompression. The rotator cuff should be evaluated for partial- and full-thickness tears before and after the debridement of calcifications. If a partial- or full-thickness rotator cuff tendon tear is identified, it should be treated in a fashion consistent with those without associated calcium deposits. In our hands, tears 5 mm or greater in depth are repaired using a tendon-to-tendon or tendon-to-bone technique. Tears with less depth are debrided and then left alone. Arthroscopic debridement of calcific tendonitis can yield excellent functional results and high patient satisfaction.

Barber, F. Alan; Cowden, Courtney H.

2014-01-01

61

Arthroscopic treatment of calcific tendonitis.  

PubMed

Calcific tendonitis, or calcifying tendonitis, is a common disorder characterized by the multifocal accumulation of basic calcium phosphate crystals within the rotator cuff tendons. In most cases, the multifocal calcifications are located 1 to 2 cm from the insertion of the supraspinatus tendon on the greater tuberosity. The initial treatment should be nonoperative including oral anti-inflammatory medication and physical therapy. If this is unsuccessful, arthroscopic debridement of the deposit is effective. The technique used is an arthroscopic localization and debridement without associated subacromial decompression. The rotator cuff should be evaluated for partial- and full-thickness tears before and after the debridement of calcifications. If a partial- or full-thickness rotator cuff tendon tear is identified, it should be treated in a fashion consistent with those without associated calcium deposits. In our hands, tears 5 mm or greater in depth are repaired using a tendon-to-tendon or tendon-to-bone technique. Tears with less depth are debrided and then left alone. Arthroscopic debridement of calcific tendonitis can yield excellent functional results and high patient satisfaction. PMID:24904767

Barber, F Alan; Cowden, Courtney H

2014-04-01

62

Arthroscopic Recognition and Repair of the Torn Subscapularis Tendon  

PubMed Central

Although the subscapularis has historically received less attention than posterosuperior rotator cuff tears, repair of a torn subscapularis tendon is critically important to restoring anatomy and achieving the best functional outcome possible. Arthroscopic repair begins with proper recognition of the tear. A systematic approach can then be used to arthroscopically repair all types of subscapularis tendon tears, from partial tears to full-thickness tears, as well as those which are retracted and have adhesions medially. Subscapularis footprint restoration can be accomplished with a variety of repair techniques that must be matched to the extent of the tear and mobility of the tendon.

Denard, Patrick J.; Burkhart, Stephen S.

2013-01-01

63

Arthroscopic recognition and repair of the torn subscapularis tendon.  

PubMed

Although the subscapularis has historically received less attention than posterosuperior rotator cuff tears, repair of a torn subscapularis tendon is critically important to restoring anatomy and achieving the best functional outcome possible. Arthroscopic repair begins with proper recognition of the tear. A systematic approach can then be used to arthroscopically repair all types of subscapularis tendon tears, from partial tears to full-thickness tears, as well as those which are retracted and have adhesions medially. Subscapularis footprint restoration can be accomplished with a variety of repair techniques that must be matched to the extent of the tear and mobility of the tendon. PMID:24400185

Denard, Patrick J; Burkhart, Stephen S

2013-01-01

64

Achilles Tendonitis  

MedlinePLUS

... Kim she had Achilles tendonitis. What Is Achilles Tendonitis and Who Gets It? Your Achilles tendon is ... painful. Continue What Are the Symptoms of Achilles Tendonitis? Most cases of Achilles tendonitis start out slowly, ...

65

Basic mechanisms of tendon fatigue damage  

PubMed Central

Pathologic processes intrinsic and extrinsic to the tendons have been proposed as the underlying cause of rotator cuff disease, but the precise etiology is not known. Tear formation is, in part, attributable to the accumulation of subrupture tendon fatigue damage. We review the molecular, mechanical, and structural changes induced in tendons subjected to controlled amounts of fatigue loading in an animal model of early tendinopathy. The distinct tendon responses to low and moderate levels of loading, as opposed to high levels, provide insight into the potential mechanisms for the therapeutic benefits of exercise in the treatment of rotator cuff tendinopathy. The progression of damage accumulation leading to fiber rupture and eventual tendon tearing seen with higher loading illustrates the progression from tendinopathy to full-thickness tearing. We hope that this more realistic animal model of tendon fatigue damage will allow better assessment of biologic, mechanical, tissue-engineering, and rehabilitation strategies to improve repair success.

Neviaser, Andrew; Andarawis-Puri, Nelly; Flatow, Evan

2012-01-01

66

Biomechanical comparison of stimulated and nonstimulated skeletal muscle pulled to failure  

Microsoft Academic Search

We compared the biomechanical properties of passive and stimulated muscle rapidly lengthened to failure in an experimental animal model. The mechanical param eters compared were force to tear, change in length to tear, site of failure, and energy absorbed by the muscle- tendon unit before failure. Paired comparisons were made between 1) muscles stimulated at 64 Hz (tetanic stimulation) and

William E. Garrett; Marc R. Safran; Anthony V. Seaber; Richard R. Glisson; Beth M. Ribbeck

1987-01-01

67

Tendonitis (image)  

MedlinePLUS

Tendonitis is the inflammation, irritation, and swelling of a tendon. It can occur as a result of ... repetitive strain on the forearm muscles can cause tendonitis. The most common symptom of tendonitis is pain, ...

68

Diagnosis of tears in rotator-cuff-injuries  

Microsoft Academic Search

Pathology of the rotator cuff is the cause of most common problems at the shoulder joint. Acute injuries are not as frequent as chronic cuff disease, but often they aggravate inflammatory or degenerative tendon alterations, even if they are of minor severity. Traumatic rotator cuff tears predominantly affect the supraspinatus tendon or the rotator interval. The subscapularis tendon is involved

Claudius Gückel; Andreas Nidecker

1997-01-01

69

Imaging of Tendons  

PubMed Central

Both magnetic resonance imaging (MRI) and sonography are well suited to tendon imaging. A normal tendon on MRI demonstrates low signal intensity and on sonography, an echogenic fibrillar pattern. MRI is considered the imaging gold standard, providing an anatomic overview and excellent soft tissue contrast. Sonography is a more rapidly performed examination; it has greater resolution than that of MRI; it allows dynamic evaluation of tendons and muscles; and it can guide percutaneous therapeutic procedures. Moreover, the advent of sonographic extended-field-of-view imaging allows the demonstration of the entire length of a tendon, matching MRI’s ability to display a large anatomic region. Sonography should best be considered a focused examination, concentrating on the area of pain and clinical suspicion of pathology, whereas MRI can provide a global assessment of the region of concern. Both modalities demonstrate high accuracy for abnormalities of various tendons. This article reviews normal tendon anatomy and its imaging appearance, as well as the imaging appearances of tendon degeneration and tear.

Chang, Anthony; Miller, Theodore T.

2009-01-01

70

Clinical and biological aspects of rotator cuff tears  

PubMed Central

Summary Rotator cuff tears are common and are a frequent source of shoulder pain and disability. A wide variation in the prevalence of rotator cuff tears has been reported. The etiology of rotator cuff tear remains multifactorial and attempts to unify intrinsic and extrinsic theories tried to explain the etiopathogenesis of rotator cuff tears. Knowledge of the etiopathogenesis of rotator cuff tears is important to improve our therapies, surgical techniques and promote tendon repair. Several strategies have been proposed to enhance tendon healing and recently research has focused on regenerative therapies, such as Growth Factors (GFs) and Plasma Rich Platelet (PRP), with high expectations of success.

Giai Via, Alessio; De Cupis, Mauro; Spoliti, Marco; Oliva, Francesco

2013-01-01

71

Comparison of Low-Abundance Biomarker Levels in Capillary-Collected Nonstimulated Tears and Washout Tears of Aqueous-Deficient and Normal Patients  

PubMed Central

Purpose. Low tear volume limits the use of nonstimulated (NS) microcapillary tear collection in aqueous-deficient (AD) patients. Adding a small amount of “washout” fluid to the eye prior to tear collection is a potentially viable alternative method for abundant proteins, but is relatively untested for low-abundance biomarkers. This study determined the feasibility of the washout (WO) method as an NS alternative for low-abundance biomarkers. NS and WO biomarker profiles were compared between AD patients and non-AD controls to determine if the two methods identify the same intergroup differences. Methods. Matching NS and WO tears were collected from 48 patients by micropipette, the WO sample after instillation of 10 ?L saline. Tear cytokine levels were measured by 27-Plex Bio-Rad assay. Bland–Altman analyses for each biomarker determined the agreement between tear sample types. Patients were grouped as AD or non-AD based on Schirmer score to determine if NS profile between-group differences were preserved in WO tears. Results. Bland–Altman plots showed good biomarker level agreement between NS and WO tears for most cytokines. Five biomarkers, among those most often cited as differing in AD dry eye, differed significantly between non-AD and AD groups in both tear types. Additional biomarker differences were seen in NS tears only. Conclusions. The WO tear collection method is a viable alternative to NS tears for many low-abundance biomarkers and is able to replicate major NS tear differences between dry eye groups. More subtle intergroup differences are lost in WO samples because of reduced statistical power.

Guyette, Nicole; Williams, Larezia; Tran, My-Tho; Than, Tammy; Bradley, John; Kehinde, Lucy; Edwards, Clara; Beasley, Mark; Fullard, Roderick

2013-01-01

72

Light microscopic histology of supraspinatus tendon ruptures  

Microsoft Academic Search

We analysed the morphological features of the human surgical specimens of supraspinatus tendon from patients with rotator\\u000a cuff tears. Tendon samples were harvested from 31 subjects (21 men and 10 women; mean age 51 years, range 38–64) who underwent\\u000a arthroscopic repair of a rotator cuff tear, and from five male patients who died of cardiovascular events (mean age, 69.6 years).\\u000a Histological examination

Umile Giuseppe Longo; Francesco Franceschi; Laura Ruzzini; Carla Rabitti; Sergio Morini; Nicola Maffulli; Francisco Forriol; Vincenzo Denaro

2007-01-01

73

Comparison of ophthalmic sponges and extraction buffers for quantifying cytokine profiles in tears using Luminex technology  

PubMed Central

Purpose Evaluating cytokine profiles in tears could shed light on the pathogenesis of various ocular surface diseases. When collecting tears with the methods currently available, it is often not possible to avoid the tear reflex, which may give a different cytokine profile compared to basal tears. More importantly, tear collection with glass capillaries, the most widely used method for taking samples and the best method for avoiding tear reflex, is impractical for remote area field studies because it is tedious and time-consuming for health workers, who cannot collect tears from a large number of patients with this method in one day. Furthermore, this method is uncomfortable for anxious patients and children. Thus, tears are frequently collected using ophthalmic sponges. These sponges have the advantage that they are well tolerated by the patient, especially children, and enable standardization of the tear collection volume. The aim of this study was to compare various ophthalmic sponges and extraction buffers to optimize the tear collection method for field studies for subsequent quantification of cytokines in tears using the Luminex technology. Methods Three ophthalmic sponges, Merocel, Pro-ophta, and Weck-Cel, were tested. Sponges were presoaked with 25 cytokines/chemokines of known concentrations and eluted with seven different extraction buffers (EX1–EX7). To assess possible interference in the assay from the sponges, two standard curves were prepared in parallel: 1) cytokines of known concentrations with the extraction buffers and 2) cytokines of known concentrations loaded onto the sponges with the extraction buffers. Subsequently, a clinical assessment of the chosen sponge-buffer combination was performed with tears collected from four healthy subjects using 1) aspiration and 2) sponges. To quantify cytokine/chemokine recovery and the concentration in the tears, a 25-plex Cytokine Panel and the Luminex xMap were used. This platform enables simultaneous measurement of proinflammatory cytokines, Th1/Th2 distinguishing cytokines, nonspecific acting cytokines, and chemokines. Results We demonstrated the following: (i) 25 cytokines/chemokines expressed highly variable interactions with buffers and matrices. Several buffers enabled recovery of similar cytokine values (regulated and normal T cell expressed and secreted [RANTES], interleukin [IL]-13, IL-6, IL-8, IL-2R, and granulocyte-macrophage colony-stimulating factor [GM-CSF]); others were highly variable (monocyte chemotactic protein-1 [MCP-1], monokine induced by interferon-gamma [MIG], IL-1?, IL-4, IL-7, and eotaxin). (ii) Various extraction buffers displayed significantly different recovery rates on the same sponge for the same cytokine/chemokine. (iii) The highest recovery rates were obtained with the Merocel ophthalmic sponge except for tumor necrosis factor-?: the Weck-Cel ophthalmic sponge showed the best results, either with cytokine standards loaded onto sponges or with tears collected from the inner canthus of the eye, using the sponge. (iv) IL-5, IL-10, and interferon-? were not detected in any tear sample from four normal human subjects. Twenty-two cytokines/chemokines that we detected were extracted from the Merocel sponge to a satisfactory recovery percentage. The recovery of IL-7 was significantly lower in the extracted Merocel sponge compared to the diluted tear samples. The cytokine/chemokine extraction from tears showed the same pattern of extraction that we observed for extracting the standards. Conclusions Simultaneous measurement of various cytokines using ophthalmic sponges yielded diverse results for various cytokines as the level of extraction differs noticeably for certain cytokines. A second set of controls (standard curves “with sponges”) should be used to delineate the extent of extraction for each cytokine to be analyzed. Many cytokines/chemokines were detected in tear samples collected with the Merocel sponge, including many that have been implicated in ocular surface disease. Luminex detection of

Inic-Kanada, Aleksandra; Nussbaumer, Andrea; Montanaro, Jacqueline; Belij, Sandra; Schlacher, Simone; Stein, Elisabeth; Bintner, Nora; Merio, Margarethe; Zlabinger, Gerhard J.

2012-01-01

74

Biochemical markers in the synovial fluid of glenohumeral joints from patients with rotator cuff tear.  

PubMed

It is known that rotator cuff tears are sometimes accompanied by joint destruction. Our purpose was to elucidate the pathology with this condition. Thirty-two synovial fluid (SF) samples aspirated from the glenohumeral joints of patients with rotator cuff tears, including 7 with partial-thickness and 25 with full-thickness tears of the rotator cuff (10 massive and 15 isolated supraspinatus tendon (SSp) tears), were examined. Collagenase (MMP-1), stromelysin 1 (MMP-3), tissue inhibitor of metalloproteinases-1 (TIMP-1) and carboxy-terminal type II procollagen peptide (pCOL Il-C) were measured in the SF using the respective sandwich enzyme immunoassays. Glycosaminoglycan (GAG) was also quantified with a cationic dye binding method using 1,9-dimethylmethylene blue. Levels of any molecules except pCOL II-C in the SF appeared to be higher in full-thickness tears than those in partial-thickness tears. Moreover, levels of MMP-1, MMP-3 and GAG in the SF were significantly higher in massive tears of the rotator cuff in comparison with those in isolated SSp tears. Such significance was not observed in the levels of TIMP-1 or pCOL II C in the SF. We examined the relation of those levels with operative findings or clinical parameters from full-thickness tears, and observed significant correlations of the tear size with the levels of MMP-1, MMP-3 and GAG in the SF. Although these marker molecules in SF do not always originate from cartilage, our results may indicate the potential for accelerated cartilage-degrading activity in the glenohumeral joint in massive tears of the rotator cuff. PMID:11518264

Yoshihara, Y; Hamada, K; Nakajima, T; Fujikawa, K; Fukuda, H

2001-07-01

75

The repair of the Achilles tendon rupture: comparison of two percutaneous techniques.  

PubMed

This study proposes a comparison between two percutaneous techniques of subcutaneous Achilles tendon rupture by evaluating the risk of lesion developing, the morbidity of the surgical technique adopted and the effectiveness of each technique. Sixty patients were operated at Padua Orthopaedic Clinic by using the two different procedures: (1) Ma and Griffith in 30 cases and (2) Tenolig in 30 cases. Risk of rupture developing has been evaluated in relation to sex, age, side, kind of trauma, work and presence of preoperative risk factors. The Morbidity of surgical technique has been evaluated in with respect to surgical time, hospital permanence, immobilization, active nonweight-bearing mobilization, assisted weight bearing until the full one, number of early and late complications before and after hospital discharge. Effectiveness has been evaluated in relation to return time to common life, work and sport; anatomical and functional features have been evaluated using McComis score, rating results as: very good (from 80 to 70), good (from 69 to 60), fair (from 59 to 50) and poor (<50). Tenolig group shows shorter average time from hospital admission and operation, hospital permanence and immobilization (P < 0.05), and it results in an easier and quicker execution and functionally stimulates the tendon healing in a short time. Effectiveness was the same for both techniques because average McComis score was good (P = 0.35), and there was no significant differences in common life returning time (P = 0.12). Tenolig technique seems to be preferable to Ma and Griffith. PMID:22065368

Taglialavoro, G; Biz, C; Mastrangelo, G; Aldegheri, R

2011-11-01

76

Massive tears of the rotator cuff treated with a deltoid flap  

Microsoft Academic Search

We retrospectively reviewed the charts of 29 patients younger than 65 years at surgery treated with deltoid flap reconstruction for massive postero-superior rotator cuff tears. All tears involved supraspinatus and infraspinatus tendons and were associated with tendon stump retraction to the glenoid rim, a preservable long biceps tendon, and an intact subscapularis tendon. Mean follow-up was 10.5 years. Patient satisfaction

Eric Vandenbussche; Moncef Bensaïda; Céline Mutschler; Thierry Dart; Bernard Augereau

2004-01-01

77

Endoscopic Repair of a Gluteus Medius Tear at the Musculotendinous Junction  

PubMed Central

Abductor tendon tears are an increasingly recognized clinical entity in patients with lateral thigh pain and weakness. These “rotator cuff tears of the hip” typically result from chronic, nontraumatic rupture of the anterior fibers of the gluteus medius. Although the abductor tendon typically tears from the osseous insertion, the case discussed here ruptured at the musculotendinous junction. This is the first report of this abductor tear subtype and its endoscopic repair.

Yanke, Adam B.; Hart, Michael A.; McCormick, Frank; Nho, Shane J.

2013-01-01

78

The bursal and articular sides of the supraspinatus tendon have a different compressive stiffness  

Microsoft Academic Search

Objective. To measure the compressive stiffness of the supraspinatus tendon and to determine whether regional difference exists in the bursal and articular side of the tendon.Design. Indentation testing was performed on both the bursal and articular sides of the supraspinatus tendon, focused on the ‘critical area’, where rotator cuff tears often occur.Background. When the supraspinatus tendon wraps around the humeral

Seok-Beom Lee; Tomotaka Nakajima; Zong-Ping Luo; Mark E Zobitz; Yi-Wen Chang; Kai-Nan An

2000-01-01

79

SLAP Tears  

MedlinePLUS

... caused by acute trauma or by repetitive shoulder motion. An acute SLAP injury may result from: • A ... labrum tears as a result of repeated shoulder motion. Many SLAP tears, however, are the result of ...

80

Meniscus tears  

MedlinePLUS

... provider if symptoms of a meniscus tear occur after an injury to the knee. Call your health care provider if you are being treated for a meniscus tear and: Pain and swelling returns You have increased instability in ...

81

Peroneus longus tear and its relation to the peroneal tubercle: A review of the literature  

PubMed Central

Summary Tear of the peroneal tendon may occur in different anatomical sites. The most prevalent site is around the lateral malleolus. Tear of the peroneus longus at the level of the peroneal tubercle is unusual. Anatomically, the lateral surface of the calcaneous can be divided into thirds. The middle third includes the peroneal tubercle, which separates the peroneus longus tendon from the peroneus brevis. An anatomic variation of the peroneal tubercle may lead to chronic irritation of the peroneus longus tendon that could ultimately cause a longitudinal tear. We conducted this review aiming to clarify the anatomy, biomechanics of the tendon, and the clinical features of tear of the peroneus longus tendon on the lateral surface of the calcaneous due to an enlarged peroneal tubercle. In addition, we reviewed the diagnostic and treatment options of peroneal tendon tears at this site.

Palmanovich, Ezequiel; Laver, Lior; Brin, Yaron S.; Kotz, Evgeny; Hetsroni, Iftach; Mann, Gideon; Nyska, Meir

2011-01-01

82

Marked pathological changes proximal and distal to the site of rupture in acute Achilles tendon ruptures  

Microsoft Academic Search

A laboratory study was performed to evaluate the histopathological features of the macroscopically intact portion of the Achilles\\u000a tendon in patients undergoing surgery for an acute rupture of the Achilles tendon. Tendon samples were harvested from 29 individuals\\u000a (21 men, 8 women; mean age: 46 ± 12) who underwent repair of an Achilles tendon tear tear, and from 11 male patients who

Nicola MaffulliUmile; Umile Giuseppe Longo; Gayle D. Maffulli; Carla Rabitti; Anil Khanna; Vincenzo Denaro

2011-01-01

83

Meniscus Tears  

MedlinePLUS

... snowboarding Meniscus tears often happen along with other knee injuries such as ligament tears. How Can You Prevent a Meniscus Tear? ... For Kids For Parents MORE ON THIS TOPIC Knee Injuries Anterior Cruciate Ligament (ACL) Injuries Runner's Knee Knee Injury: Caroline's Story ...

84

Effect of glenohumeral abduction angle on the mechanical interaction between the supraspinatus and infraspinatus tendons for the intact, partial-thickness torn, and repaired supraspinatus tendon conditions.  

PubMed

Rotator cuff tears are difficult to manage because of the structural and mechanical inhomogeneity of the supraspinatus tendon. Previously, we showed that with the arm at the side, the supraspinatus and infraspinatus tendons mechanically interact such that conditions that increase supraspinatus tendon strain, such as load or full-thickness tears, also increase infraspinatus tendon strain. This suggests that the infraspinatus tendon may shield the supraspinatus tendon from further injury while becoming at increased risk of injury itself. In this study, the effect of glenohumeral abduction angle on the interaction between the two tendons was evaluated for supraspinatus tendon partial-thickness tears and two repair techniques. Principal strains were quantified in both tendons for 0 degrees , 30 degrees , and 60 degrees of glenohumeral abduction. Results showed that interaction between the two tendons is interrupted by an increase in abduction angle for all supraspinatus tendon conditions evaluated. Infraspinatus tendon strain was lower at 30 degrees and 60 degrees than at 0 degrees abduction angle. In conclusion, interaction between the supraspinatus and infraspinatus tendons is interrupted with increase in abduction angle. Additionally, 30 degrees abduction should be further evaluated for management of rotator cuff tears and repairs as it is the angle at which both supraspinatus and infraspinatus tendon strain is decreased. PMID:20058264

Andarawis-Puri, Nelly; Kuntz, Andrew F; Ramsey, Matthew L; Soslowsky, Louis J

2010-07-01

85

Effect of Glenohumeral Abduction Angle on the Mechanical Interaction between the Supraspinatus and Infraspinatus Tendons for the Intact, Partial-thickness Torn and Repaired Supraspinatus Tendon Conditions  

PubMed Central

Rotator cuff tears are difficult to manage because of the structural and mechanical inhomogeneity of the supraspinatus tendon. Previously, we showed that with the arm at the side, the supraspinatus and infraspinatus tendons mechanically interact such that conditions that increase supraspinatus tendon strain, such as load or full-thickness tears, also increase infraspinatus tendon strain. This suggests that the infraspinatus tendon may shield the supraspinatus tendon from further injury while becoming at increased risk of injury itself. In this study, the effect of glenohumeral abduction angle on the interaction between the two tendons was evaluated for supraspinatus tendon partial-thickness tears and two repair techniques. Principal strains were quantified in both tendons for 0°, 30° and 60° of glenohumeral abduction. Results showed that interaction between the two tendons is interrupted by an increase in abduction angle for all supraspinatus tendon conditions evaluated. Infraspinatus tendon strain was lower at 30° and 60° than at 0° abduction angle. In conclusion, interaction between the supraspinatus and infraspinatus tendons is interrupted with increase in abduction angle. Additionally, 30° abduction should be further evaluated for management of rotator cuff tears and repairs as it is the angle at which both supraspinatus and infraspinatus tendon strain is decreased.

Andarawis-Puri, Nelly; Kuntz, Andrew F.; Ramsey, Matthew L.

2012-01-01

86

Comparison of mechanical and histological properties between the immature and mature tendon attachment  

Microsoft Academic Search

We tested the tensile strength of the Achilles tendon attachment to the calcaneus in skeletal mature and immature rabbits. The mean ultimate failure load was 179.6ᆰ.6 N in the mature animals, and 138.5ᆸ.1 N in the immature animals (P Résumé. Nous avons testé la résistance à la tension de l'insertion du tendon Achille au Calcanéum chez les lapins matures et

Kazutoshi Furikado; Hiroyuki Fujioka; Masahiro Kurosaka; Shinichi Yoshiya; Takeshi Makino; Kenji Fujita

2002-01-01

87

Biomechanical comparisons of anterior cruciate ligament: reconstruction procedures with flexor tendon graft.  

PubMed

An experimental study was conducted to compare the biomechanical characteristics of six currently available anterior cruciate ligament (ACL) reconstruction procedures with flexor digitorum profundus tendons. Forty porcine knees were divided into eight groups, of 5 knees each. In groups A, B, C, and D, the flexor tendon graft was fixed with sutures and an Endobutton, with 20-mm-wide polyester tapes and staples, with 10-mm-wide polyester tapes and an Endobutton, and with bone plugs and interference screws, respectively. In group E, the graft was fixed using a combined procedure of those in groups B and D. In group F, the graft was directly fixed with interference screws. In groups G and H, the bone-patellar tendon-bone graft was fixed with interference screws, and sutures, respectively. Each femur-graft-tibia complex specimen was tested with a tensile tester by anteriorly translating the tibia until failure. This study demonstrated that the biomechanical properties of the femur-graft-tibia complex reconstructed with the flexor tendon graft were significantly affected by synthetic fixation devices. Regarding the average maximal load of the groups with the flexor tendon graft, group B had the highest (893 N) and group C had the second highest (770 N). Groups E and A were in the third rank. Group F had the second lowest (312 N), and Group D had the lowest (230 N). The maximal load of group B was significantly greater (P < 0.01) than that of group G (656 N) with the bone-patellar tendon-bone grafts. As to clinical relevance, this study indicated that the flexor tendon graft can be an alternative substitute for the bone-patellar tendon-bone graft for ACL reconstruction, if we understand the biomechanical characteristics of each reconstruction procedure. PMID:11180923

Miyata, K; Yasuda, K; Kondo, E; Nakano, H; Kimura, S; Hara, N

2000-01-01

88

Intra-articular Partial-Thickness Rotator Cuff TearsAnalysis of Injured and Repaired Strain Behavior  

Microsoft Academic Search

Background: There are few biomechanical studies regarding partial-thickness rotator cuff tears and subsequent repair.Hypothesis: Partial-thickness intra-articular supraspinatus tendon tears increase articular-sided tendon strain as they increase in size. Repair of these tears will return strain to the intact state.Study Design: Controlled laboratory study.Methods: Twenty fresh-frozen human cadaveric shoulders were prepared by dissecting to the supraspinatus tendon and leaving the native

Augustus D. Mazzocca; Lina M. Rincon; Robert W. OConnor; Elifho Obopilwe; Matthew Andersen; Lauren Geaney; Robert A. Arciero

2008-01-01

89

Refixation of the supraspinatus tendon in a rat model--influence of continuous growth factor application on tendon structure.  

PubMed

The purpose was to evaluate histological changes of the supraspinatus tendon (SSP) after refixation under continuous growth factor application over 20 days in comparison to the native healing process. In a chronic rat tendon tear model (15 rats/group), a transosseous SSP refixation was performed and growth factors (control, G-CSF, b-FGF, combination) were continuously released into the subacromial space by an osmotic pump. Tendon healing was evaluated histologically by a modified MOVIN-Score, and Collagen I/III content was determined by immunohistology at 6 weeks. A modified MOVIN sum score showed significant lower counts for G-CSF and b-FGF in comparison to the control group (p = 0.050/p = 0.027) and the combined group (p = 0.050/p = 0.043). Collagen III was significantly reduced in the combined group compared to the control group (p = 0.028). Collagen I showed no significant differences. The Collagen I/III ratio was nearly doubled for b-FGF and the combined group compared to the control. At the study endpoint, 33% of pump dislocations were detected. The continuous application of both isolated growth factors (G-CSF/b-FGF) achieved improved tendon-remodeling. However, the continuous application via an osmotic pump showed a relative high dislocation rate when applied in the rat model. PMID:22912341

Buchmann, Stefan; Sandmann, Gunther H; Walz, Lars; Hoppe, Henriette; Beitzel, Knut; Wexel, Gabriele; Tian, Weiwei; Winter, Gerhard; Imhoff, Andreas B

2013-02-01

90

Rat supraspinatus muscle atrophy after tendon detachment.  

PubMed

Rotator cuff tears are one of the most common tendon disorders found in the healthy population. Tendon tears not only affect the biomechanical properties of the tendon, but can also lead to debilitation of the muscles attached to the damaged tendons. The changes that occur in the muscle after tendon detachment are not well understood. A rat rotator cuff model was utilized to determine the time course of changes that occur in the supraspinatus muscle after tendon detachment. It was hypothesized that the lack of load on the supraspinatus muscle would cause a significant decrease in muscle mass and a conversion of muscle fiber properties toward those of fast fiber types. Tendons were detached at the insertion on the humerus without repair. Muscle mass, morphology and fiber properties were measured at one, two, four, eight, and 16 weeks after detachment. Tendon detachment resulted in a rapid loss of muscle mass, an increase in the proportion of fast muscle fibers, and an increase in the fibrotic content of the muscle bed, concomitant with the appearance of adhesions of the tendon to surrounding surfaces. At 16 weeks post-detachment, muscle mass and the fiber properties in the deep muscle layers returned to normal levels. However, the fiber shifts observed in the superficial layers persisted throughout the experiment. These results suggest that load returned to the muscle via adhesions to surrounding surfaces, which may be sufficient to reverse changes in muscle mass. PMID:15734235

Barton, Elisabeth R; Gimbel, Jonathan A; Williams, Gerald R; Soslowsky, Louis J

2005-03-01

91

Supraspinatus tears: Propagation and strain alteration  

Microsoft Academic Search

It was hypothesized that there would be an alteration in strain when macroscopically normal supraspinatus tendons were subjected to three patterns of surgically created tear. The propagation of joint-side partial-thickness tears was also examined. Cadaveric shoulders were tested on a purpose-built rig with static loading from 20 to 200 N and during glenohumeral abduction from 0° to 120° with a

Peter Reilly; Andrew A. Amis; Andrew L. Wallace; Roger J. H. Emery

2003-01-01

92

Tendon's ultrastructure  

PubMed Central

Summary The structure of a tendon is an important example of complexity of ECM three-dimensional organization. The extracellular matrix (ECM) is a macromolecular network with both structural and regulatory functions. ECM components belong to four major types of macromolecules: the collagens, elastin, proteoglycans, and noncollagenous glycoproteins. Tendons are made by a fibrous, compact connective tissue that connect muscle to bone designed to transmit forces and withstand tension during muscle contraction. Here we show the ultrastructural features of tendon’s components.

Tresoldi, Ilaria; Oliva, Francesco; Benvenuto, Monica; Fantini, Massimo; Masuelli, Laura; Bei, Roberto; Modesti, Andrea

2013-01-01

93

Comparison of tear protein levels in breast cancer patients and healthy controls using a de novo proteomic approach  

PubMed Central

Noninvasive biomarkers are urgently needed for early detection of breast cancer since the risk of recurrence, morbidity and mortality are closely related to disease stage at the time of primary surgery. In the past decade, many proteomics-based approaches were developed that utilize the protein profiling of human body fluids or identification of putative biomarkers to obtain more knowledge on the effects of cancer emergence and progression. Herein, we report on an analysis of proteins in the tear fluid from breast carcinoma patients and healthy women using a de novo proteomic approach and 25 mixed samples from each group. This study included 25 patients with primary invasive breast carcinoma and 25 age-matched healthy controls. We performed a MALDI-TOF-TOF-driven semi-quantitative comparison of tear protein levels in cancer (CA) and control (CTRL) using a de novo approach in pooled samples. Over 150 proteins in the tear fluid of CTRL and CA were identified. Using an in-house-developed algorithm we found more than 20 proteins distinctly upregulated or downregulated in the CTRL and CA groups. We identified several proteins that had modified expression in breast cancer patients. These proteins are involved in host immune system pathways (e.g., C1Q1 or S100A8) and different metabolic cascades (ALDH3A or TPI). Further validation of the results in an independent population combined with individual protein profiling of participants is needed to confirm the specificity of our findings and may lead to a better understanding of the pathological mechanism of breast cancer.

BOHM, DANIEL; KELLER, KSENIA; PIETER, JULIA; BOEHM, NILS; WOLTERS, DOMINIK; SIGGELKOW, WULF; LEBRECHT, ANTJE; SCHMIDT, MARCUS; KOLBL, HEINZ; PFEIFFER, NORBERT; GRUS, FRANZ-HERMANN

2012-01-01

94

Comparison of tear protein levels in breast cancer patients and healthy controls using a de novo proteomic approach.  

PubMed

Noninvasive biomarkers are urgently needed for early detection of breast cancer since the risk of recurrence, morbidity and mortality are closely related to disease stage at the time of primary surgery. In the past decade, many proteomics-based approaches were developed that utilize the protein profiling of human body fluids or identification of putative biomarkers to obtain more knowledge on the effects of cancer emergence and progression. Herein, we report on an analysis of proteins in the tear fluid from breast carcinoma patients and healthy women using a de novo proteomic approach and 25 mixed samples from each group. This study included 25 patients with primary invasive breast carcinoma and 25 age-matched healthy controls. We performed a MALDI-TOF-TOF-driven semi-quantitative comparison of tear protein levels in cancer (CA) and control (CTRL) using a de novo approach in pooled samples. Over 150 proteins in the tear fluid of CTRL and CA were identified. Using an in-house-developed algorithm we found more than 20 proteins distinctly upregulated or downregulated in the CTRL and CA groups. We identified several proteins that had modified expression in breast cancer patients. These proteins are involved in host immune system pathways (e.g., C1Q1 or S100A8) and different metabolic cascades (ALDH3A or TPI). Further validation of the results in an independent population combined with individual protein profiling of participants is needed to confirm the specificity of our findings and may lead to a better understanding of the pathological mechanism of breast cancer. PMID:22664934

Böhm, Daniel; Keller, Ksenia; Pieter, Julia; Boehm, Nils; Wolters, Dominik; Siggelkow, Wulf; Lebrecht, Antje; Schmidt, Marcus; Kölbl, Heinz; Pfeiffer, Norbert; Grus, Franz-Hermann

2012-08-01

95

A 10Year Comparison of Anterior Cruciate Ligament Reconstructions With Hamstring Tendon and Patellar Tendon AutograftA Controlled, Prospective Trial  

Microsoft Academic Search

Background: There are no controlled, prospective studies comparing the 10-year outcomes of anterior cruciate ligament (ACL) reconstruction using patellar tendon (PT) and 4-strand hamstring tendon (HT) autografts.Hypothesis: Comparable results are possible with HT and PT autografts.Study Design: Cohort study; Level of evidence, 2.Methods: One hundred eighty ACL-deficient knees that met inclusion criteria underwent ACL reconstruction (90 HT autograft, 90 PT

Leo A. Pinczewski; Jeffrey Lyman; Lucy J. Salmon; Vivianne J. Russell; Justin Roe; James Linklater

2007-01-01

96

[Pathological study of the supraspinatus tendon].  

PubMed

To clarify the aging process and pathogenesis of rotator cuff tears, left supraspinatus tendons from 268 cadaveric specimens (171 men and 97 women, ages 0 to 87 years) were studied. The incidence of complete thickness tear was 6.7%, and that of incomplete thickness tear was 13.8% (bursal side tears: 2.6%, intratendinous tears: 7.5% and joint side tears: 3.7%). Microscopic examinations were conducted topographically in five sites near the supraspinatus insertion. In the articular side of the tendon, there were fewer tenocytes, fewer arterioles and more chondrocyte like cells than in any other portions. The incidence of hyperplasia of intima was higher in the specimens of aged persons in all portions. At the insertion in the aged specimens the arrangement of four transitional zones became much more irregular and the numbers of tidemark was occasionally increased with granulomatous tissue. The pathogenesis of the rotator cuff tear can be ascribed to the combination of aging, enthesopathy, inherent property of the supraspinatus tendon, injury and subacromial impingement. PMID:3249097

Yamanaka, K

1988-12-01

97

Lower muscle regenerative potential in full-thickness supraspinatus tears compared to partial-thickness tears  

PubMed Central

Background and purpose Rotator cuff tears are associated with secondary rotator cuff muscle pathology, which is definitive for the prognosis of rotator cuff repair. There is little information regarding the early histological and immunohistochemical nature of these muscle changes in humans. We analyzed muscle biopsies from patients with supraspinatus tendon tears. Methods Supraspinatus muscle biopsies were obtained from 24 patients undergoing arthroscopic repair of partial- or full-thickness supraspinatus tendon tears. Tissue was formalin-fixed and processed for histology (for assessment of fatty infiltration and other degenerative changes) or immunohistochemistry (to identify satellite cells (CD56+), proliferating cells (Ki67+), and myofibers containing predominantly type 1 or 2 myosin heavy chain (MHC)). Myofiber diameters and the relative content of MHC1 and MHC2 were determined morphometrically. Results Degenerative changes were present in both patient groups (partial and full-thickness tears). Patients with full-thickness tears had a reduced density of satellite cells, fewer proliferating cells, atrophy of MHC1+ and MHC2+ myofibers, and reduced MHC1 content. Interpretation Full-thickness tears show significantly reduced muscle proliferative capacity, myofiber atrophy, and loss of MHC1 content compared to partial-thickness supraspinatus tendon tears.

2013-01-01

98

Subcutaneous rupture of the flexor hallucis longus tendon: a case report.  

PubMed

It is well known that rupture of the flexor hallucis longus tendon can be associated with open injuries and that closed rupture of the flexor hallucis longus tendon is rare. Tendon injuries of the foot can occur secondary to direct, indirect, or repetitive injury. Repetitive tendon injuries can cause tendinitis or stenosing tenosynovitis. Tendinitis is associated with internal tendon injury that can present with tendon thickening, mucinoid degeneration, nodule development, or in situ partial tears. Stenosing tenosynovitis is the development of tendon adhesions within the tendon sheath that interfere with tendon gliding, known as trigger toe. The flexor hallucis longus tendon is susceptible to injury along its entire course. A total of 35 cases of complete or partial closed ruptures of the flexor hallucis longus tendon have been reported. We present the case of complete subcutaneous rupture of the flexor hallucis longus tendon associated with trauma at the proximal phalangeal head. PMID:22153296

Noda, Daisuke; Yoshimura, Ichiro; Kanazawa, Kazuki; Hagio, Tomonobu; Naito, Masatoshi

2012-01-01

99

Gender Comparison of Patellar Tendon Tibial Shaft Angle with Weight Bearing  

Microsoft Academic Search

The objective of this study was to compare the patellar tendon tibial shaft angle at specific angles of knee flexion in young male and female athletes with lower extremity weight-bearing to determine if a gender difference exists. Twenty healthy recreational athletes (10 males and 10 females) aged 22 to 28 years with normal knees were recruited. Seven lateral radiographs of

Ryan M. Nunley; Donna Wright; Jordan B. Renner; Bing Yu; William E. Garrett Jr

2003-01-01

100

Infraspinatus and Supraspinatus Tendon Strain Explained Using Multiple Regression Models  

PubMed Central

Supraspinatus tendon tears are complex yet common. We have shown that the supraspinatus and infraspinatus tendons interact, indicated by parallel changes in strain in the supraspinatus and infraspinatus with increasing size of supraspinatus tear, load applied to the supraspinatus, and changes in glenohumeral rotation but not abduction angle, suggesting disruption in the interaction between the two tendons with increase in abduction angle. While considering these factors individually is valuable, the contribution of each factor in the context of all others on strain in the supraspinatus, or on the interaction between the two tendons is unknown and has important implications in the management of rotator cuff tears. In this study, regression models using least-square estimation with backward and forward elimination were used to predict strains in the infraspinatus and supraspinatus from joint position, supraspinatus load, and supraspinatus tear size or repair. Interestingly, despite previous findings showing that supraspinatus tear size significantly affects infraspinatus strain, tear size was not a significant predictor of infraspinatus strain, emphasizing the importance of other factors evaluated such as joint position and shoulder loading in management of cuff tears and postoperative care. A better understanding of the loading environment in rotator cuff tendons necessitates multifactorial complex models.

Andarawis-Puri, Nelly; Kuntz, Andrew F.; Jawad, Abbas F.; Soslowsky, Louis J.

2011-01-01

101

Lateral releases of the subscapularis tendon  

PubMed Central

The technique of arthroscopic subscapularis repair continues to evolve. A three-sided subscapularis release (e.g. anterior, posterior, superior) is commonly advocated for improving tendon excursion to bone. However, a lateral release is commonly required as well, particularly for full thickness, upper subscapularis tears and full thickness, complete subscapularis tears. We describe the techniques to identify and release the lateral subscapularis border, which aids in the completion of other releases.

Lo, Ian K.Y.; Nelson, Atiba A.; Burkhart, Stephen S

2013-01-01

102

A comparison of steady state and transient thermography techniques using a healing tendon model.  

PubMed

Steady state and transient thermal techniques were used to define the thermal signatures of surgically sectioned and sham-operated common calcanean tendons in four dogs. All limbs were imaged from the lateral side using an Inframetrics 525 system at - 1, 2, 4, 6, and 8 weeks after surgery. Individual video frames were used to compute absolute surface temperatures and rewarm curves for five predetermined 1 cm2 skin areas. Angiography was performed at each observation period to correlate changes in vascular morphology and thermal data. Thermal signatures and angiograms were similar in all animals before surgery. At 2 and 4 weeks after surgery, the absolute surface temperatures of the entire lateral crus area were elevated in three of four animals. During weeks 6 and 8, the surface temperatures, rewarm curves, and angiograms returned to presurgical values for the controls. Skin areas over the repaired tendons remained warmer and were shown to correlate with vascular proliferation by transient but not steady state techniques. Steady state and transient thermal imaging techniques can be used to detect vascular changes in the area around a healing tendon. However, our data indicate that transient thermal techniques are more suitable than steady state methods for localizing vascular disturbances in tissues. Thermographic imaging techniques may become a reliable noninvasive method to monitor wound healing processes if starting temperatures, cool down techniques, and time intervals for data collection are fully evaluated in future studies using transient thermal imaging protocols. PMID:3238881

Stein, L E; Pijanowski, G J; Johnson, A L; MacCoy, D M; Chato, J C

1988-01-01

103

Acute Rupture of the Anterior Cruciate Ligament and Patellar Tendon in a Collegiate Athlete  

Microsoft Academic Search

In rare incidences of combined ruptures of the ACL and patellar tendon, either the patellar tendon ruptures or the associated ACL tear is often initially missed. Even when recognized, there is no established treatment regimen. We report a case of an intercollegiate football player with a combined rupture of the ACL and patellar tendon that was successfully treated by primary

Lydia A. Futch; William P. Garth; Greg J. Folsom; William K. Ogard

2007-01-01

104

Tear System  

MedlinePLUS

... the eyelids. A thorough examination by an ophthalmic plastic surgeon can determine the cause of tearing and ... a dacryocystorhinostomy or DCR, look for an ophthalmic plastic reconstructive and cosmetic surgeon who specializes in the ...

105

Supraspinatus tears: propagation and strain alteration.  

PubMed

It was hypothesized that there would be an alteration in strain when macroscopically normal supraspinatus tendons were subjected to three patterns of surgically created tear. The propagation of joint-side partial-thickness tears was also examined. Cadaveric shoulders were tested on a purpose-built rig with static loading from 20 to 200 N and during glenohumeral abduction from 0 degrees to 120 degrees with a 100-N tensile load. Differential variable reluctance transducers were used to calculate strain. Six-millimeter-wide midsubstance full-thickness tears (n = 2) caused an increase in bursal-side strain both with abduction 1.93% (90 degrees ) and with loading 0.33% (150 N). Intratendinous delamination (n = 2) increased joint-side strain during abduction and bursal-side strain with loading. A 2-mm-deep tear across the tendon insertion (n = 5) increased the bursal-side strain in abduction by 3.54% (120 degrees ) and with load by 2.53% (200 N). Tear propagation was observed from joint to bursal sides during abduction. Tendon failure occurred at the insertion. PMID:12700564

Reilly, Peter; Amis, Andrew A; Wallace, Andrew L; Emery, Roger J H

2003-01-01

106

Matrix metalloproteases and their inhibitors are altered in torn rotator cuff tendons, but also in the macroscopically and histologically intact portion of those tendons  

PubMed Central

Summary We evaluated whether matrix metalloproteases and their inhibitors are involved in extracellular matrix remodelling and degradation of chronic rotator cuff tears. Tendon samples were harvested from 13 patients who underwent arthroscopic repair of a rotator cuff tear. Supraspinatus specimens were harvested en bloc from the arthroscopically intact middle portion of the tendon, more than 1 cm lateral to the torn edge, from the lateral edge of the tear, and from the superior margin of the macroscopically intact subscapularis tendon, used as control. The collagenases, the stromelysins, and the tissue inhibitors of metalloprotease arrays were analyzed blindly by multiplex sandwich ELISA in each specimen. Histological evidence of tendinopathy was present in all patients with a rotator cuff tear, but not in the macroscopically intact subscapularis tendon. There were significantly increased levels of MMP 1, MMP 2, MMP 3, TIMP-1, and TIMP-2 in all specimens examined, including the macroscopically intact portion of the supraspinatus tendon and the subscapularis (control specimens). The levels of specific matrix metalloproteases and their inhibitors are altered in torn rotator cuff tendons, but also in the macroscopically and histologically intact tendons. These changes extended medially to the site of tendon tear, and to other tendons.

