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.
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 tendon structure from the molecular to the gross and deals both with the extracellular matrix and with tendon cells. The latter are often called ‘tenocytes’ and are increasingly recognized as a defined cell population that is functionally and phenotypically distinct from other fibroblast-like cells. This is illustrated by their response to different types of mechanical stress. However, it is not only tendon cells, but tendons as a whole that exhibit distinct structure-function relationships geared to the changing mechanical stresses to which they are subject. This aspect of tendon biology is considered in some detail. Attention is briefly directed to the blood and nerve supply of tendons, for this is an important issue that relates to the intrinsic healing capacity of tendons. Structures closely related to tendons (joint capsules, tendon sheaths, pulleys, retinacula, fat pads and bursae) are also covered and the concept of a ‘supertendon’ is introduced to describe a collection of tendons in which the function of the whole complex exceeds that of its individual members. Finally, attention is drawn to the important relationship between tendons and fascia, highlighted by Wood Jones in his concept of an ‘ectoskeleton’ over half a century ago – work that is often forgotten today.
Benjamin, M; Kaiser, E; Milz, S
. The purpose of this study was to investigate the differences in the viscoelastic properties of human tendon structures (tendon\\u000a and aponeurosis) in the medial gastrocnemius muscle between men (n=16) and women (n=13). The elongation of the tendon and aponeurosis of the medial gastrocnemius muscle was measured directly by ultrasonography,\\u000a while the subjects performed ramp isometric plantar flexion up to
Keitaro Kubo; Hiroaki Kanehisa; Tetsuo Fukunaga
...Inservice Inspection of Prestressed Concrete Containment Structures With Grouted Tendons...Inservice Inspection of Prestressed Concrete Containment Structures with Grouted Tendons...surveillance program for prestressed concrete containment structures with grouted...
The aging population is at an increased risk of tendon injury and tendinopathy. Elucidating the molecular basis of tendon aging is crucial to understanding the age-related changes in structure and function in this vulnerable tissue. In this study, the structural and functional features of tendon aging are investigated. In addition, the roles of decorin and biglycan in the aging process were analyzed using transgenic mice at both mature and aged time points. Our hypothesis is that the increase in tendon injuries in the aging population is the result of altered structural properties that reduce the biomechanical function of the tendon and consequently increase susceptibility to injury. Decorin and biglycan are important regulators of tendon structure and therefore, we further hypothesized that decreased function in aged tendons is partly the result of altered decorin and biglycan expression. Biomechanical analyses of mature (day 150) and aged (day 570) patellar tendons revealed deteriorating viscoelastic properties with age. Histology and polarized light microscopy demonstrated decreased cellularity, alterations in tenocyte shape, and reduced collagen fiber alignment in the aged tendons. Ultrastructural analysis of fibril diameter distributions indicated an altered distribution in aged tendons with an increase of large diameter fibrils. Aged wild type tendons maintained expression of decorin which was associated with the structural and functional changes seen in aged tendons. Aged patellar tendons exhibited altered and generally inferior properties across multiple assays. However, decorin-null tendons exhibited significantly decreased effects of aging compared to the other genotypes. The amelioration of the functional deficits seen in the absence of decorin in aged tendons was associated with altered tendon fibril structure. Fibril diameter distributions in the decorin-null aged tendons were comparable to those observed in the mature wild type tendon with the absence of the subpopulation containing large diameter fibrils. Collectively, our findings provide evidence for age-dependent alterations in tendon architecture and functional activity, and further show that lack of stromal decorin attenuates these changes.
Dunkman, Andrew A.; Buckley, Mark R.; Mienaltowski, Michael J.; Adams, Sheila M.; Thomas, Stephen J.; Satchell, Lauren; Kumar, Akash; Pathmanathan, Lydia; Beason, David P.; Iozzo, Renato V.; Birk, David E.; Soslowsky, Louis J.
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
Proper replacement or repair of damaged tendons or ligaments requires functionally engineered tissue that mimics their native mechanical properties. While tendon structure–function relationships are generally assumed, there exists little quantitative evidence of the roles of distinct tendon components in tendon function. Previous work has used linear correlations to assess the independent, univariate effects of one structural or one biochemical variable
Paul S. Robinson; Tony W. Lin; Abbas F. Jawad; Renato V. Iozzo; Louis J. Soslowsky
This review highlights recent research on structure-function relationships in tendon and comments on the parallels between development and healing. The processes of tendon development and collagen fibrillogenesis are reviewed, but due to the abundance of information in this field, this work focuses primarily on characterizing the mechanical behavior of mature and developing tendon, and how the latter parallels healing tendon. The role that extracellular matrix components, mainly collagen, proteoglycans, and collagen cross-links, play in determining the mechanical behavior of tendon will be examined in this review. Specifically, collagen fiber re-alignment and collagen fibril uncrimping relate mechanical behavior to structural alterations during development and during healing. Finally, attention is paid to a number of recent efforts to augment injured tendon and how future efforts could focus on recreating the important structure-function relationships reviewed here.
Connizzo, Brianne K.; Yannascoli, Sarah M.; Soslowsky, Louis J.
Achilles tendon injuries affect both athletes and the general population, and their incidence is rising. In particular, the Achilles tendon is subject to dynamic loading at or near failure loads during activity, and fatigue induced damage is likely a contributing factor to ultimate tendon failure. Unfortunately, little is known about how injured Achilles tendons respond mechanically and structurally to fatigue loading during healing. Knowledge of these properties remains critical to best evaluate tendon damage induction and the ability of the tendon to maintain mechanical properties with repeated loading. Thus, this study investigated the mechanical and structural changes in healing mouse Achilles tendons during fatigue loading. Twenty four mice received bilateral full thickness, partial width excisional injuries to their Achilles tendons (IACUC approved) and twelve tendons from six uninjured mice were used as controls. Tendons were fatigue loaded to assess mechanical and structural properties simultaneously after 0, 1, 3, and 6 weeks of healing using an integrated polarized light system. Results showed that the number of cycles to failure decreased dramatically (37-fold, p<0.005) due to injury, but increased throughout healing, ultimately recovering after 6 weeks. The tangent stiffness, hysteresis, and dynamic modulus did not improve with healing (p<0.005). Linear regression analysis was used to determine relationships between mechanical and structural properties. Of tendon structural properties, the apparent birefringence was able to best predict dynamic modulus (R(2)=0.88-0.92) throughout healing and fatigue life. This study reinforces the concept that fatigue loading is a sensitive metric to assess tendon healing and demonstrates potential structural metrics to predict mechanical properties. PMID:24280564
Freedman, Benjamin R; Sarver, Joseph J; Buckley, Mark R; Voleti, Pramod B; Soslowsky, Louis J
Recent developments in the new field of auto-adaptive materials offer promising opportunities for developing radically new fastening mechanisms. One of the classes of materials in this category is Shape Memory Alloys (SMAs). SMAs are very attractive for structural application because of their major constitutive behaviors such as pseudoelastic characteristic. Pseudoelastic behavior of NiTi SMAs is a unique hysteretic energy dissipation behavior that combined with a very long fatigue life makes SMAs a viable candidate for developing new fasteners. Pseudoelastic behavior of Shape Memory Alloys, particularly NiTI, can be used for developing passive fastening-mechanisms and tendon-systems. In case of coastal structures, where hurricane destruction inflicted upon residential structures results in million of dollar in financial damages and loss of lives each year, development of more effective fastening-mechanisms and tendon-systems for the connections between the walls and the roofs will aid in damage reduction. A study carried out by the authors has shown that the extent of damping effect of a hybrid tendon-system, made of rigid NiTi sections directly depends on the length-ratio of the rigid NiTi section, tendon diameter and the amount of pre-strain on the tendon. Moreover, because of tendon-system passive design the nature of excitation has a profound effect on its activation and damping capability. In this paper effectiveness of a hybrid NiTi tendon-system for damage mitigation of coastal structures and optimal hybrid tendon length-ratio are studied.
Saadat, Soheil; Noori, Mohammad N.; Davoodi, Hamid; Hou, Zhikun; Masuda, Arata
Muscle performance is closely related to the architecture and dimensions of the muscle-tendon unit and the effect of maturation on these architectural characteristics in humans is currently unknown. This study determined whether there are differences in musculo-tendinous architecture between adults and children of both sexes. Fascicle length and pennation angle were measured from ultrasound images at three sites along the length of the vastus intermedius, vastus lateralis, vastis medialis and rectus femoris muscles. Muscle volume and muscle-tendon length were measured from magnetic resonance images. Muscle physiological cross-sectional area (PCSA) was calculated as the ratio of muscle volume to optimum fascicle length. Fascicle length was greater in the adult groups than in children (P < 0.05) but pennation angle did not differ between groups (P > 0.05). The ratios between fascicle and muscle length and between fascicle and tendon length were not different (P > 0.05) between adults and children for any quadriceps muscle. Quadriceps volume and PCSA of each muscle were greater in adults than children (P < 0.01) but the relative proportion of each head to the total quadriceps volume was similar in all groups. However, the difference in PCSA between adults and children (men approximately 104% greater than boys, women approximately 57% greater than girls) was greater (P < 0.05) than the difference in fascicle length (men approximately 37% greater than boys, women approximately 10% greater than girls). It is concluded that the fascicle, muscle and tendon lengthen proportionally during maturation, thus the muscle-tendon stiffness and excursion range are likely to be similar in children and adults but the relatively greater increase in PCSA than fascicle length indicates that adult muscles are better designed for force production than children's muscles. PMID:20345856
O'Brien, Thomas D; Reeves, Neil D; Baltzopoulos, Vasilios; Jones, David A; Maganaris, Constantinos N
The present study investigated the structural changes in the rat calcaneal tendon (CT), superficial flexor tendon (SFT), and deep flexor tendon (DFT) in response to jump exercises and anabolic androgenic steroids (AAS). Animals were divided into four groups: sedentary, trained, AAS-treated sedentary rats, and AAS-treated trained animals. Training increased the volume density (Vv%) of blood vessels in all regions of the CT and DFT, cell Vv% in the peritendinous sheath of the proximal and distal regions of the SFT and proximal region of DFT, and cell Vv% in the tendon proper of the proximal and distal regions of the SFT and DFT. The combination of AAS and load exercises showed little increased blood vessel Vv% at the proximal region of the CT, intermediate region of the SFT, and all regions of the DFT as opposed to an increase in adipose cell Vv% in the CT proximal region. The AAS reduced the levels of hydroxyproline in the proximal region of the DFT and in the distal region of the STF. In conclusion, exercise promoted benefits to the adaptation of the tendons to overload. These effects were absent when load exercise was combined with AAS. The abusive consumption of AAS contributes to tendon inertness and rigidity, and increases the potential risk of injury. PMID:24224869
Marqueti, R C; Paulino, M G; Fernandes, M N; de Oliveira, E M; Selistre-de-Araujo, H S
Tendons have complex mechanical properties that depend on their structure and composition. Some studies have assessed the role of small leucine-rich proteoglycans (SLRPs) in the mechanical response of tendon, but the relationships between sophisticated mechanics, assembly of collagen and SLRPs have not been well characterized. In this study, biglycan gene expression was varied in a dose dependent manner using biglycan null, biglycan heterozygote and wild type mice. Measures of mechanical (tension and compression), compositional and structural changes of the mouse patellar tendon were evaluated. Viscoelastic, tensile dynamic modulus was found to be increased in the biglycan heterozygous and biglycan null tendons compared to wild type. Gene expression analyses revealed biglycan gene expression was closely associated in a dose-dependent allelic manner. No differences were seen between genotypes in elastic or compressive properties or quantitative measures of collagen structure. These results suggest that biglycan, a member of the SLRP family, plays a role in tendon viscoelasticity that cannot be completely explained by its role in collagen fibrillogenesis.
Dourte, LeAnn M.; Pathmanathan, Lydia; Mienaltowski, Michael J.; Jawad, Abbas F.; Birk, David E.; Soslowsky, Louis J.
This study aims to demonstrate how the state of chronic hyperglycemia from experimental Diabetes Mellitus can influence the homeostatic imbalance of tendons and, consequently, lead to the characteristics of tendinopathy. Twenty animals were randomly divided into two experimental groups: control group, consisting of healthy rats and diabetic group constituted by rats induced to Diabetes Mellitus I. After twenty-four days of the induction of Diabetes type I, the Achilles tendon were removed for morphological evaluation, cellularity, number and cross-sectional area of blood vessel, immunohistochemistry for Collagen type I, VEGF and NF-?B nuclear localization sequence (NLS) and nitrate and nitrite level. The Achilles tendon thickness (µm/100g) of diabetic animals was significantly increased and, similarly, an increase was observed in the density of fibrocytes and mast cells in the tendons of the diabetic group. The average number of blood vessels per field, in peritendinous tissue, was statistically higher in the diabetic group 3.39 (2.98) vessels/field when compared to the control group 0.89 (1.68) vessels/field p?=?0.001 and in the intratendinous region, it was observed that blood vessels were extremely rare in the control group 0.035 (0.18) vessels/field and were often present in the tendons of the diabetic group 0.89 (0.99) vessels/field. The immunohistochemistry analysis identified higher density of type 1 collagen and increased expression of VEGF as well as increased immunostaining for NF?B p50 NLS in the nucleus in Achilles tendon of the diabetic group when compared to the control group. Higher levels of nitrite/nitrate were observed in the experimental group induced to diabetes. We conclude that experimental DM induces notable structural, inflammatory and vascular changes in the Achilles tendon which are compatible with the process of chronic tendinopathy.
de Oliveira, Rodrigo R.; Martins, Conceicao S.; Rocha, Yuri R.; Braga, Allysson B. R.; Mattos, Romulo M.; Hecht, Fabio; Brito, Gerly A. C.; Nasciutti, Luiz E.
Whole Body Vibration (WBV) is becoming increasingly popular for helping to maintain bone mass and strengthening muscle. Vibration regimens optimized for bone maintenance often operate at hypogravity levels (<1 G) and regimens for muscle strengthening often employ hypergravity (>1 G) vibrations. The effect of vibratory loads on tendon and ligament properties is unclear though excessive vibrations may be injurious. Our objective was to evaluate how tendon gene expression and the mechanical/histological properties of tendon and ligament were affected in response to WBV in the following groups: no vibration, low vibration (0.3 G peak-to-peak), and high vibration (2 G peak-to-peak). Rats were vibrated for 20 min a day, 5 days a week, for 5 weeks. Upon sacrifice, the medial collateral ligament (MCL), patellar tendon (PT), and the Achilles Tendon (AT) were isolated with insertion sites intact. All tissues were tensile tested to determine structural and material properties or used for histology. Patellar tendon was also subjected to quantitative RT-PCR to evaluate expression of anabolic and catabolic genes. No differences in biomechanical data between the control and the low vibration groups were found. There was evidence of significant weakness in the MCL with high vibration, but no significant effect on the PT or AT. Histology of the MCL and PT showed a hypercellular tissue response and some fiber disorganization with high vibration. High vibration caused an increase in collagen expression and a trend for an increase in IGF-1 expression suggesting a potential anabolic response to prevent tendon overuse injury.
Keller, Benjamin V.; Davis, Matthew L.; Thompson, William R.; Dahners, Laurence E.; Weinhold, Paul S.
For a nuclear containment structure, the structural health monitoring is essential because of its high potential risk and grave social impact. In particular, the tendon and anchorage zone are to be monitored because they are under high tensile or compressive stress. In this paper, a method to monitor the tendon force and the condition of the anchorage zone is presented by using the impedance-based health diagnosis system. First, numerical simulations were conducted for cases with various loose tensile forces on the tendon as well as damages on the bearing plate and concrete structure. Then, experimental studies were carried out on a scaled model of the anchorage system. The relationship between the loose tensile force and the impedance-based damage index was analyzed by a regression analysis. When a structure gets damaged, the damage index increases so that the status of damage can be identified. The results of the numerical and experimental studies indicate a big potential of the proposed impedance-based method for monitoring the tendon and anchorage system.
Min, Jiyoung; Shim, Hyojin; Yun, Chung-Bang
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.
Among the large number of exocrine glands described in bees, the tarsal glands were thought to be the source of footprint scent marks. However, recent studies showed that the compounds used for marking by stingless bees are secreted by leg tendon instead of tarsal glands. Here, we report on the structure of leg tendon glands in males of Bombus terrestris, together with a description of the chemical composition of their secretions and respective changes of both during the males' lives. The ultrastructure of leg tendon glands shows that the secretory cells are located in three independent regions, separated from each other by unmodified epidermal cells: in the femur, tibia, and basitarsus. Due to the common site of secretion release, the organ is considered a single secretory gland. The secretion of the leg tendon glands of B. terrestris males differs in its composition from those of workers and queens, in particular by (1) having larger proportions of compounds with longer chain lengths, which we identified as wax esters; and (2) by the lack of certain hydrocarbons (especially long chain dienes). Other differences consist in the distribution of double bond positions in the unsaturated hydrocarbons that are predominantly located at position 9 in males but distributed at seven to nine different positions in the female castes. Double bond positions may change chemical and physical properties of a molecule, which can be recognized by the insects and, thus, may serve to convey specific information. The function of male-specific compounds identified from their tendon glands remains elusive, but several possibilities are discussed.
Jarau, Stefan; Žá?ek, Petr; Šobotník, Jan; Vrkoslav, Vladimír; Hadravová, Romana; Coppée, Audrey; Vaší?ková, So?a; Jiroš, Pavel; Valterová, Irena
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
The effects of Tarantula cubensis extract (TC; Theranekron®) on the experimentally induced rupture of the superficial digital flexor tendon (SDFT) 28 days post-injury (DPI) was studied in rabbits. Forty mature White New Zealand male rabbits were randomly divided into two groups. TC was repeatedly injected subcutaneously over the lesion 3, 7 and 10 days after tenotomy and surgical anastomosis. Clinical and ultrasonographic evaluations were conducted at weekly intervals. The animals were euthanized 28 DPI and the tendons were investigated for macroscopic, histopathologic, ultrastructural, biomechanical and percent dry weight parameters. Treatment reduced signs of acute inflammation and strongly ameliorated clinical symptoms, structural organization and biomechanical properties (p < 0.05). Apparently, TC is effective in restoring the clinical, morphological and biomechanical properties of the injured SDFT in rabbits and may be valuable in human and veterinary medicine. PMID:22722667
Oryan, Ahmad; Moshiri, Ali; Raayat, Ali Reza
Proximal patellar tendinopathy occurs as an overuse injury in sport and is also characteristic of ankylosing spondylitis patients. It particularly affects the posteromedial part of the patellar tendon enthesis, although the reason for this is unclear. We investigated whether there are regional differences in the trabecular architecture of the patella or in the histology of the patellar tendon enthesis that could suggest unequal force transmission from bone to tendon. Trabecular architecture was analysed from X-rays taken with a Faxitron radiography system of the patellae of dissecting room cadavers and in magnetic resonance images of the knees of living volunteers. Structural and fractal analyses were performed on the Faxitron digital images using MatLab software. Regional differences at the enthesis in the thickness of the uncalcified fibrocartilage and the subchondral plate were evaluated histologically in cadaveric material. The radiological studies showed that the quantity of bone and the apparent trabecular thickness in the patella were greatest medially, and that in the lateral part of the patella there were fewer trabeculae which were orientated either antero-posteriorly or superiorly inferiorly. The histological study showed that the uncalcified fibrocartilage was most prominent medially and that the subchondral plate was thinner laterally. Overall, the results indicate that mechanical stress at the proximal patellar tendon enthesis is asymmetrically distributed and greater on the medial than on the lateral side. Thus, we suggest that the functional anatomy of the knee is closely related to regional variations in force transmission, which in turn relates to the posteromedial site of pathology in proximal patellar tendinopathy. PMID:16420378
Toumi, H; Higashiyama, I; Suzuki, D; Kumai, T; Bydder, G; McGonagle, D; Emery, P; Fairclough, J; Benjamin, M
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
Anatomically favorable structures that have a longitudinal orientation are particularly amenable to endoscopic harvest. Typically, only a single portal is necessary for access, and an optical cavity can be maintained using a mechanical retraction device. As with all minimal invasive surgery, this can still allow rapid and often a safer tissue harvest with diminished morbidity, especially with respect to wound healing and non-aesthetic scar formation. Many plastic surgery applications have already been described facilitated by the endoscopic harvest of vein, tendon, and nerve grafts, as well as certain local or free muscle flaps. PMID:20567684
Hallock, Geoffrey G; Rice, David C
Hurricane damage inflicted upon coastal structures, particularly residential structures, results in millions of dollars in financial damage and loss of life each year. A major cause of this damage usually begins with roof uplifts of coastal structures; prevention of roof uplift helps mitigate damage to coastal structures by hurricanes. Development of more effective fastening mechanisms for the connections between the walls and the roofs of these structures will aid in damage reduction to coastal structures. Recent developments in the new field of auto-adaptive materials offer promising opportunities for developing radically new fastening mechanisms. One of the classes of materials in this category is shape memory alloys (SMAs). SMAs are very attractive for structural application because of their major constitutive behaviors such as pseudoelastic characteristics. The pseudoelastic behavior of NiTi SMAs is a unique hysteretic energy dissipation behavior which, combined with a very long fatigue life, makes NiTi a viable candidate for developing new fasteners. However, as a first step it is important to develop an in-depth understanding of NiTi behavior under dynamic loads. Research carried out in this area has been very limited in scope. Therefore, in this paper, eight different configurations of bracing systems, divided into two categories, are explored on a single degree of freedom (SDOF) structure to investigate the feasibility of developing devices for the mitigation of hurricane damage. These bracing devices basically utilize the hysteretic energy dissipation of NiTi resulting from its pseudoelastic characteristic. Since the main goal of this ongoing research is to develop a thorough understanding of the pseudoelastic and hysteretic behavior of SMAs under severe dynamic loading/excitation, a series of earthquake data has been considered as the source of excitation. Through this analysis both the damping and stiffening characteristics of NiTi wires and the effect of these dynamic characteristics on changing the dynamic response of the structure are studied. In the first category the NiTi wires are not pre-strained, while in the second category they are pre-strained. In each category, four different combinations of wire length and modeling of pseudoelastic behavior of NiTi wire are considered. A bilinear stress-strain model is used for representing the pseudoelastic behavior of NiTi tendons, capable of representing internal yield, internal recovery and trigger line concepts. This study establishes that hybrid tendons have the highest damping and stiffening effects on the structure. It is also concluded that, when the amplitude of excitation is small, tendons act as stiffening devices. Once the amplitude of the excitation is large enough to initiate stress-induced phase transformations, tendons act as energy absorption devices. These findings provide very useful information for the development of more effective fastening devices that can withstand severe dynamic loads, such as hurricane loadings.
Saadat, S.; Noori, M.; Davoodi, H.; Hou, Z.; Suzuki, Y.; Masuda, A.
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
To obtain a better understanding of the adaptations of human tendon to chronic overloading, we examined the relationships between these adaptations and the changes in muscle structure and function. Fifteen healthy male subjects (20+/-2 yr) underwent 9 wk of knee extension resistance training. Patellar tendon stiffness and modulus were assessed with ultrasonography, and cross-sectional area (CSA) was determined along the entire length of the tendon by using magnetic resonance imaging. In the quadriceps muscles, architecture and volume measurements were combined to obtain physiological CSA (PCSA), and maximal isometric force was recorded. Following training, muscle force and PCSA increased by 31% (P<0.0001) and 7% (P<0.01), respectively. Tendon CSA increased regionally at 20-30%, 60%, and 90-100% of tendon length (5-6%; P<0.05), and tendon stiffness and modulus increased by 24% (P<0.001) and 20% (P<0.01), respectively. Although none of the tendon adaptations were related to strength gains, we observed a positive correlation between the increase in quadriceps PCSA and the increases in tendon stiffness (r=0.68; P<0.01) and modulus (r=0.75; P<0.01). Unexpectedly, the increase in muscle PCSA was inversely related to the distal and the mean increases in tendon CSA (in both cases, r=-0.64; P<0.05). These data suggest that, following short-term resistance training, changes in tendon mechanical and material properties are more closely related to the overall loading history and that tendon hypertrophy is driven by other mechanisms than those eliciting tendon stiffening. PMID:19478195
Seynnes, O R; Erskine, R M; Maganaris, C N; Longo, S; Simoneau, E M; Grosset, J F; Narici, M V
Multi-scale characterization of structures and mechanical behavior of biological tissues are of huge importance in order to evaluate the quality of a biological tissue and/or to provide bio-inspired scaffold for functional tissue engineering. Indeed, the more information on main biological tissue structures we get, the more relevant we will be to design new functional prostheses for regenerative medicine or to accurately evaluate tissues. From this perspective, we have investigated the structures and their mechanical properties from nanoscopic to macroscopic scale of fresh ex-vivo white New-Zealand rabbit Achilles tendon using second harmonic generation (SHG) microscopy, atomic force microscopy (AFM) and tensile tests to provide a "simple" model whose parameters are relevant of its micro or nano structure. Thus, collagen fiber's crimping was identified then measured from SHG images as a plane sine wave with 28.4 ± 5.8 ?m of amplitude and 141 ± 41 ?m of wavelength. Young's moduli of fibrils (3.0 GPa) and amorphous phases (223 MPa) were obtained using TH-AFM. From these investigations, a non-linear Zener model linking a statistical Weibull's distribution of taut fibers under traction to crimp fibers were developed. This model showed that for small strain (<0.1), the amorphous inter-fibrils phase in collagen fibers is more solicited than collagen fibrils themselves. The results open the way to modeled macroscopic mechanical behavior of aligned-crimped collagen soft tissues using multi-scale tendon observations under static or dynamic solicitations. PMID:23811279
Kahn, Cyril J F; Dumas, Dominique; Arab-Tehrany, Elmira; Marie, Vanessa; Tran, Nguyen; Wang, Xiong; Cleymand, Franck
The growth hormone/insulin-like growth factor-I (GH/IGF-I) axis is an important stimulator of collagen synthesis in connective tissue, but the effect of chronically altered GH/IGF-I levels on connective tissue of the muscle-tendon unit is not known. We studied three groups of mice; 1) giant transgenic mice that expressed bovine GH (bGH) and had high circulating levels of GH and IGF-I, 2) dwarf mice with a disrupted GH receptor gene (GHR-/-) leading to GH resistance and low circulating IGF-I, and 3) a wild-type control group (CTRL). We measured the ultra-structure, collagen content and mRNA expression (targets: GAPDH, RPLP0, IGF-IEa, IGF-IR, COL1A1, COL3A1, TGF-?1, TGF-?2, TGF-?3, versican, scleraxis, tenascin C, fibronectin, fibromodulin, decorin) in the Achilles tendon, and the mRNA expression was also measured in calf muscle (same targets as tendon plus IGF-IEb, IGF-IEc). We found that GHR-/- mice had significantly lower collagen fibril volume fraction in Achilles tendon, as well as decreased mRNA expression of IGF-I isoforms and collagen types I and III in muscle compared to CTRL. In contrast, the mRNA expression of IGF-I isoforms and collagens in bGH mice was generally high in both tendon and muscle compared to CTRL. Mean collagen fibril diameter was significantly decreased with both high and low GH/IGF-I signaling, but the GHR-/- mouse tendons were most severely affected with a total loss of the normal bimodal diameter distribution. In conclusion, chronic manipulation of the GH/IGF-I axis influenced both morphology and mRNA levels of selected genes in the muscle-tendon unit of mice. Whereas only moderate structural changes were observed with up-regulation of GH/IGF-I axis, disruption of the GH receptor had pronounced effects upon tendon ultra-structure. PMID:24080228
Nielsen, R H; Clausen, N M; Schjerling, P; Larsen, J O; Martinussen, T; List, E O; Kopchick, J J; Kjaer, M; Heinemeier, K M
Humans possess the longest Achilles tendon relative to total muscle length of any primate, an anatomy that is beneficial for bipedal locomotion. Reconstructing the evolutionary history of the Achilles tendon has been challenging, in part because soft tissue does not fossilize. The only skeletal evidence for Achilles tendon anatomy in extinct taxa is the insertion site on the calcaneal tuber, which is rarely preserved in the fossil record and, when present, is equivocal for reconstructing tendon morphology. In this study, we used high-resolution three-dimensional microcomputed tomography (micro-CT) to quantify the microstructure of the trabecular bone underlying the Achilles tendon insertion site in baboons, gibbons, chimpanzees, and humans to test the hypothesis that trabecular orientation differs among primates with different tendon morphologies. Surprisingly, despite their very different Achilles tendon lengths, we were unable to find differences between the trabecular properties of chimpanzee and human calcanei in this specific region. There were regional differences within the calcaneus in the degree of anisotropy (DA) in both chimpanzees and humans, though the patterns were similar between the two species (higher DA inferiorly in the calcaneal tuber). Our results suggest that while trabecular bone within the calcaneus varies, it does not respond to the variation of Achilles tendon morphology across taxa in the way we hypothesized. These results imply that internal bone architecture may not be informative for reconstructing Achilles tendon anatomy in early hominins. PMID:23821323
Kuo, Sharon; Desilva, Jeremy M; Devlin, Maureen J; McDonald, Gabriel; Morgan, Elise F
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
To develop a systematic review to evaluate, through the best scientific evidence available, the effectiveness of aerobic exercise in improving the biomechanical characteristics of tendons in experimental animals. Two independent assessors conducted a systematic search in the databases Medline/PUBMED and Lilacs/BIREME, using the following descriptors of Mesh in animal models. The ultimate load of traction and the elastic modulus tendon were used as primary outcomes and transverse section area, ultimate stress and tendon strain as secondary outcomes. The assessment of risk of bias in the studies was carried out using the following methodological components: light/dark cycle, temperature, nutrition, housing, research undertaken in conjunction with an ethics committee, randomization, adaptation of the animals to the training and preparation for the mechanical test. Eight studies, comprising 384 animals, were selected; it was not possible to combine them into one meta-analysis due to the heterogeneity of the samples. There was a trend to increasing ultimate load without changes in the other outcomes studied. Only one study met more than 80% of the quality criteria. Physical training performed in a structured way with imposition of overloads seems to be able to promote changes in tendon structure of experimental models by increasing the ultimate load supported. However, the results of the influence of exercise on the elastic modulus parameters, strain, transverse section area and ultimate stress, remain controversial and inconclusive. Such a conclusion must be evaluated with reservation as there was low methodological control in the studies included in this review. PMID:24868114
Bezerra, M A; Lemos, A; Lira, K D S; Silveira, P V C; Coutinho, M P G; E Moraes, S R A
To develop a systematic review to evaluate, through the best scientific evidence available, the effectiveness of aerobic exercise in improving the biomechanical characteristics of tendons in experimental animals. Two independent assessors conducted a systematic search in the databases Medline/PUBMED and Lilacs/BIREME, using the following descriptors of Mesh in animal models. The ultimate load of traction and the elastic modulus tendon were used as primary outcomes and transverse section area, ultimate stress and tendon strain as secondary outcomes. The assessment of risk of bias in the studies was carried out using the following methodological components: light/dark cycle, temperature, nutrition, housing, research undertaken in conjunction with an ethics committee, randomization, adaptation of the animals to the training and preparation for the mechanical test. Eight studies, comprising 384 animals, were selected; it was not possible to combine them into one meta-analysis due to the heterogeneity of the samples. There was a trend to increasing ultimate load without changes in the other outcomes studied. Only one study met more than 80% of the quality criteria. Physical training performed in a structured way with imposition of overloads seems to be able to promote changes in tendon structure of experimental models by increasing the ultimate load supported. However, the results of the influence of exercise on the elastic modulus parameters, strain, transverse section area and ultimate stress, remain controversial and inconclusive. Such a conclusion must be evaluated with reservation as there was low methodological control in the studies included in this review.
Lemos, A.; Lira, K.D.S.; Silveira, P.V.C.; Coutinho, M.P.G.; e Moraes, S.R.A.
The study is concerned with the possibility of utilizing fiber-reinforced plastic rods as prestressing tendons, in place of traditional steel tendons, in elements of prestressed-concrete bridges exposed to corrosive environments. A survey was made of available information on the behavior characteristics of fiber-reinforced plastic tension elements and, in particular, those of glass-fiber-reinforced (GFR) tension elements. Also, an analytical study was made of the flexural behavior of concrete elements prestressed by GFR tendons. Based on the analytical study and on the survey of available information, an assessment is made of the impact on the design of prestressed-concrete members if GFR tendons are used. Some preliminary design recommendations are made, together with proposals for research needed before GFR prestressing tendons should be used in practice. Four GFR tendons with Con-Tech Systems anchorages were tested, the primary variable being the embedded length of the GFR rods in the anchorages. All the tendons failed by the rods pulling out of the anchorages. For embedded lengths of 15.2 in or greater, the failure loads were 90% of the advertised tendon strength of 220 ksi, or about 100% of the guaranteed tensile strength of 197 ksi (60 kN/rod).
Mattock, A.H.; Babaei, K.
Fibered confocal laser scanning microscopes have given us the ability to image fluorescently labeled biological structures in vivo and at exceptionally high spatial resolutions. By coupling this powerful imaging modality with classic optical elastography methods, we have developed novel techniques that allow us to assess functional mechanical integrity of soft biological tissues by measuring the movements of cells in response to externally applied mechanical loads. Using these methods we can identify minute structural defects, monitor the progression of certain skeletal tissue disease states, and track subsequent healing following therapeutic intervention in the living animal. Development of these methods using a murine Achilles tendon model has revealed that the hierarchical and composite anatomical structure of the tendon presents various technical challenges that can confound a mechanical analysis of local material properties. Specifically, interfascicle gliding can yield complex cellular motions that must be interpreted within the context of an appropriate anatomical model. In this study, we explore the various classes of cellular images that may result from fibered confocal microscopy of the murine Achilles tendon, and introduce a simple two-fascicle model to interpret the images in terms of mechanical strains within the fascicles, as well as the relative gliding between fascicles. PMID:19122452
Snedeker, J G; Pelled, G; Zilberman, Y; Ben Arav, A; Huber, E; Müller, R; Gazit, D
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 ...
