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Sample records for dorsi tendon transfer

  1. Latissimus Dorsi Tendon Transfer for Irreparable Rotator Cuff Tears: A Modified Technique Using Arthroscopy

    PubMed Central

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

    2013-01-01

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

  2. Arthroscopically Assisted Latissimus Dorsi Tendon Transfer in Beach-Chair Position

    PubMed Central

    Jermolajevas, Viktoras; Kordasiewicz, Bartlomiej

    2015-01-01

    Irreparable rotator cuff tears remain a surgical problem. The open technique of latissimus dorsi (LD) tendon transfer to “replace” the irreparable rotator cuff is already well known. The aim of this article is to present a modified arthroscopically assisted LD tendon transfer technique. This technique was adopted to operate on patients in the beach-chair position with several improvements in tendon harvesting and fixation. It can be divided into 6 steps, and only 1 step—LD muscle and tendon release—is performed open. The advantages of the arthroscopic procedure are sparing of the deltoid muscle, the possibility of repairing the subscapularis tendon, and the ability to visualize structures at risk while performing tendon harvesting (radial nerve) and passing into the subacromial space (axillary nerve). It is performed in a similar manner to standard rotator cuff surgery—the beach-chair position does not need any modification, and no sophisticated equipment for either the open or arthroscopic part of the procedure is necessary. Nevertheless, this is a challenging procedure and should only be attempted after training, as well as extensive practice. PMID:26759777

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

    PubMed

    Grimberg, Jean; Kany, Jean

    2014-03-01

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

  4. Influence of psychomotor skills and innervation patterns on results of latissimus dorsi tendon transfer for irreparable rotator cuff tears.

    PubMed

    Werner, Clément M L; Ruckstuhl, Thomas; Müller, Roland; Zanetti, Marco; Gerber, Christian

    2008-01-01

    This investigation was performed to analyze the influence of innervation and psychomotor skills on the outcome of latissimus dorsi transfer. Patients with the 10 best and 10 worst results after latissimus dorsi transfer for irreparable rotator cuff tears were selected. All patients meeting the inclusion criteria (n = 12) were subject to a psychomotor test battery (Motorische Leistungsserie) and electromyographic innervation assessment. There was no statistical difference between the 2 groups preoperatively in terms of the commonly tested factors known to influence the results of this procedure adversely. There was a significant difference in both the pattern and selectivity of innervation in the group that had better clinical results. The psychomotor findings were negatively correlated with the range of motion and the strength of the operative shoulder. Function of the operative shoulder could also be predicted by psychomotor function of the uninjured contralateral side. Psychomotor skills testing appears to be a new, potential method by which to predict the outcome of latissimus dorsi transfer.

  5. All-Arthroscopic Latissimus Dorsi Transfer.

    PubMed

    Cutbush, Kenneth; Peter, Noel A; Hirpara, Kieran

    2016-06-01

    Massive irreparable rotator cuff tears are often associated with severe functional impairment and disabling pain. One viable treatment option is a latissimus dorsi tendon transfer. We propose an all-arthroscopic technique that we believe avoids insult to the deltoid musculature while reducing morbidity from open harvest of the tendon. The operation is performed with the patient in the lateral decubitus position, by use of a combination of viewing and working portals in the axilla. The initial viewing portal is placed along the anterior belly of the latissimus muscle in the axilla. The latissimus and teres major are identified, as is the thoracodorsal neurovascular pedicle. The tendons are carefully separated, and the inferior and superior borders of the latissimus are whipstitched using a suture passer, which helps facilitate subsequent mobilization of the muscle. The interval deep to the deltoid and superficial to the teres minor is developed into a subdeltoid tunnel for arthroscopic tendon transfer. The latissimus tendon is then transferred and stabilized arthroscopically to the supraspinatus footprint with suture anchors. Our preliminary data suggest that this surgical technique results in improvement in pain, range of motion, and function. PMID:27656385

  6. Biomechanics of Tendon Transfers.

    PubMed

    Livermore, Andrew; Tueting, Jonathan L

    2016-08-01

    The transfer of tendons in the upper extremity is a powerful technique to restore function to a partially paralyzed hand. The biomechanical principles of muscle tension and tendon excursion dictate motor function both in the native as well as transferred states. Appropriately tensioning transferred tendons to maximize the function of the associated muscle remains an area of focused research. Newer methods of tendon coaptation have proven similar in strength to the standard Pulvertaft weave, affording more options to the surgeon. PMID:27387073

  7. Radial Nerve Tendon Transfers.

    PubMed

    Cheah, Andre Eu-Jin; Etcheson, Jennifer; Yao, Jeffrey

    2016-08-01

    Radial nerve palsy typically occurs as a result of trauma or iatrogenic injury and leads to the loss of wrist extension, finger extension, thumb extension, and a reduction in grip strength. In the absence of nerve recovery, reconstruction of motor function involves tendon transfer surgery. The most common donor tendons include the pronator teres, wrist flexors, and finger flexors. The type of tendon transfer is classified based on the donor for the extensor digitorum communis. Good outcomes have been reported for most methods of radial nerve tendon transfers as is typical for positional tendon transfers not requiring significant power. PMID:27387076

  8. Principles of Tendon Transfer.

    PubMed

    Wilbur, Danielle; Hammert, Warren C

    2016-08-01

    Tendon transfers provide a substitute, either temporary or permanent, when function is lost due to neurologic injury in stroke, cerebral palsy or central nervous system lesions, peripheral nerve injuries, or injuries to the musculotendinous unit itself. This article reviews the basic principles of tendon transfer, which are important when planning surgery and essential for an optimal outcome. In addition, concepts for coapting the tendons during surgery and general principles to be followed during the rehabilitation process are discussed. PMID:27387072

  9. Tendon Transfers for Tetraplegia.

    PubMed

    Bednar, Michael S

    2016-08-01

    It is estimated that 65% to 75% of patients with cervical spinal cord injuries could benefit from upper extremity tendon transfer surgery. The goals of surgery are to restore elbow extension, as well as hand pinch, grasp, and release. Patients who have defined goals, actively participate in therapy, and understand expected outcomes, appear to have the highest satisfaction following tendon transfer procedures. PMID:27387082

  10. Tibialis Anterior Tendon Transfer.

    PubMed

    Mulhern, Jennifer L; Protzman, Nicole M; Brigido, Stephen A

    2016-01-01

    Tendon transfer procedures are used commonly for the correction of soft tissue imbalances and instabilities. The complete transfer and the split transfer of the tibialis anterior tendon are well-accepted methods for the treatment of idiopathic equinovarus deformity in children and adults. Throughout the literature, complete and split transfer have been shown to yield significant improvements in ankle and foot range of motion and muscle function. At present, there is insufficient evidence to recommend one procedure over the other, although the split procedure has been advocated for consistently achieving inversion to eversion muscle balance without overcorrection.

  11. Posterior Tibial Tendon Transfer.

    PubMed

    Shane, Amber M; Reeves, Christopher L; Cameron, Jordan D; Vazales, Ryan

    2016-01-01

    When performed correctly with the right patient population, a tibialis posterior muscle/tendon transfer is an effective procedure. Many different methods have been established for fixating the tendon, each of which has its' own indications. Passing through the interosseous membrane is the preferred and recommended method and should be used unless this is not possible. Good surgical planning based on patient needs and expectations, along with excellent postoperative care including early range of motion and physical therapy minimizes risk of complications and allows for the optimal outcome to be achieved. PMID:26590722

  12. Irreparable Rotator Cuff Tears: Restoring Joint Kinematics by Tendon Transfers

    PubMed Central

    Greenspoon, Joshua A.; Millett, Peter J.; Moulton, Samuel G.; Petri, Maximilian

    2016-01-01

    Background: Tendon transfers can be a surgical treatment option in managing younger, active patients with massive irreparable rotator cuff tears. The purpose of this article is to provide an overview of the use of tendon transfers to treat massive irreparable rotator cuff tears and to summarize clinical outcomes. Methods: A selective literature search was performed and personal surgical experiences are reported. Results: Latissimus dorsi transfers have been used for many years in the management of posterosuperior rotator cuff tears with good reported clinical outcomes. It can be transferred without or with the teres major (L’Episcopo technique). Many surgical techniques have been described for latissimus dorsi transfer including single incision, double incision, and arthroscopically assisted transfer. Transfer of the pectoralis major tendon is the most common tendon transfer procedure performed for anterosuperior rotator cuff deficiencies. Several surgical techniques have been described, however transfer of the pectoralis major beneath the coracoid process has been found to most closely replicate the force vector that is normally provided by the intact subscapularis. Conclusion: Tendon transfers can be used successfully in the management of younger patients with massive irreparable rotator cuff tears and minimal glenohumeral arthritis. Improvements in clinical outcomes scores and range of motion have been demonstrated. This can delay arthroplasty, which is of particular importance for younger patients with high functional demands.

  13. Principles of tendon transfers.

    PubMed

    Coulet, B

    2016-04-01

    Tendon transfers are carried out to restore functional deficits by rerouting the remaining intact muscles. Transfers are highly attractive in the context of hand surgery because of the possibility of restoring the patient's ability to grip. In palsy cases, tendon transfers are only used when a neurological procedure is contraindicated or has failed. The strategy used to restore function follows a common set of principles, no matter the nature of the deficit. The first step is to clearly distinguish between deficient muscles and muscles that could be transferred. Next, the type of palsy will dictate the scope of the program and the complexity of the gripping movements that can be restored. Based on this reasoning, a surgical strategy that matches the means (transferable muscles) with the objectives (functions to restore) will be established and clearly explained to the patient. Every paralyzed hand can be described using three parameters. 1) Deficient segments: wrist, thumb and long fingers; 2) mechanical performance of muscles groups being revived: high energy-wrist extension and finger flexion that require strong transfers with long excursion; low energy-wrist flexion and finger extension movements that are less demanding mechanically, because they can be accomplished through gravity alone in some cases; 3) condition of the two primary motors in the hand: extrinsics (flexors and extensors) and intrinsics (facilitator). No matter the type of palsy, the transfer surgery follows the same technical principles: exposure, release, fixation, tensioning and rehabilitation. By performing an in-depth analysis of each case and by following strict technical principles, tendon transfer surgery leads to reproducible results; this allows the surgeon to establish clear objectives for the patient preoperatively. PMID:27117119

  14. Massive cuff tears treated with arthroscopically assisted latissimus dorsi transfer. Surgical technique

    PubMed Central

    De Cupis, Vincenzo; De Cupis, Mauro

    2012-01-01

    Summary Latissimus dorsi transfer is our preferred treatment for active disabled patients with a posterosuperior massive cuff tear. We present an arthroscopically assisted technique which avoids an incision through the deltoid obtaining a better and faster clinical outcome. The patient is placed in lateral decubitus. After the arthroscopic evaluation of the lesion through a posterior and a posterolateral portal, with the limb in traction we perform the preparation of the greater tuberosity of the humerus. We place the arm in abduction and internal rotation and we proceed to the harvest of the latissimus dorsi and the tendon preparation by stitching the two sides using very resistant sutures. After restoring limb traction, under arthroscopic visualization, we pass a curved grasper through the posterolateral portal by going to the armpit in the space between the teres minor and the posterior deltoid. Once the grasper has exited the access at the level of the axilla we fix two drainage transparent tubes, each with a wire inside, and, withdrawing it back, we shuttle the two tubes in the subacromial space. After tensioning the suture wires from the anterior portals these are assembled in a knotless anchor of 5.5 mm that we place in the prepared site on the greater tuberosity of the humerus. A shoulder brace at 15° of abduction and neutral rotation protect the patient for the first month post-surgery but physical therapy can immediately start. PMID:23738290

  15. Tendon Transfers for Combined Peripheral Nerve Injuries.

    PubMed

    Makarewich, Christopher A; Hutchinson, Douglas T

    2016-08-01

    Combined peripheral nerve injuries present a unique set of challenges to the hand surgeon when considering tendon transfers. They are often associated with severe soft tissue trauma, including lacerations to remaining innervated muscles and tendons, significant scar formation, and substantial sensory loss. In the case of combined nerve injuries, there are typically fewer options for tendon transfers due to fewer tendons of shared function that are expendable as well as associated injuries to tendon or muscle bellies. As such, careful preoperative planning must be performed to make the most of remaining muscle tendon units. PMID:27387081

  16. Tendon transfers for the drop foot.

    PubMed

    Schweitzer, Karl M; Jones, Carroll P

    2014-03-01

    The paralytic drop foot represents a challenging problem for even the most experienced orthopedic surgeon. Careful patient selection, thorough preoperative examination and planning, and application of tendon transfer biomechanical and physiologic principles outlined in this article can lead to successful results, either through a posterior tibialis tendon transfer, Bridle transfer, or variations on these procedures. Achilles lengthening or gastrocnemius recession may also be needed at the time of tendon transfer. PMID:24548510

  17. Arthroscopic fixation with a minimally invasive axillary approach for latissimus dorsi transfer using an endobutton in massive and irreparable postero-superior cuff tears.

    PubMed

    Goldstein, Yariv; Grimberg, Jean; Valenti, Philippe; Chechik, Ofir; Drexler, Michael; Kany, Jean

    2013-04-01

    Arthroscopically assisted latissimus dorsi transfer is a viable option for treatment of patients in their 50s to 70s, without arthritis of the glenohumeral joint, who suffer from massive rotator cuff tears that are not amendable to primary repair due to fatty changes in the muscle tissue, or that have failed previous repair attempts. This procedure offers immediate and dramatic pain relief and is not as technically demanding as one might think. Understanding and respecting the principles of tendon transfer is a key to the success of this procedure.

  18. Arthroscopic fixation with a minimally invasive axillary approach for latissimus dorsi transfer using an endobutton in massive and irreparable postero-superior cuff tears

    PubMed Central

    Goldstein, Yariv; Grimberg, Jean; Valenti, Philippe; Chechik, Ofir; Drexler, Michael; Kany, Jean

    2013-01-01

    Arthroscopically assisted latissimus dorsi transfer is a viable option for treatment of patients in their 50s to 70s, without arthritis of the glenohumeral joint, who suffer from massive rotator cuff tears that are not amendable to primary repair due to fatty changes in the muscle tissue, or that have failed previous repair attempts. This procedure offers immediate and dramatic pain relief and is not as technically demanding as one might think. Understanding and respecting the principles of tendon transfer is a key to the success of this procedure. PMID:23960367

  19. Bipolar Latissimus Dorsi Transfer through a Single Incision: First Key–Step in Poland Syndrome Chest Deformity

    PubMed Central

    di Summa, Pietro G.; Raffoul, Wassim

    2016-01-01

    Summary: Poland syndrome is a rare congenital anomaly characterized by a unilateral congenital absence of the sternocostal head of the pectoralis major muscle. The absence of the pectoralis major does not only result in chest asymmetry but also in a missing anterior axillary fold, which is essential for natural anatomical appearance in both male and female patients. In Poland syndrome patients, we perform bipolar latissimus dorsi flap transfer, which can be associated with a sublatissimus implant in women. All procedures are performed through a single short midaxillary incision, and tendon translocation in this technique allows the creation of the anterior axillary fold and thus a natural chest appearance. Moreover, this technique can be performed by any plastic surgeon operating under a basic operating room setting. PMID:27622115

  20. Bipolar Latissimus Dorsi Transfer through a Single Incision: First Key-Step in Poland Syndrome Chest Deformity.

    PubMed

    Watfa, William; di Summa, Pietro G; Raffoul, Wassim

    2016-08-01

    Poland syndrome is a rare congenital anomaly characterized by a unilateral congenital absence of the sternocostal head of the pectoralis major muscle. The absence of the pectoralis major does not only result in chest asymmetry but also in a missing anterior axillary fold, which is essential for natural anatomical appearance in both male and female patients. In Poland syndrome patients, we perform bipolar latissimus dorsi flap transfer, which can be associated with a sublatissimus implant in women. All procedures are performed through a single short midaxillary incision, and tendon translocation in this technique allows the creation of the anterior axillary fold and thus a natural chest appearance. Moreover, this technique can be performed by any plastic surgeon operating under a basic operating room setting. PMID:27622115

  1. Bipolar Latissimus Dorsi Transfer through a Single Incision: First Key–Step in Poland Syndrome Chest Deformity

    PubMed Central

    di Summa, Pietro G.; Raffoul, Wassim

    2016-01-01

    Summary: Poland syndrome is a rare congenital anomaly characterized by a unilateral congenital absence of the sternocostal head of the pectoralis major muscle. The absence of the pectoralis major does not only result in chest asymmetry but also in a missing anterior axillary fold, which is essential for natural anatomical appearance in both male and female patients. In Poland syndrome patients, we perform bipolar latissimus dorsi flap transfer, which can be associated with a sublatissimus implant in women. All procedures are performed through a single short midaxillary incision, and tendon translocation in this technique allows the creation of the anterior axillary fold and thus a natural chest appearance. Moreover, this technique can be performed by any plastic surgeon operating under a basic operating room setting.

  2. Percutaneous techniques for tendon transfers in the foot and ankle.

    PubMed

    Panchbhavi, Vinod Kumar

    2014-03-01

    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

  3. Tendon Transfers in the Rheumatoid Hand for Reconstruction.

    PubMed

    O'Sullivan, Michael Brody; Singh, Hardeep; Wolf, Jennifer Moriatis

    2016-08-01

    Long-standing rheumatoid arthritis can result in spontaneous tendon rupture caused by attrition of the tendons. Ruptures of the ulnar-sided extensor tendons, flexor pollicis longus, and the flexor digitorum profundus can be seen. Primary repair of these tendon ruptures is frequently not possible because of delayed presentation and tendon damage by the disease process. Tendon transfers are the preferred method of treatment in patients with rheumatoid arthritis. At surgery, it is critical to address the underlying cause of rupture to prevent future tendon ruptures. Rates of tendon rupture may decrease due to improved medications for rheumatoid arthritis. PMID:27387084

  4. Extensive Loss of Tibialis Anterior Tendon: Surgical Repair With Split Tendon Transfer of Tibialis Posterior Tendon: A Case Report.

    PubMed

    Miyazaki, Tsuyoshi; Uchida, Kenzo; Kokubo, Yasuo; Inukai, Tomoo; Sakamoto, Takumi; Yamagishi, Atsushi; Kitade, Makoto; Baba, Hisatoshi

    2016-01-01

    Extensive damage of the tibialis anterior tendon is rare and mainly caused by trauma. Surgical treatment of these injuries can become challenging owing to the limited availability of autogenous graft resources for reconstruction of the defect. In the present case report, we describe a large defect in the midfoot soft tissue after a traffic injury, which included complete loss of the tibialis anterior tendon. The tendon was reconstructed by split tendon transfer of the tibialis posterior tendon without sacrificing function, which was confirmed by the follow-up examination at 6 years after injury. We believe split tendon transfer of the tibialis posterior tendon can be one of the treatment options for patients with extensive disruption of the tibialis anterior tendon. PMID:26213163

  5. Tendon Transfers for the Hypoplastic Thumb.

    PubMed

    Wall, Lindley B; Goldfarb, Charles A

    2016-08-01

    Thumb hypoplasia is a component of radial longitudinal deficiency. The severity of hypoplasia can range from a slightly smaller thumb to a complete absence. Types II and IIIA hypoplastic thumbs are candidates for reconstruction to improve function, stability, and strength. There are 2 commonly used tendon transfers that can augment thumb opposition strength: the Huber abductor digiti minimi muscle transfer and the flexor digitorum superficialis opposition transfer. Both transfers use ulnar-sided structures to augment the thenar musculature. The Huber opposition transfer increases thenar bulk, but does not provide additional tissue for metacarpophalangeal stability. PMID:27387085

  6. Patch-Augmented Latissimus Dorsi Transfer and Open Reduction–Internal Fixation of Unstable Os Acromiale for Irreparable Massive Posterosuperior Rotator Cuff Tear

    PubMed Central

    Petri, Maximilian; Greenspoon, Joshua A.; Bhatia, Sanjeev; Millett, Peter J.

    2015-01-01

    Latissimus dorsi transfer is a reasonable treatment option for massive posterosuperior rotator cuff tears that can substantially improve chronically painful and dysfunctional shoulders. This report and accompanying video describe the treatment of an active 43-year-old man with severe pain and weakness in the right shoulder after 3 failed rotator cuff repairs. Preoperative imaging showed a massive posterosuperior rotator cuff tear retracted to the glenoid as well as a hypermobile os acromiale likely causing dynamic impingement and recurrent rotator cuff tears. After diagnostic arthroscopy, the latissimus tendon is harvested and augmented with a 3-mm human acellular dermal patch (ArthroFlex; Arthrex, Naples, FL). The native rotator cuff tissue is repaired as much as possible, and the latissimus tendon is passed underneath the deltoid and posterior to the teres minor. The patch-augmented tendon is then integrated into a double-row SpeedBridge repair of eight 4.75-mm BioComposite SwiveLock anchors (Arthrex). The bony surface of the os acromiale is prepared and then fixed to the acromion with 2 cannulated partially threaded screws and additional tension-band wiring. Postoperative rehabilitation initially focuses on early passive range of motion, followed by active and active-assisted motion and a biofeedback program starting at 6 weeks postoperatively. PMID:26697309

  7. Tendon transfers in the treatment of the adult flatfoot.

    PubMed

    Backus, Jonathon D; McCormick, Jeremy J

    2014-03-01

    Tendon transfers are critical to successful surgical correction of adult flexible flatfoot deformity and may be beneficial in correcting rigid deformities as well. Patients with refractory stage I and II deformities often require selective osteotomies in addition to tendon transfer. Patients with stage III and IV deformities typically require hindfoot arthrodesis. One of several tendons can be used for transfer based on surgeon's preference. Flexor digitorum longus (FDL) and flexor hallucis longus (FHL) transfers have been shown to have good results. A peroneus brevis transfer is typically used to supplement small FDL or FHL transfer donors or in revision cases.

  8. Tendon transfers in the treatment of the adult flatfoot.

    PubMed

    Backus, Jonathon D; McCormick, Jeremy J

    2014-03-01

    Tendon transfers are critical to successful surgical correction of adult flexible flatfoot deformity and may be beneficial in correcting rigid deformities as well. Patients with refractory stage I and II deformities often require selective osteotomies in addition to tendon transfer. Patients with stage III and IV deformities typically require hindfoot arthrodesis. One of several tendons can be used for transfer based on surgeon's preference. Flexor digitorum longus (FDL) and flexor hallucis longus (FHL) transfers have been shown to have good results. A peroneus brevis transfer is typically used to supplement small FDL or FHL transfer donors or in revision cases. PMID:24548507

  9. Tendon Transfers Around the Foot: When and Where.

    PubMed

    Kuo, Ken N; Wu, Kuan-Wen; Krzak, Joseph J; Smith, Peter A

    2015-12-01

    Tendon transfers are invaluable in the treatment of severe children's foot deformities. They are often preferable to simple releases, lengthening, or fusion in surgical treatment because they provide an active motor function for deformity correction and, when properly selected, the procedures stabilize the foot against progressive deformity. The authors describe 4 commonly used tendon transfer procedures that are useful in children's foot deformity surgeries.

  10. Flexor Digitorum Longus Tendon Transfer and Modified Kidner Technique in Posterior Tibial Tendon Dysfunction.

    PubMed

    Maskill, James T; Pomeroy, Gregory C

    2016-01-01

    The modified Kidner procedure and flexor digitorum longus tendon transfer are common procedures used today when addressing posterior tibial tendon dysfunction. These techniques are often used in conjunction with a combination of osteotomies to correct flatfoot deformity, and have been proved to be reliable and predictable. PMID:26590720

  11. Tendon transfer options in managing the adult flexible flatfoot.

    PubMed

    Aronow, Michael S

    2012-06-01

    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

  12. Tibialis Anterior Tendon Transfer for Posterior Tibial Tendon Insufficiency.

    PubMed

    Ramanujam, Crystal L; Stapleton, John J; Zgonis, Thomas

    2016-01-01

    The Cobb procedure is useful for addressing stage 2 posterior tibial tendon dysfunction and is often accompanied by a medial displacement calcaneal osteotomy and/or lateral column lengthening. The Cobb procedure can also be combined with selected medial column arthrodesis and realignment osteotomies along with equinus correction when indicated. PMID:26590721

  13. Cadaveric limb analysis of tendon length discrepancy of posterior tibial tendon transfer through the interosseous membrane.

    PubMed

    Pappas, Alexander J; Haffner, Kyle E; Mendicino, Samuel S

    2013-01-01

    The posterior tibial tendon transfer through the interosseous membrane, as popularized by Watkins in 1954, is a procedure for treating reducible eversion and dorsiflexory paresis used by lower extremity foot and ankle surgeons. The posterior tibial tendon has been transferred to various locations on the midfoot for equinus and equinovarus deformities. Dorsiflexory paresis is a common symptom in equinovarus deformity, clubfoot deformity, Charcot-Marie-Tooth disease, leprosy, mononeuropathy, trauma to the common peroneal nerve, cerebrovascular accident, and Duchenne's muscular dystrophy. The main difficulty with this procedure, often discussed by surgeons, is inadequate tendon length, making anchoring to the cuneiforms or cuboid difficult. The goal of our cadaveric study was threefold. First, we sought to determine whether the tendon length is sufficient when transferring the posterior tibial tendon to the dorsum of the foot through the interosseous membrane for a dynamic or a static transfer. Second, we wished to describe the surgical technique designed to obtain the maximal length. Finally, we sought to discuss the strategies used when the tendon length for transfer is insufficient. PMID:23369302

  14. Tendon Transfers Around the Foot: When and Where.

    PubMed

    Kuo, Ken N; Wu, Kuan-Wen; Krzak, Joseph J; Smith, Peter A

    2015-12-01

    Tendon transfers are invaluable in the treatment of severe children's foot deformities. They are often preferable to simple releases, lengthening, or fusion in surgical treatment because they provide an active motor function for deformity correction and, when properly selected, the procedures stabilize the foot against progressive deformity. The authors describe 4 commonly used tendon transfer procedures that are useful in children's foot deformity surgeries. PMID:26589081

  15. Outcome following addition of peroneus brevis tendon transfer to treatment of acquired posterior tibial tendon insufficiency.

    PubMed

    Song, S J; Deland, J T

    2001-04-01

    The flexor digitorum longus, the tendon most often used for transfer in posterior tibial tendon insufficiency, is one-half to one-third the size of the posterior tibial tendon. Occasionally it may be particularly small or may have been previously used for transfer. In these cases, the senior author has felt that the addition of a transfer of the Peroneus Brevis (PBr) tendon may be helpful in maintaining sufficient tendon and muscle mass to rebalance the foot. Thirteen patients who underwent this procedure were retrospectively identified and matched by age and length of follow-up to patients who underwent a more standard tendon transfer operation minus the addition of the PBr transfer. Pain and functional status were then assessed by the American Orthopaedic Foot and Ankle Society's ankle/hindfoot rating scale. Each patient was tested by an independent physical therapist to evaluate inversion and eversion strength. The mean duration of follow-up was 20.6 months (12 to 34 months). The average AOFAS score of the PBr group was 75.8 compared to 71.5 for the standard control group. There was no significant difference between the groups when inversion or eversion strengths were compared. Inversion strength and eversion strength was rated good or excellent (4 or 5) in 12 out of 13 of the PBr transfer group patients. No major complications were encountered in either group. Although it does not increase inversion strength, a PBr transfer can be used to augment a small FDL without causing significant eversion weakness. This can be useful when the FDL is particularly small or in revision surgery. PMID:11354442

  16. Tendon Transfer Surgery for People With Tetraplegia: An Overview.

    PubMed

    Dunn, Jennifer A; Sinnott, K Anne; Rothwell, Alastair G; Mohammed, Khalid D; Simcock, Jeremy W

    2016-06-01

    After cervical spinal cord injury, the loss of upper limb function is common. This affects an individual's ability to perform activities of daily living and participate in previous life roles. There are surgical procedures that can restore some of the upper limb function lost after cervical spinal cord injury. Tendon transfer surgery has been performed in the tetraplegic population since the early 1970s. The goals of surgery are to provide a person with tetraplegia with active elbow extension, wrist extension (if absent), and sufficient pinch and/or grip strength to perform activities of daily living without the need for adaptive equipment or orthoses. These procedures are suitable for a specific group, usually with spinal cord impairment of C4-8, with explicit components of motor and sensory loss. Comprehensive team assessments of current functioning, environment, and personal circumstances are important to ensure success of any procedure. Rehabilitation after tendon transfer surgery involves immobilization for tendon healing followed by specific, targeted therapy based on motor learning and goal-orientated training. Outcomes of tendon transfer surgery are not limited to the improvements in an individual's strength, function, and performance of activities but have much greater life affects, especially with regard to well-being, employment, and participation. This article will provide an overview of the aims of surgery, preoperative assessment, common procedures, postoperative rehabilitation strategies, and outcomes based on clinical experience and international published literature. PMID:27233594

  17. Double tendon transfer for correction of drop-foot.

    PubMed

    Grauwin, M-Y; Wavreille, G; Fontaine, C

    2015-02-01

    Many conditions can cause foot drop, which makes walking difficult because the foot easily bumps into obstacles, or the knee must be kept more flexed than usual during the swing phase of gait, especially when going up stairs. Several techniques that have been described to correct foot drop rely on bone procedures or tendon transfer, with or without bone fixation. In this article, we describe a simple technique that is heavily used in leprosy-endemic countries and provides long-lasting results. It requires a double tendon transfer through the interosseous membrane of leg; the tibialis posterior and flexor digitorum longus are sutured to the tibialis anterior, and extensor hallucis longus and extensor digitorum longus, respectively, proximally to the extensor retinaculum. PMID:25623271

  18. Treatment of peroneal nerve injuries with simultaneous tendon transfer and nerve exploration

    PubMed Central

    2014-01-01

    Background Common peroneal nerve palsy leading to foot drop is difficult to manage and has historically been treated with extended bracing with expectant waiting for return of nerve function. Peroneal nerve exploration has traditionally been avoided except in cases of known traumatic or iatrogenic injury, with tendon transfers being performed in a delayed fashion after exhausting conservative treatment. We present a new strategy for management of foot drop with nerve exploration and concomitant tendon transfer. Method We retrospectively reviewed a series of 12 patients with peroneal nerve palsies that were treated with tendon transfer from 2005 to 2011. Of these patients, seven were treated with simultaneous peroneal nerve exploration and repair at the time of tendon transfer. Results Patients with both nerve repair and tendon transfer had superior functional results with active dorsiflexion in all patients, compared to dorsiflexion in 40% of patients treated with tendon transfers alone. Additionally, 57% of patients treated with nerve repair and tendon transfer were able to achieve enough function to return to running, compared to 20% in patients with tendon transfer alone. No patient had full return of native motor function resulting in excessive dorsiflexion strength. Conclusion The results of our limited case series for this rare condition indicate that simultaneous nerve repair and tendon transfer showed no detrimental results and may provide improved function over tendon transfer alone. PMID:25099247

  19. Tendon Transfers Part II: Transfers for Ulnar Nerve Palsy and Median Nerve Palsy

    PubMed Central

    Sammer, Douglas M.; Chung, Kevin C.

    2009-01-01

    Objectives After reading this article (part II of II), the participant should be able to: 1. Describe the anatomy and function of the median and ulnar nerves in the forearm and hand. 2. Describe the clinical deficits associated with injury to each nerve. 3. Describe the indications, benefits, and drawbacks for various tendon transfer procedures used to treat median and ulnar nerve palsy.4. Describe the treatment of combined nerve injuries. 5. Describe postoperative care and possible complications associated with these tendon transfer procedures. Summary This article discusses the use of tendon transfer procedures for treatment of median and ulnar nerve palsy as well as combined nerve palsies. Postoperative management and potential complications are also discussed. PMID:19730287

  20. Evaluation of elbow flexion following free muscle transfer from the medial gastrocnemius or transfer from the latissimus dorsi, in cases of traumatic injury of the brachial plexus☆

    PubMed Central

    de Moraes, Frederico Barra; Kwae, Mário Yoshihide; da Silva, Ricardo Pereira; Porto, Celmo Celeno; de Paiva Magalhães, Daniel; Paulino, Matheus Veloso

    2015-01-01

    Objective To compare the gain in elbow flexion in patients with traumatic injury of the brachial plexus following muscle transfer from latissimus dorsi with the gain following free muscle transfer from the medial belly of the gastrocnemius. Methods This was a retrospective study in which the medical files of a convenience sample of 13 patients operated between 2000 and 2010 were reviewed. Group 1 comprised seven patients who underwent transfers from the gastrocnemius and group 2 (controls) comprised six patients who underwent transfers from the latissimus dorsi. The following functions were evaluated: (1) range of motion (ROM) of elbow flexion, in degrees, using manual goniometry and (2) grade of elbow flexion strength, using a muscle strength scale. Satisfactory results were defined as: (1) elbow flexion ROM ≥ 80° and (2) elbow flexion strength ≥ M3. The Fisher exact and Kruskal–Wallis tests were used (p < 0.05). Results The patients’ mean age was 32 years (range: 17–56) and 72% had been involved in motorcycle accidents. Elbow flexion strength ≥ M3 was observed in seven patients (100%) in group 1 and in five patients (83.3%) in group 2 (p = 0.462). None of the patients presented M5, and one patient (16.7%) in group 2 had a poor result (M2). Elbow flexion ROM with a gain ≥ 80° (daily functions) was found in six patients (86%) in group 1 and in three patients (50%) in group 2 (p = 0.1). Conclusion The patients in group 1 had greater gains in strength and ROM than did those in group 2, but without statistical significance. Thus, transfers from the gastrocnemius become a new surgical option, if other techniques cannot be used. PMID:27218077

  1. Single-stage Reconstruction of Elbow Flexion Associated with Massive Soft-Tissue Defect Using the Latissimus Dorsi Muscle Bipolar Rotational Transfer

    PubMed Central

    Cuéllar, Vanessa G.; Ghiassi, Alidad; Sharpe, Frances

    2016-01-01

    Introduction: In the upper extremity, the latissimus dorsi muscle can be used as an ipsilateral rotational muscle flap for soft-tissue coverage or functional reconstruction of arm and elbow. Patients who have both major soft-tissue loss and functional deficits can be successfully treated with a single-stage functional latissimus dorsi rotational muscle transfer that provides simultaneous soft-tissue coverage and functional reconstruction. Methods: Our data base was queried for all patients undergoing a rotational latissimus dorsi muscle transfer for simultaneous soft-tissue coverage and functional reconstruction of elbow flexion. Four patients were identified. A chart review documented the mechanism of injury, associated injuries, soft-tissue defect size, number of surgical procedures, length of follow-up, last elbow range of motion, and flexion strength. Results: Four patients with loss of elbow flexion due to traumatic loss of the anterior compartment muscles and the overlying soft tissue underwent simultaneous soft-tissue coverage and elbow flexorplasty using the ipsilateral latissimus dorsi as a bipolar muscle rotational tissue transfer. All flaps survived and had a recovery of Medical Research Council Grade 4/5 elbow flexion strength. No additional procedures were required for elbow flexion. The surgical technique is described and supplemented with surgical technique video and patient outcome. Conclusions: This patient series augments the data provided in other series supporting the safety and efficacy of this procedure which provides both soft-tissue coverage and functional restoration of elbow flexion as a single-stage procedure in the setting of massive traumatic soft-tissue loss of the arm. PMID:27757363

  2. Endoscopic-Assisted Flexor Hallucis Longus Transfer: Harvest of the Tendon at Zone 2 or Zone 3.

    PubMed

    Lui, Tun Hing

    2015-12-01

    Flexor hallucis longus (FHL) tendon transfer is indicated for reconstruction of the Achilles tendon with a gap larger than 5 cm. The tendon can be harvested at zone 2 or zone 3 by minimally invasive techniques with the advantage of minimal soft-tissue dissection. The tendon can be harvested under the sustentaculum tali by zone 2 FHL tendoscopy. It is adequate for FHL transfer to the posterior calcaneal tubercle. If a double-thickness reconstruction of a huge gap of the Achilles tendon is indicated, the tendon can be harvested at the level of the hallux by means of a tendon stripper. However, the interconnection tendon of the master knot of Henry can be split together with the FHL or flexor digitorum longus tendon instead of being cut. Zone 2 FHL tendoscopy can be used to release the split tendon to complete the FHL harvest. PMID:27284516

  3. Scapholunate stabilization with dynamic extensor carpi radialis longus tendon transfer.

    PubMed

    Peterson, Steven L; Freeland, Alan E

    2010-12-01

    Dynamic extensor carpi radialis longus tendon transfer to the distal pole of the scaphoid acts synchronously and synergistically with wrist motion to restore the slider crank mechanism of the scaphoid after scapholunate interosseous ligament (SLIL) injury. The procedure is designed to simulate a hypothetical dorsal radioscaphoid ligament that more closely approximates the normal viscoelastic forces acting on the scaphoid throughout all phases of wrist motion than does the static checkrein effect and motion limitations of capsulodesis or tenodesis. Extensor carpi radialis longus transfer may be independently sufficient to support normal or near-normal scapholunate and midcarpal kinematics and prevent further injury propagation in patients with partial SLIL tears and dynamic scapholunate instability. Extensor carpi radialis longus transfer alone may improve carpal congruity in patients with static scapholunate instability, but SLIL and dorsal lunate ligament repair or reconstruction is essential for favorable durable outcomes. Extensor carpi radialis longus transfer offers a simple and reasonable alternative to capsulodesis or tenodesis to support these ligament repairs or reconstructions, does not require intercarpal fixation, and allows rehabilitation to proceed expeditiously at approximately 1 month after surgery. PMID:21134618

  4. Temporalis Muscle Tendon Unit Transfer for Smile Restoration After Facial Paralysis.

    PubMed

    Owusu Boahene, Kofi D

    2016-02-01

    Temporalis muscle tendon unit (MTU) transfer may be used as a single-stage procedure for dynamic reanimation of the paralyzed face. Principles and biomechanics of muscle function and tendon transposition are essential in optimizing outcome. Critical steps and pearls for success include minimizing scarring, maintaining glide plains, mobilizing adequate tendon length, insertion of MTU at ideal tension based on intraoperative dynamic tension-excursion relationship, and insertion of tendon as close to the lip margin as possible. Because muscles adapt to tension, load, and task changes by altering their sarcomere arrangement and muscle fiber composition, physiotherapy should be initiated to use the repurposed temporalis MTU for smile restoration.

  5. Treatment of posterior tibial tendon dysfunction without flexor digitorum tendon transfer: a retrospective study of 34 patients.

    PubMed

    Didomenico, Lawrence; Stein, Dawn Y; Wargo-Dorsey, Mari

    2011-01-01

    A retrospective study of patients who underwent gastrocnemius recession, double calcaneal osteotomy (Evans osteotomy and percutaneous calcaneal displacement osteotomy), and medial column fusion for the treatment of posterior tibial tendon dysfunction was conducted. The senior author performed the procedures between November 2002 and January 2009 on 34 patients who displayed at least Johnson and Strom stage II deformity and had undergone 12 months of failed conservative treatment. The coauthors evaluated the patients' radiographs before and after the operation. At a mean of 14 (range 3 to 44) months after surgery, radiographic measurements demonstrated statistically significant changes in the structural alignment of the feet. Based on our experience with these patients, we believe that a double calcaneal osteotomy combined with a gastrocnemius recession and stabilization of the medial column for the treatment of posterior tibial tendon dysfunction provides satisfactory correction, stability, and realignment of the foot. Furthermore, we feel that the use of flexor digitorum longus transfer, as well as triple arthrodesis, can be avoided without compromising the outcome when surgically treating posterior tibial tendon dysfunction. PMID:21397524

  6. Neglected Achilles Tendon Rupture Treated with Flexor Hallucis Longus transfer with two turndown gastrocnemius fascia flap and reinforced with plantaris tendon.

    PubMed

    Mao, Haijiao; Shi, Zengyuan; Xu, Dachuan; Liu, Zhenxin

    2015-09-01

    Neglected Achilles Tendon Ruptures are commonly seen by orthopaedic surgeons. In cases resistant to conservative treatment, a variety of surgical procedures have been utilized in the past. The senior -surgeon at our institution has utilized a technique -employing two turndown fascia flaps fashioned from the proximal Achilles tendon augmented by a tenomyodesis of the flexor hallucis longus and plantaris tendon. The purpose of this study was to assess the clinical outcome of all patients who underwent this procedure. The medical records of 10 cases that underwent this procedure were retrospectively reviewed. We completed data collection sets using the American Orthopaedic Foot and Ankle Society ankle-hind foot scores, isokinetic evaluation, and postoperative magnetic resonance imaging (MRI) at 1 year of follow-up. The mean American Orthopaedic Foot and Ankle Society ankle-hind foot scores improved from 64.4±3.54. Isokinetic testing at 30º/sec and 120º/sec revealed an mean deficits of 24.5%, respectively, in the plantar flexion peak torque of the involved ankle than non-involved ankle. The flexor hallucis longus tendon, gastrocnemius fascia flap and plantaris were well -integrated into the Achilles tendon forming a homogenous tendon, which was confirmed in MRI. Our subjective and objective data indicate that the reconstructive technique using flexor hallucis longus transfer with two turndown gastrocnemius fascia flaps and plantaris tendon is a good option for repairing large gap defect of Achilles tendon.

  7. Complete fifth ray amputation with peroneal tendon transfer--a staged surgical protocol.

    PubMed

    Boffeli, Troy J; Abben, Kyle W

    2012-01-01

    Nonhealing neuropathic ulcers overlying the fifth metatarsal are frequently associated with cavus foot structure and are often complicated by osteomyelitis. Partial fifth ray amputation for metatarsal phalangeal joint ulceration and osteomyelitis is a time-proven procedure. Recurrent wounds and persistent osteomyelitis at the amputation stump or fifth metatarsal base create significant challenges in a cavus foot with neuropathy. Long-term success with removal of the entire fifth ray is largely dependent on preventing infection of the cuboid and maintaining peroneal tendon function. The described technique demonstrates our surgical principles and technical pearls in performing a staged complete fifth ray amputation with initial antibiotic bead placement and delayed peroneal tendon transfer. The peroneus longus tendon transfer has the advantage of preserving the eversion force to counterbalance the posterior tibial tendon and allowing the first ray to elevate, thereby alleviating some of the sagittal plane deformity associated with a cavus foot structure. The surgical tips and pearls are accompanied by procedure indications and incision planning options. To our knowledge, this is the first report of a staged protocol involving complete fifth ray resection, initial antibiotic bead placement, and delayed peroneus longus tendon transfer. PMID:22621858

  8. Pseudoaneurysm of the Posterior Tibial Artery After Posterior Tibial Tendon Transfer.

    PubMed

    Elabdi, Monsef; Roukhsi, Redouane; Tijani, Youssef; Chtata, Hassan; Jaafar, Abdeloihab

    2016-01-01

    Pseudoaneurysm of the posterior tibial artery is an uncommon condition that, left untreated, can lead to hemorrhage, thrombosis, or emboli. We present the case of a 54-year-old male who developed pseudoaneurysm of the posterior tibial artery 4 months after undergoing tibialis posterior tendon transfer for management of peroneal nerve palsy, which had developed as a complication of hip arthroplasty. PMID:26972754

  9. Combined Total Ankle Arthroplasty With Posterior Tibial Tendon Transfer for End-Stage Cavovarus Deformity.

    PubMed

    Schuberth, John M; Bowlby, Melinda A; Christensen, Jeffrey C

    2016-01-01

    Posterior tibial tendon transfer has been described to reduce and balance the cavovarus deformity in those patients who receive a total ankle replacement for end-stage arthritis. In this article, we discuss the indications and provide a detailed description of the technique for this powerful procedure. Case examples that demonstrate the utility of the procedure are provided. PMID:27095088

  10. Combined Total Ankle Arthroplasty With Posterior Tibial Tendon Transfer for End-Stage Cavovarus Deformity.

    PubMed

    Schuberth, John M; Bowlby, Melinda A; Christensen, Jeffrey C

    2016-01-01

    Posterior tibial tendon transfer has been described to reduce and balance the cavovarus deformity in those patients who receive a total ankle replacement for end-stage arthritis. In this article, we discuss the indications and provide a detailed description of the technique for this powerful procedure. Case examples that demonstrate the utility of the procedure are provided.

  11. Posterior tibial nerve as a tendon transfer for drop foot reconstruction: a devastating complication.

    PubMed

    Armangil, Mehmet; Basat, H Çağdaş; Bilgin, S Sinan

    2015-01-01

    Iatrogenic peripheral nerve injuries can result from numerous medical procedures, particularly transection, stretching, compression, injections, heat, radiation, and the use of anticoagulant agents. Late diagnosis may lead to atrophy of the motor endplate and result in poor outcomes. We report a case in which the posterior tibial nerve was accidentally sectioned as the posterior tibial tendon for transfer to the anterior tibial tendon in the reconstruction of drop foot. This iatrogenic complication ultimately required foot amputation. Physicians must be aware of the anatomy of the posterior tibial nerve in order to avoid such complications. PMID:25803264

  12. Tailoring Tendon Transfer Surgery and Rehabilitation for a Musician: A Case Study

    PubMed Central

    Watkins, Cynthia; Rivlin, Michael; Beredjiklian, Pedro K.

    2016-01-01

    Tendon transfers in hand patients are a commonly performed procedure after extensor tendon rupture. However, the standard side to side technique is not applicable in every patient. We present a case of a musician with unique demands to demonstrate the option to customize surgical technique and therapy regimen to the unique needs of each patient. An extensor indicis proprius to extensor digitorum communis transfer was performed in a 73 year old musician. A controlled active motion therapy protocol was followed. The patients musical practice regimen was incorporated into the therapy. The patient was able to independently extend her ring and small fingers in order to play her instrument and resumed play within one month postoperatively. A patient’s functional goals including avocations need to be considered when selecting the appropriate surgical and therapeutic approach. PMID:27200400

  13. Tailoring Tendon Transfer Surgery and Rehabilitation for a Musician: A Case Study.

    PubMed

    Watkins, Cynthia; Rivlin, Michael; Beredjiklian, Pedro K

    2016-04-01

    Tendon transfers in hand patients are a commonly performed procedure after extensor tendon rupture. However, the standard side to side technique is not applicable in every patient. We present a case of a musician with unique demands to demonstrate the option to customize surgical technique and therapy regimen to the unique needs of each patient. An extensor indicis proprius to extensor digitorum communis transfer was performed in a 73 year old musician. A controlled active motion therapy protocol was followed. The patients musical practice regimen was incorporated into the therapy. The patient was able to independently extend her ring and small fingers in order to play her instrument and resumed play within one month postoperatively. A patient's functional goals including avocations need to be considered when selecting the appropriate surgical and therapeutic approach. PMID:27200400

  14. Split tendon transfers for the correction of spastic varus foot deformity: a case series study

    PubMed Central

    2010-01-01

    Background Overactivity of anterior and/or posterior tibial tendon may be a causative factor of spastic varus foot deformity. The prevalence of their dysfunction has been reported with not well defined results. Although gait analysis and dynamic electromyography provide useful information for the assessment of the patients, they are not available in every hospital. The purpose of the current study is to identify the causative muscle producing the deformity and apply the most suitable technique for its correction. Methods We retrospectively evaluated 48 consecutive ambulant patients (52 feet) with spastic paralysis due to cerebral palsy. The average age at the time of the operation was 12,4 yrs (9-18) and the mean follow-up 7,8 yrs (4-14). Eigtheen feet presented equinus hind foot deformity due to gastrocnemius and soleus shortening. According to the deformity, the feet were divided in two groups (Group I with forefoot and midfoot inversion and Group II with hindfoot varus). The deformities were flexible in all cases in both groups. Split anterior tibial tendon transfer (SPLATT) was performed in Group I (11 feet), while split posterior tibial tendon transfer (SPOTT) was performed in Group II (38 feet). In 3 feet both procedures were performed. Achilles tendon sliding lengthening (Hoke procedure) was done in 18 feet either preoperatively or concomitantly with the index procedure. Results The results in Group I, were rated according to Hoffer's clinical criteria as excellent in 8 feet and satisfactory in 3, while in Group II according to Kling's clinical criteria were rated as excellent in 20 feet, good in 14 and poor in 4. The feet with poor results presented residual varus deformity due to intraoperative technical errors. Conclusion Overactivity of the anterior tibial tendon produces inversion most prominent in the forefoot and midfoot and similarly overactivity of the posterior tibial tendon produces hindfoot varus. The deformity can be clinically unidentifiable in

  15. Arthroscopic Conjoint Tendon Transfer: A Technique for Revision Anterior Shoulder Stabilization.

    PubMed

    Tennent, Duncan; Colaço, Henry B; Arnander, Magnus; Pearse, Eyiyemi

    2016-02-01

    Revision anterior stabilization of the shoulder presents a challenge to the surgeon and carries a higher risk of recurrent dislocation than primary repair. The Latarjet procedure may be more reliable than revision soft-tissue repair but may not be indicated in patients without significant glenoid bone loss. We describe an arthroscopic technique of conjoint tendon transfer using a combination of suspensory and interference screw fixation for patients without significant glenoid bone loss (<15%). The arthroscopic approach to this procedure allows intra-articular visualization to assist in mobilization of the conjoint tendon, accurate bone tunnel placement, and subsequent labral repair. It avoids the additional steps of bone block preparation and the larger portals required for arthroscopic Latarjet techniques, in addition to eliminating potential complications due to coracoid bone block resorption. PMID:27274454

  16. Comparative objective and subjective analysis of temporalis tendon and microneurovascular transfer for facial reanimation.

    PubMed

    Erni, D; Lieger, O; Banic, A

    1999-04-01

    The aim of this study was to compare objectively and subjectively the results after temporalis tendon and microneurovascular transfer for reanimation of the paralysed face. For the objective analysis, measurements of the distances between static and dynamic points in three-dimensional space were performed at rest and during smiling. The patients were assessed subjectively by non-professionals scoring videotapes. The range of motion of the oral commissure on smiling was 1.7 mm (0.8, mean and SE) after tendon and 5.5 mm (1.6) after microneurovascular transfer (P < 0.05) without showing teeth, and 0.6 mm (1.3) vs 3.6 mm (2.4, ns) with showing teeth. Compared with the healthy side, the excursions reached 6% (16) after tendon and 71% (26, P < 0.05) after microneurovascular transfer for smiling without, and -4% (14) vs 19% (14, ns) for smiling with showing teeth, respectively. Virtually no difference was found in the measurements at rest as well as in the subjective evaluation. Swelling of the cheek (28%) and tethering of the skin (24%) were shown to be the most disturbing symptoms after microneurovascular transfer. Better excursion and symmetry of the oral commissure were achieved by microneurovascular reconstruction for voluntary smile. However, the aesthetic outcome after microneurovascular transfer is markedly impaired by chronic complications including swelling of the cheek and tethering of the skin, which were not detected by the three-dimensional measurement technique used. We conclude that the aesthetic appearance should be considered equally important as the range of motion in the reanimated face.

  17. A Comprehensive Guide on Restoring Grasp Using Tendon Transfer Procedures for Ulnar Nerve Palsy.

    PubMed

    Diaz-Garcia, Rafael J; Chung, Kevin C

    2016-08-01

    Ulnar nerve paralysis results in classic stigmata, including weakness of grasp and pinch, poorly coordinated flexion, and clawing of digits. Restoration of grasp is a key portion of the reconstructive efforts after loss of ulnar nerve function. Improving flexion at the metacarpophalangeal joint can be done by static and dynamic means, although only the latter can improve interphalangeal extension. Deformity and digital posture are more predictably corrected with surgical intervention. Loss of strength from intrinsic muscle paralysis cannot be fully restored with tendon transfer procedures. Preoperative patient education is paramount to success if realistic expectations are to be met. PMID:27387079

  18. [Transfer of the posterior tibialis tendon to restore an active dorsiflexion of the foot].

    PubMed

    Mehling, I; Lanz, U; Prommersberger, K-J; Fuhrmann, R A; van Schoonhoven, J

    2012-01-01

    After lesions of the peroneal nerve or damage of the tibialis anterior muscle a lack of active dorsiflexion leads to a drop foot deformity. Ober (1933) described a transfer of the posterior tibialis tendon to the dorsum of the foot to restore active extension of the foot. The aim of this retrospective study was to evaluate the results of this method and to compare our results with those in the literature.Between 1992 and 2004 we performed a posterior tibialis tendon transfer in 16 patients with an average age of 40 years. 10 patients suffered from complete peroneal nerve palsy, which was due to a traumatic lesion (n=8) or iatrogenic damage (n=2). 3 patients had an incomplete peroneal nerve palsy caused by iatrogenic lesion (n=2) and lumbar disc herniation (n=1). 3 patients demonstrated a malfunction of the anterior tibial muscle following a compartment syndrome. 14 patients were available for a clinical follow-up after an average of 64 months. Clinical assessment included the hindfoot, muscular strength, pain, limitation of function and subjective satisfaction. The clinical result was evaluated using the Stanmore score (0-100).8 patients were very satisfied and 2 were satisfied with their results, 4 patients were not satisfied. 11 patients had no pain. The active dorsal ankle extension averaged - 5.7° (10 to - 30°). The Stanmore score revealed an average of 62 points with an excellent result in 2, a good result in 5, a fair result in 2 and a poor result in 5 patients.Transfer of the posterior tibial muscle to restore active dorsiflexion of the foot is a therapeutic option. As it is known from the literature objective results were mostly fair, but there was a high degree of satisfaction among the patients. PMID:22382906

  19. Tendon transfer for irreparable rotator cuff tears: indications and surgical rationale

    PubMed Central

    Merolla, Giovanni; Chillemi, Claudio; Franceschini, Vincenzo; Cerciello, Simone; Ippolito, Giorgio; Paladini, Paolo; Porcellini, Giuseppe

    2014-01-01

    Summary Background: treatment of symptomatic irreparable rotator cuff tears is extremely challenging because, at present, there are no ideal solutions to this problem. Many patients respond favorably to nonsurgical treatment. However, when conservative measures fail to improve the patient’s pain and disability, surgery should be considered. Methods: different surgical techniques are available and the choice of the most appropriate procedure depends on the presenting symptoms, age of the patient, functional demand, medical comorbidities, joint stability and presence of arthritic changes. The transposition of the surrounding muscles to replace the rotator cuff function represents a viable option in the treatment of younger patients without glenohumeral osteoarthritis and with severe functional limitation. Purpose: aim of this study is to give an overview of the currently available evidence regarding tendon transfer procedures for irreparable rotator cuff tears. PMID:25767779

  20. Subtotal Scapulectomy With Scapulothoracic Fusion and Local Tendon Transfer for Management of Chondrosarcoma.

    PubMed

    Schoch, Bradley; Shives, Thomas; Elhassan, Bassem

    2016-06-01

    Scapulectomy can dramatically alter glenohumeral function and the ability of patients to conduct activities of daily living. In oncologic cases, treatment of the tumor can compromise local musculature, making successful reconstruction difficult to achieve. Depending on the resection level, local musculature may be inadequate to restore shoulder range of motion and/or glenohumeral stability. Surgeons have attempted to address these issues via soft-tissue repairs, allograft replacement, and prosthetic replacement, with variable success. Outcomes are better when a greater portion of the scapula is preserved, thus saving functional rotator cuff muscle bellies. However, preservation of significant rotator cuff musculature is not routinely possible. To our knowledge, no authors in the English-language orthopaedic literature have reported on local tendon transfers as a technique to augment and reconstruct the rotator cuff in a patient with previous scapulectomy. PMID:27115794

  1. Variation of the latissimus dorsi

    PubMed Central

    Shah, Ishani P; Yadav, Amit; Mehta, Rujuta; Thatte, Mukund

    2014-01-01

    A typical muscle variation of latissimus dorsi — the axillary arch is represented by the muscular or fibromuscular slip detached from the anteroinferior border of the musculus latissimus dorsi passing over the axilla under the axillary fascia crossing the medial side of the brachial plexus to continue as a septum intermusculare mediale brachii distally to the medial epicondyle of humerus. The full extent of the muscle is rarely present. Slips of muscle extend from the latissimus dorsi at the inferior angle of scapula to insert into pectoralis major (Langer), coracobrachilis, biceps or coracoid process forming what is described as a common variant - the muscular axillary arch. We report three cases of variants of latissimus dorsi, one of which has not been reported in the literature before. PMID:25593441

  2. Posterior Deltoid-to-Triceps Tendon Transfer for Elbow Extension in a Tetraplegia Patient: A Case Report

    PubMed Central

    Jeong, Ji Hun; Ahn, Dong Heun; Kim, Yong Rok; Hong, Mi Jin; Lee, Yung Jin; Park, Chang-il; Heo, Youn Moo

    2016-01-01

    In tetraplegia patients, activities of daily living are highly dependent on the remaining upper limb functions. In other countries, upper limb reconstruction surgery to improve function has been applied to diverse cases, but few cases have been reported in Korea. The current authors experienced a case of posterior deltoid-to-triceps tendon transfer and rehabilitation in a complete spinal cord injury with a C6 neurologic level, and we introduce the case—a 36-year-old man—with a literature review. The patient's muscle strength in C5 C6 muscles were normal, but C7 muscles were trace, and the Spinal Cord Independence Measure III (SCIM III) score was 24. The tendon of the posterior deltoid was transferred to the triceps brachii muscle, and then the patient received comprehensive rehabilitative treatment. His C7 muscle strength in the right upper extremity was enhanced from trace to fair, and his SCIM III score improved to 29. PMID:27152287

  3. Posterior Deltoid-to-Triceps Tendon Transfer for Elbow Extension in a Tetraplegia Patient: A Case Report.

    PubMed

    Jeong, Ji Hun; Park, Jong Bum; Ahn, Dong Heun; Kim, Yong Rok; Hong, Mi Jin; Lee, Yung Jin; Park, Chang-Il; Heo, Youn Moo

    2016-04-01

    In tetraplegia patients, activities of daily living are highly dependent on the remaining upper limb functions. In other countries, upper limb reconstruction surgery to improve function has been applied to diverse cases, but few cases have been reported in Korea. The current authors experienced a case of posterior deltoid-to-triceps tendon transfer and rehabilitation in a complete spinal cord injury with a C6 neurologic level, and we introduce the case-a 36-year-old man-with a literature review. The patient's muscle strength in C5 C6 muscles were normal, but C7 muscles were trace, and the Spinal Cord Independence Measure III (SCIM III) score was 24. The tendon of the posterior deltoid was transferred to the triceps brachii muscle, and then the patient received comprehensive rehabilitative treatment. His C7 muscle strength in the right upper extremity was enhanced from trace to fair, and his SCIM III score improved to 29. PMID:27152287

  4. Flexor Carpi Radialis to Palmaris Longus Tendon Transfer for Spontaneous Rupture of the Flexor Carpi Radialis Tendon-A Review of an Uncommon Finding and Surgical Technique for Operative Correction.

    PubMed

    Shearin, Jonathan Winkworth; Walters, Brian; Yang, S Steven

    2016-10-01

    Spontaneous ruptures of the flexor carpi radialis tendon (FCR) are rare and associated with systemic inflammatory diseases, localized tendinopathy related to scaphotrapezial-trapezoidal arthritis, or chronic immunosuppression from corticosteroids. While most cases do not require operative intervention, some patients develop weakness, impaired range of motion, and persistent pain. Previously reported surgical options include synovectomy, tendon stump resection, and osteophyte removal. We describe a surgical technique for patients with persistent symptomatology following FCR rupture in which the FCR is transposed end-to-side to the palmaris longus tendon. Three cases using this technique are presented with follow-up of 4-9 months that were collected at Lenox Hill Hospital. All three patients did well regarding specific outcome measures: grip strength, range of motion, and functional activity. FCR transfer to palmaris is an alternative to other surgical options for the spontaneous rupture of the FCR tendon in patients who remain symptomatic despite a course of non-operative therapy. PMID:27595965

  5. Latissimus dorsi free flap for coverage of sacral radiodermatitis in the ambulatory patient

    SciTech Connect

    Stark, D.; Tofield, J.J.; Terranova, W.; Hurley, D.; Kenney, J.

    1987-07-01

    Ambulatory patients with large sacral ulcers can represent extremely challenging coverage problems. Technical options become fewer when sacral ulcers are coupled with radiation dermatitis. Latissimus dorsi free flap transfer, with direct anastomoses to sacral vessels, is described in 2 patients.

  6. Musculoskeletal diseases—tendon

    PubMed Central

    Sakabe, Tomoya; Sakai, Takao

    2011-01-01

    Introduction Tendons establish specific connections between muscles and the skeleton by transferring contraction forces from skeletal muscle to bone thereby allowing body movement. Tendon physiology and pathology are heavily dependent on mechanical stimuli. Tendon injuries clinically represent a serious and still unresolved problem since damaged tendon tissues heal very slowly and no surgical treatment can restore a damaged tendon to its normal structural integrity and mechanical strength. Understanding how mechanical stimuli regulate tendon tissue homeostasis and regeneration will improve the treatment of adult tendon injuries that still pose a great challenge in today's medicine. Source of data This review summarizes the current status of tendon treatment and discusses new directions from the point of view of cell-based therapy and regenerative medicine approach. We searched the available literature using PubMed for relevant original articles and reviews. Growing points Identification of tendon cell markers has enabled us to study precisely tendon healing and homeostasis. Clinically, tissue engineering for tendon injuries is an emerging technology comprising elements from the fields of cellular source, scaffold materials, growth factors/cytokines and gene delivering systems. Areas timely for developing research The clinical settings to establish appropriate microenvironment for injured tendons with the combination of these novel cellular- and molecular-based scaffolds will be critical for the treatment. PMID:21729872

  7. Tendon repair

    MedlinePlus

    Repair of tendon ... Tendon repair can be performed using: Local anesthesia (the immediate area of the surgery is pain-free) ... a cut on the skin over the injured tendon. The damaged or torn ends of the tendon ...

  8. Tendon Structure and Composition.

    PubMed

    Thorpe, Chavaunne T; Screen, Hazel R C

    2016-01-01

    Tendons are soft, fibrous tissues that connect muscle to bone. Their main function is to transfer muscle generated force to the bony skeleton, facilitating movement around a joint, and as such they are relatively passive, inelastic structures, able to resist high forces. Tendons are predominantly composed of collagen, which is arranged in a hierarchical manner parallel to the long axis of the tendon, resulting in high tensile strength. Tendon also contains a range of non-collagenous proteins, present in low amounts, which nevertheless have important functional roles. In this chapter, we describe general tendon composition and structure, and discuss how variations in composition and structure at different levels of the tendon hierarchy confer specific mechanical properties, which are related to tendon function. PMID:27535244

  9. [Split posterior tibial tendon transfer as a selected technique of treatment of spastic equino-varus deformity in children].