Castagna, Alessandro; Cesari, Eugenio; Garofalo, Raffaele; Gigante, Antonio; Conti, Marco; Markopoulos, Nikolaos; Maffulli, Nicola

2013-01-01

107

Matrix metalloproteases and their inhibitors are altered in torn rotator cuff tendons, but also in the macroscopically and histologically intact portion of those tendons.  

PubMed

We evaluated whether matrix metalloproteases and their inhibitors are involved in extracellular matrix remodelling and degradation of chronic rotator cuff tears. Tendon samples were harvested from 13 patients who underwent arthroscopic repair of a rotator cuff tear. Supraspinatus specimens were harvested en bloc from the arthroscopically intact middle portion of the tendon, more than 1 cm lateral to the torn edge, from the lateral edge of the tear, and from the superior margin of the macroscopically intact subscapularis tendon, used as control. The collagenases, the stromelysins, and the tissue inhibitors of metalloprotease arrays were analyzed blindly by multiplex sandwich ELISA in each specimen. Histological evidence of tendinopathy was present in all patients with a rotator cuff tear, but not in the macroscopically intact subscapularis tendon. There were significantly increased levels of MMP 1, MMP 2, MMP 3, TIMP-1, and TIMP-2 in all specimens examined, including the macroscopically intact portion of the supraspinatus tendon and the subscapularis (control specimens). The levels of specific matrix metalloproteases and their inhibitors are altered in torn rotator cuff tendons, but also in the macroscopically and histologically intact tendons. These changes extended medially to the site of tendon tear, and to other tendons. PMID:24367772

Castagna, Alessandro; Cesari, Eugenio; Garofalo, Raffaele; Gigante, Antonio; Conti, Marco; Markopoulos, Nikolaos; Maffulli, Nicola

2013-07-01

108

Prospective randomised comparison of arthroscopic versus mini-open rotator cuff repair of the supraspinatus tendon  

Microsoft Academic Search

Purpose  The aim of the study was to evaluate whether arthroscopic (ASC) repair of rotator cuff ruptures causes less postoperative\\u000a pain and better range of motion (ROM) in the early postoperative period than a mini-open (MO) technique.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Inclusion criteria were a rupture of the supraspinatus tendon with retraction with a maximum to the apex of the humeral head\\u000a and minor fatty

Philip Kasten; Christoph Keil; Thomas Grieser; Patric Raiss; Nikolaus Streich; Markus Loew

109

Statistical comparison of classifiers applied to the interferential tear film lipid layer automatic classification.  

PubMed

The tear film lipid layer is heterogeneous among the population. Its classification depends on its thickness and can be done using the interference pattern categories proposed by Guillon. The interference phenomena can be characterised as a colour texture pattern, which can be automatically classified into one of these categories. From a photography of the eye, a region of interest is detected and its low-level features are extracted, generating a feature vector that describes it, to be finally classified in one of the target categories. This paper presents an exhaustive study about the problem at hand using different texture analysis methods in three colour spaces and different machine learning algorithms. All these methods and classifiers have been tested on a dataset composed of 105 images from healthy subjects and the results have been statistically analysed. As a result, the manual process done by experts can be automated with the benefits of being faster and unaffected by subjective factors, with maximum accuracy over 95%. PMID:22567040

Remeseiro, B; Penas, M; Mosquera, A; Novo, J; Penedo, M G; Yebra-Pimentel, E

2012-01-01

110

Statistical Comparison of Classifiers Applied to the Interferential Tear Film Lipid Layer Automatic Classification  

PubMed Central

The tear film lipid layer is heterogeneous among the population. Its classification depends on its thickness and can be done using the interference pattern categories proposed by Guillon. The interference phenomena can be characterised as a colour texture pattern, which can be automatically classified into one of these categories. From a photography of the eye, a region of interest is detected and its low-level features are extracted, generating a feature vector that describes it, to be finally classified in one of the target categories. This paper presents an exhaustive study about the problem at hand using different texture analysis methods in three colour spaces and different machine learning algorithms. All these methods and classifiers have been tested on a dataset composed of 105 images from healthy subjects and the results have been statistically analysed. As a result, the manual process done by experts can be automated with the benefits of being faster and unaffected by subjective factors, with maximum accuracy over 95%.

Remeseiro, B.; Penas, M.; Mosquera, A.; Novo, J.; Penedo, M. G.; Yebra-Pimentel, E.

2012-01-01

111

Identification and Comparison of the Polar Phospholipids in Normal and Dry Eye Rabbit Tears by MALDI-TOF Mass Spectrometry  

PubMed Central

Purpose To identify and compare the phosphorylated lipids in normal and dry eye rabbit tears using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Methods MALDI-TOF MS studies were performed on tear samples from normal and dry eyes of female New Zealand White rabbits. Experimental dry eye was induced by complete removal of the main and accessory lacrimal glands and nictitating membranes. A solid ionic crystal MALDI matrix of paranitroaniline and butyric acid was used to enhance the mass spectral responses of the phospholipids. In addition, a novel lipid isolation, preconcentration, and clean-up method using pipettes containing immobilized metal ion affinity chromatography (IMAC) medium was used. Results The polar phospholipids present in the normal and dry eye rabbit tears showed both similarities and differences. Species related to platelet-activating factor (PAF) and/or lysophosphatidylcholine (lyso-PC), phosphatidylcholine (PC), and sphingomyelin (SM) were found in both the normal and dry eye rabbit tears. However, the number of types and the concentrations of SM molecules were markedly greater in the dry eye tears than in the normal tears. In addition, phosphatidylserine (PS) species that were readily detectable in dry eye tears were not found in normal tears. Conclusions The combination of immobilized metal ion affinity chromatography and the solid ionic crystal matrix for MALDI enabled the detection and study of phosphorylated lipids in the tears. Specific differences between phospholipid levels in normal and dry eye tears were observable with this methodology. The appearance of various SM species only in the dry eye tears may provide markers for this disease state in the future.

Ham, Bryan M.; Cole, Richard B.; Jacob, Jean T.

2008-01-01

112

Histologic evidence of degeneration at the insertion of 3 rotator cuff tendons: A comparative study with human cadaveric shoulders  

Microsoft Academic Search

We determined on histologic examination the degree of degeneration at the insertion of 3 rotator cuff tendons in 76 cadaveric shoulders, 17 of which had a partial tear of the supraspinatus. Fiber thinning, the presence of granulation tissue, and incomplete tearing of fibers, all evidence of degeneration, were quantified separately for each tendon. Among the shoulders that were intact on

Hirotaka Sano; Hirotada Ishii; Guy Trudel; Hans K Uhthoff

1999-01-01

113

A biomechanical comparison of EndoButton versus suture anchor repair of distal biceps tendon injuries.  

PubMed

The purpose of this study was to compare suture anchor and EndoButton repair of distal biceps injuries in a human bone-tendon model. Right and left arm repairs were alternately performed with either the EndoButton or 2 single-loaded 5-mm suture anchors. Each construct was cyclically loaded by use of a servohydraulic materials testing machine. Initial and final displacements were recorded. All repairs were then loaded to ultimate failure. Ten millimeters of displacement was designated the clinical failure point. The EndoButton group had more stiffness than the suture anchor group during initial cyclic loading (P = .01). There were no differences in final displacement measured after cyclic loading (2.06 mm for suture anchors and 2.58 mm for EndoButton). The EndoButton group had a 16% greater ultimate tensile load than the suture anchor group (274.77 N vs 230.06 N). The EndoButton group also had a 16% higher load to clinical failure (249.95 N vs 209.56 N). These differences were not statistically significant. The EndoButton and suture anchors provide comparable fixation strength for the repair and rehabilitation of distal biceps tendon ruptures. PMID:16831659

Spang, Jeffrey T; Weinhold, Paul S; Karas, Spero G

2006-01-01

114

Glenohumeral joint motion after subscapularis tendon repair: an analysis of cadaver shoulder models  

PubMed Central

Background As for the surgical treatment of the rotator cuff tears, the subscapularis tendon tears have recently received much attention for the mini-open or arthroscopic repair. The results of surgical repair for the subscapularis tendon tear are satisfactory, but the range of external rotation is reported to be restricted after the repair. The purpose of this study was to evaluate the range of glenohumeral joint motion after repairs of various sizes of subscapularis tendon tears. Methods Using eight fresh frozen human cadaveric shoulders (mean age at death, 81.5 years), three sizes of subscapularis tendon tear (small, medium, and large) were made and then repaired. With the scapula fixed to the wooden jig, the end-range of glenohumeral motion was measured with passive movement applied through 1.0-Nm torque in the directions of scapular elevation, flexion, abduction, extension, horizontal abduction, and horizontal adduction. The passive end-ranges of external and internal rotation in various positions with rotational torque of 1.0 Nm were also measured. Differences in the ranges among the three type tears were analyzed. Results As tear size increased, range of glenohumeral motion in horizontal abduction after repair decreased gradually and was significantly decreased with the large size tear (P?tear size in every glenohumeral position. The prominent decrease in external rotation (around 40° reduction from intact shoulders) was observed in shoulders after repair of large size tear at 30° to 60° of scapular elevation and abduction. Conclusions As the size of the subscapularis tendon tear increased, the passive ranges of horizontal abduction and external rotation of the glenohumeral joint after repair decreased significantly. In shoulders with a subscapularis tendon tear, it is necessary to consider the reduction of external rotation depending on tear size.

2014-01-01

115

Quantification of rotator cuff tear geometry: the repair ratio as a guide for surgical repair in crescent and U-shaped tears  

Microsoft Academic Search

Introduction  Surgical repair of symptomatic, retracted rotator cuff tears unresponsive to non-operative treatments requires closure of\\u000a the tear without undue tension and reattaching the torn tendon to its former insertion site. In this study, the length of\\u000a the torn tendon edge was hypothesized to be longer than the length of the humeral insertion site. The objective of this study\\u000a was to

Utku Kandemir; Robert B. Allaire; Richard E. Debski; Thay Q. Lee; Patrick J. McMahon

2010-01-01

116

Toward an Animal Model of the Human Tear Film: Biochemical Comparison of the Mouse, Canine, Rabbit, and Human Meibomian Lipidomes  

PubMed Central

Purpose. Secretions that are produced by meibomian glands (also known as meibum) are a major source of lipids for the ocular surface of humans and animals alike. Many animal species have been evaluated for their meibomian lipidomes. However, there have been a very small number of studies in which the animals were compared with humans side by side. Therefore, the purpose of this study was to compare meibum collected from humans and three typical laboratory animals, canines, mice, and rabbits, for their meibomian lipid composition in order to determine which animal species most resembles humans. Methods. High pressure liquid chromatography (HPLC) and gas-liquid chromatography (GLC) in combination with mass spectrometry were used to evaluate lipidomes of all tested species. Results. Among three tested animal species, mice were found to be the closest match to humans in terms of their meibomian lipidomes, while canines were the second closest species. The lipids of these three species were close to each other structurally and, for most lipid classes, quantitatively. The rabbit meibomian lipidome, on the other hand, was vastly different from lipidomes of all other tested species. Interestingly, a previously described class of lipids, acylated omega-hydroxy fatty acids (OAHFA), was found to be present in every tested species as the major amphiphilic component of meibum. Conclusions. Our side by side comparison of the rabbit and the human meibum demonstrated their vast differences. Thus, the rabbit seems to be a poor animal model of the human tear film, at least when studying its biochemistry and biophysics.

Butovich, Igor A.; Lu, Hua; McMahon, Anne; Eule, J. Corinna

2012-01-01

117

Pathology and pathogenesis of the intratendinous tearing of the rotator cuff viewed from en bloc histologic sections.  

PubMed

Histologic sections from 17 en bloc surgical specimens were studied to clarify the pathogenesis of intratendinous tears of the rotator cuff. The specimens consisted of the bony insertion, the partially torn area, and the musculotendinous junction of the supraspinatus tendon. An intratendinous tear alone was present in two patients, and was associated with bursal side cuff tears in seven patients and joint side cuff tears in eight. There were 13 men and 4 women, whose average age was 49.8 years. Trauma was noted in all intratendinous tears and combined intratendinous and joint side cuff tears and in two of the seven patients who had intratendinous plus bursal side tears. All patients exhibited clinical evidence of subacromial impingement. Histologic sections were stained with azan and hematoxylin and eosin. Microscopically, the sections demonstrated several abnormalities in addition to degeneration. The intratendinous tears was located in the midlayer of the tendon in 15 specimens and eccentrically in two, the axis of which were parallel to tendon fibers in all. The intratendinous tears continued to local disruptions of the enthesis in 11 cases. The inner surface of the tear appeared smooth in 16 specimens. Despite the presence of granulation tissue and vessel proliferation near the intratendinous tears, there was no evidence of closure of the defect in any specimen. Intratendinous tears develop between superficial and deep layers of the degenerated rotator cuff. Shear within the tendon appears to be responsible in pathogenesis. Concomitant subacromial bursitis is very common. PMID:8020235

Fukuda, H; Hamada, K; Nakajima, T; Tomonaga, A

1994-07-01

118

Peroneal Tendonitis  

MedlinePLUS

... peroneal tendinosis. Also, patients who have a hindfoot varus posture may be more susceptible. This is because ... ankle to the outside, which fights against the varus position. The harder the tendons work, the more ...

119

The Effects of Donor Age and Strain Rate on the Biomechanical Properties of Bone-Patellar Tendon-Bone Allografts  

Microsoft Academic Search

Over 50% of all knee injuries involve partial or com plete tear of the anterior cruciate ligament. Surgical reconstruction of this ligament using an isometrically placed bone-patellar tendon-bone autograft is the cur rent technique of choice; however, harvest of patellar tendon as a free graft can lead to increased morbidity. To address this issue, allogenic patellar tendon grafts have been

Field T. Blevins; Aaron T. Hecker; Gregory T. Bigler; Arthur L. Boland; Wilson C. Hayes

1994-01-01

120

Comparison of the effects of first and second generation silicone hydrogel contact lens wear on tear film osmolarity  

PubMed Central

AIM To compare the effects of first and second generation silicone hydrogel (SiH) contact lens wear on tear film osmolarity. METHODS The healthy subjects who have never used contact lenses before were enrolled in the study. Tear film osmolarity values of 16 eyes (group 1) who wore first generation SiH contact lenses were compared with those of 18 eyes (group 2) who wore second generation SiH contact lenses after three months follow-up. RESULTS Before contact lens wear, tear film osmolarity of groups 1 and 2 were 305.02±49.08 milliosmole (mOsm) and 284.66±30.18mOsm, respectively. After three months of contact lens wear, osmolarity values were found 317.74±60.23mOsm in group 1 and 298.40±37.77mOsm in group 2. Although osmolarity values for both groups of SiH contact lens wear after three months periods were slightly higher than before the contact lens wear, the difference was not statistically significant. CONCLUSION Contact lens wear may cause evaporation from the tear film and can increase tear film osmolarity leading to symptoms of dry eye disease. In the current study, there is a tendency to increase tear film osmolarity for both groups of SiH contact lens wear, but the difference is not statistically significant.

Iskeleli, Guzin; Karakoc, Yunus; Ozkok, Ahmet; Arici, Ceyhun; Ozcan, Omer; Ipcioglu, Osman

2013-01-01

121

Intramuscular fluid collections and their association with longitudinal rotator cuff tears.  

PubMed

This study draws attention to the association between intramuscular fluid collections occurring at the myo-tendinous junction of the rotator cuff secondary to longitudinal tears of their tendons. PMID:11903172

Coates, M H; Breidahl, W H; Marks, P

2001-11-01

122

The microvascular pattern of the supraspinatus tendon.  

PubMed

The vascular pattern of the supraspinatus tendon was studied in 18 human anatomic specimens. The ages of the specimens ranged from 26 to 84 years. Selective vascular injection with a silicon-rubber compound allowed visualization of the vascular bed of the rotator cuff and humeral head. The presence of a hypovascular or critical zone close to the insertion of the supraspinatus tendon into the humeral head was confirmed. However, only a uniformly sparse vascular distribution was found at the articular side, as opposed to the well-vascularized bursal side. This was also confirmed with histologic sections of the tendon. The poor vascularity of the tendon in this area could be a significant factor in the pathogenesis of degenerative rotator cuff tears. PMID:2323147

Lohr, J F; Uhthoff, H K

1990-05-01

123

Rotator cuff tears in overhead athletes.  

PubMed

The rotator cuff is under significant stress during overhead athletics, which can predictably lead to a certain spectrum of rotator cuff injuries in this population. Although the cause is often multifactorial; tensile overload, outlet impingement, and internal impingement are common causes of cuff pathologic conditions in this group. Identification of symptomatic rotator cuff disease can be challenging in the overhead athlete because abnormalities of the rotator cuff are common in asymptomatic throwers and rotator cuff pathologic conditions often occur in conjunction with other injuries. Although nonoperative options should be exhausted, surgical treatment is typically necessary for any rotator cuff tear for which conservative treatment fails. Tear thickness has been classically used to determine the surgical approach, with tears involving less than 50% of the tendon thickness treated with debridement and more substantial tears treated with formal repair. However, some authors and some noted surgeons with experience in managing this patient population have more recently advocated a higher threshold of tendon involvement before considering formal repair. Multiple repair options have been described, but few reports have focused specifically on the outcomes of rotator cuff surgery in overhead athletes. The limited available data do lead, however, to a few reasonable conclusions. Surgical results typically correlate with tear severity. Partial-thickness tears treated with arthroscopic debridement and management of concomitant pathologic conditions seem to have fairly good outcomes in the literature, with most athletes able to return to activity at their preinjury level. Full-thickness tears, however, have fared much more poorly in the overhead athlete, with largely dismal outcomes after surgical repair. What is abundantly clear is that further refinement of surgical options is necessary to improve patient outcomes after rotator cuff repair in this particularly challenging patient population and to allow more consistent return to sports. Identification of symptomatic rotator cuff disease can be challenging in the overhead athlete because abnormalities of the rotator cuff are common in asymptomatic throwers and rotator cuff pathologic conditions often occur in conjunction with other injuries. Although nonoperative options should be exhausted, surgical treatment is typically necessary for any rotator cuff tear for which conservative treatment fails. Tear thickness has been classically used to determine the surgical approach, with tears involving less than 50% of the tendon thickness treated with debridement and more substantial tears treated with formal repair. However, some authors and some noted surgeons with experience in managing this patient population have more recently advocated a higher threshold of tendon involvement before considering formal repair. Multiple repair options have been described, but few reports have focused specifically on the outcomes of rotator cuff surgery in overhead athletes. The limited available data do lead, however, to a few reasonable conclusions. Surgical results typically correlate with tear severity. Partial-thickness tears treated with arthroscopic debridement and management of concomitant pathologic conditions seem to have fairly good outcomes in the literature, with most athletes able to return to activity at their preinjury level. Full-thickness tears, however, have fared much more poorly in the overhead athlete, with largely dismal outcomes after surgical repair. What is abundantly clear is that further refinement of surgical options is necessary to improve patient outcomes after rotator cuff repair in this particularly challenging patient population and to allow more consistent return to sports. PMID:23040553

Economopoulos, Kostas J; Brockmeier, Stephen F

2012-10-01

124

Rotator Cuff Tears  

MedlinePLUS

... risk for overuse tears. Many jobs and routine chores can cause overuse tears, as well. • Lack of ... American Academy of Orthopaedic Surgeons. Symptoms The most common symptoms of a rotator cu? tear include: • Pain ...

125

Comparison of tear osmolarity and ocular comfort between daily disposable contact lenses: hilafilcon B hydrogel versus narafilcon A silicone hydrogel.  

PubMed

The aim of this study was to evaluate tear osmolarity and ocular comfort with two different types of hydrogel daily disposable lenses. The right eyes of 15 first-time contact lens users were included in this prospective study. All eyes wore hilafilcon B silicone hydrogel contact lenses for 8 h (group 1). After 1 week without contact lenses, all eyes wore narafilcon A silicone hydrogel contact lenses for 8 h (group 2). Tear osmolarity measurement was performed before and after 4 and 8 h of each contact lens wear. Ocular comfort was assessed after 4 and 8 h of each contact lens wear. In group 1, the mean baseline, 4- and 8-h tear osmolarity values were 293 ± 10.57, 303.00 ± 10.5 mOsm/L (p = 0.023), and 295.0 ± 1.4 mOsm/L (p > 0.05), respectively. In group 2, the mean baseline, 4- and 8-h tear osmolarity values were 294 ± 13.65, 300.9 ± 11.3 mOsm/L (p = 0.007), and 298.80 ± 7.2 mOsm/L (p > 0.05), respectively. In group 1, the mean comfort score was 7.20 ± 0.45 and 8.60 ± 0.45 at 4 and 8 h, respectively (p = 0.038). In group 2, the mean comfort score significantly decreased from 9.80 ± 0.45 to 7.80 ± 0.84 at 4 h (p = 0.039). Both hydrogel and silicone hydrogel daily disposable contact lenses elevated tear osmolarity during 8 h of contact lens wear. The increase in tear osmolarity with both contact lenses was below the cut-off value for dry eye and was not associated with ocular comfort. PMID:22484700

Sarac, Ozge; Gurdal, Canan; Bostanc?-Ceran, Basak; Can, Izzet

2012-06-01

126

Failure modes and fracture toughness in partially torn ligaments and tendons.  

PubMed

Ligaments and tendons are commonly torn during injury, yet the likelihood that untreated initial tears could lead to further tearing or even full rupture has proven challenging to predict. In this work, porcine Achilles tendon and human anterior longitudinal ligament samples were tested using both standard fracture toughness methods and complex loading conditions. Failure modes for each of 14 distinct testing cases were evaluated using a total of 131 soft tissue tests. Results showed that these soft tissues were able to completely resist any further crack propagation of an initial tear, regardless of fiber orientation or applied loading condition. Consequently, the major concern for patients with tendon or ligament tears is likely not reduction in ultimate tissue strength due to stress risers at the tip of the tear, but rather a question of whether or not the remaining cross-section is large enough to support the anticipated loading. PMID:24747098

Von Forell, Gregory A; Hyoung, Peter S; Bowden, Anton E

2014-07-01

127

Trabecular microstructure and surface changes in the greater tuberosity in rotator cuff tears  

Microsoft Academic Search

Objective. When planning surgery in patients with rotator cuff tear, strength of bone at the tendon insertion and trabecular bone structure in the greater tuberosity are usually taken into consideration. We investigated radiographic changes in bone structure of the greater tuberosity in rotator cuff tears. Design. Twenty-two human cadaveric shoulders from subjects ranging from 55 to 75 years of age

Yebin Jiang; Jenny Zhao; Marnix T. van Holsbeeck; Michael J. Flynn; Xiaolong Ouyang; Harry K. Genant

2002-01-01

128

Popliteomeniscal fascicle tear: diagnosis and operative technique.  

PubMed

The occurrence and the consistency of the popliteomeniscal fascicle between the popliteus tendon and the lateral meniscus have been the subject of debate. It is difficult to diagnose and treat popliteomeniscal fascicle tears. Furthermore, popliteomeniscal fascicle tears are difficult to identify with arthroscopy. This article describes the diagnostic factors for popliteomeniscal fascicle tears and the safe, effective operative techniques that can be used for their treatment. We suggest that popliteomeniscal fascicle tears are diagnosed when the following 3 conditions are confirmed: (1) existence of mechanical symptoms such as pain, locking, and giving way in the lateral compartment of the knee; (2) identification of hypermobility of the lateral meniscus through arthroscopic probing; and (3) occurrence of an osteochondral lesion in the posterior area of the lateral femoral condyle. In the case of popliteomeniscal fascicle tears, the tear area can be repaired with a suture hook and polydioxanone with an all-inside technique. If the joint space is narrowing because of soft-tissue tightness, it can be repaired with a zone-specific cannula through an inside-out technique. PMID:23766962

Shin, Hong-Kwan; Lee, Hee-Sung; Lee, Young-Kuk; Bae, Ki-Cheor; Cho, Chul-Hyun; Lee, Kyung-Jae

2012-09-01

129

Tear film mucins: front line defenders of the ocular surface; comparison with airway and gastrointestinal tract mucins.  

PubMed

The ocular surface including the cornea and conjunctiva and its overlying tear film are the first tissues of the eye to interact with the external environment. The tear film is complex containing multiple layers secreted by different glands and tissues. Each layer contains specific molecules and proteins that not only maintain the health of the cells on the ocular surface by providing nourishment and removal of waste products but also protect these cells from environment. A major protective mechanism that the corneal and conjunctival cells have developed is secretion of the innermost layer of the tear film, the mucous layer. Both the cornea and conjunctiva express membrane spanning mucins, whereas the conjunctiva also produces soluble mucins. The mucins present in the tear film serve to maintain the hydration of the ocular surface and to provide lubrication and anti-adhesive properties between the cells of the ocular surface and conjunctiva during the blink. A third function is to contribute to the epithelial barrier to prevent pathogens from binding to the ocular surface. This review will focus on the different types of mucins produced by the corneal and conjunctival epithelia. Also included in this review will be a presentation of the structure of mucins, regulation of mucin production, role of mucins in ocular surface diseases, and the differences in mucin production by the ocular surface, airways and gastrointestinal tract. PMID:23954166

Hodges, Robin R; Dartt, Darlene A

2013-12-01

130

Aspect ratio effects on neoclassical tearing modes from comparison between DIII-D and National Spherical Torus Experiment  

SciTech Connect

Neoclassical tearing mode islands are sustained by helically perturbed bootstrap currents arising at finite beta from toroidal effects that trap a fraction of the particles in non-circulating orbits. DIII-D and NSTX are here operated with similar shape and cross-sectional area but almost a factor of two difference in inverse aspect ratio a/R. In these experiments, destabilized n=1 tearing modes were self-stabilized (reached the 'marginal point') by reducing neutral-beam power and thus beta. The measure of the marginal island gives information on the small-island stabilizing physics that in part (with seeding) governs onset. The marginal island width on NSTX is found to be about three times the ion banana width and agrees with that measured in DIII-D, except for DIII-D modes closer to the magnetic axis, which are about two times the ion banana width. There is a balance of the helically perturbed bootstrap term with small island effects with the sum of the classical and curvature terms in the modified Rutherford equation for tearing-mode stability at the experimental marginal point. Empirical evaluation of this sum indicates that while the stabilizing effect of the curvature term is negligible in DIII-D, it is important in NSTX. The mode temporal behavior from the start of neutral-beam injection reduction also suggests that NSTX operates closer to marginal classical tearing stability; this explains why there is little hysteresis in beta between mode onset, saturation, and self-stabilization (while DIII-D has large hysteresis in beta). NIMROD code module component calculations based on DIII-D and NSTX reconstructed experimental equilibria are used to diagnose and confirm the relative importance of the stabilizing curvature effect, an advantage for low aspect ratio; the relatively greater curvature effect makes for less susceptibility to NTM onset even if the classical tearing stability index is near marginal.

La Haye, R. J.; Buttery, R. J. [General Atomics, P.O. Box 85608, San Diego, California 92186-5608 (United States); Gerhardt, S. P. [Princeton Plasma Physics Laboratory, P.O. Box 451 Princeton, New Jersey 08543 (United States); Sabbagh, S. A. [Columbia University, 2960 Broadway, New York, New York 10027-6900 (United States); Brennan, D. P. [University of Tulsa, 800 South Tucker Drive, Tulsa, Oklahoma 74104 (United States)

2012-06-15

131

Arthroscopic Intratendinous Repair of the Delaminated Partial-Thickness Rotator Cuff Tear in Overhead Athletes  

Microsoft Academic Search

A distinct type of partial-thickness rotator cuff tear has been observed in overhead athletes, characterized by partial failure of the undersurface of the posterior supraspinatus and anterior infraspinatus tendons with intratendinous delamination. We present a technique of percutaneous intratendinous repair using nonabsorbable mattress sutures designed for the management of articular-side delaminated partial-thickness tears. After tear evaluation and preparation, the torn

Stephen F. Brockmeier; Christopher C. Dodson; Seth C. Gamradt; Struan H. Coleman; David W. Altchek

2008-01-01

132

Influence of nanofibers on growth and gene expression of human tendon derived fibroblast  

Microsoft Academic Search

BACKGROUND: Rotator cuff tears are a common and frequent lesion especially in older patients. The mechanisms of tendon repair are not fully understood. Common therapy options for tendon repair include mini-open or arthroscopic surgery. The use of growth factors in experimental studies is mentioned in the literature. Nanofiber scaffolds, which provide several criteria for the healing process, might be a

Christina Theisen; Susanne Fuchs-Winkelmann; Karola Knappstein; Turgay Efe; Jan Schmitt; Juergen RJ Paletta; Markus D Schofer

2010-01-01

133

Single-row, double-row, and transosseous equivalent techniques for isolated supraspinatus tendon tears with minimal atrophy: A retrospective comparative outcome and radiographic analysis at minimum 2-year followup  

PubMed Central

Purpose: The purpose of this study was to measure and compare the subjective, objective, and radiographic healing outcomes of single-row (SR), double-row (DR), and transosseous equivalent (TOE) suture techniques for arthroscopic rotator cuff repair. Materials and Methods: A retrospective comparative analysis of arthroscopic rotator cuff repairs by one surgeon from 2004 to 2010 at minimum 2-year followup was performed. Cohorts were matched for age, sex, and tear size. Subjective outcome variables included ASES, Constant, SST, UCLA, and SF-12 scores. Objective outcome variables included strength, active range of motion (ROM). Radiographic healing was assessed by magnetic resonance imaging (MRI). Statistical analysis was performed using analysis of variance (ANOVA), Mann — Whitney and Kruskal — Wallis tests with significance, and the Fisher exact probability test <0.05. Results: Sixty-three patients completed the study requirements (20 SR, 21 DR, 22 TOE). There was a clinically and statistically significant improvement in outcomes with all repair techniques (ASES mean improvement P = <0.0001). The mean final ASES scores were: SR 83; (SD 21.4); DR 87 (SD 18.2); TOE 87 (SD 13.2); (P = 0.73). There was a statistically significant improvement in strength for each repair technique (P < 0.001). There was no significant difference between techniques across all secondary outcome assessments: ASES improvement, Constant, SST, UCLA, SF-12, ROM, Strength, and MRI re-tear rates. There was a decrease in re-tear rates from single row (22%) to double-row (18%) to transosseous equivalent (11%); however, this difference was not statistically significant (P = 0.6). Conclusions: Compared to preoperatively, arthroscopic rotator cuff repair, using SR, DR, or TOE techniques, yielded a clinically and statistically significant improvement in subjective and objective outcomes at a minimum 2-year follow-up. Level of Evidence: Therapeutic level 3.

McCormick, Frank; Gupta, Anil; Bruce, Ben; Harris, Josh; Abrams, Geoff; Wilson, Hillary; Hussey, Kristen; Cole, Brian J.

2014-01-01

134

Progression from calcifying tendinitis to rotator cuff tear  

Microsoft Academic Search

This report documents the clinical, radiographic and histologic findings in a 46-year-old man with calcifying tendinitis in his left shoulder which progressed to rotator cuff tear. The patient had a 1-year history of repeated calcifying tendinitis before being referred to our hospital. On the initial visit, radiographs and magnetic resonance imaging (MRI) revealed calcium deposition localized in the supraspinatus tendon

Masafumi Gotoh; Fujio Higuchi; Ritsu Suzuki; Kensuke Yamanaka

2003-01-01

135

Infraspinatus delamination does not affect supraspinatus tear repair.  

PubMed

Supraspinatus full-thickness tears with associated infraspinatus delamination are a frequent lesion, although the results of repair have not been reported. We retrospectively identified 35 patients treated for this cuff lesion among 378 open repaired full-thickness cuff tears. The aim of the study was to assess the subjective, objective, and anatomic outcomes of a subset of patients with supraspinatus tears involving delamination of the whole infraspinatus tendon. Thirty of the 35 patients were reviewed with magnetic resonance imaging at a minimum followup of 2 years (mean, 3.5 years; range, 2-6.5 years). The mean nonweighted Constant-Murley score at followup was 80/100 points, with an average gain of 17 points. Magnetic resonance imaging revealed all supraspinatus tendons but two were continuous. We observed no tear of the infraspinatus tendon, although a persistent delamination was present in 11 cases. One half of the patients had minor weakness in external rotation. One third of the infraspinatus muscles had minor fatty infiltration. Conservation of the infraspinatus tendon after closing the delamination did not seem to compromise the outcome of the supraspinatus repair. Avoiding resection of the infraspinatus delamination and treatment with simple curettage and closure yields satisfactory midterm functional and anatomic results. PMID:17308479

Zilber, Sébastien; Carillon, Yannick; Lapner, Peter C; Walch, Gilles; Nové-Josserand, Laurent

2007-05-01

136

Proximal Biceps Tendonitis  

MedlinePLUS

... arm for a few weeks. What Is Biceps Tendonitis? The biceps is the muscle in your upper ... with rest and medication. Signs of Proximal Biceps Tendonitis Proximal biceps tendonitis usually starts out slowly and ...

137

Comparison of partial meniscectomy versus meniscus repair for bucket-handle lateral meniscus tears in anterior cruciate ligament reconstructed knees  

Microsoft Academic Search

Purpose: For patients who underwent anterior cruciate ligament (ACL) reconstruction and had an unstable bucket-handle tear and no other meniscus lesions or articular damage, we sought to determine if repair of the lateral meniscus was superior to partial meniscectomy with regard to subjective and objective results.Type of Study: Retrospective cohort study.Methods: Between 1982 and 1995, 91 patients met the inclusion

K. Donald Shelbourne; Michael D Dersam

2004-01-01

138

Single eye analysis and contralateral eye comparison of tear proteins in normal and dry eye model rabbits by MALDI-ToF mass spectrometry using wax-coated target plates  

PubMed Central

A study of rabbit tear protein expression in a dry eye rabbit model was performed to determine if a pattern in expressed proteins could be identified. The uniqueness of the model allows the comparison of normal (control) eye tear protein expression with surgically induced dry eye tear protein expression in individual animals. The sensitivity of the method allows for single eye analysis. One-dimensional mini-gel electrophoresis of the tear proteins did not show substantial differences between band patterns of the normal versus the dry eye, but was used to assess the molecular weight ranges of the major proteins. Specific assignments of some of the predominant proteins were obtained by tandem mass spectrometry (MS) which showed that the lower molecular weight lipid-binding proteins (approximately 10 kDa to 36 kDa) constitute a considerable amount of the observed protein, followed in lesser quantities by the transferrins which have higher molecular weights ranging from 70 kDa to 85 kDa. Enhancement of matrix-assisted laser desorption/ionization time-of-flight (MALDI-ToF) MS linear mode analysis of intact proteins in tear fluid was demonstrated through the use of wax-coated MALDI plates and spot washing. MALDI-ToF MS analysis of the expressed tear proteins illustrates that differences between normal eye tear and dry eye tear protein content are manifested in changes in the lower molecular weight lipid-binding proteins such as lipophilin which exhibits an increase in concentration in the dry eye, and ?-2 microglobulin which undergoes a decrease.

Ham, Bryan M.; Jacob, Jean T.

2008-01-01

139

Results of the repair of acute rotator cuff tears is not influenced by tear retraction  

PubMed Central

Purpose: This study evaluated retraction in the setting of acute rotator cuff tears and determined its effects on patient outcomes and tendon repair integrity. Materials and Methods: A total of 22 patients had surgery within 6 weeks or less from the time of injury. Fifteen of these patients were prospectively followed at a minimum of 2 years; average 40.5 months (range 24-69). Pre-operative objective and subjective outcomes were compared. Tendon repair integrity was assessed with ultrasound at a minimum of 1 year from surgery. The population was stratified into Group 1 (8 patients) with minimal intra-operative medial tendon retraction to the mid-line level of the humeral head and Group 2 (7 patients) with a large medial tendon retraction to the glenohumeral joint or greater. Results: The average time to surgery from the onset of symptoms was 27 days (range, 6-42). Post-operative motion increased significantly for external rotation and forward elevation, 77% of patients were pain free, 80% were completely satisfied, and 100% would have the surgery again. Group 1 (small retraction) versus Group 2 (large retraction) showed that post-operative pain levels, satisfaction, range of motion, strength, subjective shoulder value (95.4% vs. 92.3%), Constant Score (80.8 vs. 78.1), and American Society of Shoulder and Elbow Surgeons (96.2 vs. 93.5) scores were not statistically different. Ultrasound showed a tendon repair integrity rate of 87%. 2 patients who did have a re-tear were in Group 2, yet had comparative outcomes. Conclusion: In acute rotator cuff tears, equal patient satisfaction, pain scores, range of motion, strength, and outcome measures should be expected with surgical repair despite the level of retraction. Level of Evidence: Therapeutic level IV

Butler, Bryan R.; Byrne, Abigail N.; Higgins, Laurence D.; Shah, Anup; Fowler, Rachel L.

2013-01-01

140

Ultrasonographic evaluation of tendons and enthesal sites in rheumatoid arthritis: comparison with ankylosing spondylitis and healthy subjects  

Microsoft Academic Search

The objective of this study was to determine tendon involvements and enthesal abnormalities in patients with rheumatoid arthritis (RA) using high-resolution ultrasonographic images and to compare the findings with those seen in patients with ankylosing spondylitis (AS) and healthy controls. A total of 24 patients with RA, 18 with AS, and 20 healthy controls matched by age and body mass

Hakan Genc; Burcu Duyur Cakit; I??l Tuncbilek; Hatice Rana Erdem

2005-01-01

141

Anterior Cruciate Ligament Graft FixationInitial Comparison of Patellar Tendon and Semitendinosus Autografts in Young Fresh Cadavers  

Microsoft Academic Search

The initial biomechanical properties of semitendinosus and patellar tendon autografts and their fixation strengths were investigated. Twenty fresh cadaveric knees from donors under 42 years of age were used in the study. After removing all soft tissues other than the anterior cruciate ligament, we determined the ultimate tensile strength (2195 ± 427 N) and stiffness (306 ± 80 N\\/mm) of

Neville J. Rowden; Doron Sher; Greg J. Rogers; Klaus Schindhelm

1997-01-01

142

Histologic determination of ontogenetic patterns and processes in hadrosaurian ossified tendons  

Microsoft Academic Search

Development and metaplasia of ossified tendons in two hadrosaurine dinosaurs (Maiasaura peeblesorum and Brachylophosaurus canadensis) are described by comparison with the known developmental processes of ossified tendons in turkeys (Meleagris gallopavo). Mineralized primary tendon tissue and replacement patterns suggest that ossified tendons in hadrosaurs grew initially in a manner similar to those in turkeys. That is, biomineralization begins with apatite

Jason S. Adams; Christopher L. Organ

2005-01-01

143

Comparison of corneal sensitivity, tear function and corneal staining following laser in situ keratomileusis with two femtosecond laser platforms  

PubMed Central

Purpose To evaluate longitudinal changes in corneal sensitivity, tear function, and corneal staining in patients who underwent laser in situ keratomileusis (LASIK) using two different femtosecond lasers. Methods In a prospective, randomized clinical trial, contralateral eyes of 45 patients underwent flap creation by either VisuMax or IntraLase™ femtosecond laser. Corneal sensitivity, tear break up time (TBUT), Schirmer’s test, and corneal fluorescein staining were assessed preoperatively and at 1 week, 1 month, and 3 months postoperatively. Results There were no statistical differences in any clinical outcome measure between the two femtosecond lasers (P > 0.05), although there was a trend towards slightly lower reductions for corneal sensitivity and TBUT in VisuMax-operated eyes. Overall, corneal sensitivity was significantly reduced at 1 week (P < 0.05), 1 month (P < 0 .001), and 3 months (P < 0.001) postoperatively. A significantly greater reduction of corneal sensitivity was noted in eyes with a myopic spherical equivalent of ?6.00 diopters (D) to ?11.25 D as compared with eyes that had a relatively lower level of myopia of less than ?6.00 D (P < 0.001). TBUT and Schirmer’s test values were significantly diminished at 1 week postoperatively (P < 0.04). Overall, corneal staining was significantly increased at 1 week postoperatively (P < 0.001). The level of myopia did not significantly affect postoperative changes in TBUT, Schirmer’s test values, or corneal staining (P > 0.05). Conclusion This study showed that changes in corneal sensitivity, tear function, and corneal staining were statistically similar in LASIK using VisuMax and IntraLase femtosecond lasers for flap creation. However, the trend towards faster recovery of corneal sensitivity and TBUT observed in VisuMax-operated eyes may be attributable to improved technical specifications.

Petznick, Andrea; Chew, Annabel; Hall, Reece C; Chan, Cordelia ML; Rosman, Mohamad; Tan, Donald; Tong, Louis; Mehta, Jodhbir S

2013-01-01

144

MR assessment of the repaired rotator cuff: prevalence, size, location, and clinical relevance of tendon rerupture.  

PubMed

The objectives of this study were to use magnetic resonance (MR) imaging to evaluate the prevalence, size, location, and clinical relevance of tendon rerupture following complete repair of full-thickness rotator cuff tear (RCT). A total of 78 surgically proven full-thickness rotator cuff tears in 74 patients were retrospectively included in the study. Clinical assessment was performed using the University of California at Los Angeles score. Postoperative MR imaging was evaluated to determine prevalence, size, and location of tendon rerupture. At a mean 48.4 months' follow-up, 62 shoulders (79.5%) had favorable outcomes and 45 shoulders (57.6%) showed rerupture on MR imaging studies. Reruptures were significantly more prevalent among patients with intermediate-to-bad outcomes (81.3%), with surgically demonstrated two-tendon tears (78.9%) or three-tendon tears (100%), and with preoperative fatty degeneration of the supraspinatus muscle greater than 1 (91.6%). Reruptures were also significantly larger in those subgroups. Complete repair of RCT of all sizes may have favorable outcomes in a significant proportion of patients in spite of a high prevalence of reruptures. Preoperative tear size and degree of muscle fatty degeneration influence the prevalence and rerupture size. After repair of supraspinatus tears, reruptures tend to invade the posterior aspect of the tendon. PMID:16518655

Mellado, J M; Calmet, J; Olona, M; Ballabriga, J; Camins, A; Pérez del Palomar, L; Giné, J

2006-10-01

145

Retinal Tear and Detachment  

MedlinePLUS

Retinal Tear and Detachment Introduction The retina is the layer of tissue in the back of the eye that is responsible ... much. This reference summary explains what retinal tears and detachments are. It discusses their symptoms, causes, diagnosis ...

146

Iliopsoas Tendon Reformation after Psoas Tendon Release  

PubMed Central

Internal snapping hip syndrome, or psoas tendonitis, is a recognised cause of nonarthritic hip pain. The majority of patients are treated conservatively; however, occasionally patients require surgical intervention. The two surgical options for iliopsoas tendinopathy are step lengthening of the iliopsoas tendon or releasing the tendon at the lesser trochanter. Although unusual, refractory snapping usually occurs soon after tenotomy. We report a case of a 47-year-old active female with internal snapping and pain following an open psoas tenotomy. Postoperatively she was symptom free for 13 years. An MRI arthrogram revealed reformation of a pseudo iliopsoas tendon reinserting into the lesser trochanter. The pain and snapping resolved after repeat iliopsoas tendon release. Reformation of tendons is an uncommon sequela of tenotomies. However the lack of long-term studies makes it difficult to calculate prevalence rates. Tendon reformation should be included in the differential diagnosis of failed tenotomy procedures after a period of symptom relief.

Garala, K.; Power, R. A.

2013-01-01

147

Iliopsoas tendon reformation after psoas tendon release.  

PubMed

Internal snapping hip syndrome, or psoas tendonitis, is a recognised cause of nonarthritic hip pain. The majority of patients are treated conservatively; however, occasionally patients require surgical intervention. The two surgical options for iliopsoas tendinopathy are step lengthening of the iliopsoas tendon or releasing the tendon at the lesser trochanter. Although unusual, refractory snapping usually occurs soon after tenotomy. We report a case of a 47-year-old active female with internal snapping and pain following an open psoas tenotomy. Postoperatively she was symptom free for 13 years. An MRI arthrogram revealed reformation of a pseudo iliopsoas tendon reinserting into the lesser trochanter. The pain and snapping resolved after repeat iliopsoas tendon release. Reformation of tendons is an uncommon sequela of tenotomies. However the lack of long-term studies makes it difficult to calculate prevalence rates. Tendon reformation should be included in the differential diagnosis of failed tenotomy procedures after a period of symptom relief. PMID:23662230

Garala, K; Power, R A

2013-01-01

148

Blocked tear duct  

MedlinePLUS

A blocked tear duct is a partial or complete blockage in the pathway that carries tears from the surface of the eye into the ... Tears are constantly being made to help protect the surface of your eye. They drain into a ...

149

Inhomogeneous mechanical behavior of the human supraspinatus tendon under uniaxial loading.  