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.
Tendons can broadly be categorized according to their function: those that act purely to position the limb and those that have an additional function as energy stores. Energy-storing tendons undergo many cycles of large deformations during locomotion, and so must be able to extend and recoil efficiently, rapidly and repeatedly. Our previous work has shown rotation in response to applied strain in fascicles from energy-storing tendons, indicating the presence of helical substructures which may provide greater elasticity and recovery. In the current study, we assessed how preconditioning and fatigue loading affect the ability of fascicles from the energy-storing equine superficial digital flexor tendon to extend and recoil. We hypothesized that preconditioned samples would exhibit changes in microstructural strain response, but would retain their ability to recover. We further hypothesized that fatigue loading would result in sample damage, causing further alterations in extension mechanisms and a significant reduction in sample recovery. The results broadly support these hypotheses: preconditioned samples showed some alterations in microstructural strain response, but were able to recover following the removal of load. However, fatigue loaded samples showed visual evidence of damage and exhibited further alterations in extension mechanisms, characterized by decreased rotation in response to applied strain. This was accompanied by increased hysteresis and decreased recovery. These results suggest that fatigue loading results in a compromised helix substructure, reducing the ability of energy-storing tendons to recoil. A decreased ability to recoil may lead to an impaired response to further loading, potentially increasing the likelihood of injury. PMID:24747261
Thorpe, Chavaunne T; Riley, Graham P; Birch, Helen L; Clegg, Peter D; Screen, Hazel R C
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
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
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.
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
Constructs containing autogenous mesenchymal stem cells (MSCs) seeded in collagen gels have been used by our group to repair rabbit central patellar tendon defect injuries. Although these cell-gel composites exhibit improved repair biomechanics compared to natural healing, they can be difficult to handle at surgery and lack the necessary stiffness to resist peak in vivo forces early thereafter. MSCs are typically suspended in collagen gels around two posts in the base of a well in a specially designed silicone dish. The distance between posts is approximately the length of the tendon wound site. MSCs contract the gel around the posts prior to removal of the construct for implantation at surgery. We hypothesized that in vitro construct alignment and stiffness might be enhanced in the midregion of the longer construct where the end effects of the posts on the bulk material (St. Venant effects) could be minimized. Rabbit MSCs were seeded in purified bovine collagen gel at 0.04 M cells/mg collagen. The cell-gel mixture was pipetted into silicone dishes having two post-to-post lengths (short: 11 mm and long: 51 mm) but equivalent well widths and depths and post diameters. After 14 days of incubation, tensile stiffness and modulus of the constructs were measured using equivalent grip-to-grip lengths. Collagen fiber orientation index or OI (which measures angular dispersion of fibers) was quantified using small angle light scattering (SALS). Long constructs showed significantly lower angular dispersion vs. short constructs (OI of 41.24 degrees +/-1.57 degrees vs. 48.43 degrees +/-1.27 degrees , mean+/-SEM, p<0.001) with significantly higher linear modulus (0.064+/-0.009 MPa vs. 0.024+/-0.004 MPa, p=0.0022) and linear stiffness (0.031+/-0.005 MPa vs. 0.018+/-0.004 N/mm, mean+/-SEM, respectively, p=0.0404). We now plan to use principles of functional tissue engineering to determine if repairs containing central regions of longer MSC-collagen constructs improve defect repair biomechanics after implantation at surgery. PMID:17258749
Nirmalanandhan, Victor S; Rao, Marepalli; Sacks, Michael S; Haridas, Balakrishna; Butler, David L
The peroneal (fibularis) tendons are held in place within the malleolar groove by the superior peroneal retinaculum. If this is torn, the tendons can subluxate or dislocate. Understanding the anatomy of the region is important for treating these injuries when it becomes necessary to reconstruct the malleolar groove surgically. Serial transverse sections of the groove were cut from 10 dissecting room cadavers after routine histology processing. The structure of the malleolar groove differed significantly in its proximal and distal parts. Distally, the bone is convex and the shape of the groove is determined by a thick periosteal cushion of fibrocartilage that covers the bone surface. Proximally, the groove shape is determined by the bone itself, and the periosteum is thin and fibrous. The restriction of a periosteal fibrocartilage to the distal end suggests that it serves to adapt the shape of the malleolar groove to that of the tendons within it and thus promotes stress dissipation. Paradoxically, however, it increases the risk of damage to subluxated tendons, because these can be sliced longitudinally by a sharp ridge created from periosteal fibrocartilage when the retinaculum is torn. Our results suggest that if bone-block surgical procedures are used to reconstruct the malleolar groove, they are best restricted to its proximal part.
Kumai, T; Benjamin, M
The glycosaminoglycan (GAG) side-chains of small leucine-rich proteoglycans have been postulated to mechanically cross-link adjacent collagen fibrils and contribute to tendon mechanics. Enzymatic depletion of tendon GAGs (chondroitin and dermatan sulfate) has emerged as a preferred method to experimentally assess this role. However, GAG removal is typically incomplete and the possibility remains that extant GAGs may remain mechanically functional. The current study specifically investigated the potential mechanical effect of the remaining GAGs after partial enzymatic digestion. A three-dimensional finite element model of tendon was created based upon the concept of proteoglycan mediated inter-fibril load sharing. Approximately 250 interacting, discontinuous collagen fibrils were modeled as having a length of 400 ?m, being composed of rod elements of length 67 nm and E-modulus 1 GPa connected in series. Spatial distribution and diameters of these idealized fibrils were derived from a representative cross-sectional electron micrograph of tendon. Rod element lengths corresponded to the collagen fibril D-Period, widely accepted to act as a binding site for decorin and biglycan, the most abundant proteoglycans in tendon. Each element node was connected to nodes of any neighboring fibrils within a radius of 100 nm, the slack length of unstretched chondroitin sulfate. These GAG cross-links were the sole mechanism for lateral load sharing among the discontinuous fibrils, and were modeled as bilinear spring elements. Simulation of tensile testing of tendon with complete cross-linking closely reproduced corresponding experiments on rat tail tendons. Random reduction of 80% of GAG cross-links (matched to a conservative estimate of enzymatic depletion efficacy) predicted a drop of 14% in tendon modulus. Corresponding mechanical properties derived from experiments on rat tail tendons treated in buffer with and without chondroitinase ABC were apparently unaffected, regardless of GAG depletion. Further tests for equivalence, conservatively based on effect size limits predicted by the model, confirmed equivalent stiffness between enzymatically depleted tendons and their native controls. Although the model predicts that relatively small quantities of GAGs acting as primary collagen cross-linking elements could provide mechanical integrity to the tendon, partial enzymatic depletion of GAGs should result in mechanical changes that are not reflected in analogous experimental testing. We thus conclude that GAG side chains of small leucine-rich proteoglycans are not a primary determinant of tensile mechanical behavior in mature rat tail tendons. PMID:20950629
Fessel, Gion; Snedeker, Jess G
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
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
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
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
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
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
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
Tendinopathy is a debilitating musculoskeletal condition which can cause significant pain and lead to complete rupture of the tendon, which often requires surgical repair. Due in part to the large spectrum of tendon pathologies, these disorders continue to be a clinical challenge. Animal models are often used in this field of research as they offer an attractive framework to examine the cascade of processes that occur throughout both tendon pathology and repair. This review discusses the structural, mechanical, and biological changes that occur throughout tendon pathology in animal models, as well as strategies for the improvement of tendon healing. Cite this article: Bone Joint Res 2014;3:193-202. PMID:24958818
Hast, M W; Zuskov, A; Soslowsky, L J
Conflicts, snapping and instability of the tendons are common, and ultrasound (US) is the method of choice for evidencing these conditions thanks to the possibility to perform dynamic maneuvers during imaging studies. A conflict can occur between a tendon and a bone structure, other tendons, the retinacula or pulleys. Snapping can occur due to instability caused by rupture of the retinaculum, conflict between a thickened retinaculum and a bone prominence or due to an abnormal position of the tendon. Instability can occur due to insufficient ability of the retinaculum to keep the tendons in the bone groove or its failure to hold the tendons applied to the bone. The technique for evidencing conflicts, snapping and instability of the tendons is very demanding because it requires a thorough knowledge of the US appearance and dynamic maneuvers. However, at the present time US examination completed with dynamic maneuvers is the investigation of choice for evidencing these disorders and providing the clinicians with the necessary information.
Fantino, Olivier; Borne, J.; Bordet, Bertrand
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
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.
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
Surgical reconstruction and mobilization therapy for a retracted extensor hallucis longus laceration and tendon defect repaired by split extensor hallucis longus tendon lengthening and dermal scaffold augmentation.
A reconstructive technique and physical therapy protocol is presented for the treatment of extensor hallucis longus (EHL) lacerations with critical size defects caused by tendon retraction. The primary goal of treatment was to restore EHL structure and function without the use of a bridging allograft or tendon transfer. The technique is performed by split lengthening the distal segment of the lacerated EHL and rotating the lengthened segment proximally 180° to bridge the tendon defect. The lengthened tendon is then sutured to the proximal segment of the EHL. The EHL is then tubularized with an acellular dermal scaffold at the region of tendon rotation to improve tendon strength, minimize the probability of tendon overlengthening or re-rupture, and improve the tendon gliding motion, which can be compromised by the tendon irregularity caused by rotation of the tendon. Postoperative range of motion therapy should be initiated at 3 weeks postoperatively. A case report of this technique and postoperative mobilization protocol is presented. The American Orthopaedic Foot and Ankle Society midfoot score at 3 and 6 months postoperatively was 90 of 100. The patient regained active dorsiflexion motion of the hallux without functional limitations, deformity, or contracture of the hallux. The advantages of this technique include that a large cadaveric allograft is not needed to bridge a critical size tendon defect and tendon lengthening provides a biologically active tendon graft without the secondary comorbidities and dysfunction commonly associated with tendon transfer procedures. PMID:22658790
Joseph, Robert M; Barhorst, Jessica
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
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.
Fibrous extracellular matrix of tendon is considered to be an inextensible anatomical structure consisting of type I collagen fibrils arranged in parallel bundles. Under polarized light microscopy the collagen fibre bundles appear crimped with alternating dark and light transverse bands. This study describes the ultrastructure of the collagen fibrils in crimps of both relaxed and in vivo stretched rat Achilles tendon. Under polarized light microscopy crimps of relaxed Achilles tendons appear as isosceles or scalene triangles of different size. Tendon crimps observed via SEM and TEM show the single collagen fibrils that suddenly change their direction containing knots. The fibrils appear partially squeezed in the knots, bent on the same plane like bayonets, or twisted and bent. Moreover some of them lose their D-period, revealing their microfibrillar component. These particular aspects of collagen fibrils inside each tendon crimp have been termed 'fibrillar crimps' and may fulfil the same functional role. When tendon is physiologically stretched in vivo the tendon crimps decrease in number (46.7%) (P<0.01) and appear more flattened with an increase in the crimp top angle (165 degrees in stretched tendons vs. 148 degrees in relaxed tendons, P<0.005). Under SEM and TEM, the 'fibrillar crimps' are still present, never losing their structural identity in straightened collagen fibril bundles of stretched tendons even where tendon crimps are not detectable. These data suggest that the 'fibrillar crimp' may be the true structural component of the tendon crimp acting as a shock absorber during physiological stretching of Achilles tendon. PMID:17229278
Franchi, Marco; Fini, Milena; Quaranta, Marilisa; De Pasquale, Viviana; Raspanti, Mario; Giavaresi, Gianluca; Ottani, Vittoria; Ruggeri, Alessandro
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
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
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.
Tendons are collagen-rich structures that link muscle to cartilage. By using quail-chick chimeras, it has been shown that tendon and cartilage cells originate from the same mesodermic compartment, which is distinct from that giving rise to muscle cells. Axial tendons originate from the sclerotomal compartment, and limb tendons originate from the lateral plate, whereas axial and limb muscles derive from dermomyotomes. Despite these different embryologic origins, muscle and tendon morphogenesis occurs in close spatial and temporal association. Facilitated by the distinct embryologic origin of myogenic and tendon cells, surgical studies in the avian embryo have highlighted interactions between tendons and muscles, during embryonic development. However, these interactions seem to differ between axial and limb levels. The molecular mechanisms underlying muscle and tendon interactions have been shown recently to involve different members of the fibroblast growth factor family. This review covers the available data on the early steps of tendon formation in the limb and along the primary axis. The relationship with muscle morphogenesis will be highlighted. PMID:14991700
Edom-Vovard, Frédérique; Duprez, Delphine
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
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
Fung, David T; Wang, Vincent M; Laudier, Damien M; Shine, Jean H; Basta-Pljakic, Jelena; Jepsen, Karl J; Schaffler, Mitchell B; Flatow, Evan L
In the last few years, the effectiveness of cement grout in galvanized or polyethylene ducts, the most widely used corrosion protection system for multistrand bonded post-tensioned concrete tendons, has been under debate, due to significant tendon corrosion damage, several reported failures of individual tendons as well as a few collapses of non-typical structures. While experience in the USA has been
Ruben Mario Salas Pereira
Summary Tissue regeneration is aimed at producing biological or synthetic scaffolds to be implanted in the body for regenerate functional tissues. Several techniques and materials have been used to obtain biodegradable synthetic scaffolds, on which adhesion, growth, migration and differentiation of human cells has been attempted. Scaffolds for tendon regeneration have been less frequently proposed, because they have a complex hierarchical structure and it is very difficult to mimic their peculiar mechanical properties. In this review, we critically analyzed the proposed materials and fabrication techniques for tendon tissue engineering and we indicated new preparation processes, based on the use of supercritical fluids, to produce scaffolds with characteristics very similar to the native tendon structure.
Reverchon, Ernesto; Baldino, Lucia; Cardea, Stefano; De Marco, Iolanda
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
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
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
A study of nutrition of various tendon graft preparations in adult chickens (up to 2 weeks after grafting), using tritiated proline and a trichloracetic acid extraction technique which separated the free and metabolized amino acid fractions, suggests that diffusion of nutrients is an important process in the initial nutrition of tendon grafts, that tendon grafts are metabolically active and viable structures, that adhesions which are frequently associated with tendon grafts do not appear to be essential to the nutrition of grafts, and that tendon grafts within fibrous pseudosheaths are nourished as effectively as grafts within synovial sheaths. PMID:512314
Manske, P R; Lesker, P A; Bridwell, K
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
With the role of the biceps tendon being the source of considerable controversy, the treatment of its disease has been even more confusing. Our understanding of its role in shoulder pathology has ranged from describing it as a vestigial structure, to a vital structure of shoulder function with distinct disease pathology. This chapter analyzes the anatomic and biomechanical functions of the proximal biceps tendon. PMID:18703968
Gastrointestinal motility is ensured by the correct coordination of the enteric nervous system and the visceral smooth muscle cells (SMCs), and defective development of SMCs results in gut malformations and intestinal obstructions. In order to identify the molecular mechanisms that control the differentiation of the visceral mesenchyme into SMCs in the vertebrate stomach, we developed microarrays to analyze the gene expression profiles of undifferentiated and differentiated avian stomachs. We identify Scleraxis, a basic-helix-loop-helix transcription factor, as a new marker of stomach mesenchyme and find that expression of Scleraxis defines the presence of two tendons closely associated to the two visceral smooth muscles. Using targeted gene misexpression, we show that FGF signaling is sufficient to induce Scleraxis expression and to establish two tendon domains adjacent to the smooth muscle structures. We also demonstrate that the tendon organization is perturbed by altering Scleraxis expression or function. Moreover, using primary cells derived from stomach mesenchyme, we find that undifferentiated stomach mesenchyme can give rise to both SMCs and tendon cells. These data show that upon FGF activation, selected stomach mesenchymal cells are primed to express Scleraxis and to differentiate into tendon cells. Our findings identify a new anatomical and functional domain in the vertebrate stomach that we characterize as being two intermuscular tendons closely associated with the visceral SMC structures. We also demonstrate that the coordinated development of both tendon and smooth muscle domains is essential for the correct morphogenesis of the stomach. PMID:19176584
Le Guen, Ludovic; Notarnicola, Cécile; de Santa Barbara, Pascal
Tendons are composed of fibroblasts and collagen fibrils. The fibrils are organized uniaxially and grouped together into fibers. Collagen VI is a non-fibrillar collagen expressed in developing and adult tendons. Human collagen VI mutations result in muscular dystrophy, joint hyperlaxity and contractures. The purpose of this study is to determine the functional roles of collagen VI in tendon matrix assembly. During tendon development, collagen VI was expressed throughout the extracellular matrix, but enriched around fibroblasts and their processes. To analyze the functional roles of collagen VI a mouse model with a targeted inactivation of Col6a1 gene was utilized. Ultrastructural analysis of Col6a1?/? versus wild type tendons demonstrated disorganized extracellular micro-domains and collagen fibers in the Col6a1?/? tendon. In the col6a1?/? tendon, fibril structure and diameter distribution was abnormal compared to wild type controls. Col6a1?/? fibrils had smaller diameters and the diameter distributions were shifted significantly toward the smaller diameters. An analysis of fibril density (number/?m2) demonstrated an ~2.5 fold increase in the Col6a1?/? versus wild type tendons. In addition, the fibril arrangement and structure was aberrant in the peri-cellular regions of Col6a1?/? tendons with frequent very large fibrils and twisted fibrils observed restricted to this region. The biomechanical properties were analyzed in mature tendons. A significant decrease in cross sectional area was observed. The percent relaxation, maximum load, maximum stress, stiffness and modulus were analyzed and Col6a1?/? tendons demonstrated a significant reduction in maximum load and stiffness compared to wild type tendons. An increase in matrix metalloproteinase activity was suggested in the absence of collagen VI. This suggests alterations in tenocyte expression due to disruption of cell-matrix interactions. The changes in expression may result in alterations in the peri-cellular environment. In addition, the absence of collagen VI may alter the sequestering of regulatory molecules such as leucine rich proteoglycans. These changes would result in dysfunctional regulation of tendon fibrillogenesis indirectly mediated by collagen VI.
Izu, Yayoi; Ansorge, Heather L.; Zhang, Guiyun; Soslowsky, Louis J.; Bonaldo, Paolo; Chu, Mon-Li; Birk, David E.
Tendon-to-bone healing following acute injury is generally poor and often fails to restore normal tendon biomechanical properties. In recent years, the murine patellar tendon (PT) has become an important model system for studying tendon healing and repair due to its genetic tractability and accessible location within the knee. However, the mechanical properties of native murine PT, specifically the regional differences in tissue strains during loading, and the biomechanical outcomes of natural PT-to-bone healing have not been well characterized. Thus, in this study, we analyzed the global biomechanical properties and regional strain patterns of both normal and naturally healing murine PT at three time points (2, 5, and 8weeks) following acute surgical rupture of the tibial enthesis. Normal murine PT exhibited distinct regional variations in tissue strain, with the insertion region experiencing approximately 2.5 times greater strain than the midsubstance at failure (10.80±2.52% vs. 4.11±1.40%; mean±SEM). Injured tendons showed reduced structural (ultimate load and linear stiffness) and material (ultimate stress and linear modulus) properties compared to both normal and contralateral sham-operated tendons at all healing time points. Injured tendons also displayed increased local strain in the insertion region compared to contralateral shams at both physiologic and failure load levels. 93.3% of injured tendons failed at the tibial insertion, compared to only 60% and 66.7% of normal and sham tendons, respectively. These results indicate that 8weeks of natural tendon-to-bone healing does not restore normal biomechanical function to the murine PT following injury. PMID:24210849
Gilday, Steven D; Chris Casstevens, E; Kenter, Keith; Shearn, Jason T; Butler, David L
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
Tendons are composed of longitudinally aligned collagen fibrils arranged in bundles with an undulating pattern, called crimp. The crimp structure is established during embryonic development and plays a vital role in the mechanical behaviour of tendon, acting as a shock-absorber during loading. However, the mechanism of crimp formation is unknown, partly because of the difficulties of studying tendon development in vivo. Here, we used a 3D cell culture system in which embryonic tendon fibroblasts synthesise a tendon-like construct comprised of collagen fibrils arranged in parallel bundles. Investigations using polarised light microscopy, scanning electron microscopy and fluorescence microscopy showed that tendon constructs contained a regular pattern of wavy collagen fibrils. Tensile testing indicated that this superstructure was a form of embryonic crimp producing a characteristic toe region in the stress-strain curves. Furthermore, contraction of tendon fibroblasts was the critical factor in the buckling of collagen fibrils during the formation of the crimp structure. Using these biological data, a finite element model was built that mimics the contraction of the tendon fibroblasts and monitors the response of the Extracellular matrix. The results show that the contraction of the fibroblasts is a sufficient mechanical impulse to build a planar wavy pattern. Furthermore, the value of crimp wavelength was determined by the mechanical properties of the collagen fibrils and inter-fibrillar matrix. Increasing fibril stiffness combined with constant matrix stiffness led to an increase in crimp wavelength. The data suggest a novel mechanism of crimp formation, and the finite element model indicates the minimum requirements to generate a crimp structure in embryonic tendon. PMID:21735243
Herchenhan, Andreas; Kalson, Nicholas S; Holmes, David F; Hill, Patrick; Kadler, Karl E; Margetts, Lee
1. The responses elicited in individual tendon organs by the contraction of single motor units were studied in peroneus longus, peroneus brevis, tibialis anterior and soleus muscles. 2. No simple relation was found between the discharge frequency of a tendon organ and the tension produced in the muscle tendon by the contraction of individual motor units. 3. The sensitivity of a given tendon organ to contractile tension was not the same for each of the motor units which elicited its discharge. There was no correlation between the sensitivity of the receptor and the strength of the motor units. 4. Upon repetitive stimulation of a tendon-organ-activating motor unit at increasing rates, the frequency of the receptor sustained discharge reached a maximal value for rates of stimulation eliciting submaximal tetanic tension. Higher rates only produced an increase in the dynamic component of the tendon organ response. 5. These observations show that the contractile tension sensed by a tendon organ is not a simple fraction of the tension which appears at the muscle tendon. They might be accounted for as consequences of the fine structure of tendon organs and of variations in the number of muscle fibres contributed by different motor units to the bundle inserted on each receptor. The location of most tendon organs at musculo-aponeurotic junctions rather than in the tendon proper, could also be responsible for some of the observed discrepancies.
Jami, L; Petit, J
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
Wearing high heels (HH) places the calf muscle-tendon unit (MTU) in a shortened position. As muscles and tendons are highly malleable tissues, chronic use of HH might induce structural and functional changes in the calf MTU. To test this hypothesis, 11 women regularly wearing HH and a control group of 9 women were recruited. Gastrocnemius medialis (GM) fascicle length, pennation angle and physiological cross-sectional area (PCSA), the Achilles' tendon (AT) length, cross-sectional area (CSA) and mechanical properties, and the plantarflexion torque-angle and torque-velocity relationships were assessed in both groups. Shorter GM fascicle lengths were observed in the HH group (49.6+/-5.7 mm vs 56.0+/-7.7 mm), resulting in greater tendon-to-fascicle length ratios. Also, because of greater AT CSA, AT stiffness was higher in the HH group (136.2+/-26.5 N mm(-1) vs 111.3+/-20.2 N mm(-1)). However, no differences in the GM PCSA to AT CSA ratio, torque-angle and torque-velocity relationships were found. We conclude that long-term use of high-heeled shoes induces shortening of the GM muscle fascicles and increases AT stiffness, reducing the ankle's active range of motion. Functionally, these two phenomena seem to counteract each other since no significant differences in static or dynamic torques were observed. PMID:20639419
Csapo, R; Maganaris, C N; Seynnes, O R; Narici, M V
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
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.
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
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
Devastating volar hand injuries with significant damage to the pulley structures and fibro-osseous sheath, flexor tendons, and volar plates pose a major problem to the reconstructive hand surgeon. Despite advances in tendon handling, operative technique, and postoperative hand rehabilitation, patients who have undergone flexor tendon reconstruction are often plagued by chronic pain, stiffness, and decreased range of motion with resultant decreased ability to work and poor quality of life. Postoperative adhesion formation and lack of suitable donor material for tendon autograft are 2 fundamental problems that continue to challenge the hand surgeon. In 1967, Erle E. Peacock, Jr, described a technique of flexor tendon reconstruction using cadaveric composite flexor tendon allograft, which consisted of both the flexor digitorum profundus and superficialis tendons in their respective fibro-osseous sheaths consisting of the digital pulley structures and the underlying periosteum and volar plates. This technique never gained widespread acceptance due to concerns regarding tissue antigenicity, infectious disease transmission, and the rising popularity of the method of Hunter for silastic rod-based flexor tendon reconstruction initially described during the same period. With modern-day advances in tissue processing with acellularization and extensive donor screening for transmissible diseases, this technique should be revisited to address the reconstructive needs of patients with extensive volar soft tissue and tendon injury. Herein, we describe the operative technique of composite flexor tendon procurement and reconstruction with key modifications from the initial technique described by Peacock for improved composite construct elevation, soft tissue inset, and bony attachment. PMID:24691346
DeGeorge, Brent R; Rodeheaver, George T; Drake, David B
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
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
The intrasynovial bone-tendon interface is a gradual transition from soft tissue to bone, with two intervening zones of uncalcified and calcified fibrocartilage. Following injury, the native anatomy is not restored, resulting in inferior mechanical properties and an increased risk of re-injury. Recent in vivo studies provide evidence of improved healing when surgical repair of the bone-tendon interface is augmented with cells capable of undergoing chondrogenesis. In particular, cellular therapy in bone-tendon healing can promote fibrocartilage formation and associated improvements in mechanical properties. Despite these promising results in animal models, cellular therapy in human patients remains largely unexplored. This review highlights the development and structure-function relationship of normal bone-tendon insertions. The natural healing response to injury is discussed, with subsequent review of recent research on cellular approaches for improved healing. Finally, opportunities for translating in vivo findings into clinical practice are identified.
Rothrauff, Benjamin B; Tuan, Rocky S
Mathematical and computational modeling is in demand to help address current challenges in mechanobiology of musculoskeletal tissues. In particular for tendon, the high clinical importance of the tissue, the huge mechanical demands placed on it and its ability to adapt to these demands, require coupled, multiscale models incorporating complex geometrical and microstructural information as well as time-based descriptions of cellular activity and response.This review introduces the information sources required to develop such multiscale models. It covers tissue structure and biomechanics, cell biomechanics, the current understanding of tendon's ability in health and disease to update its properties and structure and the few already existing multiscale mechanobiological models of the tissue. Finally, a sketch is provided of what such models could achieve ideally, pointing out where experimental data and knowledge are still missing. PMID:23681792
Thompson, Mark S
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
Fibered confocal laser scanning microscopes have given us the ability to image fluorescently labeled biological structures in vivo and at exceptionally high spatial resolutions. By coupling this powerful imaging modality with classic optical elastography methods, we have developed novel techniques that allow us to assess functional mechanical integrity of soft biological tissues by measuring the movements of cells in response
J. G. Snedeker; G. Pelled; Y. Zilberman; A. Ben Arav; E. Huber; R. Müller; D. Gazit
The purpose of this study was to investigate the role of lubricin on the gliding resistance of intrasynovial tendons by comparing lubricin knockout, heterozygous, and wild type mice. A total of thirty-six deep digital flexor (DDF) tendons in the third digits of each hind paw from eighteen adult mice were used, including six lubricin knockout mice (Prg4 –/–), six heterozygous mice (Prg4 +/–), and six wild type mice (Prg4 +/+). The tendon gliding resistance was measured using a custom-made device. Tendon structural changes were evaluated by scanning electron and light microscopy. The gliding resistance of intrasynovial tendons from lubricin knockout mice was significantly higher than the gliding resistance of either wild type or heterozygous mice. The surface of the lubricin knockout tendons appeared to be rougher, compared to the wild type and heterozygous tendons. Synovial hyperplasia was found in the lubricin knockout mice. Cartilage-like tissue was found in the tendon and pulley of the lubricin knockout mice. Our findings confirm the importance of lubricin in intrasynovial tendon lubrication. This knockout model may be useful in determining the effect of lubricin on tendon healing and the response to injury.
Hayashi, Masanori; Zhao, Chunfeng; Thoreson, Andrew R.; Chikenji, Takako; Jay, Gregory D.; An, Kai-Nan; Amadio, Peter C.
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
The aim of the present study was to investigate the effects of various decellularization methods on the histological and biomechanical properties of rabbit tendons. In total, six chemical reagents, including 1% t-octyl-phenoxypolyethoxyethanol (Triton-X 100), 0.5% sodium dodecyl sulfate (SDS), 1% tri-n-butyl phosphate (TnBP), 1% Triton-X 100 + 0.5% SDS, 1% TnBP + 0.5% SDS and 1% TnBP + 1% Triton-X 100, were used on rabbit semitendinosus muscles and flexor digitorum tendons for 24 h to remove cells. Hematoxylin and eosin staining was applied for histological observation, while tension testing was used for biomechanical studies. The effects of the various decellularization methods on the histological structure and biomechanical properties of rabbit tendons were evaluated. A group of fresh tendons treated with phosphate-buffered saline served as controls. The various decellularization methods resulted in different effects on the tendons. All the treatment groups exhibited a decrease in tendon biomechanical properties, but no statistically significant differences were observed among the experimental groups. The extensibility of the 1% TnBP-treated group was found to be greater than that of the other groups; however, the difference was not statistically significant. Histologically, the 1% TnBP + 0.5% SDS treatment was shown to have the least impact on the rabbit tendon structure, with good decellularization and no clear cellular remnants observed. The 1% Triton-X 100 + 0.5% SDS treatment had a pronounced effect on the tendon collagen structure and a number of collagen ruptures were observed. Overall, 1% TnBP + 0.5% SDS was found to be the most effective compared with the other treatments, as this treatment preserved the tendon collagen structure while completely removing the cells. Tendons treated with 1% TnBP + 0.5% SDS were histologically similar to normal tendon tissue and biomechanically similar to the tendons in the control group.
XING, SHUXING; LIU, CONG; XU, BING; CHEN, JIANCHANG; YIN, DONGFENG; ZHANG, CHUNHAO
Sonomicrometrics of in vivo axial strain of muscle has shown that the swimming fish body bends like a homogenous, continuous beam in all species except tuna. This simple beam-like behavior is surprising because the underlying tendon structure, muscle structure and behavior are complex. Given this incongruence, our goal was to understand the mechanical role of various myoseptal tendons. We modeled
John H. Long; Bruce Adcock; Robert G. Root
Proteoglycans (PG) and their associated glycosaminoglycan (GAG) side chains are known to play a key role in the bearing of compressive loads in cartilage and other skeletal connective tissues. In tendons and connective tissues that are primarily loaded in tension, the influence of proteoglycans on mechanical behavior is debated due to conflicting experimental evidence that alternately supports or controverts a functional role of proteoglycans in bearing tensile load. In this study we sought to better reconcile these conflicting data by investigating the possibility that GAG content is differentially related to tensile tendon mechanics depending upon the anatomical subregion one considers. To test this hypothesis, we quantified the mechanical consequences of proteoglycan disruption within specific tendon anatomical subregions using an optical-mechanical measurement approach. Achilles tendons from adult mice were treated with chondroitinase ABC to obtain two groups consisting of native tendons and GAG-depleted tendons. All the tendons were mechanically tested and imaged with high-resolution digital video in order to optically quantify tendon strains. Tendon surface strains were locally analyzed in three main subregions: the central midsubstance, and the proximal and distal midsubstance near the muscle and bone insertions, respectively. Upon GAG digestion, the tendon midsubstance softened appreciably near the bone insertion, while elastic modulus in the central and proximal thirds was unchanged. Thus the contribution of PGs to tensile tendon mechanics is not straightforward and points to a heterogeneous and complex structure-function relationship in tendon. This study further highlights the importance of performing local strain analysis with regard to tensile tendon mechanics. PMID:19394024
Rigozzi, S; Müller, R; Snedeker, J G
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
Collagen content and cross-linking are believed to be major determinants of tendon structural integrity and function. The current study aimed to investigate the effects of transforming growth factor (TGF)-beta1 on the collagen content and cross-linking of Achilles tendons, and on the histological and biomechanical changes occurring during Achilles tendon healing in rabbits. Bone marrow-derived mesenchymal stem cells (BMSCs) transfected with the TGF-beta1 gene were surgically implanted into experimentally injured Achilles tendons. Collagen proteins were identified by immunohistochemical staining and fiber bundle accumulation was revealed by Sirius red staining. Achilles tendons treated with TGF-beta1-transfected BMSCs showed higher concentrations of collagen I protein, more rapid matrix remodeling, and larger fiber bundles. Thus TGF-beta1 can promote mechanical strength in healing Achilles tendons by regulating collagen synthesis, cross-link formation, and matrix remodeling. PMID:19345669
Hou, Yu; Mao, ZeBing; Wei, XueLei; Lin, Lin; Chen, LianXu; Wang, HaiJun; Fu, Xin; Zhang, JiYing; Yu, ChangLong
Patellar tendon rerupture is a relatively uncommon condition that severely compromises the function of the extensor mechanism of the knee. Few cases described in the literature does not show a unique mode of treatment for this type of lesion. We report the case of a young athlete with traumatic patellar tendon rerupture. The first rupture was treated with the use of Statak anchors. Following a second rerupture incident as a result of a sporting accodent, the tendon was reconstructed with the use of an autologous graft tendon of semitendinosus and biological augmentation with gracilis tendon. For both tendons the distal insertion part was preserved to facilitate the healing process. The treatment was completed with the application of a neutralization cerclage wire and with local injection of plateket reach plasma (PRP). At 12 months follow up, a full recovery of the structure and function of the extensor mechanism was observed and the patient was able to resume normal sports competitive activity. PMID:24314874
Moretti, L; Vicenti, G; Abate, A; Pesce, V; Moretti, B
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
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.