    PubMed

    Lipczyk, Zbigniew; Golański, Grzegorz; Flont, Paweł; Niedzielski, Kryspin Ryszard

    2010-01-01

    Equinovarus deformity is one of the most common deformities seen in patients with cerebral palsy. During years between 1993 and 2004 in 36 patients with cerebral palsy 46 operative procedures of split posterior tibial tendon transfer to peroneus brevis muscle were performed to correct varus deformity of the foot. Additionally equinus was corrected by lengthening lengtheninglengthening of the calcaneal tendon in 42 cases and in 4 cases by gastrocnemius recession according to Baker modification of Vulpius procedure. Children's age at the time of operation was between 3.5 and 16 years of age (average 7.5). In our cohort of 36 patients there were 10 cases of quadriplegia (28%), 12 cases of hemiplegia (33%), 12 cases of paraparesis inferior (33%) and 2 cases of monoplegia (6%). 25 patients with 34 operated feet (73.9%) reported for final examination. Follow-up period was from 18 months to 11 years (average 5.5 years). At final examination we evaluated clinical effectiveness of gait, passive and active range of movement, plantograms, and subjective evaluation of patient and patients' parents. Wearing of orthoses and orthopaedic footwear was noted. The results were divided into groups according to Green's classification. There were 67.6% of very good results, 23.6% of good results and 8.8% of poor results. Basing on our experience in treatment of spastic equinovarus deformity of the foot in children with cerebral palsy we stand, that split posterior tibial tendon transfer can bring good results and is a valuable surgical technique in treatment of equinovarus deformity. PMID:20496775

  10. Tendonitis (image)

    MedlinePlus

    ... tendon. It can occur as a result of injury, overuse, or with aging as the tendon loses elasticity. Any action that places prolonged repetitive strain on the forearm muscles can cause tendonitis. The ...

  11. Tendon Innervation.

    PubMed

    Ackermann, Paul W; Salo, Paul; Hart, David A

    2016-01-01

    The regulation of tendon metabolism including the responses to loading is far from being well understood. During the last decade, however, accumulating data show that tendon innervation in addition to afferent functions, via efferent pathways has a regulatory role in tendon homeostasis via a wide range of neuromediators, which coordinate metabolic and neuro-inflammatory pathways.Innervation of intact healthy tendons is localized in the surrounding structures, i.e paratenon, endotenon and epitenon, whereas the tendon proper is practically devoid of neuronal supply. This anatomical finding reflects that the tendon metabolism is regulated from the tendon envelope, i.e. interfascicular matrix (see Chap. 1 ).Tendon innervation after injury and during repair, however, is found as extensive nerve ingrowth into the tendon proper, followed by a time-dependent emergence of different neuronal mediators, which amplify and fine-tune inflammatory and metabolic pathways in tendon regeneration. After healing nerve fibers retract to the tendon envelope.In tendinopathy innervation has been identified to consist of excessive and protracted nerve ingrowth in the tendon proper, suggesting pro-inflammatory, nociceptive and hypertrophic (degenerative) tissue responses.In metabolic disorders such as eg. diabetes impaired tendon healing has been established to be related to dysregulation of neuronal growth factors.Targeted approaches to the peripheral nervous system including neuronal mediators and their receptors may prove to be effective therapies for painful, degenerative and traumatic tendon disorders. PMID:27535247

  12. Ex vivo adenoviral transfer of bone morphogenetic protein 12 (BMP-12) cDNA improves Achilles tendon healing in a rat model.

    PubMed

    Majewski, M; Betz, O; Ochsner, P E; Liu, F; Porter, R M; Evans, C H

    2008-08-01

    The aim of our study was to evaluate the histological and biomechanical effects of BMP-12 gene transfer on the healing of rat Achilles tendons using a new approach employing a genetically modified muscle flap. Biopsies of autologous skeletal muscle were transduced with a type-five, first-generation adenovirus carrying the human BMP-12 cDNA (Ad.BMP-12) and surgically implanted around experimentally transected Achilles tendons in a rat model. The effect of gene transfer on healing was evaluated by mechanical and histological testing after 1, 2, 4 and 8 weeks. One week after surgery, the maximum failure load of the healing tendons was significantly increased in the BMP-12 group, compared with the controls, and the tendon stiffness was significantly higher at 1, 2 and 4 weeks. Moreover, the size of the rupture callus was increased in the presence of BMP-12 and there was evidence of accelerated remodeling of the lesion in response to BMP-12. Histological examination showed a much more organized and homogeneous pattern of collagen fibers at all time points in lesions treated with the BMP-12 cDNA muscle graft. Both single fibrils and the collagen fibers had a greater diameter, with a higher degree of collagen crimp than the collagen of the control groups. This was confirmed by sirius red staining in conjunction with polarized light microscopy, which showed a higher shift of small yellow-green fibers to strong yellow-orange fibers after 2, 4 and 8 weeks in the presence of BMP-12 cDNA. There was also an earlier shift from fibroblasts to fibrocytes within the healing tendon, with less fat cells present in the tendons of the BMP-12 group compared with the controls. Treatment with BMP-12 cDNA-transduced muscle grafts thus produced a promising acceleration and improvement of tendon healing, particularly influencing early tissue regeneration, leading to quicker recovery and improved biomechanical properties of the Achilles tendon. Further development of this approach could have

  13. Management of the recurrent deformity in a flexible foot following failure of tendon transfer: is arthrodesis necessary?

    PubMed

    Hatic, Safet O; Philbin, Terrence M

    2012-06-01

    Recurrent deformity in the adult flatfoot following previous tendon transfer represents a challenging treatment dilemma for even the most experienced foot and ankle surgeon. The evaluation must be comprehensive, resulting in a clear understanding of the extent to which previous surgical procedures either failed to address the deformity initially or led to progressive recurrence. Particularly in younger, more high-demand patients, every effort to preserve normal joint mechanics while alleviating pain and restoring functional alignment must be made. LCL coupled with MDCO and a comprehensive medial soft tissue reconstruction represents a joint-sparing modality for approaching even the most challenging flexible flatfoot deformities. Care to avoid overcorrection, particularly with a double calcaneal osteotomy, must be taken. In the presence of progressive degenerative changes or patient factors such as morbid obesity and advanced age, hindfoot arthrodesis, particularly realignment subtalar joint arthrodesis, provides a technically straightforward, predictable means of achieving a pain-free plantigrade foot. Talonavicular arthrodesis and double arthrodesis, although reliable means of achieving pain relief and functional alignment, do sacrifice considerably more hindfoot motion and are likely more appropriately reserved for elderly, low-demand patients or those with more severe fixed deformities. PMID:22541527

  14. Interference screw fixation and short harvest using flexor digitorum longus (FDL) transfer for posterior tibial tendon dysfunction: a technique.

    PubMed

    Bussewitz, Bradly W; Hyer, Christopher F

    2010-01-01

    Posterior tibial tendon dysfunction is a common clinical entity treated by foot and ankle specialists, and numerous surgical treatments are available to the modern foot and ankle surgeon. Fixation methods are constantly evolving as new products are developed and new uses for existing products are attempted. Interference screw fixation is the gold standard fixation for tendon autograft and allograft in orthopedic sports medicine. The technique that we describe in this article uses a less extensive harvest of the flexor digitorum longus tendon and a sound fixation method using an interference screw positioned in the tarsal navicular. PMID:20797592

  15. Simultaneous anterolateral thigh flap and temporalis tendon transfer to optimize facial form and function after radical parotidectomy.

    PubMed

    Revenaugh, Peter C; Knott, P Daniel; Scharpf, Joseph; Fritz, Michael A

    2012-01-01

    Background Extirpation of aggressive parotid or cutaneous facial tumors often involves facial nerve sacrifice and the creation of a large soft-tissue defect. We describe a method for single-stage reconstruction during radical parotidectomy to restore facial form and function without additional morbidity. Methods We conducted a review of immediate reconstruction/reanimation of radical parotidectomy defects with the use of anterolateral thigh (ALT) fat and fascia flaps for facial contouring, orthodromic temporalis tendon transfer (OTTT), cable grafting of the facial nerve, and fascia lata lower lip suspension. Results Five patients (mean age, 67.4 years) underwent extirpation of malignant tumors with facial nerve sacrifice resulting in large soft-tissue deficits. All patients had ALT free tissue transfer to correct facial contour defects and OTTT to restore facial form and function. Four patients underwent cable grafting of facial nerve branches. Branches of the motor nerve to the vastus lateralis harvested from the ALT surgical site were used for cable nerve grafting in 3 patients. Fascia lata from the same ALT harvest site was used for lower lip suspension to the OTTT in 4 patients. There were no donor site complications. All patients achieved midfacial symmetry at rest, oral competence with dynamic corner-of-mouth movement, and full eye closure. Conclusions Tumor clearance, symmetric facial appearance, as well as dynamic facial rehabilitation were accomplished in a single-stage procedure using the method described herein. The ALT free flap provides versatile options for soft-tissue defects as well as access to motor nerves optimal for grafting without additional morbidity. Patients undergoing extirpation of malignant tumors requiring facial nerve sacrifice can undergo immediate free tissue contour reconstruction and facial reanimation procedures with no additional morbidity.

  16. Tribological characteristics of healthy tendon.

    PubMed

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

    2012-07-26

    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.

  17. Addressing stage II posterior tibial tendon dysfunction: biomechanically repairing the osseous structures without the need of performing the flexor digitorum longus transfer.

    PubMed

    DiDomenico, Lawrence A; Thomas, Zachary M; Fahim, Ramy

    2014-07-01

    The clinical presentation of adult flatfoot can range from a flexible deformity with normal joint integrity to a rigid, arthritic flat foot. Debate still exists regarding the surgical management of stage II deformities, especially in the presence of medial column instability. This article reviews and discusses various surgical options for the correction of stage II flatfoot reconstructive procedures. The authors discuss their opinion that is not always necessary to transfer the flexor digitorum longus tendon to provide relief and stability in this patient population. The anatomy, diagnosis, and current treatments of flexible flatfoot deformity are discussed. PMID:24980929

  18. Tendon Transfer Surgery

    MedlinePlus

    ... Fireworks Safety Lawnmower Safety Snowblower safety Pumpkin Carving Gardening Safety Turkey Carving Removing a Ring Español Artritis ... Fireworks Safety Lawnmower Safety Snowblower safety Pumpkin Carving Gardening Safety Turkey Carving Removing a Ring Español Artritis ...

  19. Early postoperative active mobilisation versus immobilisation following tibialis posterior tendon transfer for foot-drop correction in patients with Hansen's disease.

    PubMed

    Rath, Santosh; Schreuders, Ton A R; Selles, Ruud W

    2010-03-01

    After tibialis posterior tendon transfer surgery for foot-drop correction, the foot is traditionally immobilised for several weeks. To test the feasibility of early mobilisation after this procedure in patients with Hansen's disease, 21 consecutive patients received active mobilisation of the transfer starting on the 5th postoperative day. Transfer insertion strength was enhanced by Pulvertaft weave. The results were compared with a historical cohort of 21 patients receiving 4 weeks of immobilisation. The primary outcomes were active dorsiflexion, active plantar flexion and total active motion at the ankle, tendon-insertion pullout and time until discharge from rehabilitation with independent walking without aid. Assessments at discharge from rehabilitation and the last clinical follow-up at more than 1 year were compared between both groups. The Student's t-test was used to compare data between the groups, and 95% confidence interval of the difference between groups was determined. A p-value of 0.05 was considered statistically significant. The average follow-up was 22 months for both groups. There was no incidence of insertion pullout of the tendon transfer in either group. In addition, there was no difference in active dorsiflexion angle between the groups at discharge (mean difference: 2.2 degrees, p=0.22) and final assessment (mean difference: 2.3 degrees, p=0.42). The plantar flexion angles were similar in both groups at discharge (mean difference: 0.5 degrees, p=0.86) and final assessment (mean difference: 0.5 degrees, p=0.57). In addition, there was no difference in total active motion between the groups at discharge (mean difference: 2 degrees, p=0.54) and final assessment (mean difference: 1 degrees, p=0.49). The patients were discharged from rehabilitation with independent walking at 44.04+/-7.9 days after surgery in the mobilisation group compared to 57.07+/-2.3 days in the immobilisation group. This indicates a significant difference in morbidity (mean

  20. Long-term follow-up of flexor digitorum longus transfer and calcaneal osteotomy for stage II posterior tibial tendon dysfunction.

    PubMed

    Chadwick, C; Whitehouse, S L; Saxby, T S

    2015-03-01

    Flexor digitorum longus transfer and medial displacement calcaneal osteotomy is a well-recognised form of treatment for stage II posterior tibial tendon dysfunction. Although excellent short- and medium-term results have been reported, the long-term outcome is unknown. We reviewed the clinical outcome of 31 patients with a symptomatic flexible flat-foot deformity who underwent this procedure between 1994 and 1996. There were 21 women and ten men with a mean age of 54.3 years (42 to 70). The mean follow-up was 15.2 years (11.4 to 16.5). All scores improved significantly (p < 0.001). The mean American Orthopedic Foot and Ankle Society (AOFAS) score improved from 48.4 pre-operatively to 90.3 (54 to 100) at the final follow-up. The mean pain component improved from 12.3 to 35.2 (20 to 40). The mean function score improved from 35.2 to 45.6 (30 to 50). The mean visual analogue score for pain improved from 7.3 to 1.3 (0 to 6). The mean Short Form-36 physical component score was 40.6 (sd 8.9), and this showed a significant correlation with the mean AOFAS score (r = 0.68, p = 0.005). A total of 27 patients (87%) were pain free and functioning well at the final follow-up. We believe that flexor digitorum longus transfer and calcaneal osteotomy provides long-term pain relief and satisfactory function in the treatment of stage II posterior tibial tendon dysfunction. PMID:25737518

  1. Posterior Tibial Tendon Dysfunction

    MedlinePlus

    ... when the posterior tibial tendon becomes inflamed or torn. As a result, the tendon may not be ... repetitive use. Once the tendon becomes inflamed or torn, the arch will slowly fall (collapse) over time. ...

  2. Achilles tendon repair

    MedlinePlus

    Achilles tendon rupture-surgery; Percutaneous Achilles tendon rupture repair ... To fix your torn Achilles tendon, the surgeon will: Make a cut down the back of your heel Make several small cuts rather than one large cut ...

  3. Achilles tendon rupture - aftercare

    MedlinePlus

    Heel cord tear; Calcaneal tendon rupture ... MRI scan to see what type of Achilles tendon tear you have. An MRI is a type ... partial tear means at least some of the tendon is still OK. A full tear means your ...

  4. Tendon latch

    SciTech Connect

    Watkins, B. J.

    1985-01-01

    A latch connects tendons run from a floating platform to a socket in a foundation on the sea floor. The latch includes a latch body having a plurality of dogs disposed within and urgible outward from the latch body. A piston is releasably disposed within the latch body above the dogs and moves downwardly when released to urge the dogs outwardly from the body into latching engagement with the socket. A trigger mechanism in the latch releases the piston when the latch body lands in the socket and contacts a trigger pin projecting upwardly from the bottom of the socket. A series of wedges are disposed exteriorally on the body and inhibit lateral movement of the body relative to the socket when the tendon is subjected to a cycle bending loads.

  5. Elastofibroma dorsi. Our experience with 11 lesions.

    PubMed

    Novati, Federico Cesare; Franchi, Alberto; Papa, Giovanni; Arnež, Zoran Marij

    2014-12-29

    Elastofibroma is a rare benign lesion that typically arises on the posterior chest wall beneath the scapula. The etiopathogenesis is still unclear and the knowledge about its diagnosis and management mainly comes from small case series. We collected all the data related to 11 Elastofibroma Dorsi treated at our institution between January 2003 and July 2014. The definitive diagnosis was made by histological examination of the mass. We analyzed the characteristic of the patients, (i.e. age, sex, dominant hand, and occupation), the presenting symptoms and signs, the preoperative investigations, surgical management and complications comparing our findings with the current medical literature on the subject. We found that preoperative investigations are of limited value and when clinical presentation is typical the diagnosis could be made presumptively. Surgery should be performed under general anaesthesia since local anaesthetic infiltration and sedation are often inadequate to reduce intraoperative discomfort.

  6. Distribution of proteins within different compartments of tendon varies according to tendon type.

    PubMed

    Thorpe, Chavaunne T; Karunaseelan, Kabelan J; Ng Chieng Hin, Jade; Riley, Graham P; Birch, Helen L; Clegg, Peter D; Screen, Hazel R C

    2016-09-01

    Although the predominant function of all tendons is to transfer force from muscle to bone and position the limbs, some tendons additionally function as energy stores, reducing the energetic cost of locomotion. To maximise energy storage and return, energy-storing tendons need to be more extensible and elastic than tendons with a purely positional function. These properties are conferred in part by a specialisation of a specific compartment of the tendon, the interfascicular matrix, which enables sliding and recoil between adjacent fascicles. However, the composition of the interfascicular matrix is poorly characterised and we therefore tested the hypothesis that the distribution of elastin and proteoglycans differs between energy-storing and positional tendons, and that protein distribution varies between the fascicular matrix and the interfascicular matrix, with localisation of elastin and lubricin to the interfascicular matrix. Protein distribution in the energy-storing equine superficial digital flexor tendon and positional common digital extensor tendon was assessed using histology and immunohistochemistry. The results support the hypothesis, demonstrating enrichment of lubricin in the interfascicular matrix in both tendon types, where it is likely to facilitate interfascicular sliding. Elastin was also localised to the interfascicular matrix, specifically in the energy-storing superficial digital flexor tendon, which may account for the greater elasticity of the interfascicular matrix in this tendon. A differential distribution of proteoglycans was identified between tendon types and regions, which may indicate a distinct role for each of these proteins in tendon. These data provide important advances into fully characterising structure-function relationships within tendon. PMID:27113131

  7. Use of previously divided latissimus dorsi muscle for bronchopleural fistula.

    PubMed

    Kaplan, Tevfik; Kaya, Basar; Kazbek, Baturay Kansu; Kocer, Bulent; Han, Serdar; Yormuk, Erdem

    2015-06-01

    Management of postpneumonectomy bronchopleural fistula remains a major challenge for thoracic surgeons. Successful closure of a postpneumonectomy bronchopleural fistula was performed in a 60-year-old man, using a flap made by a combination of serratus anterior and latissimus dorsi muscle which had been divided during the pneumonectomy operation. The flap was prepared on the presence of a dependable collateral serratus anterior branch to the lateral thoracic artery, which provides retrograde flow to the latissimus dorsi muscle.

  8. The “Reverse” Latissimus Dorsi Flap for Large Lower Lumbar Defect

    PubMed Central

    Kotti, Bouraoui; Jaidane, Olfa; Ben Hassouna, Jamel; Rahal, Khaled

    2012-01-01

    The latissimus dorsi (LD) flap is one of the most common flaps used in plastic surgery based on its dominant thoracodorsal pedicle as well as free tissue transfer. The “distally based” or “reverse” fashion design has been used to repair myelomeningoceles, congenital diaphragmatic agenesis, or thoracolumbar defects. We present a case of a large lumbar defect after cancer resection covered by a combined tegument solution starring the “reverse” LD flap in its muscular version with a cutaneous gluteal flap. This flap is a safe and reliable way to cover large distal lumbar defect. PMID:23082273

  9. Lengthening osteotomy of the calcaneus and flexor digitorum longus tendon transfer in flexible flatfoot deformity improves talo-1st metatarsal-Index, clinical outcome and pedographic parameter.

    PubMed

    Richter, Martinus; Zech, Stefan

    2013-03-01

    Lengthening osteotomy of the calcaneus (LO) and flexor digitorum longus tendon (FDL) transfer to the navicular is one option for the treatment of flexible flatfoot deformity (FD). The aim of the study was to analyse the amount of correction and clinical outcome including pedographic assessment. In a prospective consecutive non-controlled clinical followup study, all patients with FD that were treated with LO and FDL from September 1st 2006 to August 31st, 2009 were included. Assessment was performed before surgery and at 2-year-followup including clinical examination (with staging of posterior tibialis insufficiency) weight bearing radiographs (Talo-1st metatarsal angles (TMT)), pedography (increased midfoot contact area and force) and Visual Analogue Scale Foot and Ankle (VAS FA). 112 feet in 102 patients were analysed (age, 57.6 (13-82), 42% male). In 12 feet (9%) wound healing delay without further surgical measures was registered. All patients achieved full weight bearing during the 7th postoperative week. Until followup, revision surgery was done in 3 patients (fusion calcaneocuboid joint (n=2), correction triple arthrodesis (n=1)). 101 feet (90%) completed 2-year-followup. TMT dorsoplantar/lateral/Index and VAS FA scores were increased, and posterior tibialis insufficiency stage, pedographic midfoot contact area and force percentage were decreased (each p<.05). All relevant parameters (stage of posterior tibialis insufficiency, TMT angles and Index, pedographic midfoot contact area and force percentage, VAS FA) were improved 2 years after LO and FDL transfer to the navicular in FD. The complication rate was low. This method allows safe and predictable correction.

  10. Abductor pollicis longus tendon division with swan neck thumb deformity.

    PubMed

    Zacharia, Balaji; Puthezhath, Kishore

    2012-08-01

    Swan neck thumb deformity can be caused by osteoarthritis, rheumatoid arthritis, systemic lupus erythematosus, tendon transfers and paralytic diseases. Abductor pollicis longus is one of the major stabilizing tendon of the carpometacarpal joint of thumb. To the best of our knowledge, swan neck thumb deformity owing to division of abductor pollicis longus tendon is rare. In this article, we describe a case of isolated division of abductor pollicis longus tendon presenting with swan-neck deformity of thumb and discuss the mechanism, management and outcome. The patient was treated by repair of the divided tendon using palmaris longus tendon graft. At approximately 107 weeks following treatment, the patient was having full range of thumb movement and the deformity completely disappeared. We also describe the unusual mechanism whereby an isolated division of abductor pollicis longus tendon results in swan neck thumb deformity. Level of clinical evidence IV. PMID:22825877

  11. Cerebral Palsy Tendon Transfers: Flexor Carpi Ulnaris to Extensor Carpi Radialis Brevis and Extensor Pollicis Longus Reroutement.

    PubMed

    Bansal, Anchal; Wall, Lindley B; Goldfarb, Charles A

    2016-08-01

    The flexor carpi ulnaris to extensor carpi radialis brevis transfer and extensor pollicis longus rerouting combined with thenar release are 2 successful surgical interventions for children with spastic cerebral palsy. The goal of both procedures is to improve quality of life for patients who have previously failed conservative management, and the degree of expected improvement is predicated on several patient variables, making careful patient selection crucial for ensuring successful outcomes. Here, surgical technique is described; risk factors are discussed, and outcomes related to both procedures are presented. PMID:27387086

  12. Transverse Compression of Tendons.

    PubMed

    Salisbury, S T Samuel; Buckley, C Paul; Zavatsky, Amy B

    2016-04-01

    A study was made of the deformation of tendons when compressed transverse to the fiber-aligned axis. Bovine digital extensor tendons were compression tested between flat rigid plates. The methods included: in situ image-based measurement of tendon cross-sectional shapes, after preconditioning but immediately prior to testing; multiple constant-load creep/recovery tests applied to each tendon at increasing loads; and measurements of the resulting tendon displacements in both transverse directions. In these tests, friction resisted axial stretch of the tendon during compression, giving approximately plane-strain conditions. This, together with the assumption of a form of anisotropic hyperelastic constitutive model proposed previously for tendon, justified modeling the isochronal response of tendon as that of an isotropic, slightly compressible, neo-Hookean solid. Inverse analysis, using finite-element (FE) simulations of the experiments and 10 s isochronal creep displacement data, gave values for Young's modulus and Poisson's ratio of this solid of 0.31 MPa and 0.49, respectively, for an idealized tendon shape and averaged data for all the tendons and E = 0.14 and 0.10 MPa for two specific tendons using their actual measured geometry. The compression load versus displacement curves, as measured and as simulated, showed varying degrees of stiffening with increasing load. This can be attributed mostly to geometrical changes in tendon cross section under load, varying according to the initial 3D shape of the tendon. PMID:26833218

  13. Transverse Compression of Tendons.

    PubMed

    Salisbury, S T Samuel; Buckley, C Paul; Zavatsky, Amy B

    2016-04-01

    A study was made of the deformation of tendons when compressed transverse to the fiber-aligned axis. Bovine digital extensor tendons were compression tested between flat rigid plates. The methods included: in situ image-based measurement of tendon cross-sectional shapes, after preconditioning but immediately prior to testing; multiple constant-load creep/recovery tests applied to each tendon at increasing loads; and measurements of the resulting tendon displacements in both transverse directions. In these tests, friction resisted axial stretch of the tendon during compression, giving approximately plane-strain conditions. This, together with the assumption of a form of anisotropic hyperelastic constitutive model proposed previously for tendon, justified modeling the isochronal response of tendon as that of an isotropic, slightly compressible, neo-Hookean solid. Inverse analysis, using finite-element (FE) simulations of the experiments and 10 s isochronal creep displacement data, gave values for Young's modulus and Poisson's ratio of this solid of 0.31 MPa and 0.49, respectively, for an idealized tendon shape and averaged data for all the tendons and E = 0.14 and 0.10 MPa for two specific tendons using their actual measured geometry. The compression load versus displacement curves, as measured and as simulated, showed varying degrees of stiffening with increasing load. This can be attributed mostly to geometrical changes in tendon cross section under load, varying according to the initial 3D shape of the tendon.

  14. Traumatic Tear of the Latissimus Dorsi Myotendinous Junction

    PubMed Central

    Friedman, Michael V.; Stensby, J. Derek; Hillen, Travis J.; Demertzis, Jennifer L.; Keener, Jay D.

    2015-01-01

    A case of a latissimus dorsi myotendinous junction strain in an avid CrossFit athlete is presented. The patient developed acute onset right axillary burning and swelling and subsequent palpable pop with weakness while performing a “muscle up.” Magnetic resonance imaging examination demonstrated a high-grade tear of the right latissimus dorsi myotendinous junction approximately 9 cm proximal to its intact humeral insertion. There were no other injuries to the adjacent shoulder girdle structures. Isolated strain of the latissimus dorsi myotendinous junction is a very rare injury with a scarcity of information available regarding its imaging appearance and preferred treatment. This patient was treated conservatively and was able to resume active CrossFit training within 3 months. At 6 months postinjury, he had only a mild residual functional deficit compared with his preinjury level. PMID:26502450

  15. Achilles tendon: US examination

    SciTech Connect

    Fornage, B.D.

    1986-06-01

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

  16. Elastofibroma dorsi: MRI diagnosis in a young girl.

    PubMed

    Devaney, D; Livesley, P; Shaw, D

    1995-01-01

    Elastofibroma dorsi is a slowly growing tumour-like process composed of an ill-defined mass of fibro-elastic tissue. It occurs almost exclusively in the elderly and is thought to result from mechanical friction. It has received little attention in the radiological literature and is considered a rare lesion. With indications for computerised imaging expanding, elastofibroma dorsi will probably be seen more frequently. This report describes an elastofibroma presenting in an 11-year-old girl and its appearance by magnetic resonance imaging. Presumptive diagnosis by magnetic resonance imaging may prevent unnecessary radical surgery.

  17. Latissimus dorsi flap remains an excellent choice for breast reconstruction.

    PubMed

    Sternberg, Erez G; Perdikis, Galen; McLaughlin, Sarah A; Terkonda, Sarvam P; Waldorf, James C

    2006-01-01

    Latissimus dorsi flap has been unfairly relegated to a second option in breast reconstruction. One hundred consecutive latissimus dorsi muscle flaps (LDMF) with tissue-expander reconstruction were studied, mean follow-up 34.5 months (range, 1-175), 50 immediate, 50 delayed. With attention to a few technical details, excellent esthetic, soft reconstructions were achieved. Complications included 1 partial flap loss; 2 patients required inframammary fold revision; and 6 patients required surgery for capsular contracture. Donor-site seroma occurred in 34 patients; 6 required operative revision. Results were similar in the immediate versus the delayed groups. LDMF remains an esthetic, reliable, safe reconstructive choice.

  18. Tendon development and diseases.

    PubMed

    Gaut, Ludovic; Duprez, Delphine

    2016-01-01

    Tendon is a uniaxial connective tissue component of the musculoskeletal system. Tendon is involved in force transmission between muscle and bone. Tendon injury is very common and debilitating but tendon repair remains a clinical challenge for orthopedic medicine. In vertebrates, tendon is mainly composed of type I collagen fibrils, displaying a parallel organization along the tendon axis. The tendon-specific spatial organization of type I collagen provides the mechanical properties for tendon function. In contrast to other components of the musculoskeletal system, tendon biology is poorly understood. An important goal in tendon biology is to understand the mechanisms involved in the production and assembly of type I collagen fibrils during development, postnatal formation, and healing processes in order to design new therapies for tendon repair. In this review we highlight the current understanding of the molecular and mechanical signals known to be involved in tenogenesis during development, and how development provides insights into tendon healing processes. WIREs Dev Biol 2016, 5:5-23. doi: 10.1002/wdev.201 For further resources related to this article, please visit the WIREs website.

  19. Pressurized gas filled tendons

    SciTech Connect

    Silcox, W. H.

    1985-06-04

    Pressurized gas filled tubular tendons provide a means for detecting leaks therein. Filling the tendon with a gaseous fluid provides increased buoyancy and reduces the weight supported by the buoyant structure. The use of a corrosion inhibiting gaseous fluid reduces the corrosion of the interior tendon wall.

  20. Biologics for tendon repair☆

    PubMed Central

    Docheva, Denitsa; Müller, Sebastian A.; Majewski, Martin; Evans, Christopher H.

    2015-01-01

    Tendon injuries are common and present a clinical challenge to orthopedic surgery mainly because these injuries often respond poorly to treatment and require prolonged rehabilitation. Therapeutic options used to repair ruptured tendons have consisted of suture, autografts, allografts, and synthetic prostheses. To date, none of these alternatives has provided a successful long-term solution, and often the restored tendons do not recover their complete strength and functionality. Unfortunately, our understanding of tendon biology lags far behind that of other musculoskeletal tissues, thus impeding the development of new treatment options for tendon conditions. Hence, in this review, after introducing the clinical significance of tendon diseases and the present understanding of tendon biology, we describe and critically assess the current strategies for enhancing tendon repair by biological means. These consist mainly of applying growth factors, stem cells, natural biomaterials and genes, alone or in combination, to the site of tendon damage. A deeper understanding of how tendon tissue and cells operate, combined with practical applications of modern molecular and cellular tools could provide the long awaited breakthrough in designing effective tendon-specific therapeutics and overall improvement of tendon disease management. PMID:25446135

  1. Fibrillins in Tendon

    PubMed Central

    Giusti, Betti; Pepe, Guglielmina

    2016-01-01

    Tendons among connective tissue, mainly collagen, contain also elastic fibers (EF) made of fibrillin 1, fibrillin 2 and elastin that are broadly distributed in tendons and represent 1–2% of the dried mass of the tendon. Only in the last years, studies on structure and function of EF in tendons have been performed. Aim of this review is to revise data on the organization of EF in tendons, in particular fibrillin structure and function, and on the clinical manifestations associated to alterations of EF in tendons. Indeed, microfibrils may contribute to tendon mechanics; therefore, their alterations may cause joint hypermobility and contractures which have been found to be clinical features in patients with Marfan syndrome (MFS) and Beals syndrome. The two diseases are caused by mutations in genes FBN1 and FBN2 encoding fibrillin 1 and fibrillin 2, respectively. PMID:27812333

  2. Closed rupture of the flexor tendons caused by carpal bone and joint disorders.

    PubMed

    Yamazaki, H; Kato, H; Hata, Y; Nakatsuchi, Y; Tsuchikane, A

    2007-12-01

    We analysed 21 patients with closed rupture of the flexor tendons caused by carpal bone and joint disorders. The tendon that ruptured depended on the location of the bone perforation into the carpal tunnel. Radiocarpal arthrography was performed in 13 patients and capsular perforation was demonstrated by contrast medium leakage into the carpal canal in 11 patients. This proved a useful diagnostic test. The flexor tendon(s) were reconstructed with free tendon graft in 17 patients, cross-over transfer of flexor tendons from adjacent digits in two and buddying to an adjacent flexor tendon in one patient. Postoperative total active range of motion in the fingers after 13 free tendon graft reconstructions averaged 213 degrees (range 170-265 degrees ). The active range of motion of the thumb-interphalangeal joint after free tendon graft reconstruction in three cases improved from 0 degrees to 33 degrees on average (range 10 degrees -40 degrees ).

  3. Active tendon implants in flexor tendon reconstruction.

    PubMed

    Hunter, J M; Singer, D I; Jaeger, S H; Mackin, E J

    1988-11-01

    Forty-five active flexor tendon implants were evaluated after placement in scarred tendon beds of digits II through V. The implant is constructed of silicone rubber with a Dacron core, terminating in a loop proximally and a metal plate distally. Modification of the implant during the period of study has improved its reliability and longevity. The improvement in total active motion (TAM) averaged 72 degrees during implant functioning (stage I) in a group of digits that before operation were classified as 78% Boyes grade 5 (salvage). Complication rate during stage I was 11% (5 out of 45). Of the 27 digits evaluated after implant replacement by tendon autograft (stage II), there was an overall improvement in 62 degrees total active motion with 70% of digits being Boyes grade 5. Many of the complications were believed to be avoidable with experience. This study demonstrates the feasibility of an active tendon implant and the possibility of a permanent prosthesis. PMID:2976074

  4. Atraumatic quadriceps tendon tear associated with calcific tendonitis.

    PubMed

    Abram, Simon G F; Sharma, Akash D; Arvind, Chinnakonda

    2012-11-27

    Calcific tendonitis of the quadriceps tendon is an uncommon condition. We present the first case of a quadriceps tendon tear associated with calcific tendonitis. In this case, the patient presented with symptoms mimicking a rupture of the quadriceps tendon. This case illustrates that although calcific tendonitis of the quadriceps is a rare condition it is not benign and should be considered when investigating acute symptoms associated with the extensor mechanism of the knee.

  5. Riser and tendon management system

    SciTech Connect

    Devlin, P.V.

    1992-02-18

    This patent describes a riser and tendon management system. It comprises means to set nominal conditions for the risers and tendons; means to measure actual riser and tendon conditions; means to compare the actual and nominal conditions of the risers and tendons; and means responsive to a differential between the actual and nominal riser and tendon conditions, which difference exceeds specified limits, and recommending corrective action to bring the risers and tendons back to within nominal conditions.

  6. Tendon and ligament imaging

    PubMed Central

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

    2012-01-01

    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. PMID:22553301

  7. Tendon Homeostasis in Hypercholesterolemia.

    PubMed

    Soslowsky, Louis J; Fryhofer, George W

    2016-01-01

    Hypercholesterolemia is a serious health problem that is associated not only with heart disease, but also tendon pathology. In high cholesterol environments (e.g. familial hyperlipidemia), lipids accumulate within the tendon extracellular matrix and form deposits called xanthomas. Lipid-related changes are known to affect several tendon mechanical properties, including stiffness and modulus, in uninjured and injured tendons, alike. Mechanisms to explain these cholesterol-related changes are multiple, including alterations in tenocyte gene and protein expression, matrix turnover, tissue vascularity, and cytokine production. Clinically, rotator cuff tear and Achilles tendon rupture are clearly associated with metabolic derangements, and elevated total cholesterol is often among the specific metabolic parameters implicated. Treatment of hypercholesterolemia using statin medications has also been shown to affect tendon properties, resulting in normalization of tendon thickness and improved tendon healing. Despite current work, the pathophysiology of lipid-related tendon pathology remains incompletely understood, and additional hypothesis-generating studies, including those incorporating whole-genome and whole-transcriptome technologies, will help to point the field in new directions. PMID:27535257

  8. Inflammation in Tendon Disorders.

    PubMed

    Speed, Cathy

    2016-01-01

    The role of inflammation in tendon disorders has long been a subject of considerable debate. Developments in our understanding of the basic science of inflammation have provided further insight into its potential role in specific forms of tendon disease, and the circumstances that may potentiate this. Such circumstances include excessive mechanical stresses on tendon and the presence of systemic inflammation associated with chronic diseases. In this chapter a brief review of the basic science of inflammation is provided and the influence that it may play on tendons is discussed. PMID:27535263

  9. Bilateral elastofibroma dorsi: a case report of an uncommon and under-diagnosed tumor

    PubMed Central

    Braun, Stefanie; Richter, Matthias; Ernst, Tom; Flade, Andreas

    2015-01-01

    Elastofibroma dorsi is a rare benign tumor of the back, located between the latissimus dorsi and the rhomboid muscle. In most cases it is unilateral, but in up to 10% it occurs on both sides. The etiology is still in discussion. Here we report a case of a 51-year-old man with bilateral elastofibroma dorsi. The therapy of choice was surgical resection. No long-term complications were reported in a 6-month follow-up. PMID:26855655

  10. Fatigue loading of tendon

    PubMed Central

    Shepherd, Jennifer H; Screen, Hazel R C

    2013-01-01

    Tendon injuries, often called tendinopathies, are debilitating and painful conditions, generally considered to develop as a result of tendon overuse. The aetiology of tendinopathy remains poorly understood, and whilst tendon biopsies have provided some information concerning tendon appearance in late-stage disease, there is still little information concerning the mechanical and cellular events associated with disease initiation and progression. Investigating this in situ is challenging, and numerous models have been developed to investigate how overuse may generate tendon fatigue damage and how this may relate to tendinopathy conditions. This article aims to review these models and our current understanding of tendon fatigue damage. We review the strengths and limitations of different methodologies for characterizing tendon fatigue, considering in vitro methods that adopt both viable and non-viable samples, as well as the range of different in vivo approaches. By comparing data across model systems, we review the current understanding of fatigue damage development. Additionally, we compare these findings with data from tendinopathic tissue biopsies to provide some insights into how these models may relate to the aetiology of tendinopathy. Fatigue-induced damage consistently highlights the same microstructural, biological and mechanical changes to the tendon across all model systems and also correlates well with the findings from tendinopathic biopsy tissue. The multiple testing routes support matrix damage as an important contributor to tendinopathic conditions, but cellular responses to fatigue appear complex and often contradictory. PMID:23837793

  11. The tibialis posterior tendon.

    PubMed

    Lhoste-Trouilloud, A

    2012-02-01

    The tibialis posterior tendon is the largest and anteriormost tendon in the medial ankle. It produces plantar flexion and supination of the ankle and stabilizes the plantar vault. Sonographic assessment of this tendon is done with high-frequency, linear-array transducers; an optimal examination requires transverse retromalleolar, longitudinal retromalleolar, and distal longitudinal scans, as well as dynamic studies. Disorders of the posterior tibial tendon include chronic tendinopathy with progressive rupture, tenosynovitis, acute rupture, dislocation and instability, enthesopathies. The most common lesion is a progressive "chewing gum" lesion that develops in a setting of chronic tendinopathy; it is usually seen in overweight women over 50 years of age with valgus flat feet. Medial ankle pain must also be carefully investigated, and the presence of instability assessed with dynamic maneuvers (forced inversion, or dorsiflexion) of the foot. Sonography plays an important role in the investigation of disorders involving the posterior tibial tendon.

  12. The interfascicular matrix enables fascicle sliding and recovery in tendon, and behaves more elastically in energy storing tendons

    PubMed Central

    Thorpe, Chavaunne T.; Godinho, Marta S.C.; Riley, Graham P.; Birch, Helen L.; Clegg, Peter D.; Screen, Hazel R.C.

    2015-01-01

    While the predominant function of all tendons is to transfer force from muscle to bone and position the limbs, some tendons additionally function as energy stores, reducing the cost of locomotion. Energy storing tendons experience extremely high strains and need to be able to recoil efficiently for maximum energy storage and return. In the equine forelimb, the energy storing superficial digital flexor tendon (SDFT) has much higher failure strains than the positional common digital extensor tendon (CDET). However, we have previously shown that this is not due to differences in the properties of the SDFT and CDET fascicles (the largest tendon subunits). Instead, there is a greater capacity for interfascicular sliding in the SDFT which facilitates the greater extensions in this particular tendon (Thorpe et al., 2012). In the current study, we exposed fascicles and interfascicular matrix (IFM) from the SDFT and CDET to cyclic loading followed by a test to failure. The results show that IFM mechanical behaviour is not a result of irreversible deformation, but the IFM is able to withstand cyclic loading, and is more elastic in the SDFT than in the CDET. We also assessed the effect of ageing on IFM properties, demonstrating that the IFM is less able to resist repetitive loading as it ages, becoming stiffer with increasing age in the SDFT. These results provide further indications that the IFM is important for efficient function in energy storing tendons, and age-related alterations to the IFM may compromise function and predispose older tendons to injury. PMID:25958330

  13. The interfascicular matrix enables fascicle sliding and recovery in tendon, and behaves more elastically in energy storing tendons.

    PubMed

    Thorpe, Chavaunne T; Godinho, Marta S C; Riley, Graham P; Birch, Helen L; Clegg, Peter D; Screen, Hazel R C

    2015-12-01

    While the predominant function of all tendons is to transfer force from muscle to bone and position the limbs, some tendons additionally function as energy stores, reducing the cost of locomotion. Energy storing tendons experience extremely high strains and need to be able to recoil efficiently for maximum energy storage and return. In the equine forelimb, the energy storing superficial digital flexor tendon (SDFT) has much higher failure strains than the positional common digital extensor tendon (CDET). However, we have previously shown that this is not due to differences in the properties of the SDFT and CDET fascicles (the largest tendon subunits). Instead, there is a greater capacity for interfascicular sliding in the SDFT which facilitates the greater extensions in this particular tendon (Thorpe et al., 2012). In the current study, we exposed fascicles and interfascicular matrix (IFM) from the SDFT and CDET to cyclic loading followed by a test to failure. The results show that IFM mechanical behaviour is not a result of irreversible deformation, but the IFM is able to withstand cyclic loading, and is more elastic in the SDFT than in the CDET. We also assessed the effect of ageing on IFM properties, demonstrating that the IFM is less able to resist repetitive loading as it ages, becoming stiffer with increasing age in the SDFT. These results provide further indications that the IFM is important for efficient function in energy storing tendons, and age-related alterations to the IFM may compromise function and predispose older tendons to injury.

  14. Drug-Induced Tendon Disorders.

    PubMed

    Knobloch, Karsten

    2016-01-01

    Drug-induced tendon disorders are an often underestimated risk factor. The range from detrimental effects on the tendon include tendinopathy as well as potentially tendon rupture. As for today, four main drug classes have been reported to be associated with potentially deteriorated tendon properties: 1. Corticosteroids, 2. Chinolon antibiotics, 3. Aromatase inhbitors, 4. Statins as HMG-CoA-reductase inhibitors. Most often, the Achilles tendon is affected in terms of tendinopathy and/or subsequent tendon rupture. However, nearly every tendon of the entire body might be affected in a detrimental way by one or a combination of the aformentioned agents. PMID:27535265

  15. Tendon Gradient Mineralization for Tendon to Bone Interface Integration

    PubMed Central

    Qu, Jin; Thoreson, Andrew R.; Chen, Qingshan; An, Kai-Nan; Amadio, Peter C.; Zhao, Chunfeng

    2014-01-01

    Tendon-to-bone integration is a great challenge for tendon or ligament reconstruction regardless of use of autograft or allograft tendons. We mineralized the tendon, thus transforming the tendon-to-bone into a “bone-to-bone” interface for healing. Sixty dog flexor digitorum profundus (FDP) tendons were divided randomly into 5 groups: 1) normal FDP tendon, 2) CaP (Non-extraction and mineralization without fetuin), 3) CaPEXT (Extraction by Na2HPO4 and mineralization without fetuin), 4) CaPFetuin (Non-extraction and mineralization with fetuin), and 5) CaPEXTFetuin (Extraction and mineralization with fetuin). The calcium and phosphate content significantly increased in tendons treated with combination of extraction and fetuin compared to the other treatments. Histology also revealed a dense mineral deposition throughout the tendon outer layers and penetrated into the tendon to a depth of 200 μm in a graded manner. Compressive moduli were significantly lower in the four mineralized groups compared with normal control group. No significant differences in maximum failure strength or stiffness were found in the suture pull-out test among all groups. Mineralization of tendon alters the interface from tendon to bone into mineralized tendon to bone, which may facilitate tendon-to-bone junction healing following tendon or ligament reconstruction. PMID:23939935

  16. Tendon gradient mineralization for tendon to bone interface integration.

    PubMed

    Qu, Jin; Thoreson, Andrew R; Chen, Qingshan; An, Kai-Nan; Amadio, Peter C; Zhao, Chunfeng

    2013-11-01

    Tendon-to-bone integration is a great challenge for tendon or ligament reconstruction regardless of use of autograft or allograft tendons. We mineralized the tendon, thus transforming the tendon-to-bone into a "bone-to-bone" interface for healing. Sixty dog flexor digitorum profundus (FDP) tendons were divided randomly into five groups: (1) normal FDP tendon, (2) CaP (non-extraction and mineralization without fetuin), (3) CaPEXT (Extraction by Na2 HPO4 and mineralization without fetuin), (4) CaPFetuin (non-extraction and mineralization with fetuin), and (5) CaPEXTFetuin (extraction and mineralization with fetuin). The calcium and phosphate content significantly increased in tendons treated with combination of extraction and fetuin compared to the other treatments. Histology also revealed a dense mineral deposition throughout the tendon outer layers and penetrated into the tendon to a depth of 200 µm in a graded manner. Compressive moduli were significantly lower in the four mineralized groups compared with normal control group. No significant differences in maximum failure strength or stiffness were found in the suture pull-out test among all groups. Mineralization of tendon alters the interface from tendon to bone into mineralized tendon to bone, which may facilitate tendon-to-bone junction healing following tendon or ligament reconstruction.

  17. How Obesity Affects Tendons?

    PubMed

    Abate, Michele; Salini, Vincenzo; Andia, Isabel

    2016-01-01

    Several epidemiological and clinical observations have definitely demonstrated that obesity has harmful effects on tendons. The pathogenesis of tendon damage is multi-factorial. In addition to overload, attributable to the increased body weight, which significantly affects load-bearing tendons, systemic factors play a relevant role. Several bioactive peptides (chemerin, leptin, adiponectin and others) are released by adipocytes, and influence tendon structure by means of negative activities on mesenchymal cells. The ensuing systemic state of chronic, sub-clinic, low-grade inflammation can damage tendon structure. Metabolic disorders (diabetes, impaired glucose tolerance, and dislipidemia), frequently associated with visceral adiposity, are concurrent pathogenetic factors. Indeed, high glucose levels increase the formation of Advanced Glycation End-products, which in turn form stable covalent cross-links within collagen fibers, modifying their structure and functionality.Sport activities, so useful for preventing important cardiovascular complications, may be detrimental for tendons if they are submitted to intense acute or chronic overload. Therefore, two caution rules are mandatory: first, to engage in personalized soft training program, and secondly to follow regular check-up for tendon pathology.

  18. How Obesity Affects Tendons?

    PubMed

    Abate, Michele; Salini, Vincenzo; Andia, Isabel

    2016-01-01

    Several epidemiological and clinical observations have definitely demonstrated that obesity has harmful effects on tendons. The pathogenesis of tendon damage is multi-factorial. In addition to overload, attributable to the increased body weight, which significantly affects load-bearing tendons, systemic factors play a relevant role. Several bioactive peptides (chemerin, leptin, adiponectin and others) are released by adipocytes, and influence tendon structure by means of negative activities on mesenchymal cells. The ensuing systemic state of chronic, sub-clinic, low-grade inflammation can damage tendon structure. Metabolic disorders (diabetes, impaired glucose tolerance, and dislipidemia), frequently associated with visceral adiposity, are concurrent pathogenetic factors. Indeed, high glucose levels increase the formation of Advanced Glycation End-products, which in turn form stable covalent cross-links within collagen fibers, modifying their structure and functionality.Sport activities, so useful for preventing important cardiovascular complications, may be detrimental for tendons if they are submitted to intense acute or chronic overload. Therefore, two caution rules are mandatory: first, to engage in personalized soft training program, and secondly to follow regular check-up for tendon pathology. PMID:27535258

  19. Sex Hormones and Tendon.

    PubMed

    Hansen, Mette; Kjaer, Michael

    2016-01-01

    The risk of overuse and traumatic tendon and ligament injuries differ between women and men. Part of this gender difference in injury risk is probably explained by sex hormonal differences which are specifically distinct during the sexual maturation in the teenage years and during young adulthood. The effects of the separate sex hormones are not fully elucidated. However, in women, the presence of estrogen in contrast to very low estrogen levels may be beneficial during regular loading of the tissue or during recovering after an injury, as estrogen can enhance tendon collagen synthesis rate. Yet, in active young female athletes, physiological high concentration of estrogen may enhance the risk of injuries due to reduced fibrillar crosslinking and enhanced joint laxity. In men, testosterone can enhance tendon stiffness due to an enhanced tendon collagen turnover and collagen content, but testosterone has also been linked to a reduced responsiveness to relaxin. The present chapter will focus on sex difference in tendon injury risk, tendon morphology and tendon collagen turnover, but also on the specific effects of estrogen and androgens. PMID:27535256

  20. Absence of the flexor digitorum longus tendon: an MRI study.

    PubMed

    Magra, Merzesh; Taqvi, Syed; Cooper, Robert; Blundell, Chris M; Davies, Mark B

    2012-11-01

    Flexor digitorum longus (FDL) is the primary flexor of the lateral four toes. It is a reliable source of tendon for transfer surgery. We present a case whereby a patient who required a reconstruction for adult acquired flatfoot deformity using FDL as a dynamic structure for transfer was found to have an absent FDL tendon at the time of operation, necessitating the use of flexor hallucis longus (FHL) instead. This unusual finding prompted us to investigate the frequency of absence of the FDL tendon. We reviewed our hospital MRI database of foot and ankle images specifically looking for patients with absence of this tendon. After randomization, 756 images were reviewed independently by two surgeons and a consultant musculoskeletal radiologist. No instances of an absent FDL tendon were identified. In conclusion, the frequency of absence of the FDL tendon is less than 1 in 750. Surgeons who require FDL for tendon transfer surgery need not image the foot preoperatively to anticipate the need for the use of FHL as an alternative. PMID:22334461

  1. Modelling approaches for evaluating multiscale tendon mechanics.

    PubMed

    Fang, Fei; Lake, Spencer P

    2016-02-01

    Tendon exhibits anisotropic, inhomogeneous and viscoelastic mechanical properties that are determined by its complicated hierarchical structure and varying amounts/organization of different tissue constituents. Although extensive research has been conducted to use modelling approaches to interpret tendon structure-function relationships in combination with experimental data, many issues remain unclear (i.e. the role of minor components such as decorin, aggrecan and elastin), and the integration of mechanical analysis across different length scales has not been well applied to explore stress or strain transfer from macro- to microscale. This review outlines mathematical and computational models that have been used to understand tendon mechanics at different scales of the hierarchical organization. Model representations at the molecular, fibril and tissue levels are discussed, including formulations that follow phenomenological and microstructural approaches (which include evaluations of crimp, helical structure and the interaction between collagen fibrils and proteoglycans). Multiscale modelling approaches incorporating tendon features are suggested to be an advantageous methodology to understand further the physiological mechanical response of tendon and corresponding adaptation of properties owing to unique in vivo loading environments.

  2. Relationship between tendon stiffness and failure: a metaanalysis

    PubMed Central

    LaCroix, Andrew S.; Duenwald-Kuehl, Sarah E.; Lakes, Roderic S.

    2013-01-01

    Tendon is a highly specialized, hierarchical tissue designed to transfer forces from muscle to bone; complex viscoelastic and anisotropic behaviors have been extensively characterized for specific subsets of tendons. Reported mechanical data consistently show a pseudoelastic, stress-vs.-strain behavior with a linear slope after an initial toe region. Many studies report a linear, elastic modulus, or Young's modulus (hereafter called elastic modulus) and ultimate stress for their tendon specimens. Individually, these studies are unable to provide a broader, interstudy understanding of tendon mechanical behavior. Herein we present a metaanalysis of pooled mechanical data from a representative sample of tendons from different species. These data include healthy tendons and those altered by injury and healing, genetic modification, allograft preparation, mechanical environment, and age. Fifty studies were selected and analyzed. Despite a wide range of mechanical properties between and within species, elastic modulus and ultimate stress are highly correlated (R2 = 0.785), suggesting that tendon failure is highly strain-dependent. Furthermore, this relationship was observed to be predictable over controlled ranges of elastic moduli, as would be typical of any individual species. With the knowledge gained through this metaanalysis, noninvasive tools could measure elastic modulus in vivo and reasonably predict ultimate stress (or structural compromise) for diseased or injured tendon. PMID:23599401

  3. Relationship between tendon stiffness and failure: a metaanalysis.

    PubMed

    LaCroix, Andrew S; Duenwald-Kuehl, Sarah E; Lakes, Roderic S; Vanderby, Ray

    2013-07-01

    Tendon is a highly specialized, hierarchical tissue designed to transfer forces from muscle to bone; complex viscoelastic and anisotropic behaviors have been extensively characterized for specific subsets of tendons. Reported mechanical data consistently show a pseudoelastic, stress-vs.-strain behavior with a linear slope after an initial toe region. Many studies report a linear, elastic modulus, or Young's modulus (hereafter called elastic modulus) and ultimate stress for their tendon specimens. Individually, these studies are unable to provide a broader, interstudy understanding of tendon mechanical behavior. Herein we present a metaanalysis of pooled mechanical data from a representative sample of tendons from different species. These data include healthy tendons and those altered by injury and healing, genetic modification, allograft preparation, mechanical environment, and age. Fifty studies were selected and analyzed. Despite a wide range of mechanical properties between and within species, elastic modulus and ultimate stress are highly correlated (R(2) = 0.785), suggesting that tendon failure is highly strain-dependent. Furthermore, this relationship was observed to be predictable over controlled ranges of elastic moduli, as would be typical of any individual species. With the knowledge gained through this metaanalysis, noninvasive tools could measure elastic modulus in vivo and reasonably predict ultimate stress (or structural compromise) for diseased or injured tendon.

  4. Anatomic variation of the 5th extensor tendon compartment and extensor digiti minimi tendon.

    PubMed

    Tanaka, Toshikazu; Moran, Steven L; Zhao, Chunfeng; Zobitz, Mark E; An, Kai-Nan; Amadio, Peter C

    2007-08-01

    Anatomic variation within the 5th extensor compartment may contribute to the development of tenosynovitis and limit the usefulness of the extensor digiti minimi (EDM) for tendon transfer. The purpose of this study was to assess the anatomic variation of the EDM tendon and its surrounding retinaculum, with particular attention to anatomical variation between specimens. Forty-one fresh cadaver hands were dissected. The length of the 5th compartment retinaculum was noted. The incidence of an intercompartmental septum was noted in each specimen as well as the type of tendinous attachments present between the EDM and extensor digitorum communis (EDC) tendons. The presence and length of any accessory retinacular bands distal to the edge of proper extensor retinaculum was also noted. Only one specimen contained a single EDM tendon, while 71% (n = 29) of specimens contained two slips and 23% (n = 9) had three slips; 24% (n = 10) of EDC tendons had no slip to the small finger, while 61% (n = 25) of specimens had a single slip to the small finger. The EDC's contribution to the small finger was found to be an independent tendon in 42% of cases (n = 17), while 34% (n = 14) of specimens were found to have a common EDC slip, which branched to both the ring and small finger. Three EDM tendons divided distal to the extensor retinaculum, while the remaining EDM tendons divided beneath or proximal to the extensor retinaculum. Seventy-three percent (n = 30) of the specimens had an accessory retinacular band surrounding the EDM tendon identified at the base of the 5th metacarpal. Eighty-eight percent (n = 36) of hands had a septum between the EDM slips. The surgeon should be aware of variability within the 5th dorsal compartment in cases of trauma and in cases of tendon transfer. In our series 30 of 41 specimens were noted to contain an accessory dorsal retinacular band surrounding the EDM and 36 specimens were noted to contain a septum within the 5th compartment. The presence of an

  5. Use of a Hunter Rod for Staged Reconstruction of Peroneal Tendons.

    PubMed

    Raikin, Steven M; Schick, Faith A; Karanjia, Homyar N

    2016-01-01

    Peroneal tendon pathology is a commonly reported cause of lateral ankle pain. The causes include cavovarus foot type, overuse, chronic tendinosis, peroneal subluxation or dislocation, acute traumatic split tears, and traumatic rupture. The purpose of the present report is to describe an alternative approach for surgical reconstruction of the peroneal tendons in patients when repair might no longer be effective. The use of a Hunter rod was originally described by Hunter in 1971 for 2-stage reconstruction of tendons in the hand. We present a 2-stage surgical technique with the use of a Hunter rod as a temporary implant to stimulate generation of a healthy peroneal tendon sheath to host a flexor hallucis longus tendon transfer. This has proved to be a successful treatment option for patients with severe peroneal tendon damage and scarring along the peroneal tendon sheath. We offer a sample case to illustrate a patient with such indications.

  6. Spontaneous rupture of the extensor pollicis brevis tendon in a baseball pitcher: a case report.

    PubMed

    Fujimoto, Takuya; Tanase, Yoshihiro; Oribe, Takashi; Watanabe, Yasushi

    2009-01-01

    A 15-year-old pitcher on a boys' Little League baseball team suffered spontaneous rupture of the extensor pollicis brevis (EPB) tendon. Since the EPB tendon was, at surgery, found hypoplastic and non-functional, transfer of the extensor indicis proprius (EIP) tendon was carried out. After a 6-month period of rehabilitation and follow-up, the patient was able to resume playing baseball. Although rupture of the EPB is rare, transfer of the EIP tendon is one of the treatments of choice for such injuries.

  7. SHEAR CARRYING CAPACITY OF SEGMENTAL CONCRETE BEAMS WITH DRAPED EXTERNAL TENDONS

    NASA Astrophysics Data System (ADS)

    Nguyen, Dinh Hung; Matsumoto, Koji; Watanabe, Ken; Hasegawa, Tsuyoshi; Niwa, Junichiro

    This study presents an investigation of the shear be havior of segmental concrete beams with draped external tendons. Deviator force and transfer mechanism of prestressing force from an anchorage that affect the shear failure mechanism have been examined base d on the results of experimental procedure and FEM with different location of deviator and inclined angle of draped tendons. The modified model proposed by authors has been extended for segmental concrete beam s with draped external tendons with considering the effect of deviator force and transfer mechanism of prestressing force from the anchorage. The results from the extended modified model for draped external tendons had a good agreement with experimental results.

  8. [Simultaneous rupture of a patellar tendon and contralateral quadriceps tendon].

    PubMed

    Horas, U; Ernst, S; Meyer, C; Halbsguth, A; Herbst, U

    2006-09-01

    The simultaneous bilateral rupture of the quadriceps tendon is a rare injury; only occasional reports exist about the bilateral simultaneous rupture of the patellar tendon. Degenerative changes of the tendon due to drugs or diseases lead to the rupture. We describe two cases of simultaneous rupture of the patellar and contralateral quadriceps tendons; only one patient had special risks. We report the management of therapy and the functional results using the Lysholm score and Knee Rating Scale.

  9. Characterization of mechanical and biochemical properties of developing embryonic tendon.

    PubMed

    Marturano, Joseph E; Arena, Jeffrey D; Schiller, Zachary A; Georgakoudi, Irene; Kuo, Catherine K

    2013-04-16

    Tendons have uniquely high tensile strength, critical to their function to transfer force from muscle to bone. When injured, their innate healing response results in aberrant matrix organization and functional properties. Efforts to regenerate tendon are challenged by limited understanding of its normal development. Consequently, there are few known markers to assess tendon formation and parameters to design tissue engineering scaffolds. We profiled mechanical and biological properties of embryonic tendon and demonstrated functional properties of developing tendon are not wholly reflected by protein expression and tissue morphology. Using force volume-atomic force microscopy, we found that nano- and microscale tendon elastic moduli increase nonlinearly and become increasingly spatially heterogeneous during embryonic development. When we analyzed potential biochemical contributors to modulus, we found statistically significant but weak correlation between elastic modulus and collagen content, and no correlation with DNA or glycosaminoglycan content, indicating there are additional contributors to mechanical properties. To investigate collagen cross-linking as a potential contributor, we inhibited lysyl oxidase-mediated collagen cross-linking, which significantly reduced tendon elastic modulus without affecting collagen morphology or DNA, glycosaminoglycan, and collagen content. This suggests that lysyl oxidase-mediated cross-linking plays a significant role in the development of embryonic tendon functional properties and demonstrates that changes in cross-links alter mechanical properties without affecting matrix content and organization. Taken together, these data demonstrate the importance of functional markers to assess tendon development and provide a profile of tenogenic mechanical properties that may be implemented in tissue engineering scaffold design to mechanoregulate new tendon regeneration.

  10. Autologous hamstring tendon used for revision of quadiceps tendon tears.

    PubMed

    McCormick, Frank; Nwachukwu, Benedict U; Kim, Jaehon; Martin, Scott D

    2013-04-01

    A paucity of literature exists on quadriceps tendon reruptures. Failed quadriceps tendon repair can cause significant morbidity and disability. Surgical management of quadriceps tendon rerupture can be challenging due to tissue degeneration, tendon retraction, muscle atrophy, and poor bone fixation. A lack of guidance in the literature exists on the appropriate surgical techniques for managing quadriceps tendon reruptures.This article describes the case of a male recreational athlete with a failed primary quadriceps tendon repair who presented 10 months after rerupture. Examination was significant for morbid obesity, assisted ambulation, and a significant defect at the superior pole of the patella on the affected side. Intraoperative findings were consistent with a 2.0- to 4.5-cm tendon defect across the extensor mechanism with complete retinaculi tears. The authors performed a novel surgical approach for revision of quadriceps tears using a bilateral hamstring autograft through a quadriceps tendon weave and a transosseous patellar repair. Tendon length was restored, and extensor mechanism tension was reapproximated. Postoperatively, the patient achieved a good outcome and had returned to full, painless, sport participation at 2-year follow-up.This surgical technique is suitable for revision quadriceps tendon repairs of large tendon gap defects, repairs desiring tendon-to-bone in-growth, and repairs requiring large-force transmission across the repair.

  11. The role of hind limb tendons in gibbon locomotion: springs or strings?

    PubMed

    Vereecke, Evie E; Channon, Anthony J

    2013-11-01

    Tendon properties have an important effect on the mechanical behaviour of muscles, with compliant tendons allowing near-isometric muscle contraction and facilitating elastic energy storage and recoil. Stiff tendons, in contrast, facilitate rapid force transfer and precise positional control. In humans, the long Achilles tendon contributes to the mechanical efficiency of running via elastic energy storage and recovery, and its presence has been linked to the evolution of habitual bipedalism. Gibbons also possess relatively long hind limb tendons; however, their role is as yet unknown. Based on their large dimensions, and inferring from the situation in humans, we hypothesize that the tendons in the gibbon hind limb will facilitate elastic energy storage and recoil during hind-limb-powered locomotion. To investigate this, we determined the material properties of the gibbon Achilles and patellar tendon in vitro and linked this with available kinematic and kinetic data to evaluate their role in leaping and bipedalism. Tensile tests were conducted on tendon samples using a material testing machine and the load-displacement data were used to calculate stiffness, Young's modulus and hysteresis. In addition, the average stress-in-life and energy absorption capacity of both tendons were estimated. We found a functional difference between the gibbon Achilles and patellar tendon, with the Achilles tendon being more suitable for elastic energy storage and release. The patellar tendon, in contrast, has a relatively high hysteresis, making it less suitable to act as elastic spring. This suggests that the gibbon Achilles tendon might fulfil a similar function as in humans, contributing to reducing the locomotor cost of bipedalism by acting as elastic spring, while the high stiffness of the patellar tendon might favour fast force transfer upon recoil and, possibly, enhance leaping performance.

  12. [Quadriceps and patellar tendon ruptures].