PubMed

Disorders of the rotator cuff, particularly tears of the rotator cuff tendons, cause significant shoulder disability. Among numerous factors thought to be responsible for the initiation and progression of supraspinatus tears are those related to the tendon's biomechanical properties. We hypothesized that in supraspinatus tendons subjected to tensile loading a strain gradient (difference) exists between the articular and bursal tendon surfaces, that regional strain differences exist on each of these two tendon surfaces, and that tendon surface strains vary with glenohumeral abduction. To test these hypotheses, the intrinsic inhomogeneous deformational characteristics of the articular and bursal surfaces of eight intact human cadaveric supraspinatus tendons were studied at three glenohumeral abduction angles using a novel multiple strain measuring system which simultaneously recorded surface marker displacements on two opposing soft tissue surfaces. Under applied tensile loads, the articular surface exhibited greater strain at 22 degrees (7.4+/-2.6% vs. 1.3+/-0.7%, p=0.0002) and 63 degrees (6.4+/-1.6% vs. 2.7+/-1.2%, p=0.0001) whereas the bursal surface exhibited greater strain at 90 degrees (7.6+/-2.8% vs. 4.9+/-0.4%, p=0.013). At all abduction angles, insertion strains were higher than those of the mid-tendon and tendon-muscle junction regions. The existence of inhomogeneous surface strains in the intact supraspinatus tendon demonstrates that intratendinous shear occurs within the tendon. The higher strain on the articular side of the tendon, especially at the insertion region, suggests a propensity for tears to initiate in the articular tendinous zone. PMID:16023009

Huang, Chun-Yuh; Wang, Vincent M; Pawluk, Robert J; Bucchieri, John S; Levine, William N; Bigliani, Louis U; Mow, Van C; Flatow, Evan L

2005-07-01

150

Comparison of step-cut and Pulvertaft attachment for flexor tendon graft: a biomechanics evaluation in an in vitro canine model  

PubMed Central

The purpose of this study was to compare two different methods of joining tendons of similar and dissimilar sizes between recipient and donor tendons for flexor tendon grafts. Flexor digitorum profundus (FDP) and peroneus longus (PL) canine tendons were harvested and divided into four groups. The repair technique we compared was a step-cut (SC) suture and a Pulvertaft weave (PW). FDP tendons were significantly larger in diameter than PL tendons (p < 0.05). The volume of the SC repairs using either FDP or PL tendon as a graft was significantly smaller than PW repairs (p < 0.05). The ultimate load to failure and repair stiffness in FDP graft tendons significantly increased compared with the PL graft tendons (p < 0.05). The SC suture can be used as an alternative to the PW, with similar strength and less bulk for repairs using graft tendons of similar diameter. Surgeons should be aware of the effect of graft tendon size and repair method on strength and bulk when performing flexor tendon grafts.

Hashimoto, T; Thoreson, A. R.; An, K.-N.; Amadio, P. C.; Zhao, C.

2013-01-01

151

Split peroneus brevis tendon: an unusual cause of ankle pain and instability.  

PubMed

Tears of the peroneus brevis tendon may cause ankle pain, swelling, and instability. Supportive therapy with ankle bracing and analgesics is the mainstay of therapy, but surgical repair is often required in patients with ongoing symptoms. Surgical options include debridement, tubularization, or, in severe cases, resection of the damaged tendon and tenodesis. We describe a 64-year-old woman with a split peroneus brevis tendon presenting with lateral ankle pain, swelling, and instability, and we review the literature regarding presentation, diagnostic testing, pathophysiology, predisposing factors, and treatment recommendations. Primary care physicians should consider peroneal tendon injuries in patients with chronic lateral ankle pain and instability. PMID:24610194

Chauhan, Bindiya; Panchal, Pina; Szabo, Edward; Wilkins, Thad

2014-01-01

152

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

PubMed Central

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.

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

2009-01-01

153

Massive rotator cuff tears: arthroscopy to arthroplasty.  

PubMed

The understanding of rotator cuff disease has increased exponentially since Codman drew attention to this pathology in the early 1900s. Although challenging, the surgical treatment of massive rotator cuff tears is rational, with treatment decisions based on physical examination, imaging, biologic, and patient factors. Arthroscopy can be used to treat ancillary pain generators, débride necrotic tissue, and possibly restore balance to the force couples about the shoulder. Tendon transfers may be effective in restoring functional strength to irreparable, ineffectual muscle units. Arthroplasty is both a primary treatment and a salvage option. PMID:20415384

Singh, Anshu; Jawa, Andrew; Morman, Monica; Sanofsky, Benjamin; Higgins, Laurence

2010-01-01

154

Distal biceps tendon injuries--current treatment options.  

PubMed

Three percent of all biceps tendon ruptures occur at the distal aspect, where the tendon inserts into the radial tuberosity. Distal bicep tendon ruptures typically occur in middle-aged males after an eccentric extension load is applied to the elbow. Patients usually complain of a sudden, sharp, and painful tearing sensation in the antecubital region, with a palpable defect. The biceps squeeze and hook tests are specific maneuvers by which to diagnose distal biceps ruptures on physical examination. Magnetic resonance imaging (MRI) or ultrasound maybe be helpful to distinguish between partial and complete tears. Anatomic studies suggest there are two distinct insertions for the short and long heads of the distal biceps. The short head may be a more powerful flexor, and the long head may be a more powerful supinator. Nonoperative treatment typically results in loss of flexion and supination strength and endurance. Early anatomic re-attachment is the goal. Surgical approaches include one- or two-incision techniques, and tendon fixation methods include the use of suture anchors, bone tunnels, an endobutton, or biotenodesis screws. Biomechanical studies have shown that endobuttons have higher load-to-failure strengths, compared to the other fixation methods. However, clinical studies have demonstrated that patients do well regardless of surgical approach or fixation method. Possible complications include nerve injuries, heterotopic ossification, postoperative fracture, tendon rerupture, complex regional pain syndrome, and wound infection. Partial ruptures are significantly less common and initially can be treated conservatively. Chronic tears are more difficult to treat because of possible tendon retraction and poor tissue quality. Tendon grafts using semitendinosus, fascia lata, hamstring, Achilles (calcaneal), or flexor carpi radialis have been successfully used for length restoration in these cases. PMID:20632985

Quach, Tony; Jazayeri, Reza; Sherman, Orrin H; Rosen, Jeffrey E

2010-01-01

155

The tension required at repair to reappose the supraspinatus tendon to bone rapidly increases after injury.  

PubMed

Rotator cuff tears occur frequently and can cause significant pain and reduced shoulder function. A high percentage of patients are satisfied after surgical repair of rotator cuff tears, but a smaller percentage of patients with chronic tears continue to have pain and poor shoulder function. This may be partly attributable to an increase in the repair tension, the force required at repair to reappose the tendon to its original insertion site on the humerus. Increases in repair tension have been shown to occur for long-standing ruptures of the supraspinatus tendon, but the precise tension at various times after injury are unknown. Therefore, the objective of the current study was to determine the repair tension at various times after a rotator cuff tear. This was achieved by creating a full-thickness supraspinatus tendon tear in a rat model and measuring the mechanical characteristics of the musculotendinous unit at 0, 2, 4, 9, and 16 weeks after injury. The repair tension rapidly increased initially after injury followed by a progressive, but less dramatic, increase with additional time. These findings suggest that rotator cuff tears should be repaired early in the clinical setting. Future studies will investigate the effect of repair tension on tendon to bone healing after repair. PMID:15346083

Gimbel, Jonathan A; Mehta, Samir; Van Kleunen, Jonathan P; Williams, Gerald R; Soslowsky, Louis J

2004-09-01

156

Achilles tendon: US examination  

SciTech Connect

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

Fornage, B.D.

1986-06-01

157

The influence of the acromial coverage index in rotator cuff tears.  

PubMed

Several intrinsic and extrinsic factors have been advocated in the pathogenesis of rotator cuff tears, but it is still unclear whether the origin of the tear is related to tendon degeneration itself or induced by several morphologic changes. The purpose of this study is to determine the relationship between the acromial coverage of the humeral head and the presence of a cuff tear. We evaluated 148 shoulders, including 45 that underwent surgical rotator cuff repair (group I), 26 with documented rotator cuff tears treated conservatively (group II), and 77 with no cuff pathology as a control group (group III). The mean acromial coverage index was 0.68 in group I, 0.72 in group II, and 0.59 in group III, giving a highly significant difference (P < .0001) between the control group and both cuff tear groups. Patients with a cuff tear have a significantly higher acromial coverage index than the control group. PMID:17113323

Torrens, Carlos; López, Joan-Miquel; Puente, Isabel; Cáceres, Enrique

2007-01-01

158

Tenotomy versus Tenodesis in the treatment of the long head of biceps brachii tendon lesions  

PubMed Central

Background The superiority of tenotomy vs. tenodesis for surgery on lesions of the long head of the biceps brachii tendon is still under debate. Indeed, high-quality evidence is lacking, mainly because of methodological problems, such as retrospective design, population sample size or lack of patient randomization. Methods/Design The study will be a two-center, double-blind, randomized, controlled trial to compare patients treated with biceps tenotomy or tenodesis for lesions of the long head of the biceps brachii tendon over a 2-year follow-up period. The study participants will be 128 adults with biceps brachii tendinopathy and supraspinatus tendon tears. The primary end point will be the postoperative difference in the Constant-Murley score (CMS) between the 2 groups at the two-year follow-up. A comparison of the mean improvement with standard age- and gender-related CMS will be performed. The secondary end point will be evaluation of the postoperative general health of patients, as evaluated with Short Form 36 (SF-36) scores. The number and severity of complications associated with use of the different surgical techniques will be assessed. Discussion This study will be the first randomized and appropriately powered clinical trial to directly compare tenotomy and biceps tenodesis. The results of this study will help to establish clinical practice guidelines for patients suffering from lesions of the long head of the biceps brachii tendon, providing important information to patients and health care providers about the possible complications, outcome predictors and effectiveness of the targeted interventions. Trial Registration Current Controlled Trials ISRCTN38839558

2012-01-01

159

Tear fluid protein biomarkers.  

PubMed

The tear film covers and protects the ocular surface. It contains various molecules including a large variety of proteins. The protein composition of the tear fluid can change with respect to various local and systemic diseases. Prior to the advent of the proteomic era, tear protein analysis was limited to a few analytical techniques, the most common of which was immunoelectrophoresis, an approach dependent on antibody availability. Using proteomics, hundreds of tear proteins could potentially be identified and subsequently studied. Although detection of low-abundance proteins in the complex tear proteome remains a challenge, advances in sample fractionation and mass spectrometry have greatly enhanced our ability to detect these proteins. With increasing proteomic applications, tears show great potential as biomarkers in the development of clinical assays for various human diseases. In this chapter, we discuss the structure and functions of the tear film and methods for its collection. We also summarize potential tear protein biomarkers identified using proteomic techniques for both ocular and systemic diseases. Finally, modern proteomic techniques for tear biomarker research and future challenges are explored. PMID:24772667

You, Jingjing; Willcox, Mark D; Madigan, Michele C; Wasinger, Valerie; Schiller, Belinda; Walsh, Bradley J; Graham, Peter H; Kearsley, John H; Li, Yong

2013-01-01

160

Histologic evidence of degeneration at the insertion of 3 rotator cuff tendons: a comparative study with human cadaveric shoulders.  

PubMed

We determined on histologic examination the degree of degeneration at the insertion of 3 rotator cuff tendons in 76 cadaveric shoulders, 17 of which had a partial tear of the supraspinatus. Fiber thinning, the presence of granulation tissue, and incomplete tearing of fibers, all evidence of degeneration, were quantified separately for each tendon. Among the shoulders that were intact on macroscopy, no significant difference in degeneration score could be found. In all 3 tendons degeneration was more prominent on the articular sides compared with the bursal sides (P < .0001). The degeneration score of partially torn supraspinatus was significantly higher than that of the intact tendons (P < .0001). The extent of granulation tissue, 1 criterion of degeneration, seemed to contribute mostly to this difference. Intrinsic degeneration occurred foremost in the articular side of the rotator cuff and might constitute the primary cause of rotator cuff tearing. PMID:10633891

Sano, H; Ishii, H; Trudel, G; Uhthoff, H K

1999-01-01

161

Achilles tendon disorders.  

PubMed

Achilles tendon disorders include tendinosis, paratenonitis, insertional tendinitis, retrocalcaneal bursitis, and frank rupture. Patients present with pain and swelling in the posterior aspect of the ankle. Magnetic resonance imaging and ultrasound are helpful in confirming the diagnosis and guiding treatment. Nonsurgical management of Achilles tendon disorders includes nonsteroidal anti-inflammatory drugs, physical therapy, bracing, and footwear modification. Surgical treatment includes debridement of the diseased area of the tendon with direct repair. Tendon transfer may be necessary to augment the strength of the Achilles tendon. PMID:24559878

Weinfeld, Steven B

2014-03-01

162

Isolated partial tear of subscapularis muscle in a competitive water skier. A case report.  

PubMed

Partial tears of the subscapularis tendon associated with anterior shoulder dislocation, are frequently described while the isolated lesions of this tendon are quite rare. We report the case of a 33 years old water-skier who injured his right subscapularis muscle during a forced movement of adduction and internal rotation. Ultrasound evaluation and then MRI were used to depict the entity of the lesion. The ruptured tendon was surgically repaired using a MITEK anchor system. Four months after surgery, the athlete returned back to his full athletic activity. PMID:7643588

Dragoni, S; Giombini, A; Candela, V; Rossi, F

1994-12-01

163

The Use of an Intra-Articular Depth Guide in the Measurement of Partial Thickness Rotator Cuff Tears  

PubMed Central

Purpose. The purpose of this study was to compare the accuracy of the conventional method for determining the percentage of partial thickness rotator cuff tears to a method using an intra-articular depth guide. The clinical utility of the intra-articular depth guide was also examined. Methods. Partial rotator cuff tears were created in cadaveric shoulders. Exposed footprint, total tendon thickness, and percentage of tendon thickness torn were determined using both techniques. The results from the conventional and intra-articular depth guide methods were correlated with the true anatomic measurements. Thirty-two patients were evaluated in the clinical study. Results. Estimates of total tendon thickness (r = 0.41, P = 0.31) or percentage of thickness tears (r = 0.67, P = 0.07) using the conventional method did not correlate well with true tendon thickness. Using the intra-articular depth guide, estimates of exposed footprint (r = 0.92, P = 0.001), total tendon thickness (r = 0.96, P = 0.0001), and percentage of tendon thickness torn (r = 0.88, P = 0.004) correlated with true anatomic measurements. Seven of 32 patients had their treatment plan altered based on the measurements made by the intra-articular depth guide. Conclusions. The intra-articular depth guide appeared to better correlate with true anatomic measurements. It may be useful during the evaluation and development of treatment plans for partial thickness articular surface rotator cuff tears.

Carroll, Michael J.; More, Kristie D.; Sohmer, Stephen; Nelson, Atiba A.; Sciore, Paul; Boorman, Richard; Hollinshead, Robert; Lo, Ian K. Y.

2013-01-01

164

Restoration of anterior-posterior rotator cuff force balance improves shoulder function in a rat model of chronic massive tears.  

PubMed

The rotator cuff musculature imparts dynamic stability to the glenohumeral joint. In particular, the balance between the subscapularis anteriorly and the infraspinatus posteriorly, often referred to as the rotator cuff "force couple," is critical for concavity compression and concentric rotation of the humeral head. Restoration of this anterior-posterior force balance after chronic, massive rotator cuff tears may allow for deltoid compensation, but no in vivo studies have quantitatively demonstrated an improvement in shoulder function. Our goal was to determine if restoring this balance of forces improves shoulder function after two-tendon rotator cuff tears in a rat model. Forty-eight rats underwent detachment of the supraspinatus and infraspinatus. After four weeks, rats were randomly assigned to three groups: no repair, infraspinatus repair, and two-tendon repair. Quantitative ambulatory measures including medial/lateral forces, braking, propulsion, and step width were significantly different between the infraspinatus and no repair group and similar between the infraspinatus and two-tendon repair groups at almost all time points. These results suggest that repairing the infraspinatus back to its insertion site without repair of the supraspinatus can improve shoulder function to a level similar to repairing both the infraspinatus and supraspinatus tendons. Clinically, a partial repair of the posterior cuff after a two-tendon tear may be sufficient to restore adequate function. An in vivo model system for two-tendon repair of massive rotator cuff tears is presented. PMID:21308755

Hsu, Jason E; Reuther, Katherine E; Sarver, Joseph J; Lee, Chang Soo; Thomas, Stephen J; Glaser, David L; Soslowsky, Louis J

2011-07-01

165

Tendon Properties Remain Altered in a Chronic Rat Rotator Cuff Model  

Microsoft Academic Search

Background  Chronic rotator cuff tears are often associated with pain or poor function. In a rat with only a detached supraspinatus tendon,\\u000a the tendon heals spontaneously which is inconsistent with how tears are believed to heal in humans.\\u000a \\u000a \\u000a \\u000a \\u000a Questions\\/purposes  We therefore asked whether a combined supraspinatus and infraspinatus detachment in the rat would fail to heal and result\\u000a in a chronic injury

LeAnn M. Dourte; Stephanie M. Perry; Charles L. Getz; Louis J. Soslowsky

2010-01-01

166

The native tensile strength of the supraspinatus tendon. A biomechanical study  

Microsoft Academic Search

Summary  \\u000a The traumatic tear of the rotator cuff has been discussed very intensively for a long time despite the fact that there do\\u000a not exist representative objective data about the native tensile strength of these tendons. The aim of this study was to evaluate\\u000a the age related native strength of the supraspinatus tendon. 25 fresh frozen cadaver specimen (age: 23–94,

M. Rickert; H. Georgousis; U. Witzel

1998-01-01

167

Partial-Thickness Rotator Cuff Tears  

PubMed Central

Although the incidence of partial-thickness rotator cuff tears (PTRCTs) was reported to be from 13% to 32% in cadaveric studies, the actual incidence is not yet known. The causes of PTRCTs can be explained by either extrinsic or intrinsic theories. Studies suggest that intrinsic degeneration within the rotator cuff is the principal factor in the pathogenesis of rotator cuff tears. Extrinsic causes include subacromial impingement, acute traumatic events, and repetitive microtrauma. However, acromially initiated rotator cuff pathology does not occur and extrinsic impingement does not cause pathology on the articular side of the tendon. An arthroscopic classification system has been developed based on the location and depth of the tear. These include the articular, bursal, and intratendinous areas. Both ultrasound and magnetic resonance image are reported with a high accuracy of 87%. Conservative treatment, such as subacromial or intra-articular injections and suprascapular nerve block with or without block of the articular branches of the circumflex nerve, should be considered prior to operative treatment for PTRCTs.

2011-01-01

168

Clinical comparison of intraarticular anterior cruciate ligament reconstruction using autogenous semitendinosus and gracilis tendons in men versus women.  

PubMed

Reconstruction of the anterior cruciate ligament using a hamstring tendon autograft has often been recommended for female athletes. We compared the results of acute, isolated, intraarticular anterior cruciate ligament reconstructions using quadruple-looped hamstring autografts in 39 female and 26 male patients. All reconstructions were performed by the same surgeon using a similar surgical technique and the same postoperative management. In each case, patients had Endobutton femoral fixation and either post or button fixation for the tibial side. The average follow-up was 40.9 months for women and 39.0 months for men. Objective analysis of results included examination for the presence of effusion and crepitus, Lachman and pivot shift testing, and KT-1000 arthrometer testing for side-to-side differences. Subjective analysis consisted of a 15-item visual analog scale completed by patients postoperatively, and pre- and postoperative Tegner and Lysholm scores. The clinical failure rate was 23% (9 of 39) for the female patients and 4% (1 of 26) for the male patients, which was statistically significant. There was also a trend toward increased laxity in female patients. Subjectively, the women also reported a higher frequency and intensity of pain. Based on Tegner activity levels, more of the men returned to their preinjury level of activity than did the women. When compared with the male patients, female patients had a significantly higher failure rate after reconstruction. PMID:11101098

Noojin, F K; Barrett, G R; Hartzog, C W; Nash, C R

2000-01-01

169

Arthroscopic Double-Locked Stitch: A New Technique for Suturing Rotator Cuff Tears  

PubMed Central

There are a number of reasons for failed rotator cuff tear repair. In such cases the suture-tendon interface seems to be the most vulnerable area, especially when tendon degeneration is present. We describe a new technique, the arthroscopic double-locked suture, that increases the tendon fixation and has the added benefit of being placed parallel to the blood vessels, therefore avoiding damage to the tendon vascularization. The suture may be achieved by use of knots or knotless anchors and suture passers, without the need for any additional instrumentation. The new technique is especially helpful in cases in which the tendon is retracted and degeneration is present, impeding the use of the double-row technique or its transosseous equivalents.

Miyazaki, Alberto N.; Zanella, Luiz A.Z.; La Salvia, Joao C.; Fregoneze, Marcelo; Santos, Pedro D.; da Silva, Luciana A.; Sella, Guilherme do Vall; Checchia, Sergio L.

2014-01-01

170

Arthroscopic double-locked stitch: a new technique for suturing rotator cuff tears.  

PubMed

There are a number of reasons for failed rotator cuff tear repair. In such cases the suture-tendon interface seems to be the most vulnerable area, especially when tendon degeneration is present. We describe a new technique, the arthroscopic double-locked suture, that increases the tendon fixation and has the added benefit of being placed parallel to the blood vessels, therefore avoiding damage to the tendon vascularization. The suture may be achieved by use of knots or knotless anchors and suture passers, without the need for any additional instrumentation. The new technique is especially helpful in cases in which the tendon is retracted and degeneration is present, impeding the use of the double-row technique or its transosseous equivalents. PMID:24904764

Miyazaki, Alberto N; Zanella, Luiz A Z; La Salvia, João C; Fregoneze, Marcelo; Santos, Pedro D; da Silva, Luciana A; Sella, Guilherme do Vall; Checchia, Sergio L

2014-04-01

171

Fibronectin in the Tear Film  

Microsoft Academic Search

Purpose. Fibronectin plays an important role in corneal wound healing and has been detected previously in the tear film. To investigate the levels of fibronectin in normal human tears, the authors measured and compared fibronectin concentration in open-eye, closed-eye, and reflex tear fluid. The origin of fibronectin in the tear film was investigated by comparing fibronectin concentration in sequentially collected

Masahiko Fukuda; Roderick J. Fullard; Mark D. P. Willcox; Cristina Baleriola-Lucas; Fakhry Bestaxvros; Deborah Sweeney; Brien A. Holden

1996-01-01

172

Meniscus tears - aftercare  

MedlinePLUS

... you will learn exercises to make the muscles, ligaments, and tendons around your knee stronger and more flexible. If you have surgery to repair your meniscus, you may need physical therapy to regain the full use of your knee. ...

173

Tendon and ligament imaging  

PubMed Central

MRI and ultrasound are now widely used for the assessment of tendon and ligament abnormalities. Healthy tendons and ligaments contain high levels of collagen with a structured orientation, which gives rise to their characteristic normal imaging appearances as well as causing particular imaging artefacts. Changes to ligaments and tendons as a result of disease and injury can be demonstrated using both ultrasound and MRI. These have been validated against surgical and histological findings. Novel imaging techniques are being developed that may improve the ability of MRI and ultrasound to assess tendon and ligament disease.

Hodgson, R J; O'Connor, P J; Grainger, A J

2012-01-01

174

Comparative Effectiveness of Nonoperative and Operative Treatments for Rotator Cuff Tears: Comparative Effectiveness Review, Number 22.  

National Technical Information Service (NTIS)

The rotator cuff (RC) is comprised of four muscle-tendon units, which stabilize the humeral head within the shoulder joint and aid in powering the movement of the upper extremity. RC tears refer to a partial or full discontinuation of one or more of the m...

B. Vandermeer J. C. Seida J. R. Schouten L. Tjosvold S. S. Mousavi

2010-01-01

175

Glenoid Cartilage Mechanical Properties Decrease after Rotator Cuff Tears in a Rat Model  

PubMed Central

Summary Rotator cuff repairs are commonly performed to reduce pain and restore function. Tears are also treated successfully without surgical intervention; however, the effect that a torn tendon has on the glenohumeral cartilage remains unknown. Clinically, a correlation between massive rotator cuff tears and glenohumeral arthritis has often been observed. This may be due to a disruption in the balance of forces at the shoulder, resulting in migration of the humeral head and subsequently, abnormal loading of the glenoid. Our lab previously demonstrated changes in ambulation and intact tendon mechanical properties following supraspinatus and infraspinatus rotator cuff tendon tears in a rat model. Therefore, the purpose of this study was to investigate the effects of supraspinatus and infraspinatus rotator cuff tears on the glenoid cartilage. Nine rats underwent unilateral detachment of the supraspinatus and infraspinatus tendons and were sacrificed after four weeks. Cartilage thickness significantly decreased in the antero-inferior region of injured shoulders. In addition, equilibrium elastic modulus significantly decreased in the center, antero-superior, antero-inferior, and superior regions. These results suggest that altered loading after rotator cuff injury may lead to damage to the joint with significant pain and dysfunction. Clinically, understanding the mechanical processes involved with joint damage will allow physicians to better advise patients.

Reuther, Katherine E.; Sarver, Joseph J.; Schultz, Susan M.; Lee, Chang Soo; Sehgal, Chandra M.; Glaser, David L.; Soslowsky, Louis J.

2012-01-01

176

Double-row fixation of upper subscapularis tears with a single suture anchor.  

PubMed

The recognition of and discussion of operative techniques for subscapularis tendon tears have lagged behind those for the posterosuperior rotator cuff. The advancement of shoulder arthroscopy has provided the opportunity to see the articular side of the rotator cuff and has led to increased recognition of subscapularis tears. Double-row fixation of the posterosuperior rotator cuff has become popular because of improved biomechanical strength, footprint restoration, and tendon healing compared with single-row fixation. Double-row fixation of the subscapularis, however, has been challenging because of the small anterior space overlying the subscapularis. Whereas the subacromial space allows freedom of movement, the limited subcoracoid space makes visualization, instrument manipulation, and knot tying more difficult. We describe a new technique for double-row fixation of the upper subscapularis footprint using a knotless technique without an additional anchor, which eases some of the aforementioned difficulties. The technique is indicated for partial- or full-thickness tears of the upper 50% of the subscapularis tendon and therefore applies to the majority of tears involving the subscapularis tendon. PMID:21704472

Denard, Patrick J; Lädermann, Alexandre; Burkhart, Stephen S

2011-08-01

177

Biomimetic scaffold design for functional and integrative tendon repair.  

PubMed

Rotator cuff tears represent the most common shoulder injuries in the United States. The debilitating effect of this degenerative condition coupled with the high incidence of failure associated with existing graft choices underscores the clinical need for alternative grafting solutions. The 2 critical design criteria for the ideal tendon graft would require the graft to not only exhibit physiologically relevant mechanical properties but also be able to facilitate functional graft integration by promoting the regeneration of the native tendon-to-bone interface. Centered on these design goals, this review will highlight current approaches to functional and integrative tendon repair. In particular, the application of biomimetic design principles through the use of nanofiber- and nanocomposite-based scaffolds for tendon tissue engineering will be discussed. This review will begin with nanofiber-based approaches to functional tendon repair, followed by a section highlighting the exciting research on tendon-to-bone interface regeneration, with an emphasis on implementation of strategic biomimicry in nanofiber scaffold design and the concomitant formation of graded multi-tissue systems for integrative soft-tissue repair. This review will conclude with a summary and discussion of future directions. PMID:22244070

Zhang, Xinzhi; Bogdanowicz, Danielle; Erisken, Cevat; Lee, Nancy M; Lu, Helen H

2012-02-01

178

The relevance of long head biceps degeneration in the presence of rotator cuff tears  

PubMed Central

Background Long head biceps (LHB) degeneration in combination with rotator cuff tears can be a source of chronic shoulder pain. LHB tenotomy is an approved surgical procedure for pain reduction and improvement of joint function, however, the pathophysiology of LHB degeneration is not fully understood. In the literature, neoangiogenesis in tendon tissue has previously been shown to be associated with tendon degeneration. Vascular Endothelial Growth Factor (VEGF) is an important inducer of neoangiogenesis. The hypotheses are first that an elevated VEGF expression and vessel density can be found in degenerated LHB tissue and second that there is a relation between VEGF expression, vessel density and the different types of rotator cuff tears. Methods LHB samples of 116 patients with degenerative rotator cuff tears were harvested during arthroscopic tenotomy. The samples were dehydrated and paraffin embedded. VEGF expression was determined using immunohistochemistry. Vessel density and vessel size were determined on Masson-Goldner stained tissue sections. On the basis of intraoperative findings, patients were assigned to 4 different groups (control group, partial thickness rotator cuff tear, full thickness rotator cuff tear and cuff arthropathy). Partial thickness rotator cuff tears were classified according to Ellman grade I-III, full thickness rotator cuff tears according to Bateman's classification (grade I-IV). The control group consisted of eight healthy tendon samples. Results VEGF expression in the LHB was significantly higher in the presence of rotator cuff tears than in healthy tendons (p < 0.05) whereas vessel density and vessel size were significantly higher in the LHB of patients with cuff arthropathy (p < 0.05). Furthermore, there was significantly higher VEGF expression in LHB samples from patients with articular-sided compared to bursal-sided partial thickness rotator cuff tears (p < 0.05). No significant dependence was found between VEGF expression, vessel size and vessel density in LHB of patients with full thickness rotator cuff tears and the extent of the cuff tear following Bateman's classification. Conclusion Elevated VEGF expression can be detected in degenerated LHB tissue. The quantity of VEGF expression and vessels are related to the extent of LHB degeneration.

2010-01-01

179

Intratendinous strain fields of the intact supraspinatus tendon: the effect of glenohumeral joint position and tendon region.  

PubMed

Rotator cuff tears are a common shoulder pathology and are hypothesized to relate to excessive tissue deformation. Few data exist, however, describing deformation of the rotator cuff as an intact, functional unit. Our purpose was to determine regional variations of intratendinous rotator cuff strain over a range of clinically relevant joint positions. A novel, MRI-based technique was utilized to quantify intratendinous strains in cadaveric shoulder specimens at 15 degrees, 30 degrees, 45 degrees, and 60 degrees of glenohumeral abduction in the scapular plane. The strain data were grouped into superior, middle, and inferior locations across the region where most rotator cuff tears occur clinically. A repeated measures ANOVA assessed the effects of joint position and tendon region on intratendinous strain. Few differences in intratendinous strain existed across tendon regions, but joint position had a pronounced effect. Specifically, intratendinous strain increased with increasing joint angle, and the 60 degrees strain was significantly greater than the 15 degrees strain across all tendon regions. These data suggest that joint position plays a larger role in rotator cuff mechanics than previously believed. Future studies will utilize this technique for quantifying intratendinous strain to assess the effects of partial-thickness rotator cuff tears. PMID:12168680

Bey, Michael J; Song, Hee Kwon; Wehrli, Felix W; Soslowsky, Louis J

2002-07-01

180

Repair of Achilles tendon ruptures with Dacron vascular graft.  

PubMed

A technique has been developed for the repair of Achilles tendon ruptures that allows for early mobilization of the patient. A Dacron vascular graft is woven from distal to proximal and across the site of the rupture in a Bunnell-type fashion. The patients are immobilized in a short-leg cast for two weeks and are then fitted for a posterior fiberglass splint. Seven patients with acute ruptures who were treated with repair with the Dacron graft were followed for a period ranging from ten to 38 months. They were allowed to return to their normal level of activity approximately five months after surgery. There have been no reruptures. This technique also holds particular promise for the late reconstruction of an Achilles tendon rupture as well as for the treatment of partial tears in the severely degenerated tendon. PMID:2970358

Lieberman, J R; Lozman, J; Czajka, J; Dougherty, J

1988-09-01

181

Acute rupture of the anterior cruciate ligament and patellar tendon in a collegiate athlete.  

PubMed

In rare incidences of combined ruptures of the ACL and patellar tendon, either the patellar tendon ruptures or the associated ACL tear is often initially missed. Even when recognized, there is no established treatment regimen. We report a case of an intercollegiate football player with a combined rupture of the ACL and patellar tendon that was successfully treated by primary augmented repair of the patellar tendon along with ACL reconstruction. Similar to other reported cases, the mechanism of injury involved forceful eccentric contraction of the quadriceps against a fixed foot. Superior displacement of the patella with a palpable defect of the patellar tendon, a positive Lachman test, and an inability to perform terminal knee extension noted during the on-field examination indicated the combined injury. Magnetic resonance and radiographic imaging confirmed conclusions from the on-field examination. The patient also underwent safe early mobilization and weight bearing following surgical repair. PMID:17210443

Futch, Lydia A; Garth, William P; Folsom, Greg J; Ogard, William K

2007-01-01

182

A new method for knotless fixation of an upper subscapularis tear.  

PubMed

The advancement of shoulder arthroscopy has provided the opportunity to see the articular side of the rotator cuff and has led to increased recognition of subscapularis tears. One of the unique challenges to arthroscopic subscapularis repair is the small anterior space overlying the subscapularis. Whereas the subacromial space allows freedom of movement, the limited subcoracoid space makes visualization, instrument manipulation, and knot tying more difficult. We describe a technique for knotless restoration of the upper subscapularis footprint that eases some of the aforementioned difficulties. The technique is indicated for partial- or full-thickness tears of the upper 50% of the subscapularis tendon and therefore applies to the majority of tears involving the subscapularis tendon. PMID:21489743

Denard, Patrick J; Burkhart, Stephen S

2011-06-01

183

Forefoot tendon transfers.  

PubMed

Flexible forefoot deformities, such as hallux varus, clawed hallux, hammer toes, and angular lesser toe deformities, can be treated effectively with tendon transfers. Based on the presentation of the flexible forefoot deformities, tendon transfers can be used as the primary treatment or as adjuncts to bony procedures when there are components of fixed deformities. PMID:24548515

Veljkovic, Andrea; Lansang, Edward; Lau, Johnny

2014-03-01

184

An Artificial Tendon with Durable Muscle Interface  

PubMed Central

A coupling mechanism that can permanently fix a forcefully contracting muscle to a bone anchor or any totally inert prosthesis would meet a serious need in orthopaedics. Our group developed the OrthoCoupler™ device to satisfy these demands. The objective of this study was to test OrthoCoupler’s performance in vitro and in vivo in the goat semitendinosus tendon model. For in vitro evaluation, 40 samples were fatigue-tested, cycling at 10 load levels, n=4 each. For in vivo evaluation, the semitendinosus tendon was removed bilaterally in 8 goats. Left sides were reattached with an OrthoCoupler, and right sides were reattached using the Krackow stitch with #5 braided polyester sutures. Specimens were harvested 60 days post-surgery and assigned for biomechanics and histology. Fatigue strength of the devices in vitro was several times the contractile force of the semitendinosus muscle. The in vivo devices were built equivalent to two of the in vitro devices, providing an additional safety factor. In strength testing at necropsy, suture controls pulled out at 120.5 ± 68.3 N, whereas each OrthoCoupler was still holding after the muscle tore, remotely, at 298±111.3N (mean ± SD)(p<0.0003). Muscle tear strength was reached with the fiber-muscle composite produced in healing still soundly intact. This technology may be of value for orthopaedic challenges in oncology, revision arthroplasty, tendon transfer, and sports-injury reconstruction.

Melvin, Alan; Litsky, Alan; Mayerson, Joel; Witte, David; Melvin, David; Juncosa-Melvin, Natalia

2010-01-01

185

Extra-articular Mimickers of Lateral Meniscal Tears  

PubMed Central

Context: Lateral meniscus tears are a common entity seen in sports medicine. Although lateral-side knee pain is often the result of a meniscus injury, several extra-articular pathologies share signs and symptoms with a meniscus tear. It is critical for the clinician to be able to identify and understand extra-articular pathologies that can present similar to a lateral meniscus tear. Evidence Acquisition: Data were collected through a thorough review of the literature conducted through a MEDLINE search for all relevant articles between 1980 and February 2010. Study Type: Clinical review. Results: Common extra-articular pathologies that can mimic lateral meniscal tears include iliotibial band syndrome, proximal tibiofibular joint instability, snapping biceps femoris or popliteus tendons, and peroneal nerve compression syndrome or neuritis. The patient history, physical examination features, and radiographic findings can be used to separate these entities from the more common intra-articular knee pathologies. Conclusions: In treating patients who present with lateral-sided knee pain, clinicians should be able to recognize and treat extra-articular pathologies that can present in a similar fashion as lateral meniscus tears.

Barker, Joseph U.; Strauss, Eric J.; Lodha, Sameer; Bach, Bernard R.

2011-01-01

186

Estimation of total collagen and types I and III collagen in canine rotator cuff tendons.  

PubMed

The collagen composition of the supraspinatus, infraspinatus, and subscapularis tendons, which form part of the rotator cuff of the shoulder, was determined. Tendons were obtained from adult, male beagle dogs and total collagen was estimated by measurement of hydroxyproline. There was little variation in collagen content among the three major cuff tendons and the quantity approximated that cited in the literature for other tendons. However, the collagen content in the insertion zone of the supraspinatus tendon was significantly higher than in the tendon proper. NaCl fractionation of supraspinatus collagen indicated that type I was the predominant collagen but significant amounts of type III and possibly some type II and type V were also present. Interestingly, there appeared to be more type III collagen in the insertion zone than in the tendon proper, cyanogen bromide digestion and peptide mapping confirmed this finding. The differential collagen composition of the supraspinatus tendon may contribute to the high incidence of tear that is associated with this rotator cuff tendon. PMID:9262514

Fan, L; Sarkar, K; Franks, D J; Uhthoff, H K

1997-09-01

187

Tears at the rotator cuff footprint: Prevalence and imaging characteristics in 305 MR arthrograms of the shoulder  

Microsoft Academic Search

Objectives  To evaluate the prevalence, imaging characteristics and anatomical distribution of tears at the rotator cuff (RC) footprint\\u000a with MR arthrography (MR-A) of the shoulder.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  MR arthrograms obtained in 305 patients were retrospectively reviewed. Partial articular-sided supraspinatus tendon avulsions\\u000a (PASTA), concealed interstitial delaminations (CID), reverse PASTA lesions and full-thickness tears (FT) at the humeral tendon\\u000a insertion were depicted. Anatomical locations were

Christoph Schaeffeler; Dirk Mueller; Chlodwig Kirchhoff; Petra Wolf; Ernst J. Rummeny; Klaus Woertler

2011-01-01

188

Arthroscopic Transtendon Repair of Partial-Thickness Articular-Side Tears of the Rotator CuffAnatomical and Clinical Study  

Microsoft Academic Search

Background: The precise results of arthroscopic transtendon repair of partial-thickness articular-side tears of the rotator cuff remain to be reported.Hypothesis: Arthroscopic transtendon repair is useful in patients with Ellman grade 3 (>6 mm) partial-thickness articular-side tears of the supraspinatus tendon.Study Design: Descriptive laboratory study and case series; Level of evidence, 4.Methods: In 43 cadaveric shoulders (mean age, 80 years; range,

Junji Ide; Satoshi Maeda; Katsumasa Takagi

2005-01-01

189

Teres major muscle activation relates to clinical outcome in tendon transfer surgery  

Microsoft Academic Search

BackgroundIn massive rotator cuff tears a teres major (TMj) tendon transfer to the insertion of the supraspinatus (SSp) reverses its adduction moment arm into abduction which is supposed to be an adequate salvage procedure. Analysis of muscle function to find biomechanical ground of such success is scarce.

Frans Steenbrink; Rob G. H. H. Nelissen; Carel G. M. Meskers; Michiel A. J. van de Sande; Piet M. Rozing; Jurriaan H. de Groot

2010-01-01

190

Deep posterior knee pain caused by a ganglion of the popliteus tendon — a case report  

Microsoft Academic Search

The most common causes of posterior and posterolateral knee pain (besides referred pain) are knee joint effusions, tendinitis of the hamstring tendons, Baker cyst (semimembranous cyst), bursitis, meniscal pathologies such as tears and ganglions and lesions of the anterior cruciate ligament. Less common causes include popliteus and gastrocnemius tendinitis, arthrofibrosis after trauma. posterior cruciate ligament sprains. deep venous thrombosis and\\/or

D. Weber; N. F. Friederich; A. Nidecker; W. Miiller

1996-01-01

191

Magnetic resonance imaging of the elbow. Part II: Abnormalities of the ligaments, tendons, and nerves  

Microsoft Academic Search

Part II of this comprehensive review on magnetic resonance imaging of the elbow discusses the role of magnetic resonance imaging in evaluating patients with abnormalities of the ligaments, tendons, and nerves of the elbow. Magnetic resonance imaging can yield high-quality multiplanar images which are useful in evaluating the soft tissue structures of the elbow. Magnetic resonance imaging can detect tears

Richard Kijowski; Michael Tuite; Matthew Sanford

2005-01-01

192

Tendon injuries of the hand  

PubMed Central

Tendon injuries are the second most common injuries of the hand and therefore an important topic in trauma and orthopedic patients. Most injuries are open injuries to the flexor or extensor tendons, but less frequent injuries, e.g., damage to the functional system tendon sheath and pulley or dull avulsions, also need to be considered. After clinical examination, ultrasound and magnetic resonance imaging have proved to be important diagnostic tools. Tendon injuries mostly require surgical repair, dull avulsions of the distal phalanges extensor tendon can receive conservative therapy. Injuries of the flexor tendon sheath or single pulley injuries are treated conservatively and multiple pulley injuries receive surgical repair. In the postoperative course of flexor tendon injuries, the principle of early passive movement is important to trigger an “intrinsic” tendon healing to guarantee a good outcome. Many substances were evaluated to see if they improved tendon healing; however, little evidence was found. Nevertheless, hyaluronic acid may improve intrinsic tendon healing.

Schoffl, Volker; Heid, Andreas; Kupper, Thomas

2012-01-01

193

Identification, quantification and comparison of major non-polar lipids in normal and dry eye tear lipidomes by electrospray tandem mass spectrometry  

PubMed Central

Millions of individuals suffer from a health condition known as keratoconjunctivitis sicca (KCS, also known as ‘dry eye’). Studies have indicated that the lipids in the tear film layer, which covers the outer portion of the eye, may be directly correlated with the existence of dry eye syndrome. By identifying and comparing the major, non-polar lipids in normal eye tears with a dry eye model, it may be possible to identify a symptom of, or a contributing factor to, dry eye. Electrospray tandem mass spectrometry (ES-MS/MS) was used to identify and compare the non-polar lipids, detected as lithium adducts, from normal and dry eye tear samples obtained from rabbits. A limited number of normal human tear samples were also examined for lipid content, and a close resemblance to rabbit was observed. Three distinct regions were delineated in the ES mass spectra of the non polar lipids, m/z 20–500, 500–800 and 800–1100. A common feature noted among identified lipid components was a glycerol backbone with fatty acyl substituents attached. Product ion spectra were obtained for lithiated monoacyl-, 1,2- and 1,3-diacyl- and triacylglyceride standards. Newly proposed structures and fragmentation pathways for the major product ions are presented for the 1,2- and 1,3-diglycerides, and also for the monoglyceride. New approaches to distinguishing asymmetric 1,2-diglycerides and 1,2- from 1,3-diglycerides are proposed. For the rabbit tear samples, the m/z 20–500 range contains monoester diols with empirical formulas CnH2nO4, the m/z 500–800 range includes diesters with empirical formulas CnH2n?2O5 and the m/z 800–1100 range contains triesters with empirical formulas CnH2n?4O6. Also found in the extracts were three isoprene acetals (terpenoids).

Ham, Bryan M.; Jacob, Jean T.; Keese, Monica M.; Cole, Richard B.

2008-01-01

194

Rat rotator cuff tendon-to-bone healing properties are adversely affected by hypercholesterolemia  

PubMed Central

Background Rotator cuff tendon tears represent a major component of reported orthopaedic injuries. In addition, more than one quarter of U.S. adults either currently have high cholesterol levels or have reduced their previously high cholesterol levels through the use of pharmaceuticals. Our clinical data have already linked hypercholesterolemia to full-thickness rotator cuff tears, and experimental data from our laboratory have shown effects on native tendon properties in multiple species. The objective of this study was to evaluate healing of supraspinatus tendons in our rat rotator cuff injury model. We hypothesized that tendon healing would be inferior in rats receiving a high-cholesterol diet for 6 months compared with those receiving standard chow. Methods All animals were subjected to a unilateral supraspinatus detachment and repair surgery, with contralateral limbs serving as within-animal comparative data. Animals continued their respective diet courses, and their supraspinatus tendons were biomechanically or histologically evaluated at 2, 4, and 8 weeks postoperatively. Results Biomechanical testing revealed a significant reduction in normalized stiffness in hypercholesterolemic rats compared with controls at 4 weeks after injury, whereas histologic analyses showed no significant differences in collagen organization, cellularity, or cell shape between groups. Conclusion On the basis of our findings, hypercholesterolemia may have a detrimental biomechanical effect on tendon healing in our rat rotator cuff injury and repair model. Level of evidence Basic Science Study, Animal Model.

Beason, David P.; Tucker, Jennica J.; Lee, Chang Soo; Edelstein, Lena; Abboud, Joseph A.; Soslowsky, Louis J.

2014-01-01

195

Distal biceps tendon rupture  

Microsoft Academic Search

The authors report a rupture of the distal tendon of biceps brachii in a 42-year-old athlete. Magnetic resonance imaging confirmed the injury. Early surgical repair was performed by reinsertion of the tendon on the radial tuberosity according to modified Boyd-Anderson technique. Indomethacin was administered prophylactically. No complications were noted. At the latest follow-up, the patient had full elbow range of

Olga D. Savvidou; Panayiotis J. Papagelopoulos; Andreas F. Mavrogenis; Antonios A. Partsinevelos; Evangelos J. Karadimas; Demetrios S. Korres

2004-01-01

196

Subrupture tendon fatigue damage.  