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
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
Magnetic resonance imaging (MRI) has commonly been applied to determine tendon cross-sectional area (CSA) and length either to measure structural changes or to normalize mechanical measurements to stress and strain. The ability to reproduce CSA measurements on MRI images has been reported, but the accuracy in relation to actual tendon dimensions has never been investigated. The purpose of this study was to compare tendon CSA measured by MRI with that measured in vitro with the mould casting technique. The knee of a horse was MRI-scanned with 1.5 and 3 tesla, and two examiners measured the patellar tendon CSA. Thereafter, the patellar tendon of the horse was completely dissected and embedded in an alginate cast. The CSA of the embedded tendon was measured directly by optical imaging of the cast impression. 1.5 tesla grey tendon CSA and 3 tesla grey tendon CSA were 16.5% and 13.2% lower than the mould tendon CSA, respectively. Also, 3 tesla tendon CSA, based on the red-green border on the National Institute of Health (NIH) colour scale, was lower than the mould tendon CSA by 2.8%. The typical error between examiners was below 2% for all the measured CSA. The typical error between examiners was below 2% for all the measured CSA. These data show that measuring tendon CSA on the grey-scale MRI images is associated with an underestimation, but by optimizing the measurement using a 3 tesla MRI and the appropriate NIH colour scale, this underestimation could be reduced to 2.8% compared with the direct measurements on the mould. PMID:24119143
Couppé, C; Svensson, R B; Sødring-Elbrønd, V; Hansen, P; Kjaer, M; Magnusson, S P
Left ventricular (LV) false tendons are chordlike structures that traverse the LV cavity. They attach to the septum, to the papillary muscles, or to the free wall of the ventricle but not to the mitral valve. They are found in approximately half of human hearts examined at autopsy. Although it has been more than 100 years since their initial description, the functional significance of these structures remains largely unexplored. It has been suggested that they retard LV remodeling by tethering the walls to which they are attached, but there are few data to substantiate this. Some studies have suggested that false tendons reduce the severity of functional mitral regurgitation by stabilizing the position of the papillary muscles as the left ventricle enlarges. LV false tendons may also have deleterious effects and have been implicated in promoting membrane formation in discrete subaortic stenosis. This article reviews current understanding of the anatomy, echocardiographic characteristics, and pathophysiology of these structures. PMID:23602169
Silbiger, Jeffrey J
The assembly, deposition and organization of collagen fibril bundles and their composite fibrils were studied during morphogenesis of the chick embryo tendon using electron microscopy, serial sections and computer-assisted three-dimensional reconstruction techniques. The 14-day chick embryo is a stage when tendon architecture is being established and rapid changes in the mechanical properties occur between days 14 and 17 of development. Tendon matrix structure develops from discrete subunits, bundles of collagen fibrils. The bundles branch; undergo a gradual rotation over several micrometers; are intimately associated with the cellular elements of the developing tendon; and form arborizing networks within and among fascicles. The organization of discrete fibril segments into bundles, during the establishment of tendon architecture and function, where the segmental fibrillar components could interact with the interfibrillar matrix as well as with adjacent fibrils would contribute to the stabilization of this structure. The observed gradual rotation of the bundles would serve to stabilize the immature bundle through the physical twining of the composite fibrils while the extensive branching of the bundles observed at 14-days of development and their intimate association with the cellular elements would provide a higher order of structure stabilization. PMID:2612371
Birk, D E; Southern, J F; Zycband, E I; Fallon, J T; Trelstad, R L
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
Objective: To describe the evaluation, diagnosis, and conservative treatment of a 31-year-old female recreational athlete with a snapping iliopsoas tendon. Background: The iliopsoas tendon has been implicated as an inflamed structure in this unique form of snapping hip. Hip pain, limitation of motion, or both may severely restrict vocational and recreational function and activities of daily living. Differential Diagnosis: Left snapping hip syndrome secondary to the iliopsoas tendon or the iliotibial band. Treatment: The treatment goal was to restore the athlete's pain-free, functional abilities. The primary focus of the treatment program was stretching of the left hip flexors. The patient demonstrated reduced pain and improved function following a 4-week stretching program and was fully functional and symptom free at 6 months. Uniqueness: Snapping hip syndrome is a clinical entity that may be described as hip pain associated with an audible snap of the hip during motion. The most common and well-known cause of this syndrome involves the snapping of the iliotibial band over the greater trochanter. A less common cause is the snapping of the iliopsoas tendon over the iliopectineal eminence. Conclusions: Understanding the anatomy and function of the iliopsoas tendon and related structures provides a basis for evaluation and treatment of this unique problem. ImagesFigure 1.Figure 2.
Keskula, Douglas R.; Lott, Jason; Duncan, Jewell B.
Tendon function involves the development of an organized hierarchy of collagen fibrils. Small leucine-rich proteoglycans have been implicated in the regulation of fibrillogenesis and decorin is the prototypic member of this family. Decorin-deficient mice demonstrate altered fibril structure and mechanical function in mature skin and tail tendons. However, the developmental role(s) of decorin needs to be elucidated. To define these role(s) during tendon development, tendons (flexor digitorum longus) were analyzed ultrastructurally from postnatal day 10 to 90. Decorin-deficient tendons developed abnormal, irregularly contoured fibrils. Finite mixture modeling estimated that the mature tendon was a three-subpopulation mixture of fibrils with characteristic diameter ranges. During development, in each subpopulation the mean diameter was consistently larger in mutant mice. Also, diameter distributions and the percentage of fibrils in each subpopulation were altered. Biomechanical analyses demonstrated that mature decorin-deficient tendons had significantly reduced strength and stiffness; however, there was no reduction in immature tendons. Expression of decorin and biglycan, a closely related family member, was analyzed during development. Decorin increased with development while biglycan decreased. Spatially, both had a comparable localization throughout the tendon. Biglycan expression increased substantially in decorin-deficient tendons suggesting a potential functional compensation. The accumulation of structural defects during fibril growth, a period associated with decorin expression and low biglycan expression, may be the cause of compromised mechanical function in the absence of decorin. Our findings indicate that decorin is a key regulatory molecule and that the temporal switch from biglycan to decorin is an important event in the coordinate regulation of fibrillogenesis and tendon development. PMID:16518859
Zhang, Guiyun; Ezura, Yoichi; Chervoneva, Inna; Robinson, Paul S; Beason, David P; Carine, Ehren T; Soslowsky, Louis J; Iozzo, Renato V; Birk, David E
We have developed a new device to measure the friction force and calculate the friction coefficient between a rabbit flexor tendon, a pulley and a proximal phalanx. The flexor digitorum fibularis tendon of a rabbit was taken intact with the proximal phalanx, and tendon pulleys were attached to both ends of the bone. Both ends of the tendon were clamped to acrylic plates and connected to stainless-steel plates equipped with strain gauges. A pretension of 1.96 N was applied so as not to loosen the tendon. The proximal phalanx was fixed to an acrylic plate on the actuator, which gave 8 mm of transfer to the acrylic plate at a speed of 2 mm/s. The interface between the tendon and the surrounded tissue created the friction force, when the load was applied on the distal pulley. The friction force could be obtained from the difference between the tension of both ends of the tendon, which was measured with strain gauges and sampled with a personal computer. The friction force and the friction coefficient were calculated from the measured force and the applied load. The load and the pre-loading time, which was defined as loading duration before gliding, were varied in order to observe the change of the friction coefficient. The friction coefficient was not affected by the load and increased with the pre-loading time. The value of mu(s) ranged from 0.027 to 0.111 (0.072 +/- 0.023), and that of (mu)d ranged from 0.010 to 0.069 (0.039 +/- 0.014) (pre-loading time was 5 s). Our method will allow for the examination of various surgical treatments and lubricants. Moreover, it can be applied to other tissues of any animals with similar structures to the rabbit's digitorum. PMID:10476853
Moro-oka, T; Miura, H; Higaki, H; Arimura, S; Mawatari, T; Murakami, T; Iwamoto, Y
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
The extracellular matrix (ECM) of connective tissues enables linking to other tissues, and plays a key role in force transmission and tissue structure maintenance in tendons, ligaments, bone and muscle. ECM turnover is influenced by physical activity, and both collagen synthesis and metalloprotease activity increase with mechanical loading. This can be shown by determining propeptide and proteinase activity by microdialysis, as well as by verifying the incorporation of infused stable isotope amino acids in biopsies. Local tissue expression and release of growth factors for ECM such as IGF-1, TGF-beta and IL-6 is enhanced following exercise. For tendons, metabolic activity (e.g. detected by positron emission tomography scanning), circulatory responses (e.g. as measured by near-infrared spectroscopy and dye dilution) and collagen turnover are markedly increased after exercise. Tendon blood flow is regulated by cyclooxygenase-2 (COX-2)-mediated pathways, and glucose uptake is regulated by specific pathways in tendons that differ from those in skeletal muscle. Chronic loading in the form of physical training leads both to increased collagen turnover as well as to some degree of net collagen synthesis. These changes modify the mechanical properties and the viscoelastic characteristics of the tissue, decrease its stress-susceptibility and probably make it more load-resistant. The mechanical properties of tendon fascicles vary within a given human tendon, and even show gender differences. The latter is supported by findings of gender-related differences in the activation of collagen synthesis with exercise. These findings may provide the basis for understanding tissue overloading and injury in both tendons and skeletal muscle.
Kjaer, Michael; Magnusson, Peter; Krogsgaard, Michael; M?ller, Jens Boysen; Olesen, Jens; Heinemeier, Katja; Hansen, Mette; Haraldsson, Bjarki; Koskinen, Satu; Esmarck, Birgitte; Langberg, Henning
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
Fourier transform-second-harmonic generation (FT-SHG) imaging is used to quantitatively assess the structural organization of collagen fibers in tendonitis-induced horse tendons. Fiber orientation, isotropy, and the ratio of forward to backward SHG signal (F/B ratio) are used to differentiate the fiber organization between the normal and diseased horse tendons. Each second-harmonic generation (SHG) image is divided into several smaller regions of interest (ROI) and the aforementioned quantitative metrics are calculated across the whole grid. ROIs are further labeled as dark (no or minimal presence of fibers), isotropic (random fiber organization), or anisotropic (regular fiber organization) regions. Results show that the normal tendon possesses minimal isotropic regions and small standard deviations in the histograms of orientation and F/B ratio, indicating an intact and highly regular fiber organization. However, the tendonitis-induced horse tendons possess higher number of dark and isotropic regions, and larger standard deviations of the measured parameters, suggesting significantly disoriented and disorganized collagen fibers. This type of quantification would be highly beneficial in diagnosing and determining the stage of tendonitis in clinical settings. Not limited to tendonitis, the technique could also be applied to other diseases that structurally affect collagen fibers. The advantage of FT-SHG over the conventional polarization microscopy is also discussed.
Sivaguru, Mayandi; Durgam, Sushmitha; Ambekar, Raghu; Luedtke, David; Fried, Glenn; Stewart, Allison; Toussaint, Kimani C., Jr.
Tendon cells are specialized cells of the insect epidermis that connect basally attached muscle tips to the cuticle on their apical surface via prominent arrays of microtubules. Tendon cells of Drosophila have become a useful genetic model system to address questions with relevance to cell and developmental biology. Here, we use light, confocal, and electron microscopy to present a refined model of the subcellular organization of tendon cells. We show that prominent arrays of F-actin exist in tendon cells that fully overlap with the microtubule arrays, and that type II myosin accumulates in the same area. The F-actin arrays in tendon cells seem to represent a new kind of actin structure, clearly distinct from stress fibers. They are highly resistant to F-actin–destabilizing drugs, to the application of myosin blockers, and to loss of integrin, Rho1, or mechanical force. They seem to represent an important architectural element of tendon cells, because they maintain a connection between apical and basal surfaces even when microtubule arrays of tendon cells are dysfunctional. Features reported here and elsewhere for tendon cells are reminiscent of the structural and molecular features of support cells in the inner ear of vertebrates, and they might have potential translational value.
Alves-Silva, Juliana; Hahn, Ines; Huber, Olga; Mende, Michael; Reissaus, Andre
Tendons are connective tissues required for motion and are frequently injured. Poor healing and inadequate return to normal tissue structure and mechanical function make tendon a prime candidate for tissue engineering; however functional tendons have yet to be engineered. The physical environment, from substrate stiffness to dynamic mechanical loading, may regulate tenogenic stem cell differentiation. Tissue stiffness and loading parameters derived from embryonic development may enhance tenogenic stem cell differentiation and tendon tissue formation. We highlight the current understanding of the mechanical environment experienced by embryonic tendons and how progenitor cells may sense and respond to physical inputs. We further discuss how mechanical factors have only recently been used to induce tenogenic fate in stem cells. PMID:23916867
Schiele, Nathan R; Marturano, Joseph E; Kuo, Catherine K
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
Two-dimensional (2D) electrospun fibre mats have been investigated as fibrous sheets intended as biomaterials scaffolds for tissue repair. It is recognised that tissues are three-dimensional (3D) structures and that optimisation of the fabrication process should include both 2D and 3D scaffolds. Understanding the relative merits of the architecture of 2D and 3D scaffolds for tendon repair is required. This study investigated three different electrospun scaffolds based on poly(?-caprolactone) fibres intended for repair of injured tendons, referred to as; 2D random sheet, 2D aligned sheet and 3D bundles. 2D aligned fibres and 3D bundles mimicked the parallel arrangement of collagen fibres in natural tendon and 3D bundles further replicated the tertiary layer of a tendon's hierarchical configuration. 3D bundles demonstrated greatest tensile properties, being significantly stronger and stiffer than 2D aligned and 2D random fibres. All scaffolds supported adhesion and proliferation of tendon fibroblasts. Furthermore, 2D aligned sheets and 3D bundles allowed guidance of the cells into a parallel, longitudinal arrangement, which is similar to tendon cells in the native tissue. With their superior physical properties and ability to better replicate tendon tissue, the 3D electrospun scaffolds warrant greater investigation as synthetic grafts in tendon repair. PMID:23504088
Bosworth, L A; Alam, N; Wong, J K; Downes, S
Multi-wire steel strands are used in civil structures as pre-stressing tendons in prestressed concrete and as stay-cables in cable-stayed and suspension bridges. Monitoring the structural performance of these components is important to ensure the proper functioning and safety of the entire structure. Among the various NDE techniques that are under investigation for monitoring tendons and cables, the use of ultrasonic
Piervincenzo Rizzo; Francesco Lanza di Scalea
Sonomicrometrics of in vivo axial strain of muscle has shown that the swimming fish body bends like a homogenous, continuous beam in all species except tuna. This simple beam-like behavior is surprising because the underlying tendon structure, muscle structure and behavior are complex. Given this incongruence, our goal was to understand the mechanical role of various myoseptal tendons. We modeled a pumpkinseed sunfish, Lepomis gibbosus, using experimentally-derived physical and mechanical attributes, swimming from rest with steady muscle activity. Axially oriented muscle-tendons, transverse and axial myoseptal tendons, as suggested by current morphological knowledge, interacted to replicate the force and moment distribution. Dynamic stiffness and damping associated with muscle activation, realistic muscle force generation, and force distribution following tendon geometry were incorporated. The vertebral column consisted of 11 rigid vertebrae connected by joints that restricted bending to the lateral plane and endowed the body with its passive viscoelasticity. In reaction to the acceleration of the body in an inviscid fluid and its internal transmission of moment via the vertebral column, the model predicted the kinematic response. Varying only tendon geometry and stiffness, four different simulations were run. Simulations with only intrasegmental tendons produced unstable axial and lateral tail forces and body motions. Only the simulation that included both intra- and intersegmental tendons, muscle-enhanced segment stiffness, and a stiffened caudal joint produced stable and large lateral and axial forces at the tail. Thus this model predicts that axial tendons function within a myomere to (1) convert axial force to moment (moment transduction), (2) transmit axial forces between adjacent myosepta (segment coupling), and, intersegmentally, to (3) distribute axial forces (force entrainment), and (4) stiffen joints in bending (flexural stiffening). The fact that all four functions are needed to produce the most realistic swimming motions suggests that axial tendons are essential to the simple beam-like behavior of fish. PMID:12485683
Long, John H; Adcock, Bruce; Root, Robert G
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.
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.
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
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
Cell and matrix composites recently have been used to repair tendons and ligaments. In the current study the authors briefly review prior studies in this area, and the contributions these findings have made toward solving this clinical problem. The authors then provide a perspective on the necessary characteristics that the cells and delivery vehicles of these composites must possess, separately and in combination, to function successfully after surgery. The authors conclude by applying these functional tissue engineering principles to two tendon injury models in which mesenchymal stem cells have been suspended in Type I collagen gel to form composites for patellar and Achilles tendon repair. In the first study, mesenchymal stem cells were suspended in gel (5 million cells/mL) with no attempt to align the cells during incubation. The resulting composites were implanted in window defects in one patellar tendon in the rabbit knee, with gel alone in a matching defect on the contralateral side. Biomechanical evaluation at 4 weeks showed that the material properties of the mesenchy-mal stem cell based repairs were 18% to 33% greater than results for contralateral controls. In the second study, mesenchymal stem cells were suspended in gel (4 million cells/mL), contracted on a tensioned suture during incubation, placed in an Achilles gap defect, and compared with repairs of contralateral gap injuries containing suture alone (controls). By 4 weeks, the repairs treated with mesenchymal stem cells had achieved twice the structural properties of the contralateral controls and 50% to 60% of the stiffness and strength of normal tendons that were not surgically treated. In addition, the material properties of the repairs treated with mesenchymal stem cells had increased with time to 37% of normal by 12 weeks after surgery. Both studies reveal the benefits of using pluripotential cells in a collagen gel matrix, and suggest additional research that might enhance the repair quality of healing tendons. PMID:10546656
Butler, D L; Awad, H A
The glycosaminoglycan (GAG) dermatan sulfate and chondroitin sulfate side-chains of small leucine-rich proteoglycans have been increasingly posited to act as molecular cross links between adjacent collagen fibrils and to directly contribute to tendon elasticity. GAGs have also been implicated in tendon viscoelasticity, supposedly affecting frictional loss during elongation or fluid flow through the extra cellular matrix. The current study sought to systematically test these theories of tendon structure-function by investigating the mechanical repercussions of enzymatic depletion of GAG complexes by chondroitinase ABC in a reproducible tendon structure-function model (rat tail tendon fascicles). The extent of GAG removal (at least 93%) was verified by relevant spectrophotometric assays and transmission electron microscopy. Dynamic viscoelastic tensile tests on GAG depleted rat tail tendon fascicle were not mechanically different from controls in storage modulus (elastic behavior) over a wide range of strain-rates (0.05, 0.5, and 5% change in length per second) in either the linear or nonlinear regions of the material curve. Loss modulus (viscoelastic behavior) was only affected in the nonlinear region at the highest strain-rate, and even this effect was marginal (19% increased loss modulus, p=0.035). Thus glycosaminoglycan chains of small leucine-rich proteoglycans do not appear to mediate dynamic elastic behavior nor do they appear to regulate the dynamic viscoelastic properties in rat tail tendon fascicles. PMID:19698786
Fessel, Gion; Snedeker, Jess G
A lot of people, overall athletic one suffer from tendinitis or complete rupture of the Achilles tendon. This structure becomes inflamed and damaged mainly from a variety of mechanical forces and sometimes due to metabolic problems, such as diabetes or arthritis. Over the past three decades extensive studies have been performed on the structural and mechanical properties of Achilles tendon trying to explain the constitutive equations to describe and foresee tendon behavior. Among the various mechanical parameters, the vibrational behavior is also of interest. Several investigations are performed in order to study how the Achilles tendon vibrations influence the response of the muscle proprioception and human posture. The present article describes how in vitro tensile experiments can be performed, taking into account the need to simulate physiological condition of Achilles tendon and thus approaching some opened problems in the design of the experimental set-up. A new system for evaluating tendon vibrations by non contact techniques is proposed. Preliminary simple elongation tests are made extracting the main mechanical parameters: stress and strain at different fixed stretches, in order to characterize the tissue. Finally, a vibration study is made at each pretensioned tendon level evaluating the oscillating curves caused by a small hammer.
Revel, Gian M.; Scalise, Alessandro; Scalise, Lorenzo; Pianosi, Antonella
Achilles tendon ruptures are traumatic injuries, and techniques for assessing repair outcomes rely on patient-based measures of pain and function, which do not directly assess tendon healing. Consequently, there is a need for a quantitative, in vivo measure of tendon properties. Therefore, the purpose of this study was to validate ultrasound imaging for evaluating collagen organization in tendons. In this study, we compared our novel, high-frequency ultrasound (HFUS) imaging and analysis method to a standard measure of collagen organization, crossed polarizer (CP) imaging. Eighteen mouse Achilles tendons were harvested and placed into a testing fixture where HFUS and CP imaging could be performed simultaneously in a controlled loading environment. Two experiments were conducted: (1) effect of loading on collagen alignment and (2) effect of an excisional injury on collagen alignment. As expected, it was found that both the HFUS and CP methods could reliably detect an increase in alignment with increasing load, as well as a decrease in alignment with injury. This HFUS method demonstrates that structural measures of collagen organization in tendon can be determined through ultrasound imaging. This experiment also provides a mechanistic evaluation of tissue structure that could potentially be used to develop a targeted approach to aid in rehabilitation or monitor return to activity after tendon injury. PMID:24356929
Riggin, Corinne N; Sarver, Joseph J; Freedman, Benjamin R; Thomas, Stephen J; Soslowsky, Louis J
An active tendon, consisting of a displacement actuator and a co-located force sensor, has been adopted by many studies to suppress the vibration of large space flexible structures. The damping, provided by the force feedback control algorithm in these studies, is small and can increase, especially for tendons with low axial stiffness. This study introduces an improved force feedback algorithm, which is based on the idea of velocity feedback. The algorithm provides a large damping ratio for space flexible structures and does not require a structure model. The effectiveness of the algorithm is demonstrated on a structure similar to JPL-MPI. The results show that large damping can be achieved for the vibration control of large space structures.
Guo, Tieneng; Liu, Zhifeng; Cai, Ligang
An active tendon, consisting of a displacement actuator and a co-located force sensor, has been adopted by many studies to suppress the vibration of large space flexible structures. The damping, provided by the force feedback control algorithm in these studies, is small and can increase, especially for tendons with low axial stiffness. This study introduces an improved force feedback algorithm, which is based on the idea of velocity feedback. The algorithm provides a large damping ratio for space flexible structures and does not require a structure model. The effectiveness of the algorithm is demonstrated on a structure similar to JPL-MPI. The results show that large damping can be achieved for the vibration control of large space structures. PMID:23112660
Guo, Tieneng; Liu, Zhifeng; Cai, Ligang
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
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
Biologic and synthetic scaffolds, mechanical loads, vitamin D, and diabetes can affect tendon and tendon-to-bone healing, muscle recovery, and growth in the perioperative period. Despite important advances in technical approaches to achieve surgical repair of soft tissues in a minimally invasive fashion, structural healing after tendon-to-bone repair remains a formidable challenge that is complicated by our incomplete knowledge of complex natural biologic processes and a diverse patient population with various comorbidities and deficiencies. Scientific research has led to promising strategies for promoting a structural repair that recapitulates the native anatomy of the tendon or enthesis. Augmentation with scaffolds may reinforce the initial repair biomechanically and can be coupled with growth factors to promote a favorable biologic environment for healing. Careful consideration of the implications of postoperative rehabilitation and endocrine and nutritional deficiencies on structural healing and muscle recovery are also critical to optimize patient outcomes. PMID:24720330
Nossov, Sarah; Dines, Joshua S; Murrell, George A C; Rodeo, Scott A; Bedi, Asheesh
Background: Tendon surface modification with a synthetic biopolymer, carbodiimide-derivatized hyaluronic acid and gelatin with the addition of lubricin (CHL), has been shown to reduce gliding resistance after tendon repair in an in vitro model. The purpose of the study was to investigate whether CHL would reduce adhesion formation and improve digital function after flexor tendon repair in a canine model in vivo. Methods: Sixty dogs were randomly assigned to either a biopolymer-treated group (n = 30) or an untreated control group (n = 30). The second and fifth flexor digitorum profundus tendons from each dog were lacerated fully at the zone-II area and then repaired. Passive synergistic motion therapy was started on the fifth postoperative day and continued until the dogs were killed on day 10, day 21, or day 42. The repaired tendons were evaluated for adhesions, normalized work of flexion, gliding resistance, repair strength, stiffness, and histological characteristics. Results: The normalized work of flexion of the repaired tendons treated with CHL was significantly lower than that of the non-CHL-treated repaired tendons at all time points (p < 0.05), and the prevalence of severe adhesions was also significantly decreased in the CHL-treated tendons at day 42 (p < 0.05). However, the repair failure strength and stiffness of the CHL-treated group were also significantly reduced compared with those of the control group at days 21 and 42 (p < 0.05) and the rate of tendon rupture was significantly higher in the treated group than in the control group at day 42 (p < 0.05). Conclusions: Treatment with the lubricin-containing gel CHL appears to be an effective means of decreasing postoperative flexor tendon adhesions, but it is also associated with some impairment of tendon healing. Future studies will be necessary to determine if the positive effects of CHL on adhesion formation can be maintained while reducing its adverse effect on the structural integrity of the repaired tendon.
Zhao, Chunfeng; Sun, Yu-Long; Kirk, Ramona L.; Thoreson, Andrew R.; Jay, Gregory D.; Moran, Steven L.; An, Kai-Nan; Amadio, Peter C.
The insufficient temporal resolution of imaging devices has made the analysis of very fast movements, such as those required to measure active muscle-tendon unit stiffness, difficult. Thus the relative contributions of tendon, aponeurosis, and fascicle to muscle-tendon unit compliance remain to be determined. The present study analyzed the dynamic interactions of fascicle, tendon, and aponeurosis in human gastrocnemius medialis during the first milliseconds of an ankle quick-release movement, using high-frame-rate ultrasonography (2,000 frames/s). Nine subjects performed the tests in random order at six levels of maximal voluntary contraction (MVC) (30% to 80% of MVC). These tests were carried out with the ultrasound probe placed on the muscle belly and on the myotendinous junction. Tendon, muscle fascicle, and aponeurosis length changes were quantified in relation to shortening of the muscle-tendon unit during the first few milliseconds following the release. The tendon was the main contributor (around 72%) to the shortening of the muscle-tendon unit, whereas the muscle fascicle and aponeurosis contributions were 18% and 10%, respectively. Because these structures can be considered in series, the quantified contributions can be regarded as relative contributions to muscle-tendon compliance. These contributions were not modified with the level of MVC or the time range used for the analysis between 10 and 25 ms. The constant contribution of tendon, muscle fascicle, and aponeurosis to muscle-tendon unit compliance may help to simplify the mechanism of compliance regulation and to maintain the important role of tendons in enhancing work output and movement efficiency. PMID:24311746
Farcy, Stevy; Nordez, Antoine; Dorel, Sylvain; Hauraix, Hugo; Portero, Pierre; Rabita, Giuseppe
Tendon fibroblasts synthesize collagen and form fibrils during embryonic development, but to what extent mature fibroblasts are able to recapitulate embryonic development and develop normal tendon structure is unknown. The present study examined the capability of mature human tendon fibroblasts to initiate collagen fibrillogenesis when cultured in fixed-length fibrin gels. Fibroblasts were dissected from semitendinosus and gracilis tendons from healthy humans and cultured in 3D linear fibrin gels. The fibroblasts synthesized an extracellular matrix of parallel collagen fibrils that were aligned along the axis of tension. The fibrils had a homogeneous narrow diameter that was similar to collagen fibrils occurring in embryonic tendon. Immunostaining showed colocalization of collagen type I with collagen III, XII and XIV. A fibronectin network was formed in parallel with the collagen, and fibroblasts stained positive for integrin alpha(5). Finally, the presence of cell extensions into the extracellular space with membrane-enclosed fibrils in fibripositors indicated characteristics of embryonic tendon. We conclude that mature human tendon fibroblasts retain an intrinsic capability to perform collagen fibrillogenesis similar to that of developing tendon, which implies that the hormonal/mechanical milieu, rather than intrinsic cellular function, inhibits regenerative potential in mature tendon. PMID:20356622
Bayer, Monika L; Yeung, Chin-Yan C; Kadler, Karl E; Qvortrup, Klaus; Baar, Keith; Svensson, René B; Magnusson, S Peter; Krogsgaard, Michael; Koch, Manuel; Kjaer, Michael
KEVLAR is a high strength, high modulus synthetic fiber manufactured by the E.I. DuPont de Nemours Company. The fiber is resistant to chloride and alkali attack. The resistance is enhanced when the fibers are assembled into a resin matrix and fabricated as rods. These properties suggest that KEVLAR reinforced rods may be a substitute for high strength steel prestress tendons in certain applications such as bridge decks and parking structures. This dissertation presents the background, theoretical development, and experimental investigations of KEVLAR reinforced rod strength, anchorage, fabrication and performance in prestressed concrete structures. The study concludes that KEVLAR has significant potential for these prestressed concrete applications. However, the reliability of the long term anchorage of the KEVLAR reinforced rods must be improved before production applications are undertaken. KEVLAR has a low shear strength compared to its tensile capacity. The anchorage of KEVLAR reinforced rods is sensitive to the shear forces generated in the anchorage assembly. Finite element analyses, using interface elements to simulate the addition of a mold release agent in a conic anchor, predict the behavior of resin socketed anchors. Test results confirm that mold release agents reduce the anchor shear stresses and suggest that moderate strength resins may be used in the anchor. KEVLAR is nearly linearly elastic to failure, yet ductility of a structure is an important design concern. Prestressed concrete beam tests using both bonded and unbonded tendons demonstrated that ductile structural behavior is obtained. Methods of predicting the strength and deflection behavior of the prestressed beams are presented and the theoretical predictions are compared to the experimental results. The overall correlation between predicted and theoretical results is satisfactory.
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.
Injured adult tendons do not exhibit optimal healing through a regenerative process, whereas fetal tendons can heal in a regenerative fashion without scar formation. Hence, we compared FFs (mouse fetal fibroblasts) and AFs (mouse adult fibroblasts) as seed cells for the fabrication of scaffold-free engineered tendons. Our results demonstrated that FFs had more potential for tendon tissue engineering, as shown by higher levels of tendon-related gene expression. In the in situ AT injury model, the FFs group also demonstrated much better structural and functional properties after healing, with higher levels of collagen deposition and better microstructure repair. Moreover, fetal fibroblasts could increase the recruitment of fibroblast-like cells and reduce the infiltration of inflammatory cells to the injury site during the regeneration process. Our results suggest that the underlying mechanisms of better regeneration with FFs should be elucidated and be used to enhance adult tendon healing. This may assist in the development of future strategies to treat tendon injuries.
Tang, Qiao-Mei; Chen, Jia Lin; Shen, Wei Liang; Yin, Zi; Liu, Huan Huan; Fang, Zhi; Heng, Boon Chin; Ouyang, Hong Wei; Chen, Xiao
Injured adult tendons do not exhibit optimal healing through a regenerative process, whereas fetal tendons can heal in a regenerative fashion without scar formation. Hence, we compared FFs (mouse fetal fibroblasts) and AFs (mouse adult fibroblasts) as seed cells for the fabrication of scaffold-free engineered tendons. Our results demonstrated that FFs had more potential for tendon tissue engineering, as shown by higher levels of tendon-related gene expression. In the in situ AT injury model, the FFs group also demonstrated much better structural and functional properties after healing, with higher levels of collagen deposition and better microstructure repair. Moreover, fetal fibroblasts could increase the recruitment of fibroblast-like cells and reduce the infiltration of inflammatory cells to the injury site during the regeneration process. Our results suggest that the underlying mechanisms of better regeneration with FFs should be elucidated and be used to enhance adult tendon healing. This may assist in the development of future strategies to treat tendon injuries. PMID:24992450
Tang, Qiao-Mei; Chen, Jia Lin; Shen, Wei Liang; Yin, Zi; Liu, Huan Huan; Fang, Zhi; Heng, Boon Chin; Ouyang, Hong Wei; Chen, Xiao
We recently reported a small study at the Federation of European Societies for Surgery of the hand, which was entitled ‘What is secondary flexor tendon surgery’? This study concluded that ‘secondary flexor tendon surgery’ was a generic name encompassing a multitude of pathologies. Between 10% and 15% of cases exhibited pathology of the skin and subcutaneous fat and required flap reconstruction of these tissues. Skin replacement may be used prophylactically at primary surgery or become necessary at secondary surgery after release of scar contractures, to achieve cover of vital structures. The long-term problem of skin deficiency relating to flexor tendon function is one of loss of extension from longitudinal scar shortening of the integument, even if the flexor tendons are primarily concerned with bending the digits, not straightening them. This loss of extension can only be tolerated in a hand to a certain degree without significant loss of function. This paper is largely an analysis of the flaps available and suitable for different degrees of skin deficiency and at different places along the course of the flexor system. It attempts to dispel the idea that ‘any flap will do’ provided the flexors are adequately covered.
Elliot, David; Giesen, Thomas
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
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
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
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.