    PubMed

    Grim, C; Lorbach, O; Engelhardt, M

    2010-12-01

    Ruptures of the quadriceps or patellar tendon are uncommon but extremely relevant injuries. Early diagnosis and surgical treatment with a stable suture construction are mandatory for a good postoperative clinical outcome. The standard methods of repair for quadriceps and patellar tendon injuries include the placement of suture loops through transpatellar tunnels. Reinforcement with either a wire cerclage or a PDS cord is used in patellar tendon repair. The PDS cord can also be applied as augmentation in quadriceps tendon repair. In secondary patellar tendon repair an autologous semitendinosus graft can be used. For chronic quadriceps tendon defects a V-shaped tendon flap with a distal footing is recommended. The different methods of repair should lead to early functional postoperative treatment. The clinical outcome after surgical treatment of patellar and quadriceps tendon ruptures is mainly good.

  13. Hyperuricemia in Tendons.

    PubMed

    Andia, Isabel; Abate, Michele

    2016-01-01

    Hyperuricemia, particularly gout, and the immune inflammatory response are highly integrated. Both, long standing hyperuricemia and monosodium urate (MSU) crystal deposition can challenge tendon homeostasis because of their potential to cause inflammation to the host. Knowledge is emerging from clinical imaging research depicting where MSU crystals deposit, including patellar tendon, triceps and quadriceps tendons. Remarkably, subclinical tendon inflammation and damage are also present in asymptomatic hyperuricemia. Monosodium urate crystals act as danger activating molecular patterns (DAMPs), activating the inflammasome and inducing the secretion of IL-1beta, a key mediator of the inflammatory response. The crucial role of IL-1beta in driving the inflammatory events during gout attacks is supported by the clinical efficacy of IL-1beta blockade. Some data implicating IL-1beta as an initiator of tendinopathy exist, but the link between hyperuricemia and the development of tendinopathy remains to be validated. Further knowledge about the interactions of uric acid with both innate immune and tendon cells, and their consequences may help to determine if there is a subclass of hyperuricemic-tendinopathy. PMID:27535254

  14. Tendon Driven Finger Actuation System

    NASA Technical Reports Server (NTRS)

    Ihrke, Chris A. (Inventor); Reich, David M. (Inventor); Bridgwater, Lyndon (Inventor); Linn, Douglas Martin (Inventor); Askew, Scott R. (Inventor); Diftler, Myron A. (Inventor); Platt, Robert (Inventor); Hargrave, Brian (Inventor); Valvo, Michael C. (Inventor); Abdallah, Muhammad E. (Inventor); Permenter, Frank Noble (Inventor); Mehling, Joshua S. (Inventor)

    2013-01-01

    A humanoid robot includes a robotic hand having at least one finger. An actuation system for the robotic finger includes an actuator assembly which is supported by the robot and is spaced apart from the finger. A tendon extends from the actuator assembly to the at least one finger and ends in a tendon terminator. The actuator assembly is operable to actuate the tendon to move the tendon terminator and, thus, the finger.

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

    PubMed Central

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

    2015-01-01

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

  16. Effect of suspension method and aging time on meat quality of Chinese fattened cattle M. Longissimus dorsi.

    PubMed

    Hou, Xu; Liang, Rongrong; Mao, Yanwei; Zhang, Yimin; Niu, Lebao; Wang, Renhuan; Liu, Chenglong; Liu, Yuqing; Luo, Xin

    2014-01-01

    Objectives of the present study were to evaluate the effects of suspension method and aging time on quality traits of Chinese fattened cattle M. Longissimus dorsi (LD). At the end of the slaughter line, the right sides of carcasses were re-hung from the pelvic bone obturator foramen, while the left sides remained hung by Achilles tendon suspension (AS). LD muscles were aged for 1, 7, 14 and 21 days and were then evaluated for quality index. Pelvic suspension (PS) significantly decreased the WBSF of beef muscle at 1 d and 7 d postmortem compared with AS. The tenderness with PS at 7 d postmortem was similar with that of AS at 14 d. Moreover, PS increased sarcomere length and decreased purge loss of LD significantly. In addition, aging time had a significant effect on pH, meat color, Warner-Bratzler shear force, and myofibril fragmentation index of LD muscle. To conclude, PS is valuable to be introduced to the beef industry in China for rapid (within 7 days) improvement of beef tenderness and decreased aging time of Chinese fattened cattle.

  17. Neuronal regulation of tendon homoeostasis.

    PubMed

    Ackermann, Paul W

    2013-08-01

    The regulation of tendon homoeostasis, including adaptation to loading, is still not fully understood. Accumulating data, however, demonstrates that in addition to afferent (sensory) functions, the nervous system, via efferent pathways which are associated with through specific neuronal mediators plays an active role in regulating pain, inflammation and tendon homeostasis. This neuronal regulation of intact-, healing- and tendinopathic tendons has been shown to be mediated by three major groups of molecules including opioid, autonomic and excitatory glutamatergic neuroregulators. In intact healthy tendons the neuromediators are found in the surrounding structures: paratenon, endotenon and epitenon, whereas the proper tendon itself is practically devoid of neurovascular supply. This neuroanatomy reflects that normal tendon homoeostasis is regulated from the tendon surroundings. After injury and during tendon repair, however, there is extensive nerve ingrowth into the tendon proper, followed by a time-dependent emergence of sensory, autonomic and glutamatergic mediators, which amplify and fine-tune inflammation and regulate tendon regeneration. In tendinopathic condition, excessive and protracted presence of sensory and glutamatergic neuromediators has been identified, suggesting involvement in inflammatory, nociceptive and hypertrophic (degenerative) tissue responses. Under experimental and clinical conditions of impaired (e.g. diabetes) as well as excessive (e.g. tendinopathy) neuromediator release, dysfunctional tendon homoeostasis develops resulting in chronic pain and gradual degeneration. Thus there is a prospect that in the future pharmacotherapy and tissue engineering approaches targeting neuronal mediators and their receptors may prove to be effective therapies for painful, degenerative and traumatic tendon disorders.

  18. Neuronal regulation of tendon homoeostasis

    PubMed Central

    Ackermann, Paul W

    2013-01-01

    The regulation of tendon homoeostasis, including adaptation to loading, is still not fully understood. Accumulating data, however, demonstrates that in addition to afferent (sensory) functions, the nervous system, via efferent pathways which are associated with through specific neuronal mediators plays an active role in regulating pain, inflammation and tendon homeostasis. This neuronal regulation of intact-, healing- and tendinopathic tendons has been shown to be mediated by three major groups of molecules including opioid, autonomic and excitatory glutamatergic neuroregulators. In intact healthy tendons the neuromediators are found in the surrounding structures: paratenon, endotenon and epitenon, whereas the proper tendon itself is practically devoid of neurovascular supply. This neuroanatomy reflects that normal tendon homoeostasis is regulated from the tendon surroundings. After injury and during tendon repair, however, there is extensive nerve ingrowth into the tendon proper, followed by a time-dependent emergence of sensory, autonomic and glutamatergic mediators, which amplify and fine-tune inflammation and regulate tendon regeneration. In tendinopathic condition, excessive and protracted presence of sensory and glutamatergic neuromediators has been identified, suggesting involvement in inflammatory, nociceptive and hypertrophic (degenerative) tissue responses. Under experimental and clinical conditions of impaired (e.g. diabetes) as well as excessive (e.g. tendinopathy) neuromediator release, dysfunctional tendon homoeostasis develops resulting in chronic pain and gradual degeneration. Thus there is a prospect that in the future pharmacotherapy and tissue engineering approaches targeting neuronal mediators and their receptors may prove to be effective therapies for painful, degenerative and traumatic tendon disorders. PMID:23718724

  19. Latissimus Dorsi Flap Invasion by Ductal Breast Carcinoma after Lipofilling

    PubMed Central

    Alharbi, Muhannad; Garrido, Ignacio; Vaysse, Charlotte; Chavoin, Jean Pierre; Grolleau, Jean Louis

    2013-01-01

    Summary: Autologous fat grafting is commonly performed in reconstructive breast surgery but also increasingly in breast augmentation surgery. On the international level, we are witnessing an important increased confidence for this procedure. Nevertheless, it continues to raise questions on the risks of cancer. A 66-year-old patient benefited from a lipofilling to improve a latissimus dorsi flap breast reconstruction, 7 years after initial cancer management. Two years later, constant pain in the flap leads to reoperation. The flap showed a major retraction with histologically massive infiltration of the muscle by an undifferentiated carcinoma of breast origin. The tumor cells were displayed directly in contact with lipofilling inside the muscle. Without establishing any causal link between these 2 events, this case raises the question once more of the risks of breast cancer and encourages us to continue being careful. PMID:25289263

  20. Open Achilles tendon lacerations.

    PubMed

    Said, M Nader; Al Ateeq Al Dosari, Mohamed; Al Subaii, Nasser; Kawas, Alaa; Al Mas, Ali; Al Ser, Yaser; Abuodeh, Yousef; Shakil, Malik; Habash, Ali; Mukhter, Khalid

    2015-04-01

    In contrast to closed Achilles tendon ruptures, open injuries are rarely reported in the literature. This paper provides information about open Achilles tendon wounds that are eventually seen in the Middle East. The reporting unit, Hamad Medical Corporation, is one of the biggest trauma centers in the Gulf area and the major health provider in Qatar. This is a retrospective study including patients admitted and operated for open Achilles tendon injuries between January 2011 and December 2013. Two hundred and five cases of open Achilles tendon lacerations were operated in Hamad General Hospital in this period. Forty-eight cases showed partial injuries, and the remaining are complete tendons cut. In the same period, fifty-one closed ruptured Achilles tendons were operated in the same trauma unit. In the majority of cases, the open injury resulted from a slip in the floor-leveled traditional toilette seats. Local damage to the toilette seats resulted in sharp edges causing the laceration of the heel if the patient was slipping over the wet floor. This occurrence is the cause in the vast majority of the cases. Wounds were located 1-5 cm proximal to tendon insertion. Standard treatment principles were applied. This included thorough irrigation in the emergency room, intravenous antibiotics, surgical debridement and primary repair within 24 h. Patients were kept in the hospital 1-7 days for intravenous antibiotics and possible dressing changes. Postoperatively below knee slabs were applied in the majority of patients and were kept for about 4 weeks followed by gradual weight bearing and range of motion exercises. Outpatients follow up in 1-2 weeks. Further follow-up visits at around 2-, 4-, 8- and 12-week intervals until complete wound healing and satisfactory rehabilitation outcome. Sixteen cases needed a second procedure. A high incidence of Achilles tendon open injuries is reported. This seems to be related to partially damaged floor-level toilettes in the

  1. Distal Triceps Tendon Injuries.

    PubMed

    Keener, Jay D; Sethi, Paul M

    2015-11-01

    Acute triceps ruptures are an uncommon entity, occurring mainly in athletes, weight lifters (especially those taking anabolic steroids), and following elbow trauma. Accurate diagnosis is made clinically, although MRI may aid in confirmation and surgical planning. Acute ruptures are classified on an anatomic basis based on tear location and the degree of tendon involvement. Most complete tears are treated surgically in medically fit patients. Partial-thickness tears are managed according to the tear severity, functional demands, and response to conservative treatment. We favor an anatomic footprint repair of the triceps to provide optimal tendon to bone healing and, ultimately, functional outcome. PMID:26498552

  2. Arthroscopic treatment of infrapatellar tendonitis.

    PubMed

    Romeo, A A; Larson, R V

    1999-04-01

    Infrapatellar tendonitis is a chronic overload lesion in the patellar ligament at the attachment to the lower pole of the patella. This lesion is found primarily in athletes who participate in jumping sports. Magnetic resonance imaging or ultrasound can show the extent of tendon pathology. Patellar tendonitis is treated with modification of activities, medications, and therapy. When conservative measures fail, operative debridement has been recommended. Previous reports have described a technique of open debridement of the patellar tendon, followed by an extended period of rehabilitation before returning to sports. Two athletes with persistent infrapatellar tendonitis were treated with an arthroscopic debridement. Both athletes returned to full activities without restrictions within 8 weeks of surgery. Arthroscopic treatment of infrapatellar tendonitis has not been previously described. This technical note describes the technique and two case reports of the arthroscopic treatment of infrapatellar tendonitis.

  3. Fetal reconstructive surgery: experimental use of the latissimus dorsi flap to correct myelomeningocele in utero.

    PubMed

    Meuli-Simmen, C; Meuli, M; Hutchins, G M; Harrison, M R; Buncke, H J; Sullivan, K M; Adzick, N S

    1995-10-01

    A recent study in human fetuses with myelomeningocele produced evidence that nonclosure of the spine leads to progressive damage of the exposed spinal cord during pregnancy. Thus in utero coverage might spare function. We tested the use of the latissimus dorsi flap for fetal myelomeningocele repair. In seven sheep fetuses, a lumbar myelomeningocele type of lesion was created at 75 days' gestation and was covered with a "reversed" latissimus dorsi flap at 100 days. At term, the three survivors had healed cutaneous wounds and normal hindlimb function. The vascular pedicle of the latissimus dorsi flap was patent, the viable flap covered the entire lesion, and the underlying spinal cord was grossly intact. We conclude that the latissimus dorsi flap repair is suitable for fetal surgery and provides efficient coverage of the lesion. These results have clinical implications, since fetal myelomeningocele repair may be a compelling way to reduce the severe neurologic deficit in humans. PMID:7568473

  4. Age-related changes in mechanical properties of the Achilles tendon.

    PubMed

    Waugh, C M; Blazevich, A J; Fath, F; Korff, T

    2012-02-01

    The stiffness of a tendon, which influences muscular force transfer to the skeleton and increases during childhood, is dependent on its material properties and dimensions, both of which are influenced by chronic loading. The aims of this study were to: (i) determine the independent contributions of body mass, force production capabilities and tendon dimensions to tendon stiffness during childhood; and (ii) descriptively document age-related changes in tendon mechanical properties and dimensions. Achilles tendon mechanical and material properties were determined in 52 children (5-12 years) and 19 adults. Tendon stiffness and Young's modulus (YM) were calculated as the slopes of the force-elongation and stress-strain curves, respectively. Relationships between stiffness vs. age, mass and force, and between YM vs. age, mass and stress were determined by means of polynomial fits and multiple regression analyses. Mass was found to be the best predictor of stiffness, whilst stress was best related to YM (< 75 and 51% explained variance, respectively). Combined, mass and force accounted for up to 78% of stiffness variation. Up to 61% of YM variability could be explained using a combination of mass, stress and age. These results demonstrate that age-related increases in tendon stiffness are largely attributable to increased tendon loading from weight-bearing tasks and increased plantarflexor force production, as well as tendon growth. Moreover, our results suggest that chronic increases in tendon loading during childhood result in microstructural changes which increase the tendon's YM. Regarding the second aim, peak stress increased from childhood to adulthood due to greater increases in strength than tendon cross-sectional area. Peak strain remained constant as a result of parallel increases in tendon length and peak elongation. The differences in Achilles tendon properties found between adults and children are likely to influence force production, and ultimately movement

  5. Shear Loads Induce Cellular Damage in Tendon Fascicles

    PubMed Central

    Kondratko-Mittnacht, Jaclyn; Lakes, Roderic; Vanderby, Ray

    2016-01-01

    Tendon is vital to musculoskeletal function, transferring loads from muscle to bone for joint motion and stability. It is an anisotropic, highly organized, fibrous structure containing primarily type I collagen in addition to tenocytes and other extracellular matrix components contributing to maintenance and function. Tendon is generally loaded via normal stress in a longitudinal direction. However, certain situations, including fiber breakage, enzymatic remodeling, or tendon pathology may introduce various degrees of other loading modalities, such as shear-lag at the fiber level, potentially affecting cellular response and subsequent function. Fascicles from rat tail tendon were dissected and placed in one of three paired groups: intact, single laceration, or double laceration. Each pair had a mechanically tested and control specimen. Single laceration fascicles contained one transverse laceration to mimic a partial tear. Double laceration fascicles had overlapping, longitudinally separated lacerations on opposite sides to cause intra-fascicular shear transfer to be the primary mechanism of loading. Elastic properties of the fascicle, e.g. peak load, steady state load, and stiffness, decreased from intact to single laceration to double laceration groups. Surprisingly, 45% of the intact strength was maintained when shear was the primary internal load transfer mechanism. Cellular viability decreased after mechanical testing in both laceration groups; cell death appeared primarily in a longitudinal plane where high shear load transfer occurred. This cell death extended far from the injury site and may further compromise an already damaged tendon via enzymatic factors and subsequent remodeling associated with cell necrosis. PMID:26162546

  6. Shear loads induce cellular damage in tendon fascicles.

    PubMed

    Kondratko-Mittnacht, Jaclyn; Lakes, Roderic; Vanderby, Ray

    2015-09-18

    Tendon is vital to musculoskeletal function, transferring loads from muscle to bone for joint motion and stability. It is an anisotropic, highly organized, fibrous structure containing primarily type I collagen in addition to tenocytes and other extracellular matrix components contributing to maintenance and function. Tendon is generally loaded via normal stress in a longitudinal direction. However, certain situations, including fiber breakage, enzymatic remodeling, or tendon pathology may introduce various degrees of other loading modalities, such as shear-lag at the fiber level, potentially affecting cellular response and subsequent function. Fascicles from rat tail tendon were dissected and placed in one of three paired groups: intact, single laceration, or double laceration. Each pair had a mechanically tested and control specimen. Single laceration fascicles contained one transverse laceration to mimic a partial tear. Double laceration fascicles had overlapping, longitudinally separated lacerations on opposite sides to cause intra-fascicular shear transfer to be the primary mechanism of loading. Elastic properties of the fascicle, e.g. peak load, steady state load, and stiffness, decreased from intact to single laceration to double laceration groups. Surprisingly, 45% of the intact strength was maintained when shear was the primary internal load transfer mechanism. Cellular viability decreased after mechanical testing in both laceration groups; cell death appeared primarily in a longitudinal plane where high shear load transfer occurred. This cell death extended far from the injury site and may further compromise an already damaged tendon via enzymatic factors and subsequent remodeling associated with cell necrosis. PMID:26162546

  7. Gastrocnemius myotendinous flap for patellar or quadriceps tendon repair, or both.

    PubMed

    Rhomberg, M; Schwabegger, A H; Ninkovic, M; Bauer, T; Ninkovic, M

    2000-08-01

    The authors' experience with simultaneous reconstruction of the quadriceps femoris or patellar tendon or both and soft tissue defect using a musculotendinous unit of the gastrocnemius muscle is presented. Five patients with a partial or complete defect of the quadriceps or patellar tendon or both and additional large soft tissue defects underwent reconstruction applying this technique as a one-stage surgical procedure in different variations. In cases with a partial defect of the tendon or loss of tendon thickness, the thick aponeurosis from the deeper aspect of the gastrocnemius was dissected and transferred as a pedicled tendon flap to reconstruct the tendon defect. In cases with a complete defect of the tendon, the superficial layer of the Achilles tendon together with the deep aponeurotic layer of the gastrocnemius muscle served to reconstruct the tendon. In both procedures the gastrocnemius muscle belly provided soft tissue coverage and was covered with a split thickness skin graft. One patient had a marginal deep necrosis develop that had to be covered with the other gastrocnemius muscle in a second operation. One patient with chronic polyarthritis and infection of his knee prosthesis declined additional reconstruction surgery and had the leg amputated. The average followup was 3.5 years. All patients achieved good results in active extension of the knee with an extension deficit of only 5 degrees to 15 degrees. The range of flexion was at least 90 degrees. The surgical technique described in this report provides functional tendon reconstruction and adequate soft tissue repair simultaneously.

  8. [Damage to large tendons: Achilles, patellar and quadriceps tendons].

    PubMed

    Amlang, M H; Zwipp, H

    2006-07-01

    The etiology and mechanisms of Achilles, patellar and quadriceps tendon ruptures are very similar. Age dependent changes in tendon structure and disorders such gout, diabetes, rheumatic diseases and chronic renal failure are associated causes. The main mechanism of rupture is indirect trauma. Although clinical diagnosis is easy, ruptures are still frequently missed. Sonography is the main standard diagnostic tool. MRI is indicated only in special cases. Open operative repair is the most common treatment for quadriceps and patellar tendon ruptures. Treatment of Achilles tendon ruptures is moving towards an individualized choice of therapy. Percutaneous and other "minimally invasive" techniques will play an increasingly important role.

  9. Scaffolds in Tendon Tissue Engineering

    PubMed Central

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

    2012-01-01

    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. PMID:22190961

  10. Activity Patterns in Latissimus Dorsi and Sternocleidomastoid in Classical Singers

    PubMed Central

    Watson, Alan H.D.; Williams, Caitlin; James, Buddug V.

    2012-01-01

    Summary Objectives The aim of this study was to investigate and compare the roles of the accessory respiratory muscles, latissimus dorsi (LD), and sternocleidomastoid, in classical singing. Methods Electromyography was used to record the activity of these muscles in six classically trained female singers carrying out a number of singing and nonsinging tasks. Movements of the chest and abdominal walls were monitored simultaneously using inductive plethysmography, and the sound of the phonations was recorded. Results In normal breathing, LD is active transiently during very deep inhalations and in inhalation against resistance. During exhalation it becomes active again as residual capacity is approached or when air is expelled with great force. Sternocleidomastoid (SCM) supports inhalation when lung volume nears 100% vital capacity or when this is very rapid. All singers engaged LD in supported singing where it was associated with maintaining an expanded thorax. In coloratura singing, pulses of activity of increasing amplitude were often seen in LD toward the end of the breath. These were synchronized with each note. During a short phrase typical of the end of an aria, which was sung at full volume with the projected voice, both LD and SCM were active simultaneously. Spectral analysis of muscle activity demonstrated that in some singers, activity in LD and more rarely SCM, fluctuated in phase with vibrato. Conclusions LD appears to play a significant role in maintaining chest expansion and the dynamic processes underlying vibrato and coloratura singing in classically trained singers. PMID:21724365

  11. Activity of latissimus dorsi muscle during inspiratory threshold loads.

    PubMed

    Orozco-Levi, M; Gea, J; Monells, J; Aran, X; Aguar, M C; Broquetas, J M

    1995-03-01

    The ability of the latissimus dorsi muscle (LD) to participate as an accessory inspiratory muscle has been the subject of controversy. Electromyographic (EGM) activity of LD was evaluated in 11 healthy subjects (aged 30 +/- 2 yrs; forced expiratory volume in one second (FEV1) 106 +/- 5% predicted; maximal inspiratory pressure (Pmax), 120 +/- 6 cmH2O) under different breathing conditions. The ipsilateral biceps brachii was chosen as the control muscle. The EMG was recorded from surface electrodes, but needle electrodes were also used for LD evaluation in a subset of three subjects. The EMG signal from both muscles was recorded simultaneously, rectified and integrated, with subtraction of the electrocardiographic signal. Situations evaluated were: 1) maximal voluntary contraction (MVC); 2) apnoea; and 3) breathing under progressive inspiratory threshold loads (20-100% Pmax, at 20% intervals). A close relationship was evident between LD recordings from surface and needle electrodes (r = 0.975). Activity of LD at baseline was 1.8 +/- 0.4% MVC, and showed a phasic increase during inspiration under loads. This change had a linear tendency and was significant for loads corresponding to 40, 60, 80 and 100% of Pmax when compared to the control muscle. At this latter level, LD activity was equivalent to 32 +/- 5% MVC (range 11-61%), whereas mean activity of the control muscle was less than 7.5% MVC.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7789491

  12. Peroneal tendons subluxation.

    PubMed

    Oliva, Francesco; Del Frate, Dario; Ferran, Nicholas Antonio; Maffulli, Nicola

    2009-06-01

    Subluxation of the peroneal tendons is uncommon. It occurs especially in skiing, soccer, basketball, rugby, ice skating, judo, sprint, water-skiing, mountaineering, and gymnastics. We present an overview of the injury, with the classification commonly used. Many surgical techniques have been described to manage recurrent subluxation of the peroneal tendons, but only Level IV/Grade C evidence has been produced. Thus, randomized controlled trials are necessary to determinate the best surgical management method. It appears that high-demand individuals should be primarily managed surgically, and retinaculoplasty seems to be, when indicated, the best surgical option: it affords less complications and a high rate of return to sports without reducing their activity levels.

  13. Isolated vastus lateralis tendon avulsion.

    PubMed

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

    2013-10-01

    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.

  14. Architectural analysis and predicted functional capability of the human latissimus dorsi muscle.

    PubMed

    Gerling, Michael E; Brown, Stephen H M

    2013-08-01

    The latissimus dorsi is primarily considered a muscle with actions at the shoulder, despite its widespread attachments at the spine. There is some dispute regarding the potential contribution of this muscle to lumbar spine function. The architectural design of a muscle is one of the most accurate predictors of muscle function; however, detailed architectural data on the latissimus dorsi muscle are limited. Therefore, the aim of this study was to quantify the architectural properties of the latissimus dorsi muscle and model mechanical function in light of these new data. One latissimus dorsi muscle was removed from each of 12 human cadavers, separated into regions, and micro-dissected for quantification of fascicle length, sarcomere length, and physiological cross-sectional area. From these data, sarcomere length operating ranges were modelled to determine the force-length characteristics of latissimus dorsi across the spine and shoulder ranges of motion. The physiological cross-sectional area of latissimus dorsi was 5.6±0.5 cm2 and normalized fascicle length was 26.4±1.0 cm, indicating that this muscle is designed to produce a moderate amount of force over a large range of lengths. Measured sarcomere length in the post-mortem neutral spine posture was nearly optimal at 2.69±0.06 μm. Across spine range of motion, biomechanical modelling predicted latissimus dorsi acts across both the ascending and descending limbs of the force-length curve during lateral bend, and primarily at or near the plateau region (where maximum force generation is possible) during flexion/extension and axial twist. Across shoulder range of motion, latissimus dorsi acts primarily on the plateau region and descending limbs of the force length curve during both flexion/extension and abduction/adduction. These data provide novel insights into the ability of the latissimus dorsi muscle to generate force and change length throughout the spine and shoulder ranges of motion. In addition, these

  15. The Scarless Latissimus Dorsi Flap Provides Effective Lower Pole Prosthetic Coverage in Breast Reconstruction

    PubMed Central

    Miteff, Kirstin G.

    2014-01-01

    Background: The evolution of surgical breast cancer treatment has led to the oncologically safe preservation of greater amounts of native skin, yet we are still often using flaps with large skin paddles, thereby resulting in significant donor-site scars. This explains the increasing appeal of acellular dermal matrix reconstructions. Acellular dermal matrices can, however, have significant problems, particularly if there is any vascular compromise of the mastectomy skin flaps. We have developed a method of raising the latissimus dorsi flap through the anterior mastectomy incisions without requiring special instruments or repositioning. This can provide autologous vascularized cover of the prosthesis. Methods: A clear surgical description of the scarless latissimus dorsi flap harvest is provided, and our results of a retrospective cohort review of 20 consecutive patients with 27 traditional latissimus dorsi breast reconstructions were compared with those of 20 consecutive patients with 30 scarless latissimus dorsi breast reconstructions. Results: Operative time, length of stay, and complication rates were reduced in the scarless group. Patients Breast-Q scores were equivalent in each group. The aesthetic assessment was good/excellent in 77% of both groups; however, subscale assessment was better in the scarless group. This was statistically significant (P = 0.0). Conclusions: Breast reconstruction using the scarless latissimus dorsi flap is time effective, requires no patient repositioning, and uses standard breast instrumentation. It is safe and versatile while reducing the risk of exposed prosthesis if native skin necrosis occurs. It is a vascularized alternative to acellular dermal matrices. PMID:25289340

  16. Structure of the latissimus dorsi muscle and respiratory function.

    PubMed

    Orozco-Levi, M; Gea, J; Sauleda, J; Corominas, J M; Minguella, J; Aran, X; Broquetas, J M

    1995-03-01

    The aim of this study was to evaluate whether respiratory function influences the structure of the latissimus dorsi muscle (LD). Twelve patients (58 +/- 10 yr) undergoing thoracotomy were studied. Lung and respiratory muscle function were evaluated before surgery. Patients showed a forced expired volume in 1 s (FEV1) of 67 +/- 16% of the reference value, an FEV1-forced vital capacity ratio of 69 +/- 9%, a maximal inspiratory pressure of 101 +/- 21% of the reference value, and a tension-time index of the diaphragm (TTdi) of 0.04 +/- 0.02. When patients were exposed to 8% CO2 breathing, TTdi increased to 0.06 +/- 0.03 (P < 0.05). The structural analysis of LD showed that 51 +/- 5% of the fibers were type I. The diameter was 56 +/- 9 microns for type I fibers and 61 +/- 9 microns for type II fibers, whereas the hypertrophy factor was 87 +/- 94 and 172 +/- 208 for type I and II fibers, respectively. Interestingly, the histogram distribution of the LD fibers was unimodal in two of the three individuals with normal lung function and bimodal (additional mode of hypertrophic fibers) in seven of the nine patients with chronic obstructive pulmonary disease. An inverse relationship was found between the %FEV1-forced vital capacity ratio and both the diameter of the fibers (type I: r = -0.773, P < 0.005; type II: r = -0.590, P < 0.05) and the hypertrophy factors (type I: r = -0.647, P < 0.05; type II: r = -0.575, P = 0.05).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7775307

  17. An Artificial Tendon with Durable Muscle Interface

    PubMed Central

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

    2010-01-01

    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. PMID:19639642

  18. Diabetes alters mechanical properties and collagen fiber re-alignment in multiple mouse tendons.

    PubMed

    Connizzo, Brianne K; Bhatt, Pankti R; Liechty, Kenneth W; Soslowsky, Louis J

    2014-09-01

    Tendons function to transfer load from muscle to bone through their complex composition and hierarchical structure, consisting mainly of type I collagen. Recent evidence suggests that type II diabetes may cause alterations in collagen structure, such as irregular fibril morphology and density, which could play a role in the mechanical function of tendons. Using the db/db mouse model of type II diabetes, the diabetic skin was found to have impaired biomechanical properties when compared to the non-diabetic group. The purpose of this study was to assess the effect of diabetes on biomechanics, collagen fiber re-alignment, and biochemistry in three functionally different tendons (Achilles, supraspinatus, patellar) using the db/db mouse model. Results showed that cross-sectional area and stiffness, but not modulus, were significantly reduced in all three tendons. However, the tendon response to load (transition strain, collagen fiber re-alignment) occurred earlier in the mechanical test, contrary to expectations. In addition, the patellar tendon had an altered response to diabetes when compared to the other two tendons, with no changes in fiber re-alignment and decreased collagen content at the midsubstance of the tendon. Overall, type II diabetes alters tendon mechanical properties and the dynamic response to load.

  19. Study of optical properties and proteoglycan content of tendons by polarization sensitive optical coherence tomography

    NASA Astrophysics Data System (ADS)

    Yang, Ying; Rupani, Asha; Bagnaninchi, Pierre; Wimpenny, Ian; Weightman, Alan

    2012-08-01

    The highly orientated collagen fibers in tendons play a critical role for transferring tensile stress, and they demonstrate birefringent optical properties. However, the influence that proteoglycans (PGs) have on the optical properties of tendons is yet to be fully elucidated. PGs are the essential components of the tendon extracellular matrix; the changes in their quantities and compositions have been associated with tendinopathies. In this study, polarization sensitive optical coherence tomography (PS-OCT) has been used to reveal the relationship between PG content/location and birefringence properties of tendons. Fresh chicken tendons were imaged at regular intervals by PS-OCT and polarization light microscopy during the extraction of PGs, using guanidine hydrochloride (GuHCl). Complementary time-lapsed images taken from the two modalities mutually demonstrated that the extraction of PGs disturbed the local organization of collagen bundles. This corresponded with a decrease in birefringence and associated banding pattern observed by PS-OCT. Furthermore, this study revealed there was a higher concentration of PGs in the outer sheath region than in the fascicles, and therefore the change in birefringence was reduced when extraction was performed on unsheathed tendons. The results provide new insights of tendon structure and the role of PGs on the structural stability of tendons, which also demonstrates the great potential for using PS-OCT as a diagnostic tool to examine tendon pathology.

  20. Study of optical properties and proteoglycan content of tendons by polarization sensitive optical coherence tomography.

    PubMed

    Yang, Ying; Rupani, Asha; Bagnaninchi, Pierre; Wimpenny, Ian; Weightman, Alan

    2012-08-01

    The highly orientated collagen fibers in tendons play a critical role for transferring tensile stress, and they demonstrate birefringent optical properties. However, the influence that proteoglycans (PGs) have on the optical properties of tendons is yet to be fully elucidated. PGs are the essential components of the tendon extracellular matrix; the changes in their quantities and compositions have been associated with tendinopathies. In this study, polarization sensitive optical coherence tomography (PS-OCT) has been used to reveal the relationship between PG content/location and birefringence properties of tendons. Fresh chicken tendons were imaged at regular intervals by PS-OCT and polarization light microscopy during the extraction of PGs, using guanidine hydrochloride (GuHCl). Complementary time-lapsed images taken from the two modalities mutually demonstrated that the extraction of PGs disturbed the local organization of collagen bundles. This corresponded with a decrease in birefringence and associated banding pattern observed by PS-OCT. Furthermore, this study revealed there was a higher concentration of PGs in the outer sheath region than in the fascicles, and therefore the change in birefringence was reduced when extraction was performed on unsheathed tendons. The results provide new insights of tendon structure and the role of PGs on the structural stability of tendons, which also demonstrates the great potential for using PS-OCT as a diagnostic tool to examine tendon pathology.

  1. Spontaneous bilateral quadriceps tendon rupture.

    PubMed

    Vigneswaran, N; Lee, K; Yegappan, M

    2007-11-01

    Spontaneous bilateral quadriceps tendon ruptures are uncommon. We present a 30-year-old man with end-stage renal failure, who sustained this injury, and subsequently had surgical repair of both tendons on separate occasions. He has since regained full range of movement of both knees.

  2. Reconstruction of Rare Skull Metastases Using Free Latissimus Dorsi Flap and the Role of Preoperative Embolization in Hypervascular Skull Tumors.

    PubMed

    Singh, Mansher; Ricci, Joseph A; Talbot, Simon G; Chiocca, E Antonio; Dunn, Ian F; Caterson, Edward J

    2015-11-01

    Metastatic tumors are the most common cranial neoplasms in adults. Skull metastases from rare primary tumors, such as cholangiocarcinoma or pancreatic neuroendocrine tumor, are extremely uncommon and rarely reported. Given the scarcity and variation of these rare skull metastases, treatments and outcomes of such patients are of interest to treating surgeons. The authors describe the treatment algorithm, course, and outcomes of 2 patients with rare gastrointestinal skull metastases. The first patient had intrahepatic cholangiocarcinoma metastatic to the skull, while the second patient developed a solitary skull metastasis secondary to a pancreatic neuroendocrine tumor. As part of this report, the authors include a literature review of rare skull metastases as well as the treatment of these 2 patients. Both the patients ultimately underwent successful resection of the tumor for relief of their clinical symptoms. Wide resections in both patients necessitated reconstruction using a free latissimus dorsi muscle flap in both the patients. Preoperative embolization of the hypervascular cholangiocarcinoma skull metastasis was performed prior to resection in the first patient. To date, there have been only 4 such reports of skull metastases from intrahepatic cholangiocarcinoma and limited reported cases of isolated skull metastases from a pancreatic neuroendocrine tumor.In patients with large or numerous skull metastasis from rare primary tumors, surgical resection should be considered for symptomatic improvement. In cases of hypervascular lesions, preoperative embolization can be considered to decrease the intraoperative bleeding. Free tissue transfers using myocutaneous flaps such as latissimus dorsi help in obliterating dead space, and creating a healthy soft tissue envelope to withstand postoperative radiation treatment. In addition, a chimeric flap can be designed to include additional muscle or soft tissue to obliterate and exclude the sinus cavities.

  3. The Healing Effects of Aquatic Activities and Allogenic Injection of Platelet-Rich Plasma (PRP) on Injuries of Achilles Tendon in Experimental Rat

    PubMed Central

    Rajabi, Hamid; Sheikhani Shahin, Homa; Norouzian, Manijeh; Mehrabani, Davood; Dehghani Nazhvani, Seifollah

    2015-01-01

    BACKGROUND Clinical tendon injuries represent serious and unresolved issues of the case on how the injured tendons could be improved based on natural structure and mechanical strength. The aim of this studies the effect of aquatic activities and alogenic platelet rich plasma (PRP) injection in healing Achilles tendons of rats. METHODS Forty rats were randomly divided into 5 equal groups. Seventy two hours after a crush lesion on Achilles tendon, group 1 underwent aquatic activity for 8 weeks (five sessions per week), group 2 received intra-articular PRP (1 ml), group 3 had aquatic activity together with injection PRP injection after an experimental tendon injury, group 4 did not receive any treatment after tendon injury and the control group with no tendon injuries. of 32 rats. After 8 weeks, the animals were sacrificed and the tendons were transferred in 10% formalin for histological evaluation. RESULTS There was a significant increase in number of fibroblast and cellular density, and collagen deposition in group 3 comparing to other groups denoting to an effective healing in injured tendons. However, there was no significant difference among the studied groups based on their tendons diameter. CONCLUSION Based on our findings on the number of fibroblast, cellular density, collagen deposition, and tendon diameter, it was shown that aquatic activity together with PRP injection was the therapeutic measure of choice enhance healing in tendon injuries that can open a window in treatment of damages to tendons. PMID:25606479

  4. Physico-chemical and processing quality of porcine M. longissimus dorsi frozen at different temperatures.

    PubMed

    Sakata, R; Oshida, T; Morita, H; Nagata, Y

    1995-01-01

    Longissimus dorsi muscle from six pigs (24 h post-mortem) was cut into portions of similar size and shape (c. 700 g) and vacuum-packed in polyfilm. The muscle specimens were divided into three samples, one frozen at -20°C, another at -80°C and the third served as the control (not frozen). The meat sample frozen at -80°C was transferred to the -20°C freezer. After one month, both frozen pork samples were thawed at -2°C and drip loss (%) was measured. Hunter colour, metmyoglobin (MetMb) formation (%), water-holding capacity (WHC), TBA value, transmission value (TM) and myofibril fragmentation were also determined. There was no significant difference in drip loss for the two frozen samples. No MetMb formation could be detected and Hunter values were basically the same for all three samples. WHC, TBA value and TM were essentially the same for all three samples. TBA value was quite low for each frozen sample, indicating that lipid oxidation did not occur during freezing. Histological examination of both frozen samples indicated inter- and intracellular ice crystal formation at -20°C, and intracellular ice at -80°C, the extent being less than at -20°C. At -20°C, ice crystals were larger and muscle fibre diameter smaller than for the control or -80°C sample. Myofibril fragmentation in both frozen samples was significantly higher than in the control. Pork sausage was prepared from all three samples by adding 2% NaCl and 100 ppm NaNO(2). Cooking loss and colour forming ratios were essentially the same. The sausage sample made from the -20°C frozen meat was harder than that of the other two samples according to rheological measurement.

  5. Intraoperative hemodynamic evaluation of the latissimus dorsi muscle flap: a prospective study.

    PubMed

    Lorenzetti, Fulvio; Giordano, Salvatore; Tukiainen, Erkki

    2012-05-01

    The aim of this study was to assess intraoperatively the hemodynamic changes in the donor vessel of free latissimus dorsi (LD) flap before and after denervation and to analyze flow changes after flap transfer. Twenty-seven patients underwent LD muscle microvascular reconstruction for lower-limb soft tissue defects. Measurements of blood flow were performed intraoperatively by using a 2- to 5-mm probe ultrasonic transit-time flowmeter around the dissected vessels. Registrations were made in the thoracodorsal artery before and after harvesting the flap, after compressing and cutting the motor nerve, and after anastomosis. Mean blood flow of in situ harvested thoracodorsal artery as measured intraoperatively by transit-time flowmeter was (mean ± standard deviation) 16.6 ± 11 mL/min and was significantly increased after raising the flap to 24.0 ± 22 mL/min (p <0.05); it was 25.6 ± 23 mL/min after compressing the motor nerve and was significantly increased after cutting the motor nerve to 32.5 ± 26 mL/min (p <0.05). A significant increase of blood flow to 28.1 ± 19 mL/min was also detected in the thoracodorsal artery after flap transplantation with end-to-side anastomosis (p <0.05). Vascular resistance in the thoracodorsal artery significantly decreased after flap raising and anastomosis (from 7.5 ± 3.4 to 4.0 ± 1.9 and to 4.5 ± 2.4, respectively, p <0.05). LD flap harvesting increases blood flow and decreases resistance in the thoracodorsal artery, especially after denervation. PMID:22492006

  6. Two cases of peroneus brevis tendon tear.

    PubMed

    Minoyama, O; Uchiyama, E; Iwaso, H; Hiranuma, K; Takeda, Y

    2002-02-01

    A longitudinal tear of the peroneal tendon is thought to be the result of repetitive peroneal subluxation. However, this report documents two cases of longitudinal split of the peroneus brevis tendon that had no peroneal tendon subluxation. Primary suture was performed. Subluxation of the peroneal tendons was not identified surgically in either case.

  7. Achilles Tendon Rupture

    PubMed Central

    Wertz, Jess; Galli, Melissa; Borchers, James R.

    2013-01-01

    Context: Achilles tendon (AT) rupture in athletes is increasing in incidence and accounts for one of the most devastating sports injuries because of the threat to alter or end a career. Despite the magnitude of this injury, reliable risk assessment has not been clearly defined, and prevention strategies have been limited. The purpose of this review is to identify potential intrinsic and extrinsic risk factors for AT rupture in aerial and ground athletes stated in the current literature. Evidence Acquisition: A MEDLINE search was conducted on AT rupture, or “injury” and “risk factors” and “athletes” from 1980 to 2011. Emphasis was placed on epidemiology, etiology, and review articles focusing on the risk for lower extremity injury in runners and gymnasts. Thirty articles were reviewed, and 22 were included in this assessment. Results: Aerial and ground athletes share many intrinsic risk factors for AT rupture, including overuse and degeneration of the tendon as well as anatomical variations that mechanically put an athlete at risk. Older athletes, athletes atypical in size for their sport, high tensile loads, leg dominance, and fatigue also may increase risk. Aerial athletes tend to have more extrinsic factors that play a role in this injury due to the varying landing surfaces from heights and technical maneuvers performed at various skill levels. Conclusion: Risk assessment for AT rupture in aerial and ground athletes is multivariable and difficult in terms of developing prevention strategies. Quantitative measures of individual risk factors may help identify major contributors to injury. PMID:24427410

  8. Extensor pollicis brevis tendon can hyperextend thumb interphalangeal joint in absence of extensor pollicis longus: Case report and review of the literature

    PubMed Central

    Strauch, Robert J; Strauch, Carolyn B

    2016-01-01

    We are reporting a case of extensor pollicis longus tendon rupture which did not require tendon transfer owing to the ability of the intact extensor pollicis brevis (EPB) to fully hyperextend the thumb interphalangeal joint. The thumb metacarpophalangeal joint was also able to be fully actively extended by the EPB. Previous anatomical studies have demonstrated that the insertional anatomy of the EPB tendon is highly variable and sometimes inserts onto the extensor hood and distal phalanx, which is likely the mechanism by which our patient was able to fully extend the thumb interphalangeal joint. Despite the potential for the EPB to extend the IP joint of the thumb, virtually all previously reported cases of extensor pollicis longus (EPL) tendon rupture had deficits of thumb IP extension requiring tendon transfer. This case highlights the potential ability of the EPB tendon to completely substitute for the function of the EPL tendon in providing thumb IP joint extension. PMID:27458556

  9. Extensor pollicis brevis tendon can hyperextend thumb interphalangeal joint in absence of extensor pollicis longus: Case report and review of the literature.

    PubMed

    Strauch, Robert J; Strauch, Carolyn B

    2016-07-18

    We are reporting a case of extensor pollicis longus tendon rupture which did not require tendon transfer owing to the ability of the intact extensor pollicis brevis (EPB) to fully hyperextend the thumb interphalangeal joint. The thumb metacarpophalangeal joint was also able to be fully actively extended by the EPB. Previous anatomical studies have demonstrated that the insertional anatomy of the EPB tendon is highly variable and sometimes inserts onto the extensor hood and distal phalanx, which is likely the mechanism by which our patient was able to fully extend the thumb interphalangeal joint. Despite the potential for the EPB to extend the IP joint of the thumb, virtually all previously reported cases of extensor pollicis longus (EPL) tendon rupture had deficits of thumb IP extension requiring tendon transfer. This case highlights the potential ability of the EPB tendon to completely substitute for the function of the EPL tendon in providing thumb IP joint extension. PMID:27458556

  10. Tendon grafts: their natural history, biology and future development.

    PubMed

    Wong, R; Alam, N; McGrouther, A D; Wong, J K F

    2015-09-01

    The use of tendon grafts has diminished as regimes of primary repairs and rehabilitation have improved, but they remain important in secondary reconstruction. Relatively little is known about the cellular biology of grafts, and the general perception is that they have little biological activity. The reality is that there is a wealth of cellular and molecular changes occurring with the process of engraftment that affect the quality of the repair. This review highlights the historical perspectives and modern concepts of graft take, reviews the different attachment techniques and revisits the biology of pseudosheath formation. In addition, we discuss some of the future directions in tendon reconstruction by grafting, which include surface modification, vascularized tendon transfer, allografts, biomaterials and cell-based therapies.

  11. Tendon-to-Bone Attachment: From Development to Maturity

    PubMed Central

    Zelzer, Elazar; Blitz, Einat; Killian, Megan L.; Thomopoulos, Stavros

    2014-01-01

    The attachment between tendon and bone occurs across a complex transitional tissue that minimizes stress concentrations and allows for load transfer between muscles and skeleton. This unique tissue cannot be reconstructed following injury, leading to high incidence of recurrent failure and stressing the need for new clinical approaches. This review describes the current understanding of the development and function of the attachment site between tendon and bone. The embryonic attachment unit, namely, the tip of the tendon and the bone eminence into which it is inserted, was recently shown to develop modularly from a unique population of Sox9- and Scx-positive cells, which are distinct from tendon fibroblasts and chondrocytes. The fate and differentiation of these cells is regulated by transforming growth factor beta and bone morphogenetic protein signaling, respectively. Muscle loads are then necessary for the tissue to mature and mineralize. Mineralization of the attachment unit, which occurs postnatally at most sites, is largely controlled by an Indian hedgehog/parathyroid hormone-related protein feedback loop. A number of fundamental questions regarding the development of this remarkable attachment system require further study. These relate to the signaling mechanism that facilitates the formation of an interface with a gradient of cellular and extracellular phenotypes, as well as to the interactions between tendon and bone at the point of attachment. PMID:24677726

  12. Effects of quantitative trait loci on mineral content 1 of bovine longissimus dorsi muscle

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Beef cattle require dietary minerals to maintain their health, production and reproduction. Concentrations of minerals in tissues are at least partially genetically determined. Mapping genomic regions related to the mineral content of the bovine longissimus dorsi muscle may help in the identificatio...

  13. Stochastic Interdigitation as a Toughening Mechanism at the Interface between Tendon and Bone

    PubMed Central

    Hu, Yizhong; Birman, Victor; Demyier-Black, Alix; Schwartz, Andrea G.; Thomopoulos, Stavros; Genin, Guy M.

    2015-01-01

    Reattachment and healing of tendon to bone poses a persistent clinical challenge and often results in poor outcomes, in part because the mechanisms that imbue the uninjured tendon-to-bone attachment with toughness are not known. One feature of typical tendon-to-bone surgical repairs is direct attachment of tendon to smooth bone. The native tendon-to-bone attachment, however, presents a rough mineralized interface that might serve an important role in stress transfer between tendon and bone. In this study, we examined the effects of interfacial roughness and interdigital stochasticity on the strength and toughness of a bimaterial interface. Closed form linear approximations of the amplification of stresses at the rough interface were derived and applied in a two-dimensional unit-cell model. Results demonstrated that roughness may serve to increase the toughness of the tendon-to-bone insertion site at the expense of its strength. Results further suggested that the natural tendon-to-bone attachment presents roughness for which the gain in toughness outweighs the loss in strength. More generally, our results suggest a pathway for stochasticity to improve surgical reattachment strategies and structural engineering attachments. PMID:25606690

  14. Basic FGF or VEGF gene therapy corrects insufficiency in the intrinsic healing capacity of tendons

    PubMed Central

    Tang, Jin Bo; Wu, Ya Fang; Cao, Yi; Chen, Chuan Hao; Zhou, You Lang; Avanessian, Bella; Shimada, Masaru; Wang, Xiao Tian; Liu, Paul Y.

    2016-01-01

    Tendon injury during limb motion is common. Damaged tendons heal poorly and frequently undergo unpredictable ruptures or impaired motion due to insufficient innate healing capacity. By basic fibroblast growth factor (bFGF) or vascular endothelial growth factor (VEGF) gene therapy via adeno-associated viral type-2 (AAV2) vector to produce supernormal amount of bFGF or VEGF intrinsically in the tendon, we effectively corrected the insufficiency of the tendon healing capacity. This therapeutic approach (1) resulted in substantial amelioration of the low growth factor activity with significant increases in bFGF or VEGF from weeks 4 to 6 in the treated tendons (p < 0.05 or p < 0.01), (2) significantly promoted production of type I collagen and other extracellular molecules (p < 0.01) and accelerated cellular proliferation, and (3) significantly increased tendon strength by 68–91% from week 2 after AAV2-bFGF treatment and by 82–210% from week 3 after AAV2-VEGF compared with that of the controls (p < 0.05 or p < 0.01). Moreover, the transgene expression dissipated after healing was complete. These findings show that the gene transfers provide an optimistic solution to the insufficiencies of the intrinsic healing capacity of the tendon and offers an effective therapeutic possibility for patients with tendon disunion. PMID:26865366

  15. An unusual array of extensor musculature and tendons of the hand clinico-anatomical insight.

    PubMed

    Dave, V; Gandhi, S; Mehta, V; Kumar, A; Arora, J; Suri, R K; Rath, G

    2014-01-01

    Extensor tendon injury is a frequent finding in clinical practice. During a routine dissection class of undergraduate medical students examining the extensor aspect of the right hand, they found an interesting pattern of extensor tendons. The extensor digitorum (ED) exhibited three tendons for the middle and ring fingers. The intermediate tendon of the ED was found to pass to the junctura connecting the tendons of the ring and middle fingers. Additionally the Extensor carpi ulnaris displayed two tendinus slips. The lateral slip was inserted on the base of fifth metacarpal as usual, whereas the medial slip divided into two strands- proximal and distal. Apart from the above findings in the current case specimen, there was an accessory muscle belly for the index finger and the extensor digiti minimi bifurcated into two tendinus slips which gained attachment to the dorsal digital expansion of the little finger. These accessory muscle bellies and tendons could possibly be utilized for tendon reconstructions such as repairs, tenoplasties or tendon transfers.

  16. Hyaluronic acid and tendon lesions

    PubMed Central

    Kaux, Jean-François; Samson, Antoine; Crielaard, Jean-Michel

    2015-01-01

    Summary Introduction recently, the viscoelastic properties of hyaluronic acid (HA) on liquid connective tissue have been proposed for the treatment of tendinopathies. Some fundamental studies show encouraging results on hyaluronic acid’s ability to promote tendon gliding and reduce adhesion as well as to improve tendon architectural organisation. Some observations also support its use in a clinical setting to improve pain and function. This literature review analyses studies relating to the use of hyaluronic acid in the treatment of tendinopathies. Methods this review was constructed using the Medline database via Pubmed, Scopus and Google Scholar. The key words hyaluronic acid, tendon and tendinopathy were used for the research. Results in total, 28 articles (in English and French) on the application of hyaluronic acid to tendons were selected for their relevance and scientific quality, including 13 for the in vitro part, 7 for the in vivo animal part and 8 for the human section. Conclusions preclinical studies demonstrate encouraging results: HA permits tendon gliding, reduces adhesions, creates better tendon architectural organisation and limits inflammation. These laboratory observations appear to be supported by limited but encouraging short-term clinical results on pain and function. However, controlled randomised studies are still needed. PMID:26958533

  17. The axillary approach to raising the latissimus dorsi free flap for facial re-animation: a descriptive surgical technique.

    PubMed

    Leckenby, Jonathan; Butler, Daniel; Grobbelaar, Adriaan

    2015-01-01

    The latissimus dorsi flap is popular due to the versatile nature of its applications. When used as a pedicled flap it provides a robust solution when soft tissue coverage is required following breast, thoracic and head and neck surgery. Its utilization as a free flap is extensive due to the muscle's size, constant anatomy, large caliber of the pedicle and the fact it can be used for functional muscle transfers. In facial palsy it provides the surgeon with a long neurovascular pedicle that is invaluable in situations where commonly used facial vessels are not available, in congenital cases or where previous free functional muscle transfers have been attempted, or patients where a one-stage procedure is indicated and a long nerve is required to reach the contra-lateral side. Although some facial palsy surgeons use the trans-axillary approach, an operative guide of raising the flap by this method has not been provided. A clear guide of raising the flap with the patient in the supine position is described in detail and offers the benefits of reducing the risk of potential brachial plexus injury and allows two surgical teams to work synchronously to reduce operative time.

  18. The long head of the biceps tendon is a suitable cell source for tendon tissue regeneration

    PubMed Central

    Pietschmann, Matthias F.; Gülecyüz, Mehmet F.; Ficklscherer, Andreas; Jansson, Volkmar; Müller, Peter E.

    2014-01-01

    Introduction Tendon tissue engineering (TTE) tries to produce tendinous tissue of high quality to replace dysfunctional tissue. One possible application of TTE might be the replacement of ruptured tissue of the rotator cuff. Autologous tenocytes seem to be most suitable as no differentiation in vitro is necessary. Today it is still uncertain if there is a difference between tendon-derived cells (TDC) of different native tissues. Moreover, the search for suitable scaffolds is another important issue in TTE. Material and methods This study compared TDC of the long head of the biceps tendon (LHB), the anterior cruciate ligament (ACL) and the tendon of the musculus semitendinosus (TMS). The TDC were isolated using the cell migration method. Cell morphology was assessed using light microscopy and gene expression was performed using polymerase chain reaction (PCR). Afterwards, cell seeding efficiency and proliferation were tested on a collagen I scaffold using the WST-1 assay. Results were confirmed using H + E staining. Results The TDC of the LHB showed higher expression levels of collagen type I and decorin (p < 0.01) compared to TDC of other origin. Results showed efficient cell seeding and proliferation within the scaffold. Proliferation within the scaffold was not as high as when cells were cultivated without a scaffold. Conclusions The TDC of the LHB seems to be the most suitable cell source. Further research is necessary to find out if the results can be transferred to an in vivo model. The new collagen I scaffold seems to offer an opportunity to combine good biocompatibility and mechanical strength. PMID:25097592

  19. Early Management, With a Minimal Initial Hospitalization Length, of Major Self-inflicted Rifle Wounds to the Face by a Single Latissimus Dorsi Free Musculocutaneous Flap: A 10-Year Experience

    PubMed Central

    Danino, A. M.; Hariss, P. G.; Servant, J. M.

    2009-01-01

    Objective: Severe ballistic injuries to the face create complex, composite defects of 2 facial subunits. These injuries have an extremely high economic impact for the Medicare system. The surgical goal with these patients is to restore basic functions of the face with a rapid morphological improvement. Our hypothesis is as follows: Early restoration of facial segments with a single free multiple island latissimus dorsi flap without primary bone reconstruction can significantly reduce hospitalization time and allow earlier psychiatric therapy with good morphological results. Surgical method: (1) Large debridement, bony stabilization with external fixation, and tracheotomy. (2) Definitive early reconstruction of soft tissue with composite free latissimus dorsi-scapular musculocutaneous flap. (3) Several refinements will optimize the results. Study design: Retrospective case series of lower- and middle-face composite facial close-range high-energy gunshot wound patients were evaluated. Age, gender, mechanism of injury, anatomic subsites involved, surgical procedures, flaps utilized, complications, functional outcomes, time of tracheotomy closure, hospitalization duration, and beginning of psychiatric treatment were analyzed. Results: Twelve defects were gunshot wounds, 12 free latissimus dorsi flaps, and no flap losses. Patients received psychiatric treatment after 22 days (7–29); the tracheotomy was removed in 10 patients with normal alimentation in all cases. Mean hospitalization duration was 21 days. Conclusions: Free tissue transfer techniques allow early reconstruction of the soft tissue framework of the face with a single multiple-island flap. Rapid restitution of facial compartments at a soft tissue level can dramatically reduce duration of hospitalization. PMID:19587777

  20. Operative treatment in case of a closed rupture of the anterior tibial tendon.

    PubMed

    Otte, Stephanie; Klinger, Hans-Michael; Lorenz, Frank; Haerer, Thomas

    2002-04-01

    Closed rupture of the tibial anterior tendon is a rare clinical entity. Case reports in the literature reveal a total of only 49 cases up to the year 2000. According to these reports, the age group affected is 50 to 70 years old, and there are more men than women affected. Although the functional limitation is quite considerable, late diagnosis is common. An appropriate clinical examination, including an exact history taking, should lead to the right diagnosis. Ultrasound examination and magnetic resonance imaging (MRI) may be helpful. 'Restitutio ad integrum' can only be achieved by operative treatment. If technically possible, reinsertion of the tendon directly into bone or direct tendon repair is preferred. After delayed diagnosis, a secondary reconstruction through tendon transfer or transplantation is often necessary. A 64-year-old woman presented with pain and swelling in the area of the ankle joint 5 months after falling. She showed insecurity in walking, and the heel-walk could not be demonstrated. The distal neurovascular function was intact. The area of the retinaculum showed a swelling, and the tendon was not palpable in comparison with the other forefoot. An intact tendon could not be seen by ultrasound, and MRI confirmed these findings. A complete rupture was noted during the operative revision. The proximal and the distal tendon stumps were found to be thickened and knotted, the proximal stump was also atrophic. An augmented tenoplasty was performed. Afterwards, the tendon was tense in the neutral position. The lower leg was put in a plaster cast for 6 weeks, followed by physiotherapy. Ten months after the operation, the tendon was palpable in the correct position, the dorsal extension was powerful, and the patient did not experience any difficulty. Rupture of the anterior tibial tendon is a rare clinical entity and should be considered in the differential diagnosis of pain in the area of the ankle joint. An early operative treatment is advantageous.

  1. The study of optical properties and proteoglycan content of tendons by PS-OCT

    NASA Astrophysics Data System (ADS)

    Yang, Ying; Rupani, Asha; Weightman, Alan; Wimpenny, Ian; Bagnaninchi, Pierre; Ahearne, Mark

    2011-03-01

    Tendons are load-bearing collagenous tissues consisting mainly of type I collagen and various proteoglycans (PGs) including decorin and versican. It is widely accepted that highly orientated collagen fibers in tendons a play critical role for transferring tensile stress and demonstrate birefringent optical properties. However, the influence that proteoglycans have on the optical properties of tendons is yet to be fully elucidated. Tendinopathy (defined as a syndrome of tendon pain, tenderness and swelling that affects the normal function of the tissue) is a common disease associated with sporting injuries or degeneration. PG's are the essential components of the tendon extracellular matrix; changes in their quantities and compositions have been associated with tendinopathy. In this study, polarization sensitive optical coherence tomography (PS-OCT) has been used to reveal the relationship between proteoglycan content/location and birefringent properties of tendons. Tendons dissected from freshly slaughtered chickens were imaged at regular intervals by PS-OCT and polarizing light microscope during the extraction of PGs or glycosaminoglycans using established protocols (guanidine hydrochloride (GuHCl) or proteinase K solution). The macroscopic and microscopic time lapsed images are complimentary; mutually demonstrating that there was a higher concentration of PG's in the outer sheath region than in the fascicles; and the integrity of the sheath affected extraction process and the OCT birefringence bands. Extraction of PGs using GuHCl disturbed the organization of local collagen bundles, which corresponded to a reduction in the frequency of birefringence bands and the band width by PS-OCT. The feature of OCT penetration depth helped us to define the heterogeneous distribution of PG's in tendon, which was complimented by polarizing light microscopy. The results provide new insight of tendon structure and also demonstrate a great potential for using PS-OCT as a

  2. Achilles tendon rupture rehabilitation

    PubMed Central

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

    2015-01-01

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

  3. Adaptation of the tendon to mechanical usage.

    PubMed

    Reeves, N D

    2006-01-01

    Tendons primarily function as contractile force transmitters, but their mechanical properties may change dependent upon their level of mechanical usage. Using an ultrasound-based technique we have assessed tendon mechanical properties in vivo in a number of conditions representing different levels of mechanical usage. Ageing alters tendon mechanical properties; stiffness and modulus were lower in older adults by 10 and 14%, respectively, compared to young adults. Increased levels of exercise loading in old age can however partly reverse this process, as tendon stiffness and modulus were found to increase by 65 and 69%, respectively. Complete unloading due to bed rest or spinal cord injury both reduce tendon stiffness and modulus, however, only chronic unloading due to spinal cord injury seems to cause tendon atrophy. Alterations in tendon mechanical properties due to changes in the levels loading have implications for the speed of force transmission, the muscle's operating range and the likelihood of tendon strain injury.

  4. Quadriceps and patellar tendon rupture.

    PubMed

    Ramseier, L E; Werner, C M L; Heinzelmann, M

    2006-06-01

    Ruptures of the patellar and/or quadriceps tendon are rare injuries that require immediate repair to re-establish knee extensor continuity and to allow early motion. We evaluated 36 consecutive patients with quadriceps or patellar tendon rupture between 1993 and 2000. There were 37 primary ruptures, 3 reruptures, 21 quadriceps and 19 patellar tendon ruptures. Follow up examination (>24 months postoperatively) included the patient's history, assessment of risk factors, clinical examination of both knees, isometric muscle strength measurements and three specific knee scores, Hospital for Special Surgery Score, Knee Society Score and Turba Score, and a short form SF-36. We evaluated 29 patients (26 men) with 33 ruptures (16 patellar tendon, 17 quadriceps tendon). Seven patients were lost to follow up. We found no difference between the range of motion and muscle strength when the injured leg was compared to the non-injured leg. Risk factors did not influence the four scores, patient satisfaction, pain, muscle strength or range of motion. Multiple injured patients had a significant reduction in muscle strength and circumference, however patient satisfaction did not differ to the non-multiple injured patient group.

  5. Triceps tendon rupture in weight lifters.

    PubMed

    Sollender, J L; Rayan, G M; Barden, G A

    1998-01-01

    Triceps tendon avulsion injuries are rare. We report four weight lifters with triceps tendon raptures, two of whom had received local steroid injections for pain in the triceps. All four patients had taken oral anabolic steroids before injury. All patients had closed avulsion of the triceps tendon from its insertion into the olecranon. Three patients were injured while bench pressing heavy weights, and one patient was injured while swinging a baseball bat. Satisfactory results were achieved after surgical reinsertion of the tendon.

  6. Staged tendon grafts and soft tissue coverage

    PubMed Central

    Elliot, David

    2011-01-01

    The objective of the two-staged flexor tendon method is to improve the predictability of final results in difficult problems dealing with tendon reconstruction. This article reviews the evolution and benefits of this procedure. It also considers the use of the technique to help deal with problems requiring pulley and skin reconstruction simultaneously with re-constituting the flexor tendon system. PMID:22022043

  7. Achilles tendon reflex measuring system

    NASA Astrophysics Data System (ADS)

    Szebeszczyk, Janina; Straszecka, Joanna

    1995-06-01

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

  8. Reconstruction of transhumeral amputation stumps with ipsilateral pedicled latissimus dorsi myocutaneous flap in high voltage electrical burns.