PubMed

The mechanical and microstructural bases of tendon fatigue, by which damage accumulates and contributes to degradation, are poorly understood. To investigate the tendon fatigue process, rat flexor digitorum longus tendons were cyclically loaded (1-16 N) until reaching one of three levels of fatigue damage, defined as peak clamp-to-clamp strain magnitudes representing key intervals in the fatigue life: i) Low (6.0%-7.0%); ii) Moderate (8.5%-9.5%); and iii) High (11.0%-12.0%). Stiffness, hysteresis, and clamp-to-clamp strain were assessed diagnostically (by cyclic loading at 1-8 N) before and after fatigue loading and following an unloaded recovery period to identify mechanical parameters as measures of damage. Results showed that tendon clamp-to-clamp strain increased from pre- to post-fatigue loading significantly and progressively with the fatigue damage level (p tendons exhibited fiber dissociation and localized ruptures of the fibers. Histomorphometric analysis showed that damage area fraction increased significantly with fatigue level (p tendon fatigue process and indicate that tendon deformation can be used to accurately assess the progression of damage accumulation in tendons. PMID:18683881

Fung, David T; Wang, Vincent M; Laudier, Damien M; Shine, Jean H; Basta-Pljakic, Jelena; Jepsen, Karl J; Schaffler, Mitchell B; Flatow, Evan L

2009-02-01

197

Tearing Java Cards  

Microsoft Academic Search

This paper reports on investigations into the JAVA CARD transaction mechanism, especially on the interaction with so-called non- atomic methods in the JAVA CARD API. This work started with eorts to develop a formalisation of the transaction mechanism that could be used to formally verify the correctness of applications that use these mechanisms to protect themselves from card tears—the sudden

Engelbert Hubbers; Wojciech Mostowski; Erik Poll

2006-01-01

198

Tears of Wine  

ERIC Educational Resources Information Center

The unique occurrence of the upward motion of a thin film of wine, and its formation into drops inside the wall of a wine glass is explained. Evaporation of alcohol generates a surface tension gradient, moving the film of wine upwards on the internal sides of a wine glass, where it collects and forms into drops or tears.

Gugliotti, Marcos

2004-01-01

199

New Solution for Massive, Irreparable Rotator Cuff Tears: The Subacromial "Biodegradable Spacer"  

PubMed Central

Massive, irreparable rotator cuff tears are a source of pain and disability. Although most rotator cuff tears can be completely repaired, a significant number are considered massive and irreparable. Numerous operative techniques have been described for the treatment of these kinds of tears including arthroscopic debridement, biceps tenotomy, tendon transfer, grafting, and reverse arthroplasty. We describe a surgical technique using a biodegradable subacromial balloon spacer (InSpace; OrthoSpace, Kfar Saba, Israel) implanted between the humeral head and acromion that permits smooth, frictionless gliding, restoring the shoulder biomechanics. The technique is easy to perform and is less invasive than the conventional surgical techniques available, and it may potentially serve as a bridging option in patients with massive, irreparable tears who are normally candidates for reverse arthroplasty.

Savarese, Eugenio; Romeo, Rocco

2012-01-01

200

Pathology and pathogenesis of bursal-side rotator cuff tears viewed from en bloc histologic sections.  

PubMed

Histologic sections from 12 en bloc surgical specimens were studied in order to clarify the pathogenesis of bursal-side rotator cuff tears (BSRCTs). The specimens consisted of the bony insertion, the partially torn area, and the musculotendinous junction of the supraspinatus tendon. There were eight men and four women, with an average age of 48.7 years. Trauma was noted in three instances. All patients exhibited clinical evidence of subacromial impingement, which was confirmed at surgery. Histologic sections were stained with azan or hematoxylin and eosin. All the tears developed from within 1 cm of the insertion. The depth of the tears varied from a superficial flap to a nearly full-thickness tear. Microscopically, the sections demonstrated several abnormalities in addition to degeneration. At the site of insertion and in the distal stump, local disruptions of the normal four layers of enthesis and areas of hypervascularity were observed in all sections. The proximal stumps were rounded, retracted, and avascular, with abundant chondrocytes. No active repair was noted in the proximal stumps. The pathogenesis of BSRCTs appears to be related to: (1) a combination of aging and precarious vascularity of the tendon, (2) repetitive movements of the arm at above-horizontal levels, (3) injury, and (4) especially subacromial-tendon impingement. PMID:2323150

Fukuda, H; Hamada, K; Yamanaka, K

1990-05-01

201

Endoscopic Repair of Full-Thickness Gluteus Medius Tears  

PubMed Central

Tears in the gluteus medius and minimus tendons recently have emerged as an important cause of chronic greater trochanteric pain syndrome. Increasing recognition of the gluteal insertion as a cause of chronic pain and weakness, as well as technologic advances in endoscopic hip surgery, has made gluteal insertional repair a rapidly emerging technique in minimally invasive surgery of the hip. We present an endoscopic double-row technique for gluteal insertional repair that allows for visualization, debridement, and repair, re-creating the normal footprint.

Domb, Benjamin G.; Carreira, Dominic S.

2013-01-01

202

Minimally invasive surgery for Achilles tendon pathologies  

PubMed Central

Minimally invasive trauma and orthopedic surgery is increasingly common, though technically demanding. Its use for pathologies of the Achilles tendon (AT) hold the promise to allow faster recovery times, shorter hospital stays, and improved functional outcomes when compared to traditional open procedures, which can lead to difficulty with wound healing because of the tenuous blood supply and increased chance of wound breakdown and infection. We present the recent advances in the field of minimally invasive AT surgery for tendinopathy, acute ruptures, chronic tears, and chronic avulsions of the AT. In our hands, minimally invasive surgery has provided similar results to those obtained with open surgery, with decreased perioperative morbidity, decreased duration of hospital stay, and reduced costs. So far, the studies on minimally invasive orthopedic techniques are of moderate scientific quality with short follow-up periods. Multicenter studies with longer follow-up are needed to justify the long-term advantages of these techniques over traditional ones.

Maffulli, Nicola; Longo, Umile Giuseppe; Spiezia, Filippo; Denaro, Vincenzo

2010-01-01

203

Epidemiology, genetics and biological factors of rotator cuff tears.  

PubMed

Rotator cuff disease is among the most common musculoskeletal disorders with high direct and indirect costs in industrialized countries. Not all rotator cuff tears are symptomatic. Genetics has recently been investigated as a factor involved in the pathogenesis of rotator cuff pathology. Genetic factors seem to be involved in symptom presentation and tear progression. As rotator cuff disease is multifactorial, no single gene is directly involved in the pathology. Phenotypic expression of genetic susceptibility manifests at the level of ultrastructure of the tendon. Predisposing genes may also operate through apoptosis and regenerative capacity. Studies on cellular and molecular biology are more numerous, but still incomplete, and recently have focussed on the role of apoptosis in tendinopathy, analyzing its key mediators and cellular changes. Oxidative stress is responsible for reduction of collagen synthesis. Biological investigations have identified recently new risk factors. Preliminary reports introduced the possible role of glucose as a risk factor for rotator cuff tear. Further studies are required to fully clarify the genetic and biological factors involved in rotator cuff tears. PMID:21986040

Longo, Umile Giuseppe; Berton, Alessandra; Papapietro, Nicola; Maffulli, Nicola; Denaro, Vincenzo

2012-01-01

204

[Achilles tendon rupture].  

PubMed

The treatment of acute of Achilles tendon rupture experienced a dynamic development in the last ten years. Decisive for this development was the application of MRI and above all the ultrasonography in the diagnostics of the pathological changes and injuries of tendons. The question of rupture morphology as well as different courses of healing could be now evaluated objectively. These advances led consequently to new modalities in treatment concepts and rehabilitation protocols. The decisive input for improvements of the outcome results and particularly the shortening of the rehabilitation period came with introduction of the early functional treatment in contrast to immobilizing plaster treatment. In a prospective randomized study (1987-1989) at the Trauma Dept. of the Hannover Medical School could show no statistical differences comparing functional non-operative with functional operative therapy with a special therapy boot (Variostabil/Adidas). The crucial criteria for therapy selection results from the sonographically measured position of the tendon stumps in plantar flexion (20 degrees). With complete adaptation of the tendons' ends surgical treatment does not achieve better results than non-operative functional treatment in term of tendon healing and functional outcome. Regarding the current therapeutic standards each method has is advantages and disadvantages. Both, the operative and non-operative functional treatment enable a stable tendon healing with a low risk of re-rupture (1-2%). Meanwhile there is consensus for early functional after-treatment of the operated Achilles' tendons. There seems to be a trend towards non-operative functional treatment in cases of adequate sonographical findings, or to minimal invasive surgical techniques. PMID:10798233

Thermann, H; Hüfner, T; Tscherne, H

2000-03-01

205

Integrated Approach for Prediction of Hot Tearing  

NASA Astrophysics Data System (ADS)

Shrinkage, imposed strain rate, and (lack of) feeding are considered the main factors that determine cavity formation or the formation of hot tears. A hot-tearing model is proposed that will combine a macroscopic description of the casting process and a microscopic model. The micromodel predicts whether porosity will form or a hot tear will develop. Results for an Al-4.5 pct Cu alloy are presented as a function of the constant strain rate and cooling rate. Also, incorporation of the model in a finite element method (FEM) simulation of the direct-chill (DC) casting process is reported. The model shows features well known from literature such as increasing hot-tearing sensitivity with increasing deformation rate, cooling rate, and grain size. Similar trends are found for the porosity formation as well. The model also predicts a beneficial effect of applying a ramping procedure during the start-up phase, which is an improvement in comparison with earlier findings obtained with alternative models. In principle, the model does not contain adjustable parameters, but several parameters are not well known. A full quantitative validation not only requires detailed casting trials but also independent determination of some thermophysical parameters of the semisolid mush.

Suyitno; Kool, W. H.; Katgerman, L.

2009-10-01

206

Thyroid hormones and tendon: current views and future perspectives. Concise review  

PubMed Central

Summary Thyroid hormones (THs) T3 and T4, play an essential role in the development and metabolism of many tissues and organs, and have profound metabolic effects in adult life. THs action is mediated mainly by the thyroid hormone receptor (TRs) which seem to be ubiquitous. To-date thyroid-associated disease are not thought to be related in tendinopathies and tendons tears. Recent study demonstrated the presence of TRs in tendons and their possible role in the proliferation and apoptosis of human tenocyte isolated from tendon. We review new discovery that revisit our current thinking on the tendon biology focusing on thyroid hormones (THs) T3 and T4, and their possible role on human tenocyte.

Oliva, Francesco; Berardi, Anna C.; Misiti, Silvia; Maffulli, Nicola

2013-01-01

207

Mechanical environment of the supraspinatus tendon: a two-dimensional finite element model analysis.  

PubMed

We performed 2-dimensional finite element model analysis to estimate the mechanical environment of the supraspinatus tendon. The geometric shape of the finite element model was determined by magnetic resonance imaging of a normal human shoulder obtained at 0 degrees, 30 degrees, and 60 degrees of abduction, whereas the histologic location of noncalcified and calcified fibrocartilage was determined from a cadaveric specimen. The supraspinatus tendon was pulled proximally with the force of 10 N at 0 degrees, 53 N at 30 degrees, and 115 N at 60 degrees of abduction. The area of high principal stress maximum was observed on the articular side of the supraspinatus tendon, which shifted toward the insertion as the arm was abducted. High stress concentration on the articular side of the supraspinatus tendon near its insertion during arm elevation may explain the frequent occurrence of rotator cuff tears at this site. PMID:14671529

Wakabayashi, Ikuko; Itoi, Eiji; Sano, Hirotaka; Shibuya, Yotsugi; Sashi, Ryuji; Minagawa, Hiroshi; Kobayashi, Moto

2003-01-01

208

All-Arthroscopic Patch Augmentation of a Massive Rotator Cuff Tear: Surgical Technique  

PubMed Central

Surgical management of massive rotator cuff tears remains challenging, with failure rates ranging from 20% to 90%. Multiple different arthroscopic and open techniques have been described, but there is no current gold standard. Failure after rotator cuff repair is typically multifactorial; however, failure of tendon-footprint healing is often implicated. Patch augmentation has been described as a possible technique to augment the biology of rotator cuff repair in situations of compromised tendon quality and has shown promising short-term results. The purpose of this article is to describe our preferred surgical technique for arthroscopic rotator cuff repair with patch augmentation.

Chalmers, Peter N.; Frank, Rachel M.; Gupta, Anil K.; Yanke, Adam B.; Trenhaile, Scott W.; Romeo, Anthony A.; Bach, Bernard R.; Verma, Nikhil N.

2013-01-01

209

The basic science behind biologic augmentation of tendon-bone healing: a scientific review.  

PubMed

Rotator cuff tears are common musculoskeletal injuries that often require surgical repair. Despite advances in surgical techniques, including progression from a single row of anchors to double-row constructs, recurrent tearing or failure to heal still complicates 10% to 94% of repairs. The surgical treatment of rotator cuff tears is aimed at providing the best mechanical environment for tendon healing. Despite appropriate surgical management and a normal healing response, the resultant tendon healing does not regenerate the tendon-bone architecture initially formed during prenatal development. Instead, a mechanically weaker, fibrovascular scar is formed, leading to suboptimal healing rates and/or higher retear rates. Biologic augmentation strategies aim to improve healing rates by introducing higher concentrations of growth factors and cytokines, mesenchymal stem cells, and enzymatic antagonists to the repair site in the hope of directing a more sophisticated healing response. Biologic augmentation and tissue engineering to improve tendon-to-bone healing remains promising but will require more study before its clinical application is realized. PMID:24720329

Weeks, Kenneth D; Dines, Joshua S; Rodeo, Scott A; Bedi, Asheesh

2014-01-01

210

Autologous tenocyte implantation, a novel treatment for partial-thickness rotator cuff tear and tendinopathy in an elite athlete.  

PubMed

Tendinopathy and small partial-thickness tears of the rotator cuff tendon are common presentations in sports medicine. No promising treatment has yet been established. Corticosteroid injections may improve symptoms in the short term but do not primarily treat the tendon pathology. Ultrasound-guided autologous tenocyte implantation (ATI) is a novel bioengineered treatment approach for treating tendinopathy. We report the first clinical case of ATI in a 20-year-old elite gymnast with a rotator cuff tendon injury. The patient presented with 12 months of increasing pain during gymnastics being unable to perform most skills. At 1 year after ATI the patient reported substantial improvement of clinical symptoms. Pretreatment and follow-up MRIs were reported and scored independently by two experienced musculoskeletal radiologists. Tendinopathy was improved and the partial-thickness tear healed on 3 T MRI. The patient was able to return to national-level competition. PMID:23314880

Wang, Allan W; Bauer, Stefan; Goonatillake, Matthew; Breidahl, William; Zheng, Ming-Hao

2013-01-01

211

Infraspinatus/Teres Minor Transfer Biceps In Situ Tenodesis Procedure: Initial Results of a Technique for Massive Cuff Tears  

PubMed Central

Massive rotator cuff tears may not be primarily repairable with salvage options not necessarily providing acceptable results. Extrinsic tendon transfer is a significant undertaking with prolonged rehabilitation and variable outcome. A novel technique for the reconstruction of massive tears, not amenable to primary repair, by performing a transfer of the intrinsic posterior rotator cuff onto an intact, tenodesed long head of biceps tendon acting as a scaffold for the intrinsic transfer is described. The clinical results at short to medium term in 17 initial patients are presented. Encouraging results from this study suggest that this is a viable option for the management of massive rotator cuff tears with an intact posterior cuff with results equal or superior to other reconstructive techniques.

Fletcher, Matt D. A.

2013-01-01

212

The snapping iliopsoas tendon.  

PubMed

Herein we describe a previously seldom recognized variety of snapping hip, which is caused by snapping of the iliopsoas tendon over the iliopectineal eminence when the femur is moved from the flexed position at the hip and extended through 45 degrees of flexion. The finding is demonstrated with the patient supine and gently resisting gravity with the iliopsoas muscle, thus placing it under tension. At approximately 45 degrees of flexion, the iliopsoas tendon in two patients was confirmed radiographically to snap abruptly, coincident with an audible sound over the iliopectineal eminence of the pelvis. We believe that this occurs relatively frequently and is generally asymptomatic. PMID:6727425

Lyons, J C; Peterson, L F

1984-05-01

213

A prospective comparison of bone-patellar tendon-bone and hamstring grafts for anterior cruciate ligament reconstruction in female patients  

Microsoft Academic Search

The aim of the study is to compare the results after arthroscopic anterior cruciate ligament (ACL) reconstruction using central-third, bone-patellar tendon-bone (BTB group) (n=28) and four-strand semitendinosus\\/gracilis (ST\\/G group) (n=31) autografts in female patients. The type of study was non-randomised prospective consecutive series. A consecutive series of 61 female patients, all with unilateral ACL ruptures, was included in the study.

Michael Svensson; Ninni Sernert; Lars Ejerhed; Jon Karlsson; Jüri T. Kartus

2006-01-01

214

ACL Reconstruction with Autologous Hamstring Tendon: Comparison of Short Term Clinical Results between Rigid-fix and PINN-ACL Cross Pin  

PubMed Central

Purpose To compare the short term clinical results of anterior cruciate ligament (ACL) reconstruction with autologous hamstring tendon between Rigid-fix and PINN-ACL Cross Pin for femoral side fixation. Materials and Methods 127 patients who underwent arthroscopic ACL reconstruction using autologous hamstring tendon and had been followedup for over than one year were enrolled for the present study. Rigid-fix was used in 71 cases (group 1), and PINN-ACL Cross Pin was used in 56 cases (group 2). Clinical and radiological results, operation time, and perioperative complications were compared amongst the two groups. Results The International Knee Documentation Committee subjective score and Lysholm score were 94 and 95 in group 1 and 87 and 91 in group 2, with no statistical difference (p=0.892, p=0.833), respectively. However, significant difference was observed in one-leg hop test between the two groups (p=0.032). Five cases in group 1 and 40 cases in group 2 were found to be associated with perioperative complications with statistical difference (p<0.0001). Conclusions There was no resultant difference between the employment of PINN-ACL Cross Pin and Rigid-fix as femoral graft fixation for ACL reconstruction with hamstring tendon. However, PINN-ACL Cross Pin led to complications with extensive operation times. Hence, it needs further improvement of tools for minimization of complications.

Seo, Seung-Suk; Nam, Tae-Seok; Choi, Sang-Yeong

2011-01-01

215

Anterior-Posterior Instability of the Knee Following ACL Reconstruction with Bone-Patellar Tendon-Bone Ligament in Comparison with Four-Strand Hamstrings Autograft.  

PubMed

Purpose. To evaluate anterior-posterior knee laxity using two different autografts. Material-Methods. 40 patients, (34 males and 6 women), 17-54 years old (mean: 31), were included in the present study. Group A (4SHS = 20) underwent reconstruction using four-strand hamstrings, and group B (BPBT = 20) underwent reconstruction using bone-patellar tendon-bone autograft. Using the KT-1000 arthrometer, knee instability was calculated in both knees of all patients preoperatively and 3, 6, and 12 months after surgery at the ACL-operated knee. The contralateral healthy knee was used as an internal control group. Results. Anterior-posterior instability using the KT1000 Arthrometer was found to be increased after ACL insufficiency. The recorded laxity improved after arthroscopic ACL reconstruction in both groups. However, statistically significant greater values were detected in the bone-patellar tendon-bone group, which revealed reduction of anteroposterior stability values to an extent, where no statistical significance with the normal values even after 3 months after surgery was observed. Conclusions. Anterior-Posterior instability of the knee improved significantly after arthroscopic ACL reconstruction. The bone-patellar tendon-bone graft provided an obvious greater stability. PMID:23956862

Angoules, A G; Balakatounis, K; Boutsikari, E C; Mastrokalos, D; Papagelopoulos, P J

2013-01-01

216

Bone suture anchors versus the pullout button for repair of distal profundus tendon injuries: a comparison of strength in human cadaveric hands.  

PubMed

Avulsion or distal tendon laceration of flexor digitorum profundus (FDP) is classically repaired to the base of the distal phalanx via a pullout suture over a button. Bone suture anchors, used extensively in other surgical areas, have recently been proposed for reattachment of the FDP to the distal phalanx. The FDP tendons of the index, long, and ring fingers in 9 fresh frozen cadeveric hands were randomized to 1 of 3 repair techniques after simulated distal avulsion injuries. These were the pullout button using 3-0 monofilament nylon in a 2-strand Bunnell suture pattern, the 1.8 mm Mini QuickAnchor (Mitek Products, Norwood, MA) using 3-0 braided polyester in a 2-strand Bunnell suture pattern, and the Mitek micro anchor using 3-0 braided polyester with a modified 4-strand Becker suture pattern. Nine specimens were loaded to failure, noting maximum load and mode of failure. The 1.3 mm Micro QuickAnchor (Mitek) technique (69.6 +/- 10.8 N) was significantly stronger than the pullout button (43.3 +/- 4.8 N) or the Mini anchor technique (44.6 +/- 12.7 N). The Micro bone suture anchor provides a stronger tendon to bone repair than the pullout button or the Mini anchor. Given the disadvantages of the pullout button, the Micro bone suture anchor with the modified Becker technique is worth consideration as an alternative method to repair distal FDP avulsions. PMID:11418912

Brustein, M; Pellegrini, J; Choueka, J; Heminger, H; Mass, D

2001-05-01

217

Anterior-Posterior Instability of the Knee Following ACL Reconstruction with Bone-Patellar Tendon-Bone Ligament in Comparison with Four-Strand Hamstrings Autograft  

PubMed Central

Purpose. To evaluate anterior-posterior knee laxity using two different autografts. Material-Methods. 40 patients, (34 males and 6 women), 17–54 years old (mean: 31), were included in the present study. Group A (4SHS = 20) underwent reconstruction using four-strand hamstrings, and group B (BPBT = 20) underwent reconstruction using bone-patellar tendon-bone autograft. Using the KT-1000 arthrometer, knee instability was calculated in both knees of all patients preoperatively and 3, 6, and 12 months after surgery at the ACL-operated knee. The contralateral healthy knee was used as an internal control group. Results. Anterior-posterior instability using the KT1000 Arthrometer was found to be increased after ACL insufficiency. The recorded laxity improved after arthroscopic ACL reconstruction in both groups. However, statistically significant greater values were detected in the bone-patellar tendon-bone group, which revealed reduction of anteroposterior stability values to an extent, where no statistical significance with the normal values even after 3 months after surgery was observed. Conclusions. Anterior-Posterior instability of the knee improved significantly after arthroscopic ACL reconstruction. The bone-patellar tendon-bone graft provided an obvious greater stability.

Angoules, A. G.; Balakatounis, K.; Boutsikari, E. C.; Mastrokalos, D.; Papagelopoulos, P. J.

2013-01-01

218

Comparison of radiographic measurements of the patellar tendon-tibial plateau angle with anatomical measurements in dogs. Validity of the common tangent and tibial plateau methods.  

PubMed

Objective: To evaluate the validity of the common tangent and conventional tibial plateau angle methods for measuring the patellar tendon angle (PTA) in dogs. Methods: Radiographs of cadaveric stifles (n = 20) placed at 135° in true lateral position were obtained to measure the PTA with both methods. A Kirschner wire was inserted perpendicularly to the patellar tendon at its insertion on the tibia and the stifle was dissected. Two Kirschner wires were then used to identify the anatomical landmarks of the tibial plateau. A digital image was obtained of the proximal tibia in true lateral position. Six blinded observers measured each PTA digitally while the anatomical PTA was determined by an independent blinded observer from the angle between the line representing the tibial plateau and the Kirschner wire representing the perpendicular to the patellar tendon. The agreement between the methods was determined statistically from an intraclass correlation coefficient (ICC). Results: The global ICC for the common tangent method (0.44) and for the conventional method (0.4) indicated that their overall validity is poor. The measurements obtained by common tangentmethod and conventional method were respectively below and above the anatomical measurements. The reproducibility of the PTA measurements based on images of the dissected stifles was very good. Clinical significance: Both the common tangent and conventional methods show poor concordance with the anatomical measurement of PTA. Further studies are needed to determine if errors in measurements affect the clinical outcome. PMID:24763422

Bismuth, C; Ferrand, F X; Millet, M; Labrunie, A; Marin, B; Pillard, P; Deroy, C; Fau, D; Carozzo, C; Cachon, T; Viguier, E

2014-05-19

219

Free Biceps Tendon Autograft to Augment Arthroscopic Rotator Cuff Repair  

PubMed Central

Arthroscopic rotator cuff repairs have become the standard of treatment for all sizes of tears over the past several years. Current healing rates reported in the literature are quite good, but improving the healing potential of rotator cuff repairs remains a challenging problem. There has been an increase recently in the use of augmentation of rotator cuff repairs with xenografts or synthetics for large and massive tears. Biceps tenodesis is often indicated as part of the treatment plan while one is performing rotator cuff surgery. A subpectoral biceps tenodesis provides a source of autograft to augment rotator cuff repairs of all sizes. Two techniques are presented to augment rotator cuff repairs with a free biceps tendon autograft. This is a novel idea in an attempt to improve healing rates and long-term results of rotator cuff repairs of all sizes.

Obma, Padraic R.

2013-01-01

220

Dacryocystorhynostomy (DCR) - Creating a New Tear Drain  

MedlinePLUS

... is a surgery performed to create a new tear drain between the eye and nose when your current tear drain becomes blocked or obstructed. What is the anatomy? The tear drain consists of two small openings called punctum ; ...

221

Humeral head cysts: association with rotator cuff tears and age.  

PubMed

The objective of this study was to retrospectively evaluate the prevalence of the cystic changes at rotator cuff footprint on proximal humeral tuberosities and investigate their relationship with rotator cuff tears and patient age. Magnetic resonance (MR) images of 657 patients who underwent shoulder arthroscopy for treatment of rotator cuff disorders were reviewed to localize the cystic changes at anterior (supraspinatus insertion) and posterior (infraspinatus insertion) aspects of greater tuberosity (GT) and lesser tuberosity (subscapularis insertion). Preoperative MR reports as well as cyst size and locations on MR images were correlated with arthroscopic records of rotator cuff pathology (tear type, size, location and tendon involvement) and patient age. The prevalence of cystic changes was 9.1 % (60 patients) in the study population. Anterior GT cysts were found in 56 % of patients and were strongly associated with full-thickness (p < .001) and articular-sided partial-thickness rotator cuff tears (p = .02). Posterior GT and lesser tuberosity cysts were found in 27 and 17 % of patients, respectively, and were not significantly related to rotator cuff tears, although there was an increased trend of posterior cysts in patients with infraspinatus tears (p = .09). A significant relation was found between patient age and the cyst size (p = .01), while none of the cyst localizations were statistically related to age. Anterior GT cysts were more common in this patient group and demonstrated a strong association with rotator cuff disorders regardless of age. Posterior GT and lesser tuberosity cysts were less common and showed no association with rotator cuff pathology or patient age. PMID:23748696

Suluova, Fatih; Kanatli, Ulunay; Ozturk, Burak Yagmur; Esen, Erdinc; Bolukbasi, Selcuk

2014-07-01

222

Degeneration at the insertion weakens the tensile strength of the supraspinatus tendon: a comparative mechanical and histologic study of the bone-tendon complex.  

PubMed

The purpose of this investigation was to determine the relationship between the degree of degeneration at the supraspinatus insertion, the tensile strength, and the site of failure of this tendon. Thirty-three fresh cadaveric shoulders (average age: 62 years; range: 39-83 years) were examined. A tensile load to failure was applied at a constant crosshead speed of 25.4 mm/min to a 10 mm wide strip of the supraspinatus tendon that remained attached to the bone. Preexisting degenerative changes at the insertion were assessed and scored histologically and compared with the ultimate tensile stress. Twenty tendons failed at the insertion (the insertion group), and 11 failed in the midsubstance (the midsubstance group). The histologic score of degeneration for the insertion group was significantly higher than that for the midsubstance group (p = 0.0026). There was a negative correlation between the ultimate tensile stress at the insertion and the degeneration score for the insertion group (r = -0.60; p = 0.013). Histologic observations revealed that disruptions of tendon fibers were located mostly in the articular half of the tendon and that they enlarged during mechanical testing in 90% of the specimens of the insertion group. It seems that degenerative changes at the supraspinatus insertion reduce the tensile strength of the tendon and constitute a primary pathogenetic factor of rotator cuff tear. PMID:9420602

Sano, H; Ishii, H; Yeadon, A; Backman, D S; Brunet, J A; Uhthoff, H K

1997-09-01

223

Tearing of stagnant slab.  

PubMed

Subducted slabs of oceanic lithosphere below the western Pacific tend to be stagnant in the transition zone with poorly known mechanical properties. Typical examples are the Izu-Bonin and Japan slabs that meet each other to form a cusplike junction beneath southwest Japan. Here, we show that these two slabs are torn apart at their junction when they bend to flatten over the 660-kilometer discontinuity, as is expected from a simple geometric argument. We present three lines of evidence for this ongoing slab tear. PMID:19478177

Obayashi, Masayuki; Yoshimitsu, Junko; Fukao, Yoshio

2009-05-29

224

Shoulder labral pathomechanics with rotator cuff tears.  

PubMed

Rotator cuff tears (RCTs), the most common injury of the shoulder, are often accompanied by tears in the superior glenoid labrum. We evaluated whether superior humeral head (HH) motion secondary to RCTs and loading of the long head of the biceps tendon (LHBT) are implicated in the development of this associated superior labral pathology. Additionally, we determined the efficacy of a finite element model (FEM) for predicting the mechanics of the labrum. The HH was oriented at 30° of glenohumeral abduction and neutral rotation with 50N compressive force. Loads of 0N or 22N were applied to the LHBT. The HH was translated superiorly by 5mm to simulate superior instability caused by RCTs. Superior displacement of the labrum was affected by translation of the HH (P<0.0001), position along the labrum (P<0.0001), and interaction between the location on the labrum and LHBT tension (P<0.05). The displacements predicted by the FEM were compared with mechanical tests from 6 cadaveric specimens and all were within 1 SD of the mean. A hyperelastic constitutive law for the labrum was a better predictor of labral behavior than the elastic law and insensitive to ±1 SD variations in material properties. Peak strains were observed at the glenoid-labrum interface below the LHBT attachment consistent with the common location of labral pathology. These results suggest that pathomechanics of the shoulder secondary to RCTs (e.g., superior HH translation) and LHBT loading play significant roles in the pathologic changes seen in the superior labrum. PMID:24636720

Hwang, Eunjoo; Carpenter, James E; Hughes, Richard E; Palmer, Mark L

2014-05-01

225

Medial Versus Lateral Supraspinatus Tendon Properties: Implications for Double-Row Rotator Cuff Repair  

PubMed Central

Background Rotator cuff repair re-tear rates range from 25-90% necessitating methods to improve repair strength. While numerous laboratory studies have compared single to double row fixation properties, little is known regarding regional (i.e., medial versus lateral) suture retention properties in both intact and torn tendons. Hypothesis A torn supraspinatus tendon will have reduced suture retention properties on the lateral aspect of the tendon compared to the more medial musculotendinous junction. Study Design Controlled Laboratory Study Methods Human supraspinatus tendons (torn and intact) were randomly assigned for suture retention mechanical testing, ultrastructural collagen fibril analysis, or histology following suture pullout testing. For biomechanical evaluation, sutures were placed either at the musculotendinous junction (medial) or 10 mm from the free margin (lateral), and tendons were elongated to failure. Collagen fibril assessments were performed using transmission electron microscopy (TEM). Results Intact tendons showed no regional differences with respect to suture retention properties. In contrast, among torn tendons the medial region exhibited significantly higher stiffness and work values relative to the lateral region. For the lateral region, work to 10 mm displacement (1592±261 N-mm) and maximum load (265±44 N) for intact tendons were significantly higher (p<0.05) than those of torn tendons (1086±388 N-mm and 177±71 N, respectively). For medial suture placement, maximum load, stiffness and work of intact and torn tendons were similar (p>0.05). Regression analyses for the intact and torn groups revealed generally low correlations between donor age and the three biomechanical indices. For both intact and torn tendons, the mean fibril diameter and area density were greater in the medial region relative to the lateral (p?0.05). In the lateral tendon, but not the medial region, torn specimens showed a significantly lower fibril area fraction (48.3±3.8%) than intact specimens (56.7±3.6%, p<0.05). Conclusions Superior pullout resistance of medial placed sutures may provide a strain shielding effect for the lateral row following double row repair. Larger diameter collagen fibrils as well as greater fibril area fraction in the medial supraspinatus tendon may provide greater resistance to suture migration. Clinical Relevance While clinical factors such as musculotendinous integrity warrant strong consideration for surgical decision making, the present ultrastructural and biomechanical results appear to provide a scientific rationale for double-row rotator cuff repair where sutures are placed more medial at the muscle tendon junction.

Wang, Vincent M.; Wang, FanChia; McNickle, Allison G.; Friel, Nicole A.; Yanke, Adam B.; Chubinskaya, Susan; Romeo, Anthony A.; Verma, Nikhil N.; Cole, Brian J.

2013-01-01

226

Histological Study of Fresh Versus Frozen Semitendinous Muscle Tendon Allografts  

PubMed Central

OBJECTIVE: The purpose of this study was to histologically analyze allografts from cadaveric semitendinous muscle after cryopreservation at ?80°C in comparison to a control group kept at only ?4°C to test the hypothesis that the histological characteristics of the tissue are maintained when the tendons are kept at lower temperatures. METHODS: In a tissue bank, 10 semitendinous tendons from 10 cadavers were frozen at ?80ºC as a storage method for tissue preservation. They were kept frozen for 40 days, and then a histological study was carried out. Another 10 tendon samples were analyzed while still “fresh”. RESULTS: There was no histological difference between the fresh and frozen samples in relation to seven variables. CONCLUSIONS: Semitendinous muscle tendon allografts can be submitted to cryopreservation at ?80ºC without suffering histological modifications.

Bitar, Alexandre Carneiro; Santos, Luiz Augusto Ubirajara; Croci, Alberto Tesconi; Pereira, Joao Alberto Ramos Maradei; Franca Bisneto, Edgard N.; Giovani, Arlete Mazzini Miranda; Oliveira, Claudia Regina G. C. M.

2010-01-01

227

Giant retinal tears.  

PubMed

A giant retinal tear (GRT) is a full-thickness neurosensory retinal break that extends circumferentially around the retina for three or more clock hours in the presence of a posteriorly detached vitreous. Its incidence in large population-based studies has been estimated as 1.5% of rhegmatogenous retinal detachments, with a significant male preponderance, and bilaterality in 12.8%. Most GRTs are idiopathic, with trauma, hereditary vitreoretinopathies and high myopia each being causative in decreasing frequency. The vast majority of GRTs are currently managed with a pars plana vitrectomy; the use of adjunctive circumferential scleral buckling is debated, but no studies have shown a clear anatomical or visual advantage with its use. Similarly, silicone oil tamponade does not influence long-term outcomes when compared with gas. Primary and final retinal reattachment rates are achieved in 88% and 95% of patients, respectively. Even when the retina remains attached, however, visual recovery may be limited. Furthermore, fellow eyes of patients with a GRT are at higher risk of developing retinal tears and retinal detachment. Prophylactic treatment under these circumstances may be considered but there is no firm evidence of its efficacy at the present time. PMID:24138895

Shunmugam, Manoharan; Ang, Ghee Soon; Lois, Noemi

2014-01-01

228

A Comparison of the Fixation Strengths Provided by Different Intraosseous Tendon Lengths during Anterior Cruciate Ligament Reconstruction: A Biomechanical Study in a Porcine Tibial Model  

PubMed Central

Background The purpose of this study was to determine the tibial fixation strength provided by different intraosseous soft tissue graft lengths within the tibial tunnel. Methods Porcine tibial bones and digital flexor tendons were used for testing. Bone mineral densities of proximal tibial medial condyles were measured, and two-strand tendon bundles of 8 mm diameter were used. An intraosseous graft length of 2 cm was used in group 1 (n = 10), and a graft length of 4 cm was used in group 2 (n = 10). Tunnels were 4 cm in length and 8 mm in diameter. Tibial fixation was performed using a suture tied around a screw post with a washer and an additionally inserted 7 × 20 mm bioabsorbable screw. After applying preconditioning loading of 10 cycles, 1,000 cycles between 70-220 N were applied at a frequency of 1 Hz. Graft slippage and total graft movement were recorded. Ultimate tensile strength was measured by pull-out testing at an Instron crosshead speed of 1,000 mm/min. Results No significant intergroup difference was found for total graft movement after cyclic loading (slippage in group 1, 1.2 mm and group 2, 1.2 mm, respectively, p = 0.917; and total graft movement in group 1, 3.3 mm and group 2, 2.7 mm, respectively, p = 0.199). However, mean ultimate tensile strength in group 2 was significantly higher than that in group 1 (group 1, 649.9 N; group 2, 938 N; p = 0.008). Conclusions In a porcine model, ultimate tensile strength was greater for a 4 cm long intraosseous flexor tendon in the tibial tunnel. However, no intergroup difference in graft slippage or total graft movement was observed. The results show that a 2 cm intraosseous graft length in the tibial tunnel is safe and has sufficient strength (> 450 N) for adequate rehabilitation after anterior cruciate ligament reconstruction.

Yang, Dong-Lyul; Cheon, Sang-Ho; Oh, Chang-Wug

2014-01-01

229

Mineral Distributions at the Developing Tendon Enthesis  

PubMed Central

Tendon attaches to bone across a functionally graded interface, “the enthesis”. A gradient of mineral content is believed to play an important role for dissipation of stress concentrations at mature fibrocartilaginous interfaces. Surgical repair of injured tendon to bone often fails, suggesting that the enthesis does not regenerate in a healing setting. Understanding the development and the micro/nano-meter structure of this unique interface may provide novel insights for the improvement of repair strategies. This study monitored the development of transitional tissue at the murine supraspinatus tendon enthesis, which begins postnatally and is completed by postnatal day 28. The micrometer-scale distribution of mineral across the developing enthesis was studied by X-ray micro-computed tomography and Raman microprobe spectroscopy. Analyzed regions were identified and further studied by histomorphometry. The nanometer-scale distribution of mineral and collagen fibrils at the developing interface was studied using transmission electron microscopy (TEM). A zone (?20 µm) exhibiting a gradient in mineral relative to collagen was detected at the leading edge of the hard-soft tissue interface as early as postnatal day 7. Nanocharacterization by TEM suggested that this mineral gradient arose from intrinsic surface roughness on the scale of tens of nanometers at the mineralized front. Microcomputed tomography measurements indicated increases in bone mineral density with time. Raman spectroscopy measurements revealed that the mineral-to-collagen ratio on the mineralized side of the interface was constant throughout postnatal development. An increase in the carbonate concentration of the apatite mineral phase over time suggested possible matrix remodeling during postnatal development. Comparison of Raman-based observations of localized mineral content with histomorphological features indicated that development of the graded mineralized interface is linked to endochondral bone formation near the tendon insertion. These conserved and time-varying aspects of interface composition may have important implications for the growth and mechanical stability of the tendon-to-bone attachment throughout development.

Schwartz, Andrea G.; Pasteris, Jill D.; Genin, Guy M.; Daulton, Tyrone L.; Thomopoulos, Stavros

2012-01-01

230

Tear secretion and tear film function in insulin dependent diabetics  

PubMed Central

BACKGROUND—Diabetic patients often complain of dry eye symptoms, such as burning and/or foreign body sensation. The aim of the present study was to investigate whether diabetes mellitus is correlated with tear film dysfunction and/or tear hyposecretion.?METHODS—In 86 consecutive insulin dependent diabetics with retinopathy and 84 non-diabetic controls (age and sex matched) we performed fluorophotometry of tear secretion, the Schirmer test, and impression cytology of the conjunctival epithelium and determined the tear film break up time.?RESULTS—When compared with the healthy control group diabetics showed decreased Schirmer test readings (?37%, p <0.001) and significantly more frequent and pronounced signs of conjunctival metaplasia. None of the other values differed between groups.?CONCLUSION—In insulin dependent diabetics, reflex tearing was demonstrated to be significantly decreased. In contrast, unstimulated basal tear flow and tear film break up time were found to be normal. However, a majority of insulin dependent diabetics shows distinct signs of conjunctival surface disease.??

Goebbels, M.

2000-01-01

231

Role of Serum Fibrinogen Levels in Patients with Rotator Cuff Tears  

PubMed Central

Although rotator cuff (RC) tendinopathy is a frequent pathology of the shoulder, the real understanding of its aetiopathogenesis is still unclear. Several studies showed that RC tendinopathy is more frequent in patients with hyperglycemia, diabetes, obesity, or metabolic syndrome. This paper aims to evaluate the serum concentration of fibrinogen in patients with RC tears. Metabolic disorders have been related to high concentration of serum fibrinogen and the activity of fibrinogen has been proven to be crucial in the development of microvascular damage. Thus, it may produce progression of RC degeneration by reducing the vascular supply of tendons. We report the results of a cross-sectional frequency-matched case-control study comparing the serum concentration of fibrinogen of patients with RC tears with that of a control group of patients without history of RC tears who underwent arthroscopic meniscectomy. We choose to enrol in the control group patients with pathology of the lower limb with a likely mechanic, not metabolic, cause, different from tendon pathology. We found no statistically significant differences in serum concentration of fibrinogen when comparing patients with RC tears and patients who underwent arthroscopic meniscectomy (P = 0.5). Further studies are necessary to clarify the role of fibrinogen in RC disease.

Longo, Umile Giuseppe; Petrillo, Stefano; Berton, Alessandra; Spiezia, Filippo; Loppini, Mattia; Maffulli, Nicola; Denaro, Vincenzo

2014-01-01

232

Role of serum fibrinogen levels in patients with rotator cuff tears.  

PubMed

Although rotator cuff (RC) tendinopathy is a frequent pathology of the shoulder, the real understanding of its aetiopathogenesis is still unclear. Several studies showed that RC tendinopathy is more frequent in patients with hyperglycemia, diabetes, obesity, or metabolic syndrome. This paper aims to evaluate the serum concentration of fibrinogen in patients with RC tears. Metabolic disorders have been related to high concentration of serum fibrinogen and the activity of fibrinogen has been proven to be crucial in the development of microvascular damage. Thus, it may produce progression of RC degeneration by reducing the vascular supply of tendons. We report the results of a cross-sectional frequency-matched case-control study comparing the serum concentration of fibrinogen of patients with RC tears with that of a control group of patients without history of RC tears who underwent arthroscopic meniscectomy. We choose to enrol in the control group patients with pathology of the lower limb with a likely mechanic, not metabolic, cause, different from tendon pathology. We found no statistically significant differences in serum concentration of fibrinogen when comparing patients with RC tears and patients who underwent arthroscopic meniscectomy (P = 0.5). Further studies are necessary to clarify the role of fibrinogen in RC disease. PMID:24817887

Longo, Umile Giuseppe; Petrillo, Stefano; Berton, Alessandra; Spiezia, Filippo; Loppini, Mattia; Maffulli, Nicola; Denaro, Vincenzo

2014-01-01

233

Meniscal tear film fluid dynamics near Marx's line.  

PubMed

Extensive studies have explored the dynamics of the ocular surface fluid, though theoretical investigations are typically limited to the use of the lubrication approximation, which is not guaranteed to be uniformly valid a-priori throughout the tear meniscus. However, resolving tear film behaviour within the meniscus and especially its apices is required to characterise the flow dynamics where the tear film is especially thin, and thus most susceptible to evaporatively induced hyperosmolarity and subsequent epithelial damage. Hence, we have explored the accuracy of the standard lubrication approximation for the tear film by explicit comparisons with the 2D Navier-Stokes model, considering both stationary and moving eyelids. Our results demonstrate that the lubrication model is qualitatively accurate except in the vicinity of the eyelids. In particular, and in contrast to lubrication theory, the solution of the full Navier-Stokes equations predict a distinct absence of fluid flow, and thus convective mixing in the region adjacent to the tear film contact line. These observations not only support emergent hypotheses concerning the formation of Marx's line, a region of epithelial cell staining adjacent to the contact line on the eyelid, but also enhance our understanding of the pathophysiological consequences of the flow profile near the tear film contact line. PMID:23820726

Zubkov, V S; Breward, C J W; Gaffney, E A

2013-09-01

234

Scaffolds in Tendon Tissue Engineering  

PubMed Central

Tissue engineering techniques using novel scaffold materials offer potential alternatives for managing tendon disorders. Tissue engineering strategies to improve tendon repair healing include the use of scaffolds, growth factors, cell seeding, or a combination of these approaches. Scaffolds have been the most common strategy investigated to date. Available scaffolds for tendon repair include both biological scaffolds, obtained from mammalian tissues, and synthetic scaffolds, manufactured from chemical compounds. Preliminary studies support the idea that scaffolds can provide an alternative for tendon augmentation with an enormous therapeutic potential. However, available data are lacking to allow definitive conclusion on the use of scaffolds for tendon augmentation. We review the current basic science and clinical understanding in the field of scaffolds and tissue engineering for tendon repair.

Longo, Umile Giuseppe; Lamberti, Alfredo; Petrillo, Stefano; Maffulli, Nicola; Denaro, Vincenzo

2012-01-01

235

Common Disorders of the Achilles Tendon  

MedlinePLUS

... to raise the heel off the ground. Achilles Tendonitis and Achilles Tendonosis Two common disorders that occur in the heel cord are Achilles tendonitis and Achilles tendonosis. Achilles tendonitis is an inflammation ...