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
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
Actuators and gear trains of most biped humanoid robots are divergently allocated on the links of two legs. Disadvantages of such a mechanical design are complicated wiring of power cord and sensing/ control signal bundles and imprecise kinetics models of mixed link-and-actuator structures. Based on these drawbacks, this paper proposes a tendon-driven mechanism to develop a lower body structure of a full-size biped humanoid robot. The actuators are compacted as an actuator module, and they are placed at a distal site. A 12 degree-of-freedom mechanical structure is proposed with 100 cm in height and 45 kg in weight. The gait planning module is simulated and evaluated using the Matlab software. At the same time, an ARM7 based controller is developed to automatically generate walking patterns as well as to control the motors. Finally, a tendon-driven biped humanoid robot prototype is realized for practical waling control in the future.
Kuo, Chung-Hsien; Chiou, Kuo-Wei
Outcomes after tendon repair are often unsatisfactory, despite improvements in surgical techniques and rehabilitation methods. Recent studies aimed at enhancing repair have targeted the paucicellular nature of tendon for enhancing repair; however, most approaches for delivering growth factors and cells have not been designed for dense connective tissues such as tendon. Therefore, we developed a scaffold capable of delivering growth factors and cells in a surgically manageable form for tendon repair. The growth factor PDGF-BB along with adipose-derived mesenchymal stem cells (ASCs) was incorporated into a heparin/fibrin-based delivery system (HBDS). This hydrogel was then layered with an electrospun nanofiber poly-lactic-co-glycolic acid (PLGA) backbone. The HBDS allowed for the concurrent delivery of PDGF-BB and ASCs in a controlled manner, while the PLGA backbone provided structural integrity for surgical handling and tendon implantation. In vitro studies verified that the cells remained viable, and that sustained growth factor release was achieved. In vivo studies in a large animal tendon model verified that the approach was clinically relevant, and that the cells remained viable in the tendon repair environment. Only a mild immunoresponse was seen at dissection, histologically, and at the mRNA level; fluorescently-labeled ASCs and the scaffold were found at the repair site 9 days postoperatively; and increased total DNA was observed in ASC-treated tendons. The novel layered scaffold has the potential for improving tendon healing due to its ability to deliver both cells and growth factors simultaneously in a surgically convenient manner.
Manning, CN; Schwartz, AG; Liu, W; Xie, J; Havlioglu, N; Sakiyama-Elbert, SE; Silva, MJ; Xia, Y; Gelberman, RH; Thomopoulos, S
The aim of this study was to examine the structural and mechanical properties of the patellar tendon in elite male badminton players with and without patellar tendinopathy. Seven players with unilateral patellar tendinopathy (PT group) on the lead extremity (used for forward lunge) and nine players with no current or previous patellar tendinopathy (CT group) were included. Magnetic resonance imaging was used to assess distal patellar tendon dimensions. Patellar tendon mechanical properties were assessed using simultaneous tendon force and deformation measurements. Distal tendon cross-sectional area (CSA) normalized for body weight (mm(2) /kg(2/3) ) was lower in the PT group compared with the CT group on both the non-lead extremity (6.1 ± 0.3 vs 7.4 ± 0.2, P < 0.05) and the lead extremity (6.5 ± 0.6 vs 8.4 ± 0.3, P < 0.05). Distal tendon stress was higher in the PT group compared with the CT group for both the non-lead extremity (31 ± 1 vs 27 ± 1 MPa, P < 0.05) and the lead extremity (32 ± 3 vs 21 ± 3 MPa, P < 0.01). Conclusively, the PT group had smaller distal patellar tendon CSA on both the injured (lead extremity) and the uninjured side (non-lead extremity) compared with the CT group. Subsequently, the smaller CSA yielded a greater distal patellar tendon stress in the PT group. Therefore, a small tendon CSA may predispose to the development of tendinopathy. PMID:23227947
Couppé, C; Kongsgaard, M; Aagaard, P; Vinther, A; Boesen, M; Kjaer, M; Magnusson, S P
Tendons are known to exhibit complex mechanical behavior when transferring forces from muscles to bone. This nonlinear mechanical\\u000a response varies with age due to the presence of degenerative effects which is attributed to the structural changes and interactions\\u000a observed in each hierarchical level of the dense connective tissue.\\u000a \\u000a In this study, mouse tail tendons were excised from the C57BL6 mice
Jolene Liu; Siaw Meng Chou; Kheng Lim Goh
\\u000a The important mechanisms by which soft collagenous tissues such as ligament and tendon respond to mechanical deformation include\\u000a non-linear elasticity, viscoelasticity and poroelasticity. These contributions to the mechanical response are modulated by\\u000a the content and morphology of structural proteins such as type I collagen and elastin, other molecules such as glycosaminoglycans,\\u000a and fluid. Our ligament and tendon constructs, engineered from
J. Ma; H. Narayanan; K. Garikipati; K. Grosh; E. M. Arruda
Tendons and ligaments are elastic collagenous tissues with similar composition and hierarchical structure, contributing to\\u000a motion. Their strength is related to the number and size of the collagen fibrils. Collagen fibrils increase in size during\\u000a development and in response to increased physical demands or training. Tendon disorders are commonly seen in clinical practice\\u000a and give rise to significant morbidity. Treatment
Andrea Hoffmann; Gerhard Gross
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
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.
Background Acute traumatic tendon injuries of the hand and wrist are commonly encountered in the emergency department. Despite the frequency, few studies have examined the true incidence of acute traumatic tendon injuries in the hand and wrist or compared the incidences of both extensor and flexor tendon injuries. Methods We performed a retrospective population-based cohort study of all acute traumatic tendon injuries of the hand and wrist in a mixed urban and rural Midwest county in the United States between 2001-2010. A regional epidemiologic database and medical codes were used to identify index cases. Epidemiologic information including occupation, year of injury, mechanism of injury and the injured tendon and zone were recorded. Results During the 10-year study period there was an incidence rate of 33.2 injuries per 100,000 person-years. There was a decreasing rate of injury during the study period. Highest incidence of injury occurred at 20-29 years of age. There was significant association between injury rate and age, and males had a higher incidence than females. The majority of cases involved a single tendon, with extensor tendon injuries occurring more frequently than flexor tendons. Typically, extensor tendon injuries involved zone three of the index finger, while flexor tendons involved zone two of the index finger. Work-related injuries accounted for 24.9% of acute traumatic tendon injuries. The occupations of work-related injuries were assigned to major groups defined by the 2010 Standard Occupational Classification structure. After assigning these patients' occupations to respective major groups, the most common groups work-related injuries occurred in construction and extraction occupations (44.2%), food preparation and serving related occupations (14.4%), and transportation and material moving occupations (12.5%). Conclusions Epidemiology data enhances our knowledge of injury patterns and may play a role in the prevention and treatment of future injuries, with an end result of reducing lost work time and economic burden.
de Jong, Johanna P.; Nguyen, Jesse T.; Sonnema, Anne J. M.; Nguyen, Emily C.; Amadio, Peter C.
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
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
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
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
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
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
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
Abstract Attachment of dissimilar materials is a major challenge because high levels of localized stress may develop at their interfaces. An effective biologic solution to this problem exists at one of nature's most extreme interfaces: the attachment of tendon (a compliant, structural “soft tissue”) to bone (a stiff, structural “hard tissue”). The goal of our study was to develop biomechanical models to describe how the tendon-to-bone insertion derives its mechanical properties. We examined the tendon-to-bone insertion and found two factors that give the tendon-to-bone transition a unique grading in mechanical properties: 1), a gradation in mineral concentration, measured by Raman spectroscopy; and 2), a gradation in collagen fiber orientation, measured by polarized light microscopy. Our measurements motivate a new physiological picture of the tissue that achieves this transition, the tendon-to-bone insertion, as a continuous, functionally graded material. Our biomechanical model suggests that the experimentally observed increase in mineral accumulation within collagen fibers can provide significant stiffening of the partially mineralized fibers, but only for concentrations of mineral above a “percolation threshold” corresponding to formation of a mechanically continuous mineral network within each collagen fiber (e.g., the case of mineral connectivity extending from one end of the fiber to the other). Increasing dispersion in the orientation distribution of collagen fibers from tendon to bone is a second major determinant of tissue stiffness. The combination of these two factors may explain the nonmonotonic variation of stiffness over the length of the tendon-to-bone insertion reported previously. Our models explain how tendon-to-bone attachment is achieved through a functionally graded material composition, and provide targets for tissue engineered surgical interventions and biomimetic material interfaces.
Genin, Guy M.; Kent, Alistair; Birman, Victor; Wopenka, Brigitte; Pasteris, Jill D.; Marquez, Pablo J.; Thomopoulos, Stavros
Attachment of dissimilar materials is a major challenge because high levels of localized stress may develop at their interfaces. An effective biologic solution to this problem exists at one of nature's most extreme interfaces: the attachment of tendon (a compliant, structural "soft tissue") to bone (a stiff, structural "hard tissue"). The goal of our study was to develop biomechanical models to describe how the tendon-to-bone insertion derives its mechanical properties. We examined the tendon-to-bone insertion and found two factors that give the tendon-to-bone transition a unique grading in mechanical properties: 1), a gradation in mineral concentration, measured by Raman spectroscopy; and 2), a gradation in collagen fiber orientation, measured by polarized light microscopy. Our measurements motivate a new physiological picture of the tissue that achieves this transition, the tendon-to-bone insertion, as a continuous, functionally graded material. Our biomechanical model suggests that the experimentally observed increase in mineral accumulation within collagen fibers can provide significant stiffening of the partially mineralized fibers, but only for concentrations of mineral above a "percolation threshold" corresponding to formation of a mechanically continuous mineral network within each collagen fiber (e.g., the case of mineral connectivity extending from one end of the fiber to the other). Increasing dispersion in the orientation distribution of collagen fibers from tendon to bone is a second major determinant of tissue stiffness. The combination of these two factors may explain the nonmonotonic variation of stiffness over the length of the tendon-to-bone insertion reported previously. Our models explain how tendon-to-bone attachment is achieved through a functionally graded material composition, and provide targets for tissue engineered surgical interventions and biomimetic material interfaces. PMID:19686644
Genin, Guy M; Kent, Alistair; Birman, Victor; Wopenka, Brigitte; Pasteris, Jill D; Marquez, Pablo J; Thomopoulos, Stavros
Summary Tendon tissue regeneration is an important goal for orthopedic medicine. We hypothesized that implantation of Smad8/BMP2–engineered MSCs in a full-thickness defect of the Achilles tendon (AT) would induce regeneration of tissue with improved biomechanical properties. A 2 mm defect was created in the distal region of murine ATs. The injured tendons were then sutured together or given implants of genetically engineered MSCs (GE group), nonengineered MSCs (CH3 group), or fibrin gel containing no cells (FG group). Three weeks later the mice were killed, and their healing tendons were excised and processed for histological or biomechanical analysis. A biomechanical analysis showed that tendons that received implants of genetically engineered MSCs had the highest effective stiffness (> 70% greater than natural healing, p < 0.001) and elastic modulus. There were no significant differences in either ultimate load or maximum stress among the treatment groups. Histological analysis revealed a tendon-like structure with elongated cells mainly in the GE group. ATs that had been implanted with Smad8/BMP2–engineered stem cells displayed a better material distribution and functional recovery than control groups. While additional study is required to determine long-term effects of GE MSCs on tendon healing, we conclude that genetically engineered MSCs may be a promising therapeutic tool for accelerating short-term functional recovery in the treatment of tendon injuries.
Pelled, Gadi; Snedeker, Jess G.; Ben-Arav, Ayelet; Rigozzi, Samuela; Zilberman, Yoram; Kimelman-Bleich, Nadav; Gazit, Zulma; Muller, Ralph; Gazit, Dan
This paper investigates an alternative explanation for widely reported paradoxical intracellular water properties. The most frequent biological explanation assumes water structure extending multiple layers from surfaces of compactly folded macromolecules to explain large amounts of perturbed water. Long range water structuring, however, contradicts molecular models widely accepted by the scientific majority. This study questions whether the paradoxical cell water could result from larger than expected amounts of first layer interfacial water on internal protein surfaces rather than structured multilayers. Native mammalian tendon is selected for the study because (1) the organ consists of highly compact structures of a single macromolecular protein--collagen, (2) molecular structure and geometry of collagen is well characterized by X-ray diffraction, (3) molecular structure extends to the macroscopic tendon level and (4) perturbed water behavior similar to cellular water is reported on tendon. Native tendon holds 1.6 g water/g dry mass. The 62% native water content simulates the water content of many cell types. MicroCT studies of tendon dilatometry as a function of hydration are measured and correlated to X-ray diffraction measurements of interaxial separation. Correlations show that native tendon has sufficient water for only a single monolayer of interfacial water. Thus the paradoxical properties of water in native tendon are first-layer interfacial water properties. Similar water behavior on globular proteins suggests that paradoxical cell water behavior could be caused by larger than expected amounts of first layer interfacial water on internal and external macromolecular surfaces of cell components. PMID:16488837
Fullerton, Gary D; Amurao, Maxwell R
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
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
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.
A previous ultrasound study showed inflammation around the extensor pollicis longus tendon and surrounding structures at 6 weeks after manipulation, with or without pin fixation, and immobilization for distal radius fracture. Ultrasound examination after plating of distal radius fracture followed by early active mobilization of the wrist showed a short-lived inflammatory response, evident at 2 weeks but not at 6 weeks, around the extensor pollicis longus tendon (26 wrists examined) and flexor pollicis longus tendon (18 wrists examined). Early active mobilization of the wrist appears to limit the duration of inflammation around these tendons. PMID:22733699
Owers, K L; Grieve, P P; Mee, S; Chew, N S; Ansede, G; Lee, J
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
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
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
Collagen fibres are ubiquitous macromolecular assemblies in nature, providing the structures that support tensile mechanical loads within the human body. Aligned type I collagen fibres are the primary structural motif for tendon and ligament, and therefore biomaterials based on these structures are considered promising candidates for mediating regeneration of these tissues. However, despite considerable investigation, there remains no collagen-fibre-based biomaterial
S. J. Kew; J. H. Gwynne; D. Enea; M. Abu-Rub; A. Pandit; D. Zeugolis; R. A. Brooks; N. Rushton; S. M. Best; R. E. Cameron
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
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
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
Extracellular matrix (ECM) materials are currently utilized for soft tissue repair applications such as vascular grafts, tendon reconstruction, and hernia repair. These materials are derived from tissues such as human dermis and porcine small intestine submucosa, which must be rendered acellular to prevent disease transmission and decrease the risk of an immune response. The ideal decellularization technique removes cells and cellular remnants, but leaves the original collagen architecture intact. The tissue utilized in this study was the central tendon of the porcine diaphragm, which had not been previously investigated for soft tissue repair. Several treatments were investigated during this study including peracetic acid, TritonX-100, sodium dodecyl sulfate, and tri(n-butyl) phosphate (TnBP). Of the decellularization treatments investigated, only 1% TnBP was effective in removing cell nuclei while leaving the structure and composition of the tissue intact. Overall, the resulting acellular tissue scaffold retained the ECM composition, strength, resistance to enzymatic degradation, and biocompatibility of the original tissue, making 1% TnBP an acceptable decellularization treatment for porcine diaphragm tendon. PMID:21210498
Deeken, C R; White, A K; Bachman, S L; Ramshaw, B J; Cleveland, D S; Loy, T S; Grant, S A
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
The peroneal tubercle is an osseous structure on the lateral side of the calcaneus present in 90% of individuals. Hypertrophy of the peroneal tubercle resulting in stenosing peroneal tenosynovitis has been well described in the literature. Repair of this condition involves operative treatment to remove the hypertrophied peroneal tubercle and repair any resulting tendon pathology. The authors report a unique case of a hypertrophied peroneal tubercle with an associated tarsal coalition, resulting in complete bony encasement of the peroneal tendons. In this case, a 50-year-old white man presented with worsening bilateral foot and ankle pain for several years. On examination, he had fixed hindfoot varus and bilateral equinocavovarus feet. Magnetic resonance imaging and weight-bearing radiographs showed a calcaneonavicular coalition. Intraoperatively, the authors discovered complete bony encasement of the peroneal longus and brevis tendons. On examination, the peroneal longus and brevis were severely stenotic, with the peroneal brevis to the point of near laceration. This painful condition was repaired by takedown of the calcaneonavicular coalition, the peroneal tubercle was resected, and the peroneal tendons were freed from their bony encasement. Tenodesis of the peroneus brevis to longus was performed and the hindfoot varus was corrected with wedge osteotomy of the calcaneus. The patient reported excellent postoperative results. At 3 months postoperatively, he was pain-free and his calcaneal osteotomy was well healed. This case appears to be the first of its type to be reported in the literature. The details of the case are presented along with a review of the relevant literature. PMID:24992061
Lalli, Trapper A J; King, Jonathan C; Santrock, Robert D
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
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
Imaging techniques are high in demand for modern nondestructive evaluation of large-scale concrete structures. The travel-time tomography (TTT) technique, which is based on the principle of mapping the change of propagation velocity of transient elastic waves in a measured object, has found increasing application for assessing in situ concrete structures. The primary aim of this technique is to detect defects that exist in a structure. The TTT technique can offer an effective means for assessing tendon duct filling of prestressed concrete (PC) elements. This study is aimed at clarifying some of the issues pertaining to the reliability of the technique for this purpose, such as sensor arrangement, model, meshing, type of tendon sheath, thickness of sheath, and material type as well as the scale of inhomogeneity. The work involved 2D simulations of wave motions, signal processing to extract travel time of waves, and tomography reconstruction computation for velocity mapping of defect in tendon duct. PMID:24737961
Liu, Kit Fook; Chai, Hwa Kian; Mehrabi, Nima; Yoshikazu, Kobayashi; Shiotani, Tomoki
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
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
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
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
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
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)
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.
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
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
Computer modeling is gaining popularity in the design and verification of cathodic protection (CP) systems for offshore structures. The work presented in this article expands the use of CP simulation to consider the metallic electrical resistance of risers/tendons used with tension leg platforms where anodes are mounted on the hull or subsea structure. The SEACORR/CP computer system was used to perform a parametric study to identify the limitations of CP and coatings in providing corrosion protection. The effect of using a titanium riser instead of a steel riser was also considered.
Osvoll, H.; Gartland, P.O. [CorrOcean AS, Trondheim (Norway); Thomason, W.H. [Conoco Inc., Ponca City, OK (United States)
Magnetic resonance imaging (MRI) has proven to be an ideal technique for evaluating tendons and ligaments, which, because of their fibrous structure, have a low signal intensity on all sequences. Trauma and a wide variety of other conditions cause aberrations in the normal appearance of these structures, ranging from minor alterations in shape, size, appearance, and continuity to various changes
Jamshid Tehranzadeh; Roger Kerr; Jay Amster
Physical exercise and massage are regarded as key factors in regulating tendon structure. However, information on the mechanism through which massage influences the structure and biology of a tendon is scarce. In this study, we attempted to define the impact of these two activities on rat tendons by using morphological and molecular techniques, determining the expression of VEGF-A, FGF-2, and CD34 in the tendons of rats subjected to 10 weeks of physical exercise (running) with massage of varied duration. The group of rats that was trained and massaged during the entire study was characterized by the highest expression of these markers, compared to the rats subjected to massage before training and to the control group subjected to physical exercises only. The greatest significant differences, compared to the control, were noted in the expression of all the studied markers at mRNA level, and in the case of VEGF-A, at protein level, in the third and fifth weeks of the experiment. The results of this study could point to the synergistic impact of simultaneous massage and physical exercise on the expression of angiogenesis markers in rat tendons.
Andrzejewski, Waldemar; Kassolik, Krzysztof; Dziegiel, Piotr; Pula, Bartosz; Ratajczak-Wielgomas, Katarzyna; Jablonska, Karolina; Kurpas, Donata; Halski, Tomasz; Podhorska-Okolow, Marzena
Repair of acute Achilles tendon rupture is a common procedure. There are many accepted surgical techniques; suture selection is largely due to surgeon preference. We present a case report of a granulomatous reaction to suture material following Achilles tendon repair. 'Fiberwire(®)' is an increasingly popular suture material for the repair of tendons and ligamentous structures; the polyethelene braided structure with silicone and polyester coating provides high tensile strengths and good handling characteristics. Eight months following uneventful Achilles tendon repair surgery in an otherwise fit and well patient, pain, swelling and loss of function was noted. She required revision surgery with debridement and reconstruction of the tendo Achillis with flexor hallucis longus tendon transfer. Histology revealed a granulomatous reaction with giant cell response surrounding sections of the suture. Both the silicone coating of Fiberwire(®) and polyethylene core have the potential to cause a severe granulomatous reaction. We would advise caution in the use of this suture for tendo Achillis repair, and use the readily available alternatives. PMID:24796842
Ollivere, Ben J; Bosman, Hilary A; Bearcroft, Philip W P; Robinson, Andrew H N
Purpose. This work introduces a distinct sonographic classification of Achilles tendon ruptures which has proven itself to be a reliable instrument for an individualized and differentiated therapy selection for patients who have suffered an Achilles tendon rupture. Materials and Methods. From January 1, 2000 to December 31, 2005, 273 patients who suffered from a complete subcutaneous rupture of the Achilles tendon (ASR) were clinically and sonographically evaluated. The sonographic classification was organized according to the location of the rupture, the contact of the tendon ends, and the structure of the interposition between the tendon ends. Results. In 266 of 273 (97.4%) patients the sonographic classification of the rupture of the Achilles tendon was recorded. Type 1 was detected in 54 patients (19.8%), type 2a in 68 (24.9%), type 2b in 33 (12.1%), type 3a in 20 (7.3%), type 3b in 61 (22.3%), type 4 in 20 (7.3%), and type 5 in 10 (3.7%). Of the patients with type 1 and fresh ASR, 96% (n = 47) were treated nonoperative-functionally, and 4% (n = 2) were treated by percutaneous suture with the Dresden instrument (pDI suture). Of the patients classified as type 2a with fresh ASR, 31 patients (48%) were treated nonoperatively-functionally and 33 patients (52%) with percutaneous suture with the Dresden instrument (pDI suture). Of the patients with type 3b and fresh ASR, 94% (n = 34) were treated by pDI suture and 6% (n = 2) by open suture according to Kirchmayr and Kessler. Conclusion. Unlike the clinical classification of the Achilles tendon rupture, the sonographic classification is a guide for deriving a graded and differentiated therapy from a broad spectrum of treatments.
Amlang, Michael H.; Zwipp, Hans; Friedrich, Adina; Peaden, Adam; Bunk, Alfred; Rammelt, Stefan
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
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.
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
...SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices Â§ 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...
...SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices Â§ 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...
To stimulate healing and prevent tendinosis through optimized physical exercise, it is important to elucidate the tendon response to repetitive mechanical loading. However, the study of this response is challenging due to complex cell-matrix interactions. In an initial approximation, the authors examined tendon mechanical response only, and did not consider cellular activity. The authors investigated the hypothesis that mechanical degradation occurs relatively rapidly (< 24 h) even at very low stress levels. The authors subjected rat tail tendons to mechanical loadings oscillating between 0 and 1.5 MPa up to one of three fatigue levels: 4% strain, 8% strain, or rupture. Using non-destructive mechanical tests, changes in tendon strain and compliance over the entire fatigue testing period were evaluated. Using microscopy techniques, the structural evidence of mechanical degradation was examined. The changes in tendon strain and compliance progressed nonlinearly and accelerated before rupture which took place around the 15-h mark. Histological analyses revealed a higher degree of alteration in the collagen network at increased fatigue levels. At rupture, local zones of damage with low fibril density were evident. These results imply that a repair process must act rapidly at critical sites; otherwise, enzymatic degradation could cause further damage in the manner of a vicious cycle. PMID:21287276
Parent, Gabriel; Huppé, Nicolas; Langelier, Eve
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
PURPOSE: The present study evaluated the presence of stem cells in hamstring tendons from adult subjects of different ages. The aim was to isolate, characterize and expand these cells in vitro, and to evaluate whether cell activities are influenced by age. METHODS: Tendon stem cells (TSCs) were isolated through magnetic sorting from the hamstring tendons of six patients. TSC percentage, morphology and clonogenic potential were evaluated, as well as the expression of specific surface markers. TSC multi-potency was also investigated as a function of age, and quantitative polimerase chain reaction was used to evaluate gene expression of TSCs cultured in suitable differentiating media. RESULTS: The presence of easily harvestable stem cell population within adult human hamstring tendons was demonstrated. These cells exhibit features such as clonogenicity, multi-potency and mesenchymal stem cells markers expression. The age-related variations in human TSCs affect the number of isolated cells and their self-renewal potential, while multi-potency assays are not influenced by tendon ageing, even though cells from younger individuals expressed higher levels of osteogenic and adipogenic genes, while chondrogenic genes were highly expressed in cells from older individuals. CONCLUSIONS: These results may open new opportunities to study TSCs to better understand tendon physiology, healing and pathological processes such as tendinopathy and degenerative age-related changes opening new frontiers in the management of tendinopathy and tendon ruptures. PMID:23503946
Ruzzini, Laura; Abbruzzese, Franca; Rainer, Alberto; Longo, Umile Giuseppe; Trombetta, Marcella; Maffulli, Nicola; Denaro, Vincenzo
The extracellular matrix (ECM) of skeletal muscle and tendon is composed of different types of collagen molecules that play important roles in the transmission of forces throughout the body, and in the repair and regeneration of injured tissues. Fibroblasts are the primary cells in muscle and tendon that maintain, repair, and modify the ECM in response to mechanical loading, injury, and inactivity. Matrix metalloproteinases (MMPs) are enzymes that digest collagen and other structural molecules, which are synthesized and excreted by fibroblasts. MMPs are required for baseline ECM homeostasis, but disruption of MMP regulation due to injury or disease can alter the normal ECM architecture and prevent proper force transmission. Chronic injuries and diseases of muscles and tendons can be severely debilitating, and current therapeutic modalities to enhance healing are quite limited. This review will discuss the mechanobiology of MMPs, and the potential use of MMP inhibitors to improve the treatment of injured and diseased skeletal muscle and tendon tissue. PMID:23640595
Davis, Max E; Gumucio, Jonathan P; Sugg, Kristoffer B; Bedi, Asheesh; Mendias, Christopher L
Flexor tendon injuries still remain a challenging condition to manage to ensure optimal outcome for the patient. Since the first flexor tendon repair was described by Kirchmayr in 1917, several approaches to flexor tendon injury have enabled successful repairs rates of 70-90%. Primary surgical repair results in better functional outcome compared to secondary repair or tendon graft surgery. Flexor tendon injury repair has been extensively researched and the literature demonstrates successful repair requires minimal gapping at the repair site or interference with tendon vascularity, secure suture knots, smooth junction of tendon end and having sufficient strength for healing. However, the exact surgical approach to achieve success being currently used among surgeons is still controversial. Therefore, this review aims to discuss the results of studies demonstrating the current knowledge regarding the optimal approach for flexor tendon repair. Post-operative rehabilitation for flexor tendon surgery is another area, which has caused extensive debate in hand surgery. The trend to more active mobilisation protocols seems to be favoured but further study in this area is needed to find the protocol, which achieves function and gliding but avoids rupture of the tendons. Lastly despite success following surgery complications commonly still occur post surgery, including adhesion formation, tendon rupture and stiffness of the joints. Therefore, this review aims to discuss the appropriate management of these difficulties post surgery. New techniques in management of flexor tendon will also be discussed including external laser devices, addition of growth factors and cytokines. PMID:22431948
Griffin, M; Hindocha, S; Jordan, D; Saleh, M; Khan, W
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
We describe a novel technique of tubularizing flat tendons in tendon transfer procedures, including Jones procedure and Chrisman-Snook reconstruction. The technique strengthens the tendon, facilitates passage and fixation through bony tunnels, and helps protect it from fraying. PMID:18348833
Pace, Alistair; Dhar, Sunil
The central third of the patellar tendon of the right knee was removed in 40 adult New Zealand White (NZW) rabbits. The animals were divided into two groups of 20 animals each. In group 1 the tendon defect was left open and in group 2 the tendon defect was closed. The peritenon was closed in all cases. The animals were
Giuseppe Milano; Antonio Gigante; Alfredo Schiavone Panni; Pier Damiano Mulas; Carlo Fabbriciani
The snapping tendon syndrome may be caused by abnormalities of the fascia lata, gluteus maximus muscle, or less commonly, the iliopsoas tendon. One case is reported in which fluoroscopic monitoring after computed tomography-guided injection of contrast material confirmed the diagnosis of snapping iliopsoas tendon syndrome. PMID:3340787
Staple, T W; Jung, D; Mork, A
Phylogenetically, tendinous tissue first appears in the invertebrate chordate Branchiostoma as myosepta. This two-dimensional array of collagen fibers is highly organized, with fibers running along two primary axes. In hagfish the first linear tendons appear and the myosepta have developed specialized regions with unidirectional fiber orientation—a linear tendon within the flat sheet of myoseptum. Tendons react to compressive load by
Adam P. Summers; Thomas J. Koob
Collagen-based tissue mimics are important in clinical research because collagen is the main structural element in tendons. The current study aimed to improve the mechanical strength of Electronically Aligned Collagen (ELAC) threads by optimizing several crosslinking parameters. The results indicated that elevating the concentration of genipin to 2% and the solvent to 90% ethanol significantly enhanced the wet ultimate tensile stress of ELAC threads to 109 MPa with a crosslinking degree of 65%. Furthermore, significantly higher adhesion and proliferation of hMSCs was observed in ELAC threads crosslinked with 2% genipin in 90% ethanol compared to 0.625% genipin in 1X PBS. In conclusion, ELAC threads with mechanical strength on par with native tendon have significant potential to be used as scaffolds in tendon tissue engineering applications. PMID:23032437
Alfredo Uquillas, Jorge; Kishore, Vipuil; Akkus, Ozan
We report 22 patients (19 women and three men) of mean age 20.8 years who had painful snapping sensations in the groin. Most were able to reproduce the click by extending the affected hip from a flexed, abducted and externally rotated position and most were tender in the adductor triangle. Plain radiographs and an arthrogram were normal. A clinical diagnosis of subluxation of the iliopsoas tendon was made. Conservative management failed in 14 patients, two of whom had bilateral pain. All 14 had surgical release of the iliopsoas tendon through a medial approach. At follow-up (mean 17 months) the click had resolved in ten hips, was occasional but painless in five and unchanged in one. The syndrome of a painful 'snapping' psoas may result in disproportionately disabling symptoms. It may be diagnosed on clinical grounds and effectively treated, when severe, by release of the iliopsoas tendon. PMID:7593099
Taylor, G R; Clarke, N M
\\u000a \\u000a Background and Purpose:\\u000a Calcifying tendonitis is a degenerative inflammatory joint disorder. Pain relief can be successfully achieved with low-dose\\u000a radiotherapy. It is actually unknown which types of calcifying tendonitis respond to radiotherapy and which do not. The authors\\u000a tried to get predictive objectives for the response to radiotherapy on the basis of different morphological patterns of calcifications\\u000a evaluated by X-ray
Boris Adamietz; Rüdiger Schulz-Wendtland; Sedat Alibek; Michael Uder; Rolf Sauer; Oliver Ott; Ludwig Keilholz
Rupture of the Achilles tendon is a considerable cause of morbidity with reduced function following injury. Recent studies have shown little difference in outcome between the techniques of open and non-operative treatment using an early active rehabilitation programme. Meta-analyses have shown that non-operative management has increased risk of re-rupture whereas surgical intervention has risks of complications related to the wound and iatrogenic nerve injury. Minimally invasive surgery has been adopted as a way of reducing infections rates and wound breakdown however avoiding iatrogenic nerve injury must be considered. We discuss the techniques and outcomes of percutaneous and minimally invasive repairs of the Achilles tendon.