    PubMed

    Kesiktas, Erol; Eser, Cengiz; Gencel, Eyuphan; Aslaner, Emrah Efe; Yavuz, Metin

    2015-03-01

    Injury due to high-voltage (>1000V) electricity is one of the most challenging problems in emergency medicine and plastic surgery. Extremity amputation because of electrical injury yields a stump that leaves vital structures, such as bone, muscle, blood vessels, and nerves, exposed; these structures should be covered with appropriate tissue. We designed a retrospective study that included twelve patients with a high-voltage electrical injury followed by trans-humeral amputation who were evaluated between 2004 and 2013. The ages of the patients ranged between 8 and 35 years (mean, 16.9 years). Following amputation, the defects were covered with an ipsilateral pedicled latissimus dorsi (LD) myocutaneous flap for stump protection and functional transfer. We concluded that the use of an ipsilateral LD myocutaneous flap is an adequate surgical operation in upper extremity amputations resulting from high-voltage electrical burn injuries and that this procedure permits stump length maintenance, contributes to arm functioning, avoids extended operation times, and prepares patients for prosthesis usage.

  9. The clinical effect of tendon repair for tendon spontaneous rupture after corticosteroid injection in hands

    PubMed Central

    Lu, Hui; Yang, Hu; Shen, Hui; Ye, Ganmin; Lin, Xiang-Jin

    2016-01-01

    Abstract Corticosteroid injections for hand tendinitis can lead to a rare significant complication of tendon spontaneous rupture. However, only sporadic cases were reported in the literature before. This study was designed to gauge the clinical effect of tendon repair in patients of tendon spontaneous rupture after corticosteroid injection and analyze our experience. This was a retrospective observational study of 13 patients (8 women and 5 men) operated between July 2011 and December 2015 for tendon spontaneous rupture after corticosteroid injection. Demographic data, clinical features, imaging data, and surgical treatments were carefully reviewed. The average age was 52.308 ± 15.381 years (range 29–71). The average injection times were 2.538 ± 1.664 times (range 1–6). The average rupture time (after last injection) was 10.923 ± 9.500 weeks (range 3–32). Nine patients were treated by tendon suture (69% of cases), and 4 patients were treated by tendon grafting (31% of cases). All patients received follow-up in our outpatient clinic. The sites of the tendon rupture (15 tendons of 13 patients had involved) include extensor pollicis longus (6 tendons, 40% of cases), extensor digiti quinti and extensor digiti minimi (4 tendons, 27% of cases), ring finger of extensor digitorum communis (3 tendons, 20% of cases), and middle finger of extensor digitorum communis (2 tendons, 13% of cases). Two patients who had tendon adhesion (15% of cases) were treated by tendon release. One patient who had tendon rerupture (8% of cases) was treated by tendon grafting. No patient had complications of infections, vascular, or nerve injury. Tendon spontaneous rupture is a serious complication after corticosteroid injection for tendinitis. Rigid standard of corticosteroid injection is very important. Magnetic resonance imaging was contributory to preoperative assess tendon defect and can be used to monitor healing quality of tendons during the follow-up. PMID:27741145

  10. Reconstruction of Kuwada grade IV chronic achilles tendon rupture by minimally invasive technique

    PubMed Central

    Miao, Xudong; Wu, Yongping; Tao, Huimin; Yang, Disheng; Huang, Lu

    2016-01-01

    Background: Transfer of a flexor hallucis longus (FHL) tendon can not only reconstruct the Achilles tendon but also provide ischemic tendinous tissues with a rich blood supply to enhance wound healing. This retrospective study aims to investigate clinical outcomes in patients who underwent repair of Kuwada grade IV chronic Achilles tendon rupture with long hallucis longus tendons harvested using a minimally invasive technique. Materials and Methods: 35 patients who were treated for Kuwada grade IV Achilles tendon injuries from July 2006 to June 2011 were included in this retrospective study. The age ranged between 23 and 71 years. The duration from primary injury to surgery ranged from 29 days to 34 months (mean value, 137.6 days). All 35 patients had difficulties in lifting their calves. Thirty two were followed up for a mean 32.2 months (range 18–72 months), whereas three were lost to followup. Magnetic resonance imaging (MRI) showed that the tendon rupture gap ranged from 6.0 to 9.2 cm. During surgery, a 2.0 cm minor incision was made vertically in the medial plantar side of the midfoot, and a 1.5 cm minor transverse incision was made in the plantar side of the interphalangeal articulation of the great toe to harvest the FHL tendon, and the tendon was fixed to the calcaneus with suture anchors. Postoperative appearance and function were evaluated by physiotherapists based American Orthopedic Foot and Ankle Society-ankle and hindfoot score (AOFAS-AH), and Leppilahti Achilles tendon ratings. Results: Results were assessed in 32 patients. Except for one patient who suffered complications because of wound disruption 10 days after the operation, all other patients had primary wound healing, with 28 of 32 able to go up on their toes at last followup. The AOFAS-AH score was increased from preoperative (51.92 ± 7.08) points to (92.56 ± 6.71) points; Leppilahti Achilles tendon score was increased from preoperative (72.56 ± 7.43) to (92.58 ± 5.1). There were

  11. Structural and Ultrastructural Characteristics of Bone-Tendon Junction of the Calcaneal Tendon of Adult and Elderly Wistar Rats

    PubMed Central

    Cury, Diego Pulzatto; Dias, Fernando José; Miglino, Maria Angélica; Watanabe, Ii-sei

    2016-01-01

    Tendons are transition tissues that transfer the contractile forces generated by the muscles to the bones, allowing movement. The region where the tendon attaches to the bone is called bone-tendon junction or enthesis and may be classified as fibrous or fibrocartilaginous. This study aims to analyze the collagen fibers and the cells present in the bone-tendon junction using light microscopy and ultrastructural techniques as scanning electron microscopy and transmission electron microscopy. Forty male Wistar rats were used in the experiment, being 20 adult rats at 4 months-old and 20 elderly rats at 20 months-old. The hind limbs of the rats were removed, dissected and prepared to light microscopy, transmission electron microscopy and scanning electron microscopy. The aging process showed changes in the collagen fibrils, with a predominance of type III fibers in the elderly group, in addition to a decrease in the amount of the fibrocartilage cells, fewer and shorter cytoplasmic processes and a decreased synthetic capacity due to degradation of the organelles involved in synthesis. PMID:27078690

  12. Structural and Ultrastructural Characteristics of Bone-Tendon Junction of the Calcaneal Tendon of Adult and Elderly Wistar Rats.

    PubMed

    Cury, Diego Pulzatto; Dias, Fernando José; Miglino, Maria Angélica; Watanabe, Ii-sei

    2016-01-01

    Tendons are transition tissues that transfer the contractile forces generated by the muscles to the bones, allowing movement. The region where the tendon attaches to the bone is called bone-tendon junction or enthesis and may be classified as fibrous or fibrocartilaginous. This study aims to analyze the collagen fibers and the cells present in the bone-tendon junction using light microscopy and ultrastructural techniques as scanning electron microscopy and transmission electron microscopy. Forty male Wistar rats were used in the experiment, being 20 adult rats at 4 months-old and 20 elderly rats at 20 months-old. The hind limbs of the rats were removed, dissected and prepared to light microscopy, transmission electron microscopy and scanning electron microscopy. The aging process showed changes in the collagen fibrils, with a predominance of type III fibers in the elderly group, in addition to a decrease in the amount of the fibrocartilage cells, fewer and shorter cytoplasmic processes and a decreased synthetic capacity due to degradation of the organelles involved in synthesis. PMID:27078690

  13. Hamstring tendon harvesting--Effect of harvester on tendon characteristics and soft tissue disruption; cadaver study.

    PubMed

    Charalambous, C P; Alvi, F; Phaltankar, P; Gagey, O

    2009-06-01

    The purpose of this study was to determine whether the type of hamstring tendon harvester used can influence harvested tendon characteristics and soft tissue disruption. We compared two different types of tendon harvesters with regard to the length of tendon obtained and soft tissue disruption during hamstring tendon harvesting. Thirty six semitendinosus and gracilis tendons were harvested using either a closed stripper or a blade harvester in 18 paired knees from nine human fresh cadavers. Use of the blade harvester gave longer lengths of usable tendon whilst minimising the stripping of muscle and of any non-usable tendon. Our results suggest that the type of harvester per se can influence the length of tendon harvested as well as soft tissue disruption. Requesting such data from the industry prior to deciding which harvester to use seems desirable.

  14. Multiple Fibromas of Tendon Sheath: Unusual Presentation

    PubMed Central

    Park, Se Young; Jin, Seon Pil; Yeom, Bora; Kim, Shin Woo; Cho, So Yun

    2011-01-01

    Fibroma of the tendon sheath is an uncommon soft tissue tumor presenting as a solitary, slow-growing, firm, painless, small nodule, which shows strong attachment to the tendon or tendon sheath. It is usually localized on fingers and hand tendons in adults between the age of 20 and 40 years old. This case concerns a 61-year-old man presenting with a 5-year history of multiple cutaneous nodules on both palms and soles. Skin biopsy confirmed fibroma of the tendon sheath. Blood tests showed a high titer of rheumatoid factor and positivity to anti-nuclear antibody. No case of fibroma of the tendon sheath occurring multifocally on both palms and soles has been previously reported. Herein, we report on a very rare case of multiple fibromas of the tendon sheath arising from palms and soles, which supports the pathogenetic hypothesis that this tumor may be a reactive process rather than a true neoplasm. PMID:22028571

  15. Histologic analysis of ruptured quadriceps tendons.

    PubMed

    Trobisch, Per David; Bauman, Matthias; Weise, Kuno; Stuby, Fabian; Hak, David J

    2010-01-01

    Quadriceps tendon ruptures are uncommon injuries. Degenerative changes in the tendon are felt to be an important precondition for rupture. We retrospectively reviewed 45 quadriceps tendon ruptures in 42 patients. Quadriceps tendon ruptures occurred most often in the sixth and seventh decade of life. Men were affected six times as often as women. A tissue sample from the rupture-zone was obtained in 22 cases and histologic analysis was performed. Degenerative changes were present in only 14 (64%) of the 22 samples. We observed an increasing ratio of degenerative to nondegenerative tendons with increasing patient age. Our data suggests that quadriceps tendon rupture, especially in younger patients, can occur in the absence of pathologic tendon degeneration.

  16. Bioreactor Design for Tendon/Ligament Engineering

    PubMed Central

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

    2013-01-01

    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. PMID:23072472

  17. Nanostructured substrate fabricated by sectioning tendon using a microtome for tissue engineering

    NASA Astrophysics Data System (ADS)

    Dai, Xiaoshu; Xu, Qiaobing

    2011-12-01

    This paper describes an efficient and versatile method for the fabrication of nanostructured substrates from a piece of tendon which comprises aligned collagen nanofibers. We used a microtome to generate the tendon slices (10-50 µm thick), which were used as a scaffold for guiding directional cell growth. Highly aligned and uniform monolayer cells sheets were obtained. The tendon slices were used as a master, and the nanostructures outlined by the bundles of collagen nanofibers were successfully transferred onto a polystyrene film using standard soft lithography. The cell growing on the nanostructured polystyrene substrate showed good adhesion and alignment. The technique developed here enables one to fabricate nanostructured substrates without using any traditional micro/nanofabrication tools. The nanostructured substrate, e.g. a slice of tendon, has excellent biocompatibility and relatively good mechanical stability, which makes this technique useful in constructing complicated 3D tissues.

  18. Anatomy of the pectoralis minor tendon and its use in acromioclavicular joint reconstruction.

    PubMed

    Moinfar, Amir R; Murthi, Anand M

    2007-01-01

    Many procedures described for operative management of acromioclavicular joint separations entail transfer of the coracoacromial ligament. We sought to describe the anatomy and morphology of the pectoralis minor tendon better, to assess its anatomic potential as a substitute for sacrificing the coracoacromial ligament, and to compare the ultimate tensile strength of the pectoralis minor with that of the coracoacromial ligament and detached coracoclavicular ligament. The morphology of the pectoralis minor tendon was carefully delineated and compared with that of the coracoacromial ligament, and 10 paired fresh-frozen cadaveric shoulders were tested to failure by applying a single uniaxial tensile load. Anatomic study of the pectoralis minor tendon confirmed its adequacy as a source of local autograft tissue in acromioclavicular joint reconstruction. We hypothesize that, in cases of acromioclavicular joint separation necessitating operative intervention, the use of the pectoralis minor tendon as a potential source of autograft tissue is anatomically feasible and it is slightly stronger than the coracoacromial ligament.

  19. Pectoralis Major Tendon Repair

    PubMed Central

    Cordasco, Frank A.; Degen, Ryan; Mahony, Gregory Thomas; Tsouris, Nicholas

    2016-01-01

    Objectives: Systematic reviews of the literature have identified 365 reported cases of Pectoralis Major Tendon (PMT) injuries. While surgical treatment has demonstrated improved outcomes compared to non-operative treatment, there is still relatively limited data on the functional outcome, return to sport and need for 2nd surgery in athletes following PMT repair. This study comprises the largest series of athletes following PMT repair reported to date. The Objective is to report on the functional outcomes, return to sport and need for 2nd surgery in a consecutive series of PMT tears. Methods: From 2009, 81 patients with PMT tears were enrolled in this prospective series. Baseline evaluation included patient demographics, mechanism of injury, physical examination and PMT specific MRI for confirmation of the diagnosis and analysis of the extent of injury. Each patient underwent surgical repair by the senior author utilizing a previously published surgical technique. Patients were then followed at 2 weeks, 6 weeks, 3 months and 6 months and further follow-up was conducted annually thereafter with functional outcome scores and adduction strength testing. The return to sport and incidence of 2nd surgery data were recorded. This study includes the first 40 athletes to reach the 2-year post-operative period. Results: All athletes were male, with an average age of 34.4 years (range 23-59). The patient cohort consisted of 4 professional NFL players and 36 recreational athletes. Average follow-up duration was 2.5 years (range 2 - 6.0 years). The most common mechanisms of injury occurred during the bench press (n=26) and contact sport participation (n=14). Sixteen injuries were complete avulsions involving both the clavicular and sternocostal heads, while 24 were isolated sternocostal head avulsions. Average pre-injury bench press of 396 lbs (range 170-500 lbs) was restored to 241 lbs post-operatively (range 140-550 lbs). Single Assessment Numeric Evaluation (SANE) scores

  20. The Effects of Glucocorticoid on Tendon and Tendon Derived Cells.

    PubMed

    Dean, Benjamin John Floyd; Carr, Andrew Jonathan

    2016-01-01

    Glucocorticoids are generally used to relieve pain and/or inflammation in a wide variety of musculoskeletal disorders including osteoarthritis, inflammatory arthritis, tendinopathy and degenerative spine disease. Glucocorticoids reduce tendon derived cell proliferation in vitro and reduce extracellular matrix synthesis both in vitro and in vivo, in particular type I collagen synthesis. Glucocorticoids also appear to result in acute deleterious changes in healthy in vivo tendon including collagen necrosis, collagen disorganisation and inflammatory cell infiltration; while the overall effect of glucocorticoid administration on the mechanical properties of healthy in vivo tendon are generally negative. Overall the existing in vitro and in vivo evidence suggests that glucocorticoids should be used with caution in treating painful tendinopathy. Certainly a real need exists to follow up the long term clinical effects of glucocorticoid in treating tendinopathy, as there is currently a paucity of evidence in this area. However in this context while the short term benefits are clear, glucocorticoids remain a useful treatment option provided they are used in the right patients in sensible moderation. PMID:27535266

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

    PubMed Central

    Jielile, Jiasharete; Aibai, Minawa; Sabirhazi, Gulnur; Shawutali, Nuerai; Tangkejie, Wulanbai; Badelhan, Aynaz; Nuerduola, Yeermike; Satewalede, Turde; Buranbai, Darehan; Hunapia, Beicen; Jialihasi, Ayidaer; Bai, Jingping; Kizaibek, Murat

    2012-01-01

    Active Achilles tendon kinesitherapy facilitates the functional recovery of a ruptured Achilles tendon. However, protein expression during the healing process remains a controversial issue. New Zealand rabbits, aged 14 weeks, underwent tenotomy followed immediately by Achilles tendon microsurgery to repair the Achilles tendon rupture. The tendon was then immobilized or subjected to postoperative early motion treatment (kinesitherapy). Mass spectrography results showed that after 14 days of motion treatment, 18 protein spots were differentially expressed, among which, 12 were up-regulated, consisting of gelsolin isoform b and neurite growth-related protein collapsing response mediator protein 2. Western blot analysis showed that gelsolin isoform b was up-regulated at days 7–21 of motion treatment. These findings suggest that active Achilles tendon kinesitherapy promotes the neurite regeneration of a ruptured Achilles tendon and gelsolin isoform b can be used as a biomarker for Achilles tendon healing after kinesitherapy. PMID:25317130

  2. On the mechanical function of tendon.

    PubMed

    Kafka, V; Jírová, J; Smetana, V

    1995-01-01

    A mesoscopic approach is followed for mathematical modelling of the specific deformation properties of tendon. The approach starts from our general concept of modelling mechanical behaviour of heterogeneous media and assumes that the structure of tendon is optimized in such a way that it enables its adjacent muscle to work with a constant performance in the course of increasing loading (acting like a gearbox in a car). The model based on this assumption gives results that are in a very good accordance with observed properties of tendons. Clinical experience reveals that if this function of tendon is violated pathological changes appear in the respective muscle. RELEVANCE: Clarification and mathematical modelling of the mechanical function of tendon is of intellectual interest in its own right, but it is important also for cautioning surgeons against unnecessary violation of this function, and for tissue engineering aspects if tendon must be replaced.

  3. Common conditions of the achilles tendon.

    PubMed

    Mazzone, Michael F; McCue, Timothy

    2002-05-01

    The Achilles tendon, the largest tendon in the body, is vulnerable to injury because of its limited blood supply and the combination of forces to which it is subjected. Aging and increased activity (particularly velocity sports) increase the chance of injury to the Achilles tendon. Although conditions of the Achilles tendon are occurring with increasing frequency because the aging U.S. population is remaining active, the diagnosis is missed in about one fourth of cases. Injury onset can be gradual or sudden, and the course of healing is often lengthy. A thorough history and specific physical examination are essential to make the appropriate diagnosis and facilitate a specific treatment plan. The mainstay of treatment for tendonitis, peritendonitis, tendinosis, and retrocalcaneobursitis is ice, rest, and nonsteroidal anti-inflammatory drugs, but physical therapy, orthoties, and surgery may be necessary in recalcitrant cases. In patients with tendon rupture, casting or surgery is required. Appropriate treatment often leads to full recovery.

  4. Tensile mechanical properties of human forearm tendons.

    PubMed

    Weber, J F; Agur, A M R; Fattah, A Y; Gordon, K D; Oliver, M L

    2015-09-01

    Previous studies of the mechanical properties of tendons in the upper limb have used embalmed specimens or sub-optimal methods of measurement. The aim of this study was to determine the biomechanical properties of all tendons from five fresh frozen cadaveric forearms using updated methodology. The cross-sectional area of tendons was accurately measured using a laser reflectance system. Tensile testing was done in a precision servo-hydraulic device with cryo-clamp fixation. We determined that the cross-sectional area of some tendons is variable and directly influences the calculated material properties; visual estimation of this is unreliable. Data trends illustrate that digital extensor tendons possess the greatest tensile strength and a higher Young's modulus than other tendon types. PMID:25940499

  5. Mesenchymal stem cell applications to tendon healing

    PubMed Central

    Chaudhury, Salma

    2012-01-01

    Summary Tendons are often subject to age related degenerative changes that coincide with a diminished regenerative capacity. Torn tendons often heal by forming scar tissue that is structurally weaker than healthy native tendon tissue, predisposing to mechanical failure. There is increasing interest in providing biological stimuli to increase the tendon reparative response. Stem cells in particular are an exciting and promising prospect as they have the potential to provide appropriate cellular signals to encourage neotendon formation during repair rather than scar tissue. Currently, a number of issues need to be investigated further before it can be determined whether stem cells are an effective and safe therapeutic option for encouraging tendon repair. This review explores the in-vitro and invivo evidence assessing the effect of stem cells on tendon healing, as well as the potential clinical applications. PMID:23738300

  6. Tensile mechanical properties of human forearm tendons.

    PubMed

    Weber, J F; Agur, A M R; Fattah, A Y; Gordon, K D; Oliver, M L

    2015-09-01

    Previous studies of the mechanical properties of tendons in the upper limb have used embalmed specimens or sub-optimal methods of measurement. The aim of this study was to determine the biomechanical properties of all tendons from five fresh frozen cadaveric forearms using updated methodology. The cross-sectional area of tendons was accurately measured using a laser reflectance system. Tensile testing was done in a precision servo-hydraulic device with cryo-clamp fixation. We determined that the cross-sectional area of some tendons is variable and directly influences the calculated material properties; visual estimation of this is unreliable. Data trends illustrate that digital extensor tendons possess the greatest tensile strength and a higher Young's modulus than other tendon types.

  7. Nutrient pathways of flexor tendons in primates

    SciTech Connect

    Manske, P.R.; Lesker, P.A.

    1982-09-01

    The perfusion and diffusion pathways to the flexor profundus tendons of 40 monkeys were investigated by measuring the uptake of tritiated proline by various tendon segments. In the absence of all vascular connections, the process of diffusion provides nutrients to all areas of flexor tendon and in this study the process of diffusion was greater. The distal segment of tendon was observed to be profused most rapidly. The proximal tendon segment is perfused from both the muscular-tendinous junction and the vinculum longus; vincular segment perfusion is via the vinculum longus vessels alone; central segment perfusion is shared by the vinculum longus and vinculum brevis vasculature. The distal segment uptake is by both the process of diffusion or vinculum brevis perfusion. The osseous attachment at the distal phalanx contributes little to tendon nutrition.

  8. Dynamic behavior of tendons in random seas

    SciTech Connect

    Niedzwecki, J.M.; Rijken, O.R.; Soemantri, D.S.

    1995-12-31

    The dynamic behavior of large scale (1:55) undistorted models of TLP tendons were investigated. The tendons modeled were for a TLP designed to be deployed in a water depth of 914 m. The tendon motions were studied without the presence of the hull, In the study reported, the tendon models were subjected to three quite different design seas and the single and paired tendon configurations were compared under identical wave conditions. The main objective of this study was to examine the dynamic response of TLP tendons under controlled environmental conditions in order to better quantify the observed dynamic behavior. Underwater video tracking techniques were utilized in the experiments to obtain direct measurement of the inline and transverse displacements. Envelopes characterizing the extreme displacement behavior, spatial variations in response and collision behavior are presented and discussed.

  9. Extensor tendon injuries in athletes.

    PubMed

    Chauhan, Aakash; Jacobs, Bruce; Andoga, Alexandra; Baratz, Mark E

    2014-03-01

    Extensor tendon injuries of the hand and wrist in high-level athletes can cause a delay in return to play and permanently affect their performance. Given the inherent demand for a speedy and complete recovery, orthopedic surgeons must have an understanding of how to best direct an athlete's treatment for these injuries. The extensor anatomy is very intricate and a thorough understanding of the anatomy can help with both diagnosis and treatment. However, untreated or poorly managed injuries are at risk of leading to chronic deformities. We will discuss the diagnosis and management of the most common extensor tendon injuries and tendinopathies of the hand found in athletes: mallet fingers, swan-neck deformities, boutonniere deformities, central slip ruptures, sagittal band ruptures, intersection syndrome, extensor carpi ulnaris tendinitis, and extensor carpi ulnaris subluxation. PMID:24651290

  10. Ulnar Nerve Injury after Flexor Tendon Grafting.

    PubMed

    McCleave, Michael John

    2016-10-01

    A 43-year-old female is presented who underwent a two-stage tendon reconstruction and developed a low ulnar nerve palsy postoperatively. Exploration found that the tendon graft was passing through Guyon's canal and that the ulnar nerve was divided. This is a previously unreported complication. The reconstruction is discussed, the literature reviewed and a guide is given on how to identify the correct tissue plane when passing a tendon rod. PMID:27595967

  11. Management of complications of extensor tendon injuries.

    PubMed

    Lutz, Kristina; Pipicelli, Joey; Grewal, Ruby

    2015-05-01

    Treatment goals for the management of extensor tendon injuries include restoration of function, minimizing disability, and decreasing the risk of complications. These goals can be achieved with an accurate understanding of the zone-specific concerns for extensor tendon injuries, early referral to hand therapy, and active communication between hand surgeons and therapists. This article reviews extensor tendon injuries by zone, outlines optimal management strategies that help prevent complications, and describes the treatment of these complications. PMID:25934204

  12. Microstructural and mechanical properties of camel longissimus dorsi muscle during roasting, braising and microwave heating.

    PubMed

    Yarmand, M S; Nikmaram, P; Djomeh, Z Emam; Homayouni, A

    2013-10-01

    This study was conducted to investigate the effects of various heating methods, including roasting, braising and microwave heating, on mechanical properties and microstructure of longissimus dorsi (LD) muscle of the camel. Shear value and compression force increased during microwave heating more than roasting and braising. Results obtained from scanning electron microscopy (SEM) showed more damage from roasting than in either braising or microwave heating. Granulation and fragmentation were clear in muscle fibers after roasting. The perimysium membrane of connective tissue was damaged during braising, while roasting left the perimysium membrane largely intact. The mechanical properties and microstructure of muscle can be affected by changes in water content during cooking.

  13. Lubricin Surface Modification Improves Tendon Gliding After Tendon Repair in a Canine Model in Vitro

    PubMed Central

    Taguchi, Manabu; Sun, Yu-Long; Zhao, Chunfeng; Zobitz, Mark E.; Cha, Chung-Ja; Jay, Gregory D.; An, Kai-Nan; Amadio, Peter C.

    2011-01-01

    This study investigated the effects of lubricin on the gliding of repaired flexor digitorum profundus (FDP) tendons in vitro. Canine FDP tendons were completely lacerated, repaired with a modified Pennington technique, and treated with one of the following solutions: saline, carbodiimide derivatized gelatin/hyaluronic acid (cd-HA-gelatin), carbodiimide derivatized gelatin to which lubricin was added in a second step (cd-gelatin + lubricin), or carbodiimide derivatized gelatin/HA + lubricin (cd-HA-gelatin + lubricin). After treatment, gliding resistance was measured up to 1,000 cycles of simulated flexion/extension motion. The increase in average and peak gliding resistance in cd-HA-gelatin, cd-gelatin + lubricin, and cd-HA-gelatin + lubricin tendons was less than the control tendons after 1,000 cycles (p < 0.05). The increase in average gliding resistance of cd-HA-gelatin + lubricin treated tendons was also less than that of the cd-HA-gelatin treated tendons (p < 0.05). The surfaces of the repaired tendons and associated pulleys were assessed qualitatively with scanning electron microscopy and appeared smooth after 1,000 cycles of tendon motion for the cd-HA-gelatin, cd-gelatin + lubricin, and cd-HA-gelatin + lubricin treated tendons, while that of the saline control appeared roughened. These results suggest that tendon surface modification can improve tendon gliding ability, with a trend suggesting that lubricin fixed on the repaired tendon may provide additional improvement over that provided by HA and gelatin alone. PMID:18683890

  14. Can angiogenesis induced by chronic electrical stimulation enhance latissimus dorsi muscle flap survival for application in cardiomyoplasty?

    PubMed

    Overgoor, Max L E; Carroll, Sean M; Papanicolau, George; Carroll, Camilla M A; Ustüner, Tuncay E T; Stremel, Richard W; Anderson, Gary L; Franken, Ralph J P M; Kon, Moshe; Barker, John H

    2003-01-01

    In cardiomyoplasty, the latissimus dorsi muscle is lifted on its primary neurovascular pedicle and wrapped around a failing heart. After 2 weeks, it is trained for 6 weeks using chronic electrical stimulation, which transforms the latissimus dorsi muscle into a fatigue-resistant muscle that can contract in synchrony with the beating heart without tiring. In over 600 cardiomyoplasty procedures performed clinically to date, the outcomes have varied. Given the data obtained in animal experiments, the authors believe these variable outcomes are attributable to distal latissimus dorsi muscle flap necrosis. The aim of the present study was to investigate whether the chronic electrical stimulation training used to transform the latissimus dorsi muscle into fatigue-resistant muscle could also be used to induce angiogenesis, increase perfusion, and thus protect the latissimus dorsi muscle flap from distal necrosis. After 14 days of chronic electrical stimulation (10 Hz, 330 microsec, 4 to 6 V continuous, 8 hours/day) of the right or left latissimus dorsi muscle (randomly selected) in 11 rats, both latissimus dorsi muscles were lifted on their thoracodorsal pedicles and returned to their anatomical beds. Four days later, the resulting amount of distal flap necrosis was measured. Also, at predetermined time intervals throughout the experiment, muscle surface blood perfusion was measured using scanning laser Doppler flowmetry. Finally, latissimus dorsi muscles were excised in four additional stimulated rats, to measure angiogenesis (capillary-to-fiber ratio), fiber type (oxidative or glycolytic), and fiber size using histologic specimens. The authors found that chronic electrical stimulation (1) significantly (p < 0.05) increased angiogenesis (mean capillary-to-fiber ratio) by 82 percent and blood perfusion by 36 percent; (2) did not reduce the amount of distal flap necrosis compared with nonchronic electrical stimulation controls (29 +/- 5.3 percent versus 26.6 +/- 5

  15. Traumatic Tear of the Latissimus Dorsi Myotendinous Junction: Case Report of a CrossFit-Related Injury.

    PubMed

    Friedman, Michael V; Stensby, J Derek; Hillen, Travis J; Demertzis, Jennifer L; Keener, Jay D

    2015-01-01

    A case of a latissimus dorsi myotendinous junction strain in an avid CrossFit athlete is presented. The patient developed acute onset right axillary burning and swelling and subsequent palpable pop with weakness while performing a "muscle up." Magnetic resonance imaging examination demonstrated a high-grade tear of the right latissimus dorsi myotendinous junction approximately 9 cm proximal to its intact humeral insertion. There were no other injuries to the adjacent shoulder girdle structures. Isolated strain of the latissimus dorsi myotendinous junction is a very rare injury with a scarcity of information available regarding its imaging appearance and preferred treatment. This patient was treated conservatively and was able to resume active CrossFit training within 3 months. At 6 months postinjury, he had only a mild residual functional deficit compared with his preinjury level.

  16. Two Cases of Single-Stage Closure of a Bronchopleural Fistula Using Latissimus Dorsi Musculocutaneous Flaps after Lung Surgery

    PubMed Central

    Akiyama, Hirohiko; Kinoshita, Hiroyasu; Inoue, Takuya; Hamahata, Atsumori; Uramoto, Hidetaka

    2015-01-01

    Two cases of successful primary closure of a bronchopleural fistula with favorable infection control using latissimus dorsi musculocutaneous flaps are reported. Case 1 was a 70-year-old man who underwent resection of the right lower pulmonary lobe due to right lung metastasis of sigmoid colon cancer. A bronchopleural fistula was found on day 28 after surgery. Infection was controlled by antibiotic administration and tube drainage. Closure of the bronchopleural stump, thoracoplasty and plombage of latissimus dorsi muscles were performed for single-stage closure without open treatment, based on a negative pleural effusion culture. Case 2 was a 64-year-old man who underwent right lower pulmonary lobe resection due to right lung cancer. A bronchopleural fistula was found on day 14 after surgery. In single-stage closure, thoracoplasty and plombage of latissimus dorsi muscles were performed due to infection control and a negative pleural effusion culture. Both cases had a good postoperative course. PMID:26004108

  17. Traumatic Tear of the Latissimus Dorsi Myotendinous Junction: Case Report of a CrossFit-Related Injury.

    PubMed

    Friedman, Michael V; Stensby, J Derek; Hillen, Travis J; Demertzis, Jennifer L; Keener, Jay D

    2015-01-01

    A case of a latissimus dorsi myotendinous junction strain in an avid CrossFit athlete is presented. The patient developed acute onset right axillary burning and swelling and subsequent palpable pop with weakness while performing a "muscle up." Magnetic resonance imaging examination demonstrated a high-grade tear of the right latissimus dorsi myotendinous junction approximately 9 cm proximal to its intact humeral insertion. There were no other injuries to the adjacent shoulder girdle structures. Isolated strain of the latissimus dorsi myotendinous junction is a very rare injury with a scarcity of information available regarding its imaging appearance and preferred treatment. This patient was treated conservatively and was able to resume active CrossFit training within 3 months. At 6 months postinjury, he had only a mild residual functional deficit compared with his preinjury level. PMID:26502450

  18. Outcome of quadriceps tendon repair.

    PubMed

    Puranik, Gururaj S; Faraj, Adnan

    2006-04-01

    Complete rupture of the quadriceps tendon is a well-described injury. There is a scarcity of literature relating to the outcome of patients with this injury after surgery. We undertook a retrospective analysis of patients who had surgical repair of their quadriceps tendon at our institution over a 13-year period, totalling 21 patients. Males were more commonly affected, with a male/female ratio of 4:1. The peak incidence was in the sixth decade of life. Assessment consisted of the completion of a functional knee questionnaire and a clinical examination. Symptomatic outcome following surgical repair was good with a mean symptom score generated of 19.16 out of a maximum of 25 using the Rougraff et al scoring system. Most of the patients returned to their pre-injury level of activity. Five degrees deficit and extension lag was present in three patients; these patients had the quadriceps repaired using transosseous sutures. Patients who had direct repair of the tendon using the Bunnell technique had lower Rougraff scores than the rest.

  19. Quadriceps and patellar tendon ruptures.

    PubMed

    Lee, Dennis; Stinner, Daniel; Mir, Hassan

    2013-10-01

    The diagnosis of quadriceps and patellar tendon ruptures requires a high index of suspicion and thorough history-taking to assess for medical comorbidities that may predispose patients to tendon degeneration. Radiographic assessment with plain films supplemented by ultrasound and magnetic resonance imaging when the work-up is equivocal further aids diagnosis; however, advanced imaging is often unnecessary in patients with functional extensor mechanism deficits. Acute repair is preferred, and transpatellar bone tunnels serve as the primary form of fixation when the tendon rupture occurs at the patellar insertion, with or without augmentation depending on surgeon preference. Chronic tears and disruptions following total knee arthroplasty are special cases requiring reconstructions with allograft, synthetic mesh, or autograft. Rehabilitation protocols generally allow immediate weight-bearing with the knee locked in extension and crutch support. Limited arc motion is started early with active flexion and passive extension and then advanced progressively, followed by full active range of motion and strengthening. Complications are few but include quadriceps atrophy, knee stiffness, and rerupture. Outcomes are excellent if repair is done acutely, with poorer outcomes associated with delayed repair.

  20. High axial load termination for TLP tendons

    SciTech Connect

    Salama, M.M.

    1992-03-03

    This patent describes a hollow high axial load termination for a composite tubular tendon. It comprises: a curved hollow termination body open at one end wit a circular opening and connected at the opposite curved end with an elongated hollow member of lesser diameter than the diameter of the circular opening of the termination body, a composite tubular tendon containing axial fibers and helical fibers laid on an inner hollow liner; fibers of the composite tubular tendon extending over and covering the termination body from the abutment with the composite tubular tendon to the elongated member of lesser diameter than the termination body.

  1. Determining the contribution of glycosaminoglycans to tendon mechanical properties with a modified shear-lag model.

    PubMed

    Ahmadzadeh, Hossein; Connizzo, Brianne K; Freedman, Benjamin R; Soslowsky, Louis J; Shenoy, Vivek B

    2013-09-27

    Tendon has a complex hierarchical structure composed of both a collagenous and a non-collagenous matrix. Despite several studies that have aimed to elucidate the mechanism of load transfer between matrix components, the roles of glycosaminoglycans (GAGs) remain controversial. Thus, this study investigated the elastic properties of tendon using a modified shear-lag model that accounts for the structure and non-linear mechanical response of the GAGs. Unlike prior shear-lag models that are solved either in two dimensions or in axially symmetric geometries, we present a closed-form analytical model for three-dimensional periodic lattices of fibrils linked by GAGs. Using this approach, we show that the non-linear mechanical response of the GAGs leads to a distinct toe region in the stress-strain response of the tendon. The critical strain of the toe region is shown to decrease inversely with fibril length. Furthermore, we identify a characteristic length scale, related to microstructural parameters (e.g. GAG spacing, stiffness, and geometry) over which load is transferred from the GAGs to the fibrils. We show that when the fibril lengths are significantly larger than this length scale, the mechanical properties of the tendon are relatively insensitive to deletion of GAGs. Our results provide a physical explanation for the insensitivity for the mechanical response of tendon to the deletion of GAGs in mature tendons, underscore the importance of fibril length in determining the elastic properties of the tendon, and are in excellent agreement with computationally intensive simulations. PMID:23932185

  2. Tenderization of Bovine Longissimus Dorsi Muscle using Aqueous Extract from Sarcodon aspratus.

    PubMed

    Kim, Ho-Kyoung; Lee, Sang-Hoon; Ryu, Youn-Chul

    2015-01-01

    The aim of this study was to investigate the effects of aqueous extract from Sarcodon aspratus on tenderization of the bovine longissimus dorsi muscles in comparison with commercial proteolytic enzymes. Furthermore, meat quality and muscle protein degradation were examined. We marinated meat with 2% Sarcodon aspratus extract, 2% kiwi extract, and 0.2% papain. Beef chunks (3×3×3 cm(3)) were marinated with distilled water (control), Sarcodon aspratus extract (T1), kiwi extract (T2) or papain (T3) for 48 h at 4℃. There were no significant differences in muscle pH and lightness between control and treated samples. T1 had the lowest redness (p<0.01), and higher cooking loss and water holding capacity than control and T2 (p<0.05). T1 and T3 exhibited lower shear force values than control (p<0.05). Total protein solubility did not differ significantly between T1 and control, but T1 had less myofibrillar protein solubility than control and T2 (p<0.001). The degradation of myosin heavy chain in T1 and T3 was observed. This degradation of myofibrillar protein suggests that Sarcodon aspratus extract could influence tenderization. These results show that aqueous extract of Sarcodon aspratus extract actively affect the tenderness of the bovine longissimus dorsi muscle. PMID:26761876

  3. Tenderization of Bovine Longissimus Dorsi Muscle using Aqueous Extract from Sarcodon aspratus

    PubMed Central

    Kim, Ho-Kyoung; Lee, Sang-Hoon

    2015-01-01

    The aim of this study was to investigate the effects of aqueous extract from Sarcodon aspratus on tenderization of the bovine longissimus dorsi muscles in comparison with commercial proteolytic enzymes. Furthermore, meat quality and muscle protein degradation were examined. We marinated meat with 2% Sarcodon aspratus extract, 2% kiwi extract, and 0.2% papain. Beef chunks (3×3×3 cm3) were marinated with distilled water (control), Sarcodon aspratus extract (T1), kiwi extract (T2) or papain (T3) for 48 h at 4℃. There were no significant differences in muscle pH and lightness between control and treated samples. T1 had the lowest redness (p<0.01), and higher cooking loss and water holding capacity than control and T2 (p<0.05). T1 and T3 exhibited lower shear force values than control (p<0.05). Total protein solubility did not differ significantly between T1 and control, but T1 had less myofibrillar protein solubility than control and T2 (p<0.001). The degradation of myosin heavy chain in T1 and T3 was observed. This degradation of myofibrillar protein suggests that Sarcodon aspratus extract could influence tenderization. These results show that aqueous extract of Sarcodon aspratus extract actively affect the tenderness of the bovine longissimus dorsi muscle. PMID:26761876

  4. Proteomic changes involved in tenderization of bovine Longissimus dorsi muscle during prolonged ageing.

    PubMed

    Polati, Rita; Menini, Michele; Robotti, Elisa; Millioni, Renato; Marengo, Emilio; Novelli, Enrico; Balzan, Stefania; Cecconi, Daniela

    2012-12-01

    To study proteomic changes involved in tenderization of bovine Longissimus dorsi four Charolaise heifers and four Charolaise bull's muscles were sampled at slaughter after early and long ageing (2-4°C for 12 and 26days respectively). Descriptive sensory evaluation of samples were performed and their tenderness evaluated by Warner-Bratzler shear force test. Protein composition of fresh muscle and of meat aged was analysed by cartesian and polar 2-D electrophoresis. Student's t-test and Ranking-PCA analyses were performed to detect proteomic modulation, and the selected protein spots were identified by nano-HPLC-Chip MS/MS. This research has demonstrated that there are no differences between proteomic patterns of male and females Longissimus dorsi muscle, and that the extension of ageing beyond 12days, did not brings any concrete advantage in terms of sensory quality. Furthermore, the data presented here demonstrated that meat maturation caused changes of the abundance of proteins involved in metabolic, structural, and stress related processes.

  5. Calcific tendonitis of the tibialis posterior tendon at the navicular attachment

    PubMed Central

    Harries, Luke; Kempson, Susan; Watura, Roland

    2011-01-01

    Calcific tendinosis (tendonosis/tendonitis) is a condition which results from the deposition of calcium hydroxyapatite crystals in any tendon of the body. Calcific tendonitis usually presents with pain, which can be exacerbated by prolonged use of the affected tendon. We report a case of calcific tendinosis in the posterior tibialis tendon at the navicular insertion. The pathology is rare in the foot, and extremely rare in the tibialis posterior tendon, indeed there are only 2 reported in the published literature. This case report highlights the need to consider calcific tendinosis in the foot despite its rarity. If this diagnosis is considered early, appropriate investigations can then be requested and unnecessary biopsies, use of antibiotics and surgery can be avoided. We also discuss possible causes of calcific tendinosis in the tibialis posterior tendon, the role of imaging modalities and review treatment methods. PMID:22470798

  6. Augmentation of tendon-to-bone healing.

    PubMed

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

    2014-03-19

    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.

  7. Tendons Involvement in Congenital Metabolic Disorders.

    PubMed

    Abate, Michele; Salini, Vincenzo; Andia, Isabel

    2016-01-01

    Congenital metabolic disorders are consequence of defects involving single genes that code for enzymes. Blocking metabolic pathways, the defect leads to the shortage of essential compounds, and/or to the accumulation of huge quantities of precursors, which interfere with normal functions. Only few of these diseases are characterized by a clinically significant tendon involvement.Heterozygous Familial Hypercholesterolaemia results from the inheritance of a mutant low-density lipoprotein receptor gene; patients show high cholesterol levels, precocious coronary artery disease, and may develop tendon xanthomata (mainly in Achilles tendon). The detection of xanthomata is important, because it allows an early diagnosis and treatment of the disorder. Cerebrotendinous Xanthomatosis is a rare genetic metabolic disorder of cholesterol and bile acid metabolism, characterized by accumulation of cholestanol in brain and tendons. Tendon abnormalities are similar to those reported in Heterozygous Familial Hypercholesterolaemia. Alkaptonuria is caused by a deficiency of the enzyme homogentisic acid oxidase. Due to the accumulation of the homogentisic acid, tendons and ligaments are characterized by a typical ochre/yellow pigmentation (ochronosis), with ensuing inflammation, calcification and rupture. In Congenital Hypergalactosemia an increased tendon collagen cross-linking by non-enzymatic galactosylation can be observed. Finally, Congenital Hypophosphatasia may be associated to deposition of hydroxyapatite crystals in rotator cuff, elbow, and Achilles tendons. PMID:27535253

  8. Simultaneous and spontaneous bilateral quadriceps tendons rupture.

    PubMed

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

    2012-07-01

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

  9. Measuring Regional Changes in Damaged Tendon

    NASA Astrophysics Data System (ADS)

    Frisch, Catherine Kayt Vincent

    Mechanical properties of tendon predict tendon health and function, but measuring these properties in vivo is difficult. An ultrasound-based (US) analysis technique called acoustoelastography (AE) uses load-dependent changes in the reflected US signal to estimate tissue stiffness non-invasively. This thesis explores whether AE can provide information about stiffness alteration resulting from tendon tears both ex vivo and in vivo. An ex vivo ovine infraspinatus tendon model suggests that the relative load transmitted by the different tendon layers transmit different fractions of the load and that ultrasound echo intensity change during cyclic loading decreases, becoming less consistent once the tendon is torn. An in vivo human tibialis anterior tendon model using electrically stimulated twitch contractions investigated the feasibility of measuring the effect in vivo. Four of the five subjects showed the expected change and that the muscle contraction times calculated using the average grayscale echo intensity change compared favorably with the times calculated based on the force data. Finally an AE pilot study with patients who had rotator cuff tendon tears found that controlling the applied load and the US view of the system will be crucial to a successful in vivo study.

  10. [Multiple calcifications and ossifications of tendons].

    PubMed

    Gaucher, A; Péré, P; Gillet, P

    1991-06-21

    Multiple calcifications and ossifications of tendons are, as a rule, associated with similar lesions of other articular and/or periarticular structures. The nature and multiplicity of these lesions gives them an unquestionable diagnostic and nosological value. Multiple calcifications are part of the apatite arthritis or of diffuse articular chondrocalcinosis. Multiple ossifications of tendons often suggest Forestier's disease and ankylosing spondylitis.

  11. Structure-mechanics relationships in mineralized tendons.

    PubMed

    Spiesz, Ewa M; Zysset, Philippe K

    2015-12-01

    In this paper, we review the hierarchical structure and the resulting elastic properties of mineralized tendons as obtained by various multiscale experimental and computational methods spanning from nano- to macroscale. The mechanical properties of mineralized collagen fibres are important to understand the mechanics of hard tissues constituted by complex arrangements of these fibres, like in human lamellar bone. The uniaxial mineralized collagen fibre array naturally occurring in avian tendons is a well studied model tissue for investigating various stages of tissue mineralization and the corresponding elastic properties. Some avian tendons mineralize with maturation, which results in a graded structure containing two zones of distinct morphology, circumferential and interstitial. These zones exhibit different amounts of mineral, collagen, pores and a different mineral distribution between collagen fibrillar and extrafibrillar space that lead to distinct elastic properties. Mineralized tendon cells have two phenotypes: elongated tenocytes placed between fibres in the circumferential zone and cuboidal cells with lower aspect ratios in the interstitial zone. Interestingly some regions of avian tendons seem to be predestined to mineralization, which is exhibited as specific collagen cross-linking patterns as well as distribution of minor tendon constituents (like proteoglycans) and loss of collagen crimp. Results of investigations in naturally mineralizing avian tendons may be useful in understanding the pathological mineralization occurring in some human tendons.

  12. Tendon Vasculature in Health and Disease

    PubMed Central

    Tempfer, Herbert; Traweger, Andreas

    2015-01-01

    Tendons represent a bradytrophic tissue which is poorly vascularized and, compared to bone or skin, heal poorly. Usually, a vascularized connective scar tissue with inferior functional properties forms at the injury site. Whether the increased vascularization is the root cause of tissue impairments such as loss of collagen fiber orientation, ectopic formation of bone, fat or cartilage, or is a consequence of these pathological changes remains unclear. This review provides an overview of the role of tendon vasculature in healthy and chronically diseased tendon tissue as well as its relevance for tendon repair. Further, the nature and the role of perivascular tendon stem/progenitor cells residing in the vascular niche will be discussed and compared to multipotent stromal cells in other tissues. PMID:26635616

  13. Ultrasonic evaluation of flood gate tendons

    SciTech Connect

    Thomas, G.; Brown, A.

    1997-10-01

    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 in diameter. Moisture may seep into the grout around the tendons and cause corrosion. Lawrence Livermore National Laboratory is working with the California Department of Water Resources to develop advanced ultrasonic techniques for nondestructively inspecting their tendons. A unique transducer was designed and fabricated to interrogate the entire tendon. A robust,portable unit was assembled that included a computer controlled data acquisition system and specialized data processing software to analyze the ultrasonic signals. This system was tested on laboratory specimens and is presently being fielded at two dam sites.

  14. The Role of Detraining in Tendon Mechanobiology

    PubMed Central

    Frizziero, Antonio; Salamanna, Francesca; Della Bella, Elena; Vittadini, Filippo; Gasparre, Giuseppe; Nicoli Aldini, Nicolò; Masiero, Stefano; Fini, Milena

    2016-01-01

    Introduction: Several conditions such as training, aging, estrogen deficiency and drugs could affect the biological and anatomo-physiological characteristics of the tendon. Additionally, recent preclinical and clinical studies examined the effect of detraining on tendon, showing alterations in its structure and morphology and in tenocyte mechanobiology. However, few data evaluated the importance that cessation of training might have on tendon. Basically, we do not fully understand how tendons react to a phase of training followed by sudden detraining. Therefore, within this review, we summarize the studies where tendon detraining was examined. Materials and Methods: A descriptive systematic literature review was carried out by searching three databases (PubMed, Scopus and Web of Knowledge) on tendon detraining. Original articles in English from 2000 to 2015 were included. In addition, the search was extended to the reference lists of the selected articles. A public reference manager (www.mendeley.com) was adopted to remove duplicate articles. Results: An initial literature search yielded 134 references (www.pubmed.org: 53; www.scopus.com: 11; www.webofknowledge.com: 70). Fifteen publications were extracted based on the title for further analysis by two independent reviewers. Abstracts and complete articles were after that reviewed to evaluate if they met inclusion criteria. Conclusions: The revised literature comprised four clinical studies and an in vitro and three in vivo reports. Overall, the results showed that tendon structure and properties after detraining are compromised, with an alteration in the tissue structural organization and mechanical properties. Clinical studies usually showed a lesser extent of tendon alterations, probably because preclinical studies permit an in-depth evaluation of tendon modifications, which is hard to perform in human subjects. In conclusion, after a period of sudden detraining (e.g., after an injury), physical activity should

  15. Ankle dorsi- and plantar-flexion torques measured by dynamometry in healthy subjects from 5 to 80 years

    PubMed Central

    2013-01-01

    Background Ankle strength is often impaired in some of the most common neuromuscular disorders. Consequently, strength generated around this joint is important to assess, because it has a great impact on balance and gait. The objectives of this study were to establish normative data and predictive equations for both ankle dorsi- and plantar-flexion strength from a population of healthy subjects (children and adults), to assess the reliability of the measurements and to study the feasibility of using a novel dynamometer on a group of patients with a neuromuscular disorder. Methods Measurements of maximal isometric torque for dorsi- and plantar-flexion were performed on 345 healthy subjects from 5 to 80 years of age. The feasibility of the method was tested on nine patients diagnosed with type 2A limb girdle muscular dystrophy. Results The results documented normal strength values depending on gender and age on ankle dorsi- and plantar-flexion. The reliability of the technique was good with no evaluator effect and a small learning effect. The dynamometer was found suitable in the group of patients, even very weak. Conclusions The device developed was both reliable and accurate in assessing both ankle dorsi-flexion and plantar-flexion torque measurements from weak patients and children to strong healthy adults. Norms and predictive equations are provided for these two muscle functions. PMID:23522186

  16. Engineered scaffold-free tendon tissue produced by tendon-derived stem cells.

    PubMed

    Ni, Ming; Rui, Yun Feng; Tan, Qi; Liu, Yang; Xu, Liang Liang; Chan, Kai Ming; Wang, Yan; Li, Gang

    2013-03-01

    Most of the exogenous biomaterials for tendon repair have limitations including lower capacity for inducing cell proliferation and differentiation, poorer biocompatibility and remodeling potentials. To avoid these shortcomings, we intend to construct an engineered tendon by stem cells and growth factors without exogenous scaffolds. In this study, we produced an engineered scaffold-free tendon tissue (ESFTT) in vitro and investigated its potentials for neo-tendon formation and promoting tendon healing in vivo. The ESFTT, produced via tendon-derived stem cells (TDSCs) by treatment of connective tissue growth factor (CTGF) and ascorbic acid in vitro, was characterized by histology, qRT-PCR and immunohistochemistry methods. After ESFTT implanted into the nude mouse, the in vivo fluorescence imaging, histology and immunohistochemistry examinations showed neo-tendon formation. In a rat patellar tendon window injury model, the histology, immunohistochemistry and biomechanical testing data indicated ESFTT could significantly promote tendon healing. In conclusion, this is a proof-of-concept study demonstrating that ESFTT could be a potentially new approach for tendon repair and regeneration.

  17. Preparation and characterization of decellularized tendon slices for tendon tissue engineering.

    PubMed

    Ning, Liang-Ju; Zhang, Yi; Chen, Xiao-He; Luo, Jing-Cong; Li, Xiu-Qun; Yang, Zhi-Ming; Qin, Ting-Wu

    2012-06-01

    To develop a naturally derived tendon tissue engineering scaffold with the preservation of the native ultrastructure, tensile strength, and biochemical composition of the tendon extracellular matrix (ECM), decellularized tendon slices (DTSs) were prepared using repetitive freeze/thaw of the intact Achilles tendons, frozen section, and nuclease treatment. The DTSs were characterized in the native ultrastructure, mechanical properties, biochemical composition, and cytocompatibility. Histological examination and DNA quantification analysis confirmed that cells were completely removed from tendon tissue by repetitive freeze/thaw in combination with nuclease treatment 12 h. The intrinsic ultrastructure of tendon tissue was well preserved based on scanning electron microscopy examination. The tensile strength of the DTSs was retained 85.62% of native tendon slice. More than 93% of proteoglycans (fibromodulin, biglycan) and growth factors (TGF-β1, IGF-1, VEGF, and CTGF) inherent in tendon ECM were preserved in the DTSs according to ELISA analysis. Furthermore, the DTSs facilitated attachment and repopulation of NIH-3T3 fibroblasts in vitro. Overall, the DTSs are sheet scaffolds with a combination of elemental mechanical strength and tendon ECM bioactive factors that may have many potential applications in tendon tissue engineering.

  18. Is higher serum cholesterol associated with altered tendon structure or tendon pain? A systematic review

    PubMed Central

    Tilley, Benjamin J; Cook, Jill L; Docking, Sean I; Gaida, James E

    2015-01-01

    Background Tendon pain occurs in individuals with extreme cholesterol levels (familial hypercholesterolaemia). It is unclear whether the association with tendon pain is strong with less extreme elevations of cholesterol. Objective To determine whether lipid levels are associated with abnormal tendon structure or the presence of tendon pain. Methods We conducted a systematic review and meta-analysis. Relevant articles were found through an electronic search of 6 medical databases—MEDLINE, Cochrane, AMED, EMBASE, Web of Science and Scopus. We included all case–control or cross-sectional studies with data describing (1) lipid levels or use of lipid-lowering drugs and (2) tendon structure or tendon pain. Results 17 studies (2612 participants) were eligible for inclusion in the review. People with altered tendon structure or tendon pain had significantly higher total cholesterol, low-density lipoprotein cholesterol and triglycerides, as well as lower high-density lipoprotein cholesterol; with mean difference values of 0.66, 1.00, 0.33, and −0.19 mmol/L, respectively. Conclusions The results of this review indicate that a relationship exists between an individual’s lipid profile and tendon health. However, further longitudinal studies are required to determine whether a cause and effect relationship exists between tendon structure and lipid levels. This could lead to advancement in the understanding of the pathoaetiology and thus treatment of tendinopathy. PMID:26474596

  19. Repair of quadriceps tendon ruptures using suture anchors.

    PubMed

    Richards, David P; Barber, F Alan

    2002-01-01

    The repair of ruptured quadriceps tendon is commonly performed by weaving sutures through the ruptured tendon and then attaching the tendon to the bone by passing these sutures through tunnels in the superior patella. This technical note is the first report we are aware of in the English language literature of a technique that uses suture anchors to attach the tendon to bone.

  20. Active vibration control of a free-free beam by using a tendon mechanism

    NASA Astrophysics Data System (ADS)

    Tani, Junji; Ueda, Hiroki

    This paper is concerned with an active vibration control of a free-free beam. The beam is reduced to a finite-degree-of-freedom system by the modal analysis, in which the mode function is derived from the transfer matrix method. A control force is produced by a pair of tendons and a DC servo motor attached to the beam. The state of the beam is presumed by the minimum order state observer and the control force is determined by the digital optimum regulator theory. It is found that the active tendon control method is effective to suppress the vibration of the free-free beam.

  1. Tendon Stem Cells: Mechanobiology and Development of Tendinopathy.

    PubMed

    Wang, James H-C; Komatsu, Issei

    2016-01-01

    Millions of people suffer from tendon injuries in both occupational and athletic settings. However, the restoration of normal structure and function to injured tendons still remains as one of the greatest challenges in orthopaedics and sports medicine. In recent years, a remarkable advancement in tendon research field has been the discovery of tendon stem/progenitor cells (TSCs). Unlike tenocytes, the predominant resident cell in tendons, TSCs have the ability to self-renew and multi-differentiate. Because of these distinct properties, TSCs may play a critical role in tendon physiology as well as pathology such as tendinopathy, which is a prevalent chronic tendon injury. Additionally, because TSCs are tendon-specific stem cells, they could potentially be used in tendon tissue engineering in vitro, and serve as a promising cell source for cell-based therapy to effectively repair or even regenerate injured tendons in clinical settings. PMID:27535248

  2. Effects of posterior tibial tendon augmented with biografts and calcaneal osteotomy in stage II adult-acquired flatfoot deformity.

    PubMed

    Lee, Daniel

    2009-02-01

    Adult-acquired flatfoot deformity (AAFD) is a well-known condition leading to flexible flatfoot deformity. However, only recently have the function and muscle strength for balancing opposing muscles been more appreciated in laboratory studies. With the advancements in collagen science in tendon structure, the rationale and concept of some of the most common procedures in tendon transfer have been challenged. The current availability of biograft technology has provided an alternative in augmentation procedures instead of sacrificing autologous tendons. This novel approach may offer a viable option in AAFD, delivering much-needed collagen in a degenerative tendon. These biografts have shown ease of use and tissue biocompatibility in many orthopaedic and plastic surgery procedures and may prove to be an adjunct in the surgical option for AAFD. PMID:19825747

  3. Viscoelasticity of Tendons Under Transverse Compression.

    PubMed

    Paul Buckley, C; Samuel Salisbury, S T; Zavatsky, Amy B

    2016-10-01

    Tendons are highly anisotropic and also viscoelastic. For understanding and modeling their 3D deformation, information is needed on their viscoelastic response under off-axis loading. A study was made, therefore, of creep and recovery of bovine digital extensor tendons when subjected to transverse compressive stress of up to ca. 100 kPa. Preconditioned tendons were compression tested between glass plates at increasing creep loads. The creep response was anomalous: the relative rate of creep reduced with the increasing stress. Over each ca. 100 s creep period, the transverse creep deformation of each tendon obeyed a power law dependence on time, with the power law exponent falling from ca. 0.18 to an asymptote of ca. 0.058 with the increasing stress. A possible explanation is stress-driven dehydration, as suggested previously for the similar anomalous behavior of ligaments. Recovery after removal of each creep load was also anomalous. Relative residual strain reduced with the increasing creep stress, but this is explicable in terms of the reducing relative rate of creep. When allowance was made for some adhesion occurring naturally between tendon and the glass plates, the results for a given load were consistent with creep and recovery being related through the Boltzmann superposition principle (BSP). The tendon tissue acted as a pressure-sensitive adhesive (PSA) in contact with the glass plates: explicable in terms of the low transverse shear modulus of the tendons. PMID:27496279

  4. Biological Augmentation of Rotator Cuff Tendon Repair

    PubMed Central

    Kovacevic, David

    2008-01-01

    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. PMID:18264850

  5. THE ROLE OF MECHANOBIOLOGY IN TENDON HEALING

    PubMed Central

    Killian, Megan L.; Cavinatto, Leonardo; Galatz, Leesa M.; Thomopoulos, Stavros

    2011-01-01

    Mechanical cues affect tendon healing, homeostasis, and development in a variety of settings. Alterations in the mechanical environment are known to result in changes in the expression of extracellular matrix proteins, growth factors, transcription factors, and cytokines that can alter tendon structure and cell viability. Loss of muscle force in utero or in the immediate postnatal period delays tendon and enthesis development. The response of healing tendons to mechanical load varies depending on anatomic location. Flexor tendons require motion to prevent adhesion formation, yet excessive force results in gap formation and subsequent weakening of the repair. Excessive motion in the setting of anterior cruciate ligament reconstruction causes accumulation of macrophages, which are detrimental to tendon graft healing. Complete removal of load is detrimental to rotator cuff healing, yet large forces are also harmful. Controlled loading can enhance healing in most settings; however, a fine balance must be reached between loads that are too low (leading to a catabolic state) and too high (leading to micro-damage). This review will summarize existing knowledge of the mechanobiology of tendon development, homeostasis, and healing. PMID:22244066

  6. Latissimus dorsi reconstruction: a good option for patients with failed breast conservation therapy.

    PubMed

    Freeman, Mark E; Perdikis, Galen; Sternberg, Erez G; TerKonda, Sarvam P; Waldorf, James C

    2006-08-01

    The majority of patients with breast carcinoma are being treated with breast conservation therapy (BCT): lumpectomy and postoperative radiation. Local recurrence reported at 8% to 11% is often treated with salvage mastectomy. This has led to a growing group of patients requiring breast reconstruction after failed BCT. Reluctance to use the latissimus dorsi flap (LDF) has resulted from reports of high implant capsular contracture rates. We present a series of 12 patients who underwent LDF reconstruction after the development of recurrent breast cancer after BCT. All 12 patients had a satisfactory esthetic result. Despite previous radiation, the capsular contracture rate was 12.5% (median follow up, 50 months; range, 20-93 months). The most common complication was donor site seroma in 25% (3 of 12) of cases. The LDF yielded satisfactory esthetic results with a low capsular contracture rate. Despite prior radiation, LDF remains a good option for breast reconstruction after failure of BCT.

  7. Comparative proteomic analysis of longissimus dorsi muscle in immuno- and surgically castrated male pigs.

    PubMed

    Shi, Xuebin; Li, Chunbao; Cao, Miaodan; Xu, Xinglian; Zhou, Guanghong; Xiong, Youling L

    2016-05-15

    We compared proteomic profiles of male pig muscles after active immunization against gonadotropin releasing hormone (GnRH) and surgical castration. Longissimus dorsi samples were collected from immunocastration (IC) and surgical castration (SC) groups (n=15 each). Muscle proteins were extracted and then identified by data-independent label-free nano LC-MS/MS. A total of 610 proteins were identified, 50 of which were differentially expressed (P<0.05) between immuno- and surgical castration. Twenty-two of 50 differentially expressed proteins were higher in abundance for IC group and 27 proteins with abundance change folds greater than 1.5 differed with castration methods. Proteins involved in cytoskeleton and immunity were abundant in IC group. Several heat shock proteins (HSPs) and laminins were abundant in SC group.