236

Biceps long head tendon revisited: a case report of split tendon arising from single origin.  

PubMed

A 27-year-old, right-hand-dominant woman with a posttraumatic anterior shoulder dislocation 3 months earlier after traffic accident presented because of pain and limited range of motion in the right shoulder. On physical examination, the patient had negative instability tests and a sulcus sign. On arthroscopic examination, a bifurcate long biceps tendon with two limbs was observed about 1 cm distal to the origin in the supraglenoid tubercle. We found no evidence of a tear in the long biceps tendon on probing, and the margin of each limb was smooth and round. Although this anatomic variant may be benign, its presence might be associated with other shoulder pathology. It is interesting to speculate whether the aberrant biceps anatomy in our patient contributed to transfer of injury at dislocation to the rotator cuff rather than to the classic anterior-inferior capsulolabral complex. In addition, recognition of the described anatomic variant on arthroscopy can aid the shoulder surgeon in focusing treatment on the actual pathology. PMID:17622545

Kim, Kyung Cheon; Rhee, Kwang Jin; Shin, Hyun Dae; Kim, Young Mo

2008-05-01

237

[Percutaneous repair of achilles tendon rupture--a technical note].  

PubMed

The treatment of the acute ruptures of the achillean tendon remains controversial. For the time being, there is no consent regarding the ideal therapeutic approach. The therapeutical procedure for the recent achilean tendon tears varies between two possible solutions, one conservative and the other surgical. The choice between these is made based on the type of rupture and the experience of the surgeon. The conservative techniques can have good results in selected cases, but they produce a degree of elongation of the tendon, which may lead to improper functional results. The classical surgical treatment (the open technique) has the handicap of a relatively large, longitudinal incision, which is made in an area with relatively poor skin vascular supply. Also, the vascular supply of the tendon itself is based mainly on perforant, subfascial vessels, which are intercepted during the approach. Taking these facts into consideration, some new, minimally invasive (percutaneous) techniques, were imagined. The principles of the standard percutaneous technique consist of: 1) union of the ruptured ends without using a large surgical approach, thus also avoiding the drainage of the local hematoma and rushing the repair; 2) avoiding damaging of the tendon's vascular supply. This techique leads to a rapid transformation of the collagen fibers into elastic fibers, which are mechanically effective. We present in this paper the method which uses the TENOLIG kit. This kit consists of two wires with anchors at one end and needles at the other end; two washers and two poliethylene disks for securing the distal end of the wire. We obtained good morphological (proven by MRI scan) and functional results with this technique. The postoperative protocol includes immobilization with the foot initially in equinous, then in normal position, with isometric muscle contractions and non-weight-bearing, then removal of the cast and wires at 45 days postoperatively and continuing the recovery by kinetotherapy. PMID:20209775

Alexa, O; Veliceasa, B; Puha, C; Popia, I

2008-01-01

238

The Upper Band of the Subscapularis Tendon in the Rat has Altered Mechanical and Histologic Properties  

PubMed Central

Hypothesis/Background The subscapularis is an important mover and stabilizer of the glenohumeral joint and since the advent of shoulder arthroscopy, partial tears are found in 43% of rotator cuff patients. While partial tears to the upper band occur more commonly, little is known about the structure and mechanical behavior of the individual bands. Therefore, the objective of this study was to measure tensile mechanical properties, corresponding collagen fiber alignment, and histology in the upper and lower bands of the rat subscapularis tendon. Materials and Methods Thirty, adult Sprague-Dawley rats were euthanized and subscapularis tendons dissected out for mechanical, organization (n = 24), and histologic assessment (n = 6). Collagen organization was measured with a custom device during mechanical testing. Results Linear-region modulus at the insertion site was significantly lower in the upper band compared to the lower band while no differences were found at the midsubstance location. The upper band was found to be significantly less aligned and demonstrated a more rounded cell shape than the lower band at the insertion site. Discussion This study demonstrated that the two bands of the subscapularis tendon have differential mechanical, organizational, and histological properties. This suggests that a functional deficit exists to the upper band of the subscapularis and may be contributing to the prevalence of partial subscapularis tears. Conclusions Clinicians should be aware that the upper band of the subscapularis tendon may be at higher risk of developing tears due to the decreased mechanical properties and a more disorganized collagen fiber distribution. Level of Evidence Basic Science Study, Biomechanics, Animal Model.

Thomas, Stephen J.; Miller, Kristin S.; Soslowsky, Louis J.

2011-01-01

239

Isolated vastus lateralis tendon avulsion.  

PubMed

Isolated avulsion of the vastus lateralis tendon is a very rare injury. To our knowledge, only 1 case has been reported in the literature. This tendon is crucial to knee stability and proper patellofemoral tracking. As isolated avulsion of the tendon tends to occur in young, active males, early surgical repair is recommended to allow them to maintain a high level of functional ability. We present the case of a 49-year-old man who sustained an isolated vastus lateralis tendon avulsion injury. The injury was successfully treated with suture anchor repair. PMID:24278905

Frank, Jonathan M; Riedel, Matthew D; McCormick, Frank M; Nho, Shane J

2013-10-01

240

Tribological characteristics of healthy tendon.  

PubMed

Tendons transfer muscular forces efficiently and painlessly, facilitating joint motion. Whilst the tribology of articular cartilage is constantly explored, a poorer understanding remains of tendon lubrication and friction. This study reports experimental data describing the tribological characteristics of tendon and its surrounding tissue, before presenting an arithmetic solution to facilitate numerical modelling. The experimental characteristics of the tensile (i.e. mid-substance) and compressive (i.e. fibrocartilaginous) regions of bovine flexor tendon were investigated using a pin-on-plate tribometer, with immunofluroscence analysis describing the relative intensity and distribution of surface-bound lubricin. Arithmetic analysis considering the digital extensor tendon determined that, in physiological conditions, the tensile tendon region was able to generate elastohydrodynamic lubrication (EHL). The equivalent region of compressive tendon exhibited a higher intensity of surface-bound lubricin which, it is hypothesised, serves to minimise the increased frictional resistance due to generating only mixed or boundary lubrication regimes. Arithmetic analysis indicates that, given a more favourable biomechanical environment, this region can also generate EHL. Whilst acknowledging the limitations of transferring data from an animal model to a clinical environment, by providing the first data and equations detailing the film thicknesses and lubrication regime for these two tendon regions it is hoped that clinicians, engineers and scientists can consider improved clinical strategies to tackle both tendinopathy and tendon rupture. PMID:22704825

Theobald, Peter S; Dowson, Duncan; Khan, Ilyas M; Jones, Michael D

2012-07-26

241

Correlation of acromial morphology with impingement syndrome and rotator cuff tears  

PubMed Central

Background and purpose Indications for acromioplasty are based on clinical symptoms and are generally supported by typical changes in acromial morphology on standard radiographs. We evaluated 5 commonly used radiographic parameters of acromial morphology and assessed the association between different radiographic characteristics on the one hand and subacromial impingement or rotator cuff tears on the other. Patients and methods We measured acromial type (Bigliani), acromial slope (AS), acromial tilt (AT), lateral acromial angle (LAA), and acromion index (AI) on standard radiographs from 50 patients with full-thickness supraspinatus tendon tears, 50 patients with subacromial impingement, and 50 controls without subacromial pathology. Results The acromial type according to Bigliani was not associated with any particular cuff lesion. A statistically significant difference between controls and impingement patients was found for AS. AT of controls was significantly smaller than that of impingement patients and cuff-tear patients. LAA of cuff-tear patients differed significantly from that of controls and impingement patients, but LAA of controls was not significantly different from that of impingement patients. Differences between impingement patients and cuff-tear patients were also significant. AI of controls was significantly lower than of impingement patients and of cuff-tear patients. A good correlation was found between acromial type and AS. Interpretation A low lateral acromial angle and a large lateral extension of the acromion were associated with a higher prevalence of impingement and rotator cuff tears. An extremely hooked anterior acromion with a slope of more than 43° and an LAA of less than 70° only occurred in patients with rotator cuff tears.

2013-01-01

242

Biomechanical comparison between single-bundle and double-bundle anterior cruciate ligament reconstruction with hamstring tendon under cyclic loading condition  

PubMed Central

Purpose The purpose of this study was to compare the anterior tibial translation (ATT) of the anterior cruciate ligament (ACL) reconstructed-knee between single-bundle and double-bundle ACL reconstruction under cyclic loading. Methods Single-bundle and double-bundle reconstructions of the knee were performed sequentially in randomized order on the same side using eight human amputated knees. After each reconstruction, the reconstructed-knee was subjected to 500-cycles of 0 to 100-N anterior tibial loads using a material testing machine. The ATT before and after cyclic loading and “laxity increase”, which indicated a permanent elongation of the graft construct, was also determined. Results The ATT after cyclic loading increased in both single-bundle and double-bundle reconstruction techniques compared to that without cyclic loading. Changes in ATT before and after cyclic loading were 3.9?±?0.9 mm and 2.9?±?0.6 mm respectively, and were significantly different. Laxity increase was also significantly different (4.3?±?0.9 mm and 3.2?±?0.8 mm respectively). Although no graft rupture or graft fixation failure was found during cyclic loading, the graft deviated into an eccentric position within the tunnel. Conclusions Although ATT was significantly increased in both single-bundle and double-bundle reconstruction with hamstring tendon after cyclic loading test, there was significant difference. Double-bundle reconstruction might be superior to prevent increasing ATT under cyclic loading. Deformation of hamstring tendon after cyclic loading might result in deterioration of knee stability after ACL reconstruction, and is one of disadvantages of soft tissue graft.

2012-01-01

243

Suture-bridge subscapularis tendon repair technique using low anterior portals.  

PubMed

A suture-bridge technique has been introduced to facilitate fixation procedures and to achieve increased holding strength in posterosuperior rotator cuff. Based on biomechanical studies, this technique has been suggested as an effective method that could optimize rotator cuff tendon-footprint contact area and mean pressure, as well as holding strength. In this technique, the suture-bridge creation is adapted for arthroscopic subscapularis repair to attain the ideal cuff integrity and footprint restoration. To obtain enough working portals and space, two accessory portals were made on the anterior aspect of the shoulder and use an elevator to retract the conjoined tendons and deltoid muscle. This technique could be useful for the repair of subscapularis tears, which are not easily approached using other arthroscopic techniques. From a biomechanical point of view, the subscapularis tendon could be restored more ideally using the suture-bridge technique. PMID:20890701

Park, Jin-Young; Park, Jun-Suk; Jung, Jae-Kyung; Kumar, Praveen; Oh, Kyung-Soo

2011-02-01

244

Tenosynovitis of the peroneal tendons associated with a hypertrophic peroneal tubercle: radiography and MRI findings.  

PubMed

An enlarged peroneal tubercle can cause a peroneal tendon tear and/or tenosynovitis due to chronic friction. We present the case of a 45-year-old man with tenosynovitis in the peroneus longus and brevis tendons associated with a hypertrophic peroneal tubercle. On admission to our facility, the patient presented with pain while walking and had a fixed mass on the lateral aspect of his right foot. In addition, an osseous prominence corresponding to a hypertrophic peroneal tubercle was seen on the lateral side of the right calcaneus on radiography. MRI confirmed the hypertrophic peroneal tubercle and revealed high-signal intensity within the peroneus longus and brevis tendons along with fluid in their sheaths. PMID:24748135

Celikyay, Fatih; Yuksekkaya, Ruken; Almus, Ferdag; Bilgic, Erkal

2014-01-01

245

Dynamic Distribution of Artificial Tears on the Ocular Surface  

Microsoft Academic Search

Objective: To study the effects of artificial tear viscos- ity on tear film thickness, upper and lower tear menisci, and tear volume using optical coherence tomography. Methods: The central tear film and tear menisci before and immediately after the instillation of different artifi- cial tears were imaged in 40 eyes of 20 healthy indi- viduals. Carboxymethylcellulose sodium, 1.0% (viscos- ity,

Jianhua Wang; Peter Simmons; James Aquavella; Joseph Vehige; Jayachandra Palakuru; Suk Chung; Changyong Feng

2008-01-01

246

Unusual accessory tendon connecting the hallucal extensors.  

PubMed

During routine dissection of an adult human cadaver, a suite of tendinous anomalies was discovered in the left hallucal region. Whereas the main tendon of the extensor hallucis longus muscle inserted normally, two accessory tendons were found coursing medial and lateral to the main tendon. The most lateral tendon originated from a supernumerary muscle belly and merged with the tendon of extensor hallucis brevis to form a composite tendon. The most medial tendon crossed the metatarsophalangeal joint and joined the composite tendon deep to the tendon of extensor hallucis longus. A terminal tendon, consisting of these three contributions, inserted upon the proximal hallucal phalanx. This variant likely arose due to atypical differentiation of the common extensor muscle mass during development, and is of particular significance to clinicians performing arthroscopy, tendon transfers, and other surgical procedures. PMID:19159364

Hill, Robert V; Gerges, Luke

2008-12-01

247

Effect of blinking on tear volume after instillation of mid-viscosity artificial tears  

PubMed Central

Purpose To determine by optical coherence tomography (OCT) the effect of blinking on ocular surface tear volume after instillation of artificial tears. Design Experimental study. Methods Normal human (n = 21) eyes were imaged to get dimensions of the tear film and menisci during blinking. The imaging was done immediately and 5 minutes after the instillation of 35 µl of mid-viscosity artificial tears (1.0% carboxymethylcellulose, Refresh Liquigel, Allergan, Irvine, CA). The exposed ocular surface area and the lid lengths were used to calculate the volumes. Results Immediately after the instillation, total tear volume was increased (P<0.001) compared to 5 minutes after the instillation with the major increases in the lower tear meniscus volume and tear film volume. After the instillation, blinking caused tear loss in total tear volume due to the decrease of the lower tear meniscus volume (P<0.05). In contrast, blinking increased the tear film volume (P<0.05). At the end of eye opening period, tear film volume decreased and lower tear meniscus volume increased significantly (P<0.05) with no significant changes in total tear volume (P>0.05). During the blink cycle immediately after the instillation, net loss was evident in tear film volume, lower tear meniscus volume and total tear volume (P<0.05). Conclusions Blinking plays a crucial role in distribution and removal of instilled tears. When the tear system is overloaded, the increase in blink output helps restore balance.

Palakuru, Jayachandra R.; Wang, Jianhua; Aquavella, James V.

2008-01-01

248

Disorders of the Achilles tendon  

Microsoft Academic Search

The Achilles tendon is susceptible to various types of acute and chronic injuries as a consequence of its large size, enormous continuous functional demands during gait, and poor blood supply. Also, the occurrence of overuse syndromes of the Achilles tendon is increasing due to the modern physical life style. In this article the different forms of tendinitis (insertional and non-insertional),

Aleksander Lesic; Marko Bumbasirevic

2004-01-01

249

Posterior Tibial Tendon Dysfunction (PTTD)  

MedlinePLUS

The official consumer website of: Visit ACFAS.org | About ACFAS | Información en Español ... tendon serves as one of the major supporting structures of the foot, helping it to function while walking. Posterior tibial tendon dysfunction (PTTD) is a condition caused ...

250

The subaortic tendon as a mimic of hypertrophic cardiomyopathy.  

PubMed

Originally described by Brock and Teare, today hypertrophic cardiomyopathy is clinically defined as left (or right) ventricular hypertrophy without a known cardiac or systemic cause, such as systemic hypertension, Fabry's disease or aortic stenosis.Also appreciated today is the enormous genotypic and phenotypic heterogeneity of this disease with more than 300 mutations over more than 24 genes, encoding various sarcomeric, mitochondrial and calcium-handling proteins, all as genetic causes for hypertrophic cardiomyopathy.Phenotypically, the disease can vary from negligible to extreme hypertrophy, affecting either the left and/or right ventricle in an apical, midventricular or subaortic location.Left ventricular false tendons are thin, fibrous or fibromuscular structures that traverse the left ventricular cavity. Recently, a case report was presented where it was shown that such a false tendon, originating from a subaortic location, was responsible for striking ST-segment elevation on the surface electrocardiogram.In this case report, a case is presented where such a subaortic tendon led to the classic echocardiographic appearance of hypertrophic cardiomyopathy, thus in the assessment of hypertrophic cardiomyopathy, this entity needs to be excluded in order to prevent a false positive diagnosis of hypertrophic cardiomyopathy. PMID:19573250

Ker, James

2009-01-01

251

Ultrasound-guided tendon fenestration.  

PubMed

A potential treatment for chronic tendinosis or tendinopathy is percutaneous ultrasound-guided tendon fenestration, also termed dry needling or tenotomy. This procedure involves gently passing a needle through the abnormal tendon multiple times to change a chronic degenerative process into an acute condition that is more likely to heal. This article reviews the literature on tendon fenestration and describes the technical aspects of this procedure including postprocedural considerations. Although peer-reviewed literature on this topic is limited, studies to date have shown that ultrasound-guided tendon fenestration can improve patient symptoms. Several other percutaneous treatments for tendinopathy that include prolotherapy, autologous whole-blood injection, and autologous platelet-rich plasma injection are often performed in conjunction with fenestration. It is currently unknown if these other percutaneous procedures have any benefit over ultrasound-guided tendon fenestration alone. PMID:23487340

Chiavaras, Mary M; Jacobson, Jon A

2013-02-01

252

Rabbit supraspinatus motor endplates are unaffected by a rotator cuff tear.  

PubMed

Rotator cuff tears are a major cause of morbidity. Following rotator cuff tears, muscle atrophy and fatty infiltration begin in the tissue, limiting repair potential and leading to a higher re-tear rate and a worse functional outcome. We evaluated whether fatty degeneration resulting from a complete supraspinatus tear with retraction is associated with an injury to the suprascapular nerve. Four skeletally mature New Zealand white rabbits were randomized to receive an index procedure on either their right or left shoulder with the opposite shoulder serving as a control. At the index procedure, the supraspinatus tendon was transected at its insertion and allowed to retract. At 3 months, the rabbits were euthanized, and both supraspinatus muscles were harvested. The specimens were then examined with confocal microscopy and histology. Atrophy was grossly visible in all four test muscles, and fatty infiltration was confirmed with osmium tetroxide staining. In all four rabbits, the degree of denervation (p?=?0.71) and partial denervation (p?=?0.91) was not significantly different between control and experimental muscle. Rotator cuff tear does not affect the motor endplate or innervation status of the supraspinatus. Fatty infiltration occurs independent of denervation of the supraspinatus. PMID:22836785

Gayton, J Christopher; Rubino, L Joseph; Rich, Mark M; Stouffer, Mark H; Wang, Qingbo; Boivin, Gregory P

2013-01-01

253

Arthroscopic intratendinous repair of the delaminated partial-thickness rotator cuff tear in overhead athletes.  

PubMed

A distinct type of partial-thickness rotator cuff tear has been observed in overhead athletes, characterized by partial failure of the undersurface of the posterior supraspinatus and anterior infraspinatus tendons with intratendinous delamination. We present a technique of percutaneous intratendinous repair using nonabsorbable mattress sutures designed for the management of articular-side delaminated partial-thickness tears. After tear evaluation and preparation, the torn rotator cuff undersurface is held in a reduced position with a grasper through an anterolateral rotator interval portal while viewing intra-articularly. Two spinal needles are then placed percutaneously through the full thickness of the torn and intact rotator cuff. A polydioxanone suture is passed through each needle, retrieved out the anterior portal, and used to shuttle a single nonabsorbable No. 2 suture through the tissue, creating a mattress suture. Multiple mattress sutures can be placed as dictated by tear size and morphology, with suture retrieval and knot securing then proceeding in the subacromial space. We have adopted this approach with the goals of anatomically re-establishing the rotator cuff insertion and sealing the area of intratendinous delamination while preventing significant alteration to the anatomy of the rotator cuff insertion, which could lead to motion deficits, internal impingement, and potential tear recurrence. PMID:18657747

Brockmeier, Stephen F; Dodson, Christopher C; Gamradt, Seth C; Coleman, Struan H; Altchek, David W

2008-08-01

254

PRIMARY FLEXOR TENDON REPAIR IN ZONE 1  

Microsoft Academic Search

This paper presents an analysis of the results of repair of 102 complete flexor tendon disruptions in zone 1 which were rehabilitated by an early active mobilization technique during a 7 year period from 1992 to 1998. These injuries were subdivided into: distal tendon divisions requiring reinsertion; more proximal tendon divisions but still distal to the A4 pulley; tendon divisions

N. S. MOIEMEN; D. ELLIOT

2000-01-01

255

Long durations of immobilization in the rat result in enhanced mechanical properties of the healing supraspinatus tendon insertion site.  

PubMed

Rotator cuff tears frequently occur and can lead to pain and decreased shoulder function. Repair of the torn tendon back to bone is often successful in relieving pain, but failure of the repair commonly occurs. Post-operative activity level is an important treatment component that has received minimal attention for the shoulder, but may have the potential to enhance tendon to bone healing. The objective of this study was to investigate the effect of short and long durations of various activity levels on the healing supraspinatus tendon to bone insertion site. Rotator cuff tears were surgically created in Sprague-Dawley rats by detaching the supraspinatus tendon from its insertion on the humerus and these tears were immediately repaired back to the insertion site. The post-operative activity level was controlled through shoulder immobilization (IM), cage activity (CA), or moderate exercise (EX) for durations of 4 or 16 weeks. The healing tissue was evaluated utilizing biomechanical testing and a quantitative polarized light microscopy method. We found that activity level had no effect on the elastic properties (stiffness, modulus) of the insertion site at four weeks post injury and repair, and a decreased activity level had a positive effect on these properties at 16 weeks (IM>CA=EX). Furthermore, a decreased activity level had the greatest positive effect on these properties over time (IM>CA=EX). The angular deviation of the collagen, a measure of disorganization, was decreased with a decrease in activity level at 4 weeks (IMtendon to bone healing, which progresses by first increasing the organization of the collagen and then increasing the mechanical properties. Future studies in this area will investigate the effect of passive motion and remobilization on both tendon to bone healing and shoulder function. PMID:17536907

Gimbel, J A; Van Kleunen, J P; Williams, G R; Thomopoulos, S; Soslowsky, L J

2007-06-01

256

Tear dynamics in healthy and dry eyes.  

PubMed

Abstract Purpose: Dry-eye disease, an increasingly prevalent ocular-surface disorder, significantly alters tear physiology. Understanding the basic physics of tear dynamics in healthy and dry eyes benefits both diagnosis and treatment of dry eye. We present a physiological-based model to describe tear dynamics during blinking. Materials and methods: Tears are compartmentalized over the ocular surface; the blink cycle is divided into three repeating phases. Conservation laws quantify the tear volume and tear osmolarity of each compartment during each blink phase. Lacrimal-supply and tear-evaporation rates are varied to reveal the dependence of tear dynamics on dry-eye conditions, specifically tear osmolarity, tear volume, tear-turnover rate (TTR), and osmotic water flow. Results: Predicted periodic-steady tear-meniscus osmolarity is 309 and 321 mOsM in normal and dry eyes, respectively. Tear osmolarity, volume, and TTR all match available clinical measurements. Osmotic water flow through the cornea and conjunctiva contribute 10 and 50% to the total tear supply in healthy and dry-eye conditions, respectively. TTR in aqueous-deficient dry eye (ADDE) is only half that in evaporative dry eye (EDE). Conclusions: The compartmental periodic-steady tear-dynamics model accurately predicts tear behavior in normal and dry eyes. Inclusion of osmotic water flow is crucial to match measured tear osmolarity. Tear-dynamics predictions corroborate the use of TTR as a clinical discriminator between ADDE and EDE. The proposed model is readily extended to predict the dynamics of aqueous solutes such as drugs or fluorescent tags. PMID:24502301

Cerretani, Colin F; Radke, C J

2014-06-01

257

Comparison of Transverse Intraosseous Loop Technique and Pull Out Suture for Reinsertion of the Flexor Digitorum Profundus tendon. A Retrospective Study.  

PubMed

We compared the results of two methods for reinsertion of flexor digitorum profundus tendons retrospectively. In 35 fingers of 29 patients pull-out suture and in 13 fingers of 11 patients transverse intraosseous loop technique was performed with a mean follow-up of 8 and 6 months, respectively. Eleven and nine fingers achieved "excellent" or "good" function according to Strickland and Glogovac at 8 weeks; 20 and ten at the last control in the pull-out and transverse intraosseous loop groups, respectively. The difference at 8 weeks was statistically significant in favour of the transverse intraosseous loop group. Ten patients underwent 12 complications in the pull-out group (four superficial infections; one rerupture, one PIP and one DIP joint contracture, one adhesion, two granulomas, one nail deformity and one carpal tunnel syndrome) and four of them were reoperated (one carpal tunnel release, one teno-arthrolysis and two resections of granuloma). There was no complication and no reoperation in the transverse intraosseous loop group, the difference being statistically significant for the former. In our study the transverse intraosseous loop technique seemed to be a safe alternative with possibly better functional results compared to the pull-out suture. PMID:24426678

Rigó, István Zoltán; Røkkum, Magne

2013-12-01

258

Unusual accessory tendon connecting the hallucal extensors  

Microsoft Academic Search

During routine dissection of an adult human cadaver, a suite of tendinous anomalies was discovered in the left hallucal region.\\u000a Whereas the main tendon of the extensor hallucis longus muscle inserted normally, two accessory tendons were found coursing\\u000a medial and lateral to the main tendon. The most lateral tendon originated from a supernumerary muscle belly and merged with\\u000a the tendon

Robert V. Hill; Luke Gerges

2008-01-01

259

Tensile properties of a morphologically split supraspinatus tendon.  

PubMed

The supraspinatus tendon consists morphologically of two sub-regions, anterior and posterior. The anterior sub-region is thick and tubular while the posterior is thin and strap-like. The purpose of this study was to compare the structural and mechanical properties of the anterior and posterior sub-regions of the supraspinatus tendon. The supraspinatus tendons from seven human cadaveric shoulders were morphologically divided into the anterior and posterior sub-regions. Length, width, and thickness were measured. A servo-hydraulic testing machine (MTS Systems Corporation, Minneapolis, MN) was used for tensile testing. The maximal load at failure, modulus of elasticity and ultimate tendon stress were calculated. Repeated measures were used for statistical comparisons. The mean anterior tendon cross-sectional area was 47.3 mm(2) and the posterior was 32.1 mm(2) . Failure occurred most often at the insertion site: anterior (5/7) and posterior (6/7). All parameters of the anterior sub-region were significantly greater than those of the posterior sub-region. The moduli of elasticity at the insertion site were 592.4 MPa in the anterior sub-region and 217.7 MPa in the posterior (P = 0.01). The ultimate failure loads were 779.2 N in the anterior sub-region and 335.6 N in the posterior (P = 0.003). The ultimate stresses were 22.1 MPa in the anterior sub-region and 11.6 MPa in the posterior (P = 0.008). We recognized that the anterior and posterior sub-regions of the SSP tendon have significantly different mechanical properties. In a future study, we need to evaluate how best to repair an SSP tendon considering these region-specific properties. Clin. Anat. 27:702-706, 2014. © 2013 Wiley Periodicals, Inc. PMID:24214830

Matsuhashi, Tomoya; Hooke, Alexander W; Zhao, Kristin D; Goto, Akira; Sperling, John W; Steinmann, Scott P; An, Kai-Nan

2014-07-01

260

Exercise Therapy for Total Tear of Rotator Cuff: A Case Report  

PubMed Central

Background Shoulder pain is one of the most common problems in ages older than 60 years of age. Rotator cuff pathology is the most common etiology of shoulder pain. Most of rotator cuff pathologies are treated conservatively in old ages and exercise therapy is not an accepted intervention for management of rotator cuff tear yet. Case presentation The case was a man of 53 years age with shoulder pain who had total tear of supraspinatus tendon and biceps tendinitis in the right shoulder. He had regularly gone swimming, mountain climbing and running in the last 10 years. The case was managed by exercise therapy for 3 months and physical modalities for 20 sessions. Shoulder pain and his function and right shoulder range of motion increased after 3 months. Para clinical findings did not change after treatment, though. The improvements continued 15 months after the beginning of the treatment. Conclusion Exercise therapy was very effective for improving pain and function in total tear of supraspinatus tendon and tendinitis of biceps.

Nejati, Parisa; Akbari, Faramarz

2013-01-01

261

Partial Tendon Release for Treatment of a Symptomatic Snapping Biceps Femoris Tendon  

PubMed Central

Snapping of the biceps femoris tendon over the fibular head is an uncommon condition. Reported causes include an anomalous insertion of the tendon, trauma at the insertion site of the tendon, and an abnormality of the fibular head. This article reports a case of a painful snapping biceps femoris tendon in a patient without an anomalous tendon insertion or an abnormality of the fibular head. Partial release of the superior aspect of the tendon resulted in resolution of symptoms.

Crow, Scott A.; Quach, Tony; McAllister, David R.

2009-01-01

262

Reconstruction of a chronic extensor hallucis longus tendon laceration with a gracilis tendon autograft.  

PubMed

Extensor hallucis longus tendon injuries are uncommon, representing < 2% of tendon injuries. Lacerations are more common than spontaneous ruptures, and if neglected are often difficult to primarily repair because of tendon retraction and scarring. Few reports address the operative treatment of chronic extensor hallucis longus tendon injuries. To our knowledge the use of a gracilis tendon autograft has not been reported. We describe the use of this free tendon autograft with a hallux interphalangeal joint arthrodesis in one patient. PMID:19225994

Smith, Bertil; Coughlin, Michael

2008-10-01

263

Radial side (1D) tears.  

PubMed

The triangular fibrocartilage complex (TFCC) is the key structure at the wrist that facilitates the rotation of the radius and the carpus on the distal ulnar. The radial or type 1D tears of the TFCC are uncommon, but they pose a major disruption of the articular contact between the carpus and the distal ulna. The tears can heal by arthroscopically repairing the TFCC back to the radius using sutures through bone tunnels. This procedure allows patients to return to their work and sports activities with significant recovery of strength and range of motion. PMID:21871347

Trumble, Thomas

2011-08-01

264

Preserved Fascia and Tendon Homografts.  

National Technical Information Service (NTIS)

A discussion is presented on the practical use of preserved fascia and tendon homografts. Clinical observations on 58 patients treated at the clinic of traumatology and orthopedics at the Military Medical Academy are reviewed.

I. L. Krupko S. S. Tkachenko

1966-01-01

265

Sonographic findings during and after Platelet Rich Plasma injections in tendons  

PubMed Central

Summary Platelet rich plasma has been used in the treatment of tendinopathies, but the sonographic modifications of tendons have received less attention. In this paper we report the results of an ultrasound evaluation, performed during and after plasma injection, in patients with tendinopathy. The sonographic abnormalities and neovascularization were registered in twenty tendons. Three plasma injections (once a week) were performed, and a rehabilitation program was recommended. Pain and patients’ satisfaction were evaluated. During the injections plasma spread along the collagen fibers, and an intratendineous cleft produced by the injected volume was observed. At 12 months two tendons regained a normal echotexture, while neovessels were absent in seven. The remaining tendons showed less abnormalities and neovascularization in comparison with baseline. The clinical improvement was earlier and more consistent. The discrepancy between the ultrasound and clinical results may be explained by the peculiar modalities of tendon healing induced by plasma administration.

Abate, Michele; Verna, Sandra; Di Gregorio, Patrizia; Salini, Vincenzo; Schiavone, Cosima

2014-01-01

266

Sonographic findings during and after Platelet Rich Plasma injections in tendons.  

PubMed

Platelet rich plasma has been used in the treatment of tendinopathies, but the sonographic modifications of tendons have received less attention. In this paper we report the results of an ultrasound evaluation, performed during and after plasma injection, in patients with tendinopathy. The sonographic abnormalities and neovascularization were registered in twenty tendons. Three plasma injections (once a week) were performed, and a rehabilitation program was recommended. Pain and patients' satisfaction were evaluated. During the injections plasma spread along the collagen fibers, and an intratendineous cleft produced by the injected volume was observed. At 12 months two tendons regained a normal echotexture, while neovessels were absent in seven. The remaining tendons showed less abnormalities and neovascularization in comparison with baseline. The clinical improvement was earlier and more consistent. The discrepancy between the ultrasound and clinical results may be explained by the peculiar modalities of tendon healing induced by plasma administration. PMID:24932444

Abate, Michele; Verna, Sandra; Di Gregorio, Patrizia; Salini, Vincenzo; Schiavone, Cosima

2014-01-01

267

Ocular surface assessment in soft contact lens wearers; the contribution of tear osmolarity among other tests.  

PubMed

Purpose:  To determine whether tear osmolarity contributes to the assessment of the ocular surface in soft contact lens (CL) wearers. Methods:  Prospective, case-control series in 44 CL wearers (28 tolerant and 16 intolerant) and 34 healthy subjects. Every patient underwent a thorough ophthalmic examination with a tear osmolarity test (TearLab System), conjunctival impression cytology and meibomian lipid sampling. Symptoms, break-up time (BUT), tear osmolarity, conjunctival expression of HLA-DR and meibomian fatty acid composition were evaluated. Results:  Tear osmolarity did not differ between controls and CL wearers (p?=?0.23). Flow cytometry results expressed in antibody-binding capacity (ABC) units and percentage of positive cells revealed a significant difference between the intolerant CL wearer group and the control group (p?Comparisons between tolerant and intolerant CL wearers showed only a significant difference for mean fluorescence levels expressed in ABC units (p?tear osmolarity was not modified in these selected CL wearers. The yield of tear osmolarity with TearLab™ in assessing ocular surface disorders in CL wearers deserves further investigation. PMID:23506409

Muselier-Mathieu, Aurore; Bron, Alain M; Mathieu, Bénigne; Souchier, Maxime; Brignole-Baudouin, Françoise; Acar, Niyazi; Brétillon, Lionel; Creuzot-Garcher, Catherine

2014-06-01

268

Management of Extensor Tendon Injuries  

PubMed Central

Extensor tendon injuries are very common injuries, which inappropriately treated can cause severe lasting impairment for the patient. Assessment and management of flexor tendon injuries has been widely reviewed, unlike extensor injuries. It is clear from the literature that extensor tendon repair should be undertaken immediately but the exact approach depends on the extensor zone. Zone I injuries otherwise known as mallet injuries are often closed and treated with immobilisaton and conservative management where possible. Zone II injuries are again conservatively managed with splinting. Closed Zone III or ‘boutonniere’ injuries are managed conservatively unless there is evidence of displaced avulsion fractures at the base of the middle phalanx, axial and lateral instability of the PIPJ associated with loss of active or passive extension of the joint or failed non-operative treatment. Open zone III injuries are often treated surgically unless splinting enable the tendons to come together. Zone V injuries, are human bites until proven otherwise requires primary tendon repair after irrigation. Zone VI injuries are close to the thin paratendon and thin subcutaneous tissue which strong core type sutures and then splinting should be placed in extension for 4-6 weeks. Complete lacerations to zone IV and VII involve surgical primary repair followed by 6 weeks of splinting in extension. Zone VIII require multiple figure of eight sutures to repair the muscle bellies and static immobilisation of the wrist in 45 degrees of extension. To date there is little literature documenting the quality of repairing extensor tendon injuries however loss of flexion due to extensor tendon shortening, loss of flexion and extension resulting from adhesions and weakened grip can occur after surgery. This review aims to provide a systematic examination method for assessing extensor injuries, presentation and management of all type of extensor tendon injuries as well as guidance on mobilisation pre and post surgery.

Griffin, M; Hindocha, S; Jordan, D; Saleh, M; Khan, W

2012-01-01

269

Stress biomarkers in the tear film  

Microsoft Academic Search

Tear fluid plays a vital role in protecting the ocular surface and maintaining conditions optimal for ocular health and vision. Tear fluid may also potentially have a role as a diagnostic fluid, in a similar manner to the way in which saliva has increasingly been utilized for diagnostic tests. This study aimed to determine if tear fluid analysis could distinguish

Linda K Banbury

2009-01-01

270

STAR: a consensus for skin tear classification  

Microsoft Academic Search

Until now the Payne-Martin Classification System for Skin Tears has been the only skin tear classification system reported in the literature. Considering that the development of this taxonomy began over twenty years ago, it is rather puzzling that it has been poorly utilised in Australia. Especially in light of the fact that skin tears are perceived to be common wounds

Carville K; Lewin G; Newall N; Haslehurst P; Michael R; Santamaria N; Roberts P

2007-01-01

271

Efficacy of a mesenchymal stem cell loaded surgical mesh for tendon repair in rats  

PubMed Central

Objectives The purpose of this study was to investigate the efficacy of a composite surgical mesh for delivery of mesenchymal stem cells (MSCs) in tendon repair. Methods The MSC-loaded mesh composed of a piece of conventional surgical mesh and a layer of scaffold, which supported MSC-embedded alginate gel. A 3-mm defect was surgically created at the Achilles tendon-gastrocnemius/soleus junction in 30 rats. The tendon defects were repaired with either 1) MSC-loaded mesh; or 2) surgical mesh only; or 3) routine surgical suture. Repaired tendons were harvested at days 6 and 14 for histology, which was scored on the bases of collagen organization, vascularity and cellularity, and immunohistochemisty of types I and III collagen. Results In comparison with the other two repair types, at day 6, the MSC-loaded mesh significantly improved the quality of the repaired tendons with dense and parallel collagen bundles, reduced vascularity and increased type I collagen. At day 14, the MSC-loaded mesh repaired tendons had better collagen formation and organization. Conclusion The MSC-loaded mesh enhanced early tendon healing, particularly the quality of collagen bundles. Application of the MSC-loaded mesh, as a new device and MSC delivery vehicle, may benefit to early functional recovery of the ruptured tendon.

2014-01-01

272

Paralabral rupture of the proximal biceps tendon from light weightlifting.  

PubMed

Rupture of the long head of the biceps is usually seen in older adults, in conjunction with rotator cuff tears or tenosynovitis secondary to chronic subacromial impingement; it is rarely seen as a result of trauma. We present the case of a young active patient who denied prodromal symptoms but ruptured the long head of the biceps brachii tendon (LHB) while performing 25-pound biceps curls. Upon examination, the patient was noted to have a readily apparent biceps defect and decreased strength. He was brought to the operating room, where open subpectoral tenodesis of the LHB was performed. At the 6-week follow-up evaluation, the patient had regained full range of motion. By 6 months, he had regained his previous strength. This case demonstrates an unusual presentation of a LHB rupture in a young healthy man with no prodromal symptoms. PMID:19149346

Miller, Kyle E; Solomon, Daniel J

2008-12-01

273

Atraumatic Flexor tendon retrieval- a simple method  

PubMed Central

Background Zone 2 flexor tendon injuries still represent a challenging problem to hand surgeons despite the well developed surgical techniques and suture materials. Meticulous surgical repair with atraumatic handling of the severed tendon stumps and minimal damage to the tendon sheath are particularly important to prevent postoperative adhesions and ruptures in this area. In zone 2 flexor tendon injuries proximal to the vinculas, the cut ends of the flexor tendons retract to the palm with muscle contraction. To retrieve the severed proximal flexor tendon under tendon sheath and pulley system is very difficult without damaging these structures. Many techniques are described in the literature for the delivery of the retracted proximal tendon stump to the repair site. Methods In this report we would like to present a simple and relatively atraumatic technique that facilitates passing of the retracted flexor tendon through the pulleys in zone 2. We sutured the proximal tendon stump at the distal palmar crease with 3–0 polypropylene suture and used a 14 gauge plastic feeding tube, acting like a conduit for the passage of straightened needle to the finger. Results We have used this technique 21 times without any complication in our clinic. We have not seen any suture breakage during the passage or needle breakage due to the bending of the needle. Conclusions We have found this technique is very simple and very effective in retrieving the retracted tendon stump without causing undue damage to the tendon stump or tendon sheath.

2013-01-01

274

Method and apparatus for tear film measurement  

US Patent & Trademark Office Database

Tear film is measured without contacting the eye by comparing reflectance from the eye when the tear film is undisturbed with reflectance from the eye when the when the tear film is disturbed. If the reflectance levels differ somewhat, it is an indication that a healthy tear film exhibiting good specular reflection was present initially and was disturbed by the air pulse. However, if the reflectance levels are close to one another, it is an indication that a less-than-normal tear film was present initially (dry eye). In a described embodiment, tear film is disturbed by an air pulse directed at the eye, and a photosensitive detector is positioned to receive light from an illumination beam after the beam is reflected by the eye to generate a reflectance signal. The reflectance signal is evaluated to calculate a tear film index.

2010-08-10

275

Rotator cuff re-tear or non-healing: histopathological aspects and predictive factors  

Microsoft Academic Search

Purpose  The aim of the study was to evaluate the histopathological changes that occur in the tendon and subacromial bursal tissue\\u000a in patients with rotator cuff tear trying to correlate these changes to their healing capability.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Eighty-four patients were clinically evaluated with the Constant Scale. Radiographs and MRI were performed preoperatively\\u000a and ultrasound were performed postoperatively. For each patient, a biopsy

C. Chillemi; V. Petrozza; L. Garro; B. Sardella; R. Diotallevi; A. Ferrara; A. Gigante; C. Di Cristofano; A. Castagna; C. Della Rocca

276

[Histologic pattern and mechanical properties of tissue-engineered tendon implants for tendon defects].  

PubMed

This is a study on the histologic pattern and mechanical properties of tissue-engineered tendon implanted for treatment of tendon defects. Tendons were resected from Roman chickens. Tendon cells were isolated from the tendons and cultured in vitro. The 2nd-4th passages of tendon cells were seeded on the degradable polyglycolic acid mesh to form cell-scaffold composites, which were further cultured for 7-10 days to construct tissue-engineered tendons. The tendon defects, 0.5 cm-0.8 cm in length, were made in the second digit flexor tendon bilaterally in 20 Roman chickens and then bridged with the constructed tissue-engineered tendons. At 2 weeks, 4 weeks, 6 weeks, and 8 weeks post-operation, the samples of regenerated tendons were collected for gross examination, histologic staining and biomechanical test. After implantation of the tissue-engineered tendons, the wounds healed well. The gross appearance, the cells and collagen fibers arrangement of the regenerated tendons were similar to those of natural tendons, but there were relatively not many closely packed collagen fiber bundles organized in parallel with the tendons ("remodel"), so the maximum tensile force increased slowly and its value was 15.40+/-10.63 N at 8 weeks after surgery, reaching only 23% of that of natural tendon. The maximum strain was 22.49%+/-10.21% at 8 weeks, being 10% higher than that of natural tendons. Polyglycolic acid scaffolds are degraded in vivo so rapidly that the regenerated tendons lose the normal biomechanical stimulus and then are unable to be remodeled. As a result, the mechanical strength of regenerated tendons is much lower than that of natural tendons. These results suggest that the normal biomechanical stimulus may be an important factor for the regenerated tendons to remodel. PMID:15357423

Qin, Tingwu; Zhang, Shujiang; Yang, Zhiming; Li, Xiuqun

2004-08-01

277

Effect of timolol with and without preservative on the basal tear turnover in glaucoma.  

PubMed Central

AIMS--The purpose of this study was to assess whether the preservative benzalkonium chloride (BAC 0.01%) present in timolol induced a decrease in basal tear turnover and a deterioration of precorneal tear film in patients with glaucoma and ocular hypertension using topical timolol. METHODS--The basal tear turnover of 20 patients with open angle glaucoma or ocular hypertension was measured by computerised objective fluorophotometry when using topical timolol preserved with BAC and 2 weeks after changing to topical timolol containing no preservative. Evaluation of the precorneal tear film was done by measuring the break up time (BUT) before and 2 weeks after changing medication. RESULTS--The tear turnover of the patients before the change was 32% lower than that of healthy controls (mean tear turnover values (SD) (%/min): 10.7 (3.0) and 15.6 (5.4), respectively, p < 0.0001). A mean increase of 28% (47%) in the individual tear turnover values was found after the change to the preservative-free timolol (p = 0.04). The BUT values before the change of medication did not differ significantly from those after the change (p = 0.5) but both values were significantly lower than the values of healthy controls (p = 0.009 and p = 0.003, respectively). CONCLUSION--Preservative-free timolol solution has a favourable effect on the tear turnover of patients with glaucoma and ocular hypertension in comparison with timolol containing BAC. The integrity of the precorneal tear film persisted to be affected when using timolol without BAC. Timolol without preservative can be recommended in those patients who have keratoconjunctivitis sicca or a borderline tear production since BAC may exacerbate a dry eye state.

Kuppens, E V; de Jong, C A; Stolwijk, T R; de Keizer, R J; van Best, J A

1995-01-01

278

[Ligamentous extensor tendon ruptures of the DIP joint : surgical indications and techniques].  

PubMed

Management of soft tissue ruptures of extensor tendon lesions of zone I is both difficult and controversial. Because of their superficial position already minor injury can be sufficient for laceration. Furthermore many authors are convinced of an easy way of diagnosing and repairing extensor tendon ruptures in comparison to injuries of the flexor tendons. However, this injury can cause significant hand dysfunction and has to be treated with attention in order to provide the best possible outcome for the patient. Therefore we try to evaluate the common treatment procedures and to give guidelines for management of this injury. PMID:18854971

Pliefke, J; Ekkernkamp, A; Eisenschenk, A

2008-12-01

279

Tendon to bone healing: differences in biomechanical, structural, and compositional properties due to a range of activity levels.  