Flat foot due to rupture of the tibialis posterior tendon has not previously been described in children. We present three young patients who developed unilateral pes planus after old undiagnosed lacerations of the tendon. Transfer of the flexor hallucis longus to the distal stump of the tibialis posterior tendon achieved good results in all three cases. PMID:8175850
Masterson, E; Jagannathan, S; Borton, D; Stephens, M M
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
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
Management of patella infera remains a difficult therapeutic endeavor. We report a case of a 21-year-old man, who had development of patella infera and knee flexion contracture after a patella fracture. Patella infera was treated by patellar tendon lengthening and augmentation with a tibialis anterior tendon allograft fixed with bioabsorbable cross-pins. The patient regained an anatomic patellar position and full range of motion at two years after surgery. PMID:24231623
Jeong, Ju Seon; Wang, Joon Ho
Bacterial contamination of tendon allografts at the completion of processing has historically been about 2 %, with tendons that are found to be culture positive being discarded. Treatment of tendon allograft with hydrogen peroxide at the beginning of tissue processing may reduce bacterial contamination, however, the potential side effects of hydrogen peroxide treatment include hydrolysis of the collagen and this may alter the mechanical properties of the graft. Pairs of human tendons were used. One was washed in 3 % hydrogen peroxide for 5 min and the untreated tendon was used as a control. The ultimate tensile strength of the tendons was determined using a material testing machine. A freeze clamp technique was used to hold the tendons securely at the high loads required to cause tendon failure. There was no statistical difference in the ultimate tensile strength between the treated and untreated tendons. Mean strength ranged from Extensor Hallucis Longus at 588 Newtons to Tibialis Posterior at 2,366 Newtons. Hydrogen peroxide washing may reduce bacterial contamination of tendon allograft and does not affect the strength of the tendon. PMID:23681552
Gardner, E M H; VonderHeide, N; Fisher, R; Brooker, G; Yates, P J
The aim of this study was to evaluate the expression of key genes responsible for tendon remodeling of the proximal and distal regions of calcaneal tendon (CT), intermediate and distal region of superficial flexor tendon (SFT) and proximal, intermediate and distal region of deep flexor tendon (DFT) submitted to 7 weeks of jumping water load exercise in combination with AAS administration. Wistar male rats were grouped as follows: sedentary (S), trained (jumping water load exercise) (T), sedentary animals treated with AAS (5 mg/kg, twice a week) and animals treated with AAS and trained (AAST). mRNA levels of COL1A1, COL3A1, TIMP-1, TIMP-2, MMP-2, IGF-IEa, GAPDH, CTGF and TGF-?-1 were evaluated by quantitative PCR. Our main results indicated that mRNA levels alter in different regions in each tendon of sedentary animals. The training did not alter the expression of COL1A1, COL3A, IGF-IEa and MMP-2 genes, while AAS administration or its combination with training reduced their expression. This study indicated that exercise did not alter the expression of collagen and related growth factors in different regions of rat tendon. Moreover, the pattern of gene expression was distinct in the different tendon regions of sedentary animals. Although, the RNA yield levels of CT, SFT and DFT were not distinct in each region, these regions possess not only the structural and biochemical difference, but also divergence in the expression of key genes involved in tendon adaptation. PMID:21842416
Marqueti, Rita Cássia; Marqueti, Rita de Cássia; Heinemeier, Katja Maria; Durigan, João Luiz Quaglioti; de Andrade Perez, Sérgio Eduardo; Schjerling, Peter; Kjaer, Michael; Carvalho, Hernandes Faustino; Selistre-de-Araujo, Heloisa Sobreiro
The purpose of this study was to measure the tension in the flexor digitorum profundus (FDP) tendon in zone II and the digit angle during joint manipulations that replicate rehabilitation protocols. Eight FDP tendons from eight human cadavers were used in this study. The dynamic tension in zone II of the tendon and metacarpophalangeal (MCP) joint angle were measured in various wrist and digit positions. Tension in the FDP tendon increased with MCP joint extension. There was no tension with the finger fully flexed and wrist extended (synergistic motion), but the tendon force reached 1.77 ± 0.43 N with the MCP joint hyperextended 45 degrees with the distal interphalangeal and proximal interphalangeal joints flexed. The combination of wrist extension and MCP joint hyperextension with the distal interphalangeal and proximal interphalangeal joints fully flexed, what the authors term ‘‘modified synergistic motion,’’ produced a modest tendon tension and may be a useful alternative configuration to normal synergistic motion in tendon rehabilitation.
Tanaka, Tatsuro; Amadio, Peter C.; Zhao, Chunfeng; Zobitz, Mark E.; An, Kai-Nan
The attachment of dissimilar materials is a major challenge because of the high levels of stress that develop at such interfaces. An effective solution to this problem develops at the attachment of tendon (a compliant "soft tissue") to bone (a stiff "hard tissue"). This tissue, the "enthesis", transitions from tendon to bone through gradations in structure, composition, and mechanical properties. These gradations are not regenerated during tendon-to-bone healing, leading to a high incidence of failure after surgical repair. Understanding the development of the enthesis may allow scientists to develop treatments that regenerate the natural tendon-to-bone insertion. Recent work has demonstrated that both biologic and mechanical factors drive the development and morphogenesis of the enthesis. A cascade of biologic signals similar to those seen in the growth plate promotes mineralization of cartilage on the bony end of the enthesis and the formation of fibrocartilage on the tendon end of the enthesis. Mechanical loading is also necessary for the development of the enthesis. Removal of muscle load impairs the formation of bone, fibrocartilage, and tendon at the developing enthesis. This paper reviews recent work on the development of the enthesis, with an emphasis on the roles of biologic and mechanical factors. PMID:20190378
Thomopoulos, S; Genin, G M; Galatz, L M
Sterility testing is the final, and critical, step in quality control of tissue banking. It informs the decision whether to release the tissue allografts for clinical use, or not. The most common method for sterility testing of structural bone and tendon allografts is to swab using cotton tip streaks. This method provides low recovery efficiency; and therefore may pass allografts with low bioburden, providing false negatives. Our pilot data revealed organism recovery efficiencies of 60, 30 and 100% from cotton swab, membrane filtration and sponge swaps, respectively. Our aim was to develop a high sensitivity sterility test for structural bone and tendon allografts using a sponge sampling method. Eighty-one bone and tendon allograft samples were inoculated with organism suspensions (10(2) or less organisms per 0.1 mL) of Clostridium sporogenes, Staphylococcus aureus, Pseudomonas aeruginosa, Candida albicans, Bacillus subtilis, Aspergillus niger, Staphylococcus epidermidis and Micrococcus spp. Nasco sponges (4 × 8 cm) were used to aseptically sample the whole surface of allograft samples. The sponges were cut in half and cultured in either tryptone soya or fluid thioglycollate broths for 14 days. Positive culture samples were further examined for microbial morphology. The results showed that the sensitivity of the method, and negative predictive value, is 100% for all inoculated organisms incubated with thioglycollate. We conclude that this sponge sampling method should be applied as the standard for sterility testing of structural bone and tendon allografts. PMID:21603957
Nguyen, Huynh; Morgan, David A F; Cull, Sharon; Benkovich, Morris; Forwood, Mark R
Tissues and organs in vivo are under a hypoxic condition; that is, the oxygen tension is typically much lower than in ambient air. However, the effects of such a hypoxic condition on tendon stem cells, a recently identified tendon cell, remain incompletely defined. In cell culture experiments, we subjected human tendon stem cells (hTSCs) to a hypoxic condition with 5% O2, while subjecting control cells to a normaxic condition with 20% O2. We found that hTSCs at 5% O2 had significantly greater cell proliferation than those at 20% O2. Moreover, the expression of two stem cell marker genes, Nanog and Oct-4, was upregulated in the cells cultured in 5% O2. Finally, in cultures under 5% O2, more hTSCs expressed the stem cell markers nucleostemin, Oct-4, Nanog and SSEA-4. In an in vivo experiment, we found that when both cell groups were implanted with tendon-derived matrix, more tendon-like structures formed in the 5% O2 treated hTSCs than in 20% O2 treated hTSCs. Additionally, when both cell groups were implanted with Matrigel, the 5% O2 treated hTSCs showed more extensive formation of fatty, cartilage-like and bone-like tissues than the 20% O2 treated cells. Together, the findings of this study show that oxygen tension is a niche factor that regulates the stemness of hTSCs, and that less oxygen is better for maintaining hTSCs in culture and expanding them for cell therapy of tendon injuries.
Zhang, Jianying; Wang, James H.-C.
A common feature in biological neuromuscular systems is the redundancy in joint actuation. Understanding how these redundancies are resolved in typical joint movements has been a long-standing problem in biomechanics, neuroscience and prosthetics. Many empirical studies have uncovered neural, mechanical and energetic aspects of how humans resolve these degrees of freedom to actuate leg joints for common tasks like walking. However, a unifying theoretical framework that explains the many independent empirical observations and predicts individual muscle and tendon contributions to joint actuation is yet to be established. Here we develop a computational framework to address how the ankle joint actuation problem is resolved by the neuromuscular system in walking. Our framework is founded upon the proposal that a consideration of both neural control and leg muscle-tendon morphology is critical to obtain predictive, mechanistic insight into individual muscle and tendon contributions to joint actuation. We examine kinetic, kinematic and electromyographic data from healthy walking subjects to find that human leg muscle-tendon morphology and neural activations enable a metabolically optimal realization of biological ankle mechanics in walking. This optimal realization (a) corresponds to independent empirical observations of operation and performance of the soleus and gastrocnemius muscles, (b) gives rise to an efficient load-sharing amongst ankle muscle-tendon units and (c) causes soleus and gastrocnemius muscle fibers to take on distinct mechanical roles of force generation and power production at the end of stance phase in walking. The framework outlined here suggests that the dynamical interplay between leg structure and neural control may be key to the high walking economy of humans, and has implications as a means to obtain insight into empirically inaccessible features of individual muscle and tendons in biomechanical tasks.
Krishnaswamy, Pavitra; Brown, Emery N.; Herr, Hugh M.
Wrist injuries in the gymnast are due to the transformation of the upper extremity into a weight bearing entity. Gymnast wrist pain presents a difficult diagnostic and therapeutic challenge. Here, we present a new case of extensor tendon impingement in an elite gymnast. To our knowledge, there is no similar report in the literature. PMID:16253406
Wilson, S M; Dubert, T; Rozenblat, M
This study aims to verify the effects of AsGa Laser in the scarring of tendon lesion in rats with low nourishment condition and to analyze the ideal light density by means of histopathologic findings highlighted by light microscopy. After the proposed nutritional condition was verified the animals were divided into 3 groups denominated as follows: GI control group, GII laser
P. T. C. Carvalho; Cheila O. C. Batista; C. Fabíola
We report the clinical features, radiographic findings, management and results of a patient with a post-traumatic synovial sarcoma of the anterior tibialis tendon. Our patient was managed operatively and with radiotherapy with good clinical results. No evidence of recurrence or metastatic disease was seen at 3-year follow-up. PMID:22461273
Papapietro, Nicola; Longo, Umile Giuseppe; Palumbo, Alessio; Bianchi, Antonella; Maffuli, Nicola; Denaro, Vincenzo
Flexor tendon injuries were already treated in antiquity by Hippocrates, Galien and Avicenne. Since the Renaissance, other surgeons have attempted to repair flexor tendon injuries, but without success due to problems related to unsuitable materials and ignorance of the basic rules of asepsis and the absence of antiseptics until the second half of the 19th century. The first successful flexor tendon grafts in man were performed by K. Biesalski in 1910, E. Lexer in 1912 and L. Mayer in 1916. These three authors published their series of grafts and described in detail the anatomical, physiological and technical principles to be respected. St. Bunnell, in 1918, developed various pull-out direct suture procedures, but faced with the problems of adhesions, he abandoned this technique and proposed not to repair flexors in the digital tunnels but to graft them. He defined the famous zone which he called No man's land, which subsequently became Claude Verdan's zone II, in 1959. In 1960, C. Verdan published his first series of sutures maintained by 2 pins in zone II with comparable results to those obtained after grafting. In 1967, H. Kleinert, with his mobile suture, became the leader of direct tendon repair in zone II. 2-stage grafts were introduced in 1965 under the impetus of J. Hunter, who revised and popularized the studies conducted by A. Bassett and R.E. Caroll in 1950. PMID:9131943
The simultaneous, complete rupture of both quadriceps tendons is a rare event. Only 30 previous cases have been reported and the majority have had well-documented predisposing factors, such as chronic renal failure, gout, hyperparathyroidism, diabetes and obesity. We report a case which presented without any predisposing cause, and review the literature to date. PMID:2692688
Ribbans, W J; Angus, P D
Collagens V and XI comprise a single regulatory type of fibril-forming collagen with multiple isoforms. Both co-assemble with collagen I or II to form heterotypic fibrils and have been implicated in regulation of fibril assembly. The objective of this study was to determine the roles of collagens V and XI in the regulation of tendon fibrillogenesis. Flexor digitorum longus tendons from a haplo-insufficient collagen V mouse model of classic Ehlers Danlos syndrome (EDS) had decreased biomechanical stiffness compared with controls consistent with joint laxity in EDS patients. However, fibril structure was relatively normal, an unexpected finding given the altered fibrils observed in dermis and cornea from this model. This suggested roles for other related molecules, i.e. collagen XI, and compound Col5a1+/?,Col11a1+/? tendons had altered fibril structures, supporting a role for collagen XI. To further evaluate this, transcript expression was analyzed in wild type tendons. During development (E18-P10) both collagen V and XI were comparably expressed; however, collagen V predominated in mature (P30) tendons. The collagens had a similar expression pattern. Tendons with altered collagen V and/or XI expression (Col5a1+/?; Col11a1+/?; Col5a1+/?,Col11a1+/?; Col11a1?/?; Col5a1+/?,Col11a1?/?) were analyzed at E18. All genotypes demonstrated a reduced fibril number and altered structure. This phenotype was more severe with a reduction in collagen XI. However, the absence of collagen XI with a reduction in collagen V was associated with the most severe fibril phenotype. The data demonstrate coordinate roles for collagens V and XI in the regulation of fibril nucleation and assembly during tendon development.
Wenstrup, Richard J.; Smith, Simone M.; Florer, Jane B.; Zhang, Guiyun; Beason, David P.; Seegmiller, Robert E.; Soslowsky, Louis J.; Birk, David E.
This is a descriptive study of tendon pathology with different structural appearances of repair tissue correlated to immunolocalization of cartilage oligomeric matrix protein (COMP) and type I and III collagens and expression of COMP mRNA. The material consists of nine tendons from seven horses (5–25 years old; mean age of 10 years) with clinical tendinopathy and three normal tendons from horses (3, 3, and 13 years old) euthanized for non-orthopedic reasons. The injured tendons displayed different repair-tissue appearances with organized and disorganized fibroblastic regions as well as areas of necrosis. The normal tendons presented distinct immunoreactivity for COMP and expression of COMP mRNA and type I collagen in the normal aligned fiber structures, but no immunolabeling of type III collagen. However, immunoreactivity for type III collagen was present in the endotenon surrounding the fiber bundles, where no expression of COMP could be seen. Immunostaining for type I and III collagens was present in all of the pathologic regions indicating repair tissue. Interestingly, the granulation tissues showed immunostaining for COMP and expression of COMP mRNA, indicating a role for COMP in repair and remodeling of the tendon after fiber degeneration and rupture. The present results suggest that not only type III collagen but also COMP is involved in the repair and remodeling processes of the tendon.
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
The Achilles tendon is one of the most frequently injured tendons in humans, and yet the mechanisms underlying its injury are not well understood. This study examines the ex vivo mechanical behavior of excised human Achilles tendons to elucidate the relationships between mechanical loading and Achilles tendon injury. Eighteen tendons underwent creep testing at constant stresses from 35 to 75
Tishya A. L. Wren; Derek P. Lindsey; Gary S. Beaupré; Dennis R. Carter
Tissue engineering techniques using novel scaffolding materials offer potential alternatives for managing tendon disorders. An ideal tendon tissue engineered scaffold should mimic the three-dimensional (3D) structure of the natural extracellular matrix (ECM) of the native tendon. Here, we propose a novel electrospun nanoyarn network that is morphologically and structurally similar to the ECM of native tendon tissues. The nanoyarn, random nanofiber, and aligned nanofiber scaffolds of a synthetic biodegradable polymer, poly(L-lactide-co-?-caprolactone) [P(LLA-CL)], and natural collagen I complex were fabricated using electrospinning. These scaffolds were characterized in terms of fiber morphology, pore size, porosity, and chemical and mechanical properties for the purpose of culturing tendon cells (TCs) for tendon tissue engineering. The results indicated a fiber diameter of 632 ± 81 nm for the random nanofiber scaffold, 643 ± 97 nm for the aligned nanofiber scaffold, and 641 ± 68 nm for the nanoyarn scaffold. The yarn in the nanoyarn scaffold was twisted by many nanofibers similar to the structure and inherent nanoscale organization of tendons, indicating an increase in the diameter of 9.51 ± 3.62 ?m. The nanoyarn scaffold also contained 3D aligned microstructures with large interconnected pores and high porosity. Fourier transform infrared analyses revealed the presence of collagen in the three scaffolds. The mechanical properties of the sample scaffolds indicated that the scaffolds had desirable mechanical properties for tissue regeneration. Further, the results revealed that TC proliferation and infiltration, and the expression of tendon-related ECM genes, were significantly enhanced on the nanoyarn scaffold compared with that on the random nanofiber and aligned nanofiber scaffolds. This study demonstrates that electrospun P(LLA-CL)/collagen nanoyarn is a novel, 3D, macroporous, aligned scaffold that has potential application in tendon tissue engineering. PMID:23557537
Xu, Yuan; Wu, Jinglei; Wang, Haoming; Li, Hanqin; Di, Ning; Song, Lei; Li, Sontao; Li, Dianwei; Xiang, Yang; Liu, Wei; Mo, Xiumei; Zhou, Qiang
The regulatory mechanisms involved in tendon homeostasis and repair are not fully understood. Accumulating data, however, demonstrate that the nervous system, in addition to afferent (sensory) functions, through efferent pathways plays an active role in regulating pain, inflammation, and tissue repair. In normal-, healing- and tendinopathic tendons three neurosignalling pathways consisting of autonomic, sensory and glutamatergic neuromediators have been established. In healthy tendons, neuromediators are found in the paratenon, whereas the proper tendon is practically devoid of nerves, reflecting that normal tendon homeostasis is regulated by pro- and anti-inflammatory mediators from the tendon surroundings. During tendon repair, however, there is extensive nerve ingrowth into the tendon proper and subsequent time-dependent appearance of sensory, autonomic and glutamatergic mediators, which amplify and fine-tune inflammation and tendon regeneration. In tendinopathy, excessive and protracted sensory and glutamatergic signalling may be involved in inflammatory, painful and hypertrophic tissue reactions. As our understanding of these processes improves, neuronal mediators may prove to be useful in the development of targeted pharmacotherapy and tissue engineering approaches to painful, degenerative and traumatic tendon disorders. PMID:24896349
Ackermann, Paul W; Franklin, Sarah L; Dean, Benjamin J F; Carr, Andrew J; Salo, Paul T; Hart, David A
PURPOSE: The purpose of this study was to establish a relationship between the lengthening of the Achilles tendon post-rupture and surgical repair to muscle activation patterns during walking in order to serve as a reference for post-surgical assessment. METHOD: The Achilles tendon lengths were collected from 4 patients with an Achilles tendon rupture 6 and 12 months post-surgery along with 5 healthy controls via ultrasound. EMG was collected from the triceps surae muscles and tibialis anterior during overground walking. RESULTS: Achilles lengths at 6 and 12 months post-surgery were significantly longer (p < 0.05) on the involved side compared to the uninvolved side, but there were no side-to-side differences in the healthy controls. The integrated EMG (iEMG) of the involved side was significantly higher than the uninvolved side in the lateral gastrocnemius at 6 months and for the medial gastrocnemius at 12 months in the patients with Achilles tendon rupture; no side-to-side difference was found in the healthy controls. The triceps surae muscles' activations were fair to moderately correlated to the Achilles lengths (0.38 < r < 0.52). CONCLUSIONS: The increased Achilles tendon length and iEMG from the triceps surae muscles indicate that loss of function is primarily caused by anatomical changes in the tendon and the appearance of muscle weakness is due to a lack of force transmission capability. This study indicates that when aiming for full return of function and strength, an important treatment goal appears to be to minimize tendon elongation. LEVEL OF EVIDENCE: Prognostic prospective case series, Level IV. PMID:23609529
Suydam, Stephen M; Buchanan, Thomas S; Manal, Kurt; Silbernagel, Karin Gravare
We hypothesized that the transplantation of Scx-transduced tendon-derived stem cells (TDSCs) promoted better tendon repair compared to the transplantation of mock-transduced cells. This study thus aimed to investigate the effect of Scx transduction on the expression of lineage markers in TDSCs and the effect of the resulting cell line in the promotion of tendon repair. Rat non-GFP or GFP-TDSCs were transduced with Scx or empty lentiviral vector (Mock) and selected by blasticidin. The mRNA expressions of Scx and different lineage markers were examined by qRT-PCR. The effect of the transplantation of GFP-TDSC-Scx on tendon repair was then tested in a rat unilateral patellar tendon window injury model. The transplantation of GFP-TDSC-Mock and scaffold-only served as controls. At week 2, 4 and 8 post-transplantation, the repaired patellar tendon was harvested for ex vivo fluorescent imaging, vivaCT imaging, histology, immunohistochemistry and biomechanical test. GFP-TDSC-Scx consistently showed higher expressions of most of tendon- and cartilage- related markers compared to the GFP-TDSC-Mock. However, the effect of Scx transduction on the expressions of bone-related markers was inconclusive. The transplanted GFP-TDSCs could be detected in the window wound at week 2 but not at week 4. Ectopic mineralization was detected in some samples at week 8 but there was no difference among different groups. The GFP-TDSC-Scx group only statistically significantly improved tendon repair histologically and biomechanically compared to the Scaffold-only group and the GFP-TDSC-Mock group at the early stage of tendon repair. There was significant higher expression of collagen type I in the window wound in the GFP-TDSC-Scx group compared to the other two groups at week 2. The transplantation of GFP-TDSC-Scx promoted healing at the early stage of tendon repair in a rat patellar tendon window injury model.
Lee, Yuk Wa; Wong, Yin Mei
The aim of this study was to investigate the association between foot type and the morphometry of selected muscles and tendons of the lower limb. Sixty-one healthy participants (31 male, 30 female; aged 27.1?±?8.8 years) underwent gray-scale musculoskeletal ultrasound examination to determine the anterior-posterior (AP) thickness of tibialis anterior, tibialis posterior, and peroneus longus muscles and tendons as well as the Achilles tendon. Foot type was classified based on arch height and footprint measurements. Potentially confounding variables (height, weight, hip and waist circumference, rearfoot and ankle joint range of motion, and levels of physical activity) were also measured. Multiple linear regression models were used to determine the association between foot type with muscle and tendon morphometry accounting for potentially confounding variables. Foot type was significantly and independently associated with AP thickness of the tibialis anterior tendon, peroneus longus muscle, and Achilles tendon, accounting for approximately 7% to 16% of the variation. Flat-arched feet were associated with a thicker tibialis anterior tendon, a thicker peroneus longus muscle, and a thinner Achilles tendon. Foot type is associated with morphometry of tendons that control sagittal plane motion of the rearfoot; and the peroneus longus muscle that controls frontal plane motion of the rearfoot. These findings may be related to differences in tendon loading during gait. PMID:23301865
Murley, G S; Tan, J M; Edwards, R M; De Luca, J; Munteanu, S E; Cook, J L
Background Among the various complications described in literature, the patellar tendon ossification is an uncommon occurrence in anterior cruciate ligament (ACL) reconstruction using bone – patellar tendon – bone graft (BPTB). The heterotopic ossification is linked to knee traumatism, intramedullary nailing of the tibia and after partial patellectomy, but only two cases of this event linked to ACL surgery have been reported in literature. Case presentation We present a case of a 42-year-old Caucasian man affected by symptomatic extended heterotopic ossification of patellar tendon after 20 months from ACL reconstruction using BPTB. The clinical diagnosis was confirmed by Ultrasound, X-Ray and Computed Tomography studies, blood tests were performed to exclude metabolic diseases then the surgical removal of the lesion was performed. After three years from surgery, the patient did not report femoro-patellar pain, there was not range of motion limitation and the clinical-radiological examinations resulted negative. Conclusion The surgical removal of the ossifications followed by anti-inflammatory therapy, seems to be useful in order to relieve pain and to prevent relapses. Moreover, a thorough cleaning of the patellar tendon may reveal useful, in order to prevent bone fragments remain inside it and to reduce patellar tendon heterotopic ossification risk.
46 fingers in 42 patients undergoing 2-stage flexor tendon grafting for traumatic injury in zone 2 were evaluated with an average follow up of 13 months (range 6 to 120 months). 24 anastomoses between FDS and FDP were performed according to the Paneva Holevitch procedure. In all other cases, palmaris longus or plantaris were used as tendon grafts during the second stage. Proximal fixation was always performed in the palm. 3 or more pulleys were reconstructed in all cases. In 21 cases, pulley reconstruction required the use of excised tendon remnants or retina-culum dorsalis. Distal fixation was performed to the distal phalanx in 42 cases and to the second phalanx in 4 cases, during the second stage. Overall, 85% patients obtained a good or fair result in terms of TAM (total active motion) with
Alnot, J Y; Mouton, P; Bisson, P
Ossification of the Achilles tendon is a rare condition. We recently treated a patient with ossification of bilateral Achilles tendons. The patient was a 50 year old male whose chief complaint was discomfort around the Achilles tendon. He had a previous history of treatment of bilateral club feet. On the roentgenograms, the length of the bony mass in the Achilles tendon was 5.5 cm on the right side and 1.5 cm on the left side. The left side was treated by surgical removal of a bony mass and suture of the tendon. Microscopic examination of the extirpated specimen revealed bone formation through enchondral and intramembranous ossification in the Achilles tendon. PMID:7981796
Hatori, M; Kita, A; Hashimoto, Y; Watanabe, N; Sakurai, M
While tendons typically undergo primarily tensile loading, the human supraspinatus tendon (SST) experiences substantial amounts of tension, compression, and shear in vivo. As a result, the functional roles of the extracellular matrix components, in particular the proteoglycans (PGs), are likely complex and important. The goal of this study was to determine the PG content in specific regions of the SST that exhibit differing mechanical function. The concentration of aggrecan, biglycan, and decorin were determined in six regions of the human SST using immunochemical techniques. We hypothesized that: aggrecan concentrations would be highest in areas where the tendon likely experiences compression; biglycan levels would be highest in regions likely subjected to injury and/or active remodeling such as the anterior regions; decorin concentrations would be highest in regions of greatest tensile stiffness. Our results generally supported these hypotheses and demonstrated that aggrecan and biglycan share regional variability, with increased concentration in the anterior and posterior regions and smaller concentration in the medial regions. Decorin, however, was in high concentration throughout all regions. The data presented in this study represent the first regional measurements of PG in the SST. Together with our previous regional measurements of mechanical properties, these data can be used to evaluate SST structure-function relationships. With knowledge of the differences in specific PG content, their spatial variations in the SST, and their relationships to tendon mechanics, we can begin to associate defects in PG content with specific pathology, which may provide guidance for new therapeutic interventions.
Matuszewski, Paul E; Chen, Yi-Ling; Szczesny, Spencer E; Lake, Spencer; Elliott, Dawn M; Soslowsky, Louis J; Dodge, George R
Despite the critical role tendons play in transmitting loads throughout the musculoskeletal system, little is known about the microstructural mechanisms underlying their mechanical function. Of particular interest is whether collagen fibrils in tendon fascicles bear load independently or if load is transferred between fibrils through interfibrillar shear forces. We conducted multiscale experimental testing and developed a microstructural shear lag model to explicitly test whether interfibrillar shear load transfer is indeed the fibrillar loading mechanism in tendon. Experimental correlations between fascicle macroscale mechanics and microscale interfibrillar sliding suggest that fibrils are discontinuous and share load. Moreover, for the first time, we demonstrate that a shear lag model can replicate the fascicle macroscale mechanics as well as predict the microscale fibrillar deformations. Since interfibrillar shear stress is the fundamental loading mechanism assumed in the model, this result provides strong evidence that load is transferred between fibrils in tendon and possibly other aligned collagenous tissues. Conclusively establishing this fibrillar loading mechanism and identifying the involved structural components should help develop repair strategies for tissue degeneration and guide the design of tissue engineered replacements. PMID:24530560
Szczesny, Spencer E; Elliott, Dawn M
Isolated dislocation of the posterior tibial tendon is an uncommon pathologic entity that typically occurs in the setting of acute trauma. The diagnosis remains challenging and is often delayed second to the rarity of the injury and symptoms similar to that of medial ankle sprains and other routinely diagnosed injuries about the ankle. The factors that predispose this tendon to dislocation include a hypoplastic retromalleolar groove, flexor retinaculum insufficiency, chronic repetitive trauma, and a structural abnormality from a previous medial malleolar fracture, or a combination thereof. Dislocation has also been cited as a complication of multiple local steroid injections and tarsal tunnel release. The mechanism of injury appears to involve forced dorsiflexion and eversion of the ankle when the posterior tibial tendon is contracted. Most cases do not respond well to conservative treatment and will require surgery to restore function and eliminate symptoms. We report a case of posterior tibial tendon dislocation related to a snowboarding injury and offer our technique for surgical correction. PMID:24361009
Gambardella, Gabriel V; Donegan, Ryan; Caminear, David S
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
\\u000a Stark first described distal biceps tendon rupture in 1843.1 The earliest reports of surgical repair was in 1897 by Johnson and later in 1898 by Acquaviva.1, 2 Fischer and Shepanek in 19563 and Meherin and Kilgore in 19604 reported on a single incision for reattachment of the biceps to the radial tuberosity. This was shown to significantly improve\\u000a flexion and
Jason A. Schneider; Peter D. McCann
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
Atypical tuberculous tenosynovitis of the foot and ankle is extremely rare. The determination of the Mycobacterium species is essential because resistance of atypical mycobacterial strains to antituberculous drugs is often encountered. We report a case of Mycobacterium chelonae paratendinous and intratendinous infection involving the Achilles tendon. Repeat aggressive irrigation and debridement procedures, coupled with removal of foreign materials and the appropriate use of prolonged antibiotic therapy, can result in a successful long-term outcome. PMID:24529751
Lui, Tun Hing; Chan, Kwok Bill
We present a case of quadriceps tendon (QT) rupture. QT ruptures can occur in all ages. The cause is mostly traumatic in origin. Spontaneous ruptures that are thought to result from predisposing conditions are rare. Post-convulsion QT ruptures lacking traumas in their history can be overlooked in clinical examinations. This should be born in mind by the attending physician, as early diagnosis and treatment of the condition can lead to satisfactory outcomes.
Erkut, Adem; Guvercin, Yilmaz; Sahin, Rifat; Keskin, Davut
Eighteen patients with 20 symptomatic hips underwent lengthening of the iliopsoas tendon for persistent painful snapping of this "internal" variety of snapping hip. We referred to the pathologic, painful snapping of the iliopsoas in the deep anterior groin as the "internal" snapping hip. This is in contrast to the more common and better-known "external" snapping that involves the greater trochanter and its overlying soft tissues. The results of our iliopsoas lengthening procedure are presented here. Lengthening of the iliopsoas tendon was accomplished by step cutting of the tendinous portion of the iliopsoas. The pathoanatomy of this poorly understood symptom complex was described in 1984 paper from this institution and is reviewed here. Iliopsoas bursography demonstrated a sudden jerking movement of the iliopsoas tendon between the anterior inferior iliac spine and iliopectineal eminence, synchronous with the patient's pain and often accompanied by an audible snap. The average preoperative duration of symptoms was 2.9 years, and the average length of postoperative followup was 25 months. All patients, except one, had a marked reduction in the frequency of snapping after tendon lengthening, and 14 of 20 hips had no snapping postoperatively. Of the six patients who had recurrence of snapping, all but one stated that this occurred much less frequently and was much less painful compared to the preoperative state. Two hips required reoperation. Postoperatively, only three patients complained of subjective weakness, and most patients were unlimited in physical activity with return to activities such as competitive football, pole vaulting, and long-distance running.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2252086
Jacobson, T; Allen, W C
We present a case of a closed rupture of the flexor digitorum profundus tendon of the small finger. It is our hypothesis that because of pisotriquetral instability as a result of a lesion of the pisotriquetral ligaments the flexor digitorum profundus tendon was entrapped repeatedly between the pisiform and triquetrum. This resulted in an attritional lesion of the tendon. The pisotriquetral joint showed no bone abnormalities. PMID:15043895
Corten, Eveline M L; van den Broecke, Duco G; Kon, Moshe; Schuurman, Arnold H
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
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
This study aims to verify the effects of AsGa Laser in the scarring of tendon lesion in rats with low nourishment condition and to analyze the ideal light density by means of histopathologic findings highlighted by light microscopy. After the proposed nutritional condition was verified the animals were divided into 3 groups denominated as follows: GI control group, GII laser 1 J/sq.cm. and GIII laser 4 J/sq.cm. The lesions were induced by means of routine surgical process for tendon exposure: There was a crushing process with Allis pincers followed by saturated incision. The data obtained in relation to the amount of macrophage, leukocyte, fibroblast, vessel neoformation, fibrosis and collagen were submitted to parametric statistic procedures of variance analysis and "Tukey" Test and the result obtained was p < 0,05. According to the obtained results it can be concluded that low power laser therapy proved to be efficient in tendon repairing even though the animals suffered from malnutrition as well as the 1 J energy density proved to be more efficient in this case.
Carvalho, P. T. C.; Batista, Cheila O. C.; Fabíola, C.
Surgical reattachment of tendon and bone such as in rotator cuff repair, patellar-patella tendon repair and anterior cruciate ligament (ACL) reconstruction often fails due to the failure of regeneration of the specialized tissue ("enthesis") which connects tendon to bone. Tendon-to-bone healing taking place between inhomogenous tissues is a slow process compared to healing within homogenous tissue, such as tendon to tendon or bone to bone healing. Therefore special attention must be paid to augment tendon to bone insertion (TBI) healing. Apart from surgical fixation, biological and biophysical interventions have been studied aiming at regeneration of TBI healing complex, especially the regeneration of interpositioned fibrocartilage and new bone at the healing junction. This paper described the biology and the factors influencing TBI healing using patella-patellar tendon (PPT) healing and tendon graft to bone tunnel healing in ACL reconstruction as examples. Recent development in the improvement of TBI healing and directions for future studies were also reviewed and discussed.
With recent advances in multidetector computed tomography (MDCT) acquisition and reconstruction options, MDCT can now be used successfully for evaluating tendon abnormalities. In this article, MDCT protocol optimization for the imaging of tendons is underscored, and applications of MDCT for assessing tendon pathology are highlighted. Although our retrospective experience of CT imaging with 2-dimensional multiplanar reconstructions and 3-dimensional postprocessing techniques is reviewed, potential applications for newer CT technologies, including dual-energy CT and 4-dimensional CT imaging of the peripheral tendons, are also discussed. PMID:24625602
Demehri, Shadpour; Chalian, Majid; Farahani, Sahar J; Fishman, Elliot K; Fayad, Laura M
We report a rare case of subcutaneous peroneus longus tendon rupture associated with os peroneum fracture. Three dimensional computed tomographic scan was useful to understand this disorder. We treated the patient with excision of fractured os peroneum and tenodesis of the proximal stump of the ruptured peroneus longus tendon to the lateral aspect of the calcaneus. Key points In order to understand a rare case of subcutaneous peroneus longus tendon rupture associated with os peroneum fracture, three dimensional computed tomographic scan was useful. The patient was treated with excision of fractured os peroneum and tenodesis of the proximal stump of the ruptured peroneus longus tendon to the lateral aspect of the calcaneus.