  8. Changes in meat quality of ovine longissimus dorsi muscle in response to repeated freeze and thaw.

    PubMed

    Qi, Jun; Li, Chunbao; Chen, Yinji; Gao, Feifei; Xu, Xinglian; Zhou, Guanghong

    2012-12-01

    Changes in eating and technological quality attributes of ovine longissimus dorsi muscle during repeated freeze and thaw were investigated. Shear force value, L* value, a* value and fiber diameter decreased (P<0.05) but lipid oxidation increased (P<0.05) with repeated freeze-thaw cycles. Sarcomere length and pH decreased (P<0.05) within the first 10 freeze-thaw cycles but increased (P<0.05) after 5 further cycles. Total and myofibrillar protein solubility, and intramuscular free fatty acids concentration decreased (P<0.05) after 1 cycle of freeze and thaw but then increased (P<0.05) gradually with further cycles. Hardness, chewiness, cohesiveness and resilience of comminuted lamb products decreased (P<0.05) with increased freeze-thaw cycles. And therefore, repeated freeze and thaw should be minimized in terms of meat color for commercial value and water holding capacity for further processing. PMID:22749539

  9. Unusual Presentation of Elastofibroma Dorsi on 18F-FDG-PET/CT

    PubMed Central

    Martin, Steve P.; Gariani, Joanna; Tabouret Viaud, Claire

    2016-01-01

    Abstract A 70-year-old male patient underwent an Fluorodeoxyglucose-positron emission tomography-computed tomography for staging of a left parahilar lung neoplasm found during work-up for fatigue and asthenia. The scan demonstrated a hypermetabolic lung tumor, a hypermetabolic pleural effusion and 4 hypermetabolic bilateral soft tissue lesions of the chest wall corresponding to 4 elastofibroma dorsi. Initially, the oncologic disease was classified as stage IV because of the hypermetabolic pleural effusion. A transbronchial biopsy showed squamous cell carcinoma and the cytology of the pleural effusion revealed no malignant cells. As the other 4 hypermetabolic thoracic wall lesions were correctly diagnosed as benign despite their unusual presentation, the patient underwent surgery by left pneumonectomy and mediastinal lymphadenectomy. The lymph node involvement required adjuvant chemotherapy. Diagnostic confidence of the benignity of the hypermetabolic chest wall lesions allowed a more aggressive treatment with a better outcome after a malignant pleural effusion was excluded. PMID:26886641

  10. Updates in biological therapies for knee injuries: tendons.

    PubMed

    Demange, Marco Kawamura; de Almeida, Adriano Marques; Rodeo, Scott A

    2014-09-01

    Tendons are subjected to tendinopathies caused by inflammation, degeneration, and weakening of the tendon, due to overuse and trauma, which may eventually lead to tendon rupture. Recently, there has been increasing interest in biological approaches to augment tissue healing. Tendon healing occurs through a dynamic process with inflammation, cellular proliferation, and tissue remodeling. In this review article, we discuss the more frequently proposed biological therapies for tendon injuries as platelet-rich plasma, mesenchymal stem cells, extracorporeal shockwave, and scaffolds.

  11. Interfibrillar shear stress is the loading mechanism of collagen fibrils in tendon.

    PubMed

    Szczesny, Spencer E; Elliott, Dawn M

    2014-06-01

    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

  12. Patellar tendon rupture: an ultrasound case report.

    PubMed

    Berg, Kenneth; Peck, Jeff; Boulger, Creagh; Bahner, David P

    2013-01-01

    This article discusses a case in which ultrasound was the primary modality for diagnosis of traumatic patellar tendon rupture. Traditionally, this diagnosis has been made using MRI. This case highlights the growing need for emergency medicine physicians to become facile with bedside ultrasound and its indications as a supplement to traditional musculoskeletal examination. Normal and pathological patellar tendon examinations with ultrasound are discussed in detail. Furthermore, the advantages of ultrasound over the more traditional imaging modalities of x-ray and MRI in cases where tendon rupture is suspected are discussed.

  13. Informing Stem Cell-Based Tendon Tissue Engineering Approaches with Embryonic Tendon Development.

    PubMed

    Okech, William; Kuo, Catherine K

    2016-01-01

    Adult tendons fail to regenerate normal tissue after injury, and instead form dysfunctional scar tissue with abnormal mechanical properties. Surgical repair with grafts is the current standard to treat injuries, but faces significant limitations including pain and high rates of re-injury. To address this, we aim to regenerate new, normal tendons to replace dysfunctional tendons. A common approach to tendon tissue engineering is to design scaffolds and bioreactors based on adult tendon properties that can direct adult stem cell tenogenesis. Despite significant progress, advances have been limited due, in part, to a need for markers and potent induction cues. Our goal is to develop novel tendon tissue engineering approaches informed by embryonic tendon development. We are characterizing structure-property relationships of embryonic tendon to identify design parameters for three-dimensional scaffolds and bioreactor mechanical loading systems to direct adult stem cell tenogenesis. We will review studies in which we quantified changes in the mechanical and biochemical properties of tendon during embryonic development and elucidated specific mechanisms of functional property elaboration. We then examined the effects of these mechanical and biochemical factors on embryonic tendon cell behavior. Using custom-designed bioreactors, we also examined the effects of dynamic mechanical loading and growth factor treatment on embryonic tendon cells. Our findings have established cues to induce tenogenesis as well as metrics to evaluate differentiation. We finish by discussing how we have evaluated the tenogenic differentiation potential of adult stem cells by comparing their responses to that of embryonic tendon cells in these culture systems.

  14. Multiscale mechanical integrity of human supraspinatus tendon in shear after elastin depletion.

    PubMed

    Fang, Fei; Lake, Spencer P

    2016-10-01

    Human supraspinatus tendon (SST) exhibits region-specific nonlinear mechanical properties under tension, which have been attributed to its complex multiaxial physiological loading environment. However, the mechanical response and underlying multiscale mechanism regulating SST behavior under other loading scenarios are poorly understood. Furthermore, little is known about the contribution of elastin to tendon mechanics. We hypothesized that (1) SST exhibits region-specific shear mechanical properties, (2) fiber sliding is the predominant mode of local matrix deformation in SST in shear, and (3) elastin helps maintain SST mechanical integrity by facilitating force transfer among collagen fibers. Through the use of biomechanical testing and multiphoton microscopy, we measured the multiscale mechanical behavior of human SST in shear before and after elastase treatment. Three distinct SST regions showed similar stresses and microscale deformation. Collagen fiber reorganization and sliding were physical mechanisms observed as the SST response to shear loading. Measures of microscale deformation were highly variable, likely due to a high degree of extracellular matrix heterogeneity. After elastase treatment, tendon exhibited significantly decreased stresses under shear loading, particularly at low strains. These results show that elastin contributes to tendon mechanics in shear, further complementing our understanding of multiscale tendon structure-function relationships.

  15. Multiscale mechanical integrity of human supraspinatus tendon in shear after elastin depletion.

    PubMed

    Fang, Fei; Lake, Spencer P

    2016-10-01

    Human supraspinatus tendon (SST) exhibits region-specific nonlinear mechanical properties under tension, which have been attributed to its complex multiaxial physiological loading environment. However, the mechanical response and underlying multiscale mechanism regulating SST behavior under other loading scenarios are poorly understood. Furthermore, little is known about the contribution of elastin to tendon mechanics. We hypothesized that (1) SST exhibits region-specific shear mechanical properties, (2) fiber sliding is the predominant mode of local matrix deformation in SST in shear, and (3) elastin helps maintain SST mechanical integrity by facilitating force transfer among collagen fibers. Through the use of biomechanical testing and multiphoton microscopy, we measured the multiscale mechanical behavior of human SST in shear before and after elastase treatment. Three distinct SST regions showed similar stresses and microscale deformation. Collagen fiber reorganization and sliding were physical mechanisms observed as the SST response to shear loading. Measures of microscale deformation were highly variable, likely due to a high degree of extracellular matrix heterogeneity. After elastase treatment, tendon exhibited significantly decreased stresses under shear loading, particularly at low strains. These results show that elastin contributes to tendon mechanics in shear, further complementing our understanding of multiscale tendon structure-function relationships. PMID:27472764

  16. Les plaies du tendon patellaire

    PubMed Central

    Mechchat, Atif; Elidrissi, Mohammed; Mardy, Abdelhak; Elayoubi, Abdelghni; Shimi, Mohammed; Elibrahimi, Abdelhalim; Elmrini, Abdelmajid

    2014-01-01

    Les plaies du tendon patellaire sont peu fréquentes et sont peu rapportés dans la littérature, contrairement aux ruptures sous cutanées. Les sections du tendon patellaire nécessitent une réparation immédiate afin de rétablir l'appareil extenseur et de permettre une récupération fonctionnelle précoce. A travers ce travail rétrospectif sur 13 cas, nous analysons les aspects épidémiologiques, thérapeutiques et pronostiques de ce type de pathologie en comparant différents scores. L’âge moyen est de 25 ans avec une prédominance masculine. Les étiologies sont dominées par les accidents de la voie publique (68%) et les agressions par agent tranchant (26%) et contendant (6 %). Tous nos patients ont bénéficié d'un parage chirurgical avec suture tendineuse direct protégée par un laçage au fils d'aciers en légère flexion. La rééducation est débutée après sédation des phénomènes inflammatoires. Au dernier recul les résultats sont excellents et bon à 92%. Nous n'avons pas noté de différence de force musculaire et d'amplitude articulaire entre le genou sain et le genou lésé. Les lésions ouvertes du tendon patellaire est relativement rare. La prise en charge chirurgicale rapide donne des résultats assez satisfaisants. La réparation est généralement renforcée par un semi-tendineux, synthétique ou métallique en forme de cadre de renfort pour faciliter la réadaptation et réduire le risque de récidive après la fin de l'immobilisation. PMID:25170379

  17. Multi-Layer Electrospun Membrane Mimicking Tendon Sheath for Prevention of Tendon Adhesions

    PubMed Central

    Jiang, Shichao; Yan, Hede; Fan, Dapeng; Song, Jialin; Fan, Cunyi

    2015-01-01

    Defect of the tendon sheath after tendon injury is a main reason for tendon adhesions, but it is a daunting challenge for the biomimetic substitute of the tendon sheath after injury due to its multi-layer membrane-like structure and complex biologic functions. In this study, a multi-layer membrane with celecoxib-loaded poly(l-lactic acid)-polyethylene glycol (PELA) electrospun fibrous membrane as the outer layer, hyaluronic acid (HA) gel as middle layer, and PELA electrospun fibrous membrane as the inner layer was designed. The anti-adhesion efficacy of this multi-layer membrane was compared with a single-layer use in rabbit flexor digitorum profundus tendon model. The surface morphology showed that both PELA fibers and celecoxib-loaded PELA fibers in multi-layer membrane were uniform in size, randomly arrayed, very porous, and smooth without beads. Multi-layer membrane group had fewer peritendinous adhesions and better gliding than the PELA membrane group and control group in gross and histological observation. The similar mechanical characteristic and collagen expression of tendon repair site in the three groups indicated that the multi-layer membrane did not impair tendon healing. Taken together, our results demonstrated that such a biomimetic multi-layer sheath could be used as a potential strategy in clinics for promoting tendon gliding and preventing adhesion without poor tendon healing. PMID:25822877

  18. Canine tendon studies. II. Biomechanical evaluation of normal and regrown canine tendons.

    PubMed

    Walker, P; Amstutz, H C; Rubinfeld, M

    1976-01-01

    Some of the mechanical properties of regrown canine tendons are compared to those of normal tendons of young and mature animals. Patellar and Achilles tendons from 12 beagle dogs were removed and studied with their bone origin and insertions. Mechanical tests were performed within 24 hr and test conditions simulated the physiological function of the tendon in vivo at room temperature. Specimens were soaked in Ringers solution and mounted in an Instron testing machine with load deflection curves plotted automatically. The parameters used for analysis were load extension, stress relaxation, elastic limit, and strain rate dependence. The regrown tendons in young animals appeared to quickly adjust in dimension and structure so that their properties were not significantly different from those of normal tendons on a load extension basis. The normal tendons were stiffer than regrown ones but the modulus of elasticity increased with age. The Achilles were stiffer than patellar tendons. Cyclic loading with 25 kg did not affect reconstructed tendon models, although some increase in stiffness was noted. The elastic modulus decreased with an increase in ambient temperature and increasing strain rate.

  19. Famotidine suppresses osteogenic differentiation of tendon cells in vitro and pathological calcification of tendon in vivo.

    PubMed

    Yamamoto, Kenichi; Hojo, Hironori; Koshima, Isao; Chung, Ung-il; Ohba, Shinsuke

    2012-12-01

    Heterotopic ossification or calcification follows any type of musculoskeletal trauma and is known to occur after arthroplasties of hip, knee, shoulder, or elbow; fractures; joint dislocations; or tendon ruptures. Histamine receptor H2 (Hrh2) has been shown to be effective for reducing pain and decreasing calcification in patients with calcifying tendinitis, which suggested that H2 blockers were effective for the treatment of tendon ossification or calcification. However, the detailed mechanisms of its action on tendon remain to be clarified. We investigated the mechanisms underlying H2 blocker-mediated suppression of tendon calcification, with a focus on the direct action of the drug on tendon cells. Famotidine treatment suppressed the mRNA expressions of Col10a1 and osteocalcin, ossification markers, in a tendon-derived cell line TT-D6, as well as a preosteoblastic one MC3T3-E1. Both of the cell lines expressed Hrh2; histamine treatment induced osteocalcin expression in these cells. Famotidine administration suppressed calcification in the Achilles tendon of ttw mice, a mouse model of ectopic ossification. These data suggest that famotidine inhibits osteogenic differentiation of tendon cells in vitro, and this inhibition may underlie the anti-calcification effects of the drug in vivo. This study points to the use of H2 blockers as a promising strategy for treating heterotopic ossification or calcification in tendon, and provides evidence in support of the clinical use of famotidine.

  20. IFSSH Flexor Tendon Committee report 2014: from the IFSSH Flexor Tendon Committee (Chairman: Jin Bo Tang).

    PubMed

    Tang, Jin Bo; Chang, James; Elliot, David; Lalonde, Donald H; Sandow, Michael; Vögelin, Esther

    2014-01-01

    Hand surgeons continue to search for the best surgical flexor tendon repair and treatment of the tendon sheaths and pulleys, and they are attempting to establish postoperative regimens that fit diverse clinical needs. It is the purpose of this report to present the current views, methods, and suggestions of six senior hand surgeons from six different countries - all experienced in tendon repair and reconstruction. Although certainly there is common ground, the report presents provocative views and approaches. The report reflects an update in the views of the committee. We hope that it is helpful to surgeons and therapists in treating flexor tendon injuries. PMID:23962872

  1. Delayed reconstruction of a quadriceps tendon.

    PubMed

    Pocock, C A J; Trikha, S P; Bell, J S P

    2008-01-01

    Rupture of the quadriceps tendon is an uncommon injury and rapid diagnosis is important because delay in surgical repair generally is believed to adversely affect outcome. One study of 20 patients suggests repair should be done during the first 48 to 72 hours postinjury to achieve a successful outcome and late repair led to unsatisfactory recovery. Cases of delayed tendon repair have been reported, the longest to our knowledge being 11 months before surgical intervention. We present a case of successful outcome of a quadriceps tendon rupture reconstructed at least 8 years after occurrence and a review of the literature of delayed reconstructions. We show that successful restoration of extensor mechanism function can be achieved several years after tendon rupture.

  2. Heel pain and Achilles tendonitis - aftercare

    MedlinePlus

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

  3. Glycosaminoglycans in Tendon Physiology, Pathophysiology, and Therapy.

    PubMed

    Ryan, Christina N M; Sorushanova, Anna; Lomas, Alex J; Mullen, Anne Maria; Pandit, Abhay; Zeugolis, Dimitrios I

    2015-07-15

    Although glycosaminoglycans constitute a minor portion of native tissues, they play a crucial role in various physiological processes, while their abnormal expression is associated with numerous pathophysiologies. Glycosaminoglycans have become increasingly prevalent in biomaterial design for tendon repair, given their low immunogenicity and their inherent capacity to stimulate the regenerative processes, while maintaining resident cell phenotype and function. Further, their incorporation into three-dimensional scaffold conformations significantly improves their mechanical properties, while reducing the formation of peritendinous adhesions. Herein, we discuss the role of glycosaminoglycans in tendon physiology and pathophysiology and the advancements achieved to date using glycosaminoglycan-functionalized scaffolds for tendon repair and regeneration. It is evidenced that glycosaminoglycan functionalization has led to many improvements in tendon tissue engineering and it is anticipated to play a pivotal role in future reparative therapies.

  4. Position Control of Tendon-Driven Fingers

    NASA Technical Reports Server (NTRS)

    Abdallah, Muhammad E.; Platt, Robert, Jr.; Hargrave, B.; Pementer, Frank

    2011-01-01

    Conventionally, tendon-driven manipulators implement some force control scheme based on tension feedback. This feedback allows the system to ensure that the tendons are maintained taut with proper levels of tensioning at all times. Occasionally, whether it is due to the lack of tension feedback or the inability to implement sufficiently high stiffnesses, a position control scheme is needed. This work compares three position controllers for tendon-driven manipulators. A new controller is introduced that achieves the best overall performance with regards to speed, accuracy, and transient behavior. To compensate for the lack of tension feedback, the controller nominally maintains the internal tension on the tendons by implementing a two-tier architecture with a range-space constraint. These control laws are validated experimentally on the Robonaut-2 humanoid hand. I

  5. Regional adaptations in three rat tendons.

    PubMed

    Covizi, D Z; Felisbino, S L; Gomes, L; Pimentel, E R; Carvalho, H F

    2001-10-01

    Although detailed histological and immunocytochemical studies have been published for the rat calcanear tendon (CT), little is known of the structure, composition and biomechanics of the deep (DFT) and superficial (SFT) flexor tendons. In this study, we examined the structural specialization of these three tendons in 90-day-old rats by applying histochemical and biochemical assays to different tendon regions (proximal, intermediate and distal regions of the DFT and SFT, and proximal and distal regions of the CT). There were regional differences in tissue structure, glycosaminoglycan type and content, swelling properties and in the amount and distribution of elastic fibers. Dermatan sulfate occurred in all regions, but chondroitin sulfate predominated in the intermediate region of the DFT and in the distal region of the CT. These two chondroitin sulfate-bearing regions showed swelling in water, while all other regions lost fluid in water. Fibrocartilaginous sites were observed on the CT, one at the insertion to the bone and another distally at the innermost area of the tendon. The intermediate region of the DFT showed round cells disposed in lacunae, while the proximal and distal regions were typically fibrous. The intermediate region of the SFT showed a wavy array of collagen bundles but neither toluidine blue staining in the matrix nor round cells. Elastic fibers were present in each region of the three tendons, but were more prominent in the intermediate zone of the SFT. These results demonstrate regional variation in the three tendons. Tendon differentiation may occur by an increase in the number of elastic fibers and by variations in the arrangement of collagen fibers, without fibrocartilage formation.

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

    PubMed

    Amlang, M H; Zwipp, H

    2012-02-01

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

  7. [Bilateral rupture of the quadriceps tendon].

    PubMed

    Modrego, Francisco J; Molina, Juan

    2004-01-01

    Simultaneous, bilateral, and spontaneous rupture of the quadriceps tendon is a very rare injury. Individuals with this injury are usually predisposed by chronic renal disease with secondary hyperparathyroidism, gout, diabetes, and lupus erythematosus. Often, primary diagnostic confusion can lead to a delay in treatment. Two cases of a bilateral lesion of the quadriceps tendon, that were treated surgically using the technique of Scuderi, followed by an intense rehabilitation programme, are presented. Surgical treatment yields satisfactory results.

  8. A biomechanical assessment of tendon repair after radiofrequency treatment.

    PubMed

    Tibor, Lisa M; Leek, Bryan T; Chase, Derek C; Healey, Robert M; Linn, Michael S; Tasto, James P; Amiel, David

    2012-09-01

    After acute tendon injury, rapid mobilization prevents adhesions and improves the ultimate strength of the repair. Radiofrequency (RF) ablation is proposed to enhance angiogenesis in the early stages of healing. The mechanism and effect of RF have not yet been described in an animal model of tendon injury. To investigate the biomechanical effect of bipolar RF on acute injury in a rabbit model of partial Achilles tendon transection and suture repair, RF-treated tendon repairs were compared to untreated tendons. Cross-sectional area, Young's modulus, and ultimate tensile strength were determined. At 6 and 12 weeks after repair, RF-treated tendons had significant increases in cross-sectional area (P<.001; P< .0001) and ultimate tensile strength (P<.0001; P<.01). Young modulus of RF-treated tendons was increased at 6 weeks but not at 12 weeks (P<.01) Compared with untreated tendons, RF-treated tendons showed faster return to mechanical integrity. This may allow earlier rehabilitation.

  9. Tension Distribution in a Tendon-Driven Robotic Finger

    NASA Technical Reports Server (NTRS)

    Abdallah, Muhammad E. (Inventor); Platt, Robert (Inventor); Wampler, II, Charles W. (Inventor)

    2013-01-01

    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.

  10. Grasp Assist Device with Shared Tendon Actuator Assembly

    NASA Technical Reports Server (NTRS)

    Ihrke, Chris A. (Inventor); Bergelin, Bryan J. (Inventor); Bridgwater, Lyndon (Inventor)

    2015-01-01

    A grasp assist device includes a glove with first and second tendon-driven fingers, a tendon, and a sleeve with a shared tendon actuator assembly. Tendon ends are connected to the respective first and second fingers. The actuator assembly includes a drive assembly having a drive axis and a tendon hook. The tendon hook, which defines an arcuate surface slot, is linearly translatable along the drive axis via the drive assembly, e.g., a servo motor thereof. The flexible tendon is routed through the surface slot such that the surface slot divides the flexible tendon into two portions each terminating in a respective one of the first and second ends. The drive assembly may include a ball screw and nut. An end cap of the actuator assembly may define two channels through which the respective tendon portions pass. The servo motor may be positioned off-axis with respect to the drive axis.

  11. In vivo identity of tendon stem cells and the roles of stem cells in tendon healing.

    PubMed

    Tan, Qi; Lui, Pauline Po Yee; Lee, Yuk Wa

    2013-12-01

    We investigated the spatial distribution of stem cells in tendons and the roles of stem cells in early tendon repair. The relationship between tendon-derived stem cells (TDSCs) isolated in vitro and tendon stem cells in vivo was also explored. Iododeoxyuridine (IdU) label-retaining method was used for labeling stem cells in rat patellar tendons with and without injury. Co-localization of label-retaining cells (LRCs) with different markers was done by immunofluorescent staining. TDSCs were isolated from patellar tendon mid-substance after IdU pulsing, and the expression of different markers in fresh and expanded cells was done by immunofluorescent staining. More LRCs were found at the peritenon and tendon-bone junction compared with the mid-substance. Some LRCs at the peritenon were located at the perivascular niche. The LRC number and the expression of proliferative, tendon-related, pluripotency, and pericyte-related markers in LRCs in the window wound increased. Most of the freshly isolated TDSCs expressed IdU, and some TDSCs expressed pericyte-related markers, which were lost during expansion. Both freshly isolated and subcultured TDSCs expressed pluripotency markers, which were absent in LRCs in intact tendons. In conclusion, we identified LRCs at the peritenon, mid-substance, and tendon-bone junction. There were both vascular and non-vascular sources of LRCs at the peritenon, while the source of LRCs at the mid-substance was non-vascular. LRCs participated in tendon repair via migration, proliferation, activation for tenogenesis, and increased pluripotency. Some LRCs in the window wound were pericyte like. Most of the mid-substance TDSCs were LRCs. The pluripotency markers and pericyte-related marker in LRCs might be important for function after injury.

  12. Microstructural stress relaxation mechanics in functionally different tendons.

    PubMed

    Screen, H R C; Toorani, S; Shelton, J C

    2013-01-01

    Tendons experience widely varying loading conditions in vivo. They may be categorised by their function as either positional tendons, which are used for intricate movements and experience lower stress, or as energy storage tendons which act as highly stressed springs during locomotion. Structural and compositional differences between tendons are thought to enable an optimisation of their properties to suit their functional environment. However, little is known about structure-function relationships in tendon. This study adopts porcine flexor and extensor tendon fascicles as examples of high stress and low stress tendons, comparing their mechanical behaviour at the micro-level in order to understand their stress relaxation response. Stress-relaxation was shown to occur predominantly through sliding between collagen fibres. However, in the more highly stressed flexor tendon fascicles, more fibre reorganisation was evident when the tissue was exposed to low strains. By contrast, the low load extensor tendon fascicles appears to have less capacity for fibre reorganisation or shearing than the energy storage tendon, relying more heavily on fibril level relaxation. The extensor fascicles were also unable to sustain loads without rapid and complete stress relaxation. These findings highlight the need to optimise tendon repair solutions for specific tendons, and match tendon properties when using grafts in tendon repairs.

  13. Arthroscopic quadriceps tendon repair: two case reports.

    PubMed

    Saito, Hidetomo; Shimada, Yoichi; Yamamura, Toshiaki; Yamada, Shin; Sato, Takahiro; Nozaka, Koji; Kijima, Hiroaki; Saito, Kimio

    2015-01-01

    Recently, although some studies of open repair of the tendon of the quadriceps femoris have been published, there have been no reports in the literature on primary arthroscopic repair. In our present study, we present two cases of quadriceps tendon injury arthroscopically repaired with excellent results. Case 1 involved a 68-year-old man who was injured while shifting his weight to prevent a fall. MRI showed complete rupture at the insertion of the patella of the quadriceps tendon. The rupture was arthroscopically repaired using both suture anchor and pull-out suture fixation methods via bone tunnels (hereafter, pull-out fixation). Two years after surgery, retearing was not observed on MRI and both Japan Orthopedic Association (JOA) Knee and Lysholm scores had recovered to 100. Case 2 involved a 50-year-old man who was also injured when shifting his weight to prevent a fall. MRI showed incomplete superficial rupture at the insertion of the patella of the quadriceps tendon. The rupture was arthroscopically repaired using pull-out fixation of six strand sutures. One year after surgery, MRI revealed a healed tendon and his JOA and Lysholm scores were 95 and 100, respectively. Thus, arthroscopic repair may be a useful surgical method for repairing quadriceps tendon injury.

  14. Laminar Tendon Composites with Enhanced Mechanical Properties

    PubMed Central

    Alberti, Kyle A.; Sun, Jeong-Yun; Illeperuma, Widusha R.; Suo, Zhigang; Xu, Qiaobing

    2015-01-01

    Purpose A strong isotropic material that is both biocompatible and biodegradable is desired for many biomedical applications, including rotator cuff repair, tendon and ligament repair, vascular grafting, among others. Recently, we developed a technique, called “bioskiving” to create novel 2D and 3D constructs from decellularized tendon, using a combination of mechanical sectioning, and layered stacking and rolling. The unidirectionally aligned collagen nanofibers (derived from sections of decellularized tendon) offer good mechanical properties to the constructs compared with those fabricated from reconstituted collagen. Methods In this paper, we studied the effect that several variables have on the mechanical properties of structures fabricated from tendon slices, including crosslinking density and the orientation in which the fibers are stacked. Results We observed that following stacking and crosslinking, the strength of the constructs is significantly improved, with crosslinked sections having an ultimate tens ile strength over 20 times greater than non-crosslinked samples, and a modulus nearly 50 times higher. The mechanism of the mechanical failure mode of the tendon constructs with or without crosslinking was also investigated. Conclusions The strength and fiber organization, combined with the ability to introduce transversely isotropic mechanical properties makes the laminar tendon composites a biocompatiable material that may find future use in a number of biomedical and tissue engineering applications. PMID:25691802

  15. The cell biology of suturing tendons.

    PubMed

    Wong, J K F; Alyouha, S; Kadler, K E; Ferguson, M W J; McGrouther, D A

    2010-07-01

    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 12h. 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. PMID:20600895

  16. Arthroscopic Quadriceps Tendon Repair: Two Case Reports

    PubMed Central

    Saito, Hidetomo; Shimada, Yoichi; Yamamura, Toshiaki; Yamada, Shin; Sato, Takahiro; Nozaka, Koji; Kijima, Hiroaki; Saito, Kimio

    2015-01-01

    Recently, although some studies of open repair of the tendon of the quadriceps femoris have been published, there have been no reports in the literature on primary arthroscopic repair. In our present study, we present two cases of quadriceps tendon injury arthroscopically repaired with excellent results. Case 1 involved a 68-year-old man who was injured while shifting his weight to prevent a fall. MRI showed complete rupture at the insertion of the patella of the quadriceps tendon. The rupture was arthroscopically repaired using both suture anchor and pull-out suture fixation methods via bone tunnels (hereafter, pull-out fixation). Two years after surgery, retearing was not observed on MRI and both Japan Orthopedic Association (JOA) Knee and Lysholm scores had recovered to 100. Case 2 involved a 50-year-old man who was also injured when shifting his weight to prevent a fall. MRI showed incomplete superficial rupture at the insertion of the patella of the quadriceps tendon. The rupture was arthroscopically repaired using pull-out fixation of six strand sutures. One year after surgery, MRI revealed a healed tendon and his JOA and Lysholm scores were 95 and 100, respectively. Thus, arthroscopic repair may be a useful surgical method for repairing quadriceps tendon injury. PMID:25815224

  17. Biochemical and anisotropical properties of tendons.

    PubMed

    Aparecida de Aro, Andrea; Vidal, Benedicto de Campos; Pimentel, Edson Rosa

    2012-02-01

    Tendons are formed by dense connective tissue composed of an abundant extracellular matrix (ECM) that is constituted mainly of collagen molecules, which are organized into fibrils, fibers, fiber bundles and fascicles helicoidally arranged along the largest axis of the tendon. The biomechanical properties of tendons are directly related to the organization of the collagen molecules that aggregate to become a super-twisted cord. In addition to collagen, the ECM of tendons is composed of non-fibrillar components, such as proteoglycans and non-collagenous glycoproteins. The capacity of tendons to resist mechanical stress is directly related to the structural organization of the ECM. Collagen is a biopolymer and presents optical anisotropies, such as birefringence and linear dichroism, that are important optical properties in the characterization of the supramolecular organization of the fibers. The objective of this study was to present a review of the composition and organization of the ECM of tendons and to highlight the importance of the anisotropic optical properties in the study of alterations in the ECM.

  18. Scalp reconstruction by microvascular free tissue transfer

    SciTech Connect

    Furnas, H.; Lineaweaver, W.C.; Alpert, B.S. )

    1990-05-01

    We report on a series of patients with scalp defects who have been treated with a variety of free flaps, spanning the era of microvascular free tissue transfer from its incipient stages to the present. Between 1971 and 1987, 18 patients underwent scalp reconstruction with 21 free flaps: 11 latissimus dorsi, 3 scalp transfers between identical twins, 3 groin, one combined latissimus dorsi and serratus anterior, two serratus anterior, and one omentum. These flaps were used to cover scalp defects resulting from burns, trauma, radiation, and tumors in patients ranging from 7 to 79 years of age. Follow-up has ranged from 3 weeks to 7 years. All of our flaps survived and covered complex defects, many of which had failed more conservative attempts at cover. One patient received radiation therapy to his flap without unfavorable sequelae. This experience began with a pioneering omental flap and includes cutaneous and muscle flaps. The latissimus dorsi is our first choice for free flap reconstruction of extensive, complicated scalp wounds because of its large size, predictable blood supply, ease of harvesting, and provision of excellent vascularity to compromised beds.

  19. Stem cell therapy: a promising biological strategy for tendon-bone healing after anterior cruciate ligament reconstruction.

    PubMed

    Hao, Zi-Chen; Wang, Shan-Zheng; Zhang, Xue-Jun; Lu, Jun

    2016-04-01

    Tendon-bone healing after anterior cruciate ligament (ACL) reconstruction is a complex process, impacting significantly on patients' prognosis. Natural tendon-bone healing usually results in fibrous scar tissue, which is of inferior quality compared to native attachment. In addition, the early formed fibrous attachment after surgery is often not reliable to support functional rehabilitation, which may lead to graft failure or unsatisfied function of the knee joint. Thus, strategies to promote tendon-bone healing are crucial for prompt and satisfactory functional recovery. Recently, a variety of biological approaches, including active substances, gene transfer, tissue engineering and stem cells, have been proposed and applied to enhance tendon-bone healing. Among these, stem cell therapy has been shown to have promising prospects and draws increasing attention. From commonly investigated bone marrow-derived mesenchymal stem cells (bMSCs) to emerging ACL-derived CD34+ stem cells, multiple stem cell types have been proven to be effective in accelerating tendon-bone healing. This review describes the current understanding of tendon-bone healing and summarizes the current status of related stem cell therapy. Future limitations and perspectives are also discussed.

  20. Anabolic and Catabolic Signaling Pathways in mouse Longissimus Dorsi after 30-day BION-M1 Spaceflight and Subsequent Recovery

    NASA Astrophysics Data System (ADS)

    Mirzoev, Timur; Blottner, Dieter; Shenkman, Boris; Lomonosova, Yulia; Vilchinskaya, Natalia; Nemirovskaya, Tatiana; Salanova, Michele

    The aim of the study was to analyze some of the key markers regulating anabolic and catabolic processes in mouse m. longissimus dorsi, an important back muscle system for trunk stabilization, following 30-day spaceflight and 8-day recovery period. C57/black mice were divided into 3 groups: 1) Vivarium Control (n=7), 2) Flight (n=5), 3) Recovery (n=5). The experiment was carried out in accordance with the rules of biomedical ethics certified by the Russian Academy of Sciences Committee on Bioethics. Using Western-blotting analysis we determined the content of IRS-1, p-AMPK, MURF-1 and eEF2 in m. longissimus dorsi. The content of IRS-1 in mice m. longissimus dorsi after the 30-day flight did not differ from the control group, however, in the Recovery group IRS-1 level was 80% higher (p<0.05) as compared to Control. Phospho-AMPK content remained unchanged. In the Recovery group there was an increase of eEF2 by 75% compared to the Control (p<0.05). After spaceflight MuRF-1 content was increased more than 2 times compared to the control animals. Thus, our findings showed that the work of the IRS-1 - dependent signaling pathway is only active in the recovery period. The content of the ubiquitin-ligase MURF-1 that takes parts in degrading myosin heavy chain was increased after the spaceflight, however, after 8-day recovery period MURF-1 level did not exceed the control indicating normalization of protein degradation in m. longissimus dorsi. The work was supported by the program of basic research of RAS and Federal Space Program of Russia for the period of 2006-2015.

  1. The effect of decellularized matrices on human tendon stem/progenitor cell differentiation and tendon repair.

    PubMed

    Yin, Zi; Chen, Xiao; Zhu, Ting; Hu, Jia-jie; Song, Hai-xin; Shen, Wei-liang; Jiang, Liu-yun; Heng, Boon Chin; Ji, Jun-feng; Ouyang, Hong-Wei

    2013-12-01

    It is reported that decellularized collagen matrices derived from dermal skin and bone have been clinically used for tendon repair. However, the varying biological and physical properties of matrices originating from different tissues may influence the differentiation of tendon stem cells, which has not been systematically evaluated. In this study, the effects of collagenous matrices derived from different tissues (tendon, bone and dermis) on the cell differentiation of human tendon stem/progenitor cells (hTSPCs) were investigated, in the context of tendon repair. It was found that all three matrices supported the adhesion and proliferation of hTSPCs despite differences in topography. Interestingly, tendon-derived decellularized matrix promoted the tendinous phenotype in hTSPCs and inhibited their osteogenesis, even under osteogenic induction conditions, through modulation of the teno- and osteolineage-specific transcription factors Scleraxis and Runx2. Bone-derived decellularized matrix robustly induced osteogenic differentiation of hTSPCs, whereas dermal skin-derived collagen matrix had no apparent effect on hTSPC differentiation. Based on the specific biological function of the tendon-derived decellularized matrix, a tissue-engineered tendon comprising TSPCs and tendon-derived matrix was successfully fabricated for Achilles tendon reconstruction. Implantation of this cell-scaffold construct led to a more mature structure (histology score: 4.08 ± 0.61 vs. 8.51 ± 1.66), larger collagen fibrils (52.2 ± 1.6 nm vs. 47.5 ± 2.8 nm) and stronger mechanical properties (stiffness: 21.68 ± 7.1 Nm m(-1) vs.13.2 ± 5.9 Nm m(-1)) of repaired tendons compared to the control group. The results suggest that stem cells promote the rate of repair of Achilles tendon in the presence of a tendinous matrix. This study thus highlights the potential of decellularized matrix for future tissue engineering applications, as well as developing a practical strategy for functional tendon

  2. CT scanning carcases has no detrimental effect on the colour stability of M. longissimus dorsi from beef and sheep.

    PubMed

    Jose, C G; Pethick, D W; Jacob, R H; Gardner, G E

    2009-01-01

    This study investigated the effect of computerised tomography imaging (CT scan), for carcase composition determination, on the oxy/metmyoglobin ratio, hue and L(∗), a(∗) and b(∗) scores of M. longissimus dorsi from both beef and lamb. Beef and lamb M. longissimus dorsi were divided into four proportions and randomly allocated to one of the following treatments; CT 30 day aged; CT fresh; control 30 day aged; control fresh. Colour measurements were made over a 96h retail display period. CT scan had little effect on the colour of both lamb and beef across all colour parameters. There was a small negative affect observed in CT aged samples (P<0.05) for ratio, hue, a(∗) and b(∗) values, however these differences were so small that they are unlikely to impact upon the commercial shelf-life of the product. Other factors such as aging, species and vitamin E concentration play a much greater role in colour stability than CT. Aged M. longissimus dorsi clearly had a worse colour stability than the fresh packaged samples, while beef was a lot more colour stable than lamb. It appears that CT scan for the purpose of body composition determination will not have any commercially relevant impact on colour stability of both beef and lamb.

  3. Expression of ADAMTS4 and ADAMTS5 in longissimus dorsi muscle related to meat tenderness in Nanyang cattle.

    PubMed

    Zhang, X H; Qi, Y X; Gao, X; Li, J Y; Xu, S Z

    2013-10-18

    The ADAMTS4 and ADAMTS5 are secreted proteases, which can cleave aggrecan, brevican and versican to regulate rebuilding of the extracellular matrix. We analyzed the ADAMTS4 and ADAMTS5 gene expression patterns in longissimus dorsi muscle at intervals from 135 days fetal age to 30 months old by qRT-PCR in Nanyang cattle. Expression of ADAMTS4 was significantly higher in 135 and 185-day-old fetuses than at other stages, while expression of ADAMTS5 decreased during development. The promoter regions of ADAMTS4 and ADAMTS5 were cloned and the transcription factor binding sites were analyzed with bioinformatic methods. Twelve and six potential transcription factor binding sites were found in the promoter regions of ADAMTS4 and ADAMTS5 genes, respectively. Three transcription factors (MZF1, C/EBPb, and NF-kap) were selected to analyze the expression pattern during the development of the longissimus dorsi muscle. MZF1 was significantly co-expressed with ADAMTS4, while C/EBPb expression was significantly negatively associated with that of ADAMTS4. We concluded that the expression of ADAMTS4 is positively regulated by MZF1 and negatively regulated by C/EBPb. We examined the relationships of ADAMTS4 and ADAMTS5 expression with tenderness of longissimus dorsi muscle; ADAMTS4 was significantly and negatively correlated with meat tenderness. We conclude that ADAMTS4 participates in the regulation of muscle development in cattle.

  4. Elastographic characteristics of the metacarpal tendons in horses without clinical evidence of tendon injury.

    PubMed

    Lustgarten, Meghann; Redding, W Rich; Labens, Raphael; Morgan, Michel; Davis, Weston; Seiler, Gabriela S

    2014-01-01

    Tendon and ligament injuries are common causes of impaired performance in equine athletes. Gray-scale ultrasonography is the current standard method for diagnosing and monitoring these injuries, however this modality only provides morphologic information. Elastography is an ultrasound technique that allows detection and measurement of tissue strain, and may provide valuable mechanical information about equine tendon and ligament injuries. The purpose of this study was to determine the feasibility, reproducibility, and repeatability of elastography; and to describe elastographic characteristics of metacarpal tendons in sound horses. Nineteen legs for 17 clinically sound horses without evidence of musculoskeletal pathology were included. Elastographic images of the superficial and deep digital flexor tendons and the branches of the suspensory ligament (tendon of the interosseous muscle) were described quantitatively and qualitatively. There was no statistically significant difference between operators (P = 0.86) nor within operators (P = 0.93). For qualitative assessments, reproducibility (0.46) was moderate and repeatability (0.78) was good. Similar to human Achilles tendons, equine tendons were classified as predominantly hard using elastography. There was no statistically significant difference in stiffness of the flexor tendons (P = 0.96). No significant difference in stiffness was found with altered leg position during standing (P = 0.84) and while nonweight bearing (P = 0.61). The flexor tendons were softer when imaged in longitudinal versus transverse planes (P < 0.01) however, the suspensory branches were not (P = 0.67). Findings supported future clinical application of elastography as a noninvasive "stall-side" imaging modality for evaluation of the tendons and ligaments of the distal forelimb in horses.

  5. The effect of tendon surface treatment on cell attachment for potential enhancement of tendon graft healing: an ex vivo model.

    PubMed

    Hashimoto, Takahiro; Sun, Yu-Long; An, Kai-Nan; Amadio, Peter C; Zhao, Chunfeng

    2012-12-01

    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, and (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.

  6. Nutritional research may be useful in treating tendon injuries.

    PubMed

    Curtis, Luke

    2016-06-01

    Tendon injures cause a great deal of disability and pain, and increase medical costs. However, relatively little is known about tendon biology and healing. Many tendon-related surgical procedures are not very successful and leave the patient with essentially a chronic injury. New therapeutic approaches for tendon injury are needed. Preliminary evidence suggests that various nutrients such as proteins, amino acids (leucine, arginine, glutamine), vitamins C and D, manganese, copper, zinc, and phytochemicals may be useful in improving tendon growth and healing. More research on nutrition and tendon health is needed. Because many nutrients are required for tendon health, nutritional interventions involving multiple nutrients may be more effective than single-nutrient strategies. In the future, ideal treatment regimens for tendon injuries may include a multifaceted "bundle" of nutrition, drugs, biologic products, extracellular matrix therapies, exercise/physical therapy, and possibly surgery. PMID:26921066

  7. A histological study of macroscopically normal equine digital flexor tendons.

    PubMed

    Webbon, P M

    1978-10-01

    The normal appearance of the superficial (SFT) and deep (DFT) digital flexor tendons was described and the difference between their histological structures was emphasised. Further differences were recognised between different sites from the same tendon and between tendons in the fore and hind limbs of the same animal. Both of the tendons underwent changes with age but although a number of alterations in the histological appearance were described, a particular change, involving a patchy loss of stainable nuclei, was found at the common site of SFT injuries. While this appearance has been seen in injured tendons and described as tendon necrosis, the author warns that no cause and effect relationship has been established between the acellularity and the clinical lesions. Neither is it certain that the loss of tendon cells results in mechanical weakness of the tendon.

  8. Nutritional research may be useful in treating tendon injuries.

    PubMed

    Curtis, Luke

    2016-06-01

    Tendon injures cause a great deal of disability and pain, and increase medical costs. However, relatively little is known about tendon biology and healing. Many tendon-related surgical procedures are not very successful and leave the patient with essentially a chronic injury. New therapeutic approaches for tendon injury are needed. Preliminary evidence suggests that various nutrients such as proteins, amino acids (leucine, arginine, glutamine), vitamins C and D, manganese, copper, zinc, and phytochemicals may be useful in improving tendon growth and healing. More research on nutrition and tendon health is needed. Because many nutrients are required for tendon health, nutritional interventions involving multiple nutrients may be more effective than single-nutrient strategies. In the future, ideal treatment regimens for tendon injuries may include a multifaceted "bundle" of nutrition, drugs, biologic products, extracellular matrix therapies, exercise/physical therapy, and possibly surgery.

  9. Robot Arm with Tendon Connector Plate and Linear Actuator

    NASA Technical Reports Server (NTRS)

    Ihrke, Chris A. (Inventor); Diftler, Myron A. (Inventor); Bridgwater, Lyndon (Inventor); Nguyen, Vienny (Inventor); Millerman, Alexander (Inventor)

    2014-01-01

    A robotic system includes a tendon-driven end effector, a linear actuator, a flexible tendon, and a plate assembly. The linear actuator assembly has a servo motor and a drive mechanism, the latter of which translates linearly with respect to a drive axis of the servo motor in response to output torque from the servo motor. The tendon connects to the end effector and drive mechanism. The plate assembly is disposed between the linear actuator assembly and the tendon-driven end effector and includes first and second plates. The first plate has a first side that defines a boss with a center opening. The second plate defines an accurate through-slot having tendon guide channels. The first plate defines a through passage for the tendon between the center opening and a second side of the first plate. A looped end of the flexible tendon is received within the tendon guide channels.

  10. Bilateral infrapatellar tendon rupture in a patient with jumper's knee.

    PubMed

    Rosenberg, J M; Whitaker, J H

    1991-01-01

    This is the fourth case report of bilateral infrapatellar tendon rupture as a result of indirect trauma in a patient without systemic disease. This is the only report we have found of jumper's knee leading to simultaneous infrapatellar tendon ruptures.

  11. Management of Chronic Expanding Haematoma Using Triamcinolone after Latissimus Dorsi Flap Harvesting

    PubMed Central

    Hamada, Mariko; Aramaki-Hattori, Noriko; Kato, Tatsuya; Takada, Keiko; Aoki, Marie; Kishi, Kazuo; Nagasao, Tomohisa

    2015-01-01

    Chronic expanding haematoma (CEH) is a rare type of haematoma that enlarges slowly and continuously without coagulation. It can occur following surgery because of shear stress-induced bleeding in the scar tissue between the subcutaneous fat and fascia. We present three cases of large chronic CEH that were successfully treated with triamcinolone injections. Three female patients developed large chronic CEH at 9 months, 5 years, and 6 years, respectively, after latissimus dorsi flap harvesting for breast reconstruction. Although the condition did not improve after multiple sessions of haematoma aspiration in the first two patients, it resolved following a single 40-mg triamcinolone injection along with appropriate compression dressing for several weeks. In the third patient, triamcinolone was injected immediately after the initial aspiration of the haematoma, and the condition improved considerably. There were no side effects in any of the patients. To the best of our knowledge, this is the first report of successful treatment of large CEH using triamcinolone. Therefore, we suggest that triamcinolone injections be considered for the treatment of CEH. PMID:25798395

  12. Myosin Isoforms and Contractile Properties of Single Fibers of Human Latissimus Dorsi Muscle

    PubMed Central

    Pacelli, Quirico F.; Cancellara, Pasqua; Toniolo, Luana; Moro, Tatiana; Canato, Marta; Miotti, Danilo; Reggiani, Carlo

    2013-01-01

    The aim of our study was to investigate fiber type distribution and contractile characteristics of Latissimus Dorsi muscle (LDM). Samples were collected from 18 young healthy subjects (9 males and 9 females) through percutaneous fine needle muscle biopsy. The results showed a predominance of fast myosin heavy chain isoforms (MyHC) with 42% of MyHC 2A and 25% of MyHC 2X, while MyHC 1 represented only 33%. The unbalance toward fast isoforms was even greater in males (71%) than in females (64%). Fiber type distribution partially reflected MyHC isoform distribution with 28% type 1/slow fibers and 5% hybrid 1/2A fibers, while fast fibers were divided into 30% type 2A, 31% type A/X, 4% type X, and 2% type 1/2X. Type 1/slow fibers were not only less abundant but also smaller in cross-sectional area than fast fibers. During maximal isometric contraction, type 1/slow fibers developed force and tension significantly lower than the two major groups of fast fibers. In conclusion, the predominance of fast fibers and their greater size and strength compared to slow fibers reveal that LDM is a muscle specialized mainly in phasic and powerful activity. Importantly, such specialization is more pronounced in males than in females. PMID:23971027

  13. Latissimus Dorsi and Teres Major Injuries in Major League Baseball Pitchers: A Systematic Review.

    PubMed

    Mehdi, Syed K; Frangiamore, Salvatore J; Schickendantz, Mark S

    2016-01-01

    Injuries to the upper extremity in baseball pitchers are not uncommon, with extensive literature on shoulder and elbow pathology. However, there is minimal literature on isolated teres major (TM) and latissimus dorsi (LD) injuries. As a result, there is no consensus on an optimal treatment method. An extensive Medline search on studies focusing on the treatment of isolated LD and TM injuries in professional baseball pitchers was performed to explore this topic. Of the 20 retrieved articles, 5 met our inclusion criteria. There were a total of 29 patients who underwent conservative treatment and 1 who underwent surgical treatment. The average time required to return to pitching was 99.8 days in the conservative group and 140 days in the surgically treated group. Five patients in the conservative group suffered from complications and/or setbacks during their treatment and rehabilitation. The lone surgical patient suffered no complications, returned to preinjury form, and was elected an all-star the following year. The goal of this review is to provide a concise summary of the current literature in order to assist physicians when discussing treatment options with their patients.

  14. Effects of tetracycline administration on the proteomic profile of pig muscle samples (L. dorsi).

    PubMed

    Gratacós-Cubarsí, M; Castellari, M; Hortós, M; García-Regueiro, J A; Lametsch, R; Jessen, F

    2008-10-01

    Effect of tetracycline (TC) administration on the proteomic profile of pig muscle was evaluated by 2D electrophoresis and MALDI-TOF mass spectrometry. The TC content at slaughter was determined in L. dorsi samples by HPLC-DAD. Mean residual concentration of TC in the muscle of treated animals, calculated as the sum of TC and epi-TC was 126.3 microg/kg, indicating a rapid elimination of TC in this tissue. Several differential spots (n = 54, p < 0.05) were observed in protein profiles from control and treated animals. MALDI-TOF identification gave a positive match for 5 differential spots, that is, glycerol-3-phosphate dehydrogenase 1 (G3PD1), phosphoglycerate kinase 1, novelprotein (0610037L13Rik), leucine aminopeptidase 3 (LAP), and hypothetical protein isoform 2. Results show that proteomics could be a useful tool to reveal pharmacological treatments with TC, even if the possible uses of differential spots as biomarkers to detect illegal administration of TC require further studies. Different spot patterns as a consequence of TC treatments seem to be another interesting issue for the consequences on tissue metabolism and meat quality. PMID:18778074

  15. Transcriptome profiling of Musculus longissimus dorsi in two cattle breeds with different intramuscular fat deposition

    PubMed Central

    Albrecht, Elke; Komolka, Katrin; Ponsuksili, Siriluck; Gotoh, Takafumi; Wimmers, Klaus; Maak, Steffen

    2015-01-01

    Intramuscular fat (IMF) deposition is a physiological process in cattle and is highly variable among breeds suggesting a large influence of genetic factors besides environmental factors. In order to elucidate molecular pathways underlying the genetic variation in this trait we compared transcriptomes of Musculus longissimus dorsi (MLD) in steers of Japanese Black and Holstein Friesian cattle breeds fed a high energy diet typically applied in Japan to achieve maximum IMF content. We identified a total of 569 differentially expressed genes (DEGs) with the majority (433) up-regulated in Japanese Black cattle. This breed is characterized by an extreme capacity for IMF deposition. Subsequent Ingenuity Pathway Analysis (IPA) revealed a gene network linking parameters of cell morphology and maintenance with lipid metabolism. The data from this study were deposited in NCBI's Gene Expression Omnibus and are accessible through GEO Series accession number GSE75348. We provide here a dataset which is of potential value to dissect molecular pathways influencing differences in fat deposition under high-energy nutrition. PMID:26981380

  16. Latissimus Dorsi and Teres Major Injuries in Major League Baseball Pitchers: A Systematic Review.

    PubMed

    Mehdi, Syed K; Frangiamore, Salvatore J; Schickendantz, Mark S

    2016-01-01

    Injuries to the upper extremity in baseball pitchers are not uncommon, with extensive literature on shoulder and elbow pathology. However, there is minimal literature on isolated teres major (TM) and latissimus dorsi (LD) injuries. As a result, there is no consensus on an optimal treatment method. An extensive Medline search on studies focusing on the treatment of isolated LD and TM injuries in professional baseball pitchers was performed to explore this topic. Of the 20 retrieved articles, 5 met our inclusion criteria. There were a total of 29 patients who underwent conservative treatment and 1 who underwent surgical treatment. The average time required to return to pitching was 99.8 days in the conservative group and 140 days in the surgically treated group. Five patients in the conservative group suffered from complications and/or setbacks during their treatment and rehabilitation. The lone surgical patient suffered no complications, returned to preinjury form, and was elected an all-star the following year. The goal of this review is to provide a concise summary of the current literature in order to assist physicians when discussing treatment options with their patients. PMID:26991570

  17. Spectral absorption index in hyperspectral image analysis for predicting moisture contents in pork longissimus dorsi muscles.

    PubMed

    Ma, Ji; Sun, Da-Wen; Pu, Hongbin

    2016-04-15

    Spectral absorption index was proposed to extract the morphological features of the spectral curves in pork meat samples (longissimus dorsi) under the conditions including fresh, frozen-thawed, heated-dehydrated and brined-dehydrated. Savitzky-Golay (SG) smoothing and multiplicative scatter correction (MSC) were used for calibrating both the spectral reflectance and absorbance values. The absorption values were better than the reflectance values and the calibrated spectra by MSC were better than the raw and SG smoothing corrected spectra in building moisture content predictive models. The optimized partial least square regression (PLSR) model attained good results with the MSC calibrated spectral absorption values based on the spectral absorption index features (R(2)P=0.952, RMSEP=1.396) and the optimal wavelengths selected by regression coefficients (R(2)P=0.966, RMSEP=0.855), respectively. The models proved spectral absorption index was promising in spectral analysis to predict moisture content in pork samples using HSI techniques for the first time.

  18. No Telescoping Effect with Dual Tendon Vibration

    PubMed Central

    Bellan, Valeria; Wallwork, Sarah B.; Stanton, Tasha R.; Reverberi, Carlo; Gallace, Alberto; Moseley, G. Lorimer

    2016-01-01

    The tendon vibration illusion has been extensively used to manipulate the perceived position of one’s own body part. However, findings from previous research do not seem conclusive sregarding the perceptual effect of the concurrent stimulation of both agonist and antagonist tendons over one joint. On the basis of recent data, it has been suggested that this paired stimulation generates an inconsistent signal about the limb position, which leads to a perceived shrinkage of the limb. However, this interesting effect has never been replicated. The aim of the present study was to clarify the effect of a simultaneous and equal vibration of the biceps and triceps tendons on the perceived location of the hand. Experiment 1 replicated and extended the previous findings. We compared a dual tendon stimulation condition with single tendon stimulation conditions and with a control condition (no vibration) on both ‘upward-downward’ and ‘towards-away from the elbow’ planes. Our results show a mislocalisation towards the elbow of the position of the vibrated arm during dual vibration, in line with previous results; however, this did not clarify whether the effect was due to arm representation contraction (i.e., a ‘telescoping’ effect). Therefore, in Experiment 2 we investigated explicitly and implicitly the perceived arm length during the same conditions. Our results clearly suggest that in all the vibration conditions there was a mislocalisation of the entire arm (including the elbow), but no evidence of a contraction of the perceived arm length. PMID:27305112

  19. No Telescoping Effect with Dual Tendon Vibration.

    PubMed

    Bellan, Valeria; Wallwork, Sarah B; Stanton, Tasha R; Reverberi, Carlo; Gallace, Alberto; Moseley, G Lorimer

    2016-01-01

    The tendon vibration illusion has been extensively used to manipulate the perceived position of one's own body part. However, findings from previous research do not seem conclusive sregarding the perceptual effect of the concurrent stimulation of both agonist and antagonist tendons over one joint. On the basis of recent data, it has been suggested that this paired stimulation generates an inconsistent signal about the limb position, which leads to a perceived shrinkage of the limb. However, this interesting effect has never been replicated. The aim of the present study was to clarify the effect of a simultaneous and equal vibration of the biceps and triceps tendons on the perceived location of the hand. Experiment 1 replicated and extended the previous findings. We compared a dual tendon stimulation condition with single tendon stimulation conditions and with a control condition (no vibration) on both 'upward-downward' and 'towards-away from the elbow' planes. Our results show a mislocalisation towards the elbow of the position of the vibrated arm during dual vibration, in line with previous results; however, this did not clarify whether the effect was due to arm representation contraction (i.e., a 'telescoping' effect). Therefore, in Experiment 2 we investigated explicitly and implicitly the perceived arm length during the same conditions. Our results clearly suggest that in all the vibration conditions there was a mislocalisation of the entire arm (including the elbow), but no evidence of a contraction of the perceived arm length. PMID:27305112

  20. Complications of the treatment of Achilles tendon ruptures.

    PubMed

    Molloy, Andy; Wood, Edward V

    2009-12-01

    Since the first reports in the medical literature of treatment of the Achilles tendon, complications have been recognized from both non-operative and operative techniques. These include tendon rerupture, sural nerve morbidity, wound healing problems, changes in tendon morphology, venous thromboembolism, elongation of the tendon, complex regional pain syndrome, and compartment syndrome. This article delineates the incidence for each of these complications, with differing techniques, methods of avoiding these complications and treatment methods if they occur. PMID:19857846

  1. p38 MAPK Signaling in Postnatal Tendon Growth and Remodeling

    PubMed Central

    Schwartz, Andrew J.; Sarver, Dylan C.; Sugg, Kristoffer B.; Dzierzawski, Justin T.; Gumucio, Jonathan P.; Mendias, Christopher L.

    2015-01-01

    Tendon is a dynamic tissue whose structure and function is influenced by mechanical loading, but little is known about the fundamental mechanisms that regulate tendon growth and remodeling in vivo. Data from cultured tendon fibroblasts indicated that the p38 MAPK pathway plays an important role in tendon fibroblast proliferation and collagen synthesis in vitro. To gain greater insight into the mechanisms of tendon growth, and explore the role of p38 MAPK signaling in this process, we tested the hypotheses that inducing plantaris tendon growth through the ablation of the synergist Achilles tendon would result in rapid expansion of a neotendon matrix surrounding the original tendon, and that treatment with the p38 MAPK inhibitor SB203580 would prevent this growth. Rats were treated with vehicle or SB203580, and subjected to synergist ablation by bilateral tenectomy of the Achilles tendon. Changes in histological and biochemical properties of plantaris tendons were analyzed 3, 7, or 28 days after overload, and comparisons were made to non-overloaded animals. By 28 days after overload, tendon mass had increased by 30% compared to non-overloaded samples, and cross-sectional area (CSA) increased by around 50%, with most of the change occurring in the neotendon. The expansion in CSA initially occurred through the synthesis of a hyaluronic acid rich matrix that was progressively replaced with mature collagen. Pericytes were present in areas of active tendon growth, but never in the original tendon ECM. Inhibition of p38 MAPK resulted in a profound decrease in IL6 expression, and had a modest effect on the expression of other ECM and cell proliferation genes, but had a negligible impact on overall tendon growth. The combined results from this study provided novel insights into tendon mechanobiology, and suggest that p38 MAPK signaling does not appear to be necessary for tendon growth in vivo. PMID:25768932

  2. Partial tear of the quadriceps tendon in a child.

    PubMed

    Khanna, Geetika; El-Khoury, George

    2008-06-01

    We present a case of partial rupture of the quadriceps tendon in an 8-year-old girl. This is one of the youngest patients reported with a quadriceps tendon rupture, an entity seen predominantly in middle-aged people. The strength of the muscle tendon unit in a child makes tendon injuries extremely unusual as compared to apophyseal avulsions. The MR imaging findings of this unusual pediatric injury are illustrated.

  3. Structure-function relationships in tendons: a review

    PubMed Central

    Benjamin, M; Kaiser, E; Milz, S

    2008-01-01

    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. PMID:18304204

  4. 21 CFR 888.3025 - Passive tendon prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Passive tendon prosthesis. 888.3025 Section 888...) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3025 Passive tendon prosthesis. (a) Identification. A passive tendon prosthesis is a device intended to be implanted made of silicon elastomer or...

  5. 21 CFR 888.3025 - Passive tendon prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Passive tendon prosthesis. 888.3025 Section 888...) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3025 Passive tendon prosthesis. (a) Identification. A passive tendon prosthesis is a device intended to be implanted made of silicon elastomer or...

  6. 21 CFR 888.3025 - Passive tendon prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Passive tendon prosthesis. 888.3025 Section 888...) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3025 Passive tendon prosthesis. (a) Identification. A passive tendon prosthesis is a device intended to be implanted made of silicon elastomer or...

  7. 21 CFR 888.3025 - Passive tendon prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Passive tendon prosthesis. 888.3025 Section 888...) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3025 Passive tendon prosthesis. (a) Identification. A passive tendon prosthesis is a device intended to be implanted made of silicon elastomer or...

  8. 21 CFR 888.3025 - Passive tendon prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Passive tendon prosthesis. 888.3025 Section 888...) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3025 Passive tendon prosthesis. (a) Identification. A passive tendon prosthesis is a device intended to be implanted made of silicon elastomer or...

  9. Effect of pulley excision on flexor tendon biomechanics.

    PubMed

    Peterson, W W; Manske, P R; Bollinger, B A; Lesker, P A; McCarthy, J A

    1986-01-01

    Flexor tendon function following excision of various portions of the fibro-osseous pulley system was measured biomechanically using a tensile testing machine. The biomechanical parameters measured were tendon excursion (the excursion of the tendon required to fully flex the digit) and work of flexion (the area under the force-excursion curve, representing all the forces that resist tendon flexion). In this experiment, work of flexion included the forces necessary to accomplish full digital flexion against a 15-g counter-weight, as well as the frictional forces that resist tendon gliding. The results indicate that the work of flexion was affected to a greater degree by pulley loss than was tendon excursion, suggesting that it is a more sensitive measurement of tendon function. A2 was found to be the single most important pulley for flexor tendon function, followed by A4. However, both A2 and A4 had to be present if near-normal hand function was to be achieved; sacrificing the A1 pulley was not associated with a significant loss of flexion. The "pulley effect" of the skin and soft tissue as a supplement to the fibro-osseous pulleys in reducing tendon bow-stringing was also noted. Although the parameters of tendon excursion and work of flexion were used in this study to determine the effect of pulley loss on tendon function, they can also be used to evaluate other flexor tendon studies, such as pulley reconstruction.

  10. Can Shockwave Therapy Improve Tendon Metabolism?

    PubMed

    Zwerver, Johannes; Waugh, Charlotte; van der Worp, Henk; Scott, Alex

    2016-01-01

    Shockwave treatments are commonly used in the management of tendon injuries and there is increasing evidence for its clinical effectiveness. There is a paucity of fundamental (in vivo) studies investigating the biological action of shockwave therapy. Destruction of calcifications, pain relief and mechanotransduction-initiated tissue regeneration and remodeling of the tendon are considered to be the most important working mechanisms. The heterogeneity of systems (focussed shockwave therapy vs. radial pressurewave therapy), treatment protocols and study populations, and the fact that there seem to be responders and non-responders, continue to make it difficult to give firm recommendations with regard to the most optimal shockwave therapy approach. Specific knowledge with regard to the effects of shockwave therapy in patients with metabolic tendon disorders is not available. Further fundamental and clinical research is required to determine the value of shockwave therapy in the management of tendinopathy.

  11. Can Shockwave Therapy Improve Tendon Metabolism?

    PubMed

    Zwerver, Johannes; Waugh, Charlotte; van der Worp, Henk; Scott, Alex

    2016-01-01

    Shockwave treatments are commonly used in the management of tendon injuries and there is increasing evidence for its clinical effectiveness. There is a paucity of fundamental (in vivo) studies investigating the biological action of shockwave therapy. Destruction of calcifications, pain relief and mechanotransduction-initiated tissue regeneration and remodeling of the tendon are considered to be the most important working mechanisms. The heterogeneity of systems (focussed shockwave therapy vs. radial pressurewave therapy), treatment protocols and study populations, and the fact that there seem to be responders and non-responders, continue to make it difficult to give firm recommendations with regard to the most optimal shockwave therapy approach. Specific knowledge with regard to the effects of shockwave therapy in patients with metabolic tendon disorders is not available. Further fundamental and clinical research is required to determine the value of shockwave therapy in the management of tendinopathy. PMID:27535269

  12. Adhesive bacterial colonization of exposed traumatized tendon.

    PubMed

    Webb, L X; Hobgood, C D; Meredith, J W; Gristina, A G

    1987-05-01

    Recent studies of compromised or damaged tissues, as well as biomaterials, have shown that they provide a particularly fertile substratum for bacterial colonization. Colonization in these environments is mediated by a process of microbial adhesion to surfaces of the substrata. In this report, we present electron microscopic studies of a portion of damaged and infected tendon. These studies demonstrate colonies of bacteria surrounded by a ruthenium red-staining exopolysaccharide biofilm and adhesion to the surface of the tendon by means of an exopolysaccharide polymer. We suggest that this adhesive form of bacterial colonization may partially explain the resistance of exposed tendon to effective debridement by simple mechanical measures and to coverage with granulation tissue, partial-thickness skin grafts, and vascularized tissue grafts.