PubMed

Little knowledge exists about the healing process of the tendon to bone insertion, and hence little can be done to improve tissue healing. The goal of this study is to describe the healing of the supraspinatus tendon to its bony insertion under a variety of loading conditions. Tendons were surgically detached and repaired in rats. Rat shoulders were then immobilized, allowed cage activity, or exercised. Shoulders that were immobilized demonstrated superior structural (significantly higher collagen orientation), compositional (expression of extracellular matrix genes similar to the uninjured insertion), and quasilinear viscoelastic properties (A = 0.30 +/- 0.10 MPa vs. 0.16 +/- 0.08 MPa, B = 17.4 +/- 2.9 vs. 15.1 +/- 0.9, and tau 2 = 344 +/- 161 s vs. 233 +/- 40 s) compared to those that were exercised, contrary to expectations. With this knowledge of the healing response, treatment modalities for rotator cuff tears can be developed. PMID:12661203

Thomopoulos, S; Williams, G R; Soslowsky, L J

2003-02-01

280

Diagnostic assessment in anterior cruciate ligament (ACL) tears.  

PubMed

(Full text is available at http://www.manu.edu.mk/prilozi). The aim of this study was to compare findings from clinical examinations, MRI scans and arthroscopy in ACL injury of the knee in order to assess the diagnostic significance of both examination findings. This study was conducted to manage the reliability of clinical diagnosis in ACL tear injuries. All patients attending our clinic with knee pain from 2009 to 2013 underwent systematic and thorough clinical assessment. Of 103 patients with knee problems arthroscopy ACL tears was diagnosed in 73. All these patients underwent therapeutic arthroscopic knee surgery. The clinical diagnosis was evaluated and confirmed during this procedure. The accuracy, sensitivity and specificity were calculated based on these arthroscopic findings. The MRI accuracy of clinical diagnosis in our study was 82.5% for ACL tears. Accuracy for two of three clinical examination tests of clinical diagnosis in our study was 96% and 94% for ACL tears. According to our obtained correlation between clinical examinations, MRI scan and arthroscopy for ACL injuries, we concluded that carefully performed clinical examination can give equal or better diagnosis of ACL injuries in comparison with MRI scan. Our study revealed MRI scan high sensitivity and specificity and not so high accuracy for ACL injuries of the knee joint in comparison with arthroscopy. MRI is an appropriate screening tool for therapeutic arthroscopy, making diagnostic arthroscopy unnecessary in most patients. According to our findings we can conclude that a positive anterior drawer test and a positive Lachman clinical examination test is more accurate for predicting, i.e. diagnosis of ACL tear. On the ither hand, MRI scan findings showed less accuracy for predicting, i.e. diagnosis of ACL tear. According to many studies of clinical examination tests compared (correlated) with arthroscopy, the accuracy of predicting ACL tears depends on the level of the skilled orthopaedic or trauma surgeon's hands. Based on these findings, we feel that MRI, except in certain circumstances, is an expensive and unnecessary diagnostic test in patients with suspected meniscal and ACL pathology. Key words: clinical examination test, MRI, arthroscopy, ACL, knee. PMID:24798607

Kostov, H; Arsovski, O; Kostova, E; Nikolov, V

2014-01-01

281

An arthroscopic technique for confirming intra-articular subluxation of the long head of the biceps tendon: the ramp test.  

PubMed

The purpose of this technical note is to introduce the ramp test and explain this arthroscopic technique. The ramp test is used to test the integrity of the soft tissue restraint to intra-articular subluxation of the long head of the biceps tendon. Injury to the soft tissue restraint, the hidden lesion, has been proposed as occurring in conjunction with a full-thickness rotator cuff tear. Both cadaveric dissections and arthroscopic patient assessments were conducted to develop the ramp test. In this study, 17 patients also presented with refractory anterior shoulder pain and underwent arthroscopy to further characterize the ramp test. An abnormal examination result showed that the long head of the biceps tendon translated medially and inferiorly across the humeral head. In addition, this subgroup of 17 patients all had an abnormal ramp test but did not have a full-thickness rotator cuff tear. The ramp test is now applied to all arthroscopic procedures by the senior author, and we recommend its use for arthroscopic confirmation of intra-articular subluxation of the long head of the biceps tendon. Thus, we advocate that an abnormal ramp test result indicates pathology and warrants the surgical removal of the long head of the biceps tendon from the glenohumeral joint. PMID:12426555

Motley, Gregory S; Osbahr, Daryl C; Holovacs, Thomas F; Speer, Kevin P

2002-01-01

282

The effect of seprafilm on adhesion formation and tendon healing after flexor tendon repair in chicken.  

PubMed

Adhesion of the tendon, which can occur during healing of tendon repair, is negatively affected by the outcome of surgery. In this experimental study, we sought to prevent adhesion of the tendon, and determined the mechanical stiffness of repair tissue by wrapping sodium hyaluronate and carboxymethylcellulose (Seprafilm; Genzyme, Cambridge, Massachusetts) around the repaired tendon segments. The study group comprised 2 groups of 20 chickens. In group I, the right gastrocnemius tendons of the chickens were cut smoothly, and after tendon and sheath repair, the skin was sutured. In group II, the right gastrocnemius tendons of the chickens were cut, the tendons were repaired, and before skin closure, Seprafilm was wrapped around the repaired tendon segments. Plastic splints were used for holding the chickens' ankles in a neutral position, and they were allowed weight bearing for 8 weeks. In group II, anatomic space between the tendon-sheath and tendon was clear and the tendon-sheath complex was sliding easily around the repaired tendon segment, and this complex was more functional both biomechanically and histologically. Also, the Seprafilm-applied tendons (group II) were observed to be biomechanically more resistant to the tensile forces in group I. Seprafilm is an easily applied interpositional material that can be used safely to prevent adhesion during the tendon healing process. PMID:20349872

Yilmaz, Erhan; Avci, Mustafa; Bulut, Mehmet; Kelestimur, Halidun; Karakurt, Lokman; Ozercan, Ibrahim

2010-03-01

283

High Prevalence of Abnormal MR Findings of the Distal Semimembranosus Tendon: Contributing Factors Based on Demographic, Radiographic, and MR Features.  

PubMed

OBJECTIVE. The objective of our study was to determine the prevalence of thickening and signal alteration of the distal semimembranosus (SM) tendon on knee MRI and analyze the patient factors associated with abnormal MR findings of the distal SM tendon. MATERIALS AND METHODS. Knee MRI scans of 116 subjects (58 men, 58 women; mean age, 48.5 years; range, 18-79 years) who underwent knee surgery were evaluated to assess the distal SM tendons in terms of signal alteration and thickness. To determine the factors associated with MR findings of the distal SM tendon, we assessed demographic characteristics; Kellgren-Lawrence radiographic osteoarthritis grading; history of trauma; the condition of the cruciate ligaments, collateral ligaments, and menisci; and whether there were cystic lesions around the SM tendon. In addition, 55 control subjects with normal knee MRI findings based on the electronic MRI patient database who had anterior knee pain and did not undergo surgery were enrolled. RESULTS. Abnormal thickening of the distal SM tendon was found in 52.6% of knees and signal alteration in 44.8%. Univariate analysis revealed significant associations between abnormal thickening and age, body mass index, history of trauma, osteoarthritis, medial collateral ligament (MCL) thickening, and anterior cruciate ligament (ACL) tear. As for signal alteration, univariate analysis showed that age, body mass index, osteoarthritis, and MCL thickening were statistically significant factors. Multivariate binary logistic regression analyses showed that osteoarthritis and MCL thickening were the strong independent predictors in thickening and signal alteration of the distal SM tendon. CONCLUSION. Signal alteration and abnormal thickening of the distal SM tendon on MRI are frequently seen in daily practice. These MR findings are strongly associated with osteoarthritis and MCL thickening. PMID:24758664

Yoon, Min A; Choi, Ja-Young; Lim, Hyun Kyong; Yoo, Hye Jin; Hong, Sung Hwan; Choi, Jung-Ah; Kang, Heung Sik

2014-05-01

284

Ultrasound of tibialis anterior muscle and tendon: anatomy, technique of examination, normal and pathologic appearance.  

PubMed

Lesions of the tibialis anterior muscle and tendon are not frequently reported in international literature although pathology is not rare. Pathology can be spontaneous, associated with arthropathy or more generalized conditions. Clinical assessment may not be sufficient for distinguishing conditions like tendinopathy, tears, bursitis, etc. Therefore, imaging studies are necessary to plan appropriate therapy. US has a number of advantages, including widespread availability, absence of contraindications and low cost. It can also be used for dynamic studies of the muscle during contraction and relaxation. This article reviews the anatomy of the tibialis anterior, normal variants, the technique used for standard US examination of this muscle and tendon, its normal appearance on US and the sonographic characteristics of the most common lesions that affect it including tips on US-guided injections used for treatment. PMID:24883132

Varghese, Ajay; Bianchi, Stefano

2014-06-01

285

Repair of rotator cuff tears in tennis players  

Microsoft Academic Search

Twenty-three tennis players with a symptomatic full- thickness rotator cuff tear underwent anterior acro mioplasty and rotator cuff repair. There were 8 small tears (<1 cm), 5 moderate tears (1 to 3 cm), 2 large tears (3 to 5 cm), and 8 massive tears (>5 cm). The dominant shoulder was involved in all patients and all were unable to play

Louis U. Bigiliani; Jay Kimmel; Peter D. McCann; Ira Wolfe

1992-01-01

286

REHABILITATION OF A PARTIALLY TORN DISTAL TRICEPS TENDON AFTER PLATELET RICH PLASMA INJECTION: A CASE REPORT  

PubMed Central

Background: Platelet Rich Plasma (PRP) is an emerging non?surgical intervention used for the treatment of tendon and ligament pathology. Despite the growing popularity of PRP in musculoskeletal medicine, there is a paucity of research that describes appropriate rehabilitation procedures following this intervention. Case Description: This case report presents the rehabilitation strategy used following a PRP injection for a patient with a partially torn distal triceps tendon who previously failed physical therapy interventions. Outcome: The patient returned to light weight training and coaching activity after completing 15 visits over a 3 month period. One month after discharge, the patient reported pain?free activities of daily living and a return to previously performed gym activities. Discussion: PRP presents a viable treatment option for individuals who are recalcitrant to conservative interventions yet elect to avoid more invasive surgical measures. Despite the growing popularity of PRP, a paucity of evidence exists to guide physical therapists in the rehabilitation process of these patients. The rehabilitation strategies used in a patient who had a PRP injection for a partial triceps tendon tear are outlined. Although this case report highlights a successful rehabilitation outcome, future research regarding the concomitant effects of PRP injection and rehabilitation for tendon pathology are needed. Level of Evidence: 4?Case Report

Kolber, Morey J.; Salamh, Paul A.; Hanney, William J.

2013-01-01

287

Can PRP effectively treat injured tendons?  

PubMed Central

Summary PRP is widely used to treat tendon and other tissue injuries in orthopaedics and sports medicine; however, the efficacy of PRP treatment on injured tendons is highly controversial. In this commentary, I reason that there are many PRP- and patient-related factors that influence the outcomes of PRP treatment on injured tendons. Therefore, more basic science studies are needed to understand the mechanism of PRP on injured tendons. Finally, I suggest that better understanding of the PRP action mechanism will lead to better use of PRP for the effective treatment of tendon injuries in clinics.

Wang, James H-C.

2014-01-01

288

Tendon Ruptures Associated With Corticosteroid Therapy  

PubMed Central

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

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

1977-01-01

289

Isolated Traumatic Rupture of the Subscapularis Tendon  

Microsoft Academic Search

Background: Although rotator cuff tears are well documented in the literature, there have been rela- tively few reported cases of isolated subscapularis tears. To our knowledge, no case has been reported that describes an isolated subscapularis tear in a woman without anterior shoulder dislocation or bony avulsion. Methods: This report outlines the case of a healthy 46-year-old woman with no

Russell J. Clark; Jeffrey Marchessault; Phillip S. Sizer; James Slauterbeck

290

Snapping knee caused by a popliteomeniscal fascicle tear of the lateral meniscus in a professional Taekwondo athlete.  

PubMed

A 19-year-old male professional Taekwondo athlete presented with a 2-year history of pain-free snapping of his right knee. He reported that his right knee joint gave way during games and training and that he could induce pain-free snapping between the proximal-to-fibular head and the lateral knee joint line. None of these physical findings suggested a meniscal pathology or ligamentous instability. Routine radiographs were normal. Magnetic resonance imaging of his right knee joint showed that the shape of the lateral meniscus was normal, and no lateral meniscus tears existed. On arthroscopic examination, popliteal hiatus view showed a posterosuperior popliteomeniscal fascicle tear between the posterior horn of the lateral meniscus and the posterior joint capsule just posteromedial to the popliteus tendon. With medial traction by probing, this popliteomeniscal tear made visible the significant subluxation of the posterior horn of the lateral meniscus to the center or anterior half of the tibial plateau. Based on the diagnosis of a posterosuperior popliteomeniscal tear of the right knee, Fast-Fix (Smith & Nephew, Andover, Massachusetts) was used for the direct repair of the peripheral portion of the lateral meniscus and joint capsule, targeting the popliteomeniscal junction. At 24 months postoperatively, the patient was performing athletic exercises relevant to his profession and was taking part in Taekwondo games, with no pain or recurrence of snapping. To the authors' knowledge, this is the first report of snapping of the lateral aspect of the knee due to a popliteomeniscal fascicle tear. PMID:22784909

Park, Jong-Hoon; Ro, Kyung-Han; Lee, Dae-Hee

2012-07-01

291

Work-related lesions of the supraspinatus tendon: a case–control study  

Microsoft Academic Search

Objectives  To examine the dose–response relationship between cumulative duration of work with highly elevated arms (work above shoulder\\u000a level) as well as of manual material handling and ruptures of the supraspinatus tendon in a population-based case–control\\u000a study.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  In 14 radiologic practices, we recruited 483 male patients aged 25–65 with radiographically confirmed partial (n = 385) or total (n = 98) supraspinatus tears associated with shoulder

Andreas Seidler; Ulrich Bolm-Audorff; Gabriela Petereit-Haack; Elke Ball; Magdalena Klupp; Noëlle Krauss; Gine Elsner

2011-01-01

292

Bioreactor Design for Tendon/Ligament Engineering  

PubMed Central

Tendon and ligament injury is a worldwide health problem, but the treatment options remain limited. Tendon and ligament engineering might provide an alternative tissue source for the surgical replacement of injured tendon. A bioreactor provides a controllable environment enabling the systematic study of specific biological, biochemical, and biomechanical requirements to design and manufacture engineered tendon/ligament tissue. Furthermore, the tendon/ligament bioreactor system can provide a suitable culture environment, which mimics the dynamics of the in vivo environment for tendon/ligament maturation. For clinical settings, bioreactors also have the advantages of less-contamination risk, high reproducibility of cell propagation by minimizing manual operation, and a consistent end product. In this review, we identify the key components, design preferences, and criteria that are required for the development of an ideal bioreactor for engineering tendons and ligaments.

Wang, Tao; Gardiner, Bruce S.; Lin, Zhen; Rubenson, Jonas; Kirk, Thomas B.; Wang, Allan; Xu, Jiake

2013-01-01

293

Transcription factor EGR1 directs tendon differentiation and promotes tendon repair  

PubMed Central

Tendon formation and repair rely on specific combinations of transcription factors, growth factors, and mechanical parameters that regulate the production and spatial organization of type I collagen. Here, we investigated the function of the zinc finger transcription factor EGR1 in tendon formation, healing, and repair using rodent animal models and mesenchymal stem cells (MSCs). Adult tendons of Egr1–/– mice displayed a deficiency in the expression of tendon genes, including Scx, Col1a1, and Col1a2, and were mechanically weaker compared with their WT littermates. EGR1 was recruited to the Col1a1 and Col2a1 promoters in postnatal mouse tendons in vivo. Egr1 was required for the normal gene response following tendon injury in a mouse model of Achilles tendon healing. Forced Egr1 expression programmed MSCs toward the tendon lineage and promoted the formation of in vitro–engineered tendons from MSCs. The application of EGR1-producing MSCs increased the formation of tendon-like tissues in a rat model of Achilles tendon injury. We provide evidence that the ability of EGR1 to promote tendon differentiation is partially mediated by TGF-?2. This study demonstrates EGR1 involvement in adult tendon formation, healing, and repair and identifies Egr1 as a putative target in tendon repair strategies.

Guerquin, Marie-Justine; Charvet, Benjamin; Nourissat, Geoffroy; Havis, Emmanuelle; Ronsin, Olivier; Bonnin, Marie-Ange; Ruggiu, Mathilde; Olivera-Martinez, Isabel; Robert, Nicolas; Lu, Yinhui; Kadler, Karl E.; Baumberger, Tristan; Doursounian, Levon; Berenbaum, Francis; Duprez, Delphine

2013-01-01

294

Non-operative treatment of meniscal tears.  

PubMed

In a retrospective review of the results of 3,612 arthroscopic procedures that were performed for the treatment of an acute or a chronic meniscal lesion, with or without an associated ligamentous lesion, we identified eighty meniscal tears (in seventy-five patients) that had been assumed to be stable. Seventy were vertical longitudinal tears and ten were vertical radial tears. The seventy longitudinal tears included fifty-two lateral and eighteen medial meniscal lesions. All of the radial tears were in the lateral meniscus. Of the seventy-five patients, fifty-two had been followed for two to ten years. At the time of follow-up, only six of these fifty-two patients had needed additional intervention because of symptoms that were related to the meniscal tear. Four of them had the intervention after a sports-related traumatic extension of a stable tear, and two, because persistent symptoms were caused by the original meniscal lesion. A repeat arthroscopy was performed on thirty-two patients (twenty-six of whom had a longitudinal tear and six of whom had a radial tear), at an average of twenty-six months after the original arthroscopy. Seventeen of the twenty-six longitudinal tears had completely healed. Five of the six radial tears had no evidence of healing and one had extended. Neither ligamentous laxity nor a meniscal tear that was chronic at the time when it was discovered appeared to preclude healing of the stable longitudinal tears. No localized degenerative changes in the adjacent articular cartilage were found in association with any of the stable vertical longitudinal or radial meniscal lesions. Excluding the six patients who had had additional surgical treatment, none of the fifty-two patients who filled out a questionnaire reported that they had symptoms of a meniscal lesion, and none of the forty-two patients who were re-examined two years or more after the operation had signs of a meniscal lesion. Stable vertical longitudinal tears, which tend to occur in the peripheral vascular portions of the menisci, have great potential for healing. The tear should be left alone unless it is the only abnormality that is found and it is causing symptoms that warrant treatment. Stable radial tears, which tend to occur in the avascular inner one-third of the meniscus, have little potential for healing. Whether it is best to leave these lesions alone or to fashion an intact rim by contouring the meniscus was not established by this study. PMID:2745476

Weiss, C B; Lundberg, M; Hamberg, P; DeHaven, K E; Gillquist, J

1989-07-01

295

Tear analysis in ocular surface diseases.  

PubMed

The thin layer of tears covering the ocular surface are a complex body fluid containing thousands of molecules of varied form and function of several origins. In this review, we have discussed some key issues in the analysis of tears in the context of understanding and diagnosing eye disease using current technologies of proteomics and metabolomics, and for their potential for clinical application. In the last several years, advances in proteomics/metabolomics/lipidomics technologies have greatly expanded our knowledge of the chemical composition of tear fluid. The quickened pace of studies has shown that tears as a complex extra-cellular fluid of the ocular surface contains a great deal of molecular information useful for the diagnosis, prognosis, and treatment of ocular surface diseases that has the ability to addresses the emphasis on personalized medicine and biomarkers of disease. Future research directions will likely include (1) standardize tear collection, storage, extraction, and sample preparation; (2) quantitative proteomic analysis of tear proteins using multiple reaction monitoring (MRM)-based mass spectrometry; (3) population based studies of human tear proteomics/metabolomics; (4) tear proteomics/metabolomics for systemic diseases; and (5) functional studies of tear proteins. PMID:22732126

Zhou, Lei; Beuerman, Roger W

2012-11-01

296

An investigation of the tear energy of five soft lining materials.  

PubMed

The purpose of this in vitro study was to compare the tear energy of three silicone rubber materials and two acrylic resin soft lining materials in different solutions and times of storage. The tear energy of specimens stored in artificial saliva, denture cleanser and distilled water was measured over 1, 4, and 16 weeks, using a tensile testing machine. Data were analyzed with a one-way analysis of variance and a Duncan multiple comparison test. Silicone rubber materials had the least tear energy. The type of material, time of storage and solution were statistically significant factors affecting on tear energy. The ability of the material to resist rupture during normal use (including constantly being in saliva and usually immersed in denture cleanser or water for storage) is of practical importance. PMID:15005221

Dinçkal Yaniko?lu, Nuran; Denizo?lu, Saip

2003-12-01

297

Computational modeling of neoclassical and resistive MHD tearing modes in tokamaks  

SciTech Connect

Numerical studies of the nonlinear evolution of MHD-type tearing modes in three-dimensional toroidal geometry with neoclassical effects are presented. The inclusion of neoclassical physics introduces an additional free-energy source for the nonlinear formation of magnetic islands through the effects of a bootstrap current in Ohm`s law. The neoclassical tearing mode is demonstrated to be destabilized in plasmas which are otherwise {Delta}` stable, albeit once an island width threshold is exceeded. The plasma pressure dynamics and neoclassical tearing growth is shown to be sensitive to the choice of the ratio of the parallel to perpendicular diffusivity ({Chi}{parallel}/{Chi}{perpendicular}). The study is completed with a demonstration and theoretical comparison of the threshold for single helicity neoclassical MHD tearing modes, which is described based on parameter scans of the local pressure gradient, the ratio of perpendicular to parallel pressure diffusivities {Chi}{perpendicular}/{Chi}{parallel}, and the magnitude of an initial seed magnetic perturbation.

Gianakon, T.A.; Hegna, C.C.; Callen, J.D.

1996-06-24

298

Relationships between Central Tear Film Thickness and Tear Menisci of the Upper and Lower Eyelids  

Microsoft Academic Search

PURPOSE. To investigate the relationship between central tear film thickness (TFT) and tear menisci of the upper and lower eyelids using real-time optical coherence tomography (OCT). METHODS. Both eyes of healthy subjects were imaged with a real-time OCT to obtain height, curvature, and area of upper and lower tear menisci simultaneously. Central TFT was indi- rectly measured by calculating the

Jianhua Wang; James Aquavella; Jayachandra Palakuru; Suk Chung; Changyong Feng

2006-01-01

299

Repeated Measurements of Dynamic Tear Distribution on the Ocular Surface after Instillation of Artificial Tears  

PubMed Central

Purpose To determine the repeatability of real-time optical coherence tomography (OCT) measurements of tear film thickness (TFT) and variables of tear film menisci. Methods Forty eyes were imaged with a custom-built, real-time OCT to obtain heights, curvatures, and cross-sectional areas of upper and lower tear menisci simultaneously. The central TFT was indirectly determined as the difference between the combined thickness of the central cornea and tear film and the true corneal thickness obtained after instillation of artificial tears. Dynamic tear distribution was determined by OCT imaging immediately and 5, 20, 40, and 60 minutes after tear instillation. Measurements taken after two blinks of one eye at each visit were repeated on the next day. Measurements from the companion eye were made on separate days. Results There were no significant differences between the two measurements of each variable made on consecutive days. At baseline, upper tear meniscus variables were strongly correlated with the comparable lower meniscus variables. However, there were no significant correlations between TFT and any tear meniscus variable. Immediately after instillation of artificial tears, all measured variables increased significantly. TFT, upper and lower menisci heights, and upper meniscus area remained elevated for at least 5 minutes. In addition there were significant correlations between TFT and the lower tear meniscus height and area. Conclusions The custom-built OCT showed good repeatability and holds promise in measuring the dynamic distribution of artificial tears on the ocular surface.

Wang, Jianhua; Aquavella, James; Palakuru, Jayachandra; Chung, Suk

2012-01-01

300

49 CFR 173.340 - Tear gas devices.  

Code of Federal Regulations, 2013 CFR

...2013-10-01 2013-10-01 false Tear gas devices. 173.340 Section 173.340...REQUIREMENTS FOR SHIPMENTS AND PACKAGINGS Gases; Preparation and Packaging § 173.340 Tear gas devices. (a) Packagings for tear...

2013-10-01

301

Anterior cruciate ligament injury: Evaluation of intraarticular reconstruction of acute tears without repairTwo to seven year followup of 155 athletes  

Microsoft Academic Search

To evaluate the effectiveness of our treatment regimen, we retrospectively studied the surgically treated knees of 155 athletes, aged 15 to 42 years, who had sustained acute ACL tears. All were treated with ligament excision and intraarticular bone-patellar tendon-bone recon struction followed by early motion with emphasis on full extension. The follow-up period ranged from 2 to 7 years. Of

K. Donald Shelbourne; H. Jeffrey Whitaker; John R. McCarroll; Arthur C. Rettig; Lynne D. Hirschman

1990-01-01

302

Knotless anatomic double-layer double-row rotator cuff repair: a novel technique re-establishing footprint and shape of full-thickness tears  

Microsoft Academic Search

The standard technique for restoring footprint after full-thickness tears of the rotator cuff includes double-row or transosseous-equivalent\\u000a techniques. However, the anatomically typical bird’s beak shape and profile of tendon insertion may not be originally restored\\u000a and biomechanics may be altered. In this report, the authors describe a technique that involves creating two intratendinous\\u000a stitches at different levels of the torn

Pierre Hepp; Thomas Engel; Georg Osterhoff; Bastian Marquass; Christoph Josten

2009-01-01

303

Evaluation of global load sharing and shear-lag models to describe mechanical behavior in partially lacerated tendons.  

PubMed

The mechanical effect of a partial thickness tear or laceration of a tendon is analytically modeled under various assumptions and results are compared with previous experimental data from porcine flexor tendons. Among several fibril-level models considered, a shear-lag model that incorporates fibril-matrix interaction and a fibril-fibril interaction defined by the contact area of the interposed matrix best matched published data for tendons with shallow cuts (less than 50% of the cross-sectional area). Application of this model to the case of many disrupted fibrils is based on linear superposition and is most successful when more fibrils are incorporated into the model. An equally distributed load sharing model for the fraction of remaining intact fibrils was inadequate in that it overestimates the strength for a cut less than half of the tendon's cross-sectional area. In a broader sense, results imply that shear-lag contributes significantly to the general mechanical behavior of tendons when axial loads are nonuniformly distributed over a cross section, although the predominant hierarchical level and microstructural mediators for this behavior require further inquiry. PMID:24845861

Pensalfini, Marco; Duenwald-Kuehl, Sarah; Kondratko-Mittnacht, Jaclyn; Lakes, Roderic; Vanderby, Ray

2014-09-01

304

Ultrasound Transient Shear Wave Elasticity Imaging for Tendon Tissue  

Microsoft Academic Search

Degeneration of tendon tissue is a common cause of tendon dysfunction with the symptoms of repeated episodes of pain and palpable increase of tendon thickness. Tendon mechanical properties are directly related to its physiological composition and the structural organization of the interior collagen fibers which could be altered by tendon degeneration due to overuse or injury. Thus, measuring mechanical properties

Pengfei Song

2010-01-01

305

Synergy of tendon stem cells and platelet-rich plasma in tendon healing.  

PubMed

Injured rat Achilles tendons were treated with botulism toxin to create a mechanically unloaded condition (unloaded) or left untreated (loaded), and then treated with phosphate-buffered saline (PBS), platelet-rich plasma (PRP), tendon stem cells (TSCs), or a combination (TSCs?+?PRP). mRNA and protein expression of collagen I, collagen III, tenascin C, and Smad 8 were determined by real time PCR and immunostaining, respectively. Loaded tendons treated with PBS, PRP, or TSCs for 3 or 14 days had higher collagen I mRNA expression than unloaded tendons. Loaded tendons treated with PBS for 3 or 14 days or with PRP for 3 days had higher collagen I protein levels than unloaded tendons. Loaded tendons treated for 3 days with PBS, for 14 days with PRP or TSCs or TSCs?+?PRP for 3 or 14 days had higher collagen III protein levels than unloaded tendons. Collagen I mRNA levels were higher in TSCs?+?PRP-treated loaded tendons compared to PBS-treated loaded tendons on day 3 of treatment. Based on changes in the expression of tendon-healing genes, our data suggest that the combination of TSCs and PRP has synergistic effects on tendon healing under both loaded and unloaded conditions, and loaded conditions improve tendon healing. PMID:22161871

Chen, Lei; Dong, Shi-Wu; Liu, Jun-Peng; Tao, Xu; Tang, Kang-Lai; Xu, Jian-Zhong

2012-06-01

306

Informing tendon tissue engineering with embryonic development.  

PubMed

Tendon is a strong connective tissue that transduces muscle-generated forces into skeletal motion. In fulfilling this role, tendons are subjected to repeated mechanical loading and high stress, which may result in injury. Tissue engineering with stem cells offers the potential to replace injured/damaged tissue with healthy, new living tissue. Critical to tendon tissue engineering is the induction and guidance of stem cells towards the tendon phenotype. Typical strategies have relied on adult tissue homeostatic and healing factors to influence stem cell differentiation, but have yet to achieve tissue regeneration. A novel paradigm is to use embryonic developmental factors as cues to promote tendon regeneration. Embryonic tendon progenitor cell differentiation in vivo is regulated by a combination of mechanical and chemical factors. We propose that these cues will guide stem cells to recapitulate critical aspects of tenogenesis and effectively direct the cells to differentiate and regenerate new tendon. Here, we review recent efforts to identify mechanical and chemical factors of embryonic tendon development to guide stem/progenitor cell differentiation toward new tendon formation, and discuss the role this work may have in the future of tendon tissue engineering. PMID:24484642

Glass, Zachary A; Schiele, Nathan R; Kuo, Catherine K

2014-06-27

307

Human tendon behaviour and adaptation, in vivo  

PubMed Central

Tendon properties contribute to the complex interaction of the central nervous system, muscle–tendon unit and bony structures to produce joint movement. Until recently limited information on human tendon behaviour in vivo was available; however, novel methodological advancements have enabled new insights to be gained in this area. The present review summarizes the progress made with respect to human tendon and aponeurosis function in vivo, and how tendons adapt to ageing, loading and unloading conditions. During low tensile loading or with passive lengthening not only the muscle is elongated, but also the tendon undergoes significant length changes, which may have implications for reflex responses. During active loading, the length change of the tendon far exceeds that of the aponeurosis, indicating that the aponeurosis may more effectively transfer force onto the tendon, which lengthens and stores elastic energy subsequently released during unloading, in a spring-like manner. In fact, data recently obtained in vivo confirm that, during walking, the human Achilles tendon provides elastic strain energy that can decrease the energy cost of locomotion. Also, new experimental evidence shows that, contrary to earlier beliefs, the metabolic activity in human tendon is remarkably high and this affords the tendon the ability to adapt to changing demands. With ageing and disuse there is a reduction in tendon stiffness, which can be mitigated with resistance exercises. Such adaptations seem advantageous for maintaining movement rapidity, reducing tendon stress and risk of injury, and possibly, for enabling muscles to operate closer to the optimum region of the length–tension relationship.

Magnusson, S Peter; Narici, Marco V; Maganaris, Constantinos N; Kjaer, Michael

2008-01-01

308

Threshold Tear Strength of some Molecular Networks.  

National Technical Information Service (NTIS)

The tear strength of polydimethylsiloxane (PDMS) networks was found to be only about one-third as large as that of polybutadiene (PB) or polyisoprene (PI) networks of similar M sub c when the tear strength was measured under threshold conditions, i.e., at...

A. N. Gent R. H. Tobias

1981-01-01

309

Interferometric characterization of tear film dynamics  

NASA Astrophysics Data System (ADS)

The anterior refracting surface of the eye is the thin tear film that forms on the surface of the cornea. When a contact lens is on worn, the tear film covers the contact lens as it would a bare cornea, and is affected by the contact lens material properties. Tear film irregularity can cause both discomfort and vision quality degradation. Under normal conditions, the tear film is less than 10 microns thick and the thickness and topography change in the time between blinks. In order to both better understand the tear film, and to characterize how contact lenses affect tear film behavior, two interferometers were designed and built to separately measure tear film behavior in vitro and in vivo. An in vitro method of characterizing dynamic fluid layers applied to contact lenses mounted on mechanical substrates has been developed using a phase-shifting Twyman-Green interferometer. This interferometer continuously measures light reflected from the surface of the fluid layer, allowing precision analysis of the dynamic fluid layer. Movies showing this fluid layer behavior can be generated. The fluid behavior on the contact lens surface is measured, allowing quantitative analysis beyond what typical contact angle or visual inspection methods provide. The in vivo interferometer is a similar system, with additional modules included to provide capability for human testing. This tear film measurement allows analysis beyond capabilities of typical fluorescein visual inspection or videokeratometry and provides better sensitivity and resolution than shearing interferometry methods.

Primeau, Brian Christopher

310

Role of biomechanics in the understanding of normal, injured, and healing ligaments and tendons  

PubMed Central

Ligaments and tendons are soft connective tissues which serve essential roles for biomechanical function of the musculoskeletal system by stabilizing and guiding the motion of diarthrodial joints. Nevertheless, these tissues are frequently injured due to repetition and overuse as well as quick cutting motions that involve acceleration and deceleration. These injuries often upset this balance between mobility and stability of the joint which causes damage to other soft tissues manifested as pain and other morbidity, such as osteoarthritis. The healing of ligament and tendon injuries varies from tissue to tissue. Tendinopathies are ubiquitous and can take up to 12 months for the pain to subside before one could return to normal activity. A ruptured medial collateral ligament (MCL) can generally heal spontaneously; however, its remodeling process takes years and its biomechanical properties remain inferior when compared to the normal MCL. It is also known that a midsubstance anterior cruciate ligament (ACL) tear has limited healing capability, and reconstruction by soft tissue grafts has been regularly performed to regain knee function. However, long term follow-up studies have revealed that 20–25% of patients experience unsatisfactory results. Thus, a better understanding of the function of ligaments and tendons, together with knowledge on their healing potential, may help investigators to develop novel strategies to accelerate and improve the healing process of ligaments and tendons. With thousands of new papers published in the last ten years that involve biomechanics of ligaments and tendons, there is an increasing appreciation of this subject area. Such attention has positively impacted clinical practice. On the other hand, biomechanical data are complex in nature, and there is a danger of misinterpreting them. Thus, in these review, we will provide the readers with a brief overview of ligaments and tendons and refer them to appropriate methodologies used to obtain their biomechanical properties. Specifically, we hope the reader will pay attention to how the properties of these tissues can be altered due to various experimental and biologic factors. Following this background material, we will present how biomechanics can be applied to gain an understanding of the mechanisms as well as clinical management of various ligament and tendon ailments. To conclude, new technology, including imaging and robotics as well as functional tissue engineering, that could form novel treatment strategies to enhance healing of ligament and tendon are presented.

Jung, Ho-Joong; Fisher, Matthew B; Woo, Savio L-Y

2009-01-01

311

IETI - Isogeometric Tearing and Interconnecting  

PubMed Central

Finite Element Tearing and Interconnecting (FETI) methods are a powerful approach to designing solvers for large-scale problems in computational mechanics. The numerical simulation problem is subdivided into a number of independent sub-problems, which are then coupled in appropriate ways. NURBS- (Non-Uniform Rational B-spline) based isogeometric analysis (IGA) applied to complex geometries requires to represent the computational domain as a collection of several NURBS geometries. Since there is a natural decomposition of the computational domain into several subdomains, NURBS-based IGA is particularly well suited for using FETI methods. This paper proposes the new IsogEometric Tearing and Interconnecting (IETI) method, which combines the advanced solver design of FETI with the exact geometry representation of IGA. We describe the IETI framework for two classes of simple model problems (Poisson and linearized elasticity) and discuss the coupling of the subdomains along interfaces (both for matching interfaces and for interfaces with T-joints, i.e. hanging nodes). Special attention is paid to the construction of a suitable preconditioner for the iterative linear solver used for the interface problem. We report several computational experiments to demonstrate the performance of the proposed IETI method.

Kleiss, Stefan K.; Pechstein, Clemens; Juttler, Bert; Tomar, Satyendra

2012-01-01

312

Muscle Force and Power Following Tendon Repair at Altered Tendon Length  

PubMed Central

Background While a great deal is known regarding the performance of muscle with intact tendon, little is known about muscle performance when tendon is surgically lengthened or shortened. This knowledge may allow surgeons to more accurately predict functional outcome following tendon repair when correcting a simple tendon laceration or performing a more complex vascularized neuromuscular transfer. Materials and Methods We studied muscle performance 12 weeks following extensor tendon repairs producing altered tendon lengths. Forty male Fischer 344 rats underwent division of the proximal and distal tendons of the extensor digitorum longus muscle. Tendons were immediately repaired producing tendons with increased length, decreased length, or pre-surgical length (control). Observation confirmed that altered tendon length produced inverse changes in initial resting muscle tension. Results Muscle in the Decreased Tendon Length group demonstrated a 15.2% greater muscle mass, 4.9% greater muscle length, 9.6% greater physiologic cross-sectional area, 12.6% greater maximum isometric force, and 31.9% greater maximum power relative to the Control Tendon Length group (p < 0.05). The Increased Tendon Length group did not differ significantly from the Control Tendon Length group for any measurement. Histologically, muscles set with a decreased tendon length demonstrated normal appearing hypertrophied fibers, without evidence of detrimental histological effects such as fibrosis, denervation, necrosis, inflammation, fiber type changes, or fiber splitting. Conclusion These data support the clinical practice of setting muscles with increased passive tension when performing tendon transfer surgeries. Conversely, setting muscles with decreased tension does not necessarily result in a force or power deficit.

Krochmal, Daniel J.; Kuzon, William M.; Urbanchek, Melanie G.

2008-01-01

313

Achilles tendon rupture in badminton.  

PubMed Central

The typical badminton player with an Achilles tendon rupture is 36 years old and, despite limbering up, is injured at the rear line in a sudden forward movement. He resumes work within three months and has a slight lack of dorsiflexion in the ankle as the main complication. Most patients resume badminton within one year, but some finish their sports career, mainly due to fear of a new injury. The investigation discusses predisposing factors and prophylactic measures.

Kaalund, S; Lass, P; H?gsaa, B; N?hr, M

1989-01-01

314

Biomechanical effect of medial advancement of the supraspinatus tendon. A study in cadavera.  

PubMed

During the repair of some rotator-cuff tears, the torn tendon cannot be freed up adequately to permit reattachment at its original anatomical site of insertion. An option is to advance the site of insertion medially and reattach the tendon to a trough in the sulcus or to the humeral head. The biomechanical effects of such medial advancement on the moment arm of the supraspinatus muscle during glenohumeral elevation were studied in ten fresh-frozen shoulders from cadavera. Medial advancement of the site of insertion of the supraspinatus tendon was simulated by the placement of suture anchors in the sulcus of the proximal part of the humerus at points three, ten, and seventeen millimeters medial to the junction of the supraspinatus tendon and the bone. These distances were chosen not because they represent clinical options but because the large range allowed biomechanical study of medial advancement. Nylon lines were attached to the suture anchors and were passed back through an eyehook at the midpoint of the supraspinatus muscle. The excursion of each line was measured as the humerus was elevated, and the moment arm was estimated from the joint angle and excursion data with use of the principle of virtual work. Three and ten millimeters of medial advancement of the tendon (attachment in the sulcus) had a minimum (non-significant) effect on the moment arm during elevation compared with the value determined for the intact condition. However, seventeen millimeters of medial advancement was found to reduce the moment arm significantly (p < 0.05). PMID:9655103

Liu, J; Hughes, R E; O'Driscoll, S W; An, K N

1998-06-01

315

Transosseous fixation in insertional Achilles tendonitis.  

PubMed

The surgical approach of severe insertional Achilles tendonitis involves debridement, repair, and reattachment. Previously described techniques for bone-tendon reattachment involved the use of suture anchors in the sparsely trabeculated calcaneus. The following technique tip is a reintroduction of bicortical transosseous fixation previously used in rotator cuff repairs. Bone tunnels are a viable option in the treatment of insertional Achilles tendonitis; however, additional research is necessary to validate its efficacy in this application. PMID:22841157

Sundararajan, Priya Ponnapula

2012-01-01

316

Automatic CAD of meniscal tears on MR imaging: a morphology-based approach  

NASA Astrophysics Data System (ADS)

Knee-related injuries, including meniscal tears, are common in young athletes and require accurate diagnosis and appropriate surgical intervention. Although with proper technique and skill, confidence in the detection of meniscal tears should be high, this task continues to be a challenge for many inexperienced radiologists. The purpose of our study was to automate detection of meniscal tears of the knee using a computer-aided detection (CAD) algorithm. Automated segmentation of the sagittal T1-weighted MR imaging sequences of the knee in 28 patients with diagnoses of meniscal tears was performed using morphologic image processing in a 3-step process including cropping, thresholding, and application of morphological constraints. After meniscal segmentation, abnormal linear meniscal signal was extracted through a second thresholding process. The results of this process were validated by comparison with the interpretations of 2 board-certified musculoskeletal radiologists. The automated meniscal extraction algorithm process was able to successfully perform region of interest selection, thresholding, and object shape constraint tasks to produce a convex image isolating the menisci in more than 69% of the 28 cases. A high correlation was also noted between the CAD algorithm and human observer results in identification of complex meniscal tears. Our initial investigation indicates considerable promise for automatic detection of simple and complex meniscal tears of the knee using the CAD algorithm. This observation poses interesting possibilities for increasing radiologist productivity and confidence, improving patient outcomes, and applying more sophisticated CAD algorithms to orthopedic imaging tasks.

Ramakrishna, Bharath; Liu, Weimin; Safdar, Nabile; Siddiqui, Khan; Kim, Woojin; Juluru, Krishna; Chang, Chein-I.; Siegel, Eliot

2007-03-01

317

A novel technique to measure active tendon forces: application to the subscapularis tendon  

Microsoft Academic Search

This paper describes the design and use of a novel system for quantification of active tendon forces. An arthroscopically implantable force probe (AIFP) was inserted arthroscopically into the subscapularis tendon of the shoulder in vivo. The output response of this device was calibrated in situ with known forces applied to the tendon using an arthroscopic technique. On recovery of motor

Anthony M. J. Bull; Peter Reilly; Andrew L. Wallace; Andrew A. Amis; Roger J. H. Emery

2005-01-01

318

Pectoralis Major Tendon Repair Post Surgical Rehabilitation  

PubMed Central

Pectoralis major tendon rupture is a rare shoulder injury, most commonly seen in weight lifters. This injury is being seen more regularly due to the increased emphasis on healthy lifestyles. Surgical repair of the pectoralis major tendon rupture has been shown to provide superior outcomes regarding strength return. Thus it appears that surgical repair is the treatment of choice for those wishing to return to competitive or recreational athletic activity. This article describes the history and physical examination process for the athlete with pectoralis tendon major rupture. Surgical vs conservative treatment will be discussed. This manuscript provides post surgical treatment guidelines that can be followed after surgical repair of the pectoralis tendon rupture.

Prohaska, Dan

2007-01-01

319

Fracture of an ossified tibialis anterior tendon.  

PubMed

Fractures of ossified tibialis anterior tendon have been successfully managed by the excision of the ossified tendon and transfer of the extensor hallucis longus tendon. A 64-year-old man sustained an injury during mountain hiking 2 weeks prior to presentation, falling down on his heels with his ankle fully plantarflexed. Two tender and bony hard masses were palpable along the course of the tibialis anterior tendon, one at the anteromedial aspect of the ankle and another at the dorsum of the talonavicular joint. Radiographs of the ankle demonstrated an approximately 2x1-cm ovoid-shaped bony mass at the anterior aspect of the ankle joint and another bony mass of similar size and shape at the dorsal aspect of the talonavicular joint. He underwent operative exploration, and complete rupture of the tendon through a bony mass was observed. The gap between the torn ends of the tendon after excision of the mass was too long to be repaired directly. Extensor hallucis longus tendon was retrieved 1 cm proximal to the metatarsophalangeal joint and was passed through the insertion of the anterior tibial tendon and pulled proximally and sutured to itself with the ankle in neutral. At 1 year after surgery, plain radiographs and ultrasonography showed no recurrence of calcification or ossification in the tendon and good mobility of the tibialis anterior muscle was observed. PMID:19301787

Lee, Woo-Chun; Moon, Jeong-Seok; Kim, Ji-Yeong; Ko, Hyeong-Tak

2009-02-01

320

Knee Flexion Strength Before and After ACL Reconstruction Using Hamstring Tendon Autografts  

PubMed Central

Background Anterior cruciate ligament (ACL) injury is the most common sports injury in both athletes and nonathletes; it can cause disability if not treated correctly. In cases with minor injuries, conservative treatments suffice. But, in cases with ACL tear, surgery by different methods and autografts are indicated. The most prevalent method for ACL reconstruction is the use of hamstring tendon autograft; this requires tendon removal and results in subsequent weakness in patient’s knee flexion strength which can cause dissatisfaction. Objectives In this study we evaluate a common procedure used for treating ACL injuries. Patients and Methods This study was performed at a hospital in Tehran on 30 patients with ACL tears. Patients’ knee flexion strengths before and 2, 4, 6, and 12 months after reconstruction were measured separately at 20, 45, 90, and 110? knee flexion angles, and their means were analyzed using paired t-test. Results In this study, knee flexion strength decreased after ACL reconstruction. The greatest decrease in knee flexion strength was observed at 90 and 110? knee flexion angles. Conclusions Some previous studies have confirmed reduced knee flexion strength following ACL reconstruction at high knee flexion angles. However, some others have denied it. The present study confirmed the reduction in knee flexion strength one year after ACL reconstruction at 90 and 110? flexion angles (P = 0.000). Furthermore, the need for physiotherapy, as a process for rehabilitating these patients was also confirmed.