Fujioka, Hiroyuki; Kokubu, Takeshi; Makino, Takeshi; Nagura, Issei; Maeda, Toshihisa; Kurosaka, Masahiro; Okuno, Hiroaki; Yamagiwa, Tokuyoshi; Tanaka, Juichi; Yoshiya, Shinichi
Tendon adhesions are one of the most concerning complications after surgical repair of flexor tendon injury. Extracellular signal-regulated kinase (ERK) 2 plays crucial roles in fibroblast proliferation and collagen expression which contributes to the formation of tendon adhesions after flexor tendon surgery. Using a chicken model, we have examined the effects of a small interfering RNA (siRNA) targeting ERK2 delivered by a lentiviral system on tendon adhesion formation with an adhesion scoring system, histological assessment, and biomechanical evaluation. It was found that ERK2 siRNA effectively suppressed the increase of fibroblasts and the formation of tendon adhesions (p < 0.05 compared with the control group). Moreover, no statistically significant reduction in breaking force was detected between the ERK2 siRNA group and the control group. These results show that the lentiviral-mediated siRNA system is effective in preventing tendon adhesion formation but not to tendon healing, and may be used for tendon repair after confirmation and improvement by future detailed studies.
Ruan, Hongjiang; Liu, Shen; Li, Fengfeng; Li, Xujun; Fan, Cunyi
Patients undergoing surgery for posterior tibial tendon dysfunction may require tendon transfer. The flexor digitorum longus is most commonly transferred, although the flexor hallucis longus and peroneus brevis have also been described in the literature. This article discusses the advantages and disadvantages of the different tendons, the surgical techniques used to perform them, and their results in the literature, concentrating principally on studies in which additional bone procedures were not performed. This article will also discuss the potential role for isolated soft tissue procedures in the treatment of stage 2 posterior tibial tendon dysfunction. PMID:22541521
Aronow, Michael S
The purpose of this study was to examine patellar tendon (PT) size and mechanical properties in subjects with a side-to-side strength difference of > or =15% due to sport-induced loading. Seven elite fencers and badminton players were included. Cross-sectional area (CSA) of the PT obtained from MRI and ultrasonography-based measurement of tibial and patellar movement together with PT force during isometric contractions were used to estimate mechanical properties of the PT bilaterally. We found that distal tendon and PT, but not mid-tendon, CSA were greater on the lead extremity compared with the nonlead extremity (distal: 139 +/- 11 vs. 116 +/- 7 mm(2); mid-tendon: 85 +/- 5 vs. 77 +/- 3 mm(2); proximal: 106 +/- 7 vs. 83 +/- 4 mm(2); P < 0.05). Distal tendon CSA was greater than proximal and mid-tendon CSA on both the lead and nonlead extremity (P < 0.05). For a given common force, stress was lower on the lead extremity (52.9 +/- 4.8 MPa) compared with the nonlead extremity (66.0 +/- 8.0 MPa; P < 0.05). PT stiffness was also higher in the lead extremity (4,766 +/- 716 N/mm) compared with the nonlead extremity (3,494 +/- 446 N/mm) (P < 0.05), whereas the modulus did not differ (lead 2.27 +/- 0.27 GPa vs. nonlead 2.16 +/- 0.28 GPa) at a common force. These data show that a habitual loading is associated with a significant increase in PT size and mechanical properties. PMID:18556433
Couppé, C; Kongsgaard, M; Aagaard, P; Hansen, P; Bojsen-Moller, J; Kjaer, M; Magnusson, S P
Pentadecapeptide BPC 157, composed of 15 amino acids, is a partial sequence of body protection compound (BPC) that is discovered in and isolated from human gastric juice. Experimentally it has been demonstrated to accelerate the healing of many different wounds, including transected rat Achilles tendon. This study was designed to investigate the potential mechanism of BPC 157 to enhance healing of injured tendon. The outgrowth of tendon fibroblasts from tendon explants cultured with or without BPC 157 was examined. Results showed that BPC 157 significantly accelerated the outgrowth of tendon explants. Cell proliferation of cultured tendon fibroblasts derived from rat Achilles tendon was not directly affected by BPC 157 as evaluated by MTT assay. However, the survival of BPC 157-treated cells was significantly increased under the H(2)O(2) stress. BPC 157 markedly increased the in vitro migration of tendon fibroblasts in a dose-dependent manner as revealed by transwell filter migration assay. BPC 157 also dose dependently accelerated the spreading of tendon fibroblasts on culture dishes. The F-actin formation as detected by FITC-phalloidin staining was induced in BPC 157-treated fibroblasts. The protein expression and activation of FAK and paxillin were determined by Western blot analysis, and the phosphorylation levels of both FAK and paxillin were dose dependently increased by BPC 157 while the total amounts of protein was unaltered. In conclusion, BPC 157 promotes the ex vivo outgrowth of tendon fibroblasts from tendon explants, cell survival under stress, and the in vitro migration of tendon fibroblasts, which is likely mediated by the activation of the FAK-paxillin pathway. PMID:21030672
Chang, Chung-Hsun; Tsai, Wen-Chung; Lin, Miao-Sui; Hsu, Ya-Hui; Pang, Jong-Hwei Su
The formation of the musculoskeletal system represents an intricate process of tissue assembly involving heterotypic inductive interactions between tendons, muscles and cartilage. An essential component of all musculoskeletal systems is the anchoring of the force-generating muscles to the solid support of the organism: the skeleton in vertebrates and the exoskeleton in invertebrates. Here, we discuss recent findings that illuminate musculoskeletal assembly in the vertebrate embryo, findings that emphasize the reciprocal interactions between the forming tendons, muscle and cartilage tissues. We also compare these events with those of the corresponding system in the Drosophila embryo, highlighting distinct and common pathways that promote efficient locomotion while preserving the form of the organism.
Schweitzer, Ronen; Zelzer, Elazar; Volk, Talila
Superficial digital flexor tendon (SDFT) injury in equine athletes is one of the most well-accepted, scientifically supported companion animal models of human disease (i.e., exercise-induced Achilles tendon [AT] injury). The SDFT and AT are functionally and clinically equivalent (and important) energy-storing structures for which no equally appropriate rodent, rabbit, or other analogues exist. Access to equine tissues has facilitated significant advances in knowledge of tendon maturation and aging, determination of specific exercise effects (including early life), and definition of some of the earliest stages of subclinical pathology. Access to human surgical biopsies has provided complementary information on more advanced phases of disease. Importantly, equine SDFT injuries are only a model for acute ruptures in athletes, not the entire spectrum of human tendonopathy (including chronic tendon pain). In both, pathology begins with a potentially prolonged phase of accumulation of (subclinical) microdamage. Recent work has revealed remarkably similar genetic risk factors, including further evidence that tenocyte dysfunction plays an active role. Mice are convenient but not necessarily accurate models for multiple diseases, particularly at the cellular level. Mechanistic studies, including tendon cell responses to combinations of exercise-associated stresses, require a more thorough investigation of cross-species conservation of key stress pathway auditors. Molecular evidence has provided some context for the poor performance of mouse models; equines may provide better systems at this level. The use of horses may be additionally justifiable based on comparable species longevity, lifestyle factors, and selection pressure by similar infectious agents (e.g., herpesviruses) on general cell stress pathway evolution. PMID:24936032
Patterson-Kane, Janet C; Rich, Tina
Tendon injuries are one of the most common orthopaedic problems in both human and equine athletes. When a damaged tendon heals naturally, it loses a substantial part of the original strength and elasticity. Therefore, tendons recover structurally (reparation) but not functionally (regeneration) after conservative medical or surgical treatment. Since the structure and matrix composition of human and equine tendons share many similarities, the nature of tendon injuries are also strongly comparable in both species. Therefore, the evaluation of regenerative therapies in horses may have applications for future human medicine and vice versa. The current review focuses briefly on the physiology of human and equine tendon in order to better comprehend the modus operandi of this structure under pathophysiological circumstances. In addition, the reparative effects of conservative medical and surgical interventions are discussed concisely, and an extensive overview is given on the regenerative therapies that are currently being explored. For the latter, the results of equine clinical studies might prove invaluable for gaining additional insights into the treatment of human tendinopathies, since not all of these novel regenerative therapies have been evaluated in humans yet. PMID:22963225
Spaas, Jan H; Guest, Deborah J; Van de Walle, Gerlinde R
Arthroscopic suprapectoral techniques for tenodesis of the long head of the biceps tendon (LHB) are appropriate for the treatment of proximal biceps lesions. Several types of techniques and fixation devices have been described and evaluated in biomechanical studies regarding primary stability. In this technical note, we describe an all-arthroscopic suprapectoral technique using the 6.25-mm Bio-SwiveLock device (Arthrex, Naples, FL) for an interference screw–like bony fixation after having armed the tendon with a lasso-loop stitch. Both the interference screw fixation and securing of the lasso-loop tendon have been well described and approved in biomechanical tests concerning the primary stability. One advantage of this technique performed from the glenohumeral space, in addition to the strong and secure fixation with ingrowth of the tendon in a bony canal, is the avoidance of touching the soft tissue above the bicipital groove, which results in a smooth fitting of the tendon into its natural canal and therefore avoids mechanical irritation of the stump at the rotator interval. In conclusion, the all-arthroscopic suprapectoral LHB tenodesis performed from the glenohumeral space with the modified lasso-loop stitch for securing of the tendon and the 6.25-mm Bio-SwiveLock suture anchor for interference screw–like bony tendon fixation is an appropriate technique for the treatment of LHB-associated lesions.
Patzer, Thilo; Kircher, Jorn; Krauspe, Ruediger
Whenever a tendon or its bone insertion is disrupted or removed, existing surgical techniques provide a temporary connection or scaffolding to promote healing, but the interface of living to nonliving materials soon breaks down under the stress of these applications, if it must bear the load more than acutely. Patients are thus disabled whose prostheses, defect size, or mere anatomy limit the availability or outcomes of such treatments. Our group developed the OrthoCoupler™ device to join skeletal muscle to prosthetic or natural structures without this interface breakdown. In this study, the goat knee extensor mechanism (quadriceps tendon, patella, and patellar tendon) was removed from the right hind limb in 16 goats. The device connected the quadriceps muscle to a stainless steel bone plate on the tibia. Mechanical testing and histology specimens were collected from each operated leg and contra lateral unoperated control legs at 180 days. Maximum forces in the operated leg (vs. unoperated) were 1400± 93N (vs. 1179± 61 N), linear stiffnesses were 33± 3 N/mm (vs. 37 ± 4N/mm), and elongations at failure were 92.1 ± 5.3 mm (vs. 68.4 ± 3.8 mm; mean ± SEM). Higher maximum forces (p = 0.02) and elongations at failure (p = 0.008) of legs with the device versus unoperated controls were significant; linear stiffnesses were not (p = 0.3). We believe this technology will yield improved procedures for clinical challenges in orthopaedic oncology, revision arthroplasty, tendon transfer, and tendon injury reconstruction.
Melvin, Alan J.; Litsky, Alan S.; Mayerson, Joel L.; Stringer, Keith; Juncosa-Melvin, Natalia
Ruptures of tendons and ligaments are a widely common injury in traumatology. The aim of the study was the development of a substitute tissue for such defects by methods of tissue-engineering. Human bone marrow stromal cells (hBMSC) were seeded on a decellularized bovine Achilles tendon and cultivated in a special bioreactor. We examined the influence of continuous perfusion on proliferation and biomechanical stability compared to static cultivation. Samples were taken on day 0, 7 and 14. Decellularized tendons were chosen as a negative control. Cell quantity was measured by the MTS-Test. Histology was analyzed by Haematoxylin-Eosin- and Pentachrome-coulouring. The cultivated tendons were tested biomechanically compared with the decellularized control group. MTS-Test revealed an increase of cell count of 7% in the static group and a decrease of 9% in the perfusion group. The perfusion group showed a stronger network of the fibroblasts and a higher amount of produced extracellular matrix. Biomechanical testing revealed significantly higher stability in the decellularized control group. This trial shows up new possibilities of managing defects of tendons and ligaments. The continuous perfusion in a bioreactor can improve the structure of the matrix seeded with hBMSC. PMID:21849734
Petri, M; Kruppa, C; Haasper, C; Broese, M; Liodakis, E; Krettek, C; Hurschler, C; Jagodzinski, M
Tendons are typically composed of two histologically different regions: the midsubstance and insertion site. We previously showed that Gli1, a downstream effector of the hedgehog (Hh) signaling pathway, is expressed only in the insertion site of the mouse patellar tendon during its differentiation. To test for a functional role of Hh signaling, we targeted the Smoothened (Smo) gene in vivo using a Cre/Lox system. Constitutive activation of the Hh pathway in the mid-substance caused molecular markers of the insertion site, e.g. type II collagen, to be ectopically expressed or up-regulated in the midsubstance. This was confirmed using a novel organ culture method in vitro. Conversely, when Smo was excised in the scleraxis-positive cell population, the development of the fibrocartilaginous insertion site was affected. Whole transcriptome analysis revealed that the expression of genes involved in chondrogenesis and mineralization was down-regulated in the insertion site, and expression of insertion site markers was decreased. Biomechanical testing of murine adult patellar tendon, which developed in the absence of Hh signaling, showed impairment of tendon structural properties (lower linear stiffness and greater displacement) and material properties (greater strain), although the linear modulus of the mutant group was not significantly lower than controls. These studies provide new insights into the role of Hh signaling during tendon development.
Liu, Chia-Feng; Breidenbach, Andrew; Aschbacher-Smith, Lindsey; Butler, David; Wylie, Christopher
The deep tendon reflex (DTR) is often utilized to characterize the neuromuscular health of individuals because it is cheap, quick to implement, and requires limited equipment. However, DTR assessment is unreliable and assessor-dependent improve the reliability of the DTR assessment, we devised a novel standardization procedure. Our approach is based on the hypothesis that the neuromuscular state of a muscle changes systematically with respect to the indentation depth of its tendon. We tested the hypothesis by progressively indenting the biceps tendons on each side of nine hemiplegic stroke survivors to different depths, and then superimposing a series of brief controlled taps at each indentation depth to elicit a reflex response. Our results show that there exists a unique indentation depth at which reflex responses are consistently recorded (termed the Reflex Threshold) with increasing amplitude along increasing indentation depth. We further show that the reflex threshold depth is systematically smaller on the affected side of stroke survivors and that it is negatively correlated with the Modified Ashworth Score (VAF 70%). Our procedure also enables measurement of passive mechanical properties at the indentation location. In conclusion, our study shows that controlling for the indentation depth of the tendon of a muscle alters its reflex response predictably. Our novel device and method could be used to estimate neuromuscular changes in muscle (e.g., spasticity). Although some refinement is needed, this method opens the door to more reliable quantification of the DTR. PMID:24621852
Chardon, Matthieu K; Rymer, W Zev; Suresh, Nina L
Knowledge of topographical anatomy and physiological interplay of several structures is considered essential for regaining the normal function of the extensor apparatus of the finger after an acute or an old injury. For better comprehension of the extensor apparatus and because of its anatomical and functional complexity, two types of structural systems are described, namely, the tendinous and the retinacular system. Aetiological aspects and the pathophysiological mechanisms of deformities such as the "swan-neck deformity, boutonnière deformity and mallet finger" are also described and possibilities of surgical treatment are discussed. Rare injuries such as laceration of the extensor pollicis longus tendon or laceration of the metacarpophalangeal extensor hood with a consecutive radial or ulnar shift of the long extensor tendon are also described and mentioned with possible surgical treatment methods. PMID:6119887
Hesoun, P; Marecek, N
Scleraxis is a bHLH transcription factor that plays a central role in promoting fibroblast proliferation and matrix synthesis during the embryonic development of tendons. Mice with a targeted inactivation of scleraxis (Scx?/?) fail to properly form limb tendons, but the role that scleraxis has in regulating the growth and adaptation of tendons of adult organisms is unknown. To determine if scleraxis expression changes in response to a physiological growth stimulus to tendons, we subjected adult mice that express GFP under the control of the scleraxis promoter (ScxGFP) to a six week treadmill training program designed to induce adaptive growth in Achilles tendons. Age matched sedentary ScxGFP mice were used as controls. Scleraxis expression was sparsely observed in the epitenon region of sedentary mice, but in response to treadmill training, scleraxis was robustly expressed in fibroblasts that appeared to be emerging from the epitenon and migrating into the superficial regions of tendon fascicles. Treadmill training also led to an increase in scleraxis, tenomodulin, and type I collagen gene expression as measured by qPCR. These results suggest that in addition to regulating the embryonic formation of limb tendons, scleraxis also appears to play an important role in the adaptation of adult tendons to physiological loading.
Mendias, Christopher L; Gumucio, Jonathan P; Bakhurin, Konstantin I; Lynch, Evan B; Brooks, Susan V
The standard post-mortem storage method for biomechanical testing is freezing. Freezing minimally alters the biomechanical characteristics of tendons but only suspends the process of decay. Chemical fixation arrests decay and overcomes risk of infection, but alters the biomechanical properties of tendons. On the other hand, Thiel preservation has been reported to maintain soft tissue consistency similar to that of living tissue. The current study investigates the effects of Thiel embalming on human digitorum profundus tendons (FDP) from fresh-frozen and Thiel embalmed cadavers. Cross-sectional area was measured at pre-load, samples were preconditioned and then ramped at a constant strain-rate to failure. Thiel preserved tendons had statistically lower failure stress with median of 38MPa compared to fresh frozen samples with median of 60MPa (p-value=0.048) and trended to a decreased tangential modulus. To overcome limited donor number and masking factors of age, gender, and time embalmed, we also performed experiments in rat tail tendon fascicle. Similar quasi-static ramp to failure tests were performed with control and Thiel treated sample pairs. Similar differences were observed to those found as in human FDP, however these trends were statistically significant. In both tendons, Thiel preserved samples demonstrated altered failure characteristics, indicating a different collagen fiber/collagen network failure mechanism most likely due to partial denaturing by boric acid in Thiel solution. In conclusion, Thiel embalmed tendons did not faithfully represent the biomechanical characteristics of fresh frozen tendons. PMID:21511447
Fessel, Gion; Frey, Kevin; Schweizer, Andreas; Calcagni, Maurizio; Ullrich, Oliver; Snedeker, Jess G
An important function of skeletal muscle is deceleration via active muscle fascicle lengthening, which dissipates movement energy. The mechanical interplay between muscle contraction and tendon elasticity is critical when muscles produce energy. However, the role of tendon elasticity during muscular energy dissipation remains unknown. We tested the hypothesis that tendon elasticity functions as a mechanical buffer, preventing high (and probably damaging) velocities and powers during active muscle fascicle lengthening. We directly measured lateral gastrocnemius muscle force and length in wild turkeys during controlled landings requiring rapid energy dissipation. Muscle-tendon unit (MTU) strain was measured via video kinematics, independent of muscle fascicle strain (measured via sonomicrometry). We found that rapid MTU lengthening immediately following impact involved little or no muscle fascicle lengthening. Therefore, joint flexion had to be accommodated by tendon stretch. After the early contact period, muscle fascicles lengthened and absorbed energy. This late lengthening occurred after most of the joint flexion, and was thus mainly driven by tendon recoil. Temporary tendon energy storage led to a significant reduction in muscle fascicle lengthening velocity and the rate of energy absorption. We conclude that tendons function as power attenuators that probably protect muscles against damage from rapid and forceful lengthening during energy dissipation.
Konow, Nicolai; Azizi, Emanuel; Roberts, Thomas J.
Posterior tibial tendon dysfunction is common and a major cause of flat foot (pes planus) and functional impairment in adults. It is frequently undiagnosed and therefore inappropriately managed. This review raises awareness of posterior tibial tendon dysfunction with the intention of improving patient management. PMID:22875521
Singh, Rahul; King, Amanda; Perera, Anthony
Achilles tendinopathy is a common disorder and is more prevalent in men. Although differences in tendon mechanics between men and women have been reported, understanding of tendon mechanics in young active people is limited. Moreover, there is limited understanding of changes in tendon mechanics in response to acute exercise. Our purpose was to compare Achilles tendon mechanics in active young adult men and women at rest and after light and strenuous activity in the form of repeated jumping with an added load. Participants consisted of 17 men and 14 women (18-30 years) who were classified as being at least moderately physically active as defined by the International Physical Activity Questionnaire. Tendon force/elongation measures were obtained during an isometric plantarflexion contraction on an isokinetic dynamometer with simultaneous ultrasound imaging of the Achilles tendon approximate to the soleus myotendinous junction. Data were collected at rest, after a 10-minute treadmill walk, and after a fatigue protocol of 100 toe jumps performed in a Smith machine, with a load equaling 20% of body mass. We found greater tendon elongation, decreased stiffness, and lower Young's modulus only in women after the jumping exercise. Force and stress were not different between groups but decreased subsequent to the jumping exercise bout. In general, women had greater elongation and strain, less stiffness, and a lower Young's modulus during plantarflexor contraction. These data demonstrate differences in tendon mechanics between men and women and suggest a potential protective mechanism explaining the lower incidence of Achilles tendinopathy in women. PMID:24552794
Joseph, Michael F; Lillie, Kurtis R; Bergeron, Daniel J; Cota, Kevin C; Yoon, Joseph S; Kraemer, William J; Denegar, Craig R
We present the case of a 13-year-old girl with painful calcific tendinitis of the supraspinatus tendon of the left shoulder. The pathologic finding was the presence of a small calcium deposit within the supraspinatus tendon. Pediatricians should be aware of this entity in shoulder pain in children. PMID:16432777
The authors describe a new radiographic sign of rupture of the Achilles tendon system. It is a fracture, with separation through an osteophyte at the insertion of this tendon. Previously reported signs are also discussed as well as the present case report.
Newmark, H.; Mellon, W.S. Jr.; Malhotra, A.K.; Olken, S.M.; Halls, J.
An important function of skeletal muscle is deceleration via active muscle fascicle lengthening, which dissipates movement energy. The mechanical interplay between muscle contraction and tendon elasticity is critical when muscles produce energy. However, the role of tendon elasticity during muscular energy dissipation remains unknown. We tested the hypothesis that tendon elasticity functions as a mechanical buffer, preventing high (and probably damaging) velocities and powers during active muscle fascicle lengthening. We directly measured lateral gastrocnemius muscle force and length in wild turkeys during controlled landings requiring rapid energy dissipation. Muscle-tendon unit (MTU) strain was measured via video kinematics, independent of muscle fascicle strain (measured via sonomicrometry). We found that rapid MTU lengthening immediately following impact involved little or no muscle fascicle lengthening. Therefore, joint flexion had to be accommodated by tendon stretch. After the early contact period, muscle fascicles lengthened and absorbed energy. This late lengthening occurred after most of the joint flexion, and was thus mainly driven by tendon recoil. Temporary tendon energy storage led to a significant reduction in muscle fascicle lengthening velocity and the rate of energy absorption. We conclude that tendons function as power attenuators that probably protect muscles against damage from rapid and forceful lengthening during energy dissipation. PMID:21957134
Konow, Nicolai; Azizi, Emanuel; Roberts, Thomas J
A musculoskeletal model of the hand is needed to investigate the pathomechanics of tendon-related disorders and carpal tunnel syndrome. The purpose of this thesis was to develop a model with realistic extrinsic finger flexor tendon excursions and moment arms. An existing upper extremity model served as a starting point, which had programmed movement for the index finger. Movement capabilities were
Aaron Michael Joseph Kociolek
A Clinical Decision Support System has been developed using the Exsys software for the flexor tendon injuries in Zone II encompassing the continuum from injury to complete rehabilitation of the tendon. The system architecture uses the rules based logic blocks to create a decision support system, which takes the user through series of questions, and based on the answers input,
Prashant Junankar; Dinesh P. Mital; Syed Haque; Shankar Srinivasan
The presence of tendon xanthomas is an almost certain indicator of familial hypercholesterolemia (FH). They also reflect coronary atherosclerotic burden and therefore must be treated aggressively. Tendon xanthomas also occur in two rare conditions, cerebrotendinous xanthomatosis and sitosterolemia, which are not easily confused with FH, can be easily differentiated with clinical history and biochemical tests. PMID:23993019
Patil, Shivanand; Kharge, Jayashree; Bagi, Vittal; Ramalingam, Rangaraj
The presence of tendon xanthomas is an almost certain indicator of familial hypercholesterolemia (FH). They also reflect coronary atherosclerotic burden and therefore must be treated aggressively. Tendon xanthomas also occur in two rare conditions, cerebrotendinous xanthomatosis and sitosterolemia, which are not easily confused with FH, can be easily differentiated with clinical history and biochemical tests.
Patil, Shivanand; Kharge, Jayashree; Bagi, Vittal; Ramalingam, Rangaraj
The purpose of this article is to update the orthopedic community on the planning and implementation of tendon transfers in the foot and ankle. This information will serve to reinforce those principles and factors that are inherent in successful performance of tendon transfer. In addition, the authors highlight recent updates that impact decision-making for these procedures. PMID:24548506
Dowd, Thomas; Bluman, Eric M
ObjectivesExtensor hallucis longus (EHL) tendon injuries can occur in taekwondo athletes when performing hyperplantarflexed barefoot kicking exercises. A state of full excursion of the extensor tendon is used to strike opponents in which the metatarsal bone and the proximal phalanx area is in contact with the opponent. The purpose of this study is to examine the incidence of extensor hallucis
Kyung Tai Lee; Yun Sun Choi; Young Koo Lee; Jeong Pil Lee; Ki Won Young; Shin Yi Park
Chronic tendon pathology is a common and often disabling condition, the causes of which remain poorly understood. The continuum model of tendon pathology was proposed to provide a model for the staging of tendon pathology and to assist clinicians in managing this often complex condition (Br. J. Sports Med., 43, 2009, 409). The model presents clinical, histological and imaging evidence for the progression of tendon pathology as a three-stage continuum: reactive tendinopathy, tendon disrepair and degenerative tendinopathy. It also provides clinical information to assist in identifying the stage of pathology, in addition to proposed treatment approaches for each stage. The usefulness of such a model is determined by its ability to incorporate and inform new and emerging research. This review examines the degree to which recent research supports or refutes the continuum model and proposes future directions for clinical and research application of the model.
McCreesh, Karen; Lewis, Jeremy
We present an unusual case of an athletic 17-year-old male cyclist with bilateral chronic dislocating biceps femoris tendons. On flexion of the knee, the biceps tendon subluxed over a large exostosis, creating a snapping sound. Snapping of tendons is common around the hip, ankles, shoulder, and elbow, but rare at the knee. When it does occur, snapping about the knee can be due to discoid meniscus, rheumatoid nodules, synovial plicae, iliotibial band syndrome, congenital snapping knee, and snapping tendons. Research revealed only 5 previous cases due to subluxation of the biceps femoris tendon. The case we present is the only one due to an exostosis, as well as the only one that required bilateral surgical repair. The patient presented when his pain became significant enough to interfere with his ability to continue competitive cycling. PMID:18300673
Fung, Daniel A; Frey, Steven; Markbreiter, Lance
Summary Pectoralis major (PM) muscle is the powerful dynamic stabiliser of the shoulder that acts as a flexor, adductor and internal rotator. The rupture of the PM tendon is a relatively rare injury that was firstly described in a French boy by Patissier in 1822 and later, in 1861, by Letenneur who reported another similiar case. To date, over 200 cases have been published. In this article we describe the clinical anatomy and the mechanism of injuries of PM and we review the surgical procedures for acute and chronic ruptures.
Merolla, Giovanni; Paladini, Paolo; Campi, Fabrizio; Porcellini, Giuseppe
Summary Tendon lesions are among the most frequent musculoskeletal pathologies. Vascular endothelial growth factor (VEGF) is known to regulate angiogenesis. VEGF-111, a biologically active and proteolysis-resistant splice variant of this family, was recently identified. This study aimed at evaluating whether VEGF-111 could have a therapeutic interest in tendon pathologies. Surgical section of one Achilles tendon of rats was performed before a local injection of either saline or VEGF-111. After 5, 15 and 30 days, the Achilles tendons of 10 rats of both groups were sampled and submitted to a biomechanical tensile test. The force necessary to induce tendon rupture was greater for tendons of the VEGF-111 group (p<0.05) while the section areas of the tendons were similar. The mechanical stress was similar at 5 and 15 days in the both groups but was improved for the VEGF-111 group at day 30 (p <0.001). No difference was observed in the mRNA expression of collagen III, tenomodulin and MMP-9. In conclusion, we observed that a local injection of VEGF-111 improves the early phases of the healing process of rat tendons after a surgical section. Further confirmatory experimentations are needed to consolidate our results.
Kaux, Jean-Francois; Janssen, Lauriane; Drion, Pierre; Nusgens, Betty; Libertiaux, Vincent; Pascon, Frederic; Heyeres, Antoine; Hoffmann, Audrey; Lambert, Charles; Le Goff, Caroline; Denoel, Vincent; Defraigne, Jean-Olivier; Rickert, Markus; Crielaard, Jean-Michel; Colige, Alain
We hypothesized that altered fate of tendon-derived stem cells (TDSCs) might contribute to chondro-ossification and failed healing in the collagenase-induced (CI) tendon injury model. This study aimed to compare the yield, proliferative capacity, immunophenotypes, senescence, and differentiation potential of TDSCs isolated from healthy (HT) and CI tendons. TDSCs were isolated from CI and healthy Sprague-Dawley rat patellar tendons. The yield, proliferative capacity, immunophenotypes, and senescence of TDSCs (CI) and TDSCs (HT) were compared by colony-forming unit assay, BrdU assay, flow cytometry, and ?-galactosidase activity assay, respectively. Their osteogenic and chondrogenic differentiation potentials and mRNA expression of tendon-related markers were compared using standard assays. More TDSCs, which showed a lower proliferative potential and a higher cellular senescence were present in the CI patellar tendons compared to HT tendons. There was a higher alkaline phosphatase activity and mineralization in TDSCs (CI) in both basal and osteogenic media. More chondrocyte-like cells and higher proteoglycan deposition, Sox9 and collagen type II expression were observed in TDSCs (CI) pellets upon chondrogenic induction. There was a higher protein expression of Sox9, but a lower mRNA expression of Col1a1, Scx, and Tnmd in TDSCs (CI) in a basal medium. In conclusion, TDSCs (CI) showed altered fate, a higher cellular senescence, but a lower proliferative capacity compared to TDSCs (HT), which might contribute to pathological chondro-ossification and failed tendon healing in this animal model.
Rui, Yun Feng; Wong, Yin Mei; Tan, Qi; Chan, Kai Ming
Background: Increase in expression of substance P (SP) and calcitonin gene-related peptide (CGRP) has been reported in clinical samples of tendinopathy.Purpose: To examine the spatial-temporal expression of these neuropeptides as well as their association with activity-related tendon pain, matrix degeneration, failed healing, and pathologic calcification in an established collagenase-induced tendon injury rat model.Study Design: Controlled laboratory study.Methods: Collagenase or saline
Pauline Po-Yee Lui; Lai-shan Chan; Sai-chuen Fu; Kai-ming Chan
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
Background: Although many studies involving rotator cuff repair fixation have focused on ultimate fixation strength and ability to restore the tendon’s native footprint, no studies have characterized the stability of the repair with regard to motion between the tendon and repair site footprint.Hypothesis: Suture anchor fixation for rotator cuff repair has greater interface motion between tendon and bone than does
Christopher S. Ahmad; Andrew M. Stewart; Rolando Izquierdo; Louis U. Bigliani
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
Background We developed a novel technique to improve tendon-bone attachment by hybridizing calcium phosphate (CaP) with a tendon graft using an alternate soaking process. However, the long-term result with regard to the interface between the tendon graft and the bone is unclear. Methods We analyzed bone tunnel enlargement by computed tomography and histological observation of the interface and the tendon graft with and without the CaP hybridization 2 years after anterior cruciate ligament (ACL) reconstruction in goats using EndoButton and the postscrew technique (CaP, n = 4; control, n = 4). Results The tibial bone tunnel enlargement rates in the CaP group were lower than those in the control group (p < 0.05). In the CaP group, in the femoral and tibial bone tunnels at the anterior and posterior of the joint aperture site, direct insertion-like formation that contained a cartilage layer without tidemarks was more observed at the tendon-bone interface than in the control group (p < 0.05). Moreover, the gap area between the tendon graft and the bone was more observed at the femoral bone tunnel of the joint aperture site in the control group than in the CaP group (p < 0.05). The maturation of the tendon grafts determined using the ligament tissue maturation index was similar in both groups. Conclusions The CaP-hybridized tendon graft enhanced the tendon-bone healing 2 years after ACL reconstruction in goats. The use of CaP-hybridized tendon grafts can reduce the bone tunnel enlargement and gap area associated with the direct insertion-like formation in the interface near the joint.