  13. Influence of Thyroid Hormones on Tendon Homeostasis.

    PubMed

    Oliva, Francesco; Piccirilli, Eleonora; Berardi, Anna C; Tarantino, Umberto; Maffulli, Nicola

    2016-01-01

    Tendinopathies have a multifactorial etiology driven by extrinsic and intrinsic factors. Recent studies have elucidated the importance of thyroid hormones in the alteration of tendons homeostasis and in the failure of tendon healing after injury. The effects of thyroid hormones are mediated by receptors (TR)-α and -β that seem to be ubiquitous. In particular, T3 and T4 play an antiapoptotic role on tenocytes, causing an increase in vital tenocytes isolated from tendons in vitro and a reduction of apoptotic ones; they are also able to influence extra cellular matrix proteins secretion in vitro from tenocytes, enhancing collagen production. From a clinical point of view, disorders of thyroid function have been investigated only for rotator cuff calcific tendinopathy and tears. In this complex scenario, further research is needed to clarify the role of thyroid hormones on the onset of tendinopathies. PMID:27535255

  14. Murine Flexor Tendon Injury and Repair Surgery.

    PubMed

    Ackerman, Jessica E; Loiselle, Alayna E

    2016-01-01

    Tendon connects skeletal muscle and bone, facilitating movement of nearly the entire body. In the hand, flexor tendons (FTs) enable flexion of the fingers and general hand function. Injuries to the FTs are common, and satisfactory healing is often impaired due to excess scar tissue and adhesions between the tendon and surrounding tissue. However, little is known about the molecular and cellular components of FT repair. To that end, a murine model of FT repair that recapitulates many aspects of healing in humans, including impaired range of motion and decreased mechanical properties, has been developed and previously described. Here an in-depth demonstration of this surgical procedure is provided, involving transection and subsequent repair of the flexor digitorum longus (FDL) tendon in the murine hind paw. This technique can be used to conduct lineage analysis of different cell types, assess the effects of gene gain or loss-of-function, and to test the efficacy of pharmacological interventions in the healing process. However, there are two primary limitations to this model: i) the FDL tendon in the mid-portion of the murine hind paw, where the transection and repair occur, is not surrounded by a synovial sheath. Therefore this model does not account for the potential contribution of the sheath to the scar formation process. ii) To protect the integrity of the repair site, the FT is released at the myotendinous junction, decreasing the mechanical forces of the tendon, likely contributing to increased scar formation. Isolation of sufficient cells from the granulation tissue of the FT during the healing process for flow cytometric analysis has proved challenging; cytology centrifugation to concentrate these cells is an alternate method used, and allows for generation of cell preparations on which immunofluorescent labeling can be performed. With this method, quantification of cells or proteins of interest during FT healing becomes possible. PMID:27684281

  15. An unusual cause of Achilles tendon xanthoma.

    PubMed

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

    2016-01-01

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

  16. Structure-strength relations in mammalian tendon.

    PubMed Central

    Lanir, Y

    1978-01-01

    The stress-strain relations in mammalian tendon are analyzed in terms of the structure and mechanics of its constituents. The model considers the tensile and bending strength of the collagen fibers, the tensile strength of the elastin fibers, and the interaction between the matrix and the collagen fibers. The stress-strain relations are solved through variational considerations by assuming that the fibermaxtrix interactions can be modeled as beam on elastic foundation. The tissue thus modeled is a hyperelastic material. It is further shown that on the basis of the model, the dominant parameters to the tendon's behavior can be evaluated from simple tensile tests. PMID:728528

  17. Spontaneous Achilles tendon rupture in alkaptonuria

    PubMed Central

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

    2015-01-01

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

  18. [Isolated injury of the subscapular muscle tendon].

    PubMed

    Thielemann, F W; Kley, U; Holz, U

    1992-03-01

    Avulsion of the subscapularis tendon is caused by a combined abduction and external rotation trauma of the upper limb. Weakness of internal rotation and a positive apprehension test are clinical signs of the injury. A fracture of the lesser tuberosity in the x-ray film or a disruption of the subscapularis tendon documented in dynamic sonography of the shoulder clarify the diagnosis. Operative treatment is indicated of prevent weakness of internal rotation as well as anterior instability. This recommendation is supported by four cases with full range of motion and good anterior stability after surgery. PMID:1585252

  19. Tendon ruptures: mallet, flexor digitorum profundus.

    PubMed

    Yeh, Peter C; Shin, Steven S

    2012-08-01

    Mallet injuries are the most common closed tendon injury in the athlete. Flexor digitorum profundus ruptures are rare in baseball, but are common injuries in contact sports. The diagnosis for each condition is based on clinical examination, although radiographs should be evaluated for a possible bony component. Treatment for mallet injury depends on the athlete's goals of competition and understanding of the consequences of any treatment chosen. Gripping, throwing, and catching would be restricted or impossible with the injured finger immobilized. Treatment of FDP ruptures is almost always surgical and requires reattachment of the torn tendon to the distal phalanx.

  20. Lubricin in human achilles tendon: The evidence of intratendinous sliding motion and shear force in achilles tendon.

    PubMed

    Sun, Yu-Long; Wei, Zhuang; Zhao, Chunfeng; Jay, Gregory D; Schmid, Thomas M; Amadio, Peter C; An, Kai-Nan

    2015-06-01

    Achilles tendon is one of the most commonly injured tendons. Mechanical force is regarded as a major causative factor. However, the biomechanics of Achilles tendon and mechanical mechanism of the injuries are unclear. Lubricin expresses at regions exposed to sliding motion and shear force in a number of tissues. This study investigated the distribution and concentration of lubricin in human Achilles tendons for better understanding the biomechanics of Achilles tendon. Achilles tendons were harvested from nine cadavers. Lubricin was extracted from various locations proximal to the calcaneal insertion and quantified with ELISA. The distribution of lubricin was investigated with immunohistochemistry. Lubricin was mainly identified at the interfaces of tendon fascicles, especially in the mid-portion of the tendon. The concentration of lubricin in Achilles tendons varied by individual and the distance from its calcaneal insertion. The distal portion of the tendon had a higher concentration of lubricin than the proximal regions of the tendon. This study suggests the presence of intratendinous sliding motion of fascicles and shear force at interfaces of fascicles in human Achilles tendon. Shear force could be an important mechanical factor for the development of Achilles tendinopathy and rupture.

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

    PubMed Central

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

    2015-01-01

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

  2. The role of animal models in tendon research

    PubMed Central

    Hast, M. W.; Zuskov, A.; Soslowsky, L. J.

    2014-01-01

    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

  3. A rare complication of scaphoid nonunion: Multiple flexor tendon lesions. A case report and review of literature.

    PubMed

    Pierrart, J; Rétoré, J-Y; Leclercq, C

    2016-04-01

    This case report describes a patient who presented with a complete rupture of the flexor pollicis longus (FPL) tendon and partial rupture of the flexor digitorum profundus of the index finger, secondary to scaphoid nonunion. This is a rare, late complication that deserves to be described because of the potential diagnostic confusion with anterior interosseous nerve palsy. No case has been reported since 1999 in the literature. The mechanism was an attrition rupture due to sharp osteophytes. The scaphoid osteophytes were removed and the FPL was repaired by tendon transfer. The results were satisfactory at the last follow-up. PMID:27117128

  4. Fatty acid and transcriptome profiling of longissimus dorsi muscles between pig breeds differing in meat quality.

    PubMed

    Yu, Kaifan; Shu, Gang; Yuan, Fangfang; Zhu, Xiaotong; Gao, Ping; Wang, Songbo; Wang, Lina; Xi, Qianyun; Zhang, Shouquan; Zhang, Yongliang; Li, Yan; Wu, Tongshan; Yuan, Li; Jiang, Qingyan

    2013-01-01

    Fat and lean pig breeds show obvious differences in meat quality characteristics including the fatty acid composition of muscle. However, the molecular mechanism underlying these phenotypes differences remains unknown. This study compared meat quality traits between Lantang (a Chinese indigenous breed) and Landrace (a typical lean breed). The Lantang pigs showed higher L* values and intramuscular fat content, lower pH(45min), pH(24h) and shear force in longissimus dorsi (LD) muscle than Landrace (P < 0.05). Fatty acid analysis demonstrated the lower monounsaturated fatty acids (MUFA) and higher polyunsaturated fatty acids (PUFA) percentage in Lantang LD than that in Landrace LD (P < 0.05). To further identify candidate genes for fatty acid composition, the transcriptome of LD muscle from the two breeds were measured by microarrays. There were 586 transcripts differentially expressed, of which 267 transcripts were highly expressed in Lantang pigs. After the validation by real-time quantitative PCR, 13 genes were determined as candidate genes for fatty acid composition of muscle, including Stearoyl-CoA desaturase (SCD). Then, a SCD over-expression plasmid was transfected into C2C12 cells to reveal the effect of SCD on the fatty acid composition in vitro. The results showed that SCD over-expression significantly increased PUFA proportion, while reduced that of saturated fatty acids (SFA) in C2C12 cells (P < 0.05). In summary, this study compared the differences of fatty acid composition and transcriptome in two breeds differing in meat quality, and further identified the novel role of SCD in the regulation of PUFA deposition.

  5. Myofascial force transmission between the latissimus dorsi and gluteus maximus muscles: an in vivo experiment.

    PubMed

    Carvalhais, Viviane Otoni do Carmo; Ocarino, Juliana de Melo; Araújo, Vanessa Lara; Souza, Thales Rezende; Silva, Paula Lanna Pereira; Fonseca, Sérgio Teixeira

    2013-03-15

    There are extensive connections between the latissimus dorsi (LD) and gluteus maximus (GMax) muscles and the thoracolumbar fascia (TLF), which suggests a possible pathway for myofascial force transmission. The present study was designed to provide empirical evidence of myofascial force transmission from LD to contralateral GMax through TFL in vivo. To accomplish this goal, we evaluated whether active or passive tensioning of the LD results in increased passive tension of the contralateral GMax, indexed by changes in the hip resting position (RP) or passive stiffness. The hip RP was defined as the angular position in which the passive joint torque equals zero, and passive hip stiffness was calculated as the change in passive torque per change in joint angle. Thirty-seven subjects underwent an assessment of their passive hip torque against medial rotation by means of an isokinetic dynamometer. These measures were carried out under three test conditions: (1) control, (2) passive LD tensioning and (3) active LD tensioning. Electromyography was used to monitor the activity of the hip muscles and the LD under all conditions. Repeated measures analyses of variance demonstrated that passive LD tensioning shifted the hip RP towards lateral rotation (p=0.009) but did not change the passive hip stiffness (p>0.05). Active LD tensioning shifted the hip RP towards lateral rotation (p<0.001) and increased the passive hip stiffness (p≤0.004). The results demonstrated that manipulation of the LD tension modified the passive hip variables, providing evidence of myofascial force transmission in vivo. PMID:23394717

  6. Two-Stage Latissimus Dorsi Flap with Implant for Unilateral Breast Reconstruction: Getting the Size Right

    PubMed Central

    Feng, Jiajun; Pardoe, Cleone I; Mota, Ashley Manuel; Chui, Christopher Hoe Kong

    2016-01-01

    Background The aim of unilateral breast reconstruction after mastectomy is to craft a natural-looking breast with symmetry. The latissimus dorsi (LD) flap with implant is an established technique for this purpose. However, it is challenging to obtain adequate volume and satisfactory aesthetic results using a one-stage operation when considering factors such as muscle atrophy, wound dehiscence and excessive scarring. The two-stage reconstruction addresses these difficulties by using a tissue expander to gradually enlarge the skin pocket which eventually holds an appropriately sized implant. Methods We analyzed nine patients who underwent unilateral two-stage LD reconstruction. In the first stage, an expander was placed along with the LD flap to reconstruct the mastectomy defect, followed by gradual tissue expansion to achieve overexpansion of the skin pocket. The final implant volume was determined by measuring the residual expander volume after aspirating the excess saline. Finally, the expander was replaced with the chosen implant. Results The average volume of tissue expansion was 460 mL. The resultant expansion allowed an implant ranging in volume from 255 to 420 mL to be placed alongside the LD muscle. Seven patients scored less than six on the relative breast retraction assessment formula for breast symmetry, indicating excellent breast symmetry. The remaining two patients scored between six and eight, indicating good symmetry. Conclusions This approach allows the size of the eventual implant to be estimated after the skin pocket has healed completely and the LD muscle has undergone natural atrophy. Optimal reconstruction results were achieved using this approach. PMID:27018318

  7. Fewer Revisions in Abdominal-based Free Flaps than Latissimus Dorsi Breast Reconstruction after Radiation

    PubMed Central

    Smith, Benjamin D.; Liu, Jun; Robb, Geoffrey L.; Kronowitz, Steven J.; Garvey, Patrick B.

    2016-01-01

    Background: The most commonly chosen flaps for delayed breast reconstruction after postmastectomy radiation therapy (PMRT) are abdominal-based free flaps (ABFFs) and pedicled latissimus dorsi (LD) musculocutaneous flaps. The short-and long-term advantages and disadvantages of delayed ABFFs versus LD flaps after PMRT remain unclear. We hypothesized that after PMRT, ABFFs would result in fewer postoperative complications and a lower incidence of revision surgery than LD flaps. Methods: We retrospectively reviewed a prospectively maintained database of consecutive patients who underwent unilateral, delayed breast reconstruction after PMRT using ABFFs or pedicled LD flaps with implants at the MD Anderson Cancer Center between January 1, 2001, and December 31, 2011. We compared outcomes and additional surgeries required between the 2 groups. Univariate and multivariate logistic regression modeling analyzed the relationships between patient and reconstruction characteristics and postoperative outcomes. Results: A total of 139 consecutive patients’ breast reconstructions were evaluated: 101 ABFFs (72.7%) versus 38 LDs (27.3%). Average follow-up was similar for ABFF and LD reconstructions. Although ABFF and LD reconstructions experienced similar rates of overall (30.7% vs 23.7%, respectively; P = 0.53), donor-site (8.91% vs 5.13%, respectively; P = 0.48), and flap (20.7% vs 17.9%, respectively; P = 0.37) complications, the LD reconstructions required more additional surgeries (92.1% vs 67.3%; P < 0.001). Furthermore, LDs required more revision surgeries more than 1 year after reconstruction (37.1% vs 14.7%; P = 0.02). Conclusion: Although early complication rates were similar for both types of reconstructions, ABFFs seem to have the advantage of providing a more durable result that required fewer revision surgeries in the long term. PMID:27757331

  8. Is tendon stiffness correlated to the dissipation coefficient?

    PubMed

    Fouré, A; Cornu, C; Nordez, A

    2012-01-01

    The assessment of Achilles tendon mechanical properties in vivo has received much attention in the literature. Many studies investigated mechanical properties by assessing tendon stiffness. Despite tendon dissipative properties being representative of a storage-recoil process, its determination has received minimal attention in the literature. The aim of this study was to determine if Achilles tendon stiffness is associated with dissipative properties. The cross-sectional area, stiffness and dissipation coefficient of the Achilles tendon were measured in 35 subjects. No significant correlation was found between stiffness and the dissipation coefficient, irrespective of stiffness normalization with cross-sectional area (P > 0.05). Thus, it appears that both stiffness and dissipative properties must be assessed to determine the storage-recoil process capacities of the Achilles tendon in order to precisely characterize changes in the tendon mechanical properties after chronic interventions or rehabilitation programs.

  9. Transosseous-Equivalent Repair for Distal Patellar Tendon Avulsion.

    PubMed

    Galos, David K; Konda, Sanjit R; Kaplan, Daniel J; Ryan, William E; Alaia, Michael J

    2016-04-01

    Extensor mechanism disruptions are relatively uncommon injuries involving injury to the quadriceps tendon, patella, or patellar tendon. Patellar tendon avulsions from the tibial tubercle in adults are rare; as such, little technical information has been written regarding surgical management of this injury in the adult. Transosseous-equivalent repairs have been described in the management of several types of tendon ruptures, including rotator cuff and distal triceps tendon ruptures, but not previously in patellar injuries. We present a technique for repairing an avulsion injury of the patellar tendon from the tibial tubercle using suture anchors in a transosseous-equivalent manner. This technique for treating distal patellar tendon avulsion injuries likely increases contact area at the repair site while potentially improving fixation strength. PMID:27462538

  10. Plyometric training effects on Achilles tendon stiffness and dissipative properties.

    PubMed

    Fouré, Alexandre; Nordez, Antoine; Cornu, Christophe

    2010-09-01

    The aim of this study was to determine the effects of 14 wk of plyometric training on mechanical properties of the Achilles tendon. Nineteen subjects were randomly assigned to trained or control group. Cross-sectional area (CSA), stiffness, and dissipation coefficient of the Achilles tendon were measured before and after the training period. In the trained group, a decrease in dissipation coefficient (-35.0%; P<0.05) and an upward trend in stiffness (+24.1%) of the Achilles tendon was found, without any changes in Achilles tendon CSA (P>0.05). Plyometric training enhances the muscular tension transmission mainly through a reduction in energy dissipated by the tendon. The lack of changes in the Achilles tendon CSA indicates that changes in mechanical properties would mainly result from a qualitative change in tendinous tissues rather than from changes in the geometry of the Achilles tendon.

  11. Bilateral patellar tendon rupture associated with statin use

    PubMed Central

    Kearns, Marie C.; Singh, Vinay K.

    2016-01-01

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

  12. Flexor digitorum profundus tendon tension during finger manipulation.

    PubMed

    Tanaka, Tatsuro; Amadio, Peter C; Zhao, Chunfeng; Zobitz, Mark E; An, Kai-Nan

    2005-01-01

    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.

  13. Anatomical heterogeneity of tendon: Fascicular and interfascicular tendon compartments have distinct proteomic composition

    PubMed Central

    Thorpe, Chavaunne T.; Peffers, Mandy J.; Simpson, Deborah; Halliwell, Elizabeth; Screen, Hazel R. C.; Clegg, Peter D.

    2016-01-01

    Tendon is a simple aligned fibre composite, consisting of collagen-rich fascicles surrounded by a softer interfascicular matrix (IFM). The composition and interactions between these material phases are fundamental in ensuring tissue mechanics meet functional requirements. However the IFM is poorly defined, therefore tendon structure-function relationships are incompletely understood. We hypothesised that the IFM has a more complex proteome, with faster turnover than the fascicular matrix (FM). Using laser-capture microdissection and mass spectrometry, we demonstrate that the IFM contains more proteins, and that many proteins show differential abundance between matrix phases. The IFM contained more protein fragments (neopeptides), indicating greater matrix degradation in this compartment, which may act to maintain healthy tendon structure. Protein abundance did not alter with ageing, but neopeptide numbers decreased in the aged IFM, indicating decreased turnover which may contribute to age-related tendon injury. These data provide important insights into how differences in tendon composition and turnover contribute to tendon structure-function relationships and the effects of ageing. PMID:26842662

  14. Simultaneous reconstruction of quadriceps tendon rupture after TKA and neglected Achilles tendon rupture.

    PubMed

    Lee, Yong Seuk; Min, Byoung-Hyun; Han, Kyeong-Jin; Cho, Jae Ho; Han, Seung Hwan; Lee, Doo-Hyung; Oh, Kyung Soo

    2010-05-12

    We report a case of simultaneous reconstruction of a quadriceps tendon rupture after total knee arthroplasty (TKA) and neglected Achilles tendon rupture, which occurred before TKA with an ipsilateral hamstring autograft. A 64-year-old woman presented with persistent right knee pain. She also had right heel pain and had received multiple steroid injections at the knee joint and heel. On examination, she showed osteoarthritis in the medial and lateral compartments of the knee joint and an Achilles tendon rupture in the ipsilateral limb. There was skin dimpling and the proximal portion of tendon was migrated. We performed TKA, and the postoperative course was satisfactory. She returned 3 months postoperatively, however, with skin dimpling around the suprapatellar area and weakness of knee extension. Her ankle symptoms were also aggravated because she could not use the knee joint freely. We performed simultaneous reconstruction of the quadriceps tendon and the Achilles tendon using an ipsilateral hamstring autograft.Hamstring autograft offers a good alternative treatment option for rupture repair, particularly with concommitant ruptures of multiple sites when primary repair is not possible or the viability of repaired tissue is poor.

  15. Proteomic Assessment of the Relevant Factors Affecting Pork Meat Quality Associated with Longissimus dorsi Muscles in Duroc Pigs

    PubMed Central

    Cho, Jin Hyoung; Lee, Ra Ham; Jeon, Young-Joo; Park, Seon-Min; Shin, Jae-Cheon; Kim, Seok-Ho; Jeong, Jin Young; Kang, Hyun-sung; Choi, Nag-Jin; Seo, Kang Seok; Cho, Young Sik; Kim, MinSeok S.; Ko, Sungho; Seo, Jae-Min; Lee, Seung-Youp; Shim, Jung-Hyun; Chae, Jung-Il

    2016-01-01

    Meat quality is a complex trait influenced by many factors, including genetics, nutrition, feeding environment, animal handling, and their interactions. To elucidate relevant factors affecting pork quality associated with oxidative stress and muscle development, we analyzed protein expression in high quality longissimus dorsi muscles (HQLD) and low quality longissimus dorsi muscles (LQLD) from Duroc pigs by liquid chromatographytandem mass spectrometry (LC-MS/MS)–based proteomic analysis. Between HQLD (n = 20) and LQLD (n = 20) Duroc pigs, 24 differentially expressed proteins were identified by LC-MS/MS. A total of 10 and 14 proteins were highly expressed in HQLD and LQLD, respectively. The 24 proteins have putative functions in the following seven categories: catalytic activity (31%), ATPase activity (19%), oxidoreductase activity (13%), cytoskeletal protein binding (13%), actin binding (12%), calcium ion binding (6%), and structural constituent of muscle (6%). Silver-stained image analysis revealed significant differential expression of lactate dehydrogenase A (LDHA) between HQLD and LQLD Duroc pigs. LDHA was subjected to in vitro study of myogenesis under oxidative stress conditions and LDH activity assay to verification its role in oxidative stress. No significant difference of mRNA expression level of LDHA was found between normal and oxidative stress condition. However, LDH activity was significantly higher under oxidative stress condition than at normal condition using in vitro model of myogenesis. The highly expressed LDHA was positively correlated with LQLD. Moreover, LDHA activity increased by oxidative stress was reduced by antioxidant resveratrol. This paper emphasizes the importance of differential expression patterns of proteins and their interaction for the development of meat quality traits. Our proteome data provides valuable information on important factors which might aid in the regulation of muscle development and the improvement of meat

  16. Comparison of longissimus dorsi Fatty Acids Profiles in Gansu Black Yak and Chinese Yellow Cattle Steers and Heifers

    PubMed Central

    Zhang, S. G.; Liu, T.; Brown, M. A.; Wu, J. P.

    2015-01-01

    Fatty acid (FA) composition of longissimus dorsi intramuscular fat in Black Yak and Chinese Yellow Cattle were evaluated in 44 Black Yak and 41 Chinese Yellow Cattle of both genders. Interactions of species with gender were observed for total saturated fatty acid (SFA), unsaturated fatty acid (UFA), monounsaturated fatty acid (MUFA), polyunsaturated fatty acid (PUFA), palmitic acid, stearic acid, oleic acid, linolenic acid, arachidonic acid, EPA, and DHA concentrations, as well as PUFA/SFA ratio in the longissimus dorsi (p<0.05). The SFA percentage was greater in yellow cattle than yak in both genders but the species difference in heifers was greater than in steers (p<0.05). Yak had greater UFA, MUFA and PUFA percentages than yellow cattle in both steers and heifers (p<0.05) but the difference between yak and yellow cattle heifers was greater than yak and yellow cattle steers. The percentages of inolenic acid, arachidonic acid, eicosapentaenoic acid, and docosahexaenoic acid; and PUFA/SFA were greater in yak than yellow cattle in both steers and heifers (p<0.05). In addition, the ratio of n-6/n-3 PUFA in yak was lesser than in yellow cattle (p<0.05). These results indicated that FA composition generally differed between yak and yellow cattle but the differences were not the same in heifers as compared to steers. Results also suggested that species differences in FA composition tended to favor Black Yak over Chinese Yellow Cattle, indicating that the longissimus dorsi of Black Yak may have a higher nutritive value than that of Chinese Yellow Cattle and potential for development as a desirable natural product. PMID:26761841

  17. Minimally Invasive Approach to Achilles Tendon Pathology.

    PubMed

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

    2016-01-01

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

  18. On muscle, tendon and high heels.

    PubMed

    Csapo, R; Maganaris, C N; Seynnes, O R; Narici, M V

    2010-08-01

    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

  19. Tendon fatigue in response to mechanical loading

    PubMed Central

    Andarawis-Puri, N.; Flatow, E. L.

    2015-01-01

    Tendinopathies are commonly attributable to accumulation of sub-rupture fatigue damage from repetitive use. Data is limited to late stage disease from patients undergoing surgery, motivating development of animal models, such as ones utilizing treadmill running or repetitive reaching, to investigate the progression of tendinopathies. We developed an in vivo model using the rat patellar tendon that allows control of the loading directly applied to the tendon. This manuscript discusses the response of tendons to fatigue loading and applications of our model. Briefly, the fatigue life of the tendon was used to define low, moderate and high levels of fatigue loading. Morphological assessment showed a progression from mild kinks to fiber disruption, for low to high level fatigue loading. Collagen expression, 1 and 3 days post loading, showed more modest changes for low and moderate than high level fatigue loading. Protein and mRNA expression of Ineterleukin-1β and MMP-13 were upregulated for moderate but not low level fatigue loading. Moderate level (7200 cycles) and 100 cycles of fatigue loading resulted in a catabolic and anabolic molecular profile respectively, at both 1 and 7 days post loading. Results suggest unique mechanisms for different levels of fatigue loading that are distinct from laceration. PMID:21625047

  20. Combined use of the latissimus dorsi musculocutaneous free flap and split-rib grafts for cranial vault reconstruction

    SciTech Connect

    Stueber, K.; Salcman, M.; Spence, R.J.

    1985-08-01

    The patient described in this article had a large skull defect under the scalp which had been irradiated during treatment of a malignant brain tumor. The patient desired reconstruction of her defect. To provide good soft-tissue coverage for the bony reconstruction, a free latissimus dorsi musculocutaneous flap was used. The bony defect was partially reconstructed with split-rib grafts. The two parts of the reconstruction were combined into one operation, since it was felt that the well-vascularized muscle would ensure viability of the bone grafts.

  1. Morphometrics of the Anterior Belly and Intermediate Tendon of the Digastric Muscle: Sexual Dimorphism and Implications for Surgery.

    PubMed

    Zdilla, Matthew J; Pancake, Alex R; Lambert, H Wayne

    2016-07-01

    The anterior belly of the digastric muscle (ABDM) is important in a variety of surgeries including submental lipectomy, rhytidectomy, alteration of the cervicomental angle via muscle resection, the "digastric corset" procedure for submental rejuvenation, the submental artery flap, and reanimation of the mouth after facial nerve palsy. Despite its clinical significance, little information exists regarding the morphometrics of the ABDM or its associated intermediate tendon. This study analyzed a total of 35 intact ABDMs and 43 intact intermediate tendons from 23 cadavers. Measurements were taken of the following parameters: muscle belly area, muscle belly length, intermediate tendon length, and intermediate tendon width at mid-tendon. Normative descriptive statistics are included within the report. Males were found to have significantly longer left-sided muscle bellies than right-sided bellies from males (U = 23.0; P = 0.044), left-sided bellies from females (U = 19.0; P = 0.020), and right-sided bellies from females (U = 12.0; P = 0.035). The morphometry, including sexual dimorphism, presented in this report can aid in the surgical planning and execution of numerous operations performed in head and neck, especially digastric muscle transfer surgery. PMID:27258716

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

    PubMed Central

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

    2015-01-01

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

  3. Combined vascular reconstruction and free flap transfer in diabetic arterial disease.

    PubMed

    Vermassen, F E; van Landuyt, K

    2000-01-01

    Gangrenous lesions of the foot or lower leg due to severe diabetic arterial disease resulting in extensive soft tissue defects with exposed bones or tendons often result, even after successful revascularisation, in staged or primary amputation. We present our experience with 45 such patients treated with combined arterial reconstruction and free tissue transfer for limb-salvage. All presented with peripheral vascular disease of diabetic origin, and extensive gangrenous lesions that could not be treated by simple wound closure or skin-grafting without major amputation. A total of 53 arterial reconstructions and 47 free-flap transfers were performed. In the majority of patients, the distal anastomosis was on a pedal or tibial vessel. These bypass grafts or a native revascularized artery served as the inflow tract for the free flap which was anastomosed using microsurgical techniques. Venous anastomoses were preferentially performed on the deep venous system. Donor muscles were Musculus rectus abdominis (n=37), Musculus latissimus dorsi (n=5), Musculus serratus anterior (n=3), and a perforator flap (n=2) tailored to the size of the defect and covered with a split thickness graft (STG). The operation was set up as a combined procedure in 39/45 patients, two teams working simultaneously, limiting the mean operative time to 6 h. Early reinterventions had to be performed in 14 patients resulting in five flap losses of which two could be treated with a new free flap transfer and three were amputated. Three other patients died in the postoperative period, leaving us with a total of 39/45 patients leaving the hospital with a full-length limb. Independent ambulation was achieved in 32 of these 39 patients. During late follow-up (mean 26 months) eight bypasses occluded resulting in two amputations and two new vascular reconstructions. Combined survival and limb-salvage rate was 84% after 1 year, 77% after 2 years and 65% after 3 years. The advantages of this combined technique

  4. Accessory bands of the hamstring tendons: A clinical anatomical study.

    PubMed

    Yasin, M N; Charalambous, C P; Mills, S P; Phaltankar, P M

    2010-10-01

    Gracilis and semitendinosus tendons are commonly used as grafts in ligamentous reconstruction. Awareness of accessory bands of these tendons is essential in preventing inadvertent diversion of the tendon harvester into the main tendon resulting in premature tendon amputation and inadequate tendon graft. The aim of this study was to describe the characteristics of these accessory bands. Twenty five patients undergoing arthroscopic anterior cruciate ligament reconstruction using hamstring tendons were included. The number of accessory bands and distance of the most proximal band from the distal periosteal insertion point on the tibial crest was recorded for both gracilis and semitendinosus. In most cases gracilis had two accessory bands; the average distance of the most proximal band from the tibial crest insertion being 5.1 cm. Semitendinosus had three bands in most cases, the average distance of the most proximal band from the tibial crest insertion being 8.1 cm. Five (20%) semitendinosus but no gracilis tendons had an accessory band originating greater than 10 cm from the tibial crest insertion. Semitendinosus had more accessory bands compared to gracilis. A significant proportion (20%) of semitendinosus and none of the gracilis tendons had bands originating greater than 10 cm proximal to the tibial crest insertion. This knowledge about the accessory bands of the hamstrings can guide toward safe harvesting of these tendons.

  5. Decellularized and Engineered Tendons as Biological Substitutes: A Critical Review

    PubMed Central

    Lovati, Arianna B.; Bottagisio, Marta; Moretti, Matteo

    2016-01-01

    Tendon ruptures are a great burden in clinics. Finding a proper graft material as a substitute for tendon repair is one of the main challenges in orthopaedics, for which the requirement of a biological scaffold would be different for each clinical application. Among biological scaffolds, the use of decellularized tendon-derived matrix increasingly represents an interesting approach to treat tendon ruptures. We analyzed in vitro and in vivo studies focused on the development of efficient protocols for the decellularization and for the cell reseeding of the tendon matrix to obtain medical devices for tendon substitution. Our review considered also the proper tendon source and preclinical animal models with the aim of entering into clinical trials. The results highlight a wide panorama in terms of allogenic or xenogeneic tendon sources, specimen dimensions, physical or chemical decellularization techniques, and the cell type variety for reseeding from terminally differentiated to undifferentiated mesenchymal stem cells and their static or dynamic culture employed to generate implantable constructs tested in different animal models. We try to identify the most efficient approach to achieve an optimal biological scaffold for biomechanics and intrinsic properties, resembling the native tendon and being applicable in clinics in the near future, with particular attention to the Achilles tendon substitution. PMID:26880985

  6. A new strategy for the decellularisation of large equine tendons as biocompatible tendon substitutes.

    PubMed

    Bottagisio, M; Pellegata, A F; Boschetti, F; Ferroni, M; Moretti, M; Lovati, A B

    2016-07-08

    Tendon ruptures and/or large losses remain to be a great clinical challenge and often require full replacement of the damaged tissue. The use of auto- and allografts or engineered scaffolds is an established approach to restore severe tendon injuries. However, these grafts are commonly related to scarce biocompatibility, site morbidity, chronic inflammation and poor biomechanical properties. Recently, the decellularisation techniques of allo- or xenografts using specific detergents have been studied and have been found to generate biocompatible substitutes that resemble the native tissue. This study aims to identify a novel decellularisation protocol for large equine tendons that would produce an extracellular matrix scaffold suitable for the regeneration of injured tendons in humans. Specifically, equine tendons were treated either with tri (n-butyl) phosphate alone, or associated to multiple concentrations of peracetic acid (1, 3 and 5 %), which has never before been tested in vitro.Samples were then analysed by histology and with biochemical, biomechanical, and cytotoxicity tests. The best decellularisation protocol, resulting from these examinations, was selected and the chosen scaffold was re-seeded with murine fibroblasts. Resulting grafts were tested for cell viability, histologic analysis, DNA and collagen content. The results identified 1 % tri (n-butyl) phosphate combined with 3 % peracetic acid as the most suitable decellularised matrix in terms of biochemical and biomechanical properties. Moreover, the non-cytotoxic nature of the decellularised matrix allowed for good fibroblast reseeding, thus demonstrating a biocompatible matrix that will be suitable for tendon tissue engineering and hopefully as substitutes in severe tendon damages.

  7. A new strategy for the decellularisation of large equine tendons as biocompatible tendon substitutes.

    PubMed

    Bottagisio, M; Pellegata, A F; Boschetti, F; Ferroni, M; Moretti, M; Lovati, A B

    2016-01-01

    Tendon ruptures and/or large losses remain to be a great clinical challenge and often require full replacement of the damaged tissue. The use of auto- and allografts or engineered scaffolds is an established approach to restore severe tendon injuries. However, these grafts are commonly related to scarce biocompatibility, site morbidity, chronic inflammation and poor biomechanical properties. Recently, the decellularisation techniques of allo- or xenografts using specific detergents have been studied and have been found to generate biocompatible substitutes that resemble the native tissue. This study aims to identify a novel decellularisation protocol for large equine tendons that would produce an extracellular matrix scaffold suitable for the regeneration of injured tendons in humans. Specifically, equine tendons were treated either with tri (n-butyl) phosphate alone, or associated to multiple concentrations of peracetic acid (1, 3 and 5 %), which has never before been tested in vitro.Samples were then analysed by histology and with biochemical, biomechanical, and cytotoxicity tests. The best decellularisation protocol, resulting from these examinations, was selected and the chosen scaffold was re-seeded with murine fibroblasts. Resulting grafts were tested for cell viability, histologic analysis, DNA and collagen content. The results identified 1 % tri (n-butyl) phosphate combined with 3 % peracetic acid as the most suitable decellularised matrix in terms of biochemical and biomechanical properties. Moreover, the non-cytotoxic nature of the decellularised matrix allowed for good fibroblast reseeding, thus demonstrating a biocompatible matrix that will be suitable for tendon tissue engineering and hopefully as substitutes in severe tendon damages. PMID:27386840

  8. Primary Combined Latissimus Dorsi and Serratus Anterior Flap Repair of Right-Sided Congenital Diaphragmatic Agenesis in a Neonate

    PubMed Central

    Samuel, Madan; Parapurath, Rajiv

    2016-01-01

    Large diaphragmatic defects can be repaired with latissimus dorsi and serratus anterior muscle flaps. We report the first successful primary repair of complete congenital diaphragmatic agenesis using a combination of autologous living bio-tissue and synthetic mesh in a neonate born in the NMC Specialty Hospital in Dubai, United Arab Emirates, in May 2014. Poor Apgar scores, a scaphoid abdomen and absent breath sounds over the right hemithorax were observed at birth. Chest and abdominal X-rays revealed a diaphragmatic hernia. The neonate was stabilised using high-frequency oscillatory ventilation, nitric oxide and sildenafil. The right diaphragm was reconstructed using combined latissimus dorsi and serratus anterior muscle flaps reinforced by a flexible composite mesh. At 12 months old, the infant had normal respiratory function and the diaphragm was intact. No disabilities of the shoulder or scapula were observed. This case indicates that a combination of living tissue and synthetic mesh can be used to reconstruct a functional diaphragm with efficient pleuroperitoneal separation. PMID:26909223

  9. Increased unilateral tendon stiffness and its effect on gait 2-6 years after Achilles tendon rupture.

    PubMed

    Agres, A N; Duda, G N; Gehlen, T J; Arampatzis, A; Taylor, W R; Manegold, S

    2015-12-01

    Achilles tendon rupture (ATR) alters tissue composition, which may affect long-term tendon mechanics and ankle function during movement. However, a relationship between Achilles tendon (AT) properties and ankle joint function during gait remains unclear. The primary hypotheses were that (a) post-ATR tendon stiffness and length differ from the noninjured contralateral side and that (b) intra-patient asymmetries in AT properties correlate to ankle function asymmetries during gait, determined by ankle angles and moments. Ultrasonography and dynamometry were used to assess AT tendon stiffness, strain, elongation, and rest length in both limbs of 20 ATR patients 2-6 years after repair. Three-dimensional ankle angles and moments were determined using gait analysis. Injured tendons exhibited increased stiffness, rest length, and altered kinematics, with higher dorsiflexion and eversion, and lower plantarflexion and inversion. Intra-patient tendon stiffness and tendon length ratios were negatively correlated to intra-patient ratios of the maximum plantarflexion moment and maximum dorsiflexion angle, respectively. These results suggest that after surgical ATR repair, higher AT stiffness, but not a longer AT, may contribute to deficits in plantarflexion moment generation. These data further support the claim that post-ATR tendon regeneration results in the production of a tissue that is functionally different than noninjured tendon.

  10. A Tendon Cell Specific RNAi Screen Reveals Novel Candidates Essential for Muscle Tendon Interaction.

    PubMed

    Tiwari, Prabhat; Kumar, Arun; Das, Rudra Nayan; Malhotra, Vivek; VijayRaghavan, K

    2015-01-01

    Tendons are fibrous connective tissue which connect muscles to the skeletal elements thus acting as passive transmitters of force during locomotion and provide appropriate body posture. Tendon-derived cues, albeit poorly understood, are necessary for proper muscle guidance and attachment during development. In the present study, we used dorsal longitudinal muscles of Drosophila and their tendon attachment sites to unravel the molecular nature of interactions between muscles and tendons. We performed a genetic screen using RNAi-mediated knockdown in tendon cells to find out molecular players involved in the formation and maintenance of myotendinous junction and found 21 candidates out of 2507 RNAi lines screened. Of these, 19 were novel molecules in context of myotendinous system. Integrin-βPS and Talin, picked as candidates in this screen, are known to play important role in the cell-cell interaction and myotendinous junction formation validating our screen. We have found candidates with enzymatic function, transcription activity, cell adhesion, protein folding and intracellular transport function. Tango1, an ER exit protein involved in collagen secretion was identified as a candidate molecule involved in the formation of myotendinous junction. Tango1 knockdown was found to affect development of muscle attachment sites and formation of myotendinous junction. Tango1 was also found to be involved in secretion of Viking (Collagen type IV) and BM-40 from hemocytes and fat cells. PMID:26488612

  11. Tendon Differentiation on Decellularized Extracellular Matrix Under Cyclic Loading.

    PubMed

    Youngstrom, Daniel W; Barrett, Jennifer G

    2016-01-01

    Tendon bioreactors combine cells, scaffold, and mechanical stimulation to drive tissue neogenesis ex vivo. Faithful recapitulation of the native tendon microenvironment is essential for stimulating graft maturation or modeling tendon biology. As the mediator between cells and mechanical stimulation, the properties of a scaffold constitute perhaps the most essential elements in a bioreactor system. One method of achieving native scaffold properties is to process tendon allograft in a manner that removes cells without modifying structure and function: "decellularization." This chapter describes (1) production of tendon scaffolds derived from native extracellular matrix, (2) preparation of cell-laden scaffolds prior to bioreactor culture, and (3) tissue processing post-harvest for gene expression analysis. These methods may be applied for a variety of applications including graft production, cell priming prior to transplantation and basic investigations of tendon cell biology. PMID:27062597

  12. Preliminary study of tendon biopsy in the horse.

    PubMed

    Webbon, P M

    1986-09-01

    A series of experimental tendon biopsies is described. Three biopsies were taken from the lateral digital extensor tendon (LDET) and three from the superficial flexor tendon (SFT). The LDET biopsies resulted in little discomfort whereas the SFT biopsies led to temporary lameness. The tendons were examined histologically up to 99 days after the biopsies were removed. In all of the tendons the defect filled with granulation tissue which subsequently became organised as a longitudinally orientated collagenous scar tissue. In this small series of biopsies the histological effects of the biopsy persisted longer in the SFT than in the LDET. It is concluded that tendon biopsy cannot be advocated for safe routine use in the horse.

  13. Influence of autograft removal on rabbit patellar tendon length.

    PubMed

    Monllau, J C; Hinarejos, P; Alvarez, P; Alameda, F; Ballester, J

    2004-02-01

    Twelve adult New Zealand white rabbits were randomly divided into two groups. In group 1, 30% of the central mass of the right patellar tendon was removed. In group 2, 60% was removed. The left knees served as controls. The animals were killed 1 year later. The patella-patellar tendon-tibial tuberosity units of all knees were studied using histological and morphometric analysis. In both groups, the tendons had lengthened. Lengthening average was 2.50 mm in group 1 and 8.17 mm in group 2. In both groups, histology revealed poor alignment of the collagen fibres and high cellularity, although the findings in group 1 were nearer the normal histological pattern. The results suggest that removal of significant portions of the patellar tendon leads to lengthening of the resulting tendon. In clinical practice, it seems prudent to pay attention to the dimensions of the patellar tendon when harvesting a graft.

  14. Tendon Differentiation on Decellularized Extracellular Matrix Under Cyclic Loading.

    PubMed

    Youngstrom, Daniel W; Barrett, Jennifer G

    2016-01-01

    Tendon bioreactors combine cells, scaffold, and mechanical stimulation to drive tissue neogenesis ex vivo. Faithful recapitulation of the native tendon microenvironment is essential for stimulating graft maturation or modeling tendon biology. As the mediator between cells and mechanical stimulation, the properties of a scaffold constitute perhaps the most essential elements in a bioreactor system. One method of achieving native scaffold properties is to process tendon allograft in a manner that removes cells without modifying structure and function: "decellularization." This chapter describes (1) production of tendon scaffolds derived from native extracellular matrix, (2) preparation of cell-laden scaffolds prior to bioreactor culture, and (3) tissue processing post-harvest for gene expression analysis. These methods may be applied for a variety of applications including graft production, cell priming prior to transplantation and basic investigations of tendon cell biology.

  15. Biceps femoris tendon injuries sustained while playing hockey

    PubMed Central

    Watura, Christopher; Harries, William

    2011-01-01

    A 42-year-old female nurse presented in March 2008 with a left proximal hamstring tendon injury sustained while playing hockey. At surgery, the proximal biceps femoris tendon and semitendonosus were found to be ruptured and were repaired. The patient made a good recovery but sustained a further hockey injury in January 2010 involving a complete tear and rupture of the biceps femoris tendon distally. This was managed conservatively and the patient was able to return to playing hockey 10 months later. Biceps femoris tendon injuries have been reported in sport but this is the first documented case of the injury occurring while playing hockey and is also the first reported case of a biceps tendon rupture proximally (hamstring tendon) followed by distal biceps femoris rupture at the knee in the same leg. PMID:22715185

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

    PubMed

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

    2012-01-01

    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

  17. An efficient robotic tendon for gait assistance.

    PubMed

    Hollander, Kevin W; Ilg, Robert; Sugar, Thomas G; Herring, Donald

    2006-10-01

    A robotic tendon is a spring based, linear actuator in which the stiffness of the spring is crucial for its successful use in a lightweight, energy efficient, powered ankle orthosis. Like its human analog, the robotic tendon uses its inherent elastic nature to reduce both peak power and energy requirements for its motor. In the ideal example, peak power required of the motor for ankle gait is reduced from 250 W to just 77 W. In addition, ideal energy requirements are reduced from nearly 36 J to just 21 J. Using this approach, an initial prototype has provided 100% of the power and energy necessary for ankle gait in a compact 0.95 kg package, seven times less than an equivalent motor/gearbox system.

  18. Anterior cruciate ligament reconstruction with allograft tendons.

    PubMed

    Strickland, Sabrina M; MacGillivray, John D; Warren, Russell F

    2003-01-01

    Allograft tissue allows reconstruction of the ACL without the donor site morbidity that can be caused by autograft harvesting. Patients who must kneel as a part of their occupation or chosen sport are particularly good candidates for allograft reconstruction. Patients over 45 years of age and those requiring revision ACL surgery can also benefit from the use and availability of allograft tendons. In some cases, patients or surgeons may opt for allograft tendons to maximize the result or morbidity ratio. Despite advances in cadaver screening and graft preparation, there remain risks of disease transmission and joint infection after allograft implantation. Detailed explanation and informed consent is vitally important in cases in which allograft tissue is used.

  19. Anterior cruciate ligament reconstruction with allograft tendons.

    PubMed

    Strickland, Sabrina M; MacGillivray, John D; Warren, Russell F

    2003-01-01

    Allograft tissue allows reconstruction of the ACL without the donor site morbidity that can be caused by autograft harvesting. Patients who must kneel as a part of their occupation or chosen sport are particularly good candidates for allograft reconstruction. Patients over 45 years of age and those requiring revision ACL surgery can also benefit from the use and availability of allograft tendons. In some cases, patients or surgeons may opt for allograft tendons to maximize the result or morbidity ratio. Despite advances in cadaver screening and graft preparation, there remain risks of disease transmission and joint infection after allograft implantation. Detailed explanation and informed consent is vitally important in cases in which allograft tissue is used. PMID:12735200

  20. Comparison of modified Kessler tendon suture at different levels in the human flexor digitorum profundus tendon and porcine flexors and porcine extensors: an experimental biomechanical study.

    PubMed

    Havulinna, J; Leppänen, O V; Järvinen, T L N; Göransson, H

    2011-10-01

    This study compared the biomechanical behaviour of repairs in the human flexor digitorum profundus tendon in zones I, II and III with repairs of different segments of the porcine flexor tendon of the second digit and the extensor digiti quarti proprius tendon, in order to assess the validity of porcine tendons as models for human flexor tendon repairs. These porcine tendons were selected after comparing their size with the human flexor digitorum profundus tendon. The tendon repairs were done in three segments of each porcine tendon and repairs in the human tendons were done in zones I,II and III. Ten tendons in each group yielded a total of 90 specimens. A modified Kessler repair was done with 3-0 coated braided polyester suture and subjected to uniaxial tensile testing. In human flexor tendons, the ultimate force was higher in zones I and II than in zone III. The porcine flexor digitorum profundus tendon from the second digit and the proximal segment of the extensor digiti quarti proprius tendon behaved similarly to the human flexor tendon in zone III and can be considered as surrogates for the human flexor tendon. PMID:21816887

  1. A 3-Dimensional Anatomic Study of the Distal Biceps Tendon

    PubMed Central

    Walton, Christine; Li, Zhi; Pennings, Amanda; Agur, Anne; Elmaraghy, Amr

    2015-01-01

    Background Complete rupture of the distal biceps tendon from its osseous attachment is most often treated with operative intervention. Knowledge of the overall tendon morphology as well as the orientation of the collagenous fibers throughout the musculotendinous junction are key to intraoperative decision making and surgical technique in both the acute and chronic setting. Unfortunately, there is little information available in the literature. Purpose To comprehensively describe the morphology of the distal biceps tendon. Study Design Descriptive laboratory study. Methods The distal biceps terminal musculature, musculotendinous junction, and tendon were digitized in 10 cadaveric specimens and data reconstructed using 3-dimensional modeling. Results The average length, width, and thickness of the external distal biceps tendon were found to be 63.0, 6.0, and 3.0 mm, respectively. A unique expansion of the tendon fibers within the distal muscle was characterized, creating a thick collagenous network along the central component between the long and short heads. Conclusion This study documents the morphologic parameters of the native distal biceps tendon. Reconstruction may be necessary, especially in chronic distal biceps tendon ruptures, if the remaining tendon morphology is significantly compromised compared with the native distal biceps tendon. Knowledge of normal anatomical distal biceps tendon parameters may also guide the selection of a substitute graft with similar morphological characteristics. Clinical Relevance A thorough description of distal biceps tendon morphology is important to guide intraoperative decision making between primary repair and reconstruction and to better select the most appropriate graft. The detailed description of the tendinous expansion into the muscle may provide insight into better graft-weaving and suture-grasping techniques to maximize proximal graft incorporation. PMID:26665092

  2. Quadriceps Tendon Rupture due to Postepileptic Convulsion

    PubMed Central

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

    2014-01-01

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

  3. Applications of absolute extrinsic Fabry-Perot interferometer (EFPI) fiber optic sensing system for measurement of strain in pre-tensioned tendons for prestrained concrete

    NASA Astrophysics Data System (ADS)

    de Vries, Marten J.; Bhatia, Vikram; Claus, Richard O.; Murphy, Kent A.; Tran, Tuan A.

    1995-04-01

    The application of a state-of-the-art fiber optic sensing system for the quantitative analysis of strain in strands used in prestressed concrete is proposed. Compressive stress in concrete is used to counterbalance any tensile force due to loading, which might lead to cracking or deflection. In pre-tensioning prestressed concrete, a tendon is tensioned before concrete is placed and the prestress is transferred to the concrete after it has cured by releasing the tension on the tendon. In linear prestressing it is often required to determine the axial strain on the tendon during the initial procedure of pre-tensioning, so that the required longitudinal force to achieve maximum concrete strength, can be accurately determined. Conventional techniques for this purpose involve the use of conventional foil strain gages, which are not only expensive to use, but are also known for their failure rate in high strain environments. We discuss the absolute extrinsic Fabry-Perot interferometer (AEFPI) fiber optic sensing system for monitoring strain in pretensioned tendons while this tendon is being loaded. The experiments performed at the Turner Fairbanks Federal Highway Administration at McLean, Virginia exhibit the survivability of the EFPI sensor at strain in excess of 12,000 (mu) (epsilon) while being attached to the tendon surface. The results are compared to those obtained from a collocated foil strain gage and excellent correlation is obtained. Applications of the AEFPI system to high performance smart materials and structures are analyzed and future work in this area is discussed.

  4. Free Flap Functional Muscle Transfers.

    PubMed

    Garcia, Ryan M; Ruch, David S

    2016-08-01

    Free functional muscle transfers remain a powerful reconstructive tool to restore upper extremity function when other options such as tendon or nerve transfers are not available. This reconstructive technique is commonly used for patients following trauma, ischemic contractures, and brachial plexopathies. Variable outcomes have been reported following free functional muscle transfers that are related to motor nerve availability and reinnervation. This article highlights considerations around donor motor nerve selection, dissection, and use of the gracilis muscle, and the surgical approach to performing a free functional muscle transfer to restore elbow flexion and/or digit flexion. PMID:27387083

  5. Endoscopic Management of Gluteus Medius Tendon Tears.

    PubMed

    Thaunat, Mathieu; Noël, Eric; Nové-Josserand, Laurent; Murphy, Colin G; Sbiyaa, Mouhcine; Sonnery-Cottet, Bertrand

    2016-03-01

    Tears in the gluteus medius and minimus tendons have been recognized as an important cause of recalcitrant greater trochanteric pain syndrome. Because of the frequency of partial-thickness undersurface tears, this relatively unknown pathology is often misdiagnosed and left untreated. Surgery is indicated in case of 4 associated conditions: (i) Failure of conservative treatment with duration of symptoms >6 months; (ii) magnetic resonance imaging showing a tendon tear; (iii) positive ultrasound-guided infiltration test; and (iv) the absence of an evolved fatty degeneration or atrophy of the gluteus medius and minimus muscle. Endoscopic repair of partial or full-thickness tears, with systematic resection of the bony structures implicated in the impingement, and a complete bursectomy appear to give satisfactory results, although these results remain to be confirmed by clinical studies with longer follow-up. The degree of tendon degeneration may compromise the tissue left for reattachment, raising concerns over its healing capacity, durability, and ultimate strength of the repair. PMID:26752773

  6. Low level laser therapy in healing tendon

    NASA Astrophysics Data System (ADS)

    Carvalho, P. T. C.; Batista, Cheila O. C.; Fabíola, C.

    2005-11-01

    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.

  7. Evolutionary transformations of myoseptal tendons in gnathostomes.

    PubMed Central

    Gemballa, Sven; Ebmeyer, Leoni; Hagen, Katja; Hannich, Tobias; Hoja, Kathrin; Rolf, Mara; Treiber, Kerstin; Vogel, Felix; Weitbrecht, Gerd

    2003-01-01

    Axial undulations in fishes are powered by a series of three-dimensionally folded myomeres separated by sheets of connective tissue, the myosepta. Myosepta have been hypothesized to function as transmitters of muscular forces to axial structures during swimming, but the difficulty of studying these delicate complex structures has precluded a more complete understanding of myoseptal mechanics. We have developed a new combination of techniques for visualizing the three-dimensional morphology of myosepta, and here we present their collagen-fibre architecture based on examination of 62 species representing all of the major clades of notochordates. In all gnathostome fishes, each myoseptum bears a set of six specifically arranged tendons. Because these tendons are not present outside the gnathostomes (i.e. they are absent from lampreys, hagfishes and lancelets), they represent evolutionary novelties of the gnathostome ancestor. This arrangement has remained unchanged throughout 400 Myr of gnathostome evolution, changing only on the transition to land. The high uniformity of myoseptal architecture in gnathostome fishes indicates functional significance and may be a key to understanding general principles of fish swimming mechanics. In the design of future experiments or biomechanical models, myosepta have to be regarded as tendons that can distribute forces in specific directions. PMID:12816635

  8. Extensor tendon ruptures after total knee arthroplasty.

    PubMed

    Bonnin, M; Lustig, S; Huten, D

    2016-02-01

    Extensor tendon rupture is a rare but serious complication after total knee arthroplasty (TKA) that impairs active knee extension, thereby severely affecting knee function. Surgery is usually required. Surgical options range from simple suturing to allograft reconstruction of the entire extensor mechanism and include intermediate methods such as reconstruction using neighbouring tendons or muscles, synthetic ligament implantation, and partial allograft repair. Simple suturing carries a high failure rate and should therefore be routinely combined with tissue augmentation using a neighbouring tendon or a synthetic ligament. After allograft reconstruction, outcomes are variable and long-term complications common. Salvage procedures for managing the most severe cases after allograft failure involve reconstruction using gastrocnemius or vastus flaps. Regardless of the technique used, suturing must be performed under tension, with the knee fully extended, and rehabilitation must be conducted with great caution. Weaknesses of available case-series studies include small sample sizes, heterogeneity, and inadequate follow-up duration. All treatment options are associated with substantial failure rates. The patient should be informed of this fact and plans made for a salvage option. Here, the main techniques and their outcomes are discussed, and a therapeutic strategy is suggested.

  9. Long head of the biceps tendon pathology

    PubMed Central

    Ibáñez, Maximiliano; Calvo, Ana Belén; Alvarez, Victoria; Lepore, Salvador; Ibañez, Federico; Reybet, Juan; Vedova, Franco Della; Aeschlimann, Mauro; Taborro, Betina

    2015-01-01

    Introduction: Disorders of the long head of the biceps tendon can exist in conjunction with other shoulder pathologies. It was proposed as a cause of pain in patients with rotator cuff injury. A detailed history, thorough physical examination and radiographical evaluation are necessary for a correct diagnosis. The aim of our study was to describe the surgical technique and analyze the results obtained in patients based on the same. Materials and Methods: Were included in this retrospective study 70 patients who had lesions in the long head of the biceps tendon, diagnosed with MRI treated at our institution with arthroscopic biotenodesis technique of the tendon with interference screw in the lower portion of the bicipital groove since January 2009 to January 2012. Functional clinical evaluation was performed with the appropriate scores for the disease (ASES, Rowe, Simple Shoulder Test, Constant Murley). Pain was evaluated using Visual Analog Scale. Results: The Rowe score was 86 points, 81 points ASES, SST 9 points, Constant and Murley 87 points. The VAS showed poor post surgical pain. At the time, no associated deformity similar to a Popeye sign was observed. Discussion: The decision to perform a surgical management of the long head of the biceps pathology depends on the clinical presentation, thorough physical examination with specific test, the presence of associated pathologies and failure of nonsurgical treatment.

  10. Evolutionary transformations of myoseptal tendons in gnathostomes.

    PubMed

    Gemballa, Sven; Ebmeyer, Leoni; Hagen, Katja; Hannich, Tobias; Hoja, Kathrin; Rolf, Mara; Treiber, Kerstin; Vogel, Felix; Weitbrecht, Gerd

    2003-06-22

    Axial undulations in fishes are powered by a series of three-dimensionally folded myomeres separated by sheets of connective tissue, the myosepta. Myosepta have been hypothesized to function as transmitters of muscular forces to axial structures during swimming, but the difficulty of studying these delicate complex structures has precluded a more complete understanding of myoseptal mechanics. We have developed a new combination of techniques for visualizing the three-dimensional morphology of myosepta, and here we present their collagen-fibre architecture based on examination of 62 species representing all of the major clades of notochordates. In all gnathostome fishes, each myoseptum bears a set of six specifically arranged tendons. Because these tendons are not present outside the gnathostomes (i.e. they are absent from lampreys, hagfishes and lancelets), they represent evolutionary novelties of the gnathostome ancestor. This arrangement has remained unchanged throughout 400 Myr of gnathostome evolution, changing only on the transition to land. The high uniformity of myoseptal architecture in gnathostome fishes indicates functional significance and may be a key to understanding general principles of fish swimming mechanics. In the design of future experiments or biomechanical models, myosepta have to be regarded as tendons that can distribute forces in specific directions. PMID:12816635

  11. How High Glucose Levels Affect Tendon Homeostasis.

    PubMed

    Snedeker, Jess G

    2016-01-01

    Among the many factors playing a role in tendon disease, unregulated biochemical reactions between glucose and the collagen extracellular matrix are coming increasingly into focus. We have shown that formation of advanced glycation end-products that cross-link the collagen extracellular matrix can drastically affect cellular level mechanical properties of the matrix, and in turn affect cell-level biomechanical stimuli during physiological loading of the tissue. We suggest that these may adversely affect tendon cell response to matrix damage, as well as the quality of the consequent repair. If such mechanical feedback loops are altered, the ability of tendon cells to maintain tissue in a functional, healthy state may be compromised. Although key foundational elements of biochemical, biomechanical, and biological understanding are now in place, the full extent of how these aspects interact, including the precise mechanisms by which advanced glycation end-products pathologically disrupt connective tissue homeostasis and damage repair, are only beginning to be adequately appreciated. PMID:27535261

  12. Patellar tendon rupture in a basketball player.

    PubMed

    Johnson, Sean D; Kulig, Kornelia

    2009-11-01

    The patient was a 21-year-old male who was referred to physical therapy with a 1-week history of right knee pain and stiffness following an injury of traumatic onset. While attempting to jump off of both legs to dunk a basketball during a game, the patient heard and felt a pop in his right knee that was associated with an immediate onset of pain and swelling. He was unable to bear weight following the injury and, therefore, immediately went to the emergency department, where radiographs were completed and interpreted as negative for a fracture. However, the patella for the right knee was superiorly displaced. The patient was issued crutches and referred to physical therapy. At the time of the initial physical therapy examination, the patient was still not able to bear full weight on the right lower extremity or actively fully extend his right knee. Due to concern over possible meniscal, medial collateral ligament, or patellar tendon involvement, the patient's physician was contacted and magnetic resonance imaging was ordered. Five days later, the patient presented with decreased knee effusion and the special tests for the medial collateral ligament and meniscus were negative. However, the patient was still not able to actively extend his knee, suggesting a possible rupture of the patellar tendon, which was later confirmed on magnetic resonance imaging. Surgical repair of the patellar tendon was performed 2 weeks later.