Emami Meybodi, Mohammad Kazem; Jannesari, Morteza; Rahim Nia, Alireza; Yaribeygi, Habib; Sobhani Firoozabad, Vahid; Dorostegan, Ahmad

2013-01-01

321

Partial-thickness articular surface rotator cuff tears in patients over the age of 35: Etiology and intra-articular associations  

PubMed Central

Purpose: Partial-thickness articular-sided rotator cuff tears have a multifactorial etiology and are associated with degeneration of the tendon. They are often described as an injury of the young athlete, although they are also found in the older population. The aim of this study was to investigate the frequency and associations of partial-thickness articular-sided tears in patients over the age of 35 years. Design: Retrospective Materials and Methods: A retrospective study of all arthroscopic procedures for rotator cuff pathology in patients over the age of 35 years over a 2-year period by a single surgeon was performed. The included patients were divided into two groups based on the arthroscopic findings: those with a partial-thickness articular-sided rotator cuff tear and those with pure tendinopathy. The groups were then compared to identify the associated pathology with the rotator cuff lesions. 2×2 contingency table analysis and unpaired Student's t-test were used for statistical analysis. Results: One hundred patients were included in the study of whom 62 had a partial articular-sided tear. Those with a partial articular-sided tear were older (P=0.0001), were more commonly associated with a documented injury (P=0.03), and more commonly had biceps degeneration (P=0.001) and synovitis (P=0.02) within the joint. Conclusion: Partial-thickness articular-sided tears are a common occurrence in patients requiring arthroscopic surgery for rotator cuff pathology over the age of 35 years. This probably reflects an injury in an already degenerate cuff. This would support the theory of intrinsic degeneration of the tendon in this age group and probably represent a different etiology to those seen in the young athletes. Level of Evidence: Level 3

Modi, Chetan S; Smith, Christopher D; Drew, Stephen J

2012-01-01

322

Matrix metalloproteinase levels as a marker for rotator cuff tears.  

PubMed

Although many studies report the role of matrix metalloproteinases (MMPs) in rotator cuff tears, a paucity of data exists correlating the clinical severity of the disease with the implicated MMP levels. The purpose of this study was to investigate and compare the levels of expression of MMP-1, -3, -9 and -13 in patients with rotator cuff tears. We hypothesized that patients with clinically worse symptoms as measured by a standardized pain and function scale would have a higher expression of MMPs.Rotator cuff specimens were obtained from 16 consecutive patients undergoing rotator cuff repair. Total protein was extracted from these specimens and quantified. Equalized total protein extracts were used for performing enzyme-linked immunosorbent assay for quantitative determination of MMP-1, -3, -9 and -13. Preoperatively, the University of California, Los Angeles (UCLA) Shoulder Rating Scale was administered to each patient. Statistical comparisons were performed using analysis of variance. The expression of MMP-13 was notably increased in the rotator cuff extracts of all patients (P=.02). In addition, MMP-13 levels showed a significant proportional correlation with the patient pain score as per their UCLA ratings (r=-0.5). Although higher MMP-9 levels were assayed, this was not statistically significant. Expression of MMP-1 and-3 was insignificant.Our data suggest a critical role for MMP-13 in rotator cuff tears; elevated levels are a possible indicator for an impending tear. Further studies with increased sample size are warranted to prove the possible use of MMP-13 as therapeutic targets that may be inhibited by anti-inflammatory agents to limit disease progression. PMID:22495845

Jacob, Jinny; Eisemon, Eric; Sheibani-Rad, Shahin; Patel, Archit; Jacob, Theresa; Choueka, Jack

2012-04-01

323

Control of neoclassical tearing modes  

NASA Astrophysics Data System (ADS)

Neoclassically driven tearing modes (NTMs) are a major problem for tokamaks operating in a conventional ELMy H-mode scenario. Depending on the mode numbers these pressure-driven perturbations cause a mild reduction in the maximum achievable ?N = ?t/(Ip/aBt) before the onset of the NTM, or can even lead to disruptions at a low edge safety factor, q95. A control of these types of modes in high ?N plasmas is therefore of vital interest for magnetically confined fusion plasmas. The control consists of two major approaches, namely the control of the excitation of these modes and the removal, or at least mitigation, of these modes, once an excitation could not be avoided. For both routes examples will be given and the applicability of these approaches to ITER will be discussed.

Maraschek, M.

2012-07-01

324

Effect of Pterygium Surgery on Tear Osmolarity  

PubMed Central

Purpose. To investigate changes of dry eye test results in patients who underwent pterygium surgery. Methods. Seventy-four patients who underwent primary pterygium surgery were enrolled in this study. At the baseline, 3-, 12-, and 18-month visits, measurements of tear osmolarity, BUT, and Schirmer test were performed. The patients were divided into 2 groups: Group 1, which consisted of patients in whom pterygium did not recur, and Group 2, which consisted of patients in whom pterygium recurred after surgery. Results. The patients in Group 1 had lower tear osmolarity levels after surgery than those at baseline (all P < 0.001). In Group 2 the tear osmolarity levels did not differ from baseline after 18 months (P = 0.057). The prevalence rates of dry eye syndrome (DES) were lower than that at baseline and 18 months after surgery in Group 1 (P = 0.002). In Group 2, the incidence of DES was lower after 3 months than at baseline (P = 0.03) but was similar to the baseline rate after 12 and 18 months (both P > 0.05). Conclusions. Anormal tear film function associated with pterygium. Pterygium excision improved tear osmolarity and tear film function. However, tear osmolarity deteriorated again with the recurrence of pterygium.

Turky?lmaz, Kemal; Oner, Veysi; Sevim, Mehmet Sahin; Kurt, Ali; Sekeryapan, Berrak; Durmus, Mustafa

2013-01-01

325

Chemomechanics control of tearing paths in graphene  

NASA Astrophysics Data System (ADS)

Owing to its molecular membrane structure, tearing is the predominant fracture mode for a monolayer graphene. Yet, the tearing mechanics of monolayer graphene as a two-dimensional (2D) crystal remains poorly understood. Here, we performed molecular dynamics simulations with reactive force field to determine the fracture path of monolayer graphene under tearing. Our simulations revealed that the chemomechanical tearing conditions play a regulatory role on the edge structures of graphene nanoribbons (GNRs) produced by tearing. In vacuum, the resulting GNR features the armchair edge, whereas in the presence of chemical additives (such as oxygens) to the fracture surface, the resulting GNR edge changes from armchair to zigzag. In addition, due to the large in-plane stretching to out-of-plane bending stiffness ratio of monolayer graphene, tearing causes local bending at the crack tip, giving rise to a fracture mode mixity that also modulates the fracture path. In addition to provide an atomistic understanding of tearing mechanics of 2D crystal membranes, our findings shed light on chemomechanical engineering of GNRs with controlled edge structures.

Huang, Xu; Yang, Hui; van Duin, Adri C. T.; Hsia, K. Jimmy; Zhang, Sulin

2012-05-01

326

Tendon-derived stem cells (TDSCs) promote tendon repair in a rat patellar tendon window defect model.  

PubMed

Injured tendons heal slowly and often result in the formation of mechanically and functionally inferior fibrotic scar tissue or fibrous adhesions. This study investigated the use of tendon-derived stem cells (TDSCs) for tendon repair in a rat patellar tendon window defect model. Fibrin glue constructs with or without GFP-TDSCs were transplanted into the window defect. The patellar tendons were harvested for histology, ex vivo fluorescent imaging and biomechanical test at various time points up to week 4. Our results showed that TDSCs significantly enhanced tendon healing as indicated by the increase in collagen production as shown by hematolxylin stain-ability of the tissue, improvement of cell alignment, collagen fiber alignment and collagen birefringence typical of tendon. The labeled cells were observed at weeks 1 and 2 and became almost undetectable at week 4. Both the ultimate stress and Young's modulus were significantly higher in the TDSCs group compared to those in the fibrin glue group at week 4. In conclusion, TDSCs promoted earlier and better repair in a rat patellar tendon window defect model. PMID:21928428

Ni, Ming; Lui, Pauline Po Yee; Rui, Yun Feng; Lee, Yuk Wa; Lee, Yuk Wai; Tan, Qi; Wong, Yin Mei; Kong, Siu Kai; Lau, Pui Man; Li, Gang; Chan, Kai Ming

2012-04-01

327

Human tear viscosity: An interactive role for proteins and lipids  

Microsoft Academic Search

Human tear viscosity is poorly understood. Tears need to remain on the ocular surface for lubrication without causing damage to the surface epithelia due to drag when blinking. Whole tears are shear-thinning (non-Newtonian), which cannot be explained by the amount of mucin present, nor by individual proteins. Whole tears minus lipids become Newtonian. Though no free lipids had previously been

Scott M. Gouveia; John M. Tiffany

2005-01-01

328

Polyimide Film of Increased Tear Strength  

NASA Technical Reports Server (NTRS)

High-temperature linear aromatic polyimide with improved resistance to tearing made by new process that incorporates elastomer into polyimide. Linear aromatic condensation polyimides are materials of prime choice for use as films and coatings on advanced spacecraft and aircraft where durability at temperatures in range of 200 to 300 degree C required. Elastomer-containing polyimide film with improved toughness proves useful for applications where resistance to tearing and long-term thermal stability necessary. Desired resistance to tearing achieved by careful control of amount and chemical composition of added elastomer.

St. Clair, A. K.; Hinkley, J. A.; Ezzell, S. A.

1986-01-01

329

The Factors Affecting the Clinical Outcome and Integrity of Arthroscopically Repaired Rotator Cuff Tears of the Shoulder  

PubMed Central

Background The purpose of this study was to evaluate the functional and anatomic results of arthroscopic rotator cuff repair, and to analyze the factors affecting the integrity of arthroscopically repaired rotator cuff tears of the shoulder. Methods One hundred sixty-nine consecutive shoulders that underwent arthroscopic rotator cuff repair, had a postoperative MRI evaluation and were followed for at least two years were enrolled in this study. The mean age was 57.6 years (range, 38 to 74 years) and the mean follow-up period was 39 months (range, 24 to 83 months). Results The rotator cuff was completely healed in 131 (77.5%) out of 169 shoulders and recurrent tears occurred in 38 shoulders (22.5%). At the last follow-up visit, the mean score for pain during motion was 1.53 (range, 0 to 4) in the completely healed group and 1.59 (range, 0 to 4) in the group with recurrent tears (p = 0.092). The average elevation strength was 7.87 kg (range, 4.96 to 11.62 kg) and 5.25 kg (range, 4.15 to 8.13 kg) and the mean University of California at Los Angeles score was 30.96 (range, 26 to 35) and 30.64 (range, 23 to 34), respectively (p < 0.001, p = 0.798). The complete healing rate was 87.8% in the group less than 50 years of age (49 shoulders), 79.4% in the group over 51 years but less than 60 years of age (68 shoulders), and 65.4% in the group over 61 years of age (52 shoulders, p = 0.049); it was 96.7% in the group with small-sized tears (30 shoulders), 87.3% in the group with medium-sized tears (71 shoulders), and 58.8% in the group with large-sized or massive tears (68 shoulders, p = 0.009). All of the rotator cuffs with a global fatty degeneration index of greater than two preoperatively had recurrent tears. Conclusions Arthroscopic repair of full-thickness rotator cuff tears led to a relatively high rate of recurrent defects. However, the minimum two-year follow up demonstrated excellent pain relief and improvement in the ability to perform the activities of daily living, despite the structural failures. The factors affecting tendon healing were the patient's age, the size and extent of the tear, and the presence of fatty degeneration in the rotator cuff muscle.

Cho, Nam Su

2009-01-01

330

Repeated Measurements of Dynamic Tear Distribution on the Ocular Surface after Instillation of Artificial Tears  

Microsoft Academic Search

PURPOSE. To determine the repeatability of real-time optical coherence tomography (OCT) measurements of tear film thick- ness (TFT) and variables of tear film menisci. METHODS. Forty eyes were imaged with a custom-built, real- time OCT to obtain heights, curvatures, and cross-sectional areas of upper and lower tear menisci simultaneously. The central TFT was indirectly determined as the difference be- tween

Jianhua Wang; James Aquavella; Jayachandra Palakuru; Suk Chung

2006-01-01

331

Tendons attached to prostheses by tendon-bone block fixation: an experimental study in dogs.  

PubMed

To develop a method of tendon attachment to a metallic endoprosthesis, we evaluated fixation strength, clinical function of the tendon, and morphological changes in an experimental model. The canine supraspinatus tendon was removed from the greater tubercle of the humerus and attached to a titanium prosthesis. In 12 animals, the bone block underlying the tendon insertion was preserved and attached in one limb; the soft part of the tendon was attached directly to the prosthesis in the contralateral limb. Fixation strength was evaluated after 16 weeks of in vivo implantation (12 specimens) and compared with the in vitro fixation strength (12 specimens) and with intact normal controls (six specimens from cadavera). Function of the tendon in vivo was evaluated by force-plate analysis (at 3-week intervals). All specimens were evaluated histologically. Sixteen weeks after surgery, the tendon-bone block attachment was significantly stronger (mean, 16%) than the direct tendon attachment and not significantly different from the normal control, and the direct tendon attachment was significantly weaker (mean, 68%) than the normal control. There was significantly more weight-bearing on the limbs with a tendon-bone block attachment than on the limbs with a direct tendon attachment at both 3 and 6 weeks postoperatively. Both front legs showed increased weight-bearing with time, but the differences were not statistically significant. Anchorage by tissue ingrowth to the titanium prosthesis was found consistently--there was bone ingrowth in the tendon-bone block attachments and fibrous tissue ingrowth in the direct tendon attachments. When a bone block was preserved, the strength and stiffness were comparable with those of a normal tendon insertion.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7983557

Gottsauner-Wolf, F; Egger, E L; Schultz, F M; Sim, F H; Chao, E Y

1994-11-01

332

Ultrasonic evaluation of flood gate tendons  

Microsoft Academic Search

Our water resources infrastructure is susceptible to aging degradation just like the rest of this country`s infrastructure. A critical component of the water supply system is the flood gate that controls the outflow from dams.Long steel rods called tendons attach these radial gates to the concrete in the dam. The tendons are typically forty feet long and over one inch

G. Thomas; A. Brown

1997-01-01

333

Ultrasonic evaluation of flood gate tendons  

Microsoft Academic Search

Our water resources infrastructure is susceptible to aging degradation just like the rest of this country's infrastructure. A critical component of the water supply system is the flood gate that controls the outflow from dams. Long steel rods called tendons attach these radial gates to the concrete in the dam. The tendons are typically forty feet long and over one

Graham H. Thomas; Albert E. Brown

1998-01-01

334

Abduction moment arm of transposed subscapularis tendon  

Microsoft Academic Search

Objective. The purpose of this study was to analyze the effects of the procedure of superior transposition of the subscapularis on the biomechanics of glenohumeral abduction.Design. The abduction moment arms of the subscapularis muscle for the normal attachment and transposed tendon were measured on 10 cadaver shoulders and compared to that for the normal supraspinatus tendon for which it is

Tomotaka Nakajima; Jain Liu; Richard E. Hughes; Shawn O'Driscoll; Kai-Nan An

1999-01-01

335

Ex vivo Mechanical Loading of Tendon  

PubMed Central

Injuries to the tendon (e.g., wrist tendonitis, epicondyltis) due to overuse are common in sports activities and the workplace. Most are associated with repetitive, high force hand activities. The mechanisms of cellular and structural damage due to cyclical loading are not well known. The purpose of this video is to present a new system that can simultaneously load four tendons in tissue culture. The video describes the methods of sterile tissue harvest and how the tendons are loaded onto a clamping system that is subsequently immersed into media and maintained at 37°C. One clamp is fixed while the other one is moved with a linear actuator. Tendon tensile force is monitored with a load cell in series with the mobile clamp. The actuators are controlled with a LabView program. The four tendons can be repetitively loaded with different patterns of loading, repetition rate, rate of loading, and duration. Loading can continue for a few minutes to 48 hours. At the end of loading, the tendons are removed and the mid-substance extracted for biochemical analyses. This system allows for the investigation of the effects of loading patterns on gene expression and structural changes in tendon. Ultimately, mechanisms of injury due to overuse can be studies with the findings applied to treatment and prevention.

Asundi, Krishna; Rempel, David

2007-01-01

336

Ex vivo mechanical loading of tendon.  

PubMed

Injuries to the tendon (e.g., wrist tendonitis, epicondyltis) due to overuse are common in sports activities and the workplace. Most are associated with repetitive, high force hand activities. The mechanisms of cellular and structural damage due to cyclical loading are not well known. The purpose of this video is to present a new system that can simultaneously load four tendons in tissue culture. The video describes the methods of sterile tissue harvest and how the tendons are loaded onto a clamping system that is subsequently immersed into media and maintained at 37 degrees C. One clamp is fixed while the other one is moved with a linear actuator. Tendon tensile force is monitored with a load cell in series with the mobile clamp. The actuators are controlled with a LabView program. The four tendons can be repetitively loaded with different patterns of loading, repetition rate, rate of loading, and duration. Loading can continue for a few minutes to 48 hours. At the end of loading, the tendons are removed and the mid-substance extracted for biochemical analyses. This system allows for the investigation of the effects of loading patterns on gene expression and structural changes in tendon. Ultimately, mechanisms of injury due to overuse can be studies with the findings applied to treatment and prevention. PMID:18979013

Asundi, Krishna; Rempel, David

2007-01-01

337

Augmentation of tendon-to-bone healing.  

PubMed

Tendon-to-bone healing is vital to the ultimate success of the various surgical procedures performed to repair injured tendons. Achieving tendon-to-bone healing that is functionally and biologically similar to native anatomy can be challenging because of the limited regeneration capacity of the tendon-bone interface. Orthopaedic basic-science research strategies aiming to augment tendon-to-bone healing include the use of osteoinductive growth factors, platelet-rich plasma, gene therapy, enveloping the grafts with periosteum, osteoconductive materials, cell-based therapies, biodegradable scaffolds, and biomimetic patches. Low-intensity pulsed ultrasound and extracorporeal shockwave treatment may affect tendon-to-bone healing by means of mechanical forces that stimulate biological cascades at the insertion site. Application of various loading methods and immobilization times influence the stress forces acting on the recently repaired tendon-to-bone attachment, which eventually may change the biological dynamics of the interface. Other approaches, such as the use of coated sutures and interference screws, aim to deliver biological factors while achieving mechanical stability by means of various fixators. Controlled Level-I human trials are required to confirm the promising results from in vitro or animal research studies elucidating the mechanisms underlying tendon-to-bone healing and to translate these results into clinical practice. PMID:24647509

Atesok, Kivanc; Fu, Freddie H; Wolf, Megan R; Ochi, Mitsuo; Jazrawi, Laith M; Doral, M Nedim; Lubowitz, James H; Rodeo, Scott A

2014-03-19

338

The Mechanical Properties of Rat Tail Tendon  

Microsoft Academic Search

The load-strain and stress-relaxation behavior of wet rat tail tendon has been examined with respect to the parameters strain, rate of strain- ing, and temperature. It is found that this mechanical behavior is reproducible after resting tile tendon for a few minutes after each extension so long as the strain does not exceed about 4 per cent. If this strain

BERNARD J. RIGBY; OHN D. SPIKES; HENRY EYRING

1959-01-01

339

Rotator Cuff Tears: Surgical Treatment Options  

MedlinePLUS

... rotator cu? tears. Advancements in surgical techniques for rotator cu? repair include less invasive procedures. While each of the ... Surgeons. The three techniques most commonly used for rotator cu? repair include traditional open repair, arthroscopic repair, and mini- ...

340

Hall resistive tearing mode: A variational formulation  

NASA Astrophysics Data System (ADS)

A unified linear tearing-mode formulation is given incorporating both resistivity and Hall effects. A variational method is used that appears to be best suited to deal with the difficulties peculiar to the triple-deck structure associated with the Hall resistive tearing mode but also to lead to a convenient analytical dispersion relation for the Hall resisitive tearing mode. This analytical dispersion relation: a) recovers the Furth-Killeen-Rosenbluth (Phys. Fluids, 6 (1963) 459) result for the resistive branch; b) gives a growth rate for the Hall branch which appears to be consistent with the growth rate of the electron-inertia-driven tearing mode given previously (Coppi B., Phys. Lett. A, 11 (1964) 226); c) recovers the scaling relation for the transition from the resisitive regime to the Hall regime numerically established by Fitzpatrick (Phys. Plasmas, 11 (2004) 937) in a driven Hall resistive reconnection situation.

Shivamoggi, B. K.

2008-09-01

341

Neoclassical tearing modes in a tokamak  

SciTech Connect

Linear tearing instability is studied in the banana collisionality regime in tokamak geometry. Neoclassical effects produce significant modifications of Ohm's law and the vorticity equation so that the growth rate of tearing modes driven by ..delta..' is dramatically reduced compared to the usual resistive MHD value. Consequences of this result, regarding the presence of pressure-gradient-driven neoclassical resistive interchange instabilities and the evolution of magnetic islands in the Rutherford regime, are discussed. 10 refs.

Hahm, T.S.

1988-08-01

342

Neoclassical tearing modes in a tokamak  

SciTech Connect

Linear tearing instability is studied in the banana collisionality regime in tokamak geometry. Neoclassical effects produce significant modifications of Ohm's law and the vorticity equation, so that the growth rate of tearing modes driven by ..delta..' is dramatically reduced compared to the usual resistive magnetohydrodynamic values. Consequences of this result, regarding the presence of pressure-gradient-driven neoclassical resistive interchange instabilities and the evolution of magnetic islands in the Rutherford regime, are discussed.

Hahm, T.S.

1988-12-01

343

Functional tissue engineering of tendon: Establishing biological success criteria for improving tendon repair.  

PubMed

Improving tendon repair using Functional Tissue Engineering (FTE) principles has been the focus of our laboratory over the last decade. Although our primary goals were initially focused only on mechanical outcomes, we are now carefully assessing the biological properties of our tissue-engineered tendon repairs so as to link biological influences with mechanics. However, given the complexities of tendon development and healing, it remains challenging to determine which aspects of tendon biology are the most important to focus on in the context of tissue engineering. To address this problem, we have formalized a strategy to identify, prioritize, and evaluate potential biological success criteria for tendon repair. We have defined numerous biological properties of normal tendon relative to cellular phenotype, extracellular matrix and tissue ultra-structure that we would like to reproduce in our tissue-engineered repairs and prioritized these biological criteria by examining their relative importance during both normal development and natural tendon healing. Here, we propose three specific biological criteria which we believe are essential for normal tendon function: (1) scleraxis-expressing cells; (2) well-organized and axially-aligned collagen fibrils having bimodal diameter distribution; and (3) a specialized tendon-to-bone insertion site. Moving forward, these biological success criteria will be used in conjunction with our already established mechanical success criteria to evaluate the effectiveness of our tissue-engineered tendon repairs. PMID:24200342

Breidenbach, Andrew P; Gilday, Steven D; Lalley, Andrea L; Dyment, Nathaniel A; Gooch, Cynthia; Shearn, Jason T; Butler, David L

2014-06-27

344

Evolution of the Achilles tendon: The athlete's Achilles heel?  

Microsoft Academic Search

The Achilles tendon is believed to have first developed two million years ago enabling humans to run twice as fast. However if the Achilles tendon is so important in terms of evolution, then why is this tendon so prone to injury – especially for those more active like athletes. The Achilles tendon had an integral role in evolving apes from

S. Malvankar; W. S. Khan

345

Outcome and Structural Integrity of Rotator Cuff after Arthroscopic Treatment of Large and Massive Tears with Double Row Technique: A 2-Year Followup  

PubMed Central

Purpose. The purpose of this study was to evaluate the functional outcome and the tendon healing after arthroscopic double row rotator cuff repair of large and massive rotator cuff tears. Methods. 82 patients with a full-thickness large and massive rotator cuff tear underwent arthroscopic repair with double row technique. Results were evaluated by use of the UCLA, ASES, and Constant questionnaires, the Shoulder Strength Index (SSI), and range of motion. Follow-up time was 2 years. Magnetic resonance imaging (MRI) studies were performed on each shoulder preoperatively and 2 years after repair. Results. 100% of the patients were followed up. UCLA, ASES, and Constant questionnaires showed significant improvement compared with preoperatively (P < 0.001). Range of motion and SSI in flexion, abduction, and internal and external rotation also showed significant improvement (P < 0.001). MRI studies showed 24 cases of tear after repair (29%). Only 8 cases were a full-thickness tear. Conclusions. At two years of followup, in large and massive rotator cuff tears, an arthroscopic double row rotator cuff repair technique produces an excellent functional outcome and structural integrity.

Carbonel, Ignacio; Martinez, Angel A.; Aldea, Elisa; Ripalda, Jorge

2013-01-01

346

Biological Augmentation of Rotator Cuff Tendon Repair  

PubMed Central

A histologically normal insertion site does not regenerate following rotator cuff tendon-to-bone repair, which is likely due to abnormal or insufficient gene expression and/or cell differentiation at the repair site. Techniques to manipulate the biologic events following tendon repair may improve healing. We used a sheep infraspinatus repair model to evaluate the effect of osteoinductive growth factors and BMP-12 on tendon-to-bone healing. Magnetic resonance imaging and histology showed increased formation of new bone and fibrocartilage at the healing tendon attachment site in the treated animals, and biomechanical testing showed improved load-to-failure. Other techniques with potential to augment repair site biology include use of platelets isolated from autologous blood to deliver growth factors to a tendon repair site. Modalities that improve local vascularity, such as pulsed ultrasound, have the potential to augment rotator cuff healing. Important information about the biology of tendon healing can also be gained from studies of substances that inhibit healing, such as nicotine and antiinflammatory medications. Future approaches may include the use of stem cells and transcription factors to induce formation of the native tendon-bone insertion site after rotator cuff repair surgery.

Kovacevic, David

2008-01-01

347

Percutaneous techniques for tendon transfers in the foot and ankle.  

PubMed

Tendon transfer procedures are useful for replacing a dysfunctional or diseased tendon or for restoring muscle imbalance. The tendon to be transferred is harvested as distal as is necessary to provide adequate length for rerouting and attachment at the different site. The harvesting of tendon itself can be attained using an open surgical approach or minimally invasive percutaneous techniques that limit surgical exposure. This article describes percutaneous techniques for tendon transfer procedures used to address foot and ankle disorders. PMID:24548514

Panchbhavi, Vinod Kumar

2014-03-01

348

Tendon and Ligament Regeneration and Repair: Clinical Relevance and Developmental Paradigm  

PubMed Central

Tendon and ligament (T/L) are dense connective tissues connecting bone to muscle and bone to bone, respectively. Similar to other musculoskeletal tissues, T/L arise from the somitic mesoderm, but they are derived from a recently discovered somitic compartment, the syndetome. The adjacent sclerotome and myotome provide inductive signals to the interposing syndetome, thereby upregulating the expression of the transcription factor Scleraxis, which in turn leads to further tenogenic and ligamentogenic differentiation. These advances in the understanding of T/L development have been sought to provide a knowledge base for improving the healing of T/L injuries, a common clinical challenge due to the intrinsically poor natural healing response. Specifically, the three most common tendon injuries involve tearing of the rotator cuff of the shoulder, the flexor tendon of the hand, and the Achilles tendon. At present, injuries to these tissues are treated by surgical repair and/or conservative approaches, including biophysical modalities such as physical rehabilitation and cryotherapy. Unfortunately, the healing tissue forms fibrovascular scar and possesses inferior mechanical and biochemical properties as compared to native T/L. Therefore, tissue engineers have sought to improve upon the natural healing response by augmenting the injured tissue with cells, scaffolds, bioactive agents, and mechanical stimulation. These strategies show promise, both in vitro and in vivo, for improving T/L healing. However, several challenges remain in restoring full T/L function following injury, including uncertainties over the optimal combination of these biological agents as well how to best deliver tissue engineered elements to the injury site. A greater understanding of the molecular mechanisms involved in T/L development and natural healing, coupled with the capability of producing complex biomaterials to deliver multiple growth factors with high spatiotemporal resolution and specificity, will allow tissue engineers to more closely recapitulate T/L morphogenesis, thereby offering future patients the prospect of T/L regeneration, as opposed to simple tissue repair.

Tuan, Rocky S.

2014-01-01

349

Influence of nanofibers on growth and gene expression of human tendon derived fibroblast  

PubMed Central

Background Rotator cuff tears are a common and frequent lesion especially in older patients. The mechanisms of tendon repair are not fully understood. Common therapy options for tendon repair include mini-open or arthroscopic surgery. The use of growth factors in experimental studies is mentioned in the literature. Nanofiber scaffolds, which provide several criteria for the healing process, might be a suitable therapy option for operative treatment. The aim of this study was to explore the effects of nanofiber scaffolds on human tendon derived fibroblasts (TDF's), as well as the gene expression and matrix deposition of these fibroblasts. Methods Nanofibers composed of PLLA and PLLA/Col-I were seeded with human tendon derived fibroblasts and cultivated over a period of 22 days under growth-inductive conditions, and analyzed during the course of culture, with respect to gene expression of different extra cellular matrix components such as collagens, bigylcan and decorin. Furthermore, we measured cell densities and proliferation by using fluorescene microscopy. Results PLLA nanofibers possessed a growth inhibitory effect on TDF's. Furthermore, no meaningful influence on the gene expression of collagen I, collagen III and decorin could be observed, while the expression of collagen X increased during the course of cultivation. On the other hand, PLLA/Col-I blend nanofibers had no negative influence on the growth of TDF's. Furthermore, blending PLLA nanofibers with collagen had a positive effect on the gene expression of collagen I, III, X and decorin. Here, gene expression indicated that focal adherence kinases might be involved. Conclusion This study indicates that the use of nanofibers influence expression of genes associated with the extra cellular matrix formation. The composition of the nanofibers plays a critical role. While PLLA/Col-I blend nanofibers enhance the collagen I and III formation, their expression on PLLA nanofibers was more comparable to controls. However, irrespective of the chemical composition of the fibres, the collagen deposition was altered, an effect which might be associated with a decreased expression of biglycanes.

2010-01-01

350

[Factors influencing the measurement of tear film lipid layer thickness with interferometry].  

PubMed

Introduction: The quantitative measurement of the tear film lipid layer thickness is a relatively new and promising method. However, so far it has not been investigated whether there is a diurnal or a day to day variability and whether certain factors are confounding the measurement of the lipid layer thickness. Materials and Methods: In three different experimental settings, 10 subjects without known sicca syndrome were examined at three different time points on one day, on three different days and before and after therapeutic expression of the Meibomian glands. As a comparison, the parameters tear film break-up time, tear meniscus height, diagnostic expression of the Meibomian glands and subjective symptoms, determined using the OSDI (ocular surface disease index) questionnaire, were measured. Results: The results of the study showed a smaller variation of the lipid layer thickness measurements during the day and from day to day compared to the tear film break-up time. The expression of the Meibomian glands significantly increased the lipid layer thickness. There was a correlation between the baseline values of tear film break-up time and the lipid layer thickness. Discussion: Our data showed that the lipid layer thickness as measured with the Lipiview® interferometer appears to be a relatively constant parameter over time. In addition, the expression of the Meibomian glands could be identified as a potential confounding factor. In this study we included only healthy subjects without known sicca syndrome. For the future our findings need to be validated in dry eye patients. PMID:24940758

Finis, D; Pischel, N; Borrelli, M; Schrader, S; Geerling, G

2014-06-01

351

Relationship between clinical and surgical findings and reparability of large and massive rotator cuff tears: a longitudinal study  

PubMed Central

Background The literature has shown good results with partial repairs of large and massive tears of rotator cuff but the role of factors that affect reparability is less clear. The purpose of this study was twofold, 1) to examine clinical outcomes following complete or partial repair of large or massive full-thickness rotator cuff tear, and 2) to explore the value of clinical and surgical factors in predicting reparability. Methods This was a secondary data analysis of consecutive patients with large or massive rotator cuff tear who required surgical treatment (arthroscopic complete or partial repair) and were followed up for two years. Disability measures included the American Shoulder and Elbow Surgeons (ASES), the relative Constant-Murley score (CMS) and the shortened version of the Western Ontario Rotator Cuff Index (ShortWORC). The relationship between predictors and reparability was examined through logistic regressions and chi-square statistics as appropriate. Within group change over time and between group differences in disability outcomes, range of motion and strength were examined by student’s T-tests and non-parametric statistics. Results One hundred and twenty two patients (41 women, 81 men, mean age 64, SD?=?9) were included in the analysis. There were 86 large (39 fully reparable, 47 partially reparable) and 36 (10 fully reparable, 26 partially reparable) massive tears. Reparability was not associated with age, sex, or pre-operative active flexion or abduction (p?>?0.05) but the fully reparable tear group showed a better pre-operative ASES score (p?=?0.01) and better active external rotation in neutral (p?=?0.01). Reparability was associated with tear shape (p?tendon quality (p?tears is affected by a number of clinical and surgical factors. Patients whose tears could not be fully repaired showed a statistically significant improvement in range of motion, strength and disability at 2 years, although they had slightly inferior results compared to those with complete repairs.

2014-01-01

352

Flexor carpi radialis tendon ultrasound pictorial essay.  

PubMed

Disorders of the flexor carpi radialis tendon (FCRt) are often missed even though they are a relatively frequent cause of volar radial wrist pain. They can manifest as tenosynovitis, tendinopathy, synovial sheath cysts with or without scaphoid-trapezoid-trapezium (STT) joint pathology, and partial or complete rupture. Because FCRt disorders often present with non-specific symptoms and a non-diagnostic clinical examination, imaging is often necessary for accurate evaluation and therapeutic planning. Conventional radiography provides good visualization of the neighboring bones and joints, as well as rare intratendinous calcifications. MRI enables evaluation of the FCRt and adjacent anatomical structures with excellent tissue resolution. In comparison, ultrasound (US) evaluation of the FCRt is less commonly described in the radiology literature, despite its affordability, exquisite soft tissue resolution, and the advantages of quick, dynamic diagnostic imaging. This pictorial essay describes and demonstrates the normal anatomy of the FCRt, its US examination technique and normal US appearance, and US findings of clinically relevant FCRt disorders. PMID:24658615

Luong, Dien Hung; Smith, Jay; Bianchi, Stefano

2014-06-01

353

Stem Cells for Augmenting Tendon Repair  

PubMed Central

Tendon healing is fraught with complications such as reruptures and adhesion formation due to the formation of scar tissue at the injury site as opposed to the regeneration of native tissue. Stem cells are an attractive option in developing cell-based therapies to improve tendon healing. However, several questions remain to be answered before stem cells can be used clinically. Specifically, the type of stem cell, the amount of cells, and the proper combination of growth factors or mechanical stimuli to induce differentiation all remain to be seen. This paper outlines the current literature on the use of stem cells for tendon augmentation.

Gulotta, Lawrence V.; Chaudhury, Salma; Wiznia, Daniel

2012-01-01

354

Functional efficacy of tendon repair processes.  

PubMed

Despite various attempts to repair and replace injured tendon, an understanding of the repair processes and a systematic approach to achieving functional efficacy remain elusive. In this review the epidemiology of tendon injury and repair is first examined. Using a traditional paradigm for repair assessment, the biology and biomechanics of normal tendon, natural healing, and repair are then explored. New treatment strategies such as functional tissue engineering are discussed, including a functional approach to treatment that involves the development of in vivo functional design parameters to judge the acceptability of a repair outcome. The paper concludes with future directions. PMID:15255772

Butler, David L; Juncosa, Natalia; Dressler, Matthew R

2004-01-01

355

An insight on multiscale tendon modeling in muscle–tendon integrated behavior  

Microsoft Academic Search

This paper aims to highlight the need for a refined tendon model to reproduce the main mechanical features of the integrated\\u000a muscle–tendon unit (MTU). Elastic nonlinearities of the tendon, both at the nano and microscale, are modeled by a multiscale\\u000a approach, accounting for the hierarchical arrangement (from molecules up to the fibers) of the collagen structures within\\u000a the tissue. This

Franco Maceri; Michele Marino; Giuseppe Vairo

356

Tendon-Holding Capacities of Two Newly Designed Implants for Tendon Repair: An Experimental Study on the Flexor Digitorum Profundus Tendon of Sheep  

PubMed Central

Background: Two main factors determine the strength of tendon repair; the tensile strength of material and the gripping capacity of a suture configuration. Different repair techniques and suture materials were developed to increase the strength of repairs but none of techniques and suture materials seem to provide enough tensile strength with safety margins for early active mobilization. In order to overcome this problem tendon suturing implants are being developed. We designed two different suturing implants. The aim of this study was to measure tendon-holding capacities of these implants biomechanically and to compare them with frequently used suture techniques Materials and Methods: In this study we used 64 sheep flexor digitorum profundus tendons. Four study groups were formed and each group had 16 tendons. We applied model 1 and model 2 implant to the first 2 groups and Bunnell and locking-loop techniques to the 3rd and 4th groups respectively by using 5 Ticron sutures. Results: In 13 tendons in group 1 and 15 tendons in group 2 and in all tendons in group 3 and 4, implants and sutures pulled out of the tendon in longitudinal axis at the point of maximum load. The mean tensile strengths were the largest in group 1 and smallest in group 3. Conclusion: In conclusion, the new stainless steel tendon suturing implants applied from outside the tendons using steel wires enable a biomechanically stronger repair with less tendon trauma when compared to previously developed tendon repair implants and the traditional suturing techniques.

Ag?r, Ismail; Aytekin, Mahmut Nedim; Basc?, Onur; Cayp?nar, Bar?s; Erol, Bulent

2014-01-01

357

[Management of the avulsion of the flexor pollicis longus and flexor indicis profundus tendons by tendon transfer. Case report].  

PubMed

Tendon injuries are common in hand wounds and their functional consequences are not negligible. In emergency, tendon repairs techniques are well codified to restore function. These tendon repairs can be made in one session, in two sessions, or even use tendon transfers. Tendon transfers are not usual in the emergency but more common in the treatment of sequelae or failure of primary repair. We report one case of transfer to restore thumb flexion in emergency. PMID:23499269

Mesnil, P; Szymanski, C; Fontaine, C; Chantelot, C

2013-04-01

358

Intrasynovial Tendon Graft for Chronic Flexor Tendon Laceration of the Finger: A Case Report  

PubMed Central

We present the case of a patient with flexor digitorum profundus tendon laceration at the A2 pulley level caused by an injury to the base of the right ring finger by a knife. The patient was treated by flexor tendon reconstruction from the palm to the fingertip by using the left second toe flexor tendon as a graft, which improved the active range of motion. Further improvement was achieved by subsequent tenolysis, which eventually restored nearly normal function. Our experience with this case indicates that the intrasynovial tendon is a reasonable graft source for the synovial space in fingers and may enable restoration of excellent postoperative function.

Sasaki, Jun; Itsubo, Toshiro; Nakamura, Koichi; Hayashi, Masanori; Uchiyama, Shigeharu; Kato, Hiroyuki

2013-01-01

359

Allergy and allergic mediators in tears.  

PubMed

The identification of inflammatory mediators in the tear fluid have been extensively used in ocular allergy to find either a 'disease marker', to better understand the immune mechanisms involved in the ocular surface inflammation, or to identify potential targets for therapeutic interventions. While the clinical characteristics allow a relatively convincing diagnosis of ocular allergic diseases, in the initial, non active phases, or in the chronic stages, the diagnosis may not be clear. Although not highly specific, total tear IgE can be measured with local tests by inserting a paper strip in the lower meniscus. The measurement of tear specific inflammatory markers, such as histamine, tryptase, ECP, IL-4, IL-5 and eotaxin, may be useful for the diagnosis or monitoring ocular allergy. New technologies such as multiplex bead assays, membrane-bound antibody array and proteomic techniques can characterize the distribution of a wide range of bioactive trace proteins in tears. Dozens of mediators, cytokines, chemokines, growth factors, angiogenic modulators, enzymes and inhibitors were thus identified in small tear samples using these techniques, providing the possible identification of specific biomarker for either specific disease or disease activity. However, to date, there is no a single specific laboratory test suitable for the diagnosis and monitoring of allergic conjunctivitis. PMID:23891862

Leonardi, Andrea

2013-12-01

360

Collisionless and Collisional Tearing Mode in Gyrokinetics  

NASA Astrophysics Data System (ADS)

We present numerical results of linear tearing mode simulations for collisionless and collisional regimes in a strong guide magnetic field limit using the AstroGK astrophysical gyrokinetics code. In the collisionless regime, the two-fluid effect, instead of the resistivity, mediates reconnection. Mirnov et al. and Fitzpatrick et al. have derived linear and nonlinear versions of reduced two-fluid models for the tearing mode in the presence of the guide field^1,2. We compare numerically obtained tearing mode growth rate with those theories. For the collisional regime, we compare gyrokinetic simulation results with the classical tearing mode theory by Furth, Kileen, and Rosenbluth, and with a fluid simulation. This benchmarks recently implemented resistivity term in the code. AstroGK can smoothly connect those two regimes. We also discuss the scaling of the growth rate against the collisionality in the intermediate regime, and how the kinetic effects play roles in the tearing mode. 1. V. V. Mirnov, C. C. Hegna, and S. C. Prager, Phys. Plasmas 11, 4468, (2004). 2. R. Fitzpatrick and F. Porcelli, Phys. Plasmas 11, 4713 (2004).

Numata, Ryusuke; Tatsuno, Tomoya; Dorland, William; Rogers, Barret

2009-05-01

361

Exercise following a short immobilization period is detrimental to tendon properties and joint mechanics in a rat rotator cuff injury model.  

PubMed

Rotator cuff tears are a common clinical problem that can result in pain and disability. Previous studies in a rat model showed enhanced tendon to bone healing with postoperative immobilization. The objective of this study was to determine the effect of postimmobilization activity level on insertion site properties and joint mechanics in a rat model. Our hypothesis was that exercise following a short period of immobilization will cause detrimental changes in insertion site properties compared to cage activity following the same period of immobilization, but that passive shoulder mechanics will not be affected. We detached and repaired the supraspinatus tendon of 22 Sprague-Dawley rats, and the injured shoulder was immobilized postoperatively for 2 weeks. Following immobilization, rats were prescribed cage activity or exercise for 12 weeks. Passive shoulder mechanics were determined, and following euthanasia, tendon cross-sectional area and mechanical properties were measured. Exercise following immobilization resulted in significant decreases compared to cage activity in range of motion, tendon stiffness, modulus, percent relaxation, and several parameters from both a structurally based elastic model and a quasi-linear viscoelastic model. Therefore, we conclude that after a short period of immobilization, increased activity is detrimental to both tendon mechanical properties and shoulder joint mechanics, presumably due to increased scar production. PMID:20058271

Peltz, Cathryn D; Sarver, Joseph J; Dourte, Leann M; Würgler-Hauri, Carola C; Williams, Gerald R; Soslowsky, Louis J

2010-07-01

362

The "dark tendon sign" (DTS): a sonographic indicator for idiopathic trigger finger.  

PubMed

Although the diagnosis of "idiopathic trigger finger" (stenosing tenovaginitis) is normally based on clinical examination alone, to date there is no reliable evaluation defining this idiopathic disease beyond an exclusion of secondary causes or an unnecessary sonographic certification of high-grade impairment. By standardized assessment of 32 patients who retrospectively fulfilled the study inclusion criteria and their comparison to a matched group of volunteers, we defined the diagnostic efficiency of the here newly proposed sonographic dark tendon sign (DTS) alone, of impaired tendon gliding alone and the combination of these two features. Pulley thickness in patients and volunteers was significantly different. The combination of clinically impaired tendon gliding plus the DTS reached a sensitivity and diagnostic efficiency of 100%. We propose this diagnostic combination as the new first line assessment features for the quick definition of idiopathic stenosing tendovaginitis during daily routine PMID:21458147

Gruber, Hannes; Peer, Siegfried; Loizides, Alexander

2011-05-01

363

Is sonoelastography of value in assessing tendons?  

PubMed

Sonoelastography is a newly introduced ultrasound technique that evaluates tissue elasticity and thus provides additional information to that offered by conventional ultrasound images. In the musculoskeletal field, sonoelastography can help improve estimation of tendon stiffness. In this article, the principles and future developments of sonoelastography are discussed using the strongest and thickest tendon of the human body, the Achilles tendon, for illustrative purposes. Preliminary findings of sonoelastography in healthy and pathological Achilles tendons, technical considerations, examination technique and several limitations are addressed. The usefulness of elastography can be expected to increase rapidly in the musculoskeletal field, as soon as we learn to interpret elastographic artifacts as well as to take advantage of the new information provided by sonoelastography. PMID:20539957

Klauser, Andrea S; Faschingbauer, Ralph; Jaschke, Werner R

2010-09-01

364

Effect of age on fatty infiltration of supraspinatus muscle after experimental tendon release in rats  

PubMed Central

Background Rotator cuff tendon tear is a leading cause for atrophy, fibrosis and fatty infiltration of the rotator cuff muscles. The pathophysiology of fatty muscle infiltration is not well understood. An animal model suited to study cellular and molecular mechanisms would therefore be desirable. While a rat model has been established for chronic rotator cuff tendon pathology, sufficient and easily identifiable fatty infiltration of the muscle has not yet been shown in rats. As younger animals regenerate better, we hypothesized that the absence of a sufficient amount of fatty infiltration in previous experiments was due to the selection of young animals and that older animals would exhibit higher amounts of fatty infiltration after tendon tear. Findings The supraspinatus tendon was released using tenotomy in 3 young (6 weeks old) and in 3 aged (24 months old) Sprague Dawley rats (group I and II). Another 3 aged (24 months old) rats underwent sham surgery and served as a control group (group III). In group I and II retraction of the musculotendinous unit was allowed for 6 weeks. All animals were sacrificed 6 weeks after surgery and the supraspinatus muscles were harvested. Each sample was examined for fatty infiltration of the muscle by histological methods and micro-CT. In histology, fat cells were counted with a 10-fold magnification in 6 fields of view twice. An adjusted measurement setup was developed for the use of micro-CT to quantify the absorption coefficient of the muscle as a reciprocal indicator for fatty infiltration, based on the established procedure for quantification of fatty infiltration on CT in humans. Tenotomy resulted in an insignificant increase of fat cells in histological sections in both, aged and young rats. Micro-CT was able to quantify small differences in the absorption coefficients of muscle samples; the absorption coefficient was 8.1% ± 11.3% lower in retracted muscles (group I and II) compared with the control (group III), indicating a tendency towards a higher amount of intra- and/or extracellular fat. Absorption was 4.28% ± 3.2% higher in aged compared with young muscles; however, this difference could not be confirmed by histology. Conclusions Substantial fatty muscle infiltration following chronic retraction after supraspinatus tenotomy could be documented histologically neither in young nor aged rats. Although micro-CT was able to reveal minor differences in absorption between the studied groups, the differences were too small to make the rat supraspinatus model interesting to study fatty infiltration of the chronically retracted muscle.