All patients with badminton-related acute Achilles tendon ruptures registered during 1990 to 1994 at the University Hospital of Umeå were retrospectively followed up using a questionnaire. Thirty-one patients (mean age, 36.0 years), 27 men and 4 women, were included. Thirty patients (97%) described themselves as recreational players or beginners. The majority of the injuries (29 of 31, 94%) happened at the middle or end of the planned game. Previous local symptoms had been noticed by five patients (16%). Long-term results showed that patients treated with surgery had a significantly shorter sick leave absence than patients treated without surgery (50 versus 75 days). There was no obvious selection favoring any treatment modality. None of the surgically treated patients had reruptures, but two reruptures occurred in the nonsurgically treated group. There seemed to be fewer remaining symptoms and a higher sports activity level after the injury in the surgically treated group. Our results indicate that local muscle fatigue may interfere with strength and coordination. Preventive measures such as specific treatment of minor injuries and adequate training of strength, endurance, and coordination are important. Our findings also indicate that surgical treatment and careful postoperative rehabilitation is of great importance among badminton players of any age or sports level with Achilles tendon rupture. PMID:9617415
Fahlström, M; Björnstig, U; Lorentzon, R
Abstract The purpose of this study was to measure the tension in the flexor digitorum profundus (FDP) tendon in zone II and the digit angle during joint manipulations that replicate rehabilitation protocols. Eight FDP tendons from eight human cadavers were used in this study. The dynamic tension in zone II of the tendon and metacarpophalangeal (MCP) joint angle were measured in various wrist and digit positions. Tension in the FDP tendon increased with MCP joint extension. There was no tension with the finger fully flexed and wrist extended (synergistic motion), but the tendon force reached 1.77 +/- 0.43 N with the MCP joint hyperextended 45 degrees with the distal interphalangeal and proximal interphalangeal joints flexed. The combination of wrist extension and MCP joint hyperextension with the distal interphalangeal and proximal interphalangeal joints fully flexed, what the authors term "modified synergistic motion," produced a modest tendon tension and may be a useful alternative configuration to normal synergistic motion in tendon rehabilitation. PMID:16059854
Tanaka, Tatsuro; Amadio, Peter C; Zhao, Chunfeng; Zobitz, Mark E; An, Kai-Nan
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.
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
Ossification of the Achilles tendon (OTA) is an unusual clinical condition. It is characterized by the presence of an ossified mass within the fibrocartilaginous substance of the Achilles tendon. The etiology of the ossification of the Achilles tendon is unknown. Review of the literature suggests that its etiology is multifactorial. The major contributing factors are trauma and surgery with other minor causes such as systemic diseases, metabolic conditions, and infections. To our knowledge, no previous reports suggest any genetic/hereditary predisposition in OAT. We report 3 siblings who have OAT with no history of any of the aforementioned predisposing factors. Could OAT have a hereditary component as one of its etiologies?
The preferred treatment of distal biceps tendon ruptures is by operative repair. However, the best approach for repair (single vs double incision) is still subject of debate. Grewal and colleagues recently presented the results of a randomized clinical trial evaluating two different surgical approaches for the repair of distal biceps tendon ruptures. Despite the fact that this article currently presents the highest level of evidence for the surgical repair of distal biceps tendon ruptures, we have some comments on the study that might be interesting to discuss. We think that some of the results and conclusions presented in this study need to be interpreted in the light of these comments.
Kodde, Izaak F; van den Bekerom, Michel P J; Eygendaal, Denise
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
In vitro cell studies might be a useful tool for studying tendon pathology, but no suitable in vitro models exist for tendon disorders. The purpose of this study was to confirm whether cell scratch culture using tendon-derived fibroblasts can provide a suitable in vitro tendon disorder model. Extracellular matrix components were examined immunohistochemically in tendon tissue, and then their related gene expression levels were analyzed by conventional reverse transcription polymerase chain reaction (RT-PCR) and/or quantitative real-time RT-PCR in tissues and cells. Collagen type I (Col I), collagen type III (Col III), tenascin-C (TN-C) and cartilage oligomeric matrix protein (COMP) were detected in tendon tissue sections, and RT-PCR confirmed their expression in tendon tissue and cells. Cells that had been cultured from explanted tendon tissue maintained the characteristics of in vivo tendon cells. The combination of TN-C and COMP might be a useful marker of tendon cells because they display more tendon-specific expression than Col I and III. In particular, the significant increase of TN-C mRNA expression in the scratch wound assay, at 12 hr after scratching, concomitant with the regeneration of the cell sheet, indicates its crucial role in tendon cell proliferation and migration. Thus, TN-C appears to be a key factor in tendon wound healing. In vitro cell scratch assays using tendon cells appear to mimic the repair of tendon tissue after injury.
NEMOTO, Manabu; KIZAKI, Keiichiro; YAMAMOTO, Yoshio; OONUMA, Toshina; HASHIZUME, Kazuyoshi
Background. The optimal surgical treatment for Kienböck's disease with stages IIIB and IV remains controversial. A cadaver study was carried out to evaluate the use of coiled extensor carpi radialis longus tendon for tendon interposition and a strip obtained from the same tendon for ligament reconstruction in the late stages of Kienböck's disease. Methods. Coiled extensor carpi radialis longus tendon was used to fill the cavity of the excised lunate, and a strip obtained from this tendon was sutured onto itself after passing through the scaphoid and the triquetrum acting as a ligament to preserve proximal row integrity. Biomechanical tests were carried out in order to evaluate this new ligamentous reconstruction. Results. It was biomechanically confirmed that the procedure was effective against axial compression and distributed the upcoming mechanical stress to the distal row. Conclusion. Extensor carpi radialis longus tendon has not been used for tendon interposition and ligament reconstruction in the treatment of this disease before. In view of the biomechanical data, the procedure seems to be effective for the stabilization of scaphoid and carpal bones.
Karalezli, Naz?m; Uz, Aysun; Esmer, Ali F?rat; Demirtas, Mehmet; Tasc?, Arzu Gul; Kutahya, Harun; Ulusoy, Gurhan
Flexor tendon injuries are often encountered clinically and typically require surgical repair. Return of function after repair is limited due to adhesion formation, which leads to reduced tendon gliding, and due to a lack of repair site strength, which leads to repair site gap formation or rupture. The application of the growth factors basic fibroblastic growth factor (bFGF) and platelet derived growth factor BB (PDGF-BB) has been shown to have the potential to enhance tendon healing. The objectives of this study were to examine: (1) the conditions over which delivery of bFGF can be controlled from a heparin-binding delivery system (HBDS) and (2) the effect of bFGF and PDGF-BB released from this system on tendon fibroblast proliferation and matrix gene expression in vitro over a 10-day interval. Delivery of bFGF was controlled using a HBDS. Fibrin matrices containing the HBDS retained bFGF better than did matrices lacking the delivery system over the 10-day period studied. Delivery of bFGF and PDGF-BB using the HBDS stimulated tendon fibroblast proliferation and promoted changes in the expression of matrix genes related to tendon gliding, strength, and remodeling. Both growth factors may be effective in enhancing tendon healing in vivo.
Thomopoulos, Stavros; Das, Rosalina; Sakiyama-Elbert, Shelly; Silva, Matthew J.; Charlton, Nichole; Gelberman, Richard H.
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
Tendinopathy is a vexing clinical problem as its onset and development is often asymptomatic and unrecognized until tendon rupture. While extensively studied in the rotator cuff, Achilles, and patellar tendons, no study to date has examined the histological and molecular characteristics of the tendinopathic biceps long-head (LHB). The anatomy of the LHB is unique in that it comprises intra- and extra-articular portions, each exposed to differing loading patterns. Eleven LHBs post-tenotomy were sectioned, fixed in formalin, and stained (H and E; Alcian Blue), and gross structural organization of collagen measured using polarized light microscopy. Protein expression of intra- and extra-articular portions of the tenotomized biceps for IGF-I, collagen III, and MMP-1, -2, -3, and -13 was determined with Western blot analyses. The intra-articular LHB exhibited significantly greater histological evidence of tendinopathy inclusive of increased proteoglycan (p < 0.05) and decreased organization as measured by polarized light microscopy (p < 0.01). The intra-articular LHB also had significantly increased expression of collagen type III (p < 0.01) and of MMP-1 and 3 (p < 0.01, p < 0.05 respectively). No significant differences were found for IGF-I or for MMP-2 and -13. The intra-articular LHB exhibited histological characteristics of tendinopathy. Protein expression of the intra-articular LHB did not universally display signs of tendinopathy in comparison to the extra-articular portion of the tendon. PMID:19340876
Joseph, Michael; Maresh, Carl M; McCarthy, Mary Beth; Kraemer, William J; Ledgard, Felicia; Arciero, Cristina L; Anderson, Jeffrey M; Nindl, Bradley C; Mazzocca, Augustus D
Patellar tendon (PT) allografts for anterior cruciate ligament (ACL) reconstruction are potentially immunogenic and incorporate slowly compared with autografts. Our tissue-engineering approach to improve allograft efficacy is to (1) remove intrinsic cells from the graft to reduce antigenicity and then (2) seed the graft with extrinsic cells to improve ligamentization. To remove cells, tendons were soaked in 1% extraction solutions of tri(n-butyl)phosphate (TBP) or sodium dodecyl sulfate (SDS) for various time periods (24-72 h) and rinsed exhaustively. After treatment, we measured tendon cellularity, crimp structure, and mechanical properties. Treatment with either SDS or TBP removed approximately 70-90% of the intrinsic PT cells. Mechanical properties of treated PTs were similar to those of controls, despite changes in appearance. TBP- and SDS-treated PTs were then seeded with fibroblasts and cultured for up to 2 weeks in vitro. Fibroblast proliferation was retarded on SDS-treated PTs; in contrast, TBP-treated PTs supported cell proliferation similar to that of untreated controls. Extrinsic fibroblasts were successfully cultured on the TBP-treated PTs in vitro, creating viable tissue-engineered grafts potentially useful for ACL reconstruction. These modified allografts have the potential to be developed into mechanically functional delivery vehicles for cells, gene therapy vectors, or other biological agents. PMID:15363164
Cartmell, Jeffrey S; Dunn, Michael G
Purpose The aim of our study was to evaluate the pathological anatomy of the ligaments, tendons and muscles in clubfeet, and to show whether the dysbalance of shortened and elongated structures is an adaptive process or a primary factor inducing the misshaped bones and cartilagines. Methods Surgical exposure was performed on seven idiopathic clubfeet specimens, aborted between the 25th and 37th week of gestation and compared to two normal feet (27th and 36th week of gestation). Results The medial stabilisation system of the foot was found shortened, but all ligaments could be dissected. On the lateral side, the calcaneofibular ligament in particular was both ‘shortened’ and ‘elongated’, depending on the course of the fibres to the axis of motion in the subtalar and talocalcaneonavicular joint. The main difference to the normal feet was found in the thickened tendon of the tibialis posterior forming a bulbus before dividing into fascicules. Conclusions We presume the ossification disturbance of the calcaneus to be the primary fault. This disturbance will influence the reduction of the varus position, so ligaments and tendons will be conformed to the misshaped bones.
Anderhuber, Friedrich; Haldi-Brandle, Verena; Exner, Gerhard Ulrich
Connective tissues are biological composites comprising of collagen fibrils embedded in (and reinforcing) the hydrated proteoglycan-rich (PG) gel within the extracellular matrices (ECMs). Age-related changes to the mechanical properties of tissues are often associated with changes to the structure of the ECM, namely, fibril diameter. However, quantitative attempts to correlate fibril diameter to mechanical properties have yielded inconclusive evidence. Here, we described a novel approach that was based on the rule of mixtures for fiber composites to evaluate the dependence of age-related changes in tendon tensile strength (sigma) and stiffness (E) on the collagen fibril cross-sectional area fraction (rho), which is related to the fibril volume fraction. Tail tendons from C57BL6 mice from age groups 1.6-35.3 months old were stretched to failure to determine sigma and E. Parallel measurements of rho as a function of age were made using transmission electron microscopy. Mathematical models (rule of mixtures) of fibrils reinforcing a PG gel in tendons were used to investigate the influence of rho on ageing changes in sigma and E. The magnitudes of sigma, E, and rho increased rapidly from 1.6 months to 4.0 months (P-values <0.05) before reaching a constant (age independent) from 4.0 months to 29.0 months (P-values >0.05); this trend continued for E and rho (P-values >0.05) from 29.0 months to 35.3 months, but not for sigma, which decreased gradually (P-values <0.05). Linear regression analysis revealed that age-related changes in sigma and E correlated positively to rho (P-values <0.05). Collagen fibril cross-sectional area fraction rho is a significant predictor of ageing changes in sigma and E in the tail tendons of C57BL6 mice. PMID:18412498
Goh, K L; Holmes, D F; Lu, H-Y; Richardson, S; Kadler, K E; Purslow, P P; Wess, T J
Tenomodulin (Tnmd, also called Tendin) is classified as a type II transmembrane glycoprotein and is highly expressed in developing as well as in mature tendons. Along with scleraxis (scx), Tnmd is a candidate marker gene for tenocytes. Its function is unknown, but it has been reported to have anti-angiogenic properties. Results in a knockout mouse model did not substantiate that claim. It has homology to chondromodulin-I. Single nucleotide polymorphisms of TNMD have been associated with obesity, macular degeneration, and Alzheimer's disease in patients. In the present study, three Tnmd isoforms with deduced molecular weights of 20.3 (isoform II), 25.4 (isoform III), and 37.1 (isoform I) kDa were proposed and verified by Western blot from cells with green fluorescent protein-linked, overexpressed constructs, tissue, and by qPCR of isoforms from human tissues and cultured cells. Overexpression of each Tnmd isoform followed by immunofluorescence imaging showed that isoforms I and II had perinuclear localization while isoform III was cytoplasmic. Results of qPCR demonstrated differential expression of each Tnmd isoform in patient's specimens taken from flexor carpi radialis, biceps brachii, and flexor digitorum profundus tendons. Knockdown of Tnmd increased the expression of both scleraxis (scx) and myostatin, indicating a potential negative feedback loop between Tnmd and its regulators. Knockdown of all Tnmd isoforms simultaneously also reduced tenocyte proliferation. I-TASSER protein three-dimensional conformation modeling predictions indicated each Tnmd isoform had different structures and potential functions: isoform 1, modeled as a cytosine methyltransferase; isoform 2, a SUMO-1-like SENP-1 protease; and isoform 3, an ?-syntrophin, plextrin homology domain scaffolding protein. Further functional studies with each Tnmd isoform may help us to better understand regulation of tenocyte proliferation, tendon development, response to injury and strain, as well as mechanisms in tendinoses. These results may indicate novel therapeutic targets in specific tenomodulin isoforms as well as treatments for tendon diseases. PMID:22700804
Qi, J; Dmochowski, J M; Banes, A N; Tsuzaki, M; Bynum, D; Patterson, M; Creighton, A; Gomez, S; Tech, K; Cederlund, A; Banes, A J
Background Mesenchymal stromal cells attract much interest in tissue regeneration because of their capacity to differentiate into mesodermal origin cells, their paracrine properties and their possible use in autologous transplantations. The aim of this study was to investigate the safety and reparative potential of implanted human mesenchymal stromal cells (hMSCs), prepared under Good Manufacturing Practice (GMP) conditions utilizing human mixed platelet lysate as a culture supplement, in a collagenase Achilles tendon injury model in rats. Methods Eighty-one rats with collagenase-induced injury were divided into two groups. The first group received human mesenchymal stromal cells injected into the site of injury 3 days after lesion induction, while the second group received saline. Biomechanical testing, morphometry and semiquantitative immunohistochemistry of collagens I, II and III, versican and aggrecan, neovascularization, and hMSC survival were performed 2, 4, and 6 weeks after injury. Results Human mesenchymal stromal cell-treated rats had a significantly better extracellular matrix structure and a larger amount of collagen I and collagen III. Neovascularization was also increased in hMSC-treated rats 2 and 4 weeks after tendon injury. MTCO2 (Cytochrome c oxidase subunit II) positivity confirmed the presence of hMSCs 2, 4 and 6 weeks after transplantation. Collagen II deposits and alizarin red staining for bone were found in 6 hMSC- and 2 saline-treated tendons 6 weeks after injury. The intensity of anti-versican and anti-aggrecan staining did not differ between the groups. Conclusions hMSCs can support tendon healing through better vascularization as well as through larger deposits and better organization of the extracellular matrix. The treatment procedure was found to be safe; however, cartilage and bone formation at the implantation site should be taken into account when planning subsequent in vivo and clinical trials on tendinopathy as an expected adverse event.
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.
The present study aimed to investigate the influence of isometric training protocols with long- and short-duration contractions on the elasticity of human tendon structures in vivo. The elasticity was assessed through in vivo determination of the elongation (L) of the tendons and aponeuroses using ultrasonography, while the subjects performed ramp isometric exercise up to maximum voluntary contraction (MVC).Eight young males completed 12 weeks (4 days per week) of a unilateral isometric training programme on knee extensors, which consisted of two different combinations of contraction and relaxation times at 70 % MVC: one leg was trained using a short-duration protocol (3 sets of 50 repetitions of contraction for 1 s and relaxation for 2 s), and the other leg was trained using a long-duration protocol (4 sets of a combination of contraction for 20 s and relaxation for 1 min). The training volume per session, expressed as the integrated torque, was the same for the two protocols.Both protocols resulted in a significant increase in MVC: 31.8 ± 17.2 % for the short-duration protocol and 33.9 ± 14.4 % for the long-duration protocol. Moreover, the training produced significant increases in the muscle volume of the constituents of the quadriceps femoris, with similar relative gains for the two protocols: 7.4 ± 3.9 % for the short-duration protocol and 7.6 ± 4.3 % for the long-duration protocol.The short-duration protocol produced no significant change in L values at any of the force production levels. For the long-duration protocol, however, the L values above 550 N were significantly shorter after training. Analysis revealed that the group × test time interaction effect on tendon stiffness was significant. Stiffness increased significantly for the long-duration protocol, but not for the short-duration protocol.The present study demonstrates a greater increase in stiffness of human tendon structures following isometric training using longer duration contractions compared to shorter contractions. This suggests that the changes in the elasticity of the tendon structures after resistance training may be affected by the duration of muscle contraction.
Kubo, Keitaro; Kanehisa, Hiroaki; Fukunaga, Tetsuo
Crovace, A., Lacitignola, L., De siena, R., Rossi, G. and Francioso, E., 2007. Cell therapy for tendon repair in horses: An\\u000a experimental study. Veterinary Research Communications, 31(Suppl. 1), 281–283
A. Crovace; L. Lacitignola; R. De siena; G. Rossi; E. Francioso
... Subscribe Protect Your Tendons Preventing the Pain of Tendinitis You’ve probably heard of such sports injuries ... jumper’s knee. These are just 2 examples of tendinitis, a painful condition caused by overusing and straining ...
Rupture of the distal biceps tendon is a relatively un- common clinical entity. Typically, patients are middle-aged males who experience a sudden forced extension against an actively con- tracting biceps muscle. Patients usually describe a \\
WILLIAM HAMILTON; MATTHEW L. RAMSEY
Few case reports have described the surgical treatment of calcifying tendonitis of the subscapularis tendon. We present a case of symptomatic diffuse calcifying tendonitis involving the subscapularis and infraspinatus insertions that was difficult to detect arthroscopically. The patient was treated with arthroscopic incision of the tendinous insertions thorough removal of the calcific deposits and subsequent repair using a suture-anchor technique. Two years after the surgical procedure, the patient was completely pain-free and attained full range of motion. Radiographic evaluation performed 2 years after the procedure revealed no calcific deposits. We conclude that the combination of incision of the subscapularis and infraspinatus insertions, complete removal of the calcific deposits, and subsequent suture-anchor repair in an all-arthroscopic manner can lead to an excellent clinical outcome without compromising the functional integrity of the rotator cuff tendons.
Mitsui, Yasuhiro; Gotoh, Masafumi; Tanesue, Ryo; Shirachi, Isao; Shibata, Hideaki; Nakama, Kenjiro; Okawa, Takahiro; Higuchi, Fujio; Nagata, Kensei
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.
Summary Over the past five decades we have seen numerous iterations of suture repair methods for tendon. The pursuit of the ultimate repair has led to many repair methods being described. This comprehensive compilation of the suture repair techniques will describe the factors that affect repair success, including repair strength, gapping resistance, glide and rehabilitation. Different approaches to rejoining severed tendons will be critiqued on their biomechanical ability to improve tendon repair strength, maintaining glide, reducing tendon damage, and minimising adhesion formation. It is important to highlight how the suture repairs have evolved and improved but also review how they may contribute to their own trauma. The apparent paradox between providing mechanical strength and minimising adhesions require refinements in the field to improve on functional outcomes.
Rawson, Shelley; Cartmell, Sarah; Wong, Jason
Background: Although knee injuries are common among professional football players, ruptures of the patellar tendon are relatively rare. Predisposing factors, mechanisms of injury, treatment guidelines, and recovery expectations are not well established in high-level athletes.Hypothesis: Professional football players with isolated rupture of the patellar tendon treated with timely surgical repair will return to their sport.Study Design: Case series; Level of
Martin Boublik; Theodore Schlegel; Ryan Koonce; James Genuario; Charles Lind; David Hamming
\\u000a Ligaments and tendons are non-linear viscoelastic materials and their response functions are typically assessed using creep\\u000a and stress relaxation tests. Non-linear viscoelastic models such as multiple Maxwell elements in parallel and the quasilinear\\u000a viscoelastic model (QLV) used to capture the non-linear viscoelastic response of ligaments and tendons frequently employ multiple\\u000a relaxation time constants determined from curve-fitting the entire available data
Jinjin Ma; Ellen M. Arruda
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
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
Extensor hallucis longus tendon contracture can lead to hyperextension deformity of the big toe. We describe an endoscopic\\u000a approach of Z-lengthening of the tendon. Extensor hallucis longus tendoscopy is performed with a distal portal at the level\\u000a of the metatarsal neck and a proximal portal at the level of the navicular. At the distal portal, the medial half of the
T. H. Lui
SUMMARY Although post-rehabilitation is routinely performed following flexor tendon repair, in some clinical scenarios post-rehabilitation must be delayed. We investigated modification of the tendon surface using carbodiimide derivatized hyaluronic acid and lubricin (cd-HA-Lub) to maintain gliding function following flexor tendon repair with postoperative immobilization in a in vivo canine model. Flexor digitorum profundus tendons from the 2nd and 5th digits of one forepaw of six dogs were transected and repaired. One tendon in each paw was treated with cd-HA-Lub; the other repaired tendon was not treated. Following tendon repair, a forearm cast was applied to fully immobilize the operated forelimb for 10 days, after which the animals were euthanized. Digit normalized work of flexion (nWOF) and tendon gliding resistance were assessed. The nWOF of the FDP tendons treated with cd-HA-Lub was significantly lower than the nWOF of the untreated tendons (p < 0.01). The gliding resistance of cd-HA-Lub treated tendons was also significantly lower than that of the untreated tendons (p < 0.05). Surface treatment with cd-HA-Lub following flexor tendon repair provides an opportunity to improve outcomes for patients in whom the post-operative therapy must be delayed after flexor tendon repair.
Zhao, Chunfeng; Sun, Yu-Long; Jay, Gregory D.; Moran, Steven L.; An, Kai-Nan; Amadio, Peter C.
Due to their superficial course, the extensor tendons are frequently lacerated over the dorsum of the hand and fingers. Excellent functional results are obtained in repairs of simple tendon lacerations. ‘Open’ mallet lacerations over the distal IP joint or involving the central extensor slip over the proximal IP joint require more precise suturing methods. More proximal extensor tendon divisions near the wrist involve dissection of the retracted finger extensors or long thumb extensor in the distal forearm and more formal tendon repairs, including a possible tendon transfer to the thumb. ‘Closed injuries’, with varying degrees of extensor tendon disruption, occur at three main sites. The mallet injury at the DIP joint and the boutonnière deformity over the PIP joint are sometimes recognized late, but respond to conservative splinting for a minimum of four weeks with guarded motion avoiding secondary stiffening of the remaining small joints of the hand. Surgery of closed injuries most frequently involves the intra-articular traction fracture type of mallet deformities in which the DIP joint has taken the brunt of the injury.
Kontor, J. A.
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
Objective: The aim of this study was to determine the effects of resveratrol on the tendon healing process of streptozotocin-induced diabetic rats. Methods: The study included 16 male Sprague-Dawley rats. Streptozotocin was administered to induce diabetes and bilateral tenorrhaphy of the Achilles tendons was performed. Intraperitoneal resveratrol was injected in the experimental group (n=8) and saline in the control group (n=8) during the postoperative period. Rats were sacrificed at the 14th day. Right side tendons were evaluated biomechanically and left side tendons histologically. Results: Difference in mean tendon tensile strength was not statistically significant between groups (p>0.05). Histologic evaluations of the repair zones showed greater configuration of the newly synthesized collagen in the experimental group. The ratio of the newly synthesized collagen area to the healing region area was significantly higher in the experimental group then the control group (p<0.01). Conclusion: Resveratrol appears to have a positive impact on the process of tendon healing in diabetic conditions in the first 14 days. PMID:24901929
Zeytin, Kayhan; Cilo?lu, Nesibe Sinem; Ate?, Filiz; Vardar Aker, Fugen; Ercan, Feriha
The authors devised an alternative arthroscopic double bundle ACL reconstruction technique using a bone patellar tendon bone (BPTB)-gracilis tendon composite autograft. One tibial and two femoral tunnels were used to reconstruct two bundles of anterior cruciate ligaments (ACL) [an anteromedial bundle (AM) and a post-erolateral bundle (PL)]. BTBB was fixed in the tunnels produced on the isometric points of the tibia and femur using the conventional technique. The gracilis tendon was then fixed in a PL tunnel produced using the outside-in technique. The authors consider that the devised technique based on a combination of autogenous bone patellar bone graft and gracilis tendon, can minimize tunnel widening post-operatively, allow easier revision should the reconstructed ACL fail, and also provides an alternative means of restoring rotation stability. PMID:18066529
Jung, Kwang Am; Lee, Su Chan; Song, Moon Bok; Lee, Choon Key
Muscle tendon unit (MTU) transfer is a common procedure performed to restore hand function after peripheral nerve or spinal cord injury. The principles of MTU transfer established for hand surgery can be adopted to optimize the dynamic excursion of the temporalis tendon transfer procedure for facial reanimation. Additionally, the force generating ability of a transferred MTU depends on the ideal length-tension relationship of the donor muscle. There are unclear guideline for selecting the ideal tension at which a transferred MTU will generate maximum force and excursion and current practice often leads to overstretch and suboptimal actin myosin interaction. The use of intraoperative electrical stimulation is an option for determining the ideal tension to optimize excursion of transferred temporalis tendon units in simile restoration. Understanding the biomechanics and principles of MTU and applying it to the temporalis tendon transfer procedure is necessary to improve its use in facial reanimation. PMID:23208742
Boahene, Kofi D O
Prestressed-concrete containments in the United States using greased prestressing tendons are inspected periodically to ensure structural integrity and to identify and correct problem areas before they become critical. An analysis of the available utility inspection data and an evaluation of the current and proposed guidelines were conducted to provide a measure of the reliability of the inspection process. Comments from utility and industry personnel were factored into the analysis. The results indicated that the majority of the few incidences of problems or abnormalities which occurred were minor in nature and did not threaten the structural integrity of the containment.
Dougan, J.R.; Ashar, H.
Advances in muscle physiology suggest that the perimysium plays a role in the transmission of lateral contractile forces. This hypothesis is strongly supported by our recent demonstration of the existence of "Perimysial Junctional Plates" in bovine Flexor carpi radialis muscle [Passerieux, E., Rossignol, R., Chopard, A., Carnino, A., Marini, J.F., Letellier, T., Delage, J.P. 2006. Structural organization of the perimysium in bovine skeletal muscle: junctional plates and associated intracellular subdomains. J. Struct. Biol. 154 (2), 206-216] However, the overall organization of the perimysium collagen network, as well as its continuity and heterogeneity, have still not been described in detail throughout the entire muscle. We used an extension of the standard NaOH digestion technique and scanning electron microscopy to analyze perimysium architecture in bovine Flexor carpi radialis muscle. First, we observed that the perimysium is made of a highly ordered network of collagen fibers, binding the myofibers from tendon to tendon. We identified basic collagen cable structures, characterized by a straight portion (3 cm long) in the direction of the myofibers and a curved terminal portion at 60 degrees. These cables reach the myofiber surface at the level of the previously described "Perimysial Junctional Plates". At a higher level of organization, these cables stick together to form the walls of numerous tubes arranged in a overlapping honeycomb pattern around the myofibers. At the ends of these tubes, the straight portions of the collagen cables ramify in large bundles that merge with the tendons. Taken together, these observations identify four levels of organization in the perimysium: (i) Perimysial Junctional Plates that constitute the focal attachment between the perimysium and the myofibers, (ii) collagen plexi attaching adjacent myofibers, (iii) a loose lattice of large interwoven fibers, and (iv) honeycomb tubes connecting two tendons. This spatial arrangement of the perimysium supports the view of a complex pattern of lateral force transmission from myofibers to tendons and adjacent muscles. PMID:17433715
Passerieux, E; Rossignol, R; Letellier, T; Delage, J P
ABSTRACT We report here the clinical presentation, magnetic resonance imaging (MRI) findings and successful surgical management associated with triceps tendon avulsion in a dog. A definitive diagnosis of triceps tendon avulsion was made based on MRI with evidence of displacement of the triceps tendon. Surgical correction of triceps tendon avulsion was performed with two horizontal mattress sutures using polyester and two tunnels drilled in the olecranon to reattach the tendon to the proximal olecranon. At 9 months, there was no evidence of lameness on the left thoracic limb. This is the first case report to describe MRI evaluation for the diagnosis of the triceps tendon avulsion.
YOON, Hun-Young; JEONG, Soon-Wuk
We report here the clinical presentation, magnetic resonance imaging (MRI) findings and successful surgical management associated with triceps tendon avulsion in a dog. A definitive diagnosis of triceps tendon avulsion was made based on MRI with evidence of displacement of the triceps tendon. Surgical correction of triceps tendon avulsion was performed with two horizontal mattress sutures using polyester and two tunnels drilled in the olecranon to reattach the tendon to the proximal olecranon. At 9 months, there was no evidence of lameness on the left thoracic limb. This is the first case report to describe MRI evaluation for the diagnosis of the triceps tendon avulsion. PMID:23708931
Yoon, Hun-Young; Jeong, Soon-Wuk
Relative contributions of mechanical degradation, enzymatic degradation, and repair of the extracellular matrix on the response of tendons when subjected to under- and over- mechanical stimulations in vitro.
Tendon response to mechanical loading results in either homeostasis, improvement, or degeneration of tissue condition. In an effort to better understand the development of tendinopathies, this study investigated the mechanical and structural responses of tendons subjected to under- and over-stimulations (1.2% and 1.8% strain respectively, 1 Hz). The objective was to examine three sub-processes of tendon response: mechanical degradation, enzymatic degradation, and repair of the extracellular matrix. We subjected rat tail tendons to a 10-day stimulation protocol with four periods of 6 h each day: 30 min of stimulation and 5 h 30 min of rest. To investigate the contribution of the three sub-processes, we controlled the contribution of the cells through variations in the nutrient and protease inhibitor content in the in vitro solutions. Using nondestructive cyclic tests, we evaluated the daily changes in the peak stress. To assess structural changes, we carried out microscopic analyses at the end of the study period. We observed that the relative contributions of the sub-processes differed according to the stimulation amplitude. With over-stimulation of tendons immersed in DMEM, we succeeded in reducing enzymatic degradation and increasing peak stress. In under-stimulation, the addition of protease inhibitors was required to obtain the same result. PMID:19725106
Cousineau-Pelletier, Paule; Langelier, Eve
Quantitative ultrasound (QUS) techniques have recently been widely applied for the characterization of tissues. For example, they can be used for the quantification of Achilles tendon properties based on the broadband ultrasound attenuation (BUA) and the speed of sound (SOS) when the ultrasound wave passes through the tissues. This study is to develop an integrated system to investigate the properties of Achilles tendons using QUS images from UBIS 5000 (DMS, Montpellier, France) and B-mode ultrasound images from HDI 5000 (ATL, Ultramark, USA). Subjects including young (32 females and 17 males; mean age: 23.7 ± 2.0) and middle-aged groups (8 female and 8 males; mean age: 47.3 ± 8.5 s) were recruited and tested for this study. Only subjects who did not exercise regularly and had no record of tendon injury were studied. The results show that the BUA is significantly higher for the young group (45.2 ± 1.6 dB MHz-1) than the middle-age group (40.5 ± 1.9 dB MHz-1), while the SOS is significantly lower for the young (1601.9 ± 11.2 ms-1) compared to the middle-aged (1624.1 ± 8.7 m s-1). On the other hand, the thicknesses of Achilles tendons for both groups (young: 4.31 ± 0.23 mm; middle age: 4.24 ± 0.23 mm) are very similar. For one patient who had an Achilles tendon lengthening (ATL) surgery, the thickness of the Achilles tendon increased from 4 mm to 4.33 mm after the surgery. In addition, the BUA increased by about 7.2% while the SOS decreased by about 0.6%. In conclusion, noninvasive ultrasonic assessment of Achilles tendons is useful for assisting clinical diagnosis and for the evaluation of a therapeutic regimen.