  13. Engineering Tendon: Scaffolds, Bioreactors, and Models of Regeneration.

    PubMed

    Youngstrom, Daniel W; Barrett, Jennifer G

    2016-01-01

    Tendons bridge muscle and bone, translating forces to the skeleton and increasing the safety and efficiency of locomotion. When tendons fail or degenerate, there are no effective pharmacological interventions. The lack of available options to treat damaged tendons has created a need to better understand and improve the repair process, particularly when suitable autologous donor tissue is unavailable for transplantation. Cells within tendon dynamically react to loading conditions and undergo phenotypic changes in response to mechanobiological stimuli. Tenocytes respond to ultrastructural topography and mechanical deformation via a complex set of behaviors involving force-sensitive membrane receptor activity, changes in cytoskeletal contractility, and transcriptional regulation. Effective ex vivo model systems are needed to emulate the native environment of a tissue and to translate cell-matrix forces with high fidelity. While early bioreactor designs have greatly expanded our knowledge of mechanotransduction, traditional scaffolds do not fully model the topography, composition, and mechanical properties of native tendon. Decellularized tendon is an ideal scaffold for cultivating replacement tissue and modeling tendon regeneration. Decellularized tendon scaffolds (DTS) possess high clinical relevance, faithfully translate forces to the cellular scale, and have bulk material properties that match natural tissue. This review summarizes progress in tendon tissue engineering, with a focus on DTS and bioreactor systems. PMID:26839559

  14. ACL reconstruction: patellar tendon versus hamstring grafts--economical aspects.

    PubMed

    Forssblad, Magnus; Valentin, Anders; Engström, Björn; Werner, Suzanne

    2006-06-01

    The aim of the present investigation was to compare the costs for the use of patellar tendon versus hamstring tendons as grafts for anterior cruciate ligament (ACL) reconstruction including the different fixation methods. The background is that during recent years there has been a dramatic shift from patellar tendon to hamstring tendons in ACL reconstructions in Sweden. All our patients with ACL reconstructions performed during 1 year (2004) were included. Knee joints numbering 440 in 439 patients were primary ACL reconstructions. A hamstring graft was used in 345 knee joints (78.4%) and a patellar tendon graft in 95 (21.6%) of the patients (Table 2). On average 34 (SD 12.9; range 14-63) ACL reconstructions per surgeon were performed by a total of 14 surgeons. The average cost for patellar tendon procedure was 197 euros compared to 436 euros for the hamstring procedure. Mean time for surgery in primary reconstructions was 11.5 min shorter (P<0.001) for patellar tendon reconstructions (71.3+/-31 min) compared to hamstring reconstructions (83.2+/-27 min). This means a difference in cost of 90 euros. The total additional cost (fixation and surgery time) for the hamstring method compared to the patellar tendon method was on an average 329 euros. From a strict economic point of view we therefore recommend or at least consider the use of the patellar tendon as a graft in ACL reconstructions. PMID:16570193

  15. Nanoparticles for Tendon Healing and Regeneration: Literature Review.

    PubMed

    Parchi, Paolo D; Vittorio, Orazio; Andreani, Lorenzo; Battistini, Pietro; Piolanti, Nicola; Marchetti, Stefano; Poggetti, Andrea; Lisanti, Michele

    2016-01-01

    Tendon injuries are commonly met in the emergency department. Unfortunately, tendon tissue has limited regeneration potential and usually the consequent formation of scar tissue causes inferior mechanical properties. Nanoparticles could be used in different way to improve tendon healing and regeneration, ranging from scaffolds manufacturing (increasing the strength and endurance or anti-adhesions, anti-microbial, and anti-inflammatory properties) to gene therapy. This paper aims to summarize the most relevant studies showing the potential application of nanoparticles for tendon tissue regeneration. PMID:27597828

  16. Nanoparticles for Tendon Healing and Regeneration: Literature Review

    PubMed Central

    Parchi, Paolo D.; Vittorio, Orazio; Andreani, Lorenzo; Battistini, Pietro; Piolanti, Nicola; Marchetti, Stefano; Poggetti, Andrea; Lisanti, Michele

    2016-01-01

    Tendon injuries are commonly met in the emergency department. Unfortunately, tendon tissue has limited regeneration potential and usually the consequent formation of scar tissue causes inferior mechanical properties. Nanoparticles could be used in different way to improve tendon healing and regeneration, ranging from scaffolds manufacturing (increasing the strength and endurance or anti-adhesions, anti-microbial, and anti-inflammatory properties) to gene therapy. This paper aims to summarize the most relevant studies showing the potential application of nanoparticles for tendon tissue regeneration.

  17. Multiple variations of the tendons of the anatomical snuffbox

    PubMed Central

    Thwin, San San; Zaini, Fazlin; Than, Myo

    2014-01-01

    INTRODUCTION Multiple tendons of the abductor pollicis longus (APL) in the anatomical snuffbox of the wrist can lead to the development of de Quervain's syndrome, which is caused by stenosing tenosynovitis. A cadaveric study was performed to establish the variations present in the tendons of the anatomical snuffbox in a Malaysian population, in the hope that this knowledge would aid clinical investigation and surgical treatment of de Quervain's tenosynovitis. METHODS Routine dissection of ten upper limbs was performed to determine the variations in the tendons of the anatomical snuffbox of the wrist. RESULTS In all the dissected upper limbs, the APL tendon of the first extensor compartment was found to have several (3–14) tendon slips. The insertion of the APL tendon slips in all upper limbs were at the base of the first metacarpal bone, trapezium and fascia of the opponens pollicis muscle; however, in seven specimens, they were also found to be attached to the fleshy belly of the abductor pollicis brevis muscle. In two specimens, double tendons of the extensor pollicis longus located in the third extensor compartment were inserted into the capsule of the proximal interphalangeal joints before being joined to the extensor expansion. In two other specimens, the first extensor compartment had two osseofibrous tunnels divided by a septum that separated the APL tendon from the extensor pollicis brevis tendon. CONCLUSION Multiple variations were found in the anatomical snuffbox region of the dissected upper limbs. Knowledge of these variations would be useful in interventional radiology and orthopaedic surgery. PMID:24452976

  18. Reconstruction of neglected patellar tendon ruptures using the quadriceps graft.

    PubMed

    Gomes, João Luiz Ellera; de Oliveira Alves, Jairo André; Zimmermann, José Mauro

    2014-08-01

    Several techniques using different grafts have been described for reconstruction of the patellar tendon after a neglected rupture. Retraction of the quadriceps tendon may compromise repair integrity due to progressive stretching of the graft. The authors present a surgical technique using the central one-third of the quadriceps tendon. This is supported by the fact that the resistance to traction of this segment of the quadriceps tendon equals that of a double-looped semitendinosus graft and that the harvesting of this specific graft promotes muscle inhibition, thus protecting the reconstruction during the recovery period.

  19. Inflammation activation and resolution in human tendon disease

    PubMed Central

    Dakin, Stephanie G; Martinez, Fernando O; Yapp, Clarence; Wells, Graham; Oppermann, Udo; Dean, Benjamin JF; Smith, Richard DJ; Wheway, Kim; Watkins, Bridget; Roche, Lucy; Carr, Andrew J

    2016-01-01

    Improved understanding of the role of inflammation in tendon disease is required to facilitate therapeutic target discovery. We studied supraspinatus tendons from patients experiencing pain before and after surgical subacromial decompression treatment. Tendons were classified as having early, intermediate or advanced disease and inflammation was characterized through activation of pathways mediated by Interferon, NF-κB, glucocorticoid receptor and STAT-6. Inflammation signatures revealed expression of genes and proteins induced by Interferon and NF-κB in early stage disease and genes and proteins induced by STAT-6 and glucocorticoid receptor activation in advanced stage disease. The pro-resolving proteins FPR2/ALX and ChemR23 were increased in early stage disease compared to intermediate-advanced stage disease. Patients who were pain-free post-treatment had tendons with increased expression of CD206 and ALOX15 mRNA compared to tendons from patients who continued to experience pain post-treatment, suggesting that these genes and their pathways may moderate tendon pain. Stromal cells from diseased tendons cultured in vitro showed increased expression of NF-κB and Interferon target genes after treatment with lipopolysaccharide or IFNγ compared to stromal cells derived from healthy tendons. We identified 15-epi Lipoxin A4, a stable lipoxin metabolite derived from aspirin treatment, as potentially beneficial in the resolution of tendon inflammation. PMID:26511510

  20. Nanoparticles for Tendon Healing and Regeneration: Literature Review

    PubMed Central

    Parchi, Paolo D.; Vittorio, Orazio; Andreani, Lorenzo; Battistini, Pietro; Piolanti, Nicola; Marchetti, Stefano; Poggetti, Andrea; Lisanti, Michele

    2016-01-01

    Tendon injuries are commonly met in the emergency department. Unfortunately, tendon tissue has limited regeneration potential and usually the consequent formation of scar tissue causes inferior mechanical properties. Nanoparticles could be used in different way to improve tendon healing and regeneration, ranging from scaffolds manufacturing (increasing the strength and endurance or anti-adhesions, anti-microbial, and anti-inflammatory properties) to gene therapy. This paper aims to summarize the most relevant studies showing the potential application of nanoparticles for tendon tissue regeneration. PMID:27597828

  1. Engineering Tendon: Scaffolds, Bioreactors, and Models of Regeneration

    PubMed Central

    Youngstrom, Daniel W.; Barrett, Jennifer G.

    2016-01-01

    Tendons bridge muscle and bone, translating forces to the skeleton and increasing the safety and efficiency of locomotion. When tendons fail or degenerate, there are no effective pharmacological interventions. The lack of available options to treat damaged tendons has created a need to better understand and improve the repair process, particularly when suitable autologous donor tissue is unavailable for transplantation. Cells within tendon dynamically react to loading conditions and undergo phenotypic changes in response to mechanobiological stimuli. Tenocytes respond to ultrastructural topography and mechanical deformation via a complex set of behaviors involving force-sensitive membrane receptor activity, changes in cytoskeletal contractility, and transcriptional regulation. Effective ex vivo model systems are needed to emulate the native environment of a tissue and to translate cell-matrix forces with high fidelity. While early bioreactor designs have greatly expanded our knowledge of mechanotransduction, traditional scaffolds do not fully model the topography, composition, and mechanical properties of native tendon. Decellularized tendon is an ideal scaffold for cultivating replacement tissue and modeling tendon regeneration. Decellularized tendon scaffolds (DTS) possess high clinical relevance, faithfully translate forces to the cellular scale, and have bulk material properties that match natural tissue. This review summarizes progress in tendon tissue engineering, with a focus on DTS and bioreactor systems. PMID:26839559

  2. Ossification of the bilateral Achilles tendon: a rare entity.

    PubMed

    Arora, Abhishek J; Arora, Richa

    2015-09-01

    Ossification of the Achilles tendon is a rare clinical entity comprising of one or more segments of variable sized ossified masses in the fibrocartilaginous substance of the tendon. The etiology of ossification of the Achilles tendon is multifactorial with recurrent trauma and surgery comprising major predisposing factors, with others being metabolic, systemic, and infectious diseases. The possibility of a genetic predisposition towards this entity has also been raised, but has not yet been proven. We present a rare case of ossification of the bilateral Achilles tendons without any history of trauma or surgery in a 48-year-old female patient. PMID:26413314

  3. Engineering Tendon: Scaffolds, Bioreactors, and Models of Regeneration.

    PubMed

    Youngstrom, Daniel W; Barrett, Jennifer G

    2016-01-01

    Tendons bridge muscle and bone, translating forces to the skeleton and increasing the safety and efficiency of locomotion. When tendons fail or degenerate, there are no effective pharmacological interventions. The lack of available options to treat damaged tendons has created a need to better understand and improve the repair process, particularly when suitable autologous donor tissue is unavailable for transplantation. Cells within tendon dynamically react to loading conditions and undergo phenotypic changes in response to mechanobiological stimuli. Tenocytes respond to ultrastructural topography and mechanical deformation via a complex set of behaviors involving force-sensitive membrane receptor activity, changes in cytoskeletal contractility, and transcriptional regulation. Effective ex vivo model systems are needed to emulate the native environment of a tissue and to translate cell-matrix forces with high fidelity. While early bioreactor designs have greatly expanded our knowledge of mechanotransduction, traditional scaffolds do not fully model the topography, composition, and mechanical properties of native tendon. Decellularized tendon is an ideal scaffold for cultivating replacement tissue and modeling tendon regeneration. Decellularized tendon scaffolds (DTS) possess high clinical relevance, faithfully translate forces to the cellular scale, and have bulk material properties that match natural tissue. This review summarizes progress in tendon tissue engineering, with a focus on DTS and bioreactor systems.

  4. Mechanical characteristics of native tendon slices for tissue engineering scaffold.

    PubMed

    Qin, Ting-Wu; Chen, Qingshan; Sun, Yu-Long; Steinmann, Scott P; Amadio, Peter C; An, Kai-Nan; Zhao, Chunfeng

    2012-04-01

    The purpose of this study was to characterize the mechanical behavior of tendon slices with different thicknesses. Tendon slices of 100, 200, 300, 400, and 500 μm thickness were mechanically tested. The 300 μm slices were further tested for strength and modulus after 21,000-cycle fatigue testing under different applied strain levels (0, 1, 3, 5, 8, 10, and 12%). The tendon slice structure, morphology, and viability of bone marrow stromal cells (BMSCs) seeded onto the slices were also examined with histology, scanning electron microscopy, and vital cell labeling, respectively. Tendon slices 300 μm or more in thickness had similar ultimate tensile strength and Young's modulus to the intact tendon bundle. A strain of 5% or less did not cause any structural damage, nor did it change the mechanical properties of a 300 μm-thick tendon slice after 21,000-cycle fatigue testing. BMSCs were viable between and on the tendon slices after 2 weeks in tissue culture. This study demonstrated that, if tendon slices are used as a scaffold for tendon tissue engineering, slices 300 μm or more in thickness would be preferable from a mechanical strength point of view. If mechanical stimulation is performed for seeded-cell preparations, 5% strain or less would be appropriate.

  5. Biology and augmentation of tendon-bone insertion repair

    PubMed Central

    2010-01-01

    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. PMID:20727196

  6. Patellar and quadriceps tendon ruptures--jumper's knee.

    PubMed

    Kelly, D W; Carter, V S; Jobe, F W; Kerlan, R K

    1984-01-01

    We reviewed 13 patients with end stage jumper's knee, 10 with patellar tendon ruptures, and 3 with ruptures of the quadriceps tendon to evaluate our long-term results in treating these tendon ruptures in an athletic population. The focus was on the natural history, the time until return, and the level of return, to athletic activity. Jumper's knee affected all patients to a varying degree prior to rupture. Basketball was the most common sport involved. At followup, averaging 4 1/2 years, patients underwent functional and clinical, as well as Cybex and roentgenographic, evaluations. Results indicated patellar tendon ruptures, where the ruptures are complete, have a more favorable prognosis than those of the quadriceps tendon which are incomplete. All of the latter patients continued to have quadriceps tendinitis following repair. In both groups, the poor results were obtained in patients with chondromalacia and/or patella alta. Cybex testing yielded results of greater than 100% strength in three patients with patellar tendon ruptures, but no patient with quadriceps rupture had comparable test results. There was no apparent relationship between ruptures and cortisone injections. Patellar and quadriceps tendon ruptures from indirect injury in athletes represent the end stage of jumper's knee and result from repetitive microtrauma. Excellent function usually follows repair of patellar tendon ruptures when surgery is performed early and care is taken to restore normal patellar tendon length. Results of quadriceps ruptures are less satisfactory since these ruptures are usually incomplete and all degenerative tissue may not be involved in the healing response.

  7. Impact of oestrogen deficiency and aging on tendon: concise review

    PubMed Central

    Frizziero, Antonio; Vittadini, Filippo; Gasparre, Giuseppe; Masiero, Stefano

    2014-01-01

    Summary The knowledge about tendons and tenocyte biological behaviour during aging and, especially, oestrogen deficiency is limited. Women differ from men with regard to muscle and tendon, most likely due to differences in sex hormones activity and tissue response. To-date the interest in metabolic factors that may induce tendon disorders is growing. The aim of this paper is to elucidate the current findings in the correlation between oestrogen deficiency, aging and tendon pathology and to encourage future researches to ameliorate assessment and management of tendinopathies in postmenopausal women. PMID:25489550

  8. Evaluation of Columbia, USMARC-Composite, Suffolk, and Texel rams as terminal sires in an extensive rangeland production system: VIII. Quality measures of lamb longissimus dorsi

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Quality measures of lamb longissimus dorsi were evaluated in 514 crossbred wether lambs to assess sire breed differences. Wethers were produced over 3 yr from single-sire matings of 22 Columbia, 22 USMARC-Composite (Composite), 21 Suffolk, and 17 Texel rams to adult Rambouillet ewes. Lambs were rear...

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

    PubMed Central

    Meinert, Ilka; Brown, Niklas; Alt, Wilfried

    2016-01-01

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

  10. The promoting effect of pentadecapeptide BPC 157 on tendon healing involves tendon outgrowth, cell survival, and cell migration.

    PubMed

    Chang, Chung-Hsun; Tsai, Wen-Chung; Lin, Miao-Sui; Hsu, Ya-Hui; Pang, Jong-Hwei Su

    2011-03-01

    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

  11. Tendon progenitor cells in injured tendons have strong chondrogenic potential: the CD105-negative subpopulation induces chondrogenic degeneration.

    PubMed

    Asai, Shuji; Otsuru, Satoru; Candela, Maria Elena; Cantley, Leslie; Uchibe, Kenta; Hofmann, Ted J; Zhang, Kairui; Wapner, Keith L; Soslowsky, Louis J; Horwitz, Edwin M; Enomoto-Iwamoto, Motomi

    2014-12-01

    To study the cellular mechanism of the tendon repair process, we used a mouse Achilles tendon injury model to focus on the cells recruited to the injured site. The cells isolated from injured tendon 1 week after the surgery and uninjured tendons contained the connective tissue progenitor populations as determined by colony-forming capacity, cell surface markers, and multipotency. When the injured tendon-derived progenitor cells (inTPCs) were transplanted into injured Achilles tendons, they were not only integrated in the regenerating area expressing tenogenic phenotype but also trans-differentiated into chondrogenic cells in the degenerative lesion that underwent ectopic endochondral ossification. Surprisingly, the micromass culture of the inTPCs rapidly underwent chondrogenic differentiation even in the absence of exogenous bone morphogenetic proteins or TGFβs. The cells isolated from human ruptured tendon tissues also showed connective tissue progenitor properties and exhibited stronger chondrogenic ability than bone marrow stromal cells. The mouse inTPCs contained two subpopulations one positive and one negative for CD105, a coreceptor of the TGFβ superfamily. The CD105-negative cells showed superior chondrogenic potential in vitro and induced larger chondroid degenerative lesions in mice as compared to the CD105-positive cells. These findings indicate that tendon progenitor cells are recruited to the injured site of tendons and have a strong chondrogenic potential and that the CD105-negative population of these cells would be the cause for chondroid degeneration in injured tendons. The newly identified cells recruited to the injured tendon may provide novel targets to develop therapeutic strategies to facilitate tendon repair.

  12. MR appearance of bilateral, spontaneous patellar tendon rupture in systemic lupus erythematosus.

    PubMed

    Gould, E S; Taylor, S; Naidich, J B; Furie, R; Lane, L

    1987-01-01

    Bilateral spontaneous patellar tendon rupture is an unusual complication in patients with systemic lupus erythematosus. The ability of magnetic resonance to detect these tendon abnormalities is demonstrated.

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

    PubMed

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

    2010-11-05

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

  14. Repair of Achilles tendon defect with autologous ASCs engineered tendon in a rabbit model.

    PubMed

    Deng, Dan; Wang, Wenbo; Wang, Bin; Zhang, Peihua; Zhou, Guangdong; Zhang, Wen Jie; Cao, Yilin; Liu, Wei

    2014-10-01

    Adipose derived stem cells (ASCs) are an important cell source for tissue regeneration and have been demonstrated the potential of tenogenic differentiation in vitro. This study explored the feasibility of using ASCs for engineered tendon repair in vivo in a rabbit Achilles tendon model. Total 30 rabbits were involved in this study. A composite tendon scaffold composed of an inner part of polyglycolic acid (PGA) unwoven fibers and an outer part of a net knitted with PGA/PLA (polylactic acid) fibers was used to provide mechanical strength. Autologous ASCs were harvested from nuchal subcutaneous adipose tissues and in vitro expanded. The expanded ASCs were harvested and resuspended in culture medium and evenly seeded onto the scaffold in the experimental group, whereas cell-free scaffolds served as the control group. The constructs of both groups were cultured inside a bioreactor under dynamic stretch for 5 weeks. In each of 30 rabbits, a 2 cm defect was created on right side of Achilles tendon followed by the transplantation of a 3 cm cell-seeded scaffold in the experimental group of 15 rabbits, or by the transplantation of a 3 cm cell-free scaffold in the control group of 15 rabbits. Animals were sacrificed at 12, 21 and 45 weeks post-surgery for gross view, histology, and mechanical analysis. The results showed that short term in vitro culture enabled ASCs to produce matrix on the PGA fibers and the constructs showed tensile strength around 50 MPa in both groups (p > 0.05). With the increase of implantation time, cell-seeded constructs gradually form neo-tendon and became more mature at 45 weeks with histological structure similar to that of native tendon and with the presence of bipolar pattern and D-periodic structure of formed collagen fibrils. Additionally, both collagen fibril diameters and tensile strength increased continuously with significant difference among different time points (p < 0.05). In contrast, cell-free constructs failed to form good

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

    PubMed Central

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

    2010-01-01

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

  16. Incorporating plasticity of the interfibrillar matrix in shear lag models is necessary to replicate the multiscale mechanics of tendon fascicles.

    PubMed

    Szczesny, Spencer E; Elliott, Dawn M

    2014-12-01

    Despite current knowledge of tendon structure, the fundamental deformation mechanisms underlying tendon mechanics and failure are unknown. We recently showed that a shear lag model, which explicitly assumed plastic interfibrillar load transfer between discontinuous fibrils, could explain the multiscale fascicle mechanics, suggesting that fascicle yielding is due to plastic deformation of the interfibrillar matrix. However, it is unclear whether alternative physical mechanisms, such as elastic interfibrillar deformation or fibril yielding, also contribute to fascicle mechanical behavior. The objective of the current work was to determine if plasticity of the interfibrillar matrix is uniquely capable of explaining the multiscale mechanics of tendon fascicles including the tissue post-yield behavior. This was examined by comparing the predictions of a continuous fibril model and three separate shear lag models incorporating an elastic, plastic, or elastoplastic interfibrillar matrix with multiscale experimental data. The predicted effects of fibril yielding on each of these models were also considered. The results demonstrated that neither the continuous fibril model nor the elastic shear lag model can successfully predict the experimental data, even if fibril yielding is included. Only the plastic or elastoplastic shear lag models were capable of reproducing the multiscale tendon fascicle mechanics. Differences between these two models were small, although the elastoplastic model did improve the fit of the experimental data at low applied tissue strains. These findings suggest that while interfibrillar elasticity contributes to the initial stress response, plastic deformation of the interfibrillar matrix is responsible for tendon fascicle post-yield behavior. This information sheds light on the physical processes underlying tendon failure, which is essential to improve our understanding of tissue pathology and guide the development of successful repair. PMID:25262202

  17. Incorporating Plasticity of the Interfibrillar Matrix in Shear Lag Models is Necessary to Replicate the Multiscale Mechanics of Tendon Fascicles

    PubMed Central

    Szczesny, Spencer E.; Elliott, Dawn M.

    2015-01-01

    Despite current knowledge of tendon structure, the fundamental deformation mechanisms underlying tendon mechanics and failure are unknown. We recently showed that a shear lag model, which explicitly assumed plastic interfibrillar load transfer between discontinuous fibrils, could explain the multiscale fascicle mechanics, suggesting that fascicle yielding is due to plastic deformation of the interfibrillar matrix. However, it is unclear whether alternative physical mechanisms, such as elastic interfibrillar deformation or fibril yielding, also contribute to fascicle mechanical behavior. The objective of the current work was to determine if plasticity of the interfibrillar matrix is uniquely capable of explaining the multiscale mechanics of tendon fascicles including the tissue post-yield behavior. This was examined by comparing the predictions of a continuous fibril model and three separate shear lag models incorporating an elastic, plastic, or elastoplastic interfibrillar matrix with multiscale experimental data. The predicted effects of fibril yielding on each of these models were also considered. The results demonstrated that neither the continuous fibril model nor the elastic shear lag model can successfully predict the experimental data, even if fibril yielding is included. Only the plastic or elastoplastic shear lag models were capable of reproducing the multiscale tendon fascicle mechanics. Differences between these two models were small, although the elastoplastic model did improve the fit of the experimental data at low applied tissue strains. These findings suggest that while interfibrillar elasticity contributes to the initial stress response, plastic deformation of the interfibrillar matrix is responsible for tendon fascicle post-yield behavior. This information sheds light on the physical processes underlying tendon failure, which is essential to improve our understanding of tissue pathology and guide the development of successful repair. PMID:25262202

  18. Multilayered electrospun scaffolds for tendon tissue engineering.

    PubMed

    Chainani, Abby; Hippensteel, Kirk J; Kishan, Alysha; Garrigues, N William; Ruch, David S; Guilak, Farshid; Little, Dianne

    2013-12-01

    Full-thickness rotator cuff tears are one of the most common causes of shoulder pain in people over the age of 65. High retear rates and poor functional outcomes are common after surgical repair, and currently available extracellular matrix scaffold patches have limited abilities to enhance new tendon formation. In this regard, tissue-engineered scaffolds may provide a means to improve repair of rotator cuff tears. Electrospinning provides a versatile method for creating nanofibrous scaffolds with controlled architectures, but several challenges remain in its application to tissue engineering, such as cell infiltration through the full thickness of the scaffold as well as control of cell growth and differentiation. Previous studies have shown that ligament-derived extracellular matrix may enhance differentiation toward a tendon or ligament phenotype by human adipose stem cells (hASCs). In this study, we investigated the use of tendon-derived extracellular matrix (TDM)-coated electrospun multilayered scaffolds compared to fibronectin (FN) or phosphate-buffered saline (PBS) coating for use in rotator cuff tendon tissue engineering. Multilayered poly(ɛ-caprolactone) scaffolds were prepared by sequentially collecting electrospun layers onto the surface of a grounded saline solution into a single scaffold. Scaffolds were then coated with TDM, FN, or PBS and seeded with hASCs. Scaffolds were maintained without exogenous growth factors for 28 days in culture and evaluated for protein content (by immunofluorescence and biochemical assay), markers of tendon differentiation, and tensile mechanical properties. The collagen content was greatest by day 28 in TDM-scaffolds. Gene expression of type I collagen, decorin, and tenascin C increased over time, with no effect of scaffold coating. Sulfated glycosaminoglycan and dsDNA contents increased over time in culture, but there was no effect of scaffold coating. The Young's modulus did not change over time, but yield strain

  19. Stabilization of medial longitudinal foot arch by peroneus longus transfer.

    PubMed

    Lui, T H

    2016-06-01

    The mechanical integrity of the medial longitudinal arch depends on the dynamic support of muscles and the static support of ligaments. Although the posterior tibial tendon is the main dynamic stabilizer of the arch, the static structures provide the most support especially while the person is standing. After rupture of the posterior tibial tendon, the spring ligament may be compromised under increased stress and leads to talar derotation and peritalar subluxation. Surgical repair of the spring ligament has become an important adjunct to treating posterior tibial tendon abnormalities. A technique of peroneus longus transfer to augment the static stabilizers of the medial column is described in this article. PMID:27058034

  20. Reconstruction of chronic patellar tendon rupture using graft from contralateral patella graft together with reinforcement from flexor tendons. Case report.

    PubMed

    Frois Temponi, Eduardo; de Carvalho, Lúcio Honório; da Silva Bernardes, Cláudio Otávio; Presses Teixeira, Bruno

    2016-01-01

    Chronic patellar tendon rupture is a rare disabling injury that is technically difficult to repair. The true prevalence of this injury is unknown. Delayed reconstruction of chronic patellar tendon rupture has yielded suboptimal clinical and functional results. Many different surgical methods for reconstruction of chronic patellar tendon injury have been reported. In this report, we present a case with chronic patellar tendon injury that was addressed using a technique that had not previously been described in the literature, through combining procedures that had been described separately. The reconstruction method presented in this article has the advantages of being easy and reproducible, without a requirement of allografts.

  1. Bronchopleural fistula after pneumonectomy: interdisciplinary surgical closure by an ipsilateral pedicled latissimus dorsi flap supported by video-assisted thoracoscopy.

    PubMed

    Wolter, A; Scholz, T; Diedrichson, J; Arens-Landwehr, A; Schroeder-Finckh, R; Liebau, J

    2013-11-01

    Post-pneumonectomy bronchopleural fistula (BPF) remains a rare but often life-threatening complication and therapeutic challenge. Traditional surgical procedures include chronic open drainage, attempts at direct stump closure, thoracoplasty with or without chest wall muscle transposition and trans-sternal bronchial closure. We describe a case with successful closure of a chronic BPF after pneumonectomy by intrathoracic transposition of a pedicled latissimus dorsi muscle flap circumferentially fixed on the surrounding pleural tissue under continuous video-assisted thoracoscopic overview. The postoperative course was without complications; no tumour, empyema or fistula re-occurred. In this article we want to present the potential advantages of video-assisted thoracoscopic support and interdisciplinary teamwork to improve the outcome of patients with BPFs after pneumonectomy.

  2. [Effect of 30-day space flight and subsequent readaptation on the signaling processes in m. longissimus dorsi of mice].

    PubMed

    Mirzoev, T M; Vil'chinskaia, N A; Lomonosova, Iu N; Nemirovskaia, T L; Shenkman, B S

    2014-01-01

    Some steps of anabolic and catabolic signaling pathways were investigated in postural/tonic m. longissimus dorsi of mice following the 30-day orbital flight of biosatellite "Bion-M1" and 8-day recovery. Western blotting was used for determining insulin receptor substrate 1 (IRS-1) and AMR-activated protein kinase (AMPK) involved in reciprocal regulation of anabolic and catabolic pathways, as well as E3-ligase MURF-1, and elongation factor eEF2. Functioning of the IGF-1-dependent IRS-1 signaling pathway was activated in the recovery period only. Though the content of ubiquitinligase MURF-1 showed an increase after flight, on completion of the recovery period it did not exceed the pre-flight level unambiguously.

  3. Mineral content of longissimus dorsi thoracis from water buffalo and Zebu-influenced cattle at four comparative ages.

    PubMed

    Giuffrida-Mendoza, M; Arenas de Moreno, L; Uzcátegui-Bracho, S; Rincón-Villalobos, G; Huerta-Leidenz, N

    2007-03-01

    The longissimus dorsi thoracis (LDT) of 64 water buffalo and 68 Zebu-influenced cattle was used to determine the mineral content variation (mg/100g of fresh tissue) according to species, age (7, 17, 19 and 24 months-of-age, MOA) and gender (steers and bulls). Buffalo LDT had higher concentrations of K, Mn, Fe, Zn and Cu at weaning (P<0.05). Phosphorous content was higher (P<0.05) at post-weaning ages. Mineral profile was affected by age without clear trends; the Na and K contents increased at 24 MOA. The age×species, age×gender and species×gender interactions affected (P<0.05) Fe content that ranged from 1.74 to 2.56mg/100g fresh tissue. Meat from both species contributes with more of 25% of K, P, Fe and Zn of the daily requirement for an adult.

  4. Controlled Bioactive Molecules Delivery Strategies for Tendon and Ligament Tissue Engineering using Polymeric Nanofibers.

    PubMed

    Hiong Teh, Thomas Kok; Hong Goh, James Cho; Toh, Siew Lok

    2015-01-01

    The interest in polymeric nanofibers has escalated over the past decade given its promise as tissue engineering scaffolds that can mimic the nanoscale structure of the native extracellular matrix. With functionalization of the polymeric nanofibers using bioactive molecules, localized signaling moieties can be established for the attached cells, to stimulate desired biological effects and direct cellular or tissue response. The inherently high surface area per unit mass of polymeric nanofibers can enhance cell adhesion, bioactive molecules loading and release efficiencies, and mass transfer properties. In this review article, the application of polymeric nanofibers for controlled bioactive molecules delivery will be discussed, with a focus on tendon and ligament tissue engineering. Various polymeric materials of different mechanical and degradation properties will be presented along with the nanofiber fabrication techniques explored. The bioactive molecules of interest for tendon and ligament tissue engineering, including growth factors and small molecules, will also be reviewed and compared in terms of their nanofiber incorporation strategies and release profiles. This article will also highlight and compare various innovative strategies to control the release of bioactive molecules spatiotemporally and explore an emerging tissue engineering strategy involving controlled multiple bioactive molecules sequential release. Finally, the review article concludes with challenges and future trends in the innovation and development of bioactive molecules delivery using polymeric nanofibers for tendon and ligament tissue engineering.

  5. Influence of cathodic polarization upon bond strength of pretensioned tendons in concrete

    SciTech Connect

    Joubert, E.; Hartt, W.H.

    1996-11-01

    The possibility of bond loss for pretensioned tendon in concrete in response to cathodic protection has the potential for limiting applicability of this corrosion control methodology to this material class. To investigate the possible occurrence and significance of such bond loss, a series of pretensioned concrete beams were cathodically polarized utilizing current densities in the range 50--5,000 mA/m{sup 2} (tendon steel surface area basis), during which time specimen dimensional changes were monitored using strain gages which were both mounted upon the tendon and embedded in the concrete. Experimental difficulties were encountered in that the strain gages were not adequately durable; and the results were variable in that the strain data for some specimens at a given current density indicated partial bond loss whereas there was no indication of this for others. In the case of specimens that may have experienced partial bond loss, the results showed that this transpired at a lower total charge transfer the higher the applied cathodic current density and that, if current density upon an actual pretensioned concrete structure is uniform and in the range typical for cathodic protection, bond loss should not occur within the remaining service life of most structures.

  6. Comparative genomic approach reveals novel conserved microRNAs in Inner Mongolia cashmere goat skin and longissimus dorsi.

    PubMed

    Su, Rui; Fu, Shaoyin; Zhang, Yanjun; Wang, Ruijun; Zhou, Yanhong; Li, Jinquan; Zhang, Wenguang

    2015-05-01

    MicroRNA (miRNA) is a large class of non-coding RNA which usually acts a fine-tuned regulation in repressing gene expression on transcriptional and post-transcriptional level during ontogenetic development, metabolism, and occurrence of disease. Due to the lateness of goat genome investigation, registered goat microRNAs are little known and the function of it is poorly understood. In this study, we identified 5 novel miRNAs express in cashmere goat skin and longissimus dorsi using comparative genomic approach combined with expression profile analysis. Further qPCR and sequencing validation demonstrated that the novel miRNAs we identified expressed in goat skin and longissimus dorsi, three of them with the highest expression in February and two in October, indicating these novel microRNAs were involved in growth and cessation of goat hair production. Subsequently, potential target genes were explored via base-pairing with complementary sequences miRNA/mRNA interaction searching. WDR12 and CSNK1A1 involved in Notch/Wnt signal transduction pathway were finally identified. Collectively, the approach of comparative genomics combining expression profile analysis is a powerful tool to identify novel miRNA in goat and the 5 identified novel miRNAs(chi-miR-2284n, chi-miR-421*, chi-miR-421, chi-miR-1839 and chi-miR-374; Accession number: JQ002550-JQ002554) play a essential role in goat hair production of cashmere goat, both in entering growth and cessation phase. This study is also a meaningful complement to the present goat miRNA database for further understanding function of miRNAs in regulation of goat cashmere production.

  7. Promoter Variant-Dependent mRNA Expression of the MEF2A in Longissimus Dorsi Muscle in Cattle

    PubMed Central

    Starzyński, Rafał Radosław; Wicińska, Krystyna; Flisikowski, Krzysztof

    2012-01-01

    The myocyte enhancer factor 2A (MEF2A) gene encodes a member of the myocyte enhancer factor 2 (MEF2) protein family that is involved in vertebrate skeletal, cardiac, and smooth muscle development and differentiation during myogenesis. According to recent studies, MEF2 genes might be major regulators of postnatal skeletal muscle growth; thus, they are considered to be important, novel candidates for muscle development and body growth in farm animals. The aim of the present study was to search for polymorphisms in the bovine MEF2A gene and analyze their effect on the MEF2A mRNA expression level in the longissimus dorsi muscle of Polish Holstein-Fresian cattle. In total, 4094 bp of the whole coding sequence and the promoter region of MEF2A were re-sequenced in 30 animals, resulting in the detection of 6 novel variants as well as one previously reported SNP. Three linked mutations in the promoter region (-780T/G, g.-768T/G, and g.-222A/G) and only two genotypes were identified in two Polish breeds (TTA/TTA and TTA/GGG). Three SNPs in the coding region [g.1599G/A (421aa), g.1626G/A (429aa), and g.1641G/A (434aa)] appeared to be silent substitutions and segregated as two intragene haplotypes: GGG and AAA. Expression analysis showed that the mutations in the promoter region are highly associated with the MEF2A mRNA level in the longissimus dorsi muscle of bulls carrying two different genotypes. The higher MEF2A mRNA level was estimated in the muscle of bulls carrying the TTA/TTA (p<0.01) genotype as compared with those with TTA/GGG. The results obtained suggest that the nucleotide sequence mutation in MEF2A might be useful marker for body growth traits in cattle. PMID:22320864

  8. Distinctive genes determine different intramuscular fat and muscle fiber ratios of the longissimus dorsi muscles in Jinhua and landrace pigs.

    PubMed

    Wu, Ting; Zhang, Zhenhai; Yuan, Zhangqin; Lo, Li Jan; Chen, Jun; Wang, Yizhen; Peng, Jinrong

    2013-01-01

    Meat quality is determined by properties such as carcass color, tenderness and drip loss. These properties are closely associated with meat composition, which includes the types of muscle fiber and content of intramuscular fat (IMF). Muscle fibers are the main contributors to meat mass, while IMF not only contributes to the sensory properties but also to the plethora of physical, chemical and technological properties of meat. However, little is known about the molecular mechanisms that determine meat composition in different pig breeds. In this report we show that Jinhua pigs, a Chinese breed, contains much higher levels of IMF than do Landrace pigs, a Danish breed. We analyzed global gene expression profiles in the longissimus dorsi muscles in Jinhua and Landrace breeds at the ages of 30, 90 and 150 days. Cross-comparison analysis revealed that genes that regulate fatty acid biosynthesis (e.g., fatty acid synthase and stearoyl-CoA desaturase) are expressed at higher levels in Jinhua pigs whereas those that regulate myogenesis (e.g., myogenic factor 6 and forkhead box O1) are expressed at higher levels in Landrace pigs. Among those genes which are highly expressed in Jinhua pigs at 90 days (d90), we identified a novel gene porcine FLJ36031 (pFLJ), which functions as a positive regulator of fat deposition in cultured intramuscular adipocytes. In summary, our data showed that the up-regulation of fatty acid biosynthesis regulatory genes such as pFLJ and myogenesis inhibitory genes such as myostatin in the longissimus dorsi muscles of Jinhua pigs could explain why this local breed produces meat with high levels of IMF.

  9. Distinctive Genes Determine Different Intramuscular Fat and Muscle Fiber Ratios of the longissimus dorsi Muscles in Jinhua and Landrace Pigs

    PubMed Central

    Yuan, Zhangqin; Lo, Li Jan; Chen, Jun; Wang, Yizhen; Peng, Jinrong

    2013-01-01

    Meat quality is determined by properties such as carcass color, tenderness and drip loss. These properties are closely associated with meat composition, which includes the types of muscle fiber and content of intramuscular fat (IMF). Muscle fibers are the main contributors to meat mass, while IMF not only contributes to the sensory properties but also to the plethora of physical, chemical and technological properties of meat. However, little is known about the molecular mechanisms that determine meat composition in different pig breeds. In this report we show that Jinhua pigs, a Chinese breed, contains much higher levels of IMF than do Landrace pigs, a Danish breed. We analyzed global gene expression profiles in the longissimus dorsi muscles in Jinhua and Landrace breeds at the ages of 30, 90 and 150 days. Cross-comparison analysis revealed that genes that regulate fatty acid biosynthesis (e.g., fatty acid synthase and stearoyl-CoA desaturase) are expressed at higher levels in Jinhua pigs whereas those that regulate myogenesis (e.g., myogenic factor 6 and forkhead box O1) are expressed at higher levels in Landrace pigs. Among those genes which are highly expressed in Jinhua pigs at 90 days (d90), we identified a novel gene porcine FLJ36031 (pFLJ), which functions as a positive regulator of fat deposition in cultured intramuscular adipocytes. In summary, our data showed that the up-regulation of fatty acid biosynthesis regulatory genes such as pFLJ and myogenesis inhibitory genes such as myostatin in the longissimus dorsi muscles of Jinhua pigs could explain why this local breed produces meat with high levels of IMF. PMID:23301040

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

    PubMed Central

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

    2009-01-01

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

  11. Achilles tendon biomechanics in response to acute intense exercise.

    PubMed

    Joseph, Michael F; Lillie, Kurtis R; Bergeron, Daniel J; Cota, Kevin C; Yoon, Joseph S; Kraemer, William J; Denegar, Craig R

    2014-05-01

    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.

  12. Ultrasonic assessment of extracellular matrix content in healing Achilles tendon.

    PubMed

    Ghorayeb, Sleiman R; Shah, Neil V; Edobor-Osula, Folorunsho; Lane, Lewis B; Razzano, Pasquale; Chahine, Nadeen; Grande, Daniel A

    2012-04-01

    Although several imaging modalities have been utilized to observe tendons, assessing injured tendons by tracking the healing response over time with ultrasound is a desirable method which is yet to be realized. This study examines the use of ultrasound for non-invasive monitoring of the healing process of Achilles tendons after surgical transection. The overall extracellular matrix content of the transection site is monitored and quantified as a function of time. B-mode images (built from successive A-scan signatures) of the injury site were obtained and compared to biomechanical properties. A quantitative measure of tendon healing using the extracellular matrix (ECM) content of the injury site was analyzed using linear regression with all biomechanical measures. Contralateral tendons were used as controls. The trend in the degree of ECM regrowth in the 4 weeks following complete transection of excised tendons was found to be most closely paralleled with that of linear stiffness (R(2) = 0.987, p < .05) obtained with post-ultrasound biomechanical tests. Results suggest that ultrasound can be an effective imaging technique in assessing the degree of tendon healing, and can be used to correlate structural properties of Achilles tendons.

  13. The role of carbon fibre as a flexor tendon substitute.

    PubMed

    Rawlins, R

    1983-06-01

    Experiments have been carried out on Rhesus monkeys to determine the effectiveness of carbon fibre as a flexor tendon substitute. Though the strength, flexibility and capacity to induce a neotendon make carbon fibre an ideal flexor tendon substitute, induction of fibrosis and accompanying increase in bulk of the implant resulted in failure.

  14. Quadriceps tendon rupture through a superolateral bipartite patella.

    PubMed

    Woods, G William; O'Connor, Daniel P; Elkousy, Hussein A

    2007-10-01

    We report a case of a quadriceps tendon rupture through a bipartite patella. Although quadriceps tendon ruptures and patella fractures are common, rupture through a bipartite patella fragment is rare. This case was managed similar to a quadriceps rupture with an excellent result.

  15. Single-Stage Flexor Tendon Grafting: Refining the Steps.

    PubMed

    Fletcher, Derek R; McClinton, Michael A

    2015-07-01

    Single-stage tendon grafting for reconstruction of zone I and II flexor tendon injuries is a challenging procedure in hand surgery. Careful patient selection, strict indications, and adherence to sound surgical principles are mandatory for return of digital motion. PMID:26026357

  16. Muscle power attenuation by tendon during energy dissipation

    PubMed Central

    Konow, Nicolai; Azizi, Emanuel; Roberts, Thomas J.

    2012-01-01

    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

  17. Current concepts in the management of tendon disorders.

    PubMed

    Rees, J D; Wilson, A M; Wolman, R L

    2006-05-01

    Primary disorders of tendons are common and constitute a high proportion of referrals to rheumatologists. Certain tendons are particularly vulnerable to degenerative pathology; these include the Achilles, patella, elements of the rotator cuff, forearm extensors, biceps brachi and tibialis posterior tendons. Disorders of these tendons are often chronic and can be difficult to manage successfully in the long term. Significant advances have been made in understanding the pathophysiology of these conditions. Histopathological evidence, together with advances in imaging techniques, has made us more appreciative of the degenerative (rather that inflammatory) nature of these conditions. Additionally the presence of neovascularization is now well-recognized in long-standing tendinopathy. We review the mechanical, vascular and developing neural theories that attempt to explain the aetiology of degenerative tendinopathy. We also explore theories of why specific tendons (such as the Achilles and supraspinatus tendons) are particularly prone to degenerative pathology. Traditionally, treatments have placed a heavy emphasis on anti-inflammatory strategies, which are often inappropriate. Recently, however, significant advances in the practical management of tendon disorders have been made. In particular the advent of 'eccentric loading' training programmes has revolutionized the treatment of Achilles tendinopathy in some patients. This concept is currently being extended to include other commonly injured tendons. Other current treatments are reviewed, as are potential future treatments.

  18. Stem Cell Applications in Tendon Disorders: A Clinical Perspective

    PubMed Central

    Young, Mark

    2012-01-01

    Tendon injuries are a common cause of morbidity and a significant health burden on society. Tendons are structural tissues connecting muscle to bone and are prone to tearing and tendinopathy, an overuse or degenerative condition that is characterized by failed healing and cellular depletion. Current treatments, for tendon tear are conservative, surgical repair or surgical scaffold reconstruction. Tendinopathy is treated by exercises, injection therapies, shock wave treatments or surgical tendon debridement. However, tendons usually heal with fibrosis and scar tissue, which has suboptimal tensile strength and is prone to reinjury, resulting in lifestyle changes with activity restriction. Preclinical studies show that cell therapies have the potential to regenerate rather than repair tendon tissue, a process termed tenogenesis. A number of different cell lines, with varying degrees of differentiation, have being evaluated including stem cells, tendon derived cells and dermal fibroblasts. Even though cellular therapies offer some potential in treating tendon disorders, there have been few published clinical trials to determine the ideal cell source, the number of cells to administer, or the optimal bioscaffold for clinical use. PMID:22448174

  19. Harnessing endogenous stem/progenitor cells for tendon regeneration

    PubMed Central

    Lee, Chang H.; Lee, Francis Y.; Tarafder, Solaiman; Kao, Kristy; Jun, Yena; Yang, Guodong; Mao, Jeremy J.

    2015-01-01

    Current stem cell–based strategies for tissue regeneration involve ex vivo manipulation of these cells to confer features of the desired progenitor population. Recently, the concept that endogenous stem/progenitor cells could be used for regenerating tissues has emerged as a promising approach that potentially overcomes the obstacles related to cell transplantation. Here we applied this strategy for the regeneration of injured tendons in a rat model. First, we identified a rare fraction of tendon cells that was positive for the known tendon stem cell marker CD146 and exhibited clonogenic capacity, as well as multilineage differentiation ability. These tendon-resident CD146+ stem/progenitor cells were selectively enriched by connective tissue growth factor delivery (CTGF delivery) in the early phase of tendon healing, followed by tenogenic differentiation in the later phase. The time-controlled proliferation and differentiation of CD146+ stem/progenitor cells by CTGF delivery successfully led to tendon regeneration with densely aligned collagen fibers, normal level of cellularity, and functional restoration. Using siRNA knockdown to evaluate factors involved in tendon generation, we demonstrated that the FAK/ERK1/2 signaling pathway regulates CTGF-induced proliferation and differentiation of CD146+ stem/progenitor cells. Together, our findings support the use of endogenous stem/progenitor cells as a strategy for tendon regeneration without cell transplantation and suggest this approach warrants exploration in other tissues. PMID:26053662

  20. A biomechanical study of pediatric flexor profundus tendon repair

    PubMed Central

    Al-Thunayan, Turki A.; Al-Zahrani, Mohammed T.; Hakeem, Ahmad A.; Al-Zahrani, Fahad M.; Al-Qattan, Mohammad M.

    2016-01-01

    Objectives: To investigate the tensile strength of repaired flexor profundus tendons in young lambs, which would be equivalent to repairs in children older than 2 years of age. Methods: A comparative in-vitro experimental study conducted at King Saud University, Riyadh, Kingdom of Saudi Arabia from October 2014 to December 2015. We utilized 30 flexor profundus tendons of young lambs with a width of 4 mm. All tendons were repaired with a 4-strand repair technique using 4/0 polypropylene core sutures. In group I (n=10 tendons), 2 separate figure-of-eight sutures were applied. In group II (n=10 tendons), simple locking sutures were added to the corners of 2 separate figure-of-eight sutures. In group III (n=10 tendons), the locked cruciate repair was used. All tendon repairs were tested to single-cycle tensile failure. Results: There was no significant difference between groups II and III with regards to gap and breaking forces; and all forces of these 2 groups were significantly higher than the forces in group I. Conclusion: It was concluded that 4 mm-wide pediatric flexor tendons allow a 4-strand repair and the use of 4/0 sutures. The use of locking sutures increases the tensile strength to values that may allow protective mobilization in children. PMID:27570850

  1. Suitability of Thiel embalmed tendons for biomechanical investigation.

    PubMed

    Fessel, Gion; Frey, Kevin; Schweizer, Andreas; Calcagni, Maurizio; Ullrich, Oliver; Snedeker, Jess G

    2011-05-01

    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.

  2. Physiological loading of tendons induces scleraxis expression in epitenon fibroblasts.

    PubMed

    Mendias, Christopher L; Gumucio, Jonathan P; Bakhurin, Konstantin I; Lynch, Evan B; Brooks, Susan V

    2012-04-01

    Scleraxis is a basic helix-loop-helix 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 green fluorescent protein (GFP) under the control of the scleraxis promoter (ScxGFP) to a 6-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.

  3. Simultaneous bilateral quadriceps tendon rupture while playing basketball.

    PubMed

    Shah, M; Jooma, N

    2002-04-01

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

  4. Recycle of temporal muscle in combination with free muscle transfer in the treatment of facial paralysis.

    PubMed

    Kurita, Masakazu; Takushima, Akihiko; Shiraishi, Tomohiro; Kinoshita, Mikio; Ozaki, Mine; Harii, Kiyonori

    2013-07-01

    We experienced three patients with long-standing unilateral complete facial paralysis who previously underwent temporalis muscle transfer to the cheek for smile reconstruction. All patients complained of insufficient and uncomfortable buccal motion synchronised with masticatory movements and incomplete eyelid closure with ptotic eyebrow. To attain a near-natural smile and reliable eyelid closure, temporalis muscle was displaced from the cheek to the eyelid, and a neurovascular free latissimus dorsi muscle was transferred for the replacement of cheek motion. As a result, cheek motion synchronised with the contralateral cheek upon smiling and sufficient eyelid closure were obtained in all cases. Smile reconstruction using the temporal muscle is an easy and a versatile way in general. However, spontaneous smile is not achieved and peculiar movement of the cheek while eating is conspicuous in some cases. Replacement with neurovascular free latissimus dorsi muscle and recycling previously used temporalis muscle for eyelid closure are considered to be valuable for such cases.

  5. Co-cultured tissue-specific scaffolds for tendon/bone interface engineering

    PubMed Central

    Bumgardner, Joel D; Cole, Judith A; Smith, Richard A; Haggard, Warren O

    2014-01-01

    The tendon/ligament-to-bone interface has a complex organization to enable transfer of forces through the tendon/ligament to the bone. The purpose of this study is to create a co-culture environment enabling a tissue-specific tendon region and tissue-specific bone region on a degradable scaffold, using NIH 3T3 fibroblast–deposited extracellular matrix and MC 3T3 osteoblast–deposited extracellular matrix, respectively. Before full characterization of the deposited extracellular matrix coating can be analyzed, co-culture parameters including culture medium and seeding technique should be addressed. An appropriate medium formulation was developed to reduce fibroblast to osteoblast mineralization by adjusting beta-glycerophosphate concentrations. Standard growth medium with fetal bovine serum + 3 mM beta-glycerophosphate + 25 µg/mL ascorbic acid was found to be the most suitable formulation evaluated in these study conditions. Seeding and cell migration studies of co-cultured fibroblast- and osteoblast-specific scaffolds were performed to identify whether tissue regions could be created on the scaffold. Fibroblast and osteoblast regions were successfully seeded and little to no cell migration was observed up to 42 h after seeding. Finally, a preliminary analysis of basic extracellular matrix components was measured in the fibroblast, osteoblast, and transition regions. Tissue-specific DNA, glycosaminoglycan, and collagen were found in uniform amounts on the scaffolds and were not different significantly between scaffold regions. In conclusion, initial steps to create tissue-specific fibroblast and osteoblast regions on a degradable scaffold were successful in preparation for further characterization investigations as a tendon-to-bone interface scaffold. PMID:25383167

  6. Co-cultured tissue-specific scaffolds for tendon/bone interface engineering.

    PubMed

    Cooper, Jared O; Bumgardner, Joel D; Cole, Judith A; Smith, Richard A; Haggard, Warren O

    2014-01-01

    The tendon/ligament-to-bone interface has a complex organization to enable transfer of forces through the tendon/ligament to the bone. The purpose of this study is to create a co-culture environment enabling a tissue-specific tendon region and tissue-specific bone region on a degradable scaffold, using NIH 3T3 fibroblast-deposited extracellular matrix and MC 3T3 osteoblast-deposited extracellular matrix, respectively. Before full characterization of the deposited extracellular matrix coating can be analyzed, co-culture parameters including culture medium and seeding technique should be addressed. An appropriate medium formulation was developed to reduce fibroblast to osteoblast mineralization by adjusting beta-glycerophosphate concentrations. Standard growth medium with fetal bovine serum + 3 mM beta-glycerophosphate + 25 µg/mL ascorbic acid was found to be the most suitable formulation evaluated in these study conditions. Seeding and cell migration studies of co-cultured fibroblast- and osteoblast-specific scaffolds were performed to identify whether tissue regions could be created on the scaffold. Fibroblast and osteoblast regions were successfully seeded and little to no cell migration was observed up to 42 h after seeding. Finally, a preliminary analysis of basic extracellular matrix components was measured in the fibroblast, osteoblast, and transition regions. Tissue-specific DNA, glycosaminoglycan, and collagen were found in uniform amounts on the scaffolds and were not different significantly between scaffold regions. In conclusion, initial steps to create tissue-specific fibroblast and osteoblast regions on a degradable scaffold were successful in preparation for further characterization investigations as a tendon-to-bone interface scaffold.

  7. Three-dimensional study of pectoralis major muscle and tendon architecture.

    PubMed

    Fung, Lillia; Wong, Brian; Ravichandiran, Kajeandra; Agur, Anne; Rindlisbacher, Tim; Elmaraghy, Amr

    2009-05-01

    A thorough understanding of the normal structural anatomy of the pectoralis major (PM) is of paramount importance in the planning of PM tendon transfers or repairs following traumatic PM tears. However, there is little consensus regarding the complex musculotendinous architecture of the PM in the anatomic or surgical literature. The purpose of this study is to model and quantify the three-dimensional architecture of the pectoralis muscle and tendon. Eleven formalin embalmed cadaveric specimens were examined: five (2M/3F) were serially dissected, digitized, and modeled in 3D using Autodesk Maya; six (4M/2F) were dissected and photographed. The PM tendon consisted of longer anterior and shorter posterior layers that were continuous inferiorly. The muscle belly consisted of an architecturally uniform clavicular head (CH) and a segmented sternal head (SH) with 6-7 segments. The most inferior SH segment in all specimens was found to fold anteriorly forming a trough that cradled the inferior aspect of the adjacent superior segment. No twisting of either the PM muscle or tendon was noted. Within the CH, the fiber bundle lengths (FBL) were found to increase from superior to inferior, whereas the mean FBLs of SH were greatest in segments 3-5 found centrally. The mean lateral pennation angle was greater in the CH (29.4 +/- 6.9 degrees ) than in the SH (20.6 +/- 2.7 degrees ). The application of these findings could form the basis of future studies to optimize surgical planning and functional recovery of repair/reconstruction procedures.

  8. Modeling Implantable Passive Mechanisms for Modifying the Transmission of Forces and Movements Between Muscle and Tendons.

    PubMed

    Homayouni, Taymaz; Underwood, Kelsey N; Beyer, Kamin C; Martin, Elon R; Allan, Christopher H; Balasubramanian, Ravi

    2015-09-01

    This paper explores the development of biomechanical models for evaluating a new class of passive mechanical implants for orthopedic surgery. The proposed implants take the form of passive engineered mechanisms, and will be used to improve the functional attachment of muscles to tendons and bone by modifying the transmission of forces and movement inside the body. Specifically, we present how two types of implantable mechanisms may be modeled in the open-source biomechanical software OpenSim. The first implant, which is proposed for hand tendon-transfer surgery, differentially distributes the forces and movement from one muscle across multiple tendons. The second implant, which is proposed for knee-replacement surgery, scales up the forces applied to the knee joint by the quadriceps muscle. This paper's key innovation is that such mechanisms have never been considered before in biomechanical simulation modeling and in surgery. When compared with joint function enabled by the current surgical practice of using sutures to make the attachment, biomechanical simulations show that the surgery with 1) the differential mechanism (tendon network) implant improves the fingers' ability to passively adapt to an object's shape significantly during grasping tasks (2.74× as measured by the extent of finger flexion) for the same muscle force, and 2) the force-scaling implant increases knee-joint torque by 84% for the same muscle force. The critical significance of this study is to provide a methodology for the design and inclusion of the implants into biomechanical models and validating the improvement in joint function they enable when compared with current surgical practice.

  9. Double lateral band transfer for treatment of traumatic hyperextension instability of the proximal interphalangeal joint: a report of two cases.

    PubMed

    Ko, Jason H; Kalainov, David M; Hsu, Lawrence P; Fang, Robert C; Mastey, Robert D

    2012-03-01

    Post-traumatic hyperextension instability of the proximal interphalangeal joint may lead to pain, difficulty with initiating finger flexion, and a swan-neck deformity. Most techniques to correct a traumatic hyperextension deformity of the proximal interphalangeal joint require a window in the flexor retinaculum, retraction of the flexor tendons, and manipulation of the joint capsule with a conceivable potential for joint stiffness, tendon adhesions, and tendon bowstringing. We describe an extra-articular lateral band transfer technique that utilizes strips of both lateral bands and preserves the functional integrity of the flexor tendon sheath. PMID:23450120

  10. IDENTIFICATION OF A TENDON PHENOTYPE IN GDF6 DEFICIENT MICE

    PubMed Central

    Mikic, Borjana; Rossmeier, Kerri; Bierwert, LouAnn

    2009-01-01

    Increasing evidence suggests that the growth/differentiation factors, GDFs 5, 6, and 7 in particular, may play a role in tendon and ligament biology. Mice with genetic mutations in Gdf5 have altered tendon composition and mechanical behavior, while animals with functional null mutations in Gdf7 have a more subtle tendon phenotype. The present study demonstrates for the first time that a null mutation in Gdf6 is associated with substantially lower levels of tail tendon collagen content (−33%) in four-week-old male mice, which has direct functional consequences for the mechanical integrity of the tissue (45-50% reduction in material properties). These data support a role for GDF6 in tendon matrix modeling. PMID:19248159

  11. Continuum model of tendon pathology – where are we now?

    PubMed Central

    McCreesh, Karen; Lewis, Jeremy

    2013-01-01

    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. PMID:23837792

  12. Torque Control of Underactuated Tendon-driven Robotic Fingers

    NASA Technical Reports Server (NTRS)

    Abdallah, Muhammad E. (Inventor); Ihrke, Chris A. (Inventor); Reiland, Matthew J. (Inventor); Wampler, Charles W. (Inventor); Diftler, Myron A. (Inventor); Platt, Robert (Inventor); Bridgwater, Lyndon (Inventor)

    2013-01-01

    A robotic system includes a robot having a total number of degrees of freedom (DOF) equal to at least n, an underactuated tendon-driven finger driven by n tendons and n DOF, the finger having at least two joints, being characterized by an asymmetrical joint radius in one embodiment. A controller is in communication with the robot, and controls actuation of the tendon-driven finger using force control. Operating the finger with force control on the tendons, rather than position control, eliminates the unconstrained slack-space that would have otherwise existed. The controller may utilize the asymmetrical joint radii to independently command joint torques. A method of controlling the finger includes commanding either independent or parameterized joint torques to the controller to actuate the fingers via force control on the tendons.

  13. Specialisation of extracellular matrix for function in tendons and ligaments

    PubMed Central

    Birch, Helen L.; Thorpe, Chavaunne T.; Rumian, Adam P.

    2013-01-01

    Summary Tendons and ligaments are similar structures in terms of their composition, organisation and mechanical properties. The distinction between them stems from their anatomical location; tendons form a link between muscle and bone while ligaments link bones to bones. A range of overlapping functions can be assigned to tendon and ligaments and each structure has specific mechanical properties which appear to be suited for particular in vivo function. The extracellular matrix in tendon and ligament varies in accordance with function, providing appropriate mechanical properties. The most useful framework in which to consider extracellular matrix differences therefore is that of function rather than anatomical location. In this review we discuss what is known about the relationship between functional requirements, structural properties from molecular to gross level, cellular gene expression and matrix turnover. The relevance of this information is considered by reviewing clinical aspects of tendon and ligament repair and reconstructive procedures. PMID:23885341

  14. System and Method for Tensioning a Robotically Actuated Tendon

    NASA Technical Reports Server (NTRS)

    Reiland, Matthew J. (Inventor); Diftler, Myron A. (Inventor)

    2013-01-01

    A tendon tensioning system includes a tendon having a proximal end and a distal end, an actuator, and a motor controller. The actuator may include a drive screw and a motor, and may be coupled with the proximal end of the tendon and configured to apply a tension through the tendon in response to an electrical current. The motor controller may be electrically coupled with the actuator, and configured to provide an electrical current having a first amplitude to the actuator until a stall tension is achieved through the tendon; provide a pulse current to the actuator following the achievement of the stall tension, where the amplitude of the pulse current is greater than the first amplitude, and return the motor to a steady state holding current following the conclusion of the pulse current.

  15. Force Model for Control of Tendon Driven Hands

    NASA Technical Reports Server (NTRS)

    Pena, Edward; Thompson, David E.

    1997-01-01

    Knowing the tendon forces generated for a given task such as grasping via a model, an artificial hand can be controlled. A two-dimensional force model for the index finger was developed. This system is assumed to be in static equilibrium, therefore, the equations of equilibrium were applied at each joint. Constraint equations describing the tendon branch connectivity were used. Gaussian elimination was used to solve for the unknowns of the Linear system. Results from initial work on estimating tendon forces in post-operative hands during active motion therapy were discussed. The results are important for understanding the effects of hand position on tendon tension, elastic effects on tendon tension, and overall functional anatomy of the hand.

  16. Bioreactor optimization of tissue engineered rabbit flexor tendons in vivo.

    PubMed

    Thorfinn, J; Angelidis, I K; Gigliello, L; Pham, H M; Lindsey, D; Chang, J

    2012-02-01

    Tissue-engineered rabbit flexor tendons reseeded with cells are stronger in vitro after culture in a bioreactor. It is not known whether this effect persists in vivo. Tenocytes from New Zealand white rabbits were seeded onto rabbit rear paw flexor tendons that were deprived of cells and exposed to cyclic strain in a bioreactor. Reseeded constructs that were kept unloaded in a medium for 5 days were used as controls. The tendons were implanted to bridge a zone II defect in the rabbit. After explantation 4 weeks later, the ultimate tensile strength (UTS) and elastic modulus (EM) were determined. Tendon constructs that were exposed to cyclic strain had significantly improved UTS and EM. Histology showed that cellularity was increased in the bioreactor tendons.

  17. Do Dietary Factors Influence Tendon Metabolism?

    PubMed

    Scott, Alex; Nordin, Cara

    2016-01-01

    There is very little direct research to conclusively prove the relevance of diet in primary tendinopathies, however it seems prudent to ask whether our current knowledge about the impact of nutrition on collagen metabolism could be useful in assessing, preventing, or treating tendinopathy. The objective of this chapter is to discuss the potential impact (negative or positive) that nutrition may have on the metabolism of tendons by summarizing the related research. The chapter briefly discusses the roles that specific vitamins, amino acids, lipids, and antioxidants have in various processes of the body that may be directly or indirectly related to tenocyte metabolism. PMID:27535270

  18. The anisotropic compressive mechanical properties of the rabbit patellar tendon.

    PubMed

    Williams, Lakiesha N; Elder, Steven H; Bouvard, J L; Horstemeyer, M F

    2008-01-01

    In this study, we examine the transverse and longitudinal compressive mechanical behavior of the rabbit patellar tendon. The anisotropic compressive properties are of interest, because compression occurs where the tendon attaches to bone and where the tendon wraps around bone leading to the development of fibro-cartilaginous matrices. We quantified the time dependent viscoelastic and anisotropic behavior of the tendon under compression. For both orientations, sections of patellar tendon were drawn from mature male white New Zealand rabbits in preparation for testing. The tendons were sequentially compressed to 40% strain at strain rates of 0.1, 1 and 10% strain(s) using a computer-controlled stepper motor driven device under physiological conditions. Following monotonic loading, the tendons were subjected to stress relaxation. The tendon equilibrium compressive modulus was quantified to be 19.49+/-11.46 kPa for the transverse direction and 1.11+/-0.57 kPa for the longitudinal direction. The compressive modulus at applied strain rates of 0.1, 1 and 10% strain(s) in the transverse orientation were 13.48+/-2.31, 18.24+/-4.58 and 20.90+/-8.60 kPa, respectively. The compressive modulus at applied strain rates of 0.1, 1 and 10% strain/s in the longitudinal orientation were 0.19+/-0.11, 1.27+/-1.38 and 3.26+/-3.49 kPa, respectively. The modulus values were almost significantly different for the examination of the effect of orientation on the equilibrium modulus (p=0.054). Monotonic loading of the tendon showed visual differences of the strain rate dependency; however, no significant difference was shown in the statistical analysis of the effect of strain rate on compressive modulus. The statistical analysis of the effect of orientation on compressive modulus showed a significant difference. The difference shown in the orientation analysis validated the anisotropic nature of the tendon. PMID:19065006

  19. Recurrent patellar tendon rupture in a patient after intramedullary nailing of the tibia: reconstruction using an Achilles tendon allograft.