2011-01-01

365

Biological Augmentation of Rotator Cuff Tendon Repair  

Microsoft Academic Search

A histologically normal insertion site does not regenerate following rotator cuff tendon-to-bone repair, which is likely due\\u000a to abnormal or insufficient gene expression and\\/or cell differentiation at the repair site. Techniques to manipulate the biologic\\u000a events following tendon repair may improve healing. We used a sheep infraspinatus repair model to evaluate the effect of osteoinductive\\u000a growth factors and BMP-12 on

David Kovacevic; Scott A. Rodeo

2008-01-01

366

[Reconstructive augmentation of the metacarpal tendons].  

PubMed

When splitting a metacarpal pulley, a diagonal incision allows, after sliding its margins and suturing them, to restore a pulley larger than before. With a small counter incision, it is possible to have a yet larger one. It is a very proper way to treat a "trigger finger". A similar technique may be used in flexor tendons lacerations, which make possible the suture of both tendons. This technique permits the tenolysis with pulley reconstruction. PMID:9382649

Kapandji, I A

1983-01-01

367

Surgical treatment of snapping medial hamstring tendons  

Microsoft Academic Search

Three patients were seen for pain and snapping over their medial knee during active knee flexion and extension. Physical examination\\u000a revealed an audible and visible subluxation that was localized to the posteromedial aspect of their symptomatic knee. One\\u000a patient underwent a semitendinosus tendon harvest, and two patients underwent a release of their semitendinosus and gracilis\\u000a tendons. All three patients had

Andrew G. Geeslin; Robert F. LaPrade

2010-01-01

368

Traumatic flexor tendon injuries in 27 cattle.  

PubMed

Information for all cattle with a diagnosis of tendon injury entered into the Veterinary Medical Data Base (VMDB) was retrieved and selected medical records reviewed. The proportional morbidity rate for tendon disruption was 0.89 cattle/1,000 cattle admissions and 95 of 99 cattle survived. Female and dairy cattle had a greater risk of tendon disruption than male or beef cattle, respectively. Also, cattle 6 months to 7 years old had a greater risk than cattle younger than 6 months old. Complete medical records were examined for 27 cattle. Affected cattle were 2.5 +/- 1.8 years old and weighed 593.6 +/- 315.6 kg. Injuries were most commonly caused by accidents involving farm machinery (72%). Unilateral superficial digital flexor tendon injury occurred in 8 cattle (30%); multiple tendon injury occurred in the other 19 cattle (70%). A single limb was involved in 25 cattle, a rear limb was involved in 24 cattle, and an open wound was associated with the injury in 26 cattle. Wounds were identified most commonly at the mid (13 cattle) and proximal metatarsus (4 cattle). Treatment of tendon disruption included tenorrhaphy and casting (9 cattle), external coaptation, alone, (14 cattle), stall confinement, alone, (1 cow), and euthanasia or salvage (3 cattle). External coaptation was maintained for 74.4 +/- 34.3 days, and total confinement period was 88.3 +/- 59.5 days. Short-term complications included severe tendon laxity (one cow) and fatal septic peritonitis (one bull). Twenty-two of 24 cattle treated for tendon disruption survived. Follow-up information was available for 16 cattle; 14 cattle (87%) returned to productivity and 11 of 15 cattle with long-term follow-up (73%) were considered productive. Long-term complications included persistent lameness (56%) and persistent hyperextension of the digits (19%). PMID:8810022

Anderson, D E; St-Jean, G; Morin, D E; Ducharme, N G; Nelson, D R; Desrochers, A

1996-01-01

369

Tension Distribution in a Tendon-Driven Robotic Finger  

NASA Technical Reports Server (NTRS)

A method is provided for distributing tension among tendons of a tendon-driven finger in a robotic system, wherein the finger characterized by n degrees of freedom and n+1 tendons. The method includes determining a maximum functional tension and a minimum functional tension of each tendon of the finger, and then using a controller to distribute tension among the tendons, such that each tendon is assigned a tension value less than the maximum functional tension and greater than or equal to the minimum functional tension. The method satisfies the minimum functional tension while minimizing the internal tension in the robotic system, and satisfies the maximum functional tension without introducing a coupled disturbance to the joint torques. A robotic system includes a robot having at least one tendon-driven finger characterized by n degrees of freedom and n+1 tendons, and a controller having an algorithm for controlling the tendons as set forth above.

Abdallah, Muhammad E. (Inventor); Platt, Robert (Inventor); Wampler, II, Charles W. (Inventor)

2013-01-01

370

[Functional tear production indices in thyroid eye disease].  

PubMed

Analysis of functional tear production indices in patients with Grave's disease and thyroid eye disease confirmed lacrimal gland involvement in inflammatory autoimmune process. Close direct correlation was found between tear production and main disease characteristics - severity and activity. PMID:23879029

Safonova, T N; Likhvantseva, V G; Gontiurova, O A; Rudenko, E I; Vygodin, V A

2013-01-01

371

The cell biology of suturing tendons  

PubMed Central

Trauma by suturing tendon form areas devoid of cells termed “acellular zones” in the matrix. This study aimed to characterise the cellular insult of suturing and acellular zone formation in mouse tendon. Acellular zone formation was evaluated using single grasping sutures placed using flexor tendons with time lapse cell viability imaging for a period of 12 h. Both tension and injury were required to induce cell death and cell movement in the formation of the acellular zone. DNA fragmentation studies and transmission electron microscopy indicated that cells necrosed. Parallel in vivo studies showed that cell-to-cell contacts were disrupted following grasping by the suture in tensioned tendon. Without tension, cell death was lessened and cell-to-cell contacts remained intact. Quantitative immunohistochemistry and 3D cellular profile mapping of wound healing markers over a one year time course showed that acellular zones arise rapidly and showed no evidence of healing whilst the wound healing response occurred in the surrounding tissues. The acellular zones were also evident in a standard modified “Kessler” clinical repair. In conclusion, the suture repair of injured tendons produces acellular zones, which may potentially cause early tendon failure.

Wong, J.K.F.; Alyouha, S.; Kadler, K.E.; Ferguson, M.W.J.; McGrouther, D.A.

2010-01-01

372

Ply-tear webbing energy absorber  

NASA Technical Reports Server (NTRS)

Ply-tear webbing is essentially two plain webbings that are bound together by a portion of the warps and that can be torn apart and do work by breaking the binders. Nylon webbing were woven to range in tear force from 1 to 10 kilonewtons. This force is substantially independent of speed, which was as high as 100 m/sec in some cases. A specific energy absorption of 90 J/g was achieved in the dry state. However, lower rated webbings that absorb approximately 40 J/g are recommended for use in practice where it is acceptable.

Stevens, G. W. H.

1972-01-01

373

Long-term outcome and structural integrity following open repair of massive rotator cuff tears  

PubMed Central

Background: Surgical repair of massive rotator cuff tears is associated with less favorable clinical results and a higher retear rate than repair of smaller tears, which is attributed to irreversible degenerative changes of the musculotendinous unit. Materials and Methods: During the study period, 25 consecutive patients with a massive rotator cuff tear were enrolled in the study and the tears were repaired with an open suture anchor repair technique. Preoperative and postoperative clinical assessments were performed with the Constant score, the simple shoulder test (SST) and a pain visual analog scale (VAS). At the final follow-up, rotator cuff strength measurement was evaluated and assessment of tendon integrity, fatty degeneration and muscle atrophy was done using a standardized magnetic resonance imaging protocol. Results: The mean follow-up period was 70 months. The mean constant score improved significantly from 42.3 to 73.1 points at the final follow-up. Both the SST and the pain VAS improved significantly from 5.3 to 10.2 points and from 6.3 to 2.1, respectively. The overall retear rate was 44% after 6 years. Patients with an intact repair had better shoulder scores and rotator cuff strength than those with a failed repair, and also the retear group showed a significant clinical improvement (each P<0.05). Rotator cuff strength in all testing positions was significantly reduced for the operated compared to the contralateral shoulder. Muscle atrophy and fatty infiltration of the rotator cuff muscles did not recover in intact repairs, whereas both parameters progressed in retorn cuffs. Conclusions: Open repair of massive rotator tears achieved high patient satisfaction and a good clinical outcome at the long-term follow-up despite a high retear rate. Also, shoulders with retorn cuffs were significantly improved by the procedure. Muscle atrophy and fatty muscle degeneration could not be reversed after repair and rotator cuff strength still did not equal that of the contralateral shoulder after 6 years. Level of evidence: Level IV

Bartl, Christoph; Kouloumentas, Pannos; Holzapfel, Konstantin; Eichhorn, Stefan; Wortler, Klaus; Imhoff, Andreas; Salzmann, Gian M

2012-01-01

374

Tensile properties of the in vivo human gastrocnemius tendon.  

PubMed

In the present experiment we obtained the tensile properties of the human gastrocnemius tendon, a high-stressed tendon suitable for spring-like action during locomotion. Measurements were taken in vivo in six men. The gastrocnemius tendon elongation during tendon loading-unloading induced by muscle contraction-relaxation was measured using real-time ultrasonography. Tendon forces were calculated from the moment generated during isometric plantarflexion contraction, using tendon moment arm length data obtained in vivo with the tendon travel method. Tendon stiffness data were calculated from the slope of the tendon force-elongation curve, and were then normalized to the tendon's original dimensions, obtained from morphometric analysis of sonographs, to estimate the tendon Young's modulus. Mechanical hysteresis values were obtained from area calculations by numerical integration. The elongation of the tendon increased curvilinearly with the force acting upon it, from 1.7+/-1mm (0.8+/-0.3% strain) at 87.5+/-8.5 N to 11.1+/-3.1mm (4.9+/-1% strain) at 875+/-85 N. The tendon Young's modulus and mechanical hysteresis were 1.16+/-0.15 GPa and 18+/-3%, respectively. These values fall within the range of values obtained from in vitro experiments and are very similar to the respective values recently obtained from in vivo measurements in the less highly stressed human tibialis anterior tendon (1.2 GPa and 19%), thus indicating that the material properties of tendon are independent of physiological loading and function. Combining the present tendon force-elongation data with previously reported Achilles tendon force data recorded during walking indicates that the gastrocnemius tendon would provide approximately 6% of the total external work produced by the locomotor system. This estimate illustrates the contribution of passive elastic mechanisms on the economy and efficiency of walking. The contributions would be greater in more active exercise such as running. PMID:12445617

Maganaris, Constantinos N; Paul, John P

2002-12-01

375

Evolution of the Achilles tendon: The athlete's Achilles heel?  

PubMed

The Achilles tendon is believed to have first developed two million years ago enabling humans to run twice as fast. However if the Achilles tendon is so important in terms of evolution, then why is this tendon so prone to injury - especially for those more active like athletes. The Achilles tendon had an integral role in evolving apes from a herbivorous diet to early humans who started hunting for food over longer distances, resulting in bipedal locomotion. Evolutionary advantages of the Achilles tendon includes it being the strongest tendon in the body, having an energy-saving mechanism for fast locomotion, allows humans to jump and run, and additionally is a spring and shock absorber during gait. Considering these benefits it is therefore not surprising that studies have shown athletes have thicker Achilles tendons than subjects who are less active. However, contradictory to these findings that show the importance of the Achilles tendon for athletes, it is well known that obtaining an Achilles tendon injury for an athlete can be career-altering. A disadvantage of the Achilles tendon is that the aetiology of its pathology is complicated. Achilles tendon ruptures are believed to be caused by overloading the tensed tendon, like during sports. However studies have also shown athlete Achilles tendon ruptures to have degenerative changes in the tendon. Other flaws of the Achilles tendon are its non-uniform vascularity and incomplete repair system which may suggest the Achilles tendon is on the edge of evolution. Research has shown that there is a genetic influence on the predisposition a person has towards Achilles tendon injuries. So if this tendon is here to stay in our anatomy, and it probably is due to the slow rate of evolution in humans, research in genetic modification could be used to decrease athletes' predisposition to Achilles tendinopathy. PMID:21900004

Malvankar, S; Khan, W S

2011-12-01

376

Arthroscopic Fixation of Bursal-Sided Rotator Cuff Tears  

Microsoft Academic Search

Subacromial decompression and debridement of partial-thickness bursal-sided rotator cuff tears are often reported with a high rate of unsatisfactory outcomes. We describe an arthroscopic procedure to repair partial-thickness bursal-sided rotator cuff tears without converting to a full-thickness tear in patients with a normal articular-sided rotator cuff and an A0B2 or A0B3 pattern of tear (minimum thickness of 25% to 75%).

Andrew B. Wolff; David P. Magit; Seth R. Miller; Jeff Wyman; Paul M. Sethi

2006-01-01

377

Treatment of non-traumatic rotator cuff tears: A randomised controlled trial with one-year clinical results.  

PubMed

We have compared three different methods of treating symptomatic non-traumatic tears of the supraspinatus tendon in patients above 55 years of age. A total of 180 shoulders (173 patients) with supraspinatus tendon tears were randomly allocated into one of three groups (each of 60 shoulders); physiotherapy (group 1), acromioplasty and physiotherapy (group 2) and rotator cuff repair, acromioplasty and physiotherapy (group 3). The Constant score was assessed and followed up by an independent observer pre-operatively and at three, six and twelve months after the intervention. Of these, 167 shoulders were available for assessment at one year (follow-up rate of 92.8%). There were 55 shoulders in group 1 (24 in males and 31 in females, mean age 65 years (55 to 79)), 57 in group 2 (29 male and 28 female, mean age 65 years (55 to 79)) and 55 shoulders in group 3 (26 male and 29 female, mean age 65 years (55 to 81)). There were no between-group differences in the Constant score at final follow-up: 74.1 (sd 14.2), 77.2 (sd 13.0) and 77.9 (sd 12.1) in groups 1, 2 and 3, respectively (p = 0.34). The mean change in the Constant score was 17.0, 17.5, and 19.8, respectively (p = 0.34). These results suggest that at one-year follow-up, operative treatment is no better than conservative treatment with regard to non-traumatic supraspinatus tears, and that conservative treatment should be considered as the primary method of treatment for this condition. PMID:24395315

Kukkonen, J; Joukainen, A; Lehtinen, J; Mattila, K T; Tuominen, E K J; Kauko, T; Aärimaa, V

2014-01-01

378

Arthroscopic Percutaneous Repair of Anterosuperior Rotator Cuff Tear Including Biceps Long Head: A 2-Year Follow-up  

PubMed Central

Background To report the results of an arthroscopic percutaneous repair technique for partial-thickness tears of the anterosuperior cuff combined with a biceps lesion. Methods The inclusion criteria were evidence of the upper subscapularis tendon tear and an articular side partial-thickness tear of the supraspinatus tendon, degeneration of the biceps long head or degenerative superior labrum anterior-posterior, above lesions treated by arthroscopic percutaneous repair, and follow-up duration > 24 months after the operation. American Shoulder and Elbow Surgeons (ASES) score, constant score, the pain level on a visual analogue scale, ranges of motion and strength were assessed. Results The mean (± standard deviation) age of the 20 enrolled patients was 56.0 ± 7.7 years. The forward flexion strength increased from 26.3 ± 6.7 Nm preoperatively to 38.9 ± 5.1 Nm at final follow-up. External and internal rotation strength was also significantly increased (14.2 ± 1.7 to 19.1 ± 3.03 Nm, 12.3 ± 3.2 to 18.1 ± 2.8 Nm, respectively). Significant improvement was observed in ASES and constant scores at 3 months, 1 year and the time of final follow-up when compared with preoperative scores (p < 0.001). The mean subjective shoulder value was 86% (range, 78% to 97%). Conclusions The implementation of complete rotator cuff repair with concomitant tenodesis of the biceps long head using arthroscopic percutaneous repair achieved full recovery of normal rotator cuff function, maximum therapeutic efficacy, and patient satisfaction.

Kim, Do-Young; Lee, Sang-Soo; Seo, Eun-Min; Hwang, Jung-Taek; Kwon, Sun-Chang; Lee, Jae-Won

2012-01-01

379

Explosive tearing mode reconnection in the magnetospheric tail  

Microsoft Academic Search

A speculative model for the nonlinear phase of the collisionless tearing instability is developed for the case of a single long wavelength tearing mode. Using an energy principle formalism, we find that the nonlinear growth rate is linearly proportional to the mode amplitude. Hence in the nonlinear phase, the tearing mode grows explosively in time, and saturates when the width

A. A. Galeev; F. V. Coroniti; M. Ashour-Abdalla

1978-01-01

380

Quantitative tear lysozyme assay: a new technique for transporting specimens.  

PubMed Central

We have developed a method for assaying the concentration of tear lysozyme using eluates of tear fluid collected on filter paper discs. Specimens can be stored and transported to remote laboratories for assay. We have shown that the 'indirect' or eluate method gives statistically comparable results to the 'direct' method using fresh, neat tear fluid. Images

Seal, D V; Mackie, I A; Coakes, R L; Farooqi, B

1980-01-01

381

Deltoid muscle shape analysis with magnetic resonance imaging in patients with chronic rotator cuff tears  

PubMed Central

Background It seems appropriate to assume, that for a full and strong global shoulder function a normally innervated and active deltoid muscle is indispensable. We set out to analyse the size and shape of the deltoid muscle on MR-arthrographies, and analyse its influence on shoulder function and its adaption (i.e. atrophy) for reduced shoulder function. Methods The fatty infiltration (Goutallier stages), atrophy (tangent sign) and selective myotendinous retraction of the rotator cuff, as well as the thickness and the area of seven anatomically defined segments of the deltoid muscle were measured on MR-arthrographies and correlated with shoulder function (i.e. active abduction). Included were 116 patients, suffering of a rotator cuff tear with shoulder mobility ranging from pseudoparalysis to free mobility. Kolmogorov-Smirnov test was used to determine the distribution of the data before either Spearman or Pearson correlation and a multiple regression was applied to reveal the correlations. Results Our developed method for measuring deltoid area and thickness showed to be reproducible with excellent interobserver correlations (r?=?0.814–0.982). The analysis of influencing factors on active abduction revealed a weak influence of the amount of SSP tendon (r?=??0.25; p?tears did not appear to influence the deltoid shape, i.e. did not lead to muscle atrophy. Conclusions Our data support that in chronic rotator cuff tears, there seems to be no disadvantage to exhausting conservative treatment and to delay implantation of reverse total shoulder arthroplasty, as the shape of deltoid muscle seems only to be influenced by natural aging, but to be independent of reduced shoulder motion.

2013-01-01

382

Water-evaporation reduction by duplex films: application to the human tear film.  

PubMed

Water-evaporation reduction by duplex-oil films is especially important to understand the physiology of the human tear film. Secreted lipids, called meibum, form a duplex film that coats the aqueous tear film and purportedly reduces tear evaporation. Lipid-layer deficiency is correlated with the occurrence of dry-eye disease; however, in-vitro experiments fail to show water-evaporation reduction by tear-lipid duplex films. We review the available literature on water-evaporation reduction by duplex-oil films and outline the theoretical underpinnings of spreading and evaporation kinetics that govern behavior of these systems. A dissolution-diffusion model unifies the data reported in the literature and identifies dewetting of duplex films into lenses as a key challenge to obtaining significant evaporation reduction. We develop an improved apparatus for measuring evaporation reduction by duplex-oil films including simultaneous assessment of film coverage, stability, and temperature, all under controlled external mass transfer. New data reported in this study fit into the larger body of work conducted on water-evaporation reduction by duplex-oil films. Duplex-oil films of oxidized mineral oil/mucin (MOx/BSM), human meibum (HM), and bovine meibum (BM) reduce water evaporation by a dissolution-diffusion mechanism, as confirmed by agreement between measurement and theory. The water permeability of oxidized-mineral-oil duplex films agrees with those reported in the literature, after correction for the presence of mucin. We find that duplex-oil films of bovine and human meibum at physiologic temperature reduce water evaporation only 6-8% for a 100-nm film thickness pertinent to the human tear film. Comparison to in-vivo human tear-evaporation measurements is inconclusive because evaporation from a clean-water surface is not measured and because the mass-transfer resistance is not characterized. PMID:23694847

Cerretani, Colin F; Ho, Nghia H; Radke, C J

2013-09-01

383

Living with a symptomatic rotator cuff tear 'bad days, bad nights': a qualitative study  

PubMed Central

Background Rotator cuff tears are a common cause of shoulder pain. There is an absence of information about symptomatic rotator cuffs from the patients’ perspective; this limits the information clinicians can share with patients and the information that patients can access via sources such as the internet. This study describes the experiences of people with a symptomatic rotator cuff, their symptoms, the impact upon their daily lives and the coping strategies utilised by study participants. Methods An interpretive phenomenological analysis approach was used. 20 participants of the UKUFF trial (The United Kingdom Rotator Cuff Surgery Trial) agreed to participate in in-depth semi-structured interviews about their experiences about living with a symptomatic rotator cuff tear. Interviews were digitally recorded and fully transcribed. Field notes, memos and a reflexive diary were used. Data was coded in accordance with interpretive phenomenological analysis. Peer review, code-recode audits and constant comparison of data, codes and categories occurred throughout. Results The majority of patients described intense pain and severely disturbed sleep. Limited movement and reduced muscle strength were described by some participants. The predominantly adverse impact that a symptomatic rotator cuff tear had upon activities of daily living, leisure activities and occupation was described. The emotional and financial impact and impact upon caring roles were detailed. Coping strategies included attempting to carry on as normally as possible, accepting their condition, using their other arm, using analgesics, aids and adaptions. Conclusions Clinicians need to appreciate and understand the intensity and shocking nature of pain that may be experienced by participants with known rotator cuff tears and understand the detrimental impact tears can have upon all areas of patient’s lives. Clinicians also need to be aware of the potential emotional impact caused by cuff tears and to ensure that patients needing help for conditions such as depression are speedily identified and provided with support, explanation and appropriate treatment.

2014-01-01

384

Evaluation of medial meniscus tears and meniscal stability: weight-bearing MRI vs arthroscopy.  

PubMed

To assess the role of dedicated low-field standard and weight-bearing MRI in the evaluation of stable or unstable tears of medial meniscus in comparison with arthroscopy. Our series included 1750 knee MRI scans performed with a high-field MRI scanner from July 2010 to August 2011. We retrospectively reviewed and analyzed 20 MRI exams of normal knee and 57 MRI exams of knee with clinical evidence of tears of the medial meniscus. In the same session, after conventional 1.5T and "dedicated" 0.25T supine MRI exam, the patients underwent weight-bearing examination with the same dedicated MRI unit. In all cases sagittal and coronal PD-W were used. All patients underwent arthroscopy 18-25 days after the weight-bearing MRI. In the first group, no statistically significant anatomical modifications of shape, intensity and position of the medial meniscus between standard 1.5T, dedicated supine and upright MRI were observed. In group A, the images acquired in the supine position (dedicated and 1.5T MRI) documented in 21 cases a traumatic tear (group 2A) and in 36 cases a degenerative tear (group 2B). In group 2A, weight-bearing MRI showed presence of unstable tear a degenerative unstable meniscal tear only in 19 out of 36 cases. In group 2B, weight-bearing MRI showed only in 9 out 21 cases. Arthroscopy confirmed weight-bearing MRI diagnosis in all cases. This new approach to meniscus pathology gives an important contribution to a better management of a diagnostic-therapeutic approach in which standard MRI has not played a key role, so far. PMID:23199751

Barile, Antonio; Conti, Laura; Lanni, Giuseppe; Calvisi, Vittorio; Masciocchi, Carlo

2013-04-01

385

Tear nitric oxide levels in Behçet's disease.  

PubMed

The aim of this study was to evaluate the tear nitric oxide (NO) level in patients with Behçet's disease and to compare it with that in healthy subjects. MATERIAL AND METHODS. The subjects were divided into 3 groups: the active disease, inactive disease, and control groups. NO concentrations were determined by a nitrate/nitrite colorimetric assay kit and measured spectrophotometrically at 540 nm. RESULTS. The tear nitrate/nitrite levels were 0.06 nmol/?L (SD, 0.05) in the active disease group, 0.05 nmol/?L (SD, 0.05) in the inactive disease group, and 0.02 nmol/?L (SD, 0.01) in the control group. The tear nitrate/nitrite levels of both active and inactive groups were higher than those of the control group (P=0.001 and P=0.047, respectively), but there was no significant difference between the active and inactive groups. CONCLUSION. Our results demonstrated that the tear NO levels were elevated in the patients with Behçet's disease. We imply that a better understanding of NO function in the pathogenesis of Behçet uveitis is necessary to develop new therapies based on the inhibitors of NO synthases. PMID:23455889

??can, Yalç?n; Yi?it, Ulviye; Tu?cu, Betül Çakmak; Erdo?an, Mehmet; Erdo?an, Derya Ars; Öner, Veysi; Ta?, Mehmet; Özyazgan, Y?lmaz

2012-01-01

386

A case of recurrent bloody tears  

PubMed Central

Well-known causes of blood-tinged epiphora are conjunctival lesions, tumors of the lacrimal apparatus, and systemic bleeding disorders. We describe an unusual patient who presented with recurrent episodes of bloody tearing which began following an erythema multiforme-like drug eruption. He experienced chronic conjunctivitis which resulted in a few minor symblephara. One year later, the patient developed attacks of bloody tearing. All clinical, radiologic, and laboratory investigations related to bloody epiphora were within normal limits except for a mild, nonspecific chronic inflammatory reaction in the perivascular tissues of the lacrimal gland and orbital soft tissues. Also, an increase in vascular permeability and contrast extravasation on carotid angiography was detected. High-dose vitamin C was administered. The patient continued to have unilateral bloody tears intermittently for two years, but the episodes became much less frequent and had resolved by three years. It is conceivable that increased vascular permeability following the systemic inflammatory process could have played a role in the etiology of recurrent bloody tears in this atypical patient.

Karsl?oglu, Safak; Simsek, Ilke Bahceci; Akbaba, Muslime

2011-01-01

387

An Athlete's Nightmare: Tearing the ACL  

MedlinePLUS

... ACL tear. Recent studies have shown that young female athletes sustain more ACL injuries than young males. ... is that women have more of a knock-knee alignment," says Dr. Boden, who is conducting research on the injury with funding from the National Institutes of Health. " ...

388

Hybrid simulations of collisionless ion tearing  

Microsoft Academic Search

Ion tearing in a thin collisionless neutral sheet is investigated using hybrid (particle ion, massless fluid electron) simulations in which dissipation effects are included through a model of the full electron pressure tensor in which self-consistently generated anisotropies are reduced via an isotropization time factor. The linear growth rates and ion dynamics are in qualitative agreement with linear theory and

Michael Hesse; Dan Winske

1993-01-01

389

Specialization of tendon mechanical properties results from interfascicular differences  

PubMed Central

Tendons transfer force from muscle to bone. Specific tendons, including the equine superficial digital flexor tendon (SDFT), also store and return energy. For efficient function, energy-storing tendons need to be more extensible than positional tendons such as the common digital extensor tendon (CDET), and when tested in vitro have a lower modulus and failure stress, but a higher failure strain. It is not known how differences in matrix organization contribute to distinct mechanical properties in functionally different tendons. We investigated the properties of whole tendons, tendon fascicles and the fascicular interface in the high-strain energy-storing SDFT and low-strain positional CDET. Fascicles failed at lower stresses and strains than tendons. The SDFT was more extensible than the CDET, but SDFT fascicles failed at lower strains than CDET fascicles, resulting in large differences between tendon and fascicle failure strain in the SDFT. At physiological loads, the stiffness at the fascicular interface was lower in the SDFT samples, enabling a greater fascicle sliding that could account for differences in tendon and fascicle failure strain. Sliding between fascicles prior to fascicle extension in the SDFT may allow the large extensions required in energy-storing tendons while protecting fascicles from damage.

Thorpe, Chavaunne T.; Udeze, Chineye P.; Birch, Helen L.; Clegg, Peter D.; Screen, Hazel R. C.

2012-01-01

390

Evaporation-driven instability of the precorneal tear film.  

PubMed

Tear-film instability is widely believed to be a signature of eye health. When an interblink is prolonged, randomly distributed ruptures occur in the tear film. "Black spots" and/or "black streaks" appear in 15 to 40 s for normal individuals. For people who suffer from dry eye, tear-film breakup time (BUT) is typically less than a few seconds. To date, however, there is no satisfactory quantitative explanation for the origin of tear rupture. Recently, it was proposed that tear-film breakup is related to locally high evaporative thinning. A spatial variation in the thickness of the tear-film lipid layer (TFLL) may lead to locally elevated evaporation and subsequent tear-film breakup. We examine the local-evaporation-driven tear-film-rupture hypothesis in a one-dimensional (1-D) model for the evolution of a thin aqueous tear film overriding the cornea subject to locally elevated evaporation at its anterior surface and osmotic water influx at its posterior surface. Evaporation rate depends on mass transfer both through the coating lipid layer and through ambient air. We establish that evaporation-driven tear-film breakup can occur under normal conditions but only for higher aqueous evaporation rates. Predicted roles of environmental conditions, such as wind speed and relative humidity, on tear-film stability agree with clinical observations. More importantly, locally elevated evaporation leads to hyperosmolar spots in the tear film and, hence, vulnerability to epithelial irritation. In addition to evaporation rate, tear-film instability depends on the strength of healing flow from the neighboring region outside the breakup region, which is determined by the surface tension at the tear-film surface and by the repulsive thin-film disjoining pressure. This study provides a physically consistent and quantitative explanation for the formation of black streaks and spots in the human tear film during an interblink. PMID:23842140

Peng, Cheng-Chun; Cerretani, Colin; Braun, Richard J; Radke, C J

2014-04-01

391

The use of motion analysis to measure pain-related behaviour in a rat model of degenerative tendon injuries.  

PubMed

Chronic tendinopathy is characterized with longstanding activity-related pain with degenerative tendon injuries. An objective tool to measure painful responses in animal models is essential for the development of effective treatment for tendinopathy. Gait analysis has been developed to monitor the inflammatory pain in small animals. We reported the use of motion analysis to monitor gait changes in a rat model of degenerative tendon injury. Intratendinous injection of collagenase into the left patellar tendon of Sprague Dawley rat was used to induce degenerative tendon injury, while an equal volume of saline was injected in the control groups. Motion analyses with a high speed video camera were performed on all rats at pre-injury, 2, 4, 8, 12 or 16 weeks post injection. In the end-point study, the rats were sacrificed to obtain tendon samples for histological examination after motion analyses. In the follow-up study, repeated motion analyses were performed on another group of collagenase-treated and saline-treated rats. The results showed that rats with injured patellar tendon exhibited altered walking gait as compared to the controls. The change in double stance duration in the collagenase-treated rats was reversible by administration of buprenorphrine (p=0.029), it suggested that the detected gait changes were associated with pain. Comparisons of end-point and follow-up studies revealed the confounding effects of training, which led to higher gait velocities and probably a different adaptive response to tendon pain in the trained rats. The results showed that motion analysis could be used to measure activity-related chronic tendon pain. PMID:19428542

Fu, Sai-Chuen; Chan, Kai-Ming; Chan, Lai-Shan; Fong, Daniel Tik-Pui; Lui, Po-Yee Pauline

2009-05-15

392

Comparison study of indirect MR arthrography and direct MR arthrography of the shoulder  

Microsoft Academic Search

Objective  To compare the diagnostic value of indirect magnetic resonance arthrography (I-MRA) with that of direct MR arthrography (D-MRA)\\u000a for labral tears, rotator cuff tears, and long head of biceps tendon (LHBT) tears using a 3-T MR unit.\\u000a \\u000a \\u000a \\u000a Materials and methods  Institutional review board approval was given; written informed consent was obtained from all patients. From November 2005\\u000a to June 2006, 19

Jee Young Jung; Young Cheol Yoon; Sang-Kyu Yi; Jaechul Yoo; Bong-Keun Choe

2009-01-01

393

The Effect of Tendon Surface Treatment on Cell Attachment for Potential Enhancement of Tendon Graft Healing: An Ex Vivo Model  

PubMed Central

For both tendon allografts and autografts, the surface, initially optimized for gliding, may not be ideal to facilitate tissue integration for graft healing to host tendon or bone. As a prelude to studying tendon-bone integration, we investigated the effect of surface treatments with trypsin or mechanical abrasion on cell attachment to the tendon surface in a canine ex vivo intrasynovial tendon tissue culture model. Intrasynovial tendon allograft surfaces were seeded with cells after the following treatments: 1) no treatment, 2) mechanical abrasion, 3) trypsin, 4) abrasion and trypsin. The area covered by cells was determined using confocal laser microscopy at one and two weeks. Results were compared to untreated extrasynovial tendon. Additional tendons were characterized with scanning electron microscopy. Tendons with trypsin treatment had significantly more surface coverage with cells than the other groups, after both one and two weeks of culture. In terms of the cellular shape and size, cells on tendons with trypsin treatment spread more and were more polygonal in shape, whereas tendons with mechanical abrasion with/without trypsin treatment contained smaller, more spindle-like cells. Surface roughening can affect cell behavior with topographical stimulation. Trypsin surface digestion exposes a mesh-like structure on the tendon surface, which could enhance cell adherence and, possibly, tendon/bone healing.

Hashimoto, Takahiro; Sun, Yu-Long; An, Kai-Nan; Amadio, Peter C.; Zhao, Chunfeng

2012-01-01

394

Ultrastructural aspects of rat tail tendon sheaths.  

PubMed Central

An investigation was carried out on the sheaths which envelop rat tail tendons. The samples were processed for observation by light and electron microscopy. In the case of electron microscopy, thin sections of specimens embedded in epoxy resin and replicas of freeze etched samples were used. On the basis of histological and ultrastructural observations, four distinct connective tissue sheaths have been detected. The paratendineum is a thick fibrous sheath that covers externally the four groups of tendons arranged around the vertebrae of the tail; the epitendineum is a distinct fibrous sheath surrounding each tendon group; the peritendineum is composed of concentric cellular laminae enveloping each tendon; lastly, the endotendineum is made up of one cellular lamella which adheres to the fibres of the tendon, projecting trabeculae between the individual tendon fascicles. In the para- and epitendineum, thick bundles of collagen fibrils, running parallel to the fibres of the tendon, were visible. The collagen fibrils had a wide variability of diameters (from 35 to 220 nm) and, when examined in replica, their microfibrillar arrangement appeared to be straight. In the peri- and endotendineum, thin bundles of collagen fibrils were visible between the cellular laminae, parallel to the main axis of the tendon. Among these collagen bundles, elastic fibres and numerous glycoproteins containing microfibril-like filaments were visible. The collagen fibrils were small and of uniform diameter (50 nm) and, when observed on replica, showed a helicoidal microfibrillar arrangement. The cell layers of the peri- and endotendineum were made up of flattened fibroblasts which were connected by specialised junctions and which contained numerous micropinocytotic vesicles. A thin layer of granular electron-dense material, with ultrastructural characteristics similar to those of a basement membrane, was visible on the surface of the most external cellular layer of the peritendineum and on the outer surface of the cellular lamella of the endotendineum. Due to their morphological characteristics it is supposed that the four tendon sheaths are involved in different and special functions. Moreover, collagen Type I and collagen Type III, demonstrated by means of immunofluorescence techniques in previous investigations, show respectively a close similarity in distribution to the thick collagen fibrils, with a straight microfibrillar arrangement, of the two external sheaths, and to the thin collagen fibrils, with a helicoidal microfibrillar arrangement, of the two internal sheaths. Images Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 Fig. 7 Fig. 8 Fig. 9

Strocchi, R; Leonardi, L; Guizzardi, S; Marchini, M; Ruggeri, A

1985-01-01

395

21 CFR 888.3025 - Passive tendon prosthesis.  

Code of Federal Regulations, 2010 CFR

...SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3025 Passive tendon prosthesis. (a...use in the surgical reconstruction of a flexor tendon of the hand. The device is implanted for a period of 2 to 6...

2009-04-01

396

21 CFR 888.3025 - Passive tendon prosthesis.  

Code of Federal Regulations, 2010 CFR

...SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3025 Passive tendon prosthesis. (a...use in the surgical reconstruction of a flexor tendon of the hand. The device is implanted for a period of 2 to 6...

2010-04-01

397

MR Imaging-based Diagnosis and Classification of Meniscal Tears.  

PubMed

Magnetic resonance (MR) imaging is currently the modality of choice for detecting meniscal injuries and planning subsequent treatment. A thorough understanding of the imaging protocols, normal meniscal anatomy, surrounding anatomic structures, and anatomic variants and pitfalls is critical to ensure diagnostic accuracy and prevent unnecessary surgery. High-spatial-resolution imaging of the meniscus can be performed using fast spin-echo and three-dimensional MR imaging sequences. Normal anatomic structures that can mimic a tear include the meniscal ligament, meniscofemoral ligaments, popliteomeniscal fascicles, and meniscomeniscal ligament. Anatomic variants and pitfalls that can mimic a tear include discoid meniscus, meniscal flounce, a meniscal ossicle, and chondrocalcinosis. When a meniscal tear is identified, accurate description and classification of the tear pattern can guide the referring clinician in patient education and surgical planning. For example, longitudinal tears are often amenable to repair, whereas horizontal and radial tears may require partial meniscectomy. Tear patterns include horizontal, longitudinal, radial, root, complex, displaced, and bucket-handle tears. Occasionally, meniscal tears can be difficult to detect at imaging; however, secondary indirect signs, such as a parameniscal cyst, meniscal extrusion, or linear subchondral bone marrow edema, should increase the radiologist's suspicion for an underlying tear. Awareness of common diagnostic errors can ensure accurate diagnosis of meniscal tears. Online supplemental material is available for this article. ©RSNA, 2014. PMID:25019436

Nguyen, Jie C; De Smet, Arthur A; Graf, Ben K; Rosas, Humberto G

2014-01-01

398

Tear function and ocular surface after muller muscle- conjunctival resection.  

PubMed

Muller muscle-conjunctival resection (MCR) is a surgical technique to correct mild and moderate ptosis. In this study, tear function tests and ocular surface are evaluated in patients who underwent unilateral surgery. Sixteen patients with normal preoperative tear function who underwent unilateral MCR were evaluated prospectively. The fellow eyes of the patients were taken as the control group. A dry eye assessment questionnaire, Schirmer testing, tear film break-up time, fluorescein stain, Rose-Bengal stain, and conjunctival impression cytology were used to assess the tear film functions and ocular surface changes in the operated and non-operated eyes. There was no statistically significant difference in the tear function tests and goblet cell densities between the operated and non-operated eyes. The results indicate that an MCR procedure has no apparent effect on tear function tests and goblet cell density in patients with normal preoperative tear function. PMID:24088631

U?urba?, Suat Hayri; Alpay, Atilla; Bahad?r, Burak; U?urba?, S?lay Cant Rk

2014-05-01

399

Tear function and ocular surface after muller muscle- conjunctival resection  

PubMed Central

Muller muscle-conjunctival resection (MCR) is a surgical technique to correct mild and moderate ptosis. In this study, tear function tests and ocular surface are evaluated in patients who underwent unilateral surgery. Sixteen patients with normal preoperative tear function who underwent unilateral MCR were evaluated prospectively. The fellow eyes of the patients were taken as the control group. A dry eye assessment questionnaire, Schirmer testing, tear film break-up time, fluorescein stain, Rose-Bengal stain, and conjunctival impression cytology were used to assess the tear film functions and ocular surface changes in the operated and non-operated eyes. There was no statistically significant difference in the tear function tests and goblet cell densities between the operated and non-operated eyes. The results indicate that an MCR procedure has no apparent effect on tear function tests and goblet cell density in patients with normal preoperative tear function.

Ugurbas, Suat Hayri; Alpay, Atilla; Bahad?r, Burak; Ugurbas, S?lay Canturk

2014-01-01

400

Arthroscopic fixation with a minimally invasive axillary approach for latissimus dorsi transfer using an endobutton in massive and irreparable postero-superior cuff tears  

PubMed Central

Arthroscopically assisted latissimus dorsi transfer is a viable option for treatment of patients in their 50s to 70s, without arthritis of the glenohumeral joint, who suffer from massive rotator cuff tears that are not amendable to primary repair due to fatty changes in the muscle tissue, or that have failed previous repair attempts. This procedure offers immediate and dramatic pain relief and is not as technically demanding as one might think. Understanding and respecting the principles of tendon transfer is a key to the success of this procedure.

Goldstein, Yariv; Grimberg, Jean; Valenti, Philippe; Chechik, Ofir; Drexler, Michael; Kany, Jean

2013-01-01

401

Lateral force transmission between human tendon fascicles.  

PubMed

Whether adjacent collagen fascicles transmit force in parallel is unknown. The purpose of the present study was to examine the magnitude of lateral force transmission between adjacent collagen fascicles from the human patellar and Achilles tendon. From each sample two adjacent strands of fascicles (phi 300-530 mum) enclosed in a fascicular membrane were dissected. The specimen was deformed to approximately 3% strain in three independent load-displacement cycles in a small-scale tensile testing device. Cycle 1: the fascicles and the fascicular membrane were intact. Cycle 2: one fascicle was transversally cut while the other fascicle and the fascicular membrane were kept intact. Cycle 3: both fascicles were cut in opposite ends while the fascicular membrane was left intact. A decline in peak force of 45% and 55% from cycle 1 to cycle 2, and 93% and 92% from cycle 2 to cycle 3 was observed in the patellar and Achilles tendon fascicles, respectively. A decline in stiffness of 39% and 60% from cycle 1 to cycle 2, and of 93% and 100% from cycle 2 to cycle 3 was observed in the patellar and Achilles tendon fascicles, respectively. The present data demonstrate that lateral force transmission between adjacent collagen fascicles in human tendons is small or negligible, suggesting that tendon fascicles largely act as independent structures and that force transmission principally takes place within the individual fascicles. PMID:17931846

Haraldsson, Bjarki T; Aagaard, Per; Qvortrup, Klaus; Bojsen-Moller, Jens; Krogsgaard, Michael; Koskinen, Satu; Kjaer, Michael; Magnusson, S Peter

2008-03-01

402

Tendon crimps and peritendinous tissues responding to tensional forces.  

PubMed

Tendons transmit forces generated from muscle to bone making joint movements possible. Tendon collagen has a complex supramolecular structure forming many hierarchical levels of association; its main functional unit is the collagen fibril forming fibers and fascicles. Since tendons are enclosed by loose connective sheaths in continuity with muscle sheaths, it is likely that tendon sheaths could play a role in absorbing/transmitting the forces created by muscle contraction. In this study rat Achilles tendons were passively stretched in vivo to be observed at polarized light microscope (PLM), scanning electron microscope (SEM) and transmission electron microscope (TEM). At PLM tendon collagen fibers in relaxed rat Achilles tendons ran straight and parallel, showing a periodic crimp pattern. Similarly tendon sheaths showed apparent crimps. At higher magnification SEM and TEM revealed that in each tendon crimp large and heterogeneous collagen fibrils running straight and parallel suddenly changed their direction undergoing localized and variable modifications. These fibril modifications were named fibrillar crimps. Tendon sheaths displayed small and uniform fibrils running parallel with a wavy course without any ultrastructural aspects of crimp. Since in passively stretched Achilles tendons fibrillar crimps were still observed, it is likely that during the tendon stretching, and presumably during the tendon elongation in muscle contraction, the fibrillar crimp may be the real structural component of the tendon crimp acting as shock absorber. The peritendinous sheath can be stretched as tendon, but is not actively involved in the mechanism of shock absorber as the fibrillar crimp. The different functional behaviour of tendons and sheaths may be due to the different structural and molecular arrangement of their fibrils. PMID:17703588

Franchi, M; Quaranta, M; De Pasquale, V; Macciocca, M; Orsini, E; Trirè, A; Ottani, V; Ruggeri, A

2007-01-01

403

Structure-function relationships in tendons: a review  

PubMed Central

The purpose of the current review is to highlight the structure-function relationship of tendons and related structures to provide an overview for readers whose interest in tendons needs to be underpinned by anatomy. Because of the availability of several recent reviews on tendon development and entheses, the focus of the current work is primarily directed towards what can best be described as the ‘tendon proper’ or the ‘mid-substance’ of tendons. The review covers all levels of