Du, Yi-Chun; Chen, Yung-Fu; Chen, Pei-Jarn; Lin, Yu-Ching; Chen, Tainsong; Lin, Chii-Jeng
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
The pathogenesis and management of lateral epicondylalgia, or tennis elbow, a common ailment affecting middle-aged subjects of both genders continue to provoke controversy. Currently it is thought to be due to local tendon pathology, pain system changes, and motor system impairment. Its diagnosis is usually clinical, based on a classical history, as well as symptoms and signs. In selected cases, additional imaging (X-rays, ultrasound, and magnetic resonance imaging) can help to confirm the diagnosis. Different treatment modalities have been described, including the use of orthotics, non-steroidal anti-inflammatory drugs, steroid injections, topical glyceryl trinitrate, exercise therapy, manual therapy, ultrasound therapy, laser therapy, extracorporeal shockwave therapy, acupuncture, taping, platelet-rich plasma injections, hyaluronan gel injections, botulinum toxin injections, and surgery. Nevertheless, evidence to select the best treatment is lacking and the choice of therapy depends on the experience of the management team, availability of the equipment and expertise, and patient response. This article provides a snapshot of current medical practice for lateral epicondylalgia management. PMID:24584568
Luk, James K H; Tsang, Raymond C C; Leung, H B
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
Although the link between altered stem cell properties and tissue aging has been recognized, the molecular and cellular processes of tendon aging have not been elucidated. As tendons contain stem/progenitor cells (TSPC), we investigated whether the molecular and cellular attributes of TSPC alter during tendon aging and degeneration. Comparing TSPC derived from young/healthy (Y-TSPC) and aged/degenerated human Achilles tendon biopsies (A-TSPC), we observed that A-TSPC exhibit a profound self-renewal and clonogenic deficits, while their multipotency was still retained. Senescence analysis showed a premature entry into senescence of the A-TSPC, a finding accompanied by an upregulation of p16(INK4A). To identify age-related molecular factors, we performed microarray and gene ontology analyses. These analyses revealed an intriguing transcriptomal shift in A-TSPC, where the most differentially expressed probesets encode for genes regulating cell adhesion, migration, and actin cytoskeleton. Time-lapse analysis showed that A-TSPC exhibit decelerated motion and delayed wound closure concomitant to a higher actin stress fiber content and a slower turnover of actin filaments. Lastly, based on the expression analyses of microarray candidates, we suggest that dysregulated cell-matrix interactions and the ROCK kinase pathway might be key players in TSPC aging. Taken together, we propose that during tendon aging and degeneration, the TSPC pool is becoming exhausted in terms of size and functional fitness. Thus, our study provides the first fundamental basis for further exploration into the molecular mechanisms behind tendon aging and degeneration as well as for the selection of novel tendon-specific therapeutical targets. PMID:23826660
Kohler, Julia; Popov, Cvetan; Klotz, Barbara; Alberton, Paolo; Prall, Wolf Christian; Haasters, Florian; Müller-Deubert, Sigrid; Ebert, Regina; Klein-Hitpass, Ludger; Jakob, Franz; Schieker, Matthias; Docheva, Denitsa
Rotator Cuff Tendonitis; Bicipital Tendonitis; Subdeltoid Bursitis of the Shoulder; Subacromial Bursitis of the Shoulder; Medial Epicondylitis of the Elbow; Lateral Epicondylitis of the Elbow; DeQuervain's Tenosynovitis of the Wrist
The necessity of tendon interposition for the maintenance of joint space after basal joint resection arthroplasty with ligament reconstruction has not been established. A prospective, randomized study was performed. In Group I (nine patients), ligament reconstruction was performed to suspend the first metacarpal in addition to placement of a rolled tendon interposition to fill the void created by resection of the trapezium. In Group II (11 patients), ligament reconstruction alone was performed, with use of a Mitek suture anchor. No tendon interposition was performed. This allowed use of a more limited incision and shorter length of tendon graft. Average followup was 23 months. There was no difference between the two groups in range of motion of the thumb, grip strength, lateral pinch strength, the ability to perform activities of daily living, or subjective satisfaction with the procedure. Two- and three-point pinch strength was statistically significantly greater in Group II. Lateral radiographs of the basal joint at followup, at rest and with pinch, showed maintenance of the joint space, and no difference between the two groups. Tendon interposition is not necessary for maintenance of joint space after basal joint resection arthroplasty if ligament reconstruction is performed. PMID:9308523
Gerwin, M; Griffith, A; Weiland, A J; Hotchkiss, R N; McCormack, R R
Bovine and human tendon tissue do not induce calcification in vitro. However, extraction of those tissues with 3% Na2HPO4 converts them to calcifiable matrices. The supernatant fraction derived from the extraction contains a nondialyzable, perchloric acid soluble component that inhibits calcification of the extracted matrix. This inhibitory substance is characterized by a molecular weight in the range of 85,000-100,000. Exposure to pronase or hyaluronidase did not alter the inhibitory potency but did render the inhibitor dialyzable. Commercial sources of hyaluronic acid, chondrotitin-6-sulfate, chrondroitin-4-sulfate, dermatan sulfate, heparin and lysozyme did not inhibit calcification of the extracted matrix. Phosvitin, a phosphoglycoprotein is a potent inhibitor. Although phosvitin and the tendon extract also inhibit calcification of previously calcified matrix, they have no detectable effect on the rate of decalcification. We conclude that the mechanism of inhibition is characterized by a degree of specificity and that phosvitin and a macromolecular component of tendon tissue blocks conversion of an intermediate matrix-bound CaP complex to crystalline apatite. It seems reasonable that the tendon inhibitor could function in situ and possibly in vivo to control calcification of tendon tissue. PMID:667663
Quittner, C; Wadkins, C L
Biological fixation of soft tissue-based grafts for anterior cruciate ligament (ACL) reconstruction poses a major clinical challenge. The ACL integrates with subchondral bone through a fibrocartilage enthesis, which serves to minimize stress concentrations and enables load transfer between two distinct tissue types. Functional integration thus requires the reestablishment of this fibrocartilage interface on reconstructed ACL grafts. We designed and characterized a novel mechanoactive scaffold based on a composite of poly-?-hydroxyester nanofibers and sintered microspheres; we then used the scaffold to test the hypothesis that scaffold-induced compression of tendon grafts would result in matrix remodeling and the expression of fibrocartilage interface-related markers. Histology coupled with confocal microscopy and biochemical assays were used to evaluate the effects of scaffold-induced compression on tendon matrix collagen distribution, cellularity, proteoglycan content, and gene expression over a 2-week period. Scaffold contraction resulted in over 15% compression of the patellar tendon graft and upregulated the expression of fibrocartilage-related markers such as Type II collagen, aggrecan, and transforming growth factor-?3 (TGF-?3). Additionally, proteoglycan content was higher in the compressed tendon group after 1 day. The data suggest the potential of a mechanoactive scaffold to promote the formation of an anatomic fibrocartilage enthesis on tendon-based ACL reconstruction grafts.
Spalazzi, Jeffrey P.; Vyner, Moira C.; Jacobs, Matthew T.; Moffat, Kristen L.
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.
Chronic insertional tendinopathy of the Achilles tendon is a frequent and disabling pathologic entity. Operative treatment is indicated for patients for whom nonoperative management has failed. The treatment can consist of the complete detachment of the tendon insertion and extensive debridement. We biomechanically tested a new operative technique that uses buttons for fixation of the Achilles tendon insertion on the posterior calcaneal tuberosity and compared it with 2 standard bone anchor techniques. A total of 40 fresh-frozen cadaver specimens were used to compare 3 fixation techniques for reinserting the Achilles tendon: single row anchors, double row anchors, and buttons. The ultimate loads and failure mechanisms were recorded. The button assembly (median load 764 N, range 713 to 888) yielded a median fixation strength equal to 202% (range 137% to 251%) of that obtained with the double row anchors (median load 412 N, range 301 to 571) and 255% (range 213% to 317%) of that obtained with the single row anchors (median load 338 N, range 241 to 433N). The most common failure mechanisms were suture breakage with the buttons (55%) and pull out of the implant with the double row (70%) and single row (85%) anchors. The results of the present biomechanical cadaver study have shown that Achilles tendon reinsertion fixation using the button technique provides superior pull out strength than the bone anchors tested. PMID:24556479
Awogni, David; Chauvette, Guillaume; Lemieux, Marie-Line; Balg, Frédéric; Langelier, Ève; Allard, Jean-Pascal
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
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
The tibialis posterior tendon and the spring and deltoid ligament complexes combine to provide dynamic and passive stabilization on the medial side of the ankle and hindfoot. Some of the injuries will involve acute injury to previous healthy structures, but many will develop insidiously. The clinician must be aware of new treatment strategies and the level of accompanying scientific evidence regarding injuries sustained by athletes in these areas, while acknowledging that more traditional management applied to nonathletic patients is still likely to be appropriate in the setting of treatment for elite athletes. PMID:23707177
Ribbans, William John; Garde, Ajit
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
Musculo-tendon forces and joint reaction forces are typically estimated using a two-step method, computing first the musculo-tendon forces by a static optimization procedure and then deducing the joint reaction forces from the force equilibrium. However, this method does not allow studying the interactions between musculo-tendon forces and joint reaction forces in establishing this equilibrium and the joint reaction forces are usually overestimated. This study introduces a new 3D lower limb musculoskeletal model based on a one-step static optimization procedure allowing simultaneous musculo-tendon, joint contact, ligament and bone forces estimation during gait. It is postulated that this approach, by giving access to the forces transmitted by these musculoskeletal structures at hip, tibiofemoral, patellofemoral and ankle joints, modeled using anatomically consistent kinematic models, should ease the validation of the model using joint contact forces measured with instrumented prostheses. A blinded validation based on four datasets was made under two different minimization conditions (i.e., C1 - only musculo-tendon forces are minimized, and C2 - musculo-tendon, joint contact, ligament and bone forces are minimized while focusing more specifically on tibiofemoral joint contacts). The results show that the model is able to estimate in most cases the correct timing of musculo-tendon forces during normal gait (i.e., the mean coefficient of active/inactive state concordance between estimated musculo-tendon force and measured EMG envelopes was C1: 65.87% and C2: 60.46%). The results also showed that the model is potentially able to well estimate joint contact, ligament and bone forces and more specifically medial (i.e., the mean RMSE between estimated joint contact force and in vivo measurement was C1: 1.14BW and C2: 0.39BW) and lateral (i.e., C1: 0.65BW and C2: 0.28BW) tibiofemoral contact forces during normal gait. However, the results remain highly influenced by the optimization weights that can bring to somewhat aphysiological musculo-tendon forces. PMID:24210475
Moissenet, Florent; Chèze, Laurence; Dumas, Raphaël
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
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.
The authors present a case of a traumatic extensor hallucis longus tendon rupture sustained 2 days after hallux valgus and hammer toe correction. The ruptured tendon, separated by a 6-cm defect, was repaired using a fascia lata allograft. This case demonstrates a serious complication of a commonly performed procedure and a salvage technique useful for dealing with large tendon defects. PMID:12237269
Zielaskowski, Lorne A; Pontious, Jane
Background: To date, no studies document the effect of anabolic steroids on rotator cuff tendons.Study Design: Controlled laboratory study.Hypothesis: Anabolic steroids enhance remodeling and improve the biomechanical properties of bioartificially engineered human supraspinatus tendons.Methods: Bioartificial tendons were treated with either nandrolone decanoate (nonload, steroid, n = 18), loading (load, nonsteroid, n = 18), or both (load, steroid, n = 18).
Ioannis K. Triantafillopoulos; Albert J. Banes; Karl F. Bowman; Melissa Maloney; William E. Garrett; Spero G. Karas
Most muscle stretching studies have focused on defin ing the biomechanical properties of isolated elements of the muscle-tendon unit or on comparing different stretching techniques. We developed an experimental model that was designed to evaluate clinically relevant biomechanical stretching properties in an entire muscle- tendon unit. Our objectives were to characterize the viscoelastic behavior of the muscle-tendon unit and to
Dean C. Taylor; James D. Dalton; Anthony V. Seaber; William E. Garrett
Magic angle magnetic resonance (MR) imaging consists of imaging tendons at 55° to the magnetic field. In people, magic angle MR imaging is valuable for detection of chronic tendon lesions and allows calculation of tendon T1 values. Increased T1 values occur in people with chronic tendinopathy. The T1 values of normal equine tendons have been reported but there are no available data for abnormal equine tendons. Twelve limbs were studied. Two limbs had diode laser tendon lesions induced postmortem, four limbs had diode laser tendon lesions induced in vivo and six limbs had naturally occurring tendon lesions. The limbs were imaged at 1.5 T using both conventional MR imaging and magic angle MR imaging. The post-mortem laser induced lesions were identified only with magic angle MR imaging. The in vivo induced lesions and naturally occurring lesions were identified with both techniques but had a different appearance with the two imaging techniques. Magic angle imaging was helpful at identifying lesions that were hypointense on conventional imaging. Increased T1 values were observed in all abnormal tendons and in several tendons with a subjectively normal MR appearance. The increased T1 value may reflect diffuse changes in the biochemical composition of tendons. Magic angle imaging has potential as a useful noninvasive tool to assess the changes of the extracellular tendon matrix using T1 values. PMID:22548673
Spriet, Mathieu; Murphy, Brian; Vallance, Stuart A; Vidal, Martin A; Whitcomb, Mary Beth; Wisner, Erik R
The distal attachments of the extensor hallucis longus (EHL) tendons in 47 amputated legs and in eight cadavers were examined. The EHL had two tendons in 34 of the amputated legs and bilaterally in five cadavers. The lateral tendon was inserted to the middle of the dorsal aspect of the base of the distal phalanx of the hallux and the
C. C. Denk; A. Öznur; H. S. Surucu
A simple modification of the catheter technique for retrieving flexor tendons is presented. The technique is based on the Seldinger principle. A flexible metal guide-wire is used to route a polythene catheter through the flexor tendon sheath, enabling tendon retrieval. PMID:8771486
Titley, O G
This study evaluated the insertional anatomy and orientation of the biceps tuberosity and tendon to assess the anatomic validity of repairs made with 1 incision vs 2 incisions. Computed axial tomography was used to image 30 cadaver radii, and each tendon insertion was measured with a digital micrometer. Specimens were sectioned and imaged with Faxitron radiography (Faxitron X-Ray Corp, Wheeling, IL) to determine the angular orientation of the biceps tendon insertion relative to the tuberosity apex. The tuberosity axis of orientation averaged 65 degrees (range, 15 degrees -120 degrees ) of pronation from anterior, with angular orientation encompassing a mean 59 degrees (range, 15 degrees -100 degrees ) arc with the midpoint of the insertion averaging 50 degrees (range, -5 degrees to 105 degrees ). Most biceps tendons inserted on the anterior aspect of the apex of the tuberosity, with an average width of 7 mm and length of 22 mm. The biceps tuberosity is oriented in more pronation than is typically described, prohibiting anatomic reinsertion of the tendon in 35% of specimens with current single-incision techniques. PMID:18325797
Forthman, Christopher L; Zimmerman, Ryan M; Sullivan, Michael J; Gabel, Gerard T
Masticatory muscle tendon-aponeurosis hyperplasia (MMTAH) is a new disease associated with limited mouth opening that is often misdiagnosed as a temporomandibular disorder; subsequently, patients are mistakenly treated with irreversible operations. Due to the poor presentation and characterization of symptoms, the underlying pathological conditions remain unclear. We have previously conducted a proteomic analysis of tendons derived from one MMTAH subject and one facial deformity subject using two-dimensional fluorescence difference gel electrophoresis and liquid chromatography coupled with tandem mass spectrometry. However, the results were obtained for only one subject. The aim of the present study was to confirm the expression of specific molecules in tendon tissues from multiple subjects with MMTAH by applying two-dimensional polyacrylamide gel electrophoresis with matrix-assisted laser desorption ionization time-of-flight mass spectrometry. Of the 19 proteins identified in tendons from both MMTAH and facial deformity patients, fibrinogen fragment D and beta-crystallin A4 were up-regulated, whereas myosin light chain 4 was down-regulated in MMTAH. We also found fibrinogen to be expressed robustly in tendon tissues of MMTAH patients. Our data provide the possibility that the distinctive expression of these novel proteins is associated with the pathology of MMTAH. PMID:23870541
Nakamoto, A; Sato, T; Hirosawa, N; Nakamoto, N; Enoki, Y; Chida, D; Usui, M; Takeda, S; Nagai, T; Sasaki, A; Sakamoto, Y; Yoda, T
A total of 32 digits, including 3 thumbs, were reconstructed in an outpatient clinic. The patients were allowed to go home 3-4 hours after the operation. The patients had injury to the flexor tendon in no man's land without other complications except for an injury to the digital nerve in 6 cases. The tendon was reconstructed secondarily using a free graft. The minimum follow-up time was 6 months. The results were classified in three ways. With all methods the results, which were deemed satisfactory in 79% and poor in 21%, reached the average standard for this type of repair. Increasing age of the patients, injury to the pulley, preoperative adhesions, digital nerve injury, and time elapsed from injury to surgery impaired the results. This study indicates that tendon surgery of the hand with short postoperative care can also be conducted with satisfactory results in an outpatient clinic. PMID:4083778
Jaroma, H; Suomalainen, O; Sivula, U M; Turpeinen, L
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
The present study aimed to investigate the effects of repetitive muscle contractions on the elasticity of human tendon structures in vivo. Before and after each endurance test, the elongation of the tendon and aponeurosis of vastus lateralis muscle (L) was directly measured by ultrasonography while the subjects performed ramp isometric knee extension up to maximal voluntary isometric contraction (MVC). Six male subjects performed muscle endurance tests that consisted of knee extension tasks with four different contraction modes: 1) 50 repetitions of maximal voluntary eccentric action for 3 s with 3 s of relaxation (ET1), 2) three sets of 50 repetitions of MVC for 1 s with 3 s of relaxation (ET2), 3) 50 repetitions of MVC for 3 s with 3 s of relaxation (ET3), and 4) 50 repetitions of 50% MVC for 6 s with 6 s of relaxation (ET4). In ET1 and ET2, there were no significant differences in L values at any force production levels between before and after endurance tests. In the cases of ET3 and ET4, however, the extent of elongation after the completion of the tests tended to be greater. The L values above 330 N in ET3 and 440 N in ET4, respectively, were significantly greater after endurance tests than before. These results suggested that the repeated longer duration contractions would make the tendon structures more compliant and that the changes in the elasticity might be not be affected by either muscle action mode or force production level but by the duration of action. PMID:11408441
Kubo, K; Kanehisa, H; Kawakami, Y; Fukunaga, T
Surgical approaches to postoperative mediastinitis that imply wire removal achieve earlier infection recovery but leave the patient with sternal instability. In 10 patients after wound surgical debridement, my colleagues and I achieved sternal synthesis by using Achilles tendons retrieved from multiorgan donors and stored in glutaraldehyde. Three tendons were used in each patient; they were passed through the bone at the manubrium and parasternally at the midsternum and the lower sternum. Thirty-day computed tomographic scan results, infection recovery, and quality of life were satisfactory. PMID:15620987
De Feo, Marisa; Carozza, Antonio; Della Corte, Alessandro; Quarto, Cesare; Torella, Michele; De Santo, Luca Salvatore; Nappi, Gianantonio; Cotrufo, Maurizio
A 45-year-old woman presented to the emergency department with a 2-day history of severe left shoulder pain made worse with movement. Emergency department (ED) bedside point-of-care static and dynamic ultrasound examination of the supraspinatus tendon revealed supraspinatus tendon calcification with impingement syndrome, and the patient was urgently referred to orthopedics after ED pain control was achieved. Bedside shoulder and supraspinatus tendon evaluation with static and dynamic ultrasonography can assist in the rapid diagnosis of supraspinatus tendon calcification and supraspinatus tendon impingement syndrome in the emergency department.
Background: For arthroscopic anterior cruciate ligament reconstruction, the most commonly used graft constructs are either the hamstring tendon or patellar tendon. Well-controlled, long-term studies are needed to determine the differences between the 2 materials.Hypothesis: There is a difference between hamstring and patellar tendon grafts in the clinical results of anterior cruciate ligament reconstructions at 7 years.Study Design: Cohort study; Level
Justin Roe; Leo A. Pinczewski; Vivianne J. Russell; Lucy J. Salmon; Tomomaro Kawamata; Melvin Chew
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
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.
The purpose of this study was to investigate an engineered composite of multilayer acellular tendon slices seeded with bone marrow stromal cells (BMSCs) as a possible solution for tendon reconstruction. BMSCs were harvested from 15 rabbits and infraspinatus tendons were harvested from 17 dogs. The decellularized tendons were sectioned in longitudinal slices with a thickness of 50 ?m. The BMSCs were seeded on the slices and then the slices were bundled into one composite. The composite was implanted into a rabbit patellar tendon defect. Tendon slices without BMSCs were implanted into the contralateral patellar tendon as a control. The composites were evaluated by histology and qRT–PCR. The viability of BMSCs was assessed using a fluorescent marker. Histology showed viable cells between the collagen fibres on the cell-seeded side. Analysis by qRT–PCR showed higher tenomodulin, collagen type III, MMP3 and MMP13 expressions and lower collagen type I expression in the cell-seeded composite than in the tendon slices without BMSCs. We conclude that BMSCs can survive in a multilayer composite, express a tendon phenotype and enhance the metabolism of tendon in vivo. This in vivo study suggests a potential utility of this composite in tendon reconstruction.
Omae, Hiromichi; Sun, Yu Long; An, Kai-Nan; Amadio, Peter C.; Zhao, Chunfeng
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
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
Mechanical loading can influence tendon collagen homeostasis in animal models, while the dynamics of the human adult tendon core tissue are more debatable. Currently available data indicate that human tendon adaptation to loading may happen primarily in the outer tendon region. A role of inflammation in this peritendinous adaptation is supported by a rise in inflammatory mediators in the peritendinous area after physiological mechanical loading in humans. This plays a role in the exercise-induced rise in tendon blood flow and peritendinous collagen synthesis. Although inflammatory activity can activate proteolytic pathways in tendon, mechanical loading can protect against matrix degradation. Acute tendon injury displays an early inflammatory response that seems to be lowered when mechanical loading is applied during regeneration of tendon. Chronically overloaded tendons (tendinopathy) do neither at rest nor after acute exercise display any enhanced inflammatory activity, and thus the basis for using anti-inflammatory medication to treat tendon overuse seems limited. PMID:23620492
Kjaer, Michael; Bayer, Monika L; Eliasson, Pernilla; Heinemeier, Katja M
Summary To determine if tendon cell ciliary length could be used as a biomarker of cytoskeletal tensional homeostasis, 20 mm long adult rat tail tendons were placed in double artery clamps set 18 mm apart to create a 10% laxity. The tendons were allowed to contract over a 7 day period under culture conditions. At 0, 1, 5, and 7 days the tendon cell cilia were stained and ciliary length measured using confocal imaging. There was a significant (p<0.001) increase in ciliary length at 1 day. At day 5 (when the tendon became visibly taut) there was a significant (p<0.001) decrease in ciliary length compared to day 1. By day 7 the tendon remained taut and ciliary length returned to day zero values (p=0.883). These results suggest that cilia length reflects the local mechanobiological environment of tendon cells and could be used as a potential in situ biomarker of altered cytoskeletal tensional homeostasis.
Lavagnino, Michael; Gardner, Keri; Sedlak, Aleksa Michele; Arnoczky, Steven Paul
Tendon rupture as a complication of distal radius fractures has been documented; however, flexor tendon rupture associated with closed distal radius fractures is rare. We report a case of a 43-year-old man who suffered a closed distal radius fracture. Intraoperatively, it was discovered that the flexor carpi radialis tendon had ruptured. From the frayed ends of the tendon and review of the radiographs, it was determined that the sharp ends of the fractured radius had lacerated the tendon at the time of injury. After fixation of the fracture with locking plate, the severed tendon was repaired and the wrist immobilised with a splint. The patient has been pain free after 5 months of follow-up, with full range of motion. This outcome demonstrates that timely detection and treatment of concurrent flexor carpi radialis tendon rupture and a closed distal radius fracture can achieve good functional results and outcome. PMID:24722721
Chen, Perng-Jong; Liu, Andy Li-Jen
The structural integrity and the biomechanical characteristics of ligaments and tendons result from the interactions between collagenous and non-collagenous proteins (e.g. proteoglycans, PGs) in the extracellular matrix. In this paper, a dissipative theory of temporary interfibrillar bridges in the anisotropic network of collagen type I, embedded in a ground substance, is derived. The glycosaminoglycan chains of decorin are assumed to mediate interactions between fibrils, behaving as viscous structures that transmit deformations outside the collagen molecules. This approach takes into account the dissipative effects of the unfolding preceding fibrillar elongation, together with the slippage of entire fibrils and the strain-rate-dependent damage evolution of the interfibrillar bridges. Thermodynamic consistency is used to derive the constitutive equations, and the transition state theory is applied to model the rearranging properties of the interfibrillar bridges. The constitutive theory is applied to reproduce the hysteretic spectrum of the tissues, demonstrating how PGs determine damage evolution, softening and non-recoverable strains in their cyclic mechanical response. The theoretical predictions are compared with the experimental response of ligaments and tendons from referenced studies. The relevance of the proposed model in mechanobiology research is discussed, together with several applications from medical practice to bioengineering science.
Ciarletta, P.; Ben Amar, M.
Synovial chondromatosis (SC) is a benign proliferative process of synovial tissue creating multiple cartilaginous nodules in joints. It most commonly occurs in the large joints of the knee, hip, and shoulder, uncommonly in the small joints of the hand and foot, and only rarely in the tenosynovial membrane of tendon sheath, termed tenosynovial chondromatosis (TC). Unlike SC, TC predisposes to the foot or hand. The rarity and unfamiliarity of imagers with TC, as well as the variability of its histologic features often lead to an erroneous diagnosis of extraskeletal chondroma or even chondrosarcoma as in the present case. Calcium pyrophosphate dehydrate (CPPD) crystals are usually deposited in the articular cartilage or periarticular structures such as synovium and capsule, and rarely in other soft tissue structures including bursa, tendon, subcutaneous tissue, and dura mater. CPPD crystals may also be deposited in extraskeletal chondroma and SC. We present an exceptionally rare case of huge tophaceous pseudogout associated with TC that is considered to arise from the flexor digitorum longus tendon sheaths of the foot, initially mistaken for a chondrosarcoma. PMID:23828620
Bahk, Won-Jong; Chang, Eun-Deok; Lee, An-Hi; Kang, Yong-Koo; Park, Jung-Mi; Chung, Yang-Guk
Injectable calcium phosphate cement (ICPC) has been applied to enhance the tendon-to-bone healing. However, its slow degradation delays the osteointegration of grafted tendon in bone tunnels. We therefore constructed a synthetic biomaterial of ICPC combined with recombined bone xenograft granules (RBX). In this study, the first stage study demonstrated that the ICPCB contained 3 mg BMPs (ICPCB-3) obtained a porous structure. More importantly, the values of ICPCB-3 were highest in cell proliferation, alkaline phosphatase (ALP) activity, expression of osteogenic genes, and newly ectopic bone-forming area (P < 0.05). Then, ICPCB-3 was used in an anterior cruciate ligament (ACL) reconstruction model. Ninety skeletal mature rabbits underwent bilateral ACL reconstructions and were assigned to 3 groups: control group, ICPC alone group, and ICPCB-3 group. Animals were sacrificed at 6, 12 and 24 weeks. The results showed compared with ICPC, ICPCB-3 composite markedly accelerated tendon-to-bone healing. In addition, little remnants were observed in ICPCB-3 group. Moreover, the maximum loads to failure of ICPCB-3 group was significantly higher than ICPC group at 24 weeks (P < 0.01). We conclude that the ICPCB composite, with a porous structure and better osteointegration effect, has direct clinical instruction to arthroscopic techniques of the ACL reconstruction. PMID:24075477
Weimin, Pan; Dan, Li; Yiyong, Wei; Yunyu, Hu; Li, Zhou
The intrinsic capacity of tendons to heal in response to injury has recently been demonstrated by many investigators. Electrical stimulation is often assumed to augment regeneration of various tissues. Using newly developed methods of whole-tendon culture, the authors examined the effect of direct-current electricity on healing in vitro. Deep flexor tendons of rabbits were excised, transected, repaired, and grown in an acellular culture medium for seven, 14, 21, or 42 days. Tendons through which a continuous 7-microAmp current was passed at the repair site were compared with nonstimulated controls. The incorporation of (14C)proline and its conversion to (14C)hydroxyproline was measured at seven days. The mean (14C)proline and (14C)hydroxyproline activities were 91% and 255% greater, respectively, in the stimulated group. The activity was also higher in the stimulated group, by 42 days. Histologic sections showed that intrinsic tenoblastic repair may be enhanced with electrical stimulation in vitro. PMID:3493869
Nessler, J P; Mass, D P
Mycobacterial tuberculous tenosynovitis of the extensor tendon sheath is an extremely rare manifestation of extrapulmonary tuberculosis. The diagnosis may be easily delayed because of its non-specific clinical signs. We report a new case of tuberculous tenosynovitis of the extensor without concomitant pulmonary tuberculosis or documented immunodeficiency.
Mrabet, Dalila; Ouenniche, Kmar; Mizouni, Habiba; Ounaies, Mouna; Khemiri, Chekib; Sahli, Hela; Sellami, Slaheddine
Achilles tendon rupture is a relatively uncommon occurrence in a general ED population. The history can be subtle, and physical findings may not be clear-cut. Prompt diagnosis and treatment of these injuries, however, is important to improved clinical outcome. The emergency physician needs to remain vigilant for this diagnosis to avoid this orthopedic pitfall. This review article examines the clinical
Jacob Ufberg; Richard A. Harrigan; Thomas Cruz; Andrew D. Perron
Flatfoot deformity is characterized by loss of the medial longitudinal arch, forefoot abduction, hindfoot eversion, and often Achilles tendon contracture. Our objectives were to validate a cadaveric flatfoot model that involves selective ligament attenuation and to determine if Achilles tendon overpull is associated with increased pes planus severity. We measured the three-dimensional (3D) orientation of the bones of interest in the unloaded, loaded, and Achilles tendon overpull conditions. A flatfoot model was created by attenuating ligaments involved in the pes planus deformity followed by cyclic axial loading, and bone orientations were acquired in the three conditions. Significant differences seen between normal feet and flat feet were consistent with those seen with the pes planus deformity. The first metatarsal dorsiflexed and abducted relative to the talus. The navicular abducted relative to the talus. The calcaneus everted relative to the tibia. The talus plantar flexed and adducted. Achilles overpull resulted in first metatarsal-to-talus dorsiflexion and navicular-to-talus abduction. Thus, selective ligament attenuation followed by cyclic axial loading can create a cadaveric flatfoot model consistent with the in vivo deformity. Longitudinal arch depression, hindfoot eversion, talonavicular joint abduction, forefoot abduction, and talar plantar flexion were seen. Simulated Achilles tendon contracture increased the severity of the deformity, particularly in arch depression and forefoot abduction. PMID:19530145
Blackman, Andrew J; Blevins, Joanna J; Sangeorzan, Bruce J; Ledoux, William R
Early in the development of the ultra long duration balloon (ULDB), Zylon was selected as the tendon material due to its favorable stress-strain properties. It is a next generation fiber whose strength and modulus are almost double those of the Kevlar fibers. In addition there are two versions of the Zylon, as spun (AS) and high modulus (HM). Data will be presented on why HM was chosen. Early in the development process, it was learned that this material exhibited an unusual sensitivity to degradation by ambient light. This is in addition to the expected sensitivity to UV (Ultraviolet) radiation. The fiber manufacturer reported all of these properties in their literature. Due to the operating environment of the ULDB it is necessary to protect the tendons from both visible and UV radiation. Methods to protect the tendons will be discussed. In addition, information on the long term exposure of the braided tendon over a thirty-two month period in a controlled manufacturing plant will be provided. Special testing methods will be noted.
Seely, Loren; Zimmerman, Mike; McLaughlin, Joe
Ten athletes with distal biceps tendon ruptures that had been anatomically repaired with a double-incision technique were reviewed to determine their functional recovery. All of the patients were men, with an average age of 40 years (range, 25 to 49). Eight of the 10 patients were weight lifters or body builders, and 7 had participated on a competitive level at
Donald F. DAlessandro; Clarence L. Shields; James E. Tibone; Robert W. Chandler
Giant cell tumor of tendon sheath is the second most common tumor of the hand. It can also occur in larger joints. Radiologic features include a soft-tissue mass with or without osseous erosion. Less commonly, it can cause periostitis or permeative osseous invasion; it may rarely calcify. The entire imaging spectum of this lesion is presented, with emphasis on atypical
David Karasick; Stephen Karasick
The diameter of collagen fibrils in connective tissues, such as tendons and ligaments is known to decrease upon injury or with age, leading to inferior biomechanical properties and poor healing capacity. This study tests the hypotheses that scaffold fiber diameter modulates the response of human tendon fibroblasts, and that diameter-dependent cell responses are analogous to those seen in healthy versus healing tissues. Particularly, the effect of the fiber diameter (320?nm, 680?nm, and 1.80??m) on scaffold properties and the response of human tendon fibroblasts were determined over 4 weeks of culture. It was observed that scaffold mechanical properties, cell proliferation, matrix production, and differentiation were regulated by changes in the fiber diameter. More specifically, a higher cell number, total collagen, and proteoglycan production were found on the nanofiber scaffolds, while microfibers promoted the expression of phenotypic markers of tendon fibroblasts, such as collagen I, III, V, and tenomodulin. It is possible that the nanofiber scaffolds of this study resemble the matrix in a state of injury, stimulating the cells for matrix deposition as part of the repair process, while microfibers represent the healthy matrix with micron-sized collagen bundles, thereby inducing cells to maintain the fibroblastic phenotype. The results of this study demonstrate that controlling the scaffold fiber diameter is critical in the design of scaffolds for functional and guided connective tissue repair, and provide new insights into the role of matrix parameters in guiding soft tissue healing.
Erisken, Cevat; Zhang, Xin; Moffat, Kristen L.; Levine, William N.
In patients with tennis elbow, the common extensor tendon showed a pronounced reactive change consisting of mesenchymal cell proliferation along with aggregates of newly formed vascular channels. When studied ultrastructurally, many of the mesenchymal cells adjacent to the vascular channels were surrounded by a basal lamina, which is not normally seen around tenocytes. The cytoplasm of these cells showed features
Kiriti Sarkar; Hans K. Uhthoff