    PubMed

    Jagow, Devin M; Garcia, Branden J; Yacoubian, Stephan V; Yacoubian, Shahan V

    2015-05-01

    Various complications after intramedullary (IM) nailing of the tibia have been reported, the most common of which are anterior knee pain and symptoms similar to patella tendonitis. Complete rupture of the patellar tendon after IM nailing of the tibia has been reported on 2 occasions, in conjunction with predisposing patient factors, such as systemic disease or a proud tibial nail. Patellar tendon ruptures are disabling injuries that can be technically difficult to repair because of the poor quality of remaining tendon tissue, quadriceps muscle atrophy and/or contracture, and scar-tissue formation. Many methods have described the surgical reconstruction of the knee extensor mechanism, which is most commonly performed after total knee arthroplasty. We report the successful surgical and clinical outcome of patellar tendon reconstruction using an Achilles tendon allograft in a patient subject to late and recurrent ruptures after IM nailing of the tibia through a mid-patellar tendon-splitting approach. Seven months after tendon reconstruction, the patient exhibited full knee flexion, an extension lag of 10º, 4/5 quadriceps strength, and return to her baseline ambulatory status.

  20. Muscle-tendon glucose uptake in Achilles tendon rupture and tendinopathy before and after eccentric rehabilitation: Comparative case reports.

    PubMed

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

    2016-09-01

    Achilles tendon rupture (ATR) is the most common tendon rupture injury. The consequences of ATR on metabolic activity of the Achilles tendon and ankle plantarflexors are unknown. Furthermore, the effects of eccentric rehabilitation on metabolic activity patterns of Achilles tendon and ankle plantarflexors in ATR patients have not been reported thus far. We present a case study demonstrating glucose uptake (GU) in the Achilles tendon, the triceps surae, and the flexor hallucis longus of a post-surgical ATR patient before and after a 5-month eccentric rehabilitation. At baseline, three months post-surgery, all muscles and Achilles tendon displayed much higher GU in the ATR patient compared to a healthy individual despite lower plantarflexion force. After the rehabilitation, plantarflexion force increased in the operated leg while muscle GU was considerably reduced. The triceps surae muscles showed similar values to the healthy control. When compared to the healthy or a matched patient with Achilles tendon pain after 12 weeks of rehabilitation, Achilles tendon GU levels of ATR patient remained greater after the rehabilitation. Past studies have shown a shift in the metabolic fuel utilization towards glycolysis due to immobilization. Further research, combined with immuno-histological investigation, is needed to fully understand the mechanism behind excessive glucose uptake in ATR cases. PMID:27428528

  1. Calcium phosphate-hybridized tendon graft to enhance tendon-bone healing two years after ACL reconstruction in goats

    PubMed Central

    2011-01-01

    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. PMID:22166674

  2. Influence of neglecting the curved path of the Achilles tendon on Achilles tendon length change at various ranges of motion

    PubMed Central

    Fukutani, Atsuki; Hashizume, Satoru; Kusumoto, Kazuki; Kurihara, Toshiyuki

    2014-01-01

    Abstract Achilles tendon length has been measured using a straight‐line model. However, this model is associated with a greater measurement error compared with a curved‐line model. Therefore, we examined the influence of neglecting the curved path of the Achilles tendon on its length change at various ranges of motion. Ten male subjects participated in this study. First, the location of the Achilles tendon was confirmed by using ultrasonography, and markers were attached on the skin over the Achilles tendon path. Then, the three‐dimensional coordinates of each marker at dorsiflexion (DF) 15°, plantarflexion (PF) 0°, PF15°, and PF30° were obtained. Achilles tendon length in the curved‐line model was calculated as the sum of the distances among each marker. On the other hand, Achilles tendon length in the straight‐line model was calculated as the straight distance between the two most proximal and distal markers projected onto the sagittal plane. The difference of the Achilles tendon length change between curved‐line and straight‐line models was calculated by subtracting the Achilles tendon length change obtained in curved‐line model from that obtained in straight‐line model with three different ranges of motion (i.e., PF0°, PF15°, and PF30° from DF15°, respectively). As a result, the difference in Achilles tendon length change between the two models increased significantly as the range of motion increased. In conclusion, neglecting the curved path of the Achilles tendon induces substantial overestimation of its length change when the extent of ankle joint angle change is large. PMID:25303951

  3. Tissue engineering in flexor tendon surgery: current state and future advances.

    PubMed

    Galvez, M G; Crowe, C; Farnebo, S; Chang, J

    2014-01-01

    Tissue engineering of flexor tendons addresses a challenge often faced by hand surgeons: the restoration of function and improvement of healing with a limited supply of donor tendons. Creating an engineered tendon construct is dependent upon understanding the normal healing mechanisms of the tendon and tendon sheath. The production of a tendon construct includes: creating a three-dimensional scaffold; seeding cells within the scaffold; encouraging cellular growth within the scaffold while maintaining a gliding surface; and finally ensuring mechanical strength. An effective construct incorporates these factors in its design, with the ultimate goal of creating tendon substitutes that are readily available to the reconstructive hand surgeon.

  4. Region-specific mechanical properties of the human patella tendon.

    PubMed

    Haraldsson, B T; Aagaard, P; Krogsgaard, M; Alkjaer, T; Kjaer, M; Magnusson, S P

    2005-03-01

    The present study investigated the mechanical properties of tendon fascicles from the anterior and posterior human patellar tendon. Collagen fascicles from the anterior and posterior human patellar tendon in healthy young men (mean +/- SD, 29.0 +/- 4.6 yr, n = 6) were tested in a mechanical rig. A stereoscopic microscope equipped with a digital camera recorded elongation. The fascicles were preconditioned five cycles before the failure test based on pilot data on rat tendon fascicle. Human fascicle length increased with repeated cycles (P < 0.05); cycle 5 differed from cycle 1 (P < 0.05), but not cycles 2-4. Peak stress and yield stress were greater for anterior (76.0 +/- 9.5 and 56.6 +/- 10.4 MPa, respectively) than posterior fascicles (38.5 +/- 3.9 and 31.6 +/- 2.9 MPa, respectively), P < 0.05, while yield strain was similar (anterior 6.8 +/- 1.0%, posterior 8.7 +/- 1.4%). Tangent modulus was greater for the anterior (1,231 +/- 188 MPa) than the posterior (583 +/- 122 MPa) fascicles, P < 0.05. In conclusion, tendon fascicles from the anterior portion of the human patellar tendon in young men displayed considerably greater peak and yield stress and tangent modulus compared with the posterior portion of the tendon, indicating region-specific material properties.

  5. Patellar tendon properties with fluctuating menstrual cycle hormones.

    PubMed

    Burgess, Katherine E; Pearson, Stephen J; Onambélé, Gladys L

    2010-08-01

    Debate continues over whether skeletal muscle performance and injury risk vary over the course of the menstrual cycle. Alterations in tendon properties may play a role in the potential fluctuations of both of these variables. The aim of the current study was to determine any association between menstrual cycle phase and corresponding levels of female sex hormones and tendon properties. Fifteen normally menstruating (28-32-day cycles) healthy females (age 23 +/- 1 years, mass 63.1 +/- 2.6 kg, height 1.66 +/- 0.02 m) not taking any form of hormonal contraceptive took part in this study. In vivo patellar tendon properties and associated circulating hormonal levels were assessed on 3 occasions including days 3 +/- 0.4, 13 +/- 0.2, and 21 +/- 0.3. Dynamometry, ultrasonography, electromyography, and biochemical assessment of circulating levels of estradiol and progesterone were utilized. No significant differences were seen in tendon mechanical properties among the 3 phases of the menstrual cycle (p > 0.05). Regressions were carried out and revealed that estrogen and maximal voluntary tendon force explained 17.8% (p = 0.043) of the variance in young's modulus. Our findings link estrogen to a chronic, rather than an acute, impact on tendon behavior. These findings are relevant to clinical outcomes, exercise performance, and injury risk. In terms of tendon properties, menstrual cycle phase does not necessarily need to be considered when organizing training and competition schedules.

  6. Temporal healing in rat achilles tendon: ultrasound correlations.

    PubMed

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

    2013-03-01

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

  7. Current Concepts in Examination and Treatment of Elbow Tendon Injury

    PubMed Central

    Ellenbecker, Todd S.; Nirschl, Robert; Renstrom, Per

    2013-01-01

    Context: Injuries to the tendons of the elbow occur frequently in the overhead athlete, creating a significant loss of function and dilemma to sports medicine professionals. A detailed review of the anatomy, etiology, and pathophysiology of tendon injury coupled with comprehensive evaluation and treatment information is needed for clinicians to optimally design treatment programs for rehabilitation and prevention. Evidence Acquisitions: The PubMed database was searched in January 2012 for English-language articles pertaining to elbow tendon injury. Results: Detailed information on tendon pathophysiology was found along with incidence of elbow injury in overhead athletes. Several evidence-based reviews were identified, providing a thorough review of the recommended rehabilitation for elbow tendon injury. Conclusions: Humeral epicondylitis is an extra-articular tendon injury that is common in athletes subjected to repetitive upper extremity loading. Research is limited on the identification of treatment modalities that can reduce pain and restore function to the elbow. Eccentric exercise has been studied in several investigations and, when coupled with a complete upper extremity strengthening program, can produce positive results in patients with elbow tendon injury. Further research is needed in high-level study to delineate optimal treatment methods. PMID:24427389

  8. Quantification of regional blood flow to canine flexor tendons

    SciTech Connect

    Weidman, K.A.; Simonet, W.T.; Wood, M.B.; Cooney, W.P.; Ilstrup, D.M.

    1984-01-01

    Although the blood supply and the microcirculation of flexor tendons have been studied and defined extensively using qualitative methods, the quantitative assessment of blood flow has been lacking because of the limitations of the available experimental techniques. The authors studied the regional blood supply to the flexor tendons of dogs by the technique of radionuclide-labeled microspheres. Seven adult mongrel dogs were used. Microsphere injection and tissue-counting techniques previously used for other tissues were applied. Samples of proximal, isthmus, and distal portions of the profundus and superficialis flexor tendons were harvested from each digital unit of available limbs from each dog. Mean (+/- SE) flows (ml/100 g dry tissue/min) were proximal profundus 1.78 +/- 0.60 and superficialis 7.10 +/- 1.50. The differences were significant. The study suggests that regional variation in blood flow to canine digital flexor tendons exists, so that a single value for blood flow to these tendons is not relevant. Furthermore, the study supports the concept of dual (vascular and synovial) nutrition to the digital flexor tendons in dogs. These observations may have implications regarding tendon repair techniques.

  9. Injury of the Achilles tendon: diagnosis with sonography.

    PubMed

    Kainberger, F M; Engel, A; Barton, P; Huebsch, P; Neuhold, A; Salomonowitz, E

    1990-11-01

    We determined the diagnostic accuracy of sonography for the assessment of injury to the Achilles tendon. After anatomic investigations in three human cadavers, we performed a clinical study in 24 healthy volunteers and 73 symptomatic patients referred for achillodynia or signs of heel thickening or both in whom a clinical diagnosis of acute total rupture was excluded. High-resolution real-time sonography was performed and the results were compared with final clinical diagnoses (55 patients) and surgical findings (18 patients). Fifty-two of the patients had been involved in various sporting activities (long-distance runners, jumpers, and basketball players), three patients had familial hypercholesterolemia, five patients had systemic inflammatory disease, and 13 patients had no known underlying cause. Anatomic investigation demonstrated accurate assessment of tendon structure and thickness. Sonograms were abnormal in 53 patients (sensitivity, 0.72; specificity, 0.83), and the extent of structural disorders of the tendon could be assessed properly. Abnormalities occurred in the form of tendon swelling (45%), abnormal tendon structure (42%), rupture (15%), and peritendinous lesions (47%). No changes were detected in low-grade disease of short duration, which suggests symptoms caused by functional disorders. Sonography is valuable in the diagnosis of various lesions of the Achilles tendon and its surrounding tissue. Furthermore, it can be used to estimate the degree of tendon abnormality and to differentiate between functional and morphologic conditions.

  10. Tenocyte contraction induces crimp formation in tendon-like tissue

    PubMed Central

    Holmes, David F.; Hill, Patrick; Kadler, Karl E.; Margetts, Lee

    2013-01-01

    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 synthesize a tendon-like construct comprised of collagen fibrils arranged in parallel bundles. Investigations using polarized 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 ECM. 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

  11. Spatial variations in Achilles tendon shear wave speed

    PubMed Central

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

    2014-01-01

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

  12. Imaging horse tendons using multimodal 2-photon microscopy.

    PubMed

    Sivaguru, Mayandi; Eichorst, John Paul; Durgam, Sushmitha; Fried, Glenn A; Stewart, Allison A; Stewart, Matthew C

    2014-03-15

    Injuries and damage to tendons plague both human and equine athletes. At the site of injuries, various cells congregate to repair and re-structure the collagen. Treatments for collagen injury range from simple procedures such as icing and pharmaceutical treatments to more complex surgeries and the implantation of stem cells. Regardless of the treatment, the level of mechanical stimulation incurred by the recovering tendon is crucial. However, for a given tendon injury, it is not known precisely how much of a load should be applied for an effective recovery. Both too much and too little loading of the tendon could be detrimental during recovery. A mapping of the complex local environment imparted to any cell present at the site of a tendon injury may however, convey fundamental insights related to their decision making as a function of applied load. Therefore, fundamentally knowing how cells translate mechanical cues from their external environment into signals regulating their functions during repair is crucial to more effectively treat these types of injuries. In this paper, we studied systems of tendons with a variety of 2-photon-based imaging techniques to examine the local mechanical environment of cells in both normal and injured tendons. These tendons were chemically treated to instigate various extents of injury and in some cases, were injected with stem cells. The results related by each imaging technique distinguish with high contrast and resolution multiple morphologies of the cells' nuclei and the alignment of the collagen during injury. The incorporation of 2-photon FLIM into this study probed new features in the local environment of the nuclei that were not apparent with steady-state imaging. Overall, this paper focuses on horse tendon injury pattern and analysis with different 2-photon confocal modalities useful for wide variety of application in damaged tissues.

  13. The Expression of Carnosine and Its Effect on the Antioxidant Capacity of Longissimus dorsi Muscle in Finishing Pigs Exposed to Constant Heat Stress

    PubMed Central

    Yang, Peige; Hao, Yue; Feng, Jinghai; Lin, Hai; Feng, Yuejin; Wu, Xin; Yang, Xin; Gu, Xianhong

    2014-01-01

    The objective of this study was to assess the effects of constant high ambient temperatures on meat quality, antioxidant capacity, and carnosine expression in longissimus dorsi muscle of finishing pigs. Castrated 24 male DLY (crossbreeds between Landrace×Yorkshire sows and Duroc boars) pigs were allocated to one of three treatments: constant ambient temperature at 22°C and ad libitum feeding (CON, n = 8); constant high ambient temperature at 30°C and ad libitum feeding (H30, n = 8); and constant ambient temperature at 22°C and pair-fed with H30 (PF, n = 8). Meat quality, malondialdehyde (MDA) content, antioxidant capacity, carnosine content, and carnosine synthetase (CARNS1) mRNA expression in longissimus dorsi muscle were measured after three weeks. The results revealed that H30 had lower pH24 h, redness at 45 min, and yellowness at 24 h post-mortem (p<0.05), and higher drip loss at 48 h and lightness at 24 h post-mortem (p<0.01). Constant heat stress disrupted the pro-oxidant/antioxidant balance in longissimus dorsi muscle with higher MDA content (p<0.01) and lower antioxidant capacity (p<0.01). Carnosine content and CARNS1 mRNA expression in longissimus dorsi muscle of H30 pigs were significantly decreased (p<0.01) after three weeks at 30°C. In conclusion, constant high ambient temperatures affect meat quality and antioxidant capacity negatively, and the reduction of muscle carnosine content is one of the probable reasons. PMID:25358371

  14. Recurrent hypertrophic peroneal tubercle associated with peroneus brevis tendon tear.

    PubMed

    Ochoa, Leah M; Banerjee, Rahul

    2007-01-01

    Stenosing peroneal tenosynovitis resulting from hypertrophy of the peroneal tubercle has been well described. Successful surgical treatment addresses the hypertrophied peroneal tubercle as well as any intrinsic tendon pathology. We report a case of recurrent foot pain caused by stenosing peroneal tenosynovitis in a 16-year-old woman. Four months after excision of a hypertrophic peroneal tubercle, the patient developed a recurrence of symptoms. Imaging studies, repeat operative exploration, and pathologic specimen demonstrated a recurrence of the peroneal tubercle hypertrophy associated with a longitudinal tear of the peroneus brevis tendon. Re-resection of the hypertrophied tubercle and peroneal tendon repair resulted in a resolution of symptoms. PMID:17761327

  15. Arthroscopic Recognition and Repair of the Torn Subscapularis Tendon

    PubMed Central

    Denard, Patrick J.; Burkhart, Stephen S.

    2013-01-01

    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

  16. Measurement of friction between pulley and flexor tendon.

    PubMed

    An, K N; Berglund, L; Uchiyama, S; Coert, J H

    1993-01-01

    When tendon excursion takes place through the pulley, friction and drag are encountered at the interface. Repetitive exposure to such friction and attrition of the tendon has been considered one of the important factors causing cumulative trauma and leading to disorders such as tendinitis and tenosynovitis. In this study, development of an experimental method to evaluate friction and drag between the pulley and tendon under different loading conditions and joint configurations is considered. Verification of the model under an ideal situation of sutures across a mechanical pulley was performed.

  17. Endoscopic Resection of Lipoma of the Patellar Tendon

    PubMed Central

    Lui, Tun Hing; Lee, Man Wai

    2015-01-01

    Synovial lipoma of the patellar tendon is a very rare entity. It can be associated with rupture of the patellar tendon. We present a case of synovial lipoma that was successfully resected endoscopically. The other indications for patellar tendoscopy include chronic patellar tendinitis and tendinosis, recalcitrant bursitis around the tendon, Osgood-Schlatter disease, and jumper's knee. The major potential danger of this endoscopic procedure is iatrogenic damage to the patellar insertion during endoscopic debridement in patients with jumper's knee or the tibial insertion during endoscopic debridement in patients with Osgood-Schlatter disease. PMID:25973368

  18. Tendon bottom connector for a tension leg platform

    SciTech Connect

    Kipp, R.M.

    1991-04-02

    This patent describes a floating tension-leg platform having anchoring tendons extending from the platform with the lower ends of the tendons being connected in tension to anchor means fixedly secured to the ocean floor in deep water, the connection being made by underwater-actuatable and remotely-connectable and releasable tendon connector means. It includes first and second connector portions a first inwardly-directed camming surface; a circumferential latching groove; a latching shoulder; a second camming surface; a latching sleeve; collet spring fingers; and outwardly-extending latches.

  19. Repair of severe muscle belly lacerations using a tendon graft.

    PubMed

    Botte, M J; Gelberman, R H; Smith, D G; Silver, M A; Gellman, H

    1987-05-01

    Fourteen patients with 58 severe forearm muscle belly lacerations had muscle repair using tendon grafts. At mean follow-up of 14 months, results of manual muscle testing (N = 58) were: grade 5, 42%, grade 4, 14%, grade 3, 9%, grade 2, 9%, grade 1, 12%, and grade 0, 15%. Mean grip strength of the injured extremity, in pounds per square inch, was 33.5 compared with 83.4 on the noninjured side. Tendon excursion and joint mobility were maintained, and there were no postoperative complications. Tendon grafting of severe muscle lacerations is an effective method to overcome extensive defects.

  20. Compressive properties of cd-HA-gelatin modified intrasynovial tendon allograft in canine model in vivo.

    PubMed

    Ikeda, Jun; Zhao, Chunfeng; Chen, Qingshan; Thoreson, Andrew R; An, Kai-Nan; Amadio, Peter C

    2011-06-01

    Although we sometimes use the intrasynovial tendon allograft as a donor, the gliding ability of allograft prepared by lyophilization is significantly decreased. The gliding ability of the grafted tendon after tendon reconstruction is very important because the high gliding resistance causes more adhesion and leads to poor clinical results. We recently revealed that tendon surface treatment with a carbodiimide derivatized HA (cd-HA)-gelatin mixture for intrasynovial tendon allograft significantly improved its gliding ability. The purpose of this study was to investigate whether this cd-HA-gelatin treatment affects the tendon mechanical property or not. A total of 40 flexor digitorum profundus (FDP) tendons from canines were evaluated for compressive property by using indentation test. Indentation stiffness was measured for normal tendon, rehydrated tendon after lyophilization, rehydrated tendon after lyophilization that was implanted 6 weeks in vivo, and cd-HA treated rehydrated tendon after lyophilization that was implanted 6 weeks in vivo. The results for all groups showed no significant difference in the tendon compressive properties. The findings of these results demonstrate that cd-HA treatment for intrasynovial tendon allograft is an excellent method to improve the tendon gliding ability after lyophilization without changing the compressive property of donor tendon. PMID:21549380

  1. Human hamstring tenocytes survive when seeded into a decellularized porcine Achilles tendon extracellular matrix.

    PubMed

    Lohan, Anke; Stoll, Christiane; Albrecht, Marit; Denner, Andreas; John, Thilo; Krüger, Kay; Ertel, Wolfgang; Schulze-Tanzil, Gundula

    2013-01-01

    Tendon ruptures and defects remain major orthopaedic challenges. Tendon healing is a time-consuming process, which results in scar tissue with an altered biomechanical competence. Using a xenogeneic tendon extracellular matrix (ECM) as a natural scaffold, which can be reseeded with autologous human tenocytes, might be a promising approach to reconstruct damaged tendons. For this purpose, the porcine Achilles (AS) tendons serving as a scaffold were histologically characterized in comparison to human cell donor tendons. AS tendons were decellularized and then reseeded with primary human hamstring tenocytes using cell centrifuging, rotating culture and cell injection techniques. Vitality testing, histology and glycosaminoglycan/DNA quantifications were performed to document the success of tendon reseeding. Porcine AS tendons were characterized by a higher cell and sulfated glycosaminoglycan content than human cell donor tendons. Complete decellularization could be achieved, but led to a wash out of sulfated glycosaminoglycans. Nevertheless, porcine tendon could be recellularized with vital human tenocytes. The recellularization led to a slight increase in cell number compared to the native tendon and some glycosaminoglycan recovery. This study indicates that porcine tendon can be de- and recellularized using adult human tenocytes. Future work should optimize cell distribution within the recellularized tendon ECM and consider tendon- and donor species-dependent differences.

  2. Extended healing validation of an artificial tendon to connect the quadriceps muscle to the Tibia: 180-day study.

    PubMed

    Melvin, Alan J; Litsky, Alan S; Mayerson, Joel L; Stringer, Keith; Juncosa-Melvin, Natalia

    2012-07-01

    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 non-living 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 contralateral unoperated control legs at 180 days. Maximum forces in the operated leg (vs. unoperated) were 1,400 ± 93 N (vs. 1,179 ± 61 N), linear stiffnesses were 33 ± 3 N/mm (vs. 37 ± 4 N/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 orthopedic oncology, revision arthroplasty, tendon transfer, and tendon injury reconstruction.

  3. Extended Healing Validation of an Artificial Tendon to Connect the Quadriceps Muscle to the Tibia: 180-day Study

    PubMed Central

    Melvin, Alan J.; Litsky, Alan S.; Mayerson, Joel L.; Stringer, Keith; Juncosa-Melvin, Natalia

    2011-01-01

    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. PMID:22179930

  4. Human iPSC-Derived Neural Crest Stem Cells Promote Tendon Repair in a Rat Patellar Tendon Window Defect Model

    PubMed Central

    Xu, Wei; Wang, Yequan; Liu, Erfu; Sun, Yanjun; Luo, Ziwei; Xu, Zhiling; Liu, Wanqian; Zhong, Li; Lv, Yonggang; Wang, Aijun; Tang, Zhenyu; Li, Song

    2013-01-01

    Induced pluripotent stem cells (iPSCs) hold great potential for cell therapy and tissue engineering. Neural crest stem cells (NCSCs) are multipotent that are capable of differentiating into mesenchymal lineages. In this study, we investigated whether iPSC-derived NCSCs (iPSC-NCSCs) have potential for tendon repair. Human iPSC-NCSCs were suspended in fibrin gel and transplanted into a rat patellar tendon window defect. At 4 weeks post-transplantation, macroscopical observation showed that the repair of iPSC-NCSC-treated tendons was superior to that of non-iPSC-NCSC-treated tendons. Histological and mechanical examinations revealed that iPSC-NCSCs treatment significantly enhanced tendon healing as indicated by the improvement in matrix synthesis and mechanical properties. Furthermore, transplanted iPSC-NCSCs produced fetal tendon-related matrix proteins, stem cell recruitment factors, and tenogenic differentiation factors, and accelerated the host endogenous repair process. This study demonstrates a potential strategy of employing iPSC-derived NCSCs for tendon tissue engineering. PMID:23815150

  5. The suture loop holding capacity of flexor digitorum profundus tendon within and outside the digital tendon sheath.

    PubMed

    Havulinna, J; Leppänen, O V; Göransson, H

    2013-09-01

    In a previous study we found that the strength of a Kessler core suture in the flexor tendon was greater in flexor zone 2 than in zone 3. To further investigate the material properties of the flexor tendon without the influence of a locking suture configuration, we measured the ultimate strength of a simple loop suture in the flexor digitorum profundus tendon in zones 1, 2, and 3. Eight cadaver flexor digitorum profundus tendons were tested in 10 mm increments with a 3-0 polyester suture loop pull-out test in the mid-substance of the tendon. The mean strength in zones 1 and 2 (26.7 N, SD 5.6) was significantly higher than the mean strength in zone 3 (17.7 N, SD 5.4). We conclude that the difference is owing to variations of the structure of the flexor tendon in different sections of the tendon, as the suture configuration was a simple loop without a locking or grasping component. PMID:23315625

  6. Late quadriceps tendon rupture at the donor site following cruciate ligament reconstruction using central quadriceps tendon graft.

    PubMed

    Pandey, Vivek; Madi, Sandesh; Joseph, Amy; Acharya, Kiran

    2015-10-16

    Central quadriceps tendon (CQT) graft has been successfully used as a viable autograft option in cruciate ligament reconstruction of the knee. The prime emphasis in the majority of the literature is given to surgical details of quadriceps graft harvesting and outcome of cruciate ligament reconstruction. There is less discussion about donor site morbidity in CQT graft, and it is less frequent as compared to that in bone patellar tendon bone graft. We report an extremely unusual case of late quadriceps tendon rupture at the donor site following anterior cruciate ligament reconstruction using CQT graft.

  7. Technical tips: reconstruction of deep and superficial deltoid ligaments by peroneus longus tendon in stage 4 posterior tibial tendon dysfunction.

    PubMed

    Lui, T H

    2014-12-01

    The deltoid ligament is composed of the superficial and deep layers. Disruption of the deltoid ligament can occur in rotational ankle fracture, chronic ankle instability, or stage 4 posterior tibial tendon dysfunction. Correcting valgus tilt at the time of flatfoot reconstruction in case of stage 4 posterior tibial tendon dysfunction may prevent future collapse and the need for ankle arthrodesis or possibly ankle arthroplasty. We describe a technique of reconstruction of both the superficial and deep deltoid ligaments by peroneus longus tendon. PMID:25457670

  8. Tension Stiffened and Tendon Actuated Manipulator

    NASA Technical Reports Server (NTRS)

    Doggett, William R. (Inventor); Dorsey, John T. (Inventor); Ganoe, George G. (Inventor); King, Bruce D. (Inventor); Jones, Thomas C. (Inventor); Mercer, Charles D. (Inventor); Corbin, Cole K. (Inventor)

    2015-01-01

    A tension stiffened and tendon actuated manipulator is provided performing robotic-like movements when acquiring a payload. The manipulator design can be adapted for use in-space, lunar or other planetary installations as it is readily configurable for acquiring and precisely manipulating a payload in both a zero-g environment and in an environment with a gravity field. The manipulator includes a plurality of link arms, a hinge connecting adjacent link arms together to allow the adjacent link arms to rotate relative to each other and a cable actuation and tensioning system provided between adjacent link arms. The cable actuation and tensioning system includes a spreader arm and a plurality of driven and non-driven elements attached to the link arms and the spreader arm. At least one cable is routed around the driven and non-driven elements for actuating the hinge.

  9. Augmented repair of acute Achilles tendon ruptures.

    PubMed

    Zell, R A; Santoro, V M

    2000-06-01

    Twenty-five patients who had an acute Achilles tendon rupture were managed with an augmented repair using the gastrocnemius-soleus fascia. All patients healed their repair and there were no re-ruptures. There was one infection. Augmented repair allowed early functional recovery as evidenced by full ankle motion by four to eight weeks, full unassisted weight bearing by three weeks, cessation of braces by four weeks, and return to work by one to six weeks post-operatively. Augmentation adds a sufficient amount of collagen to allow early range of motion and weight bearing without re-rupture. Disadvantages included a long incision, soft tissue prominence, one infection, and sural nerve injury.

  10. Right ventricular false tendons, a cadaveric approach.

    PubMed

    Loukas, Marios; Wartmann, Christopher T; Tubbs, R Shane; Apaydin, Nihal; Louis, Robert G; Black, Brandie; Jordan, Robert

    2008-06-01

    Left ventricular false tendons (LFTs) have been extensively described and recognized by gross anatomic studies. However, there is very little information available regarding right ventricular false tendons (RFTs). The aim of our study, therefore, was to explore and delineate the morphology, topography and morphometry of the RFTs, and provide a comprehensive picture of their anatomy across a broad range of specimens. We identified 35/100 heart specimens containing right ventricular RFTs and classified them into five types. In Type I (21, 47.7%) the RFTs, was located between the ventricular septum and the anterior papillary muscle; in Type II (11, 22.9%) between ventricular septum and the posterior papillary muscle; in Type III (7, 14.5%) between the anterior leaflet of the tricuspid valve and the right ventricular free wall; in Type IV (5, 10.4%) between the posterior papillary muscle and the ventricular free wall; and lastly, in Type V (4, 8.3%) between the anterior papillary muscle and ventricular free wall. The mean length of the RFTs was 18 +/- 7 mm with a mean diameter of 1.4 +/- 05 mm. Histologic examination with Masson trichrome and PAS revealed that 20 (41.6%) of the 48 RFTs carried conduction tissue fibers. The presence of conduction tissue fibers within the RFTs was limited to Types I, III, and IV. In Types II and V the RFTs resembled fibrous structures in contrast with Type I, II and IV, which were composed more of muscular fibers, including conduction tissue fibers. RFTs containing conduction tissue fibers were identified, which may implicate them in the appearance of arrhythmias.

  11. Prestressed concrete using KEVLAR reinforced tendons

    SciTech Connect

    Dolan, C.W.

    1989-01-01

    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.

  12. An ink surgical marker pen is damaging to tendon cells

    PubMed Central

    Franklin, S. L.; Jayadev, C.; Poulsen, R.; Hulley, P.; Price, A.

    2012-01-01

    Objectives Surgical marking during tendon surgery is often used for technical and teaching purposes. This study investigates the effect of a gentian violet ink marker pen, a common surgical marker, on the viability of the tissue and cells of tendon. Methods In vitro cell and tissue methods were used to test the viability of human hamstring explants and the migrating tenocytes in the presence of the gentian violet ink. Results The outcome of this study was that a constituent of the surgical marker pen causes cell and tissue death in culture, implying the same would occur in vivo. Conclusions This is a cause for concern when marking tendon during surgical procedures, as it may compromise healing and repair and potentially contribute to a poor outcome. The authors suggest that an alternative surgical marking procedure should be found, or that all marker pens should undergo testing on human tendon tissue in vitro prior to use. PMID:23610669

  13. [Neglected ipsilateral simultaneous ruptures of patellar and quadriceps tendon].

    PubMed

    Karahasanoğlu, İlker; Yoloğlu, Osman; Kerimoğlu, Servet; Turhan, Ahmet Uğur

    2015-01-01

    Neglected patellar and quadriceps tendon rupture is a rare injury, but ipsilateral simultaneous patellar and quadriceps tendon rupture was not described in the literature to our knowledge. In this article, we report a 40-year-old healthy male patient with neglected ipsilateral patellar and quadriceps tendon ruptures treated by peroneus longus tendon autograft. Patient had received some conservative and surgical treatments for patellar fracture before applying to our clinic. After our treatment using peroneus longus autograft and interference nails, patient was immobilized for six weeks in cylindrical cast. Flexion exercises and full weight bearing were started after cast removal. Patient had no complaint at postoperative second year. Patient was a neglected case. Surgical repair and early rehabilitation enabled us to achieve a satisfactory outcome.

  14. Rupture of adductor longus tendon due to ciprofloxacin.

    PubMed

    Mouzopoulos, George; Stamatakos, Mihalis; Vasiliadis, George; Skandalakis, Panagiotis

    2005-12-01

    We present a rare case of spontaneous rupture of the adductor longus tendon induced by ciprofloxacin. A 35-year-old man was diagnosed with pneumonia and was recommended ciprofloxacin 500 mg iv twice a day for 7 days. Three days after receiving the initial dose, he developed discomfort in his left medial thigh, and pain and swelling in the same area followed ten days later. He consulted us when he noted a palpable mass on the medial side of his left thigh, and MRI study revealed adductor longus tendon rupture. There was no obvious underlying disease or other factor causing fragility of his adductor longus tendon. We review the pathophysiological mechanisms leading to fluoroquinolone-related tendon rupture as well as the risk factors and discuss proper management.

  15. A comprehensive approach for studying muscle-tendon mechanics.

    PubMed

    Hawkins, D; Bey, M

    1994-02-01

    A comprehensive approach for studying the mechanics of partially intact muscle-tendon (MT) complexes was developed. This approach utilizes a work station which integrates state-of-the-art equipment and software. The hardware includes a nerve stimulator, ergometer, high speed video camera and recorder, computer, and temperature regulated chamber. When used in conjunction with a small animal muscle model, the work station provides accurate control of muscle stimulation, MT length, and MT shortening or stretching velocity. Simultaneously, muscle force and both muscle and tendon kinematics can be recorded. This approach is unique in that it allows simultaneous testing of both muscle and tendon under physiological conditions. Additionally, both gross and local deformations of the muscle and tendon can be determined. Sample results from a study of a rat tibialis anterior muscle illustrate the utility of this approach.

  16. Full-thickness quadriceps tendon: An easy cruciate reconstruction graft.

    PubMed

    Slullitel, D; Blasco, A; Periotti, G

    2001-09-01

    Full-thickness quadriceps tendon strength has been found to be similar or higher than that of the patellar tendon. Current techniques spare the deep vastus intermedius to avoid piercing the suprapatellar pouch, which might result in loss of visualization. This approach mainly results in loss of graft thickness and surgical problems related to the dissection made through the tendon. We describe a technique where a full-thickness graft can be used, making tendon stripping easier. We also describe how to preserve visualization during surgery. A double anchorage of the tendinous part of the graft on the femoral side is used together with fixation of the bone end on the tibial side, allowing early motion and thereby avoiding suprapatellar pouch adhesions.

  17. Cellular therapy in bone-tendon interface regeneration

    PubMed Central

    Rothrauff, Benjamin B; Tuan, Rocky S

    2014-01-01

    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. PMID:24326955

  18. Cyclic tensile strain upregulates collagen synthesis in isolated tendon fascicles

    SciTech Connect

    Screen, Hazel R.C. . E-mail: H.R.C.Screen@qmul.ac.uk; Shelton, Julia C.; Bader, Dan L.; Lee, David A.

    2005-10-21

    Mechanical stimulation has been implicated as an important regulatory factor in tendon homeostasis. In this study, a custom-designed tensile loading system was used to apply controlled mechanical stimulation to isolated tendon fascicles, in order to examine the effects of 5% cyclic tensile strain at 1 Hz on cell proliferation and matrix synthesis. Sample viability and gross structural composition were maintained over a 24 h loading period. Data demonstrated no statistically significant differences in cell proliferation or glycosaminoglycan production, however, collagen synthesis was upregulated with the application of cyclic tensile strain over the 24 h period. Moreover, a greater proportion of the newly synthesised matrix was retained within the sample after loading. These data provide evidence of altered anabolic activity within tendon in response to mechanical stimuli, and suggest the importance of cyclic tensile loading for the maintenance of the collagen hierarchy within tendon.

  19. Cost effective TLP installation methods and tendon top connectors

    SciTech Connect

    Wybro, P.G.; Chaison, M.

    1995-05-01

    This paper describes a novel TLP tendon top connector and motion arrest system. The top connector and motion arrest system is inherently linked to the method used to install the platform, and methods for platform installation are described. This method of installation is most suitable for deepwater and/or large TLP structures, but can also be used in moderate water depth as well. The tendon installation method utilizes the so-called Platform Arrestor Concept (PAC). The installation is procedurally not complex and calls for relatively simple installation equipment, and also enables the use of simple tendon tie-off equipment, such as a single piece nut. The tendons can be pre-installed to the foundation prior to platform arrival, or can be co-installed, i.e., installed while the platform is on location.

  20. Nonlinear optical imaging characteristics in rat tail tendon

    NASA Astrophysics Data System (ADS)

    Liu, N. R.; Zhang, X. Z.; Qiu, Y. S.; Chen, R.

    2013-04-01

    The aim of this study was to examine the characteristics of skeletal muscle fibers in tail tendons, explore the content of intrinsic components at different depths and ascertain the optimum excitation wavelength, which will help to establish a relationship between diagnosis and therapy and the tendon injury. A multiphoton microscopic imaging system was used to achieve the images and spectra via an imaging mode and a Lambda mode, respectively. This work demonstrates that the skeletal muscle fibers of the tail tendon are in good order. Second harmonic generation (SHG) and two-photon excited fluorescence (TPEF) signals originating from certain intrinsic components are varied with depth, and the SHG/TPEF intensity ratios are varied at different excitation wavelengths. Below 800 nm is the optimum for cell TPEF, while above 800 nm is the optimum for SHG. With the development of imaging techniques, a nonlinear optical imaging system will be helpful to represent the functional behaviors of tissue related to tendon injury.

  1. Tendon and ligament adaptation to exercise, immobilization, and remobilization.

    PubMed

    Wren, T A; Beaupré, G S; Carter, D R

    2000-01-01

    This study provides a theoretical and computational basis for understanding and predicting how tendons and ligaments adapt to exercise, immobilization, and remobilization. In a previous study, we introduced a model that described the growth and development of tendons and ligaments. In this study, we use the same model to predict changes in the cross-sectional area, modulus, and strength of tendons and ligaments due to increased or decreased loading. The model predictions are consistent with the results of experimental exercise and immobilization studies performed by other investigators. These results suggest that the same fundamental principles guide both development and adaptation. A basic understanding of these principles can contribute both to prevention of tendon and ligament injuries and to more effective rehabilitation when injury does occur.

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

    PubMed Central

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

    2016-01-01

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

  3. High-affinity glutamate transporter and glutamine synthetase content in longissimus dorsi and adipose tissues of growing Angus steers differs among suckling, weanling, backgrounding, and finishing production stages.

    PubMed

    Matthews, J C; Huang, J; Rentfrow, G

    2016-03-01

    Skeletal muscle and adipose tissues play important roles in maintaining whole-body Glu and N homeostasis by the uptake of Glu and release of Gln. To test the hypothesis that expression of high-affinity Glu transporters (GLAST1, EAAT4, EAAC1, GLT-1) and glutamine synthetase (GS) would increase in longissimus dorsi and adipose tissue of newborn Angus steers randomly assigned ( = 6) to develop through suckling (S; 32 d) and/or weanling (W; 184 d), backgrounding (B; 248 d), and finishing (F; 423 d) production stages. Carcass quality was determined at slaughter to verify shifts in adipose and lean deposition with development. Expression of mRNA (RT-PCR/Southern) and relative protein abundance (Western analysis) were determined in tissue homogenates isolated from longissimus dorsi, and kidney and subcutaneous adipose. The effect of production stage or tissue type on carcass and protein abundance was assessed by 1-way ANOVA using the GLM procedure of SAS, and Fisher's protected LSD procedure was used to separate data means. Neither GLAST1 nor EAAT4 mRNA or protein was detected. EAAC1, GLT-1, and GS mRNA were identified in all tissues, but GLT-1 and GS protein were not detected in kidney or subcutaneous adipose, and GS protein was not detected in longissimus dorsi. The EAAC1 content of subcutaneous ( = 0.06) and kidney ( = 0.02) adipose was 2 times greater in B and F than W steers, whereas GS was 5 times greater ( < 0.07) in B than F steers (B = W > F). For longissimus dorsi, EAAC1 ( < 0.01) and GLT-1 ( < 0.04) content decreased with development (S > W > B = F, S = W > B = F, respectively). Within F steers, EAAC1 and GLT-1 mRNA was expressed by subcutaneous, kidney, omental, mesenchymal, and intramuscular adipose tissues, whereas GS mRNA was expressed by all except for intramuscular. Only EAAC1 protein was detected in any adipose tissue, with EAAC1 content being 104% and 112% greater ( < 0.01) in intramuscular than in kidney or subcutaneous adipose, respectively, and not

  4. High-affinity glutamate transporter and glutamine synthetase content in longissimus dorsi and adipose tissues of growing Angus steers differs among suckling, weanling, backgrounding, and finishing production stages.

    PubMed

    Matthews, J C; Huang, J; Rentfrow, G

    2016-03-01

    Skeletal muscle and adipose tissues play important roles in maintaining whole-body Glu and N homeostasis by the uptake of Glu and release of Gln. To test the hypothesis that expression of high-affinity Glu transporters (GLAST1, EAAT4, EAAC1, GLT-1) and glutamine synthetase (GS) would increase in longissimus dorsi and adipose tissue of newborn Angus steers randomly assigned ( = 6) to develop through suckling (S; 32 d) and/or weanling (W; 184 d), backgrounding (B; 248 d), and finishing (F; 423 d) production stages. Carcass quality was determined at slaughter to verify shifts in adipose and lean deposition with development. Expression of mRNA (RT-PCR/Southern) and relative protein abundance (Western analysis) were determined in tissue homogenates isolated from longissimus dorsi, and kidney and subcutaneous adipose. The effect of production stage or tissue type on carcass and protein abundance was assessed by 1-way ANOVA using the GLM procedure of SAS, and Fisher's protected LSD procedure was used to separate data means. Neither GLAST1 nor EAAT4 mRNA or protein was detected. EAAC1, GLT-1, and GS mRNA were identified in all tissues, but GLT-1 and GS protein were not detected in kidney or subcutaneous adipose, and GS protein was not detected in longissimus dorsi. The EAAC1 content of subcutaneous ( = 0.06) and kidney ( = 0.02) adipose was 2 times greater in B and F than W steers, whereas GS was 5 times greater ( < 0.07) in B than F steers (B = W > F). For longissimus dorsi, EAAC1 ( < 0.01) and GLT-1 ( < 0.04) content decreased with development (S > W > B = F, S = W > B = F, respectively). Within F steers, EAAC1 and GLT-1 mRNA was expressed by subcutaneous, kidney, omental, mesenchymal, and intramuscular adipose tissues, whereas GS mRNA was expressed by all except for intramuscular. Only EAAC1 protein was detected in any adipose tissue, with EAAC1 content being 104% and 112% greater ( < 0.01) in intramuscular than in kidney or subcutaneous adipose, respectively, and not

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

    PubMed

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

    2010-04-19

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

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

    PubMed

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

    2010-04-19

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

  7. Regional differences in elements of human peroneus longus tendons.

    PubMed

    Matsumoto, Norikazu; Kumai, Tsukasa; Isomoto, Shinji; Shinohara, Yasushi; Tanaka, Yasuhito; Azuma, Cho; Minami, Takeshi; Tohno, Yoshiyuki

    2013-08-01

    Many studies have been performed on the structure, molecular composition, and biochemical properties of tendons. However, comparatively little research has been conducted on the content of various trace elements within tendons. Six elements were analyzed in four regions of the peroneus longus tendon: the tensional part of the tendon immediately proximal to the lateral malleolus (region A), the compressive region of the tendon in contact with the lateral malleolus (region B), the compressive region of the tendon in contact with the deep surface of the cuboid (region C), and the tensional part of the tendon between the cuboid and first metatarsal, to which the tendon is attached (region D). Regions B and C are wraparound regions. The calcium content was higher in region C (2.10 ± 0.93 mg/g) than in both regions A (1.25 ± 0.51 mg/g) and D (1.43 ± 0.41 mg/g) (p < 0.05), indicating that it is likely related to regional differences in cartilage degeneration. The phosphorus content was also higher in region C, possibly because of low alkaline phosphatase activity in this region. The sulfur content was higher in the wraparound regions (region B: 0.98 ± 0.09 mg/g, region C: 1.24 ± 0.19 mg/g) than in both regions A (0.83 ± 0.11 mg/g) and D (0.83 ± 0.1 mg/g) (p < 0.01); sulfur content is thought to be influenced by tendon-bone compression. Finally, the magnesium content in the wraparound regions was also higher, which is probably related to a higher level of fibrocartilage. No significant relationships were found with regard to zinc or iron. Overall, the findings of the present study indicate that element contents are related to function and anatomical differences in tendons, and that they may even vary within the same tendon.

  8. Dietary influence on the m. longissimus dorsi fatty acid composition of lambs in relation to protein source.

    PubMed

    Turner, T D; Karlsson, L; Mapiye, C; Rolland, D C; Martinsson, K; Dugan, M E R

    2012-08-01

    Dietary lipid effect, as a consequence of protein supplement, on lamb m. longissimus dorsi fatty acid composition was investigated, with emphasis on biohydrogenation intermediates. Crossbred lambs (White Swedish Landrace × Texel) were fed a barley-based diet without (CON) or with protein supplements including peas (PEA), rapeseed cake (RC) or hempseed cake (HC). The HC diet resulted in the highest muscle 22:6n-3 proportion, with the RC diet being similar (P<0.05). Protein supplement did not affect the c9,t11 conjugated linoleic acid (CLA) proportion, however the HC diet increased some minor CLA isomers, including t10,c12 CLA (P<0.05). The t10-18:1 and total trans-18:1 were lowest for the RC diet (P<0.05), likely relating to rumen conditions and precursor availability. The saturated, monounsaturated and branched-chain fatty acids were largely unaffected by protein supplement. In conclusion, feeding the RC diet lowered the t10-18:1 and total trans-18:1 in meat, and modestly increased 22:6n-3 content. The direction of these changes would be beneficial, making the RC diet the preferred protein supplement; however the magnitude of the changes in the present experiment may not be sufficient to have an impact on human health.

  9. Dorsal decubitus positioning: a novel method to harvest the latissimus dorsi flap for massive upper extremity defect reconstruction.

    PubMed

    Boa, Olivier; Servant, Jean-Marie; Revol, Marc; Salib, Emmanuel G; Guberman, Daniel; Harris, Patrick G; Danino, Alain M

    2011-09-01

    The latissimus dorsi, whether taken as a muscle or with a skin paddle, is one of the most useful flaps in the reconstructive surgeon's arsenal. With its predictable type V vascular pedicle, this broad muscle can be elevated on its dominant thoracodorsal pedicle or used in a reverse manner on its secondary thoracic and lumbar perforators. Traditionally harvested in a lateral decubitus position, over the last 10 years we have chosen to elevate this muscle in a dorsal decubitus position, enabling 2 surgical teams to operate simultaneously. With only one cushion placed along the vertebral column between the scapulas, each element of the subscapular system, including scapular bone, can be used to reconstruct complex upper limb defects. A vertical incision in front of the anterior axillary line is performed to identify the anterior border of the muscle, followed by a dissection in the submuscular plane to reveal the thoracodorsal pedicle and its branches. When a more complex chimeric flap is required, scapular bone, serratus muscle, and scapular or parascapular fasciocutaneous flaps are all available. To achieve the longest length possible, the pedicle can be isolated from the axillary vessels. The most common complications are related to donor site, with seroma and delayed wound healing being the most prevalent. Complaints of shoulder pain and functional disability were rare and mostly encountered in the first 2 weeks postoperatively.

  10. Influence of Restricted Grazing Time Systems on Productive Performance and Fatty Acid Composition of Longissimus dorsi in Growing Lambs

    PubMed Central

    Wang, Zhenzhen; Chen, Yong; Luo, Hailing; Liu, Xueliang; Liu, Kun

    2015-01-01

    Fifty 3-month-old male Tan lambs (similar in body weight) were divided into 5 groups to investigate the effects of different restricted pasture grazing times and indoor supplementation on the productive performances and fatty acid composition of the intramuscular fat in growing lambs. The lambs grazed for different periods of time (12 h/d, 8 h/d, 4 h/d, 2 h/d, and 0 h) and received various amounts of supplementary feedings during the 120-day trial. Pasture dry matter intake (DMI), total DMI, average daily gains and the live body weights of the lambs were measured during the experiment. The animals were slaughtered at the end of the study, their carcass traits were measured, and their longissimus dorsi muscles were sampled to analyze the intramuscular fat (IMF) content and fatty acid profiles. The results indicated that the different durations of grazing and supplementary feedings affected the animal performances and the composition of fatty acids. Grazing for 8 h/d or 2 h/d with the corresponding supplementary concentrate resulted in lambs with higher body weights, carcass weights and IMF contents. Lambs with longer grazing times and less concentrate accumulated more healthy fatty acids such as conjugated linoleic acid and n-3 polyunsaturated fatty acid and had higher n-3/n-6 ratios. Overall, a grazing allowance of 8 h/d and the corresponding concentrate was recommended to maintain a high quantity and quality of lamb meat. PMID:26104518

  11. Effect of Quillaja saponaria dietary administration on colour, oxidative stability and volatile profile of muscle longissimus dorsi of Barbarine lamb.

    PubMed

    Nasri, S; Luciano, G; Vasta, V; Aouadi, D; Priolo, A; Makkar, H P S; Ben Salem, H

    2012-12-01

    Eighteen Barbarine lambs were assigned during 77 days to three dietary treatments (n=6): control, oat hay ad libitum and 400 g of concentrate; QS60 and the QS90 control diet supplemented with 60 mg and 90 mg Quillaja saponaria (QS) bark extract/kg dry matter, respectively. The analysis of pre-frozen longissimus dorsi muscle showed that the QS90 treatment reduced meat redness (a*) and saturation (C*) measured after 2h of blooming. It also reduced the rate of decrease in a* values (P=0.02) during 14 days of refrigerated storage. Supplementation with QS extended meat colour stability by reducing (P<0.05) the rate of increase in hue angle (H*) values. Neither the rate of metmyoglobin accumulation at the meat surface nor lipid peroxidation over storage duration differed between treatments. The overall meat volatile compound profile was similar between the groups. We conclude that supplementing QS affects meat colour development at the meat surface and extends its stability without producing detrimental effects on meat volatile compounds.

  12. Dietary influence on the m. longissimus dorsi fatty acid composition of lambs in relation to protein source.

    PubMed

    Turner, T D; Karlsson, L; Mapiye, C; Rolland, D C; Martinsson, K; Dugan, M E R

    2012-08-01

    Dietary lipid effect, as a consequence of protein supplement, on lamb m. longissimus dorsi fatty acid composition was investigated, with emphasis on biohydrogenation intermediates. Crossbred lambs (White Swedish Landrace × Texel) were fed a barley-based diet without (CON) or with protein supplements including peas (PEA), rapeseed cake (RC) or hempseed cake (HC). The HC diet resulted in the highest muscle 22:6n-3 proportion, with the RC diet being similar (P<0.05). Protein supplement did not affect the c9,t11 conjugated linoleic acid (CLA) proportion, however the HC diet increased some minor CLA isomers, including t10,c12 CLA (P<0.05). The t10-18:1 and total trans-18:1 were lowest for the RC diet (P<0.05), likely relating to rumen conditions and precursor availability. The saturated, monounsaturated and branched-chain fatty acids were largely unaffected by protein supplement. In conclusion, feeding the RC diet lowered the t10-18:1 and total trans-18:1 in meat, and modestly increased 22:6n-3 content. The direction of these changes would be beneficial, making the RC diet the preferred protein supplement; however the magnitude of the changes in the present experiment may not be sufficient to have an impact on human health. PMID:22459498

  13. Protein and lipid oxidation in Longissimus dorsi and dry cured loin from Iberian pigs as affected by crossbreeding and diet.

    PubMed

    Ventanas, Sonia; Estevez, Mario; Tejeda, Juan Florencio; Ruiz, Jorge

    2006-04-01

    Lipid and protein oxidation in Longissimus dorsi (LD) and dry-cured loins from pigs with different genetic (pure Iberian (IBP), Iberian female×Duroc male (IB×D) and Duroc female×Iberian male (D×IB)) and feeding backgrounds (free rearing on acorn and pasture (MON), concentrates high in oleic acid and supplemented with 250ppm of vitamin E(HOVE) and control concentrates (CON)) were investigated. Diet influenced the fatty acids profile from PL and α- and γ-tocopherol contents of LD. IBP-MON pigs showed the lowest malonaldehyde (MDA) values at 200min of iron induced muscle oxidation. Dry-cured loins from IBP-HOVE pigs had significantly (p<0.05) higher values of TBARS than those from the other batches. Neither the diet nor crossbreeding affected hexanal counts in dry-cured loins. Protein carbonyl content showed a similar trend to that observed for MDA values in LD, suggesting a protective role of tocopherol against lipid and protein oxidation. The positive and significant correlations between iron induced lipid oxidation in LD (200 min) and carbonyl content in LD and dry-cured loin (R(2): 0.55 and R(2): 0.52, respectively, p<0.01) support the relationship between lipid and protein oxidation.

  14. Integrative transcriptomics and proteomics analysis of longissimus dorsi muscles of Canadian double-muscled Large White pigs.

    PubMed

    Liu, Shuqin; Han, Wenpeng; Jiang, Shunyan; Zhao, Chunjiang; Wu, Changxin

    2016-02-10

    Canadian double-muscled Large White pigs are characterized by notable muscle mass, showing high daily gain and lean rate and good meat quality. In order to identify the major genes or proteins involved in muscle hyperplasia and hypertrophy, three pairs of full-sib pigs with extreme muscle mass difference from Canadian Large White were selected as experimental animals at 3 months age. The phenotypic differences of longissimus dorsi muscles (LD) were investigated with microarray and proteomics (2-DE, MALDI-TOF-MS), and results were verified by real-time PCR and western bolting respectively. The gene expressing profiling identified 57 and 260 and 147 differently expressed genes (DEGs) from the three pairs respectively with Bayesian statistics and significant analysis of microarrays (SAM) (p<0.05, q<0.05, fold>2). From the network of these DEGs, some major genes were displayed, such as EGF, PPARG, FN1, SERPINE1, MYC, JUN, involved in Wnt, MAPK and TGF-β signal pathway respectively, which mainly participated in cell differentiation and proliferation. In parallel, proteomics analyses revealed 50 differently expressed protein (DEP) spots with mass spectrum, and 33 spots of them were found annotated, which took part in energy metabolism and the structure and contraction of muscle fiber. In brief, our integrated study provides a good foundation for the further study on the genetic mechanism of the double muscle traits in pigs.

  15. Effect of Dietary Supplementation with Processed Sulfur on Meat Quality and Oxidative Stability in Longissimus dorsi of Pigs

    PubMed Central

    Noh, Ha-Young; Kim, Gyeom-Heon; Kim, Soo-Ki

    2015-01-01

    The effects of dietary supplementation of processed sulfur in pigs according to the level provided during the fattening phase were examined. The pigs were divided into three groups: control (CON), non-sulfur fed pigs; T1, 0.1% processed sulfur fed pigs; T2, 0.3% processed sulfur fed pigs. Physicochemical and sensory properties, as well as meat quality and oxidative stability of the Longissimus dorsi muscle were investigated. The feeding of processed sulfur did not affect moisture and protein contents (p>0.05). However, the crude fat content of T2 was significantly decreased compared to CON (p<0.05), while the pH value of T2 was significantly higher than those of both CON and T1 (p<0.05). Cooking loss and expressible drip of T2 were also significantly lower than that of CON (p<0.05). The redness of meat from T1 was significantly higher than both CON and T2 (p<0.01). During storage, lipid oxidation of the meat from sulfur fed pigs (T1 and T2) was inhibited compared to CON. Examination of omega-3 polyunsaturated fatty acids revealed T2 to have significantly higher content than CON (p<0.05). In the sensory test, the juiciness and overall acceptability of T2 recorded higher scores than CON. This study demonstrated that meat from 0.3% processed sulfur fed pigs had improved nutrition and quality, with extended shelf-life. PMID:26761847

  16. Tendon Reconstruction with Tissue Engineering Approach--A Review.

    PubMed

    Verdiyeva, Gunay; Koshy, Kiron; Glibbery, Natalia; Mann, Haroon; Seifalian, Alexander M

    2015-09-01

    Tendon injuries are a common and rising occurrence, associated with significant impairment to quality of life and financial burden to the healthcare system. Clinically, they represent an unresolved problem, due to poor natural tendon healing and the inability of current treatment strategies to restore the tendon to its native state. Tissue engineering offers a promising alternative, with the incorporation of scaffolds, cells and growth factors to support the complete regeneration of the tendon. The materials used in tendon engineering to date have provided significant advances in structural integrity and biological compatibility and in many cases the results obtained are superior to those observed in natural healing. However, grafts fail to reproduce the qualities of the pre-injured tendon and each has weaknesses subject to its constituent parts. Furthermore, many materials and cell types are being investigated concurrently, with seemingly little association or comparison between research results. In this review the properties of the most-investigated and effective components have been appraised in light of the surrounding literature, with research from early in-vitro experiments to clinical trials being discussed. Extensive comparisons have been made between scaffolds, cell types and growth factors used, listing strengths and weaknesses to provide a stable platform for future research. Promising future endeavours are also described in the field of nanocomposite material science, stem cell sources and growth factors, which may bypass weaknesses found in individual elements. The future of tendon engineering looks bright, with growing understanding in material technology, cell and growth factor application and encouraging recent advances bringing us ever closer to regenerating the native tendon. PMID:26485923

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

    PubMed Central

    Kumar, Nishikant; Yadav, Chandrashekhar; Kumar, Ashok

    2015-01-01

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

  18. Tendon Reconstruction with Tissue Engineering Approach--A Review.

    PubMed

    Verdiyeva, Gunay; Koshy, Kiron; Glibbery, Natalia; Mann, Haroon; Seifalian, Alexander M

    2015-09-01

    Tendon injuries are a common and rising occurrence, associated with significant impairment to quality of life and financial burden to the healthcare system. Clinically, they represent an unresolved problem, due to poor natural tendon healing and the inability of current treatment strategies to restore the tendon to its native state. Tissue engineering offers a promising alternative, with the incorporation of scaffolds, cells and growth factors to support the complete regeneration of the tendon. The materials used in tendon engineering to date have provided significant advances in structural integrity and biological compatibility and in many cases the results obtained are superior to those observed in natural healing. However, grafts fail to reproduce the qualities of the pre-injured tendon and each has weaknesses subject to its constituent parts. Furthermore, many materials and cell types are being investigated concurrently, with seemingly little association or comparison between research results. In this review the properties of the most-investigated and effective components have been appraised in light of the surrounding literature, with research from early in-vitro experiments to clinical trials being discussed. Extensive comparisons have been made between scaffolds, cell types and growth factors used, listing strengths and weaknesses to provide a stable platform for future research. Promising future endeavours are also described in the field of nanocomposite material science, stem cell sources and growth factors, which may bypass weaknesses found in individual elements. The future of tendon engineering looks bright, with growing understanding in material technology, cell and growth factor application and encouraging recent advances bringing us ever closer to regenerating the native tendon.

  19. Temporal response of canine flexor tendon to limb suspension

    PubMed Central

    Thoreson, Andrew R.; Cha, Stephen S.; Zhao, Chunfeng; An, Kai-Nan; Amadio, Peter C.

    2010-01-01

    Tendon disuse, or stress deprivation, frequently accompanies clinical disorders and treatments, yet the metabolism of tendons subject to stress deprivation has rarely been investigated systematically. The effects of stress deprivation on canine flexor tendon were investigated in this study. One adult canine forepaw was suspended for 21 or 42 days. Control forepaws were collected from dogs that had no intervention on their limbs and paws. The expression of collagen I and III was not significantly altered in the tendons disused for 21 days but was significantly decreased at 42 days (P < 0.03). The expression of collagen II, aggrecan, decorin, and fibronectin was significantly decreased in the tendons in the suspended limbs at 21 days (P < 0.002) and further reduced at 42 days. With stress deprivation, the expression of matrix metalloproteinase 2 (MMP2) was significantly increased (P < 0.004) at 21 and 42 days. The expression of MMP3 was significantly decreased at 21 and 42 days (P < 0.03). The expression of MMP13 was not altered with stress deprivation at 21 and 42 days. The expression of MMP14 was significantly increased at 21 days (P = 0.0015) and returned to the control level at 42 days. Tissue inhibitor of metalloproteinase 1 (TIMP1) expression was decreased after the limbs were suspended for 42 days (P = 0.0043), but not 21 days. However, TIMP2 expression was not significantly different from control at 21 or 42 days. Furthermore, the cross-sectional area of the stress-deprived tendons at 42 days was decreased compared with the control group (P < 0.01). The intervention method in this study did not result in any alteration of stiffness of the tendon. Our study demonstrated that stress deprivation decreases the anabolic process and increases the catabolic process of extracellular matrix in flexor tendon. PMID:20947711

  20. Giant cell tumour of tendon sheath with simultaneous two tendon involvement of the foot treated with excision of the tumour and reconstruction of the flexor retinaculum using tibialis posterior tendon in a paediatric patient: A rare case report.

    PubMed

    Tiwari, Vivek; Ansari, Tahir; Mittal, Samarth; Sharma, Pankaj; Nalwa, Aasma

    2015-12-01

    Giant cell tumour of tendon sheath is a benign soft tissue tumour arising from the tendon sheath. The involvement of foot and ankle by such tumours is relatively rare. Children are not commonly afflicted by this condition. All such tumours are reported to arise either from a single tendon sheath or one joint. We report a case of giant cell tumour of tendon sheath in a 12-year-old child, arising simultaneously from the tendon sheaths of tibialis posterior and flexor digitorum longus tendons, as well as extending into the ankle joint. It was treated by complete excision of the mass along with the tendon sheaths with reconstruction of the flexor retinaculum. The location of the tumour, age of the patient, diffuse nature of the tumour and novel technique of reconstruction of the flexor retinaculum make this case extremely rare and the first to be reported in literature.